Virtual Group Practice Leadership with Sara Makin
In this episode (quick summary):
Virtual group practice leadership requires more than offering therapy online; it takes intentional culture, values-based hiring, strong systems, and a clear commitment to clinician support. Dan King speaks with Sara Makin, Founder and CEO of Makin Wellness, about building a fully virtual mental health organisation and leading a remote team with care, clarity, and clinical integrity.
TL;DR:
A strong virtual practice is built by combining ethical clinical care, deliberate remote culture, smart systems, and a hiring process where alignment matters as much as credentials.
What you’ll learn:
- How Sara Makin built Makin Wellness as a virtual mental health organisation across multiple states.
- Why remote practice culture needs more intentional leadership than in-office culture.
- How values-based hiring helps protect clients, clinicians, and the wider team.
- Why clinician retention should include career development, not just compensation.
Sara Makin’s quote: “My goal is to impact millions of patient lives.”
Best for: Group practice owners, therapists, psychologists, psychiatrists, clinic operators, and mental health leaders building or refining virtual teams.
Key terms: virtual group practice leadership, remote practice culture, telehealth practice, values-based hiring, clinician retention, clinical leadership, mental health organisation, mental health organization, counselling practice, counseling practice
Virtual group practice leadership: building culture, trust, and ethical scale remotely
“My goal is to impact millions of patient lives.”– Sara Makin
Virtual group practice leadership is central to this conversation with Sara Makin, Founder and CEO of Makin Wellness. Sara shares how she built a virtual mental health organisation providing evidence-based and specialised therapy across Pennsylvania, Florida, Vermont, and Maine, while staying anchored in her mission to help people heal.
Dan King and Sara explore what changes when a practice operates fully remotely. Sara explains that virtual care can expand access, but the culture does not happen automatically. Without shared office space, casual conversations, and in-person connection, leaders must be much more deliberate about how clinicians feel supported, heard, and connected to the organisation.
A major theme in Sara’s approach to virtual group practice leadership is hiring. She describes a process that goes beyond credentials and clinical skill. Candidates meet different team members, complete assessments, answer hypothetical questions, and are evaluated for values alignment. Her standard is clear: if everyone involved is not genuinely excited about the hire, the answer is no.
The conversation also highlights the operational realities behind sustainable practice growth. Sara compares efficient role design to Aldi’s staffing model: fewer people, clearer roles, better productivity, and stronger retention. She also explains how technology can reduce friction in scheduling, payments, billing, and documentation, while recognising that clinical judgement and patient care cannot be automated away.
Sara offers a mature perspective on clinician retention. Instead of expecting team members to stay forever, she is building a career development programme that helps clinicians and non-clinicians clarify where they want to be in one, three, five, and ten years. That shift reflects a deeper form of clinical leadership: supporting people while they are in the practice and helping them leave better than they arrived if their path eventually changes.
For Dan, the episode also connects to a broader question about the future of independent mental health practices. Sara argues that independent and privately held organisations need to keep raising the standard, especially as roll-ups and venture-backed models reshape the field. Virtual group practice leadership, in this context, becomes both a business discipline and an ethical responsibility.
Takeaways
- Remote culture needs deliberate rituals, clear communication, and leadership consistency across every management layer.
- Values-based hiring protects the team, the clients, and the long-term health of the practice.
- Credentials matter, but they are not enough if the person does not strengthen the culture.
- Virtual group practice leadership requires smart systems that reduce administrative burden for clinicians.
- Technology is most useful when it improves scheduling, billing, documentation, and the provider experience without weakening clinical quality.
- Retention improves when leaders invest in career development and stop taking every departure personally.
Transcript: Virtual group practice leadership with Sara Makin
"Virtual group practice leadership requires intentional culture, not just technology." - Sara Makin
Read the full transcript
Dan King:
[0:00] Hello, everyone. I am feeling all of a sudden very peaceful,
Dan King:
[0:04] even though it's been a chaotic Thursday. And I am really looking forward to a conversation with Sarah Makin. She is the founder and CEO of Makin Wellness. Welcome to your group practice, Sarah. We'd love to hear a little bit about you and your practice.
Sara Makin:
[0:17] I'm sarah i started up making wellness about oh my gosh i don't even remember it was 2017 so how many years ago was that nine nine years ago at this point we are a virtual mental health care organization we provide evidence-based and specialized therapy to people across pennsylvania Florida, Vermont, and Maine. And my number one mission is helping people to heal and come ahead and begin.
Dan King:
[0:48] I love it. And when you say virtual, does that mean the entire practice is virtual and no patients are seen in person?
Sara Makin:
[0:53] Correct. Whenever we first started up, it was virtual and in person. And I remember I had some pushback from some providers in the field telling, telling me that it's unethical to see patients virtually. And then when COVID happened, those same people, you know, were the ones, how are we supposed to get this set up? How can you make Zoom HIPAA compliant?
Sara Makin:
[1:16] Like all of these things. So I find that interesting. My philosophy is looking and sort of anticipating where society is heading and making adjustments for that.
Dan King:
[1:27] We all live and learn. We've all been wrong about many things, right? Oh, yeah. A lot of people did not get that one right. And it's interesting, speaking to so many different practice owners now, many still have a strong bias towards in-person. And I can understand how the therapeutic alliance plays out a little differently in person. And the reality is so many people just won't have access to care if there isn't a virtual option.
Sara Makin:
[1:49] Absolutely.
Dan King:
[1:50] So how does culturally, how do you think that shaped your practice, the fact that every patient is seen virtually and everyone is working remotely?
Sara Makin:
[1:57] You have to do a lot of additional things to make sure that the accompanying culture is being felt whenever you work in an in-office sort of setting. You get to see all of your team members and have a lot more conversations than, what you tend to do whenever you're working remotely, especially for clinical teams. They're mostly supporting patients. Then after that, doing their documentation. So you have to do a lot of additional things to make sure that there's still that feeling of connection and support. It's from having the experience of doing that in-person versus remote, it's much harder to do it remotely. You have to be a lot more intentional about it.
Dan King:
[2:39] So with around 30 clinicians now, have you found it even harder to do those things intentionally? And what shifted as you've grown culturally?
Sara Makin:
[2:48] That's a great question, Dan. It goes from you to you plus your direct reports, to you plus your direct reports, plus their direct reports, and really making sure that every level, within the leadership team, anyone that's providing any type of supervision or management of any sort is taking things on and handling things in a way, where every person feels supported and heard and they're creating a psychologically safe organization so you start with yourself, and you the goal is to bring people on that are aligned with your values, and handle things which should be evident in your company values in your company mission And the way that they do it might be slightly different, but the intention is the same.
Dan King:
[3:38] How do you screen for connection and alignment with those company values in your interview process?
Sara Makin:
[3:44] Asking them so many different questions. Different assessments are administered. They meet with different team members. And everyone that is involved in the hiring process needs to be excited to hire the person. We're not all excited. Yes. It just can't be, okay, we need someone.
Dan King:
[4:03] We need a body.
Sara Makin:
[4:04] Exactly. Because that doesn't work well, Dan. It doesn't work well for the clients. It doesn't work well for the rest of the team. Because again, you're ideally reflecting the needs and the culture of the rest of the team, right? So if you guys are all not excited to bring this person on and there's anything that feels off, there normally is something. And I cannot tell you how many times I've ignored feelings of, oh, I'm not sure about this person, or they're saying all the right things, they have a great resume. I don't know. I just and I and I every time I've hired them, there's been some sort of unusual challenge.
Dan King:
[4:42] Yes.
Sara Makin:
[4:43] And so that's when we adjusted our process to be like, we all have to be excited.
Dan King:
[4:50] It's a hell yes. Unanimously.
Sara Makin:
[4:52] Well, no.
Dan King:
[4:54] Yeah. Yeah. Yeah. Intuition and hiring is a beautiful thing. I fully agree with you. I have had the same experience. I will say the way it's played out for me more recently is if something feels off, it probably is and it should be a no. But in situations in which something doesn't feel off, it perhaps still should be a no has been my experience. So that there's an absence of that sort of feeling doesn't necessarily mean it's a yes. But if that feeling is there, then it should definitely be a no.
Sara Makin:
[5:22] Correct.
Dan King:
[5:23] Does that jive with your experience?
Sara Makin:
[5:25] Absolutely.
Dan King:
[5:26] Yeah. And I love that your standard is high. The standard is excitement. And that's not an easy standard to meet, right? Most people you interview probably aren't going to meet you.
Sara Makin:
[5:35] No, no. I do have to say we do tend to have a lot of quality providers. But for me and my team, I'm not just looking for quality evidence-based and specialized providers. I'm looking for someone with a certain set of values in someone that's going to be a joy and a pleasure to work with. That's important. You know, I don't want to come into work every day and have people that are clinicians and kind of hating their job and not. Liking, you know, what they're doing and kind of bringing the culture down. Because, I mean, we all like have to work. We all have to work and we've already, you know, we have a mission greater than
Sara Makin:
[6:16] ourselves and that's ultimately to help patients. And so that's what I look for.
Dan King:
[6:22] I love that. You mentioned assessments in your hiring process. What assessments do you use?
Sara Makin:
[6:29] I use the DISC assessment, and we also ask them a lot of different hypothetical questions. We reach out to the references in full transparency. I myself, I'm involved in one interview with them. So I'm not the one administering and asking the vast majority of the questions by the time I meet with them. I just kind of want to get a feel of how they're like. They've already passed all of the other markers, you know, regarding skill set and education and credentials and relevant experience and all those things.
Dan King:
[7:07] It's good that you're systematic about it. I think that's great. And that interview process is so easy. It's so vital because this is a people business. Yeah. And most practices are not systematic about how they do it. And most practices in a very short term way think, all right, more people equals growth. Therefore, I need more people. And I'm not going to take the process so seriously because, you know, they can get the job done. That's enough.
Sara Makin:
[7:32] Yeah. Yeah. I mean, it really depends on what someone is looking for with their practice and more people is not always better. Ideally, every position is optimized and every role is conducted in a way where there's a lot of contribution happening. I think of it like the way that Aldi hires. Aldi actually does not have a ton of employees. The ones that they have, they structure the rule to be extremely efficient and productive. And because of that, they're able to pay them much more. And because of that, they're able to retain them, which is hard to do in a grocery store type setting when you can very easily quit and go to a different place. So whenever we're structuring positions or handling a restructure, I always think in terms of that. And can I use technology to streamline things and make things easier for the team?
Dan King:
[8:29] And is the answer yes?
Sara Makin:
[8:30] The vast majority of the time, yes. There are certain things that technology cannot do for you, clinically speaking, or within your practices, operations. But there's certain things that I can certainly help with. Like, for example, scheduling. That's a big thing that can be helpful. Payment related things, billing related things. There's a lot of different things, you know, making your documentation more documentation process, more streamlined.
Dan King:
[8:57] Mm hmm.
Sara Makin:
[8:59] While still making sure it's audit-proof, that's something that makes a big difference to the quality, to the experience that your providers have. It makes their work much easier.
Dan King:
[9:10] Yeah, part of the reason any clinician chooses to work at a group practice is so much is done for them. And if what is being done for them is not being done well, then that undermines the whole value proposition. In an environment where it's easier than ever for clinicians to go off on their own, we always have to be asking, why would they work in a group?
Sara Makin:
[9:28] Yeah, yeah. It's something that one of my mentors was talking about recently,
Sara Makin:
[9:33] consistently providing a lot of value to your clinicians. One of the projects that we're actually working on behind the scenes, we haven't rolled this out yet, so... If any of my team members hear this, I apologize in advance, but this is what's going to happen. We are creating a career development program internally at Make and Wellness where we're going to meet with every single team member, clinicians, non-clinicians, and see where they want to be at within certain time frames, like one year, three years, five years, ten years, and seeing what we can do to support them throughout the process. The reality is, in today's day and age, it's unlikely to retain any team member for the duration of their career.
Sara Makin:
[10:22] I believe the average length of stay people have working in a private practice is only like two years. It's like the average length. And then they go somewhere else. And so initially, when I was very naive, my goal was, you know, I was raised by boomer parents. They have one job. We literally had one job and that was it. They were there forever. This is what i want to create an experience where people want to grow here, and then i realized it's just people no matter how well you pay them no matter what what you do it's going to happen and so my goal has transitioned into how can i retain them and support them here as long as possible and make sure that by the time they do end up leaving, that i contributed, the company contributed to their professional development in some way. Like, I want people to be in a better position once they leave. I was going to say, not that I want, you know, any of my team members to leave, but that's the way that I view things now. Because sometimes people get very upset about that. And it used to really bother me. I used to take it so personally. Like, what did I do wrong for someone to leave? Especially when I knew they weren't getting paid more. I'm like, I just don't understand that.
Sara Makin:
[11:37] And then you realize that people have different dreams for themselves and sometimes they need a change of pace and to not take it personally. I feel like a lot of group practice owners I've talked to, especially when they're kind of starting out, that's something that's, it really hurts them like deeply. And it used to hurt me very deeply too. Yeah. Now I'm like, yeah.
Dan King:
[11:58] There's ways in which the business takes on the energy of the founder. And each I mean any business that someone starts is is going to be a reflection of them in a certain sense yeah and one of our one of fireside's advisors and investors is a brilliant group practice owner she built a 120 clinician practice in texas her name is danielle hayes and danielle always says now when she's working with practice owners that she's interested in looking at the ways in which the practice is a reflection of the owner and back and forth and back and forth And it can be very confronting to see some of your own challenges as an entrepreneur and as a human show up in the practice.
Sara Makin:
[12:38] Oh, absolutely.
Dan King:
[12:40] It's a great opportunity for you and the practice both to grow when you do.
Sara Makin:
[12:43] Absolutely. There's no end to that process. It's one of the interesting things about owning your own practice is you're faced with addressing your weaknesses and opportunities
Sara Makin:
[12:56] on an ongoing basis and there's no end to it, essentially.
Dan King:
[13:01] Well, speaking of which, I'm curious, one of the things I like to ask practice owners is, how do you see the future of your practice? Is there an endpoint you wish to get to? Is now the endpoint? How do you see it evolving and where where do you want to take it
Sara Makin:
[13:16] My goal is to impact millions of patient lives we've already impacted millions of lives virtually like online but we have not rendered treatment to millions of people yet so that is, something i want to experience within making wellness before before i do that, and i don't think i'm retiring for a very long long long time, and so that's the biggest thing i want to see is true impact, where i get to see this vision come to life and we've already made so much progress towards it there's so much more to do and i feel like with.
Sara Makin:
[13:58] Where the world is heading and how our sector has been especially the past couple of years it's more and more important especially for the independently held and privately held organizations for all of us to step it up as much as we possibly can.
Sara Makin:
[14:16] Okay i know that the quality of care that we provide is exceptional especially compared to a lot of major systems and it's kind of been breaking my heart seeing, a lot of these roll-ups occur not so much this year but within the past several years and just seeing these beautiful practices that, helped so many people screwing over the employees after, buyouts occur and you know seeing some of these venture-backed organizations and how they handle things it's it makes it it like almost like forces us to like me to do even better and better and, our competitive advantage is being clinically minded and because of that operating in an ethical way and supporting patients in the most effective way that we possibly can where top of mine is not not necessarily like revenue profitability but rather like true impact if you're doing that on a consistent basis the other things will follow you know so i don't know what you feel about, about that i know i mentioned a lot of different things but i feel like especially recently there's been a lot of the concerning sort of updates and that's what brings that to mind.
Dan King:
[15:32] Yeah yeah i mean that's a whole that's a whole other podcast i've done that that subject i'm actually doing another podcast soon on that subject. It's one of my favorites to discuss. It's changing the whole field and we need to understand exactly what's happening. And I agree that an independent outpatient group practice is still at the core of mental health in America. So about 60% of patients do get seen through some kind of independent outpatient practice. It's still, to me, the backbone of mental health for the average American. In cases where someone has super, super severe conditions, that that's a slightly different story. But if we're talking about the kind of run-of-the-mill mental health issues that pop up across the country,
Dan King:
[16:15] The independent group practice is the best thing we've so far come up with. And so I am a huge believer in it, both from a business perspective,
Dan King:
[16:23] as well as a clinical perspective. And it's interesting, you know, sitting in the seat where I sit as an investor and advisor to outpatient group practices, I also believe that the best group practices are partnerships between clinicians and non-clinicians. This is what I've come to believe, because I think that there's just certain, And, you know, clinicians have to be at the core of the work, have to be founders and are generally. And there's a level of impact that just requires, it requires the right people around the table. And you're absolutely right that there are many non-clinician business people that don't give a snot about the clinical side of the equation. And that is a terrible, terrible thing. And I don't believe in throwing the baby out with the bathwater because there's just a level of business skill and there's a level of complexity to what an independent outpatient practice can become if you solve really, really hard problems. And we need people who bring very different brains to the table to solve hard problems. And so what I've come to believe is I believe in partnerships,
Dan King:
[17:23] But I would share the exact philosophy you have about hiring when it comes to creating partnerships. Everyone has to be excited and it has to feel right. Yeah. And there has to be values alignment. And I think the future of mental health is going to require larger practices having more impact and it has to, we just have to encourage the right business people to get into this universe to partner with the right clinician founders. That's my overall view.
Sara Makin:
[17:48] Yeah, yeah. It's a great take to have for sure. We talk about multi- disciplinary teams i look at having practices you're running the ultimate multidisciplinary team where every single department is trained and specialized in something different, i can't have a therapist answering the phone because we're going to be chit-chatting and going on and on and on forever you know i can't have any of my marketers handle the billing, there you know that it's that's not what they specialize in and so having that harmony and again understanding that there is value in multi or in a variety
Sara Makin:
[18:33] of approaches is important.
Dan King:
[18:35] Agreed as we come towards the end of our time together sarah i always love to end on a human note and ask when you are not growing making wellness when you're not building you're not working, what do you do for fun?
Sara Makin:
[18:48] I love trash TV. I love rotting. Are you familiar with what rotting is? Yeah. No.
Dan King:
[18:54] No, no clue.
Sara Makin:
[18:56] It's like laying on the couch and just washing trash TV.
Dan King:
[19:00] Rotting?
Sara Makin:
[19:01] Yeah, they call it rotting. It's a good time. I rot every Sunday for like maybe like two hours. Love that. Normally, I play a lot of tennis.
Dan King:
[19:10] Oh, you're a fellow tennis player. Awesome.
Sara Makin:
[19:12] I want to deep, deep play.
Dan King:
[19:15] I'm a massive. I was born with a racket in my hand. I watch, I play. Oh, yeah.
Sara Makin:
[19:19] That's incredible. My son, his baby shower. I had a lot of my tennis friends there. He has all this tennis stuff like already and I take him to watch his dad play and he loves watching it.
Dan King:
[19:34] Amazing.
Sara Makin:
[19:35] I love music. I love like rap. I love EDM and I love to like laugh. Whenever I'm not working, I'm a very, very silly, sarcastic person. So I look for the humor and light things so.
Dan King:
[19:52] Speaking of funny you just conjured up this image of of in my head of a tennis tournament with EDM in the background
Sara Makin:
[19:59] Oh my gosh.
Dan King:
[20:00] That we need to create
Sara Makin:
[20:02] That would be phenomenal our tennis pro likes music that's like um from like the 70s, in the 80s and a certain crowd really enjoys that but like I personally don't I I'd loved And I'd love for there to be like EDM or something more exciting in the background. I bring my phone with me out to the courts and put Drake on. Blasting Drake at my country club.
Dan King:
[20:29] It's a great combo.
Sara Makin:
[20:30] I'm hoping I don't get in trouble.
Dan King:
[20:32] Well, you heard it here first. EDM tennis and Drake at the country club. That sounds pretty human to me. So, Sarah, so appreciate your insight as well as the little fun we had at the end there. Hope I'm confident practice owners will get a lot of value out of this conversation. So thanks for coming on.
Sara Makin:
[20:50] How wonderful. And thank you for having me on. Anything I can do to give back and to support our community, I'm all about it.
Transcript: Virtual group practice leadership with Sara Makin
"Virtual group practice leadership requires intentional culture, not just technology." - Sara Makin
Read the full transcript
Dan King:
[0:00] Hello, everyone. I am feeling all of a sudden very peaceful,
Dan King:
[0:04] even though it's been a chaotic Thursday. And I am really looking forward to a conversation with Sarah Makin. She is the founder and CEO of Makin Wellness. Welcome to your group practice, Sarah. We'd love to hear a little bit about you and your practice.
Sara Makin:
[0:17] I'm sarah i started up making wellness about oh my gosh i don't even remember it was 2017 so how many years ago was that nine nine years ago at this point we are a virtual mental health care organization we provide evidence-based and specialized therapy to people across pennsylvania Florida, Vermont, and Maine. And my number one mission is helping people to heal and come ahead and begin.
Dan King:
[0:48] I love it. And when you say virtual, does that mean the entire practice is virtual and no patients are seen in person?
Sara Makin:
[0:53] Correct. Whenever we first started up, it was virtual and in person. And I remember I had some pushback from some providers in the field telling, telling me that it's unethical to see patients virtually. And then when COVID happened, those same people, you know, were the ones, how are we supposed to get this set up? How can you make Zoom HIPAA compliant?
Sara Makin:
[1:16] Like all of these things. So I find that interesting. My philosophy is looking and sort of anticipating where society is heading and making adjustments for that.
Dan King:
[1:27] We all live and learn. We've all been wrong about many things, right? Oh, yeah. A lot of people did not get that one right. And it's interesting, speaking to so many different practice owners now, many still have a strong bias towards in-person. And I can understand how the therapeutic alliance plays out a little differently in person. And the reality is so many people just won't have access to care if there isn't a virtual option.
Sara Makin:
[1:49] Absolutely.
Dan King:
[1:50] So how does culturally, how do you think that shaped your practice, the fact that every patient is seen virtually and everyone is working remotely?
Sara Makin:
[1:57] You have to do a lot of additional things to make sure that the accompanying culture is being felt whenever you work in an in-office sort of setting. You get to see all of your team members and have a lot more conversations than, what you tend to do whenever you're working remotely, especially for clinical teams. They're mostly supporting patients. Then after that, doing their documentation. So you have to do a lot of additional things to make sure that there's still that feeling of connection and support. It's from having the experience of doing that in-person versus remote, it's much harder to do it remotely. You have to be a lot more intentional about it.
Dan King:
[2:39] So with around 30 clinicians now, have you found it even harder to do those things intentionally? And what shifted as you've grown culturally?
Sara Makin:
[2:48] That's a great question, Dan. It goes from you to you plus your direct reports, to you plus your direct reports, plus their direct reports, and really making sure that every level, within the leadership team, anyone that's providing any type of supervision or management of any sort is taking things on and handling things in a way, where every person feels supported and heard and they're creating a psychologically safe organization so you start with yourself, and you the goal is to bring people on that are aligned with your values, and handle things which should be evident in your company values in your company mission And the way that they do it might be slightly different, but the intention is the same.
Dan King:
[3:38] How do you screen for connection and alignment with those company values in your interview process?
Sara Makin:
[3:44] Asking them so many different questions. Different assessments are administered. They meet with different team members. And everyone that is involved in the hiring process needs to be excited to hire the person. We're not all excited. Yes. It just can't be, okay, we need someone.
Dan King:
[4:03] We need a body.
Sara Makin:
[4:04] Exactly. Because that doesn't work well, Dan. It doesn't work well for the clients. It doesn't work well for the rest of the team. Because again, you're ideally reflecting the needs and the culture of the rest of the team, right? So if you guys are all not excited to bring this person on and there's anything that feels off, there normally is something. And I cannot tell you how many times I've ignored feelings of, oh, I'm not sure about this person, or they're saying all the right things, they have a great resume. I don't know. I just and I and I every time I've hired them, there's been some sort of unusual challenge.
Dan King:
[4:42] Yes.
Sara Makin:
[4:43] And so that's when we adjusted our process to be like, we all have to be excited.
Dan King:
[4:50] It's a hell yes. Unanimously.
Sara Makin:
[4:52] Well, no.
Dan King:
[4:54] Yeah. Yeah. Yeah. Intuition and hiring is a beautiful thing. I fully agree with you. I have had the same experience. I will say the way it's played out for me more recently is if something feels off, it probably is and it should be a no. But in situations in which something doesn't feel off, it perhaps still should be a no has been my experience. So that there's an absence of that sort of feeling doesn't necessarily mean it's a yes. But if that feeling is there, then it should definitely be a no.
Sara Makin:
[5:22] Correct.
Dan King:
[5:23] Does that jive with your experience?
Sara Makin:
[5:25] Absolutely.
Dan King:
[5:26] Yeah. And I love that your standard is high. The standard is excitement. And that's not an easy standard to meet, right? Most people you interview probably aren't going to meet you.
Sara Makin:
[5:35] No, no. I do have to say we do tend to have a lot of quality providers. But for me and my team, I'm not just looking for quality evidence-based and specialized providers. I'm looking for someone with a certain set of values in someone that's going to be a joy and a pleasure to work with. That's important. You know, I don't want to come into work every day and have people that are clinicians and kind of hating their job and not. Liking, you know, what they're doing and kind of bringing the culture down. Because, I mean, we all like have to work. We all have to work and we've already, you know, we have a mission greater than
Sara Makin:
[6:16] ourselves and that's ultimately to help patients. And so that's what I look for.
Dan King:
[6:22] I love that. You mentioned assessments in your hiring process. What assessments do you use?
Sara Makin:
[6:29] I use the DISC assessment, and we also ask them a lot of different hypothetical questions. We reach out to the references in full transparency. I myself, I'm involved in one interview with them. So I'm not the one administering and asking the vast majority of the questions by the time I meet with them. I just kind of want to get a feel of how they're like. They've already passed all of the other markers, you know, regarding skill set and education and credentials and relevant experience and all those things.
Dan King:
[7:07] It's good that you're systematic about it. I think that's great. And that interview process is so easy. It's so vital because this is a people business. Yeah. And most practices are not systematic about how they do it. And most practices in a very short term way think, all right, more people equals growth. Therefore, I need more people. And I'm not going to take the process so seriously because, you know, they can get the job done. That's enough.
Sara Makin:
[7:32] Yeah. Yeah. I mean, it really depends on what someone is looking for with their practice and more people is not always better. Ideally, every position is optimized and every role is conducted in a way where there's a lot of contribution happening. I think of it like the way that Aldi hires. Aldi actually does not have a ton of employees. The ones that they have, they structure the rule to be extremely efficient and productive. And because of that, they're able to pay them much more. And because of that, they're able to retain them, which is hard to do in a grocery store type setting when you can very easily quit and go to a different place. So whenever we're structuring positions or handling a restructure, I always think in terms of that. And can I use technology to streamline things and make things easier for the team?
Dan King:
[8:29] And is the answer yes?
Sara Makin:
[8:30] The vast majority of the time, yes. There are certain things that technology cannot do for you, clinically speaking, or within your practices, operations. But there's certain things that I can certainly help with. Like, for example, scheduling. That's a big thing that can be helpful. Payment related things, billing related things. There's a lot of different things, you know, making your documentation more documentation process, more streamlined.
Dan King:
[8:57] Mm hmm.
Sara Makin:
[8:59] While still making sure it's audit-proof, that's something that makes a big difference to the quality, to the experience that your providers have. It makes their work much easier.
Dan King:
[9:10] Yeah, part of the reason any clinician chooses to work at a group practice is so much is done for them. And if what is being done for them is not being done well, then that undermines the whole value proposition. In an environment where it's easier than ever for clinicians to go off on their own, we always have to be asking, why would they work in a group?
Sara Makin:
[9:28] Yeah, yeah. It's something that one of my mentors was talking about recently,
Sara Makin:
[9:33] consistently providing a lot of value to your clinicians. One of the projects that we're actually working on behind the scenes, we haven't rolled this out yet, so... If any of my team members hear this, I apologize in advance, but this is what's going to happen. We are creating a career development program internally at Make and Wellness where we're going to meet with every single team member, clinicians, non-clinicians, and see where they want to be at within certain time frames, like one year, three years, five years, ten years, and seeing what we can do to support them throughout the process. The reality is, in today's day and age, it's unlikely to retain any team member for the duration of their career.
Sara Makin:
[10:22] I believe the average length of stay people have working in a private practice is only like two years. It's like the average length. And then they go somewhere else. And so initially, when I was very naive, my goal was, you know, I was raised by boomer parents. They have one job. We literally had one job and that was it. They were there forever. This is what i want to create an experience where people want to grow here, and then i realized it's just people no matter how well you pay them no matter what what you do it's going to happen and so my goal has transitioned into how can i retain them and support them here as long as possible and make sure that by the time they do end up leaving, that i contributed, the company contributed to their professional development in some way. Like, I want people to be in a better position once they leave. I was going to say, not that I want, you know, any of my team members to leave, but that's the way that I view things now. Because sometimes people get very upset about that. And it used to really bother me. I used to take it so personally. Like, what did I do wrong for someone to leave? Especially when I knew they weren't getting paid more. I'm like, I just don't understand that.
Sara Makin:
[11:37] And then you realize that people have different dreams for themselves and sometimes they need a change of pace and to not take it personally. I feel like a lot of group practice owners I've talked to, especially when they're kind of starting out, that's something that's, it really hurts them like deeply. And it used to hurt me very deeply too. Yeah. Now I'm like, yeah.
Dan King:
[11:58] There's ways in which the business takes on the energy of the founder. And each I mean any business that someone starts is is going to be a reflection of them in a certain sense yeah and one of our one of fireside's advisors and investors is a brilliant group practice owner she built a 120 clinician practice in texas her name is danielle hayes and danielle always says now when she's working with practice owners that she's interested in looking at the ways in which the practice is a reflection of the owner and back and forth and back and forth And it can be very confronting to see some of your own challenges as an entrepreneur and as a human show up in the practice.
Sara Makin:
[12:38] Oh, absolutely.
Dan King:
[12:40] It's a great opportunity for you and the practice both to grow when you do.
Sara Makin:
[12:43] Absolutely. There's no end to that process. It's one of the interesting things about owning your own practice is you're faced with addressing your weaknesses and opportunities
Sara Makin:
[12:56] on an ongoing basis and there's no end to it, essentially.
Dan King:
[13:01] Well, speaking of which, I'm curious, one of the things I like to ask practice owners is, how do you see the future of your practice? Is there an endpoint you wish to get to? Is now the endpoint? How do you see it evolving and where where do you want to take it
Sara Makin:
[13:16] My goal is to impact millions of patient lives we've already impacted millions of lives virtually like online but we have not rendered treatment to millions of people yet so that is, something i want to experience within making wellness before before i do that, and i don't think i'm retiring for a very long long long time, and so that's the biggest thing i want to see is true impact, where i get to see this vision come to life and we've already made so much progress towards it there's so much more to do and i feel like with.
Sara Makin:
[13:58] Where the world is heading and how our sector has been especially the past couple of years it's more and more important especially for the independently held and privately held organizations for all of us to step it up as much as we possibly can.
Sara Makin:
[14:16] Okay i know that the quality of care that we provide is exceptional especially compared to a lot of major systems and it's kind of been breaking my heart seeing, a lot of these roll-ups occur not so much this year but within the past several years and just seeing these beautiful practices that, helped so many people screwing over the employees after, buyouts occur and you know seeing some of these venture-backed organizations and how they handle things it's it makes it it like almost like forces us to like me to do even better and better and, our competitive advantage is being clinically minded and because of that operating in an ethical way and supporting patients in the most effective way that we possibly can where top of mine is not not necessarily like revenue profitability but rather like true impact if you're doing that on a consistent basis the other things will follow you know so i don't know what you feel about, about that i know i mentioned a lot of different things but i feel like especially recently there's been a lot of the concerning sort of updates and that's what brings that to mind.
Dan King:
[15:32] Yeah yeah i mean that's a whole that's a whole other podcast i've done that that subject i'm actually doing another podcast soon on that subject. It's one of my favorites to discuss. It's changing the whole field and we need to understand exactly what's happening. And I agree that an independent outpatient group practice is still at the core of mental health in America. So about 60% of patients do get seen through some kind of independent outpatient practice. It's still, to me, the backbone of mental health for the average American. In cases where someone has super, super severe conditions, that that's a slightly different story. But if we're talking about the kind of run-of-the-mill mental health issues that pop up across the country,
Dan King:
[16:15] The independent group practice is the best thing we've so far come up with. And so I am a huge believer in it, both from a business perspective,
Dan King:
[16:23] as well as a clinical perspective. And it's interesting, you know, sitting in the seat where I sit as an investor and advisor to outpatient group practices, I also believe that the best group practices are partnerships between clinicians and non-clinicians. This is what I've come to believe, because I think that there's just certain, And, you know, clinicians have to be at the core of the work, have to be founders and are generally. And there's a level of impact that just requires, it requires the right people around the table. And you're absolutely right that there are many non-clinician business people that don't give a snot about the clinical side of the equation. And that is a terrible, terrible thing. And I don't believe in throwing the baby out with the bathwater because there's just a level of business skill and there's a level of complexity to what an independent outpatient practice can become if you solve really, really hard problems. And we need people who bring very different brains to the table to solve hard problems. And so what I've come to believe is I believe in partnerships,
Dan King:
[17:23] But I would share the exact philosophy you have about hiring when it comes to creating partnerships. Everyone has to be excited and it has to feel right. Yeah. And there has to be values alignment. And I think the future of mental health is going to require larger practices having more impact and it has to, we just have to encourage the right business people to get into this universe to partner with the right clinician founders. That's my overall view.
Sara Makin:
[17:48] Yeah, yeah. It's a great take to have for sure. We talk about multi- disciplinary teams i look at having practices you're running the ultimate multidisciplinary team where every single department is trained and specialized in something different, i can't have a therapist answering the phone because we're going to be chit-chatting and going on and on and on forever you know i can't have any of my marketers handle the billing, there you know that it's that's not what they specialize in and so having that harmony and again understanding that there is value in multi or in a variety
Sara Makin:
[18:33] of approaches is important.
Dan King:
[18:35] Agreed as we come towards the end of our time together sarah i always love to end on a human note and ask when you are not growing making wellness when you're not building you're not working, what do you do for fun?
Sara Makin:
[18:48] I love trash TV. I love rotting. Are you familiar with what rotting is? Yeah. No.
Dan King:
[18:54] No, no clue.
Sara Makin:
[18:56] It's like laying on the couch and just washing trash TV.
Dan King:
[19:00] Rotting?
Sara Makin:
[19:01] Yeah, they call it rotting. It's a good time. I rot every Sunday for like maybe like two hours. Love that. Normally, I play a lot of tennis.
Dan King:
[19:10] Oh, you're a fellow tennis player. Awesome.
Sara Makin:
[19:12] I want to deep, deep play.
Dan King:
[19:15] I'm a massive. I was born with a racket in my hand. I watch, I play. Oh, yeah.
Sara Makin:
[19:19] That's incredible. My son, his baby shower. I had a lot of my tennis friends there. He has all this tennis stuff like already and I take him to watch his dad play and he loves watching it.
Dan King:
[19:34] Amazing.
Sara Makin:
[19:35] I love music. I love like rap. I love EDM and I love to like laugh. Whenever I'm not working, I'm a very, very silly, sarcastic person. So I look for the humor and light things so.
Dan King:
[19:52] Speaking of funny you just conjured up this image of of in my head of a tennis tournament with EDM in the background
Sara Makin:
[19:59] Oh my gosh.
Dan King:
[20:00] That we need to create
Sara Makin:
[20:02] That would be phenomenal our tennis pro likes music that's like um from like the 70s, in the 80s and a certain crowd really enjoys that but like I personally don't I I'd loved And I'd love for there to be like EDM or something more exciting in the background. I bring my phone with me out to the courts and put Drake on. Blasting Drake at my country club.
Dan King:
[20:29] It's a great combo.
Sara Makin:
[20:30] I'm hoping I don't get in trouble.
Dan King:
[20:32] Well, you heard it here first. EDM tennis and Drake at the country club. That sounds pretty human to me. So, Sarah, so appreciate your insight as well as the little fun we had at the end there. Hope I'm confident practice owners will get a lot of value out of this conversation. So thanks for coming on.
Sara Makin:
[20:50] How wonderful. And thank you for having me on. Anything I can do to give back and to support our community, I'm all about it.