[00:00:00] If you're looking to grow your business as a registered dietitian, you've come to the right place. If you're not sure what to do or what steps to take next so that you can create flexibility and freedom in your life, then you're going to learn a lot from tuning into our podcast here at Dietitian Boss.
[00:00:17] I'm Libby Rothschild, the founder of Dietitian Boss, a [00:00:20] fellow registered dietitian and business owner. And in our podcast, I share the highs and the lows, and I talk all about how to grow your business. Get it started. And I interview our clients to date. We've had over 200 interviews from clients who share their journey on our podcast dietitian boss.
[00:00:37] Libby: Markay is the founder of All Voices Nutrition, an [00:00:40] outpatient eating disorder specialized group practice. She is also the co founder of Nutris, the first medically tailored meal delivery service for those in eating disorder recovery. Markay has been working in the food and nutrition fields since 2007 and takes a Hays aligned body respecting and inclusive approach to care and operating her business.
[00:00:59] Libby: She [00:01:00] continues to evolve as she uses the mantra of leading and learning at the same time. And all her pursuits, she accomplishes this by allowing curiosity, science, and empathy to assist her in co creating options for her clients and teammates. She uses specific storytelling to connect ideas and empowers her clients to bring to life possible paths [00:01:20] forward so that they can move towards living the meaningful and authentic lives they are interested in.
[00:01:25] Libby: You can find Markay on her website at allvoicesnutrition.com and mynutriste.com. And she welcomes you to reach out so you can collaborate with her. Welcome to today's podcast episode.
[00:01:35] Libby: So happy to have you here today, Markay. If you could just share a little bit more about your background [00:01:40] beyond the bio that we introduced you with today.
[00:01:42] Markay: Absolutely. Thanks so much for having me, Libby. As you shared, my name is Markay. I'm a registered dietitian, the founder of All Voices and Nutriste, as you have mentioned.
[00:01:52] Markay: But in that sense, I didn't always start out as a dietitian. My degree is in nutrition and food science. But long time ago when I first [00:02:00] started, the options were clinical and that didn't quite resonate with me. And so I actually spent a lot of my career in and out of the food industry and in and out of private practice.
[00:02:11] Markay: And as a result of that, I really learned for myself, the area in which I wanted to work in after spending time going back and getting [00:02:20] my MBA and then really wanting to bring into my private practice. Some mentorship and professional development, which is really important for me to help other people, especially dietitians.
[00:02:31] Markay: Our education sometimes is lacking this private practice space and what it's like to run a business. And so I guess I would say [00:02:40] that's kind of encompassing for where I am right now.
[00:02:42] Libby: Excellent. And in terms of the space that you specialize in, what helped you really want to dive into eating disorders?
[00:02:50] Libby: Sure.
[00:02:50] Markay: I guess first and foremost, I have lived experience. when I was working through my eating disorder, dietitians were not an integral part of the care team, [00:03:00] probably could have used some of that support. And the irony is, I was actually in college learning about nutrition. There was no recollection in my mind of eating disorders, even being brought up.
[00:03:10] Markay: And it's fundamental. And so, in that sense, we know eating disorders are mental health conditions, which greatly impact the metabolic processes of the body. [00:03:20] who better suited to help with metabolic processes of the body? and so as a result of that, I didn't spend my early career, probably 15 years, not at all focused on being I came into the eating disorder world from the yoga therapy aspect as well.
[00:03:35] Markay: I'm a yoga therapist too, and I started working for a nonprofit [00:03:40] that leverages yoga therapy for those in various stages of recovery. And I was like, this is my people. I understand to a certain extent, through my lived experience, how an eating disorder can disrupt all aspects of a person's life, I always believe that we teach from our own experience.
[00:03:58] Markay: And so, in that [00:04:00] standpoint, I always kind of tell my clients, I'm leading and learning at the same time we're together and I truly believe day in and day out. My clients teach me incredible things. And so I kind of just found myself working as a yoga therapist, like I said, and then was like, okay. I might be able [00:04:20] to do some of this on my terms, so obviously surrounded myself with very strong mentors so I could learn, you know, went back, worked for some treatment facilities over the course of my kind of career coming back into the dietetic space and then combined with my business and entrepreneurial education was able to create both All Voices [00:04:40] Nutrition and Nutrist.
[00:04:42] Libby: That's beautiful. Thank you for sharing that background and compared to how eating disorders are seen mental health and behavioral health and nutrition today is represented versus how it was 10 or 20 years ago. Do you think we've come a long way?
[00:04:55] Markay: I do. I think that the recognition, first and foremost, that dietitians [00:05:00] have an integral role to play in all levels of care is fundamental.
[00:05:05] Markay: I often think of myself as a cognitive, behavioral, and somatic dietitian in that sense. So that's the recognition of body and brain, mind, right? We believe the brain is where our mind is housed. And so in that [00:05:20] aspect, sure, dietitians that work with eating disorders and people that are struggling through the symptomology, the behaviors for the eating disorder, the disruption of their lives, we have to go beyond just our formal education of the body.
[00:05:35] Markay: And so a lot of my continued education, the supervision, the mentorship [00:05:40] that I have sought out is very much on that cognitive behavioral, the understanding of the intersection of the mind and body.
[00:05:47] Libby: Yeah. And that's an important gap that we need to fill. And I appreciate you representing that. One of the reasons I'm really excited to have you on today is because talking about the topic of working with clients [00:06:00] that are situations come up and the term difficult comes to mind, although that might not be a sensitive word.
[00:06:06] Libby: So I want to talk to you about that, but I want to hear from your experience through the lens of not only your niche, but your group practice. What do you do when you have a client that needs extra attention or situation comes up that maybe [00:06:20] is out of the norm. So you might label, I'm labeling it as difficult, although help me out with the word here.
[00:06:25] Libby: And why is that seem triggering to you in terms of labeling a client as difficult?
[00:06:30] Markay: I have reflected on this word language does matter, especially when it comes to treating a human that aspect labeling of [00:06:40] this, that or the other can have both benefits and drawbacks. I'll be right honest about that.
[00:06:45] Markay: And so I love the study of linguistics. And so in my mind, I kind of did like a bit of a brain exploration, like what could difficult mean, right? Maybe it could be frankly, a difference in personality. It could be logistical when it comes to [00:07:00] scheduling. It could be interest and goals. It could be brain just processes information a different way, and that could be hard for both parties. Maybe a person is neurodivergent, maybe they have experienced trauma, abuse and frankly, for the eating disorder population, we often experienced a malnourished brain as a [00:07:20] result of inappropriate food intake in one way or another.
[00:07:24] Markay: And so in that standpoint, especially in working in higher levels of care, right, there is. commonly used like non compliant clients or a difficult client. And that can have a ripple effect, right? We talk about at least in the business world of a halo [00:07:40] or a horn effect. And so in that sense, that principle says that if a person is deemed of a horn, meaning that they are not so great in one area that can then spill over into a lot of other areas of a person's brain.
[00:07:55] Markay: And so in that standpoint. I challenged myself. I challenged my [00:08:00] whole team as well to come to a place of curiosity, and compassion really try to understand from that client's perspective what might be coming up as perceived, difficulty. they might have a fear around something that's being discussed a topic.
[00:08:17] Markay: They could have [00:08:20] misinformation or disinformation. they might have a trauma that their brain associates with this, that, or the other that could be either talked about. and so we really work to come from that curiosity, compassion and kindness, rather than that critical and judgmental standpoint that I think difficult [00:08:40] portrays now in that standpoint as well we always talk about like a full expression of a person.
[00:08:47] Markay: All parts welcome here from taking from the internal family systems way of approaching care. And so we don't blame. We don't shame. We don't judge a person. We get curious. And so a lot of the [00:09:00] work for those that practice and are supporting those for their recovery journey is about being a detective.
[00:09:05] Markay: The same exact thoughts. Could be discussed. The behaviors could be presenting for two different people. But the reason in which those thoughts could be coming up or those behaviors might be manifesting could be from [00:09:20] miles apart when it comes to the reasoning for that. So in that sense, we always try to create and model a relationship where that person can have the space, the time, so they can bravely speak some of their truth here. that might be a very new experience for clients if they have grown up in an [00:09:40] environment or, you know, a place in which either their voice was quieted, or, you know, some abuse was taking place. And so might have to, like, Tread cautiously. And so in that standpoint, that could be presented might have been documented as a difficult client.
[00:09:57] Markay: And so I think that's on us as well, too, to [00:10:00] recognize is that us putting some of our expectations on what treatment progress and timeline kind of looks like when in fact that person just might need some additional time. They might need to be discussing things in a different manner. They might need to go over things many times.
[00:10:15] Markay: We know that repetition is a way in which we take in new [00:10:20] information or information that's different from maybe some of those patterns that have been well worn and associations that our brain often has.
[00:10:28] Libby: And you talk about modeling. Is this something with your staff, since you own a large New York City based practice?
[00:10:35] Libby: Is this something that you train your staff or do you qualify them in terms of before you [00:10:40] hire you make sure that they have this type of training and sensitivity to ensure that your clients are receiving the best support possible?
[00:10:47] Markay: think it's probably both. We really believe in one of our principles at All Voices Nutrition is that clarity is a form of kindness.
[00:10:55] Markay: that goes through my interactions with the teammates that, you know, goes into the [00:11:00] interactions that they have with our clients, family members, therapists. the entire care team. And so in that sense, especially for a person who has like a very strong eating disorder voice, right? We ground ourselves in truth.
[00:11:14] Markay: Truth might not be what a person wants to always hear. But in that sense, [00:11:20] because the eating disorder part of the brain can sometimes morph reality, right? I really feel like a part of our job is to help ground them. and we deliver the message of kind, compassionate, and frankly, authentic to each of the different teammates their own way.
[00:11:34] Markay: Right. Trust is something that is earned. It's not just gained. It's not just like [00:11:40] given freely away.
[00:11:41] Libby: thank you for sharing that. And it's clear the compassion that you and your team have for your patients and the great care that they get. And I think that's so good to share that with our listeners so that they have that to model, not just for eating disorder clinics, but for how we practice for any client, right? And making sure that we're being understanding in [00:12:00] my work as a business coach for dietitians. I see difficult to me when I work with our clients. And when I've worked with clients before, in terms of on the nutrition side, it's noncompliance. It's also.
[00:12:13] Libby: Clients that don't fall through or they want to push the boundaries when it comes to policies and procedures. [00:12:20] So I want to ask you about that in a minute, but I just wanted to share that. That's how I perceive difficult. And that's how I've seen our clients perceive it is they'll come to me and say, gosh, I'm just struggling with this client that, you know, will show up, but they're not following any of the goals that they're pushing back on during the counseling session.
[00:12:36] Libby: And I think some of that is a combination of how we are [00:12:40] counseling our clients. And then perhaps. Like the principles that we're living by and how we're marketing our services, et cetera. So there's probably a combination of things going on with that. And so I like to come from curiosity as well. When I find out why is that happening?
[00:12:54] Libby: So if you have anything to add to that I would be open to hearing it. And I also next want to talk [00:13:00] about policies and procedures and what responsibility do we have to set for our own boundaries and communication for appropriate levels of care. So if you could just speak to that, I think that would be helpful.
[00:13:11] Markay: Yeah, I think to answer that, that first part that you mentioned that is key reason and where supervision and surrounding yourself [00:13:20] with people who might have different or an increased amount of experience can be helpful as well, too, because in that sense, I would never want a person to underestimate the value that a client might have simply showing up there.
[00:13:34] Markay: Could be the what it is that they are capable of accomplishing in that [00:13:40] day. that's where I was going back to showcasing what a respectful relationship could look like for a person. And so that's actually a lot of the way that we help. clients is by kind of showcasing, we use a phrase like this is, I'm showing you the mirror, right?
[00:13:58] Markay: Without judgment. And I'm reflecting [00:14:00] back for you, what I'm seeing, what I'm hearing. Yes, it is a bit through my own lenses, but when I said to you, language is important, I will. Often encourage my other teammates and I do this myself to use the exact language that the client is using Because that's going to connect with them or they have chosen that word They're using that in a sense as well, [00:14:20] too and so that might be reminding them Well, I hear like we talked about this last time and right you're coming in and you're saying hey I didn't get that There, like, let's talk about what some of the barriers, what some of the things might be getting in the way.
[00:14:34] Markay: And we use a phrase instead of using that E A S Y word, we say, Hey, [00:14:40] how could we make this less hard for you in that
[00:14:43] Libby: sense? Yeah, that's great.
[00:14:46] Markay: I think as well, too, we often use the principle of having enough safety in an adventure and change is an adventure, like, even if we believe that change is going to be helpful, it's going to be life changing.
[00:14:59] Markay: It's [00:15:00] going to be positive. It's something different. And so we spend a lot of time talking with clients to ensure that we can have, like, either boundaries or safety in whatever shape or form that might look like to support them to take, once again, we don't say baby steps, we say BB steps, bold and brave, [00:15:20] Yeah, and so those, I guess, are some of ways when it comes to policies and procedures. As you mentioned, we have all of that shared with the client at the very beginning. teammates are verbalizing then for them the expectations around like cancellation or like we're an insurance based practice.
[00:15:38] Markay: And so we communicate, [00:15:40] I myself do a full insurance review for every client coming in. And then I share that information with them, the medical system is one of those strange, but very important systems within our lives that sometimes we don't know what something costs, but we've already, agreed to buy it.
[00:15:57] Markay: and so that's a way, Like some [00:16:00] people in the past would have told me like, Oh, that's probably above and beyond. And I was like, maybe, but when I take and I continue, like I said, to listen to my clients, that's something that's been very helpful for them. And it provides them with a level of that safety and security.
[00:16:16] Markay: As they enter into this adventure and [00:16:20] oftentimes eating disorder dietitians are like public enemy number one for that eating disorder. And so if we can try to get ahead of that, that's absolutely something that I'm happy to do.
[00:16:30] Libby: I love that. Thank you for sharing that. And that's so important. Where you had mentioned that you might be going above and beyond.
[00:16:36] Libby: If I heard that correctly, you said that, but that's one way of looking at it. Another [00:16:40] way of looking at it is that's what my patients need. And given what they come to you with the serious mental health and they see. Perhaps your role, the role of a eating disorder.
[00:16:52] Libby: Dietitian is scary. You're demystifying that by helping them navigate. I would agree. I think strange is a beautiful way of labeling our American [00:17:00] health care system, which, can feel daunting, not only for the provider, right? When you're paneled with insurance, but also for the patient, right.
[00:17:08] Libby: And even for their. care team, it can be challenging. So that could be a whole episode in itself in terms of like your role with insurance. I really appreciate you sharing that. I also for this episode wanted to [00:17:20] really dive into, difficult situations and defining that term.
[00:17:23] Libby: And when I say difficult, it's just situations you might not expect. And it might feel different at the beginning of your career versus when you're further on, or when you're managing a team like you versus if you're a solo practitioner, but no matter your situation, we're going to deal with situations that we didn't expect that there might not be a [00:17:40] handbook for, or that we have to use our discretion.
[00:17:42] Libby: And I think when it comes to using our decision making skills in the midst of wanting to be a clinician, but having to put on the hat of being a manager, dietitians can feel very frustrated. So that's why I wanted to address those topics and your stories this episode. And I think that you've given some really great tips so far from your lens.
[00:17:59] Libby: So I [00:18:00] really appreciate that. Of course, when it comes to policies and procedures, you mentioned it to them. So I'm guessing is that some type of orientation during the initial or is that when you mention it?
[00:18:09] Markay: I think it even starts probably before an insurance review.
[00:18:13] Markay: I do free discovery call for all clients. It can be, like, we're sitting here now talking. It could be like [00:18:20] video, so I even think that recognition in a sense it can be really supportive because they get to ask some questions. And I always preface it in that standpoint.
[00:18:30] Markay: lot of other practices don't do that. They're like, that's 15 minutes. That really adds up. Yeah, it does add up. But for me, it's a little bit of a pebble in that trust. bank [00:18:40] that they get to gain in the beginning of our interactions. so I spend the time like allowing them to share as much as they feel comfortable with, to answer any of their questions.
[00:18:51] Markay: While I'm always thinking as well, like who on my team would be best skilled to work with them. If there's someone has an experience with [00:19:00] a therapist, which we have, Every single client at all voices is also working with a therapist or have they worked with a dietitian in the past? Well, what aspects about those relationships do you find helpful?
[00:19:11] Markay: But things maybe were not so helpful so that I can make sure that i'm doing my best there and then just like you said at that point if they're interested in moving forward, it [00:19:20] is always a question It's not a foregone conclusion. They're going to work with us I encourage people as they're in that discovery phase go talk to a lot of different providers Like, I want you to find the person that you think is going to resonate with you.
[00:19:35] Markay: And if that's not us, like, I'm so glad that you learned that early on. And [00:19:40] then from there, that's where the insurance review comes in. They'll be filling out their intake forms, right? This is individual as well as family medical and mental health history. then from there, give them a whole report as to kind of what's covered.
[00:19:53] Markay: We ask them if they have further questions and then share options for the clinician that I think would be best suited to work with [00:20:00] them.
[00:20:00] Libby: Fantastic. It sounds like you have a lot of processes and systems in order to support the client and also support the practice, right? In terms of almost, I'm visualizing some type of an algorithm in terms of how they answer a question, which provider might be the best fit, making sure the paperwork, having the workflow, giving them that great onboarding experience, which segway into my next [00:20:20] talking point, which is you've been very clear about how you onboard them and honestly let them know about the choice they have and invite them to the experience if they feel that your practice is a fit for them, what happens if, and when, and maybe this doesn't happen often in your practice, they're not following the 24 hour or whatever your policy is. I didn't mean to say 24 hour cancellation [00:20:40] because I don't know what yours is. That's one, one of many ways you could do it. Any of your policies and procedures are not honored by the patient. And you find the situation where that patient might be fighting back or asking for some type of exception.
[00:20:54] Libby: And you could let me know what some of these situations are. How do you handle that with discretion? Can [00:21:00] you give a story or an example of what you might do?
[00:21:03] Markay: Sure. And it does happen fairly frequently, especially working with eating disorder population. Mundane tasks that you and I might take for granted and not think too much about could be completely overwhelming and unsettling for a person if they have severe [00:21:20] debilitating anxiety, depression and a very harsh inner critic.
[00:21:24] Markay: Often termed eating disorder voice. That's also kind of chirping around in their mind. And so in that standpoint do communicate, right? 24 hour is our cancellation policy. It's on all of our paperwork. you were starting to mention, it is something that I [00:21:40] encourage all of our teammates to verbalize with them.
[00:21:43] Markay: spend time together in a like coming up with when will we see you next? We also Rather than just sending 24 hour email reminders, we set 48 hour email reminder. So then it gives them a whole extra day to really take a look [00:22:00] forward. we do our best to show up in a way that it will hopefully reduce the likelihood of a missed session, right?
[00:22:08] Markay: Or a cancellation, a no show, any of those things. But life also happens in that standpoint. so in that regard, like if I know a client like has limited financial means or something of [00:22:20] that sort, like we will often kind of do one of two things. We'll either say like, Hey, this is the first time moving forward.
[00:22:27] Markay: Like, we will charge you, our full equitable standard rate, and that's a cash based rate for the missed session. We can't charge to insurance for a session in which a client is not present. We communicate all of those [00:22:40] amounts in our intake forms, or I guess sometimes we will also do something of like a, hey, let's split this for the first time.
[00:22:48] Markay: That way neither of us, the practice, nor you have to carry that full financial burden. Okay, and then from there, we remind them like, hey, This is important work. This is something [00:23:00] that happens when we're together so that we can process this information. We can talk about some of maybe the hurdles or the, I don't know if it's a thought exercise that someone has been, tasked to consider in between sessions, like what has come up about that.
[00:23:15] Markay: And so, in that standpoint, we will encourage, but yes, I think eating [00:23:20] disorders. Population has both a longer time in which they are meeting with multiple teammates, because it is, as we mentioned earlier, both mental and medical nature, but then also it's a really scary place to be for some people.
[00:23:34] Markay: And so, in that standpoint, if a person has experienced dissociation, or maybe this 1st [00:23:40] home has not been a safe space for them, it can be very hard to come into these sessions and share some of the most intimate and vulnerable parts of them and that absolutely does happen, right?
[00:23:52] Markay: It's often food and medical and blood and all that kind of stuff that we are talking about, but it's so much [00:24:00] more.
[00:24:00] Libby: Well thank you for sharing in terms of your discretion and the options that you have. And you were mentioning before that these patients stay with you longer. You mean that you have like a higher retention rate because they're with you longer term?
[00:24:14] Libby: Is that what you mean? what's the average? Like value or length of time that they're with you.
[00:24:19] Markay: [00:24:20] Unfortunately, I'm just going to have to say it does depend. and in that sense, yes, we are an outpatient eating disorder group practice. And so there are some expectations around the skills, the medical stability, right?
[00:24:32] Markay: The additional team and the support that a person has when they are working in the outpatient space. But in that [00:24:40] standpoint, because we are talking so much more than just the food or a meal plan, if it's even applicable and moderating like movement in a way that's fulfilling and joyful for a person, we often use the analogy that the relationship that a person has with food on the plate is often representational of [00:25:00] other areas of life off the plate. and I often say to my teammates, yes, scope of practice is really important, but if we are starting and the client brings into session something that is interfering with their ability to care and nourish for themselves, we should spend some time.
[00:25:17] Markay: talking with them about it and that might [00:25:20] be depending on a person where they're at or the way in which their brain works. It might be that we're going into deeper levels of detail Rather than just okay make a grocery list and go to the store for some of our neurodivergent patients We will literally spend the time like let's make a list here together Let's talk about [00:25:40] where in the week this could fit into your schedule.
[00:25:42] Markay: Which store are you going to go into? And I often will help a client as well, like, in thinking of the grocery store as kind of like a museum. Could you walk into the grocery store, imagining it's a museum, you can just look, you don't need to touch, right, you don't touch things in a museum.
[00:25:58] Markay: You don't usually buy [00:26:00] things from a museum. Can you use this as an adventure to just walk an aisle or go into a specific section of the store and be curious? Just see what is said. No expectation of buying anything. Okay, there's going to be insights that come from that in that sense. And so, in that [00:26:20] regard, yes, I do believe that we can probably be meeting with clients for a longer duration, and it might also be more frequent sessions over the course of our tenure working together.
[00:26:31] Libby: Yeah, well, I love that. It depends because I do understand in this context that it's individualized for where they're at and [00:26:40] you're working with the medical team, which is really incredible because you have that whole team approach for the patients or some type of nutrition care might not always involve the medical team or there's pros and cons to that, but it must be really nice to have that comprehensive care plan.
[00:26:55] Libby: Right. And so that can be really rewarding for the patient as well as [00:27:00] I'm sure you and your team are working really closely with the staff in total. So that can be really rewarding and educational because you're able to create great relationships with the care team and get not only referrals, but education and all of that.
[00:27:11] Libby: It's just a matter of finding the care team that does support and understand the role of an R. D. As you mentioned, which some time ago might have been more challenging. I'm sure it's still challenging now, [00:27:20] but I think that's really incredible that your team has been able to make that work so well and provide such great care to New York City patients.
[00:27:27] Libby: You do serve only New York City patients, right? Cause you're insurance based.
[00:27:30] Markay: We are licensed in many states and so insurance coverage is different than licensure. That's also a whole nother podcast episode. but the team is spread [00:27:40] out. There are five of us here in New York remaining. and we can see clients in nearly any state virtually, but I guess on your point as well when it comes to like, duration, right?
[00:27:52] Markay: A person's recovery journey is not only going to be nuanced and tenure and depth and level of care comes into a big [00:28:00] consideration for the specific population as well, And in that. standpoint, it might be that they start out in outpatient and we realize with working together that they might need to have an assessment to go to a higher level of care.
[00:28:13] Markay: And so that's a part of how our team works and vice versa, right? Building the relationships with the eating [00:28:20] disorder, higher level of care community, knowing that they could come to all voices. or utilize the services of new trees to help their clients as they transition back into their home or their school setting in comparison, is something that we work really hard to do.
[00:28:37] Markay: And those actually come back to one of the topics that we talked about [00:28:40] in the beginning. Being open, honest and transparent in our communication. And so, in that sense, we really work to sequence. If we're starting to see some behaviors, like, let's have a conversation about It's not to threaten or give ultimatums.
[00:28:56] Markay: It is the reality and the response. of us in the [00:29:00] outpatient space to be able to recognize outpatient can only do so much when it comes to support for a person, they might need to find themselves with a dedicated team, even like around the clock to help them with the increased support or medical attention that the outpatient care provides.
[00:29:17] Markay: Like said, he just cannot provide and it's not expected to [00:29:20] provide for them.
[00:29:21] Libby: And I love that throughout this episode, you're talking about living your values in so many different scenarios. And that's what makes your practice so strong, right? And makes your brand so strong is to live your values and really represent them through all the different ways that you help clients from the care team, to the nuance of the different [00:29:40] recovery types, to how you're able to attract new staff to help.
[00:29:43] Libby: Your future clients and current clients. So I think that's great role modeling. I have one more question to ask you about your team and just from the business side. But first I was wondering if you could share any examples that might show up as difficult since we just to wrap up that part of our discussion today and.[00:30:00]
[00:30:00] Markay: How we can be curious. You did mention some examples. If you have any more examples about how we can be curious about how we might, what might be at play and why supervision is important. Yeah, I think this is where, like, counter transference comes in a lot.
[00:30:14] Markay: Like, we are human, just as every person that we work with. And that's actually [00:30:20] an expression that we use a lot in the practice. Like, how human of you, right, for wanting this, or interested or curious in this, that, or the other. And so ensuring that the team does have an outlet to be able to express questions or confusion or an understanding.
[00:30:39] Markay: And then they might not [00:30:40] have experience in area that they don't have experience in. Or maybe it's just frankly untested. They've never seen anything of that sort. And so in that regard, right? Counter transference is when us as a provider might project some of our lived experiences, biased, unresolved feelings onto a [00:31:00] client in that aspect.
[00:31:01] Markay: And so that is something that supervision plays a big role in. So getting together, like helping a person, and this relates to the somatic way in which we do operate, the recognition that are we in a sympathetic or a parasympathetic state? That can be sensed by others. [00:31:20] Okay, and that can even transfer virtually in that regard.
[00:31:24] Markay: And so having a space for the team to express some of these things, right? It's a safe space. It's a brave space that we come together twice a month. I always tell my team, like, hey, I'm available for, you know, individual sessions, like for [00:31:40] us to talk through, like some very specific stuff anytime that it's helpful.
[00:31:44] Markay: And I'm constantly doing that for myself as well. I think that's actually where from the therapy side, right, if you are a practicing therapist, you are also supposed to be in therapy and in supervision for yourselves. And so that's of the ways that we have implemented that [00:32:00] in the eating disorder community and specifically within our practice.
[00:32:04] Markay: we have had some clients, that are neurodivergent. Some of our clinicians are also neurodivergent. And so hearing from their perspective, I'm not saying it's always going to be apples to apples, right? They're two different people, two expressions of the human form.
[00:32:19] Markay: And so in [00:32:20] that regard, it can then help us to be curious because like I mentioned to you, the same behaviors could be showing up for two different people, but in which it could be coming to life could be completely different. Maybe it's a history of family food insecurity. Or maybe it's a person who has recently immigrated to the [00:32:40] country.
[00:32:40] Markay: And they don't have access to their more familiar food ingredients. And then when they have access to it, they might find themselves. Taking in more than they would have expected and feeling uncomfortable. Maybe it would be a binge. Maybe it would be a subjective or objective binge. and so in that sense, we [00:33:00] definitely need to take the time to better understand the realities which are playing for that individual client.
[00:33:07] Libby: Yeah, that's really helpful. Practical tips. And you stress supervision a couple times during this episode. So I think that's a great nugget for the listeners to remember. I want to ask you as we wrap up here, you are so [00:33:20] knowledgeable about business and clinical. Which is important for your role and in the practice, would you be able to share a little bit, whatever you're comfortable with, what does your typical day look like?
[00:33:30] Libby: How much of it is business versus clinical and what do you prefer or enjoy more? I have a feeling you're going to say clinical, but you just seem so natural with how you're navigating [00:33:40] business. Because if you're operating in multiple states, that means you have to have partnerships with healthcare teams in multiple states.
[00:33:45] Libby: And I can imagine that it's not easy to find that type of partnership. Given how I knew you had a large practice, I didn't realize that you had those partnerships across different states. And so that's really impressive, not only for you to manage that for your team [00:34:00] managing that.
[00:34:00] Libby: I can imagine that that's a lot of work.
[00:34:03] Markay: Yeah, I think to answer your question, it has evolved. I started as a Solo practice owner like learning what it's like to take insurance, how to create partnership, as you mentioned. My background is in business and so in that regard, I [00:34:20] actually led very large international sales teams and so in that regard networking. Sometimes can give people a yucky taste in their mouths. But for me, it is really about like learning about what unique things and what interesting aspects this specific, let's say, higher level of care [00:34:40] facility specializes in and sharing with them how we could partner a lot of referrals.
[00:34:46] Markay: I would say all of my referrals are word of mouth. Because you're out there, you're talking to them, like, and so in the early part of my career, when I didn't have the caseload for myself, it was, [00:35:00] okay, Markay, you're going to meet five new people each week, something very tangible. I can measure that.
[00:35:05] Markay: I can see the impact of that. And then I am a person who is, Just like you have mentioned earlier, very systematized. And so I would hold myself accountable to sending the follow up and that is acting with integrity, doing what we [00:35:20] say we're going to do. That is how we build trust. Okay. And as we have talked about, trust is a huge component for how we work here at all voices.
[00:35:29] Markay: And that might mean that I have like 10 reminders or a to do list or setting calendar notes out into the future, snoozing emails for two weeks because I said I would follow up. And so in that [00:35:40] regard, that was a lot of where my beginning of the work was to share with people. Hey, All Voices is a partner for you.
[00:35:47] Markay: You can trust in your referral that your client will be in good hands and that we will have the communication channels open. Yes, then it got to a point where I and I always recommend this for [00:36:00] any practice owner like figure out the amount of time That you want to and are capable of spending in your business and then kind of work backwards How do you want to allocate the time across those things?
[00:36:11] Markay: Minimizing the stuff. It is not fun. That's tedious and that's going to be different for every person while Making sure it doesn't interfere [00:36:20] with that client work. And so Burnout is one thing that is constantly on my radar for myself, for my teammates as well. And so we are openly communicating, like we actually use a stoplight model in our practice.
[00:36:34] Markay: And so the teammates. No questions asked. They they own their own calendar. In that [00:36:40] sense, they block some days and times read, meaning do not schedule me. Then they use yellow for market. Please ask me. And then there's the green. Go ahead and schedule me. And so they're, yeah, they're managing their time in that sense.
[00:36:54] Markay: And right, we're constantly touching base. I would say probably every couple of months. How are [00:37:00] you feeling? Like, you know, what does your caseload look Like, are there specific demographics or presentations that you would like some more experience and that you would like some more time spent discussed in supervision?
[00:37:12] Markay: and so that's kind of where it has evolved to, one thing that I very much missed from my corporate career, of managing [00:37:20] the large teams that I did was the mentorship and the professional development. So I knew that I wanted a group practice from the very beginning because I believe that I thrive best in conversation and having a community of strong and good hearted, dedicated [00:37:40] people.
[00:37:40] Markay: and so in that standpoint, that is a part of my interview process. We talk about these things, when I'm doing referral checks. I also am specifically asking these questions of those that, have been used as a reference point. And so my time has very much shifted in that standpoint. As you mentioned, I still see clients [00:38:00] every single day.
[00:38:00] Markay: I hope that that's a part of how I continue to work because it is the foundation for what we do. Frankly, all of the stuff behind the scenes, my goal is that the clients actually have no idea about it because frankly, that's my job. I say the same thing to my teammates. Any [00:38:20] insurance, any money type of questions, please send them my way for your clients because I want you to maintain the integrity of that relationship that you are working on some really hard stuff there.
[00:38:30] Markay: Let me do some of that in that aspect but it's still the same. It's making sure that you're staying aware of new like research. [00:38:40] And so we're always doing like webinars as a team. We're talking, we're actually going to be starting up a book club. So we'll be reading books here together as a team.
[00:38:48] Markay: We'll then be coming together in our supervision as a group, talking through some of it and things of that sort. And so that's kind of a bit of how my time has shifted. I would say. 90 percent of the [00:39:00] time when it was just me was very much client focused, and then outreach was maybe like 10%.
[00:39:06] Markay: And I would say it's probably shifted in that sense, where I don't know, maybe, maybe 20 percent of my time is on clients, another 20 percent on like admin, and then a lot of other stuff and just [00:39:20] making sure that the experience and working with a person from All Voices Nutrition is as seamless as possible.
[00:39:26] Markay: For our dietitians, for our clients, and for all the therapists that we collaborate with.
[00:39:30] Libby: so well said, thank you for sharing that last follow up question for that. Markay would be, what was the mindset that you had to embody and how long did it [00:39:40] take for you to shift from it being, let's say, I can't remember if it was 90 percent client, 10 percent outreach to the larger percentage of outreach and a smaller percentage of client.
[00:39:47] Libby: Cause I know a lot of clinicians that want to grow really struggle with letting go of more of their clients or any of their clientele to have the space to do outreach and sales. So if you, through. thinking of that type of person, what would you say [00:40:00] your experience was where you said from the beginning you wanted to do it?
[00:40:03] Libby: So is it just part of your plan or did you do some mindset work for that?
[00:40:07] Markay: Huh? That's a good question. I think on like the very tangible, logistical part. Clients do have a natural progression of their own journeys. And so there is attrition for a [00:40:20] multitude of reasons that take place.
[00:40:22] Markay: And so it was scary to say, I am not taking new clients in that standpoint. But I will say I have utmost confidence in my team, frankly, some of them are so much better than I am They're newer and more in touch with research in that standpoint. And I learned from them all the time [00:40:40] as a mindset.
[00:40:41] Markay: I don't know. I hope to not come across arrogant, but in that sense, I have always believed that if I am courageous enough and put enough focus and have enough heart behind something, I can do anything. And so in that aspect, yeah, it [00:41:00] is surrounding yourself. It's not me doing it all myself. It's number one rule of reaching out when you don't know the answer or you need more information. And so that's something that we infuse all the time in our conversations with clients as well.
[00:41:13] Libby: Yeah, and I love how every time I ask some type of a business question, you also bring it over to how you talk and [00:41:20] interact with clients, which is great for your values, right?
[00:41:22] Libby: How you live your values. And I think that's a theme I'm hearing in this episode. Is there any final things you would like to end with? Or have one question I'd like to ask, which is the biggest piece of business advice or one of the most important doesn't have to be the biggest, right?
[00:41:37] Libby: That feels a little heavy. what is one important [00:41:40] business, piece of advice that you think would be helpful for the listeners and anything else you'd like to share before we wrap up?
[00:41:45] Markay: I guess I come back myself to one fundamental question when I'm kind of faced with like big decisions in my life.
[00:41:53] Markay: And my question is, are you going to regret not doing it? Not giving it a try [00:42:00] and so I understand that that also comes with an immense amount of privilege. That being said, though, there are ways in which I believe. Most people are able to find a way where they can have a bit more information, increase confidence in one way or another to see if whatever it is that we're saying business [00:42:20] decision, if it's expanding to a new program or taking on a new teammate or, you know, anything of that sort.
[00:42:28] Markay: There are ways that we can reduce risk and in that standpoint, and that could be going and talking to other people about it to learn some more information. Maybe it's learning under the [00:42:40] wing and being paid for it by working for someone else for a while, like, you know, the former mentorship kind of apprenticeship models of that sort.
[00:42:50] Markay: But I don't know who said this. I think it was. It's one of the philosophers. It might've been like Nietzsche or something like that, that we often are living in cages. We've created [00:43:00] ourselves and that door is wide open.
[00:43:02] Libby: That's beautiful. I love that. Thank you for sharing that.
[00:43:05] Markay: welcome.
[00:43:06] Libby: Well, thank you so much. It's been an absolute pleasure, Markay, to have you. And could you just share for the listeners where they can find you? Of course, everything will be listed on the show notes on our website at dietitianboss. com. But if you want to let people know where they can contact you.[00:43:20]
[00:43:20] Markay: Absolutely. You're welcome to email me. My email is [email protected]. Multiple voices. So, [email protected]. The same website www.allvoicesnutrition.com or on the mynutriste site. It's www.mynutriste.com
[00:43:39] Libby: [00:43:40] amazing. It's been an absolute pleasure. Thank you.
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