Starting and scaling a private practice can feel overwhelming, especially in a rural region with limited resources. Brent Metcalf, a trauma therapist and group practice owner at Tri-Star Counseling, joins Michael Fulwiler to share how he built a thriving therapy business in Appalachia while staying true to his mission of expanding access to care.

Brent opens up about transitioning from social work to private practice, navigating financial uncertainty, and building a practice that reflects his values. He shares the strategies that helped him grow, from offering pro bono sessions during a natural disaster to hiring provisionally licensed therapists and negotiating with insurance companies.

Listen to hear how Brent balances business growth with community care, and why leading with heart can be a powerful strategy for therapists building something of their own.

In the conversation, they discuss:

• What it takes to launch a successful practice in a rural area
• How to grow from solo to group practice without burning out
• Ways to stay connected to your mission while running a business

Connect with the guest:

• Brent on LinkedIn: https://www.linkedin.com/in/brent-metcalf-028870272/ 
• Visit the Tri-Star Counseling website: https://tri-starcounseling.com/ 

Connect with Michael and Heard:

• Michael’s LinkedIn: https://www.linkedin.com/in/michaelfulwiler/ 
• Newsletter: https://www.joinheard.com/newsletter 
• Book a free consult: joinheard.com/consult 

Jump into the conversation:

(00:00) Welcome to Heard Business School

(01:36) Introducing Brent Metcalf

(03:01) Growing Up in Rural East Tennessee

(04:31) Small-Town Roots and Musket Bowl Tradition in High School

(05:06) From Ministry to Social Work

(06:11) Joining CPS and Getting Hooked on Fieldwork

(08:10) Choosing to Go Back to Graduate School

(08:52) Transitioning to Vanderbilt and Mental Health Consulting

(10:18) Starting a Therapy Practice Without Business Experience

(14:18) How a Financial Advisor Pushed Him to Go Full-Time

(17:33) Expanding from Part-Time Practice to Full-Time Mission

(18:52) The Importance of Therapy Access in Appalachia

(24:18) Building Trust in Resistant Communities

(30:35) Offering Free Therapy After a Natural Disaster

(34:02) Overcoming Fear of Hiring Employees

(37:17) Navigating Healthcare Crisis Without a Biller

(39:48) The Stress Group Owners Face Daily

(43:27) Negotiating Higher Insurance Reimbursement Rates

(48:15) Staying Connected to Your Why to Prevent Burnout

This episode is to be used for informational purposes only and does not constitute legal, business, or tax advice. Each person should consult their own attorney, business advisor, or tax advisor with respect to matters referenced in this episode.