WEBVTT 00:00:00.000 --> 00:00:02.870 When did you first think I need to do this on 00:00:02.870 --> 00:00:06.629 my own. What was that push to start at your service 00:00:06.629 --> 00:00:08.789 psychiatry, would you say? I knew that I went 00:00:08.789 --> 00:00:10.890 back to school to not be an employee anymore. 00:00:10.949 --> 00:00:13.189 I went back to nurse practitioner school. I knew 00:00:13.189 --> 00:00:16.289 I was not cut out for being working for someone. 00:00:16.449 --> 00:00:20.269 I started learning about API and all the software 00:00:20.269 --> 00:00:22.789 stuff. When was your like biggest burnout period, 00:00:22.789 --> 00:00:25.969 would you say? I had a very public meltdown in 00:00:25.969 --> 00:00:30.489 the inpatient in front of many people, two of 00:00:30.489 --> 00:00:33.539 whom were my later so they didn't judge me too 00:00:33.539 --> 00:00:36.119 harshly. I do have to tell myself you get 30 00:00:36.119 --> 00:00:38.039 minutes and then you have to put this down and 00:00:38.039 --> 00:00:41.000 I go over everything and I obsess for a while. 00:00:41.159 --> 00:00:43.539 You know I don't like following rules so I think 00:00:43.539 --> 00:00:48.899 it's... Everyone say you can't do that. A girl 00:00:48.899 --> 00:00:51.619 can't start a health tech company and even if 00:00:51.619 --> 00:00:55.399 it is just seeing patients you're caring for 00:00:55.399 --> 00:01:00.020 hundreds of people. Hi, everyone. Welcome to 00:01:00.020 --> 00:01:02.380 No Prior Off, the podcast where we celebrate 00:01:02.380 --> 00:01:05.040 psychiatric NPs who didn't wait for permission 00:01:05.040 --> 00:01:07.579 to build something extraordinary. I'm Lindsay 00:01:07.579 --> 00:01:09.599 Hill, and today's guest is someone who didn't 00:01:09.599 --> 00:01:12.180 just start her own practice. She saw a broken 00:01:12.180 --> 00:01:14.799 system and decided to fix it. Alison Sikorski 00:01:14.799 --> 00:01:17.420 is a board -certified psychiatric mental health 00:01:17.420 --> 00:01:20.159 nurse practitioner with over 30 years in healthcare. 00:01:20.879 --> 00:01:23.900 She built at -your -service psychiatry into a 00:01:23.900 --> 00:01:26.790 multi -state telepsychiatry practice, and then, 00:01:27.069 --> 00:01:28.769 because apparently running a practice across 00:01:28.769 --> 00:01:31.730 20 states wasn't enough, she founded PMH Scribe, 00:01:31.969 --> 00:01:35.170 an AI -powered documentation tool built by a 00:01:35.170 --> 00:01:38.469 psych NP for psych NP's. And here's the thing 00:01:38.469 --> 00:01:41.709 I love. PMH Scribe literally has a built -in 00:01:41.790 --> 00:01:44.989 Prior Authorization Tool. So if anyone understands 00:01:44.989 --> 00:01:47.569 why this podcast is called No Prior Auth, it's 00:01:47.569 --> 00:01:50.310 Alison. Today, she's going to walk us through 00:01:50.310 --> 00:01:52.730 her journey from the bedside to building health 00:01:52.730 --> 00:01:54.870 tech and what drove her to create a tool she 00:01:54.870 --> 00:01:57.810 couldn't find anywhere on the market. Also what 00:01:57.810 --> 00:02:00.549 she would tell every NP who's been up till midnight 00:02:00.549 --> 00:02:03.230 finishing charts. So let's get into it. Thanks 00:02:03.230 --> 00:02:04.650 for being here, Alison. Thank you for that nice 00:02:04.650 --> 00:02:08.150 introduction. Wow. Thank you. I'm honored. We 00:02:08.150 --> 00:02:11.129 are honored that you're our first guest. Okay. 00:02:11.310 --> 00:02:15.629 So you've been in healthcare for over 30 years, 00:02:15.930 --> 00:02:18.169 starting as a pharmacy tech. Take me back to 00:02:18.169 --> 00:02:20.310 that moment you realized you wanted to become 00:02:20.310 --> 00:02:23.270 a psychiatric nurse practitioner. I did not start 00:02:23.270 --> 00:02:26.349 there. I was, I will say my first job, I was 00:02:26.349 --> 00:02:29.750 16. So that's my journey. That's when I started 00:02:29.750 --> 00:02:33.710 as a pharmacy technician and started learning 00:02:33.710 --> 00:02:36.590 a little bit about medications and calls into 00:02:36.590 --> 00:02:39.800 the pharmacy and things like that. And then After 00:02:39.800 --> 00:02:41.939 that, I knew I wanted to go to nursing school. 00:02:42.099 --> 00:02:45.219 I didn't quite know what I wanted to do and worked 00:02:45.219 --> 00:02:49.939 at an apartment complex for adults with physical 00:02:49.939 --> 00:02:54.759 disabilities and built a team of unlicensed assisted 00:02:54.759 --> 00:02:56.879 personnel there that did a lot of health care, 00:02:57.000 --> 00:02:59.419 but they also were not nursing assistants or 00:02:59.419 --> 00:03:02.479 anything like that and did a lot of the staffing 00:03:02.479 --> 00:03:06.289 and fundraising and working with state. billing 00:03:06.289 --> 00:03:08.729 and things like that and then became a nurse 00:03:08.729 --> 00:03:14.169 in 1999 and At the time my father was ill so 00:03:14.169 --> 00:03:18.150 I wanted a terminally ill so I wanted a job that 00:03:18.150 --> 00:03:21.129 I Could have my nights and weekends and holidays 00:03:21.129 --> 00:03:23.889 off. So I went right into an office. I did not 00:03:23.889 --> 00:03:27.849 do bedside I went right to soft nursing and Went 00:03:27.849 --> 00:03:32.280 into internal medicine in an office where I was 00:03:32.280 --> 00:03:35.960 very much the youngest person there in my early 00:03:35.960 --> 00:03:38.840 20s and quickly became the clinical coordinator, 00:03:39.439 --> 00:03:42.840 building the team of clinicians there, staffing 00:03:42.840 --> 00:03:46.400 with physicians and APPs and we had a laboratory 00:03:46.400 --> 00:03:48.879 and we put a pharmacy in there and we brought 00:03:48.879 --> 00:03:52.180 in some alternative treatment like a chiropractor 00:03:52.180 --> 00:03:55.460 and integrated that into the system and then 00:03:55.460 --> 00:04:00.400 did a concierge branch off of that and how that 00:04:00.400 --> 00:04:04.039 all worked in 2001, I was often brought in to 00:04:04.039 --> 00:04:08.319 maximize billing and coding and to clean up after 00:04:08.319 --> 00:04:11.900 an audit and figure out the national coverage 00:04:11.900 --> 00:04:14.759 determines all kinds of fun projects I had back 00:04:14.759 --> 00:04:17.439 then and fix up the after hours coverage and 00:04:17.439 --> 00:04:20.279 things. And after my father passed, I became 00:04:20.279 --> 00:04:22.740 a hospice nurse for a bit and I did a bit of 00:04:22.740 --> 00:04:26.740 bedside. And then I had been looking at what 00:04:26.740 --> 00:04:30.180 degree I wanted, I wasn't Thrilled about nursing 00:04:30.180 --> 00:04:33.639 at the time. It was okay. It was good, but I 00:04:33.639 --> 00:04:36.420 don't like blood and guts I'm not a say I'm a 00:04:36.420 --> 00:04:39.519 chat kind of person so it just didn't suit me 00:04:39.519 --> 00:04:43.040 as well and I was looking into going into counseling 00:04:43.040 --> 00:04:47.730 or something like that and It just didn't financially 00:04:47.730 --> 00:04:50.129 make a lot of sense. And then I was looking into 00:04:50.129 --> 00:04:52.730 psychology and then haphazardly someone said, 00:04:52.930 --> 00:04:55.550 Well, why wouldn't you do psychiatric nurse practitioner? 00:04:56.129 --> 00:04:58.329 And I had never heard of it. None of my nursing 00:04:58.329 --> 00:05:00.209 instructors, I had called them, asked them what 00:05:00.209 --> 00:05:03.970 to do. And I looked it up and ran home that day 00:05:03.970 --> 00:05:06.290 and told my husband, I'm quitting my job and 00:05:06.290 --> 00:05:08.509 going to school right now. I need to do this. 00:05:08.529 --> 00:05:11.670 And it didn't happen that fast. But it was I 00:05:11.670 --> 00:05:15.089 need to stop everything I'm doing and go to the 00:05:15.089 --> 00:05:19.350 psych NP school. And so I signed up at Rush University 00:05:19.350 --> 00:05:21.569 at the time it was the top one in the nation. 00:05:22.189 --> 00:05:24.730 One of the first founding ones, they did not 00:05:24.730 --> 00:05:26.870 like my soft nursing. So they made me go back 00:05:26.870 --> 00:05:29.850 and get some bedside nursing experience. So I 00:05:29.850 --> 00:05:34.329 had been a nurse since 99 and I had gotten in 00:05:34.329 --> 00:05:36.649 the interim a bachelor's in behavioral science 00:05:36.649 --> 00:05:39.750 because it was half psychology, half business, 00:05:39.829 --> 00:05:43.110 and team leadership, and that fit me well. And 00:05:43.110 --> 00:05:46.589 so though I had done a lot of volunteerism in 00:05:46.589 --> 00:05:48.589 high school at a community mental health center, 00:05:48.649 --> 00:05:50.670 and I had been a hospice nurse with a lot of 00:05:50.670 --> 00:05:54.029 grief therapy and pharmacy and all that, and 00:05:54.029 --> 00:05:56.790 managing an outpatient office and such, they 00:05:56.790 --> 00:05:59.209 didn't feel it was the nursing experience I needed. 00:06:00.759 --> 00:06:03.839 I had to go get some bedside nursing experience. 00:06:04.019 --> 00:06:06.279 I went into geriatric psychiatry. I thought it'd 00:06:06.279 --> 00:06:09.660 be close to hospice nursing. It was not. And 00:06:09.660 --> 00:06:12.759 it was a very wild time. It was a wild floor. 00:06:13.180 --> 00:06:15.740 It was all of the local geriatric psychiatric 00:06:15.740 --> 00:06:17.920 units. When they couldn't handle the patients, 00:06:18.000 --> 00:06:22.459 they transferred them to Rush. And so for context, 00:06:22.660 --> 00:06:25.480 the nursing ratio is one to two. So we had two 00:06:25.480 --> 00:06:27.879 at the max patients because it was so highly 00:06:27.879 --> 00:06:31.629 acute. So I did that for a while and that was 00:06:31.629 --> 00:06:35.449 terrible and then I was having babies at the 00:06:35.449 --> 00:06:38.029 time and I was going to school and I had three 00:06:38.029 --> 00:06:41.750 babies in three and a half years and I got a 00:06:41.750 --> 00:06:44.589 bit burnt out and said I just can't do school 00:06:44.589 --> 00:06:48.050 and everything and work in this unit and all 00:06:48.050 --> 00:06:52.089 of that so I ended up quitting for a while and 00:06:52.089 --> 00:06:56.069 then Just went back to hospice, but more management. 00:06:56.350 --> 00:06:58.329 I did weekend team leader. I built the after 00:06:58.329 --> 00:07:02.670 hours team We went from 1 to 35 within a year 00:07:02.670 --> 00:07:05.889 building that team and front loading all of our 00:07:05.889 --> 00:07:08.569 home health and hospice Staff on the weekends 00:07:08.569 --> 00:07:11.449 and nights when it made more sense to do a lot 00:07:11.449 --> 00:07:14.399 of those intakes. So we built this whole after 00:07:14.399 --> 00:07:17.959 hours on call triage telephone triage system 00:07:17.959 --> 00:07:20.939 and sending people out we covered about eight 00:07:20.939 --> 00:07:24.980 counties so back then we were faxing people other 00:07:24.980 --> 00:07:27.459 things and we had all this cool remote work but 00:07:27.459 --> 00:07:30.939 it was back in the day we were printing up map 00:07:30.939 --> 00:07:33.779 quest directions and faxing it to their paper 00:07:33.779 --> 00:07:37.420 faxes at home on their beepers it was it was 00:07:37.420 --> 00:07:41.199 wild so i did that for a while and then my heart 00:07:41.199 --> 00:07:44.790 hurt that i wasn't a psych NP. Of course, I went 00:07:44.790 --> 00:07:48.170 back to school and graduated. By then it was 00:07:48.170 --> 00:07:51.949 2011. So it was quite the journey to get there. 00:07:52.189 --> 00:07:56.490 Wow. What was your experience like at Rush? And 00:07:56.490 --> 00:07:59.009 how did that shape the clinician that you are 00:07:59.009 --> 00:08:05.069 today? I had a lot of rigorous as I said, they 00:08:05.069 --> 00:08:07.069 made me go back and get some bedside. They said, 00:08:07.170 --> 00:08:09.790 don't come back until you have at least six months 00:08:09.790 --> 00:08:13.529 under your belt. Don't apply. I also didn't have 00:08:13.529 --> 00:08:16.889 the best registered nurse grades, so I had to 00:08:16.889 --> 00:08:19.970 really push myself into Rush and say, I will 00:08:19.970 --> 00:08:23.509 get the good grades. I was a kid. My dad was 00:08:23.509 --> 00:08:25.810 dying, like all of the things and working full 00:08:25.810 --> 00:08:28.810 time. And yeah, I got seasoned my nursing degree, 00:08:28.870 --> 00:08:31.389 but I will be the top of my class here. So I 00:08:31.389 --> 00:08:34.950 pushed and pushed and was, but it was an interesting 00:08:34.950 --> 00:08:38.990 time. Back then we had to interview to get matched 00:08:38.990 --> 00:08:43.340 into a system that would take us on. I had a 00:08:43.340 --> 00:08:46.440 community mental health provider who was amazing, 00:08:46.700 --> 00:08:51.100 took me on into a facility. So back then we stayed 00:08:51.100 --> 00:08:53.600 in the same place. So we got to manage the same 00:08:53.600 --> 00:08:56.940 patients for over a year and have our own patient 00:08:56.940 --> 00:09:00.299 panel. And they really plugged me in there so 00:09:00.299 --> 00:09:03.039 I could learn all about the billing and the fundraising 00:09:03.039 --> 00:09:06.120 and state funds and how to balance it in a community 00:09:06.120 --> 00:09:08.580 mental health center. We had a capstone back 00:09:08.580 --> 00:09:12.980 then so we Mine was on cardiometabolic monitoring 00:09:12.980 --> 00:09:17.659 of seriously mentally ill patients on atypical 00:09:17.659 --> 00:09:20.299 antipsychotics. So we did chart reviews and then 00:09:20.299 --> 00:09:23.500 trying to get like a blood pressure station so 00:09:23.500 --> 00:09:25.679 they could learn self -efficacy and then the 00:09:25.679 --> 00:09:28.379 fundraising for that. So it was a really long 00:09:28.379 --> 00:09:31.399 capstone process, which was fun and cool and 00:09:31.399 --> 00:09:34.399 rigorous. And we got to do some inpatient work. 00:09:35.590 --> 00:09:38.590 all the different run groups and run individual 00:09:38.590 --> 00:09:41.129 therapy and then have our own caseload. So it 00:09:41.129 --> 00:09:44.269 was a really amazing experience. That sounds 00:09:44.269 --> 00:09:47.570 incredible. It was. It was a very high quality 00:09:47.570 --> 00:09:52.570 experience. It was good. When did you first think, 00:09:52.570 --> 00:09:56.590 I need to do this on my own? Like, what was that 00:09:56.590 --> 00:09:59.549 push to start at your service psychiatry, would 00:09:59.549 --> 00:10:02.529 you say? I knew that I went back to school to 00:10:02.529 --> 00:10:04.610 not be an employee anymore. I went back to nurse 00:10:04.610 --> 00:10:07.289 practitioner school. I knew I was not cut out 00:10:07.289 --> 00:10:10.529 for being working for someone. So I initially 00:10:10.529 --> 00:10:13.450 went and wanted to learn all the things about 00:10:13.450 --> 00:10:15.870 psychiatry. So I went to a practice where as 00:10:15.870 --> 00:10:18.799 self -employed contractor. that could plug me 00:10:18.799 --> 00:10:22.200 into outpatient, do inpatient rounds, partial 00:10:22.200 --> 00:10:25.279 hospitalization rounds, long -term care. I still 00:10:25.279 --> 00:10:28.799 wanted the gerosike and hospital consultant liaison 00:10:28.799 --> 00:10:31.340 for a few hospitals. So I knew this place could 00:10:31.340 --> 00:10:33.840 get me into all those places. A lot of times 00:10:33.840 --> 00:10:36.720 I got to be the first nurse practitioner in a 00:10:36.720 --> 00:10:40.740 hospital system, which was Strange and fun also 00:10:40.740 --> 00:10:44.700 going and trying to explain our role to a panel 00:10:44.700 --> 00:10:47.100 of people who weren't thrilled to have us there 00:10:47.100 --> 00:10:50.120 and talking myself into getting into the facility. 00:10:50.779 --> 00:10:55.179 So I had been doing that about seven years and 00:10:55.179 --> 00:10:57.759 even before that thought about telehealth and 00:10:57.759 --> 00:11:00.220 concierge and could I do this? I came up with 00:11:00.220 --> 00:11:02.580 the name in 2013. So I had only been practicing 00:11:02.580 --> 00:11:04.679 a couple of years, but I just kept putting it 00:11:04.679 --> 00:11:08.059 off because felt like I needed to see everything 00:11:08.059 --> 00:11:12.940 in psychiatry and I did not but I saw all but 00:11:12.940 --> 00:11:15.320 what I felt like it was all of the things and 00:11:15.320 --> 00:11:20.639 then around 2017 I Decided I wanted to keep my 00:11:20.639 --> 00:11:22.960 insurance practice I thought at the time and 00:11:22.960 --> 00:11:26.580 then have this little side gig where I would 00:11:26.580 --> 00:11:30.919 see go to other places Illinois had dropped the 00:11:30.919 --> 00:11:33.519 ball on full practice authority they didn't we 00:11:33.519 --> 00:11:35.840 just couldn't get it to go through and it that 00:11:35.840 --> 00:11:38.360 went through and it was still limited and I still 00:11:38.360 --> 00:11:41.000 needed a physician collaborator for if I ever 00:11:41.000 --> 00:11:44.440 prescribed a benzo and I we had all been fighting 00:11:44.440 --> 00:11:47.480 so hard like going to the Capitol and and talking 00:11:47.480 --> 00:11:51.519 to legislators that I just became very frustrated 00:11:51.519 --> 00:11:55.149 and signed up for all the full practice authority 00:11:55.149 --> 00:11:56.929 states. I said, that's enough. I'm just going 00:11:56.929 --> 00:12:00.330 to go and I'm going to spread my net wide because 00:12:00.330 --> 00:12:02.889 telehealth was not a thing that everyone was 00:12:02.889 --> 00:12:05.610 doing back then. So like, well, I'll just have 00:12:05.610 --> 00:12:09.169 patients throughout the different states. That 00:12:09.169 --> 00:12:11.789 also was intentional to not mess with my Illinois 00:12:11.789 --> 00:12:14.649 insurance contracts or Medicaid contracts. So 00:12:14.649 --> 00:12:17.740 I wasn't. some of them specified you can't be 00:12:17.740 --> 00:12:19.559 charging out a network and things like that. 00:12:19.679 --> 00:12:21.299 And I said, well, if I'm not even in Illinois, 00:12:21.440 --> 00:12:23.159 it's not going to mess with my contracts. It 00:12:23.159 --> 00:12:26.700 won't mess with my non -compete. And so I started 00:12:26.700 --> 00:12:29.559 applying and then looking at the rules. And back 00:12:29.559 --> 00:12:31.980 then nothing was in a concise place. Like now 00:12:31.980 --> 00:12:33.899 we have the Center for Connected Health and you 00:12:33.899 --> 00:12:36.320 could just look it up and you have all the backlinks. 00:12:36.779 --> 00:12:39.379 And back then I had to get a lawyer to do a lot 00:12:39.379 --> 00:12:43.889 of that research for me and figure out I figured 00:12:43.889 --> 00:12:46.450 out which states were independent, but then which 00:12:46.450 --> 00:12:48.389 ones had good telehealth rules. The rules were 00:12:48.389 --> 00:12:52.809 very different in 2017 and then started. I had 00:12:52.809 --> 00:12:55.490 this vision of how patients would come to see 00:12:55.490 --> 00:12:58.730 me. They would find me online. I already knew 00:12:58.730 --> 00:13:01.870 I'd been eight years in, in a outpatient practice 00:13:01.870 --> 00:13:04.090 that what the pain points were. And I said, I 00:13:04.090 --> 00:13:05.850 don't want them having to call the office. I 00:13:05.850 --> 00:13:08.690 don't want them filling out these big packets 00:13:08.690 --> 00:13:10.769 and waiting for a call back. And I don't want 00:13:10.769 --> 00:13:13.750 to hire. just a staff member for its scheduling 00:13:13.750 --> 00:13:15.929 and then another one for a prior office and then 00:13:15.929 --> 00:13:19.610 another one for this and all that. So I did the 00:13:19.610 --> 00:13:22.210 self scheduling and how to kind of make sure 00:13:22.210 --> 00:13:25.610 that the correct patient to come on that it wasn't 00:13:25.610 --> 00:13:27.909 drug seeking, but it was people who wanted care 00:13:27.909 --> 00:13:30.490 and that they were the right fit, but in a digital 00:13:30.490 --> 00:13:33.610 way without having any touch points of a person. 00:13:34.330 --> 00:13:37.019 So kind of built. found I couldn't find any HR 00:13:37.019 --> 00:13:39.779 for it. I kept looking, I did 50 demos, I did 00:13:39.779 --> 00:13:44.580 150 more other ones looking at them. And I couldn't 00:13:44.580 --> 00:13:46.940 find it. So I had to build my own system. And 00:13:46.940 --> 00:13:49.659 that's where I started getting excited with technology. 00:13:49.759 --> 00:13:53.820 I was like, wait, what is this? Oh, this is really 00:13:53.820 --> 00:13:58.419 cool. Like, I started learning about API and 00:13:58.419 --> 00:14:02.269 all the software stuff and really just had so 00:14:02.269 --> 00:14:05.269 much fun with it. So I spent about six months 00:14:05.269 --> 00:14:07.669 looking at different systems, building it out. 00:14:07.789 --> 00:14:10.769 Back then, again, we didn't have all of the places 00:14:10.769 --> 00:14:14.330 I demoed. All I need is the patient to see the 00:14:14.330 --> 00:14:16.750 availability first, so they can decide if they 00:14:16.750 --> 00:14:19.409 want to wait or not, and then get through the 00:14:19.409 --> 00:14:22.309 consents, and they want a brief, and I want them 00:14:22.309 --> 00:14:25.049 consistent with what I would need. Like, we don't 00:14:25.049 --> 00:14:27.649 prescribe this, but we do this. Are you okay? 00:14:27.929 --> 00:14:31.210 And then pay to secure the visit. And that flow 00:14:31.210 --> 00:14:33.570 didn't exist back then. So I had to build that 00:14:33.570 --> 00:14:36.850 out. None of them. They all said you have a unique 00:14:36.850 --> 00:14:40.230 use case. And so I said, OK, I'll just build 00:14:40.230 --> 00:14:43.029 it. I feel like you were always like ahead of 00:14:43.029 --> 00:14:46.309 your time. It feels like when I hear about all 00:14:46.309 --> 00:14:48.570 the different things you were doing early on, 00:14:48.750 --> 00:14:52.450 like even doing telehealth, like before it was 00:14:52.450 --> 00:14:55.649 mainstream. Did you see somebody else doing that 00:14:55.649 --> 00:14:59.370 or like what made you kind of go all in on telepsychiatry? 00:15:00.330 --> 00:15:03.669 I did call, or no, I Facebook messaged someone, 00:15:03.990 --> 00:15:06.230 and for the life of me, I don't even remember 00:15:06.230 --> 00:15:08.809 who it was. It was this lovely lady, and I said, 00:15:09.190 --> 00:15:12.309 I wanna do concierge, and I wanna do telehealth. 00:15:12.429 --> 00:15:15.269 Can it be done? She said, yes, I do that. And 00:15:15.269 --> 00:15:17.049 I said, how long have you done it? I've been 00:15:17.049 --> 00:15:19.409 doing it for three years. And I said, that's 00:15:19.409 --> 00:15:22.029 all I needed. Thank you. I just needed to hear 00:15:22.029 --> 00:15:25.009 you could do it, and that it was okay. And then 00:15:25.009 --> 00:15:29.799 I was in... the office and my colleague was attacked 00:15:29.799 --> 00:15:35.519 and stabbed by a patient and that shook me more 00:15:35.519 --> 00:15:38.860 than it probably even shook her. She was a trooper 00:15:38.860 --> 00:15:42.580 and went back to work within three days but I 00:15:42.580 --> 00:15:45.759 was rattled and I had been through inpatient 00:15:45.759 --> 00:15:49.159 and I always rounded with a guard and I had done 00:15:49.159 --> 00:15:52.120 hospital CL and you have to take all the precautions 00:15:52.120 --> 00:15:55.929 and I didn't want to And I started taking Krav 00:15:55.929 --> 00:15:58.450 Maga and doing things to protect myself. And 00:15:58.450 --> 00:16:01.029 then it just clicked that if I was telehealth, 00:16:01.070 --> 00:16:04.950 I wouldn't be exposed to the violence and I won't 00:16:04.950 --> 00:16:08.350 go back in person. And so at that moment, when 00:16:08.350 --> 00:16:11.830 that happened, I, it kind of clicked that I'm 00:16:11.830 --> 00:16:14.110 just going to do all telehealth from now on. 00:16:14.370 --> 00:16:18.070 And it again wasn't instantaneous, but it was, 00:16:18.269 --> 00:16:22.279 I'm not going in person anymore. And then At 00:16:22.279 --> 00:16:26.220 the same time, I had already been doing a little 00:16:26.220 --> 00:16:29.379 telehealth, but I got the idea for online ADHD 00:16:29.379 --> 00:16:33.720 care where I could pre -screen someone, see them 00:16:33.720 --> 00:16:37.980 in person one time, and then we could just forever 00:16:37.980 --> 00:16:41.039 be telehealth, and that would be great. I love 00:16:41.039 --> 00:16:44.259 my ADHD population. I had already been just seeing, 00:16:44.899 --> 00:16:46.960 when I had regular outpatient psych, I would 00:16:46.960 --> 00:16:50.789 just do ADHD on Saturdays. It was like, we're 00:16:50.789 --> 00:16:53.269 just talking and everyone's quick and we're like 00:16:53.269 --> 00:16:56.309 having fun. And I was like, what if I did that 00:16:56.309 --> 00:16:59.830 all the time? So that's where I specialized in 00:16:59.830 --> 00:17:02.730 ADHD. We had a little system for an in -person. 00:17:02.870 --> 00:17:07.009 And then right away I called up a girlfriend 00:17:07.009 --> 00:17:08.430 at Raj and I'm like, what are you doing? You 00:17:08.430 --> 00:17:10.049 want to do telehealth with me? Where do you live 00:17:10.049 --> 00:17:13.109 right now? And so I added her right away. And 00:17:13.109 --> 00:17:18.500 so we had a system where we had some other locations 00:17:18.500 --> 00:17:20.819 where someone could be seen in person one time 00:17:20.819 --> 00:17:24.259 and then transfer them to telehealth. That was 00:17:24.259 --> 00:17:27.339 a little known kind of loophole back then was 00:17:27.339 --> 00:17:30.779 there was a few ways of getting that one time 00:17:30.779 --> 00:17:33.380 in person visit and was the in person visit even 00:17:33.380 --> 00:17:35.500 needed and there wasn't a lot of drama around 00:17:35.500 --> 00:17:40.519 ADHD. So it was that you could have a live visit 00:17:40.519 --> 00:17:43.279 like we're doing right now with the patient. 00:17:43.500 --> 00:17:45.859 So one, two, three, you're sitting with the patient 00:17:45.859 --> 00:17:49.700 in another state. You're the DEA registered primary 00:17:49.700 --> 00:17:52.579 care provider. I'm the telehealth and you can 00:17:52.579 --> 00:17:55.240 do a pass off with all the contracts and things 00:17:55.240 --> 00:17:59.059 like that in place. So at the time, I can't recall 00:17:59.059 --> 00:18:03.089 anyone else doing. ADHD care that way. And then 00:18:03.089 --> 00:18:06.490 COVID hit and a lot of my friends in the field 00:18:06.490 --> 00:18:08.690 said, you know, I need to figure out this telehealth. 00:18:08.849 --> 00:18:11.349 A good friend of mine said she was taking care 00:18:11.349 --> 00:18:13.549 of her husband who had a physical disability. 00:18:13.549 --> 00:18:15.450 And she said, I can't be going in the hospital 00:18:15.450 --> 00:18:17.970 and bring this disease home to them. And I can't 00:18:17.970 --> 00:18:20.269 get caregivers in the house anymore. Can you 00:18:20.269 --> 00:18:22.190 teach me how to do telehealth? I went just join 00:18:22.190 --> 00:18:25.369 me, it'll be fun. And so she joined me and then 00:18:25.369 --> 00:18:28.710 a few others joined the group. And then we also 00:18:28.710 --> 00:18:31.730 had before any of the waivers, then we had a 00:18:31.730 --> 00:18:34.650 few offices throughout the different states that 00:18:34.650 --> 00:18:36.950 they had a little practice here or there, maybe 00:18:36.950 --> 00:18:40.049 were struggling to get it going, or they had 00:18:40.049 --> 00:18:42.089 a location where they'd see someone one time 00:18:42.089 --> 00:18:44.609 in person, then convert them to telehealth. And 00:18:44.609 --> 00:18:47.309 then the waivers went through and then we then 00:18:47.309 --> 00:18:50.650 no one knew how to do telehealth back then. So 00:18:50.650 --> 00:18:54.089 there's a big surge, especially ADHD. No one 00:18:54.089 --> 00:18:55.730 knew if they could do it or not, we had already 00:18:55.730 --> 00:18:58.390 been doing it for years. So it was a natural 00:18:58.390 --> 00:19:03.039 progression. to do that. And then then some bad 00:19:03.039 --> 00:19:07.079 actors came in after and kind of started up ADHD 00:19:07.079 --> 00:19:10.339 focused, but their focus was opposite instead 00:19:10.339 --> 00:19:13.240 of us looking to make sure they had ADHD. And 00:19:13.240 --> 00:19:15.980 if not, okay, we're going to treat your bipolarism 00:19:15.980 --> 00:19:18.599 or we're going to treat your other things. Other 00:19:18.599 --> 00:19:22.680 companies seem to be convincing people they had 00:19:22.680 --> 00:19:27.539 ADHD or not, or starting them on medicine for 00:19:27.769 --> 00:19:31.470 Maybe nefarious reasons are not for good reasons 00:19:31.470 --> 00:19:34.690 and then not having a system if it went bad And 00:19:34.690 --> 00:19:37.670 we had already had years of a system if it went 00:19:37.670 --> 00:19:41.809 bad what to do next. Yeah Wow, that's interesting. 00:19:42.349 --> 00:19:45.809 Did you have a lot of naysayers or like skeptics 00:19:45.809 --> 00:19:50.069 that were like kind of? Instilling fear in you 00:19:50.069 --> 00:19:55.029 or trying to trying to let them but at my old 00:19:55.029 --> 00:19:57.450 practice I was balancing both I had this insurance 00:19:57.450 --> 00:20:00.109 practice I had this telehealth practice for a 00:20:00.109 --> 00:20:02.670 while I was overlapping especially building up 00:20:02.670 --> 00:20:06.049 a direct -to -consumer model where there's no 00:20:06.049 --> 00:20:08.789 insurance you don't you have to do a lot of marketing 00:20:08.789 --> 00:20:11.819 and a lot of networking so I just assumed I would 00:20:11.819 --> 00:20:14.960 have both all the time until COVID hit, then 00:20:14.960 --> 00:20:16.759 I couldn't manage them both because the other 00:20:16.759 --> 00:20:18.759 one blew up. But at the time, people are like, 00:20:18.799 --> 00:20:21.660 no one's gonna like telehealth. That's just for 00:20:21.660 --> 00:20:26.200 rural care. Like I was doing talks about this 00:20:26.200 --> 00:20:28.819 cool new thing called telehealth that's like 00:20:28.819 --> 00:20:33.039 can be used for the convenience factor and trying 00:20:33.039 --> 00:20:35.440 to explain to people what telehealth was and 00:20:35.440 --> 00:20:39.119 why it's so cool and why telepsychiatry is the 00:20:39.119 --> 00:20:41.779 perfect fit for it. Back then, a lot of clinics 00:20:41.779 --> 00:20:44.420 would not see someone on an atypical antipsychotic 00:20:44.420 --> 00:20:47.660 because they couldn't fathom how to do an abnormal 00:20:47.660 --> 00:20:50.039 involuntary movement scale or something like 00:20:50.039 --> 00:20:53.339 that. So I had a lot of naysayers there. I also 00:20:53.339 --> 00:20:57.299 had a surprising phenomenon that people were 00:20:57.299 --> 00:21:01.500 a bit aggressive about Not taking insurance like 00:21:01.500 --> 00:21:04.819 they they were really offended that someone would 00:21:04.819 --> 00:21:08.019 take on that model instead and there was a misconception 00:21:08.019 --> 00:21:12.339 that there was that concierge or direct -to -consumer 00:21:12.339 --> 00:21:15.539 model meant patients could come and order up 00:21:15.539 --> 00:21:20.240 drugs like of abuse and it was no that they don't 00:21:20.240 --> 00:21:23.980 even come in because they've been filtered out 00:21:23.980 --> 00:21:28.450 to not be Attempting to get drugs of abuse by 00:21:28.450 --> 00:21:31.470 paying direct to consumers. So that was a big 00:21:31.470 --> 00:21:35.710 stigma that I had to overcome. Yeah, absolutely. 00:21:36.329 --> 00:21:39.670 I feel like you're one of the few group practices 00:21:39.670 --> 00:21:42.970 I know that's direct to consumer. And that was 00:21:42.970 --> 00:21:45.210 kind of what always intrigued me when I first 00:21:45.210 --> 00:21:47.250 heard about what you were doing. I was like, 00:21:47.250 --> 00:21:51.670 that's very unique because I feel like I run 00:21:51.670 --> 00:21:54.190 into this all the time with my mentees where 00:21:54.380 --> 00:21:57.680 They're like, do I take insurance? How did you 00:21:57.680 --> 00:22:00.819 make that decision? Like, did you kind of I felt 00:22:00.819 --> 00:22:03.660 like taking insurance initially helped me understand 00:22:03.660 --> 00:22:06.039 how to navigate the health care system. No, I 00:22:06.039 --> 00:22:09.660 had been in the health care, navigating outpatient 00:22:09.660 --> 00:22:13.779 offices and such since 1999 and even Medicaid 00:22:13.779 --> 00:22:19.160 before that. So I knew I would go into the insurance 00:22:19.160 --> 00:22:23.329 world because I wanted to learn. acute psychiatry 00:22:23.329 --> 00:22:25.869 and all the different facets. You can't really 00:22:25.869 --> 00:22:28.009 work in a hospital and be direct -to -consumer, 00:22:28.069 --> 00:22:29.690 that kind of thing. And I wanted to have all 00:22:29.690 --> 00:22:33.369 the settings to be well -rounded. So for that 00:22:33.369 --> 00:22:35.450 reason, I always thought I would take insurance, 00:22:35.490 --> 00:22:38.809 but I had that concierge where they pay a subscription 00:22:38.809 --> 00:22:43.029 fee model or just direct -to -consumer pay in 00:22:43.029 --> 00:22:45.230 the back of my head because I had that exposure 00:22:45.230 --> 00:22:50.289 back in 2000 when we took a physician who had 00:22:50.569 --> 00:22:52.930 I think his clinic had two or three thousand 00:22:52.930 --> 00:22:55.150 at the time it was internal medicine and we brought 00:22:55.150 --> 00:22:57.450 it down to five hundred and turned them into 00:22:57.450 --> 00:23:01.789 concierge and and did that break off of the insurance 00:23:01.789 --> 00:23:06.289 process back then and so I had that in my mind 00:23:06.289 --> 00:23:09.250 and then knowing that psychiatrists about forty 00:23:09.250 --> 00:23:11.170 six percent of them are out of network don't 00:23:11.170 --> 00:23:15.960 take any insurance that it's The way our insurance 00:23:15.960 --> 00:23:18.660 is set up with separating mental health from 00:23:18.660 --> 00:23:22.319 medical and all of that. I knew psychiatry is 00:23:22.319 --> 00:23:25.500 a place where people often can do out of network. 00:23:26.160 --> 00:23:29.619 But if I also knew that it took would take a 00:23:29.619 --> 00:23:31.819 lot longer because I had to rebuild a panel. 00:23:32.039 --> 00:23:35.359 I didn't take my 880 people from my insurance 00:23:35.359 --> 00:23:38.759 panel over. I knew that would be a huge burden 00:23:38.759 --> 00:23:41.200 for them. And I wasn't even going to ask of that 00:23:41.200 --> 00:23:44.940 or anything. So I figured It would take me double 00:23:44.940 --> 00:23:47.579 the time to create an out -of -network panel. 00:23:48.900 --> 00:23:51.759 That's why I did two. But if I were a new grad, 00:23:52.900 --> 00:23:55.460 I would start out with insurance. You learn the 00:23:55.460 --> 00:23:58.140 ins and outs. You get it. You get filled right 00:23:58.140 --> 00:24:01.759 away. It doesn't take you two and a half years 00:24:01.759 --> 00:24:05.200 to get 300 patients. Yeah. And are you talking 00:24:05.200 --> 00:24:08.000 about in private practice or just like in general? 00:24:09.539 --> 00:24:13.380 I'd say in general but in in outpatient office 00:24:13.380 --> 00:24:16.160 or private practice. Yeah, I think it helps to 00:24:16.160 --> 00:24:19.900 understand the insurance. I also I think a lot 00:24:19.900 --> 00:24:23.200 of people are willing to pay out a network or 00:24:23.200 --> 00:24:26.059 want to because I have experience and they'll 00:24:26.059 --> 00:24:30.490 say I need an expert and They'll come, they'll 00:24:30.490 --> 00:24:33.130 say, okay, I need a second opinion. I also don't 00:24:33.130 --> 00:24:35.529 have a lot of things like if you're not keeping 00:24:35.529 --> 00:24:38.049 up and seeing me, I don't want to see you. If 00:24:38.049 --> 00:24:40.289 they're coming to me just for a second opinion, 00:24:40.730 --> 00:24:42.650 that's no problem. And then I've served them. 00:24:42.779 --> 00:24:45.960 one time and I'll be here if they want it or 00:24:45.960 --> 00:24:48.539 if they want a bridge person because we're in 00:24:48.539 --> 00:24:50.900 different states and they say, I gotta pop in. 00:24:51.140 --> 00:24:53.779 I move around every six months for my work. I 00:24:53.779 --> 00:24:55.940 say, okay, you're always with me. Just come back 00:24:55.940 --> 00:24:58.200 in when you move back into one of my states. 00:24:58.599 --> 00:25:03.460 That flexibility, so the things I knew people 00:25:03.460 --> 00:25:06.420 would pay out of network for, so flexibility, 00:25:08.799 --> 00:25:13.180 not having As some people calm boundaries I don't 00:25:13.180 --> 00:25:16.819 have a lot of rules other than I do have a lot 00:25:16.819 --> 00:25:18.940 of controlled medication rules before they come 00:25:18.940 --> 00:25:23.400 in but the ones who come in I'm flexible if if 00:25:23.400 --> 00:25:25.619 they change their appointment the last minute, 00:25:25.619 --> 00:25:28.259 okay, and they've already paid for it They just 00:25:28.259 --> 00:25:31.460 move it around I I don't fuss about some of the 00:25:31.460 --> 00:25:34.279 small things that get that you need to an insurance 00:25:34.279 --> 00:25:39.339 on a big big scale Right. How much did it? cost 00:25:39.339 --> 00:25:42.500 you do you remember roughly to kind of do your 00:25:42.500 --> 00:25:49.460 own thing? About $30 ,000. Okay, so I had a pretty 00:25:49.460 --> 00:25:54.920 big marketing budget. A lot of telehealth platforms 00:25:54.920 --> 00:25:59.140 out there to contend with. I was going in 30 00:25:59.140 --> 00:26:02.640 state or I think I applied to 25. I think I ended 00:26:02.640 --> 00:26:05.619 up with 22 or something around there. So there 00:26:05.619 --> 00:26:09.519 was that cost of the licensure which was typically 00:26:09.519 --> 00:26:13.420 about $1 ,000. It wasn't a huge cost, but there 00:26:13.420 --> 00:26:15.960 was a pretty big marketing cost. And how do I 00:26:15.960 --> 00:26:17.779 set up marketing when you don't have a Google 00:26:17.779 --> 00:26:21.900 My Business account and those things. But if 00:26:21.900 --> 00:26:24.359 someone is just starting telehealth in their 00:26:24.359 --> 00:26:26.720 state, they're not going to need a huge budget. 00:26:26.779 --> 00:26:28.759 And if they're not hiring a bunch of people right 00:26:28.759 --> 00:26:33.359 away. And I brought on staff day one because 00:26:33.359 --> 00:26:37.440 I wanted to build this into kind of an enterprise 00:26:37.440 --> 00:26:41.009 where nurse practitioners could join. Right. 00:26:41.210 --> 00:26:44.829 Yeah, I know that makes sense. So there's a misconception 00:26:44.829 --> 00:26:47.950 that tools like PMH scribe are only for cash 00:26:47.950 --> 00:26:50.710 pay practices. Can you talk about how you specifically 00:26:50.710 --> 00:26:53.730 designed the templates for insurance billing 00:26:53.730 --> 00:26:56.890 and audit readiness and whatnot? Yes. When I 00:26:56.890 --> 00:26:59.569 was in the insurance world, I was audited quite 00:26:59.569 --> 00:27:03.309 a bit. I was told I was a high numbers provider. 00:27:04.130 --> 00:27:07.769 So received audits more is what The reason UBH 00:27:07.769 --> 00:27:10.430 gave me to audit me every year, I saw about 100 00:27:10.430 --> 00:27:13.190 people a week. And so it might've looked different 00:27:13.190 --> 00:27:17.170 to insurers because I'd be in a PHP in the morning 00:27:17.170 --> 00:27:19.630 and like the place of service is changing all 00:27:19.630 --> 00:27:23.309 the time. And I would do Saturday rounds at a 00:27:23.309 --> 00:27:26.069 hospital. So that's 20 people right there. So 00:27:26.069 --> 00:27:29.009 I was audited at least every year, if not a couple 00:27:29.009 --> 00:27:31.470 of times a year that I was in the insurance world 00:27:31.470 --> 00:27:36.069 for eight years. So really built it. based on 00:27:36.069 --> 00:27:40.710 how the auditors, knowing that they are not always 00:27:40.710 --> 00:27:43.329 medical people, they don't always have a degree 00:27:43.329 --> 00:27:46.450 in it, they have the checklist that they would 00:27:46.450 --> 00:27:49.150 just go down and they would be looking for particular 00:27:49.150 --> 00:27:51.750 words. And now with AI doing that, and a lot 00:27:51.750 --> 00:27:54.450 of these audits, setting it up for the words 00:27:54.450 --> 00:27:58.329 that they look for. So every year since 1999, 00:27:58.329 --> 00:28:02.549 I would get the CPT, AMA CPT book, and I would 00:28:02.549 --> 00:28:05.440 pour through it, see the changes, and adjust 00:28:05.440 --> 00:28:08.200 the templates to really capture every word that 00:28:08.200 --> 00:28:11.859 they're looking for. So yeah, I have I probably 00:28:11.859 --> 00:28:19.440 even have it in here. Like there's a book with 00:28:19.440 --> 00:28:24.940 tabs every year that I go through and get all 00:28:24.940 --> 00:28:27.680 of the new billing codes, everything. Oh, here's 00:28:27.680 --> 00:28:29.900 the twenty six. Twenty twenty six had a lot of 00:28:29.900 --> 00:28:33.059 codes for us. So get all of the codes that we 00:28:33.059 --> 00:28:37.839 could ever build. I also was always into maximizing 00:28:37.839 --> 00:28:40.740 collections for outpatient practices in internal 00:28:40.740 --> 00:28:44.460 medicine labs and home health and all of those. 00:28:45.119 --> 00:28:48.000 And then psychiatry, when I was billing on my 00:28:48.000 --> 00:28:51.140 own, I was out. So I would always set up the 00:28:51.140 --> 00:28:54.380 templates to follow along all the new parameters, 00:28:54.799 --> 00:28:57.140 every new checklist that they're looking for. 00:28:57.980 --> 00:29:00.720 and spell it out the way the auditors, they take 00:29:00.720 --> 00:29:03.160 their sheet and they go down. It's probably not 00:29:03.160 --> 00:29:06.680 a sheet anymore, but they take their audit tabs 00:29:06.680 --> 00:29:09.200 or the AI is programmed to look for these things. 00:29:09.460 --> 00:29:12.759 So really doing it in a manner that captures 00:29:12.759 --> 00:29:17.809 what they're looking for and making it. Should 00:29:17.809 --> 00:29:20.250 I say dummy proof make it try to make it real 00:29:20.250 --> 00:29:23.589 dummy like spell out the words they use for example 00:29:23.589 --> 00:29:27.269 the psychotherapy add -on is is it separate and 00:29:27.269 --> 00:29:31.130 distinct might I'll say Psychotherapy outside 00:29:31.130 --> 00:29:35.559 of the E &M visit this like spelling it out for 00:29:35.559 --> 00:29:38.700 the auditors though. Same with all the phone 00:29:38.700 --> 00:29:42.680 calls and the collaborative calls and any asynchronous 00:29:42.680 --> 00:29:46.660 telemedicine and nursing homes. I had a very 00:29:46.660 --> 00:29:49.359 big Medicare audit in the nursing homes where 00:29:49.359 --> 00:29:52.500 they froze all my collections past and anything 00:29:52.500 --> 00:29:54.480 in the future until they finished their audit. 00:29:55.200 --> 00:29:59.319 So really looking at like getting it real clear 00:29:59.319 --> 00:30:01.539 for them. My audit passed very quick compared 00:30:01.539 --> 00:30:04.450 to my colleagues because I had it templated for 00:30:04.450 --> 00:30:08.089 the auditor. So all of us were audited, me and 00:30:08.089 --> 00:30:10.750 everyone using it, my templates were fine. And 00:30:10.750 --> 00:30:12.869 it passed in a couple of weeks, everyone else's 00:30:12.869 --> 00:30:16.049 took months and then they got down coded. So 00:30:16.049 --> 00:30:19.269 that, and then the state audits when they, I 00:30:19.269 --> 00:30:21.549 don't know if it's Jayco, who the state is anymore 00:30:21.549 --> 00:30:24.609 in nursing homes, but how they would audit the 00:30:24.609 --> 00:30:26.990 gradual dose reductions and spelling it out for 00:30:26.990 --> 00:30:30.259 them and things like that. Gotcha. Gotcha. Gotcha. 00:30:30.799 --> 00:30:33.759 So you've been a psych NP for how many years? 00:30:34.480 --> 00:30:40.680 Since 2011. So about when was your like biggest 00:30:40.680 --> 00:30:43.559 burnout period? Would you say I had a very public 00:30:43.559 --> 00:30:48.740 meltdown in the inpatient in front of many people, 00:30:49.079 --> 00:30:51.720 two of whom were my students later. So they didn't 00:30:51.720 --> 00:30:55.519 judge me too harshly. It had been a period of 00:30:55.519 --> 00:30:59.829 time where one Something happened with the insurance 00:30:59.829 --> 00:31:01.990 reimbursement. So my collections were off which 00:31:01.990 --> 00:31:05.569 was making upsetting me because I believe they 00:31:05.569 --> 00:31:09.029 put me through as an FNP instead of PMA 10p. 00:31:09.029 --> 00:31:13.390 So my rates dropped in half and at the same time 00:31:13.390 --> 00:31:18.869 I had lost a few patients to suicide in and We 00:31:18.869 --> 00:31:22.359 can't know what someone's gonna do when you discharge 00:31:22.359 --> 00:31:25.599 them. And if you're in that discharge period 00:31:25.599 --> 00:31:29.740 of seven days from inpatient, then you all have 00:31:29.740 --> 00:31:32.480 to sit in a root blame analysis. It's called 00:31:32.480 --> 00:31:35.460 a root cause analysis meeting or any of those 00:31:35.460 --> 00:31:37.759 and they ask they kind of part your charts and 00:31:37.759 --> 00:31:41.400 how'd you let them die and all of this. Gosh. 00:31:42.119 --> 00:31:46.500 And that kind of scenario and then you're proving 00:31:46.500 --> 00:31:49.819 the nurses did everything they could. This wasn't 00:31:49.819 --> 00:31:53.220 anyone's problem. No one did this. We spelled 00:31:53.220 --> 00:31:55.740 out, you know, the assessments we did. It's a 00:31:55.740 --> 00:31:58.839 tragedy. And everyone's very stoic. And I'm like 00:31:58.839 --> 00:32:01.720 my mushy, squishy self, like sobbing for this 00:32:01.720 --> 00:32:06.460 person whose family is left. The family understood. 00:32:07.079 --> 00:32:10.400 They weren't upset, but that was probably my 00:32:10.400 --> 00:32:13.500 biggest burnout is like sitting there trying 00:32:13.500 --> 00:32:16.180 to explain to non -medical people how someone 00:32:16.180 --> 00:32:20.599 may pass from suicide and how that occurs when 00:32:20.599 --> 00:32:23.200 you discharge someone and the limitations of 00:32:23.200 --> 00:32:25.920 what you can do inpatient with all the feelings 00:32:25.920 --> 00:32:30.460 of that and how heavy it was and you know they're 00:32:30.460 --> 00:32:34.180 well how can we support the physicians and I'm 00:32:34.180 --> 00:32:36.720 like well you know the nurses are here too like 00:32:36.720 --> 00:32:39.549 there's was on the floor. No one stopped and 00:32:39.549 --> 00:32:42.089 held space for them. No one stopped and held 00:32:42.089 --> 00:32:44.690 space for this person who lost their life or 00:32:44.690 --> 00:32:47.150 their family. And it had just been a bit too 00:32:47.150 --> 00:32:51.089 much. And the level of violence had been escalating 00:32:51.089 --> 00:32:53.750 in the inpatient unit that I really didn't feel 00:32:53.750 --> 00:32:59.220 comfortable there anymore. So I probably sobbed 00:32:59.220 --> 00:33:01.460 through the eventually sobbed through the meeting. 00:33:01.579 --> 00:33:03.779 First, I was mad that we were having it. And 00:33:03.779 --> 00:33:06.380 then I said, you know, don't worry about us because 00:33:06.380 --> 00:33:08.660 I quit like I'm done. And I just kind of walked 00:33:08.660 --> 00:33:11.880 out and was done with that chapter. And so that 00:33:11.880 --> 00:33:14.599 was probably my biggest burnout moment is the 00:33:14.599 --> 00:33:20.200 emotional stuff with it. And make sense. What 00:33:20.200 --> 00:33:24.920 would you suggest to Psych NP who loses a patient 00:33:24.920 --> 00:33:27.759 to suicide. I know that's a heavy question. I 00:33:27.759 --> 00:33:31.839 just I've had mentees in my boot camp who have 00:33:31.839 --> 00:33:34.420 gone through it And so I've been in situations 00:33:34.420 --> 00:33:37.299 where I'm like, okay How do I best support this 00:33:37.299 --> 00:33:39.759 person and I just didn't know if you had any 00:33:39.759 --> 00:33:43.779 I've had things I do that's not right and things 00:33:43.779 --> 00:33:48.819 that do and so my not right thing is obsessively 00:33:48.819 --> 00:33:51.799 check the charts for I do have to tell myself 00:33:51.799 --> 00:33:53.900 you get 30 minutes and then you have to put this 00:33:53.900 --> 00:33:57.200 down and I go over everything and I obsess for 00:33:57.200 --> 00:34:01.440 a while and yeah I blame myself and I fall in 00:34:01.440 --> 00:34:07.400 a puddle and I just sit there and I've even gone 00:34:07.400 --> 00:34:09.940 on social media and look them up just to see 00:34:09.940 --> 00:34:12.679 their face again and then I tell myself that's 00:34:12.679 --> 00:34:15.260 enough I can't keep doing that and then I reach 00:34:15.260 --> 00:34:18.789 out I do therapy modality called breath work 00:34:18.789 --> 00:34:22.869 where you I have a lady I go to on speed dial 00:34:22.869 --> 00:34:27.110 and I say I need a breath work session and we 00:34:27.110 --> 00:34:30.869 just It's very outside of what we typically do 00:34:30.869 --> 00:34:33.590 in psychiatry So it takes me out of like I can 00:34:33.590 --> 00:34:36.329 CBT myself all day long I can great therapy myself 00:34:36.329 --> 00:34:39.010 quite a bit from being a hospice nurse, but I 00:34:39.010 --> 00:34:43.309 can't breathe off the trauma and scream out what 00:34:43.309 --> 00:34:47.860 ever is in my subconscious like One time it was, 00:34:48.559 --> 00:34:54.500 why didn't you try as hard as I did? Or, damn 00:34:54.500 --> 00:34:59.159 it. Like, damn it, we didn't catch it. Or I'm 00:34:59.159 --> 00:35:02.280 sorry, or any of that stuff that comes up. And 00:35:02.280 --> 00:35:07.480 so doing that in a safe space, there's this beautiful, 00:35:07.659 --> 00:35:09.579 if you're going to have someone else on a podcast, 00:35:09.679 --> 00:35:11.639 there's this beautiful nurse practitioner out 00:35:11.639 --> 00:35:15.559 in Virginia who does all this breath work. What's 00:35:15.559 --> 00:35:18.909 her name? Mary Crutchfield is the beautiful soul, 00:35:18.909 --> 00:35:21.969 yes, who does that breath work. And I believe 00:35:21.969 --> 00:35:24.550 she does it for nurse practitioners and other 00:35:24.550 --> 00:35:27.710 clinicians. I have someone local who does it, 00:35:27.710 --> 00:35:31.349 but it's a very powerful way of processing that. 00:35:31.809 --> 00:35:34.849 I like active resolution therapy is another interesting 00:35:34.849 --> 00:35:37.769 therapy modality, but I like the breath work. 00:35:37.969 --> 00:35:41.909 I'm a bit spiritual, so I put their name. and 00:35:41.909 --> 00:35:43.789 something about them, just their first name, 00:35:44.170 --> 00:35:46.409 and put it in the Bible. I don't read the Bible, 00:35:46.550 --> 00:35:48.989 but I just put it in there. I don't even know 00:35:48.989 --> 00:35:52.190 where my Bible is. It's just my symbol of I'm 00:35:52.190 --> 00:35:56.349 giving this up to God. And that's kind of my 00:35:56.349 --> 00:36:00.210 routine after having been inpatient and PHP. 00:36:01.010 --> 00:36:04.510 And my specialization was high suicidality and 00:36:04.510 --> 00:36:06.710 treating people with electroconvulsive therapy 00:36:06.710 --> 00:36:12.139 and all of those things. probably in that space 00:36:12.139 --> 00:36:15.639 lost a patient a year and sometimes a couple 00:36:15.639 --> 00:36:18.360 and and with people with substance use disorder 00:36:18.360 --> 00:36:21.940 and and when they relapse they often Pass from 00:36:21.940 --> 00:36:26.139 that. Yeah having been through that I kind of 00:36:26.139 --> 00:36:31.460 picked up a thing to do and then I would always 00:36:31.460 --> 00:36:35.139 call my collaborator and say what did I do? It's 00:36:35.139 --> 00:36:39.130 a it was a very kind man. He'd say else and do 00:36:39.130 --> 00:36:41.090 you remember where they started you met them 00:36:41.090 --> 00:36:44.309 in the icu after their first very serious attempt 00:36:44.309 --> 00:36:46.809 you took them through impatient you took them 00:36:46.809 --> 00:36:50.949 and this was a cycle that you couldn't stop and 00:36:50.949 --> 00:36:53.909 you're watching a derailed train off the tracks 00:36:53.909 --> 00:36:56.289 going down a hill and you're trying to jump in 00:36:56.289 --> 00:37:00.679 front and you can't always stop it yeah Thank 00:37:00.679 --> 00:37:02.599 you for sharing so vulnerably because I think 00:37:02.599 --> 00:37:04.599 it's something that a lot of us have dealt with 00:37:04.599 --> 00:37:09.239 and it really makes you feel burned out and just 00:37:09.239 --> 00:37:11.980 like, what's the point? It feels very bleak, 00:37:11.980 --> 00:37:14.860 you know? And I will say, I always call the family. 00:37:15.460 --> 00:37:17.980 I know that's controversial, but I call the family. 00:37:18.280 --> 00:37:23.960 And I'm usually sobbing like a mess, but I call 00:37:23.960 --> 00:37:27.699 the family and I even invite them in. and I even 00:37:27.699 --> 00:37:30.719 sit with them and spend space. When we lost someone 00:37:30.719 --> 00:37:34.460 in PHP, I had to go in that room. There's, you 00:37:34.460 --> 00:37:36.380 know, 10 other people who were sharing space 00:37:36.380 --> 00:37:40.800 with that other person and saying they didn't 00:37:40.800 --> 00:37:44.480 make it. And you all are in this very vulnerable 00:37:44.480 --> 00:37:47.900 spot. So I talked to the people around them. 00:37:47.960 --> 00:37:52.000 I invite the family in. I've had a few come in 00:37:52.000 --> 00:37:56.579 and I don't charge for it. It's just I sit with 00:37:56.579 --> 00:37:59.579 them and share space with that sorrow. Yeah, 00:37:59.579 --> 00:38:03.079 that's really beautiful. To pivot a little bit. 00:38:04.539 --> 00:38:08.420 Your streams of income now. If we were looking 00:38:08.420 --> 00:38:12.860 like in a little pie chart. I feel like it's 00:38:12.860 --> 00:38:17.639 a hemorrhage out because I'm funny. Because I 00:38:17.639 --> 00:38:22.250 was self funded for the startup of the a pH scribe, 00:38:22.690 --> 00:38:25.690 the health tech. So yeah, I don't know if it's 00:38:25.690 --> 00:38:29.849 a stream. It feels like a tiny little drip right 00:38:29.849 --> 00:38:33.769 now is how it is. Yeah. Yeah. With your businesses, 00:38:34.789 --> 00:38:39.190 have you like, did you set out to build a business 00:38:39.190 --> 00:38:43.070 that you would eventually sell or maybe not? 00:38:43.469 --> 00:38:48.789 I love creating things. So I like I could see 00:38:49.179 --> 00:38:53.300 At your service psychiatry maybe one day as I'm 00:38:53.300 --> 00:38:55.579 spending less and less time in there and just 00:38:55.579 --> 00:38:58.519 mostly Focusing on the AI scribe, but it also 00:38:58.519 --> 00:39:01.599 runs itself now. So I just get like I want to 00:39:01.599 --> 00:39:06.000 do something new and the AI scribe has been Cool 00:39:06.000 --> 00:39:08.739 because I'll hear something. I'm on social media 00:39:08.739 --> 00:39:12.019 all the time and someone will say like oh and 00:39:12.019 --> 00:39:14.019 you could charge for a phone call. And I was 00:39:14.019 --> 00:39:16.219 like, yeah, you just chart for it. And someone's 00:39:16.219 --> 00:39:17.639 like, well, how do you chart for it? I'm like, 00:39:18.039 --> 00:39:20.340 oh, well, I'll just build that. Let me show you. 00:39:20.539 --> 00:39:22.679 And I'll go and build it and bring it. And like, 00:39:22.760 --> 00:39:26.159 that's so exciting for me. So those things, and 00:39:26.159 --> 00:39:28.760 we have all kinds of things on our roadmap for 00:39:28.760 --> 00:39:32.340 PMH scribe to build this AI layer into psychiatry 00:39:32.340 --> 00:39:37.519 practice that that will just be continual development 00:39:37.519 --> 00:39:40.579 with our team. That's cool. What would you say 00:39:40.579 --> 00:39:44.139 makes PMH Scribe different from all the other 00:39:44.139 --> 00:39:46.480 AI scribes that we're kind of like inundated 00:39:46.480 --> 00:39:49.559 with now? Like, try this one, try that one. You 00:39:49.559 --> 00:39:54.000 know, what's the specialization for psychiatry, 00:39:54.139 --> 00:39:57.780 the setting it up to be audit ready for the auditors, 00:39:58.280 --> 00:40:02.619 the practice management tools. So things outside 00:40:02.619 --> 00:40:04.980 of just the scribe and as we're building onto 00:40:04.980 --> 00:40:08.219 it and onto it, it's been interesting because 00:40:08.429 --> 00:40:11.610 a lot of our users are nurse practitioners and 00:40:11.610 --> 00:40:14.869 how much they like to chart. They like to do 00:40:14.869 --> 00:40:17.710 these very long charts. So we had to tweak them 00:40:17.710 --> 00:40:20.929 for like the psychiatrists use these and then 00:40:20.929 --> 00:40:23.150 some of the nurse practitioners. Sometimes there's 00:40:23.150 --> 00:40:26.050 overlap, but we learned pretty quick. We better 00:40:26.050 --> 00:40:29.610 make a system where we can get more verbose charts. 00:40:29.949 --> 00:40:32.510 And so having these prompt engineers and hiring 00:40:32.510 --> 00:40:34.969 people to put together people's templates and 00:40:34.969 --> 00:40:38.280 making systems. to build templates and all the 00:40:38.280 --> 00:40:42.119 things behind the AI building. So we also have 00:40:42.119 --> 00:40:45.059 medication education specific for psychiatry. 00:40:45.079 --> 00:40:47.039 So the way you would talk to your patient, if 00:40:47.039 --> 00:40:50.960 a patient is a sophisticated patient and really 00:40:50.960 --> 00:40:54.079 wants all the details, we'll have that where 00:40:54.079 --> 00:40:57.179 like Prozac, it's can be used for depression 00:40:57.179 --> 00:41:01.260 or OCD or this or this and explains to them the 00:41:01.260 --> 00:41:04.920 way we would talk to a patient so that the provider 00:41:04.920 --> 00:41:08.579 can send it or patient is in ADHD medicine it's 00:41:08.579 --> 00:41:10.420 like well if you're traveling just bring the 00:41:10.420 --> 00:41:12.599 exact amount you need it's often still in there 00:41:12.599 --> 00:41:14.980 keep it in a safe place like all of those little 00:41:14.980 --> 00:41:17.619 things you wouldn't see on a printout from the 00:41:17.619 --> 00:41:20.500 pharmacy or if you have an anxious patient who 00:41:20.500 --> 00:41:22.800 you might say you might not want to read the 00:41:22.800 --> 00:41:24.980 printout from the pharmacy, but here's the actual 00:41:24.980 --> 00:41:27.679 information lots of details might get an upset 00:41:27.679 --> 00:41:30.000 stomach for a few days, but it'll go away and 00:41:30.000 --> 00:41:33.639 and those kind of things so that specialization 00:41:33.639 --> 00:41:37.420 to psychiatry and Trying to build a tool with 00:41:37.420 --> 00:41:41.039 care as the underlying care of the clinicians 00:41:41.039 --> 00:41:44.420 care of the patients When I'm telling a patient 00:41:44.420 --> 00:41:46.340 about it, they're like, Oh, I need this letter. 00:41:46.480 --> 00:41:50.860 I got AI to do it. Lindsay's great, but you need 00:41:50.860 --> 00:41:53.099 some noise canceling headphones, and I'll shoot 00:41:53.099 --> 00:41:54.679 it off to you in a minute. And they're like, 00:41:54.679 --> 00:41:58.000 Oh, that's cool. I like that. So it's been I 00:41:58.000 --> 00:42:01.900 love your both. Yes. Yeah. You've always wanted 00:42:01.900 --> 00:42:04.219 things to be automated. Yeah, I don't like doing 00:42:04.219 --> 00:42:10.440 the stuff. Perfect sense, you know Yeah, I use 00:42:10.440 --> 00:42:14.539 PMH scribe and I love it I'm not this isn't sponsored 00:42:14.539 --> 00:42:16.760 or I'm not an affiliate or anything like that. 00:42:16.880 --> 00:42:19.219 But one of the things I've noticed about it is 00:42:19.219 --> 00:42:22.940 it's I Think it's much less verbose than a lot 00:42:22.940 --> 00:42:26.019 of the other. Yes. I did at the baseline templates 00:42:26.019 --> 00:42:29.800 It's it's concise like a typical like a psychiatrist 00:42:29.800 --> 00:42:32.659 might chart or someone who's passing notes on 00:42:32.659 --> 00:42:36.139 to I like Yeah, because I don't like to put too 00:42:36.139 --> 00:42:39.019 much in there, but if they want it in there, 00:42:39.460 --> 00:42:41.920 build a template for it for all the including 00:42:41.920 --> 00:42:45.159 more and more stuff. But yeah. What's your proudest 00:42:45.159 --> 00:42:48.960 moment across both businesses? I had this woman 00:42:48.960 --> 00:42:52.639 reach out and she was she was frantic. She was 00:42:52.639 --> 00:42:57.179 like, my job is going to take away this because 00:42:57.179 --> 00:43:00.119 I can't produce security documents. I got that. 00:43:00.010 --> 00:43:01.989 Don't worry, I'll look at it for you. She's like, 00:43:02.250 --> 00:43:05.170 I have, for the first time in four years of practice, 00:43:05.550 --> 00:43:09.289 I watched a movie with my son after work, and 00:43:09.289 --> 00:43:13.530 she had not done it in four years. She had been 00:43:13.530 --> 00:43:17.730 spending hours, she said, I have ADHD, I can't 00:43:17.730 --> 00:43:20.309 do this, I'm running my own practice, I am a 00:43:20.309 --> 00:43:23.309 single mom, I make all the money for the household, 00:43:23.409 --> 00:43:26.449 I can't cut down, and I got to watch a movie 00:43:26.449 --> 00:43:30.369 after using the software, and I was like, So 00:43:30.369 --> 00:43:33.230 touched and even I brought on this like wonderful 00:43:33.230 --> 00:43:36.550 salesman and he says I can't believe how nice 00:43:36.550 --> 00:43:39.769 all these people are and they tell us these great 00:43:39.769 --> 00:43:43.389 stories and he came from Like facial recognition 00:43:43.389 --> 00:43:45.210 software and all this other kind of software 00:43:45.210 --> 00:43:47.469 that doesn't seem related He's like we're just 00:43:47.469 --> 00:43:50.909 making a difference here. These people need us 00:43:50.909 --> 00:43:54.610 and it was such a touching moment that even Someone 00:43:54.610 --> 00:43:57.809 outside of our field who doesn't quite get it. 00:43:57.829 --> 00:44:02.360 Yes Wow This is impactful. You're helping people 00:44:02.360 --> 00:44:07.139 help people. And when I'd see a provider say, 00:44:07.360 --> 00:44:10.599 hey, I'm, you know, I had a busy day and we don't 00:44:10.599 --> 00:44:12.739 really look into it, but they said, I saw 40 00:44:12.739 --> 00:44:16.980 people, a Saturday provider, not a nurse practitioner, 00:44:17.179 --> 00:44:19.900 but a provider who sees that they spend the whole 00:44:19.900 --> 00:44:22.940 Saturday, that's their week. And they said, I 00:44:22.940 --> 00:44:25.920 could see them all. And I got home and I was 00:44:25.920 --> 00:44:29.900 done. and that's my week and that's all I do 00:44:29.900 --> 00:44:34.460 and that was really cool to see it work for two 00:44:34.460 --> 00:44:37.079 and then I got to do a talk with another gentleman 00:44:37.079 --> 00:44:41.179 who does like slow visits he sees like he does 00:44:41.179 --> 00:44:44.480 acupuncture and he does all these like cool like 00:44:44.480 --> 00:44:46.800 fun things which I'll give you his name too because 00:44:46.800 --> 00:44:48.920 he's a great speaker I just got to speak with 00:44:48.920 --> 00:44:52.840 him and And he uses AI so he can do all the other 00:44:52.840 --> 00:44:56.099 things. So he's not a pace person. He's a I want 00:44:56.099 --> 00:44:59.699 to share space and do these cool things and just 00:44:59.699 --> 00:45:01.320 have it in the background. So I don't have to 00:45:01.320 --> 00:45:05.260 think about the charting and then just really. 00:45:05.340 --> 00:45:08.739 Yeah. Touching how many ways people can use these 00:45:08.739 --> 00:45:11.980 tools. Yeah. And there's like there's a lot of 00:45:11.980 --> 00:45:14.940 pain associated with it. If you know the pain 00:45:14.940 --> 00:45:17.539 of like just having those charts built up and 00:45:17.539 --> 00:45:19.300 then you're carrying the emotional heaviness 00:45:19.300 --> 00:45:21.630 and then it's like most of my weekend, I'm going 00:45:21.630 --> 00:45:25.010 to be charting. It's very heavy. So that's incredible 00:45:25.010 --> 00:45:27.130 to hear. I know that's one of the biggest things 00:45:27.130 --> 00:45:30.349 I've loved to in private practice, like how present 00:45:30.349 --> 00:45:33.489 I can be. You know, that's part of kind of why 00:45:33.489 --> 00:45:35.550 I felt like I needed to pivot because I was more 00:45:35.550 --> 00:45:37.889 worried about my checklists, not more worried 00:45:37.889 --> 00:45:41.510 about them, but it was taking away from the focus. 00:45:41.889 --> 00:45:44.469 Right. Right. It's pretty incredible what you've 00:45:44.469 --> 00:45:48.170 built. Okay, one last question, I guess. You 00:45:48.170 --> 00:45:50.590 recently became the co -chair of the Telemental 00:45:50.590 --> 00:45:52.710 Health Special Interest Group at the American 00:45:52.710 --> 00:45:55.550 Telemedicine Association. What does that role 00:45:55.550 --> 00:45:59.460 mean to you? That organization has been amazing. 00:45:59.860 --> 00:46:02.840 It's typically for enterprises and because I 00:46:02.840 --> 00:46:06.460 was in so many states, I joined that and back 00:46:06.460 --> 00:46:08.480 when I started, so I think I've been a member 00:46:08.480 --> 00:46:12.400 since 2018 or 19. It was a larger investment 00:46:12.400 --> 00:46:15.539 for me because it's an enterprise thing, but 00:46:15.539 --> 00:46:21.059 to have them ask me to join and help do talks 00:46:21.059 --> 00:46:26.000 about either AI or telemedicine and then Speak 00:46:26.000 --> 00:46:28.159 with all these people who are in the field and 00:46:28.159 --> 00:46:30.400 they just love to it's like all they do they 00:46:30.400 --> 00:46:32.980 love telemedicine they think everything's great 00:46:32.980 --> 00:46:37.440 in that world and then the president is his mother's 00:46:37.440 --> 00:46:40.159 a nurse practitioner and so it's one of the rare 00:46:40.159 --> 00:46:44.199 organizations that brings enterprises payers 00:46:44.199 --> 00:46:49.159 individual providers and physicians and nurse 00:46:49.159 --> 00:46:53.639 practitioners and physician associates all together 00:46:53.639 --> 00:46:56.989 and they have the stance that nurse practitioners 00:46:56.989 --> 00:47:00.949 and physician associates should be to the top 00:47:00.949 --> 00:47:04.349 of their license. And so they really promote 00:47:04.349 --> 00:47:08.030 independent practice and telemedicine and nursing. 00:47:08.510 --> 00:47:11.710 The nursing has grown in the last few years of 00:47:11.710 --> 00:47:16.250 having a whole department. So being able to even 00:47:16.250 --> 00:47:20.670 facilitate these important talks about getting 00:47:20.670 --> 00:47:23.369 the rules and regulations out there and how to 00:47:23.369 --> 00:47:26.789 safe prescribe and telemedicine and deliver care 00:47:26.789 --> 00:47:30.929 in a safe manner has been really impactful in 00:47:30.929 --> 00:47:35.570 that part and getting to talk to the DEA directly 00:47:35.570 --> 00:47:40.010 and say, hey, I'm a little guy. Compared to these, 00:47:40.110 --> 00:47:43.110 I'm the little guy and this is what it means 00:47:43.110 --> 00:47:48.650 to treat either ADHD or prescribed testosterone 00:47:48.650 --> 00:47:53.039 or how that impacts the world and if it's taken 00:47:53.039 --> 00:47:57.300 away for no reason, you know, the communities 00:47:57.300 --> 00:48:00.159 that we're supporting are going to have that 00:48:00.159 --> 00:48:03.079 cliff where all their care drops off and that 00:48:03.079 --> 00:48:07.099 those of us doing it do it well and safely. And 00:48:07.099 --> 00:48:10.340 I even argued safer than it was inpatient or 00:48:10.340 --> 00:48:13.900 in person because I didn't get pinned in a room 00:48:13.900 --> 00:48:17.559 threatened if I don't prescribe. If that occurs 00:48:17.559 --> 00:48:20.139 in telemedicine, I can And I could check all 00:48:20.139 --> 00:48:22.139 the prescription drug monitoring before they 00:48:22.139 --> 00:48:24.980 even come in across all the states, cancel it 00:48:24.980 --> 00:48:28.840 out before it happens, call everyone. So just 00:48:28.840 --> 00:48:32.880 being able to bring that to the DEA advocates 00:48:32.880 --> 00:48:36.619 there and talk directly to them, the rule makers 00:48:36.619 --> 00:48:40.599 has been exciting. Yeah, that's awesome. OK, 00:48:40.659 --> 00:48:44.260 Lide, I have two more questions. What does no 00:48:44.260 --> 00:48:46.480 prior auth mean to you, not just the insurance 00:48:46.480 --> 00:48:49.019 term, but as a philosophy? Well, you know, I 00:48:49.019 --> 00:48:56.019 don't like following rules. So I think it's not 00:48:56.019 --> 00:48:59.579 waiting. Now I follow the rules, but I will push 00:48:59.579 --> 00:49:03.380 it to the edge of the rules or help foster change 00:49:03.380 --> 00:49:06.760 in the rules. So just like with telemedicine, 00:49:06.780 --> 00:49:10.119 someone says you can't do that. And so I go to 00:49:10.119 --> 00:49:12.480 my lawyer and I say they say I can't do that. 00:49:12.480 --> 00:49:14.420 And the lawyer says, yeah, I don't know. I don't 00:49:14.420 --> 00:49:16.760 know if you can do that. Instead, I say, how 00:49:16.760 --> 00:49:19.969 can I do that? Within these rules, how can I 00:49:19.969 --> 00:49:24.849 do that? So not letting Everyone say you can't 00:49:24.849 --> 00:49:29.510 do that not You can't a girl can't start a health 00:49:29.510 --> 00:49:33.769 tech company You can't change careers while having 00:49:33.769 --> 00:49:37.809 children You can't do any of this. I didn't ask 00:49:37.809 --> 00:49:42.630 for Authorization or to do it. So to me, that's 00:49:42.630 --> 00:49:47.539 what it means especially in this field as advanced 00:49:47.539 --> 00:49:51.059 practice providers and advanced practice nurses, 00:49:51.619 --> 00:49:54.860 we have the capacity to do all these different 00:49:54.860 --> 00:49:59.900 things. Yeah. And even if it is just seeing patients, 00:49:59.940 --> 00:50:03.719 you're caring for hundreds of people and they're 00:50:03.719 --> 00:50:06.239 caring for hundreds of families and caring for 00:50:06.239 --> 00:50:09.659 hundreds of others. So your reach as all of that 00:50:09.659 --> 00:50:14.250 and and not Letting the box getting put in the 00:50:14.250 --> 00:50:19.150 box. Hold your back Yeah, that's incredible Where 00:50:19.150 --> 00:50:22.889 can people find you and then also I think I think 00:50:22.889 --> 00:50:26.889 you made my audience a custom code that They 00:50:26.889 --> 00:50:31.090 can get a discount, right? Yes. I think it's 00:50:31.090 --> 00:50:36.590 Lindsey Lindsey in the coupon then they can get 00:50:36.590 --> 00:50:41.920 the discount I'm on probably Facebook the most 00:50:41.920 --> 00:50:47.699 because of I don't know my age there or Alison 00:50:47.699 --> 00:50:53.059 at PMH scribe .ai LinkedIn I try to stay active 00:50:53.059 --> 00:50:56.679 on that yeah I'm not active on TikTok other than 00:50:56.679 --> 00:50:59.139 watching and lurking and liking people's stuff 00:50:59.139 --> 00:51:01.260 so one day I'll get active on it but I haven't 00:51:01.260 --> 00:51:04.900 had time for that one but yeah any of those places 00:51:05.559 --> 00:51:07.800 Cool. Well, thanks for being on. I'd love to 00:51:07.800 --> 00:51:09.760 have you on again. You're the kind of person 00:51:09.760 --> 00:51:11.699 that I know nurse practitioners want to hear 00:51:11.699 --> 00:51:14.940 from. And I know your time is limited, but yeah, 00:51:14.940 --> 00:51:18.320 I think I found you in the big PMHMP group is 00:51:18.320 --> 00:51:21.420 how I first came across you. I think I do. I 00:51:21.420 --> 00:51:25.559 moderate quite a few of them just to see what's 00:51:25.559 --> 00:51:28.079 going on. And because I'm on social media so 00:51:28.079 --> 00:51:30.940 much because of the businesses, like might as 00:51:30.940 --> 00:51:33.219 well moderate the groups and make sure they're 00:51:33.159 --> 00:51:36.000 Usually, I'm just the one checking the licenses. 00:51:36.539 --> 00:51:39.300 The people at NURCES know me well, the N -U -R 00:51:39.300 --> 00:51:42.559 -S -Y -S system. I got to meet them. They talked 00:51:42.559 --> 00:51:45.539 to me about how I use it. We're using it in Facebook 00:51:45.539 --> 00:51:48.739 groups to ensure that the people are who they 00:51:48.739 --> 00:51:51.780 say they are. I'm checking the licenses. That's 00:51:51.780 --> 00:51:53.340 usually my role. We provide a lot of free value 00:51:53.340 --> 00:51:55.239 on there, too, because I see your responses to 00:51:55.239 --> 00:51:57.679 people, and I'm like, wow, that was jam -packed. 00:51:58.139 --> 00:52:02.039 Try to pass it on to empower anyone. to just 00:52:02.039 --> 00:52:05.659 go do it, do your thing. You can learn. There's 00:52:05.659 --> 00:52:07.840 so much you can learn. You can ask questions. 00:52:08.159 --> 00:52:10.340 Sometimes it's just reaching out to someone who's 00:52:10.340 --> 00:52:12.679 been there, done that, get some support, go to 00:52:12.679 --> 00:52:16.900 mentors like yourself. I've always had a business 00:52:16.900 --> 00:52:19.920 coach or business mentor or... personal coach. 00:52:20.179 --> 00:52:22.519 I know it's easy, but I like life coaches and 00:52:22.519 --> 00:52:25.760 things like that. So I employ all of them in 00:52:25.760 --> 00:52:28.780 the journey. It helps me have someone on my side 00:52:28.780 --> 00:52:32.920 and then things I can't see if if we need to 00:52:32.920 --> 00:52:35.460 see force for the trees and have another pair 00:52:35.460 --> 00:52:38.659 of eyes on that. So having a good mentor the 00:52:38.659 --> 00:52:42.039 whole way is probably the most helpful, especially 00:52:42.039 --> 00:52:46.780 when starting businesses or navigating family 00:52:46.780 --> 00:52:50.760 and practice. Yeah, that was one of the biggest 00:52:50.760 --> 00:52:52.900 things I did different was starting to invest 00:52:52.900 --> 00:52:55.440 in like coaching and mentorship when I went out 00:52:55.440 --> 00:52:58.840 on my own. I was actually just at a scaling workshop 00:52:58.840 --> 00:53:01.380 this last week. Do you know who Alex Hermosi 00:53:01.380 --> 00:53:05.920 is? Not yet. You might not. He's all over social 00:53:05.920 --> 00:53:07.860 media. He's a marketing guy. And I got to ask 00:53:07.860 --> 00:53:10.480 him a question. So I was like, damn girling. 00:53:10.599 --> 00:53:13.900 Naturally, I came up with the practice in a set 00:53:13.900 --> 00:53:17.530 of breathwork session with my life coach lady 00:53:17.530 --> 00:53:19.909 and I said I'm going to call it at your service 00:53:19.909 --> 00:53:23.449 psychiatry because it'll be a service based tech 00:53:23.449 --> 00:53:26.869 enabled practice and it was having a coach just 00:53:26.869 --> 00:53:28.949 kind of take me out of my head for a bit and 00:53:28.949 --> 00:53:31.710 think about what's possible or same with the 00:53:31.710 --> 00:53:36.010 scribe I was in a mastermind group and even unrelated 00:53:36.010 --> 00:53:37.730 to healthcare and they're like you just light 00:53:37.730 --> 00:53:39.949 up when you talk about technology I don't know 00:53:39.949 --> 00:53:43.289 any other nerds that are that excited about automation 00:53:43.289 --> 00:53:46.710 but you light up you need to Put your energies 00:53:46.710 --> 00:53:50.690 on that because it brings you so much joy. So 00:53:50.690 --> 00:53:53.489 yeah, having that mentorship to have those areas 00:53:53.489 --> 00:53:57.110 in your life where you find joy. So. OK, well, 00:53:57.230 --> 00:53:59.630 thanks, Allison. Thank you. Talk to you next 00:53:59.630 --> 00:54:02.650 time. All right. Take care. Thank you.