A lot of new grads feel like they need to work
for someone else or... a couple of years before
going independent. It's, you know, one of those
debated topics, right? What gave you the confidence
to jump in, would you say? I would say, I mean,
a lot of it is, it's just never comparing ourselves
to others because I always do it. But it's like,
you don't know, you know, obviously the whole
story. Some people seem like they take off and
they have a lot of success, but we don't know
what's kind of under the hood and stuff. I just
use Headway and now we've become a group practice
and I use Headway still. I have independently
credentialed for myself as kind of a backup.
and kind of working on the rest of the providers.
What is your view on like in -person versus like
virtual versus like hybrid psychiatric care?
I think probably the hybrid's the best option.
After COVID, people just want to do online. I
always tell people, you know, prior practice
is half clinical and half business. And business
does not care anything about clinical. So you
can be the best clinician, but if you don't know
how to market and get the business stuff going,
then you're going to struggle. Hi, everyone.
Welcome to No Priora, the podcast where we celebrate
psychiatric NPs who didn't wait for permission
to build something extraordinary. I'm Lindsay
Hill, and today's guest has one of the most incredible
timelines I've come across. He grew up on a family
farm in Washington's Yakima Valley, went to Texas
to earn his doctorate in psychiatric nursing,
and then came home to Washington and built a
multi -location practice with five offices across
the state in under two years. Dr. Miguel de la
Mora is a board -certified psychiatric mental
health nurse practitioner, a Jonas Scholar, and
the owner of Bellevue Psychiatry, with locations
in Bellevue, Kirkland, Kennewick, Vancouver,
and Moses Lake. He's bilingual. He treats everything
from ADHD and depression to substance use disorders.
And his approach to care is all about treating
the whole person, not just the symptoms. And
here's what I love about his story. He didn't
do the safe thing. He didn't work for someone
else for 10 years first. He saw a need in his
home state and he went and built it. That's what
No Prior Off is all about. Today, Miguel's going
to walk us through how a kid from Yakima Valley
Farm ended up running a psychiatric practice
across five cities, what it takes to scale that
fast, and why he believes real healing requires
way more than just medication. Let's get into
it. All right. Well, thank you for having me.
What an intro. Now I got a lot to bring with
that kind of intro. So thank you, Lindsay. Thanks
for being here, Miguel. Thanks for being here.
Yeah, I think it's really cool that you were...
raised in Washington. I probably have told you,
but I'm also from Washington. So that's kind
of a cool commonality that we have. So you grew
up on a family farm in Yakima Valley. Paint me
a little bit of a picture as far as what that
was like and how does a farm kid end up in psychiatry?
Yeah, so that is an interesting kind of result
from there. So, I mean, both of my parents are
from Mexico, so I came to the U .S. to better
their life and hopefully the kids that they were
going to have. And my dad kind of worked as a
foreman for a lot of the big apple orchards back
in the 80s. That was a big moneymaker. It was
just apples and all the fruit. And then he just
decided to have his own business while he still
worked for someone, so got a farm there in the
Yakima Valley. That's where I grew up, me and
my siblings. And it was, we weren't the kids
that had the video games or stuff. We were just,
you know, working on the farm, going to school,
playing sports and stuff like that. So I think
when I look back, it was a great segue to learn
about hard work, determination, and just what's
possible just because I would see it in my dad.
Even though to him, it was always kind of a side
thing to do. It was something that we saw the
end result once we had Cherry. orchards so either
the harvest happened or cattle so whenever the
cattle was sold or whatever you know that happened
but yeah i mean i think that it was uh one is
i i think i was 25 i got diagnosed with adhd
so it kind of covered up my symptoms because
um some of the literature shows that people that
grow up on farms or a lot around a lot of labor
apart from sports they can manage their symptoms
sometimes without medication so i think even
my own struggles it was way to help because i
was always working it was like uh i get told
like uh even now from people just like you eat
fast and it's like that's kind of how i was raised
like it was like hurry up and eats because we
got to go back to the farm and work and stuff
like that so i think it was a great foundation
and then from there um just the idea of i always
wanted to be a doctor wanted to go to med school
elementary middle school and high school very
typical for an immigrant family one of the kids
be either a doctor or lawyer it's kind of what
it's a common theme. And then my first year in
college, I pivoted to business because I had
had a little entrepreneur spirit and had, you
know, interest in that. Did that for about six,
seven years. Did like finance and sales and lending
and stuff like that. And then I kind of got burnt
out. At the time, it was the last few years of
those seven. I was in Los Angeles, California.
So I was working there and then my best friend
was living in Houston and he had been looking
at getting into medicine. He was kind of doing
similar sales. So I ended up kind of packing
my bags and then went to Houston. I worked probably
one more year and then started the prereqs. I
got into the University of Texas there in Houston,
the BSN program, and then I worked for a year
and then did the DMP. And psychiatry, I think
for me, it was just that was what interests me
just from struggles I've had or just stuff that
I would see. A lot of times you have that uncle
that drinks and that's how he's coping with stuff
or just people you see that you're like, well,
it's not the substance or the activity. It's
what's the pain from that and stuff. And then
as soon as I got done, just came back to my home
roots of Washington and where I'm at here today
in Bellevue, Washington. So that's really cool.
Yeah, thanks for sharing that. It's also ironic
because my dad always worked in Bellevue as I
was growing up. So again, another thing we have
in common, but that's a really cool story. Very
inspiring. I'm also curious because a lot of
psych NPs who are in Texas struggle as far as
the laws there and opportunities. And I find
it interesting that you kind of when you finished
your ENP at UT that you were like. I'm going
back to Washington. Tell me about that. Like,
was there, did you look for opportunities in
Texas and it wasn't quite what you were hoping?
Yeah, I did. So we had to do like a thousand
hours of clinical hours for the DMP. So I did
my first two rotations were inpatient and the
last two were outpatient. So I'm a talker, networker.
And with some of the preceptors I had, one of
them owned a kind of a med spa set up there in
the suburbs of Houston. Really nice office. She
had three other providers and she had staff and
everything. and kind of taught me a lot and just
kind of mentioned like well you know if you do
have interest of going back home she's like i
think that washington's probably one of the best
if not the best states i would for sure do that
her thing was There in Texas, psychiatrists,
they got kind of smart and they were charging,
I think, $1 ,500 to $2 ,000 a month to be collaborative
with PsychMP. So for her, it was her, three other
providers she had. So she was paying, I think
she was paying maybe the $2 ,000. So she was
paying $8 ,000 a month just to be able to practice
medicine and stuff for her and the other people
that she had. so she would tell me Miguel she's
like I sometimes struggle with that when I'm
sleeping because one of these days this you know
psychiatrist can say hey I'm retiring or I don't
want to do this and then what the heck am I supposed
to do with me and the other providers that I
have and kind of my whole operation and stuff
so I think that was a little bit of of just hearing
that and hearing that like it's just a lot of
uncertainty there also with my director for the
dmp program she had mentioned that like the previous
cohort i think they had had a small class like
four people um none of them had been not licensed
in texas they all lived there but they had been
licensed in other states so she was mentioning
that that was because of the environment and
atmosphere for the practice uh availability and
what you can and can't do there in texas for
nurse practitioner so i think both of those and
just the fact that I was from Washington, was
a driving force to finish school in 2023 and
then move back. Yeah, absolutely. I can definitely
understand why you would do that because Washington
is a great state to practice in and not to hate
on Texas, but it seems like it's possibly one
of the worst to practice in. So that makes a
lot of sense. So you're bilingual. In Washington,
especially in the areas that you're in, how important
is it to have Spanish speaking psychiatric providers,
would you say? I mean, it's big. I think central
Washington for sure. And more eastern Washington,
it's even bigger. I think my clinic manager and
the rest of my staff is bilingual. And then right
now, I guess I'm the only provider that is, but
we're always looking. And that would for sure
be a plus. It's just finding someone that speaks
Spanish. So it's just it's a big part. With the
availability of speaking Spanish, I mean, when
I have those patients, it's good because it gets
me to practice my medical Spanish and how do
you ask them this and ask them that and stuff.
But yeah, no, it's a huge thing. How is it there,
I guess, in Arizona with you? It's definitely
helpful to be bilingual. I wish that I was bilingual
and I'm not, but definitely makes you much more
marketable as a psych NP and a lot more opportunities
for sure. Yeah. A lot of new grads feel like
they need to work for someone else for a couple
of years before going independent. It's, you
know, one of those debated topics, right? You
clearly didn't subscribe to that belief. What
gave you the confidence to jump in, would you
say? I would say, I mean, a lot of it is it's
just never comparing ourselves to others because
I always do it. But it's like you don't know,
you know, obviously the whole story. Some people
seem like they take off and they have a lot of
success, but we don't know what's kind of under
the hood and stuff. I'm more of the hybrid, like
I always tell other students, like MP students
or new providers, if you can go work for someone
for a year. More like a 4 -10 schedule than that
fifth day look at doing your own practice and
kind of building. I think that that's probably
like a healthier way to do it. That's what I
did. I worked for about a year at a community
mental health, learned a ton. We took their everything,
which was great because I would see from five
years old up to 90 years old. And it was just
not a niche, but it got me to see a little bit
of everything. And then just kind of when I went
on my own, be in a position where I was. least
a little bit comfortable, but I would say you
worked in community health there in Washington
first. Yeah. But I, I mean, I was pretty much
since day one, I had my own practice. It was
just a matter of, um, just doing it on, on the
side or one Saturday a month or that's right.
And stuff. So, yeah. Um, how much was your salary
at that community health position? If you don't
mind me asking, uh, I think it was around 160
,000. So, yeah, which was for it was in central
Washington. So it was not like the cost up here
in Seattle. So it was pretty fair. It also just
came with a lot of good benefits. So I think
you can go either way. I mean, I get usually
week to week people send me Facebook messages
or different chats about like mentorship or like,
you know, I have a question about this or that.
I think if. If you want to be successful from
day one without going to work for someone, then
you just, one, you better have a good chunk of
money for investment for like everything that
needs to be put in there. And then two, just
be someone that you can learn quick and just,
you know, go with change. Because if you're a
brand new clinician and then also trying to start
a business, it's doable. It's just going to be
a lot. Yeah, for sure. How long did you stay
at that community health clinic on the side?
Yeah, I stayed about a year. So I think it was
like 12, 13 or 14 months. So, OK, were you getting
student loan repayment at the community health?
Yeah, that that job was just unicorn. They were
giving me 1500 bucks a month with no commitment.
So and that was just a check to me. So which
every year, which was the one year I would give
them like the statements that it was applied,
obviously, to the loans. But yeah, it was there
was no contingency on you have to work here for
this long or this or that. It was just a flat
1500 bucks. Gotcha. Wow. That is cool. Okay.
So people are very curious about kind of how
to open a practice. So I just have a couple of
questions for context as far as like how much
money you spent kind of getting started with
your practice, I think is a good place to start.
And did you get credentialed independently off
the bat or a little bit more about kind of taking
insurance or referral sources and whatnot? yeah
so i think doing it kind of hybrid start like
i had mentioned it gives you a lot of avenues
to um have that set income um if you're someone
that has a spouse that makes more enough income
well then even even more you can maybe do it
but um initially when i started um I probably
started with like $5 ,000 as far as just startup
for just general stuff. But once I had that,
I had Fridays off. So it was a Friday. Once I
had that Friday, pretty much booked up to, I
don't know, 9, 10, 11 patients. And that was
like a consistent, you know, volume coming in.
Then that's when I decided to spend more money
and get help. Because the thing is, once you
start getting help is when your practice will
grow even more. So a lot of providers I've seen,
they like to champion themselves of like doing
everything. But that's going to be only for so
long because you're either going to get burnt
out or there's going to be a bottleneck of how
much you can grow based on you doing admin plus
doing the clinical side of it. OK, so you hired
a virtual assistant. Yeah, so mine. Yeah, because
maybe my ADHD or who knows why, I just hired
someone full time that was in person because
I had the I guess the more traditional would
be hire a virtual assistant. People want 20 hours,
but you really have to hire them for 40 hours
because they don't really like do anything with
the part time. The way I did was when I was full
on Fridays. I was probably bringing around 10
,000 revenue just from Fridays. So I was like,
well, I can hire someone for four or 5 ,000.
If it's someone that is going to be full -time
in person where we can meet up and also someone
that I can invest for the rest of the time. I
found someone that was a clinic manager at a
family doctor's office, which is a little different,
but they knew a little bit about everything.
And then just basically offered them a full -time
position. We waited a little bit on the benefits
just because like, okay, give me some runway,
you know, four or five months. And then we'll
look at that. But I, you know, mentioned like
my goal is for you to grow, for us to get you
to a much higher position. Eventually get over
a hundred thousand salary, like something where
it's worth, you know, your time and stuff. it
offered me the ability to train them in the time
that i could but also they already knew how to
be a manager so a lot of these roles they were
able to like really run with the reception role
the kind of medical assistant role the prior
auths all that kind of stuff and then i knew
that this person was the person i was going to
use for any virtual assistant that i hired to
train them yeah so in that case um you know for
most people that's like well that's way too much
to pay for someone but I knew it was a value
that I was going to get down the road versus
just thinking of it short term. And thus far,
it's panned out really good. Yeah, I think kind
of reinvesting strategically is really smart.
And I think that's a unique kind of approach
and model. And you're right. I think a lot of
providers wait to hire support. But I think that's
really interesting and cool. So does that person
still work with you? And how has that role kind
of... expanded and, you know, what kinds of things
did she start out doing versus maybe what she
does now? Yeah. So, um, yeah, I mean, they're,
from what I know, kind of in the long haul of
it, she started out with intake Q, which is what
we use for EHR. She started out with headway
who we use for billing, got those down and then
did a little bit of the medical assistant work
of like Q and me meds or like, you know, doing
the prior odds or stuff like that. And then I
was because she was in person, I was able to
have her go to all the therapy offices in person,
shake hands, give flyers and stuff like that.
So she was kind of a little bit of everything
in the beginning. And then after I decided to
go full time in the in the practice, then we
hired our first two assistants. And they did
one did like patient care coordinator, which
was like the reception work and the insurance
stuff. And then the other one was a medical assistant
work. So she was able to train them and kind
of get them going. And then we just kind of grown
from there. So that's cool. And were the two
that you brought on, were they? Yeah. One was
from Costa Rica and the other one's from Nicaragua.
So. And how did you find them? So I used a company,
you know, I did my research and I see that there
was, you know, the Asia's where a lot of the
companies are at, like the Philippines and stuff
like that. I know Hello Reach is kind of big
in that area. And then there's Latin America
and there's the Middle East. because of having
some patients that speak Spanish and because
I wanted them to be in the same time zone for
the most part. We use Remote Leverage, which
is a company that I think they do everywhere,
but they really concentrate on Latin America.
So that's how we interviewed them, went through
the panel and then landed on. I was going to
hire one, but then just with my mind of like,
OK, I'm growing, I need more. I ended up hiring
initially two because at some point it's like,
well, if you're going to train one, you might
as well train two. If you can see if you can
forecast growth there. So, yeah. OK. And for
those positions, do you pay them like an affordable
kind of hourly rate? Is that how that works?
Yeah, so it's anywhere between, what do I pay
them? Like 10 to, I think thus far we're up to
11 bucks an hour. I mean, just trying to really
keep people long -term. We probably do a lot
of stuff that's kind of outside the box, but
I think it'll pay in return. So we do the quarterly
bonuses up to $300 a quarter. So that's based
on performance. And then we do, so that's every
quarter, just based on how you perform. We do
five. days uh i think it's five days of major
holidays off so they get those days for free
They get up to five days off of vacation so they
can pick whatever five days to use them however
they want. And then we do summer break and winter
break off. So what that looks like is the last
week of June we'll have off. The whole clinic
will have off and they get paid for that. And
then winter we do December 24th till January
1st of nine days. They'll have off and they get
paid for. So the recruiters like those are just
benefits I've never heard people doing. But like
that's going to pay in return on investment down
the road. because you're going to keep people
there and stuff. And it's worked well. I think
most people are very happy with working for us
because we treat them like humans and just treat
them well as best as we can. Yeah, it sounds
like it's really important for you to reinvest
in your business and your people and treat them
right so that you retain them and they want to
continue to work for you, which is, I think,
really smart. Okay, so headway initially. So
at what point did you start getting credentialed
outside of Headway? And yeah, what did that look
like? Or did you use any other platforms additionally?
I just use Headway and now we've become a group
practice and I use Headway still. I have independently
credentialed for myself as kind of a backup and
kind of working on the rest of the providers.
I just from networking and talking to people,
I had these two mentors that I met. One was in
New York City and one was in Orange County, California.
They both had like 10 plus provider group practice.
So obviously knew what they were doing and got
to that stage. And both of them use Headway.
yeah they both use headway group practice billing
so to me i'm like wait a minute if these people
have these huge practices and they're using headway
and they're fine with it and they've been using
it for three or four years then i'm gonna guess
that it probably should be okay so there's you
know pros and cons to everything um I'm actually
on, we'll probably can put in your links this
Thursday at 515 Pacific Time. I'm going to do
like a free like webinar kind of on Zoom as far
as group practice on Headway because some people
have asked me some like might as well just do
some webinar. But with that, we just find that,
you know, we get paid no matter what. I know
there's like some code you can't use, but for
us, it's mostly, you know, three or four billing
codes and we just stick to that. So that's. who
we use for any of the providers, including myself.
I'll look later at maybe doing independent billing
and stuff. It's just that opens a whole can of
worms of like, do I hire a biller? And like,
how good are they about chasing claims? Should
we hire someone in -house to do them? So I think
it's just a lot of stuff to think about there.
Okay. So you run all your billing no matter where
the referrals come from through Headway. Okay.
Okay. That makes sense. It's interesting because
I remember seeing a guy in, I believe it was
Oregon, who same thing, he had scaled a group
practice using Headway. And I reached out to
him because I was considering at the time doing
something similar. But I don't know. It was weird.
I met with Headway and it seemed like they were
like, we're not doing group. practice support
or maybe they were like in the middle of a transition
um but it was like kind of vague at the time
so i just think it's interesting that like it
sounds like for you it's worked great and it's
possible and in what what's what month is it
april 20 26 it's possible to build a group practice
with using headway as kind of um your billing
what percentage of your referrals would you say
have come through headway i mean it peaks in
you know highs and lows but i think on average
i don't know probably maybe 20 of them come from
there so i think a lot of it is just our availability
having different uh providers um i hear from
other providers who like i don't get anything
from headway it's just for billing which is 100
it's for billing but i don't know if it's the
way our profiles are on there or what we do but
we've actually had some pretty good success from
just getting people to go on headway and stuff
i think the i mean the biggest thing is just
availability so people want to be seen today
not tomorrow so it's part of it is the more providers
you have the more availability someone could
see someone today so yeah what's the main drawback
would you say to using headway probably that
sometimes when they verify benefits it might
not be 100 what it is and then six months down
the road the person can the patient can get like
information that's different and now they've
already established a relationship and now they
have to decide what they want to do or if they
you know been charged this different amounts
on their credit card from the deductible So,
yeah, I mean, that's probably the biggest drawback
that there's no way around it. It's going to
be what it's going to be. Yeah. How many providers
do you have working for you now, Miguel? Four
or five of us, including myself. So they're all
1099. So most of them are full time, but some
have more of a part time. And then the full time,
they some of them work. I mean, the amount of
patients I see or not, I'm probably the one that
sees the most patients still just because I'm
using the income to grow the practice. But we
haven't set up a 1099. So with 1099, you can't
control our schedule. So you can tell them like,
you know, our full time goal is to get you four
days a week and have, you know, one day off for
admin or to do whatever. But they can dictate
how many patients they see that the days that
they do, they do work and stuff. So. So, yeah,
right now it's five of us. Okay. And how does
the pay work for them, if you don't mind me asking?
Yeah. So with the 1099, we just have a flat 70
-30 split. So they get 70 % of what we collect,
and then we get 30%. We're pretty good about
even cancellation. So our cancellation are pretty
much the full appointment visit. So most of the
time, we don't have any cancellations from patients.
But if we do, they even get from that split as
well. Okay. Okay. That's cool. And what is your
view on like in -person versus like virtual versus
like hybrid psychiatric care? Yeah, I think,
I mean, I've seen it both ways. I think probably
the hybrid's the best option, but it's hard.
I mean, you, you know, from seeing patients still
after COVID people just want to do online. for
many reasons and stuff. So many of the providers
that I've networked or talked with, I always
ask them that question like, hey, how many people
do you see in person versus virtual? And most
of the time it's 80 to 90 % is still virtual.
So I think that. For us, it's, I mean, I see
patients in person on Fridays if they want to
be seen in person, but if not, the rest of the
time it's all virtual and stuff. So I've seen
people scale completely virtual and I've seen
other ones that do a mix of both. So I think
for us, it's a little bit more possible. I would
say like if I open up a therapy practice and
have therapists. For that, I would say I could
see where more patients want for an hour to see
someone in person. But there's people that do
also just virtual for therapy. So but I think
I think hybrid is probably the best option if
you can. But I've seen it done both ways. So
your in -person locations, because now I'm curious,
like, are your providers all in Washington? And
then also, like, do you have a lot of overhead
with these in -person locations or is it like
space you rent from a therapist? Does it help
with like the marketing? yeah so we have out
of the five we have um three that are like offices
and then the other two are more satellite offices
they're offices but they're ones that we rent
space from so um the providers we have they're
all from washington um i've kind of made that
as a rule i don't know if it's good or bad but
just um i need to be able to shake your hand
i need to be able to like go to lunch or else
have conversations about how stuff's going how
stuff's growing so i know i mean i can get a
provider in maine i can get a provider anywhere
to work here but i think since we only focus
on washington i want to have providers from here
and stuff and i mean there's enough providers
to hire so thus far that's where it's at but
i've been approached by um different providers
like hey are you hiring i'm in texas i'm in these
other places but as of right now we've been just
hiring local Okay. And are these people you like,
like word of mouth or Facebook groups or how
do you usually hear about the providers you hire?
Yeah. So they've been surprisingly, cause I haven't
too, too much of pre -settling or affiliate before
the last couple of months with the universities.
They've been, I think all the ones that I have
are from LinkedIn. Interesting. Yeah, I posted
a job and then they applied and they liked what
they heard and they decided to come on board.
I love that. I love that. So a lot of your referrals
come from therapists, right? Mm -hmm. And have
you done a lot of the boots on the ground marketing
or primarily has it been like your office manager?
So initially I did, I did a lot of like lunch
meets, even though it was like a virtual kind
of resume meets. And then I had the clinic manager
do some in -person marketing. And then when we
went from the referral coordinator and the medical
assistant, patient care coordinator, then came
a referral coordinator, aka our marketing person.
So we hired her and she was the one that's really
helped us to grow even more. Her main, role is
to talk to every therapist in washington state
so find a way to get to that level so she does
zoom chat she does phone calls and she's on the
in most states you have facebook groups per county
or per area for facebook therapists where they
like hey i you know in search of a prescriber
or psychiatrist that can help this patient so
she's on there she's commenting and then she's
also connecting with them and trying to set up
chat so she can get they can get to know her
and get to know our practice and that's worked
wonders i think that that's um something that
i'm looking at maybe rolling out later with hiring
more staff that people can like hire subcontract
from me, someone that can do that for them. Because
when you look at all different people and referrals,
nothing beats a therapist referral because they're
more committed patients. They're more serious
about getting better. And you can refer back
to the therapist after the initial appointment
and say, Hey, how are they doing? Give me some
insight. And then they give you all this insight.
So compared to headway or ZocTalk or any of the
referral source, I always tell any provider therapist
referrals are the best referral sources. Okay.
And so basically you're saying you hired somebody
to full -time be like marketing for you, right?
Yeah. That's cool. That's really cool. compared
to the google ads or compared to everything else
um i think it's just the best way to go it's
just you gotta know how to train them you gotta
get someone that's you know good personality
kind of bubbly someone that's gonna not be afraid
to get on the phone or do zoom stuff i mean she's
she's been able to have uh like group owners
of therapy clinic or uh offices with like i don't
know 10 15 therapists to chat with herself so
when you get someone to that caliber like you're
they're doing just fine so uh some of these they'll
talk to me and we'll have that conversation after
or some she's doing fine with and networking
with them so yeah i think yeah that's smart she's
a little bit of a unicorn i don't know how i
would say you're gonna find a bunch of times
this situation but she's been working well for
us and stuff and i think with a lot of providers
that's where they struggle is like i don't know
how to do marketing which I always tell people,
you know, prior practice is half clinical and
half business and business does not care anything
about clinical. So you can be the best clinician,
but if you don't know how to market and get the
business stuff going, then you're going to struggle.
Yeah. Have you put a lot of money into like Google
ads? I don't think we put any dollars into Google
ads. So we've been able to just from our referral
sources, get patients to keep growing. Okay.
And how did you find this marketing? I don't
know what her title is, but how did you find
her? Through remote leverage, through like the
virtual assistant setup too. Oh, so she's not
in Washington. Nope. That's incredible. Yeah.
She is in Nicaragua too. so um i've actually
i'm it might be even some people that hear this
but i've had two psychiatrists and three psych
mps try to poach her for me and she sends me
like the little screenshots what they send her
and i'm like here's 100 bucks for doing that
like i appreciate you letting me know because
they're basically like oh i'll pay you more you
know it's like okay but Because she, you know,
likes the culture we have here with all the other
staff and everything, I'm sure, you know, and
the pay and different things, she's not going
to just go somewhere else. So, and I, and I've
told her if we keep growing and you can, if I
get venture this idea of training someone to
kind of have another provider want to use the
services, you know, we'll increase pay or we'll
do some other stuff. So I'm always going to,
I'm going to expect a lot from you, but I'm also
going to pay you for that added value you're
bringing. So that's intriguing though, because
it's like, I feel like it is. harder to form
those relationships virtually? You know, is it
just like she's doing the Zoom coffee chats or
is she providing value to these practice to the
therapy therapists? Yeah. So one of the things
that I started initially that she kind of took
over was I started a therapist referral network.
And what that looks like, it's an outlook email
group. And every so often, like not every so
often, every few days in a week. they're like
blind carbon copy they'll get an email saying
hey we have two patients the 21 female this is
their issue this is their insurance you know
30 year old uh male this is their insurance this
is their issue please reply if you have availability
in the next two weeks if you take their insurance
and if you want to help them and uh we've grown
that network to about almost 200 therapists in
washington state so with this is another way
for her to stay in touch with the therapist so
And we've been we've been able to get a lot of
referrals from there, too. So. OK. OK. Those
patients are like your guys's patients that you're
referring to therapists. OK. So in a way, she
acts almost like a social worker of all finding
resources, which is huge because no one, no one
that I know from the practice here in Washington
is doing stuff like that. Unless you're in community
mental health and you have just the funds to
hire someone to do that. So let's say I get a
patient and they seem like they need a therapist
from their ACE score, from the like stuff they
mentioned. I'll ask them if they want one. If
they say, yeah, then on Spruce, I'll page JC.
She'll call them, get a little bit of info. and
then she'll blast this email group with the patient.
And then usually within 48 hours, they'll have
an email with who replied and who the patient
has to just call. So I always tell the patients,
we literally do all the heavy lifting. Instead
of telling you, go on psychology today and call
these 10 people that maybe two will call back
and then they'll tell you they don't have availability
for a month. We're pretty much doing all the
heavy lifting. So that gets us good with a therapist.
Because they're like, well, crap, they're giving
me free referrals. But that also gets them to
be friendly with us to send us referrals. So
it's a win -win. Very smart. So these kind of
strategies, did you like come up with these yourself
or was it from these business mentors? And then
also, did you like pay these business mentors
or do you pay for coaching or business mentorship?
Yeah, the that idea with a therapist, that's
just out of my own brain as far as just like
being in cells before and just saying, OK, like
what can be something that could work? And just
knowing that I wanted to focus on therapists
and stuff. So that was just organically just
like other ideas that kind of came up. But yeah,
I mean, I have two kind of business mentors that
I see. I pay them every month. And then I have
also Dr. Hecox, who's a psychiatrist there in
Colorado, and he does. case consults monthly
so with him we just talked shop about like the
the cases i mean he's been a psychiatrist for
25 years so he's pretty much seen it all and
stuff um and that's probably a thing that i'm
always trying to tell anybody that i talk to
is just like we need to focus on mentors and
we need to focus on just stop being the silo
at this profession is which a lot of it once
you get into especially telehealth it's like
you're by yourself all the time and that's not
healthy for us so getting mentors for clinical
stuff as well as for business i think is like
there's no reason to reinvent the wheel so just
pay someone that's done it get you know all the
stuff they're going to save you and i'm sure
they'll save you way more than what you're paying
them so Yeah. I always see you on the Facebook
groups. Are you just like trying to provide free
value to kind of build? Yeah, I. but right now
yeah i mean um some of it is i feel like with
some of the clinicians that are coming out from
the stuff that i see um i think the schools need
to like the schools are in their own uh disaster
because of the funding cuts and different things
with a lot of the nursing schools and they're
just you know teaching to whatever the boards
are but there's a lot of like what i call common
sense which is a lot of like your mentorship
programs or stuff like that um or some of the
other ones but there's a lot of stuff that they
just don't learn So some of the stuff I'll post
on there is for that last week. And then this
week I did these webinars and those are just
one -offs. Like I'm not asking for any money
or anything. It's just like, here's some information
from my experience. And then just cause I keep
seeing people fail and just struggle. And it's
like, they need to understand that the reason
that they're struggling is because of this reason.
So, yeah, but some of the stuff, I guess in the
beginning I was on it a lot more than you see
it kind of burnt out sometimes I'm being on this
group. So, yeah. Some of your comments make me
laugh sometimes. Well, I just I'm like the worst
about the anonymous ones. Like we should have
something where like you don't post anonymous
because I understand so many reasons why. But
at the same time, it can provide like you don't
know who's asking the question and what's their
intent and stuff like that. So I think some of
the times it's been some of that. Yeah. You have
been such a wealth of information. I'm not quite
done yet. I have a few more questions if you
have the time for it. Yeah. What does a personal
brand kind of mean to you as a psych NP? Like,
do you think it's important for psych MPs in
2026? And what does it really mean? Yeah, I think
this is one of the areas that I think I've even
asked you about and just like the dynamic of
the whole social media and just like, you know,
even how to balance that. But I mean, the answer
is 100%. You have some of these influencers or
drifters that are just like saying stuff, doing
stuff that have no business, but they have a
following and people listen to them. And I think
just the morph of podcasts and just the social
media influencers, there's just a lot of misinformation
out there. So I think, yeah, I mean, I think
that would be, I mean, I'm sure even if you did,
I don't know if you have a course or not for
like that stuff, I'm sure you would get a lot
of people that would be interested in learning
from your experience. But that's something that
I've considered of hiring someone to help me
with some of that. I just. I have way too much
on my plate right now with different business
services or ventures that I'm looking at. But
I know down the road, I need to hire someone
that can help me with more strategic stuff. But
I would say, yeah. I would say, I don't know
if you agree with this or not. I don't know if
that's going to be a real big referral source
to get patients. But I think it's more of people
are going to Google you patients all the time.
Google the provider, I'm sure, or look up who
they are. And if stuff comes up where you're
educating, then that's going to give you a little
bit more. you know kudos and stuff what do you
think about from you and your experience and
people you've coached um does it bring referrals
or is it more just for like branding sometimes
but i would say unless your social page is like
specifically for private practice and you're
like talking to the people who are like the niche
of your practice like i think there's a therapist
uh what's her name kelly sit with Kelly. I think
her handle is she's in Florida and, you know,
she has a page dedicated to her private practice.
And so she gets a lot of patients that way. But
I think kind of how I've done my social media
focusing more like. broad, not necessarily. And
that was never like my goal or intention. Well,
I guess I shouldn't say that because I did start
out with the page being like my private practice
name because I felt more comfortable like just
showing up under my business instead of just
showing up as me. You know what I mean? But yeah,
I wouldn't say like a huge referral source. I
would say more opportunities as far as like coaching,
consulting, different revenue streams have been
come about from that visibility. Yeah. Yeah.
Yeah. I mean, I think I just wish that everything
in life is about plug and play. Most people just
want something to easy to some extent. So I wish
in a way there was more of these options because
there are some very brilliant providers out there
that just, I think, get scared about like the
how you do everything and how much time consuming
where it'd be nice if there's some like some
service in between that would help them with
that. I agree. I know. For physicians, there's
a group called like, so me docs, and I think
they do that kind of thing for physicians, but
there's not really so much for psych NPs, but
I 100 % agree. And this is like, even just like
a small step, this podcast trying to get like,
maybe people who would be more under the radar,
like, to share their knowledge and their gems,
because, you know, to your point, like, you're
the psychiatrist you meet with, is he the one
who did that therapy retreat? Yeah, that's cool.
yeah the two -day workshop in fort collins colorado
yeah But yeah, I think that, I mean, I think
in the beginning, I mean, it's good to have a
case consult with someone probably monthly. And
then also if you can do group ones. So here in
Washington, in Seattle, there's a group one that
I got kind of invited to and I've been doing
it for two months now. And it's the second Friday
of the month, they meet for two hours and it's
kind of round table. It's like 15 psych MPs that
talk about cases or different things. So I could
do a lot of this because of having a lot of assistants
or staff to help me with everything else. But
like once you are doing this for a while, like
even with open evidence or with everything else
out there and Carla, there's still going to be
stuff that you're like, I just don't know what
to do in this situation. So, yeah, especially
with the world we live in, with layoffs and with
AI and with everything else, there are certain
problems that there's nothing we can do. It's
just going to be what it's going to be. So, yeah,
no, 100 percent. How did you find that group?
It was actually a psych MP who's retiring and
she reached out if anybody wanted her patients
pretty much. And, you know, I'm going to be quick
on that. So I met with her for a Zoom chat and
then she mentioned about that group. And then
I was like, well, is there any way I can join?
And she's like, yeah, it's closed, closed end
group. It's not like just anybody can come. But
she's like, let me just talk to them. They get
to know you. And then they kind of let me in.
And they just their rules is that you miss no
more than two sessions per year. So they want
people. People are going to be interactive and
participate in stuff. But yeah, there's there's
different ones out there. That's cool. Yeah,
you're definitely not shy to like put yourself
out there, be like networking and building relationships,
which I think is very, very, very, very important
to build those relationships early, you know.
So I think that's super smart. AI, how much time
do you commit to learning like AI stuff? Yeah,
I mean, recently I had put like a post about
Claude for, I think, private practice, like a
little Facebook group that I had just started.
But I've been just, you know, maybe two hours
a week of trying to look at it. I mean, I use
it already in the practice with free with the
notes. And but this just that world is just changing
so fast. I was trying to just find someone to
pay and just be like, hey, I need an hour, two
hours, three hours consult. Here's, you know,
pay whatever you want. But. it's growing so fast
that there's no one that's really an expert in
that field so um and it just depends on the industry
and all that so um yeah there's uh i mean that
could be a whole podcast on its own about like
what are the different options um i i'll be interested
i don't know if you're going in june to the site
congress elevate that just the mini um in vegas
but i'll be interested to see like what boosts
they have there or what they talk about that
Yeah. A hundred percent. I want to go. I'm not
a hundred percent decided, but I would like to
go. I have a couple of friends who are going,
it would be cool to network. I think that's how
you and I met back in the day, a couple of years
ago. Yep. It was, uh, yeah, two years ago. So,
I mean, those are, it's just. We got to get out
of the silo work. You can't just be like seeing
patients and going home to your family. Like,
I mean, a perfect world maybe, but you just got
to network. We don't know what the future holds
and we don't know what stuff will be out there
and stuff. I saw recently about the idea of AI
replacing every single physician or medical provider
out there. And the idea of that, it is possible.
It's just, we might not accept it. So, and I
saw some compelling stuff. So I'm like, ugh.
Yeah, I think you got to just know what value
you're bringing to patients and to anybody else.
Because, I mean, there's a lot of stuff that
as long as there's an algorithm, it can be automated.
Yeah, absolutely. What would you say to the psych
NP who just. graduated and is having a hard time
finding a job yeah i mean my idea was always
like um be able to be you know work for someone
for a year at least and then um really decide
if like entrepreneurship is for you because i
think it's more glamorified than what it is like
it's a lot of work it's pretty much a baby that
never grows up but i've seen those cases where
people live in rural america and they're like
dude there's no jobs like there's nothing that
i can do and stuff so i think for those situations
then finding the thought of maybe a private practice
might be right for you. And that might be the
only option. In that case, for sure, I would
say get someone who can provide you clinical
information because you need clinical consult.
And then also someone that does the business
side, because I think that you need both of those
coaches and put that into the cost for the first
year. So I think those, I mean. They talk about
saturation. And I do think that with some of
the schools kind of pumping out, you know, providers
and just jobs, you know, being different shapes,
especially with the Medicaid cuts and some of
these community health not hiring as many providers.
There is going to be, you know, a saturation
and stuff. What I guess what advice have you
given the people that you train all this struggle
with that? I mean, get your LinkedIn profile
up to date. To your point of having found all
those providers on LinkedIn, I think people underestimate
LinkedIn. And so it's like, make it professional.
Have a professional headshot. If you're in one
of these mentorship or fellowship groups, put
that on there. Really show some intention. I'll
get messages all the time on social media. That
one yesterday that was like, hey, Linda. Can't
find a job like it just you could tell there
wasn't a lot of time put into the message, which
I I get like social media is like casual. But
I think if you're, you know, more intentional
with the communication that you do send out,
because knowing that providers get a lot of inquiries
and there you do kind of have to like differentiate
yourself and be like, here's how why I would
provide value to your specific organization.
So. Yeah, I would say that. One of the questions
I ask at the end of the podcast episode to all
providers is, what does the phrase no prior auth
mean to you? I mean, obviously, it quickly reminds
me of just, you know, the prior auth that are
great for companies, insurance companies not
to pay for stuff. But I think what it means to
me, if I really kind of sit back and think about
it, it's just not letting barriers get to you.
So, you know, whatever you want to get to and
accomplish, you can. One of the best phrases
I've heard in life is you can have it all. You
can have it all at once. So there's percentage
in our, you know, in providers that they want
to have work life balance. depending on what
stage your practice is if you do prior practice
that's not going to be feasible and you have
to accept that or you have to get out of the
room and just go work for someone else and stuff
so yeah i think that um just understanding that
and just um that you know barriers are barriers
but there's ways around them so yeah i do agree
with you that i think people underestimate the
work that's required. If you are going to be
scaling a group, you know, kind of insurance
-based practice, I think that people don't realize
the repetitions that they're going to need to
put in for marketing and for these things. So
I totally, totally agree with you. If people
want to find you, where can they find you? Probably
just sending me a message on LinkedIn. I have
like a website, but it's not the most up to date
on it. But yeah, I mean, I'm working on some
stuff. So I'll probably have you post my LinkedIn
and they can message me there. Or if they, you
know, anything on Facebook, they can reach out
as well. Yeah. Okay. Awesome. I know I saw your
like Miguel de la Mora website and I was like,
dang, he was kind of ahead of the curve having
his personal brand website up back in 2023. Yeah.
Yeah. That's the one I just haven't. I mean,
you can, there's a way to message on there, but
it's not something that I, I don't have it all,
uh, glamified. I'm sure like yours is and stuff.
So, yeah, no, I get you. I get you. Okay. Well,
thank you so much for taking the time. And, um,
yeah, I know people are going to find a lot of
value in this episode and, uh, it's just really
inspiring what you've, what you've grown in the
course of two years. So. yeah no no thank you
thank you for having me i think that even your
i mean your story's been inspirational since
i met you and just a lot of stuff you were doing
and where you're at now and stuff so thank you
for having me and just being able to share my
story and if anybody has any questions they can
reach out awesome okay thanks miguel we'll see
you next time okay all right bye