WEBVTT 00:00:00.000 --> 00:00:02.950 I've probably been along like in TikTok longer 00:00:02.950 --> 00:00:05.049 than anyone else. I think that I was the first 00:00:05.049 --> 00:00:07.370 psych NP that was out on TikTok making videos. 00:00:07.610 --> 00:00:09.550 And I think that's where like the following came 00:00:09.550 --> 00:00:11.210 in. So you have these people who come in and 00:00:11.210 --> 00:00:13.009 they're like, well, you need to increase your 00:00:13.009 --> 00:00:15.310 productivity and see more patients in 15 minutes 00:00:15.310 --> 00:00:17.030 and do more evaluations. And I'm like, hey, this 00:00:17.030 --> 00:00:20.350 is garbage. I know that it hasn't been easy working 00:00:20.350 --> 00:00:23.969 with insurance, right? No, never. They will underpay 00:00:23.969 --> 00:00:27.170 us and they expect you not to notice. When people 00:00:27.170 --> 00:00:29.210 are on like the PMHNP board saying like, oh, 00:00:29.269 --> 00:00:30.969 what's wrong with this person? I think it's a 00:00:30.969 --> 00:00:32.539 person. personality disorder it's access to and 00:00:32.539 --> 00:00:33.659 like i'm reading it and i'm like they're fucking 00:00:33.659 --> 00:00:36.039 autistic like why is nobody asking about that 00:00:36.039 --> 00:00:38.240 as the differential it blows my mind sometimes 00:00:38.240 --> 00:00:40.219 when i like sit down and look at it because like 00:00:40.219 --> 00:00:41.899 i don't know on the day -to -day i'm just exhausted 00:00:41.899 --> 00:00:44.520 and drowning and there's just so much to do but 00:00:44.520 --> 00:00:47.619 like it did take off and it is it's its own thing 00:00:47.619 --> 00:00:50.079 and you know our practice has paved the way for 00:00:50.079 --> 00:00:54.350 a lot of similar practices to also be vocal Welcome 00:00:54.350 --> 00:00:56.909 to No Prior Off. This week, I'm sitting down 00:00:56.909 --> 00:01:00.049 with Dr. Maria Ingala. Maria is the founder of 00:01:00.049 --> 00:01:03.630 Paper Flower Psychiatry in Arizona, a 16 provider. 00:01:04.230 --> 00:01:06.829 five -location neurodivergent affirming practice 00:01:06.829 --> 00:01:10.150 that she launched in October 2020 after a string 00:01:10.150 --> 00:01:12.329 of community health jobs that ended in what she 00:01:12.329 --> 00:01:16.209 generously calls unplanned career detours. Translation, 00:01:16.329 --> 00:01:18.489 she kept getting pushed out for fighting her 00:01:18.489 --> 00:01:21.469 employers over pill mill quality care. She's 00:01:21.469 --> 00:01:25.170 also a DNP, a perinatal certified psych NP, a 00:01:25.170 --> 00:01:27.930 nationwide psychiatric consultant to pediatricians 00:01:27.930 --> 00:01:31.489 and OBGYNs, former ASU nursing faculty, and the 00:01:31.489 --> 00:01:34.760 co -host of the podcast Brain Trap. trash, psychiatry 00:01:34.760 --> 00:01:38.260 from DSM to dumpster fire. And she runs an education 00:01:38.260 --> 00:01:41.280 platform called Paper Flower Institute. She's 00:01:41.280 --> 00:01:43.379 also the kind of honest that only a mom of two 00:01:43.379 --> 00:01:45.319 small children and two dogs named Marshmallow 00:01:45.319 --> 00:01:47.420 and Potato can be. If you've ever wondered how 00:01:47.420 --> 00:01:49.760 to scale your practice without scaling the soul 00:01:49.760 --> 00:01:52.299 of it, scaling out the soul of it, Maria is the 00:01:52.299 --> 00:01:56.420 one to ask. Let's go. Also, she recently founded 00:01:56.420 --> 00:01:59.579 a nonprofit that we are going to be talking about. 00:02:00.640 --> 00:02:02.159 We have so many things to cover, Maria. I feel 00:02:02.159 --> 00:02:04.299 like we could meet for like three hours and not 00:02:04.299 --> 00:02:06.420 touch it, but we're going to do our part. And 00:02:06.420 --> 00:02:08.759 if we have to do a second episode, we can do 00:02:08.759 --> 00:02:11.860 that. We're here for it. Thank you for being 00:02:11.860 --> 00:02:14.639 here. Yeah. Thanks for having me. I'm super stoked 00:02:14.639 --> 00:02:19.520 for this. Me too. I remember like Facebook messaging 00:02:19.520 --> 00:02:23.659 you. I think it was probably 2020 because I remember 00:02:23.659 --> 00:02:25.900 coming across your stuff and I was like, this 00:02:25.900 --> 00:02:27.620 is really cool. Like you wrote an article for 00:02:27.620 --> 00:02:30.409 something. I'm sure you remember it. It was 2020 00:02:30.409 --> 00:02:35.490 because in 2020, I got fired again from yet another 00:02:35.490 --> 00:02:38.629 job and got really feisty and wrote an article. 00:02:38.669 --> 00:02:40.830 And that article gained like a mass amount of 00:02:40.830 --> 00:02:42.949 media attention, which was crazy because like 00:02:42.949 --> 00:02:46.849 it was just written in like spite. Speaking of 00:02:46.849 --> 00:02:49.069 which, I didn't even cover that, but you have 00:02:49.069 --> 00:02:52.849 quite a media following other than Kojo. Like 00:02:52.849 --> 00:02:54.990 as far as Psyche and Peace go, I feel like you 00:02:54.990 --> 00:02:57.370 have the biggest media platform, if you will. 00:02:57.740 --> 00:02:59.580 I would be. I mean, that's interesting if that's 00:02:59.580 --> 00:03:02.979 true. It's I probably been along like in TikTok 00:03:02.979 --> 00:03:05.219 longer than anyone else. I think that I was the 00:03:05.219 --> 00:03:07.879 first like NP that was out on TikTok making videos. 00:03:08.060 --> 00:03:10.000 And I think that's where like the following came 00:03:10.000 --> 00:03:12.180 in. I'm not as active now because, as you said, 00:03:12.259 --> 00:03:14.639 I have two small children and they make my life 00:03:14.639 --> 00:03:18.000 very difficult. Yeah. Yeah. Children do that, 00:03:18.039 --> 00:03:21.379 don't they? How old are they? Two and four. So, 00:03:21.379 --> 00:03:25.500 yeah. Yeah, both both autistic, both very needy 00:03:25.500 --> 00:03:29.419 in their own ways. So lots of work there. I don't 00:03:29.419 --> 00:03:31.020 know how you do it. I don't. But we're going 00:03:31.020 --> 00:03:32.740 to find out today. We're going to find out today. 00:03:32.780 --> 00:03:35.340 I know that you're big on your support staff, 00:03:35.560 --> 00:03:37.580 virtual assistants. I want to dive into that. 00:03:37.680 --> 00:03:40.039 I want to dive into kind of I mean, you work 00:03:40.039 --> 00:03:43.039 with insurance, too. And I want to know about 00:03:43.039 --> 00:03:44.979 that because that's another thing that people 00:03:44.979 --> 00:03:47.340 struggle with. Do I work with insurance? Do I 00:03:47.340 --> 00:03:49.539 not? Do I work with these platforms? Headway, 00:03:49.560 --> 00:03:51.930 Alma? What do I do? You know what I mean? And 00:03:51.930 --> 00:03:55.689 I think you've built a really unique model. And 00:03:55.689 --> 00:03:59.030 I actually love that you are like fully focused 00:03:59.030 --> 00:04:02.610 on Arizona and that you're not like multi -state. 00:04:02.650 --> 00:04:04.229 Not that there's anything wrong with being multi 00:04:04.229 --> 00:04:06.610 -state, but like, I don't know. I just feel like 00:04:06.610 --> 00:04:09.689 you can really help on a different level when 00:04:09.689 --> 00:04:12.199 you really know your community. Yeah, that's 00:04:12.199 --> 00:04:13.860 like the biggest thing for us is like we've always 00:04:13.860 --> 00:04:15.840 been very like community based. And when I built 00:04:15.840 --> 00:04:18.319 this, it was like I'm going to network with everyone 00:04:18.319 --> 00:04:21.139 I can find who will have a coffee with me. And 00:04:21.139 --> 00:04:23.500 like if I did that in Colorado or I opened in 00:04:23.500 --> 00:04:25.720 Alaska, I mean, like, I don't know anybody. What 00:04:25.720 --> 00:04:27.199 am I going to do? Fly out there and be like, 00:04:27.259 --> 00:04:28.740 hello, does anyone want to meet with me? Like 00:04:28.740 --> 00:04:32.319 I have no presence. So true. You just reminded 00:04:32.319 --> 00:04:33.959 me I messaged somebody yesterday. I was like 00:04:33.959 --> 00:04:35.779 a provider. I was like, I'd love to do a coffee 00:04:35.779 --> 00:04:37.839 chat. And she's like, tell me what a coffee chat 00:04:37.839 --> 00:04:41.199 entails. And I was like. well doesn't everybody 00:04:41.199 --> 00:04:43.240 want to like that work and get to know other 00:04:43.240 --> 00:04:45.519 people I just want to see how we can synergize 00:04:45.519 --> 00:04:49.379 but anyway okay so let's first talk about this 00:04:49.379 --> 00:04:53.769 foundation that you have founded When did you 00:04:53.769 --> 00:04:56.189 get the idea? What's the heart of it? The soul 00:04:56.189 --> 00:04:58.569 of it? Like how can other people get involved 00:04:58.569 --> 00:05:01.810 both in Arizona and outside of Arizona? Yeah, 00:05:01.850 --> 00:05:04.350 I have been interested in like public health 00:05:04.350 --> 00:05:06.209 and access to care and kind of dreamed of having 00:05:06.209 --> 00:05:10.779 a nonprofit for like as long as I have. been 00:05:10.779 --> 00:05:14.060 you know aware of public health so like since 00:05:14.060 --> 00:05:16.639 my early college days I ended up like having 00:05:16.639 --> 00:05:20.279 this specific idea probably like 2018 2019 of 00:05:20.279 --> 00:05:22.160 like how can we increase access to care like 00:05:22.160 --> 00:05:24.699 the system is really broken it kind of like continued 00:05:24.699 --> 00:05:27.360 because access is a nightmare you really don't 00:05:27.360 --> 00:05:29.540 get a choice of providers access very much limits 00:05:29.540 --> 00:05:33.759 its panels so like how do we help people to continue 00:05:33.759 --> 00:05:38.040 to get good care that they choose while like 00:05:38.540 --> 00:05:40.879 you know, sustaining our own practices. I took 00:05:40.879 --> 00:05:42.860 a lot of pro bono patients in my practice when 00:05:42.860 --> 00:05:45.240 I left community mental health. Like I took a 00:05:45.240 --> 00:05:47.439 ton of patients with me and I just kept them 00:05:47.439 --> 00:05:50.540 for free. And I mean, like eventually that wears 00:05:50.540 --> 00:05:53.899 down on your time and like your income and that's 00:05:53.899 --> 00:05:57.370 just hard. So. When I decided like finally, like, 00:05:57.410 --> 00:05:59.370 look, I'm going to do this. I kind of like made 00:05:59.370 --> 00:06:02.509 this plan of like, OK, so what we do, we're called 00:06:02.509 --> 00:06:04.689 Paper Flower Foundation. We are going to offer 00:06:04.689 --> 00:06:06.970 financial assistance for psychiatric medications. 00:06:07.230 --> 00:06:09.009 You can't afford your copay. You can't afford 00:06:09.009 --> 00:06:12.029 your med. We will pay for it for you. For like 00:06:12.029 --> 00:06:14.310 people who have high deductible plans for psychiatric 00:06:14.310 --> 00:06:17.290 appointments or therapy or people who just can't 00:06:17.290 --> 00:06:18.990 afford the self -pay of it. Right. Like you have 00:06:18.990 --> 00:06:20.769 an insurance lap. You have a job loss, something 00:06:20.769 --> 00:06:22.569 like that. We can come in and we can cover that 00:06:22.569 --> 00:06:24.449 for you so you don't have to lapse in treatment. 00:06:24.970 --> 00:06:26.910 And then on the other side, we have like tons 00:06:26.910 --> 00:06:29.350 of providers that we work with. So we started 00:06:29.350 --> 00:06:31.910 like the provider partner network. You can pay 00:06:31.910 --> 00:06:35.189 a fee and then come in and we'll reimburse you 00:06:35.189 --> 00:06:37.250 like a percentage. So that way you're not doing, 00:06:37.250 --> 00:06:40.149 you know, pro bono and sliding scale work for. 00:06:40.730 --> 00:06:43.470 like nothing for pennies, right? Right. Like 00:06:43.470 --> 00:06:45.589 it's not worth it if you're going to see tons 00:06:45.589 --> 00:06:46.990 and tons of patients. It's going to eventually 00:06:46.990 --> 00:06:49.550 limit like how many people can you help or like, 00:06:49.670 --> 00:06:51.850 hey, I can't continue to like sustain my practice 00:06:51.850 --> 00:06:53.930 like this. So we can offer payment for that. 00:06:53.949 --> 00:06:59.250 That's fair. That's amazing. So the partners 00:06:59.250 --> 00:07:02.209 for like provider partners, they need to be in 00:07:02.209 --> 00:07:06.060 Arizona, right? As of right now, I'm very community 00:07:06.060 --> 00:07:08.439 focused. And like if we could like move this 00:07:08.439 --> 00:07:10.939 model to, you know, expand into like the Southwest 00:07:10.939 --> 00:07:13.560 or other states, I would love that. But like 00:07:13.560 --> 00:07:16.199 we need to make this model work first. And like 00:07:16.199 --> 00:07:18.750 once this pilot works, we can expand it. Yeah, 00:07:18.829 --> 00:07:20.910 that's a great point. That's a great point. Okay, 00:07:20.990 --> 00:07:25.110 so we can put in the show notes, the links to 00:07:25.110 --> 00:07:28.089 the foundation. And people could donate even 00:07:28.089 --> 00:07:29.930 if they're not in Arizona, right to the cause. 00:07:30.329 --> 00:07:32.730 So if you want to like support this model and 00:07:32.730 --> 00:07:34.730 kind of see success in like, you know, an NP 00:07:34.730 --> 00:07:38.110 launching a nonprofit that is increasing access 00:07:38.110 --> 00:07:40.730 to care and helping people, you want to like 00:07:40.730 --> 00:07:42.569 support someone's copay, you can pay for someone's 00:07:42.569 --> 00:07:44.149 copay, you can pay for their therapy session, 00:07:44.310 --> 00:07:46.170 you can like, you know, let's still be community 00:07:46.170 --> 00:07:48.389 partners, you can be our partner. corporate sponsor 00:07:48.389 --> 00:07:50.610 without being in Arizona. Just the partners that 00:07:50.610 --> 00:07:52.990 we work with for therapists and our people we 00:07:52.990 --> 00:07:56.269 help are in Arizona. Okay. And you're also looking 00:07:56.269 --> 00:07:59.470 for board members, correct? We have one more 00:07:59.470 --> 00:08:01.769 board slot open and then we're looking for advisory 00:08:01.769 --> 00:08:04.149 board members. So if there are folks in Arizona 00:08:04.149 --> 00:08:06.550 who've had trouble with access to care, you don't 00:08:06.550 --> 00:08:08.350 have to be a healthcare provider. Or if you are 00:08:08.350 --> 00:08:10.610 a healthcare provider, we are looking for partners 00:08:10.610 --> 00:08:13.389 in Arizona and people to do on the advisory board 00:08:13.389 --> 00:08:17.199 for partners. Okay. And how do we get the word 00:08:17.199 --> 00:08:20.660 out to patients, do you think? It's already like 00:08:20.660 --> 00:08:23.480 kind of going. My hope is that like once we get 00:08:23.480 --> 00:08:26.319 partners coming in, therapists, psych NPs, they're 00:08:26.319 --> 00:08:27.420 coming in with us. They're going to say, who 00:08:27.420 --> 00:08:29.660 am I seeing pro bono already? Let me go ahead 00:08:29.660 --> 00:08:31.639 and like send them this application so they can 00:08:31.639 --> 00:08:33.340 get paid for those people they're already seeing. 00:08:33.480 --> 00:08:35.059 And as people come in and they're like, I lost 00:08:35.059 --> 00:08:37.700 my insurance. OK, let me take care of you. And 00:08:37.700 --> 00:08:39.100 then other than that, the word's going to spread. 00:08:39.220 --> 00:08:41.100 Right. Like that's how everything works is word 00:08:41.100 --> 00:08:43.340 of mouth. So I have no doubt that we'll have 00:08:43.340 --> 00:08:45.019 more than enough applications. We just don't 00:08:45.019 --> 00:08:47.740 have enough funding. you need more community 00:08:47.740 --> 00:08:51.139 partners and more donations. We need more partners. 00:08:51.440 --> 00:08:53.940 Well, it's a really great cause. I saw on TikTok 00:08:53.940 --> 00:08:56.360 yesterday, somebody posting like, I think it 00:08:56.360 --> 00:08:58.299 was some type of mental health provider. Do you 00:08:58.299 --> 00:09:00.580 know of any nonprofits? Basically what you're 00:09:00.580 --> 00:09:02.360 doing, but like in other states, it was like 00:09:02.360 --> 00:09:05.720 in Alabama and in Alaska. And I was like, well, 00:09:05.879 --> 00:09:08.779 I do in Arizona. How did you even get this idea? 00:09:08.919 --> 00:09:11.179 Like, when did you get this idea? I feel like 00:09:11.179 --> 00:09:12.980 it's just been like coming for a while of like, 00:09:13.039 --> 00:09:14.879 what am I going to do? Because like we do this 00:09:14.879 --> 00:09:17.220 kind of thing. where we're compensating for people 00:09:17.220 --> 00:09:18.840 coming to see our providers, right? We have an 00:09:18.840 --> 00:09:20.940 application people fill out. They can get sliding 00:09:20.940 --> 00:09:23.620 scale and pro bono. And it's like, OK, this helps 00:09:23.620 --> 00:09:26.059 some people with us. Sure. But like what happens 00:09:26.059 --> 00:09:27.419 when they can't afford their medication? What 00:09:27.419 --> 00:09:28.899 happens when they can't afford their therapy? 00:09:29.080 --> 00:09:31.500 They can see us, but that's it. So like this 00:09:31.500 --> 00:09:34.460 was kind of like my effort to like kind of create 00:09:34.460 --> 00:09:37.100 the wraparound for everybody everywhere. Yeah, 00:09:37.139 --> 00:09:39.179 that's really cool. I love what you're doing 00:09:39.179 --> 00:09:44.320 there. OK, let's talk about your practice. When 00:09:44.320 --> 00:09:47.980 you set out to do your practice, did you set 00:09:47.980 --> 00:09:52.080 out to be like I am going to scale a group practice? 00:09:53.299 --> 00:09:55.000 Yeah. Like, did you know that you were going 00:09:55.000 --> 00:09:57.980 to have like 16 providers and probably more than 00:09:57.980 --> 00:10:00.480 that pretty quickly here? Dude, no. Like, I didn't 00:10:00.480 --> 00:10:02.259 even want to have a private practice. I didn't 00:10:02.259 --> 00:10:04.879 want any of this. Like, I would have fought you 00:10:04.879 --> 00:10:06.820 if you told me in 2018, like, you're going to 00:10:06.820 --> 00:10:08.379 have a private practice someday and you're going 00:10:08.379 --> 00:10:10.200 to have lots of providers. I would have laughed. 00:10:10.539 --> 00:10:12.539 Like, I always wanted to work in community mental 00:10:12.539 --> 00:10:14.759 health. And like, I only did this because I kept 00:10:14.759 --> 00:10:16.580 getting fired. This is my third time getting 00:10:16.580 --> 00:10:21.480 fired in 2020 in October. Third time getting 00:10:21.480 --> 00:10:26.519 fired? As a psych MP? Yeah. For what? Like, I 00:10:26.519 --> 00:10:28.980 don't get it. That's ridiculous. I mean, like, 00:10:28.980 --> 00:10:30.940 speaking out. It's like speaking out. Like, I 00:10:30.940 --> 00:10:32.639 have authority concerns. So you have these people 00:10:32.639 --> 00:10:34.700 who come in and they're like, well, you need 00:10:34.700 --> 00:10:36.980 to increase your productivity and see more patients 00:10:36.980 --> 00:10:39.080 in 15 minutes and do more evaluations. And I'm 00:10:39.080 --> 00:10:41.980 like, hey, this is garbage. Like, nobody's getting 00:10:41.980 --> 00:10:43.820 better. Like, how am I going to spend 15 minutes? 00:10:43.860 --> 00:10:46.000 Somebody came in, you know. 15 minutes late to 00:10:46.000 --> 00:10:47.960 their appointment. See them in two minutes. I 00:10:47.960 --> 00:10:49.980 saw children. Like, how am I going to see a five 00:10:49.980 --> 00:10:52.259 year old who has like a history of sexual abuse 00:10:52.259 --> 00:10:55.840 and haven't seen a provider in two years and 00:10:55.840 --> 00:10:58.100 I'm going to see them in two minutes? Like, that's 00:10:58.100 --> 00:11:01.759 insane. So I was like, no, this is disgusting. 00:11:01.980 --> 00:11:04.179 Yeah. You guys can't make me do this. Give me 00:11:04.179 --> 00:11:06.549 longer appointments. Give me more breaks. Give 00:11:06.549 --> 00:11:09.370 me this. Give me that. Pay me more. Like, this 00:11:09.370 --> 00:11:11.269 is you're exploiting me. How come the psychiatrist 00:11:11.269 --> 00:11:13.809 down there is making like six times as much as 00:11:13.809 --> 00:11:16.690 me and I'm seeing more people pay me? Right. 00:11:16.990 --> 00:11:20.529 So, yeah, they just kept firing me. Yeah. And 00:11:20.529 --> 00:11:23.029 so you were like, OK, this is my next step. Like, 00:11:23.090 --> 00:11:24.889 I'm not just going to go work for another place 00:11:24.889 --> 00:11:26.750 where the same thing is going to happen. Yeah, 00:11:26.870 --> 00:11:28.529 I just got a house. So I was like, well, I'm 00:11:28.529 --> 00:11:30.340 going to lose my house if I don't. you know, 00:11:30.340 --> 00:11:32.860 if I keep getting fired and I was, yeah, I was 00:11:32.860 --> 00:11:34.320 supporting my husband through nursing school. 00:11:34.399 --> 00:11:36.320 So I was like, let me just make a practice. It's 00:11:36.320 --> 00:11:38.519 just going to be me. At the time I had a student 00:11:38.519 --> 00:11:40.500 who she was like, Hey, I have somebody else who 00:11:40.500 --> 00:11:41.740 wants to pre -step with you. And I was like, 00:11:41.799 --> 00:11:44.559 okay. And it was John Frank. And he came in when 00:11:44.559 --> 00:11:46.539 I was just launching my private practice. And 00:11:46.539 --> 00:11:48.620 like, I ended up hiring him only because he was 00:11:48.620 --> 00:11:53.100 my student. Right. Right. Okay. How much money 00:11:53.100 --> 00:11:55.820 did you spend? on the front end of like starting 00:11:55.820 --> 00:11:57.259 your practice i know it's been a while so it's 00:11:57.259 --> 00:11:58.779 probably hard to remember but people ask that 00:11:58.779 --> 00:12:00.820 a lot like how much money do you need and what 00:12:00.820 --> 00:12:03.100 did you spend money on let me see i paid for 00:12:03.100 --> 00:12:06.740 a website so maybe like 100 bucks um i made it 00:12:06.740 --> 00:12:10.179 myself and then i paid for like a logo on fiverr 00:12:10.179 --> 00:12:14.320 maybe like 20 bucks and then that's it dude like 00:12:14.320 --> 00:12:16.279 i paid for like my llc paperwork through zen 00:12:16.279 --> 00:12:18.879 business i didn't a telehealth platform so i 00:12:18.879 --> 00:12:21.840 just did psych today $29 .99 and that was it. 00:12:21.940 --> 00:12:24.080 I never took out loans. I never put down like 00:12:24.080 --> 00:12:26.600 hundreds and thousands of dollars. Like I just 00:12:26.600 --> 00:12:30.019 organically grew it. And as I got money, I would 00:12:30.019 --> 00:12:33.600 reinvest it. So you really launched pretty minimum 00:12:33.600 --> 00:12:38.519 viable. Yeah. Yeah. I love that. Were the platforms 00:12:38.519 --> 00:12:41.600 around like the headways and the almost in the. 00:12:42.360 --> 00:12:45.360 No. So back in the day, I actually did my own 00:12:45.360 --> 00:12:50.169 insurance credentialing myself. But I did it 00:12:50.169 --> 00:12:53.809 wrong. So I ended up hiring like a credentialing 00:12:53.809 --> 00:12:56.230 billing agency after I started to kind of expand 00:12:56.230 --> 00:12:57.570 a little bit. And I was like, I can't do this 00:12:57.570 --> 00:12:59.830 by myself. I don't understand it. They screwed 00:12:59.830 --> 00:13:02.710 me over even more. And like they missed claims. 00:13:02.830 --> 00:13:04.970 There were things that were underpaid. They messed 00:13:04.970 --> 00:13:07.309 up the credentialing. Like it was a whole nightmare 00:13:07.309 --> 00:13:10.809 that has taken me years to come over. So I did 00:13:10.809 --> 00:13:12.190 it all myself back in the day, but it wasn't 00:13:12.190 --> 00:13:13.970 done correctly. Now I have somebody who does 00:13:13.970 --> 00:13:16.710 credentialing for me. Who's that? Or like, you 00:13:16.710 --> 00:13:20.120 don't say who, but like it's it. It's my virtual 00:13:20.120 --> 00:13:22.679 medical assistant. So I went and I looked for 00:13:22.679 --> 00:13:25.139 a person from the Philippines that would do my 00:13:25.139 --> 00:13:26.620 credentialing. So she already had experience 00:13:26.620 --> 00:13:29.200 in credentialing. I hired her in and she does 00:13:29.200 --> 00:13:32.019 all of it for us. Wow. That's incredible. And 00:13:32.019 --> 00:13:33.980 she does it right. It's amazing. She does everything 00:13:33.980 --> 00:13:36.740 correct. Like she will negotiate rates. And then 00:13:36.740 --> 00:13:38.360 she also like crossworks on the billing team 00:13:38.360 --> 00:13:41.399 and our support team. That's incredible. Wait, 00:13:41.440 --> 00:13:43.580 when did you hire your first support staff? So 00:13:43.580 --> 00:13:47.039 I had hired like some people here in the United 00:13:47.039 --> 00:13:49.700 States for a while and I had terrible experiences, 00:13:49.860 --> 00:13:54.320 like horrendous. Really? Horrendous, dude. Horrendous. 00:13:54.320 --> 00:13:57.019 Like. people just like pretending they were working 00:13:57.019 --> 00:13:59.320 and like they weren't doing anything, like doing 00:13:59.320 --> 00:14:01.639 things incorrectly, like not being professional. 00:14:01.799 --> 00:14:05.480 Like it was just horrible. So I ended up hiring 00:14:05.480 --> 00:14:07.759 my first like virtual medical assistant through 00:14:07.759 --> 00:14:12.279 a company in like 2022. It was 2022. And I like 00:14:12.279 --> 00:14:13.519 was talking to him and I was like, dude, how 00:14:13.519 --> 00:14:14.940 much are they paying you? I'm paying $2 ,000 00:14:14.940 --> 00:14:16.860 a month to have you and you're working overnight. 00:14:16.980 --> 00:14:20.220 So he's like $3 an hour. And I was like. I'm 00:14:20.220 --> 00:14:23.139 paying $2 ,000 and you're getting $3 an hour. 00:14:23.179 --> 00:14:25.500 You can't even support your family. And his wife 00:14:25.500 --> 00:14:27.080 was pregnant. And I was like, how are you even 00:14:27.080 --> 00:14:29.179 going to like you don't have insurance. You don't 00:14:29.179 --> 00:14:33.580 have anything. I fired the company and I rehired 00:14:33.580 --> 00:14:36.879 the VA low key and paid for his wife to give 00:14:36.879 --> 00:14:39.740 birth in a hospital and paid him $10 an hour. 00:14:40.360 --> 00:14:42.899 That's cool. Yeah. And that's kind of like how 00:14:42.899 --> 00:14:44.860 I started my VA journey. And now I have tons 00:14:44.860 --> 00:14:47.700 of VAs. I don't even know how many like 15. Wow. 00:14:48.139 --> 00:14:51.519 And you so you hire them all directly. I hire 00:14:51.519 --> 00:14:55.659 them directly. Yeah. So I made a course on like 00:14:55.659 --> 00:14:57.720 how you can do this because there's like a lot 00:14:57.720 --> 00:14:59.779 of nuances of like, how do you communicate? What 00:14:59.779 --> 00:15:01.980 systems can they use in the Philippines? Right. 00:15:02.059 --> 00:15:05.100 Like phones, all of that stuff. So, yeah, I hire 00:15:05.100 --> 00:15:06.980 everybody directly and I pay them very fairly. 00:15:07.120 --> 00:15:08.919 So I actually have like my in -laws are from 00:15:08.919 --> 00:15:11.080 the Philippines, like my husband has family in 00:15:11.080 --> 00:15:12.679 the Philippines. This isn't like, oh, I'm going 00:15:12.679 --> 00:15:15.120 to find some worker and exploit them. This is 00:15:15.120 --> 00:15:18.279 like, no, these are my people and I'm not going 00:15:18.279 --> 00:15:21.000 to cause harm to people in a culture that's like, 00:15:21.019 --> 00:15:23.799 you know, my children's. So it's very important 00:15:23.799 --> 00:15:26.419 to me to take care of those people. Yeah. Wait, 00:15:26.480 --> 00:15:28.299 so you have almost as many support staff as you 00:15:28.299 --> 00:15:30.940 do providers? Yeah. So I have a whole billing 00:15:30.940 --> 00:15:32.960 team. I have a credentialing person. I have a 00:15:32.960 --> 00:15:35.019 social media person. I have a website person. 00:15:35.320 --> 00:15:38.720 Like, yeah. Did it take a lot of like training 00:15:38.720 --> 00:15:42.620 of them to? No, like that's like the misconception. 00:15:42.919 --> 00:15:44.039 Everyone's like, well, what am I going to do 00:15:44.039 --> 00:15:45.240 with them? How am I going to train them? It's 00:15:45.240 --> 00:15:47.080 like, bro, they're trained. They've already worked 00:15:47.080 --> 00:15:49.179 for places. They come from these companies and 00:15:49.179 --> 00:15:51.700 they're looking for like fair pay. Yeah. They 00:15:51.700 --> 00:15:53.059 know how to do it. You just kind of show them 00:15:53.059 --> 00:15:55.190 the system and that's it. That's incredible. 00:15:55.610 --> 00:15:59.950 So your course is for providers who want to kind 00:15:59.950 --> 00:16:03.330 of hire virtual assistants directly and how to 00:16:03.330 --> 00:16:06.370 do that. Training, like interviews, like all 00:16:06.370 --> 00:16:08.149 of that. Like, what do you ask? How do you kind 00:16:08.149 --> 00:16:09.909 of vibe out somebody who's lying? Because people 00:16:09.909 --> 00:16:11.870 can, you know, misrepresent themselves. So we 00:16:11.870 --> 00:16:14.070 go over that. And I have like a little kind of 00:16:14.070 --> 00:16:16.610 video of me talking to my VA. So you can actually 00:16:16.610 --> 00:16:18.769 see like what the communication style is like 00:16:18.769 --> 00:16:21.889 and like how they are as people. That's really 00:16:21.889 --> 00:16:24.940 cool. I know that it hasn't been easy working 00:16:24.940 --> 00:16:28.600 with insurance, right? No, never. What's been 00:16:28.600 --> 00:16:32.419 the hardest part? Dude, they are like, how do 00:16:32.419 --> 00:16:34.620 I want to phrase this? They are like so manipulative 00:16:34.620 --> 00:16:38.539 and they prey. They prey on us as private practices. 00:16:38.779 --> 00:16:41.559 And that's the hard thing is that they will underpay 00:16:41.559 --> 00:16:44.820 us and they expect you not to notice. So you 00:16:44.820 --> 00:16:46.759 get. People don't really understand it either 00:16:46.759 --> 00:16:48.460 when they're doing it themselves. You get a contracted 00:16:48.460 --> 00:16:50.179 rate. I'm getting 100 bucks for every med check 00:16:50.179 --> 00:16:52.720 I do. Right. So like the insurance will send 00:16:52.720 --> 00:16:54.480 me 100, 100, 100 for every med check. And then 00:16:54.480 --> 00:16:56.580 randomly they'll start sending me 99. And then 00:16:56.580 --> 00:16:58.860 they'll start sending me 9902. And then they'll 00:16:58.860 --> 00:17:02.080 send me like 9804. Right. And then all of a sudden 00:17:02.080 --> 00:17:04.259 they're sending me $60 for a med check. And then 00:17:04.259 --> 00:17:06.339 they're sending me 100. And it's so mixed in 00:17:06.339 --> 00:17:08.000 there. And there's so many claims coming back. 00:17:08.079 --> 00:17:09.700 And you contact them and you're like, why did 00:17:09.700 --> 00:17:11.559 you underpay me? This is not my rate. And they're 00:17:11.559 --> 00:17:15.049 like, oops, resubmit it. More paperwork. So they 00:17:15.049 --> 00:17:17.190 create these administrative burdens so you don't 00:17:17.190 --> 00:17:18.990 notice. And if you don't notice within six months, 00:17:19.069 --> 00:17:22.309 you cannot resubmit it. So I lost tens of thousands 00:17:22.309 --> 00:17:25.369 of dollars, probably like $30 ,000 to $40 ,000 00:17:25.369 --> 00:17:27.809 because I didn't notice on time. And Blue Cross 00:17:27.809 --> 00:17:29.930 told me, too bad. You're bad. We're keeping it. 00:17:30.250 --> 00:17:33.190 Oh, my gosh. How did you realize it? You just 00:17:33.190 --> 00:17:36.549 started looking more closely? So I fired my billing 00:17:36.549 --> 00:17:38.890 company and I hired from the Philippines and 00:17:38.890 --> 00:17:40.190 I said, I don't understand what's going on with 00:17:40.190 --> 00:17:42.369 my money, but I have no money. Like I'm not making 00:17:42.369 --> 00:17:44.730 anything. We're bleeding money. Find out what's 00:17:44.730 --> 00:17:46.170 going on. And they looked at everything and they're 00:17:46.170 --> 00:17:48.450 like, this is the problem. And we started like 00:17:48.450 --> 00:17:51.150 fighting it and Blue Cross said too bad. Yeah. 00:17:51.410 --> 00:17:54.289 Wow. Wow, wow, wow. How long are your follow 00:17:54.289 --> 00:17:56.609 up appointments? 30 minutes. They're always 30 00:17:56.609 --> 00:18:00.579 minutes. OK. And what percentage of those do 00:18:00.579 --> 00:18:02.819 you think your providers do like brief psychotherapy 00:18:02.819 --> 00:18:05.140 with? So like there's like an ethical concern 00:18:05.140 --> 00:18:07.359 with that where I like I don't want my providers 00:18:07.359 --> 00:18:11.000 going into a 30 minute encounter and being like, 00:18:11.160 --> 00:18:13.859 OK, I'm going to, you know, overcharge people 00:18:13.859 --> 00:18:15.519 and add in the surprise charge and they're going 00:18:15.519 --> 00:18:17.299 to get hit with this feed that they weren't anticipating. 00:18:17.380 --> 00:18:19.599 I try to be very transparent in our pricing like 00:18:19.599 --> 00:18:22.299 that. If it's like to the insurance company, 00:18:22.500 --> 00:18:24.460 like maybe they'll consider doing it. But like 00:18:24.460 --> 00:18:27.910 I would say like less than 20 percent. OK. Yeah. 00:18:28.369 --> 00:18:30.710 Gotcha. Gotcha. Gotcha. Yeah. Because there's 00:18:30.710 --> 00:18:34.890 been places that are like, you're doing 30 minutes. 00:18:34.910 --> 00:18:36.809 You have to bill this, which is unethical. No. 00:18:37.329 --> 00:18:39.569 No. It's like, did you actually do it? And that's 00:18:39.569 --> 00:18:40.849 the thing. And like, these people are going to 00:18:40.849 --> 00:18:43.150 get hit with those charges. Or like, you're fraudulently 00:18:43.150 --> 00:18:45.309 sending it to insurance, which also isn't great. 00:18:45.950 --> 00:18:48.029 Right. It's like, have the conversation with 00:18:48.029 --> 00:18:50.190 the person that you're going to be doing this 00:18:50.190 --> 00:18:52.529 service and make sure that they're on board with 00:18:52.529 --> 00:18:54.509 that. Yeah. And they're actually getting something, 00:18:54.569 --> 00:18:56.190 not just like, oh, we have a longer med check. 00:18:56.289 --> 00:19:00.829 I'm going to. Throw this in. Yeah. The five in 00:19:00.829 --> 00:19:04.069 -person locations you have. Wait, how many of 00:19:04.069 --> 00:19:06.210 your providers are like virtual versus like in 00:19:06.210 --> 00:19:08.970 person? I think the easier question is how many 00:19:08.970 --> 00:19:10.789 in person do we have? We have one in Flagstaff. 00:19:10.829 --> 00:19:13.450 We have two in Tucson. We have two in Phoenix. 00:19:13.650 --> 00:19:17.890 We have two in Tempe. And we have one in Mesa. 00:19:18.549 --> 00:19:22.250 How do you like determine who is like fully virtual 00:19:22.250 --> 00:19:25.890 versus in person? Who wants to be in person? 00:19:26.509 --> 00:19:28.210 I'm like more like a little bit more on like 00:19:28.210 --> 00:19:30.029 I want my newer people coming in to do some in 00:19:30.029 --> 00:19:32.269 person. So like I'll make the contract for hybrid, 00:19:32.329 --> 00:19:34.390 but also I'll open offices near where they live. 00:19:34.730 --> 00:19:36.490 So like I'm not going to expect you to drive 00:19:36.490 --> 00:19:38.849 45 minutes to your location. Like I'll just find 00:19:38.849 --> 00:19:41.210 a therapy office that's got, you know, a room 00:19:41.210 --> 00:19:43.069 open and we'll run it out and you can just do 00:19:43.069 --> 00:19:47.829 your work there. Yeah. Okay. As far as like marketing 00:19:47.829 --> 00:19:51.890 and where your referrals come from, what's the 00:19:51.890 --> 00:19:55.140 like breakdown there? Is it like? I feel like 00:19:55.140 --> 00:19:58.319 early on, I probably did so much networking with 00:19:58.319 --> 00:20:00.859 like therapists, primary care, everyone I could 00:20:00.859 --> 00:20:05.039 find. So midwives, doulas. So I think like a 00:20:05.039 --> 00:20:06.779 lot of the people still come from that. And then 00:20:06.779 --> 00:20:08.680 we get a lot of like word of mouth of like, you 00:20:08.680 --> 00:20:10.880 know, this patient had great care. We're very 00:20:10.880 --> 00:20:14.680 much like a very loud, affirming practice. And 00:20:14.680 --> 00:20:17.640 I feel like that's beneficial too. So we do see 00:20:17.640 --> 00:20:19.859 like a lot of therapists as patients who then 00:20:19.859 --> 00:20:22.380 send us their patients too, because they feel 00:20:22.380 --> 00:20:25.170 cared for. Yeah. I mean, I'm, I'm a patient. 00:20:27.930 --> 00:20:30.009 I mean, it's a good practice. We have great providers. 00:20:30.450 --> 00:20:33.690 Right. I mean, what can I say? That's cool though. 00:20:33.769 --> 00:20:35.630 That's really cool. Yeah. I think that's kind 00:20:35.630 --> 00:20:37.730 of how I even got started was another provider 00:20:37.730 --> 00:20:41.609 being like, yeah. Yeah. So that's, I love that. 00:20:41.690 --> 00:20:45.329 Your providers that you've found, where have 00:20:45.329 --> 00:20:48.920 you found them from primarily? Usually my preference 00:20:48.920 --> 00:20:51.599 and like maybe half are students. So if we have 00:20:51.599 --> 00:20:53.500 precepted you and we have trained you and we 00:20:53.500 --> 00:20:55.960 have verified that you are great at your job 00:20:55.960 --> 00:20:58.680 and will be great at your job, then we will hire 00:20:58.680 --> 00:21:00.900 on. And then you're kind of already into the 00:21:00.900 --> 00:21:03.539 culture. The other ones I feel like I posted 00:21:03.539 --> 00:21:06.660 maybe like on Indeed or there was somebody who 00:21:06.660 --> 00:21:08.420 found us like, you know, maybe from a TikTok 00:21:08.420 --> 00:21:11.519 or something, one of my TikToks, and they submitted 00:21:11.519 --> 00:21:13.819 an application from that. But usually like either 00:21:13.819 --> 00:21:18.650 an application or a student. OK, how do you decide 00:21:18.650 --> 00:21:20.430 what students you'll take? Because I know like 00:21:20.430 --> 00:21:25.369 people are very, very thirsty for finding a preceptor. 00:21:25.390 --> 00:21:27.829 And it's like, how would one get in the door 00:21:27.829 --> 00:21:31.380 at Paper Flower for precepting? Well, you would 00:21:31.380 --> 00:21:34.019 read the website and realize what kind of practice 00:21:34.019 --> 00:21:36.680 we are and read our story and read our values 00:21:36.680 --> 00:21:38.640 and then decide if you align with those values. 00:21:38.799 --> 00:21:40.980 And if you do, you would look at the precepting 00:21:40.980 --> 00:21:43.299 page and see that I don't want a bullshit cover 00:21:43.299 --> 00:21:46.460 letter saying like, hello, I have all of this 00:21:46.460 --> 00:21:49.220 experience as an RN and I blah, blah, blah. I 00:21:49.220 --> 00:21:51.519 don't care. I don't fucking care about your professionalism. 00:21:51.539 --> 00:21:53.240 I don't fucking care about that in a job application. 00:21:53.480 --> 00:21:55.880 I want to know who are you as a person. Did you 00:21:55.880 --> 00:21:58.180 read my website and do you vibe with that? Like 00:21:58.180 --> 00:21:59.900 if you're not writing a personal. personalized 00:21:59.900 --> 00:22:02.619 cover letter and a personalized email, I don't 00:22:02.619 --> 00:22:05.460 want it. I will literally delete it. Yeah, I 00:22:05.460 --> 00:22:07.700 love that. I love that. I think that's really 00:22:07.700 --> 00:22:09.740 awesome that you're just like straightforward 00:22:09.740 --> 00:22:12.059 about that and direct because I think like, yeah, 00:22:12.140 --> 00:22:14.519 there are standards and we need to kind of up 00:22:14.519 --> 00:22:16.880 our professionalism, I think. And when we're 00:22:16.880 --> 00:22:19.160 looking for those rotations, personally, that's 00:22:19.160 --> 00:22:21.539 how I feel. Or down it. You know, for us, it's 00:22:21.539 --> 00:22:23.180 down your professionalism and throw, like, a 00:22:23.180 --> 00:22:24.900 fuck into your email and, like, I'll probably 00:22:24.900 --> 00:22:29.000 respond. Yeah. But, like, it's about catering 00:22:29.000 --> 00:22:30.819 it to the. Maybe professionalism isn't the right 00:22:30.819 --> 00:22:32.779 term, but, like, intention. Intention. I'll get 00:22:32.779 --> 00:22:36.559 messages that are like, hey, Linda, like, on 00:22:36.559 --> 00:22:38.940 TikTok or something, like, I need a preceptor, 00:22:38.940 --> 00:22:40.599 you know, and I'm just like. And Mariah. Yeah, 00:22:40.720 --> 00:22:43.039 I get that, too. And, like, Mariah, I would like 00:22:43.039 --> 00:22:46.019 to be at Paper Flowers Psychiatry. And I'm like, 00:22:46.119 --> 00:22:49.710 that's cute. Okay. Good luck. Yeah. You're like, 00:22:49.789 --> 00:22:51.470 this is not going to be a fit. This is not going 00:22:51.470 --> 00:22:53.509 to be a fit. You hired somebody from my fellowship. 00:22:53.630 --> 00:22:56.269 That was exciting. God, dude, she is great like 00:22:56.269 --> 00:22:59.349 that. This fellowship is so cool because like 00:22:59.349 --> 00:23:01.710 when I'm hiring somebody and like they're not 00:23:01.710 --> 00:23:04.589 a student with us, like I have no idea if they're 00:23:04.589 --> 00:23:06.589 going to suck at their job. Like, what did they 00:23:06.589 --> 00:23:08.910 learn? Who did they precept with? Do I need to 00:23:08.910 --> 00:23:12.190 teach things? But like she came in so prepared 00:23:12.190 --> 00:23:14.630 and you could vouch for her and like she is everything 00:23:14.630 --> 00:23:18.230 and more than you vouch for. I love that. I love 00:23:18.230 --> 00:23:20.150 her. She's a great provider. She's a great dude. 00:23:20.490 --> 00:23:22.529 And that makes me really happy. I love, I kind 00:23:22.529 --> 00:23:24.009 of feel like a psych and fee matchmaker a little 00:23:24.009 --> 00:23:26.029 bit sometimes where I'm like, I'm kind of about 00:23:26.029 --> 00:23:28.269 that. Yeah. You know what I mean? Like who would 00:23:28.269 --> 00:23:32.029 be a good fit? And yeah, I enjoy it. So thanks 00:23:32.029 --> 00:23:33.910 for giving her a chance. I know she's very grateful 00:23:33.910 --> 00:23:36.609 and she's learned a lot. And also like, it was 00:23:36.609 --> 00:23:39.069 super cool because when you connected with her 00:23:39.069 --> 00:23:40.730 here, she's like been having such a hard time 00:23:40.730 --> 00:23:42.630 finding a job in Arizona, which is so different 00:23:42.630 --> 00:23:46.849 than when I graduated in 2015. And. She's like, 00:23:46.930 --> 00:23:49.990 oh, they're doing like a retreat. And Maria said 00:23:49.990 --> 00:23:53.210 I could come. I was like, incredible. Like you 00:23:53.210 --> 00:23:55.829 really reinvest into your providers, don't you? 00:23:56.349 --> 00:23:59.410 Yeah, that's the thing is like people will underpay 00:23:59.410 --> 00:24:01.289 people and like you're not going to have a good 00:24:01.289 --> 00:24:03.329 retention rate. I literally don't take a huge 00:24:03.329 --> 00:24:05.289 salary from this. We make a ton of money, but 00:24:05.289 --> 00:24:07.250 like I will put that into like let's have an 00:24:07.250 --> 00:24:09.089 annual retreat. Let's go to Seattle. I'm going 00:24:09.089 --> 00:24:10.630 to pay for everybody. Like I'm going to pay for 00:24:10.630 --> 00:24:12.950 the hotels. Let's go to Hawaii. Like let me pay 00:24:12.950 --> 00:24:15.680 for a boat for everybody to hang out. And like 00:24:15.680 --> 00:24:17.559 we get to have these amazing times where we're 00:24:17.559 --> 00:24:20.119 bonding for like a week. And that's sick. Like, 00:24:20.119 --> 00:24:22.579 why am I going to take a salary? You know, if 00:24:22.579 --> 00:24:24.839 I don't. Well, I guess I could need it. But like, 00:24:24.920 --> 00:24:27.079 you know, there's better ways to keep people 00:24:27.079 --> 00:24:29.759 and have your business going well. Right. Yeah. 00:24:29.859 --> 00:24:33.019 And it's like you care about the impact that 00:24:33.019 --> 00:24:35.720 you're making on patients, on providers. You 00:24:35.720 --> 00:24:38.400 know, you're not just like trying to make money 00:24:38.400 --> 00:24:41.630 and go live the high life and be like. I've never 00:24:41.630 --> 00:24:44.549 in five, six years of having this, like looked 00:24:44.549 --> 00:24:45.890 at a provider and said, you're not making me 00:24:45.890 --> 00:24:47.710 enough money. I've never looked at their productivity 00:24:47.710 --> 00:24:51.650 numbers, nothing. Like if they can't come into 00:24:51.650 --> 00:24:53.130 work because like something happened with their 00:24:53.130 --> 00:24:54.650 family, I'll be like, dude, are you okay? Can 00:24:54.650 --> 00:24:56.069 I send your refills for you? Do you need anything? 00:24:56.190 --> 00:24:58.130 I send them flowers to their house. Like I'll 00:24:58.130 --> 00:25:00.410 send them like a love basket. What do they need? 00:25:00.670 --> 00:25:02.529 You know? Okay. Yeah, sorry. I'm not laughing 00:25:02.529 --> 00:25:04.890 at that. I'm laughing because I remember like, 00:25:04.950 --> 00:25:08.950 you know, who you hired from the fellowship calling 00:25:08.950 --> 00:25:11.210 me and be like. marie is all concerned about 00:25:11.210 --> 00:25:13.869 like my health and she's like so nice i'm like 00:25:13.869 --> 00:25:17.569 super tripped out like she cares like i'm super 00:25:17.569 --> 00:25:19.710 like thrown off right now just because she didn't 00:25:19.710 --> 00:25:21.349 come from an environment like that right yeah 00:25:21.349 --> 00:25:24.430 so i just i thought that was really cool she's 00:25:24.430 --> 00:25:26.789 like i'm not used to this i'm not i sent her 00:25:26.789 --> 00:25:28.650 like i think she got into an accident at one 00:25:28.650 --> 00:25:30.630 point and i sent her like just a fender bender 00:25:30.630 --> 00:25:33.029 and i sent her like stuff for you know like self 00:25:33.029 --> 00:25:34.930 -care stuff so she could take the day off and 00:25:34.930 --> 00:25:36.690 just like chill because like that's stressful 00:25:36.690 --> 00:25:40.019 you know yeah For sure. Speaking of stress, like 00:25:40.019 --> 00:25:43.460 how many patients do you see now these days? 00:25:43.980 --> 00:25:46.599 Jeez, man, maybe like I've given up my whole 00:25:46.599 --> 00:25:52.359 load. I might have like three left. Three patients? 00:25:52.880 --> 00:25:54.859 Yeah, I think that's my caseload right now is 00:25:54.859 --> 00:25:57.579 three. I've given up most of them. Yeah, because 00:25:57.579 --> 00:26:01.859 it's like I'm sure it's full time running and 00:26:01.859 --> 00:26:04.220 scaling a practice like this, right? Like you're 00:26:04.220 --> 00:26:07.369 probably. pretty available to like staff cases 00:26:07.369 --> 00:26:10.130 and, you know, help the VAs out. Or I don't know, 00:26:10.150 --> 00:26:11.970 what does a typical day look like for you? To 00:26:11.970 --> 00:26:15.789 be quite honest. I could see patients full time 00:26:15.789 --> 00:26:17.210 or at least like part time. I could probably 00:26:17.210 --> 00:26:18.890 see them realistically part time and then do 00:26:18.890 --> 00:26:21.609 like admin part time. Like my day is typically 00:26:21.609 --> 00:26:24.230 like I'll answer urgent things. I'll do on call. 00:26:24.349 --> 00:26:26.990 Like if somebody is off on a holiday and there's 00:26:26.990 --> 00:26:29.029 a patient in need, I'll see that patient. I'll 00:26:29.029 --> 00:26:31.049 do like, you know, somebody can't get in for 00:26:31.049 --> 00:26:32.769 an eval and they really need it. I'll do it and 00:26:32.769 --> 00:26:35.589 then send them to someone else. Yeah. But usually 00:26:35.589 --> 00:26:38.190 it's like I'm there for provider questions. I'm 00:26:38.190 --> 00:26:40.509 there to kind of like, you know, put out fires, 00:26:40.650 --> 00:26:44.000 answer stuff. But like I mostly don't see patients 00:26:44.000 --> 00:26:45.940 because of my kids. Like I'm with my kids so 00:26:45.940 --> 00:26:49.400 full time and like I just don't have I don't 00:26:49.400 --> 00:26:51.920 have time because of them. If I didn't have my 00:26:51.920 --> 00:26:53.460 kids and like when they go to school, I'll be 00:26:53.460 --> 00:26:56.279 seeing patients more. Yeah. But right now I just 00:26:56.279 --> 00:27:00.579 can't. Yeah. Hundred percent. You also do a lot 00:27:00.579 --> 00:27:04.920 of education around autism, neurodivergence. 00:27:05.140 --> 00:27:08.019 Yeah. Talk to us about like the Institute, Paperflower 00:27:08.019 --> 00:27:09.640 Institute. I know you're going to be coming in 00:27:09.640 --> 00:27:11.839 speaking to my fellowship to educate the providers 00:27:11.839 --> 00:27:15.160 more on diagnosing that because it's not real 00:27:15.160 --> 00:27:18.400 accessible here in Arizona. I know that. And 00:27:18.400 --> 00:27:20.339 I think there's like so many misconceptions around 00:27:20.339 --> 00:27:23.019 the diagnoses in general and so much stigma from 00:27:23.019 --> 00:27:25.279 providers is the problem, because like most of 00:27:25.279 --> 00:27:27.079 us, when we were trained back in the day or even 00:27:27.079 --> 00:27:29.059 if we were trained now, like we're not getting 00:27:29.059 --> 00:27:32.819 the correct information about what this looks 00:27:32.819 --> 00:27:35.539 like. Right. Like we have kind of like for people 00:27:35.539 --> 00:27:36.819 who don't understand it, like you kind of come 00:27:36.819 --> 00:27:38.319 into this like what does autism look like? It 00:27:38.319 --> 00:27:39.779 looks like somebody who's like flapping their 00:27:39.779 --> 00:27:41.940 hands. It looks like a little boy who loves trains. 00:27:42.259 --> 00:27:45.549 Right. Like I don't. probably present as autistic 00:27:45.549 --> 00:27:47.210 to most people who are going to look at me. I 00:27:47.210 --> 00:27:50.349 am autistic. My kids are autistic. And they wouldn't 00:27:50.349 --> 00:27:52.750 have like, you know, scored as autistic on the 00:27:52.750 --> 00:27:55.269 gold standard, the ADOS. Like they failed that 00:27:55.269 --> 00:27:58.680 technically. So like. When people are on like 00:27:58.680 --> 00:28:00.940 the PMHNP board saying like, oh, what's wrong 00:28:00.940 --> 00:28:02.359 with this person? I think it's a personality 00:28:02.359 --> 00:28:04.059 disorder. It's access to and like I'm reading 00:28:04.059 --> 00:28:05.779 it and I'm like, they're fucking autistic. Like, 00:28:05.799 --> 00:28:07.700 why is nobody asking about that as the differential? 00:28:08.140 --> 00:28:10.539 Like, you guys are not like looking at so many 00:28:10.539 --> 00:28:12.819 like missing components of like, what can autism 00:28:12.819 --> 00:28:15.619 present as? So I've been trying to like advocate 00:28:15.619 --> 00:28:18.460 more for my providers, my team, like let's implement 00:28:18.460 --> 00:28:21.119 sensory screenings on every single new patient 00:28:21.119 --> 00:28:23.380 we have. Like, sure, you have a PHQ -9, you have 00:28:23.380 --> 00:28:25.440 a GAD, but why not send a sensory screener? And 00:28:25.440 --> 00:28:26.980 then you can see like, are they answering? these 00:28:26.980 --> 00:28:28.940 questions too literally their sensory screener 00:28:28.940 --> 00:28:31.460 is really high like it's a possibility of neurodivergence 00:28:31.460 --> 00:28:34.819 right so we're not misdiagnosing people so very 00:28:34.819 --> 00:28:37.799 much like focused on that yeah because i remember 00:28:37.799 --> 00:28:40.059 early on where i was working them being like 00:28:40.059 --> 00:28:43.339 well you know in arizona like it's not recognized 00:28:43.339 --> 00:28:46.920 for psych mps to diagnose this so basically you 00:28:46.920 --> 00:28:48.740 know don't diagnose it because you're not going 00:28:48.740 --> 00:28:50.500 to be able to treat it and try to just refer 00:28:50.500 --> 00:28:53.599 out and i'm like okay to who like But that's 00:28:53.599 --> 00:28:55.079 the right. And there's not a lot of providers 00:28:55.079 --> 00:28:58.259 who do. But we can diagnose it if you feel competent. 00:28:58.400 --> 00:29:01.180 We just don't have that accepted by DDD. However, 00:29:01.420 --> 00:29:03.700 there are a large amount of people now looking 00:29:03.700 --> 00:29:06.460 for answers for a late diagnosis of why am I 00:29:06.460 --> 00:29:08.859 so different? What's wrong with me? Like, am 00:29:08.859 --> 00:29:10.920 I autistic? And like you have these providers 00:29:10.920 --> 00:29:12.259 who are throwing them back saying, well, you 00:29:12.259 --> 00:29:14.440 make eye contact. You can't be autistic. Like, 00:29:14.460 --> 00:29:16.380 why are you here? These people have done hours 00:29:16.380 --> 00:29:18.759 and weeks of research before presenting to your 00:29:18.759 --> 00:29:22.039 office and probably very much are autistic. Right. 00:29:22.039 --> 00:29:24.220 So like we can prevent like we can go ahead and 00:29:24.220 --> 00:29:27.440 like give validating diagnoses. We do that. I 00:29:27.440 --> 00:29:29.180 do that. That's good to know, though, because 00:29:29.180 --> 00:29:31.119 I've had patients who come to me who have been 00:29:31.119 --> 00:29:33.619 like, I paid a couple thousand dollars for this 00:29:33.619 --> 00:29:36.279 diagnosis, you know, at this place in New York 00:29:36.279 --> 00:29:38.940 because I didn't really know where to go for 00:29:38.940 --> 00:29:41.839 that. So they can they can, you know, come to 00:29:41.839 --> 00:29:44.200 Paper Flower and get that type of treatment and 00:29:44.200 --> 00:29:47.180 help. We do like long neurodivergence evals. 00:29:47.180 --> 00:29:49.180 I'll send out like a 30 page report with like 00:29:49.180 --> 00:29:51.240 recommendations for OT and sensory stuff. And 00:29:51.240 --> 00:29:52.599 we talk about like, what does it look like to 00:29:52.599 --> 00:29:54.460 be late diagnosed? I'm late diagnosed. I wasn't 00:29:54.460 --> 00:29:58.119 diagnosed until like two years ago. And then 00:29:58.119 --> 00:30:01.579 can you talk about Leucovorin? Is that how you 00:30:01.579 --> 00:30:04.140 say it? I think so. That's how I've been saying 00:30:04.140 --> 00:30:09.660 it. This is a medication that was recently kind 00:30:09.660 --> 00:30:13.299 of like. spoken about loudly by our government 00:30:13.299 --> 00:30:15.200 saying like, this could be the cure for autism. 00:30:15.319 --> 00:30:17.140 This is not in fact a cure for autism. However, 00:30:17.319 --> 00:30:19.259 this is a very beneficial medication that's been 00:30:19.259 --> 00:30:21.500 around for like a decade. People have been using 00:30:21.500 --> 00:30:23.940 this medication for quite a long time. This is 00:30:23.940 --> 00:30:27.839 actually a high dose of folic acid, right? So 00:30:27.839 --> 00:30:29.859 there's different forms of folate. It's very 00:30:29.859 --> 00:30:31.680 complicated when you look at it. I actually made 00:30:31.680 --> 00:30:33.930 a a course too on paper flower institute of how 00:30:33.930 --> 00:30:36.650 to prescribe it how to kind of like anticipate 00:30:36.650 --> 00:30:39.109 side effects dosing all that stuff because it's 00:30:39.109 --> 00:30:41.589 not in like stall right but essentially like 00:30:41.589 --> 00:30:45.289 people find anecdotal benefits so if you're looking 00:30:45.289 --> 00:30:47.730 at reddit versus like you know evidence -based 00:30:47.730 --> 00:30:50.509 shit that like nobody's done the study yet you'll 00:30:50.509 --> 00:30:52.089 find that people are like my non -verbal child 00:30:52.089 --> 00:30:54.430 is speaking like personally i put my kids on 00:30:54.430 --> 00:30:57.789 it and i saw insane benefits wow that's incredible 00:30:57.789 --> 00:31:01.470 so How is it different than like L -methylfolate? 00:31:01.630 --> 00:31:03.710 That's a good question. So like L -methylfolate 00:31:03.710 --> 00:31:07.349 is like a already processed form of folate that 00:31:07.349 --> 00:31:09.470 kind of goes into the brain and it does one job, 00:31:09.470 --> 00:31:12.529 right? It just has one job. Folinic acid, which 00:31:12.529 --> 00:31:16.890 is leucovorin, is like kind of the truck of supplies. 00:31:17.049 --> 00:31:19.130 It's like all of the types of folate and it can 00:31:19.130 --> 00:31:22.819 morph into anything. Passes the blood -brain 00:31:22.819 --> 00:31:25.099 barrier, like, very easily and can, like, spread 00:31:25.099 --> 00:31:28.500 and kind of restore things. Interesting. So it 00:31:28.500 --> 00:31:30.420 works a lot differently. There's, like, some 00:31:30.420 --> 00:31:32.799 thought that, like, up to 60 % of autistic people 00:31:32.799 --> 00:31:36.480 might be deficient in folinic acid. Gotcha. So 00:31:36.480 --> 00:31:38.559 you've had a lot of success with this, sounds 00:31:38.559 --> 00:31:42.700 like. Yes. With your paychecks, too. Yes. For 00:31:42.700 --> 00:31:46.640 sure. Cool. I gotta get my... fellowship people 00:31:46.640 --> 00:31:48.920 access to your course somehow we'll talk about 00:31:48.920 --> 00:31:52.660 that later good discount I got you because it's 00:31:52.660 --> 00:31:54.420 like they they've asked about it right and to 00:31:54.420 --> 00:31:58.039 your point it's like evidence -based versus like 00:31:58.039 --> 00:32:02.099 reddit like yeah it is hard sometimes you know 00:32:02.099 --> 00:32:04.079 being on like more the teaching front as far 00:32:04.079 --> 00:32:06.579 as like yeah like oritate lithium oritate you 00:32:06.579 --> 00:32:08.440 know I've been doing that and I feel like it's 00:32:08.440 --> 00:32:11.960 helpful but it's like yeah it's kind of like 00:32:11.960 --> 00:32:16.430 you know Big wellness is making a lot of money, 00:32:16.470 --> 00:32:19.369 too. Right. So it's like trying to be judicious 00:32:19.369 --> 00:32:22.509 when looking at these types of interventions. 00:32:22.710 --> 00:32:24.549 You know what I mean? Because patients will come 00:32:24.549 --> 00:32:28.710 and ask. So because they're hearing it with their 00:32:28.710 --> 00:32:32.069 on social media, Reddit, like it's like same 00:32:32.069 --> 00:32:34.750 thing with like even, you know, micro tapers 00:32:34.750 --> 00:32:37.960 and deprescribing and like. And people are seeking 00:32:37.960 --> 00:32:39.920 me out for that because they're like, we can't 00:32:39.920 --> 00:32:43.799 afford like Dr. Whatever's paper clinic. And 00:32:43.799 --> 00:32:46.000 we thought, you know, but will you work with 00:32:46.000 --> 00:32:47.720 me in a compounding pharmacy? And I'm like, yeah, 00:32:47.759 --> 00:32:49.400 sure. Yeah, I'll do that. That's like a huge 00:32:49.400 --> 00:32:51.180 thing. And for people who don't know about that, 00:32:51.220 --> 00:32:52.940 it's a really important topic, right? Because 00:32:52.940 --> 00:32:55.220 if you've never withdrawn from antidepressants 00:32:55.220 --> 00:32:58.359 before, it's quite uncomfortable. So if there's 00:32:58.359 --> 00:33:01.579 a solution, there's a solution. Yeah, 100%. I 00:33:01.579 --> 00:33:04.700 agree. How do you take care of your mental health 00:33:04.700 --> 00:33:08.180 with like balancing these like three branches 00:33:08.180 --> 00:33:12.720 of paper flower and having two kids? Like how 00:33:12.720 --> 00:33:15.640 do you? I don't think that there's a great answer 00:33:15.640 --> 00:33:17.539 for me because I feel like I'm constantly drowning, 00:33:17.640 --> 00:33:20.559 but I have my own therapist. I try to like do 00:33:20.559 --> 00:33:22.599 some time like I have a respite provider now 00:33:22.599 --> 00:33:25.099 for my kids for a few hours a week. And that's 00:33:25.099 --> 00:33:27.720 been like insanely helpful. So even when they're 00:33:27.720 --> 00:33:29.180 at preschool, I'm trying to take advantage of 00:33:29.180 --> 00:33:30.599 like, OK, I'm going to work for a couple hours. 00:33:30.680 --> 00:33:32.640 I'm going to do something for myself. For me, 00:33:32.640 --> 00:33:34.279 it's like I'm going to take my dogs for a walk 00:33:34.279 --> 00:33:36.440 and I'm going to tattoo myself. That's all I 00:33:36.440 --> 00:33:37.880 want to do. You know, it's just zone out. You 00:33:37.880 --> 00:33:42.309 tattoo yourself? I do. Yeah. I got a little tattoo 00:33:42.309 --> 00:33:46.109 setup kit over here. What? I had no idea. I'm 00:33:46.109 --> 00:33:49.710 working on my knees today. Wow. I had no idea. 00:33:49.730 --> 00:33:52.509 That's just impressive. It's new. It's new. It's 00:33:52.509 --> 00:33:54.630 our paper flower hobby for a few of us. We just 00:33:54.630 --> 00:33:56.690 tattoo ourselves and autistically talk about 00:33:56.690 --> 00:33:58.829 it on text of, what did you tattoo yourself today? 00:33:59.190 --> 00:34:01.950 And when we get together, we tattoo each other 00:34:01.950 --> 00:34:05.089 quietly. That is hilarious. Why did I not know 00:34:05.089 --> 00:34:07.349 this about you? It's a fun fact. Yeah, it is 00:34:07.349 --> 00:34:10.070 a fun fact. We got into all the logistics. We 00:34:10.070 --> 00:34:11.829 didn't even really get to talk about you just 00:34:11.829 --> 00:34:13.670 on a personal level. Where were you born and 00:34:13.670 --> 00:34:16.449 raised? Do you have siblings? Massachusetts. 00:34:17.469 --> 00:34:20.750 I was born in rural Berkshires, the mountains. 00:34:20.949 --> 00:34:22.989 There's not much there. There's really no hope 00:34:22.989 --> 00:34:25.170 for life there. I was only able to go to nursing 00:34:25.170 --> 00:34:27.489 school because I got a scholarship from the nurse 00:34:27.489 --> 00:34:30.550 corps. So they paid for me to go to school. Otherwise, 00:34:30.630 --> 00:34:32.429 I would have been probably still in Pittsfield 00:34:32.429 --> 00:34:35.730 watching people die from heroin overdoses. Gotcha. 00:34:36.050 --> 00:34:39.559 So pretty bleak. Pretty bleak, pretty sad place. 00:34:39.860 --> 00:34:42.219 Like, yeah, it's just not a good place. And I 00:34:42.219 --> 00:34:43.800 don't really have much contact with my family 00:34:43.800 --> 00:34:46.639 anymore. Just kind of like everything's here. 00:34:46.699 --> 00:34:49.179 Everything's Arizona for me. When did you move 00:34:49.179 --> 00:34:53.460 to Arizona? 2017. I got divorced in 2016. I said, 00:34:53.480 --> 00:34:55.260 I'm leaving here. I'm never coming back to this 00:34:55.260 --> 00:34:57.619 place. And I just applied all over the country. 00:34:57.760 --> 00:34:59.679 Arizona gave me a job and said they'd pay for 00:34:59.679 --> 00:35:02.780 me to move. So I said, OK, here I go. And me 00:35:02.780 --> 00:35:06.460 and my cat moved. Wow. I didn't realize that 00:35:06.460 --> 00:35:10.719 you moved to Arizona in 2016. Yeah. Yeah. Right 00:35:10.719 --> 00:35:11.760 after I graduated. When did you graduate psych 00:35:11.760 --> 00:35:14.880 NP school? It was 2017. So 2017, I graduated 00:35:14.880 --> 00:35:18.539 and I just left like that week. I left. Where 00:35:18.539 --> 00:35:21.539 did you go for your DNP? I went to UMass Amherst 00:35:21.539 --> 00:35:24.579 for my DNP online, but then it was just a great 00:35:24.579 --> 00:35:26.719 program. I really loved it. Oh, that's cool. 00:35:27.099 --> 00:35:29.920 And then Regis College back in the day in like 00:35:29.920 --> 00:35:32.559 2014 for nursing school and psych NP school. 00:35:33.079 --> 00:35:36.510 Okay. Okay. Gotcha. It was in person back then. 00:35:37.090 --> 00:35:39.469 Would you recommend that program? I don't know. 00:35:39.489 --> 00:35:40.949 Like 10 years ago, I would say, yeah, I don't 00:35:40.949 --> 00:35:43.030 know about it now, but you know, it was a great, 00:35:43.110 --> 00:35:44.989 I worked as a professor at ASU and their nursing 00:35:44.989 --> 00:35:46.989 program is a great program too. I can say that. 00:35:47.349 --> 00:35:53.389 Yeah. What do you think about the influx of people 00:35:53.389 --> 00:35:57.070 becoming psych NPs? Like, like, you know, the 00:35:57.070 --> 00:36:01.090 pandemic hit virtual stuff. Like, I mean, surely 00:36:01.090 --> 00:36:03.980 you've noticed like a difference. from when we 00:36:03.980 --> 00:36:06.579 were first starting out right to like now like 00:36:06.579 --> 00:36:08.800 what do you think about all of it because it's 00:36:08.800 --> 00:36:12.460 it's a lot it's really fucking scary for the 00:36:12.460 --> 00:36:15.099 people who are going out there blind after 600 00:36:15.099 --> 00:36:18.739 hours of clinical and like your clinicals are 00:36:18.739 --> 00:36:20.820 varied I've had multiple people I've hired through 00:36:20.820 --> 00:36:22.539 my practice that I've had to terminate because 00:36:22.539 --> 00:36:25.099 they were poor providers that like they must 00:36:25.099 --> 00:36:27.739 have learned we were like beyond level one in 00:36:27.739 --> 00:36:29.780 nursing school like I couldn't even we couldn't 00:36:29.780 --> 00:36:31.980 catch up I'm very much a mentor but like the 00:36:32.510 --> 00:36:34.769 like the fact that they passed boards was terrifying 00:36:34.769 --> 00:36:38.789 to me like medication errors not knowing dosing 00:36:38.789 --> 00:36:40.909 not knowing side effects like very basic things 00:36:40.909 --> 00:36:43.989 and not knowing anything they're graduating like 00:36:43.989 --> 00:36:46.409 this and passing the boards there are people 00:36:46.409 --> 00:36:48.690 like it's all about like what you put into it 00:36:48.690 --> 00:36:50.309 and there's people who graduate from Walden and 00:36:50.309 --> 00:36:52.329 Frontier and these accelerated programs and they 00:36:52.329 --> 00:36:54.369 can be phenomenal because they put the extra 00:36:54.369 --> 00:36:56.590 work into it but then there's people who just 00:36:56.590 --> 00:36:57.969 don't give a fuck and they want to make money 00:36:57.969 --> 00:37:00.760 and that's terrifying It really is. So you've 00:37:00.760 --> 00:37:03.179 seen like this difference in the quality of. 00:37:04.179 --> 00:37:06.960 Yes. And like I am very much like the person 00:37:06.960 --> 00:37:09.000 of like, let's do this is kind of like a fellowship 00:37:09.000 --> 00:37:11.619 new job and we'll kind of ease you in. And like, 00:37:11.619 --> 00:37:13.880 dude, like sometimes there's no hope. Like there's 00:37:13.880 --> 00:37:16.940 just no hope. It's so scary. So, I mean, I appreciate 00:37:16.940 --> 00:37:20.820 your like fellowship program because like, dude, 00:37:20.980 --> 00:37:23.179 if without that, like people would be lost. So 00:37:23.179 --> 00:37:24.980 it kind of like adds that extra oomph of like 00:37:24.980 --> 00:37:27.300 here you're going to walk into a job and actually 00:37:27.300 --> 00:37:30.389 not be scared. Yeah. Because it has been a drastic 00:37:30.389 --> 00:37:32.389 change that I've noticed, too, where I'm just 00:37:32.389 --> 00:37:35.909 like, this is a serious job. Like, I mean, sure, 00:37:35.969 --> 00:37:37.369 you can have fun. You don't have to be a super 00:37:37.369 --> 00:37:40.289 serious person. You don't have to be super professional. 00:37:40.630 --> 00:37:43.510 But, like, we're impacting people's lives. Like, 00:37:43.550 --> 00:37:45.809 take it seriously, you guys. You could kill people. 00:37:45.949 --> 00:37:47.769 Like, you can very much kill people. And although 00:37:47.769 --> 00:37:50.480 they have not yet, like. like I've seen providers 00:37:50.480 --> 00:37:53.119 we've had patients in my practice die right from 00:37:53.119 --> 00:37:55.579 like all sorts of things suicides or whatever 00:37:55.579 --> 00:37:57.860 and like that happens and I don't know if these 00:37:57.860 --> 00:37:59.980 people are unaware like you think you're just 00:37:59.980 --> 00:38:01.659 gonna make a bunch of money in psych like this 00:38:01.659 --> 00:38:06.880 shit's wild yeah no 100 100 what would you say 00:38:06.880 --> 00:38:10.420 like brings you the most impact with what you're 00:38:10.420 --> 00:38:14.039 doing now in your career versus like what's been 00:38:14.039 --> 00:38:16.650 like The hardest part. The most impact I feel 00:38:16.650 --> 00:38:18.510 like has been sticking by my ethics. And I feel 00:38:18.510 --> 00:38:21.610 like that has brought me to wonderful places 00:38:21.610 --> 00:38:23.829 and it has kept me retention and it has grown 00:38:23.829 --> 00:38:26.090 this and it has had like, you know, patients 00:38:26.090 --> 00:38:28.429 come because there's like authenticity and I'm 00:38:28.429 --> 00:38:29.789 staying with my ethics. And I feel like that 00:38:29.789 --> 00:38:33.449 has been like a saving grace is not selling out. 00:38:34.289 --> 00:38:37.550 The hardest thing, dude, I don't know. I feel 00:38:37.550 --> 00:38:40.989 like as like a boss, like firing people fucking 00:38:40.989 --> 00:38:44.969 sucks. I feel like. like insurance is hard like 00:38:44.969 --> 00:38:46.730 there's just so many like HIPAA is hard we had 00:38:46.730 --> 00:38:48.869 a HIPAA violation had to get lawyers involved 00:38:48.869 --> 00:38:51.130 and like when you move into a big practice like 00:38:51.130 --> 00:38:54.369 there are so many like it just sucks I didn't 00:38:54.369 --> 00:38:56.429 come in to be an administrator I'm only the administrator 00:38:56.429 --> 00:38:58.570 and have a big practice because I got kids like 00:38:58.570 --> 00:39:01.409 and I can't see patients yeah so I feel like 00:39:01.409 --> 00:39:04.730 that whole part is just awful for me yeah I can't 00:39:04.730 --> 00:39:07.690 imagine like yeah having to fire but yeah I mean 00:39:07.690 --> 00:39:10.769 I have had to do it before but it's not fun you 00:39:10.769 --> 00:39:15.079 know It's like, yeah, but I can see where it's 00:39:15.079 --> 00:39:18.000 necessary, you know? So your husband's a nurse. 00:39:18.719 --> 00:39:21.440 Yeah, he is. What does he think about this whole, 00:39:21.619 --> 00:39:23.679 I don't even know what to call it, empire you've 00:39:23.679 --> 00:39:25.360 built? It's hilarious because I don't think he 00:39:25.360 --> 00:39:27.260 thinks anything. He didn't even, like, believe 00:39:27.260 --> 00:39:29.320 I had followers on TikTok for the longest time. 00:39:29.380 --> 00:39:32.199 I'm like, look, it's over 100 ,000. And he's 00:39:32.199 --> 00:39:34.590 like. Uh -huh. You know, he's like so apathetic 00:39:34.590 --> 00:39:37.190 about everything. I had him like try to help 00:39:37.190 --> 00:39:38.650 me in the early days, like make phone calls. 00:39:38.730 --> 00:39:40.409 And he was just like not into helping. That's 00:39:40.409 --> 00:39:42.030 why I'm like people have husbands who help them. 00:39:42.090 --> 00:39:44.869 That's amazing. Mine gives no fucks. He literally 00:39:44.869 --> 00:39:47.230 doesn't say anything. I don't know. Maybe it's 00:39:47.230 --> 00:39:53.170 his autism. Like, do you see what I built? Yeah. 00:39:53.250 --> 00:39:54.929 I'm like, I'm proud of myself. Look at it. Look 00:39:54.929 --> 00:39:57.969 at this nonprofit. I mean, he's like, cool. Okay. 00:39:58.550 --> 00:40:00.369 Go play with your Legos. Like, I don't know. 00:40:02.230 --> 00:40:05.750 It actually is kind of it's crazy to think about, 00:40:05.789 --> 00:40:08.710 like when we first connected back in 2020 to 00:40:08.710 --> 00:40:11.510 now, like all the different things that you felt. 00:40:12.269 --> 00:40:14.650 It blows my mind sometimes when I like sit down 00:40:14.650 --> 00:40:16.190 and look at it because like, I don't know, on 00:40:16.190 --> 00:40:17.989 the day to day, I'm just exhausted and drowning 00:40:17.989 --> 00:40:20.809 and there's just so much to do. But like it did 00:40:20.809 --> 00:40:23.610 take off and it is it's its own thing. And, you 00:40:23.610 --> 00:40:25.969 know, our practices paved the way for a lot of 00:40:25.969 --> 00:40:29.269 similar practices to also be vocal. So that's 00:40:29.269 --> 00:40:31.429 been cool. Yeah. Have you gotten a lot of that 00:40:31.429 --> 00:40:35.269 feedback from other providers? Oh, we're allowed 00:40:35.269 --> 00:40:38.949 to speak out and be authentically us and not 00:40:38.949 --> 00:40:42.170 be professional. I've had like quite a few people 00:40:42.170 --> 00:40:44.289 who say like our practice is the way it is because 00:40:44.289 --> 00:40:47.710 of yours. So that was cool, you know, to feel 00:40:47.710 --> 00:40:50.849 like I did something special. Yeah, 100 % and 00:40:50.849 --> 00:40:53.650 actually make a difference in the provider's 00:40:53.650 --> 00:40:55.730 lives who are helping patients like there's that 00:40:55.730 --> 00:40:58.789 ripple effect, which is why I'm guessing. would 00:40:58.789 --> 00:41:02.230 you ever sell paper flower? No, no. I knew the 00:41:02.230 --> 00:41:04.489 answer to that. I just wanted to, you know, it's 00:41:04.489 --> 00:41:06.710 funny, like funny story. So like our first retreat 00:41:06.710 --> 00:41:09.050 ever, Bree, who's like one of my first providers 00:41:09.050 --> 00:41:11.269 I hired, she's like, Maria, someday this is going 00:41:11.269 --> 00:41:13.150 to get so big that someone's going to offer you 00:41:13.150 --> 00:41:15.570 $2 million. And I just want you to know when 00:41:15.570 --> 00:41:18.050 you take that, just like, tell me, you have to 00:41:18.050 --> 00:41:19.989 tell me so I can leave and make my own practice. 00:41:20.050 --> 00:41:21.730 And I'll just hire everybody. And I was like, 00:41:21.750 --> 00:41:24.449 why would you think I would accept it? And she 00:41:24.449 --> 00:41:26.250 was like, because you're going to take two million 00:41:26.250 --> 00:41:28.769 dollars. I've been offered millions for my practice 00:41:28.769 --> 00:41:30.929 and I will not take it. I have. Have you been? 00:41:31.230 --> 00:41:35.349 Have you been? I have been like millions. By 00:41:35.349 --> 00:41:38.809 random. Random investors or companies that wanted 00:41:38.809 --> 00:41:41.690 to buy out and move here because we're very established. 00:41:41.769 --> 00:41:44.110 And I said no, because like all my VAs would 00:41:44.110 --> 00:41:45.829 lose their jobs. They'd have nowhere to go. They'd 00:41:45.829 --> 00:41:47.449 have nowhere to support themselves. No one's 00:41:47.449 --> 00:41:50.670 going to pay them this much. Right. Like it's 00:41:50.670 --> 00:41:54.860 my baby. Yeah. And it's like also like. I get 00:41:54.860 --> 00:41:57.539 the impression your like sense of purpose, sense 00:41:57.539 --> 00:42:00.099 of identity. Like, you know, I think about that 00:42:00.099 --> 00:42:02.739 too. Like, I'm like, I love doing what I do every 00:42:02.739 --> 00:42:04.699 day. Yeah. You know, if I didn't have that, I'd 00:42:04.699 --> 00:42:07.099 probably not be doing well mentally. Like I can 00:42:07.099 --> 00:42:10.199 do that. Like kind of, yeah, it's a huge part 00:42:10.199 --> 00:42:13.300 of who I am. Yeah. I love my company. Like this 00:42:13.300 --> 00:42:15.360 is my baby and I built this and like, I don't 00:42:15.360 --> 00:42:17.929 want to watch somebody just trash it. Yeah. And 00:42:17.929 --> 00:42:19.530 I think that's reassuring for providers who go 00:42:19.530 --> 00:42:21.710 to work for you too, though, because that's why 00:42:21.710 --> 00:42:24.469 I left my last job. They got acquired and I was 00:42:24.469 --> 00:42:29.090 like, uh, hi, you know, and that was the right 00:42:29.090 --> 00:42:31.489 decision because it's completely changed the 00:42:31.489 --> 00:42:34.530 culture, everything, you know, it's like, I don't 00:42:34.530 --> 00:42:37.309 know. Yeah. Things have changed a lot with telehealth 00:42:37.309 --> 00:42:40.469 and the pandemic and venture capital and it's, 00:42:40.469 --> 00:42:43.710 yeah. All those places now that people are moving 00:42:43.710 --> 00:42:46.079 into and like. You know, there's just so many 00:42:46.079 --> 00:42:48.739 like corporations, I think, preying on providers. 00:42:49.519 --> 00:42:52.019 Yeah. Speaking of which, like how do you feel 00:42:52.019 --> 00:42:54.179 about newer providers working for themselves? 00:42:54.539 --> 00:42:57.480 In the way of like making their own LLC or the 00:42:57.480 --> 00:43:00.099 way of like just gotten on headway or what do 00:43:00.099 --> 00:43:02.179 you mean? Like, yeah, building a private practice 00:43:02.179 --> 00:43:03.960 because that's like one of the number one asked 00:43:03.960 --> 00:43:06.820 questions. Oh, like out of school, like straight 00:43:06.820 --> 00:43:11.079 out of school? Yes. Scary? For me, learning to 00:43:11.079 --> 00:43:14.659 run a practice was its own thing. Never mind, 00:43:14.719 --> 00:43:16.280 you're going to be learning coding, you're going 00:43:16.280 --> 00:43:17.920 to be learning credentialing, you're going to 00:43:17.920 --> 00:43:20.099 be learning how to prescribe and you have no 00:43:20.099 --> 00:43:24.219 one to ask or resources. That shit's crazy. I 00:43:24.219 --> 00:43:25.739 feel like you should find a job with a mentor 00:43:25.739 --> 00:43:29.420 and build in. Actually, I didn't have that. I 00:43:29.420 --> 00:43:31.460 went home and I got drunk and cried myself to 00:43:31.460 --> 00:43:34.280 sleep and read textbooks every night until I 00:43:34.280 --> 00:43:36.480 felt competent. And, like, that was my, like, 00:43:36.480 --> 00:43:38.139 mission in coming here and training my providers 00:43:38.139 --> 00:43:39.679 and saying no one should have to do that as a 00:43:39.679 --> 00:43:41.519 new graduate. But also, who's going to, like, 00:43:41.519 --> 00:43:43.739 voluntarily choose that? That fucking sucked. 00:43:43.960 --> 00:43:46.440 I didn't know anything. Yeah, right. You know? 00:43:46.659 --> 00:43:49.719 100%. Yeah, I can't imagine opening a private 00:43:49.719 --> 00:43:52.320 practice where I was at as a new grad, you know? 00:43:52.599 --> 00:43:56.719 No. No. Like, that's ballsy. That's really ballsy. 00:43:56.719 --> 00:43:58.599 That's what I needed to learn, you know? Yeah. 00:43:58.719 --> 00:44:02.360 So. I'm not saying it's not like possible and 00:44:02.360 --> 00:44:04.800 people are doing it and outsourcing their mentorship. 00:44:04.860 --> 00:44:07.739 And, you know, that's great just for me. Like, 00:44:07.760 --> 00:44:11.460 I can't imagine my anxiety levels. Same girl. 00:44:11.639 --> 00:44:14.420 Same. Like, would have regretted that hard. Like, 00:44:14.500 --> 00:44:16.780 I only was able to do this because I had so much 00:44:16.780 --> 00:44:18.900 experience and like hire people in because like, 00:44:18.960 --> 00:44:20.639 hey, I have experience. I can help you. Like, 00:44:20.639 --> 00:44:23.340 we can support you. Like, imagine like having 00:44:23.340 --> 00:44:24.840 a private practice and you've just been a new 00:44:24.840 --> 00:44:27.000 grad and then hiring people like you can't even 00:44:27.000 --> 00:44:30.329 offer them anything. You're all lost. Right. 00:44:30.409 --> 00:44:32.869 And then the clinical decisions, you know, and 00:44:32.869 --> 00:44:36.309 like I'm sure how like are you putting out fires 00:44:36.309 --> 00:44:39.150 a lot with like patient situations? Yeah. Yeah. 00:44:39.190 --> 00:44:42.570 All the time. Right. All the time. All the time. 00:44:42.710 --> 00:44:45.809 Yeah. All the time. So like that's exhausting. 00:44:46.130 --> 00:44:48.769 Like, you know, you have like things come up 00:44:48.769 --> 00:44:50.989 on holidays. Like, do you have plans for that? 00:44:51.050 --> 00:44:52.530 Like, do you know all of the scientifics that 00:44:52.530 --> 00:44:54.309 could happen? Like, can you anticipate like what 00:44:54.309 --> 00:44:56.599 this is going to look like? Like, I don't. Maybe 00:44:56.599 --> 00:44:58.380 if you take the most stable people ever who are 00:44:58.380 --> 00:45:00.719 going to be on like Lexapro 2 .5 forever. Sure. 00:45:01.039 --> 00:45:03.099 Open a private practice. But like you don't know 00:45:03.099 --> 00:45:05.820 what's coming in your door. Yeah. No, 100 percent. 00:45:05.900 --> 00:45:10.340 100 percent. What would you recommend to a new 00:45:10.340 --> 00:45:14.360 grad psych NP as far as just like. main advice? 00:45:14.619 --> 00:45:18.119 My main advice would be to take initiative for 00:45:18.119 --> 00:45:20.179 yourself. Your school has failed you already 00:45:20.179 --> 00:45:22.900 by graduating you, no matter where you come from. 00:45:22.920 --> 00:45:25.239 I was also failed coming from a very like intense 00:45:25.239 --> 00:45:27.920 program. Like you don't know anything coming 00:45:27.920 --> 00:45:32.340 out of 600 hours. So find resources and immerse 00:45:32.340 --> 00:45:34.840 yourself. You should be like studying after you 00:45:34.840 --> 00:45:37.000 pass sports. You should be like doing a program 00:45:37.000 --> 00:45:40.849 like yours. I read, I bought textbooks. for psychiatrists 00:45:40.849 --> 00:45:43.429 i bet like sleep textbooks i've got everything 00:45:43.429 --> 00:45:46.110 i could do and i like read all of those textbooks 00:45:46.110 --> 00:45:49.389 and i studied for like two years after i graduated 00:45:49.389 --> 00:45:52.269 to continue learning like you know nothing graduating 00:45:52.269 --> 00:45:54.429 so my main advice is like continue learning because 00:45:54.429 --> 00:45:56.630 we even like years in like dude i don't know 00:45:56.630 --> 00:45:59.250 anything like don't pretend you know everything 00:45:59.250 --> 00:46:01.969 that's my advice That's good advice, honestly. 00:46:02.230 --> 00:46:04.510 Yeah. It's like have some intellectual humility 00:46:04.510 --> 00:46:06.909 to realize that like we don't know a lot in this 00:46:06.909 --> 00:46:10.309 field as much as we would like to know. So yeah, 00:46:10.389 --> 00:46:13.309 let's be humble about that. Minus out the clinical 00:46:13.309 --> 00:46:15.409 experience out of that because we don't get enough 00:46:15.409 --> 00:46:18.250 in school. I mean, like that's yeah. Speaking 00:46:18.250 --> 00:46:20.929 of which, how are your clinicals? Fantastic. 00:46:21.840 --> 00:46:24.760 Fucking fantastic. I love my clinicals. My first 00:46:24.760 --> 00:46:27.480 one was actually awful because like she was super 00:46:27.480 --> 00:46:29.780 on a different value system. Trump had just won. 00:46:29.840 --> 00:46:32.019 She was very Trump. She was very money, very 00:46:32.019 --> 00:46:34.059 private practice, had people pill mill style 00:46:34.059 --> 00:46:37.539 coming in and out like I just didn't. respect 00:46:37.539 --> 00:46:40.579 her and her like decisions were awful. But my 00:46:40.579 --> 00:46:43.320 next one, I was at UMass Memorial and like the 00:46:43.320 --> 00:46:45.619 most phenomenal preceptor I could have ever asked 00:46:45.619 --> 00:46:47.780 for. And she taught me about autism and ADHD 00:46:47.780 --> 00:46:50.500 and she taught me about like child mental health. 00:46:50.579 --> 00:46:53.400 And she got me into every opportunity to be with 00:46:53.400 --> 00:46:56.280 psychiatrists or like social workers or anywhere 00:46:56.280 --> 00:46:58.400 in the hospital that I could learn. Like she 00:46:58.400 --> 00:47:01.320 was incredible. Wow. That's incredible. And your 00:47:01.320 --> 00:47:04.199 school placed you for those? Yeah. Both of them. 00:47:04.280 --> 00:47:07.199 Yeah. like that's another thing I worry about 00:47:07.199 --> 00:47:08.820 is just like the clinical experiences that people 00:47:08.820 --> 00:47:10.360 are getting where they're like paying for these 00:47:10.360 --> 00:47:12.239 experiences where there's multiple people on 00:47:12.239 --> 00:47:14.079 a call and they're not, I would not suggest people 00:47:14.079 --> 00:47:18.059 do that because it's like, like find a good rotation 00:47:18.059 --> 00:47:19.440 where you're going to learn. You're going to 00:47:19.440 --> 00:47:21.260 be able to like ask questions. Like I had to 00:47:21.260 --> 00:47:23.800 interview for some of my rotations. I did too. 00:47:23.960 --> 00:47:27.840 You did? Yeah. I interviewed. I didn't know that. 00:47:28.400 --> 00:47:32.159 Yeah. Now like, like people who come to you. 00:47:32.639 --> 00:47:34.820 Absolutely. Yeah. Yeah. I'll never take people 00:47:34.820 --> 00:47:36.440 blind. We have to interview them first or we 00:47:36.440 --> 00:47:38.179 have to like know them first or talk to them 00:47:38.179 --> 00:47:41.679 first. Have a good sense. Yeah. A hundred percent. 00:47:41.900 --> 00:47:44.119 That's crazy. And like some of this, like if 00:47:44.119 --> 00:47:46.199 you're not doing the evaluations independently 00:47:46.199 --> 00:47:48.659 and making the medication decisions and education 00:47:48.659 --> 00:47:50.800 independently by the end, you are not prepared. 00:47:50.980 --> 00:47:53.219 And I've had people who've never asked a single 00:47:53.219 --> 00:47:56.380 question to a patient graduate. Like that was 00:47:56.380 --> 00:47:59.539 like. I did all of my own evaluations. Like my 00:47:59.539 --> 00:48:01.340 preceptor gave me two days before I was doing 00:48:01.340 --> 00:48:03.460 them. And that's how I've always precepted people 00:48:03.460 --> 00:48:05.159 too. You get two days to watch me and then you're 00:48:05.159 --> 00:48:08.460 doing it. Jump in. Right. Yeah. No, a hundred 00:48:08.460 --> 00:48:10.179 percent. And then can you imagine the transition 00:48:10.179 --> 00:48:14.179 from, if you hadn't, like, I'm just like, I know 00:48:14.179 --> 00:48:16.960 it's, it floors me. It floors me. Like you don't 00:48:16.960 --> 00:48:18.320 even have a template. You don't have anything. 00:48:19.639 --> 00:48:22.679 Oh my God. Yeah. It's not good. What are your 00:48:22.679 --> 00:48:26.340 favorite resources that you encourage your employees 00:48:26.340 --> 00:48:29.059 to use and like would encourage other psych NPs 00:48:29.059 --> 00:48:31.760 to use? I've made a lot of resources because 00:48:31.760 --> 00:48:33.519 like I don't like the resources that are out 00:48:33.519 --> 00:48:36.059 there. I don't like stall very much. So I've 00:48:36.059 --> 00:48:38.380 like made a lot for them when I think about it. 00:48:38.420 --> 00:48:40.599 But I do like the perinatal mental health one 00:48:40.599 --> 00:48:42.960 postpartum .net is amazing. Like their training. 00:48:43.019 --> 00:48:45.760 I have all my providers do it. I love that. The 00:48:45.760 --> 00:48:49.489 PSI? PSI. Okay. That's cool to have all your 00:48:49.489 --> 00:48:51.829 providers. I love that. I love that. Because 00:48:51.829 --> 00:48:54.610 I remember that like you and I, I think we did 00:48:54.610 --> 00:48:57.690 like a live together and like just like realizing 00:48:57.690 --> 00:49:00.650 like, wow, I need a lot more training in this 00:49:00.650 --> 00:49:04.070 area. And I was a mom who was pregnant and a 00:49:04.070 --> 00:49:06.190 psych provider. And why didn't I know this kind 00:49:06.190 --> 00:49:09.289 of stuff? Yeah. Yeah. I remember that. And like 00:49:09.289 --> 00:49:11.170 there were not a lot of people trained back in 00:49:11.170 --> 00:49:12.989 like 2018 when I did it, but there's a lot more 00:49:12.989 --> 00:49:17.190 people now who are. That's cool. So common. Yeah. 00:49:17.289 --> 00:49:18.670 But that's probably like the biggest one that 00:49:18.670 --> 00:49:20.630 I'm like, this is amazing. And then just finding 00:49:20.630 --> 00:49:22.909 like ways to learn about neurodivergence and 00:49:22.909 --> 00:49:25.150 like, honestly, Reddit, like start reading Reddits 00:49:25.150 --> 00:49:27.849 and understanding people. And like, yeah, that's 00:49:27.849 --> 00:49:29.949 the biggest thing, dude. Yeah. And then I would 00:49:29.949 --> 00:49:31.730 say your program is also big, like for people 00:49:31.730 --> 00:49:34.010 who are graduating with nothing, like go to the 00:49:34.010 --> 00:49:37.789 program. Yeah. Get your contact hour, 75 contact 00:49:37.789 --> 00:49:40.710 hours. Do it. Yeah. That's really cool, though, 00:49:40.750 --> 00:49:42.849 that you pay for people to do the PSI training 00:49:42.849 --> 00:49:44.210 because I really feel like everybody should. 00:49:44.730 --> 00:49:46.650 Everyone should do it. I mean, like your patients 00:49:46.650 --> 00:49:48.590 get pregnant all the time, right? Like somebody's 00:49:48.590 --> 00:49:49.670 going to be pregnant. Somebody's going to be 00:49:49.670 --> 00:49:51.849 postpartum. Like somebody already has kids and 00:49:51.849 --> 00:49:54.250 experienced something. It's just so important. 00:49:54.769 --> 00:49:57.489 Yeah. How much of a difference do you feel like 00:49:57.489 --> 00:49:59.909 our medications make? Like how much of your practice 00:49:59.909 --> 00:50:03.949 is like also like lifestyle education? I would 00:50:03.949 --> 00:50:05.929 say it's like integrated into most appointments. 00:50:06.050 --> 00:50:07.769 Like everybody's trying to kind of look at that 00:50:07.769 --> 00:50:11.650 too. Maybe like, but I mean, medication is still 00:50:11.650 --> 00:50:14.079 like the biggest focus for it. Yeah, I don't 00:50:14.079 --> 00:50:16.079 know. I would say it's kind of like 50 -50 implementing. 00:50:16.219 --> 00:50:17.980 Like everybody's kind of like we do 90 minute 00:50:17.980 --> 00:50:20.059 evaluations. We really get to know a person and 00:50:20.059 --> 00:50:22.420 kind of like have those conversations to like 00:50:22.420 --> 00:50:24.000 what's going on with sleep hygiene, what's going 00:50:24.000 --> 00:50:26.820 on with like X, Y and Z. Like what else? But 00:50:26.820 --> 00:50:28.460 I mean, a good provider is probably going to 00:50:28.460 --> 00:50:30.840 do like 40 percent of like what's the environmental 00:50:30.840 --> 00:50:34.119 situation? You know, like how is this being impacted 00:50:34.119 --> 00:50:36.400 by the medication and what's not related and 00:50:36.400 --> 00:50:38.559 what is related? Where are the patterns? Yeah. 00:50:38.880 --> 00:50:41.480 Addressing that. Right. Yeah. It's important. 00:50:42.119 --> 00:50:44.460 I know we're going on like an hour and I try 00:50:44.460 --> 00:50:47.119 to keep these episodes like 20 or 30 minutes, 00:50:47.159 --> 00:50:48.820 but it's like, I knew that we would have like 00:50:48.820 --> 00:50:50.480 a ton to cover and I still feel like we didn't 00:50:50.480 --> 00:50:52.059 even get to cover everything. Okay. One, two 00:50:52.059 --> 00:50:56.719 last questions. AI, how do you use it right now 00:50:56.719 --> 00:51:02.900 in your practice? My practitioners use Heidi. 00:51:03.099 --> 00:51:05.460 I think that's what it's called for documentation. 00:51:05.699 --> 00:51:08.559 I personally am too old for that now. I feel 00:51:08.559 --> 00:51:10.179 like I just have to type everything and that's 00:51:10.179 --> 00:51:12.099 always how I do my evaluations. I can't get into 00:51:12.099 --> 00:51:13.679 it. I'm like, no, I don't want it to type for 00:51:13.679 --> 00:51:18.679 me. I want to type. It's like an old lady saying 00:51:18.679 --> 00:51:20.500 that. It's so embarrassing. Everyone else does 00:51:20.500 --> 00:51:23.360 it. I'm like, okay. I've been typing for 10 years. 00:51:23.440 --> 00:51:27.300 I just want to type. So tools I use, I use Claude. 00:51:27.360 --> 00:51:30.260 Is that how you say it? cloud clod and i use 00:51:30.260 --> 00:51:32.119 it just for administrative things like letter 00:51:32.119 --> 00:51:34.199 writing kind of like understanding ethics like 00:51:34.199 --> 00:51:37.119 understanding just anything all i just my whole 00:51:37.119 --> 00:51:40.940 life is on that yeah like you're like a yeah 00:51:40.940 --> 00:51:43.659 i'm a clod girl too now i love love out there 00:51:43.659 --> 00:51:46.579 dude they have the best i love the work did you 00:51:46.579 --> 00:51:48.619 check out co -work no i haven't done it yet i 00:51:48.619 --> 00:51:50.780 have to make a note because i forgot don't talk 00:51:50.780 --> 00:51:54.440 to me on my adderall that's why it'll change 00:51:54.440 --> 00:51:56.789 your life you're gonna you're gonna love it And 00:51:56.789 --> 00:52:00.949 then what does the phrase no prior auth mean 00:52:00.949 --> 00:52:03.449 to you? I ask all the people who come on this 00:52:03.449 --> 00:52:06.030 podcast that at the end. Oh, I wish I had prepared 00:52:06.030 --> 00:52:09.949 that. No prior auth would mean no bureaucratic 00:52:09.949 --> 00:52:13.610 restrictions when I think of that. Yeah, which 00:52:13.610 --> 00:52:19.449 I feel like is your entire like being. My being. 00:52:21.849 --> 00:52:24.730 It's my essence. It's your essence. That was 00:52:24.730 --> 00:52:27.210 the word I was looking for. Yeah, which I think 00:52:27.210 --> 00:52:31.969 people are inspired by. Like, I mean, you're 00:52:31.969 --> 00:52:35.570 brave. You're not afraid to get criticized or, 00:52:35.690 --> 00:52:39.429 you know, get you're like, I am who I am. Take 00:52:39.429 --> 00:52:41.329 it or leave it. Yeah, it gets me in trouble. 00:52:42.110 --> 00:52:44.510 I'll, you know, have my pile of cease and desist 00:52:44.510 --> 00:52:47.949 for being loud and obnoxious. So I'll just really 00:52:47.949 --> 00:52:50.530 those quietly. Yeah, I don't even know if I'm 00:52:50.530 --> 00:52:52.960 allowed to talk. about it but you know i have 00:52:52.960 --> 00:52:55.900 my my liberal opinions and have i called people 00:52:55.900 --> 00:52:58.699 out for practices that i found unethical sure 00:52:58.699 --> 00:53:01.659 have i gotten cease and desist from their lawyers 00:53:01.659 --> 00:53:04.820 sure yeah that you're like i'm not gonna let 00:53:04.820 --> 00:53:09.320 like people's fear base at the end of the day 00:53:09.320 --> 00:53:11.099 like i'm living authentically and my practice 00:53:11.099 --> 00:53:13.000 is authentic you do you if you want to have an 00:53:13.000 --> 00:53:15.539 inauthentic practice that's on yourself you know 00:53:15.539 --> 00:53:18.719 yeah just kind of taking responsibility for yourself 00:53:18.719 --> 00:53:22.840 and for the practice you're growing and that's 00:53:22.840 --> 00:53:26.019 that period the end your airport i love that 00:53:26.019 --> 00:53:28.099 where can people find you if they want to follow 00:53:28.099 --> 00:53:30.539 along and get involved in some of these initiatives 00:53:30.539 --> 00:53:33.420 if you want to follow me on tiktok dr .maria 00:53:33.420 --> 00:53:37.380 and gala And my foundation is paperflowerfoundation 00:53:37.380 --> 00:53:38.980 .org. I would ask you, even if you're not in 00:53:38.980 --> 00:53:41.159 Arizona, please make a donation, just like 20 00:53:41.159 --> 00:53:42.800 bucks, something just so we can like continue 00:53:42.800 --> 00:53:45.639 our work. Paperflower Psychiatry, if you want 00:53:45.639 --> 00:53:48.539 to work for me and you are super liberal, I will 00:53:48.539 --> 00:53:50.900 hire you if you don't suck at your job and you 00:53:50.900 --> 00:53:54.159 can't be professional. If you don't suck at your 00:53:54.159 --> 00:53:59.559 job. Yeah. And you can't suck at your job. That's 00:53:59.559 --> 00:54:02.460 me. Yep. I love it. Okay. What about if providers 00:54:02.460 --> 00:54:05.139 want to take your courses? Oh, paperflowerinstitute 00:54:05.139 --> 00:54:07.360 .com. So paperflowerinstitute .com. I have a 00:54:07.360 --> 00:54:09.380 lot of free educational resources, even learn 00:54:09.380 --> 00:54:11.199 more about autism, learn about neurodivergence. 00:54:11.300 --> 00:54:12.920 Like there are a lot of things that you can give 00:54:12.920 --> 00:54:15.099 to patients on there too and refer your patients 00:54:15.099 --> 00:54:17.420 to that website. You can also take continuing 00:54:17.420 --> 00:54:19.840 education courses. They are accredited. So you 00:54:19.840 --> 00:54:22.260 can take those courses. Yeah. And your podcast. 00:54:22.559 --> 00:54:24.239 Like I hadn't really listened to your podcast 00:54:24.239 --> 00:54:26.960 until like the other day. And I was like learning 00:54:26.960 --> 00:54:29.420 a lot about like, it was like something with 00:54:29.420 --> 00:54:32.320 autism. And I was like, wow. Yeah. Brain Trash 00:54:32.320 --> 00:54:35.880 is on Apple podcasts on YouTube and Tabitha is 00:54:35.880 --> 00:54:38.340 like super brilliant. She talks a lot about neurodivergence 00:54:38.340 --> 00:54:40.380 too. It's just two of us autistic folks with 00:54:40.380 --> 00:54:43.039 no filter talking about. That's the whole podcast. 00:54:43.119 --> 00:54:46.280 That's cool. Yeah. About autism, about neurodivergence, 00:54:46.280 --> 00:54:49.519 about why the DSM sucks. Yeah. How do you, how 00:54:49.519 --> 00:54:52.340 many episodes do you have out? We have like two 00:54:52.340 --> 00:54:54.960 seasons, dude. It's like a solid amount, maybe 00:54:54.960 --> 00:54:57.059 like 20 or something. And Tabitha is one of your 00:54:57.059 --> 00:54:59.329 providers? Yeah, Tabitha is a provider. She's 00:54:59.329 --> 00:55:01.929 my homie. I love Tabitha. That's awesome. I love 00:55:01.929 --> 00:55:04.230 that. Well, thank you, Maria, for taking the 00:55:04.230 --> 00:55:06.449 time to be here. We love your heart. We love 00:55:06.449 --> 00:55:08.429 your mission, what you're doing. We're going 00:55:08.429 --> 00:55:10.010 to have you on for a part two because I know 00:55:10.010 --> 00:55:11.630 people are going to have questions, additional 00:55:11.630 --> 00:55:14.510 questions, because you do things outside the 00:55:14.510 --> 00:55:17.789 lines. Sure do. I'm ready for questions. So leave 00:55:17.789 --> 00:55:20.590 them for Lindsay and we can do a part two. Okay, 00:55:20.690 --> 00:55:22.929 awesome. Thanks for being here. Thank you so 00:55:22.929 --> 00:55:23.190 much.