WEBVTT

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I knew that psych was something I wanted to do,

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but believe it or not, back in 2003, you typically

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went into med -surg as soon as you got out of

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school. So I did work med -surg for about a year

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and a half before I started doing inpatient psych.

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I knew in school that someday I wanted to open

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a private practice, but did not have any idea

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how to even. jumpstart that. We had to move into

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a new a new practice and now we have well over

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3 ,000 patients. We lost a lot of money on billing

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which is that's another thing too. How you grew

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from like no patients to a thousand patients.

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We hired a marketing team. They take care of

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all of our social media. They're fantastic. The

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truth is we're in Tennessee and we're probably

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one of the most restricted states. When we first

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opened, just to make some extra money through

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NP Hub. So every once in a while, I'll get one

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through there that, you know, pays. But if it's

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word of mouth, I don't charge them. Welcome to

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another week of no prior auth. This week, I'm

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talking to Angie Janicek. Angie is a DNP board

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-certified psychiatric mental health nurse practitioner

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and the co -owner of Premier Psychiatric Services

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in Goodlettsville, Tennessee, just north of Nashville.

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She became a CNA in 2001, got her ADN in 2003,

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spent the next 16 years working inpatient psych

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and raising four kids, including twins, before

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going back for her BSN, then her MSN, then her

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DNP from Frontier Nursing University. Her husband,

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John, they've known each other since they were

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13, is the practice CFO. Her co -owner's wife

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is the practice manager. She runs a Spravato

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clinic for treatment -resistant depression. She

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specializes in ADHD in women, and her office

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dog, Murphy, is officially listed as CEO on the

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company website. If you've ever worried you waited

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too long to build the career you actually wanted,

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Angie's story is going to wreck that excuse.

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Let's get into it. Hi, Angie. Hi. How are you,

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Lindsay? I'm doing well. How are you? I'm doing

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well. It's a good day. Thanks for being on. I

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appreciate it. For sure. For sure. Yeah. Really

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excited to be here. You are my first guest who

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I've never met via video before our episode.

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It's like we've been acquaintances for a while

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now. So I'm really excited about this one. I've

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been wanting to get to know you more for a while,

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and I think your story is going to really inspire

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Psych NPs. So just start out telling us a little

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bit about yourself as far as... At what point

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you decided that you wanted to have a private

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practice and kind of what got you started down

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this career path to begin with? Yeah, I fell

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in love with psych in nursing school. That rotation

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was. just eye -opening for me. I really fell

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in love with it. So I knew that psych was something

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I wanted to do. But believe it or not, back in

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2003, you typically went into med -surg as soon

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as you got out of school. So I did work med -surg

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for about a year and a half before I started

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doing inpatient psych. And my first psych unit

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was a military unit which I absolutely loved

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and it just kind of progressed from there to

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different units to you know the really acute

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units to more of like a mood and stress I worked

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in intake for a while and then I ultimately before

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I went back to school landed in the emergency

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department as the behavioral health assessment

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nurse. So I would see patients when they would

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come in really acute, having a psych issue, and

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then I would assess them and then kind of go

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from there. Do I think they meet criteria for

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inpatient admission? If I did think they did,

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then I would reach out to the psych NP or the

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psychiatrist at that time. And that's when I

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learned, it was that job where I learned that

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there was such a thing as a psych NP. I did not

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know until a few years ago. Yeah. Oh, really?

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Okay. So just a couple of years ago, you kind

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of realized what that role was. Probably back

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in 2020 is when I learned that, you know, I had

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a friend that said, you should go back to school

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for your MP. I was like, I have no desire. And

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he said, you could be a psych MP. I was like,

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what? I mean, that's fascinating to me because

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you had been working in psych for how long at

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that point? I had been working in psych since.

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like 2004, 2005. But the hospital that I work

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for, a big company that we usually refer to with

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letters and big corporation. And they, at that

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time for inpatient, all they had was psychiatrists.

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They didn't have any psych MPs at that time.

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They did not get psych MPs until about a year

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before I graduated. And they had one. And I was

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already in school. When I met her and became

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friends with her. So she was the first psych

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NP at this particular freestanding hospital.

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They didn't have them. Right. Yeah. I always

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wonder, like, because I'm from Ohio and I had

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never heard of the role of a psych NP until I

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moved to Arizona and got a job at Arizona State

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University. So it's just like, I wonder. how

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long it would have taken for me to become acquainted,

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to become aware of the role if I had stayed in

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Ohio longer, you know? So that's, that's just

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fascinating. So what year did you start your

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private practice? I started it in 2024. And that's

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kind of an interesting story in itself because

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by 2024, there were four. nurse practitioners

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and one PA working at the hospital. They just

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took it and ran with it. And so I'd been there

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a little bit of time. I'd been there a couple

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of years. I was like the second one they had

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hired on. And I started meeting some of these

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NPs that they were bringing in and became really

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good friends with them. One of them being my

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current business partner, Trey. And I knew in

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school that someday I wanted to open a private

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practice, but did not have any idea how to even

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jumpstart that. So I had several of the other

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NPs come to me and say, do you want to start

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a private practice? And I thought about it for

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a long time and then ultimately called my current

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business partner, Trey, and said, listen, no

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knock to anyone else, but why don't we, you know,

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I loved everybody that was, you know, asking

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about it, but I knew Trey. Trey's a great businessman.

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And I knew that our friendship would allow for

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us to be in practice together without arguing

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or, you know, having a bunch of we just get along

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really well. We're we both are really kind of

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go along with things. We're both laid back. So

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I knew that that would work really well. So I

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called Trey and said. This is what I'm thinking

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about doing. Do you want to partner with me?

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And he said, absolutely. Yeah, let's do it. Okay.

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And so you started out with a business partner

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and you still have a business partner, right?

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I still have Trey. Yep. Yes. Okay. Okay. And

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what are his credentials? Trey is actually dual

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certified. He's an FNP and a psych NP and he's

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working on his DNP right now. Yeah. Very cool.

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That's awesome. Yes. So you spent. Was it, I

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think it said 16 years as like an ADN and, and

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all these different healthcare roles and you

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were raising four kids, right? Tell us about

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what that was like. That must've been a lot.

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That was a lot. Yes. I mean, especially working

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12 hour shifts and having smaller kids at home.

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That was really tough. We muddled through it.

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And so we're. pretty competitive family. And

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I'm only telling you that because it kind of

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leads into what I'm about to tell you next. And

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so my oldest went off to college. She went to

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UT Knoxville, got into their nursing program,

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which is very hard to get into. So proud of her.

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And I started realizing, wait a second, my husband

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has his MBA. My oldest is getting her bachelor's.

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My twins are going to school in a couple of years

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to get their degree. And then my youngest, he's

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currently working on his degree now, his psychology

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degree now. And I thought, I'm going to have

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the smallest degree in this house. So I was like,

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I cannot have, no, this could not happen. So

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I went back to school initially just to get my

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BSN. And it was then that I really decided I'm

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going to get my master's. I initially, my dad

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is an IT guy and he really encouraged me at that

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time to maybe try to fit nursing in with IT.

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And while that was a fantastic idea, I shadowed

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someone that I knew and I, it just didn't really

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appeal to me. So that's when I had a friend that

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said, you love psych so much. Why don't you become

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a psych NP? When I started looking at, you know,

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programs, I thought. This is exactly what I wanted

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to do. And I knew that I wanted to do that because

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I wanted to be able to help patients on a deeper

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level. I wanted to be able to branch out and

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not just pass meds. I wanted to be able to do

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a lot more in a role. And that's, I felt like

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that was the way to do it. Right. Yeah. That

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makes a lot of sense. And from what I understand,

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your husband's the CFO, right? You have a practice

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manager. We do. Yeah. So has, yeah, go ahead.

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I was just going to say, so little story about

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that. When we first opened, we had just a little

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bit of money and a credit card. And so we were

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like, what are we going to do? So we decided

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to hire family because they were free at the

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time. So that's kind of how that worked. You

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know, we, my husband is an accountant. He's a

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college professor. He teaches accounting, teaches

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marketing, teaches business as his MBA. He's

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really smart at that kind of stuff. And he said,

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listen, I'll manage your books in the beginning.

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He still doesn't, but he's your books for free.

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I'll help. And then Trey's wife, Brittany said,

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She actually quit her job. She's a respiratory

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therapist. Oh, okay. And she was at the hospital.

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I didn't realize Brittany was Trey's wife. Okay,

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got it. Brittany is Trey's wife, yes. And we

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knew we had to have somebody answer the phones.

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So we hired her. She came in and started helping

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for free. So then we added my son on board. And

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that's when we started looking at paying people.

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We had really picked up. We started in this small,

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like little 1 ,700 square feet office. And we

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grew within six months to almost 1 ,000 patients.

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Like it was, it just exploded. And we were the

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only group practice in the area, which that's

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something too, how we decided on that. We were

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the only group practice in the area. We had immediate

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openings. We took insurance. And so we just exploded.

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So within six months, we had to find another

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location. And we came upon a location which is

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like 4 ,000 square feet now. And we had to move.

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Before we were even a year old, we had to move

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into a new practice. And now we have well over

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3 ,000 patients. And we've been open two years.

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Wow. Wow. It grew huge. It sounds like it. Yeah.

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One of the things that our listeners really like

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to hear about, too, is kind of like how much

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money did you spend getting started and on what?

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And when you look back at that, like, is there

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anything you do different? Yes, for sure. We

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started what we had to pay first and last month's

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rent, which I think at that time the rent was

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like thirty five hundred dollars on the first

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place. So. We gave them a total of, it was like

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$7 ,000. We had to do that. We kind of pieced

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that together on our own. I think we each gave

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like $3 ,500, you know, to do that. And then

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we immediately had to get an EHR system, which

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we got, we hired Silverleaf and then IntakeQ

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is what we wound up getting. And so whatever

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that, I think that's like $2 ,000 maybe to start

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and then for them to set it up. So we did that.

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And then did you do spruce, too, or just didn't

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take you? We did spruce in the beginning as well.

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We did that as well, which I really like. I really

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like spruce. I do, too. We've kind of moved away

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from it a little bit for some reason. I don't

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I don't know why, but but we we still haven't

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take you still. I love it. I love it. And I actually

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you still use the paperwork that they gave us.

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I guess I didn't even think about we could trim

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it down some because it definitely. is it's definitely

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audit proof for sure. I'll give them that. But

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patients complain about how much paperwork it

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is. What I like about it is it tells me the story

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before I meet with the patient. So I feel like

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I can get right into it with the patient and

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we can kind of skip all the questions because

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they fill it out before they see us. And so I

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feel like that gives me the story. for the most

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part you know for the most part gives me the

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story and then as soon as I see them we can start

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right into yeah what brings you in today you

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know here are my thoughts I've looked through

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your chart you know that kind of stuff so that's

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that's what I like about it but I didn't realize

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I didn't even think about that we could probably

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trim it down and I would love to do that because

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patients do complain about how extensive the

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paperwork is yeah Do patients self -schedule?

00:14:22.110 --> 00:14:24.850
We turned off self -scheduling a while back.

00:14:24.950 --> 00:14:27.389
We like for them to call and get scheduled because

00:14:27.389 --> 00:14:31.070
a lot of times they're looking for something

00:14:31.070 --> 00:14:35.990
specific. Like I specialize in ADHD, so they

00:14:35.990 --> 00:14:39.350
don't necessarily know that. And then so when

00:14:39.350 --> 00:14:42.370
they call, we can ask them, what are you looking

00:14:42.370 --> 00:14:43.870
for? What are you wanting treated? And then they

00:14:43.870 --> 00:14:47.230
know which provider to put them with. Yeah. Okay,

00:14:47.289 --> 00:14:50.250
that makes sense. So you started out with an

00:14:50.250 --> 00:14:54.809
in -person space. What played into that decision?

00:14:54.970 --> 00:14:57.889
Because I know that's something too that people

00:14:57.889 --> 00:15:00.049
are sometimes on the fence about. And sometimes

00:15:00.049 --> 00:15:02.710
they sign a lease prematurely, they feel like,

00:15:02.750 --> 00:15:05.149
before they have enough income coming in. But

00:15:05.149 --> 00:15:07.730
sometimes they have to because of an insurance

00:15:07.730 --> 00:15:11.070
requirement or state law. And I'm just curious,

00:15:11.129 --> 00:15:13.210
yeah, how you guys made that decision. That's

00:15:13.210 --> 00:15:15.850
a great question. We really did want the space.

00:15:16.559 --> 00:15:19.580
There was a group of about five of us that were

00:15:19.580 --> 00:15:24.100
really, really close. We all had the same mentor,

00:15:24.100 --> 00:15:28.200
which is our current medical director and psychiatrist.

00:15:28.720 --> 00:15:33.639
So we all had him as the mentor. And our initial

00:15:33.639 --> 00:15:37.700
thought was, we want to open this practice with

00:15:37.700 --> 00:15:42.059
our friends. Won't that be fun? You know, we're

00:15:42.059 --> 00:15:43.500
going to work with our friends. It's going to

00:15:43.500 --> 00:15:46.659
be so much fun. There was a lot that came with

00:15:46.659 --> 00:15:50.460
that that we didn't think about. And if I love

00:15:50.460 --> 00:15:54.740
having them all here, I do. If I could go back

00:15:54.740 --> 00:15:57.840
and start again, I would just have it be myself,

00:15:58.120 --> 00:16:02.320
Trey, and then Dr. Sastry, our psychiatrist,

00:16:02.720 --> 00:16:09.100
and build from there. Right. And so we started

00:16:09.100 --> 00:16:13.669
as a group practice. And it was a little accidental.

00:16:13.909 --> 00:16:15.629
Like when Trey and I said, we're opening this

00:16:15.629 --> 00:16:17.970
practice, everybody said, we want to come with

00:16:17.970 --> 00:16:19.950
you. And we're like, sure. The more, the merrier.

00:16:20.090 --> 00:16:22.730
We didn't think about, you've got to fill up

00:16:22.730 --> 00:16:26.570
everybody's schedule. You know, you've got to,

00:16:26.570 --> 00:16:29.990
you don't think about, or I didn't think about

00:16:29.990 --> 00:16:33.230
that stuff in the beginning. And that was really

00:16:33.230 --> 00:16:37.289
tough to do because, you know, everything that

00:16:37.289 --> 00:16:40.960
Trey was coming in for Trey and I. was going

00:16:40.960 --> 00:16:44.139
right back into the practice. But anything that

00:16:44.139 --> 00:16:47.120
another provider brought in, they got a cut of

00:16:47.120 --> 00:16:51.659
that. And so they had to fill me up. They had

00:16:51.659 --> 00:16:54.120
to fill Trey up first because that was the money

00:16:54.120 --> 00:16:56.639
that was paying the bills, you know, as things

00:16:56.639 --> 00:17:00.480
went. Yeah. So you and Trey probably didn't get

00:17:00.480 --> 00:17:04.819
paid for a while. For a long time. That's another

00:17:04.819 --> 00:17:08.400
thing I don't think that we know is that for

00:17:09.079 --> 00:17:12.740
Up until recently, we weren't taking any money.

00:17:12.799 --> 00:17:14.500
It was all going right back into the practice

00:17:14.500 --> 00:17:17.619
because then we turned around eight months later

00:17:17.619 --> 00:17:20.039
and got a second building still having a lease

00:17:20.039 --> 00:17:23.920
on the first building. And so all of that, all

00:17:23.920 --> 00:17:27.420
that we were bringing in had to go right back

00:17:27.420 --> 00:17:30.960
into the practice. And so it's still even now

00:17:30.960 --> 00:17:34.589
not. consistent. I mean, there are weeks we take

00:17:34.589 --> 00:17:37.490
more weeks, we take less. And a lot of that's

00:17:37.490 --> 00:17:39.710
just because we have such a big practice, a big

00:17:39.710 --> 00:17:42.849
group practice that because now we have two therapists

00:17:42.849 --> 00:17:47.490
on staff, we have two admin. Now we are getting

00:17:47.490 --> 00:17:50.769
ready to hire a third one. We lost a lot of money

00:17:50.769 --> 00:17:53.410
on billing, which is that's another thing too.

00:17:53.630 --> 00:17:57.859
Yeah. Okay. Yeah. I'm curious about like. credentialing,

00:17:57.900 --> 00:18:01.660
how you got credentialed. Yeah. And any billing

00:18:01.660 --> 00:18:04.180
tips for people, because that's a huge, huge

00:18:04.180 --> 00:18:06.200
thing, right? It's like, do we do billing ourself?

00:18:06.359 --> 00:18:09.980
Do we outsource it? Who do we hire? Can we bill

00:18:09.980 --> 00:18:13.640
psychotherapy with these 30 -minute visits? There's

00:18:13.640 --> 00:18:15.839
just a lot of stress around those topics. So

00:18:15.839 --> 00:18:20.039
any words of wisdom for people listening? I think

00:18:20.039 --> 00:18:24.700
if you don't want to use Grow or Headway or Amar

00:18:24.700 --> 00:18:28.230
or one of those, I think keep billing in -house

00:18:28.230 --> 00:18:32.710
because outside billers do not care about your

00:18:32.710 --> 00:18:34.910
business like you do. Nobody cares about this

00:18:34.910 --> 00:18:37.970
business like Trey and I do. It's our baby, you

00:18:37.970 --> 00:18:42.529
know? And so we're constantly hustling. But an

00:18:42.529 --> 00:18:45.450
outside biller is not going to care about it.

00:18:45.529 --> 00:18:48.130
And we've been through three billers and have

00:18:48.130 --> 00:18:51.289
lost thousands of dollars on billers until we

00:18:51.289 --> 00:18:55.240
finally moved it in -house. Yeah. Really? We

00:18:55.240 --> 00:18:58.160
finally moved it into Trey's wife and my son.

00:18:58.279 --> 00:19:00.700
They do it now. They've learned enough over three

00:19:00.700 --> 00:19:03.740
billers to be able to do it themselves. So they

00:19:03.740 --> 00:19:06.819
do it now. And if, you know, if there's anybody

00:19:06.819 --> 00:19:10.380
that cares about growing this business as much

00:19:10.380 --> 00:19:13.559
as Trey and I do, it's the two of them. So they

00:19:13.559 --> 00:19:17.230
stay on top of billing every day. You know, they're

00:19:17.230 --> 00:19:19.089
doing stuff constantly. They're on the phone

00:19:19.089 --> 00:19:22.049
constantly. You know, they'll be in our office.

00:19:22.490 --> 00:19:24.769
You know, such and such insurance lapsed. What

00:19:24.769 --> 00:19:26.390
do you want to do? How do you want to handle

00:19:26.390 --> 00:19:29.009
it? You know, I mean, the dream would be to have

00:19:29.009 --> 00:19:31.650
an all cash practice and it full nine to five

00:19:31.650 --> 00:19:35.400
Monday through Friday. But it's a lot. we decided

00:19:35.400 --> 00:19:37.559
not to go all cash because we wanted to build

00:19:37.559 --> 00:19:39.380
it quickly. We knew we needed money coming in

00:19:39.380 --> 00:19:42.559
pretty quickly. Yeah. So yeah. Paid for the rent.

00:19:42.660 --> 00:19:46.240
We had paid for the EHR and hired a billing team

00:19:46.240 --> 00:19:49.859
to do our credentialing and our billing. And

00:19:49.859 --> 00:19:52.859
so I think the credentialing per provider was

00:19:52.859 --> 00:19:57.500
around $1 ,200. And keep in mind, we were sticking

00:19:57.500 --> 00:20:01.519
this on a credit card. Right. To pay, which we've

00:20:01.519 --> 00:20:04.299
been able to pay that off. And, you know, get

00:20:04.299 --> 00:20:07.480
return on that. But that's a group practice that

00:20:07.480 --> 00:20:13.240
you're credentialing as well. And when, again,

00:20:13.359 --> 00:20:15.799
if I could, I probably have a lot of hindsight

00:20:15.799 --> 00:20:19.660
on here, but if I could give hindsight, then

00:20:19.660 --> 00:20:23.160
it may have been more beneficial to go with like

00:20:23.160 --> 00:20:27.579
Grow or with Headway and do the billing for us.

00:20:28.619 --> 00:20:31.519
Yeah. That, yeah, that's a huge question right

00:20:31.519 --> 00:20:34.599
now, right? People are like, Do we start with

00:20:34.599 --> 00:20:37.119
that? Do we not? I totally agree with you. If

00:20:37.119 --> 00:20:39.720
you're trying to build quickly, taking insurance

00:20:39.720 --> 00:20:43.799
is definitely the route to go. But I can see

00:20:43.799 --> 00:20:47.559
the value of starting with one of those companies.

00:20:47.680 --> 00:20:50.680
I'm not financially affiliated with any of them

00:20:50.680 --> 00:20:53.460
or saying that all of you guys should use them

00:20:53.460 --> 00:20:55.680
to start. But I think you need to weigh that

00:20:55.680 --> 00:20:58.859
risk -benefit. So you didn't use any of those

00:20:58.859 --> 00:21:02.319
companies? In the very beginning, we used Grow

00:21:02.319 --> 00:21:05.619
and Headway just because we needed to get paid

00:21:05.619 --> 00:21:09.920
quickly with money coming in. And we grew quickly,

00:21:10.019 --> 00:21:14.700
too. We grew so fast. And so that wasn't the

00:21:14.700 --> 00:21:16.740
issue. And then, you know, getting the money

00:21:16.740 --> 00:21:19.160
to come in, it was coming in. It's just we had

00:21:19.160 --> 00:21:21.769
a lot of overhead at that time. You know, which

00:21:21.769 --> 00:21:24.670
going back, I would have I would have still rented

00:21:24.670 --> 00:21:27.990
the space. I love the space that we had. We would

00:21:27.990 --> 00:21:30.250
have just done it just three of us to start.

00:21:30.490 --> 00:21:33.470
Then, you know, we probably could have kept the

00:21:33.470 --> 00:21:36.210
overhead a lot less because you've got to pay

00:21:36.210 --> 00:21:39.869
for the EHR for everybody as well. Right. So

00:21:39.869 --> 00:21:42.349
if somebody joins you now, do you use that same

00:21:42.349 --> 00:21:44.250
company that you got started with to get them

00:21:44.250 --> 00:21:47.630
credentialed or? No, we have. another company

00:21:47.630 --> 00:21:49.730
now because they were attached to billing and

00:21:49.730 --> 00:21:53.390
credentialing and we had to let them go. And

00:21:53.390 --> 00:21:56.130
so we have a separate just credentialing company

00:21:56.130 --> 00:21:58.730
that if we need it, they get us credentialed.

00:21:59.130 --> 00:22:02.970
Okay. Gotcha. Gotcha. That makes sense. So are

00:22:02.970 --> 00:22:05.690
most of your providers, like what percentage

00:22:05.690 --> 00:22:08.769
are in person versus telehealth? I do about 50,

00:22:08.849 --> 00:22:14.730
50. I really like telehealth. I feel like, you

00:22:14.730 --> 00:22:16.309
know, when they come. the patients that want

00:22:16.309 --> 00:22:19.490
in person they can come in person i feel like

00:22:19.869 --> 00:22:22.809
I waste time getting up, going to the lobby because

00:22:22.809 --> 00:22:24.730
I get my own patients to get them, bring them

00:22:24.730 --> 00:22:27.089
back. Then you chit chat for a few minutes and

00:22:27.089 --> 00:22:29.789
then you kind of get into it. We're on telehealth.

00:22:29.869 --> 00:22:32.549
I feel like we can log right on. How are you?

00:22:32.569 --> 00:22:35.130
I'm doing well. How are things going with this?

00:22:35.349 --> 00:22:36.990
You know, how are things going with this? And

00:22:36.990 --> 00:22:39.170
I feel like I get to spend more time with them

00:22:39.170 --> 00:22:42.230
over telehealth than I do in person because my

00:22:42.230 --> 00:22:45.029
schedule is packed from nine to five. So it's

00:22:45.029 --> 00:22:49.220
like. you know, constant pack. So trying to get

00:22:49.220 --> 00:22:51.480
somebody out of the office is a lot more difficult

00:22:51.480 --> 00:22:53.759
than telehealth. How many hours a week do you

00:22:53.759 --> 00:22:56.799
see patients? 40 hours. Monday through Friday,

00:22:56.920 --> 00:23:00.440
nine to five. Some Fridays, well, that's inaccurate.

00:23:00.640 --> 00:23:03.480
Probably, you know, 35 -ish because I usually

00:23:03.480 --> 00:23:06.299
leave early on Fridays. And I was taking Fridays

00:23:06.299 --> 00:23:08.480
off and I've just had to open up my Friday books.

00:23:08.859 --> 00:23:11.339
To get patients in? To get patients in, yeah.

00:23:11.779 --> 00:23:15.059
Okay. Yeah, that's a lot of direct patient care

00:23:15.059 --> 00:23:18.079
hours on top of running a practice. You're right.

00:23:18.240 --> 00:23:21.960
And my follow -ups, like my stable follow -ups,

00:23:21.980 --> 00:23:24.880
I do 15 minutes. So there's some days that it

00:23:24.880 --> 00:23:28.740
is every 15 minutes from 9 to 5. Wow. I take

00:23:28.740 --> 00:23:31.519
lunch from 12 to 1. So I see a lot of patients.

00:23:31.980 --> 00:23:36.019
Do you use an AI scribe at all? I do. I use Breed.

00:23:36.480 --> 00:23:40.890
Okay. And I actually, this is a splurge. So it's

00:23:40.890 --> 00:23:43.529
not that I'm recommending this, but I hired a

00:23:43.529 --> 00:23:47.690
scribe as well. So, and she's been worth every

00:23:47.690 --> 00:23:50.089
penny. She takes all kinds of coding classes.

00:23:50.329 --> 00:23:52.869
She keeps us completely updated. She'll tell

00:23:52.869 --> 00:23:55.730
me. you know, you can bill a therapy code for

00:23:55.730 --> 00:23:58.829
this appointment. Or she'll say, you cannot bill

00:23:58.829 --> 00:24:01.789
a therapy code on this one. She knows exactly

00:24:01.789 --> 00:24:03.890
what to tell me. Or she'll say, you can do a

00:24:03.890 --> 00:24:07.349
99205 on this initial appointment because A,

00:24:07.410 --> 00:24:09.829
B, and C, you know, or she'll say, you need to

00:24:09.829 --> 00:24:12.849
go down on this one before you send it in. So

00:24:12.849 --> 00:24:15.609
she's been fantastic. And I found her through

00:24:15.609 --> 00:24:20.059
a Facebook group. a couple of years ago and I've

00:24:20.059 --> 00:24:22.640
been using her for about two years. So she has

00:24:22.640 --> 00:24:26.440
my freed login. She'll go in through that and

00:24:26.440 --> 00:24:28.920
she'll get the transcript and then make the note

00:24:28.920 --> 00:24:33.420
based on that. Okay. Okay. Yeah. So it's like,

00:24:33.460 --> 00:24:36.880
it's like an asynchronous kind of setup, right?

00:24:36.960 --> 00:24:39.559
Correct. She's not like on appointments virtually

00:24:39.559 --> 00:24:42.380
or anything. No, no, no, no, no, no. She works

00:24:42.380 --> 00:24:44.099
from home. I think she lives in Florida and she

00:24:44.099 --> 00:24:46.799
works from home. Yeah. But she has started, Trey

00:24:46.799 --> 00:24:49.819
hired her to do his stuff too. That's smart,

00:24:49.859 --> 00:24:52.240
honestly. That's super smart because that's the

00:24:52.240 --> 00:24:57.420
downside to using AI, right? Yeah, I know. And

00:24:57.420 --> 00:25:03.799
I will say the hard part about seeing so many

00:25:03.799 --> 00:25:05.940
patients is keeping up with the charting. That's

00:25:05.940 --> 00:25:07.859
the hard part because I don't want to have to

00:25:07.859 --> 00:25:10.000
go home and chart. I will if I have to, but I

00:25:10.000 --> 00:25:14.259
didn't want to. And so that money. that I'm spending

00:25:14.259 --> 00:25:20.240
for that was worth my not risking burnout to

00:25:20.240 --> 00:25:23.400
be at home all evening charting as, as well,

00:25:23.420 --> 00:25:25.200
because, you know, if you're doing 15 minute

00:25:25.200 --> 00:25:27.460
appointments, you don't have time to chart in

00:25:27.460 --> 00:25:31.160
between. Right. And so, and I, I was spending

00:25:31.160 --> 00:25:33.480
my lunch break doing some charting. I didn't

00:25:33.480 --> 00:25:36.339
want to do that anymore. And so same thing with

00:25:36.339 --> 00:25:38.619
Trey, you know, he found himself getting behind.

00:25:38.720 --> 00:25:41.819
He hired him. She hired her, hired Gina. That's

00:25:41.819 --> 00:25:44.480
our scribe's name. Got her. She got him caught

00:25:44.480 --> 00:25:48.220
up and it's just been the best money we've ever

00:25:48.220 --> 00:25:52.220
spent for sure. For sure. Yeah. Okay. That's,

00:25:52.220 --> 00:25:53.640
that's interesting. I know people are going to

00:25:53.640 --> 00:25:55.359
be intrigued about that because I know that's

00:25:55.359 --> 00:25:58.640
a pain point for many people. So it's like, that's.

00:25:59.470 --> 00:26:01.490
Interesting. Was it just a random Facebook group?

00:26:01.549 --> 00:26:03.609
And she's like, hey. Yeah, it was a random Facebook

00:26:03.609 --> 00:26:05.750
group. And she said, does anybody know how to

00:26:05.750 --> 00:26:09.210
hire a scribe? And she said, I do it. And so

00:26:09.210 --> 00:26:12.109
I contacted her and she called me and we did

00:26:12.109 --> 00:26:14.190
kind of like a little interview where she was

00:26:14.190 --> 00:26:17.009
wanting to know what I was doing and, you know,

00:26:17.009 --> 00:26:19.970
if I was behind and, you know, kind of told me

00:26:19.970 --> 00:26:21.890
her rates, which I think are very, very reasonable.

00:26:22.049 --> 00:26:24.750
And roughly, can you tell us what those are?

00:26:25.049 --> 00:26:27.789
I don't know if it's increased, but. because

00:26:27.789 --> 00:26:29.230
I hate to speak out of turn because I'm happy

00:26:29.230 --> 00:26:32.269
to share her information as well. She's open

00:26:32.269 --> 00:26:35.789
for additional. She is open for additional. Yes.

00:26:35.849 --> 00:26:38.869
Gina Ahrens is her name. And I think when I first

00:26:38.869 --> 00:26:42.609
started, she was, I think it was $12 for a new

00:26:42.609 --> 00:26:46.849
eval. And then it might've been nine or $10 for

00:26:46.849 --> 00:26:50.170
follow -ups. Oh, okay. So maybe a little less

00:26:50.170 --> 00:26:52.250
on the follow up. So she does it for a chart.

00:26:52.289 --> 00:26:55.829
Yes. And I'll tell you, probably for as many

00:26:55.829 --> 00:27:00.170
patients as we see, we probably spend between

00:27:00.170 --> 00:27:04.089
$4 ,000 and $5 ,000 a month on her. Yeah. Because

00:27:04.089 --> 00:27:07.250
that's for all the charts she does. Yes. Worth

00:27:07.250 --> 00:27:10.240
it though. Oh, yeah. Yeah, I might be reaching

00:27:10.240 --> 00:27:14.619
out to Gina. Yes. And she's fantastic. She goes

00:27:14.619 --> 00:27:17.460
to all of the, she sends herself to these coding

00:27:17.460 --> 00:27:23.140
classes. She'll check in with you. She's taught

00:27:23.140 --> 00:27:26.000
us so much just about what we should and shouldn't

00:27:26.000 --> 00:27:29.000
be charting. And she will keep you on it. I do

00:27:29.000 --> 00:27:31.460
not worry. I just welcome an audit because I

00:27:31.460 --> 00:27:33.900
know her charting is so fantastic that I'm like,

00:27:33.940 --> 00:27:37.779
so go ahead. look over them at some point, like

00:27:37.779 --> 00:27:39.960
with the turnaround, that she does her part and

00:27:39.960 --> 00:27:42.519
then you get the charts closed. Usually she's

00:27:42.519 --> 00:27:45.400
a day behind. So if she's free today, she'll

00:27:45.400 --> 00:27:48.759
start working on charts today. And sometimes

00:27:48.759 --> 00:27:52.079
the next morning I come in and they're done from

00:27:52.079 --> 00:27:57.180
the day before. Okay. But I know in the beginning

00:27:57.180 --> 00:28:00.519
when Trey first hired her, he would change some

00:28:00.519 --> 00:28:03.730
things and she went to him and said, You can

00:28:03.730 --> 00:28:05.609
change things if you want, but this that you're

00:28:05.609 --> 00:28:10.430
putting in here is going to flag insurance. And

00:28:10.430 --> 00:28:12.710
he was like, okay, I'll leave it alone. And so,

00:28:12.710 --> 00:28:15.690
so yeah, so she really knows her stuff. Yeah.

00:28:15.750 --> 00:28:17.809
And I'll share her information with you. That's

00:28:17.809 --> 00:28:20.470
pretty cool. Yeah. So, so you guys don't have

00:28:20.470 --> 00:28:24.670
to spend a ton of time kind of. No. Okay. I haven't

00:28:24.670 --> 00:28:26.730
done, I can't remember the last time I had to

00:28:26.730 --> 00:28:29.710
do a chart. Nice. Do you have a template you

00:28:29.710 --> 00:28:32.769
like in freed? I just use the regular one that

00:28:32.769 --> 00:28:34.809
they've got. You know, I'll either say it's a

00:28:34.809 --> 00:28:37.730
new eval or a follow up visit. She just kind

00:28:37.730 --> 00:28:40.369
of takes it from there. I think she probably

00:28:40.369 --> 00:28:43.210
has. I'm sure she does have her own template

00:28:43.210 --> 00:28:46.450
templates that she uses for the charting. But

00:28:46.450 --> 00:28:49.569
like the, you know, the section at the bottom

00:28:49.569 --> 00:28:52.109
of intake queue of the forms where you can kind

00:28:52.109 --> 00:28:54.849
of put your plan or, you know, if you're going

00:28:54.849 --> 00:28:57.529
to follow up, that kind of stuff. It's just this

00:28:57.529 --> 00:29:00.880
long. stuff that she puts in there. If you do

00:29:00.880 --> 00:29:03.700
psychotherapy, she does this fantastic wording

00:29:03.700 --> 00:29:06.220
for psychotherapy. She really took it and ran

00:29:06.220 --> 00:29:08.779
with it and has done a great job. Anytime I have

00:29:08.779 --> 00:29:11.759
students, they'll always say your charting is

00:29:11.759 --> 00:29:13.519
incredible. And I'm like, thank you. I didn't

00:29:13.519 --> 00:29:17.019
do it, but thank you. Yeah. That's awesome. Oh

00:29:17.019 --> 00:29:19.319
man. I have so many more questions for you. Cause

00:29:19.319 --> 00:29:24.200
I'm curious about how you grew from like no patients

00:29:24.200 --> 00:29:28.059
to a thousand patients. in six months? Like what

00:29:28.059 --> 00:29:30.140
did you do specifically to make that happen?

00:29:30.460 --> 00:29:32.960
So one thing that we did in the beginning that

00:29:32.960 --> 00:29:35.599
was another cost, but we felt like was worth

00:29:35.599 --> 00:29:40.339
it is we hired a marketing team and that runs

00:29:40.339 --> 00:29:43.920
us about a thousand dollars a month. They take

00:29:43.920 --> 00:29:46.559
care of all of our social media. So you still

00:29:46.559 --> 00:29:48.859
have the same marketing team? We still have the

00:29:48.859 --> 00:29:51.220
same marketing team. They are like handshake,

00:29:51.220 --> 00:29:56.119
good old boy run. They're fantastic. do like

00:29:56.119 --> 00:29:58.299
if we decide to run Google ads, which we have

00:29:58.299 --> 00:30:01.319
run some Google ads and they handle all of that.

00:30:01.859 --> 00:30:04.559
They handle the advertisement. Now they don't

00:30:04.559 --> 00:30:07.059
do that. What I call kind of boots on the ground,

00:30:07.220 --> 00:30:10.660
you know, marketing. They're more of like, they

00:30:10.660 --> 00:30:13.819
maintain our website. They do all of our social

00:30:13.819 --> 00:30:16.799
media, our Facebook and our Instagram for premiere.

00:30:17.059 --> 00:30:20.299
They keep track of all of that for us. And so

00:30:20.299 --> 00:30:23.240
that's worth it because it got to where my husband,

00:30:23.400 --> 00:30:26.930
because He also started out managing our website

00:30:26.930 --> 00:30:30.529
and it just got to be too much. There's a lot

00:30:30.529 --> 00:30:33.369
of traffic through there. And so he was like,

00:30:33.430 --> 00:30:35.490
I cannot keep up with your socials either. So

00:30:35.490 --> 00:30:38.910
they post daily, sometimes multiple times a day.

00:30:39.009 --> 00:30:41.329
If we want something posted, we'll just reach

00:30:41.329 --> 00:30:43.609
out to them and just tell them, can you post

00:30:43.609 --> 00:30:46.210
about this today? You know, that kind of stuff.

00:30:46.329 --> 00:30:49.559
So they do a great job. Wow. You don't hear that

00:30:49.559 --> 00:30:52.579
very often. People are like, I hired a marketing

00:30:52.579 --> 00:30:55.519
team from the beginning and I'm still using them

00:30:55.519 --> 00:30:57.740
and I'm happy with them. And we're happy with

00:30:57.740 --> 00:31:03.799
them. Yes. The first time I met with the guy

00:31:03.799 --> 00:31:06.940
that owns the company, which is Nixon Pro is

00:31:06.940 --> 00:31:09.259
the name of that company. He said, I don't do

00:31:09.259 --> 00:31:11.619
contracts. It's a handshake only. And that just

00:31:11.619 --> 00:31:14.509
really sold me. You know, he's local. They knew

00:31:14.509 --> 00:31:17.029
the area. They knew there wasn't anything in

00:31:17.029 --> 00:31:20.769
this area like what we had. And then Trey and

00:31:20.769 --> 00:31:23.950
I, in the beginning, we literally got in my car

00:31:23.950 --> 00:31:26.609
and went around to different doctor's offices

00:31:26.609 --> 00:31:29.470
and therapist offices ourselves. We did all of

00:31:29.470 --> 00:31:32.569
that kind of boots on the ground marketing ourselves

00:31:32.569 --> 00:31:36.190
in the beginning. We did all of that. And then

00:31:36.190 --> 00:31:39.990
our name started getting out there and we started,

00:31:40.029 --> 00:31:43.859
it just. The floodgates just opened with referrals

00:31:43.859 --> 00:31:47.500
for us. That's awesome. So if you were going

00:31:47.500 --> 00:31:49.640
to like if we were looking at a pie chart of

00:31:49.640 --> 00:31:51.799
kind of the breakdown of where your referrals

00:31:51.799 --> 00:31:56.380
come from, what would you say roughly as far

00:31:56.380 --> 00:31:59.440
as like primary care versus therapist versus

00:31:59.440 --> 00:32:03.319
Google ads? I would say now we're probably about

00:32:03.319 --> 00:32:09.109
70, probably 60 percent from therapist. And probably

00:32:09.109 --> 00:32:13.329
30 percent from PCPs and then maybe like 10 percent

00:32:13.329 --> 00:32:17.829
just Google searching. Maybe a little more, you

00:32:17.829 --> 00:32:21.329
know, that's just kind of like a rough estimate

00:32:21.329 --> 00:32:25.150
because I get a lot from therapists and they'll

00:32:25.150 --> 00:32:26.970
say, my therapist sent me, my therapist sent

00:32:26.970 --> 00:32:29.130
me. So, yeah, I get a lot from the therapist's

00:32:29.130 --> 00:32:32.359
office. OK, so do you feel like that's a direct

00:32:32.359 --> 00:32:34.599
result of like your and Trey's kind of boots

00:32:34.599 --> 00:32:37.960
on the ground effort? Yeah, I think so. I think

00:32:37.960 --> 00:32:40.319
so. We started and we're getting ready to kind

00:32:40.319 --> 00:32:43.160
of redo it. Like what we're going to do is my

00:32:43.160 --> 00:32:47.039
son Will and Brittany are going to start going

00:32:47.039 --> 00:32:52.059
out on Wednesdays like every other week and just

00:32:52.059 --> 00:32:54.420
do like we did when we were brand new. Just revisit

00:32:54.420 --> 00:32:58.220
places, see if there's any new any. Anybody new

00:32:58.220 --> 00:33:01.480
and just same thing, just going into buildings

00:33:01.480 --> 00:33:04.180
and offices and saying, hey, we're here. We've

00:33:04.180 --> 00:33:07.400
got pretty much immediate openings. You know,

00:33:07.440 --> 00:33:09.660
we can help. Just let us know what you need.

00:33:09.920 --> 00:33:15.059
And so we just every so often that cycle. OK,

00:33:15.059 --> 00:33:17.859
bringing in like business cards or anything like

00:33:17.859 --> 00:33:19.519
that? We'll take business cards and we'll take

00:33:19.519 --> 00:33:23.559
pamphlets in. I think for really big PCP offices,

00:33:23.839 --> 00:33:26.160
Trey and I will go take them lunch ourselves

00:33:26.160 --> 00:33:31.259
and see them that way. But like the smaller offices,

00:33:31.779 --> 00:33:34.759
you know, Will and Brittany will go and we'll

00:33:34.759 --> 00:33:38.200
we'll take the pamphlets and say, hey, just wanted

00:33:38.200 --> 00:33:40.559
you to know, because I think sometimes after

00:33:40.559 --> 00:33:43.359
a while people forget that you're there. So we

00:33:43.359 --> 00:33:46.019
just want to. Just a quick reminder, we're here

00:33:46.019 --> 00:33:49.819
if you need us. Yeah, absolutely. Another question

00:33:49.819 --> 00:33:54.740
people ask is like, how do you decide when someone's

00:33:54.740 --> 00:33:59.319
caseload is full, quote unquote? That's a good

00:33:59.319 --> 00:34:03.279
question. I think, no, and we haven't really

00:34:03.279 --> 00:34:05.500
thought about it, to be honest with you. I will

00:34:05.500 --> 00:34:10.849
say this, Trey. is working. We still both cover

00:34:10.849 --> 00:34:15.230
the hospital inpatient. So I will do it some

00:34:15.230 --> 00:34:19.210
weekends PRN and he still does it full time.

00:34:19.349 --> 00:34:21.949
So Trey will be gone to the hospital in the mornings

00:34:21.949 --> 00:34:25.010
and then he will come here and he will see a

00:34:25.010 --> 00:34:27.989
ton of people in the afternoon. That is getting

00:34:27.989 --> 00:34:30.610
ready to change though, because we are getting

00:34:30.610 --> 00:34:34.030
so, I told him, I need you here, you know, full

00:34:34.030 --> 00:34:37.070
time. I said it. different but I basically said

00:34:37.070 --> 00:34:42.610
I need you to be here full -time and so he has

00:34:42.610 --> 00:34:44.650
put his notice in at the hospital and he's going

00:34:44.650 --> 00:34:47.369
to be starting full -time next month I think

00:34:47.369 --> 00:34:49.949
once we both get to a place where we're like

00:34:49.949 --> 00:34:53.610
a month you know if it's like a month booked

00:34:53.610 --> 00:34:57.030
out then at that point you know maybe that we

00:34:57.030 --> 00:35:00.769
say you know we're not taking anybody or we need

00:35:00.769 --> 00:35:04.800
to hire somebody because we've got a PA that

00:35:04.800 --> 00:35:07.719
she sees adolescents online because there's such

00:35:07.719 --> 00:35:10.739
a need for kids and adolescent, but it's not,

00:35:10.820 --> 00:35:15.460
that's not where I'm strong. I'm not strong with

00:35:15.460 --> 00:35:19.750
kids or adolescents. And so. she will see kids

00:35:19.750 --> 00:35:23.170
online. And then we have another NP that does

00:35:23.170 --> 00:35:26.150
mostly online in the afternoons as well. And

00:35:26.150 --> 00:35:28.570
she's kind of full. She, she has stopped taking

00:35:28.570 --> 00:35:30.630
new patients because she's just doing it in the

00:35:30.630 --> 00:35:34.210
afternoon. So right now it's just Trey and I

00:35:34.210 --> 00:35:37.949
taking new patients. And so we haven't really

00:35:37.949 --> 00:35:39.789
gotten to a place where we're like, I can't take

00:35:39.789 --> 00:35:45.309
anymore. I think the dream would be to really

00:35:45.309 --> 00:35:50.079
grow and We can step back a little bit, just

00:35:50.079 --> 00:35:52.219
keep the patients that we have and maybe do more

00:35:52.219 --> 00:35:56.960
of an oversight of providers. And I don't know

00:35:56.960 --> 00:36:00.019
really what that growth looks like. I know I.

00:36:00.869 --> 00:36:03.210
Just I have a Florida license. I have a Kentucky

00:36:03.210 --> 00:36:06.429
license. I have a Texas license. I just applied

00:36:06.429 --> 00:36:09.510
for autonomy in Florida, which you can do, I

00:36:09.510 --> 00:36:12.170
think, after 3000 hours. I just applied for that.

00:36:12.230 --> 00:36:14.809
I haven't heard back yet and just got my day

00:36:14.809 --> 00:36:17.630
in Florida. So we'd like to branch out telehealth

00:36:17.630 --> 00:36:20.869
to Florida. We're right on the Kentucky border.

00:36:21.469 --> 00:36:25.170
So that might be an area to target as well. OK,

00:36:25.289 --> 00:36:30.300
interesting. So wait. Are you guys multi -state

00:36:30.300 --> 00:36:34.659
or are you guys all? We're just, Premier is just

00:36:34.659 --> 00:36:38.000
in Tennessee, but we would like to be multi -state,

00:36:38.059 --> 00:36:40.340
which I know several of the guests that you've

00:36:40.340 --> 00:36:42.900
had have been multi -state and I find it fascinating.

00:36:43.320 --> 00:36:46.619
You know, like I've had so much more, so many

00:36:46.619 --> 00:36:49.579
more questions. You know, when I listen to all

00:36:49.579 --> 00:36:51.639
your episodes, I'm like, I have questions about

00:36:51.639 --> 00:36:53.960
this. I just have so many questions, you know,

00:36:53.960 --> 00:36:59.980
and we would like to. you know, be able to look

00:36:59.980 --> 00:37:02.460
at some of the autonomous states as well, because

00:37:02.460 --> 00:37:05.280
the truth is we're in Tennessee and we're probably

00:37:05.280 --> 00:37:10.000
one of the most restricted states. And it's really

00:37:10.000 --> 00:37:12.980
tough. We got really lucky. That's another thing

00:37:12.980 --> 00:37:16.179
that I know that's been talked about before is

00:37:16.179 --> 00:37:19.000
having to pay supervisor fees. We don't have

00:37:19.000 --> 00:37:22.579
to because we knew that. our psychiatrist and

00:37:22.579 --> 00:37:24.800
our mentor so well, he doesn't charge us any

00:37:24.800 --> 00:37:28.059
fees. So we're very lucky in that. So that's

00:37:28.059 --> 00:37:31.260
a fee that we don't have to pay right now, as

00:37:31.260 --> 00:37:34.659
long as he's good, you know, and still with us.

00:37:35.800 --> 00:37:38.840
But Tennessee, they've been, NPs have been fighting

00:37:38.840 --> 00:37:42.480
for autonomy for a while. Trey and I actually

00:37:42.480 --> 00:37:45.000
went and met with one of our senators about it.

00:37:45.340 --> 00:37:48.920
maybe about six months ago. And we took him all

00:37:48.920 --> 00:37:51.619
the statistics on, because I think the big thing

00:37:51.619 --> 00:37:53.940
here is opioid abuse. And we're like, well, first

00:37:53.940 --> 00:37:56.619
of all, we don't even prescribe opioids. So,

00:37:56.619 --> 00:38:01.880
you know, but this is the problem with needing

00:38:01.880 --> 00:38:05.400
the supervisor. And he told us literally, it's

00:38:05.400 --> 00:38:08.320
a money thing. This is why it's not being passed

00:38:08.320 --> 00:38:13.260
thing with these doctors. And so they, he did

00:38:13.260 --> 00:38:16.760
agree to get it back on the, the board for this

00:38:16.760 --> 00:38:21.800
year and I think the governor did a big at the

00:38:21.800 --> 00:38:27.900
governor's state address he addressed autonomy

00:38:27.900 --> 00:38:31.760
for nurse practitioners said that several rural

00:38:31.760 --> 00:38:34.480
facilities were closing because they could not

00:38:34.480 --> 00:38:36.679
find a supervising physician in Tennessee and

00:38:36.679 --> 00:38:38.719
these people were not getting the care they needed

00:38:38.719 --> 00:38:41.710
and that His suggestion was to give autonomy

00:38:41.710 --> 00:38:45.150
to APRNs in the state of Tennessee. So hopefully

00:38:45.150 --> 00:38:47.070
they'll listen to that. And that is something

00:38:47.070 --> 00:38:50.949
that can happen, I'm hoping. But, you know, when

00:38:50.949 --> 00:38:53.530
you're in a really restricted state, you've got

00:38:53.530 --> 00:38:55.869
to find a supervising physician. And it is not

00:38:55.869 --> 00:38:58.789
cheap. It is not cheap. That's what makes it

00:38:58.789 --> 00:39:03.400
really hard. Yeah. Did you hire a lawyer? Or

00:39:03.400 --> 00:39:06.199
have you along the way or not? Well, my sister

00:39:06.199 --> 00:39:09.579
is an attorney, so we just picked her brain on

00:39:09.579 --> 00:39:13.119
things. Now, she doesn't do health care law,

00:39:13.320 --> 00:39:15.739
but she was able to help us with a lot of the

00:39:15.739 --> 00:39:20.780
basics. Yeah. And then a lot of our I .T. stuff

00:39:20.780 --> 00:39:23.820
and our, you know, Internet, things like that.

00:39:23.900 --> 00:39:26.780
My dad stepped in and it was really a family

00:39:26.780 --> 00:39:29.659
thing. You know, we had to do that. You know,

00:39:29.719 --> 00:39:33.260
we didn't. We just didn't have it, but I am really,

00:39:33.320 --> 00:39:36.199
we do have an attorney now that I should have

00:39:36.199 --> 00:39:38.480
said that we do have an attorney now that if

00:39:38.480 --> 00:39:40.599
we need him to look over contracts, we've put

00:39:40.599 --> 00:39:42.960
him on retainer and he, he does help with stuff

00:39:42.960 --> 00:39:45.000
like that. We've only had to use them one time.

00:39:45.099 --> 00:39:48.059
We had a biller that was not doing what they

00:39:48.059 --> 00:39:49.659
were supposed to do in their contract. So we

00:39:49.659 --> 00:39:51.920
shut them out of the system and they tried to

00:39:51.920 --> 00:39:55.400
sue us for like seven or $8 ,000 in our, we,

00:39:55.480 --> 00:39:58.000
that's when I know that's when we retained this

00:39:58.000 --> 00:40:02.050
attorney. And it's somebody local. And he looked

00:40:02.050 --> 00:40:04.389
over the contract and sent him a letter and said,

00:40:04.510 --> 00:40:09.230
this is not going to fly. And if you don't drop

00:40:09.230 --> 00:40:11.070
this, we're going to look at a countersuit. And

00:40:11.070 --> 00:40:13.829
we've not heard from him since. So we do have

00:40:13.829 --> 00:40:16.969
someone on retainer right now. Yeah. Okay. Do

00:40:16.969 --> 00:40:21.389
you hire your practitioners W -2, 1099, if you

00:40:21.389 --> 00:40:25.829
are comfortable sharing? I am. We, they're 1099s

00:40:25.829 --> 00:40:30.570
right now. If I could go back, I would do W -2

00:40:30.570 --> 00:40:34.369
and just give them an hourly rate because we

00:40:34.369 --> 00:40:38.449
were really generous, I think, in the beginning

00:40:38.449 --> 00:40:42.909
and did a 70 -30 with them. And then we really

00:40:42.909 --> 00:40:46.769
started losing money on the business. So we renegotiated

00:40:46.769 --> 00:40:49.489
with them and they agreed to a 60 -40, which

00:40:49.489 --> 00:40:51.170
was still giving them a good amount of money.

00:40:51.530 --> 00:40:54.409
So if I could go back, I would probably just

00:40:54.409 --> 00:40:58.039
give them a flat rate. Sometimes it muddies the

00:40:58.039 --> 00:41:01.139
water with 1099s, especially when you take insurance,

00:41:01.300 --> 00:41:03.920
because if they're making a certain percentage,

00:41:04.280 --> 00:41:07.000
then sometimes you're waiting for claims to come

00:41:07.000 --> 00:41:10.179
in. But then if claims get denied or if clawbacks

00:41:10.179 --> 00:41:15.300
happen, then it makes it difficult to wade through

00:41:15.300 --> 00:41:19.699
that when that happens. Yeah. Yeah. Being on

00:41:19.699 --> 00:41:21.739
the opposite end of it, I had a job where I was

00:41:21.739 --> 00:41:24.280
a 1099. Yeah. I didn't realize that I was going

00:41:24.280 --> 00:41:26.920
to be like waiting to get paid. Right. So it

00:41:26.920 --> 00:41:29.840
felt like I wasn't getting paid, but yeah, I

00:41:29.840 --> 00:41:32.679
was, I was new to it and it wasn't really explained

00:41:32.679 --> 00:41:35.980
that explicitly. So I was like, just kind of

00:41:35.980 --> 00:41:39.500
like, huh, this is not loving this. So you guys

00:41:39.500 --> 00:41:42.539
are a practice that takes students. It sounds

00:41:42.539 --> 00:41:46.699
like. Trey and I both take students. I usually

00:41:46.699 --> 00:41:48.980
will have, you know, a couple float through here.

00:41:49.900 --> 00:41:51.719
And I know how hard it was. I had to pay for

00:41:51.719 --> 00:41:54.059
preceptors. So I know how hard it is to find

00:41:54.059 --> 00:41:56.420
preceptors. So I try not to say no to students,

00:41:56.480 --> 00:41:59.199
but I don't want to have too many. And I want

00:41:59.199 --> 00:42:02.239
to make sure they're getting what they need because

00:42:02.239 --> 00:42:05.440
my appointments can move pretty quick, especially

00:42:05.440 --> 00:42:08.500
with my really stable patients. And so I want

00:42:08.500 --> 00:42:10.500
to make sure they're getting enough from it.

00:42:10.579 --> 00:42:15.159
And so I do take students. I've got one or two

00:42:15.159 --> 00:42:18.190
with me right now. And so sometimes they'll come

00:42:18.190 --> 00:42:21.829
in. Sometimes I'll let them, you know, kind of

00:42:21.829 --> 00:42:24.010
listen. If they can't make it in, then I have

00:42:24.010 --> 00:42:27.530
a Zoom room they can come into and listen. If

00:42:27.530 --> 00:42:29.929
the patient allows, part of the paperwork is

00:42:29.929 --> 00:42:32.630
for student observation with our patients. And

00:42:32.630 --> 00:42:35.409
if they check no, then no students. If they check

00:42:35.409 --> 00:42:38.050
yes, they can listen in or sit in on the visit.

00:42:38.210 --> 00:42:40.070
But that's part of the standard paperwork is

00:42:40.070 --> 00:42:45.110
the student observation. Okay. Is there a certain

00:42:45.110 --> 00:42:47.409
place that these students come from? Do you charge

00:42:47.409 --> 00:42:51.110
for clinicals? No, I don't typically charge.

00:42:51.329 --> 00:42:53.849
Most of the time they come from a friend. Like

00:42:53.849 --> 00:42:55.929
a friend says, I know, or a nurse that I used

00:42:55.929 --> 00:42:58.909
to work with. I've gotten a lot more now. Like

00:42:58.909 --> 00:43:00.690
a nurse that I used to work with that knows what

00:43:00.690 --> 00:43:02.449
I'm doing now will say, I've got this friend.

00:43:02.550 --> 00:43:04.690
She needs somebody for clinicals. And of course

00:43:04.690 --> 00:43:10.449
I'm like, sure. You know, I did sign up. Some

00:43:10.449 --> 00:43:13.659
of them, I did sign up at one point. when we

00:43:13.659 --> 00:43:16.239
first opened just to make some extra money through

00:43:16.239 --> 00:43:19.840
NP hub. So every once in a while, I'll get one

00:43:19.840 --> 00:43:23.340
through there that, you know, pays, but if, if

00:43:23.340 --> 00:43:26.199
it's word of mouth, I don't charge them. You

00:43:26.199 --> 00:43:27.880
know, if it's somebody I know, I don't charge

00:43:27.880 --> 00:43:31.119
them any money. I don't, you know, I just, I

00:43:31.119 --> 00:43:35.780
just agree to it. Yeah. How do you determine

00:43:35.780 --> 00:43:40.320
the length of follow -up appointments and like,

00:43:41.019 --> 00:43:43.519
How what's that conversation like in your group

00:43:43.519 --> 00:43:45.519
practice as far as like the billing of brief

00:43:45.519 --> 00:43:47.099
psychotherapy? Because I think that's another

00:43:47.099 --> 00:43:49.739
one of those kind of can be, I guess, controversial

00:43:49.739 --> 00:43:51.960
topics. People don't always agree or see eye

00:43:51.960 --> 00:43:54.760
to eye on it. So I was just curious. So if I

00:43:54.760 --> 00:43:57.800
do a follow up in person, it's 30 minutes. And

00:43:57.800 --> 00:44:00.420
if we do get into some psychotherapy things,

00:44:00.579 --> 00:44:05.639
then I will bill the 90833. I do not bill psychotherapy

00:44:05.639 --> 00:44:08.659
for my 15 minute appointments at all. Not at

00:44:08.659 --> 00:44:12.710
all. And so those I do not bill for. Sometimes,

00:44:13.070 --> 00:44:15.010
you know, sometimes you just have a patient come

00:44:15.010 --> 00:44:16.730
in person, you're scheduled for 30 minutes and

00:44:16.730 --> 00:44:19.230
it legitimately only takes like 15 minutes, you

00:44:19.230 --> 00:44:21.070
know, because sometimes the patient just sits

00:44:21.070 --> 00:44:23.050
and they're like, I'm fine. Everything's good.

00:44:23.110 --> 00:44:25.110
You know, and you try to pull information from

00:44:25.110 --> 00:44:26.309
them and they're not going to give you anything.

00:44:26.829 --> 00:44:29.530
Those I just bill for like 15 minutes. But if

00:44:29.530 --> 00:44:32.429
they're here for 30 minutes and we do some psychotherapy

00:44:32.429 --> 00:44:36.769
with it, then I will bill for the psychotherapy.

00:44:36.769 --> 00:44:39.940
But only if I have. seen them for 30 minutes.

00:44:40.099 --> 00:44:43.340
Do I feel that if we did some psychotherapy that

00:44:43.340 --> 00:44:45.659
I might do it? But I'll tell you a little secret.

00:44:45.900 --> 00:44:49.320
I do not love the psychotherapy part. I love

00:44:49.320 --> 00:44:52.340
the medication management part. I love to hear

00:44:52.340 --> 00:44:55.420
the good stories. I love the reason I fell in

00:44:55.420 --> 00:44:58.219
love with psych was there's got to be a reason

00:44:58.219 --> 00:45:01.099
that this is happening. What's the reason? And

00:45:01.099 --> 00:45:03.599
then finding the right medication for a patient

00:45:03.599 --> 00:45:08.929
is. what i love about it so i don't i don't get

00:45:08.929 --> 00:45:11.650
super jazzed but i'll do psychotherapy because

00:45:11.650 --> 00:45:15.949
sometimes it's just it it is but i don't look

00:45:15.949 --> 00:45:18.769
for it if i build the code or if it's happened

00:45:18.769 --> 00:45:21.809
it's happened very organically and it's on that

00:45:21.809 --> 00:45:24.329
so yeah that makes sense that makes sense why

00:45:24.329 --> 00:45:26.329
your follow -up visits are mostly 15 minutes

00:45:26.329 --> 00:45:29.320
too that's right yes for sure yeah This is kind

00:45:29.320 --> 00:45:30.920
of an interesting one, but especially having

00:45:30.920 --> 00:45:33.579
a business partner, have you guys ever had the

00:45:33.579 --> 00:45:36.139
conversation of like, is our goal to eventually

00:45:36.139 --> 00:45:40.099
sell the practice? Is it to just kind of like

00:45:40.099 --> 00:45:42.039
you mentioned earlier, maybe step back a little

00:45:42.039 --> 00:45:45.219
bit more and do more oversight, maybe less direct

00:45:45.219 --> 00:45:48.739
patient care hours? Like, yeah, I'm curious.

00:45:49.199 --> 00:45:51.860
Yeah, no, it's a great question. We have talked

00:45:51.860 --> 00:45:55.940
about at some point if it gets so huge that would

00:45:55.940 --> 00:45:58.940
we sell it? you know, I think, and trail say

00:45:58.940 --> 00:46:01.780
for the right price. I don't think about that

00:46:01.780 --> 00:46:05.300
as much because, you know, we started this, this

00:46:05.300 --> 00:46:08.199
is our baby. We love it. You know, I'm happy

00:46:08.199 --> 00:46:12.619
every day when I get up, come to work and I love

00:46:12.619 --> 00:46:16.360
what I do. So that's not something I'm anxious

00:46:16.360 --> 00:46:20.880
to get rid of. We would like to grow, but I don't

00:46:20.880 --> 00:46:23.039
want so much growth that we become like a big

00:46:23.039 --> 00:46:25.920
chain, like something like Athena. you know,

00:46:25.940 --> 00:46:30.539
one of those just exploded. I like, I want to

00:46:30.539 --> 00:46:33.679
stay premier. You know, I, I would like to grow,

00:46:33.760 --> 00:46:36.800
but not so big that we lose sight of what we

00:46:36.800 --> 00:46:40.460
opened and why we opened it. But we do talk about

00:46:40.460 --> 00:46:44.500
that as, as we grow, we would like to hire more

00:46:44.500 --> 00:46:48.889
providers. step back some from direct patient

00:46:48.889 --> 00:46:52.449
care, do more like oversight or, you know, kind

00:46:52.449 --> 00:46:56.550
of supervision for new NPs and go that route

00:46:56.550 --> 00:46:58.789
with it. Or we'd love to be able to get to a

00:46:58.789 --> 00:46:59.989
place where we're saying we're not taking any

00:46:59.989 --> 00:47:01.889
new patients. We're just going to keep what we've

00:47:01.889 --> 00:47:05.610
got, you know, and start giving other NPs the

00:47:05.610 --> 00:47:09.230
new patients. And so I think that is a potential

00:47:09.230 --> 00:47:11.570
within a year, especially with Trey coming on

00:47:11.570 --> 00:47:16.599
full time. I think that's a big potential. you

00:47:16.599 --> 00:47:20.039
know, to happen. We get a lot of people that

00:47:20.039 --> 00:47:22.500
we've known wanting to work here. We get a lot

00:47:22.500 --> 00:47:24.539
of calls, you know, students wanting to work

00:47:24.539 --> 00:47:27.800
here. And I, I'm sure it, you know, it looks

00:47:27.800 --> 00:47:30.039
fun, like that we're all here and we're working

00:47:30.039 --> 00:47:32.500
and it's great, but it's going to take a lot

00:47:32.500 --> 00:47:35.199
for us. We're going to have to explode some more

00:47:35.199 --> 00:47:40.460
before we really hire a number of NP patients

00:47:40.460 --> 00:47:43.619
because we just need, there's nothing worse than

00:47:43.619 --> 00:47:45.860
hiring someone and they're just sitting. you

00:47:45.860 --> 00:47:48.440
know, for weeks at the patient load. So we're

00:47:48.440 --> 00:47:51.340
going to have to get to a place where, you know,

00:47:51.360 --> 00:47:54.920
we, we really are just cannot handle the senses

00:47:54.920 --> 00:47:57.440
that we currently have before we really look

00:47:57.440 --> 00:48:02.239
into doing that. Yeah. Okay. So from like a mentorship

00:48:02.239 --> 00:48:04.920
or coaching perspective, it sounds like you have

00:48:04.920 --> 00:48:07.820
that psychiatrist that has been really supportive,

00:48:08.039 --> 00:48:11.199
but is there anything else that you've invested

00:48:11.199 --> 00:48:14.199
in or like found for free that's been really

00:48:14.199 --> 00:48:16.840
helpful as far as mentorship, coaching, resources?

00:48:18.099 --> 00:48:22.559
Yes. I love NEI. I use it every day, sometimes

00:48:22.559 --> 00:48:25.320
multiple times a day. I always recommend it to

00:48:25.320 --> 00:48:27.539
students because they have a student rate, but

00:48:27.539 --> 00:48:31.099
I absolutely love it. It's a daily thing for

00:48:31.099 --> 00:48:34.980
me. I like Psychiatry Redefined. I'm actually

00:48:34.980 --> 00:48:38.380
just working through their hormone and mental

00:48:38.380 --> 00:48:41.679
health course. It's a three -part course because

00:48:41.679 --> 00:48:45.880
I started to niche down a little bit with ADHD

00:48:45.880 --> 00:48:51.500
and that kind of perimenopause, menopausal female.

00:48:52.139 --> 00:48:57.929
I see a lot of those. wanted to become you can

00:48:57.929 --> 00:49:00.349
get certified through the course I really wanted

00:49:00.349 --> 00:49:03.610
to become more educated on it I don't think there's

00:49:03.610 --> 00:49:05.889
a ton out there so I was really excited to find

00:49:05.889 --> 00:49:10.730
that course to take but trying to find you know

00:49:10.730 --> 00:49:14.869
someone that's going to talk about hormones and

00:49:14.869 --> 00:49:17.909
mental wellness I think there's more light coming

00:49:17.909 --> 00:49:22.650
to it but still not enough right okay so you're

00:49:22.650 --> 00:49:25.800
not in the fellowship you signed up for a three

00:49:25.800 --> 00:49:29.880
-part hormone course. Correct. Yes. How far into

00:49:29.880 --> 00:49:32.340
it are you? I am in the middle of the first,

00:49:32.599 --> 00:49:36.840
there's three live sessions, but I joined after

00:49:36.840 --> 00:49:39.539
the first two had already come on. So the third

00:49:39.539 --> 00:49:41.820
one is this week. So I'm working through the

00:49:41.820 --> 00:49:45.840
first live session now. Okay. And are you liking

00:49:45.840 --> 00:49:48.960
it so far? Because people ask me a lot about

00:49:48.960 --> 00:49:51.659
like trainings and education on that. I do like

00:49:51.659 --> 00:49:55.079
it. I do. What was the price point roughly? It

00:49:55.079 --> 00:49:59.719
was $399 for the whole course. Okay. I've looked

00:49:59.719 --> 00:50:01.820
at the fellowship too. I know I think you're

00:50:01.820 --> 00:50:04.659
doing the fellowship. Do you, or you're working

00:50:04.659 --> 00:50:08.460
through it. Do you find it helpful? I do. I do

00:50:08.460 --> 00:50:11.159
find it helpful. Yeah. I've definitely branched

00:50:11.159 --> 00:50:14.179
out with what I recommend to patients. Sure.

00:50:14.380 --> 00:50:18.360
Okay. And I, I'm behind on the content as per

00:50:18.360 --> 00:50:22.480
usual with the courses I sign up for, but yeah,

00:50:22.519 --> 00:50:24.889
I've definitely found it. helpful and kind of

00:50:24.889 --> 00:50:27.329
given me more confidence to try some of these

00:50:27.329 --> 00:50:31.909
integrative interventions that aren't as established,

00:50:32.170 --> 00:50:36.449
you know, so I'm enjoying, I'm learning. That's

00:50:36.449 --> 00:50:39.150
what I liked about it too. I was diagnosed with

00:50:39.150 --> 00:50:43.309
ADHD when I was in grad school and that's what

00:50:43.309 --> 00:50:47.650
prompted me to, to start taking training courses

00:50:47.650 --> 00:50:50.800
and become. you know, trained in how to treat

00:50:50.800 --> 00:50:53.980
ADHD. And so one of the reasons that I really

00:50:53.980 --> 00:50:57.539
like psychiatry redefined is we're looking at

00:50:57.539 --> 00:51:00.280
the integrative part, you know, the fun part

00:51:00.280 --> 00:51:06.000
more instead of just, you know, handing out stimulants,

00:51:06.000 --> 00:51:08.300
even though they are the treatment. I understand

00:51:08.300 --> 00:51:11.599
that. I want to see better options. I want to

00:51:11.599 --> 00:51:15.230
see, you know. And not just diet or exercise.

00:51:15.309 --> 00:51:18.409
I want to see what supplements can we use? What,

00:51:18.409 --> 00:51:21.429
you know, what do I need to really be honing

00:51:21.429 --> 00:51:26.130
in on with women, especially in their late 30s,

00:51:26.130 --> 00:51:29.210
40s, 50s, and they're having these hormonal shifts

00:51:29.210 --> 00:51:32.769
and it's just exacerbated ADHD that they've had

00:51:32.769 --> 00:51:35.630
to live with all these years. You know, no one's

00:51:35.630 --> 00:51:38.489
taking them serious because sometimes they still

00:51:38.489 --> 00:51:41.519
think that menopause is just hysteria. you know,

00:51:41.559 --> 00:51:47.619
and, and so I really wanted to become, you know,

00:51:47.619 --> 00:51:51.539
better educated in that area because I'm starting

00:51:51.539 --> 00:51:54.320
to see a lot of my patients are, are kind of

00:51:54.320 --> 00:51:57.699
in that category right now. I love that. I love

00:51:57.699 --> 00:52:00.360
that. That's really cool. Yeah. One of the questions

00:52:00.360 --> 00:52:02.500
that I ask at the end of the podcast, all my

00:52:02.500 --> 00:52:05.679
guests is, um, what does the phrase no prior

00:52:05.679 --> 00:52:11.789
auth mean to you? I think for me, You know, no

00:52:11.789 --> 00:52:16.869
prior auth would mean maybe without, you know,

00:52:16.869 --> 00:52:20.349
boundaries or without any kind of restrictions.

00:52:20.349 --> 00:52:25.730
So it would be autonomy for all states, for NPs,

00:52:25.789 --> 00:52:28.170
you know, that we're not having to ask permission.

00:52:28.349 --> 00:52:30.730
We're not having to, you know, fall under that

00:52:30.730 --> 00:52:33.530
guideline and that we can do what we were trained

00:52:33.530 --> 00:52:35.690
to do, what we went to school for, what we spent

00:52:35.690 --> 00:52:40.980
years doing, and just be able to. you know, practice

00:52:40.980 --> 00:52:44.179
to the best of our ability to help patients because

00:52:44.179 --> 00:52:46.639
there is such a need for that. And there's such

00:52:46.639 --> 00:52:49.280
a shortage of supervising physicians that it

00:52:49.280 --> 00:52:52.420
would just be autonomy for everybody. Yeah, absolutely.

00:52:52.980 --> 00:52:55.559
I lied. I think I have one more question for

00:52:55.559 --> 00:52:58.000
you. Go ahead. And then I'll let you go. No,

00:52:58.079 --> 00:53:01.260
you're fine. Anything else, you know, you mentioned

00:53:01.260 --> 00:53:03.559
like there's probably a lot in hindsight I would

00:53:03.559 --> 00:53:05.139
do different. Anything else that you can think

00:53:05.139 --> 00:53:08.719
of? Because that is part of. You know, this podcast's

00:53:08.719 --> 00:53:11.659
purpose is trying to help psych NPs at different

00:53:11.659 --> 00:53:14.099
phases of their journeys and kind of thinking

00:53:14.099 --> 00:53:16.480
to, yeah, I had known this six months ago or

00:53:16.480 --> 00:53:18.739
nine months ago, a year ago. This probably would

00:53:18.739 --> 00:53:21.320
have saved me some hardship. So anything else

00:53:21.320 --> 00:53:23.980
you can think of that our guests or our listeners

00:53:23.980 --> 00:53:28.219
might benefit from? I think if you're currently

00:53:28.219 --> 00:53:32.039
working a full -time job and you're nervous about

00:53:32.039 --> 00:53:35.099
starting your own practice, then do it. Do it

00:53:35.099 --> 00:53:38.400
slow, but just do it. Do it slow. If you need

00:53:38.400 --> 00:53:42.360
to see patients in the evening times, not that

00:53:42.360 --> 00:53:45.179
it's super ideal to work that long, but if you

00:53:45.179 --> 00:53:47.980
need to start really small and see people in

00:53:47.980 --> 00:53:51.440
the evenings and work up to that, where then

00:53:51.440 --> 00:53:53.940
you go part -time, that's what I did. Like, I

00:53:53.940 --> 00:53:56.039
still worked full -time with people in the evenings

00:53:56.039 --> 00:53:58.000
until I could manage to move over full -time.

00:53:58.480 --> 00:54:02.739
I think you just got to do it. It is scary, but

00:54:02.739 --> 00:54:05.219
it's okay to be scared. you know, of that kind

00:54:05.219 --> 00:54:09.300
of stuff. I think just doing it, just, just do

00:54:09.300 --> 00:54:12.039
it. That's the best thing I know to say, just

00:54:12.039 --> 00:54:14.739
make it happen. You can, you can. I did it at

00:54:14.739 --> 00:54:18.480
45. I went back to school, became a nurse practitioner

00:54:18.480 --> 00:54:21.659
and opened my own practice at, you know, 50,

00:54:21.820 --> 00:54:25.480
49, 50 years old. So I tell people all the time,

00:54:25.500 --> 00:54:29.039
if I can do it, anybody can do it. Yeah. Yeah.

00:54:29.219 --> 00:54:31.079
And wait, did you go straight to private practice

00:54:31.079 --> 00:54:32.670
when you graduated? Or did you work somewhere

00:54:32.670 --> 00:54:35.869
else? No, I worked for two years. So I went back

00:54:35.869 --> 00:54:40.610
to school in 2019 is when I went back to school.

00:54:41.130 --> 00:54:45.789
And then I finished up my doctorate in 24. So

00:54:45.789 --> 00:54:47.809
we were opening the practice. I was finishing

00:54:47.809 --> 00:54:50.570
up my doctorate, but I had worked as an NP since

00:54:50.570 --> 00:54:53.789
2022. So I'd been working as an NP for at least

00:54:53.789 --> 00:54:55.710
two years at the hospital before we opened up

00:54:55.710 --> 00:54:59.190
a practice. Okay. Because, yeah, again, people

00:54:59.190 --> 00:55:02.349
are curious about that. Did they have experience

00:55:02.349 --> 00:55:05.070
before they worked? I did. That's just the way

00:55:05.070 --> 00:55:08.150
I did it. But I had hospital experience, which

00:55:08.150 --> 00:55:10.590
we know is a very different animal than outpatient.

00:55:10.809 --> 00:55:12.650
They're very different, very different beasts.

00:55:12.809 --> 00:55:15.230
And the other thing I meant to say earlier, too,

00:55:15.289 --> 00:55:17.429
was that we do get some referrals from other

00:55:17.429 --> 00:55:21.309
practices because we handle the tough stuff.

00:55:21.789 --> 00:55:24.929
Trey is really good at those really good acute

00:55:24.929 --> 00:55:28.869
complex cases that other outpatients feel like

00:55:28.869 --> 00:55:31.789
they can't handle. So we get a lot. What amount

00:55:31.789 --> 00:55:33.949
of referrals from other psychiatric practices

00:55:33.949 --> 00:55:37.170
because they know that we treat the tough stuff.

00:55:37.929 --> 00:55:40.750
You guys have that reputation for like, oh, if

00:55:40.750 --> 00:55:42.969
it's high acuity outpatient, they can handle

00:55:42.969 --> 00:55:47.409
it. For sure. Yes. That's awesome. Well, would

00:55:47.409 --> 00:55:49.710
love to have you on for another episode down

00:55:49.710 --> 00:55:52.650
the road because I haven't really having fun

00:55:52.650 --> 00:55:54.409
doing this. And I think it's really cool to see

00:55:54.409 --> 00:55:58.480
people's journey as it kind of. unfolds so thank

00:55:58.480 --> 00:56:03.199
you angie for taking the time and thank you for

00:56:03.199 --> 00:56:06.000
having me today yeah all right you