Welcome to another episode of No Prior Off. This
week, I'm sitting down with Dennis. Dennis is
a board -certified psychiatric mental health
nurse practitioner, a disabled veteran, and the
founder of D &Y Integrated Psychiatry in Monrovia,
California. His path to private practice is unlike
anything we've had on the show. He was born in
Ukraine, immigrated to Seattle as a kid, enlisted
in the Air Force right out of high school, got
selected for the Air Force Academy, and became
a captain and special agent in the Air Force
office. of Special Investigations, the unit that
investigates crime in the military. After 10
years of service, he got an MBA from ASU, worked
in management at Amazon, and then made a hard
left into healthcare. He became an ER nurse at
LAC and USC, one of the most intense trauma centers
in the country, then completed a full year. of
psychiatric residency at the VA in Los Angeles.
In January of this year, 2026, he launched his
own private practice, named it after himself
and his wife, Yesenia, and built a panel of 60
clients in four months. He speaks three languages,
takes TRICARE and VA community care, and his
Psychology Today bio reads, you're not broken,
you are exhausted from surviving. If you ever
wondered what it looks like to reinvent yourself
five times and end up exactly where you belong,
this one's for you. So let's get into it. Thank
you so much for being here, Dennis. Yeah, happy
to be here. Thank you, Lindsay. So tell us a
little bit about what, like your path to becoming
a psych NP. What kind of led to that? Oh my gosh,
where do I start, right? I mean, if you kind
of look back, as you mentioned, thank you for
the warm introduction. I'm an immigrant by trade.
I was born and raised in Ukraine, moved over
here when I was a kid, enlisted, became an officer,
became a manager later. So a lot of moving, shifting
parts in my life in terms of kind of redefining
my own career and kind of trying to realize what
I want to do with my life, right? So, and I think
it was kind of a combination of different things
where previous life choices kind of led me to
where I am now. And so through different experiences,
I suppose, I eventually became, you know, a nurse
and a nurse practitioner. And that led me to,
you know, to open up my practice fairly recently,
as you mentioned. So, yeah, I'm going to have
to kind of dive into it and tell you a little
bit more. Okay, awesome. How long have you been
a psych NP? So let's see, I graduated from California
State in Long Beach. That was back in 23, so
about three years now. Three years. And what
kind of setting were you working in before you
launched this private practice? My experience
essentially as a nurse, I started in psychiatry,
inpatient science specific than psychiatry as
a new grad. And I was working back in Pasadena
here near Los Angeles. Then I made a switch.
I stayed there for about a year and then made
a switch to LACUC Medical Center, which is a
trauma level one trauma center. So I was working
for the ER emergency department down there for
a couple of years. And then, so that was a great
experience. One of the main reasons why I want
to do that is to, I was always kind of aware
that in psychiatry, we're not exposed to, you
know, the medical background as much. So kind
of like part of my, kind of back of my mind is
thinking, you know, sure, you want to, well,
advance yourself in terms of psychiatry and kind
of become a nurse practitioner down the road.
I already kind of knew, even nursing school,
like that's the direction I want to go. But I
was also very aware that I need to have the medical
skill set too. So that, not to say that I want
to be a medical expert, but by no means, but
to have the medical knowledge so that if I do
see medical emergency on the psychiatrist side,
I'm able to at least recognize it and able to,
you know, refer them out to the, you know, and
make sure that they're all safe. person's life,
essentially, which I've seen. In psychiatry,
I've actually seen people who had, you know,
strokes and things like that. So I'm very happy
that I've gained that training in the emergency
department. And following that, I did some travel
assignments, and then I did the nursing practitioner
school. And then after that, I did one year residency
with the VA, which I can tell you a little bit
more later. Yeah, I think, I mean, I know that's
just a question that a lot of people have is
like, is it hard to get into the residency at
the VA? Is it worth it? So you did one in California,
I'm assuming. And do you mind sharing a little
bit about that experience and if it was hard
to get? No, happy to tell you a little bit more.
I'm open book when it comes down to talk about
myself and really teaching others on kind of
like lessons learned, kind of like don't make
the same mistakes I made, right? I'm happy to
share my knowledge, whatever, you know, that
knowledge is. In terms of the VA, it is competitive
to get accepted. The timeline, I believe, and
this could be a little bit state dependent, but
this is specific for California. The timeline,
I believe, was to apply like back in February.
So essentially, there's a lot of tuition you
have to obtain. And the criteria is fairly strict.
I believe about, don't quote me an exact number,
but I believe the number is anywhere from 16
to 20 of applicants. how many we had for that
location cycle, and only three. So it's fairly
competitive. Yeah. So I put the package together,
I applied. In my case, I believe what kind of
helped me a little bit potentially was the fact
that I was former military. And the fact is,
you know, I think that's looked favorably. There's
a fairly rigorous, you know, interview process
that you have to go through after you apply,
where essentially you have to, you know, be able
to explain your life story and why working for
the B makes sense. which for me was a natural
fit, given the fact that, you know, I was former
military and I do strong passion to, you know,
to serve veterans. And as you mentioned, even
now in private practice, that is my niche specialty
that I really gravitate towards serving military.
So that was, I think, a factor, not don't factor,
but definitely a factor that kind of. you know,
maybe work to my advantage a little bit to be
selected for the residency. And then more, they
have to talk about, I guess, more in detail about
the residency itself. Did you feel like it was
a worthwhile experience, clinically speaking?
Would you recommend it? Yeah, I would, honestly.
Everything has pros and cons in life, right?
So in terms of, you know, some, I guess, cons,
what is the bad? The pay is very low. And this
is, again, state of the art. California is one
of the highest, probably, but still low. uh 89
000 per year for np that's a good low salary
where my you know new grad friends were making
150 160 in california market that's kind of the
average year so 89 was lower than my nursing
salary essentially but i was willing to you know
uh accept that knowing full well that first year
is not about the money it's about the experience
it's about the knowledge it's about you know
i mean the mentorship you're surrounded with
is phenomenal for a whole year into different
clinical sites, you know, you start an outpatient,
you know, clinic, essentially, my case was a
homeless clinic. So essentially, you know, very
difficult cases, they are very complex cases,
with a lot of substance use mixed in there. So,
you know, kind of toes off your guard a little
bit as a new bride, and you're going to turn
it immediately, you know, these are not your
typical low acuity outpatient cases, you know.
Part of that, you learn that, and then you kind
of rotate every month or two. You rotate to different
settings. Essentially, you do inpatient ER, which
is an amazing experience. You do some substance
use exposure. You do pretty extensive street
medicine. You do what's called consult liaison,
where you're out in a hospital setting, surrounding
doctors and psychiatric residents, essentially,
to around the medically complex patients that
have psychiatric conditions as well. A lot of
times, you know. intermediate for different things.
So that's a very complex field that you learn.
And that's exciting, you know, to learn as a
new grad. Yeah. So you're very well rounded at
the end of the residency, I feel. And your confidence
in yourself, which let's be honest, a lot of
us as new grads are not very confident. At least
I wasn't when I finished my nutrition program.
Afterwards, I felt so much more confident. I
really felt, aside from a few things that maybe
like, Addiction is not my strong element because,
again, you have to kind of work the addiction
field. But aside from that limitation, I feel
pretty strongly that I can handle a lot of cases
going my way. Yeah, that's fantastic. So do you
mind me asking, what were you getting paid as
an RN in California when you took that pay cut?
Oh, my gosh. Well, so that depends. Are we talking
about, you know, the contract I did in Riverside
where I paid $4 ,400 a week? That was back in
the COVID days. Oh, my gosh. So that was, I couldn't
take up with that money. I mean, that's just
phenomenal money. For my fellow nurse practitioners
there, or nurses, I guess, you're not going to
see that money anymore. You know, the contracts
out there are dried up. I mean, I would say at
most, I still kind of keep a pulse on that. At
most, it pays like, you know, I mean, it was
for three shifts, somewhere around $3 ,000 range
in California, which is low compared to, you
know. $4 ,000, $5 ,000 they used to pay. Per
week? Per week. As an RN? As an RN. Okay. Just
wanted to, yeah, because this is a topic too
that people, especially my California mentees,
struggle with because the pay is pretty good,
you know, as working as an RN. And so I think
it's interesting that you... made that decision
to go, I'm okay to make, to have that pay cut
for a year, to have this strong foundation. Because
I know it's, it's controversial. Some people
aren't of that mindset. And I, same as you, I
wasn't super confident. And so I would have taken
less pay for that experience. And I know, yeah,
some people don't necessarily agree with that,
but I have the same kind of mindset. Yeah, but
yeah, exactly. And two, you know, full caveat,
I'm talking about, travel pay, not usual rent
pay. I don't want me sleepy thinking like, oh
my gosh, come to California, you get paid $5
,000 a week. No, no, no. That was basically when
rates were blowing up, right now it's much lower.
I would say traditional rates, depending of course
on experience and things like that, here in the
local market as a traditional kind of W -2, anywhere
from like 50 to 60 is what you would expect.
on years of experience. In South, in the local
market, Northern California is a lot higher,
obviously. Yeah. But yeah, at a few point, I
was very aware that I'm giving off a lot of money
by doing the VA residency, but I was also aware
that it's going to make the confidence boost,
it's going to open more doors, and it did, which
is my next follow -up was I worked at a TMS clinic.
I can share a little bit more if you want. Yes,
please do. You said at a TMS clinic? So an opportunity
that came about from your exposure in the residency.
Yeah. One interesting fact about VA, and this
is a little bit unfortunate, but it had to do
with the government cuts. So all of us, all the
residents, this is psych residents, primary care
residents, Giro residents, all the nurse practitioners
who started with me in the same cohort, when
we finished our one -year residency, the expectation
was that VA is going to hire us, right? That
was a big... to join the VA in the first place.
And unfortunately, the reality is that just timing
-wise, the government had budget cuts where they
said, you know what, we just cannot bring residents
on board at this time. And so all three psych
residents, I was one of those three, were not
hired. And moreover, we were in the first cohort
ever in the West Los Angeles VA. So that's kind
of cool. That's very cool. Yeah. Yeah, we set
the path, so to speak. The interesting thing
is second cohort, the one after us, and even
third cohort, nobody got hired. So the budget
cuts are still remaining in place, which is super
unfortunate because people want to join because
of the promise of after being a new grad and,
you know, and you're going to sacrifice your
pay a little bit. Now that we're going to bring
you on board instead of 89, we're not going to
bring you. $200 ,000 to $20 ,000 on board, which
is a decent salary, right, after one year experience.
And about primary care folks on board, but unfortunately,
none of the psych people, which is very unfortunate.
Gotcha. Gotcha, gotcha. Yeah, that is definitely
a bummer. Okay, so private practice. When did
you decide, I want to do private practice? At
what point? After the VA, I essentially kind
of like, you know, to your point, I was thinking
about what's a logical kind of next step to do
since VA is not hiring us. So I pivoted to look
at different opportunities in the area. One of
them came up, TMS clinic, which is an outpatient
clinic. And again, you know, I don't know how
much I guess our audience really knows about
TMS. That stands for transcranial magnetic stimulation.
Essentially, the way it really works is like
this. It's a clinic. It's a fairly small clinic.
Usually, there's one or two TMS machines in there.
In TMS, actually, the way that kind of works,
we're going to briefly, because that could be
an hour -long explanation in itself. Yeah. They
have 36 sessions. Each session is about 20 minutes.
They have a big magnet that's placed over their
head. It sends magnetic waves. And essentially,
it's for treating resistant depression. So over
time, the way I kind of think about it, it's
kind of like physical therapy for the brain,
where over time, you slowly give people a relief.
That's really good for people who try two, three,
maybe different depressants. working. So TMS
is kind of like a last minute option. And it's
pretty effective. I would say maybe 60, 70 %
effective. Not 100%, but pretty effective. So
what's our role as nurse practitioners in TMS
clinic? Well, you're not going to do the TMS
itself. That's because, again, the clinic is
hiring you for the high yield. They want you
to kind of maximize patient care, not run a machine
that a $20 tech can run, right? cost -efficient
for them to hire you for that role. Although,
interestingly enough, I've seen some companies
here in California who do partially use their
own piece to run the TMS. It's very unusual to
me. My clinic, though, they specifically use
our service for initial and follow -up intakes.
And then, of course, if something is appropriate
for TMS, they will bring them on board. And then,
you know, they will kind of hand off to them,
to the TMS technician, to the doctor who does
the... The TMS collaboration and sessions, the
process that way. So we'll kind of get the folks
in the door and then they get the TMS treatment
after that. Okay. So that is like the main service
line you were doing at that job, it sounds like,
is TMS. You weren't like necessarily prescribing
medications in that role, right? The way you're
going to think about this is I would still, so
someone would come in and say like, hey, I'm
interested in potentially TMS. I've tried different
medications. So your pronunciation would be.
you know, would you like us to manage your medication
for you while you're doing TMS? Oh, okay. But
then the decision by the person will be yes or
no. Some people, no, I have a psychiatrist on
board. I'm just here just for TMS. And then great.
We can still give you TMS on board while you
have your medication managed by somebody else.
Or a lot of times they'll be like, you know what,
since I'm already here and, you know, why don't
you take over my medication for me? So then I
would manage the medication piece of it while
still kind of monitoring how the TMS is going
for them while, you know, They're being seen
by the rest of the team for the TMS treatment
itself. Okay, that makes sense. So when did you
first start kind of making plans with your private
practice? Yeah, so what happened is, so I stayed
at my clinic, the TMS clinic, for about a year.
And as I was kind of coming to a year point,
I kind of knew down the road that I always kind
of wanted to be my own boss, you know. And I
was working for somebody else. Yes, the salary
is decent. And yes, the benefits are decent.
And it's a good working environment in terms
of mentorship. And you're learning a lot, especially
in your book. Yes, I knew nothing about KMS.
So that was really cool to kind of learn about
that aspect. Also, you're very aware that you're
working for a large corporation, right? Meaning
that your time is limited. Your vacation time
is limited. Your sick time is limited. You have
to, it's very difficult to get time off to do
things, you know. If you have kids, if you got
from bed, get sick, it's very difficult to get
like a week off if you really need it, right?
Right. Because essentially then they have to
reschedule your patients for the day. And when
you're seeing, you know, 18 to 20 patients a
day, that's difficult. Right. For patients and
for the clinic too. A lot of these are very lean
because again, you don't have like, you know,
two or three people back up. If you're out for
the day, they just have to cancel all the patients
for that day. So you're very aware that everything
kind of rests on you. Really kind of down the
road, I really knew that I kind of want to be
more of a boss. Kind of like, well, I had the
clinical know -how and I felt really confident
that I was doing. And I was like, thinking to
myself, you know what? I mean, I can do the same
amount of work that I'm doing now, except to
see patients a day. I could see, you know, eight
to 10 patients a day and actually make more money.
It financially made sense, but also on the flexibility
side, it made a lot more sense to work on myself
because. Yes, initially, you take a hit financially
for, I would say, first six months. You're kind
of rebuilding your caseload from zero to whatever
the magic is. In my case, 100, where I feel comfortable.
Right now, it's 65. But once you get to 100,
you feel very comfortable. And, of course, the
goal is about 300, 400 down the road because
I want to be a big group practice, you know,
employing at least four to five NPs and maybe
three admin. This is like a three -year goal
down the road. I'm only five months into my practice
now. But that's really the short answer to your
question is I kind of knew that I wanted to be
more of a boss. And I had the clinical confidence
to do my work. So I put an infrastructure in
place so that I could leave my group practice
and start working for myself day one. Yeah, that
makes sense. What do you wish you had known?
six months ago nine months ago when you when
this was more in the ideation phase oh my gosh
i wish someone told me that there's so many hats
that you have to wear the easiest hat to wear
my fellow indie friends clinical work is actually
not to say it's easy it's not easy you're gonna
have complex cases you're gonna have to consult
with your collaborative doctor at least in california
you have to because you were required to have
a doctor here to have a practice So, but honestly,
that part is not that bad for me because I feel
pretty confident. If I truly get stuck, I just
slow things down and I try to really do a deep
dive of really understanding the clinical history
before making a medication. But what's really
tricky, I think at first is knowing that you
have to wear the admin hat, right? The credential
hat, unless you outsource that. The billing hat,
unless you outsource that. The marketing is taking
me. So much money and resources and time. It's
kind of ridiculous. I'm always talking to people,
trying to market myself because nobody teaches
you how to market yourself effectively. So it's
a lot of mistakes made along the way. Right.
Speaking of marketing yourself, where have those
patients come from? Those 65 patients, that's
awesome that you've built your caseload up in
these past four months. But yeah, where are they
coming from? Yeah. Oh, boy. I could write you
a book. I would not to do. I've spent an ungodly
amount of money on things that don't work. Okay.
I'll just briefly tell you so that hopefully
our audience knows what not to do. Okay. Yeah.
I've used the service of this guy who claimed
to be a Google expert based on his LinkedIn presence
and everything else. I'm not going to throw his
name under the bus here, but that's not important.
But what's important is, you know, he sold himself
as an expert where, you know, $4 ,000 later,
he promised me 20 leads a month, those are convertible.
And I understand nothing is guaranteed, but ultimately,
for that kind of money, you do expect results.
And ultimately, that resulted in zero patients.
After four months of working together, after
$4 ,000 investment into this building infrastructure
and everything else. And again, so I guess the
lesson learned is, for our friends listening
is, Whoever contractor you hire, really do a
deep dive because people will promise you the
world out there. And we don't know. We're not
experts in Oracle. We don't know if they promise
you what is going to work or not. And I understand
nothing is guaranteed, but also that's a big
mistake. Right. Cause you thought you were going
to be getting that outcome of those 20 leads
that were convertible type thing. Cause the last
guest I had, she hired a marketing team from
day one that was like a thousand a month and
it like where they manage her social media and
stuff. And she still uses them even a couple
of years in. So I think that's a good piece of
advice as far as just like really vetting what
they're going to be doing for you and, and whatnot
and have the expectations really clear. Okay.
Money is a big topic when it comes to launching
a private practice. How much have you spent in
total so far? And on what? And what's been worth
it? And what not so much? I've spent too much.
I would say, gosh, I've spent at least... Initially,
I would spend at least $10 ,000, if not more,
right? I would say, you know, plan to have at
least... depending on how far you want to be,
plan to at least $5 ,000 to $10 ,000 in terms
of everything to put in place. For example, the
legal infrastructure to put in place. I suppose
you can do it yourself. In California, which
is very heavy on legalese forms, it made sense
to me to hire somebody as a retainer for $7 ,000.
But that offers you a lifetime service. So that
made sense to me to use this person. It's also
like... NP himself. So it kind of makes sense.
He's a legal expert. He also knows my field pretty
well. And it's for lifetime, which is something,
you know, they'll be out on the road. The felon
below are usually services. Is that Nick Webb
by chance? That's right. Okay, cool. I know a
lot. Some of my mentees have worked with him.
And it sounds like, you know, because of the
nuance in California and the laws, working with
an attorney is. often worth it and whatnot. So
that's good to know that you've had a good experience
with that. What EHR did you go with? Yeah. So,
oh my gosh, I made so many mistakes with this.
I went, kids don't do what I did. I went with
what I was familiar with, which is Dr. Connor
EHR. Okay. The reason I did that is because I
was extremely familiar with it because that's
why I used my group practice, the one I just
left. So I was very comfortable with it. Having
said that. once I transitioned into it and started
using it, I've realized a couple of major problems
with it. So this is one of those HRs I do not
recommend for a variety of reasons. One, you
get locked to a contract at least a year or two
years. Any system that requires your contract
should be automatic no, honestly. Because if
down the road you want to leave that system and
go to something else, you can't. Those companies
make it perfectly impossible to leave without
you know, breaking a contract and essentially
forcing you to pay the remainder of the money,
which essentially what I end up doing, I end
up being, you know, quite a bit of money back
just to kind of leave before my contract was
over, you know? So that's number one. I went
with a very expensive system that was not fully
integrated. And I could write a book about Dr.
Korner being inefficient in different ways, how
you had to buy all these add -ons to do an intake
form, how the portal wasn't working, how... I
mean, it's kind of insane once you go deep dive
as a private practice owner on how inefficient
that system is in order for us to do our work.
So I'm actually this month switching to a practice
queue based on the feedback. One, it's a lot
cheaper. And two, everybody's using it. All my
friends are using it. So I can, you know, balance
them, ask them for advice in terms of, you know,
here's how you integrate the system. A lot more
automated, a lot more integrated, which is exactly
what I'm looking for. And no contract, which
is important. Right. Yeah, I also use practice
queue. One of the things with practice queue
is, you know, do you set it up yourself or do
you pay somebody to set it up? What are you doing?
So this week, I'm actually, great question. I'm
actually addressing it this week because I'm
switching this week. I'm going to try my best
because I know there's companies out there that
you can pay several thousand dollars and they
kind of set it up for you. I'm going to do my
best to set it up maybe for like a week or two
myself. Yeah. And if I, I suppose if I struggle,
Or if it thinks it's automated as I want, then
I suppose maybe it makes sense to invest more
money into somebody setting it up for me. But
at the moment, I honestly don't know. I don't
know how simple it is to set up. So I guess I'll
find out shortly. Yeah. Yeah, that makes sense.
Do you use an AI scribe or how are you utilizing
AI right now? Or are you? I try different ones.
I mean, I know there's like Beery's, there's
a Pimagescope, Pimagescribe, which is, I believe
Allison set it up. So good for her. That's one
of your guests. Yeah. Great for her. I mean,
it's a great tool. I might lean into that one,
to be honest, just because I've looked into it.
It kind of does it. And I like how you can customize
it into making a template of something I want.
You essentially lose focus and say, hey, this
is kind of like the example of how I want the
note to be. And then they customize it for you.
So that piece is really nice for me. So that's
kind of the direction I'm going to go because
I think it is critical these days to really cut
down on the time it takes for the notes to do
your notes. So that's kind of the direction I'm
going right now. Nice. When will you hire your
first provider, your first psych NP? I'm already
thinking about that. My first admin and my first
NP. Okay. Yeah. This is a little tricky because
this is uncharted territory for me. I screen
the year and I'll tell you, let's learn, right?
But my kind of rough estimate is that once I
hit, I would say a hundred. So I'm at five now.
Once I hit a hundred patients, that'll be a good
estimate to get a VA board, virtual assistant
board. And maybe once I get like 150, that will
be a good kind of rough point to start thinking
about hiring. In California, and I'm kind of
learning this as I go, I was just talking to
Nick, my lawyer, about this in terms of kind
of like, how do you even hire somebody, whether
it's a VA, whether it's NP, what's the legal
kind of process to do that? And essentially what
he was explaining to me is that NP cannot be
1099, they have to be a W -2 employee. So again,
kind of navigating those waters a little bit,
trying to, I still have time before I have to
make that switch and hire somebody, but ultimately
I'm already trying to put that. framework in
place now so that, you know, so I can kind of
understand when the time comes. So I'm ready
to go and ready to make that switch. But yeah,
it's certainly happening 100%. It's just a matter
of when do you really pull the switch? Yeah.
How'd you find your collaborating position? And
is that, would you recommend what you're using
right now or who you're using? Oh my God. This
was one of those interesting, you know, Dennis
makes a lot of mistakes along the way. And then
learn and kind of, and eventually find a way
that works. I've really tried, and I think maybe
you've seen it because I tried to share my lessons
learned on Facebook and things like that. But
kind of like, hey, here's what not to do kind
of thing. I've tried, I want to say at least
like six or seven different services where you
can pay money and then you can get like an MD
award. It doesn't mean I paid for it, but I've
researched it, right? And so I've kind of narrowed
down cost -wise, at least in California, is that
most of those services weren't anywhere from,
you know, $600, $700 to $1 ,000 or somewhere
more than $1 ,000. So I've kind of learned that
the cheapest way to do it is really through Indeed
paid posting. So essentially you go to, there's
a free version, there's an employee version.
So you click on employee one, and then you essentially
pay, I want to say $40, something like that,
for a day to post your advertisement. And essentially
in the post, you know, you title it psychiatrist.
And I really had, I called them, Indeed people.
I was like, hey, walk me through how to do this
like the most efficient way. And they literally
said, the title should be like psychiatry, just
keep it short. You know, the body should be very
simple. You can use like chat GPT to give you
a quick, concise way to frame it. But essentially,
you just explain what you're looking for. You
put your price. In my case, it was $500. That's
the price I wanted to pay. So that's what I put
in there. Minimum supervision, like, you know.
One, usually 30 minutes, 30 minutes to an hour.
You can usually ask in California for a month
and then usually maybe like occasional here and
there phone call, like just quick phone calls.
Here, psychiatrists, they're not really looking
for you to spend like hours and hours, you know,
like on the phone to you about your case. They
do expect that you know what you're doing. So
that's kind of like my caveat to anybody who
starts their prior practice. I've always cringed
a little bit when I see new brides jumping straight
into prior practice. It's not. It can be done.
It's just that you don't know what you don't
know as a new grad, right? I know for me, it
was really important to be very comfortable before
starting prior practice because I knew that psychiatrists
are not going to be like, oh, Dennis, I will
spend hours and hours telling you basic stuff
that you should know by now, you know? So that's
my little caveat, I suppose, to anybody who wants
to open prior practice. Be confident in your
skills. For some people, that'll be one, honestly.
Some people come in guns blazing like, hey, I
want to do this. I know, I really know my craft.
Amazing. I wasn't like that. So, but for them,
yeah, you were like me a little bit where you
wanted to get more experience on your belt first.
So, but some people, you know, need more time
and that's fine. I, to your mark, I felt very
confident. I was not confident. Yeah, I think
there's something to be said because of how much
there is to figure out and how much new stuff
you're learning when you start private practice.
If you're solid on the clinical front, it's like
that's one, I don't want to say one less thing
to worry about, but it's not like an active concern
as opposed to like a lot of new grads are actively
concerned about like knowing how to manage X,
Y, and Z. So I totally understand what you're
saying. So you offer, do you have an in -person
space? I do. So in California, you have to, per
DEA rules, you have to rent a building one day
a month. Even if you're 100 % virtual, which
I really am, I still have to maintain that space.
So one day a month, I do offer patients to see
me in person since I'm required to have a clinic
open. Having said that, I try to downplay the
fact that it's open because then... If everybody
wants to come in every single day, that's a little
bit inconvenient for me because I live, you know,
45 minutes away from Monrovia. So driving every
day would be, you know, would be pretty tricky
for me because you have to deal with traffic
or you have to. So now it's a little bit more
inconvenient, I suppose, because virtual telehealth
is so easy. But luckily for me, my patients are
all over the place. I mean, Northern California,
Southern California, all the way to San Diego.
So kind of like in the middle, like Southern
California part, obviously, Monrovia. So it's
kind of nice because virtually people don't mind
that. I would say most of them prefer it. And
that's something I'm very open and transparent
about. When somebody comes in first day and they
kind of say, do you have on -site clinic visits?
I say, I do, but it's usually one day a month.
If you're kind of open with that, great. But
if you're looking more like day -to -day, kind
of like see me in person, I'm probably not the
best provider for you. Right. Okay. So how did
you find that space for one day a month and what's
the cost for that? Yeah. I work with Alicia.
So I joined Alicia. She's another practitioner
here in California. She runs this mentorship
program called Strong Roots. And so I joined
that community that she built. And through that,
she offers, you know, she subleases her building
that she leases herself in Monrovia. So a lot
of practitioners, it's a big, big two -story
building. Oh, that's cool. I love Alicia. Yeah,
yeah. I met her and we go to a lot of conferences
together. We just run into each other all the
time. Oh, I love that. That's cool. So you're
in her like private practice group. For some
reason, I thought that in that group, they help
with the intake queue setup. Am I confused? Well,
she offers, she has templates for intake queue
as part of the mentorship program. I don't know
if her team specifically sets it up for you.
But then I believe you'll have to kind of yourself.
Yeah. Okay. Okay. So let's talk about that for
a second, though, like, because I think a lot
of people are like, do I join a coaching program,
fellowship, mentorship program? Do I join these
Facebook groups? Do I go on LinkedIn? Like, where
do I get my advice from? What have you like paid
in mentorship and coaching versus like free advice?
And what would you hindsight kind of recommend
to people who are kind of just getting started
and contemplating some of those things? Yeah,
I mean, I personally think there's a lot of value
in finding a mentor because whether you're a
new grad or I'm actually looking for a mentor
myself at the moment, somebody who could take
me from a solo practice to a group practice owner
mindset in terms of skill. Make sure the workflow
process is in place to be scalable for the big
group practice with five, six NPs on board and
multiple admin on board. So I'm already thinking
that level of influencing my own business down
the road. I think Miguel was on your podcast
earlier. He's one of my mentors that I talk to
once a month about someone. and kind of learn
from him because I see myself kind of like where
he is, like down the road, obviously, but, you
know, in terms of expanding my own business.
So I think it's critical to have a mentor like
that, whether you're a little bit more experienced
like me or whether you're just brand new. I would
say even more critical if you're brand new because
you don't know what you don't know. So it's very
easy to make mistakes when you're not even aware
you're making mistakes, especially where, you
know, with building a practice, there's so many
moving parts to it. Right, right. So how did
that come about, if I can ask? Because I think
people are like, they don't know sometimes how
to connect with someone like that. So like, how
did you and Miguel connect? Is it like a paid
service? Is it just like more pure stuff? If
I can ask that. Yeah, no, of course. And I'm
happy to share. I mean, I don't know if you want
me to share, but I suppose I can share my part
of it. So I pay him $150 and that's 30 minutes
per month kind of mentorship. He offers a lot
more in -depth services where I believe he charges
more, where, you know, he can have up to an hour
weekly service and he has it all walking down
in terms of different layers of different mentors.
provides but so that's his part but to your other
question how do you find mentors i mean you could
simply start by reaching out through facebook
groups that we all kind of big part of and just
simply ask a question hey you know here's my
background here's my situation here's who i'm
looking for a mentor with this type of you know
approach and then people always come back and
then you can interview them back and kind of
have a you know like i would miguel i simply
had a we chatted like on one -on -one kind of
like a virtual coffee thing where I just kind
of pick his brain a little bit about his mentorship
philosophy, what he's doing to mentor. He's what
I'm looking for. Make sure it's a kind of a match.
That's what I recommend for anybody looking for
a mentor. Really simply ask on Facebook and then
just interview those people and find a good match
for yourself. Yeah, I love that. And I love the
virtual coffee chats for networking. I think
it's just really smart to form those relationships
as you can and spend time intentionally doing
that. And then I think, are you also in another
private practice group too, right? Or no? No,
I mean, so I only run my own solo private practice.
I used, like I said, I used to be in a group
practice, but then I left and now I'm working
just for myself. Sorry, I meant for the coaching
aspect. Let me see. So Miguel is one. I'm actually
interviewing this week. In fact, later today,
another person who is kind of like a more, more
like on a weekly basis, because Miguel is more
like once a month. But this person is more like
a weekly kind of follow up. And this week, I'm
really looking more in terms of kind of like
more nitty gritty of here's my workflow process.
Let's break it down. How is it sustainable to
build it up? Don't need to kind of fine tune
it a bit. So it's more kind of a micromanagement
kind of level where Miguel, I guess, has big
ideas. Break down my process a little bit and
rebuild it a little bit stronger. So they're
moving forward. Like, for example, the biggest
example I shared was I'm ditching Dr. Conner
and going to Partiscule. So I'm kind of rebuilding
that part of my workflow. So I really kind of
want to. have this expert mentor take a kind
of closer look at, here's my workload process
in place, analyzing kind of, you know, identify
weak points so I can make it longer as I kind
of get more patient on board, more in peace on
board. Because if you don't have infrastructure
in place and you scale up in terms of volume,
I mean, essentially your business will be very
shaky, right? You need to have really fundamentals
on board first before you can scale up. would
be yeah yeah so this person that you're interviewing
this afternoon is it something an established
service that she offers or is this somebody like
how did you kind of vet this person like what
were you looking for yeah so and this was exactly
how i described essentially post on facebook
saying like hey here's what i'm looking for is
essentially still ability from solo to group
but i need something like more hands -on kind
of look deep dive, and she was one of the people
who responded. I think like five or six people
responded, and I talked to briefly all of them,
but she seemed to be the best fit. All right,
essentially, we're going to kind of do a deeper
dive in terms of her services. She sent me some
information already, but ultimately, I kind of
want to understand, does the cost align in terms
of how much you need to pay her, but also her
service on a weekly basis, does it kind of align
what I'm looking for? And so far, everything
she sent me does align, but again, better for
a little bit. That's what I would recommend is
always... Do your research and make sure it's
a good fit. Yeah. Yeah. Are you also in Robbie
Westerman's like Psych NP community too? I am.
Yeah. Robbie. Good point. Yeah. He's another
mentor. Although that's a little bit more, I
guess, hands off, I would say, because he offers
more like Saturday mentorship, which a lot of
times I can't do because of my schedule. But
I believe from the 3 p .m. to about 6 p .m. my
time, he does mentorship. Once he'll jump on
live calls and occasionally I'll be able to join
so that I can ask, you know, more individual
questions. So technically you can, you know,
you can talk to him for like 30 minutes, not
every week because, you know, like a schedule
slots that he puts for certain people. Oh, it's
at least a month. You're able to talk to him
for 30 minutes and kind of deep dive with him
on whatever's going on. So he's another for sure.
That's very, very capable. He's very successful.
Okay. Yeah. So it sounds like what, like hindsight's
20, 20 again, like, and because people are here,
like comparing these types of programs, should
I join them? Like, would you have spent, I know
Alicia's programs like closer to, I think, I
don't know, six or 7 ,000, right? Would you go
back and like still invest in those programs
and whatnot? I mean, I suppose the answer is
it depends. It depends on what you're looking
for. Yeah. What I was looking for is, you know,
more guidance in terms of, you know, have a community
where you can ask questions and people respond
back to you. So from that sense, her community
is amazing because as opposed to asking somebody
on Facebook who may or may not know what they're
talking about, right? Now, in Alicia Strongwood's
network, you essentially have a community of...
like -minded individuals who don't either open
prayer practice or in the middle of opening prayer
practice. So these are people who are living
and breathing exactly what you're doing. So in
that sense, it's very helpful to me personally.
And that trial could be very helpful too. I try
to be very active in that community to answer
other people's questions. Kind of like, hey,
here's what I learned. So this is kind of like
my way to kind of give back to people who are
just starting to perform prayer practice. give
and take in that sense so yeah i think my short
answer to that question would be find the right
mentor for you in terms of the community yeah
and i believe you offer one as well if you can
i don't know too much because i didn't do yours
obviously but um i hear great things about your
your mentorship too right like i don't know i
appreciate that yeah tell them about like your
your service i have a A boot camp and a fellowship,
it's evolved a lot over the years. So I think,
you know, people who joined at varying points
of where the program was at. had different experiences,
I'm sure. You know what I mean? But that makes
me happy to hear you're hearing good things.
I love doing it. I love mentorship. It really
just like reignites the passion that I have for
our profession, you know? So the fellowship,
now the bootcamp is self -paced completely. Before
there was a live coaching component, but we found
that people wanted to join earlier and they wanted
something more self -paced and at a... more accessible
price point before committing to something like
the fellowship that's more structured. You get
75 contact hours, 25 of which are psychopharmacology.
We have an in -person intensive, so there's that
networking benefit with speakers. Debbie Granik.
I don't know if you know her, but she's well
known in the brief psychotherapy space, thought
leader in that area. So yeah, it's evolved. It's
changed a lot. It always is. I'm trying to always
listen to the people who are in my community,
what they're looking for, what kind of support
they want and help and go from there. You know
what I mean? So it's something I really am passionate
about, though, and love. I have a coaching group
this afternoon, actually. I wish I found you
two years ago when I was a new grad, you know?
Yeah, because we do have those case consult groups.
And it's definitely like it was initially made
to like help people with clinical confidence.
You know what I mean? And now there's like other
types of support, too. But like we're going to
have a monthly private practice group that's
more of a peer support situation. But yeah, for
sure, clinical confidence has been kind of the.
the meat and potatoes of the program. It's so
different state to state, honestly, and situation
to situation with private practice. That's part
of that's not the whole purpose of this podcast.
But I did want to get private practice owners
at various stages on to kind of share what they
wish they had known. Yeah, six months ago kind
of thing just to help help people out because
I think that it's stressful, as you know, to
be on the Facebook forums and not knowing like.
who to listen to, what decisions to make, what
to invest in. So yeah, we really like appreciate
you taking that time with us to share more. I
have two questions left, I think. I guess the
second to last would be, is there anything else
that you would say to our fellow psych NPs out
there who are, you know, considering what their
next move is? I suppose it depends on what their
personal goals are, what they're trying to achieve.
Some people, you know, want to jump into prior
practice, but they're not really ready for it.
And so I suppose that, you know, follow your
own passion and whatever you're pursuing, because
prior practice is amazing, but it's also not
for everybody, right? Who I'll reach out to them
and I'll be like, hey, I'm building this amazing
prior practice. Are you interested potentially
either joining in down the road or maybe start
your own? And they're like, no, I'm perfectly
happy. Just do my own thing. clock in, clock
out. I don't need the headache. And I was like,
at first I was kind of taken back. I was like,
really? Like, why does everybody like me want
to like be your boss and have like this amazing
like career, like, you know, just build up your
own financial attendance. And then I kind of
learned it's okay. Like not everybody wants the
headache of power practice. And I think that's
important to highlight that just the other day
I was on Instagram and this one person, you know,
stated something that I just didn't like because
essentially she said, hey, you know, I just have
in one month, I have 300 patients immediately
and it's amazing. So chiropractic is so easy.
And I was like, oh my gosh, this is sending the
wrong message, you know, because, you know, maybe
the person, and I don't want to invalidate the
personal experience. If that truly happened,
amazing for that person. But also I don't want
people to think that chiropractic is easy. It's
anything but easy, right? I mean, there's so
many days I get up at six in the morning and
go to bed at 11 o 'clock. Not because I have
to, but because there's so many layers to running
prior practice. And it has nothing to do with
clinical stuff. It's the admin part. It's the
marketing. So many layers to it. And so that's
kind of like my little caveat. I want to jump
into the prior practice. Like just, it's a lot
of hard work. I don't want you guys thinking
like, oh my gosh, I jump in and like all these
patients will be like showered upon me immediately.
And my practice will blow up with thousands of
patients. Because some of these Instagram influencers
are sending the wrong message. That's what happens.
Right. If that's truly what happens to them,
I mean, I don't know their experience, but that
wasn't my experience. Right. I don't think it's
the vast majority of people's experiences that
I talk to, you know. So I think that that is
a very important point because, you know, a lot
of people are puzzled by the fact that I haven't.
kind of grown into more of a group practice and
scaled my practice. And, you know, it's very,
very time consuming to run a group practice and
do it well. And it's very long hours a lot of
times. And yeah, I think that people kind of
underestimate the work that it's going to take.
Thankfully, I was part of a practice where they
scaled quickly. So I kind of got to see the process,
but also like of how much boots -on -the -ground
work that they were putting in, and then they
ended up selling it in just a couple of years.
But yeah, I think, you know, if you're in a phase
of life where you're ready to do that, kind of
live and breathe and really, you know, hustle,
then I think it makes sense. But I would agree
with you that it's not just like a walk in the
park, scaling group practice. Well, and also,
two points, agree, and two points. You know,
your passion is in education. You really enjoy
teaching. And I do as well. I just don't have
a course. But to me, it's really fun to teach
people, essentially be a mentor in a way, I guess.
But, you know, your way, what you describe with
your course and everything else, you're really
taking somebody who is maybe brand new or maybe
even more experienced and kind of teaching them
things to make a more competent clinician. And
so you don't need to. necessarily do other things
if that's truly your passion and that's what
gives you me joy and just it's fun for you because
what i request is not for everybody you know
it's not it's a lot of you know hard work in
the sense that if it's not something greek gives
you tons of meaning like why do it you know right
yeah yeah exactly i think people need to really
think about where they're at in their life personally
and what's important to them at that phase of
their life and the implications of their decisions.
Because, yeah, I have a young kiddo. He just
turned six. And, you know, I love flexibility.
Flexibility is really important to me in this
phase of my life. Right. So it's like, yeah,
having an in -person location and scaling to
a group practice is not where I'm at right now.
You know, maybe down the line. Who knows? But
I think it's important to kind of stay true to
that and know kind of what is that priority and
varying. phases and seasons of life. One of the
questions I ask everyone is, what does the phrase
no prior auth mean to you? No prior auth. Well,
I would say it's the permission to build your
own practice the way you want it without asking
anybody permission. Yep. Yeah. I like that. Yeah,
I was just talking to another... She has a private
practice, but she does intensives, which I think
is really interesting. She's also a psych MP.
Yeah, like several day kind of experiences that
she does with people. But she said something
that she's like, I just I don't want to have
to like, how did she say it? Something about
like basically being told what to do by an organization.
And I was like, I can resonate with that. I can
resonate with that. Yeah, we've all had that.
I'll give you an example. All the time. And this
is a real life story. There was a time where
it was a Christmas Eve and I was like, well,
can I have this day off to spend with my family?
And the answer back I got, you can, but you still
need to work half day and then you can have the
other half day off. And I was like, are you kidding
me? I was like, this is the same thing I've ever
heard in my life. Yeah. Yeah. It's like the moments
like that where you kind of really reflect on,
yeah, your goals. Thank you so much, Dennis,
for being on today. We appreciate it. And I think
this is going to help a lot of people. I'd love
to have you back on down the road and we can
hear the updates. Oh, I guess one other last
minute question. Are you intending to scale a
practice to sell it or do you see yourself kind
of like working in it for, you know, like, and
you're one of those people who's like, I'm never
going to retire and I'm going to just be doing
my practice. Lindsay, I'm an old guy. I'm almost
50 this year. So I'm looking at 10 more years
than possibly sell it after that. Okay. Okay,
cool. I think people are just always curious
about that too. So thank you for your transparency
and have a great rest of your day. You too. Thank
you. Thank you. Bye -bye.