Join hosts Phoebe Gutierrez and Leo Damasco on Telemedicine Talks as they chat with PA Ashlyn Smith about breaking into telemedicine entrepreneurship. Discover how PAs can navigate licensing compacts, overcome barriers, and build practices like her telehealth-focused Elm Endocrinology and Lifestyle Medicine for better hormone health and patient access.
This episode is sponsored by Lightstone DIRECT. Lightstone DIRECT invites you to partner with a $12B AUM real estate institution as you grow your portfolio. Access the same single-asset multifamily and industrial deals Lightstone pursues with its own capital – Lightstone co-invests a minimum of 20% in each deal alongside individual investors like you. You’re an institution. Time to invest like one.
__________________________
What if PAs could lead the charge in closing healthcare deserts through telemedicine—and what's holding them back?
In this episode of Telemedicine Talks, hosts Phoebe Gutierrez and Leo Damasco welcome Ashlyn Smith, as she shares her journey from aspiring veterinarian/dancer to endocrine specialist embracing telehealth during COVID. She highlights telemedicine's advantages like meeting patients at home for deeper insights, fewer missed appointments, and family "pop-ins" while addressing PA challenges: limited infrastructure, state-specific supervision vs. collaboration agreements, and the upcoming 2026 PA Licensure Compact for multi-state practice. Ashlyn discusses pivoting to entrepreneurship amid work-life tensions, reading contracts meticulously, overcoming imposter syndrome, and blending evidence-based endocrinology with lifestyle medicine. Her clinic offers telehealth care in Arizona, nationwide coaching/e-consults, EHR templates, and resources to empower clinicians and patients. This episode inspires PAs to explore independence, collaborate across specialties, and expand access in underserved areas like endocrinology, where reimbursement issues widen care gaps.
Three Actionable Takeaways:
About the Show:
Telemedicine Talks explores the evolving world of digital health, helping physicians navigate new opportunities, regulatory challenges, and career transitions in telemedicine.
About the Guest:
Ashlyn Smith is a board-certified PA and distinguished fellow of the American Academy of PAs, with 14 years in endocrinology and over a decade in medical education. A certified Diabetes Prevention Program lifestyle coach, she owns Elm Endocrinology and Lifestyle Medicine, a telehealth practice blending hormone health with evidence-based lifestyle medicine. Past president of the American Society of Endocrine Physician Assistants, she lectures on pituitary disorders at Creighton University and supports clinicians through e-consults, coaching, and resources.
· Connect with Ashlyn Smith:
📧 Email: myelmheath@gmail.com
🌐 Website: https://www.elm-health.com
📱 Instagram: @elm.pac
About the Hosts:
[00:00:00]
Hey, welcome back everybody to telemedicine talks, we have Phoebe Gutierrez, our awesome host.
This is Leo Damasco. The co-host and we have a great guest today. We have Ashlyn Smith. She's a board certified PA and distinguished fellow of the American Academy of PAs and Certified Diabetes Prevention Program, lifestyle coach with 14 years of clinical expertise and over a decade of commitment to medical education.
Also she's owner educator and clinician at Elm Endocrinology and Lifestyle Medicine. We're gonna talk about that more. And she's also the past president of the American Society of Endocrine Physician Assistant, and lectures regularly on pituitary disorders at Creighton University's PA program. So we have a heavy hitter.
So awesome that you're gracing us with your presence. Welcome to the show. Thank you so much. I've been excited to be here with you and talk about something that I'm really passionate about too. I think we have some good shared interests, so I'm excited to get [00:01:00] started. Absolutely. Awesome. So we didn't warn you about this, but we started asking this question to all the guests in the very beginning.
so doing what you're doing now what did you wanna be when you grow up? is this where you saw yourself, you know, growing up at pre-K hey, this is gonna be me, or what did you wanna be back in the days?
It was pretty much a tie when I was very young. I either wanted to be a veterinarian or I wanted to be a dancer, and it turns out I'm not really cut out to be a dancer, just kind of casually, so that dream ended relatively quickly. And then surprisingly, I just couldn't, I did some shadowing in the vet clinic and I just couldn't do it, but humans.
I'm fine with working with humans. I can talk to humans and explain to them what's going on. So that just suited me a lot better. So not a vet? No, not a dancer. Ended up being a pa. Awesome. And tell us about your journey, where you went and where you came from, and how you got where you are and the passions that kind of led you [00:02:00] there.
So it's been a journey for sure. I realized pretty early on that I loved endocrinology, so hormone health and how complex it was that it was somehow still really beautiful. And I was excited about partnering with patients on that journey. so I actually had a surgeon ask me once, why wouldn't you just wanna fix people and then send them on their way?
but I thought, really being able to partner with somebody over the long haul and like sharing that journey with them and find what motivates them and what's really important to them. So I love that idea of, chronic disease management that endocrinology brings.
And I started in practice about 14 years ago. initially as the insulin pump person at an internal medicine office. I was replacing a PA that they had there who was doing that job. and the physicians there were very nervous about doing any diabetes technology. It was still really young back then.
And I was able to. Step into that role and just, absolutely loved it. [00:03:00] And I did a little bit of dabbling in pediatric endocrinology, but really settled into adult endocrinology for about the past decade, working in the adult endo space. And then of course when COVID happened, it changed to a good chunk of telehealth.
Once we saw how that worked, I think it's here to stay. And so my practice transitioned even after all the restrictions, it's transitioned to a predominantly telehealth practice, which has some great advantages that we can talk about. No, That's amazing. And, more power to you, I'm an ER doctor, I'm a pediatrician.
And I'll be honest, just like your surgeon friend, I stayed away from endocrinology. I just couldn't, get those pathways in chronic care. I was like, oh, I'll just treat 'em and treat them. but that's amazing. So tell us how, and it seemed like COVID was kind of the crux, right?
Well, it kind of just transitioned and a lot of telemedicine's like that, right? it's pre COVID, post COVID telemedicine. What did [00:04:00] you see the change, how did it change for you and, what possibilities did you see after, going through that, I wanna say era two, three years.
It's almost like two, three lost years, but yeah, that era there. Well, I think it had some surprising impact on patient care, especially when we're talking about that chronic medical management model. one of the things is that we are really meeting the patients wherever they're at. So they could be at home, they could be in a grocery store, you know, they could really be anywhere.
And I have found some really cool advantages to that. like if somebody is not sure what medication they take or do they have biotin in their multivitamin or, all these different things, I can actually have them, they're at their home. I can have them go check on that or I can see what kind of environment they're in and really help kind of meet them wherever they are.
And I think it allows you to share Some deeper insight into how patients are living. And then I love the little pop-in by the loved ones. You know, a daughter pops into frame or [00:05:00] the wife says, Hey, that's not exactly right. Or, give some sort of feedback. So it's just a different environment.
And when I was practicing, in person, especially in Arizona, there are such care deserts for specialty care, people would travel for hours just to have, their 15 minute appointment and then they'd have to book a hotel and it was a whole thing. So by actually utilizing telehealth, you're able to really reach that audience and you have, fewer missed appointments.
And that helps with treatment progress by offering telehealth. So when I was thinking about what I was going to do for my clinic, that just made the most sense to make it a telehealth clinic. obviously from a. Startup cost standpoint, there's an advantage there. But really just having lived the experience where I saw the advantage to, helping people take care of themselves more consistently, [00:06:00] get to their appointments more consistently with lower burden.
And it's scalable. Yeah. Right. The telehealth is significantly more scalable, especially with the PA licensure compact, changes that are coming up. So I think it's just so. Full of opportunities that it's definitely here to stay. No, that's amazing to hear. And you made a good point.
A lot of the arguments right now for those against telemedicine is like, Hey, it's not brick and mortar. You're not face to face. You know, you don't develop this rapport or this relationship, but you make a good point where you meet them at. They're home. you meet them in their natural location where their defenses are down, you get the little family pop-ins, and you could see the greater family interplay and really what this patient is in the entire sense.
So I really like that too. No, that's a great point. You are actually the first PA that I've talked to that's focused on [00:07:00] telemedicine. did we maybe have, had another PA and, I have a bunch of PA friends.my initial part of my career was in the military.
And the military used a lot of PAs, primarily PAs, not necessarily nps. And when I went to the telemedicine side, it was mostly nps. And I've tried to get my PA friends. You know, and some are my best buddies to get into telemedicine, but they haven't gotten the opportunities that the NPS have.
But now you mentioned this and part of it is the licensing, right? It's just the nitpicking licenses. Tell me, you've kind of mentioned this compact. What is that? I've never heard of compact coming in. I'm glad to hear that what's in the future for this and how can PAs utilize this so they could.
dive deep in the telemedicine game. I totally agree with your comments. There have just been some kind of logistical and legislative battles that the profession has faced. And thankfully I think we are heading in the right direction. And, many of the professions out there have this kind of built in [00:08:00] infrastructure for if they do wanna go into, a.
Entrepreneurship space. They have that support already there, which I'll talk a little bit about that for bas. And the other is, like you mentioned with the licensing The PA license has not had any sort of reciprocal licensure with other states before, and thankfully there's a lot of work that's going into that.
So, a PA, is working hard at trying to work with the state organizations as well. And last I checked, we were at 19 states within the PA licensure Compact. We are making progress, with more added as we go along. And the anticipated launch is sometime in 2026 that PA licensure compact is going to go live.
I don't know when in 2026, but, it's already late in 25, so it could be here soon. So I think that really does change the landscape of what PAs are going to be able to [00:09:00] do. And it really helps with both marketing them to companies in general. especially the telehealth companies that are looking for, licenses in multiple states.
And we, get kicked out of the running before we even get started. that can help change the game. And then it does help open a lot of doors for PAs who are thinking about, opening their own practice or going into something independent. Which brings me to my next point one of the biggest reasons that Phoebe and I got to know each other was as I was starting my journey into PA entrepreneurship.
She was at a workshop at a PA actually talking about this very topic, and we got to chatting about how, PAs just do not have. That infrastructure like some of the other medical professions have. And it's not that we aren't capable, it's not that we don't have a passion for it, it's really that we don't have that support system.
Through Phoebe's passion supporting PAs, I'm working with her through the independent PA collective to really help [00:10:00] with that. So walking through compliance issues and legislative things and how it varies so much from state to state depending on where you're practicing. and then compliance and operations and working through the things they don't teach you in PA school, like marketing yourself.
Yeah, we're used to just stepping into a clinic and patients arrive and this is a very different animal when we have to do things like worry about marketing and SEO optimization and all that. Yeah the PA approach is really interesting too. 'cause like Leo, you probably will understand this, but nurses, like you have your nursing board that's like fighting for you.
PAs are represented by the medical board, which is the same board that is representing the physicians. So it's this very interesting kind of dynamic where like. Let's not give PAs too much independence. Let's not allow them to do certain things. 'cause it kind of conflicts with like, then you have the physicians all pissed off at you.
Yeah. So it's this really weird battle. And then like me as [00:11:00] a consumer, I'm like, we don't have enough freaking doctors and we don't have enough providers. And like, oh my gosh, we need more specialty access and we need more specialty care. And like, we need to stop trying to make it so like competitive and hard.
And to Ashlyn's point, like. PAs don't have an infrastructure, nurses do. Doctors do, but PAs were kind of missing that whole, look like we can band together and actually launch our own clinic. Like, you'd be surprised at how many PAs don't even know that that's an option for them because you don't hear too many success stories.
No, I was just about to say the whole mindset, and I'm just talking about my buddies who, you know, lifelong PAs and they've been doing a lot of. side gigs with dabbling in telemedicine. But we've been trying to find entrepreneurship kind of opportunities.
We've been trying to find opportunities where they could advance ourselves like we've seen the NPS do, and it's just, maybe we're looking at the wrong places, but it's just been absent. And I think, the mindset is also different [00:12:00] and, maybe I've interpreted this wrong or.
you know, correct me if I'm wrong, but the PAs have always kind of nestled themselves under the decisions, said, Hey, we are gonna support the decisions. While the nps, right now, they've done that too, but there's been a lot of push to go on and, practice on their own.
And that's not necessarily what the PAs push has been historically. And so I think, that kind of mindset has created kind of the space that we see now. it's nice to see branching out. 'cause Yeah, we have these healthcare deserts. We have a paucity of providers where, you know it, if we had a lot of doctors sitting around twiddling their thumbs, it'd be different. But It's not. We have a lot of patients twiddling their thumbs, wait times three months or longer. Mm-hmm. If they're lucky. Yeah. I'm sure this affects other specialties, but especially endocrinology.
there is such terrible reimbursement for physicians that a lot of physicians are not going into that. Specialty. So I think that those care gaps are gonna get even bigger Because [00:13:00] of the reimbursement. And you are right. So the PA profession was kind of created, to be a part of a team-based healthcare.
Right? Yeah. And I think that's still what a lot of us focus on. We still focus as a treat. Practice as part of a team. but Where I think that has somewhat handicapped us is we didn't have that initial push to, be able to stand on our own and have our own scope and rely on our own expertise.
because we were focused on kind of that team based model. And it is changing, at least like here in Arizona, you can move from a supervising agreement with a. Position to a collaborative practice agreement if you've had at least 8,000 hours of clinical practice so that it really starts to support that change from, okay, I have a supervisory agreement and I need to follow the scope of whoever I'm working for, so no matter what I've done in the past, I'm limited [00:14:00] by their scope.
And it shifts it more to having some more of that flexibility of who you can partner with as your collaborative doc. And it allows you to be able to practice under your own experience and your own scope. So I think we are moving the needle. We're just behind the times a little bit. So I think we'll catch up.
But the model was really. kind of team-based medicine. I mean, it was naval corpsman that started our profession. So that's where we started. and I just think that shift is happening a little later than other professions. Yeah. so you mentioned something, and this probably my lack of knowledge, so the supervisory agreement versus a collaborative agreement.
What's the main differences between that and why is that important to make that distinction? It is so important. So a supervisory agreement is pretty restrictive on what you can do. And you basically have to mirror the scope that your physician has. So let's [00:15:00] say you've, been in family practice and you've seen adults and pediatrics and done the whole age range.
And then you move to an internal medicine practice and now they say, well, you can't. See children or you can't do anything like that because that's not what my scope is. I don't know that you'd be seeing children at interim medicine anyway, but for the sake of argument, let's say that you would, so you kind of lose the advantage of all this experience that you've had because that's not what the physician's scope is.
That has its place. So certainly people that are starting out and do need more of that support and they don't have that benefit of years of experience, then it, is very beneficial. it's really helps build that foundation. But. Collaborative practice is for those who've been practicing for quite a bit longer, and you have to go through, at least in Arizona, you have to go through a whole certification process and get attestations about your hours of clinical practice.
And it's very strict. I know [00:16:00] Phoebe and I were talking, it took a couple months to get All the paperwork in place. But once that's in place now, especially working in telemedicine, I can have a collaboration agreement with somebody. Maybe somebody who's endocrinology, maybe somebody who's internal medicine, maybe someone who's in gynecology.
really anybody. As long as we're both comfortable with that. And we do still have to have, I believe it's about an hour of, interaction time a month. So there is. Still that interaction time, but it's not the same as with the supervisory agreement. And you don't have that, you know, the detail like chart reviews and signing off on all of that that more day-to-day minutiae.
Because once you've practiced for so long there's that understanding of, Your experience. So it's very different and I would encourage PAs that have practiced for a while, if that's an option within your state. Look into what that would take to get that certification.
[00:17:00] Because for me, I actually held off on certain parts of launching my business until I got that certification because it just opened so many more doors. So I think it's a game changer now with the compact. is there a talk that, let's say you do qualify for a collaborating like I guess status in one state.
Is that gonna be part of the compact, or are you gonna have to go each state that you're part of the compact and qualify? Still each day. It's like, it's not gonna be that easy Leo, wishful thinking. Right. Well, that would make more sense, but why would we do things that would make more sense?
Simplify. No, no. We're not gonna make anything easy. And the collaborating rules and the supervising rules will still vary even though you can, qualify for the compact. I think the interesting thing is. I don't wanna say micromanaged, but it is like a interesting, like where PAs are like micromanaged closer.
That's like the way that it's almost like they have to be like directly supervised, like a PA in Pennsylvania that's wants to practice independently, has to [00:18:00] work on site with their supervising or their collaborating physician for six months before they can get granted independent to even just practice virtually, which to me I mean, unless you're working with the person in the hospital today, like you're just, that's never gonna work. And so there's a lot of states that are just not necessarily caught up with the times of virtual health and telemedicine that, I think it'll be a slower ramp, but I am hopeful that, there's a lot of legislation that is kind of mimicking what NPS have today.
Yeah. Whereas like to Ashlyn's point, like. Ashlyn could totally practice independently. And I probably trust her. I would trust her with my hormones more than I would trust you, Leo. Oh, I would too, for God's sakes. I hope so. Don't trust me to suture anybody though. I promise You don't want that to happen.
And, I'll be honest. So when I was a baby doctor, it was a PAs that taught me, you know, the two friends I talk about all the time, my first duty station as a military doctor, it was a PA that took me under his wing and it was like. Just follow me for a month and I'll teach you all that you need to [00:19:00] know.
And I did, and we're still friends now. Thanks, really. But, no, and to the point is like, yes, there are very highly qualified folks and this is no knock on anybody, but sometimes, I've had PAs that I've went to er residency with, I will definitely trust them with my life more than, you know, some of the er doctors that I know.
Yeah. So tell us more about, you've alluded to it, but tell us more about your entrepreneurialship kind of pathway and being a pa Right. We've talked about this kind of a new pathway ahead.
What have you seen as roadblocks and as hardships that you've seen specifically because you're a PA and not necessarily NP physician per se. So my entrepreneurial journey, I didn't realize it, but it actually started years ago when I started doing medical education work on the size. So on top of a full-time job, I just happened to add these med ed pieces.
and through that building a lot of those relationships and, [00:20:00] doing more of that 10 99 work. and I learned. A couple of things. One is read every single contract that you are given. I think we're all used to that. Just scroll to the end of the terms and conditions at the end of an agreement, click.
I agree. But no, when it comes to your profession definitely read those contracts. And then for me, the journey into full entrepreneurship, was a little bit earlier this. Year and I was really feeling that tension between wanting both a work-life balance for myself and feeling like I was pouring so much energy into what others prioritized, and still somehow not being able to give as comprehensive care as I felt that people needed.
and especially within endocrinology. There's a space between when you tell somebody that their labs are normal, even if it's been a long journey, you know, to get there, a space between that and I feel, okay, there's this space where you could say, I still don't feel right though. [00:21:00] And it was pretty early on in my profession where I would notice kind of the shoulders drop and just go almost like this disappointed look that things were normal.
And what I found is that really. Not letting that be the end of the conversation, right? Take a more whole health approach. Look at some of those lifestyle factors that may be at play. Look at other things. Maybe we're talking about sleep apnea or depression or chronic pain or something else that might be influencing how they feel.
And continuing on with that. Say, yes, these labs are normal. Let's talk about what else might be going on. And I have found How important that work is, that's,when I chose to go into entrepreneurship, I wanted to make sure that those were the two pillars of my practice that we both, did evidence-based.
Medicine and make sure we do endocrinology the right way, but also fold in evidence-based lifestyle medicine. not just kind of whatever makes you feel better, but actual [00:22:00] evidence-based medicine and make those as foundational to the clinic. And I will say right off the bat, one of the hardest things is just.
Fear, Right. Not knowing should I do this, you know, I'm the primary breadwinner in my family. What happens if this doesn't work? and where do I start? That was one of the hardest things is just understanding who to. Ask first, where to look first. So I'm really grateful that I didn't even know about the workshop at a PA until, like a day before, and I decided to take that leap.
'cause that's really changed the trajectory of my professional career. And I think that I learned really early on, there are odd little nuances to PA practice That I didn't really know existed. Like I didn't realize the collaborative practice certification existed until I started looking into this.
And then the state by state rules are very different depending on where you're practicing. And that makes it really confusing. And I remember, I even. reached out to the Arizona Regulatory Board of [00:23:00] PAs, and I was like, just so I'm clear, are these the specific rules about PAs owning a clinic?
And there was some legalese response. It was like, oh. All the information can be found, blah, blah, blah, blah, blah. And I had to kind of go look at it myself. So I remember reaching out to people and saying, am I reading this Right. Is this what this means? so trying to figure out what your state's rules are as a pa.
Can PAs even own their own practice? Because some states that's, yes. In some states that's no. Some states it's kind of. You don't know about that at all though, Leo, you don't know about No, no. It's all been straightforward, yeah. Having experience with going through the boards. It's just like that, right?
It's like, well, we think it's a great idea, but oh wait, no, it's not. Or, it's very gray. There is not a black and white answer. and you know, we come from a profession that appreciates black and white answers. Right. So we have [00:24:00] a very hard time trying to navigate, you know, I think any profession has a very hard time navigating the answers that we're given.
But you're right. It's just never a straightforward answer. Yeah, so I'm lucky in that Arizona is pretty flexible for PAs, so PAs can own their own practice. there's of course community medical practice rules that we have to follow. So how much ownership in terms of kind of the ethical medical-legal type of side type of the picture.
So where, I can. Pick my name of my clinic, I can pick the specialty focus. I can pick, what patients I accept and what hours I work and that sort of thing. But in terms of that community of medical practice, there is still that 51% physician. Yeah. we're talking about the CP om laws that also differ from state to state.
So Yes. Yeah. And it's important to really do your research, ask the experts, really find out what your state's rules are even [00:25:00] before you start creating the business. Because from moment one, there could be rules in place. And I know Phoebe could probably talk about this a lot more thoroughly than I can.
'cause it's very confusing. Yeah, no, I think we could dedicate a whole week of one of these podcasts just to go through and, yeah. I think before this Ashlyn and I had to sit and explain a contract to leave for an hour . we were talking about that and she was like, do you wanna go through the contract?
And I was like, yeah, we'll go through the contract. Let's go through it. Yeah, let's go do it. Let's go through it. No, it's a complicated process. I think it's very overwhelming. I think if there's one thing, like it's not impossible, and I think it's intimidating by design, unfortunately.
But I will say that it is a lot of work, but it's a different kind of work when you're pouring your energy into something that you're passionate about and that you know, it's for a good reason. And for me, I know it's serving my family and my work life balance. So there is kind of [00:26:00] that.
wanna say for me, there's kind of that renewed energy and passion in the professional work because of the focus and I'm being able to create something that's really meaningful, that I can be really proud of. So it is hard work, but in my mind, it's worth the work and it's worth the wait.
Isn't it amazing once you step out of the clinical monkey role? And doing something that you actually love and really that's yours, right? And in this, you know, I think as professionals, providers, we've given up that in the brick and mortar space.
So it's awesome to see, yourself, others getting into that space and getting really excited. But how scary was it for you stepping outta that role? you know, how many classes did you have in PA school, that taught you how to do this, how to talk business, how to set up a business, and how to, rely on your business acumen and do that.
Zero. Yeah, exactly. Exactly. [00:27:00] Less than a handful, right? Yeah. Yeah, there definitely were no classes in PA school about even. Contract reading. So definitely not about building a business. I have a couple of unique advantages that I'm so grateful for. one of them is that I come from a family of entrepreneurs, so I've kind of grown up seeing my parents walk that path and understanding that there will be highs and lows and it's kind of part of the process and just kind of.
Learning from their business acumen. So while I was thinking about this, I definitely spent some good time talking with them, as well just, they're not in medicine, but they are business owners and successful business owners. and then I also had the advantage of having, a decade of medical education experience that I was able to kind of, when,
We were looking as a family at the situation, I could really rely on that and dive full time into entrepreneurship, which I think is [00:28:00] really helpful because I'm able to make more progress. But it's still terrifying. And there are still moments as you're going through everything, especially as you're growing or you're having to make a pivot that you didn't.
Fact that, you know, imposter syndrome is real. Yes. That idea that who's gonna wanna listen to me? I'm just, this random PA in Arizona. Why would anybody want to come to my clinic? And, I have other aspects of the business that are, supporting primary care clinicians through e consultations and,
Educational resources and EEHR templates and webinars and that sort of thing. And even as I'm putting those together, I'm like, gosh, is anybody gonna really want this? but those are the questions that I get asked all the time. I get asked that as I'm doing med ed and as I'm just, living my life as a pa, I get asked those types of questions like not just, how do I manage X and y?
Condition, but how do I work through the prior authorization process? So kind of things that have worked for [00:29:00] me, and then, you know, really answering those pressing questions. But it's hard because we, at, like most clinicians, PAs, are. kind of trained that you just, get the medicine right, and you walk into a clinic and it's all set up.
Yeah. The credentialing for insurance is set up. The patient panel is there, someone's doing your scheduling. The marketing's already been done. It's already set up. so learning things like how to build a website and how to, do marketing and just all of that, and having to do the backend work.
there has not been any structure to put that into place for PAs, so a lot of learning on the job, and I think a lot of it is also being flexible. Really looking for feedback from those in healthcare, but also just in, legislation and compliance and those industries as well.
But also listening to your customers, you know, getting that honest feedback and I think it's important to get that honest feedback and then listen to it. 'cause it can be really [00:30:00] challenging when You've created your baby, but then there's some negative feedback, but that will help shape it to be even better in the future.
Yeah, no, that's a good point. And let's talk about Elm. Let's talk about specifically what you've built and tell us a little bit more about that, what you do and, how people could reach out if they need your services. Yeah,so Elm is my baby, elm endocrinology and lifestyle medicine.
Really pairing that hormone health with evidence-based lifestyle medicine. So, uh, there's actually even a certification for that the American College of Lifestyle Medicine. And they have some really robust. Evidence-based courses and materials for that. So it really put a name to what I was trying to, pair with endocrinology from the beginning.
so it's. A telehealth based clinic, spanning at this point, all of Arizona. we'll see how that changes as time goes on and as the compact comes into place. [00:31:00] But, really anybody within Arizona who's looking for that hormone support, can come to elm. There are a few different things.
There's health coaching. Very soon there will be medical care as well. also, you know, blogs and information, just. In terms of medical conditions and kind of explaining a complex world of endocrinology in plain patient language, I've also developed some health screeners that you can use to kind of see am I at risk for X, Y, and Z?
So we have kind of two arms, right? We have the patient focused arm, which is what I've been describing so far, but there's also the clinician facing, services. So that, spans anything from those resources that I was mentioning. So, a guide the most recent one that I made was crafting your EHR templates to double as your prior authorization for obesity medications.
So that's one of the big questions that I get is how do I get this approved? And it takes so much [00:32:00] time and so much effort. And what I've learned just from practice is that, there are certain phrases that you want to make sure are. Included in that, and then, when your staff knows, or if you're doing it yourself.
but if your staff knows, then they just pull that right from your note and they have it all kind of prepared. So it helps facilitate a workflow, but it also decreases some of that administrative burden. Yeah. Which ultimately improves access to these medications, right? If we're able to stream that in that prior authorization process.
and then, quick references for things like continuous glucose monitoring, billing and workflow processes as well as e consultations. So submitting a case, maybe it's. A new endocrinopathy that you're looking at, or maybe it's just a complex case. You wanna get some of that specialty expertise without fully, sending a patient over for a referral.
So that's a really cool way [00:33:00] to have more of that collaboration between primary care and specialty. AndIt helps bolster that endocrine expertise within the primary care space too. So ultimately that's expanding access, which is really great. Okay. And then straightforward professional coaching too.
If you just say, Hey, I don't have a specific case, but I wanna learn more about diabetes management or about osteoporosis or thyroid management. that is another option too, because that's what I've been doing for the last 10 years is teaching people about endocrinology. So I think those two missions go hand in hand.
Providing that quality care to patients, but also equipping other clinicians to do the same thing. Again, kind of showing that collaborative model we're, in medicine is a team-based sport, so we are in this together. And I think when we all work together to share our strengths, then that helps all of us grow.
No, absolutely. I agree. Yes, you have to be in Arizona to do the clinical practice part, but does a [00:34:00] clinician facing and the patient education part, does that have to be limited in Arizona or can you have clients outside of the state since you're not necessarily offering direct care?
That is such a good point, and thank you for bringing that up because you are absolutely right when it comes to medical care. So when you're actually diagnosing somebody, you're running tests, you are, prescribing that sort of thing. that has to be where your license is, which for me right now is all of Arizona.
But when it comes to health coaching For patients when it comes to e consultations, when it comes to professional coaching, that is not limited by your state, that's really anywhere. Nationwide. If there was somebody who needs support, for instance, I just saw somebody that was. In Denver.
so I'm not providing medical care to that person, but I was able to do some really foundational education and help kind of walk through some of the options, pros versus cons, and what some next steps [00:35:00] might be. And then, you know. Really equipping that person with having a more thorough look at his options for his care plan and risk versus benefits.
So yes, that, is not limited by your state, but your medical care is limited to where your license is. Yeah. No, and I think that's an important distinction, right? Because then, you know, making that distinction, understanding that full distinction increases your reach and it's able to increase kind of who you're able to.
Sway. So I think that's huge. So, no, thank you for making that distinction there. Phoebe, do you have any other questions? We are kind of closing out, any other questions that you have or, no, just Ashlyn's been working her butt off to get Elm up and running and she is just a phenomenal clinician and she cares, and I'm super passionate about just like hormone health and you know, kind of all these things where I think all the listeners probably know, like I constantly am trying to advocate from like the patient perspective [00:36:00] and like Ashlyn is just the provider.
I think we all would want. So anybody needs any sort of care or just wants to be educated, she's an amazing resource now. And How do they get in contact with you? So my website is elm, health dot com. So elm health.com. And then Instagram is another one. I'm really active on Instagram, with, Educational content and, such, so Elm dot Ppac. And then of course you can always just reach out and email me, my Elm Health, at gmail.com. And one other thing that I'll give a little plug if you're not sure, maybe you're patient and thinking, I'm not sure if this is a good fit for me.
I'm. Offering free those free initial health consultations so that first, you know, 50 minutes, get to know me, let's chat, see if it feels like a good fit. similarly if you're a clinician and if you're like, yeah, I really would like to learn more about Endo, but I'm not sure how that might look.
[00:37:00] Or maybe you have an idea for a service that I haven't mentioned. Let's chat, book a discovery call with me and we'll just chat about it, you know, no obligation at all. We'll just chat about what you have in mind or how I might be able to support you. So like I mentioned it may look one way right now, but as needs change and people give that feedback, right?
They say, Hey, it would be really helpful to have this, definitely open to pivoting and folding in other services with ultimately the goal to. Empower patients and empower clinicians and have better health outcomes. Oh, thank you. That's amazing. And looking forward, hopefully getting you back on the show and seeing how this pans out and give us your success stories a little later down the line.
'Cause no, this has been a great talk and especially after the compact hits and, I'd like to see more PAs getting in the telemedicine game and, you know, as you learn, maybe you could help. Those looking into it you know mm-hmm. Follow your [00:38:00] lead, absolutely. I think that's gonna be a game changer.
So I think a follow up after that's in place. And just like with anything medically focused, similarly professionally, if I learn something, I just wanna give it back to other people. So I'm happy to share what I've learned professionally as well along the way. And if it helps another pa maybe take that leap.
Then I will have served a great purpose. Awesome. Thank you so much. Thank you for your time.
yeah. we'll post along your contacts and your socials, but we appreciate your time and again, looking forward to catching up in the near future. So thank you folks and if you have any questions, concerns, you could definitely email us at, phoebe@telemedicinetalks.com, leo teles medicine talks.com and info telemedicine talk.com.
Until next time, aloha and thank you all. Thank you guys.