Health policy isn’t background noise, it’s the operating system of healthcare. In this episode of Telemedicine Talks, hosts Phoebe Gutierrez and Dr. Leo Damasco sit down with Ashlyn Smith, Christina Davis, Savannah Elgins, and Katie Wakeland to explore how physician assistants (and one nurse practitioner) are breaking into telemedicine, overcoming regulatory hurdles, and building independent practices focused on underserved areas like endocrinology and developmental behavioral pediatrics.
Why are so few Physician Assistants (PAs) entering the telemedicine space, and how can they overcome the barriers to start their own practices?
In this episode of Telemedicine Talks, Phoebe Gutierrez and Dr. Leo Damasco are joined by a panel of innovative providers: Ashlyn Smith, Christina Davis, Savannah Elgins, and Katie Wakeland. Together, they share their journeys from traditional clinic settings to telemedicine entrepreneurship, highlighting the frustrations with the broken healthcare system, insurance challenges, and the shift to cash-pay models.
The group discusses state-specific regulations like corporate practice of medicine (CPOM), the differences between supervising and collaborating physicians, and business structures such as PLLCs, PC-MSOs, and LLCs. They emphasize the importance of finding your "why," building community through groups like the Independent PA Collective (IPAC), and embracing an entrepreneurial mindset—including learning from mistakes, pivoting, and overcoming imposter syndrome. From addressing care gaps in rural areas to leveraging telemedicine for flexible, patient-centered care, this episode offers practical insights for PAs (and NPs) looking to disrupt healthcare and scale their impact nationwide.
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 Guests:
Ashlyn Smith is an endocrine PA based in Arizona with 15 years of experience, passionate about whole-person care in endocrinology. She's certified in lifestyle medicine and advanced diabetes management, and runs her own telemedicine practice focused on bridging care gaps.
Christina Davis is a PA in Florida's Panhandle specializing in developmental behavioral pediatrics with a functional medicine approach. She operates a hybrid telemedicine practice to serve underserved families nationwide.
Savannah Elgins is a PA with over 20 years living with type 1 diabetes and an endocrinology background. She's co-founder of a telemedicine practice dedicated to specialized type 1 diabetes care.
Katie Wakeland is a nurse practitioner with an endocrinology focus and type 1 diabetes experience. She partners with Savannah Elgins to provide patient-centered, tech-savvy care outside traditional systems.
About the Hosts:
[00:00:00]
Hey, welcome back to Telemedicine Talks everybody. I am super stoked, with this episode. we have a bunch of guests here and, we're gonna talk to physician assistants,
I've worked a lot of telemedicine platforms and I think this is an untapped resource in untapped market, and it's awesome to see a bunch of y'all here. And I can't wait to hear your stories, to hear your journeys and, what you're looking forward to. So, let's start with just introductions.
I'm Ashlyn Smith. I'm an endocrine PA based out of Arizona. I've been practicing for 15 years now. Really passionate about all of general endocrinology and applying that in a whole person. With a whole person focus, so really looking at all aspects of their healthcare. and recently got certified in lifestyle medicine and board certified advanced Diabetes Management.
So really trying to see how I can best serve folks with ENDOCRINOPATHIES in a whole person perspective. [00:01:00] And that is what led me to, my business, which I'm sure we'll get into. Yeah. Well,
welcome back too. So it's nice
to be back, Michelle. Thank you. Thanks for having me back.
Alright,
So I'm Christina Davis. I'm a PA here in Florida Panhandle. And here I do currently developmental behavioral pediatrics. I start off in primary care pediatrics, mainly saw a lot of behavioral cases. So that's when I sought out further training in DBP, developmental, behavioral pediatrics, and also functional medicine.
'cause I felt like that was a. Big component to that too, and that's how I led into what I do today.
Aw, pediatrician, that's like down to my heart. I'm a general pediatrician, first and foremost. That went to the dark side, to the er, so, okay. I love seeing peds. All right.
Okay. I am Savannah Elgins. I'm a pa.
This is my 50 50 business partner.
I am Katie Wakeland. I am a nurse practitioner actually, so I'm the odd man out.
And [00:02:00] traditionally I have an endocrinology background. That's where Katie and I both met. I have type one diabetes. I've had it for over 20 years. And so I decided to pursue the love of many decades of learning with type one.
I did endocrinology. And then that kind of led us to where we are today.
Yeah. And, I'm a nurse practitioner and we worked together in an endocrine clinic. and I am also a type one diabetic. So we bonded over that and decided that, you know, we needed some extra subspecialty care for our type one patients, and that's what put our brains together and led us to where we are.
That's amazing. Gosh, you know, kudos to you. I'm gonna bring this back to a story. The way that I learned how to manage diabetes in the pediatric clinic was through a type one diabetic named Jevon Brown. He was a five-year-old that taught me how to manage his own medications and his own insulin pump.
When I was doing [00:03:00] rounds, Jevon would be like, Hey, here's how to use my pump. And to this day, I credit Jevon. As, who taught me the most on how to manage diabetes, it's amazing.
Ah, yeah.
We Love it. So, welcome. Thank you for taking your time. And, y'all being here, you know, it's amazing to see we see a lot of, physicians, nurse practitioners as well, but we don't see a lot of PAs, doing telemedicine.
And I'm gonna go off on a tangent, two of my best buddies and the people that taught me the most in military medicine were the PAs that supposedly worked under me. But really I worked under them and they taught me everything I knew about military medicine.
And, you know, we hold a close bond now, and I've been trying to break them into the telemedicine space. And it's been difficult. it hasn't been there, the structure hasn't been there. You know, I guess first question is, what was your thoughts into getting into this space and how did you [00:04:00] break into this space and, what kind of, speed bumps did you all run into in getting there?
So this is something in you being a general pediatrician, I'm sure you know, like how can she do DVP from home in a sense? So I do hybrid. most of us telemed, I say 75% telemed. 25% either in the home or in a office located near the child. But my thing was for the Florida panhandle, there was no resources or anybody practicing within this specialty.
And I found this to be true throughout the entire us. For the most part, it's very few pediatricians compared to other specialties, and then very few specialized within DVP. that was one my two biggest things that started my mission. How do I take care of my Florida Panhandle families? But then also how do I educate and expand this throughout the US and be able to help other people?
So I have the clinical part [00:05:00] and the education portion. So that's my two biggest things. I would say the biggest hurdles is working with insurance That is one of the biggest things and just getting patients and families to trust that part of, Hey, I may not be taking insurance, but this is because I want to provide the best care to you all.
I don't want it to be limited based off of the stipulations of what they say. I wanna be able to give everybody the exact same care, and tailor it to what the families need.
Got it. Interesting. So you're strictly cash pay then, just out of pocket pay,
correct.
Huh. Okay.
Correct.
That's an easy answer.
And a lot of these companies started direct pay, direct to consumer. Right. It's a headache. Mm-hmm. You know,dealing with the payers.
Yes.
I had a similar experience. I know we've talked about this a little bit before, but really what I was seeing outside of. My personal journey into entrepreneurship, just the telemedicine side of it.
You know, I was working in general endocrine for over a decade and people were driving [00:06:00] hours and hours to come do their 15 minute appointment with me. And it just started to become really obvious that. People were missing appointments or they were putting off appointments because it was such a hassle, or, you know, somebody forgot about their appointment and there were these gaps in their care.
And just really realizing that there are whole sections of Arizona that don't have endocrinologists. So they have the choice to either forego specialty care or really travel a long way and. I think COVID really changed a lot of our perspectives on what telemedicine could really look like. And now telemedicine probably isn't for every specialty.
If you're in surgery, it may not be the best option for you. But, you know, something like endocrinology, we can do a lot of it. A lot of it's lab reviews, diabetes tech report reviews. There's so much that we can do remotely and through. COVID and post COVID, I was really seeing a couple really cool things [00:07:00] that I could see into the person's home and their normal life.
And you get a different perspective than how they act and how they present in, a clinic. And sometimes it's just they're more relaxed, but Like, oh, I see their living environment. And that helps put, their priorities their situation in context. And it also just helps with keeping appointments.
I can't tell you how many times before I was fully telemed, I would have somebody who totally forgot their appointment panic, called the office. I was like, we'll just do a video. It's okay. Like, we'll still get that care, still be able to talk. So I think it was a combination of just. Lessons learned throughout the pandemic and then just seeing the care gaps, and it really didn't need to be that way
For some people telemedicine is not their cup of tea, but for a lot of people they are really open to it because of that flexibility. I have probably five other stories I could share like that, including somebody I just [00:08:00] started seeing totally telehealth, change because his provider was making him come into the office every time he needed a pump adjustment.
And he is like, I'm taking so much time off of work and he's making me come in, you know, every couple of weeks, to change things. And I said, well, why don't we. Do it over tele. I said, I see him over his lunch break and you know, we get things taken care of. So, for certain people it really makes a lot of sense
kind of to.
Piggyback on that. the original system was broken, like it wasn't working. Yeah. Which is why we decided to get out. And so specifically, we didn't feel like our type ones were getting the care that they needed in 15 minutes, because that is the amount of time it takes to download the pump and then the visit's over.
That's it, that's all we got. I'll call you later for your adjustments. and then I have, you know, multiple people backing up and so we were limited strictly by time. Katie and I were very, very big proponents of we want you to [00:09:00] manage this the best way that you feel possible. So we wanted to make sure that we were incorporating all the latest and greatest technology and whatever the patient felt comfortable with doing.
we saw a lot of limitations with people outside of. Us that would pick one insulin pump system and then just kind of stick to that because that's what they were comfortable with. that's what they felt comfortable with prescribing. And so we just felt like our type ones deserved more. there was a little bit that I went to social media.
It was like my first time really niching down on like a type one community and like looking and observing and listening and. For as much effort that we were putting in, trying to do the best for our patients in general, all endocrine patients the type ones in particular had so many negative things to say about their endos and it hurt my heart quite a bit.
I'm trying really hard to do everything that as a type one myself, I would want to give to you. And it's not my type ones that were complaining to be clear, it's just like nationwide. Everyone was at. [00:10:00] Set by lack of appointments and limited availability driving forever, four months booked out.
something comes up with the physician or the NP or the pa, and then they're moved another three months. They can't get their prescriptions. Insulin is a requirement. And we were just like, you know what? If we took insurance out of this? What could we do? What could we do for our patients? How much time could we give them?
Could we willingly give somebody over an hour who's just diagnosed with type one as an adult? 'cause the pediatric system obviously has a lot more things in place that for better education. But our type one adults, it just wasn't working. And so can we give them more than an hour to understand this life changing disease that you have?
Can we tell you from a personal. Experience. We are living with this. We had babies with this. We went to college with this. Like we can be their guidance from a healthcare perspective and a personal perspective, but we couldn't do that inside of the traditional roles of the healthcare system.
Yeah, and it's a common theme, right?
As all of you guys kind of related. It's [00:11:00] just, hey, the system's broken, right? The system wasn't benefiting patients, it was not benefiting the providers. And you know, you saw an opening and you're just like, Hey, I could do something better. We could do something better. And another common theme is, insurance is making this very hard and, it's sounding like cash pay is kind of the easy answer.
And we could go on a whole nother talk about that. but, other question. and actually this is, Katie and Savannah, maybe you could shed light on it. You know, I kind of mentioned it before. A lot of nps are in the telehealth space, but not a lot of PAs, right. Why? And of course y'all can answer, but you know, I have an MP and a PA right there.
why do you think there's a discrepancy in that? What about being a PA makes it a little bit harder to break into the space and really own your own company? And start things.
Well, it starts at the top. so laws, corporate [00:12:00] practice and medicine, is the big one.
And when you're talking about nursing and medicine, they're completely different services, right? Yeah. So we live under different boards, whereas a nurse practitioner. according to the Texas Nursing Board, I never practice medicine. I've never practiced medicine. I practice advanced nursing. And so that's where the two differ in is fact.
As far as business ownership, I can be in my scope of practice and practice advanced nursing and own a business that practices advanced nursing under that scope. But as a PA who services under the Texas Medical Board who does practice medicine under the supervision of a physician, the rules and regulations get way more sticky when it comes to owning a practice.
Not impossible, but very sticky. So
nuanced.
Yes.
And I think you guys all have three different business structures, right? I think you guys were all covered under the different umbrella. 'cause like Savannah, you're like, P-C-M-S-O.
[00:13:00] Yes.
Ashlyn, you have a different structure and then, Christina is not subject to corporate practice of medicine.
Now
I have A-P-L-L-C.
Yeah.
And do you have to have a physician overseer, like physician supervisor as right. And trying to convince the medical board that PAs now could own their own company, I bet is way harder than trying to convince the nursing board.
It's coming. It's like state by state coming and Texas.
Physician assistants can own 49%.
Yeah.
Would not own majority. and so, but every state is a little bit different. Texas was one that I don't think is gonna budget. I hope it does, but I don't think it's budgeting anytime soon.
It's
Texas.
Yeah. I was lucky. I think Arizona is a little more flexible in those situations. So, that's why I can own My PLLC, but I have to have, I think technically she's a medical director. So there are two different hats. There's the [00:14:00] collaborating physician hat, like somebody that I practice with, and so I meet with her and, but she's a collaborating versus a supervising.
That's another nuance. So there's the collaborating physician hat, and then there's kind of the medical director hat, which is that corporate practice of medicine. So in that piece. she owns 51% of that piece, and it's so confusing the way it's all, divvied out. So I own my own PLLC, but I have 51% ownership of the corporate practice of medicine for the physician.
So do you have the PLLC that you own, but then You work with your medical director or the physician that has their own. Company structure and then you co-own. Like how does that work?
No, it's all housed under, it's like a separate contract, essentially. A separate contract to be the medical director.
So yeah, it's different than the PC MSO structure, which is good because that makes my brain hurt.
It [00:15:00] makes my brain hurt too.
Yeah,
literally poor Katie. She thinks of something in the middle of the night and it's like, oh no. Yeah. Did we do right? We always do. Yeah.
It's just terrifying.
so in your structure, you own a percentage and the doctor owns a percentage.
So
we
own an LLC, which is a management company. got it. And so physician owns the business full out, a hundred percent P-L-P-L-L-C. And then you have contracts of those two businesses that tie them together.
We can work for the medical company or under the medical company and own the management organization. But they have to be separate entities, period and story according to Texas.
And is your structure P-C-M-S-O then too,
correct?
it is. Okay. Okay. And Ashlyn, sorry to clarifyI know A-P-C-M-S-O structure better than your structure.
So then you just co-own basically the company together with [00:16:00] your physician, right?
In a matter of speaking, like I created it my own. so she didn't have to be there for creating it for the business, correct. for the CPOM part? Yeah.
Got it. Okay. And then Christina, you're under A-P-C-M-S-O.
No I'm not. Oh my God. Okay, so here in Florida. Yes. All three different I would say mine is a little simpler Uhhuh than all of theirs. So here in Florida we can have an LLC. Okay. You don't have to have A PLC. So I have a LLC, and then I just have to make the supervising physician or have somebody separate as the medical director.
So that's really the only thing, having a supervisor, physician, and a medical director.
But you could own the bus. Mm-hmm. I thought Florida was CPOM.
Mm-hmm.
No. No, it isn't. Okay. that's where my confusion was. 'cause I know a lot of people create PCs in the PCMA structure in Florida to be their mega pc,
but they're not clinicians.
So that's the
difference there. Christina's a
clinician.
Ah, okay. So I think
probably the biggest takeoff message here [00:17:00] is know
your state loss, right?
Definitely, definitely.
But the other, bottom line message here is it's doable, right? It's doable.
you know, it may not be as straightforward as, let's say, Florida. with the lack of laws in Florida, but it's doable, right? And I think that's a resounding message too, that, for the PAs out there, you know, I've been talking to my buddies too, and they're like, how do we do it?
I don't think we can do it. You know, it can be done. It's just sometimes a little bit more finagling, wherever you are.
Yeah, the biggest thing to think about is like if you can do it in a state and you could have a collaborating physician, supervising physicians, a little bit hard, there's a lot of states that still require, like, almost like you're onsite with the doctor.
so like, South Carolina PAs, I feel so bad they have to work with their supervising physician for six months, at least 40 hours a week in the same location before they can own their own practice. So the only PAs that are really ever gonna be able to do that are PAs who are working [00:18:00] with a doctor in the ER maybe, or in clinic.
And there's some weird non-compete or no non-compete, you know what I mean? So those are some of the barriers I think that come up. But I think. The majority of the states are similar to how you guys have it structured, where there is the flexibility in the room to be able to do it.
Now go back to what you just said, because there's a little nuance. Maybe I need a little clarification on collaborating physician. I can't say physician. Doctor versus supervising doctor. Two different terms, right? can somebody educate me? I use that interchangeably when I work brick and mortar with my PAs, but.
Yeah. What's the difference and
why does it matter ? Yeah.
it's an important one. And again, it kind of varies by state what their requirements are for it. so in Arizona, if you've been practicing for 8,000 hours, you can apply to get certification for a collaboration [00:19:00] agreement.
So it's a whole process. to get attestations from the physicians you've worked for and for how many hours and everything. But once you do that, then it takes it fromfor Arizona, at least the supervising physician, dictates your scope.
Hmm.
So let's say that I have worked in endocrinology all along, but they just see.
I don't know, gestational diabetes, I'm gonna say something really specific. Well, now I can only see what they see and if I previously saw adults and pediatrics and now they only see adults, I can only see adults. So it's really restrictive. There's a lot more oversight. the agreements a lot stricter versus collaboration.
I can work under my own scope. So my own experience and my collaborating physician could be in that same arena, but doesn't have to be. and there's less in terms of like co-signing. Mm-hmm. [00:20:00] And the percentage of chart review and that sort of thing because you've established that you've been a clinician doing her job for a long time.
Like we can stand on our own two feet because we've shown that experience. I think that is a huge step in the right direction because almost every PA that you'll talk to, we think of practicing medicine in a team because that's what healthcare is. None of us. Operate in a vacuum. You know, even if you have, you're the only person in your practice, you have other specialties.
You have, your primary care team, mental health team, diabetes educators, you have so many people that you're working with. So we think about it as a team and everybody working to the fullest potential within that team. We want everybody at the top of their scope, everybody giving their best to patients.
Thank you for that. Sorry.
A little bit of a soapbox issue for
Me.
No, no, no, no. And it's good education because, people like me, you know, again, using it interchangeably, but it's, you know, especially with on my end physicians, [00:21:00] wanting to partner up with PAs, they need to understand the distinction.
Right. And they just, you know.
Mm-hmm. So the better they're
Educated. I think. No, thank you for that. I appreciate
it. Yep. To make it more confusing. I know like here in Florida, it's a little different, you know? Yeah. So the terms still stand the same. Mm-hmm. Like supervising physician versus collaboration.
But here, we still follow up under supervising physician. So like Ashlyn was saying, as far as the scope, like it determines my scope of what I can do. Mm-hmm. However, about two, three years ago, maybe they try to change it to collaboration within the supervising. Physician part of it. So it made it to where now like through contract, you have to lay out your scope, but it can be other things as long as they would be eligible to do those things,
Yes. So like a pediatrician that would be eligible to, I'm using this as an example 'cause this is what I do within my practice, like I do gut health. A pediatrician that is able to order those gut health [00:22:00] labs, although they may not be doing it on a regular, if it's something they can do, then here in Florida, they can write it into my scope of practice and I'm able to do that.
Got it. That's interesting. And, Hey, do you have any questions? By chance,
you're thinking about this as you're probably supervising and you know, all these supervising relationships and you're like,
yeah, no, it's different though. 'cause I've never really had to think about the distinction.
Right. Again, you know, in my ignorance, I was using the terms interchangeably, collaborating, supervision. But it makes a huge difference. especially, and, thinking about, yeah, I'm being a little selfish, I wanna hook up my buddies, they're, and I'm trying to figure out ways they could break in.
And so this is helpful knowing the different ways to do so, and kind of the terminology to do so. I'm gonna tell 'em to listen to this. So Brian and really if you're listening to this. Yeah, these questions are for you. so, one other question I had too is, flipping the question a bit is, doctors, physicians, we could get licensed all 51 states, not easily, but available, [00:23:00] right?
I could hire somebody and boom, six months later. Is that possible? in the PA world or is there, you know, 'cause in some states, NPS can't do that. Right? there's not a 51 licensed NP out there. I know there's some states they just can't do for some reason or other, I'm blanking on why.
But is that possible to do in the PA world?
I mean, you can license. In any state that you want to license, as long as you're following that board's instructions. Able to do that, whether or not you can open a practice, own a business in that state's a whole nother ballgame.
Yeah. And there's some states where I think there's some scope limitations in some strict states where the nps.
Either there's supervisory kind of requirements where it's just not scalable. So a lot of platforms don't use NPS in certain states. and
they probably can't prescribe,
there's always gonna be some little
limitation .
Every
state's different. Like there are actually some states that are like really, really, really PA friendly. Yeah. Where it basically says like. Your scope is [00:24:00] actually the same as a doctor. So like, there are some of those. it heavily depends. So the big thing is, you just need to understand like what your rules are.
But I mean, I've probably told you guys this, like this is actually the easy part. So everyone thinks this is like the hardest part of starting a private practice. this is the one that everybody focuses on because it's so tangible, all people in clinical world think of like there's this step by step process and at the very end of this, I'm gonna have a business and it's gonna be great.
And so it's actually the easy part to get this done once you crack the code, most people just don't speak this language. The harder part is, to their point, figuring out their why and getting over that mental hurdle to just like, I'm doing this because, oh my gosh, I cannot work for this clinic anymore.
Figuring out the website. Flexing these skills that you never thought you'd have to try and giving it a shot. Before you joined Leo, we were saying, Christina's gonna teach us TikTok 'cause [00:25:00] none of us can figure it out. Right. Oh gosh. These are all the things that it's as much as, I joke 'cause I always try to, keep things light and fun, but to me it's like it's this whole different journey that you guys are on.
It's this whole process of learning and trying and. it's kind of fun, you know, if you take like this scary part of like, how do I find patients out of the brain.
Well, in my experience, figuring out my why is really what motivates me because in my opinion, I don't think this journey would be successful without having. That, true North Mission because it's scary. Like you have to take some leaps and learn things you have never been taught at all and, try things and get feedback that maybe is negative and pivot and figure it out.
So in my mind figuring out your why and what you're going to [00:26:00] serve is probably the most important thing before anything else, because that is what will remind you when you wake up at two o'clock in the morning panicking about something. Remember, this is why I'm doing this, and there is a bigger mission here.
And It's okay. It'll take time, but it's worth it.
And the startup is only a startup one time.
We only have to do this part one time
for the most part unless You Wanna expand. And so that's what really is motivating me, that if I figure all of this out now and we can get the hang of it, the rest is easy.
Really. The rest I know how to do the rest. I spent six years of school in so.
I mentor a lot of PA students and I tell them all the time, write your mission statement. Like not the one, like the personal statement that you had to go into school. I'm like, write your mission statement and as long as you're like, my mission statement for my company now is still what I did before.
Like it's changed. based [00:27:00] off of my knowledge, but it's still the same baseline. And I think if you know your mission, just kind of like piggyback off of what Ashlyn said, then that's gonna be able to get you through where you're at now and take you to continually grow on your journey
and you'll make mistakes and that's okay.
Totally. Okay.
and we've talked about this before, right? You know, in the medical community, it's just we're trained not to make. Right? Mm-hmm. We're expected to bat a hundred percent, right? Yeah. You, you make a mistake in the medical community, well, maybe you lose somebody, and it's ingrained in us to, plan, so you don't make those mistakes.
But now in the business world, you know, it's totally different, right? It's expected to make mistakes. This whole, oh, you know, we could fix it later, or we're gonna try this out. If it doesn't work, then okay, then we'll pivot. It's just so strange at least to me, it's just like, it's one of the biggest things that I had to get over.
it just felt super unnatural and super uncomfortable, [00:28:00] so, no, I totally agree.
Yeah, that's been an interesting kind of observation for me. Like working with so many clinicians is like I'm the risk adverse one, right? Like compliance,
And I'm telling you guys to take some risks and to like, it doesn't have to be perfect, you know? It is interesting though because, I would be curious kind of like how you guys each have seen yourself evolve over the last. Six or so months, like from the shift of how you were as a clinician, but now moving into the entrepreneurial mindset.
I am, I'm trying. Katie's gonna put me in my place right now. I am trying to be actually more laid back about things. It's very challenging. But I came into this, like, in the clinic world, I wanted things to run my way, like the schedule the way that I saw patients, everything.
And during this transition, I have made an effort to take a step back and be a little bit more [00:29:00] flexible and just kinda let things fall into place. There are certain things that I can't let go of, but for the most part, like I'm doing my best at turn the clinic brain off of it must go this way and be more open-minded as to, you know what, that's not a battle that like whatever happens with that, I'm okay with that because.
We have so many more battles now than we did when we were just seeing 15, 18 patients a day like that was a set number, and you can encounter so many more different nuanced problems, so you can't fight the way that you used to. I don't know if you would agree with that.
Yeah. It's just, you learn and you pivot.
And that's all you have to do. and I didn't go to school for this. I was not in business school. I actually, interesting story. My husband went to business school and after he graduated, I told him, we're not starting a business, we're not gonna do this. And then here I am.
Seven years later
in your [00:30:00] blood.
Yeah. He's a little heated about that. But, all in all, it's. Practice and finding the support from people that you can trust on the things that you don't know. 'cause you don't know what you don't know. And I think that's the first wall that you come into when you step into this world is, oh my gosh, this is not what I anticipated.
So find those people that you can trust and you can get advice from, and it saves you. A lot of sleep time.
Yeah. from my perspective, I think the moment I stopped thinking that there was a destination oh, I'm gonna do this thing and then the business is gonna be here, I'm gonna do this other thing, and then the business is gonna be launched and I'm gonna find peace and I'm gonna be, when I finally took a step back and realized this is life, like life is actually me, that I get to do this, and like, oh my gosh,
I get to try this thing and learn this different thing, and so it was almost like I just approach every day as like some baby steps forward versus thinking about like [00:31:00] racing to get there. It like automatically just like kind of, makes you feel like you can like have some stuff off of your shoulders a little bit, but I think that also comes with like.
You know, I've made what, 47,000 mistakes and pivots and adjustments
at this time .
I
think the biggest thing for myself, since we talked about TikTok earlier, I was always one, I've been a private person and kind of put in things I'm like, I put out there what I wanna put out there. Like even on my personal social media accounts, that's always how I've been. But being on this entrepreneur side, I'm like, okay, you have this knowledge.
You're saying you want it to go out across the us, put it out there. Going on a video and I'm like, okay, let me put myself out here. Thank you for inviting me to this podcast. But even that was a struggle for me at times, where I'm like, okay, just go do it. You don't have to be perfect in that sense.
So that's where I would say I have evolved and being more comfortable within those spaces. I don't know why I can go give a lecture, but [00:32:00] going up on camera for things like this and I'm like, I kind of freeze up. Am I awkward? Am I this? But it's just about getting the information out there.
You know, imposter syndrome is real, right?
Like mm-hmm. still struggle with it, but especially the, you know, medical provider entrepreneur kind of role, right? Like you said, we've never, where was that curriculum when we were going through school? There wasn't, right. So stepping into this role, I think we naturally are like,
I don't know if I'm made for this. Who's gonna listen to me? Like, You know, what authority do I have to do this? 'cause Well, I'm just medical, I use that a lot of excuse too. But, you know, I'm just medical. But no, you're more than that, right?
Going through the medical training you've had, you've realized that, you know, you're, you're pretty damn smart. And we could adapt right? And learn things on the fly and faster. We were trained to do that. We were trained to actually pivot. It is just a matter of just believing [00:33:00] that we can.
So,
no offense Katie, but one of the reasons why I, really wanted to partner with PAs and why, I really enjoy working with so many PAs is because PAs are just. So much more independent than most other clinicians. Like I'm not a pa I don't know what you guys did in school and how your training was, but you know, something in each of you is like, I'm gonna take the reins of this and I just need somebody to teach me.
And like, show me. Mm-hmm. And so it's been, you know, for me, part of the fun part of working with PAs is one, you guys make my life really easy. but also like, no, there's honestly nobody out there that really wants to help you. nps have some, really good lobbyists and are really pushing forward on the business education and how to do all this.
I mean, to me, I can't help but think it's like some weird, we don't want PAs to go do this because it kind of conflicts with physicians and the whole thing.
Well, I think it goes back to how it was structured
in the first place .
Yeah.
Right. I think [00:34:00] the different boards, it makes a big difference.
'cause when I was talking to my buddies, it's like, Hey, why don't you guys just do this? They're like, well, your medical board won't allow me to. Right. And they're like, oh yeah, that's right. You're under, the board of medicine where, you have these decision leaders that historically, Are meant to control. And this is a generalization, but you get the idea, it's just that's how it was structured. So breaking away from that structure, and I think we need to because you mentioned it the paucity of medical care out there, necessitates the expansion of care
absolutely. I keep thinking about the imposter syndrome 'cause that's such a very real thing. But I think the other side of that is I think I kind of had maybe the opposite experience that you had. Savannah, like I went from feeling really powerless and. not feeling like I wasn't doing good work, and I had no say at all to now when I think about it, I'm like, [00:35:00] I built my website, I created this business structure.
I negotiated these contracts. I created my whole model and put everything together. And now that The patients are starting to pick up again. I have this renewed sense of fulfillment that, I'm able to really practice medicine again and not under, somebody else's priorities.
And not in a really broken system, but in a way that makes sense for me and my patients. So, I probably work more now for each individual patient than I did before because I have that renewed passion and I feel like my cup is full again. And so I love that I have new skills.
I'm gonna keep learning new skills 'cause I have a lot to learn. But that's really cool. I'm glad that, you know, we all did this on our own instead of hiring somebody and paying so much money just to have an end [00:36:00] product. But now You know, we have all these badass skills. Like that is awesome.
And I wanna add to that too. I wish that I saw more community like ours. But whenever I go online, there's like a group. I don't wanna name the group, but there's a group. And whenever somebody asks a question anonymously they ask like, how are other people doing this? Why am I not finding the answers?
Why is nobody coming forward? I just replied, not a honestly. I said, go check out ipac. I don't even know how, you know, actually it was SERMO and it was you, Ashlyn, you were posting on Sermo. And that's how I found out about ipac and that's how I went into the drawing.
It happened to fall in a place where we were whispering, can we even do this? I don't know how we would do this, and you can probably do this. Can I do this? I don't know. Like we did, we had no idea. And Then I found ipac and I'm just grateful that this community like welcomed me and was like, Hey, we can do this [00:37:00] together.
We can troubleshoot everything together. I think that's unique and I am more than happy to welcome other people into this and share everything that we've learned, but I think whatever secrets are out there, people are like keeping them themselves and I don't really know why.
That's the same thing that I noticed, and I know everybody else kind of knows my story in this. I tried to partner with pediatricians at first. I love the collaborative approach. That's why I became a pa, and I kind of had gave up because I would get to that point where they're like, oh, yes, let's go through with it and then fall back.
So I had the vision. I'm like, let's do it. The community needs it. Everybody sees that the community needs it. Why are we stopping? Is it because I'm a pa? what's going on? And so I kind of had gave up in a sense. It wasn't long, it was maybe five days, and I found ipac and I was like, let me just check this out.
And it was the best thing that I could have ever done. This practice would not [00:38:00] be open if it wasn't for me. Joining ipac.
I'm gonna ask a question.
What is ipac ? ? And If people want to figure that out how do they get there?
If you are looking for a PA community that's what IPAC can be for you.
If you're looking to be, what I affectionately call a healthcare disruptor, somebody looking to shake things up a little bit. Definitely the independent PA collective is for you.
Got it. The independent pa, or it's the independent ppac.com, right?
All one word. Right. I'm looking at the website. I think that's,
you're at the website I don't
even
remember what the website is
independent ppac com. Just FYI your website. no, but I'm gonna, exclamation point, the whole idea of the community, I think it's huge. It's important. And there's a lot of communities out there, but finding community, which, share your values and cheer yourself on, and, just further, the group is key.
So I'm super stoked to know that there's a community out there that the PAs could go and be a [00:39:00] part of, and really just, go through the struggle with each other, but also bounce ideas off each other. why think with one brain when you can think with a collective brain, right?
So,
yeah. Well, no, and to Savannah's point, I think with PAs, one of the reasons why people don't wanna share information is they pay a lot of money for it. So like, the only way they're getting this and one of the reasons why, been so passionate about the PA side and how, Ashlyn and I launched, IPAC together.
Was because I was talking to other PAs and they were paying 15, $20,000 for this. I mean, if I pay 15 and $20,000, I don't wanna give my secrets away. So it's this interesting kind of dynamic where nobody wanted to share the information that honestly, now that you guys have been through it.
it's tedious, but it's possible, you know, it's not $20,000 worth, but you were able to do it. And so I think part of the problem is that, and again, that's why we started this where it should not cost an arm and a leg for you all to be able [00:40:00] to even figure out if you can start a business and for you to feel stuck in a crappy environment and system when we need providers.
we should be empowering you guys, not making it hard for you to provide care We are so desperately need you.
and information's not proprietary. it's funny that way. it's great to have a community so you could pull the information faster, quicker.
And again, you know, use the collective versus not, but Right. So it's always been kind of a funny thing to me. When, like it becomes super, super exclusive right? And becomes
prohibitory
the thing that I love is that they're like, Phoebe's been really amazing at bringing different experts in.
So you're getting a lot of different perspectives on things. so. Really kind of, no matter where we were in our journey, there was something for each of us. And it's been really cool to get everybody's, you know, different perspectives, these different mentors and experts out there. And then of course, [00:41:00] Phoebe's expertise on her own.
it's a place where you can come and ask the really weird questions. Go ahead, ask the tough questions. I don't remember which week it was, but Christina, I remember I was having a really hard time and I remember you were saying I was just where you were just a little while ago and just hang on 'cause it will get better and heck yeah, it did get better.
And That community of knowing, like you get it, and I can come to this place and say, this is a really hard time throughout this process, and get that encouragement, not just, yeah, sure you can do it, but like somebody who really understands. I don't know. Another place where PAs can get that.
That's invaluable. So come ask your weird questions. Ask your crazy questions. Come be a part of the community. Like we're, we're here for it.
We're also all friends now. So part of it, talk not pa stuff. We talk random [00:42:00] stuff. Like we're all humans at the end of the day too, and it's like, I think the really cool thing is the thing I love seeing in, you know, our little space is like, yeah, we're sharing different ideas.
Like, hey, like I saw this really cool Instagram post. You should do something like this 'cause this is in your scope and makes sense for your audience. Or have you listened to this podcast? I think you'd be really, you should listen to it or go take this course. Like they share there is no, this is my information or your information or secrets.
I think my favorite session that we honestly did together where it was like everybody just like brainstormed their pricing. And again, you have people offering the same kind of services, like in a traditional setting, you'd be like, that's my competitor. I'm not sharing. And it's like, oh, that's your pricing.
Okay. That's cool. What's the feedback you're getting? I mean, to me, like that's the beautiful part of, what I said earlier, that's like the cool part of going through this whole journey is like, through this, you're gonna try things and it's hard enough to stay motivated because it's just so hard.[00:43:00]
But having people, keep you you know, like to Ashlyn's point on Christina, you got this, you get through it, it'll get better. And it's interesting because honestly, every week we're getting new people join. So it's nice 'cause you guys are like now like OGs like the veterans, so you're coming out with all, we got it.
We're also starting to think about how we can expand it, right? Like we have a lot of people, and I don't wanna speak for you Ashlyn, but like Ashlyn does so much in the lifestyle medicine space, that there's other PAs that are like, well, can you teach me? And it's like, well maybe we can build a little community around Ashlyn.
And Ashlyn could actually even go educate further and it could just be like PA supporting PAs.
Yes. Love it. I love anything that we can give back to the community. I'm all for it. you know me, I love education. I've been doing that basically as long as I've been practicing. But yeah, that's the true, I got so much just from chatting with people in the community that they suddenly were saying, wait, [00:44:00] how did you do that?
What's the process? Can you tell me a little bit about it? How does that differ between this and this? And just learning from each other. yeah, you never know. It'll spark an idea.
I know. That's huge. That's huge.
Yeah. I'm all in with ipac, so any, yeah,
we have fun obviously.
So unfortunately our time's coming kind of to an end.
Last question. So you see little baby PAs out there. What's your number one kind of advice. that you could give 'em to kind of just get 'em going to get 'em to where you guys are at and, get 'em going, basically
in general, or entrepreneurship.
Oh, this is an open question.
Open.
Yeah.
Either or. You decide,
oh, I'm in education. So I feel like you have all the
babies.
You know what I'll say? I'll say to the, because this just kind of hits home right now. I missed you guys this week. We had the ice storm and it has been [00:45:00] insanity here. my kids for the fourth day in a row did not go to school.
This today. It was canceled. so just insanity. I feel like I'm back in my COVID days attempting to work with a crazy, so what I would say. To all the students is all of the hardships you're going through right now in your courses are very applicable to clinic life, are very applicable to entrepreneur life.
It is building to that point. If we get canceled for weather, guess what? You're gonna have 55 patients canceled for weather and it doesn't matter in what setting. And so I would just say that this incredibly tough point in your life, and whether you're in school or you are just new grad and you're figuring it all out, all these hardships are making you, the pa that is going to, you're gonna look back and be so proud of every single milestone and hardship that you went through.
I would have two things to say. I already talked about the mission statement. Find why you do this, why you became a pa, what you're doing, [00:46:00] and it will be able to take you through your journey no matter what you're doing. But then my second thing would be to find balance. No matter where you're at, where you're in school, or you are just becoming a pa.
Because a lot of the times when you go. From that transition, nobody prepares you to graduate and then get your first job, and so then you're just like, I'll take anything. And then you become just so engulfed in whatever you're doing at that time because you kind of will take anything, like I said. So being able to say, I still need this balance, and knowing my work within it.
And I think we all have a similar vein about finding your why, so I won't talk about that one again. but I think I'm gonna give two pieces of advice as well. One is, just a good general rule that no is a complete sentence. So when you're going through. Your professional life and everything, they're gonna come up with situations that don't feel right or, you know, you need to put a boundary out.
So being able to, [00:47:00] especially, unfortunately females have a hard time with this, I think, but just being able to stand up and just say, no. And when that pushback comes, understanding that it's okay to just say no. And the other piece of it, the one that kind of launched me into this whole journey wasa piece of advice that I heard, which was that you are only indispensable to your loved one.
And that made me really think about where my priorities were and that I was pouring so much of myself into work who could replace me tomorrow. So really remembering where you're irreplaceable and keeping that as your priority and where you put your energy.
I like that one. I like that one.
Especially
Leo. Can I add one?
Oh, yes, yes, yes.
And I would say, and to all of you too, to everybody we all have a really little voice in our head that sometimes does not say the nicest things. And so it's [00:48:00] be kind to yourself and just remember to give yourself some grace. That's all.
Yes,
I love it.
I tell my kids that every day, like, you gotta be kind and you gotta give yourself grace. I wish more people did it.
Well, hey, thank you for taking your time. This is amazing. And, I love seeing the community. Again, it's reach out, right? You all join the community. It sounds like, you guys have something great.
So it's refreshing to see. Yeah. And again, hey, thank you for listening. if you want to reach out to Phoebe and I, it's leo@telemedicinetax.com. phoebe@telemedicinetax.com. Or info@telemedicinetalks.com and we'll see you again next time. Mahalo.