Podcast

Ep 11: Opening and Scaling a TMS Practice with Dr. Kalyan Dandala of DAN MED TMS

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Ep 11: Opening and Scaling a TMS Practice with Dr. Kalyan Dandala of DAN MED TMS
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About Dr. Kalyan Dandala:

Dr. Kalyan Dandala is passionate about changing the status quo for psychiatric care. He has been a leader in TMS Treatment in The Nation and is a Clinical Consultant for the most preferred TMS system by physicians: Magventure. His goal is to make TMS available to as many people as possible and was the first Physician in Washington State to make it available to Medicare and Medicaid patients. He continues to work with the National Clinical TMS Society to expand TMS treatments to pain, addiction, dementia, autism and other diseases on top of depression and anxiety.


Dr. Kalyan Dandala is a Diplomat of the American Board of Psychiatry and Neurology. He has several publications and is a member of the American Medical Association, American Psychiatric Association, American Society of Addiction Medicine, American Academy of Addiction Psychiatry and the Clinical TMS Society.

Interested in connecting with Dr. Dandala? Reach him on LinkedIn.

Learn more about his TMS practice at https://danmedtms.com/.

The Newest Standard of Care In Psychiatry

There’s a lack of awareness for TMS right now, because big pharma has a lot of money throw at a new antidepressant or whatever that comes out. What they spend in a weekend, device companies like TMS spend in a year, right?

So a lot of physicians that are mental health providers, don’t really know or understand TMS — what the indications are. And most patients don’t know about it, right? So I think anything that will help elevate the game to say, all right, the standard of care is med management, but you know what?

The new standard of care is interventional psychiatry with TMS. As long as we can help other practices do it, all boats rise with the tide. So it’s a win-win.

Psychiatry Is Moving Past Basic Med Management

What I’ve quickly realized is anyone can go ahead and do med management, right? The typical Prozac, Zoloft and whatnot. And so I was like, okay, my own brother, sister, mother, if they had depression, anxiety, and they went to Stanford, Hopkins, Mayo, the creme de la creme, what would they get? TMS kept coming up.

And I interacted with a group that did TMS and it just felt like a great fit. It’s the next generation of treatment and more and more you see it. It is that — it’s the future of psychiatry. It’s interventional treatment without being invasive. So we’re going to get more and more indications. And I think there’s a lot of growth here for the next generation or so into TMS for psychiatry.

Pre-Launch Marketing For Private Practices w/ No Budget

We didn’t have the luxury of a marketing budget and we still don’t,  to be bluntly honest. I wish we could spend the marketing dollars that we want to drive patients to us.

I think at some point in time we will. So we had really a lot of organic growth — ensuring that the insurance companies knew what our new addresses were because patients find you on the insurance company. It was really boots on the ground effort to actually go ahead and email the contacts that I had locally in the area, set up meetings and have them, let them know that we’re opening up a clinic at such and such date, inviting them to an open house.

And letting the referring doctors know when your launch date is, what you’re really focused on what you treat and ensuring that they have enough volume and spending a little bit of time and resources on that.

The Toughest Part of Starting a Private Practice

When you’re taking on the role of saying, “I’m going to start my own practice”, you are the physician. You’re the part-time marketing guy. You’re the CEO, you’re the CFO. You’re everything right? You’re a jack of all trades master of none. So I think the most important thing is to surround yourself with a team that’s good at what they do, and you do what you do best. Right?

So I had a couple of folks that are very good on the phone with prior authorizations, back office stuff and saying, “we know how to talk to patients to get them the right information to get them to care”. So I think surrounding yourself with the right team is really important, ensuring obviously that you know what your bottom line costs are for, how much is my rent going to be, and what am I going to spend on my overhead for the phone, to my internet. Blah, blah, blah.

So you have to take all those into factor and go, how can I start, what’s my budget to start and budget that out. And go, okay, how much money am I going to burn through for a month, three months, six months? And when are we going to start being profitable? All of these are things that you have to take into account, but the ideal scenarios never happen.

Transcript

Hey everyone, Omar,  your host for journey to private practice. I’m joined by another fantastic guest. Somebody that you know has come up on LinkedIn and social media because of his thought leadership when it comes to, uh, TMS specifically in the private practice setting.

And that’s Dr. Kalyan Dandala. Thanks for joining us. How are you doing today? 

Thanks so much. Thanks for having me here. I’m doing great. 

Absolutely. Now first, I guess a congratulations do. Cause I believe you guys just opened your third clinic, correct? 

Yeah, we’re very excited about that. Uh, hobbyists early 2020 was not friendly to us.

It was a large, uh, it was a long, hard road, but uh, we have a very dedicated team. Um, Very fortunate to have the team that I have up in Seattle. And, uh, yeah, we were able to endure through uh COVID and we did not close a single day. We stayed open for our patients. That was the low level of dedication of our team too.

So, um, and we’re fortunate enough to be where we are and opening our third location now. 

Absolutely. And that’s fantastic. And it’s such a great success story because I know so many physicians, the culture of medicine is to stay independent and have your own practice. In my opinion, you know, care is much better and that the data even shows offs are lower.

And I think the quality of care is also better, but, you know, getting to this point, there has to be some kind of journey. So first question for you, what’s your origin story? Like how did you get into medicine? Yeah, good question. So, um, well, you know, I grew up in Michigan’s Midwest and went to college out in Arizona and I think, you know, medicine’s always been in the background of my mind right.

Of what I wanted to do. And, uh, it was just exciting for me, both from like loving biology and saying, okay, Helping people will be a great thing. Right. And, uh, I’m not going to lie being of Indian origin. That was a big expectation too, in the Indian community. You’re either going to be a doctor or an engineer.

And so, you know, doctors seem more fun to me. And so going down that route, you know, um, I really was going to go surgery or psychiatry. The two fields that I really liked, you know, uh, doing rotations and whatnot. Um, I really enjoyed psychiatry a lot because of the transformative changes that you could really make in people’s lives pretty quickly.

Uh, so I ran a detox and rehab center after. Uh, doing a fellowship in addiction, psychiatry at university of Washington school notes. And, and, uh, did that for about 10 years and realized a lot of my patients were relapsed and due to depression, anxiety, uh, partnered up, uh, with some outpatient clinics as a partner.

What I’ve quickly realized is anyone can go ahead and do med management, right? The typical Prozac, Zoloft and whatnot. And so I was like, okay, my own brother, sister, mother, if they had depression, anxiety, and they went to Stanford, Hopkins, Mayo, the creme de la creme, what would they get? TMS kept coming up.

And I interacted with a group that did TMS and it just felt like a great fit. It’s the next generation of treatment and more and more you see it. It is that — it’s the future of psychiatry. It’s interventional treatment without being invasive. So we’re going to get more and more indications.

And I think there’s a lot of growth here for the next generation or so into TMS for psychiatry.

 Absolutely. And I think, you know, the effects and impacts that will have on patients, it’s going to be so huge just because you find a technological intervention at events, going to the route of, you know, patient and drug, anything which has own thing.

And of course that increases cost to healthcare systems. So I think, you know, the future of medicine is really about the prediction and intervention early on. And I think, especially given COVID, I know there’s all this money thrown at COVID relief, something that I didn’t see a whole lot of. What about.

You know, COVID relates specifically for mental health. Right, right, right. Absolutely. I think we for, I don’t know how best to say it, but it seems like, you know, there’s. It w the right thing was to hyper-focus on COVID. I get that from a, my gosh pandemic standpoint. But, uh, I think now that we see a light at the end of the tunnel, when we got the vaccines out and the cases are going down, we do need to address what we neglected is all the mental health ramifications that the lockdowns, the pandemic that put on everyone across the board.

And so we do need to address that, and I think there needs to be some focus on mental health now. Absolutely so quick shifts. So, you know, with press credit, magnetic stimulation, it’s it’s hands dabbling, technologically advanced form to treat anxiety and depression. And. Again, in my opinion, this is best in a private practice setting.

I just, because of some nature that therapy and everything, and, you know, customer experiences is unrivaled in a practice setting versus a lot of them. But you just opened your third clinic. What was it like opening your first clinic and what was that transition like? Yeah, no. A good question. So I think I had the fortune of almost beta testing when I was a partner with four other clinics.

We did TMS and we grew it to the largest TMS center in Washington. I did, uh, within like a matter of nine months, I felt like we had to really focal eyes on just. TMS as a, uh, entity. And that’s why the team that I built, we regrouped rebranded and we opened up two centers and July, 2019, probably the worst year to start a startup, but, you know, knock on wood.

We survived through, you know, nobody predicted, uh, So they didn’t whatnot. So, um, it was very exciting actually, because the team was well from, uh, that I, you know, they’re well prepped for what we wanted to do, our mission, our vision, to say we’re going to be the front Delta prime of interventional, uh, psychiatry in the Seattle area.

And we’re going to keep doing that. We’re going to help. Other practices that don’t have this operationalized TMS. So our next goal is to help a, uh, med management addiction center, operationalized team, as in Arizona, right now, we are doing that for an entity that did primarily, that does primarily therapy.

So we’re adding on a little bit management, but DMS is a focus to help the therapist to go. Here’s an additional resource to get that wrap around level of care for that patient. 

That’s fascinating. And you said something very interesting. I have to go back and dig into, but sure. You mentioned that you’d started this group.

With the mission and vision of being the creme de LA creme, like we’re going to be the best at it. And then we’re also going to teach others how to do this as well. That correct? Yeah. So I, a hundred percent agree with that. That goes against the grain of like usual practice. Private practice is like, oh, be really good, but don’t share the secret software.

Why, why this kind of growth mentality? Like what made you think about this? 

I think it’s, well, you know, There’s plenty of work to be done. Uh, in the nation, there’s not a shortage of people with depression, anxiety, right? So it’s, it’s not for a lack of business. There’s a lack of awareness for TMS right now, because big pharma has a lot of money throw at a new antidepressant or whatever that comes out. What they spend in a weekend, device companies like TMS spend in a year, right?

So a lot of physicians that are mental health providers, don’t really know or understand TMS — what the indications are. And most patients don’t know about it, right? So I think anything that will help elevate the game to say, all right, the standard of care is med management, but you know what?

The new standard of care is interventional psychiatry with TMS. As long as we can help other practices do it, all boats rise with the tide. So it’s a win-win.

Absolutely I a hundred percent agree. I mean, E I have that same marketing philosophy. When it comes to a med device, which is the world I come from because there’s no shortage.

And plus in a way you’re kind of powering and teaching others how to market the problem and the solution to the problem. And at that point, people decide, well, okay, I know about this problem. I know the solution. Well, who’s the best thought leader for this and it it’s no wonder why you guys focused on Seattle.

And now you just opened your third clinic in Newport, California. 

Yeah. Yeah, no, absolutely. I think we’re not region dependent. Of course. I want to do more de Novo centers in Washington. I think Seattle is a very underserved area for mental health. So that’s my. I guess the, or, uh, where my family is and whatnot.

So I do want to provide that community a lot more with, uh, more centers. And we are looking into a third center up in Seattle, uh, by end of year, maybe a fourth. Uh God-willing. And to reach out to as many folks as we can, but I’m not reading dependent. If there’s an opportunity to work in the Midwest east coast with a doctor that.

Wants us to help them operationalize TMS. That’s fine. If there’s someone in Israel that wants to help, that wants us to help them operationally team, I, the world is global. I mean, you know, I think we have to think very globally right now and not so much nationally. And, uh, the more we help our fellow human beings, wherever they are, it’s a win.

Absolutely. Absolutely. So when you first started, you know, uh, your, your very first clinic aside from. Really pointing out a mission, a vision, again, like what’s the aspirational goal. We’re going to go after from an operational standpoint, what was your first order of visit? Was it finding capital to invest in the technology?

Was it looking for a building? Like how, what, what’s the easiest step? Because a lot of physicians were listened to as psychiatrist or not who want to follow your spirit of steps, but they just don’t know where to start and how. 

Oh, gosh, you know, I opened a can of worms there. 

It’s a daunting question because it’s very overwhelming, right?

It’s multifaceted. When you’re taking on the role of saying, “I’m going to start my own practice”, you are the physician. You’re the part-time marketing guy. You’re the CEO, you’re the CFO. You’re everything right? You’re a jack of all trades master of none. So I think the most important thing is to surround yourself with a team that’s good at what they do, and you do what you do best. Right? So I had a couple of folks that are very good on the phone with prior authorizations, back office stuff and saying, “we know how to talk to patients to get them the right information to get them to care”. So I think surrounding yourself with the right team is really important, ensuring obviously that you know what your bottom line costs are for:

how much is my rent going to be, and what am I going to spend on my overhead for the phone, to my internet. Blah, blah, blah. So you have to take all those into factor and go, how can I start, what’s my budget to start and budget that out. And go, okay, how much money am I going to burn through for a month, three months, six months?

And when are we going to start being profitable? All of these are things that you have to take into account, but the ideal scenarios never happen. There’s always a, uh, that happened, you know, for example, we lost several buildings, uh, that we wanted to rent because one didn’t want a medical practice in them.

So. You’re going to come with challenges, whatever you think your timeline is, it’s always going to get changed. Shifted. Uh, there was, there was definitely a lot of challenges. Got it. So it sounds like aside from, you know, first step is understanding like your, your goal and your mission and understanding what you’re going to stand for and how you’re going to do it.

Finding a facility of course, is, is important. And I agree with you, you know, it should be an easy lift, something where it’s like maybe a short-term lease just to. Validate the idea kind of like a minimally viable product as they say here in the startup world. But after that, the next step is of course, like what technology you go to.

And of course everyone has their bias, you know? So you, you, you can mention the technology you prefer. That’s fine. But how do you evaluate the technology to invest in, and then what was the financing like? You know, like how did you, how did you think about that? Yeah, not everybody has three, 400 grand in cash to buy it if you buy a machine.

Absolutely. Absolutely. So, um, there’s about, uh, there’s a handful of TMS manufacturing devices, and some of them look nicer, some of them are more modular to use and you go, okay. Uh, what’s my volume going to be. And the part of it is not even the expense of the machine. There’s certain companies that, uh, that will have a per treatment cost.

And that really. Consumes a lot of your, um, profits. And so it makes it less viable to treat Medicare and Medicaid patients that, uh, we get reimbursed less. So we kind of pick the one that was the leader to say, okay, this is the most cost efficient way to do it. Um, So we’re going to switch over to that.

And we did switch over that after going with the more expensive, easier to use device, too. I wouldn’t say this device is not as easy, but once you get the hang of it, uh, it’s not bad. It’s like going from an iPhone to an Android, right? A little bit of changes. You get used to it and go, oh, I love the Android now, you know, after you’re done with the ease of the iPhone and then, uh, luckily good relationship with banking, um, partner, a buddy of mine that is, uh, and so he was able to get us a good line of credit, uh, with reasonable terms.

And so we can go ahead and, uh, service our debt in a very controlled way. Well, we’re wrapping up. 

Got it, got it. And, you know, One of the things is this question about volume. It’s always hard to gauge. What were the, you know, more of the metrics that you kind of look to to figure out like more or less he never predicted, but what did you use to kind of, you know, separate the signal from the noise and say, you know, I’m pretty confident that conservatively, this is what the volume could look like and that this is how it translates to me financing the technology and the space that we’re going to be doing it.

I wish I was that savvy business guy. You got to take a leap of faith, I think, you know, and go, okay, there’s enough people with mental health issues. There’s enough people with depression. I know they’re going to come through the door. So, uh, did I noodle out all the numbers as best as I should. Probably not, you know, um, knowing what I know from when operationalized it, when I was a minority partner at other clinics, I go, okay, I know enough patients will come along.

I know, um, I have enough Goodwill in the community now with my name doing TMS that, um, I ensured that, um, for example, the director of behavioral health at valley medical center, which is by a rent, an office, had a good conversation with him to make sure all the TMS patients from their practice come to us because they weren’t doing it internally.

So ensuring that we were going to get the volume to say sustainable. 

Uh, and that makes complete sense. I think it’s a much easier lift. Uh, if you were say a psychiatrist who’s already in private practices, you can just add it’s an add on to your core business, but if you don’t have a private practice and you’re looking to make that leap, you have to take that leap at some point, you’ll never have enough numbers to make you feel fully comfortable, but tell us, you know, again, my, one of my favorite topics is marketing, but tell us about some of the things, you know, strategies and tactics you use to.

Ensure that as you took faculty, the faculty paid the kind, had a soft landing. So you mentioned, uh, talking to, uh, uh, sort of local local providers. What did, what did that look like from a marketing standpoint? Both. I get to say, you can say traditional and digital. Yeah. Um, you know, we, 

We didn’t have the luxury of a marketing budget and we still don’t,  to be bluntly honest. I wish we could spend the marketing dollars that we want to drive patients to us.

I think at some point in time we will. So we had really a lot of organic growth — ensuring that the insurance companies knew what our new addresses were because patients find you on the insurance company. It was really boots on the ground effort to actually go ahead and email the contacts that I had locally in the area, set up meetings and have them, let them know that we’re opening up a clinic at such and such date, inviting them to an open house.

And letting the referring doctors know when your launch date is, what you’re really focused on what you treat and ensuring that they have enough volume and spending a little bit of time and resources on that. 

And that makes complete sense. And again, what’s interesting is that you say you’re not, you’re not savvy, but you, you actually are because what you just described as the same sort of process at tech companies, we’d go through.

And four o’clock just writing, which is you have your own, your date that you’re actually opening the practice, but beforehand it’s not, you know, you did some quote unquote like open houses or demos. Like people come in, you, you work with referring practices. How far in advance. Did you start doing that process back then?

And then if you were to go back and do it again, would you stay with that same amount of time or would you add more or less time? 

I think they can’t hurt you to add a little bit more time. We probably, if we launched in July, 2019, I think we started having, I started having the email conversations back in March, 2019 by April, 2019 around there.

So a good three, four months, right? At least, uh, I think the entire quarter is a good idea to. Get people prepared to say, all right, are they going to be able to attend my open house or not? You have enough lead time. Um, and it’s going to be multiple conversations too, right? Because their schedule, your schedule has to match up.

Um, and you want to meet them a couple of times to kind of reiterate what’s going on too. And it’s just not a one-time touch. It’s a continual touch. 

Absolutely. It makes it, it makes complete sense. Um, you know, when it comes to say. Dealing, you know, when, when you, when you, when you have like either a position liaison or in my opinion, the doctor actually it’s, it’s even better when the doctor does a stock to the doctor.

But when you talk to the referring practices and you mentioned that you’re doing this treatment, they should refer patients to you. Do you send over any materials, for example, to make it easier for that practice to educate their patients? What does that look like? Absolutely. So we do have our new marketing brochure that we built in-house to make it very quick and easy.

What’s the easiest way to refer, what are we treating for? So keep it as simple as possible. So usually it’ll practices that are private to, they don’t have a lot luxury of multiple staffing, like in large entities do. Right. So, uh, it’s usually the front desk person that answers phone calls for first page.

So because the doc says, Hey, can you refer patient X out for our psychiatrist? So making it very easy for that front desk staff, uh, to, uh, refer out to you as important. 

Got it now, you know, shifting a little bit. So, you know, on the growth side, what’s interesting is that, you know, once the practice starts getting some traction, right.

There’s always this question of what, you know, in any business, when do we expand at scale, right? Yeah. Because again, it’s, it’s one of those things where yeah. You could look at numbers. I, but part of it’s intuition, part of it is, uh, object objectivity. At what point did you say yourself? You know what. We have enough momentum at this one clinic.

It’s time to expand and open a second one. How did you make that decision? And then geographically, what did you decide to do. 

For me, I think it was a little different. It was more based on opportunities. I was coming towards me, uh, to a Denovo clinics are always harder. When you say I’m going to get another space at another center, the ramp up time is longer the burn rate of money as longer, so that you have to be a little bit more.

Calculative on your cash flow and what you’re doing versus, you know, the opportunity to embed TMS into an existing practice like we’re doing here and bringing wellness Institute down in Newport beach, California. That’s an easier, uh, leap because it just adds to our base of, we have baseline costs, no matter what.

So the staff to say, okay, we’re going to have additional patients. It’s just the cost of the machine and the ramp up. And the cost of the ramp up decreases, uh, uh, very significantly, uh, by doing these embedded models. So, uh, that you didn’t have to, I didn’t have to be as calculative about, um, but adding a third center of Denovo up in Washington, uh, I was waiting for a California to launch here with this embedded model, pick up an attraction, start going back home to add more centers.

And when you say, when you mentioned embedded model that’s meaning like an existing practice, you’re just adding on to the technology because a patient-based and pro basis already established. 

Correct? Exactly. Got it. 

Got it. So with, with, on the side of the technology, right, there’s there’s whether it’s TMS or any other, uh, like in practice capital equipment, there’s always this question of, we start with one machine.

Right. And sort of build, build a business from there. Or do we start with who and try and do double time with it that way we, we have, we have a quicker, quicker path to profit, you know, there’s no right answer for it, but like, what’s your, what’s your approach to that? You know, I, right now I always go single machine for location to say, we can always throw on another machine and.

Throwing, you know, at that, onto that schedule, that’s not a problem. Right? So as long as you know, the center, your end has that ability to expand. And usually even if it doesn’t guess what your landlords are willing to always give you more space for more money. So I don’t think that’s a separate issue. Um, so I started with one machine per location.

Um, again, I’m not a business guy, so am I doing all the right things? Probably not. I making a hundred, one mistakes. Probably so, um, there’s a lot of things that I think the next Genesis is that is partnering up with the right business team to streamline and say, now we can scale you, you know, you’ve done a great okay.

Part of the base, but let’s scale you now. And I don’t think I have the wherewithal to really have that level of sophistication of scaling, uh, like a seasoned business person that is, uh, educated in that field to do so. 

Got it. Got it now. So the towards where’s the tail tail end of this episode, I kind of want to ask you some sort of interesting questions and I’m going to take you a little bit back to your training days.

So it’s like you had M and M boards of morbidity and mortality. If you did, if you do the M and M approach, uh, who your private practice, like what were some. I guess painful lessons that you’ve learned and you look back and you’re like, you know, definitely gonna make sure that I don’t do that again. What were some of those, those, those pearls so that people can learn from your story and avoid making those, those, uh, pitfalls.

Oh, where to begin? This list is so long. 

That’s the first thing that comes to mind. 

Uh, I think the first thing that comes to mind is saying, okay, uh, for example, we chose a device that we thought, okay, it’ll be great for marketing because they offered X, Y, and Z. It was great for a startup, uh, when you didn’t know anything about TMS, but since we got to that point of knowing how to run our own, uh, operations for TMS internally, We didn’t need to pay the per treatment cost anymore.

And there was no value add. And yet I, I was like, okay, do I continue with this? Because my staff is comfortable using this machine. So if I were to Rigo redo it, I would probably have shifted away from them immediately more quickly to a more cost-effective model and, uh, helped with the training of staff, um, more aggressively.

And being motivated to change that new device. And so sometimes, you know, you make decisions. If you have a small game to go, gosh, my team really likes this machine, but it’s not a good financial decision. Right. So I think you have to divorce yourself a little bit. And go, okay, well, you know what numbers do count?

And so that’s what some of the things I would say is like motivate your team and have those conversations on why you’re making the switch. And especially if you have the small end of a team, they’ll either get on board or they’re like, this is not for me. And you really want the team that gets on board.

So they’re going to see you through thick and thin. 

Yeah. And I’m so happy. You mentioned that because, and again, I’m going to I’m to piss off a lot of my peers in medical devices, but I think a lot of physicians who are taking this sort of journey on it, private practice, it’s very attractive when you see that, oh, if I go this brand.

Yeah, the marketing is there. And then they give me these marketing assets in the medical device industry. And I’ve, I’ve spoken about this at conferences.  does a very poor job of actually doing marketing to patients to actually drive them to the practice. So when you open practice, like pick out the brands there.

But I’m actually seeing patients come in and have it because there’s an active role on the device manufacturer, which is not through, they, you know, they give you some chotsky marketing stuff and it’s like, good luck, 

right. You’re, you’re 110% right on this. 

I’m gonna get that a lot of really angry messages because that, but it’s true.

The fact of the matter is true. It 

is, they just don’t have the sophistication of marketing, 

like big pharma does. Yeah. And, you know, I would say even with big pharma, I mean, big pharma does there. They are very sophisticated on, very on non-branded marketing patient communities. But the, at the other side of it, I mean, they spent so much money.

I mean, you’re right. You’re, you’re actually, you’re, you’re very kind by saying that. But pharma spends in a week med device spends in a year. I would say sometimes that’s like three years now. Yeah. Yeah. 

But yeah, but you know, again, um, I want to mention this too, to the audience, your advice early, which is so true, and this goes back to good traditional, not only business, but medicine.

This is the same thing my father went through. My father is an immigrant from Iraq. When he came, when he started surgical practice. First thing he did, he went and talked to other physicians in the community for help. Right. But again, it’s not just a one phone call and that’s it. It’s a, it’s a relationship, right?

Yeah, exactly. Yeah. 

How do you continue to nurture that relationship with your referring practices? Where I guess perhaps you’re, you’re doing something that’s maybe to their benefit or something that helps them. How do you, how do you keep that behavior there? 

Yeah, it’s important that you’re helping your colleagues practice.

It’s not like you’re just looking for referrals, right? And then the day you want to be collaborative to go, okay, they’re struggling in their practice to deal with depression because of the resources they have or don’t have. And you go, how can you be an asset to their patient to ensure that, okay, you know what?

We stabilized their depression. Now they’re more compliant with their high blood pressure medications. They’re more compliant with their diabetic medications. So there’s less. The visits to the ER, the ed, and now this primary care doctor is on the outpatient side is like, ah, thank you. But patients more on cruise control.

So it’s that ensuring that, Hey, are we doing a good job or not good enough job? Are you seeing better outcomes on the medical side because of what we’re doing on the behavioral health side for you? So you want to ensure that you’re adding value to, to them and you’re. Almost taking some of the burden off of their plate too.

That’s a really interesting way of putting it. And, and I really liked that because it, it starts to put you more in the shoes of your peer and spring to see, well, the solution that I provide solves this problem, and this problem is having an impact on my peers, ability to care for this patient, because unless this gets taken care of whether those things or depression.

The compliance with, let’s say medication or all these other things is never going to be there and they keep going back. 

Yep. Exactly. 

Interesting. Yeah, no, I completely agree with that along the way, you know, and I noticed that, uh, prior to you being in practice, I think you’re, are you, you’re still in academia or not so much?

Uh, we, you know, when I was in the previous practice, I had the luxury of having a larger staff and taking on nurse practitioner, students, uh, for rotations, uh, not too proactive in that right now, just, you know, trying to get. To a baseline of growth to say, okay, now we can take, I had my goal is to get future nurse practitioners to our clinics and hopefully medical students and even residents in psychiatry.

Um, the more students that we get exposure to it’s just for the benefit. Uh, long-term. Absolutely. 

So my, my question to you is that a lot of physicians, whether they’re in training or they’re in a, in a hospital setting, um, and again, it’s no knock on anybody in academia, but people weren’t active, even they have their own bias towards academia and against let’s say private practice.

So back when you were thinking about doing this and getting started, do you have any mentors? Do you have anybody who you looked up to or inspired by and what kind of lessons do you get from them? 

Um, you mean back in academia or across the board? Even in, uh, like just starting my career and whatnot. I would say, I would say both in a and more specifically, like when you made that, you know, that leap.

Yeah, no, definitely. Um, I think my, one of my mentors is the person that gave me my first job. Uh, Richard St. Peter, he is, he was the CEO of St channel hospital at the time when I was doing my fellowship in addiction, psychiatry, and just a very dynamic personality. He was one of the guys who took Petco idea originally.

And I think he really. Uh, was a mentor in the sense that he ensured, I always bounce ideas off of him even now to go, okay, am I keeping the train on the tracks? Are there certain things that are not going well in the business side to ensure that we stay viable for our patients? And I think he was a, it was a very good, uh, confidant for me throughout the process of being able to knock ideas around.

And he very much likes a lot of things as far as what’s the latest and greatest in tech for depression, anxiety, addiction. So, you know, just bouncing this idea off of him. Uh, it was, it was great. It was a good sounding board. 

Fantastic. Darken dollar, you know, again, thanks for spending some time with us, just to kind of wrap things up.

You know, we like to do a little bit of a rapid fire at the end of these. And so I’m going to ask you some questions you can take as long as you want pantser but that’s the sooner you answer it, the faster I move to the next question. Okay. Okay. No worries. All right. So my first question to you, what was the most memorable, but painful thing someone ever told you, and how did that change your life?

Lack of patience is your biggest enemy.

And who told you that? 

Richard tells me that my significant other told me that multiple people have dealt with that. So it’s helped me a lot too. And I’m still working at it, uh, to learn patients through dealing with it, uh, as being leader of the team. Right. So I think it’s very important to have patience to slow down and think about it from other people’s perspective.

Absolutely. That’s great. I love that. All right. Next question. You know, as a, as a position, you know, continuing education is, is in our culture. It’s in our genes. Like it just does not stop. What’s a book that you have gifted most often to people. And why? 

Um, best book I can think of is Dale. Carnegie’s how to win friends and influence people.

I love that book. I know it’s dated, but it’s still very relevant for life. Forget about your career. I mean, across the board for career relationships, I think it’s a great book. If you can follow it, even if you can follow 10% of it, you’re doing great. It’s a hard book to follow. 

Oh a hundred percent. I actually had that in my bookshelf, but it’s such a classic and yeah, it’s, I, I feel like once a book, if it’s more than 30 or 40 years old, if it’s still being read, that’s a it’s it’s it’s it lasted the test of time.

So my next question to you. Is a, and my last one is, you know, there’s a lot of physicians, whether they’re in the practice and academia and residency medical students who are listening to this talk right now, and you will never know how full your words are going to be. So let’s pretend that for the next year in front of every hospital, in front of, in every major city for a whole year, there’s one billboard and every physician who’s even slightly aspiring to go on a journey to go into private practice is going to see this billboard. What message do you put on that billboard going to see?

This is a very tough one to answer. I’m sorry. Take your time. Yeah. I don’t know if I may answer for this because there’s so much to be said on that one. Billboard. Um, gosh.

how about the me? What’s the message that you put to inspire specific action, but what would you put there to inspire?

I would say if someone. W is on the fence or right now there’s a lot of consolidate. I’m going to answer this a very long winded way of calling it. So right now there’s a lot of consolidation and our in the medical industry, meaning practices being gobbled up by large entities. And now you have a bunch of, uh, for-profit nonprofit entities that, uh, your shift worker as a physician, you really are.

You’re just a. Another cog in the machine and you’re almost not human to them anymore. Right. So to the bean counters and the administrators, and I think we need to empower physicians to say, okay, you know what? You got into this field to help patients first and foremost, that’s why you got into this, right?

So you’re not. And to really empower yourself is to go back into private practice and to step away from these large entities where you’re just a number to them. Your patient is just a number you gain so much gratification saying, you know what? I am going to spend that extra hour with this patient.

Because it’s the right thing to do. And you know what, there is this toxic patient is that even though the, uh, patient satisfaction scores might not go up, I’m going to kick him out of our, her, out of my practice because they yelled and screamed at most of my staff. So you’re restricted from doing certain things like that.

If you’re a part of a large entity, but in private practice, you can take care of your team that believes in you. You can give that boutique. Wonderful level of care that you want for the, uh, patients, uh, on your terms. 

I would love that. I love that. And actually, it’s, I think it’s so much better than something that’s summed up on a Gilbert.

We’ll have to figure that out, but, you know, just to kind of share, you know, again, you know, my, my father, um, he’s retired now, but some of his friends who are in their seventies are not, and all of them started private practice and he was telling me that he’s like, you know, so until you’re never going to believe it, but they actually just joined a pro uh, a big group now, or so-and-so is now working for this hospital.

And when you, when I hear it in his voice, I can hear how sad he is about that, right? Because they’re going, they’re going into the machine and they’re losing, they’re leaving their independence, their freedom. And more importantly, they don’t get to decide how to do, to do medicine. Someone else is going to tell them.

Yep, exactly. 

I can’t think of a better way to, to, to wrap up like an episode on journey, journey to private practice, but Dr. Dell, thank you so much for joining us. I’m going to leave it in the show notes, but what’s the best way for people, uh, to, to follow you on online? What are your social handles? 

So we obviously our website, uh, www dot Dan med, tms.com.

We have a Facebook page as well. Our Twitter accounts, probably not so effective. Um, but, uh, we do have a blog that, uh, I will say we’re not doing our blog updates. Like we should, um, just focusing on. Taking care of patients. Right? So I think, uh, our website has a lot of information just objective, not even from our clinic, but it’s, you know, a.edu.gov studies on TMS.

If you want to learn, educate yourself about it. So yeah, that would be a great way to start. 

Fantastic. And I’ll leave a link also. I know you’re, you’re getting more active on LinkedIn. Love your posts there. So I’ll leave that there, but Darden Dallas, thank you so much for joining. So thank you all. There’s another episode of journey to private practice

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