Podcast Episode 81 – No More Excuses: Dauntless Entrepreneurship and Your Practice – Dr. Brook Choulet

Episode 81 -Dr. Brook Choulet is one of the only concierge psychiatrists in the US and is currently in the process of expanding her private practice to a large wellness center that offers several different wellness services. She built this practice from the ground up in less than 1 year and started it as a resident!  She’s got an incredible story and I’m excited for her to share some tips from her experience that I think will help you as you’re building or growing your own business. After hearing this episode, you are going to wonder what’s stopping you.

 

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Meet Dr. Brook Choulet!

Dr. Brook Choulet is a concierge psychiatrist and the founder of Choulet Wellness in Scottsdale, Arizona. Dr. Choulet was raised in San Diego, California, and graduated from La Jolla Country Day School. She completed a Bachelor’s Degree in Liberal Arts and her medical degree at the University of Missouri Kansas City’s rigorous six year BA/MD program. She obtained her medical degree at the age of 24 and pursued training in General Psychiatry at the University of Arizona College of Medicine Phoenix. During her residency training, she had the opportunity to learn from expert psychiatrists and carried a large panel of outpatients for 2 years. As a result, she is an excellent diagnostician as well as psychotherapist. Dr. Choulet continued her training in Child and Adolescent Psychiatry through Creighton University’s fellowship program in Phoenix, Arizona. She is currently in her last year of the program and had the honor of being nominated as Vice Chief Fellow. Following in the footsteps of her mother and grandfather, she will be a third-generation adult, child and adolescent psychiatrist. Currently, Dr. Choulet has a medical license in the state of Arizona but is also pending a medical license in the state of California.

Dr. Choulet is a member of the Arizona Medical Association, American Academy of Child and Adolescent Psychiatry, The Obesity Society, Obesity Medicine Association, Arizona Psychiatric Society, American Psychiatric Association, and American Medical Association. 

Dr. Choulet has a passion for helping others, which led her to found Choulet Wellness. She is committed to delivering the highest level of mental and physical wellness care with individualized treatment plans to promote personal growth. Dr. Choulet strives to take a concierge approach with her panel of patients. Dr. Choulet has had outpatient practice experiencing serving the community since 2018, treating Mood Disorders, Anxiety Disorders, Obsessive-Compulsive Disorder (OCD), Psychotic Disorders, Substance Use Disorders, Posttraumatic Stress Disorder (PTSD), PersonalityDisorders, Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorders (ASD). 

 

Outside of work, Dr. Choulet enjoys traveling, spending time with her family, and playing golf and tennis.

Connect to Dr. Brook Choulet

 

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Access the Show Transcript Here

No More Excuses: Dauntless Entrepreneurship And Your Practice

2021, Brent Lacey And The Scope Of Practice Podcast
The Scope of Practice Podcast

Transcript

[0:00] So I’ve never been to Stonehenge I’ve seen tons of pictures and it’s well known around the world there’s lots of myth lots of Legend I think most people would recognize the picture of those stones stacked on top of each other but nobody really understands the story.

[0:15] Everyone who has seen that giant rock formation that was built hundreds of years before the invention of heavy construction equipment has asked the same thing how did they build that.

[0:25] Well that’s the question that I asked when I heard the story of today’s podcast guest she opened up her Psychiatry practice while she was still in residency.

[0:34] That’s amazing I’ve told her story to lots of people and they always ask the same thing how did she do that.

[0:41] Well it’s not nearly the mystery that stonehenge’s which is good for us because it means that we can go to school on her success and after you hear her story you’re going to stop asking how did she do that and start saying I’m ready to do something like that to let’s kick it.

[0:56] Music.

[1:03] Welcome to the scope of practice podcast where we help busy Healthcare professionals learn to manage their businesses successfully in master their personal finances.
Now here’s your host dr. Brent Lacey.

[1:17] Hey y’all thanks so much for joining me for the scope of practice podcast where you can get the knowledge and resources you need to grow your leadership skills your business and your personal finances.
Welcome to episode 81 if you haven’t already subscribe to the podcast please be sure you go ahead and hit that subscribe button right now and also
hit the button at the top of the podcast player to turn on the automatic downloads so that way you can listen to these episodes anytime.
Anywhere even if you’re in a place like my office doesn’t have good cell phone service also hey big announcement the podcast is now eligible for CME credits.
So I’m really excited about this by popular demand I have arranged to have every podcast episode going forward to be eligible for a ma.
Pra category 1 CME credits so if you listen to every podcast episode each year you will have fulfilled.
All of your CME requirements for nearly every state so just click the link in the podcast description or go to www.desktoplearn.com / podcasts eme and you can download your CME credits for free.

[2:20] I want to remind you to sign up for the free online Summit that I’m hosting on November 15th through 17th this year called marriage and money MD.
It’s a free 3 Day online event that would give physician families the tools resources
and encouragement they need to strengthen their marriage and build wealth so they can have the happy family and financial Independence they deserve.

[2:38] Just go to www.marriageguy.com unnie m d.com or click the link in the podcast description to sign up.
It’s completely free to sign up so make sure you go ahead and sign up today and even if you can’t attend Live sign up anyway and you’ll get access to the replays of the talks for the rest of the week.

[2:54] The conference is also eligible for up to 21 category 1 CME credits so don’t miss out on getting to knock out all of your CME for the year in this one event.
Also if you want to get access to the 10-plus hours of bonus content from our speakers
plus exclusive access to join the live Q&A sessions at the end of each night with our speakers and lots more bonus content
then you can upgrade to an all-access VIP pass for just $99.
Ticket prices go up to 149 once the conference starts so upgrade today and you can take advantage of those savings.
Again the Summit is free to attend so sign up today at www.marriageguy.com EMD.com.

[3:32] Before we get into the show let’s talk about this month sponsor empath IQ.
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[4:33] My guest today is dr. Brook XU Lai
she is one of the only concierge psychiatrist in the country and is currently in the process of expanding her private practice to a large Wellness Center that offers several different Wellness Services she built this practice from the ground up in less than a year and started it.

[4:51] As a resident let me pause to let that sink in.

[4:55] She started her clinical practice as a resident I don’t know about you but I felt like I barely had time to eat and sleep in residency let alone start a clinical practice.

[5:05] She’s got an incredible story and I’m excited for her to share some tips from her experience that I think will help you as your building or growing your own business it’s going to be great.
So here is my conversation with dr. Brooke shoelace.
Hey y’all thank you so much for joining me to welcome my guest this week on the scope of practice podcast
this is the founder of XU Lai Wellness in Scottsdale Arizona dr. Brook shulay dr. Shalay thank you so much for joining us.

[5:36] Thank you for having me I’m excited to be here today well I’m really excited to dive into your story and really lets you kind of Coach us and teach us about.

[5:45] Concierge medicine and some entrepreneurial strategies to grow a business because you’ve really done this in a unique way.
And so I’m really excited to just tear you up to just you know teach us and Coach us and.
Help us learn from from you as a as a case study but I want to start with the idea of concierge practice concierge medicine in general I think there’s a lot of misnomers a lot of
about what a concierge practice actually is so can you give us an idea what does it mean to have a concierge practice or to sort of practice concierge medicine.

[6:23] Yeah definitely I think there’s a lot of misconceptions about concierge medicine
there’s so many different models that people use like in Primary Care there’s often a retainer or monthly fee where they include a package of services but
to me concierge medicine is really just that high level of service where patients can actually get a hold of their physician or their therapist easily and they have longer appointment times so
to me I think the concierge practice is really focusing in on less number of patients and giving them a longer time of service
so what made you decide that you wanted to start a concierge practice because there’s a lot of different business models rise you’ve got academic medicine you’ve got concierge you’ve got direct primary care or direct in your case Psychiatry you’ve got
just general Private Practice there’s a lot of different ways you could do it so what made you choose this method so my grandfather was a Child and Adolescent psychiatrist and he
did academic medicine a lot of juvenile work and academics in Ohio and my mom is a concierge Child and Adolescent psychiatrist in La Jolla California
and I’ve just seen how much of an impact she’s able to have on people’s lives over working with them from anywhere from a few months to several years in some cases a few decades so I really love.

[7:45] That kind of close connection with someone and seeing them grow over time so to me I really wanted to dive into that space and Scottsdale because I just think there aren’t
really any child
concierge psychiatrist order adult concierge psychiatrist and I think I could count on one hand how many there are in the nation probably really that’s.

[8:06] That’s interesting I mean I guess it makes sense to a certain extent because it’s a fairly new model relative to the general practice of medicine it’s newer on the scene and
I’ve got to think that for Psychiatry especially having the ability to have longer appointments and dive really deep I would think that the concierge model would really lend itself well in the field of psychiatry
definitely I think that people are coming in and they’re most vulnerable States when they come to see psychiatrists and.

[8:38] That was my whole goal throughout training I saw people come in for these 15-minute appointments
you’re crunched on doing your notes so you’re looking at your computer you’re trying to write the note trying to talk to them.
Only to get prepared and not fall behind with the next eight patients you have to see so my goal really was to create a space where these you know these clients felt really heard and listened and understood
and not just assigned kind of a diagnosis and then told to leave and go pick up their medications so I’ve got to ask you about how you started this practice because we were talking a few minutes ago and you
let me know that you started this practice while you were in residency which sounds insane to me sounds.
Flash amazing I remember my third year of residency and the idea of starting a practice in the middle of my residency followed by going on to fellowship and trying to run the thing from a.

[9:39] Is an unconscionable idea to me but you’re doing it I mean you did it in our doing it so first off what in the world possessed you just to start a clinical practice while you’re still in the middle of residency
so I think one thing for me is I saw the residents that we’re leaving the program who wanted to pursue private practice and they felt kind of like they have to pursue a hybrid model just for that kind of secure income where there
getting a part-time inpatient job and then they’re starting their practice and kind of that uncertainty of what that income stream is going to be so for me I really wanted to be kind of teed up and ready to go by the time I left training
so starting in my third year of residency
I started kind of putting the business end of things together creating an LLC getting an EIN all those fun things that go into starting a business
and really trying to figure out what I wanted to do so during that third year of Psychiatry residency was really just putting the business together.
And initially I really did think I was going to be on my own and solo kind of like how my mom’s been her whole career.

[10:49] And then as I got into fellowship and started building the practice.
Then I realized that there was a lot of interest from other people and joining something like this because
there really aren’t that many concierge psychiatrist or wellness centers and it just kind of took off from there and kind of evolved rapidly
so then I would love to hear from you as someone who went through medical school went through residency.

[11:16] I’m going to make an assumption and assume that you probably didn’t get a lot of formal business training while you were in medical school and residency is that right.

[11:23] That’s right so how did you acquire the skills and the knowledge that you needed to do all these things.
A lot of research so I spent a lot of time talking with people who had started businesses whether it be medical or non-medical
we can kind of get into later some real estate interests that I had and started learning about how to put together a company and manage those so I think from all of the
networking talking to people trying to piece it together on my own I was able to figure out those things and I was really motivated to do it myself so I made my own LLC and I did all of that stuff myself and I learned
the basics of small business Bookkeeping on QuickBooks just spent a lot of time learning the basics of business so I’ve got a good friend has started a direct primary care practice
in central Pennsylvania after leaving the military and I remember him
showing me his business plan when we were still working together while we were both still in the Navy and it was it was fascinating it was this
I don’t know probably 40 50 page document that he had put together and it was incredibly detailed incredibly complex and
you know I just remember looking at this thing going man you’ve just you’ve done amazing job you’ve really been thinking of just everything here so
what was it like putting the business plan together for you I mean I assume you had one or had.

[12:51] Maybe not in a formalized sense even but in a but you know as you start to think about okay I need to figure out land and you figure out physical space and you figure out hiring a new figure out financing.

[12:59] How did you start to put that together share so you may not believe me but I did not have a business plan I had a vision of what I wanted to happen.

[13:08] I started small so I rented an office space from Regis which is a co-working space
which I know you know not a lot of other Medical Specialties can just rent an office somewhere but I don’t need any equipment so I just rented literally this hundred fifty square foot room while I was
still in residency and just kind of put this together and started marketing with a location and.
With a website and just kind of getting it all lined up so I did not have a business plan I had a vision for what I wanted to do.
And then you know a few things happen that kind of led me into growing it into more than just me.

[13:49] So what was your vision like then I mean you have this dream you have this idea but
Translating that from a dream into a practical action plan is very different so what is this Vision that you had or are you thinking five ten years down the road or you just thinking okay
I’m gonna go and do this step I’m going to see how far this takes me and then we’ll think about the next step
yeah I think it was very stepwise for sure because when you’re coming up with a brand new idea it’s great to have the 5 and 10-year goals but
you don’t know if you’ll actually be able to achieve them when you’re just starting so I had several steps and place like get the office and make my website known
tell people I’m there get my first patient you know like all these things and then something kind of random happened where I was talking to this girl
I was getting a facial she was telling me how unhappy she was there and we ended up talking and she wanted to leave and.

[14:51] I kind of came up with the idea of well I think you should come join my office at that time I really had no idea how I was going to incorporate her.
I have my office at Regis.
I was kind of freaking out when I got home I told my husband I’m like I just offered this girl this job and I really think she’d be great and like wellness space environment.

[15:11] I don’t really know how I’m going to do it yet but I really want her to work with me I think she’d be really great in the space so
that’s kind of what initially led me to start looking at other options and growing this so here I was I was at the
middle to end of my first year of Fellowship so that these last six months I’ve been looking at office spaces and we’re growing into a 3,000 square foot space in October and she’s going to come work in that space with me and.
And then it just snowballed into
getting all these other people who are very interested in and now I have no offices left in the space that we haven’t even moved into that is amazing I love it this is the classic entrepreneurial Journey you’ve gone from
working in your business to working on your business and starting to step out of the role of
solopreneurs or practitioner even though I mean you’re still doing your medical practice of course but sort of stepping back and also putting on that CEO hat and saying okay
I’m not just the physician in the space now I’m also the person who’s responsible for hiring and firing now I’m also the person who’s responsible for payroll I’m also the person who’s responsible for.
Workplace safety so.

[16:25] How did you make that transition what was what was that like yes I’m still asking myself that sometimes
but you know what happened was I was in that Regis space and I had a few other people who wanted to join me so I got them offices at the Regis face and they’re all working under the umbrella of my clinic
as we wait to move into this larger space this fall.
And so it was really a learning process and get a really good attorney get a really good accountant who can help with these things of
setting up payroll and how to do the bookkeeping when it gets more complicated so
I just started to kind of put that together as I added one person on at a time slowly.

[17:09] So we have about eight people total working in the clinic and no physical office space yet for all eight of those people
so how do you start to find some of those people I mean are these people that you knew from residency or they’re they’re people you had met or did you put out
you know advertisements or something or you know because this first girl she’s just kind of
walked into your life one day while you’re at the salon or whatever so how did the next three and four and seven hires actually happened they people you know or how did you find
yeah so one kind of marketing strategy I had just for my own solo practice was to meet with a lot of therapists meet with a lot of other psychiatrists in Scottsdale and just tell them who I was and where my clinic was and.

[17:52] Really just as me a solo practitioner
and then I kind of tagged people approached me saying like hey are you hiring or are you bringing people on I love your idea and so I just started talking with people they weren’t people I knew two of them are from just friends and you know from the hospital so the nutritionist is a friend of mine and then the physician who will be doing Botox and fillers is a friend of mine
but although their psychiatrists all came to me through different streams online or through a meeting with people and really just worried about so
I’m nerding out over here with all this stuff because this is just this is just so fun this is I’m a personal growth junkie so this is just I’m here in marketing I’m hearing website I’m hearing you know I’m hearing entrepreneurs I mean I’ve been sharing all this great stuff so
what’s
kind of blowing my mind here and I hope that our listeners are understanding the sheer Insanity / bravado that has to take
to do what you’re doing and you’re basically just doing what you have to do in order to get things going people are always asking like
well how am I supposed to start a business how am I supposed to do this and you’re just like I’m just gonna go do it I’m just going to go start talking to people I’m just going to go find people I’m just gonna go look online I’m just going to I’m just going to start to do things and not everything is going to work but I’m going to find something that works and do that more.

[19:15] Yeah I think it really is just kind of a trial-and-error some people it just doesn’t work out or they’re not the right fit and then it’s really just a lot of time and effort like I really want the listeners to realize that they can do it too.
You know it doesn’t matter what level of your career you are you can go and learn these things you can go figure out how to start a business whether it’s in medicine or not medicine and
you know have a side gig may be totally medicine unrelated so I just I really think it’s important for people to realize that they can self teach and finances and business are scary they don’t teach us that in medical school but
it’s something that we can learn ourselves and apply to our lives yeah it’s a great frustration that that this stuff is not taught in.
Medical school or residency it’s the reason why I started the scope of practice was to give people
these tools in the knowledge and the resources they need to manage their business more successfully and to master their personal finances because we don’t learn that stuff in med school and it.
Sets us behind all the people that have been out in their job and in their career for 10 years by the time that we even get out of residency and fellowship so it I think that really puts us at a disadvantage and I’m just in all over here that you
I said okay I don’t know any of that stuff whatever I’m going to go learn it I don’t know what it I don’t know what A business plan is whatever I’m just gonna go make one.

[20:41] Yeah I think you know I think the important thing that I’ve gotten feedback on because it being in Psychiatry we love to ask for feedback so I asked
people like you know what is it that made you want to join this Clinic like
you know the people I’m hiring are well out of training they’re looking at me like wait you’re still in training
and I’m joining this clinic and so I really think it’s important to be passionate and like half the motivation and drive to do whatever you’re doing
and just that alone I really think we’ll make people do it well so that’s the feedback I received this they’re like well you’re just so passionate and you have such a vision
that we wanted to be a part of that I know there’s a lot of people out there thinking well this all sounds well and good for for dr. XU Lai but
I don’t have a concierge practice or I’m part of a bigger organization or I’m not the business owner so so maybe the stuff doesn’t apply to me but
but maybe you can coach us a little bit and tell us what are some of the maybe strategies or the or the tricks or that or the habits maybe that you’ve picked up along the way that.
Have enabled you to succeed in doing what you’re doing that you think might be applicable to non concierge practices.

[21:56] Yeah I think one thing is just really making patients feel heard because I think a lot of times in the academic centers and the Community Hospitals and the clinics.
Patients just don’t feel listened to and they feel like they’re getting assigned a diagnosis and so I think you know one thing that would really help in any setting
is to just kind of like make eye contact with your vision don’t be typing your note during it during the encounter and just really taking the time to hear why they’re there
and I find that that actually eliminates a lot of the frustrations that people come in with or they’re annoyed because they waited in the waiting room forever or
maybe their last visit got cancelled or moved but just taking that time to really hear them I think is really helpful no matter what setting people are in so
I’m interested to know how you split your time because you’re still you’re still running a clinical practice in addition to running this business right how do you split your time between physician and CEO
well primarily I’m in Fellowship Monday through Friday most of the time but I do wake up very early I work on business admin stuff.

[23:06] So I started that around six a.m.
And then I’ll go to Fellowship for the day do my thing there and then in the evenings I’ll come back kind of work on any like lingering issues that any of the Physicians or providers had during the day.
Follow up and make sure some of the administrative stuff is done like super bills were sent out
patients were responded to on the portal things like that and then I take boards this September 13th so I also have been studying studying for that and then for
the patient’s I currently see I see them mostly on the weekends right now and the late afternoons Okay so.
Anyone who’s out there that’s listening to think that that is still thinking okay well I don’t have
time to do X I don’t I don’t know how I’m gonna find the time to work on stuff I don’t know how I’m going to do this I don’t think it’s possible I don’t think I can I don’t think it’s it’s it’s fair I don’t think it’s reasonable all right
you just lost all of your excuses okay all of you out there you have no more excuses so doctor XU Lai is in the middle of Fellowship.
And running a clinical practice with like seven or eight other people on the side okay so all excuses officially have gone out the window so.

[24:21] So you just need to get out there and just
do I am super impressed well it’ll be great when you’re done with the fellowship and you really have time to devote even more so
let me ask you how your how you think maybe your vision has changed now because you’re several years out of residency or a couple years out of residency now and
you know your vision at the time was okay I’m going to go get this hundred fifty square foot room and I’m just going to start seeing patients and I’m going to steal someone from the salon next door and you know I’m going to do these things
so now it’s a couple years later the business has expanded you’re offering all these new Services you got a killer website and all this stuff and so
what’s next what are you thinking about next as far as strategic planning and casting a strategic vision for the next 3 years 5 years 10 years.

[25:09] Yeah I think I would really like to expand all over Phoenix so I would like to have different sites in different locations because Phoenix is huge it takes.
You know a few hours to get from Super South-East to really Northwest so I think I want to have other locations in Phoenix where I can provide
more of these services to more areas because I do get a lot of calls and people live far away and I’ll give them other resources and the area that they’re in so I think I just want to expand.
Locations and then maybe even extend one day to San Diego because I would love to be close to my parents and by the beach.

[25:49] Well I was stationed in San Diego for six years with the Navy loved it beautiful city wicked expensive but I mean then again I guess so Scottsdale so but that’s all that’s that’s awesome I love hearing that I mean so.

[26:03] One of the two of the books that I have recommended on the podcast a few times before our by a guy named Jim Collins one is called good to Great and the other one is called built to last and in those books he
looks at each one is a five-year longitudinal research study looking at different companies in the same industry and looking at ones that
really
went from what he calls good to great they were okay companies and then they just took off and became super successful while competitive company in the same industry really stagnated and languished and.
In one of the books I think it’s in built to last he talks about the concept of Abby hag bhag which is a big hairy audacious goal and this is a concept that he came up with that I love the idea that
all truly great leaders have a be hag they all have this really audacious really
seemingly unattainable goal that they’re saying nope this is what I want and it doesn’t matter that people think it can be done I’m going to find a way to make it happen and so this is awesome I love hearing about this you’re taking this concept that is clearly working.
Clearly successful and talking about okay so now how can I expand that to help even more.

[27:20] People how can I get these services to the people who are hurting in Central Phoenix and Western Phoenix and Northern Phoenix how can I expand that I think that’s fabulous.

[27:29] Thank you yes there’s definitely a lot of psychiatrist in the area but I really think what sets us apart is the ability to access your physician or your therapist or your
Wellness specialist in between appointments it’s so difficult to get a physician on the phone these days so I think
when we send our patients out the door with our cell phone number with our email with a way to get ahold of us it’s just an immediate relief for them
yeah I remember we had Paul Thomas on the podcast in episode 20 talking about direct primary care and that was one of the things that he talked about as well was the idea of giving your patients your cell phone number and
as I’m saying that there are people out there that are grinding their teeth going no no don’t do it but there’s.

[28:15] You know you can coach people through that you can coach people okay when is it appropriate and you know let’s just don’t abuse it and that sort of thing and it’s it is possible there’s some ways to do that but no I think that’s really really great well I want to get real practical for a minute because I’d love to
lets you teach on some of the business strategies that you have learned maybe some things that work maybe some things that didn’t work.
You’ve referenced a few different things so let’s talk about marketing for a second so so how did you start to Market your practice you mentioned going and talking to therapist and talking to psychiatrist but
what were some of the strategies you use for marketing maybe some things that really worked or maybe some things that really didn’t.
Great so I think because we’re in the beginning stages of the clinic my goal was really to see how much marketing do I even need I think sometimes with some of these big companies out there
they see Physicians and they see dollar signs and they see an ability to make a lot of money off of them.

[29:08] And I really wanted to make sure my business was operating in a lean way where the expenses were necessary and the you know
the revenue was greater not only for the Physicians there but just to promote happiness in the workplace so in terms of marketing strategies.
I really didn’t have a whole lot other than meeting with therapist meeting with psychiatrist telling physicians in the community that the clinic was opening I think having a lot of actual meetings in person with
those people was really helpful because and I got calls from new patients saying hey so-and-so therapist referred me to you and it seemed to be working
the only marketing strategy I paid for was Google click ads other than that I did not use any sophisticated expensive marketing strategy
so this is boots on the ground this is walking around to different practices with I don’t know a box of donuts on a smile and going hey you got people who can’t see a psychiatrist for three months they can get in to me
tomorrow yeah I mean it takes a special kind of client to one
concierge Psychiatry Services a lot of people want to go in network so you know it’s unfortunately.

[30:23] I really have to just send a whole lot of emails at first to see who was even interested in meeting with me and then go from there and then set up those in-person meetings with them but it really seemed to work well people were very receptive to the idea of thought it was well needed
and we get you know several new inquiries a day now after only being
open like with these other providers for a few months so that’s pretty impressive and so did you find that early on were you frustrated by The Crickets or frustrated by the the rejections or did you
did you feel like it took off pretty quickly I do feel like it took off really quickly I do think that’s a huge benefit of starting while you’re in training
is because you’re not waiting for the phone to ring you’re not waiting for that next patient to call so having something I was primarily doing and then just
saying like it’s okay I know that this may take time and may not take time it may take off really quickly or really slowly it may not even work I was okay with that because I was in training and this was really something I was trying to pursue and
get off the ground with nothing to lose really.
So let’s talk about the financing aspect for a second because you’ve alluded to this several times you mentioned that you rented the space you didn’t go buy a building you didn’t go borrow 2 million dollars to build a place you.

[31:41] Rented a small office space you started with very lean overhead very lean expenses which I’ve got to believe that must have been very comforting not having
not having these huge monthly expense obligations and
yeah I can I can only imagine the stress that that would bring to feel like oh man I got to get 25 clients this month and I’ve only got four you know how in the world am I going to make ends meet I mean if you have a lot
less money going out in terms of expenses then that’s a lot less stress that’s a lot it’s got to be a big weight off right
right and people tolerate different risks to so people have to do whatever they’re comfortable with I did look at all of the options I looked at buying a building I looked at
renting a large space and what I ultimately settled on at the beginning was the Regis space because it is very
doable you know you can just see a few patients a month or take a few phone calls and Moonlight and pay for the space and not be losing money so to anyone out there who’s
even considering jumping into their own private practice I would definitely.

[32:46] Start small and then when you’re ready to scale then you can go ahead and look at larger spaces and in terms of my own financing I just basically did a lot of Moonlighting in residency and fellowship and that’s how I paid for my
initial expenses love it no I think that’s really really smart and there’s a lot of ways that people can do that same kind of thing where maybe it maybe if people aren’t as
eager to do it while they’re in residency let’s say as an internal medicine doc I know lots of people that went and did
a hospitalist medicine for a year or two and so they’re doing seven off in seven on and on the seven days that they’re off their they’re either their Moonlighting or they’re starting to work on.

[33:31] You know building a practice there’s lots and lots of ways that you can double dip your time like that and I think the key phrase and I think you said it is being okay with starting slow.
You know not starting with this Grand building this Grand Vision.
You know the the the forever home whatever the equivalent of the forever home is for medical practice but but starting small and I think it’s important you know it’s a an old proverb says do not despise humble beginnings.
And I think that we’ve lost sight of that to a certain extent
or become maybe enamored of the The Glitz and the Glam and you know I want this to be this great and wonderful beautiful place and you know it’s okay if you if you start small I mean it’s you know I started I started scope of practice as a Blog on my laptop.

[34:16] Right I mean it’s it doesn’t have to be this big fancy this big fancy gargantuan thing you can really start small and grow organically and grow by scale.
Definitely I think that you know a lot of people get held back because of the unknown like how do I even start a business and how do I rate this business plan and I think just
putting your foot on the gas and just figuring out how you’re actually going to do that is beneficial and I kind of fell into coaching
psychiatrists on how to start practices recently I hoped I would say
10 across the country kind of meeting with them talking about how to start a practice the business end of things and I do have to say the ones that did not end up going forward and doing it were
I think out of the fear of the unknown
well and that’s a legitimate fear I mean if you’re if you’re running a race and you know you’ve only got a quarter of a mile left you’re gonna
you know kick into gear and run because you know what the end point is but when you’re running a race that’s essentially endless and you don’t know when you’re going to stop or when you’re going to reach your goal you tend to go more conservative you tend to pull back or hang back and so
you know I think that I think that that’s legitimate and some people.

[35:34] That’s okay some people just aren’t really wired for that and for some people it’s like you know let’s do this I have a dream and I am going to see you I’m going to do what it takes to make it happen
yeah it definitely is again a lot of people have different risk tolerances and
what they’re willing to do and not do and a lot of people that I’ve talked to
one that W2 job where it’s like guaranteed income versus a 1099 where maybe they have to wait for that work to come so it’s really just kind of person dependent yeah and I think one of the things that the
covid shutdown taught us is that the security of a W-2 job maybe not as secure as we used to think it was and so there’s
there’s a lot more work there’s a lot more hassle in owning your own business and in running your own practice but there are some real advantages in that you have autonomy you have flexibility you control the decisions
yes I definitely I think that’s what mainly drew me
to private practice and the concierge route and then my husband is kind of the counterpart he is in academic medicine he’s a hospitalist with that.

[36:42] Kind of set schedule and so I see both sides very clearly in our household
how was that running a dual physician practice what is what is that like for you guys I mean that’s I mean
I could I can’t even it’s not even a dual physician practice it’s or dual physician household it’s really almost like a three physician household right because I got your husband’s job and then you’ve got your.
Primary Fellowship job and then you’ve got the business on top of that how in the world do you balance all that
well he is kind of removed from the business he’s doing a pslf and so with this academic systems that they’re in there’s pretty strict non-competes so
he is not participating in the business that he’s very supportive of it.

[37:26] That’s wonderful I it’s so refreshing and so comforting to have a spouse who is supportive and you know who buys into the vision that you have and supports you and wants to wants to work with you for that that’s really wonderful
well let’s talk about the hiring process because I’m always interested to know how people do this I mean so your first person sounds like
was maybe an anomaly is like oh yeah you’re great and you do a great facial so let’s do this thing I know it’s more complicated than that but
but how did you evolve your hiring process over the course of the next three to five to eight hires mean did you what’s your strategy do you do a series of interviews is this
recommendations from people or do you have people Moonlighting with you or have people working with you as a trial basis what’s your strategy.

[38:14] Sure so I’m still trying to figure that out myself the last I think in the last one and a half months I hired five people.
So it was very very fast and the people all kind of found me and I just talked with them got some references.
I looked at some of their work verified their licenses and that was pretty much it
you know it takes a special person to want to join this Clinic because it’s not off the ground yet and it is still in the building stages and
we don’t have our office yet until the fall so the people who join me we’re really passionate about the vision passionate about the project.

[38:52] And I just wanted really nice kind people who wanted to provide the same service I did so really there wasn’t any sort of like.

[39:01] Interview process other than us just sitting down I heard what they wanted they heard what my vision was and it was a good match
one of the things that you’re likely finding at this stage I would imagine is that you’re getting to a place or maybe already are at a place where
there’s only so much that you can personally do as the primary leader of the company and at some point you really have to start developing
additional tiers or additional echelons of leadership underneath you because
eventually you start growing all you know you grow from you know Scottsdale to Mesa to surprise and you know all these different places and you can’t possibly be in all these places at once so what is your strategy for developing leaders under you
definitely I think that’s one of the main things that I told people when they came on I said I want this to grow I want you to grow
you know a lot of them are in the beginning or middle stages of their career and so I said I want us to be kind of the core team learn really well from each other and then kind of disseminate out into the community later on when we expand to other locations and.
And spearhead those locations what would you say is your strategy for growing and scaling the business I mean you’ve got a great vision I love the idea of expanding all over the Metroplex but how do you know when it’s
time to make the next move like how did you decide when it was time to.

[40:29] Add another person or how did you decide when it was time to expand your services or when do you decide that
Now’s the Time to start thinking about opening our next location like what are those decision Branch points or is it just just you just sort of know.

[40:43] Yeah I think you know I ask myself that when I started and I’m still
not really sure what the right answer is I guess you know for me it was getting the interest from people and I had so much interest in wanting to join that
I hired three psychiatrist within a span of a month and I told them I said I do not know
how quickly you will get patients it would be much easier if just one of you came in at a time and
filled before hiring the next and they knew what they were signing up for they knew the clinic was in its early stages and
and they were all in so you know we got three people very quickly who are all MD’s knowing exactly what the situation of the clinic was wanting to join despite knowing that it might take a little while to gain
patience so I think whether it’s people hiring until someone’s full and then moving on to the next tires great or just being pretty honest about the position of the business in the current moment
and seeing what people’s responses are yeah that’s really interesting
it’s an interesting idea you know you hire people and say look I cannot pay you a full salary right now but here’s what I have if you can come in and start to grow your practice the more you grow the faster you go the more I’ll be able to pay you
that’s a wrap that’s a really interesting model and you’re right it does take its it does take a certain person with a particular mindset and a particular.

[42:07] Stage of life to really make that work but there’s no reason that that model can’t be adapted to other things there’s no reason that an OBGYN or a pediatrician or a or even a general surgeon could take on a model
similar to that but sometimes it requires a little bit of creativity a little outside the box thinking like say thinking outside the box as in
I don’t know starting a concierge practice while still in residency right and I think that’s you know there’s nothing to lose at this point for me like I’m very motivated I really want this to work I have a vision for this.
And doing this wall being in training allowed me that opportunity to still have somewhat of an income while pursuing this.

[42:49] And I’m very competitive and my goal for myself was to not have a month where I’m losing money
and so far I’ve been able to achieve that I have not lost money in this process.
Whether it be nearly breaking even or making a little bit in the beginning is more than okay with me that’s very impressive
well I mean all these things sound like they’ve worked really well but have there been any.
Moments of there been any times when something really didn’t work out the way you wanted it to or a moment that you thought oh this was
this was not good or we really didn’t execute this well or something that just didn’t go off as well as you wanted it to
yeah I guess my only frustration in the process was not knowing how long it
it takes to negotiate a commercial lease you know I anticipated that it’s like shopping for an apartment where you just go and you’re like I want that one and then they give you some papers to sign in your in but
this has been.
At least a three-month negotiating period before they even can execute permits and build out the space so that was all very.

[43:57] Very shocking to me so what does that process been like in terms of the negotiations tough are you did you hire a lawyer or an intermediary of some kind or are you just going back and forth with the.
With the Builder and negotiating terms and amending and counter proposing and things like that
yeah so I made sure that when I first hired an attorney that they were well-versed in healthcare and real estate.
Which I think was a very important combination to me so the same person that helped kind of Ensure my practice was set up the right way was the same person who I was able to send those lease agreements to have him review them
come back to me with concerns going back and forth with the builder you know it’s a very very long process no matter
how quickly you’re acting its you know from day one of signing the letter of intent we’re now three months later and almost at the end has there been anything during this whole process that
really surprised you like something that you.
You thought was going to work out one way but ended up working out a completely different way or something that you just didn’t expect the way it was going to turn out and you had to.
Pmab pivot or completely change the way you were going to approach it.
Yeah I think you know in terms of bringing on people and the speed at which bringing on people would happen was really surprising to me I almost was like whoa like do you know that the clinic is just getting started are you sure you want to join this do you have another kind of like
back up.

[45:26] Option that you know and people were on board with it and they were excited about it but to me that was the biggest almost surprise was how many people wanted to join at such an early stage that I had to kind of
check myself and be like is this going to work out is this going to be okay and I think that was the most challenging for me is the unknown of
will this work and now I’m I have all these people who want to join in will they have people to see
so you’ve got a bunch of people that are listening right now and a lot of people are either in training or in the very early stages of their career
what would be the biggest piece of advice that you wouldn’t want you would want to give someone who’s in that position so someone who’s where you were say either now or a few years ago what’s what’s the number one thing that you would want to tell people as they’re thinking about all this stuff.

[46:18] Yeah I think the most important thing is just doing something you love and not being afraid to go for it you know I think a lot of people get afraid and they get worried and it makes them not do it and then they see
job offers from academic centers which that is awesome and it works for a lot of people but then if you’re really feeling inside like you want to go private practice router concierge
don’t be afraid to take that jump because it can work you just have to put in the time
and the energy and it’s kind of like like raising a small child you know you have to care for it and put love and time into it
to make it really grow well love it that is a great great word for us to end on well if people want to connect to you if people want to learn more from you maybe get some coaching or maybe just
pick your brain and let and say okay I would love to do that how in the world did you do that if people want to continue that conversation how can people connect to you.

[47:14] Yeah they can email me at be XU Lai actually wellness.com so that the bch OU L ET at Chu Lai wellness.com
awesome and we’ll make sure to include that in the show notes and the website will be in the show notes so people can go check that out and you know if you’re in the Phoenix area go look her up
so because she’s going to be coming to a center near you very soon it sounds like well dr. Shirley this was a fabulous discussion I really appreciate you coming on everybody needs to go and connect with all your social media channels and
learn more about you and all these great things that you’re doing in Arizona I’ll make sure to link to all that stuff.

[47:51] In the show notes for everybody well she is dr. Brook shul a doctor XU Lai I want to say again thank you so much for joining us on the scope of practice podcast today we really appreciate you coming on.
Thank you for having me.

[48:02] Music.

[48:07] Well.

[48:08] The bad news about this episode is that I officially have no excuses for anything anymore doctor XU Lai started and grew her clinical practice while she was still in residency.
Man I mean talk about taking away all the excuses but.
I don’t want to just tell you her story so that you’re impressed with her story I want you to hear her story and inspire you to go write your own not tomorrow not next week but today.

[48:35] So what have you been waiting to do that you know it’s time to do.

[48:39] What’s been holding you back and how can you break through that barrier now it is time to seize your moment don’t wait for tomorrow don’t even wait till you’re ready just take the plunge that’s my challenge to you this week go seize that moment.
Take hold of that opportunity you’ve been excited to pursue in that you’ve been putting off whatever it is you’ve got this you can do it and I want to help give you the tools to do that.
So for today’s free resource I’m giving you a free ticket to the new 2021 physician practice automation Summit that I’ll be speaking at which is happening online from October 17th through 24th 2021.

[49:15] The virtual Summit is hosted by dr. Chang Ron.
Who was our guest on the podcast just a few weeks ago he’s brought together 40 experts in medicine a i automation marketing accounting the law and more to help you grow scale and optimize your private practice in 2022.
You’ll also receive a free copy of my guide called the five critical tools all physician leaders need that guide will help you cut through the noise and give you the five most impactful resources that you need to succeed in private practice.

[49:43] I can’t wait to share this guide and the summit with you I’m speaking on several different topics at the summit I really believe in this thing
the organizers great you heard him on the podcast recently
so you got to go sign up it is going to be amazing even if you can’t attend live you’ll catch the replays afterwards so go discover the incredible power of AI and automation so you can build a thriving practice that you’re deeply proud of.
Download the free guide and sign up for the summit at the scope of practice.com / AI Summit.
Also don’t forget you can also sign up for free for the marriage and money MD Summit on November 15th through 17th at www.marriageguy.com money MD.com.
Don’t miss out on either of these two amazing Summits they’re both free and they’re going to have amazing speakers and phenomenal.
Best of all did I was mention they’re both free so sign up today click the links in the podcast description and sign up.
Thanks so much for joining me on the scope of practice podcast today you can also find all those resources in the show notes at www.scopemonth.com episode 81 or just click the links in the podcast description.

[50:50] Thanks so much for joining me and I’ll see you next time.

[50:53] Thanks for listening to the scope of practice podcast at www.visaplace.com.

[51:02] Before we end here’s a quick reminder if you want to streamline your five star patient review generation.
Contact empath IQ at www.scopemonth.com / empath IQ that’s www.thekingofrandom.com EMP ath IQ.

[51:21] And mention the scope of practice podcaster received two months for free.

business, concierge, culture, healthcare, human resources, leadership, physician, practice management, private practice

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