OUT OF THE SYSTEM | From Debt and Doubt to Practice Freedom

So for years and years, we were putting women on it without symptoms just for—

my mom was on it—

bone protection.

I remember my mom being on it, which makes total sense. Yeah.

That was the one good thing that Premarin did have. So in the positives, it was decreasing the risk of osteoporosis and decreasing, you know, fractures. But then it was doing all these bad things with heart disease, stroke, and breast cancer. Women were dying.

You didn't build your clinic to feel like an employee in your own business. I'm Matthew Colobley, and on Out of the System hosted by Dr. Talks, we challenge the broken rules holding healthcare entrepreneurs back. Hear from clinic owners, rebels, and builders who are creating bold, profitable, patient-centered practices and doing it their way. Okay. So you're having Topo Chico on the way to the airport?

In the airport.

Oh, in the airport. And you put a little salt on it?

Yeah.

You carry, do you carry like a little tin of salt?

You go, you know, any kind of fast food place or whatever has little salt, you know, your little white thing with the red salt label on it. So you put a little bit on the edge and got your little margarita right there.

Well, in case you're listening, you're a first-time listener, you might be wondering, are we talking about drinking margaritas? Sort of, but actually I'm here with Dr. Amy Duffy and she's in beautiful Clemson, South Carolina, and longtime client alum. And tell everybody what you do.

I am a functional medicine, integrative medicine doctor, family practice by trade.

Sorry, I'm just kidding. I'm just joking.

I like, I'm, I'm glad that I did that actually. Yeah. Sometimes I actually will tell a patient I'm embarrassed to be a doctor sometimes, but at least I have some credibility behind my name, I think. And you know, I appreciate having the, the science behind what I do so I can more understand.

Yeah. How long have you been in the functional space?

Most of the things that—

How long have you been in the functional space?

15 years. So my practice is Carolina Integrative Medicine in Clemson, and in October we'll be celebrating 15 years.

And it's been a piece of cake, right?

Oh yeah.

Yeah. No problems at all.

Never, ever, ever.

Never any financial challenges. Yeah.

It was a mess.

Well, okay. So explain what a mess, what do you mean by that?

One, and I feel lucky in a lot of ways. I did family practice, but I did a rural residency program in Seneca, South Carolina, which is 6 miles down the road from Mm-hmm. And we did a ton of OB. So by the time I finished my practice and the 4 other residents that were in this program didn't like OB at all, so I got to do all of their babies too.

And you were pregnant at the time, weren't you?

I've had 2 babies.

While you were—

One in med school, 3rd year of med school was baby number 1, 1st year of residency, baby number 2. So—

So you're just a really keep it simple kind of gal, right? No complexity.

Nothing can be, uh, Easy.

When you tell me those stories, I'm like, first of all, how do you make it through residency? Second, how do you make it through residency pregnant with already a little one at home?

Yeah. Already.

Um, yeah. Yeah.

At that time, their dad would bring both of them to the call room and just sleep in the call room so I could go breastfeed the baby, you know, in the few minutes between the ER or whatever I was doing at the time. And then I got in trouble for doing that. And so they had to not come anymore.

Whoops.

Just, they didn't, it, you know, apparently I was, you know, nobody was like dying while I was breastfeeding my baby, but you know, they, it wasn't kosher cuz other people weren't taking breaks like that. So, you know, right when I was in residency is when they did the 80-hour work week rule. So like I was like a 3rd-year resident when that came out. So if we were in the hospital after midnight, then you didn't, you got to go home at noon the next day kind of thing. So.

Wow.

Prior to that, we didn't have—

how can you create a great doctor without working 120-hour work weeks? Isn't that crazy?

So when I did family practice, it was interesting. I'll go way back when I was little, little, little girl. I loved babies. I wanted to play with all the babies. I had 12 Cabbage Patch Kids. And one of the ladies that babysat me was a seamstress. So she made all Cabbage Patch doll clothes and I had all these accessories with strollers and high chairs and little food packets and all this stuff. And so I was real into babies. And when I was 11, we went to a pancake breakfast at a, at a park. And there was this like Michelin baby. I mean, he was like bald and just chubby everywhere, like wrinkles everywhere. And I was just in love with him. His name was Alan. And I just walked up and started playing with him on the playground. And he was in the sand or something. He was about 8, 9 months old. And the mom was like, oh, he loves you. Like, can you babysit for us? And I was like, I'm 11. I don't think I'm allowed to babysit. But that was my first job. So I went over and just was mom's helper. So I just started playing with the baby.

Right.

And then turned into babysitting once I was old enough. And then she had a baby and then her sister had babies. And so I was just all in the family. That was my job my whole, you know, from 12 years old through even college, I'd go back home in the summertime and babysit for them. And so when I was a senior in high school, the sister was having baby number 2 and invited me to be in the delivery room with them. And so that was my first like real medical experience.

Had you thought about being a doctor prior to that?

I think I was, I, because I loved kids so much and babies, I thought about pediatrician or a teacher, but I hadn't really made a decision. I played softball and I just knew I was going to go to college and play softball. And didn't really have a plan, but I was a good student. And so, you know, doctoring was definitely something that was suggested. And so when I saw this baby be born and I thought, this is really cool. Like I wanna deliver babies.

And that was, you were 18 and was that, that was the first time you'd seen a baby delivered?

Yeah.

Yeah.

First time ever.

That must have been wild.

Yeah. Like I had never seen a delivery. I'd never really been in the hospital.

Like my mom had a C-section when I was like in middle school.

And I remember going to the hospital room for like 2 minutes. Saw her pushing her little button. That's all I remember. And then I didn't spend very much time there just to visit. So I didn't have a whole lot of hospital medical stuff. So I don't have the story about, you know, I knew I was going to be a doctor because of whatever.

Mom and dad were not doctors, not in the medical field, didn't have an aunt or uncle.

Dad was a Lutheran minister. My mom was in software. She was a software engineer, computer geek. So nothing like that. So then I grew up in Boulder, Colorado. So I would say it was rather granola. And so it was like, well, maybe I'll be a midwife.

Right.

And then I was just gonna, you know, be cool and like deliver babies at home and stuff. And then my chemistry professor was like, no, you're not. Like, you're smart enough. Like, you should go to med school. You can do that. So I did. I went to med school. I actually took 5 years in college just because I played softball and I redshirted one year due to an injury. And so I just took a lot of ceramics. So, and well, of course, the whole—

Were you in Boulder? Where'd you go to college? Were you, were you in Boulder?

Texas Lutheran University. Okay.

Texas Lutheran. Where was, is that West Texas or?

No, it was right outside of San Antonio in Seguin. Okay. Okay. Just west of, um, San Antonio. No, east of San Antonio. So then I went to med school and, you know, first 2 years normal. I mean, whatever normal med school is, but lots of studying, lots of figuring it out. And then you start doing your rotations. Well, I got pregnant the July of my third year of medical school. So like the very first rotation, found out I was pregnant. And so I had to make some adjustments. And so I did all of my hospital stuff at one time so that, you know, I wasn't stuck in the hospital when I was super pregnant. So basically like, I, you know, I remember going to BAMC, which is Brooke Army Medical Center in San Antonio, and walk in, find the bathroom, puke, and then go do my rounds and then puke again. It was August, you know, it's the middle of summer in San Antonio.

Which is like being right next to the pizza oven in hell.

Our air conditioner went out in the house that we were renting for a while, and we ended up going and staying in a hotel for like a week because I just couldn't— I was dying. Like, I couldn't be in the room, in the house. So, you know, when, when you're in the hospital and, and it was back to back because the medicine and surgery are both 12-week rotations. So it's basically 6 months of the beginning of my pregnancy was all just in the hospital. And when you're in these hospital rotations, I mean, there's no time. Like, I don't even know if their clocks existed, right? Like you're in the ER.

It's like a casino.

It's just, yeah, you finish what you're doing, you round at 4 in the morning, then you round again at 6, and then you round again at 8, and then you're in the OR all day and you're just, I mean, it just never ends. And so I got to family medicine when I was super pregnant and it was like first patient starts at 9 or I don't know what time, maybe it was 8, but it seemed like it was the latest, you know, of all the times. And then they were like, what are we going to do for lunch today? And then they would have, you know, drug rep lunches, or they'd all go out to eat somewhere from the clinic. And then, you know, last patients at 4, 4:30, where are we going? You know, for— it doesn't— it wasn't all about drinking.

Right.

But yeah, this is the plan for after, you know, and then they would have— they would still be on call. I mean, I don't want to say it was all, you know, rainbows and cookies or whatever, but I mean, it was just cush compared to the hardcore Hospital system. And so I thought I was going to do OB because I wanted to deliver babies, but they were all so mean and miserable and just, it was such an unpleasant experience to be in the hospital and watch these people.

Well, it's because yeah, they're sleeping 3 hours in 48 hours.

They're not getting any sleep. It's just super hardcore. Like when you watch, I don't, I don't even know that there's a movie or a show that you could watch that was realistic enough, you know? ER doesn't even—

no.

Yeah. You know, they bring some stress to it, but in terms of just like the hierarchy, you know, it's like the, if the chief does this and it, I mean, it was just so, ugh, it was awful. So then that turned me way off, but then I realized that family doctors were delivering babies too. And so when I was like, you could deliver babies and then you get to be the pediatrician, so you get to take care of babies, which is kind of what I wanted to do anyway. And so I got the best of both worlds. I'm like, I'm gonna do family practice then. I can do all the things.

But not, what was it more of like a specialty where you, you weren't doing peds though? You weren't doing pediatrics fully. You were just family medicine.

Just, well, in my residency, like we taught—

Okay. In the residency. Yeah. Okay.

In residency we taught, we were taught everything. So in residency was a lot like med school cuz for family practice you do rotations and everything. So you'd have a month in surgery, you do a month of cardiology, you do, you know, a month in the ER, you would do Um, urology we did, I think we got 2 weeks of GYN, so that'll come back in a minute. And then, you know, a couple weeks of orthopedics, but then you kind of, in your 3rd year, you have a little, you know, some more elective time and whatnot. So you kind of specialize if you wanna call it. So like a lot of family doctors will lean towards dermatology or they'll lean towards sports medicine.

Mm-hmm.

So I just leaned more into the obstetric part and like anytime that I could, I was on labor and delivery. You know, we were a very small hospital. And there was only 4 residents. There was 2 a year. And we did our first internship year at a bigger hospital in Anderson. And so by the time the second and third year were there, there's 4 residents in the entire hospital. You could do whatever you want.

Right, right.

And so, you know, you'd show if you liked cardiology, you could say, hey, call me when you're doing a cath, you know, I'll run down from wherever I'm at. Or, you know, you like doing surgery. Okay, call me when you have a surgery. So I'd be like, call me when you're doing C-sections. I'll get there. I'll do the scheduled C-section every day at 7:00 AM. And then I'd go off to whatever my rotation was. So I just did tons of deliveries. And just absolutely loved it. So when it was time to graduate, they invited me to stay on at the family practice residency program as an attending position. At that time I was like, absolutely. I'm loving what I'm doing. Who wants to go interview and try to find a job and move and, you know, all the things again, 3 years after you just barely got there. This time I had 2 babies, so I had—

Yeah. I mean, you've got 2 kids, you're married, you're— Yeah.

My husband had a job at the time that was fine.

And so You know, it must've been like really confirming or must've been very satisfying or relieving, you know, that you didn't have to worry about all that.

Yeah. And I mean, flattering at the same time to be, you know, good enough if you wanna call it to say, hey, we trust you to teach, you know, teach these guys coming up. And so, um, I stayed and then just months after that, like 6, 7 months, the OB-GYN guy next door, you know, out takes me out to dinner and says, we have an opportunity for you. One of our, our partners is leaving, moving to North Carolina or something, and we'd like you to join our practice. And, you know, we would share the OB calls. You get to do a whole lot of OB and then you would just do women's health. You know, you could be primary care. So many women come to us for their primary care. What year is this? This is 2006-ish, 2007.

And had you, were you familiar with like the functional medicine space or hormones or anything like, okay.

Not at all. So this was going like, I'm okay. Hardcore normal family medicine.

Yep.

Insurance-driven everything. Had 2 weeks of OB-GYN or 2 weeks of GYN, not even OB, but just GYN rotation. You know, I remember having some lecture about birth control and like, you know, here's a chart of like the different types of birth control you might use.

Here's where everything's located.

Right. You know? Yeah. And it's like, you know, really what I, what I joke about is I think that 2 weeks of GYN was what I learned is how to do a pap smear, number one, and then what was in the closet. was basically like what, what was the choice of the day was whatever was in the sample closet to choose for, you know, either birth control or hormone replacement. Like there was very little conversation about it. There was very little science of, of this. It was very trial and error, you know, just give them this one. And if they, you know, come back in 3 months and they're complaining about something, you just switch them to something else. And like this chart was supposed to be like trying to, you know, help guide you as to If somebody had more acne, choose this one, or if somebody had more whatever, I don't know, choose this one. And so, but it was very, it was nothing related to the science or physiology of what was going on. So I joined this OB-GYN office and, and loved it. I'm delivering babies. You know, there's 3 of us who are on call Q3, 3 weekends a month. You know, we're just delivering tons of babies.

I'm curious, what did you love about delivering babies?

I think it was just so happy. Like, it was just, you know, people— I think sometimes in medicine, especially being in the hospital, you know, was scary because people don't want to be in the hospital.

They're scared because they think it's going to be the end.

They're having a heart attack. They're, you know, chronic disease was just frustrating. I mean, you know, post-surgical complications, geriatric people who don't do normal things, you know, it was just, ugh. And then you go into labor and delivery and it's like, woo, you know, we're having a baby here. Now, were there times when it was freaking scary and babies died and moms died and, you know, that was not cool. But I think, you know, for me, the good far outweighed. Some people, that one event would turn them off completely and they'd say, that is just too scary for me. Like, I want nothing to do with that. But I, you know, that didn't bother me. I felt—

How did you handle that the first time? And we'll go more into the I wanna, but I'm curious about this. How did you handle that the first time you lost a patient like that in delivery, either a child or a mother?

Yeah.

And I know you can't talk about particulars, right? I know, but like—

Oh, I mean, I can tell stories. I mean, nobody, no names are gonna be said, right? So I'm trying to think about first time, you know, definitely like in residency, probably. I think the first time, whether it affected me, I don't know, because I was tired and I had my own babies to deal with. And I rem— I remember somewhat being scared of my own baby. And like the concern about were they going to be okay as opposed to anything else. And not to say that I wasn't, I mean, sometimes you have to emotionally connect or else you would go insane. I think because I was a resident, it wasn't, it wasn't my fault. I wasn't there. I wasn't, I mean, I was there, but I was more—

You weren't calling the shots.

I was not the responsible person. So I couldn't, I mean, I could feel sad for the situation, but I wasn't No, I wasn't feeling like just terrible because I did something wrong. But there was a time I remember first year residency, I was doing OB and the, and the attending physician, this is the small hospital still, the attending physician was at another delivery. And so I'm in the room pushing with, with this other mom and they started having where the heart rate decelerates and, you know, you got to make a decision and do something. And so we had This is, you know, beyond forceps time. So we had the, the suction cup thing basically that you could put on. And so, you know, I had done several deliveries with this suction cup, so I was like, well, you know, it's right there. The head's right there. I can put this suction cup on and help the mom get this baby out. You could see the heart rate going down. So I did it without the attending in the room. And we had some, he had some words for me after that because I was just an intern and I should not be doing those things. But the, the outcome was—

Right.

Good. You know, so I'm like, what else should we do? I mean, they were paging you and you couldn't leave because you were in the middle of delivering this other baby. Like, should I just have let the baby die or try to do something? Right. They didn't like me arguing that way, but— Yeah.

God forbid you should speak up.

No. So, and, and I think I was just really good at it. Like, so I liked it because it was, you know, that's what I wanted to do. Right. I wanted to be a midwife. I wanted to deliver babies. I was very calm. I mean, that's just my personality anyway. I was super calm. I wanted things to to happen as natural as possible. If they wanted to come and bring woo-hoo stuff and, you know, hey, can you olive oil my perineum? Absolutely.

Like, we'll do whatever you want to, you know, you want to sage the room, you know, like everybody should have their, they should bring olive oil and put it on the perineum.

Yeah. We didn't have bathtubs or all. Well, I would've been happy to deliver babies in the bathtub for them, you know? So we did have scary moments.

I'm sorry, but I was just, there was just a video that came across. It It was talking about clitoral stimulation during labor.

Yeah.

I'm like, okay, sure, why not?

Like, you know, let's see what happens.

Right? I don't know what could, what could possibly go wrong.

The best one was a mom who named their kid Charles and they called him Chuck because she literally vomited him out. So like vomiting is a really great, you know, I mean, huge abdominal pressure when you're vomiting and the baby just came flying out.

All this science and this is what we get down to is puking the child out.

Yeah. She called him Chuck. So I'll tell you, one of the scariest ones was, you know, this is when I was an attending and the small hospital we had, the anesthesiologists were not in-house. So we had to call them in if we were going to do a C-section. Well, that's really stupid if you're doing an emergency C-section and they're not there.

Yeah.

And so, you know, this was definitely an emergency. I mean, like things were going downhill fast. And so literally I'm like, you guys tell me what to do. Like, this is the first time this has ever happened to me. So I didn't have experience. With, I mean, I've done tons of C-sections. I've done, you know, plenty of deliveries, but we, we literally had to just use like lidocaine, you know, and we put like loads of lidocaine to numb up this mom's stomach.

Are you shitting me?

Cut in, you know, and then like basically she, she passed out at some point.

Yeah. No shit. Um, I'm about ready to pass out.

But I'll tell you that, you know, I saw her after, you know, after the fact. So the baby had to go to the NICU. Like this was definitely not, not a good ex— like how'd we waited even 10 more minutes, I'm not sure this baby would've lived. And the mom's life was not in danger. I mean, she was just in a lot of pain, but you know, there wasn't bleeding, there wasn't anything going on. And so basically doing a C-section with no pain meds, and I don't think they'll come back and sue me 'cause I don't do, you know, I didn't do anything wrong. Good thing. Yeah. But like, you know, the anesthesia guy later said, you know, like you could, you know, now we're using ketamine for everything, right? Like he's like, you could have used ketamine. That would've been safe for the baby where you could have Knocked her out without, uh, you know, respiratory concerns or anything like that. I'm like, I don't know anything about that. Like, I'm not anesthesia. Like, I didn't learn that stuff. So then I have a whole conversation with him. I'm like, teach me what I need to do. Like, I'm writing this down so that if this ever happened again, you know, we don't have to go through that. But saw the mom, the mom of this baby, and then her parents came for their 2-week follow-up or whatever. And I mean, they were just super grateful. Like they knew what I did and that it saved their baby's life. And she said she doesn't remember. So, I mean, she, her body did what it was supposed to do and checked out at that point. So she doesn't remember anything. Yeah.

Andrew, our second.

That was more traumatic than any other experience, you know? Yeah.

We were having, Sarah was having her second, Andrew, and we had a, you know, we, Megan's daughter, and then that was a C-section. And then we know that we're having a boy. And so we're like, girl, boy, we're gonna be done, right? We're in Pensacola, Florida. And Sarah's like, I wanna use a midwife. 'Cause I wanna have the baby vaginally. We're not gonna have any more children after this. Girl, boy, we're gonna be done. Right? And they go through like a couple of days of like trying to do inducement with Pitocin. Doesn't, you know, she'd get up to a certain point, then would stop.

Yeah.

Then we have to go home, do it, start all over again. So she's going through the delivery and all of a sudden, Andrew gets stuck in the canal and they had to cut her stem to stern.

Yep.

Uh, sorry, Sarah, you're never gonna hear this, but sorry anyway.

Um, yeah.

And like, I just remember her passing out, kind of. They cut her, she passed out, blood splattering everywhere. My son comes out and he's blue. He looks dead. Like he was not breathing. They had to resuscitate him. And, you know, he's been fine, right?

Yeah.

Theoretically, he's been fine, right? You know, he's a 28-year-old boy, who the heck knows? Or young man, I should say. But You know, I find it, we take, I think we take birth and delivery for granted.

Yeah. I mean, nature's amazing. And that's what, you know, when everybody says, you know, can you do home deliveries and all that kind of stuff?

You can do whatever you want.

You can do whatever you want, but I'll tell you that one moment. And that's like, you know, you don't have time to call 911 or get in the car and get there. Like it can happen as fast as what you experienced. Right. I mean, if they didn't, if they, and they did that type of C-section because They don't have time to go through the layers and do it the, the normal way.

Pulled out a pair of scissors about this big and cut her from her ass to her vagina.

Yeah. We gotta get it out.

Yeah.

And, um, you know, so, you know, at that point, like there's no, there's no time on the clock. It's just how quick, how quickly can we move? So those are the scary moments for sure.

When you were doing, when you were doing that, when you're delivering babies and Did you ever feel slighted that people didn't respect you when you'd be like, hey, we're gonna do a home delivery. And you'd be like, that's fine, but you know, we need to have a backup plan. And they didn't. Did you ever feel slighted?

Definitely. I mean, well, we didn't have, we didn't have midwives and stuff in our, in our practice or at the hospital. So we were not involved in any home deliveries. Okay. Or I didn't have any patients who were telling me that they were doing a home delivery. Now being on call, In the hospital, we would get people who were doing a home delivery with a midwife where things weren't going as planned or whatever. And then the baby would come, or the mom would come and we would have to intervene. So I do remember that scenario at one point where, I mean, it wasn't necessarily a bad outcome, but they had been at home with the midwife, like pushing for hours and hours and hours and no, no progress. And the baby was fine. And they came, you know, and I think we probably did some either forceps or You know, some, some intervention that helped, right? And then the baby's born, but it was having some respiratory distress. Like we didn't have to resuscitate or anything, but we're like, we need to take him to the NICU. Well, they were just, you know, because their birth plan is home delivery, like, you know, baby's going to bond.

Bond and lay on your chest.

Like, no, he's gone. I mean, they fought and fought and fought and they were so mad that the baby was in the nursery, you know, on oxygen and whatever. They're like, he's fine. He's fine. When are we going to be able to put him chest to chest? And he's got to breastfeed at some point. We're like, he needs to breathe for, you know, I mean, it was just, let's get this. I'm family practice. So now I'm the ped in the nursery just after I delivered baby in the, in the labor and delivery. And so that was one, that was just one time that I remember, you know, somewhat being involved in somebody like that where they were just mad at us.

Yeah.

But you know, yeah, it's, I find it, I find the whole OB-GYN lifestyle incredibly You know, they'd make fun of people who had a birth plan because they're just like, the second you have a birth plan, you're, you're asking for a C-section. Right. And they want cookie cut, just like we talk about cookie cutter medicine. They want obstetrics to be cookie cutter too. You know, like one of my partners, if the baby wasn't out by dinnertime, he was doing a C-section. It didn't matter whether they were progressing or not progressing. It's like, you know, he'd come and check them at lunchtime and he'd literally walk away and say, Set up the C-section room, call anesthesia at 5:00 PM. I'll be back if they hadn't delivered yet. You know, that's not nice.

No, that's not nice.

That's not fair.

You know, I mean, but in a way I understand it. I mean, they work insane hours. I mean, we have a new client. Her husband just was, you know, on call for the weekend. She goes, I don't talk to him for 72 hours. He's, he might sleep 5 hours the entire weekend.

That was her choice, you know, to some degree, like you chose to stick it out to a position. A position where you knew you were gonna be on call. You know, it's not like, yeah, you know, you work banking hours 8 to 5 and then people know you're closed, right? You can't close.

Sorry, it's Friday at 5. Cross your legs. We'll see you Monday at 8.

But he did a lot, you know, and you'd talk about the C-section rate and all that kind of stuff. So, so another time, it's not that much more, that drove me absolutely insane. This is where you can really get into the common sense of stuff, right? So we'll do a C-section for nothing, you know, just absolutely nothing. Like we're, you know, and they're very safe now. They used to be not safe.

Right.

But they're super safe. So there's no issue there. Then we get mom who has, you know, bad insulin-dependent diabetic, very, you know, she was 5'0 and 300 pounds. And so very unhealthy mom to begin with. And we sent her off to what they call maternal fetal medicine, which is like the specialists of OB, you know, so they could monitor her. And they actually recommended that she terminate the pregnancy.

Really?

I can't remember if there was some—

Some other underlying—

Genetic, you know, chromosomal defect or something. Um, there was something wrong, not just, not just her health. I mean, Something else was wrong and she chose not to, and that's fine. And so, you know, we went through, well, the baby had a, what we call a fetal demise at like 32 weeks. So, you know, she comes in for her regular checkup and there's no heartbeat.

So she has to deliver.

So she has to deliver. I'm like, cut the thing, cut it out. Like, why are we going to put her through hours? You know, at 32 weeks, her cervix is closed. There's no, so we go through the same process that we would for an induction. Right. So we're trying to You know, Pitocin, and we do vaginal Cytotec is what it's called, where you're trying to soften the cervix up. And, you know, I mean, this is like 3 days of her in the hospital, like with a dead baby inside her, trying to deliver this baby vaginally. So by the time it comes out, it's peeling. It's just, you know, I mean, it's, it was awful. And I'm over here like, we could have done a C-section on day 1, been done in less than an hour. And she recovers and everything's fine. Well, there, and the argument is that the risk to the mom of that surgery is too high.

Right. The thing to me about that, because I had a partner that she, her second child died in utero, same thing. She had to deliver the baby. And all I could think of is there has to be a chemical thing that is going on. I'm sure there is. You'll probably tell me that, that process of what the mom is going through, what the woman is going through of the stress, or not the stress, but like the energetic to push the baby, you know, to go through labor and delivery. And then there's that excitement, right? Of like, oh my God. And then there's that dopamine hit, right? And then they, there's that bonding moment, but you go through all of that and then there's none of that. That's gotta be incredibly—

Absolutely awful.

I know that this, uh, Former girlfriend of mine or partner of mine, she, that, you know, she just like, it was—

It's very traumatic.

It was, it's unbelievably traumatic.

Um, I mean, I've luckily, I've not experienced that personally, so I don't know, you know, the difference between that, like, you know, a miscarriage at an early age. I mean, it's all exciting and fun, right? I mean, or exciting to be pregnant. And then, you know, if you miscarry at 8 weeks or miscarry at 11 weeks, I mean, it's still going to be It's painful. Traumatic. And, and, but I think that would be awful.

My sister lost one at like 30 weeks or whatever, you know, like 28 to 30 weeks or something like that and had to deliver it. I just couldn't imagine. Once I, and granted Sarah just had, Sarah had 3 C-sections, so we never experienced a vaginal delivery, but that, but that joy, like even when the baby comes out, You know, even though your freaking uterus is sitting over here, right? Yeah. But the baby's still on you.

So there were definitely, you know, the downtimes for sure.

Yeah. So how did you then— so I'm really curious. So when did the light bulb start to go on for you about women's hormone health? When did that— so you're in this space in 2006. When did this start to kind of Kick in.

So, I mean, I did it because I loved obstetrics, right? And then it was like, okay, by the way, when you're not delivering babies, you have GYN day. Mm-hmm. And so GYN day for me was all pap smears and, you know, nothing better than, boy, nothing passes a day like 20 pap smears. Um, lots of annual exams and then an occasional, I, I mean, I didn't get the complicated GYN stuff that needed surgery, you know?

Right.

Those went to the surgeons, but You know, I got the teenagers, the irregular bleeding, you know, that kind of stuff. The, the menopausal women either on hormones and I'm like, you need to come off. So, so this is women's health initiative, right?

How many times did you have that conversation? Do you ever wanna call 'em all up and just be like, say, I'm sorry?

Well, it was right in that Premarin was causing a lot of problems. And so we definitely wanna get people off Premarin and Prempro. But you know, the whole just all hormones are bad thing was a little Over the top for sure. So the Women's Health Initiative was like in 2000, 2002, somewhere in there. Mm-hmm. So I was in medical school at the time. And so, you know, I remember being in some auditorium where this announcement came out.

And tell everybody like, what's, tell everybody what the Women's Health Initiative is.

The Women's Health Initiative basically was a study that the Women's Health Initiative was doing with regards to women's health and hormone replacement. Mm-hmm. And they were studying Premarin and Prempro. Which Premarin stands for pregnant mare's urine. And so it was the hormone replacement we were using at the time that went way back into like the 1950s was when Premarin first was introduced as hormone replacement. And it's funny if you go back to the, the history of like the marketing of that and you know how they got away with like being patented forever and ever and never went generic. And I mean, it was very political and money, money involved and stuff like that.

Oh my goodness.

Yeah. And maybe that's why the Women's Health Initiative was studying them. I don't know. But anyway, so what happened is they actually stopped the study earlier than the planned— I think it was supposed to be 7 to 10 years, and they stopped it like 3 to 4 years. Because what they were finding is that the— in their research of women that had been on Premarin— or Premarin happened, you know, 2002, basically. I was in medical school. And so Women's Health Initiative was studying Premarin, which is pregnant mare's urine, which is what we were using for hormone replacement.

Mm-hmm.

replacement, basically. And there's some really interesting marketing. Like there's articles that show like, you know, if your woman's having menopause, like, you know, we have the cure for it or something like that. It was all directed to men.

Right.

Because women were at home. They're—

Women weren't making medical decisions. Yeah. It was like, the man's like, why don't you go do this, honey? You're, you're being a bitch.

No, like my grandma, um, was 89 when she passed away several years ago, 10 years ago now, but she was on Premarin for a long time and they said it was just for her bones. So for years and years, we were putting women on it without symptoms, just for—

My mom was on it.

Bone protection.

I remember my mom being on it.

Which makes total sense.

Yeah.

That was the one good thing that Premarin did have. So in the positives, it was decreasing the risk of osteoporosis and decreasing, you know, fractures. But then it was doing all these bad things with heart disease, stroke, and breast cancer. Women were dying. And so the Women's Health Initiative came out and said, you know, this should be stopped, like you know, you need to take women off of it. ACOG, which is American College of Obstetrics and Gynecology, says, you know, use the lowest dose possible for the shortest period of time to get women through the menopause.

Get through.

Get through. Yeah. So, you know, 2 years maybe, you know, some of the flashes, like, we'll just— well, you know, because it just, you know, if you put them on it and you take them off of it, then they're just going through menopause again.

Like, you're just delaying it.

Wean them off. You got to do something right. And so nobody was really looking Deeper outside of that one statement that, okay, Premarin is helping with osteoporosis, but they weren't really looking at any other, you know, sort of benefits. And it's like when you, when you start, I'll go back in a second to, you know, when I started really looking at hormones differently. But now, you know, like literally what's today, Thursday? On Sunday I'm presenting. We're, we're both presenting at the same conference.

We're both gonna be in Dallas. Are you on the 5? I get to go.

I get to go before you.

Okay.

Good.

Warm 'em up.

We're— so I'm presenting actually on the chronic diseases associated with hormone decline.

Mm-hmm.

And so, you know, this is not just about I'm having a hot flash symptom or I'm having, you know, vaginal dryness or, you know, I'm emotionally crazy when I went through menopause or whatever the case is, but literally talking about as hormones go away, the risk of bad things happening goes way up. And, you know, it's like, At age 50, what do we tell everybody? You know, I'm in family practice, so we're all about preventative health. So our job when you turn 50 is to say, have you had your colonoscopy? Have you had your, you know, your mammograms yet? Are you getting, you know, whatever the screening that was supposed to happen at age 50, right? Well, what happens at age 50, that's when our hormones go away. Like for both men and women, really at or around age 50 is when menopause and andropause happens for men. And so nobody's putting two and two together that, that like these risks are going up because our hormones are going away and we're not doing anything about it.

Mm-hmm.

So it was driven for a long time as just symptom, you know, symptom control. So if we can't—

No correlation. Give you between the fact that my hormones are dropping and my health risks.

Correct. Yeah. My cholesterol goes up. Okay. Here's where we can get fun.

And I've experienced that. Keep going.

And here, this is what I think is the funniest thing. So, so I'm in college and you have to take biochemistry for, you know, if you're gonna go to med school, you gotta take biochemistry. So I got a C in Biochem 1 and Biochem 2 and college and like, that was devastating cuz you know, I'm trying to get into med school and like getting a C on your report card is the worst thing ever.

You should've seen mine.

Anyway. Yeah. Whatever. I survived and then go to med school, got a C in biochemistry. And then every day, all day long, all I'm doing is biochemistry. Like, cuz hormones are all biochemistry. Mm-hmm. And like, not everybody might picture that and see that, but like when I didn't have something practical to put it into, I couldn't do it. You know, I'm over here like, I don't know what these letters and sticks and all this stuff is. But now I picture it, you know, I'm got, I've got the steroid hormone cascade on my screen in my office.

Mm-hmm.

And I'm, I'm explaining this to patients all the time. And so at the top of this hormone cascade is cholesterol. And then it goes into 2 places. It goes into progesterone and it goes into DHEA.

Mm-hmm.

Which then filters into estrogen and testosterone.

Mm-hmm.

And then progesterone and cortisol are on the same side over here.

Mm-hmm.

So What's fascinating is that as your hormones start to go away, your body goes, hey, those were really cool. Can we have some of those back? And so it sends signals to make more. So what does it need to do? It needs to increase your cholesterol. So we're getting high cholesterol, not because, I mean, you could get high cholesterol because your lifestyle sucks and you're eating McDonald's and pizza, but you could also start getting high cholesterol around age 50, 45, somewhere in there because your hormones are going away and your body's going, those were protecting us. We should make more. Mm-hmm. And then the signal, because we don't then have the signals from our ovaries or testes to turn that cholesterol into actual hormones, it just stays up there for a while. So you now have high cholesterol. So we can actually treat high cholesterol by putting people on bioidentical hormone replacement. And I see it all the time in men. It is perfect and beautiful. Women are a little bit more complicated.

No shit. Really?

Really?

Yeah.

Geez.

Newsflash. Well, I'll tell you a funny, interesting story about that. So I was 42, 43, and, you know, we had survived the Great Recession and Sarah got a job working in the hospital. So we had healthcare, right? So I'm like, well, you know, I'm going to go get my annual physical, right? And I go get my annual physical and, you know, they do the blood work and everything and it comes back and I'm 43 years old and I have high triglycerides and high cholesterol. I can't remember the number, but maybe my cholesterol was 225.

Yeah.

My tris are always, has always been starting in my 40s, have always been historically high. And so of course, you know, he wants to put me on a statin and I'm like, I don't want to do a statin. I just didn't want to, I didn't know what statins were horrible at that time. This was whatever, 19, whatever it was, 90, 2000.

Just intuition.

I don't— 10, just intuition. I'm like, this doesn't make sense. Kills rats. So I, he's like, go, go eat low fat. So of course I eat low fat, which then makes the number go up even higher.

Right? Right. 'Cause you're eating high carb.

'Cause I'm eating high carb. Duh. So anyway, then I wind up owning the clinics. Okay. And he puts me on a statin. So I'm like 45, right? And I'm going to the gym. I'm like, my legs hurt and all this stuff. So then I own the clinics, 47. We do, we decide we're gonna start offering testosterone therapy, HRT. We don't, clinic have been open 6 months. I do, I'm, I'm patient zero. We do my blood panel. My cholesterol's like, I swear to God, my cholesterol My cholesterol's like 3-something, something stupid like that.

Yeah.

My triglyceride's like 4-something and my testosterone level is 92.

Yeah.

And my DHEA is like no vitamin D. Like my vitamin D is like nonexistent.

Yeah.

And my DHEA is like both of all nonexistent. And this was back in the day.

Things that regular doctors don't, still don't look for. Right.

Oh, and this was, this was 2014. Right. So like back then HRT was like You know, take some DHEA and do like a shot once a week kind of thing. Right. So, and, you know, take some, you know, pregnenolone, I think. And anyway, I start testosterone and DHEA and vitamin D. I come back and get my blood work done 4 weeks later. My testosterone level's 750. My cholesterol's 215. My triglycerides or whatever, it was like 190, whatever the number was. It was a significant drop.

Way better.

And all I did was vitamin D, DHEA, and testosterone. And I start reading the literature then. So I'm not anywhere near where I am today, like in understanding all this. And so I start reading the literature. I'm like, son of a bitch. DHEA is like the magic. It's like the magic drug to a certain degree.

The caulk that fills in the cracks.

Yeah. I called it the sticky. I wrote marketing pieces around it because this is back in the day when like, oh, testosterone's bad. Men shouldn't do it. That's just the natural progression. I'm like, If you got a '67 Mustang and it needs a new carburetor, you're gonna get a new carburetor in it. Like, come on, let's do this. So I start writing marketing pieces about it. And what I did was I called DHEA is the magic elixir. And what it does is it makes the cells sticky so it can receive the testosterone that is floating in your body. Now I know that's not 100% medically correct, right?

They all work together though.

But that, that thing right there, guys went Okay. That makes sense. Right. And we saw the same thing because we would check, we would do their lipid profiles and we saw it's just, isn't it? Does it piss you off?

Yes.

How badly?

This is when I say I'm embarrassed to be a doctor because it's just like common, you know, I mean, some of this stuff is just common sense.

Well, you know what Mark Twain said? The problem with common sense is it's just not that common. So anyway, I interrupted you. What you say is common sense.

No, I mean, you just start thinking about, you know, Like in hormones, it's like okay, we can talk about bioidentical in just a second. It was like bioidentical, you can't control that. You know, it's not what da da da da. You know, so we're just going to put somebody on this for the shortest period of time. Like well-known things that we know cause harm to people, but we're okay with saying yes to that, but saying no to this that you know also has plenty of studies that say it's actually way better. So you know, I mean the first. So let's go backwards for a second. So 2008. So I've been in this practice 2 years, you know, trying to deliver all these babies and do whatever kind of women's health I can make up at the time. You know, I had, you know, I had partners down the road and down the hallway. You know, I go ask them, what do we do? I remember having drug reps come for lunch. I mean, this is back when they brought really good food. Yeah. And we had lunch and we would have our sample closet and it's just like Evamist. Do you ever remember Evamist was this—

What was Evamist?

Pump. Estrogen, estrogen replacement pump. So we started getting all this on right here on your arm.

So it was like, wait, you would have a pump right here in your arm?

Well, not a pump. Like it was like a little device where you stick it on and you would push the button and it would, it would dump, uh, you know, an appropriate amount of estradiol. And so, so when the Women's Health Initiative came out, you know, of course the Premarin reps coming in, like, you know, it still helps with osteoporosis. They're just dying. Nobody wants to use it anymore. But, you know, all these other reps then are coming out with all the, the healthy ways to, you know, use hormone replacement. And so Evomist came out and it's, it's still dosed, you know, like Androgel for men is dosed like way high. And Evomist is dosed, you know, probably 4 or 5 times higher than what actual estradiol—

'Cause what they just want you to get like a bump and then you have a decline, then you peak the palate.

Well, they're also mountains and valleys. This is where we can get into the science. If you're putting topical hormones on, you can't really measure them in the bloodstream because they don't show up. Like, they're going into your blood— I mean, they're going into your skin, they're going to go where they need to go, and then they, they don't show up in your veins, which is the leftover blood after it's already gone somewhere. And so they're dosing based on blood levels, and so you have to get the dose really, really high in order to actually see it kick up in the blood. So like testosterone in men, if you're doing injections, it's fine because it's going, you know, you're going to measure it in the bloodstream.

Mm-hmm.

But if you're doing anything topical, you have to measure it either In saliva or urine. So blood testing for topical hormones does not, is not accurate. So you're going to way overdose somebody. So that's what I was seeing. Well, I didn't know it at the time until I started figuring it out and learning. So 2008, I call this divine intervention of whatever sort, universe, whoever.

Whoever's calling the shots.

So my sister, my half-sister, I guess you call it, was in San Diego at the time. And she was getting married in October of 2008. And I happened upon one of those mag— you know, this was way back when we actually had magazines that we read. And there was an article for this conference. It was called Practical CME and it was a GYN, interestingly lives about an hour and a half from me, but we met in San Diego and he was a GYN who was teaching about bioidentical hormones and hormone replacement. So he had a conference in San Diego the same week, weekend that my sister was getting married in San Diego. And so I said, perfect timing, I'm going to go to this conference. I think it was Wednesday, Thursday, Friday, something like that. I missed whatever day was happening on Saturday to go to this wedding. And then, and that was on natural hormone balancing, uh, natural weight loss solutions. That's back when HCG was very popular. So I learned all that HCG.

Good stuff.

Came home, put everybody on HCG diets.

Great stuff.

So that was my first introduction to saliva testing for hormones, adrenal, looking at thyroid in a different way than just TSH. Like I had never been taught any of that stuff. Like the only conversation I remember having about anything to do with adrenal was something about Addison's, you know, like in medical school. Like I had personally never seen a patient with any, you know, severe either Cushing's or Addison's disease or something like that, which was like Textbook adrenal dysfunction.

Right.

But I had never, never heard about testing for cortisol levels, you know, actually measuring hormones. Like, you know, and I remember kind of asking like, why don't we measure hormones? Well, you know, we're just gonna put them on birth control or whatever. Like you don't really have to measure them. You just go by their symptoms. Like you just put 'em on something and if they're good, fine. If not, increase the dose. Like that was literally the brain. One of, one of the guys That taught me how to do hormone pellets. So I did pellets for a while in my practice in, in the OB-GYN office. We were doing pellets and I mean, it was like we didn't even measure blood level. It was just like, did one work for you? How long did it take?

Really? So you were just—

Oh my gosh. That's how I was taught.

Oh my God.

So I just—

so you weren't measuring at all? You're like, let's start with 2 pellets and see how it goes.

Give 'em one. So the first one was give 'em one. This was estradiol. Give them one. And literally he would be like, if they come back around 3 to 4 months, wait for them to make their appointment. If they come back around 3 to 4 months, one was good. If they call at 2 months, then one was not enough and they need 2. If they go all the way to 6 months, they can decide, do they want, you know, do they want to want them to last for 6 months or do you want to decrease the dose to get them into the, you know, 3 to 4 month cycle? That was the conversation. That's how I was trained to hormone replacement when I was in residency.

Okay. Do you ever just like— so we're driving to the airport today, right? We're driving from LA to the Santa Monica Airport, flying here today. And I was like, where does the phrase blow smoke up your ass come from? Yeah.

Okay.

So of course I've gotta go over to Perplexity and look it up, right? So it comes from England in the 1700s and the 1800s, and people would apparently fall into the Thames River and drown all the time, right? And so what they would do is they had all these things along the Thames, and they were these cones with tobacco. And what you would do is you would light the tobacco and you would blow smoke up people's ass. And the thought was the nicotine would revive them. This was a practice that went on for like 100 years.

Somebody that's already dead and they would try to—

Yeah. Now you think after like 100 times it not working, you think you would've been like, maybe, maybe this isn't a good idea. Like, I just get cracked up at the things even today. Like, let's just put one in and see how it goes. Yeah. Like the shit that we come up with.

There's no sense.

About how How we're gonna like, how we're gonna like, let's just, it's just, it's such bullshit. It's like leeches. Let's, let's let 'em, let's bloodlet 'em. We'll get better.

See what happens.

Yeah. Kill the president of the United States that way.

There was literally, you know, I mean, and, and hormone replacement was like, you know, this is the, the algorithm was, do you have a uterus? Yes or no? You know? So if you have a uterus, then you should get estrogen and progesterone, which was really a progestin, which is the opposite of progesterone. We can get into that science. Or if you don't have a uterus anymore, then you just need estrogen and nothing else. And then really—

So they would just say, just give the guy testosterone. Just give the guy estrogen.

No, this is for, this is for women.

Oh, for women. If they don't, if they'd had a—

okay.

I'm sorry.

I was in the GYN world.

I was— Yeah. I'm sorry.

You gotta remember, you gotta leave breadcrumbs for me. So I started doing man clinic on Friday afternoons. We all, we closed the office on Fridays. In the OB-GYN office, I had man clinic because I started seeing men for hormone replacement. 'Cause I was doing hormone replacement on all these women and they'd be like, do you do this for men? men too, or the HCG. I was doing, you know, a lot of weight loss.

Yeah, no, HCG was great.

And then, you know, people were sending in their, their husbands to get HCG or to get hormone replacement. And so I'd opened up man clinic on Friday afternoons in the OB-GYN office. So anyway, no, this is women's health. And so it was uterus yes or no, meaning they had—

Just had to make sure it was clear.

I'm like, that's why they had Premarin and then they had Prempro. And so Prempro is the one that, you know, technically So here's the theory behind this is that you need this progesterone to protect the uterine lining from overstimulation of estrogen so the estrogen doesn't cause endometrial cancer.

Okay.

So what happened is that it was doing that job. So, so the progestin, which is a synthetic progesterone that we were getting, sits in the receptor but doesn't allow regular progesterone to get in. And so it's basically blocking all the good progesterone receptors. It's also blocking estrogen. So it's doing its job by not, not causing endometrial cancer. Mm-hmm. But, but by the way, this is the study that showed increased risk of strokes and breast cancer.

Right, right.

So it's not protecting the breast tissue from the overestrogen and it's not protecting the cardiovascular system. Progesterone is fabulous. It's anti-inflammatory. It does all kinds of good stuff. For your brain, for your heart, your skin, your hair, your mood, your sleep. I mean, it's just the magic hormone really. And so, you know, we were depriving women basically of that because we were giving them anti-progesterone basically when we were doing that. And so, you know, that's kind of the theory is, you know, do you have a uterus? Yes or no? And so this is the drug I'm going to choose. We don't need to test for anything because you're, I mean, we could test you, but your hormones are going to be low if you're menopausal. What's the point of testing? And it was completely just driven by symptom control and nothing else. So, you know, then you would say, well, hormones are good for your bones, you know, so you should just be on it whether you have symptoms or not. So what was happening is I started, I was seeing a lot of women that were having like what, what we might consider non-traditional hormone symptoms. So a lot of sleep issues, a lot of fatigue, you know, weight gain, depression, mood, you know, mood type stuff, that sort of thing. And so these band-aids for You know, sleep aids and antidepressants weren't working. You know, I mean, that's what happened is like women were going to the nuthouse when they went, you know, when they went menopausal back in the '50s, '60s, whatever. I mean, it was just, you know, your mom went crazy. Like there was no—

I remember.

You know, and they didn't have antidepressants back then. So they really didn't have a whole lot of good support for these symptoms. So literally like in, in the OB-GYN world, I mean, I make fun of it now, but it's like we You know, our 2 drugs were birth control and antidepressants, you know, made—

What a combination.

Yeah. You know, then it was Nuvigil came out or Provigil. So if somebody was tired, you know, that those were drugs for narcolepsy, but they started being used, they're amphetamines. And so they started being used for just to help people with energy and to get through the day. This kind of before ADD and Adderall kind of came out as adults, right? In kids, we were using Focalin and ADD and whatever all the time, but not in adults. We just used NuVigil, which was the same thing. Um, you know, I mean, we're just drugging people up.

So when did you— okay, so when you, you were just, so you're just kind of making this shit up.

Yeah.

Like, so when did you start to be like, there's no rhyme or reason. So maybe we should do like a urine test. Maybe we should do a blood test. When did that start to kick in?

So this was October of 2008. Yep. I go to this conference and I was introduced to saliva testing. And I mean, I literally talk about this all the time. I'm like, it felt like this Alice in Wonderland experience of going through this tiny little hole into this like entire world of, I don't know, like I just picture jungle, you know, blues and reds and I don't know, like just gorgeous.

And you didn't even take psychedelics when you got all that.

Yeah, I mean, it was just that, that's my, my description, this visual of like this aha moment of like, wait, like we could actually see what's going on with people. And so, you know, I come back And I remember a patient, Teresa, her name. I mean, I had given her everything under the sun. And so I sat down with her. I said, hey, I just, I just learned this new thing. Like, bear with me, but will you do this test? You take it home, you collect these samples. And so, you know, people that are starting now, you know, we teach a lot in BHRT training academy, whatever. And they're like, I still feel like I don't know what to do. I said, I called that lab every day for 9 months. You know, I mean, like if I did a test on somebody, I called the lab and said, here's my patient, here's their lab. What do I do? Right. Like I didn't have BHRT training. I mean, I didn't have anything, you know, sometimes I might've emailed the guy that was there, but that, you know, that's, I self-taught basically because I, I mean, the lab taught me, but like I did a test and then I called and said, right.

What were the numbers? Yeah.

And I remember using one, one lab. There were a couple of different labs that were doing this at the time. And one lab, what would happen is that the doctors that worked for them, I think they were just spread out all over the place. And so they were very inconsistent in their responses. You know, they were, they were all different in what they were saying. And, you know, some of them could prescribe, and so they would tell me the prescription, but some of them were like naturopaths or, you know, some— not, not that naturopaths are bad, but like they were in a place where they couldn't prescribe.

Right.

So then they're giving me all these supplements to try. And so it was just like all over the place. And then I started Again, kind of not really scientifically beta testing, but then I would do a different lab to see what was going on. And when I called this lab, they were very consistent, you know, like it wasn't cookie cutter necessarily, but it was like they had a protocol and they said, when this, do this, right? When this, do this, like it, and it just kind of, it fit my brain. It fit, I could visually see what they were talking about. And so then they had a conference. Probably that following spring. And I ended up going to that one. I think they called it Advanced Hormone Workshop or something like that. And so I ended up going to that one for Labrix was the name of that company. They're now bought out by Doctor's Data. And, and I went to that conference. I mean, if they had a conference, I was there. I mean, I was like, yeah, that's the way you are too.

Once you get something, you like, you consume it.

And they started doing like neurotransmitter testing and then they would talk about gut health and all this stuff. And so I got to the point where I went to their conference so many times that they invited me to speak because I was doing, I mean, I was like the highest—

Sounds familiar. I see the pattern.

You know, the highest customer. Yeah. I mean, I was like, you know, everybody used to be little brown boxes. And so I said, nobody walks out of my office without a brown box. I mean, I'm just like, everybody needs a saliva test. Like you can't function without like everything revolved around—

And this was 2008 up to like '09, '10.

Yeah. So I'm doing this in the OB office and they were receptive to it. Like they would send, you know, even my partners were like, hey, I did this saliva test on my patient, you know, can we look at it together and whatever. So like they were, they were picking up on what I was doing.

Was all this covered by insurance back then?

Yes.

Oh God.

So we could bill, yeah, we could bill saliva tests because, well, until the insurance figured out. So what, what happened is that the, the code for an assay for estradiol It didn't matter whether it was saliva or blood. They didn't know, you know, I mean, it's just one code that says, what's the level of estradiol? So what happened though is that when we started charging for 4 cortisols, because when we measure adrenal function, we measure 4 cortisols a day, and then the insurance would go, why are you doing this 4 times? Is that a, is that a typo? Is that an error? We need to know why. Then they had to say, oh, well that's a saliva test. And you go, oh, well we don't we don't cover saliva testing. And so then it was like, you didn't even know it was saliva test until we told you. So that took, that took a few years for, for them to kind of figure things out a little bit. But it was, you know, in when I opened my practice in 2011. So this was 2008 when I started doing this. I was, you know, doing a lot of hormone stuff, delivering babies, living the dream. Then the OB-GYN office brought in a consultant to evaluate the practice and just say, where, you know, where are we? We need, we need some help with our numbers and whatnot. And the consultant was also there to help value whether the hospital could come buy out the practice or not.

Got it.

And I didn't really know that when they first came in, but, you know, it wasn't a secret or anything, but I realized, you know, later when they came in, they said, okay, well, here's where we're seeing where, you know, Your, your, um, accounts receivable is whatever percent.

Whatever it is, yeah.

All these numbers I didn't really care about at the time. Like, I didn't know anything about the business of medicine back then. And so, you know, they were like, I think it makes sense for you to get bought out by the hospital. So the partner, the, the main partner was, was responsible for that. And so he's like, I think this is what we're gonna do. And, um, that, that consultant I worked a lot with him because we were, you know, in the office together for whatever couple weeks that he was there. And we went out for Mexican that night and he said, I think— and I was just like, I'm not doing that. Like, I— this is—

Yeah, I'm not gonna go work for the hospital.

I'm not working for the hospital. I don't know where they're gonna put me. I'm family practice and OB-GYN. Like, are they gonna put me in the family practice place? Are they gonna even keep me? Like, I don't, I don't know. I was just— that was not my thing. And I was doing all this alternative stuff at this point. So 3 years I've been Doing saliva tests. And you know what, now I, now we have supplements in the office for DHEA and adrenals and gut health stuff. I'm doing stool testing now, things like that. So this is like me dabbling in functional medicine stuff. And so I've got literally a shelf in my office with supplements that I'm buying with my own credit card and, you know, selling 'em to patients.

Huh.

'Cause this office didn't have any, didn't have any money. So We didn't have a credit card that I could buy. I mean, the OB-GYN office is going downhill anyway, which is why they're gonna get bought out by the hospital system. Right. And so, you know, he said, well, you can do it. Like, why don't you open your own practice? And I was like, are you kidding?

So were you in, were you still in Anderson then?

Were you still in Anderson?

Seneca. In Seneca. Okay. 7 miles south of where you are now.

Yeah. So that was just this crazy idea and I was just like, how do I even do that? And he says, well, you hire me. So it was $25,000. To hire him to—

To get accredited.

And he opened my practice. You know, he had the checklist of here's all the things you do if you're gonna start up your practice. So, you know, we started looking for locations and had to— had— he did it all. I mean, I didn't do anything, but, but, you know, I had a business plan. I went to Wells Fargo, got a $300,000 loan, you know, announced to my partner that this is what my plan is. I'm not gonna be bought out by the hospital. I'm gonna open my own practice. And it was amicable. I mean, like, yeah. He didn't care, you know, I mean, he cared, but like, right, he was fine, whatever. So that was, um, my practice was going to open October of 2011. And my plan was that it was a 5-day work week. So I was like, I'm going to work 1 day a week, you know, in my practice over here and keep working for you and call for month 1. Month 2, I'm going to do 2 and 2. And then month 3, I'm going to be 1 day a week here and 3 days a week in my practice. I guess it was 4 days. And, um, and that was the plan. And so I, you know, I said, go, we're gonna open everything up. And—

What was the scariest thing for you once you opened the practice? Like, you know, there's the honeymoon stage, right? Like, I have my own place, this is great. I write my own paycheck. And then like, you know, week 6, like there's no money in the bank. Like what?

Yeah. I mean, it was definitely because here's, here's the scariest, well, scary, scary part is that My husband at the time was my office manager. Don't do that, number one. I mean, you know, there are couples that work well together. That did not work for us.

It's rare.

But, you know, he was actually a stay-at-home dad. So by this point we have 4 babies. Baby number 4 was 1 year old. So she was born in 2009. So in 2010, when I'm having this conversation about, I'm going to, I'm going to think about opening this practice or You know, she's 1.5 years old while I'm doing this, like, 'cause I have nothing better to do, right? Yeah.

The oldest is what, 8 or something like that?

Yeah.

Yeah. So, uh, and you were insurance with a little bit of cash?

No cash at all.

No cash at all. It was all insurance. All insurance. Everything being covered by insurance.

Basically family practice with hormones on the side.

Okay. You know, when did the hormones become like the primary thing?

I mean, it was the primary thing. I mean, I, I opened it and the name was Carolina Integrative Medicine. Like I'm doing integrative stuff with hormones, whatever. But I'm primary care, you know, I'm doing all the sick visits, I'm doing all the annual exams, you know, still. And then I thought I'll still deliver babies too. So, you know, I added that onto my malpractice on top of that thinking I could still do this. So I had like 8 patients.

God, you are making all the classic mistakes, right? Well, I'll do this just in case because I can make a little bit of money and I'll help.

Well, no, I just wanted to deliver babies.

Okay.

So that turned into a problem with my marriage because it was, You know, my job at the OB-GYN office to be on call and deliver babies. Once I opened my own practice, that was fun. And that was volunteer. Like I didn't have to deliver babies. I just wanted to, but yet I still had to be on call. So the, the agreement or the arrangement that I made with the family practice residency program that I left was that I would take call with them. So I left the OB-GYN office, you know, shut, shut, burned bridges there. Because, you know, this, we can just keep going on forever. Like how much time do we have?

No, I mean, so anyway, so yeah, let's, so I opened my own practice.

I had this whole plan for like 3, 4 months. This is how I'm like my exit strategy to kind of support, you know, I still needed a paycheck from the OB-GYN office until my, my practice gets up and running. And so that, you know, that was the verbal agreement that I had with, with my partner who was the owner of the OB-GYN office. So when I went to the lawyer and I had this written up and I said, okay, so We need a decision about how I'm gonna get paid. Do you wanna pay me by the day? Do you wanna pay me by, you know, patient revenue?

Right.

You know, however. And so, you know, I went to the lawyer, I went to our accountant that we used and said, you know, tell me how, you know, how we would divide this up. And so I had paperwork ready to go. I just need you to sign this cuz it's time to, you know, time for me to go. And he wouldn't sign it. I wanna talk to the accountant. I wanna talk to the lawyer. I wanna do, you know, I wanna look at it again. So 2 weeks, I, you know, went by. I'm like, okay, you know, it's time. Did you look at it? Did you look at it? No, I'm not sure that this is fair. You know, whatever, whatever. And so I just—

You just went cold turkey?

Friday afternoon, I went and got all my shit and I said, I'm done. And so I had to call the hospital, you know, I'm no longer on call for OB-GYN. I left and he had different story about how I abandoned and whatever, whatever. And, you know, so I had to, I had to have lunch with the other partner because she was pissed off at me because now, you know, she's having to do every other day call instead of every 3, because I'm like, I'm not taking call for you guys. I'm out. Like, I— You're not going to pay me. I'm not going to— You're not going to pay me. Yeah, it's not, I can't do this. So he did not follow up with our original agreement. So that was scary. 'Cause I mean, I just, yeah, it was scary.

So all of a sudden, cold turkey, your husband's a stay-at-home dad. You got 4 kids ages 8 to 1 or whatever.

Yep.

And now you've got no paycheck.

Yep. $300,000 loan.

$300,000 loan.

You can't pay yourself with that. I mean, there's significant rules about like you had, yeah, I didn't know anything. Right. You have to go like ask the bank for, I need money for this and I need money for that. And you had to, I mean, it wasn't like you just got $300 given to You got $300 line of credit basically, and you had to ask for payoffs.

When did you make the full move and completely get rid of all insurance and just go full cash?

That was 2021, 2020.

You did that for the better part of 10 years. And did you try to do hybrid?

A little bit. So I, so then I learned, uh, 2017, one of the drug reps actually from Zymogen kept telling me, he's like, you need to do like these wellness programs. You know, there's people out there doing these things. He's like, you probably know Michael from Zymogen.

Oh yeah, yeah, yeah.

He lives in Charlotte.

Yep.

So he'd been telling me and I'm like, I don't know what that is. You know, I'm just like in my own bubble of like crazy and I don't have time to do anything else. Right. And he's like, they take you to Texas and they tell you everything about it. Like you should just go to Texas and check it out.

Right.

And like he just kept telling me about it cuz all these Charlotte doctors were doing it.

Was Deb doing it then too?

Yep.

Yeah.

So she's probably 2 years ahead of me. Okay. And so, you know, finally I went. And so basically it was another eye-opening experience of packaging your services. You didn't exist at the time. And so it was, you know, sort of coming to what I was already doing, trying to piecemeal it with, you know, visits every 6 weeks. And I was always behind because I have so much to talk about. I couldn't do a 20-minute visit.

Right.

And so I'd be—

And you're still trying to get all this paid for by insurance.

I'm trying to pay by insurance. You get, you know, $38 for whatever.

Wow.

I had 2 practitioners at the time. I had 13 employees. I had 3 people at the front desk just answering the phones. We had 3,000 patients. So, I mean, it was, you know, from that it looked very—

The perspective, but little did they know you're like—

We weren't paying ourselves. Yeah. Sweat and payroll plan, you know, paying, using this credit card to pay this credit card to move this stuff around. You know what I mean? It was just, it was awful. So then from that OB-GYN office, what I didn't know, so he never got bought out by the hospital system. 18 months after I left, he shut the doors.

Wow.

And just moved to Kentucky or, you know, took one of the OB-GYN recruiting jobs in Kentucky. So while I was there as a partner, we got a loan for the practice. So when he shut the business down, went, the building went into foreclosure, there were multiple loans throughout the history of that practice. So, when the building went in foreclosure, they got, you know, pennies on the dollar for it, went through and paid the oldest loan off first. And the loan that we had left had $109,000. They came after me for it. I'm like, I don't have $109,000. Where are you going to find that? We had a personal guarantee on that loan. He's in Kentucky. They don't come after him.

Wow.

So, they're coming after me. I get a lawyer. What am I supposed to do? They're like, you know, you don't have any assets. Like, they can't do anything. You know, well, they hire a forensic attorney, start going through our credit card records. And so this is the biggest mistake you can make in your business is to mix your business credit cards and your personal credit cards, because we did it. I didn't know we were doing it, but my really smart office manager husband was just using whatever credit card that we had money for to pay the bills and to pay whatever. And so they said, If you're doing this, then now we have now availability or ability to have access to your office records because your personal— you were using your office for your personal card, and we looked at your personal stuff, which means now we have an avenue to look at your office stuff. And they decided that the office was profitable enough that I had to pay $109,000 in 2 weeks. So we went to court and they, you know, they said, you owe this money. And you owe it in 2 weeks. And he, my lawyer at the time said you could file for bankruptcy. And I was like, I don't know what that is. That's scary.

Right.

I'm not doing that. I go get some stupid-ass loan for 35% or whatever.

Mafia money.

You know, I could get it in 10 days. You know, you could have the money in the bank in whatever days, you know, that sounded amazing and fun. And so I got this huge loan to pay off the $109,000 lawsuit basically. And, you know, I mean, we barely met. That was 2018, 2019. We hardly, you know, we couldn't function after that.

Yeah.

Like we were so far in debt. Yeah. So every amount, I mean, we had 3,000 patients, we're billing insurance, money's coming in and it's just going out, you know, like crazy.

So was this the impetus then to say we got to get out of the insurance system?

Somewhat. Um, so all this is happening and it's 2000-whatever time, you know, '17, '18, somewhere in there. So I was doing wellness programs. But I was trying to hybrid. So I was like, we still have insurance going on. Hybrid is just a nightmare, you know this, but then we have these wellness programs. And so I started doing talks in the office, bringing in our current patients. And so my first 4 programs were our own patients who were like, yes, I'll do this.

And do you remember what you were charging?

$3,000, $3,500, something.

Barely covering all your costs.

If you did an individual program, it was $7,000 if you work just with me and not with the health coach or whatever. I don't even know what it was. Only one patient paid that once.

Yeah, but that's statistically what would happen. But that's good.

So, and then COVID hit.

Oh God.

So 2019, back to— so I'm in this coaching program, we're doing wellness programs, whatever. And I'm like, I need help, I need help. Like, you know, I'm doing these programs, but I'm not doing enough. I can't afford the marketing that you're recommending for us to go get dinner talks. You know, we had to go Spend ads and do, you know, pay $1,000 a week to do a dinner talk. That was their recommendation.

Yep.

And I'm like, I don't have the money to do that. Like, I've got to do something else. I, you know, and then so finally I'm just crying to the coach. I'm crying to this person, crying all the time. And, you know, middle of going through a divorce at the same time, got divorced in 2018. So kicked him out. We bought a 9-round gym so that he would just have something to go do. So we spent another, you know, probably $40,000 of our own money to buy a 9-round gym so he could go do that.

Go do that.

And then get out of the business. And so finally the financial guy from this coaching company sat down with me and looked at my numbers. This was in like October, November of 2019. And he just said, I don't, I don't think there's any way for you to get out of this. Like you, you have to file for bankruptcy. So when, you know, December of 2019, found the bankruptcy lawyer, started the whole process and filed March 6th, 2020, signed the papers for bankruptcy. And, you know, at the time—

Did you find that freeing?

Yes. Oh, 100%.

When I, when I signed my paperwork in 2010, phone stopped ringing. Like my cortisol levels dropped through. It was like, it was like, what a relief.

All that debt. All the bills went away, you know, but, and I think what I resisted for so long is that I thought I was going to have to announce it to the world. I thought I would have to shut my business down. You know, I didn't know, like I thought it was going to be like—

You did 7, Chapter 7? Yeah.

But I didn't know the difference between, you know, before I was educated about it, I really thought that was the end of it. You had to shut your business down. So I finally go to the lawyer. He gives me an explanation. He's like, no, all it is is just refinancing. Basically, you keep your business name, you keep doing business. Yeah, as normal, everything's normal. We just take all these loans and go after, go ask them, you know, what would they take instead? And so we had to have some negotiation obviously and stuff like that. But yeah, I mean, I went from whatever I was paying in debt, I don't even know what that number is, to like $3,600 a month was what I was paying off of. Yeah.

And you were never making up any, it was all interest.

Yeah. And the one, the only one that was secured was the Wells Fargo loan. So I had to finish paying that off, which was fine. I mean, that's the one I got for the practice to begin with. So yeah, filed for bankruptcy 2020, March of 2020, and then COVID hit March of 2020.

So. And then we met when? April, was it '21 or '22? Was it October of '20?

No, I think it was '21.

It was '21. It was October '21.

We were not in COVID anymore.

Yeah. Um, well, North Carolina, South Carolina, we weren't in COVID. California, New York, they still were.

Yeah.

The South were like beyond that.

We were not, you know, 'cause October of '20, there were still like Like we weren't, we weren't gathering in groups. No.

Even back then. Remember, you remember I so lived on the North Carolina, South Carolina border. And so Charlotte was draconian, like shut down and stay in your house. Like we're all gonna die. And you drive like 3 miles south, like all the gyms are open. Yeah. People are like hanging out at the park drinking.

That's how it was. We're Georgia, we're Georgia, South Carolina. Yeah. So we drive to Georgia just so we could go out to eat.

Yeah.

Yeah. 'Cause they were open in Georgia, but not in South Carolina.

So yeah. It was hilarious.

So that, you know, COVID was crazy. I mean, it for everybody, but I mean, we were—

So what, so by that time, so we meet in '21, you're all cash at the time, or you still do a little insurance?

So 2019, I should go backwards. 2019, January of 2019 is when we sent the letter to 3,000 patients saying by May 1st, you need to be, you know, in a, in a membership. So we were doing the membership thing. And that was probably worse than the bankruptcy, I would say, from a stress perspective. So that's why I always tell people, rip the bandaid off, just get it, get it over with.

How many people of the 3,000 joined?

Do you remember? 150, 174, like less than the 10% that they said that you would get.

It's a great pitch, by the way. It's a great— so I've got a, one of these days I'm going to do a podcast on this topic, a solo podcast of the math never works In the membership model. Yeah. Because it's a great pitch. All you need is 200 people paying you $200 a month. It's $40,000 a month. Who can't cover all their bills in 40? You deal with all the patients on the phone. You have like 2 staff members. The problem is, is you never get to the 200.

Yeah.

Because there's always a 3 to 5% churn every single month from nonpayments, people dying, they give up, whatever it is.

Right? Yeah.

It's, it's a—

Or they do it for a little bit and then they quit. They quit.

That's why you gotta have the, you gotta have the transactional business.

Marketing the new ones. Yeah.

You know?

So yeah, we're, we're dabbling in the, in the program. So I had started doing the programs already and then we're, we're wanting, you know, post-program membership opportunity. And so we had to create the membership, which means everybody else had to get out of, you know, traditional way of doing it. So that was kind of the transition is programs first, then we made this membership, then we got rid of insurance. So I felt, I mean, that was so stressful and I'll tell you, You know, looking back on it, what I would coach people is the biggest mistake I made was not giving good scripting to my team. And so I was the one having to have all the conversations of why we're doing membership, what, you know, what that's about and whatever. So I said I broke up with 2,900 people in the course of 5 months. Also, January to May was just way too long. Like make it, you know.

Yeah. 20, 21 days.

Yeah. Next month, whatever.

If I'd been coaching you then, it would've been a 21-day pitch.

I didn't have you back then.

I would've been— I would've, would've been a 21-day pitch and We would have had like some kind of teaser rate to get them in.

I was figuring all this out on my own.

Yeah, I know.

I'm not giving you shit. We had coaching to help with the programs, but they did not do any coaching on membership and, you know, anything else to do with kind of practice management stuff. So, so, you know, I would say between, you know, bankruptcy, divorce, COVID, you know, like 2017, 2018, 2019, 2020, bad, bad, bad, bad. Yeah.

Well, you know, they go in cycles, right? Like, I mean, I think that's one of the, you know, now at 58, you really do see the patterns in life. You know, there really is something to the whole 7-day cycle, like, or 7-year cycle, I mean.

Yeah.

Like, you know, the whole thing that they talked about in the Old Testament of like 7 days and, you know, or 7 years, I should say, not 7 days. It's really fascinating to me. There is a real cycle to it.

Yeah.

You know, so the thing for me is like when I, so I thought, I thought I was thinking about this as I was flying out here today, like when we met. So it was like November, I think of 20—

It was October of '21.

'21. October of '21.

In Charlotte.

And I did a half day or a full day in Charlotte.

Mm-hmm.

And I remember I was talking about raising prices and you said to me, if I, I don't know if I got this right, you were charging what, $6,000 at the time?

$8,160 or something like that.

$8,160.

I had this perfect number of, you know, and it was like we needed to do about $8,000, like when we started raising the prices from the $5,000, whatever. This was a 6-month program, and it was $8,160. And so what I did with my office manager at the time is like, okay, let's just play with the numbers. Do we want $7,900? And I just like, it was like looking in a mirror, and we just, is it $8,159? Is it $8,000? Whatever, whatever. And so we hit $8,160, and it was like, Like it just rolled off my tongue. I could smile while saying it. So like, that's how we decided what our pricing was. Like, it was much more like, how do you say, how do you enunciate the word instead of like what number, you know, it needed to be. So we were $8,160 for a really long time and I was so proud of it. I remember walking up to you and I was like, my close rate is like 90%. And you're like, oh, you need to, you need to raise your prices.

And I was like, yeah, if your close rate's 90%, you're not charging enough.

I wanted you to be like, oh, you're amazing.

Well, you are amazing, Amy. You're, you're, you're fucking amazing.

And so what you told me, so one of my questions during that day was I said, you know, we, we were doing $8,160 and then crediting people $2,000 for their lab appointments. So I was doing this lab appointment thing at the time. And so we were giving them a credit back, or I was saying, what should I do? Because people keep asking for that. And you said, well, just raise your price, you know, $2,000.

I think I told you, raise your price $2,000.

And so he goes, well, make it $10,000. Then, you know, then you went, no, no, you mean make it $12,000, actually make it $14,000. So it's $14,000 and then you subtract the $2,000. And, uh, and, and literally that was on a Saturday. We were there and shot it. And Monday, like my, my office manager at the time was there, Kimberly. Thank God she was there with me. And we literally came back Monday morning. We said, we're charging $14,000.

For the same package, for the same 6-month program.

We'd give them the credit of, of $2,000. So we felt good about that. And then, so we raised our price from $8,000 to $12,000. And what happened? Basically, and we sold the same amount. But of course got, you know, $6,000 more. And so, I mean, from that—

What was that like for you? What was that? What was that? Because remember you like called me, I think you emailed me on Tuesday, said, I'm in. If that's the free advice, what's the paid advice gonna be like?

Um, you know, anything like that is scary, but I think having, having a support system, you know, where, where somebody who has experience with this is giving you that advice, you know, it's like, okay, well, you just gotta try it and see what happened. I mean, surely, If it didn't work, we could always go back to the $8,000.

You can always drop it back down. Nobody ever does it.

So we did. And then, I mean, yeah, we were selling them and, you know, it was all, it was almost like, and that, you know, you look back on it and we'll say this now, the higher your prices, the more people buy them. It's ridiculous. Isn't it? It is ridiculous.

It's ridiculous, isn't it? It's the hardest thing for people to understand. It's one of the hardest.

Scared of, you know, so now, you know, from there, that was 6, 6-month program was $8,000 at the time. We went to $12,000 and then $14,000. Now it's $18,500.

And what's your business like now?

Um, I don't know, 'cause I'm not there. No, I do not.

No, you, well, you aren't there.

I do know I'm not there.

Yeah.

You're, um, no, I mean, so it was slow, slow moving at the time and I can tell, just tell you from gross revenue, it was less than a million in 2020 to 1.2 to 2.4 to 2 point whatever we did. 2.6 this year.

Yeah. Um, but the interesting thing about that is you do 2.6, but you don't see that many patients anymore.

Right. So, so 2.6 $2.6 million. I actually had to pay $40,000 in taxes this year. So to me—

Congratulations.

Thank you. That's a, that's a profitable business. So, so, you know, we always look at the revenue and think, oh, I didn't grow enough. You know, I didn't— I went from $2.2 to $2.4 to $2.6. That wasn't very much. But now we're profitable, we're paying taxes, and I only work like 4 to 6 days a month.

You spend a lot of time in Cabo. We're here in Scottsdale. Every time Every time I see your Insta, Facebook feed, you are somewhere.

So the other thing that's happening is that my side gig, you know, I just started this second, third, fourth business. I don't know. But I started, I, I just created an LLC, one to pay my kids because you can pay your kids and, um, get a tax break on that. So I was learning all this, you know, business stuff that I didn't know anything about. And so then I started coaching and I started speaking and I started doing all these things. And then all of a sudden this side business that I thought was just a place to put some money was actually making money. So that was a 6-figure business last year.

And what's that? Tell us about that business.

So, well, I just call it ADMD LLC. So I mean, that's, you know, any kind of coaching, any sort of, you know, I do some coaching for Deb, you know, she pays me, I speak for A4M, I speak for whatever. So any money that I get that's not patient-related money that goes into Carolina Integrative Medicine is my side gig is what I call it. And then I'm the medical advisor of Zymogen. And so there's a stipend for that, that sort of thing. So then, so another side gig is I supervise nurse practitioners.

Talk about that because this is an important thing.

Yeah, it's a very important thing. So probably 2 or 3 years ago, a chiropractor that I know in Charlotte, Fort Mill actually, so not Charlotte, but came to me and said, we wanna add a nurse practitioner. Would you be their supervisor? And I was like, what does that mean? But okay. And so we've figured it out and it was just this little thing on the side, whatever. And so then that nurse practitioner called me one day and said, hey, I'm gonna, I'm gonna buy out the chiropractor and I'm gonna hire another nurse practitioner. So I need you to be the supervisor for that one. And she had a friend who had a friend who had a, you know, all of a sudden I have 9 nurse practitioners that I'm supervising. So this is the side gig. And, you know, I'm charging anywhere from $300, $600, $1,000 a month depending on their number of patients. And so early, literally about a year ago in June, was in, um, here I was at Camelback Resort and I'm like, you know, okay, I'm gonna like grow this business and I'm gonna go, we, we had this conversation.

Yeah. I remember it was—

I'm gonna go get licensed in all these states. Yep. And I'm gonna do all this stuff and I'm gonna be a supervisor for a bazillion people. And that was, you know, my idea. And then I had this moment and I didn't really move on it. You know, we talked about it for months and months and I—

Yeah. Well, but that's—

Why am I not doing this? What's holding me back? Right. And so I did this, this transcendence exercise one morning and it was like, you know, we're just doing weird stuff. What weird granola people do on the grass in, um, in San Diego. I thought it was Camelback. That was another weird experience of the energy of the mountain or whatever. And so we had this moment and she was like, think big. How can you be bigger? How can you be bigger? And I had this moment, I was like, I can't be bigger if it's just me.

Right.

And so even though I was gonna go get licensed in all these states and be the supervisor, I was like, what happens to me? You know, my— Right.

You then have a job again. You've just spent 15 years getting yourself out and all of a sudden this happens all the time, by the way.

Oh yeah. I see it with Deb particularly.

Deb, Deb particularly.

So, you know, I was like, no wonder I haven't done it because I got licensed in Nevada and that was the only state because I was going to get the IMLCC thing. Yeah.

The compact thing.

Yeah. And so, so I had this epiphany June of last year that like, if I'm going to do this, I need it to be bigger than me. And so what I, what I realized is that all these nurse practitioners are going and getting, you know, BHRT certified. They're going to IFM, they're going to A4M, they're going to SAF, all these functional medicine, whatever. They are getting educated in this work that we're doing to help people. They're getting outside of the system and they're opening their own practices. And in 26 states, nurse practitioners have to have a supervising physician in order for them to practice independently. And so, you know, there's a need out there. There's, we, we have more patients than any of us can see. I mean, you see it. I mean, these, you know, Yes. You wouldn't be in business if you didn't have Doctors who had the patients, right? So there are so many patients out there that we could help. And so many, you know, women, men, whoever it is that, that you're trying to help, you know, live a better life and get on hormones and get their gut fixed and get their inflammation under control and all the things that we do in functional medicine. And so if these nurse practitioners, what they're finding is that they can't find a supervising physician that speaks the language. So they're like, I'm paying them, but they can't answer any questions.

It's a big deal. Right? You can find the supervising physician.

You know, I mean, like, you know, the whole point of supervision is that you can call them, email them, whatever, and get answers to your questions. So they're either paying them with no real support, and they don't know anything about them, or they can't find one that will agree to it because they think they're doing voodoo woo-hoo medicine. They know nothing about it. And so they're like, I don't want to put my, my license on the line for this medicine. I don't know what you're practicing. Or they're getting charged, you know, bazillion, you know, $5,000 a month for something that shouldn't be expensive. So these are all the stories I'm hearing. And so all these people are coming to me, let me know when you get licensed in Texas, let me know when you get licensed in Oklahoma, whatever, whatever. And so I was like, I need to create this, this matchmaking service basically. So I invented Functional Medicine Collaborator is the business that I called it.

What's the website?

functionalmedicinecollaborator.com. And so it's basically a matchmaking service. So we have recruited, I think, 6 MDs now over the, across the country, multiple licenses. I need a Georgia person, by the way. So if you're a Georgia MD that wants to do this, I might have to please check and see if I have somebody for you. Because I have, I would say, 8 to 10 nurse practitioners in Georgia right now that are ready to go. And I don't have an MD in Georgia. And the reason I'm licensed in Georgia, but Georgia law is that the practitioner that's a supervisor has to physically be in Georgia. Um, and so I guess I need to go buy a building in Georgia and do it that way if I need to.

But let's just find you a doctor. You know what, this is a—

anyway, it's, it's just come out of nowhere and here it is, another business that is growing.

What would you tell, what would you tell your, with the wisdom you have now? What would you tell your younger self in 2011 that was going out?

Hold on for the ride. That's why I did, I did a Mother's Day, like breathing exercise or something. And it was like, you know, go back to some time in your life. And I was like, hold on, you know, hold on for the ride. But, um, you know, never give up is something like I literally, I get because I do coaching, because I'm out there in, in this world and speaking and everything, you know, you hear it all, you know, people ask you advice, ask you questions. I actually had a conversation in the airport today with a chiropractor who's had an experience where he had 2 nurse practitioners in his practice. Both have gone through BHRT Training Academy and then left and opened their own business. And so he is like, I don't know, is that a sign I just shouldn't do that? And I said, no, just don't make it happen again. You know, learn from it. Don't give up. There's plenty of patients out there that need your help and just make sure that when you hire the next one that you put all the pieces in place that that's not gonna happen again. So don't give up. Don't let these obstacles get in your way. Like, you know, and, and that's what, where, when I'm coaching, when I'm mentoring, when I'm supporting other practitioners that are going through opening their own practice or, you know, helping with the people that you're working with, uh, if I could just help them fast forward, you know, let's not make the mistakes I made. Like I said, rip the bandaid off. 3, you know, 5 months is way too little. Get rid of insurance.

Just go.

Let's just not even do insurance, but Yeah. You know, I mean, look at Josh. Like, it took him forever to get out of that. And he's the, you know, so free now. And insurance is such a— listen to us. It just, you know, you can't— you got to get out of your own way because it's so—

it's, it's like getting off.

It's very scary.

It's like, it's like getting off SSRIs. Like, you don't realize the damage it's doing to you.

Yeah.

You know, I was at a party in LA and this guy came up to me and he goes, you, you're an entrepreneur? I'm like, yeah, I'm an entrepreneur. I'm like, oh God, I know where this conversation is going to go. He's like, so I really— I got— I want to, I want to start my own business. What do you think I should do? And I looked at him. I said, don't fucking do it. So it's like, he would go, he goes, what?

I've heard of a day off.

I go, just don't do it. And he's like, no, I got this really good idea. It's like, I was looking at him, I'm like, yeah, no, you just, I, I hope I didn't fire hose him. I'm gonna, I'm kind of joking, but I'm kind of being serious. It's like a lifestyle, you know? It's like, yeah, I always tell people, it's like joining, it's like taking a vow. It's like the vow of omertà in the mafia. You'd never get out. Like, it's just, it's like coal mining. It dust gets on you. It's never getting off of you.

So. I mean, there's no clocking in, there's no clocking out. There's no, I mean, you can work anywhere, you know? So yes, I live the life of lots of travel, preferably travel to, you know, tropical places that are warm and fun. I love it though. I mean, I love speaking. I love teaching. If I can help one person, you know, live a better life of freedom, that can help so many, you know, my passion is to help people, right? Like that's why I went in. I delivered babies.

You like to heal.

For a living. I like—

You love healing, don't you?

I love healing. I love, you know, I always say I went into this business Bringing life into the world. And now it's like, you get to restore life back to those who, you know, are lost along the way. I mean, people are miserable and we can help them. They don't have to keep being miserable. So.

Well, your final, just kind of your final thoughts on this, like your, what do you, do you see in the future for our industry? You, you were in it when there was, we didn't know what the hell we were doing or you were doing, cause I don't practice medicine, but where do you see the industry going right now? What do you, what makes you excited?

Yeah, I mean, I think it's really good. You know, the availability of the education is really exciting. I mean, I know A4M's been there, but I didn't know about it. You know, I, I went to this one tiny little conference. There was 20, not even 20 people in the room, right?

In some—

now there's 250. Yeah, yeah. Now there's 7,000, 8,000 people at A4M. Like, it's, you know, I'm excited about that because I think, you know, we don't, we don't have to defend ourselves so much anymore.

Mm-hmm.

I mean, the science is catching up. This, you know, the big the big deal with estradiol being, you know, off the black box warning and whatever. Like, I didn't really care because I'm like, I've been doing it for 15 years, 20 years now. But it makes it exciting because it's not so scary. It also makes it where everybody can do it now, or, you know, they could do it before, but they are doing it now. So like, there's still a little, you know, are they going to come to us?

What would you say to somebody—

Their regular doctor, right?

But what would somebody say that they're like, oh, now it's going to become too saturated that they're going to be able to get anywhere. What would you say to a doctor that says something like that?

Well, they're still not really doing bioidentical hormones. Yeah. So are they testing? I mean, they can give people estrogen freely, but I mean, we have a lot of hormones in our body. Like estrogen's just one of them. And so I still think progesterone's way underused. Nobody's testing adrenal and cortisol. And like, that's my favorite thing in the world to do. I mean, mm-hmm, nobody leaves my, it's now a white box, but you know, every single patient gets a white box. So it ha— I mean, it's just growing. I think it's exciting. I think, you know, the world of, of social media and, and chat and all that stuff can be scary, but it can also be informative for the patients. So they're coming in much more informed. They're coming in saying, I want, you know, hormone replacement. I don't want to go the traditional route. I don't want all the medications. So, you know, I think that they're coming in more educated and it's allowing us to, you know, it's easier for us to sell, for lack of a better, I don't like the word selling, but for, for help people understand what we're doing. And, and, and the, and, and on the flip side, the traditional system is getting worse. And so that's helping us. I mean, the amount of—

God, it's just, it's like, it's just fascinating to watch how bad it's getting.

I mean, less payments, less, you know, it's not even about the money. I mean, the medical care is just sad.

I'm in the middle of hiring an EA. And so we've got, you know, we're going through our network of people that we know and living in LA now. Like, you know, there's a lot of, there's a lot of carnage in the entertainment industry. So they're all looking for work.

Yeah.

Right. And so Christine sends this out to her list. And one of the questions that I asked, they go to a Google form. One of the questions they ask is, have you or a family member ever experienced the hell that basically the hell that is the American healthcare system? You should see the responses. It is unbelievable. Like, it's, it's a real lesson in how bad it is. Nobody— people don't understand how bad the system is. We do, because we're— we live it every day.

Yeah. Yeah. If you don't— I mean, luckily, if you don't have to experience it, but I think that we see it and we can see the bad in it. But I think there's so many things that happen that people aren't really even aware that that was a bad thing.

Do you know what I mean?

Like, they just, just, they, you know, you get put on your statin, you get put on your whatever, you know, you walk out with 10 medications and you're like, cool, my doctor's really good. They're thorough and they give me all these meds, right? Like that's what people think like is a good thing. Yeah.

You know, not good.

Or they want me to go, you know, give my stress test every year. And I don't know, I mean, it's just silly. Like all this stuff that would be, you know, they told me I need a colonoscopy instead of Cologuard because I'm special. You know, like they're like just stupid stuff like that, right?

It really is.

People think that it's normal. And so I Because that is happening so much more, unfortunately, you know, for the people that are experiencing it, but it's just helping us.

It's totally helping us. I really think—

We can say you don't have to do, you don't have to live that way anymore.

I'll just say this. I think in, you know, I've been in the medical space 11 years now. It is, it's amazing to me how it has changed. I think in 5 years, I can't wait to sit down with you in 5 years because I think it's going to, you know, I really Especially the work you're doing, right? And the speaking you're doing and the coaching you're doing and what Deb is doing and what we're doing and other people out there like JJ Virgin, like all of them. Everybody's like, oh, don't you, aren't you worried? Like there's more competition. I'm like, no, it's more people spreading the message. It's why when Deb was a client, we spent more time talking about her coaching program. And like, she's like, you okay with this? I'm like, yeah, I've been coaching for 20 years. Let me show you how to build the system. Like, let's get, you're gonna get, let's do it the right way. Like, let me help you reach. Yeah.

That's why it's like, are you okay with having more practitioners that are your competition? Right?

Yeah, there is no competition. Let's all, what did John Kennedy say? A rising, all boats in a rising tide, green, whatever it is. I don't have it right.

So rising tide lifts all boats.

Thank you. See, this is why you have more college education than me.

So I just heard it a lot.

Well, Amy, I appreciate you coming in. I'm glad we finally got this. We'll have to do a part 2 because I know there's even more to the story, but how do people, give them your site again for the—

Yeah. So functionalmedicinecollaborator.com or Facebook, you know, it's on Facebook, Functional Medicine Collaborator. Amy Duffy, MD. You can find me, Carolina Integrative Medicine is my—

Follow you on Instagram. You got great posts between you and Deb. The two of you are like, I always know where the two of you are. Yeah. I always know where the two of you are. Yeah. It's a blast. So, oh, they're in Cabo this weekend. I got to get to Cabo. Awesome. Well, cool. I'm looking forward to the next couple of days. You hiking Camelback Mountain while you're here?

I don't know. We'll see if I wake up. Okay.

I won't not. So, and then, and then we'll fly to Dallas. We'll fly to Dallas and we'll speak at Boston BioLife together.

So, we will do that.

Cool. Thanks. Appreciate you coming in.

All right. Thank you.

If this episode got you thinking differently, hit follow and share it with someone stuck in the system. Please leave a review. It helps us grow. Want more? Visit mavericksprofitsystem.com to schedule your free discovery call and explore how far your business can go.