Episode 60: Turning Tough Career Experiences Into Empathetic Patient Care w. Dr. Jessica Jameson

Aug 17, 2020

This Episode

Dr. Jessica Jameson

You Will Learn

– Dr. Jameson’s experience with being a flight surgeon
– Dr. Jameson will discuss why she loves to sing with/for her patients
– Why Dr. Jameson has started to focus more on medication management for obesity for her patients
– Dr. Jameson will discuss her experience during COVID
– Why you shouldn’t mess with Dr. Jameson on the soccer field

Resources & Links

This week, I am joined by Dr. Jessica Jameson to discuss her journey from hospital work to opening her own practice. Dr. Jameson discusses how she is trying to create the best environment for both her employees and her patients as well as how her work as a flight surgeon helped prepare her for opening her own practice.

Justin (00:04):
Hey everybody. Couple of quick announcements on the front end of this episode, we just passed over 35,000 downloads of anesthesia success. And it’s hard to imagine just how far things have come, but I just wanted to pause and say, thank you for listening, for sharing this podcast for leaving reviews. It’s been a lot of fun. We’re at somewhere between 65 and 70 episodes I’ve have hazardly numbered them. So I’m not sure exactly, but,uI’ve had an absolute blast getting to meet so many amazing people. If you’re one of the guests out there listening, thanks for lending your experience to this show, to share your story and help close the information gap for our physician audience. Secondly, I’ve been getting a handful of requests from people about doing seminars this fall for either a residency or fellowship, classify a zoom, and we’ve done a few of these in the past.

Justin (01:15):
They’ve been really fun and I wanted to open up this opportunity more broadly to the anesthesia success community. So if this sounds like something that you and a few of your peers may be interested in, we can set up a do it yourself, zoom happy hour or something with an appearance from yours truly, and do a personalized group presentation about negotiating position contracts, business of pain management, student loans, financial independence, whatever you think might be most valuable. And we can throw in some Q and a to make sure that it’s as valuable as possible. If you’re interested, you can email me@justinatanesthesiasuccess.com drop me a line. We’ll get something on the books for the next couple months. As far as this week’s episode, I really enjoyed my conversation with dr. Jessica Jamison. It’s clear that she’s someone who really leads through both example and mentorship, not only in her pain practice in Idaho, but also in the pain community more broadly, we covered her career as a flight surgeon in the air force to some of the important pitfalls that she experienced in private practice to what it was like for her to launch her own practice in collaboration with a physician partner.

Justin (02:18):
We also spent some time talking about leadership in her organization and how she uses her own leadership influence to create a culture of transparency and empathy towards patients. There’s a ton of good stuff. In this week’s episode, I could have talked to dr. Jamison in front of the two hours, but we had to cut it short, but really hope you enjoy it. Hello and welcome to episode 62 of the anesthesia success podcast. I’m very pleased to be joined today by dr. Jessica Jamison. Dr. Jamison is a triple boarded, anesthesia pain management and obesity medicine physician practicing in Idaho and has a very not only a lot of business and leadership skills, but also just some very dynamic, I think, perspectives and other things outside of clinical medicine that I’m really excited to discuss with her today. So dr. Jamison, thanks for joining us.

Dr. Jessica Jameson (03:05):
Thank you. That’s quite the intro. I hope I can live up to that excitement.

Justin (03:09):
So in researching for this discussion, I found a couple of articles that you had written on Kevin MD. It’s amazing. Like if you, what Google will tell you about, about people, if you just take two minutes digging, and I was really fascinated by this, this article that you had written about the role of music and singing specifically in a clinical interaction. So tell us a little bit about what that means for you.

Dr. Jessica Jameson (03:32):
So, you know, I grew up singing, I was professionally trained for many, many years. I was a wedding singer in college, and then I promptly realized that that was not going to pay the rent. And so I thought I better do something else. So so singing was always a part of my every day growing up. Right. And then you start, then you go to med school and ain’t nothing part of your everyday except going to med school. Right? So that big part of my life was no longer there. And so I really kinda missed that. And then I went through residency and kind of the same thing where you’re just focusing on, you know, nose to the grindstone and getting through and learning all the stuff you need to learn. And so when I got out into private practice and you know, those first couple years, you’re really trying to make, you’re figuring out how to be a doctor, right.

Dr. Jessica Jameson (04:15):
And that’s kind of the important part. So those first couple of years I’m doing that. And then gradually at some point during that time, as I’m doing procedures, I started to realize that I was loosening up a little bit and the way I realized that was because I was singing, I was just singing along to whatever happened to be on the radio that morning, usually Disney because my children were very little at that point in time. And that became just sort of, that’s what I do for every procedure now. And, and what I noticed was that my patients really appreciated it and they would start talking about it and I’d be out in the community and people would say, rumor has it, you sing. And I would be like, who’s told you this information, right? So I just started to kind of ask patients about it and my nurse practitioner would ask patients about it.

Dr. Jessica Jameson (04:55):
And patients would just really say how calming it was. I think I’ve had one patient in the last 10 years that has said it was irritating. And my response was something to be effective. You should probably find someone else to take care of your pain needs cause I’m gonna keep singing. You know, so I think that, you know, music is is, is very unique in its ability to create emotion and to calm emotion. And so I tend to use it in that way. And you know, my patients who are going back for more of the advanced surgical procedures will always give me a list of songs to sing while they’re kind of drifting off to, to sleep so to speak. And so I’ve just found that it’s a really great way to kind of calm fears, calm anxiety, to connect with patients and that patients that chime in and, and harmonize and that I just love that. I just love it. And so it’s just been a wonderful way for me to get something that was really important to me back into my life. But also at the same time to really kind of connect with patients on a, on a different level and calm some of that anxiety. Okay.

Justin (05:54):
Absolutely. That’s a, yeah, I’m just by that story. I have my own, you know, I’m a, I said like a hobbyist musician, not classically trained, certainly, but I also, I did the wedding thing for while. So I actually did some wedding deejaying in a prior life and, and I loved the, in a different way, but, but related, you know, the ability that music has to like unite people and just invigorate an atmosphere and it’s a real gift and to be able to share it with people is just brings me a lot of joy. And so that particular story, I just really, really enjoyed. I read that you spent some time as a flight surgeon. So I don’t know, I thought for a while that that was like doing surgery, like on an airplane or something, and we haven’t had someone on the show yet who has that kind of experience. So talk a little bit about in the context of, you know, your career, where that fell for you and what does it mean to be a flight surgeon?

Dr. Jessica Jameson (06:47):
Sure. Yeah. It’s it’s not as exciting as it sounds. It is not, it is not surgery while flying. There is a lot of flying that happens, but, but in reality, you know, just to sum it up, it’s, it’s basically primary care for the active duty folks. Right? So I when I graduated from high school, I was planning to go play soccer for the United States military Academy. My grandfather had graduated from there. That was a big part of our lives. Our basic premise in our family growing up was duty honor country. And we would recite this left and right all the time. And so that was a really big, very important thing to me. And so I was planning to go play soccer for the United States military Academy. And at the very last minute some things changed and I made a different decision and did not go.

Dr. Jessica Jameson (07:28):
And so I always sort of felt like, you know, I really would have loved to have been able to serve my country. And then my grandfather actually found out about the it’s called the, at that point, it was called the health professional scholarship program where the military would pay for medical school and you would pay them back. Right. And so like anything in life it’s time or money, right. So people who don’t serve in the military, they’re not giving that time, but they’ve got student loans to the tune of hundreds of thousands. So at that point, I thought, boy, this would be a wonderful opportunity for me to get my education paid for. And for me to really have the opportunity to serve my country. So I I joined the air force, I thought long and hard about air force, army Navy.

Dr. Jessica Jameson (08:11):
My partner is a career Navy guy, and so we have some interesting discourse throughout the day on that, but I chose the air force and was very happy. I chose the air force after that. And so what ends up happening is they pay for your medical school and then after medical school, you apply to residency. So at that point in time, the military was really in need of primary care. So, so what they do is they send a certain chunk of people, of physicians, graduating physicians into do an internship and then into flight surgery. So the Navy has flight surgeons. The air force has flight surgeons. I think the army calls them something different now, but the basic premise is you’ve completed an internship because that’s what allows you to get licensed and then are assigned to, in my case, a squadron.

Dr. Jessica Jameson (08:57):
So I did an internship in family practice. I actually started a whole residency in family practice and was planning to do family practice and realized about six months into that, that that was not what I wanted to do. And so that’s where flight surgery came in. So finished the internship year, went to be a flight surgeon was assigned to 300 gentlemen and wherever they went and I went with them and provided essentially primary care for them. And I did that for four years and got to go all over the world with some wonderful, wonderful people who are still my friends to this day. And ended up without any student student loans. So for me, it was a win all around that’s for sure.

Justin (09:34):
Yeah. Awesome. Did you have any favorite either like locations that stick out in your mind or maybe some interesting stories from, from that time?

Dr. Jessica Jameson (09:42):
It’s very interesting when you become the primary care physician with minimal training, right? One year of internship for this, this squadron of, for me, it was all males and there was 300 and then there was two females and then I was the third female. And so we would I just remember I’ve got two stories. So one is that we, we went, we deployed to United Arab Emirates cause we’re air force and we stay kind of in the safe zone and we fly into the bad places. And so we deployed there and we had sort of this, this outbreak of chlamydia and as a flight surgeon, you are, there’s a public health component of what you do. Right? And so this, the squadron commander came to me and he said, what are we going to do about this? And I just looked at him and I said, sir, there are two females in this squadron.

Dr. Jessica Jameson (10:30):
So my suggestion is we just treat those two females. And he said, what if it’s coming from somewhere else? And I said, again, sir, only two females in the squadron. So why don’t we just go ahead and treat them? And sure enough, you know, we treated the two females in the squadron and the problem, so to speak went away. But so that’s my public health experience, which doesn’t come in handy really for anything else. But the other, the other story I have is that, you know, I, so we did a lot of antidrug cartel missions in Ecuador and such. And so there would be some time that we would have kind of two free time, but in Ecuador, in particular, it’s not, it wasn’t a particularly safe area. And so we were stuck kind of staying on the base. So we played a lot of soccer.

Dr. Jessica Jameson (11:10):
Now at this point in my life, I was 22, 23 years old. I played college soccer and then I played semi-pro soccer before I went to medical school. So at this point I was like tip top shape. And I was pretty sure that I could beat any of these little airmen. And I was again, one of three females out of 300. So I was determined to make sure that they all knew how good I was at soccer anyway. So we went out and played soccer and this poor little 18 year olds airman first class we went up for a tackle. I thought it was like a regular routine tackle. I came away with the ball thinking I was the best thing in the world and the kids on the floor with a fractured ankle all the way through fractured ankle. And it was my fault.

Dr. Jessica Jameson (11:48):
And then I had to take care of it. Right. So then I had to, you know, we took him to the Ecuador in hospital, no one spoke English. I couldn’t figure out what was going on, but I knew that we needed to get out of that place. It did not seem like the best place for for an orf with an ankle fracture. And so we ended up actually calling in the medivac team and and I think it was the army at that point that came in and, and, and took my poor airmen to some definitive care back in the States. But you know, you just don’t plan for it to be your fault when these kinds of things happen. And so that was, that was my second kind of interesting story I picked,

Justin (12:21):
Well, that probably set a tone. And then whenever you’re going after a loose ball, after that people would ease up and let you have your space.

Dr. Jessica Jameson (12:28):
It was early on in my, in my assignment. And so after nobody messed with me after that, I’ll tell you that much. That’s amazing.

Justin (12:35):
So tell us, you know, post the flight surgeon period, then you did a residency and you did anesthesiology ultimately. Right. So talk about how that evolved in your mind from thinking, you know, maybe like the family practice or, or whatever you kind of initially described to what you ended up pivoting into.

Dr. Jessica Jameson (12:54):
Yeah. Oh, so that was interesting because I was in in my flight surgery group at the air force base, there was about six flight surgeons. We were all assigned to these different squadrons and four of them were, were going into anesthesia. And so I had never done a rotation in anesthesia. I’d never been on that side of the drape. And so during my flight surgery time talking to these gentlemen about me, they had done lots of externships and they were convinced that this was what they were going to do. They were, they were sold so to speak. And so I talked to them for quite a while about kind of the pluses and minuses, and I did some shadowing and I said, what? This thing’s awesome. I’m gonna apply the answer to residency. So I applied to anesthesia residency, got into anesthesia residency residency had a three week old on the first day of my anesthesia residency.

Dr. Jessica Jameson (13:40):
And I got six months in and said, what these people are all asleep. And no one is able to talk to me. And I looked at my husband who replied with, Nope, we quit one residency. We are not quitting the next one. And I loved the anesthesia. I loved a lot of parts of it, but the piece that was missing for me was this sort of connecting with patients on a longterm basis. And then I did a pain rotation and I said, Oh, this is, this is what I want to do. And so that’s kinda how I got into the pain space from anesthesia. And I haven’t done any anesthesia since and you know, some parts of it I miss, but overall I really, I really just enjoy the connection with my patients that that happens over years rather than count back from 10, you know, right.

Justin (14:22):
Early patient interactions on that first, you know, pain clinic rotation that sort of solidified that, or maybe opened the door to allow you to explore that further.

Dr. Jessica Jameson (14:31):
Yeah. We, we, we had a lot of cancer pain that we were taking care of and I think that’s really what got me. And at the same time my grandmother had ovarian cancer, like at the exact same time that I was, that I just finished up a pain rotation. So I was able to sort of watch the difference that paid physicians can have on, on end of life and, and that connection that can happen, how we can really make that process of dying so much more comfortable. And so that really is kind of what that’s really what solidified it for me.

Justin (15:00):
That makes sense. And I’m interested to hear about the obesity medicine component of this. Cause I was, I was, it’s funny. I was filling through my LinkedIn feed and, you know, there’s always these doctors posing with this box of the latest thing that they implanted. And I noticed you know, I couldn’t help, but notice like some of the little patient testimonials that were happening, I was like, Oh, these people are overweight in some cases. And I was just thinking about, you know, the relationship between your BMI and any chronic pain issues. And I’m curious to know, first of all, how did you sort of get into that and how has that informed the way that you practice clinically maybe compared to somebody who hasn’t had the kind of exposure that you’ve had to that?

Dr. Jessica Jameson (15:40):
Yeah, so it has changed. It has changed my practice completely. So I do quite a bit of, of medication management for, for obesity. And the obesity medicine association has come up with algorithms, with processes, for how these things work. And I really got into it because I was getting frustrated with doing epidural injections and Fossette injections on patients who who the primary problem was, was obesity. I mean, people with BMI of 50 and you’re sitting there thinking the only thing in my wheelhouse for your back pain is this, but I know what’s really going to fix that. And so I started looking into it based on that. And, and then kind of went down that road of becoming board certified in it, and then really implementing it into my practice. And it’s it has definitely changed the way I practice, you know, every patient that comes in with a BMI over 30 gets a informational handout that says, Hey, your spine health is directly related to your weight, right?

Dr. Jessica Jameson (16:39):
There is no question about that. And so we’re able to sort of say to patients, instead of being previously, I would say, yeah, you should, you should really lose weight. And then that would be the end of it. Now I say, listen, you know, weight is a big part of this and I can help you with that. Let me tell you how I can help you with that. Let me talk to you about what my struggles have been in that regard. And then let’s talk about what the evidence shows for longterm improvement in your weight and then your other diseases. And so watching these patients kind of buy into that because they’re all told many times, you know, all they hear is, Oh, I’m fat, Oh, I’m fat and fat, right? And so instead I’m saying, listen, I’ve got some things that can help you.

Dr. Jessica Jameson (17:16):
Here’s how we can work together so that you can improve your health, thereby improve your diabetes or hypertension and your back pain. And so implementing that has really changed kind of how I practice and and my partners, you know, send all their patients to me for that as well. And for surgical procedures and even at the advanced pain procedures, we know that that the BMI really affects those outcomes. And so prior to considering those things, we enroll these patients in our weight management program and we get them to a reasonable BMI before we go doing, you know, elective spine cases

Justin (17:50):
Are, those is the sort of the treatment or the recommended you know, treatment for the obesity cases. Is that something you handle all in house with the team that you have assembled at access spine, or are there external partners with whom you’re working or referring?

Dr. Jessica Jameson (18:03):
We have some external partners. If we feel like there’s a big component of of psychology that needs to happen. But predominantly we’re doing that all in house. So I have a nurse practitioner who has also gotten some advanced training in this and she, and I kind of worked together to establish this program. And it includes, you know, frequent visits and includes the medication per that algorithm. It includes referring out for gastric bypass. I mean, gastric sleeve has really good long track record. And there are patients where I say, listen, you need a gastric sleeve. You don’t need, you know, what I have to offer, but we also do group sessions. We monitor, you know, they come in for weigh-ins and, and with, with with weight management, there’s a lot of ability to do sort of remote monitoring with these patients too. So they don’t have to come in here and pay a copay every time they can remotely weigh in. And that can go into my EMR and these kinds of things. So most of it, I would say 90% of it is done here in house. Okay.

Justin (18:58):
Okay. I’m curious to hear about sort of your career trajectory. I know you’ve gone through several different like phases of different practice models and there were probably some lessons learned along the way. So why don’t you just briefly give us the 30,000 foot view and then we can kind of zoom in on those different timeframe.

Dr. Jessica Jameson (19:13):
Okay. So I came let’s see. So I was a fellow in Boston and during that time, you know, I had told my husband, gosh, if you follow me around for military residency fellowship, you can pick where we end up. And he said, I want to move to quarterly in Idaho. And I was like, Idaho, Idaho. Like, I don’t even, I had never been to the Pacific Northwest. This wasn’t even on my radar. And I said, okay, if you can find me a job in Idaho, we’ll move to Idaho. Well, sure enough, he’s persistent. And he found who I needed to call. And that gentleman said he was hiring. And so we ended up out here and that was a private practice. And so I joined the gentlemen right out of fellowship who had been in private practice for almost 15 years at that point in time, a excellent physician learned so much from him.

Dr. Jessica Jameson (19:55):
But during that time, you know, it became one of these things where the, the path to partnership was not spelled out. And I think you hear the story over and over again, right there. It’s kind of a dangling carrot that seems to move. And so as time goes on that could just create such a rift between the junior person and the senior person. And ultimately we just were not able to, to get over that. And then carrot kept dangling and I became more sort of disillusioned with that process. And I decided to leave that scenario. So I put in, you know, my three month notice or six month notice and ended up being asked to leave much sooner than that. And so I didn’t have a job, had no job at that point. And you know, a six month old and two other kids and my husband was staying home.

Dr. Jessica Jameson (20:42):
And so it became, Hmm, I need a job. So I actually went to the hospital, local hospital. I didn’t have a, and I said, Hey, I want to set up my own practice. I know that for my personality type and how I work, I really want to be in private practice. I don’t want to be hospital employed. I want to be private practice. So I went to that hospital and said, can you help me set this up quickly? And then once we’re kind of up and going, and everything’s looking good, and then I can kind of take it back over and they agreed to that. So for a year I was hospital employed. And during that time it was, it was what you would imagine with hospital employment, much of the frustrations, you know, I would want to make a change to an intake paper, and I would have to ask a committee that only met on the fourth, Wednesday after a blue moon.

Dr. Jessica Jameson (21:25):
And so that wasn’t happening. So these kinds of things became very frustrating. And you know, when you’re hospital employed or, or employed by anyone really, you don’t have control over the staff. And so I would hear staff talking to my patients on the phone in ways that, you know, I wouldn’t even consider talking to a patient and you just don’t have control. So ultimately I said, listen, I can’t keep doing this. This is, this is killing me and my practice. Right? Cause at that point I had a referral base and, and these patients were just not happy with the service that they were getting, you know, outside of me and my my practicing. So anyway so I decided to start my own, my own practice from the ground up at that point. So I went in and started my own practice. And so far haven’t looked back. So it’s been, it’s been a wild ride. It’s been a lot of work and exactly what everyone says, which is, you know, it’s so much work, but at least I’m working for myself. And so I think, I think for me, it’s been totally worth it. Yeah.

Justin (22:23):
So these are, you know, a pretty wide spectrum of different, you know, the hospital based, and then starting with the, it sounds like a small, was it just you and the, the, the other physician who was the partner? So it was like just the two of you. So you got like the very small, the micro group and then the hospital, and then the entrepreneurial experience to draw from. So I’m curious when you’re sitting down, when you go to, you know, an ACEP meeting and somebody says, dr. Jameson, can we grab coffee? I’m just about to finish fellowship. And I want to know, like, give me just the shotgun blast. Like, what do you think about what I should be thinking? The important questions I should be asking myself for the next couple of years what, how are, what kind of conversation is happening there?

Dr. Jessica Jameson (23:05):
So, yeah, this is very interesting. So when we do, you know ACEP and Nan’s, and some of these organizations have these mentor mentorship programs, which I’ve been a part of on the mentee side, and then now on the mentor side, and I always start with, you really have to know what your priorities are as a human being. Before you can decide whether, you know, whether an employed hospital position versus a private practice in a small group, private practice in a big group, right? So some of that I think comes down to personality and I mean, this is a little bit of a tangent here, but we’ve started implementing within our private practice personality testing for every person that’s, that’s, that’s going to be hired here and where we saw the biggest change was in our practitioners, right? So nurse practitioners and physicians, we, we make them all take this test.

Dr. Jessica Jameson (23:49):
And, you know, we walk around calling people by their numbers or whatever the case may be. So I’m curious, Oh gosh. So we do the disc profile. And then we do the Enneagram, which is like a really old free it was actually, I think it has a religious basis, but we don’t we don’t do that, but it’s, it’s awesome to walk to your front desk and hear somebody on the phone with another person in the office and hang up and you’re behind them. They don’t know you’re there. And he says, of course, she responded like that. She’s a two, right? We’ve got some insight, no, we can work with this. Right. Instead of, you know, I’m angry because she responded like that. It’s a course because this is what’s important to too. And so it takes training of the staff to understand each other, but I think it really, really helps them.

Dr. Jessica Jameson (24:30):
And from a leadership standpoint, it’s it’s imperative. But I think the first thing I say is, you know, what is your personality type? If you are somebody who has always been a leader, always wants to be kinda on the forefront of all sorts of things, technology, that kind of thing, that hospital employed is going to be difficult for you. If you’re somebody who has a lot of other responsibilities, you know, whether it be financial or family hospital employee may be great for you. I mean, essentially you go and you do your job and then you go home. There’s not a lot of other admin sort of time that is required of you. And so once you sort of figure out and then there’s hybrid models, right? And I think the beauty of, of doing your own thing is that you over time can create what you want, right.

Dr. Jessica Jameson (25:11):
So may not start out that way, but over time you can really store sort of create the best scenario for you. So I always say, what’s your personality? What are your responsibilities? I mean you know, if you, if you have $700,000 in student loans that are going to be due to payback in three months, then starting your own practice from ground up is probably not an option for you. I always say, what’s your fellowship like? Right. Because I came from a great fellowship, but there are a lot of people who come from fellowships that are not as heavy in much of the interventional stuff. And so Ben, you really want to find a practice where there’s somebody that’s willing to kind of mentor you a little bit during that first year,

Justin (25:48):
Especially this last class who, if they were their last rotation was the one where they’re doing the interventional stuff and Holy cow, now they’re integrating people in the ICU. It’s a crazy situation. Yeah,

Dr. Jessica Jameson (25:58):
Yeah. That’s exactly it. And we had a lot of discussions about what are those fellows going to do, because essentially they’re going to, they’re really going to need more sort of hand holding and rightfully so then than maybe other fellows from previous years.

Justin (26:11):
Yeah. And we had a recent conversation with dr. Shachi Patel, who I think has maybe a, a friend of yours. And she was actually saying that the two of you are not infrequently on the phone together talking to somebody who’s thinking about taking the plunge themselves. And she was very helpfully shared some of her own story about, especially the financial element and the flexibility she had being married to somebody who was making an income. And she didn’t have a lot of student loans because of some moonlighting. And so it was sort of the perfect storm to position her to be able to launch a practice straight out of fellowship. But that, that self knowledge was the launch pad that positioned her for success. So that’s definitely critically important. I always love the entrepreneur story as an entrepreneur. I’m just really interested in sort of the psychological kind of makeup and then the journey, the moments of self doubt, the, the moments of like the decision making. So tell me about axis spine, which is your current private practice and you’re the founder and how going from being fed up at the hospital led to, I think I’m gonna start something from scratch.

Dr. Jessica Jameson (27:16):
Oh yeah. Okay. So, you know, I was at that hospital in our area and I don’t think this is unique to our area, but we, we don’t have a lot of surgeons who are willing to operate on patients who have been operated on before. And so there was really only one of those individuals in my area. And I sent a lot of patients to him and he would send a lot of patients to me. And he would do things like call me at 8:00 PM and say, it’s not a good time to talk. You know, I just wanna let you know, I took care of mrs. Smith. She’s doing great. Thanks for the referral. And I’d be like, what surgeon does this? Right. So just a wonderful human being all around patients. Anyway. So at some point about four months into my employment with, with the hospital, he said, Hey, how happy are you?

Dr. Jessica Jameson (27:59):
And I said, not happy at all. Well, first I said, in what my job, or what are we asking about? And then I said, I’m just not happy at all. And he was employed in Spokane, which is about 20 miles West of us, and was also unhappy. And so we sort of got together and said, could we make this work? And what would that look like? We had a riff, we were fortunate that we had a referral base already. So he had a full referral based from Spokane. I’d been here for five years. So I had, you know, my referral base there. And we said, you know, what, what would this look like? There, wasn’t a lot of guidance and there’s still not a lot of guidance. I’m trying to change that, but there’s, there, wasn’t a lot of guidance as far as, you know, what do you do first or next, or you know, just silly things.

Dr. Jessica Jameson (28:38):
Like you need to have an address before you can apply for credentialing, you know, things that you just had no idea. So at that point in time, I was very fed up with my practice. My husband was very fed up with me, I think because I was fed up with my practice. And so he was quite supportive and said, you, you know, you’re not cut out to be employed. So you’re going to have to do something different. This seems like a good time to kinda kind of take this leap. And so we essentially sat down and poured hours and hours into creating this before we left our, our previous jobs. So that we, there wasn’t a lot of downtime between those two jobs. But it was, and still is a lot of work. I mean, it’s a lot of, as you would imagine, trying to grow that practice because private practice is difficult and you really have to, I think, position yourself to, to be an, an, a group or an organization that can’t be replicated by a hospital system. And that was our goal from day one was that I want to make sure that our organization is something that is so unique and, and have a sufficient size that the hospital next door can’t just go reproduce what we’re doing.

Justin (29:47):
Yeah. I think that is a fascinating idea. I’m curious, how do you implement, how do you, how do you make yourself different enough so that they can’t, they can discernibly tell the difference between an experience with you and your practitioners and the hospital, and want to come back other than maybe singing during procedures, but maybe that’s actually part of it.

Dr. Jessica Jameson (30:07):
I do. I actually do think that’s part of it. And I think so. So, you know, my, my partner is a unique surgeon and that he’s, I shouldn’t say that, but he’s, he’s extremely personable. He spends a lot of time with patients, patients, just patients just adore him. I mean, every five minutes, I’m listening to an 85 year old lady who tells me how gorgeous he is, which is totally irrelevant, but they come back and they tell their little friends and they all come back to. Right. So, but I think that what makes us, what makes us unique is that our focus from the beginning was on caring for patients. And so when we sat down and said, okay, who are we as an organization? And what are our values? We are caring. We are competent, we are comprehensive. And those three things were the guide for everything we did.

Dr. Jessica Jameson (30:48):
And so we’ll stay late to see patients. We’ll add patients on all of our referring docs, know that if they pick up the phone and say, can you see Mrs. Smith, we will get Mrs. Smith in, within 24 hours, we will just go above and beyond to care for these patients. And then gradually word of that gets out there. In marketing is, is, you know, a big piece of, of anything you do and appropriate marketing and that kind of thing. But really the biggest thing has been word of mouth from other patients. So our patients have good experiences, have good surgical outcomes or, or get better with our physical therapy alone or a chiropractor or these sort of things. And they tell their friends and then that continues. And so we have quite a few referrals that are coming from primary cares, where it says, write in the note, mrs.

Dr. Jessica Jameson (31:31):
Smith wants to see X’s spine. And from my standpoint, that’s when we’re winning, right. When the patient is going in saying, Oh, this is where I want to go. This is where I want to be taken care of. But we’re also unique in that, you know, we looked around at the other hospitals and they’re all trying to create these spine centers or neuroscience centers of excellence, and they pour millions of dollars into it, and then nothing happens, right? And so we said, well, it can’t be, it can’t be that hard. It has to be the organization that’s having the issue. And so far we’ve proven that. And so what we said was, if we’re going to, if we are going to take care of spine and pain patients in the best way possible, we have to have a multidisciplinary approach. And so from the very beginning, our plan was to say, you know, keep all of this under, under one roof, so to speak. And I think we’ve been the only ones in the, in the region that have been able to, to really do that. And, and our outcomes are better because of that. And we’ll be able to prove that with our data tracking longterm as well.

Justin (32:27):
Awesome. I, I love what you’re saying about outcomes and I I’m, I’m just wondering, you know, I talked to dr. Christian of a couple of weeks ago. He you know, has elaborated in a lot of research and a couple startups. He has like a lot of team organizing to do different things. And the way you talked about when I’m in a hospital, I can’t control the way the staff talks to my patients and you probably hear the phone call and they hang up the phone and you’re just like, Oh my gosh, that patient is probably like feeling so, whatever, very put off by that interaction. And, you know, you talked about doing the disk and doing the Enneagram, and you’re, you have this emphasis on knowing who you’re getting as a team member, and then making sure that when your team member communicates to patients, that that patient feels really cared for and empathized with. And they have a really positive experience. And I, this is one of those things that falls in the categories of things that I think, but can’t prove that somebody should write a white paper on this. Like when you intentionally build a team of people that care, and especially in like a physician owned practice where there’s buy in from the top down, and everyone is pushing hard with that empathetic ethos, that it literally you have better outcomes. It sounds like that’s been your experience.

Dr. Jessica Jameson (33:42):
It has been our experience. And, you know, some of it is anecdotal, but we are tracking these things as well. And I mean, I’m not tracking like, did you like the front desk guy? And now your pain’s better. I’m tracking more of the whole process, right? And so we’re, we’re doing this data tracking where we’re tracking, you know, function, we’re tracking pain scores, which to me are kind of less important, but we’re tracking all of these things so that we can kind of collate all this information and sort of prove those things. Cause I think it’s important, but actually what you’re saying about it is top down. And I think it’s top down in a hospital setting to just by function of being a physician, you do have a leadership position. You may not have control over a lot of things, but you’re still people look to you to be a leader, but it’s very different in the private practice setting where the buck stops with you.

Dr. Jessica Jameson (34:25):
Right? And so we have created this, this culture and we’ve been very intentional about the culture that we’ve created here. And I say that we are slow to hire and quick to fire. So, you know, we spend a lot of time going through the people that are coming into this organization to make sure that they’re going to be a great fit. But if there is something that happens that says this person is not a fit, then we were very quick to say, because that is your reputation on the line as an organization, as a physician. And so we spent a lot of time doing that. I spent countless hours doing leadership development with my department heads, these sort of things where we, we just function. You know, we just focus a lot on how do we create the culture that we want. I mean, we want to be vulnerable. We want to be daring. We want to do things that are right for the right reasons. And we want everybody to buy into that. And once everyone’s bought into that, the recipe comes very easy. You know, people just behave according to according to that culture and patient sense that, and patients see it. And it just becomes very rewarding overall.

Justin (35:30):
How do you show vulnerability as a leader in a way that makes it a part of the fabric of the culture and that enhances rather than detracts from credibility? That’s like, I feel like that’s like one of the ultimate leadership questions.

Dr. Jessica Jameson (35:44):
Yeah. So, and I firmly believe that that vulnerability in any way, shape or form actually enhances and doesn’t ever detract. I think that we sort of have a culture in, in many organizations and have for many years in corporate America and many other places where it’s vulnerability is viewed as a weakness. And I think that, that discussion surrounding this with some of Bernie Brown’s work and this kind of stuff have really opened our eyes to say, Oh, you know, maybe this isn’t the best way to, to do this, to lead an organization, even, even in our military leadership, we’re starting to see a lot of this sort of vulnerability process work in. But for me, what that looks like what that looks like on a, on a day to day basis is owning up to mistakes is you know, I feel like I, I try very hard to own up to mistakes.

Dr. Jessica Jameson (36:35):
I can send, send you copies of multiple emails. I’ve sent to the staff where I’ve made a mistake mistake or said something that was inappropriate. And, you know, I’m the first to say that was completely inappropriate and this is not who we are, and this is not who I am. And so I think that that is one aspect of it, but I think also, you know, being, being vulnerable, just when we’re dealing with kind of the leaders within our, within our organization to say, Hey, I don’t know how to do all of this stuff. And you’ve been doing this for 20 years. So my partner, and I like to say that they are the subject matter experts, right? So I’ve got a biller that’s been building for 25 years for me as a 40 year old to walk in and say, listen, this is how the billing department’s going to run is asinine.

Dr. Jessica Jameson (37:14):
I don’t know anything about billing, right? So she becomes the subject matter expert. And I sort of defer to her and say, listen, how can we make this better? How can we make this process better? What are we doing well, what are we not doing well? And how can we sort of have a culture where we are willing to kind of rumble about these things and figure out ways to make it better versus a, you know, Sally, doesn’t like Frank and Frank’s talking about Sally at the break room, all this kind of stuff like that is just not, it’s just, it doesn’t help anything. And so, you know, our leaders are sort of empowered to make decisions, to make changes and to, to really have honest conversations and, and the people that are under them have these same honest conversations on a weekly basis, on a monthly basis, whatever that schedule looks like.

Dr. Jessica Jameson (38:02):
And then we have all staff meetings where we have the same thing and we, we, we carve out time for what we call this rumble at the end of it, where we say, okay, what’s going well, what’s not going well. And, and our staff is free to say things that are really hard and they do, they do now that this culture has been sort of established previously before we really started being intentional about this, I think they would have just been quiet in the corner. But I think now they feel like there’s not going to be some sort of ramification for saying something that the boss doesn’t like, and that’s the culture that we want so that we can you know, avoid errors and so that we can improve our processes and take better care of our patients.

Justin (38:39):
Yeah. That makes a lot of sense. I’m interested to hear what your COVID experience has been. There’s a funny saying in the investment world, I think it was Warren buffet who said, whenever the tide goes out, you can tell who’s been swimming naked. And this has been an experience where there’s been a reshuffling and where some practices have been running on such a tiny margin, perhaps the parts of their, what they’ve been doing have been sloppy. You know, if you’re only collecting, you know, 85 instead of 90 or 70% of collections or whatever, like those types of errors, if you’re, if your margins, aren’t where they need to be from a profitability standpoint, then you don’t have the ability to persist when times are really tough. So I’m curious, how has this, how has your experience been the last few months and what has enabled you guys to thrive if that’s what you would describe your experience being now, and how has this time, how do you think it’s going to change the, the private practice dynamic or the physician owned pain practice dynamic? Because I think there’s definitely implications there. And I’m curious to hear what your thoughts are on that.

Dr. Jessica Jameson (39:38):
Yeah. So I would say that we have come out the other side of this. I don’t know if we’re not probably at the other side yet, but you know what I’m saying, sort of in actually a better place. I think that I call it the COVID reset button because I, I was, we were swimming to keep our head above water, head above water. And then all of a sudden you have this forced, mandatory pause where you can relook at everything, every process, every team, every every payer, every, every, everything, and kind of have this chance to pause and say, okay, how are we doing with this? And some things we did great with, and some things we’re saying, wow, you know, a lot of things had to change. And so I think that for us, it became a chance to really reassess all of our processes and figure out where the extraneous stuff was, so that we could trim some of that fat.

Dr. Jessica Jameson (40:27):
And I think a lot of times you don’t have the luxury of being able to really look with a fine tooth comb at your processes and at what you’re doing from a business standpoint. And so this really gave us that opportunity. And I think that it’s also shown us that we can actually function the same that we were before with much less staff. Right. So when you start to look at your teams and say, okay, we’re paying this person for 40 hours a week, but they’re probably only doing 25 hours of work in this thing. How can we get that person to do something else for those other 25 hours and eliminate another position? So I think what we’re going to see for pain practices, first of all, I think we’re going to see a trend toward people wanting to be in private practice.

Dr. Jessica Jameson (41:05):
I think that that is going to increase significantly because I mean, people were told they weren’t taking salaries or they’re taking salary pay cuts or whatever the case may be in hospital settings. And that’s a big deal, you know? And so I think it became very apparent, the lack of control that physicians as a whole have over the, the day to day lives, we don’t run medicine, executives, run medicine and every, every sense of the word. And so the only way to sort of avoid is to kind of take back take back medicine and say, Hey, listen, we’re the subject matter experts. We know how to do this. And honestly, I think we know how to, how to do it better than somebody who’s telling us how we should do it. Right. So that’s what I think we’ll see. And then I think we’ll start to see much leaner practices too. I think that’s going to be kind of a, kind of a trend in that. Practices will really start to focus on processes and improvement, proving those processes to make things very, very lean and sleek moving forward.

Justin (42:02):
So then you would say that from a, like a macro standpoint that somebody who’s trying to considering doing what you have done or what dr. Patel has done or, or others, what maybe it doesn’t need to be like a solo thing, but merging with another physician, you don’t view this as a more hostile environment to do that than it was maybe 12 months ago.

Dr. Jessica Jameson (42:22):
Not that it was 12 months ago. I mean, I think, I think one of the, one of the things that sort of really helped us during this COVID process was our ability to pivot early on. So ability to change to telemedicine very early on so that we were still keeping patients engaged, getting, keeping some of that revenue coming in. Our ability to do that was, I mean, it was very different from our local hospitals or even the hospitals in the state over. And so being able to make adjustments like that fast, I think are going, are going to position private practices in a better spot. And I think that, you know, it’s not easy. Reimbursements are continuing to be cut these sort of things, but there’s so many unique ways as a private practitioner that you can increase revenue through what you’re doing on a day to day basis where you can, you know, work smarter, not harder kind of thing. And so I actually think it’s, it’s a reasonable time to start in private practice. I mean, I think that we’re going to start to see that, like I said, even more in the coming months, people really wanting to get into the private practice

Justin (43:30):
As I was cruising around on the internet, doing some more research for this discussion. I found your personal web page or your personal brand page or whatever you want to call it. And I, I’m a big fan of this and I’m doing this. And we had dr. Anita goop to own a while back. I think she’s somebody who’s done it early well. But more and more having a physician own their own brand. I’m sort of using that to mean when somebody thinks about dr. Smith, they don’t think about the university hospital at which dr. Smith works with. And like, I want to see dr. Smith and I’m going to go wherever dr. Smith is. And that starts to create that sort of sticky patient relationship. And there’s just 1,000,001 reasons that I think that’s really valuable, you are someone who I think has done this well and is doing this.

Justin (44:13):
And you have, you know, I was like, there’s like some speaking and consulting, and you’ve got some courses that are all attached to Jessica James, an MD a and it’s sort of your own thing. So talk a little bit about how you think about that and what that means to you and kind of the way that you perceive that idea in the life of a clinician. Maybe just starting to think, you know, what, maybe I should put a little time and effort and energy into doing something like, cause it is a lot of time and effort, and it’s the kind of thing where you’ve got to build the chassis and hope that eventually there’s, there’s some payoff at the end.

Dr. Jessica Jameson (44:45):
Yeah. Yeah, no. And I totally agree with you that I think we have to own our personas or somebody else is going to right. And so my, my point on that is that I think that putting the time and effort and energy into into owning that is well worth the time. Even if, even if you never make an extra dollar out of it, what it allows for is, is, is you to, to create who you, who you want to be and what population you want to reach, it allows you to have more opportunities within the healthcare space than you would if you were you know, dr. Smith at the university and the only place you could find anything about him was this one little link on the seventh webpage on the, on their, on their page. So I think that, you know, we’re seeing, we’re seeing a couple of things.

Dr. Jessica Jameson (45:32):
One thing that we’re seeing differently is that the direct to consumer marketing, which has been taking off both from drug companies, from from, from everything, but especially for physicians, right? And through practice, most of our marketing is actually direct to consumer marketing. We’re creating videos that pull on heartstrings, but that Sally sees on Facebook and tells her mom who’s struggling with the same thing much more so than maybe even five years ago where we would basically be going into private or into a family practice offices and saying, here’s who we are. Here’s what we can do. We still do that. I think that’s very important, but we’re spending the majority of our budget on direct to consumer. And I think that that’s how patients are going to find people in the future. And so I think that that is, is very important. And when they, when they start looking for me, I want them to see what I want to be put out there versus versus something else.

Dr. Jessica Jameson (46:28):
And so I think that, that, that, and the social media aspect are huge. I mean, people coming out of residency and fellowship have been, have had experience with social media for years. Right. And so I mean, we just saw the kind of debacle with the thoracic surgeon paper that came out. But I, but I think when it goes to show us is that these things do matter. And so I think that that there’s going to be a lot more of this in the future, right? I mean, if you get on social media, I have, I have my social media and then I have my physician social media and they’re two separate things. And that allows me to really sort of create the person and the physician that I, that I want. And, and have a lot more opportunities that come from that as well.

Justin (47:20):
I have one more thing I want to tackle real quick and then we’ll wrap it up. And I’m really grateful for your time today. You’re talking about the, you mentioned earlier the marketing approach that your practice is taken, and you said like dumping money into it as if it’s like this intentional thing. We’re thinking about marketing, we’re thinking about how do we make the brand that we have known in the community among people who may need our help. That is something that takes dollars. It takes effort and it takes intention. It doesn’t people don’t just especially at the beginning, people don’t just come in off the street and say, let me talk to dr. Jameson. So talk a little bit about how you and your partners have thought about marketing. Some of the ideas you’ve had, some of the different things that you have done to build patient volume and what you found to be either like a terrible mistake or a waste of time and money or something that’s been really high yield for you. And I’m asking as, as someone who has spent huge piles of money on things that could paid off zeros, I’m very

Dr. Jessica Jameson (48:12):
Very true. Yeah, I’ve got plenty of those as well, but I think, you know, that that process has changed. So when we first started and it was just the two of us with a small practice and we were just trying to get off the ground, the marketing was done by me. I did all of our social media. I did all of that. So, so you can do it yourself. I think that, you know, one, one piece of advice I have as far as marketing goes is that you want to create content that’s applicable to the people that you were trying to talk to and you want to do it routinely, right? You can’t do it like on Monday and then wait six weeks and do another one. So you want to just be real intentional about that if you’re doing it yourself.

Dr. Jessica Jameson (48:47):
And then I think the other piece of marketing, especially if you’re a solo practitioner or a small practice, that’s just kind of starting, I think a big piece is going to be the marketing to referring physicians. And so we have, you know, I have a referral base that refers to me, but every three months we do something for them. Whether, you know, whether it’s just send them a card or sometimes we’ll, you know, get him some coffee or something like this, but something that says basically, Hey, we didn’t forget that you’re keeping us in business, that kind of thing. And so I think that’s, that’s important to remember as well. We now have a marketing team, right? So we’re now at the point where we have a professional that does this for us, but I think once you’re at that point, things to consider are, are these things like you have to define who the organization is, what sets you apart, who you’re trying to influence and then sort of go from there.

Dr. Jessica Jameson (49:34):
So for us, we said, you know, our organization, we are comprehensive. So we make a big push on marketing the comprehensiveness. And so we talk a lot about our group meetings that we have, where our surgeons that are paying docs in our mid levels, in our you know physical therapists and chiropractors, we’re all sitting around kind of chatting about difficult patients, right? So that doesn’t happen anywhere else. So we, we, we market that, we market the fact that we have these people here and that we’re all under the same roof. We are also fellowship training. All of our physicians are fellowship trained and that’s very unique. And, and we feel very important. So we market that a lot. One of the biggest successes for us has been what we started during Colvin, which was basically these lunch and learn seminars.

Dr. Jessica Jameson (50:16):
We had time to sort of pivot. And so now we have you know, when patients come into your office, you get their email address. So you have all of these, and then you can post on social media. You can send out a blast of these email kind of things. And we have a hundred and to 200 people on the third, Wednesday of every month now watching our info sessions on stenosis or spondylosis or thesis, these sort of things. And then we can follow up and we can record that. We put it on our YouTube channel, and then we can follow up with those people because we now have all of their contact information, even if it’s a new person from Facebook, they still have to put in their email in order to be able to register for that. Right. So then we, we really start to use this group of email addresses and contact information to kind of send out newsletters, reach out and follow up, you know, one, one link to schedule an appointment, make it very easy for them, these sort of things versus you need a referral, you need five people to say that your back is actually hurting you, and then you can come see us.

Dr. Jessica Jameson (51:07):
Right. So if it’s that hard, nobody’s coming. And so I think a big piece of it is to make it really easy and, and to create content like that, that, that really resonates with

Justin (51:18):
Yeah. Are there any resources that you have leaned on to be able to have maybe a paradigm in which you’re like, okay, here’s like the six boxes of marketing success. We’ve got, gotta fill all those in to have a comprehensive plan, or is it maybe it’s been some of the consultants you’ve worked with that have helped with that?

Dr. Jessica Jameson (51:32):
I think it’s been I think it’s been the most recent consultant that we have actually. So, you know, because what we have is we have sort of these pillars of marketing. So we have social media, which is definitely separate from our videos and the video content is, I mean, it’s expensive to put together these videos, but it’s, it’s very powerful and moving. And I think it really helps. So we have about us videos where you can listen to our PA that you’re going to come talk to next week. You can, she can tell you about what her thoughts are on, on whatever, and what she does for fun and this kind of thing. And so it just becomes a more personable, interactive thing. So we have the social media, we have these videos, then we have the website. I think your website is, is a really big piece.

Dr. Jessica Jameson (52:13):
If you have a website that looks like you created it, people just don’t like that. I mean, there’s, they don’t have a lot of tolerance for that anymore. So it makes you kind of look like, what does he really, I mean, if he, if his website looks like this, so we really know what he’s doing with a needle, that kind of thing. And so it doesn’t have to be outrageously expensive, but it has to be quality and it has to have good quality information on it, which will also help with your SEO and that kind of stuff too. So the website is another piece and then our community aspect as a piece, right? So we have the community aspect of marketing is for us is we support, you know, triathlon teams our, our advanced practice practitioners in order to receive. So we have this kind of compensation structure set up where they have to volunteer for some of these events, so that we’re out in the community in order to get you know, the bonus at the end of the year, these sort of things where we incentivize people to be part of our marketing team.

Dr. Jessica Jameson (53:00):
Right. So go volunteer at the race and where your access by tee-shirt and that looks that’s great for the community. And then so that’s our sort of community thing. And then we move into this you know, how do we, our provider relations, you know, our referring docs, how do we, what do we do for them? We’ve had, we’ve done some dinners in the past where we’ve given, you know, here’s a lecture on spinal stenosis or, Hey, Virta flex is new. You guys want to learn about, and we do the same thing for physical therapists and they really eat it up because they don’t have to pay anything for it. We get them a little CME but it’s, and it’s knowledge that we want them to have, but it’s also you know, it’s also great advertisement for our organization as well.

Justin (53:40):
Yeah. Awesome. Lots of great Intel there. I want to probably like chop that out and share it in a bunch of different places. I think that’s something a lot of people are going to benefit from. I got one last question I want to close with dr. Jameson. you have accomplished a lot. You’ve been a lot of places you’ve done a lot of things whether it’s research or patient care or, you know, flying all over the world. I’m curious to hear a story of just professional actualization where you helped someone, or you accomplished something, or maybe it was launching your in practice, where you in the midst of all the pushing, pushing, pushing really hard to achieve and to be able to pursue your vocation. You’re able to pause in that moment. And maybe it was a moment of gratitude or reflection to think that like, I’m actually, I’m doing it, I’m making it, I’m living the life that I want. And this is the dream of, you know, the practice of medicine.

Dr. Jessica Jameson (54:27):
Such a great question. I think that the one that comes to mind to me is, is, is in my practice of doctorate. I think that it, it becomes very easy when you’re seeing a lot of patients over a lot of time to sort of think, you know, we see the same things over and over, no matter what specialty, it’s not unique to ours, but you’re seeing the same things over and over and over. And about just before COBIT hit, I had a patient who came in, who no one else would see, but sort of chalked up as being just a chronic pain patient. Nobody could figure it out this, you know, the typical story that you hear I agreed to see him for a colleague of mine, just for a consult to say, is there something else we could do?

Dr. Jessica Jameson (55:09):
And you know, it turns out this guy has a horrible demyelinating disease that nobody picked up on. And I think it’s those sorts of times where you get to you really change people’s lives when it, when it comes to those sorts of things. And I changed people’s lives when it comes to pain as well. But when, when you give them the time of day, when you listen, I think that, you know, I think patients come to me because, because I’ll, listen, I may not, I may not be the best at transfer animals in the world. I may not be the best spinal cord stimulator neuromodulator, but what, I’m pretty darn good at listening and there’s, that goes a huge long way. And when patients come in and feel like they’ve been heard, even if I don’t make them better, or if they have a complication, if they feel like they’ve been heard the, the outcomes tend to be a little bit better.

Dr. Jessica Jameson (55:54):
And so I think that it was just a reminder to me that, you know, it’s so easy to get in this rut of next patient, next patient, next patient, especially these difficult patients where you think, Oh, if you’ve seen one, you’ve seen them all. But to be able to really kind of to help this particular gentlemen, gentlemen was just an opportunity for me to pause and say, yes, this is why I do this, right? Like this, this is the purpose of me being a board certified fellowship trained physician, right? So he’s been to a million other places and nobody else has taken the time to do the exam and to listen to the story and to say these two things don’t fit. Let’s, you know, let’s move to the next step. So that would be my that’s my one from the doctor standpoint.

Justin (56:35):
Awesome. Cool. Well, thank you, dr. Jamison for joining us today, it’s been a pleasure speaking with you, and I wish you all the best. Thank you. It’s been wonderful. If you liked what you heard this week, head on over to anesthesia success.com, where you can find more content and free resources to help you build a successful career in anesthesiology and pain management. If you wanted to leave a review in iTunes, I would also really appreciate it. Thanks for using some of your valuable time to join me today on the anesthesia success podcast.