Transcript

Dr. Tea  0:52  
I want to welcome fellow podiatrist, functional podiatrist I should say, Dr. Emily Splichal. I have taken her online courses, she has proven herself to be the leader in functional medicine and educator, a public speaker, you look at her resume and the podcast she's spoken on she is she is an amazing human being. I'm so grateful to have you here to speak with us about your direct care practice so that others can see what's possible and maybe borrow some of your ideas into our own practice. So welcome to the podcast.

Dr. Splichal  1:24  

Thank you so much. It is a pleasure and honor.

 

Dr. Tea  1:27  

So we had connected in the past, you talked a lot about functional Podiatry in your practice. You've written a book about barefoot walking, you're a big proponent of natural, healthy ways to heal and also regenerative medicine. Could you take us back to where you conceptualize just leaving the insurance conundrum and pursue this path? 

 

Dr. Splichal  1:50  

Absolutely. So I think what is important to notice is that I had this curiosity and desire to seek more from podiatry education from the moment I started podiatry school. So I kind of came in with his deeper appreciation of human movements. And a lot of that is because of my background in fitness and athletics. And I was a personal trainer all the way through podiatry school. And why that's important is that I felt that there was always more to how the foot connected to the rest of the body. And that the way that we are assessing our patients or our recommendations could have been a little bit broader in how we offer that to the patient. So that's important to know. Because my journey through podiatry was very much not linear. Actually, when I was going through residency and learning to be a surgeon, I actually left residency to go back to school to get a Master's in Human Movement, so that I could really shape my practice around this integrated concept that I knew was there. I just didn't have the academic knowledge and the credentials that say to build that practice. So once I got my Masters, I went back to residency, obviously became licensed, completed it and then entered into the profession from day one with this deeper appreciation. What I found is that being under insurance and being part of a traditional podiatry practice, I was part of a large, multi specialty group in New York City. There were about eight podiatrists and then the world MDs, DOs, so again, multispecialty, that I was very much restricted by the insurances. And the larger goal of that practice based off of the time I could spend with the patient, the depth of the assessments that I wanted to give the education I wanted to provide. So it just started to conflict with what intuitively I knew I needed to offer the patient. And that's why in 2017, I actually left and then went fully into direct care, was it. I was finding that restrictions in modern traditional health care run in practices. 

 

Dr. Tea  4:13  

I can't imagine leaving in the middle of residency to pursue something else and then come back, like you had to have conviction to do something so wildly different and untraditional, what really pushed you or gave you the security that this was the right path? Or was this kind of a guessing game for you? What did that look like for you?

 

Dr. Splichal  4:36  

I would say that that is truly the power of intuition. Like I knew that it was something that I was being drawn to. And I'm very much a person of listening to our intuition and what our body knows, resonates. It's what our calling is, what our passion is, what our purpose is. I didn't know what it would look like but I was being drawn in that direction. It was was scary. I potentially burned bridges by doing it because I literally had to quote unquote, quit residency. And I'm sure that now, I've interacted with my attendings at that point who now know me a decade later. And I'm sure they were like, oh, yeah, we did not, we did not like you then, because of what I was doing. But I knew that there was something, something more that I was drawn to offer patients and movement and the profession and the industry. And that was this deeper seeking of movements, and how our feet are so much more than just our feet, how they interconnect to other fascial lines or diaphragm, to stress level to emotion to cognition, there's just a very powerful aspect. So I knew that I needed to do it. And like I said, it was very scary. But I had other professionals, podiatrists who saw something in me and knew that there was, there was something special that was percolating over there. And that when I was ready to come back into residency, they accepted me and they gave me the chance to essentially come back. And then the partners that hired me right out of residency saw the same thing. They knew that there was something special that I was doing, even though I would leave the country for four weeks and be like, Okay, I'll be back in a month, I'm traveling the world to teach about feats, they still knew that there was something there that they gave me that chance, and they gave me a home when I first came out of residency.

 

Dr. Tea  6:44  

That's incredible. I don't think I've heard a story like this anywhere. Well, not only did you pursue what you felt was best for you, you created an entire legacy. You have your educational platform, you've created Noboso which I refer to patients a lot. So tell me about this journey of having a clinical practice, but also having these other hats too, just, it all seems to tie together. But they're all very unique skills to just uphold. You know, you have to be the clinician, you have to be the CEO, you have to be the creator of your imagination. How did that come together?

 

Dr. Splichal  7:23  

I think the biggest thing is what all of the physicians that are listening as we go, were drawn to medical school. I think because of a curiosity and academic curiosity, a curiosity in the human body, some people are drawn to be medical doctors, maybe they come from a family, medical doctors, so they are essentially inherited into that profession. I love academia. I am a very curious person. I love the human body and am very analytical in the way that my brain works. But as I was going through school, and then residency, what I was finding is that I wasn't drawn to be a healer like that wasn't it wasn't satisfying the deeper purpose in my being of why I went to medical school in the first place. And I think a lot of people feel what I felt, but are like, Hey, I'm a quarter million dollars in debt for this. This is my life. This is the road I chose. And I actually sat back and was like, I love it. But how do I use that information, that knowledge, that skill set a little bit different. So that resonates authentically and why I have this knowledge. And what I came across is that I actually love education. I love learning. So I started to do webinars, I started to give lectures, I started to read a lit review and write blogs, this is in 2010 around 8-9-10. And what I found of what then ignited my passion as I was going through the medical journey and residency was keeping that aspect of education and acting academia in my life in my culture of who I am. And that's why I founded my education company, is I was like, oh, it's actually education. That is what inspires me and lights me up. So how can I take my knowledge of feet medicine, and bring it into that educational component, and then that felt authentic to me, which is then how I started to see my patients. So every patient interaction, I bring an excitement and an enthusiasm to teach them and I see every plantar fasciitis patient, which can be quite routine or mundane as a new opportunity to teach this patient about their foot, their foot type How the foot actually gets plantar fasciitis. And it honestly brought a new excitement to my practice. So it was really finding that deeper purpose of, I'm actually an educator and identifying that

 

Dr. Tea  10:13  

What I really love about your story is something that we don't talk about enough when we go into medical school, podiatry school, we're kind of put in a box that you have to work your clinical practice on Monday, Monday, through even Saturday or Sunday. And all we are to insurance companies is we are just robots, we see patients a few minutes at a time we spit them out, they come back in a revolving door. And I think to a lot of us who have this creative aptitude, we were craving to help the patients deeper than just another prescription, just another orthotic. And I think it's just being different is so shunned upon that a lot of us never really get the opportunity to do what we truly love, or what we know is meaningful to us. So to see somebody like you step out and say, This is what I want, there's nothing else to it is impactful for our generation. Like for me as a woman who is a mom, and I know you're a mom, too. We crave a lot of different things in our life that just aren't mainstream. And I think by just seeing and hearing your story is going to help a lot of burned out students burn out medical residents to see that there's more to medicine. Would you agree?

 

Dr. Splichal  11:25  

Absolutely. I think that coming out of medical school, or if you've been practicing medicine for, you know, 1020 years, is to see it as an opportunity to actually do many things. And honestly, I am so proud to be a podiatrist, I think that was the best decision that I ever did, because I see it as this, this niche that is essentially untapped. As far as the potential of how I can use this education or this degree, this credential for, let's say, business. So another aspect of where I encourage younger doctors are printout physicians is what could you do from a consulting perspective, I actually spend a majority of my time not seeing patients, I run several businesses, but I also do consulting for a lot of other companies. And the other aspect of what gets me very fired up about education is that education is really content creation. And to me, I educate also through content through creating videos, YouTube videos, from blogs, from social media, and I've really found the power of using the degree to be an asset to then other businesses, which is using the medical degree not to see patients in the traditional way that people think of their MD do DPM. So I think that all of the professionals should stay curious. See it not as I have a medical degree, therefore, the only way I can make money is through seeing patients. And the more that you get restricted from health insurances, you just have to see more patients, if you want to make the same amount of money, that is a very narrow way to think of your power, right. And there's power in innovation, there's power and creativity, there's power in curiosity. And that's something that I very much encourage professionals to do.

 

Dr. Tea  13:35  

So going back to your clinical practice you opened in 2017.

 

Dr. Splichal  13:39  

Yes, so I officially put my scalpel down 2017. And I had shaped it around that I was starting to carve out a niche as a human movement specialist and a podiatrist at that time, I wasn't really pulling in the functional podiatry aspect of it, but it was podiatry and human movement. And I knew that I needed to be able to spend sufficient time with the patient. So I needed an hour, I needed an hour to do an in depth assessment for the patient. And I needed an hour to educate the patient. I was even when I was part of traditional medicine and under insurance as part of how I built my referral. Knowing that I looked at the body very differently from day one to look at the body very much integrated very much into barefoot stimulation very much into getting my patients out of their shoes, and strengthening their feet, having their feet connect to their pelvic floor. So there's this, there's a deeper way that I was starting to look at feet and movement. The way that I was getting patients is that I literally went to every physical therapy group in New York City in Manhattan, and I was giving lectures, they all do and services because that's just part of how they do, you know, Team education and stuff like that. And I would just start teaching and saying this is how I look at movement. This means a podiatrist, this is, I want you to know how I look at patients and movement. So when I refer you to a patient, I just want you to understand that that's my mindset. So when you get a referral, just, let's all keep treating that patient from a very integrative perspective. So what started happening is I was then getting referrals from the physical therapists from orthopedics from HSS, in New York City, that were saying, I'm starting to hear this is this podiatrist in town who looks at the foot very different, they're not going to say the same thing, they're not going to put them into orthotics, or push them to the surgery, she's going to think outside of the box. So that's what started to feed the referral basis to give me the confidence to leave health insurance because most of my patients weren't coming from health insurance anyway, they weren't looking on the Health Insurance website to find a provider who was in the area. To me, it was very much based off of, I have to educate whoever's going to send me a patient, how I see patients. And I also wanted to spend my time doing what I love, which is complex movement, dysfunction, chronic pain, movement disorders, that's as a movement specialist, what I'm drawn towards, so I don't want referrals for toenail fungus, or for wound care. That's not my that's not my passion. That's there's many, many other providers, who would bring a better skill set than I would to that pathology. So I knew I wanted to see a very specific type of patient. So when that built to a specific point, then I knew that I could confidently I loosely use that word confidently step out and create my own practice

 

Dr. Tea  16:48  

To transition out of the insurance mindset. And to create this direct care practice. What do you think are key things to consider or have prepared before making that move?

 

Dr. Splichal  17:00  

I think what is your referral network? And that referral network has to be strong enough? Because how are you going to attract people to your practice, who's going to see patients that they will think of you to then consult with them, I think having a very clear distinction of what differentiates you from anyone else? So why would someone pay out of pocket to see me when there's a podiatrist next door? Who could treat that same presentation who's under their insurance, or they just have a $50 copay? So really understanding that differentiation, and then confidently being able to articulate that. So when a patient does inquire, and it's like, oh, wait, you're not under insurance, that you can say, No, I'm not. And the reason why I'm not is because I need to spend an hour with my patients. I am doing probably one of the most in depth movement assessments, you will get that you can't get that in 15 minutes, it takes too much time. I'm actually going to listen to you. I'm just going to sit here quietly or ask you very specific questions. So you can actually fully tell me what's going on. And honestly, just the listening part is probably worth the most to these patients, because I have time to actually listen to them. And then to give a personalized program to them. So I knew exactly what was the deliverable also. So it wasn't just my time. They're not technically paying just for that hour. But they're then paying for the care so I'm available via email. I'm gonna send them a detailed email summary, that detailed email is going to have video links, it's going to have their protocol. So there's this next step, to fully guide them towards their success.

 

Dr. Tea  19:00  

I love that. And I want to really dig into what you mean by deliverables because the first time I've ever heard that word was by a lawyer, when I would meet up when I needed a lawyer, their deliverables were like PDFs for my practice policies, you know, things like that, but I've never heard that term in medicine. I think this is an important bridge to clarify what that tangible deliverable is to a patient who needs our guidance outside of clinics. So what is that exactly for your patients?

 

Dr. Splichal  19:30  

So what I have found is having a boutique practice having a direct care practice, just the way that I practice medicine is based around truly achieving success with my patients. I really want them to get better. I don't want to see them anymore. I really want to help them as much as I can. So for that, and I think the aspect that we often overlook in medicine Is that the success of the patient is not when they're in the office with you. This is literally every specialty. And unless there's some sort of follow through, the patient isn't going to remember, they don't know the words that you're saying to them, you're telling them a lot of information as far as the diagnosis, what they need to do, how they'll get over what their options are. So what can they expect? That's a lot when you're telling a patient something, especially if it is, people get very emotional around a diagnosis and the number of patients that will cry, just for a hallux rigidus diagnosis or a bunion diagnosis, something like that. I will have patients cry for that. And part of us could say, just a bunion, right. But it's not , it's something that allows that patient to move, to run, to do what they love, that is an important part of their identity and their mental health and their well being, which means I honor that time. But I also want them to be successful in my recommendations. So my deliverables will be an email recap, it will have their diagnosis, what our goals are. So the goal from the meeting, what we discussed, so essentially a summary, a recommendation based off of their present rotation. So I will say this is going to be your daily foot release, this is going to be how I want you to strengthen your foot several times a week, and it'll be a program, it'll be something they could print out, there'll be links to videos, if it's recommending certain products, I'm going to link exactly to that product. So they know which insole to get, not just go to Amazon and get some insoles. So it's really about empowering them. So they have that program. And then I will have a very specific follow up in four weeks, and then have them do that. So they understand the next action plan. 

 

Dr. Tea  22:04  

Is your clinical practice based on the time visit? Or do you also have a membership all inclusive type of offer.

 

Dr. Splichal  22:13  

So I don't think of a membership. It is something that I thought about where I've seen that model with let's say a family practice or internal medicine, and you essentially are under this membership, the medical doctor will take X number of patients and then you are essentially, that is your personal doctor and you have access to that doctor, you can ask questions. I absolutely love that model a little bit with podiatry. That part of where I find it hard with podiatry is that it may be just this intermittent flare up in plantar heel pain. And then once we get them to a great place, I don't need to see them again. Right. So that is a model I thought of. I think with podiatry, it might be a little bit hard. If you have someone who does routine foot care, maybe they have to have that recurring follow up, that could be where it would work. Most of my patients I will see once or follow up with them again, six weeks, six to eight weeks later, maybe three months. And then most of them are good to go and I never hear from them again. So that's not really built into how I treat my patients because of what I treat.

 

Dr. Tea  23:31  

I mean, that makes sense. We're here to heal people. So why, why swing them back if we don't need to totally. Do you offer other modalities other than your brain? Are you giving regenerative therapies, injectables, lasers, what cash services have been helpful in helping patients succeed?

 

Dr. Splichal  23:49  

Yes, so I do custom orthotics, I do regenerative injections, that's actually most of my in person patients are here for Regenerative injections. Most of my patients are actually telemedicine. So that is something that's also unique about my practice is that my patients are all over the US actually, most of my patients are all over the world, because there are many countries that don't have foot providers. So they are not getting the answers that they need. And that's something that's very important for me is to make sure that the consistency of care as far as it relates to the foot and the foot connection to the rest of the body is being treated everywhere. And that's where the telemedicine side is important to me from the in person cache that would be custom orthotics and then regenerative injections. I do have some at home programs that I've created that allows a patient to essentially bypass me if they don't want to pay my fee, it would be a way to start, obviously, there's no diagnosis to it, there isn't, it's more controlled than them going to YouTube or Instagram and trying to just make their own treatment plan, which is what I see a lot of patients who get hurt doing that become my patients. So it's something that's trying to guide them through it and say, Okay, if you have a bunion, I just want to set the record straight that bunions cannot be reversed without surgery. And I'm just kind of teaching them a little bit. But this is what we can do, right? Oftentimes, there is this association between a bunion and an unstable over pronated, flat foot loosely using the flat foot. So we need to understand how to find a neutral position, how to wake up our foot muscles. So it's me, essentially putting some structure to what people are already finding of my work on YouTube and on social media, but I'm putting it a little bit more in a program that they can start. And then based off of that, if they're like, I'm still not getting the results. Let me do an actual consultation with Dr. Splichal, then I'm doing that. So that's another way that I work with patients. 

 

Dr. Tea  26:17  

Are there legal restrictions on doing telehealth outside the United States? Like do other countries have stringent? You must be licensed here in order to provide a diagnosis of medical care? Or is that more of health coaching? What does that look like for you?

 

Dr. Splichal  26:32  

Yes, you could probably call it health coaching. I'm not because I'm just guiding them, I'm not doing injections, there's obviously nothing interventional as far as what I'm doing. I think what's also important with that is that if they don't have the proper guidance, a lot of these countries that have public health care, that they're in very long waiting periods to get anything done to get an answer to start to do something, and the patient doesn't know. So by the time they start to go down one path, it could have been completely the wrong path. And now they're just not, they just get in this last hamster wheel in a sense, right, where they're either misguided, or they have very long periods of, of getting information, getting imaging, it takes months to get an MRI in most countries, and they need something that is kind of filling the gap. And again, I'm doing it in a let's say health coach way. Like I'm just giving you information that ultimately you're making the decision for yourself on what you want to do.

 

Dr. Tea  27:47  

What has been the most rewarding part about creating your practice?

 

Dr. Splichal  27:52  

I would say the most rewarding thing is to see the impact it's having on patients, thank you so much, I got better doing this. I was able to, you know, walk up the stairs. Again, things that have become like a quality of life are very, very inspiring to me. The other would be providers who are seeing the content that I put out, telling themselves, there's more to their profession, that they can treat patients in another way, that they can bring a new excitement that there was opportunity beyond just what they think that there is, that is honestly, the most inspiring. I was just at the Ontario Chiropody conference in Canada, and a lot of the professionals, there's a stagnation, right, it's kind of the same thing. We're very restricted by scope, we find this lower valued association of our profession, and the patient then looks at us as that lower values. So then from our respect, and how it just works in the medical hierarchy is very complex. And I went there to try to show them the excitement and the broadness and that there is so much more that they can be doing with these patients, even if it's just the communication of the ownership of their body. And that's really honestly that is why I left healthcare to go into direct care so that my practice, and my message can be built around patient empowerment. And I want them to know that they have control over their own body. They have the right to ask why there are more? Is that it? Right? And we need to empower patients to do that versus this is your option. And that's your only option. Oftentimes that's not true. So I'm a huge advocate for patients. And then educating and empowering patients and many patients will tell me through my content that I put on, on YouTube and through the internet that they will say thank you for not talking down to me, thank you for actually educating me and speaking to me to a level that is respectful. That is bringing a curiosity that encourages me to want to seek even more information. I think that that is something very, very powerful. And that is not going to stop.

 

Dr. Tea  30:33  

I don't want to assume that everything has been smooth sailing, what have been your biggest challenges, if any?

 

Dr. Splichal  30:39  

So my practice is very boutique. And that's because I run several other businesses. So by design, I can only take so many patients. Thankfully, from a marketing perspective, I've actually never really marketed for patients, I get a lot of my patients who will seek me out through the internet and through my content. So that's great. I think as I go through different evolutionary phases of my career, my goal is to sell off one of my companies, and then shift more into patient care. So I just want to make sure that at the level it's at right now, if I put more energy and say, Okay, I want to see twice as many patients, do I actually have that referral base, because I have a referral base for how many I want to see right now. But we can never become complacent. And I think that's, that's the thing that if I think, Oh, this is smooth sailing, I'm great. The moment I get complacent, and I don't think about continuously putting out content, continuously educating, continuously speaking at conferences, so other providers know how to treat patients, then that's where I'll start to see the decline in my patients. So do not get complacent or lazy and think that it's just smooth sailing.

 

Dr. Tea  32:02  

For the doctor who's listening and they're on the fence, and they are sick and tired of insurance. They're sick and tired of being disrespected. They're sick of the declining reimbursement. But they're scared. They're like, how do I actually do this? What would you advise this doctor?

 

Dr. Splichal  35:04  

When I would validate their concern or their fear to do it, it was by far the scariest thing I ever did, was to do that, because I was also leaving surgery. And I knew if I left surgery, and the insurance, because once you leave the insurance, it's very hard to get back on them. That I didn't want to have any regrets. What I will say is that as soon as I did it, I was like, I should have done this sooner. But you do it as you do it to make sure that you have all of the business pieces in place. And I absolutely love business and medicine is a business. So if you are going to step out of insurance, you have to really think like an entrepreneur and a business owner, it is very easy to lose the necessary business skills. When you are part of a large group, when you're under insurance, when someone else is doing your billing, someone else is feeding into your patience, if you're on ZocDoc, or whatever it is. And that's what's feeding into your patient scheduling, it's easy to say I show up for work, I come to work, my schedule is full, I go home, right and you really an employer or employee to it, you're not an entrepreneur, you're not a business owner. So you have to think completely differently. If you step out, go direct care and have your own practice, which means you need to understand marketing, you have to understand branding, you have to understand all the other aspects, right? The financial aspect, the organizational aspect. To me, the most important part that was important for me is the branding. And the marketing is just how are you going to differentiate yourself from someone down the street with the exact same credentials, and they treat the exact same type of patient? Why would someone pay you and have that very clear, delineated? And then make sure that you truly deliver what that is. I did a lecture on branding before like a year ago at a conference, and a lot of it is sometimes we think about the way that our brand is and what our values are and what we stand for. We have that but then if we don't actually ask, let's say the patients, or whoever we interact with is if you ask your patients and say Do you see me as a provider, who represents transparency, trust, authenticity, compassion, right? If you're not getting that same thing, validation back from your patients, then you would want to essentially do an assessment and say, Okay, why is that? Why is what I think my values are and my brand, what my brand values stand for? Why is that not being interpreted by the public or by my patients? So make sure you do a brand assessment that way as well.

 

Dr. Tea  35:21  

Do you have any last words to those are, that was all really amazing. 

 

Dr. Splichal  35:24  

So the time that you know that you're ready to do this, this is one of my favorite quotes from Parkour is called breaking the jump. And breaking the jump is when you have one foot, you're kind of running to the edge, and then you hesitate and you run. And you're like, I'm right there. Breaking the jump means when intuitively in your gut, you know that you're ready, you know that this is your calling, you know that you have the passion and the the excitement and the the opportunity that can be delivered through direct care, you know, you will know the moment and that's called breaking the jump. And when you feel that you need to push into the jump and you need to just do it. 

 

Dr. Splichal  36:13  

Just do it your way. All right, you heard it. Well, thank you so much, you are a breath of fresh air, you brought new excitement for me as a podiatrist. I love what I do. Doesn't seem like most of us love what we do. But that's what I'm here for. We're trying to change our experience, even if we can't change the system, we can change our experience by opening up and being more curious as you say. And I so appreciate you being here and sharing your knowledge.

 

Dr. Splichal  36:43  

Thank you so much. I hope that I've inspired at least one doctor to break the jump.

 

Dr. Tea  36:51  

If you have additional resources, I'll be sure to put it down in the show notes down below. So everybody, please do connect with Dr. Emily Splichal. And say hello to her on all of her social issues, highly active, teaching the world about how to move better without pain and who can ask for more from a podiatrist. Thank you so much for your time.