Dr. Rishin Shah on Running A Practice In 30 Hours / Week

(upbeat music) - Welcome to Practice Care with Carl White, the podcast where we help practice owners in healthcare know just enough about the business side to make good business decisions and keep their practices independent. Now our host, Carl. (upbeat music) - Ask most private practice owners how many hours a week they work, and you'll typically get, the answer you're typically gonna get is way more than 40. Is it possible to run a successful practice in less than that? Well, my guest today is doing it, and he's gonna describe what he's doing in this episode. I'm Carl White, principal at Market Advisory Group, which is a healthcare marketing agency, and I'm also the host of practice care. The mission for both is the same, and that's to help private practice owners stay private. It's usually what they want, but care is better when it's the providers of care who own the practice because then any decision that's gotta get made, patient care business, whatever it is, is made by those who have to go back and treat patients so we can feel really, really confident that patient care and what patients need is always gonna stay top of mind. My guest today is Dr. Rishan Shah. Rishan is an interventional cardiologist with prime heart and vascular in the Dallas area. He's also the founder of Goldene Health, a staffing company for healthcare practices. He's passionate about patient care and helping other physicians thrive in private practice. That's what we're gonna get into. Rishan, thanks for coming on practice care. - Thank you so much for having me. - Yeah, it's good to have you here. It's been a while since we've had a practitioner, somebody living it day to day as a guest. So I've been looking forward to this one. I wanna start where we start with every guest. You're a new one. That was quite the lean bio, which is what I asked for. Tell us more about you, your practice. Help us get to know you a bit better. - Sure. I've been in private practice for about a decade. Last eight of those in my own practice. Just like most people coming out of residency, just tried to find a group and thought that'd be where I'd land for the rest of my career. But it was a big conglomerate, large group. And we didn't get the kind of autonomy and those sorts of things that I think most physicians want. We went to school for a long time. We wanna be able to make our own decisions, kind of run the show. - Yeah. - And so after a couple of years, that didn't work out. So we started this practice. We've actually expanded to four different practices. And just through the process and journey of running this, I've really decided that learning entrepreneurship and business has become a passion of mine. 'Cause we don't learn any of that in medical school, right? We learn how to be good doctors. And so gaining that knowledge, now I've been trying to impart that knowledge to other doctors. - Yeah. - So one part of my career that really enjoyed now. Was, I think I know the answer to this, but I haven't asked in a while. Was was any facet of business anywhere in the curriculum while you were in medical school? - Zero in medical school. As far as I remember, I do remember during my cardiology training, there was a private practice guy where I had my training in New York that had thrived and had grown to, you know, double digit doctors. And he did a one hour talk. - Now is it? - Now is it. - What do you talk about? - That's, you know, I have to tell you, it's just, it's made me angry. This lack of attention because a healthy percentage of all of you are gonna go open a business. And it's like, and you're smart and you can figure it out, but still it just really bothers me. And I've sort of, I don't know what to do about it, other than stay angry about it. But what did he talk about? - I think his topic was more about how to find a job, you know, and not necessarily running a practice, but of course you get into his history and things like that. I think we, I mean, most, most people learn academia, right? - The universities. - And so those doctors obviously have no interest in the business aspects. And in one instance, like we wanna just focus all our time on learning how to become good doctors. - Yes. - But yes, I agree with you. Some more business training would have been helpful, but the best way to do it is by doing it. - It is, it is. And I love the trade craft of marketing, but I run a business too. And so you, yes, I get it, but still. All right, so the topic that we have is, run a thriving practice, you know, without killing yourself day to day in the hours and such. So I wanna start with, I'd like you to describe your practice in a bit more detail for context, just so we can all, when you start to talk about what you did to make it the way it is today, people ask me a context. And I mean, you mentioned for, I think you meant for locate, you said for businesses that know if you meant for locations or for businesses. - We actually have four different practices, but my main one is the cardiology practice and we have three locations. So it's been around for eight years. First, handful of years was really just trying to make it, you know, trying to build a patient base. I was going to the hospital every single weekend. I was on call half the month, not a fun life, you know, a newborn. So I think I started the practice when my daughter was six months old. My wife is also a physician, so just a busy life in general. And with doing the business and learning from online and other people, I said there must be a better way to do it. - Okay. - Not sustainable. I think I also read some data where doctors do not live as long as other people. - It's believable. There's one study that just stuck in my mind. It was more on the primary care side, but the conclusion was for a primary care physician to do all that is required, it would take something like 25.7 hours a day. - Right. - And they become inboxologists. - Yeah. - They're checking their EHR inbox and they're responding to patients because we care, right? They care. They want to take care of it, but it is not safe. - The thing has a simple algorithmic question. It just, you gotta sit and ponder on what's going on and look up the history and it's not automated responses. - And it's very rare to just want to click, right? You click to look at the inbox and click to look at the labs and click to make sure you know the history and put it all together. And there might be some information missing. So you gotta go somewhere else. You know, the EHRs are not, they're more billing machines. You know, they're not really-- - Yeah, I like that. - They're to optimize billing at the expense of us. - Yes, yes. So you started with one location for a few years. When did you start opening up, you know, the second and the third? - Well, I actually started. I decided to go all in and decided three locations. - Oh, all along. Oh my God. - So I was running around to those three locations. My mentality was go where the patients are. This is a big metropolitan area. So patients do not want to drive more than maybe 10 miles. So go where the patients are. And then slowly but surely I kind of learn how to run it much more, much better, much more efficiently and we can get into that. - Sure, sure, sure. - My life is great. And I basically stopped taking call at the hospitals for my sanity mostly. I eat some because cardiology, you gotta take care of sick patients to remain a doctor. - Sure. - It's not out of necessities because I want to. And you're a better doctor when you want to do these things. - Yeah. So at the time, a typical day was running all over the place way more than 40 hours. Just the logistics of work and home life when you describe it. Like that's, I mean, I'm picturing a spreadsheet with ours and who's where and who's picking up the kid and who's doing this. - Yeah, I mean, it's just, yes, a lot of planning. - A lot of planning, going to five hospitals, going to clinic, trying to figure out, I mean, fortunately we did have a nanny that helped us out. - Sure. - Same time, you know, that's not the end all be all by any means. - Yeah. - But that was my first step of delegation, you know, when we had our nanny. - Yeah, there you go, start at home. Yeah, and it probably a tightly packed schedule before any speed bumps hit. Like there's, I don't know, you're driving to the hospital and there's an accident on the highway. - We're sorry. - Yeah, and it just ripples through. And my schedule's gonna be unpredictable. Patient's right, it's a good time to get scheduled. - Yeah, exactly. - It's a good time for the day and night. So if hard time comes in 2 a.m., I come home, it's 5 a.m., I've got to get ready to go do the next day, right now. And I am not in a good mood that night. So I need my sleep. - Yeah, this episode is sponsored by Next Step Advisory. Running a medical practice today means managing patient care, reimbursement pressure, staffing shortages, and ever changing compliance requirements. Managing your people can not just be administrative, it must support the business. Next Step Advisory provides senior level, fractional HR leadership to medical practices and healthcare adjacent businesses nationwide. With more than 30 years of HR experience, including deep work in healthcare and professional services environments, Next Step helps practice owners strengthen their teams, reduce risk, improve retention, and build the people infrastructure needed to scale. If your practice is growing or feeling operational strain, experienced HR leadership may be the advantage you are missing to learn more, go to nextstepadvisory.us. And now back to the show. - Found the copy and let's do this. So to go from that to today, which is much more in control. And the business side, there's really two levers you pull. One is revenue streams, and the other is getting more efficient operationally. [BLANK_AUDIO] I want to dig into each one and I want to start with the operational efficiencies because any practice, any organization can look at its operational efficiency and wonder how they can get better. So let's start there. High level, give us a few of the things that you did that you changed that, you know, to get you from then to now. I think I would put in three big buckets. Number one is delegation. Number two is automation. Number three is systemization. So those three buckets, I mean, we're still work at it, but those are the three big buckets that I think really has helped us and helped me get out of working. Of course, I have to work in the business always, but like, yeah, so work on the business as well. Yeah. Get a great lifestyle. Yeah, I wonder probably systemization would have to, but that's the one that probably underpins the other two, right? Without a good system, it's tough to automate. It's really tough to delegate. So that exactly. And when that's a daily process of, you know, fixing their systems, you know, we have standard operating procedures, but those are living documents and optimizing onboarding, off-boarding training, optimizing the system. It's not a done and you forget it. Correct. It's like that, you know, it's a constant work at it. Yeah. But that does, you know, that is the underlying principle of all the other things. Yeah. Would you mind giving us an example or two of like, you know, a couple of the systems you set up where you think these really made a big difference for us? I think the biggest one in service businesses is if a key person leaves. Right? Okay. Your office manager leaves. What do you do? No, currently, plenty of practices that it's, it's a, you know, bad few weeks at when a practice manager leaves. So number one is always documentation, right? What is their job? And being able to write out the process in a level where, you know, my eight year old or 10 year old kid can understand. Yes. And it's actually become so much easier with AI and all the video recording tools these days. It's just going on, you know, putting it in a word document. And so really optimizing that documentation, we had, we use something called notion, which is where we put all our processes. It's available for anyone to look at. They can search now with they have an AI tool on there so they can search for any process. So those main key people functions documenting it, making sure they're trained, having a good onboarding system with training. That is, I think, just as important as hiring a good person. So again, having a systematic process to onboard train, systematic process for your operations director manager, whatever you decide to call them. I think those are the biggest difference makers. So you document the job description. And then for each, is it like for each sort of bullet point in the description, there is a, you know, a set of processes and tools and such that tell because you're right, that person leaves and X person is going to get hired and come in. You don't want all the knowledge to leave when the person leaves. Right. All the knowledge in the head has to be on paper. Correct. Electronically has to be somewhere. And we have one person accountable for each process. Yeah. So if something's not getting done, hey, this phone call didn't get responded to. There's one accountable person. It's not five accountable people like we're looking around, right. It's one accountable person per process. At the end of the day, you're the person that's got to make sure that this gets done. Yeah. You know, so we have a list of who's accountable for each process as well. That being said, it is sometimes difficult to have people go back and look at these processes. Yeah. But you know, for some people, it's a concert reminder. Did you look at it? Did you, you know, or did you study it? Are you sure? This is not what we have written down right here. So that is a constant battle that I haven't figured out yet to be frank. Have the balance, the balance of oversight and. Exactly. We have auditing processes and you know, this is what needs to get done daily, weekly, monthly, whatever, maybe. So we have some of that does that. So it is, it is a fine balance of both sides. Yeah. You said two things I just want to emphasize. The first one is the call the reading level. What I what I was taught was what you know, what's the reading level? Well, it's if you grabbed a reasonably intelligent person off the street who didn't know anything about you and you said read this and tell me what you think it says and what we ought to do. They'd get it. Right. You said you're a year, but that's the same thing. And the second one is the accountability. If if if many people are accountable, nobody's accountable. I it makes me think of Elon the Elon Musk biography, the really popular one. And they're talking about factory floor and trying to get tessels out the door. And there was this little thing and he's there. Who's accountable for this? Oh, that's the quality department. No, no, no, the name and what the specific person in quality who and my goodness, do you clear things up? You know, there is no beating hard in a department. There's a person. So yes, I love it. How you know, what was the problem? How did you have to go into detail in this? But so you just you started with the people like the process, the systems for people for hiring, for training, for onboarding. Where did you go next from there? I just want to get one more level in because in terms of like systems. How did you know what to systematize and what to say? That's not a good fit for it. How did I know what to systemize ties? I think it was a thing you don't systematize. My clinical decision. I'm the business side. Yeah, yeah, yeah. operationally. I try to systemize as much as you can. These want, you know, there are some one-off things that I don't, you know, try to train someone or, you know, and I just take care of it. So, but like as much as I can, you systemize it. I read a lot of books, you know, to help me figure this out because I didn't know business. You know, I had a list of all of business books. One of the first ones I read probably a decade ago is called the emith physician and he has a whole series of books. Whether it's the entrepreneurial myth, especially those of us that are in professional services, we tend to just buy ourselves a job, right? So trying to systemize and try to get myself as much out of, out of it as I can, then it becomes a business and not just a job. Correct. Correct, which job meaning it relies. If you don't show up, the whole thing sits and waits for you, whereas the business, it hums along, you know, whether you're there or not. And it's somewhere along the way I also read a book called, I believe it's called, who not why or who not what? I forget what I said. Yes, I know that one. Yes, who not how or something. Who not how? Exactly. How you do it, but it's who does it for you. So finding those key people. So that's where kind of the delegation stuff came out. Yeah, let's sit on that because you had delegation and automation. Just touch on each of those, but maybe a couple of examples. Yeah, the big part of delegation that I think really helped is one, not just the one is the concept that if you hire the right people, one, potentially, they should be able to do the job even better than you. But even if not, if they can do 80% is good for you, but you get all that time back, that's okay. And that's hard, I think, especially for high, high level people to get. I'm going to hire someone that can't do it as good as me. It's okay sometimes. Yes, ideally, they can do it even better. That's why we outsource for example, marketing. We're going to hire you for marketing because we're going to do it way better than us. And even if you could do it as well, you're consuming all that time. You got to figure out what your hourly value is. For me, it makes more sense to see patients. One, that's what I like to do, too. I want to take care of it in three. That's where the business parts thrive. And you spent a minute learning how to do that. So yeah, yeah. But one of the things about medicine that people don't understand is insurance based medicine is we don't control how much revenue you get, right? And reimbursements go down every year, and especially since the pandemic, wages have gone up, costs have gone up, so our expenses have gone up significantly. And so touching on the delegation, it's really hard for me to hire a bunch of people locally. And so I just I feel qualification just of the cost. Us, us. People don't necessarily stick around. So you're having lots of turnover. It's not necessarily a career, long-term career for people. So most medical practices do have turnover. And so I decided to look offshore. And so at this point, we probably have 25, 30 people employed offshore between all of our practices. And that's been a game changer for us. I can hire enough to delegate every single part of my practice out. You don't have to be in the office, right? If you're direct patient care, of course, you're going to be in the office. Fones are getting answered when we used to miss phone calls. Patients billing questions are getting answered. You know, our prior odds, so we're getting the prior odds in a much more efficient manner, so we can get patients procedures, imaging tests done. So it's great for patient care, great for the business. And frankly, we pay a lot more than, you know, people get in their native country. So it's great for them. So it's a win-win win all around. Yeah. And so once I learned how to recruit good people, train, going back to the systems that really changed everything. And I can also now spend money on marketing. Whatever you need, whatever, yes. - Exactly, whatever you think about things. - Whatever you think about things. - Yes. And so that delegation part has been huge for us. - That's great, that's great. And maybe that's a pretty decent transition into the revenue stream side of how you get more control over your time, which sounds counterintuitive, right? If you're starting up second and third businesses, that would take more time, but here you are 30 hours a week. So to speak. So tell us a bit on the revenue stream side, like what you did. So you're not just pounding through patient appointments all day at a fixed, slightly declining annually reimbursement rate. Yeah. - Well, I did a couple of things, but from a clinical perspective, I learned that if you refer patients out for a test that many times they won't get it done, or delays their care, they have to call another office, pay another copay, see another doctor, all those sorts of things. So anytime there's friction or barriers to care, they're not gonna get care done. And then they come back in three months, six months. Oh, did you get, for example, your sleep study, 'cause you probably have sleep apnea that can increase your risks for part of your life. No, I didn't do it yet. Okay, another six months. So I decided why not just bring some of these other things. - Yeah, smart. - And so we started doing, for example, home sleep studies, and now 98% of people get their sleep test. - Nice. - Initially, I would refer out to a sleep doctor. - And out of curiosity, roughly what percentage of them confirm, yep, sleep apnea, it's rippling through to your cardiac. So let's do something about it. - Oh yeah. - Oh, yeah. - 99% of people have. - Got it, okay, yeah. So there you go. - Yeah, in a cardiology office, most people are gonna have sleep apnea. It's a big contributing factor in these processes, but under-recognized. And so that was kind of the first step. Another example is we also have a weight loss nutrition practice that my wife, my wife is board certified in obesity medicine. And so I would again, try to get people to go see her. Okay, of course, diet exercise, lifestyle changes is very important in cardiac health. What people don't realize is usually seeing dietitian personal trainers is free through health insurance. So all they have to do is call another person, another practice see the provider, you know, my wife or one of her just as in her practitioners. And everything else is free. Even that, people wouldn't go. Not more barriers to care. Now we just hire dietitian personal trainer in our office, and it's all virtual. My pitch is lifestyle is very important. This is free for you. You know, so it's a, what are you waiting for? - No, not brainer, right? - We will dial the first six of the seven phone numbers. - Right. - You know, just what do we need to do? - Right. And we get you scheduled. And it's a virtual call, telemedicine, you know, video call and so people do it. And the vast majority of people, you know, lose weight, they're healthier, it's better. So I love doing things that are win-win, right? This is great obvious for patients. It does bring an extra revenue into the practice as well. - Mm-hmm. - And so. - But the revenue's going somewhere, bring it into you. It gets used faster, better. - Right. - It makes it's obvious when you say it, yeah. - And none of this involves my one-on-one time, right? - Yeah. - And so that also helps to give me my life back. - Yeah, okay. - I can be focused on patients and not burnt out. I mean, I was burnt out. I mean, we'll get into that. But I was completely burnt out a couple of years ago. Before I started really getting into doing all these things. - Yeah. Now, I mean, it is at the point of burnout, where it probably seems like that mountain decline to escape burnout is the highest in tallest. And so you're burned out, but then you say, I need to spend more energy just to. It takes energy to get out of burnout, which is the least thing you've got. So is it just the will to change? Like what? What was that moment where you said, this is no more? And I ask it because it's gotta be a few listeners who, I mean, are feeling it. Yeah, he's right. I mean, but I can't imagine. I'm stuck. - Yeah, frankly, I was not enjoying life. This is not enjoyable. And then your family's not enjoying time with you, right, being present. And still, honestly, being present can be tough for me. But when your burnt out is 10 times worse, I think initially it was just, it's okay to do less. You know, I don't think I really had clear cut. I'm gonna do all this 'cause you're right. It takes more energy that, even that one extra thing that takes two minutes, the thought of doing it, you don't want it. - Yeah. - And so first, I was like, it's okay to cut back. So I just cut back at some hospitals. And I'd kind of been transitioning to doing some of this stuff anyway. But then after reading some more of these books and just thinking about some more, I said, this is very doable. - Okay. - If we can become physicians, you can spend a little bit of time. Think about these things, maybe read a book and implement. So just slowly chipped away. None of this was all by one. All together is one by one. It's slowly chipped away at figure out ways to make things better in the practice. And therefore, it makes it better. - There you go. Yeah. And there it is, chip away. It's not gonna happen overnight. And yeah, I remember when I started set up sort of systems and processes for virtual assistant that we use. Yeah, it took time. I mean, it takes time. It probably took, but the ROI is, it's all but infinite. I mean, you know, you take, for every hour you spend, I found, for every hour I spent setting up the VA, I say that every month. So obviously, but you know, it takes, when you're in the thick of it, it's one in the morning, like, I can't imagine, you know. - Although, you know, since, although I've been able to do it, since we have obviously lots of physician clients with our virtual staffing company, one of the big things that we do is we help develop their SOPs for them. - Oh good, smart. - We are very involved in their onboarding and training process. We were talking about this earlier, right? We got no business education. So we are heads down, taking care of our patients, and just moving forward. And so one of our value ads is really trying to help, develop these processes, help with the onboarding training as best as we can. - Mm-hmm. - And so far, it seems I've worked out. - Yeah, yeah. So you brought in, all right. So you brought in, you know, all the, the treatments that would make sense to help a cardiologist do a better job with their patients. What else have you done since then to try to add to this? - Well, we were getting back to the automation. So I think that also has played a big role. - Okay. - So although I love delegating human still make mistakes. So as much as you can automate an AI world, it's gonna be a hundred times more. But trying to automate as much of patient intake, patient registration, even the repetitive questions that I asked, I asked patients for their history. We try to automate all as much of that as possible. And so it's already done before we get into the office. A big part of other automation is also what happens post visit, or marketing, so getting reviews and feedback. You know, it's not necessarily just about, you know, optimizing my Google business profile, which is important because you're a good doctor. You want patients to know about you and how to find it. - Yeah. - And also learning from their feedback as well. So automating those sorts of things. And so, when I think, and then once I kind of figure that out, I started offering these services kind of to other doctors. And it's like, I still, you know, I know that title of this is, "Burning a practice in 30 hours a week." I do work way more, but I don't spend it all on the practice, right? I do other things that are also interesting. - Sure. - As well so I can help other other doctors to. - Sure, sure, sure. But the practice side is not, the practice by itself is not. - Right, not overwhelming anymore by any. - Any more, very good. So what's next? - Well, I'm definitely gonna keep working. (laughing) - For those of you who watch us on YouTube, he's not gonna put it in the air. - It's not gonna put it in the air. - Yes. - I got a long ways towards retirement. One of the things I'm doing is putting myself out there now. So I've opened up time to try to go on some podcasts, but add some information. Just because I've learned a lot through social media. For all the downsides of social media, if you go to the right people, the right sources, you can learn a lot. So there's a lot of good business content on X and LinkedIn and podcasts like yours, where we can learn a lot of things and implement. And so we'll start some of that knowledge on other people too. - Yeah. - So I think I'm gonna be spending more of my time on there. One of the great things, personally, that's come out of this is I have tons of time to work out. Right before this, I worked out for probably two hours. And my health has gotten way better. I've been super consistent for the last two, three years. If I'm gonna preach it, my eyes are-- - I was just gonna say you're eating your own cooking. It's, yes, how can we get to the gym today? Patient X, I did. - Yes, it's hard. - And look at me, man, I'm busy. So yes, well, if you ever, you know, in your-- But you know, journey to help, you ever cracked the code on getting any med school curriculum business attention. I would love to help out just because it kills me. It just kills me. It's like, it just kills me. I mean, and I had a guest early on in the podcast and I'll never forget it. He said, you know, Carl, he's a gastroenterologist. In medical school, they never came out and said earning money by treating patients is bad dirty and ugly. Man, oh man, that came through loud and clear. And I thought, but you go to a pretty, he's like, I get it. Reach your choir car all I get it. So if you ever figure out, get some dean who say, you know what, come on in and let's talk. Oh, I would love to help out because it kills me. We covered a lot in the context though of what we've been talking about. Is there anything you think we should have touched on, but just didn't get to? No, I think we did a good job. I think one thing that, you know, that I do hear from physicians a lot is how you recruit good people when it comes to delegations. Like they get the concept, oh yeah, that's great. That's great. But how do we do it? And I'm planning on putting out some coaching material on that, just PDF and things like that. But finding good people is hard. Finding those A players, those need on the haystack takes a lot of effort. There were a lot of B and C players to try to get players. And the other big thing I've learned is higher slow, fire fast, right? That's right. And it is, it is very true. It used to be I would hire fast, fire slow. Because you're like, I need, I need today. I need it. I know that's right. Now that system wise, you can do that. But I would recommend just, you know, reading some books and recruiting and finding good people. It is just like medicine, art and science. But if we can help in any way of going help, happy to do that as well. Yeah. We had a different guest, Dr. Michael Neal. He's a tumultuous, or ophthalmologist, forgive me, Dr. Neal, who's got a hiring and it made so much sense. He's like, look, it's not, yes, you have to be able to do the technical competencies of the job. But we spend most of our time when we hire for clients. It's the fit. Do they fit the culture? Do they fit? Do they fit? And if you get the fit and they can, we think, you know, because you can learn the technical aspects of the job. Oh, yeah. So soft skills added to it. Yes. Right. Add it to wanting to learn ownership. Yes. The hard things are, like, you can take constructive criticism. So it's all those soft skills that are really hard to screen for. Yes. But I think we've figured a way to do decent work. Perfect. And then real life assessments, you know, you don't know how you're going to do until you do the job. So trying to do assessments as well. Before necessary, how are you for a full-time job? Perfect. Absolutely. And then the other question I ask is, you know, let's imagine we've caught a listener's attention. I bet we have. And they say, I want what he's got. But I just don't know where to get started. I'm stuck at the starting line. What's one or two super simple things you think you'd recommend that they do just to get some momentum going down the path? I think one before necessary even an action, it's like the mindset. Yeah. But this is doable. You can do it. Doctors positions are very conservative. So we will tend to aim, aim, aim, aim for the next five years and it may be we'll shoot. I would say be very action oriented. Okay. Whatever you decide. So go ahead and shoot and aim the worst. You're, you know, what's the worst you can do? This is right in business. You might lose a few weeks or lose a few dollars. But I would be very prone to action. So whether it is, you know, we were just talking to a client the other day who was solo pediatrician. She's answering her phone calls, rooming her own patients. Geez. You know, she just started. I mean, some of that makes sense, but you know, really trying to convince her it's okay to spend some money to get your time back and you can focus on the things that really matter which is seeing your patients. And so she went with the virtual assistant and so far so good. I think it's just the mindset and take these, try to work at the top of your license, you know, your top of your degree, as much as you can. Yeah. You will learn more by doing it and trying it, you know, aiming, aiming, aiming is not learning. There's just, there's not much to learn. Just try it, figure it out. You're not betting the practice on whatever it is you're trying. Absolutely. Try, try, try. Rich and Shaw, thank you for coming on practice care. This has been great. I've really enjoyed it. Thanks very much. Thanks Carl. Thanks for your time. Yeah. And we've got contact info, so we're going to put that into the show notes for your episode. So anyone who wants to get a hold of you or check you out, now they've got another way to do it. Couple of quick points before we wrap up. First, please subscribe to practice care. If you haven't, it's one word easy to find. Spell just like it sounds. We're everywhere. Every player, Apple, YouTube, Spotify. We do a new episode every week and the easiest way to stay up to date is just to subscribe. And finally, if you're like Rich and Shaw and you're your private practice owner, you think you've figured out some stuff on the business side of private practice and don't overthink what that is. You think it's simple and boring and who would care. I promise you lots of other people do. They're struggling with something you've figured out or you're someone like us who serves private practice owners either way. You've got some experience. We want you to share it with our listeners in the show notes for every episode. There's a link, couple of clicks. Take a minute. Tell us what's on your mind and we'll get you scheduled as soon as possible. Thanks very much. Until next time.