Telemedicine Business Essentials

Hey everybody, and welcome to this special session for our IFM member-related friends. And, uh, we have a whole bunch of things to talk about tonight, um, or this afternoon. So, I also want to do some interactive stuff and going around and ask people questions, see where you guys are at, and what you're looking for. But we have, I'd say, like, you know, four different themes for tonight, which is kind of a lot. Uh, but we want to talk about, uh, my, the My Practice Plan course, our collaboration with IFM, and see if some of you might be interested in signing up for that class that's starting soon on November 9th. And we have a special discount for IFM-related folks. You save about 50% of the tuition, cut the price down to $1750 for the entire course, which is a pretty good deal. It's a pretty extensive training program if you're interested in doing that. And that's all about business. And I'll talk about why we partnered with IFM and how that all came about.

And then, um, I also want to get into, uh, speaking a little bit about telehealth, telemedicine, and building a virtual clinic. We have a whole bunch of materials on that. And then also speak in general about the functional medicine space and perhaps come to an understanding of where you guys are at and what you're looking for in general, um, in terms of your next step in education, you know? And so those are kind of, that's kind of an ambitious agenda. We try to get through this in an hour and, uh, and see where we're at. So, let me start off by, um, maybe giving you, like, the biggest picture view here of why we partnered with IFM and, and how this My Practice Plan course came about in the first place.

And so, what, you know, the, uh, a bunch of years ago, IFM put together a five-year strategic plan, and one of their issues that they brought to the forefront of that plan was looking at practice implementation because they realized that people went through their wonderful curriculum with really the best teachers in the industry, but that some people stumbled at the end of the process, or in the middle of the process, or even at the beginning of the process of doing IFM certification, and weren't able to implement or start a practice. And so they wanted to get a practice implementation partner in a, you know, a collaborative relationship. And so they looked around the industry and they did a lot of research, and they ended up settling on the Kalish Institute and the course that I teach in how to build the practice. And we renamed it My Practice Plan and went into this collaborative, um, relationship with IFM about, it's been about three or four years now.

And so, one of the things that, um, we were seeing, and our IFM was seeing as well as myself for the Kalish Institute, were that a lot of practitioners were struggling. They loved the work, they got certified, or they did a bunch of IFM modules, or they did their first CP, but they just weren't sure how to implement all this. And they weren't sure from a business perspective, they weren't sure from a clinical model perspective. And, and so we decided to, you know, try to fill this gap for people that are studying functional medicine and provide Kalish Institute courses through, in conjunction with IFM, and, you know, it's kind of in partnership with collaboration with IFM specifically for their students. And where we saw it, you know, this kind of, you know, fleshing out is that this amazing information comes in from IFM and you get all the clinical, you get the, you know, education in an academic sense, and you have an understanding of functional medicine. But then there's these two buckets of problems that happen. Either it's not really clear how you should start a business in these days, specifically, you know, how you could get going with telehealth or telemedicine. And then on the other side, there's problems with lab interpretation, supplement program design, patient communication skills, and the kinds of things that happen in the patient treatment room. So there's either front and back office problems, or problems structurally with business startup issues, or problems with clinical models, patient education, lab interpretation, that kind of stuff. And so at Kalish Institute, we try to solve both these problems, right? And My Practice Plan is a very thorough course around all the different aspects of starting a business. And now, of course, we're adapting that. And today's talk is about this, a little bit, you know, how this can play into a telehealth or a telemedicine environment now that that's sort of where a lot of people have been, you know, forced to go.

And, um, we also, you know, just noticed over the time of working with IFM, there's certain sort of characteristics that we find that happen a lot, and some of you may identify with this, in that some people feel like they're alone, they're not really connected with the community as much as they would want to be, especially now with COVID and the lack of live, you know, conferences. And [Music] people also struggle a lot with legal issues, you know, not sure how the legal aspect of this works, they're not sure about financial or business planning or sales, and they just get stuck and, you know, kind of unsure about how to progress. And the idea of the course, all the courses that we teach, including tonight and My Practice Plan, if you guys decide to go on to that class, is to, um, kind of unlock that, kind of unleash your power. And now I talk to doctors literally every day. We talked to this one doctor today, medical doctor, he took My Practice Plan like a year and a half ago. Now he's literally opening his clinic. He's like, today on the phone, he's like, "Dan, I'm picking out the tiles for the new bathroom in my clinic. I'm so excited." And he's a medical doctor. He partnered with a chiropractor, and they're opening this wellness center, and he's kind of fulfilling his dream. And he's like, "I really appreciate the class, and, you know, if I, I wouldn't have gotten this done if it weren't for doing this." So, we really are kind of a rubber-meets-the-road, let's make this happen organization. That's what Kalish Institute is all about. We don't want to talk about business, we want you to start a business. You know, we don't want to talk about clinical models, we want you to use a clinical model in practice. And, and that's really been the goal of mine for the last 20 or so years that I've been teaching. Okay.

And then we've built a pretty robust community. We have really good, great, great groups of doctors to take our classes that you can get to meet and interact with. And we want to try to, you know, open this up for you so you can see this is a very doable project. Should not be overwhelming. You know, it is overwhelming if you try to do it on your own, but it doesn't need to be. All right.

And then, um, we also want to deal with the other aspects, not just business planning and financial planning and legal issues, but also, like, that, you know, the nitty-gritty. Like, do you know how to design a supplement program that really works so you get clinical results that you want? Do you know what a therapeutic dose of N-acetylcysteine is or arginine? Did you know you could give three grams or six grams or nine grams of arginine if you really have to, not just like a thousand milligrams? You know, and, you know, N-acetylcysteine, could you do like four or five thousand milligrams? Yeah, you could if a person's, you know, really got a glutathione problem, that's probably what it's going to take. So we also want to help you guys become versatile and understanding about how to design supplement programs that are clinically effective, and not just about business coaching and advice, but how to interpret labs and this whole sort of package of the practical implementation side, right? And so tonight's primarily about the business side. And as soon as I say that, you know, I feel the energy and the internet drop a little bit, right? We don't want to alienate you guys because none of us went into this field, uh, because we were like, "Oh yeah, I really want to start a small business. I think I'll get a thorough medical education, then I'll specialize in functional medicine, then so I can start my business." Right? That's just not how it works. No one in the history of humankind has ever started a functional medicine practice because they wanted to start a small business. It's more like we have to do that. Okay.

So I want to talk a little bit about that as an opening here and maybe go around and just open up the mics for a second and get a little bit of feedback from you guys and where you're at and what you're looking for. And then I have a whole series of PowerPoint lectures I put together tonight, uh, for tonight, if we want to get to them, if we can get to them. But I really wanted to make today sort of a laying out of a series of resources that you guys have to really start to understand how to tackle all this stuff. And if you forget everything I'm talking about, you can just go to the Kalish Institute website, and right there on the home page, you see the sign-up information for the My Practice Plan course. Okay. So you don't have to remember anything. Just go to KalishInstitute.com. You can sign up for My Practice Plan here. You can also look at the other classes and offerings that we have as well, right?

So, um, I want to just go around for a minute and just unmute people and just give me like a few-second blurb on what you would really like to get out of today. Okay. So let's start off, uh, with Amelia. Let's see if, uh, if I can unmute Amelia. And some of you, um, it takes a second. You have to unmute yourself once I unmute you, um, but let's see if Amelia can chime in here. And I'll, I'll do a couple people at a time because sometimes it takes a while for people to get their mics undone. So Amelia, you can unmute yourself if you feel like it. Alexis, I'm gonna do the same for you here. And eventually, we'll get somebody that can talk. Uh, Carrie, I'll unmute you up. Carrie, your mic is on. Can you speak?

Yeah, hi. Hi, everyone. Uh, oh, hey. Yeah, tell me what you're looking for. Like, what, where are you at in your practice development now? What can we help you solve?

Well, yeah, I'm getting really close to starting up my micro practice, which is just myself. I'm waiting on some final website design and working with my electronic medical record. And, um, you and I actually had a talk a couple, like, a couple weeks ago. We talked for about 15 minutes on the phone. I'm in South Dakota. So, yeah, that was really helpful talking to you the other day. So, yeah, I'm just excited to be a part of this.

Oh, great. All right. Thanks, Carrie. That is great. And, uh, Amelia, you're unmuted now.

Yes, can you hear me?

Yeah, you're good. Great. Yeah, um, so my name is Amelia Lowe. I'm a family nurse practitioner. Um, I'm working on starting up my practice called Guiding Light Holistic Healthcare here in Arizona. And I'm starting out primarily as a telehealth practice. So I'm really excited to see what I could learn from this presentation today to make sure I'm definitely starting my business that's covering my liabilities and making sure I'm not, I'm not missing out on anything that I need to worry about. So.

Okay. All right. Great. Well, welcome, Amelia. And let's see. Let me grab Greg. If you can speak for a second, I can also unmute Hillary here. So Greg, or Hillary, you guys can unmute yourselves. I'll go for Jackie and whoever gets unmuted first can talk. Um, Jennifer. Up, Hillary, I see you have, I muted yourself.

Yeah, hi. Hey. So I am a chiropractor and I've been running a busy practice for 20 years. And I, about four years ago, five years ago, I got my DABCI, so I'm doing more functional medicine now. I've hired a chiropractic doctor to be an associate for me to see almost all of my chiropractic patients. I see very few now and I'm doing a transition into a more functional medicine practice. So running a business is not foreign to me by any means, you know, as far as like the CPA and the business and all of that kind of stuff. But, um, running the functional medicine practice is a little bit different because it's time-based and not, uh, you know, base, right? And the, there's no billing, it's all cash, which I love, but it's very different in that way. And then the, the other thing is I tend to be, which is a little bit different than I think what you recommend, I tend to be old school and I love paper charts. There's nothing wrong with that. I'm open to that. Yeah, I don't know if that's necessarily the best use of my time all the time. And it can be limiting because I'm in the process right now of hiring a registered dietitian, functional medicine, who has a lot of great experience working in functional medicine as well, but she's used to doing things all online, you know, mostly online and doing a lot of telehealth. I think is certainly to our advantage, but I don't know that I'm very good at it. Yeah.

Okay. All right. All right. Well, we'll try to drag you into the 1990s here, maybe you can start typing things into the computer.

I know, I know. No, I, I totally support paper. I'm not against that.

Okay. All right. Thanks, Larry. And Jennifer, do you have a comment and what you're looking for for tonight or in general in life here with your practice?

Yeah, so I am, um, I was just intrigued by it because, oh, we lost you, Jennifer. We had you there for a second and we lost you. All right, I'll leave your mic open, Jennifer, but for some reason, maybe lost your sound. Let me grab, uh, Christina, if she's available. Lisa, I'll unmute the Lisa's. There's two Lisa's, Lisa K and Lisa Z, and me. But oh, there's Lisa. Lisa K, you want to chime in?

Yeah, so this is, hi, this is actually Wes Kimball. I'm, um, and Lisa's husband. So I'm an entrepreneur. I've started several businesses, but not nothing in the health space. So our interest is specifically in telemedicine or telehealth. How to set that up? What kind of legal entity, you know, is it a PLLC or what? And how does the licensing work, you know, across states and all that, all that stuff? As well as insurance, or, um, I guess malpractice insurance, how does that work? So kind of, kind of basic 101, how to start the entity type stuff, specifically for telemedicine or telehealth.

Okay. Excellent. All right. Thanks, guys. And let's see. Let's just get a few more people if we can here to chime in. Mary, I'll try to unmute. Oh, we have Lisa Z. You're live now. Lisa, you there?

Hi, can you hear me?

Yeah, you're good. So I'm a pharmacist and I'm currently attending, um, the School of Applied Functional Medicine. And I would like to, my goal is to set up, um, a virtual functional medicine practice. But I have not, I've basically just picked out my business name and that's it. So I'm at the very beginning.

Right. Okay. Great. And let's grab Christina Rodriguez. Christina, are you there?

Yes, I'm here. Hello.

Hey, um, I signed, I'm a registered nurse and I'm actually certified in functional medicine and I'm operating as a health coach. And I'm at the stage where I'm really wanting to, to branch out and working on my website and just trying to figure out all the legalities on how, how to operate in a good way. And, um, you know, things with patient communication and keeping it very simple. And also how to market myself to other functional medicine practitioners out there so I can work with their clientele as well. So that's essentially why I'm here is to get some dealers out there and see how I can streamline and put myself out there.

Okay. Great. Thank you. And one more here, and then we'll get into the materials. Um, I, I know I didn't call on everybody, but let me see if I can grab, is it Cher or Sherry? Share, is that you with the last name Conway? Oh, you're unmuted, but no chatter there. Okay. Well, I got a general idea anyways. So if any of you guys that I, and you guys can raise your hands later too, if you want to chime in, or you can type a little note into the chat box. Um, and so, uh, let, well, let me, let me go through the original, I have these original slides that I wanted to do first, and then we can talk about, um, some of the questions that you guys are thinking about in terms of telehealth and telemedicine practices, okay? And I think part of this, the biggest picture here, I look at, like, the 30,000-foot view of what's really happening is I see functional medicine as a movement for social change. And this is a couple of statues that my grandfather, Max Kalish, made back in the 1920s and '30s. He was a socialist realist artist. And this idea of social change is not new to America. And I think my father followed in the same footsteps. He was an academic, studied the field of death and dying, and, you know, back in the 1960s was a leader in that area. He died a long time ago, but, you know, thinking about my dad again, like a leader in the movement for social change. I carried this on. I went to Antioch College. I lived with monks in Thailand for several years as me and my best friend in the monastery, many, many years ago. And I see what we're doing here in functional medicine as this movement for social change. And I always want to mention that because we're about to talk about business for like an hour, 45 minutes, or whatever. And that it's not about money here. We're talking about how are we going to get out there and start to help people? And how can we become good enough business people nowadays in the context of telemedicine or telehealth, perhaps sort of a special area of interest for a lot of people, but how can we do that in a high-integrity way that helps a lot of people, but that you can still make a living and keep your business running? Okay.

And so when I first started off my practice in the early 1990s, um, I didn't even really acknowledge the fact. I know this sounds insane to me now, but I didn't really acknowledge the fact that I was running a small business. I really didn't think I was. I think I thought I was just treating patients. And I, I started my own clinic. I had to build a lot of different clinics. And then over the years, you know, I ended up building three huge and very profitable, uh, integrative clinics. And then I started teaching, and then we started collaborating with IFM, and then here we are today. So I have this, you know, history, you know, going back a couple generations of my family, and being kind of anti-business, pro-academics, pro-art, pro-labor, pro, you know, social change. But now I've come to the point to realize, hey, you know, you got to make enough profit to make this thing work and to really make it run in a kind of smooth way. And that's really the goal. Okay.

And we see a lot of people that we work with that are relatively new to the field are, um, you know, concerned. They have fears of the transition of the change. Certainly with COVID, this is a huge sort of unknown that's happening to all of us. And people are scared to make this leap into telemedicine or telehealth. They're afraid that their income is going to drop. Perhaps your income has already gone away, you know, for a lot of practitioners, they're already in some serious financial trouble. And it's hard for them to trust that this leap into functional medicine or into telemedicine or telehealth could actually work. And they're not really sure what the models are that they should do or how this is all going to go down. And so there's also, for a lot of us who are coming into this area, like I was maybe 30 years ago, just kind of uncomfortable about charging people for money because you're like, "Hey, I signed up to be a healer. I don't really want to make a lot of money doing this." And this is just kind of weird that I have to tell people how much this costs. And, you know, that can be very frustrating for people. There's also sort of a model problem here, and that we don't usually have a clinical model. So people are reinventing every single patient, doing something completely different, which is just absolutely crazy-making, you know, like hitting your head against the wall. And it can be a very difficult thing to figure out how to get your emotional and spiritual well-being working as you're working for money, right? To make all that happen.

And when I look around and I see the students that, you know, complete the Kalish Institute courses, that are super successful, like several that I talked to earlier today, there's pretty much, uh, a set of characteristics that we always see. One is that they have a deep passion and excitement for functional medicine. And you don't need to have good business skills to do this. You can have pretty mediocre, even bad business skills, and still be able to do this and make it work financially because there's thousands and thousands of patients that are looking for practitioners right now, right? There's a huge reservoir of people that want this kind of work. And if you can set up your business that's efficient, that's profitable, you plan it out, you make sure that however you're going to do telehealth or telemedicine is, you know, legally defensible and, you know, has a good financial and business plan behind it, then you're going to be in super good shape. But you do need to, especially if you're new to this and you don't, you know, have a long history of working on a phone or working on, uh, Skype or some kind of internet connection, you're gonna have to really focus on the business side of this to build it up, okay? And that does take a little bit of time.

And then we also have people that are at all ends of the spectrum. They're either brand new to functional medicine, looking, you know, to just get started. They may be in practice for 10 or 15 years and just wanting to streamline and make their practice work better, right? And these principles are going to apply to all of that. What we really want to do in every case is make sure that we get your mission and your financial goals and your spiritual goals lined up in a way so you can have a sustainable business, not something that's just going to happen for, you know, a few months, then you're going to burn out. Okay. So whether you're just starting out in functional medicine, whether you've been investing in this for a while, you're coming into this field, or whether you've been doing this for a long time, there's sort of a spectrum, just like you see with human beings. There's a toddler phase and a teenager phase and a young adult phase, right? We see that in practices as well. And that there's certain characteristics at each stage of the practice that are going to be a little different that we want to focus on. But I think it sounds like for most of you, you're pretty new to this, right? And so we're thinking more about, uh, the maybe first zero to five years, you know, especially if you're new to telehealth or telemedicine, and what are the, you know, issues that are going to be involved in getting yourself off the ground there. So we'll try to focus on that, just based on, um, you know, the feedback I got from, uh, talking to people just a few minutes ago.

So the things that you have to do, in no particular order, have a business plan. And it doesn't count if you just kind of imagine a business plan. No, you can't write it on the back of a napkin or something. You've got to have, like, a written business plan. Can it be handwritten on paper? Absolutely. For our paper friend there, she is welcome to write this down on a piece of paper with a pen, but you gotta write it down or type it down. And you have to have a really clear, coherent business plan. If you don't have a business plan, you can't really have a business. You can have, you know, an operation or, you know, have something happening, but it has to be planned out. Part of business planning is financial planning, so you have to have a financial plan too. And if you haven't done this part yet, then you've got to sit down and kind of struggle and grasp with this, right? And we have a whole section in My Practice Plan, the class, about business planning. We have a whole massive section on financial planning, and we have assignments around this. So if this is new to you, you want to think about perhaps taking a course, especially since we just cut the price in half.

You need to figure out what your target market is, you know? And with telehealth, telemedicine, you got to be really careful. It may be that depending on how you're licensed, if you're a pharmacist, or a medical doctor, or a chiropractor, or an acupuncturist, depending on if you're in Vermont, or New Hampshire, or Arizona, or California, or Canada, or New Zealand, and depending on where that patient is, you may or may not be able to do these things legally, right? So you have to be really clear about how that's going to play out and make sure that your target market, like if you're based in Florida and your target market is in Texas, you know, that may not be feasible for a telehealth, telemedicine practice because you may be, you know, breaking laws in terms of practicing across state lines. So making sure that you figure out what's a realistic target market, what kind of products and services you want to offer, a really complete list, but don't make it too long, keep it really short.

And then legal strategy. And so I teamed up with a Cohen Law Group, gosh, I've known, I've known Michael for, I don't know, maybe eight years, ten years, something like that. Anyways, he was my attorney a long, long time ago. He and I did some kind of co-teaching things together. And then when we started the My Practice Plan collaboration with IFM, I was like, "Hey, you know, could you do the legal, you know, part of this class?" And so he and I spent a couple weekends, and it was supposed to be like an hour or two of legal content. Okay, this guy charges five or, you know, $500 an hour. So I just wanted him to come over to my IFM studio and we're going to film a couple hours. We ended up laying down 10 hours. 10 hours of Michael talking about high-level legal concepts. Can I say that again? 10 hours of Michael talking about high-level legal concepts. And that's part of the My Practice Plan course. Okay, that's like $5,000 of this guy's time. And who is Michael? Well, he's the only attorney that was ever given a faculty position at Harvard, not Harvard Law School, Harvard Medical School. Okay. He has the most extreme credentials of any human being on the planet. He's been published in dozens of articles in medical journals and everywhere else. He's written books. He's got, like, I think four advanced degrees. But he, um, he left Harvard. He was on their medical school faculty, right, setting up all their legal structures for all their integrative medicine stuff at Harvard. And he left Harvard, left academics, and he wanted to, you know, focus on the solo practitioners, the people like you and me, and really start to help us with legal strategy at a super high level. So anyways, I'm gonna say that's the third or fifth time. We have 10 hours of Michael talking about legal strategy as part of My Practice Plan. Okay. And that's a huge thing. He talks about agreements, patient agreements. He talks a lot about telehealth in there. He talks about Medicare. If there's a big section on HIPAA, all the basic stuff that you need to need to know around legal strategy. And as Michael and I have worked together over the years, we've really kind of come with this sort of synergistic concept that as you're doing business planning, you have to include legal strategy as part of that, right?

Let me just give you, like, a classic example. Is we had a doctor a couple, three years ago. She designs the most beautiful website known to the, known to humans. It's this great. She probably spent $10, $12,000 on it, maybe $15,000 on it. And then after designing the whole website and it's done, she comes, you know, for legal review to Michael's Law Group. And like, "Well, you're going to have to redo like 70% of this because you're making all kinds of medical claims that aren't legal." And no. And so you really want to, as you're designing your website, or as you're setting up your practice, or as you're getting your patient agreements in place, to include your legal strategy and your legal ideas and your legal counsel, right, in the mix with your business planning. And I know it's painful. Doctors don't like to pay lawyers money. That's sort of this, um, I was gonna say genetic, but it's like in, inborn, like uncomfortableness between doctors and attorneys. But it's at least a $5,000 bill, no matter what you give them, like a retaining, retainer fee thing to someone like Michael. Or Peter Hoppenfeld is another attorney we work with a lot. You give them a $5,000 retainer, and they help you get all this stuff set up. It varies from state to state. All the rules vary from state to state. So you can't just say you can do this, you know, via telemedicine because it varies from state to state. It's changing every year in each state. And it depends on what you're licensed as, medical doctor, chiropractor, acupuncturist, not only depending on the state, but what your license, licensing board is up to, right? And then of course, it's changing every year. So this is a complicated thing. So the, the, the advice in My Practice Plan course is rather general and it's enough to get you started. And I usually advise you, and people listen to that part of the class two or three times, come up with a long list of questions, then hire an attorney. You spend the $5,000 on the, you know, retainer fee and, and say, "Hey, I've been studying this for a while. I've got 16 questions I want you to answer. Let's get to work." And you can be really efficient that way in terms of setting up legal strategy. And that's a big roadblock for a lot of people. So we want to overcome that.

Marketing and sales strategy. This is a whole other thing that you want to think through. And one thing I would say about marketing is you don't want to spend a lot of money on marketing. Almost all the marketing money I've spent has been a total waste. Most of the marketing that you're going to do that's going to make you really successful will be free because you're going to do it yourself in a variety of different ways, okay? And then operations. So that's another section of the class. All right.

So now, if you're not yet possessing a business plan, a financial plan, a clear legal strategy, operational books, procedural handbooks, and all that kind of stuff, then you should think about taking the course. Okay. Um, and what we don't want is what I call "frozen practice syndrome." And, you know, I go to these IFM conferences, pre-COVID, right? And year after year, I'll run into the same doctor. And she'll come up to me in the hall. I don't know, this is caller Eleanor. And Eleanor will come up and say, "Oh, you know, I talked to you last year, and ever since last year, what's been happening, Eleanor?" "Nothing. I'm still thinking about starting a practice." "Well, I'm still an OB-GYN. I still don't really want to deliver babies anymore, but I'm just kind of stuck in this group." And I, you know, so we don't want that. We want you to break out. And if you really have a passion for functional medicine, you should be doing it in the next 12 to 18 months. You can just make that transition, okay? It's usually about how long it takes. But we want to snap people out of this frozen practice syndrome, whether it's legal issues that are holding you back, or you don't feel super comfortable starting a cash practice, or whether it's ethical issues around selling supplements, whatever it may be, we want to try to break you out of that.

There is absolutely a predictable series of steps that anyone can do to build a practice. And we, I've seen some of the least business-oriented people set up the most beautiful practices. I mean, it's really quite a remarkable thing to see. So you don't have to be like the next super fancy business person to make all this work. There's some pretty predictable patterns of missteps, you know, that people make. And I've pretty much seen them all in the last 20 years, over and over and over again. So we'll just tell you what those are and show you how to not do those, okay? That's the goal of a lot of these courses. And we don't want you just being stuck. I really do feel like we all have a social and moral obligation to get these practices running, to get them profitable so you can support your staff, so you can support yourself, and make all this work, okay?

So anyways, we're starting the My Practice Plan course November. Uh, it's ridiculously low price now. We've knocked it down to $1750. So I hope that takes any kind of monetary decision out of this. If you feel like you need the, the help, you know, you should sign up for the class. And we try to make that a no-brainer, okay, for this time. And we want to get a big group, so we want a bunch of you guys to sign up now. I'm going to pause for a moment here and then we're going to talk about telemedicine. Let me pull up a different thing here. Uh, okay. Huh. There we go.

So, Telehealth Essentials: Building Your Virtual Clinic. I want to just give you guys some shotgun kind of ideas here to start to get this going. Oh, and to answer Lisa's question, the class is, uh, it's a two to three-month class, depending on the holidays and the breaks. It's about two or three months. Um, okay.

So, Telehealth Essentials. So we're gonna have this broken out into three sort of discrete sessions here, and we'll see how much time we have to get, uh, if we can get through all of them. We'll probably get through the first two, um, before our time is up, okay? If this is super popular, um, you know, we can do another one or, um, at some other point, we can do another one of these. So, session one is from the practitioner perspective: what you need to do in order to get new patients on board. And we started doing these transition to telehealth webinars back in March, early March. I was teaching these, and so we've already had six or eight months of experience watching people actually make this work. This is not like some made-up thing, but actually, we're in this. This is like round three of me teaching these classes. So this actually really works, okay? I've watched chiropractors, medical doctors, acupuncturists, naturopaths, I've watched all of them apply these principles since COVID hit. And there's a whole bunch of them that are in the mentorship class now that I teach that are actually, you know, have full-time telehealth practices, you know, that they built in about three to six months. Now, of course, they were under huge amounts of pressure to make this happen, um, so it's kind of an extraordinary time. What used to take people 18 to 24 months, people are doing in two or three months because they were broke, out of work, kicked out of their clinics, and, you know, didn't have a whole lot of choice. But basically, we want to start off with this practitioner perspective right now, and what are the things that you need to know in order to get new patients on board, you know, quickly with telehealth? Clear clinical model is an essential aspect to that. What kind of labs can you order to make it work? And the format for presenting labs, we'll go through that in the next minute. And then we'll talk a little bit about about a patient experience and, and how you can think that through, especially with the current crisis that we're all in, and how you can direct people then to your telehealth solution. And then after the patient experience, we'll talk a little bit about front and back office systems, so you can see how this may play out, right?

So, um, one of the issues that usually gets overlooked, but I'm starting with because I think it's the most important thing, is that you have a clear clinical model that you can define, that you can explain to a patient on the phone in a couple of minutes, maybe even in 30 seconds. And that if you're going to do this through a telehealth model, you have to make it really simple and easy for patients to understand because you're going to be communicating through websites, through email, you're gonna be talking to people, yes, also, but it's a really different beast. And you need to just, people's online attention spans are really short. So you have to make this a crisp and clear clinical model that anyone could understand really, really quickly. And in general, we usually move in the opposite direction. So as a little note here says, practitioners are often challenged in the face of managing complex patients and not knowing where to start. It seems the more we learn what the potential treatment options are, the more unclear it is what we should do first. Okay. So that's like a big conundrum. So I want to talk about the value of creating a clinical model that you can apply to complex or simple patients, any patient, that's the whole point of having a clinical model, and how to achieve the patient needs within this reproducible patient process you can do this over and over again. And then what are the potential, you know, treatments, uh, that you can deal with, you know, there's a range of these from solving underlying health problems all the way to symptomatic care.

And so if you're an acupuncturist, or, you know, an acupuncturist, you will know that they have models in acupuncture, well, don't they? When I go see my acupuncturist, Franco, he always does the exact same thing. I walk in, the music's on, it's really mellow, I love his office. I lie down on the table, it's really comfortable. I feel like I'm going to fall asleep because I'm usually kind of overworking and tired. He comes in, he's a really mellow healer guy, he's got the healing energy thing down, right? He comes in, I stick out my tongue, he checks my pulses, then he'll mumble something about my liver chi or whatever, and I don't even pay attention because I'm half asleep by this point. Then he'll do a bunch of needle stuff, I don't really know how that works at all. And then I'll get up a half an hour later, and he'll give me a bunch of herbs. And I usually don't even ask him what they're for, I'll just take them, right? But every single time I see Franco, he checks the pulse, he checks my tongue, I do the needle thing, and I get my herbs. It's not like sometimes he's like, "Oh, you know, I'm not going to check your pulse today. I'm going to do this whole other thing." You know, he has a really clear, coherent model within Chinese medicine that he follows, right? There's a structure to it. And that's what we need to have to have successful practices, especially in online practice. You have to have a crystal clear model.

So I'm going to share my model with you. I'm not attached to this. You can use it if you want, that's why I'm talking about it. But if you want your own model, that's fine. It's even better, probably. But you have to have a model that you can explain quickly to patients that makes sense, okay? So here's my model, basically. Is that, "Why do I, why do I feel so bad, Dr. Kalish? Why am I tired all the time?" Well, I look at it in terms of body systems, and I think there's three key body systems: there's a neuroendocrine and a GI and a detox system. And usually, when we're under a lot of stress, emotional stress, or dietary stress, or inflammatory stress, that neuroendocrine, neuroendocrine system gets dysregulated. It doesn't work very well. That leads to a failure of our immune response. The gut gets not so great. You start to have what we call leaky gut, or start to react to foods. And then eventually, toxins can build up. And that's the basic model. How am I going to fix this? We're going to fix those problems in the order in which the problems occurred. So we're going to start off with lifestyle medicine, getting your diet and stress under control, getting you to exercise and sleep properly. We're going to measure and test your neuroendocrine system and fix your thyroid, or your adrenals, or your brain, or whatever's going on. We're then going to check your gut and get your microbiome to be like the most beautiful microbiome on the planet. And then we're going to get all the toxins and environmental toxins out of your system to get all the detox pathways working. So this three systems model, I use neuroendocrine, GI, and detox, is how I explain to people why they're sick. And it's also how I explain to people why they're gonna, how they're gonna get better. I have a lab test for the neuroendocrine that's called an HPA axis adrenal test. We have a microbiome test for the gut. And we have organic acids that looks at detox. So three tests, three body systems, makes a lot of sense. And we had this call yesterday and one of the boot camps I teach, and it was Karen, this woman Karen. She took one boot camp class with us, and she's got a 100% conversion in all her patients to buy all the tests. Okay. If you just explain this logically, people want to do all the testing.

So a key here to a successful telehealth practice is that you have a clinical model that you can explain, or your staff can explain on your website, on the phone, through email, through YouTube videos, that's really short and easy to understand. Three body systems, three lab tests. People can get their minds around that, you know? And it's, it's simple enough that people can understand it, okay? Is it entirely true? No, there's more than three body systems. I know that, you know that. But, you know, I don't really even have the immune system in here. That's a pretty big omission. I mean, there's a lot of things that aren't in here. But we're talking about patient understanding and having a clear model. So I try to keep it super simple. Maybe you can have five body systems if you want, but I wouldn't go a whole lot more than five or six, okay? And if you can explain why people get sick and then how you're going to get them better, that's enough that people will start to stream into your virtual practice because they'll, they'll look at your YouTube videos or your website and go, "Wow, this person really knows what they're doing. I totally get this. I, I am under emotional stress. I'm not eating that great, and I have a lot of inflammation. I totally get that this is how the sickness thing started because I'm living it, right?" And if, when patients relate to this model, then they're going to want to come in and see you as, as a, as a client, right?

So then, um, that's the first thing, having a clear model. Oh, and by the way, the, the testing that I actually do in practice, salivary hormones with the adrenals, GI microbiome testing, you know, stool testing, one of the good labs, and then organic acids is done from urine. So it's saliva, stool, and urine. They can do all the samples at home. They don't have to go into a lab or go anywhere. This is very, kind of COVID-friendly way to do things. And they buy either one or two or all three tests. The lab companies will drop ship them directly to the patient's home. They can do the test samples at home, send them in, and then you can talk to them when the labs come in, okay? So it's a really simple model to run in a phone practice. You don't have to stock the lab kits. The lab companies will.

ship direct. And once you get the results online, proof you set up a call, and you can be off and running.

Now, we also see that, you know, when you're on the phone, it's a little different than in person. And so you want to have some techniques to keep people engaged. And I think that there are some things I've learned over the years because I've actually had a full-time telehealth practice for, well, the years are going by. I used to be able to say 15 years. It's more than that. Um, since 2004, I've only seen patients. I've only talked to patients on the phone. I haven't had an in-person practice since 2003-2004. So I've been on the phone exclusively for 15, 16 years now. Okay? And it's a little different, a little weird at first, but actually, you come to like it after a while, right?

But one of the things is that with your new patient interviews on the phone, you want to make sure that you're adhering to a script. And we actually have some new patient scripts that I use in the more advanced classes that we teach. But the idea here is that you want to be a clear communicator. You want to make sure that you understand what they're interested in, you understand what their perspective is. But the same time, that you let them know by using a word every five or ten minutes that they don't understand, that you actually know a lot more than they do. Because this whole Doctor Google problem now, where some patients just feel like they know more about a subject area than you might. And that's not a really healthy attitude for a patient. You want to be sure that it's clear that you are an expert and that you want to support them and understand what's going on with them, but that you also are going to be the one that's going to primarily call the shots. I mean, it's an interactive relationship, and you're sharing a relationship in a lot of ways, but it's also kind of like you're a coach. And so like, you know, like the basketball player wouldn't tell the coach how to coach, right? So there has to be some kind of control that we hold in this relationship, as much as it is collaborative. Because patients really want that. They want to talk to someone who knows more than they do. Otherwise, they wouldn't really, you know, be paying you, right?

And one of the things that I use on the phone a lot, and this works really, really well, is what I call the condition description technique. And if you can master this technique, you're going to get 95% of the people that are new cases started on the phone to do labs, right? It's, um, it's a little, it's not the easiest thing in the world to do, but let me, let me show you here. You can learn how to do this probably in a weekend if you really kind of focus on it. So I have this condition description document here. I'll pull up real quick because this may or may not be intuitively obvious to all of you. So I think it's worth learning how to do this. Now, I don't like the word sales because it's kind of like a weird word, but this is basically a sales technique. But I call it a condition description technique. And because most doctors don't like the word sales, so I just made up this other term. So you're describing their condition, basically, right? Condition description. You're describing their condition. So like, if the person is depressed, you're describing why that condition will respond really well to the neuroendocrine, GI, and detox tests. However, if that person has a female hormone problem, then you're describing why the hormone, digestive, and detox lab testing will help them with that particular condition. And if they have fatigue, then you're describing why the neuroendocrine, GI, and detox labs will help with that condition. And so on and so on, right? So you see how that works. It's always the same labs, but depending on the condition, you're going to describe why, you know, the person needs to do that particular test. And if you master this, you will get almost everybody on the phone to buy the lab kit or kits, depending on how extensive you want to take this. Okay?

So let's just, let me just show you one example. So let's say the person has depression, that's their main complaint. Then I would say, well, there's a very strong correlation between depression and stress. And there's more research than any of us could probably read right now about how stress impacts the brain and the HPA axis and how stress can lead to chronic stress can lead to depression. So we want to test, measure your HPA axis as part of an overall assessment to see if there's a neuroendocrine or HPA axis component to the depression. Digestion is very well known now that there's a gut-brain connection. And that an inflamed gut can lead to an inflamed brain. And that an imbalance in the microbiome can cause absolute chaos in the brain. And you can have depression or anxiety symptoms that you experience cognitively in the brain that are a direct result of what's going on in the gut. So I think we should do this microbiome analysis as well. Toxins, neurotoxins are very famous, right? Very well, the name implies, right? Neurotoxins. Neurotoxins can penetrate through the fatty tissues. They can get into the brain, which is surrounded and protected by fat. Oops, right? And cause serious problems with your ability to send brain signals or neurotransmitter conduction. Neurons themselves can be physically damaged by neurotoxins. So we want to measure your detox pathways and see if there is an environmental toxin component to your depression. So basically, if you learn how to do a brief description for why each test is important for each major condition that you treat, people will basically buy the tests. And then once that happens, your phone practice will just grow and grow and grow, and you will all be happy and successful. Because once the testing is ordered and the patient does the test, if you're good at doing lab interpretation and you figure that part out, you're going to have super successful results with your lab-based programs. And then people are going to get better. Now, if you don't know how to do lab interpretation, that's a whole other story. You can take one of my lab interpretation classes, okay? And then we have some specific ways to present the labs as well. So you want to kind of dialogue around this and have a general understanding about how to actually do that, how to present adrenal labs, for example, or how to present GI labs. That's probably beyond the scope of this particular hour, but, um, there's something else to learn. Okay?

And then let's go ahead. Now, we still have the time. I think let's look at session two and get into the patient experience a little bit. Give me one sec here. So again, session one, quick review. Get a clinical model figured out that you can explain easily. Get them doing some labs. I prefer the adrenal, GI, and organic acids test, salivary, stool, and urine. Really easy to do in a virtual practice. They don't have to get their blood drawn. People are a little nervous about going to places to get their blood drawn now. So it's an easy sell, okay? And then, um, then you're off and running. Maybe you take some lab interpretation classes or just wing that part, or you come back and do some more courses with us. But that, that's like a key series of components to getting your virtual practice started, okay? And if you're really serious about this, then, you know, I think most of you that are really serious about this will go on and you'll take some of the courses, either the business track that we offer or the clinical training track that we offer, depending on where you're at, okay? And you're welcome to set up a phone call. I have my salesperson, Jennifer, that does calls. I do calls every week myself too. If you're curious about more of our classes, you set up a phone call and, um, we can get you signed up for a free call and talk through what coursework that we offer might be the best, okay? All right.

So let's go on to subject number two. Now, this is again, building your virtual clinic, but now we're talking about the patient experience. How to capture the attention of a patient in a crisis environment and direct them to a telehealth solution. A couple of different things here. And depending on where some of you are at, this may be a little different. But tools to transition an in-office patient to a virtual clinic. Some of you may not have patients yet, so you're starting from scratch. It's a little different. But let's talk about this first for those of you that, for whom this is relevant. So, and again, I watched in March. We had, I offered a free telehealth class in March. We had 1200 doctors sign up for that series. And when COVID first hit, those first weeks in March, I was doing every Tuesday and Thursday for an hour or two, these free webinars, just over and over and over. I got burned out doing it, but I was in a panic, just like everyone else was. I was like, holy crap, you know, every acupuncture and chiropractic and half the medical offices just closed. What are these doctors going to do? So anyways, we were hustling and we got 1200 people into these free courses, and a bunch of them took the mentorship, probably 20 or 30 of them or more. And so I've watched that group that I've been able to track in the mentorship class, and they've done really, really well with these basic techniques, okay? This is not particularly fancy, but this works. And depending on where you are in your practice, if you have an in-office practice and you want to try to transition it, you just need to get together a comprehensive sort of transition. Now, that's good. Now, this would also go for some of you that are like having an acupuncture, chiropractic, or medical practice, and that's working now, but you want to just gradually transition over to functional medicine with or without telemedicine. Doesn't have to just be telemedicine only, right? You want to get a series of up to seven emails out over the course of two or three weeks. The email has to have something that's helpful in it that they're going to be interested to read, but then also let them know that they can do a free 15-minute consult to learn more about what you're doing with telehealth, okay? Or with functional medicine, if you're going to not do, if you're just doing a functional medicine thing, okay? And then next, then you want to also ask for referrals to your virtual clinic from your existing patients. So not only to bring in the current patients, but to let them know, hey, I'm starting this functional medicine practice now, and if you any of your friends or family might be interested, this is something that you could think about doing.

All right, let me just pause for one second. We got a question here from Kelly. Let me grab Kelly before I forget. Kelly, you there? I unmuted you on my side. Hi, yes, I'm here. I have children in the background, just to give you an idea. Um, so I'm new. I'm, I'm a physiatrist, so in physical medicine and rehab. I cur-, I'm new in my career. I'm in an academic institution. So by new, I mean I'm in practice, you know, less than three years. I'm actually on maternity leave. I have school-aged children, and I'm, you know, kind of wondering how to make this happen. If, if I can make the leap and the jump while both I'm still learning functional medicine, but also, I'm a little scared and understand that I don't know the business background, even though as much as I'm sort of in a love fest with functional medicine right now. Yeah. So the earlier in the process you do the planning, the better. The earlier in the process, you know, we get people who are still in medical school. Great. Plan this out before. Because what happens most of the time is people start the practice and then they realize that they need to plan it. And so they're trying to practice and plan their practice at the same time. That doesn't work as well, right? That would be like, imagine if you opened a restaurant, but you really didn't know what kind of food you wanted to serve yet. You didn't have a menu, and you didn't really, you know, have dishes or tables. I mean, you just, it'd be total pandemonium, right? That's what most people do. They just open up a functional medicine clinic, but they have no financial plan, no business plan, no operational plan, no procedure plan, no legal strategy, and it's just a mess. And so it's very, very stressful to do it that way. Now, people pull it off all the time, but if you can plan the whole thing out six months or a year or even two or three years before you start it, it will save you a massive amount of time and money and stress when you actually get the thing rolling. Oh, we lost Kelly. I think she got muted again. Does that make sense, Kelly? Oh, she's got kids. Yeah, I think that answered a question. Yeah, that is. And, and the planning process that we're talking about, it's not like you can write a business plan and then that's it, right? This is it. What my cousin Alan calls an iterative process, right? You're going to do that, you know, go through this process, you know, over and over again until you get it just right.

Now, let me grab Srada. Had a question from earlier. Srada, are you there? I'm here, Dan. Oh, yeah. You had a question about, was it about New York? Yeah, this was, um, I, I had just listed a bunch of concerns and things that I was, you know, hoping to get a little bit of clarity on today. Possible. Um, but yeah, but that part of the question is, I'm, I'm in New York. You know, so our access to certain tests, um, is limited here in New York. So one of the things I was wondering is, should I create an entity like just over the border in Pennsylvania so I can, you know, get access to tests like, you know, line testing and the full, you know, GI panel and even access to establishing accounts with certain labs and lab codes? I would, I would check with a couple of New York-based docs. I've been doing this for 10 or 15 years and see what their workarounds are because you want to make sure it's very, very legal. You don't get into trouble, okay? Okay. But there are, there's tons of docs just in Manhattan alone right that I've worked this out. Okay. Okay. Yeah, I'll check with, I'll check with them. And I know, I know I can make do with some of the, um, you know, the testing. I spoke with Genova Diagnostics recently and, um, and they said, you know, you can, you can do really good clinical work with what we have available in New York. So, okay. Yeah. So, so I feel good about that. And then, and then just other questions I had were about pricing. Huh? Yeah, I'm, I'm, I'm interested in that. I know, you know, creating packages for like, you know, like three, maybe three, six, and 12 months packages are better than like one-off visits because then you have people committed to a a journey and a plan. But, um, you know, didn't know what your thoughts were about that. And, yeah. So I, you know, I've seen it go both ways. I, um, some people, some practitioners are much happier with packages, or some practitioners are much happier with a membership type model where people pay a monthly fee. So I've seen membership models as low as like $75 a month up to, you know, $5,000 a year in that range. And I see packages are usually like a six-month package. It's usually in the $3,000 to $4,000 range. Really expensive packages, like for cognitive decline, might be in the $6,000 to $12,000 range. Okay. Um, now, personally, I do everything a la carte. We just charge by the hour. I much prefer that because it's, um, I just find it easier and less stressful. However, if you can do a three or $4,000 package, you do get people to buy in. You do get their attention for six months quite fully. Don't worry about them scheduling their consults because they want to use up the time that they already prepaid for. Um, it's just harder to sell, obviously. You have to do a much bigger sales job on the front end to get people to buy into something that's, you know, in the $3,000 to $4,000 range, right? Yeah, the whole enrollment process has to be really all laid out. Now, I, what, you know, the chiropractors mastered this like in the 1800s, you know, like any good chiropractor can sell a package to anything for anybody, you know? So like, I mean, and I'm kind of making fun of my own profession a little bit, but, you know, when I, when I was in chiropractic college, we did these spinal screenings at like health fairs, and you just learn how to sell because, you know, chiropractors always been all cash, and if you couldn't sell your services, you'd be out on the street in a minute. And so, um, there are some people like I have a good friend in New York City's chiropractor, he sells packages for three, $4,000. He could do it in his sleep, you know, it's like he does a dinner talk, 90 minutes later, he's got like 15 people doing $4,000 packages. He's just got a system to it. But for a lot of us, that's, you know, hard to get that good at sales. So like for myself, I much prefer to sell somebody on a $400 new patient consult, and then they get, oh, I should do the lab. Someone has $1,000, $1,200. Okay, I'll pay for the labs. Well, now I did the labs and I got to talk to this guy again. So we do, you know, kind of nickel and dime people a little bit, but it's a process that makes sense. And they're just buying into a $400 thing. They're buying the labs. They're buying the follow-up consult. When they do the follow-up consult, they always buy the supplements. Kind of makes no sense if you have to buy the sellers, right? Wouldn't make any sense. So we kind of lead them down a path. It's not a pre-structured package, but it's a very clearly delineated path of steps, and one leads to the next. And that can work really well too, okay? Okay. All right. Thank you so much. Yeah. And let me grab Mary. Had her hand up here. Mary, you there? And I tried to unmute you. Mary, you should be on. If you unmute yourself, you should be good. And then Christina had a question. Let me grab Christina. Christina, are you there? Yes, I am. Hi. I'm, I'm wondering, as, as a functional medicine provider, but I'm also a nurse and then a health coach, and wanting to progress my career in a lot of different ways, whether or not it's in my best interest to continue to put energy into developing my own personal business or if I would be able to reach more people by working with various providers in that way. And I don't know if you're able to really answer that, but I, I just, I feel like I'm going to continue to run into these walls of not being able to have access to the things that I need to be able to help people, um, specifically because of the, the limitations of my with my license. Yeah, that's where I was talking earlier about how legal strategy needs to coincide with business planning. That's like a Michael question or a Peter Hoppenfeld question, you know? Because, and there may be some really simple, straightforward, easy answers. Like, partner with an acupuncturist, chiropractor, nurse practitioner, or medical doctor. Find, uh, I just, this happened. We just have, one of our new students just did this in Connecticut. She partnered with a group of medical doctors that wanted to offer functional medicine but didn't want to do it themselves. They just brought in some folks to do it. So they're working under that medical license. Great for the medical docs because they don't want us, you know, they have this, you know, huge booming practice in Connecticut. It's in one of those really ritzy little Connecticut towns, or Greenwich. Greenwich, right? And they don't want to, they don't want these patients going away to someone else down the street. So they got, you know, nurse, nurse practitioner people now working under their medical license to do the functional medicine stuff. They don't want to deal with it. They don't really even know what it is. They just know that their patients want it, and they don't want to lose the business. So they're keeping it in-house. So you can find relationships like that, you know? Or you might find a more independent relationship where, you know, you're working under someone's license, but you have a little more independence. So there's a bunch of different options there, depending on what your, you know, your bigger picture or vision is for your future, you know? Gotcha. Yeah. Yeah. And it depends on what state you're in, right? And then how you can make these other connections. So I know it's a huge expense to spend three to $5,000 on an attorney upfront, but it's just kind of the cost of doing business to figure these things out on the front end so that you have a really working model. And for someone like yourself, it could like totally settle these questions. But what I've seen with legal, when we sit around, we sit around this, we sat around this table with, it's like over 20 doctors, right, with legal problems. And the invariably, invariably, what the doctors thought were their major legal liabilities and potential problems were not. And oftentimes, their biggest worries were non-worries. And the attorneys would say, like, well, yeah, it could happen, but I've never seen a lawsuit for that. So just forget about worrying about that particular problem. But then, ironically, the things that are most commonly getting people in legal trouble are not being thought about. So we obsess on the non-legal. People like me and you obsess on the wrong things that really don't matter, but we don't obsess on the things that these attorneys see every day people get into trouble for. So it's just something to keep in mind, how how off we can be with our own estimations of things. Um, okay. Let me grab, uh, Mary, you were unmuted for a second and I lost you there, but can you unmute again? Yes, I, um, thanks for checking with me. I put my hand up by accident. Oh, all right. Do you have any, any questions, anyways? Just something on your mind? I don't. Thank you. Okay. All right. Thanks. Well, that was easy. Uh, okay. So let's get back. We're talking about the patient's side. Oh, and Kelly asked questions. What's the initial amount of funding necessary to launch a functional medicine business? I don't know. Let's say $5,000 for legal. Almost all of the money is your time. If you already have a laptop, a chair, and a computer, and you can get cheap rent, maybe you need a couple grand for rent, a couple grand for equipment, you know, maybe a grand for a website. Probably $10,000, $15,000, you could get something pretty good going for that much. And it's not like more is better, like $100,000 necessarily. Not necessarily going to get you something better. No. Um, okay. Ongoing engagement required. So we're talking about the patient experience here, right? And, and how, especially for online practices, this can make a huge difference. So, and almost all of this part is free. Don't spend a lot of money on marketing. I've never seen a big marketing budget really work out for the doctor. You know, you generally want to spend about 10% of your total income on marketing. So if you're bringing in $100,000 a year, about $10,000 of that you can spend on marketing, but no more, okay? No more than 10%. And don't get caught into some marketing scheme where you're paying people thousands of dollars a month. It just doesn't really work very well, and it's not worth it. So digital engagement tactics that we're talking about depend on you, right? And what you feel like. Like some people like to write, you can do a blog. Some people just love to chat, you can do YouTube videos. Some people like to do things live, you can do Facebook Live or Instagram Live. You know, some people like newsletters and recipes and that kind of stuff, you can put together a little newsletter. A lot of people like to do patient education classes, you know, 100 or 200 or even a free class, but probably a couple hundred dollar class that would then funnel people into your practice. So that ongoing engagement, if you're doing a couple hours a week promoting yourself by doing these kinds of things, you will invariably build an online audience that'll want to do telephone or telehealth consultations with you, you know? And I've seen this over and over again. If you're consistent and you do this for long enough, it'll start to pay off. The first couple months, you might be a little frustrated. The vast majority of new patients that I talked to have watched my YouTube videos on our Chaos Institute YouTube channel. Almost all of them have done that before, and they're like, yeah, I watched the video and you're talking about the Ion panels and that really sounded like me. Almost all of our patients come in that way. It was free. It took my time to make the videos. I put together the PowerPoints myself. I gave the talks, recorded them for free, and paid my staff a couple bucks to put them up on YouTube. So it doesn't have to be a big costly thing. Same with blogs, right? You know, a lot of this work you can do on your own with the help of some IT people. And then in terms of, you know, how do you really engage an online telehealth patient? Key, key is you have to have some reason why they need to talk to you. So you have to have some knowledge that they can't get on their own. And that's really the role of lab tests. They are this motivational tool. They're this analytical tool that give you something really clear to talk about. They also give you obviously the ability to prescribe very clinically impactful supplement programs. So when you're doing an adrenal lab-based program with DHEA and pregnenolone and licorice root, people are going to feel better. When you're doing a neurotransmitter support program based on organic acids with tryptophan and tyrosine and Mucuna, people are going to, you know, have their brains ignite and feel better. So there's this kind of clinical benefit thing that happens as well. But in that early stage of building an online practice or telehealth practice, the lab tests are absolutely the key motivational tool. That's why the patient has to see you. That's the reason why you can't just figure this stuff out on their own is because of the lab. So having your sort of suite of labs, again, like mine is neuroendocrine, GI, and organic acids, you have your three tests or your two tests, whatever you end up doing, um, that is like the key, key patient engagement tool to make this whole thing work. And then as a general rule of thumb, you know, your supplement sales income should be about the same as your consultation fee income, right? So let's say you're charging three or $400 an hour for your consults, you should also have about three or $400 an hour profit from your supplement sales. If that is not happening, then you're not doing a very good job at interpreting the labs and getting people their programs, okay? That's ballpark around where you should be. So you can see the math there's pretty easy. You can make $600, $800 an hour doing this pretty easily, you know, I wouldn't say it shouldn't say easily, but that's very, very realistic once you get your practice up and running. $600 or $800 an hour of income is, uh, you know, probably at the low end. I'll also think a lot about the patient's life cycle, right? And how are you going to step them through this process, especially since they're not walking into your office? You don't have these normal sort of social cues that we would have in an in-person setting. In a telehealth setting, you want to really map this out in a digital age kind of way. And so this is, um, I think my patient life cycle here, I'm just going to step through it just to give you an idea of what one is like, but we've tried to map out each step in the patient process, right? They walk in the door, or in this case, sorry, they email or they call, right? And they're like, interested. And then, um, we send them a new patient packet by email, or it's the links to the website, right? Now, if people don't proceed, you should have a list, a spreadsheet that says, these are the people that inquired last month but didn't set up a consult. And guess what? You want your staff to go back to those people that inquired and follow up with emails and phone calls to move them to the next step. You get them to step two, they've done the new patient consult, they completed that. You recommended they do these three labs. Then you want to have a reminder system set up. And there's a little spreadsheet column thing, right? That's got new patient consult completed but no lab back yet, or they didn't buy the labs yet. So then your staff can then say, hey, we saw you talked to Dr. Kalish, you know, yesterday. You didn't buy the labs yet. Anything I can help you with to make sure that this works, you know, whatever. So same thing. They bought the labs, but you didn't get the labs back. That happens a lot. You'd be shocked. When I first was, when I first looked at this, is John Ayo, my old, old business partner. I don't know, this is like 15 years ago, but we're sitting down in my clinic in San Diego one day, and John's looking at the bookkeeping. He's like, what the hell is this? It's like $46,000. I'm like, I don't know what that is. I mean, look at that. And I'm like, oh, well, that's people who bought labs but never did them. And he was like, really? Like, yeah. And I was, I never really looked at that number before. And I'm disturbed because I'm thinking, well, these are patients that didn't follow through. And I'm feeling bad. And John's smiling. He's like, wow, that's like pure profit. You collected all that money upfront. They never did labs. You didn't have to pay the lab company. I'm like, yeah. In my mind, it's a disaster because there's a patient that didn't complete things. In his mind, it's like this profit center. It's not a profit center. You want to get people to buy labs and do labs. Selling labs and having them not do them is not a good thing. So now we have a very robust lab tracking system. If people buy labs and don't do them, we are all over them. What happened? And a lot of times it's something really dumb. It's like, oh, the adrenal lab says you can't have a cup of coffee. And if I don't drink coffee, I'll get headaches. What should I do? Or, oh, the stool test says if you're on antibiotics, you can't take the stool test. And I had to take antibiotics because I went to the dentist. What should I do? So it's always really dumb, stupid stuff. Or, um, this just happened yesterday. The guy's like, I moved. I lost my lab kit. I moved. We're like, okay, we'll send you a new lab. All right, we'll get you a new kit. It's not a big deal. So you want to make sure that you track people in each one of these steps in the cycle. And if they're not moving to the next step, then you follow up with them in an appropriate manner, okay? And there's like 10 steps here that you can look at. And then maintenance programs and continuity programs. So when you look at these practices that we all have from a financial perspective, really the most important part is moving patients from a therapeutic program where they've gotten better. Now, that fertility patient had a baby. That person that couldn't sleep is sleeping through the night. That person that was anxious is no longer anxious. That, you know, whatever it is that was causing whatever is gone now. Then you move them from a therapeutic program to a continuity or a maintenance program. That's the main financial driver for all of these practices. And if you can have a couple hundred people that you've helped over the years that are doing a continuity program, meaning they're buying some supplements from you, one, you know, every month, and they're doing a lab test perhaps once a year, sort of a check-in, then that in and of itself becomes quite a robust business. It's not easy to do this, but once you get that going, you're going to be in really good shape, okay?

Now, we're a little out of time. The last section I was going to do was on back office systems. Um, I don't know, we could vote, I guess. If you guys are, you guys tired? Do you want to stop? Or can I get away with doing one more thing here? Well, you know what? I'll tell you, how everything is recorded. If you need to go, we're way over the hour that we had allotted. So if you need to go, we'll send you a copy of the recording tomorrow, okay? So if you have kids, even better. If you don't have kids, if you want to watch, I highly recommend Amazon's show, The Boys. If you have a twisted, dark, sadistic, and violent sense of humor, it's a great TV show, The Boys. So go watch The Boys. Bosch is also really good if you like detective shows. Go do that. You can come back and watch this later, okay? So I'm going to pause. I'm going to do the last section, and you guys are welcome to take off. I won't feel bad if you leave. And again, we'll send out recordings tomorrow, probably. So you can do that, okay? Oh, and then reminder, um, starting November 9th, my practice plan. It's $1,700 bucks. You guys, it's half off of half off. We used to charge $5,000 for this class when I first started doing it, pre, uh, pre-IFM. It was a $5,000 class, okay? And now it's like $1,700. Just, you know, don't let the money hang you up. Just sign up for it if you need the help, okay? And we'll step you through all this, okay?

So now, step three, building your virtual clinic. Talked about you, the practitioner. We talked about the patient experience. And now we want to talk about the back end, or the practice. What I call the three Ps: Practitioner, Patients, and Practice. You being in a blissful state of energetic healing all the time. Your patients being attracted to that and being engaged, right? I have this old lady patient, she's probably like 87 or something. Mary is her name. And I talked to her yesterday, and, um, she's so sweet. And we're just getting off the phone, and she's like, oh, Doctor, every time I talk to you, I feel so much better. You know, she has, um, pseudomembranous colitis or something like that, you know? But anyways, like, if you can radiate healing energy, and your emotional and spiritual life is just going full guns, you know, just like amazing, people are going to be attracted to that. So we put the practitioner part first because if your life is falling apart, and you're really stressed about money, your business model sucks, your legal liability is through the roof, you don't even know what you're supposed to be worrying about, then, you know, it's not going to end well. So if you can plan and get your models in shape and all this stuff in your calm, then this whole process will roll out. Patients will be attracted to you. And then the third P, which will be something that you have to work on, is kind of like the grunt work here, is the practice itself. So if you want to transition to telehealth, oh, here, let me see. Uh, Lisa is asking here, patient life cycle. Hand. I didn't cover all of them. So let me, I'm going to just do this handy-dandy little thing here because I can. And I'm going to upload this. Lisa, I'm going to upload this into the handout thing. Let's see if I can do this. Oh, no. Choose a file. Hang on a second. So this should, this should appear in your download thing now. It says drag and drop, but that didn't work very well, dude. Let me try dragging and dropping one more time. Oh, maybe you have to drag and drop the thing in a second. Let me just do this right, right here. So I can figure this out, then you guys can download it since I didn't cover the whole thing. Uh, there. Oh, while we're at it, I can download a whole bunch of things. Hang on a second. This would be kind of fun. So I'm going to put a bunch of things in here you guys can look at, um, on your own time. So one of, I'm going to put in is the Kalish Kelly Method research study I did with Mayo Clinic. Super proud of that. My mom was so excited. Her little boy did a study with the Mayo Clinic. And it's on the Chaos Method. It's on exactly the same stuff we teach in the class. And then I'll drag and drop the patient life cycle that Lisa was asking for. Yeah. So the Mayo Clinic study is pretty cool. It has nothing to do with anything that we're talking about today, but I'll just show it to you because it came up in my mind here. So we did a study with Mayo Clinic. Five of the Mayo Clinic practitioners took, took the class, believe it or not. And Larry Birdstrom took it twice. But anyways, and so they're like, hey, what do we do? We're Mayo Clinic. Let's do a study. So we put 25 women through the Kalish Method, uh, adrenal and GI testing, and then we wrote it all up and published it. Sue Cutshall and Larry Birdstrom from Mayo and myself did this study. So you guys got a copy of that now. Anyways, I think it's the only functional medicine study at Mayo Clinic. Stone. All right. Um, transition to telehealth. So practice front and back office. The key here. Oh, let me grab Ed had a question. Had you there? No. Oh, I got you. I needed that. It may have been a mistakenly raised hand, but if not, I've got you. I mean, oh, there you are, Eddie. You got a question? I'm sorry. You, you answered my question. I could not find the, the, the downloadable file, but that's there. Oh, you got it? Okay. Good. Thanks. All right. So, um, you know, one of my old, old students, this woman who's an acupuncturist in Santa Cruz, sent me this email a couple days ago, and I would, there, there was something that I taught her like 10 years ago, and she finally figured out, you know, what I was saying. You know, and so this is like me. So when my first business coach was a guy named Lenny Coco, and Lenny would always say, every coaching session, low overhead is the key. And so, of course, I went out and I built three very high overhead practices before I settled on a low overhead one. And now I'm realizing after, you know, 28 years, oh, when Lenny said low overhead, he didn't mean a really fancy office on the beach in San Diego, you know, and then try to like be cheap about the light bill. He meant low overhead. So one of the things as you're thinking about transitioning to telehealth, telemedicine, keep the overhead low. Every dollar that you can save in your overhead is going to be worth 10 or more dollars in terms of profit down the road, okay? So keep the overhead really tight. And as you're transitioning these tools from front office systems, think about efficiency and how easy you can make it. And it's online scheduling, so it's automatic reminders, and you're really eliminating almost all the labor when you're doing these things. You do, of course, need some front office staff. And these days, you know, you can have this person working remotely. You could all be going to an office then be calling in on the phone, but why even bother paying for an office on those days, right? If you're going to have a phone practice, you know, potentially you can be working from home, your staff can be working from their home, and you don't really have to have an office for the portion of the work that you're doing that's going around telehealth. I've done it both ways. I've had a telemedicine practice with an office, I pay three or $4,000 a month for. And then I've had telemedicine practice without an office where it was all virtual. And if you can save $3,000 a month on rent and all the costs of running an office, it's a lot of money that adds up really quickly. Then, um, I'm thinking about local or long-distance staff, right? So I've had staff like right now, I could throw a football practically and hit my office manager's house. I've also had office managers that were in a different state, you know, halfway across the country. So you have a whole bunch of different options there. And then also, you know, hiring the right employees. There's a, there's a whole kind of art to that, which is challenging. I'm certainly not an expert in that, but it's something if you're not good at hiring, then you want to help have someone help you that's an expert at doing hiring. Now, on the on the back office side, lab tracking systems are essential, right? And you don't have to have fancy software. Financial and billing systems, you know, the one that's the most popular these days is Serbo. Everybody seems to love that program. If you're looking for, you know, some, you know, what do you call it, EHR, EMR kind of thing, Serbo with the C seems to be the most popular. Power to Practice is the other one that I hear about a lot, you know, um, some people like these, you know, really cheap or free ones. Um, so there's a bunch of options out there depending on your budget, but I think Serbo's probably the right balance of not too expensive, but pretty robust, you know? And then scheduling systems, you know, they can fold into all that and making sure that you're doing all this in a really streamlined way. And there's some companies that have free apps. Designs for Health just came out with a free app. So if you have an account with Designs for Health, you can throw all your patients onto their app. Of course, you got to sell them Designs for Health supplements to make the thing work, but, you know, it's a beautiful app. It's called Well World. It's really well designed and there's a lot of features and sort of buzzy, cool things about that if you want to check that out. And, um, and then making sure that you have someone that is good at IT that can help you with your Facebook and your social posting and your YouTube channel and all that good stuff. Um, let me see. Christina had a question here too on this subject. Let me see. Let me grab Christina. Christina, you there? Yes. Um, I know IFM, hi, IFM recommends, uh, Living Matrix. I don't know if they recommend, but we hear a lot of commercials or info about Living Matrix. Just wondering what you thought. Yeah, Living Matrix is wonderful if you are an IT-oriented person, okay? So it can be intimidating if you're not good with computers and a little overwhelming. If you're not afraid of computers and you kind of embrace the whole digital revolution, like our person earlier, I forgot, I think it was Lisa, who's like still writing things on paper, would not like Living Matrix. But if you love the idea of putting everything on a digital platform and having it be totally organized and streamlined, then, and you're not afraid of getting into a computer and hacking around a little bit and setting things up, and you're not afraid of looking at all your patient files on a computer and in a digital way, then it's a really great program. It's very efficient, and patients love it because they can fill out these long questionnaires that populate the matrix for you. You can have them do that again at the three and six month mark, so they can see their progress and whatnot with all the MSQs and that kind of stuff. So it manages all that data for you. But if you're easily overwhelmed by technology, then it's not great. Okay. Thank you. Yeah. And some of our doctors, I mean, they sign up for like the boot camp class or my practice plan, and they can't even figure out their password, you know? My office has to spend five or six phone calls.

to show them how to enter the password. So if you're like at that level of IT skills, then probably you don't want a really robust software package like Living Matrix, okay? So be careful. Um, okay. Um, let's see here. And then I think Ed, his hands up again. I think so. Let me see if I actually got a question at this time. Ed, you there? Uh, yeah, I do not have any question. No.

Okay, all right. I tried. All right. Um, working with a health coach and other staff members to maximize supplement sales and patient follow-up and systems to consider. So I have a health coach. She does the new patient intake for an hour. She's the one that deals with Living Matrix stuff and populates all the data and all that kind of stuff, right? And then I have one full-time staff member that runs the office. So we're doing it with a part-time health coach and one full-time staff member. We bring in, I don't know, in a good year, $800 or $900,000. In a bad year, maybe $400 or $500,000. A bad year means I took a lot of breaks and I didn't work that much. A good year means that I worked full time, not full time, but you know, I worked every week. I see patients on Tuesdays and Wednesdays from 10 to 3. So I do about 10 hours a week. And if I take off a lot of time, you know, do vacations or other kinds of work, then the money kind of slows down, obviously. You know, that is an issue.

Let me grab Elizabeth. Had a question here. Elizabeth, you there? Elizabeth, can you hear me? There. Yeah, sorry, it was just to see if you put up here. Can you hear me? Yeah, you're good. To see if you'd put up your mentorship class info one more time before you go. Oh, yeah, yeah. Let me show you guys this. So you can go on the website, on the home page of the website. We have my practice plan because we're launching that in a few days. But if you go to classes here and click on classes, then you can see the boot camps that we offer. And then the mentorship information is right here. Okay. And if you're curious about the mentorship, probably the easiest thing is to set up a call with either myself or Jennifer after you read the website, and we can talk you through any questions you might have about that. Okay. All right.

And then, oh, yeah, you're welcome. And then a question from Lisa about legal entities. Lisa, you there? Oh, we're animated. Um, oh, there you are. So there's, there's very strict rules about legal entities. I don't know about what state you're in, but in the state of California, where I set up my original corporations, if you're a professional offering professional services, you cannot be a C corp. Okay? You have to be a professional corporation. But that's legal advice, and I don't know that probably varies from state to state. So you have to check with a CPA on that one. And then there's sometimes people try to split things where they'll do professional services under the professional corporation and then sell products under a different status, you know, to get a tax advantage on that. So you can ask your CPA about that as well. So they'll break out like the supplement sales and put that under some kind of a more retail-ish kind of thing to get some tax advantage there. Um, and then, you know, for malpractice insurance for telehealth, that's a wild, wild west kind of situation in that, you know, I think everyone's scrambling to try to figure that one out. Most of the doctors that we work with use their original malpractice carrier and then try to get telemedicine included in that, which seems to be something that's becoming more and more accepted post-COVID, right?

So I think that's, you know, people are being forced to do this now. So the, the worm is kind of turning. It used to be kind of the odd thing, but now it's almost everyone needs this service. So are you, are you only telemedicine right now or phone? Or are you? Awesome. I am correct. I only work on the phone. Correct. Yep. And so do you have a recommendation for an insurance provider that you use? I just used the regular one that I used before, so I don't have a new one. Yeah. Okay. All right. Thanks. All right.

Um, so working with a health coach to maximize supplement sales and patient follow-up. We talked about that. We talked about packages already. Now, clinical model. I'm kind of harp on this again. I already talked about this in the beginning, but the clinical model that you set up, in my case, neuroendocrine, GI, detox, that is the business model, right? So if you're running a Japanese restaurant, you're gonna sell sushi and maybe some, you know, teriyaki dishes, and then you have dessert. Okay? You have like three things. That's your model. That's the business model, right? The business model is what you're offering. In a restaurant, in a clinic, the clinical model, if you're streamlined about this, three lab tests, three body systems, that is actually the business model in and of itself. There's not a lot of other moving parts. And so because it's so simple, it's very easy to scale it up and do it with a lot of people and make a decent amount of money. If you're ordering different labs on every single patient and you're do using completely different sets of supplements on every single patient, then the economic model starts to fall apart pretty quickly. It's very hard to make money that way. If you have a set of labs that are your standard workup, you're going to be in much better shape. A set of supplements, it's about 50 supplements that I use for almost all my programs. I very rarely veer outside of that. If you have unlimited supplement use and unlimited lab ordering, you're going to have a very difficult time, you know, even breaking even in your clinic, okay? You're gonna have to work a lot more hours to make it work.

And then we talked about this already. Like just like legal strategy needs to company business strategy and planning, your business model and your clinical model are the same thing. You know, we tend to look at them separately, but they have to be integrated into a single structure. Just like the restaurant example, you figure out the kind of food and the menu, you figure out, you're not offering, it's not like, oh, Sam, what do you want to eat today? It's more like, here's the menu, Sam, you can have fried chicken or burgers, right? You're not going to reproduce an entirely different experience for everyone that walks in your restaurant. You couldn't do that. It's the same in a functional medicine clinic. You might think you can do that, but it's not an economically viable model. What ends up happening if you do do that is you're going to work more and more hours, you're going to get burned out. So I also have a treatment model. As you can see, I'm really into models. I like this model. This took me like 20 years to put together, basically, that, you know, we're working with people to try to find the underlying cause, but we also want to make sure that we treat their symptoms and that we can be anywhere in between. So that, you know, you're very flexible in terms of what you're offering to people and making all this work.

All right, common pitfalls. Understanding the cost and the value of your time. How much is your time worth? And not spending your time on things that you could pay someone else to do for $20 an hour. Underinvestment in the patient life cycle. Remember, if you can just keep your current customer base fully engaged, that's going to be the most successful business model. Lack of follow-up is what's one of the most crippling things that we see. Doctors just are good at the beginning part of the life cycle of a patient, but they're not really good at the long-term follow-up. Hiring the wrong people doesn't work very well, very either. Well, either. And so if you're not good at hiring people, you want to have someone to help you hire people. Find a friend or family member or someone that's good at hiring to help you do that. And then kind of understanding in general what the roles are that are required. That you're doing all these things simultaneously, right? You're a manager, you're running the company, you're the entrepreneur with all the ideas out there, you're the technician that's actually doing all the work. And seeing that it's a lot to take on, you know, and that you want to make sure that you pace yourself and structure this in a way that you're generating enough profit that you don't have to overwork. That's one of the most crippling things that we see is that the practice isn't set up in a, you know, properly, and so it's not enough planning, so the person has to overwork.

And let me grab Lisa here. She had a question too. Lisa, are you there? All right, we were just interested in the general breakdown you're seeing in revenue for consult fees versus supplements or continuing programs, just just a rough small part that you should expect. So in my practice, if I work about 10 hours a week, let me get a calculator up. A chart, it's pretty easy math. I do 10 hours a week of patient care. I charge $500 an hour, so that's $5,000 a week, $20,000 a month, right? So what's that? $20,000 a month times 12 months? Yeah, it's like $240,000 in consults. If I work that many hours, I always sell around the same dollar amount in supplements, right? In terms of profit. So we'll have about $240,000 a year in supplement profit as well. And then we'll sell typically about the same amount in labs, but I don't markup labs, so there's not really any profit in labs. But we'll sell $15 to $20,000 in labs. And my goal for most years to keep this whole thing running, to stay in the six to eight K array, you know, six to $800,000 a year range, is about 10 new patients a month. If I'm doing 10 new patients a month, I know this whole thing will just keep going. And right now, we have maybe like a three or four week wait list. We got our 10 patients coming in every month. And I don't even know what our numbers are gonna be. I haven't looked at it recently, but we'll probably do like right in the six to seven range this year, you know? Yeah, you're very happy. And that's on 10 hours. That's on two half days a week, by the way. If I actually worked full time, I don't know if I worked full time, I'd probably make like a million dollars a year. Um, but I have other things. I teach, and I have like nine bicycles. I just have other stuff that I like to do. So and I don't want to burn out on a patient care thing. 10 hours a week is really enough after 28 years. That's like, okay. So basically 50/50 break, 50% breakdown, almost? Yeah. And if that's not happening, then there's something off with how you're doing the supplement sales. Okay. Very helpful. Thank you.

All right, you guys. So I'm going to wrap it up. That was the, the end of our third part. So remember practitioners, patients, practices. We covered that. We talked a little way back in the beginning of this adventure that we're on tonight about, uh, about my practice plan. Again, the class is $17.50 total for the whole thing. It's a couple month long extravaganza. It's $5,000 worth of legal advice in there alone. And this other huge, there's six, there's seven huge modules in this class. It's a very robust program. Starts November 9th. If you're an IFM student or IFM affiliated person, you know, you can just go to the homepage of the website and sign up, or you can set up a call with one of us. And here's a little breakdown on my practice plan. Online content, lectures, assignments, case studies. You get access all the time. We have a live Q&A call throughout the class every couple weeks. And then community of peers that are going on there. We start off looking at self-care, get into business strategy, financial planning, operations, communications, sales and marketing, and then a big section by Michael on legal strategy. Okay. And that's the gist of the course. All right. So I hope you guys sign up if you're interested. If you're interested in the mentorship, like Lisa was, you can go again to the Chaos Institute website and check out information on the mentorship on our courses page. Okay. And I look forward to connecting with you guys. Join us later. All right, take care. Bye for now. You.