Episode Transcript
[00:00:00] Speaker A: Foreign.
[00:00:12] Speaker B: Welcome to the Comeback with Boomerang Healthcare, your podcast for relief, recovery, and restoration.
[00:00:18] Speaker C: I'm Dr. Peter Abaci And I'm Dr. Sarah Guzet. As doctors, we know healing isn't just about treatment. It's about having the right tools, mindset, and support to move you forward.
[00:00:31] Speaker B: You can have pain, you might be injured or even hurting on the inside, but with all that you got going on, you can still have a really great life. And that is what we are here for. This is the Comeback. Let's get started, Sarah. Let's get started.
[00:00:46] Speaker C: Welcome, ladies. We're super excited. We have a full house today, and we're here to talk about all things about advanced practice providers. And why don't we start with Boomerang's own, shall we? Peter?
[00:01:00] Speaker B: Yes. In the house, Alyssa Gomez. Alyssa, would you like to tell us a little bit about yourself?
[00:01:07] Speaker A: Yeah. Well, first, I'm really excited to be here on the Comeback podcast. My name is Alyssa Gomez, and I'm a nurse practitioner, and I'm also the director of advanced practice providers here at Boomerang Healthcare. I've been very fortunate to be able to work alongside some amazing providers at BHC, and Dr. Abachi is one of them, as is Dr. Guzet.
I've been Dr. Abachi's app for almost 10 years in the Los Gatos Clinic, and I've learned so much from him.
Interestingly, pain management wasn't part of my original plan.
Most of my nursing career was spent in acute care settings, so I assume that I'd eventually end up either in cardiology or urgent care. Even the error.
But during my final semester in NP school, I completed a clinical rotation at Boomerangs Capitola Clinic, and that experience completely changed my career trajectory.
I was immediately drawn to the way BHC approached patient care. Instead of focusing solely on the diagnosis or the physical impairment, we looked at the whole person and worked as an interdisciplinary team to address all the factors of impacting recovery.
What also really resonated with me was that we weren't just treating pain. We were helping people get their lives back. We were treating them back to work or reconnecting with their families and regaining confidence in themselves. And that really aligned with my philosophy of why I went into healthcare.
So I knew pretty well that this is where I wanted to be. And here I am ten years later.
[00:02:39] Speaker C: Fantastic. And we're happy to have you here and glad we haven't scared you away.
And, Tracy, why don't you tell the listeners a little about yourself?
[00:02:49] Speaker D: Absolutely. Well, thank you all for having me. I feel like the outside are not being employed by Boomerang, but I know Dr. Abachi very well and I know Alyssa very well and Sarah is really nice to meet you and I feel part of the pain management family.
So. I'm Tracy Malik Searle. I'm a nurse practitioner in the division of pain medicine at Stanford.
And I celebrated my 30th year at Stanford this year and yay, got my free parking pass. I'm excited.
And I started in the perioperative setting and something that attracted me to pain medicine is I used to do conscious sedation for all the interventional pain procedures that we did. And so when I had an opportunity to go back to school, get my master's at ucsf, I stayed as a nurse practitioner at Stanford and I transitioned really nicely into the pain service and, and similar to Alyssa, you know, when we first got started, and Dr. Abachi can speak to this too, because I think a lot of the fellows that were in attendings that were in pain medicine back in 1995, 96 when the clinic started, moved out into practice out in the community. But there were not many of us, right? So not many of us definitely in terms of apps, but fellows or physicians that specialized in pain medicine at all. So we were all learning, learning together. So 30 years at Stanford, I've been doing pain medicine for about 25 as an advanced practice provider and really excited to talk about all that we do today.
[00:04:23] Speaker B: You know, Tracy, I gotta say, I think you've gotta be like one of the most well known, well respected nurse practitioners in the pain management space.
When I started working for what I remember, I won't say how long ago, but I think you were the first nurse practitioner that I came across who was working in a pain clinic. You've been a pioneer, you've been a leader in academics, you've spoken at international conferences, you've been a patient advocate, you've been involved in pharmaceutical development. I mean, you have had a great career with us. So it's, it's certainly an honor to have you. Maybe we could start by just kind of for listeners who don't know what an app is, what an MP is, what a PA is, what all those letters in the Alphabet mean. Maybe kind of, let's start with that.
[00:05:25] Speaker D: There's definitely. It's Alphabet soup, right. When it comes to medicine in general. So be it physicians or psychologists or apps. So APP stands for advanced practice provider and it's a catch all that mostly includes non physician clinicians and for all Intents and purposes, we're talking about nurse practitioners and physician associates. And that can also include other advanced practice registered nurses that act as clinicians, such as CRNAs, nurse anesthetists or clinical nurse specialists that also have a clinical function.
The NP and the PA profession goes back to 1965, believe it or not. So 1965, the first nurse practitioner program came out of the University of Colorado. Loretta Ford pioneered that. And in 1965, out of Duke University, the first PA program was introduced. And on the PA realm, I think it was more coming back from the Vietnam War, you had a lot of medics that had been trained in health management and as clinicians and really didn't have a place to go. And so even though it feels like it's a relatively new specialty, and we're talking today about apps in pain medicine, really, there's been a basis of advanced practice provider care in healthcare for many, many years. Many, many dec.
[00:06:58] Speaker C: Fantastic. And I think it's important for individuals to know, you know, the educational pathway that got you to this point. How does one become an app? And more importantly, how do you become specialized, especially in such a field that can be so complex that we all know pain management can be sure.
[00:07:20] Speaker D: And you know, I think what we see with advanced practice providers, similar to our physician colleagues, is that many of us, even though we're trained as generalists, subspecialize. And so when you look at American healthcare today, you know, it's gone by the wayside, I think a lot. The Marcus Welby, you know, the primary care provider, maybe I'm dating myself by using that as an analogy, has gone by, you know, the wayside. And even in primary care, you have healthcare providers that subspecialize in one area or another.
So advanced Practice providers, both NPs and PAs, are trained as generalists.
For nurse practitioners, you have an RN license, so you've become a registered nurse and then you do continuing education for an additional two years in medical management. Right. So assessment, diagnosis, treatment of chronic disease and acute disease, and again, mostly in primary care.
And it's the same for physician associate. Right. So physician associate is not necessarily an rn. Some registered nurses choose to go that PA track, but mostly physician associates have a baccalaureate, maybe even a master's in some kind of science background, either biology or chemistry, and then go into a PA program, which is also another 24 month or two year program for the same type of medical training, diagnose to assess and treat chronic disease and acute disease. And what you're seeing now specializing, because Specializing is so routine. Back up what you're seeing, what you're seeing in training now is a series throughout the country. We see this mostly on the east coast. It's making its way to the west coast. Host of app residencies or fellowships where you'll have an advanced practice provider that's been trained as a generalist that wants to say, subspecialize in surgery or in emergency room medicine or oncology, and they can apply to do a fellowship, a 12 year, excuse me, 12 month fellowship or residency specific to that specialty. And at Stanford, we have five different fellowship tracks. So apps get hired on, they get a salary, and then they, for 12 months will have a combination of didactic and clinical work.
Unfortunately, that does not exist for pain medicine. And so those of us going into pain medicine now have kind of learned by the seat of our pants, have had some interest, be it family member who's had chronic pain patients in the past that have had chronic pain. For me, it was interaction with the pain service, doing interventional pain procedures. I got to know that patient population, fell in love with that patient population, fell in love with the physicians I worked with. Right. Sometimes it's that mentor that you wind up coming in contact with that then takes you under their wing to train you and educate you in a subspecialty.
So that's kind of where we are right now. There are no good residencies, fellowships, advanced training.
And so that's one of our objectives, I think, going forward in the pain medicine space in terms of advanced practice provider continuing education.
[00:11:09] Speaker B: Alyssa Gomez, you have been involved in integrating apps into comprehensive teams.
You've been involved on the treatment side.
You've been on the kind of team player side. You've also been on the training side. And you've, I think, I don't know what the number is. You maybe would know how many apps you've, you've helped train into practicing pain management. Maybe talk a little bit about how an app fits into a healthcare team, an interdisciplinary team, certainly a pain management practice, and then maybe a little bit about how you train people to be able to, you know, do their job at a high level.
[00:11:56] Speaker A: Yeah, you know, I think pain management is really the perfect example of why healthcare works best as a team sport.
When someone has chronic pain, there's rarely ever a single cause or a single solution.
There are physical factors, psychological factors, social factors, workplace factors, lifestyle factors that all influence recovery. And at Boomerang, our apps work alongside physicians, pain psychologists, rehabilitation specialists, physical therapists, acupuncturists, chiropractors case managers and all support staff. And each discipline brings a different perspective and expertise and apps. We often serve as the connector between all of those moving pieces. So we spend time educating patients, reinforcing treatment plans, monitoring progress, we identify barriers to recovery and we really help coordinate the care across the team.
And so when everybody is aligned towards the same goal and, you know, patients can receive more comprehensive care and ultimately we see better outcomes.
And so I like to say every member of the team sees a, see the different piece of the puzzle and together we see the whole patient.
[00:13:12] Speaker B: So if I was a patient and I was coming in for a visit and I'm going to see a nurse practitioner PA and it's a pain management visit, what can I expect?
[00:13:25] Speaker A: I mean, you expect anything that you would expect to see when you're seeing a physician.
You know, we're going to talk to you, we're going to find out what, any issues, any problems that you're arising, any symptoms. We're going to help with symptom management, we're going to see what you actually need and we're going to meet you where you're at. We would figure out what exactly is needed during the visit, order any physical therapy, acupuncture, chiro psychology and really just meet the patient where they're at and what the needs are and any medication management and really just kind of see where, what we would do if you were seeing a physician.
[00:14:02] Speaker C: I can tell you, in my experience, I've had a lot of patients where it has been really evident how close of a relationship and how much rapport and understanding they get with their app.
I will often get a referral for a patient and maybe they no show to the appointment and I might alert the app and they'll tell me, oh, let me talk to them, let me make sure that they're motivated, they understand the purpose of this appointment or I've also had them tell me, oh, this patient, I know her, I've been working with her for years, she's got lousy sleep. Was your appointment at 8am, don't do 8ams for her. And I'm like, thank you. And we change the appointment time. Like that level of coordination and care makes such a difference. And I can see it when I talk to patients and I'll ask them about when I'm doing my intake, about like, what are the treatments you've tried? Or oh, I noticed you have an appointment. And then they'll mention their app by name. They're like, yeah, I'm going to See so and so next week. And I can see, see them like, yes, I feel like they understand me. They have a good treatment plan. The communication's really clear. And I love how well everybody coordinates with each other so that, you know, whether it be from the physician down to, you know, the therapist, we're there to support the patient and understand things that may not always be so clearly you know, marked in the charts, you know, patient's apprehension, patient's concerns. And so that way we can speak to them and make sure that the patient also is still the most important person on that treatment team.
[00:15:22] Speaker D: I think, you know, just listening to you all, and obviously I work in a different. A different facility, but the model I hear and I see at Boomerang is like kind of gold standard, really what you want to achieve, right? And the type of care that we want to provide to our chronic pain patients is everything that you're doing under one roof.
And I would say that the apps, not only at Boomerang, but, you know, in the community, are doing the glue that helps, you know, keep the treatment together. Right, Keep the patient centric to the treatment, but really is the one behind the scenes making sure that everything is getting done and taken care of.
[00:16:02] Speaker A: In Boomerang, in Los Gatos, we have physical therapists, we have acupuncturists, we have our mental health providers. So I'm constantly talking with them to see how are they progressing, how are they going to. Can we do. We need to do additional sessions to get the patient where they need to go. You know, Dr. Massey used to always say, you have to find out what makes your patients tick, what makes them, where is their happy and healthy. For some patients, it's getting back to work, and I'm going to do everything I can to get them back to work. For some people, it's they're going to retire, but they want to be able to go to coffee with friends or pick up their grandkids or just know, be a functioning person. And so that's really our job as apps, making sure, finding out what that is, what's their happy and healthy and getting them there in whatever, whatever ways we can get them there.
[00:17:00] Speaker B: Traci, you have a pilot survey that you have been in charge of and what got you into that and tell us a little bit about that.
[00:17:10] Speaker D: So a few years back, a group of Apps and myself got together and started thinking about, you know, really what is needed in terms of app education to take care of these very complicated patients. Right? We see pain management, acute and Chronic as a subspecialty. Right. That doesn't necessarily own their patients.
You know, patients get referred to us, we optimize their care and transition them back into the community.
We know that that doesn't work really, really well. Right. So how do we really assess what the need is for that type of patient? And what is the education for an app that wants to go into pain medicine and really manage the complexity that they're faced with?
We know, and it's been well documented in medical education that physicians do not get enough training in pain management. Right. You might get a little bit in pharmacology, you might get a little bit in terms of physiology, but the lack of education. So we know that it's when well documented.
So we did a review of the literature to see really what was out there for app education. Again, as we talked about earlier, app general education education outside of fellowships and residencies is in primary care. Right. You kind of get educated in two years about all of healthcare when it comes to taking care of patients.
We couldn't find anything, so we decided to start a pilot study so we could just figure out really what, hear it from the horse's mouth, if you will, what kind of education and pain medicine are app apps, NPS and PAS getting in their secondary education?
So we sent out a survey, 10 question survey, and we got close to 400 responses back. We sent it out on social platforms, LinkedIn, you know, Facebook, we sent emails. We just kind of blanketed the community and we got responses all throughout the country. We even got a couple from the UK and from Canada and globally. What, what we found is what we had expected was that folks that were in practice now, be it acute care, primary care, surgery, general medicine, they couldn't remember having any kind of advanced education in pain management in their secondary education.
The nurses had had some right, particularly the nurses that had been in practice for a while before they went back and went to MD school. But essentially there was maybe you got a module in your quarter class on pain management.
In terms of pharmacology, you were told how to prescribe back then, you know, opiates and the safety of prescribing opiates. But, but that was it.
And so it was kind of a call to arms for us. And it was an acknowledgment that that where people are getting their continuing education is at conferences if they're lucky.
Like if you work at Boomerang, you can get it from Melissa, you can get that education, that continuing education.
But it was the responsibility of us. Peter, you had talked about the fact that I do a lot of lecturing and I go to conferences and I do podcasts like this and webinars and whatnot.
It really now is the burden for us to bear to make sure that we're giving evidence based quality education to those peers that are coming to conferences to learn about how to manage pain.
And we will continue to do that until it's better offered in the curriculum, right, in their, in their Master's and PhD training.
[00:21:00] Speaker B: I think it would be helpful too, you know, for the listeners to understand.
When you're talking about pain management training, I think what you're talking about is understanding neurology, understanding the brain, understanding the musculoskeletal system, understanding anatomy, understanding psychology at many levels, from personality disorders to mood disorders, understanding trauma, understanding the microbiome, understanding vocational needs, understanding social needs, understanding family dynamics. Those, that's just the tip of the iceberg. But those are the things that you guys are trying to get your arms around with every single patient that comes through your office every single day. And that's why it's such a critical educational need.
[00:21:52] Speaker D: It's lifelong learning. It's lifelong learning. And you know, I think you need to start with the basics, right? And then you need to have, you need to get employed in an organization, an institution, find a mentor and, and then continue to get educated along the way. Because when you just start the tip of the iceberg in your education and your training and you start with the background, right, the basics in pain, before you can learn how to sophisticatedly treat pain, you need to continue to educate yourself because the specialty is changing constantly and evolving.
[00:22:29] Speaker C: So Tracy, I understand that you as well as some colleagues have started an app, organization, organization and an annual conference. I'm curious to hear a little bit more about that.
[00:22:44] Speaker D: Yeah, Sarah, thank you for asking about that. So again, to go along the lines of what we were talking about before, about the importance of quality continuing education for advanced practice providers in pain medicine, not only for those that are interested in going into pain management as a specialty, but we know that pain is the universal human condition, right? So you'd be hard pressed to find any advanced practice provider, or any MD or DO or PhD for that matter, that's in healthcare that doesn't have patient situation where the pain may come up.
So again, it's well seen out there in the community that we enjoy our specialty organizations when it comes to healthcare, right? So historically, our physician led organizations in specialty practice have understood the importance not only of quality Continuing education.
Right.
But also the importance of these organizations for networking, for peer collaboration. So some of our physician led organizations, American Academy of pain medicine being one, you know, Dr. Bach and I went to that conference back in September in Utah.
They're really important organizations to get involved with. And what we're seeing in terms of the physician led organizations is the understanding about the importance. And I'm giving you a lot of background, I apologize, but the importance of the, the app colleg. Right. In their practices. And so many of these organizations have, you know, one day set aside in their conferences or a small section of the time of the conference for advanced practice providers to get additional education, to be able to collaborate and network with their peers. And that's great, but that's not enough.
Right. The importance of having a organization, a body of peers, is more than powerful. And I think that industry understands that, I think that the app group understands it. And actually we see an expanding explosion of organizations in specialty app practice. Right. Rheumatology, neurology, obesity medicine. Right. So this is kind of not a new platform.
So some colleagues and myself decided that we need to do this in pain medicine again, not only our mission is not only to provide quality education for the ever evolving needs of the chronic pain patient and acute pain patient, but also for the networking, support, collaborative feeling of togetherness, essentially and advocacy.
And so we started Pain Medicine Academy of Advanced Practice Providers, or PMAP for short.
In 2024, we had our first conference in Orlando. In 25, we have our next conference, here's the plug in October in Dallas, October 15th through the 17th.
And we're just really excited.
It is an opportunity for us to collect, to gather and to essentially learn from each other.
[00:26:11] Speaker A: I went to the conference in Orlando last year to the pmap and it was amazing. I've been a part of the organization since it started in 2024 and I just. It's so amazing to get all of us together under one roof and it just be app led. It's just something different about it. I've gone to so many different conferences that a physician led. They have app tracks, which are wonderful too.
I'm so glad that we have that. But just to have an ENT conference dedicated for pain management apps and really collaborating and networking and that's kind of how I've met so many people. I've met Tracy, well, I think almost 10 years now at a conference. But it's so nice to network and to just, just get together with, with your community of apps. It's really nice
[00:27:06] Speaker B: I wanted to add with your PMAP education that you guys are doing, which is really important.
It seems like in addition to apps who are working in pain management specialty clinics, all the primary care practices and offices and clinics around the country are the first line for people with pain. I mean, the number one reason why people go see their primary care doctor is because something hurts.
And the more educated that they are, the more comfortable that they are. Assessing some of these pain challenges and helping patients treat them in the primary care setting seems like would be super important, super valuable. Do you get a lot of primary care apps reaching out or coming to the conference looking for education? Because I bet they're seeing so many patients in their primary care offices that could use your help.
[00:28:02] Speaker D: Absolutely. And thank you for that question. When we first decided how we were going to what we wanted this organization to look like, we were very selective in the board that we chose. Right. And so we did, understanding that so much of pain management being again, the universal human condition presents to primary care first. Right. How many patients now are not being able to get medications right from their specialty providers? And so again, medication management, medication understanding is vital, important. And then who do you refer to? If you have to refer out to pain, do you refer to a psychologist? Right, pain psychologist, that might be the first place that you want to go, or is it to an interventionalist? Right. Does this patient just need to have an injection and maybe doesn't need to wait eight months to go and see a comprehensive pain management center.
So we chose on our board, well known nurse practitioner in New Hampshire who actually runs two or three NP run primary care practices.
We chose surgical pa, we chose an acute page care np. So we really tried to have the board look as we would want the organization membership to be.
And absolutely.
The first conference that we had, I think it was probably closer to 75% pain management specialty, but we did get 20, 25% primary care. And we're really hoping to bring more of our primary care colleagues under the fold because for all the reasons that you stated, absolutely, there's not enough pain specialists out there to treat the volume of what needs to be treated in the population.
[00:30:03] Speaker C: Not to mention, I imagine oftentimes it's right in primary care that their path starts. Right. So often we get patients where they're like, I wish I knew pain medicine specialists existed.
[00:30:14] Speaker D: Right.
[00:30:15] Speaker C: Whether it be pain psychology, pain providers, because they've been seeing primary care and just getting refills and suffering. Right. And didn't know, oh, there are all these cutting edge interventions and procedures and, you know, new medications that are out there, and then understanding the whole biopsychosocial approach, let alone various, you know, Eastern medicine, acupuncture, all these different interventions, and one of those might fit, or a combination of them might fit really well for this patient and increase their, their quality of life. And so I think it's fantastic that it's not just for pain medicine specialists, but all apps are invited and welcome to come. I think that's phenomenal.
And so, so remind me the, the dates and the location this year, because I know it was in Orlando last year.
[00:30:58] Speaker D: Where is it this year? So as a national conference, we do rotate the location. So this year it's going to be in Dallas. It's going to be October 15th through the 17th.
And our website is www.pmap pmapp.org and you can get all the information there. Thank you.
[00:31:20] Speaker A: Fantastic.
[00:31:23] Speaker B: I have a question, actually, for both Tracy and Alyssa.
I think, you know, one of the things that keeps us going are, you know, inspirational stories of the patients that we treat. And, you know, it fills our cup when we see people, you know, express gratitude and just are so thankful for the services that you've provided them. That's what keeps us going.
Would you be able to share any memorable stories from your career, you know, that you've come across where you felt like you really made a huge difference in a person's life and maybe in their whole family's life?
[00:32:05] Speaker A: I've had, I've had quite a few patients that have really stayed with me, but one of them, you know, she said that I saved her life and this was a medication management.
This patient was on high level, high doses of opioids, and she was fearful that people were going to take him away from her.
Everywhere she goes, they're like, you're not going to give them to me.
And I said, I'm not taking them away, but let's, let's feel, let's see what the best role is for you. What is the best medication? What's the best plan?
And so we really.
She went into our psycho. She worked with our psychologist. She worked with our acupuncture. She worked with our physical therapist. I was able to titrate and get her onto buprenorphine, onto Suboxone zone.
And she, her life has just turned around so much. She's able to, to work, she's able to leave the house before. She wasn't even able to leave the house. She, she was so afraid.
She's like, I've tried so many things and nothing was working for me. And I was. I was going to end my life. And you talking to me and getting me through all of these services and getting me onto Suboxone that, that her life has completely changed from there. So that's probably one of the stories that. Or one of the patients that I have that, you know, fills my cup and I think about from time to time.
[00:33:37] Speaker B: That's great.
[00:33:38] Speaker D: You know, something that's really powerful about that too is you could see in the course of a busy practice, and I don't know at what point in time that you had your initial engagement with this patient, but it'd be so easy for another clinician to just say, oh, you know, I'm hearing that suicidal talk. You know, I'm going to refer you and get you, you know, kind of again, yet another person that just kind of puts them away or pushes them away versus taking the time to listen to the patient and hear what they really need and making a huge difference in their life. So thank you for sharing that story.
That's awesome.
[00:34:16] Speaker A: How about.
[00:34:16] Speaker C: How about for you, Tracy? Any that just, you know, feeds your soul and keeps you going on those long, stressful days? Because I know you're very busy. So I imagine that there's been a few patients that definitely have left an impression with you.
[00:34:32] Speaker D: So I have a couple that I think about. I'll start with the easier one.
So I had a patient.
I'm going to be HIPAA compliant, so I don't want to give too much information or too much detail. So I had a patient who was a physician themselves and had surgery that left them with a big scar neuroma.
And so I met this patient actually doing procedural treatments for them, right. Doing scar injections.
And, you know, over the course of time developed a really close relationship with this individual.
And it was just so hard to see someone who was such a high achiever, you know, top of her profession, was doing so many different things and was trying to take care of herself, but really, you know, had a hard time.
And about a year forward, she wound up having metastatic cancer.
And it was a really hard road to try and get her essentially to the end of life.
And we don't do as many management of patients with cancer and then not terminal cancer, we usually refer them to oncology.
And she was working with all the appropriate specialists, but being able to stay involved with her career really until the end just gave me such.
It filled my cup up, you know, heaps.
And for many years I actually had A picture of her and her family, a Christmas picture, because we got really close and. And I had it, you know, in my bulletin board behind me. And anytime I was having a difficult situation with another patient or, you know, their challenges administratively, I would just look at that picture and it calmed me down. Maybe that's more a story about me than the care, you know, but we are part of that journey of that patient, aren't we?
The other one was. And I'll be brief, I'm going to start crying. The other one was a patient that was introduced to our clinic on the acute care service, and she had a lot of other medical comorbidities, and she kind of was taking solace in the fact that she was sick. But the family unit, and again, a really important aspect to really kind of discover the family dynamics. And they can be helpful or they can be detrimental.
And in this situation, you know, I think it was pretty early on that it was discovered that her family. It was a detrimental. It was keeping her sick, even though the family came across as very helpful and supportive and, you know, and she really wasn't doing well.
But as, you know, time went on, very short period of time, it was discovered that she had other medical comorbidities that could be treated. And then her pain started getting a lot better and she started getting stronger, and her family dynamics fell apart.
But she was doing well, and she felt strong and she felt empowered. And even though she continued to have chronic pain and she continued to see us, she was doing so much better.
And that really made me feel good because, again, it taught me, right. We learn every day with all of our patients. It taught me that it's not just looking at the pain, right. The pain complaint, the pain generator, it's looking at the whole experience and how it's affecting the family and the environment and for the positive or the negative.
So that was a really good patient outcome, even though there was some family dynamics that. That needed to be put back into shape.
[00:38:35] Speaker C: What a great illustration of paying attention to the whole ecosystem.
[00:38:38] Speaker A: Right.
I love that.
[00:38:43] Speaker B: Alyssa, tell us about your. Your role around onboarding and education. You know, when you bring in a new app into the organization, tell us about that process and the impact of you doing that has had on the organization, BHC as a whole.
[00:39:05] Speaker A: Yeah. So as director of apps, one of my biggest responsibilities is helping apps successfully transition into pain medicine and continue to grow throughout their careers.
So, you know, as we talked about, pain management is highly specialized, and most apps, we don't really get a lot of Resource and trainings in this. So because of that, the onboarding that we do is, is really, really important.
And it's not just where they're going to learn priorities and workflows. It's about developing clinical judgment, confidence and understanding how to care for the complex patients.
So at Boomerang we built a six week onboarding program for new apps. They train closely with the physician that they'll be working alongside with. But really I pair them with an experienced app who serves as their primary mentor and that mentor becomes their go to person for questions and guidance and support during the onboarding. But then you know, going forward for the their time at bhc, the training itself, it's very comprehensive.
We have obviously hands on clinical training but we also provide didactic education.
The didactic is clinical. Didactic. There's documentation didactic in the clinicals. They're learning all things about, you know, lumbar spine one week, all the differentials, symptom management, the physical exam goes with that and the treatment algorithms for all the different body parts that we treat. Every week is a different body part.
We also go into documentation.
We have a large population of workers comp and we know dealing with any type of insurance, whether it be workers comp or private insurance, commercial, we have to document a lot to get things authorized. So we go through a whole six weeks of learning about how to document properly and how to do proper physical exams.
We also go into pain medicine, fundamentals, personal injury, workers comp and the authorization process.
The new apps are also learning about all the programs that BHC offers. Things like our functional restoration program, our traumatic brain injury program, our trauma restoration program and all of our psychological services.
Dr. Gouzet, you do all the onboarding trainings for all of our new hires when it comes to the psychological component.
And now Dr. Abachi is taking on our matriculation, why we do what we do for all of our new hires.
He, he's the, the Zen teacher of that.
And then we really just want them to understand not only how to treat patients but also all the resources that we have to support recovery. And then education doesn't stop at onboarding.
Every month I host a monthly app meeting where I bring in both internal and external, external experts to share knowledge and best practices.
Tracy has actually come on a couple times and present at my app monthly meeting. Love to have her.
And every time I'm always, I'm always looking to connect with when I go to conferences and hey, do you want to come and talk to my apps? Bring your knowledge and it's so important.
I also have a monthly Fireside chat where apps can discuss challenging cases, ask questions questions, and interact with different members of our interdisciplinary team.
Recently, we had a nurse case manager join us, and it sparked some fantastic discussions that help apps better understand a key partner in patient care.
So for me, it's really all about creating a culture where apps feel supported, connected, and comfortable asking questions and they get all the education they need to be successful for themselves and build confidence, but also provide exceptional care for our. For our patients.
[00:43:09] Speaker D: And I've got to tell you, that is so unique.
And I know a couple of other programs nationally that, that put that much time and investment into the onboarding and the education, and it speaks volumes because I've got to assume that your turnover rate, particularly you've got a large, you know, population of apps is very low. There was an interesting article that was just pub, actually, the lead author is a nurse practitioner in the VA in Palo Alto, was published in Pain Medicine. And it talks about the importance of having a really solid onboarding program because it's not, you know, insignificant in terms of cost. Right. And the level of turnover in general pain practices is so high for apps. And if you don't get that kind of those basics.
So applaud you guys for what you do. That's fantastic.
[00:44:06] Speaker B: I would also add that the apps that I work with make my life so much better. I mean, I'm a much more effective physician and healer to my patients because I have a team that's on the same page with me, clinically supporting, you know, what I'm trying to do, helping in the background, you know, get things done, fighting for the patient's treatment or fighting denials and doing appeals and doing all those things that I may not have time to do for every single patient myself every day.
And so without that help and support, it would really dampen the impact that we have on our patients. So, you know, so thankful to have so many great, well trained app, you know, healers that are, you know, part of my life.
[00:45:06] Speaker A: You're welcome.
[00:45:11] Speaker C: I've had the pleasure of attending many of these app meetings in the Fireside chats. And I gotta say, Alyssa's enthusiasm for patient care is infectious.
And, you know, it's. You've done a great job with creating such a warm and nonjudgmental space. And I love seeing the, the questions. And our new hires, right, they get to meet with certain leaders individually, and so now they know us and we take away that intimidation of, don't hesitate to reach out if you have a tough case, we're happy to consult, we're happy to connect. You know, no such thing as a stupid question.
And, and that communication goes both ways where if I'm seeing one of their tough patients and I want to alert them to something, it's great to that paved. So thank you, Alyssa, for the change that you've done in BHC and growth and making sure that, you know, our, all of our providers are supported. And you know, and Tracy, you calling it out nationwide that, you know, as a country in our education system for higher ed, setting up our providers for success when it comes to managing chronic pain because it is complex and they're not necessarily getting it in their accredited programs. But that doesn't mean that they can't get that training and support in organizations and at conferences such as yours. So as we start to wrap up, I am curious, Tracy, what is one thing that you would like our listeners to take away with today?
And additionally, where can people learn a little bit more about you and about the conference?
[00:46:44] Speaker D: Sure.
So I think kind of what I'd like the audience to take away is just to encourage them to stay curious and stay engaged and know your value.
Right. Find if the, if the first job doesn't work for you and the second job doesn't work for you, maybe the third one will. So find, you know, your supported team and do the best that you can for your patients. So stay curious, stay diligent, know your value, and enjoy the journey.
Oh, and then I think I already, I already talked about this. But probably the best way to interact with me and PMAP and to learn more about what we're doing is to go onto our website and maybe we can put that somewhere visually for the audience to look at, but it's www.pmapp.org pmaps. We'll see you in October.
[00:47:48] Speaker C: Fantastic. And then how about for you, Alyssa, what is one thing that you want listeners to take away?
[00:47:56] Speaker A: So different things for patients that are listening.
You know, many patients come to us feeling defeated.
They've seen multiple providers and, you know, they believe that nothing's going to help them. What I really want you to understand is that's not true.
You know, patients, if you have the right team, if you have the right education, the right support system around you, recovery is there. And it doesn't always mean that we're going to eliminate every single symptom that you have.
Sometimes recovery looks different. It means getting back to work or returning to hobbies that you used to do. Or finding a new hobby or just spending time with family, exercising again, or just regaining confidence in yourself. That's what recovery looks like.
So that's what I really want listeners to know that are patients.
And as far as patients to know too, is the listeners that walk away with a better understanding of what advanced practice providers are, apps and the role that we play in healthcare. You know, sometimes patients are hesitant to see an app because they aren't sure of what our training is or how well we fit into their care.
And the reality is that apps are highly trained clinicians who work collaboratively with the physicians, the mental health providers and all the members of our healthcare team.
So we all don't work in isolation. We work together to come up with the best possible care for you. So that's what I hope they get out of listening us today.
[00:49:27] Speaker C: Thank you both for joining us today and for our listeners. We appreciate you tuning in on the comeback with Boomerang Healthcare. We're grateful to have you here. If you've enjoyed today's episode, be sure to subscribe so you never miss an update. You can always follow us on social media for more tips and tips, information and inspiration.
Until next time. Keep moving forward. Your comeback is just getting started.
