Dan King: [0:01] Hello, everyone. Welcome to the Fortune by Fireside podcast. Our mission is to build a much-needed superior mental health system, and we do this here mostly by advocating for stronger outpatient group practices. We believe that the single most important way to improve American mental health and when well run, they're deeply rewarding for founders, clinicians, and patients. So this podcast is for practice owners and clinicians, whether you want to grow, scale, or sell your group practice, or work as a clinician in a group practice. This podcast is for you. I'm delighted today to be joined by Dr. Eric Arzubi, co-founder of Frontier Psychiatry. Eric, welcome. Eric Arzubi: [0:38] Thanks, Dan. I appreciate it. Thanks for having me. Dan King: [0:40] Always a pleasure. So we'd love to start with just the basics on Frontier Psychiatry. How long has it been around? How many team members are there? Give us the basics on the practice. Eric Arzubi: [0:49] Sure, of course. So yeah, so Frontier Psychiatry, it's an all telehealth practice. We were founded and launched in, interestingly, March of 2020, which is the month that COVID took off. Eric Arzubi: [1:05] Um and uh it was started by me and um and a buddy of mine who's a psychiatrist uh based out of seattle we we just felt strongly that telemedicine was being underutilized in rural settings right so it really had nothing to do with co because we've been thinking about that for the year leading up to that i'm based in montana i still had patients driving four hours to come see me for a half hour visit so moms had to take time off from work kids had to leave school and then the expense of driving. So that just didn't make any sense given the technology we had. So we launched Frontier Psychiatry that year. Our focus is on the medical part of mental health. So psychiatry, which includes child psychiatry, adult psychiatry, addiction psychiatry, geriatric psychiatry, and perinatal psychiatry. We have about 30 providers at the moment. About half are psychiatrists and the other half are advanced practice providers, a combination of physician assistants and nurse practitioners. And right now we actually serve, we started with Montana. I'd say about 80% of our work is still in Montana, but we've expanded as of last year into Idaho and Alaska. Again, really pushing hard to deliver high quality psychiatric care to communities that are typically underserved or don't have access to the quality of care that they deserve. Dan King: [2:29] Is it still the case today, five years later, that you feel telehealth is underused in those communities? Eric Arzubi: [2:35] Yes, absolutely. It's, you know, it's still, you know, certainly COVID, I think, accelerated the uptake and the comfort on both the provider side and the patient side. And certainly telehealth is becoming more, I think, more visible. But I've seen studies where, you know, certainly the use of telehealth really kind of spiked And then it's kind of tapered off in many specialties. It's really tapered off back down to around, I think the general number is around five or seven percent of all medical visits right now are around are in telehealth, in mental health and numbers higher. I think it's closely, I think it's like around 40 percent or something. But but still, it's interesting to me, even when I go to Alaska and talk to people in really, really, really remote communities, how underutilized telehealth is. They still have people, I'd say, who might fly in once a month to see people in person. And it's not necessarily a broadband issue. It's really like anything in medicine, right? It's like, this is the way we've always done it. This is what we're used to doing. This is what we're comfortable with. So still some getting used to and some issues around comfort using telemedicine. Dan King: [3:52] And that comfort is more from providers than it is patients, you think? Eric Arzubi: [3:57] Yeah. Good question. I'd say probably both. I think there's some education required on both ends. Patients, although patients, especially those, like if you give patients an option and say, look, you can drive four hours to your half hour visit, or you can stay at home and we'll hook you up with a camera. You can speak to someone. Most patients are going to say, no, no, I'll definitely do the video visit. But there are still providers who sometimes resist the idea of using telemedicine, because that's not what they're used to. They weren't trained in it. Or they feel that, oh, no, in-person care is better. And the way I think about it is that I try to avoid comparing in-person care to telehealth care. What I do is I compare telemedicine versus nothing at all or telemedicine versus the real alternative. So to me, it's kind of an artificial debate of in-person or telemedicine. Well, a lot of people don't have the luxury to choose either or. So how can we, as mental health professionals, which I think is our job, deliver high-quality care to the communities? Dan King: [5:12] Yes. And do you find that with your practice, I'm assuming it's much greater than 40% telehealth? Eric Arzubi: [5:20] Ours is 100% telehealth. Dan King: [5:22] 100, wow. Eric Arzubi: [5:24] Yeah, we chose right away. We said we're just going to only just telehealth. And a couple of reasons number one we felt very strongly that that is the abs in a place like montana uh idaho alaska the only way to scale access to care is telehealth there i there you can't be convinced there's another way like the alternative is what you put in an office in every town in montana like i don't like there's no there's really no other way to scale and so And also, research, again, has been exploding in terms of what the impact of telehealth visits are, and it's become pretty clear that you can get high-quality care over telehealth and is many times equivalent to that of in-person care. Dan King: [6:15] Interesting. And do you find then, so does this mean that the practice's physical footprint is much more limited than it otherwise would be? You guys have, well, what kind of office space do you guys use? Eric Arzubi: [6:27] Sure. We have a pretty small office. Eric Arzubi: [6:32] The office here today, there's me and another provider, and then we have, I think, four support staff here. But we have about 60 employees, and they're kind of all over the place. What what i love and so there's certainly been a challenge uh in in terms of creating um, a team spirit a culture when people are remote so that's a that's a challenge um because this work can be isolating i know it can be for me um you know sometimes if i work you know i don't have to come to the office but i if i spend two days Eric Arzubi: [7:09] working from home i start getting cabin fever i I need to be around other people. So that's a real issue. But what I love, love, love about telepsychiatry, telehealth in general is, you know, Montana only has about 100 psychiatrists. And so with the shortage of psychiatrists in states like Montana, Alaska, Idaho, I can import expertise. I can import, for example, I think there's maybe one perinatal psychiatrist in Montana, but because of telehealth, I can actually, quote-unquote, import two of our perinatal psychiatrists to be able to deliver that sort of care statewide. I think Montana has, in the state, has one addiction psychiatrist. Eric Arzubi: [7:58] We have two on our team that we, quote-unquote, import that provide care into Montana. So it's really, again, bringing expertise and resources into areas that otherwise would rarely, if ever, get access to them. Dan King: [8:13] You prefigured where I was going to go next, which is culture. So you and I have talked a bunch about culture before. I know it's a big theme in your LinkedIn posts. How have you addressed that challenge of having such limited physical space and having such a remote team? How have you built culture? Eric Arzubi: [8:30] Yeah, no, it's it. So, first of all, I think I had to. you know this is this is a second organization where i've been a leader of uh or led a mental health team before this i worked at a hospital system and um that was i think starting 2014, i became chair of the department of billings clinic in here in montana and led a group of psychiatrists and staff about 150 staff and i learned how not to lead and uh and made made lots of mistakes and was not i learned the hard way about how really important uh culture is and how absolutely deliberate you need to be about nurturing culture every single day because the second there's any kind of vacuum in terms of information or communication it gets filled with with things that aren't necessarily productive. So I read somewhere, and hopefully this resonates, your organization is going to have culture no matter what. You get to decide what kind of culture. And so I tried early on to... Eric Arzubi: [9:46] Always, always talk about culture and really elicit from our teams, what do you want? What kind of place do you want to work at? What do you want from your colleagues? What do you expect from your colleagues? And being very vocal about that and writing those things down, like what kind of, what's our purpose? Like asking our teams, like individually, like in terms of the people, what's your purpose? Why are you here? What's your purpose? What's your purpose? Eric Arzubi: [10:13] Then does that align with why Frontier exists, right? Frontier exists. And I need that alignment to be there so that people feel that alignment when they come to work, right? Because I know many of us have worked in organizations where you have your sense of purpose and mission that maybe it aligns with what the organization says, but it doesn't align with what the organization does. And that feels bad. And I desperately want to avoid having an organization where people felt that. So I want to understand what the individual purpose is of the people that work on our team. And then I want to make sure that they're validating to me that what we actually do every day, not what we say, not what our mission statement is, but that what we actually do every day aligns with what their purpose and their mission is. Right. So we feel strongly that if you live in a small town in Idaho or Alaska, you should get access, same quality care as if you live down the block from, I don't know, NYU, Columbia, or University of Washington and had access to these clinics with world-class people. Why should rural communities not have access to that? And so that gets people excited. A lot of the people on our team currently live in or came from rural communities. And what I love about. Eric Arzubi: [11:39] Sort of being able to i feel like a coach and i was able to pick my team right like i get to i that's that's what i feel like and i was never able to do that until i kind of started my own thing with my partner like oh i'm the coach and i get to pick my team and and right it's like it's like any sports team like people who perform those are those are your starters some of them were on the bench and some of them just don't make a cut and um but so i think we've been able to do that successfully but i think being very honest about look we just want people who are aligned with a mission we're excited about this and and if you're not let me let me help you let me understand why or why not and uh let's just make sure this is a good fit but um the other thing is also feeding back data to our teams like hey last last month guess what we saw we saw close to 4 500 patients in rural communities these are 4 500 people that wouldn't have had care otherwise Nice job. Hey, guess what? We are now serving patients in all 56 counties in Montana. So many of those counties would never have access to psychiatric care. Nice job. Right? So these are wins that I want my teams to feel. And if they feel that and I keep feeding them this information, it gets people excited. Dan King: [13:00] It's so easy to forget to celebrate, especially when you're working in a field like mental health where sometimes where, you know, you're surrounded by darkness and so celebration is absolutely vital so that you're not consumed by the darkness. Eric Arzubi: [13:13] Yep. And, and the other thing I've done, I guess I've probably been doing this for a couple of years now. I do weekly videos that I send, uh, like we have, so we have kind of, uh, you know, the, the Google enterprise system where you have a Google, you have Gmail and other Google stuff. And then within that there's kind of Google chat. And every week I send mostly silly, funny videos that I record, but that give everybody updates in terms of what we're up to. So I'm fully transparent about here's what's going on with the finances. We had a good month. We didn't have a good month. Here's what we're working on. Here's a new project we launched. Hey, we just launched in Idaho. Nice work. But I will record those videos. They're about two to three minute videos. I'll make fun of myself. I'll make fun of other people try to keep it lighthearted but informative and I feel, I feel validated because a lot of people sort of at the end of the year when I get when I'm in touch with them are so grateful for these videos because, Too often, the folks on the front line have no clue what leadership is doing or what leadership is thinking. So I want all of my team, my entire team to always know what I'm thinking. There's no reason they shouldn't know. I know, hopefully that makes sense and resonates. Dan King: [14:31] It does. It does. And that decision to be financially transparent is a big one, right? A lot of businesses don't do that. What have the implications been of being financially transparent Eric Arzubi: [14:40] So i think so the other so we are we're a we're not a non-profit we're you know we're a we're business we're a for-profit um and we've decided to give everybody whether whether a provider or you know frontline staff everybody has stock up and you know with some vesting schedules but i felt very strongly i wanted everybody to to feel like they had a piece of this and as a result they're part owners and if they're part owners you better know what your company's doing and so so that's so i i think i feel like when people aren't given that transparency it's it's a to me it feels like a little bit disrespectful and like you're almost not trusting people with information and people feel that like if they you're not giving that information and You're not trusting people. I'm afraid people feel that like, okay, leadership doesn't trust me. So I guess, I guess what it's done is it's, it's made people feel like I, hopefully, like I trust them with important and sensitive information. And why wouldn't I? I'm trusting them with the lives of patients that we take care of. So why couldn't I trust them with some numbers? Dan King: [15:57] How long has it been since you decided to give all staff stock options? Eric Arzubi: [16:04] I'd say probably like three years. Yeah, probably been about three years, like very early on, very early on. Dan King: [16:11] Yes. That too is uncommon in general and in our space. What have the implications of that been? Have you noticed? Have there been retention impacts? How have people's behavior changed since you did that? Eric Arzubi: [16:24] So, you know, I don't know how much of it is. i don't know if i can really point to stock options being the thing yeah i i i like to think it's a combination of you have stock options you hear from me every week i tell you about the financials um uh we celebrate you um our team our team for example uh gosh i have i have a couple of people who are these incredible they're they're i guess for black or white or they're like culture champions like they hear me constantly talking about this stuff like all right i guess eric cares about this so they come up with their own ideas to do things like um we'll do monthly. Eric Arzubi: [17:05] We'll do like monthly after hours like get togethers where two of the folks last month they created like it was brilliant they created their own escape room to do online for a bunch of us to get together after hours um every week we have uh like a 15 minute like coffee break online where people get together have coffee and just check in and you're not allowed to talk about work uh another one people have done is um creating uh just collaborative work time so for example it's like all right from this hour that hour just turn on you know turn on google meet zoom and we're just going to work quietly together uh and just kind of sit there work i know that you're sitting there working too so so half of the ideas haven't come from me it's come from, people who know we care about this and so they're like hey i have these other ideas to make culture better which is amazing right because then it empowers empowers your frontline staff because you've you've told them what's important they come forward with some ideas and what that that That alone reinforces kind of the idea that culture is important and everybody owns a piece of it. Dan King: [18:19] Very, very powerful and very unusual. And I think when you combine all of that with the fact that you have a distinctive mission, so there's a lot of mental health practices out there. And, you know, you can go to a website and you can look at what they say their values are, and you can look at what they say their mission is, and no disrespect, but it often feels pretty similar, one practice to another, right? And the fact that you're focused on telehealth in rural communities, right, in the Northwest, that's very distinctive and specific. And one of the advantages of that is with your hiring and your culture, people can opt in or opt out when the mission is clear and distinctive. I can choose whether to be a part of it. I know what I'm getting into or not. Eric Arzubi: [18:58] That's, that's a great point. And, you know, one of the things I'll, I'll tell you, and maybe it's a kind of a little pointer for folks who, who run practices. Eric Arzubi: [19:08] Um, the, for me, you know, when I, when I first started posting on LinkedIn over a year ago on a regular basis. I didn't know what, I didn't know what the ROI was going to be other than I'm like, you know what? I, I have thoughts in my head around mental health that I think I like to think maybe it's for my ego. Other people should know about. And if they agree, great. If not, great. Hopefully half the information is useful. Anyway, I start posting and then you start seeing people respond. And then, and then it kind of creates this, you know, this kind of, um, it builds us like a little community and, and it's, and I've learned a ton. I mean, it's been really powerful for me personally posting. Cause that would be clarify my thoughts. It helps me understand what people are caring about, but I would tell you the biggest ROI and the speaking, it's just from a business perspective. The biggest ROI for me from posting on LinkedIn has been what you just, what you just mentioned. And that is people are clear about what I stand for and so what Frontier Psychiatry stands for. So when we post a job, the quality of the applicants has gone way up because they know what I stand for. They know what we stand for. Eric Arzubi: [20:23] And so I've been able to recruit and actually retain some great people that I otherwise I'm confident, like it's night and day, pre-LinkedIn versus post-LinkedIn in terms of recruiting and hiring, totally different, much, much better now. Dan King: [20:41] Yes, makes absolute sense to me. And you again have prefigured what I was going to ask. I was going to ask about your relation to LinkedIn, which I think you answered pretty well. But if you were to give pointers to folks who haven't done it, so I'm running a group practice. I definitely see some benefits in what you said around retention, right? But how do I stand out in the noise? Because there's a lot of people who are posting on LinkedIn. Dan King: [21:06] Over the course of the year, you've been able to build a brand, which is awesome. You'd be able to attract and retain great clinicians, how do I stand out? If I'm persuaded by the idea of investing some time in it, how do I do LinkedIn well if I'm a group practice owner? Eric Arzubi: [21:19] Yeah. So number one, I mean, it's a lot of work. Wow. I had no idea how much work it was going to be. I would say, I know it's going to sound a little scary and maybe kind of a little silly, but I'd say for the last 15 months i've probably spent at least an hour a day on linkedin every single day um and, it's it's a lot it's a lot of time and i'm not and again it's not for everyone i happen to enjoy it um i used to back in the 90s i worked as a journalist for a couple years so i enjoy writing, um but and and over time and and again i'd say the first four or five months i was really frustrated and uh because i wasn't sure do i do i write every day do i not write every day how often what is i should be writing about and so a couple of couple of pointers and i and i've and i've tried a bunch of different sort of linkedin classes or courses and stuff and i And finally, most of them were a waste except for one. And that was a huge game changer for me. And so just a couple of pointers I would point out is the following. Number one. Eric Arzubi: [22:40] You're going to have to show up every day. If you really want to, if you want to kind of develop really following and followers, you have to show up every day. Eric Arzubi: [22:48] Number two, you have to deliver value. So instead of writing, instead of writing for yourself, think about what do people want to learn about? And so you need to, when, when people see your post, you want people to look at it going, Oh, cool. Look what I learned about today. Or I can't believe that he's, he or she's saying that I need to get involved and say like, no, right so it'll spark conversation or discussions um but but um and then you know kind of developed what are called and again i had to learn a lot of like this this linkedin course i took was like a whole new marketing degree like so i learned about content pillars so you know so you need to have like identify for yourself like what are three to five topic areas that you want to show up with every day like you know and every day you pick pick one of those content pillars and write about it um and and then uh the other thing is it's just showing up and and for a while you're going to get frustrated and feel like nobody's listening like you're not getting any traction over time it'll start to compound but it takes a long time and what's interesting is when i when i started doing the research on linkedin to see you know who are the highest ranked um mental health creators on LinkedIn, there's this tool called Fabicon where you can look at rankings. Eric Arzubi: [24:12] They weren't mental health professionals. These are people who are kind of these creators who liked writing about mental health, but they weren't mental health professionals. So in my mind, yes, there's a lot of noise, but there's a lot of opportunity for people who know mental health well to build a brand and be really authorities on this topic because there are a lot of non-authorities writing about this and that's one of my motivators too is like i better be loud because i like to think i'm informed i mean i i do this for a living so my voice better be heard um at at least at the same uh loudness as those people who are not uh sort of really professionals in this in this space. Dan King: [24:56] Makes sense. Have there been any downsides to investing all this time and energy? Or has it been all outside? Eric Arzubi: [25:02] Of course. I mean, it's like, sometimes I feel like, yeah, sometimes it just, it takes, I feel like it takes too much time and energy. Like from it i guess can be too distracting sometimes uh i have 18 year old twin daughters who make fun of me because they think i'm an influencer and so i get crap from them my wife gets frustrated like eric are you on linkedin again um so so that there's downside there, um but and so so it's again what's interesting is there'll be moments where i'm like all right is this just a waste is it and as soon as i start thinking that like something pops up like i'll meet well shoot you and i for example met over linkedin right so i've met i've met some fascinating people that i otherwise wouldn't have been connected with and eventually met met many of them in person too so again i think i've done well uh um the the upsides there but again it takes a huge investment you got to be you got to like it too i mean because if you if you hate it, you're going to stop within a couple of weeks. So again, I just kind of happen to enjoy it. Dan King: [26:16] That is a beautiful thing. Yeah. That background as a journalist is also unusual for a mental health professional, but it looks like it's serving you well. You got Wall Street and journalists, right? Eric Arzubi: [26:25] Yeah, that's right. Exactly. So I got to tap into those other parts of my brain. Dan King: [26:30] Yes. Yes. A conversation for another day to dig into those background points. Dan King: [26:35] But listen, I think this has been super informative. If you were to lead group practice owners or clinicians at group practices with one or two sort of parting thoughts. Well, what might they be? Eric Arzubi: [26:53] I culture is again, I know I said, I broke up culture is way more important than you think it is. You need to nurture it every single day. The second, the second you, if you under communicate or don't spend enough time nurturing culture, it's going to hurt you. Eric Arzubi: [27:12] Make sure you're hiring for culture. And if you have somebody in your team who is, doesn't fit the culture or some reason, some weight toxic get them out get them out now don't wait um because you know and sometimes people wonder like you know in health care do you know do i is it patient first is it my provider first like is it what is it i've for me it's my team comes first if my team my team needs to come first and if my team comes first and they're feeling inspired energized driven by the mission, only then can my patients get great care if i flip it around it it's you can't do that um and so so really so by default the best way that i know how to give great patient care is by, right so when i think about like who are my who are my uh sort of quote-unquote customers my my customers are my team my patients and then you know the referring partners organizations and And these are all my customers. So my psychiatrists, they're my customer. If I don't take care of them, they're going to go away. So we don't do that enough in healthcare. Think about customer service and really being attentive to that. Sadly, the bar is so low in healthcare. Eric Arzubi: [28:39] And so don't fall into that trap. Set a whole new bar when it comes to customer service for your patients as well as your own teams. Dan King: [28:49] Beautiful. And to wrap us up on a human note, when you're not working super hard on the practice or spending an hour a day on LinkedIn, what do you do for fun? Eric Arzubi: [28:58] Um i started riding a motorcycle a couple years ago uh my wife finally let me get one so there's that and then um now that my girls are in college um my wife and i get to spend some more time together and traveling around montana so i get to rediscover montana and the rest of the time we drive down to uh fort collins where my girls go to college and probably doing that a lot more than they want us to, but I don't care because I miss them. There you go. Dan King: [29:27] Eric, such a pleasure. So many really, really fascinating insights that I think practice owners and clinicians can benefit from. So, so grateful for that hour a day that you spend on LinkedIn and meeting you and hearing these insights. So thank you. Eric Arzubi: [29:42] Thank you, Dan. I appreciate it. Very flattered to be on this podcast with you.