PRACTICE: IMPOSSIBLE™

019 - How Two Judes Make it Right - Lessons From Jude-Farley Pierre, DPM

December 02, 2021 Jude-Farley Pierre, DPM Season 1 Episode 19
PRACTICE: IMPOSSIBLE™
019 - How Two Judes Make it Right - Lessons From Jude-Farley Pierre, DPM
Show Notes Transcript

Not too many people in this world can say that they are good friends with someone with the same name.  In this week’s episode Coach JPMD has a great conversation with Jude-Farley Pierre, DPM.  They discuss how they met and how Dr. Pierre combined forces to provide terrific care for their patients.  Dr. JF Pierre will help you understand the differences in podiatry training and how it has evolved over the years.  Podiatry can be considered a surgical subspeciality and Dr. JF Pierre describes the intricate relationships that podiatrists can have with negotiating groups such as Independent Practice Association (IPA).  You will not want to miss this fun episode. 

Coach JPMD helps physicians go from feeling overwhelmed to confident while increasing their income and freeing up time in 90 days or less. Check out the show notes for more information or click here to schedule an introductory call.

Show Notes



Intro  0:00  
Welcome to the practice Impossible Podcast where your host, Jude A. Pierre MD, also known as Coach JPMD discusses medical practice topics that will guide you through the maze that is the business of medicine, and teach you how to increase profits and help populations live long. Your mission should you choose to accept is to listen and be transformed. Now, here's your host, Coach JPMD.

Coach JPMD  0:24  
Thank you for listening to the practice impossible podcast with your host, Coach JPMD. That's me. I hope that you all had a great Thanksgiving holiday week last week. And I know that I did and took some time off as well to do some home purging. And that's going well. So before we head into this episode, I want to remind you, my listeners that I show physicians, how to go from feeling overwhelmed about the practice in the business of medicine, to confident while increasing their income in less than 90 days. If you're interested, click on the calendar link at the bottom of this page or the show notes and set up a call and you can learn more. So today's episode is a fun episode, one where I interview, Dr. Jude Pierre. And no, I'm not interviewing myself, I'm actually interviewing Dr. Jude Farley Pierre, who is a podiatrist and has really become, I shouldn't say become, he is a brother from another mother. And he discusses family overcoming stress and his podiatry practice. And it's an honor to have him on the practice impossible podcast. And so it's actually fun that we're going to be able to memorialize our friendship through this conversation. And I know that you guys and gals are gonna really enjoy this conversation. So here we go. So we're here with Jude Pierre. It's just funny saying that. And it's such it's such a pleasure to have you on the podcast practice impossible podcast, Jude Farley Pierre. So today, we're going to talk about specialists, your specialist and medicine and you're a podiatrist in the Spring Hill area. And, you know, before we even get into the practicing, we have to just clear the air out with the origin story, our origin story and how we met and I don't know if you want me to start or...

Jude Farley Pierre, MD  2:18  
Yeah, go for it. I'll just interject.

Coach JPMD  2:21  
So I met Jude, when in 2002, I had just moved to Spring Hill, I probably what, four or five months into Spring Hill?

Jude Farley Pierre, MD  2:28  
 Same here. 

Coach JPMD  2:29  
And I got a phone call from my team member. And she was like Dr. Pierre, there's a Jude Pierre on the phone. He says he wants to speak to you. I'm like, what is this? Come on? What do you mean Jude.., and he says, no this is Dr. Jude Pierre wants to speak to you. So I said, Okay, whatever I get on the phone. And you tell me well, I just tried to apply for privileges at the hospital. And they said, I have privileges. So tell me how that started. Like, what were you? You hadn't had privileges. And so you called you called or you went to the hospital had that had that work?

Jude Farley Pierre, MD  2:59  
So I moved in May 2002. I started working with this podiatrist in Spring Hill, of course, I was living in Palm Harbor. So in the process of getting credentialed and getting on staff at some of the area hospitals, I don't know what happened, but somehow I don't remember applying for privileges at Oak Hill, but somehow, they sent me a welcome package. I'm like, why, okay. And at the same time, there was an ad in the paper said, welcome Dr. Jude Pierre to Spring Hill. I'm like, wow, this is really a small town coming from New York, of course, I'm thinking, Well, I must be really in the greens because, man, you can't sneeze without someone saying, you know, just gesundheit. So I was like, Okay, well, it must be a small town thing. Whatever, I'll go, I'll roll with it. So when I did go to the hospitals, I'm like, you know, you have a mistake here. I'm not an MD, I'm a DPM, though I, but that's not what your application says. I'm like, what application? So needless to say, I found out there was another Jude Pierre in the area. So I'm like, that's impossible. I mean, I'm from New York, from Brooklyn, where pretty much every Haitian person lives and I come to like the most backwards corner of Florida to find another Jude Pierre, that doesn't make any sense.

Coach JPMD  4:25  
In the same hospital system to.

Jude Farley Pierre, MD  4:27  
Yeah, it made no sense whatsoever. So like, No, there's no way so I think I can't remember who the person was, but they gave me the number and said you need to call and figure this out. Alright, so I called the number and I was actually anxious because I'm thinking maybe it's a small mistake. Maybe it's just one accent away just something different. And of course, the person who answered the phone said, you know, Dr Jude Pierre's office. I'm like, Huh?! It's so weird to call and having hearing your name being said back to you. So I'm like... Alright? Well, I'd like to speak to Dr Pierre because you know, I'm thinking this is gotta be a joke. So hey, I want to hear this from the horse's mouth, so to speak. And then that's where you picked up.

Coach JPMD  5:14  
And then I think I told you, you need to come to the office. I remember saying, I said, you need to come to the office. 

Jude Farley Pierre, MD  5:18  
Absolutely, I remember that conversation. Just like, No, we have to, I have to see who you are. Because we just started talking like, Okay, where are you from? New York. I'm like, wow. Okay. And then found out here from Queens. Laurelton area?

Coach JPMD  5:30  
Yeah, yeah, I was born in Brooklyn. So you were living. You were living in Brooklyn. 

Jude Farley Pierre, MD  5:34  
I was living in Brooklyn. 

Coach JPMD  5:36  
And your parents moved to New York, I think around the same time that my parents moved to New York from Haiti.

Jude Farley Pierre, MD  5:42  
Yeah, yeah. Let me see, I think they're from different parts of Haiti, which was... cause my dad's from up north. Ironically, he looks a lot more like your dad. They looked like they could be brothers. small stature, fair skin, baldings. So it was kind of a shock. I remember at the end of the conversation, though, you said, Alright, one more question. Is your wife named Christine? I was like, no. I'm not married. I was like, okay, good. Cuz after even you were like, Yeah, this must be a twighlight zone.

Coach JPMD  6:15  
Yeah. And I actually think I asked you for your licence. I said, let me see your licence. Yeah. Yeah, you're right. 

Jude Farley Pierre, MD  6:21  
Yeah. 

Coach JPMD  6:23  
And then you said your dad's first name is my middle name. That's absolutely correct. So you could have easily been a Jude Antoine Pierre. So in my infinite wisdom, you know, I said, You know what, you need to join us at Access. Because I was like, I have to say it was selfish on my part. I was like, we can do the marketing blitz on this and Jude Pierre and Jude Pierre, MD, podiatrists, and internist on the same block. So you ended up moving your office or joining us on the same street, actually, right. Next Door, two doors down from where my office was.

Jude Farley Pierre, MD  7:00  
We were actually pretty much next door if that you were 5362. And I was 5374.

Coach JPMD  7:05  
Yeah, it was great marketing. I mean, it was just gonna cause mass confusion and, and cross promotion. Yeah.

Jude Farley Pierre, MD  7:13  
The hospital was the worst because I think there are times when you were on call, and you had patients sitting in the hospital for at least three or four days before I even found out because they would use my name.

Coach JPMD  7:25  
I don't know if we should admit that right now. 

Jude Farley Pierre, MD  7:27  
Probably not. Though, it worked out. 

Coach JPMD  7:31  
Well. So actually, recently, it's still happening. So recently, I was I was being Judah in creole Judah is like nosy and I listened to everything my staff is saying on the phones try to try to interject if I need to the way they speak to patients and stuff. But last week, we had like a plethora of phone calls. And they kept saying no, this is this is not a podiatrist office, this is the internists office. I'm like why they keep saying that why. So I do a Google search. And I do a Google search on your name. And my phone number pops up on your Google on your Google page. So I had to actually contact and it's interesting cuz I tell in our course, on the llama course I have a course on marketing, that actually tells providers that they need to go on Google make sure their stuff is updated, because who knows what they're doing online. So it causes a mass confusion. So So now you're in Spring Hill, it's been, you know, a couple of years. And if we can, I want to kind of talk on talk about some personal stuff. Oh, sure. Before we get delve into the medical because I think you went through some traumas initially, just after I met you a couple of years after I met you with your first son who was Yeah, preemie.

Jude Farley Pierre, MD  8:39  
Yeah, he was. He was born three months early. We were expecting them in November. And while we were vacationing in New York, he decided to make an appearance. So we ended up having to, actually, we ended up having to stay there for a few months. And while I was working in Spring Hill, so I was flying back and forth while he was in the hospital. I mean, they kept him there for three months. That was whew that was crazy.

Coach JPMD  9:10  
Yeah, I remember those times. 

Jude Farley Pierre, MD  9:11  
Yeah, it was, it was rough. 

Coach JPMD  9:13  
How did you cope with that?

Jude Farley Pierre, MD  9:15  
Man tell you it was hard, because it was like, first time, I mean, becoming a parent, and you know, then there are no books nor instruction manuals on this stuff. So and no one I know, ever, ever went through that. So it was really it was mind boggling. I was I think I even went through some depression, because it was just like, I didn't know and not just what was happening in terms of him being born early, but also what the long term consequences would be. For someone born in that type of predicament. I mean, those types of disabilities from the beginning, but I do remember having a conversation with a very good friend of mine who actually said something that I kept for forever till this day. He said, nice and you know, nothing crazy. Nothing, hey, I'm sorry, nothing. The typical things that people would come and tell you, you know, the oh, I feel bad for you, oh, blah, blah, blah. But in the meantime, you know, that don't wish that on themselves at all. So this friend of mine just said, you know, one thing you should keep in mind is that God never gives you more than you can handle. It was a quote from Job's and I was like, really? Wow. So I kept that for forever. And I'll see that that's how I was able to deal with it. I just kept thinking to myself, Okay, you're right. You know, and God can't is not giving me more than I can handle. So that means I should be able to handle this. So just plugged plugged away. One day at a time, went through countless sessions of physical therapy, occupational therapy, speech therapy, countless appointments with the ophthalmologist. Alright, it was just crazy. Then seeing the light at the end of the tunnel, but I just kept marching through because the back of my head, I'm like, You know what? God is definitely not giving me more than I can handle so that meas like, definitely I can handle this. So I don't know. For those of you guys who may be wondering who this friend was. His name is Jude Antoine Pierre. 

Coach JPMD  11:27  
Yeah, yeah, yeah.

Jude Farley Pierre, MD  11:30  
 So I never forgot that, that that's that stayed with me for forever. And every time I go through any type of adversity, I just kind of recall that conversation. And it definitely does get me through a lot of times.

Coach JPMD  11:43  
And... I'm sorry... 

Jude Farley Pierre, MD  11:45  
No, it's okay. 

Coach JPMD  11:46  
And seeing Nemo, I mean, if I can say his name, I'm gonna, I'm gonna call him out now. The guy is what? 200 pounds? 

Jude Farley Pierre, MD  11:55  
Oh God, yeah. 

Coach JPMD  11:56  
Solid muscle... solid muscle thriving in college. 

Absolutely. He's, he's, he's far exceeded anything that the doctors and all the specialists even thought about him. Because the scary part was when he was warranted. Tell us hey, you know, what does it you know, every day was a small victory. But they said Don't get excited because he may not be able to see. oh, he may not be able to walk, or he may not be able to hear, may not be able to talk. I mean every day was okay, he passed the hearing test. Yay. You celebrate for like, just a few minutes, and then you're on to the next one. And is he gonna be able to see Is he gonna be able to walk? So seeing him now? It's just like amazing. Kids almost six feet tall. 200 pounds, pays football, soccer, solid muscle. smart as a whip. Lazy, but Smart.

Aw you can't call him out like that now. I'm sticking up for you Nemo.

Jude Farley Pierre, MD  12:58  
He's not that lazy, but... Hey, listen, you know what, you're right. He's not lazy. He plays instruments. He plays the cello. He's a classical cellist, speaks three languages. So he's always been a good kid. And he still is to this day, having his best life and at Florida State. And so we'll see what happens. 

Coach JPMD  13:16  
Cool and you got two more after that.

Jude Farley Pierre, MD  13:19  
Yeah, I'll say again, I might have to go back to this friend of mine who talked me into having more kids, which is ridiculous. At the time, you know, we both had one kid and everyone thought it was great, you know, and then all sudden, he decided to have another kids like, whoa, hey, listen, you need to have one too like, really? Is this is how we're gonna do this? We're gonna match pair for pair. So yup ended up having a beautiful daughter named Jaele Pierre who happens to be my good friends god daughter. Obviously, it was only fitting because he played such an instrumental part in my life and getting me through a lot of difficult time. So...

Coach JPMD  14:01  
But you did the work man, you did the work. So...

Jude Farley Pierre, MD  14:03  
Yeah, but sometimes it's good to have someone point out the road. You know, I mean, hey, you know, it's it's a good.

Coach JPMD  14:09  
Good deal. So you're a podiatrist? 

Jude Farley Pierre, MD  14:12  
Yes sir.

Coach JPMD  14:13  
I know this, and you had to explain to me that there's a difference between podiatry and podiatric surgeon. So you're going to have to explain to our audience, for those who don't really know. So is a schooling different or what, what's what's difference between a podiatrist, podiatric surgeon, and or an orthopaedic surgeon that does foot surgery?

Jude Farley Pierre, MD  14:14  
Okay. So I will start with the, you know, orthopaedic surgeons. So orthopaedic surgeons are basically someone who went through a traditional allopathic School of Medicine or an osteopathic School of Medicine and they specialize in Orthopaedic Surgery and they're able to work on different parts of the body, mostly involving bones. Some orthopaedic surgeons specialize in backs, some specialize in hips, knees, some actually specialize in foot neck whole as well. But I podiatrists now, again, I'm gonna be, you know like dating myself, and I'm not that old but still when I went to podiatrist school, way back when, there was a difference because so you can go through podiatry school which is a four year program after you've had your bachelor's degree as a science, and then you go on to do a residency program. So back then the residency program was somewhat varied. So there are some podiatrists who only did what's called a primary podiatric medicine residency where they do mostly routine functions, diabetic nail care and so forth. There are those who did a podiatric orthopaedic residency and those involved mostly bracing orthotics and even Sports Therapy and a lot of them end up working with from sports teams, recommending shoes, orthotics and so forth. And then there was the podiatric surgical residency. So now everyone could choose which one of those they would go into. And that would obviously determine where you end up and what your practice basically consists of. So I did the later, which was the podiatric surgical residency, therefore, I became a podiatric surgeon, as opposed to my sisters who chose to do a podiatric primary medic medicine or residency and therefore did not do much surgery. I mean, you can still do surgery. But you're not. You're not board certified. That's that's what happens.

So what did you see yourself doing after the podiatric surgeon surgical residency? Were you going to stay in New York? Were you going to travel? Were you were you actually looking to come down to Florida or?

Well, no, actually, that's a that's another funny story. So I don't even know if I should admit this. But I was quite disillusioned with the field of Podiatry. Because you have to understand when I finished I was in New York. So they weren't that many positions open to people that look like me. So a lot of them were open to people who already had a parent who was in the field, and therefore those positions were passed down to them. So you had to fight in order to at least be recognized, or shine a little bit. So if you weren't at the top of your class, you probably weren't going to get noticed. And I've had, you know, people just say, Hey, you're not going to make it, at least not in New York anyway, so that then this disillusioned me just a lot. And then, so I've thought about just quitting. And then a friend of mine, who actually graduated with me, she's a she's a podiatric surgeon over in Pennsylvania, she, she said, No, I'm not gonna let you give up. We went through too much studied too hard. No, we're not doing this. So we did one final year residency with one of our mentors, Dr. Amelia Gomez, and I learned different things that we did a lot of trauma rotations. So I found that I actually liked limb salvaging, I liked, cutting people, so to speak, legally, of course, I like I liked the idea of putting things back together or taking things off that didn't belong there no longer liable, basically. So I thought about surgery, I thought it was a good field to go into because you can make a drastic difference in the outcome of someone's life. So I wanted to start practicing in New York, but 911 happened. So where I did my surgical residency, who has downtown Manhattan, the hospital is actually called NYU downtown. It was one of the most sought after surgical residency programs because of its location number one, so it's literally right there at ground zero. Like we could see planes actually crashing into the buildings, our hospital as well as another hospital down there and Guven air, we saw the majority of the traumas that occured from that tragedy. So we volunteered we were treating dogs and firemen, police officers. I mean, it was just chaos, trauma, everywhere, amputations, limb loss, all sorts of things. And so... 

Coach JPMD  19:22  
I didn't realize that.

Jude Farley Pierre, MD  19:23  
Oh yeah, it was a tough, tough time to. And again, I was a resident and I was literally graduating it was done. So the only thing I had to do was start applying Medicare number licence, you know, instead of going from the resident licence to a regular licence, so all that stuff got frozen, and nothing New York shut down. The government shut down. Every application everything a piece of mail was being sprayed down for anthrax. I was nothing I couldn't do anything so I was stuck after graduation. After finishing up my residency and not knowing how I'm going to work and where I'm going to work. So I started Googling and started looking around and found that Florida was one of the few states that had reciprocity, meaning whatever you accomplished in New York, they would recognize all you had to do was just pay, you didn't have to take another exam, you didn't have to jump through hoops. It was just pay your money. Here's your licence and that's it.

Coach JPMD  20:27  
So, I mean, you struck me as as a almost a miracle worker on some of my patients. So I know that it's probably some of the experiences that you had in New York, but I had a we had a patient, Dr. Singh and I, and we were just starting out and growing the practice, and we had a patient that had a wound, I think, for about a year, I won't say his name, but I think you remember him. Yeah, charcot, charcot joint, he I mean, heavy guy. So it's very hard to get its weight off his foot. And you came along. And I think within three months, the wound was healed. And I'm like, What is this? Who are you and so from that point on, you know, because you were right next door to me, in our marketing ploy, I would just send patients to Jude and he'd take care of the wounds, or he'd come over to the office. So that really, really helped us in the Managed Care world. Because, you know, our idea is to manage the whole patient, right, and make sure that they don't go to the hospital that they don't get expensive drugs or medications and expensive surgeries that they that may not work. So what had been your managed care experience prior to joining us? And how has it been since then? 

Jude Farley Pierre, MD  21:33  
Okay, so that's easy. My prior managed care experience was zilch, zero, nothing, never even heard of the word. And I had no idea what that was, at all, I knew Medicare, Medicaid, and you know, some things in between. And that's it. So, I was completely taken aback by this whole match care system. And it took a while for me to actually understand it. So doctor saying, through some exhaustive, late night sessions, tried to drill it into my head, how the system is supposed to work. And then of course, you hear a lot of stories from other outside doctors and colleagues of mine as well. And everyone hated managed care, because Oh, you don't get paid, they expect you to work like a dog, and you do pay you pennies on the dollar. And so I was starting to become a little jaded, and like, Oh, God, this is probably not the best thing for me. So being part of a group like Access Healthcare started to open up my eyes and give me a new perspective and how patients should be treated. So I know I've heard this before. And this is from school from podiatry school where they tell you, you know, you need to understand that a patient's feet don't walk in by themselves, they're attached to a body. So you have to be mindful of the fact that that person has issues, systemic issues that may contribute through their foot problems. And so you have to be a doctor, you're not a pedicurist you're not a nail technician, you're you're a physician, and you need to treat the patients accordingly. So, my approach then became like that, I basically started asking more questions, I started looking at the patient as a whole. And therefore I was able to coordinate the care with my colleagues such as yourself in order to, you know, attain reasonable and desirable goals and as far as wound care, so I fell in love with wound care early on, and I loved it. I have to thank Dr. Trainer who, who had a huge impact on my life. She was a PhD and RN with a PhD in wound care. I remember everyone hated going to wound care clinic because it smelled so bad. It was so much work having to put on those Unna boots every week. Horrible, but man, I thrived on that and I loved it. So I made up my mind I didn't even bother doing. I was born eligible for surgery. I decided to take my boards and limb salvaging and diabetic foot ulcers management instead. So now I'm a wound care board certified Podiatric physician who also does surgery. So in that capacity, I'm able to do a lot of things that your traditional wound care specialist can't, which is not just matched a wound but I can also manage the underlying osseous issues that are causing the wounds like if someone has a metatarsal that's just too pronounced or prominent. I can alleviate that problem by doing certain certain surgical procedures that can take care of that and as well as take care of the wound forever, rather than just put them in a pair of shoes.

Coach JPMD  25:00  
Yeah, so you've niched out you've niched out even the podiatry practice. 

Jude Farley Pierre, MD  25:03  
Absolutely. 

Coach JPMD  25:04  
In terms of what you do, what are your other colleagues doing? Are they? Because I know that I mean, not everyone is doing this. Or how are the colleagues managing their practices? I know some are going to nursing homes assisted livings. How do they land these these jobs and these positions? How do they practice?

Jude Farley Pierre, MD  25:23  
So I noticed a lot of the podiatrist in this on our area specifically, so the majority of them they did a lot of nursing homes, what I also did in the beginning as well, because, again, it's one of those like, Oh, hey, this is what you're supposed to do. So I did it. Until I was like, No, this, this had to has to be a better way. So I, that's when I decided to niche out again, with Dr. Singh's help. It was it was kind of easy to say hey, you know, pick out what you think you're good at, and then just do that. Other guys, I noticed that do a lot of primary care stuff. Like they'll hire podiatric assistants, which is someone that they trained to do a lot of the basic functions like nail care, callus care, and things of that nature. So you have five or six of those girls like or guys working on the patient, and you're able to, I guess, it's kind of like networking, you have five or six people doing the work, and then you just go in, and you provide a certain amount of care, but they're working under you. So that's how they're able to do some of the things that they do otherwise, it's impossible to make a good living because it's it's a numbers game. It's a numbers game.

Coach JPMD  26:34  
So and it's mostly a fee for service, right? 

Jude Farley Pierre, MD  26:36  
Yeah, it's mostly fee for service. 

Coach JPMD  26:37  
So but I also heard you speak about contracts and some HMOs or some managed care organizations will give podiatry groups contracts? Are they capitated contracts are they fee for service contracts as well?

Jude Farley Pierre, MD  26:48  
So now, there are certain podiatry groups who who have been here for existence for quite some time in the Tampa Bay area, and they're able to form what you call an IPA and therefore, compete for some of the capitated contracts that some of the managed care plans had to offer. Now, again, business savvy, that's fine, because it serves a group, you go in you you lowball, basically, you you offer the best price you think the insurance company is going to allow, and then they give you the contract, and you it's a numbers game, again, you're like, Okay, I'm gonna be the only group to see all of these members, therefore, it's gonna be fine. Now, when the match scare plans grow. And therefore you're you don't have a presence in this county in the managed care plans there. Then you subcontract with another podiatrist like myself, for instance, you give them a fee for service contract there, you're able to so that they can see the patient, but basically underneath your cap a contract, so you send in a claim, and they'll pay you based on the contract that you signed with them. And that contracts, usually for a set amount, based on a certain amount of codes that they allow, which is actually a really good system, because it definitely cuts out a lot of the menial nonsense that you have to deal with for a traditional Medicare plan, which is modifiers. And different codes. You know what I mean, when you have a managed care plan, it's so much easier because you have X amount of codes, this how much you get paid. Boom, it's very easy, submit claim, you get paid. That's it.

Coach JPMD  28:39  
So what Jude is talking about is really something that I've been trying to hone in on the money tree series that I started a couple weeks ago. And he's describing IPA contracting. So if you take a look at the money tree series, there's a couple of series already out there. I invite you, the listeners to actually re listen to those episodes, especially the one about the IPA, the MSOs. Because that will kind of help you understand what we're talking about here. And that MoneyTree series so so that was a plug to another series.

Jude Farley Pierre, MD  29:10  
And it all ties in.

Coach JPMD  29:11  
It all ties in and that's what we're trying to do here to help physicians understand this stuff, because we're definitely not taught this stuff in medical school or residency.

Jude Farley Pierre, MD  29:18  
So not at all. Never even heard of it, honestly. 

Coach JPMD  29:22  
So one thing I want to touch on is, you know, as you grew, you got busier. And you invited your sister to be part of your practice. How was that?

Jude Farley Pierre, MD  29:34  
That was that was interesting. So as we grew, and it got to a point where again, being part of a group such as Access allowed me to get very busy very quickly because I had a tremendous amount of support from my colleagues. As far as referrals are concerned. It didn't hurt things that I was the only podiatrist in the group so it was kind of easy Oh Wow, you have a problem, boom, instead of taking care of it myself now, we have someone who can do it for you so that it was easy. So I stayed very busy. We we tried hiring different podiatrists for over time, and things just never actually worked out. Because again, it's sad to say, but you know, when you go to med school, podiatry school, dental school, chiropractic schools, you're just not taught the business of it. So a lot of them came in with unrealistic expectations, they thought things were the exact same as when they were in residency, not a clue as to how it is to manage a practice, let alone a managed care practice. It's just not that black and white, there are so many different variables that you have to take into account. It's not hard once you actually commit yourself to learning it. Once you learn the system, it's fairly easy. It literally wrote it runs by itself, but you have to understand it in order to do it. And needless to say, we went through a few, at least a couple didn't work out. And at the time, I think my sisters were in New York, and they were getting a little tired of politics and the hustle and bustle of New York City, therefore, they were looking to relocate. So I told them, hey, listen, you know, we have a growing practice here. Why don't you bring your expertise down to Florida if you want to, and we can see if it works. So you no, what five years in, then she's still there. It's a work in progress. Working with family is never easy, but you have to kind of find a way to do it. It's it's definitely a lot more challenging than I'd expect before. But it's still there you know, there's they're pros and cons. I mean, the pros are good, in fact that you can actually pull her aside and say, Hey, listen, this is not working, or you need to do some different because you can't do that with someone who's not related to you because that person will take offence quickly. As far as like, well, you're trying to tell me how to practice no, but if it's coming from a sibling, it's a little bit easier to swallow.

Coach JPMD  32:18  
Well, you're you're you got a big heart. Yeah, yes.

Jude Farley Pierre, MD  32:23  
Yes, well, you could say that.

Coach JPMD  32:25  
So what would you tell the younger version of you now that you've done this for 20 plus years, about practicing podiatry or even practicing medicine? What would you tell them that you would have done differently?

Jude Farley Pierre, MD  32:37  
Wow, there's so many things I would tell my younger self, let me say, first thing I would tell my younger self is probably don't do it. Don't go to med school. 

Coach JPMD  32:45  
Don't say that! 

Jude Farley Pierre, MD  32:46  
Become a DJ. You can make more money in less time. But if you absolutely have to do it, I'd say because..

Coach JPMD  32:57  
You want to do it, because you have the heart to do it.

Jude Farley Pierre, MD  32:58  
Because rather, I would say you need to learn everything, not just the stuff the teachers school. But you also need to learn the business of it. You need to actually know how to run a business. Because at the end of the day, yes, we're taking care of patients, but it's still a business. And if you don't have you don't have that type of mentality, you're not going to make it for very long, you're gonna burn out quickly. Because you have to learn how to work smart, not just hard. Working hard is absolute, because that's going to happen regardless. But you also have to learn how to work smart.

Coach JPMD  33:40  
That's great advice. That's great advice. And that's what we're trying to teach in the practice impossible podcasts. So how do we reach you if someone wanted to talk more about you just or if theres a podiatrist that's looking to join the community? 

Jude Farley Pierre, MD  33:54  
Oh, absolutely. Email me. I'm extremely accessible and very easy going. I love to teach, especially after learning so much over the past 20 years from a number of people. I mean, some of the stuff that I've learned, I know for sure that no one's teaching that as a matter of fact, we have podiatry residence at Oak Hill now. And when I ran with them, it's tough to kind of see that things have changed to some degree, because I remember when we were talking about previously about the different types of Podiatry residencies that they had, and therefore, that would obviously give you a podiatrist versus a paediatric surgeon now, podiatry in its, you know, the wisdom decided that makes no sense. It's about time. So now they decided to make it a three year residency for podiatry period, and it includes surgery so everyone who comes out is literally a podiatric surgeon so there's no different sets of Podiatry it's because it became too difficult in hospitals, because you have a podiatrist on call, and something comes into the ER, and you call that podiatrist, he's like, Oh, I don't do that. It doesn't make any sense. So now everyone's trained the exact same way, which is, thank you God that someone did that. So, but talk to the residents, it's, you can still see where there's a huge lack of teaching, they they're not learning, or they're not being taught rather, the things that they really do need to learn. So I find myself teaching them, those things like little things like how to, like carefully dissect, you know, a chart and how to see the patient in a different way how to manage a patient afraid, you don't just go and start ordering pre albumin levels on every patient, because that's an expensive test that's unnecessary. You know, I mean, you need to learn not to order an MRI on every single person who has a wound, completely unnecessary. So things like that, you know, you have to Sad to say, but you have to kind of unteach them what they learn. So, it's a it's a challenge, but I'm up for it.

Coach JPMD  36:08  
I love Yeah, we're all up for it. That's why we're that's why we're here. That's, that's what we're doing.

Jude Farley Pierre, MD  36:14  
So I wish there was someone like us back then, you know,

Coach JPMD  36:18  
Well, their were just, you know, they're in pockets they're in pockets. We got to make it so it's everywhere. And that's what we do and we're gonna do it. We're gonna do it. 

Jude Farley Pierre, MD  36:29  
I hope so.

Coach JPMD  36:29  
We're gonna do it. Alright. Thank you so much for the conversation and it's been great. And now we've got it, memorialized.

Jude Farley Pierre, MD  36:37  
That's alright.

Coach JPMD  36:37  
It's gonna be around for kids to listen to for Nemo to listen to.

Jude Farley Pierre, MD  36:42  
I love it. That's gonna be good. It's gonna be good.

Coach JPMD  36:46  
Thank thank you again now. You're welcome. Bye