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Welcome back to another episode of the Aspire for More with Erin podcast, where I have the utmost privilege of having the two, I'll say one dermatologist and one nurse practitioner who doesn't give herself enough credit. From mainstream dermatology in Clarkston, Michigan. Dr. Jennifer Cottle and Kenzie Gardner, nurse practitioner, Welcome the aspire for more with Aaron podcast. Thank you all for being here.
Jennifer:Thank you so much for having us. We're so excited as an
Erin:honor. Yes. So I caught wind of what you guys were trying to do, and I'm going to let you explain it. But from my. My point of view, you're trying to bring dermatology services into the assisted living and memory care world. And I thought, that's cool. I want to talk to them a little bit more about this. So thank you for being here and take it away. Tell us what mainstream dermatology and you two beautiful ladies do to innovate and grow inside the senior living world.
Jennifer:So Main Street Dermatology, I have been in private practice, for, close to 15 years, treating seniors in a outpatient care setting. And I'd always been asked by families of patients, can you come see my mom? at her assisted living center or her independent living center. and it was something where, you're busy, you're in private practice, you're like, I can't get out to do that at this point in my career. So we would watch these patients come in with their transportation services, and they would sit in our waiting room for hours, and they would come with their family members. They didn't have the continuity of care that we wished we could give them when they had to make these large trips from their community or ask a family member to take off work to bring them. And it was always an idea, this would be such a great opportunity for us to see patients where they're the most comfortable, where they live, where they don't have to get transportation to us. and it was just the right time. Of finding the group of people that, Kenzie and I have to do this project and be able to care for people where they live. and I think the biggest thing is, Yeah, offering people the opportunity to have a service independently of other means. They don't have to pay for transportation. They don't have to ask their family members. They can be more independent with their health care.
Erin:Yeah, I think customer service these days and being a caregiver is really hard, especially when your loved one who's in senior living is going to lots of different specialists. And some senior livings have really opened up and allowed a podiatrist in the community, a primary care specialist. You certainly have that as a marketing perspective, but a dermatology service is. Is fascinating to me, and in some of us, some of our residents don't have a lot of skin issues, but then some of them do, and then the preventative part of that. So how so it started with family members saying, Hey. can you come and then. Y'all thought about it and said, maybe we can, how does that work?
Jennifer:Yeah. and I didn't actually know, so I was like, okay, great. We'll just, I'll show up to the communities that live right around my private practice. And I walked to the front desk and I would say, hi, I'm Dr. Connell. I'm with Main Street Dermatology and I want to come to deliver onsite dermatologic care to the residents. And the first thing most of the reception would say is, we've never heard of that, I would say, is there anyone here I can speak with and then they would make a phone call and say, no one's available. Can you come back another time? And I'm like, oh, okay. I'll leave you my information. We would email we would call and it was. really difficult to learn who would be the best point of contact at a community to give them our pitch of Oh, this would be a great service. And one thing that I think a lot of people don't necessarily know is that one in four Americans have skin cancer and 70 percent of people over the age of 65 have pre cancerous skin. So we're all affected or know someone who's been affected by this. And so the idea is when you transition from your own life in your own home and you may move across town to be closer to family to an independent living or assisted living center. And you move from Arizona or Florida. We have a lot of people who are. back. And so when you lose team, it's really hard to new people to get into new So, um, once we figured o And we were able to say, Hey, look, there's this many people that you might not even realize could use this service that have this history. Just ask them. It worked pretty well. And so we started with this skin care night where we said, okay, let us just introduce ourselves to the community and gauge what the interest is, who wants to hear about skin. We would give tips and tricks and things. And once we did that, we realized there was an overwhelming response. And I think even the community, the executive directors and the nursing teams at these communities were like, wow, we had no idea they would really love this service so much.
Kenzie:And then just the other communities getting on board, it's been really helpful as well. So we can say we're down the street, we're helping out this community. Can we come help you as well? It's been really well received. Families love it. They don't have to come coordinate transportation and go to doctor's visits. Yeah. They can come and actually spend quality time with their family member and loved one. I think it's starting to gain a little traction, but it's been an definitely a different world for us and very interesting.
Jennifer:I think as a, yeah, as a physician, you're used to being. People say yes to you a lot. You're in demand, right? people want your help. You're in the hospital. You're doing consults or whatever. So when it was the first couple experiences where I came to a community and they were like, Oh, we don't have anyone that could need that. And I'm like, Oh, yeah. Oh my gosh, I really, really think you might, or, when is more health care providers on site a bad thing? and I think I, yeah, it was the concept of,
Erin:You
Jennifer:learning that this is independent living and assisted living is a very hospitality driven, community and service versus healthcare. And so that was, us stepping out of our box into the hospitality and learning a bit of that and them understanding, that more healthcare is going to help them achieve their goals as well.
Erin:Yeah. So what. Have you found, have you the good comments from residents, what have you found that they appreciate the most? and honestly, how does it make you feel to know? Because I'm sure you were adding value and I like to say changing lives because healthcare does, but, making relationships with these residents. I'm sure that is heartwarming and it's all the fields. for having me.
Kenzie:There's literally nothing more rewarding than caring for people that have cared for them. For us in some way, right have set up are the generation that we're going to live in and the world that we're going to live in. I just saw a patient this morning. Who's fantastic. And he was used to seeing a dermatologist regularly in Arizona was thrilled that we were coming today. Just it's already part of his life. He understands the importance. He spent 20 years in Arizona was a golfer has tons of pre cancerous spots and this means he doesn't have to call his son and he was really excited because he hates to be a burden. on his son. He could go. He was going off to a senior center to go play. card. And so he could go do that. And it was, I wasn't, impinging on his life too much. He was like, that was the fastest, easiest dermatology visit I've ever received in my entire life. and it was tailored to him, Where he is physically, emotionally, mentally, I was able to be there for him. I was able to write out the instructions. Instructions on a handout, Mr. Jones, this is for you. This is what we did today. This is when we'll be back. This is our number if you need us and I was able to physically be there for him. So he didn't have to take his Walker and figure out how to get it on the bus transportation service. That would be the facility and coordinate the care with the doctor's office. He didn't have to come to maybe a little bit more of a rushed office setting. sit in the lobby with other people that might be sick, and have to take everything in, in a brief amount of time. He was really thrilled with the entire experience. And again, it's just so rewarding. It's so neat. And it's something we really believe in.
Erin:When
Jennifer:you get these communities together for the skin care night and they all come together, you get to hear all the bits and pieces of their lives. And what's so much fun is you're sitting in a room and you have a teacher, an engineer, a retired physician, a pilot, and the interaction is, We don't, normally as a physician, you're not sitting in a room full of patients all together. You're seeing them independently. So that kind of community and the questions and the answers is something we found that has been really fun for us to do. And it's been really engaging, I think, for the communities and, swapping a lot of information. So it comes to, there was a, TV series, doctor Marcus Welby. And. If you bring this up to this community of patients, they, it's, they're like, Oh my gosh, it was when healthcare was the best, he made house calls and it was a TV show with pre, raise anatomy, ER, all of our generation of shows we remember. and they do, they light up. and it, and so we really dug into that of, it was a time in healthcare where We weren't rushed. We didn't have five other people to go see at the same in the same hour. We had, you, you could go to where the patient lived and you can get a lot of information from that setting. what resources they have, how can they do this treatment regimen that you want them to do? And and you get to know them. And so I think, it bringing that back is, it's been really exciting. And, I think we can get a whole healthcare community are, the future physicians to recognize also that there is an advantage to not doing this in an outpatient office setting. There is an advantage to being where someone is so comfortable that they can. Talk to you easier, and not feel like they need a list and they're worried. They're going to miss something and they have to catch another, transportation service or whatever. it's been, exciting in that way.
Kenzie:I think it's so important, though, to realize that the senior living world. They're the gatekeepers to this experience. and so we're learning every day. How can we, best communicate the, what we're trying to do to help care for people. And I think, like you said, it's a rushed environment. Everyone's very busy. there's a lot of different services that are being offered. to residents, but prioritizing healthcare, and access to care is really important. and I think the senior living professionals, like I said, are truly in a huge position to be number one gatekeepers on the care that we're going to receive and our parents are going to receive, here and in the coming years. So how to get people on board to recognize that, we should have all. Truly, we should have access to care physicians, specialty services, everyone should be going on site. It makes more sense. It's better for, we know it's better for the patients, decreased ER visits, it leads to improved quality of care overall.
Jennifer:And the communication between physicians, if you have a healthcare team all in one place and we're not communicating, in 12 different spots, by telehealth or by emails and faxes and EMRs and we're all together. there's no chance that multi disciplinary approach doesn't lead to better outcomes.
Kenzie:We have one facility. It's so neat. They have an internal medicine doctor the same day that we're there. So I can literally walk down the hall. And be like, Hey, any patients that you have in mind that could use my service today. and how cool is that? that's truly going back to the best times in medicine where physicians collaborate. A person in person together. and they, we can talk like, how can I better serve your patients? and so it's a really interesting way of not only caring for residents, but yeah, in changing the entire world of health care. And what we, What we want to do for the future. And
Jennifer:I think that our, I think that we're finding like the adult children now who are looking for places for their family members, they have different expectations and the expectation is going to be, I have a busy life. I have, my career, it's not easy for me to transport mom or dad, all these places. They may not even live in the same place. what is the healthcare going to be like? And people want. that the idea of, health span, not just how long and how many days you live, but how healthy can you live them? And so I think that the demands that these, families will have for these communities are going to increase in terms of that, because people are smart. They understand that. getting something at the pre cancer will prevent you from having a large surgery, 10 years from now when you're less able and mobile and your healing is slower. So there's so much we can do up front, through those years that we can really change the cost of healthcare down the road and the health span of the patient.
Erin:Yeah, I think you're right. The caregiver, The daughter, the son, the cousin, the nephew who's caring for the resident is going to look at communities and they're going to see what does the community offer them to take some of the load off and transportation is always up top on that list, especially with more active adults who may not drive right, but still need that still have the ability to take care of their own personal needs and their own needs. health care needs and so having more options inside the community is going to make that community more desirable to the people that they want to move in. yes, you are correct with that. And then being proactive. I had a resident in a memory care who had that most procedure done. It was like right here and had we had. Dermatologist in right, and just doing their proactive scans. We probably would have noticed that before it got to the point where it needed a most procedure. And then all she did was pick at it, right? And pick at it and pick at it and pick at it. talk me through, I know you just said, we would have noticed that before the most procedure happened. Part of the goal, especially with communities who do have memory care and assisted living in different regs in different states, the proactive scans, the proactive skin assessments that you guys do prevent big procedures or can prevent big procedures like the most procedures, right?
Kenzie:Oh, absolutely. and that's the key, is persistent prevention. It is never too late. It's never too late to protect our skin and prevent spots from getting larger. and obviously we're. We're taking different factors into consideration, like the patient's quality of life. We don't need to do 50 sprays if that's not the priority. But if we can get the largest ones treated of the precancerous actinic keratosis spots, that decreases the chance of that person ever having to undergo major invasive surgery, which like you said, when they're more of an independent state is not as big of a deal, but for someone that is 80, 90, that the healing process is not going to happen. So it's just not realistic that we do a major Mohs surgery. On every person that's diagnosed, with a skin cancer on the face or scalp at that age,
Jennifer:we can conservatively manage the condition without big surgeries and come up with ways to treat them that will optimize their health span. and that's been
Kenzie:fun for us, too. We're in the process of working with a medical student that is really excited about helping us develop protocols. And alternative therapies for skin cancer. for this specific population so we can continue to be leaders in this subspecialty that we're creating. So it's not that we're just gonna do necessarily the standard of care of what a general dermatologist would do in an outpatient setting. We're able to offer alternative options at the bedside or in The community is that are going to be more appropriate. and so we're super excited about continuing to develop those as well. and learn on about how we can best treat these people.
Erin:So they were talking when we talk about memory care. That is what that's what's needed. yeah, our memory care residents don't understand sometimes when they break their arm that keeping a sling on like that. that's almost. That's almost, I'm not gonna be able to have her keep her sling on. She doesn't want it. She's gonna take it off. You know what I mean? And so it's a path of least resistance and making sure that what the quality is for her can be met and the same thing goes for skin, which is huge. You are on to something in regards to creating protocols for what a resident or a patient can handle. Appropriate
Kenzie:community can handle right alongside the nurses. A lot of times in the memory unit and 1 consult. it was just an issue that I'm like, I wouldn't worry about this. this isn't a priority truly for her. You are, you need to focus on other things for her at this time. And. That it's the rosacea that's going to be there to stay. it's really as long as she's not itchy or it's not bothering her. It doesn't matter right now. there are other things that are most important to her health and that's helpful to as a community. to recognize that we're partners, with you, because the nurses are going through a lot. turning the patients every two hours. Everyone's busy. Yes. And so we're not here to bring more work or add more creams or prescribe more things. We understand that there's a priority of care.
Jennifer:And again, what we're hoping to see as we do this over a longer period of time is that if we get regular treatment. In the independent living space, in the assisted living space, that by the time you get to memory care, none of them need to have a major most procedure because we've prevented that. So even if you have a very small skin cancer, there can be a simple procedure that you can use at the bedside or a cream, and you can avoid having this big wound that requires a lot of care from the community, the nurses. And then the patient is uncomfortable. The family's looking at this bloody bandage and this wound that's never healing. And they feel like their loved one isn't being well taken care of when they see that. So there's so much you can avoid with that persistent prevention and really the changing the culture of the assisted living and independent living space to include more healthcare early.
Erin:because I've been in the senior living industry for so long, the change is hard, but change is here and change is coming. And the more, the older the boomers get, the baby boomers get, and the more that they're moving in and the more that we realize as a senior living profession, that. we have to change. we have to. Then, services like this are welcomed. I can't tell you when I tell people, Oh, we have a medical director here, and we have an audiologist that comes. Oh, and we have a nurse practitioner that comes. You don't have to worry about these things. Now let me add to the list the podiatrist and the dermatologist. You know what I mean? that's huge. It's huge. It's
Jennifer:huge.
Erin:And
Jennifer:when that family member is listing, you're listing off all of those things, and you know what that person thinks, they think, you've thought of everything. This has got to be a great place. You've thought of everything. And that is something that when I'm going into a community, I'm saying, okay, hear me out. I know this is Sounds wild, and I know you don't have a dermatology service that comes in here, but this is what I wanna do. I've had a lot of luck with people who are working with sales and leasing and things to say, okay, wait, this could be good. This could give me some talking points, and it could make a family choose. this place over somewhere else because we have more services. So that's been a learning curve. I didn't think when I walked into a community and said, okay, I should talk to the nurse. that makes sense. Let me talk to your healthcare team. What do you need? And in some places it's been better for me to come from that approach and say, okay, wait a second. We want people to come here. You offer all these hospitality things that are so much fun and amazing. But what else could you have that would make you stand out and have a family shoot? And so that's been, that wasn't my first thing that, but yeah, now I've learned that part of, getting people to take a chance on us. And I do think that, there are a lot of people in this space. space that are really excited to add new things and innovate it. it's been really positive, overwhelmingly positive in the communities who's taken a chance on this. And then they see the opportunity. They're the ones who are like, you think we can get an ENT? I'm like, I don't know, I can only do my space, they're like, wow, this would be great if we could get all of these others. And yeah, we hope that this is the future.
Kenzie:And the truth is that you can. these senior living communities are amazing. They're so beautiful. Incredible. They're, the, yeah, the food can be good. The entertainment can be amazing and they can have fantastic healthcare. Like we truly believe that it can happen. it's, it's a learning process and it takes some time to establish the care. I get it. It's not going to happen overnight, but there's hope. Like I definitely think we can. Demand that. And again, we can, help facilitate that and grow the access
Jennifer:to care. And we're hoping that if we can be successful in our little subspecialty of medicine, other doctors and other nurse practitioners and physician assistants will be like, wow, I want to try to do this too in my specialty and then you know, you've got this great big team that can be, in each community doing all of the work together and it's fun. It's fun. that's, I think the biggest thing it's so rewarding. it really is special in that way and different than an outpatient setting.
Kenzie:It's humbling for me because any idea of a schedule is immediately thrown out. The door I, it might be 20 minutes of talking with a resident about, something that they love or about breakfast or about what they're going to do today. And that's what matters. it's not like I have to meet a patient quota and see 50 people or it's can I make a difference? Can I make this person? understand that this is a valuable service and come back and see me again. that's just the main goal. So it's been a really neat, fulfilling experience just, and yeah, again, there's no schedule, there's no rules, anything can happen. It's wild every time. Yeah. Something new happens all the time where you're like, wow, we have never seen that before anywhere, but Or you hear some crazy story and you're like, Oh, that is, yeah, yes, it's great. We talk about it
Jennifer:nonstop. We say we could write a book with all of the little, nuggets like Mr. Jones and this whole, Part of his life and their
Kenzie:secrets, like their secrets to life and all, some of our 90 and 100 year olds. It's amazing. Like just they're hilarious. They are. Yeah. It's fun.
Erin:Yeah. It's a lot of fun. People don't understand how much fun senior living is. Until you actually get in there and you see it's really like a college dorm.
Jennifer:Yes, it is. it's exactly like a college dorm and maybe even more wild, there's less rules and nobody's filtered and what they're saying. There's clicks, like they are, they're teasing that goes on.
Kenzie:Oh, I hear about it. There's
Erin:relationships. There's relationships.
Jennifer:Yes, it is. It's, yeah, it's, it's definitely, it's fun. It is.
Erin:And not to mention, in your practice, people who are potentially looking For senior living for their parents or their animals. And so you now are able to offer your customers some insights. Number one, number two, your referral source for communities that you serve in, because you see, the fun and the life changing benefits inside senior living. So it really is a win win. You can support your customer base in far more detailed ways. And you have insights and you're serving more customers in a very unique and specialty way. So it only makes sense. It only makes sense.
Kenzie:Glad it makes sense to
Jennifer:you. I know. It's all great. But I think, yeah, we're, we're really, we're moving the needle. it's, one, one place at a time, but people are starting to get wind of it. And there has been a lot more requests. Quests for our service as a one patient going to a new facility that we have not approached. and so once we can get our foot in the door and we say, okay, look what we can do for this one person. Imagine what we could do and the buzz that we could create, as a new service. So it's, it's, yeah. It's been exciting. Busy.
Erin:Yeah. Okay, so before we end this episode, because I know that y'all are incredibly busy and I have two dermatology specialists give us 40 something plus women, give us some advice to have skin like yours. So what is the top advice besides stay out of the sun? And
Jennifer:that's real. That's true. That's true. So definitely sunscreen. It's not, it's not the coolest thing to say, but definitely sunscreen is a really big component of any sort of anti aging regimen. And there's amazing sunscreens out there and it's sunscreen every single day and we're in Michigan and it's actually sunny today, but normally it's cloudy, even in February clouds, you still should wear a sunscreen to your face every day. But other than that, there's two vitamins. I think every dermatologist and provider would recommend one is a vitamin A at night. So it's something that can, repair your barrier at night and then topically vitamin A. So retin A, retin L, retinol. There are many over the counter versions. There's prescription versions. And then in the morning with your sunscreen, before you put that on, a vitamin C, an antioxidant to help. Prevent more damage and, help with, you can get help with brown spots and things like that too. So the two vitamins, A at night, C in the morning and a sunscreen every day.
Kenzie:And they prevent cancer too. Not just anti aging. Prevents. Yeah.
Jennifer:So then you wouldn't have to see us in independent living for sprays later on. That's great. And a skin check. Actually, I would say the one thing you can absolutely do, is a skin check once a year, at least a baseline skin check, because most skin cancer, almost all skin cancer, even melanoma is, curable if caught early.
Erin:thank you for that advice. Okay. A at night, C in the morning, C in the morning, A at night. Okay. All right. And if you are a community. In Clarkston, Michigan and surrounding areas, my best advice is to give Main Street Dermatology a call. What are we waiting for people? What are we waiting for? I am sold. Maybe it's a little more work, right? Maybe, depending on the regs, I don't know what the regs are for Michigan. It's crazy. It can't be. The work cannot outweigh the benefit. It cannot outweigh the customer service, the marketing, and the healthcare benefit. It's that trifecta win box. if you can get these two beautiful, smart, intelligent, beautifully skinned dermatologists in here to give you excellent service and tidbits on how to have skin like that too. Thank you ladies for doing what I like to say is God's work, right? You're innovating and you're meeting people where they are and. It's just the beginning. once you do, once you're in there, it's just the beginning. So grab a few more students and let's get going.
Kenzie:Thank you. for
Erin:listening. You're welcome. Thank y'all for being here. And as always for my listeners aspire for more for you.