Interview with Dr. Luissa Kiprono – Episode 334
In today's episode, we explore the entrepreneurial journey of Dr. Luissa Kiprono who recently decided to start a new telemedicine service. She is a maternal-fetal medicine specialist who transitioned her traditional practice into telemedicine with the creation of TeleMed MFM.
The interview delves into the pivotal moments, challenges, and strategic decisions that led to the establishment of this innovative healthcare model. During our conversation, Luissa describes the importance of self-discipline and adaptability when making such a significant commitment.
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Dr. Debra Blaine is a physician like many of you, and her greatest challenge was fear. The whole concept of leaving clinical medicine was terrifying. But she is so much happier now as a professional writer and a coach. According to Debra, “It’s like someone turned the oxygen back on.”
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Evolution of TeleMed MFM: Dr. Luissa Kiprono's Entrepreneurial Journey
Dr. Luissa Kiprono faced challenges when her previous practice closed unexpectedly, leading her to choose the less-traveled path of starting TeleMed MFM. Motivated by a desire for independence and the vision to extend high-risk pregnancy care globally, she committed to a telemedicine-centric approach.
Her strategic decisions included establishing TeleMed MFM as the first to integrate telemedicine into maternal-fetal medicine services so completely. The practice adopted a hybrid model, combining consulting and procedures. Dr. Kiprono started by partnering exclusively with a prominent organization in Kansas City.
Push, Then Breathe: Dr. Luissa Kiprono's Memoir and Thought Empowerment Platform
Dr. Kiprono also described the other major project she has been working on for the past few years, her memoir, “Push, Then Breathe: Trauma, Triumph, and the Making of an American Doctor,“ revealing her experiences from the time she was a 19-year-old immigrant to becoming a successful American doctor.
Summary
To connect with Dr. Luissa Kiprono and learn more about TeleMed MFM and her upcoming memoir, “Push, Then Breathe: Trauma, Triumph, and the Making of an American Doctor,” you can reach out to her at (210)-660-9906 or via email at DrK@TeleMedMFM.com.
Visit the TeleMed MFM for information on the practice. For updates and insights, explore Dr. Luissa Kiprono's thought empowerment platform at drluissak.com and sign up for her newsletter by emailing hello@drluissak.com. Stay tuned for the release of her memoir on February 13, 2024, available in hard copy, audiobook, and Kindle formats through major retailers in the United States.
NOTE: Look below for a transcript of today's episode.
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Links for Today's Episode:
- TeleMed MFM
- Dr. Kiprono's New Book Website
- Push, Then Breathe: Trauma, Triumph, and the Making of an American Doctor on Amazon
- How to Be a Leader and Humanitarian Improving Maternal-Fetal Health – 204
- How Do I Generate Awesome Income with Telemedicine Services? – 222
- What Is the Best Way to Leverage Telemedicine? – 181
- What Is the Latest Telemedicine-Supported Specialty? – 173
- Debra Blaine's Coaching Page
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Transcription PNC Podcast Episode 334
- Interview with Dr. Luissa Kiprono
John: Today's guest first appeared on the podcast in July of 2021, and since then a lot of things have changed. She's a maternal fetal medicine specialist who's now providing care using telemedicine. I definitely wanted to hear about that. She's a University of Tennessee physician executive MBA graduate and holder. I just remind you of that because that's one of our sponsors. And she's also the author with a soon to be released memoir. This should be fun and interesting. Welcome back to the podcast, Dr. Luissa Kiprono.
Dr. Luissa Kiprono: Good morning, John. I'm very excited to be here. Thank you for inviting me back to your podcast, Physician NonClinical Careers.
John: Yeah. I think it was very inspirational last time, what you were doing then. And now some new things have happened, which I find extremely interesting and again, inspirational. Let's just get right into it. For the listeners, if you go back to episode, I think it was 204, you can learn more details of Dr. Kiprono's background and so forth. But to get us started, just go through a little bit of a list of what's happened since we talked back in 2021, if you would.
Dr. Luissa Kiprono: Okay. In August, 2022, right at the conclusion of the COVID pandemic, my organization pediatrics decided to shut doors of the practice I was leading at the time, Texas Perinatal Group. That came as a surprise, I have to say. And at that time, I really came at a crossroads, whether to sign another agreement with another organization or to take a different road, that less travel road, and that is to open my own practice. And really I realized how exhausting has been to invest in someone else's dream and in someone else's endeavor. I said I might as well just start investing in my own. So that is how TeleMed MFM was born.
John: Now, was that from the very get go going to be heavily involving or solely involving telemedicine type of interactions?
Dr. Luissa Kiprono: It was started a hundred percent with a vision to become telemedicine. I have to say that I had plenty of experience in the matter due to the way COVID kind of pushed us with medicine and medical practices. But also I was the first practice in both CompHealth agency, which is the Locum Tenants Agency, and in pediatrics medical group that as a maternal lymph fetal medicine practice would hire and maintain telemedicine in their services. Not only during the pandemic, but also up to the day that the practice closed in August, 2022.
I did have experience in the matter, and I think that's where it kind of started. I was like "I know what to do, I know how to handle it, and it works." But it was scary. I have to tell you, it was exciting and it was scary, to both start a new practice in my fifties and also to start not only just any practice, telemedicine in maternal fetal medicine.
John: Yeah, anytime you make a change like that, it's both. You've got all the business aspects of it, and then also like, "Okay, how am I going to deliver care? What's the best way to do it?" And in telemedicine, I have zero familiarity with. That's like how in that environment you deliver your services. You're to be commended for that and I think when you do that, while it's very stressful, and it probably takes some time and some money, as you mentioned, you have more freedom and independence. So, it's a trade off.
Dr. Luissa Kiprono: Yes, it is. You are your own boss. You also are doing telemedicine, you practice medicine from the comfort of your private office, home office. But I always give award to the wisest, to the newly grads, and the newly grads are excited. Let me tell you. This generation is like, "Oh, yes, this is so exciting, we're going to do telemedicine" and so forth. It does take a lot of self-discipline, and it does take a lot of fortitude to not cut corners because it's easy. Just think about what used to happen during COVID. When Zoom meetings start, you're like, "Oh, I got all this freedom. I can also check an email. Oh, I can also do this. I can also do that." So here you are at the end of the meeting, you're like, "What exactly the meeting was all about?" Those same dangers come when you do telehealth. But it comes with a price.
So you do have to be self-disciplined, you have to say "How it would be if I am the patient and the physician that can renders care on the other side, doesn't pay attention, and they don't give me the best care that is because they do it through telemedicine or they miss something?" You do have to have respect, and also you be yourself like your watchdog, "Hey, I got to do it, this is my job." It's only the place that's different. The care, the connection with the patient, the services render for the patient. They should always be there just like I would be physically in the same office with them.
John: One of the things that attracted me to want to talk to you about this, that prompted me is that I get questions all the time from I'll just say specialists. Some of them are surgeons, some are medical subspecialists. And in their minds they're like, "Well, yeah, primary care, urgent care, that's fine. Telemedicine is very common. People have low risk, colds and respiratory, and they can get treated over the phone or the telemedicine service for a UTI or something."
But it's a different type of telemedicine when you're a consultant. And I've seen surgeons and other specialists do this, but never have I talked to a perinatologist that has done this. And so, my question is, tell me a little bit more about what the interactions are like. Since you have really a close relationship normally with the obstetricians as well as the patient, are you interacting with both and do you do some consults with an obstetrician in which you don't actually talk to the patient? Or are they always involving the patient directly?
Dr. Luissa Kiprono: It is very involved. Communication is the key, at least when it comes from me. My advice is always, always communicate. I'm an over communicator. I speak with my obstetrician, that if I make any changes to the care and we switch gears, I call my referring OB provider, and I say, "Hey, this has come up. This is how I recommend." Then I speak with my patients after I discuss it with the obstetrician. Just imagine everything the same like you would go in a doctor's office. The only difference is through the screen. We are talking live here doing a podcast. Same thing I'm talking live with my patient. Patient comes in, whether it is a video consult from the comfort of their home, or it's a telehealth consultation that is in the practice in the hospital or in the MFM practice where the patient is scheduled to come.
The patient gets an ultrasound. I read the ultrasound, and then we have a consultation. And I conveyed the findings to the patient. We discuss just like you would talk face-to-face with the physician. Medical history, go through the entire finding of the ultrasound, counseling, render an assessment and discuss the plan. And then I finish a consultation through the EMR and sign it. And that's it. It's very, very doable. It goes very seamless. There will be things. Think about it when you are in the office. Does your computer need an update? Sure. Is your computer maybe going to crash and you need to reboot? Yes. Do you have EMR when you go and work in a brick and mortar office? Yes. Or in the hospital? Yes.
All those are happening. The only difference is I am not physically with the patient in the room but my sonographer are by my nurses. If I need to send the patient to the hospital, I call the nurse, let her know. I call the obstetrician and the nurse calls the hospital and the patient shows up just like that.
There are a couple of procedures that obviously I cannot do like amniocentesis, DBS. Those are for prenatal diagnosis of congenital or genetic abnormalities. But that is when the physician who is physically in the office comes into place. And that brings me to my next point, hybrid practice. The hybrid medical practices of healthcare are here to stay because you have to have the hybrid. Think about if you have a team that some of them do just consulting, but some of them do also procedures. People who do procedures have to be during the procedure in that room, in the operating room, or if I have an amniocentesis, the physician, the MFM that is in the office that day, they will go ahead and they take care of that for us.
John: Ah, okay. I've talked to people that are doing telemedicine as primary care. They're constrained by where they're licensed, states they have to be licensed in multiple states, although I know some of that during the pandemic was a little loosened up a little bit. It was a little easier to get. Do you focus on certain locations? Is it kind of local, even though it's telemed or is it countrywide? How does that work?
Dr. Luissa Kiprono: I am licensed in multiple states. Every state has its own slight differences. Now we have Compact. Compact made it easier and more streamlined to be able to be licensed faster in different states. I personally hold multiple licenses, but right now, as a matter of fact, my practice has signed an agreement, an exclusive agreement with a very well-known large organization in Kansas City, Missouri. TeleMed MFM is providing maternal fetal medicine services virtually for their patients.
John: Okay. Yeah, that kind of segues into my question I had about how do you get the word out and where do you find business? And so, it sounds like at least one way is to identify a particular organization, work directly with them. Tell me a little bit more about that.
Dr. Luissa Kiprono: We did a lot of marketing, but when I say marketing, it's not like you've got to put an ad in the paper or an ad in YouTube. That doesn't work that way. A lot has to do with your expertise. Maternal fetal medicine, it's a very close knit environment. The MFM subspecialty really was formed 50 years ago. 50 years ago next year. It is a relatively new specialty. And there are about 1,300 of us, but only about 900 to 1,000 that practice full-time. Now, if you take that to 340 million United States citizens and 77 million women between the age 15 and 49, which we consider the fertile age, you can imagine how big the need is, how tiny the group that we are in of specialists.
To go back to your question, when it comes to marketing or advertising, I started working for this organization through an agency, through my company. My company was contracted by the agency to work for this organization, and they learn how I work, they learn my practices. They were very impressed with my ethics and my expertise. They say we just would like to contract directly with you and do partnership between your company and our organization. Without saying, I was extremely excited. And we actually just executed the partnership last month.
John: Nice. Excellent. How does the lifestyle for you doing your practice this way, have you stuck pretty much to the same kind of hours? Or is there more flexibility doing it this way? That's one of the things that attracts certain physicians to telemedicine because they don't have to travel, obviously. It's very much more efficient. Tell me how it's affected your lifestyle.
Dr. Luissa Kiprono: I worked the same hours that I were before. Actually, I worked more. I work more now than I worked before. When you look at any company, any business that you start, I want to make a caveat, you will work a lot more in the beginning to start it. It just has to. It's just thinking about building momentum to have this business going. But I do work the same, if not more, because when I'm done with my clinical duties, then I start working the administrative duties after hours for my practice. And also now with my adventure, you do have to have the electronic capabilities. I do have literally six monitors in my office. And so, I high grade monitors. I have to have a high speed internet, camera video equipment, audio equipment. That is my livelihood. That's my job is to read ultrasound. I just don't have small screen laptops and have large screen monitors because I read ultrasound about 90% of the time with or without consultations.
That are the requirements that have to be in place in order to do this kind of endeavor. Yes, it is more relaxed because I work from my home office, from my private office. But again, going back to that same caveat that I made the beginning of the podcast, be your own watchdog. Stay disciplined. Because it's easy to become relaxed because you are at home. Well now, you're still at work, you are not at home, you are at work. Home is you go to the other room after your work is done.
John: I'm not exactly sure how your practice worked before. This question might be stupid, but I can imagine especially in MFM, maybe you're doing the ultrasound yourself physically, or you have ultra-sonographers that you typically work with. And now I'm assuming that you're actually getting a lot of different ultrasounds that you're reading from different ultrasonographers maybe. How is the quality? I know you've got the technology, I'm just wondering if it's affected your ability to feel the confidence in what you're looking at.
Dr. Luissa Kiprono: It is an excellent question. It is not a silly question. As a maternal fetal medicine physician, we do have highly trained sonographers. They are not radiologists and they are not OB-GYN sonographers. They are sono techs who spend about 18 months to specialize in fetal ultrasounds. When it comes to that, I had other offers prior to this and they said, "Well, you're just going to read the ultrasound, that an OB tech is going to do it." And I said, no, it just doesn't cut it because I am not there to be able to troubleshoot and I need certain images.
What happened is the maternal fetal medicine, sonographers are going by strict guidelines, imposed by AIUM. They are ARDMS certified and fetal echo certified. Think about this. Just like everything else, if you have a radiologist that reads general X-rays or general MRIs, then he'll have a radiologist who specialized in fetal MRIs, and then you go further, radiologists that have specialized in neuro fetal MRIs. That is so important for me to be able to have this at my fingertips, to trust my staff. I have to trust my sonographers because they are my eyes. And let's say they didn't get the image. I would just ask them, "Hey, can you get another image for me?" And they know exactly what I'm looking for.
Otherwise, the learning curve is very steep. Especially if I'm not there, the trust is not there. Just like you said, the liability is very high on my end because if they miss something, then I miss something, then the patient doesn't get the counseling they should have. The follow-up is not the proper follow-up. And then at delivery, the baby doesn't get the care that they should have been anticipated otherwise.
John: Yes, we don't like surprises in medicine and we really don't like surprises in maternal fetal medicine. I happen to have two daughters that are pregnant at the moment. I'm hearing a lot of things third hand. And one thing is not an ultrasound that's not given the right answers. That was very interesting. We're going to run out of time soon and we're not going to run out quickly because I have a whole other topic I want to talk to you about, but I do want you to go ahead and give the website for the telemedicine MFM business just in case there's physicians listening who may need your services or want to learn more or even contact you on LinkedIn if they're starting something similar.
Dr. Luissa Kiprono: Sure. My practice number is (210)-660-9906. My website, you can find me at telemedmfm.com. And my email is DrLuissaK@TelemedMFM.com. If you go to my website, you can always find there the contact info. And please send me an email, ask me a question. I'll be very, very happy to share my knowledge with you and my expertise. Both how to launch a telemedicine practice, and also how to navigate through the intricacies with both medical but also insurance and licensing.
John: Excellent. I will put all those in the show notes, of course, and even in the email that I send out about the episode. We'll have all those links and a few others that we're going to talk about. But in the process that you've described, you've been busy starting this, but in the meantime, you've also had another activity. I guess I wouldn't call it a hobby, something going on, and it's about a book, a memoir. And so, we definitely want to hear about that as well. When did that start to come up as something you wanted to do?
Dr. Luissa Kiprono: Five years ago I embarked on this journey writing my own memoir. This memoir takes the reader on a journey that I have started back in 1987 as a 19-year-old woman immigrant who came to America for two months. I came to America to meet and know my father. And that turned into a lifetime. And without spoiling the drum roll and transferred the book, it's been a journey. It's been a journey of a lifetime. And that journey of 15 years really takes me and it takes the reader all the way to my graduation date in 2002.
And at this time, I'm thrilled to announce the debut of this first nonfiction book. Its name is Push, Then Breathe: Trauma, Triumph, and the Making of an American Doctor. At the same time, I'm launching my platform, it's called Dr. Luissa K. And it is a thought empowerment platform in both leadership and overcoming trauma and thriving by achieving one's own potential. Date of release is February 13th, 2024, and it's going to be launched at all the major retailers in the United States in hard copy, audiobook and Kindle format.
John: Nice. Is this like a traditionally published book through a large publisher?
Dr. Luissa Kiprono: It is a hybrid publishing. The publisher is Greenleaf Publishing Group.
John: Now, we always have questions to address with authors and writers. It's not easy, it's not easy to organize. What method did you use to write? Some people will do blocks three or four hours at a time. Other people will maybe work on a weekend. How did you actually sit down to create this book?
Dr. Luissa Kiprono: I started the first chapter of this book 35 years ago in Romania. Then I wrote that first chapter and I put it aside because life got in the way big time. About five years ago, I found myself recording every morning for about half an hour. I was very intent into doing it. And it lasted about two weeks. When you run a practice, at that time as I was running that huge 52 employee practice. And then also you have a family, children. Life, let's call it. I said I really want to write this book, but there is no way I can write this in my lifetime at the pace I'm going. I started looking at ghost writers and I partnered with my book coach and ghost writer. And that is how the book was finally written through both our collaborations.
I want to tell you something that we all physicians and really some non-physicians, but usually type A personalities, we feel that we must write this book like as if I have to physically write it. But what I can tell you is that the thought out there is that it's actually smarter to work with a book coach and a ghost writer than trying to do it yourself.
It's like delegating. Think about if you are in your office and you're trying to do everything. Trying to vitalize somebody, take fetal heart tones, put the patient in the room, do the ultrasound, be the physician, check out the person, and start that again. How long can you last? You won't last. It's not sustainable. Probably you'll last about three days.
Same thing here. Can you be a full-time physician and write the book and be a mom or a dad and do it all perfectly? No, you can't. You have to A) prioritize, B) work smart. It still took us a couple of years. The book was finalized in December, 2022, which was last year. And then in March was accepted for publication by Greenleaf Publishing Group. And it's now in print, the audiobook is on the way. And it's happening. It's really, really close. The hybrid publishing it's very, very convenient. They work very well in many, many ways. It's hybrid. You do have to put your buy-in and you have to do work and also financially you will have an interest in it.
However, they will put all the wills in motion for publishing and marketing the book. You tell them how much or how little you want them to do, and they will do it for you, and you will approve everything along the way. I would be more than happy John to have a separate podcast to just talk about the process. It is an amazing process that I knew nothing about, like literally nothing. It's unnerving. And I can say it's like rapid fire sequencing. We have to do this, we have to do this, we have to do this. Why? It has to be approved by you, the author. Because at the moment, they accept you and then you sign the agreement with them. We'll also sit down and figure out when do you want this book to be released? And now everything starts dominoing backwards because you are on a schedule. And everybody's going to know that your book comes out, in my case February 13th. Well, we don't want to arrive on February 12th and realize there is no book to be presented.
John: Yeah, absolutely. If I'm not mistaken, and I've talked to other authors, some of the benefits of doing the hybrid is you definitely have more control. If you do a big publisher, one of the big three or four, number one, you lose pretty much all control and they're going to tell you what title they want and how the chapters are going to be put. And it takes a lot longer. And in a hybrid, I think you get to reserve a little bit more of the income that comes into. I'd say most of the guests I've had that have written books have gone that route. Now I've got a few that will self-publish, but I think most everybody's going the route you've gone, especially with one of the really good top-notch hybrid publishers. Boy, this sounds fantastic.
Dr. Luissa Kiprono: Well, just to put a little bit of data out there. 80% of people want to write a book. Out of which 1% finish writing the book. Out of which 1% get accepted for publication. Even with all that, there are about a million books coming on the market every year in the United States, and 4 million all comers, meaning 1 million that are accepted for publication and four millions that includes also self-publishing a year. It's crazy. That's just amazing to me how much influx it is.
John: Well, congratulations.
Dr. Luissa Kiprono: Thank you.
John: Here's what we're going to do. You're going to have to remind me about a week or two beforehand so we'll promote that at that time. And we can obviously promote it through this podcast, which it'll probably be the beginning of January when people see this and hear this. But definitely do something special for that February date. That'll be fun. Tell us where to go to look for that.
Dr. Luissa Kiprono: Okay. To learn more about my book and my platform, my website is www.drluissak.com. My email is hello@drluissak.com. If you sign up for my newsletter, you're going to get it in the mail, but also bring up the updates, any news that come out. And also just to put it out there, just in case anyone wants to join me, February 13th, that will be a destination book launch.
John: Okay. You're going to have to send me the specifics on that so I can put that in the show notes.
Dr. Luissa Kiprono: Sure, we can do that.
John: All right. I think we are getting out of time at this point, but this has been a very interesting episode. We learned a lot about how to implement telemedicine, the pros, the cons, some things to keep in mind. Definitely some good advice. And then about a memoir that's coming out... From the time this is posted about a month after this is going to be posted. So, maybe we'll have some people follow you for that as well. Any last words of advice to our listeners about anything that we've talked about today before I let you go?
Dr. Luissa Kiprono: What I would like to say is that my advice regarding personal growth, follow your heart's desire. If there is something that keeps you up at night, an idea or a goal, whether it is opening a practice, starting a business, or just open up a flower shop. And if that is what you really truly want, if when you talk about it, your eyes are sparkling and your heart starts beating faster, do it. Just do it because you'll never regret it. And don't be afraid that you're going to fail because you know what? You are never going to know unless you try something, especially when you really, really are passionate about it.
John: Thank you for that advice. Very inspirational. You've got this book pretty much in the can we would say. Are you thinking of doing another book later? I'm going to ask that question. Or are you going to rest for a while and think about it?
Dr. Luissa Kiprono: I am going to rest for a while. These last few years have been quite eventful, especially last year with the practice and the entire book publishing. So I will take a break and let's just see. I won't smell the roses for a couple before I decide where am I going to move, what's my next steps are in life.
John: Yeah. Okay. Well, I'll be watching from the sidelines and if you do something else really interesting, I'll have you back on the podcast. Thanks a lot for being here today, Luissa. It's been very fun and educational really.
Dr. Luissa Kiprono: Thank you. I really appreciate the time. And thank you for inviting me for this conversation, John. Happy holidays.
John: You too. Bye-Bye.
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Transcription PNC Podcast Episode 334
- Interview with Dr. Luissa Kiprono
John: Today's guest first appeared on the podcast in July of 2021, and since then a lot of things have changed. She's a maternal fetal medicine specialist who's now providing care using telemedicine. I definitely wanted to hear about that. She's a University of Tennessee physician executive MBA graduate and holder. I just remind you of that because that's one of our sponsors. And she's also the author with a soon to be released memoir. This should be fun and interesting. Welcome back to the podcast, Dr. Luissa Kiprono.
Dr. Luissa Kiprono: Good morning, John. I'm very excited to be here. Thank you for inviting me back to your podcast, Physician NonClinical Careers.
John: Yeah. I think it was very inspirational last time, what you were doing then. And now some new things have happened, which I find extremely interesting and again, inspirational. Let's just get right into it. For the listeners, if you go back to episode, I think it was 204, you can learn more details of Dr. Kiprono's background and so forth. But to get us started, just go through a little bit of a list of what's happened since we talked back in 2021, if you would.
Dr. Luissa Kiprono: Okay. In August, 2022, right at the conclusion of the COVID pandemic, my organization pediatrics decided to shut doors of the practice I was leading at the time, Texas Perinatal Group. That came as a surprise, I have to say. And at that time, I really came at a crossroads, whether to sign another agreement with another organization or to take a different road, that less travel road, and that is to open my own practice. And really I realized how exhausting has been to invest in someone else's dream and in someone else's endeavor. I said I might as well just start investing in my own. So that is how TeleMed MFM was born.
John: Now, was that from the very get go going to be heavily involving or solely involving telemedicine type of interactions?
Dr. Luissa Kiprono: It was started a hundred percent with a vision to become telemedicine. I have to say that I had plenty of experience in the matter due to the way COVID kind of pushed us with medicine and medical practices. But also I was the first practice in both CompHealth agency, which is the Locum Tenants Agency, and in pediatrics medical group that as a maternal lymph fetal medicine practice would hire and maintain telemedicine in their services. Not only during the pandemic, but also up to the day that the practice closed in August, 2022.
I did have experience in the matter, and I think that's where it kind of started. I was like "I know what to do, I know how to handle it, and it works." But it was scary. I have to tell you, it was exciting and it was scary, to both start a new practice in my fifties and also to start not only just any practice, telemedicine in maternal fetal medicine.
John: Yeah, anytime you make a change like that, it's both. You've got all the business aspects of it, and then also like, "Okay, how am I going to deliver care? What's the best way to do it?" And in telemedicine, I have zero familiarity with. That's like how in that environment you deliver your services. You're to be commended for that and I think when you do that, while it's very stressful, and it probably takes some time and some money, as you mentioned, you have more freedom and independence. So, it's a trade off.
Dr. Luissa Kiprono: Yes, it is. You are your own boss. You also are doing telemedicine, you practice medicine from the comfort of your private office, home office. But I always give award to the wisest, to the newly grads, and the newly grads are excited. Let me tell you. This generation is like, "Oh, yes, this is so exciting, we're going to do telemedicine" and so forth. It does take a lot of self-discipline, and it does take a lot of fortitude to not cut corners because it's easy. Just think about what used to happen during COVID. When Zoom meetings start, you're like, "Oh, I got all this freedom. I can also check an email. Oh, I can also do this. I can also do that." So here you are at the end of the meeting, you're like, "What exactly the meeting was all about?" Those same dangers come when you do telehealth. But it comes with a price.
So you do have to be self-disciplined, you have to say "How it would be if I am the patient and the physician that can renders care on the other side, doesn't pay attention, and they don't give me the best care that is because they do it through telemedicine or they miss something?" You do have to have respect, and also you be yourself like your watchdog, "Hey, I got to do it, this is my job." It's only the place that's different. The care, the connection with the patient, the services render for the patient. They should always be there just like I would be physically in the same office with them.
John: One of the things that attracted me to want to talk to you about this, that prompted me is that I get questions all the time from I'll just say specialists. Some of them are surgeons, some are medical subspecialists. And in their minds they're like, "Well, yeah, primary care, urgent care, that's fine. Telemedicine is very common. People have low risk, colds and respiratory, and they can get treated over the phone or the telemedicine service for a UTI or something."
But it's a different type of telemedicine when you're a consultant. And I've seen surgeons and other specialists do this, but never have I talked to a perinatologist that has done this. And so, my question is, tell me a little bit more about what the interactions are like. Since you have really a close relationship normally with the obstetricians as well as the patient, are you interacting with both and do you do some consults with an obstetrician in which you don't actually talk to the patient? Or are they always involving the patient directly?
Dr. Luissa Kiprono: It is very involved. Communication is the key, at least when it comes from me. My advice is always, always communicate. I'm an over communicator. I speak with my obstetrician, that if I make any changes to the care and we switch gears, I call my referring OB provider, and I say, "Hey, this has come up. This is how I recommend." Then I speak with my patients after I discuss it with the obstetrician. Just imagine everything the same like you would go in a doctor's office. The only difference is through the screen. We are talking live here doing a podcast. Same thing I'm talking live with my patient. Patient comes in, whether it is a video consult from the comfort of their home, or it's a telehealth consultation that is in the practice in the hospital or in the MFM practice where the patient is scheduled to come.
The patient gets an ultrasound. I read the ultrasound, and then we have a consultation. And I conveyed the findings to the patient. We discuss just like you would talk face-to-face with the physician. Medical history, go through the entire finding of the ultrasound, counseling, render an assessment and discuss the plan. And then I finish a consultation through the EMR and sign it. And that's it. It's very, very doable. It goes very seamless. There will be things. Think about it when you are in the office. Does your computer need an update? Sure. Is your computer maybe going to crash and you need to reboot? Yes. Do you have EMR when you go and work in a brick and mortar office? Yes. Or in the hospital? Yes.
All those are happening. The only difference is I am not physically with the patient in the room but my sonographer are by my nurses. If I need to send the patient to the hospital, I call the nurse, let her know. I call the obstetrician and the nurse calls the hospital and the patient shows up just like that.
There are a couple of procedures that obviously I cannot do like amniocentesis, DBS. Those are for prenatal diagnosis of congenital or genetic abnormalities. But that is when the physician who is physically in the office comes into place. And that brings me to my next point, hybrid practice. The hybrid medical practices of healthcare are here to stay because you have to have the hybrid. Think about if you have a team that some of them do just consulting, but some of them do also procedures. People who do procedures have to be during the procedure in that room, in the operating room, or if I have an amniocentesis, the physician, the MFM that is in the office that day, they will go ahead and they take care of that for us.
John: Ah, okay. I've talked to people that are doing telemedicine as primary care. They're constrained by where they're licensed, states they have to be licensed in multiple states, although I know some of that during the pandemic was a little loosened up a little bit. It was a little easier to get. Do you focus on certain locations? Is it kind of local, even though it's telemed or is it countrywide? How does that work?
Dr. Luissa Kiprono: I am licensed in multiple states. Every state has its own slight differences. Now we have Compact. Compact made it easier and more streamlined to be able to be licensed faster in different states. I personally hold multiple licenses, but right now, as a matter of fact, my practice has signed an agreement, an exclusive agreement with a very well-known large organization in Kansas City, Missouri. TeleMed MFM is providing maternal fetal medicine services virtually for their patients.
John: Okay. Yeah, that kind of segues into my question I had about how do you get the word out and where do you find business? And so, it sounds like at least one way is to identify a particular organization, work directly with them. Tell me a little bit more about that.
Dr. Luissa Kiprono: We did a lot of marketing, but when I say marketing, it's not like you've got to put an ad in the paper or an ad in YouTube. That doesn't work that way. A lot has to do with your expertise. Maternal fetal medicine, it's a very close knit environment. The MFM subspecialty really was formed 50 years ago. 50 years ago next year. It is a relatively new specialty. And there are about 1,300 of us, but only about 900 to 1,000 that practice full-time. Now, if you take that to 340 million United States citizens and 77 million women between the age 15 and 49, which we consider the fertile age, you can imagine how big the need is, how tiny the group that we are in of specialists.
To go back to your question, when it comes to marketing or advertising, I started working for this organization through an agency, through my company. My company was contracted by the agency to work for this organization, and they learn how I work, they learn my practices. They were very impressed with my ethics and my expertise. They say we just would like to contract directly with you and do partnership between your company and our organization. Without saying, I was extremely excited. And we actually just executed the partnership last month.
John: Nice. Excellent. How does the lifestyle for you doing your practice this way, have you stuck pretty much to the same kind of hours? Or is there more flexibility doing it this way? That's one of the things that attracts certain physicians to telemedicine because they don't have to travel, obviously. It's very much more efficient. Tell me how it's affected your lifestyle.
Dr. Luissa Kiprono: I worked the same hours that I were before. Actually, I worked more. I work more now than I worked before. When you look at any company, any business that you start, I want to make a caveat, you will work a lot more in the beginning to start it. It just has to. It's just thinking about building momentum to have this business going. But I do work the same, if not more, because when I'm done with my clinical duties, then I start working the administrative duties after hours for my practice. And also now with my adventure, you do have to have the electronic capabilities. I do have literally six monitors in my office. And so, I high grade monitors. I have to have a high speed internet, camera video equipment, audio equipment. That is my livelihood. That's my job is to read ultrasound. I just don't have small screen laptops and have large screen monitors because I read ultrasound about 90% of the time with or without consultations.
That are the requirements that have to be in place in order to do this kind of endeavor. Yes, it is more relaxed because I work from my home office, from my private office. But again, going back to that same caveat that I made the beginning of the podcast, be your own watchdog. Stay disciplined. Because it's easy to become relaxed because you are at home. Well now, you're still at work, you are not at home, you are at work. Home is you go to the other room after your work is done.
John: I'm not exactly sure how your practice worked before. This question might be stupid, but I can imagine especially in MFM, maybe you're doing the ultrasound yourself physically, or you have ultra-sonographers that you typically work with. And now I'm assuming that you're actually getting a lot of different ultrasounds that you're reading from different ultrasonographers maybe. How is the quality? I know you've got the technology, I'm just wondering if it's affected your ability to feel the confidence in what you're looking at.
Dr. Luissa Kiprono: It is an excellent question. It is not a silly question. As a maternal fetal medicine physician, we do have highly trained sonographers. They are not radiologists and they are not OB-GYN sonographers. They are sono techs who spend about 18 months to specialize in fetal ultrasounds. When it comes to that, I had other offers prior to this and they said, "Well, you're just going to read the ultrasound, that an OB tech is going to do it." And I said, no, it just doesn't cut it because I am not there to be able to troubleshoot and I need certain images.
What happened is the maternal fetal medicine, sonographers are going by strict guidelines, imposed by AIUM. They are ARDMS certified and fetal echo certified. Think about this. Just like everything else, if you have a radiologist that reads general X-rays or general MRIs, then he'll have a radiologist who specialized in fetal MRIs, and then you go further, radiologists that have specialized in neuro fetal MRIs. That is so important for me to be able to have this at my fingertips, to trust my staff. I have to trust my sonographers because they are my eyes. And let's say they didn't get the image. I would just ask them, "Hey, can you get another image for me?" And they know exactly what I'm looking for.
Otherwise, the learning curve is very steep. Especially if I'm not there, the trust is not there. Just like you said, the liability is very high on my end because if they miss something, then I miss something, then the patient doesn't get the counseling they should have. The follow-up is not the proper follow-up. And then at delivery, the baby doesn't get the care that they should have been anticipated otherwise.
John: Yes, we don't like surprises in medicine and we really don't like surprises in maternal fetal medicine. I happen to have two daughters that are pregnant at the moment. I'm hearing a lot of things third hand. And one thing is not an ultrasound that's not given the right answers. That was very interesting. We're going to run out of time soon and we're not going to run out quickly because I have a whole other topic I want to talk to you about, but I do want you to go ahead and give the website for the telemedicine MFM business just in case there's physicians listening who may need your services or want to learn more or even contact you on LinkedIn if they're starting something similar.
Dr. Luissa Kiprono: Sure. My practice number is (210)-660-9906. My website, you can find me at telemedmfm.com. And my email is DrLuissaK@TelemedMFM.com. If you go to my website, you can always find there the contact info. And please send me an email, ask me a question. I'll be very, very happy to share my knowledge with you and my expertise. Both how to launch a telemedicine practice, and also how to navigate through the intricacies with both medical but also insurance and licensing.
John: Excellent. I will put all those in the show notes, of course, and even in the email that I send out about the episode. We'll have all those links and a few others that we're going to talk about. But in the process that you've described, you've been busy starting this, but in the meantime, you've also had another activity. I guess I wouldn't call it a hobby, something going on, and it's about a book, a memoir. And so, we definitely want to hear about that as well. When did that start to come up as something you wanted to do?
Dr. Luissa Kiprono: Five years ago I embarked on this journey writing my own memoir. This memoir takes the reader on a journey that I have started back in 1987 as a 19-year-old woman immigrant who came to America for two months. I came to America to meet and know my father. And that turned into a lifetime. And without spoiling the drum roll and transferred the book, it's been a journey. It's been a journey of a lifetime. And that journey of 15 years really takes me and it takes the reader all the way to my graduation date in 2002.
And at this time, I'm thrilled to announce the debut of this first nonfiction book. Its name is Push, Then Breathe: Trauma, Triumph, and the Making of an American Doctor. At the same time, I'm launching my platform, it's called Dr. Luissa K. And it is a thought empowerment platform in both leadership and overcoming trauma and thriving by achieving one's own potential. Date of release is February 13th, 2024, and it's going to be launched at all the major retailers in the United States in hard copy, audiobook and Kindle format.
John: Nice. Is this like a traditionally published book through a large publisher?
Dr. Luissa Kiprono: It is a hybrid publishing. The publisher is Greenleaf Publishing Group.
John: Now, we always have questions to address with authors and writers. It's not easy, it's not easy to organize. What method did you use to write? Some people will do blocks three or four hours at a time. Other people will maybe work on a weekend. How did you actually sit down to create this book?
Dr. Luissa Kiprono: I started the first chapter of this book 35 years ago in Romania. Then I wrote that first chapter and I put it aside because life got in the way big time. About five years ago, I found myself recording every morning for about half an hour. I was very intent into doing it. And it lasted about two weeks. When you run a practice, at that time as I was running that huge 52 employee practice. And then also you have a family, children. Life, let's call it. I said I really want to write this book, but there is no way I can write this in my lifetime at the pace I'm going. I started looking at ghost writers and I partnered with my book coach and ghost writer. And that is how the book was finally written through both our collaborations.
I want to tell you something that we all physicians and really some non-physicians, but usually type A personalities, we feel that we must write this book like as if I have to physically write it. But what I can tell you is that the thought out there is that it's actually smarter to work with a book coach and a ghost writer than trying to do it yourself.
It's like delegating. Think about if you are in your office and you're trying to do everything. Trying to vitalize somebody, take fetal heart tones, put the patient in the room, do the ultrasound, be the physician, check out the person, and start that again. How long can you last? You won't last. It's not sustainable. Probably you'll last about three days.
Same thing here. Can you be a full-time physician and write the book and be a mom or a dad and do it all perfectly? No, you can't. You have to A) prioritize, B) work smart. It still took us a couple of years. The book was finalized in December, 2022, which was last year. And then in March was accepted for publication by Greenleaf Publishing Group. And it's now in print, the audiobook is on the way. And it's happening. It's really, really close. The hybrid publishing it's very, very convenient. They work very well in many, many ways. It's hybrid. You do have to put your buy-in and you have to do work and also financially you will have an interest in it.
However, they will put all the wills in motion for publishing and marketing the book. You tell them how much or how little you want them to do, and they will do it for you, and you will approve everything along the way. I would be more than happy John to have a separate podcast to just talk about the process. It is an amazing process that I knew nothing about, like literally nothing. It's unnerving. And I can say it's like rapid fire sequencing. We have to do this, we have to do this, we have to do this. Why? It has to be approved by you, the author. Because at the moment, they accept you and then you sign the agreement with them. We'll also sit down and figure out when do you want this book to be released? And now everything starts dominoing backwards because you are on a schedule. And everybody's going to know that your book comes out, in my case February 13th. Well, we don't want to arrive on February 12th and realize there is no book to be presented.
John: Yeah, absolutely. If I'm not mistaken, and I've talked to other authors, some of the benefits of doing the hybrid is you definitely have more control. If you do a big publisher, one of the big three or four, number one, you lose pretty much all control and they're going to tell you what title they want and how the chapters are going to be put. And it takes a lot longer. And in a hybrid, I think you get to reserve a little bit more of the income that comes into. I'd say most of the guests I've had that have written books have gone that route. Now I've got a few that will self-publish, but I think most everybody's going the route you've gone, especially with one of the really good top-notch hybrid publishers. Boy, this sounds fantastic.
Dr. Luissa Kiprono: Well, just to put a little bit of data out there. 80% of people want to write a book. Out of which 1% finish writing the book. Out of which 1% get accepted for publication. Even with all that, there are about a million books coming on the market every year in the United States, and 4 million all comers, meaning 1 million that are accepted for publication and four millions that includes also self-publishing a year. It's crazy. That's just amazing to me how much influx it is.
John: Well, congratulations.
Dr. Luissa Kiprono: Thank you.
John: Here's what we're going to do. You're going to have to remind me about a week or two beforehand so we'll promote that at that time. And we can obviously promote it through this podcast, which it'll probably be the beginning of January when people see this and hear this. But definitely do something special for that February date. That'll be fun. Tell us where to go to look for that.
Dr. Luissa Kiprono: Okay. To learn more about my book and my platform, my website is www.drluissak.com. My email is hello@drluissak.com. If you sign up for my newsletter, you're going to get it in the mail, but also bring up the updates, any news that come out. And also just to put it out there, just in case anyone wants to join me, February 13th, that will be a destination book launch.
John: Okay. You're going to have to send me the specifics on that so I can put that in the show notes.
Dr. Luissa Kiprono: Sure, we can do that.
John: All right. I think we are getting out of time at this point, but this has been a very interesting episode. We learned a lot about how to implement telemedicine, the pros, the cons, some things to keep in mind. Definitely some good advice. And then about a memoir that's coming out... From the time this is posted about a month after this is going to be posted. So, maybe we'll have some people follow you for that as well. Any last words of advice to our listeners about anything that we've talked about today before I let you go?
Dr. Luissa Kiprono: What I would like to say is that my advice regarding personal growth, follow your heart's desire. If there is something that keeps you up at night, an idea or a goal, whether it is opening a practice, starting a business, or just open up a flower shop. And if that is what you really truly want, if when you talk about it, your eyes are sparkling and your heart starts beating faster, do it. Just do it because you'll never regret it. And don't be afraid that you're going to fail because you know what? You are never going to know unless you try something, especially when you really, really are passionate about it.
John: Thank you for that advice. Very inspirational. You've got this book pretty much in the can we would say. Are you thinking of doing another book later? I'm going to ask that question. Or are you going to rest for a while and think about it?
Dr. Luissa Kiprono: I am going to rest for a while. These last few years have been quite eventful, especially last year with the practice and the entire book publishing. So I will take a break and let's just see. I won't smell the roses for a couple before I decide where am I going to move, what's my next steps are in life.
John: Yeah. Okay. Well, I'll be watching from the sidelines and if you do something else really interesting, I'll have you back on the podcast. Thanks a lot for being here today, Luissa. It's been very fun and educational really.
Dr. Luissa Kiprono: Thank you. I really appreciate the time. And thank you for inviting me for this conversation, John. Happy holidays.
John: You too. Bye-Bye.
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