Flourish by Advaita Health

Fall in Love with the Problem: Compensation to Conferences

• Tripp Johnson • Season 4 • Episode 5

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0:00 | 45:46

In this episode, Tripp Johnson and Marcus Shumate dive deep into the challenges and rewards of leading a healthcare organization through growth and transformation. They discuss the recent developments at the Advaita Collective, including the successful on-time and under-budget completion of the Chapel Hill office, and explore the complexities of updating compensation models to stay competitive in a rapidly changing market. Tripp and Marcus also share insights on maintaining balance amidst the pressures of work, the importance of clear data in decision-making, and the ongoing quest to solve meaningful healthcare problems. This candid conversation sheds light on the realities of managing a healthcare enterprise and the constant iteration required to stay ahead.

Key Topics:

  • The completion of the Chapel Hill office project
  • Adjusting compensation models in response to market shifts
  • Balancing work demands with personal well-being
  • The role of data in making informed decisions
  • The challenges of applying research in clinical practice
  • The need for more substantive and practical behavioral health conferences

About Flourish by Advaita Health

Flourish by Advaita Health explores how people, providers, and communities move from suffering to flourishing. Each episode weaves together perspectives from healthcare, wellness, and human experience — from the science of mental and physical health to the art of living well.

Advaita Health is a North Carolina–based behavioral health organization dedicated to supporting whole-person flourishing. Learn more about our work and clinical services below.

Tripp Johnson (00:00.672)
Now I looked so bad when I saw myself like this. was like, this is rough. Like I can't put a video looking like this. Like I look like I'm the bait, like the off white blending into my off white walls or something. least a hat makes it feel a little better.

Marcus Shumate (00:03.728)
Yeah.

Marcus Shumate (00:09.231)
Yeah.

Marcus Shumate (00:15.802)
Yeah.

Marcus Shumate (00:19.886)
Yeah, that's exactly how you want to look at the end of summer as a pal with no tan at all and sickly. Yeah. So how's the week going?

Tripp Johnson (00:27.512)
That's the vibe I've got.

Tripp Johnson (00:32.894)
Week one at Chapel Hill. So very exciting. I'm pretty sick under the weather. So I just had to cancel a trip to Maine. My family's up there. So a little disappointed about that. But pretty excited. I think one of the first times we've had a project, especially like such a big project, renovations, essentially come in on time and under budget. So I'm pretty stoked.

Marcus Shumate (01:00.336)
Yeah, that's the first for us.

Tripp Johnson (01:03.532)
Yeah. How about you?

Marcus Shumate (01:05.71)
Yeah, it's a good week. A little weird. I think adjusting to things like digital and the workflow and sort of these things are a little bit different and learning what this stuff looks like because what it turns into is like, and we've talked about this, but these massive amounts of just tinkering, tinkering, looking up resources, trying to absorb information.

You're wandering around in the desert. don't know if any like, at I don't know, like north, south, any direction that I'm going in. And then I'll have these like punctuated periods of clarity where it turns into this like frantic, really self -fulfilling, enjoyable workflow or something. But Jesus Christ, man, getting to that spot is like a trudging up a hill or something. no, man. But it's fun.

Tripp Johnson (01:52.787)
Yeah.

Tripp Johnson (02:00.82)
I think it's Yeah, I'm, I'm gonna butcher this. But the I was talking to Tyler about Tyler and Nick a lot about this the last day or so was, you know, like we make so many mistakes as an organization. And it feels like you can feel pretty dumb and bad about it. And then I remind everyone that like, the

amount that they're getting paid allows them to be kind of dumb and bad at it. Because if they were really good at it, I'd have like they'd be getting paid a lot more. It's just like a fact. And so like, the interesting tension is, and I don't mean to, I would say about myself too, like, let me be clear. I'm like, not a very well compensated CEO. And if I was better at my job, I'd probably be able to pay myself more. But

Marcus Shumate (02:34.32)
Yeah, yeah, yeah.

Marcus Shumate (02:41.68)
What?

Tripp Johnson (02:54.156)
We were talking in terms of, we're seeing, this has been one of the more interesting, this is actually probably really interesting. So over the last, like we've really increased the compensation to our medical team over the last like three to four months. And a lot of the people that came in over the last six months were already in this kind of already higher adjusted kind of salary or productivity range.

Marcus Shumate (03:19.3)
Yeah.

Tripp Johnson (03:23.554)
But the last, basically, you like I talked to a lot of people as they're considering joining our practice and whatnot. And I would say the market seems to have shifted dramatically, like in terms of compensation. You know, people are coming in wanting what was originally, let's just, I'll just stay in salaries for now. What two years ago 110 wasn't like a bad salary for

PA doing behavioral health. And so we were coming in usually at like the 125 to 135 range for someone who's been in practice. And now everyone who is coming to us that's been in practice for a few years is looking for, mean 135 is like low and people are asking for like, you know, 175, 180 off the bat. that like something, you know, it's a negotiation to some extent, but

Marcus Shumate (03:54.181)
Mm -hmm.

Marcus Shumate (04:00.974)
Yeah?

Marcus Shumate (04:16.536)
wow.

Tripp Johnson (04:22.378)
we have definitely seen, the market just seems to have shifted. And so like that causes us to have to update all of our, you know, compensation models and then spread it out. Cause we, can't just because it makes sense to hire someone at, you know, again, like we're going to make money off of that position. And that's not the main goal we get into that, but you know, we're to make money off that position regardless, as long as they're seeing the patients that they're supposed to.

So, and we want to be known for paying top of market. But it's, you know, it's just complex to keep all of this in line. So we've got, you know, like we have an offer letter going out that just went out and it gives us 90 days before they would start. Like a lot of people, you know, it's a 90 to 120 day transition for a medical provider. you know, starting December 1st was the offered start date.

Marcus Shumate (05:10.148)
Hover.

Tripp Johnson (05:18.114)
And then a 90 day probationary kind of period where it's at like a lower comp and then it raises to like a higher rate. And that gives us six months to essentially shift everyone we have who's already like producing that amount of work. We have to shift their comp up to be equitable as an organization. And I'm going to tie that in with like, Hey guys, we're going to do that. And like strategically now we're

we're looking at a lot of positions getting, call it a 15 to 20 % raise to start the new year or something like that. So pretty significant opportunity for a provider to increase their compensation. And then I think we have to talk about how we use that information and we think about strategically, I don't wanna say it's like a token of good faith, I think it's the right thing to do, but your compensation's going up. And so we're also asking for you to like,

I'd say step up performance. doesn't mean see more patients. It means, you know, really just like work alongside the organization in the sense of like, hey, we really need to be good at online scheduling and online intake. This is going to happen. People are going to hate it. We're going to talk about it over and over. But when you get paid 20 % more, hopefully that's like a little bit of sugar with the medicine, right?

Marcus Shumate (06:23.205)
Hmm.

Tripp Johnson (06:39.178)
So as we do that, as we look at online intakes and online scheduling, do new patient appointments have to be in person? We all think that's better, but it doesn't necessarily have to be in person. And if we're thinking in terms of big healthcare problems, quality access and affordability, we need to be more on demand than we are right now, balancing that access with the quality. So I say all of that to say the thing I love about my

This job is like we're constantly redrawing the lines to like adjust to the market and hopefully ahead of others. Because like the last thing we want is like really good people leaving because like we're just not paying enough and we weren't paying attention to the market trend shifting.

Marcus Shumate (07:11.322)
Yeah.

Marcus Shumate (07:25.072)
Well, I think it's an interesting proposition with what we're like the needle. We're all trying to thread with this is how do you free providers up to do more of providing and more of what they want to do? How do you create upward mobility for them? And then how do you balance that with not increasing patient costs? Like those are sort of the three propositions that sit in tension with each other. I think this is, know, frankly, you know,

For me, is the interesting thing to sit in, the tension to sit in and the problem to try to solve. We've talked about this a lot, just whatever way that we're wired for good and bad, don't think either one of us are wired in such a way that we're good at being bored. If there's not a sufficient enough problem for me to go after, I get anxious, I get weird, get in my head.

Tripp Johnson (07:58.081)
Yeah.

Tripp Johnson (08:12.257)
Yeah.

Marcus Shumate (08:22.308)
But like I can see the amount of pacing that I do, you know, my smartwatch when I'm like listless or aimless versus like a difficult, you know, trying to understand or make sense of a difficult problem is just, for whatever reason, is satisfying and fun to me at least. But so I think holding those three tensions in place, creating more equitability, access for patients, making sure that staff and employees have upward mobility and then

Yeah, not adding to the cost. think all of that fascinating tension promise it in.

Tripp Johnson (08:55.967)
No.

Tripp Johnson (09:00.936)
And like, it's also it. Yeah, I mean, it's interesting because like, they're just constraints on us. And so you have like, you're kind of like constantly just pulling the different levers that you've got. And, you know, like, that's one of the reasons again, like, why growth isn't bad. Like, this is the number one thing like, we can we are going to be able to increase, you know, provider compensation, because

Marcus Shumate (09:18.703)
Yeah.

Marcus Shumate (09:24.782)
Mm -hmm.

Tripp Johnson (09:28.406)
we're now becoming more, you know, the goal being more efficient as an organization, leveraging good people, process and technology to deliver the same care with lower overhead allows us to create more upward mobility for our team. And I think like, yeah, it's been, it's super interesting. So then you got to go and like, yeah, like we're taking that information about the market changing, right? And then we go to the insurance company and we say, look, we're

we're paying 15 % more than we were for providers this time last year. Like, please help us with the rate increase. Like we're trying to keep quality providers. And so you got to make an argument to the insurance company that you need, that you can, and you got to justify that your rate should go up because like the market has shifted and you know, you'll ask for a 20 % increase and maybe get five to 10. So anyway, yeah, it's fascinating to me that I get to

dabble in all of these problems.

Marcus Shumate (10:29.486)
Yeah. Or fighting off the plague or something. Yeah. Yeah. That is the like interesting piece I found with this stuff is the like total adrenal fatigue that at least I have with it. Like Mondays and Tuesdays for both of us end up being pretty meeting heavy, intensive days. And maybe I would assume the same for you, but I know for me, they tend to require the most thinking and you know,

Tripp Johnson (10:33.642)
Yeah, it's probably just exhaustion.

Marcus Shumate (10:59.564)
Often most of my skis in terms of the like meeting with our data advising board, AI advising board and trying to just provide them enough information and commentary for it to be a useful time for all involved and trying to keep up with that. Again, it's fun and I love it, but it also you have these like wild sort of moments of just wandering, wandering, wandering and then something becoming.

abundantly clear the path being revealed for you, then it's this mad.

Tripp Johnson (11:32.003)
You gotta quit just talking so abstractly. No one knows what path is being revealed. What fucking path are you talking about? The Yellow Brick Road?

Go back to the meeting. This is something we talk about offline a lot is just the structure. I'd be curious, like, walking through the structure of your days or weeks. Like you just mentioned, like Mondays being a really heavy meeting day, Tuesdays having some meetings, and then I know you do kind of like the deep work, project -based work throughout the week. But I'd also be curious kind of like your routine for work and how like it's shifted as your

role has gone from like business development, kind of like on the phone, on the road a lot to like managing projects and how you've had to adjust your kind of personal routines to, you know, like you said, like there's a different rhythm to it and it's hard to adjust. So I'd be curious how you've done that.

Marcus Shumate (12:31.63)
Yeah, think so the ways that I've tried to adjust really for that are especially Mondays and Tuesdays when I know that there's going to be meeting heavy heavy days deliverables us for stuff making sure that I've got like time to get mentally prepped. So sitting down looking at reports, looking at information, making sure that I have whatever I need going into the meetings so they can try to be as efficient as possible.

And some of that's just a pain point, right? Like one, you don't want to look stupid, but two, you also want to use other people's time well. And three, at this stage of competing interests, to not go unprepared and have a good meeting feels 10 times more painful than it otherwise would. So Mondays and Tuesdays for me often start, my morning starts with a sitting practice, usually early morning exercise, do something and then prep work for

for the meetings. And I've tried to, for the most part, put off any real project production work starting on Wednesdays. But normally what that means is there is, at least for me, this ambient level of anxiety on Mondays and Tuesdays because it's like, what have I accomplished today? I don't know what hell I did today. I was in seven hours of meetings and I'm exhausted, but I don't have one thing to show for it.

And so, you know, to your

Tripp Johnson (14:03.264)
And you don't, the other thing, you don't get that like fake productivity from like business development either, right? Like business, like, was out there chapping it up. Like people know more about, you know, whatever, it's kind of work. Whereas like now like work is like project based more. And it's like, yeah. So you feel like you're like, holy shit. hopefully by the end of Wednesday or Thursday, like, I feel like I did something. Cause right now I feel like this is not going well.

Marcus Shumate (14:08.57)
Right, right,

Marcus Shumate (14:19.632)
Yeah.

Marcus Shumate (14:23.258)
Yeah.

Marcus Shumate (14:28.452)
Yeah, that's yeah, and that is funny. I have to fight the impulse to like just do something that gives me a tangible product. And I think it's one of the funny things about like being a data and tech tech forward company in this space is that like, you know, we're always looking at tools and things that can help. And that's just a freaking rabbit hole, man. Like, you know, I caught myself the other day.

writing an SEO blog and looking at some of the AI prompts. And I realized like this whole thing is like gamified because this, I can get the, I can get a number or get a report on it where it's like, Ooh, this writings at a green and you're good to go. This looks great. And you tweak something and then it gets a little better. Then you tweak something and it goes down and it's just like, cool. I produced something and tinkered and tinkered and tinkered for my own anxiety or whatever. Cause I don't feel like accomplished as much on a Monday or Tuesday.

So there's this like impulse like to have to sort of really contain that time on Mondays and Tuesdays and then be ready to like prep or produce some stuff on Wednesdays and Thursdays and kind of throughout. And like that's normally kind of how my workflow is and I've become pretty devout and religious adherent to that, more so than I normally am, right? Exercise, sitting practice, research, that sort of stuff. And then

Wednesdays I try I know that I usually work really well in the morning. There's like a stretch from like 830 until about 1130 or so that I can just I can get things kind of done and called up and I always find that to be this thing sort of anxiety relieving piece and then usually follow something similar on Thursdays and Fridays and then try to Yeah, but you know, I think the other piece of this too is like what do you say yes to and what do you say?

know to in terms of meetings and people and maintaining relationships and all that sort of stuff, right? That has to be a lot more calculating for me, which isn't, to be honest, is not my natural disposition. So.

Tripp Johnson (16:42.228)
Yeah, I found I mean, I'm actually well, there's the there's been a lot of changes in the last six months. You know, new office in chapel. I mean, I had a kid six months ago, eight months, seven, eight months ago, and then new office like, least the one individual office three and a half months ago, bought the building two and a half months ago, renovated it. Now we're up and running.

Marcus Shumate (17:12.419)
Yeah.

Tripp Johnson (17:12.638)
And I've just gotten, I feel like I've just in the last week gotten back to like having some semblance of a like kind of routine, even though my day is not as super structured as I would like yet, like where I can do my yoga at the same time, sit at the same time and everything. But I've been real, I've been back on my, you know, I'm like obsessed with the old best self journals and I've added a few more, you know, we've talked about the,

Marcus Shumate (17:37.178)
Yeah.

Tripp Johnson (17:41.602)
I've gotten a little bit back into so I every day I have my habit tracker for sitting, practicing yoga, learning something, creating something, try to get 10 ,000 steps for I just feel better when I move like it seems dumb and I hate like the but like you just got to walk like you got it like I'm not going to go for a run. have no interest. I don't even like lifting that much, which is the other one. And then like, I've just been really trying to get those things in and track it.

Marcus Shumate (17:56.634)
Yeah.

Tripp Johnson (18:11.914)
And it's just paid off a lot. you know, less of that anxiety. I I've created that I have that learn and create piece, which I think, because I actually do it even on Monday and Tuesday. Like that's my, but like for me, like creating on Monday and Tuesday is like, maybe like the, the learn is like, I'm taking a course online and Python and I, because I want to be able to understand API is better and how to, you know, connect apps and talk to developers, more at the right level.

So I'll at least do like a 15 minute course to like check the box and kind of like get some momentum. And then I do like a social media post or like create some piece of art for the office. Like it helps me scratch the itch because like I think I was feeling so bad about it that like I needed to get some sort of wins. But yeah, anyway.

Marcus Shumate (18:45.914)
Right.

Marcus Shumate (19:05.444)
Yeah, no, I totally get that. mean, it's like the walking piece that you just mentioned is really funny because this becomes such a like, if I can tell that I have the, like there's these periods of time where I'll hit this really, really pleasant like workflow where I don't want to stop. But then it's, hit the, I'll hit this point of diminishing returns where it's like just exhaust, like just mental fatigue and exhaustion. And I, know, you'll start to feel the anxiety come up and all that sort of stuff.

Tripp Johnson (19:26.924)
Yeah.

Marcus Shumate (19:35.088)
It's not necessarily like you have to suffer from the anxiety, but you can still have it and it can be unpleasant, but you don't have to suffer with it because you're not wrestling with it necessarily. But what becomes interesting is like how effective a 10 minute walk is. I have to look like a lunatic to my neighbors. Like you walk outside barefooted and just go pick up a bucket of heartworm.

Tripp Johnson (19:50.646)
Yeah.

Tripp Johnson (19:58.408)
yeah. Yeah. I walked down to the gas station, grab a diet, Dr. Pepper and get a, get a mile in. Good to go.

Marcus Shumate (20:04.044)
Yeah, we're usually on the same cadence with that.

Tripp Johnson (20:08.278)
Yeah, the Yeah, that's the other I think like, as well as we've grown, and I think this is just natural, like as you grow in an organization, and you're at kind of the top of it, you know, there's, I think one of the things that I've pushed you and myself, but you know,

with you to stay focused on is it's not just like how much we work. It's just like making sure we're working on the right problems. And that like stepping away to go for a walk is like often how I'm like, okay, I'm good enough here or yeah, I'm working on the right problem and I can like reset and feel a little better about it or just say like, I don't have anything left in the tank and we'll try again tomorrow. But yeah.

Marcus Shumate (20:50.48)
Dude, you know, we've talked about that. We landed on this last week. was like, it was really orienting and helpful for me is this idea of like iteration, right? Like we're not, man, you know, I think about this with some of the Sam Harris lectures and things that I've listened to or some different meditation teachers. Like oftentimes like we labor under this idea that some that like will finally be done, right? Like that there will be no more problems to be solved that like we've arrived.

Tripp Johnson (21:00.404)
huh.

Marcus Shumate (21:19.524)
shit is so buttoned up that it's easy sailing and coasting. it's one of those things that if you just spend like one second reflecting on it, you will see that there's absolutely no evidence that that aligns with reality at all. And so oftentimes, if I'm, again, if I'm not careful to just get out of, to do some sort of movement or just start walking around in some sort of capacity, like I really do start to let,

unconsciously or without volition, without choice, just starts to weigh on me. This idea that if I could just do a little more, a little more, a little more, I'll be done. I like, we're not going to be done.

Tripp Johnson (21:53.942)
Yeah.

Tripp Johnson (21:59.786)
Mmm.

No, and all it takes to say, mean, again, one fucking air and thought passes through your head and you go from like, I'm relaxing on the couch to I'm a piece of shit. you know, so like, mean, yeah, like the idea, you know, so I think that's, that's a good segue. You know, like that's why you got to fall in love with the problems, right? Like, I think like that's...

Marcus Shumate (22:14.448)
It's 3am every morning for me.

Marcus Shumate (22:28.121)
Yeah, yeah,

Tripp Johnson (22:30.496)
That's been one of and even why like even for me when I just went through my checklist, like I have like my checklist says learn and create. Like it says lift, practice, walk like these are very accomplishable tasks. But like, if I get to like I can love the problem. But if I'm too obsessed with like making some arbitrary progress to it, I'm going to drive myself crazy.

and it's not going to become enjoyable. like it's yeah, it's a constant balancing act.

Marcus Shumate (23:04.148)
That's the phrase that's come to that pointer instruction that's come to mind recently for me is that just begin again. There's always just every day it's just just begin again. Just get it in. Like any time I'm in a sitting practice or like in this. God, like this is.

Tripp Johnson (23:11.116)
Mm -hmm.

Marcus Shumate (23:23.76)
Like having a good, I don't know, good is not the best word, but like having a contemplative practice where you're looking and sort of considering and pondering the nature of mind and all that sort of stuff, or just experiencing the nature of mind, however the best way of saying that is, or whatever.

It's absolutely fascinating for this sort of stuff, right? Because it is so easy, like you were saying, that one errant thought, like, man, I freaking suck. There's no I to actually suck at this, right? It's just you're experiencing that right now and then just begin again. mean, like this whole idea of whatever went wrong today, whatever went right today, you will just begin again. then you have no choice of it. You can fight that. You can go with it.

But frankly, I find that to just be this tremendously relieving sensation to sort of have or experience this just beginning in, think, so you do anyway, it's going to happen one way or the other, But I think about this with like some of the data projects that we were working on, I think last week, we, least relative to some of the like growth department and marketing efforts, we had kind of a good breakthrough with some of the

Tripp Johnson (24:29.13)
Yeah, that's all you can do anyway.

Marcus Shumate (24:47.524)
the data and reporting. And then we quickly landed on this is just the first iteration of this. And so we're just going to start reporting on this, knowing that we're going to look back in three months on this reporting and we're going to wonder why we were reporting in that way, right? Like that it wasn't useful, that it was not sufficient. then we're, so it's always just going to be this process of iteration and beginning again.

Tripp Johnson (24:56.736)
Mm -hmm.

Marcus Shumate (25:15.438)
You lay the foundation, but you just keep coming back to it. And there is something very relieving to me about that. You're not like, don't have to, it's, there is no final draft of any of this stuff. It's always this iterative building process.

Tripp Johnson (25:15.456)
Mm -hmm.

Tripp Johnson (25:32.278)
Yeah, totally.

Tripp Johnson (25:36.668)
Yeah, what else is going on? Do we want to talk about the book I'm Where did it go? I think I lost it. It's by the guy who started Waze. But it's Falling in Love with the Problem, Not the Solution. And I mean, I think it's easy to understand that kind of methodology.

Marcus Shumate (25:45.816)
Yeah, I want to hear about the book you're reading.

Marcus Shumate (25:57.53)
Mmm.

Tripp Johnson (26:05.93)
And we can go in a number of directions with this. But the way I think about this is like I fall like I have personally and I think you have like fallen in love with this health care problem. And we could zoom in at a level and say again, one of the things that I find interesting about this problem is how cumbersome patient onboarding is and we want it to be as easy as calling an Uber. Like I can share my contact card with you.

Like, shouldn't I just be sharing my medical history when I walk in with you? Like once, like from an app. If I don't want to share everything, just like when you're sharing a contact info, you can click what you want to share and you know, whatever. Seems great. Like that's one process improvement. You know, other improvements are like transparency just around pricing, right? Or around compensation. So like there's so many problems about delivering high quality, you know, healthcare that's affordable.

Marcus Shumate (26:36.154)
Right. Yeah.

Tripp Johnson (27:01.974)
that there will always be problems. A few years ago I was worried that if we didn't pick the right problem to solve, they'd all go away. At a macro healthcare level, when there's like, no, motherfucker, you don't even know enough to have interesting problems to solve yet.

Marcus Shumate (27:12.494)
Yeah. Yeah, yeah, yeah.

Marcus Shumate (27:22.192)
Yeah.

Tripp Johnson (27:24.04)
And like, don't, still, now I feel like I'm further away from even landing on like the big one than ever. Well, we're still, mean, while we're, you know, we're addressing market needs, but I don't think we've found anything like truly innovative yet, but that begin again is like, again, we're just going to come, we're just going to solve another problem tomorrow. And hopefully there's some strategic direction that is taking us somewhere instead of just like, you know, swatting away flies.

Marcus Shumate (27:30.863)
Yeah.

Tripp Johnson (27:53.28)
like because you can problem solve like that you can just bail water out of the boat all day to keep a float which is like what it felt like with Green Hill back in the day versus like what we're doing now is like it feels like just a thousand mile march where you're you're taking your licks but you just keep going.

Marcus Shumate (28:02.639)
I'm sorry.

Marcus Shumate (28:11.855)
Right.

Yeah, there's this tension, I think, between the idea of solving the problem in front of you. There's always the tension between the most pressing problem and then what's the future hold. I think all of us are always sitting in tension with that. That's become much, much clearer to me.

Tripp Johnson (28:22.518)
Yeah.

Marcus Shumate (28:38.626)
Right now, right? Like is this, there's going to be immediate problems that pop up that have to be solved. And then there's going to be these long -term problems and these long -term projects that will never be solved. They're just iterative over and over and over again. But man, don't know. like as taxing as that sort of stuff is, it's fun. It's enjoyable. Like, I don't know, like a lot of people, maybe that's not their interest and,

Tripp Johnson (28:55.115)
Mm -hmm.

Marcus Shumate (29:08.044)
That's cool, man. you there's, you don't always need like not everybody needs to function the sort of same, but, there is this sort of joy that I think I derive from, that sort of, from abiding in those tensions.

Tripp Johnson (29:19.093)
yeah.

Yeah, I mean, that's always the, you know, constant tension between like performance today and like building an enterprise for the future. Or, you know, it's a Yeah, because like, yeah, and I've largely decided that, you know, it's more fun to build for the future. And we have to maintain enough currently, but we can maintain a lot better with good data. We don't have to be as like, you don't have to try as hard if you've got

Marcus Shumate (29:43.609)
Mm

Tripp Johnson (29:52.084)
clear data in front of you about performance and what's going well and what's not. And it's a lot less mythical. So when it's not going well, you don't just try harder. You just, you're like, say, okay, we need to fix this. Let's pull the binder off the shelf and let's go fix this and put it back on the shelf versus like, we just got to go out there and call more people. We got to go do this. We got to, know, which is, dude, I'm going to, I want to go on a rant about this.

Marcus Shumate (29:56.463)
Right.

Marcus Shumate (30:09.902)
Yeah.

Marcus Shumate (30:16.004)
That's the worst feeling.

Tripp Johnson (30:21.57)
conference coming up the global exchange, which is, to me the epitome of the problems with private pay healthcare, which ends up having ramifications throughout healthcare. There's this giant conference that's starting. I don't even know when it is, but I went to it last year. And I think within just arriving at the Walt Disney Resort, I was like, I should not have come.

Marcus Shumate (30:49.988)
them.

Tripp Johnson (30:51.402)
And you've got these like all star, you know, you've got some like true thought leaders in the field. Dan Siegel, I'm blanking on the guy who's the guy from Harvard, the addiction guy, John Kelly, you got some like rock star people, like absolutely. But then like the people who are in attendance are the people blowing thousands of dollars from all over the country or the world because it's global. You got these people blowing thousands of dollars to go talk to the top of the field.

Marcus Shumate (31:01.284)
Yeah, John Kelly. Right.

Tripp Johnson (31:20.892)
And those people's background is mostly in like clinical research and public health. And none of us are applying any of what they're saying to those populations if you're paying thousands of dollars to go to a conference. So really you're just all hanging out with the same people doing the same thing, talking about your horses and your mountain biking and your canoeing. And those are great things, but like we don't need to go to Walt Disney to do it.

Marcus Shumate (31:38.831)
Yeah.

Tripp Johnson (31:50.238)
And it just bothers me to play in that world that that's what you do. And there's not a real discernible value in it, in my opinion.

Marcus Shumate (31:53.36)
Thank you.

Marcus Shumate (32:04.922)
What's interesting, because I think these sort of behavioral health conferences or whatever you want to call them, they tend to bifurcate and split into two different directions. And in some ways, that actually mirrors what I think is the largest issue with a lot of therapeutic clinical work, is that there's this really sharp divide between research and practice. And so what you end up with in terms of the people practicing is you end up with a bunch of people that don't have a research background.

or even I would say decent ability to ascertain knowledge or to like see what like knowledge is, right? Like they just, they see an expert in front of them speaking. And so it becomes this, becomes the, know, that, that's, that is the research, right? For them that is they, someone else has done it. They don't, they can't judge it for any of their quality. I'm speaking to the expert. So you have that line.

And then what you end up having is this other sort of conference where there's actual researchers, people that are doing the academic work and they're presenting. And oftentimes you're not seeing those two things intersect.

Tripp Johnson (33:14.786)
And these are just marketing events that are veiled in a very thin cloak of like, get your CEUs. Right? Like, these are the top minds. Like, come on. Like you would be better served by reading a book and actually like trying to learn something than you would going to an hour talk and saying like, now I'm no more about heart spotting.

Marcus Shumate (33:22.64)
Yeah.

Marcus Shumate (33:37.252)
Right. Yeah. Like I presented at those conferences. I'm not an expert at anything, right? Yeah. That's true. I forgot about that. It's interesting. I was talking to a therapeutic consultant sometime last year and he had gone to the Low Country Behavioral Middle Health Conference in South Carolina. And I've always wanted to go to it. I've always heard really good things about it. And like typically

Tripp Johnson (33:42.895)
No, no, I've those conferences.

Tripp Johnson (33:49.571)
yeah.

Tripp Johnson (33:59.274)
Mm -hmm.

Marcus Shumate (34:06.788)
you know, if I'm wrong on this and they brought in, you know, someone, you know, deviated from that, don't take my word for it. don't know. But, you know, in years past, it's always looked like there was academics being, you know, coming presenting up to date research, like interesting stuff. And so I was talking to this consultant about it. said, man, what was that like? He's like, well, it's a lot different than the normal conferences we go to. He's like, where people like you are speaking. And he was like, he was good. He was like, go to me a little bit. Like, yeah, like this, like you got like,

we go out there to Stanley Bell marketing versus he's like actual academics and people doing the research and presenting it. And I think there is, and I often, when you look at things like the replication crisis or like some of the academic research on clinical practice, there's just such this bifurcation between people practicing and people researching. And I find that to be something kind of fascinating.

And maybe a more clear point of that that I really love is I've often been really, when I hear someone like me, IE someone that maybe they're broadly intelligent or something like that, but they don't have a tremendous amount of expertise in anything. And I hear that person start talking about neuroscience and you realize like neuroscience becomes this like proxy word for

Hey, I'm really smart and don't poke around at this too much.

Tripp Johnson (35:31.658)
Yeah, we're going to use a lot of big words about the brain and Adam.

Marcus Shumate (35:34.49)
We're going to use a lot of video. versus like, man, I have to look this lady's name up. She's great. But I read this really cool article and she was an actual neuroscientist and researcher. And she was talking about how much it drove her crazy to listen to people talk about neuroscience. And it's all marketing, right? Like they all had some sort of, it's like biofeedback. It's this, it's that. You repackage it. It's, know, this is why brain spotting works. This is why whatever.

Tripp Johnson (35:53.858)
Yeah, 100%.

Marcus Shumate (36:02.85)
And they start speaking about it with some degree of authority and like they use the language that's, you know, people don't have access to, so you can't penetrate it. And she was saying what drove her crazy about it is like, is a science, like neuroscience is this really new sort of thing. And her metaphor was like, it's, it would be like listening to the radio, opening the radio and expecting to see the newspaper. And it's just, that's not what it is, right?

Tripp Johnson (36:31.466)
Yeah. And I mean, there's also, mean, don't talk to me about neuroscience if you haven't already read like Sapolsky and Sam Harris. And at least like, you have to be able to refute that because the fundamental premise just being A, we're not, there's no you there. There's no free will. And so we are now superimposing this idea that

Marcus Shumate (36:39.588)
Yeah, yeah.

Tripp Johnson (36:55.744)
we're using neuroscience to justify our free will to do things as a clinician or as like, this is what's going on with the patient. And it's like, but you're, ignoring the fundamental premise that like the brain, you know, the brain is doing things before we're aware it's doing it. like it did, I mean, it just doesn't, yeah, it doesn't, it doesn't work out. And the other piece I was going to say, you know, I haven't, I feel like I have kind of an interesting firsthand experience with the research versus

Marcus Shumate (37:12.142)
Yes.

Tripp Johnson (37:25.536)
maybe secondhand research versus like clinical practice, like with my wife, you know, she's a, was a master's level speech pathologist, got a PhD to go kind of clinical and academic and, or sorry, academic and research. And yeah, I mean, it's, it's a totally different world. And it doesn't even so like, let's, let's go back to what's the gold standard in, in clinical research, randomized controlled trials.

randomized controlled trials, and none of our programs have any randomization to it. And they're definitely not controlled. So, you know, we're not taking a sampling of the population, which actually gives some credence to like, hey, if we're treating a specific niche, maybe the population research doesn't apply. Like if we're treating rich white kids, maybe there's not research out there on rich white kids. But

Marcus Shumate (38:22.158)
Right.

Tripp Johnson (38:23.66)
But again, the fundamentals of what people need are going to be the same. I, I, I've actually pushed back. I pushed back a few years ago on the idea of evidence -based practice because I thought it was bullshit anyway. But I've come back the other direction to say it's not bullshit, but I'd just never seen anyone like really doing it because back to like the fundamental problem that people in behavioral health, especially higher levels of care are solving for is census. The primary.

problem of the organization is growing the census and expanding the locations. Like that's the game. So the conferences are set up, you know, so that you're just out there talking to each other about your own programs. Like your agenda there is not to learn. And anyone who says otherwise just needs to look at how many marketers are there versus how many clinicians are there.

Marcus Shumate (39:08.442)
that.

Marcus Shumate (39:19.384)
Yeah, and even then it's the I've seen attempts at this before where you read it It's the we're gonna get the leaders to speak or we're gonna have whatever But it's like you're not again, right? Like you're not talking about policymakers. You're not talking about someone that's This doing academic research. You're not talking about like that's not usually what it is It's like what is the person that's been able to brand themselves as the expert? Shockingly easy to do right like you just repeat something long enough with enough

Tripp Johnson (39:47.04)
Yeah. I mean, you presented on AI the other day. And like, -f -fuck now.

Marcus Shumate (39:55.31)
Yeah, and it's funny, know, the paradox of all like this stuff, it's, it always reminds me of South Park or something where they like one of the characters is pointing out like, hey, I'm not an expert on this. I don't know what I'm talking about. Like this guy's being humble. And it's like, no, no, I'm not trying to be humble. Like I think I'm broadly intelligent or something like, but there's a difference in it. the metaphor that I've kind of land on to try to explain this is like, you know, I'll make you roll your eyes, but maybe Kristen will feel good.

Tripp Johnson (40:15.424)
Yeah.

Marcus Shumate (40:24.538)
if she ever listens to the jujitsu, right? Like I'm pretty good for an amateur, right? Like I hold my own, all that sort of stuff. But literally the second that I like wrap, like tie up with someone that actually competes at a professional level, it's like, I'm out of my depths immediately, right? Like there's, and there's a difference between like having casual familiarity with this and understanding the concepts and being able to speak about them versus the level of expertise that comes into play. And it's like,

Tripp Johnson (40:27.944)
Yeah

Marcus Shumate (40:54.512)
When those two things come into conflict, it's immediate and apparent, right?

Tripp Johnson (40:58.528)
Yeah. Yeah. And then the, you know, but to the flip side of that, right? Like Nick, I know showed someone how to use chat GPT yesterday. And I mean, that's like life changing if you're like, if you're not using it. So, you know, I guess it, you know, it is all relative to just to, you know, you're not that big of a dumb dumb on the AI. But yeah. Yeah, it'll be, it'll be interesting. I'm, I'm

Marcus Shumate (41:10.894)
Right? Yeah.

Marcus Shumate (41:20.068)
Nah.

Tripp Johnson (41:28.106)
Yeah, back to the conferences. I don't know what I'm trying to think what I want to see though. I've complained a lot over time about the problems with private pay and the problems with what I consider like conference culture. But I'm really working on like articulating a thesis on like what I'd like to see. And I do think it goes back to, but I don't know like who would even be involved because to your point, right?

the real problems are solved at the intersections of industries to some extent. So to me, the real problems are solved when you combine healthcare with technology, with policy, with insurance companies. That's where real change happens. And that's not really very sexy. There's so many substantive things that we could talk about at conferences that we just don't.

Marcus Shumate (42:26.18)
Yeah.

Tripp Johnson (42:26.262)
So anyway, I guess I need to come up with the conference that we want to host and probably won't be well attended, but maybe substantive.

Marcus Shumate (42:35.476)
Yeah, right. Yeah, there'll be five people there, but they'll be interesting to each other. Yeah. I think that is an interesting proposition, right? Like it's one thing to, they always ripple like postmodernists and stuff for this. It's like, listen, deconstructionism is fun, right? Like ripping something apart super easy, but then building a solution is

Tripp Johnson (42:43.146)
Yeah.

Marcus Shumate (43:03.172)
for building the alternative is where the real work and meaning, you know, like quote unquote, meaningful stuff happens.

Tripp Johnson (43:08.438)
Yeah.

Tripp Johnson (43:12.212)
well we got anything else? I know you gotta get out town soon.

Marcus Shumate (43:16.066)
Yeah. Yeah. Nothing really on my end.

Tripp Johnson (43:19.562)
How many, let's see, this will be interesting. Maybe we'll end each podcast with some stats on the podcast, because.

Marcus Shumate (43:31.184)
Don't we really want to do that to ourselves?

Tripp Johnson (43:32.482)
No, no, we don't, but we're going to do it anyway. All right. So, over the last three podcasts, we are downloading, we are averaging 15 downloads per podcast. And I'm one of each of the, you know, I'm one of those obviously, and you're not. look, outside of my family, are 10 people who could regularly listen. So, thank you.

Marcus Shumate (43:35.6)
Hahaha

Marcus Shumate (43:46.441)
Ayyyy

Marcus Shumate (43:51.056)
Hey, but I'm not. I'm not one of them. Yeah, I can't stand listening to myself talk on a recording.

Marcus Shumate (44:00.88)
Yeah. Yeah. Yeah. Maybe next time we can start putting up my, my growth and digital numbers too. That'll feel good.

Tripp Johnson (44:02.399)
It means a lot.

Tripp Johnson (44:11.874)
But wait, wait, we did go, let me say, let me say we went 13, 15, 17. We're on an upward trend. Then we hit maybe even 20. So please, please like, share, follow, you know, we're trying to grow the podcast to grow transparency because there's a huge need for transparency and that's our mission here at Open Source Health. Woo!

Marcus Shumate (44:17.582)
Yeah. Pretty sizable growth.

Marcus Shumate (44:37.626)
That's sizzle reel.

Tripp Johnson (44:39.134)
All right, deuces.

Marcus Shumate (44:42.53)
Alright, peace.