Bill Fukui 0:08
Hello everybody. I want to welcome you into another episode of The MedShark Insider. I’m Bill Fukui with MedShark Digital, and today’s guest is, I’m privileged to have really, a well-known and respected clinician in the psychiatry field with a specialty primarily in treating major depressive disorder and other types of emotional types of patients. Dr. Melissa Fickey. Hi, Dr. Fickey.

Dr. Melissa Fickey 0:45
Hi there, Bill. Thanks for having me.

Bill Fukui 0:46
Yeah. Well, I want to give you an opportunity to—I was so impressed when I first met you. I mean, we—you were already kind of working with one of my colleagues already, and had a relationship with her, so I didn’t get to know you right off. I wasn’t the first one you met with at our agency, but when I looked into you, I had a conversation with you. I was very impressed with your credentials, which is why I wanted you on this show. So do me a favor if you can kind of give a little bit of background to our audience, just so they can get to know you, you know, on your terms.

Dr. Melissa Fickey 1:26
Sure! So as you stated, I’m Dr. Melissa Fickey. I am a child and adult psychiatrist. So I did medical school at the University of South Florida, and then did my adult psychiatry residency at the University of Florida, followed by the child fellowship back at the University of South Florida. I’m born and raised in the Tampa area, and I started private practice shortly after finishing my child fellowship with another office in 2010, and around the end of 2014, I decided I wanted to venture out and start an idea I had of my own of how I wanted mental health to be delivered in a certain type of space and environment that was really esthetically pleasing, inviting, very calming, kind of a spa-like feeling, and putting a kind of a different face on mental health. I felt that a lot of places weren’t as caring, inviting, as esthetically pleasing, as comfortable as it should be, especially with mental health patients. And so I wanted to make them feel special and wanted them to feel happy and excited to come to their visits at our office, and to really offer a caring environment where we listen well to our patients and really do a very thorough evaluation. I think that my child fellowship program, being trained in child, really prepared me for seeing the individual as a whole person, all the way back from childhood. So that really has been important that we do a very thorough evaluation of every individual, where everyone is different. No one fits into a box, no one. You don’t really treat diagnoses per se. I mean, it’s important to tease out diagnoses for sure, but no one fits into a box. I treat more symptoms. Sometimes it’s more of an art in treating psychiatric patients, so it’s really important to be a good listener and to ask the right questions. So we started our private practice called Embracing Life Wellness Center in Riverview, Florida, in 2014, and then in 2023, we started our second location in the South Tampa area. So we treat patients ages 5 to 65 and we’ve been growing ever since we started, because the need is there, and I feel like we do a good job at it, so I don’t feel so overwhelmed, because I’m growing at the right pace, and we offer good care. So it feels very rewarding. So it’s now myself and six other nurse practitioners, and we have probably a total of about 21 staff members.

Bill Fukui 4:11
Great. And you kind of mentioned, you know, and we helped you build your website, and I can already tell when I first saw your website, because, again, I wasn’t the one that was actually doing the work or participating in that. When I did finally get a chance to see your website, I can already tell you had a big thumbprint on what that site looked like—the images, the quote “brand” in it—it had your stamp, right? What is, and I will say, I encourage people, you should look up her website. I think it sets the standard, in my opinion, of trying to communicate a brand. It’s exactly what you said. You wanted to create a different environment when it comes to depressed patients—they need, or want, or really should have a different environment than just going into a medical office in a small little room. Where did that all come from? Where did that vision of what, where you got to today, that’s—you have the most amazing place, right?

Dr. Melissa Fickey 5:30
Well, I feel like, first of all, when you’re dealing with mental health issues, when you’re talking with patients, they’re struggling, and we all are struggling, right? We all have our own issues as well. So I feel like, you know, everybody has their own history, their own stressors, and including me and my workspace, so we wanted to work in an environment that’s also inviting and comfortable and that we want to be at. Because when you’re dealing with stress all the time, you want to be in an environment that’s esthetically pleasing and calming and spa-like. So I wanted it selfishly, also for myself and our staff, but also for our patients. So I just felt I wanted them to feel comfortable and special, because I felt a lot of other offices weren’t like that, and I wanted it to feel very inviting, and that they have individualized care, kind of almost boutique style.

Bill Fukui 6:27
Mhm, mhm. The other thing that I will say is, I like what I’m hearing when you say that, you know, treatment and diagnosing, you know the course of treatment, it’s not cookie cutter, right? It’s not in a box, you don’t just one size fits all kind of thing. And it is about asking the right questions. And I would say, more important to be a better listener than it is to be a good talker. You know, when it comes to, you know, clinically treating patients, when it comes to interviewing patients, what’s your—how are you thinking in terms of when you’re sitting down with a patient, because they’re not all the same. How do you size up a patient, and how do you know what you need to be asking that patient to kind of peel back the onion?

Dr. Melissa Fickey 7:29
Well, I—we first start by obviously asking them, what was the impetus to bring you in? So what? Why are you here today? What? Why now? You know, what? What’s going on at this moment that decided, that made you decide to come here? And from there, you know, you don’t—what happens a lot of times is some people will just focus on that chief complaint, that only thing, well, there could be a lot of other things behind that the patient’s not really aware that they’re experiencing unless you ask the right questions. So I make sure that I’m asking all symptoms to check all symptomatology so I can get a clear idea what’s going on, even if the patient doesn’t broach that topic. So you got to have the tough conversations. You also need to steer the interview sometimes, because you can’t spend so much time on one thing on that first visit. Because I really need to—the first visit, I need to make sure I do no harm. If we’re going to prescribe a medication, I got to do the right thing at that moment. And if I don’t feel that I got enough information on that visit, we’ll hold and let’s follow up again, maybe next week or the following. Because one thing I want to do is not to prescribe the wrong medication or the wrong treatment plan. So sometimes I will steer the patient to make sure that I’m getting all the questions answered that I need to in that eval in order for us to come up with the proper treatment plan. So you have to have those hard questions. Asking about things about trauma. You want to ask about things about eating disorder behaviors, things that might make them feel uncomfortable,

Bill Fukui 9:14
Uncomfortable, yeah.

Dr. Melissa Fickey 9:15
Might make them feel, you know, it’s a tough topic, but maybe no one’s ever asked that before. Often, when people leave and say, no one’s ever asked me so many questions before, broke it down like that, but that’s the proper evaluation that we want to make sure that we do.

Bill Fukui 9:30
Yeah, you know. And I think, I think you’re right, and I think the—you know, the—this, I think the word is vulnerable. Even patients are, you know, when they they come in and they’re, they’re kind of raising their hand. I’ve got a problem, right? They are vulnerable when it comes to this, so—but at some particular point, they’re also, you know, keeping some things close to the vest that they haven’t shared with other people. I find that that’s, you know, as—I don’t know, is—would you call that more of a skill or an art, in order to basically get people to, you know, open up, right? Okay, fine, I’ll tell you, right?

Dr. Melissa Fickey 9:56
I think it’s somewhat of an art in being empathetic and allowing that patient to feel comfortable feeling vulnerable, and so having those difficult questions. Sometimes they—if they—they may not want to say anything, and you could say, and that’s okay, we don’t have to go there today. Maybe down the road, you’ll feel more comfortable and you move on. But if you don’t ask, they won’t share, probably, and so you might miss out on nuggets if you don’t ask the right questions.

Bill Fukui 10:19
You know, and it is, and I will say, with patients of any kind. It is a relationship. It’s not a one-time prescribed treatment, and we’re done, right? It is, it is the relationship. And you’ll find that as the relationship builds, you’re learning new things about them, like, like any other kind of relationship, right?

Dr. Melissa Fickey 10:56
Absolutely.

Bill Fukui 11:01
You learn more. And you know, they may, you know, expose. You may get exposed to something you didn’t think of before, or ask or know about them that, oh, you know, the light turns on, right?

Dr. Melissa Fickey 11:17
Right, absolutely.

Bill Fukui 11:18
So one of the things that I’ve also found out about you, is, you are, you know, highly into the, you know, the research of all of this, right? There’s, give me a little bit of insights on some of the things that you’ve done, beyond just being a clinician, but participating in, you know, advancing the, you know, advancing treatments.

Dr. Melissa Fickey 11:30
Well, we make sure that we stay up to date with all the ethical standards and the guidelines by the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry. So I make sure that I am up to date with all of the, going to all the conferences regularly, including like Site Congress, and also making sure that I’m up to date with the newer treatments. One example would be like Neurostar TMS. So that’s not really a new treatment. It’s FDA approved since 2008, but it’s new to patients. So being abreast of all of that, like with the clinical TMS society, making sure that I’m attending all of those, making sure I’m just on top of all the new options for our patients, is really important to us, because we want to make sure we’re staying up with the times and offering the best care that we can.

Bill Fukui 12:20
You know, one of the—you had mentioned, you know, Neurostar TMS. And I know recently that TMS has now been FDA cleared. Neurostar TMS has been FDA cleared for the treatment of adolescent. What does that mean when you say adolescent? I’m not exactly sure, as a lay person, what does that mean?

Dr. Melissa Fickey 12:46
Yeah, so the FDA clearance was for 15 and older, and that’s 15 to 21. Now some insurances were covering, actually 18 and up, but it was approved just for 21 and up, but insurance would still pay for the treatments. However, now we have down to 15, which is just a huge advancement in the field of psychiatry, because there were only two options that were actually FDA approved, and that was two medications, which was Lexapro and Prozac. That’s all we’ve had. So we’ve been using a lot of things that were off label because there wasn’t much. But now we have the Neurostar TMS that we’ve known has been a very safe procedure, you know, no systemic side effects. But now we actually have the FDA approval for it and clearance for it, which has been very exciting, has opened up a lot of doors of treatment options now for patients that otherwise maybe couldn’t afford it as a self-pay option.

Bill Fukui 13:42
Yeah, so you know, for those patients, and you’re right, because even though TMS has been around, transcranial magnetic stimulation has been around for gee, the, you know, a long time it’s been around, but it hasn’t been overly exposed to the general consumer. Consumers, you know, if I talk about Invisalign, people know what that is, right? Or Align Technologies, people know what that is, TMS, not so much. I can probably walk down the street and ask 20 people, have you ever heard of TMS? And they’ll, you know, it’s crickets, right? Give me and our audience a little bit of background on what TMS is.

Dr. Melissa Fickey 14:27
Sure. So transcranial magnetic stimulation, this is, it’s a machine that delivers magnetic pulses. It delivers it to the area of the brain that’s involved in emotional regulation. If you’re doing it for you know, depression, anxious depression. There are different things that it treats actually, that may not be FDA approved yet in the United States, but it is improved for other things in Europe. And there’s a lot of things that’s going to coming through the pipelines, but right now, we have it approved for major depressive disorder, anxious depression, and OCD, smoking cessation. And so this delivers magnetic pulses, and by doing so, it forms an action potential across the neurons, which gets them to fire on their own and to essentially form new connections that are thought to be in the press patients, is thought to be some under activity going on. And so by delivering magnetic pulses and making these neurons fire on their own, as well as some neuroplasticity. You know, there’s that phrase: what fires together, wires together. So it’s getting things woken up that’s been underactive, and by doing so, it has not the systemic side effects, because it’s a localized treatment that’s going directly to the area of the brain, rather than taking a medicine that has to go all through the GI. Yes, everywhere and the brain. This is directed to the source, and it’s just—the results are amazing. It far outweighs the results that medications deliver.

Bill Fukui 16:06
So in terms of that type of treatment, you know, what qualifies or what, how can a patient know that they’re going to be potentially qualified to have that treatment and have insurance, you know, possibly covered for that?

Dr. Melissa Fickey 16:22
Well, so the American Psychiatric Association actually recommends Neurostar TMS after one medication failure. So insurances require, you know, two, three or four medication failures.

Bill Fukui 16:57
Oh my goodness, really?

Dr. Melissa Fickey 16:59
So, yeah, so, so anybody is a Neurostar TMS candidate? I mean, anybody. So it’s, it works far better than medication when you look at remission and response rates, there’s no systemic side effects. However, if you’re looking from an insurance coverage point of view, they might require two, three, or four med failures.

Bill Fukui 16:57
Okay, okay. And out of your patients, how many patients do you find where you know because you still do med management, you know as a course of treatment. How many of those patients are you finding that, you know? You know? They really are qualified as a patient regardless. Let’s put insurance aside, right? What percentage of your patients are you finding? You know, are really qualified patients, candidates for this treatment?

Dr. Melissa Fickey 17:33
I personally feel that every depressed patient is a qualified patient for the treatment. Every OCD patient as well. So all of them are qualified. I mean, if someone wants to do a treatment, and they failed one medic, and they prefer to try the medication and then it failed, then they’re definitely in the guidelines of our American Psychiatric Association, which is our guru of medicine, we follow their ethical standards or research-based guidelines, and that’s what they recommend, so they’re going to have a far more likely chance of improving their symptoms and reaching a remission by doing that then following a second, a third, and a fourth medication. So I feel that, I mean, we recommend it to all of our patients. We just want to make sure that they know that it’s an option. If we don’t let them know it exists, they won’t even, you know, have the information to make an informed decision.

Bill Fukui 18:22
Yeah, and I would say this, that it’s just informing patients. I mean, that’s where I think TMS is today, is they just need to know that there’s an option out there. That there’s an option. You know, I’m going to kind of take this a step back, and I have a huge respect for you as a business owner, as an entrepreneur with a different vision, right? When you’re talking about having a different environment for patients, what do you say to the, you know, to the clinician who’s either working for somebody, working in a hospital setting, or something like that. What did—what—what did you do where you finally—the light turned on, and so I said, I’ve got, what in your life, what changed? Where you said, you know what, I’m going to do something different. You said, I want to do something different. What was that? What—what thing made you do that?

Dr. Melissa Fickey 19:26
Well, I wanted to be able to, not only, like I said, set the environment, have my own place that sets the environment that I feel is needed in this space, but I also wanted to be able to set my own, you know, make sure my own T’s and I’s are dotted. Because my t’s are crossed, my i’s are dotted, because at the end of the day, it’s on me, and I feel like I do very well at making sure things are taken care of appropriately. So I, and then I made sure I hired appropriate staff to get it done. I think a lot of people you know, are understaffed, and so it makes their providers feel overwhelmed. I wanted to set my own hours that I want for me, you know, that I want to do. I don’t. I usually don’t work on Fridays, which is nice, and I, you know, so I can take the time off when I want. I think it’s important to have a good force on the front lines, so to have quality employees is very important that understands your vision and it feels the same passion you do where you do regular meetups, regular discussions, so that everyone is on the same page and shares in the vision that you have, so that that passion is always there.

Bill Fukui 20:43
You know, I can’t agree with you more. Regardless of the medical industry that you’re in, you are as good as your staff. You know, at the end of the day, your practice is as good as your staff. And I even look at practices that are focused on, you know, their reviews, and everybody’s talking about, oh, you know, when you I get a negative review, I hate that. You know, it—it becomes something they become obsessed with when they see a negative review. When they actually read through the review of a lot of those negative reviews, it’s not about the provider, it’s not about the clinician. It’s about their experience with staff. It’s their experience with, you know, the phone, the front desk, or with, you know, how you process something. It wasn’t so much the doctor, but it was the things that you’ve surrounded yourself with.

Dr. Melissa Fickey 21:42
Yes, great, 100%

Bill Fukui 21:44
You know. So how do you go about getting—you know, we could say we’ve surrounded ourselves with great people. How do you do that? How do you go about—

Dr. Melissa Fickey 22:00
Yeah, because it’s sometimes hard to find good quality people. But I do feel, so I am very involved in the hiring process. I look for certain qualities in someone when I’m hiring, and you also have to be willing to pay someone appropriate pay to get good work, too. So you can’t, like, nitpick, like, when you’re thinking, oh, if I pay someone $2 more an hour, that’s only $80 a week for less of a headache. I mean, you know, like, so I don’t nitpick as much regarding money. I feel like it takes money to make money, and that’s one thing. I put a lot of money into the business, but it comes back because of that. So I think quality people deserve quality pay. I’d rather have, you know, pay some people more, pay more to my staff, than have, like, double the amount of them that’s making less, and they’re just in there spinning their wheels. So I think quality people deserve quality pay. I offer good benefits, and I make sure, you know, I screen them well. I don’t want to spend all my time interviewing people in person because I’m busy. So I might first do a communication via an email, see how they talk, see how they’re responding. If it sounds, you know, appropriate, then I might do a Zoom. And then if that goes further from there, then I’ll meet them in person. If I don’t do the Zoom, I’ll have my office manager do the Zoom. And then before we hire them, I always meet them. I wouldn’t let anybody else do it but me.

Bill Fukui 23:25
Yeah, I think really two good primary points. I mean, when it comes to hiring good people, I agree. Unfortunately, a lot of practices say—they almost in their mind, this is what this position I’m going to pay for, regardless of who they have in there, right? They already have it in their mind. This position is worth this much. I think when you think like that, you’ve already set yourself up for failure for that position. That’s why it’s a revolving door. Because you’ve done that. You pigeonholed the people, whoever I’m going to hire, this is where they’re going to have to fit, right?

Dr. Melissa Fickey 24:06
And that’s one of the things. When I was at the prior office, one of the things was when you can’t expect the staff to do all this, when they’re only making this much, well, then I’m like, well, you could either pay them or get another person. So I feel like, and when you have, you know, consistency in your office and stability—T’s crossed, i’s dotted—everyone is less stressed, too. So you’ve got to have a well-oiled machine. In order to do that, you have to have quality people.

Bill Fukui 24:32
You know, I’m going to end this with one last question to you, and I don’t want it to come across in the wrong way. I’ve always—my own personality—whether it’s my dentist, whether it’s my orthopedic surgeon, my GP, they’re all women. Right? I’ve become more comfortable choosing female providers, and I have my own reasons for that, right? Do you find that true with your patients, that there is something—or how you market your practice, being a female provider? Is that different than, you know, than, say, if it were me running a practice, right? Are there things you do different as a female provider?

Dr. Melissa Fickey 25:23
Well, so—and I know we didn’t say this on our call, but my office is actually all women. I mean, at first, at first, my husband did start, helped me start the office. Then he actually helps take care of our kids. So, but he’s a great cook, too.

Bill Fukui 25:41
Hey, I would be a great—I would be a great stay-at-home dad.

Dr. Melissa Fickey 25:47
But we just realized that I feel that there is not only a like a mothering nature in psychiatry, kind of like they feel more comfortable maybe opening up and being vulnerable. I think men sometimes, unfortunately, feel uncomfortable admitting to certain symptoms, or, you know, feeling that it’s, you know, quote-unquote weak, if you know, that whole stigma. And so I think that having women is a little bit of a softer approach, and I do think that it bodes well for our office. But I have a lot of male, you know, providers that I know in the psychiatry space, that I know they’re amazing at what they do, but I think for our office, and it’s interesting that all of us, women too, we empower each other, we empower our patients, and it’s a really cool environment and vibe that you have all women that are really getting along and fighting for each other to just be better, stronger, and to have comfort and support. So I feel it’s something pretty special that we have.

Bill Fukui 26:53
I would have to agree. If I was in Tampa, I’d be your patient. And just for whatever it’s worth. It’s kind of gravitated to my family—my youngest daughter is just finishing up with her residency in pediatric neurology out in New York City, so she’s coming home. But yeah, I said the same thing. She’s going to be a great doctor. She is going to be a great doctor. She, in many ways, reminds me of you. So.

Dr. Melissa Fickey 27:48
Oh, that’s awesome.

Bill Fukui 27:49
So, in any case, I would love to have you on another show. I have some other ideas and topics I would like for you to kind of share your opinions on. So maybe I’ll reach out to you for another episode. But I appreciate all your time today, and I love your insights.

Dr. Melissa Fickey 27:53
Thank you so much. I appreciate you.

Bill Fukui 27:55
You bet. So have a great day. We’ll chat with you soon.

Dr. Melissa Fickey 27:56
Okay, bye, Bill.

Bill Fukui 27:57
Bye.

MSD Insider 27:59
Thanks for joining us for the MedShark Insider with Bill Fukui. Join us next week for another dive into all things medical marketing. All episodes can be streamed at www.medsharkdigital.com/medshark-insider.