Latest / The Inspired Stories Podcast / Wound Care: Dr. Payam Tehrani on Bringing Expert Wound Care to Nursing Homes | Healthcare Series

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Wound Care: Dr. Payam Tehrani on Bringing Expert Wound Care to Nursing Homes | Healthcare Series · The Inspired Stories Podcast

0:04
Welcome to another edition of the Inspired Stories podcast,
0:08
where leaders share their experiences so we can learn from
0:11
their successes and be inspired by how they've overcome
0:14
adversity. My name is Anthony Kotaspoti and
0:16
today's guest is Doctor Payam Tarani, CEO of SNF Wound Care
0:22
based in Beverly Hills, CA. They provide expert bedside
0:26
surgical wound and skin care for skilled nursing facilities
0:30
across the country. They focus on reducing hospital
0:33
readmissions by offering services like G tube
0:36
replacements, wound vacuum applications and in service
0:41
training at no cost to the facilities.
0:44
Dr. Tarani has been leading SNF Wound Care since 2017 and is a
0:49
Board Certified Wound Care Specialist with training in
0:52
internal medicine and hyperbaric oxygen therapy.
0:56
Before starting the company, he served as an attending physician
1:00
at Long Beach Memorial Medical Center, where he worked closely
1:03
with the renowned Doctor Michael Strauss to develop specialized
1:07
wound care programs. Under his leadership, SNF Wound
1:10
Care has grown steadily, earning reputation for outstanding
1:14
patient support and innovative treatment strategies.
1:17
Now before we get into all that good stuff, today's episode is
1:20
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1:48
Now back to our guest today, the CEO of SNF Wound Care, Doctor
1:52
Payam Tarani. I appreciate you making the time
1:54
to Share your story today. Thank you, Anthony.
1:56
I appreciate for having me. OK, so how did this all begin?
1:59
How did you get into the field of specifically wound care?
2:05
So I used to be a hospitalist, which is an internal medicine
2:10
physician at a facility at Long Beach Memorial Hospital.
2:14
And you know, as a hospitalist, you take in a lot of patients.
2:18
You know, when they go through the ER, they have, you know,
2:21
some issues, the hip fracture, what not.
2:23
They call you and they say, hey, patient's coming in with the hip
2:26
fracture and, you know, we have an orthopedic surgeon on call
2:30
who's taking, you know, the page of the OR, but we want you to do
2:32
their medical management. And, you know, so I would be the
2:34
medical management for these for these patients and they would
2:39
always use a specific, you know, surgeon, Doctor Michael Strauss
2:44
that, you know, it was extremely helpful and I had a close
2:48
relationship with him. And what would happen is that,
2:53
you know, he would do the surgery and then I would do
2:55
their medical management. And then after the when when all
2:58
was said and done, they would end up back at his clinic just
3:00
to make sure the patient's wound was healing.
3:04
So Doctor Michael Strauss would do their surgery, do the also
3:07
the, you know, the follow up wound care on these patients.
3:10
And then after some time I was told like, hey, come to my
3:13
clinic and, you know, see some of these patients for, you know,
3:16
basic wound care who have these wounds.
3:18
Some of them are healing great, some of them are not healing so
3:21
great. So I went over to his clinic one
3:24
day and he kind of taught me how to do wound care. 0 Expectations
3:28
took me and, you know, like a son and pretty much showed me
3:31
how to do wound care for all sorts of wounds, not just
3:34
surgical wounds, but, you know, pressure wounds, diabetic foot
3:37
ulcers, venous ulcers, all sorts of stuff.
3:40
So I kind of learned it, and that's kind of how I got into
3:43
the, you know, wound care aspect of life.
3:46
So for the layperson, the outsider, somebody not in the
3:50
medical profession, wound care to me is, I don't know, wash it
3:56
with soap and water. You put a bandage on it, you
3:58
wrap it up clearly there. I see you sort of smirking.
4:01
There's a lot more to it. Like, educate us what?
4:05
Why is this sort of a specific area of medical care?
4:09
So there's a lot more to it, depending on the amount that it
4:11
drains, the etiology of what caused it, you want to make sure
4:15
the cause is not there anymore. You know, the amount of
4:18
drainage, there's multiple different, you know, ointments
4:20
that we can apply to these certain ones help it, you know,
4:23
clean it up. Certain ones are for moisture.
4:26
So it's a little bit more than that.
4:29
But yeah, we see a lot of improvement with one cream
4:32
versus another. There's so many different ways
4:34
you can treat these rooms and a lot of it's trial and error.
4:39
Are there tests that you do on the wound to see?
4:41
I don't know like what the bacterial culture is.
4:44
So there's a lot of marketing out there for that, like use
4:47
this test, run this test. But our patient population,
4:50
because they're in nursing homes, a lot of them are
4:52
incontinent. And if they're, you know,
4:56
incontinent and you know they're going, you know, you swab these
5:00
wounds, you're going to grow multiple different bacteria just
5:04
because they're soiled and what not.
5:06
And then you don't know if this bacteria is really causing an
5:09
infection or if it's a contaminant.
5:11
So we really don't swab them as often because we're getting a
5:17
lot of contaminants and then we have to treat the contaminant
5:20
and then we're exposing these patients to a lot of
5:22
antibiotics. So we have more of a clinical
5:24
judgement. Do we think the wound is
5:26
infected? If we do, then we'll probably
5:28
get a, you know, a deep culture and go from there.
5:32
But just swabbing them, we will grow a lot of resistant bacteria
5:37
that aren't necessarily doing anything.
5:39
They're just hanging out on the wound and they just need to be,
5:42
you know, flushed off as opposed to taking antibiotics.
5:46
Gotcha. OK.
5:47
So we have Neosporin in our house.
5:50
Is that something we should be using?
5:52
I mean, Neosporin's great, you know, it, it works even in some
5:55
of these nursing homes we use in Neosporin.
5:58
But does it? You know, there's a lot of other
6:01
things that are a lot better. But there's no downside to be
6:05
using it. Sometimes I see articles online
6:07
that say oh it it's worse for the wound, it slows down the
6:10
healing. But.
6:12
I mean, I would put it, if you're home and you have a
6:14
wound, I would put Neosporin on it for a few days.
6:16
And if you see it's getting better, hey, continue.
6:18
If you see it's getting masturbated and getting worse,
6:20
you know, maybe time to reach out to somebody, be like, hey,
6:23
applying it, not getting better and go from there.
6:26
But yeah, it would be a good starting point.
6:28
OK. So, doctor, I understand that
6:31
you've introduced bedside surgical wound care in skilled
6:35
nursing facilities specifically. Is this a rather unusual
6:39
approach? So I think, you know, a lot of
6:42
these nursing homes have these elderly patients, a lot of these
6:45
elderly patients on top of their multiple comorbidities, they
6:48
have, you know, a long list of comorbidities.
6:51
Another one they have is the skin and wound issues on top of
6:54
it. As you get older, you become
6:56
more, you know, immobile, more bed bound and you know, you bump
7:00
your leg here, you lay in bed for longer, you get all sorts of
7:03
skin and wound issues. And, you know, certain, certain
7:09
nursing homes that kind of are in very rural areas, they are
7:12
sending these patients out to a, you know, getting an ambulance
7:16
because these patients are immobile on a Gurney, bed bound,
7:19
and they're transferring them out to a wound clinic.
7:21
And it's very costly. You know, they have to pay for
7:23
the ambulance, the whole transportation, right?
7:26
And who's paying for this, right?
7:28
So a lot of these, you know, physicians, we send out the
7:33
physician to the nursing home. And then on average, I would say
7:36
there's about a 15% wound rate. So if you have a facility that
7:39
has about 100 patients, about 15 patients will have a wound that
7:43
we would go out there and we would see pretty much anyone
7:45
with any sort of skin or wound issue.
7:47
This way you're avoiding that transportation costs.
7:50
It's easier for the patient, you know, the patient doesn't have
7:53
to be transferred out and and all that.
7:58
So you said let's cut out that expensive transportation
8:00
process, which is probably also relatively unsettling to the
8:04
patient and let's bring the care right to where the patients are,
8:08
right, the nursery facility. Where the patients are as
8:10
opposed to transferring patients out.
8:12
You know, imagine 15 ambulances a week trying to transfer
8:15
patients to wound clinics. OK.
8:18
So, OK, so you learn from Doctor Michael Strauss that kind of got
8:23
you started in this, and then what was sort of the next leap
8:26
into actually starting your own practice?
8:29
So started with him, I learned it and then as a hospitalist,
8:34
which is just basic internal medicine, following up patients
8:37
at the hospital. I would also go to the nursing
8:39
homes and just see them for primary care management and make
8:42
sure you know that everything's OK, their blood sugars and
8:44
whatnot. And I remember, you know, one of
8:48
the, you know, the heads of the nursing home says, hey, we're
8:52
using, you know, a certain company.
8:54
We're not happy with them. You know, your your patients
8:58
that you have that are under you also have wounds.
9:00
And then we heard that you're familiar with wound care.
9:02
Do you want to see a few of these patients yourself?
9:05
So we don't have to give them to this other company that we're
9:08
using. I'm just sure I'll see my own
9:11
patients myself and I'll take care of it.
9:13
So the few patients that I did have in in that facility, I saw
9:16
myself and I did a great job and I became friends with, you know,
9:20
the, the nursing home people. And then they're like, hey, do
9:23
you want a couple more patients? And I thought about it and said,
9:26
sure, I'll take a couple more, you know, patients without
9:28
having care. But the problem was it was a
9:30
weekly thing. I'd have to go there weekly to
9:31
see these patients. So I ended up going there weekly
9:34
to see these residents and they did well.
9:36
And then the nursing home's like, hey, like we plan on
9:38
cutting our contract with this company and going with another
9:41
company. But if you want the contract,
9:42
we'd be happy to give it to you. So I took one facility, that was
9:49
my first one that was in Long Beach, I don't know, 2/20/17.
9:54
And yeah, that was the first one.
9:58
And then they, this company had multiple nursing homes, 7:00 or
10:01
8:00. And then they kind of put me
10:03
into the different ones as well. They said, hey, come to this
10:05
one, come to this one, come to this one.
10:07
And at that time, you know, my full time job was to work in the
10:10
hospital. It wasn't really these nursing
10:11
home stuff. So once these nursing homes
10:13
became, you know, 789 nursing homes, I'm like, do I leave my
10:18
full time job at the hospital? And do you know full time
10:20
nursing homes? So what I was doing was I was
10:22
like, wake up at 3:00 in the morning, go to the hospital, see
10:25
my 25 patients at the hospital, leave at, like, 8:00 AM, you
10:30
know, from three to five, three to seven, eight.
10:32
See those patients, take all the calls that come in for them and
10:35
then also go to these nursing homes in the, you know, late a
10:39
lot. Yeah.
10:40
So it was a lot. And I was doing that for about a
10:42
good year and until these nursing homes became excessive
10:46
and I couldn't do the hospital work anymore.
10:47
Like, OK, I'm gonna just have my own business doing nursing home
10:50
moon care. So I just ended up, you know,
10:53
cutting the hospital work off, going to these nursing homes and
10:56
seeing these wound patients. And then I just got called for
10:58
more and more and more nursing homes.
11:00
And then some of these nursing home, like the heads would leave
11:04
and go to another city, another state.
11:06
They would call me and say, hey, can you come to Phoenix?
11:10
Can you come here? I mean, now I'm in Alaska,
11:12
Florida, Maine, all over the place.
11:15
And then, you know, it just keeps growing.
11:17
As long as you're, you know, you offer good service, you're
11:20
honest and you do what's right, you know, if they see you're
11:22
doing what's right and you're not just there billing and doing
11:25
it for the money, they honestly bring you in.
11:28
And I think that's kind of where I grew was because we don't
11:31
always do what's profitable. We do what's right.
11:34
Payam What was it that you were doing that was so different
11:39
slash better than the companies that they were already using to
11:43
where they they approached you. You're not knocking on their
11:46
doors. You're not marketing.
11:47
Say, hey, doctor, we love what you're doing.
11:49
What? What were you doing that was so
11:50
much better? So initially I was knocking on
11:52
doors, but I was picking up my phone on them.
11:55
You know, how many times or do you have direct access to a
12:00
physician who's going to pick up his phone at 2:00 in the morning
12:03
and get the job done, get your notes for you, show up at 2:00
12:06
in the morning for something urgent.
12:08
Other people don't pick up their phone or when you're dealing
12:11
with them, they they don't pick up their phone.
12:13
So I was actually picking up the phone, getting all the work
12:16
done, showing up when they needed me, you know, getting
12:19
them out of problems, you know, doing the documentation
12:22
correctly, getting it done promptly, all these things, and
12:25
not a lot of other people are doing it.
12:30
You know, a lot of facilities cite cost as a barrier to this
12:34
kind of advanced wound care that you provide, but if I'm
12:38
understanding this correctly, you offer your specialized
12:41
services at no direct expense to them.
12:44
Correct. So what we do is these patients,
12:47
so these nursing homes are, you know, it's a business they take
12:50
in these patients and they, you know, build their their health
12:55
plan, right? So when you go there, you know
12:57
they build whatever health plan the patient has for the stay and
13:00
for the rehab and for everything.
13:01
So we also build the patient's health plan as well.
13:04
So when we see the patient on a visit for, you know, whatever
13:08
issue they have, we don't build the facility.
13:10
We build the patient's health plan.
13:13
So it's free for the facility more or less because we're not
13:16
billing the facility. And then we also see all
13:18
patients. We don't discriminate and say,
13:19
oh, this one has, you know, their insurance isn't very good.
13:22
We're not going to see them Now. We just, you know, everybody's
13:25
got to be seeing whoever has an issue has to be seen.
13:27
I remember when we first came from, you know, my parents came
13:30
from Iran. They didn't have the best
13:32
insurance. They probably had no insurance.
13:33
And I remember one doctor saying, oh, I can't see them
13:35
because they don't have an insurance.
13:37
And that's the last thing I wanna do, say no, I'm not giving
13:39
care because your insurance is isn't the best.
13:43
So that's, you know, something we don't do is we just see
13:46
everybody with the same standard.
13:47
And, you know, if we get paid, great.
13:49
If we don't get paid, you know, we just write it off.
13:52
Oh wow. I'm gonna guess that most of the
13:54
patients have some kind of insurance 'cause if you're in
13:57
nursing homes, at least they've got Medicare, right?
14:00
Correct. Most of the patients have almost
14:02
all have some insurance, but they don't all have decent
14:06
insurance, some very bad insurance.
14:08
Some of their insurance doesn't pay us.
14:10
They make an excuse not to pay us.
14:12
I would say about 70% we get paid.
14:13
The other 30%, we just eat it. Is that typical in medical
14:18
field? Based on what I'm here, well, I
14:20
mean some providers are just like no, we're only going to see
14:23
patients that the insurances that actually pay us and they
14:25
want you know a pre authorization that they are
14:27
going to get paid. But I mean by the time we sit
14:31
there and wait for pre authorization we could just saw
14:33
the patient and got it over with.
14:36
So it's interesting your background, your parents coming
14:39
from Iran and saying, oh, hey, we, we can't see those folks,
14:43
that their insurance isn't very good.
14:45
Like that's stuck with you, that that's imprinted on you.
14:48
Yeah. That's not a situation that you
14:51
want to put somebody else in and.
14:52
Especially when you're elderly, you know, a lot of these
14:55
patients and nurse homes are confused.
14:57
They're demented, you know, and to say no to one of these
15:01
patients that can't see them, can't care for them, especially
15:04
when they can't even make decisions, their health plan is
15:07
telling you what to do. So we just, yeah, it's the last
15:11
position I want, would want to be in if I'm in that case.
15:14
We need more doctors like you. You.
15:16
Know. So let's talk about treating
15:19
tough wounds like venous stasis ulcers and pressure ulcers.
15:25
Why are these challenging and how do you deal with them?
15:29
So pressure is very challenging. Pressure wounds develop because
15:35
the patient is immobile. Usually these are, you know, as
15:39
you get older, you become less mobile and you're not going to
15:42
become more mobile with time. You're just going to become more
15:44
immobile with time. Or if you're, you know,
15:47
paraplegic, you're immobile and it's not going to change.
15:50
And when you're immobile, you're prone to pressure injury,
15:54
pressure wounds that sorts. So the problem is these wounds
15:58
are developing because you're immobile and you're not going to
16:00
get better. You're likely only going to get
16:02
worse. So it's very hard to treat these
16:05
patients if the underlying problem of immobility is not,
16:09
you know, it doesn't doesn't get better.
16:11
So pressure wounds are very hard to treat because the patient's
16:15
immobile and their, their weight continues to put pressure on the
16:19
site, for example, the heel. And you know, when, when you
16:24
have that pressure on the heel, the blood supply or whatever
16:26
tissue is underneath that heel is compressed because of the,
16:29
the, the weight of the foot. And then there's poor blood
16:32
supply. So it's just not going to heal
16:35
regardless of how much we care for these wounds because of
16:37
that, you know, their immobility remains.
16:39
But if you can remove the inciting agent, it gets better.
16:42
But one, you know, but when we can't get these patients, you
16:46
know, more mobile, they can't turn and reposition them where
16:49
they're, you know, we're supposed to reposition these
16:51
patients every two hours. Almost all nursing homes do a
16:53
great job of doing this, but you know, they go for four hours
16:58
without being repositioned. It causes a problem.
17:00
A lot of these patients are non compliant.
17:02
They don't want to wake up at, you know, three in the morning
17:04
to be turned. You know, it's hard to wake them
17:07
up three in the morning, 5:00 in the morning, turn them they they
17:09
want to sleep. But then on the other hand,
17:11
their wounds are getting worse and because they're, you know,
17:14
paraplegic or, you know, they're not feeling the wound either.
17:18
So they're like, well, don't wake me up and.
17:20
Then their wound gets worse. Doctor, I think you've got
17:25
e-mail or an instant messenger kind of open in the background
17:28
that's dinging it, but that's something that you're able to
17:31
close. But while you're looking at
17:34
that, I'd like to understand what hyperbaric oxygen therapy
17:39
is. Can you talk about that?
17:40
So now when I was in the hospital, we did some hyperbaric
17:43
oxygen therapy. This was more for acute stuff
17:47
when they had patient had like a surgical flap that failed.
17:50
There's not enough blood flow to it.
17:53
We would have them go under hyperbaric chamber.
17:55
I think it was like close to 30 different sessions of
17:58
hyperbaric. But we don't do it for the
18:01
nursing home population. The nursing home population's
18:04
wounds are chronic and these are chronic.
18:08
I'm sorry, my, I don't know how to turn off the sound for that
18:10
thing. So the, the, the emails that
18:14
come in are yeah. So, you know, the, the, the
18:17
patients at nursing homes, the the their wounds are chronic and
18:22
hyperbaric is more for more acute stuff for flap, you know,
18:25
flap issues that are not getting enough blood flow.
18:27
So we want to increase the oxygen in the blood to get it to
18:31
these acute stuff. But for these chronic wounds,
18:33
these these patients have had it for four years, 10 years, 20
18:37
years. So giving them hyperbaric is not
18:40
necessarily gonna going to help them much.
18:43
We've tried it. We didn't see much improvement
18:46
with the chronic wounds. And then also it's very hard to
18:49
put these patients in a chamber, especially if they're confused.
18:52
Put them in a chamber. They're, you know, they're
18:54
probably like, why am I in a chamber?
18:56
So it's hard to put this population in a chamber.
18:59
And So what happens when somebody's in the chamber?
19:02
It's. Yeah, they put them in a
19:05
hyperbaric chamber. It's like a tube and they're
19:09
there for 90 minutes and then they, you know, increase the
19:13
oxygen to that chamber. And as you inhale higher levels
19:16
of oxygen, it goes into your lungs, it goes into your
19:19
circulation system. And they think with the
19:22
hyperbaric oxygen, you, you know, these wounds are supposed
19:25
to be healing better. I've seen it for acute wounds.
19:30
I've seen acute wounds do better with it.
19:32
You can see it's more, you know, more red, more pink the the
19:36
acute wound. But does it always work?
19:38
No, some insurances cover it, some insurances don't cover it,
19:43
but it doesn't always work and sometimes it doesn't work.
19:46
But heck, you know, if it's your last resort, you might as well
19:48
try it and see if you get better.
19:50
Yeah. So doesn't work so well in the
19:53
nursing home environment to where you're dealing with some
19:55
of these, a lot more of these chronic wounds, correct.
20:00
Given what I've already heard from you, hey, we want to take
20:03
care of the patients. You know, we're not going to
20:05
argue that they don't have coverage.
20:07
I have to imagine that you've probably got a collection of
20:10
stories, like specific stories of like success.
20:13
You know, you go in with a patient and here's a problem
20:16
that they had and and here's what you guys did to kind of
20:18
help them recover. And I'm wondering if maybe you
20:21
can pull one from your memory banks that would be fun to
20:23
share. Yeah, we've had a few of these
20:25
where, you know, there was one gentleman.
20:30
He had, he was very immobile, fairly young guy, fairly
20:34
immobile. And we were hopeful that he's
20:36
going to be, you know, back up and walk.
20:37
I think it was a motorcycle accident.
20:39
We were hopeful that he's going to get up and walking again.
20:41
But, you know, he had a couple pressure wounds and fairly
20:45
large, I would say the size of like a grapefruit.
20:48
And, you know, he was getting extensive rehab trying to get
20:51
him back up and we were doing the wound care on him.
20:54
Initially it got a little bit worse.
20:56
And with time, you know, he wanted to heal.
20:59
He, you know, he was on a feeding tube at that time,
21:01
couldn't even swallow. But we changed his feeding, you
21:05
know, sources and we gave him additional rehab therapies.
21:07
And he was seeing being seen for his wounds on a regular basis,
21:11
cleaning it out. And, you know, he stood out.
21:15
He stood out and he eventually all of his wounds healed.
21:18
He had a sacrococcyx wound, which is the very common wound
21:21
on the bottom when these patients are immobile.
21:24
He finally did better and he was, you know, and he reached
21:27
out to me down the line and said, hey, I'm finally healed.
21:31
And he's, that's got to be very rewarding.
21:33
Very rewarding. Yeah.
21:34
I, you know, every so often he gives me a call.
21:37
Now I'm like, well, OK, that's nice.
21:40
Said you a Christmas card maybe. So as you were growing and more
21:45
of these facilities were contacting you to do for them
21:48
what you've been doing, you know, for a lot of other nursing
21:51
homes, obviously you Higham can't be everywhere all at once.
21:56
So you had to start hiring people and training them in in
22:01
the way that you do things. The folks that you're training,
22:04
are they other doctors? Are they licensed nurses?
22:08
Like what level of? They're a little bit of
22:10
everything, a little bit of physician, surgeon, nurse
22:13
practitioner, physician assistant.
22:16
So we're about 40 total now as a group of 40 NPPAS physicians who
22:22
go across the country and seeing these residents and there's a
22:27
whole team that trains them. There's a whole, you know,
22:31
there's teams of nurses that train them on how do you measure
22:35
a wound, how do you document it, how do you treat it?
22:38
What ointment do you apply? And once they're ready, we give
22:42
them an exam to take, then make sure they're ready.
22:45
And then also we have another team of nurses that once they do
22:49
start seeing patients, they start reviewing all of their
22:51
notes to make sure all of their notes are perfected as well.
22:55
So quite a bit of, you know, training is going in it and then
22:58
ongoing training as well. You're documenting this, but
23:02
you're applying this cream. What is your reasoning behind
23:04
it? So all of this is in there as
23:06
well, you know, to make sure we're, you know, since it's
23:11
fairly big, you know, we want to make sure all of the providers
23:14
are on top of it. So you said they travel around.
23:18
So it's not like when you've got, you know, clients in
23:21
Alaska, you don't have a A-Team there in Alaska, you.
23:24
Have folks that are moving the facilities in Alaska.
23:29
There's one provider who lives in Alaska and he sees those
23:32
patients who are in Alaska. But when he uploads his notes,
23:37
those notes are all remote. And then we audit them remotely
23:41
to make sure that what he's documenting is, you know,
23:43
correct and accurate and whatnot.
23:45
So he uploads his notes and then we, you know, the team of nurses
23:48
review those notes. OK.
23:51
And then there's one group of, you know, provider in Louisiana,
23:55
another one in, you know, Florida or whatnot.
23:56
And everybody just uploads their note to the hub.
23:58
And then everybody take, you know, then they review it and
24:00
then they e-mail them and say, hey, you've documented this, but
24:02
maybe it should have been this and whatnot.
24:05
Gotcha. OK, So you've mentioned Doctor
24:08
Strauss before, who was a bit of a mentor to you.
24:14
What practical insights or techniques did you learn from
24:18
him and how have they shaped the way that you do wound care?
24:23
So he was a little bit older and he was, you know, he liked the
24:26
old school stuff. There's so many new products
24:29
that come out, but he liked the old school stuff.
24:33
And that's what kind of what I was taught from, you know, these
24:37
are the old school stuff and the nursing homes like these old
24:39
school stuff as well. So, you know, he showed me how
24:42
to do a debridement, which is cleaning the wound.
24:45
You take a little small surgical knife, it's a disposable knife
24:48
and you cut out the the dead tissue.
24:52
If you leave the dead tissue in there, it's, you know, at high
24:54
risk for, you know, not healing, possibly getting infected, but
25:00
the wound will not close and heal over a dead tissue.
25:03
So the dead tissue has to be removed.
25:04
And that's done through debridement and different creams
25:07
that we apply to get rid of the dead tissue and, you know, keep
25:10
the blood flow there. You you apply a cream to get rid
25:13
of the dead tissue instead of like physically cutting it out.
25:15
You do both. So you first, you know, cut it
25:18
out and then of course, you can't cut everything out.
25:21
You know, it's kind of hard. It could be painful for the
25:23
patient even though we applied numbing, you know, sprays and
25:27
injections, but you can't get rid of all of it.
25:30
And it can be the patient can be bleeding a lot and whatnot.
25:32
So therefore, you know, at the end, we also apply a cream that
25:36
will remove some of the dead tissue if the dead tissue
25:38
remains. So he kind of taught me how to
25:40
do all that, how to clean the wound, how to debride the wound,
25:43
which ointments go on, you know, and it worked, you know, how to
25:48
flush a wound out. You know, sometimes people are
25:50
just cleaning the surface of the wound, but sometimes the wound
25:52
is deep. So how to irrigate them and all
25:55
this sorts of stuff? And you mentioned that there's a
25:57
lot of new products that have come out.
25:59
Are they mostly just like other ointments that have different
26:03
substances in them that that sort of affects the healing in a
26:07
different way? There's all sorts of stuff,
26:09
ointments, patches, cleansers, you name it.
26:13
They have new products that come out every day that you know, and
26:17
a lot of it's the same stuff, just rebranded differently, to
26:20
be honest. Is there?
26:23
Is there something that you want to see come out that doesn't
26:26
exist yet? I don't think there's any, you
26:29
know, magical cream or ointment. A lot of it's, you know, getting
26:33
rid of the inciting agent what caused the problem First, you
26:36
know, get rid of that problem and then just making sure the
26:40
moisture, it's not too dry and it's not too wet to cause
26:43
maceration. I think these are the two main,
26:46
you know, and keeping the wound clean, you know, keeping the
26:52
wound clean and making sure it's not too dry or too wet.
26:56
Doctor, what advice would you have for folks listening that
26:59
are interested in advancing their own career in this field?
27:02
Work hard, show up and don't you know, work hard, show up, be
27:08
there on time, be punctual, you know, don't show up late and you
27:13
know, give it a chance. You know, I think marketing is
27:17
important. You have to have a good
27:19
marketing team as well, otherwise nobody's going to hear
27:22
about you. Word of mouth, you know, goes
27:23
far, but it doesn't go, you know, you can't become
27:26
nationwide with word of mouth. And yeah, work hard and do
27:31
what's right. Don't always go after and chase
27:33
the money. If you do what's right, you
27:35
know, if there's a need for something and you can sell it,
27:39
you know, go after it. And don't just always look at
27:41
the money. Do you feel like that's been the
27:44
biggest key to your growth and your success, or are there other
27:47
sort of creative levers that you've pulled that have allowed
27:49
you to grow? People help me a lot, you know,
27:54
make systems for me that run, that run well, you know,
27:59
computer systems for marketing that has done quite well.
28:02
I have online courses for nurses to renew their license.
28:06
We offer these, you know, to to a lot of the facilities and also
28:10
the general population for all healthcare professionals to take
28:13
these courses. But you got to get your name out
28:16
there. You got to get your name out
28:18
there and, you know, be responsive to them.
28:20
What does your marketing look like?
28:22
You're talking about the courses, and that's probably
28:24
great. It's probably another kind of
28:26
revenue generator, but it's also a way to kind of build your name
28:29
and your brand. What what do the ads look like
28:31
that you're running? Is this like Facebook, LinkedIn
28:34
kind of stuff? All of them, Facebook, Google,
28:38
you know, running for the course, running for the
28:40
services, you know, and you just have to keep running it, you
28:44
know? Yeah, some months you see
28:46
nothing, but some months you know the course does pretty
28:48
well. Yeah, the course is at an all
28:50
time high this month, so. Why do you think that is?
28:54
Here we are very end of January 2025.
28:56
What's? Time, you know, the word gets
28:59
out there and you have to price it fairly competitively compared
29:04
to others. You have to give them what they
29:06
need. If they need X amount of hours
29:09
to renew their license, I try to give them what you know.
29:11
Fulfill their all their hours, give them exactly what they need
29:15
and market it fairly. How would somebody find your
29:18
course? I think I'm on like the number
29:21
one or two spot, so if you check for wound care certification or
29:24
wound care courses, I come up on Google as like the number one.
29:29
OK. Yeah.
29:30
And would they also find it on your main website,
29:32
snfwoundcare.com? Correct.
29:34
They can find it on snfwoundcare.com or on Google.
29:37
We come up, you know, pretty immediately.
29:40
Right. And we'll include those links in
29:42
the show notes for folks. Thank you.
29:44
So let's. See a book, course or a podcast,
29:50
something like that that's been particularly helpful for you
29:53
that you might recommend to somebody else.
29:56
Honestly, a lot of my stuff has been trial and error on my own,
29:59
you know, finding, you know, a, a, a problem and looking, you
30:04
know, finding for a solution to, to get it going.
30:08
A lot of these, you know, like needing supplies from places.
30:11
So I would ask people, you know, where can I go to get this?
30:15
And I ended up on Alibaba finding something, ordering it.
30:17
And now pretty much all of my stuff is ordered, you know, via
30:20
that. But honestly, there's a you have
30:24
a problem and you figure out a way to solve it yourself.
30:27
Is what what I come across, Yeah.
30:32
Let's see, where do we want to go here?
30:36
Everything is sort of self-taught.
30:37
Is there? Is there a particular philosophy
30:42
that guides you in your daily work, in your business?
30:47
Yeah, you know, be available and do what's right honestly is the
30:53
philosophy that has worked. That is our main goal is, you
30:59
know, care for these residents, you know, don't look what you
31:02
know what's what it's going to bring in value wise, you know,
31:09
see the patient and take care of them.
31:10
And eventually, you know, everything falls into place.
31:13
We get called out to go do things, you know, 30-40 miles
31:16
away and the patient has no insurance.
31:18
We still go, you know, and then that's.
31:21
And you know that in advance, you know, going there, they've
31:24
got no insurance. I don't even, I mean, I, it
31:26
happens all the time where I just tell the office to have
31:28
somebody take care of it. It doesn't matter.
31:31
So I know in advance we're not going to get paid, but it is
31:33
what it is. You know, somebody gets sent out
31:35
and I still have to pay the provider who's going out there
31:36
and they're not going to do it for free, but they still go out
31:40
there to take care of it. And, you know, but you look at
31:42
the, the big picture, the big picture it's, it's very
31:44
profitable in what we're doing. So you eat some costs.
31:49
I wonder where this comes from. You mentioned sort of, you know,
31:52
early your parents coming to this country from Iran and that,
31:56
you know, experience of going to the doctor and, and saying, hey,
31:58
we're not going to see you because you don't have good
32:00
insurance. Is there more to sort of this
32:04
'cause I mean, I agree with you and I love what you're doing,
32:07
just sort of do the right thing and everything else takes care
32:09
of itself. But not everybody's wired that
32:12
way. Is that something that was
32:13
taught to you from a very early age?
32:15
Were there any other formative experiences that sort of shaped
32:19
that in you? I've had quite a few mentors.
32:21
One of my other when I was in residency, there was another
32:25
gentleman, Doctor Scott Ragland. Ellen Scott Ragland, he was the
32:30
same way. He would just say, you know,
32:33
don't look at the money, you don't look at it that way, just
32:36
do what's right for the patient. And that I remember when we were
32:41
walking down the hallway and he had his cup of coffee in his
32:44
hand and he would always slam it down and say do what's right.
32:48
And these things just stick with you.
32:49
You know, it's, you know, we're in this field to help.
32:53
And honestly, there are some physicians out there who, you
32:56
know, I don't think they're always doing the best and what
32:59
not. But if you are actually out
33:02
there caring, people will notice it.
33:04
People will tell that, you know, that you know, you're not going
33:08
to get anything out of this, but you're still doing it.
33:10
And they will call you out and say, hey, like this guy goes and
33:14
does these things regardless. He won't even ask what the
33:17
patient's insurance is. He'll go and he'll take care of
33:19
it if you're likely to use him. It signals that you're a good
33:23
human being, and that's who we want to work with.
33:25
Yeah. Yeah.
33:26
So as you've grown Payam, I'm wondering how much time you
33:31
actually get to still practice and see patients versus, you
33:35
know, kind of running this business?
33:37
I don't see patients anymore unless something urgent comes up
33:41
or it's like a, you know, please go and see my loved 1, you know,
33:45
I'll go and take a look. But it's just all administrative
33:48
work now. But I have a lot of time to
33:51
myself, you know, it's quite nice.
33:52
I just, as long as I have my phone on me, I pretty much, you
33:55
know, get to go to the gym at 10:00 AM and enjoy life.
34:00
And, you know, I walk around. People think I don't have a job,
34:04
but that's nice. But.
34:06
Do you miss any of that direct patient contact or like it's,
34:11
you know, I, I assume it's got to be pretty stressful,
34:13
especially to see people in, you know, conditions that aren't
34:17
always great. I I do miss it.
34:20
I mean, it's nice, but I like what I do better.
34:22
I do, you know, I mean, waking up at 4:00 in the morning going
34:26
into work, seeing these patients was nice, but it, it was tolling
34:30
it's, it's, it's not easy, you know, be up and then go to bed
34:33
at 7:00 to wake up at 3-4. But you know, I do miss it.
34:38
But I love what I do now, you know, running a company, you
34:41
don't know, it's very stressful in, in what I do currently.
34:44
I, since we have so many facilities, I always get called
34:47
with complaints. Nobody calls to say how
34:49
wonderful we are, but even though you know you get 3 or 4
34:53
complaints a day, which is pretty good, when you have, you
34:55
know, 300 facilities or you get 3 or 4 complaints, it's not bad.
34:59
Yeah, that's a pretty good ratio, especially when it comes
35:02
to medical care, 'cause there's all kinds of things that are
35:04
outside your control. And honestly, a lot of it's like
35:07
their problem because they procrastinate or they don't do
35:10
things well. And then they're calling me
35:11
asking me like, well, how I can help.
35:13
And I'm like I don't even know how to get out of this one but
35:16
they try to always figure it out.
35:19
What's it like there in the nursing homes for the patients
35:22
themselves? You know, I always thought about
35:26
this. I think it's, you know, a lot of
35:28
these patients. I mean, I go in the morning when
35:30
I was going, so maybe that's why I don't.
35:33
There's a lot of these patients. Nobody comes and visits them.
35:35
There's not a lot of family or there are families out of the
35:37
state. They're alone in there.
35:41
Some of these nursing homes have a, you know, unfortunately have
35:43
a turnover that can be higher than normal.
35:47
So then if, if they're using an agency to staff, it could be a
35:52
problem. They don't care as much.
35:54
But some of the nursing homes are amazing that are well run.
35:56
And some of them you see like the high turnover staff don't
35:59
care and then the patients suffer.
36:03
So, you know, but it is what it is.
36:08
What, you know, getting old is not for the, it's, it's very
36:11
tough. It's very tough.
36:13
And we're all you know, we're headed that way.
36:15
You talk about a lot of these nursing homes, They have a fair
36:19
bit of employee turnover. How do you approach your team
36:25
building, recruiting, retaining good folks?
36:28
What's your approach there? I give them a lot of, you know,
36:32
they're their own boss. They go out there and they see
36:34
these patients. I don't like, you know,
36:37
micromanage any of them. They do their own thing.
36:39
They get paid pretty well and do we have a high turnover?
36:44
The only time do I see turnover is when the provider is going to
36:48
like one building and they're like not happy just servicing
36:51
one facility. They want like a full time gig.
36:54
So that's when we'll see like, you know, I have high turnover
36:57
and these facilities is when I can't give them enough work.
37:00
But usually the people that we are servicing more than 3 or 4
37:03
facilities don't leave us. They stay with us for quite a
37:06
while. You know, doctor, growth often
37:12
comes from some of the biggest challenges that we face in our
37:14
lives. I'd be curious to hear about a
37:17
serious challenge that you've had to overcome, whether it's
37:20
personal or professional or maybe both, what that was like,
37:24
how you got through it, and some lessons that you learned.
37:27
Yeah. So I would say being my
37:29
competitors coming after me when I first started out, when I
37:32
first started out, honestly, I was seeing two or three patients
37:36
and I get a lot, I get a like a cease and desist letter from a
37:40
competitor. That's all you need, you know,
37:42
to pull, you know, back off. And I was just so confused, you
37:46
know, and at that time I didn't have, you know, I was a tiny
37:51
little, you know, I wasn't even a company then.
37:53
It was just me solo trying to see patients and getting a cease
37:56
and desist letter from a, you know, decent sized company was
37:58
kind of scary, you know, like how am I going to pay for this?
38:01
What am I going to do? And I remember like their
38:04
attorney calling me and I'm like, like, what do you even
38:06
want? But you know, you just know that
38:11
what you're doing is you're not doing anything wrong.
38:13
So they can, you know, and I pretty much told their attorney,
38:16
I didn't have even have my own attorney.
38:17
I'm just like, no, I'm not doing anything wrong.
38:18
You can do whatever you want. Send me as many.
38:20
Letters. What were they trying to say
38:21
that you were doing wrong? Kind of pushed me out trying to
38:24
monopolize the, you know, do whatever kind of work they do,
38:27
good or bad, you know, and then just don't let anybody else in
38:31
the field, right? Because if you get into the same
38:33
business and you do more than them, you do better services
38:36
than them, then you're going to get more of the clients and then
38:39
they're going to be pushed out. So the less competition that you
38:42
know, they have, the better it is.
38:44
So just trying to push people out.
38:46
So I just stood my ground and then they kept coming after me
38:49
for other stuff and other bogus, you know, and you just stand
38:54
your ground. And then the latest one was
38:55
another, you know, lawsuit, but this time I got my own attorney
39:00
and we won the case. So, you know, but they keep
39:03
coming. You know, competitors can be,
39:05
I've never sued anybody in my life, but competitors come after
39:08
me. But I stand my ground at this
39:09
point. I don't back off because I know
39:12
I'm what I'm doing is not. Wrong.
39:14
What are they trying to say? Pretty much just push you out
39:19
trying to say you're taking over these contracts for, you know,
39:25
the the latest 1 is like my phone number, like get rid of
39:29
your phone number. I'm like, I've had this phone
39:30
number for seven years. Something illegal about the
39:34
sequence of digits in your phone number.
39:36
My phone number is 833, Doctor wound, Dr. Wound.
39:41
So remove doctor wound from your number.
39:43
My license plate says doctor wound on it.
39:46
So they called me to tell me to remove these things because
39:49
they're using it in a different state.
39:50
And I'm like, oh man, you know, I'm like, I don't even know how
39:54
this even affects your business, but you know, I have my own
39:57
trademark attorney and I just send him a letter, explore to
40:00
him and he sends the guy a letter within a day.
40:01
And we're going to hear what the results are.
40:04
But you know, but I, I, I try not to back down anymore and
40:07
just, you know, as long as I'm doing what, you know what's
40:09
right, we go forward and we push strong.
40:12
If you clearly people are clearly people are threatened by
40:15
you. Yeah, they're threatened by me,
40:18
but, you know, get your act together and, you know, provide
40:21
more services. Level up your game.
40:23
Yeah, that's the way to compete. Not with these goofy lawsuits,
40:26
correct? Provide more services.
40:28
You know, don't, don't complain. And you know, don't complain
40:31
when they call you at 2:00 in the morning.
40:32
Take care of the job. They won't switch out.
40:36
So what do growth plans look like for SNF wound care?
40:40
Is this more territories? More.
40:42
More services, yeah. I don't know if I could do more
40:45
services. I pretty much do all of them
40:47
that you can ever imagine, but more territories, you know, a
40:50
lot of these nursing homes are very scared to switch.
40:55
They're like, oh, we're going to switch to you.
40:56
We're scared and whatnot. And I'm just like, you have to
40:59
try new things. So you know, I'm like in my,
41:03
even in our agreement, when we sign them up, it says you can
41:06
cancel the same day if you don't even need to give us a one day
41:08
notice. If you don't like us, we leave.
41:09
We're not coming back. Don't you know?
41:11
So just to make sure they're not threatened that like we're going
41:14
to want to come there and stay around like you don't like our
41:16
services, we leave the next same day.
41:18
So but yeah, look to expand, get more territories, get the name
41:22
out there. And, you know, I have a great
41:24
team in the back that runs all of these, you know, facilities.
41:28
And we have a great team and, you know.
41:31
So just I love, I love what you guys do with the contract there.
41:35
Obviously there's some businesses where, you know, the
41:37
service provider has got a lot of upfront fixed costs and so
41:40
they want to be able to make sure that, you know, they can
41:43
recruit that over time. And, and so I understand that,
41:46
you know, kind of the purpose and the value of having
41:49
contracts with terms in them. But yeah, and a service like
41:52
yours, like what you're doing is providing people with the
41:57
ultimate level of comfort, saying that I'm so confident in
42:02
what we do and the way that we do it and that you'll be happy
42:04
with it, that, you know, right in the middle of the service, if
42:08
you don't like it, you can tell me to leave.
42:09
And that's it. There's, there's no, I think
42:11
that's great. Some of these facility, some of
42:14
these other companies have like a 90 day, you know, 6 month
42:17
termination notice. I'm like, you could sign the
42:21
contract now and tell and cancel it in 10 minutes and tell me you
42:24
don't want me to come back. But yeah, so I don't want, you
42:27
know, if they're unhappy, I don't want to go there.
42:28
We don't want to go there, right?
42:29
We want you to be happy with our services.
42:32
Yeah. So payam any daily practices
42:35
that kind of help you through your day and make sure that
42:39
you're ready for everything. Yeah, wake up early in the
42:41
morning, go to the gym. And I think that's a nice way to
42:45
de stress, you know, get to the gym every day and get my cup of
42:51
coffee and pretty much get the day going.
42:53
Yeah. So did you hit the gym this
42:55
morning before our interview? Waiting to get, you know, after
42:58
this, I'll be heading to this. It's still pretty early here.
43:00
Yeah. I was going to say, that means
43:02
you're a pretty early riser, yeah.
43:04
And go to the gym and just enjoy the day.
43:06
You go to lunch. But you know, always be ready
43:08
because you never know, right? Somebody might call out sick and
43:10
I have to go somewhere, fly out somewhere.
43:12
So, you know, be ready to go. No, sometimes in my experience,
43:19
our mistakes end up becoming our greatest teachers.
43:23
Is there an early career moment that seemed like a set back to
43:26
you at the time that actually helped to propel you
43:28
forward-looking back now? Yeah, there's actually a
43:32
malpractice lawsuit that was very unfortunate but pretty
43:37
bogus that happened, you know, while I was in, right, when I
43:44
got, you know, right when I got out of training.
43:47
And even though I had nothing to do with the case, they sued
43:51
everybody in that case. And it kind of, you know, I'm
43:56
like, I don't want to be doing this hospital work forever.
43:59
This is high risk stuff. You know, even though I had 0
44:03
involvement, 0 exposure, they still sue you and they still,
44:06
you know, try to go after you. So that was like a turning
44:11
moment. And I learned a lot about the,
44:13
you know, the legal aspects of things of, you know, how these,
44:17
you know, malpractice lawsuits work, how to document
44:20
appropriately and how to save yourself.
44:24
Otherwise that would have been a, you know, it was a disaster.
44:26
I mean, it was a disaster case that happened.
44:29
But, you know, even though you have no involvement, no
44:32
exposure, they still come after you and you learn the whole
44:35
legal system of these malpractice cases.
44:38
And at that point, I'm like, I want to get out of this, you
44:40
know, hospital work. It can you know it can be very
44:42
problematic. Which is terrible, right?
44:44
Because we need more doctors and medical professionals.
44:47
We don't need to be scaring them off with these kinds.
44:49
Of things they scare you off, correct.
44:50
They it's so wrong, but they scare you off.
44:52
And it's all about, you know, them, you know, making a buck.
44:56
But yeah, they scare you off. What's a specific thing that you
44:59
learned about how to protect yourself and be sort of
45:02
proactive? Oh, just document appropriately.
45:06
Document, you know what you saw, who you spoke with, your
45:12
treatment plan and you know the hospital's very helpful with
45:15
these things. The hospital has so many
45:17
different layers of protection that help protect physicians as
45:20
well. But when a case goes wrong, you
45:22
know, you know, you have 10,000 cases, all of them go, well, one
45:26
goes wrong, you know, it bites you, you know, it bites you.
45:31
But, and there's multiple, you know, and when you have a, you
45:34
know, when a patient's hospitalized, there's not just
45:36
one physician, there's usually 10, you know, this is the ICU
45:39
case patient. There was about, you know, 15
45:42
physicians on the case. And everybody got sued from the
45:45
residents to the ICU to the ER doc here to everybody.
45:49
So we pretty much learned from that case of what can go wrong.
45:53
You know it's. Put the legal stuff aside.
45:56
And obviously, like we were sort of touching on this before, you
45:59
know, in medical care, things are going to go wrong.
46:02
Not everything is within your control.
46:03
You are not a God. Like you can't heal everybody.
46:08
And so when you are, again, legal stuff aside, just on the
46:12
personal side, like, how does it affect you?
46:14
How do you work through when there's an outcome that's less
46:18
than favorable? You know, I'm in a lot of these
46:21
physician group chats on Facebook and what not.
46:25
And I mean, you can't sleep for many, many nights.
46:28
You, you can't sleep. You're worried and you know, you
46:32
know, you tried your best or something went wrong and you
46:34
know, it was out of your control.
46:36
But night sweats, you don't sleep well, you're worried,
46:42
you're bothered, you don't go out, you become depressed.
46:45
It was pretty bad. You know, I thought, you know,
46:47
I'm like one month out, one month out of my residency and
46:50
I'm getting sued. Am I going to lose my license
46:52
for this? But luckily, you know,
46:54
absolutely nothing happened and but I can see, you know, other
46:57
physicians going through the same thing and they might have
46:59
other issues going on at the same time.
47:01
You know, it's very haunting, but you know, the medical.
47:06
Board, is it helpful to be able to talk with other physicians
47:09
and sort of have a little support group there?
47:12
When you talk to other physicians, they'll tell you
47:14
they've had the same thing happen to them and you know
47:16
there's a light at the end of the tunnel just waded through.
47:18
The medical board is fair. They look at the case, they
47:21
review it and, you know, and they understand, you know, and
47:24
it's happened so many times before, so, and they understand,
47:27
you know, we're trying to do our best and things go wrong, you
47:30
know, or, you know, a lot of, I would say most of the cases of
47:33
these law, you know, medical malpractice lawsuits tend to be
47:37
frivolous. They just, you know, send out
47:39
letters trying to see what they can do.
47:42
What's the best decision you ever made for your business,
47:44
doctor? Ha, the best decision, honestly.
47:49
So Juan was leaving the hospital and starting my own business.
47:52
That was the best, you know, decision.
47:54
And from there, honestly, it was just I, I had a big vision when
47:58
I started, like when I went to go pick my mailbox, I didn't get
48:02
a small mailbox to be like, oh, I'm gonna get like, you know, 10
48:05
pieces of mail. I got the largest mailbox at
48:08
the, at the post office. Literally it was like one of
48:10
those massive ones. And now that mailbox gets full
48:13
to the brim every few days. So I had this vision where like
48:17
I'm going to grow nationwide from the day I started.
48:20
It wasn't, you know, I'm going to go little and something and
48:23
just service some there. I had this vision that I'm going
48:25
to be huge, like my competitors that and I got the biggest
48:29
mailboxes. I got everything like nationwide
48:32
stuff. So I don't just market locally.
48:34
And it grew into that. It it grew into that.
48:38
So I had these big visions of what I wanted to be nice.
48:43
And then people would look at me like, what are you doing with
48:45
this big mailbox with four pieces of mail?
48:46
And I'm just like, it'll come, yeah.
48:50
You had you had faith in yourself.
48:52
I knew I can't go wrong. I knew it's like this is only
48:56
like room for growth and expansion.
48:59
You know, I'm son of an immigrant.
49:01
My father came to this country when he was young with his
49:05
parents and his brothers. And, you know, it was very
49:09
challenging for them to make that move.
49:12
You know, they didn't know the language.
49:13
They had to learn the culture, find jobs, you know, lots of
49:19
challenges there that I think built a a sturdiness and a
49:25
robustness in them that propelled them to be, you know,
49:30
very successful in what they were doing.
49:32
I'm curious if you think that there's some of that going on in
49:37
you as well? You know, to be honest, I don't
49:39
know how my dad and mom moved from Iran not knowing, you know,
49:44
more than a couple words to America with three kids and
49:48
raising us. It's like us moving to another
49:51
country like the China, like I have nobody.
49:53
I'm alone. I know I'm single.
49:54
Yeah, You know, I could do it maybe for myself as being
49:57
difficult, but I can't imagine how my dad did it with, you
50:01
know, my mom. No English with three kids,
50:04
moving to another country and starting a family.
50:08
You know, it's kind of mind boggling.
50:10
I don't think I would. I wouldn't be able to do it.
50:12
But they did it. And, you know, and I saw their
50:16
struggles. You know, I saw my parents
50:18
struggles. And, you know, we didn't have
50:20
anything. We were very simple and barely
50:23
making it day by day going to public school.
50:25
And, you know, I had great parents, you know, they were all
50:29
people, loving, caring. And you, you get that love, you
50:33
know, from them. You learn from them.
50:35
You see how hardworking they are.
50:37
And you become the same. You know, I see my dad still,
50:40
and my dad is 84 and he's still hardworking, more hardworking
50:44
than me, you know, Well. The apple doesn't fall far from
50:49
the tree there. Yeah.
50:51
So innovation requires courage, right?
50:53
Tell us about a time that you tried something completely
50:57
different in your business, whether it worked or it didn't.
51:00
What did you learn from that? So what if I tried differently?
51:04
Honestly, the marketing, it was totally different.
51:06
Like out of my, you know, I just listened to some person, they
51:11
said, hey, let's try to put you on these, you know, e-mail and
51:15
stuff and platforms. And I had no idea what I'm
51:20
signing up for. But this person just, you know,
51:23
I paid her and she pretty much just did everything.
51:26
And then the next, after a while, I realized what she had
51:29
made only to realize like, that is the reason why it grew to as
51:35
much as it did is, you know, became so big outside of the
51:39
local areas because of this platform that she made.
51:43
And I'm very thankful for her, but I, I didn't want to do it
51:47
initially because I'm like, you know, it's going to be like,
51:50
what are you even making me? And it was this whole marketing
51:53
platform that's amazing. And we use it pretty much all
51:57
day every day now. What was it that she said that
52:01
convinced you? Well, she's just like, you need
52:05
a way to reach out to people. You know, you can't go to every
52:08
nursing home yourself. You need a way to reach out to
52:11
people and you know, you got to do it through either phone calls
52:14
or emails or something. And I'm like, yeah, she's right.
52:18
But I'd understand the nature of what she's going to build me.
52:21
And she built me like this beast program where people get
52:25
non-stop, you know, notifications, you know, from
52:29
us. And even though you don't sign
52:31
up now, you've seen my logo, you've seen my picture, you've
52:34
seen my name. So you're going to remember if
52:36
you need a wound care doctor, you know that phone number is
52:40
going to stick out, that you know something's going to stick
52:42
out, and you'll reach out to. Us, give us the phone number
52:44
again. 833 Doctor wound. I like it.
52:50
Just one more question for you, Payam.
52:52
But before I ask it, I want to do a couple of things.
52:53
First of all, for those listening today, I know that you
52:56
love today's content. Doctor Tarani has been a
53:00
wonderful guest sharing all kinds of interesting stories.
53:03
Make sure that you don't miss out on future content like this.
53:06
Hit the like, share, subscribe, follow button on your favorite
53:08
podcast app. I also want to let people know
53:11
the best way to follow you or to get in touch with you Payam.
53:15
What would that be? Just on our Instagram page.
53:19
Follow us on snfwoundcare.com and I'd be happy to, you know,
53:24
get back to you guys or e-mail us info@snfwoundcare.com.
53:28
info@snfwoundcare.com. Honestly, there's even a lot of
53:32
people who send me a picture of their foot or their back or
53:35
their wound and, you know, somebody replies to them and
53:37
helps them out. Regard that, yeah.
53:40
What does SNF stand for? Skilled.
53:41
Nursing facility. So it's like, you know, skilled
53:44
nursing facilities where we work at, these are called nursing
53:46
homes, skilled nursing facilities.
53:47
So it's SNF wound care? Gotcha.
53:51
So last question, as we look to the future, Doctor, whether
53:55
thinking specifically about your business or the larger industry
53:58
in general, what are some of the changes that you're most excited
54:01
about? What are the changes I'm most
54:04
excited about? Well, I'm looking to expand.
54:09
Honestly, I don't know if there's any changes that are
54:12
coming about based on, you know, what we provide.
54:15
Those pretty much are stable, but I'm just looking to grow,
54:19
get out there and yeah. Are there any parts of the
54:23
country where you would not operate or is it pretty much?
54:27
Everywhere. I mean, we everywhere Alaska,
54:30
right? So, yeah, Alaska, Maine, pretty
54:33
much anywhere. I mean, because these patients
54:35
are everywhere, right? Yeah.
54:38
And, and is there, what's the chicken or egg like?
54:41
I would guess like you're looking for the the the facility
54:44
first and then once you've got an agreement or a pending
54:47
agreement, you know it's going to happen, then you go and you
54:50
try to build a team there. Correct.
54:52
Yeah. So first it's the facility.
54:54
Once you get the facility, then you can figure out how to get
54:57
things started out there. Yeah.
55:00
And and does that generally involve sending one of your
55:02
established people there to kind of do some recruiting in person
55:05
or you just look to hire somebody brand new in the area
55:08
to kind of be your your coordinator it really?
55:10
Varies. We usually send somebody out
55:12
there to meet with them, tell them on the services that we
55:14
offer after that and if they're agreeable, then we get somebody
55:20
out there to service them. Got you.
55:24
Well, Payam, I want to be the first one to thank you for
55:26
sharing both your time and your story with us today.
55:28
I really appreciate it. Thank you for having me, I
55:30
appreciate it. Folks, that's a wrap on another
55:33
episode of the Inspired Stories podcast.
55:35
Thanks for learning with us today.