What It Looks Like to Join a Series A Healthcare Startup as One of the First Clinical Hires with Andrew Shiflett
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From Primary Care to Startup Leadership: Why Clinicians Matter Most in Early Chaos
From Primary Care to Startup Leadership: Why Clinicians Matter Most in Early Chaos
Andrew Shiflett, PA-C, brings more than a decade of experience in complex primary care and was one of the first clinical hires at a Series A mobile primary care startup. Joining within the first months of the company’s life, Andrew stepped into patient homes without playbooks. He had no formal title, but a role as the clinician others trusted to navigate uncertainty and advocate for their needs.
In this conversation, Andrew reflects on leaving a stable practice for the unpredictability of startup life, weighing risk against opportunity while raising a young family. He shares candid stories of knocking on doors with nothing but a stethoscope and a printed schedule, building trust with patients in underserved communities, and learning to translate clinical realities into business language.
Helen and Andrew revisit pivotal moments, including advocating against a productivity-based compensation model that threatened clinician retention and patient outcomes. The importance of clinician voices in shaping startup culture, the responsibility of early hires to smooth the path, and the leadership that emerges when clinicians step into uncharted territory.
This episode is for clinicians considering the leap into startups, leaders building early teams, and anyone curious about how frontline expertise drives innovation.
Must-Hear Insights and Key Moments
Andrew was one of the earliest clinical hires at a Series A mobile primary care startup, stepping into patient homes without established systems.
Leaving a secure practice in Richmond for startup chaos, he weighed risk against stability while raising a young family.
Clinician leadership emerged without a formal title, as colleagues relied on him to navigate uncertainty and raise concerns to leadership
Knocking on doors with no playbook showed the realities of startup medicine and the physical demands of home‑based care.
Dog years of startup life meant each month felt like a year in traditional practice.
Trust before titles became the foundation for patient care and clinician advocacy in early chaos.
Partnering with Helen Tanner, he pushed back against productivity‑based compensation models that threatened retention and outcomes.
Building the plane while flying captured the challenge of asking patients to trust a system still being created
From Series A chaos to a $13B Series E Medicare Advantage startup, Andrew’s journey shows how clinicians shape healthcare innovation.
Words of Wisdom: Standout Quotes from This Episode
“ You would not attach yourself to something that you didn't have a lot of faith in.”- Andrew Shiflett
”Establishing that trust and rapport was the bedrock kind of anchoring piece that made me comfortable to do this”- Andrew Shiflett
“A lot of doubt in the beginning, and what fueled me as well was seeing how much the patients and the families needed us."- Andrew Shiflett
“There is an important responsibility to show them confidence and solidarity that we're building as we go“- Andrew Shiflett
”Good leadership is always looking for ways to do more. Let's do more.” - Andrew Shiflett
“Transparency, promise of good, promise of impact; we were able to build such a strong team by that.”- Helen Tanner
“There are wonderful and innovative people ready for the next step, even if you didn't realize it at the time, who can thrive in these settings and really add such incredible value.”- Helen Tanner
“Where medicine is, whether you're entering into a startup or in a large health system or in a busy clinic, you do need to understand some of the business side if you really want to succeed in your career, without feeling like you get ping‑ponged around.” - Helen Tanner
“You have to be honest about where you are as a company, as much as you can possibly be, but still say, ‘Come join us. It’s great.’” - Helen Tanner
About Andrew
Andrew Shiflett, PA-C is a physician assistant with more than a decade of experience in complex primary care. He began his career in Richmond, Virginia, where he built lasting patient relationships in established practices and developed a reputation for compassionate, patient-centered care.
He later joined a Series A mobile primary care startup as one of the earliest clinical hires, stepping into patient homes without established systems or protocols. In that role, Andrew quickly became the trusted clinician colleagues relied on to navigate uncertainty, raise concerns to leadership, and anchor care in trust and outcomes.
Today, Andrew is part of a Series E Medicare Advantage startup valued at nearly $13 billion. He continues to bring frontline expertise into large-scale healthcare innovation, shaping systems that empower clinicians and improve patient outcomes.
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Blog Transcript:
Note: We use AI transcription so there may be some inaccuracies
Helen Tanner: Hi, I'm Helen, your host of The Early Hires. There's a version of the startup story that gets told all the time. The founder who had the vision, the executive team that built the model, the investors who made it possible. But there's another version, and it belongs to the clinician who showed up in the first months of a company's existence, before there were systems, before there were protocols, before there was a playbook for any of it, and became the person that other clinicians quietly relied on to make sense of it all.
Andrew Shiflett is a PA with more than a decade of experience in complex primary care, and one of the first clinical hires at a Series A mobile primary care startup, brought on within the first six to eight months of the company's life. was not a director. He was not running operations. He was on the front lines in patient homes doing the work.
And because was there so early and because people trusted him, he became something that did not have a formal title, but the person that clinicians came to when something fell off, when they had a question they didn't know how to ask, when they needed someone who had the ear of leadership and would use it.
We worked together during that chapter, and when I needed a practicing clinician and colleague in the room to help make the case for the people doing the work, he was who I called. Eventually, Andrew moved on to a startup that had already survived the early chaos. He's now at a Series E Medicare Advantage startup that has raised over two billion dollars and holds a valuation of nearly thirteen billion, and is recognized as one of the most innovative healthcare companies in the country.
It's still a startup, but just a very different phase and a very different one. I'm so glad he's here. Welcome, Andrew.
Andrew Shiflett: Thank you so much, Helen. I'm so honored and excited to be here. my aim is to certainly, provide a candid and honest, lens into what it like in those early days.
I hope this encourages several clinicians to not be intimidated by the startup space and to jump in with both feet, but also have eyes wide open of the challenges, but also the, the great joys in working in that space.
Helen Tanner: Yes, absolutely.
And, you are the perfect person to talk to. I am so glad that we were finally able to align, and I get a little bit of your time. And so tell us a little bit about your clinical background. What kind of PA are you, and where did you practice before startups entered the picture?
Andrew Shiflett: it all starts really with my motivation to become a PA.
Andrew’s Primary Care Roots
I love that PAs have, uh, such a broad in what we're
able to do and how we can practice, and I could never, envision myself necessarily specializing in one thing. So primary care was always my calling. I love relationships, I love getting to know my patients, I love treating my patients like they're families, and I also enjoy being able to stay and, uh, kind of being a generalist in all forms and practices of medicine.
so primary care has always been my, calling card. And, uh, coming out of school, I worked in a traditional established practice that's been in the Richmond, Virginia area for decades. And, it was a wonderful place to cut my, clinical teeth because I had a lot of support. Protocols were very much entrenched and established.
the startup days for them were, years in the past. Um, and as you're learning, as a new clinician, it's imperative to have those guardrails. And, help was always just sticking my head out the, the door and yelling down the hall, and usually you'd find somebody, if not many, that would help.
but over uh, as you develop experience, start to think, "How could we do this better? How could we do this efficiently? How could I best care for my patients?" And in that environment, it's very difficult to, sometimes find nuanced, changes that you can, um, employ that, might work better than what we've been doing for years.
So Helen, that's when you came along, you brought forth an amazing opportunity for me that I'll be honest, it sounded... wild at first. Because I was seven years into a very predictable, every day was formulaic. I kind of knew what I was doing. There was no doubt about that. And you phrased it so well, I'll never forget.
It's, an opportunity to not only improve patients' lives at a microscopic level in the home, macroscopic in how we deli- deliver care in the community to homebound complex patients, but also an opportunity to improve the way we practice medicine and to build something bigger than we are, And it was just such a amazing opportunity that we often don't get as clinicians.
so dove in feet first. I obviously had some, like any of us do, some second thoughts leaving a very established, sure thing for something that was in its infancy, but the beauty was it was very malleable and we could practice the art of medicine in in that environment.
Helen Tanner: walk me through a little bit some of, your thoughts of what you had to weigh before- Mm-hmm ... you said yes to leaving a very established place. L- not only in the way that the protocols and practice was, but also what it- offered for your family and the stability.
Sure. what did you kind of have to weigh a little bit before you jumped into a really, really safe- Oh, absolutely.
Andrew Shiflett: believe at that point I had a new baby. Mm-hmm. so it wasn't just me I was thinking about. And any time in life we l- leave something that's incredibly stable and take a risk, it's something that definitely keeps you up at night sometimes as you think through the pros and cons.
Startup Risks and Considerations: Family
And I remember, thinking to myself literally, "Am I gonna see, am I gonna have access to enough patients to, put food on the table?" I mean, it was that bare bones, uh, survivalist thinking, in terms of the next step. I think through many conversations with you, and I had the opportunity to shadow you many times, 'cause you'd been there for several months.
You'd been there since the beginning. and we kind of shared in those discussions, um, that there, the patients are here. The need is so great, that is not to be worried about. And, it actually ended up I probably had too many patients at, one point. Yes . So.
Helen Tanner: You were the most sought after provider , yes.
Which was
Andrew Shiflett: also a challenge, right? That was a challenge later on. But in the very beginning, was absolutely a risk because, even things like salary and benefits, there were no repetitions to that. We were setting the benchmark for mobile medicine in Richmond. There was nothing to compare it to per se, because a lot of the,the other competitors were, and the timeline I'd have to double check it, but maybe phasing out.
They were part of big systems, Big local systems, so totally different than what we were doing. I also saw that they were starting to fall aside. And I said, "Well, what makes us different- Right ... as a grassroots effort from the big players in the area?" So, certainly a, concern, but that opportunity that just does not grow on trees to join something that's growing and building momentum, and to have in my case just so much trust in you.
And I've told you before, I knew that, you would not attach yourself to something that you didn't have a lot of faith in. whether I knew it or not at the time, I think I had a desire for something more. I wanted to, in a capacity whereas the APP I could serve in more of a leadership role- Mm
both for my colleagues, but also in help using my clinical expertise to build something from a more business side. Admittedly, I needed to know a lot more about the business side before I could do that, which, in a startup in the early days you kind of glean more than you realize as you go- Yeah
how it works. and I think the great Dr. Adam Perry, said that very well, and I encourage listeners to listen to episode one. He kind of speaks to that process of how much we have to learn, from a business and operations standpoint too, be able to sit at the table-
as an APP in that space.
Helen Tanner: that's a really good point. And as I've- dug deeper into this and really met some others, in this startup space, clinicians in this startup space, it's becoming more and more obvious that our clinical training is obviously key and the point of what, why we do what we do. But now where medicine is, whether you're entering into a startup or in a large health system or in busy clinic, you do need to understand some of the business side if you really wanna succeed in your career, um, without feeling like you get ping-ponged around.
And so it's interesting to see what our training and our schools are going to do and are doing to provide some more of that education on top of the important clinical education. So tell us, When you walked in day one when you started, series A, early days, what existed
What were you handed on day one? What did that kinda look like to you, if you remember? Or week one, you
Day One in the Startup
Andrew Shiflett: I will never forget. We walked into our office where we work, and, eventually this space is completely filled up over months, but when I walk in I notice the first thing is there's all these cubicles and all these work spaces, and two or three people total in the office.
Yes. And I'm thinking to myself, I hope we didn't overshoot the runway, right? I have a laptop. And I remember, Helen, you gave me a list of things I should, have on the road, if you will, to pack in my bag, see patients, in their homes. And a stethoscope, and that was basically it.
And at this point we were literally printing the schedules out, so I had a hard copy of the roster of patients I was gonna see that day. And I'll never forget the first time, after being in... All you know is a clinic, right? Where the boundaries are very well-defined. it's a very neutral space. If anything, it's my space.
I know where everything is. I control, the temperature of my exam rooms literally and figuratively. the conditions, the amount of time I'm gonna spend with a patient for the most part. I'll never forget knocking on that first door on my own. and I've got my bag with probably too much, equipment that I didn't need, but I wanted to be prepared for everything, right?
I'm kinda trying to pull this thing up a flight of stairs, which I never had to do, so the physical demands was, were so different. And I get into this home and I realize quickly there's so many variables that have completely, spiraled, not outta control, but in unfamiliar ways, And it can feel very overwhelming. And your next thought is, "Okay, well, what resources do I have to help me control these variables more?" And then you quickly realize, well, they're not built yet. They're not built yet. And what I found was, it felt very much like being on a river with no bridge, and it's moving very quickly.
It looks familiar, but in totally different ways. Yeah. The key is finding your footing in what really matters, the bedrock principles. Finding those rocks that are big and not slippery to help get across, and that's the patient connection. Once you kinda get past my EMR doesn't work, at this point we didn't have a lab.
I don't have a necessarily a way yet to get this home bounds patient BMP and A1C drawn. But what I can do and what I can control is build connection and build rapport. because if you think about it, we're asking them to trust us a great deal too in that process, in that step of the start.
Because they ask you inevitably, "How long have you guys been around for?" And to sheepishly sometimes and proudly though say, " Well, about nine months." They all have a similar look, and they think to themselves, "Okay, so you're brand new. Can you do this? Can you do that?" And in so many ways, patients can diagnose themselves if you listen, right?
Right. Medically. We know that as clinicians. What I also found is they also told us exactly what we needed to do if you listened-
through their struggles in getting care, through the gaps they've previously had or currently had if they've been one of our patients for a while. So often they would give me great ideas, " Hey, we should look at it this way," or, "We should try this instead," I think that hopefully were passed on to leadership and built into process and we can improve.
we use the analogy of building a plane as we go. We were expecting them, the patient, to get on the plane and fly with us as we were building. Right. Imagine that, So, uh, I think establishing that trust and rapport was the bedrock anchoring piece that made me comfortable to do this, because a lot of the tangible supports were not there yet,
in terms of if I do have a problem, what's the correct way of reporting it, just culturally. that's not built out yet, So I think finding the anchoring universal important pieces. I think Dr. Perry also said, I'm gonna quote him, " Patient care is first."
Yeah. "Patient outcomes are first." Thank you. "Everything else is negotiable." we're working on it as we go. So I think establishing that early on, not only with your patients, but the clinical team and also operations, was huge.
Helen Tanner: and you're bringing up an important point, They are so early that the clinical care model was still being
you mentioned walking into that first visit, and you kind of entered into, quote, " chaos." It wasn't just like, "Oh, what's your chief complaint today?" And then let's walk through that. you were walking into an elderly... We were home-based primary care for seniors with complex health conditions who really could no longer get out, and their health had been suffering because of that.
And you're walking in to more than just a chief complaint. you're walking into potentially, food insecurity and hoarding and, all the things that you're able to see at home. And We were in the middle of developing, how do we as clinicians address this in the field?
And we eventually came up with a really strong model with the help of, um, Dr. Perry and team to navigate through these chaotic situations, to develop a care plan, and really become outstanding at managing that, which is one of the reasons we, the company scaled so quickly. But, but on the beforehand, you are painting a picture of what, many people may not understand joining a startup early on as a clinician.
You have to be the type of person okay with navigating through this- Yeah ... and then being able to bring it back to your leadership team- Right ... of what's working and what's not and, how we can build this out. and this is what you were so... One of the things, but a really valuable thing that you, brought to the table.
And I know from my standpoint of hiring and building teams, this was something I really looked for in people is not everybody can do that. Actually, very few people can do that early on. and, that's a really unique skill set. but it is so needed or else your team's just gonna churn and churn and churn, and you're not gonna find...
You have to be honest about where you are as a company, as much as you can possibly be, but still say, "Come join us. It's, great." So- Right. Yeah ... it's a challenge on the hiring side, but it's also exciting because There are wonderful and innovative people ready for the next step, even if you didn't realize it at the time- Yeah
who can thrive in these settings and really add such incredible value. And so, Was there ever a point, in those first months that you were like, " What the heck did I join?" You is this maybe perhaps too, early on, or, were you always like- Okay. I knew this was gonna be like this.
keep going, you know?
Andrew Shiflett: I think that's a really good question. And to be incredibly candid- Mm-hmm ... and stay consistent in my promise of being honest, absolutely. Yeah. I think it, every day, that would cross my mind. And, one of the challenges of home-based medicine is we try to limit this, but some days there were drives in between patients' homes, and sometimes they'd be up to 20 to 30 minutes at the beginning because there were so few of us covering- Right
so much ground. Maybe more. I remember my furthest out was about 45 minutes. So you had a lot of time to think. obviously there's some recency bias. If you had an amazing success with a patient, I think we're like this in the clinic- ... in the hospital setting too, but you go in and you feel like you just had an amazing visit.
You were able to help the patient, things went smoothly. That drive is amazing. The sun's shining, you're listening to music. Yeah. You're, best decision in the world. But then as you mentioned, so often you're, formulating your plan, your framework for a patient visit, and you open that door and you find that suddenly their diabetes and their blood pressure is, like, second and third priority because there's insects everywhere.
There's a hoarding situation. there's no caregiver, right? Where it's really needed, and you have to pivot so quickly, and that's when the, where do I go for resources, um, friction can really happen. And those were the, drives after those, you say, "Well, I hope I did the best I could for this patient, escalate it correctly," but what in the world am I doing?
Doubt and Isolation in Startup Leadership
Are we equipped for this? Are we taking on more than we can handle? Is this safe? And, you at that point, I think the, key ingredient here is even in the beginning, we had an awesome team, and I did have some providers. I think I was provider,
actually two at the time.
Yeah. There was one provider that joined a few months before me. Yeah. And I often joke with her, and joke with everybody, I've joked with you, Helen, we talk about dog years, right? A dog year is, what, seven years for every person's year, right? We always say. in a startup, each month is like a year in a regular practice, right?
Yeah. So her being there three months before me, it was like she had been there for three years, And having, you know, least that boots on the ground contact in addition to you, Helen- was huge because, being out on the road, you in patients' homes, you're very much on an island. You can feel very much like a lone wolf.
when the infrastructure's not always built, it can sometimes feel even more isolating. So having the ability to reach out to a seasoned colleague that has, been doing this for a little bit longer and having trust in that, how would you approach this? what would you have done differently?
What do you think we need to do? And I think that, Helen, early on, you put a huge priority on the clinical team building in a smart way, building in ways that the personalities come together and, engender, all the qualities that, we strive for, but can work together even though we're all outgoing in separate directions literally, right?
And that clinical team was just so imperative to bounce things off of, because sometimes is this a reasonable concern? Is this something that's realistic to ask for? And to be able to have a safe space to do that and then come together and kind of, create a more unified, effective communication of leadership is powerful.
It's powerful. Yeah. So because if, we're having the, problem in our vehicle with our patient in their home, so is our colleague, but we need to talk about it, right? so absolutely, to answer your original question, there was a lot of doubt in the beginning, and what fueled me as well was seeing how much the patients and the families needed us.
And it felt like my impact, even though it may not have been, sometimes it felt like one hand tied behind my back, was quadruple what it could be- Yeah ... in a traditional clinic. And that, that's meaningful to me because I wanna sleep at night, and my ability to help people superseded the worry-
Helen Tanner: Mm-hmm
Andrew Shiflett: early days. Yeah. And that's what kept me going.
Helen Tanner: It was really underserved medicine. we have- Right ... so many people in this country with insurance.
With and without insurance, but in this particular case, in this company, it was for patients with Medicare. Mm-hmm. So they had insurance, and some of them were incredibly impoverished and underserved.
and it really did feel good, to really be able to move the needle just a step at a time. And it may have taken years to get them to, or, a year to get them to a better overall point, but step by step. And, and you were the king of this, establishing incredibly close relationships with patients and trust, and their families.
That's key also in this model. with that said, you didn't have a, quote, "official leadership title." But as one of the first clinicians, the earliest in this company- The other clinicians, as we built our team, looked to you as a leader. how did that dynamic develop?
did you want that role or I feel like it- Yeah ... landed on you just, I know your personality and your professionalism and kindness. But talk about how you felt about how that was forming or formed.
Andrew Shiflett: as I mentioned, when I was kind of chugging away in the primary clinic, for about seven years, loved it.
Loved the rapport I built, loved my team I worked with. There was so much comfort in that. But there was a thirst I had that I didn't even realize I had. Something was missing with that job, and the opportunity to lead and have, more of an impact definitely was at the forefront in making the decision to join the startup.
Leadership Without a Nameplate
So, I think I needed that leadership opportunity more than I realized professionally and personally. And it was incumbent on us, as, more seasoned providers. I mentioned one month of, startup life is one year- in a traditional, more established clinic, to be there. And I think our responsibility to the new hires was we want each generation of hire to have it easier and better and more efficient than we did,
Because we've been through some of the battles that we don't wanna fight two or three times. So hopefully they've been kind of smoothed out. And that comes from making mistakes. Not, medical errors, not medical mistakes, but how do we draw labs more, effectively? How do we utilize the MR more effectively?
How do we route just the day-to-day? let's be honest. How do we find a bathroom, when you need to go on the road? Yes. You know, little things- Yeah ... like that. It's like when you join a new office, where's the lunch room, right? That's sometimes the... Where's the refrigerator?
That's the most important question. So from the higher level down to that, just being there, because they all had probably the same apprehension and hesitancy and, they were just as reticent probably as, we were when we, took the leap to the startup world. So I think there was, an important responsibility to show them confidence and solidarity that, we're building the as we go, as we always say, but we're doing it together, and we're gonna continue to do it together.
And it just really filled my cup. In addition to the patient, need and, how we were filling that gap, but also the opportunity to work with really experienced clinicians, though, that were brand new to this space, and bridging that gap. it was exhilarating. It really was my favorite part were the patient interactions, but building a team together.
Helen Tanner: when something was broken or missing, workflow issue, documentation gap, safety concern, how did you raise it, especially in those early days, and did you feel like the business side understood what you were flagging?
Andrew Shiflett: Yeah. So the interesting thing, I think, in my experience with the startup, journey,
There's some innocence, I in the, the early phases, and that I feel like you have operations ear more than you ever will in the beginning. and the clinical side of things is absolutely paramount at that point because if you don't have patients, you don't have good patient care, you don't have good outcomes, there won't be anything else, so in the very beginning when we needed the most, feel like the communication was very direct. was just population-wise a much smaller operation. Right. It was very, very, very, efficient and, I would even say easy to communicate, problems, and most of the time the problems were the EMR isn't working effectively or, how do we get this lab off the ground, or how do we implement pharmacy with, delivery pharmacy arm with, our patient experiences and outcomes?
Um, how do we deliver them blood pressure cuffs for remote patient monitoring? They were big-ticket items that generally aren't so controversial. They're pretty straightforward, and they need and have to work well for us to do our job to build. as we grew and got bigger, obviously, the plane infrastructure becomes more complex.
Instead of building wings and a framework that we can all agree on, it's it's the fine-tuning, the wiring, how fast we go, how slow we go. it just becomes less efficient sometimes to, advocate and to educate, uh, the op side on, what we need. so I think that once again the importance, uh, the team, you sometimes you have to, advocate together at that point as a unified front.
This is a non-negotiable for patient safety, This is an absolute need for us to hit the, benchmark we need to from the business side inevitably, So I think in the, early days, much easier, to simply knock on a door or send a Teams message, " Hey, can we catch up on this?" As we got, more advanced and larger, little more technique and a little bit more, within the team discussing a problem and then delivering in a professional, non-emotional way.
Helen Tanner: Correct. Yeah. And that's a great bridge into a very specific moment that you and I had together as, um, you know, colleagues, and I wanna set some context here because I, I just think it, it matters. So there came a point where the business leadership side was pushing a compensation model that would have docked clinicians for falling under productivity goals, and you and I know that's, um, not necessarily...
That's not a very common way th- um, to manage clinicians. And I had been working on this and trying to articulate what are some other ways that we can address this on the leadership team, and it got to a point that... And you, uh, very nicely elaborated earlier about coming together as a team on some of the more challenging issues and really being able to paint a strong picture.
Um, and so I really needed that help, and so I asked you to come into a meeting with me with, um, the, the leaders of the company because I needed a practicing clinician full time in that room who had really outstanding reputation and was c- certainly... I mean, what you were doing, you were, um, in that role, and I needed you or your help to help make the case against this move.
Knowing that this is not commonly done, it would certainly drive our clinicians, our wonderful experienced clinician team that we had built take... You know, worked so hard to build away and prevent hiring in the future. So this was a very detrimental, um, potentially detrimental move. I understood on the business side something.
They wanted some kind of guarantee that our provider team was going to be productive and help meet the goals that the company needed to do to pr- to meet. But how can we come together to not accidentally make a move that would hurt our model more than help? And so I needed you. I needed your help. Um, so I would love to have you share a little bit about that story in your own words in a, in a way that, um, kind of helps paint the picture of how sometimes we do need to come together to help- A model get, become formed that is beneficial for clinicians, but also in a way that's beneficial to the company.
So take us back to that, if you will. What was going through your head, um, when you walked into that room, or even before that? What, what... Tell me a little bit about that.
Andrew Shiflett: A- absolutely. And I, I think that was an incredible inflection point for our development. Uh, we had had a, as you said, a, a, a simpler version of our model to that point that I think was working incredibly well.
And I think good leadership is always looking for ways to do more. Let's do more. Let's build faster. Let's build quicker. But sometimes it's easy to lose sight of, how do we do that in a way where everyone's best interests are, are accounted for, right? And I am so excited to be a leader at this point, but I'm thinking to myself, "Well, I like the fun parts of being a leader."
I like just helping people and, and, you know, helping my colleagues and educating when I can, but this is an important, the most important part about being a leader. Sometimes, uh, having a counterpoint or counterargument or, or being able to advocate, uh, for those we work with and care about, right? And for our patients.
Um, because provider satisfaction at work has clear correlation with patient outcomes. And if you rock that boat a little bit, in sometimes ways that are a little unorthodox, it trickles down. Not only are you risking your team morale, you're, you're risking retention, but you're ultimately risking patient outcomes and safety, right?
Because we're, we're not as focused. We're not as supported. We don't feel as secure, right, with our leadership team we're working with. So it was one of the first times, if not the first time, that, that I was in a position where I had to go kind of, uh, maybe a little overly direct head-to-head with, uh, operations, right?
And I was so glad and honored that you asked me to do that. And, you know, walking in, you're rehearsing in your head, you know, all your talking points and, and, uh, you know, all the awesome data you have as to, to why this isn't gonna be a good idea. And you walk in and you sit down at the table, and you think, "I'm not in Kansas anymore."
You see the stern looks and, and, um, you know, they're very much entrenched in belief, in, in, in strong belief that their, their approach is the most sound way. So it was an awesome experience to be able to kinda stand, uh, side by side with you and implement that team approach where, you know, we'd had an opportunity to discuss our concerns and, and, you know, we had, you know, very reasonable talking points from a clinical expertise as to why this was not gonna be a sustainable change.
Um, and it was heard. I feel like it was heard, but it was very much that, I feel like, chapter two of the startup journey where suddenly- Our op- our, our clinical side is doing great. How can we get more out of them, right? And there was a switch, and, uh, as, as I think there often is in the startup world, a switch to where operations has somewhat more of the advantage in the tug of war.
And it shouldn't be a tug of war. It should be very much a harmonious balance where we're not building a plane where there's three propellers on one side and two on the other, right? For this plane to fly smoothly through the air, we've got to build it sensibly now that we've got the structure. So it was absolutely a point in my career I'll never forget as an APP.
Not a situation I'd been in as an APP, um, but a powerful one. I think that eventually it wasn't easy, um, but we were able to stave off those changes, and a couple, uh, you know, follow-up iterations of it were presented, and it didn't go quietly into the night. But as a unified clinical front, it was a win for us.
It, it never ended up, the RVU model ended up, uh, changing and, and kind of, uh, evolving in a different way, but it was not punitive. It was not punitive. Um, you know, the, the morale hit did not happen. I think we at that point found, uh, a good rhythm where the RVU model actually hit, hit levels of productivity we hadn't seen before.
Exactly. Right? You know, by not going that route. So- Right ... it was definitely a huge win for the clinical side, and it was needed. It was absolutely needed. It was one of those great checks and balances. And, um, there were also times when, when ops needed to balance us out and our wants and needs and, you know, use their expertise for, uh, the ultimate success.
So I, I was so appreciative of that opportunity. Definitely a stressful one going into it, and also a very telling moment of our, of our practice culture, right? Yeah. At the time.
Helen Tanner: Yeah. You know, um, there is a, and, and I had shared this with you a couple times, but there was, um, as the clinician leader that's sitting on the executive team, there was many times that I, to be honest, it was quite a lonely spot, um, because, uh, you know, I'm advocating for the clinical side and, and not, and, and really having to articulate- Mm-hmm
um, and translate what we're doing in the field into a business setting. And that was, uh, definitely a learning experience for me. Yeah. And one of the big reasons I've created this is because I think we all, like I said, uh, earlier, can benefit from that in any point of our career. Um, but I really, just like you had mentioned earlier, y- before, when you're in a clinic setting, you lean out the door and you can banter back- Right
and forth or whatever, and that really wasn't the case here. So to have you And then, um, you know, and then other people as we grew, as the company grew, you know, people rise to, to their strengths and, and people start to be able to call on them for those needs. But I, I guess, you know, what I'm trying to say is, um, you know, you were able to be in the corner and advocate for the clinician team, the two of us, to make a huge impact on the forward movement of the company, and it wasn't easy.
And, um, I, I wonder, you know, after that experience, did you look at things a little differently after that in maybe how you, um, you know, thought about business decisions and things that were being rolled out, or how did that impact you kind of moving forward, if at all?
Andrew Shiflett: Yeah, absolutely. That, that was the beginning, uh, the phase of the startup we were in of very rapid operational changes and asks.
And the, the priority, uh, I think certainly changed. We were so successful in our clinical models, how do we scale? How do we scale and replicate this over and over again in the most, uh, you know, um, high quality and efficient, but repeatable way? And each new policy that came out seemed to come out a little faster with less discussion on the clinical side.
And I realized very quickly the, the only way to, uh, to, to kind of counter this a- and to maintain a seat at the table is to fly together. You know, that old adage, uh, that we all love, you know, "If you wanna go fast, go alone. You wanna go far, go together." It became even more important to do that. And it also kind of having that first opportunity to stand up for the clinical side and advocate for the clinical side, it was empowering.
It was empowering, and I, you know, I think we all realized very quickly that the squeaky wheel always gets the oil, and that's even more true when things are going at warp speed, right? And, you know, at that point, I think, you know, each of us looked at each operational change with a little more scrutiny.
And, you know, it was important to, you know, stay together with that because we all seemed to have the same concerns, and sometimes when you're alone with those concerns, you feel like, "Well, I'm, I'm the only one. Everybody else is probably fine with it." When you join together and you talk about it, that was the impor- importance of our meetings, right?
Of our meetings and staying together, having those safe places to, you know, to kind of push together, um, you know, with our ultimate goal of patient care, but also making this a healthy place to work for clinicians, right? That, and we wanna- Yeah.
Helen Tanner: And I think one of the things that's important is when we would meet together is to really be solutions-focused because- Yes
our business colleagues- Want to support us, but they also have to meet their goals. So if we come to them with just problems- Mm-hmm ... and no solutions, that is just, just like as, us as leaders, that, that becomes annoying and infuriating at time. Like, well- That's right ... what do you want me to do? Absolutely.
What are... They may not always approve of what we bring to the table, but we do need to bring solutions to the table. And I do think having a team, a clinical team, whether if it's everybody or a large subset, um, who can take these, these problems and what are solutions we can offer, um, to the business colleagues to, you know, is key.
That's right. And I, and, and I, I wonder, did you... Have you always worked like that, or did you realize through this experience that there did have to be a little bit of a shift when addressing problems to be more solutions-oriented?
Andrew Shiflett: I think absolutely there was a shift. There was a shift. Uh, you know, I, I realized, uh, as you said, that we have to learn to speak the language.
I think there has to be some learning on the, on the operational sides to, to do the best they can, and there were opportunities. A lot of times our, uh, our, uh, executive leaders would, would ride along with us and see what we do- Yes ... see what we deal with on a daily basis, and that meant the world to me because- Yeah
there's no other way, uh, to even begin to understand what it looks like boots on the ground, and how can we make the best operational decisions when we don't know what it physically looks like, right? And one of our leaders rode with us o- rode with me rather one day, and said, "I can see you need this and this."
And I don't, I don't exactly remember what it was, but, uh, it just meant so much, and that was just so healthy and important and, you know, one of those building blocks that allowed me to feel more comfortable and at ease and at peace and excited about being a part of something. But our, our responsibility, once again, is to learn how to communicate with the ops side and kind of put ourselves in their shoes, as you said.
And this is one thing you did really well, Helen. Um, you know, we would meet and we would discuss solution-based. That's exactly right. Non-emotional, solution-based. Let's think it through, sleep on it, come together as a group. You were an amazing mouthpiece of our needs as a clinical team. And I think one of the important things is there, there are strength in numbers.
There's strength in numbers, and I think it's, you know, so imperative to have, you know, more than one clinical ambassador, right? And as you said, clinicians, we can rise to the occasion in certain ways. We naturally do, but there, there has to be, uh, there has to be support for even the greatest leaders, right?
Yeah. And I think sometimes the startup space can get a little imbalanced with that, right? Because we're growing, growing, growing, growing. The clinical side is running itself. It's working great. We just need, we need more operational pull, more operational investment. And I think without meaning to, we can start to, instead of being a plane that's flying level through the air, we're, we're like one air is...
one wing's up in the air, the other isn't. We're starting to do corkscrews, right? Mm-hmm. And how do you prevent that? And that's... I, I will always applaud you and, and have so much respect for your ability to kind of condense down what the team would often need and want, even before we knew it, and communicate that in a very, uh, solutions driven way to, to leadership.
And, um, that's what worked. I mean, that was, that was the key to success.
Helen Tanner: Well, thanks for that. Um, I... One of the things that is also unique that I wanted to point out that I really appreciated and learned- Mm ... from, from you and, um- You know, when we were bringing people on board and building a strong team, uh, I, I started to very quickly figure out who was going to succeed and thrive on this team as building it, and who was not a, a great fit.
Right. Uh, and when I say who, I mean, uh, again, general, general characteristics or whatnot. And one of the things that was implemented was an early ride-along or, um, you know, time with one of our current clinicians, uh, um, to really be honest about what it's like practicing- Right ... in this environment. Um, you were really a, a, a leader in this, um, 100%.
I mean, so much so that you became asked to do this with even when investors came. And I mean, you were such a wonderful advocate, but also a really strong clinician and able to talk about our care delivery model. I mean, you helped really shape it. And so, um, but one of the things... And, and I have seen this now talking with so many other startup clinical leaders, um, especially in those series A and early building days, it's, it's really key to be very transparent where you are before joining a company at this stage.
You know- Right ... I've seen people try to recruit like a normal- Mm-hmm ... clinical role of a job. You know, you're gonna see this many patients. You're gonna, you know, diagnose, treat, prescribe, you know, all, all this that you see on j- And, and the reality is, yes, but then there's reality probably over 50% of the job is being incredibly adaptable, flexible, being okay if not- Yeah
all structures are perfect, uh, not all protocols. You're, you're calling out, "We need a protocol for this. Okay, let's get it together- "
Andrew Shiflett: Exactly. Right ... and
Helen Tanner: approve it. Um, uh, it's being transparent about that, and that is how I believe that we were able to build such a strong team by that- Yeah ... transparency. You know, the, the promise of good, the promise of impact, 'cause it can't all be just cross your fingers and join us, you know?
Um, you know, speak to a little bit about being leaned on and, and having that role to really have somebody come on and speak candidly. You're kind of, quote, "selling the model." Um, but also you're responsible for clinical care that day, and you're, you're still needing to do the things that you need to do to care for your patients.
Andrew Shiflett: Yeah, that, that was actually one of my va- very favorite parts, but also most challenging parts of being more of a leader in building the, the practice, uh, because you're absolutely right. You wanna attract the very best fits for what we're doing. Um, you know, at the bare bones of it, our patients have been through so much, and we're asking them to trust so much.
So we want retention, we want continuity, we want... We don't want turnover where, um, you know, we're asking our patients to, to follow along and grow with us, uh, and then every time somebody, somebody there is new, right? We, we can't have that, uh, in, in the care model. So, um, it was, it was imperative that, that our clinicians come in, as you said, eyes wide open.
Uh, and, and I think back to my ride along with you, when I was deciding do I stay at Commonwealth Primary Care, a very safe, known thing, or do I move on to a startup, which is a, a, a ball of clay, right? It could go any which direction, and I've got a family to think about. And whatever discussion I would have, whether it was an investor or a potential hire, was very much modeled after that first discussion we had.
Um, we of course talked about the potential, the potential to impact lives, to build something as an APP, to leave a lasting mark on our community, right, in such a positive way. But, I mean, we're going to have to feel some discomfort. We're gonna have to think on our feet. We're gonna have to re- rely and lean on our clinical instincts and skills like you never have before.
Um, I have a, a colleague I went to PA school with who does wilderness medicine- Mm-hmm ... in Wyoming, and I remember hearing some of his stories and things he'd get into, uh, you know, in the Snake River or up in the, the Tetons. And this was when I was in a predictable practice and, you know, 20 patients a day.
You just, you know, you, you enjoy it, but it's very predictable. And this was my opportunity to do that, not to compare a patient's home to the Snake River, but in terms of the unpredictability-
Helen Tanner: Yeah ... the,
Andrew Shiflett: the variables or the headwinds sometimes that, that we're, we're fighting against. And, uh, you know, that someone has to be, um, you know- Very much interested, whether it's home-based medicine or a startup in general, to have some wilderness medicine in them, right?
“Magic” in Clinical Uncertainty
To have that drive, to have that, "I don't know what today's gonna hold and I don't know that I'll have the tools to handle it, but I'm gonna lean on my clinical skills and my team, uh, as much as I possibly can." That's the magic in it. That's the magic that makes it one of, one of a kind. But I think, you know, when I was, you know, driving some candidates around, I could see in their eyes very quickly whether that resonated with them or it, it didn't.
And, you know, to kind of frame it that way was so powerful because I think, you know, it, it, it, it very much, uh, painted the picture of what our day-to-day is like. And finding the balance of honesty, but also this is the best job ever, but also sometimes the hardest job ever, that's a hard balance to find.
Right. But you have to find it to recruit the best, and I think that's why our team works so well. Yeah. Our team very much had that same fire to, "Let's make a difference in a way that hasn't been done before."
Helen Tanner: Right. Oh,
Andrew Shiflett: yeah. And, and we're all at different phases of life too. Some of us are in chapters where we, where we want that challenge.
Others say, "Wow, well, you know, I think I'm gonna stick to what I know." And that's okay. That's, uh, but it's so important. You'd rather have the right fit and it take a little longer, right, than build our ranks quickly only to find this isn't for me later. Right. So very delicate balance. I, I think I got better at that with time.
Obviously, more repetition. I could, I could speak to it more from a personal standpoint. But I always reflect, I remember we... You and I went out, um, you had a patient that was, you know, ways out of town, and it was a beautiful drive and we had time to talk. And, you know, you, you very much gave me, I'm gonna say it plainly, the good, the bad, and the ugly, but in such a way that was very, uh, consistent with, you know, um, my experience and, and what you knew of me.
And I think tailoring that message to each, you know, candidate too, you did a great job of getting to know the candidate before you got to that point, right? So I always give you a lot of credit for that.
Helen Tanner: Well, thanks. And speaking of next chapters, so you were with very, you know, with us, with the company a really early stage through the growth Series A, through Series B, and then you were ready for a new chapter.
And so y- um, you moved on after a very- Right ... successful- Mm-hmm ... building with the company. And now you're with a startup that has survived that really early chaos- Right ... and is really in a completely different chapter and, you know, more established, much larger. But, you know, uh, uh, techs established, much more processes, more structure again.
You know, what's the biggest difference in how that feels in your practice day to day and, you know, how do you feel about that now?
Andrew Shiflett: Absolutely. Well, I, I think my, uh, my experience starting at the... at, at the very beginning, the grassroots phase, it's kind of, we've called it the scrappy startup environment- Yeah
right, in the past, is, is so helpful. Because even with a, a, a, a major nationwide endeavor that's, I believe, 11 or 12 years in, uh, there are still changes on a weekly basis. We still have- Wow ... changes in, in process, and what we were doing two weeks ago still can change. Now, the messaging sometimes is different, the way it's implemented is sometimes different, 'cause obviously we have more infrastructure to, to kinda, to kinda siphon and filter that through.
But the flexibility I gained, uh, from, from my first startup experience and journey, I didn't have coming from a traditional practice. And I, I, I mean this when I say it, it's, it's improved the way I approach life beyond the clinical realm, right? I find that I'm more flexible in my day-to-day life with my kids, with my family, with my friends.
Something comes up, there's always a better way to do it, and I... my wheels are turning on how can I improve what we're doing, uh, in my personal life on a daily basis. So it, it really rewires the way we think and approach the world, not just patient care. But I've been fascinated. Certainly, the systems run smoother.
Um, we've had time on the timeline to work through all those, those things that you mentioned. But, uh, the change is still there, the endeavor to do things better than you did two months ago is still there. Um, and there's still very much the encouragement to speak up if, if things are not working well.
Let's hear from you. And, um, you know, it's interesting to see the, the balance of clinical and ops in a much larger, uh, system where, you know, we're all over the country. I thought I was on my own when we were all in Richmond going in different cars, different directions. Yeah. We're all over the nation now.
Yeah. Different time zones from Hawaii to the East Coast. So how do you, how do you find that balance even more spread out in a, in more of a remote setting? So, um, the, the skills I gleaned from the first effort, I, I would encourage any clinician to dive in. Uh, certainly, um, do your research and ask the right questions, which we can kinda get into a little bit more, uh, if we have time.
But, um, try it, because the skills that I've actually gleaned, not only clinical, but in terms of the way I approach my life now, having that kind of unstable ground beneath my feet with, with a core mission of let's help people. But that, that unpredictability is just... It's getting comfortable with that is such a powerful thing.
Helen Tanner: Yeah. And perfect segue, because my, my next question was, so- If a clinician colleague is, uh, you know, PA, MP, MD is thinking about joining an early-stage company, and, and I guess in, in our case as a practicing clinician, as part of their role or their full role, what should they ask in an interview that maybe they wouldn't think to ask?
Or what would you... What is some advice that you might share? Um, any red flags, green flags?
Andrew Shiflett: Absolutely. Lots
Helen Tanner: of questions there.
Andrew Shiflett: Whenever I've gone into an interview in my entire life, whether it was the grocery store in high school or as a, you know, as an APP now, um, I always try to take the mindset going into it, we're interviewing, uh, the company or the practice just as much as- Yeah
they're interviewing us. So that mentality's so important just to... This is a, you know, a foundation for an interview. I often get asked the question, "Name a clinical scenario where, uh, uh, you had difficulty, and how did you- Mm ... how did you work through it?" So my advice would be to flip that question and ask, uh, an executive team member, whoever's doing the interview on that side, the op side, "Name a time when there was an operational and clinical, uh, maybe disagreement, and what was your process in working through that?"
Flipping the script- I like that ... and asking that question back I think will give you all the potential red flags and green flags you may need. And that's not a question I asked in the beginning. I didn't think of that. I didn't have the, the context. I didn't have the experience to think to ask that. Uh, that's an important one.
My other questions would really be, "Tell me what you envision if there are not clinical, um, leaders in place. Do you have a plan for that avenue where, you know, as we build this together, what kind of clinical representation do you envision and foresee?" Or, you know, "Tell us about what's the process like getting from, you know, day one hire to clinical leadership?
Uh, what's... Is there a pathway for that?" And I think that's an really important thing to hammer out before you commit if that's something that... Because it, whether you want to be a leader or not, you're gonna have to be in a space. You, you just are to survive and to, for the betterment of our patients. Uh, it's a prerequisite to surviving.
So I think those two kind of key elements will, um, will kind of, uh, kind of sift out any red flags or green flags. I think the answers to those questions will be very apparent in terms of the, the real culture.
Helen Tanner: That is, uh, I love those questions, and I love the flipping the script. Mm-hmm. Um, that will tell you a lot.
And as, as you know, and I think just that one question alone, because that spins off quite a conversation- Right ... gives a good picture. And, um, that's an excellent question. I'm gonna keep that in my back pocket. Yeah. Um, all right. So as we close, I have a couple of questions my- Okay ... that I like to ask at the end, but is there anything else that you'd like to share or, I don't know, uh, that- You know, just kind of leave with the listeners who might, you know, anything else, any tidbits, anything.
Andrew Shiflett: Absolutely. And this, this may be redundant, and frankly I'm okay with that- Yeah ... because I think to hammer it home a third time, um, a colleague that I really respect that I work with now, um, phrased this so well when it comes to a team approach in a startup. And it taught me something about biology, but also- You know, building a team and why a team's important.
Uh, aviation themes still too. So the reason why geese, Canadian geese don't fly alone, they fly in a V. If a goose is flying on its own, it goes, I'm making these numbers up, but 300 miles per hour, something crazy like that. If they fly in a V together in that harmonious balanced pattern, they can go exponentially faster.
That's why, due to aerodynamics. And the reason they're so noisy, they're talking to one another. They can actually go, they found, faster than that when they're encouraging each other on- Hmm ... and communicating and building. And every time I see that V flying overhead, I think of the startup space, honestly, since I've heard that, because it's absolutely so true.
Yeah, that's amazing. We're not always building a plane. We have to remember to fly in, in, in a, in a rhythm, in a pattern that's healthy and natural, that's balanced, that's, you know, communicative and, and, uh, moving in the right direction. And that just resonated with me so much. So the number one takeaway from this, I would say, would be ask the right questions as we talked about.
You know, dive in feet first. If you have any hesitancy if those first questions check out okay and you feel like you have the lay of the land as best you can before you go in. The leadership potential that you'll find, the inevitable stress that you'll work through together as a team. And the team you build, it becomes a family.
You can't get that anywhere else other than the startup space, in my opinion. So there's a lot of struggle to that. There's a lot of, um, there's a lot of wins to that. There's a lot of troubleshooting. But, uh, I would- wouldn't trade anything for the experience and to work with such a great team. And I think we always went further together, we always went faster when it was together, and the patients got the absolute best outcomes when we were communicating, so.
Helen Tanner: Absolutely. And- Um,
Andrew Shiflett: I would close on that one. Yeah. That is my line. I'm not taking credit for the, for the geese metaphor. It was just-
Helen Tanner: I love the geese metaphor. I'm never gonna- It was one
Andrew Shiflett: that just really rang true ... think about it the same. And I didn't know any of that, right? So I learned a lot about... So our listeners maybe will learn a little bit about, uh, our natural biology here and, uh- Love
Helen Tanner: it
Andrew Shiflett: you know, too, so.
Helen Tanner: But, uh- Love it. Well, thanks for that. And just, uh, before we go, was there a resource that you turned to, you know, as you were starting into a startup space? You know, what's the single most helpful resource for you? A person, a tool, book, community, mindset, and what was it? You know, I,
Andrew Shiflett: I think it was the, it was a mindset.
I had to shift my mindset. I mean, all those things were important. I had resources. I had teammates, as I've said. Um, you know, I ha- I've had sounding words. But I think the, the mindset was the most important thing. Very early on, I realized I was gonna have to be comfortable in chaos. And as long as I'm doing the best I can for the patient in front of me, everything else will work out Through my team, through my communication, through my clinical skill.
Everything else is gonna take care of itself. And I, I feel like in the very beginning phases, I was very much, uh, in my own head, as we all probably were. How is this gonna work? How are we gonna do this logistical, um, you know, operational, uh, financial? How is any of this gonna work? I had to s- flip that switch quickly to, to focus on what was really important.
And, and I think that mindset of showing myself grace and showing myself, um, you know, the, the latitude that this is difficult. You walked into an environment that has been broken for many years unfortunately, and, and you're just starting the process of turning around and fixing it in a very new, uh, in a very new, um, practice.
Flexibility, showing yourself grace, um, being able to sleep at night knowing you did the best for the patient is the most important thing in the early days. And that was critical for my survival more so than any resource or, uh, any piece of technology in the beginning. Just flipping your mindset.
Helen Tanner: Yeah.
That's... I love that. And last question. How... And you kind of have spoken to this, but- Mm-hmm ... how has being a clinician shaped the way you operate in startup environments? And then vice versa, how has the startup work shaped the way you think as a clinician?
Andrew Shiflett: Yeah. So once again, it's the flexibility- Yeah ... that it's taught me.
And there's never one route. There's always multiple routes to get to the same outcome, and sometimes what you learn taking the more scenic route ends up being a, a pretty, uh, watershed moment in your clinical career or a, or a clinical journey with a patient, right? There's always more than one way.
That's what it's taught me in the clinical realm as well as the, uh, beyond the clinical world.
Helen Tanner: Yeah. Well, Andrew, thank you so, so much. I loved our time today and your wonderful insight and perspective and, um- I look forward to continuing to follow you and see what you're doing in your new space.
Andrew Shiflett: Absolutely. Thank you so much, Helen. It's been a privilege and an honor, and I hope my thoughts are helpful for, you know, other clinicians looking to maybe delve into the startup realm or maybe just starting out in the startup realm. If it feels a little uncertain and a little scary and unpredictable, it's supposed to.
Yeah. It's supposed to. And, you know, show leadership when you can, speak up when you can, lean and work with your team, and it will all work out. And o- obviously put the patient, uh, at the, at the foundation of it all and their outcomes and safety. It's all gonna work out just fine, and it will continue to improve your clinical skills and, and I, I think life beyond, uh, the startup.
Helen Tanner: Yes, and we'll never think about geese flying over us- ... the same again. That's it. That's it. And they are more powerful- I don't think- ... than ever before.
Andrew Shiflett: If anyone fact check- fact checks me, the, the speed I, I quote is probably a little off, but the, the point and the moral of the story stands. So- Good, good ... uh, hopefully that'll be helpful too there for our listeners.
Helen Tanner: Well, thank you, Andrew.
Andrew Shiflett: Thank you, Helen. Appreciate it.
