Part 2: Interview with Dr Gregory Sam, Psychiatrist and Director of Conduit Health

First published April 28, 2016

We hope you enjoyed Part 1 of our interview with Dr Gregory Sam of Conduit Health. His telehealth psychiatry service provides nationwide consulting services which benefit rural and remote or mobility-affected communities. Consults can be done from the comfort of a patient’s local GP clinic or residential care facility, with no sign-up fee for GPs, and bulk-billing for patients.

Greg hopes to expand one day into other areas of the globe. Learn more about his journey below.

Dr Gregory Sam, Consultant Psychiatrist, Australia. Image courtesy of Dr Sam.

How did you go about funding your project?

I’m a big fan of lean startups. Not needing huge capital. Also a huge advocate of self funding. Conduit Health was completely self funded. I was confident I could make the business model work.

I didn’t seek outside funding. There are alot of strings that come with outside funding, and you’re suddenly answerable to the government or your VCs (venture capitalists) or your angel (investor), and I didn’t want to do that. So I self funded everything. The benefit of the lean startup was, it didn’t cost me anything. I set my budget and said, “this is what I have to work with, what can I do with it?”

I started my company in the garage at home and a small office– which used to be for boys’ nights! So I said, no more poker nights, and converted it into an office. Conduit started from there. No overheads, no rents or anything. Yes, it was a home, and my wife helped me with marketing, pictures- I remember days sitting in the back office packing thousands of letters to send to GPs nationally- just me and my wife. More and more, big successful companies have that kind of beginning, they don’t have the multimillion dollars to spend at the start.

Sometimes you have to be able to sacrifice the ego and go, I’m doing the secretarial work. I typed up letters for my psychiatrists. I needed to do all this for the company, and if I didn’t have the money to employ a secretary or typist, I’m doing it. It’s rewarding at the same time, you get to see the company growing. From one referral to multiple referrals a day.

You must be critical of what you do. I always think, is this the right thing to do? Reflect and analyse, ask, “in terms of the business strategy, is this a good idea?” Not being complacent, “oh I can spend all this money now,” it’s about growing your business. Some people create meaning without making money.

Often if a company has created meaning, they then create money. But often people focus on making money first.

What got you interested in entrepreneurship in general? 

Wanting to make a change on a larger scale, to create something and grow it organically. And it’s exciting. Hard to describe the feeling but it’s a huge challenge. Something that can consume every moment of every day. But very rewarding. 

What sort of doubts or worries did you come across?

I didn’t study business. The difficulty within the medical field is, there aren’t many entrepreneurial people. I keep thinking of so many examples where my medical colleagues have such great ideas but don’t have the support or environment to foster that development. 

And I think taking myself out of that comfort zone,being with my business friends, listening and learning from them, really addressed those doubts.

One thing I know is that I’m a doctor, I know the medical part as well as the business side of things. Psychiatrists I work with feel comfortable with me because I know what it’s like to be a psychiatrist, I know the difficulties they face, I know what it’s like to treat patients. Whereas if it’s a purely business person,  you wouldn’t know what to give the patient, or how to be a psychiatrist, you’d possibly be like “oh it’s good for business, let’s do it.” That’s my advantage.

I think a lot of doctors should see it as an advantage, “I’m in business but I have a medical background.” So my doctors and nursing staff, they all understand. Which is why I’m all for doctors getting into business. As a doctor you would be able to empathise, with a business heart.

The other fear was, I got into medicine to be a doctor, and do my clinical training and be a psychiatrist. The path is very set. Once you start thinking of deviating from that, it’s quite scary. The reality is, actually it’s very refreshing. Because all we’ve known for ages is patients, medicine, being a clinical doctor. So actually, its very liberating.

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

 One of the problems when starting out with telehealth is the many barriers. Like technology, for example, Internet speed, willingness to try out technology, video technology, and costs.

I thought, what are all the barriers? One by one, I addressed them and ticked them off. We bulk bill, so patients don’t pay. GPs win because patients get seen by specialists for no sign-up fee. Patients win because they don’t have to travel. Psychiatrists win because they don’t have to have room fees, which can amount to $70-80K a year. It’s an untapped market. Lots of patients need help. Whereas the metropolitan market is completely saturated. So we’ve tried to knock down all these barriers, and create a win-win situation for everybody. 

I think less so that people choose entrepreneurship, more so entrepreneurship chooses people. I think about ideas all the time. There are all sorts of naysayers who will come and tell you it’s not going to work. Why does this person say it won’t work, and how do I prove them wrong? I take what he says, think of the meaning behind what he says, and maybe he’s thinking it won’t work for xyz reason, how do I address xyz?

I think more and more power to doctors who become entrepreneurs in the medical field, or outside of medicine. So that studying medicine doesn’t become this one-track path, you will see patients and that’s it. People can become disillusioned by it, it’s so straight, the path doesn’t have any chance to vary. Yes, medicine does offer many specialties to choose from. But it’s still so contained like a nucleus, and no one’s thinking of addressing the outer shells.

Specialty training itself is all-encompassing. It will suck your life dry so that you just focus on training and that’s it. Same thing happened to me til I failed a few times, then you step back, and I said I don’t want my life to just be about training and fellowship. I want it to mean more, and that’s where the value is. 

Did you have a mentor?

 I had a few different mentors for different things. I try to draw upon the things that I want to gain.Positives and negatives. I draw analogies with badminton training. I had a coach for 6-12 months, and I drew as much as I could their positives. A certain coach would be good on physical stuff, another would be on mental aspects of the game. Same with psychiatry training. One would be clinically good so I’d take those aspects off them. Another had a good lifestyle setup, so I wanted to draw upon that.

For a business, it’s more offsite. I’m a member of business groups. The guy who did my websites runs an IT company in Malaysia, from a business perspective I love bouncing ideas off him, and learnt lots of things from him.

It’s important to be able to have many mentors for different things, because there’s a risk, if you follow just one person, you absorb all their flaws, and are unable to see their flaws. That’s a risk in medicine, too. 

I also learnt heaps from watching talks by Guy Kawasaki and Elon Musk and a few others. 

Part 3 will be released soon! In the meantime, if you’ve got any comments or questions about our article, comment below.

You can view Part 1 here and visit Conduit Health here. 

If you wish to contact Greg for more enquiries about Conduit Health, or to sign up as a GP or psychiatrist for his service, please email enquiries@conduithealth.com.au. Conduit Health is also on Facebook. 

Interview with Dr Gregory Sam, Psychiatrist and Director of Conduit Health: Part 1

First published April 26, 2016

 Dr Gregory Sam is a consultant psychiatrist who founded Australia’s first bulk-billing telehealth psychiatry consulting service, Conduit Health, in 2014. Focusing particularly on rural and remote communities, Greg currently runs Conduit Health along with his private practice work in the city. In this three-part interview series, Greg kindly shared his tips for success, the road to Conduit Health, mixing business with medicine, and rising from failure.

Image credit: Dr Gregory Sam

How did you get the idea for Conduit Health?

I think the idea started during my rural rotation of training in 2009. It was often a whole-day affair to see these clients, 4-5 hours’ trip each way, and that was disheartening to see people suffer so much. It’s supposed to be easy access. But they had to wait ages before seeing a psychiatrist.

So I aimed to fill that gap.

I started because I was so frustrated at the way things were.

I found so many deficiencies in rural mental health care, and thought, how do I improve things? There area lot of difficulties and shortcomings in the system. I was always into tech stuff. So I tried to think of the amalgamation of the healthcare and mental health care sectors. Telehealth was in its infancy then. So I thought, why can’t we assess the patient through telehealth conferencing?

I struggled to get through my exams, failed 3 or 4 times, and started to get a bit disillusioned about my career in general. I wasn’t sure why I wasn’t getting through. A lot of thoughts were going through my head. Is this the life for me? Should I be changing careers? A whole heap of stuff. But I thought, there’s still good things I can do in this field, whether it’s as a registrar or consultant or not. I’ve learnt a whole heap about my specialty through this. 

How long did it take you from having the idea to taking action, alongside your clinical work and studies?

Honestly, a few years. My idea has been since 2009, and it’s very tempting to get distracted by training. I was so focused on training that all these other things I could do fell by the wayside. I had the idea for a few years, but only started something solid in 2014.

I think 2014 was when overcoming all the inertia of starting a business occurred, planning and actually doing things. 

Failing my exams gave me that opportunity to start thinking outside the box. I took 3 months off work to have a break. I think that’s the best thing I did during training. I focused on badminton and other things I like doing, and started to make moves on my company. I had meetings with colleagues and friends in business, picked their brains, tried to absorb as much as I could from them, both guys and girls, to understand what it’s like to get into business. My business friends said, “it sounds like a brilliant idea, why don’t you do something about it?” So that gave me a kick to start.

When I went back to work, I left business for awhile and focused on passing exams. Once I passed, during our year of Advanced Training, I set learning goals on things like, “I want to learn more about drug and alcohol,” and other goals which I did in my day job, and also focused my energy on Conduit Health. That’s when the wheels started turning.

2015 was the launch date. Our first consult was February 2015, so 2015 has been a big year in that it’s a startup, and for most startups it’s about sustaining that growth, so 2016 is another big year. A lot of planning happens with regards to how to continue that growth, otherwise it’s too tempting to have a firework effect where it starts then fizzles up. 

Overcoming inertia is hard, but once you overcome it, things start rolling, and you can’t stop.  It’s a lot of commitment but so rewarding, more rewarding than my day job. I find treating patients rewarding, I can help them and their families as a psychiatrist. Whereas with Conduit Health, I’m helping so many more people across the country. We’ve had referrals from far and wide, from every state, and remote locations like the Kimberley and the Great Barrier Reef. I’m working with primary health networks (PHNs) across the country to expand our reach. 

How does a typical consult run?

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

Either the psychiatrist dials in (from their location), or the patient (who’s hosted at their GP clinic) dials into us, then the psychiatrist introduces the consult. We need to say at the start that we’re doing it via teleconferencing, that there’s no one else in the office, and check who’s in the office. This sets the scene so the patient can understand that there are no unseen people in the room. We discuss confidentiality, unless risks in which case we need to notify particular people. It’ll go between five minutes to an hour, we state our aims, then start the diagnostic interview.

The video quality is quite good, but if there’s any lag or dropout, we disconnect and call back. We check at the start, “can you see me? Can you hear me?” We check camera position so the webcam points directly at the patient and so the patient can see us. We also make sure it’s appropriate, eg. the psychiatrist is in a quiet isolated room, not at the beach. We set rules for our psychiatrists. They use the Conduit Health backdrop. 

Sometimes a mental health care nurse will be there. We offer to GPs, if you want to be present for the whole assessment or in the last 5-10 minutes, you can. Some GPs stay for the whole interview, others come in the last 5 minutes and ask the psychiatrist, “what’s your diagnostic impression and what’s your plan?” They can get immediate feedback, (and sometimes help with scripts and so on).

We also get constant feedback from other GPs. My role is partly to ask patients and GPs, “how are you finding the process? Can we make things better for you?” Constantly evolving the company.

One benefit of Conduit is confidentiality. You don’t need to go into a psychiatric facility where everyone knows it’s a psychiatry facility, and sit in a waiting room with other mentally ill patients. Patients have said that’s a benefit, so people don’t have to know they’re seeing a psychiatrist. In a way that’s also bad. We’re not trying to promote stigma of mental health, but unfortunately this is a barrier to receiving care.

How did the name Conduit come about?

I was building a house at the time, and working with the builders, one said, “I want to dig a tunnel under your garden to create a conduit for your electrical wires to go through.” Also from my cardiothoracic surgical rotation in med school, “they harvest the conduit” in bypass surgery, and they explained what a conduit was to me. I then thought about what Conduit Health does, it takes away big distances and gaps.

The logo is a bridge, to embody bridging gaps.Suddenly, 300 kilometres to go to an appointment doesn’t matter anymore. It’s a link, a conduit, from point A to B. So patients don’t have to travel.

I don’t think telehealth will replace traditional face consults, but it can address geographical barriers.

Would you expand Conduit to non-psychiatry services?

The immediate next need would be psychology. It would be great to have psychologists who can do tests and consults. But at the start, I want to focus on psychiatry. Some companies have one of every specialty, but I want to focus (for now). If there is demand later on, for say, neuropsychology, social work, we will expand to fill the need.

What about your plans for aged care?

A big arm we’re developing in 2016 is to work with residential aged care facilities. There’s such a huge need, patients can’t often go see a psychiatrist. Aged care services are often floundering, “can we get the psychiatrist to come here?” but not many psychiatrists want to do that to see one or two patients, it’s not feasible. But we can go in and have a session there, and it’s immediate. So 2016 will be a big year for Conduit Health Aged Care branch. We want to expand to all the big aged care facilities. 

To learn more about Conduit Health, click here. 

Stay tuned for Parts II and III of Greg’s interview, in which he discusses his business inspirations, his insights on failure, and running a business as a medical professional.