Dr Andrew Greenland: 0:05

Welcome back to Voices in Health and Wellness. This is the show where we spotlight the bold thinkers and frontline leaders reshaping healthcare from the ground up. I'm your host, andrew Greenland, and today we're diving into a powerful conversation around the future of small health clinics, what's working, what's keeping clinic leaders up at night and where we go from here. So our guest today brings an incredible dual perspective to the table. She's both a certified paediatric nurse practitioner and a certified paediatric mental health specialist. Melissa Smith is the founder of NewView Integrative Paediatrics in Watkinsville, georgia, where she's created a care model that fuses medical and mental health support for kids and families under one roof. In a time where many clinics are stretched thin, melissa's approach is a breath of fresh air focused, compassionate, deeply responsive to what modern families need. We're thrilled to have her on the show and to unpack some of the big trends and big decisions shaping the future of community based care. So, melissa, thank you very much for your time this afternoon and thank you very much for coming on to the show.

Melissa Smith: 1:00

Thank you so much for having me.

Dr Andrew Greenland: 1:02

So maybe we could start at the top. Could you maybe share a little bit about your role at NewView and how your background in both pediatric primary care and mental health care plays out day to day?

Melissa Smith: 1:12

Yes. So I have been a nurse for 26 years, got my NP in 2014 and started to look at kind of the changes I was seeing, especially in pediatric mental health. And my mom had got had cancer around the time and she was working with a naturopath and it kind of dove into her treatment and just the power of even diet alone with cancer and I started to kind of question what we were doing, especially in the pediatric model. So what we see a lot of now, because these children are inundated with different toxins, is that they present with a lot of behavior changes ranging from anywhere from, you know, aggressive behavior to OCD, to tics, to there's a range of them, and so when I opened my clinic, I wanted to specialize in especially PANS, which is Pediatric Autoimmune Neuropsychiatric Syndrome, and other autoimmune disorders, especially in the pediatric world, because it's a different world we live in now than when I grew up and my goal is to provide functional, integrative health care that they can get to the root cause of what's driving these changes that you're seeing in kids.

Dr Andrew Greenland: 2:20

Amazing. So what does a typical day look like for you in your clinic? At the moment, and I guess there is no such thing as a typical day, but how does it generally pan out for you?

Melissa Smith: 2:29

So we have, typically, I do, a combination of also just traditional well checks and sick visits as well, and then I do functional medicine. So it kind of depends on what the visits are. My functional medicine visits tend to be an hour a little bit longer, and then the well checks and sick visits kind of fill the spaces. Right now I'm struggling a little bit with being able to get everybody seen. I think this is definitely a growing field. People want this for sure. I have patients that come from out of state. I have a lot of different, because they're looking for someone who will look at the root cause, and so my biggest thing I'm trying to balance right now is my schedule to be able to have some downtime for myself but then to be able to see everybody in a timely fashion.

Dr Andrew Greenland: 3:12

And I guess you're quite unique in being able to deliver sort of functional medicine as well as the mental health aspects. And was that? Did you see a gap for something like this when you were kind of thinking about what you do in NewView?

Melissa Smith: 3:24

So I think when you start to look at things through a different lens specifically, that really opened my eyes. I think, in mental health, what happens, what I see a lot in children is that they have labels right. They can have ADHD, they can have autism, but what happens when you get to the root cause is none of them are methylating well, none of them are detoxing well. They have a lot of extra things on board. Their gut microbiome isn't in a good place and when you start to balance things like that, these symptoms improve. So it got me thinking. You know, mental health is a big. It's getting worse with children. But my goal was to get to what is driving this, what has changed in our world from even when I was younger, because we didn't have the same amounts of adhd and autism and all the things that are rising as we did when I grew up. So what's changing in environment, of course, is a big player in all of this. So my goal is to stare away from labels and get to the root cause, and the beautiful thing about that is, once you do, these kids get better. I mean, I've seen autistic children get their speech back right Just from gut microbiome, health and methylation support. I've seen, you know, PANS. Kids be able to return to their normal selves, where they're not having anger outbursts and all of these these catastrophic symptoms.

Melissa Smith: 4:36

And these, these families that come in are in crisis. I mean they're, they're living in a crisis situation. So when they come to me, it's like you know what's wrong with my child? They've gone to all the regular doctors and everyone said he's fine, there's nothing wrong with them. But children, parents know their children and they'll come in and say, well, something's not right, right. And my response is always well, yeah, we need to look at, we need to do the groundwork first. Right, let's look at. What does his gut microbiome look like?

Dr Andrew Greenland: 5:05

Once you start to balance all of that, it's amazing how well these kids do Amazing. So I've had quite a few conversations with practitioners around the world and we've been hearing a lot from small clinics about the rising costs, more complex patient needs and tech fatigue and what are you seeing any of these in your world? Or are you seeing any other shifts that sort of predominate in your world?

Melissa Smith: 5:22

So cost is a big one. And insurance, so in my clinic I don't take insurance. The biggest reason is because there are different types of appointments and so I and most people, when they come for functional medicine, they're they're more kind of prepared for that because they want the time. But what I hear a lot of is, you know, insurance would cover this, but the problem with that is that the reimbursement on my part isn't the time I put into these appointments.

Melissa Smith: 5:47

So that's where I struggle is finding a balance between, um, charging for your time and your expertise and then also being cost effective, because I obviously I mean that's a huge part of this and I don't want to be someone who's going to, you know, price gouge people, people but it is a balance, and so I think that when you do this type of medicine specifically, it's very different. Most people understand that. Most people will say I understand this isn't kind of your routine. I go and I have a sick visit, I get an antibiotic right. This is an hour appointment, digging into your whole history and then addressing these root causes, and so most people understand that.

Dr Andrew Greenland: 6:27

But that is always a concern for me is trying to balance those costs Amazing. And how do you balance the dual demands of physical mental health? I mean, you mentioned PANS, which is a classical case of there are physical and mental health issues. I'm just wondering how you managed to kind of package this all up into a single visit. Obviously, I know most patients have more than one visit, but how do you get the balance right for these kind of complicated cases?

Melissa Smith: 6:48

So it's interesting because anything mental so that could be anxiety, depression, ocd, I mean any of them I have seen anecdotally that it's 100% linked to the gut microbiome. So my conversation with parents always is let's go ahead and kind of like, get this whole history, let's clear things. Let's do ahead and kind of like, get this whole history, let's clear things, let's do some testing to dig into the root cause and let's start to help the body do what it does. Naturally, I always tell the parents it's like it can't put out 12 fires. It's trying but it can't, and so that's where you see symptoms that happen, and I think it's very reassuring and refreshing for parents when they can understand the pathways. So I will go through that with them and show them this is what your body is choosing to do and this is why these symptoms occur.

Melissa Smith: 7:27

So I feel like any of these and most people, at some point I'm dealt with anxiety, depression, all the different things. But there's a huge role in toxin burden in that. There's a huge role in methylation support in that, and once you start to do that, then I think you open a pathway. So I think there's always a connection there with mental health, just because most of my kids have something ADHD is another big one that I see a ton of and when you balance all of that, those symptoms go away.

Melissa Smith: 7:53

A lot of my children will come in on multiple medicines, which is another big, you know, pet peeve of mine, because I'm trying to kind of figure out that. That makes it a little more tricky right when they come in with psychropic drugs being treated for different things when they haven't done what I call the groundwork, which is always getting back to the root cause, and the foundation, which is always the gut microbiome. So when you look at that, then they're able to come off these medicines. So there's kind of a balance there. But anything, any mental concerns, is 100% linked back to the same thing.

Dr Andrew Greenland: 8:25

Interesting, I guess. I don't know, but I'm guessing that you probably see more child and anxiety. It certainly is becoming very predominant in practice. I just wondered how that's affected demand for what you do. There's this sort of epidemic of child anxiety and sort of low-level mental health issues and I just wondered how that affects what comes through your door.

Melissa Smith: 8:46

Yeah. So that's a big reason why I chose to start NewView, because I couldn't change the lens anymore. So I would have kids that would come in, that would have severe anxiety and the parents would want them to go on different medications. And it's hard when you see what you can do on the other flip side, which is diet, sleep right, all of the things that we don't really address necessarily in the traditional medicine world because we have a 15-minute appointment. When you start to actually get to all of that, it's very difficult to change that thought pattern. So that's why I started NewView and so I always tell parents you know, yes, it's definitely something that we're going to look at and we're looking at the whole body, how the whole body is working right. What's driving this anxiety?

Melissa Smith: 9:31

There's a lot to be said for overgrowth in the GI gut microbiome that increases different neurotransmitter levels and most of my children are high dopamine kids, right. So they come in and they have very high dopamine symptoms and when you go into kind of clear all of that, it really does make a huge difference. So I think that's where my um, that's where I took a step back. I wanted to start new things because I wanted to. I couldn't see it through the other lens. There's definitely a balance between, I always think, functional medicine and traditional medicine. For sure, but I don't think in traditional medicine we do a very good job of getting to the whole thing, which is also diet, sleep right, what's your stress level, are your cortisol levels, and there's a lot to be said for all of that, and so what I try to do is incorporate that over, obviously, multiple visits, because it can get to be a lot to try to balance that for them.

Dr Andrew Greenland: 10:15

Amazing. And tell me about your team. Are you a one man person, a one man band, or do you have a team behind you? How does it all work from a team perspective at NewView?

Melissa Smith: 10:29

So it's just me as a primary practitioner right now. I do have a medical assistant and a receptionist, so it's kind of a small practice right now. We are growing, which is great. So that's another thing. I'm going to, as we continue to grow, have to kind of balance it out because the demand is definitely increasing from my time and so that's something that talk about challenges with small business practice. That's a big challenge with my time is balancing that out between telehealth and also messages and you know all of the different things. So they do a great job of helping me with that and kind of kind of helping to support my time.

Dr Andrew Greenland: 10:57

Amazing and what's working particularly well for you at the moment in your practice Anything you can. You're particularly proud of anything that you kind of champion in what you do.

Melissa Smith: 11:06

So I feel like I take a very different approach to PANS. Pandas, I think PANS is. A lot of people get focused on the antibody titers that can drive these symptoms and my what I look into I always go back to gut health. A big thing with PANS is antibiotic treatment, things like that. One of the things I steer away from is that because, again, it doesn't fix the root cause.

Melissa Smith: 11:31

So I always said I kind of look at PANS through a different lens than most people do and anecdotally I can tell you it works because I've seen it over the years. When I first started treating it, I did it kind of like they do right, they gave antibiotics and these patients get better, but then I started to see that they didn't stay better and so my question always was what's going on right? And so what was happening is you lower dopamine levels for a little bit with antibiotics, but it always comes back. So that's why I'm proud of that, because I feel like I've kind of come up with a really good approach now for PANS kids that helps get to the root cause so they don't have these recurrent flares and you're not using antibiotics and steroids and all the things that really don't work long term.

Dr Andrew Greenland: 12:10

Got it, and, on the flip side, is there anything that you find particularly frustrating or challenging in what you do?

Melissa Smith: 12:17

I would say time management is probably my hardest. And what you do, I would say time management is probably my hardest, especially as we grow. So when, when I have new patients that come in, we do functional medicine testing, there's always that follow up that has to happen, and right now we're being pushed out further and further. So parents are getting a little bit frustrated with that. So I think that's a balance for me and I'm not. We're kind of working through that that daily.

Melissa Smith: 12:39

So what I try to do is when they come in for that visit, always get them on the schedule. But if they're delayed in sending off testing or whatever, then they don't get on the schedule as quickly and then I run into angry parents where the test results come in and why can't I get in to see me? So I think time management is my biggest challenge and but having a team that helps me with that is is huge. That way it takes me kind of out of that picture a little bit. So I'm not looking at the schedule and I'm not getting overwhelmed, and that's a huge help, it's a release for me, it's just a huge relief.

Dr Andrew Greenland: 13:09

So Got it and I mean you mentioned about growth and you like wanting to grow and be able to offer your services to more people. So where would you like to be in sort of 12 months time? Is it going to be sort of more patients, more services, less burnout?

Melissa Smith: 13:22

I'm not suggesting that you are burnt out but a lot of practitioners are when do you want to go? Yeah, I definitely think more growth and a balance. So I do think burnout is a very real thing. I think it's hard, especially when you're dealing with very emotionally charged cases. A lot of my cases are very difficult, they're very complex and you have a lot of emotions with the parents and the kids, and so for me that I'm an empath, so I tend to absorb a lot of that, so I do kind of I feel like I can be leaning towards burnout quicker. So my goal is to find a balance in this next year. Right, I wanna help as many people with P as I can, because I I know parents are looking for that and it's a very real diagnosis and it's something that is can be treated. But then on the flip side is making sure that I I can see the patients I see and then I'm able to um also balance my home life and my, my mental um, my mental health as well thank you.

Dr Andrew Greenland: 14:19

Um, so, in when you think about wanting to grow and expand, have more people, what are the systems and processes that are the hardest to scale from where you are to where you want to be, do you think?

Melissa Smith: 14:36

That's a very difficult question. I don't know how to answer that one. I think most of my patients come to me from word of mouth, so I think that's where that's being spread, that way kind of word of mouth, and so I think I don't even know how to really answer that. I think I just have to find that balance as best I can, to where I grow, but still because I don't want to grow to the point where it's not it's not kind of personal right, then they can get ahold of you and that you are their doctor, that you can. So I don't want to grow into a big practice like that.

Melissa Smith: 15:08

However, I know that the need is much growing and as people are starting to look at changes in children's behaviors, they're saying, okay, something else is going on here and, to be honest, there are so many people, even adults, walking around with toxic issues, and so it's just one of those things that's going to continue to grow and I think people are waking up. Covid was a big game changer for a lot of people and I think that opened their eyes to alternative types of medicine and like what's at the heart of all of this. So I think, keeping it personal and keeping it small, but then again helping as many people as I can.

Dr Andrew Greenland: 15:40

So that's going to be a tricky balance to find, completely understand. And obviously functional medicine I mean, I'm in functional medicine as well, so I completely understand what you do and where you're coming from Still regarded a little bit alternative. How are things in the US for this? I think functional medicine has got a bit of a better rap than it has in the UK because it's still very small and very niche over here and people haven't really heard of it. But do you see, is there any sort of a view taken by the conventional medical establishment against things like functional medicine in your world?

Melissa Smith: 16:09

Absolutely it's ignorance, I mean. I just I think that they haven't well I know they haven't done the research. So parents are absolutely asking more I think. I think this demographic in pediatrics is different than adults, because with kids, parents want to know what's going on in their body, what's being put into their children's body right, what's at the heart of the treatment. So this is very much a growing field here very much, and I do think COVID kind of put that seed in people where they were like okay, this vaccine seems a little different. This kind of got pushed through. What about the other vaccines? What about everything else that's happened? What about what's in our food? So it's very much growing here.

Melissa Smith: 16:46

There are, we are receiving a lot of pushback from traditional medicine, especially when it comes to vaccines in this country, and so that is a big drive of what comes into to see me because I don't. I don't push vaccines, I don't do it because there's a it's not a one size fits all, right. So I always look at the bigger picture and so I think that's a big driver for a lot of parents. But they're being dismissed from pediatric practices because they don't follow their rules right, and that's sad to me because I think the research is definitely out there. I think practitioners need to open their minds a little bit and look into it. There's definitely research and so, anyway, I think it's more ignorance and just not wanting to to learn more about what's in the functional integrative medicine world. It's amazing when you do.

Dr Andrew Greenland: 17:26

Brilliant. So on this sort of theme of growth, because I'm very interested in what you do and obviously very keen to see how you expand and reach more people. So if a genie handed you $100,000 grant tomorrow, how would you invest it in your practice?

Melissa Smith: 17:41

handed you a hundred thousand dollar grant tomorrow, how would you invest it in your practice? So one of the big things I really want to do is start to train other professionals. I feel like there is there's a very little research not really research. There's very little um on how to treat pants. Most of the people that come to me they've done antibody titers and that's it right. So when they come to me we talk about the much bigger picture.

Melissa Smith: 18:02

I think there's a need in the community for more practitioners that are treating this for sure, and I would love to reach more people to be able to say, hey, this is what I've seen through the years. That's worked. This is a great way to start. This is the testing that I recommend. You know, you kind of start with and then people can start to, because I think the burden would then be lifted off me a little bit because people are looking for that right. So more getting more information out there would be probably how I would invest that money, especially more into traditional medicine doctors and looking into this other side of things and how it works. Also doing research on my own to what I see right and starting to publish some things there to say this is what I'm seeing in the clinic, this is what's working, and just letting people see, like what anecdotally works for in this type of medicine.

Dr Andrew Greenland: 18:47

And are there any services or supports you wish you could offer but you can't do yet? I know with growth it's all about sort of trying to reach out to more people. Are there any things that you'd like to be able to bring on board as you kind of grow and expand from your in your practice?

Melissa Smith: 19:00

I would love to live to bring on, like traditional or like Chinese medicine or acupuncture or different services, massage services. There's so many things that red light, therapy, all the different things to bring on and also have as an adjunct with that, because my practice focuses on supplementation and focuses on, you know, diet, support, sleep, but the other part of that is so many things that go beautifully with that that I would love to offer for parents so that they can have it all in one spot and have complimentary treatment as well.

Dr Andrew Greenland: 19:31

So true, true holistic care.

Melissa Smith: 19:33

Yes absolutely yes.

Dr Andrew Greenland: 19:36

And if I could get the same genie who's also given you the $100,000 grant to solve one big roadblock or challenge? What would that be?

Melissa Smith: 19:46

I think the biggest roadblock would probably be understanding the difference between this type of medicine and traditional. And I say that because that is a common question I get from parents why don't you take insurance? Why don't you? You know, why can't you get on board with the insurance companies? And so I think, trying to explain that this is a different model and that this is a different approach, when they, when they come and they see the approach, it's a different, they understand more.

Melissa Smith: 20:13

But I think the phone calls I get are always like well, she doesn't take insurance, so I'm not going to go to her, right, and that's fine. But I try to explain to people this is the reason why I don't take insurance. So that's a big roadblock for me as far as getting people to come and offer services. And it hurt, hurts my heart a little bit, because I've seen people that haven't come because of that reason and I know that I can help them. And so that's where I kind of go back and forth, because I my heart wants to help everybody. I know I can't, but that's where the roadblock is with insurance versus not taking insurance.

Dr Andrew Greenland: 20:46

Amazing. And finally, what do you? Who do you look to for inspiration and guidance in this space? Is it other clinics, other thought leaders, other mentors? Who kind of gives you the inspiration to keep going and do what you do?

Melissa Smith: 20:57

Yep. So I did work under a physician in the United States for a little bit and got a lot of his models. He was very inspirational for me. Also, mosaic Diagnostics there's a lot of people through them. Dr Waller's one of them, dr Shaw. All of those people that I go to for support and help because some of my cases are very complex and that's also another roadblock is finding practitioners who understand the testing I'm doing, can help me with it because they are pretty complex. So those are my big support people. And then I'm always reading, always learning different types of conferences and things like that is just a huge inspiration.

Dr Andrew Greenland: 21:33

Brilliant. So I think before we did the recording you were asking me whether we have nurse practitioners in the UK, and we do. It's a much smaller thing. Do you get any pushback from people coming to see you expecting? I don't know that. We want to go and see a doctor. Is there any pushback for nurse practitioners in the US or are they very much a bedded in thing?

Melissa Smith: 21:53

So in different states it's different. There's a lot of states where we don't practice under a physician. Georgia is one of the ones where we still do. So the physician that I work under though he's not on site, he's actually in South Georgia and so, yes, I do receive that sometimes. But when you sit down and talk to people and explain your role, then that clears it up pretty quickly. Most people, to be honest, if you ask them, would you rather see a nurse practitioner or doctor, they're going to tell you a nurse practitioner because they are more holistic in their care. They tend to be more nurses. So we just a little bit different approach to things. So most people are incredibly receptive to that and if there is any of that kind of questions, I always sit down and say this is kind of what our role is, what we do, and this is in Georgia how this works right and people are very supportive of that.

Dr Andrew Greenland: 22:41

Amazing. Melissa, thank you so much for your time this afternoon. It's been a really interesting conversation, really interesting to hear what you do. The people that you serve and you know from one functional medicine practitioner to another, I mean really appreciate what you do because we're definitely on the same page. I love your approach. I love the fact that you're able to integrate mental health into what you do. I think that's a really useful and helpful case mix for the patients that you treat. But thank you so much for your time and talking to me this afternoon.

Melissa Smith: 23:07

And thank you so much for having me. I so enjoyed it.

Dr Andrew Greenland: 23:09

You're welcome.