Welcome And Guest Background

Dr Andrew Greenland 0:00

Welcome to Voices in Health and Wellness, the podcast where we speak with practitioners, founders, and innovators who are redefining what care looks like and what it takes to build something meaningful in healthcare today. Today I'm joined by Dr. Troy Hailparn, a board-certified gynecologist with over 30 years of clinical experience and the founder of the Cosmetic Gynecology Center of San Antonio. Dr. Hailparn is widely recognized as a pioneer in cosmetic and functional gynecology, working in areas that have historically been overlooked in conventional medical training, particularly around women's sexual health, pelvic function, and quality of life. What makes her work especially compelling is that this wasn't a strategic career pivot, it was a direct response to patient needs that were not being met elsewhere. Over the past few decades, she has practiced in this space. She's helped to define it. From training with early innovators in the field to authoring the ACOG's first labio plastic training module and educating other physicians. Her impact extends far beyond her own clinic. So with that, I'd like to welcome you to the show, Troy. Thank you so much for joining us today.

Dr Troy Hailparn 1:00

My pleasure to be here. Thank you for having me.

Dr Andrew Greenland 1:03

Maybe we could start with your journey because what stood out to me is that this wasn't a calculated move into a niche. You began in traditional OBGYN. What started to shift for you?

Dr Troy Hailparn 1:13

Well, I'd been practicing for over a decade, and I was noticing that there were issues women were having that weren't getting met. And they were coming in with issues related to tightening, not feeling their partners, an extra tissue that was in the way. And you know, my skills weren't as what I would have liked them to be. So I sought out training. And so back in 2003, I took my first training course in cosmetic plastic gynecology and learned how to use a laser to do procedures, which later on down the line I found I could put aside. I didn't really need another instrument. It was a matter of learning the surgical techniques. And so labia reduction, clitoral hood reduction, hymen reconstruction, outer lip reduction. All of these things were not taught to me in residency. And once I learned them, I became more aware of how many women had these issues. And then I developed questionnaires to help me fine-tune and pinpoint their concerns. And so I started using those questionnaires in my practice to help define postpartum issues that weren't being addressed, like leakage or having to manually assist moving their bowels or partner fallout and reduce sensation. And the thing is that OBGYNs, after women have their babies, they have their postpartum visit, and then they're really sent out. And there's no re-evaluation after a year. How is your body working for you? And the three areas of function are bladder bowel and sexual function. And because that wasn't being met, I kind of shifted my practice over and stopped doing regular OBGYN and just focusing on the sexual function problems related to childbirth and the extra skin that was really completely being ignored. I mean, it surprises me that a lot of gynecologists don't understand the vulvar anatomy. Everything's about inside the vagina, but not about the outside. And so when we put in a speculum, we can ask, does this tissue bother you or get in the way? And it's not being asked. When pediatricians discuss breast development and teenagers, they don't discuss the fact that the label also develop, and there can be issues of hygiene and discomfort doing phys ed or riding their bike or in their certain clothing. So these gaps in care are really part of what drove me is seeing all this stuff. And over the years it kept snowballing. And so I kept evolving my practice to address these issues.

Dr Andrew Greenland 3:53

Thank you, really helpful background. I think you were mentioning that a lot of women were being told that this is normal or nothing can be done. So was there a moment when you realized if I don't do something about this, no one will?

Dr Troy Hailparn 4:04

Yes, absolutely. So I was I had several patients have very bad experiences with their partners, and they really were, you know, just doing the routine posterior repair wasn't enough anymore because it wasn't taking partners into consideration. So don't laugh, but getting a girth measurement when you're bringing the vaginal opening muscles back together is not routinely done. We're making everybody the same, but the fact is that all partners are not the same size. And so learning, you know, just that that moment was realizing that there was a need that wasn't being met by the majority of doctors. And a huge misperception that was being propelled by the media that women are shaving and looking and seeing their parts, and that is motivating them to have surgery. And there have actually been surveys that have shown that is not the case at all.

Dr Andrew Greenland 5:00

You found David, Dr. David Matlock and sought out training at a time when almost no one was doing this work. What was that like stepping into something so early with so little existing structural acceptance?

Postpartum Function Questions We Miss

Dr Troy Hailparn 5:10

It was scary, to be honest. Going from an insurance-based practice where all your patients are fed to you, basically they're led to you, to a practice where it's private pay, and you have, you know, you have to now recreate a whole new background for yourself. You have to now learn to market. You have to learn to run a practice in a different way because a cash-based practice is very different from an insurance-based practice. And so there was definitely a learning curve, okay, and it was scary, like jumping off a diving board and not knowing if there's going to be water in the pool, you know. But what was really exciting was learning new techniques that I hadn't been taught in residency, which then kind of frustrated me that I wasn't exposed to this earlier on. I never saw a labia uh reconstruction for trauma when I was in residency. There was never discussions about how labial issues could impact spontaneous living and quality of life. And so Dr. Matlock exposed me to all of those things and seriously increased my awareness of how what we're not doing in our practices and how we should change our practices to incorporate sexual function after childbirth in a much better way.

Dr Andrew Greenland 6:32

So you also the ACOG's first labioplasty training module, and now you're training other physicians. What's that journey been like helping shape a field that wasn't really formally taught before?

Dr Troy Hailparn 6:43

Well, very, very exciting. So I always wanted to do a TED Talk, and I spent a whole summer thinking about it and then put in an application. And here in San Antonio, 150 people applied, and 15 people got picked. And I was completely surprised. It was a privilege and an honor, and to be able to put some basic information out there for women on the TED Talk that will always be available. I feel like that's just the first one that I have a few more talks to do. And then the ACOG eModule, I had presented at two separate meetings information on labioplasty. And at the second meeting, they approached me and asked me if I would do something educational for my colleagues. The one thing that I was disturbed about is there's still nothing for residents. It's for colleagues, it's for people. So, yes, it was 110 PowerPoint presentation. It talked about the development, the questions we should be asking, which we're not asking routinely, pigmentation and lesions and what to look for so we're not taking off something that might need further evaluation, um, how to counsel with trauma, women who've been abused and come in and want to change their bodies, partly because of the traumatic experiences they've had. So I always look at the whole person. And so with those kinds of things, I make sure we get counselors, they should have a good therapist. Um, I make sure that they feel well supported here, but I always think women need a team. Okay, and we're just one part of that team. But yeah, the learning experience has been incredible, and it has been an honor to be a part of educating my colleagues. Both of my parents are were college professors, they were both PhDs. So I grew up with education being the most important thing that we could do for our patients and to do for people. No one can take education away from us, and it empowers women to make better choices. And so that's really my biggest thing is being able to educate not only patients but my colleagues as well to hopefully help them think about their patients differently and bring their practices up to be more inclusive.

Dr Andrew Greenland 9:00

I'll ask you, why do you think this has been left out of traditional training? Obviously, you pick up you've picked up the mantle and filled in a gap here, but why was it ever missed out?

Learning Skills Residency Never Taught

Dr Troy Hailparn 9:08

I think there's several reasons. One is I think there's a lack of comfort with talking about the genitals. It's easier to talk about what's going on inside the vagina than the outside. I also think that there is a lack of exposure. There's a lack of education. Okay, you learn the drawing and where all the parts are, but it doesn't go beyond that. They don't talk about uh clitoral issues like access or hygiene issues or lycan sclerosis matting down and burying and affecting orgasmic response and sexual function. Um, they don't talk about the fact that the when the labia grow, that we don't talk about the fact there can be an appearance component. Chronically irritated labia become darker, thicker, and stick out more. So, you know, the perception is oh, we we're seeing it and we don't like what we see. But actually, when you're a kid, it hurts. That's how it starts. It's pain, it's discomfort, it's looking down and then being aware that your body is different from the people around you, the women around you in the locker rooms or at the gym, and then suddenly being limited with what you can do, your ability to ride your bike anymore, or going out socially, wearing tight clothes. Suddenly, women are more self-conscious about their bodies. And so body image issues can develop in these young women if it's not addressed and they have no one to talk to. You know, our moms weren't comfortable or educated about their bodies, and so we don't do the best job educating our daughters about their bodies and their changes. And so I really think that the basic part of this is education in residency programs. In medical school, just doing your first pelvic exam, learning how to do a pelvic exam and talk to a patient, learning when you put in the speculum to ask about the labia and not leave these body parts and educate and say, these are your inner lips, these are your outer lips, this is your hood, this is your mons. There's no discussion. And so I have patients who are in their 50s and 60s and they've never looked at their genitals. They come in and they know there's an issue and they don't know if it's the outer lips or the inner lips. They just know there's a problem and they use down there a lot in Texas. How far down are we going, you know? But the reality is that they're not comfortable talking about it. And that starts from the practitioner. If we don't teach them their anatomy, and these are the words to use, so we can teach our daughters so they don't get into trouble not knowing what part is what part, or they're not living with discomfort and feeling, you know, like their body is not working the way they want it to.

Dr Andrew Greenland 11:55

Thank you. So you talked about your kind of curriculum in terms of the important topics that you try to teach, but clearly, this is a space where nuance really matters. So, how do you approach that nuance in all of this?

Teaching The Field And Trauma Care

Dr Troy Hailparn 12:07

Well, I so I do offer four courses a year for my colleagues because I really think that, and I teach a lot of basic stuff there, things that I would hope they were exposed to in the past, but a lot of them surprisingly haven't been, which is just good suture technique, and it's how to evaluate a patient for their issues because there's no standard forms that we can use. Although I would highly recommend sharing, I would share my forms to anybody who wants them. And they ask basic questions about bladder function, bowel function, sexual function, and about the labia inner and outer lips. And this way they come in and they you already have a good idea of what their functional issues are and whether there's an appearance concern or not, and how to direct your visit. So I think that um it's hard to break people in. I don't want to say that the old dogs don't want to learn new tricks, but a lot of the doctors are set in their ways, and labioplasy is meticulous surgery. You also have to have an artful eye, you have to be patient, and you have to hand hold a lot. This is a very sensitive surgery. And I've had women come to me who've said, you know, doctors have just taken a picture and sat and talked to them and never really did a full exam or never fully explained procedures and then ended up having things done to them that they didn't want done because they didn't even realize what the discussion was about. So we have a responsibility as physicians to make sure that our patients have a good understanding of their bodies and what's being done to them.

Dr Andrew Greenland 13:43

You've also mentioned challenging some widely accepted practices. So, for example, pelvic floor assumptions, the limitations of kegels and decisions around hysterectomy. What do you think practitioners are often getting wrong in women's health today?

Dr Troy Hailparn 13:58

Well, I think that the actual understanding of when pelvic floor muscles are damaged, that the back wall muscles have been separated from having a baby. And so trying to cagle, you're just squeezing muscles that aren't connected anymore. So it really is a waste of good energy. If it's done for more than three months and nothing happens, I'll tell my patients that that makes them a surgical candidate. That says something is functionally not working. Okay, and because women are told a lot of the problems they're having are normal consequences of childbirth. So, like constipation and hemorrhoids and tampons not staying in or feeling open and wide. They're not normal. They did not have these issues before childbirth. They're acquired, it's an acquired sensation of wide vagina. They didn't have it before the babies. And so the changes, the functional changes are not being assessed. And so, because of that, I think we're not doing the best job in taking care of women the way we could be. And so I would love to have more of this knowledge included in basic education, but also in basic everyday practice. And it's not just for OBGINs, but for internists, for family practitioners, for pediatricians who may not know that their patients, their children patients are having labial issues. If they don't ask, you don't get the information. And so saying it's normal consequences, I would put a big red game show X through the word normal. Okay, they're consequences, but they're not normal to live with. And the other thing, like you said, about hysterectomies, women are not counseled appropriately about surgical options. And when women are offered hysterectomies, they have to understand what their options are and why and what kind of hysterectomy might benefit them. Because we have a lot of women get their uteruses taken out with the cervix. And many times the cervix can be left behind for support of the top of the vagina and for lubrication for the vagina. If it's fibroids or adenomyosis, benign conditions. Women can leave their cervix, but they're not counseled on the importance of leaving their cervix. Many times their ovaries are taken out, but there's still functional ovaries in their 40s. They could have another 10 years of ovarian hormone production. Um, I also think there's a big fear with estrogen because women live with ovaries making estrogen for 45 to 55 years and we're not getting cancer. We're not all getting cancer. So estrogen is not the source of cancer. And I think that fear, again, women are coming to doctors not wanting estrogen because they're afraid of cancer. They have to understand who's at higher risk, and that the majority of women are not. And estrogen is like water to a plant and it helps keep us functioning the best we can. I mean, if your thyroid stops working, we give thyroid hormone. When the hormones, the estrogen stops, we should be re-replenishing that. So I think that um improving education in our practices is the best way we can improve the care to our patients.

Dr Andrew Greenland 17:13

And how do you approach informed consent? Because I suspect that you have a slightly different model to many practitioners. What's your kind of take on it?

Why Vulvar Anatomy Gets Ignored

Dr Troy Hailparn 17:21

So I do have a consent form. I really give three consent forms. One, the Texas Medical Board gave us a sheet several years ago because they felt like doctors weren't doing their jobs of really talking about. And so that's now my extra piece of paper. And on their one line, I write C understanding risks and complications form because I have a consent form that has them initial exactly what they're doing. I then talk about the general risks and I go through a list. Then I have a sheet for each procedure and the specific risks, and we go through each one and initial every line, and then the second sheet reconfirms all of that, and I make sure they understand they can change their mind at any time. Sometimes things happen we don't expect and get their permission to take care of them, ask them to sign about giving blood, even though my blood loss, I until last week I hadn't given anybody blood for 25 years. And I'm just like, okay, you know, this is a very low-risk surgeries if you know what you're doing to take care of these women.

Dr Andrew Greenland 18:32

Thank you. So um moving on to your business, your clinic, because your clinic is a business. I know you made a very deliberate decision to stay in solo practice and operate outside of insurance. That's a pretty big decision. What led you to that model?

Dr Troy Hailparn 18:46

Well, so when I first came out of residency, I joined a practice with two gentlemen, and I was the third and the only woman. And it was also at a time where all the male practices were looking for their token female practice. That's what was happening nationally here. So um it didn't work out, and I ended up opening myself up to locum tenants and ended up coming down to San Antonio and joining a multi-specialty group for almost two years. And I was a nine to five in clinic, one in every five uh on call, had a very nice setup, loved the practice, was building up a lot of patient practice. And then the clinic decided to let all of the specialists go. So I went through a short period of trying to figure out do I want to stay here? Do I want to have a solo practice here? Do I want to go back up to New Jersey and practice there? And so when I went up to New Jersey, because I did, I started interviewing there, just kind of testing the waters. I interviewed with a five-male practice, and one of the questions they asked me was, how long does it take you to see a patient? And I said, 15 minutes. And they said, it takes us five, you'll get faster. And I walked out of there and I thought to myself, A, I can't work for somebody who's going to dictate to me how I can practice, and B, there's no way to take care of a woman in five minutes. Okay. The beauty and the pleasure that I get about being a cash pay physician in solo practices, I can dictate how much time I spend with my patients. So my consults are an hour and a half. So I if I see two or three patients a day, that's a good day. If I see three new patients and I can help each of them with their issues, then that is a successful day. So I think that giving time to your patients, one of the biggest problems is women don't feel heard. And doctors talk over their heads about what they have to offer.

Dr Andrew Greenland 20:53

So obviously, this allows you greater autonomy and the time to spend with patients. Are there any trade-offs from this model?

Dr Troy Hailparn 21:01

Well, there's no guarantee you have patients, and so you have to learn a new way of doing business, which has been new for me, learning how to do social media, learning what I need to do that, because my knowledge was almost none when I started out. And none of us are given any business background when we come out of med, you know, medical school and residency. There are no courses on how to choose what kind of practice you want to be in and what to look for, and what about malpractice? And there's nothing. And really, we should have a six-month program on continuing after how to set up a practice, how to make good choices, how to you know, understand what kind of business you want to have and be in. And I loved working with my multi specialty group. I had five doctors, we interacted really well, and being on call when every five was wonderful, and and every fifth weekend. I mean, it really spread the workload out. But being solo, I give every Patient, my phone number. I'm in touch with every one of them. If they need me, they can text me, they can call me, and they don't abuse it. It's a privilege. No other doctors give them their cell phone number and say you can call me anytime with a problem. So I try very hard. I'm a listener. I want them to have accessibility and I have compassion and passion. And I love my patients. They feel cared for here. I am warm. I embrace them. I have warm jelly. I have fuzzy socks. I mean, I do little things that make a difference for that care. And so I think that separates me out from a lot of my colleagues. I would love if they would do the same. I would love for women to feel this way across the board. But I think it's something that they can learn and bring into their practices if they choose to.

Dr Andrew Greenland 22:51

Amazing. I mean, you made a very good case for sale practice. I just wonder whether you thought more practitioners, whether you thought more practices are moving into sale practice or should be.

Pelvic Floor Myths And Hormone Fear

Dr Troy Hailparn 23:00

Well, I'll tell you, I would love it if they did. I think there's a big fear. There's that fear of the unknown of taking that step to set yourself up and not know how it's going to be. I started doing radio ads when I first came to San Antonio that nobody else was doing. And I got flacked from my colleagues because OBGYNs is all about referring and by mouth. And I'm like, look, I had patients who I had, I actually had my patients help deliver their babies. Their husband's hands were on the baby coming out. I brought them down to the radio station and talking about how their husbands got to deliver the baby. I mean, how wonderful is that? I talk about PMS on the radio. I've talked about incontinence. And my patients will know my voice. They'll say, we heard you, we knew you from the other room, you know. And so making learning how to get yourself out there is not a comfortable thing at the beginning. But you have to find ways to make your practice stand out and be unique and let them know what makes you different. So learning how to practice differently, you know, and then learning how to balance a PL sheet, learning how to watch what you're spending. When you're in a big group and you have other people watching out, you don't have to deal with that. But watching your everyday spending is something that you have to do when you're in private private practice. And so you do learn um a different sense of business when you're doing this.

Dr Andrew Greenland 24:26

So you obviously learnt lots of lessons about operating in solo practice. But if we think about today, sorry.

Dr Troy Hailparn 24:32

Um I think just one thing about also colleagues not wanting to learn new information. Like I said before, they're comfortable in their niche. When I first started doing this, people were like, What is she doing? Like it's some voodoo or taboo or some secret. And I'm practicing science-based medicine. Labioplasty is the number one most written about female genital surgery in the literature. And so when people say, Oh, you know, there's not enough data, there's plenty of data, there's lots of data out there. And so, unfortunately, because we have resistance by ACOG, you know, about cosmetic plastic gynecology, my colleagues are afraid. They don't know what it is, they they don't want to do something against ACOG. And the fact is now ACOG is starting to embrace some of this stuff, including the regenerative medicine stuff. One of my colleagues gave a talk about the use of PRP and exosomes to one of the one of the ACOG meetings. He was invited. So they're starting to get a little more open-minded. Um, but really the residents need to learn about labioplasty and vaginal tightening for childbirth damage, and the perspective has to change. But I really think that there's a fear of learning and a fear of going solo because all of a sudden it's completely new and uncharted territory for that.

Dr Andrew Greenland 26:00

Thank you. So you've obviously learned many lessons around operating in solo practice. But I just wonder what challenges or bottlenecks are most impactful in your business right now, the things that you haven't quite solved yet or you're working on or finding a path through.

Informed Consent Done Properly

Dr Troy Hailparn 26:15

So, regenerative medicine is the newest thing I've incorporated into my practice. I use platelet-rich plasma, which has been called the OSHOT, and that helps treat anti-inflammatory conditions, vaginal pain issues, and scar tissue. It can also be used to support the bladder for incontinence treatment. And so I'm using the PRP more in my practice. And now exosomes have been made available, and exosomes are intracellular carriers, and the RNA they carry can be manipulated, and they have anti-inflammatory exosomes and they have hair growth exosomes. There's a lot of advertising now about all the newest technologies for hair growth, and they can be pushed into the skin, into the tissues. It's called plasmaferation, and it opens the cell membranes up, this little radio frequency device, and allows the exosomes to get pushed into the cells and to change the way the cells work. And so it's a wonderful, it's really the cutting edge of technology of people using exosomes. You can also use your own, have your blood drawn, spun down, your own exosomes concentrated and injected in to help fight disease and pain and chronic issues. So I I love that. I love the idea of regenerative medicine. I also want to help people have better quality of life. So if they come in with other medical problems and they're suffering in with pain, I would like to kind of expand my practice. I can't operate forever, but what else can I do to help with quality of life? And so pain management in the back of my mind is something that I'm interested in. I've also took a six-month Chinese herbal medicine course because I want to bring in some of the non-hormonal ways to treat women who have menopausal stuff who may not be hormonal candidates or who may not want hormones. And so I want to use bring more of that into my practice. So I have these back burner, that's more back burner, but I'm I'm starting to bring that in now. So just ways to bring, I always want to keep my practice at the forefront and offer new things to my patients, but always scientifically based things. I'm not a cowgirl, I'm a data collector. And I've actually been collecting data since I first started doing labioplasty and the vaginal rejuvenation procedure since 2003. And so it's shown a lot of good things have come out of these procedures over the years.

Dr Andrew Greenland 28:49

Amazing. So if you had a magic wand and you could fix one thing in the business or clinic tomorrow, what would that be, if anything?

Building A Cash Pay Solo Clinic

Dr Troy Hailparn 28:57

It would be to get this to get education into the residency programs. That would really be that's my next thing I want to do before I retire is have a fellowship program. If they're not going to get it into the residency programs, we need to establish a fellowship program for one to two years so they can learn the procedures, practice the procedures, and go out and practice and be good at what they're doing and really be able to do a great job taking care of women. And I think that concentrated practice, you know, that concentrated education would be a blessing. And if all the doctors got exposed to it, so many perspectives would change when they're evaluating their patients, even if they're not practicing it.

Dr Andrew Greenland 29:43

So what's your take? What's your take on um growing and scaling? Because obviously you're in solo practice. There's a ceiling as to how many hours you have in the day. What do you how do you view this and and where do you like to get to?

Dr Troy Hailparn 29:54

So I'm sorry, there we go. Um, so how many hours again? Say that.

Dr Andrew Greenland 30:00

I was just saying that so I was just asking for your take on growing and scaling because there's only one people in solo practice. How do you think? Yeah.

Dr Troy Hailparn 30:08

So for me now, I'm at the point. Well, I'm 65, believe it or not, but I'm at the point where I'm ready to bring in two doctors, younger doctors, and I would like to train them myself. They'll have their own personal fellowship program with me. And after a year, if there's an interest and we're compatible, I would love to bring them into the practice and expand my practice with more doctors so I can step back. I would love to write. I've got several books brewing in the back of my head and articles. And I want to, I really would love to do grand rounds across the country and talk about the controversy of labioplasty and why we're not educating and talking about it more and bringing it into our programs. So that's that's really where I see myself moving forward too. Fantastic.

Dr Andrew Greenland 30:55

What will be your ideal profile for an apprentice that you're looking for to join you?

Dr Troy Hailparn 31:00

Somebody who really has a compassion and passion for taking care of women. That's really what I'm looking for. You can learn anything, but if you don't care and if you don't have a love for what you're doing, then that's not going to work here because I have a very small practice and we work very, very well, and we all have a very high level of caring about our patients' customer service. You have to focus a lot more on when you're a solo practitioner and when you're private pay. When you are insurance-based and when you're a big clinic, people move in and out all the time. And yes, you want everybody to be treated well, but when it's a small practice like this, you want them to leave feeling great about their visit, not rushed, not disgruntled about anything. Um, you know, not that they don't have to wait. I mean, I see six to 10 patients a day. I don't see 20 to 30, which is another motivation for me when I changed my practice because here insurance reimbursement had gone down significantly. Practice had gone up two years in a row, and all the doctors were pushing from 20 to 30 patients a day. How much can you do in a day? And to be fair to your patients and to be fair to yourself. You want time to eat and go to the bathroom, you have to run to the hospital and see your patients in the hospital. So, where is that balance? So I got to a point where I felt like I should have a t-shirt on that said, I'm sorry, I'm late, because I would see my patients for as long as they needed, whether they needed 15 or they needed 45. I didn't go by what insurance dictated. I never did. And my OBGIN practice was complete and compassionate OBGYN care because my goal was to treat women the way I thought that they needed to be treated, which was thoroughly and with compassion. But, you know, I think that that's a really important aspect that I would want someone to bring in is to really be a caring human being and somebody who has a love for taking care of women. Those would be the main things.

Dr Andrew Greenland 33:01

You obviously love what you do, but what's the biggest time dream for you in your work? The things that you don't really enjoy doing or the things you would rather not have to do.

Regenerative Medicine And Future Plans

Dr Troy Hailparn 33:11

Well, I don't have, I need more than one secretary. I have one here and then I really need one at home. I need really a wife, is what I need. But um, because you know, I I do take things home with me. Um, when people write in during the day um or email in or call and there are people interested in the practice, I contact every single one of those people. So I usually will bring their information home, put them in my phone, send them an email introducing myself and recommending things they can look at and making sure that we've established a communication. So I do that. I take home new patient charts at home. And when we get a whole flurry, I'll take six charts home at night and I'll be reviewing them. And some will be for the later in the week and some will be from a week from now. But there's always things to be done, you know, invoices to pay, and and and then because all my patients have my number, I might get three or four patient texts a day and I will respond to those as well. Um, so you know, it's just there is work that goes home with you. And I do feel like sometimes when I'm on vacation, especially, and I would just like to be on vacation, I will still have patients call me, or I may still have something that needs to be done while I'm away. Um, but it's all part of the job. And because I love what I do, even though it's kind of like, ugh, I still have more to do, it's still all within what I'm doing, the big picture. And that's I love what I'm doing. And so it just I do what I need to do to keep moving forward.

Dr Andrew Greenland 34:49

Fantastic. So you talked about your professional bucket list and things you'd like to be doing in the future. But if we just take the next sort of six to 12 months, do you have any kind of immediate um short-term goals for the practice?

Dr Troy Hailparn 35:00

Well, several, yes. Thank you for asking. So I am in September, I'm going to a conference in India. And this is the third conference I will be participating in there. And it is the RECO Gin. It's Reconstructive, Cosmetic, and Plastic Gynacology, and doctors from all over come. And I have at the very first meeting, I had a pre and post course, I had several presentations, and I love educating, I love teaching, and so it's an opportunity for me to teach. But we're also going to next year, in the middle of the year, in the middle of 27, have a meeting here. And so I will be responsible for putting that meeting on. So I'm very excited about being part of putting on a meeting that will hopefully bring doctors from across this country to learn as well.

Dr Andrew Greenland 35:53

Troy, this has been such an incredibly insightful conversation. What I really appreciate is how grounded your work is in patient need and how much of what you built came from simply refusing to ignore those gaps. So thank you for joining me. Thank you for sharing your perspective and your passion for what you do. I really appreciate it.

Dr Troy Hailparn 36:09

Oh, total pleasure. Thank you for having me.