Virtual Health Care: Meegan McCullagh

Lisa Belisle: Hello, I am Dr. Lisa Belisle and you are listening to, or watching Radio Maine, our video podcast where we celebrate creativity and the human spirit, and we are sponsored by the Portland Art Gallery in Portland, Maine. Today I have with me someone that I have worked with previously, Meegan McCullagh, who is a fantastic PA, physician assistant, or actually physician associate, I believe we are now saying, and appropriately so, who works with Gardiner Family Medicine in Gardiner and actually half the time does remote work. So I'm really interested to talk to Meegan because she and I are sort of offering healthcare in very similar ways, and it's great to see you again.

Meegan McCullagh: Great to see you too. Thanks for having me.

Lisa Belisle: So Meegan, you grew up in Bangor, which I didn't know when you and I first started working together, and I'm wondering if you had a thought back when you were growing up that you would end up doing halftime virtual care as a family medicine PA and halftime in-person care. Did you have any sense that this was the direction medicine was going to go in?

Meegan McCullagh: Absolutely not. I originally thought I wanted to be a surgeon, so I think even just being in family medicine was a huge shift, and telehealth has really only been something I'm aware of for the last couple of years, since Covid started.

Lisa Belisle: So tell me about that. That's very interesting. You originally wanted to be a surgeon, so why the change into family medicine? What was it about family medicine that drew you?

Meegan McCullagh: I always knew I wanted to be in medicine since I was a really young child, and so I tried on a lot of things, shadowing different people. I was in high school, shadowed a surgeon, and that's when I first was introduced to the PA profession. I always kind of knew I wanted to have that work-life balance, and PA just stood out to me. I could still have autonomy in medicine, but also I didn't have to go through residency. I had a little bit more free time, and so that stood out to me. And family medicine seemed almost kind of like the residency. I could just learn everything I needed to learn. It was never meant to be. I thought I would do it for a couple of years, but then I just fell in love with it. It's just so nice to be able to meet someone at one point in their life and just stay with them for many, many years and see how their life changes, and also know their family members. You kind of know their whole life story, which helps so much when making medical decisions.

Lisa Belisle: There's so many rich things that you just said because of course I resonate with this, being somebody who's been in family medicine a long time. I feel the same way that you do about longitudinal relationships and the importance of that on care. I also love that you're a physician associate and that you chose to go that path because you felt strongly that you were going to be offering something really valuable, but just in a different way. I think that's a great choice because you're such an important member of a collaborative care team. For people who don't understand or don't know what physician associates actually do, can you give a little background?

Meegan McCullagh: Yeah, so the PA profession was created for medics who came home from the war and didn't know what they were going to do with their life. These medics got to go into healthcare as this role of PA, and I think at the time they didn't need to do any additional schooling, they kind of just went into it. Since then, it's been a graduate level program, but I would say we fill a similar role as other providers in the office. I have my own panel of patients, I see people independently. Now that I've been working for seven years I can work completely independent. Actually post Covid, Maine was the first state that allowed PAs to be independent once they've passed their two years. But the benefit is I always have this team, and I think that's the same regardless of what you do in medicine, you always have this team to work with.

Lisa Belisle: Having been in medicine a long time now, what I've really enjoyed seeing is how the team has evolved. Back when I first started it was very hierarchical, and we had sort of the physicians who took a position that was more authoritative, and then other people worked as supporters. But that's not the way that modern medicine is right now. What we now have is people showing up all with their own things to offer and working collaboratively to really improve the health of our patients.

Meegan McCullagh: I really like that aspect. At Gardiner Family Medicine, all the providers, the docs, the APPs, are amazing. So I can go and talk to who are technically my collaborative physicians, but they also come to me sometimes if there's something that I might know. And so that feels really great.

Lisa Belisle: Well, and you're actually pretty special for Gardiner Family Medicine because you were, I believe, the first medical staff person that started offering remote work.

Meegan McCullagh: In 2023 I started doing it in the office as we were kind of piloting "is this possible?" And after about four months I was able to go completely remote one day a week. And then I think it was just a few months later, they added a second day. It was just so popular.

Lisa Belisle: Laura Mrazik, who works and does the telehealth program with MaineGeneral, that's her other job. She's an artist. And she also does that. She said, you really need to talk to Meegan because she's been doing this for long enough that she has these valuable insights about this. But I remember when we started this whole thing, it was a risk for the organization. People were like, oh no, are we going to get enough volume? Are we going to get enough reimbursement? And I'm wondering how you worked through that, how you worked through that time of potential partial skepticism. And to be clear, I was never skeptical.

Meegan McCullagh: It's very interesting. I never really set out to pilot anything or do anything more than my original job of seeing patients. It kind of fell into my lap. It was 2023, I was a couple years postpartum, had a young toddler at home, and I was feeling a little burnt out. I think that my manager saw that and she was like, this could be an opportunity for her to work at home. And she put me up for it. It took a lot of work actually, that I was not planning for originally, but it's something I've grown to be very proud of. We've created this whole template of how it works, and it's been able to expand into not even just other primary care practices, but other specialties, and opened up healthcare for our MaineGeneral family. So it's been really great, and something I never thought I was going to do, but I'm very proud of.

Lisa Belisle: So you stumbled into your leadership role is, I think, what I hear you say.

Meegan McCullagh: Absolutely.

Lisa Belisle: What you're bringing up is something that's really important to me, and that is the idea of burnout. It's a very real thing. It was very real post Covid. It's very real now. And one of the things that we know is that people are coming into the medical field with the same set of contexts that we always did, which is many of them are young and would like to have additional things outside of their profession, i.e. families, whatever that looks like. And I think trying to strike that work-life balance is increasingly important because for a long time it was just, well, you just need to do this job, that is all that you do. But all of us would like to have something outside of this job. So do you feel like that's enabled you to strike more of a balance?

Meegan McCullagh: Oh, absolutely. I commute about 30 minutes when I go into the office. So now that two days a week I have an hour extra with my son, which is just amazing. It's also just very different medicine that I'm doing. When I'm in the office two days a week, I'm basically doing physicals the whole day, which is very fun. I get to see people. I'm now excited to go into the office, which there was a little period where I wasn't feeling that anymore. And then two days a week I'm doing more established care visits and a lot of mental health practice stuff and following up on labs. So it's just that variety also helps with the burnout, I feel.

Lisa Belisle: Talk to me about this idea of it being a specialty, because I'm now in leadership in a virtual care startup, and we offer virtual first primary care and we interface with healthcare systems. And what I have found is we have virtual primary care, virtual urgent care, we now have behavioral health, but it is its own specialty. It absolutely is. It's building on a skillset that we have in medicine with communication, but it is not the same type of interface with patients. That's my experience. Tell me your experience.

Meegan McCullagh: I remember when I was first learning, they were talking about how much power touch had. Just listening to heart and lungs, touch, that's the way you build a connection with people. You don't have that with telehealth, so you do have to learn how to build that connection just with the tone of your voice and the way you eye contact and the way you listen. And I think with telehealth, it's really easy to cut people off and feel rushed. So I think there is a balance of figuring out that communication. So yeah, it's definitely a skillset. Not to mention we've got to figure out how to do a physical exam sometimes when we're just completely telehealth. So that's stuff that we've just been learning, and I now see it in our CME practices. You can go to telehealth conferences where you learn how to do those physical exams too.

Lisa Belisle: And that is really important. The physical exam is just as important when you're doing virtual care as when you're in person. What I've found in doing virtual first care is that it's actually really empowering for the patients, leading them through a physical examination of themselves. So when you're saying, I'm going to have you touch your belly and I want you to tell me what you feel underneath it and tell me if it feels tender at all, for them, it can be very eyeopening. Like, oh, how often do any of us ever touch our bellies? So I kind of love that aspect of things.

Meegan McCullagh: I knew none of that. So that's been kind of a process of relearning how to do a different type of medicine, which has been really cool. But I think the way it's working really well with family medicine is just the talking. Family medicine is really just having those relationships. That's why mental health is just so great for doing that. With telehealth, we can just have so much more time to talk to our patients. For example, if they're in the office, I start them on a medication. A couple of years ago I wouldn't really have the opportunity to follow up in the time that I'd want to in a month, but now I can even follow up in two weeks if I wanted to, which just wasn't available before.

Lisa Belisle: So it opens up access that way. And it also opens up access for many of the patients who work outside the home, many of the patients who, like us, commute to jobs, have children, have other responsibilities. So what I think is fantastic is that it's like here is another way that we can meet people where they're coming from.

Meegan McCullagh: Absolutely. So I do a lot where people are at work and they just took a quick 15 minute break, and if they were to come into the office, that would've been the commute time, also the waiting time with us, whereas I can get right to it and they can get back to their work. I think if people are hesitant to be in healthcare just because of how much delays and everything, this is just another access point.

Lisa Belisle: Well, plus it's a place where during Covid, nobody wanted to come in and see us because they would get sick. And so this is a way for some people especially who still have that lingering fear to continue to touch the wellness aspect of their trajectory personally, but also not expose themselves to things that other people are bringing into small spaces.

Meegan McCullagh: I found people also, my geriatric patients, that's been a really good thing that I wasn't expecting initially. Especially for the people who have support systems, if they're in an assisted living facility, their team can set up the Zoom and then sometimes even their family is on the Zoom as well. And not having to get those patients into the office, which was really challenging, just opens up another level of healthcare.

Lisa Belisle: It sounds like you've been pleasantly surprised, and you've already described some of the things that you've been surprised by. Are there other things that you've been surprised by as you've continued to have this hybrid model of care?

Meegan McCullagh: I do quite a bit of new patient visits, not for myself, but I establish them for the practice and then kind of hold onto them until we can get them for a physical. And that's one of the things that's been really great for our program. Dropped down wait times to see a provider from 18 months, I think, to about two weeks I can see someone. On the level of burnout, there was a little bit of not wanting to do that before just because it's another person to manage, but I found that I'm having this new appreciation about what we do in medicine. Like, wow, I'm really helping these people who really needed their diabetes managed that hadn't been for the last year, or their mental health, or I can get them in touch with our social worker. So I think for me, that's kind of helped with knowing I'm doing something good here, which in turn just makes me a better provider.

Lisa Belisle: Yeah, I love that. I happen to know your practice well, and I know the people that you work with, and I know that there's a lot of collaborative leadership that's going on there. Some of my favorite people, I hope they're your favorite people too, work at your practice. Tell me some of the things about being in kind of a collaborative leadership situation that have been effective for you. You've had to be a leader, or you stumbled into this leadership, but you need everybody else to kind of step up and also be leaders. So what has worked well for you in this?

Meegan McCullagh: For telehealth?

Lisa Belisle: Yeah, yeah.

Meegan McCullagh: While I do work pretty independently when I'm at my house, I couldn't do it without my PSR scheduling. They make sure that I'm not seeing 10, 15 minutes in a row, that I have the balance of 15 and 30 minutes so that I have the time that I need for people. I have my MA who's on the other side of my computer if I need to look up any documents, she can help me with that. And then our practice manager who's been piloting this program, Liz, has been amazing for anything I need. Most of the time it's just me figuring out I need something which we didn't know we needed before, and she can help facilitate that, which has been great. I do a lot of talks with other people who are starting doing the virtual visits and they're just like, I don't understand. How is this working so well? And I'm just like, yes, it's some level of me advocating for my patients. Virtual visits are excellent, but it's a lot the people behind the scenes who are just making it go smoothly for me.

Lisa Belisle: That's such an important thing. Some of the best situations I've ever been in have required all of the front office and the medical assistants and all of my colleagues. Everybody needs to appreciate everybody else's contribution.

Meegan McCullagh: Yeah, my scheduler, my PSR, the day before, she'll look through my schedule, make sure I have all the documents I need to fill out, make sure she tries to call everyone to make sure they have the right links. And I absolutely wouldn't have the ability to do that in my schedule. So the fact that she does it makes my life so much smoother.

Lisa Belisle: So as you're thinking about the future of medicine, and this is a bigger question, so we'll take a minute here, because you're coming in at this very interesting time where medicine has been a certain way and I think it's evolving to the next way it's going to be, what would you say to somebody who's, say, going to UNE, University of New England, to the PA program and is thinking about whatever specialty they're going into? What would you say to them to get them excited about where we're going in what's kind of an uncertain milieu right now, let's say?

Meegan McCullagh: I think we are more trying to meet patients where they're at, and I think that's one of the benefits of the telehealth, but realizing that there's so many barriers to people's healthcare. I would hope that we're trying to look at all aspects of the person. So not just looking at, oh, why do they have depression? What could be contributing to it? How can we manage that better? Why are they late to their appointment? How can we help them so that they're not, and they can actually show up. And while going to UNE or any other school, that's just about memorizing things and learning it. There's so much more to medicine. It comes down to just the patient, their whole person, and how we can best help them. And truly that's the most fun part of medicine, I think.

Lisa Belisle: So it sounds like keeping people connected to the reason for going into medicine, which is really the relationships and seeing how you can contribute positively.

Meegan McCullagh: Absolutely. I think that especially social media makes it hard, especially primary care, of how primary care is viewed, of maybe not always listening as well, having these quick appointment times and not getting to the things that people need. And it can be really hard to be in primary care when you're like, no, but I actually am trying to help you. So I think that remembering that when you have that connection with a patient, they'll understand and they'll appreciate it. And I think in turn, we all just want to be appreciated too, but that does make it easier to work really hard to figure out things for people.

Lisa Belisle: Yeah, I agree. I've also been struck by, I think in medicine you're always called to kind of problem solve and troubleshoot, but in virtual care, I've found that I end up doing things that I wouldn't normally do. I now have the ability to schedule patients for things, so I can actually go in and offer them an appointment, which I never did before, but they're like, oh, thank you so much, I would've had to stay on hold for the phone system. Just being able to offer that, even though it's not technically a medical thing, it's so rewarding because they're so happy to just get the appointment.

Meegan McCullagh: That's one of the things I actually started. I haven't gotten to the point of scheduling yet, but I check people in myself. I think the process had been that someone would call them and then they would wait on, but I was just like, let's just make it simpler and I'll check them in as they're on the phone, and it takes one minute. I think it also saves my PSR time, it saves the patient time, and it just helps with the autonomy of the telehealth too.

Lisa Belisle: And also the other thing that I find interesting about telehealth is you're at your house, and if something goes wrong, it's you. So it makes it that you're like, oh, I just have to be kind of nimble and flexible, and if there's a camera issue, I've got to try this, this, or this. Whereas I think there is something about medicine, which I love it when everything works and all the team members show up and you can always rely on somebody else, but in this case you're kind of relying on yourself also.

Meegan McCullagh: Definitely. We work off of the Storefront, and so if that system is down, I have no access to anyone's medical records, and that has happened on a couple occasions. So I've just had to jump on the Zoom and I'm like, okay, we're just going to have to, tell me every aspect of your life so that we can make the best decisions. And it helps when I know the patient, but sometimes we just have to bring it back to pencil and paper and get creative there.

Lisa Belisle: And I think patients really appreciate that, because when you get on the call and you're like, sorry, I can't see you, our systems are down, they're like, okay, but I just took time out of my day to do this with you. So your ability to again meet them even when you have limited resources, I think people really appreciate.

Meegan McCullagh: And I think sometimes you have to get creative. Sometimes not all visits are appropriate for telehealth too. So I get some of my schedule that it says maybe I want a referral, and it turns out it was an actual issue that they probably should have been seen in the office for first. And then I usually can kind of finagle it where we do a visit virtually and then I just say, okay, we're going to get you scheduled in the office so we can finish this visit. And I think they appreciate that too, versus just being like, let me book you out a month to get this addressed.

Lisa Belisle: I'm wondering if you found also, it's not just what you say, it's how you say it. So in cases where there's somebody that you need to have them come in to be seen, you don't just say, well, that was stupid that you signed up for a virtual visit. You say, oh, I really want to help you, and how can we make this happen in a way that works for you and also is offering good care. It's exactly the same kind of idea, but it's how you say it. And in medicine, I think we sometimes forget that.

Meegan McCullagh: I think about that a lot actually, the power our words have and how that connection can change for a patient. It could be really turned off if a provider said that, and maybe then that ends for them. Maybe they just don't follow up on their healthcare because they had a bad experience that way. So yeah, telehealth really makes you think how much your words matter.

Lisa Belisle: You came into your profession at a time of kind of upheaval. You were a relatively new PA as Covid hit and now you're more established. You said you've been out for seven years. What do you envision for your professional path? Do you see yourself doing any teaching? Are you loving patient care so much that you think you just want to keep getting better and better at this? Where do you see yourself going?

Meegan McCullagh: I'm loving how my workday is split up now, or my work week is split up right now where I'm doing the patient care in the office two days a week and virtual two days a week. And I'll probably continue that while my kid is young just because it works out so well. But I do really like teaching. I currently have a nurse practitioner student and I would love to be able to do more of that, but it does take a lot of time. So I think I'll focus first on being a mom and then look into that more maybe when they're out of the house.

Lisa Belisle: I'm so glad you're saying that, because I think that the medical profession has always been based on teaching. So you learn, you teach, and even when you teach, you learn.

Meegan McCullagh: Absolutely.

Lisa Belisle: It's always a back and forth. And also just recognizing at different stages of your life, you have different kind of challenges to your energetic ability to do everything.

Meegan McCullagh: For sure.

Lisa Belisle: So for you to be saying, yeah, I've got a son, he's a certain age, he's not going to be this age forever, but I also really like doing this thing, let's see how I can integrate that. Because I think what I am also loving about what you're saying is you started to be burnt out almost as you were just starting, but we want you to be offering great care for years. So how do we make that possible over the course of your profession?

Meegan McCullagh: Absolutely. I think sometimes patients missed the doctors of years ago that were calling them late at night telling them things. But I think in general, if you really want a good primary care provider, you want them to last for 30 years. And it's much better overall if they put their computer down when they leave, have some restful time so they can come back and they can keep being a hundred percent when they come into the office. So that's kind of what I've learned in the last couple of years. It's really important for me that I don't do work outside of work, that I just come in and I work really hard the hours that I'm there, but then when I come home, I'm a mom and that's my role.

Lisa Belisle: So with you on this one, because I do think you want to show up and be your best for somebody, whoever it is that's in front of you, you want to be your best self. And if you have to work 12 hours a day and you barely get a chance to sleep, that's not going to make anybody into the best version of themselves. So I personally think that we need to continue to work on systems that will continue to evolve so that we're not asking medical staff to kind of always be doing workarounds. And I think virtual care is really perfect for this. You can create systems that make that possible.

Meegan McCullagh: It's been really convenient too. I have a toddler who's often, I get a call from daycare that I have to go pick him up. And with telehealth, it's pretty easy to finagle a change in time. So one Thursday I had to go pick him up in the middle of the day. I just moved those patients to when my husband was home, and then I could still work my entire day, but I was able to pick my sick kid up and make sure I'm there. So that's been really great several times.

Lisa Belisle: I love that. Most of the people that I work with now in my virtual care organization are women, and most of them have the primary responsibility for their children. And most of them also similarly have daycare, but also really supportive spouses. So that balance is pretty important.

Meegan McCullagh: And it's flexible too, not just telehealth, but our organization, or Gardiner, has some providers who don't have panels of patients who also help support us. When I started, that wasn't the case. So if a provider was out, we would take turns managing, so you had your own day of patients, your own tasks, and then you had someone else's. And so that's been really great to have these providers whose responsibility is to take care of the patients when a provider is out. So that kind of allows it so that we truly can leave and be done with our work.

Lisa Belisle: It makes me really happy that you're saying that, because that was another one of the things that I worked on while I was working with your organization. So I love that it's working so well.

Meegan McCullagh: It's pretty amazing.

Lisa Belisle: Yeah, I think isn't it just really about re-imagining care? We don't have to do things the way we've always done them.

Meegan McCullagh: For sure.

Lisa Belisle: I'm so excited to have the chance to touch base with you kind of fast forwarding a couple of years after you started this, because I'm really proud of the work that you're doing.

Meegan McCullagh: Thank you. Yeah, I am too. And I think the feedback from patients is amazing too. They really like it.

Lisa Belisle: That is really the most important thing. Yeah. Well, Meegan, any other words of wisdom before we let you go on and start caring for patients today?

Meegan McCullagh: Not too much more. I think that I imagine it's just going to continue to grow in other specialties too and just have more access for people, especially in Maine where a lot of our patients are quite rural. Being able to maybe see their providers, say they live in Presque Isle or they need to see a specialist in Augusta, I think that the opportunity to have those visits telehealth is just great.

Lisa Belisle: And as somebody who grew up in Bangor, which is not rural, but it's not the most urban part of the state, you probably have some pretty significant familiarity really just from your own personal background, knowing what that's like to have access to care or not.

Meegan McCullagh: Absolutely. Yeah, and really the delay of having to drive an hour is quite a significant delay, especially if you don't have appropriate transportation or childcare or any of that. So yeah, I think telehealth is definitely going to be in the future of medicine.

Lisa Belisle: Those are fantastic words of wisdom. Of course, they align with the way that I think, so I'm just going to have to admit I have that huge bias. But Meegan McCullagh, it has been really wonderful to talk with you today. It's so good to see you again.

Meegan McCullagh: Great to see you too. Thanks for having me.

Lisa Belisle: Thank you. I'm Dr. Lisa Belisle and you have been listening to or watching Radio Maine. And today I have been speaking with one of my fantastic physician associate colleagues, Meegan McCullagh, who works with Gardiner Family Medicine in Gardiner, Maine, and also from behind her camera at her home a couple of days a week. But in either case, offering great care. I encourage you to learn more about virtual care and telehealth because of course it's a special interest of mine. Learn more about Meegan McCullagh and Gardiner Family Medicine by finding her on the web. And if you'd like to explore creativity and the human spirit, then please do join us at the Portland Art Gallery art openings, which happen on the first Thursday of every month. Thank you for joining us today on Radio Maine, and thank you for joining us.

Meegan McCullagh: Absolutely. Thank you.