MICNP Podcast S1 E9: Member Spotlight Dr. John Mailey

0:00Welcome to the MyCamp Podcast. I'm Rachel Hebsner, your President-elect. Join us as we bring you the latest insights, discussions, and expert perspectives on the evolving role of Nurse Practitioners in Michigan and beyond. Posted by the Michigan Council of Nurse Practitioners, MyCamp, this podcast is your go-to resource for advocacy, education, and professional growth. Whether you're a student, a seasoned MP, or a health care leader, we're here to keep you informed, inspired, and connected. Each episode will explore critical topics and clinical practice, health care policy, legislative updates, and professional development, all tailored to the unique needs of Michigan and needs. Tune in as we amplify the voice of Nurse Practitioners and work together to shape the future of health care. Subscribe now and stay tuned for expert conversations, legislative updates, and the latest in MP practice submission. This material is provided for entertainment, general information, and educational purposes only, and is not intended to provide medical, legal, or professional advice. Nothing in this presentation, discussion, material should be interpreted as establishing a client, provider, attorney, client, or other professional relationships.

1:06The views expressed by the speakers, guests, participants, and vendors are their own, and do not necessarily reflect those of MyCamp. Additionally, references to any specific products, services, organizations, or third-party entities do not constitute an endorsement or recommendation by MyCamp. No representation or warranty is made regarding the accuracy, complete list, or reliability of the information provided. MyCamp expressly disclaims any liability for any direct, indirect, incidental, or constant control of damages arising from the use of or reliance on information provided. Participants and members of the audience should always consult their own health care providers, legal counsel, financial advisors, or professional advisors, and qualified professionals for questions and advice. Any reliance on information presented is solely at your own risk. Welcome to the MyCamp podcast. Today in our member spotlight, we are joined by Dr. John Bailey to discuss how transportation barriers translate into mist care and worse outcomes and the NP lead solutions, making a difference. Welcome to our show, Dr. Bailey. Yay. Thank you. Thank you for having me. Hello, everyone. I am Dr. Rachel Hetzner, President-elect for Michigan Council of Nurse Practitioners and co-host of the MyCamp podcast.

2:18Hello, everyone. I'm Dr. Justin Hooks, Chair of the Education Committee for MyCamp and the other co-host of the MyCamp podcast. Hi, I'm Dr. John McConnell, producer and stand in co-host of the MyCamp podcast. So before we jump into the great work that you're doing, Dr. Bailey, would you mind introducing yourself to our listeners for a minute? Sure. My name is John Bailey. I am a doctorally prepared adult general, primary care nurse practitioner. I started as an associate degree nurse from Washington all community college. I did my bachelor's at Oakland University. I did my master's and nurse practitioner degree at South University and I did my doctorate at the University of Michigan. I'm currently back in school because I'm addicted to education. You get a second certification in mental health. I should graduate in the spring of 2026.

3:28I've had a really good experience. I actually got to work with program directors from you of them and Michigan State as some of my preceptors. So I really had a really good myriad of experiences. I come from a long line of nurse. My grandmother was an LPN and she worked in labor and delivery and she was educated in the hospital programs back in the 50s. I would have to wear their white hats and their dress, they mighted corners and different things like that. She ended up having a career at Mark Carmel, which is now Sinai Grace. My mother, my mother was a critical care nurse who actually ended up going and getting her master. She became an adult general nurse practitioner and then she did her doctorate at Madonna University and she became a professor and she taught at South University.

4:46She also inspired my sister, my sister. She was the program, the assistant program director of the anesthesia program at Michigan State. She's also a nurse practitioner. So she went back to South University, both of us took advantage of my mother's tenure there to get a free education. She is now the director of the anesthesia program at Lawrence. She also has her own primary care practice and she specializes mostly in weight loss. Myself, I opened a clinic in about year 2000. My mother felt ill and she passed me eight right after I graduated so did most of her cancer care.

5:49We had to drive her to Zion, Illinois and it's a little north of Chicago with the cancered treatment centers. So I was a bit delayed, but I've been our in since 1994. My early work was in critical care. I did a publication in 20 in 2006 called reducing hospital standardized mortality with early interventions and I was one of the first people in the country to explore rapid response teams. I did a lot of that work in and I was doing rapid response even before I knew what it was. I had a job as a critical care supervisor and they would call about a patient that would go bad on the floor and I would go out with my transport box and my monitor.

6:49I used to start triaging the patient and it just became this big thing. Next thing, you know, I'm all around the country talking to anesthesiologist, different hospital executives. I got to work with Don Berwick and Gil Warden. So all the people who wrote to air is human. I got to actually have first knowledge working with them. My later work when I became a nurse practitioner focused on working with people who look like me and trying to even out the health inequities that would be full people of color. And one of my mentors is a nurse practitioner at the University of Michigan, Dr. Webbe, Hibble Webbe, and basically she's part of what's called the Transcultural Nursing Society.

7:56And so I joined the Transcultural Nursing Society. And for my doctoral project, I did a project on helping people with diabetes using motivational interviewing techniques and the sunrise in April or to help get into their culture and change habits and have people increase self efficacy with diabetes. I actually had some impactful outcomes. And I'm actually in the process of writing my translating that into a manuscript. My project was actually used as an exemplar in the Transcultural Nursing book that's out right now. Dr. McFarlane is the author. And so is Dr. Webbe. So I'm really excited that my work is.

8:57The experience that you have the family history of nursing that is incredible. I don't know if you guys know Dr. Erica Gillespie. She's also my camp. That's my first cousin as well. And then Leonore Gray. She's also, I don't know if she's part of my camp, but she is an advanced practice nurse. And I believe her, she's a CNS. And she's actually finishing her doctorate as well. I mean, all of these people that you're naming, I know I'm familiar with them too. And I always say people like that could run the world if they wanted to. I mean, they are so capable and so there's just smart and so many levels. And the people that they know and the things they do, it's incredible. So I wanted to ask you at the beginning of our podcast, we asked our guests the same question. If there was something that you know how that you wish you knew when you first started your practice and health care.

10:09What would you tell that person? And I know this is tough. You have quite. I would say learning how to un-intrench people with bad health habits in our populations. And if I could have like a magic wand, I would Harry Potter them all. And you get a low A1C and you get a low A1C. I would. I would. I'm a little blind here. But what I found is that sometimes people, when you try to change people's health behaviors, you entrench upon their sense of me. And you need really bargain with them and make them your partner. And if you don't do that, you won't have successful outcome.

11:16And the recidivism will recur. And so I've learned that you really have to become one of them. And people respond better with people who look like them. And it's just unfortunate. It's just a reality of where we are. And we're in a poignant time and you know the political system right now. So I really just try to meet my patients where they are. I talk the way they talk. One of my patients told me when I was doing some health teaching, he said he cussed me out so good. Yeah. Motivated people. When I met him, a lot of people that I serve have have criminal backgrounds.

12:28They tend to be older and they some of them have a substance abuse issues. And you know, and when I see people and I do talk screens and I see elicit substances like cocaine. And then I look at you and you're 320 pounds. And I just said, do you just want to die? And I try to bring it to a real level with them. Yeah. And so this guy understanding where they're coming from and that they deserve quality health care as well, even if some of their life choices aren't what we might make. But they also deserve quality health care and kind of imparting that. Yeah. And you have to look at the environments they grew up in too. You know, people have grown up where, you know, they, the best food source is the corner gas station.

13:35You can get a honey bun and a bagel pop and you're ready to go for the rest of the day. So, I mean, I've seen a lot of homelessness. And again, people with these transportation issues. Detroit has been what I would call a gerrymandered city where there's hard, it's hard for them to get healthy choices for food in the inner city. And the bus lines, you know, they have to catch buses or use their insurance that will only give them six transportation per quarter per year. So we really have to strategize and put our minds together and work as one and partner with patients to help get them what they need. So in the bridge Detroit piece and don't worry listeners, they'll be a link in our show notes.

14:37What did you hope readers would take away that often gets missed in policy conversations? Well, I think transportation can be a barrier to health and it directly impacts the levels of optimal health that people get. Sometimes, if they missed their appointment and you're doing good, then they come back and their numbers aren't so good, whether it be blood pressure, whether it be A1C, whether it be even just a spot check glucose, they get depressed and they lose hope in it. So I spoke about that hopelessness and helplessness that happens when people can't make their appointments. So I end up doing, you know, I, my cell phone is, oh my god, it's, it's hijacked.

15:39My cell phone hasn't been hijacked. And I get phone calls after phone call, after phone call, after text message, but, you know, it's not my duty to say that, okay, I'm tired because this work never stops. It's going to perpetuate itself. And now I have family, whole families coming to see me and, you know, they can, they can always say, hey, Doc, I don't have my insulin. Hey, Doc, I don't have this. There are limited resources for patient who have transportation, insecurities, the bus line stops and it's cold outside right now. So think about that. You're sitting there. You have diabetes. You have peripheral neuropathy. You have peripheral vascular disease and you're at a bus stop. They say we were colder than it was in Alaska in the past couple of days. That can be case.

16:40Yeah. Yeah. So what happens when I get patients that have transportation issues, I sort of put them at the top of the list. Even if somebody comes in before them, if they come in and I know they have a short window, I will see that person and then go back to the patients that have more secure financial or have more secure transportation. Yeah. That, Dr. Bailey, what is one story from your practice that captures the human cost of a misride or delayed bus? Um, so I, I had a patient, you know, he missed because appointment for his medication refilled this guy was a diabetic. And when I met him, his A1C was 15.1. Wow.

17:40He's about 10%. So he's an insulin-dependent diabetic. And I've been titrating his basil and sliding scale insulin. And I finally got his A1C down from 15. I'm running between eight and nine right now. I love that. So, yeah. So we're, and diabetes, I love treating diabetes. It's one, it's fun. It's such a challenge. So, but he ran out of his medication, tried to make his appointment. And sometimes these patients get so depressed, they forget that they can reach out. So he went maybe a week without his medications. We call sometimes their phones get cut off because if you think you have transportation issues, you might have housing issues. You might have other financial issues.

18:41And so, uh, this one gentleman ended up getting one of his toes cut off, uh, waiting at the bus stop. Oh, wow. So, so you kind of talked about like the worst outcome. If, if I'm your experience in most of your patients, just walking us through this horrible cascade that you just talked about. Having a misdeployment becomes uncontrolled blood pressure. It becomes a mismedications and then even worse because like you, I work for Medicare and Medicaid strictly and, um, based care and the unavoidable emission that will ding us. What's the steps that you'd? Well, I, if they're on my spectrum for people who don't have the self efficacy skills to do that, they're a cute three month A1C.

19:41They get their lipid panels checked every three months. They, you know, I'm seeing you. I'm making sure you're going to the eye doctor. I'm making sure you're going to the dentist. I have a contract with a podiatrist. So I'm making sure that they do all of those things and I have a checklist. Okay. Yeah. Yep. Yep. And every patient has a checklist. And if they don't meet those goals, then we have to go back and look at that and look at that patient. And then, you know, a lot of these patients, if your blood sugar runs two or 300, you're going to end up having anemia because you're your shelf life of your red blood cells going from that highly viscous fluid medium is going to affect the life span of those red blood cells. Checking a CDC with diff, seeing if they're a microstatic and hypochromic with our high hours.

20:48Or if they're macrostatic, you know, so you, you have to really look at these guys. I end up giving a lot of supplements to help keep those levels high. And that's going to be hard to because you are like, besides the primary care, you're the endocrinologist, you're probably the cardiologist, you're every because they, they at least can make it to your appointment. But getting to those specialists, they're not as forgiving as you. So you do a lot of good work. Well, and then I also have partnerships with a lot of the major hospitals where I have an app where I can actually schedule this patient to get. Yeah. This, this app I'm talking about is called later. And I can write, write a console and I can, even if I know a specialist, I can look up that specialist and send that person to that specialist.

21:58That's good. Having that. Someone who has limited resources, limited transportation, being able to communicate with the other providers too, so that you can check all those boxes. I think that's good. And transportation leads to non-compliance. And I don't like that definition because it has a negative connotation to it. And it's not like, so if somebody to me is non-compliant, I don't want to do it by definition. But for me, if I couldn't do it because I had to make a decision, was I going to get my insulin or was I going to pay my life? That patient to me is not non-compliant. That patient has some financial insecurity. You're just living or some vibing to live, right?

22:58Absolutely. Absolutely. Which conditions in your clinic are most sensitive to reliable transportation? Do you screen for transportation needs systematically? Yes. And I've actually done more since because it's always been a part of my practice, but the people from the magazine from Bridge Detroit and Planet Detroit. It just really, it made me aware of something I was unconsciously doing already. And so just putting it in the words, I think diabetes, hypertension, sexually transmitted infections, just think about that. Because I see a lot of syphilis, I see a lot of chlamydia, I see a lot of gonorrhea, even sexually associated disease like BV.

24:05People are going around anxiety, depression. Right now, at this time of year, COPD and asthma, and then think about the social construct of homelessness, I had two patients this week. One lady, she has five kids, is living from shelter to shelter. Somebody stole her medication. She didn't think she could tell me that her medication was, and I said, don't you ever do that again. Another guy, today, living in his car, and his alternator just went out. So his car isn't even heated, and he just bundles up in clothes. So I'm going to reach out tomorrow to one of my friends who's a social worker, and let's see what we can pull together for him. And let's see if we can get him off the street. I've heard stories of guys taking a brick, throw it through the window and wait for the police. And they'll give me a warm bed, a meal on a cot.

25:10Yep. And stay out of the hospital. Absolutely. That's terrible. So when it comes to fixes, practical fixes that you use in your practice for fixing a lot of these problems we're talking about. What kind of things do you find the most effective? I'm thinking about these other clinics around that have trouble with transportation and things. Is it transit vouchers, rideshare partnerships, bus passes, mobile clinics, you know, syncing your labs and visits and home med delivery, telehealth? What kind of things do you utilize? So I utilize telehealth. I definitely, again, I put my patients with transportation insecurity at the top of the list, even if they come in. I put them at the top and make sure that their rides aren't going to leave. I do a whole lot of paperwork for patients to give resources.

26:14That's going to provide those transportation vouchers to give them help. Some patients are illiterate and need somebody to come in and read things with them. I do, the paperwork is overwhelming sometimes. Some of the pharmacies have home delivery. For some patients with certain insurances, I will send them to the pharmacy that's right in my building because it will help. That's one less trip that they have to make. I draw labs myself. And then I will, you know, I have really good connections with the labs that I work with. And so they will prioritize their drives to one out to pick up my labs every night.

27:16So I think I put together a nice little system. I don't even think I've put it down. It's just all right in here. And I would save it for your book. You were the founder of the rapid response team. Now you're going to be the, you're going to be the founder of the Godfather of this integrated care model that you're developing. I think that rapid response was happening in other places. But in 96, 97, that's when I start just doing that myself. So it was, I think Australia had a couple articles talking about met teams, the medical emergency teams. So, you know, I don't say I was the, I don't think I was the beginner of rapid response.

28:17But I was one of the first pioneers. I will say that. If you look on the IHI website, I'm still, you can still see my, my name there at the resource to go to. Well, so I think a lot of our listeners, besides learning a lot from just hearing your vast knowledge, they're going to be Googling your name and seeing all your publications and everything. Like now for your, you did so many amazing things, but there had to be a point where something didn't work as what you hoped. And so I was wondering for listeners, what did you learn from it in your profession? What has not worked for me? I think, let me think about that for a second. I think I've been pretty successful in, in mostly everything I've done. I think my biggest thing is I don't take direction well.

29:27I have a very strong personality. And I think sometimes administrators can be, can find me a bit distasteful, not in a bad way, but like just like when I was doing this rapid response team, I hire the best people. And I believe they still have 90% of those people I hired in 2005. If I would have hired the ones they wanted me to, that team would have been a disaster. So, a challenge and an administrative level, but how wonderful is that that you're working with all of the most, the patients that need you the most, and they have this person on their side that has that personality and can get them in touch with these resources.

30:28And I think your patients are really lucky to have you, that's awesome. I have fun with them. And they are, you know, they'll bring, you know, they show gratitude by, they will bring, I'll get lunch. And I said, you don't have to do that, you know, but they'll, they'll bring me things, they'll bring something unhealthy. It's really showing gratitude to you. It's awesome. It, it, it's fun. Yeah. And it's not even, it doesn't feel like work. Yeah, yeah. So, where, where do nurse practitioners add a unique value in this space from care coordination, protocol design, community trust? Where do you think NPs fit in this space? Well, see, I think nurse practitioners bring a different skill set because during their time, our ends, as our ends, we learned what health looks like versus what disease looks like.

31:31You know, most nurses have that six cents where I don't like what I see something's not right there. And the nice thing about being a nurse practitioner is that we don't have to just go report those findings to the physician. We ourselves can be that first response. We can order the diagnostics. We can come up with that plan of care. And we have that unique nursing slash medical perspective. What I want to say is that I like to be proactive. I've seen in my practice that some people wait for that thing to happen where nurses prevent, we're preventive. We don't want that to happen. We don't want to put those interventions in place proactively to counteract the bad celebically that would happen down, down range if we don't do what we do.

32:43That's amazing. Like you have that gut feeling, but then we also have the ability to act on it as nurse practitioners. Bingo, I love it. It's a full circle. It's so rewarding. I kind of like, I was, I don't know if you know this, but I was a paramedic. I think we talked about this. I was a paramedic before I even became a nurse practitioner. So I rely on that sick or not sick where they were trained in a different way of seeing you walk into a room. You have to determine whether someone is sick or not sick. And so it's pretty much the similar things. But my other question was you talked about like interventions. And I want to highlight here a lot of the health disparities today. As we're taping this is Monday, December 22nd. And I don't know if you guys saw it, but the state of Michigan released their nursing survey. And in that nursing survey, I was preparing for this episode.

33:43So they address the confidence and the competence of whether nurses can address social determinants of health. And I'm not going to go into detail about it, but we still have work to do. And so for someone like you, what are the interventions specifically that you're doing to improve the most vulnerable individuals, especially African American Detroiters, people of color, older adults, and people with disabilities, what has worked that you can share with our listeners? Well, education, education is paramount. And people don't know what they don't know. What is a hidden car, brand terms of sugar. And I do the, I do the amylase test. I put a piece of brand new mouth, let it sit for a couple of minutes. Oh, my God, it's sweet. There you go, bingo. So you should not, you should not do that because you have the digestive enzymes in your saliva.

34:49And so it'll, it'll turn sweet if you, if you let it sit for a second. But I do do little things like that. I like to do mulex change. Now, this is part of that transcultural nursing sunrise and abler where you take one thing. Let's just say pasta. And instead of a pasta that's carbohydrate based, let's use a zucchini pasta this time. And it'll, it actually turns out pretty darn good. And I've had good feedback from my patient. He's used turkey chili. I mean, turkey instead of ground wild or hamburger in your chili just to get a better outcome. So things like that, you know, it's not rocket science. It's teaching people the order in which to eat things. And I always tell people, I said, when you go to McDonald's, what's the first thing you do before you get out of the drive-through?

35:51You're like, we're grabbing fries and shoving them down. And you, and you digest carbohydrates the quickest. So I tell them you need to eat your fibers and your vegetables first because those take the longest to digest. Then your meat products are second. And then your carbs third. And that way, you're not storing as much fat. Because if you take that car, everything else you eat is going to be probably stored as fat. So I like to educate in those type type of ways with my patients. All those little changes make a difference. Yeah. Well, maybe they're just really hungry when they leave the drive-through. So they need that digest quickly or not. That's our excuse right now. I don't know what's going on. I'm showing you the whole prize. There's a reason why they sell checkers fries at the big stores and not McDonald's fries.

36:54Yeah. So I was going to ask, so what kind of training helps the staff approach transportation conversations without adding that stigma or blame to the patients? Well, you know, I don't even think we're so used to it. It's a normal thing. About 15 to 20 percent of my patients have transportation and security. So we ask them about that. I ask them even about their housing. You know, what type of housing do you have? Do you not have housing? Sometimes I just sit there and we get sat together and we, you know, let's come up with something that we can do to make your life better. And what are you going to do once I put these things in order for you to help yourself too? So teaching that self-efficacy is as important as the education.

37:59That motivational interviewing is one of those great tools that we can use to build that self-efficacy in our patients. What is one policy change at the city or state level that would have the fastest impact in your opinion? How do professional groups like my camp help, whether we do, whether it's testimony, data sharing, pilot recognition, what would you recommend for my camp? Well, I think as my camp, you know, we're already in the battle of our lives trying to get total autonomy, which we should have. We have a lot of political barriers, such as our, some of our colleagues that don't want to see us get total autonomy, but I want to say with the amount of nurses and nurse practitioners, just every facet of nursing, become politically active.

39:06I think that nursing is a profession, and we need to advocate for it to remain a profession. But I think we also need to lobby our officials at the locals, the state, county, federal, all those levels to recognize the importance and the impact that nurses have. So I really think the best thing that we can do is to advocate for our patients by advocating for ourself. Yeah, that's one of the things that I always like to share with people. It's just we need to articulate what we're doing. We need to share that with other colleagues with our family, with our friends, with our patients, just to kind of help them to understand what exactly we're doing every day. So it doesn't go unnoticed and we can make those changes.

40:09And teaching nurses, I think that's another thing that we can do because they're going to be the ones taking care of us when we're in our later years. And teaching them what advocacy means, what being protective of that patient, what that truly means, giving them the opportunities and looking at them with the non-biased lens, and just appreciating their experience, their environment where they come from, and meeting them at those places. I think it's paramount to us having better health outcomes and making the patients our partners. I really think that you kind of hit that right on the head because you yourself were talking about your family and how your grandmother went through training in the hospital system and looking at basically all of these roads that have been paved for us that have not been easy and has brought us to where we are today.

41:18And now we're doing the next bit of pushing forward, which is trying to get the autonomy. And people 20 years from now that our nurse practitioners are going to look at us the same way that you looking at your mother and how your grandmother worked, and you and your sister and all the great work that you two are doing. And I think it's important that we recognize that, but then also continue that fight and continue that push of being recognized. And we have so many things to offer as nurses becoming professional providers and taking on that role that I think a lot of nurses kind of are not working outside of their scope. But they probably could if they really were given the opportunity. Because of that, you said, I see you experience and that's where I came from too. And you learn so much that you know what to expect. You know kind of in like Justin being a paramedic, you know what to look for. So there's so much that we have to offer because of our different type of training.

42:22So I think that's super important. Absolutely. Well, Dr. Maley, it has been a true honor to have you as part of our podcast. I'm excited for your future as well. And I don't think you retire anytime soon, no matter how much you want to or not, because you have a lot to give in this world and a lot for me to learn from you as well. So again, it was a pleasure having you on our episode. And with all good things, it must come to an end. That's a wrap. Stay tuned for more indeed topics and educational opportunities. Whether you're a student, a student, a student, or a healthcare leader. We're here to keep you informed, inspired, and connected. Thank you for having me. Absolutely. And as we amplify the voice of nurse practitioners, work together to shape the future of healthcare. Subscribe now and stay tuned for expert conversations, legislative updates, and the latest and NPP practice in Michigan. You can't wait for our next episode.

43:23Trust me, it's coming soon. See you next time.