From Early Struggles to Pharmacy Staffing Leader | Autumn-Kyoko Cushman, BS ShiftRx, CEO, Co-Founder

This transcript was generated automatically. Its accuracy may vary.

Mike Koelzer: Autumn, introduce yourself to our listeners.

Autumn-Kyoko Cushman: I'm Kyoko Kushman, I'm the co-founder, and CEO of Shift Direct. and we are working on solving the healthcare provider shortage, starting in pharmacy.

Mike Koelzer: autumn, last time we talked, Leanne was on here

Autumn-Kyoko Cushman: Yep.

Mike Koelzer: What's the status of Leanne?

Autumn-Kyoko Cushman: she's at the company. We are co-founders still. She's my best friend and we're rocking and rolling together. but we are in a pretty heavy product push right now, so I've been taking a lot of these podcasts solo.

but I was excited to come back on and talk to you again.

Mike Koelzer: on and talk to you again. Well, autumn, it's good to have you on and here's the thing. last time we talked, I think it was maybe a couple years

Autumn-Kyoko Cushman: Yeah, it was,

Mike Koelzer: What was it? 

Autumn-Kyoko Cushman: It was about a year and a half ago, so we started the company in May of 2023, so we're almost two years old. And we launched the product in August of 2023, and I think we talked right after we launched.

Mike Koelzer: alright, because when you and I talked, we probably recorded, I used to record shows a little bit longer. Back then, we probably recorded for about an hour and a half. The show ended up being about, I don't know, less than an hour. And here's why, because. It was such a precarious situation. I think your company was in at the time.

You had just either raised some money, but maybe you were trying to raise some more or something and you and Leanne would kind of qualify everything you said with but we don't know if this is gonna do this or that, you know, and, and we did this, but we don't know, you know, if we're still here a month from now, this or that.

I had to cut all that out because I'm like, people are gonna turn this off thinking that we have a dismal failure here, and I know you guys were just careful. You didn't want to be bigger than you were at the time and so on. Is that true? I mean, do I have that right? and where are we now because it seems like you guys are exploding now. So bring us back a little bit to that time when we talked and then when was , the turning point for you guys, assuming there has been, because when you offered to be on the show, you were like, Hey, let's do this. And so I know you've got some good information to tell us.

Autumn-Kyoko Cushman: Yeah, so I think the first time we talked, it was actually really a crazy time for us because, like I mentioned earlier, we, we came up with the idea in May of 2023, August, 2023 we launched, and then I think we recorded in like October, November. And then you ended up publishing the episode in December 

It was the hardest time that we've had at the company still to date. We started building this company, Leanne and myself. We did everything, the branding, the ux ui, the socials, getting everything ready, building the actual platform, which neither of us had come from like a coding background. And so we had, right before we recorded,

we

had added a technical co-founder, basically.

Essentially like a technical co-founder, and an engineer . And he was with our company for a little bit and we had a funding round that had come together. And he took another job at a series of startups. And the investor who was gonna lead that round found out and was like, it just doesn't really seem like he's super committed.

And so the round fell apart. And when a round falls apart, you are. Like dead. Like you're, you're dead. People don't wanna touch you. Investors are very FOMO driven. There's always jokes like, investors are sheep. 

are

not only were we trying to establish ourselves in the world of pharmacy and build that network and build a business and become trustworthy, but we were also still trying to

raise capital because we had quit our jobs, liquidated our life savings.

Like at one point Leanne, was getting declined on her card for door dashing stoop when she was sick, when we had come back from a trip from New York. So, when we went to record it was like we did not have truthfully, much money in the bank and we did not know if we were gonna survive. and that week just is ingrained into my brain.

 The week was crazy. We had a couple thousand dollars left in the bank. We had,

 big contracts that we were getting, but we had to float the cash to pay the providers 'cause they were gonna do aCH transactions. And so when we were recording that episode, it was like we weren't sure if in a couple weeks we were gonna go under.

And it was terrifying. Everything in life just happens for a reason. We made it through clearly.

but I ended up calling one of the investors, that was in that first round and said, look like this is what happened. One of our engineers left. This is all really crazy, but you really believed in us and we need capital right now.

and so

We ended up doing the same as our predecessors. And it was fantastic. And then a couple weeks later, we ended up raising our seed, and we were able to come back from the dead and I was able to figure out some of the engineering stuff and we got a couple of contractors on and it was great.

And so we, we ended up surviving and obviously we've grown quite a bit since then, but, I think a lot of the things that happened are not totally abnormal and totally outta the box for most entrepreneurs, whether you're VC-backed or you're a bootstrapped business, I think lots of people in their entrepreneurial journey have faced critical points of failure.

And if you can just figure out how to make it through that,

and survive, then you'll be okay. And you'll find out, you'll figure out how to survive and the next time. and the next time.

Mike Koelzer: In the show, I think it thrives on, Honesty. I'm not an influencer in terms of, I always have to be positive, you know, I'm not trying to sell anything.

I'm not trying to sell myself. I think I'm just trying to sell, frankness and honesty. And you guys were so honest at that time, and you're right. We talked about that you were a couple weeks from, I think, running outta money. And a lot of times I don't like having new companies on the show because everything is rosy for the investors.

You know, If an investor hears something, any question I ask, like, what challenges are you having? They always flip it into something positive, it's okay if you're having, you know, sound bites and stuff, but not for a deeper show. And so you guys were so honest, but when I'm mixing this thing, I'm thinking, oh, wait a minute.

Now, you know, it's honest if the company goes under, but I've gotta protect Leanne and Autumn here a little bit, because if someone's listening to this, you know, a month from now when things turn around. And so it was one show that I think I edited a bit out of, what would you say? It's the one show that I probably edited a bit the gist of it or the guts of it. Just because I knew that things were gonna flip for you guys and I didn't wanna have that show going in perpetuity, with too much of, you know, we're almost outta here, 

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Autumn-Kyoko Cushman: we knew we could come back from different, you know, critical points of failure.

and now fast forward to today that we're in all 50 states.

We've got over 700 pharmacies and 8,000 pharmacy professionals. We're building out new markets. We just launched, we were in five states. We launched Nationwide a couple weeks ago.

and now we're building out new critical markets. We're moving upstream to some of the healthcare systems and the large compounding pharmacies and specialty pharmacies.

 and we have like 16 employees. So things are rocking and rolling. But 

When you're in that bubble of, oh my gosh, everything could fail right now.

It is terrifying.

Mike Koelzer: So Autumn, you personally, when did you spend something. At what point did you buy yourself something or say, okay, I'm not gonna have, now, mac and cheese this week.

 I'm gonna buy this muffin, or I'm gonna get my car fixed. I've been waiting to do this. when was there a personal, if it's come and I, I assume it has. When was a personal spending time that you remember saying, I can do this now because I'm not about ready to fail.

Autumn-Kyoko Cushman: Yeah, so ironically all of this was going on, and it was just a super chaotic point in my life. This actually, this is so counterintuitive. So we went home in November, right when all this was going on, and we still had no idea if we were gonna raise, if we were gonna make it. And I had, you know, bouncing credit card debt.

I sold my Jeep, my beloved Jeep, to my brother who's in the Army. I had another car, thankfully, but I, you know, had to get rid of my fun car. And I found this necklace at this local jeweler that was just this super gorgeous necklace. And it was blue diamonds, and like a small diamond, but it was an expensive necklace.

I had maybe three K left in my bank account.

and I still had money left on my credit cards. And I wanted to buy my mom this necklace for her birthday. I thought to myself,

I bought my mother this necklace, it's something I would not have hesitated to do when I was, you know, at IBM making six figures.

But I was like, okay, if I buy my mom this necklace, then I'm gonna have to obviously pay it off. And what happens if we don't raise? What happens if we don't, whatever. And then I said, if I don't buy this necklace.

Then I do not believe that we're gonna raise and I won't be able to pay it off. And this will be the stupidest purchase I've ever made.

So it was actually before the raise but I bought her the necklace. and you know, it was like, okay, I believe in myself. I know I can do this. I'm buying this because I know next month I'll be able to pay myself a salary and I'll be able to pay it off.

And, so yeah, we're paying ourselves salaries now.

not a salary that can still justify that necklace purchase, but it was something like this vote of confidence inside myself. And then, you know, as soon as we raised and we were able to pay ourselves salaries, it was like, now we gotta pay off the debt that we racked up while we were, you know, not salaried for eight months.

Mike Koelzer: months. Now that you've got your 16 employees, what's the crappiest part of your week? What's like the 10% of your week, , so four to six to eight hours where you're like, ah, I gotta do that this week and I'm wearing this hat still and I can't wait till I unload this hat, but I haven't unloaded it yet because I still think it needs my personal touch. What part of the week is that

Autumn-Kyoko Cushman: Reading contracts. I hate reading contracts and we have legal representation, but lawyers are really expensive and not every contract requires it. A $1,500 an hour charge from a legal firm to read. Like there are a lot of contracts you can take care of yourself or like getting offer letters out to employees or reviewing like a change of terms and service agreement.

I probably spent like four hours, five hours a week just reviewing contracts for miscellaneous things, whether it's internal or external. it's easier 'cause I start learning all the contract language, but it never gets better. It's like this still sucks and I don't trust AI to fully, fully do it yet.

Mike Koelzer: Lawyers suck. I mean, lawyers are the only, like the only group that they'll give you a contract back and you'll say something like, you missed this part, or, something, and then they'll ask you for that.

 It's basically an error, then they'll charge you or they're charging you to review something just because they forgot, you know, it's like you're reviewing this, I remember this three weeks ago and you gotta review it now. So I had to get my lawyer job there.

Autumn-Kyoko Cushman: Yeah,

the AI can replace lawyers, I'll be happy, but I don't know if they'll replace them from like a, a negotiation standpoint or, you know, things that, again, require that human touch. But the actual contract reading, I think it's gonna get to the point here shortly where it's done much better by ai.

Mike Koelzer: Yeah. so Autumn, your 16 employees, break those down as far as percentages. You've got a few of 'em that do this or some in sales. There's some that send Mike, uh, nice, what's the company you sent me a cup of? The cooler company?

Autumn-Kyoko Cushman: Oh, Yeti.

Mike Koelzer: Yeti. Yeti. Yeah. I got a little happy package because I was trying to get away for spring break and I actually signed up for Shift Rx because I knew we were gonna be doing this, and so I signed up and I got all kinds of attention. Your people reached out to me And I got a Yeti cup and I got a couple T-shirts and I got something else in there. I use the cup every day. It's great. I go to the drinking fountain. I used to drink fountain water and it would warm up after like, you know, an hour now. It's nice and cool.

I think about you guys every day. It's sitting right on my table there at work. Anyways, I was treated like a king. When I went to sign up. It didn't work out because it was a time crunch and this and that, I know you have someone in charge of Yetis there. I know you've got 16 employees.

What's the breakdown as far as percentages of follow up sales, computer, all this kind of

Autumn-Kyoko Cushman: So still just me on the sales and marketing front, although we will have a new marketing person joining us shortly. I've got a chief of staff, slash ea. I've got a head of ops. and then everyone else is on product and engineering. We do have some customer support, like client success.

I think it was probably Kira or Ashley who are both fantastic that sent you the swag pack. We try to make personal connections with everyone that signs up on the platform, which is crazy . A lot of companies don't do that. When we started the company, I said from the beginning, I want this to have the ease of use that's like PayPal or Stripe.

I want it to be super easy to use, totally intuitive, very user friendly. And I wanna have the same customer love reputation as Chewy. Like, I could go order my pet food off Amazon, it's probably three or $4 cheaper, but I order it from Chewy because Chewy sends my cat a birthday card and they send flowers if a pet passes away.

And it's that real customer experience. So when a facility owner or a pharmacy owner signs up, someone on the team reaches out and says, Hey, thanks so much. We try to put in a little fun tidbit about your pharmacy and say, thanks for being this pillar to the community.

We are very still, uh, independent focused. That's the big heart of our product. We try to, say, Hey, these are real people. We're healthcare providers ourselves. We're trying to make a huge impact here and help you unlock time.

If you guys need anything, you can call us. You can text us, you can email us, and it's real people that are gonna answer your messages pretty quickly.

I

Mike Koelzer: And it seems to me, autumn, I ain't no here, but it seems to me that a company like yours , if somebody were looking at it, they would say that you have I'll throw this out there. They would say, you have a pretty high failure rate the first time with a first time customer, because here's why. It's like, I think a lot of people were like me, where you're in a rush, you sign up, and then maybe either something falls through or you get some local pharmacist who somebody knows somebody.

That was my story. I was able to get away and go down to spring break for a little bit by a friend of a friend who was looking for some pharmacy work and so on. He came on in for one day. I would imagine that happens, often. Maybe not for long-term people that are looking for long-term relief, but for this quick relief. I imagine a lot of people dabble quickly in it. , no fault of your company, just the nature of that industry that they're maybe not successful, but got their feet wet with it. they reached out to you, you reached out to them, this is gonna come up again next spring.

 This, and that's gonna happen. So I think there's a lot of companies that I. Maybe follow up too long. It's like, why are you following up for this? I just went on to order a towel or something, you know, from a company. It's like, obviously I bought a towel. If I'm at a beach company and I'm looking for a towel, I'm not gonna wait six months to buy a towel.

But in your case, it seems like there'd be a lot of that, like, dabbling in it at first, but then that follow up is important. 'cause I think people might come back, whether it's a month or a year or even years. I think that follow up is huge with you guys, of saying, you reached out once, but we're not gonna let you go

Autumn-Kyoko Cushman: Yeah. So I would say with the independence for sure, we have so many that sign up and they'll post a shift because they're curious, they get applicants. I remember your shift, actually, I know you had applicants 'cause I talked to them personally

I was like, Hey, this is a friend. We personally vetted the candidates that were applying to your shifts.

 But

That happens with independence. We knew from the beginning that we weren't gonna build this crazy billion dollar business. independence gets squeezed by PBMs. The independents have operational margins that are much lower compared to some of these big retail chains in the healthcare systems.

and we sell to the healthcare systems we sell to, the big specialties we're selling to anyone that hires a pharmacist or technician.

so for us, because we were able to do this product iteration and the deploying new features.

With independence, that is like our gift to independence.

We have kept pricing low. We make it really easy for them to have this, like, almost like an AI-like healthcare administrator in their back pocket that they probably don't have otherwise, especially if they're a one location, a four location, a five location.

And we make our money back when it comes to the bigger guys.

So like, the mid-size chains, the grocers, the big healthcare systems.

and we have had lots of,

don't wanna say lots of pushback, but we've had people that are like, Hey, just forget about the independence. Don't focus on them at all. Don't let them sign up, up their pricing. And for us it's like, look,

This is a deeply personal issue for us.

and we know we've done the stats, we've done lots of research. I published this article last summer about,

 some independent pharmacies in rural America being the only healthcare facility for our Americans within 150 miles. it doesn't feel like a lot. There's champions for independence. And if no one is going to give them

That voice, even though I know so desperately, there are so many people that are trying to do that within the independent pharmacy community, I think for us, like this is our way of giving back. And so

Even though we have independent pharmacies that sign up, they post a shift, maybe they use us for coverage once and then they don't need us for three months, or they don't end up hiring for that shift.

 Think our passion behind like trying to be, that wedge for the independent pharmacies in the US

is what makes us so special and why we are a pharmacy community above all else. We give them access to the floater pools. We allow them to post for full-time roles and part-time roles. They can trial people out. We don't charge buyout fees.

which is huge because the traditional staffing agencies charge buyout fees.

We are trying to make this as accessible as possible, because they are, getting squeezed by PBMs 

 I think because of our mission and because we try to give that really personable experience,

you are independent pharmacy owner, and that was your experience with Shift Direct, you

swag pack and you did have applicants for your shift. you have to go on vacation again, or you have a sick day, it sticks in your mind and you're saying, Hey, this is reliable.

These are real people just like me that really care about it. We have independent pharmacy owners on our advisory board. We are partnered with a ton of the, you know, GPOs.

we actually just closed a partnership with as mbia, we're partnered with

A SHP and PTCB and a couple of the other ones. We are very focused on a great personable and memorable experience.

So even if the independents sign up, they don't get immediate coverage. We want them to have that in the back of their head saying, I have this tool. I have something that I know that I can rely on and I had a great experience and there's people there that really care about me and my business. And it's not just a money grab.

Mike Koelzer: Autumn, here's why I didn't grab your applicant. one is they were from Detroit which is a few hours away.

 I thought, wait, if this person's from Detroit, how do I trust this person's going to be at my doorstep on that morning? Because if they don't, it's not like, oh, well back to my beach towel. It's not like I ordered a beach towel that didn't show up and now I can order it from someone else. This person doesn't show up now. That's the first time. Store hasn't been open when it was supposed to be open in 80 years, you know? So that's what my mind was doing. So while I was dabbling with this person, and I think another gal that was sent over, by that time I had already had a friend of a friend who had stopped in his store, and then he was able to stop.

And my story was like, okay, he knows where we are. I've seen him physically here before, so I know it can happen. So that was a little sticking point for me. And it wasn't a huge sticking point. I still would've looked at your system if this friend of a friend didn't show up miraculously in my store. that would've been a sticking point from like, what the hell, what if this person doesn't show up? And I'm assuming that that's. where you have some reviews and you've got the star rating and all that kind of stuff. And if I see this person showing up, you know, 30 outta 30 times, and I have no doubt about it, I would imagine all that's there.

I didn't look enough to do it because I just didn't need it at that time.

Autumn-Kyoko Cushman: Sure. Yeah. So, when you signed up, I think we had literally just launched in Michigan. And so, like the day before we've been building out markets based on where facility owners are signing up and posting shifts.

so we started calling all the people off our wait list, getting them in, getting them onboarded, getting them through the credentialing process.

We do background checks, licensure, the whole thing. Some people have really unique needs, I think for your pharmacy. Correct me if I'm wrong, you required Pioneer experience.

Mike Koelzer: We didn't require it, but I think your system, if it made us, there's a couple things that made us do, and I don't know if that was one of 'em . And I think part of it was, do you require this or do you suggest it?

Autumn-Kyoko Cushman: Or is it preferred and we can find people where it's

Mike Koelzer: really care. 'cause our tech would hold anybody's hand next to them.

Autumn-Kyoko Cushman: Sure.

Mike Koelzer: I think we had a couple options, but I think Pioneer was one of 'em. 

Autumn-Kyoko Cushman: And that might've just been a miscommunication on our end, but we, we say, Hey, is this person required to know the software or is it a nice to have? And so if you say it's required, then we find a talent pool where it's required. and so when we're building this out, like, and we launched in a new state, we brought everyone off the waitlist, got them background checked, went through their credentials, and then Kira and the people on our client success team,

they're interviewing people.

So they do quick phone screens with people. They sign things saying, Hey, they're gonna show up. Thankfully, we do not have very many no shows. We've been doing this for almost two years, and I think we've had

literally less than sixth. Which is incredible because we're filling a couple hundred shifts a month.

but like there are incentives for them, so if they were to nohow or they're late, that hits their attendance score. There's ratings, there's two-way ratings for the facility and for the provider. And I know that it can be a little bit. Daunting to say, Hey, I'm gonna bring someone in that I don't know.

that's where this is like really special for us, is we, you know, take their photo, we build them a uniform profile, we do all of the extra checks, we have the phone screens,

 They have to upload a clear photo of them. You know exactly who's coming in, when they're coming in.

and we do lots and lots of vetting to make sure that these are great people coming in.

And it's no different really than when you order an Uber. Like how do you know your Uber's gonna show up? How do you know that your Uber's a good driver? but they're getting vetted in the same way. And so like we've heard over and over again, one of the things about the traditional staffing agencies is that they don't have a ton of transparency on who's coming in.

It's really expensive

the person that comes in sucks. And so this platform is literally designed to try to beat all of those things. We use the AI to train on your facilities workflows, so what your pharmacy looks like, how many scripts you guys are doing a day, what your hours look like, what's your

demographic like, because what a rural pharmacy is gonna need from a provider is totally different from what an urban pharmacy is gonna need, where maybe they don't have a walkup counter.

 What's your C two policies?

so all of these things go into that onboarding and before the provider can even. Come in for your shift, they have to complete the onboarding, which takes them 10 to 30 minutes. They go through your E-H-R E-M-R system or your prescription fulfillment system, and they can see that entire clinical workflow.

And then you can tell us, Hey, I had a great experience, or I didn't have a great experience. Thankfully we don't have many people that have a great experience, but if you have an issue with a provider, you can end this shift. We'll fully reimburse you. We give you credits on your account, we say, Hey, like, we'll make this right.

But luckily, like what we found is that a lot of these people that are working these temp PRN jobs are not the same as the ones that are full-time floaters for the truthful staffing agencies.

Often we have people that are working moms, they need a more flexible schedule.

They're paying off student loan debt. Actually, the guy, who I won't, you know, reveal his name or anything,

but one of the guys that applied for your roles, he was a pharmacy tech turned pharmacist. He actually did a brief stint as a police officer and he has four kids. He went back to pharmacy school a little bit later in life and so he's still supporting his kids paying off student loans and he works at the hospital and so he's like, okay, I have a couple days a week where this would be really great for me to leverage my skills.

Mike Koelzer: I gotta go back to autumn all. I don't wanna dwell on people that haven't shown up. It's minuscule, but that would be hard if I'm in your position. would be hard to even have that potential because. I've never been hired outside . I've always just hired people. So if something doesn't show up, it's my fault that I didn't do the right work and I'm commiserating with you on this. I'm not saying this happens with you guys, but that's gotta be a sucky spot for your company to be in, to even have the possibility of not showing up.

 In any business, there's a lot of stuff that fails. You know, I might be driving down the street and my car fails and the mechanic said it was gonna be okay and it wasn't. And now I've gotta spend, you know, a hundred dollars on a tow truck and this and that. Those are kind of minuscule. That's gotta be a tough position for your company to be in, you'd have a full day of a pharmacy closing if your people don't show up. And. I am not saying this happens with your company. Even if you said, Mike, it never has happened, it won't happen. That still has to be a hard spot you to be in mentally no

Autumn-Kyoko Cushman: No, for sure it is. And we've created guardrails because of this. One of the things we do in the backend too is like when you're posting a shift and you hire an applicant, we try to get a couple extra that have marked availability for that day. So in a couple of occurrences where we've had someone we had a case where it was really terrible, and very sad.

We had a pharmacy tech on our way and her dad was hit in a car crash, and was being life flighted out. And so that was horrific. And this was for like a federally qualified medical institution, so really important that she was there. And so luckily we had backups on standby. We were able to get someone in within two hours.

and obviously that was horrible for that pharmacy tech. It was awful. And she's still on the platform. She's incredible. You know, we sent her flowers. It's,

the same case when you use a staffing agency. How do you know that someone's actually gonna show up 

Mike Koelzer: And that's a point which I've never done. And so that's why I'm saying this isn't focused on you because I'm sure you guys are gonna do 10 times better than anybody else in making sure this happens. Just as. Friend to friend, it's gotta be a hard position to be in because even if someone crappy shows up, that's a hundred times different than if nobody shows up.

And you can say, well, it might not be because they're gonna leave a bad reputation, blah, blah, blah. I know that, but I'd rather have a bad reputation than not being open. But, that makes sense. , you've got some people that are kind of backups or in the area. Maybe if you find out someone's not gonna be there, it might take an hour, but someone's gonna be there, this and that.

So that makes sense. And that's all you can do is just have some potential backups, I guess.

Autumn-Kyoko Cushman: Yeah, a hundred percent. And if we have someone, I mean we've had a couple cases over the last two years where there was like a legitimate no-show. And they show up, you know, hours later and they're like, Hey, sorry, I, blah, blah, blah. We ban those people from the platform because this is all about building this community, building trust, and building respect.

And if you commit to going to a shift, then you have to show up for that shift. And they're heavily incentivized to do so because we don't have the traditional staffing agency fees, we're able to save for the pharmacy owners. And then our providers are making five, 10, $15 more an hour with us than they'll be able to make anywhere else, especially on their day off.

And they get instant cash out. And so if someone doesn't show up for the shift,

and it's not because, you know, someone has died, then at that point we banned them from the platform. And people are getting pretty serious about that. They don't wanna be banned from the platform because this is limiting their ability to bring in additional income.

Mike Koelzer: Well, and you're not dealing with a bunch of schmucks. I mean, you're not dealing with people that it's like, Hey, I signed up for your guys thing, but you know, an opening came up at the fast food place, so I'm gonna work there instead. I mean, these are people that are, I mean, they're pharmacists.

They've done their due diligence to be there for 10 years. they've planned on this to be this kind of person. And so , I'm sure it doesn't happen, but it would just, it's a. Tough spot mentally to be in,

 Autumn, if you could, what would you like to do with your company? That it's not quite there yet. It's like, to really have it be there, we'd need to have self-driving cars that would pick these people up at their place and drive 'em there so they couldn't get lost. is there anything that you could dream doing with your company that you just, you just can't right now for some reason?

Autumn-Kyoko Cushman: Yeah, I would love to build a healthcare OS like an operating system, right? You open your phone and. What's powering your phone? It's an operating system. and I would like to automate all of the nonclinical tasks that go into the workforce, solutions when it comes to healthcare providers beyond pharmacy for all of healthcare.

so that we can. let these providers focus on what they do best and that's patient care. and put that money back in the budget so we can pay healthcare providers more. They're better resourced, better staffed, and you incentivize them to stay healthcare providers and incentivize new people to become healthcare providers.

But it starts really small, so what can we automate away? Like we're trying to get rid of any reliance on agency, these traditional staffing agencies and like LinkedIn and Indeed, we're trying to make it much easier to find and recruit and retain talent. We're trying to make it easier by automating the schedule.

So if people have PTO or they have to take time off, the AI does a much better job at playing Tetris when it comes to people's scheduling. And so that's kind of our next evolution right now that we're working on

As we move into healthcare systems and some of these larger compounding and specialty pharmacies, we're working with their pharmacy departments to automate all of the scheduling and the credentialing management.

So if someone has likes. A HIPAA license coming up for expiry or A BLS license up for expiry. But if I could wave a magic wand and have this be anything, I will have automated all of those tasks, payroll, hr, all of the, you know, workforce management tasks, within all of healthcare. And then just keep going from there.

Mike Koelzer: going from there. Alright. Lemme see if I have this. So I have a company called When I Work, and that's a company I hire, a SaaS program. And basically it's my scheduling program. And so I can, if I'm my own team, somebody needs something off unexpectedly, I can have an open shift. I can click it, I can say I want these three or four people and then, but these people, these are my own people

Autumn-Kyoko Cushman: Yes.

Mike Koelzer: You're saying that your company would be like the scheduling program that. Pharmacies would use, and then maybe six months down the road, they're not really even thinking about you guys, but they have an OpenShift. They click on it and now it's like they're not logging into Shift rx. They're already in Shift rx.

Somehow they might not know it, but then those people that they're from are your people. Do I have that right? Do you want more of that universal program like that?

Autumn-Kyoko Cushman: We are aiming to kill drones. You know, when I work a DP, a lot of these companies, and basically instead of you saying like, let's say one of your people wants to request PTO, instead of you having to approve it, you can have these like administrator settings in place that says, you know, we wanna allow people to take PTO within three days of request or whatever.

And then you don't require your oversight. The computer can automatically do that. So let's say you have a pharmacist that requests PTO in two weeks from now for three days. Then it will automatically notify the other people at the store who are off at that same provider title and say, you guys wanna work this all.

We'll try to avoid over time or utilizing your float pool or utilizing even the PRN marketplace. That is our next evolution that we're working on right now, which is really exciting. We are beta testing it with a couple of pharmacies and it's been a really, really an exciting time for us in the company.

Basically we will start competing with those SaaS tools and just make it 10 times easier. So you're not having to log in, you're not having to do approvals. it's only required if you want it to be required and in certain circumstances because you can give our platform that content.

Mike Koelzer: Is that gonna be called Shift Rx or are you going to sort of hide behind something else? Because you don't want to say that. The main gist of this is that we're, I, I, it might be too strong to say, trying to promote our PRN people, but would you, would you call it Shift

Autumn-Kyoko Cushman: Yep. It's gonna be all in one platform. That is the goal is to build an all in one platform so you can handle anything workforce management.

Mike Koelzer: gotcha. So in other words, when I think of Shift RX in the future, I might say, well, this is 95%, it's just our shifts. It's our pharmacy software. Anything that has to do with my pharmacy people is gonna be on the SaaS program called Shift R. Oh, by the way, there's a button over there as a bailout button in case you ever get in a lot of trouble. That's where some of these extra help from the outside can come in.

Autumn-Kyoko Cushman: Yeah, so it will be scheduled for your own pharmacy staff. It can utilize your established float pool. So if you have friends that have done it before, you can add them to your float pool, and it can know to ping them if no one at your store can work. It handles all of the 10 90 nines, the W twos, any of the accounting issues.

So you don't have to ping your accountant and be like, Hey, I had someone work here today, handle their payout. If you need someone from the PRN marketplace, that's just another added feature. So for, for, from our perspective, like. 

Is your SaaS doing for you? 

I'm sure you pay a lot of money for the SaaS programs or for payroll. From our perspective, SaaS is just blown up so much. Everything right now is a subscription economy. We look at making this like the bare minimum, and then you're just paying based on volume. if the SaaS subscription is for the actual, scheduling software and workforce management, you're not paying that SaaS for the PRN marketplace 

That's totally volume based. and trying again to be as minimal in pricing as we can be so we can continue to grow and really build this custom to pharmacies.

Mike Koelzer: Alright, autumn, when do you worry about getting out? Shift RX? By shift Rx. And what I mean by that is every company has this issue where right now it's like you come to Shift rx, you're gonna get the best people on your team and you're gonna get the best place to work If you want to do fill in work, well now you come along and you have this fancy program and it does the scheduling and it does the accounting and it sends out the birthday cards to your team and all this stuff. But then, Another Autumn comes along in three years and says, Hey, don't, don't use a company that their main focus is not to fill in help come to my company, which is, you know, X, Y, Z shifts something , we specialize in this. We don't do all the other baloney that autumn threw back in 2026.

So are you ever concerned about getting out shift RX by another shift Rx.

Autumn-Kyoko Cushman: No, just because for us, like. We are very careful and very strategic about how we build our product roadmap. And then we build really strong teams around that. So like this PRN marketplace that we've been working on for the last two years, it's not like the whole team just now shifts their focus on the scheduling tool.

We have a dedicated team that is only focused on the PRN marketplace and now we're starting to add new people as we build out the scheduling tool. And basically we wanna learn all the ins and outs as we build out that one product feature, which was a standalone product to begin with. And as we build out the next product feature that becomes its own team, there's a very famous instance of this in Apple where the teams are very segmented and that's their entire focus is that one product.

So there was an entire team for the iPad. There was an entire team for the iPod.

That is their only sole focus. And it's people that have been at the company that have worked on other products that are very passionate about it, and they're leading the innovation and that is the only thing they focus on for years.

 The product features are very segmented. and I think people are tired of having so many different platforms that they have to go to and services they have to use. We're trying to make

process as frictionless

as possible because as an independent owner, you have to think about so many things.

You have to think about hiring, you have to think about payroll, accounting, their birthday cards,

what type of medication reimbursements you're gonna get. You have to worry about PBMs and the doctor's offices that are giving you referrals.

We are trying to just consolidate as many things as we can,

workforce management, and so that first piece for us was how do we find talent better, cheaper, more reliable, and more competent than anyone else in the market?

And I think we've been able to prove that a little bit. And now it's like this next piece, how do you handle this scheduling? How can we automate so many of these burdens away from you, the independent pharmacy owner, and offer your staff so they can continue to focus on the actual pharmacy flow?

Mike Koelzer: pharmacy? Alright, autumn, that's a mouthful and it sounded halfway decent to me, but here's the thing. I don't care about your teams. I don't care what your teams are doing. I want one company that does one thing. They're finding me a relief help, and I'm just teasing you, basically. But, you always run into that problem, don't we? There's a book called 22 Immutable Laws of Marketing by Al Reese and Jack Trout, an old book, and you go through there. It's so outdated now because they're saying what I am. Kind of teasing you on, they're saying that the company's gonna be segmented, this store's for old people, this store's for young people, this store's for this and that. And you read this stuff years ago, you're like, okay, yeah, yeah, boy, that makes sense. And then you look at the biggest company in the world, you know, it's Amazon, where they sell every freaking thing on earth.

People, people like me, will tell you stuff. They'll say, you've gotta segment down. You know what I was just challenging you with? You've gotta segment down. 'cause people are looking for the one thing, and all you have to do is throw up in their face and say, well, look at Amazon.

And like you said, look at Apple. Apple's got EarPods and they've got, you know, desktop computers. And, Mike, if you were correct in your assessment, Amazon wouldn't exist. and Apple would only be doing. EarPods like beats, you know, because that's what they specialize in. But there's plenty of room for all that.

So, teasing you aside, I think that you guys will do a fine job with that.

Autumn-Kyoko Cushman: you have a point with Amazon, so you have to start with one niche thing and you have to do it really well. Amazon is a very famous case. Jeff Bezos saw an opportunity in the market and he started selling rare collectible books online. Now Amazon is a giant company and they handle tons of freight and shipping logistics.

They bought Whole Foods, and they have pharmacies. They are in so many different spaces. One of their biggest product lines is AWS, which is a database and developer tool. but they didn't start by saying, Hey, we're gonna do all of these things. And so that's where our focus has started.

Like the PRN marketplace are our rare collectible books. And the next evolution is, okay, how do you add more listings? How do we sell lots of different types of books and baseball cards and collectibles? Well, this is like, how do we do the scheduling? How do we make sure we're doing this credentialing tracking?

How do we make it easier ? Basically run your pharmacy, from one consolidated place. Because I order a lot of stuff on Amazon. We use AWS, but it is, starting with something very small and doing a fantastic job with it, focusing on it relentlessly, and then making sure that that never gets lost.

You can't just have the product team not focus on it and go to the next thing. And that's what Amazon has tried, strived to do, With their like two day shipping or one day prime shipping.

Mike Koelzer: Well, that's certainly the answer right there. you passed my test because that's the answer. Amazon comes at it from a position of strength. We're really good at selling rare online books. Guess what? We're gonna sell now? Rare online albums, you know, and onward from that where you get a lot of companies, it's like, well, you hear ads for this sometimes on the radio. hi, this is Joe from Just Lamps, but we sell more than just lamps. It's like, whoa, wait a minute, then why the, how'd you call yourself? Just lamps, you know? It's like they're kind of failing at that. It's not making enough money for 'em. So they're kind of switching gears. They don't really know where they belong, but your answer's spot on.

 you're gonna do it so well that you're gonna spread that love out to other places. It's coming from a position of strength, not a position of, well, we don't have a big enough market for this, or, we're gonna do this. So, I think you're spot on with that.

Autumn-Kyoko Cushman: Thanks Mike. Yeah, and I think once we get big enough, we'll probably drop the RX and just become shifted once that evolution happens. You know, we're scaling like crazy.

Mike Koelzer: That's interesting the shift now, autumn, I gotta think about this again here. See, because the shift, that's good, but then because it accepts more markets.

I'm assuming you could go. Pretty much any field. But now, a few years from now, someone's gonna come out and it's gonna be, something Rx and, someone like me is gonna say, boy, if they're just focused on pharmacists, they must really know what the hell they're doing. As soon as you drop it, I understand where you're going with that, but as soon as you drop that, you leave room for another person like you and Leanne to come in, and outdo yourself. And so what the hell do you care what I say? I'm just, I'm just thinking out loud here.

I'm just saying that there's that chance of someone out R X-ing you with that. And by that time it's like, well, it's a lot. We've got a hundred different, you know, markets here. We don't care about the someone out R X-ing us, but someone's going to, they're gonna come and they're gonna say, we specialize in the RX market.

Autumn-Kyoko Cushman: Oh no. I will certainly care. And I think competition is healthy. I think it keeps you on your toes. I think you should always stay paranoid about competition, and I think we started our roots in pharmacy. We will eventually expand to other, you know, verticals, whether that be like nursing or vet techs 

I would say though that I, Love chess, and I'm a very strategic player. And so, if I think that there's a competitor coming up onto the scene that's very worthy, that I will not, underestimate, a serious competitor and I would probably try to buy them and add them to my team because if they're smart and they're thinking the same way, then they can probably add a lot of value at Shift

Mike Koelzer: There you go. Here's a free one for you. Autumn. I don't have many good ideas, but here's one for you, and I'm sure you thought of this, but basically you have the shift rx.io and shift vet.io and shift dental io. And so the pharmacist is seeing it, someone might figure you're pulling a fast one over on them, but I don't really need to know that you are in all these different markets unless it gives me more confidence that you're big enough and, you know, all these different markets.

You can go to shift.io at some point, but I don't necessarily have to know that when I go to shift rx.io, to see all the pharmacy stuff on there and I'm not sure if it's good for me to know if you're in the vet market and that kind of thing. So that's just a, that's just a free one for you.

Autumn-Kyoko Cushman: Thanks, Mike. I'll keep it in mind. I think it's important to make sure that people feel like they're being focused on, Chewy, started with dogs, then added cats. I've ordered stuff for my chickens there. I think there is always room for thoughtful expansion, but just remembering what market you're trying to be in.

And for us, that's healthcare. We are 100% healthcare focused and I did not come from the pharmacy space. That's Leanne. I came from the nursing side.

Mike Koelzer: In your mind, would shift, remain healthcare?

Autumn-Kyoko Cushman: Always, always

going to be focused on healthcare. 

Mike Koelzer: It's always gonna be healthcare, not necessarily pharma. Oh, that makes all right. You're free. I mean, you're, you're You're good. Those, those are just some thoughts. 

 Alright, autumn, someone's pulling up to their store right now. They have a minute or two to do something. After hearing this, do you want 'em to hop on Shift rx.io?

Take a look. What do you want our listeners to

Autumn-Kyoko Cushman: Yeah, they can go to shift rx.io, click on the pharmacy owners and pharmacy managers tab, for pharmacy facilities, and they can see everything that's available to them. We like to think of this as an AI healthcare administrator right in their pocket. It can help them with scheduling and staffing, whether that's the PRN side, whether that's full-time float pool management, or finding their next great hire.

We're trying to help independent pharmacy owners build flexible and reliable teams, and we would love the opportunity to earn their business. 

Mike Koelzer: Well, golly, autumn, pleasure talking to you. This is like a movie. You know, you guys were the underdogs, you come into this. It's great. What a great story. That's still opening up, so I know you're busy. I appreciate your time, autumn. I know our listeners appreciate it and just great talking to you again.

Autumn-Kyoko Cushman: Thanks again for having me on Mike, 

Mike Koelzer: Absolutely. Take care.