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A movement founded by doctors, for doctors, dedicated to empowering medical professionals to reclaim control over healthcare decisions and advocating for their fair share of the industry's resources.
00:00:04:00 - 00:00:27:02
Justin Nabity
This is the DocNation podcast. We are a movement founded by doctors for doctors dedicated to empowering medical professional to reclaim control over health care decisions and advocating for their fair share of the industry's resources. Please note the views expressed are those of DocNation and not necessarily those of our Guest or Reference Health centers.
00:00:27:04 - 00:00:49:05
Reid Lancaster
Hey, Paul. Good to have you. I just want to start by, clarifying exactly what DocNation does and why we exist. We exist to do two things. There's a philanthropy side where we are, starting a union. We're creating a union. To to, get back the power to the physicians to keep it very simple.
00:00:49:05 - 00:01:08:23
Reid Lancaster
And then the other side is to, to represent physicians individually, just like a sports team or just like an athlete. Professional athlete has an agent. That's what we do for physicians. So to keep it very simple. But, without further ado, Paul, would you introduce yourself and, tell us tell us a little more about you?
00:01:09:00 - 00:01:35:06
Dr. Paul Morton
Sure. Hi, everybody. Thanks for having me, on your show. My name is Paul Morton. I'm a board certified orthopedic surgeon in Honolulu, Hawaii, where it is, which is where I was born and raised. And, I left for medical school for a residency training and fellowship training. But ultimately, I came back home. And the practice environment, I think is fairly different than, some of what you might be seeing on the mainland.
00:01:35:08 - 00:01:37:21
Dr. Paul Morton
Such a just an interesting comparison.
00:01:37:23 - 00:02:06:10
Justin Nabity
So one of the things we were talking about before we started recording was about the decision making, because our prior conversations, Paul, we were discussing the the difference between being in private practice versus being employed and how there's so many other parties that are calling the shots with how health care should be provided, and patients are in a lurch because they're trying to figure out, with health care not going the direction that it should be going.
00:02:06:12 - 00:02:25:08
Justin Nabity
Who's to blame? And unfortunately, the doctor is the one that gets the finger pointed out, kind of sort of because that's their best connection to what health care is. And they don't realize that there are so many other people that are behind the scenes, kind of like pulling the strings on what should be happening. And it's like, wait a second.
00:02:25:10 - 00:02:56:22
Justin Nabity
The doctor, they're on strings. Like, how's that even possible? 40 years ago, that was never a thing. So, talk to our viewers about what your perspective is in terms of making some of your own decisions. Because you are you have leadership, you have decision making ability and part of your life. But then the other part, you also have to work with other groups where they are in control and give a little bit of, insight into what it's like from a day to day on how all that works together.
00:02:56:24 - 00:03:24:09
Dr. Paul Morton
So my, my practice is relatively interesting. I, on one side, a solo practice orthopedic surgeon. About 50% of my time I spend in Honolulu, a little bit over 50% of my time is spent in Honolulu, where I, you know, primarily in charge of, you know, what I do for my practice. But I get to choose which hospital I want to go to and negotiate with and bring my cases to.
00:03:24:11 - 00:03:54:24
Dr. Paul Morton
And then about 40% of my time, I'm on the Big Island, which is a neighbor island, where I'm a 1099 contractor, which essentially, for all intents and purposes, makes me an employee of a medium size, organization. There. And I think there's a lot of pros and cons to both. I mean, the employed world, I essentially get the comfort of, being I'm not having to worry about making decisions.
00:03:54:24 - 00:04:30:14
Dr. Paul Morton
And, who am I who my staff is. On the flip side, when I'm having practice, I make all of my own decisions in terms of where where I am and which hospital I get to go to. And I think there's a lot of things that are really interesting, you know, in terms of choices of vendors, you know, if we live in a world where the hospitals are trying to cut costs, and usually this is in terms of making profit for the hospital, and so the hospitals will choose which vendors or which which systems that they want to use.
00:04:30:14 - 00:05:01:21
Dr. Paul Morton
And some of the hospitals, they're there. Some of their employees are, consultants for some of these companies. And so, you notice that there's a tiny between the, the medical director of orthopedics and the consulting firm that they're I mean, the consult consulting agreement that they have, and they're, you know, the types of equipment you're allowed to use at that hospital.
00:05:01:23 - 00:05:14:13
Dr. Paul Morton
And so, it's it's a very interesting world, in medicine that we live in, we really don't have much control over what we're choosing anymore. We.
00:05:14:15 - 00:05:17:05
Justin Nabity
Don't have control over what we're.
00:05:17:07 - 00:05:19:03
Dr. Paul Morton
Well, so let me give you an example.
00:05:19:04 - 00:05:41:19
Reid Lancaster
It's like, did you just. Yeah. Let me give you a little bit of an example. Just a real life, easy to understand example. You know, the World Series just ended. And I just think if those baseball players couldn't choose their own gloves or their own cap or their own cleats, things that that the tools that they have to have, to perform at a high level, every one of them would be making excuse.
00:05:41:19 - 00:05:58:21
Reid Lancaster
Of course, I didn't play well. I couldn't get the glove I needed. The glove doesn't fit. It's not the right. It's not the right glove for the position. It's the same thing for for physicians. You're not making decisions. You are a pawn in a giant game and they are pushing you around and putting you right where they want you to to be.
00:05:58:23 - 00:06:01:17
Reid Lancaster
And it's difficult. It's difficult.
00:06:01:19 - 00:06:27:11
Dr. Paul Morton
Well, so I mean, that's definitely true. I mean, the, you know, a lot of times like the in Honolulu, the hospitals have all decided to go either dual vendor or single vendor for or a dual vendor for their joint replacement and companies. And, you know, they're this dual vendor means, you know, they can if you go to that hospital, you can choose one of two implant companies to use.
00:06:27:11 - 00:06:51:06
Dr. Paul Morton
You can use, you know, there's there's four big ones, which is, you know, Zimmer, Depew, Stryker and, Smith the nephew. And then there's a few medium sized ones and and smaller ones. But at certain hospitals, you really can only choose two of those. And some of those sometimes, some of the medium size hospitals in Hawaii, you can, you can even choose one of the top three.
00:06:51:06 - 00:07:16:17
Dr. Paul Morton
You have to choose something out of, you know, a a second or third tier, orthopedic company, which is, which is kind of interesting, when you're trying to look for specialty equipment or, you know, you, you want to just do something as simple as changing a plastic component. They have to negotiate on, on pricing of the equipment, even for a large vendor company.
00:07:16:17 - 00:07:26:19
Dr. Paul Morton
And so you're kind of stuck with waiting for hospital contracting in order to just do sometimes even just what would be considered a simple case in that hospital.
00:07:27:00 - 00:07:49:16
Justin Nabity
And for the the patient who is listening or your fellow surgeons that maybe aren't having to deal with this, having to have the second, third, fourth or fifth option, what is that a big deal? Is that matter to the quality of care of the patient could receive or to your ability to do what you're trying to do for the patient?
00:07:49:18 - 00:07:55:06
Justin Nabity
How much of a help us understand the gravity of being you're having your hands tied like this.
00:07:55:08 - 00:08:19:21
Dr. Paul Morton
So I'll give you a great example. I, I'm very comfortable with one system. You know, I've tried I've, I've gone around and used a bunch of different robotic systems, on the market, you know, from, from all four of those top companies. And with one of them in my hand, I am much more efficient. And some of the other systems take me about twice as much time in order to perform the surgery.
00:08:19:23 - 00:08:39:09
Dr. Paul Morton
And when I what I tell people is that, you know, time under time under the knife and time open puts you at risk for things like infection. And so you want to be efficient in the operating room. You don't want to necessarily be rushed or fast, but you always want to be efficient. And if you're efficient, ultimately the time is less time for your surgery.
00:08:39:09 - 00:09:14:14
Dr. Paul Morton
And you know the last time the under the knife, the better the outcome. And, and it's actually less expensive for the hospital, but because the cost of it which, which associated with time is an indirect measured expense, the hospitals were more likely to choose something that may be less expensive, on their end when they negotiate for pricing, whereas in my hand, it may be something that ultimately would have been less expensive for the hospital, for the patient, and less risky for the patient.
00:09:14:20 - 00:09:23:02
Reid Lancaster
Contracting, administration getting in the way, doubling the time it takes to to to do a procedure.
00:09:23:04 - 00:09:35:11
Justin Nabity
Is it possible to talk about this? Because I was researching, we we discussed that white paper by Doctor Charles to cook the 12, by 12, the regular kind of transparency stuff as we were talking about biotech and I in the O.R..
00:09:35:13 - 00:09:36:02
Dr. Paul Morton
Yes.
00:09:36:02 - 00:09:56:04
Justin Nabity
You knew one of the pieces, one of the sections in there talks about once I remember how much time it was. Once you get beyond a certain amount of time, the infection risk just starts to increase. And so what is there a is there a standard there for somebody who's not a surgeon or a patient who obviously doesn't know the implications of risk?
00:09:56:04 - 00:10:22:00
Justin Nabity
Is there a a certain amount of time from this point forward that that we want to get we want to see cases get done with a certain amount of time and if we can, because obviously some cases are can take a super long time. And you have to just deal with that because of how invasive it is. But it's the fact that you are restricted on what you can use, and that puts a direct correlation to the amount of you're doubling the time it takes to do a case that affects infection risk.
00:10:22:02 - 00:10:30:06
Justin Nabity
Can you talk through that specific piece of it as far as the multiplicity of this much time, more could cause more problems.
00:10:30:08 - 00:10:49:18
Dr. Paul Morton
So it's not really that there's a specific amount of time. Right. But you know, it's more of there's a curve. The longer that you're in surgery, the higher the risk. You are getting an infection. And so, you know, if you're in surgery for 40 minutes or 20 minutes or, you know, 80 minutes, you know that that that amount of time increases your risk.
00:10:49:20 - 00:11:13:22
Dr. Paul Morton
Now, you know, if you have the equipment and tools to be able to do something faster and more efficiently, I think that that generally is going to be a win, for everybody involved, you know, whether it's the surgeon who's, you know, spending a lot of time trying to get these cases done efficiently or the patient who's, you know, open and and available to them.
00:11:13:24 - 00:11:40:10
Dr. Paul Morton
I mean, they're they're they're wounded, open to air. And then finally, the even the hospital would actually benefit from this. But again, because the costs are somewhat hidden, it's hard for them many times to measure those indirect costs. And you know what? A a famous quote that, that I, that I've heard is there is no such thing as a good slow surgeon.
00:11:40:12 - 00:11:56:11
Dr. Paul Morton
Right. And what I mean is, it's not that you want to be inefficient or I mean, it's not that you want to be fast or rushed, but you just don't. You just don't want to be under the knife for a long period of time for something that should be done with that efficiency.
00:11:56:13 - 00:12:16:11
Justin Nabity
Yeah, that makes sense. So that gives a good picture. I think in the your world you've got two worlds, one world, you get to decide what what technology, what tools, what implants that you want to use. Because you you as a group, you are in control. Then you have the other side that is loaning you to potentially two choices in some places.
00:12:16:13 - 00:12:36:23
Justin Nabity
For others, it's worse. And I think to work with the third or fourth option. Is there anything else that your you've seen along the way that is a bigger problem of doctors voice being taken away, or that's preventing them from being able to be really well, I think in the best interest of the patient.
00:12:37:00 - 00:13:05:00
Dr. Paul Morton
I think bigger than, you know, implant choices and, and hospital decision making is actually that we're we are all essentially working for insurance companies. The insurance companies are what make decisions for all of us. And they also determine, the pay rates for physicians. And so, you know, Hawaii has a, pretty significant physician shortage, even though we're in one of the most beautiful places in the world.
00:13:05:02 - 00:13:46:03
Dr. Paul Morton
And the big reason is that, we have some of the lowest reimbursement rates in the nation with, one of the highest cost of living areas in the nation. And, you know, you would you would think, okay, well, you know, maybe they they would allow for some improvements with, with some competition. But essentially what happens is that the hospitals will employ physicians and pay a higher rate, whereas the private practice physicians will find that, you know, you're stuck as a small, entity, kind of negotiate with insurance companies and the insurance companies may or may not increase their pay rate towards you.
00:13:46:05 - 00:14:21:10
Dr. Paul Morton
And so, you know, the, you know, you become invested in things like surgical centers where you're trying to, negotiate for improvements in the facility fees because with, the way that Medicare has, been trending as they've been decreasing the reimbursements to physicians while simultaneously increasing the position, the reimbursements towards facility fees and facility fee, the things, you know, that's placed, the embarrassment towards places such as hospitals, surgery centers.
00:14:21:12 - 00:15:12:01
Dr. Paul Morton
And unfortunately, a lot of times you have to, you know, these surgical centers are partnered with either hospitals or management companies and take a pretty significant cut of, those surgical fees. And so, you know, just to maintain, a physician salary, which has been reduced on a, where the reimbursements have been reduced on an annual basis, the there is this constant struggle where physicians are trying to figure out ways to recoup what what would be their losses every year, for things like facility fees and, and, you know, there's because of the increased costs of, you know, nurses salaries are going up, the staff salaries, the, space, the, you
00:15:12:01 - 00:15:47:24
Dr. Paul Morton
know, just having property, these leases go up every year. And so, whereas reimbursements don't follow, that increased costs. And so what I see is that the hospitals and, the hospitals and, insurance companies, and at least in my state, are some of the most profitable country companies. Whereas private practice and physician reimbursement continue to follow this somewhat downward trend, relative to inflation.
00:15:48:01 - 00:16:07:05
Dr. Paul Morton
And it's one of the few places in, in the, I mean, one of the few economies in the US where, our you know, what, we get paid is not linked to the market rate. It's really linked to what whatever the government decided.
00:16:07:07 - 00:16:23:18
Justin Nabity
And in what in your mind, as the one who has to deal with the fallout of this, is there any justification for why it's acceptable? The doctors are the only ones getting cut and everybody else is getting increases.
00:16:23:20 - 00:16:54:18
Dr. Paul Morton
You know, if if everybody else was was sharing in that same risk, you know, risk, meaning if there's a problem, I say a medicate with the wrong medication was given, by a nurse or, you know, the a weaker a weaker assistant during surgery was for a hard case was placed during that surgery. It doesn't matter because as as captain of the ship, the surgeon is always the one who was ultimately responsible for all these problems.
00:16:54:18 - 00:17:10:22
Dr. Paul Morton
And so, you know, we we have a liability with our insurance companies. We have, we've essentially assumed liability for from the patient standpoint. Sure. But but the control is not entirely in our hands.
00:17:10:24 - 00:17:33:10
Justin Nabity
I know, but I'm just wondering as a body of of professionals, is there so the ultimately as the leader, the the buck stops with the leader, correct. The entirety of the outcome in anything? Yes. The teammate on the team might have done something, but the leader steps up and takes away the ability for the whole team. I get that.
00:17:33:12 - 00:18:09:03
Justin Nabity
So I can see how that's the case as a surgeon. But can you could you conjure up any other potential justification that's truly legitimate, though? That's why if nurses aren't getting cut, if hospitals are not getting cut, if everybody else, every other stakeholder, that's a part of the ecosystem for health care is not getting cut, except for the physician, the doctor, the surgeon, what is the is there any legitimate justification for that other than I just don't do anything about it.
00:18:09:03 - 00:18:11:03
Justin Nabity
They just take it.
00:18:11:05 - 00:18:40:20
Dr. Paul Morton
I think the biggest thing is it positions are the easiest target. Because, you know, we do have societies where we join different societies, as a, as a collection. Our I think physicians as a whole tend to be, you know, more competitive with each other, as opposed to joining together and forming a union and trying to, you know, work out a deal with insurance companies to make sure that we maintain what we're supposed to be getting paid.
00:18:40:22 - 00:18:54:15
Dr. Paul Morton
Instead, what ends up happening is we tend to complain about it and tend to accept what's being given towards us, as opposed to making the changes that need to be have that need to be made.
00:18:54:17 - 00:19:06:01
Reid Lancaster
Paul, in your mind, what's something simple? You go to these society meetings and people are complaining, but nothing happens in your mind. What are some simple things that you can do to.
00:19:06:01 - 00:19:07:15
Justin Nabity
Change.
00:19:07:17 - 00:19:17:09
Reid Lancaster
What's going on right now? Instead of just complaining? What's something you can put into action that would actually yield results?
00:19:17:11 - 00:19:44:06
Dr. Paul Morton
Well, honestly, I don't really have a great answer for that, right? I mean, you know, in, in this state, for example, there was a recent strike where by the nurses, where the nurses in a in one of the hospitals. And I think right now another hospital was threatening to strike where they basically walked out and, there were no nurses within the hospital, and they essentially had to hire local nurses to come in and cover.
00:19:44:08 - 00:20:12:16
Dr. Paul Morton
I think you could do that to some degree in hospitals. The the issue is that, you know, there's so many different directions that all these different physicians are being pulled in, whether they're private practice or employee physicians, that even if all the employed physicians decided to walk out, they would still have enough hungry, private practice physicians that would come in and kind of take in that same area.
00:20:12:18 - 00:20:40:16
Dr. Paul Morton
Yes. And so, I don't think, I don't think that physicians are, collected and, and, you know, I think the best thing is if we could come together and actually agree that, hey, this isn't working for us. Enough is enough, that we've got to demand that our government increases what Medicare is paying every year to physicians as opposed to hospitals.
00:20:40:22 - 00:20:49:07
Reid Lancaster
Anybody listening to this podcast yet? I want you to hear the the Paul said he doesn't have a good answer, but came up with a really good answer.
00:20:49:13 - 00:20:50:04
Justin Nabity
Sure did.
00:20:50:04 - 00:21:05:22
Reid Lancaster
And that, that answer is you have to band together, even if it's 25 docs in your local area or even your state, you can get things done. How do you get how do you how do it's how do people get together? Reach out to DocNation. We can help coordinate that doesn't matter where exactly.
00:21:05:22 - 00:21:15:07
Justin Nabity
That's exactly what you kicked off the conversation with. Is helping you organize. If union is scary for you or striking sounds to be too extreme, that's okay.
00:21:15:09 - 00:21:41:22
Reid Lancaster
There's nothing we can negotiate with the hospitals. A plan will give you a 90 days. We're going to continue with this miserable situation for 90 days. But you have to change this, this or this, because the truth is, we want to be as, as least combative as possible with the decision makers. But at some point, just, changes have to be made, you know, when the nurses left, Paul, that was okay.
00:21:41:24 - 00:22:05:01
Reid Lancaster
I might get hated on by all nurses in the country. But here's the truth. You can run a hospital with all doctors. You cannot run a hospital with all nurses. You could realistically replace all the nurses with doctors. And health care not only stays the same, but increases. You cannot do that, vice versa. So there's a there's a moral obligation that you guys have that nurses don't.
00:22:05:01 - 00:22:24:21
Reid Lancaster
And that's that's the line in the sand. The insurance companies, that administration that that all the decision makers know that you won't cross. So if you come to DocNation, we will help you, even if you're if you're a single doctor and you're saying, hey, I want to find 5 or 10 around me that are having because everyone's having the same issue.
00:22:25:01 - 00:22:42:18
Reid Lancaster
We can help coordinate that. Okay, Paul. So I'm saying that to you right now. Maybe we ought to have a meeting offline to say, is there anybody around you, that you can reach out to, that we can reach out to, and we'll put a plan in place to see if we can't get some changes made. It's happening around the country in small, small pockets.
00:22:42:24 - 00:22:53:10
Reid Lancaster
It's just not happening enough. And it's not happening at scale. Because of what you just said right there. I don't know how to get everybody together. That's something that we'll do for you.
00:22:53:12 - 00:23:18:04
Justin Nabity
Yeah. You made a great point, Paul, about the societies. They kind of burrow their own little section and they kind of keep themselves. They say, okay, I'm going to do an alliance with this group and that group, and we're all collectively align. We may disagree on some of the things that are below the line, but at this level, we have to agree that our voice needs to be respected.
00:23:18:06 - 00:23:38:00
Justin Nabity
If there's so much we can do, that isn't all the way to the end. Which is not showing up to work is we hear the concern, well, if you do that, then, you know, emergencies and and people's lives that are at risk, like are you going to really just walk out on patients that are dying? No, we're not going to do that.
00:23:38:00 - 00:24:15:03
Justin Nabity
But there's enough other non-critical care related stuff that departments and things that could all be delayed and reorganized and rescheduled and all that to do what actually the patient needs, we need some short term pain to be experienced in the flow of medicine to get to better outcomes long term. If if we are in a situation today where we're in the we have the most knowledge, the most research, the most technology, the most of everything, we're the most advanced that we've ever been in society and health care.
00:24:15:05 - 00:24:26:19
Justin Nabity
But yet we have the worst health crisis ever, ever. Those who don't, those things don't fit. They don't go together. They're exactly opposite of each other.
00:24:26:19 - 00:24:28:09
Dr. Paul Morton
100%, 100. It doesn't make.
00:24:28:09 - 00:24:57:09
Justin Nabity
Sense. It's it's it's insane that that we have the most of everything and the worst of outcomes. Well, what got in the way? What what caused this divide to happen is the doctor and the patient used to be like this. And now they're like, this is because of third parties calling the shots. And so we need to have these conversations.
00:24:57:11 - 00:25:27:20
Justin Nabity
Contracts need to be renegotiated. How about we get the entire state of Hawaii to have all of their insurance contracts renegotiated? Guess what? We have a team for that. Did you know that every single CPT code, what they're worth for every single provider practitioner surgeon in the nation, is publicly available? It's just hard to get to. It's we're talking way beyond the scale of all the data that's in the Library of Congress.
00:25:27:22 - 00:25:48:00
Justin Nabity
It's a ton of information that has to get extracted by tools. We have an entire team dedicated to be able to extract that data and give it to every single doctor. So that way they know what I'm actually worth and what I should be getting paid anywhere, anywhere and everywhere. Why don't we get the entire state of Hawaii, get to get their contracts renegotiated?
00:25:48:00 - 00:26:15:04
Justin Nabity
Because if they're if reimbursements are so bad, it's one of the lower states that makes no sense. That's bad for patients as a nation. Like, why don't we have people in DC championing this to say we need the is Hawaii, not our this isn't a Hawaii. Not as important as our other states. Like, think about how strategic Hawaii is as a state for our country.
00:26:15:06 - 00:26:39:24
Justin Nabity
Strategically, it's one of the most important states, right? The most important states. And yet the quality of care is at risk because we can't get doctors there and we can't pay them right. Like this is a national this should be a national priority that we have. This is an easy fix. The conversation just needs to happen. It should be happening now and there should be action taken.
00:26:40:01 - 00:27:05:12
Justin Nabity
So Paul, thanks for jumping on the show with us and highlighting and underscoring this problem because it is a major problem if it's a national security risk. Actually, if you think about it, we don't have the care that we need for the right people, for our people on the islands. That doesn't work. We need it for the sake of defense for our country.
00:27:05:14 - 00:27:12:01
Reid Lancaster
Well said. Well said. Justin Paul, it's early there for you. What time is it there?
00:27:12:03 - 00:27:13:14
Dr. Paul Morton
It's about 7:00 in the morning.
00:27:13:17 - 00:27:18:19
Reid Lancaster
7:00. So you were up 530. You ready to rock and roll? So thank you for doing that, Paul.
00:27:18:19 - 00:27:23:01
Justin Nabity
We all knew that he he had some stuff going on yesterday and not that he needs to share it.
00:27:23:03 - 00:27:30:11
Dr. Paul Morton
But it's okay. I just had appendicitis. I had an up an appendectomy yesterday morning. So I'm just recovering from surgery.
00:27:30:13 - 00:27:32:07
Reid Lancaster
That's the that's the.
00:27:32:09 - 00:27:34:03
Justin Nabity
Bouncing back like it's nothing.
00:27:34:09 - 00:27:52:18
Reid Lancaster
That's the quality of people that the physicians are. You just givers. You're you serve, you serve, you serve. And that's part of the problem is that you guys are are not as combative, not as much of fighters in terms of, of, negotiating contracts and doing things that take care of you individually. But thank you for joining us, Paul.
00:27:52:18 - 00:27:53:24
Reid Lancaster
We really appreciate your time.
00:27:53:24 - 00:27:57:15
Dr. Paul Morton
And I spoke to both of you, Reid and, Justin.
00:27:57:17 - 00:27:58:19
Reid Lancaster
Have a great day.
00:27:58:21 - 00:27:59:20
Dr. Paul Morton
You as well.
00:27:59:22 - 00:28:17:23
Justin Nabity
But this has been the DocNation podcast. If you like what you heard, be sure to subscribe, rate, and leave us a review on Apple Podcasts, Spotify, or wherever you are listening to us. Your feedback really helps us reach more listeners like you. We'd also love to hear your thoughts and any topics you'd like us to cover in future episodes.
00:28:18:04 - 00:28:25:13
Justin Nabity
Don't forget to follow us on Facebook, Instagram, and LinkedIn for updates, behind the scenes content, and to join the conversation. Thanks for listening.