[00:00:00] Stacey Richter: Episode 402. What physicians trying to clinically integrate care in the real world need to know. Today I speak with Amy Scanlan, MD.
[00:00:27] Stacey Richter: So let me just cut to the chase here with very little preamble. And all of this is a setup to the interview that follows, although it is not really what the interview that follows is all about. A mentor of mine used to say, you can't legislate the heart.
Let me also suggest you can't give someone in finance financial incentives and then expect them to not prioritize financial incentives. So it stands to reason that if the healthcare industry is found to be quite attractive to those who are money focused, then do I need to say this? The money focused amongst us will of course do the whatever to the extent that they can make money.
They aren't gonna be throwing their backs into quality or cost effectiveness or taking care of patients. They're throwing their backs into making. Money. Is anyone shocked? Now, don't get me wrong. I'm not a Pollyanna and in this country, in order to run a healthcare business, you have to make money.
Otherwise you'll go out of business. So do well by doing good and all of that, but how much money is too much money? This is an important line to figure out because that's where you are doing well, but you've stopped doing good. You've tipped into financial toxicity. You are taking more than the good you are doing, And the net positive becomes a net negative.
Complicating facts of current life. It's becoming increasingly obvious that in order to stand up a practice that can take advantage of value-based care payments, payments, where primary care docs mainly at this time can get paid more and likely more fairly to care for patients. Well, you need a lot of infrastructure.
You need data. You need tech. You need a team translation. You need money, maybe a lot of money to invest in all of this. And let me ask you this, who has a lot of money in this country? Here's the point of everything I just said. These are the external realities that hit anyone trying to do right by patients from every direction.
But on the other hand, or maybe different fingers on the same hands, as Dr. Amy Scanlon says in the show today, physicians are the backbone of this system. Dr. Scanlon talks in the interview today about the opportunity and maybe the responsibility that physicians have here for patients, but also the Eric Reinhardt article comes up again about rampant physician moral injury.
Un pay walled link in the show notes right now. Might be a great time to read something from Dr. Denver Sally, he wrote to me the other day and he wrote, like many physicians, I did not have much understanding of the business side of medicine as I mistakenly thought, as long as I helped take great care of patients that I was doing my job.
More recently, it became apparent to me that by seeding the management of medicine to nonclinical administrators and to companies interested primarily in value extraction for the benefit of shareholders. That I needed more education in order to truly help patients. Today as aforementioned, I'm talking with Amy Scanlan, md, who is Chief Medical Officer of the clinically integrated network that is the new joint venture between Intermountain Health and UC Health in Colorado.
We talk about what it's like to be in the kind of messy middle of transformation to integrate care. In a clinically integrated network trying to figure out how to help physician practices And the clinically integrated network, the CIN itself navigate the external environment in a way that empowers different kinds of practices at different points in their transformation journey that empowers physicians to be in charge and considering clinical and financial outcomes. IE. The business of healthcare.
Dr. Scanlon brings up four main factors to consider when plotting strategy from here to there. Give practices the tools that they need to succeed. Not what you think they need, but what you've discerned they actually need because you've listened to them. Which leads me to the second thing.
Many times these tools will consist of some combination of data tech and also offering the team behind the scenes to help doctors and other clinicians help patients through what Dr. Scanlon calls the in-between spaces. The times between appointments. Here's the third thing to consider when transforming into a model, more capable of doing well in value-based payments, medical culture really has to change and in two ways, doctors learning how to be part of and or leading functional teams and building functional teams because there are teams and then there are teams.
While functioning teams can produce great results. Non-functioning teams, however, are, as Dr. Scanlon puts it, just a series of handoffs. And don't forget, handoffs are the most dangerous times for patients. The DNA of team-based care. Real team-based care, for better, for worse, are the relationships between team members.
Between physicians who work together, between doctors and patients. Between clinicians and clinicians. So fostering relationships, creating opportunities to collaborate and talk is not to be underestimated. It's like how do you recreate the doctor's lounge in 2023? And then fourth thing to be considered when transforming a practice, which is intertwined with medical culture for sure, getting out from underneath the long shadow of fee-for-service incentives, specifically the paradigm that only patients who get mind share are the ones in the exam room.
Value-based care integrated care is as much contemplating the patients who don't show up as the ones who do. This is a really big mind shift. Much bigger than many realize. My name is Stacey Richter. This podcast is sponsored by Aventria Health Group.
Amy Scanlon, md Welcome to Relentless Health Value.
[00:06:09] Amy Scanlan, MD: Thank you so much for having me, Stacey. It's so nice to be here.
[00:06:12] Stacey Richter: You have been working hard for a couple years within your CIN clinically integrated network in Colorado with uc Health to transform care management. Then in 2023, just a couple months ago, Intermountain and uc Health joined forces, and you're now working for both of these hospital systems.
In front of you, there's the vision of value-based care And the hope that it will provide a more sustainable way to take better care of patients. And then on the other side is the past, as we all know, inertia is real. And so is the allure of financial incentives, particularly for hospital systems. So let's start out here.
Where are you in the transformation process and how are you thinking about these sort of maybe anchors that can easily hold those trying to transform fast to maybe practice patterns that only work for upside, risk only, or maybe outdated paradigm?
[00:07:10] Amy Scanlan, MD: We're in kind of a unique spot here in Colorado. We have not made the shift to value as quickly as some other parts of the country for lots of different reasons.
Currently, we still have a very wide variety of practice structures in our own ACO. We have a large employed medical group, but we also have a solo practitioner in Pueblo, Colorado, and everything in between. So as an ACO trying to build a clinically integrated network, we have to accommodate all of those different practice types, the practice transformation from the individual.
I'm the doctor. I'm responsible for everything to true team-based care. It means different things to different practices. So you really have to listen as as much as you can and meet them where they're at and bring tools to the table that they can use, not that you think they can use, but that they can truly use for where they are in their journey.
I do think medical culture has gotta change. Again, that solo practitioner, the idea that it's the buck stops here, I'm the physician, I'm responsible for everything. That's the old way of thinking. And as we move towards this team-based care, it's, it's gotta change to more of a focus on. From, I take care of my patients to, we take care of our patients and everything that involves that shift.
And finally, those fee-for-service incentives, they really are strong. I think in the, in the fee-for-service world, there's a lot of this idea of I don't get paid to do that, so I need to bring the patient in, have the patient in front of me so that I get paid to do that. I only get. Paid if the patient sees me, versus in the value world where you get paid when the patient doesn't see you.
And you have to be thinking about those patients who aren't seeing you as much as you are thinking about that patient in front of you. And that's why there's a lot of change management that goes on here as you start to make those, those processes happen. So those are the things that we're thinking about as we're trying to build this clinically integrated network out.
[00:09:05] Stacey Richter: You said four things there. Let's talk about each one in sequence, if you don't mind. So the, the first thing that you said was you gotta listen to practices and meet them where they are.
[00:09:15] Amy Scanlan, MD: It is really trying to think about how do we help practices get there For a small practice, the advantage to being part of a, an ACO or a clinically integrated network.
Is largely financial. This is income on top of fee-for-service. The purpose of that income is to start to build the infrastructure that'll create success in a value-based care world where you really do need teams working behind the scenes, helping you do the work versus a a big employed medical group.
You're still getting financial benefit from being part of the network, but the individual docs may not be as involved in some of the decisions about building the teams that are gonna be necessary to go forward in value-based care. So they approach it a little bit differently. That's what I mean when I say you really have to meet the practice where we're where they're at, and as an ACO, you have to start thinking about, we have limited resources too.
So how do we deploy those resources to help the most in each one of those situations? Sometimes it's partnering with the big groups and saying, how do we help you? Sometimes it's doing the work for the practice, providing them with a team, so it really does matter where each practice is at and how do you meet them there.
[00:10:24] Stacey Richter: Yeah. It almost sounds like, from what you said, the tools And the category of help a practice might need could vary depending on the type of practice and where they are along the transformation curve. Also really the whole value prop of the endeavor, including I, I don't think I've heard as much ever as I've heard lately.
I learned that what the word factoring means, just relative to the amount of money that it takes, a practice, who wants to transform to value and get these capitated contracts. There's just so much infrastructure required there that is very capital intensive and, and so this is actually a big need.
[00:11:01] Amy Scanlan, MD: The ACO's, the clinically integrated networks, we bring a couple things to the table.
One is data, And we work very hard to try to serve it up to the doc And the teams at the point of care in a way that's actionable. So that's one thing. Many smaller practices don't have the wherewithal to be able to look at the data and really work within their EMRs to get that data to a point where it's actually, you can work with it and it's in front of you when you need it.
The other thing that the, the CIS can bring to the table is teams of people behind the scenes. So really, I like to talk about the in-between spaces. We are the people that try to work in the in-between spaces. We know that when patients get in front of a doc, the care is generally good. Doctors are working really hard to provide their patients with the best care they can.
The hard part is the in-between spaces, and that's largely because of the incentives, right? We're incented to see those people in front of us and treat them and not think quite as much about. What happens afterwards. So that's where the networks can step into those in-between spaces and provide some support.
There's culture change that that has to happen because physicians have to be open to those teams. A stepping in, and B, really collaborating with the provider who's seeing the patients.
[00:12:13] Stacey Richter: And that's your third point that you made, which is medical. Culture really needs to change from a, I will a hundred percent do everything to more of trusting the team.
And I can definitely understand how this is a big shift.
[00:12:31] Amy Scanlan, MD: Yeah. Physicians, especially physicians, as old as I am, I grew up in the, in the era where the buck stops with me, I was told go check that, that slide under the microscope yourself. Don't trust the pathologist. Now we really are moving towards, you have a team around you.
The, the hard thing about value-based care is some people look at it as I'm being held accountable for things I can't control. That's a very individualized focus, and what it says is, I'm still in the mindset that it's all about me as the physician having to fix it all. We have to be able to shift our mindset to this concept of I have a team around me helping me.
So I may not be able to control everything, but I have a team around me to help me focus on the things that I can change with the patient. And I need to learn to lead that team and collaborate with that team. And that's, that's a shift.
[00:13:19] Stacey Richter: Spoiler alert. I'm talking to Dr. Vivek Garg coming up, and one of the things that he said very crisply is just this idea of, as a clinician, one of the things that's super important to look into when being invited to join a value-based in air quotes practice is to really look into what does that mean exactly to your point?
Like is there the infrastructure there, do they actually know what they're doing, or is the team word being used euphemistically because it's a good marketing speak, but it doesn't actually exist. The term team-based care has been co-opted by certain entities who are trying basically to figure out how to cut costs and potentially not doing it in the.
Best possible way, let's just say, and they're saying that it's team-based care And the net result is that nobody is accountable for the patient. Doing this right can have great benefits, but doing it wrong can actually wind up worse.
[00:14:10] Amy Scanlan, MD: I think you're exactly right. Team-based care done badly is really just a series of handoffs.
And we know that handoffs are the most dangerous time for a patient whenever those handoffs occur. That's really something to pay attention to. Really good team-based care involves a lot of communication and collaboration. Part of the hard thing about where we are now is we are still in a system that doesn't reward that time spent, and so we have to be able to move to a place where we are rewarded for the time spent.
Outside of the exam room with the patient, collaborating with other physicians, with the rest of the team, really making sure we know the patient that we are treating and what's important to them and how to make their experience better and how to really get the kind of clinical outcomes that they want.
And we want as well. So, but that can only be done if we have the time and energy to be able to do that. That's number one. And number two, there does need to be more training around how to lead teams, because I do think teams are gonna be the main part of care going forward, especially in primary care. As we're held accountable for more and more things, we actually are going to need teams to help us do that.
So the more that we can work on those skills around what does it take to lead a team, and how do we do that well. There are some organizations around the country that have really started to focus on that and really develop some leadership training for the doctors that they are hiring And we hope to learn from them.
[00:15:34] Stacey Richter: And you just hear way too much about toxic cultures and how nurses get belittled. So like, obviously this isn't a small laughing, obviously some places are way ahead of others.
[00:15:43] Amy Scanlan, MD: Absolutely. That hierarchical culture starts very early and that's what can make it harder later on. We have to get to that point where.
The culture of collaboration is more pervasive. I remember the days of the doctor's lounge. That was when I was a resident. The doctor's lounge was still there. And it was a place where you went to, to a take a break, but also to kind of, especially as a young resident, to kind of run your case by, say a surgeon that happened to be there, or an endocrinologist with a diabetic patient that you were struggling over as.
Care has become more siloed. Those opportunities have really gone away. And the physicians that I speak with, a lot of 'em do miss those days of being able to have the time to learn from their colleagues and really have the place to do that. So I'm always amazed when you get a group of doctors in the room, they're all, they're talking to each other and usually if you listen in, they're talking about cases and about how their practice is going.
Usually if you get a group of doctors in a room and you offer them a problem to solve, they can come up with pretty good solutions. So it is always a good idea in my mind to create spaces where doctors can collaborate and then give them the time to do that.
[00:16:53] Stacey Richter: I've often heard that the core of integrated medicine care integration, everyone's like, oh, it's tech obviously, like we need tech. And I've heard more than one smart person say, and I'm getting the same gist of this from you, that actually what is the core of integrated anything are the relationships. It's the relationship between the physician And the patient. It's the relationship between physicians And the relationship between the physician and other members of the care team.
It's the relationship between physicians And the administration working closely together. If there are relationships that are strong and trusting amongst all of these parties, that has an outsized effect.
[00:17:36] Amy Scanlan, MD: The tech should serve the relationships, right? The tech should create spaces where the relationships can flourish.
So the EMR for example, as you see more things like we have secure chat now, the idea is really that EMR should allow for information exchange to support the relationships going on rather than putting them in silos. And we still aren't there yet.
[00:17:57] Stacey Richter: Going back to the first thing that you said, so just level setting here, you mentioned four things as being essential to move a number of physician groups toward a value driven path, And the first thing that you said is to make sure that you're meeting the practices where they are and listening to them.
The second thing that you said, which we'll talk about in a sec, is giving people tools, giving doctors and, and care teams tools they can actually use, not what you think they need. The third thing is this medical culture, which we're digging into right now. And then the fourth thing you said was to recognize the power of the fee-for-service incentives and just how paradigmatic they have become these invisible kind of just, we've always done it this way, types of moments, I'm assuming, but if we're talking about making sure that we're giving practices exactly what they need, but we have this sense that these relationships are so important.
Is there anything that you can do at the clinically integrated network level? Like H? How do you ensure that these interpersonal relationships are. Given the substrate to thrive at the human level.
[00:19:05] Amy Scanlan, MD: That's something we all continue to struggle with. It's not easy. Education plays a big role in helping people to understand the why without really allowing the cynicism to creep in.
So I tend to be a little bit pollyannish sometimes. I'm really excited about value-based care. I think it offers us, especially in primary care, it offers us a way to start to think about the spaces outside the exam room and how do we help. Patients in those spaces. But I think the other thing is, again, creating opportunities for people to.
Learn with each other and from each other. I'm really looking to try to create spaces where education goes on with people in the room together, whether that's virtual or in person, but really to try to create some opportunities for collaboration and, and really talking with each other about what does it mean to be part of an organization that is focused on value.
How do we as healthcare providers. Step in and solve this problem. What do we bring to the table? I often talk about how we all complain about the healthcare system, but really the system is us. We are the system, and I think that we have somewhat of a responsibility to step into this and try to help fix it because we all know it's wrong.
I think Dr. Reinhardt, who wrote an essay for the New York Times not too long ago about burnout. I talked about doctors being demoralized with the healthcare system. I absolutely agree. We are demoralized by it And we have to own it. We have to step in. And so how do we create the spaces where. We can learn from each other and start to collaborate and start to really think about how do I make this better for my patients in the in as we go forward?
Because 'cause it isn't gonna work otherwise.
[00:20:48] Stacey Richter: Eric Reinhardt's article I had mentioned on an earlier show, and I can link to it again in the show notes. But you read articles like that and then you just look across the industry. And I often wonder the same things that you just said, physicians want and should have a leadership role.
And granted there's some stuff like physicians can't own hospitals, right? So there's definitely some structural things which don't help certainly. At the same time, doctors do have a lot of power. You can certainly see that and there's, it's so often I hear people complaining. Sometimes I wonder why there's not more of a rebellion. I guess.
[00:21:30] Amy Scanlan, MD: From my perspective, we've had our heads down And we take care of patients, and that's what we've been trained to do. We have always said, I take care of patients. I wasn't trained in the business part of it, and I think for a long time. We said to ourselves, we didn't have to know the business side of it to make this work.
I think those days are gone. I, I do think part of our responsibility as physicians is to really step into the space where we're being accountable for not just the clinical outcomes. But also the cost of care. The financial toxicity extends to patients. And so if we are truly going to take care of patients, this is another thing we have to pay attention to.
And I think that's overwhelming for a lot of us. We didn't go to medical school to learn the business of medicine, but at the same time, that is gonna be become more important as we go forward. In some senses. That's where networks have to step in, And we have to start giving physicians tools to make that easier.
So for example. Things like in the EMR showing costs where, what is it gonna cost the patient for the to, if you prescribe this drug, what is it gonna cost the patient if you send them to this particular imaging center? So those are things that we'll have to push for on the system level, but I think the physicians as well need to be thinking about that and asking for that.
So physicians do have some power, And if they ask for things, generally those things move forward.
[00:22:48] Stacey Richter: And what do they always say? If you wanna help somebody else, help yourself first.
[00:22:51] Amy Scanlan, MD: Right.
[00:22:52] Stacey Richter: There are certain things that, like, if everybody thinks there should be a doctor's lounge, maybe bring back the doctor's lounge like I.
[00:22:57] Amy Scanlan, MD: Well, or even, or even a virtual doctor's lounge.
Some of this is our job at the network level may be to educate. Physicians within the system about the system. This is what we're working with, this is what we've got. How do you as physicians in this system, as providers in the system, as nurses in the system, as MAs, as care coordinators, how do you think we should change it to make it better for us and for patients?
So I think that's the thing, and we've gotta get out of this mentality of it's being done to us. I don't know that anybody has more wherewithal than people in the system to change it, but I, that's, that's my own opinion.
[00:23:33] Stacey Richter: Well, it's, it's also kind of interesting to hear you say that, which is fully logical.
[00:23:37] Amy Scanlan, MD: The hard thing is right now, especially following the pandemic, you have so much fatigue and burnout and many physicians feel like, and you're gonna ask me to do one more thing. I just don't have it in me. That's part of, in terms of thinking about a network, that's what I think about a lot. What can I bring to the table to help with that?
But I can't help with that if I don't know what's needed. And so it's, it's really that two-way street. And in some senses, the burnout gives me hope. 'cause things have to get really bad before they're gonna get better. It's amazing how hard the change is, but most people, if they're pushed hard and truly just it's not working, then hopefully something will change.
[00:24:13] Stacey Richter: Let's move on to your fourth point that you made in your list of. Things to consider as you're in right in the middle of moving an organization from fee-for-service to value. These fee-for-service incentives are internalized. And you said you've got this mix of employed physicians as well as independent physicians, but is, is, is a solution just pay 'em all salary?
[00:24:37] Amy Scanlan, MD: I don't think so. You always wanna have some incentives. To see a number of patients. I think we know there are access problems all over the place. As much as it would be great to see 10 patients a day, that's not gonna solve the access problems. So there does have to be some incentive to see patients, but I do think that has to be combined with some kind of value-based element of pay, where you are rewarded for spending the time it may take outside of those visits.
To take really good care of patients, so it has to be some combination.
[00:25:10] Stacey Richter: Are you seeing that on the basis of anything?
[00:25:12] Amy Scanlan, MD: Some of it's based on the experience I've had here in Denver and some of the, some of the healthcare groups like Kaiser for example, who had docs on salary and really saw their access numbers go down.
But I think there are fair number of bigger employed groups who do well in the value space. Ochsner Health comes to mind who've really moved forward with this value plus volume pay. For their employed physicians and uc. Health has just started doing that as well. There's some room to grow and learn, especially in the primary care space As we think about these things.
[00:25:42] Stacey Richter: The one thing that I would just point out is that I'm completely not surprised.
Incentive comp is a huge thing in every other industry. It's pretty well established in this world that paying someone. And then letting their pay solely dictate their behavior is, generally speaking, quite a bad idea that there has to be some kind of review with goals.
[00:26:04] Amy Scanlan, MD: The hard thing, again, it goes back to this idea of individual versus team, right?
Part of it is not just incenting one person, but trying to spread those incentives across a team so that we can create that team to do the work better. But I agree with you. We have to be willing to be held accountable for outcomes. That is how the rest of the world is judged. Those kind of incentives will help us to start to step in and say, how do we achieve those outcomes?
And I think that's the hard part. As much as we are wanting to be held accountable for outcomes, I think the, the second piece of that is, can I also have some autonomy in how I achieve those outcomes? And I think there have been smaller companies like Oak Street, like ChenMed, who are operating in the risk-based space, who've started to give their teams more autonomy on how they get to those outcomes.
That autonomy actually is a big thing to think about in it because I think that's a lot of what physicians would like more of is don't tell me how to practice, hold me accountable for the outcomes, but let me figure out how to get there with my patients. And so that's where. There is still this change going on in how we incent and pay for care in those spaces.
[00:27:14] Stacey Richter: Literally. I read a tweet from a very prominent venture capitalist this morning talking about founders And the types of teams that these founders built, which could very much determine the ultimate success of the organization. And he said that the best founders, what they do is they give their teams lots of autonomy, recognizing that the individuals that are on these teams are smart, capable people, and that's exactly what they want.
But what he said is, however, these founders are very good at stepping in really fast when they feel like it's going off the rails. So it's a combination of giving people autonomy, but really paying attention to what's going on there so that if it starts going in a weird direction, that it can get put within the guardrails quickly.
[00:28:02] Amy Scanlan, MD: Well, and that's where the data comes in and that's why the data is so important. And one of the frustrations in a clinically integrated network is that the data can be so lagged. 'cause you're exactly right like that. The teams on the ground are very smart people and they know their patients and they know what they need.
So you would like to be able to say, here's what outcome we're going for. You guys figure out how the best way to do that with your team and your patients. But the data we're bringing to the table is still three to six months old. And so that's the other frustration is that we know we could turn on a dime if we had data that was a little bit more timely.
And it's not always possible. We're getting better about that, especially in EMRs. But if you're using, if you're relying on claims data, that is very lagged. Physicians. Do wanna know how am I doing? But if the data is six months behind, that doesn't allow us to change course very quickly.
[00:28:48] Stacey Richter: Well, I also can see where you get into what is an outcome.
[00:28:52] Amy Scanlan, MD: Yes.
[00:28:53] Stacey Richter: There's a podcast that I did recently with David Milstein where he starts talking about all the different kinds of outcomes. He bucketed them into three main categories. One of 'em is a clinical outcome, another one is a functional outcome. Yep. And if you're thinking about clinical or functional outcomes, some of these things are 10 years coming.
So. Yes. It doesn't even, the, the data lag is the least of it in certain cases, right? When some of these diseases take so long to just manifest into any sort of, they call 'em silent killers for a reason, right? So I could see that there's kind of a compounding of issues here. It's what are you measuring? What counts.
As an outcome, and then are there signals or leading indicators along the way, and then where is that data coming from and how fast can you get it?
[00:29:35] Amy Scanlan, MD: I loved what David Millstein had to say. Part of the problem is we've been measuring process for so long, purely for that reason, because it's easier to measure process than it is to measure some of the other things, but.
Ultimately, measuring process doesn't help us feel like we're actually doing the right thing all the time.
[00:29:50] Stacey Richter: Coming back to the beginning of our conversation about relationships, aligning incentives, having everybody have the space And the time to communicate with each other, and understanding just how vital and how important that is.
Is there anything that I neglected to ask you that you think is important to mention here?
[00:30:11] Amy Scanlan, MD: Yeah, I think it's important to understand that we are in the middle of this change. Lots of us in this world get very, demoralized is not the quite the right word, but it's discouraging when we see how much still needs to get done and how far we have to go.
But at the same time, I do think we've made progress. I mean, there are some things that give me hope. Things like eConsults, for example, is one thing that uses technology to create connection and relationships between specialists and PCPs. There's something called Project Echo going on. That is another thing that gives me hope that are basically teaching rounds.
Founded at the University of New Mexico and has started to spread as a way to create those connections between providers to help care for patients. We've got a ways to go. We've got to work on the, the infrastructure And the data piece And the incentives, but I think there has been broad recognition that this can't continue the way it's continuing and you're seeing more people kind of step into the space and say, how do I help?
Change things. How do I help move this along?
[00:31:17] Stacey Richter: Do you have any advice for people who may be behind you recognizing you're right in the middle, but what advice might you have for those who aren't even at your point in the journey of trying to stand up a CIN?
[00:31:28] Amy Scanlan, MD: My biggest advice is hang in there. Meet people where they're at, collaborate, listen, empathize, support, nudge.
Push for better tools at the point of care. And in the in-between spaces. This is a marathon, not a sprint. So you, you have to take every day as it comes and, and celebrate the little wins. It's very different from seeing patients when you go home at the end of the day of seeing patients and you've seen, you know, 18 to 20 patients, a majority of those patients say thank you.
So you go home feeling lots of those pats on your back. On the administrative side of things, it's not quite so rewarding. On a immediate basis, it tends to be the long haul. But for those of us in this work, it is rewarding to look back and say, okay, we are making progress. It feels very slow, but we are making some progress.
[00:32:12] Stacey Richter: Amy Scanlan, md, is there anywhere you would direct people to learn more about your work?
[00:32:17] Amy Scanlan, MD: Feel free to reach out to me on LinkedIn.
[00:32:19] Stacey Richter: Amy Scanlan, md thank you so much for being on Relentless Health Value today.
[00:32:23] Amy Scanlan, MD: Thank you, Stacey. It's been really a pleasure.
[00:32:25] Stacey Richter: Hey, could I ask you to do me a favor? If you are part of the relentless tribe working hard to transform healthcare in this country, I don't need to tell you that we need as many on our side as we can get.
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Thanks so much for listening.