Latest / Becker’s Healthcare Podcast / Michael S. Smith, MD, MBA, Associate System Chief of Gastroenterology for Clinical Operations and Strategic Planning at The Mount Sinai Health System and Associate Professor of Medicine at the Icahn School of Medicine at Mount Sinai

Transcript

Michael S. Smith, MD, MBA, Associate System Chief of Gastroenterology for Clinical Operations and Strategic Planning at The Mount Sinai Health System and Associate Professor of Medicine at the Icahn School of Medicine at Mount Sinai · Becker’s Healthcare Podcast

• 0:00
  This is Scott Becker with the Beckert's HealthCare
• 0:03
  podcast.
• 0:05
  I am thrilled today to be joined by
• 0:06
  a brilliant physician leader.
• 0:09
  We're joined today by a gastroenterologist
• 0:11
  and a true leader, doctor Michael Smith. And
• 0:14
  doctor Smith is both a doctor. He's also
• 0:17
  an MBA.
• 0:18
  He's the associate
• 0:20
  system chief of gastroenterology
• 0:22
  for the Mount Sinai Health System,
• 0:24
  which, of course, Mount Sinai is one of
• 0:25
  the most respected systems in the world.
• 0:28
  He also is an associate professor of medicine
• 0:31
  at the Icahn School of Medicine at Mount
• 0:33
  Sinai. Just a a tremendous career. He's also
• 0:36
  served as chief of gastroenterology at different cell
• 0:39
  systems or hospitals with them outside the system.
• 0:41
  Doctor Smith, before I go any further, let
• 0:43
  me ask you to take a moment and
• 0:45
  introduce yourself and tell the audience a little
• 0:47
  bit about yourself and about Mount Sinai.
• 0:50
  Great. Scott, thanks so much for having me,
• 0:51
  and, it's great to be here with you
• 0:53
  today.
• 0:54
  I, as you said, I'm the associate system
• 0:56
  chief of gastroenterology for the Mount Sinai Health
• 0:59
  System, which includes
• 1:00
  seven hospitals and provides care at over 400
• 1:02
  sites, including several ambulatory surgical centers and endoscopy
• 1:06
  centers that has nearly 50,000
• 1:08
  employees, including over 9,000 physicians.
• 1:12
  It was formed really through a series of
• 1:14
  acquisitions,
• 1:15
  first with the, acquisition of what's now Mount
• 1:18
  Sinai, Queens by the Mount Sinai Hospital. And
• 1:20
  then about a dozen years ago,
• 1:23
  Mount Sinai
• 1:24
  acquired,
• 1:25
  Continuum Health Partners, which had a series of
• 1:27
  hospitals and care sites and subsequently added in
• 1:30
  South Nassau Communities Hospital, now known as Mount
• 1:33
  Sinai, South Nassau. So there are now these
• 1:35
  seven hospitals and all of these care sites
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  really across the five boroughs of New York
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  City and up into Westchester County and into
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  Long Island. And within Mount Sinai, there are
• 1:44
  about a 100 or so employed GIs across
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  the five boroughs, Westchester and Long Island, and
• 1:50
  many voluntary and associated faculty in gastroenterology and
• 1:53
  hepatology as well. I'm really focused today on
• 1:55
  GI because that's where I am, but, we
• 1:57
  do, have, partners who work with us in
• 2:00
  liver disease and in liver transplant.
• 2:03
  Our GI core is located in Manhattan where
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  we have two fellowship training programs with,
• 2:08
  around 10 or more new trainees coming in
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  each year to be trained in categorical gastroenterology
• 2:14
  and hepatology and advanced endoscopy
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  and and liver transplant.
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  You know, our research mission is focused in
• 2:20
  Manhattan as well with NIH funded and,
• 2:23
  research that's supported through other foundations and sources.
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  So it's really a a true academic hub
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  as well as a patient care hub, but
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  we really have been working very hard with
• 2:32
  the development of the system to,
• 2:34
  help GI to work more as a system
• 2:37
  instead of a bunch of different fiefdoms. And
• 2:39
  that is why I was asked to to
• 2:41
  come into this role about two and a
• 2:42
  half years ago and, what I've been working
• 2:44
  really hard on with my colleagues across GI
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  and across the Department of Medicine and the
• 2:48
  whole health system,
• 2:50
  in this role.
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  Literally fantastic.
• 2:53
  And and and take a moment, doctor Smith,
• 2:56
  and sort of what trends are you watching
• 2:58
  in GI right now, gastroenterology,
• 3:00
  or more broadly in health care currently?
• 3:02
  Yeah. Yeah. The, the real big thing that
• 3:05
  has has monopolized
• 3:07
  our time has been the issue of,
• 3:11
  a real sea change in how patients view,
• 3:15
  their appointments and their commitment to their physicians
• 3:17
  and to their planned health care, touches.
• 3:21
  Specifically, coming out of COVID, it seems like
• 3:23
  we are really dealing with an epidemic of
• 3:25
  what we're calling late cancellations.
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  Patients who,
• 3:29
  have appointments
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  particularly for procedures,
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  elective procedures especially,
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  who are canceling those procedures within the window
• 3:36
  where
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  in the setting of, the need to spend
• 3:40
  longer and longer getting insurance authorizations or to
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  get new patients to fill
• 3:45
  the slots, we're really in the window where
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  it's too late to put someone else into
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  the same,
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  the same
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  spot. But, that becomes a lost opportunity, goes
• 3:55
  to provide the patient care, but also to
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  collect them the revenue and reimbursement that comes
• 3:59
  with it. And as I've gone across the
• 4:01
  country speaking with colleagues, this really seems to
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  be the single greatest concern across
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  specifically academic medical centers. But I think in
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  general, even in our our, you know, private
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  practice based, ambulatory endoscopy centers, we're seeing this
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  as well.
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  And so I would argue that that right
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  now for us, that has been the laser
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  focus number one priority
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  to see how we can address that and
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  maintain
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  full schedules in the era of a changing
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  perception of,
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  of these, these appointments.
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  I would say that reimbursement is always on
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  the list, and I think no matter what
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  what year you would record this podcast,
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  that would be a, an issue there. Right?
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  We're seeing ASC reimbursement go down. The endoscopy
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  reimbursement in the hospitals is up slightly, but
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  it's not really keeping pace potentially with the
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  costs.
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  The uncertainty of where things are going with
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  telehealth, which many of us have pivoted to
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  in very significant ways
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  in the the setting of the COVID nineteen
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  pandemic. And afterwards, patients certainly seem to love
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  it, especially our patients who are older, more
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  infirmed, and can't necessarily travel to the roots
• 5:06
  of the offices as easily.
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  And seeing that,
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  you know, these folks really want it, but
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  the reimbursement may not be there. And and
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  that uncertainty each time we come,
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  to a budget impasse, is certainly something that
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  we've been trying to figure out how to
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  deal with that. And, know, certainly in Manhattan
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  where space is extremely efficient expensive,
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  the efficiency of doing things by telehealth allows
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  us to use our limited space resources and
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  our square footage for other, revenue generating opportunities
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  and and
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  other activities that the health system, and our
• 5:39
  GI division needs to deal with. And so
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  certainly,
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  that's something that we're working on. The role
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  of data and analytics and optimizing workflows and
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  scheduling mechanisms has certainly been something,
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  that we see as increasingly important in terms
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  of what's driving things and also interacting with
• 5:56
  our c suite and our leadership team from
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  the health system perspective.
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  Getting ourselves on the same page, having good
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  and actionable data,
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  is really, really important. I think there are
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  a lot
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  of different mechanisms by which we generate data
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  right now, but knowing what data is good,
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  and reliable and actionable is is something that's
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  very important as the amount of data that
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  you're trying to consume goes up.
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  I would say patient experience is a really
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  important thing as well. You know, especially right
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  now,
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  patients are demanding
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  timely communication even in off hours, nights and
• 6:29
  weekends.
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  You know, and how do we maintain
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  a high level of,
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  of patient satisfaction,
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  especially in New York where where reviews and
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  reputation are are absolutely critical
• 6:42
  to our success as an institution. It affects
• 6:44
  our payer mix. How do we keep our
• 6:46
  our providers,
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  quite frankly, sane
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  and,
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  and happy in their role so that they're
• 6:52
  not looking to go elsewhere?
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  You know, it's it's very expensive to maintain
• 6:57
  twenty four seven communication with patients with a
• 6:59
  live person. But if you bring in something
• 7:02
  like AI, and certainly AI is another trend
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  that we are watching very, very closely,
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  incorporating AI can can really help drive success
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  across all aspects of the patient journey.
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  But perhaps we need to focus just as
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  much on relieving some of the burden from
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  the providers.
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  Documentation
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  time and effort to get notes out and
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  and to communicate and correspond with patients, especially
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  during pajama time, off hours time, is really
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  something that's a a driver of physician and
• 7:29
  provider dissatisfaction
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  right now. And I think we need to
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  really look at seeing how we can use
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  those tools to do it, but in a
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  way that patients still remain comfortable with what
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  you've
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  substituted for real live, touches with,
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  an actual provider,
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  whether that be by phone or or email
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  communication or,
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  notes through a portal.
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  And and doctor Smith, let me ask you
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  another question. I mean, just to follow-up on
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  this. What strikes me about me about you
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  is whenever I get a chance to visit
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  with you, you've got this tremendously positive and
• 8:01
  upbeat attitude.
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  When you hear so much about physicians being
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  burnt out,
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  overwhelmed, and so forth, and everybody is overwhelmed,
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  and we do have shortages. They are horrendous
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  and getting worse. But how do you maintain
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  that positivity?
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  Because it's so engaging and such a great
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  thing to have.
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  Take a moment on on that.
• 8:22
  Well, I appreciate that.
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  You know, it's it's not easy. I will
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  fully admit that, and there are certainly days
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  that are really difficult.
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  To me, I circle back to my core.
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  While I've increasingly taken on administrative responsibilities as
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  part of my FTE,
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  I have always maintained a clinical practice. I'm,
• 8:41
  an esophageal specialist by nature and and and
• 8:44
  training and and,
• 8:46
  experience and and see a lot of patients
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  who are on their second, third, fourth, fifth
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  doctor,
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  to try and figure out what the right
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  answer is because they haven't gotten to a
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  a satisfactory
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  conclusion yet, and they're sort of circling around
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  trying to figure out what can I do
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  to get my life back? Imagine you know,
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  digestion in general is a pretty core piece
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  of being a human being, but not being
• 9:07
  able to swallow or to not feel good
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  when you're eating and therefore not want to
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  eat,
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  is a or or to drink is really
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  a
• 9:16
  a a threat to quality of life.
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  And so knowing that I can have that
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  piece of what I do make a difference
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  in in those patients' lives,
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  every day is is,
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  a real satisfier for me and helps to
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  balance some of the challenges of, you know,
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  the headwinds that we face on the administrative
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  and and management and supervision side. But I
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  also get the opportunity to train the next
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  generation of physicians who are,
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  bright eyed and bushy tailed and, you know,
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  really eager to learn so that they can
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  move forward,
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  in their careers and start out on the
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  trail that I I began in gastroenterology a
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  couple of decades ago. And I love the
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  fact
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  that,
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  as part of my responsibilities,
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  I get to go every Tuesday morning and
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  work with them in the general gastroenterology clinic.
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  And you never know what's gonna walk through
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  the door and who you're gonna see and
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  what kind of impact you can have on
• 10:06
  that patient's life,
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  in that moment. And you can do it
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  while teaching. And that is a a really
• 10:11
  wonderful thing because academic medicine,
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  there's certainly a squeeze right now. Right? And
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  there isn't a a lot of extra reimbursement
• 10:18
  that comes in for doing those teaching responsibilities,
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  for helping to mentor and research,
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  and to be part of, that academic mission.
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  But it is so rewarding. And if you
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  get to do it and balance it with
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  all these other responsibilities,
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  you know, I once had a mentor who
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  said that the twenty four hours of the
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  the week that he looked forward to the
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  most were the the Monday afternoon and Tuesday
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  morning that he spent in his office practice
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  and then doing endoscopy and teaching, you know,
• 10:45
  one of the fellows.
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  And then he would wait from Tuesday afternoon
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  until the next Monday,
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  lunchtime
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  to be able to start to do it
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  again. And that was the required part of
• 10:53
  his job, but his favorite part were those
• 10:55
  twenty four hours. And I I certainly see
• 10:57
  now from, you know, as my my practice
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  and my,
• 11:01
  my career has evolved,
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  why he said that,
• 11:04
  to me. And I I've kept that very
• 11:06
  close to the heart thinking about how do
• 11:08
  I manage,
• 11:09
  my role and my career trajectory to be
• 11:11
  able to, maintain those different pieces because,
• 11:15
  that probably is a saving grace, right now.
• 11:17
  I I I think it would be really
• 11:19
  tough
• 11:20
  not to have that clinical grounding and try
• 11:21
  and do the work that I do where
• 11:23
  I'm trying to, adjust physician behavior and and
• 11:27
  get buy in on, you know, some very
• 11:28
  difficult things that we sometimes have to do
• 11:30
  in terms of shaking up schedules and,
• 11:33
  and work,
• 11:34
  work processes to be able to, to be
• 11:36
  more successful financially and keep the lights on.
• 11:40
  Thank you very, very much.
• 11:41
  And and and talk about, doctor Smith, as
• 11:43
  you get into 2026,
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  what are you most focused on? What are
• 11:47
  you most excited about as you head into
• 11:49
  this next year?
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  Yeah. I I think there's a lot of
• 11:53
  stuff on the menu, and I'll give you
• 11:54
  a couple of highlights. I think,
• 11:57
  as I mentioned before, the financial challenges of
• 11:59
  today's health care climate, you know, GI, particularly
• 12:02
  in in health systems,
• 12:04
  especially academic systems, are being asked to maximize
• 12:06
  its contribution to the bottom line. Endoscopy is
• 12:09
  a moneymaker when it's done well. You know,
• 12:12
  and despite all of the headwinds that we
• 12:13
  talked about earlier with late cancellations and, you
• 12:16
  know, changing patient perceptions and insurance issues with
• 12:19
  authorizations,
• 12:20
  you know, I'm very proud that we've maintained
• 12:22
  over 10% growth year over year in our
• 12:25
  endoscopy cases that have been performed coming out
• 12:27
  of the pandemic. And,
• 12:29
  you know, it's it's been great for us
• 12:31
  to see that keep going. We,
• 12:33
  we're really hitting,
• 12:35
  you know, aspirational and, utilization targets in our
• 12:38
  hospitals, which makes it hard to squeeze,
• 12:40
  more juice,
• 12:42
  out of that orange.
• 12:43
  But, what really strikes me is that if
• 12:46
  you look at some of the reports out
• 12:47
  there, like one that came from HST that
• 12:49
  showed
• 12:50
  that GI ambulatory center utilization,
• 12:54
  not all ASCs, but GI focused,
• 12:57
  ambulatory centers, that the utilization rate is only
• 13:00
  about 59%
• 13:01
  on an average nationally.
• 13:03
  So there's really a tremendous opportunity that seems
• 13:06
  to exist there if we can counteract some
• 13:08
  of those,
• 13:10
  challenges that we talked about a little bit
• 13:11
  earlier, Scott. And, you know, to me, that's
• 13:13
  a spot where I'm collaborating with other folks
• 13:16
  in,
• 13:17
  you know, in our,
• 13:19
  leadership teams, in our ambulatory teams,
• 13:22
  in our, our digital and technology or IT
• 13:25
  team,
• 13:26
  to come up with ways that we can
• 13:28
  make some adjustments to,
• 13:31
  take away some of that,
• 13:33
  wasted opportunity,
• 13:35
  but to do so in a way that
• 13:37
  maintains
• 13:38
  physician's
• 13:39
  satisfaction. Right? The easiest thing to do is
• 13:41
  to double book a whole bunch of slots
• 13:43
  and and,
• 13:45
  hope that enough people cancel or don't show
• 13:47
  that you still finish on time, and people
• 13:49
  can go home to their families and and
• 13:51
  get a chance to rest before they come
• 13:52
  back and do it again the next day.
• 13:55
  But
• 13:56
  really coming up with the way that we
• 13:57
  design schedules, both in the the office setting
• 14:00
  and the endoscopy setting,
• 14:02
  our our inpatient,
• 14:04
  coverage models,
• 14:06
  you know, ways that we can do more,
• 14:09
  but to do it in a way that
• 14:10
  still maintains that that work life balance for
• 14:14
  our providers. Because, quite frankly, there's a war
• 14:16
  for talent in gastroenterology.
• 14:18
  And,
• 14:19
  you know, a a really good,
• 14:21
  provider, even a brand new one,
• 14:24
  fresh out of training is gonna be highly
• 14:26
  coveted. And there will be salaries that are
• 14:28
  going up and up to try and entice
• 14:30
  them
• 14:31
  to go elsewhere. And so you've really gotta
• 14:32
  design a a job
• 14:34
  and a culture that,
• 14:37
  makes them feel valued and appreciated,
• 14:40
  as difficult as it may be when you
• 14:41
  get the marching orders that say we've gotta
• 14:43
  get our numbers up by x, y, or
• 14:45
  z,
• 14:46
  in order to meet our targets and and,
• 14:49
  you know, figure out how to do that
• 14:51
  go.
• 14:53
  And so,
• 14:54
  being the
• 14:55
  the person often in the middle between our
• 14:57
  frontline,
• 14:59
  care providing team
• 15:00
  and the administrative leadership team,
• 15:03
  is a challenge.
• 15:04
  But I think figuring out how to negotiate
• 15:07
  that successfully to, make both sides happy
• 15:11
  is really something that in the next year
• 15:13
  to two years is gonna be a continued
• 15:15
  focus for me. And and, again, I would
• 15:17
  say and I know this is ubiquitous in
• 15:19
  almost every health care conversation right now, but
• 15:21
  I would say, again, how do we implement
• 15:24
  AI into everyday practice from patient touches to
• 15:27
  the analytics piece, the process change piece.
• 15:31
  You know, where where are we using it
• 15:33
  most efficiently? Where are we deploying our IT
• 15:36
  resources to implement these changes?
• 15:38
  They can't do everything that's out there all
• 15:41
  the time. So figuring out what's our rank
• 15:42
  order for where can we use this emerging
• 15:46
  tool,
• 15:47
  and all of its possible
• 15:49
  ways to improve patient care and improve the
• 15:51
  bottom line
• 15:52
  in a way that works but also is
• 15:54
  sustainable.
• 15:56
  I'm I'm a little bit confused, and I
• 15:58
  think we all need to figure out better
• 16:00
  where patients will ultimately draw the line when
• 16:03
  they're not interacting with a human. I think
• 16:04
  about the phone trees now where it takes
• 16:06
  forever. If you have a question with a
• 16:08
  reservation or a credit card or,
• 16:11
  you're trying to place an order or you're
• 16:12
  trying to return something,
• 16:14
  that you bought online and it takes forever
• 16:16
  to get to a human who can actually
• 16:18
  answer your your question. If you add on
• 16:20
  top of that,
• 16:22
  health care woes and not feeling well
• 16:25
  and you're talking to an AI,
• 16:28
  chatbot or even a synthesized
• 16:30
  voice,
• 16:32
  where are patients going to say enough is
• 16:34
  enough here? And I think right now,
• 16:37
  the pendulum is is swinging a little bit,
• 16:40
  but I think we have yet to figure
• 16:41
  out where it's gonna settle out. So,
• 16:43
  being part of that process to evaluate those
• 16:46
  tools, think about where they go in, but
• 16:48
  also maintain that high quality patient experience so
• 16:52
  that patients are are giving you those good
• 16:54
  reviews that lead to,
• 16:57
  more favorable
• 16:58
  patient demographics and and demand for services
• 17:01
  in the years to come is gonna be
• 17:02
  really, really critical for us
• 17:04
  and for everyone.
• 17:06
  And doctor Smith, one last question. You've,
• 17:09
  had this terrific leadership career.
• 17:12
  What advice would you give to emerging leaders?
• 17:14
  Any thoughts you'd give to emerging leaders?
• 17:16
  That's a that's a great question, Scott. And
• 17:18
  I think, you know, these are probably
• 17:20
  true no matter whether you're in health care
• 17:22
  or beyond. And,
• 17:24
  folks who are are coming up and are
• 17:26
  are earlier in their career trajectory, I think
• 17:28
  it's particularly important that they think about how
• 17:31
  do they build their toolkit
• 17:33
  and how do they get help building their
• 17:34
  toolkit. Because you can think about it on
• 17:36
  your own, and you can read books, and
• 17:38
  you can
• 17:39
  watch, lectures, and you can go online.
• 17:42
  But really,
• 17:43
  to me, the mentorship network is very, very
• 17:46
  important. And I would say figuring out how
• 17:49
  to build that mentorship and support network quickly
• 17:51
  and broadly,
• 17:53
  not just in your discipline, but find folks
• 17:55
  who are
• 17:56
  successful in leadership
• 17:59
  across disciplines, across
• 18:00
  fields, across,
• 18:02
  industries,
• 18:04
  I think is really, really helpful.
• 18:06
  And, you know, going along with that, as
• 18:09
  your job evolves, as your career evolves,
• 18:12
  don't worry if your mentors come and go.
• 18:14
  Keep your Rolodex open. Don't don't just discard
• 18:17
  someone because you haven't talked to them in
• 18:18
  a little while,
• 18:19
  because your needs will change over time. And
• 18:21
  you'll probably rely on certain people more or
• 18:23
  less,
• 18:24
  you know, as your your career takes twists
• 18:27
  and turns. But
• 18:28
  keep that that stable of mentors around, and
• 18:31
  that group will grow. It will morph with
• 18:33
  time, but it will be probably your greatest
• 18:36
  resource.
• 18:37
  I would say,
• 18:39
  communication
• 18:40
  is really critical and figuring out
• 18:42
  that, as an emerging leader, you will develop
• 18:45
  your own preferred
• 18:51
  your supervisors.
• 18:53
  It will not necessarily match the c suites.
• 18:55
  It will not necessarily match your mentors.
• 18:58
  And so making sure that that you check-in
• 19:01
  and that your communication approach is
• 19:03
  tailored to each person that you are working
• 19:06
  with,
• 19:06
  and that you don't make the the assumption
• 19:09
  that it's it's your style that is what
• 19:11
  they're looking for,
• 19:13
  I think is really important.
• 19:15
  And I would say,
• 19:17
  that goes specifically
• 19:18
  for allies and partners who are working in
• 19:21
  your organization
• 19:22
  toward similar goals. Embracing collaboration as a leader,
• 19:25
  I think, is really critical.
• 19:28
  Figuring out who your teammates are as well
• 19:30
  as, you know, you're the captain of a
• 19:32
  team.
• 19:33
  I look at my teams that I've led
• 19:35
  and thought, you know, this is not people
• 19:37
  who work for me. These are people who
• 19:39
  work with
• 19:40
  me. And I can't be successful without them.
• 19:43
  And I'm hoping that the work that I
• 19:45
  can do in advocating for them and the
• 19:47
  work that we're doing,
• 19:49
  will make them even more successful.
• 19:51
  And in that vein, I would say it's
• 19:53
  okay to take credit for the success of
• 19:55
  the teams that you lead, and you need
• 19:56
  to do that to some degree because your
• 19:59
  leadership is is an important part of why
• 20:01
  the team was successful.
• 20:03
  But I would argue it's even more important
• 20:04
  to thank your team and to make sure
• 20:06
  that they get a a shout out as
• 20:08
  well, particularly when you are managing up to
• 20:11
  your,
• 20:12
  your supervisors and your leadership
• 20:14
  at your institution.
• 20:16
  Make sure that they know that you value
• 20:19
  the contributions that others are making and that
• 20:21
  you are working to
• 20:22
  keep your team value. We we kind of
• 20:24
  estimate that if you lose a gastroenterologist
• 20:27
  in your practice
• 20:28
  and you have to backfill that slot, it's
• 20:31
  probably over $1,000,000
• 20:32
  of of lost revenue and probably more than
• 20:34
  that,
• 20:35
  just in the time it takes to fill
• 20:36
  the empty position,
• 20:38
  to get that person onboarded and then to
• 20:40
  get them credentialed with the different insurance companies
• 20:42
  so that they can have a full panel,
• 20:45
  and a full set of clinical activity. And
• 20:47
  so,
• 20:48
  you know, to me, investing in ways to
• 20:50
  make those people feel valued,
• 20:52
  even things that don't cost you a penny,
• 20:54
  like giving them the shout out, giving them
• 20:56
  the credit, speaking to them, and and being
• 20:59
  an active listener when they raise a concern
• 21:01
  with you and making sure that they understand,
• 21:04
  that you are there to advocate for them
• 21:06
  just as much as you are there to
• 21:08
  lead and that you respect and value their
• 21:10
  contributions, I think, is important. And in that
• 21:12
  vein, I would say the last thing I
• 21:14
  would mention is don't be afraid to get
• 21:16
  dirty. Get down there with your team.
• 21:18
  Recognize that when you're short staffed, when you
• 21:21
  have extra work that needs to get done,
• 21:23
  when you're up against the deadline,
• 21:25
  yeah, it's okay to to rely on your
• 21:27
  horses and make sure that they're they're getting
• 21:29
  things done. But but the more that you
• 21:31
  can do to be part of that solution
• 21:34
  and not just bark out orders, but to
• 21:36
  to actually be part of the implementation
• 21:38
  and to take on some more of that
• 21:40
  extra workload,
• 21:41
  that's highly valued by the people that you
• 21:43
  are leading. And I think that gets recognized
• 21:46
  by the people above you as well and
• 21:48
  that,
• 21:49
  that will help you to advance in your
• 21:51
  career,
• 21:52
  not just as a leader, but but as
• 21:54
  an effective,
• 21:56
  member of an organization. So I I think
• 21:58
  those are just a few things. I'm sure
• 22:00
  we could come up with a whole bunch
• 22:01
  more, but, just a few that come to
• 22:03
  mind, based on your question.
• 22:06
  Doctor Smith, just a fantastic pleasure to visit
• 22:09
  with you today,
• 22:10
  on the Becker's Healthcare podcast. I love your
• 22:12
  leadership. I love getting to visit with you.
• 22:14
  It it's always a pleasure. Thank you so
• 22:16
  much for taking the time with us today.
• 22:17
  We really appreciate it. Great to be here,
• 22:20
  Scott, and thanks so much for for speaking
• 22:21
  with me.