Latest / Style Points / Academic Anesthesiology vs Private Practice with Marc Cassidy and Justin Little

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Academic Anesthesiology vs Private Practice with Marc Cassidy and Justin Little · Style Points

0:09
anesthesia enthusiasts, and welcome to this month's
0:12
episode of Style Points. I'm your host, John
0:14
Crow. Every resident eventually hits the same
0:18
fork in the road, and most of them spend some
0:20
time wondering what's down the other path. That's
0:23
right, today we're talking about academic versus
0:26
private practice. Today, I'm joined by two graduates
0:29
of our own residency program who have seen both
0:31
sides of that fork. First is my friend and colleague,
0:35
Dr. Mark Cassidy, who has spent time in private
0:38
practice as well as academic practice. Second
0:41
is Dr. Justin Little of Seven Hills Anesthesia,
0:44
who has spent his career in private practice
0:46
and is now helping launch TriHealth's brand new
0:49
anesthesiology residency as its associate program
0:51
director. We don't have an RSI for you this month,
0:55
so let's jump right in. I got some inside. You
1:06
know, I'm neighbors with Macaulay. With Mark?
1:09
Yeah. Oh, I love that guy. Yeah, me too. He's
1:11
two doors down from me. Oh, that's amazing. Yeah,
1:14
he's a wonderful, wonderful dude. He's been on
1:16
the podcast. Has he? Yeah. Somebody was asking
1:20
me what the name of it was. I was like, I honestly
1:21
don't know the name of it. I'll have to look
1:23
it up. The podcast is Style Points. Oh, style.
1:31
Man, it's these are time with John Cain. Yeah.
1:34
No way. I do get confused with John Cain quite
1:36
a lot. It's these are time with John Cain. It'd
1:39
be funny to use a totally wrong name, like a
1:41
pseudonym that happens to be John Cain. John
1:43
Cain has been invited to be on the podcast, but
1:45
he has declined. Oh, really? Yeah. He's not a
1:47
podcast guy. Oh, doesn't like it. You don't know
1:51
until you try it. Yeah, I agree. Okay. Excellent.
1:56
Thank you both so much for joining me. Are you
1:59
guys ready to get started? Yeah, absolutely.
2:01
Okay, perfect. Before we get started, I want
2:05
you guys to briefly introduce yourselves, talk
2:07
about where you trained and what you do. I'll
2:12
let you go first, Mark. Okay. My name is Mark
2:14
Cassidy. I trained here at University of Cincinnati,
2:17
finished up about 2007. I've been on staff here
2:21
with the exception of a year and a half in private
2:23
practice. for almost 20 years. I focus on regional
2:28
liver transplants. Those are kind of my two main
2:32
foci, if you will. But yeah, that's basically
2:34
it in a nutshell. Excellent. I'm Justin Little,
2:38
anesthesiologist here in Cincinnati. I actually
2:41
am a private practice anesthesiologist at Seven
2:43
Hills Anesthesia. I actually did my training
2:46
here under Mark Cassidy, actually, at the University
2:49
of Cincinnati. And I was here from... 2014 to
2:54
2018. And then I've been in private practice
2:56
ever since then. Just a little bit about me.
2:59
I grew up in Cincinnati, east of Cincinnati,
3:02
a little town called Felicity and a little on
3:05
a dairy farm with a rural community and went
3:08
to undergrad at UC and then out to medical school
3:10
in Kansas City and was blessed enough to come
3:12
back home. Got five kids at home and we're busy.
3:17
Five is a lot. I have three, and I feel like
3:20
three is a lot. I have three as well. That was
3:24
enough for me. Yeah, exactly. You're very brave,
3:27
or your wife is very brave. My wife is. Exactly.
3:30
That's what it is. I'm so glad that you both
3:33
have joined us. Today we're going to be talking
3:36
about academic versus private practice, and I
3:38
felt like both of you really had good experience
3:41
in those worlds. a similar sort of talk, similar
3:50
sort of focus for our residents where we have
3:53
a panel of academic versus private practice.
3:55
I was hoping to recreate some of that for some
3:59
of our listeners so that they could get a sense
4:01
for how things are, the market for everything
4:05
today, and why you guys have made the choices
4:07
that you have and what you think about all of
4:10
it. So I'm glad you're here. Thank you, John.
4:12
Thanks for having us. Before we get too much
4:15
further, I want to ask both of you my favorite
4:18
interview question, the who would you take out
4:21
to dinner question. So if you had the chance
4:23
to take anyone out to dinner, it could be somebody
4:25
from the past or from fiction, who would you
4:29
invite and why? And you can't say each other.
4:32
That was going to be my answer. We're eating
4:36
tacos right now. Go ahead. Maybe after this.
4:40
That's right. I'll start. But this one, man,
4:44
I love Abraham Lincoln. I just, I don't know.
4:47
There's so much are around the gentleman and
4:49
I love civil war history and I just love what
4:52
he did for our country and just all the tension
4:55
that he was under, but yet still got us through
4:59
that as a country. Just in terms of so many different
5:03
things piling on him in terms of slavery, in
5:06
terms of the civil war and just how he navigated
5:09
that with such poise. but also with such great
5:13
intellect and logic. And I would just love to
5:16
sit down and have a steak with a guy. Yeah, for
5:19
sure. Did you ever read Team of Rivals? No. Oh,
5:22
you should. It's good. Phenomenal. So good. I'm
5:25
reading one right now called Where the Light
5:27
Shines Through. And it's been excellent, just
5:30
about his life, his story, and how he grew up.
5:33
And it's been so insightful to see who he was
5:37
as a guy. Mark, what's your guess? I mean, for
5:40
me, it's hard. I kind of come from a musical
5:42
background. That's my hobby. My family are all
5:45
involved in music in some way, so I could probably
5:46
come up with about a half a dozen to ten different
5:50
people, you know, songwriters, musicians, classical
5:53
composers. But honestly, for me, to be completely
5:56
honest, it's a boring answer, but it would be
5:58
my paternal grandpa. I never met him. He passed
6:01
away before I was born. My dad always speaks
6:04
highly of him, so I thought it would be kind
6:06
of cool to have dinner and meet him. That's awesome.
6:10
That's great. What would you ask him about? I
6:16
think I'd ask him about my dad. Get some insight
6:21
there. My dad was one of the younger ones in
6:24
his family, so there were a lot of his brothers
6:26
and sisters I didn't meet. My great -grand, I
6:30
mean, my great aunt and uncles. Yeah, right.
6:32
So just about family history and just different
6:34
things. I know a lot of my family comes from,
6:36
like, New York City, the East Coast, so it would
6:39
be kind of interesting to see, you know, where
6:40
they lived, what they were like, and all that
6:43
kind of stuff. So it's more family tree -oriented
6:45
than history -oriented. But that's, my honest
6:48
answer is that because I just kind of like to
6:49
learn more about that. Yeah. You could play some
6:51
guitar with them, Mark. Yeah, maybe. I don't
6:52
know if he played or not. That's why I got to
6:54
meet him. That's right. Unfortunately, I don't
6:57
have a way to arrange either of your guests.
7:00
Yeah, that's right. Sorry, I know he's either
7:05
deceased. He looks currently. I know, I'm very
7:08
disappointed. So both of you guys trained at
7:11
UC, at the anesthesiology residency here. What
7:15
did the program look like back then? It was a
7:19
lot smaller. Much smaller footprint in the hospital.
7:23
Obviously, Justin can speak more to his experience
7:25
10 years later. But at the time, I remember we
7:28
actually had a lot of locum docs working. We
7:32
didn't have a dedicated ICU team. We didn't have
7:34
a peri -op clinic. It was just a much smaller
7:38
place. It's kind of hard to remember what that
7:40
was like. But I know because when you're experiencing
7:43
something for 20 years, you kind of have a hard
7:46
time remembering discrete times in the past.
7:50
it was much much smaller um yeah i guess that's
7:53
the best description and we just kind of we didn't
7:56
have the same presence throughout the hospital
7:57
um that we have now Yeah, I feel like we kind
8:01
of got to a point with critical mass, like Mark's
8:04
generation was locum docs, and then they brought
8:07
in some of the folks from the East Coast, like
8:09
Hereford and Friedrich. And I think when I was
8:12
here as a resident, what it really looked like
8:14
was a cohort of eight residents a year, and we
8:17
were starting to get into some of the other areas
8:19
of the hospital. So that's when the periop CPC
8:21
clinic started. The CCATS team was well underway
8:24
when I was here. but we weren't doing a lot of
8:27
the NOR locations like you guys probably are
8:29
now. Yeah, the off -sites were. We did maybe
8:31
two endo locations, and doing something off -site
8:34
like in radiology was a big event because it
8:36
was usually a panic call or something like, we
8:39
need help here. It was more of a code situation
8:40
than a scheduled case. So, yeah, things have
8:44
definitely gotten bigger and evolved to kind
8:47
of work together better. Yeah, for sure. I feel
8:50
like, too, when I was here as a resident, I think
8:53
the... biggest thing that I remember was just
8:55
like the strength of the faculty that were here
8:58
and just like the mentor relationships. They
9:01
were just like so impactful. I know I can speak
9:03
for myself, but Mark was that guy. Um, when I
9:06
was looking as a CA three to where I should practice
9:09
or how I want to practice, I feel like as a resident,
9:12
you're always looking, it's kind of like a Chinese
9:15
buffet. You're like, I like a little bit of this,
9:16
a little bit, this on my plate to take the patient
9:19
safely through the perioperative process. Sometimes
9:22
you're like, I never want to do it like that.
9:24
And sometimes you're like, I absolutely love
9:26
how they do that. So you can kind of pick how
9:27
you do that. And I feel like UC was a really
9:30
strong training program for that because of the
9:33
wide backgrounds people had from East Coast or
9:37
here in the Midwest. And it was a great, great
9:41
place to train. That really rings true with me.
9:46
I've always considered myself to be sort of an
9:49
amalgamation or combination of all the attendings
9:51
that ever trained me. And I think it's really
9:54
cool to think of yourself that way, just as a
9:59
combination of all the different attendings that
10:01
you've worked with. So when it came time to graduate,
10:05
you guys were getting ready to be done with residency.
10:09
What were your thoughts about staying in academics,
10:13
going to private practice? What was that decision
10:16
like for you at the time? So for me, I guess
10:20
the main thing was kind of I wanted time with
10:23
my family. My family was much younger back then.
10:26
And I also wanted I kind of felt really comfortable
10:30
with the system at UC. I did. I looked at private
10:33
practice jobs. You know, nothing really struck
10:37
me like I want to go there. There's something
10:39
that was really pulling me that direction. So
10:41
I'm staying at UC was. It was sort of inertial.
10:45
You know what I mean? I was here. I was comfortable.
10:47
I kind of felt like it would be a good idea to
10:49
get a couple more years, you know, at a level
10:51
one trauma center doing all kind of big cases
10:53
before I went out on my own. There was also that
10:56
the chairman at the time, Bill Hereford, he offered
10:59
me a role where I would sort of be the block
11:01
guy. the regional guy. So this was back when
11:05
regional fellowships weren't as common. And so
11:07
it was an opportunity to kind of do more of what
11:10
I enjoyed. You know, he sent me to some conferences
11:12
to learn some new techniques. That was kind of
11:14
when ultrasound was coming in. You know what
11:17
I mean? So I took that opportunity. It was appealing
11:20
as far as the clinical work. I knew the place
11:24
and it was just, I think, a good stepping off
11:27
point for me. What about you, Justin? Yeah, so
11:30
being in academics as a resident. I feel like
11:34
you see at that time, and it since has changed,
11:37
but private practice was kind of like this black
11:39
box that you just didn't really get much of exposure
11:41
to because you're in just a large tertiary care
11:44
academic center and you went to children's and
11:47
that's also a large tertiary care academic center.
11:49
So seeing private practice and actually seeing
11:52
the day -to -day and what that interaction with
11:54
CRNAs was or other physicians, it was kind of
11:57
a black box for me. And I'm also a pretty loyal
11:59
guy, so I knew if I didn't... try something right
12:02
out of the gate, then I was probably just going
12:04
to stay here at UC and just stay in academics,
12:08
which is totally fine too. And I actually really,
12:11
really considered that and almost did it. So
12:13
that's really what drove me to private practice
12:15
was just chasing after something I didn't know
12:19
and seeing if that opportunity was something
12:23
that I could see myself doing. And I feel like
12:27
it's one of those things where you really don't
12:29
know until you try it. Kind of a... thought process
12:32
with it there's a lot of i think um not necessarily
12:37
misinformation but there's definitely things
12:40
that people maybe stigmas associated with private
12:42
practice versus academics on both sides um and
12:46
i just wanted to kind of let go and experience
12:48
that for myself well so dispel some myths for
12:52
us yeah i'd love to hear what the uh common things
12:59
people say about private practice are and what
13:01
your take on it is yeah I think the biggest thing
13:04
when I was a resident that I heard from folks
13:07
was that there's potentially situations where
13:10
you'll be unsafe just in terms of concurrency
13:12
and coverage issues that there's this maybe sense
13:17
of more greed in private practice, of just making
13:21
as much as you can, and then going home and not
13:24
really taking care of patients the best you can.
13:27
So those are kind of two of the big stigmas,
13:29
I think, that I got out of coming out of academics,
13:32
not necessarily from the people that worked here,
13:34
but just kind of an overall sense of talking
13:36
to other programs and other people that have
13:38
been in those situations. So I wanted to kind
13:42
of see that for myself and if that was truly
13:45
the case. And I didn't feel like that was the
13:49
case when I went there. I feel like you definitely,
13:53
your concurrency is different because in academic
13:55
centers, you typically are covering residents
13:57
or student CRNAs with CRNAs or AAs. So meeting
14:02
all the seven steps of medical direction are
14:04
really important. And to do that, you have to
14:06
have a smaller number of rooms. But I don't feel
14:09
like that is to a point where it's unsafe for
14:11
the patient in private practice. I feel like
14:14
we do a pretty good job, especially where...
14:17
I work at Seven Hills Anesthesia with the Good
14:19
Sam Division of making sure that we understand
14:22
the acuities of the patients and putting people
14:24
in cases that meet their skill sets and also
14:28
keeps the patient extremely safe. So Mark, one
14:32
thing that I thought was really interesting that
14:33
you bring to the table is you did a stint in
14:36
private practice. I wonder if you could talk
14:39
about why you decided to go and then why you
14:43
decided to come back. So much like Justin, I
14:47
was kind of wondering what the other side was
14:49
like in terms of academic versus private practice.
14:52
So I found an opportunity, I believe it was back
14:54
at the beginning of 2017, to go to a local group
14:59
and kind of experience it for myself. In terms
15:02
of learning curve, I will say the volume. of
15:06
the supervision definitely goes up in private
15:07
practice. That was probably the steepest part
15:09
of the learning curve was learning that, you
15:11
know, that kind of being able to juggle that
15:13
and to be everywhere you need to be and to kind
15:15
of time manage effectively. So that was something
15:20
that was different there for sure. You know,
15:23
it was one of those things where if I was going
15:25
to be in private practice, I wanted to become
15:27
a partner. So, you know, I looked at the, basically
15:31
the partnership track there. And for various
15:34
reasons, it just didn't work out for me. I decided
15:38
that I was taking more call, for sure. I was
15:42
just used to sort of the system and academics
15:45
and kind of the vacation scheduling and things
15:48
like that. And it was one of those things where
15:50
it just didn't work out. And I didn't want to
15:54
put in all the time to become a partner if I
15:56
wasn't super sure where I was going. So I decided
16:00
to come back here. And yeah, but it was a good
16:04
experience. I'm much better for it in terms of
16:06
time management and learning how to juggle multiple
16:10
things. And I think it was a very worthwhile
16:13
experience. So let's talk about partnership track
16:18
and what that all means. A lot of our listeners
16:22
may not have any idea what partnership track
16:26
means. And is that something that's specifically
16:28
only in private practice? How does it all work?
16:32
I'd like to open up to both of you guys. What
16:35
is partnership track? Yeah, so partnership track
16:39
ultimately in anesthesia is you're really the
16:41
owner of a small business. Essentially, you can
16:44
kind of think of it that way. So typically when
16:47
people reference partnership track, what they're
16:50
actually referring to is a break in or a honeymoon
16:53
period where they can evaluate your skills and
16:56
who you are as a person. And then you can also
16:58
evaluate that group. in terms of their skills
17:01
what they offer you and see if it's it's a worthwhile
17:04
match to be able to stay there long term kind
17:07
of like what mark cassidy said about that so
17:10
usually there's a buy -in period of a sort That
17:13
can either be time or money is typically the
17:15
kind of the equilibrium you think of. Some groups
17:19
actually have like a cash buy -in that you pay
17:21
into the group. And then after that cash value
17:24
is met, then you're a partner of the group, assuming
17:26
that you have a positive vote and affirmation
17:29
vote from everybody. Some people just have you
17:31
at a certain amount of pay for a certain amount
17:34
of time. And then after that period, then they
17:37
vote you in as a partner of which you become
17:39
basically a small business owner. within the
17:42
partnership. So what happens when you become
17:46
a partner? Is there a big pay jump? Does it mean
17:50
that you don't have to take call anymore? How's
17:52
that work? Yeah, good question. It's a great
17:56
question. That is. And honestly, I think it's
17:59
different for the private practice group. So
18:01
just speaking on my own experience with that,
18:05
really nothing changes in terms of your workload.
18:09
once you go from a non -partner to a partner.
18:11
So you're still taking the same amount of call
18:13
and you're still taking the same amount of backup
18:15
calls. You don't get this massive new responsibility
18:19
because you're a partner. I think the biggest
18:21
thing, at least in our group, is that there's
18:24
an expectation when you are a small business
18:27
owner that you're participating in the practice
18:30
of that business, which includes administrative
18:33
meetings. talking to hospital administrators,
18:37
can be on a bunch of different committees like
18:40
the pharmaceutical therapeutics or blood bank,
18:44
all different kinds of committees. And then you're
18:46
ultimately involved in the board and how you
18:49
actually run the practice as an anesthesiologist.
18:52
So I think that's probably the biggest difference
18:55
from non -partner to partner is that that expectation
18:58
is there that you're going to be actively involved
19:01
in all the facets. of the practice so it seems
19:06
like what you're saying is if you're going into
19:08
private practice to escape from the meetings
19:11
committee is right it's very much the opposite
19:15
exactly exactly absolutely right so i guess i've
19:21
got bad news for all of our listeners that's
19:24
right that's right if you're still going to have
19:26
to go to meetings uh no matter what is that pretty
19:28
much the truth you're absolutely right john yeah
19:31
so How would you each describe the culture of
19:35
the current group that you're in? That you see,
19:40
I think we're coming out of a kind of coming
19:41
out of a transition period. We've had, let me
19:44
think how long our current chair has been here.
19:46
It's probably less than two years. And anytime
19:48
you have a big leadership change like that, you're
19:51
going to have attrition. You're going to have
19:53
people leave. It's just there's a lot of uncertainty,
19:55
really. And I feel like we're kind of coming
19:57
out of that now. We've hired a lot of young.
20:02
faculty um people from different places different
20:05
ideas you know kind of refresh if you will um
20:07
so i think it's you know i think we're kind of
20:09
coming out of the transition period honestly
20:11
and i mean working here i've always felt like
20:14
in terms of culture um if i if i'm in trouble
20:17
if i need a hand i can call just about anybody
20:19
and they'll come help me out um so that's always
20:22
been that's kind of been like that for for quite
20:24
a while. It's one of the reasons I stayed here
20:25
initially was because I felt like I always had
20:28
another set of hands. I had support and backup
20:31
if I needed it. Yeah, absolutely. What about
20:34
you, Jackson? Yeah, I feel like our group at
20:38
Good Sam, I think the best word I could use to
20:41
describe it is just really collegial. We have
20:44
CRNAs, we have docs there, we have residents,
20:47
and we're starting a residency program there
20:49
too. I think the biggest thing that struck me
20:52
when I went over there is that collegiality is
20:54
not just in the department. It's across the whole
20:57
system. So the nursing staff, the perioperative
21:00
nurses, the ORAs, folks that are actually cleaning
21:03
up the ORs after each case, all the way up to
21:06
the surgeons. I feel like a personal connection
21:11
with a lot of people at the hospital. And I feel
21:15
very strongly about that. And it honestly...
21:18
when you have the foundation as your friends
21:21
and your colleagues, and you truly trust the
21:24
person that you're working with and all levels,
21:26
it makes the system better and it makes the culture
21:28
better. And I feel like that is definitely where
21:30
we are at the trial system. And I felt that too,
21:34
to Mark's point here at UC, like you get to know
21:37
your anesthesia techs really well, you know,
21:39
the pharmacists that are in the OR, like you
21:42
have a relationship that extends beyond your
21:44
clinical responsibilities. So, One of the things
21:50
that people think about when they're talking
21:53
about academics versus private practice is the
21:55
schedule. The schedule seems to be a lot less
22:02
flexible in private practice. It's more flexible
22:04
in academics. Is that actually true? What do
22:07
you guys think? Well, I mean, from my limited
22:09
experience, my academic experience versus my
22:13
private practice, I would say that for me, the
22:16
academic schedule has been more flexible. you
22:19
know it's we get actual less vacation but um
22:22
we can sort of parse it out um and sort of smaller
22:25
aliquots um and that kind of thing so um yeah
22:30
i think the schedule and the way we um essentially
22:32
the way we have things here at uc we're you know
22:35
paid per call which makes it very palatable for
22:38
you know if you have to give it away someone's
22:40
always going to take your call away so if you
22:41
get in a bind it's easy to get rid of. That being
22:44
said, I'm sure you can trade it, you know, in
22:47
private practice as well. But in my experience,
22:50
and I didn't have a very long experience either
22:52
in private practice, and the group that I was
22:55
in was quite small, so it made concessions like
22:58
that very difficult to make, you know, and at
23:00
the same time be able to meet all of the clinical
23:03
needs and things like that. That's just my personal
23:08
experience in academics. I have been able to
23:11
have a fairly flexible schedule compared to my
23:14
brief experience with private practice. Yeah,
23:17
I think Mark's absolutely right there. I think
23:19
private practice is a little bit more rigid when
23:21
it comes to that. Just speaking on some specific
23:24
examples, the way that we do our vacation draft
23:27
is you get your assortment of weeks, which is...
23:31
Typically around eight weeks of vacation and
23:33
you pick that a year in advance and you can only
23:35
take that full week. So you have to be kind of
23:38
preemptive about, you know, well, what what kids
23:43
vacation is that week? Or do we have, you know,
23:45
spring break that week? Or do we have a two week
23:47
break? And can I get off that Friday? I'm not
23:50
really sure. So I think you do have to go into
23:52
private practice thinking that that flexibility
23:56
can be there if you plan it beforehand. a little
24:00
bit so just a case in point you know if i have
24:03
a if i have an event that's on a friday then
24:06
i would need to ask to be post post call on a
24:08
friday which means i would take that first call
24:10
on thursday so there's ways that you can work
24:13
around it but i think it is a little bit more
24:15
difficult that flexibility piece just because
24:18
you don't have as large of a department so every
24:22
person that there is there has a specific role
24:26
And sometimes that flexibility piece is not there
24:29
as much. So you have to just be on your T's and
24:32
your I's in terms of crossing your T's, dotting
24:34
your I's way in advance to be able to schedule
24:37
things. Now, is that impossible with a family?
24:41
It's not impossible. There are times where it
24:43
is tricky that you're not going to get to every
24:45
kid's event or you're not going to be able to
24:48
hang out with friends every single time you want
24:50
to. But I feel like it, by and large. that probably
24:56
80 to 85 % of the time you can make it work.
25:01
So another one of the things that people will
25:05
say about academic versus private practice is
25:08
the difference in the patients. Oftentimes it's
25:13
said that the academic places get the most complicated,
25:18
the sickest patients, and the private practice,
25:21
they have... What I have come to see is the mythical
25:23
ASA1 patient. So true. Rare breed. Rare breed
25:29
patient. That's right. I'm sure there's overlap.
25:33
I have had healthy patients on occasion. Actually,
25:38
just a couple weeks ago, I had two ASA1 patients
25:42
in a row, and I think it was the first time.
25:45
that that's ever happened. Did you write that
25:47
down? Did you write that date down? Did you write
25:49
it up? In my diary. A case series. It wasn't
25:53
your diary. You won't guess what happened. You
25:55
don't get it. You won't guess what happened.
25:58
But you're absolutely right, John. That's a really
26:01
good question. And one I feel like comes up a
26:04
lot of like, well, in private practice, you never
26:07
take care of sick people or you only take care
26:09
of really, really healthy people. I always kind
26:13
of put it in the lens that with any of it, it's
26:17
a Gaussian distribution, bell -shaped curve,
26:20
and it's either skewed to the right or the left.
26:22
I feel like in academic centers, it's skewed
26:25
to the left where your acuity is much higher
26:26
because it's a tertiary care center and people
26:29
go there because they're extremely sick and they
26:31
want to go to the experts that are very specific
26:33
in a certain pathology. Whereas in private practice,
26:37
usually they're... Typically in community hospitals
26:39
that are not necessarily tertiary care centers,
26:42
although they may have their centers of excellence,
26:44
like at Good Sam we have, you know, Center of
26:47
Excellence for Spine. um adult scoliotic deformities
26:51
with mayfield that we partner with and then beacon
26:54
orthopedics does quite a bit too so we have sort
26:57
of centers of excellence for sub specialty care
27:00
but by and large at the big tertiary care centers
27:02
you have all of those in one place so with that
27:06
i feel like it skews that bell -shaped curve
27:09
to the left where your acuity is higher but that's
27:12
also all what you see Whereas in private practice,
27:15
it skews to the other side. So you'll see a wider
27:19
distribution of ASA1s to ASA5s, for instance.
27:23
But you won't necessarily get the concentration
27:26
of volume of ASA3s, 4s, and 5s that you would
27:29
at a tertiary care center. So you'll still take
27:31
care of the sick of the sick people. You just
27:33
won't see that patient four times in one day,
27:36
if that makes sense. That gets very well stated.
27:40
It's kind of like you were saying before about
27:42
bad news is you're not going to be able to avoid
27:44
any meetings, you know, having meetings at all.
27:47
You're not going to be able to avoid having sick
27:49
patients. So that's right. That's one thing to
27:51
look at when you're going to work somewhere.
27:52
You know, do you want to do liver transplant?
27:54
Do you want to do kind of big cases? And, you
27:58
know, so there's there's big cases that are big
27:59
by nature, like livers. And then there's small
28:02
cases with really sick patients that can be just
28:04
as challenging. So, you know, like. like Justin
28:08
said, you're going to get those just about anywhere.
28:10
You know, sometimes you can pick your poison
28:12
depending on where you, where you want to work.
28:13
But yeah, I would say there's, there's, you know,
28:16
plenty, probably more in academics in terms of
28:18
really ASA fours, ASA fives, but they exist everywhere.
28:22
You have to be, have to be prepared for that.
28:24
That's right. So what is the difference between
28:28
the relationships that you have with surgeons
28:31
in academic versus private practice? I don't
28:35
know. I think it's hard to split that between
28:37
academics and private practice and say there's
28:40
definitely a type of relationship you have in
28:42
one or the other. I've found over the years that
28:45
the surgeons have, in general, become a little
28:48
more collegial. I don't know if it's just me
28:50
getting older and being contemporaries with them
28:53
or if it's just kind of how things are going
28:57
in terms of medical training and things that
28:59
are focused on. I find overall I have a very
29:02
collegial relationship with the surgeons. Of
29:05
course, I've been here for a while. They kind
29:06
of know me. They know that if there's a concern,
29:09
I'm not just going to bring it up. If it's a
29:11
real concern, I'm going to bring it up and I'm
29:13
going to have some kind of solution, which hopefully
29:15
doesn't involve canceling the case, but it might.
29:18
But I think overall my personal experience, very
29:21
collegial. My brief experience in private practice
29:24
was even better. It's kind of like Justin was
29:28
saying, that the place where I was, everybody
29:29
was kind of, it felt like a small, tight -knit
29:31
group. You know what I mean? There were only
29:33
a couple general surgeons. You knew everybody
29:36
there. Everybody was friendly. It was much more,
29:40
it felt much less formal than academics did.
29:43
And it was a good environment. But I'd say I
29:45
can't make any delineation between the two, really.
29:50
I just feel like overall I've had a pretty good
29:52
experience with surgeon relationships. Yeah.
29:55
Yeah. And I feel like to, to Mark's point, totally
29:58
agree with that. Um, and academics too, you,
30:01
you somewhat get into this mode a little bit,
30:03
at least when I was here as a resident of, you
30:06
know, you may be really close with that surgeon,
30:07
but then they move and, you know, go take the
30:09
chair position somewhere else and stuff. So there's,
30:11
I feel like there is a little bit more of that
30:13
transient nature within academics. which you
30:16
have a little bit just because of the system
30:18
and academics. On the other side, with private
30:21
practice, you know, if you don't necessarily
30:22
get along with a surgeon and he's going to be
30:24
there for the next 20 years, then... That could
30:26
be a problem. So there is a little give and take
30:29
there with that. But I would say most community
30:32
hospital surgeons do want that relationship that
30:36
Mark was mentioning where they want to have a
30:38
close relationship. They want to know who you
30:40
are. They want to know your clinical abilities
30:42
and your acumen that way. And they want to have
30:44
that ability to trust you when it comes down
30:46
to the wire of like. is it safe for this patient
30:49
to have surgery? And if you think of it that
30:50
way, they're business owners too. They're usually
30:52
private practice. A lot of times private practice.
30:55
They want what's best for their patients just
30:56
like we all do. Exactly. Now I will tell you,
30:59
once you get to some throughput efficiency things,
31:02
sometimes that personal relationship really helps
31:06
with that because when it comes to, like Mark
31:09
mentioned, maybe I have this patient has... some
31:12
pulmonary hypertension that was not found, at
31:14
least on the PAT workup, and it's very, very
31:16
significant, causes functional limitations to
31:19
the patients, and this is the first time you've
31:20
seen them, you have to go have to have a conversation
31:22
about, you know, the center scalene block, is
31:24
this surgery really needed since it's an elective
31:26
surgery? Having that collegial background foundational...
31:32
relationship with the surgeons a lot easier to
31:35
have that conversation than going to somebody
31:37
that's you know the best in the city and is about
31:40
throughput and wants to get it done so I feel
31:43
like those relationships in academics or private
31:46
practice it's just good to have that sense as
31:49
an anesthesiologist to get to know your surgeons
31:51
and to spend the time that equity of building
31:55
that relationship so when you need to use it
31:57
you can and it's for the patient's benefit This
32:00
is something that I actually share with my residents
32:02
a lot about not just choosing your battles to
32:07
have with the surgeons, but putting the relationship
32:09
first in a lot of categories. Because once you
32:13
have the relationship piece, it actually makes
32:16
it more safe for all the patients overall. Absolutely.
32:20
If you are the kind of anesthesiologist that's
32:23
just going to argue incessantly with the surgeons
32:25
about whether or not you want to give Toradol.
32:29
It may be a situation where they get annoyed
32:35
with you and stop trusting you and stop communicating
32:38
things that will make things better for all of
32:41
the patients. So speaking of residents, I know,
32:47
Justin, you're part of the team that's creating
32:50
the residency program over at TriHealth. Why
32:53
would a private group want to train residents?
32:55
What's that about? That's a really, really good
32:58
question, John. And I think it's one that we
33:01
as anesthesiologists nationally just have to
33:05
grapple with. I mean, if you look at the ANA
33:07
data, the ASA data, we're going to be short all
33:10
provider types in the next 10 years. That's going
33:14
to be docs, that's going to be CRNAs, that's
33:15
going to be A's. Any way you cut it, we're going
33:19
to be short. And I think it's on us as anesthesiologists
33:24
to... really foster medical education for the
33:29
next generation I really feel strongly about
33:31
that and I know they feel strongly about that
33:33
here and I know John you feel strongly about
33:34
that and it sometimes requires people to go out
33:38
on a limb to do that in private practice medical
33:41
education is not the forefront that's really
33:44
not why you're there but I think it's a nice
33:47
balance as long as you get buy -in from your
33:51
other physicians and Mark and I were off the
33:54
cuff kind of chatting beforehand is like so there's
33:56
going to be some of the challenges that we have
33:58
is just like total buy -in from the system total
34:00
buy -in from private practice physicians to really
34:05
take that take residents under their wing and
34:08
kind of teach them what they've learned over
34:10
the last potentially 20 years in some cases for
34:13
some of my colleagues. So I think the biggest
34:15
thing is just the provider shortage. I also feel
34:19
like altruistically it's the right thing to do.
34:22
Sometimes it's the right thing to do. Even though
34:25
it's going to be a lot of work, even though it's
34:28
going to be not easy and there's going to be
34:29
bumps along the way, it's the right thing to
34:33
do. And I also think that TriHealth as a system
34:36
has made it a point to develop relationships
34:41
with Xavier University to start a new medical
34:43
school in Cincinnati. So I think there's a lot
34:47
of pieces in place moving that way to not only
34:52
establishing a new pipeline of providers in the
34:56
next 10 years, but to really garner that educational
34:59
pursuit within the city of Cincinnati for health
35:02
care. My sister actually is going to teach at
35:05
that medical school. No way! Oh, wow. Been a
35:09
PhD in the biology department for Xavier for
35:11
a while, and she accepted the spot to go help
35:14
with a med school, too. Oh, that's amazing. Congratulations.
35:16
That's great. So the biggest question that I'm
35:22
sure a lot of my medical student and resident
35:24
listeners probably have is a little bit of a
35:28
dicey question, but without naming any numbers
35:31
specifically, can you in some sense talk about
35:36
what... a pay gap might look like between academic
35:40
and private practice and what your thought or
35:44
philosophy going in to choosing based on finances
35:48
might be. I mean, from my perspective, I think
35:52
the real difference is academic versus partnership.
35:56
I think if you're an employee of a private practice,
35:59
if you're not a partner, I don't think, I mean,
36:01
to my knowledge, I don't think there's much of
36:03
a pay gap at all. The real gap comes in After
36:06
you've bought into the practice and you put your
36:08
time in, that's when the gap comes. And it's
36:13
a decent gap. You know what I mean? But, I mean,
36:16
you put your time in. You're a business owner.
36:18
You have a lot at stake there. And you put in
36:20
a lot of work. And, you know, basically it's
36:23
good old -fashioned capitalism. You know, you
36:25
do well. You make money. It's profit sharing.
36:28
It's distribution among the stakeholders. So
36:31
I think it's not just academic versus private.
36:34
I think it's... academic you know private employee
36:38
versus partner private so what i know justin
36:42
has more personal experience with that than i
36:44
do so yeah no mark you're absolutely right i
36:46
feel like just being an employee of any system
36:49
it's going to be about the same it's once you
36:51
get to that small business that partnership you're
36:54
an owner yeah yep you're an owner but with that
36:56
comes that responsibility piece that we talked
36:58
about so it's not it's not that that gap is so
37:02
substantial you're doing work for that gap and
37:04
i think that's the key thing is you don't Nobody
37:08
just, I tell my kids this all the time. They
37:10
ask about allowance. And I was like, why would
37:12
I give you money? Nobody's going to give you
37:15
money just to be you. Like, that's not a thing
37:17
that doesn't really happen. So like that, that,
37:20
that pay gap, if it is there. And I feel like
37:23
honestly, over the last 10 years, at least what
37:26
I've kind of seen as the recruiting piece for
37:29
the good Sam is that gap is closed quite a bit,
37:31
to be honest, because everybody is struggling
37:34
to find really good providers. So in order to.
37:37
get good providers, specifically anesthesiologists,
37:39
you kind of up the ante. So I feel like there's
37:42
a little bit of that, but there is a little bit
37:43
of a gap in terms of being a private practice
37:46
owner, a partner. But it comes with that responsibility
37:51
piece, for sure. Do you think that the shrinking
37:57
difference between academic and private pay structures
38:01
has to do with private equity? What do you guys
38:05
think about... corporate consolidation, private
38:08
equity, how that's affecting the landscape? It's
38:12
hard to say. I would think if consolidation,
38:14
if anything, as practitioners, we have fewer
38:17
places to go. So the market is more controlled.
38:20
I don't think that private equity will increase
38:23
salaries. Private equity is there to do its thing.
38:28
So I think, if anything, it may have a downward
38:31
pressure on salaries. You know, and again, there's
38:34
just fewer options for employment for docs in
38:38
terms of not necessarily locations or numbers
38:42
of patients, but in terms of employers. So I
38:45
know things have consolidated quite a bit here.
38:47
In Cincinnati, there used to be several smaller
38:49
groups that no longer exist. And now we have
38:53
some larger groups that have come in and filled
38:57
that void. And obviously, you know, private equity
39:00
is those larger groups. kind of manifested so
39:04
um so yeah that's kind of my take on it yeah
39:06
yeah and anesthesia is a very service oriented
39:10
industry like we we serve our patients we serve
39:14
the surgeons that bring in those patients we
39:16
don't really have our own back business models
39:19
we don't have a big overhead unless you're like
39:21
a regional company kind of like seven hills is
39:24
so what we've seen a lot in anesthesia is a lot
39:27
of the national companies So these companies
39:29
that come in, like the Team Health, the North
39:32
Stars, they come in and when it was very, very
39:36
cheap to borrow money 15, 20 years ago, they
39:40
would come in and actually buy out the private
39:42
practice groups, the small community. You don't
39:45
see that as much now just because it's a lot
39:47
more expensive to borrow money. So you're not
39:49
seeing a whole lot of that. Private equity, to
39:52
be honest with you, I haven't had a whole lot
39:54
of experience in the city of Cincinnati with
39:56
private equity in the anesthesia sphere. I've
39:59
had a lot of experience in just more anecdotal
40:01
stories about it from some of my partners within
40:04
healthcare, within some of the private practice
40:07
groups in town. And it seems like the idea is
40:10
they come in ultimately and... be able to use
40:15
some of the business infrastructure they need
40:17
to make more capital for somebody else the shareholders
40:20
and that sort of thing so i haven't really seen
40:22
that a whole lot in anesthesia in cincinnati
40:26
per se but the national companies for sure um
40:30
and you'll and you'll see that and i think anytime
40:33
like mark mentioned with the market you know
40:35
you you have competing forces so anytime a hospital
40:39
system feels like that you're not fitting the
40:41
bill in terms of that service responsibility
40:44
and promise to them then they're going to look
40:48
elsewhere and i think in private practice there's
40:50
always that idea in the back of your mind is
40:53
that our customer is the hospital system And
40:58
we're going to do our best to serve that hospital
41:00
system because that's our primary customer or
41:02
the private practice groups that we service.
41:05
All the while taking the best care we can of
41:07
our patients, which is the paramount thing. I
41:10
want to talk a little bit about burnout. Not
41:14
necessarily even your own, but in academic versus
41:19
private practice, what do you see as the major
41:23
factors that might push? you or one of your colleagues
41:28
more towards burnout? Yeah, I feel like burnout
41:33
is, it's a hot topic everywhere you look, not
41:36
even in medicine, but just in life in general.
41:40
I feel like, John, the most times I've felt burnt
41:44
out is when you're being pushed to do way more
41:49
than you can do with less and less resources.
41:54
And I think That to me is always where burnout
41:58
kind of rears its ugly head. I don't know about
42:00
you, Mark, but when a system comes to you and
42:05
asks you to grow horizontally with OR footprint,
42:09
you know, we want to do four or five more NOR
42:12
of locations, but those aren't going to be really
42:15
efficient days because the people are done it.
42:18
you know 11 30 or noon although you're going
42:20
to be paying your staff till 3 30 or 5 30 p .m
42:23
it really starts to push the envelope of now
42:27
that burden is going on the ownership to then
42:30
find those individuals which people typically
42:33
have to give up their free time or their vacation
42:36
time or their pto time so anytime you see a system
42:40
that's trying to do way more with a way less
42:43
to maximize profit i feel like that's when you're
42:48
starting to get into the burnout cycle. Yeah,
42:50
and your people start burning out. You know,
42:54
it's kind of like that's a larger macrocosm.
42:56
I mean, just personal burnout for me, like, I
42:59
mean, that's kind of like one of those catch
43:01
-all phrases that kind of, I mean, I would just
43:02
say stress. I mean, when you stack difficult,
43:05
you know, when you're doing like four or five
43:06
days of really heavy -duty stuff, tough cases,
43:09
easy cases that go poorly, it just seems like
43:12
there's cycles every once in a while, maybe every
43:14
few months where you just have a run of bad.
43:17
either bad luck or just, you know, just things,
43:19
things don't go well. And then you're kind of
43:21
like, well, man, if this cycle doesn't turn around
43:23
soon, I'm going to be pretty upset. And you just
43:26
have bad days and things like that. But I think
43:29
as long as you can kind of recover from that.
43:32
And, you know, like, like, like Justin said,
43:34
we're being asked, you know, as a system, as
43:36
people to do more and more with, it seems like
43:38
less and less. I think that's probably the biggest
43:40
contributor to burnout because you're going to
43:42
have sick patients, but it's like, you know,
43:44
when I kind of feel like I, know what I need,
43:47
but I can't get it, or I'm being asked to do
43:50
something that I, you know what I mean? It's
43:51
just one of those kinds of things. And I think
43:53
to this point in my career, um, I've been able
43:55
to deal with that. You know, I've, I've, I have
43:57
enough downtime, enough other things where I
43:59
can kind of collect myself and, and, you know,
44:01
decompress. But, um, but yeah, I think that's
44:03
the biggest source of burnout or stress is, um,
44:07
resource stress, not having what you need to
44:10
do, do your job well. So let's say that we bring
44:15
a CA3 in here. And the CA3 is trying to determine
44:20
whether or not she should do academics or private
44:24
practice. Number one, what would you advise them
44:29
to do? And number two, what are the questions
44:32
they should be asking on their interviews? Yeah.
44:37
Great, great, great, great question. I kind of
44:41
boiled it down to over the last couple of years
44:43
within every medical sphere and probably even
44:46
life in general, it really kind of boils down
44:48
to three traits and a person. You're either a
44:51
thinker, a talker, a doer. And I think the more
44:55
that I've thought about my career and where I
44:57
am and where I want to be, I think just having
45:00
that realness with yourself of who you actually
45:02
are and what drives you and what. get you to
45:06
get out and roll out of bed in the morning and
45:08
go do that 6 a .m. case. And that's going to
45:12
be different for everybody. It's not something
45:15
that I can tell one CA3 like, hey, you should
45:18
do this because I did it and it's the best route.
45:22
It's more of like an introspection of that thinker
45:25
talker. that thinker talker and doer mentality
45:28
and I always found myself as being more of like
45:31
a thinker and doer and less of a talker and when
45:34
I say talker I'm saying like more like advocacy
45:37
more research driven of like I want to research
45:41
this topic and then talk about that nationally
45:43
regionally when I say doer I was like somebody
45:46
that literally loves to do anesthesia to do all
45:50
of the facets of anesthesia take care of really
45:51
sick patients in the operating room and then
45:55
when i say um thinker is really kind of more
45:58
of that research heavy stuff of like the people
46:02
that actually look at you know perioperative
46:04
throughputs or maybe more informatics clinical
46:08
informatics and i think if you kind of look at
46:11
yourselves even though they're very very global
46:13
and they're not exactly specific for every single
46:15
person but if you look at it like in that kind
46:17
of sphere you can see there's a lot of overlap
46:20
like a venn diagram almost for like private practice
46:23
or academics because you know if you're a thinker
46:26
and a talker then academics is a great great
46:29
place because there is a lot of thought there's
46:32
a lot of intentionality in terms of you know,
46:35
residency in terms of medical education, in terms
46:37
of advocacy for the specialty of anesthesia.
46:41
There's a lot of going to meetings regionally,
46:44
like presenting stuff. But if you really like
46:46
to do anesthesia and think about anesthesia,
46:49
I mean, that's, I feel like private practice
46:51
is a lot of that, where you think about what
46:54
you're doing, think about what you've learned
46:55
and how do you apply it to every single patient,
46:57
but you're also doing the anesthesia a lot. So
47:00
that's how I've kind of boiled it down to myself
47:03
into like, very basic terms, and I think just
47:07
CA3s have to have a real sense of looking themselves
47:11
in the mirror and being like, what drives me?
47:13
What do I enjoy the most? And going from there.
47:17
Yeah, that's an excellent point, the intrinsic
47:19
motivation part of it. And I mean, if you're
47:23
talking about academics versus private practice,
47:24
which we are, you know, things are kind of being
47:27
blurred a little bit like we talked about with
47:29
residency programs now in private practice groups,
47:32
things like that. So, you know, you could probably
47:35
find a little niche somewhere if you like the
47:36
academics. You could probably, you know, do some
47:38
of the teaching and stuff like that in private
47:41
practice as well. And, you know, again, getting
47:44
back to the intrinsic motivation, you also have
47:46
to think about. you know there might be something
47:48
super exciting you love it right now um but my
47:51
experience is that everything eventually becomes
47:53
kind of mundane um so you have to find something
47:56
that um you know and obviously you can change
47:59
but ideally find something that um that motivates
48:02
you like you said to get out of bed now and something
48:05
that even when doesn't motivate you as much anymore
48:07
is still doable. You know what I mean? Just planning
48:11
ahead as somebody that's been doing this for
48:12
20 years. You know, it's just you got to kind
48:15
of get to that root of what motivates you not,
48:18
you know, sort of going forward as well. So once
48:22
things become what they are, you know, a little
48:24
more boring than they are when you start, then,
48:26
you know, you just kind of have to find what
48:28
makes you get out of bed every morning. You know,
48:31
I had a conversation with one of my friends who
48:35
did. pediatrics and this was back when I was
48:39
on the tail end of residency and we had two very
48:44
different days and we were meeting up to play
48:47
board games after work and he said to me uh yeah
48:53
my day it wasn't so bad I did get stuck late
48:56
I had you know a whole bunch of med recs to do
48:59
and I had all these you know 6 p .m consults
49:03
and I had to write all these notes and A couple
49:06
of them didn't speak English, and so that made
49:08
it harder, but it was okay. And I said, that
49:10
sounds like the worst possible growl I can possibly
49:15
imagine. And what I told him is, well, my day
49:20
wasn't so bad. I had a big gunshot wound that
49:24
came in. They were bleeding out, and I had to
49:27
start a central line under the drapes and an
49:29
A -line, and they almost died. uh we were able
49:32
to get him back and we hooked up to belmont and
49:34
you know we did all these things and he said
49:38
wow That sounds like the worst possible thing.
49:42
That's a good illustration of the talker. You're
49:45
a talker and a doer. I don't know if I can host
49:51
a podcast and not call myself some kind of a
49:54
talker. That's what I was implying. Although,
49:58
to be fair, I am asking, you guys have done most
50:01
of the talking. I'm just asking the questions.
50:03
That's true. I really appreciate you guys. coming
50:08
and talking to me. Before we wrap up, I do want
50:11
to ask my final style points question, which
50:14
is what style points or points of personal preference
50:18
have brought you success both in and out of the
50:21
operating room? I think the word we've used a
50:24
lot is collegiality. So just sort of kind of
50:28
coming to everything with sort of a level of
50:30
respect for others and sort of politeness. Anesthesia
50:33
is, it's stressful. Anytime you're dealing with
50:37
patients, you're dealing with surgeons, you're
50:38
dealing with all kinds of specialties. I think
50:41
that kind of coming to things with that sort
50:43
of attitude helps. It can help reduce the stress.
50:46
Like we were talking about relationships with
50:49
surgeons, all that kind of stuff. So I think
50:50
just you might not always have that same respect
50:54
offered to you by other people. But I think if
50:57
you kind of set your thermostat right there and
51:00
sort of approach things, I think that's just
51:03
kind of set you up a little better. and kind
51:05
of reduce the stress level. Yeah, I love that.
51:08
The set and the thermostat. What a great, great,
51:10
great line. I love that one. So true. That was
51:13
good. That was so good. I've always loved that,
51:16
the idea of the three A's. I don't know if you
51:20
guys have heard of that before, but being affable,
51:23
available, and your ability. Affable, just like
51:27
what Mark talked about, that relationship piece,
51:29
treating everybody with respect, being able to...
51:33
talk to people for where they're at and just
51:36
having a mutual respect for folks. I feel like
51:38
that's, and being collegial, you know, that's,
51:40
that's being affable, available man at the moment's
51:44
call. Like if an obstetrician calls me and they
51:48
need to consult for something, I'm ready to go,
51:50
you know, or if you get called in the middle
51:52
of the night to come do something, a second call,
51:54
you know, you got a, um, bleeding aneurysm, you
51:57
got to come in, you're available. You got to
51:59
be there. And I think the one that probably is,
52:03
The least important, even though it is, is the
52:05
ability part. If you can be affable and available,
52:07
I feel like those two things alone can set you
52:11
apart from 75 % of people. Those two get overlooked
52:15
quite a bit. They do. You know? Yeah. You're
52:18
right. Just show up. Just show up. Be good. Be
52:20
good. And be good. Be good to people. And then
52:22
the ability piece obviously comes with time,
52:25
experience, honestly, mentorship. is a big thing
52:30
that I feel like in medicine, sometimes we do
52:32
really well and sometimes we don't do so good.
52:35
And even in private practice, I don't feel like
52:38
there's really good structures for organized
52:41
mentorship at times to help with that ability
52:44
piece. And that's something that we should work
52:47
on like on the private practice side. But those
52:50
three A's is what I always think about. Justin,
52:54
Mark, this was a fantastic conversation. Thank
52:57
you both for joining me. Thanks, Sean. Thanks
53:00
for having us. Thanks for having me. Well, that's
53:05
it for this month's episode of Style Points.
53:08
My thanks to Mark and Justin for coming on and
53:10
being so candid about both sides of the fence.
53:13
If you came in hoping for a clear winner, I'm
53:15
sorry to report that both of them seem pretty
53:17
happy. If you got something out of this episode,
53:21
the single best thing you can do to help other
53:23
people find the show is to leave a rating or
53:25
a written review. In the review, tell me where
53:28
you're listening from. I'd be interested to know.
53:30
Does your department listen? As always, you can
53:33
reach me at stylepointspodcast at gmail .com.
53:36
And I'm still happy to mail you a free StylePoints
53:39
sticker for your water bottle. Take a deep breath.
53:42
Open your eyes. We're all done.