Latest / Off the Chart: A Business of Medicine Podcast / S1 Ep43: The Physician's Guide to Running for Office
Transcript
- Alice Mann 00:00:00 People who have never touched a patient in their lives are making laws about how I practice medicine. Keith Reynolds 00:00:14 Welcome to a very special election edition of Off the Chart with Medical Economics podcast, featuring lively and informative conversations with health care experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. I'm your host, Keith Reynolds, and just like everyone else, we here at Medical Economics are looking forward to the election results to see what the future holds for our nation. But rather than just wait to see which direction the country may take, many physicians across the country have chosen to get more involved in shaping policy by running for office themselves. Today, we'll take a look at what this actually entails as we present our Physicians Guide to Running for office. This is a companion piece to the wonderful print feature by medical economics editor Richard Pearson that ran back in September. What you're about to hear has been pulled from the hours of interviews you performed with physicians serving in government at the local, state, and federal level. Jasmeet Baines 00:01:11 Running for office as a physician is always difficult. Keith Reynolds 00:01:14 Doctor Jasmeet Bains is a member of the California State Assembly, who says there are lots of reasons physicians may stay away from politics. Jasmeet Baines 00:01:21 You know, you politics can get ugly. You're worried about your image as a physician. You're worried about, you know, what your patients would think about you. Anybody can pretty much say anything about you in the press, and the press can go ahead and say it. So there's that concern how it's going to impact your own family, your own personal life and physicians. You know, we we work quite a bit. You know, we're we are working around the clock. So that little bit of time that we have for personal time, we want to protect. And is politics the right place to protect that little bit of personal time that we get. So it's a big commitment. It's a big commitment for specifically a physician to want to run for office. Keith Reynolds 00:02:04 Doctor Baines was particularly hesitant to run, saying it took her being asked 21 times before she agreed. Keith Reynolds 00:02:10 On the other end of the spectrum, Doctor Ken Moore, mayor of Franklin, Tennessee, says he always liked politics and it was relatively easy to persuade to throw his head into the ring. Ken Moore 00:02:18 Somebody asked me one day, and, you know, it just hit me at the right moment and or maybe the wrong moment. And I said, yep, I think I will. So it was it wasn't a long, steady decision. It was pretty, pretty knee jerk reaction that I decided I would run and I never really you know, I had people say, well, you ought to run for mayor. I said, we've got a good player. so, you know, have things happen sometimes things just, you know. Keith Reynolds 00:02:51 Doctor Elizabeth Steiner, an Oregon state senator running for state treasurer, got her start in advocacy before realizing the legislature had a need for a physician's voice. Elizabeth Steiner 00:03:00 And the more I was involved with that, the more I realized two things. The first is that many legislators are like physicians. Elizabeth Steiner 00:03:08 They tend to specialize. Right? there's somebody who's interested in education or, public safety issues or environmental issues or take your pick. But most legislators have little or no understanding of the health system and of what's important to their constituents to help them stay healthy. Right. So that's the first thing. And very few doctors, relatively speaking, run for public office. And the second thing I realized was that, well, most of us know that only about 10% of what we consider health happens in a traditional health care setting. The vast majority of it is either genetics, which is a small part, or social determinants of health like poverty and housing and food security and education and a whole bunch of other things. Right? And furthermore, as a family physician, I'm trained to look at the world in a very matrixed way. Right. Education is connected to health care, which is connected to economic development, which is connected to the environment. And most people don't really look at the world that way. They don't see the connections. Elizabeth Steiner 00:04:19 So when I had the opportunity, when my then state senator, when people started to encourage me to run, and then my state senator when she and I were talking about whether she was going to run for Congress. And then she encouraged me to run, I thought, you know, maybe there's something here, and maybe I could bring that matrixed worldview and that understanding of upstream public health and upstream individual health to the legislature and offer something to the state. So that's what got me here. Keith Reynolds 00:04:50 Doctor Alice Mann, a Minnesota state senator, said that concern for her patients is what started her first run, and why she decided to come back after leaving office. Alice Mann 00:04:59 So, I decided to run for office in 2018, and I want a seat in the Minnesota House, where I served for two years. a lot of my work was on health care reform. That's, you know, why I ran for office in the first place? my days were becoming really quite a struggle. very disappointing. as my patients needed medications and treatments and therapies that I would get called invariably every single day, with them telling me I can't afford it. Alice Mann 00:05:30 Insurance won't cover it. I don't know what to do. And so I thought, there has to be something else that that can be done. I feel like I'm working in a system that keeps putting up barriers in front of patient care. And so I ran for office. in 2020, I decided to not run for reelection. it was in the middle of Covid. I was working in the E.R., and we were getting just bombarded in the E.R.. I mean, as many people know, I was watching three people die every shift, which is completely unheard of. and so I thought someone can replace me in the Minnesota house, but we don't have extra physicians lying around to replace me in the E.R., so I decided not to run again. And quite frankly, I don't really like politics. I don't enjoy politics. I like the policy part. I like solving problems. But I didn't enjoy politics. And so I was okay stepping back and not running for re-election. and then in 2022, we redistricted and all of a sudden, I was sitting in a district without a senator. Alice Mann 00:06:39 and so my phone rang about 30 times that day asking me, to, to go ahead and run. And, so I said yes, and I ran again. And now I'm in the Senate. Keith Reynolds 00:06:51 Doctor Ami Bera is a member of the US House of Representatives from California. He said he got into politics to make sure physicians had a seat at the table during the drafting of the Affordable Care Act. Ami Bera 00:07:01 You know, so I had never run for office before. And, you know, when I decided to run in 2010, it was on the heels of President Obama getting elected, and I knew he was going to work on health care. So it's like I could sit on the sidelines, or I could try try to get in the game and shape what this looks like. so that was a big learning curve. Keith Reynolds 00:07:22 Doctor Michael Burgess, also a member of the House of Representatives from Texas, says his choice to run was influenced by the greatest geopolitical factor of the time. Michael Burgess 00:07:31 Well, for me, it was, nine over 11 and the the events surrounding 911, was really, pretty jarring. Michael Burgess 00:07:42 Of course, as you remember, it caused me to ask, was I doing what I'm supposed to be doing with my life, or should I perhaps be doing something else? I was in my early 50s at the time and really big practice, as an ob gyn that stopped taking new patients about two years prior. But I still took a call from my group. Keith Reynolds 00:08:06 Whatever the reason, once a physician declares her candidacy, the race is on, which means campaigning and fundraising. Some physicians have a background that makes fundraising easy, like Doctor Baines in California, who worked in her family's car dealership before becoming a doctor. But some physicians are put off by the necessity of fundraising, like Doctor Kim Schrier, a member of the US House of Representatives from the state of Washington. Kim Schreier 00:08:29 So I decided I was going to do this to save health care, but I knew I needed to know a lot more. And so I decided, and of course, I come from a tradition of studying and learning and wanting depth of understanding that I needed to learn every world, leader, master, all history and geography. Kim Schreier 00:08:53 I needed a deep lesson in micro and macro economics, foreign policy research, and my team who is charged with getting me elected, wanted me to sit on the phone and ask people for money to support my campaign. And I've never asked really for anything in my life. I mean, even with my parents, I was pretty timid about asking for things. And so it was very weird to call people with a, you know, they weren't they weren't sending money to me. They were sending money to the cause that I represented for them. And the difference I could make in Congress. Right. So we had common goals, but I really felt like I was spinning my wheels and wasting my time. And so I went to my team and I was like, what are we doing here? This is crazy. I need to be studying up, so I'm good at this job. And they said, nobody is going to know what you think or how much you know if you can't afford to say it to them. Keith Reynolds 00:10:03 Doctor Steiner in Oregon says that campaigning is rough, but it gives her a chance to get out into her community and interact with constituents. Elizabeth Steiner 00:10:11 So campaigning, is kind of a slog sometimes, and requires a willingness to do a bunch of stuff you don't like and do it cheerfully. my least favorite part of campaigning is raising money, but it's a necessary evil. so I've gotten good at that. And what I do like is getting out around my district or now around the state, as I run for state treasurer, to meet people, to hear what concerns them, to think about ways to solve problems that will benefit lots of people across the state. That's exciting, right? And I do that both as part of my official work, excuse me. And as part of campaigns. Keith Reynolds 00:10:55 American politics being what it is, political campaigns are bound to go negative and nearly every elected official can give you an example. Doctor Bill Hader, a member of the Illinois House of Representatives, saw negative attacks from his own party during the primary, despite his opponent being a friend. Bill Hauter 00:11:12 That's interesting, because, I was, My district is very conservative district. Okay. So I don't have a lot of opposition from the opposing party in the general election. But in the primary, we had a, you know, first, my personal, you know, election, we had a three person primary. And, one one of those was ultimately kicked off from a petition challenge. then then it was, it was me against, my my Republican opponent most we, as a, a lady who had been, long time treasurer of my county, I'd worked with her for a long time and, and consider her a, very good and, colleague and friend. But, we were opponents and, and she was backed by more of the establishment in our party because she is was a long time name, and I was a newcomer, and they didn't they didn't know much about me. And so it was kind of interesting. There was, there was a tech ad that I wasn't a true Republican, and, I didn't, you know, I wasn't, truly, a, person that, you know, they, we, they use Trump a lot. Bill Hauter 00:12:37 They, you know, they used the old Facebook posts that I've been critical of Trump or this or that they said I wasn't. You know, I couldn't be counted on to be a true Republican or to be a, to back Trump. And so it was interesting. And, and I kind of just let it, you know, I think it was ineffective, really, in my district. I think people got turned off to that, because I had a lot of connections in my district, and people knew I was a conservative person, and they knew I was a reasonable, person, that I was a physician. And I just had a lot of family, friends, coworkers, neighbors, you know, church members of my church, so many extended family and so many connections. I had positions that are in my family that are that are physicians and, and counties in my district. So, I think people just, especially when you're talking about a Republican primary, which is self-select for a certain person, and that's a person who usually, is a very motivated voter and also is a very informed voter. Bill Hauter 00:13:54 And so, I think negative attacks on someone who, it's not just rings hollow. Keith Reynolds 00:14:01 Doctor Mann in Minnesota said that her experience with these negative campaign practices has given her a better view on the reality of political messaging. Alice Mann 00:14:10 So when I first ran for the house, I there were mailers out with my picture on it, and they what they do is they have someone follow you around and take a picture of you when you look your worst, like when you leave the gym or you know, you're all sweaty at a parade or something. So a sweaty face on a on a mailer that said, you know, I voted for a $90 million building upgrade while my constituents went hungry or something, right? I had never been in office. I had never voted for anything. another one said that I supported al-Qaida. another one said that I supported, other Islamic terrorists. And there is a picture of tombstones and guns and my face, there was one that said, I supported giving away your tax money to dead people, like, so all sorts of really bizarre, crazy things. Alice Mann 00:15:07 But yes, attack ads are very real. And it also, you know, I was never involved in politics. I never wanted to be involved in politics. but it gave me this, this learning insight that I never knew that the attack ads that you see on people are wildly false. Right? I thought, well, there must be some kernel of truth to some of these things you get in the mail. No, they don't have to have any kernels of truth whatsoever. And so that was a really good learning experience for me, going forward. Keith Reynolds 00:15:51 Oh, you say you're a practice leader or administrator. We've got just the thing. Our sister site, Physicians Practice. Com your one stop shop for all the expert tips and tricks that will get your practice really humming. Again, that's physicians practice.com. So you've decided to run. You fundraised. You've campaigned. You've done everything you can to push yourself over the finish line. But what if you don't make it? Doctor Bear of California found himself in that position when he first ran in 2010. Keith Reynolds 00:16:34 But he says it wasn't a surprise. Ami Bera 00:16:37 You know, and if I'm being perfectly honest, probably two weeks out or so. I knew I, we were probably not going to win. there's a great This American Life. if you listen to that radio program or podcast about our, 2010 congressional race, it was the first year of Citizens United. And, you know, we got really close. And then at the end of the race, a big bolus of money came in against us and really drove us back. So I actually felt like we won on every metric. it was great to just see the number of folks that came out to volunteer on a campaign and, you know, outside of votes cast. And so, you know, I thought it was a pretty thrilling experience. Certainly I would have liked to have won. But 2010 was a tough year to be a Democrat running for for office. And, you know, I had no hesitation about knowing that I wanted to run again in 2012. Keith Reynolds 00:17:31 Doctor Schrier in Washington says that she doesn't necessarily trust the numbers on election night, But she respects what the votes cast for her represent in the minds of her constituents. Kim Schreier 00:17:42 Well, I always look at them with a bit of caution because over time, in a state where pretty much all ballots are mail in, those numbers can fluctuate a little bit. And they're always close. But, you know, it feels like the skills of a physician, being able to connect with people, to build trust, to work together. I feel like those same skills, serve me in my current role of serving a district, helping people one at a time, or in aggregate, listening to problems, taking them to Congress, passing legislation. And so I feel like over time, you know, maybe at first it was just the biography of being a pediatrician who cared about people's health care, but now it's really a broader sense, I think, that, oh, yeah, we can trust her and she is going to bat for us, and she's proving that she did do all the things she said in 2018. Kim Schreier 00:18:40 And I think that just the longer that I'm in, the more people know me. They know I'm in their neighborhoods all the time. Keith Reynolds 00:18:46 We all know that politicians make and enforce the laws. But now that you're in office, the question is, what do you do all day? Here's what Doctor Bera of California says his day to day is like in the US House of Representatives. Ami Bera 00:18:58 Yeah. So, we're usually in session Monday through Thursday or Tuesday through Friday. So I'm out in California. So that entails a lot of long flights. you know, if we're in session Monday, I'll usually be on a 5 a.m. flight, which means I'm getting up at three in the morning. You get on that flight, you get into Washington DC three 330. usually had had to our place in DC. Take a quick shower, get dressed, head up to the hill, have meetings with my staff, go through what the schedule for that week looks like. talk about what legislation we might see coming to the floor. Ami Bera 00:19:36 I've got committee hearings and things like that. So, a regular day then starts the following day, usually at 8 or 9:00 in the morning. I try to go work out, before getting to the hill. Doesn't happen every every day. And then the day just continues with hearings, votes. I'm on the Intelligence Committee. So often we're down in the classified area, getting briefed on things. And that does take a lot of time. And then, you know, you may have late night votes. This past week, we had votes that happened at 9:00 at night. so you might go after your evening events and then come back to the hill. In general, though, we're finished with votes around 5 or 6:00. And then usually folks will have 1 or 2, three events, that evening and you'll kind of jump through those. I'm trying to limit the number of events because, you know, it's really easy to sit there and eat junk food and Rogers and have a glass of wine or two, and then next thing you know, you're 10 or £15 heavier than when you got to Congress. Keith Reynolds 00:20:38 Being in the state House doesn't seem any easier. Doctor Steiner of Oregon says that when the legislature is in session, her days are filled with lawmaking and her evenings are spent bridging the divide with Republican colleagues. Elizabeth Steiner 00:20:50 My day to day routine depends a little bit on whether we're in legislative session or not. When we are in session, I'm usually in the office at 730 in the morning, and I leave at 6 or 630 at night, and during that time I am for me in meetings with my staff team. I start every day with a team, meeting with my staff to make sure we're all running on the same page here. And then I have long blocks of time working with the legislative fiscal staff, working, running over the but working on budget issues. I have caucus time when I'm meeting with the other, in my case, Senate Democrats. we have floor sessions when we're on the floor voting on bills. I might have a committee. I have meetings with stakeholders of one kind or another. And then often after I'm done with the formal part of work. Elizabeth Steiner 00:21:43 You mentioned living from far away from capital. I'm about an hour from the state capital. It's not terrible. And many of my colleagues who live about the same distance commute every day. I tend not to, partly because I have really long days, and adding two hours of commute time means I'm not exercising. I'm not, you know, getting enough sleep. All the things that I need to do to stay healthy. Additionally, relationships are important. So oftentimes when we're in session, I'll go out to dinner, after work with one of my colleagues, often one of my Republican colleagues in the House or Senate, so that I can build relationships. Because when you get to know somebody as a real person, it's much easier to work together to find common ground on things that are going to benefit many people. Keith Reynolds 00:22:34 Some elected offices are considered full time careers, but many aren't. Doctor Mann sees her role in the Minnesota Statehouse is full time, just like her role in the emergency room. Alice Mann 00:22:43 Yeah, so it's considered a part time job. Alice Mann 00:22:46 but I think with my Type-A personality, and I think a lot of doctors are the same way. It's it's a full time job for me. We are in session January through May, and the rest of the year I am in the office once or twice a week. I meet with constituents regularly, I attend events. You know, you get invited to organizations or businesses or nursing homes in your district. You give, town halls where you talk to people about the work that's being done and you start working on bills for next year. In fact, right before this, I had a meeting about bills for next year. And the staff that works on writing the bill said, well, I can write multiple bills because no one has come ask me for bills yet. They come in December and January and February, and then all of a sudden I'm swamped with bills to write. so I take it as a full time job. I take it very seriously, obviously. but I also work full time, in the hospital. Alice Mann 00:23:47 So during session I will legislate Monday through Thursday usually, and then I'll be in the E.R. on the weekends. And then when we're not in session, summer and fall, I go back to the ER. Keith Reynolds 00:24:00 And how does she find time to do it? Alice Mann 00:24:02 I don't sleep. I've given up on the notion of sleep. I'm just kidding. I have a very supportive family. and I include my family in my activities as much as I can. So they go door knocking with me. We walk the streets of our district together. they come to the office. You know, I had a drying station for them with markers and papers so they can hang out here. so we, you know, like, people ask me that a lot. Where do you find the time? And the answer is simply is if it's important, you will find the time. Keith Reynolds 00:24:34 And speaking of making time, what will become of your practice when you're in office? For Doctor Banes in California, maintaining her relationship with her patients and community is key to her work as a lawmaker. Jasmeet Baines 00:24:44 So, the first year was in office, I would keep coming back on the weekends. yeah, Monday through Thursday. I'm in office in Sacramento. and then I was coming back, you know, I would drive back, which I'm in a really rural part of California. So it's a five hour drive from Sacramento to get back here. And then I would, you know, come back. I was, medical director of, recovery services for people in recovery from addiction. So I would usually come back Thursday evenings. I would go to the rehab, check in on things Fridays into the clinic or Friday into, in the office. And then Saturday I would be in the clinic, and then Sunday I would drive back. But as you can tell, the toll takes. so this year I've kind of adjusted a few things, and now I'm no longer the medical director of the rehab. But I'm still working in the clinic, and I usually do that when I'm back, on break. So last, Christmas, I cover all the holiday hours, give a break to the nurse practitioner and the PA that are there working in the urgent care. Jasmeet Baines 00:25:47 And that's really important for me because it's my ear to the ground on things that are affecting the community. Keith Reynolds 00:25:53 Doctor Crowder in Illinois says the time constraint of being an elected official is what's probably keeping many physicians away from seeking office, but it's worth it to get physician voices heard. Bill Hauter 00:26:03 I've had so many people say to me, how can you do this? How can you do, how can you do both? And I just feel like, how can I not? When I see what all needs to be done and how we need to be representative and represented in the General Assembly and, and I just feel like, we need to We need as physicians, we really need to start making time because our voice needs to be heard. Our perspective needs to be represented down in our state capitol. So, I feel like we as physicians, and it's hard because and it's it's getting harder because, I think the, the, the feeling is it's advocacy as part of your career. it's it's so hard because it takes so much time and it's not our expertise. Bill Hauter 00:26:59 And we have a big, important, challenging job. We all do. We all have something that takes all of us really committed to our patients and to continually, learning and, and, doing, you know, the reading and the, the practice of your practice. And so, it's I know it's hard, but, we really were needed, in our, in our state capitals and, were wanted definitely in our state capitals. and we have to make the time. Sydney Jennings 00:27:52 To. Say, Keith. Sydney Jennings 00:27:56 This is all well and good, but what if someone is looking for more clinical information? Keith Reynolds 00:28:01 Oh, then they want to check out our sister site, Patient Care online.com, the leading clinical resource for primary care physicians. Again, that's patient care online.com. Partisan disagreements seem as American as apple pie, but the tension between sides can impair even the best elected officials from accomplishing their agenda. While doctors tend to be a rather collegial group, Doctor Burgess of Texas says that physicians in Congress are by no means a monolith. Michael Burgess 00:28:51 Oh, no. in fact, even physicians, have a Republican for other Republican physicians, and they don't agree on everything. And we all I mean, you know, we're doctors. We got pretty we're pretty rigid. Sometimes when we decide what we what we believe and what we think. so that's, that's not at all in common. and just as with any other profession, we have a pretty active doctors caucus. in in in Congress. I'm one of three co-chairs. It's worked out well to have, to have three of us in involved in the leadership of that. there are times it is generally Republicans who attend the meetings, but there are times we do special outreach to our Democratic counterparts. Keith Reynolds 00:29:45 While the two sides usually don't agree. Doctor Schreier from Washington, says that doctoral camaraderie comes in handy when reaching across the aisle. Kim Schreier 00:29:53 Some of my favorite partners in both parties are physicians. Because we speak a common language, we all did residency. We all had practices of one sort or another. And so we work together. Kim Schreier 00:30:05 Even though we may disagree on plenty of issues, we all bring that spirit of a physician listening, finding our common ground, working together for the greater good. And so we work together on things like vaccinations for children, bumping up the Medicare physician reimbursement rates. making sure that, physician researchers can access Medicare data to do that research. getting fruits and vegetables more prominently in some of our food programs like whic. So we work together on a lot. And, it's been a really good way to really bring back a lot of bipartisanship, which is exactly what the Congress and our country needs and deserves. Keith Reynolds 00:30:56 Some of the tension between politicians is over who gets credit for what and how decisions made in office affect one's re-election prospects. Doctor Horton of Illinois doesn't see his role that way. Bill Hauter 00:31:05 There is a lot of pressure on people that want to make this a career, and they want to be career politicians, and and that's not that's not the my desire. And so, you know who gets credit for passing the bill and whose name on it is isn't that big of a deal for me? And, you know, Rick, I just feel like that gives me a ton of a ton of freedom, to, to be, a citizen legislator with my life and my livelihood and my home and everything is is back in my district. Bill Hauter 00:31:40 It's it's I don't care if I get re-elected. In fact, you know, this may sound this may sound bad, but if I don't get reelected, my life is better. Okay, so I'm doing this because I felt a real commitment to it. I feel real desire to to to do this for a temporary period of time and make an impact temporarily. But I've continued to practice, and I think that just gives me so much freedom because I don't have to. I'm not dependent on the salary. I'm not dependent on the on the stepping stone of getting me higher. And this is not a stepping stone to get me a higher office. And so it just feels like, so freeing, that that I can say what I feel I can vote how I feel. And, and a lot of, I feel like a lot of politicians that are career politicians are a little bit bound by that, by that desire. Keith Reynolds 00:32:50 So that's what it takes to get elected and to do the job when you get there. Keith Reynolds 00:32:54 But what would any conversation with the doctor be without some advice? And let me tell you, these physician politicians have a lot of it to give. Doctor Steiner of Oregon recommends finding out exactly what you have in store for you if you win before you even declare. Elizabeth Steiner 00:33:07 I think it's really important to understand that being a legislator requires a lot of patience and a lot of tenacity. And you have to be prepared to be disappointed a lot. Keith Reynolds 00:33:21 But a theme we kept hearing from all our interview subjects takes us back to the beginning of our guide. Ami Bera 00:33:26 Try to figure out why you want to run. Kim Schreier 00:33:28 Focus on your why. Remember why you authentically are getting into this race. Bill Hauter 00:33:33 Be clear on your motivations. Elizabeth Steiner 00:33:35 I think it's really important to understand why you're doing it. Keith Reynolds 00:33:38 But even if you decide that running for office isn't for you, it's important to be involved or at least informed about what's going on politically. Doctor Mann of Minnesota notes that legislatures are taking a more active role in regulating the act of providing care. Alice Mann 00:33:51 Medicine and politics are completely intertwined. Alice Mann 00:33:53 Now they are one and the same. the care that I provide for my patients has a direct correlation to what's going on in local and federal politics. People who have never touched a patient in their lives are making laws about how I practice medicine. And if we don't become more involved, the system is just going to get worse and worse. Because again, if you've never touched the patient, you have no idea what steps are necessary and what your day to day looks like and what what things need to be done to provide the best patient care. And so I always, every time I have a chance, I encourage physicians to please get involved. And that doesn't mean that you have to run for office. It just means that you have to perhaps call your representative or call your state senator. Keith Reynolds 00:35:01 And that concludes this special Election Week episode of Off the Chart with Medical Economics. We'd like to give our thanks to all the physician politicians who spoke to us for this episode, and a special thanks to medical economics editor Richard Perkin, whose reporting was key to this endeavor. Keith Reynolds 00:35:16 You'll find links to his featured report in the show. Notes. My name is Keith Reynolds, and on behalf of the whole medical economics team, I'd like to thank you for listening and ask that you please subscribe to the show on Apple Podcasts and Spotify. Also, if you'd like to digest the best stories Medical Economics publishes delivered straight to your email six days a week, subscribe to our newsletter at Medical economics.com. Medical economics, Physicians practice and patient care online are all members of the life sciences family. Thank you. And don't forget to vote.