Latest / Off the Chart: A Business of Medicine Podcast / S1 Ep127: When ICE shows up: What medical practices need to know, with Katie Russell, J.D.

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S1 Ep127: When ICE shows up: What medical practices need to know, with Katie Russell, J.D. · Off the Chart: A Business of Medicine Podcast

• 0:00 One big common misunderstanding is thinking that healthcare, because it's so critical, because it's so essential, is in some way insulated from, you know, being held to account with some of these compliance standards. I always tell folks, you know, healthcare employers are subject, you know, to the same employer compliance standard as any other industry. Welcome 0:27 to off the chart, a business of medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Luttrell. I'm the associate editor of medical economics, and I'd like to thank you for joining us today before we get started. Just a quick note, physicians practice will be hosting practice Academy's new practice management track on Thursday, March 19. The virtual learning experience is designed for physicians and practice administrators looking for practical, real world strategies to strengthen operations, improve performance and build stronger, more resilient practices. Speakers include Anders Gilbert of MGMA, Bronson, Cox of vemkoda, Justin, Lamb of cool blue, VA and Mark Herzog of Vera. Dime. You can register today by clicking the link in the show notes or by going to registration.physicianspractice.com that said in today's episode. Keith Reynolds, the managing editor of physicians practice, sat down with Kate Russell, a partner at Brown immigration law in Cleveland, Ohio. They're talking about what recent shifts in immigration enforcement mean for medical practices, including how workplace compliance audits are evolving, what employers need to understand about I nine documentation and how to respond to federal officials arrive at a practice. Katie also explains changes to H 1b visa rules, including the new $100,000 fee and what practice leaders should and shouldn't be worried about in 2026 Katie Russell, thank you again for joining us, and now let's get into the episode. 1:56 Hey there, folks today we are talking to Katie Russell, a partner at Brown immigration law. Katie, how you 2:02 doing? I'm doing great. Keith, how are you? 2:04 I can't complain too too much. We chatted back, I believe it was in October, maybe September, and, you know, we talked about all of the stuff that was going on with immigration in America. Feels like it's been a million years, because that much has happened since then. So without much ado, let's dig right in, because there's quite a bit. So since October, you know, what are the most significant changes you've seen in the way that ice enforcement is being directed, and how it's sort of affecting, let's say, medical practices, but just sort of businesses overall, definitely. 2:39 So you know, clearly, quite clearly, there have been many changes and lots of media coverage of the various new ways that ice has been utilized, and now, luckily for medical practices, not a lot of fireworks going on here. I would say that the biggest shift that we've seen really is more towards, you know, like employer focused enforcement issues, so less about having dramatic raids, and it's more about scrutinizing compliance documentation. It's a real snoozer. There's not a lot of, like I said, not a lot of stuff that the media covers with this, because it really doesn't get the clicks. But things like I nine form completion, that the forms are done accurately, record retention and visa petition adherence, if you've got non citizens that are working with you on work visas. So, you know, with the I nine form, sometimes I'll talk to employers and like, Oh, I'm not familiar with that. And like, well, that might be an issue. Please ensure that you have an admin or HR that is working on those. But you know the form I nine that is required for all employees, regardless of immigration status, and yes, US citizens must also complete them, even a small technical error on that little form, or even an outdated policy using the wrong addition, not completing the paperwork properly, that can trigger exposure. Now, I nine audits. They're very rare, but I have received many a panicked call from local businesses that say, Hey, you know I got this, this weird notice. I have three days to turn in all my I nine and supporting paperwork. I don't know what this is, and what do I do? So, you know, we can still try to address things in that three day period, but the best recommendation I have is, look, you want to be proactive. And, you know, this might not be the most exciting thing we do internal. I nine audits. Quarterly. I'm in charge of our I nine binder. You know, it's just something that's kind of we've we've seen enough horror stories come across that, you know, we really just encourage employers and HR departments, admins, whoever it is, just make sure you're documenting the I nine paperwork, supporting documentation. You want to have that done and taken care of. It's easy make it part of. Standard onboarding, because let me tell you, the fines and penalties can be substantial if a practice is not being proactive and doesn't have all that lined up. So the practical takeaway, I would say, is, you know, it's not so much dramatic enforcement operations that we're seeing being launched on practices. It's really administrative. So it's compliance driven, not operationally disruptive, but it is still good to make sure that you're in a good position. 5:27 Okay, so, you know, you mentioned that it's, you know, it's less of the dramatic stuff when it comes to, you know, practices, more clerical, you know, ticky tack, we shall say just to, you know, we have to describe these things somehow. So how have, sort of, what, what has led to the shift, would you say, of priorities? Because, you know, it's, you know, last year, especially, we were seeing a lot of, you know, workplace, workplace, like raids, sort of deals. What sort of shifted, and is that, is it really an increased risk of these sort of clerical issues compared to, you know, years past? 6:11 No, I mean, I would say that, you know, this is something that's pretty consistently come across our desk, and you know, we'll get, you know, contacted by, you know, different companies, it's not something that's new, I guess I'll say that it's just something that we've seen kind of a low volume of those just kind of in the background at all times. The best thing that you can do, really, is just being prepared, making sure you have all that documentation done, that you have good training. You know, I have been hired by a number of different employers recently just to come into their offices, come into their practices, and just sit down and meet with everybody on staff. You know, what happens if ice shows up? What type of documentation is must be provided, having, like a contact person or a go to person with, you know, kind of like a walkthrough of are, these are the things that we need to do if, you know, if an ice officer shows up, or even if it isn't ice, it could be another type of, you know, federal immigration office that may want to come up to be doing a work site visit. You know, could be something like someone here on an H, 1b, Visa, for instance. Those aren't necessarily ice, but those are still immigration officers or folks that are coming in just to ensure that, you know, there's a proper filing in place, that the right disclosures have been made, that the person is doing the job that they're supposed to be doing. So, you know, it really does not get the media attention, because these aren't like fancy fireworks, but it's, it's more of a, you know, a background thing that I always tell folks, you know, if you have us come in, or have an attorney come in, or have your HR go get some training on I nine compliance and making sure that your visa documentation is an order that is going to save so much of a headache later on down the line if Something happens. So this really isn't anything new, but because of everything else going on, environmentally, with immigration, generally, a lot of folks are going, Well, wait a second here, like, is there any type of exposure that we could have if ice shows up knocks on the door? So just making sure that all your ducks are in a row, most practices have absolutely nothing to worry about. I know that's not really going to sell much, but the fact of the matter is, is that it comes with preparation and planning. If you've got, you know, a non citizen that's working for you, or if you've sponsored a non citizen with a work visa, you know, you should already have had an immigration attorney that helped you with that process, either someone in house and House Counsel, or if you have someone that you pertain for it, you know, we keep a very close eye on all of our employment based cases, even after approval, because if there's a change, you know, in someone's job duties, if there's a material change in what they do, or a change of pay beyond a certain threshold, that technically requires an additional filing to be submitted to USCIS to amend it. So it's, you know, it's a lot of kind of low, low, simmering attention that needs to be spent on it, but just making sure you got the right people and practices in place that's gonna, that's gonna save you so much of a headache. 9:17 All right? So you know, what are, what are practices really misunderstanding about their obligations. Like, you know, you're hearing from people that, you know, what are I nines? Like, what, like, what's the big, you know, disconnect there, or disconnect? 9:32 Well, I would say one big common misunderstanding is, you know, just kind of thinking that healthcare because it's so critical, because it's so essential, is in some way insulated from, you know, being held to account with some of these compliance standards. And you know, that's not the case. I always tell folks, you know, healthcare employers are subject, you know, to the same employer compliance. Standards as any other industry. So just making sure that you have all of your documentation done again with the compliance, whether it's I nine documentation or petition terms, or just making sure that you're keeping an eye on, you know, the expiration dates coming up on someone's visa is a renewal due. Should the you know, should the practice be requiring someone to provide a new document, or if they go, oops, I just noticed that your employment authorization expired six months ago. You know, how do we, you know, go about fixing that? So it really is about preparation. I think some other concerns that I've had with work sites and practices is, you know, like, you know, when do we let lice ice in? Like, when do we, you know, have to turn things over to them? That's another reason that it's really important to have, you know, an attorney come in, even just to have, like, a, you know, a quick hour long meeting. We've got a PowerPoint presentation that we share with folks all the time. Hey guys, you know, we'll get some bagels sit through this. Hopefully this is something that never comes up. But preparation is that thing, and making sure that, you know when, hey, all right, we can handle this, or, you know what, we have to pick up the phone. We want to make sure that we get our counsel on this, and make sure that we can step aside and make sure that we're all we're covered there. 11:18 So, you know, last time we talked, you sort of explained the difference between, you know, a warrant from a judge in a administrative warrant. We're seeing in the news that there has been some mixed messaging to our brothers in ice, who you know as to what they're able to do with an administrative warrant and a judicial warrant. Are we seeing any sort of increase of them trying to expand the powers of an administrative warrants when it comes to workplace enforcements, 11:52 there have definitely been instances, you know, anecdotally, I have had some instances in which, you know, someone comes in with a piece of paper that may or may not say what it's supposed to or it may not be the correct warrant, you know, for whatever access is being requested. So that's, you know, there is a lot of there are a lot of questions, and it is, you know, kind of a challenging legal question as well that we are seeing quite a bit of shifting with, you know, is it a judicial warrant? Can we use an administrative warrant? What type of reach and what type of scope is covered under each of those things? That's something that we tend to cover under intensive trainings. Also, there is, like, a publicly accessible portion of most practices, and then behind a certain door, you know, those cannot be accessed unless consent is given or if there is a warrant granting that access. So some of the site visits that I have done is, all right, we kind of walk out there, hey, this is the area that you know, so it's open to the public. Folks can come in, but then beyond a certain point, you know, this is the hard line that folks can't come through. Do not grant access, you know, unless you have something. And you know, honestly, we're on call for a lot of those scenarios because, you know, practitioners want to protect their staff, their patients. You know, this is, this is something that's affecting, you know, real people and real individuals who find themselves in very, very vulnerable situations that if you have with someone that's going in for medical care, they need that medical care, and they shouldn't have to be worried about, you know, what could happen? Or Should I skip this doctor's appointment because I'm afraid that, you know, an agent or an officer may come through, and you know, I'd say just knowledge and training is the best way to go about it. 13:42 Okay, so I'm throw a hypothetical at you, yeah, so say we're in a practice. There's a, you know, a you know, some sort of DHS employee trying to get in. They have a warrant. Our our staff, don't know if it's a judicial warrant or an administrative warrant. They have not done the background. You know, they're they're not prepared for this moment, in the split second, you know, should they try to keep this DHS employee out of, you know, client or patient spaces? Or should they, you know, just let the DHS employee, you know, do their thing and worry about it in court later. 14:28 And that's a great question. Honestly, that's what happens. And you know, a lot of times folks will freeze because they go, you know, I want to do the right thing. I don't want to be, you know, impeding an investigation. You know, despite, you know, a lot of the negative press, you know, there's our federal agents and officers are are are doing a job, and often they're doing a very legitimate, important job that we want to make sure that we're not impeding improperly. So, you know, I always tell folks. Is, you know, first verify the warrant asked for it not, hey, it's in the mail. Or here we're gonna let you know. You know, you need to have someone who, again, is trained to look for, you know, certain languages. And we've got, you know, a handout we can give to folks with redacted examples of what these different types of warrants really look like. You know, look at who the issuing authority is, is it, you know, an internal ice officer? Is it a judge? What is the scope and any limitations that are placed on it? Because that's going to be something that's specified in a warrant. Don't just until verified staff should not grant unrestricted access. Everything should be documented. Note the officer's name, badge number, sometimes they have a card with them the time of interaction. Keep a photo or copy of all of that documentation and call Council. I would say that that's going to be the most important thing to do if you know, if they're really feeling pressured, or you know, they've got something. And while this looks legit, and this looks like it's specifying, it's signed by a judge, it's specifying our address, it's saying that they can search and see certain things, you know, then you do have to allow them to go with that. But that's why having counsel is so important, because those are split second developments, and there is always an element of surprise. They really don't give you advance notice so you can make sure you've got, you know, the person with the briefcase, they're ready to go through it with a fine tooth comb before they grant access. 16:32 It's the Monty Python thing. No one expects a Spanish inquisit No. 16:35 It's always a Spanish Inquisition. Man. It's Gotcha. You Keith, 16:47 hey there. Keith Reynolds here and welcome to the p2 management minute in just 60 seconds, we deliver proven, real world tactics you can plug into your practice today, whether that means speeding up check in, lifting staff morale or nudging patient satisfaction north, no theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom. They come from you got a clever workflow. Hack an employee engagement win, or a lesson learned the hard way. I want to feature it. Shoot me an email at K Reynolds, at mjh, life sciences.com, with your topic, quick outline or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next p2 management minute. So in every group, there are those who straggle behind, we shall say, and don't keep up on certain things. So for groups that haven't updated their compliance plans in the past year, what's the first thing they should have right now? Like, what should they be revisiting? 17:57 All right? Well, it's, it's the most exciting thing that they will do all year, they have to check in with their HR, their admin. You know, no matter how big or small a practice is, you've got employees in the United States, you've got folks that are in charge of onboarding. They have to do the documentation. They've got to complete the I nine form for every employee. That form isn't just something to this stuff in a mystery file or stick on a shelf somewhere. You got to keep them organized, all right. So no matter how big or small or how far along, how organized a practice may be, with things like I nine paperwork, which is clearly, like I said, the most thrilling thing you can do. The most practical thing is, you know, just do a check in. Where are you? See where you are at this documentation first, let's you know, is there a policy that we have is, you know, the designated employee who is completing the I nine paperwork with new employees, you know, are they trained? It might be a good idea to do a training refresher. You know, of the many, many responsibilities that admin or HR are tasked with, with running a busy practice, you know, one of those things, it's going to have to be this documentation. And it's always good to have a refresher. If you look at the i nine form itself. You know, it's really not all that intimidating. People like this is fine. I got this, but, you know, there are certain deadlines that, you know, part one is going to need to be completed, you know, before they start, or on the same day that they start, and they've got to inspect the documentation within three days of higher you know, there's a lot of little deadlines that are important to be mindful of. So having an internal policy doesn't have to be anything complicated. Could be a one pager just to go through a checklist when onboarding someone, make sure you go through it all. Make sure it's documented correctly. You're signed up for the E verify system that's basically doing the I nine on. Line and get immediate verification and confirmation back that the government says, Yes, this person is who they're saying they are, and that is their correct documentation. Do that? Make sure you have it. Keep it all organized and together. So I'd say checking in. What do we got going on? Do we have nothing? And we're just building this from the ground up. That's going to be better than where you were before, keeping it together, keeping it the binder and reaching out for help. You know, there's a lot of really great resources, not just attorneys, not just immigration attorneys. There's a lot of really great resources out there that you just want to make sure you get that put in place. So having a plan, checking in, how are you doing, and sometimes talking to an attorney, if you, if you don't know where to start, or you want a template, that's something that we help folks with too. 20:48 All right, so you know, with that, you know it's, I'm hearing about all this administrative, you know, just, you know paperwork, making sure your paperwork is in line. You know is there. And you know, I am, I am. I'm not an attorney. If you could guess, is there a point in all this, besides just trying to, like, trip up businesses and practices, like, you know, you know, is there a an affirmative reason for this beyond just, you know, trying to, trying to trick people 21:18 I know, and that's really what it feels like, and I know that, you know, that's that's not why these laws were set in place. You know, if you look at it, you know, something like the I nine, it's really just a very low bar threshold that, hey, you're you want to work for me. We've just got to make sure that we've got confirmation that we have your identifying information and then you have permission to work here, you know, so I don't, I don't mean to, you know, I never want to stress employers out. I never want to, you know, stress doctors out when they're running their practice. But, you know, it really isn't designed to trip people up again. It's just more of a paperwork thing. I know. Doctors are no strangers to the fun and joy of just endless paperwork and documentation. It's just one of those things that you know you just got to do, hopefully you go through an entire career, never having to once worry about it or question, where is our I nine binder of documentation, but it's just good to have it as insurance in the background, and I will use the insurance against them, because you know, it's, it is it is something good, just to do that, to make sure you're not going to have issues, keep yourself covered 22:28 the cya school, 22:31 name of the game. That's the name of the game. That's all it is. 22:34 All right. So let's turn now to the new $100,000 fee for H, 1b, visas. You know, how does this actually work? And you know, who's bearing the financial responsibility of these, these, you know, seemingly, you know, again, from a layman's point of view, insane amounts of money. 22:54 I think that, yeah, I mean, that really is a legal term of art when we're talking about some of the changes that were announced last year to the H 1b program, and there was considerable panic. You know, we have a very broad and diverse kind of corporate client base here at firm. And you know, small businesses, large businesses, huge corporations that you know, when they're looking for talent, and they're looking for someone to fill a position. You know, the first question in their mind isn't always Well, are you, you know, a US citizen? You know, are we hiring American? You know, that's all well and good, but in some of these very you know, critical fields, you want the right person, you know, you want to make sure that, Hey, I like this person's background. We see eye to eye. We are aligned. And this is someone that, if I'm hiring someone on to be helping my clients or serving my patients or working shoulder to shoulder with me in my practice, you know, I want to be able to have the ability to bring them on. So there was quite a bit of panic about, you know, is this the end of H 1b does this mean that we can't bring these workers anymore? Luckily, that is not the case. You know, unsurprisingly, I think it was kind of a door in the face technique with the administration and how this was presented to all of us. You know, it just said you're going to have to pay $100,000 boom. Of course, the initial announcement was not, I would say, detailed or nuanced in, you know, kind of the sense that attorneys are looking for, all right. Well, there are so many different situations in which an H, 1b can be utilized, and so many different, you know, answers that we need to be able to give, not only ourselves, but the folks that we serve. So as time went on, there was additional clarification, and luckily, you know, we've been able to come to an understanding that for the majority of our clients, they're really not effective. Now this $100,000 bound. Whatever you really want to call it, you know, from the White House's perspective, you know, they're looking at it through, you know, the lens of their agenda. You know, this is to reduce the incentive for hiring foreign workers, you know, based on lower layered costs. We want to aim to protect American workers. And that's, again, that's all well and good, but ultimately, with the H, 1b, generally, so it's a very common work visa for professionals, for specialized occupations, dentists, physician, physicians, you, you name it. It is an employer sponsored process that that means that the employer is the petitioner, meaning that they are our client when we're working through this to help them bring a worker here, but they're also responsible for these fees. Now, this $100,000 fee was clearly meant to be a deterrent, to really reduce dramatically the number of H 1v visas that are issued. However, the majority of the H 1v processes that we do are for folks that are already in the United States, let's say they came to the United States. Is a very common pathway. They come to the United States on an f1 visa, that's a student visa. Say they're here, they go to school, they graduate, they find an employer that's willing to sponsor them. They get sponsorship, if they're doing this process from within the United States in that they're changing their status, hopping from student status to OBT another temporary work permission into something like H, 1b that process has not changed. There's no $100,000 fee for that. So that has been a huge relief. Because, you know, that is a huge chunk of the folks that are are, you know, being brought over, or being brought over into that status is that they're already here in the United States. They have a relationship already established with an employer with a position here, and they want to kind of bring them on. So, you know, it's still something that is impacting quite a few folks. It's primarily affecting the people that have not yet received an H 1b visa in the past, or have never hold held that status, and if they are not doing a change of status here in the United States, but rather through their consulate overseas. It's called consular processing. So for folks that need to leave the United States or in order to enter the United States, they would first need to go and get that visa, have it issued at the embassy or consulate. Those are the applicants that are subject and I can tell you that. You know, as we're approaching H 1b season, now, the lottery is opening here in a couple weeks. We were kind of bracing for, you know, hey, with this new rule in effect, we're probably not going to see as many h, 1b, processes, you know, this spring, and we really haven't seen any difference, which is great. So that means that, you know, this is still a very common, very heavily utilized and properly utilized visa classification. I have no doubts that there were abuses that they were targeting and are using as a justification for cracking down on this. But you know, luckily, the way that we've done it with our firm, we have not seen any changes. We're hoping for no bumps ahead, but that $100,000 kind of deterrent penalty. It's not every H 1b It's many, and it is going to make harder for folks overseas that are looking to come work in the United States. But it's not, not as bad as we were all bracing for. 28:31 Okay, so when you know, when one of these, you know, are, you know, these consular H 1b are coming over, you know, who pays that? You know, are they paying it or the company that's bringing them in? Like, who's, who's dropping the who's dropping the dough? 28:46 Well, I mean, I don't, frankly, I don't know who's going to be dropping the dough, because that's, you know, it is an amount that it is. So, you know, that's more than the wage that's, you know, often more than the, you know, the annual salary that's, you know, that's offered to someone. So, you know, all fees need to be paid by the sponsoring employer. And so, you know, again, that's a hard that's a hard pill to swallow that I'm sure that there are folks out there that aren't batting an eye to make sure that they get the right person to come over to fit their business's needs, but that's pretty tall order. 29:23 Yeah, it seems, you know, it's not going to be a problem for the Cleveland clinics of the world, the John Hopkins, Johns. Hopkins got that right, almost said Bob Hoskins. That's not the 29:33 right guy. You don't know anybody named Johnny Hopkins. Yeah. 29:37 So, you know those are, you know, those are probably not going to have a problem with it. But, you know, the the the Rural Hospital in Wichita is probably, you know, not going to be able to drop that sort of dough. All right, okay, so are there any structural or legal strategies that practices could use to try to mitigate that? Uh. That that cost. Besides, of course, you know, trying to hire someone who's already in the country on a, I believe he said it was an f1 you know, what 30:12 can we Yeah, I mean, you know, they're the H 1b. Is not the only game in town. And a lot of what we do as attorneys is, you know, we've got this, this visa system in the US. It's, you know, A through Z, you know, there's, there's a visa for every letter in the alphabet. A lot of times, if, you know, if we're working with someone, and we're like, hey, let's just kind of spitball. Let's see what we got. Let's, let's play with the information a little bit. Let's see what we can kind of cook up in terms of alternatives. And oftentimes, we can find a different pathway. We can find a different type of visa, whether it's non immigrant, you know, something like the H, 1b there's a lot of different type of work visas. It's that's not the only one that folks can pick from. You know, there's, there's those non immigrant options, sometimes there's also immigrant options, meaning that an employer can also sponsor someone to get permanent residency. So that is the pathway that we often introduce to folks and say, hey, you know, I know you've done your research. I know you've heard about this stuff. I know you read online, you know, before the consultation. But let's maybe take a step back and just kind of blow this thing up. Let's reimagine what this could look like. And those conversations are often so much fun because we're able to say, All right, you came into this conversation thinking that this was all you had to work with, and that you had these list of problems and questions for us to get through, you know. And we did, but we kind of blew some walls down, and maybe we identified something that's going to be a better fit, maybe less expensive, maybe faster, maybe, you know, not going to be subject to the H, 1b, restrictions, you know, whether it's the fee or the lottery selection. You know, there's so much that comes with it that often we can find better options. And that's that always feels really good, because ultimately, we're here to help people get the folks that they want, you know, find a solution and be creative with it. So that's really satisfying. And I would say like, you know, really just comes down to what kind of relationship you have through Council, sit down and don't just assume that you can do what you've done every year for every worker that you've had. A lot of times there's better options and things get that can be a better fit. 32:30 So what I'm hearing is become friendly with your attorney. Yeah, take it. Take them out to dinner. Find out what they you know, what the options are. Okay, I get it. I get it. I get it so like for for practice leaders who are feeling overwhelmed by all this, the heightened ice enforcement, Visa costs, all this sort of stuff, you know, what is the most practical first step they can take? You know, we won't say today. You know, it's 230 on a Thursday. Nobody's going to do anything today. But we'll say, you know, this quarter, you know, you got a couple weeks left, you know, what can they, what should they be doing this quarter, to just sort of, at the very least, ease their own stress about this well, 33:13 and this is something that I say to folks, you know, whether they're running a business, a practice, if it's just, you know, an individual, someone worried about their family. I mean, this is just advice that I give to everybody. What I have seen, more than anything in the past year or so of this administration is that just knowledge is power. And I, you know, I say that in the sense of, you know, most of my nine to five, which is, which is not my complete work day. I'll add, that's the fun part of my day. That's, that's when I have conversations, that's when I have consultations, whether it's over the phone or here in the office. That is what I do from nine to five every single day. And it's, you know, cracking through issues with all different types of immigration cases, people all over the world, people from the US, you know, just let's narrow down what we've got and see if we can find something that can work. I have really found that a much higher percentage of those conversations really aren't so much about the legal issues or some specific process, but it's just helping them get a handle on what do I need to be worried about? You know, you don't have to be afraid of ice jumping on the walls to get you in the middle of the night. You haven't done anything wrong. 34:32 Alrighty, that's all I got for you. Anything you'd like to add, anything you think I'm overlooking? 34:38 No, I mean, look, I would say that. You know, it's again, it's just a lot of it, the stuff right now, it's just, you know, compliance, you know, be informed when you do have a quick minute, you know, do fit a call in with somebody, whether it's your own counsel, someone that you've worked with before, maybe someone new, just just to get your. Bases covered, and even just to have a plan in place for staff. Because, you know, even here internally, we've had meetings, just so that everybody feels that sense of assurance that, all right, you know, someone's on it. You know, we're not just left here alone in the dark. We've got a plan. We've got to go to and that, you know, my whole job now, I feel it's just kind of calming people down, easing anxiety and just throwing cold water on this panic that just seems to have gripped everybody. 35:27 Alrighty, thank you so much, Kate. It's always a pleasure. 35:30 Thank you so much, Kate. 35:42 What's Russell, a partner of brown immigration law in Cleveland, Ohio, speaking with Keith Reynolds, the managing editor of physicians practice on behalf of the whole medical economics and physicians practice teams. I'd like to thank you for listening to the show and ask that you please subscribe so you don't miss the next episode. And don't forget, physicians practice will be hosting practice Academy's new practice management track on Thursday, March 19, featuring practical, actionable education for physicians and practice administrators. You can register today by clicking the link in the show notes or by going to registration.physicianspractice.com as always, be sure to check back on Monday and Thursday mornings for the latest conversations with experts, sharing strategies, stories and solutions for practice. You can find us by searching off the chart wherever you get your podcasts. 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