058 - Who Are IndeDocs? President Dr. Marcelo Hochman Dives Into The Crucial Foundation Of The Doctor-Patient Relationship In Medical Practice

This week on PRACTICE: IMPOSSIBLE, is an individual who specializes in facial plastic and reconstructive surgery, Dr. Marcelo Hochman. JPMD hosts Dr. Hochman as he discusses his engagement with IndieDocs as well as the efforts that are being made to abolish the Certificate of Need (CON) in the state of South Carolina. 

A CON is a state permission slip that is required by medical professionals, businesses, or organizations to get, in order to construct facilities or deliver specific services. Dr. Hochman discusses the detrimental effects that the CON had on patient access and cost, as well as the successful repeal of the law in South Carolina. Additionally, he covers the difficulties that physicians face when non-compete terms are added to their contracts, as well as the significance of educating patients about the advantages of independent practices. Within the context of the future of healthcare, Dr. Hochman places a strong emphasis on the power and worth of physicians., which is evident in this important and candid, discussion.

Show Notes

Spotlight on Marcelo Hochman, MD

https://www.hispanicoutlook.com/articles/physician-spotlight-dr-marcelo-hochman

IndeDocs Website – https://indedocs.com/

The National Law Review Article on the South Carolina CON repealed law

https://www.natlawreview.com/article/south-carolina-sunsets-certificate-need-law

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Transcript

Coach JPMD (00:00.652)
Welcome to the practice impossible podcast where your host Jude Pierre MD also known as coach JP MD discusses medical practice topics that will guide you through the maze that is the business of medicine and teach you how to increase profits and help populations live long. Your mission should you choose to accept is to listen and be transformed. Now here's your host coach JP MD. Well, welcome back Dr. Marcelo Hawkman, Dr.

Hockman, you know, I thank you for coming back on the podcast again after a snafu with the audio quality on the last podcast interview. Glad to be back. In fact, I'm happy that I have a new microphone that takes care of the problem. Yeah, it sounds great. Sounds great. And we'll try to recreate that conversation. And, you know, it was a great conversation. You told us about yourself and what you've done in South Carolina. And love for you to tell us.

who you are and what you do and introduce our audience to you. Sure. Marcelo Hockman. I'm a facial plastic and reconstructive surgeon here in Charleston, South Carolina. And I'm currently the president of Indie Docs or Independent Doctors of South Carolina. And I've been here about 30 years in independent practice. Came to the U .S. originally from Venezuela.

became a US citizen and stayed on through college, medical school and training and such and ended up in Charleston where I spent 10 years in academic medicine. So full -time employed academic medicine. And then since then I've been in private practice with still a strong tie to the medical university here. My practice really is pretty broad.

I treat children with, vascular tumors, vascular anomalies, all the way to adults with collective cosmetic issues and migraine surgery. And so I see a nice breadth of, of patients, which fits and suits me well. So, you're not part of a larger organization right now. You're part of, I'm solo independent. Correct. It's just me and,

Coach JPMD (02:24.482)
I, of course, have privileges at the hospitals and in fact have a clinic at the children's hospital, but I'm, it's still just my own practice. Awesome. So let's go back a little bit to Venezuela, because I always like to hear origin stories because I think some of your stories similar to mine and that you grew up in Venezuela. So I didn't realize you were born in Venezuela. Yeah. So I was technically born in Argentina.

But grew up in Venezuela. So when people ask me where I'm from originally from Venezuela and my parents moved there because of my father's business and he was in the oil business and that's how they ended up there. went through, you know, elementary, middle school, high school in, in Venezuela. And my dream was always to come to the U S for college and go to medical school and

and it worked. So your parents are from Venezuela or Argentina? Again, they were originally from Argentina, but then spent 30 plus years in Venezuela. My father had become a US citizen in his 20s or so. And my mother to this day is still a Venezuelan citizen.

And are they local or are they? My father passed away about 19 years ago, 18 years ago. And my mother lives in Texas with one of my sisters. Awesome. So you, you described what you had done in South Carolina. And I just wanted to kind of go right into that because I thought that was fairly significant in terms of,

how you were able to be involved with legislation in the certificate of need area for the state. And I thought that it'd be interesting to help us understand what was it that you did for the state of South Carolina. So when I was president of our local county medical society, I had to have an agenda, right? You have to have a presidential agenda.

Coach JPMD (04:48.41)
And so I had been thinking about this for a while and had been involved in a variety of little things here and there. But I kind of try to come up with things that, if we were able to do it, would change the landscape of health care delivery in our small state. And the fact that doctors, I feel, have a lot more power and leverage than we give ourselves credit for or that we actually use.

So I just took that as an opportunity to say, what if we repeal the certificate of need, which would allow doctors to practice, you know, provide whatever services, you he or she wanted, and what if we got rid of non -compete clauses so a physician could practice wherever he or she wanted. And we had some way to incentivize charity care so that

physicians could do more of what we all would like to do, which is to help. But as the hospitals and physicians become employed, it's very difficult to do true pro bono care within the hospital system. I mean, it's hard to get a patient in, for example, for pro bono care. Yet in my private practice, I can do that readily. I mean, I just have to see them, and that's it.

So I figured, you know, and again, these were my ideas, but you know, it took a lot of work on a lot of people, but we decided to take on the CLN to repeal that law because there was a law to repeal. Had been a dead issue for decades and six years later or so we were able to repeal it this summer, you know, so just took.

kind of understanding what the process is, identifying a real issue that had a solution that we could educate the legislators about. Remember, legislators, they themselves will joke about that their knowledge base is about one inch deep and about six miles wide. So they have to participate in all these things, yet they only know a little bit about them.

Coach JPMD (07:14.196)
So it took really the first thing was educating the legislators about why this was a problem and slowly, you know, getting them to know. And when it finally came down to the final, final vote, it was unanimous, you know, both in the House and the Senate. So what is a certificate of need? So to kind of back up, because most people don't understand what that is in terms of health care space. Yeah. So certificate of need. So you're right. A lot of people don't recognize the term, but

all of us are affected by it when it's in effect. So the certificate of need is basically a state permission slip for a doctor or a company or a group to provide a certain service or build a certain facility. So for example, South Carolina had the ninth most restrictive

which means that there were 25 plus services and facilities that you had to convince the state that there was a need for that.

The problem with the way that that was set up was that the people who already had a certificate of need in hand, so for example, hospital has a CON for radiology suites or whatever, now you wanna come in and set up an independent imaging center, you have to prove to the state that that imaging center is needed, which in and of itself is, you know,

doesn't make sense, but what was worse was that the hospitals or anybody who had a CON for the service that you wanted to provide or build had the ability to stop it. So. So they could stop it by building their own or they can stop it just by saying, no, I don't want it built in my community. Yeah. Just saying that we don't need that. And, would basically.

Coach JPMD (09:18.89)
stymie the efforts of somebody new coming into the marketplace. In the hospitals, you know, tend to have very deep pockets and a lot of influence and most independent practices, you know, it's very hard to, you know, to, so a lot of the fights didn't even start because as soon as we filed it, the CON application, the hospitals in the area would contest it. And that was it. And they fought,

Amongst themselves, you know, I mean, the hospitals themselves sue each other and keep each other from building hospitals and this and that spend 10 years, millions of dollars. And at the end of the day, everybody builds whatever they want, but they're able to keep the fight going, you know? So as of this summer in South Carolina, the certificate of need for everything except nursing homes and hospitals is gone.

in a year and a half or so, the certificate of need for hospitals will be gone as well. So it will be basically 99 % eliminated, which means that anybody can come into the marketplace and if they're able to make that business work, it only helps patients and access and will help with pricing.

mean, it's like Lowe's being able to tell Home Depot that they can't build across the street. Which they do all the time. Which they do on purpose, right? Because it's good for everybody. It's good for the companies. It's good for us as consumers. so there's a reason why that works. So why has it been proliferated so long, so hard? mean, I think I know why, but I'd like to hear from you.

Yeah. Well, basically, you know, it was a program that started in the seventies, I believe, by the federal government, you know, trying to contain costs and try to provide prevent, I'm sorry, duplication of services. You know, do we really need 40 MRI machines and, know, that kind of thing? So it was, you know, as most laws, there's some good intention, tons of unintended consequences. So very quickly, the federal government said, yeah, forget it. That didn't work. Okay. But.

Coach JPMD (11:40.942)
In the ensuing time, states had passed laws and started enacting the CON requirements. And whenever you have a law, you have special interests, right? So if there's a law that benefits you, you're gonna fight to keep that law in place, right? So there we were, you know, 40 years later with a law that was making access harder, driving prices up.

fewer alternative for patients, clearly no improvement in quality. But there was a group that was very powerful that wanted to keep it going. I it tooth and nail and they lost. So in a year and a half from now when the hospitals no longer have a certificate of need in South Carolina, do you think that small doctor practices will...

be incentivized or want to open up hospitals because you hear about hospitals closing down in rural areas. Well, hospitals are closing regardless, right? So that was one of the arguments, in fact, that the systems were using to keep the C .O .N. law was, if we get rid of the C .O .N., then these hospitals are going to close. The fact of the matter is that hospitals were closing anyway. Right. But does. You know, it opens the door for micro hospitals.

You know for you know, maybe you don't need a 300 bed hospital, you know, maybe a certain community what they really need is a small 10 bed hospital and You know a bunch of smaller surgery centers or GI or birthing centers that you don't have to do that in the hospital, right? Yeah at hospital prices, so If you can make it work Great

If you can't make it work, then there's reasons why that's happening, right? So it just evens the playing field, you know, and the hop. It hopefully lowers the cost because if you have competition, I always say competition helps drive better services and it also potentially decreases costs because when you look at, you know, we had a patient that needed a colonoscopy and

Coach JPMD (14:00.716)
Just routine colonoscopy and they refuse to do it at surgery center. Not that they refuse. Medicare wouldn't pay for them to have the services at a surgery center because the patient had any ICD. So they needed backup for anesthesia to have a routine colonoscopy done at a hospital that is on the campus of the hospital systems, by the way. So it's absolutely crazy, but if Medicare's not paying for it, then the surgery centers are not going to able to schedule those patients.

Right. So, you know, in patients, you know, when we talk to patients about why they can't have the colonoscopy at the surgery center, or why do I have to have my carpal tunnel surgery release at the hospital when, because there are no surgery centers around, you know, they get it. They may not know or recognize the term CLN, but they got it, you know, and they were very helpful in testifying.

And again, the legislators just got educated and it makes sense. So. It's really happening everywhere. And I think you had mentioned that, you know, a friend of mine in Texas, Ben Salento, I think you might have heard his name. you mentioned the name. And he, he told me that I think he's one of the only independent ENTs in Houston, in the Houston area, which is absolutely crazy, but he does everything in the surgery center and some of the

the insurance companies are actually paying less at a surgery centers in the hospitals, but they're still having difficulty getting the authorizations. I think that's one of the things that's going to change. You know, so in, just recently Blue Cross Blue Shield, which is the big payer in South Carolina, they're in one of their company wide, reports basically said that

independent facilities and physicians, services provided by independent physicians and facilities were far more cost efficient than the same services provided by hospital -owned facilities. And we've known that for years, right? I mean, that just, we've known that's the case. However, the fact that Blue Cross Blue Shield is now put in writing and acknowledging it,

Coach JPMD (16:26.434)
then hopefully that means that they will help preferentially drive patients to Dr. Salento's and such, right? know, where it saves the company money, provides patients typically better quality and, you know, and more access, right? The more places you can go, the better off you are. So, yeah. And I think patients don't necessarily understand it. It took me a while to understand that.

The fact that if you have an insurance, let's say I have Blue Cross Blue Shield, I happen to have United Healthcare, and some patients want to have procedures done at the hospital for whatever reason, convenience, it's a big hospital system, they have great lobbies, good food in the cafeterias maybe, but when they have these procedures done at the hospitals and it costs five times more than if it were done at an outpatient center,

someone is gonna pay for that increase in expense of that insurance company. So whether it be through increasing premiums, increasing co -pays, but the insurance company is there to make money. So if they're having to spend more money because they're having to pay out more claims at hospital systems, I think patients need to understand that. As well as doctors. Literally today, I had a letter to the editor published in our local paper and you know,

again, kind of repeating the same themes, but what I'm really intent on and what IndieDocs is intent on is to have patients understand a lot of what you just said. I mean, I saw a patient today who has migraines and gets, you know, needs Botox or, you know, one of the botulinum toxins, and they had it done at a hospital, local

hospital -owned neurology practice. The bill, which they didn't pay because they have quote, great insurance, $7 ,900. They now are getting the Botox in my office because they've had a change in their plan. I'm not sure exactly what the circumstances are, but they're basically self -paying now. They're getting exactly the same amount of drugs.

Coach JPMD (18:48.398)
in a nice place, on time and all that, and their out -of -pocket charge is $1 It's the same drug, the same everything, yet the hospitals are able to charge $7 ,900 because the insurance companies will pay. So there's no incentive there for the hospitals to lower their charges because they're getting

pretty big chunk of that $7 ,900 and the insurance companies will pay it because patients are paying premiums, know, that kind of thing. So I mean, it's a circular thing, you know, and, but the more patients realize that it's always cheaper. I mean, I'm not talking about emergency care and catastrophic. That's a whole different ballgame, but it's daily, everyday, chronic maintenance care.

is far less expensive outside of a hospital system. And that's just the reality. And I think it's about education. It's about helping them understand the business model around all these things. Because I don't disagree that if you go to a hospital system, they have to pay for what they have. And they have to pay for the facilities, pay for the ORs, pay for the nursing staff, pay for the emergency rooms. So their expenses are going to be higher.

So they have to understand, patients have to understand that, hey, if it's done in my office, I don't have the hospital expenses that require me to increase my costs and my fees. So I think that's a great example as to how we, once we have the ability to have competition without the...

certificate of needs that kind of drive down competition. I think that's a good thing. So you mentioned IndieDocs and I know that we're going to be at a conference where we were graciously invited to participate in IndieDocs even though we're in Florida. But before we get to IndieDocs, you're doing work in South Carolina. Is there plans to do this in other states, in other areas?

Coach JPMD (21:05.748)
Which the organization, the organization, the indie docs, because you're based in South Carolina. I think, I mean, it is independent doctors of South Carolina, but yeah, there's nothing that says that, you know, the, if we're successful doing the things that we want to do, that there shouldn't be an indie independent doctors of Florida or, know, some sort of, you know, and there are other organizations. I think the nice thing about what we're doing is, and again, we're really focused on South Carolina because we're such a small state.

that we can make a big impact. So as the states get bigger, Florida, for example, it may be much harder to coordinate a statewide organization of, I'm not saying impossible, but for me, the fact that we are small has allowed us to do some things that I think would have taken much longer, maybe not would have happened had it not be where we are.

So tell me about the winter meeting. mean, it's very exciting. meeting is, yeah, so January 20th. It's going to be in Columbia, South Carolina. And great program, really great, great speakers who are nationally known in the direct primary care movement, in the direct specialty care movement. We have a

the renowned economist who's written about healthcare and the dysfunction of the system in general. And we've got employer benefit companies and we actually have Blue Cross Blue Shield coming. So I invited them to talk about this idea that if independent doctors are cost effective, then what can we do to work together to promote that? So it's gonna be a great meeting and

It's a full day, you know, so it'll be nine to five or so. And, you know, practice impossible will, will be there, which would be great, you know, generate some reviews and, some content for later and, you know, spread the word. And, again, maybe someday it's indeed doc of another state, you know, but, but just like the CON, you know, we just got a notice the other day that Georgia is

Coach JPMD (23:31.63)
Patterning their repeal after South Carolina So that kind of thing can happen over and over again, you know our next big thing is non -compete clauses is to try to Repeat so tell me tell me about that because not completes are a big thing for a lot of new physicians Signing contracts now they're they're looking to start jobs in six months or so a lot of residents and fellows looking for jobs Isis don't sign it period, you know

Non -competes are purely for the benefit of the employer. And in medicine, the biggest reason not to sign a non -compete is that you are giving away two things. One is your ability to do something in the future, which you don't have any idea whether

this job is going to be your dream job for the rest of your career, or whether in three years you're going to want to do something else across the street. Right? So you're giving away that option. Number two, and probably most importantly, is that you are enabling the abridgment of a patient's right to follow you should you leave. Right? So patients are

without their consent, being told that they cannot follow Dr. Hockman because he no longer works in this system and he has moved to a city that's 25 miles away to be outside the non -compete clause. And you as a patient may not be able to do that. So that to me is a serious moral and ethical problem.

with non -competes is that the patients are, their right to healthcare and their right to choose is being abridged by something that they have no control over. So those two things are reasons why I've told all the residents that come through my office and I am looking to hire somebody in my practice and I will not have a non -compete. Having said that.

Coach JPMD (25:50.478)
There's nothing wrong with a negotiated restrictive covenant, right? So if I'm gonna hire you to be in my practice and I say, you know, if this doesn't work out, you know, I'm not gonna tell you you can't open up an office across the street. Okay, so the non -compete thing is just not there. But, you know, I'm gonna be spending X amount of money to get you going, to market you, to, you know,

all the things, you know, to make you successful. And if you leave me in the first year, you owe me X amount of money, you know, to help defray some of the costs. If you leave me in the second year, you owe me a little bit less. Right. But at least there's an in you say, well, you know, gosh, forty thousand dollars, you know, it seems like a lot. How about thirty? It's OK. Fine. You you leave me in the first year. You owe me thirty thousand.

At least you and I have negotiated that exit that we both agree. The problem is that all of these systems use blanket non -compete clauses. You're about the hospital systems that are hiring these young physicians coming out. Yeah, I mean, you're at fellowship all you want. You're just so happy to get a job and you're scared to not sign the non -compete because you won't get the job.

Non -competes nationally are a big topic right now. And I'll predict that in South Carolina, they will go away in the next two or three years because, like the CON, it's just a matter of showing why they're bad. Plus, interesting thing is that the lawyers, so the legal profession,

The American Bar Association as part of the code of ethics for lawyers prohibits them from entering into blanket non -compete clauses. So lawyers don't have non -compete clauses. Now they can enter into a negotiated restrictive government like we talked about. So most the legislators are lawyers.

Coach JPMD (28:13.678)
So they get why it's not such a great idea or that there's an ethical problem, right? So I have very high hopes that physicians will be, in South Carolina, will be exempt from noncompete clauses. 50 % of states already exempt physicians from noncompete clauses. Yeah, and I think what we're doing here is creating awareness of these issues that kind of stifle

the physician entrepreneur who wants to start a business that wants to do things on their own and may not get that opportunity working with a large organization. But if that large organization does well for them, then that wouldn't be a discussion. It's what happens is they hire these physicians and

you know, offer them things that are unrealistic and then they realize that they can't participate and then they're kind of stuck with these non -competes. And I agree. I think it's part of competition. You know, if you're doing a good job, if I'm doing a good job for you as a physician, you'll stay. And if you won't, then I'm not going to prevent you from practicing somewhere else. As long as it's not direct.

When I say direct competition, I'm not stealing or taking patients directly from me. So that's a different story. So again, that can be something that can be spelled out that, you know, the patient list in the practice belongs to the belongs to the practice, right? So you can't print off the patient list. However, I don't think there's anything wrong with letting the patients whom you have treated in the practice know.

that you are opening up shops somewhere else. I think that's what the patients would want, right? If you've established a relationship with them and they wanna follow you, great. If they don't, great. But the hospitals don't own the patients, even though they act like they do and we are allowing them to enforce these contracts.

Coach JPMD (30:21.036)
which are not in the best interest of physicians or patients. yeah. And I think if, if you're a physician that's listening to this podcast and you'll, you'll know how, how we've tried, we're trying to teach physicians to understand the business of medicine, to understand how to negotiate, to understand what they can say and how they can say it so that they will benefit from any organization that they're wanting to work with or

Yeah, mean, you know, practice is not for everybody. Employed practice may be great. I mean, I'm not knocking it for everybody one way or the other. But like you said, I mean, you need to be informed and aware and exercise a little bit more leverage than you think you may not have. You know, I mean, you actually you are what the hospital systems or the practice or the clinic or whatever.

the physician is a core part of that, right? I mean, you can't practice medicine without physicians in spite of a lot of the other changes that are happening, right? But you still need MDs. And as a physician, you should know that you're much more valuable than you give yourself credit for or that we as a profession give ourselves credit for.

We don't want to leave the DOs out. Yeah, MDs, DOs, mean physicians, know, mean, Indie docs, I mean, it's really, it's MDs and DOs, you know, so. Although there is, I see a push to educating the nurse practitioners with doctorate degrees to somewhat confuse the population as well. So I think as consumers, we have to also understand the training differences between MDs, DOs and.

nurse practitioners and I have two nurse practitioners in my practice and they're doing great and they love the work that they do. But there's always a place for them. what I see, especially in urgent care settings and walk -in clinics, I see a lot of push for these hospitals to hire nurse practitioners and not MDs. And I'm wondering if that's because physicians are getting smarter maybe and negotiating better. Well, I think the reality is that hospital systems

Coach JPMD (32:42.242)
you know, that physicians are a line item now, you know, they are an employee, they're part of the staff. And as far as the hospital is concerned, the whole movement is to get rid of the hierarchy of in medicine, right? Is everybody's now an equal member of a team, you know, a provider in that practitioner. And that to me, there's a lot of

a lot of negative things that go along with that. I mean, I see this every day when patients come to see me and I'm more tertiary care for some things. And you ask them who their doctor is and they'll mention a name.

and it's not their doctor. I mean, it's the PA. So again, not that that PA has not done a good job, but the patients are confused as to who's doing what. And if you walk into the, if you're getting ready for surgery, have surgery, and in the holding area, Dr. Jones comes in and introduces himself or herself saying that, Dr. Jones, and I'll be giving your anesthesia.

and it's a CRNA with a doctorate degree, that's very different. I think that in the hospital setting, patients expect the doctor to be a doctor, MD, DO, not, you know, I mean, even in universities and all that, you know, it's okay to call professors Dr. So -and -so, but very few

very few academic or people in academia call themselves a doctor outside of their space, right? And that confuses, you it's really very confusing in the hospital, you know? So anyway. So teaching, you mentioned teaching, so do you still teach residents? Yeah, so the plastic surgery residents here in the program,

Coach JPMD (34:57.314)
through my office and they go through various other offices, but they, they get exposed. But that's one of the things that again, getting back to indy doxy plastics is a little bit different because that tends to be inherently part of the training and, and these young people see independent practice as a real option. I mean, that's just part of one of the options. However, if you're a pediatrician,

or if you're PM and R or if you are family practice or an internist, there's not a whole lot of exposure to independent private practices during training. So what happens is that if all your mentors are hospital based people and you don't ever rotate outside of a hospital owned situation, I mean, it's unreasonable to expect that all of a sudden you're going to go out and open up your own practice, right?

One of the things that we want to educate young people in training. mean, membership in IndieDocs for a medical student, a resident or a fellow is $10. You know, I mean, we want people to come see what it's like, you know, talk to people, network. And how do you do this? I mean, can I really do this as a pediatrician? The answer is yes, you know. Yeah, there's plenty of us doing it. And it's just a matter of

how you do it and where you get your knowledge from. So where do you see the future of independent doctors? I know that you feel, I'm sure you feel that the future is bright if we can educate our population, but do you see, what challenges do you see in future? Well, I mean, think the reality is, well, the reality is that more than 50 % of physicians are now employed

in practices in which they don't have ownership. That's a given, that's a reality. And that trend has, you know, has continued that way over the last few years for a lot of reasons, right? However, I think there is a great opportunity now, really great opportunity when patients are starting to know more about, and they don't like what they're exposed to.

Coach JPMD (37:17.998)
You know, I mean, they're not, they don't like the $8 ,000 Botox bill. They don't like, and if they know that there are options, and again, that's what my letter to the editor today was about, honestly, was I encourage patients to start demanding to be seen in independent practices and start asking for it. You know, start looking for options and alternatives to where you're getting your care.

And the more demand there is for that, guess what? There's going to be more of a supply, right? So there's no CON now. So, you know, if I was an OBGYN group, I I would open up a birthing center and deliver normal, healthy babies in a birthing center instead of at the hospital, you know? And I mean, every single specialty, could think of a million similar things that could be happening.

But if the patients start asking for that, they're going to happen more quickly, you know? And even, even as physicians, should be asking for that. I think it's something that we can do in our small community. If we're seeing doctors, you know, starting what we want to do this, you know, so I think there's a great opportunity. You know, I find it interesting. I think it's the fact that we, you know, physicians were able to repeal the CLN.

I mean, we started this, not IndieDocs, but doctors, right? And I think I mentioned to you, you know, the PPE project during the pandemic, you know, that we did 100 % doctor -driven, you know? And those things to me are exciting. I mean, we have a lot more leverage and power than we give ourselves credit for. And I think that's a great, great thing to say.

because I think even myself, sometimes I, you know, when I started this podcast, I'm like, I can't do this, I can't educate physicians. I had to learn, I did the things that I need to do to understand how to communicate, how to release podcasts on a regular basis. I think that's what physicians need to understand. We have the ability, if we get the right people around us.

Coach JPMD (39:37.996)
in our practices, in our personal lives, our spiritual lives, in our family lives, to do great things. We just have to know that we can do it. I thank you for your work in South Carolina and I think, and beyond, because you're gonna be an inspiration for states like Georgia and in other places as well. Well, I hope so. Plus, once you come visit us, then you'll get the word out. Yeah, I hope so. In January. That's right.

So looking forward to that trip to South Carolina and thank you for coming on the Practice Impossible podcast. It's been a pleasure having you and thank you again for redoing this take two. But I think take two is going to work this time. we're good. great. Thank you. Thank you, Dr.