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Today's clinical providers and health care systems

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need a strategic partner that is focused on

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the evolution of health care delivery.

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At Surgery Partners, we are redefining the health

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care industry

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as a nation's leading independent operator of surgical

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facilities and ancillary services.

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With an extensive presence spanning over 180

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locations nationwide,

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our commitment extends beyond healthcare.

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It's about fostering successful

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partnerships that

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enhance the quality of care in the communities

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we serve. Surgery Partners is more than an

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operator or service provider. We are your strategic

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ally committed to transforming health care delivery. Learn

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more

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atsurgerypartners.com.

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This is Alan Condon with the Becker's ASC

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podcast, and I am thrilled to be joined

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today by Melissa Wiebel,

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who's the CEO at Guam Surgery Center. Melissa,

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a pleasure to have you on your first

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Becker's podcast with us today.

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I'd love to turn the floor over to

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you. 1st and foremost, to tell our listeners

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a little bit about your role and your

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background at Guam Surgery Center.

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Okay. Thank you so much. It's a pleasure

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to be invited.

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So my, journey getting to, the Guam Surgery

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Center Guam is, obviously, a territory of the

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United States, but it's a it's over 7,000

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miles away from the rest of the mainland.

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And I started off as a nurse. I

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knew in nursing school that I wanted to

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be a perioperative nurse, so that was a

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pretty easy fix. I've spent my year on

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the floor and then transferred directly to the

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operating room

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and learned how to be a perioperative nurse.

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Did that for many years in the hospital

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setting. And then in

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2010,

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I was recruited,

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by u USPI, actually, and,

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went to work as an administrator at a

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surgery center. So it was not in my

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plans to be in the ambulatory surgery setting.

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It's just how that worked out. And I

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was there for about 4 years

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and, believe it or not, was fired from

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that job. It was that was an interesting

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turn of events.

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But it was a good thing because it

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opened the door for me to be able

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to explore other options. And

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at the time,

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the Guam Surgery Center was was posted on

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ASCA. They were looking for somebody to come

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and be their

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chief clinical officer and do some of those

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types of things, so I applied and it

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it was a whirlwind. About a month later,

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I was on the island, and I've been

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here,

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now for 14 years.

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The surgery center is a a

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4 4 room OR

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location. It it's a beautiful place.

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It has all the same things you would

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expect. The rooms were actually bigger than the

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surgery center that I first started out at.

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And the people here are so warm and

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welcoming, and they are so appreciative of anybody

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who has medical

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skills and training that wants to be here

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to serve them.

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But there are a lot of challenges with

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being on an island that's very far away

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from all of the supplies that you need.

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Because, of course, we still have to follow

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all of the US regulations, which means, you

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know, making sure everything has FDA approval.

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There's a lot of shenanigans

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that go on with,

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other countries trying to sell items to us

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that don't meet

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the specifications

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for

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US rules. So there's,

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it's a challenge. It's a challenge being this

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far out and away from everything, you know,

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and it's expensive. This is not an inexpensive

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place to live or work.

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Yeah. I mean, what a what a what

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a fascinating background. I think from starting out

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as a perioperative nurse in hospitals, as you

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said, being recruited from USPI.

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And I know it's I believe you said

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the last 13 years or so now with

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Guam Surgicenter.

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Exciting, and no doubt it has its own

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specific and unique challenges as well. So I'm

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kind of excited to kind of dive right

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in there. But

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to to your point on what you've said

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in your opening remarks, Melissa, are you still

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it is

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Guam's obviously a US territory, but, you know,

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vastly out there,

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in terms of 70,70,000

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kilometers away. We still have to follow a

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lot of those regulations,

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look, FDA approval for specific items and whatnot.

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But before we get you on that, I

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are there any

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when we talked about the health the trends

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in the health care and ASC space,

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what are the 2 or 3 trends that

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you're paying most attention to that most affect

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you, and why?

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Well, that's interesting. Right? Because, when I even

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when I, looked at those questions,

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prior to this meeting, I went, wow. It's

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so much different.

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Long, realistically,

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medical wise,

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especially in surgery, is about 20 years behind

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what the US is doing

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for multiple reasons.

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You know, we don't have representatives who are

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sitting on island just waiting to to serve

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us. You know? That that's not that's not

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possible. As a matter of fact, for the

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first,

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probably, 10 years that I was here, it

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was very rare to see a representative of

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any kind on the island. You were just

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doing everything yourself

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and really having to push hard to bring

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new things to the island. And part of

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that is because of our population size.

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A big portion of it is, you know,

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we don't have a lot of people who

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are on private pay. Most people are in

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the poverty line on the island. So

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it's difficult to bring people with highly skilled

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services available

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that

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they can do enough cases to keep their

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skill sets up.

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So that's a challenge. But for the for

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the US, you know, I the trends that

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are interesting to me are, you know, we're

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seeing a lot more AI being utilized, and

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that's certainly on the administrative side as well

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and what they're doing with those things.

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I think that there's an interesting trend for,

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you know, surgeons and that's been going on

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for a while. Surgeons specifically being hired. Right?

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And big groups also being hired and brought

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into

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hospital settings, which that's a worrisome trend for

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me.

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It's happening on this island as well. If

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all of our skilled surgeons

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are being employed by the hospital, well, the

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first thing they're gonna say is we don't

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want you working for a private privately

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run surgery center. So that's

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the that's the trend that I'm watching closely

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here specifically.

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As a matter of fact, I've got a

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I'm coming up with ways now on how

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can I recruit potentially

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surgeons that might want to rotate

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out here and provide services to the people

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here? The other thing would be that

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I love the trend that more cases are

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going into the ambulatory space.

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I think we've proven to Medicare and to

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a whole lot of other people

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that we are much better priced,

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we're much more comfortable,

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we provide a very high quality outcome for

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our patients.

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And it's in a pleasant welcoming environment that's

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easy to get to and easy to get

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out of. So I love to see that

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trend, continue.

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Interesting trends in the states are robots and

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ASCs as well and the cardiac cases that

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are going in. What we find is there's

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no way that this far out we could

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afford to do either one of those things.

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It's just cost prohibitive

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for

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a place like us.

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But it's still interesting to watch. Maybe now.

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20 years from now, maybe we'll be doing

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it.

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Wow. Wow. That's kind of interesting that you're

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also seeing going back to, I guess, the

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trend of surgeons moving more towards hospital employment,

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which obviously presents a bit of a challenge

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for for privately run ASCs like yourself and

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no doubt we're seeing the same very much

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so in the states as well. You did

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say that you were, I guess, looking at

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options to recruit some rotating surgeons. Could you

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give us a little bit more insight into

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that?

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Sure. So,

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we I actually have an example of that.

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The we have a gentleman who is a

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we have more actually than one, but there's

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one that's been doing it for, you know,

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20 years, who is a retina specialist.

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And, he's out of Beverly Hills, and he

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comes out every 6 to 8 weeks or

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so.

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And he's got a full time staff here

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on island,

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and so he's able to come out. He's

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got great relationships with our cataract surgeons that

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are on island.

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And he sees patients

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in clinic, and he's here for a week,

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and he works like a crazy man that

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week,

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not only but also in his office. I'm

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looking to maybe do the same kind of

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thing

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with

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potentially urology

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and orthopedics, specifically

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sports med. We need a really good

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sports med,

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kind of surgeon who can come in here

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and do these kinds of cases quickly and

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effectively.

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And I think that potentially

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rotating some surgeons in a bigger group,

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maybe what's needed, because maybe that's just not

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enough for them to want to be here

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and live here, but maybe I could convince

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them that's a good thing to do.

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It's a win win for them, but it's

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really a huge win for the island.

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Yeah. I'm sure Guam's sounds like a a

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really nice place to go for 6 to

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6 or 8 weeks even if you are

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gonna be working that hard. Right? But,

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I wonder how how does that come about?

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It was specifically with the Beverly Hills surgeon

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that you mentioned. Is that just a case

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of you reaching out using your own personal

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connections? Or have you kind of forged that

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relationship and ultimately recruit some of these rotating

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surgeons?

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Well, that's where, you know, it is

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I don't know if you'll see the kind

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of,

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of assistance that you see here.

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So the surgery center is very good about

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assisting our hospitals. There's actually 3 hospitals on

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this island. 1 is the community,

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hospital. There was a private hospital built here.

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Oh, my word. I think maybe they've been

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here 7 years now.

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And then we have a military hospital. The

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navy has a hospital as well.

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And so our policy has always been, if

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they have a need in order to serve

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a patient that they can't fill, then we

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will assist if possible. So if I have

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supplies

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that they need that I'm not in I'm

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not using right now in order to take

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care of patient, then we will load it

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to them. If we same with medications and

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everything else. If there's something that they need

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in the care of a patient right now,

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we will do what we can to help

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support that.

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We've shared instruments. We've shared equipment. We've shared

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supplies.

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I've even shared staff a couple of times.

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And because of that, we've seen a lot,

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that being returned

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from our community. So it's very open as

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far as that goes. The hospitals try and

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help each other, which is not, I don't

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think you're gonna see a lot of that

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stateside

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and

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and try and try and assist to take

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care of patients. Again, we don't have a

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big, you know, there's not like a big

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manufacturing plant here that's, you know, creating supplies

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that are necessary. Everything is coming from off

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island.

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And so there's lots of glitches in shipping

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there. I'm telling you, shipping has been everybody's

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nightmare since COVID and that's not getting better.

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So, you know, we have to rely on

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each other

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for the best outcomes for everybody's patients. And

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so that's

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it's interesting.

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It's

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it's also heartening that, you know, we can

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we can be competitors,

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but we can also be highly compassionate for

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the people that we live and work with.

317
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Yeah. Absolutely. It all comes down to the

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patient and patient outcomes at the end of

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the day. Right? I'm I'm curious to hear.

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00:11:29,085 --> 00:11:30,925
You talked a little bit about so you

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have the the privately the privately owned hospital

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that was recently built. You've got the military

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hospital and then I believe a community hospital.

324
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Hospital. What does the ASV landscape look like

325
00:11:39,779 --> 00:11:41,620
in Guam? I noticed yourself. There are many

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00:11:41,620 --> 00:11:43,620
other competitors or ASVs on the on the

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island?

328
00:11:44,820 --> 00:11:46,839
Yeah. So there is actually another

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00:11:47,220 --> 00:11:50,740
listed ambulatory surgery center that is on the

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island. It's much smaller. They have a

331
00:11:53,674 --> 00:11:56,154
a one room. It it was owned by

332
00:11:56,154 --> 00:11:59,195
a surgeon. He he started it. He's recently

333
00:11:59,195 --> 00:12:00,955
sold it to another surgeon, so that's good.

334
00:12:00,955 --> 00:12:03,434
I mean, we wanna continue to have the

335
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capability for patients to be utilized. Now I

336
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will also say, am I the best ambulatory

337
00:12:09,029 --> 00:12:11,669
surgery center on island? Yes. Am I the

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00:12:11,669 --> 00:12:12,149
best,

339
00:12:12,629 --> 00:12:15,429
surgical place to be, period? Yes. I I

340
00:12:15,429 --> 00:12:16,889
put us up against anybody.

341
00:12:18,745 --> 00:12:20,045
Fantastic. Love to hear.

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00:12:20,585 --> 00:12:23,384
You've mentioned earlier in the conversation we talked

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a little bit about how you plan to

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grow the surgery center. You talked about recruiting

345
00:12:26,585 --> 00:12:29,085
some of these rotating surgeons. You've touched on,

346
00:12:29,865 --> 00:12:31,965
the trend with AI maybe on the administrative

347
00:12:32,105 --> 00:12:32,845
side. But,

348
00:12:33,384 --> 00:12:35,769
whether you wanted to when you think about

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00:12:35,769 --> 00:12:38,089
the future of the ASC space, you you

350
00:12:38,250 --> 00:12:40,169
from what you said earlier, on the Guam,

351
00:12:40,169 --> 00:12:42,250
on the island maybe is 20 years behind.

352
00:12:42,250 --> 00:12:44,809
But the future of the ASC space for

353
00:12:44,809 --> 00:12:46,649
your service center in particular, what are you

354
00:12:46,649 --> 00:12:47,950
most excited about?

355
00:12:49,054 --> 00:12:51,235
You know, I'm always excited about the opportunity

356
00:12:51,455 --> 00:12:54,434
to continue to grow and bring new things

357
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to the island, actually. We've been pretty instrumental

358
00:12:57,615 --> 00:12:59,535
in in being the first in things. We

359
00:12:59,535 --> 00:13:02,309
we brought lasers here for urology. We brought,

360
00:13:02,870 --> 00:13:04,009
you know, new,

361
00:13:04,789 --> 00:13:07,429
new towers to help the physicians who are

362
00:13:07,429 --> 00:13:08,490
doing either laparoscopy

363
00:13:08,870 --> 00:13:09,690
or arthroscopy.

364
00:13:10,230 --> 00:13:13,190
You know, we've we've always been normally the

365
00:13:13,190 --> 00:13:15,450
the ones who start doing things before

366
00:13:15,985 --> 00:13:17,585
the hospitals do and then the hospitals will

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follow the trend. So I'm looking forward to

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00:13:20,144 --> 00:13:22,544
always looking for things that work in our

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00:13:22,544 --> 00:13:23,365
space that

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are good for our patients,

371
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obviously, that we can afford and support because,

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00:13:28,304 --> 00:13:30,120
again, we're not going to have

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representatives on island who are gonna be helping

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00:13:32,919 --> 00:13:34,440
us to maintain and take care of these

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00:13:34,440 --> 00:13:34,940
things.

376
00:13:35,559 --> 00:13:37,320
On the island, you have to be very

377
00:13:37,320 --> 00:13:39,480
self sufficient. You have to learn to do

378
00:13:39,480 --> 00:13:41,820
things for yourself, to fix things for yourself.

379
00:13:42,404 --> 00:13:42,904
Our

380
00:13:43,605 --> 00:13:45,845
facility, years ago, knew that we would need

381
00:13:45,845 --> 00:13:46,345
biomedical.

382
00:13:46,964 --> 00:13:48,725
And so we found a gentleman who was

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00:13:48,725 --> 00:13:51,845
highly skilled, but did didn't have certification and

384
00:13:51,845 --> 00:13:53,524
was eager to learn and to do more

385
00:13:53,524 --> 00:13:55,684
things. And so nobody else on the island

386
00:13:55,764 --> 00:13:57,284
and he worked at the hospital at the

387
00:13:57,284 --> 00:13:59,159
time. Nobody would help him to do that,

388
00:13:59,159 --> 00:14:00,679
so we did. We paid for him to

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00:14:00,679 --> 00:14:02,919
go and get those things done, which has

390
00:14:02,919 --> 00:14:06,279
benefited not just our facility, but everybody else

391
00:14:06,279 --> 00:14:07,879
on the island. So that's the other thing.

392
00:14:07,879 --> 00:14:09,259
You have to not be selfish

393
00:14:09,720 --> 00:14:11,865
when you work this this far out.

394
00:14:12,584 --> 00:14:14,424
Other trends that I think that, you know,

395
00:14:14,424 --> 00:14:16,524
we're gonna continue to see more things,

396
00:14:17,225 --> 00:14:20,504
finding their way into the the surgery center

397
00:14:20,504 --> 00:14:21,004
space,

398
00:14:21,384 --> 00:14:23,804
which I think is exciting, what new

399
00:14:24,539 --> 00:14:26,940
procedures are gonna move into our space, what

400
00:14:26,940 --> 00:14:27,440
new

401
00:14:28,059 --> 00:14:30,459
equipment's gonna be made to make things faster,

402
00:14:30,459 --> 00:14:31,279
better, easier.

403
00:14:32,059 --> 00:14:34,860
Realistically, for me, it's the bigger issue is

404
00:14:34,860 --> 00:14:37,120
keeping surgeons. Right? Keeping

405
00:14:37,815 --> 00:14:41,254
highly skilled surgeons and getting those individuals out

406
00:14:41,254 --> 00:14:41,754
here

407
00:14:42,215 --> 00:14:42,875
to work,

408
00:14:43,335 --> 00:14:45,095
and maybe they don't wanna live here. So,

409
00:14:45,095 --> 00:14:46,235
again, I think that

410
00:14:46,615 --> 00:14:48,795
thinking outside the box and finding

411
00:14:49,335 --> 00:14:51,750
surgeons that would maybe be willing to to

412
00:14:51,750 --> 00:14:54,149
come out here, work for a week, work

413
00:14:54,149 --> 00:14:55,690
really hard for a week,

414
00:14:56,389 --> 00:14:58,790
then maybe do some jumping off, you know,

415
00:14:58,790 --> 00:15:00,470
travel a little bit in Asia, and then

416
00:15:00,470 --> 00:15:03,190
return home feeling refreshed and ready to go,

417
00:15:03,190 --> 00:15:06,024
and potentially be willing to do that, you

418
00:15:06,024 --> 00:15:08,105
know, on a monthly or every other month

419
00:15:08,105 --> 00:15:09,865
basis is gonna be a win for the

420
00:15:09,865 --> 00:15:12,345
island and certainly for my surgery center and

421
00:15:12,345 --> 00:15:15,004
my staff. Those I've got great people

422
00:15:15,384 --> 00:15:17,865
and they work really hard and they're highly

423
00:15:17,865 --> 00:15:18,365
skilled

424
00:15:18,769 --> 00:15:21,330
and they deserve the opportunity to be able

425
00:15:21,330 --> 00:15:23,809
to do all the new cutting edge exciting

426
00:15:23,809 --> 00:15:26,309
things that are being done stateside and frankly

427
00:15:26,529 --> 00:15:28,230
our people deserve the same.

428
00:15:28,610 --> 00:15:30,789
Yeah. I think that's absolutely fascinating

429
00:15:31,264 --> 00:15:33,424
story, fascinating to hear the background, how you

430
00:15:33,424 --> 00:15:35,105
ended up as the the leader and the

431
00:15:35,105 --> 00:15:37,424
CEO of Guam Surgery Center, and also some

432
00:15:37,424 --> 00:15:38,544
of the trends and some of how you're

433
00:15:38,544 --> 00:15:39,904
looking to grow that center as well in

434
00:15:39,904 --> 00:15:43,105
the coming years. Well, it's a fascinating conversation.

435
00:15:43,105 --> 00:15:44,705
Thank you so much for taking the time

436
00:15:44,705 --> 00:15:46,225
out of your busy schedule to speak with

437
00:15:46,225 --> 00:15:47,790
us. We look forward to connecting with you

438
00:15:47,790 --> 00:15:49,550
again down the line. Alright. Thank you so

439
00:15:49,550 --> 00:15:51,230
much, Alan. You guys have a great time,

440
00:15:51,230 --> 00:15:52,370
and enjoy the mainland.