1 00:00:00,080 --> 00:00:02,980 Hey there, dental professionals and industry enthusiasts. 2 00:00:03,600 --> 00:00:06,000 Picture this. It's October, and you're in the 3 00:00:06,000 --> 00:00:07,779 middle of one of the most transformative 4 00:00:08,160 --> 00:00:10,880 experiences of your career. You're at the Becker's 5 00:00:10,880 --> 00:00:13,359 fall future of dentistry roundtable in the vibrant 6 00:00:13,359 --> 00:00:16,094 city of Chicago, fresh off an incredible 3 7 00:00:16,094 --> 00:00:19,154 days at the Hyatt Regency. Imagine yourself inspired 8 00:00:19,295 --> 00:00:22,974 and invigorated after attending captivating keynote sessions by 9 00:00:22,974 --> 00:00:25,714 none other than the legendary boxing world champion 10 00:00:25,774 --> 00:00:29,554 and CEO, Lila Elite, and the extraordinary professional 11 00:00:30,179 --> 00:00:33,399 player, Caitlin Clark. See yourself engaged in lively 12 00:00:33,460 --> 00:00:36,500 discussions, exchanging ideas, and collecting a stack of 13 00:00:36,500 --> 00:00:39,560 business cards from fellow dental experts and potential 14 00:00:39,619 --> 00:00:42,200 partners. You've networked with over 350 15 00:00:42,579 --> 00:00:45,140 attendees and learned from more than 80 speakers 16 00:00:45,140 --> 00:00:47,554 who are at the forefront of dental innovation. 17 00:00:48,414 --> 00:00:49,795 You sat in on educational 18 00:00:50,094 --> 00:00:52,975 sessions exploring topics that elevate dental care as 19 00:00:52,975 --> 00:00:55,774 a critical element of whole person health. You've 20 00:00:55,774 --> 00:00:58,994 witnessed firsthand how digital technology is revolutionizing 21 00:00:59,454 --> 00:01:00,530 patient outcomes 22 00:01:00,909 --> 00:01:04,209 and how both large DSOs and independent practices 23 00:01:04,349 --> 00:01:05,170 are flourishing. 24 00:01:05,469 --> 00:01:07,709 Get ready to transform your career and don't 25 00:01:07,709 --> 00:01:10,609 miss out on this incredible opportunity. The Becker's 26 00:01:10,670 --> 00:01:13,569 fall future of dentistry roundtable is from October 27 00:01:13,745 --> 00:01:16,004 30th to November 1, 2024. 28 00:01:16,465 --> 00:01:18,645 Get registered by going to beckersdental.com 29 00:01:20,145 --> 00:01:21,924 and clicking on the events page. 30 00:01:22,784 --> 00:01:25,025 Hello. This is Arianna Portelatin with the Becker's 31 00:01:25,025 --> 00:01:26,700 Dental and DSM Review podcast. 32 00:01:27,180 --> 00:01:28,700 I'm thrilled to be joined today by doctor 33 00:01:28,700 --> 00:01:30,859 Jeffrey Carter, the founder and chief medical officer 34 00:01:30,859 --> 00:01:33,259 of the US Dental Surgery Network. Doctor Carter, 35 00:01:33,259 --> 00:01:34,959 thank you so much for being here today. 36 00:01:35,739 --> 00:01:37,679 Thank you. It's my pleasure to be here. 37 00:01:37,819 --> 00:01:39,819 Mhmm. To start us off, can you introduce 38 00:01:39,819 --> 00:01:41,259 yourself and tell us a little bit about 39 00:01:41,259 --> 00:01:41,920 your background? 40 00:01:43,064 --> 00:01:43,564 Sure. 41 00:01:43,944 --> 00:01:46,364 I I'm currently a practicing oral and maxillofacial 42 00:01:46,584 --> 00:01:47,084 surgeon. 43 00:01:47,385 --> 00:01:48,844 I was one of those early, 44 00:01:49,385 --> 00:01:52,344 MD, DMD type trainees that that developed in 45 00:01:52,344 --> 00:01:54,584 19 seventies. I spent pretty much my entire 46 00:01:54,584 --> 00:01:56,685 career in the gap of medicine and dentistry. 47 00:01:57,859 --> 00:01:59,859 That that is important because it's been able 48 00:02:00,100 --> 00:02:01,859 enabled me to be able to learn lessons 49 00:02:01,859 --> 00:02:03,780 in medicine and see how they transferred it 50 00:02:03,780 --> 00:02:04,439 to dentistry. 51 00:02:05,219 --> 00:02:07,380 Early in my career, I was an academic 52 00:02:07,380 --> 00:02:09,699 chairman. I ran an oral maxillofacial surgical residency 53 00:02:09,699 --> 00:02:11,400 program at the Carls Clinic in Illinois. 54 00:02:11,915 --> 00:02:12,814 And then after 55 00:02:13,675 --> 00:02:15,775 a period of time in academics, I transitioned 56 00:02:15,835 --> 00:02:16,814 back to Nashville 57 00:02:17,194 --> 00:02:19,615 and built a 5 location oral surgery practice. 58 00:02:19,835 --> 00:02:21,435 That was in the early days of electronic 59 00:02:21,435 --> 00:02:23,275 health records where we're building them before the 60 00:02:23,275 --> 00:02:25,319 mouse was invented. So we've been at this 61 00:02:25,319 --> 00:02:26,840 for quite a while and have seen quite 62 00:02:26,840 --> 00:02:27,659 a bit of innovation. 63 00:02:28,680 --> 00:02:30,760 After that, I was I built and designed 64 00:02:30,760 --> 00:02:31,319 the first, 65 00:02:31,879 --> 00:02:34,700 dental ambulatory surgery center that was Medicare certified. 66 00:02:34,760 --> 00:02:35,900 That was built at Nashville. 67 00:02:36,360 --> 00:02:38,625 And, I served as a medical director of 68 00:02:38,625 --> 00:02:40,884 that facility for about 27 years. 69 00:02:41,824 --> 00:02:43,025 In my more recent, 70 00:02:43,424 --> 00:02:45,905 iteration, I I've sold those enterprises, and and 71 00:02:45,905 --> 00:02:48,324 now I'm building a mobile oral surgery platform 72 00:02:48,864 --> 00:02:51,824 to provide oral and maxillofacial surgery and general 73 00:02:51,824 --> 00:02:53,939 anesthesia to to the large DSOs 74 00:02:54,400 --> 00:02:56,979 that want to incorporate in house oral surgery. 75 00:02:57,360 --> 00:02:59,439 So, so far the process of this over 76 00:02:59,439 --> 00:03:01,280 the last 6 years, we're in about 70 77 00:03:01,280 --> 00:03:03,139 different locations in 6 states. 78 00:03:05,735 --> 00:03:07,655 Great to hear about your extensive experience. Thank 79 00:03:07,655 --> 00:03:08,715 you so much for that. 80 00:03:09,254 --> 00:03:10,694 First question here, what are some of the 81 00:03:10,694 --> 00:03:12,614 biggest issues that you're following right now in 82 00:03:12,614 --> 00:03:13,674 the dental industry? 83 00:03:15,734 --> 00:03:17,495 Sure. Well, one of the the trends that 84 00:03:17,495 --> 00:03:19,414 I've I've noticed is I started to leave 85 00:03:19,414 --> 00:03:21,590 one state go to multiple states is is 86 00:03:21,590 --> 00:03:23,349 how the demographics of what's going on in 87 00:03:23,349 --> 00:03:25,909 the dental industry has changed. And I'm excited 88 00:03:25,909 --> 00:03:27,909 to finally see that they're we're getting some 89 00:03:27,909 --> 00:03:28,409 national 90 00:03:28,789 --> 00:03:30,489 dental licensing and reciprocity 91 00:03:31,269 --> 00:03:33,610 rules that are being built. There's these large 92 00:03:33,895 --> 00:03:34,395 cooperatives 93 00:03:35,254 --> 00:03:36,615 where if you're in one state, you have 94 00:03:36,615 --> 00:03:38,615 reciprocity in another. And when when I first 95 00:03:38,615 --> 00:03:40,375 started this enterprise, I think I, of course, 96 00:03:40,375 --> 00:03:41,835 had to accumulate 97 00:03:43,094 --> 00:03:46,134 9 different dental dental licenses in 9 different 98 00:03:46,134 --> 00:03:47,814 states. And if you know one state, you 99 00:03:47,814 --> 00:03:49,409 know one state. So they're they're all very 100 00:03:49,889 --> 00:03:51,330 different. But when you start to do things 101 00:03:51,330 --> 00:03:51,830 like, 102 00:03:53,330 --> 00:03:55,590 have office inspections for general anesthesia, 103 00:03:56,210 --> 00:03:59,090 the the individuality between the states even becomes 104 00:03:59,090 --> 00:04:01,250 more and more granular. That's a hard thing 105 00:04:01,250 --> 00:04:03,405 to do. But, hopefully, at least with the 106 00:04:03,405 --> 00:04:05,564 with the National Dental Licensing and Rest of 107 00:04:05,564 --> 00:04:08,205 Process, it's gonna be easier for providers to 108 00:04:08,205 --> 00:04:09,985 to move from location to location. 109 00:04:11,165 --> 00:04:13,485 Dental licensing has, for a long period of 110 00:04:13,485 --> 00:04:16,000 time, been a huge barrier to to opportunities, 111 00:04:16,300 --> 00:04:17,899 and, certainly, it's a barrier when you're trying 112 00:04:17,899 --> 00:04:19,040 to build a a multistate 113 00:04:19,420 --> 00:04:19,920 organization. 114 00:04:21,259 --> 00:04:22,860 I think the second thing is is the 115 00:04:22,860 --> 00:04:25,020 issue, and everybody talks about this, but it's 116 00:04:25,020 --> 00:04:26,699 it's real. It's real, and that is the 117 00:04:26,699 --> 00:04:27,680 recruiting challenge. 118 00:04:28,105 --> 00:04:29,245 I'm in a specialty 119 00:04:29,625 --> 00:04:31,165 in a dental specialty recruiting, 120 00:04:31,944 --> 00:04:34,125 silo where we're we're trying to recruit, 121 00:04:34,504 --> 00:04:36,745 young surgeons. As you know, there's only about 122 00:04:36,745 --> 00:04:39,305 250 oral surgeons trained each year, and there's 123 00:04:39,305 --> 00:04:41,550 no immediate plans to increase that. I think 124 00:04:41,629 --> 00:04:44,189 there may have been one residency added, by 125 00:04:44,189 --> 00:04:45,409 CODA in the last 126 00:04:45,709 --> 00:04:47,550 the last 3 years. So it's not a 127 00:04:47,550 --> 00:04:49,789 large population of people coming out. And by 128 00:04:49,789 --> 00:04:51,649 last count, I think there were 17, 129 00:04:52,110 --> 00:04:54,589 oral surgery DSOs that are at the different 130 00:04:54,589 --> 00:04:55,649 stages of evolution 131 00:04:56,029 --> 00:04:57,524 all chasing the same talent 132 00:04:58,004 --> 00:04:59,685 pool. So if you're if you're a solo 133 00:04:59,685 --> 00:05:01,524 practitioner looking for a partner, if you're a 134 00:05:01,524 --> 00:05:03,285 group looking for a 5th man, or if 135 00:05:03,285 --> 00:05:04,104 you're a DSO, 136 00:05:04,404 --> 00:05:06,345 there's a lot of a lot of competition 137 00:05:06,404 --> 00:05:08,164 for the same talent. So that that's a 138 00:05:08,164 --> 00:05:08,664 significant, 139 00:05:10,164 --> 00:05:11,544 challenge for all of us. 140 00:05:12,339 --> 00:05:14,419 And are there any specific strategies that your 141 00:05:14,419 --> 00:05:15,939 company has put in place to really help 142 00:05:15,939 --> 00:05:17,560 with these, recruiting challenges? 143 00:05:19,220 --> 00:05:22,600 Well, we use, professional recruiters. We've tried that. 144 00:05:23,139 --> 00:05:24,500 And then, you know, the other the other 145 00:05:24,500 --> 00:05:26,259 interesting thing is that when you lose use 146 00:05:26,259 --> 00:05:27,319 professional recruiters, 147 00:05:27,784 --> 00:05:30,185 you're basically going, pretty much head to head 148 00:05:30,185 --> 00:05:32,425 with everybody else's offers. So what I've what 149 00:05:32,425 --> 00:05:34,104 I've seen over the years of going to, 150 00:05:34,104 --> 00:05:35,865 like, the annual oral surgery meetings, it used 151 00:05:35,865 --> 00:05:37,384 to be that, you know, you would you 152 00:05:37,384 --> 00:05:40,089 would interview somebody in that location. Now that 153 00:05:40,209 --> 00:05:42,050 that's been totally hyped up and amped up. 154 00:05:42,050 --> 00:05:43,350 But you have you have recruiters 155 00:05:43,810 --> 00:05:45,990 basically camping out in residency locations, 156 00:05:46,290 --> 00:05:48,529 signing contracts for people before they get out 157 00:05:48,529 --> 00:05:49,189 of residency, 158 00:05:49,649 --> 00:05:51,350 giving them the sign on bonuses, 159 00:05:51,810 --> 00:05:53,955 with with or without payback, you know, 160 00:05:54,654 --> 00:05:56,495 clauses to try and entice them to to 161 00:05:56,495 --> 00:05:58,495 sign up for a company 3 years from 162 00:05:58,495 --> 00:06:00,495 the time that or, you know, 3 years 163 00:06:00,495 --> 00:06:02,355 from the time they get about to finish. 164 00:06:02,415 --> 00:06:04,115 So there's a lot of heavy recruiting, 165 00:06:04,735 --> 00:06:06,879 heavy heavy recruiting that goes on and there's 166 00:06:06,879 --> 00:06:09,039 some people making decisions even before they're fully 167 00:06:09,039 --> 00:06:11,439 trained search. That's all new. You know? So 168 00:06:11,439 --> 00:06:13,139 it's it's tough to try to 169 00:06:13,439 --> 00:06:15,120 try to compete with that. You just have 170 00:06:15,120 --> 00:06:16,639 to try to find the people that have 171 00:06:16,639 --> 00:06:18,339 the best fit for what you're doing. 172 00:06:18,824 --> 00:06:20,685 One of the things that our organization, 173 00:06:21,865 --> 00:06:23,625 allows is the ability for people to be 174 00:06:23,625 --> 00:06:24,764 independent contractors. 175 00:06:25,144 --> 00:06:26,985 Now a lot of the younger surgeons don't 176 00:06:26,985 --> 00:06:29,305 really understand the the full tax implications of 177 00:06:29,305 --> 00:06:32,079 being an independent contractor versus an employee, but 178 00:06:32,079 --> 00:06:33,919 but they're numerous. And so the people that 179 00:06:33,919 --> 00:06:35,680 kind of understand that are attractive to come 180 00:06:35,680 --> 00:06:37,699 to work with a platform like ours because 181 00:06:37,839 --> 00:06:40,079 all of our our our doctors are independent 182 00:06:40,079 --> 00:06:42,319 contractors, which gives them the same flexibility that 183 00:06:42,319 --> 00:06:44,399 they, they potentially would have had if they 184 00:06:44,399 --> 00:06:45,459 were a solo practitioner. 185 00:06:46,915 --> 00:06:48,514 Gives a lot of autonomy. Gives a lot 186 00:06:48,514 --> 00:06:49,975 of flexibility of their life. 187 00:06:50,595 --> 00:06:52,834 Okay. Yeah. I'm also curious. I know these 188 00:06:52,834 --> 00:06:55,555 workforce issues, were happening before the pandemic, and 189 00:06:55,555 --> 00:06:56,774 then COVID kind of, 190 00:06:57,235 --> 00:06:58,455 exacerbated everything. 191 00:06:59,500 --> 00:07:02,060 What did shortages and really the workforce overall 192 00:07:02,060 --> 00:07:04,000 look like when you first entered the field? 193 00:07:05,660 --> 00:07:06,319 Go back. 194 00:07:07,019 --> 00:07:09,100 Yes. It's very different back back in the 195 00:07:09,100 --> 00:07:11,019 eighties. You know, the 19 eighties, we we 196 00:07:11,019 --> 00:07:13,794 would hire we would hire dental assistants or 197 00:07:13,794 --> 00:07:15,794 surgical assistants. They would be with you for 198 00:07:15,794 --> 00:07:17,334 for 25, 30 years. 199 00:07:18,754 --> 00:07:20,914 And on on the on the surgeon side, 200 00:07:20,914 --> 00:07:22,435 you'd hire us you'd hire a surgeon and 201 00:07:22,435 --> 00:07:23,954 you expect them to be your partner for 202 00:07:23,954 --> 00:07:26,294 30 years. Well, that doesn't exist anymore. 203 00:07:27,009 --> 00:07:28,370 And so if you grew up in that 204 00:07:28,370 --> 00:07:30,389 mentality where you're trying to find the perfect 205 00:07:30,449 --> 00:07:32,290 fit, I mean, the probability of that is 206 00:07:32,290 --> 00:07:34,209 is pretty much 0. You know, when you 207 00:07:34,209 --> 00:07:36,370 look at the medical profession, and I've heard 208 00:07:36,370 --> 00:07:38,129 people tell me in the nursing profession, the 209 00:07:38,129 --> 00:07:39,889 average nurse stays in a job, you know, 210 00:07:39,889 --> 00:07:42,134 over 24 months. Okay? When I first went 211 00:07:42,134 --> 00:07:43,574 to practice, I had a head nurse that 212 00:07:43,574 --> 00:07:45,974 stayed with me in my entire academic career 213 00:07:45,974 --> 00:07:47,735 of 8 years, and I had others that 214 00:07:47,735 --> 00:07:49,914 stayed with me in my private practice days, 215 00:07:49,974 --> 00:07:52,214 you know, for for 15 or 20 years. 216 00:07:52,214 --> 00:07:54,555 And and that that's absolutely unheard of today. 217 00:07:54,694 --> 00:07:56,615 It doesn't seem to make any difference kinda 218 00:07:56,615 --> 00:07:58,759 what what the benefit package is and what 219 00:07:58,759 --> 00:08:01,000 the work environment is. If if somebody moves 220 00:08:01,000 --> 00:08:02,600 or somebody has a child or somebody has 221 00:08:02,600 --> 00:08:05,000 a family, if that that the demographic movement 222 00:08:05,000 --> 00:08:06,920 of the workforce in dentistry and medicine is 223 00:08:06,920 --> 00:08:07,660 so mobile, 224 00:08:08,040 --> 00:08:10,199 that you just can't keep keep people grounded. 225 00:08:10,199 --> 00:08:12,055 You just have to continue to be very 226 00:08:12,055 --> 00:08:12,375 good at, 227 00:08:13,175 --> 00:08:15,254 at onboarding and teaching and getting people up 228 00:08:15,254 --> 00:08:17,335 to speed as soon as possible. I think, 229 00:08:17,335 --> 00:08:19,095 you know, back you know, as as I've 230 00:08:19,095 --> 00:08:21,814 seen that transition over the over the 35 231 00:08:21,814 --> 00:08:23,975 years I've been doing this, you you see 232 00:08:23,975 --> 00:08:26,160 the transition. You saw it first in the 233 00:08:26,160 --> 00:08:28,879 mobile workforce of the dental assistants. You know, 234 00:08:28,879 --> 00:08:31,459 the majority of those are females. They're sometimes 235 00:08:31,519 --> 00:08:33,440 they're they're childbearing age, and so they're gonna 236 00:08:33,440 --> 00:08:35,519 be very, very mobile in terms of their 237 00:08:35,519 --> 00:08:37,519 mobility. And then in dentistry, you know, we've 238 00:08:37,519 --> 00:08:39,700 seen the same thing. With dentistry, we've seen, 239 00:08:40,014 --> 00:08:42,894 know, the significant expansion of of women in 240 00:08:42,894 --> 00:08:43,394 dentistry, 241 00:08:43,695 --> 00:08:45,695 and then you're you're now seeing the same 242 00:08:45,695 --> 00:08:47,554 type of mobility issues with, 243 00:08:47,934 --> 00:08:50,014 with the with male and female providers. You 244 00:08:50,014 --> 00:08:51,875 know? So that's it's a it's a demographic 245 00:08:52,014 --> 00:08:53,695 shift and and the industry just has to 246 00:08:53,695 --> 00:08:54,894 figure out how do you how do you 247 00:08:54,894 --> 00:08:57,269 cope with it. But it's it's hard. I 248 00:08:57,269 --> 00:08:59,029 mean, I I can remember being a surgical 249 00:08:59,029 --> 00:09:00,950 resident of Vanderbilt. We had we had a 250 00:09:00,950 --> 00:09:03,350 female neurology resident, and it was a big 251 00:09:03,350 --> 00:09:05,269 deal when she was pregnant. People couldn't figure 252 00:09:05,269 --> 00:09:06,629 out what to do. You know, that was 253 00:09:06,629 --> 00:09:08,164 that was back in the stone age. But 254 00:09:08,164 --> 00:09:09,365 now, you know, you look at that. You 255 00:09:09,365 --> 00:09:11,284 have maternity leave. You have paternity leave. You 256 00:09:11,284 --> 00:09:13,524 have ways. You have gaps. You know, you're 257 00:09:13,524 --> 00:09:15,524 running a surgical practice. It's really tough to 258 00:09:15,524 --> 00:09:18,164 replace somebody. They disappear for 9 months or 259 00:09:18,164 --> 00:09:20,004 6 months or 3 months. You know? So 260 00:09:20,004 --> 00:09:21,524 those are new challenges. We have to kinda 261 00:09:21,524 --> 00:09:22,990 figure out how to do how to how 262 00:09:22,990 --> 00:09:24,830 to build around that. And we'll we'll figure 263 00:09:24,830 --> 00:09:26,429 it out. Just just it's a question of 264 00:09:26,429 --> 00:09:28,909 basically being innovative and and trying to, 265 00:09:29,389 --> 00:09:32,029 you know, micromanage people's time and access. But 266 00:09:32,029 --> 00:09:33,549 but I see the workforce I don't see 267 00:09:33,549 --> 00:09:35,230 that problem getting any better, to be honest 268 00:09:35,230 --> 00:09:36,584 with you. Okay. 269 00:09:37,445 --> 00:09:39,445 And I'm also curious. What are you most 270 00:09:39,445 --> 00:09:41,284 excited about when it comes to dentistry right 271 00:09:41,284 --> 00:09:42,904 now, and what makes you nervous? 272 00:09:45,924 --> 00:09:48,345 I'd say the thing I'm most excited about 273 00:09:48,789 --> 00:09:49,289 is, 274 00:09:49,910 --> 00:09:52,330 kind of the applications of technology to dentistry. 275 00:09:52,629 --> 00:09:54,470 I guess there's probably 2 examples I would 276 00:09:54,470 --> 00:09:54,970 cite. 277 00:09:55,750 --> 00:09:57,590 One is a project we're working on with 278 00:09:57,590 --> 00:10:01,034 a mobile, portable dental, electronic dental anesthesia record 279 00:10:01,434 --> 00:10:04,654 to replace, the generations old paper anesthesia records. 280 00:10:04,875 --> 00:10:06,815 There's been a lot of innovation in dentistry 281 00:10:06,954 --> 00:10:09,034 and and, you know, billing systems and revenue 282 00:10:09,034 --> 00:10:10,875 cycle stuff, but it's not not much on 283 00:10:10,875 --> 00:10:11,375 the 284 00:10:11,754 --> 00:10:14,154 the the anesthesia side. There's been innovations for 285 00:10:14,154 --> 00:10:16,320 all surgery medical records and so forth, but 286 00:10:16,480 --> 00:10:18,080 you also the anesthesia piece has kind of 287 00:10:18,080 --> 00:10:19,700 been left left to the side. 288 00:10:20,160 --> 00:10:21,679 And one of the things we found early 289 00:10:21,679 --> 00:10:23,120 on is that we if we're gonna go 290 00:10:23,120 --> 00:10:25,679 to multiple locations and deal with multiple DSOs 291 00:10:25,679 --> 00:10:26,899 with multiple EHRs, 292 00:10:27,360 --> 00:10:28,639 we had to have kind of a stand 293 00:10:28,639 --> 00:10:31,464 alone, anesthesia record that could go and follow 294 00:10:31,464 --> 00:10:34,184 us around and take care of all of 295 00:10:34,184 --> 00:10:36,184 the requirements that are that are mandated by 296 00:10:36,184 --> 00:10:38,184 these different states. And we were in the 297 00:10:38,184 --> 00:10:40,125 process we've we've kind of built an enterprise 298 00:10:40,184 --> 00:10:42,345 doing that, to try to figure out how 299 00:10:42,345 --> 00:10:43,904 we could do that digitally. And so we 300 00:10:43,945 --> 00:10:45,464 we've come up with a device that basically 301 00:10:45,464 --> 00:10:47,159 does it with an iPad. 302 00:10:47,559 --> 00:10:49,639 It's very mobile, very nimble, so we can 303 00:10:49,639 --> 00:10:51,720 pretty much go into any office, and we 304 00:10:51,720 --> 00:10:54,440 can have our own, isolated anesthesia record, which 305 00:10:54,440 --> 00:10:56,799 which tracks all of the necessary parameters that 306 00:10:56,799 --> 00:10:59,019 are required by each of the individual states. 307 00:10:59,355 --> 00:11:01,434 As I mentioned before, you have a lot 308 00:11:01,434 --> 00:11:02,574 of different variations. 309 00:11:02,875 --> 00:11:04,634 For instance, the state of Texas has its 310 00:11:04,634 --> 00:11:06,554 own set of rules that are very different, 311 00:11:06,554 --> 00:11:08,315 and your anesthesia record has to have, you 312 00:11:08,315 --> 00:11:10,235 know, 17 or 18 bullet points. If it 313 00:11:10,235 --> 00:11:12,154 doesn't have that, it's not acceptable, and you 314 00:11:12,154 --> 00:11:14,040 don't get a permit. And that's very different 315 00:11:14,040 --> 00:11:15,559 than what you see in Maryland. It's clearly 316 00:11:15,559 --> 00:11:17,559 different than what you see in Kentucky. So 317 00:11:17,559 --> 00:11:19,320 the ability to have a system that can 318 00:11:19,320 --> 00:11:21,500 morph and meet the demands of each state 319 00:11:21,720 --> 00:11:23,720 is really, really, really important to be able 320 00:11:23,720 --> 00:11:25,660 to offer a quality product. 321 00:11:26,245 --> 00:11:27,925 But when you have something like that, all 322 00:11:27,925 --> 00:11:30,004 of a sudden, you now can begin to 323 00:11:30,004 --> 00:11:31,065 improve the workflow 324 00:11:31,365 --> 00:11:34,325 because I don't in dentistry in general dentistry, 325 00:11:34,325 --> 00:11:35,865 we have hygienist and assistants 326 00:11:36,245 --> 00:11:38,245 and while the large DSOs have figured out 327 00:11:38,245 --> 00:11:40,585 ways to use technology to improve workflow. 328 00:11:41,139 --> 00:11:43,299 For example, I remember working with Heartland, they 329 00:11:43,299 --> 00:11:44,820 used to use headphones, and they use, you 330 00:11:44,820 --> 00:11:46,820 know, headphones to be able to tell when 331 00:11:46,820 --> 00:11:48,339 the hygienist is ready and so forth. They 332 00:11:48,339 --> 00:11:49,720 really improved the efficiency. 333 00:11:50,179 --> 00:11:51,860 Well, we we've done the same thing with 334 00:11:51,860 --> 00:11:54,014 the digital anesthesia record. What one example 335 00:11:54,495 --> 00:11:55,934 is if you bring your daughter to have 336 00:11:55,934 --> 00:11:58,115 her wisdom teeth taken out and she's done, 337 00:11:58,815 --> 00:12:00,254 we have to go ahead and contact you, 338 00:12:00,254 --> 00:12:02,095 the driver, to come pick her up. Right? 339 00:12:02,095 --> 00:12:03,615 Well, the one thing we learned about in 340 00:12:03,615 --> 00:12:04,115 COVID 341 00:12:05,215 --> 00:12:05,955 is that, 342 00:12:06,700 --> 00:12:08,299 people like to wait in their cars, and 343 00:12:08,299 --> 00:12:09,740 they're still waiting in their cars and working 344 00:12:09,740 --> 00:12:10,620 in their cars. You know? So we were 345 00:12:10,620 --> 00:12:11,980 able to put in the text system and 346 00:12:11,980 --> 00:12:14,220 the electronic system that says, when the patient's 347 00:12:14,220 --> 00:12:15,820 ready, you know, please drive around and pick 348 00:12:15,820 --> 00:12:18,139 up pick up the patient. That little event 349 00:12:18,139 --> 00:12:21,120 probably saves our our our staff sometimes 5,000 350 00:12:21,179 --> 00:12:23,684 steps a day. That's not tracing people down. 351 00:12:24,384 --> 00:12:26,325 The other part about that is is the 352 00:12:26,465 --> 00:12:28,144 we have the ability now to keep up 353 00:12:28,144 --> 00:12:31,105 with the DEA compliance rules and regulations because 354 00:12:31,105 --> 00:12:33,024 as a mobile surgeon, we're required to have 355 00:12:33,024 --> 00:12:34,785 a DEA number each one of these locations 356 00:12:34,785 --> 00:12:37,524 where we dispense or we actually administer medications. 357 00:12:37,980 --> 00:12:39,980 If you've got 70 offices, that's a big 358 00:12:39,980 --> 00:12:41,980 task. And to try to do that manually 359 00:12:41,980 --> 00:12:44,399 with an Excel spreadsheet, that that's pretty tough. 360 00:12:44,779 --> 00:12:47,179 So we've we've built technology that allows us 361 00:12:47,179 --> 00:12:48,080 to to support 362 00:12:48,459 --> 00:12:50,539 our DA compliance as we go from, you 363 00:12:50,539 --> 00:12:52,959 know, state to state and location to location. 364 00:12:53,339 --> 00:12:55,735 And probably probably the biggest benefit of of 365 00:12:55,735 --> 00:12:57,894 benefit of of something like that, it allows 366 00:12:57,894 --> 00:12:59,274 us to be able to report, 367 00:13:00,774 --> 00:13:01,274 prospectively, 368 00:13:02,294 --> 00:13:02,954 the current 369 00:13:03,254 --> 00:13:06,375 patient safety aspects of outpatient general anesthesia by 370 00:13:06,375 --> 00:13:07,735 by our group. Because, 371 00:13:08,709 --> 00:13:10,190 having run a surgery center for a number 372 00:13:10,190 --> 00:13:11,429 of years, we always used to have to 373 00:13:11,429 --> 00:13:13,909 report things like the number of patients transferred 374 00:13:13,909 --> 00:13:16,549 to the ER, unexpected admissions, those types of 375 00:13:16,549 --> 00:13:18,309 things. Well, none of that's really reported in 376 00:13:18,309 --> 00:13:20,709 dentistry in any systematic way. Some of the 377 00:13:20,709 --> 00:13:22,230 dental boards will require, if you have an 378 00:13:22,230 --> 00:13:25,154 anesthetic misadventure, that means transport the hospital, you 379 00:13:25,154 --> 00:13:26,595 have to report that to the dental board. 380 00:13:26,595 --> 00:13:28,195 But like I say, it's it's state by 381 00:13:28,195 --> 00:13:29,654 state. It's all over the place. 382 00:13:30,035 --> 00:13:31,795 But one of the challenges that we've had 383 00:13:31,795 --> 00:13:34,295 as an association in the oral surgery world 384 00:13:34,355 --> 00:13:35,795 is how do we how do we how 385 00:13:35,795 --> 00:13:36,695 do we actually, 386 00:13:37,554 --> 00:13:39,700 publish our results of the safety of of 387 00:13:39,700 --> 00:13:42,340 our anesthesia programs. And it's always been handicapped 388 00:13:42,340 --> 00:13:44,420 because we've got a paper record. Now you 389 00:13:44,420 --> 00:13:45,779 have the ability to have this in a 390 00:13:45,779 --> 00:13:47,540 digital format, and you can go as you 391 00:13:47,540 --> 00:13:48,660 go back at the end of the year 392 00:13:48,660 --> 00:13:50,980 and say, okay. We saw 10,000 patients and 393 00:13:50,980 --> 00:13:53,299 10,000 patients. One patient was transferred and no 394 00:13:53,299 --> 00:13:55,805 patients were transferred. Then you can actually compare 395 00:13:55,805 --> 00:13:58,445 that to how well the ambulatory surgery center 396 00:13:58,445 --> 00:14:00,605 business does. And actually, when you look at 397 00:14:00,605 --> 00:14:03,245 the data, the transfer rates out of of 398 00:14:03,245 --> 00:14:05,345 large groups that have this type of record 399 00:14:05,404 --> 00:14:07,165 are 8 times lower than what they are 400 00:14:07,165 --> 00:14:09,024 out of the ambulatory surgery center. 401 00:14:10,710 --> 00:14:12,790 The the second technology piece is kind of 402 00:14:12,790 --> 00:14:13,290 the, 403 00:14:14,149 --> 00:14:15,210 the aspect of 404 00:14:15,669 --> 00:14:16,410 of what's, 405 00:14:17,669 --> 00:14:20,549 how the large DSOs are using electronic health 406 00:14:20,549 --> 00:14:21,049 records 407 00:14:21,350 --> 00:14:23,529 to, to kind of build their platforms. 408 00:14:24,445 --> 00:14:25,725 You know, having been in medicine for a 409 00:14:25,725 --> 00:14:27,164 long time, if you go from one hospital 410 00:14:27,164 --> 00:14:28,524 to another to another, you have to jump 411 00:14:28,605 --> 00:14:30,044 you have to take, you know, 60 hours 412 00:14:30,044 --> 00:14:31,404 of education to learn how to use a 413 00:14:31,404 --> 00:14:33,565 different computer system. I was kinda getting that 414 00:14:33,565 --> 00:14:35,804 way in dentistry except it's not 60 hours. 415 00:14:35,804 --> 00:14:37,245 So if you go from one company to 416 00:14:37,245 --> 00:14:39,029 another, you have to learn the system. So 417 00:14:39,029 --> 00:14:41,190 as these systems have built built up, they're 418 00:14:41,190 --> 00:14:44,549 now building institutional silos associated with that brand 419 00:14:44,549 --> 00:14:45,049 name. 420 00:14:45,589 --> 00:14:48,549 And that that is interesting because what that 421 00:14:48,549 --> 00:14:51,209 has done is it's it's be begun to, 422 00:14:51,429 --> 00:14:54,144 you know, pull together a lot of stragglers. 423 00:14:54,205 --> 00:14:55,644 I mean, the dental industry has always been 424 00:14:55,644 --> 00:14:57,164 very fragmented, but now all of a sudden 425 00:14:57,164 --> 00:14:59,004 you pull it together and you put it 426 00:14:59,004 --> 00:15:00,924 on a Dentrix platform, you put it on 427 00:15:00,924 --> 00:15:02,845 the Epic platform. Now all of a sudden 428 00:15:02,845 --> 00:15:04,799 people can talk. You can relate. It makes 429 00:15:04,799 --> 00:15:07,519 referrals from generalist to specialist a lot easier. 430 00:15:07,519 --> 00:15:09,440 It makes the quality of the patient record 431 00:15:09,440 --> 00:15:11,200 a lot better, but also has a lot 432 00:15:11,200 --> 00:15:12,879 more demands that are put on the provider 433 00:15:12,879 --> 00:15:14,480 and the provider team to be able to 434 00:15:14,480 --> 00:15:15,460 keep up with that. 435 00:15:17,335 --> 00:15:19,914 Yeah. Definitely. Some very great insight there. 436 00:15:20,535 --> 00:15:22,535 Last question here. What will the most effective 437 00:15:22,535 --> 00:15:24,535 health care leaders need to be successful in 438 00:15:24,535 --> 00:15:25,914 the next 2 to 3 years? 439 00:15:28,054 --> 00:15:28,554 Patients. 440 00:15:30,294 --> 00:15:31,335 Yeah. I I think, 441 00:15:31,894 --> 00:15:34,559 the thing that the the younger the next 442 00:15:34,559 --> 00:15:36,559 generation of leaderships got to learn, they have 443 00:15:36,559 --> 00:15:38,799 to digest all these some of these workforce 444 00:15:38,799 --> 00:15:40,799 dynamics that we were talking about. You know, 445 00:15:40,799 --> 00:15:42,639 how how you deal with the workforce that's 446 00:15:42,639 --> 00:15:44,320 very mobile. You know, can you get them 447 00:15:44,320 --> 00:15:46,160 licensed? Can you transfer them? You know, can 448 00:15:46,160 --> 00:15:47,540 you can you do this? 449 00:15:47,920 --> 00:15:49,914 I look at some of the multistate DSOs. 450 00:15:50,054 --> 00:15:52,054 I mean, it's not uncommon. The ones we 451 00:15:52,054 --> 00:15:53,654 work with, we're I'm working in Tennessee. You 452 00:15:53,654 --> 00:15:55,254 know, I go in every morning. I see 453 00:15:55,254 --> 00:15:55,754 somebody. 454 00:15:56,294 --> 00:15:58,054 Hi. My name is Sally, and I just 455 00:15:58,054 --> 00:15:59,654 moved here from Texas. I work for the 456 00:15:59,654 --> 00:16:01,414 same company in Texas. I'm able to move 457 00:16:01,414 --> 00:16:04,259 here. So when you have common informatics into 458 00:16:04,259 --> 00:16:06,340 the training of that that the company had 459 00:16:06,340 --> 00:16:08,340 to do for that particular person, for that 460 00:16:08,340 --> 00:16:11,860 particular location is transferable to another location. Just 461 00:16:11,860 --> 00:16:13,139 kind of think of it like it's almost 462 00:16:13,139 --> 00:16:14,340 like being in the army. You know, you 463 00:16:14,340 --> 00:16:16,365 basically you've you had the knowledge of the 464 00:16:16,365 --> 00:16:16,865 particular, 465 00:16:17,325 --> 00:16:19,165 platform that you're working on. You easily can 466 00:16:19,165 --> 00:16:21,325 transfer. You step in, you're ready to go. 467 00:16:21,325 --> 00:16:23,085 You don't have to be retrained. That's a 468 00:16:23,085 --> 00:16:25,565 big deal. I think also the only thing 469 00:16:25,565 --> 00:16:27,004 that that does, that also when you look 470 00:16:27,004 --> 00:16:28,845 at the growth of these companies, whether they're 471 00:16:28,845 --> 00:16:31,250 doing de novos or whether they're doing acquisitions, 472 00:16:31,710 --> 00:16:34,929 if if I'm if I'm basically acquiring practices 473 00:16:34,990 --> 00:16:37,330 and they're on the same electronic platform design, 474 00:16:37,389 --> 00:16:39,149 it's going to make that merger, that marriage 475 00:16:39,149 --> 00:16:41,009 a lot simpler and a lot easier. 476 00:16:41,549 --> 00:16:43,309 And I think that's that way, it's a 477 00:16:43,309 --> 00:16:44,529 lot easier to 478 00:16:45,345 --> 00:16:47,345 to expand and to kind of prepare yourself 479 00:16:47,345 --> 00:16:49,105 for an acquisition if that's that's what you're 480 00:16:49,184 --> 00:16:50,404 the business are doing. 481 00:16:51,664 --> 00:16:53,024 I think, you know, the the the other 482 00:16:53,024 --> 00:16:54,544 thing you're asking about, what I was excited 483 00:16:54,544 --> 00:16:55,985 about, what I was nervous about. The other 484 00:16:55,985 --> 00:16:57,345 thing I I guess I'm kind of nervous 485 00:16:57,345 --> 00:16:58,705 about is kind of the future of the 486 00:16:58,705 --> 00:17:00,404 solo practitioner of the dentist. 487 00:17:01,710 --> 00:17:02,990 You know, when I went to dental school, 488 00:17:02,990 --> 00:17:04,430 that was kind of the gold standard. That's 489 00:17:04,430 --> 00:17:06,750 what everybody aspired to be because that was 490 00:17:06,750 --> 00:17:08,910 how dentistry is practiced. And I think, you 491 00:17:08,910 --> 00:17:10,910 know, the effective labor cost and the cost 492 00:17:10,910 --> 00:17:12,990 of cost especially the cost of health care 493 00:17:12,990 --> 00:17:14,910 insurance and so forth, it's pretty much made 494 00:17:14,910 --> 00:17:17,285 it nearly impossible for a solo practitioner 495 00:17:18,144 --> 00:17:19,984 to kind of know everything there is to 496 00:17:19,984 --> 00:17:20,484 know 497 00:17:20,865 --> 00:17:22,785 about about the business, about, 498 00:17:23,184 --> 00:17:25,265 about running the organization because it's gotten a 499 00:17:25,265 --> 00:17:27,105 lot more complicated over the over the years 500 00:17:27,105 --> 00:17:28,005 I've been in it. 501 00:17:28,859 --> 00:17:30,460 I think the last thing is kind of 502 00:17:30,460 --> 00:17:30,960 the, 503 00:17:31,740 --> 00:17:33,599 the the leaders are gonna have to understand 504 00:17:33,900 --> 00:17:34,720 how to 505 00:17:35,019 --> 00:17:36,240 build their organizations 506 00:17:36,619 --> 00:17:37,839 to be able to capture, 507 00:17:38,460 --> 00:17:41,900 this this nomadic mobile dental workforce, whether it's 508 00:17:41,900 --> 00:17:44,335 the assistant hygienist or the dentist or the 509 00:17:44,335 --> 00:17:46,815 specialist because everybody seems to be moving around 510 00:17:46,815 --> 00:17:47,555 a lot more. 511 00:17:47,934 --> 00:17:49,535 I just read an article where it it 512 00:17:49,535 --> 00:17:50,434 said that the, 513 00:17:50,734 --> 00:17:53,134 you know, a great number of physicians coming 514 00:17:53,134 --> 00:17:55,214 out are now basically going into, 515 00:17:56,440 --> 00:17:59,080 into locus positions to start out because they're 516 00:17:59,080 --> 00:18:01,000 not sure what they wanna do. Their decision 517 00:18:01,000 --> 00:18:02,440 making I think this is kind of true 518 00:18:02,440 --> 00:18:03,960 of the COVID population too. A lot of 519 00:18:03,960 --> 00:18:05,720 the people that trained in the COVID area, 520 00:18:05,720 --> 00:18:07,720 a little bit indecisive. They may not feel 521 00:18:07,720 --> 00:18:10,275 is is ready for prime time when they 522 00:18:10,275 --> 00:18:11,954 get out as other people, and so they're 523 00:18:11,954 --> 00:18:13,954 looking for mentorship or they're looking for a 524 00:18:13,954 --> 00:18:15,154 way to be able to hook up with 525 00:18:15,154 --> 00:18:16,674 somebody for a short period of time to 526 00:18:16,674 --> 00:18:19,234 prove their skills, increase their confidence before they 527 00:18:19,234 --> 00:18:20,454 go out into the workforce. 528 00:18:21,929 --> 00:18:23,929 Yeah. Definitely. Wanted to go back to a 529 00:18:23,929 --> 00:18:25,710 point that you made earlier about solo, 530 00:18:26,009 --> 00:18:28,169 practice. I know you said that you're nervous 531 00:18:28,169 --> 00:18:29,710 about the future of solo practitioners. 532 00:18:31,049 --> 00:18:32,990 Do you see, in your opinion, 533 00:18:34,304 --> 00:18:36,304 a good amount of dentists still striving for 534 00:18:36,304 --> 00:18:38,224 solo for solo practice, or do you think 535 00:18:38,224 --> 00:18:39,684 that number has kinda gone down? 536 00:18:41,105 --> 00:18:43,424 Yeah. I I think it's I think it's 537 00:18:43,424 --> 00:18:44,244 going down. 538 00:18:44,944 --> 00:18:47,090 I I think it's I've always I've often 539 00:18:47,090 --> 00:18:49,330 said that the the total cash dental practice 540 00:18:49,330 --> 00:18:51,330 is an urban legend. We I think a 541 00:18:51,330 --> 00:18:52,609 lot of people come out of dental school, 542 00:18:52,609 --> 00:18:54,390 and that's what they think they're getting into. 543 00:18:54,450 --> 00:18:55,890 And then they get out into the real 544 00:18:55,890 --> 00:18:58,210 world, and they find that that's really not 545 00:18:58,210 --> 00:18:59,750 how this industry is going. 546 00:19:00,049 --> 00:19:02,505 This industry is so so driven and shaped 547 00:19:03,065 --> 00:19:05,464 by by dental insurance, from the standpoint of 548 00:19:05,464 --> 00:19:07,384 the, you know, the PPOs. And certainly now, 549 00:19:07,384 --> 00:19:09,164 in my career, I've seen a lot more 550 00:19:09,224 --> 00:19:10,825 coverage on the on the government side, you 551 00:19:10,825 --> 00:19:13,224 know, through through Medicare and and Medicaid, of 552 00:19:13,224 --> 00:19:15,509 course. You know? So there's this huge population 553 00:19:15,509 --> 00:19:17,509 of people that that need treatment that are 554 00:19:17,509 --> 00:19:18,549 in those in those, 555 00:19:19,109 --> 00:19:19,769 in those, 556 00:19:20,309 --> 00:19:22,470 payer sectors, and and and somebody has to 557 00:19:22,470 --> 00:19:24,869 be the provider of choice for those particular 558 00:19:24,869 --> 00:19:27,369 people. And if you're a a solo practitioner, 559 00:19:27,750 --> 00:19:28,329 you know, 560 00:19:29,054 --> 00:19:31,554 needing to collect it, you know, a huge 561 00:19:31,615 --> 00:19:33,154 a huge fee for a service, 562 00:19:33,454 --> 00:19:35,054 and that's that fee has to be 3 563 00:19:35,054 --> 00:19:36,734 times what the average is or 4 times 564 00:19:36,734 --> 00:19:39,054 what the meds fee value is, it's it's 565 00:19:39,054 --> 00:19:40,815 it's very difficult to stay alive in that 566 00:19:40,815 --> 00:19:42,575 situation. So, I mean, I think a lot 567 00:19:42,575 --> 00:19:44,452 of people aspire to do it because they 568 00:19:44,452 --> 00:19:46,359 don't like the hassles of dealing with insurance. 569 00:19:46,359 --> 00:19:48,267 But I would say this, it it did 570 00:19:48,267 --> 00:19:50,413 say over the years I mean, when I 571 00:19:50,413 --> 00:19:52,320 when I left academics and I went into 572 00:19:52,320 --> 00:19:54,227 private practice, we we spent a lot of 573 00:19:54,227 --> 00:19:56,135 time kind of sword fighting with insurance companies. 574 00:19:56,135 --> 00:19:58,042 You know? Is it covered? Is it not 575 00:19:58,042 --> 00:19:59,634 covered? Is it medically necessary? Is it not 576 00:19:59,634 --> 00:20:01,714 medically necessary? And all that stuff has kind 577 00:20:01,714 --> 00:20:03,474 of evolved, but it's it's sure taking a 578 00:20:03,474 --> 00:20:04,934 lot longer than I ever thought, 579 00:20:05,394 --> 00:20:07,075 because now if you come in and you 580 00:20:07,075 --> 00:20:08,775 say, I need to have a crown. Okay. 581 00:20:09,075 --> 00:20:10,674 Are you eligible? Well, you can figure that 582 00:20:10,674 --> 00:20:12,515 out electronically before you've been there. You can 583 00:20:12,515 --> 00:20:14,210 figure out in a matter of seconds. Next 584 00:20:14,210 --> 00:20:16,630 question is the code coverage. Yes or no? 585 00:20:16,690 --> 00:20:19,109 Asterisk. Well, it's based on medical necessity. 586 00:20:19,410 --> 00:20:20,930 Well, if you're if you're in business and 587 00:20:20,930 --> 00:20:22,690 you're trying to say, can I deliver this 588 00:20:22,690 --> 00:20:24,930 service? Am I gonna be paid? Well, I 589 00:20:24,930 --> 00:20:27,234 don't know. You know? So that that's a 590 00:20:27,234 --> 00:20:29,575 very, very difficult problem for a sole practitioner. 591 00:20:29,954 --> 00:20:31,394 Now when you scale it up and you 592 00:20:31,394 --> 00:20:33,954 have large databases and you're running across multiple 593 00:20:33,954 --> 00:20:36,275 states and you know how you've profiled all 594 00:20:36,275 --> 00:20:38,115 of these insurances and you understand how they're 595 00:20:38,115 --> 00:20:40,059 gonna behave, all of a sudden that that 596 00:20:40,059 --> 00:20:42,460 task can be greatly aided by AI. But 597 00:20:42,460 --> 00:20:44,220 you can say, well, how about a guardian 598 00:20:44,220 --> 00:20:47,339 person working at Sikorsky Aircraft in Connecticut with 599 00:20:47,500 --> 00:20:49,419 in this plan? What's it gonna be covered? 600 00:20:49,419 --> 00:20:51,704 All that information is now being shared because 601 00:20:51,704 --> 00:20:53,384 the the payers have learned that it takes 602 00:20:53,384 --> 00:20:54,984 too much money to answer the phone, answer 603 00:20:54,984 --> 00:20:57,704 the questions. And even even with bots, it 604 00:20:57,704 --> 00:20:59,544 doesn't seem to make a difference. But if 605 00:20:59,544 --> 00:21:01,304 you go ahead and make it accessible, it 606 00:21:01,304 --> 00:21:03,384 lowers the cost of both ends, and that 607 00:21:03,384 --> 00:21:04,984 I think is gonna be the driving force 608 00:21:04,984 --> 00:21:06,345 going forward. I think by myself, it will 609 00:21:06,345 --> 00:21:07,325 be much more transparent. 610 00:21:08,399 --> 00:21:10,480 But, you know, it it just it takes 611 00:21:10,480 --> 00:21:11,940 a lot longer to get there. 612 00:21:13,119 --> 00:21:15,519 Okay. Yeah. Definitely a great conversation here. So 613 00:21:15,519 --> 00:21:16,960 thank you so much for joining us today, 614 00:21:16,960 --> 00:21:18,419 doctor Carter. It was, 615 00:21:18,720 --> 00:21:20,319 a great pleasure speaking with you, and I 616 00:21:20,319 --> 00:21:21,679 look forward to connecting with you again in 617 00:21:21,679 --> 00:21:22,259 the future. 618 00:21:22,976 --> 00:21:24,816 Okay. Thanks for the opportunity. Have a good 619 00:21:24,816 --> 00:21:25,316 day.