June 6, 2022: Matti (Perilstein) Burnett, Co-Founder of Eternally joins Bill for the news. Eternally www.myeternally.com is a personalized service providing advanced care planning support for patients of hospital systems. A Gartner report states that the annual quit rate will jump up nearly 20 percent from annual pre pandemic levels. Healthcare organizations should prepare themselves as this new culture of quitting becomes the norm. With more than two years having passed since the pandemic began, questions are being raised about when to end the public health emergency declarations made by the federal government. There are numerous implications of course. And Greg Till, EVP, Chief People Officer at Providence says “Workforce strategy doesn’t just ‘support’ business strategy. It IS a business strategy. That’s never been more apparent or important.”
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Our frontline workers are just getting beat up and I have a lot of empathy for what they're going through each and every day to take care of the millions of patients. And just making sure that we are giving them the tools to do their jobs well. That's becoming more and more of a challenge. And so with those limited resources, we're seeing even more strain on those healthcare workers.
It's Newsday. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to CrowdStrike, Proofpoint, Clearsense, MEDITECH, Cedars-Sinai Accelerator, Talkdesk and DrFirst who are our Newsday show sponsors for investing in our mission to develop the next generation of health ???? leaders.
Alright, here we are for another Newsday episode. And today we are joined by another Cedars-Sinai accelerator participant. We have Matti Perilstein Burnett co-founder of Eternally joining us on the show. Matti, welcome to the show. Yeah, I'm looking for, I always love having the accelerator companies on, cause you guys are doing some, some great stuff. Give us a little understanding of what Eternally does.
So eternally is a personalized service providing advanced care planning support for patients of hospital systems. So we do telehealth by helping patients through advanced care planning or end of life planning conversations from the comfort of their own home.
so if I'm doing an advanced directive, Myself or with my parents, you actually offer a service where the, a clinician would come out and sit down with us.
Yeah. So what happens today is we know that. Would love to take the time to meet with their patients and understand what are their goals of care.
What does meaningful life mean to them before diving into treatment? But oftentimes there's not enough time or resources to make that very vulnerable conversation happen. So we're outsourcing that from the health system and taking that on, on behalf of that physicians to make sure that the patient has the time and space and emotional capacity.
To continue that conversation as they choose. And by pairing that patient with one of eternalist clinicians, they're actually getting great guidance in terms of what actually happens. What does it mean for you and what does it mean for your family? How are they impacted by those decisions?
any idea what the percentage of people that don't have advanced directives when they need them, it's a pretty high percentage.
Yeah. So what's fascinating is in polls across America about a third of patients say that they do have an advanced directive, but when it comes down to it and you actually look to see when these decisions are recorded within the medical records of a health system. Around 3% of patients actually have those decisions uploaded into their medical records.
So that's where internally also helps health systems with closing the gap. Not only are we helping their patients have these conversations, but we're also informing those physicians and those care teams of what those decisions were, so that it's actionable in the event of an emergency.
What we're going to talk a lot about people challenges that that are facing health care right now. So you're in Philadelphia. Have you scaled beyond the Philadelphia market at this point?
Yeah, so we have health system partners in four states right now. So Pennsylvania, New Jersey, Delaware, and California.
Fantastic. Well, my parents are in Pennsylvania. we'll have to compare notes at some point. So we have, we have a bunch of really interesting stories. So we've talked about companies should brace for culture of quitting. Really we glossed over it in one of the previous episodes. We're going to go into it in detail in this one.
that's based on a gardener story and we have some information from that surgeon general, in fact, Marie. Sounds warning for healthcare worker, burnout, resignation, and we have some interesting things moving forward. So we're, we're going to go back and forth on some of those. And if there's some time, we'll talk about some things that's queer capital is putting out there.
So companies braise for a culture of. Was summarized in Becker's hospital. And they said organizations should prepare themselves for a continuation of quits. As a new culture of quitting becomes the norm and annual quit rates stands to jump nearly 20%, which is pretty high pre pandemic average for quits that at 31.9 million, but that figure could rise to 37 million.
So that's interesting in and of itself, but we also have the actual Gardner. Study itself. And so Gardner says us total annual employee turnover, but likely jumped by nearly 20%, which is what they summarized new employee expectations, any availability of how. Arrangements will continue to fuel the rise of attrition.
Let's stop there. Let's start the conversation there, employee expectations. they really have changed as a result of the pandemic. I mean, the, the nature of work has really changed.
Yeah. Our frontline workers are just getting beat up and I have a lot of empathy for what they're going through each and every day. to Take care of the millions of patients that have COVID or COVID symptoms and understanding what they're going through in terms of managing those COVID patients, but also the patients that are otherwise regularly coming in. And just making sure that we are giving them the tools to do their jobs well.
That's, that's becoming more and more of a challenge with resources stepping back and saying, is this something that I really want to continue? with Under these circumstances it's been challenging. And so with those limited resources, we're seeing even more strain on those healthcare workers and even more challenges arise based on those inconsistencies with matching resources, schedules, and competencies.
as we look at this. I've said on this show and a couple other venues. Now I've said we will have a nursing shortage for the next 30 years. And part of it is they now have options. Right before you were a nurse, you were nurse. This is what you did. You were, there were a traveling nurse you did home health or you were in a health system.
There, there wasn't a lot of options, but one of the options now is they could go work for eternally and help people put together advanced directives. And that's not a slight, I mean, that's, that's a phenomenal option for them. They have options and you're just one of many. We need nurses to go into clinical informatics.
We need them to go into data science. We need them And they're looking at it going, you know what that's that is more in line with the lifestyle. I want the the flexibility I'm looking for in a work arrangement and maybe they don't have, maybe they just are tired of dealing with. Potentially ornery parent or ordinary patients or ornery family members of patients who aren't happy with the care they're receiving at the health system.
So there they have options that they didn't have before. And they're looking for that flexibility and maybe it's a little different lifestyle and that's, that's a good thing for them, right? We're happy for them. They're getting those options, but it is creating. Real shortages and challenges for healthcare delivery.
That's right. One more thinking about. Patients that are going through something scary or traumatic, or even patients that are aging and need to start thinking about what type of care do I want in the event of an emergency. We know that those patients aren't being met with the same resources, the time that they might need to consider all their options because of the limited resources they might be.
Jumping to treatment, or they might be going to the next step without taking that step back with the resources that they might have typically been given. And that's really where eternally shines as an intervention in partnership with health systems, we've gotten thousands of applicants from nurses around the country.
Based on what you've said they are really looking for that. Fit both with their schedule, maybe it's families and being able to continue to provide their clinical expertise, but from the comfort of their own home. So when we talk about how do we make sure that we're scaling appropriately and we're evaluating the nurse applications that we've received number one, it's, it's not only evaluating clinical experience. Maybe it's their schooling and actual practice of medicine, but it's also about the emotional intelligence that they're able to convey over the phone or over a screen because end of life planning is hard. We need there to be compassion, empathy, and really a passionate caregiver that can connect with a patient while they're trying to absorb.
All these different scenarios that they and their families might go through in the future. And what does that mean to them and how do we make sure that they feel comfortable with those decisions? Well, we're providing a lot of education and oftentimes this is the patient's very first time hearing any of these terms and what end of life or what a meaningful life might mean to them.
And that's why it's important that our clinicians are there to provide them. Very first conversation that first step into understanding what this medical treatment might feel like.
Yeah. It's interesting as you talk about what you're looking for and nurses are so good at that. That's the reason they got into healthcare.
I read the vac Murphy's what do they call it? Advisory sound's warning on healthcare worker, burnout and resignation. And essentially what he's saying is we need health systems to have that same. Empathy for their workers and understand that they're bringing burdens to work. They're bringing again, the same burdens we all face.
We have to care for our parents. We have to care for our kids. And during the pandemic we couldn't send them to school. We had a lot of things, so they're, they're bringing all those things. And then they're fighting with things at the health system. Let me see if there's two paragraphs in here specifically.
reducing the administrative burden is essential. He said, because worker's time should be spent with patients in the community and building relationships with their colleagues or the cited research showing that it, that isn't always the case with one study revealing that on average primary care workers will spend two hours a day.
On administrative tasks for every one hour of direct patient care, he goes on among other recommendations. The advisor advisory suggested healthcare organizations provide all workers with living with. Paid second family, leave, rest breaks, evaluation of workloads and working hours, educational debt support, and family-friendly policies, including children and care for older adults and also advocates for adequate staffing, including search capacity for public health emergencies.
You mentioned that the daily commute to get to the office or to get to the health system. So I think all of those things really limit our capacity to make sure that we're showing up for our healthcare workers and making sure that we have that empathy. But when you remove those barriers and make it very simple for that clinician, you should just do the thing that they want to do and make them feel good and shine.
Allowing definition, not only to Excel at what they knew best, but driving it as well. So we're excited to be able to provide that opportunity. I get a ton of energy from our providers. They are amazing. And so passionate. So it's really enlightened me as to what happens when you remove those barriers ???? ????
All right. We'll get back to our show in just a minute. I want to tell you about the podcasts that I am the most excited about right now that I am listening to, as often as I possibly can under that is the town hall show that we launched on the community channel this week health community, and an Arizona Tuesdays and Thursdays. What I've done is I have essentially recruited these great. Hosts who are coming in and they're tapping people in their networks and having conversations with them about the things that are frontline kind of stuff. So it's, it's technical, deep dives, it's hot button issues. It's tactical challenges. it's all the stuff that is happening right there. Where you live on a daily basis. We have some braid hosts on this show. We have Charles Boise. Who's a, data scientist, Craig Richard, bill Lee, Milligan Reed, Stephan, who are all CEOs. We have Jake Lancaster Brett Oliver, who are CMIOs. We have mark Weisman who is a former CMIO and host of the CML podcast. And now a CIO. At title health and we also have the incomparable sushi shade who is fantastic. And I'm really excited about the fact that she's tapping into her network and having some great conversations as well. I'd love for you to tune into these episodes. I am learning a ton myself. You can subscribe on our community channel this week health community. You can do that on iTunes, on Spotify. On Google on Stitcher, you name it, we're out there and you can subscribe there and start having a listen to yourself. All right, let's get back to our show. ???? ????
let me put you in a different role. I just made you the head of Penn university health system. Congratulations on your promotion or demotion. I don't know. You probably have a pretty good work-life balance right now, but I'm going to put you in charge of a health system. Very challenging situation to be in right now.
You're worried about the fact that you have a lot of traveling nurses, filling in gaps for nurses that have left and gone to work for you because you have a great work environment and you're giving them the ability to do the thing they love doing. How, how are we going to stem the tide of nurses, just walking out the door so that we can continue to provide care and Philip.
Well, thank you for the new title. I'm not sure if the one that I've wanted, but there's a lot of factors that are implicating these staffing decisions. One thing that I've read a lot about recently, Is how the travel nurse industry and supply chain are also impacting the high costs going into these staffing decisions.
And when nurses are leaving quitting and droves, then how might we also align our supplies and staffing? So the costs for staffing agencies, travel nurses to supplement the nursing shortage is very, very high. So in order to make significant changes, Needs to be a fundamental shift in the way that we treat and compensate our healthcare workers.
I know that this has been making headlines in California and elsewhere, but how might we value those that are full-time on staff or even part-time on staff the same way we value those that are traveling to fill gaps in our health system. And I think that's a fundamental issue that needs to change based on some recent events, but you know, making sure that the physicians and clinicians, when they arrive, have the supplies that they need to do the job, because that's also part of how we value them and how they feel good about doing their job. It's not just about making sure that they have a team to rely on.
It's also about how the, they have the materials, the tools, the resources they need to execute. So it's kind of a balance between. Re-evaluating the compensation, but also making sure that those tools and supplies are available as well. So I might also tag my COO counterparts and other CFO counterparts to make sure that we're thinking about this more holistically in terms of bringing patient care to the forefront and balancing that with.
Really getting at the heart of why our nurses are leaving. It's not just about pay, it's certainly a big part, but it's about that evaluation of how are we failing them and it's, it's seeing the competition getting paid higher, it's seeing packages of materials and tools not arriving because of supply chain charges. So how might we better plan from the get-go?
You have a management consulting background. I have a management consulting background. So we're going to brainstorm here in a minute as CEOs of health systems. Specific strategies we would do one thing to share before we get there.
So Greg till is the chief people officer at Providence health system, and he had this one line post on LinkedIn workforce strategy. Doesn't just support business strategy. It is business strategy. That's never been more apparent or important. And I think. You and I, as CEOs of health systems, now we're looking at this going, yeah.
If it wasn't apparent before, it's really apparent now. And so what kinds of things can we do to send this tide? I mean, one of the things that we still at St Joe's we used to do these pulse surveys and the poll surveys were really interesting. We did them on a quarterly basis and I would look at the numbers.
And one of the things that would tell me very clearly is which ones of my managers have had, were able to build a culture that people want it to work in because it's not just one organization where, because you put managers in charge of different things. One of the things that would happen is I'd look across the board, I'd say, okay, these 10 managers are doing a great job.
These people like working here, they're pretty excited. They're pretty engaged. Now I'd look at these other two and go, man, that's the complete. And generally speaking, it was a manager problem. It was, they were good at, at doling out tasks and saying, Hey, the work that needed to be done. And but they, they maybe lacked the emotional intelligence.
They maybe lack the empathy. They maybe lacked the ability to create culture. And some of that might be education. Some of that might be. A bad fit. And so I think from a strategy standpoint, we have to be more cognizant of the people that we've put in charge of different things, especially in this environment.
It's very it's very sensitive right now. And if you don't have the right people in place, you're just going to see people leave in droves. So that's, I mean, that's one of the things that we did at St. Joe's. I think that was, that was helpful. As you think about the. Challenges that employees have.
What are some other things you think might be important?
Yeah. So employee surveys and poll surveys are fantastic. I think one of the challenges that I've seen with them in recent years is people saving all their comments for the survey. When the survey is released, I'm going to really let them know how I feel.
So I think that culture of transparency. Throughout the year is what enables that culture shift to take place. And when you're doing it from the top, when you're providing transparency around the mission and values of the organization, as well as the struggles, you're going to have a culture of understanding and awareness.
This is why we're doing things the way we're doing them. Maybe this is a temporary solution to the problem. But we have this ultimate goal of serving the patient first. And, and these decisions are all going to align to that. But we have to go through these tough times, whether it's due to staffing shortage or a supply shortage these are the decisions we're making in the interim so that we can get over this hump.
So I think. Really empowering leaders to communicate more transparently about these decisions. Whether it's partnering with third parties like eternally or with travel nursing agencies or elsewhere, why are we doing this? It's not because we don't believe in you. It's not because we don't value you.
It's because we're as a nation, we're going through a tough time. It's not just us. And so when you're able to check in and provide. That insight to, to managers, to line leaders to those that design staffing schedules, it is helpful in terms of making sure that these team members know that they're valued and that while it's tough, everyone is going through the same thing.
And that's where these decisions are being made. And that it's not intended to continue based on the values of the organization. Right. Having a stabbing shortage is not putting the patient first. They're not getting the treatment that they might've otherwise gotten or might get at another facility. But this is how the organization is conquering it in the short term, recognizing it's a challenging space plan.
Amanda, do you ever at your seat co founder, CEO of an organization, do you ever take a look at glass door and see the comments there? And if I were a health system, CIO, should I be taking a look at that because. I mean it's anonymous. So it's it's a little easier to just say whatever you want.
Yeah, Glassdoor is a great tool to get the pulse of the organization. I know that you can contribute as a current or former employee, and sometimes people feel a little bit safer after they've left an organization. So it could be another tool in addition to an exit interview that gives you insight of what went wrong. So I think there's always a healthy gut check from glass door. It's not the only tool that I would rely on as.
I was hired in, I had no healthcare experience and the initial reactions on glass door. If I had spent too many days out there, it, my, my I think my confidence would have been shot. I mean, people were like, this person doesn't know anything about healthcare. They've never been in healthcare. And anyway, it was that was, that was pretty difficult.
But let me give you another one that I when we talk about. Having empathy for the challenges that people are bringing into work. Jonathan Goldberg, executive VP, and CIO for a health system. I don't know which one I, it doesn't show me here. As of today, we are now offering a date adult daycare to our it department.
This innovative program allows staff who may need some time away from their kids or a significant other wants some alone time to come to our corporate center. For supervised activities or even getting some work while here, just one more reason. We are the workplace of choice in our region. This is probably the biggest benefit I think that's going on is we are rethinking the nature of work.
Healthcare is onsite at the end of the day, you're still gonna have to battle the Philadelphia traffic or the LA traffic or Chicago traffic to get to your hospital. But what can we do once people get there? To alleviate some of the concerns that they left at home or some of the some of the challenges of commuting.
I mean, are we going to pay people a little bit more? Cause they're commuting rather than flexible work or can we even come up with something in the way that supports clinicians lifestyle and get more flexible with schedule? I think those conversations are happening more regularly because we're worried about this, this this shortage of people.
And I believe. No, even even the just most health systems, most boardrooms right now are having these kinds of conversations. What can we do for our employees? What can we do to make it better for them? Any other ideas sort of strike you? Access to mental health, I think is another one that, that people are that helps systems are putting out there for their clinics.
Yeah, I, I give a lot of kudos to those that are thinking differently about the package, the total benefit package that they give to their teams. I think thinking differently, it's the only way we're going to. Get better at this. And our health care system is, is not in a good place right now in terms of how we're treating our healthcare workers in the stress that we're putting them under.
So anything that we can do to alleviate those burdens and barriers is going to be helpful. I seen a lot of companies starting to engage the healthcare community because of the benefits they offer, like Headspace or calm like Allbirds giving sneakers to healthcare workers. I think we're starting to see more of that.
Cross-section between those consumer products with the healthcare organizations. And I think, yeah, while those are appreciated, it's not changing the fundamental issues at play. So I, I like the idea of creating a space, a safe space, if you will for those that decompression period, instead of going home the amount of stress that we're putting on the caregiver in our.
It is absurd and the resources are not there to support those hours that seemingly don't go accounted for. So anything that we're doing to support that additional burden is, is helpful, whether that's actual hands on resources getting connected to financial planning services or end of life planning services.
Or health mental health services. All of those things are going to add up to support that additional burden people are taking on and it's mostly women that are taking on that burden, whether it's caring for their parents or their children and making sure that those hours, whatever they are, whatever they're spent doing are, are being supported by resources that either their employer or their community is offering them.
Startup you're enforced states. I assume you want to be in 50 states and square capital rights. This associate Qualia capital Warren's founders of longer economic downturn market. Isn't a crucible moment. So they have a couple of things in here. They had a 52 slide presentation that they gave out to 250 founders warning them about the things I just talked about.
These are turbulent financial markets. And rising inflation are going to create prolonged economic downturn. There's the potential for that, essentially what they're saying. And they're leaning more towards that is going to be the case for the next couple of years. We do not believe this is going to be another steep correction followed by an equally swift V-shaped recovery.
Like we saw on the outset of the pandemic. We expect the. Market downturn to impact consumer behavior, labor markets, supply chains, and more there'll be longer recovery. And while we can't predict how long we can advise on ways to prepare. And so they're talking to again, they're venture capital firms.
So they're talking to startups like others, such as Lightspeed ventures, partners in my Combinator who have warned startups about the upcoming difficulties. Coya suggest immediately cutting burn rates to stock up on cash reserves for the coming months. When funding may be harder to come by. Don't view cuts as negative, but as a way to conserve cash and run faster companies who move the quickest have the most runaway and it goes on.
And has a, obviously 52 slides. I'm not going to go through 52 slides. But that's sort of that sort of captures it. They're sort of looking at this saying, look, these supply chains have been have been through geopolitical issues have been in the pandemic have been and will potentially be irreparable.
Harmed and changed moving forward. So you have that, you have obviously we producers in Russia and Ukraine, not shipping. You have so we are for the first time going to supermarkets and not seeing things. So that's going to impact consumer behavior and there's a lot of things going on and they're, they're coaching to organizations like yours is, Hey the the markets may not be as open to.
Or there might not be as much capital available as you hear some of these things. How do you sort of process it? Clearly you're in a space that's needed and as a pro providing a service that is needed by health systems and needed by the community. So there's confidence there, but you're heading into a, in rough seas, I guess we'll call it. How do you process.
So, I don't know if it's a good thing or a bad thing, but we've gotten really good at running a lean and mean organization. And I think demonstrating that traction with the limited resources that eternally has had thus far. Has contributed to the attention that we're getting from the investor pool, right? How look, how far we've gotten with what little we've had. And so I'm really proud of that. And I think in terms of demonstrating a continued path forward, it's being able to articulate how we can use funds in a really smart way. And making sure that we're investing in spaces that help us grow faster.
And part of that is diversification where our funds, where our revenue streams and how might we position ourselves to make sure that we're. As much as possible trying to limit exposure to risky spaces. We're not going to be impacted by supply chain internally, however, our partners certainly are, and that affects their financial decisions of how do we partner?
When do we. So it's not we're not Bulletproof from, from those external factors. And I, I do think that that's part of our overall plan to continue to diversify revenue streams and partner with healthcare organizations and nonclinical entities in, in new and interesting ways to make sure that.ervices study in September of:
This is your decision and you are in control of your health care, and we want to help with that. So how do, how do we do that and how do we make sure that we're scaling in the right way to meet millions and millions of Americans?
So you're you're purpose-driven so you feel very calm. The optimism is, is palpable by the way in terms of what you're doing and those kinds of things.
One of the things that was interesting is there was all that I don't know what the right word is, but there's all the commotion about Elon Musk's hour and a half podcasts. He did last week and whatnot, but one of the things he said, I think it is applicable here.
Is, they asked them about a downturn in the markets and he said, I think it's a good thing. And, and he said, here's why it's a good thing. When you have a good markets for too long, the allocation of capital gets skewed. There's just so much money out there. It gets given to people that shouldn't get money to do things that aren't really needed.
Well, maybe not. Aren't really needed is a little, little overstating it, but that aren't the best. And he goes, when you have a contraction of markets, that capital goes away from the ideas that aren't the best and the things that really shouldn't be funded and the best ideas get funded. And people go to work for companies that have a value to the communities that they serve and those kinds of things.
And so you end up. Reallocating capital to the things that add value to our lives. And he said, so from that perspective, we should welcome economic downturns every, every now and then to just reallocate capital to the things that bring value to our lives. So, I mean, there's, there's a positive aspect from that perspective I'll tell you what I have been telling health system. On this is go back and look at the companies that you have partnered with, or especially on the technology side, which is the world I live in. You have to be. I mean, they have to have good sound plans entering a potential downturn.
Do they have the money or are they going to end up in a death spiral where they're getting lower evaluations? They have to take money at lower evaluations. And in which case they just auger themselves into the ground. Because if I buy the stuff as a CIO, implement the stuff, and then the company goes out of business that's, that's a, that's the worst case scenario.
And so I'm telling them anything you've done over the last five years. Just look at the. Looking at the business plan, make sure that they're solid. Anything you're looking to invest in coming up, just have the conversations. It's not that you shouldn't invest, you should continue to invest, but you need to be aware of the the, the risks in the current environment that we're operating.
Yeah, really good advice. And personally, that's a tough pill to swallow, but professionally, I think you're absolutely right. And we're seeing that both in conversations with investors, but also with talent. So a lot of the shifts in the market recently, especially with the massive layoffs and tech people are turning to those organizations that are more mission-driven that actually have back on and care about improving.
And so we've seen that and who we're looking to hire and evaluating potential new team members. And we're really excited that we can fulfill that mission with such amazing talent pool and hopefully attract more Tom because of that ever. I never thought that I would have a massive bandwagon of people trying to jump on this death tech as it's known train.
But I think in terms of making sure resources are available to those. Today or traditionally have not had access. Yeah. People are interested in changing that our healthcare system is now providing the right care at the right time right now. And we can do better,
I, I appreciate the conversation. I appreciate the work that you're doing. If people want more information on new eternally, where do they go?
My eternally.com was eternally.com already. I'm not now. I'm a little curious as that who has eternally.com?
Yeah, that's another conversation, but I'm talking to them right now. I would love to reintroduce ourselves and have that conversation to get it back.
So my eternally.com and you right now, we're in the four states, but I assume if you got phone calls from other states, you are entertaining those conversations with the right foundation. You could move into others. Fantastic. Thank you again for your time. Really appreciate it.
What a great discussion. If you know someone that might benefit from our channel, from these kinds of discussions, please forward them a note, perhaps your team, your staff. I know if I were a CIO today, I would have every one of my team members listening to show just like this one. It's conference level value every week. They can subscribe on our website thisweekhealth.com. They can also subscribe wherever they listen to podcasts. Apple, Google, Overcast. You get the picture. We are everywhere. Go ahead. Subscribe today. We want to thank our news day sponsors who are investing in our mission to develop the next generation of health leaders. Those are CrowdStrike, Proofpoint, Clearsense, MEDITECH, Cedars-Sinai Accelerator, Talkdesk and DrFirst. Thanks for listening. That's all for now.