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26. Behind the Stethoscope - A Cardiology Rotation tale
170 Plays2 years ago
In this Episode we talk about a cardiology elective rotation with some tips and things to consider for this rotation and a career in the cardiology specialty.
For more information on Locumstory, go to https://zen.ai/thepaexperience.
Check out the podcast on Youtube: https://www.youtube.com/@thepaexperience
If you are interested in being interviewed about your school email me at thepaschoolexperience@gmail.com
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Transcript
Introduction to PA Experience Podcast
00:00:15
Speaker
Welcome to the PA Experience Podcast. I'm your host, Sebring Sands, and as a PA, I take you behind the scenes to see what it takes to become a PA in all steps of the journey.
Locum Tenens as a Career Option
00:00:33
Speaker
Are you a provider, whether it be a PA, physician, or an NP looking for a change? Consider locum tenens. Whether you're burnt out or need to change a pace or looking to supplement your income, locum tenens might be the solution for you. You might ask, what is locum tenens? The story of locums began in 1979 as a way to provide physician coverage for facilities supporting underserved populations. Locums have remained true to its roots, but become a way of life for physicians, NPs, and PAs,
00:01:02
Speaker
who work locums for diverse reasons, whether it be finding the perfect work-life balance, a way to make extra income, explore the country and the world, learn new skills, have autonomy, or as transition into retirement, or even rediscover new love for medicine. There are many different specialties offered, ranging from primary care to shift work specialties like emergency medicine, hospital medicine, psychiatry, OB-GYN, and surgery.
00:01:27
Speaker
Pay is often $32 more an hour than the average permit positions for physicians and about $17 more an hour than the average permit positions for PAs and MPs. To learn more, visit the link in the description and have all your questions answered about Locum Tenens.
Advice for Recent PA Graduates
00:01:46
Speaker
Again, please visit Locum Story today to learn more about Locum Tenens and see if it is right for you.
00:01:53
Speaker
If you haven't heard, I'm wanting to curate this repository of recent grad, PA school grads from their programs to talking about different aspects of their program, pros and cons. I think this will greatly improve decision-making in pre-PAs and just overall benefit the community. So please reach out in the email in the description if you're interested in any details so that we can further conversation and set up interviews.
00:02:23
Speaker
Welcome everyone to another episode of the podcast. I have a recurring guest today. I think you guys will enjoy his take on this rotation, this topic. And I just want to bring back on Sawyer. You want to say hi Sawyer? Hi Sawyer brings it. It's nice to be back. Well, thanks. I think you're one of the few that don't mind when I asked them if they want to be back on the podcast. So.
00:02:50
Speaker
Oh, no, I was actually listening to an episode where you had Ragnar on. Oh, yeah. And you were talking about how a lot of our classmates are either they're either too shy or they're too modest to come on and like talk about themselves. And then and then Ragnar was like, oh, no, not me, though. No, come on. And then you say and then you brought my nails. You're like, yeah, you and Sawyer. And I was just I was in my car screaming. I was like, yes, you bring me back on. Yes. Yes. All the time.
00:03:19
Speaker
Well, I was actually talking with Ragnar. He texted me a few days ago.
00:03:23
Speaker
And I said, hey, you have a standing invitation to come back down anytime you want, just bring a topic and we'll talk about it. Cause it's hard sometimes coming up with content since I've like done everything I wanted to do. So awesome.
Sawyer's Role in Cardiac Surgery
00:03:36
Speaker
So we're going to talk about cardiology, um, mostly because Sawyer did a elect elective rotation in cardiology and he's working in cardiology. So do you want to tell everyone where you're working and how that's been going?
00:03:51
Speaker
Um, so yeah, so I recently started as a cardiac surgery PA. Um, I'm working at one of the bigger hospitals here in Massachusetts. Um, and while I'm involved in the cardiac surgery process, obviously, because it's, it's, it's a team and we bring patients in, um, in need of like different types of open heart surgery, whether, um, you know, as cabbages or, um,
00:04:18
Speaker
or aneurysm repairs, mitral valve repairs, like different things like that. I'm more so being trained to work on the cardiovascular ICU after. So those patients, they go through the procedure and then after they need to be in the ICU for four or five days post-op. So I'll be in charge of overseeing their care while they're recovering from the surgery.
00:04:46
Speaker
Okay. Okay. Is it pretty dicey or is it pretty straightforward? Take care of patients.
00:04:53
Speaker
It is, it is incredibly organized. I was pleasantly surprised. Um, cause obviously you, you think of, um, you know, hearing stories from the ICU and how critically sick people are. Um, but when they're coming off of surgery, everything is, is so well thought out and so organized. And there's so many incredibly knowledgeable people, everyone from, you know, the surgeons who constantly overlooking the patient's care. Um, the nurses who are incredible at monitoring all types of vital signs and
00:05:22
Speaker
fluid output and things like that. Everyone does a really incredible job. From what it seems, I've only been doing it for a month. It's a fantastic machine that they have running in there and you're only one piece of the puzzle. It certainly doesn't all fall on your shoulders as the provider. Is the ICU after those types of surgeries just the next step in the process, that step down?
00:05:49
Speaker
or is it like special cases that go to the ICU? No, so it's everyone, every type of cardiovascular surgery that my team participates in, there's usually a four or five day postdoc period. So right when they get out of the operating room, they're transferred over to the ICU where we
Day in the Life of a Cardiac Surgery PA
00:06:10
Speaker
are.
00:06:10
Speaker
And a lot of them will still be intubated, that they have chest tubes to relieve all of the residual bleeding in the mediastinal area. So you just have to oversee their care through that. And as you do the first couple hours,
00:06:27
Speaker
after the procedure takes place. That's when things are most sticy, right? Because that's when they're, you know, still recovering from the effects of the surgery. And also all the different medications that someone needs to go through in order, you know, to make it through that kind of procedure. That's, you know, when you need to monitor things most closely. And then, you know, two, three days post-op, you'll be surprised with how quickly the patient recovers.
00:06:51
Speaker
Okay, so what are some things kind of do during the day? Do you like do rounding and then just checking up on their chart and ordering things as needed?
00:07:05
Speaker
Yeah, so the shifts are 7 to 7, either day shift or night shift. So I've only been working on day shifts. So the first thing that you do when you come in is you see how the patients did overnight, just like any internal medicine or critical care type rotation that we did when we were in school. And then we round at 8 o'clock, so maybe an hour after our shift starts. And we pretty much only
00:07:34
Speaker
go and pay visit to the patients that we did surgery with. We also do consultations throughout the day as well, so someone comes into the ER and they're found to have some type of issue that might require surgery. We go down and see them as well.
00:07:55
Speaker
And then we also run the clinic as well, which I think is awesome because the clinic is that that's for post-op patients. Maybe, you know, if they're six weeks post-surgery, 12 weeks post-surgery, they come in and see us and make sure that they're healing appropriately. If they have any issues, any questions that they have that time to meet with us, then also the surgeons directly so we can answer all their questions. So I think it's really cool because you get to see patients
00:08:22
Speaker
you know, from when they're first coming into the ER with an issue, you know, and then you're there to see the surgery, you're there for the post-op period in the ICU after, and then you get to see them, you know, once they're all better. And then, you know, once they're able to graduate from your care, when they reach that 12-week
00:08:44
Speaker
period. That's when they graduate. They don't need to come in and see us anymore unless it's for a social visit. So to be able to see the whole entire process take place from beginning to end, it's really cool. That's really awesome. How did you even get this job? I know you're after school, you're mentioning maybe internal medicine. Is that just the job you're able to get or did you specifically look for this type of job?
00:09:10
Speaker
Yeah, so I really very fortuitously kind of stumbled backwards into it. I was originally applying for internal medicine positions, because I had applied for you know, cardiology position because cardiology is my thing. That's why I really like I also like inpatient medicine. So I was applying to cardiology positions everywhere. You know, wasn't really getting much good news back, just because a lot of positions that I was applying to, you know, said you need like four or five years of
00:09:38
Speaker
know, maybe they have an opening, you know, maybe they'll give me a shot. Maybe they'll see something in my resume that would make me a good candidate. So I eventually got an interview for an internal medicine position. And then I went there and I met, you know, the internal medicine team and all that and it went well. But then the recruiter that originally reached out to me said, Hey, I know you like that job, but with your ambulance experience,
00:10:02
Speaker
we have an opening in the cardiovascular ICU, how do you how do you feel about that? And I said, No, that's that seems like everything that I could that I could ever want. And then I met the team, they're sensational. They knew that I was going to come in as as a new grad. And, you know, they were invested in me, they wanted to see me become a great PA. And I want to become a great PA. And I wanted to be able to do those kinds of things.
00:10:27
Speaker
So it was a perfect match, but something that I never would have thought could have worked out just by looking and applying on Indeed and things like that. Sometimes you have to just apply to whatever you think you might be interested in, and then there can be a fantastic opportunity somewhere within that that you would never even know about.
00:10:50
Speaker
Oh, that's really cool. That worked out that way. I'm an Indeed success story. I found mine through Indeed. Well, actually, I applied to one. I wasn't my top. It was a spine position. I was like, I don't really want to do this. And then right when I applied,
00:11:11
Speaker
a general orthopedic surgery position with the same place opened up. And I was like, apply. The next day, I got an email from the recruiter saying, hey, we want to talk to you. I'm like, yes. So that's how I got into my position. But that's really cool how that recruiter really set you up with something good, something they really were looking for. And Newgrad, what's the word? Newgrad.
00:11:42
Speaker
positive and they liked having a new grad. So that's also a big plus.
Job Application Tips for New Grads
00:11:47
Speaker
Yeah. And it's also important when you're, if you're a new grad applying, don't get frustrated if like you're not hearing back from certain locations or say you have, well, first off, I don't think that you should have like a dream.
00:11:58
Speaker
I don't think you should have a dream feel, because you don't really know, especially as a new grad, you never worked. So how are you supposed to know what is right for you? But don't get mad at certain positions or certain hospitals if they're not hiring you, if they're not getting back to you. Because they literally might not have the infrastructure to be able to bring on a new PA. That's what I'm learning from being in the hospital and seeing
00:12:22
Speaker
you know, how much it takes to train someone from the ground up. I mean, obviously, you know, everyone, you know, that we know is, you know, is intelligent, hard working, very dedicated, you know, to getting to competency, but it just takes time. And not every hospital or office has the chance to be able to bring someone on. So it's not that
00:12:45
Speaker
you know they're not seeing these new grads as valuable or assets or anything like that it's just that they can't they don't have the space for you they don't have the time to be able to bring you on and bring you up to speed yeah that's a good point something to think about awesome so i knew that you did your elective in cardiology did you want to do that or you did stumble upon it or was that your third choice when picking your electives in pa school
00:13:12
Speaker
Yeah, so it was one of those things where I had a top three. Cardiology was definitely the one that I was most interested in. And then it ended up just being given to me by the faculty. But it worked out fantastic. It was exactly, at the time, what I wanted, it was a cardiology inpatient rotation. And it was at a nearby hospital.
00:13:39
Speaker
And it was awesome. I like rotations at hospitals just because there's so many people that you can learn from. I think there's value in having a family medicine rotation at an office. You can be able to come and see patients independently and all that kind of stuff.
00:13:56
Speaker
But there's only a couple of people around that you can learn from. When you're at a big hospital, you can talk to everyone about everything. You can talk to the doctors, the PAs. There's a respiratory therapist there. You can talk to the respiratory therapist about what they do. Nurses, everyone. And so that's what this rotation was at. And it was a phenomenal experience.
00:14:19
Speaker
Awesome.
Insights from Cardiology Rotation
00:14:20
Speaker
Um, so what did you do during your rotation? Just, just general inpatient internal medicine, just with the cardiology focus.
00:14:29
Speaker
Yeah, exactly. So anyone who would come into the ER with any type of cardiac issue that needed to be admitted to the hospital. So we would do consults in the emergency room as well. And sometimes, you know, patients would be admitted. Other times, you know, they will to be discharged. We would go and see them prior and give clearance from our regard.
00:14:52
Speaker
But the meat and potatoes of the job, from what I noticed, was just being able to manage all those patients once they become admitted. We were a really, really busy service. We had, I think, at times, up to 30 patients on our team. And it was between the doctor and the PA and then me to be able to go and see everyone. Of course, I kind of followed along a lot. I was able to see patients as well.
00:15:21
Speaker
you know, but mainly just following them because it was so busy, you know, it's not like you could take time and focus on one patient because there was so many people that needed to be seen and have their, their medications adjusted and all that. There was a lot of CHF, which I thought was really good because
00:15:38
Speaker
It's just so prevalent in the field and it's such a balance to be able to treat CHF, you know, in order to, you know, to be able to make sure you're taking off enough fluid off of patients with Lasix and everything like that. Bullet monitoring other things, you know, like their creatinine levels.
00:15:53
Speaker
all that kind of stuff. Things that you can't necessarily just learn a book, you have to be able to treat patients and see how they're fairing and then make adjustments based on that. It's very nuanced and being able to see it again and again during that five week period was great. Do you get any MI's or anything you've treated?
00:16:12
Speaker
Yeah. So the MIs were handled in the ER by the time that we got there. So again, so that was something where they would be admitted. And it was more so just continuing to track whether a patient was having an MI or not. Because I always thought even in my EMS experience, I thought it was black and white if a patient is having an MI.
00:16:36
Speaker
It's not always like that. You have to continue to monitor the troponin levels. If they're continuing to increase by a certain margin each time with the ST elevation and all that kind of stuff, then a patient is definitely having an MI. But it's not always like that. So sometimes we would be following patients for 24 hours or so just to be able to figure out what direction we needed to take.
00:17:01
Speaker
Hmm, that's really cool. What kind of procedures or skills you used a lot of? I mean, I'm assuming EKG stuff a lot and maybe were you even trying to figure out murmurs or is that more outpatient type of a thing?
00:17:19
Speaker
That was also another good thing about this rotation is everyone had something. It wasn't like it was always a healthy 22-year-old patient. They had no issues. Everyone had either aortic stenosis, mitral regurg, they were in rapid AFib, different things like that. It was really valuable to be able to hear the things that we've been reading about in the textbook.
00:17:45
Speaker
And then as far as procedures go, I got to see a lot of echocardiograms, TTEs, and TEEs as well. So that was really cool. I would have the cardiologist kind of going through how to interpret echoes with me, which was really valuable.
00:18:06
Speaker
Yeah, that would have been something cool to see in my air tournaments and rotation because throughout the whole clinical year experience, I always get an echo that's been read, but I never knew what it really entailed. I know it's like a fancy ultrasound.
00:18:27
Speaker
But how they go about it, especially with a esophageal one, like I just kind of know theoretically what it is. I don't really know the whole process because I'm sure. Do you have to sedate somebody in order to put a scope down their throat, down the top of the TEE? Yes, they were they were asleep. But like it was a proper procedure in the sense of like, you know, your your NPO, you know, the night before, like that kind of thing.
00:18:55
Speaker
So just being able to see patients go through that and just being able to get a chance to look at the echoes. Obviously, it takes years to be able to come well-versed and that kind of stuff. So just being able to know what I was looking at, it felt like an accomplishment. But that, of course, with the clinical picture that you have with a patient, right?
00:19:15
Speaker
Because if you heard that four out of six mitral regurgitation, and then you're seeing that backwards blood flow on the echo, then it ties together the clinical picture that you're looking at. So one finding will support the other, and it will get you to have a better understanding about the patient that you're working with. Okay. So it sounds like your rotation that you're on, it was a PA rather than a resident service.
Gaining Autonomy as a PA
00:19:43
Speaker
Is that correct?
00:19:44
Speaker
Yes, exactly. So what were what was kind of the the scope for the PAs was pretty on par with a physician and he just made the final call and they went with him with questions or was some things he only was able to do and the PAs had to do something else. How did that work out?
00:20:03
Speaker
So yeah, so I got to work with a couple of different PAs, mainly one PA and the one PA that I was with the most. She had been doing it for five years and she was sensational. And so with her, everything was under the physician.
00:20:23
Speaker
you know, we're all part of the same team. But when we had a really, really long list, the physician would see, you know, his half or her half of the patients, and then the PA would pretty much see the other half. And if like there were certain things that the PA, you know, like found or they want to mention to the doctor, then, you know, then maybe the doctor would go and see it. But
00:20:46
Speaker
The doctor really trusted that PA to be able to make whatever calls that they felt necessary, make different adjustments on the medication and all that kind of stuff. If there were days where we had a smaller service, maybe like 10 patients, then we would all go and see the patients together. But for the most part, it was divide and conquer. And there's a large amount of trust between both the doctor and then the PA as well.
00:21:14
Speaker
That's really cool because I feel like those situations, you really get to see the scope of a PA. And I think in some big hospitals with residents, you don't see PA's that much and you feel like, man, PA's can't do very much.
00:21:29
Speaker
And maybe I should just do something else. But then you, when you getting these PA services, I think we're kind of spoiled in Connecticut. Connecticut is a super friendly PA state and PAs are used everywhere. So when you have those PA and physician teams, you really get to see like, we're all in this together. We're all drowning in patients. So you're going to see patients. I'm going to see patients. If you have any questions, we'll come together and talk about it. But other than that,
00:21:58
Speaker
We're just going to treat patients, we're going to do orders, we're going to do our jobs, and that's it. And that's really cool to see. I think everyone in PA school needs to see that. Unfortunately, I think a lot of areas, especially in maybe more rural areas, you just don't have the opportunity to see that relationship with a physician and a PA. So that's really cool that you were able to see that pretty well.
00:22:22
Speaker
And I think it's cool because that autonomy is merit-based as well. I'm sure that there's a certain amount of time that needs to go by where the PA can become self-sufficient, right? Because the physician has gone through years of medical school. They've gone through residency, maybe a fellowship. They've been doing that thing for a long, long time.
00:22:47
Speaker
But the PA that I'm talking about, she got a cardiology job right out of school, and then she had been doing it for five years at that point. So after five years, maybe even before then, I'm not sure, she was at the point where she could see pages independently.
00:23:05
Speaker
But maybe at the beginning of her career, it wasn't like that. So I think that that's a good thing for people in school and even people beginning their careers to keep in mind is that if you want to be independent, if you want to be autonomous, then just continue to put the work in and then you'll develop the trust of your coworkers and you can get to that point.
Importance of Continuous Learning for PAs
00:23:26
Speaker
Yeah, I was talking with a couple of episodes ago, my mentor, and he was, he's an advocate of like heavy duty learning as a new grad and continuing in the career. I really do think as an, as a new grad, one of our main jobs is to learn. Like we won't be giving as much responsibility as someone with several years experience. So learning as much as we can, whether it be through experience or, you know,
00:23:56
Speaker
independent learning, independent reviewing of things is very, I feel like very important. And I'm trying to figure out like certain things to potentially get with my CME money to help me in that process. So I think, because I think that should be the goal of every PA is to become that autonomous. And hopefully they have a job where they are able to become that autonomous, because
00:24:21
Speaker
I think we are too skilled not to be in that position. And I feel like we are way better positioned and trained than some MPs are. And I've seen some phenomenal MPs where they took
00:24:36
Speaker
the time and they really cared about building their knowledge and skills. And they were even, I've learned probably more from some MPs than some physicians. Maybe it's just a time thing, but they really cared about teaching and they really were knowledgeable. So I think that is one of our responsibilities as PA, especially new grads to facilitate that learning that we, PE school, we learn, but it really is passing.
00:25:05
Speaker
everything like learning enough to pass so we can get out of preschool so we can really learn in in real life because it's not a test a lot of things aren't tests so
00:25:17
Speaker
Yeah, yeah, there's there's answering test questions like we were doing in school and then treating human beings, which is what we do. And when once we graduate, and, you know, there's a certain kind of responsibility that comes with that. And then even if it's just, you know, being able to answer questions that the patient has, right, you know, we want to be able to give as much information as we possibly can, you know, to put them at ease and make them feel comfortable and also give them the chance to develop a trust in us, right, because they're in a scary situation. So
00:25:44
Speaker
The more studying that we do independently, the more learning we do, you know, the more curious we come off, the better off everyone will be. So what things did you feel like you would have liked to maybe read up on or practice or be better at before you started that rotation? That rotation.
00:26:09
Speaker
I would say just really try and get an understanding of how the heart and lung system kind of interacts with each other. Because as I was saying, a lot of the patients that we saw were CHF patients, and it was just about managing their CHF. And so if the heart isn't pumping well, there's a lot of pulmonary concerns that can come from that.
00:26:36
Speaker
And so when we were going through school, we kind of broke down one organ system at a time. And when you're first learning things, that's the way to do it. That's why the schools do things the way that they do during didactic here. But once you get to clinical year, I think it's important to know how the different systems kind of interact with each other.
00:26:58
Speaker
Um, so I would just would have done more research into that CHF patients, the different managements, um, like, or like knowing, you know, if a patient goes through a certain spike in their creatinine, you know, like, like how do you adjust the medications and all that, all things that you're going to learn, um, on your rotation. Um, but when, you know, you hear the PA and the doctor, you know, kind of talking about the treatment plan for the patient, um, you know, they might move pretty quick. And if you're not well versed in that stuff, or at least.
00:27:28
Speaker
You know, a little bit of research to, you know, know some buzzwords, know some keywords. Um, you know, it might fly past you. So just try and read up a little bit ahead of time on that kind of stuff, just to, you know, know what the kind of conversation is going
EKG Learning Opportunities in Cardiology Rotation
00:27:40
Speaker
to be like. Did you get really good at EKGs during their rotation? Or was it something you just kind of did and you weren't really quizzed on that much?
00:27:50
Speaker
So, honestly, no, not really. There's so much to learn on that rotation. And I feel like EKGs are another thing that just take so long. I went through the criteria a lot, just to make sure that I knew what I was looking at.
00:28:10
Speaker
Yeah, but we only had so many patients that came in, you know, with, with STEM use or different things like that. And a lot of the EKGs that we saw were, you know, were normal because there's patients that, you know, that were under, like, under telemetry and, you know, that, you know, that they had, if they had an issue, then they had been stabilized.
00:28:26
Speaker
So there were only so many EKG changes that we were able to observe. But I really went through the criteria just to try and learn it so that if something did come up, try and be able to identify it. So are there any pros or cons you want to tell people before considering this elective or even considering this specialty as a career?
00:28:55
Speaker
Yeah, so first with the rotation, I thought from an academic standpoint, it was incredibly helpful because I think the two highest percentage of the pants and things like that are cardiology and pulmonology.
00:29:14
Speaker
So having five weeks to be able to sit down and learn all that kind of stuff, again, like without a test hanging over your head, right? Because, you know, we had it as an elective, we didn't have any OR. So just to be able to sit down and learn that stuff very, very thoroughly was awesome. I remember, you know, kind of before then on my ORs and things like that, I
00:29:34
Speaker
I wasn't doing all that well, or at least I wasn't doing as well as I wanted to. And then after I had that rotation maybe halfway through the clinical year, on the EORs after that, I did way better. And I was doing pretty well on those two main categories, cardiology and pulmonology. And I accredit that to being able to take five weeks to study that stuff and then be able to see clinical cases of that as well.
Pursuing a Cardiology Specialty
00:30:01
Speaker
And then as far as cons, just try not to be overwhelmed. Those kinds of concerns can be very daunting.
00:30:18
Speaker
You know, it's going to take a lot to be able to get used to the different issues, different lab values to take into consideration, the medication and the treatments, and also just the instincts that it takes to be able to treat a patient. You know, so just don't get overwhelmed with it.
00:30:35
Speaker
View it as an opportunity to say, okay, let me see if I like this, right? Because it's going to take years to get to the level that I want to be at. I'm not going to be able to get to a certain level within five weeks. But is this something that when I graduate, I would want to be able to invest and be able to continue to work towards improving?
00:30:57
Speaker
Okay, great. Is there any last thoughts or advice for either PE students or new grads that you want to impart? On just anything at all? Sure. You're giving me a blank canvas here. Well, like PE school related or just career related. Any career advice? Yeah.
00:31:23
Speaker
Yeah, just keep doing something every day to work towards becoming the kind of provider that you want to be. You're going to come across preceptors and teachers, professors who are sensational and really want to see you do well. And there's other ones that might give some tough love.
00:31:42
Speaker
But I truly think that everyone wants to see you do well. And you want to be able to do well also. So just keep working and maintain a good attitude. And if you're putting in the work, then don't take things too seriously. Be willing to make mistakes. And just be able to learn from those mistakes. And then you'll be surprised with the progress you make down the road.
00:32:11
Speaker
Awesome. Well, I'll have to have you back on when you're a little bit further in your career to really break down.
00:32:19
Speaker
your role and how you've learned and how you've become the best PA provider in that hospital. Hey, you're a list of gods you're receiving. Well, funny thing before we go, I just got a letter in the mail for this one magazine online like, hey, we want to write a thing about you. Like this is definitely a scam or want money for this stupid thing.
00:32:43
Speaker
And I was like, we just wanted to make sure you your profiles correct and everything like that. And it's just one of those things where people can pay to have their
00:32:58
Speaker
Profile and tell them how amazing a provider they are. It's just it's just funny. Yeah, that's not our style Well, thanks so much for trying me Sawyer. I'll have you back on in You know a little bit in the future, but it'll be probably pretty quick. Oh I can't wait see if it's always a pleasure. Okay. Yes is for me, too Okay