Increasing job dissatisfaction is leading to an influx of physicians looking to go non-clinical, resulting in these type of jobs getting harder and harder to come by. Competition is getting fierce leading to dwindling wages. More sham telemedicine companies are popping up taking advantage of desperate doctors. So what’s a doctor to do? We talk job hunting strategies with renowned non-clinical coach and mentor Michelle Mudge-Riley on what you need to do now to avoid the pitfalls, and stay ahead of the competition.
Michelle will be hosting a conference in April 2019 for physicians interested in non-clinical careers and side gigs. PHP Conference Details
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Too much competition for dwindling nonclinical jobs? Sham telemedicine companies taking advantage of desperate doctors? We’re going to talk about the pitfalls to choosing a nonclinical career as well as possible solutions on this episode of BootstrapMD.
Hey guys, this is Dr. Mike Woo-Ming with BootstrapMD, really excited today. We’re going to be talking with one of the veterans in the industry. I’ve known her. We’ve been in different circles, but we didn’t actually get to connect until recently. We’ve both been involved in physician education in terms of helping doctors with nonclinical careers in entrepreneurship. What I want you guys to get out of this is really to understand that there are so many ways that you can become successful, but the best way I believe is to have a coach or have a mentor, someone who’s actually been there and done that.
Michelle has certainly done this. Really quick bio about Michelle Mudge-Riley: She’s a physician and peer mentor coach. She spent the past 13 years assisting physician to medical students with career strategy through the company she founded in 2008 called Physicians Helping Physicians. The doctors she works with are interested in using degrees in a nontraditional way as I mentioned through non-clinic careers, optimizing their skills and passions within their career and rediscovering meaning and purpose in their work. She’s been called the doctor’s doctor in the 2010 book she co-authored because of her success in working with other doctors.
The book is called Physicians in Transition. I love things that rhyme. Dr. Mudge-Riley received her medical degree from Des Moines University, Osteopathic Medical School, and her master’s degree in health administration from Virginia Commonwealth University. Michelle, thank you for being on the podcast today.
Hi, Mike! I’m so happy to be here!
Like I said, we’ve known about each other, or I’ve at least known about you for the last decade because when we were helping physicians, there were very few other mentors in this space. I’m really glad that we’re finally connecting. One of the reasons we’re connecting is I was honored to be able to present at her conference that is coming up, the celebration network meeting coming up in Austin in April, which we’ll be talking about throughout the call here today. Thanks again for coming on the call. I know you’re really busy. You got a lot of things going on, especially with this conference. I just wanna know how did you first get started, because last time I checked, there wasn’t a residency for nonclinical careers mentor coaching.
I know. Well, I started very accidentally. I planned to be a doctor and live happily ever after. That was the plan, which probably is most of our plan. It’s most physician’s plan when they go to medical school. As happens to now a lot of us, it wasn’t the plan, so I ended up getting into somewhat of a malignant residency. While I loved med school, when I started meeting the residents and the attendants and the other physicians who were practicing, I saw how unhappy they were and I was pretty unhappy myself and I thought, “Wow, all this so the next 40 years I can be a miserable, angry person who hates what they do?”
I thought, “There’s no way I’m doing this.” I was young, and I decided to take a year off and see what else was out there, explore industry. I got a job at a medical device company, and fully intended on going back. It’s been almost 20 years and I haven’t gone back. What ended up happening was I went back to school for a business degree, a masters in health administration just to fill some of those gaps because we don’t learn business at all in med school as we all know. During the time of my transition from that, from the device company, then to a brokerage firm working in corporate wellness, I was their director of medical management.
I worked with small and medium sized companies helping them design, implement, and evaluate their wellness programs. I started talking about my story and writing about it. I actually cold called some editors, and they said, “Sure. Write us a piece and we’ll publish it.” This was back in the early 2000’s. Physician burnout was just starting to be talked about. People wanted to hear a little more. I was somewhat of a novelty. I was authentic and just spoke about my trials and tribulations if you will, and people liked it.
I always put my email address at the end, and I would get contacted by other physicians and then people who were doing conferences asking me to speak to tell my story. It was all quite accidental. I just basically told the truth and talked about what had helped me, how I did a resume, how I went to Barnes and Noble and sold a hundred resume books, and didn’t have a clue on how to even start to put together a resume, but I figured it out. These triple boarded surgeons were calling me and saying, “Hey, can you help me write a resume?” I was like, “Well, sure. All right.”
For a while, I just helped people and then I realized, “You know what, this is taking up a lot of my time” so at one point I just said, “You know, I charge for this,” and the physician was like, “Oh, okay.” I was like, “Okay,” and my business was born. Over the years, I’ve had multiple different cost structures for coaching and help with resumes and elevator pitch, and LinkedIn comes along and all these different things, but for some reason, it’s always worked. I have helped a lot of physicians, and that has been so gratifying and through the process healed myself as well, because I felt like a huge failure and like, “Why don’t I want to do this?”
Because there weren’t a lot of us out there, I didn’t really know who to talk to, and there weren’t a lot of groups like there are now. I very much felt alone at that time probably like you did, right?
Pretty much. One of the things that was interesting is I actually didn’t find a lot of conferences where you could actually talk about some of these things. Some of the medical conferences that I was attending, I actually have one where they asked me to speak, but then when I was going to talk about entrepreneurship or doing something else, one of the people who led the conference says, and they were in the pharmaceutical industry, basically said that, “Yeah, that’s kind of not what we want to talk about, because we want the doctors to write more prescriptions. They cannot do what they want. They cannot not to in certain terms.”
It’s good that you were able to find an avenue for your message that you’re able to get across.
I really think it was all just timing and a lot of luck. Again, I didn’t plan it that way. It just kind of happened. As you know, then the tide continued with things getting even worse, which is really unfortunate, so back even in the early 2000’s when things weren’t great, now they’re much worse for doctors. There are a lot of us that are saying, “No, this is enough. We’re going to diversify what we’re doing or we have other interests,” and so doing a lot of things in addition to clinical work.
That’s interesting you say that it’s getting worse because I can agree with that, but I can also disagree with that. Let me know your thoughts on it. I think one is we’re talking about it more so maybe it’s been more prevalent, and burnout and then more and more people feel like, “Hey, yeah, I’m experiencing that.” I did that initially in my career. I definitely had burnout, but I think in the other way look red, there was definitely more opportunities for physicians, especially the nonclinical route in terms of things like telemedicine, pharmaceutical industry, expert witnessing and actually now about starting your own career through an online business or through consulting is which we did around but we didn’t call it back then, but all these different conferences about getting your message out into the world.
I’m just curious about your thoughts on where you’re seeing medicine as it pertains to nonclinical careers.
I definitely agree that things are better in terms of more opportunities and more people talking about this. It’s not the pink elephant in the room anymore, and no one feels like something’s really wrong with them, at least maybe at first, but not after they start exploring it. They start to recognize that there are lots of doctors who have done something different, some who have gone totally nonclinical and never looked back and some who diversify with some clinical, some side gigs, some part-time work, a variety of stuff, a grab bag of stuff.
The reason I feel like it’s worse for physicians now practicing is because the reimbursement continues to go down. Not only that, but the environment for physicians is very malignant in a lot of places. It wasn’t that way. It was starting to be that way in the early 2000’s, maybe a few pockets of really bad places, but it has gone downhill. I continue to talk to physicians who practice, who tell me stories about how they’re vilified and how no matter what happens, it’s always the doctor’s fault.
That just makes me really sad because a lot of these doctors will start to have very low self-esteem, very low confidence in themselves because they blame themselves because they’re being blamed by the administration or the nurses. They’re even having some legal action taken against them in some cases, or they’re losing their licenses, or they’re losing their jobs. I mean, that used to be unheard of physicians being fired. I mean, that was part of the reason I wanted to go to medical school. I thought, “Gosh, this would be a great job. I’ll make a good amount of money, and I will always have a job.” Well, that’s no longer the case.
Anyway, the environment for the physician who wants to practice clinically or who is practicing clinically I feel like is much worse than it was even 10 years ago, but the environment for nonclinical careers or non-traditional careers is better. That’s been born from this bad clinical environment, so a lot of business people see an opportunity, which is good. Then there are a lot of us who have spoken up over the years and are saying, “We can help you, or look at this opportunity or that opportunity.” Then others take advantage of it, and the word spreads.
That is really interesting. Again, you’re more on the front lines than I am because you do coach these physicians who are into these malingering environments. I’d like to dig a little bit deeper into that. Are there certain environments that are worse than others? Is it more of a hospital environment? Is it affecting younger doctors who may not have as much experience or may not feel that they can go in and go against? Do you see it more in the corporate? Is there any kind of area or is that too hard to stereotype? I’m curious.
Well, it really doesn’t distinguish. I actually think the younger doctors are maybe the best off at this point, not in terms of residency because it’s just a vial time and place, and people are treated just abhorrently in residency in some places. You still see those stories. Now, there are blogs out there so you can read the stories. I just read one last week. I forget which one it was, but on some forum, someone posted something. There’s a ton of stuff out there, but for different physicians of different ages, different genders, even foreign grads versus medical grads or US medical grads, it can still be difficult for both.
I spoke with a foreign grad the other day who was telling me about the environment for him and some of his colleagues. They are having to put up with just it sounds like a little bit more than they should. I’m not 100% sure if it’s because they’re foreign medical grads or not, but he seems to think they are. You only really see one side in some of these conversations, and so I’m not sure, but I have heard that from others. That may be a piece of it as well. The older physicians are having somewhat of a hard time with the transition to the electronic medical record.
Some of them just flat out can’t do it or won’t do it, and some of them can and will, but the administration isn’t willing to give them a chance or they’re just piling so much work. It’s non-sustainable for almost anyone. It’s tough in a lot of different places. You find it in different pockets, from academic medical centers to private medical centers. It does not distinguish, unfortunately.
I wanna shift gears just a bit… I liked what you said about nontraditional careers as opposed to non-clinical careers because I consider telemedicine is a clinical, but it’s not traditional, but that’s kind of semantics. I was recently talking with a friend who’s not a doctor, and he was telling me he has a business where he markets to doctors. He says, “I can’t find doctors on social media.” I said, “That’s because they’re there, they just don’t let you know they’re there.”
I said, “Did you know one of the largest groups is a Facebook group dedicated to side gigs for physicians? Do you know, the last I checked, it’s 23,000?” Because of this influx, is it getting harder to find a “nonclinical” job just because there’s so much interest in it? I’ve talked to a few of my own clients and they think that once they quit, jobs will be plentiful for them. It seems like it’s getting more and more competitive for these types of jobs, or is there an influx of more opportunities that I’m just not aware of?
There are definitely more opportunities, which is good, but it’s getting more competitive because where it used to be a trickle of physicians applying for some of the more low hanging fruit, like the utilization review or the telemedicine jobs, now, it’s a faucet. There are just lots and lots of physicians applying, so they have made the requirements more stringent at times. Sometimes, those requirements don’t need to be so stringent, but because there are so many applicants, the companies feel like they can.
I definitely want to talk about more of the positive stuff, but I do have to mention another somewhat negative part about all of this is some of the salaries have actually gone down or the pay has gone down for some of those more low hanging fruit jobs because they can get it. There are so many physicians who want out and want more flexibility or want non-traditional work that they’re willing to take $75, $80 an hour.
Oh wow.
It’s ridiculous versus $110, $120, which is still pretty low, but I mean, there’s a pretty big difference there. Although we’ve come together as physicians to try to not stand for that and not accept that low pay, there’s talk but I think people are still accepting it because they’re just desperate and they want out. It’s better than working at Starbucks or something like that, and they don’t know what else to do. I mean, the other problem is it’s hard to find information on the different opportunities that are not the low-hanging fruit like the utilization review work or telemedicine work or expert witness work, which not everyone wants to do either, IME work, things like that.
One of the things I also noticed too just because there is people going in to try to give these nontraditional jobs, I think you have to do your due diligence. I’ve seen now where because there is so much opportunity and particularly in the telemedicine space, I’m noticing. I recently talked to a colleague and he was going to say, “Hey, I joined this telemedicine group, but they’re going to be prescribing medications online without a physical exam, or they’re going to be sending me crutches or braces, and they’re going to put it on Medicare.”
I was like, “Whoa, whoa, whoa.” As a physician, you definitely need to do your due diligence because there are these big cases now, and these telemedicine companies, not all, I’m not saying anything, but there was definitely people who are trying to use your license to make a buck. Whether or not it’s legal or not legal, you need to be very careful. I mean, have you come across any of these types of companies? I certainly have seen them, but I just want to know your thoughts. Have you worked with doctors who may have come across these kinds of things?
Absolutely. I have done a lot of due diligence to the point of calling the companies and pretending like I was going to be applying for the work just to get the information because I’m a lot more savvy only because I’ve been out there for longer. I’ve been doing this for longer, so I feel like with my clients, I can help them out by giving them not only a second opinion but also the experience that I’ve gotten over the years just in the business world and interacting with these companies and maybe pick up things that they may not.
The people I work with appreciate that, but what I found is avoid those companies. There is a lot of shady stuff that’s happening. There are a lot of loopholes that some smart people are trying to take advantage of, and when something happens, the ones who are going to take the fall are going to be the physicians and their license. Avoid those like the plague. The DME, the durable medical equipment, avoid that right now, any kind of prescribing, especially any kind of pain medication, pain creams, stuff like that.
Make sure if you’re looking at a telemedicine job that there’s some kind of electronic portal that there’s some option for a video conference. That’s not always the case. You don’t have to have a video conference. There just has to be that option. All the legal aspects are beyond the scope of this podcast, but definitely do your due diligence on these companies because, this is a gross generalization, but I would say probably a third of them are shady and they’re gonna end up taking a fall real soon.
Again, the telemedicine… It differs for in each state. I know in California for example, you can’t prescribe if you’ve not actually laid hands on the patient, but every state is different. Montana is different than California, et cetera. I’m glad of that because that’s something that not a lot of people talk about, and every now and then, you’ll see it on the forum. “Hey, I’ve got this job. Does this sound legit?” You kind of know in your gut. You gotta know in your gut.
I mean, it sounds great. That’s the problem. I mean, it sounds amazing. You do it from anywhere, anytime. They’re willing to pay. They’re quick to get back to you. Well, there’s a reason for that. They need someone and they need your license and they need your degree.
It’s those things that a lot of people think nonclinical jobs, but, again, there are definitely companies that are taking advantage of it. We kept talking about negative stuff.
I know. Let’s get into the positive!
Let’s get into the positive stuff. Doctors are listening to this working right now. Maybe they’re working full time. Maybe they’re looking to, reduce the amount of hours. They’re looking into nonclinical careers, but they don’t have the experience or they don’t know where to start, kind of an overgeneralization. I know that, but what kind of advice, what kinds of things can they be doing right now if they’re looking to transitioning to a nonclinical career?
The best thing you can do right now is free and you can do it yourself. It seems kind of contrary to what you might think because I know most people expect to get a list of different things that they can look into, and then they choose one of those and that’s it, but that is not the best way to go about doing this. You really need to look at yourself first. Where do you want to be one, three to five years from now? How much money do you want to be making? What location do you want to be in?
I know some of this is impossible to predict, but you can put together a plan, at least a skeleton of a plan somewhat easily, and that’s going to guide you because the perfect job is not the perfect job if you’re not living, say, near your family and you need to because you have aging parents or for some reason you just have to return to, I don’t know, Sacramento for some reason. If you’re not there, your life is just not worth it. I mean, again, a gross generalization, but you really need to figure out where you want to be. Then taking a look at how you work best.
Do you work best from home? Do you work best going to an office? Understanding those things is very, very helpful. Now, at some point, you do have to look at the reality. What is really available to you as well? What age are you? I’m not talking about age discrimination at all. I’m just talking about do you have time to gain a skill set that you may need to gain if that’s what you want to do? If your burning desire is to go to law school, great, but it doesn’t make sense to pay the money. Go, spend the time getting that degree, and then working up a little bit because there’s always gonna be that working up from any new jobs.
Maybe, instead, you look at law careers that aren’t going to require a law degree, and maybe it’s not being a JD or an esquire. I forget exactly what it is. Lynn Marie was coaching me on what it means to be a full attorney. I thought it was just a JD degree, but it’s much more than that.
Hey, you’re not the only one who she’s coached. Lynn Marie, I love her.
I know. We both do. Anyway, so maybe just then, “Okay, great.” You know you want to be in the legal field. You’re fascinated by that. You want to combine that with your medical background. Awesome. You don’t have to be an attorney. That helps you then start to cool down on different things rather than just opening up a book of just a thousand different careers, getting overwhelmed or jumping straight to telemedicine or utilization review.
I do want to add the caveat though that those careers are low-hanging fruit for a reason, so it is still somewhat, I don’t want to say easy, but if you want to get into that, it’s going to probably be a shorter road than completely changing your career. If that is your only option, if you are a certain age, you have certain family obligations, you have a spouse or kids or aging parents or whatever the case, there’s all kinds of different situations. Your dream may be to go into the legal field, but it just doesn’t make sense because you’re looking at your life on a big picture level.
Again, first step is to check yourself. Spend some time reflecting. Don’t spend two years. Then that’s two years wasted, but you don’t have to pay a lot of money. You don’t have to do anything real crazy. It’s really just being honest with yourself and what you want and then you can start going to some conferences or paying someone to help you. I’ve had too many people that have paid me a lot of money to help them, and we’ve gotten a lot done, but they didn’t do this first step. Then because of that, they’re still working clinically. They have an amazing resume, and they’re ready to do something else, but they haven’t gotten past really knowing where they want to be, and so finding those right opportunities.
You’re preaching to the choir. I’m a big stickler on the doctors that they love to get more degrees on their name. I have a friend who ran the MBA program at John Hopkins. I would ask him. I said, “How many of the doctors are actually using it?” He says, “Unfortunately, not as many as what we hope for. There are some who would definitely they might go into administration, et cetera, and then there are some, they’re looking for something else to do and they’d want to pay $35,000 a year to do that.”
I said, “You know what, if there is a job out there that you want and there’s someone who’s doing what you want to do, instead of paying all that money, ask to shadow them for a week, if that’s something you want to do for a few days just to see if this is something that you want, because the grass isn’t always greener just because this is maybe nonclinical. It just might be in the situation. I was in medicine, and then I was out of medicine, and then went back in. I have my own clinic because I still like medicine, but I wanted to live on my own terms.
We have an insurance free type clinic. We do have that kind of thing, but I enjoy that aspect of it. Just because it’s different to a nonclinical, that doesn’t necessarily mean it’s something that you may want to do, that you could still, like myself, enjoy medicine, but medicine is so broad. There’s still different opportunities that you can get into. For someone who is like, “I’m in clinical. I want out.” Don’t completely close that door. That’s my two cents on that.
No, that’s very astute. I find that most people have that experience when they’re starting to look at nonclinical, and they go back and forth. It’s really hard to figure out because you don’t know if you like something until you do it, so there’s a little bit of that as well. Another thing you can do is really get some freelance or project work, and there’s tons of that available now, much more than there even was five years ago. Sign up for some of these sites, freelancer, Fiverr. There’s a ton of them.
Upwork.com.
Yup. Yup. That’s another one. Yup. FlexJobs, and just get some experience doing something else and figure out, first of all, do I like this? Second of all, you’ll have some projects under your belt and experience. That’s the value that you bring. It unfortunately isn’t the fact that you’re a doctor, although we all know we can do anything, and it makes us amazing people.
That’s right.
Anyone who wants to hire us may Look at that and they may think, “Okay, well, they don’t have experience in banking or finance, and so next. Who’s the next applicant kind of thing?”
There’s a lot of stuff that are still out there. I’m glad you ended on a positive note. That’s great. Speaking about positive, we’ve got an event coming up on April. I’d call these physicians … It’s a mouthful. Physicians Helping Physicians celebration and network meeting for a PCCNM.
Love it.
Let’s talk about why you decided to put on an event. I believe this is the first, I guess, big event that you’ve put on before. Doctors who listen to this, why should they come to this besides meeting us, of course?
I know. I have been thinking about this for a very long time. As we talked about, we’ve been in this space for a long time ourselves, not only looking at something different, but helping others do something different. At some point, I feel like bringing us all together makes us stronger. It also is meeting people and hearing about their experiences in person can’t be … You cannot get that experience with Facebook groups. You cannot get that experience with podcasts. You can get a little bit of it, but it is not the same as coming together and actually meeting people, hearing their story live, hearing their advice live.
I’ve had that experience myself going to other conferences, and so I finally decided to do it. I’ve toyed with the idea. I actually had two other conferences scheduled over the years, and I ended up canceling them because it wasn’t the right time, and it wasn’t working out the way that I felt like it would be the best experience for the attendees. When I decided to try it again, I have a small army of people behind me helping me this time, other physicians. I call them the founding members, and they’ve agreed to really help me with putting this event on.
Then other people came out of the woodwork, so again, timing, so people like you, people like Lynn Marie, people like spokesperson. She’s been an anchor for over 25 years, and she’s going to come and speak and do some helping with just presenting yourself and if you want to get on TV, how to do it. It feels right this time. That’s evidenced by the amount of people who have already signed up to come. We have over 60 people already signed up for the first time, and that’s pretty amazing for a live event, because people have to travel there and they have to take time off.
I’m so grateful to those who have already signed up. It’s just going to be an amazing experience for everyone. People will get to hear about the different options in a nonclinical career. If you’re even considering it at all, you can find out what other people have done and hear their story and find out how hard it was for them. There’s gonna be tons of networking, so one of the benefits of what I’ve done is built a network of people easier. Please don’t hear that. I’m not guaranteeing anyone a job.
It happens all the time, where you’ll be speaking to someone who’s transitioned and they either are hiring or they know someone who’s hiring, and they’re willing to help you because they understand and they’ve been there. That’s the best way to get a job is networking anyway, and a good job at that. That’s what we’re doing. It’s the first time so it’s a little scary, but I am doing everything I can to make it a great experience, and hopefully it will be and it will be the first of many to come.
It’s happening April 6th and 7th in Austin, Texas.
Yes.
According to your website, the hotel, I just want to make sure, it is not sold out. You have a block of rooms apparently that may be got, but there is space at the hotel. Is that correct at least on the time of this recording?
That’s right. As of this recording right now, and today’s the sixth of March, the hotel is not sold out so you can still book a room at the conference hotel. The block of rooms that I reserved has been sold out now for a little over a month, but they didn’t give us a huge discount anyway. It’s the first time that the conference is being held, so you’re not really missing out by not getting that discount. There is still space.
I will close the registrations at some point in the next couple of weeks, just because I don’t want to overwhelm everyone and myself and making sure that I give a great experience to everyone, and for practical reasons. I have to give food, numbers, and things like that. If you haven’t signed up yet, you still have a week or two, but please do it sooner rather than later because people are registering in the next couple of days. I’ll try to let everyone know when that happens, and I’ll start a waiting list at that point.
What is the website where they go to register?
The website is Physicians Helping Physicians website. It’s www.p as in Paul, H as in Henry, physicians, with an S on the end, dotcom. If you go to that, you’ll go to the homepage, and you’ll see a button for the celebration meeting. You can click on that and it’ll take you to the page where you can register. The conference is donation only so you can choose to donate or not. I would appreciate a small donation just to cover the food expenses, but this is the first time I’m having it and so I wanted to make sure that everyone gets value out of it.
Next year, there will be a required registration fee. Take advantage now of the donation only. Are you there?
Yeah. Sorry. You’ve been cutting out. That’s okay.
No worries. Nope. That’s it.
That’s great. That donation only, that is true. I definitely know it can be very expensive to run events, especially with food and hotels trying to jack up the price and charging water for $5 or $10.
It’s crazy.
Believe me, I know that. Michelle is very generous with the donations. I would advise you to donate on the higher side if you can, because it just helps pay everything out. I guess, this is the first time I’m actually hearing it is that there might be a second one.
Yeah. As long as this is successful, and we’ll be doing surveys after the fact. As long as it works for everyone, then we’re gonna start doing this on a yearly basis. We may move the location at some point. We may have multiple locations. All remains to be seen. Let’s get through the first one.
Again, it’s coming up on April 6 and 7 in Austin, Texas. The Physicians Helping Physicians celebration and networking meeting or PHPCNM, hashtag.
That’s right. That’s right.
As we know it. I hope you can come. I’ll be there. I look forward. If I haven’t met you before, come there. If you heard this on the call, let me know and we’ll love to chat with you to see what your plans are, what your dreams are happening now because there is tremendous opportunity. We’ll end it up optimistic now. There is tremendous opportunity that is out there, but like you said, the best jobs, if that’s what you’re looking for, the best jobs aren’t usually advertising. It comes from networking, like going to events such as what we’re having.
Michelle, thank you so much on there. I know you’ve got a lot planned, especially with the event. Thank you for taking the time to join in with us on the podcast today.
Oh, thanks for having me, Mike.
Thanks again, guys. As always, go ahead and sign up on the website. Love to see at the meeting and as always, keep moving forward.
