051 - What do Patients Want from Their Care Provider Physicians? - Learn from Zach Elliot’s Concierge Medical Experience

In this episode, Coach JPMD has a conversation with Zach J. Elliot.  Zach is a pastor, husband, father, author, and Jesus follower who helps us understand the reasons why he thinks it’s possible for concierge medical practices could transform the future of healthcare. Coach JPMD also dives into how personality types or temperaments can enhance certain medical specialties. Stay tuned and don’t forget to leave a review for us.

Zach wanted to disclose that although he was gifted the opportunity to be part of a concierge medical practice, he wholeheartedly believes that there is true value in this model of care. 

***Any information in this interview is only for informational purposes and should not be used in place of an actual doctor's visit or medical treatment from your healthcare provider.

Show Notes

Discover how medical graduates, junior doctors, and young physicians can navigate residency training programs, surgical residency, and locum tenens to increase income, enjoy independent practice, decrease stress, achieve financial freedom, and retire early, while maintaining patient satisfaction and exploring physician side gigs to tackle medical school loans.

Transcript

Coach JPMD  0:00  
Welcome to the Practice Impossible Podcast with your hosts, Coach JPMD. And if you haven't had a chance to leave a review, leave a comment, tell us what you think about the podcast because that's what helps us get the word out. And without that it's much more difficult for, for those physicians that are needing to understand how to decrease his stress and increase your revenues to do so. So this week, we have a special guest, Zach Elliot, good friend of mine who I saw at school at our kids school. And it was interesting, because he asked me about cost shares, medicine and concierge practices, because he had such a great experience. And he was actually gifted that membership and wanted to share that experience with our audience. And that's something that we don't get too often and having patients share their experiences. So I thought it'd be a great episode. And so here we go.

Intro  0:57  
Welcome to the practice impossible podcast, we're your host, Jude, Pierre MD, also known as Coach JPMD discusses medical practice topics that will guide you through the maze that is the business of medicine, and teach you how to increase profits and help populations live long. Your mission should you choose to accept is to listen and be transformed. Now, here's your host, Coach JPMD.

Coach JPMD  1:21  
Welcome Zach Elliot to the practice impossible podcast. Zach, welcome to the home. Yeah, thank you for coming. By. I know you're busy. Although I have to say that this is probably the one way I can reel you into the house without without getting Tammy to yell and scream at you.

Zach Elliot  1:40  
This is great well in to be here in your studio. It's It's so cool. This is great. So no, I'm glad to be here. Thanks for the invite.

Coach JPMD  1:47  
Well, you're you're part of that inspiration to right because you, you did this way before me and you're continuing to do it. You have your own podcasts. You're a pastor, you're an author. You're a coach. And you helped us pre and post wedding. So you've been amazing friend and wise counsel. And you're here for a particular reason, as well. And that is, we saw each other almost at a couple of weeks ago at our kids school, so your daughters go to the same school as my son at St. John's. And you said you had an aha moment. You said, Jude why don't you to tell the story?

Zach Elliot  2:31  
No. Well, yeah, I was thinking about it actually, for a couple of weeks. And we hadn't run into each other. But I was thinking about you. Because I've had such a good experience with concierge medical. And there's some changes coming just personally in my relationship in that in that world. But for three years, I have enjoyed a world in medicine that I was completely unfamiliar with. And I kept thinking about you and I thought man this way, if I had access to you, Dr. Pierre, in, in that kind of a relationship, it would be, you know, it was it can be game changing. 

Coach JPMD  3:07  
Yeah, especially during the COVID. So we're gonna get to that because part of the reason why we have season two is to help physicians understand how to practice free, how to practice free of corporate medicine, how to practice the way they want to practice. And I think a lot of physicians are seeing the light, especially through the COVID experience. And physicians are stressed, people are stressed. And you bring a different perspective on life, and life and beauty. And with the work that you're doing at your organization, vi vi VO, Vu. Vu

Zach Elliot  3:39  
vi vo Yeah, everything starts up, right. There's transcendence. And I think everybody's longing for that. But then we all have an upward orientation. And that's great. But it's only great if it becomes embodied in incarnational. And so we say whatever's up has to be birthed in. And that's good. But life is relational. So it has to transform relationship. And if it's not that flow, then it's good. But it may be it's missing something. So that's why we say up and in and out.

Coach JPMD  4:11  
And so in your book you mentioned and you've, you've talked about it in different sermons and different talks that I've had, I've heard you speak about and that's the allegory of the cave. And, and what I find very fascinating is how I feel like some of us have been in that cave as physicians, as providers, especially in in this crazy COVID world that we we were in and we're probably still in a little bit. Physicians were lost. We were in a cave, we were darkened by the noise the lack of noise of noise around us. And it wasn't until until a couple of physicians out there so shed that light. And you know, we spoke about this a lot here around illness and shots and and things and, and I found myself to not feeling comfortable was very uneasy. And I think I became very uneasy when I called the hospital administrator at our local hospital and I said, Hey, I've been hearing rumblings of the need for vitamin D in our hospitalized patients, because those patients are in nursing home patients, they are not being exposed to sun. Can we get vitamin D in the hospital? Can I order that vitamin C? Yeah, I think so. Like what you mean, you think so? Yeah, I think so if it's on formulary, so I call the pharmacist, yes, some of them we don't have, but you can have the family bring in those vitamins for the patients. And you can give it I said the same families that can't go to the hospital because of COVID restrictions. So from that point on, I'm like, There's something going on. And so I know that there are physicians that are out there that are looking to do other things. And before we get into the concierge medicine and your experience with that, what are the things that you see as in parallels when you're because I've always had this question for you, as a pastor's pastor, and I understand that you counsel pastors now, do you see any parallels to what's going on in the physician, the world of medical? 

Zach Elliot  6:16  
Yeah, well, I love you starting with the cave or taking us back to the cave and Plato's Allegory of the Cave, because it's a great framework for us to think about. A reality that can exist, that is not the truth. And it's a part but it's not the whole and I think all of us no matter what discipline, whether it's medicine or theology or politics are experiencing something that we know is is dissonant, it's it's off it's it's an it's part, but not whole. And that's a pretty good way to frame it. I don't know if you're familiar with Ian McGilchrist work neurologist, just a brilliant, brilliant guy, he wrote a book called The master and his emissary, and the matter with things, which is a two part series. And he looks from a neurological perspective at the right brain versus left brain. And just the fact that Western culture post enlightenment has been increasingly increasingly kind of dominated by a left brain perspective, parts not whole, right. And so there's this famous way he unpacks it thinking about like a body, or that it gets unpacked in this conversation, like a body, you can do an autopsy and understand every part of the body. But you but you can memorize that particularize it, talk about it, but you're not talking about Jude, not talking about Zach. And I think that's what a lot of doctors, a lot of pastors experienced that might be a parallel. I write about it in my book, say we get it, but we don't have it. Right. I can give you theological answers. I can, I can talk about systematic theology. But it's almost become particularized, to the point that it's disenchanted, it's lost its meaning. And so we have all the parts, but it's not meaningful. And that's a symptom of the Enlightenment, it's a symptom of an over dependence on the left brain and not seeing from that right brain kind of a broadly vigilant, imaginative perspective. And so I think you sit down with a doctor and a pastor and a politician, which is, that's not a joke. That could be a good joke, but you sit down with all of us, especially on a day like today, but you sit down with all of us, and we all feel something is off, we've gotten really great at particular parts, and we're masters at it. But we've lost something of the whole. And that's why we got into it. That's why we wanted to be a pastor. That's why we wanted to be a doctor. And so I think all of us are trying to find our way back to a meaningful engagement in our work, that allows us to touch the parts, but in union with the whole and not just be relegated to, you know, data and part data in part. So there might be some overlap there. In a lived experience, where I think pastors are feeling this same thing, and a lot of pastors are quitting. A lot of pastors are saying, now I just have lost. It's, it's not meaningful anymore. And I've lost contact with the thing that first enchanted me and brought me into this work. And so I think that's the we've talked about that physician suicide, turnout rates, all of those things, I think that's all shared.

Coach JPMD  9:18  
So when when they're leaving, are they are they saying that they can't find their way back to that enchanted min enchantment, or that they? What is their reasoning for not going trying to find the way back? 

Zach Elliot  9:32  
Yeah, there's a cultural element to it too. Just you know, there's a we're in kind of a post secular age where it's like post Nietzsche saying, God is dead that that lasted for a while where their work became kind of irrelevant because we just all decided God didn't exist and if you're in the god business, then you kind of feel like you don't exist, which it's hard to go to work every day and that if you're here, but I think is that crumbles and people have a growing sense of spiritual hunger. There's a desire or to stay. But we've built systems very much like medicine. The church has built systems that kind of keep you from doing the meaningful parts of your work and ask you to do things that are really not the work that you felt called to. And so again, that's shared in medicine, I think, to the thing conversations we've had you put a pastor in a role, and burden them with administrative tasks and executive tasks and just keep piling on piling on piling on and trying to keep pace with with growing something scaling something, all those demands, and you put those on somebody who is legitimately called to like spiritual formation, and to talk about this other thing. They're not going to last long in that environment. 

Coach JPMD  10:42  
Yeah. And I guess it kind of dovetails into the personality of that doctor, that temporary, the doctor or the pastor, because if you put them in a situation where they're not thriving, or they're not able to thrive based on their, their profile, because you've profiled me, and, you know, we've, we've spoken, you've counseled us on that, and I didn't understand many of the profile tests that are out there. And I actually did some research, and or at least tried to do some research on whether or not there were medical specialties that were, I was conducive, or were better suited for physicians, and personalities, and how how they could merge together and there really wasn't much I see here. Healthgrades actually had a small research that stated that anesthesiologist were more introverted, and sensing cardiologists who have more intuitive internist, like myself are more intuitive and judging. So what is your take on that? Have you? Have you had any, or seen any research on the pastoral side that looked at the personality types of pastors and where what roles they should be in? 

Zach Elliot  11:59  
Yeah, know there's, there's probably, I don't know if there's more work done for pastors. But there's been some good work done on temperament and Ministry of vocational ministry. But those differences that you called out, those are all from the MBTI, the Jung Hee based Myers Briggs system, and again, Jung Hee and based introversion, extroversion sensing versus intuition, thinking versus feeling judging versus perceiving. Those seem to be again, they're those are not necessarily subjective in so you get disc, you get Strength Finders, there's all Enneagram there's a broad brush of temperament sorters, the The MBTI the Jung Hee based is a little more data driven, if you want to say it that way. Yeah, in those the reality that we can look at introversion extroversion, you think about that, like an anesthesiologist is an introvert. Yeah, I hope so. You know, maybe you've spent your whole life studying and you're comfortable studying and looking at the current data and that you're comfortable in there. That intuitive gift if you opened me up, or you're dealing with the whole of my body, that intuition over time, I think that those could be really powerful indicators in this in the spiritual vocation in pastoral care. You think about putting in, introverted, deeply introverted person who's maybe a thinker who's well suited to be a teaching pastor, and they thrive and flourish, just nose in a book 1000s of years of church history, studying doctrine, that brings them so much joy, and then to get up and unpack that. They love doing that. But to ask that person to go sit down with a grieving family and make sense of death in the moment. They're just not, that's not where they're at their best. And so we've asked that of pastors for a long time, we've said we need you to be great at you know, exegetical preaching, and we need you to be looking at Greek and looking at Hebrew note nose in a book hours of study. And then at the drop of a hat, we need you to be deeply empathetic and intuitive and extroverted to sit with this family for hours on end, and then be able to meet new people and welcome them in from the sidewalk on the street. That's a big ask. And so I think that even in Ephesians, there's a great text in the in Paul's letter to the Ephesians. To a church in Ephesus, this particular church, he said he gave some to be apostles, some to be prophets, some evangelists, some to be shepherds and teachers. And that archetype is pretty interesting. There's been some good work looking at temperament and those giftings to say that apostolic gifting is really an entrepreneurial gifting. It's the people who are thinking about pushing the boundary moving to new contexts, always missional kind of orienting, they're good for a moment and then they want to pioneer something. Prophetic types, being able to read the landscape and apply truth or wisdom into a particular moment, kind of keep the vertical and horizontal alignment of something. Evangelists being the people who are just outward facing welcoming people in. And then you've got shepherds who are caring for people and sitting with people and the teachers who are really holding on and passing down wisdom. And in Paul's letter, he said, That's five different giftings. And you need those working as a team. And I think medicine, if we think like that, I'd love to see more data. I think doctors may feel a lot of freedom to practice free.

Coach JPMD  15:27  
Yeah. And also to get the resources that they need to supplement what they are not good at coming to think what we're doing is, is telling physicians, you're going to be an ER doc, you're in view with your do this, this XYZ and then when a patient dies, or family member dies, you have to go tell the family, they may not be equipped to deal with that. And as you talk about that, I'm like thinking, how much stress are we adding to their lives?

Zach Elliot  15:53  
Well, I think about a team environment where you have a chaplain, you have a doctor, you have a social worker, you have you know, a team approach to medicine, where that doctor is a part of a team, but we want that Doctor, do it practicing their specific craft and being excellent at it, and not asking them to then have to apply that across this other spectrum of things. That's again, that's a huge ask of people. And it is temperament driven, gifting driven, expertise, training and experience all that. Yeah.

Coach JPMD  16:24  
So So then, how do you tell a patient that that doctor is not good at that, because they are expecting you as a patient, though,

Zach Elliot  16:32  
to be good at everything

Coach JPMD  16:33  
to be good, you're gonna need to be the God you are the God, quote, unquote. So that's, that's interesting, very interesting.

Zach Elliot  16:42  
I think I don't know if we can segue or you want to segue to concierge medical, but that's a great look. And maybe culture is changing, because I know I might be a great friend, I'm a great audience member to your podcast, because I love and appreciate what what you all do in the practice of medicine. And I think as a, as somebody who relies on that great care, I want you to be great at at helping me understand what I need most. And so if you say, Well, you know, I'm going to invite the chaplain, to have this conversation, and I'm going to invite this person in, what you have is my trust in that takes. So there's a lot that goes into building that trust with a relation with a patient. I want that I want to trust someone after that, if you point me in a direction and say, hey, I want you to work with so and so because they've got particular expertise. I'm good.

Coach JPMD  17:36  
Yeah. So that's, that's where consultants come on, come on board. As a as a consumers, physician, physicians need to understand where their limit of knowledge is, with a limit of expertise is and then farm that out or consult that out to other specialists. So what has been your experience with concierge medicine? Because that's really one of the things that that brought you here. And I wanted to hear what your experience is, because we want physicians to also understand what it's like on the patient side, what are you looking for in a physician? 

Zach Elliot  18:05  
Yeah. Well, it's great. And we want strike what I just said, I want you to be God and fix everything. No, I, we want to have a physician that cares about us, and actually is a person like they care about us as a person. And it may sound super sappy, but I write poetry and talk about spiritual things. So I'm gonna say it, I, I want my doctor to care about my whole being biopsychosocial spiritual self. And that's why being treated as a person and not a number, that that matters. And that's what attracted me to concierge medic medicine. And again, no critique against doctors, I just recognized the system as it exists means I have to be a number that doctor can't get to know me as a person, they just don't have time. And so first and foremost, I want to be known by my doctor, as a person, I want them to know what I struggle with what I'm afraid of what I'm concerned about what my goals are, my stage of life, I've got four kids and a wife and we, you know, I want their care to be informed by who I am as a being in. That's pretty big deal.

Coach JPMD  19:16  
Yeah, but they have to be able to afford being able to spend time to get to know you. So what what's your as a consumer? What is your, what are you looking for? What's your price point? Like? What are what's the value? What, how much is it value? How much you value that care? Are? Are your friends paying for this type of care? Do you know anyone else doing it? Or what's your experience with the with the pricing model or the value of it?

Zach Elliot  19:43  
Yeah, it's a challenge. You know, obviously, because healthcare right now, because we're in a transit, it feels like at least on my side of things, it feels like there's a transition taking place. And so we're having to buy things. It's kind of like paying for private school. Like you may have a kid Add who's going to benefit from access to a certain type of environment educationally. And so you're paying taxes to fund great public school systems. And at the same time, you have a kid who say, I'd love to get them into this program. So they have access to this. So I'm kind of paying double. And right now it feels like that with concierge medicine, that you still have to have health care, you still are paying your health insurance premiums, you're still paying for all that you're still paying for the pharmacy, you're still paying for your specialists. And on top of that, now, I'm paying, you know, a few $1,000 a year to have access to really personalized care from my physician access and responsiveness, which is amazing. Add that to the list, right to be able to email and communicate with my doctor's office. And it's not even the doctor, but just the team. That responsiveness that's personalized. It's, it's it's informed. That's, that's worth several $1,000 to me as a person on top of helping health care premiums and all the other health care costs we're paying. So the challenge with concierge medicine is keeping that ratio, right. I think my concierge doctor says they have a 300 person cap. So I'm one of 300 under my doctor's care. And I don't know how that stacks up. But that's a smaller,

Coach JPMD  21:17  
it's a very small, small pool. Yeah.

Zach Elliot  21:21  
So how does that break down, I know that if you're paying three to $5,000, for that concierge service, that's where I was comfortable in that ballpark, that that keeps going up. In fact, you and I were talking just a bit ago that we just got a letter that our our service is going to go dramatically higher than that. And so for my family, because I'm not in a profession that, you know, I there's a cap income wise in my business. And we may get priced out of this particular concierge doctor, but I'll be looking for another concierge doctor in that price point. Because again, personalized care, responsiveness and access that ability to come to you and know that I'm going to be able to ask questions that's worth that's worth that three to $5,000 price point. And I'm a I'm kind of a middle class where we were a family who is privileged well provided for, but we're not the wealthy, elite of our culture. I think that price point from my peers is consistent. People are tired of not having that responsiveness and personalized care, and they're willing to pay in that ballpark for it.

Coach JPMD  22:32  
And what when you see that physician, what is their demeanor? How do they look? Are they are they late? Are they disheveled? Or

Zach Elliot  22:40  
no, I mean, you're getting, again, it sounds it's, you put a number like three to $5,000 on the table, on top of all your other health care costs, and you go, that's a real number, right. And that's an that's not for your family, that's for you. And if your wife is doing that, that's for her too. So those numbers do add up. And so there is a level of expectation I walk into the office is beautifully clean, the experiential economy is is beautiful, and it's inspiring, and it inspires confidence and peace, when I walk into that office, and my doctor is is really well educated, they're well trained, they're probably the best and the brightest in their in their group. And they've chosen to do this because they really care about patients. And so that's what comes through. They, they there's a level of their care where they get down and they look you in the eye and and you know that they love their job, they're there not because they have to be there. But because they love to practice medicine in they're ready to do it. 

Coach JPMD  23:41  
Yeah, those are, those are some powerful words. And I think what you're doing is helping to inspire physicians understand that it is doesn't they don't have to do what they are doing. They don't have to live in that cave. Because if you are able to practice and practice well and elicit that trust from your patients, which I think most physicians can do. It can be very lucrative, but more than lucrative it can it can decrease your stress, decrease your burnout, decrease, hopefully, suicide rates, because I think a lot of the stress that we see in our profession is because of that, that push push, push, push, push, trying to make more money back in for what, really, so

Zach Elliot  24:26  
there's no specialized equipment in the office to I mean, there's EKGs so if I go in to a regular office visit and I feel my hand just feel a little weird. There's EKGs in body machines, there's access to really good equipment, but it's not like you can go in and just pop in for an MRI, you still have healthcare, you're still getting referred out to specialists. So you I, I imagine you know, what I'm paying for is that person in that person's care, and it's worth it.

Coach JPMD  24:55  
So So there's so when you say no specialized machine, so there's is no x ray machine on site, there's

Zach Elliot  25:03  
not not at my particular office, I still use our local imaging group. And we still pay for that with our health care premiums. So the concierge medical is really quarterbacking our care, it's really somebody who's our partner in care. And, again, I do hope it's inspiring to your audience. Because I'm a fan, like your craft in your care. It matters so much. And I can just tell you in the little stuff, right, we, um, the people who are at home, talking to my wife about, hey, there's a bump here, a lump here, or my blood work shows this. And we're thinking about our kids and raising kids. And those those are serious conversations and to know that we have a partner who cares about us and is willing to be responsive to us and knows that on a Friday at 3:30pm, when that test result comes back for you to personally text me and say, Hey, I got your results. And I want to talk to you about it. Give me a quick call. Yeah, will you pay $4,000 or $5,000? For that? 100%? Yes, please right. And it's trust. And it's personalized care.

Coach JPMD  26:16  
And I think for those that feel that it may be a lot, I think if you're a younger person with not as many medical problems, you have an HSA, I have an HSA plan, that's an HSA, I fund 4-5 Kids, to, you know, to the max. And if I wanted to, I could use part of that HSA monies to cover a concierge medicine medical doctorate, which is a medical cost that wouldn't come out of my pocket, it'd be pre tax. And so definitely, I think if you value the care that you're getting the value of the service that I think, like you said, three to five may not be that much for you. Some may argue that it's pricing people out that can't afford it. But I think I think our whole medical profession is doing that. I don't think it's his a concierge medical doctors. I don't know how you feel about that. But there are some people who may not be able to afford them. They say, well, that's, you know, that's only for the rich. But

Zach Elliot  27:13  
well, it Yeah. Again, I'm with you, because access to health care is deeply important. You know, you talked about like, was it a human? Right? Well, I don't know how to talk about I know from a pastoral side, from a theological perspective, the dignity of persons mattered. And you'll get me super excited I love when the church was building and funding hospitals. I love that would do I wish that our community of faith and I'm talking specifically to the the congregations that I have relationship with in a Christian context, we are responsible to make sure that there is incredible care for every person, and every person has access to that. I love that vision. And we should be cutting checks for that purpose. So you need a couple of things. You need a unit, a community of people who believe and see that vision, participating with their, with their treasure. And you need churches and institutions, religious organizations, I think that as they did in certain times, where they see the value of the good and the true and the beautiful, and they say let's build a great hospital, and let's make it possible for everyone is beautiful and aspirational. And I wouldn't put an end. And if there's a population of people who says I have the resource to partner with a doctor, because I do appreciate that personalized care. And I can do that, then Awesome. That relieves the burden from this other part of the system. And it allows those folks to have access in this way. That's great. Yeah. So I don't think it's it's an either or I think it's a both and. And I think that it's a way, I think there'll be a way forward, there were there's a so you talked about I have a friend who writes music and he says he the best advice he was given is right. If you write for one, you'll reach 1000s. If you write for 1000s, you will reach anybody. And I think in concierge medical, there's a small group of people right now who really do have particular concerns about their health, and they value that relationship with their doctor. And that niche or sub niche is going to respond to your invitation for to care for them. That's great. And then again, and let's keep having a conversation about a broader access, that brings the best medical care so that anybody regardless of socioeconomic status, race, anything, can walk in and say I need care and they get excellent care. It's above it.

Coach JPMD  29:40  
And it brings up in my mind the idea of how can we support that vision of those that are looking to do concierge medicine by allow physicians also see those patients who can't afford care. See them for free. See you at discounted rate. But do you know that our laws prohibit that 

Zach Elliot  30:00  
That's That's like I want to say criminal and I don't know the 

Coach JPMD  30:04  
If I accept Medicare, the fights up to a government insurance, I have to charge anyone that comes into my office that Medicare rate. Otherwise I could be seen as what is called favoritism or if I got the term for it, sure, but you can't undercharge that. That person even though I would love to see families who can't afford insurances, and some of they'll come to me, I might so and so doesnt have insurance? I can't afford your care. So we have to go to the emergency room. What about the cost there?

Zach Elliot  30:37  
Yeah. See, I that's the part where I think that broad community gets frustrated. Because we go, it feels that it may not be accurate, but it feels like those laws are made by people who can call their friends who are doctors in their friends who are doctors will the white couple and I'll just see. Yeah, right. Yeah, like they have that access and their wink and a nod handshake getting seen by people. Oh, come on. Come on by. I'll run. You know, I'll take a look. Hey, would you take a look at my MRI? Sure. Sure. Send it to me have so that's happening all the time by the people making the laws that say you can't do that for people? I just feel like that I don't have any data to back that up their flow they wish to get to 

Coach JPMD  31:14  
I'll get the data. Yeah, I'm a data guy. 

Zach Elliot  31:16  
So go nuts. Left Brain until it blows apart. 

Coach JPMD  31:20  
Oh, Zack, thankyou so much for for coming on the practice puzzle podcast has been a great conversation. love to have you again. There's so much we can talk about and just hang out and and heavy chill at the other dock somewhere. Oh, and when I get a doc do some fishing back there. So hey, you're welcome. Anytime.

Zach Elliot  31:39  
Thank you so much. Thanks for Thanks for what you do and I love practice  impossible like to your audience before you cut me off with like the Oscars. I'm gonna say thank you to all the people who have invested a lot to be able to care for us like it does matter. And for those of us who really value the work of doctors, it's amazing that you're practicing and having conversations like this to be excellent at your craft because we need you to thanks. 

Coach JPMD  32:09  
Thank you