[S2E1] Matthew Robinson: The Fight to Save Independent Physicians in California

The Fight to Save Independent Physicians in California

Matthew Robinson, CEO of the Physician Association of California, reveals why independent physicians have dropped from approximately 50% to 33% in just 12 years—and the critical advocacy work being done to preserve physician autonomy, reduce administrative burdens, and ensure healthcare access across California.

Discussion Topics:

• The dramatic decline of independent physicians in California over the past decade
• How practice acquisition deals actually work (3-5 year contracts, multiple sales)
• Why medical school debt and burnout drive doctors into employment
• Legislative wins: standardized credentialing and administrative burden reduction
• The challenges of evaluating AI scribes and healthcare technology innovations
• Whether concierge medicine offers a sustainable alternative model
• What PAC is doing to support practice transitions and educate medical students
• Why independent practices matter for healthcare costs and patient access

About Matthew Robinson:

Matthew Robinson serves as Chief Executive Officer of the Physician Association of California (PAC), an organization founded two years ago to represent and advocate for independent physicians who operate as small business owners with their own practices. PAC focuses on supporting independent physicians through challenges including reimbursement issues, administrative burdens, prior authorization, liability insurance costs, and out-of-pocket expenses.

About Vincent Catalano:

Vincent "Vinny" Catalano is the founder and CEO of CLEAR Healthcare Solutions, bringing decades of expertise in employee benefits and healthcare consulting. Through the CLEARly Beneficial Podcast, he explores innovative approaches to healthcare benefits, cost management, and system transformation with industry leaders who are driving real change.

This episode is brought to you by HealthNEXT. HealthNEXT helps employers build cultures of health and well-being that reduce healthcare costs, enhance workforce productivity, and create sustainable competitive advantages through data-driven population health strategies.

Disclaimer: This content is for educational purposes only and should not be considered medical or financial advice. Please consult with your healthcare provider or benefits administrator for personalized guidance regarding your specific situation.

Transcript

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Welcome to the Clearly Beneficial podcast,

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the show where we rip off the Band-Aid and explore the future of healthcare,

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benefits,

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and the people driving innovation in the industry.

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This episode is brought to you by Health Next,

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the company leading the way in helping employers build enduring cultures of health

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and wellbeing,

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and increasing organizational performance.

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To learn more how they can help you, visit healthnext.com.

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Well, Happy New Year.

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Happy New Year to you.

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And welcome to the Clearly Beneficial podcast.

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I'm Vincent Catalano.

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It's my new thing this year is pivoting to Vincent, I think, as I've aged.

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I think I've decided that that's kind of a cool thing to grow up your name as well.

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Totally.

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I mean, I kind of go Matthew, Matt.

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So I think Matthew sounds a little more sophisticated.

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Sure, sure.

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So I'm here with Matthew Robinson.

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He's the CEO of the Physicians Association of California.

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And he and I got to know each other over the last year or so and some of the

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conversations I've had with physicians and in the industry.

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And we just kind of become friends, you know, and I felt like he'd be a perfect person.

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addition to the roster of excellent people I'm talking to in the podcast.

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And I wanted to bring him in today to talk about the Physicians Association of

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California and talk about independent physicians because that's your purview is

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independent physicians.

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So let's start there.

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I mean, did you wake up one morning and say the California needed this?

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Because it's a relatively new association in the last two years.

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Correct.

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And so here we are two years in, why'd you start this?

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Well, again, Vincent, thank you.

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Hey, thanks for having me.

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Lovely setting here.

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I love this.

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And again, it's always been a pleasure talking with you and meeting with you.

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I think the first time you reached out to me was right after we launched when you

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saw it on LinkedIn,

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which was awesome.

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And we had lunch over at Camden, which was great.

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So great staying in touch.

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And again, thanks for inviting me.

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So a little bit of my background,

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which will,

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you know,

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I think help with why the Physician Association of California is

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what we're about, our mission, and so forth.

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So I've been in the government affairs lobbying space for well over a decade.

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I actually started in-house representing skilled nursing facilities with one of the

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larger trade associations here in California.

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And then from there,

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I was in-house with Kaiser Permanente,

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working mainly with their medical groups.

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And then from there, I actually worked with Amazon.

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And a little bit of a jump there,

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but it was great because that's when Amazon has really grown out their healthcare

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business.

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Here in California,

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as you may well know with Amazon pharmacy clinic acquisition,

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one medical and so forth.

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But throughout all that time,

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Vincent,

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I mean that again,

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well over a decade,

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I was seeing a lot of the trends with the various other stakeholders that we worked

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with.

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So,

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Within lobbying,

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right,

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you're working with these other groups,

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working with these other companies,

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and you're seeing different trends,

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right?

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Not just politically,

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what's going on with the demographics within the state,

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but also seeing,

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like,

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what are these various priorities for other groups and so forth?

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And whether I was at...

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CAF,

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again,

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representing the skilled nurse facilities all the way to Kaiser Permanente,

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you're starting to see this massive shift,

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not just nationally,

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but in California,

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of a lot of these independent physicians going into large groups,

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large systems,

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such as a Kaiser Permanente.

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or even being bought out by private equity, other corporate interests, and so forth.

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And you're starting to see that.

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And you're also starting to see a lot of the priorities as well with a lot of these

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groups representing them,

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which naturally most of their members then were starting to be within the large

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system.

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So getting to about a little over two years ago,

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which,

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again,

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we just hit our two-year anniversary of PAC,

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which otherwise is the Physician Association of California,

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but I'll just call it PAC.

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Nice PAC.

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Thank you very much.

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I like to brand.

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I was approached by a group that said, hey, we have an interest.

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We have some financial backing.

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We have a preliminary board.

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What are your thoughts of us starting our brand new trade association that is

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solely dedicated to independent physicians?

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What are independent physicians, you know, for the audience listening, right?

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These are the ones that they run their own practice.

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They're their own employer.

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They're not an employee.

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Right.

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So,

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for example,

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if you are a Kaiser Permanente patient,

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which I once was,

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when you went to go see your Kaiser Permanente physician,

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that would not be an independent physician,

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right?

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They are employed by the medical group and they solely exclusively see patients

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within the health plan.

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These members of ours, both the men and women of all specialties, they have their own practice.

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They actually employ other people,

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whether it's NPs,

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PAs,

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they have their own staff,

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they may be doing their own billing,

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but they are in their mode of practice because they very much have a passion for

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that patient position and also that autonomy.

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They like the relationship, they want the autonomy.

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They don't want to be told, hey, you only have five or 10 minutes to see a patient, right?

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You know,

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they don't want to be said,

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hey,

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this is only what is going to be authorized for treatment.

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They want to be able to use their own clinical judgment, right?

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I mean, that's why they went to medical school.

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So would you say that that is the primary driver there,

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that fierce independence,

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because they want to be able to spend the time with their patients and not have to

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report up to another entity somewhere?

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You know, it's a lot of it.

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I would say it's definitely a huge crux of it.

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They're also very entrepreneurial spirited.

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Right.

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So like they like building their own business.

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Right.

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They like building their own image.

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They want to build their own network of patients.

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Right.

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They're small businesses.

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I mean, you know, you know about that with your prior work as a broker.

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They are small businesses that want to build up their own marketing,

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have their own patient base,

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but also,

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again,

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they want to be able to treat them to their fullest capability.

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And again, they don't like being told what they should or should not do.

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They don't like middlemen.

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Uh, granted that they have to deal with that at times.

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Um,

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but it's more to them as far as,

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Hey,

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I'm going to treat every single patient the same,

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regardless of their insurance.

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I'm going to treat them as far as the best of my ability.

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I'm going to do what I can, what is clinically appropriate.

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And I'm going to take my time doing so.

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Wow.

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Now with that, as you well know, there's challenges, right?

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I mean,

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there's challenges such as,

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um,

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you know,

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they're not getting two weeks leave paid a year,

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right?

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It's all on their own dime.

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They have to pay their own staff.

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They have to pay for their own medical malpractice liability insurance.

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If they want to be with an association, they have to pay their own dues.

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There's a lot that goes in that workers comp, right?

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Well, and also, I mean, just the notion of running the business itself.

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I mean,

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it's not lost on anyone that running a healthcare practice with all the things you

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just said and all the additional layers on top of it in terms of technology and,

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and,

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everything that goes into running a practice, it takes a lot of work.

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It takes a lot of desire to want to be that.

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For sure, for sure.

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And I think that is what...

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what's very very consistent with everyone i talk to with you know my board members

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everywhere from up up and down the state when i talk to them it is that that driver

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that passion where hey i'm in this for like what what is best for the patient there

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is a crap ton of hurdles and barriers that they deal with and we can go down that

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road yeah yeah as you all know prior authorization reimbursement and so forth but

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again

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They're in it because that is what they're – they love that autonomy,

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and they want to make sure that they're delivering the best care that they know how

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without someone telling them how to do it.

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Okay.

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Okay.

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And so let's talk about some statistics, right?

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So either nationally or within California.

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I've seen charts that just show the number of independent physicians –

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decreasing over the last, to your point, with the acquisitions.

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And it's interesting that now,

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you know,

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insurance companies,

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and we'll keep all the names quiet to protect the innocent,

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but insurance companies are now coming into the game and buying practices.

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I think you call them, is it the Buka?

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The Big Buka?

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The Buka's.

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The Buka's.

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The Buka's, yep.

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Okay.

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They're coming in and buying practices.

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And so if I'm a physician,

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especially if I'm an aging physician,

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I mean,

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these acquirers,

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and this is no different than being an insurance broker,

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right?

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Insurance brokers have gone through a very similar trend in the last 10,

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15 years where the big brokerages,

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who are also either publicly traded or private equity-backed,

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have been acquiring smaller brokerages left and right.

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And while they may keep the principles on for a minimum two to three year period,

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They really don't care.

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They're buying butts in the seats.

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They're buying the book of business.

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They're buying cash flow.

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I can imagine that that's the same thing because people will be loyal but only be

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so loyal,

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I think.

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If a doctor leaves the practice,

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people will probably freak out a little bit and they don't know what to do because

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finding another doctor is a really painful process.

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I can imagine these doctors

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when someone's coming to the table with an offer,

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and I'm sure a lot of them are coming in unsolicited,

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they have to look at that pretty hard to say,

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do I want to stay this,

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keep this independent road or cash the check?

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Sure.

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Sure.

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And I mean, there's two, two things you also, you just mentioned there that I'll hit on.

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And one of them is let's talk about that patient that you, that you just talked about, right?

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Patient should obviously be able to choose and,

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you know,

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just all depends on,

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you know,

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what their health plan is,

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but,

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you know,

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We obviously feel with what our insurance primary is,

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like with the PPOs and so forth,

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where if the patient wants to be with that physician or they have that good of a

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relationship,

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right?

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Because that's something we're very proud of with our members, right?

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They're very proud of, hey, if I have a good relationship with this patient, right?

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And sometimes it backfires, but hey, they have my cell phone, right?

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I mean, they're not calling my office.

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They're not getting, hey, wait online until some customer service rep gets with you.

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Or they're not doing just typing an email and hopefully my

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My my doctor emailed me back in in two days.

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They have that connection.

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So there's a lot to that, depending.

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Right.

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If if a physician leaves a certain practice and goes in large system,

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they may have relationships with other doctor,

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but totally up to that patient.

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So, you know, that's that is one component.

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Like if they lose that rapport with that practice.

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Right.

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It's very natural.

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They may go somewhere else.

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Yeah.

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As far as with the acquisitions and the numbers.

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It's fascinating.

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There was a recent report.

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There's been a few, obviously, in this area, both nationally and in California.

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There was a recent report within AMA,

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the American Medical Association,

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and it was looking at between 2012 and 2024.

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A lot has gone on there, obviously, with the COVID-19 pandemic and so forth.

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But you still also looked at that decline even before the COVID pandemic.

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And what you were seeing is the number of employed physicians nationally have

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dramatically increased,

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like almost like 15 to 20 percent.

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You look at California specifically,

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probably about 10 or 12 years ago,

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I think the number was probably around 50 percent,

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five zero.

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of the physicians in california were practicing independently within that mode

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right right 50 right independent i don't think i defined that for you earlier

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vincent that is someone who's either solo cms definition is also of small practice

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15 physicians or less right so solo to 15 physicians less that was 50 um about 12

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years ago there's a recent report that just came out by the california healthcare

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foundation mm-hmm

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Right now, that number's around 33%.

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Wow.

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Huge, huge decline.

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And a lot of that are things that you just talked about, right?

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I mean, there's a whole carrot that's going out there.

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And from these larger groups, larger systems, private equities, like, hey, I can buy you out.

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I want to take in your network of patients and so forth.

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It also adds to their network as far as physicians and also patients.

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And it is very enticing at times, right?

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There's a much larger number, right?

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I mean, look at just what Netflix did with Warner Brothers.

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But this is something right here where there's a lot of these physicians and it's

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all specialties,

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right?

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It's not just primary care.

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It may be something with orthopedics, urology, OBGYN.

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I mean, you name it.

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Right.

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And there is a very big number that can be attached to it in the beginning saying,

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hey,

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we will buy this.

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Here's your bonus.

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This is what your salary will be.

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You get your PTO.

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You may get a pension depending where you're going.

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Very, very enticing.

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Now, a lot of people would say at the end that maybe doesn't add up.

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There's a lot of upfront money.

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upfront money,

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but when you pencil it out down the road,

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hey,

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this doesn't add up,

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especially if I'm a younger physician.

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But at the same time,

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Vincent,

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you're starting to see now this wave,

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which was once a lot of physicians in private practice earlier on that are getting

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older.

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They're looking for retirement, right?

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They want to cash in.

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This is a retirement.

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And my association and my board,

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we're not of the position where we should dictate to any physician on whether or

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not they should sell their practice.

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We'll have consultants that advise them whether or not this is a good sale or not.

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But hey, they're independent.

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Right.

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If they want to if they want to sell their practice, they should.

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That's what's best for families should.

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But again, our mission as my association, right, we're to protect and enhance private practice.

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So we hope they do say anything.

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No, no, no.

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I hear all that.

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And that that's that's a great mission.

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Now, let's talk a little bit about that quintessential.

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It's very interesting.

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As you're talking, I'm thinking, OK, now we have that that doc who's say early 60 ish.

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they have a practice, say they're one doctor, and let's say they maybe have 2,000 patients.

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Somebody comes along and says, we'd love to buy your practice.

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What are the typical terms of those deals?

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Does that doctor have to stay on for a certain number of years as a transition

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before they can actually say they want to retire,

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retire?

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How do those deals normally work out?

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It all kind of depends.

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A lot of it is usually between a three and five-year deal.

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It's also important to note,

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too,

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with a lot of these acquisitions,

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especially if it's through private equity,

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there's usually multiple sales.

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There's one sale, then two sales, and then the third.

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But what typically happens with it,

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right,

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if you're selling into private equity within your practice,

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you are becoming then an employee of that group,

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right?

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So you are on their terms.

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Now,

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with that said,

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there's a lot that's being offered up in the beginning as far as a bonus,

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like this is your salary.

(00:16:00):
But then, yes, also at the end, too, there is a measurement as far as performance and so forth.

(00:16:05):
No different than the acquisitions that were going on with books of business and

(00:16:10):
the brokerage business.

(00:16:11):
It's the same.

(00:16:11):
They had a three-year earn out.

(00:16:14):
Here's your two-thirds of your money up front and then a six to six to six.

(00:16:18):
And at the end of the day,

(00:16:20):
it – but you said something interesting that made me think about this,

(00:16:24):
that when I look to pencil that out for most brokers in their 50s-ish or whatever –

(00:16:31):
The cash flow you get to keep if you stayed in long-term is way better than any

(00:16:36):
deal you're gonna get by selling out in the short run.

(00:16:39):
And you give up a lot of things.

(00:16:41):
But at the same time with then a practice, Dr. X becomes an employee of practice Y.

(00:16:48):
All these people he had to worry about,

(00:16:50):
his physician assistant,

(00:16:53):
all his team that he has,

(00:16:54):
his practice manager,

(00:16:56):
those people also in turn become employees.

(00:16:59):
So he's not really as worried about them anymore.

(00:17:02):
They're on their benefits and all these different things.

(00:17:05):
And then he also doesn't have to worry,

(00:17:06):
he or she doesn't have to worry about billing the insurance companies,

(00:17:09):
collecting the revenue,

(00:17:10):
all the different things.

(00:17:12):
And so I'm sure all that plays into the conversation.

(00:17:15):
A hundred percent, Vincent.

(00:17:17):
And that is what a lot of that has become,

(00:17:20):
especially now,

(00:17:21):
which,

(00:17:21):
again,

(00:17:22):
which is why it's so important on why PAC started what we're trying to do,

(00:17:25):
right?

(00:17:25):
I mean, we have our pillars.

(00:17:27):
Everything we do is trying to advocate,

(00:17:30):
lobby,

(00:17:31):
both in the state legislature,

(00:17:34):
the regulatory environment with DMHC,

(00:17:36):
CDI,

(00:17:37):
and so forth to make sure we're focused on things that are their pain points.

(00:17:41):
Their big pain points, right, are reimbursement.

(00:17:45):
administrative burdens,

(00:17:46):
and then also out-of-pocket costs,

(00:17:48):
whether it's liability insurance,

(00:17:50):
workers' comp,

(00:17:51):
and so forth.

(00:17:51):
But again,

(00:17:52):
they're in it because they like having their business and they like to treat

(00:17:56):
patients the way they know how.

(00:17:58):
Now,

(00:17:59):
Why it's so also attractive to sell your practice,

(00:18:04):
whether it's PE,

(00:18:05):
large system,

(00:18:07):
is what is now happening is,

(00:18:09):
especially with the reimbursement rates,

(00:18:11):
it has drastically dropped.

(00:18:13):
We're talking about the number of physicians of independent that have dropped over the years.

(00:18:17):
The Medicare payment within the last,

(00:18:20):
I think it's 30 years or so,

(00:18:22):
25 years or so,

(00:18:23):
has dropped,

(00:18:24):
I mean,

(00:18:25):
non-clean inflation,

(00:18:26):
over 30%.

(00:18:28):
So now my members,

(00:18:31):
their type of leverage with these various insurance companies and so forth,

(00:18:35):
or just what they're getting reimbursement-wise for Medicare,

(00:18:37):
has drastically dropped.

(00:18:39):
Because the plans are using the physician fee schedule,

(00:18:42):
and they're basing their contracts off of that.

(00:18:44):
And they don't have the leveraging power like they once did.

(00:18:47):
Absolutely.

(00:18:48):
Independent physician, here's what we're going to reimburse you.

(00:18:50):
Yeah.

(00:18:50):
So how am I able to deliver the top quality care that I want,

(00:18:56):
seeing that patient as long as I want to,

(00:18:59):
to make sure they're getting the right diagnosis,

(00:19:01):
the right treatment.

(00:19:02):
And they're looking at this, well, I'm just on a hamster wheel.

(00:19:05):
And some of them give up.

(00:19:07):
Yeah.

(00:19:08):
There is, though, a huge – there is a huge group of people.

(00:19:12):
Again, over 33% have chosen not to give up, which we applaud them.

(00:19:15):
We're trying to lobby for, right?

(00:19:17):
But also you're now also starting to see a little bit of this younger class that

(00:19:22):
are graduating,

(00:19:23):
right?

(00:19:23):
They're smart, where they're seeing a lot of these people wanting to sell their practices.

(00:19:27):
Yeah.

(00:19:28):
And there's,

(00:19:29):
you know,

(00:19:29):
they're seeing now like,

(00:19:30):
hey,

(00:19:30):
there's an opportunity for me out of residency where I can possibly take this over.

(00:19:35):
And we're starting to see a little bit.

(00:19:37):
That's a really good point.

(00:19:38):
I mean,

(00:19:38):
I think it's also very interesting that and I have another good friend that I'm

(00:19:42):
going to be interviewing who happens to be the dean of a medical school.

(00:19:47):
Right.

(00:19:47):
And we were talking about physician education in the medical school level about how

(00:19:53):
they're only now slowly building

(00:19:55):
beginning to weave in the conversation of how to run a business.

(00:20:00):
Right, right, right, right.

(00:20:02):
You know, and it's interesting.

(00:20:06):
That is something that's completely off the radar screen.

(00:20:08):
Totally.

(00:20:09):
And it's been that way.

(00:20:10):
I mean, it's been that way for quite some time, right?

(00:20:13):
Because the people who have the time,

(00:20:16):
you know,

(00:20:16):
to whether it's teach,

(00:20:17):
you know,

(00:20:18):
whether it's in medical school or at various residency programs,

(00:20:20):
right?

(00:20:21):
They have the time that's allowed to them by their employer, right?

(00:20:24):
They can then go do this, right?

(00:20:26):
If you're your own private practice physician,

(00:20:28):
I mean,

(00:20:28):
you have your own small business,

(00:20:31):
you're having to take a lot of time out,

(00:20:32):
which means I'm not seeing my patients,

(00:20:34):
which then also hurts my bottom line as far as reimbursement.

(00:20:38):
And I also have to keep my office going.

(00:20:39):
I need to see these patients.

(00:20:40):
They want to see their doctor.

(00:20:41):
And a lot of what has been taught over the years,

(00:20:44):
right,

(00:20:45):
has been by the larger system of physicians or academics.

(00:20:50):
And a lot of the ease, I don't want to say easy way because there's nothing wrong with

(00:20:54):
with a there's nothing wrong obviously with a doctor in a larger system and I'm not

(00:20:58):
saying that one bit but a lot of what has just been kind of the the comfortable

(00:21:02):
mode is hey you may not make it on your own your best path is to go within this

(00:21:09):
large group yeah right and that is kind of been the train of thought for many many

(00:21:14):
years but again

(00:21:16):
from what your friend just said,

(00:21:17):
you're starting to see now that,

(00:21:19):
hey,

(00:21:19):
we should also be educating and teaching them on how to start their own business.

(00:21:22):
Yeah, but what an interesting, interesting business opportunity.

(00:21:26):
So if I'm sitting there and I'm a senior practicing physician and I've got a

(00:21:32):
patient panel of a couple thousand patients and I have a three-year timeline,

(00:21:37):
and this is exactly the challenge that came up to me personally when I was working

(00:21:41):
for a brokerage,

(00:21:42):
a small little independent brokerage,

(00:21:45):
know we knew that the senior guy wanted to retire at some point um and there was no

(00:21:52):
way for the rest of us to put together the nut necessary to buy him out in a way

(00:22:00):
that he wanted to be bought out that a big company came along and didn't even write

(00:22:04):
a check they gave him they gave him stock

(00:22:07):
to pay for the deal.

(00:22:10):
And so that's a really tough financial decision.

(00:22:14):
But at the same time,

(00:22:16):
somebody with the right business acumen and business knowledge can really be

(00:22:20):
working with young physicians who

(00:22:22):
to seed their ability to transition into a practice and buy it out eventually right

(00:22:29):
that's an interesting business model are you seeing that are you seeing people

(00:22:32):
starting to look at it that way versus the swoop in write the big check and see you

(00:22:36):
later we're starting to see that and uh we have a few consultants as well that we

(00:22:41):
work with i mean they actually work on this on their own as well with a lot of

(00:22:44):
these um

(00:22:46):
students, even like junior practices and so forth on, on how to swoop it up.

(00:22:50):
So, I mean, there are some playbooks out there.

(00:22:52):
I mean, I can tell you as well.

(00:22:53):
I know my board, this is something they're very interested in as well.

(00:22:56):
Again,

(00:22:56):
because it's that net,

(00:22:57):
it's that,

(00:22:58):
it's that new generation that we need,

(00:23:00):
you know,

(00:23:01):
to,

(00:23:01):
you know,

(00:23:01):
backfill.

(00:23:03):
To hang out your shingle as an independent, a young independent physician.

(00:23:07):
Yeah.

(00:23:09):
It's word of mouth.

(00:23:11):
And you're a new doctor.

(00:23:12):
Who wants to go see a new primary care physician, right?

(00:23:15):
So you need to have the ability to build a book of business while you're paying

(00:23:19):
down your medical school debt and all the things.

(00:23:22):
So, I mean, again, no different than the insurance brokerage space.

(00:23:25):
I mean, it's the same.

(00:23:27):
And I remember back in those days when we were looking to sell the brokerage,

(00:23:31):
there was a broker,

(00:23:33):
a business broker themselves,

(00:23:35):
who took our book of business,

(00:23:37):
valued it,

(00:23:38):
and then shopped it around to the brokerages that were available,

(00:23:41):
that were interested in buying it,

(00:23:42):
and there it was.

(00:23:43):
But you have a different problem.

(00:23:45):
You have these independent docs who probably,

(00:23:48):
the fiercely independent ones who want to stay that way,

(00:23:51):
would probably rather sell their practice to someone who will keep it independent.

(00:23:55):
Is that a fair statement?

(00:23:56):
Yeah, I would definitely say that's a fair statement.

(00:24:00):
I think there are some, though, where they –

(00:24:03):
They don't know or trust in someone else that may be able to take it over, right?

(00:24:08):
It's like one of those things I want to take pride in who is taking over my business.

(00:24:11):
And then some of it is like, hey, what is best for me and my family as far as retirement?

(00:24:16):
And they look at that.

(00:24:16):
And some of them, right, they may be just so exhausted, whether it's them dealing –

(00:24:21):
Them dealing with prior authorizations this whole time, lower reimbursements.

(00:24:24):
And again, like I said, it's my hands up.

(00:24:26):
I just want to exit.

(00:24:28):
I'll sell my car for whatever I get for it.

(00:24:31):
Well, there's the burnout factor, right?

(00:24:32):
I mean, there's no shortage of posts on LinkedIn talking about burnout.

(00:24:38):
And it's real.

(00:24:39):
It's real.

(00:24:40):
It is.

(00:24:40):
It is.

(00:24:41):
In fact, we're actually we're actually supporting this one documentary that's being done.

(00:24:45):
That's all about burnout,

(00:24:47):
which should be really interesting for YouTube at some point called Suck It Up

(00:24:51):
Buttercup.

(00:24:51):
And the whole thing.

(00:24:52):
Great name.

(00:24:55):
Todd Oden is the one is one doing it reached out to me.

(00:24:58):
But it's all about that burnout.

(00:25:00):
And it's burnout,

(00:25:00):
though,

(00:25:01):
obviously not just independent,

(00:25:02):
but in large systems with nurses and so forth.

(00:25:05):
Absolutely.

(00:25:07):
I think about the healthcare systems.

(00:25:09):
I try to look at it at a macro level.

(00:25:12):
I follow so much on LinkedIn.

(00:25:15):
I read a lot of stuff.

(00:25:16):
I look at the trends.

(00:25:18):
Healthcare,

(00:25:19):
and I don't want to go down this rabbit hole because that's a whole other episode,

(00:25:21):
I think.

(00:25:21):
But it's really all about...

(00:25:26):
how many very,

(00:25:27):
very,

(00:25:27):
very smart cooks can you have in the kitchen that can't perfect the recipe?

(00:25:34):
Yeah.

(00:25:35):
Right.

(00:25:35):
Yep.

(00:25:36):
Yep.

(00:25:37):
Well, yeah, I mean, absolutely.

(00:25:39):
And I mean, it is, you, you have to have a very sophisticated system as well, independently.

(00:25:48):
I'm not just, you know, just talking on behalf of our members, very sophisticated system.

(00:25:53):
to really maximize, right?

(00:25:55):
What are your reimbursements?

(00:25:56):
How do you lower overhead costs?

(00:25:58):
But that costs money.

(00:25:59):
That also costs money.

(00:26:00):
Yeah.

(00:26:01):
And that is part of the reason why a lot of these people,

(00:26:05):
when they decide to sell,

(00:26:07):
where it's like,

(00:26:07):
I just don't have the bandwidth to do this anymore.

(00:26:09):
I don't have the resources.

(00:26:11):
I want someone else doing that.

(00:26:13):
And obviously not faulting them, but it's just a reality.

(00:26:16):
This is how expensive healthcare is getting.

(00:26:18):
And we're all seeing it.

(00:26:19):
We're definitely seeing it as consumers, right?

(00:26:21):
I mean, what we pay monthly for our plans, I mean, that's not going down.

(00:26:26):
But our argument on why it's very important on what PAC's doing,

(00:26:31):
you need to keep these physicians within their mode.

(00:26:33):
They can't just all go into integrated systems or large groups.

(00:26:38):
You need to keep independent.

(00:26:39):
It's access to care.

(00:26:40):
And also, we say as well, I mean, we argue this point, we're also more cost-effective.

(00:26:45):
As far as what our reimbursement rate is compared to someone else in a different

(00:26:49):
site or in-house,

(00:26:51):
it is cheaper on the health plan for the care that we're delivering.

(00:26:54):
Yeah.

(00:26:55):
So as you're talking and as I'm thinking about time, we have time.

(00:26:59):
I mean, there's three topics I still want to cover.

(00:27:02):
The first is in the last five years,

(00:27:08):
more and more and more venture-funded companies have come to market with some type

(00:27:13):
of a solution to help physicians either be more efficient or make more money.

(00:27:18):
These could be in the areas of value-based care,

(00:27:22):
these are in the area of AI,

(00:27:25):
things like visit scribes and all these different things,

(00:27:30):
patient flow,

(00:27:32):
patient outreach.

(00:27:34):
I've seen it all.

(00:27:35):
And knowing the independent physicians I do through a local IPA,

(00:27:42):
I don't know how you mentioned the word bandwidth,

(00:27:46):
how these docs and their practices have the ability to evaluate these things when

(00:27:53):
they're getting hit up with a solution,

(00:27:57):
right?

(00:27:58):
But there may be five vendors already out there selling an AI scribe to scribe the visit.

(00:28:03):
So it's like, okay, how do I now evaluate these five vendors?

(00:28:07):
And they're trying to differentiate new technology with no playbook, right?

(00:28:12):
So how does that work?

(00:28:15):
Well, just even how they're even getting that, that information.

(00:28:18):
Right.

(00:28:19):
And most of this is like by,

(00:28:21):
by cold calls or emails,

(00:28:22):
which by the way,

(00:28:23):
they're getting,

(00:28:23):
I was with my chair yesterday who was up from Southern California.

(00:28:28):
I mean, he was telling me, he says, man, I probably get close to about 300 emails a day.

(00:28:33):
By the way, I always get a kick out of the email addresses for independent physicians.

(00:28:37):
Oh yeah.

(00:28:37):
I mean, I, I, they're like AOL.

(00:28:38):
Yeah.

(00:28:40):
They might be Yahoo.

(00:28:41):
I might've seen a MySpace still, I don't know.

(00:28:44):
But I mean, they are like using basic, it's not like, you know, a branded email.

(00:28:52):
Yeah,

(00:28:52):
well,

(00:28:53):
that's something we're gonna be working on as well with one of our webinars on best

(00:28:58):
marketing practices.

(00:28:59):
So it is funny, I get a laugh out of it.

(00:29:01):
It's like, oh my, that was my high school, what was it, AIM?

(00:29:05):
Yeah, AIM LL.

(00:29:08):
So,

(00:29:08):
I mean,

(00:29:11):
it's them having trust in a lot of what their other partners are as well,

(00:29:15):
or like an association like ours.

(00:29:17):
Like, you know, we're trying to advise them, hey, you know, we'll vet it.

(00:29:20):
We'll vet it.

(00:29:21):
This may be a good solution for you.

(00:29:23):
And a lot of the, you know, a lot of these companies as well, there is no upfront costs.

(00:29:28):
Right.

(00:29:28):
Um, there, there, there is not right.

(00:29:31):
It's called time.

(00:29:32):
Yeah, it is time.

(00:29:32):
It is time.

(00:29:33):
But you know, a lot of it is, Hey, let us, let us dissect.

(00:29:35):
Let's evaluate your practice a little bit on what you need and so forth.

(00:29:38):
Here's the package, right?

(00:29:40):
Um,

(00:29:40):
some of them,

(00:29:41):
the other as upfront costs,

(00:29:42):
but when,

(00:29:42):
at the end,

(00:29:43):
when there is savings,

(00:29:44):
which could be significant,

(00:29:46):
um,

(00:29:46):
I mean,

(00:29:46):
significant,

(00:29:47):
I mean,

(00:29:47):
I can,

(00:29:47):
in,

(00:29:47):
but it is a little mind blowing,

(00:29:49):
right?

(00:29:49):
I mean, this goes not only in the case of, in the case of, um, uh,

(00:29:54):
healthcare type practice related solutions and employee benefit solutions where I

(00:29:59):
have a lot of skills,

(00:30:00):
skillset.

(00:30:01):
Um,

(00:30:01):
it's,

(00:30:02):
it's,

(00:30:02):
you're now being asked by this vendor to turn over all your data,

(00:30:09):
all your patient files,

(00:30:10):
all your,

(00:30:11):
Oh,

(00:30:11):
it's HIPAA protected.

(00:30:12):
And then you go, they'll do a, do a little, um, research on the company.

(00:30:16):
And, you know, they have 25 employees in, in San Jose, you know, and, and,

(00:30:21):
And what's their venture back?

(00:30:22):
They may have a $10 million, $20 million funding round.

(00:30:27):
You're praying they survive and you're going to put all this energy into company X

(00:30:30):
and they may get acquired or disappear in two years.

(00:30:33):
I mean,

(00:30:33):
so to me,

(00:30:34):
it's a risk management problem that I think no one's really even looking at like

(00:30:38):
that.

(00:30:39):
Yeah, I mean, that's a very good point.

(00:30:41):
And then also too,

(00:30:42):
it's just,

(00:30:43):
I mean,

(00:30:43):
it's the amount of time for them to even conceptualize like what you just said.

(00:30:49):
No,

(00:30:49):
because I mean,

(00:30:51):
you talk about pajama time with our members on the stuff they have to do,

(00:30:55):
right?

(00:30:56):
Treating the patient, making sure they're always 100% treating their patient.

(00:31:00):
And most of the time, right?

(00:31:01):
They're still going home after 12-hour days,

(00:31:03):
seeing their family for a little bit,

(00:31:05):
doing stuff on the weekends.

(00:31:06):
But now,

(00:31:07):
hey,

(00:31:07):
let me go look through what is best here for my business on the sales and

(00:31:11):
marketing.

(00:31:12):
A lot goes into it, right?

(00:31:13):
Well, hence the challenge I had with that PEO I was rolling out.

(00:31:17):
The docs, they all loved it.

(00:31:19):
And then when the rubber met the road, they just didn't have the bandwidth to evaluate it well.

(00:31:24):
Okay.

(00:31:25):
Next thing I wanted to pivot to is the rise or I hope it's the rise.

(00:31:30):
I'm not sure.

(00:31:30):
It's the rise of concierge practices, right?

(00:31:33):
So a doctor has a choice.

(00:31:34):
Yep.

(00:31:34):
Right.

(00:31:34):
Do I stay in the insurance rat race,

(00:31:36):
the Medicare rat race,

(00:31:37):
all the begging for money from other people,

(00:31:41):
or do I build a practice of,

(00:31:44):
you know,

(00:31:45):
a thousand people that want to pay me a thousand dollars a year.

(00:31:48):
And I have a million dollar revenue, you know, situation.

(00:31:51):
So is, is that an appealing model more to docs these days?

(00:31:57):
Yes.

(00:31:58):
And no.

(00:31:59):
Um, and we'll start.

(00:32:01):
Yeah.

(00:32:02):
Let's obviously let's start with yes.

(00:32:04):
It all really depends as well with their specialty on what they're in, right?

(00:32:10):
There are certain specialties as far as where the reimbursement is at,

(00:32:17):
where they can code and so forth,

(00:32:19):
and billing and so forth,

(00:32:20):
where it's still very sufficient,

(00:32:22):
right?

(00:32:22):
And there's a great network of patients already in there.

(00:32:25):
So there isn't many issues per se with a lot of the plans,

(00:32:31):
whether it's the Big Buka or other ones,

(00:32:33):
right?

(00:32:33):
Right.

(00:32:34):
I would say with some of them,

(00:32:36):
depending on their specialty,

(00:32:38):
whether again,

(00:32:39):
it's,

(00:32:39):
you know,

(00:32:39):
pediatrics,

(00:32:40):
especially primary care where this is very hot in,

(00:32:43):
uh,

(00:32:43):
which has been a very big decline,

(00:32:44):
especially within private practice.

(00:32:47):
This is something where it is attractive and it's attractive for two reasons.

(00:32:51):
Number one,

(00:32:52):
one of the reasons is because,

(00:32:54):
Hey,

(00:32:55):
I can,

(00:32:56):
I can actually build now a much bigger book because the consumer's demanding this.

(00:33:00):
They want to do this.

(00:33:01):
They can pay it.

(00:33:02):
Now, granted, it's much more affluent.

(00:33:04):
Um, in, in some of these areas, um, and I don't need a deal.

(00:33:07):
I don't need to deal with all the burdens on dealing with the plan,

(00:33:11):
like whether it's the prior authorization.

(00:33:13):
The provider credentialing,

(00:33:15):
which again,

(00:33:15):
a bill we did this last year,

(00:33:16):
hopefully makes that much easier that we sponsor that goes in effect next year.

(00:33:20):
But there's a lot that goes on with just the whole billing cycle and so forth.

(00:33:26):
And also the reimbursement where, hey, this isn't worth the headache.

(00:33:29):
I'm actually going to drop this plan and this plan.

(00:33:32):
And they look at it.

(00:33:33):
It was like, well, hey, I still have a book of business.

(00:33:35):
Like,

(00:33:36):
like,

(00:33:36):
let me go with,

(00:33:37):
uh,

(00:33:37):
let me go this route,

(00:33:38):
like concierge or like,

(00:33:39):
there's somewhat like a quasi thing.

(00:33:41):
Hey, I'm a self keep taking traditional insurance.

(00:33:44):
However,

(00:33:44):
I may also have this whole other out of pocket thing where,

(00:33:48):
Hey,

(00:33:49):
you'll get 24 access to me with my cell phone.

(00:33:52):
So you're saying some of them will play the diversification game.

(00:33:54):
They're,

(00:33:54):
they're not going to,

(00:33:56):
and that's the same doc who probably on the weekends,

(00:33:58):
if they've got time to do in a telemedicine gig too.

(00:34:00):
Right.

(00:34:00):
Totally.

(00:34:00):
Totally.

(00:34:01):
And but, yeah, there are some where, you know, the frustration is just it's too much.

(00:34:06):
They built that book.

(00:34:08):
They built that trust within the community because, you know, they're small business.

(00:34:12):
It's like any other small business around here in Sacramento.

(00:34:14):
You know who that is.

(00:34:15):
Hey, I like that place.

(00:34:16):
I'm going to keep going there.

(00:34:17):
It's the same thing with like with these docs.

(00:34:20):
Now, it is, though, I mean, we have we have someone on our board as well.

(00:34:24):
I mean,

(00:34:25):
all the border private practice doctors,

(00:34:27):
except we do have a practice and liability consultant who's in Napa,

(00:34:31):
Deborah Ferris.

(00:34:31):
And she does a lot of consulting in this area where she will talk to a lot of these

(00:34:34):
doctors,

(00:34:35):
like whether or not like this is potentially a good thing to do or,

(00:34:38):
you know,

(00:34:39):
or,

(00:34:39):
hey,

(00:34:39):
let's look at this.

(00:34:41):
And you do have to.

(00:34:42):
I mean, the thing that I understand, I'm not an expert in this area.

(00:34:45):
You do have to have, though, right, that rapport is.

(00:34:49):
that trust, that name recognition already in the community.

(00:34:52):
Like you're talking about heading out your own,

(00:34:55):
hanging out your own shingle as far as being in private practice.

(00:34:59):
Going out right out of residency and hanging your shingle and trying to do

(00:35:03):
concierge is a much,

(00:35:04):
much different thing,

(00:35:05):
right?

(00:35:06):
You got to have that book.

(00:35:08):
And you're also starting to see this too,

(00:35:09):
Vincent,

(00:35:10):
with a lot of large system or large medical group docs that are leaving not just to

(00:35:15):
go to private practice but also going concierge.

(00:35:18):
Yes.

(00:35:18):
Because they have that rotation.

(00:35:21):
of patients that they normally see and they are willing to pay out of pocket to see

(00:35:27):
Dr.

(00:35:27):
X in much timely fashion.

(00:35:28):
Look at it this way.

(00:35:29):
I mean,

(00:35:29):
this is a debate that has started to evolve more and more about the value of

(00:35:35):
insurance at all.

(00:35:35):
I mean, someone, you know, if you look at just I'll give myself and my wife as an example.

(00:35:42):
We're paying two grand a month.

(00:35:44):
for a plan that you know that's 24 grand a year for the two of us and then um after

(00:35:52):
that and that gives me the privilege of being out of pocket another 12 000 if

(00:35:57):
something bad happens so there's total cost of ownership if something bad happens

(00:36:01):
it's 36 000 now what i'd rather take take that money some of it and redeploy it and

(00:36:07):
get access to a doc not a great doctor but if you don't

(00:36:11):
Pay something over here to have access to a dock.

(00:36:14):
So I think we're looking at potential interesting new business models in insurance,

(00:36:20):
in access to care.

(00:36:23):
And you're absolutely right.

(00:36:25):
I mean, it does boil and then we're not going to go down this road yet.

(00:36:27):
I mean, at least in this conversation.

(00:36:30):
But a have and have not scenario.

(00:36:32):
I mean, people who can afford it are going to pay for it.

(00:36:35):
People who can't are going to stay within the systems that they have.

(00:36:42):
As we wrap, I want to cover one more, I think very important topic for you is really,

(00:36:48):
to share the initiatives you're working on legislatively.

(00:36:52):
I think, you know, you have a mission.

(00:36:54):
You're representing independent physicians at the state capitol.

(00:36:58):
And I would imagine the things you're doing because of the size of California have

(00:37:03):
national implications.

(00:37:05):
So talk a little bit about some of the initiatives.

(00:37:08):
I mean, you passed some legislation.

(00:37:09):
You've got some things I'm sure you're working on.

(00:37:11):
What do you care to share about that?

(00:37:13):
Sure.

(00:37:15):
So,

(00:37:15):
you know,

(00:37:15):
I'll talk about like what we what we pass and was signed into law by the governor

(00:37:20):
this past year in the 2025 legislative session.

(00:37:22):
So,

(00:37:23):
you know,

(00:37:23):
first and foremost,

(00:37:23):
you know,

(00:37:24):
to any of the physicians here listening,

(00:37:26):
everything we do is for the benefit of private practice.

(00:37:29):
Those independent physicians and small groups doesn't matter what specialty you are.

(00:37:33):
Right.

(00:37:33):
So if this is what's good for them,

(00:37:35):
this should you know,

(00:37:36):
if you're in that specialty,

(00:37:36):
it should be good for you.

(00:37:37):
And what we do is we actually I mean,

(00:37:39):
I we survey I've done focus groups with our consultants,

(00:37:44):
our lobbyists and so forth on what you guys want to see.

(00:37:48):
So very important for our listeners to know.

(00:37:50):
Right.

(00:37:50):
We're built from the ground up.

(00:37:51):
We go after your pain points.

(00:37:52):
And we talked about the big things.

(00:37:54):
Right.

(00:37:54):
Our priorities,

(00:37:56):
the administrative burdens,

(00:37:57):
whether it's provider credentialing,

(00:37:58):
prior authorization.

(00:37:59):
Right.

(00:38:01):
And then reimbursement, obviously a massive thing.

(00:38:04):
We want to make sure we like really,

(00:38:06):
really educate people on how appropriate it is that patient physician relationship,

(00:38:11):
autonomy,

(00:38:12):
making sure liability insurance stays low.

(00:38:16):
I mean, that's something that kind of why we started.

(00:38:18):
There was a big deal with AB 35, which is raising the micro caps.

(00:38:22):
Well, again,

(00:38:23):
Our members are the ones who pay for that.

(00:38:25):
If you're in a large system, you're not paying for your medical malpractice liability insurance.

(00:38:28):
If you're independent, you're paying for that.

(00:38:29):
That's a big thing for them.

(00:38:30):
That's a big out-of-pocket cost.

(00:38:32):
We want to make sure that does not go up anymore.

(00:38:36):
One of the things that was a big head-scratcher to a lot of our members is,

(00:38:41):
Why is there so many different types of credential and applications for the plans?

(00:38:46):
Right.

(00:38:46):
So think about when you if you applied to UC, UC school, there's one application, right?

(00:38:52):
You can go to wherever it is, Berkeley, UCLA and so forth.

(00:38:54):
Why is there about 40, 50 different plans?

(00:38:56):
I mean, 40, 50 different applications.

(00:39:00):
Depending on what plan it is,

(00:39:01):
whether it's the Bucas or the small,

(00:39:03):
it's the same exact information,

(00:39:05):
yet they all have different things,

(00:39:07):
different order on what they want,

(00:39:09):
and they also have different timeframes.

(00:39:11):
We had some people respond in a survey.

(00:39:14):
They weren't getting approved by their application for credentialing for 9 to 12 months.

(00:39:20):
Why is that a big deal?

(00:39:21):
You cannot see anyone within that net.

(00:39:25):
They can't be in network or that patient unless that's the proof.

(00:39:28):
That's a big patient access issue.

(00:39:30):
So what we did this last year, Vincent, is we we sponsored a bill.

(00:39:34):
It's been attempted several times before, but.

(00:39:36):
We got a very smart group around us.

(00:39:38):
I have a very smart general counsel,

(00:39:39):
great lobbyists,

(00:39:40):
other great consultants,

(00:39:42):
and we didn't need to reinvent the wheel.

(00:39:44):
There's already an application that's out there.

(00:39:45):
That's almost being universally worked with throughout the country.

(00:39:51):
Let's use that.

(00:39:52):
It's an open network.

(00:39:53):
It's free to providers,

(00:39:55):
but let's mandate that all plans,

(00:39:57):
commercial health plans in California must use that.

(00:39:59):
And then also it must be approved immediately.

(00:40:02):
or denied within 90 days.

(00:40:04):
If they need more information, it will be provisionally approved for 180 days.

(00:40:09):
Why that's important?

(00:40:11):
Well, first, the physician's revenue.

(00:40:13):
But again, we're also of the voice on how we advocate.

(00:40:18):
Our patients want this.

(00:40:19):
The patients want to see that doctor.

(00:40:21):
Well, network is powerful.

(00:40:24):
Paramount, right?

(00:40:24):
I mean,

(00:40:24):
I'm sure that's a whole other mess that the poor docs have to deal with,

(00:40:29):
especially when – and you see it more with the systems than with the independents.

(00:40:33):
When Abuka comes along and does a negotiation for a year,

(00:40:36):
well,

(00:40:36):
we're at an impasse,

(00:40:38):
and now we're going to drop X system out of our network.

(00:40:41):
Letters go out.

(00:40:41):
People start freaking out.

(00:40:43):
And then, of course –

(00:40:44):
quietly things get resolved and by by january 1st everything's amazing again but

(00:40:49):
there have been times where it's not amazing where people have dug their positions

(00:40:53):
in the in the stand in the sand and no one they lose access to positions right

(00:40:57):
right so i mean that's you know that was our first step uh vincent i mean there's

(00:41:01):
more to it there's obviously much other priorities we're going to keep working on

(00:41:04):
but again that was our first full legislative session to sponsor bill and have it

(00:41:08):
signed by the that's amazing

(00:41:09):
I mean, again, and that's not just say, hey, hurrah, like, look at us, look at me.

(00:41:14):
But I want to tell you, I mean, that is how powerful our voice of our members are.

(00:41:17):
And there's so much more we can do because now you finally have a platform.

(00:41:20):
You never had a platform before.

(00:41:22):
Now we have it.

(00:41:23):
There's more we're going to be doing,

(00:41:24):
both in administrative burden space,

(00:41:28):
also with reimbursement,

(00:41:29):
and also for protection-wise,

(00:41:31):
right?

(00:41:31):
We want to make sure the costs,

(00:41:33):
whether it's liability insurance and other things,

(00:41:35):
stay down so you can stay in business.

(00:41:36):
So that's what we're working on.

(00:41:38):
And again,

(00:41:40):
um you got you you have a platform with us i mean i always encourage everyone

(00:41:43):
please reach out to us let us know we have our next newsletter coming out here soon

(00:41:47):
but social media um we're actually doing a podcast uh vincent we'd love to have you

(00:41:52):
on i love it back and forth yeah uh hasn't launched yet back and forth back and

(00:41:56):
forth i love it there's a whole another funny discussion on how we actually came

(00:41:59):
that name which i know with you with clearly you start googling things like oh

(00:42:02):
that's a great name it's taken

(00:42:04):
Oh, that's a great name.

(00:42:04):
It's taken.

(00:42:05):
I couldn't believe it was available.

(00:42:07):
When I named my company, I'm like, is this possible?

(00:42:10):
But clearly it came in the shower.

(00:42:12):
Clearly beneficial, literally came in the shower.

(00:42:15):
It was crazy.

(00:42:17):
Well, Matt, I mean, listen, I appreciate the work you're doing for independent physicians.

(00:42:22):
It's great to meet someone who's sharp,

(00:42:24):
who has a voice,

(00:42:25):
who is trying to give a voice to docs who want to stay independent and do that work

(00:42:29):
within the state of California and beyond.

(00:42:32):
And,

(00:42:32):
you know,

(00:42:33):
health care is a full contact sport these days,

(00:42:37):
and it's not going to get any easier unless you have sane people involved.

(00:42:41):
at the table talking about important things.

(00:42:43):
And so I'm really appreciative of you and the association and everything you're doing.

(00:42:47):
So thanks for being here.

(00:42:48):
Well, thank you, Vincent.

(00:42:49):
And before we leave, I know you're a wine guy.

(00:42:52):
Yeah, I am a wine guy.

(00:42:54):
I've heard about that.

(00:42:55):
Okay.

(00:42:56):
Vines with Vinny.

(00:42:57):
Yeah, I wanted to give you some.

(00:43:00):
Yeah, absolutely.

(00:43:02):
Well, you know, you're commenting on my swag.

(00:43:06):
We like to do a lot of swag branding and so forth.

(00:43:08):
Love it.

(00:43:08):
I have my official PAC swag.

(00:43:10):
Oh, yeah.

(00:43:11):
Look at that.

(00:43:12):
I love it.

(00:43:12):
I love it.

(00:43:13):
Thank you so much.

(00:43:14):
You're welcome.

(00:43:15):
Awesome.

(00:43:15):
Yeah.

(00:43:16):
Well, listen, thanks again.

(00:43:17):
And I'm sure there'll be more conversations.

(00:43:20):
Sounds good.

(00:43:20):
All right.

(00:43:21):
Okay, great.

(00:43:23):
This podcast reflects the personal views of the host and guests not their employers

(00:43:28):
or sponsors.

(00:43:30):
See you next time.