DGTL Voices | Gianluca Torregrossa | Surgery Without an Incision

And what about advice for persons on the technical side, how to be more collaborative?

We need to take this technique complexity and bring it down to something that is more feasible for a large majority of institutions and surgeons. To do that, you need more technology. This is a pivotal time. We need to create opportunities that are disruptive. Healthcare and healthcare leadership is in a need of disruptive. And this goes down to Welcome to Digital Voices, where healthcare and life science leaders explore the real work behind transformation.

This podcast is about people, leadership, and the conversations that move healthcare forward.

Now your host, Ed Marx.

Welcome to another edition of Digital Voices. I'm wearing my Team USA hat for soccer. The World Cup's going on right now. Tonight we play Belgium. Hopefully everything goes well. Just showing what colors. What about you, Dr. Gianluca Torrebrassa? Are you a soccer? Are you a football person?

I mean, of course. Unfortunately, coming from Italy, this World Cup, I'm hiding myself. My national team didn't even qualify. What a shame!

I know. I was shocked, actually. Yeah, because Italy traditionally, historically, has had a pretty good team. And I'm really sorry not to see them at the World Cup.

But don't you think a little bit that this is like a motif of this World Cup? You see all of these big-name teams struggling against never-known countries. That tells you, number one, the game and competitors, the competition has become higher. A lot of people around the world are playing soccer to a very high level. Like, you can be Brazil, but you get beaten up by Norway, and it's pretty unexpected, but it's the reality of the current world.

Yeah, I love that, right? It's a great— football is a great equalizer, and I love it. It is such an international sport. You know, I'm from Europe as well, and from Germany originally. And yeah, I mean, we grew up— that's life in many parts of the world. That's just part of your life. Your upbringing is football, for sure.

Completely agree. I think that has a lot to do with the current life. You cannot anymore guarantee just because you have a name or a brand that you're going to be safe.

That's right. Yeah. So that's good. That's a great message for all of us, right? Is that we've got to continue to stay on top of our game. We can't rest on our laurels, whether we belong to Emory, which is over here, or great other organizations like Cleveland Clinic or Mayo or what have you. So yeah, that's cool. So I'm super excited to have you on. We first met really just online. I watched you when you were at Mainline Health. And, you know, I have a great interest in obviously the clinical work and the technology and the things that you're innovating on. And we'll talk about that in a little bit. And so when I saw that you went to Cleveland Clinic, I was like, oh my gosh, I have to have you as a guest. But, Jean, the most important question we have for our entire time together, other than football, is what songs are on your playlist? Like, what kind of music do you listen to?

Ed, I love that you start your podcast with music. I love it because I think that already, and I'm listening to your podcast, I'm one of your listeners, not only now I have the great pleasure to be also hosted by you, but I'm one of your followers. And I love that you start with the music question. It has a lot of importance. And I can tell you, I have a playlist. And every time in my operating room for the last 10 years, we listen to the same music. And I adopted this system because, you know, nurses, they scrub out and scrub back in for lunch breaks. And for them, only by listening music, they can understand at which stage we are at the surgery. So when they are coming back, they know if there is certain music, it's not the time to talk with their colleagues about the summer camp of their kids.

Right.

It's the time to enter on your tiptoes and just hit the ground running because it's the central time of the surgery. So, my playlist starts with grunge 1990s, mostly Pearl Jam, Pearl Jam Radio. That's what we start with. And all of those songs around him. And then central time is Moby, DJ, 1990s, again, early 2000s.

Wow.

And then we finish with a combination that sometimes is back again to grunge 1990s. Sometimes we finish with Pink Floyd. And, you know, and the final song when I scrub out is Gangsta Paradise by Coolio. I just scrub, take out my gloves, I go to the radio, and while I'm writing my notes about the surgery, I put Gangsta Paradise. That's how, that's how the choreography finish.

I love it. Oh, that's awesome. I hope I never have to have surgery, cardiovascular surgery. But if I did, I would love to have you as my surgeon and knowing that you're not only professionally top in the world, but also that you're enjoying yourself as well. And you have this methodology. What about life message and mantra? Like, are there words that sort of guide how you live?

The word I will say, it's probably juju. Like, You know, I tell my patients, I tell my daughter, my wife, I mean, you need to have the right attitude. You need to have the right juju. You need to bring the best of you every time in your— when you enter in a room, when you enter in a meeting, when you speak about something in front of people, you need to have the right attitude. You need to own that place. You have to be in that moment. Particularly right now, always distracted with a phone. We are always somewhere else. Yeah. You need to come with a positive attitude, with a lot of good energy, and you have to bring this good energy into whatever you're doing. That can be your daily job, 9 to 5, your big important speech on a national and international conference, the surgery if you are a surgeon, or like for my daughter, just classwork, you know, and test on 5th grade. And I think that that's an important message. I tell all of my patients, When you go to sleep, you need to bring your good juju. You know, I'm a big believer and I'm a man of science. I publish a lot of articles. I perform science. Okay. But I believe in the energy you bring in the room. And I can ensure you that patients that goes to sleep thinking, oh my God, something bad happened. Oh my God, something, something somehow goes exactly not as you planned. It's nobody should be excited to have a surgery. But when you go to sleep for a surgery, you need to come. The patient is a very important part of the team too. Needs to go to sleep thinking positive, bringing the good energy into the game.

I love that. That's great. So tell us a little bit. We know a little bit already because we just jumped right in. Like, who are you? What's your story? Obviously, you're from Italy originally. Tell us about where you grew up.

Came from Italy and clearly also I didn't make it as a professional footballer, a soccer player. I mean, you can already like my career was very clearly defined by my I'm too tall and not exactly strong enough to play soccer. So I love it, but it was definitely not my profession. I grew up in a small town in the northeast part of Italy, close to Verona, beautiful city, and had a very, very normal life, I would say. Like, you know, my father is an officer of the Italian Air Force, is a pilot. My mom worked in a bank. I have a brother, like very good, healthy, normal life, educated by nuns. And you can only imagine what that means. And then when I was more or less in, I think one of the pivotal time and pivotal moment for me was really when I was 16, 15 actually, I decided to go to a military boarding school. And it was for me almost a need or a wish to try to self-determine myself in my own way. And it was a life-changing experience. It was a boarding school. I was there with 60 classmates. And I was still completing my high school, but I was doing a lot of sport, a lot of physical activities, a lot of military discipline. And that really boosted my self-confidence and the ability of achieving the impossible. And that was probably one of the pivotal time and moment of my life that made me realize you can really— you are the inner energy of every choices of your own life every single time. And you can change in every moment the course and the direction of your life.

Yeah, I love that. That's super fascinating. And was that throughout high school? So after you graduated from this academy, did you go then to college?

Correct. Basically after that, you have a choice. You can keep continuing your military career as a lot of my classmates did. And now they are, generals and admirals and colonels of various, various disciplines. I, together with a lot of other part, almost 50% of that class, decided to take a civilian route. So now we have already gave back the obligation of my own country for military service. So I already gave it, so I didn't have to lose any extra year after that. And I decided to just go to medical school. And was never what I wanted to do, was never my dream since I was young. My dream was to be a jet fighter pilot. That was my dream, like seeing my father go and being a pilot of a Tornado, F-104 Starfighter. I grew up around a military airbase, and that was everything I smelled. And then I read a book named The Green Parrots. And if you never read it, Ed, you should like, you should buy on Amazon. It's probably $10. Yeah. Green, the Green Parrots. The Green Parrots was written by a surgeon named, um, Gino Strada. He was the founder of an organization named Emergency. This organization operates, is an NGO that operates very similar to Doctors Without Borders. Uh, so going in, in, in remote areas, helping people for after, uh, after military events, uh, war, war zone and really providing help. And he was describing basically his years in Afghanistan after the Russians left Afghanistan and left behind these green parrots that were landmines that the Russians left behind and resembled toys in order that the landmines could capture the attention of young kids and they could activate and explode and basically destroy limbs, arms of the next generation of the Afghans. The Russians said, we cannot win in Afghanistan, but we are going to destroy your next generation. And the efforts of this surgeon was— and his first mission was literally to establish a center to operate on these kids that came in with this partial loss of limbs. And it's, it's a book really that it's 100 pages you read in an hour, but really changed my life. And that night I decided I want to be a surgeon.

Wow. That's powerful. Yeah, I'm definitely buying that book, and we'll put a link in the show notes also to Amazon to that book. Wow. And then ultimately, you actually did some service work, humanitarian work for emergency. Tell us about that.

You know, so first of all, I think that I'm the only son that, like, my father was, like, later on became very important in what he was doing. And, like, he wanted me to be, to take almost his footsteps, to go back to, you know, military academy, to be a diplomat, to go. So when I told him I'm going to medical school, he was just not happy. I think I'm—

Of course.

I am the only father, when your son tell you, I want to be a doctor, he didn't smile. You know, so I was, but because, you know, no one of our family is a doctor and he just wanted, he told me, I cannot help you. Like, I wanted for you a different type of profession, but actually it was a fantastic choice. And You know, this— I spent my years of medical education in Italy and my residency in Italy as well. And then I met this very influential for me mentor named Gino Strada. And Gino— sorry, Gino Gerosa. And Gino Gerosa is another Gino. Gino Gerosa is the current actually professor of cardiac thoracic surgery at the University of Padua. And when I was in my last year of residency, he told me, you are chief resident. You can go anywhere you want. You can go to United States to do some research. Tell me what you want to be, where you want to go. I will be happy to sponsor you. And I told him, I want to go to Sudan in Africa. And he almost tripped off of his chair and he told me, you are crazy. And I told him about this book and I told him that Emergency, the same organization, just opened a few years before. It was 2012 back then. open a cardiothoracic surgical center in Sudan. The game of Gino Strada was showing that healthcare, even in third world country, was in need of highly specialized center and was capable of performing high quality surgery, not only the emergency war zone surgery, but you need to create this healthcare system capable of offering very advanced cardiothoracic surgery in the middle of Africa. So they were looking for a young person that could be the point of contact among all of the senior surgeons that were coming and rotating. Imagine you are a senior surgeon coming from United States. You decided to dedicate 2 weeks for the organization, for this NGO, and you fly to Sudan to operate for 2 weeks. My game was to picking you up, bringing you to the hospital, put you to sleep. We had 3 cases aligned for you and we were using every minute you were in Khartoum. So the next day I was waking you up, bringing you to the conference, showing you the 3 cases we aligned. And you are the senior surgeon. You tell me, yes, this case, no, this case, yes, this case. And I was bringing you to the operating room and let you start to operate. And I was assisting you. So every 2, 3, 4 weeks we had new surgeons rotating because, you know, a senior surgeon doesn't want to stay for more than 2 weeks in a place like Khartoum. And so I stayed for 1 year taking basically care and learning from all of these experienced surgeons. They were mostly retired surgeons coming from all over Europe, but all over the world and teaching me how to, to, to operate. And most importantly, taking care of patients that were coming from all over Africa, but also from Afghanistan with the Red Cross flight coming over and being treated in Khartoum. So it was a phenomenal experience.

Yeah. So you got to learn from, like, the, as you said, the most senior surgeons in the world that were coming, dedicating their time to help these soldiers. So you were, like, as this young surgeon learning all these new things that you wouldn't have had time to learn in medical school. This is great.

This was incredible. It was basically an incredible super fellowship. We were doing free cardiothoracic surgery every single day. And imagine like, you know, you pick up so many little tricks that has been developed throughout a career. And for 2 weeks you operate 2, 3 cases with a surgeon from Finland. Then there is a surgeon from Italy and the guy from Finland teach you how to secure the cannula, the aortic cannula that we use to go on bypass in a certain way. The guy from Italy tells you how to load your needle for that specific surgery. It's just like an incredible opportunity. And I have a story about it that is incredible. So one day, and Gino Strada and I met Gino Strada, he was there for 2 weeks. He came because he was rotating among all of the hospitals that this emergency has. So one day I do a case and, you know, there was this surgeon, I think was from Finland, that let me do an aortic valve replacement surgery for, for an aortic valve. The patient was a young guy, 23 years old. So the surgeon was helping me. I was the first surgeon and I was doing the surgery and the senior surgeon was in the first assistant position. We do the case. The case goes very well. 2:00 in the morning, they call me and they tell me the patient is bleeding out of the chest tube that we leave inside the chest. There is a lot of output. There is a lot of bleeding. Sometimes, unfortunately, after heart surgery, it can happen. The patients got extubated, the blood pressure went high, and probably something opened up. So I went there. It's 2:00 in the morning. I was sleeping inside the same hospital and I see these patients effectively bleeding quite a bit. And He was stable, but I bring immediately to the operating room by myself, opening the chest and find that one of the arteries in the chest wall was actually pumping, was bleeding. Fix it, bring it back, and he's doing okay. He's now 8 o'clock in the morning. Fast forward is the next morning, 8 o'clock, he's doing okay. You know, he's also 23 strong man. So from, from, from, from, from Sudan. So Gino Strada called me in his office the same morning. And told me what happened last night. And I said, Gino, you know, like, unfortunately, it's our surgery. Sometimes this stuff happens. And, you know, the guy is like taller than me. He's a big guy. It's like intimidating almost. So he told me, come with me. So I follow him to the blood bank. He called a Sudanese nurse and he said, you know, Gianluca, we used 3 units of blood for your patients yesterday. This is not Europe. We don't have a lot of resources. Now you donate 3 units of blood to this blood bank. because you're patient. And I said, are you, are you kidding me? Like I have to operate this morning. I cannot donate 3 units of blood. So I'm going to die. And he didn't want to hear anything. So he called the nurse and the nurse started extracting my blood out of my— after 1 unit of blood that the nurse was kind enough to say, just, we stop it here. She probably saw that I was, I was pale. I was about to pass out, you know?

Oh, wow. Yeah. Talk about, yeah, giving. That's true giving right there. Anything else other than surgical? I mean, it must have had an impact on you, like, as a person as well, like, working in that kind of environment because you grew up, you know, went to military academy. You, it sounds like, you know, pretty nice situation, right? And, and then now you're in Sudan for a year.

You know, I remember, I'll just tell you one social human story. I remember this, this guy. This young patient, he was 6 years old, and he was brought to the hospital on a stretcher from a village that was basically 1 day and a half away, walking by his 2 older brothers. One is 16, the other one is 12, and they're bringing their 6-year-old brother on a stretcher for 1.5 days, counting how tall they were, 1.5 days of walking.

Wow.

They come to the hospital, they bring the brother who has a congenital heart disease to the hospital, and they camp outside for all of the time until when his brother gets better and to bring him back. You are in front of these kids that are 15 and 12 years old, that they come to take information about how his brother is doing. Try to communicate with these that are not kids, are more adult, are more man than what you are. I was 27 years old and these kids were definitely more of a man than what I was back then. And you immediately change perspective of what life is, how fortunate you are, what really you have been exposed. I cannot imagine to leave my daughter to take the bus stop by herself. I'm just at the door checking that she gets at the end of the driveway. Imagine what it is sending her for 1.5 days of walking to bring on her back her little sister to the hospital. So, these are the things that change vision completely of what life is.

Wow. That's pretty incredible. I know that your mission is to combine proven surgical principles with emerging tech to improve outcomes and accelerate recovery, expand access to advanced cardiac surgical care. Can you tell us about about how you do that? Like, what does that all mean?

You know, I it's a you never like you know I never really like woke up one day thinking about this as a motto of my life. You know, you somehow life brings you through alleys and just. showing you certain type and certain opportunity. When I came to United States at Mount Sinai Hospital for a fellowship, and my original interest was actually valve disease. I spent this year in Africa. My intention was to advance my game in valve reconstruction for these patients and potentially go back to Africa or go back to my own country. And after 3 years, I had the opportunity to stay at Mount Sinai. And at that time, I was assigned to Dr. John Paskas, that is— at Emory right now, exactly behind this beautiful skyline that you have. And it really start— I had the opportunity to start to practice a lot of coronary artery bypass grafting. And, you know, I found that this one is a unique niche and opportunity. And when I was there with him, I start to see this robotic coronary bypass grafting, something that was attempted in the late '90s, early 2000s. But then got dismissed by most of the surgeons, was meant to be defined as too complicated, too bothersome, is not going to work, too highly cost. And then more I was looking at it, more I was studying, and it was very difficult to go and find someone capable of performing it. But more I was trying to— I was, I was just saying, this is, this makes so much sense why we need to open the chest of patients, why we cannot collaborate with our interventional cardiologists in this eternal debate, stenting versus bypass grafting, why we cannot provide 1 or 2 bypass completely robotically in a closed chest, deploy to the best target and complete the revascularization with stent. So that's when my interest towards robotic, minimally invasive and new technology start to, to begin. And that was an incredible journey that really was, was born almost casually by just looking at what Dr. Pascas was doing at Sinai and bringing that baton and bringing to the next level and bringing even more technology now to being able to perform bypasses completely without any thoracotomy, without any incision to the chest of the patient. So we were able now to, to perform more than 100 of these bypasses and with patients going home in 1 or 2 days after surgery. Going back to work in a week. I had someone going golfing for 36 holes 2 weeks after, and he sent me a picture after it. And this is a change completely mentality, even for a healthcare organization. Like you don't have anymore the patients that stays within your system for 5, 6, 7 days and then goes home and he come back with atrial fibrillation and it's, it's just under your care for 90 days. These are patients that go back to the society working in their offices, being fathers, husbands, being providers for everything that they need. And that is the complete change of mentality that we were able to do it. And thanks to the new technology and to the embracing of new technologies.

Yeah, that's so fascinating because you're right. I think we all have this, you know, those of us who are not in clinical practice, When you think about heart surgery, it's probably like from 30 years ago, right? When it's very invasive and the recovery times are so long. And now you're doing so many of these techniques now robotically and without cracking open the chest. It's just amazing for the clinical clinician experience, patient experience for sure, family experience, and overall time to get well and back to normal. So it's just amazing.

Yeah, and you start to really to change the shift also of which patients should have this type of surgery.

Yeah.

Because, you know, before we were trying always to minimize the amount of, like, you reserve this type of surgery only for the most advanced disease patients that comes with a lot of problems before you expose them to an open heart, open chest surgery. But now you can literally laser focus solve the problem with minimal touching of the environment around, minimally disturbing. Now you enter on the tiptoes, you deploy those 2 arteries and you come out.

That's it.

And, you know, the most impressive situation, the most impressive patients that I did was actually a pregnant woman. And that story was pretty, pretty, pretty impressive. A poor lady that really struggled in having a baby, had a lot of rounds of IVF. Probably that contributed to develop a rupture of a plaque in one of her coronary arteries in a very young age. She was only like 40 years old, 41, I don't remember exactly. And she was pregnant. And she said, you know, I struggled so much to have this kid. There's nothing like— you cannot do anything that can potentially harm my baby. So we couldn't give stents because there's X-ray, there is antiplatelet agents that can interfere with the growth of the baby. And so we decided to do a robotic bypass on her. And I can tell you, it was an impressive moment proving that effectively you can be helping patients that never would have been ever considered for an open-heart surgery before.

Yeah. Now the patient is healthy and the baby is alive and well.

Exactly. I have a beautiful picture with the mom, the baby, and me beside it. I mean, it's a— It's an incredible picture.

That's so rewarding. So, wow, we're running out of time already. So you're at Cleveland. We have to talk about AI because this is Digital Voices. It's tech. How does AI— so whether it's further tech in your techniques or things that you're planning on doing, what's sort of the future, whether it's AI or not? But what do you think?

Look, I think that one of the challenges that we are seeing is that it's difficult to change culture among surgeons, to adopt these new technologies. Younger surgeons are better than the older ones, that's for sure. And I say with a lot of respect, don't get me wrong, but it is difficult to change the concept even among physicians that heart surgery can be something different than just cracking your chest open and opening your chest. AI has that power tool. You know, right now what I do is still very technical. It requires a lot of techniques. We need to take this technique complexity and bring it down to something that is more feasible for a large majority of institutions and surgeons. And to do that, you need more technology. Technology can simplify technique. So you take something that is incredible craftsman and is incredibly difficult, and you start to make a production. You have this beautiful handmade car, And you start instead to say, I want sustained mobility. Let's have technology to develop a line that can self-produce cars. So I think AI has the opportunity to help us make safer surgery with more technology simplifying technique. And that's where I see the value of artificial intelligence. If I can teach a car how to drive in the traffic of San Francisco, I can teach a robot how to help a surgeon, if not performing independently, but at least how to help a surgeon how to take down a mammary artery or repair a valve. In the similar way in which the pilot that flew you to Atlanta was landing in Atlanta seeing everything displayed on his screen, I can produce the same type of visible benefit for the surgeon, telling him where all of the collaterals are, where all of the pitfalls are, where all of the artery— reconstructing the anatomy based on the CT scan of the patients on that exact view that he's looking. So letting him know exactly what he should or not doing or helping him making choices, the million of choices that we do throughout our surgery. That's where I think is AI as an incredible power tool. More than just replacing surgeon, you know, that's always very, very shocking news. But I think that the value, because surgery is not only a technicality, like who, as a surgeon, I don't do just technical work. I'm also making millions of choices, human choices, clinical decision that is way more than just a mechanistic action. So I think that is where AI has an opportunity.

Yeah, that's great. And what about advice for persons on the technical side? Like, as you know, I'm former chief information officer at several organizations and I work closely with clinicians. What's your advice as a clinician having worked with people like that? Because that's about half our audience, like how to be more collaborative? Like what would you say?

Yeah, we need to find a way. We are doing such a bad job. Like we run meetings in medicine and I'm one of the secretaries of one of these meetings and there's only doctors there. I mean, I'm talking to cardiac surgeon. Come on, guys, like we can do better. Why we don't start to create platform that are integration of us? We need meetings where half of the people are engineer and you give me a talk about where is the— where are we going with the technology? And I want to give you a talk of where are we going with medicine? And we need this type of forum. We have been working in a silo. There are all of these— you know, meetings for healthcare administrators, but there was no doctors in there. And you say like, like, just like, what are you doing? This is like a club of generals, but there is no soldier that tell you that that weapon cannot be used in that environment. And I've seen this one every day. Let me tell you, all of these administrators are going crazy, but without a cognitive reality of what's happening in the hallway of their hospital. And we need to create more integration and collaboration among us. We have been working in a silo. We need to create— let's create together, Ed, the first hybrid technological and clinical meetings. We need more of that.

Yeah, I'm with you 100%. You and I are so aligned in so many ways. I'm just kind of smiling, but at the same time, like acknowledging we haven't moved the ball. We've been talking about that, doing things like that for many, many years. We just haven't moved forward. So I'm glad there's clinicians and leaders like yourself that have that mindset and that are moving those things forward. We covered so much and there was still more. We'll have to have you back. We'll definitely meet up someplace and do something again. But we talked about your early beginnings. But first, most importantly, songs on your playlist and how in your surgical suite you sort of have this orchestration of different music depending on what's going on. We talked a lot about juju and the importance of that, not just for the patient in the operating room, But also the way that you look at life. We talked about Italy and growing up in Italy and some of the things that sort of fundamentally changed your trajectory and how you came to really become passionate about cardiac surgery. You talked about a book, The Green Parrot. We'll definitely put that down. But you learned a lot through this experience working for Emergency, the humanitarian organization, and getting exposure to all these great thinkers. What a great opportunity that was for you. And then we talked a lot about your mission and bringing together the tech and the clinical and the surgical techniques and helping with the culture. You mentioned culture. That's always been an issue for every profession, like trying to move us forward. So we talk a lot about how we might do that with technical leaders as well and have more collaboration. Talk about AI. We talk about so much stuff in 30 minutes. Jean-Luc, what did we miss or anything you want to double down on?

I mean, I already feel, Ed, that you and I, we need another 2 hours like this. I mean, I'm almost sorry to leave right now. I mean, we just started.

This is just appetizer.

I'm ready to have a full meal. But no, I think that it was a pleasure to be here. I think that, you know, the last final motto is really about energy and about how to start to really think and see, think differently. I think healthcare is in a pivotal time, is in a pivotal moment, and we need to— it's not sustainable anymore. And I speak both as an Italian who has a nationalized healthcare system and as a physician who works in the United States with a completely different healthcare model. Neither of those 2 models are any more sustainable right now. Let's face it, we need to find alternatives healthcare because healthcare is so important. This goes down to the right of being human, being human to other humans. And we need to find alternatives. This is a pivotal time. We need to create opportunities that are disruptive. Healthcare and healthcare leadership is in a need of disruptive. And unfortunately, I don't witness yet the change that are in needs. I see these organizations still running with energy, individuals, human power, that resemble something that is not contemporary anymore. And that's why also for me, it's very inspiring just to be in an organization like this one, like Cleveland Clinic.

Yeah.

And I joined and I can tell you the difference that I can perceive, just, it's incredible just in a few weeks of being here, respect of previous experience. It's, you see that there is different leaders. Leadership is everything in life. So, So I'm begging out there a lot of bright individuals and guys, yes, become surgeon. Yes, get involved in this business, but also become wise, intelligent healthcare leaders.

Yes.

We are missing that. We are absolutely missing intelligent, illuminated healthcare leaders. It's unfortunately leadership in healthcare has been a second career from financial people that couldn't make it in finance. Or people that couldn't make it in medicine and they decided to just change their internist job with something different. We need better leaders in healthcare.

Well said. And we'll leave it with that. Thank you so much for being my guest.

You're welcome. Was a real pleasure. Thank you for having me.

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