134. Holding Pressure on the Wound: Dr. Stefanie Simmons on a New Way to Treat Physician Burnout

In healthcare, we have so much compassion for other people. We want to make their lives better. We want to empower them to heal themselves. But compassion without self, compassion is incomplete. So if you're listening to this and you're a healthcare worker, please take care of yourself and remember that you being here matters.

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In this episode, we are so excited to have Dr. Stephanie Simmons. She is an emergency physician and chief medical Officer of the Dr. Lorna Breen Heroes Foundation. She's a national leader in clinical well being, working to remove barriers to mental health care and change the culture of medicine so every healthcare worker can thrive. And Dr. Steff, I am so excited to have you here with Dr. Joanne and I. We met last week or a week before and we've interviewed Corey Feist, one of the co Founders of the Dr. Lorna Breen Heroes Foundation. And more of the world needs to hear about what you are doing. Welcome to our show.

Thank you, Dr. Aaron. Thank you, Dr. Joanne.

I'm happy to be here and I wanna just get right to the questions and would love to hear what led you from your own experiences as a physician to becoming a national advocate for clinical well being.

Okay, there's a little risk here that this is going to be a long, shaggy dog story, so I'll try to keep it at the CliffsNotes version. Even going into medical school, I had a very deep interest in the psychosocial aspects of medicine. It was a history major as an undergrad, very interested in the forces that shape people's actions and had the honor to do some research during residency on clinician and patient experience, how the interplay between communication of patients and physicians impacts both. And I actually, during residency had two children. So I had my first daughter during my internship year, my second daughter during my fourth year of residency and had some peripartum depression with my second pregnancy. And so that at the end of residency I was really struggling and felt like I could benefit from seeking some mental health care. But I chose not to at that point in my life because I knew that I was going to be applying for my first license, I was going to be applying for my first job, and I was worried that I would have to answer questions that were invasive to my privacy that would impact my ability to be in the job and in the state that I wanted. I had a much harder first few years of my career outside of residency than I needed to because of that decision on my part. And as I gradually emerged from that time with the hard won lessons that I had, I became involved in really throwing myself into different aspects of the leadership roles that were available to me in my hospital and my medical group and got involved with the culture of safety and the quality and safety world. I was asked to be the quality officer for our medical group. And at that point I was talking to our CMO and I said, you know, I think you can find a different person to be the quality officer for the group, but you don't have anyone looking after the patient clinician experience, and that's what I really want to do. And they said, well, we don't have that job, but why don't you write a job description and we'll see what we can do. And so I wrote the job description for my first job in patient and clinician experience, just a couple years out of residency. And that was over 15 years ago. So ever since then I've been doing this work. It was born out of both my interests, before even medical school, but then also my personal experiences and, and those that I witnessed of my, my colleagues and my coworkers.

Wow. I, I love the. And, and as a psychiatrist. Right. Like you're, you're speaking to me also of hearing other physicians wanting to understand the psychosocial aspect, the communication, the psychological part, and then of course, part of why Erin and I are in this podcast and have amazing guests like you of how is it on the side of the physician as well? It's great that we do quality measures on the patient experience, but we're not looking at the other side of the coin and such important work. So love to hear that you've been doing that for so long. And we had the opportunity to talk with Corey, I cannot pronounce his last name, Feist. And we talked about the Lorna Breen Heroes foundation and wow. How important that is. And. Right. Like my. I feel it in my heart and I would love to hear your perspective of what's the main mission of the foundation today. Mm.

Well, let, let me tell you a little bit about what that early role morphed into for me and then how the foundation started and how we got connected. So I'll sort of develop those two pieces and then connect them in the middle. So after I started doing this, this role in patient and clinician experience, we built out peer coaching and so really helping clinicians who may be struggling with patient Communication or team leadership or individual well being, professional well being, and started building out the coaching program and litigation, peer support and access to mental health resources. The group that I belong to went through a mergers and acquisitions process. And in the early 2020, my role was as the vice president for patient and clinician experience for this large national group serving 26,000 physicians across 34 states and a thousand hospitals. So that early role grew and became an executive strategic and implementation role. We all know what happened in 2020. The pandemic came. Lorna. Dr. Lorna Breen was an emergency medicine physician who was director of emergency medicine at New York Presbyterian Hospital in Manhattan. She was on vacation with her family. Jennifer and Corey Feist, their children came back to New York to care for patients, but also to care for her community and her colleagues. Became physically, emotionally and mentally overwhelmed by the degree of trauma, her own COVID infection and received mental health care back in her home state of Virginia and ultimately died by suicide. What happened next? About 12 hours after her death, the New York Times published a story about her life and her death. And first dozens and then hundreds and ultimately thousands of healthcare workers reached out to her family to share that Lorna was not alone in her concerns about her license and her credentialing. Lorna was not alone in her mental health challenges around Covid. And that burnout and mental health challenges for healthcare workers did not start in March of 2020 with the pandemic, but had existed for years beforehand. In fact, in 2019, the National Academies of Medicine issued a consensus report and said, you know, burnout in healthcare workers is an epidemic. This was in October 2019, just a few months away from our own global pandemic. So in response to those thousands of healthcare workers, Jennifer and Corey feist started the Dr. Lorna Breen Heroes foundation in order to positively impact the well being of healthcare workers. To envision a world where seeking mental health care is viewed as a sign of strength for healthcare workers and to help change the culture of healthcare and the environment of healthcare to promote the wellbeing of healthcare workers. Now, meanwhile, back at the ranch, right, like I am running the wellbeing work for this organization. And at that point I had a 20 physician coaching team and one of the coaches I worked with was getting his MBA at UVA Darden and that's where Corey was serving as a professor, talking about a wellbeing case at the School of Business. And my coach called me up and said, hey, Steph, you gotta meet this guy because he talks about this issue. The way you talk about this issue, and I think it'd be a great connection. So I cold, cold DM'd him on LinkedIn, the founder, and we connected, had a great phone call, worked together over a couple of projects. I joined the board and ultimately became the chief medical officer three years ago.

I so appreciate this journey that you've shared, and you are so right for the role that you're in now with the Dr. Lauren Evereen Heroes Foundation. And the path that you've been on just leads you to so much personal experience and also the wealth of experience as you were leading a team. And it sounds like creating the team for wellness, leading a team of coaches. And I would assume if mo, like most medical organizations where it didn't exist before, and so you're one of those people who sees there's an absence of something and you want to create something to make it even better. So profound. And I remember leading my first women's retreat back in 2020, literally two weeks before the world shut down. And how many of those women said, I'm not going to go see a mental health therapist. I'm struggling, but there's no way because of my worries of my license. And there were PAs and nurse practitioners and physicians all at this retreat. And the good news is, is now that some of those same individuals have shared, they have sought mental health services, which I'm grateful for. And yet it's still far too uncommon. And we know the ultimate sacrifice when that doesn't happen in a timely manner is physician suicide, which is way too much collateral damage for doing this work in medicine. And one of the reasons, as Joanne said, why we're doing this podcast, why we want to talk about this, why we interviewed Corey for episode 1 33, just this last episode. And if you haven't listened to it, please go back and listen to it for his perspective. Because it is so important. What we don't talk about, we can't change. And when we have to have a national day to recognize physician suicide, September 17th, that's too much. Too much. And since the Dr. Lorna Breen foundation, or Dr. Lorna Breen act was passed, what changes are healthcare workers actually feeling at the ground level?

Yeah, that's a. That's a great question. So the work that we've been doing, along with our partners in the All In Coalition, and that includes the AMA, the ANA, the AHA, and, you know, 37 other organizations, is really to remove some of those perceived barriers to mental health care for healthcare workers. So earlier this week, we co authored a report with the Heart of Safety Coalition on what barriers clinicians perceive to mental health care. And some of these won't surprise anyone who listens. It's hard to get in to see a healthcare provider for mental health. There's not enough people. The hours aren't always conducive for healthcare workers who are working odd hours at different times of day. And it can be hard to find someone for healthcare workers who has the cultural awareness of what it's like to be in a healthcare environment as well. However, close behind those sort of structural barriers of cost and access is a real concern about healthcare privacy for the healthcare workforce. Like, who's going to know about my care? Am I going to lose my job because I can't get credentialed or re credentialed? Am I going to lose my license? Because in many places around the country, licensing applications or credentialing applications have asked questions around past mental health diagnosis and treatment questions that, you know, I believe were originally intended to address public safety and make sure that, you know, physicians and other clinicians were fit to practice. But they're, they're treated. Mental health is treated differently than physical health. And so we're saying only ask about current impairing conditions for any reason. Don't ask about a history of diagnosis and treatment because that erodes the comfort that healthcare workers have in seeking care and actually preventing impairment and as you mentioned, preventing death. So some of the changes that healthcare workers have seen over the past three years, we've gone from 17 states to that were consistent with those best practice standards for medical licensing to now over 40. So just think about that. That's a change in three years, more than doubling the numbers of states that are consistent with best practice. And we're also working in nursing, pharmacy and dentistry license on a state by state basis to make sure that those questions are removed. We've also worked with hospitals and health systems. In fact, over a tenth of hospitals in the country have submitted their credentialing re credentialing and peer reference forms to us to be verified that they are free of these questions. And we've been able to verify that, as I said, over 10% of the hospitals that just started two years ago. So we're picking up steam on both the pace and the pace of change of these applications and the number of organizations that are engaging with us.

And I sit on an executive committee for the Oregon Wellness Program, which is a unique program. I don't know if any other states have it. And it was born out of three physicians suicides in Eugene, Oregon. I've spoken of this before and now it's a statewide organization that helps support, as you said, it's actually vetted therapists who are used to dealing with physicians and healthcare providers. And it started with physicians and then added nurse practitioners and PAs and, and nurses. And it's so important and so many people have accessed service. It's not nearly widespread enough. And yet the lack of funding for this very critical service. Think about when we lose a provider to suicide or they leave the field of medicine altogether, the negative impact that has. And yet it's not getting the funding it needs through the legislature and through all the organizations. And I'm a bit dumbfounded when we don't see how important these organizations are and even being able to get the word out that they're there and what are other states doing. But I believe we might have been one of the first states to remove the licensing questions, Specifically through some of the advocacy through this organization, which I'm proud to be a part of, being an Oregonian and on that executive committee.

That is great work. I know I've talked about this as a psychiatrist and I said with the number of physicians that struggle with depression, anxiety, any kind of mental health concern, and the small number of doctors that we see as patients or I'll get a phone call, you know, it's kind of under the table and, and when I do see them, those are the things that I, that I approach right away. Like there's ways then we can assess safety so that we can word it in a way than you know before where you don't have to put in your license. I shouldn't be saying this out loud, but this is a hundred percent confidential. My notes are very bare. They have like the bare minimum. And if you want to see someone outside the system, since I used to work at a big system, I have some numbers of private doctors that you could do and go be self pay and, and I've been a fierce advocate all these years of saying like it's okay to not be okay and if you're struggling, there's help and if again if you just need to call. I'm really good with boundaries. But for healthcare workers, I'm like, you have my email, just email me. It doesn't need to be me. I'll help you get set up with someone. And again, I keep on saying the same thing, Glad and hopeful that things are changing and that we're seeing that light at the end of the tunnel. And not suffering in silence like we've been doing for so long for sure.

So, so you mentioned the Lauren, the Laura Breena act, that was federal legislation that passed in 22 and that funded 45 grants around the country for hospitals and health systems to expand and and implement programs around professional well being. And then actually also funded the CDC and NIOSH for the creation of the Impact Wellbeing Guide, which is a guide for hospital and health system leaders. If you wake up on a given Tuesday morning and you want to do something about healthcare worker burnout, it can feel like a really big task for one person. Like an elephant, right? And so if you have an elephant in front of you to eat, you need to know where are the first bites. And so the Impact Wellbeing Guide says, here's your first six bites, here are the people to bring along with you to do this and we'll give you a good start in an organization for that work. And so the foundation was able to partner with the CDC and NIOSH to author the Impact Wellbeing Guide. We, you know, we tapped into the wisdom of our all in coalition members to really inform that work. And then we, you know, we've been working actually to implement that Impact Wellbeing Guide on a state level via statewide coalitions through our all in Caring for Caregivers program. So currently we've done that in Virginia over three years. We're in year two in North Carolina and New Jersey and we just kicked off in Wisconsin. And so we bring group of hospitals and health systems in the state through a journey of licensing and credentialing reform, leadership education and then learning collaboratives to actually implement some best practices in their hospitals and health systems. Whether that's optimizing the EHR for humans, right? To make people have less at home charting responsibilities that they're able to get their charting done while they're on their shift or have fewer inbox messages, whether that's developing a bi directional communication system for your hospital and health system so you can capture the voice of the frontline health workers and use that to plan what your quality improvement projects are going to be or whether that's building out peer support and coaching programs and making sure that everyone has the opportunity to talk to someone else when they're feeling isolated, alone or overburdened by their work.

And talking about that, I would love to hear your opinion and what you've learned of how do you believe hospitals can move beyond kind of in doing like my air quotes of self care solutions to truly fix More the systemic causes of burnout and kind of more upstream, like we were talking before.

So I'm an ER doc, and so the analogy I use is like a bleeding patient in front of you. That's our healthcare workforce right now, guys. We're like, we're not always in the best shape, right? We are facing 50% plus burnout rates now. Some specialties in mine of emergency medicine, over 60% in the last several years. So we have this bleeding patient in front of us. And you know, the first thing you need to do when somebody's bleeding in front of you is you hold pressure on the wound. And that's individual support, right? That is someone is injured and we're trying to prevent them from bleeding out. We're trying to make sure that they have some initial support. But if you don't go to the source of the bleeding or even better prevent somebody from getting injured in the first place, you're really just holding pressure on a wound. And so those operational changes, whether it's removing institutional stigma, making sure that the operational environment is more efficient, that people have the opportunity to share their voice in the work of quality improvement in their organization, that they have flexible scheduling opportunities so that they can integrate and appreciate their work, their work doesn't interfere with their life, their life doesn't interfere with their work, you know, but that they are synergistic with each other. All of these things are operational, systemic solutions to not just hold pressure on a wound, but to get to the source of the bleeding.

I love that analogy. With your permission here on the recording. Can I borrow that? This is so, like, totally see it. And for us doctors, that's like, perfect analogy. Wow.

So steal it shamelessly. Don't borrow it. And I only ask for attribution the first time. After that, it's yours.

I'm gonna say it always with your name. Thank you for that. That, that's, wow, really good.

The other one. And, and I'll. I'll tell you this because I stole this one from Heather Farley, who's going to be leading the AMA's professional wellbeing work. But I think she was the CWO Christiana Care when she said this. And I heard it the first time. We've spent too long trying to build stronger canaries when what we should have been doing is fix the coal mine. And I think we can all, we can all really resonate with that because we're some pretty dang strong canaries. I'll just like lay that out there. You don't get through medical training. You don't get into medical training if you're not strong, resilient, driven. Those, those traits get us to where we are. And while we do sometimes need that reframing to escape from the traits that we can be trained into that become toxic, like perfectionism and being sort of that lone ranger that's doing everything on your own, really, we're pretty tough and we're pretty resilient. And so rather than focus on trying to make resilient people more resilient, we need to say maybe we should design an environment where they don't need to be quite so resilient. Right. And then think about our training so that rather than really reinforcing some of those traits that can be less adaptive, we're actually giving people the tools and the traits that they need to be more adaptive. People who go into medical training go into medical training more resilient and mentally healthy than the background population. And that is no longer the case when we come out. That's not a people problem, that's a systems problem.

Isn't it like six months after someone enters medical school training that their depression rates or mental health starts matching that of attending physicians?

That's pretty fast.

And I think it's so important that we are talking about the individual as well as the system. And so when I'm working with somebody one on one or in a small group program, by helping those individuals, it's not fixing the system of medicine that is very broken in our country right now. And yet if we ignore the individuals, those canaries, we don't give them the oxygen mass, we don't help stave off the bleeding wound, they're not going to survive until the culture gets better. And we, I think all of us have probably seen through our coaching programs the immense changes that can happen while we also work on the systemic problems. And I wonder, Dr. Steff, if you can share an example of maybe a healthcare organization that's, that's getting it right, a story that shares some of the hope that things can get better and what others can learn from that example.

Yeah, thanks for that question. And first of all, you're absolutely right. This is a yes and not an either or. And if you go to try to address the source of the bleeding without holding pressure on the wound first, you might lose the patient. Right. So it is important to do both. There are bright spots all over, Dr. Aaron. There are organizations who are putting together amazing peer support programs like the RISE program. There are organizations who are investing in coaching. These are Individual support. There are also organizations that are implementing wide scale gross programs. So GROSS stands for get rid of stupid stuff. And I think you all know what I'm saying when I say stupid stuff. Because as Muhammad Ali said, it's not the mountain ahead that defeats you, it's the pebble in your shoe. And so it's identifying these pebbles in our shoe in the daily practice of healthcare that if removed, our work would be so much easier. So there are organizations that are systematically identifying, through bidirectional communication with their frontline workers, these pebbles. UNC is one of these organizations. They've rolled out a technology in their perioperative setting that allows Everybody from the care team, the physicians, but also the PAs, CRNAs, NPS to identify those barriers. And then they've also backed that into a system that helps address them. And they've shown that this has a reduction in intent to leave for healthcare workers. So that translates to healthcare workforce wellbeing when you're happy and you want to stay where you are. But it also translates to the bottom line of the organization. Right. We're also seeing organizations who are investing in ambient listening documentation technology, or inbox generative AI messaging technology that offloads the cognitive load and the cognitive burden from healthcare workers. While they're charting or responding to inbox messages. You're still signing your note and editing it. You're still editing and signing that inbox message before it goes out. But it's always easier to finish something than it is to start it. And the true, the same is true with communication. Right. And so by having that initial piece started, it unburdens healthcare workers. So we're seeing this happen all over the country. What needs to happen next is that these pilots, these programs, where there's bright spots, where it's working, need to scale both across the organizations, across the systems and across the regions, because we still have an implementation gap between what we know works and what we see happening.

Wow. Yes. My goodness. And we were talking recently too, and we talked about this with Corey as well, that we love these conversations and we have smart people like yourself in this, the, in the room where it happens and then it's okay. How can we put it into action and actually see the results and scale it from there? I love that. So, yes, again, it's like I've shared here, I have a kid who's going into medical school and it's sad as he has two physicians as parents and we kind of discouraged him to go into medicine. And then it's like, okay, I mean, you do what you want, but you need to really want to be in it for the right reasons, not just because this is what your parents do. And, you know, he's decides to, decided to stay and he's worked at the hospital for a couple of years as a nurse tech, which is I think should be a prerequisite for all of us based on his stories. And I worry because of things like this, like, I don't want him to struggle. And these are the conversations that give me hope, not just as a physician and a colleague, but then also as a parent and for the future in medicine. So again, it's, it, it makes me want to be involved even more.

I have a child who's considering Pre Med too, Dr. Joanne. And so I'm 100% on the same page as you. I just, as a parent, you know, it's man, it's. You want to make the decision that you think is best for your child, but it's not yours to make. And so I'm just trying to walk that line right now of like making sure whatever decision they end up making, it's with their eyes open and they have the best information I can give them.

And what a beautiful role model to have you as their mother. Right. And seeing, seeing what you're, how you're advocating for their future as well.

Yeah, I think that's very important. My son is getting, he's almost 22 and he is in the army and he's a combat medic in the Army. And when he expressed his wishes to go into the military, we, you know, my goal was go slow, to go fast. Let's research and investigate what's. What do you want to do? What branch will serve that had him. I introduced him to as many military people in the different branches as I could. And even when there was a lot of changes in the safety around the world before he had officially signed up. And I asked him, is this really what you want to do? And he, he, it was what he wanted to do. And he had his eyes wide open. He'd had experiences as a wildland firefighter. He, his dad's a firefighter medic and his mom is a pediatrician, worked in child abuse. He had a lot of knowledge going in. And we have an episode coming up with Dr. Pamela Buchanan and she wrote a book, White Coat or White coat, black Face. And she said what she wants to do with her book is make sure people going into medicine understand the sacrifices, the fortitude that it takes going in because so Many of us went in it and we had no idea. And I haven't been a emergency physician. I was just in the ER not too long ago with a family member. And I just so respect the work that you do. And yet going into it blind is hard. Even going into it eyes wide open doesn't make it easy. And we can't sugarcoat it.

And Aaron, I was the first person in my family to go into medicine. And I like to tell people when I applied to medical school, I didn't know about residency. So, like, when you talk about going into something blind, like, I had no clue what I was in for in terms of the length and depth and intensity of the training. I just know that I wanted to be a doctor and I was going to do what it took. So, you know, I do think that having more of that knowledge, being able to plan around that knowledge and really understanding if it's for you, is going to be important for, for the next generation of physicians.

Wow. And then emergency medicine, it's like, let me jump all in. If, like the, the core of medicine with its full range of all the experiences, I can only imagine what, what you all do. Goodness gracious.

So it, it's funny because I went into, I went into residency, I went into medical school thinking I was going to be a family medicine doctor. I really liked the idea of the, like, birth to death and pregnant people and some mental health and some procedures and all of that. And through the course of my clinical rotations, I realized I liked all of those things. I just didn't like clinic very much. And so it just wasn't for me. Right. It's for, it's 100% for some people, but it wasn't for me. And so I actually matched into anesthesiology because think about all those things I just said. Birth to death, pregnant people, procedures. Right? Like, and I loved the. Or I actually loved my surgical rotations. And so I matched in the anesthesiology. And it wasn't until my intern year rotating in the ER that I was like, oh, this is, this is the thing. This is the one. Because it was all of those things. Birth to death, pregnant people, procedures, and sort of the most raw cross section of humanity you could ever ask for. Right? And as somebody who loves stories and storytelling and understanding the forces that drive people to do what they do, like, you see that in the emergency department on display every shift. So, you know, it wasn't a quick decision. And in fact, I had a little, you know, little side quest into anesthesiology for a year before I came to it.

Wow, what a, what a neat, beautiful description of emergency medicine. I felt that it's like, oh, different than other people. Like, I just want the action and the adrenaline. Like, no, I want the, the full, like the, the depth of it. Wow. Yes. Thank you. For doctors like yourself in the emergency room.

Right.

Like at a very vulnerable and scary time for a lot of people who walk in through those doors. So we need big hearted physicians and staff there. So thank you.

And there's a lot of them out there. There's a lot of them out there.

We have a question that we ask all our guests because that's how our podcast is named. And based on what you do, I would love to ask you more of how are you rewriting the rules in medicine?

They're more like guidelines, really. No, I mean, the thing is, is if you don't like the way something works, change it. I mean, nobody else is going to change it for you. So, you know, we as a foundation didn't like the fact that these questions are being asked. We knew they were hurting people. So we've been working to change, to change those questions and to change those rules. But you have to get your data together and you have to grab your, your coalition together. And so we've worked with our partners to study why healthcare workers don't seek care. We've worked with state advocacy and federal advocacy teams to say, hey, you know, what's the legal ramifications of these questions? So, for instance, the Department of Justice has ruled that it's against the ADA to ask these questions on state licensing, and that has helped to move the mark. We've been able to study, you know, that this is a real barrier for healthcare workers, not just because we say so, but because healthcare workers say so. And so, you know, we've helped to move the research. We've gathered a coalition of people who know and live and breathe healthcare. The AMA, the ANA, the AHA, 37 others. And it's not just us changing the rules, it's this coalition. And then it really does require the willingness of regulators and healthcare leaders to listen and to reconsider. And so there also has to be an openness on the part of other people. So we are working to rewrite the rules of how healthcare workers privacy around mental health care is defined. But we're not doing it alone and we're not doing it without evidence. And so I guess that's the one thing, that's the first thing I'd like people to take away is, if you want to see change in the world, grab a friend, grab a dozen, and then get your data in line because that's the place you can stand on and your lever will be long enough to move. And I guess the second thing I would just say is in healthcare, we have so much compassion for other people. We want to make their lives better, we want to heal them, we want to empower them to heal themselves. But compassion without self, compassion is incomplete. And so we need to extend the same love and compassion to ourselves as we have for others. And that's really hard, but it's really important. So if you're listening to this and you're a healthcare worker, please take care of yourself and remember that you being here, you being in the world matters. And I'm glad I get to share this, this place with you.

How beautiful. Thank you for those words. I cannot wait till we publish it so I can listen to it again and take even more notes. And the pages that I've taken already. And if someone wants to connect with you more or be more involved in the foundation, what are some resources that we can share?

You know, we have so many calls to action here. Dr. Joanne, just wait. I'm gonna, I'm gonna list them all off. Okay? If you would like to be involved in the doings of the, of the foundation, if you would like to get involved in advocacy and fundraising and awareness raising with us, please become an ambassador. This and, and I'll give you the link for your show notes, but you become an ambassador. Dr. Aaron's an ambassador. If you want to write your statement, state boards for nursing, pharmacy and dentistry. If your medical board is still not changed for medicine, we have links on how to write your state boards and ask them to change the questions. You can write your federal representatives, your senators and your representatives to help reauthorize the Dr. Lorna Breen Healthcare Provider Protection act, which will provide additional funding for projects and programs around professional well being for the healthcare workforce. Okay, you can donate to the foundation. We are 100% philanthropically funded. And so we do, we do need those donations. And the number one most outrageous, most subversive thing you can do is to take care of yourself.

Wow. Thank you, Dr. Sev, so much for being here with us today. So many powerful messages. Again, this is something that we all need to spread and plant seeds and feed them and keep on moving forward. So thank you again for being here with us and a lot that we can do and the audience, please, let's all get involved. And with this, please stay tuned because our next episode is coming right up.

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