EP12 - Inside the Strike Zone: Prof. Johnnie Kallas Breaks Down Healthcare Labor Movements

In every operating room, in every ward, in every clinic, and every team meeting, a silent battle brews. Conflict, negotiation, identity. Welcome to the Scalpel and Sword podcast, where I, Dr. Lee Sharma, physician and conflict analyst, Explore the hidden negotiations behind modern medicine. Let's trade burnout for boundaries and learn the art of healing with precision and power. Hello, my peaceful warriors. Welcome to the Scalpel and Sword podcast. I am your host, Dr. Lee Sharma, physician and conflict analyst, and I am so excited to have on the podcast today Professor Jonny Callis. Professor Callas did his undergraduate degree at Oberlin University— Oberlin College, I should say. And then he also did his master's and PhD in industrial and labor relations at Cornell University. He is currently on faculty at the University of Illinois Urbana-Champaign, but he also is the director of the Labor Action Tracker, which I'm getting really excited to get into today, which follows all of the union and non-union strike activity in the United States. He's got a lot of experience in healthcare and especially with nursing strikes. And his insight, especially on fixed duration strikes, which is where I first learned about him, is going to be invaluable to us today. So welcome, Professor Callas.

Thank you so much. It's great to be with you. Looking forward to our conversation.

Same, same. So in reading your interviews, your interest in labor relations goes way back. It's really familial in its origin.

Yeah, that's a great point. I first got interested actually in the labor movement. My stepdad worked as a labor lawyer actually in the Southeast.

Wow.

In Alabama representing steelworkers, and I think it's still District 9. I went to a labor education conference down outside of Pensacola on the Panhandle, and I noticed I was in high school, I was the only person under 40, and I was like, we need a little bit of youth and energy in this movement. And, you know, Oberlin College is a place where you can develop some youth and energy related to activism. So I got into it there and worked in the labor movement, and now I'm researching. So it's been a full circle ride.

Awesome. You also spent some time, I think, I can't remember if it was after your PhD, at the Service Employees International Union. You also spent some time there, and that's the parent organization for the Council on Interns and Residents, which is one of the largest resident unions and currently growing in numbers exponentially in the United States. But I think you really got into tracking unions when you were doing your graduate work.

Yeah, so after college, I worked as a labor organizer for 3 years, 2 with SEIU, Service Employees International Union, on the then known as the Fight for $15 campaign to raise the minimum wage to a living wage. And I was actually organizing home healthcare workers in Cleveland and Memphis. And then I worked for a year with the California Nurses Association in the East Bay, in the Bay Area. And then I got, as many organizers do, a little burnt out and decided to go down the more research academic track. And that's where I got involved at Cornell.

Yeah.

with the Labor Action Tracker. Some of my interest in researching healthcare labor relations, but my experience as an organizer with those 2 organizations, SEIU and the California Nurses Association, certainly shaped that future interest.

So the Labor Action Tracker actually looks at lots of things. It looks at union strikes, non-union strikes. It's looking at strikes all over the country, all different professions. But one of the things that I think you talked about a lot, which is the reason I really was excited to talk with you today, was fixed duration strikes. Because one of the things I think is happening now, especially as physicians are becoming more employed and thus exploring unions and joining unions, not only is whether or not we should strike, because I think, and I would love to know your perspective on this, physicians have never been really thought we could strike. It was not something that we thought was available to us as a way of exercising our voice and power, mainly because of our professional responsibilities and our love of our patients. But striking is something that when it's planned well and has a duration, can actually have lasting impact on the people who are trying to affect labor change. Is that something you've seen in your research?

Yeah, so it's such a great point. And I think I understand there are some very important distinctions between registered nurses and physicians, but I think there are also some important parallels when it comes to both groups of workers really taking their professional identity and pride seriously and really being patient care advocates. At the end of the day, I understand once again, There's difference and variation in terms of educational background, experience, et cetera. But I've certainly seen, so a lot of my research, as you mentioned, have focused on the emergence of what I've termed fixed duration strikes, also might be known as limited duration strikes, short-term strikes. And it's basically when workers, often union members in the healthcare setting because of particular legal regulations, which I'll get to in a second, but workers walk out on strike for a predetermined time length, generally fewer than, less than a week, oftentimes just 1 or 2 days. They'll unconditionally return to work at the conclusion of the strike regardless of whether they actually make any meaningful progress on their contract demands or negotiations or whatever it may be. So this strike is not just unique to healthcare. This is quite common across a lot of the service sector, accommodation and food services, even K-12 public education in certain settings. But I think it plays a particularly unique role in healthcare because it allows groups of workers who are also patient care advocates to walk out of the job and protest conditions that they view not as just harmful to themselves as workers, but harmful to the patients that they're trying to advocate for, but to do so in a way that does not require them to be out indefinitely from their patient care responsibilities. And I think that's why you've seen— I've coded all strikes in the Labor Action Tracker database, which we began in January of 2021, and at least through the end of 2023, Over 75% of all strikes in healthcare have been of a fixed duration. And I think partially it's because you are sacrificing as a union member a lot less by going on a fixed duration strike. You're losing less money. You're at a much significantly reduced chance of losing your job, which we can get into. But I think it's also this important patient care advocate standpoint where you can really claim that you're advocating for your patients, but you're not walking out indefinitely. And that's certainly been a big factor behind nurses' strikes, and I think it's been a factor behind And a few of the physician or resident strikes we've seen as well. I'm happy also, I'll stop for a second to get into some of the legal regulatory environment that is different in healthcare than it is in any other industry and plays a role here, but I'll stop for now.

No, I definitely wanna get into that because I think there's a lot of things as physicians, I mean, and we definitely, I think, have learned from watching what nurses and even doctors in other countries have done in terms of labor strikes. We've been able to see what the NHS has done. I mean, I think certainly what's going on in South Korea with the extended length of that Has been really fascinating to watch. And I think also too, for a lot of physicians that are thinking about strikes, they really do see that going on strike for months and months and months is not only tenable for patient care, first of all, because that's just horrible for the healthcare system. But also, I think one of the questions that comes up when people look at fixed duration strikes is, are these really effective? Because like you said, most times if you're looking at a 48-hour or even a 5-day, You probably don't have a resolution to your issues when you go back. So are fixed duration strikes as effective as maybe talking about going on a longer duration? Was that still powerful for the people who were on strike?

Yeah, so it's a great point. And where I think these types of strikes are different in healthcare than perhaps in, for example, the accommodation and food services industry is that healthcare workers have such greater bargaining power because when they walk off, even for a short period of time, and I'd say this is especially true of nurses and physicians, Hospitals can't just completely shut down. So just to situate this in the regulatory context, what is unique, and I think important to note about the healthcare sector, is when healthcare workers were brought under the National Labor Relations Act in 1974 as part of the healthcare amendments, they were covered by existing federal labor law, which exists at least for now to this day.

Mm-hmm.

But they do have to provide a 10-day notice in advance, not just of actually any walkout. What I've always found really interesting, even in advance of non-strike picketing outside of a hospital facility, which I don't actually I understand the rationale for that. I understand the rationale if you're engaging in a work stoppage, you need to give the employer, usually the hospital, time to staff the facility. So that is unique. Healthcare unions have to provide that 10-day notice. And generally, as part of that 10-day notice, they will write in their notice letter whether or not they're going to be returning to work at such and such date unconditionally or whether the strike will be indefinite. So there's also this sort of legal component as well. The reason why I think you have seen some of these fixed duration strikes be somewhat effective is because nurses or physicians walking out even for 1 or 2 days can impose considerable, not just reputational costs on hospitals, but real economic costs. Especially we saw this in late '21, early '22 when the contracts for traveling nurses absolutely exploded.

Mm-hmm.

And you would have hospitals paying $200-something an hour for an emergency department nurse, never mind what an OR nurse would cost. And they would have to fly in those nurses as part of temporary staffing agencies. Who work a minimum of 5 days. They're flown over from all over the country. So generally, actually, oftentimes what will happen is sometimes a 1 or 2-day fixed-duration strike will be followed by a 3 or 4-day lockout because hospitals are stuck with those 5-day staffing contracts by that temporary staffing agency. So the key difference here and the reason why they can be effective is because they actually— it's not just a reputational cost on hospital, though that does exist. There's a battle And the PR department and the press, et cetera. Hospital strikes are always well covered by the news because they impact the public similar to teacher strikes incredibly. But they actually have some real meaningful economic leverage. Now, when those contracts are generally resolved, does still tend to be weeks or months after because you once go on one of these, you know, 1 or 2-day strikes and the employer knows you're going to return to work, well, you've lost all your immediate leverage, right?

Yeah.

But then the question is, through additional negotiations, is there another strike authorization? Maybe for, it's for a couple more days. There are some legal considerations. You can't just do this every couple of months. There are some legal restrictions on that, which we can get into a little bit. That does matter who's in the White House and who controls the National Labor Relations Board. And that's obviously changed. But generally, it could lead to a successful settlement, but it might take a few months. The best example, or a prominent example, is 15,000 nurses in September 2022 across the state of Minnesota went on a 3-day strike for a better contract, especially around staffing demands. Return to work unconditionally, authorized a second strike in December of that year. But before they actually had to go on strike, they reached a pretty strong contract. And you'll see cases like that at a smaller level. Not all the time. They're not always effective. But one of the reasons they're effective in healthcare especially is because there is a real economic leverage component of it that may not exist in other industries.

Absolutely. One of the things you mentioned is the reputational cost to the institution when there are physicians, nurses, healthcare employees striking. And I think there's so many examples of Of institutions trying to create negative light around the people who are striking, saying, oh, we pay them well, things like that. We've seen that in the United States. We've seen that in the NHS. We've seen that in South Korea. I think South Korea initially, the government tried to say, look at these greedy doctors. They really think they're making too much money and you should be very mad at them. And I think definitely there are hospitals and healthcare entities in the United States that have tried that with striking nurses and doctors. What I think is interesting, and I'd love to know your perspective on this, is I think most of the time what I see is when nurses and doctors go on strike, patients are aware. It's like, we know you don't want to. We know you're doing this for us. You know, when you look at staffing ratios and you go back to Minnesota, they were working 1 in 12, 1 to 14. That's insanity on a floor to have 1 nurse taking care of 14 patients. So they were striking for patient safety. They wanted to make sure there was an appropriate ratio. As you have followed labor action with healthcare in the US, do you feel like you see Do you see that trend where hospitals or healthcare tries to put that negative light? And do you feel like that's something that the public receives or they don't really have empathy? They have more empathy for the nurses and doctors.

Absolutely. And just to bring this back to also the distinction between a shorter strike and a longer strike, I've had multiple nurse union leaders tell me that if you get into one of these longer strikes, you start facing these claims by hospitals that you're abandoning your patients. And this is the most damning claim that as a nurse or a physician you can hear, because these are groups of workers who take their professional patient care responsibilities as seriously. You know, it's like an educator teaching children, except it's someone's literally life on the line in a lot of ways. So absolutely, that language often gets weaponized. It's also, as you know, Dr. Sharma, can be very gendered. And oftentimes, especially with nurses, we're talking about a largely female workforce, but increasingly that's becoming more true of physicians as well. And I think that battle is absolutely fought over. I do think what, especially in the current climate post-COVID, and I understand COVID is about 5 years ago, but what has given healthcare workers some leverage around those arguments is these people, people who put their lives on the line to save other people for multiple years during a global pandemic. And I understand for a lot of reasons in this country, we're moving away from that experience in many different ways. But I think people still understand these are frontline heroes, right? Nurses have long been the most trusted profession in America. I don't know how many years running now. Their approval rating in terms of an occupation is something like 75 or 80% the last time I checked.

Right.

So they are able to leverage that in these disputes. But it does get a little dicey, especially in communities that are maybe facing their hospital being shut down, or at least the services significantly reduced. And management through the airwaves, through the press, et cetera, as part of a longer strike, can play this language of, look at these greedy physicians, nurses who are abandoning their patients. And that's the language that gets challenging. And I do think part of the reason you see these fixed-duration strikes, it's much harder for hospitals to claim this when, yes, we're walking out to advocate for our patients, but we'll be back in 2 days, or we'll be back in 4 days, or we'll be back in a week. I do think that's another advantage of these types of strikes.

Absolutely. You mentioned that the NLRB included healthcare under their aegis in 1974, but we really didn't hear a lot about labor strikes in healthcare, nurses, doctors, until much, much later. And obviously you've been tracking this since January '21, but you've had a chance to follow this throughout your career. Why do you feel like we're seeing way more strikes now?

So, and I wish I could, I definitely think on the physician front, the fact that we're seeing any physician strikes in the United States, I also think it says, and you can speak to this extremely well, but it says something a lot in the industry for physicians and how they're becoming workers in many more cases and having a lot of the same challenges that other employees in the medical practice kind of face. But it's hard to say definitively, and I wish we had the data going back on exactly how many more strikes we're seeing by healthcare unions more broadly. But I do think a big reason that you're seeing this, especially the last few years, are the issues that healthcare workers faced before the pandemic really became exacerbated. Staffing, health and safety, and pay is always a huge issue, right? There's no getting away from that. So I think, you know, as the labor market has become more tight, as, you know, nurses feel like they're being underpaid, which is what's leading to these sort of nursing shortages, you just have more stress and burden being placed onto those healthcare workers on the front line and increasingly more problematic working conditions and situations like that. So I think that's a big reason you've seen— I think also in combination with just a shifting sort of understanding of strikes and the labor movement more broadly from the general public that has given workers more leverage, not just in healthcare, but across a lot of industries. But I think the combination of ongoing issues that have become exacerbated since 2020 and just a rise in awareness of labor-related issues and an increase in labor activism. Strikes were not always, in both healthcare and more broadly, were not seen as a tool to make gains for a long period of time in this country. They were seen as a last resort. against concessionary bargaining by management, right? And I think that also was true in the healthcare setting. But what you've seen over the last few years is both healthcare workers and workers more broadly in this country really seeing strikes as a way to secure additional gains, secure staffing ratios, secure better pay increases. And I think that's sort of the dynamic you've seen over the last few years.

I 100% agree with you. I think an already stressed healthcare system got into the pandemic And the pandemic just magnified everything that was wrong with the healthcare system. And it just made it so much worse. And at a certain point, you had to deal with those issues. And so now I think you're seeing people with more ability to negotiate and who understand what they're negotiating for. But the other thing I think you're seeing is just this rapid rise in employed physicians. You know, independents, we can't strike, but 75% of physicians in the United States are now employed. And a lot of physicians, I think, went into the sphere of employment because it was, this is great. I get to roll in. I get to go to work. I get to go home. I don't have any management issues. I'm not running a practice. But unfortunately, that gave a lot of the hiring entities more power. And as they had more power financially, they were able to sort of try to dictate to physicians, you'll do this, you'll do this. And I think in the pandemic, you had so many doctors who were trying to do more with less. And in the pandemic, we sucked it up and did it. And then once it was over, Hospitals are like, oh well, we can keep making you do more with less. And so there had to be a point at which somehow physicians could gain that power back and gain that voice back. You're also seeing that I think more the rise of residents unionizing is absolutely exponential. When I was a resident again, I'm super old. I trained in the 90s, but we just sort of accepted that we were slave labor. We accepted that we were going to work 100-hour weeks. Making less we'd make at McDonald's. We knew that there was no wellness. There was no idea of like stress or burnout or how to learn to deal with that. We didn't get business educations. We didn't know how to run a business. And looking back on it, I really do think that we just thought that's the way it was. We didn't question it. And now what I see is all these interns and residents that are coming out of medical school. They're so much more aware. Of the voices that they have, and they have way more avenues to use them. And so, they're not just advocating for themselves to make more money or work less hours. That's not what it's about. They actually do understand that there is a quality of life and existence that goes with organizing and having that unified voice. And I think that's why you're seeing so much more of that. being in a union or being unionized is going to reflect negatively on them or puts them in a negative space with regards to their employers. One of the things that you track in the Labor Action Tracker is union versus non-union strikes. So do you follow that data for physicians? Are there physicians that are unionized that are not striking or not in that space that are still taking that labor action?

Yeah, it's a great question. We've documented very few. I think I can count on one hand the number of non-union healthcare strikes and I can't even think of any of them being non-union physicians. I think we have seen a little bit, maybe physicians fighting for a first contract after organizing and they're still trying to negotiate. But it's really difficult for non-union healthcare workers to strike because of this 10-day notice requirement. And because of that, you just don't see— you would need a tremendous amount of coordination, usually with the help of some sort labor organization to be able to bring workers together and undertake that 10-day notice and really have a complete understanding of what that entails. Because if you don't provide that 10-day notice, the consequences are quite serious. You lose protection under the NLRA. You could potentially be terminated for engaging in a work stoppage. There could even be some licensure problems, et cetera. So there are some real sort of serious implications. So most of the healthcare strikes that we document are certainly union-led or union-affiliated, where that might not be the case in, for example, accommodation and food services where you more often see, oh, there's a broken AC unit, we need to walk off the job just for our own personal safety. That may be totally independent of a union affiliation. I think a really good point that you make that I just want to build off of that was very well said is I think the dynamic, and this certainly was true for nurses for a long period of time, but they've broken away from it. And it'll be interesting to trace physician organizing and striking over the next 30 years similar to nurse organizing and striking over the prior 30 years is really the sort of class identification, right? I think oftentimes physicians maybe socialize and train to become more individuals as part of the top of the healthcare hierarchy in order to— they're experts, they're usually supervisors, they're directing work. But I think as you mentioned, you're starting to see a little bit more realization and recognition of their sort of class awareness of the fact that they are in a lot of ways workers of these broader institutions who are also facing a ton of pressures from health insurance companies and HMOs, right? It's part of the whole sort of healthcare system here. So I'm not even putting it necessarily all at the blame of the hospitals per se, but I think you're starting to see that acknowledgement of class identity and collective action, though I think I'm going to guess that's still really challenging for a lot of physicians, especially some older physicians who may have been trained in a different time and place.

Absolutely. I think that's something that we are learning from the youngers. We're seeing what they're doing. I love how you express the fact that as physicians, we are taught to be very independent and very individualistic. We're very much in a silo. And I think for those of us that are older, again, we're looking at our younger generation. They do a much better job of being collaborative because they've been brought up that way. And so we are learning how to be collaborative. I will say this is one of the things that I think is very encouraging to me is a lot of the older physicians who look at the younger physicians who are trying to Build that we we believe in a quality of life. We believe in fair reimbursement. We believe in these things that make a stronger healthcare system because we have stronger providers. You do see the older doctors sympathize with that. They're not saying, "Oh my gosh, how terrible these young people are doing this!" I think initially you did a little bit. I think you heard, "Oh my gosh, they're so lazy. They don't want to work." Da da da da da. But I think now what you're seeing is, wait a second. These kids really do have the right idea. They understand that we have to be healthy healers. We can't just work ourselves into the ground with. No type of support or reimbursement. And so now what you're seeing is those older doctors supporting these younger doctors. And that's something I think you're going to see more of. You're going to see more of that consolidation. I also think you were talking about how the pandemic changed the healthcare system and changed a lot of minds about the way the system works and the flaws in it. And I know you know all about this. Back in the early, I think late '90s, 2000s, the American Medical Association tried to create national physician bargaining unit called the Physicians for Responsible Negotiation, PRN. And it lasted for 3 years, I believe. I think it was one of those things, it was a good idea. It was too early. There were not physicians that were ready to embrace that. They still saw labor unions and strikes as something that was professionally not acceptable for us. It was a great idea, just not the right time. If we follow this trend in the next 5, 10, 15 years, we are going to see more physicians who are organizing and unionizing, who are going to use striking, and especially the fixed duration strike, as a way to help get these points across to the bigger healthcare systems. I think you're just going to see more and more of it. One of the things that I did love is that you did spend time as an actual labor negotiator for the California Nurses Association. So you were actively involved in bargaining, advocating for these nurses, working with this administration and this healthcare hospital system. What were some of the biggest takeaways you took from working in that situation? What did you learn?

Nurses are very passionate. No, I think a couple of thoughts that I think can tie together some parts of our conversation. What's really interesting amongst healthcare unions in the US is you actually have quite a few different approaches to labor relations. And I think it's partially because there are so many challenges, as we've talked about, facing the healthcare industry that really come into play when just negotiating. You're not really ever just negotiating pay and benefits in healthcare because you have patient care implications. And it's always center of mind for hospital management and it's sort of center of mind for practitioners and advocates, right? So I think what's interesting is you have these different sort of ideologies or approaches to unionism. For example, in the West Coast, you have something that would seem to be really appealing and could potentially be appealing to physicians. That's pretty intricate. A labor management partnership at Kaiser Permanente hospitals across the West Coast, where you have unions and management, and this has come under a lot of stress over the last few years in the wake of the pandemic. But the partnership still exists in a couple different iterations. Really come together with the goal of fostering labor management collaboration, recognizing union. As legitimate actors, which most employers, both in healthcare and not in healthcare in the US, do not. Not true in other countries, but at least in this country do not. And really committing to partnering with each other to reach collective bargaining agreements, ideally without having to resort to strikes or other sort of confrontational actions to benefit both healthcare workers, but especially patients on the bottom line. There are some though, especially state-level nurses associations that have broken away from the American Nurses Nurses Association that have become much more sort of confrontational and adversarial nurse unions. So California Nurses Association was one of them. This is a union that proudly is anti-partnership. They commit to a much more sort of traditional adversarial approach to labor relations. And they would argue, and in some ways I do agree, I think there are arguments on both sides and there are certain conditions when each approach could be more effective, that they really need to be the a voice against further privatization and corporatization of our healthcare system, right? And in order to do that, it's really difficult to partner with employers. You have to fight against employers and stand up for things in their opinion, like Medicare for All or more progressive sort of policymaking, et cetera. So you actually have— what I've learned is you have a lot of different approaches to labor relations in this healthcare space that really varies based on the labor organization, and it can have meaningful impacts for outcomes at the bargaining table. So that might have been— I don't know if that's a little bit more niche than you were expecting me to go with that question. And you see this a lot— California Nurses Association, New York State Nurses Association, Minnesota— some of these state nurses associations that broke away from the ANA and now are sort of their own. Some of them are organized under National Nurses United, but generally they're sort of own state-affiliated nurses union that differs considerably from other labor organizations. But I would also say At the end of the day, and this relates to the commentary on strikes, nurses are patient care advocates. And really this identity around patient care advocacy and being on the front lines is just so instrumental, not just at the bargaining table, but in their willingness to fight. And I think that's why you see nurses, even though you would think maybe not compared to physicians, but compared to a lot of other healthcare workers or workers more broadly, are really protective of their occupational identity, and they're willing to fight for that, protecting their occupational identity as well.

And it's so interesting too, because especially when you talk about this California Nurses Association and these organizations that have broken away, they're not just advocating, like you said, for staffing ratios and stuff. They're advocating for policy. They're actually making— and there are lots of other places in the United States and all over the world that are looking at those disputes and those labor strikes, because the policy that's coming out of that is going to affect other people. I think California especially has been a leader, not just for nurses, but also for residents. One of my former medical students is a peds resident at UC San Diego, and she sent me her first day schedule. She has mandatory lunch breaks. She has like a 9 o'clock yoga break. I've had nurses that have been out there doing travel nursing. Their staffing ratio was 1 in 4, but they also have 2 float nurses. They're there to help you, and they're coming from the South where they may have worked one in ten. And so they're going to California going, "I have four patients, and I have two nurses who are willing to help me." This is work. But there again, California fought for that, and it's like you can't deny the fact that the reason why they have those things, the reason why the residents have quality of life, and the reason why the nurses have these staffing ratios and the support is because they fought for them. So as this policy. People start looking at California or looking at Minnesota and looking what they're fighting for, that policy does trickle over to other places. You can't keep it out. And so if someone like me in Alabama has heard what's going on in California, it doesn't take long for people in my part of the world to start fighting for that. And so I think this is the beauty of what you're doing. I think the beauty of the Labor Action Tracker and the work that you're doing is helping everybody in healthcare, physicians, nurses, all of the health professionals be aware that they have a voice, they have power. And I think the larger implications of what places like California has done with their nurses is that it has the potential to change healthcare everywhere, not just for them. And so this is why I love the work that you're doing. I was fascinated to read about the work that you're doing. Professor Callas, if people want to get in touch with you or find out more about your work, how would they do that?

Well, absolutely. Well, first of all, please, as Dr. Sharma, you've promoted, please visit the Labor Action Tracker. You can just type a Google search or any sort of search, Labor Action Tracker, it'll come up. It's a really great interactive map that's publicly accessible, and you can search for strikes by industry plus demand size, et cetera, going back to January of 2021. And for those researchers or anybody interested in a spreadsheet version of our data, we make that publicly available, and you can reach out to me at jkallas@illinois.edu or just do a Google search for my name. That'll come up. I'm always happy to Provide data or talk about the tracker, healthcare labor relations more broadly. It's a big passion of mine, and I appreciate the time.

Absolutely. Thank you so much for being here, Professor Callas. We really appreciate it. So everybody who joined us today on Scalpel and Sword, thank you so much for being here today. And as always, be at peace. Every episode is an invitation to speak. To think, to negotiate, to choose. I'm Dr. Lee Sharma. Join the dialogue by subscribing to Scalpel and Sword. Until next time, peaceful warriors, may your choices be sharp and your voice be even sharper. This podcast is a reflection of lived experience and research in conflict resolution. Grapple and Sword is not intended as medical or legal guidance. For personal matters, please consult a qualified professional.

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