From Microscope to Boardroom: Dr. Heather Signorelli on the Business of Medicine

We were sitting in a boardroom and the CFO goes, when are you going to get your mba? And it was to this gentleman, he was a doctor. And the doctor goes, when are you going to go to, when are you going to get your md? And it just like stopped the room. And so.

Hi, everybody, and welcome to the podcast. This is Generations md. My name is Stephanie and I'm joined here by my colleague Dr. Sarah Davis, who's also my mother. And today we have a very special guest, Dr. Cingerelli.

Yeah, great. Thanks for having me on. Gu. So I am a pathologist by background. I think I have loved business since early on. My dad was an OB GYN, ran his own practice for over 30 years. My mom ran and built surgery centers and hospitals throughout her career. She was actually a nurse by background. So I think the whole business side of medicine was just constantly given to me as I was growing up. Obviously became a doctor, but I kind of took a non traditional path and really started the business side of medicine actually in training. And it has encompassed my entire career as being that kind of bridge between, you know, the clinical side and the business side. And it's been fun and rewarding. And I, you know, for the listeners, you know, I think it's one of those things we don't get taught about a lot in medical school, that there are these options. It's kind of the non traditional route, I would say. I was actually kind of geared or kind of told to gear more towards the traditional path of pathology by trainees and, or attendings and so forth. But honestly, I'm, I'm kind of glad I didn't listen to them. It's, it's been a great career.

Yeah, we definitely want to hear more about that. And especially just a lot of our listeners are kind of early on in their medical training like me, and don't know about the business side of medicine. So I'm really excited to get into that. Before we do just kind of backing up. You talked about growing up with your parents being a part of the business side of medicine. Did you go into medical medical school thinking, I want to do business side of things, or did you go in like everybody else thinking just, I want.

To be a doctor, I want to be a doctor? I didn't really know what the business side of medicine really meant. I kind of had this vision though, of what I would actually be spending my time doing. And it's funny, I think I kept gravitating towards some sort of business administration. Like I would look at my mom. And I'm like, I like what she does, but I want to do it in his role, but at a bigger scale than a practice. I really loved ob GYN and I thought, oh, this would be really fun. But then my dad started waking me up at 2am to go on deliveries with him. This isn't as much fun as it used to be. So I, So pathology ended up being kind of that sweet middle ground and a lot of lab management and, and kind of the business side of, of healthcare kind of struck out to me as something that was interesting. And so, yeah, I, I, you know, didn't intend to do this, but I think on some level knew I liked business. I liked a spreadsheet, I liked finances, I liked understanding contracts. So I liked that side of it. I just didn't know at the time how it applied to what I was going to do.

Well, did that influence your decision to choose pathology or how did you choose pathology? Because I haven't really met that many pathologists. And so I was, I'm interested in how that jumped out at you as a specialty you wanted to do.

It was what my dad was. My dad was like, you really? Like, I like to study. I like, like knowing everything. I like deeping, like diving deep into a topic. And so he was the one who, you know, his third year, I guess, when we're doing those rotations, he was like, you should go sit with the pathologist. So I went and sat with a community pathologist and I was like, I don't know. Like, I don't know if I could do this. I missed the patients and so forth. And so I was thinking family practice or even psych. And then he was like, no, he's like, go do another pathology rotation. So I did it at the university and I could see the clinical laboratory, so not just reading slides under a microscope, but the side where we're managing the blood results and being consultants for physicians. And I was like, oh, no, this is cool. And so that was it. Yeah.

That's really special that your dad, like, knew you so well and didn't push you to be like, oh, you need to go into ob gyn.

Like, he was.

He knew you so well and knew kind of where you wanted to go. That's special.

Yeah, I mean, and, and it was like a constant topic and it was cool. I mean, he actually told me, he was like, don't be a doctor. I mean, not in a, like, negative way, but he was like, it's really hard and there's a lot of challenges with it. And obviously I didn't listen. And obviously I think he was happy I didn't listen, but he was trying to, you know, make sure I knew, you know, the whole picture of medicine so well.

Yeah, you have to go into it for, for yourself and for the right reasons. If you're going into it because you think your parents want to, that's a big mistake.

Yeah.

Stephanie was also.

Yeah, it's wide open. Like, you really got to know, like, there's great things about medicine, there's wonderful things about being in this role, but there's hard things. And again, that's with any job, any career, you just need to know what those pros and the cons are as you're trying to figure out what specialty you want to do or how you want to practice medicine. Because nowadays what's really cool is there's so many options. You can run a practice, you can be employed, you can go into the business side of medicine, you could do research. Like, there's just so many endless opportunities.

I think that's a great point. And. But a lot of times in medical school or even in training, you really don't get exposed to a lot of those things.

Yes. And I would say for the listeners, I think that was one thing that I, either through his help or on my own, I can't even remember at this point, but just I was constantly trying to meet with as many people in different types of roles as possible. And so in the beginning, that was, you know, him pushing me to go do the pathology residencies or pathology rotations earlier on than I would have been exposed. Like most of the time it's not in a third year curriculum. And so I kind of had to push and ask for it. And it was not like traditional. And I would say I was kind of the person who asked for lots of non traditional things because I was like, wait, no, want this? And then in residency, I did the same thing. I was constantly working with attendings going, I like this type of role. How do I learn more about it? And I'd go and seek out those people, I'd sit with them, I take them to lunch. I even at one point was consulting in residency for a couple pathologists going and doing crazy lab evaluations in Canada on these teeny tiny planes in these teeny tiny towns with all these miners, like, crazy. But it was those sort of experiences that was like, oh, no, I like this side of things. And it gave me an experience and knowledge about something so that when I was ready to get My job, they were like, oh, you're, you're already doing what we are needing you to do. Let's, let's bring you on.

So, yeah, that's amazing. And I like the perspective of looking at medicine as such a. You can go into it and do a lot of different things within it. I think you're seeing that in so many other career paths now. Not a lot of times people go and work for one company and stay in that same job for the rest of their life. And I think medicine still tends to be stuck in that mindset. You do all of this school to be able to specialize in this one thing that, so that you can do that for the rest of your life. But I like the perspective that you're bringing of being like, okay, no, there are other options, but you kind of have to be proactive and do that.

You have to be proactive. And I think you have to recognize that people are going to give you advice and you can take that in as a piece of knowledge, but you don't have to assume that that is accurate or the only truth or the only opin. And I, I think I was told a lot in residency, don't do that fellowship. You're not going to be able to get that kind of job. You know, because at the, at, in residency, I was applying for kind of some non traditional fellowships and my attendings were saying, you're never going to get a job in that. You need to just go sign out cases. Like you're just going to have to go sign out ap, you know, looking at the slides under the microscope. And I was like, no, I actually, I think I can do this. And now I am, you know, the chief medical officer for all of lab services in the largest healthcare company probably in the world. We created that, that position from scratch. I remember standing on a playground with my, I guess she was probably two at the time, my daughter. And my, you know, at the time soon to be boss was like, no, let's create a title. And at the time we called it Chief Lab Officer and we just made it up. I mean, so I would say, like, there's going to be moments in your life where you are told, well, no, that's not possible. And I think if you have a strong enough grit to say, like, I can do anything I put my mind to and whatever non traditional path that takes, you can't do it.

So, yeah, I really like that because even I think throughout all of this education, you're, you're getting so much advice constantly and everybody means well, of course, but yeah, but it is just kind of overwhelming. And sometimes you find like, oh, that's not exactly how things were for me. Like everybody has a different perspective and different things. So I, I like that.

And again, like you said, everybody meant well. Everybody was trying to protect me. Everybody was trying to say no, just go with the safe route so that you have a job and you can pay your loans back. You know, that was all with all the things that they meant well, but I was like, no, I could do it. And so here we are. I mean, I oversee labs now. I've got about 180 of them that I oversee clinically and it's been very rewarding.

Can you touch a little bit about the logistics of the education path?

Yes. I trained in anatomic and clinical pathology, which is your normal four year path of residency. Then there's your traditional anatomic pathology or fellowships, surgical pathology, ob, gyn. I mean there's a gazillion of them. And then on the clinical side, there's like blood bank and some other clinical ones that are common but not as common as anatomic. But then there's some PhD routes like microbiology or molecular pathology or chemistry, which is what I chose, which are PhD programs that did allow MDs or DOs. I'm a DO to go in into the fellowship. They're two year programs. They're geared more towards PhDs. So there was some stuff that I had probably already kind of had exposure to, but it was a really great program. I was at arup and you know, again, I found that option through another mentor at the time who he had done that. He had, you know, been part of that kind of pathway and he's like, you should look into it. And again, it was very non traditional. I think, you know, they didn't have a ton of MD or DOs who were part of that program. I ended up only staying one year because I ended up getting a really great job opportunity. And so I left. But they were able, they were, they allowed me to finished the res. The fellowship and I was able to test for it so I can get my boards.

That's awesome. I mean it seems like you really just sort of like, yeah, like kind of blazed your own path on a lot of these things that. And again, I appreciate people trying to give advice, but a lot of times people are only giving you advice on what they can see. They've just kind of got this tunnel and they don't see these other things out there. So they just say oh, those things don't exist. And you're like, I think they do well.

And I think it's a, you know, like I would say the majority of the population may not want to be having to trailblaze. Like that may not suit them and that's okay. Like, you don't have to want that and you can up and down that in your career and in your life. There's me moments where you're like, no, I'm gonna do it. And there's other moments, you're like, I've got a sleeping baby that doesn't want to sleep. So you know, there's just different moments in life where you feel like you can be a gunner. And other days where you're like, no, I just, I just, I need to kind of just do my thing. And I would say if, if, if you're a type of person who's willing to put in the work and willing to find the people and willing to just go and say, and take no, don't take no for an answer. I think, you know, don't always listen to the traditional path. So.

Well, can you tell us like, what, you know, a typical day or week looks like for you?

I wish you could see my calendar right now. It's back to back meetings, literally back to back for context. In this type of role, we've got everything from managing the clinical recommendations in the hospitals when it comes to laboratories, to helping support our laboratory staff, to working on stewardship initiatives. So right test, right time type things, to helping support picking up equipment and reference ranges, supporting contract negotiations, helping employees. I've got a team of employees, I oversee the quality for our laboratories. So we've got quality dashboards and quality programs and initiatives. Basically, I'm on meetings and I'm on meetings and I'm on meetings. But I travel. I've. I've traveled a lot in my career. I maybe travel less these days, but I have traveled a lot where I sometimes I was on the road when my kids were little, every other week. And that's just the way it was. And then that's calmed down now where it's maybe once a month. So it's changed a lot over the last 10, 12 years, but it's very rewarding. I mean, it's just, it's a very different role. It's a lot about leadership and people.

And.

How to create change in a large organization, which is not always easy, but it's, but it's really enjoyable and it's really rewarding and fun and a Lot easier than it used to be. Now that you kind of get into the hang of it, I think 10, 12 years of any career, you're like, okay, this. At least this makes sense now. You're not trying to figure it all out every day.

Yeah, you can kind of get a little on cruise control maybe.

Yes, yes. And I've been here. I've been with the company since I got out of school. I was in private practice for a year and a half, but doing the same job. And then I became employed by the healthcare system in, I guess it was a year and a half after fellowship. Oh, wow.

I just want to clarify, are you on the clinical side of things, too, or are you kind of like, okay, so you're running this. Okay, yeah, yeah.

And that's a good call out. So just for listeners, if you're like, pathology, what the heck's pathology? I don't know what pathology is. Or you haven't been exposed to that. So the traditional pathologist kind of wears two hats. They're primarily sitting under a microscope reading slides, I would say for most pathologists, not all. And then they're overseeing the clinical laboratory, maybe at a local site, or they're being a medical director, which you can have five of those licenses as a pathologist. And so I am not in the weeds at that level anymore. I'm kind of over a team of individuals who help support those clinical laboratories. And so I've got 180 over about 26 states, I think.

So you're not really looking at the microscope anymore?

I haven't actually looked at the microscope, actually. Oddly enough, since the first day out of my fellowship, I literally looked at one slide. I had already been consulting for this company, so they were like, no, we need you over here. And so I started doing these other things. And then within six months, that was my entire job, so I actually stopped. I never really looked at slides after graduating. Not intentionally. It's just, you know, it's just way the cookie crumbles sometimes.

That's interesting.

So if I pulled up my Anki cards with some various slides on there, some grand stains, or I could probably.

Pull some of it out. I actually was joking with a pathologist yesterday. He oversees one of our divisions. And I was like, come on, you think you. You think I could still sign out some slides? And he was like, maybe a gallbladder.

So.

But. But yeah. So, you know, I feel very fortunate. I've had a lot of really great mentors over. Over my career.

Nice.

But, yeah, mom, if you Want to continue?

Oh, I'm just curious because I know that you have a medical billing company and so I kind of just wanted to touch on that a little bit, just in, you know, as we're talking about like the business side of medicine and for a lot of people, you know, get to the kind of level that you are for that. But almost every doctor except for me, because I don't actually do any billing because I'm a concierge doctor, but everybody else needs to know about medical billing. So just kind of starting at like a really. Well, I mean you can kind of explain what it is that you do, but. But just start like starting to like a really basic kind of explanation about medical billing for people who are kind of just starting on their medical journey.

Yeah, sure. So I'll tell how we got here. So in my current role, obviously I have exposure to the business side, the revenue, etc. And so I was fortunate enough to have that background. My husband actually left his job several years ago and we opened up a billing company together. Now we oversee, we've got about 55 employees, maybe 25 practices that range in size, some facilities that we now bill for. And you know, I think it comes down to I love to build. I think when I think about my job that we created, I liked building it. We built the service line. And so when we decided to build this company on the side, you know, it's full time for my husband and I help support, you know, where need be, it just kind of grew and it just was something we loved doing. And for the listeners, you know, so very basic of medical billing, right? So if I'm a doctor, I'm seeing patients, I'm credentialed or I'm in network with certain payers, right? Cigna, Blue Cross, there's a Medicare gazillion of them. The office has to create claims using a CPT diagnosis or a CPT and a diagnosis and tell the insurance company what I did and why I did it. And so basically our team helps manage that entire process in software so that we get those claims to the insurance company and then we have the lovely job of fighting for those dollars every single claim so that the doctors can get paid. A big part of though of our company is the education piece. So for you guys that are listening, we have a podcast, Nat RevMD, where we talk all about medical billing. So if you're towards the end of your training, so great way for you just, just start hearing the words. We even have a medical billing course that's Very basic, but just something. Again, I. I don't think I'd mess with it. As a medical student, that may be overwhelming, but as you're, you know, in residency and completing residency, if you're planning on, you know, using insurance as a way. Not with concierge, although there is a. Some hybrid models going on. Where are, you know, where folks are doing a little bit of both. But, yeah, anyway, it's. It's been a really rewarding career because we really focus on educating the offices, which is my favorite part, because I get to spend the time with the doctors. I get to spend the time with the offices and say, like, this is a better way of how to do this, and that's what's really, really fun.

Well, and I just kind of want to point out that, yeah, as a medical student, there's so many other things that you're learning, but as a resident, it is good to really start learning that stuff, because day one of starting your practice is you have to know all of that. It's not like you have, you know, plenty of time to just kind of get all revved up. Like, you really. That. Because you need to. I mean, you know, you. You can't get paid if you don't do this correctly. You can get in trouble if you're over billing, and if you're under billing, you're not going to be making enough money to cover your overhead and everything else. And so it's like. I mean, doctors hate this stuff. It's. It's tedious and painful, and they think, why don't I have to do this? I'm like, you know what? You've learned a zillion other things. You can learn this. I mean, it doesn't take that long. It's not that complicated. You just have to get over the idea that, like, all right, this is just something I have to do, and this is the game. And so you just got to play the game.

And that's whether you're going to plan to be employed or be in private practice. Like, you've got to know these things. A. So that's either you can advocate for yourself, you can understand what the hospital's going through, or you can run your own successful practice in any of those scenarios. You've got to know the basics. And again, it's not rocket science. If you can learn the Krebs cycle and all those neuron stuff. We had to learn those neurologists, I just still remember, like, the whiteboards, and we'd sit there and just write it over and over again. You can get through that. I swear to God, you can get through charges, receipts, and accounts receivable. Yeah.

Where do you think that the biggest knowledge gaps are between doctors and billing? Like, what do you see when you go in and you talk to these people?

You know, I think you. You learn enough about, like, okay, I know I got to put a CPT on. I know I got to put a diagnosis on. I think it's the bigger picture of how the whole billing process works and the nuances that have to get. Have to be correct in order for the claim to get paid. And I think that. That it's really just. There's certain risk points in every part of the claim process that physicians just aren't exposed to. And I think that that's what we need to expose our residents to, is they've got to just understand where those little risk points are. Just so in the back of their mind, they're either doing their part so that, you know, their piece is correct, or they're helping support the office so that their part is correct. And so, again, it's. It's just, again, asking those questions, you know, in residency, just, okay, you know, how can I make sure that, you know, what we're doing is getting paid? And attendings may not always know a ton about it. And so sometimes finding other sources that are going to help you learn that again, residency, medical school, focus on figuring out, you know, the Krebs cycle? I guess probably not the Krebs cycle. I guess that's lower level. But whatever you need to learn in medical school. I forget whatever that is so important. Keep learning.

No, but it is. It is important to even just think about this, because even people ask me, like, how do doctors get paid? And it's like, I don't really know, honestly. Do you think you could maybe just kind of walk through an example about. Of doing this and you're talking about, like, these different risk points. Can you kind of, like, walk us through that?

Sure. Sure. Okay, so let's think about. Let's following up. We're going to follow a patient for a minute from the moment that they want to come see you either. Dr. Davis. Right. They're going to come see either of you, and they're like, okay, I'm a patient. I want to come see you. So first and foremost, when you are a new physician, you have to become contracted or you have to go become a contracted, you know, entity of the insurance company. So that's an entire process of itself. That's Four months of trying to become, you know, part of Blue Cross, Blue Shield or Aetna's network. But once you're in network with your list of payers, when that patient calls the office to schedule an appointment, they've got to give the insurance information. This is one of the number one areas that we see struggle, is that they give the wrong information. The patient misspells their name or the office misspells something, or gets their birth date wrong or their address wrong, or the little subscriber ID on your insurance card wrong. And if that information isn't right, then it could be 60 days before you get paid for seeing that patient. Getting that information correct. And as much as you can up front is really important. Then you see the patient, right? You say, okay, this is a new patient and it's a pretty run of the mill appointment, no major issues, but we addressed some things. So then you drop what's called a CPT code that says, okay, this is the complexity of that visit and the diagnosis that we diagnosed acute pharyngitis, and this is the diagnosis code. And those are all done by a mixture of letters and numbers. And then that information all goes to the insurance company. And if you're lucky, if all that stuff looks good, you get paid and you get paid in two to four weeks. If, if any part of that information is not accurate or wrong or missing some sort of information, then your billing team is having to call the insurance, go onto an insurance portal, figure out why it didn't go in, go incorrectly, fix the error, and then resubmit it, and then hopefully you get paid. Now imagine that on a magnitude of you're seeing 20, 40 patients a day times five days a week, times five, you know, physicians in a practice, the volume of that gets really high. And so if you have lots of errors, then those errors compile up that money to be paid to you. What's called accounts receivable piles up and then you're in a situation where you're like, I can't make payroll this month. And so it's really important to have all those little bitty processes correct and then you can know you're going to get paid. And so we track metrics are really important in medical billing so that the doctors know what's going on, our team knows what's going on, and we can help make sure everybody gets paid timely.

It's an important point because it's so different from normal other businesses that, you know, you go to get your haircut and you pay right then and There for the haircut. You know, nobody else says, okay, well, you know, just go ahead and come in, get yourself all taken care of and leave. And then, you know, and then as the doctor, like, you don't get paid. Best case scenario, you get paid two to four weeks later for that. But you still had to incur all of that overhead, you know, right then and there. So it's, it's just one of the many challenges of being in private practice.

And then the other fun fact here is that the, like the hairdresser example, the hairdresser says, okay, you know, it's $60 for a haircut. You're like, okay, I'm going to pay that. In this scenario, the doctor's not the one making the fee schedule. Right. We can make whatever we want up, but in general, it's the payer that's saying, it's Blue Cross who's saying, well, I know you'd like $60, but instead I'm going to give you 40. And you have no ability to change that. You're like, I mean, there are some renegotiation tactics, but in general, like, you don't have a lot of control, so you have to be like, okay, I charged 60, but I got 40, and that's all I'm going to get. Okay.

Yeah, it's.

It's fun.

It's messed up, man.

Yeah, you know what? Oh, go ahead.

I was just gonna say, how does your company, like, help advocate for doctors and kind of be those people?

We educate heavily on workflow. And I would say my day job, I. Lots of what I do is thinking about workflows and, and working on improving those. It's the same in medical billing offices. Offices. Right. So if I can get all that information up front. Correct, Right. If the eligibility is done, if there's all this stuff done up front with the front desk, then their AR gets way better. If we can educate the physicians to make sure they're documenting certain things so that their codes or their claims aren't getting denied, then we're. We're going to be better off. And so for us, it's really about education. We're trying to pump out as much material as possible for these offices, sit with them, hear what their struggles are, see what the metrics show, and then fix the process behind it. Not just crank out claims. I would say most billing companies, that's their main focus is cranking out claims and, and, you know, working through that way, we're trying to be proactive and say, okay, why did these Claims not get paid. Let's understand the workflow process and fix that.

Yeah, I mean, I think that that is huge. And this is all like so educational and stuff that I really don't think about because I'm thinking about the crep cycle. But like, um, it is so important to just kind of have some sort of basic understanding about how this works. I guess, like in regards to your life and making all these businesses and overseeing all these people. How do you feel like that compares to your peers who are more in or people you went to medical school with who are like in clinical practice? How does your life look differently?

I do have a little bit more flexibility. I work from home, so that's a really nice perk. I would say, looking at my colleagues. Like, everybody has had a different journey, everybody has chose different things. We've got folks who are employed, folks that own their own practice, folks that work part time, folks that opened up their own concierge practices. I mean, it's just a very wide variety. It's actually really cool to see. I actually have my, I think it's 15 year reunion coming up for medical school this summer. And so I think everybody's just had their own thing that they've kind of said, this is the path I want to take. Mine is definitely non traditional. Be curious if any of the other folks are like heavy on the business side. But it's been fun. It's been. I think if you were to ask my medical school colleagues about me at that time, I think they, they all thought that, that I would do kind of a non traditional path. So I don't think anybody will be surprised.

What do you think? So, you know, first for any of our listeners that say, well, you know, I am kind of interested in the business side of medicine, but I don't have, you know, a dad who, you know, can be kind of a mentor or, you know, and sometimes people think, oh well, you know, I need to get an MBA in order to understand this. Like what? I mean, what other ways can people kind of throughout their training, you know, try to really, you know, hone their skills and you know, maybe they really do have, you know, a brain for business, but they just don't really know it.

So I'll tell you two things. So one, there are always people in the hospital or in a medical school who have done some level of business in healthcare. So go find them. Go talk to anybody that will listen to you and say, hey, you know, tell me about your career. Okay, tell me more. You take them out to coffee, I don't know, water their plants when they're on vacation. Whatever you can do to try and just get exposure to as many humans that may be doing something that you like in a hospital setting. Go meet with the Chief Medical officer, go meet with the cmo. Like you're doing rotations here, third and fourth year. And I know you're going to be dog tired and it's not going to be the thing that sticks up in your mind, but honestly it's those moments, even if it's 10 or 15 minutes, are going to be the things that help you craft and, and kind of create your path that may be non traditional. As for the mba, I have not gotten my mba. I had a colleague of mine higher up on the food chain than I was, we were sitting in a boardroom and the CFO goes, when are you going to get my, your mba? And it was to this gentleman, he was a doctor. And the doctor goes, when are you going to go to. When are you going to get your md? And it just like stopped the room. And so, sure, like, would an mba, MBA be helpful? I think depending on where you are at in career, sure. Is it necessary? No. So just my advice is find mentors. Find people that can be your advocate, who can be your cheerleader, who can help and teach and that you can learn from. And you're not going to find that in kind of your traditional path that, that you are being put through. You do have to kind of sometimes speak up and go and find those individuals. Your.

Yeah, I think that that is huge. And that's why I love talking to people on this podcast. To just like open my mind up and open our viewers mind up to other paths that you can take. I mean, the medical education, it's, it's limited in some sense. Like they can only do so much, right? You can only do so much on your third year. You can only see so much. So it's really nice to be able to expose yourself to other opportunities, to.

Be able to.

See like what you want your life to look like. Because I think it's so easy to just think about the next step and not think about the big picture of, okay, what, like when I in practicing or when I am, you know, 10, 15 years from now, what do I want my life to look like?

So yeah, and write it down and believe that whatever it is that you say that you want, it is possible. You just gotta find the right mentors that can say, yeah, you know, that is possible and it's okay. If some people say, no, that's not possible, and just don't believe them.

And keep manifesting.

Right. I know. Just get that whatever manifest book and just open it up and just know it can happen. So, yeah.

Well, this has been great. And I know you have meeting, meeting, meeting, so we won't take up too much more of your time, but I always ask all of our guests this. I know we've talked a lot about advice and carving our own path, but just as we're kind of closing up, do you have any advice for medical students like me who are really early on in their education journey?

You know, the first two years are kind of a bear. You know, you're just in the books, you're in the classes you're studying. And then third and fourth year, I think, is where stuff kind of gets really fun. Exhausting, but fun. And I would say take every opportunity to ask questions of people that you encounter, whether that's patients or nurses or physicians. You know, learn from the people around you, because you are going to be exposed to so many different people between now and the time that you finish. And it's those little moments, even if it's five minutes, even if it's two minutes of learning about somebody else's career, somebody else's path, that may spark something in you that go, I like that plus this person plus that. And then you create this, like, dream opportunity of what your life looks like. And I think it's so easy to just accept what you're given and go, okay, this is what I'm going to do. And that you end up waking up one day and going, gosh, this isn't like the life I planned or wanted. And so I think if you take a step back and again, it's easy to just think about, okay, the next step in front of you. But try and. Try and have these moments of leveling up and going, what do I want? And then capturing those little moments from all these people. And then you'll build, I guess, your what you want over time.

That's great.

That's great.

I love that. Well, where can people find you? Where can people find your business and all of those things?

Yeah, sure. So, Nat RevMD we have a podcast on Apple or wherever you listen to podcasts and a website, N A T R E V. And if anybody's looking for career advice or just wants to chat, I'm always open to that. So any medical student, resident, whatever, you guys are welcome to reach out. It is heatheratrevmd.com and I promise to answer 100 of those emails, but just to share that, you know, anything's possible.

Awesome. And you guys know where to find us @Generations MD on TikTok and Instagram. And if you have any questions, you can email us at ask generations.mdgmail.com and we will talk to you next week. Bye, guys.

Bye.