This week’s episode features Dr. Julia Stevenson , a board certified Plastic and Reconstructive Surgeon. We talk about when she decided to pursue a career and medicine and when she realized Plastic Surgery was the specialty for her. *Hint, it was a lot later than most people would think. Dr. Stevenson talks about the incredible challenges she faced as the first Black trainee at her residency program.
Dr. Stevenson talks about starting Cardinal Plastic Surgery , her private practice. She shares some of her passion for decreasing healthcare disparities in the field of plastic surgery. Specifically, she talks about the disparites that exist when it comes to post-mastectomy reconstructive surgery.
Are you a pre-health professions student interested in a surgical specialty? Have you ever wondered what it takes to open your own practice? This is definitely the episode for you to listen to and share with a friend.
TBDP is a volunteer passion project with the goal of inspiring all who listen. In-house music and audio production, so any ideas for improvements or suggestions for future guests are welcome. Visit www.StevenBradleyMD.com to learn more about our host. He is available for consultations regarding health equity or medical ethics, as well as for mentorship.
Transcription
The black doctor’s podcast, i like the stories of minority professionals with the goal of inspiring others- you like when you here, to subscribe and share with other, because the next generation can be when he don’t see tuning every monday to hear our stories. He would welcome back to the black doctor’s podcast this week, i’m so side to be talking with dr julius stevenson. He is a board certified plastic surgeon. He graduated from the hampton university with a degree in biology before attending in state university college of medison, where she stayed or her residency at the penn state. Hershey plastics purgery residency program where she was he first african american person to complete that program after stevenson, so excited to hear from you here about all the things you’re up to with your own private practice, cardinal plasir surgery, but welcome to the show. Thank you for happy. I’m excited about this. So a doctor tevis an how was a you start by asking you how hampton istituto university i was. It was at university when i went, i was there rone thousand nine hundred n ne ninety two thousand and three so well. In ten amours got, you cut it up the way to yes, but tell us about your day in day out life as a classic surgen. We see the shows, i dipenta all the other reality tv shows. What is it like for you as a plastic surgin, i love what i do. Probably you know, i see a range of things and i know a lot of people’s understanding of platiere can sometimes be skewed, just like what you’re mentioning with tv shows and and kind of the things that are out there with regards to plastic surgery, but with plastic surgery. It’s really divided up into two sections of reconstruction and then the other is cosmetic and to simplify it as much as possible. One is insurance based and the other is not to help pay, but you can definitely do some reconstructor surgeries. If people don’t have inference that they can be self pay, but i love it because of the variety. So in a day, i can see consultations from the emergency room, whether it’s you know hand, fractures, tent and las terain. Facial fractures infections, those types of things and probably the more common things that i see on a scheduled appointment bases, are breast ree constructions and breast reductions from a reconstructive standpoint and then for cosmetic, a lot of breast augmentations tummy text and those types of things your. How many days are the week. Are you in the operating room, verses in in your clinics, one to two days in the operating room per week with some in office procedures, so that can be again little skin lesions like moles or things that are concerning for cancer? I do carpel tunnels and those types of things in my office as well as some eyelid surgery. So i try to do as much under local as possible, but those are the the number of days that i’m in the in either in the operating room or doing procedures in my office yealand. What’s the benefit of doing cases under local versus going to the oar s, some patients kind of get weird, i don’t have anesthesia yeah. You have to fuse patience wisely, but you have a captive audience, so i feel you know when i’m able to do things under local. You know people can ask the questions that they want to ask. I can really talk to them about what to expect in the recovery and what i’m doing and a lot of people are really interested in what you’re doing and again you know, if you think about surgery, especially if people are in antistia, you either have the time before surgery to tell them what to expect and what they can do afterwards and again, depending on how overwhelmed they are about even having the surgery they may forget, most of that yeah, and then it’s also difficult, if someone’s waking up for me, an a sesa or telling their family member what they can and can do so, you know if it’s under local, you can sit there and talk to them, and you know let them know what to expect and again. They can really actually ask the questions that they want to ask yeah. Is there a price different again if it’s, if it’s inference for them, not necessarily well yeah, because they’re not undergoing in as these and not, you know having something done at a facility. So when it comes to surgeries, there are really three different costs: there’s what the surgeon is paid. There is the anesthesia cost and then- and then there is the facility fee. So if it’s at a hospital orr at a surgery center or in the office, there’s different fees, and so, if you’re at a hospital, usually the price from their standpoint is going to be much higher. So, yes, there is a price difference for what the patent sees or what is sent to insurance for coverage of that based on the location, yeah and we’ll talk about some health care i parities later, but i bring it up because i was talking to someone and they felt like they were receiving a different level of care because their position wanted to do the procedure in the office, persons full at a tea. I think there’s a bit of a educational gar for this patient. I try to explain like no. This procedure is perfectly fine to be done under local and they’re, actually trying to help you and try to save you, some money yeah. You know that’s actually interesting. I’ve definitely had patience question you know doing something under local versus having it done at the hospital where sometimes they’re kind of like wait are you i’ve had i but both ways. Some people are thinking. Wait like. Are you sang like? Why are you doing it in your office but like to be frank, i could probably get you scheduled quicker yeah. We can get it done quicker and it’s going to be again cost effective. You don’t necessarily have to not eat after you know, stop eating after minute, there’s actually a lot of benefits, but because we’re so used to you know we just go here, go to sleep, that’s kind of the norm and the expectation i think the other thing is. The surgeon has to be comfortable with doing local, and i don’t think a lot of people have the patience and the skill to do that to make it as comfortable for the patients. So that’s. I think that also has a big plays, a big part in whether things are done under local versus anesthesia, yeah, absolutely yeah. So dr stevenson tell us about your journey into health care. What did you decide to become a physician and what was your process like? I always wanted to be. Maybe i should out. I always wanted to cut things i’ll set at first. Okay. I was always you know, i’m from the midwest, so my dad and my brothers fished and hunted, and so any time they were. You know, cleaning the fish or whatever i’m playing with the guts or you know do it that was kind of it. I just was drawn to it i loved, and when i can see i can look back now and say that i loved an atomy and kind of seeing the things that we don’t see. That’s on the inside, so i always knew i wanted to do medicine in with regards to surgery. I didn’t know what kind of surgery, though, so when i went to med school, i was really kind of keeping my options open. As far as you know, the types of surgery and again in medical school, you kind of have a limited amount of time to really explore all the different specialties right, and so you know in the first two years when we have you know the muscular scelle block and you have the worthed surgeons in there and you know kind of seeing what’s interesting. What’s not catton them on certain days, but i was initially drawn to gynecologic oncology right, and that was- and that was mainly because of the physician that kind of introduced me to like he was. He was amazing, and then i did my o begun rotation and i hated it. I was like, if i don’t get a guy non fellowship, there’s no way if you’re not delivering babies, i’m not doing past me or to the rest of my life. I just cannot, and so i had actually had o begin at the beginning of my third year, because i wanted to really know if that was what i wanted to do or not. Then i had my third rotation, which i was like. Okay, so i obe guines out. Let me see what surgery has and our search rotation was two months. The first month was a general surgery. I had sertain college and then the second month was two two weeks of specialties, so i actually had plastics and then transplant okay, first day of plastics, i was like i have to do this well now mind you. This is the pretty much the end of my third year, where we’re supposed to be applying for residencies yeah. I gondo yeah about like three months, so i had two weeks that i determined my whole life off of and i actually spoke to a guy in the class ahead of me, who was similar to me and that he didn’t realize classics was what he wanted to do until the very last minute, and i’m sure you recall this in medical school- that all the people that want to do like plastics, ortho yeah. They had been knowing from like day one. So they were research projects. They were, you know getting connected with people, and here i am again three months before we’re really supposed to be applying saying. Oh, my gosh is what i’m supposed to do well, and i spoke to this guy in the class ahead of me who just matched him plastics, and i said what do i do because, like this, i’m really actually blind sided, but i really didn’t didn’t think i was going to enjoy it as much as i did he’s like. I know it’s awesome right and he said go to the tar. He is a straight footer tell him, you want to apply to plastic surge you residency and if he would support your application and he said he will tell you yes or no, and you know based off on what he says like you can kind of figure out. If you want to continue on that with or without his support based off of what he says and i went and talked to the chair, and he said absolutely, i would support your application, wow and yeah, and it was you know when you find that thing that you really love in that clicks. It’s just it’s interesting. You want to work for it. You want to work hard at it and again. That was two weeks and i ended up being able to do my acting internship. The next month, like he worked about, were right. It was it was an elective month and i had something else to do and i asked him i said you know there’s no other time for me to do my acting internship for here, because you know all that stuff is scheduled. Everybody’s already put their applications in and he and i said i could potentially do it next month. He said i’ll talk to his student affairs and they got a worked out. So i did my acting internship literally the next month in my third year and work, my butt off and then i ended up applying and matching there that that is incredible and two things to highlight. One is the significance of gate keepers in meditande, there’s people in certain places which they can help you a lot or hurt you a lot, and thank god that he was there to help you and then you so led you mentioned, especially for the current medical students. You’re going to be told that if you don’t come in from day one planning on archidei surgery or neurosurgery or plastics that it can’t be done- and here you are living proof that that it still can be- and i’ll be honest, you know there were. There were a lot of lessons learned in that kind of five month period of when i did my plastic surgy rotation to my acting internship, and you know the months that followed because it gets you know it gets ugly when it comes to the competition. You know people being in your business about you know how many interviews you get, and so i you know any time i speak to students like do not get caught up in that stuff, because it’s very easy to get distracted and frustrated. But what’s for you as for you and so you, how was the residency experience for you? Because plastic surgery has this notoriously you know a lot of hype is a hypo legit, better, worse wi’m actually curious out what what’s the perception that you have yeah you guys work like dogs, yeah, yeah, yeah, pretty much so you know. There’s two ways of becoming a plastic surging: you can either do general surgery residency and which can be five to seven years depending if you do research in the or not followed by a plastic surgery fellowship which can be two to three years more commonly now you see a lot more plastic searching residences, which can be five to seven years, and i did the plastic certy residency in sen at that point in time was actually transferring from the fellowship to the residency program. Okay, i think i was in the second second class of classic servy residents, and so you know our first three years are in general surgery and it’s rough because the hope or the structure is that the general surge rata ion you. You are obviously relevant to what you’re going to encounter in plastic surgery. So you know with some of the combination cases we do with even getting familiar with. You know the gi track, because you can use different flaps from you know the e tracked and those types of things and learning, anatomy and approaches and those types of things. But i’ll tell you what probably the most intense part is: our educational conference, i’ve been a part etive general surgery, educational conference and obviously i’ve done plastic surgery, educational conferences- and i don’t know if this has come up on the podcast of pip sessions but like the whole goal of ars, is to humiliate you. Oh and this is that, like five thirty six clock in the morning and because it’s a you know, plastic surgery, when we talk about you know the reconstructive process, you have to have backup plans with back up plans that have backup plans, yeah and go. You know. Ours is obviously very visual, so you know we’re in this small little library with the dry race board as the projector screen and we project the images up there. You know you get up there, you tell them what you see tell him what your approach is going to be, and you know you t, you basically explain your thought process and what you would do and they’re like. Oh yeah, that’s cute that dies. What what do you o next and but it’s i mean it gets really brutal. Like that’s the dumbest thing i ever heard, what are you going to do next because that’s not going to work, you know like and amband it’s interesting when i think about that process and then the things that i’ve seen that it’s very true because everybody’s body’s different everybody’s had different surgeries and sometimes those things that you bank on are not options, and so you really have to think outside the box. So in that way, plastic serty training is it’s brutal, but i, but again i loved it in a way. I have a love hate relationship back. It resounds like it. I love the ili love the field. Okay, the process was very very hard. Now you think that’s the culture of certain programs or do you think across the board that they have that kind of malignant nature to him? That’s a good question. I think i think some of it is the culture of the specialty, but yeah i did some. I did some of way erotion at other facilities. I feel like they were similar huh. I do go you and you know i hate to stay like that’s how they got you confident, because i really don’t. I don’t believe you have to like, beat somebody down to build them up. I don’t i’m not a believer necessarily in that, but there again for some of the kind of stuff we do. You do have to have a certain amount of confidence yeah, because you know you think about you just like how like how do you do that? Like that’s? How does someone, let us take the skull off of their child to reconstruct like it’s yeast, some crazy stuff. You know what i mean like. There’s got to be a bit of over confidence to say yeah, and i can do that at ye. I can take. I can take your radius, we can struck. You know like it’s there’s some crazy y, crazy things that do take a certain amount of confidence, but i think i do think i do think a significant part is the personality of specialty got you. That’s is very interesting, especially. You know, because we’re kind of trying to is a push for the kinder gentler, medical education and personally, i do pretty well in that kind of more intent environment. I know some people don’t do as well. So what would you say to folks that maybe don’t thrive in environments like that that want to go to plastic surgery m, i would say, do what you need to do to get through it, but and kind of one of my mentalities is you know you learn from everybody. You learned from the people that you want to emulate. You learn for the people. You don’t want to cimuliae, so you know meaning that if you have some kind of experience during residence, he re like that was truly prometen. I will make note to myself never to do that, yeah. You know and thinking of other ways that that could have better been taught or explained or communicated. Sometimes it’s just a matter of doing what community do to get through, making that mental note of how you would do that differently and going from there and being a better surgeon and physician take king that into account yeah. No, it’s a good way to look at it and to approach things and we’re glad you made it through, and you can bet that kind. Er, gettler, plastic, surgeon, m, yeah, o it’s funny too, because the my co resident that i matched with was also a woman. I think that was the first year that they took two women and we were in the same class together graduating for medical school and we told each other. We said: listen if, if you see me starting to act like a jure like for absolutely no reason like, i give you permission to hit me because we don’t want to be that that thing that we’ve seen, i don’t want to be that i don’t want to become that. I like call me out on it. If it’s completely uncalled for call me out on it, did it ever come to that? No because i think i think we that was kind of the way that we functioned in you know, there’s there’s a better way, sometimes than you know the easy default, and that’s why we need more people like you in these specialities that are typically hard to match into. We need more representation of all sorts yeah. So, dr stevenson, you finished felt residency. You made it through. You survived you practice for a bit and then he decided to step out on your own. You started carinola surgery. Could you tell us about that decision to hang a shingle and go into private practice? So i’ll be honest, i probably have to start with finishing residency where you know there were some fellow residents that you know started private practices. Those are the people that did not go into academia. A lot of the other residents went into academia so that you know they were going to be at a hospital system. I didn’t really. Nobody was necessarily saying start your own practice. I feel like the again the default or the encouraging the way they would encourage. You was like to go into academia. Okay, so i didn’t necessarily think of any other thing other than being like a hospital employee. So you know i did what i thought was the easiest thing to do coming out of residency needing to pair for boards and being a hospital employee, and i do think that that was definitely a good learning experience, because i didn’t necessarily know any anybody like personally close to me that had a private practice and starting it from scratch, and so i do think it was very valuable, being an employed plastic surgeon at a hospital just to see what some of the barriers are in health caredom, because i don’t think medical education teaches us enough about insurance about. You know billing and coding, and just how the whole machine runs. So when i left there again, i i was actually looking for is down here virginia just wanting to get some of that business in private practice, exposure under my belt and then potentially like okay, now that you know now that i’ve gotten some of this experience on how to run practice, maybe i’ll venture out on my own- and there was no body- and this is. This- is an interesting story on its own that wanted to hire a black email, plastic surgeon m yeah, and it was interesting because at that point in time i have some other friends who are black in plastic surgeons and they were at the same time also venturing out starting their own practices, either leaving private practices or just starting their own from scratch. And one of them checked in on me. While i was you know interviewing and looking around, and he said he said no you’re going to have to start your own, like really, he said yeah. She said i point blake had somebody tell me i was the most qualified person, but their practice couldn’t take a black woman plastic surgin. What right? And so i’m you know, i’m sitting here wondering like. Why am i like you? People are saying: oh, we want to go to different direction and you know you don’t want to read it that way, because i’m like, i know that there are people right out of residency that are joining private practices. So what is the demo like? I passed my boards like what is going on and it’s true so at that point in time when she said that i said well, i guess this is what we’re doing so. It really wasn’t me starting my own. Private practice was not my plan a, but it had to be, and i’ll be honest, it’s it’s been very, very rewarding. It’s been very hard work. I wouldn’t trade it for anything, not just for the independence, but for how i’m now able to really appreciate what it’s particularly you know. People talk about the old good old days and you know everybody was like a private practice community doctor where you weren’t forced to do what a hospital or insurance company told you to do, and those are the things that i really think is missing from medical education and resident education. Nobody talks about how the machine runs you’re. I look back and i think i was just trained to be a hamster in the wheel right and so it’s been very eye opening and i i think every medical student and every resident could have some exposure to private practices. They’re disappearing, because you know larger hospital systems are buying them up. Yeah, you see a lot of private practices. Well, i would let me clarify: there are private practices that are disappearing, mainly because a lot of larger hospital systems are buying them up and the physicians are becoming employed by the by the hospital system, and you know if you have a larger hospital simi’s very difficult for those smaller practices is to compete, but you are also seeing a growing number of a practice. I now care doctors and i’m not sure if this is the topic that you haver been be very interesting, because i think more medical students and resident you know about it: direct primary care m and actually a good friend down in austin who started his practice. Where again, it’s your bad pack in the insurance company, its self pay, it’s direct relationship, keeper and more affordable health care, that’s better for the patient and the physition. So you have private practices again. That can’t compete with these larger hospital systems, but there is an independence and a power of a physician that is in private practice that i truly do feel that that would be a part of. I think the growing conversation in the medical community amongst physicians is that you know we’re losing jobs and no not if we’re not needed. Other people are taking over because again, if, if you’re employed an hospital system- and they decide to you- know fire you and hire somebody else, you feel disposable right. You went through all paining and everything for no reason, but i think private practice to me that’s the way of physicians in some way, taking their power back and being able to run and run your practice and to take care of patients. The way you want to, as opposed to how administration is telling you to that. No, it’s awesome. How long it take you to go from the idea of carnolitz to opening your doors one year. That’s oh wow, yeah! It was probab that was probably maybe may of twenty seventeen, where i had that discussion with that other plastic surgeon. Oh i take that back. I think it was like july and i literally drove down here to virginia from upstate new york to find a place to live. My mom didn’t know, that’s what i was doing and i found a place to live. I drove back and moved down here within a month and even when i was putting my deposit down on my on my town, how the bank, where i went, i asked him if they had a health care loan officer and they hooked me up with him right away, and i was starting at process when i came down here to find a place, w h live and from there it was. You know, finding a real, tur and all those types of things i moved down here and got started, and so you know with the banking and the financial aspect getting in connection with people again. I literally started from scratch, but i wasn’t from the area. People didn’t know me. I was purchasing a practice. It was literally from square one, but i’ll be honest. It was probably one of the greatest learning processes and still is it’s good. It’s really encouraging to hear that something as intimidating as opening your own practice can be successful, can be a good and rewarding experience. Yeah absolutely, and i would, i would say, the one of the first things. One of the many conversations i had with myself when i started the process because again it seemed to ron me i’m like i don’t even know what i don’t know. I gave myself permission to not know if i was talking to people who assumed that i knew the ins and outs of starting a practice of you know, properties and all those kinds of things i let them know. So you talk to me like i’m in fifth grade, even if even if i thought i’d heard it before, i said no explain it to me because the more questions you ask and the more times people are able to explain things to you, catch different things, yea and things think in a different way and you get a better appreciation. Oh so that’s what that meant. So i had. I gave myself permission to not know, and there was a huge amount of humility in that where i now people would be looking at me like. Why don’t you know that? I don’t know because i don’t know it, i’ve never done it before. I explain it to me and i think again, like in medicine we do get. We do have this there’s a pride is like oh yeah. I know that you have to kind of let that go, especially when you start your own business, and i think we should take that in medicine as well, but that’s kind of again the culture of medicine yeah. No, that’s that’s good to know so, dr dator stevenson, as a black woman plastic surgeon. What does that mean for your patience? We know. There’s health cares parties. I remember for the first time watching your social media. You mentioned some health care disparities with post mastectomy reconstruction stuff, i didn’t even know, existed as in a seselis, but what? What do you know about plastic surgery and how it disproportionately affects black people and black women yeah? You know it’s unfortunate, that you know it’s two thousand and twenty one and we still talk about a lot of health care disparities. You know the most common thing again for me when it comes to reconstruction would be breste construction and i still meet women. Who’ve had mass econe or some kind of camp breast cancer treatment, even within the last. You know five to seven years who say no one even told me that reconstruction was an option which is insane to me that my you know when it comes to recto plastic server and we talked about reconstructive process. I think of myself as someone who’s able to provide restoration and to think that there is a whole segment of people who are being denied restoration, disturbs me, and you know, when i talk about breast reconstruction or just breath in general. I feel like that is kind of a it’s symbolic of you know women’s right where people would otherwise they will just be glad you don’t have breast cancer. Well, you know, as a woman, your breath are a part, a huge part of your physical identity when you’re developing what you who, what are you comparing when you’re in fit and sixth grade who starts wearing a training braw. So you can’t say that that is not a significant, a significant part of a woman’s identity and body image, but to say that it’s not significant enough to offer restoration of that thing. Body image, motherhood, sexuality, but they’re only sexualized, that’s the only importance for them, but when it comes to breast hands, who cares that that that’s? Why i find myself on the end of being a woman’s right advocate, even when it comes to just breasts in general, where you know a lot of people, and this is any patients that i talk to you about breast street construction? I always let them know about the women’s health care and breath cancer act, stating that it has to be covered anything. You have done for reconstruction of your breath, whether you had a math teck on one side and you had a surgery on the other breast to provide symmetry. Anything you have done related to your breast cancer surgery is covered by insurance. Really, it’s not cosmetic, even if you had it done, and you know ten years, fifteen years down the road, something doesn’t look right. Something changes you wanted t address. It is not cosmetic and the fact that women do not know that again disturbs me, so it’s you have a right that you are led to believe is just superficial when it’s not and that’s a part of your body, so you know right and in the most common cowork people that that is denied to a black women yeah either either that decision is made for them that, oh you know, they want ed reconstruction or they. You know they just aren’t told about it. And again i gave a talk. I guess it was two years ago now and they had women coming up to they’re. Like yeah, i had a mess up to me like five years ago. Nobody told me that i could have reaking it’s like the horrific and not even just that part. Then you talk about how that affects their relationships with their partner, like everybody’s feeling, uncomfortable about you know the changes in the body and nobody wants to talk about it because nobody’s talking about how you talked about it like it there’s so much in this topic. Relationships and families fall part over this, but no one. You know no one, it’s this thing that nobody feels is important enough to discuss. So i get very, very passionate when it comes to not only with breste construction, even like breast reductions, insurance. Some things make it so hard for women that are in pain. To have that address. Well, i mean and what a gain as a dude i mean i didn’t know much until i saw your post. I was like whoa. This is a big deal and i looked up the article and since then i’ve at least known that this disparity exists and i’m so re glad that women have you and as if the surgical specialties become, you know more diverse, with both women, physicians and surgeons of color, that we can help to eradicate and fight back on some of these health care disparities right exactly and that and that you know, if we aren’t there to bring it up, it doesn’t get talked about yeah wow, that that is a that’s heavy, but man. Thank you so much for sharing, and hopefully you know, as our listeners are empowered by this information, they too can go out and champion for for this. No thank you for giving me this platform and thank you for having a podcast to discuss these types of things, of course, and thank you so much for coming on the show. Now we can’t let you go without you telling us about cardinal plastic surgery. What services you offer how people can get a hold of you yeah, so cardall surgery is the name of my practice and my motto is where you are the standard of beauty, because i think so often we look to other things to compare ourselves with as if we’re worthy enough, but i think everybody has something at least one thing that they admire and love about themselves. That is a point of beauty that you were the standard of beauty. My practice is located in chest to peak virginia and my website is cardinal plastic surgery: com, an active on social media. To an extent, social media is exhausting, i than to say that for the one thing so facebook and instagram- and you know either reach out on social media or i can be reached in my contact information there and on the website. We offer again general plastic surgery, so cosmetic and reconstructive. So when it comes to cosmetic, surgical and non surgical, so you know neurotoxin, dermal, fillers, skin, peels micro needle and just general, the general breadth of plastic surgery and you’ve been open for how many years now so we are in the third year right now i open december of two thousand and eighteen even year. Three congratulations. I remember i came out, visited your amazing office just to look and see and support this sister plastic surgeon. Thank you and i survived the pandemic. Listen. This was real, but yeah. How was it was that yeah t for me was the pandemic and i was stressful. I’m not gonna lie, i need it through, and things are really starting to pick up. There’s been a an interesting phenomenon that we’ve noticed in plastic surgery. Now that everybody’s doing things virtually because everybody has to look at their face all the time they’re like wait a minute i didn’t know. I look like that. Now, there’s a lot more people o in not only to get things done to their faith, but because, if they’re working from home, they you know that’s their down time to recover. So we’ve actually been a boot ind a boom and more copasetic an interesting pandemic. I don’t want to face the blood necessarily but yeah. It’s good. I’m glad you’re able to keep the doors open. Yeah yeah me to, and let me do when i can come down schedule, some calf objections or or we go work in my as ere have a top boy summer have been plant or anything like that. Yeah, like o filmer steve. I thank you so much rejoining us. I know or listeners there goin a greatly benefit and enjoy learn from the tansy shared. Thank you. Thank you for having me ye black doctor’s podcast, not profit volunteer passion project, the monsir anext week or other episode is r s r. Your friend e