Scott, I wanted to actually go back to you and pivot to a different aspect that you actually offered to answer for us, which is the diversity aspect and how we can incorporate that in our ASCs. If you can shed some light or thoughts you may have. Yeah, and thanks for asking. I know Dr. Sethi had a great talk and it was something that I've looked at the financial impact across a large network of ambulatory centers, GI ambulatory centers. And what we were doing with some analysts was looking for trends. And one of the things that it's not surprising, but the common theme was when we saw an inflection point in procedural volume, when we dug into it, it was because a new female associate was hired. And this was across a large 50 plus network of ambulatory centers. And if there's any advice I can offer large groups, small groups is I know 50% of the GI fellows right now are female and you are activating a new patient population. And if you look at the physician gastroenterology ratings for male gastroenterologists versus female gastroenterologists, particularly in diseases like IBD, it is staggering the difference. So I think this is no different than what we saw in gynecology two decades plus ago is you will activate new female head of household patients that will then activate their male spouses, as well as male family members to activate a new patient population. And I always encourage groups that I work with, whatever you can do to recruit new female associates, whether it's job share, whether it's additional, you know, work life balance hours, it is going to benefit your group. So enough said on that topic, but it's a very strategic wave of the future. And quite honestly, unfortunately, a lot of groups are just stubborn and bullheaded and, you know, don't make exceptions for new associates. And it's really a shame because of what female gastroenterologists are doing for building awareness and activating new patients. I appreciate you saying that. And I think it's so important to be open minded and make accommodations so that that female provider is successful during family obligations and things that Amrita was pointing earlier. And I am extremely cognizant of that as one of the female providers in my group. So thanks for touching on that. I have a couple of broader questions. This one goes to Praveen. This question came up in the Q&A. How was the second bite this year? I'm trying to understand. It was very tasty. So Jim, why don't you answer that? It is your question, actually, but if you're obligated not to speak about it, I can say whatever I know. No, no. I was making a joke. Go ahead. Use answer. So from what I know about the second bite, and this is not coming from Dr. Jim Leavitt, it's coming from public sources. So you can go look it up. So the gastro health was expectedly valued at mid 900 million. And that's that's that was the transaction. And a significant portion of it could be leveraged or not, like, you know, that is, again, some you have to get it from the right sources. And when you say how did the second bite do, I do think from a financial standpoint, based on everything that I'm seeing, very, very successful. It shows the way from a private equity and gastroenterology standpoint on how to systematically go about it. Again, I'm speaking purely from a business and economic standpoint. So that's a short answer to. Let me I think people have to understand something. So when there's a when when the private equity firm sells to another private equity firm, the second private equity firm just steps into the shoes of the first one. It's not the same governance documents are there. The same thing that protects physicians are there. Everything is the same. We don't feel any operational difference. And every time. And Scott can speak to this about this. But every private equity firm has its own niche. So Audax was in the lower middle market. They like to take companies from 10 million to EBITDA on the average to 50. Homers and those types of companies are middle market like to take them from EBITDA from 50 million, their expertise to 150 or 200 million in EBITDA and not just grow that, but to be able to bring resources to the companies to make them great companies if you pick the right partner. So you want to, you know, Audax, it was they didn't have the expertise to take us to the next step. And Homers does. But as far as the physicians go, it's another transaction. It's another rollout. It's another cash. And it's more equity in the new company. But functionally, we don't feel the difference, except we get more and more sophisticated. Does that change anything with your autonomy, which is one of the questions that came up? Yeah. So autonomy is it's all in our governance documents. So doctors, doctors, what do doctors care about? They care about their patients, obviously, then they care about governance and money in that order, I think. And so we built in and what you should, if you're going to do this, build in in your governance documents, what they what you care about as a physician. They can't tell us how many patients see an hour, where to go, what days to work, how much vacation. I mean, up to a point, if we started taking 30 weeks vacation, someone would probably say something. But, um, you know, but you know what I'm saying? That is in our governance documents, whoever takes over, they can't tell us what to do there. We run an independent practice. Our management is our management of our company. It was the same management. I mean, it's more sophisticated management, but that's we run the company. Now, if we were doing very poorly, they'd probably be all over us, but they're not. They're just helping us get better. Thank you. This one is for you and others can chime in as well. In terms of the pattern you've seen with the dermatology and other specialties that have consolidated, what is the path forward for those groups that are not doing anything at this point? And how has that evolved with those specialties? Do you feel 100% have consolidated one way or the other in DERM or are there private practice groups that are still standing alone? There are actually private practice groups that are standing alone. And I think, you know, in looking at dermatology or ophthalmology, the groups that are thriving that are not private equity owned have looked at ancillary streams, have optimized their ancillary streams and have really become integrated into their local markets. Whether it's leveraging their data, I look at the gastroenterology ancillary streams are very similar to both DERM and ophthalmology. I mean, ophthalmology is actually a big infusion market, similar to what we see in GI. And I always talk to my ophthalmologist about this because he has an infusion lab. He's a uveitis specialist and he is now getting into specialty pharmacy. And he is a four or five man group, very entrepreneurial and he's thriving. And he always tells me that, you know, I don't need private equity because I've set a business plan and I'm providing, you know, superior service to he came out of Mass Eye and Ear and he's in private practice. So up in the Boston area. So, you know, he's competing against, you know, arguably one of the best specialty hospitals in the country for ophthalmology and he's created a niche. And I, you know, my general suggestion is leverage your strengths. You know, if you haven't explored ancillaries, they, you know, for not a lot of extra clinical effort. And, you know, I know Dr. Levitt or, you know, can speak to this. It is a way to leverage the patient and the continuity with that patient across, you know, multiple different ancillary lines. And quite honestly, as a patient, I love it. I'm speaking from ophthalmology is I can go and, you know, talk to the infusion nurse, including my, I'm on Humira. So I'm very sensitive to, you know, the biologic mark and everything else. But, you know, it's wonderful when I go there, I can deal with my infusion. I can deal with, you know, the regular checkups I've seen. And it's kind of a one-stop shop. And I, so often I put myself in that patient experience shoes to figure out, okay, what's broken in healthcare and what's right. I totally agree with you from the patient perspective. We've seen that firsthand in terms of our infusion teams and the impact they have in providing that touch point and continuity for our IBD patients. Well, we talked about several different aspects of this particular segment of how the business is evolving and how we may see this affecting us or not. And thank you for all of the tips and ideas and the provocative questions you've provided us or thoughts you've left us with. I really hope that there are private equity companies that are giving 14 times the EBITDA, Praveen, as you pointed out, so people can benefit. But I think that's a lofty number. Thank you so much for participating, sharing your thoughts. And I really appreciate all of you being on the panel for this discussion.

diversity

ambulatory surgery centers

procedural volumes

female gastroenterologists

patient population