You guys are the hardcore last survivors, so I'll try not to belabor the point here. I will tell you that when you start talking about practice financials, things can get very dense very quickly. And quite honestly, the reason we all went to medical school is so we wouldn't have to do business, yet medicine, like it or not, is a business. It's not just a noble profession. And so paying attention and having some glancing familiarity with some of this stuff is actually fairly important. Okay, so let's just talk about RVUs. Just so you guys, everybody talks about RVUs, what's an RVU? So an RVU is a system they came up with many years ago to compensate physicians based on the work done. It's got three components, right? It's got your physician work component, your practice expense, and your malpractice component. And I won't get into all these because it's quite painful to listen to all this stuff, but really this is what you should be looking at, right? So from your practice standpoint as an outpatient gastroenterologist, these are the RVUs that you're going to be most interested in. And the top part is actually your typical outpatient office visits, whether it's a new patient visit or a follow-up office visit. And then on the bottom is your most common procedures. And you can see the difference. And these numbers are completely artificial, right? This is something that was come up with by a committee called the RUC. And the RUC is the RV Utilization Update Committee, which is a committee that makes recommendations to CMS about what these codes should be valued at. 32 members, 22 specialties represented on that committee. Gastroenterology is not one of them and has not been for a long time, which is why you see more and more devaluation of GI procedure codes and more evaluation of evaluation and management codes. And this is politics, clear and simple. And what it actually tells you very clearly is the old adage is true. If you're not at the table, you're on the menu. And that's what we're seeing in gastroenterology. And so, just to be aware of, these get revalued on every couple of year basis and GI codes are under pressure continually. Ask the American Medical Association because they made recommendations 25 years ago about what specialties should be on there as permanent members. Dermatology is a permanent member, but GI is not. And there are four chairs that are actually rotating chairs. And those are reserved for medical, internal medicine subspecialties. GI has not been on this committee for more than a decade. So it's politics. Yes. It's a pie, so if you go up in RVUs for one thing, you actually have to go down in something else. Like there's no, they don't just keep adding things in. Zero sum game. So there's going to always be winners and losers and that's what they're picking at those meetings. Okay. So there's some metrics that you're going to want to become familiar with as you get into your private practice. And these are going to be a lot more important for you if you're in private practice of any sort and maybe a little bit less so if you're in a purely employment model where you're going to really need to be primarily familiar with the RVUs and your production and their compensation formulas based on that. But you're going to want to know what revenue is and RCM, Revenue Cycle Management. I've got a slide on that a little bit and it shows you that it's actually a fairly complicated process and a huge part of any private practice and it's how you send out a bill and collect for it. Your collection percentage. So that tells you how good you are at your billing and collections process. If you send out a bill for $100 to a thousand people, how much of that $100 per thousand people do you actually collect because it's not $100. It's less than that. Your accounts receivables. You send a bill out and then you wait for it to get paid, right? You don't get paid like that. The fastest payer is actually Medicare. You typically get paid for a Medicare bill in two to three weeks, but some payers are notoriously slow and their contracts may say they have to pay you within 45 to 60 days. So they get to float their interest on that money while they're processing your claim and they can slow pay you. So be aware of that and I'll get a slide on that. Look at your average reimbursement for procedure. It sort of gives you a viability chart of, you know, you love doing ERCPs, but you take two and a half hours to do one and you get paid very little compared to a colonoscopy or polypectomy that takes you 20 minutes that you get paid reasonably well for. So just to be aware of that doesn't mean that you should change your practice patterns. Just gives you visibility into your practice. Also look at always at your operating expenses, that's your overhead, right? And the biggest expense of anybody's overhead is going to be your employee salaries. And that's just the way it is. Rent probably number two, followed closely by IT and IT support. That didn't used to be a thing 20 years ago, but it is absolutely a thing now. And then, you know, supplies in your office and paper and that kind of stuff, copiers. And then look at your profit margin, not because you're that worried about your profit margin in any specific year, that's going to be affected by a number of factors. But trending that over years is actually important to give you an idea of the direction of your practice. So let's talk about revenue cycle management real quick. This starts from the minute the patient contacts your office and goes until the last dollar is paid on a claim, right? So you schedule a patient, you register them, you got to put information in the computer. If that information is not put in the computer correctly, that claim is going to be denied. Verify insurance. Are you on their network? Is the service you're recommending covered? If it's wrong, the claim is going to be denied. It goes on and on. Patient comes into your office, you collect a copay. That copay might be $5, it might be $20, it might be a percentage of their responsibility. It depends on whether or not their deductible has been met for the year as to what they're going to owe. You need to know that because you're going to collect that money up front from the patient. If you wait to collect that money down the road, you are going to collect a fraction of that money. So make sure you're aware of that. You have to document the visit, meaning you have to finish the note, you have to justify the code that you put down, close the note, and then it goes to a bill. Your medical coding, you code it correctly, you put in the demographics, you enter the charge, you check the claim, you submit the claim, usually through a clearinghouse. The payer processes the claim and then they determine whether or not they're going to pay you based on all their criteria. Hopefully most of the time they're paying you, sometimes they don't. They deny the claim because one of those things was wrong or they made a mistake. And then your office is responsible for going back to them and saying, wait a minute, you didn't pay this claim. We did everything right. Oh, our bad, no problem. Three months later, they pay you. Your office staff has been chasing that claim for the whole three months. That's your overhead, right? Then accounts receivable follow-up and appeals. So sometimes you have to do appeals and you guys have all done peer-to-peer record requests for things like getting a biologic or getting a claim paid. And sometimes that's really very cumbersome for your time. And then finally, you might send the patient a statement. Basically saying your entire bill is claimed, is paid and we're good. This process can, in its best situation, take three weeks and its worst, it never gets done and you actually have to write off bad debt. But if you're doing the collecting within 60 days, you're doing okay. Let's talk about, and again, this is all graphical because it gets dense, and these are made up numbers, but this is a representative fee schedule. So let's look at that. So your codes are over there on the left, or your services, your codes are in the box. And so those are the codes that you are going to submit. And the fee that you charge, that's what you say, I'm going to charge for this service. And that's just a made up number. That's what's called UCR, Usual, Customary and Reasonable for your market. And you just make the number up. And then any of your payers is going to pay a percentage of that based on the contract negotiations that you did with that payer. And you might have more clout with a small payer, like a Humana. You might have less clout with a big payer, like a Blue Cross. And so it's just going to depend. But what you need to know about this is that number one, Medicare is always going to be a dog, right? That's going to likely be your lowest payer in a market, unless you're a terrible negotiator, which is certainly possible. But Medicare is going to be your lowest payer. Your fee schedule, as you can see, that number, that one listed at the top, the 140, that's the highest number on that line. It needs to be the highest number on that line. Because if it's not, if your Blue Cross pays you $160 and you're only charging $140, you just left $20 on the table. So when you hear all these stories in the media about this astronomical bill that a patient got, it's true. They got an astronomical bill for $6,000 for a CT scan. But the payer is only going to pay $320 of that. So the bill, it's much less relevant than what the payment is, okay? This exemplifies that a little bit better, right? So same two columns on the left. Your fee, which is your charge, is in the middle column. Your payment is going to be on the top, say, of a fee of $140. Your payment is going to be $105. You expect that you're going to get $105 for that charge. You're going to adjust the remainder, right? So you're going to adjust $35 on that charge. That's not bad debt. You never expected to get that. That's just the adjustment. So don't worry about the adjustments as long as the numbers all add up. That's fine. What you have to worry about is the payment and that your fee schedule is set correctly. Let's talk about accounts receivable aging. So I talked about, right, you don't get paid right away for doing something. That payment comes in later. So let's just look at this representative sample. And again, these numbers are made up, so I'm not sharing confidential information. Typically, you're going to measure your accounts receivable based on months. So 0 to 30 days, 31 to 60, 61 to 90, 91 plus, and some people do 120 plus. In this example, you're looking at the middle column, Cigna. So you're doing okay with Cigna. 49% of your claims are being paid in that first month. That's pretty good. That means you're doing a good job. Your office got their data entered correctly, et cetera. You get another 31% paid in the next month. And the good news is, the very top in the purple, you only have 8% of your claims that are not being paid within 91 days, right? So that's actually not terrible. You're doing a good job, and Cigna's paying you appropriately. Having said that, specifically looking at the Humana column, and again, Humana's fine, but I'm just giving an example, they've got 21% of your claims that have not been paid in 90 days. Why is that? It seems like your office is doing a good job with Cigna, doing a good job with Aetna, or they're doing a bad job with Humana, doubtful. Maybe it's that Humana's a dog, and that they're not paying you because their processes are terrible, their computer system's terrible. Or they've got a policy that says, we're not going to pay you on claims unless, you know, we're not even going to consider your claim for the first 60 days. That would be in your contract, but again, that's just money that you're loaning them, that you should be collecting, and it's something that's going to stay on your books. And the older your charges are, the less likely you are to collect on them. So keep an eye on that. And again, I'm going to go quickly because I know you guys are tired and it's getting late. Those are the financial metrics that you might want to become familiar with. Let's talk a little bit about more strategic metrics that you want to become familiar with. So it's really probably pretty important for you to know how many patients who are coming to your practice are new, and how many are established. Young partners who are coming in, probably going to have a whole lot of new patients because there's been a backlog, they're coming in, they're filling a need. There's lots of referrals that have been sitting out there, and the doctors who are there already are busy, and they can't fit any more people into their schedule. So they hired you to come in, and suddenly you've got 14 new patients on your schedule every day. That's great. It's really good, and you can really build a practice quickly that way. Think about it another way. You come in and you replace a doctor who had a really great practice, but who retired, had a ton of patients, and you came in to take that doctor's place. Suddenly you just walked in to a massive panel of established patients, and some of these patients might be fairly complicated, and yet you're getting 15-minute slots to learn about all these complicated patients that have had the same doctor for the last 30 years, and suddenly you're the newbie, and they're going, oh, what are you going to do for me? Dr. Smith was awesome, and you got to figure this out in your first year or two of practice as you assume that practice, but it's important to know where your patients, what's your patient mix and where they're coming from. Also as far as colonoscopies, some practices do open access colonoscopy, meaning a patient's 45, and they say, you know, I don't have any problems. I don't need to come in for an office visit. I'm completely healthy. Can I just call your office and schedule a colonoscopy? Most practices have a process for doing that, and they'll have either your medical assistant or someone who will actually do a standard interview for the patient over the phone and get them ready for the colonoscopy, and the first time you ever see them will be in the endoscopy suite when you talk to them before the procedure. That's fine. It's a way to service a demand. You need to know if you have a lot of open access or if you have a lot of patients coming in just for a screening colonoscopy visit. Most insurances, including Medicare, do not pay you for a screening colonoscopy visit. So that's freebie work. Know what your mix of is versus procedures versus evaluation and management codes, and I'll show you a little graph on that, and importantly, know what your payer mix is because your payer mix tells you how many patients of Blue Cross United, et cetera, you have and what your practice looks like from a strategic standpoint and what your opportunities are and what your vulnerabilities are as a practice, and I'll show you a graph on that also. Procedures per endoscopy day. All right. So think about this. We're all interested, and I spoke before about efficiency. The least efficient thing that you can do during your workday is travel. So what you want is you want to block yourself in one location for as long as you can, and if you can do it for an entire day, that's nirvana, right? So you want to be in the office from whatever you're eight to five, seeing patients the whole time, take a lunch, don't take a lunch, doesn't matter, but you don't have to travel. If you have a procedure day, the most efficient thing that you can do is to be in the endoscopy lab all day. Just stay there all day. Now, I'm going to temper that by saying that sometimes that leads to fatigue, and if you're doing 12 cases a day, that's very doable, pretty nice endoscopy day, quite frankly, and you're going to be happy as a clam. If you're doing 20 a day, and trust me, lots of us do 20 a day, you're going to get really tired, and your shoulder's going to hurt, and your wrists are going to hurt, and your fingers are going to be killing you, and when you get a little older, that's going to get more of an issue, and there are studies that show that your actual adenoma detection rate may be less in the afternoon than in the morning. So just be aware that the more efficient you can be in the lab means staying there longer, but there's a trade-off, and you have to learn where your personal sweet spot is as far as getting too tired to do a good job for your patients, because we're talking about finances and efficiency here, but really what it comes down to is you have to deliver high-quality care to every patient you have, specifically in the endoscopy lab, no matter whether their procedure is at 7 a.m. or 4 p.m., okay? So be aware of that. And then we're going to talk a little bit about physician productivity, and the various compensation models, and how you actually allocate overhead, because that, it turns out, is fairly important. So let's just go over a couple of these things real quick. Again, this just looks at practice revenue, and it looks at your evaluation and management codes, so that's your office visits, versus your procedure codes, and this is revenue. So this is what you would collect as a percentage of your overall collections, and this is a pretty representative sample. If you're doing a typical outpatient procedure volumes, you know, 65 to 70% of your revenue is going to be generated from procedure codes. Now I didn't break this into EGDs versus colonoscopies, but you can basically make the assumption if you have a typical outpatient practice, of that 65%, about 70% is going to be colonoscopy, and that's also where the demand is, right? So let's talk about payer mix, and this is what I discussed a little bit earlier. So in this example, you see that most of your practice, about a third is Medicare, and that's actually fairly representative of a community practice. Maybe a third of your practice is going to be Medicare, and that may be traditional Medicare, which is just people who get to 65, they sign up for Medicare, and everything's good, or what's called a Medicare Advantage Plan. So what's that? The government has decided, not a bad idea, that they want to get risk away from the government. Risk for dollars, right? And so what they've done is they said, let's take an example in Arizona. Okay, Arizona, you guys have a million Medicare patients, and we want the insurance companies, the Unitas, the Signas, the Blue Crosses, to take responsibility for some segments of those patients, usually based on geography, and we're going to give you a set dollar figure, based on historical averages, to take care of those patients, per patient. So Blue Cross, you're going to take 200,000 of those million patients, and we're going to pay you per patient, 200,000 patients, dollar figure, you get to take care of all those patients, use your business to be as efficient as you want, following some guidelines, and we're going to give you this dollar figure, and every year we're only going to increase it by 2%. So that the government is not at risk for those high, high expenditures that have been happening in healthcare for the last thousand years. So that's actually how they de-risk the government, and that's what a Medicare Advantage Plan is. So it's basically private Medicare managed by a health insurance company, but it's actually grouped into a typically into a Medicare bucket. But more importantly, this graph tells you, if you're doing contract negotiations, and you're having a hard time with a Blue Cross, and you're saying, ah, that's it, you know what, you're not going to pay us what we what we feel like we deserve. We're going to walk away. Are you really going to walk away from 22% of your practice? So think long and hard before you walk away from a Blue Cross. Don't think nearly as hard about walking away from Humana. Right? Because they're 4% of your practice and you can tolerate that. You're not going to be sitting on your hands waiting for more patients to come in the office if you walk away from Humana during contract negotiations. For Blue Cross, you might be. Doesn't mean you can't do it. It just means you need to know about that before you make those decisions. So be familiar with this number. All right, let's talk a little bit about overhead. And this is actually again made up numbers for made-up doctors. But shows you the general concept behind how you would allocate some overhead based on similar revenue generation numbers. So let's look at Dr. Jones. In the top, in the blue, Dr. Jones is collecting about 1.2 million dollars a year in total revenue. That's everything that he collected. He works hard and he's collecting a lot of money. And in the gold is his expenses. So we're just for example say it's a third. So it's about $400,000. So Dr. Jones took home $800,000 and doing well. Some of his partners are not working quite as hard, took home less. But they're all paying exactly the same amount of overhead. Because why? Because rent is rent. Whether you're there and working hard or whether you're not working hard, you still have to pay the same rent. Maybe not the same for employees. If you've got somebody working twice as hard as somebody else, they're probably using a lot more of your receptionist's time, of your office manager's time. Maybe they have two medical assistants instead of one. You know, you're using, they're using more of your billing staff's time, all the supplies in the office center. So, you know, you have to take those factors into account. So if you're talking about the top graph where everyone's paying the same amount of overhead, that's sort of a socialist model. But it still, it works for some people and that's actually how they do things. But on the bottom, look at the difference that it makes for Dr. Jones in his salary in the green, his take home, when suddenly we're looking at his overhead as a percentage of his productivity. So you see that their overhead calculations are significantly different and it does make a significant difference in patients or in overhead. I will tell you that most practices use a blend of these two methods. They might pull out things that are fixed like rent and make that a fixed percentage of overhead and they might pull out things like staff, which is going to be the biggest and make that a percentage of overhead. Okay, so again, lots of things to unpack and think about here, and I'm trying to get through these before you guys all fall asleep. You heard me tell a story yesterday, I think most of you, about embezzlement. And I just put this slide in here because I want you guys to be aware of the possibility. If you're working for an institution, the VA, a university, or even a very large group, this is probably not going to be an issue you have to worry about. But if you are working for a private group that's 20 or 40, or if you're certainly working in a small group that's 5 or 10, chances are 50-50 that you are going to get embezzled in your career. 50-50. Stunning. Now that embezzlement can be bad, like it was for my group, I mean really bad, or it can be relatively minor, such as patients are coming in and your front office is collecting a copay from them on the way in, and some of them are paying that copay in cash. And some of that cash just goes home with your receptionist. It can be something as simple as that. It can be something like diverting checks to a different account, and your recourse there is actually relatively limited. It can be credit card theft. It can be any number of these things, and there are entire courses that are taught on embezzlement and how to watch it. And I will just tell you from personal experience, there's two things you have to look for. Number one, your partners are all going, where the hell is our money? That's number one. And number two, significant, unexpected employee turnover in your office. Because if that's the case, then your office manager is trying to cover his or her tracks. So be aware of that. Cautionary tale. All right, and then I'm going to go to this, and this is my last slide, so you guys can all go to the airport after this. Think about monitoring these things for yourself over time. I have a real problem with OCD. I have an Excel spreadsheet that I've been keeping on these metrics since 1993. And it's not something I look at more than once a year, but it is very instructive to actually look at that and determine the things that are generating revenue for you and the things that you value as a professional over time. And it's not about money. It's about, you know, I'm not making any money off this teaching assignment, but boy, do I like doing teaching. I'm fine with it. I'm making okay money from the practice or something else. So it's not basically to tell you that you're always chasing a dollar, and you really absolutely should not be doing that. But it does tell you that where your time is being paid and where it's not being paid and what's important to you. And that's fine to not get paid for things. There's lots of things we do every day that we don't get paid for and that they're hugely important. But it does help you to look at it over time. So I wonder about things like practice income, and that's your professional fees. So that's the fees that you generate for an office visit or the professional component of a procedure. And you know, for every procedure, there's two components, right? At least two components. So there's a professional fee. That's what you get paid, and there's a facility fee. And the facility fee is what gets paid to your ambulatory surgical center or to the hospital, to their hospital outpatient department. And so there's definitely two components to that. So your practice is just professional fees. Your ancillaries are the other components of your practice. And this is for people in private practice. But typically what you're going to have as far as ancillaries in GI is you're going to have your ambulatory surgical center. You're likely going to have an anesthesia corporation that employs CRNAs to deliver propofol to your patients. You're going to possibly have a pathology lab that's also part of your practice. You're going to likely have an infusion center to deliver the biologics to your IBD patients. You may have a research center. You may also have call stipends. And some people in private practice cover hospitals and they get a stipend for taking call. It might be a few hundred dollars. It might be significantly more than that. Some don't get any stipend at all. And if you're covering two hospitals and you're equally happy at both of them, and one of them is paying you nothing to take call, and one of them is paying $1,000 a night to take call, you might want to go to the other hospital and ask why they're not paying you to take call. Do they not value your service? Do they have another option? Is that something that you want to keep going to that hospital? Is it important to your referral base? There's a lot of reasons why you might want to have that discussion. But I can tell you the hospitals in general have gotten very comfortable with the idea of paying specialists to take call. And then you may do consulting work. Whether it's teaching, you may or may not get paid for that. Whether it's doing outside consulting, whether it's doing medical legal work, et cetera. It can be fun, it can be gratifying. It's typically not going to be a significant portion of your income, but it's something that you might want to just keep an eye on over time, just for fun. Now, let's talk about contributions to your retirement accounts. So we talked a little bit about retirement accounts and 401ks, et cetera. And everybody should definitely maximize your 401k, right? So you're going to contribute some of your salary in untaxed pre-tax dollars to your 401k. And your employer is going to match that percentage. And it can be 2%, it can be 3%. You always want to try to maximize that percentage because that's going to increase the amount that your employer is contributing to your 401k. And I think right now the maximum you can put in is a total of about $22,000. And that's good because you can save that every year. But keep in mind that if you're in a practice and you're not employed, then you can also contribute profit-sharing to your retirement account. So what is profit-sharing? Profit-sharing is a government-sponsored mechanism where you can take a percentage of your total income through that entity and also contribute that into your same retirement account in a pre-tax manner. And that can actually triple your contribution to your retirement account in a year. So it's really a very effective way that the government is fine with, in fact, encourages to save money. And you get that money to let that grow over the course of a career, tax-free. And then you have to start taking distributions on that very nice nest egg. When you're, you can start in your 60s, but you have to start taking distributions when you're 70 and a half. And that's a really nice way to pay your expenses after you've retired. And you get taxed on that distribution as you take it at 70 and a half. But the good news is your tax bracket is going to be almost nothing because you're not working anymore. So your tax bracket is not 40% anymore. Now it's 18%. So life is good. You might want to keep an eye on your vacation days taken. I'd heard before that people don't take vacation days. And that's true, actually. My daughter actually works for a company, and they have unlimited vacation policy. She never takes vacation. It's a really effective mechanism because they got a bunch of competitive people that are working to do everything they can do to get ahead in life. And they're not taking their vacation. You should definitely take your vacation. And you should stop answering pages and texts when you're on vacation because you need that downtime. We have a very intense profession here, you know. And it does cause an issue. So keep an eye on that and figure out a minimum number of vacation days that you think you should be taking a year and stick with it. Go to Europe. Have fun. Get a life. So keep an eye also on your call days. You might get paid for taking call. You might get paid a lot for a stipend for taking call. And you'll think, man, this is great. These guys are paying me $2,000 tonight to take call. That's great. But compare that number to what you would have made if you were working in your endoscopy center for the same day. And the chances are very high that you would have done better if you were in the endoscopy center. But trend this over time and make sure you understand how many days of call you're taking because there's a limit to how much. It's great work and it's a lot of fun. And honestly, that's where you see all the really exciting stuff is in the hospital. So you may just want to do it for the fun of it. I certainly did for a very long time. But there gets to be a time where you're going to burn out there. You're tired of going in at night. And you want to just keep an eye on that, especially as you get a little older. Keep an eye on things. And these discussions were already had about disability insurance. Make sure that it's specialty specific, that you have actually it's long-term that you're mostly interested in. If you're out for a week or two, you don't want a policy that kicks in when you're out of work even for a month. But if you're out of work for six months, you definitely want a policy that starts paying you benefits at six months, maybe at three months. Right? The longer that exclusion period is, the cheaper your premiums are. So make sure you have that and look at your benefits maximum because typically you can get a policy through your work and you can get an additional policy personally so that you can double your potential benefits if you become disabled. And this is important. Especially until you're at least in your mid fifties coming up on 60 because if you are out mountain biking and you fall off the bike and you break a wrist and you can't scope, you are out of luck. So you have got to be covered for that type of an eventuality. And so just be aware of that. And then obviously medical liability. This is malpractice insurance, right? So make sure that you have a policy that covers you. It gets very complicated and I won't go into it. You can have limits of one million per occurrence and three million in aggregate. So that means if you get sued one time in a year and you lose, you would get up to a million dollars of coverage, which is fine. If you get sued three times in a year, you would get a million dollars and you lost three lawsuits in a year, hopefully not ever. But if you did that, your policy would pay you a million dollars coverage on each of those claims. So that's one million per occurrence, three million in aggregate. And you can also get up to three million per occurrence and five million in aggregate as well. So it depends on your tolerance. And GI is actually a pretty good specialty as far as malpractice. Usually our exposure is actually fairly low. And then life insurance. Get some life insurance. And I heard before that you get a life insurance when you have kids is when you're going to get life insurance. You're going to get it quickly because you're going to go, oh my God, I have a kid. And this is the way I did it. And people may have different opinions on this. I got life insurance and I got term insurance and I paid on that and I timed it. I have two girls and I timed it so that my policy would expire when my youngest girl graduated college. Why? Because that was going to represent the time period where I had the most expense and my survivors would have no income. Right? So I took a policy out that actually expired when I was 56. My daughter graduated college and I let my life insurance lapse because I was 56. I had lived conservatively. I saved a lot of money. And if I died at 57, my family would be fine. We had enough savings. Right? Life insurance gets very expensive when you're in your late 50s and into your 60s. So expensive that it is not beneficial to have it. And I'm not going to get into the financial about getting a life insurance policy later to pay your inheritance tax, but that's another story. So just be aware of that. And I actually felt the same way about disability insurance. When you're in your working prime, which is typically 45 to 55, which is going to be your prime, you absolutely need a really great disability coverage. As you get into your late 50s and early 60s, you might still want that. It gets extremely expensive to maintain disability coverage when you're getting close to 60, even if you're perfectly healthy because they know the numbers. Right? So your rates are going to go through the roof. So you may want to make sure that you're financially set by the time you're in your late 50s so you don't need to deal with that kind of an issue. So anyway, that was a very brief view, and I'll stop there and open the floor for questions. Thanks, Paul. One more time. Do you recommend getting liability insurance, a personal one, or through your employer, the same as disability? It's actually the same either way. It depends on who pays for it. Right? And I'll just give you an example. In Arizona, we have Mutual Insurance Company of Arizona, which is a physician-owned malpractice company, and you can buy a policy directly from them, and you can set your own limits, and I can pay the bill myself, or I can do it through my group. The benefit of doing it through your group is that you're paying for that in pre-tax dollars. Okay. Right? If you do it yourself, you're paying for that in post-tax dollars, so essentially it's 40% more expensive. If you work in an institution, they'll cover it generally. You won't have to worry about that. There's something called a TAIL, which I think probably only matters in pediatrics, but certainly, I mean, it matters. Yeah, we have TAILs as well. It's usually a three-year TAIL. We're talking an 18-year TAIL, right? Yeah, I know. That's what I mean. It really matters. If you did pediatric ERCPs, I'm familiar with that. I had a question about adjustment rate. I think you showed a table. Let's say your outpatient visit was $140, and then let's say Blue Cross was paying $105. Who was paying that $35? Nobody. Nobody's paying it. You were not supposed to ever get it. Okay. Right? Your fee was artificially set at $140, but you reached a deal with Blue Cross that says, I'm going to provide a $992.03, a new patient office visit, and you are going to pay me $105. You paid me $105. The $35 doesn't exist. It's an adjustment. So that $105 that you get from Blue Cross, the patient might have had a copay of $20, right? So the patient paid $20, and Blue Cross paid the other $85, but that's all part of that $105. Is it true that only time, really, the charges count is if it's self-pay? Because that's when the patients are trying to... That's true, except even in self-pay, no one expects to get paid your rates. In fact, almost every practice has a policy that says self-pay patients are going to be, you know, 70% of bill charges or Medicare plus 10% or something reasonable, because if you've got self-pay patients, then you're... Look, I mean, we all know medical care is too expensive in this country, and we look at people who don't have health insurance and say, you know, nothing's gone wrong with your finances to where you don't have health insurance, and I'm either going to charge you something that's very reasonable, or you're not going to get care because you can't afford it. So let's be humanitarian about this and say, look, how about just pay what Medicare pays? How about just pay whatever? I mean, just pay something out of goodwill, and I'll take care of it for free if you want, but don't not get the care. So I think almost everybody has a policy like that. That's pretty much it. For practices or employment models where they have the call stipend, do they pay the call stipend if you have to go to the hospital to see the patient or do the procedure, or do you get paid if you're just responding to phone calls and so forth? It depends on what you negotiate. It can be a hybrid. In general, a call stipend is a call stipend. You get paid per 24-hour period, whether or not you get called or not. Now, some call stipends may say, look, you're going to take a call for the hospital, and you're going to come in and you're going to do the case, but we, the hospital, are going to do the billing for that. So we're going to guarantee you $1,000 a day, but you might see 12 consults and do six procedures on those consults, and the hospital is actually doing all the billing and collecting all the money for that. That's way more than $1,000. So you want to make sure that you get a call stipend, that it's a set dollar figure per 24-hour period, and that you are still performing the professional service and billing for that service. Now, you're going to be doing that case in the hospital, so they're going to get the facility fee. They're going to get the anesthesia fee. They're going to get any pathology from that, and they're going to do great, really. Hospitals are doing great, but you need to get your professional fees out of that service. I think sometimes there's an activation fee, right? You come in and you hit a certain threshold, and now you get payment for that physical coming in, right? So I think it depends on the practice, certainly. So Friday, I'll stay with my friend. Okay. Thank you.

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