046 - Happy New Year - Episode Highlights of 2022 on Residency Training, Medical Practice & Burnout for Physicians

Wondering what you missed on the Practice Impossible Podcast in 2022? Here are Coach JPMD’s top picks for the most impactful podcast episodes that will help you to decrease stress and increase profits.  Click on the time stamp in the chapters tab and jump right to the highlight.

Seasons Greeting and Merry Christmas

Show Notes

 Discover how medical graduates, junior doctors, and young physicians can navigate residency training programs, surgical residency, and locum tenens to increase income, enjoy independent practice, decrease stress, achieve financial freedom, and retire early, while maintaining patient satisfaction and exploring physician side gigs to tackle medical school loans. 

Transcript

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Coach JPMD  0:11  
Welcome to the Practice Impossible Podcast with your hosts that Coach JPMD. That's me. And I want to first and foremost, thank you for a great year, this year, my second year, creating podcasts we're over, over 45 episodes recorded over the past year, year and a half now. So I want to thank you, and thank you. For those who left reviews, if you haven't had a chance to leave a review, or tell me what you think about the podcasts, how it's impacting your life, it would really be helpful if you can do that now. And so with this episode, we're going to, we're gonna do a year end review, but we're gonna pretty much call it like the cliffnotes of 2022. And what I've done is a compiled the most downloaded episodes or the most impactful episodes over the past year. And those that have really given me feedback on how they appreciated what has been said, what's been discussed. And so Merry Christmas, Happy New Year, if you haven't had a chance to, to listen to the first and last video, podcast, I encourage you to do so right now. It's exclusively on Spotify. And if you look at the the list of all the podcasts, you'll find the episode Dr. Singh, a great episode to watch, and to take a look at the room. And, you know, we we enjoyed it so much that we're probably going to have more video episodes next time, a couple of you have mentioned that you liked the interviews, the podcast interviews that we've had over the past year. And so that's what I've done, I've compiled a lot of the reviews are the interviews with guests, and in our first episode that we're going to review is was an episode on money, and is with my financial advisors. And it was a great episode. And what I learned was that my advice was had never met a generous person that was unhappy. And that really took me by surprise, because you think you don't always think of happiness is related to generosity. And I want you to take a listen to episode number 22. And my advisors will help you understand the characteristics that they observed in highly successful clients. So here we go.

Don Snyder  2:28  
Well, as a kingdom advisor, part of our role or opportunity is to help people learn to expand their level of generosity to make an impact not only in their families in their personal lives, but also in the community around them. And I think that we've never met an unhappy, generous person, right. And I think from that standpoint, there's opportunities to just be more focused about what you're passionate about what you might want to support or get behind, there has to be a heart connection there. And I would say that a lot of people they're giving is kind of the last thing they think about, and maybe it's whatever is leftover, or it's not necessarily a priority. And I think the thing is, is that to have a more deliberate giving strategy, it's like part of any other strategy, it's really helpful and beneficial. And it can help. Also your relationship with your spouse and your wife, and you need to be on the same page with those types of things. And some people are honestly more generous than others. And so it's kind of like a muscle that has to be used and, and exercised. And so from that standpoint, we certainly like to help people kind of explore different ways to be generous, there's a lot of different tools out there doesn't mean you have to give away a bunch of money as much as you just start understanding the tools that are there, how to use them, and how to leverage what's available. And honestly, there can be some tax benefit as well. And so for high income earners, that's one way to help of many to help reduce or mitigate some of the tax side of it.

Coach JPMD  4:14  
So you said something that's a huge nugget. And that was you have never met a an unhappy, generous giver. Is that what you said? 

Don Snyder  4:23  
That's right. That's right. 

Coach JPMD  4:25  
Tell me about those that you've seen or work with that are not generous? Who how do you how do you.. 

Don Snyder  4:34  
By name? 

Coach JPMD  4:35  
No not by name. Please don't get me in trouble. So tell me about the most non generous or ungenerous, ungenerous. I don't know if that's a word but a client that you've worked with.

Ryan Johns  4:49  
We'll say closed hands. 

Coach JPMD  4:52  
Okay, a closed hand client. Well, what would be your experience with them. I guess. 

Ryan Johns  4:56  
I would say that there's something going on there. And I think as, as advisors, you know, it's up to us, with our clients to draw out some of these other elements that are happening behind the scenes, because I think someone who really struggles with generosity has some fear, or some greed. Those are, you know, opposite sides of the same coin, right? And so, we we endeavor to, I think we aspire to be not only advisors who are talking about the allocation, the opportunities and the return, but also to help draw out some of these deeper concerns. And that comes through some in depth conversation. It's just not looking at the spreadsheets and the numbers. But why are you why are we fearful? And Jude, you know, we've had some conversations where we talk about history with finances, personally, with investing or saving, and we talk about with spouses, you know, what's the husband's experience with investing or saving, if any, and what is the wife's experience with investing or saving, if any, and those life experiences with money is growing up even, can really drive someone to be closed handed? Right. And so I think when we experience someone who's hesitant to be generous, we have some work to do to help them understand the plan that they have, and have some confidence in what they're doing, that they're going to be able to land the plane when they get to retirement. And there's so much fulfillment on the other side of that, if you're able to say, You know what, I'm going to make it and because I'm going to make it, I can help sell and sell, or I can, I can further this cause that I'm passionate about.

Coach JPMD  6:35  
So that was pretty insightful. So check out Episode 22, if you want to learn more about what was said in that episode, and how you really can build wealth during your career, because that's, that's what we want you to do. We want you to practice impossible, we want you to do things that are not routinely done in the field of medicine, and teach you really the business of medicine. And not only the business of practicing medicine, but also the business of taking care of your own personal life, building wealth, and retiring early. So in episode number 25, I discussed the blue zones. And the blue zone Solutions is a book I read a couple years ago and I reread it, it was by Dan Buettner. And what he does is describes the characteristics of centenarians. And he traveled around the world and found that there are five different blue zones are hotbeds where people lived greater than 100, or had an average had the highest concentration of centenarians. And it was very insightful. I encourage you to read the book, if you haven't read the book, listen to the episode to kind of hear what the the nine things and nine characteristics of the Blue Zones are. And another thing that I said I was going to share, I don't remember sharing it, but that was my vitality test results. And the blue zone solutions and their team came up with a vitality test that enables you to kind of predict what your what your life expectancy would be and in the US. As we know, the life expectancy of a US citizen is an abysmal 77 years old. I know it sounds I shouldn't say abysmal, but, but compared to the rest of the world, we ranked 46 in the world in terms of life expectancy. So it was interesting, based on my lifestyle, based on what I've done in my eating habits over the past couple of years, my life expectancies is at 89.2, which was pretty decent. I think it's a little bit more than the average US population. I think some of it is of course, going to be genetic. My dad is actually 86. And aside from a recent health issue, he had never been in the hospital over the the course of his 86 years. Unfortunately, my mom passed away in 2009, and she was 68. But she had complications of a kidney transplant. So take the vitality tests and share our results with us. We'd love to hear what your life expectancy is based on what you're doing in your lifestyle. So how could you get out of debt sooner than your colleagues? How can you retire early? Well, Episode 30. My CPA Jolene Loos describes the mindset of really successful physicians that are really practicing impossible. So if we listen to her episode, she'll describe an OBGYN doc who was able to retire I think within 15 years of practicing, and it is possible with you. And we have solutions, we have resources that we can share with you. So take a listen to this episode, or at least a snippet of this episode. And tell me what you think. So give me an example of a physician you feel because we've kind of been kind of doom and gloom here with physicians. But give me an example of a physician that's just crushing it. It's just practicing impossible that you said, wow, this guy is really doing well. I wish that all my clients were like this doctor, what would be the characteristic of that doctor?

Jolene Loos, CPA  9:59  
I'm fortunate that I can say I have numerous physicians that fall into that category. Because I have beat into their heads that they have to do personal financial planning, they have to have a plan in place. One of my ones that may be is is one of my favorite because he was he was one of my physicians, he was actually my OBGYN. And he was with the first practice I worked with. And the the partner in charge didn't want me to work with him, because of the fact that he was my physician, too. And the client came and said, If I can't work with Jolene, I'm not staying with the firm. And so the partner in charge came to me and I said, it doesn't bother me. And we put a plan in place for him. And he's been retired now 15 or 20 years, he regretfully had to retire, he hurt his back and didn't have the option to continue working. But because of all of the planning that he's done, literally, he and his wife can do anything that they would consider wanting to do. And they will not run out of money before they leave the face of the earth, and will be leaving their children and grandchildren. A nice legacy, even though one of their children is adopted out in California, and he's doing very well on his own. And he's already started the saving philosophy, and their other son is in management and actually works for Robert Half who finds accountants to place in CPA firms. And he also has done really well in saving, too. So he's one of my, he's my favorite success story. But I am fortunate that I have numerous other clients that fall in that category.

Coach JPMD  12:19  
And so with changing healthcare reform and things changing with reimbursement, and and doctors just getting into more debt coming out of residency and medical school, where do you see healthcare going in the next 20 years?

Jolene Loos, CPA  12:34  
Jude, you know that I'm fortunate that I've worked with a lot of physicians that do risk management. And so I was very fortunate that I had a client that got involved in that when I knew nothing at all about it. And at the time, it was JSA, who now has moved, merged through different companies. But I literally spent hours at JSA offices, learning how to read the reports and what they meant and, and what did my client need to do differently to not only be a physician, but be a business person, because regretfully, you don't have time to take business classes when you're going through residency and getting your degree. And most physicians that I see come out as physicians, but most of them come out as really bad business people. And medicine. It didn't used to be that way. When I started practicing, almost any physician could make an extraordinarily good amount of monies in their practice. That's not the case. In today's market. The physicians that I see that are going into practice now. They have to run their businesses like a business. They have to be aware of how they're practicing medicine, and making sure that they're  making smart decisions in how they're running the book of business that they're responsible for.

Coach JPMD  14:21  
So I have to say a great accountant, is what you really need to help accelerate your path to financial freedom. So Jolene has offered her services or at least consultation services for any physician, listen to the Practice Impossible podcast. So do contact her. Her website is www.clvalue.com. And of course we'll have the resources at the end of this episode to help you learn how you can get out of debt quickly, retire early, and live a powerful life. So episode 31 describes what happened in my career in my life that was a game changer. And I was getting a scribe, and not just any scribe, it was a virtual scribe. And I have a discussion with Ashwin, who is the CEO of VP scribes. And there are two things in my career and my practice that had been transformative. One is getting my medical assistant or my nurse to actually go over my notes with me, or my tasks or messages. We call them tasks in our office, but messages that patients leave and other details that need to be taken care of during the office that I can't take care of when I'm seeing patients. So those messages are taken. And then we go over those messages throughout the day. And those messages are responded, usually by the end of the day. And that has transformed the way patients are able to leave messages and feel comfortable that they're going to get a response by the end of the day. The other one is, you know, getting a scribe getting someone to help me with my notes. As you know, and maybe don't know that Medicare requires that we have our notes completed and signed off within 72 hours. And when you're seeing 25-30 patients a day, it's nearly impossible to do that. And to have have a life outside of medicine. I know that there are some physicians that actually take their notes home and try to complete their notes at home, dictate or transcribe their notes, finished your templated notes. You know, it's it's really difficult. And I think after after you listen to this episode, you will understand the importance of someone else helping you with your notes, someone else that you can delegate the I feel the most challenging part of the practice and take a listen.

Ashwin George, COO  16:39  
Well, actually, I went to UT Austin, I went government route, I worked in parliament in London. So that was actually totally opposite to this. But um, one day my dad came up to Austin for a meeting. He's a physician in South Texas internal medicine. And I think the scribing concept first got to him then four years ago. So I think it was still pretty big concept and in person scribing. And I know his documentation style is he takes everything home, he doesn't like to be in front of the computer in front of the patient. So usually he would come home and have two to three hours of chart work. I used to be his typist too, because he used to use chickenfinger typing one finger typing, so he would dictate. And I would go through some of his charts with him after school. But um, pretty much that concept came to him and then we kind of thought through it. And another side piece of information. My sister actually went to medical school in India, where most of my scribes are located. So she was during that time she was studying for her steps. And it usually takes about a year for someone from a foreign medical graduate to study for a step. So she was kind of in this transitionary period. So we thought that this would be kind of a good opportunity for people like that, that want to learn about how medicine is practiced here in the US. And one actually put some of their knowledge to use. And we kind of got that idea. And then I was on a plane to India, two months later, halfway through my semester, went all online and started from there.

Coach JPMD  18:08  
So you went to medical school in India.

Ashwin George, COO  18:12  
I didn't go to medical school, my sister went to medical school, I'm surprised she was able to complete it. She's back now practicing she actually got a nephrology fellowship. Recently, she she did internal medicine as well. But um, I went to India and I thought I was the first person with this idea, oh, we can get doctors, nurses or people to do virtual scribing work. And I put out an ad and little did I know there was already companies doing this.

Coach JPMD  18:39  
That's a great story. So your father. So did he also was he in part of starting this company? Or was he

Ashwin George, COO  18:47  
definitely he was a guinea pig, to say the least, I didn't have very good software in the very beginning actually, like right now I'm using zoom to connect all the scribes with their providers. They have a great HIPAA compliance license. So everything is very secure and encrypted. But back then I didn't know about that. So we were testing different software's and it was very cumbersome. Every time he would go to the exam room, he would have to login to something. So it definitely took a lot of iterations. But finally, I think we've kind of perfected that workflow. And it's been a great use to him. So he's actually had his scribe, she was like, actually maybe like our fourth or fifth employee, and it's one person he can't let go of. He can't practice without her and we've had other scribes try and he just gets upset. 

Coach JPMD  19:35  
So as you grow your practice, this scribe service may not be something for you. But I strongly recommend that you find that happy number of patients that you see you the revenue that you're that you're generating in your practice, because once you employ a scribe to help you with your notes, I guarantee that you're going to be able to see more patients which will in turn mean an increase in revenue. And it also decreases your stress because you don't have to worry about your notes. Because most of it will be done for you by the end of the day. Another thing that I discovered that has helped me decrease my stress and actually improve my sleeping habits is grounding. And I know a lot of physicians may not understand this because we didn't actually learn this in medical school. Nor do we feel like there's science behind this, but I suggest that you do the research and listen to this episode with an open mind, Episode 34 and 35, where we interview Clint Ober, who is a pioneer in the work of grounding, and earthing. And it's just interesting to hear a different perspective, a non physician perspective, who describes things that are so basic that we sometimes take for granted. And you might ask, what is earthing? What is grounding? Well, grounding is basically the act of putting your foot on the ground without shoes. And the science behind that is that you're able to de discharge the positive ions in your body that you're being exposed to on a daily basis, to Mother Earth, just like any electrical equipment can be grounded, just like the equipment I have in this office is grounded, we have grounded equipment that helps decrease interference. We're electrical beings. And you have to ask yourself, well, how are we grounding ourselves? And what are people doing in other parts of the world that actually have been shown to actually decrease inflammation, improve sleep habits, decrease cortisol levels? So interesting stuff, take a listen to episode 34, and 35. But I'll give you a little snippet of the conversation. Starting right now. I know, this is a podcast for physicians, and now we're talking about grounding electrical devices. What does that have to do with us? What does it have to do with humans?

Clint Ober  21:55  
Okay, well, first of all, the Earth is maintains a slight negative charge. And the word negative means in this case, means no charge. But it means an abundance of free electrons that can move rapidly, and reduce charge, like reduce, you know, lightning is a reduction of charge, or static electricity. If you anything, anytime you ground, anything, what you're doing is you're connecting it to the earth, so that the, the electrical service charge of the earth migrates up the wire, and then it grounds the chassis of a refrigerator or a computer, or anything in order to prevent the possibility of an electrical event where somebody might get hurt. Because if it's at earth potential, then no just blow a fuse. Okay, if there's a problem in a refrigerator or something, so, but anyhow, human body, again, you gotta use cowboy logic here.

Coach JPMD  22:53  
You're a wise cowboy, because at the beginning of you said, you know, you may need some direction, the we like to hear wise counsel at practice impossible, because, you know, we're younger physicians, and, you know, sometimes we think we know everything, but I think our wiser counterparts probably know more than we do.

Clint Ober  23:11  
Well, it's, you know, what age brings to the table is experience. And it's not that you know exactly what to do, but you know, what not to do more than anything, and then you're only left with those few things that seem to work. And, but anyhow, the human body is conductive. It's electrical first chemical second, because you have to move some electrons in order for, you know, chemical changes, or just anything goes on in the body. So you have to think about the body being electrical first. And then you then you have to go back and think like, well, before 1960 We were mostly barefoot, I was as a kid. And we wore shoes to go to school, or events, and they were leather. And if they got wet the water would, when they dried, they would ruin them. So you had to if it was wet outdoors raining, you took your shoes off and carried them or you had those dark yellow galoshes. But anyhow, the point was before 1960 we were primarily barefoot. Okay, so when a human being stands on the earth, because it's conductive. It conducts Earth's negative charge bodies an electrical conductor. So, so it's negative. And there's only one thing the ground does is reduces charge. We don't know that it does anything else, but it does maintain electrical stability in the in an electrical, like a computer or an internal, the internal workings of anything electrical. Well, human body is the most electrical thing on the planet. There is nothing more electrical every Sell every every thought everything everything is frequencies and electrons and protons and you know everything from metabolism, ATP, you name it. It's all electron base, the electron transport chain.

Coach JPMD  25:14  
We do we do EKGs. We do electrocardiograms, we do. electroencephalogram, so on those things are conductive.

Clint Ober  25:21  
Exactly. It's all Electro. So anyhow, there's more to the story. But in short, I just one day accidentally was messing around, and I had a computer, they crash kept crashing, and it was back in the 90s. So you get static electricity on your body, and you touch an Apple computer, or one of those that weren't grounded, and the computer would glitch up, then you'd have to shut it down, bring it back up, and then continue on from there. And I got really tired that day. So I took a piece of metal, copper tape layered across my desk, connected it with an alligator clip and a wire to an electrical ground. So then I would touch the ground strip, before I would touch the computer got rid of my problem. So

Coach JPMD  26:07  
So let's, let's dive into that. Because you said you connected a copper wire onto your computer, and you connected it...

Clint Ober  26:16  
It was taped by just laid it down to the edge just laid it down on the desk in front of the...

Coach JPMD  26:21  
So where was that? Where was it connected to?

Clint Ober  26:25  
Well, I connected with a wire to the electrical ground, you know, the little third?

Coach JPMD  26:30  
Ah, so you actually did in the third hole? So some of the people in the audience may not know what that is. So where does that third hole go? What what does that? Yo mean, third hole in the socket in the in the...

Clint Ober  26:42  
Yeah, in all electrical sockets have a ground. And any home the probably after 1970, they all have a ground wire in the walls. So that little hole is connected to a ground wire that goes throughout the house. And then it's connected to a ground rod that is driven into the earth. So it has nothing to do with the current electricity has everything to do with bringing the electrical potential of the earth to that point or to anything that's has a ground pin on it, in order to maintain it at Earth potential safe area of potential.

Coach JPMD  27:18  
So that's just part of the conversation. So you know, Clint is really an awesome guy. And I met him online, and we had some conversations prior to me interviewing him. And I invite you to try it. And that's all I can say. Just try it, and see if it makes a difference for you. I know it made a difference for me. So while you're grounding, think about a recurring theme that we've had on our podcast. And that is, so many of my guests on the practice impossible podcasts have talked about getting the right mentor, and finding someone that can help you with the practice of medicine with the business of medicine. My good friend, Brunel. Joseph was not the first, we had a great conversation. And I listen to what he says is the one thing that he would tell young physicians out there. So what's the one thing you would tell a younger physician such that by doing that one thing, it would make their lives much easier,

Brunel Joseph, MD  28:13  
I'll say being open to learn, right? Being open to learn and not just, and we both know, we don't get training, medical school for any of this. In terms of the financial side, there are payers, out of training, I did not know the difference between fee for service and managed care. I heard about it and I wanted to acquire more on it to learn and I felt like this is this was the way of the future. So I was willing to do that. Just like I said, some outside of even all the physicians some don't know about managed care, look at a certain way outside of people come in out of training sometimes. And even some of them are not even willing to learn. Because they they've heard that managed certain things about managed care. So I think what I would, I would say is to be open to learning about different theories open to learning about different insurances, I guess the open to learning more about medicine, because obviously, you have so much more to learn as you finish training. Those are the really the things I would maybe get a mentor, that that's something I've thought about I should have done early, get a mentor because sometimes a lot of those are in our own little bubble. You don't know what the next primary care guy is doing. Eventually, there are some questions you don't want to ask. Know how it is in terms of...

Coach JPMD  29:29  
It's a competitive landscape. I mean, if you ask this question, after you know what this guy is doing, he's gonna take patients away from you and try and there's so many patients out there there's so much, you don't need to think that way. But it was a great point.

Brunel Joseph, MD  29:45  
But even financially, so that's a big taboo also within our field, you can't talk finances.

Coach JPMD  29:53  
And that's one of the biggest things we should be talking about. Yeah, because we're coming out of debt. And I saw on of I was on a Facebook Group, a physician community Facebook group and one of the questions from a physician. And I guess this is public knowledge, because it's on Facebook, so I can say it. But he had three kids, and he just came out of residency making $250,000 a year. And they living in a 2000 square foot home, they have debt, they owe people money, and he wants to buy a house. Should you buy a house? And I know, you know the answer to this. The answer is...

no.

Brunel Joseph, MD  30:29  
exactly. 

Coach JPMD  30:30  
No

Brunel Joseph, MD  30:31  
no.

Coach JPMD  30:31  
But you know, the old me 20 years ago would have said, Oh, yeah, but you make enough money. And yeah, you should, you know, get out of the rent. No, no, no, pay off your debt. So there you have it, that's Dr. Josephs words of wisdom. And he's a great guy. He's done tremendously well, in the practice in Tampa, he took over my Tampa office several years ago, and really proud of what he's done, and how he's grown as a physician. And he's a great example of what we can do when we work together to to achieve a common goal and that is to take care of take care of our patients. And and grow great practice. And the last episode that we're going to review is episode 45. This one, this one was an interesting one. So the physician super athlete is something that Dr. Singh coined in this in this episode, and I've never heard him say this before, how we are healers, we are powerful individuals that can care for patients, heal patients, counseled patients, and help them live long. One of the most powerful things that I got out of this episode was how we can squash burnout in the medical profession. So let's listen to this and we'll chat about it. 

Pariksith Singh, MD  31:45  
And I take inspiration from some of the greatest healers in human history. You know, Christ himself was a healer. Right? So we exalt Him. He was a healer at multiple levels, but he was a healer even at the physical level. 

Coach JPMD  32:02  
Right. 

Pariksith Singh, MD  32:03  
So and every great teacher is a healer in some way or the other. We are many healers. 

Coach JPMD  32:10  
Yeah. 

Pariksith Singh, MD  32:11  
Well, as doctors, we are athletes.

Coach JPMD  32:14  
Yeah. And and, you know, when you when you bring in Christ and to the forefront, you know, you're saying exactly what I think he has told us. And there's two things He tells us to do is to love him of God, and love everyone else. We're not even loving our own colleagues. We're bad mouthing our colleagues...

yes 

Pariksith Singh, MD  32:34  
that's exactly.

Coach JPMD  32:36  
We're disparaging them. We're competing with them. Yes. We're not loving. And that I think, for me is what I try to teach my kids I try to teach them love and respect.

Pariksith Singh, MD  32:46  
That's where burnout happens. That's the secret of burnout. 

Coach JPMD  32:50  
Love. 

Pariksith Singh, MD  32:50  
Yes. That's the secret of fear. Secret of anger, secret of all negativity. If you can get rid of the negativity, you realize what you do. You can never have a burnout. How can you have a burn out?

Coach JPMD  33:04  
So there you have it. What's the one thing you can we can do to help decrease physician burnout? It's Love, love, obviously love God first, and then you love others. But part of that love is loving your fellow colleagues, your your fellow classmates, your fellow residency training grads, because I think love conquers all. Love squashes fear. Love invites us to care for each other. And so I think he makes a good point. If we love each other, like God calls us to love each other, then we would not or at least, burnout would be very minimal in our profession. I'd love to hear what you think about that, because I don't know any other other action that would transcend our ability to care for ourselves and our patients better than to love each other. Like He commands us to love. I hope that these clips inspire you to listen to more episodes. With the right people on your side, you can practice impossible. So my ask for you is to share this episode with your friends. Leave me review, because that's going to help me understand what you want to hear more about. I'm going to also set up a website so that you can sign up for updates so that you know when things are back up and running again, you can visit www dot coach jpmd.com/next season, and maybe I'll even put up a survey. Let me know what you want to hear more of. And season one, as you know is all about Medicare Advantage and how we can help our populations live long. Season two is going to be about the business of medicine but maybe a different type of medical practice. So Merry Christmas, Happy New Year. And thank you for listening and thank you for continuing to support the practice impossible podcast