Enhance Your Practice Podcast
ASPS Enhance Your Practice Podcast series serves as an educational appetizer for Plastic Surgeons and Office Professionals looking for practice management information on-the-go. It covers next steps early in a career; financial planning; staffing; med spas; starting a private practice; and much more.
Enhance Your Practice Podcast
Special Edition: A Surgeon’s Path an Interview with Dr.Miller - Hosted by Dr.Dolen
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Join us as Utku Can Dölen, MD, FACS, FEBOPRAS, engages in a gripping conversation with Arch Miller, MD, a retired plastic surgeon.
They explore the intricate balance between professional and personal life as Dr. Miller reflects on the early, chaotic years of his career. This episode is packed with hot topics — from coaching and family life to groundbreaking research, Miller shares candid insights on maintaining a sustainable practice amidst industry changes, ethical social media marketing and the future of plastic surgery in a commercialized environment.
This episode also addresses the impact of modern marketing on the plastic surgery industry. Miller contrasts traditional referrals with today's digital strategies, highlighting the ethical considerations of social media marketing.
you're listening to the enhance your practice podcast series brought to you by asps university. I'm dianean schwartz, chair of practice management committee, and I invite you to check out all of our educational offerings, from professional surgical videos, courses on practice management and much more on ASPS EdNet.
Speaker 2Hey, welcome to Enhance your Practice podcast. I am Utku Dolan. I work in Northwestern Medicine Group Plastic Surgery in Northwest suburbs of Chicago for the last six months. I do general plastic surgery with focus on breast reconstruction and body contouring. I am a member of ASPS practice management committee and I will be your guest host, interviewing Dr Archibald Miller, who has just retired from work but hasn't retired from plastic surgery. Before coming to Chicago, I had practiced for two years in Tulsa, oklahoma, where I had the privilege of knowing Dr Miller. Dr Miller, could you please introduce yourself, because I don't think that my words will be enough to introduce you.
Speaker 3My name is Arch Miller. I have been working in Tulsa since 1985. I trained in plastic surgery in North Carolina under Dr Julius Howell and Dr Connell Sharon. My general surgery preceptor was Dr Pennell George Pennell. Excellent, excellent training program that taught me honor and respect for my patients. I've been here for 35 years and really have loved every minute of it. I'm glad. I went into plastics.
Speaker 2Perfect. So it will be a pretty classic question, but what made you choose plastic surgery?
Speaker 3What made you choose plastic surgery? When I was in training I had a kind of an unusual first introduction to work. I went into the military, I went in during Vietnam and became a combat soldier. I developed, I was married, we had a child and our child came down with leukemia and this basically changed my life. We lost a second child after we lost her and I decided I was going to become an oncologist, somebody who works in cancer.
Speaker 3And essentially what happened was I went into pediatrics in medical school and worked with them very closely and I did research.
Speaker 3First I did a master's degree. I was working on my PhD in immunochemistry, first at University of Texas in Austin, and then went from there to Galveston and I was teaching and going to school there and asked to come to medical school. So I did that and worked in the pediatrics department with them. And I then went on active duty in the Army and worked with Dr Luis Canales at Fort Sam Houston where my children had passed away, and there I decided or found out that I was not going to be emotionally equipped well enough to take care of those children. Well enough to take care of those children. I went back to Galveston and worked there with the plastic surgery department and a guy named PR Ramey who I really liked, and because of the challenges that were in plastics, I decided I would do that and it was the difference and the type of men that were working in plastic surgery at the University of Texas at Galveston that convinced me. That's what I wanted to do.
Speaker 2I see, I see I didn't know that. Yeah, I share your sorrow. So then yeah, yeah, that is like multiple, uh, different paths. Um, so you were a ranger then and you did research. Then you were an assistant professor in the university, yeah, and then you switched to private practice. So do you think that this would be your path when you were a fresh graduate?
Speaker 3Oh, heck, no, heck no.
Speaker 3No my father was a career military officer. He came from Scotland. I'm a first-generation kid and my dad wanted me to be in the military. He was one of the first Army Rangers also, and he fought in the Second World War and the Korean War and I followed in his footsteps. That's what I felt I was going to do and because of my children they changed my outlook on life. It changed everything for me. I became more in tune with my universe and with people. Because of that and then, as I started teaching in the medical school and then came up here to Tulsa and started teaching here, I became an associate professor both at OSU and at OU both medical schools and then I started also teaching the physician's assistants from OCU in Oklahoma City and the OU medical, the PA school in Norman. So I took on a whole lot of different roles and I have done tons of research. I've got, I guess, about 30 or 40 patents now from doing things working with chest wall reconstruction.
Speaker 2Oh great, yeah, I know you have definitely have multiple hats, since we were talking about the wars. So the modern plastic surgery kind of the first world war has like a huge effect on it, with all these maxillofacial trauma and reconstruction with Dr Harold Gillis, and then the second world war about reconstruction again. Then the Vietnam War about the burns and all the reconstruction. So those all had huge effect, since we were talking about military. And then your experience In your opinion, during your whole career, what affected the plastic surgery the most or changed the path throughout the plastic surgery the most, or like change kind of the path throughout orthoplastic surgery.
Speaker 3Oh, there are several geniuses that stand out throughout the history of plastics and you know, first, the doctors who first built the plastic surgery program in England.
Speaker 3And they, you know, there wasn't just a general surgeon, there was an oral surgeon and there was a ENT and there was orthopedics and so on. So it was a group of doctors that collaborated to come up with what we are now calling plastic surgery. We are now calling plastic surgery, and it was that collaboration with multiple doctors and their self-discipline that created the specialty we have now. It was their genius, it on itself, because of the huge amount of experience and the sharing that went on in the first years and then that have gone on since then. We have doctors from all steps of life and all over the world who have contributed to our specialty in many different ways, everywhere, from doing things that we act as simple now, such as a skin graft, all the way up to free flaps. And so our world has expanded and improved for the simple reason of the giants upon whom we lesser people now stand, and we stand on their shoulders trying to emulate their genius.
Speaker 2Who do you think was your main mentor during your career?
Speaker 3Dr Julius Howell was the plastic surgeon that taught me kindness and patience and how to comport myself in the operating room. He was a Southern gentleman. He was an absolutely skilled plastic surgeon who actually trained in England and then he came over to North Carolina where he went into practice. He was actually a triple boarded person. He had a JD, he was an attorney and then he went from being an attorney to medical school and then he went into ENT and became a board-certified doctor there and then he went into England and became a board-certified plastic surgeon. His kindness and genius is what guided me and genius is what guided me Him and Conal Sharon Jay Conal Sharon who was my mentor the last two years of my residency.
Speaker 2Right and I am sure that this affected how you mentored new generations MPA nurse, like everybody that you work with. Do you think that like the mentorship kind of changed, like how was the mentorship in the past and then how was it later on?
Speaker 3I had the honor and the pleasure of an honor of working with people, the gentlemen and the genius of the people at North Carolina that few people have the opportunity to do. We were surrounded by brilliant surgeons and so on. We, you know, we're right next to Duke and we're right next to University of North Carolina and then Wake Forest. We're all right in that one area. People who are now hospital chairman and the heads of departments in orthopedics, plastic surgery, cardiothoracic surgery those people are the guys that I worked with when I was a resident or who taught me while I was a resident. Just to be surrounded by people like that is an honor in itself, something that, you know, I I've always held very dear to my heart, because I was so fortunate to be able to be exposed to such wonderful people so, after all these like academic collaboration, mentorship, what made you decide to go to private practice, like what was the tipping point?
Speaker 2maybe?
Speaker 3Well, actually I was going to work for Dr Lynn Puckett at University of Missouri, who was also one of my mentors, who I you know. I love that guy tremendously, tremendously, and I was going to work with him in Columbia and my, my wife and my two children. At this time, by now we had had two children of ours. That had done quite well. My wife felt like I had done enough 24 hour a day, sevenday, seven-day-a-week working and she wanted me to go into private practice. Plus, we're Orthodox Christians, so we wanted to go someplace where our church was strong. So we ended up going to Tulsa because of that. Church was strong, so we ended up going to Tulsa because of that. It was a decision that was not based so much on academics as it was simple family, family life. Yeah, yeah personal?
Speaker 2yeah, definitely, definitely. Happy wife, happy life that's what we repeat all the time. So what were the main differences between the kind of the first year, five years of your practice, and then the last five years of your practice? What kind of changed or improved?
Speaker 3um, the first five years of my practice practice were I was in a frenzy of still trying to publish. I did quite a few papers during that time, even though I was in private practice. I also was working on cardiothoracic chest wall reconstruction with a couple of heart surgeons here in town and we were doing complete chest wall reconstructions. We were doing cancer excisions of large tumors and completely reconstructing utilizing tram flaps and free flaps and rotational flaps, and we invented several different things to perform these procedures a special retractor and the sternal talon and different techniques that were never used before. We did something that we called the rib Reconstruction Technique, which was actually making ribs. We published one or two papers on that and my first, probably five to 10 years were just completely filled with working with extremely talented, intelligent people, talented, intelligent people, and we were all kind of sharing ideas and techniques and things that had never been done before. I patented a breast tissue expander and breast implant. I patented a couple of instruments, I patented a sternal talon reconstruction technique and just continued on working and publishing during that time period. So the first five to ten years it was just complete craziness. It was a lot of fun watching my kids grow up. I was coaching soccer and football because I played football in college and I was also giving papers all around the country, presenting in various sundry meetings. I did some research on the immune response with breast implants and did some studies with cyclosporine and several other types of immunomodulators and did a lot of work.
Speaker 3In that those times were just crazy. They really were. I was constantly facing new challenges and doing things that I hadn't had always wanted to do and had never done. The last five years of my practice here have been not quite as crazy. I've only published one paper in the last two years. I published with the chairman of the cardiothoracic surgery department at University of Italy at Padua, which is the oldest medical school in Italy, and we published a paper with several other doctors and 24 pages long and published that into the Annals of Thoracic Surgery. It's a pretty good article. We talked there about chest wall reconstruction and how to do it. That and breast reconstruction basically are the main things that I have done in the last four or five years. Here in Tulsa there's only one reconstructive surgeon left and he is owned by the hospital. There are no private guys working doing the stuff that I did anymore and it's kind of a sad.
Speaker 2So what was your like percentage then in the last five years, like what percentage was reconstruction and what percentage was aesthetic in your practice?
Speaker 3oh, in the beginning, uh, it was probably um 75 80 percent cosmetic, uh, and then it gradually increased to 50 in the middle portion of my practice, maybe year 18 to 25, and then in the middle portion of my practice, maybe year 18 to 25. And then in the last four or five years it's been more. It's probably been about 60% to 70% reconstruction. One of the reasons why was because I was doing so much chest wall reconstruction with the heart die guys.
Speaker 3And then just in the last year and a half or two years, I was doing um three, four or five breast reconstructions a week nice, yeah, so yeah, you were part of the patenting and producing of the first double chambered rest implant.
Speaker 2And then you mentioned about the tail on tell on sternal closure device. Yes, so that experience. What did you learn from your relation with the industry, specifically with the industry?
Speaker 3oh, I learned quite a bit. Uh, you have to realize that what you are as a doctor is not what the industry is. Our main interest was patient care and what we had to do when we did negotiations with these companies. And I'm getting ready to do a new one now, because I've gotten a new patent for a new device called the Bulldog, for a new device called the Bulldog, and essentially, we have to go sit down with them and hammer out something that not only allows them to make a profit but also allows us to gain the satisfaction of making patient care better.
Speaker 2Correct. So I keep asking questions about the private plastic surgery because that's kind of one of the demands from the audience. So myself, I have been in plastic surgery training and practicing like almost 15 years and during this whole time there was always a fear that private practice may disappear. And national trends show that physicians are more inclined to go with hospital employed positions, but it is hard to tell the same thing for plastic surgery. So now the ongoing discussion is consolidation of solo practices and private equity acquisitions of solo or group practices. So what changed during your career in private practice? I think like you were able to like support yourself better, like as a solo surgeon. I don't know if these were on the table like private equity or like acquisition by a hospital system. And then what is going to happen in the future? What do you foresee?
Speaker 3I here in Tulsa, for instance, I do not see foresee any private practice guys in another five years. I think that everybody will be an employed physician right now, everybody will be an employed physician. Right now there are, I think, four. There used to be 12 private practice docs and none of us were employed. Now the private practice guys, they're not doing half the amount that we did in the past. And I think the other problem is that we have other outside groups that are not trained in the field of plastic surgery, plastic and reconstructive surgery, that are siphoning off the cosmetic work that we do. That actually is our supportive mechanism, our basic, the basement support for plastic surgery, for doing the things that I'm talking about. The reconstructive stuff, uh, it's just hard to get uh, the cosmetic stuff without being um, excessively, um, I guess, I guess you can call it um advertise without excessive advertising, without being completely commercialized. And you know, if you spend a lot of money being a commercialized physician, you make more money.
Speaker 2Yeah, it is definitely one big part of the practice management. Now, like in the past, we were just doing before and after pictures to make sure that we can track our outcomes. But now for any new plastic surgeon either hospital employed or or private uh, they need to allocate a budget for social media marketing or like any type of marketing, and they need to have a presence. That's, that's what it shows, and an asps is working on that to keep ethical and still safe ways of doing social media management and there are really good research on the SPS website about that to educate yourself and also to improve while still being safe and ethical.
Speaker 3In the vein of what you're saying. When I first came to town, when somebody said, well, let's go on to the Internet there was hardly any Internet in those days onto the internet, there was hardly any internet in those days. I was told unequivocally by the older guys who were here in town and also guys like Dr Puckett and Dr Sharon and Dr Howell. I was told specifically you know you will be kicked out if you dare to advertise in any of these social media things because that cheapens plastic surgery. Advertising on marketing, on selling uh techniques and um, you know doing these cutesy little uh programs for um skin care and so on yeah, yeah, we are keeping this interview pretty honest and and real to the heart.
Speaker 2Now, uh, I think there is some like generational difference also. Uh, I I kind of understand you because I feel myself in between. I also agree that in the past and I can see all of the my previous mentors thinking about marketing, kind of undermining the, the seriousness and the importance of of surgery in general, but but now I can see being into it and trying to build a practice and working with younger generation also that there is definitely a demand that plastic surgeons we didn't create this demand, but now, like, there is a demand in the society to see something online to easily consume. Also, like immediately see a picture, like it immediately see a video, want to immediately see a result. I think that the fast food culture is there, but the goal is to, yes, like, while doing this, still being ethical, not compromising patient safety and and also not spending all of your effort for that. Like, we are still surgeons, we are doing clinic, we are doing surgery. This is where we should spend our energy, uh, rather than focusing month, I think.
Speaker 3I totally agree with that, because what we have done and you can see it when you go to the meetings the ASPS meetings and the Aesthetic Society meetings I go to both. You can see it when you go there, because probably I may be way overstating this, but it seems to me like 30%, maybe more, of the meetings are taken up with people lecturing on how they do their marketing and how they do their websites and how they do their pictures and how they do their talks and so on. Nothing like it used to be. I'm not saying that maybe it's not a good thing to have some marketing, but that's just my own personal opinion Because I'm an old guy now that's retired.
Speaker 3Maybe I'm just way way out of line.
Speaker 2Yeah, no, despite everything going on, still, word of mouth is the best advertisement, direct referrals from other patients that's what I believe also, and it is created by the patient and you are not forcing anyone to do anything or you are not showing audience something that they don't need, but word of mouth, definitely I still believe that it brings the most patience.
Speaker 3Yeah, and I think that's true. I think the word of mouth you know well, you did my sister, or you did my best friend, or you did my grandmother, or you know something like that I think the word of mouth is the best way. That's the most efficient way of gaining people's trust and having them come see you. But nowadays it's more internet, it's more Instagram, it's more the other types of computer analyses that are out there now, rather than the word of mouth.
Speaker 3It really is not the word of mouth as much as it used to be. Now it's all on the internet.
Speaker 2And having been practiced in Tulsa, oklahoma, so Tulsa is like for the audience, like I have been there two years it has definitely different dynamics than the national trends. It is one million town but like huge rural area, like a downtown, smaller downtown, so in such a like large geography you managed to work there since 1985 with mostly word of mouth right.
Speaker 3Yes.
Speaker 2And then your approach to social media. Like we understand that. Do you think and you managed to do it for a long time do you think if you just started to practice now would you be able to gain as many patients as you did in the past?
Speaker 3No, I don't, and I don't think it's because I've tried to have people come in and take over my practice. Because I tried that I never did get anybody to buy into my practice or even take over my practice.
Speaker 2I offered several people my practice at no cost, just to take over my patients and take over the type of practice I had and I had no takers the type of practice I had and I had no takers, yeah, so so about retiring, like that transition phase, so you mentioned about, yeah, how, how did it go? And and currently, so can you tell us, like what you did, what happened?
Speaker 3to your practice. Yeah, what I did was I made sure that all my patients were completed, all my reconstructions were completed, and I still have one or two patients that are out there that are having to go to the hospitals to have some things done. But I did that and I also sent out announcements of that. I was retiring and had to resign from all the hospitals, one at a time, and the other thing that I did was I went to the Veterans Administration.
Speaker 3A couple of the young doctors, like yourself, were working in the VA and asked me to come and do reconstruction there. So I have actually transitioned now to where I'm working, just part-time, but I'm working for the VA and doing breast reconstructions and other type of reconstructions for the vets. I get along really well with the vets because I'm one and I was a combat vet, I wasn't a doctor. So I'm having a lot of fun with that. I'm having a lot of fun with that. I'm having a lot of fun with the soldiers and the sailors and the Marines and everybody that I get to work with. It's an honor to be with them and I enjoy the job that I'm doing now very much.
Speaker 2And what happened to your office like your, your devices, stuff. Can you mention about that Like transition?
Speaker 3Oh yeah, I had to have the heartbreak of separating myself from my staff. My, my first assistant, scrub RN, first assistant, scrub RN, first assistant. She stayed with me for a total of 35 years. She was always my right-hand person office nurse. I trained from when she was just an 18-year-old kid, acting as a nursing assistant, all the way up to the RN that she is now, and she worked with me for 15 years. The office reception lady was first my wife and then my son's wife, and they've worked with me for 20 some years. So I had to tell all these people you know hey, I'm going to fire you guys, you've got to find, do stuff on your own. My first assistant she retired. She had done well with with finances and so on, and her husband had done very well too, so she just retired. It was hard to separate myself from her because she'd kick me in the shins whenever I was doing the wrong thing. She was quite the help.
Speaker 3My office nurse. She was just a wonderful young lady and she would call me up and say this is wrong and that's wrong, we need to fix this, and so on, and she'd make appointments for me and so on. My office lady, you know, they'd get me dental appointments, for heaven's sake. So it was hard, but we had to transition everybody out a little bit at a time in order that we didn't disrupt their lives Actually, I think my life was disrupted more than theirs was because it hurt me so much to have to let these folks go that I couldn't work with them anymore.
Speaker 2Correct. Yeah, so it's amazing. Yeah, having worked with someone 35 years, 15 years, what do you think, what could you recommend to the new plastic surgeons, like how they can establish such a good relation with their staff and how can we help them to be loyal to practice?
Speaker 3Number one be loyal to the. To them, you know. Number two appreciate them. In other words, every time they do something, say thank you and mean it. And then, number three, share with them your victories as well as your defeats. And, uh, number four, make sure that they know that their families and their lives are just as important as yours. If you can do all those things, then you will finish out with people who care about you as much as you care about them, because you'll develop that affection and the value of them as people. As you do those things.
Speaker 2Correct and also financially support them though.
Speaker 3Oh yeah, the money is part of it. Actually, you can probably not pay as much as the hospital does, but still have their loyalty if you do the other things, yeah.
Speaker 2Yeah, at the end, the personal relations, appreciation, gratitude, that matters, I agree with that. But also, yeah, the money is the reality of the world.
Speaker 3Yeah.
Speaker 2So then, what was the most difficult obstacle during your career?
Speaker 3maintaining enthusiasm. You can't always be up 100%, but you need to be. Sometimes it's hard. Sometimes it's hard to maintain your focus and your desire to be the best that you can be. Sometimes it's hard, but that's pretty much the most difficult.
Speaker 2Yeah, I agree, I agree, and you are old school also, so in your generation you didn't have, we weren't discussing like burnout, like we have been discussing now. There was no like wellness in your time and then like the way that you were trained.
Speaker 3I was a college athlete. Scholarship to even pay to go to college. I went and I was drafted into the army, became an airborne ranger. Everything was nothing was handed to me. Everything I had to work for and earn I couldn't. I didn't just get it handed to me at all, I never. You know, I had to always work to get whatever it is my goal, wanted to be, and so you know that taught me to never give up, basically.
Speaker 2Right taught me to never give up. Basically, Ben, what do you identify as your biggest career mistake in the practice and what did you learn from it?
Speaker 3Wow, my biggest mistake? Probably investment financial investments were my biggest mistake. I think my emotional commitments and my patient commitments have all been pretty good and my commitment to work has always been pretty good, but my financial decisions were never the best. But I was never trained to do that, correct.
Speaker 2That's kind of. There's a huge amount of knowledge and experience share going on between the physicians about the finance in all aspects. But I can see that because there's also kind of demand from your family surrounding that you are a physician, you need to invest or you need to support, you need to do something, so there could be some pressure that may be pushing to do those that we are not trained or we don't have time to train ourselves on that Yep. So I ourselves on that Yep. So I can see that and that's kind of that. Everybody's learning from that now, Like from the medical school residency. There are more talks about finance, loans, investing, disability insurance, life insurance, like all these. I think there is better knowledge now and available Yep. And then what do you identify as the biggest career achievement then? What are you most proud of?
Speaker 3I really am proud of being the first doctor to have a shaped breast implant. I worked with Dow Corning in 1984 in making a shaped breast implant I'm the first one that ever had one. And then the other thing is the talon Fixed, stable breast or sternal reconstruction is the thing that I have contributed to surgery that's probably saved more lives and allowed people to live a normal life more than anything else that I've done.
Speaker 2Yeah, at the end, yeah, you can tell that the relations that you had with your staff, patients, and then the things that you produced to help patients, these are things that's going to stay in the world so you made your footprint. You made your footprint and and that's that's a huge satisfaction. So where do you think that the plastic surgery is going for future? What do you foresee like practice-wise?
Speaker 3surgery-wise or less invasive. I think that the history of plastic surgery points to a good future.
Speaker 2So for recommendations for the young plastic surgeons like in your opinion?
Speaker 3what are the qualities of a good plastic surgeon? Intelligence, Stubbornness and respect for all mankind?
Speaker 2And what advice do you have for the young surgeons starting their own practice, maybe in private practice, or other surgeons who plan to make a career change, like maybe from academics to private practice?
Speaker 3Be prepared to sacrifice.
Speaker 2I think that's a great recommendation, especially whenever you are boss of your own work. There's a lot of commitment going on. That's the advantage of hospital employment that you don't need to deal with the administrative, you don't need to deal with the HR of your staff. You don't need to deal with administrative, you don't need to deal the hr of your staff, you don't need to deal too much with purchasing, and then you don't deal with the billing or insurance at all. There's like a huge teams departments doing that. But but when you're in private plastic surgery, your own boss, you need to own the whole practice and then follow everything, track everything. So that comes with sacrifice. Yes, I agree. Is there anything else that I should have asked you, dr Miller, that I didn't ask?
Speaker 3You could probably ask me if I'm satisfied with my career.
Speaker 2Yes, you sound pretty satisfied, but I want to ask that question.
Speaker 3Yes, I am. I'm proud of many of the things I've done, I'm proud of many of the people that I've helped and in many ways I'm humbled by my practice and, as a result, I'm glad that I lived this life and I'm looking forward just a few more years of working with the Veterans Administration so I can, just a few more years of working with the Veterans Administration so I can help a few more people, particularly the old, grizzled vets, both male and female, like me.
Speaker 2That's great. I know you continue working, you continue giving back. This is huge and I am sure that all patients and staff appreciate that. And then can you just tell us our hobbies? I know that you had an interview in ASPS before, and then you mentioned about the special birds that you have you mentioned about the special birds that you have.
Speaker 3I have Australian black swans, I have some shell ducks. I have some Peking ducks. I have a couple of other types of ducks that are just plain old ducks from Oklahoma. They are all in my backyard in a lake that's back behind my house. It gives me pleasure to sit out in my backyard and watch my ducks.
Speaker 2That's amazing. Yeah, and all these little things you had during your childhood training is what made you as a surgeon and as a person. Yes, I agree. I think that sounds perfect, Dr Miller. Is there anything else?
Speaker 3No, thank you for honoring me to ask me questions. I appreciate it.
Speaker 2No, thank you very much. I appreciate for your time.
Speaker 1We hope you enjoyed this episode of the Enhance your Practice podcast series brought to you by ASPS University. You can listen to our other episodes on other podcast platforms or you can download recordings directly from ASPS EdNet. New episodes coming soon.