{"version":"1.0.0","segments":[{"speaker":"Charles Goldfarb","startTime":0.0,"endTime":7.14,"body":"Chuck, welcome"},{"speaker":"Charles Goldfarb","startTime":0.0,"endTime":7.14,"body":"to the upper hand podcast where"},{"speaker":"Charles Goldfarb","startTime":7.14,"endTime":8.88,"body":"Chuck and Chris talk hand"},{"speaker":"Charles Goldfarb","startTime":7.14,"endTime":8.88,"body":"surgery."},{"speaker":"Chris Dy","startTime":9.54,"endTime":11.46,"body":"We are two hand"},{"speaker":"Chris Dy","startTime":9.54,"endTime":11.46,"body":"surgeons at Washington"},{"speaker":"Chris Dy","startTime":11.46,"endTime":14.4,"body":"University in St Louis, here to"},{"speaker":"Chris Dy","startTime":11.46,"endTime":14.4,"body":"talk about all things hand"},{"speaker":"Chris Dy","startTime":14.4,"endTime":16.62,"body":"surgery related, from technical"},{"speaker":"Chris Dy","startTime":14.4,"endTime":16.62,"body":"to personal."},{"speaker":"Charles Goldfarb","startTime":17.16,"endTime":19.14,"body":"Please"},{"speaker":"Charles Goldfarb","startTime":17.16,"endTime":19.14,"body":"subscribe wherever you get your"},{"speaker":"Charles Goldfarb","startTime":19.14,"endTime":20.84,"body":"podcasts, and thank"},{"speaker":"Chris Dy","startTime":20.84,"endTime":23.54,"body":"you in advance for"},{"speaker":"Chris Dy","startTime":20.84,"endTime":23.54,"body":"leaving a review and rating that"},{"speaker":"Chris Dy","startTime":23.54,"endTime":26.36,"body":"helps us get the word out. You"},{"speaker":"Chris Dy","startTime":23.54,"endTime":26.36,"body":"can email us at hand"},{"speaker":"Chris Dy","startTime":26.36,"endTime":30.44,"body":"podcast@gmail.com so let's get"},{"speaker":"Chris Dy","startTime":26.36,"endTime":30.44,"body":"to the episode. Oh,"},{"speaker":"Charles Goldfarb","startTime":30.44,"endTime":31.16,"body":"hey, Chris,"},{"speaker":"Chris Dy","startTime":31.34,"endTime":32.3,"body":"hey, Chuck, how are"},{"speaker":"Chris Dy","startTime":31.34,"endTime":32.3,"body":"you?"},{"speaker":"Charles Goldfarb","startTime":32.779,"endTime":35.299,"body":"I am better"},{"speaker":"Charles Goldfarb","startTime":32.779,"endTime":35.299,"body":"than you this morning. I think,"},{"speaker":"Charles Goldfarb","startTime":35.539,"endTime":36.139,"body":"yeah, it's been"},{"speaker":"Chris Dy","startTime":36.14,"endTime":41.56,"body":"a rough one. I, you"},{"speaker":"Chris Dy","startTime":36.14,"endTime":41.56,"body":"know, recovering from a cold and"},{"speaker":"Chris Dy","startTime":41.56,"endTime":46.24,"body":"also recovering from call. So"},{"speaker":"Chris Dy","startTime":41.56,"endTime":46.24,"body":"two things that start with C"},{"speaker":"Chris Dy","startTime":46.24,"endTime":48.7,"body":"that are, you know, interfering"},{"speaker":"Chris Dy","startTime":46.24,"endTime":48.7,"body":"with my life, and now we've got"},{"speaker":"Chris Dy","startTime":48.7,"endTime":52.42,"body":"a third with Chuck, but he loves"},{"speaker":"Chris Dy","startTime":48.7,"endTime":52.42,"body":"that alliteration. But I got"},{"speaker":"Chris Dy","startTime":52.42,"endTime":54.94,"body":"beat up a little bit on call"},{"speaker":"Chris Dy","startTime":52.42,"endTime":54.94,"body":"last night, so, but I'm happy"},{"speaker":"Chris Dy","startTime":54.94,"endTime":55.84,"body":"that we're here together."},{"speaker":"Charles Goldfarb","startTime":56.62,"endTime":61.86,"body":"Yeah, that is"},{"speaker":"Charles Goldfarb","startTime":56.62,"endTime":61.86,"body":"tough. I, you know, call is, and"},{"speaker":"Charles Goldfarb","startTime":61.86,"endTime":65.82,"body":"I generally don't mind it while"},{"speaker":"Charles Goldfarb","startTime":61.86,"endTime":65.82,"body":"I'm doing it, but as one ages"},{"speaker":"Charles Goldfarb","startTime":65.82,"endTime":68.64,"body":"Chris, it doesn't get any"},{"speaker":"Charles Goldfarb","startTime":65.82,"endTime":68.64,"body":"easier. You'll have"},{"speaker":"Chris Dy","startTime":68.64,"endTime":71.16,"body":"to tell me about that"},{"speaker":"Chris Dy","startTime":68.64,"endTime":71.16,"body":"one day. I'm not sure how that"},{"speaker":"Chris Dy","startTime":71.16,"endTime":75.54,"body":"what that feels like. I was"},{"speaker":"Chris Dy","startTime":71.16,"endTime":75.54,"body":"telling our fellow Dan Hong that"},{"speaker":"Chris Dy","startTime":75.54,"endTime":78.78,"body":"I used to like taking call with"},{"speaker":"Chris Dy","startTime":75.54,"endTime":78.78,"body":"him, but now I'm not sure he's"},{"speaker":"Chris Dy","startTime":78.78,"endTime":83.9,"body":"clearly is making me change my"},{"speaker":"Chris Dy","startTime":78.78,"endTime":83.9,"body":"mind. Still a good guy, but he"},{"speaker":"Chris Dy","startTime":83.9,"endTime":86.72,"body":"does like his podcast mentioned,"},{"speaker":"Chris Dy","startTime":83.9,"endTime":86.72,"body":"so I did mention to him that I"},{"speaker":"Chris Dy","startTime":86.72,"endTime":90.02,"body":"would shout him out again. I"},{"speaker":"Chris Dy","startTime":86.72,"endTime":90.02,"body":"had, apparently he gets it. He"},{"speaker":"Chris Dy","startTime":90.02,"endTime":92.84,"body":"gets a lot of text saying that"},{"speaker":"Chris Dy","startTime":90.02,"endTime":92.84,"body":"he's famous when this happens."},{"speaker":"Charles Goldfarb","startTime":93.38,"endTime":96.5,"body":"Oh Lord. Well,"},{"speaker":"Charles Goldfarb","startTime":93.38,"endTime":96.5,"body":"he and I have worked together a"},{"speaker":"Charles Goldfarb","startTime":96.5,"endTime":99.8,"body":"little bit, not formally, on"},{"speaker":"Charles Goldfarb","startTime":96.5,"endTime":99.8,"body":"service has been fine. And I had"},{"speaker":"Charles Goldfarb","startTime":99.8,"endTime":103.54,"body":"spoke to our previous resident,"},{"speaker":"Charles Goldfarb","startTime":99.8,"endTime":103.54,"body":"Liz grasser, who's out at Utah,"},{"speaker":"Charles Goldfarb","startTime":103.72,"endTime":106.9,"body":"and she also seems to have"},{"speaker":"Charles Goldfarb","startTime":103.72,"endTime":106.9,"body":"developed a black cloud"},{"speaker":"Charles Goldfarb","startTime":106.9,"endTime":110.02,"body":"reputation, but she said the"},{"speaker":"Charles Goldfarb","startTime":106.9,"endTime":110.02,"body":"right thing. She goes, I think"},{"speaker":"Charles Goldfarb","startTime":110.02,"endTime":113.86,"body":"I'm a black cloud, which my"},{"speaker":"Charles Goldfarb","startTime":110.02,"endTime":113.86,"body":"attendings don't like, but you"},{"speaker":"Charles Goldfarb","startTime":113.86,"endTime":116.08,"body":"kind of sort of want that as a"},{"speaker":"Charles Goldfarb","startTime":113.86,"endTime":116.08,"body":"fellow,"},{"speaker":"Chris Dy","startTime":116.44,"endTime":118.72,"body":"you got a year to"},{"speaker":"Chris Dy","startTime":116.44,"endTime":118.72,"body":"learn, right? So you got to get"},{"speaker":"Chris Dy","startTime":118.72,"endTime":121.68,"body":"it all done. I mean, you know,"},{"speaker":"Chris Dy","startTime":118.72,"endTime":121.68,"body":"you look at, you know, as as a"},{"speaker":"Chris Dy","startTime":121.68,"endTime":126.36,"body":"fellowship director, I study"},{"speaker":"Chris Dy","startTime":121.68,"endTime":126.36,"body":"people's case logs. Nice and,"},{"speaker":"Chris Dy","startTime":126.72,"endTime":129.24,"body":"you know, you have to, you see"},{"speaker":"Chris Dy","startTime":126.72,"endTime":129.24,"body":"that some people get a lot of"},{"speaker":"Chris Dy","startTime":129.24,"endTime":131.94,"body":"cases, other people don't. It's"},{"speaker":"Chris Dy","startTime":129.24,"endTime":131.94,"body":"been pretty uniform this year,"},{"speaker":"Chris Dy","startTime":132.18,"endTime":134.64,"body":"but, yeah, I think there's just"},{"speaker":"Chris Dy","startTime":132.18,"endTime":134.64,"body":"stuff that comes in unplanned"},{"speaker":"Chris Dy","startTime":134.64,"endTime":135.9,"body":"that you got to take advantage"},{"speaker":"Charles Goldfarb","startTime":136.38,"endTime":140.24,"body":"of absolutely"},{"speaker":"Charles Goldfarb","startTime":136.38,"endTime":140.24,"body":"and, and it's been, you know,"},{"speaker":"Charles Goldfarb","startTime":140.24,"endTime":144.62,"body":"the fellows are always part of"},{"speaker":"Charles Goldfarb","startTime":140.24,"endTime":144.62,"body":"the joy of call, part of the"},{"speaker":"Charles Goldfarb","startTime":144.62,"endTime":149.18,"body":"pain of call, and you know it's"},{"speaker":"Charles Goldfarb","startTime":144.62,"endTime":149.18,"body":"all sometimes it gets mixed as"},{"speaker":"Charles Goldfarb","startTime":149.18,"endTime":151.94,"body":"one into my head, fellows paying"},{"speaker":"Charles Goldfarb","startTime":149.18,"endTime":151.94,"body":"call. But let me give you a"},{"speaker":"Charles Goldfarb","startTime":151.94,"endTime":152.24,"body":"little"},{"speaker":"Chris Dy","startTime":152.24,"endTime":154.28,"body":"let me give you a"},{"speaker":"Chris Dy","startTime":152.24,"endTime":154.28,"body":"little perspective. It's a hell"},{"speaker":"Chris Dy","startTime":154.28,"endTime":157.94,"body":"of a lot better than not having"},{"speaker":"Chris Dy","startTime":154.28,"endTime":157.94,"body":"a fellow call. So let's just put"},{"speaker":"Chris Dy","startTime":157.94,"endTime":158.6,"body":"it that way."},{"speaker":"Charles Goldfarb","startTime":158.96,"endTime":162.34,"body":"There is no"},{"speaker":"Charles Goldfarb","startTime":158.96,"endTime":162.34,"body":"doubt that is very important"},{"speaker":"Charles Goldfarb","startTime":162.34,"endTime":162.7,"body":"truth."},{"speaker":"Chris Dy","startTime":162.7,"endTime":166.0,"body":"Funny. Funny story"},{"speaker":"Chris Dy","startTime":162.7,"endTime":166.0,"body":"about Liz and Dan is that when"},{"speaker":"Chris Dy","startTime":166.0,"endTime":170.32,"body":"we were at the hand society in"},{"speaker":"Chris Dy","startTime":166.0,"endTime":170.32,"body":"Minneapolis this year, it was"},{"speaker":"Chris Dy","startTime":170.32,"endTime":173.62,"body":"the end of Dan's rotation with"},{"speaker":"Chris Dy","startTime":170.32,"endTime":173.62,"body":"me. He had spent his first I"},{"speaker":"Chris Dy","startTime":173.62,"endTime":176.2,"body":"guess we split it up, so he did"},{"speaker":"Chris Dy","startTime":173.62,"endTime":176.2,"body":"six weeks with me, or something"},{"speaker":"Chris Dy","startTime":176.2,"endTime":178.48,"body":"like that. Yeah, and I was very"},{"speaker":"Chris Dy","startTime":176.2,"endTime":178.48,"body":"excited. I said, Dan, we're both"},{"speaker":"Chris Dy","startTime":178.48,"endTime":180.82,"body":"getting on a Monday night at a"},{"speaker":"Chris Dy","startTime":178.48,"endTime":180.82,"body":"hand society. Why don't we go"},{"speaker":"Chris Dy","startTime":180.82,"endTime":182.64,"body":"get dinner? We're on the same"},{"speaker":"Chris Dy","startTime":180.82,"endTime":182.64,"body":"flight, you know, let's go."},{"speaker":"Chris Dy","startTime":182.64,"endTime":186.9,"body":"Let's go have a post, rotation,"},{"speaker":"Chris Dy","startTime":182.64,"endTime":186.9,"body":"recap, little bonding time at"},{"speaker":"Chris Dy","startTime":186.9,"endTime":190.8,"body":"dinner. And I know it's coming."},{"speaker":"Chris Dy","startTime":186.9,"endTime":190.8,"body":"I set up a reservation. It was"},{"speaker":"Chris Dy","startTime":190.92,"endTime":195.36,"body":"great. I was super excited. It"},{"speaker":"Chris Dy","startTime":190.92,"endTime":195.36,"body":"was late. So, you know, I if it"},{"speaker":"Chris Dy","startTime":195.36,"endTime":197.34,"body":"was anybody else, I would have"},{"speaker":"Chris Dy","startTime":195.36,"endTime":197.34,"body":"said, No, I'm not really"},{"speaker":"Chris Dy","startTime":197.34,"endTime":201.5,"body":"interested. I'm just gonna go to"},{"speaker":"Chris Dy","startTime":197.34,"endTime":201.5,"body":"bed. So he's like, Yeah, sounds"},{"speaker":"Chris Dy","startTime":201.5,"endTime":206.72,"body":"good. He's like, do you mind if"},{"speaker":"Chris Dy","startTime":201.5,"endTime":206.72,"body":"Liz grasser comes? Said, I love"},{"speaker":"Chris Dy","startTime":206.72,"endTime":212.12,"body":"Liz. Liz, great. Sure she's"},{"speaker":"Chris Dy","startTime":206.72,"endTime":212.12,"body":"already eating. She's not going"},{"speaker":"Chris Dy","startTime":212.12,"endTime":216.14,"body":"to eat. So I was like, as"},{"speaker":"Chris Dy","startTime":212.12,"endTime":216.14,"body":"somebody who kind of knows a"},{"speaker":"Chris Dy","startTime":216.14,"endTime":218.96,"body":"little bit about restaurants and"},{"speaker":"Chris Dy","startTime":216.14,"endTime":218.96,"body":"restaurant business, like"},{"speaker":"Chris Dy","startTime":218.96,"endTime":222.1,"body":"they're not going to like that."},{"speaker":"Chris Dy","startTime":218.96,"endTime":222.1,"body":"But of course, that'd be great"},{"speaker":"Chris Dy","startTime":222.1,"endTime":225.46,"body":"if Liz can come. I would love to"},{"speaker":"Chris Dy","startTime":222.1,"endTime":225.46,"body":"see Liz. So Liz, Liz crashed our"},{"speaker":"Chris Dy","startTime":225.46,"endTime":229.96,"body":"mandate, and it was lovely to"},{"speaker":"Chris Dy","startTime":225.46,"endTime":229.96,"body":"see Liz. She had a cocktail, had"},{"speaker":"Chris Dy","startTime":229.96,"endTime":234.7,"body":"some dessert, watched him, Dan"},{"speaker":"Chris Dy","startTime":229.96,"endTime":234.7,"body":"and I mainly me eat excessively."},{"speaker":"Charles Goldfarb","startTime":235.6,"endTime":238.66,"body":"You know, that"},{"speaker":"Charles Goldfarb","startTime":235.6,"endTime":238.66,"body":"is hilarious. And Dan's"},{"speaker":"Charles Goldfarb","startTime":238.66,"endTime":243.6,"body":"connected in the in the"},{"speaker":"Charles Goldfarb","startTime":238.66,"endTime":243.6,"body":"restaurant world in St Louis, I"},{"speaker":"Charles Goldfarb","startTime":243.6,"endTime":247.14,"body":"didn't, I didn't know he shared"},{"speaker":"Charles Goldfarb","startTime":243.6,"endTime":247.14,"body":"with me his connection with, I'm"},{"speaker":"Charles Goldfarb","startTime":247.32,"endTime":252.18,"body":"going to get the name wrong, Mr."},{"speaker":"Charles Goldfarb","startTime":247.32,"endTime":252.18,"body":"Bogner, who has the really"},{"speaker":"Charles Goldfarb","startTime":252.18,"endTime":256.56,"body":"delicious sushi restaurants and"},{"speaker":"Charles Goldfarb","startTime":252.18,"endTime":256.56,"body":"has opened a third, is opening a"},{"speaker":"Charles Goldfarb","startTime":256.56,"endTime":257.04,"body":"third,"},{"speaker":"Chris Dy","startTime":258.12,"endTime":261.26,"body":"celebrated, celebrated"},{"speaker":"Chris Dy","startTime":258.12,"endTime":261.26,"body":"chef Midwest and perhaps"},{"speaker":"Chris Dy","startTime":261.26,"endTime":265.88,"body":"nationally great place. So Dan,"},{"speaker":"Chris Dy","startTime":261.26,"endTime":265.88,"body":"Merry Christmas. Happy New Year."},{"speaker":"Chris Dy","startTime":265.88,"endTime":269.18,"body":"You've gotten your, you know,"},{"speaker":"Chris Dy","startTime":265.88,"endTime":269.18,"body":"unsolicited four minutes of"},{"speaker":"Chris Dy","startTime":269.18,"endTime":272.12,"body":"airtime on our discussion. So we"},{"speaker":"Chris Dy","startTime":269.18,"endTime":272.12,"body":"have to get rolling on the"},{"speaker":"Chris Dy","startTime":272.12,"endTime":273.26,"body":"actual topic today."},{"speaker":"Charles Goldfarb","startTime":273.98,"endTime":274.28,"body":"Yes,"},{"speaker":"Chris Dy","startTime":274.28,"endTime":276.32,"body":"we do before we do"},{"speaker":"Chris Dy","startTime":274.28,"endTime":276.32,"body":"that, we should thank our"},{"speaker":"Chris Dy","startTime":276.32,"endTime":279.98,"body":"sponsors at practice link, and"},{"speaker":"Chris Dy","startTime":276.32,"endTime":279.98,"body":"I'm gonna read the copy this"},{"speaker":"Chris Dy","startTime":279.98,"endTime":282.52,"body":"time. So the upper hand is"},{"speaker":"Chris Dy","startTime":279.98,"endTime":282.52,"body":"sponsored by practice link.com,"},{"speaker":"Chris Dy","startTime":282.88,"endTime":285.1,"body":"the most widely used physician"},{"speaker":"Chris Dy","startTime":282.88,"endTime":285.1,"body":"job search and career"},{"speaker":"Chris Dy","startTime":285.1,"endTime":286.12,"body":"advancement resource."},{"speaker":"Charles Goldfarb","startTime":286.6,"endTime":289.12,"body":"Becoming a"},{"speaker":"Charles Goldfarb","startTime":286.6,"endTime":289.12,"body":"physician is hard. Finding the"},{"speaker":"Charles Goldfarb","startTime":289.12,"endTime":291.76,"body":"right job doesn't have to be"},{"speaker":"Charles Goldfarb","startTime":289.12,"endTime":291.76,"body":"join practice link for free"},{"speaker":"Charles Goldfarb","startTime":291.76,"endTime":297.34,"body":"today at www dot practice"},{"speaker":"Charles Goldfarb","startTime":291.76,"endTime":297.34,"body":"link.com, backslash the upper"},{"speaker":"Charles Goldfarb","startTime":297.58,"endTime":299.14,"body":"and now"},{"speaker":"Chris Dy","startTime":299.14,"endTime":303.42,"body":"we got a really cool."},{"speaker":"Chris Dy","startTime":299.14,"endTime":303.42,"body":"Email about some advocacy"},{"speaker":"Chris Dy","startTime":303.42,"endTime":305.7,"body":"topics, which is something that"},{"speaker":"Chris Dy","startTime":303.42,"endTime":305.7,"body":"doesn't really come up very"},{"speaker":"Chris Dy","startTime":305.7,"endTime":309.78,"body":"often, I think, for most"},{"speaker":"Chris Dy","startTime":305.7,"endTime":309.78,"body":"practicing surgeons and"},{"speaker":"Chris Dy","startTime":309.78,"endTime":313.68,"body":"therapists, but it does affect"},{"speaker":"Chris Dy","startTime":309.78,"endTime":313.68,"body":"our lives on a daily basis. And"},{"speaker":"Chris Dy","startTime":313.68,"endTime":318.18,"body":"before we jump into that great"},{"speaker":"Chris Dy","startTime":313.68,"endTime":318.18,"body":"email, I hear you have an"},{"speaker":"Chris Dy","startTime":318.18,"endTime":320.84,"body":"interesting elbow case that you"},{"speaker":"Chris Dy","startTime":318.18,"endTime":320.84,"body":"wanted to discuss."},{"speaker":"Charles Goldfarb","startTime":321.56,"endTime":325.7,"body":"Yeah, I I've"},{"speaker":"Charles Goldfarb","startTime":321.56,"endTime":325.7,"body":"talked about pediatric and"},{"speaker":"Charles Goldfarb","startTime":325.7,"endTime":329.72,"body":"adolescent elbow on this call,"},{"speaker":"Charles Goldfarb","startTime":325.7,"endTime":329.72,"body":"and for those who haven't heard"},{"speaker":"Charles Goldfarb","startTime":329.72,"endTime":332.96,"body":"discussions, I think it, first"},{"speaker":"Charles Goldfarb","startTime":329.72,"endTime":332.96,"body":"of all, it's a good example of"},{"speaker":"Charles Goldfarb","startTime":333.38,"endTime":337.64,"body":"recognizing opportunities when"},{"speaker":"Charles Goldfarb","startTime":333.38,"endTime":337.64,"body":"they are presented to you. Elbow"},{"speaker":"Charles Goldfarb","startTime":337.64,"endTime":341.2,"body":"in general, was not something I"},{"speaker":"Charles Goldfarb","startTime":337.64,"endTime":341.2,"body":"plan to focus on, but"},{"speaker":"Charles Goldfarb","startTime":341.2,"endTime":346.12,"body":"increasingly, those, those"},{"speaker":"Charles Goldfarb","startTime":341.2,"endTime":346.12,"body":"challenging Pediatric and"},{"speaker":"Charles Goldfarb","startTime":346.12,"endTime":349.24,"body":"Adolescent elbows, have become a"},{"speaker":"Charles Goldfarb","startTime":346.12,"endTime":349.24,"body":"part of my practice. And, you"},{"speaker":"Charles Goldfarb","startTime":349.24,"endTime":352.0,"body":"know, you may have always"},{"speaker":"Charles Goldfarb","startTime":349.24,"endTime":352.0,"body":"planned since you were three"},{"speaker":"Charles Goldfarb","startTime":352.0,"endTime":354.52,"body":"years old, to take care of"},{"speaker":"Charles Goldfarb","startTime":352.0,"endTime":354.52,"body":"patients with nerve injuries,"},{"speaker":"Charles Goldfarb","startTime":354.88,"endTime":358.3,"body":"maybe. But elbow, to me, is not"},{"speaker":"Charles Goldfarb","startTime":354.88,"endTime":358.3,"body":"like that. We have."},{"speaker":"Chris Dy","startTime":358.3,"endTime":362.04,"body":"We told the second."},{"speaker":"Chris Dy","startTime":358.3,"endTime":362.04,"body":"You know, I've talked in many"},{"speaker":"Chris Dy","startTime":362.04,"endTime":365.94,"body":"venues, and I cannot remember,"},{"speaker":"Chris Dy","startTime":362.04,"endTime":365.94,"body":"as you have, when I've told what"},{"speaker":"Chris Dy","startTime":365.94,"endTime":368.64,"body":"stories, but have we talked"},{"speaker":"Chris Dy","startTime":365.94,"endTime":368.64,"body":"about why, how I got into the"},{"speaker":"Chris Dy","startTime":368.64,"endTime":370.8,"body":"nerve practice at WashU, if"},{"speaker":"Charles Goldfarb","startTime":370.8,"endTime":373.56,"body":"we have my"},{"speaker":"Charles Goldfarb","startTime":370.8,"endTime":373.56,"body":"seen, senior status is showing"},{"speaker":"Charles Goldfarb","startTime":373.56,"endTime":374.94,"body":"because I do not remember,"},{"speaker":"Chris Dy","startTime":375.78,"endTime":378.18,"body":"maybe, maybe a topic"},{"speaker":"Chris Dy","startTime":375.78,"endTime":378.18,"body":"for another day. But I was"},{"speaker":"Chris Dy","startTime":378.18,"endTime":381.56,"body":"definitely voluntold, and it"},{"speaker":"Chris Dy","startTime":378.18,"endTime":381.56,"body":"worked pretty well, but I was"},{"speaker":"Chris Dy","startTime":381.56,"endTime":384.68,"body":"voluntold by one of our partners"},{"speaker":"Chris Dy","startTime":381.56,"endTime":384.68,"body":"that that was what I was going"},{"speaker":"Chris Dy","startTime":384.68,"endTime":387.98,"body":"to do. So good match. Of course,"},{"speaker":"Chris Dy","startTime":384.68,"endTime":387.98,"body":"he knew, he knew it was going to"},{"speaker":"Chris Dy","startTime":387.98,"endTime":388.58,"body":"work. So it was"},{"speaker":"Charles Goldfarb","startTime":388.58,"endTime":390.44,"body":"good. It's"},{"speaker":"Charles Goldfarb","startTime":388.58,"endTime":390.44,"body":"nice when people have that"},{"speaker":"Charles Goldfarb","startTime":390.44,"endTime":395.72,"body":"foresight before us. But what's"},{"speaker":"Charles Goldfarb","startTime":390.44,"endTime":395.72,"body":"interesting about pediatric"},{"speaker":"Charles Goldfarb","startTime":395.72,"endTime":398.66,"body":"elbow? And you know, maybe I"},{"speaker":"Charles Goldfarb","startTime":395.72,"endTime":398.66,"body":"would say pediatric is less than"},{"speaker":"Charles Goldfarb","startTime":398.66,"endTime":402.7,"body":"12, someone may write in and"},{"speaker":"Charles Goldfarb","startTime":398.66,"endTime":402.7,"body":"tell me I got the definitions"},{"speaker":"Charles Goldfarb","startTime":402.7,"endTime":409.36,"body":"wrong. But so much of the elbow"},{"speaker":"Charles Goldfarb","startTime":402.7,"endTime":409.36,"body":"is cartilage that when you have"},{"speaker":"Charles Goldfarb","startTime":409.36,"endTime":413.14,"body":"a distal humor or proximal"},{"speaker":"Charles Goldfarb","startTime":409.36,"endTime":413.14,"body":"radius or ulnar injury, it can"},{"speaker":"Charles Goldfarb","startTime":413.14,"endTime":415.3,"body":"be hard to pick up"},{"speaker":"Charles Goldfarb","startTime":413.14,"endTime":415.3,"body":"radiographically. I think we all"},{"speaker":"Charles Goldfarb","startTime":415.3,"endTime":419.68,"body":"know that you're looking for fat"},{"speaker":"Charles Goldfarb","startTime":415.3,"endTime":419.68,"body":"pad signs where the X rays show"},{"speaker":"Charles Goldfarb","startTime":419.86,"endTime":425.22,"body":"a little dark around the bones,"},{"speaker":"Charles Goldfarb","startTime":419.86,"endTime":425.22,"body":"which is fluid where an anterior"},{"speaker":"Charles Goldfarb","startTime":425.22,"endTime":428.34,"body":"fat pad sign is okay, but a"},{"speaker":"Charles Goldfarb","startTime":425.22,"endTime":428.34,"body":"poster is not. But the message"},{"speaker":"Charles Goldfarb","startTime":428.34,"endTime":432.6,"body":"is that X rays don't always tell"},{"speaker":"Charles Goldfarb","startTime":428.34,"endTime":432.6,"body":"the tale. Would you? Would you"},{"speaker":"Charles Goldfarb","startTime":432.6,"endTime":433.38,"body":"agree with that?"},{"speaker":"Chris Dy","startTime":433.8,"endTime":435.96,"body":"I agree with I"},{"speaker":"Chris Dy","startTime":433.8,"endTime":435.96,"body":"remember being tortured on the"},{"speaker":"Chris Dy","startTime":435.96,"endTime":439.56,"body":"PED service as a resident trying"},{"speaker":"Chris Dy","startTime":435.96,"endTime":439.56,"body":"to analyze these elbow X rays of"},{"speaker":"Chris Dy","startTime":439.56,"endTime":443.0,"body":"adolescents and some kids I have"},{"speaker":"Chris Dy","startTime":439.56,"endTime":443.0,"body":"peds, really, and always"},{"speaker":"Chris Dy","startTime":443.0,"endTime":448.1,"body":"struggling. I mean, has anything"},{"speaker":"Chris Dy","startTime":443.0,"endTime":448.1,"body":"changed since many, many years"},{"speaker":"Chris Dy","startTime":448.1,"endTime":450.92,"body":"ago, when I was in training"},{"speaker":"Chris Dy","startTime":448.1,"endTime":450.92,"body":"about, you know, how to think"},{"speaker":"Chris Dy","startTime":450.92,"endTime":453.38,"body":"about, you know,"},{"speaker":"Chris Dy","startTime":450.92,"endTime":453.38,"body":"radiographically, have any of"},{"speaker":"Chris Dy","startTime":453.38,"endTime":455.96,"body":"those findings changed? You"},{"speaker":"Chris Dy","startTime":453.38,"endTime":455.96,"body":"know, clearly, the X ray"},{"speaker":"Chris Dy","startTime":455.96,"endTime":458.3,"body":"technology itself hasn't"},{"speaker":"Chris Dy","startTime":455.96,"endTime":458.3,"body":"changed. But, you know, do you"},{"speaker":"Chris Dy","startTime":458.3,"endTime":460.1,"body":"jump to other types of imaging"},{"speaker":"Chris Dy","startTime":458.3,"endTime":460.1,"body":"earlier?"},{"speaker":"Charles Goldfarb","startTime":460.64,"endTime":463.18,"body":"I think, well,"},{"speaker":"Charles Goldfarb","startTime":460.64,"endTime":463.18,"body":"yes, I think we do. And I would"},{"speaker":"Charles Goldfarb","startTime":463.18,"endTime":467.62,"body":"say to start you have to know"},{"speaker":"Charles Goldfarb","startTime":463.18,"endTime":467.62,"body":"the basics. Have to know what"},{"speaker":"Charles Goldfarb","startTime":467.62,"endTime":471.46,"body":"you generally should be looking"},{"speaker":"Charles Goldfarb","startTime":467.62,"endTime":471.46,"body":"for. But there is never shame in"},{"speaker":"Charles Goldfarb","startTime":471.46,"endTime":474.58,"body":"getting the contralateral elbow."},{"speaker":"Charles Goldfarb","startTime":471.46,"endTime":474.58,"body":"And I've been doing this a long"},{"speaker":"Charles Goldfarb","startTime":474.58,"endTime":478.72,"body":"time, I get contralateral X rays"},{"speaker":"Charles Goldfarb","startTime":474.58,"endTime":478.72,"body":"all the time. Really helpful,"},{"speaker":"Charles Goldfarb","startTime":479.5,"endTime":482.1,"body":"but not always. They don't"},{"speaker":"Charles Goldfarb","startTime":479.5,"endTime":482.1,"body":"always tell the tale. So your"},{"speaker":"Charles Goldfarb","startTime":482.1,"endTime":487.5,"body":"point is good. I mean a CT or CT"},{"speaker":"Charles Goldfarb","startTime":482.1,"endTime":487.5,"body":"angio, which was ordered in this"},{"speaker":"Charles Goldfarb","startTime":487.5,"endTime":493.08,"body":"particular case, I'm sorry, not"},{"speaker":"Charles Goldfarb","startTime":487.5,"endTime":493.08,"body":"CT, angio, CT, arthrogram, but"},{"speaker":"Charles Goldfarb","startTime":493.08,"endTime":495.96,"body":"for me it's usually an MRI,"},{"speaker":"Charles Goldfarb","startTime":493.08,"endTime":495.96,"body":"which I think gives us what we"},{"speaker":"Charles Goldfarb","startTime":495.96,"endTime":502.64,"body":"need to know. Briefly, this case"},{"speaker":"Charles Goldfarb","startTime":495.96,"endTime":502.64,"body":"was of a child who had a sheer"},{"speaker":"Charles Goldfarb","startTime":502.64,"endTime":508.22,"body":"injury of the trochlea and"},{"speaker":"Charles Goldfarb","startTime":502.64,"endTime":508.22,"body":"Capitol, which was incredibly"},{"speaker":"Charles Goldfarb","startTime":508.22,"endTime":511.28,"body":"subtle on X ray, where there's"},{"speaker":"Charles Goldfarb","startTime":508.22,"endTime":511.28,"body":"just a sliver of bone that you"},{"speaker":"Charles Goldfarb","startTime":511.28,"endTime":517.04,"body":"could couldn't really see. Could"},{"speaker":"Charles Goldfarb","startTime":511.28,"endTime":517.04,"body":"see maybe, and ultimately, a CT"},{"speaker":"Charles Goldfarb","startTime":517.04,"endTime":521.92,"body":"scan was ordered. It did show"},{"speaker":"Charles Goldfarb","startTime":517.04,"endTime":521.92,"body":"there was something going on. So"},{"speaker":"Charles Goldfarb","startTime":521.92,"endTime":526.9,"body":"we did, so this is a young"},{"speaker":"Charles Goldfarb","startTime":521.92,"endTime":526.9,"body":"patient, maybe 10 years of age,"},{"speaker":"Charles Goldfarb","startTime":527.08,"endTime":530.2,"body":"and we did an oboe arthroscopy"},{"speaker":"Charles Goldfarb","startTime":527.08,"endTime":530.2,"body":"to better understand the"},{"speaker":"Charles Goldfarb","startTime":530.2,"endTime":532.84,"body":"problem, which, which,"},{"speaker":"Charles Goldfarb","startTime":530.2,"endTime":532.84,"body":"thankfully, I feel comfortable"},{"speaker":"Charles Goldfarb","startTime":532.84,"endTime":536.68,"body":"with now, but scoping a kid"},{"speaker":"Charles Goldfarb","startTime":532.84,"endTime":536.68,"body":"where, you know, the safety"},{"speaker":"Charles Goldfarb","startTime":536.68,"endTime":542.7,"body":"margins are small, it's always a"},{"speaker":"Charles Goldfarb","startTime":536.68,"endTime":542.7,"body":"little hairy. And then we ended"},{"speaker":"Charles Goldfarb","startTime":542.7,"endTime":547.02,"body":"up opening and fixing just an"},{"speaker":"Charles Goldfarb","startTime":542.7,"endTime":547.02,"body":"unbelievably distal shear injury"},{"speaker":"Charles Goldfarb","startTime":547.02,"endTime":550.86,"body":"with just a tiny bit of bone."},{"speaker":"Charles Goldfarb","startTime":547.02,"endTime":550.86,"body":"Ultimately, was great, but"},{"speaker":"Charles Goldfarb","startTime":550.86,"endTime":554.88,"body":"tricky case, and again, gets"},{"speaker":"Charles Goldfarb","startTime":550.86,"endTime":554.88,"body":"back to the point of finding"},{"speaker":"Charles Goldfarb","startTime":554.88,"endTime":557.58,"body":"enjoyment even when it wasn't"},{"speaker":"Charles Goldfarb","startTime":554.88,"endTime":557.58,"body":"what you set out to look for."},{"speaker":"Chris Dy","startTime":558.06,"endTime":560.66,"body":"Right exactly. So how"},{"speaker":"Chris Dy","startTime":558.06,"endTime":560.66,"body":"did you make the decision to go"},{"speaker":"Chris Dy","startTime":560.66,"endTime":564.5,"body":"from the scope to opening. Did"},{"speaker":"Chris Dy","startTime":560.66,"endTime":564.5,"body":"you say this is something I"},{"speaker":"Chris Dy","startTime":564.5,"endTime":567.32,"body":"can't I can diagnose it through"},{"speaker":"Chris Dy","startTime":564.5,"endTime":567.32,"body":"the scope, but I can't fix it"},{"speaker":"Chris Dy","startTime":567.32,"endTime":569.48,"body":"through the scope. Is it"},{"speaker":"Chris Dy","startTime":567.32,"endTime":569.48,"body":"something that you were better"},{"speaker":"Chris Dy","startTime":569.48,"endTime":571.88,"body":"off fixation wise doing open?"},{"speaker":"Charles Goldfarb","startTime":572.06,"endTime":573.98,"body":"Some might"},{"speaker":"Charles Goldfarb","startTime":572.06,"endTime":573.98,"body":"have skipped the scope to be"},{"speaker":"Charles Goldfarb","startTime":573.98,"endTime":576.5,"body":"honest with you. In fact, I"},{"speaker":"Charles Goldfarb","startTime":573.98,"endTime":576.5,"body":"would say most might have"},{"speaker":"Charles Goldfarb","startTime":576.5,"endTime":579.8,"body":"skipped the scope. For me, the"},{"speaker":"Charles Goldfarb","startTime":576.5,"endTime":579.8,"body":"scope was beneficial in the"},{"speaker":"Charles Goldfarb","startTime":579.8,"endTime":583.18,"body":"sense that it gave me a better"},{"speaker":"Charles Goldfarb","startTime":579.8,"endTime":583.18,"body":"sense of both what had been"},{"speaker":"Charles Goldfarb","startTime":583.18,"endTime":590.32,"body":"shared and also the injury site,"},{"speaker":"Charles Goldfarb","startTime":583.18,"endTime":590.32,"body":"and finally, looking for other"},{"speaker":"Charles Goldfarb","startTime":590.32,"endTime":593.5,"body":"injuries. So it gave me a kind"},{"speaker":"Charles Goldfarb","startTime":590.32,"endTime":593.5,"body":"of 360 view of anterior elbow,"},{"speaker":"Charles Goldfarb","startTime":593.5,"endTime":597.7,"body":"posterior elbow, and I was"},{"speaker":"Charles Goldfarb","startTime":593.5,"endTime":597.7,"body":"hoping that I could break the"},{"speaker":"Charles Goldfarb","startTime":597.7,"endTime":601.92,"body":"piece was anteriorly and so. I"},{"speaker":"Charles Goldfarb","startTime":597.7,"endTime":601.92,"body":"could bring it back posteriorly"},{"speaker":"Charles Goldfarb","startTime":602.1,"endTime":605.22,"body":"and then approach the elbow"},{"speaker":"Charles Goldfarb","startTime":602.1,"endTime":605.22,"body":"through an ink and the split and"},{"speaker":"Charles Goldfarb","startTime":605.22,"endTime":608.52,"body":"keep it really simple. Didn't"},{"speaker":"Charles Goldfarb","startTime":605.22,"endTime":608.52,"body":"turn out to be that simple. And"},{"speaker":"Charles Goldfarb","startTime":608.52,"endTime":612.36,"body":"I had to take down the lateral"},{"speaker":"Charles Goldfarb","startTime":608.52,"endTime":612.36,"body":"ligament complex to get"},{"speaker":"Charles Goldfarb","startTime":612.36,"endTime":616.74,"body":"exposure, to get the repair, and"},{"speaker":"Charles Goldfarb","startTime":612.36,"endTime":616.74,"body":"then to and then on my way out,"},{"speaker":"Charles Goldfarb","startTime":616.74,"endTime":621.56,"body":"I obviously repaired the lateral"},{"speaker":"Charles Goldfarb","startTime":616.74,"endTime":621.56,"body":"complex, yeah. So I think the"},{"speaker":"Charles Goldfarb","startTime":621.56,"endTime":624.98,"body":"scope was potentially a step"},{"speaker":"Charles Goldfarb","startTime":621.56,"endTime":624.98,"body":"that could have been skipped,"},{"speaker":"Charles Goldfarb","startTime":625.16,"endTime":627.74,"body":"but this was a big open"},{"speaker":"Charles Goldfarb","startTime":625.16,"endTime":627.74,"body":"procedure in the end."},{"speaker":"Chris Dy","startTime":628.34,"endTime":631.76,"body":"Now, is this different"},{"speaker":"Chris Dy","startTime":628.34,"endTime":631.76,"body":"fracture or injury morphology"},{"speaker":"Chris Dy","startTime":631.76,"endTime":635.12,"body":"than the Capitol shear fractures"},{"speaker":"Chris Dy","startTime":631.76,"endTime":635.12,"body":"that Dr wall had a run of a"},{"speaker":"Chris Dy","startTime":635.12,"endTime":637.88,"body":"couple of years ago. I know that"},{"speaker":"Chris Dy","startTime":635.12,"endTime":637.88,"body":"she was describing a particular"},{"speaker":"Chris Dy","startTime":637.88,"endTime":639.08,"body":"approach to get there."},{"speaker":"Charles Goldfarb","startTime":639.62,"endTime":642.88,"body":"Yeah, I would"},{"speaker":"Charles Goldfarb","startTime":639.62,"endTime":642.88,"body":"say this is similar to, but"},{"speaker":"Charles Goldfarb","startTime":642.88,"endTime":648.7,"body":"younger patient than and far"},{"speaker":"Charles Goldfarb","startTime":642.88,"endTime":648.7,"body":"more subtle. Those fractures"},{"speaker":"Charles Goldfarb","startTime":648.7,"endTime":652.84,"body":"that she was addressing had a"},{"speaker":"Charles Goldfarb","startTime":648.7,"endTime":652.84,"body":"clear, major bony component, and"},{"speaker":"Charles Goldfarb","startTime":652.84,"endTime":656.68,"body":"there was never subtlety. This"},{"speaker":"Charles Goldfarb","startTime":652.84,"endTime":656.68,"body":"was just harder to pick up, and"},{"speaker":"Charles Goldfarb","startTime":656.68,"endTime":658.96,"body":"therefore, you know, took a"},{"speaker":"Charles Goldfarb","startTime":656.68,"endTime":658.96,"body":"little longer."},{"speaker":"Chris Dy","startTime":659.32,"endTime":660.04,"body":"How'd you fix it?"},{"speaker":"Charles Goldfarb","startTime":660.34,"endTime":664.38,"body":"I use three"},{"speaker":"Charles Goldfarb","startTime":660.34,"endTime":664.38,"body":"bio absorbable headless"},{"speaker":"Charles Goldfarb","startTime":664.44,"endTime":669.78,"body":"compression screws. And the"},{"speaker":"Charles Goldfarb","startTime":664.44,"endTime":669.78,"body":"trick there is that you are then"},{"speaker":"Charles Goldfarb","startTime":669.78,"endTime":673.56,"body":"balancing fixing this fragment,"},{"speaker":"Charles Goldfarb","startTime":669.78,"endTime":673.56,"body":"which you have to do, obviously"},{"speaker":"Charles Goldfarb","startTime":674.34,"endTime":679.26,"body":"with the growth plates and"},{"speaker":"Charles Goldfarb","startTime":674.34,"endTime":679.26,"body":"stability, and then obviously"},{"speaker":"Charles Goldfarb","startTime":679.26,"endTime":681.5,"body":"early motion, because an elbow"},{"speaker":"Charles Goldfarb","startTime":679.26,"endTime":681.5,"body":"and elbows get stiff."},{"speaker":"Chris Dy","startTime":682.04,"endTime":684.74,"body":"How long does it take"},{"speaker":"Chris Dy","startTime":682.04,"endTime":684.74,"body":"for those bio dissolvable, bio"},{"speaker":"Chris Dy","startTime":684.74,"endTime":688.04,"body":"absorbable compression screws to"},{"speaker":"Chris Dy","startTime":684.74,"endTime":688.04,"body":"absorb Yeah,"},{"speaker":"Charles Goldfarb","startTime":688.04,"endTime":689.78,"body":"I don't know"},{"speaker":"Charles Goldfarb","startTime":688.04,"endTime":689.78,"body":"if there's a difference in"},{"speaker":"Charles Goldfarb","startTime":689.78,"endTime":694.76,"body":"adults and kids, but I think"},{"speaker":"Charles Goldfarb","startTime":689.78,"endTime":694.76,"body":"we're looking at 12 plus months."},{"speaker":"Charles Goldfarb","startTime":695.3,"endTime":698.24,"body":"Always worry a little. I don't"},{"speaker":"Charles Goldfarb","startTime":695.3,"endTime":698.24,"body":"use a ton of bio absorbable"},{"speaker":"Charles Goldfarb","startTime":698.24,"endTime":700.96,"body":"screws. I always worry a little"},{"speaker":"Charles Goldfarb","startTime":698.24,"endTime":700.96,"body":"bit about a joint reaction to"},{"speaker":"Charles Goldfarb","startTime":700.96,"endTime":704.92,"body":"that, but our sports colleagues"},{"speaker":"Charles Goldfarb","startTime":700.96,"endTime":704.92,"body":"use them regularly and seem to"},{"speaker":"Charles Goldfarb","startTime":704.92,"endTime":706.78,"body":"be happy with them. Now,"},{"speaker":"Chris Dy","startTime":706.78,"endTime":709.9,"body":"are these typically"},{"speaker":"Chris Dy","startTime":706.78,"endTime":709.9,"body":"trans facial or are they all"},{"speaker":"Chris Dy","startTime":709.9,"endTime":711.22,"body":"epiphyseal? Or are they,"},{"speaker":"Charles Goldfarb","startTime":711.46,"endTime":713.8,"body":"I hope to"},{"speaker":"Charles Goldfarb","startTime":711.46,"endTime":713.8,"body":"avoid the physicists in this"},{"speaker":"Charles Goldfarb","startTime":713.8,"endTime":716.44,"body":"particular we don't need to go"},{"speaker":"Charles Goldfarb","startTime":713.8,"endTime":716.44,"body":"to the details. There's a 16"},{"speaker":"Charles Goldfarb","startTime":716.44,"endTime":719.14,"body":"millimeter length. Was the"},{"speaker":"Charles Goldfarb","startTime":716.44,"endTime":719.14,"body":"shortest length. I thought about"},{"speaker":"Charles Goldfarb","startTime":719.14,"endTime":721.74,"body":"cutting it, but I didn't think"},{"speaker":"Charles Goldfarb","startTime":719.14,"endTime":721.74,"body":"I'd get the fixation, so I just"},{"speaker":"Charles Goldfarb","startTime":721.74,"endTime":726.6,"body":"went ahead and put it in, and I"},{"speaker":"Charles Goldfarb","startTime":721.74,"endTime":726.6,"body":"think it tickled the physicists,"},{"speaker":"Charles Goldfarb","startTime":726.6,"endTime":727.86,"body":"and hopefully it won't bother"},{"speaker":"Chris Dy","startTime":729.06,"endTime":731.1,"body":"I don't know the last"},{"speaker":"Chris Dy","startTime":729.06,"endTime":731.1,"body":"time I said the word epiphysis."},{"speaker":"Chris Dy","startTime":731.1,"endTime":732.54,"body":"It's been a very long time."},{"speaker":"Charles Goldfarb","startTime":733.02,"endTime":734.76,"body":"Well, say it a"},{"speaker":"Charles Goldfarb","startTime":733.02,"endTime":734.76,"body":"couple times in a row."},{"speaker":"Chris Dy","startTime":736.56,"endTime":740.54,"body":"One of my friends was"},{"speaker":"Chris Dy","startTime":736.56,"endTime":740.54,"body":"a deep sports person up in New"},{"speaker":"Chris Dy","startTime":740.54,"endTime":743.78,"body":"York, and I remember him going"},{"speaker":"Chris Dy","startTime":740.54,"endTime":743.78,"body":"on and on about all epiphyseal"},{"speaker":"Chris Dy","startTime":743.84,"endTime":747.92,"body":"ACLs and also not my thing at"},{"speaker":"Chris Dy","startTime":743.84,"endTime":747.92,"body":"all."},{"speaker":"Charles Goldfarb","startTime":748.4,"endTime":751.16,"body":"Yeah, you"},{"speaker":"Charles Goldfarb","startTime":748.4,"endTime":751.16,"body":"know, it's it does add another"},{"speaker":"Charles Goldfarb","startTime":751.22,"endTime":755.0,"body":"level of challenge sometimes,"},{"speaker":"Charles Goldfarb","startTime":751.22,"endTime":755.0,"body":"but you know, that's what makes"},{"speaker":"Charles Goldfarb","startTime":755.0,"endTime":755.36,"body":"it fun,"},{"speaker":"Chris Dy","startTime":755.72,"endTime":759.98,"body":"exactly. So before we"},{"speaker":"Chris Dy","startTime":755.72,"endTime":759.98,"body":"jump into this advocacy topic, I"},{"speaker":"Chris Dy","startTime":759.98,"endTime":763.0,"body":"did want to note that the upper"},{"speaker":"Chris Dy","startTime":759.98,"endTime":763.0,"body":"hand is sponsored by checkpoint"},{"speaker":"Chris Dy","startTime":763.0,"endTime":765.28,"body":"surgical, a provider of"},{"speaker":"Chris Dy","startTime":763.0,"endTime":765.28,"body":"innovative solutions for"},{"speaker":"Chris Dy","startTime":765.28,"endTime":767.8,"body":"peripheral nerve surgery."},{"speaker":"Chris Dy","startTime":765.28,"endTime":767.8,"body":"Checkpoint now offers a"},{"speaker":"Chris Dy","startTime":767.8,"endTime":772.0,"body":"specialized notepad to assist in"},{"speaker":"Chris Dy","startTime":767.8,"endTime":772.0,"body":"documenting Guardian stimulator"},{"speaker":"Chris Dy","startTime":772.0,"endTime":775.0,"body":"device starting settings during"},{"speaker":"Chris Dy","startTime":772.0,"endTime":775.0,"body":"surgical procedures such as"},{"speaker":"Chris Dy","startTime":775.0,"endTime":775.78,"body":"decompression. You"},{"speaker":"Charles Goldfarb","startTime":775.78,"endTime":779.26,"body":"have to"},{"speaker":"Charles Goldfarb","startTime":775.78,"endTime":779.26,"body":"explain to me what that means. I"},{"speaker":"Charles Goldfarb","startTime":779.26,"endTime":782.7,"body":"have lots of notepads, but not"},{"speaker":"Charles Goldfarb","startTime":779.26,"endTime":782.7,"body":"one related to checkpoint. But"},{"speaker":"Charles Goldfarb","startTime":782.76,"endTime":784.86,"body":"if you're interested in"},{"speaker":"Charles Goldfarb","startTime":782.76,"endTime":784.86,"body":"receiving a threshold"},{"speaker":"Charles Goldfarb","startTime":784.86,"endTime":788.88,"body":"stimulation notepad to"},{"speaker":"Charles Goldfarb","startTime":784.86,"endTime":788.88,"body":"facilitate accurate tracking of"},{"speaker":"Charles Goldfarb","startTime":788.88,"endTime":792.48,"body":"stimulation, settings, contact"},{"speaker":"Charles Goldfarb","startTime":788.88,"endTime":792.48,"body":"your local checkpoint sales"},{"speaker":"Charles Goldfarb","startTime":792.48,"endTime":794.1,"body":"representative or email"},{"speaker":"Charles Goldfarb","startTime":792.48,"endTime":794.1,"body":"marketing@checkpointsurgical.com"},{"speaker":"Charles Goldfarb","startTime":796.08,"endTime":799.62,"body":"checkpoint surgical driving"},{"speaker":"Charles Goldfarb","startTime":796.08,"endTime":799.62,"body":"innovation in nerve surgery."},{"speaker":"Charles Goldfarb","startTime":799.98,"endTime":801.38,"body":"What does this mean? Does"},{"speaker":"Chris Dy","startTime":801.44,"endTime":804.56,"body":"you know what this is?"},{"speaker":"Chris Dy","startTime":801.44,"endTime":804.56,"body":"Because I was at a meeting with"},{"speaker":"Chris Dy","startTime":804.56,"endTime":807.62,"body":"checkpoint recently, I think it"},{"speaker":"Chris Dy","startTime":804.56,"endTime":807.62,"body":"was back in August, and I was"},{"speaker":"Chris Dy","startTime":807.62,"endTime":809.96,"body":"like, What do you remember those"},{"speaker":"Chris Dy","startTime":807.62,"endTime":809.96,"body":"notepads you had where you"},{"speaker":"Chris Dy","startTime":809.96,"endTime":813.44,"body":"could, like, record, you know,"},{"speaker":"Chris Dy","startTime":809.96,"endTime":813.44,"body":"like, what if you stimulate at"},{"speaker":"Chris Dy","startTime":813.44,"endTime":817.04,"body":"certain settings, what kind of"},{"speaker":"Chris Dy","startTime":813.44,"endTime":817.04,"body":"response you get? And you know,"},{"speaker":"Chris Dy","startTime":817.1,"endTime":819.98,"body":"one of my and anybody who's used"},{"speaker":"Chris Dy","startTime":817.1,"endTime":819.98,"body":"a nerve stimulator in general,"},{"speaker":"Chris Dy","startTime":819.98,"endTime":822.22,"body":"whether it's checkpoint"},{"speaker":"Chris Dy","startTime":819.98,"endTime":822.22,"body":"Medtronic, whatever other ones"},{"speaker":"Chris Dy","startTime":822.22,"endTime":827.32,"body":"you use. The anesthesia setup"},{"speaker":"Chris Dy","startTime":822.22,"endTime":827.32,"body":"knows that we don't have a great"},{"speaker":"Chris Dy","startTime":827.32,"endTime":832.06,"body":"way of documenting how we use"},{"speaker":"Chris Dy","startTime":827.32,"endTime":832.06,"body":"the device and what kind of"},{"speaker":"Chris Dy","startTime":832.06,"endTime":835.42,"body":"responses we get, and that's"},{"speaker":"Chris Dy","startTime":832.06,"endTime":835.42,"body":"incredibly valuable information."},{"speaker":"Chris Dy","startTime":835.42,"endTime":838.0,"body":"So then they said, Oh yeah, we"},{"speaker":"Chris Dy","startTime":835.42,"endTime":838.0,"body":"have this notepad that says,"},{"speaker":"Chris Dy","startTime":838.0,"endTime":841.02,"body":"like, this is a setting, this is"},{"speaker":"Chris Dy","startTime":838.0,"endTime":841.02,"body":"a pulse duration, the pulse"},{"speaker":"Chris Dy","startTime":841.02,"endTime":846.66,"body":"width, etc. You should record"},{"speaker":"Chris Dy","startTime":841.02,"endTime":846.66,"body":"this so it's there. It's an"},{"speaker":"Chris Dy","startTime":846.66,"endTime":850.68,"body":"interesting thing. I think that"},{"speaker":"Chris Dy","startTime":846.66,"endTime":850.68,"body":"we should be great if it was"},{"speaker":"Chris Dy","startTime":850.68,"endTime":854.76,"body":"sterilizable and could be"},{"speaker":"Chris Dy","startTime":850.68,"endTime":854.76,"body":"written down by the surgeon"},{"speaker":"Chris Dy","startTime":854.76,"endTime":857.28,"body":"interop, which I think is very"},{"speaker":"Chris Dy","startTime":854.76,"endTime":857.28,"body":"challenging, because otherwise"},{"speaker":"Chris Dy","startTime":857.28,"endTime":860.48,"body":"you're just rattling off a bunch"},{"speaker":"Chris Dy","startTime":857.28,"endTime":860.48,"body":"of numbers to a circulator who"},{"speaker":"Chris Dy","startTime":860.48,"endTime":863.3,"body":"is not terribly interested in"},{"speaker":"Chris Dy","startTime":860.48,"endTime":863.3,"body":"recording this information for"},{"speaker":"Chris Dy","startTime":863.3,"endTime":867.62,"body":"you. So we've actually in our"},{"speaker":"Chris Dy","startTime":863.3,"endTime":867.62,"body":"lab, we've taken this to a the"},{"speaker":"Chris Dy","startTime":867.62,"endTime":870.44,"body":"next level and created a more"},{"speaker":"Chris Dy","startTime":867.62,"endTime":870.44,"body":"detailed version of it in red"},{"speaker":"Chris Dy","startTime":870.44,"endTime":873.62,"body":"cap that we're starting to use"},{"speaker":"Chris Dy","startTime":870.44,"endTime":873.62,"body":"for all of our nerve transfer"},{"speaker":"Chris Dy","startTime":873.62,"endTime":875.36,"body":"and nerve reconstruction cases."},{"speaker":"Charles Goldfarb","startTime":876.5,"endTime":879.92,"body":"Excellent. I"},{"speaker":"Charles Goldfarb","startTime":876.5,"endTime":879.92,"body":"don't know that I have a need"},{"speaker":"Charles Goldfarb","startTime":879.92,"endTime":883.78,"body":"for a notepad. Maybe, yeah, do."},{"speaker":"Charles Goldfarb","startTime":879.92,"endTime":883.78,"body":"Maybe I just don't know it. But"},{"speaker":"Charles Goldfarb","startTime":883.78,"endTime":884.62,"body":"hey, you"},{"speaker":"Chris Dy","startTime":884.62,"endTime":886.6,"body":"exactly. It's the"},{"speaker":"Chris Dy","startTime":884.62,"endTime":886.6,"body":"thing you never knew you needed."},{"speaker":"Chris Dy","startTime":887.56,"endTime":889.3,"body":"That's marketing, baby. That's"},{"speaker":"Chris Dy","startTime":887.56,"endTime":889.3,"body":"marketing."},{"speaker":"Charles Goldfarb","startTime":889.84,"endTime":891.4,"body":"Well, I, you"},{"speaker":"Charles Goldfarb","startTime":889.84,"endTime":891.4,"body":"know, as you know, I'm in"},{"speaker":"Charles Goldfarb","startTime":891.4,"endTime":893.38,"body":"business school, and I'm"},{"speaker":"Charles Goldfarb","startTime":891.4,"endTime":893.38,"body":"learning about this kind of"},{"speaker":"Charles Goldfarb","startTime":893.38,"endTime":898.54,"body":"stuff, and it is that, you know,"},{"speaker":"Charles Goldfarb","startTime":893.38,"endTime":898.54,"body":"Steve Jobs quote about the"},{"speaker":"Charles Goldfarb","startTime":898.54,"endTime":901.98,"body":"public doesn't know they."},{"speaker":"Charles Goldfarb","startTime":898.54,"endTime":901.98,"body":"Something until you show them"},{"speaker":"Charles Goldfarb","startTime":901.98,"endTime":905.64,"body":"that they need it. Maybe this is"},{"speaker":"Charles Goldfarb","startTime":901.98,"endTime":905.64,"body":"that. I think"},{"speaker":"Chris Dy","startTime":905.64,"endTime":908.88,"body":"it is. So why don't we"},{"speaker":"Chris Dy","startTime":905.64,"endTime":908.88,"body":"jump into the email? We have an"},{"speaker":"Chris Dy","startTime":908.88,"endTime":912.72,"body":"email from John Lundy, who is a"},{"speaker":"Chris Dy","startTime":908.88,"endTime":912.72,"body":"private practice hand surgeon in"},{"speaker":"Chris Dy","startTime":912.72,"endTime":917.04,"body":"Austin. So John emailed us at"},{"speaker":"Chris Dy","startTime":912.72,"endTime":917.04,"body":"this point, probably about a"},{"speaker":"Chris Dy","startTime":917.04,"endTime":919.74,"body":"month or so ago, saying that he"},{"speaker":"Chris Dy","startTime":917.04,"endTime":919.74,"body":"retired from the military about"},{"speaker":"Chris Dy","startTime":919.74,"endTime":922.82,"body":"a year ago and has been in"},{"speaker":"Chris Dy","startTime":919.74,"endTime":922.82,"body":"private practice and has noted"},{"speaker":"Chris Dy","startTime":922.82,"endTime":926.96,"body":"some issues, and there is a lack"},{"speaker":"Chris Dy","startTime":922.82,"endTime":926.96,"body":"of a formal professional group"},{"speaker":"Chris Dy","startTime":926.96,"endTime":930.62,"body":"in Texas. And he has founded the"},{"speaker":"Chris Dy","startTime":926.96,"endTime":930.62,"body":"Texas hand society with his"},{"speaker":"Chris Dy","startTime":930.62,"endTime":934.1,"body":"colleagues. Their vision is to"},{"speaker":"Chris Dy","startTime":930.62,"endTime":934.1,"body":"improve access to care by"},{"speaker":"Chris Dy","startTime":934.1,"endTime":938.3,"body":"working to to get access to"},{"speaker":"Chris Dy","startTime":934.1,"endTime":938.3,"body":"appropriate and high quality"},{"speaker":"Chris Dy","startTime":938.3,"endTime":941.32,"body":"hand surgery care for all"},{"speaker":"Chris Dy","startTime":938.3,"endTime":941.32,"body":"patients in Texas. And then you"},{"speaker":"Chris Dy","startTime":941.32,"endTime":943.72,"body":"need an organization to"},{"speaker":"Chris Dy","startTime":941.32,"endTime":943.72,"body":"collaborate and coordinate all"},{"speaker":"Chris Dy","startTime":943.72,"endTime":947.56,"body":"of that, of the surgeons with"},{"speaker":"Chris Dy","startTime":943.72,"endTime":947.56,"body":"the health care providers,"},{"speaker":"Chris Dy","startTime":947.62,"endTime":951.4,"body":"health systems, payers and"},{"speaker":"Chris Dy","startTime":947.62,"endTime":951.4,"body":"policy makers. And to his"},{"speaker":"Chris Dy","startTime":951.4,"endTime":954.04,"body":"recollection, he has about 55"},{"speaker":"Chris Dy","startTime":951.4,"endTime":954.04,"body":"members so far, and they're"},{"speaker":"Chris Dy","startTime":954.04,"endTime":957.64,"body":"looking to expand recruitment"},{"speaker":"Chris Dy","startTime":954.04,"endTime":957.64,"body":"efforts and emailed us so"},{"speaker":"Chris Dy","startTime":957.64,"endTime":961.5,"body":"anybody who is a hand surgeon"},{"speaker":"Chris Dy","startTime":957.64,"endTime":961.5,"body":"practicing in Texas. If you"},{"speaker":"Chris Dy","startTime":961.5,"endTime":965.58,"body":"wouldn't mind reaching out to"},{"speaker":"Chris Dy","startTime":961.5,"endTime":965.58,"body":"John Lundy, his email address,"},{"speaker":"Chris Dy","startTime":965.58,"endTime":968.58,"body":"we will put in the show notes. I"},{"speaker":"Chris Dy","startTime":965.58,"endTime":968.58,"body":"won't shout it out on the air,"},{"speaker":"Chris Dy","startTime":969.18,"endTime":972.48,"body":"but that way you can reach out"},{"speaker":"Chris Dy","startTime":969.18,"endTime":972.48,"body":"to him. He's in Austin, and that"},{"speaker":"Chris Dy","startTime":972.48,"endTime":976.2,"body":"actually not only do we want to"},{"speaker":"Chris Dy","startTime":972.48,"endTime":976.2,"body":"applaud John for his efforts,"},{"speaker":"Chris Dy","startTime":976.32,"endTime":979.56,"body":"for for gathering his"},{"speaker":"Chris Dy","startTime":976.32,"endTime":979.56,"body":"colleagues, but also talk a bit"},{"speaker":"Chris Dy","startTime":979.56,"endTime":983.06,"body":"about advocacy and the role it"},{"speaker":"Chris Dy","startTime":979.56,"endTime":983.06,"body":"might play in the practice of"},{"speaker":"Chris Dy","startTime":983.06,"endTime":984.68,"body":"hand surgery and hand therapy."},{"speaker":"Charles Goldfarb","startTime":985.52,"endTime":988.46,"body":"Yeah, kudos to"},{"speaker":"Charles Goldfarb","startTime":985.52,"endTime":988.46,"body":"John. Sounds like an important"},{"speaker":"Charles Goldfarb","startTime":988.58,"endTime":991.76,"body":"step, and off to a good start."},{"speaker":"Charles Goldfarb","startTime":988.58,"endTime":991.76,"body":"I'm not sure how many hand"},{"speaker":"Charles Goldfarb","startTime":991.76,"endTime":994.7,"body":"surgeons are in the state of"},{"speaker":"Charles Goldfarb","startTime":991.76,"endTime":994.7,"body":"Texas, or how many surgeons who"},{"speaker":"Charles Goldfarb","startTime":994.7,"endTime":999.44,"body":"also perform hand surgery are in"},{"speaker":"Charles Goldfarb","startTime":994.7,"endTime":999.44,"body":"the state of Texas, but there is"},{"speaker":"Charles Goldfarb","startTime":999.44,"endTime":1003.9,"body":"power in numbers, and that's the"},{"speaker":"Charles Goldfarb","startTime":999.44,"endTime":1003.9,"body":"point. And you know a great deal"},{"speaker":"Charles Goldfarb","startTime":1003.9,"endTime":1010.26,"body":"about advocacy. I know how"},{"speaker":"Charles Goldfarb","startTime":1003.9,"endTime":1010.26,"body":"important it is, and recognize"},{"speaker":"Charles Goldfarb","startTime":1010.26,"endTime":1015.0,"body":"that many of us, sometimes"},{"speaker":"Charles Goldfarb","startTime":1010.26,"endTime":1015.0,"body":"myself included, don't think"},{"speaker":"Charles Goldfarb","startTime":1015.0,"endTime":1020.36,"body":"enough about it. So first, maybe"},{"speaker":"Charles Goldfarb","startTime":1015.0,"endTime":1020.36,"body":"tell me how you think about the"},{"speaker":"Charles Goldfarb","startTime":1020.36,"endTime":1024.86,"body":"term advocacy and what it means"},{"speaker":"Charles Goldfarb","startTime":1020.36,"endTime":1024.86,"body":"to most of us."},{"speaker":"Chris Dy","startTime":1025.94,"endTime":1029.12,"body":"You know, I think the"},{"speaker":"Chris Dy","startTime":1025.94,"endTime":1029.12,"body":"advocacy term is a pretty broad"},{"speaker":"Chris Dy","startTime":1029.12,"endTime":1032.24,"body":"one. I mean, I think it's"},{"speaker":"Chris Dy","startTime":1029.12,"endTime":1032.24,"body":"thinking about how to, you know,"},{"speaker":"Chris Dy","startTime":1032.24,"endTime":1035.48,"body":"advocate for oneself and for a"},{"speaker":"Chris Dy","startTime":1032.24,"endTime":1035.48,"body":"group of like minded individuals"},{"speaker":"Chris Dy","startTime":1035.84,"endTime":1041.26,"body":"to in, not say, negotiations,"},{"speaker":"Chris Dy","startTime":1035.84,"endTime":1041.26,"body":"but discussions with other"},{"speaker":"Chris Dy","startTime":1041.26,"endTime":1044.26,"body":"people who control power,"},{"speaker":"Chris Dy","startTime":1041.26,"endTime":1044.26,"body":"essentially, whether that's, you"},{"speaker":"Chris Dy","startTime":1044.26,"endTime":1046.48,"body":"know, because I know that you"},{"speaker":"Chris Dy","startTime":1044.26,"endTime":1046.48,"body":"have had a lot of efforts in"},{"speaker":"Chris Dy","startTime":1046.48,"endTime":1050.14,"body":"terms of our group practice in"},{"speaker":"Chris Dy","startTime":1046.48,"endTime":1050.14,"body":"advocating with payers, with"},{"speaker":"Chris Dy","startTime":1050.14,"endTime":1053.32,"body":"insurance companies. We can go"},{"speaker":"Chris Dy","startTime":1050.14,"endTime":1053.32,"body":"through maybe the example of the"},{"speaker":"Chris Dy","startTime":1053.68,"endTime":1057.1,"body":"needle app and Neurotomy. But"},{"speaker":"Chris Dy","startTime":1053.68,"endTime":1057.1,"body":"then there's also advocacy at,"},{"speaker":"Chris Dy","startTime":1057.1,"endTime":1060.36,"body":"you know, a political level, you"},{"speaker":"Chris Dy","startTime":1057.1,"endTime":1060.36,"body":"know, you can have advocacy at a"},{"speaker":"Chris Dy","startTime":1060.36,"endTime":1063.78,"body":"local level in terms of"},{"speaker":"Chris Dy","startTime":1060.36,"endTime":1063.78,"body":"advocating for for your group of"},{"speaker":"Chris Dy","startTime":1064.2,"endTime":1067.2,"body":"practitioners, surgeons,"},{"speaker":"Chris Dy","startTime":1064.2,"endTime":1067.2,"body":"therapists, with a hospital"},{"speaker":"Chris Dy","startTime":1067.2,"endTime":1070.8,"body":"system, etc. So it really is"},{"speaker":"Chris Dy","startTime":1067.2,"endTime":1070.8,"body":"rallying the troops in a way"},{"speaker":"Chris Dy","startTime":1070.8,"endTime":1076.08,"body":"where you are trying to to make"},{"speaker":"Chris Dy","startTime":1070.8,"endTime":1076.08,"body":"people know what you're feeling,"},{"speaker":"Chris Dy","startTime":1076.44,"endTime":1080.22,"body":"how things might be able to"},{"speaker":"Chris Dy","startTime":1076.44,"endTime":1080.22,"body":"change in a mutually beneficial,"},{"speaker":"Chris Dy","startTime":1080.22,"endTime":1084.98,"body":"ideally way to to improve"},{"speaker":"Chris Dy","startTime":1080.22,"endTime":1084.98,"body":"delivery of care."},{"speaker":"Charles Goldfarb","startTime":1086.18,"endTime":1087.8,"body":"Thank you. I"},{"speaker":"Charles Goldfarb","startTime":1086.18,"endTime":1087.8,"body":"think that was, that was well"},{"speaker":"Charles Goldfarb","startTime":1087.8,"endTime":1094.7,"body":"said. You know, we sometimes we"},{"speaker":"Charles Goldfarb","startTime":1087.8,"endTime":1094.7,"body":"can have tunnel vision and"},{"speaker":"Charles Goldfarb","startTime":1094.7,"endTime":1098.84,"body":"believe in, perhaps in a perfect"},{"speaker":"Charles Goldfarb","startTime":1094.7,"endTime":1098.84,"body":"world. This is how it would be,"},{"speaker":"Charles Goldfarb","startTime":1099.26,"endTime":1101.8,"body":"that if I just take really good"},{"speaker":"Charles Goldfarb","startTime":1099.26,"endTime":1101.8,"body":"care of my patients, everything"},{"speaker":"Charles Goldfarb","startTime":1101.8,"endTime":1106.66,"body":"else will work out. As I've"},{"speaker":"Charles Goldfarb","startTime":1101.8,"endTime":1106.66,"body":"gotten more cynical with age,"},{"speaker":"Charles Goldfarb","startTime":1106.72,"endTime":1110.2,"body":"that's just not true. And you"},{"speaker":"Charles Goldfarb","startTime":1106.72,"endTime":1110.2,"body":"know, taking care of the"},{"speaker":"Charles Goldfarb","startTime":1110.2,"endTime":1114.1,"body":"patients the right way is great,"},{"speaker":"Charles Goldfarb","startTime":1110.2,"endTime":1114.1,"body":"but there are so many different"},{"speaker":"Charles Goldfarb","startTime":1114.64,"endTime":1119.26,"body":"factors to our ability to do"},{"speaker":"Charles Goldfarb","startTime":1114.64,"endTime":1119.26,"body":"that, and we could go down a"},{"speaker":"Charles Goldfarb","startTime":1119.26,"endTime":1122.4,"body":"million different tangents why"},{"speaker":"Charles Goldfarb","startTime":1119.26,"endTime":1122.4,"body":"private practice is struggling."},{"speaker":"Charles Goldfarb","startTime":1122.82,"endTime":1126.24,"body":"There's just so many things that"},{"speaker":"Charles Goldfarb","startTime":1122.82,"endTime":1126.24,"body":"affect our ability to practice"},{"speaker":"Charles Goldfarb","startTime":1126.54,"endTime":1130.8,"body":"that tunnel vision is not"},{"speaker":"Charles Goldfarb","startTime":1126.54,"endTime":1130.8,"body":"helpful. Or, I guess I would say"},{"speaker":"Charles Goldfarb","startTime":1130.8,"endTime":1132.0,"body":"bigger success."},{"speaker":"Chris Dy","startTime":1132.48,"endTime":1134.82,"body":"Yeah, no, the put your"},{"speaker":"Chris Dy","startTime":1132.48,"endTime":1134.82,"body":"head down and take care of the"},{"speaker":"Chris Dy","startTime":1134.82,"endTime":1137.52,"body":"patient mentality is probably"},{"speaker":"Chris Dy","startTime":1134.82,"endTime":1137.52,"body":"the best and worst thing about"},{"speaker":"Chris Dy","startTime":1137.52,"endTime":1141.08,"body":"being a doctor. And you know, I"},{"speaker":"Chris Dy","startTime":1137.52,"endTime":1141.08,"body":"think that those who are on the"},{"speaker":"Chris Dy","startTime":1141.08,"endTime":1143.78,"body":"other side, those who control"},{"speaker":"Chris Dy","startTime":1141.08,"endTime":1143.78,"body":"the purse strings and the power"},{"speaker":"Chris Dy","startTime":1144.32,"endTime":1147.02,"body":"love that about us, because then"},{"speaker":"Chris Dy","startTime":1144.32,"endTime":1147.02,"body":"they can then take advantage of"},{"speaker":"Chris Dy","startTime":1147.02,"endTime":1149.72,"body":"us, and then when they need the"},{"speaker":"Chris Dy","startTime":1147.02,"endTime":1149.72,"body":"care that they want, they get"},{"speaker":"Chris Dy","startTime":1149.72,"endTime":1153.86,"body":"what they want. You know, so are"},{"speaker":"Chris Dy","startTime":1149.72,"endTime":1153.86,"body":"in I think this extends beyond"},{"speaker":"Chris Dy","startTime":1153.86,"endTime":1156.5,"body":"American health care. You see"},{"speaker":"Chris Dy","startTime":1153.86,"endTime":1156.5,"body":"advocacy playing a big role,"},{"speaker":"Chris Dy","startTime":1156.5,"endTime":1161.08,"body":"especially in the UK, with with"},{"speaker":"Chris Dy","startTime":1156.5,"endTime":1161.08,"body":"the NHS, and honestly, with"},{"speaker":"Chris Dy","startTime":1161.14,"endTime":1164.74,"body":"residencies around the world and"},{"speaker":"Chris Dy","startTime":1161.14,"endTime":1164.74,"body":"the question about unionization,"},{"speaker":"Chris Dy","startTime":1165.64,"endTime":1170.68,"body":"you know, so not only, you know,"},{"speaker":"Chris Dy","startTime":1165.64,"endTime":1170.68,"body":"in other parts of Europe, but"},{"speaker":"Chris Dy","startTime":1171.1,"endTime":1173.5,"body":"also here in the States, you're"},{"speaker":"Chris Dy","startTime":1171.1,"endTime":1173.5,"body":"starting to see residents"},{"speaker":"Chris Dy","startTime":1173.74,"endTime":1177.58,"body":"residencies at different"},{"speaker":"Chris Dy","startTime":1173.74,"endTime":1177.58,"body":"hospital systems unionized. And"},{"speaker":"Chris Dy","startTime":1177.58,"endTime":1181.68,"body":"that's clearly another advocacy"},{"speaker":"Chris Dy","startTime":1177.58,"endTime":1181.68,"body":"piece. But yeah, the best part"},{"speaker":"Chris Dy","startTime":1181.68,"endTime":1184.26,"body":"about what we do is getting to"},{"speaker":"Chris Dy","startTime":1181.68,"endTime":1184.26,"body":"take care of people, and I don't"},{"speaker":"Chris Dy","startTime":1184.26,"endTime":1187.92,"body":"think we pay enough attention."},{"speaker":"Chris Dy","startTime":1184.26,"endTime":1187.92,"body":"Get our, you know, get the high"},{"speaker":"Chris Dy","startTime":1187.92,"endTime":1190.32,"body":"level view until you've been"},{"speaker":"Chris Dy","startTime":1187.92,"endTime":1190.32,"body":"doing it long enough you don't"},{"speaker":"Chris Dy","startTime":1190.32,"endTime":1193.02,"body":"have to worry about the patient,"},{"speaker":"Chris Dy","startTime":1190.32,"endTime":1193.02,"body":"not worry about but you can"},{"speaker":"Chris Dy","startTime":1193.02,"endTime":1197.34,"body":"think more than just about the"},{"speaker":"Chris Dy","startTime":1193.02,"endTime":1197.34,"body":"patient in front of you, because"},{"speaker":"Chris Dy","startTime":1197.34,"endTime":1201.26,"body":"it's so hard to do, you know, to"},{"speaker":"Chris Dy","startTime":1197.34,"endTime":1201.26,"body":"do what we do. Um. And to take"},{"speaker":"Chris Dy","startTime":1201.26,"endTime":1204.74,"body":"care of people that it's easy to"},{"speaker":"Chris Dy","startTime":1201.26,"endTime":1204.74,"body":"just miss the rest of what's"},{"speaker":"Chris Dy","startTime":1204.74,"endTime":1205.88,"body":"going on around you,"},{"speaker":"Charles Goldfarb","startTime":1206.78,"endTime":1209.24,"body":"right? And I"},{"speaker":"Charles Goldfarb","startTime":1206.78,"endTime":1209.24,"body":"think a lot of us think that our"},{"speaker":"Charles Goldfarb","startTime":1209.24,"endTime":1214.22,"body":"societies, which is one reason"},{"speaker":"Charles Goldfarb","startTime":1209.24,"endTime":1214.22,"body":"we all do and should belong to"},{"speaker":"Charles Goldfarb","startTime":1214.22,"endTime":1217.64,"body":"various societies, do this, I"},{"speaker":"Charles Goldfarb","startTime":1214.22,"endTime":1217.64,"body":"would say, quote, unquote, for"},{"speaker":"Charles Goldfarb","startTime":1217.64,"endTime":1223.72,"body":"us, but they do it in different"},{"speaker":"Charles Goldfarb","startTime":1217.64,"endTime":1223.72,"body":"ways and simplicity. Maybe we"},{"speaker":"Charles Goldfarb","startTime":1223.72,"endTime":1226.0,"body":"should talk a little bit about"},{"speaker":"Charles Goldfarb","startTime":1223.72,"endTime":1226.0,"body":"that, and then we could go back"},{"speaker":"Charles Goldfarb","startTime":1226.0,"endTime":1228.7,"body":"to some kind of boots on the"},{"speaker":"Charles Goldfarb","startTime":1226.0,"endTime":1228.7,"body":"ground examples. But you know,"},{"speaker":"Charles Goldfarb","startTime":1228.7,"endTime":1236.2,"body":"the hand society does work"},{"speaker":"Charles Goldfarb","startTime":1228.7,"endTime":1236.2,"body":"around coding and assuring that"},{"speaker":"Charles Goldfarb","startTime":1236.2,"endTime":1239.14,"body":"there is appropriate"},{"speaker":"Charles Goldfarb","startTime":1236.2,"endTime":1239.14,"body":"identification of rbus for"},{"speaker":"Charles Goldfarb","startTime":1239.32,"endTime":1243.84,"body":"procedural codes. But the hand"},{"speaker":"Charles Goldfarb","startTime":1239.32,"endTime":1243.84,"body":"study, I would not say lobbies"},{"speaker":"Charles Goldfarb","startTime":1244.14,"endTime":1247.8,"body":"like the aaos for orthopedic"},{"speaker":"Charles Goldfarb","startTime":1244.14,"endTime":1247.8,"body":"surgeons out there, is that"},{"speaker":"Charles Goldfarb","startTime":1247.8,"endTime":1249.0,"body":"accurate? Yeah, I"},{"speaker":"Chris Dy","startTime":1249.0,"endTime":1251.16,"body":"think that's accurate."},{"speaker":"Chris Dy","startTime":1249.0,"endTime":1251.16,"body":"I think because of what most"},{"speaker":"Chris Dy","startTime":1251.16,"endTime":1256.92,"body":"hand surgeons do is there are a"},{"speaker":"Chris Dy","startTime":1251.16,"endTime":1256.92,"body":"ton of unique advocacy issues"},{"speaker":"Chris Dy","startTime":1256.92,"endTime":1260.96,"body":"for hand surgeons that are"},{"speaker":"Chris Dy","startTime":1256.92,"endTime":1260.96,"body":"different from what plastic"},{"speaker":"Chris Dy","startTime":1260.96,"endTime":1264.44,"body":"surgeons, orthopedic surgeons,"},{"speaker":"Chris Dy","startTime":1260.96,"endTime":1264.44,"body":"general surgeons, physicians in"},{"speaker":"Chris Dy","startTime":1264.44,"endTime":1267.92,"body":"general are feeling, you know,"},{"speaker":"Chris Dy","startTime":1264.44,"endTime":1267.92,"body":"and most of you who are"},{"speaker":"Chris Dy","startTime":1267.92,"endTime":1270.2,"body":"listening know that to become a"},{"speaker":"Chris Dy","startTime":1267.92,"endTime":1270.2,"body":"hand surgeon, at least in the"},{"speaker":"Chris Dy","startTime":1270.2,"endTime":1273.38,"body":"US, you either train in"},{"speaker":"Chris Dy","startTime":1270.2,"endTime":1273.38,"body":"orthopedics, in plastic surgery"},{"speaker":"Chris Dy","startTime":1273.38,"endTime":1276.08,"body":"or general surgery. By far, it's"},{"speaker":"Chris Dy","startTime":1273.38,"endTime":1276.08,"body":"usually in orthopedics or"},{"speaker":"Chris Dy","startTime":1276.08,"endTime":1280.12,"body":"plastics. And at least for"},{"speaker":"Chris Dy","startTime":1276.08,"endTime":1280.12,"body":"orthopedics, there is an"},{"speaker":"Chris Dy","startTime":1280.12,"endTime":1283.24,"body":"incredibly powerful political"},{"speaker":"Chris Dy","startTime":1280.12,"endTime":1283.24,"body":"arm in Washington. It is"},{"speaker":"Chris Dy","startTime":1283.24,"endTime":1285.64,"body":"actually, if not the biggest,"},{"speaker":"Chris Dy","startTime":1283.24,"endTime":1285.64,"body":"it's the second biggest,"},{"speaker":"Chris Dy","startTime":1285.64,"endTime":1288.94,"body":"relative to the American Medical"},{"speaker":"Chris Dy","startTime":1285.64,"endTime":1288.94,"body":"Association political action"},{"speaker":"Chris Dy","startTime":1288.94,"endTime":1294.46,"body":"organization pack committee in"},{"speaker":"Chris Dy","startTime":1288.94,"endTime":1294.46,"body":"DC. And you know, I think it's"},{"speaker":"Chris Dy","startTime":1294.46,"endTime":1297.22,"body":"pretty incredible, the machine"},{"speaker":"Chris Dy","startTime":1294.46,"endTime":1297.22,"body":"that they have. So just for"},{"speaker":"Chris Dy","startTime":1297.22,"endTime":1300.1,"body":"context, when I was a resident,"},{"speaker":"Chris Dy","startTime":1297.22,"endTime":1300.1,"body":"I was very much interested in"},{"speaker":"Chris Dy","startTime":1300.1,"endTime":1303.3,"body":"health policy at this time, the"},{"speaker":"Chris Dy","startTime":1300.1,"endTime":1303.3,"body":"Washington Health Policy"},{"speaker":"Chris Dy","startTime":1303.3,"endTime":1306.3,"body":"Fellowship still existed at the"},{"speaker":"Chris Dy","startTime":1303.3,"endTime":1306.3,"body":"American Academy of Orthopedic"},{"speaker":"Chris Dy","startTime":1306.3,"endTime":1309.84,"body":"Surgeons, and I was fortunate"},{"speaker":"Chris Dy","startTime":1306.3,"endTime":1309.84,"body":"enough to do that policy"},{"speaker":"Chris Dy","startTime":1309.84,"endTime":1313.2,"body":"fellowship, you know, in one of"},{"speaker":"Chris Dy","startTime":1309.84,"endTime":1313.2,"body":"its last years of existence. And"},{"speaker":"Chris Dy","startTime":1313.38,"endTime":1317.88,"body":"there's a really neat"},{"speaker":"Chris Dy","startTime":1313.38,"endTime":1317.88,"body":"experience, because my my co"},{"speaker":"Chris Dy","startTime":1318.06,"endTime":1321.8,"body":"Policy Fellow, Eric macney, who"},{"speaker":"Chris Dy","startTime":1318.06,"endTime":1321.8,"body":"was a resident Columbia now, as"},{"speaker":"Chris Dy","startTime":1321.8,"endTime":1326.6,"body":"an attending in Detroit, doing"},{"speaker":"Chris Dy","startTime":1321.8,"endTime":1326.6,"body":"sports, he and I would go down"},{"speaker":"Chris Dy","startTime":1326.6,"endTime":1329.66,"body":"to DC. We would, we were both in"},{"speaker":"Chris Dy","startTime":1326.6,"endTime":1329.66,"body":"New York, so we would just take"},{"speaker":"Chris Dy","startTime":1329.66,"endTime":1333.56,"body":"the train down and we would go"},{"speaker":"Chris Dy","startTime":1329.66,"endTime":1333.56,"body":"lobby on the Hill, which was"},{"speaker":"Chris Dy","startTime":1333.56,"endTime":1338.42,"body":"super, super interesting to see."},{"speaker":"Chris Dy","startTime":1333.56,"endTime":1338.42,"body":"You know what the the American"},{"speaker":"Chris Dy","startTime":1338.42,"endTime":1341.38,"body":"Academy of Orthopedic Surgery"},{"speaker":"Chris Dy","startTime":1338.42,"endTime":1341.38,"body":"pack was doing, how, what issues"},{"speaker":"Chris Dy","startTime":1341.38,"endTime":1344.32,"body":"they organized around"},{"speaker":"Chris Dy","startTime":1341.38,"endTime":1344.32,"body":"participating in the health"},{"speaker":"Chris Dy","startTime":1344.32,"endTime":1349.12,"body":"policy efforts that they had"},{"speaker":"Chris Dy","startTime":1344.32,"endTime":1349.12,"body":"with big you know, they call it"},{"speaker":"Chris Dy","startTime":1350.02,"endTime":1352.3,"body":"the national orthopedic"},{"speaker":"Chris Dy","startTime":1350.02,"endTime":1352.3,"body":"Leadership Conference, but it's"},{"speaker":"Chris Dy","startTime":1352.3,"endTime":1355.0,"body":"when they get everybody in from"},{"speaker":"Chris Dy","startTime":1352.3,"endTime":1355.0,"body":"the state orthopedic societies"},{"speaker":"Chris Dy","startTime":1355.18,"endTime":1358.0,"body":"and a bunch of orthopedic"},{"speaker":"Chris Dy","startTime":1355.18,"endTime":1358.0,"body":"surgeons and related disciplines"},{"speaker":"Chris Dy","startTime":1358.36,"endTime":1361.98,"body":"hit the hill, and You meet with"},{"speaker":"Chris Dy","startTime":1358.36,"endTime":1361.98,"body":"congressional leaders, people"},{"speaker":"Chris Dy","startTime":1361.98,"endTime":1365.88,"body":"that represent your district and"},{"speaker":"Chris Dy","startTime":1361.98,"endTime":1365.88,"body":"you honestly, it gets down to"},{"speaker":"Chris Dy","startTime":1365.88,"endTime":1370.5,"body":"telling stories. Nobody really"},{"speaker":"Chris Dy","startTime":1365.88,"endTime":1370.5,"body":"cares about data. Initially. The"},{"speaker":"Chris Dy","startTime":1370.5,"endTime":1372.78,"body":"good thing about a lot of"},{"speaker":"Chris Dy","startTime":1370.5,"endTime":1372.78,"body":"physicians is that we have a lot"},{"speaker":"Chris Dy","startTime":1372.78,"endTime":1375.06,"body":"of stories to tell, if you"},{"speaker":"Chris Dy","startTime":1372.78,"endTime":1375.06,"body":"really think about it, because"},{"speaker":"Chris Dy","startTime":1375.06,"endTime":1379.14,"body":"you have patients, and people"},{"speaker":"Chris Dy","startTime":1375.06,"endTime":1379.14,"body":"can relate to patients. And I"},{"speaker":"Chris Dy","startTime":1379.14,"endTime":1382.88,"body":"think one of the examples that"},{"speaker":"Chris Dy","startTime":1379.14,"endTime":1382.88,"body":"we did recently when I went to"},{"speaker":"Chris Dy","startTime":1382.88,"endTime":1387.14,"body":"the hill as part of the hand"},{"speaker":"Chris Dy","startTime":1382.88,"endTime":1387.14,"body":"society group, is that, and this"},{"speaker":"Chris Dy","startTime":1387.14,"endTime":1389.9,"body":"is a few years ago now, but it's"},{"speaker":"Chris Dy","startTime":1387.14,"endTime":1389.9,"body":"prior authorization and"},{"speaker":"Chris Dy","startTime":1389.9,"endTime":1394.88,"body":"something that seems relatively"},{"speaker":"Chris Dy","startTime":1389.9,"endTime":1394.88,"body":"mundane, but trying to make sure"},{"speaker":"Chris Dy","startTime":1394.88,"endTime":1397.94,"body":"that you don't get bogged down"},{"speaker":"Chris Dy","startTime":1394.88,"endTime":1397.94,"body":"in prior authorization before a"},{"speaker":"Chris Dy","startTime":1397.94,"endTime":1402.1,"body":"procedure or an MRI or something"},{"speaker":"Chris Dy","startTime":1397.94,"endTime":1402.1,"body":"like that, and explaining to"},{"speaker":"Chris Dy","startTime":1402.16,"endTime":1406.54,"body":"somebody in Congress who has no"},{"speaker":"Chris Dy","startTime":1402.16,"endTime":1406.54,"body":"idea what your day to day life"},{"speaker":"Chris Dy","startTime":1406.54,"endTime":1409.48,"body":"is, trying to find a compelling"},{"speaker":"Chris Dy","startTime":1406.54,"endTime":1409.48,"body":"way, compelling story about why"},{"speaker":"Chris Dy","startTime":1409.48,"endTime":1411.88,"body":"this is important for them to"},{"speaker":"Chris Dy","startTime":1409.48,"endTime":1411.88,"body":"pay attention to, to make sure"},{"speaker":"Chris Dy","startTime":1411.88,"endTime":1416.44,"body":"that you know, they you know,"},{"speaker":"Chris Dy","startTime":1411.88,"endTime":1416.44,"body":"include details in whatever"},{"speaker":"Chris Dy","startTime":1416.44,"endTime":1419.5,"body":"upcoming legislative package"},{"speaker":"Chris Dy","startTime":1416.44,"endTime":1419.5,"body":"that make sure that they can't"},{"speaker":"Chris Dy","startTime":1419.5,"endTime":1422.1,"body":"have too much, Too much too much"},{"speaker":"Chris Dy","startTime":1419.5,"endTime":1422.1,"body":"process before you get prior"},{"speaker":"Chris Dy","startTime":1422.1,"endTime":1423.24,"body":"authorization. For example,"},{"speaker":"Charles Goldfarb","startTime":1424.86,"endTime":1427.02,"body":"yeah, it's"},{"speaker":"Charles Goldfarb","startTime":1424.86,"endTime":1427.02,"body":"funny. Every sentence or two, my"},{"speaker":"Charles Goldfarb","startTime":1427.02,"endTime":1429.78,"body":"brain would go in a different"},{"speaker":"Charles Goldfarb","startTime":1427.02,"endTime":1429.78,"body":"direction because you said so"},{"speaker":"Charles Goldfarb","startTime":1429.78,"endTime":1432.48,"body":"much, all really important"},{"speaker":"Charles Goldfarb","startTime":1429.78,"endTime":1432.48,"body":"stuff."},{"speaker":"Chris Dy","startTime":1433.14,"endTime":1435.96,"body":"That's that's you"},{"speaker":"Chris Dy","startTime":1433.14,"endTime":1435.96,"body":"saying, keep it concise. Next."},{"speaker":"Charles Goldfarb","startTime":1437.76,"endTime":1440.22,"body":"It was all"},{"speaker":"Charles Goldfarb","startTime":1437.76,"endTime":1440.22,"body":"good. One thing that came to"},{"speaker":"Charles Goldfarb","startTime":1440.22,"endTime":1444.68,"body":"mind was that were, you know, is"},{"speaker":"Charles Goldfarb","startTime":1440.22,"endTime":1444.68,"body":"the challenge of Medicare"},{"speaker":"Charles Goldfarb","startTime":1444.68,"endTime":1448.04,"body":"Advantage plans, which I think"},{"speaker":"Charles Goldfarb","startTime":1444.68,"endTime":1448.04,"body":"is actually a, probably a pretty"},{"speaker":"Charles Goldfarb","startTime":1448.04,"endTime":1453.56,"body":"good example of why we need to"},{"speaker":"Charles Goldfarb","startTime":1448.04,"endTime":1453.56,"body":"advocate for ourselves. You"},{"speaker":"Charles Goldfarb","startTime":1453.56,"endTime":1456.62,"body":"know, in the United States,"},{"speaker":"Charles Goldfarb","startTime":1453.56,"endTime":1456.62,"body":"Medicare is the big government"},{"speaker":"Charles Goldfarb","startTime":1456.62,"endTime":1461.44,"body":"payer. Medicare Advantage was"},{"speaker":"Charles Goldfarb","startTime":1456.62,"endTime":1461.44,"body":"proposed as a way to help"},{"speaker":"Charles Goldfarb","startTime":1461.44,"endTime":1467.14,"body":"control cost for Medicare"},{"speaker":"Charles Goldfarb","startTime":1461.44,"endTime":1467.14,"body":"patients. And in reality, it is"},{"speaker":"Charles Goldfarb","startTime":1467.14,"endTime":1470.2,"body":"not worked out that way. Has"},{"speaker":"Charles Goldfarb","startTime":1467.14,"endTime":1470.2,"body":"become a really challenging"},{"speaker":"Charles Goldfarb","startTime":1470.8,"endTime":1475.3,"body":"insurance payers, and every"},{"speaker":"Charles Goldfarb","startTime":1470.8,"endTime":1475.3,"body":"major commercial insurance has a"},{"speaker":"Charles Goldfarb","startTime":1475.3,"endTime":1478.48,"body":"Medicare Advantage plan. And"},{"speaker":"Charles Goldfarb","startTime":1475.3,"endTime":1478.48,"body":"actually that is where"},{"speaker":"Charles Goldfarb","startTime":1478.66,"endTime":1482.82,"body":"commercial insurance makes their"},{"speaker":"Charles Goldfarb","startTime":1478.66,"endTime":1482.82,"body":"money in 2024 and it is really,"},{"speaker":"Charles Goldfarb","startTime":1482.82,"endTime":1486.96,"body":"really challenging, and it is"},{"speaker":"Charles Goldfarb","startTime":1482.82,"endTime":1486.96,"body":"setting up roadblocks and and"},{"speaker":"Charles Goldfarb","startTime":1486.96,"endTime":1490.14,"body":"they do little things like they"},{"speaker":"Charles Goldfarb","startTime":1486.96,"endTime":1490.14,"body":"want to attract Medicare"},{"speaker":"Charles Goldfarb","startTime":1490.14,"endTime":1493.44,"body":"Advantage plans, they want to"},{"speaker":"Charles Goldfarb","startTime":1490.14,"endTime":1493.44,"body":"attract healthier patients,"},{"speaker":"Charles Goldfarb","startTime":1493.92,"endTime":1497.52,"body":"because it's essentially"},{"speaker":"Charles Goldfarb","startTime":1493.92,"endTime":1497.52,"body":"capitation. And by attracting"},{"speaker":"Charles Goldfarb","startTime":1497.52,"endTime":1500.78,"body":"healthier patients, they have to"},{"speaker":"Charles Goldfarb","startTime":1497.52,"endTime":1500.78,"body":"pay out less. By setting up"},{"speaker":"Charles Goldfarb","startTime":1500.78,"endTime":1504.2,"body":"roadblocks for prior"},{"speaker":"Charles Goldfarb","startTime":1500.78,"endTime":1504.2,"body":"authorization or declining to"},{"speaker":"Charles Goldfarb","startTime":1504.2,"endTime":1507.62,"body":"pay for inpatient rehab, they"},{"speaker":"Charles Goldfarb","startTime":1504.2,"endTime":1507.62,"body":"make more money. So one way to"},{"speaker":"Charles Goldfarb","startTime":1507.62,"endTime":1513.62,"body":"do that, as a good example is"},{"speaker":"Charles Goldfarb","startTime":1507.62,"endTime":1513.62,"body":"they offer free gym plans. So if"},{"speaker":"Charles Goldfarb","startTime":1513.62,"endTime":1517.1,"body":"you join Medicare Advantage for"},{"speaker":"Charles Goldfarb","startTime":1513.62,"endTime":1517.1,"body":"so and so firm, you get a free"},{"speaker":"Charles Goldfarb","startTime":1517.1,"endTime":1519.98,"body":"gym plan. Well, who's gonna be"},{"speaker":"Charles Goldfarb","startTime":1517.1,"endTime":1519.98,"body":"interested in going to the gym?"},{"speaker":"Charles Goldfarb","startTime":1520.1,"endTime":1522.76,"body":"The younger healthier. You know,"},{"speaker":"Charles Goldfarb","startTime":1520.1,"endTime":1522.76,"body":"I put younger in quotes,"},{"speaker":"Charles Goldfarb","startTime":1522.94,"endTime":1526.48,"body":"Medicare Advantage. So anyways,"},{"speaker":"Charles Goldfarb","startTime":1522.94,"endTime":1526.48,"body":"I'm off a little bit on a"},{"speaker":"Charles Goldfarb","startTime":1526.48,"endTime":1528.1,"body":"tangent, but that's one of the"},{"speaker":"Charles Goldfarb","startTime":1526.48,"endTime":1528.1,"body":"things you"},{"speaker":"Chris Dy","startTime":1528.1,"endTime":1530.98,"body":"definitely are off on"},{"speaker":"Chris Dy","startTime":1528.1,"endTime":1530.98,"body":"a tangent. The way I'll bring it"},{"speaker":"Chris Dy","startTime":1530.98,"endTime":1534.58,"body":"back, is that, if you're an"},{"speaker":"Chris Dy","startTime":1530.98,"endTime":1534.58,"body":"insurance company in states, you"},{"speaker":"Chris Dy","startTime":1534.58,"endTime":1537.16,"body":"want to make more money, you"},{"speaker":"Chris Dy","startTime":1534.58,"endTime":1537.16,"body":"sign more people up who are"},{"speaker":"Chris Dy","startTime":1537.16,"endTime":1539.98,"body":"going to pay to be part of your"},{"speaker":"Chris Dy","startTime":1537.16,"endTime":1539.98,"body":"service, and then you pay less"},{"speaker":"Chris Dy","startTime":1539.98,"endTime":1542.76,"body":"and, you know, you you give out"},{"speaker":"Chris Dy","startTime":1539.98,"endTime":1542.76,"body":"less money in terms of services."},{"speaker":"Chris Dy","startTime":1543.0,"endTime":1546.9,"body":"So if they can make it as hard"},{"speaker":"Chris Dy","startTime":1543.0,"endTime":1546.9,"body":"as possible to to pay for"},{"speaker":"Chris Dy","startTime":1546.9,"endTime":1550.38,"body":"services, the more money they"},{"speaker":"Chris Dy","startTime":1546.9,"endTime":1550.38,"body":"make, you know, so, and this is"},{"speaker":"Chris Dy","startTime":1550.38,"endTime":1552.66,"body":"something that is common"},{"speaker":"Chris Dy","startTime":1550.38,"endTime":1552.66,"body":"throughout medicine. It's not"},{"speaker":"Chris Dy","startTime":1552.66,"endTime":1558.48,"body":"only hand surgery, definitely"},{"speaker":"Chris Dy","startTime":1552.66,"endTime":1558.48,"body":"specialties that are procedure"},{"speaker":"Chris Dy","startTime":1558.48,"endTime":1563.0,"body":"based, like surgeons, they get"},{"speaker":"Chris Dy","startTime":1558.48,"endTime":1563.0,"body":"effects and more just because of"},{"speaker":"Chris Dy","startTime":1563.0,"endTime":1565.4,"body":"the way that the system has been"},{"speaker":"Chris Dy","startTime":1563.0,"endTime":1565.4,"body":"set up, whether you like it or"},{"speaker":"Chris Dy","startTime":1565.4,"endTime":1568.82,"body":"not, in the US is that"},{"speaker":"Chris Dy","startTime":1565.4,"endTime":1568.82,"body":"proceduralists tend to get paid"},{"speaker":"Chris Dy","startTime":1568.82,"endTime":1572.12,"body":"more, and proceduralists depend"},{"speaker":"Chris Dy","startTime":1568.82,"endTime":1572.12,"body":"more on making sure that they"},{"speaker":"Chris Dy","startTime":1572.12,"endTime":1575.3,"body":"get paid for the procedures. And"},{"speaker":"Chris Dy","startTime":1572.12,"endTime":1575.3,"body":"it's not a zero sum game in"},{"speaker":"Chris Dy","startTime":1575.3,"endTime":1577.58,"body":"terms of the money that's"},{"speaker":"Chris Dy","startTime":1575.3,"endTime":1577.58,"body":"available. Everything in the"},{"speaker":"Chris Dy","startTime":1577.58,"endTime":1580.12,"body":"States is based around what"},{"speaker":"Chris Dy","startTime":1577.58,"endTime":1580.12,"body":"Medicare, which, as you"},{"speaker":"Chris Dy","startTime":1580.12,"endTime":1583.66,"body":"mentioned, is the largest"},{"speaker":"Chris Dy","startTime":1580.12,"endTime":1583.66,"body":"government payer pays for a"},{"speaker":"Chris Dy","startTime":1583.66,"endTime":1585.82,"body":"certain procedure. Now,"},{"speaker":"Chris Dy","startTime":1583.66,"endTime":1585.82,"body":"insurance companies and work"},{"speaker":"Chris Dy","startTime":1585.82,"endTime":1589.24,"body":"comp, they may pay a certain"},{"speaker":"Chris Dy","startTime":1585.82,"endTime":1589.24,"body":"percentage higher, but"},{"speaker":"Chris Dy","startTime":1589.24,"endTime":1593.62,"body":"everything, the bar is set by"},{"speaker":"Chris Dy","startTime":1589.24,"endTime":1593.62,"body":"Medicare or by CMS. And you"},{"speaker":"Chris Dy","startTime":1593.62,"endTime":1595.72,"body":"know, if they value the"},{"speaker":"Chris Dy","startTime":1593.62,"endTime":1595.72,"body":"procedure codes more, they're"},{"speaker":"Chris Dy","startTime":1595.78,"endTime":1599.56,"body":"going to value the primary care,"},{"speaker":"Chris Dy","startTime":1595.78,"endTime":1599.56,"body":"you know, diagnosis, EM codes"},{"speaker":"Chris Dy","startTime":1599.56,"endTime":1602.82,"body":"less, and vice versa. So it's"},{"speaker":"Chris Dy","startTime":1599.56,"endTime":1602.82,"body":"this constant battle. They've"},{"speaker":"Chris Dy","startTime":1602.82,"endTime":1606.54,"body":"set us up to fight each other"},{"speaker":"Chris Dy","startTime":1602.82,"endTime":1606.54,"body":"for the same amount of money."},{"speaker":"Chris Dy","startTime":1606.54,"endTime":1610.38,"body":"The pie is not growing. So to"},{"speaker":"Chris Dy","startTime":1606.54,"endTime":1610.38,"body":"say, which is why it is really"},{"speaker":"Chris Dy","startTime":1610.38,"endTime":1613.26,"body":"important to have a big pack"},{"speaker":"Chris Dy","startTime":1610.38,"endTime":1613.26,"body":"behind you, which is what"},{"speaker":"Chris Dy","startTime":1613.26,"endTime":1616.08,"body":"orthopedic surgeons and by"},{"speaker":"Chris Dy","startTime":1613.26,"endTime":1616.08,"body":"virtue of that, hand surgeons"},{"speaker":"Chris Dy","startTime":1616.2,"endTime":1617.22,"body":"benefit from a lot."},{"speaker":"Charles Goldfarb","startTime":1617.88,"endTime":1620.66,"body":"Yeah. I mean,"},{"speaker":"Charles Goldfarb","startTime":1617.88,"endTime":1620.66,"body":"the pie is massive. You know,"},{"speaker":"Charles Goldfarb","startTime":1620.66,"endTime":1625.52,"body":"almost 20% of our GDP goes to"},{"speaker":"Charles Goldfarb","startTime":1620.66,"endTime":1625.52,"body":"you know, medical care, which is"},{"speaker":"Charles Goldfarb","startTime":1625.52,"endTime":1629.3,"body":"incredible and so much higher"},{"speaker":"Charles Goldfarb","startTime":1625.52,"endTime":1629.3,"body":"than every other country, true"},{"speaker":"Charles Goldfarb","startTime":1629.3,"endTime":1634.22,"body":"or false. The American Hospital"},{"speaker":"Charles Goldfarb","startTime":1629.3,"endTime":1634.22,"body":"Association is not our friend."},{"speaker":"Chris Dy","startTime":1634.52,"endTime":1637.58,"body":"No, they're not our"},{"speaker":"Chris Dy","startTime":1634.52,"endTime":1637.58,"body":"friend at all. Not at all. I"},{"speaker":"Chris Dy","startTime":1637.58,"endTime":1639.74,"body":"mean, I don't know what you're"},{"speaker":"Chris Dy","startTime":1637.58,"endTime":1639.74,"body":"what you were looking for with"},{"speaker":"Chris Dy","startTime":1639.74,"endTime":1643.84,"body":"that, but they also get a piece"},{"speaker":"Chris Dy","startTime":1639.74,"endTime":1643.84,"body":"of the pie on this, and the more"},{"speaker":"Chris Dy","startTime":1643.84,"endTime":1647.14,"body":"that they pay the doctors, the"},{"speaker":"Chris Dy","startTime":1643.84,"endTime":1647.14,"body":"less they have to pay the"},{"speaker":"Chris Dy","startTime":1647.14,"endTime":1650.38,"body":"hospitals. And, you know, just"},{"speaker":"Chris Dy","startTime":1647.14,"endTime":1650.38,"body":"this is a broad over"},{"speaker":"Chris Dy","startTime":1650.38,"endTime":1653.2,"body":"generalization, but I feel like"},{"speaker":"Chris Dy","startTime":1650.38,"endTime":1653.2,"body":"a lot of people talk about how"},{"speaker":"Chris Dy","startTime":1653.2,"endTime":1655.9,"body":"Medicaid, which is the"},{"speaker":"Chris Dy","startTime":1653.2,"endTime":1655.9,"body":"government, based insurance in"},{"speaker":"Chris Dy","startTime":1655.9,"endTime":1659.5,"body":"the US for those under a certain"},{"speaker":"Chris Dy","startTime":1655.9,"endTime":1659.5,"body":"income level, it was the crux of"},{"speaker":"Chris Dy","startTime":1659.86,"endTime":1664.56,"body":"expanding care under Obamacare"},{"speaker":"Chris Dy","startTime":1659.86,"endTime":1664.56,"body":"back in 2008 is, I guess, when"},{"speaker":"Chris Dy","startTime":1664.56,"endTime":1669.06,"body":"that effort started, the more"},{"speaker":"Chris Dy","startTime":1664.56,"endTime":1669.06,"body":"Medicaid is traditionally not a"},{"speaker":"Chris Dy","startTime":1669.06,"endTime":1672.24,"body":"great payer. For physicians, you"},{"speaker":"Chris Dy","startTime":1669.06,"endTime":1672.24,"body":"get a certain fraction of what"},{"speaker":"Chris Dy","startTime":1672.24,"endTime":1675.06,"body":"you would get paid for Medicare."},{"speaker":"Chris Dy","startTime":1672.24,"endTime":1675.06,"body":"It's probably the same thing for"},{"speaker":"Chris Dy","startTime":1675.06,"endTime":1678.18,"body":"therapists, too. But the"},{"speaker":"Chris Dy","startTime":1675.06,"endTime":1678.18,"body":"hospitals do very well with"},{"speaker":"Chris Dy","startTime":1678.18,"endTime":1681.26,"body":"Medicaid because it's, it is a"},{"speaker":"Chris Dy","startTime":1678.18,"endTime":1681.26,"body":"state based program, and"},{"speaker":"Chris Dy","startTime":1681.26,"endTime":1684.56,"body":"especially at some state based"},{"speaker":"Chris Dy","startTime":1681.26,"endTime":1684.56,"body":"hospitals, like university based"},{"speaker":"Chris Dy","startTime":1684.56,"endTime":1686.9,"body":"hospitals that are public"},{"speaker":"Chris Dy","startTime":1684.56,"endTime":1686.9,"body":"universities, they have carve"},{"speaker":"Chris Dy","startTime":1687.2,"endTime":1689.96,"body":"outs which they will get a much"},{"speaker":"Chris Dy","startTime":1687.2,"endTime":1689.96,"body":"better rate if you get care at a"},{"speaker":"Chris Dy","startTime":1689.96,"endTime":1693.26,"body":"certain University Hospital in"},{"speaker":"Chris Dy","startTime":1689.96,"endTime":1693.26,"body":"our state, that hospital, we"},{"speaker":"Chris Dy","startTime":1693.26,"endTime":1696.86,"body":"have paid a lot more, as opposed"},{"speaker":"Chris Dy","startTime":1693.26,"endTime":1696.86,"body":"to if you got care at a non"},{"speaker":"Chris Dy","startTime":1697.7,"endTime":1701.32,"body":"government based hospital like"},{"speaker":"Chris Dy","startTime":1697.7,"endTime":1701.32,"body":"ours. So anyway, there's a lot"},{"speaker":"Chris Dy","startTime":1701.32,"endTime":1704.2,"body":"of money in healthcare in the US"},{"speaker":"Chris Dy","startTime":1701.32,"endTime":1704.2,"body":"like you mentioned, and it's"},{"speaker":"Chris Dy","startTime":1704.26,"endTime":1708.28,"body":"encroaching on 20% of our gross"},{"speaker":"Chris Dy","startTime":1704.26,"endTime":1708.28,"body":"domestic product. And this is"},{"speaker":"Chris Dy","startTime":1708.28,"endTime":1710.5,"body":"actually a pretty timely"},{"speaker":"Chris Dy","startTime":1708.28,"endTime":1710.5,"body":"discussion. I think healthcare"},{"speaker":"Chris Dy","startTime":1710.5,"endTime":1713.26,"body":"has not been part of the"},{"speaker":"Chris Dy","startTime":1710.5,"endTime":1713.26,"body":"conversation as much this year"},{"speaker":"Chris Dy","startTime":1713.26,"endTime":1717.28,"body":"in the US election, but we are"},{"speaker":"Chris Dy","startTime":1713.26,"endTime":1717.28,"body":"recording two days before the"},{"speaker":"Chris Dy","startTime":1717.28,"endTime":1721.92,"body":"United States general election,"},{"speaker":"Chris Dy","startTime":1717.28,"endTime":1721.92,"body":"which is crazy to think of and"},{"speaker":"Chris Dy","startTime":1722.1,"endTime":1726.6,"body":"you know, all of these"},{"speaker":"Chris Dy","startTime":1722.1,"endTime":1726.6,"body":"healthcare issues really matter,"},{"speaker":"Chris Dy","startTime":1726.6,"endTime":1730.68,"body":"and whether you lean one way or"},{"speaker":"Chris Dy","startTime":1726.6,"endTime":1730.68,"body":"the other politically, I think"},{"speaker":"Chris Dy","startTime":1730.68,"endTime":1735.36,"body":"that the the single minded focus"},{"speaker":"Chris Dy","startTime":1730.68,"endTime":1735.36,"body":"on protecting the interests of"},{"speaker":"Chris Dy","startTime":1735.72,"endTime":1738.78,"body":"physicians, providers, etc, at"},{"speaker":"Chris Dy","startTime":1735.72,"endTime":1738.78,"body":"the pack tends to make it"},{"speaker":"Chris Dy","startTime":1738.84,"endTime":1742.88,"body":"relatively politically agnostic."},{"speaker":"Chris Dy","startTime":1738.84,"endTime":1742.88,"body":"I had a hard time with so I was"},{"speaker":"Chris Dy","startTime":1742.88,"endTime":1745.22,"body":"actually Chair of the hand"},{"speaker":"Chris Dy","startTime":1742.88,"endTime":1745.22,"body":"society's Government Affairs"},{"speaker":"Chris Dy","startTime":1745.22,"endTime":1749.0,"body":"Committee, and my political"},{"speaker":"Chris Dy","startTime":1745.22,"endTime":1749.0,"body":"views personally don't"},{"speaker":"Chris Dy","startTime":1749.0,"endTime":1754.4,"body":"necessarily align a lot with the"},{"speaker":"Chris Dy","startTime":1749.0,"endTime":1754.4,"body":"with the aos. And so while the"},{"speaker":"Chris Dy","startTime":1754.4,"endTime":1758.0,"body":"assh is a sub special society,"},{"speaker":"Chris Dy","startTime":1754.4,"endTime":1758.0,"body":"typically falls under the AOS"},{"speaker":"Chris Dy","startTime":1758.0,"endTime":1761.26,"body":"for a lot of things, and I"},{"speaker":"Chris Dy","startTime":1758.0,"endTime":1761.26,"body":"differed a lot with the academy,"},{"speaker":"Chris Dy","startTime":1761.26,"endTime":1763.24,"body":"and I struggle with that, and I"},{"speaker":"Chris Dy","startTime":1761.26,"endTime":1763.24,"body":"know that some of my"},{"speaker":"Chris Dy","startTime":1764.38,"endTime":1767.74,"body":"predecessors and successors on"},{"speaker":"Chris Dy","startTime":1764.38,"endTime":1767.74,"body":"that committee also do. But at"},{"speaker":"Chris Dy","startTime":1767.74,"endTime":1770.8,"body":"the end of the day, they support"},{"speaker":"Chris Dy","startTime":1767.74,"endTime":1770.8,"body":"the candidate and candidates at"},{"speaker":"Chris Dy","startTime":1770.8,"endTime":1774.4,"body":"local and state races that are"},{"speaker":"Chris Dy","startTime":1770.8,"endTime":1774.4,"body":"going to help orthopedics. So I"},{"speaker":"Chris Dy","startTime":1775.06,"endTime":1777.52,"body":"have a hard time. I struggle"},{"speaker":"Chris Dy","startTime":1775.06,"endTime":1777.52,"body":"with that, but you know, at the"},{"speaker":"Chris Dy","startTime":1777.52,"endTime":1780.16,"body":"end of the day, they really are"},{"speaker":"Chris Dy","startTime":1777.52,"endTime":1780.16,"body":"trying to protect the interests"},{"speaker":"Chris Dy","startTime":1780.16,"endTime":1782.34,"body":"of the healthcare professional,"},{"speaker":"Charles Goldfarb","startTime":1783.06,"endTime":1784.44,"body":"yeah, the"},{"speaker":"Charles Goldfarb","startTime":1783.06,"endTime":1784.44,"body":"election talk is super"},{"speaker":"Charles Goldfarb","startTime":1784.44,"endTime":1786.9,"body":"interesting because you're"},{"speaker":"Charles Goldfarb","startTime":1784.44,"endTime":1786.9,"body":"right. Remarkably, it's not been"},{"speaker":"Charles Goldfarb","startTime":1786.9,"endTime":1791.04,"body":"a primary discussion point. But"},{"speaker":"Charles Goldfarb","startTime":1786.9,"endTime":1791.04,"body":"there are huge implications for"},{"speaker":"Charles Goldfarb","startTime":1791.04,"endTime":1794.7,"body":"the results of the election here"},{"speaker":"Charles Goldfarb","startTime":1791.04,"endTime":1794.7,"body":"in the US, with which candidate"},{"speaker":"Charles Goldfarb","startTime":1794.88,"endTime":1798.36,"body":"prevails, and the concept of"},{"speaker":"Charles Goldfarb","startTime":1794.88,"endTime":1798.36,"body":"single issue voters and"},{"speaker":"Charles Goldfarb","startTime":1798.36,"endTime":1802.46,"body":"orthopedic surgeons only voting."},{"speaker":"Charles Goldfarb","startTime":1798.36,"endTime":1802.46,"body":"For the candidate that may"},{"speaker":"Charles Goldfarb","startTime":1802.46,"endTime":1805.88,"body":"support orthopedic surgeon"},{"speaker":"Charles Goldfarb","startTime":1802.46,"endTime":1805.88,"body":"priorities is really an"},{"speaker":"Charles Goldfarb","startTime":1805.88,"endTime":1810.08,"body":"interesting one, but not for"},{"speaker":"Charles Goldfarb","startTime":1805.88,"endTime":1810.08,"body":"this discussion. What about the"},{"speaker":"Charles Goldfarb","startTime":1810.08,"endTime":1816.38,"body":"AMA, the ultimate advocacy group"},{"speaker":"Charles Goldfarb","startTime":1810.08,"endTime":1816.38,"body":"for physicians? Share a few"},{"speaker":"Charles Goldfarb","startTime":1816.38,"endTime":1820.16,"body":"thoughts, and I have a few as"},{"speaker":"Charles Goldfarb","startTime":1816.38,"endTime":1820.16,"body":"well, given I interacted a lot"},{"speaker":"Charles Goldfarb","startTime":1820.16,"endTime":1825.28,"body":"with the AMA in preparation for"},{"speaker":"Charles Goldfarb","startTime":1820.16,"endTime":1825.28,"body":"an AOA American orthopedic"},{"speaker":"Charles Goldfarb","startTime":1825.28,"endTime":1828.46,"body":"Association session this past"},{"speaker":"Charles Goldfarb","startTime":1825.28,"endTime":1828.46,"body":"summer. Yes,"},{"speaker":"Chris Dy","startTime":1828.82,"endTime":1831.1,"body":"I'm a little bit out"},{"speaker":"Chris Dy","startTime":1828.82,"endTime":1831.1,"body":"of my depth on the AMA. I mean,"},{"speaker":"Chris Dy","startTime":1831.1,"endTime":1834.58,"body":"I know of the AMA, and I think a"},{"speaker":"Chris Dy","startTime":1831.1,"endTime":1834.58,"body":"lot of us, at least in you know,"},{"speaker":"Chris Dy","startTime":1834.76,"endTime":1838.24,"body":"schooling and training,"},{"speaker":"Chris Dy","startTime":1834.76,"endTime":1838.24,"body":"participated in the AMA. I know"},{"speaker":"Chris Dy","startTime":1838.24,"endTime":1843.24,"body":"that we have a loyal podcast"},{"speaker":"Chris Dy","startTime":1838.24,"endTime":1843.24,"body":"Lister Andy German, who is also"},{"speaker":"Chris Dy","startTime":1843.24,"endTime":1846.3,"body":"active on the listserv, and"},{"speaker":"Chris Dy","startTime":1843.24,"endTime":1846.3,"body":"amazingly, this is an incredible"},{"speaker":"Chris Dy","startTime":1846.3,"endTime":1849.54,"body":"shout out to Andy. He was"},{"speaker":"Chris Dy","startTime":1846.3,"endTime":1849.54,"body":"president of the AMA as a hand"},{"speaker":"Chris Dy","startTime":1849.54,"endTime":1852.96,"body":"surgeon not that long ago,"},{"speaker":"Chris Dy","startTime":1849.54,"endTime":1852.96,"body":"probably about 10 to 12 years"},{"speaker":"Chris Dy","startTime":1852.96,"endTime":1857.28,"body":"ago, I think, really amazing"},{"speaker":"Chris Dy","startTime":1852.96,"endTime":1857.28,"body":"accomplishment. So Andy, if you"},{"speaker":"Chris Dy","startTime":1857.28,"endTime":1859.86,"body":"wanted to give us some thoughts"},{"speaker":"Chris Dy","startTime":1857.28,"endTime":1859.86,"body":"about the AMA, please feel free"},{"speaker":"Chris Dy","startTime":1859.86,"endTime":1863.48,"body":"to email us, but it is, I think,"},{"speaker":"Chris Dy","startTime":1859.86,"endTime":1863.48,"body":"a different organization in"},{"speaker":"Chris Dy","startTime":1863.48,"endTime":1866.66,"body":"terms of the priorities. It's"},{"speaker":"Chris Dy","startTime":1863.48,"endTime":1866.66,"body":"got to serve the entire house of"},{"speaker":"Chris Dy","startTime":1866.66,"endTime":1870.14,"body":"medicine. And typically it is"},{"speaker":"Chris Dy","startTime":1866.66,"endTime":1870.14,"body":"nice when the House of medicine"},{"speaker":"Chris Dy","startTime":1870.14,"endTime":1872.84,"body":"aligns on issues and everybody"},{"speaker":"Chris Dy","startTime":1870.14,"endTime":1872.84,"body":"can get behind and the AMA is"},{"speaker":"Chris Dy","startTime":1872.84,"endTime":1875.72,"body":"the face of things. But there"},{"speaker":"Chris Dy","startTime":1872.84,"endTime":1875.72,"body":"are some issues within medicine"},{"speaker":"Chris Dy","startTime":1875.72,"endTime":1878.78,"body":"where, you know, the specialists"},{"speaker":"Chris Dy","startTime":1875.72,"endTime":1878.78,"body":"and the procedure lists will"},{"speaker":"Chris Dy","startTime":1878.78,"endTime":1883.0,"body":"differ from the primary care"},{"speaker":"Chris Dy","startTime":1878.78,"endTime":1883.0,"body":"oriented groups. And I think,"},{"speaker":"Chris Dy","startTime":1883.06,"endTime":1887.38,"body":"you know, the AMA is tasked, you"},{"speaker":"Chris Dy","startTime":1883.06,"endTime":1887.38,"body":"know, for better or worse, or"},{"speaker":"Chris Dy","startTime":1887.38,"endTime":1890.5,"body":"trying to unite the house of"},{"speaker":"Chris Dy","startTime":1887.38,"endTime":1890.5,"body":"medicine. Because, you know,"},{"speaker":"Chris Dy","startTime":1890.5,"endTime":1893.02,"body":"people from outside of medicine"},{"speaker":"Chris Dy","startTime":1890.5,"endTime":1893.02,"body":"don't understand that we have"},{"speaker":"Chris Dy","startTime":1893.02,"endTime":1895.54,"body":"all these different factions"},{"speaker":"Chris Dy","startTime":1893.02,"endTime":1895.54,"body":"within us. They view us at"},{"speaker":"Chris Dy","startTime":1895.54,"endTime":1896.68,"body":"sometimes, as a monolith."},{"speaker":"Charles Goldfarb","startTime":1897.28,"endTime":1900.48,"body":"Yeah, you're"},{"speaker":"Charles Goldfarb","startTime":1897.28,"endTime":1900.48,"body":"right. And Andy, obviously,"},{"speaker":"Charles Goldfarb","startTime":1900.48,"endTime":1905.64,"body":"we're proud of his leadership of"},{"speaker":"Charles Goldfarb","startTime":1900.48,"endTime":1905.64,"body":"the AMA and advocacy in general."},{"speaker":"Charles Goldfarb","startTime":1905.64,"endTime":1909.48,"body":"You know a non hand surgeon,"},{"speaker":"Charles Goldfarb","startTime":1905.64,"endTime":1909.48,"body":"Michael Sook, who I don't know"},{"speaker":"Charles Goldfarb","startTime":1909.48,"endTime":1912.66,"body":"if you know him or not. I do not"},{"speaker":"Charles Goldfarb","startTime":1909.48,"endTime":1912.66,"body":"know him well, but he has the"},{"speaker":"Charles Goldfarb","startTime":1912.66,"endTime":1915.84,"body":"best collection of initials"},{"speaker":"Charles Goldfarb","startTime":1912.66,"endTime":1915.84,"body":"after his name, because I'm"},{"speaker":"Charles Goldfarb","startTime":1915.84,"endTime":1918.96,"body":"looking at it. I looked him up,"},{"speaker":"Charles Goldfarb","startTime":1915.84,"endTime":1918.96,"body":"but you know I'm going, are you"},{"speaker":"Charles Goldfarb","startTime":1918.96,"endTime":1919.26,"body":"jealous,"},{"speaker":"Chris Dy","startTime":1919.26,"endTime":1921.68,"body":"Chuck? Because I know"},{"speaker":"Chris Dy","startTime":1919.26,"endTime":1921.68,"body":"you're adding more initials. I'm"},{"speaker":"Chris Dy","startTime":1921.68,"endTime":1921.74,"body":"a"},{"speaker":"Charles Goldfarb","startTime":1921.74,"endTime":1926.36,"body":"little"},{"speaker":"Charles Goldfarb","startTime":1921.74,"endTime":1926.36,"body":"jealous. He is an MD, JD, mph"},{"speaker":"Charles Goldfarb","startTime":1926.48,"endTime":1931.4,"body":"and MBA. That is impressive. But"},{"speaker":"Charles Goldfarb","startTime":1926.48,"endTime":1931.4,"body":"he's also, for the point of this"},{"speaker":"Charles Goldfarb","startTime":1931.4,"endTime":1936.74,"body":"conversation, the current chair"},{"speaker":"Charles Goldfarb","startTime":1931.4,"endTime":1936.74,"body":"of the Board of Trustees of the"},{"speaker":"Charles Goldfarb","startTime":1936.74,"endTime":1941.92,"body":"AMA. So incredibly important"},{"speaker":"Charles Goldfarb","startTime":1936.74,"endTime":1941.92,"body":"position, which, you know,"},{"speaker":"Charles Goldfarb","startTime":1941.92,"endTime":1947.14,"body":"again, they are the ultimate"},{"speaker":"Charles Goldfarb","startTime":1941.92,"endTime":1947.14,"body":"advocacy, advocacy committee for"},{"speaker":"Charles Goldfarb","startTime":1948.76,"endTime":1953.2,"body":"all physicians and some of our"},{"speaker":"Charles Goldfarb","startTime":1948.76,"endTime":1953.2,"body":"listeners. Many of our listeners"},{"speaker":"Charles Goldfarb","startTime":1953.26,"endTime":1958.06,"body":"are in the therapy world. And"},{"speaker":"Charles Goldfarb","startTime":1953.26,"endTime":1958.06,"body":"sometimes these advocacy"},{"speaker":"Charles Goldfarb","startTime":1958.06,"endTime":1962.16,"body":"efforts, actually, you know, can"},{"speaker":"Charles Goldfarb","startTime":1958.06,"endTime":1962.16,"body":"can be head to head clashes such"},{"speaker":"Charles Goldfarb","startTime":1962.16,"endTime":1967.14,"body":"as autonomy and independence in"},{"speaker":"Charles Goldfarb","startTime":1962.16,"endTime":1967.14,"body":"in caring for patients and the"},{"speaker":"Charles Goldfarb","startTime":1967.14,"endTime":1972.72,"body":"like. And ultimately, one of the"},{"speaker":"Charles Goldfarb","startTime":1967.14,"endTime":1972.72,"body":"AMA's primary goals is to"},{"speaker":"Charles Goldfarb","startTime":1972.72,"endTime":1976.62,"body":"encourage teamwork, but always"},{"speaker":"Charles Goldfarb","startTime":1972.72,"endTime":1976.62,"body":"have the physician as the leader"},{"speaker":"Charles Goldfarb","startTime":1976.62,"endTime":1977.22,"body":"of the team."},{"speaker":"Chris Dy","startTime":1977.7,"endTime":1979.98,"body":"Yeah. I mean, it's, I"},{"speaker":"Chris Dy","startTime":1977.7,"endTime":1979.98,"body":"mean to put it differently, it's"},{"speaker":"Chris Dy","startTime":1980.04,"endTime":1983.36,"body":"scope of practice. You see, I"},{"speaker":"Chris Dy","startTime":1980.04,"endTime":1983.36,"body":"remember when I was a resident"},{"speaker":"Chris Dy","startTime":1983.36,"endTime":1986.06,"body":"the AMA battling with the"},{"speaker":"Chris Dy","startTime":1983.36,"endTime":1986.06,"body":"podiatry organization about"},{"speaker":"Chris Dy","startTime":1986.06,"endTime":1988.88,"body":"scope of practice for podiatrist"},{"speaker":"Chris Dy","startTime":1986.06,"endTime":1988.88,"body":"in the state of New York at that"},{"speaker":"Chris Dy","startTime":1988.88,"endTime":1991.28,"body":"point, and I don't know if they"},{"speaker":"Chris Dy","startTime":1988.88,"endTime":1991.28,"body":"have gotten that success, but"},{"speaker":"Chris Dy","startTime":1991.28,"endTime":1994.7,"body":"trying to do things like knee"},{"speaker":"Chris Dy","startTime":1991.28,"endTime":1994.7,"body":"arthroscopy as a podiatrist, and"},{"speaker":"Chris Dy","startTime":1994.7,"endTime":1998.18,"body":"just encroaching on things that"},{"speaker":"Chris Dy","startTime":1994.7,"endTime":1998.18,"body":"are typically viewed as the"},{"speaker":"Chris Dy","startTime":1998.18,"endTime":2002.4,"body":"purview of the orthopedic"},{"speaker":"Chris Dy","startTime":1998.18,"endTime":2002.4,"body":"surgeon and I think the hand"},{"speaker":"Chris Dy","startTime":2002.4,"endTime":2004.68,"body":"therapy group, at least in"},{"speaker":"Chris Dy","startTime":2002.4,"endTime":2004.68,"body":"Missouri, scored a recent win,"},{"speaker":"Chris Dy","startTime":2004.68,"endTime":2007.56,"body":"which was nice for them, that"},{"speaker":"Chris Dy","startTime":2004.68,"endTime":2007.56,"body":"they can now get direct access"},{"speaker":"Chris Dy","startTime":2007.74,"endTime":2012.48,"body":"evaluations. So if you call up,"},{"speaker":"Chris Dy","startTime":2007.74,"endTime":2012.48,"body":"typically, how it's worked in"},{"speaker":"Chris Dy","startTime":2012.48,"endTime":2015.48,"body":"the past is that you would need"},{"speaker":"Chris Dy","startTime":2012.48,"endTime":2015.48,"body":"a referral and a prescription"},{"speaker":"Chris Dy","startTime":2015.48,"endTime":2018.36,"body":"from somebody like me or chuck"},{"speaker":"Chris Dy","startTime":2015.48,"endTime":2018.36,"body":"to go see a hand therapist"},{"speaker":"Chris Dy","startTime":2018.36,"endTime":2021.14,"body":"before your insurance company"},{"speaker":"Chris Dy","startTime":2018.36,"endTime":2021.14,"body":"would authorize that. But now I"},{"speaker":"Chris Dy","startTime":2021.14,"endTime":2025.7,"body":"think they do have direct access"},{"speaker":"Chris Dy","startTime":2021.14,"endTime":2025.7,"body":"for I think it's PT and OT, you"},{"speaker":"Chris Dy","startTime":2025.7,"endTime":2029.0,"body":"know, to see to see a therapist,"},{"speaker":"Chris Dy","startTime":2025.7,"endTime":2029.0,"body":"at least get worked up and"},{"speaker":"Chris Dy","startTime":2029.0,"endTime":2031.4,"body":"diagnosed, which I think is a"},{"speaker":"Chris Dy","startTime":2029.0,"endTime":2031.4,"body":"change. And not saying it's for"},{"speaker":"Chris Dy","startTime":2031.4,"endTime":2033.98,"body":"better or worse, I think in a"},{"speaker":"Chris Dy","startTime":2031.4,"endTime":2033.98,"body":"lot of ways it is a beneficial"},{"speaker":"Chris Dy","startTime":2033.98,"endTime":2036.86,"body":"thing to help access for"},{"speaker":"Chris Dy","startTime":2033.98,"endTime":2036.86,"body":"patients. But those are the"},{"speaker":"Chris Dy","startTime":2036.86,"endTime":2040.1,"body":"kinds of tensions that you can"},{"speaker":"Chris Dy","startTime":2036.86,"endTime":2040.1,"body":"see with scope of practice and"},{"speaker":"Chris Dy","startTime":2040.7,"endTime":2042.52,"body":"between professional"},{"speaker":"Chris Dy","startTime":2040.7,"endTime":2042.52,"body":"organizations."},{"speaker":"Charles Goldfarb","startTime":2042.76,"endTime":2044.86,"body":"Yeah, well"},{"speaker":"Charles Goldfarb","startTime":2042.76,"endTime":2044.86,"body":"said. And then, to be very"},{"speaker":"Charles Goldfarb","startTime":2044.86,"endTime":2049.0,"body":"specific, it's scope of practice"},{"speaker":"Charles Goldfarb","startTime":2044.86,"endTime":2049.0,"body":"and scope of practice creep, as"},{"speaker":"Charles Goldfarb","startTime":2049.0,"endTime":2054.7,"body":"it's been labeled by the AMA. I"},{"speaker":"Charles Goldfarb","startTime":2049.0,"endTime":2054.7,"body":"think we, we've I like the"},{"speaker":"Charles Goldfarb","startTime":2054.7,"endTime":2058.24,"body":"content of our conversation. I"},{"speaker":"Charles Goldfarb","startTime":2054.7,"endTime":2058.24,"body":"wonder if we could have"},{"speaker":"Charles Goldfarb","startTime":2058.24,"endTime":2060.72,"body":"organized it a little better,"},{"speaker":"Charles Goldfarb","startTime":2058.24,"endTime":2060.72,"body":"but I think some of the points"},{"speaker":"Charles Goldfarb","startTime":2060.72,"endTime":2062.88,"body":"we made are hopefully, many of"},{"speaker":"Charles Goldfarb","startTime":2060.72,"endTime":2062.88,"body":"the points we made are"},{"speaker":"Charles Goldfarb","startTime":2062.88,"endTime":2066.84,"body":"important. And my takeaways from"},{"speaker":"Charles Goldfarb","startTime":2062.88,"endTime":2066.84,"body":"this conversation is, number"},{"speaker":"Charles Goldfarb","startTime":2066.84,"endTime":2072.84,"body":"one, I have become better about"},{"speaker":"Charles Goldfarb","startTime":2066.84,"endTime":2072.84,"body":"supporting organizations that"},{"speaker":"Charles Goldfarb","startTime":2072.84,"endTime":2077.28,"body":"advocate for physicians and"},{"speaker":"Charles Goldfarb","startTime":2072.84,"endTime":2077.28,"body":"surgeons and hand surgeons. And"},{"speaker":"Charles Goldfarb","startTime":2077.28,"endTime":2079.74,"body":"I think we all should really"},{"speaker":"Charles Goldfarb","startTime":2077.28,"endTime":2079.74,"body":"think hard about that, because"},{"speaker":"Charles Goldfarb","startTime":2079.74,"endTime":2083.12,"body":"practicing in a bubble or"},{"speaker":"Charles Goldfarb","startTime":2079.74,"endTime":2083.12,"body":"practicing, you know, in a very"},{"speaker":"Charles Goldfarb","startTime":2083.18,"endTime":2087.02,"body":"you know, stay in your lane way"},{"speaker":"Charles Goldfarb","startTime":2083.18,"endTime":2087.02,"body":"is just not the way to do it in"},{"speaker":"Charles Goldfarb","startTime":2087.02,"endTime":2087.32,"body":"2024"},{"speaker":"Chris Dy","startTime":2088.4,"endTime":2092.48,"body":"right? And I think"},{"speaker":"Chris Dy","startTime":2088.4,"endTime":2092.48,"body":"there are a couple of issues I"},{"speaker":"Chris Dy","startTime":2092.48,"endTime":2094.88,"body":"could, you know, ideas I could"},{"speaker":"Chris Dy","startTime":2092.48,"endTime":2094.88,"body":"bring to the forefront here that"},{"speaker":"Chris Dy","startTime":2094.88,"endTime":2097.1,"body":"would maybe draw some attention"},{"speaker":"Chris Dy","startTime":2094.88,"endTime":2097.1,"body":"to those of you that are"},{"speaker":"Chris Dy","startTime":2097.1,"endTime":2100.12,"body":"practicing or training and don't"},{"speaker":"Chris Dy","startTime":2097.1,"endTime":2100.12,"body":"quite get it. I mean, first. Up,"},{"speaker":"Chris Dy","startTime":2100.12,"endTime":2103.3,"body":"like in Missouri, and you know,"},{"speaker":"Chris Dy","startTime":2100.12,"endTime":2103.3,"body":"Medicaid is a state based"},{"speaker":"Chris Dy","startTime":2103.3,"endTime":2105.52,"body":"program, as we mentioned"},{"speaker":"Chris Dy","startTime":2103.3,"endTime":2105.52,"body":"earlier, and you have a patient"},{"speaker":"Chris Dy","startTime":2105.52,"endTime":2108.4,"body":"with Medicaid, and you want to"},{"speaker":"Chris Dy","startTime":2105.52,"endTime":2108.4,"body":"do therapy after they're just a"},{"speaker":"Chris Dy","startTime":2108.4,"endTime":2111.88,"body":"radius fracture. Guess what?"},{"speaker":"Chris Dy","startTime":2108.4,"endTime":2111.88,"body":"Physical Therapy isn't covered"},{"speaker":"Chris Dy","startTime":2111.88,"endTime":2116.5,"body":"after surgery, amazingly, after,"},{"speaker":"Chris Dy","startTime":2111.88,"endTime":2116.5,"body":"you know, by the state of"},{"speaker":"Chris Dy","startTime":2116.5,"endTime":2118.84,"body":"Missouri for Medicaid. So this"},{"speaker":"Chris Dy","startTime":2116.5,"endTime":2118.84,"body":"is, you know, relevant for us as"},{"speaker":"Chris Dy","startTime":2118.84,"endTime":2121.36,"body":"hand surgeons, but also, like"},{"speaker":"Chris Dy","startTime":2118.84,"endTime":2121.36,"body":"say, for example, you want to do"},{"speaker":"Chris Dy","startTime":2121.36,"endTime":2123.18,"body":"a total knee replacement on"},{"speaker":"Chris Dy","startTime":2121.36,"endTime":2123.18,"body":"somebody. Replacement on"},{"speaker":"Chris Dy","startTime":2123.18,"endTime":2125.58,"body":"somebody, and you need them to"},{"speaker":"Chris Dy","startTime":2123.18,"endTime":2125.58,"body":"get access to therapy. If you"},{"speaker":"Chris Dy","startTime":2125.58,"endTime":2127.92,"body":"know that they're not going to"},{"speaker":"Chris Dy","startTime":2125.58,"endTime":2127.92,"body":"be able to go to the therapist"},{"speaker":"Chris Dy","startTime":2127.92,"endTime":2129.96,"body":"after surgery, are you still"},{"speaker":"Chris Dy","startTime":2127.92,"endTime":2129.96,"body":"going to do the total knee"},{"speaker":"Chris Dy","startTime":2129.96,"endTime":2132.66,"body":"replacement? So it becomes this"},{"speaker":"Chris Dy","startTime":2129.96,"endTime":2132.66,"body":"cycle that's very vicious and"},{"speaker":"Chris Dy","startTime":2132.66,"endTime":2137.22,"body":"very puts the patient at a"},{"speaker":"Chris Dy","startTime":2132.66,"endTime":2137.22,"body":"disadvantage. So you know, if we"},{"speaker":"Chris Dy","startTime":2137.22,"endTime":2141.5,"body":"were to look at efforts to rally"},{"speaker":"Chris Dy","startTime":2137.22,"endTime":2141.5,"body":"and advocate at the state level"},{"speaker":"Chris Dy","startTime":2141.86,"endTime":2145.58,"body":"to improve access to Medicaid or"},{"speaker":"Chris Dy","startTime":2141.86,"endTime":2145.58,"body":"access to therapy for Medicaid"},{"speaker":"Chris Dy","startTime":2145.58,"endTime":2148.4,"body":"patients. That'd be one example"},{"speaker":"Chris Dy","startTime":2145.58,"endTime":2148.4,"body":"where a practicing surgeon could"},{"speaker":"Chris Dy","startTime":2148.4,"endTime":2151.58,"body":"really provide some compelling"},{"speaker":"Chris Dy","startTime":2148.4,"endTime":2151.58,"body":"stories, also a practicing"},{"speaker":"Chris Dy","startTime":2151.58,"endTime":2153.8,"body":"therapist, we could work"},{"speaker":"Chris Dy","startTime":2151.58,"endTime":2153.8,"body":"together on something like that."},{"speaker":"Chris Dy","startTime":2154.22,"endTime":2158.6,"body":"And then, you know, people paid"},{"speaker":"Chris Dy","startTime":2154.22,"endTime":2158.6,"body":"more attention to politics when"},{"speaker":"Chris Dy","startTime":2158.6,"endTime":2161.26,"body":"it evolves the economy and their"},{"speaker":"Chris Dy","startTime":2158.6,"endTime":2161.26,"body":"pocketbook. And you can see"},{"speaker":"Chris Dy","startTime":2161.26,"endTime":2163.6,"body":"that's the leading, one of the"},{"speaker":"Chris Dy","startTime":2161.26,"endTime":2163.6,"body":"leading issues in the current US"},{"speaker":"Chris Dy","startTime":2163.6,"endTime":2166.72,"body":"election. And as a surgeon, if"},{"speaker":"Chris Dy","startTime":2163.6,"endTime":2166.72,"body":"you are paid a certain amount"},{"speaker":"Chris Dy","startTime":2166.72,"endTime":2169.24,"body":"for a certain procedure for"},{"speaker":"Chris Dy","startTime":2166.72,"endTime":2169.24,"body":"years and years and years, and"},{"speaker":"Chris Dy","startTime":2169.42,"endTime":2172.6,"body":"then it just starts to go down,"},{"speaker":"Chris Dy","startTime":2169.42,"endTime":2172.6,"body":"like the devaluing of the total"},{"speaker":"Chris Dy","startTime":2172.6,"endTime":2176.2,"body":"hip and knee replacements over"},{"speaker":"Chris Dy","startTime":2172.6,"endTime":2176.2,"body":"the last two decades. And you"},{"speaker":"Chris Dy","startTime":2176.2,"endTime":2178.72,"body":"can see that the American"},{"speaker":"Chris Dy","startTime":2176.2,"endTime":2178.72,"body":"Academy of hip and knee surgeons"},{"speaker":"Chris Dy","startTime":2178.72,"endTime":2182.04,"body":"has a huge advocacy arm that has"},{"speaker":"Chris Dy","startTime":2178.72,"endTime":2182.04,"body":"developed even outside of the"},{"speaker":"Chris Dy","startTime":2182.04,"endTime":2185.1,"body":"academies pack, because they"},{"speaker":"Chris Dy","startTime":2182.04,"endTime":2185.1,"body":"really want to protect the value"},{"speaker":"Chris Dy","startTime":2185.1,"endTime":2188.64,"body":"of those codes so they can"},{"speaker":"Chris Dy","startTime":2185.1,"endTime":2188.64,"body":"continue to be paid at least the"},{"speaker":"Chris Dy","startTime":2188.64,"endTime":2192.0,"body":"same as what they've gotten paid"},{"speaker":"Chris Dy","startTime":2188.64,"endTime":2192.0,"body":"in the past, as opposed to"},{"speaker":"Chris Dy","startTime":2192.0,"endTime":2196.8,"body":"getting cut two to three to 5%"},{"speaker":"Chris Dy","startTime":2192.0,"endTime":2196.8,"body":"if not more, every year. So"},{"speaker":"Chris Dy","startTime":2196.8,"endTime":2198.96,"body":"people pay attention"},{"speaker":"Chris Dy","startTime":2196.8,"endTime":2198.96,"body":"unfortunately or better or worse"},{"speaker":"Chris Dy","startTime":2198.96,"endTime":2201.98,"body":"when it affects their"},{"speaker":"Chris Dy","startTime":2198.96,"endTime":2201.98,"body":"pocketbooks too, you know. And I"},{"speaker":"Chris Dy","startTime":2201.98,"endTime":2204.92,"body":"think that maybe you could just"},{"speaker":"Chris Dy","startTime":2201.98,"endTime":2204.92,"body":"close us with that little"},{"speaker":"Chris Dy","startTime":2204.92,"endTime":2208.34,"body":"snippet about, you know,"},{"speaker":"Chris Dy","startTime":2204.92,"endTime":2208.34,"body":"advocating for our Surgeon group"},{"speaker":"Chris Dy","startTime":2208.34,"endTime":2209.9,"body":"with doing needle app and"},{"speaker":"Chris Dy","startTime":2208.34,"endTime":2209.9,"body":"neurotomies."},{"speaker":"Charles Goldfarb","startTime":2210.38,"endTime":2212.48,"body":"Yeah, it's a"},{"speaker":"Charles Goldfarb","startTime":2210.38,"endTime":2212.48,"body":"great it's a great way to close,"},{"speaker":"Charles Goldfarb","startTime":2212.48,"endTime":2217.46,"body":"even though we could go on, I"},{"speaker":"Charles Goldfarb","startTime":2212.48,"endTime":2217.46,"body":"think for a really long time, I"},{"speaker":"Charles Goldfarb","startTime":2217.46,"endTime":2221.26,"body":"was told that a needle app and"},{"speaker":"Charles Goldfarb","startTime":2217.46,"endTime":2221.26,"body":"Neurotomy procedure that I had"},{"speaker":"Charles Goldfarb","startTime":2221.26,"endTime":2226.0,"body":"done in the office was not going"},{"speaker":"Charles Goldfarb","startTime":2221.26,"endTime":2226.0,"body":"to be reimbursed despite having,"},{"speaker":"Charles Goldfarb","startTime":2226.0,"endTime":2229.96,"body":"you know, pre authorization or"},{"speaker":"Charles Goldfarb","startTime":2226.0,"endTime":2229.96,"body":"or pre approval. I guess, I'm"},{"speaker":"Charles Goldfarb","startTime":2229.96,"endTime":2234.1,"body":"not sure the terminology for"},{"speaker":"Charles Goldfarb","startTime":2229.96,"endTime":2234.1,"body":"this particular insurer. And I"},{"speaker":"Charles Goldfarb","startTime":2234.1,"endTime":2239.68,"body":"said, Well, why is that? Which"},{"speaker":"Charles Goldfarb","startTime":2234.1,"endTime":2239.68,"body":"led to conversations with in our"},{"speaker":"Charles Goldfarb","startTime":2239.68,"endTime":2243.0,"body":"group at the department"},{"speaker":"Charles Goldfarb","startTime":2239.68,"endTime":2243.0,"body":"orthopedic surgery at Washington"},{"speaker":"Charles Goldfarb","startTime":2243.0,"endTime":2245.82,"body":"University, and ultimately with"},{"speaker":"Charles Goldfarb","startTime":2243.0,"endTime":2245.82,"body":"the medical director for this"},{"speaker":"Charles Goldfarb","startTime":2245.82,"endTime":2249.84,"body":"particular insurance company."},{"speaker":"Charles Goldfarb","startTime":2245.82,"endTime":2249.84,"body":"And we had a great discussion,"},{"speaker":"Charles Goldfarb","startTime":2249.9,"endTime":2255.06,"body":"and he was a physician, and he"},{"speaker":"Charles Goldfarb","startTime":2249.9,"endTime":2255.06,"body":"recognized the cost savings to"},{"speaker":"Charles Goldfarb","startTime":2255.12,"endTime":2260.24,"body":"the insurer, to society, the"},{"speaker":"Charles Goldfarb","startTime":2255.12,"endTime":2260.24,"body":"benefits to the patient. All of"},{"speaker":"Charles Goldfarb","startTime":2260.24,"endTime":2263.06,"body":"those things were true if we did"},{"speaker":"Charles Goldfarb","startTime":2260.24,"endTime":2263.06,"body":"the needle procedure in the"},{"speaker":"Charles Goldfarb","startTime":2263.06,"endTime":2268.22,"body":"office, but he said, based on"},{"speaker":"Charles Goldfarb","startTime":2263.06,"endTime":2268.22,"body":"the insurer's interpretation of"},{"speaker":"Charles Goldfarb","startTime":2268.58,"endTime":2272.84,"body":"Medicare and CMS rules and"},{"speaker":"Charles Goldfarb","startTime":2268.58,"endTime":2272.84,"body":"regulations, they would no"},{"speaker":"Charles Goldfarb","startTime":2272.84,"endTime":2278.0,"body":"longer be paying for the needle"},{"speaker":"Charles Goldfarb","startTime":2272.84,"endTime":2278.0,"body":"procedure in the office. He"},{"speaker":"Charles Goldfarb","startTime":2278.0,"endTime":2282.34,"body":"agreed that it was nonsensical,"},{"speaker":"Charles Goldfarb","startTime":2278.0,"endTime":2282.34,"body":"but he felt he could not do"},{"speaker":"Charles Goldfarb","startTime":2282.34,"endTime":2286.78,"body":"anything about it, and so, and"},{"speaker":"Charles Goldfarb","startTime":2282.34,"endTime":2286.78,"body":"that's been six months. And so"},{"speaker":"Charles Goldfarb","startTime":2286.78,"endTime":2289.9,"body":"for that particular insurer, we"},{"speaker":"Charles Goldfarb","startTime":2286.78,"endTime":2289.9,"body":"no longer do needle procedures"},{"speaker":"Charles Goldfarb","startTime":2289.9,"endTime":2292.6,"body":"in the office, which is a shame,"},{"speaker":"Charles Goldfarb","startTime":2289.9,"endTime":2292.6,"body":"which"},{"speaker":"Chris Dy","startTime":2293.14,"endTime":2295.12,"body":"is crazy, because they"},{"speaker":"Chris Dy","startTime":2293.14,"endTime":2295.12,"body":"probably would pay for it if you"},{"speaker":"Chris Dy","startTime":2295.12,"endTime":2295.96,"body":"did it in the or 100%"},{"speaker":"Charles Goldfarb","startTime":2297.16,"endTime":2299.02,"body":"they wouldn't"},{"speaker":"Charles Goldfarb","startTime":2297.16,"endTime":2299.02,"body":"have done some. And what we do"},{"speaker":"Charles Goldfarb","startTime":2299.02,"endTime":2301.68,"body":"is they just wide awake in the"},{"speaker":"Charles Goldfarb","startTime":2299.02,"endTime":2301.68,"body":"operating room, and we're"},{"speaker":"Charles Goldfarb","startTime":2301.68,"endTime":2305.22,"body":"adding, you know, many multiples"},{"speaker":"Charles Goldfarb","startTime":2301.68,"endTime":2305.22,"body":"of cost."},{"speaker":"Chris Dy","startTime":2305.88,"endTime":2308.94,"body":"You got that not only"},{"speaker":"Chris Dy","startTime":2305.88,"endTime":2308.94,"body":"you paying so before you would"},{"speaker":"Chris Dy","startTime":2308.94,"endTime":2312.06,"body":"pay Chuck Goldfarb the physician"},{"speaker":"Chris Dy","startTime":2308.94,"endTime":2312.06,"body":"fee, I don't even know if we"},{"speaker":"Chris Dy","startTime":2312.06,"endTime":2316.08,"body":"were charging a facility fee as"},{"speaker":"Chris Dy","startTime":2312.06,"endTime":2316.08,"body":"a university for that. Now"},{"speaker":"Chris Dy","startTime":2316.08,"endTime":2318.84,"body":"you're paying Chuck Goldfarb the"},{"speaker":"Chris Dy","startTime":2316.08,"endTime":2318.84,"body":"physician fee, probably the same"},{"speaker":"Chris Dy","startTime":2318.9,"endTime":2322.4,"body":"you're paying the hospital for"},{"speaker":"Chris Dy","startTime":2318.9,"endTime":2322.4,"body":"their time, and through the"},{"speaker":"Chris Dy","startTime":2322.4,"endTime":2325.58,"body":"facility fee, you're adding this"},{"speaker":"Chris Dy","startTime":2322.4,"endTime":2325.58,"body":"cost on which, depending on your"},{"speaker":"Chris Dy","startTime":2325.58,"endTime":2328.34,"body":"insurance plan, does affect the"},{"speaker":"Chris Dy","startTime":2325.58,"endTime":2328.34,"body":"out of pocket for the patient,"},{"speaker":"Chris Dy","startTime":2328.34,"endTime":2331.76,"body":"which is absolutely insane with"},{"speaker":"Chris Dy","startTime":2328.34,"endTime":2331.76,"body":"the given the caveats and"},{"speaker":"Chris Dy","startTime":2331.76,"endTime":2334.28,"body":"acknowledgements that you made"},{"speaker":"Chris Dy","startTime":2331.76,"endTime":2334.28,"body":"before. Yeah,"},{"speaker":"Charles Goldfarb","startTime":2334.28,"endTime":2337.22,"body":"it's really"},{"speaker":"Charles Goldfarb","startTime":2334.28,"endTime":2337.22,"body":"crazy. And for the younger"},{"speaker":"Charles Goldfarb","startTime":2337.22,"endTime":2341.92,"body":"listeners, just to be very"},{"speaker":"Charles Goldfarb","startTime":2337.22,"endTime":2341.92,"body":"clear, if a surgeon may charge"},{"speaker":"Charles Goldfarb","startTime":2341.92,"endTime":2346.0,"body":"$5 for a procedure. You can"},{"speaker":"Charles Goldfarb","startTime":2341.92,"endTime":2346.0,"body":"guarantee yourself that the"},{"speaker":"Charles Goldfarb","startTime":2346.0,"endTime":2350.56,"body":"hospital is charging four to"},{"speaker":"Charles Goldfarb","startTime":2346.0,"endTime":2350.56,"body":"five times multiple of that, and"},{"speaker":"Charles Goldfarb","startTime":2350.56,"endTime":2354.22,"body":"so the money is in the hospital"},{"speaker":"Charles Goldfarb","startTime":2350.56,"endTime":2354.22,"body":"system, maybe for good reason,"},{"speaker":"Charles Goldfarb","startTime":2354.46,"endTime":2358.06,"body":"but to add that unnecessary cost"},{"speaker":"Charles Goldfarb","startTime":2354.46,"endTime":2358.06,"body":"to procedure like this is crazy,"},{"speaker":"Charles Goldfarb","startTime":2358.06,"endTime":2361.62,"body":"so we will continue to fight on"},{"speaker":"Charles Goldfarb","startTime":2358.06,"endTime":2361.62,"body":"this, because it's the right"},{"speaker":"Charles Goldfarb","startTime":2361.62,"endTime":2364.02,"body":"thing to do in every respect,"},{"speaker":"Chris Dy","startTime":2364.32,"endTime":2366.84,"body":"at least you're not"},{"speaker":"Chris Dy","startTime":2364.32,"endTime":2366.84,"body":"adding the anesthesis into that,"},{"speaker":"Chris Dy","startTime":2366.84,"endTime":2369.06,"body":"because that's another"},{"speaker":"Chris Dy","startTime":2366.84,"endTime":2369.06,"body":"professional fee and more"},{"speaker":"Chris Dy","startTime":2369.06,"endTime":2372.36,"body":"facility piece. Crazy. So I"},{"speaker":"Chris Dy","startTime":2369.06,"endTime":2372.36,"body":"think the point today of a"},{"speaker":"Chris Dy","startTime":2372.36,"endTime":2375.96,"body":"discussion which is timely given"},{"speaker":"Chris Dy","startTime":2372.36,"endTime":2375.96,"body":"the at least the political"},{"speaker":"Chris Dy","startTime":2375.96,"endTime":2379.08,"body":"calendar in the US, is that you"},{"speaker":"Chris Dy","startTime":2375.96,"endTime":2379.08,"body":"have to be part of the advocacy"},{"speaker":"Chris Dy","startTime":2379.08,"endTime":2382.1,"body":"efforts, and whether that's"},{"speaker":"Chris Dy","startTime":2379.08,"endTime":2382.1,"body":"doing great things like like"},{"speaker":"Chris Dy","startTime":2382.1,"endTime":2385.52,"body":"John is doing with his"},{"speaker":"Chris Dy","startTime":2382.1,"endTime":2385.52,"body":"organization, participating in"},{"speaker":"Chris Dy","startTime":2385.52,"endTime":2388.46,"body":"your local organizations,"},{"speaker":"Chris Dy","startTime":2385.52,"endTime":2388.46,"body":"contributing money to the"},{"speaker":"Chris Dy","startTime":2388.58,"endTime":2393.8,"body":"political action committees if"},{"speaker":"Chris Dy","startTime":2388.58,"endTime":2393.8,"body":"you're you know, if you're not"},{"speaker":"Chris Dy","startTime":2393.8,"endTime":2396.02,"body":"at the table, you're on the"},{"speaker":"Chris Dy","startTime":2393.8,"endTime":2396.02,"body":"menu, is what they like to say"},{"speaker":"Chris Dy","startTime":2396.02,"endTime":2398.48,"body":"in the in DC. So if you're not"},{"speaker":"Chris Dy","startTime":2396.02,"endTime":2398.48,"body":"advocating for yourself, you're"},{"speaker":"Chris Dy","startTime":2398.48,"endTime":2401.98,"body":"the one that's going to get"},{"speaker":"Chris Dy","startTime":2398.48,"endTime":2401.98,"body":"eaten up. So please, please"},{"speaker":"Chris Dy","startTime":2401.98,"endTime":2404.68,"body":"support those efforts in"},{"speaker":"Chris Dy","startTime":2401.98,"endTime":2404.68,"body":"whichever way you feel most"},{"speaker":"Chris Dy","startTime":2404.68,"endTime":2407.02,"body":"appropriate. Everybody's a"},{"speaker":"Chris Dy","startTime":2404.68,"endTime":2407.02,"body":"little bit different with how"},{"speaker":"Chris Dy","startTime":2407.02,"endTime":2409.78,"body":"they want to engage with that"},{"speaker":"Chris Dy","startTime":2407.02,"endTime":2409.78,"body":"kind of stuff. Absolutely"},{"speaker":"Charles Goldfarb","startTime":2410.08,"endTime":2412.84,"body":"fun to talk"},{"speaker":"Charles Goldfarb","startTime":2410.08,"endTime":2412.84,"body":"about this stuff, and it will be"},{"speaker":"Charles Goldfarb","startTime":2412.84,"endTime":2416.2,"body":"interesting by the time this"},{"speaker":"Charles Goldfarb","startTime":2412.84,"endTime":2416.2,"body":"podcast drops, we will have, at"},{"speaker":"Charles Goldfarb","startTime":2416.2,"endTime":2419.8,"body":"least, hopefully, we will have"},{"speaker":"Charles Goldfarb","startTime":2416.2,"endTime":2419.8,"body":"an identification of the next"},{"speaker":"Charles Goldfarb","startTime":2419.8,"endTime":2422.22,"body":"president, which will affect all"},{"speaker":"Charles Goldfarb","startTime":2419.8,"endTime":2422.22,"body":"of us"},{"speaker":"Chris Dy","startTime":2423.66,"endTime":2426.06,"body":"specifically? Oh, yes,"},{"speaker":"Chris Dy","startTime":2423.66,"endTime":2426.06,"body":"it will in"},{"speaker":"Charles Goldfarb","startTime":2426.06,"endTime":2428.58,"body":"the healthcare"},{"speaker":"Charles Goldfarb","startTime":2426.06,"endTime":2428.58,"body":"realm. All right, have a good"},{"speaker":"Charles Goldfarb","startTime":2428.58,"endTime":2433.38,"body":"day. You too. Hey, Chris, that"},{"speaker":"Charles Goldfarb","startTime":2428.58,"endTime":2433.38,"body":"was fun. Let's do it again real"},{"speaker":"Charles Goldfarb","startTime":2433.38,"endTime":2433.8,"body":"soon."},{"speaker":"Chris Dy","startTime":2434.34,"endTime":2436.5,"body":"Sounds good. Well, be"},{"speaker":"Chris Dy","startTime":2434.34,"endTime":2436.5,"body":"sure to email us with topic"},{"speaker":"Chris Dy","startTime":2436.5,"endTime":2438.96,"body":"suggestions and feedback. You"},{"speaker":"Chris Dy","startTime":2436.5,"endTime":2438.96,"body":"can reach us at hand"},{"speaker":"Chris Dy","startTime":2438.96,"endTime":2439.5,"body":"podcast@gmail.com"},{"speaker":"Charles Goldfarb","startTime":2441.24,"endTime":2443.36,"body":"and remember,"},{"speaker":"Charles Goldfarb","startTime":2441.24,"endTime":2443.36,"body":"please subscribe wherever you"},{"speaker":"Charles Goldfarb","startTime":2443.36,"endTime":2444.38,"body":"get your podcast,"},{"speaker":"Chris Dy","startTime":2444.74,"endTime":2447.62,"body":"and be sure to leave a"},{"speaker":"Chris Dy","startTime":2444.74,"endTime":2447.62,"body":"review that helps us get the"},{"speaker":"Chris Dy","startTime":2447.62,"endTime":2449.24,"body":"word out. Special,"},{"speaker":"Charles Goldfarb","startTime":2449.24,"endTime":2451.28,"body":"thanks to"},{"speaker":"Charles Goldfarb","startTime":2449.24,"endTime":2451.28,"body":"Peter Martin for the amazing"},{"speaker":"Charles Goldfarb","startTime":2451.28,"endTime":2452.6,"body":"music, and"},{"speaker":"Chris Dy","startTime":2452.6,"endTime":2454.76,"body":"remember, keep the"},{"speaker":"Chris Dy","startTime":2452.6,"endTime":2454.76,"body":"upper hand come back next time"},{"speaker":"Unknown","startTime":2462.86,"endTime":2462.98,"body":"you"}]}