Welcome And Guest Introduction

Dr Andrew Greenland 0:00

Welcome back to the Voices in Health and Wellness Podcast, where we have honest conversations with practitioners, founders, and innovators who are shaping what healthcare looks like on the ground. Today I'm joined by Dr. Tanya Harris, a physician specializing in physical medicine and rehabilitation, often referred to as PMR, a field that plays a critical role in helping patients recover function after serious illness or injury, but is still surprisingly underrecognized. Tanya is the medical director of 40-bed rehabilitation hospital at Good Samaritan, where she works closely with patients recovering from complex conditions like brain injury whilst also navigating the realities of the US healthcare system, particularly the growing challenges around insurance approvals and access to care. So with that, Tanya, I'd love to welcome you to the show. Thank you so much for joining us today.

From Neurology Dreams To Rehab

Dr Tanya Harris 0:45

Thank you for having me on this wonderful platform to talk about my field.

Dr Andrew Greenland 0:50

Thank you. So perhaps we could start. Could you walk us through your journey into medicine and what led you specifically into physical medicine and rehabilitation?

Dr Tanya Harris 0:59

I was a person who always knew I would be going into medicine. And that's probably because of my background, my family, my mom's a nurse, uh, my grandpa and my great-grandpa were eye surgeons. So I guess you can say I kind of was bred into it. So I didn't think much about what field I would go to. I just kind of got pushed toward that, and I was happy to. I'd go with my mom to her work when I was a kid, and I enjoyed um seeing people and uh collaborating with the as a little kid with the the other medical staff, and I just felt at home there, and so it started there. I didn't know specifically what field I would go into until a little bit later. My grandmother has epilepsy, so initially I thought I would go into neurology. Um, things about the brain always interested me. I'd read my mom's uh nursing books and try to figure things out. When I was uh 13, I started volunteering at a neurology office. Um, so that was my path from a young age. When I went into medical school, I still thought I would go into neurology, but I had a preceptor, and she was a PM and R doc. Um, she introduced herself as a rehab doc, and she was wonderful. She helped me cultivate my bedside manner, try to suss out what I was doing right and wrong, and try to strengthen me as not just a doc, but as a person. And toward the end of the preceptorship, she she asked me what I wanted to do. And I told her I want to be a neurologist. And she she looked, she kind of looked at me for a minute, she looked a little disappointed, and then she perked up and she said, I don't think you should go into that. I think you should be a rehab doc. And I was floored because I thought she was talking about addiction medicine. I said, Ah, no can do. That is not my interest. I don't think I could do very well with addiction medicine. And she said, no, no, no, no. Rehab medicine, what I'm talking about is physical like injuries and diseases and trying to um help people become more independent, brain injury, stroke, amputation. Oh, it never occurred to me. That is something as a field that flies under the radar. Uh, people in med school don't even hear about that. It's not one of the rotations that are offered. You really have to kind of uh either be lucky to know what it is or um know someone who will kind of guide you, but typically we didn't know about it. But um after that, I shadowed her at her work, um, and I loved it. Uh, it was a lot of neurology, but it was more hands-on, and uh focusing on trying to help the patient through the process getting better through different modalities, could be medicine like in neurology, but it could also be different therapies. Um, but it's it is definitely more hands-on, and I'm a person who enjoys being in the trenches, uh, so I thought it was a much better fit, and I'm so grateful uh that she helped me through that. Thank you, Dr. Barr.

What PM&R Actually Does

Dr Andrew Greenland 4:49

Perfect, thank you. Really, really nice background, really nice backstory. So, for people listening who may not be familiar, how do you explain PM and R and what makes it different from other specialities?

Dr Tanya Harris 5:01

So, physical medicine and rehab is really a two-part specialty, and a lot of people don't understand this. There's the physical medicine portion, which deals more with musculoskeletal issues like spine, sprain, strains, things like that, sports medicine kind of stuff. It's more outpatient-based. And then you have the rehab medicine part, which is more inpatient-based, but it can be outpatient too. And that deals with the treatment of more catastrophic diseases and injuries like stroke, amputation, spinal cord injury, burns. My field or subspecialty is uh traumatic brain injury or brain injury medicine. Um, so I try to help people after they've had insults to the brain and try to get them back uh as close as I can to where they were. But whichever you go into or a person goes into, they're both dealing with the fostering of independence for the patient by treating the impairments and the disabilities that they deal with and trying to really get them back to as close as I can or we can to a normal lifestyle, which is really what people want after going through something like that. It's different from other fields because a lot of other fields uh focus on adding years to life, which is very important. I mean, you go to a hospital, you want to live. You go to a doc, you want to make sure you uh you survive um an injury or insult. Uh, our focus is different, but that doesn't mean it's less important. We add life to years. So we focus on quality of life, uh, we have a holistic approach. What is important to the patient? What do they want to get back to doing? Is it walking? Is it um having uh a good communication with their family? Is it going back to work? Um, what is it that is meaningful for the patient? And we make that our goal and we try to further the person toward that goal.

Why Rehab Medicine Stays Hidden

Dr Andrew Greenland 7:23

Amazing. So, why do you think it's still so underrecognized even within medicine?

Dr Tanya Harris 7:33

I don't I I wish there were more people that would advocate on our field. Uh, why is it underrecognized? Um I don't want to say it's a new field, but maybe it's a newer field compared to the other uh organ system-based specialties. Uh, when I say it's not a new field, our field has been around since the World Wars. Okay. Uh basically is started as a response to uh soldiers coming back with injuries, uh, limbs blown off, or shell shock brain injury. And um our country had a hard time understanding what to do with these these young folks. Uh, so our field developed. It actually developed at my med school, uh, Temple University in Philadelphia in the in the 20s by uh a doctor named Frank Cruzen, uh, who developed a rehab unit there to help uh with these types of injuries. And then he moved over to the Mayo Clinic where he started the first residency there in physical medicine and rehabilitation. Um, so our field has been here for a long time, but um maybe not as long as some of the others, and it's taken time to really um spread the knowledge, and it takes a lot of effort. So I myself I go to residencies, I go to med schools, and I try to educate uh people on what we do. It's got to kind of start at the base level, but it takes a lot of work, and I'm not sure that we're doing enough. So maybe it's on us, I don't know. I will say, even in my hospital, Goods Marin Hospital, I'm still doing a lot of education. My um my colleagues in other fields, even the surgeons, they sometimes refer to us as PMN, like the letter R, and they don't realize this and R. And so I, you know, it takes it takes time to pull myself away from all my other duties and say, okay, this is what we do. Uh, just in case you didn't know, I I noticed your verbiage was a little bit, you know, off. And uh it's a lot of work, and we're still working on it. And I think we are getting better at recognition or becoming recognized. But I beseech all the rest of the rehab docs to to take the effort and try to educate others on our services because they're important services, and in the end, it's what um what helps with the safety of patients, helps get patients home safely, and focuses on furthering their goals as human beings.

Dr Andrew Greenland 10:44

Thank you. So we're talking about really a lack of awareness, getting maybe getting a bit better. But what's the impact of the lack of awareness in practice day-to-day?

Dr Tanya Harris 10:54

So if the other fields or our colleagues don't understand what we do, or if the patients don't understand what we do, then they don't know to engage or how to engage in our services. For example, I still get plenty of patients who come to us after a long road where they've had a stroke and they were sent home maybe too early, even though they couldn't walk and had injuries in the home setting. Okay, or they let's say they had an amputation, okay, and they got sent home, and their family realized, oh, I can't transfer this person on and off the toilet, or I can't get them a shower. I and they have all these issues. So sometimes we get patients after the injury, after they got sent home, and then after they come back to the ER because of either it more injuries or difficulty or failure in the home setting, and then we try to pick up the pieces and help them that way. So it's a delay in care, that's the problem, okay? Um, and more important than that, with rehab, oftentimes the most benefit can be achieved directly after injury, such as after brain injury or stroke. That is the time where the system, the brain, is the most plastic, okay, and more uh, I guess, uh agreeable to change, um, re-recovering pathways or creating new pathways. There's a soup of um, I guess, neurological hormones that can help with that process, and it's most notable in the first few weeks after injury. So if we can get to a patient uh closer to injury, we can often garner much more in terms of benefits uh than if they come to us a month or two months after. We can still help them and we will help them, but really we want to try to encourage people to come to us sooner than on the back end.

Dr Andrew Greenland 13:20

Got it. So, with all your great work in education and your involvement with medical schools, what have you found that is actually helping to shift this awareness? Because this is all about an awareness thing that we're talking about.

Dr Tanya Harris 13:31

It's it's boots on the ground, get out there and talk to people. And I will say doctors as a general rule they're they're overworked. You would know about this. Um yeah, so it's hard to take time out of the day to do it, but I think I think we as a specialty need to set aside some time for advocacy for our field and make it a priority. Um, yes, we want to focus on our individual patients, but um think of all the other people we're helping if we kind of broaden our approach.

Dr Andrew Greenland 14:19

Wonderful. I'd like to talk a little bit about the insurance side, because I know this is a major theme. So, can you walk us through what's actually happening when a patient needs rehab but gets denied? Okay. Deep breath.

Dr Tanya Harris 14:34

I spend time every day, and I'm talking about at least an hour every day, sometimes more than an hour, sometimes two or more, every day fighting with insurance. Um rehab is not a cheap field. It takes a lot of work for us to get a patient better. It's just not the services I provide, it's the nurses, it's the physical therapists, the occupational therapist, the speech therapist, the recreational therapist, the neuropsychologist, and then all the staff that help us run our unit. So it takes a lot to get a patient better, and therefore the cost is higher. Say it's higher than a skilled nursing facility, which typically offers an hour or an hour and a half of therapy a day, if their patient is lucky, compared to what we provide, which is three hours of aggressive therapy a day. Okay, so insurances see this, and even though we can provide much more benefit with, let's say, two weeks of aggressive inpatient rehab compared to months of skilled nursing facility, insurances tend to be short-sighted. Even though we save considerably more money if they come to us and then go home, an insurance company sees, okay, well, the day rate is going to be less if I just ship them off to a SNF, and they're they're looking at the the short end. Um whereas we if they come to us, they would progress much quicker, uh much farther in such a short amount of time. Um, and we work on caregiver training much more aggressively, and we can get them home safer. Um, so I forgot your question. I think we're talking about the issues with insurance. Yeah, the issues with insurance. So that is a problem that I have to fight every day. I will tell you, in the last five years, the insurance approvals, pre pre-authorizations for inpatient rehab have dropped substantially. And when I say substantially, I mean multiples. Um, we have inpatient rehab units shutting down across the West Coast. Um I have rehab doctors from other facilities that are shutting down calling me asking if we have a position for them. So it's it's almost an endangered finding an aggressive inpatient, an inpatient rehab facility, or an ERF as they call it. I think when I was in training, we called it an ARF-acute rehab facility. And the shift is more towards SNF skilled nursing facility, which is more about the nursing and some therapy thrown in. Um, so I have to advocate for the patient. Um I'm I'm doing peer-to-peers, pre-authorizations, appeals, trying to do what's best for the patient. And uh sometimes I win and sometimes I don't, but I I fight either way.

Dr Andrew Greenland 17:51

Amazing. So, but how does um that affect your time, energy, and ultimately patient outcomes? This whole kind of being entrenched and having to sort this out on, like you said, a daily basis.

Dr Tanya Harris 18:02

Yeah, it's it's a drain on my time. It's certainly a drain on my energy when I when I have to speak to a peer who may be a pulmonologist, not a rehab doctor, um, and try to explain what we do and why it would be better for that patient to come to us. Um but ultimately, in the cases where I am successful and we can get the patients here, um, it is a good feeling knowing that I have done the best for our patient, and that patient is going to have a much fairer shake uh at life than if they hadn't come to us. I truly believe that we offer the best care, and that's why I'm so adamant that they come to us.

Inside A 40 Bed Rehab Hospital

Dr Andrew Greenland 18:49

Amazing. So, as a medical director of a 40-bed rehab hospital, tell us a bit about your kind of working week. How do you do all the things that you have to do and what's the kind of setup there at the hospital, just for those that don't know it?

Dr Tanya Harris 19:05

So, um my day is set up into two parts. The morning is all about the patients. I come in, I uh pre-round, I check patients' labs, see how they're doing, see if they had any issues overnight. I sit down with the rest of our team on a daily basis, and our hospital is great at it. We have a team meeting every day, we call it patient progression rounds, and everyone comes. Uh, the nurses come, um, all the therapists come, our neuropsychologist is there, our case manager is there, I'm there, and we all talk about how the patient's doing, how they're progressing, and any barriers to care. The nurses are integral to this because they were with the patient overnight, they spend the most amount of time with the patients, and uh it's really good to hear the feedback. The therapists train the patients, but uh the nurses know if it's really caring over or not, and they can tell us their um their insights, and we problem solve. Okay, well, let's focus on this, or we need to focus more on this, or oh, we need um this type of equipment. What can we do to get this? Oh, the patient can't afford it. Do we have uh other options for access? So it's it's a lot of problem solving, and it's something that uh some facilities do maybe just once a week, but we do it every day, and I find that very valuable, and so do the team members. It takes time, but ultimately it's what's best for the patient. So that's my morning, and we put those plans into action, and then the afternoon is my directorship role, and I focus on the staff. So I try to figure out what are our processes, what can we do to make things more efficient, make things safer, what can we do to cultivate uh a more enjoyable environment, okay? Um, to be all on the same page, and that is a lot of work. Um medicine has a lot of strain, a lot of stress, and people see things that upset them, and that's because they care. So it's important to have a venue where we can speak to it and get it out in the open and problem solve from a larger perspective, not just the individual patients. And that's my my afternoon. Our rehab facility is basically um right now, unfortunately, we are uh we are housing the patients in semi private rooms. And maybe that's because we are less vocal of a field than others, and uh our hospital. Don't necessarily understand the importance of what we do. But typically, you in rehab, the patient has their own room. So we're struggling with that in our situation. And I'm advocating every day, much to the chagrin of our administrators, that the patients need their own individual private rooms where we house them and also teach them on bowel and bladder management, which is not sexy at all, but is one of the main factors that get a patient home. A family is much more agreeable in helping a patient with activities of daily living if they don't involve bowel and bladder care. Because you know, that's kind of private stuff for a lot of people. And so we focus on that. We focus on mobility, of course. You know, that's what physical therapy does. They focus on strength, uh, balance, and mobilizing the patient as much as possible, whether that's getting them back walking or getting them independent at a wheelchair level, really depends on the patient. We have our occupational therapists who see them, um, occupational therapists, in case people don't know. Uh, they work on activities of daily living like dressing, bathing, toileting, feeding themselves, things that we all pretty much know how to do, but after something like a stroke or brain injury or spinal cord injury, you kind of have to relearn. So they work on that. And they also look to see if there's any medical equipment which can help the patients adapt and get home safer. And we work on getting them that. And then we have speech therapists. So, speech therapists they work on speech and language, but they also work on memory cognition, cognitive issues, and they also work on swallowing. So, a lot of people after a brain insult, they have problems with their swallowing complex, and that puts them at risk for aspiration, pneumonia, pneumonitis. Um, so the speech therapists work with that and try to get them more functional with that. And in the meantime, we might have to adjust their diet. They might be on different consistency foods or uh liquids. So we'll work on that. We have a recreational therapist here, which a lot of programs don't have. Um, and she works uh also on access to the community, does community outings because that's important to people. They don't want to be just holed up in their house all day when they go back home. So that's very important. We have neuropsychologists here, which are extremely important. We have so many cognitive issues, but also mood issues. These are life-altering events that people come to our facility for, and it's good to have that support. So in our unit, we have our concerns, like I said, the semi-private rooms, but we also have a lot more than I've I've had at other facilities I've been at, like I mentioned the nurse psychologists and the recreational therapists, which are a great boon to us uh in our program.

Dr Andrew Greenland 25:18

So lots of mentions about the importance of your team, but what's your approach to building that team that can deliver the high-quality care within all the various constraints that you've mentioned on the school?

Dr Tanya Harris 25:30

In terms of building the team, well, we want to hire people that have the same mindset, optimistic mindset, helpful mindset, uh, works well with others. But once they're here, it's a day-to-day kind of training. Um, and that is really cultivated in the uh patient progression rounds that we have on a daily basis. So that is a round table type of scenario where everybody has a voice, and every voice is as valid as the next person's. Um, so the case manager's input is as important as mine, uh, and my input is as important as the therapist, but we all have an equal voice and we all um try to collaborate. So it's it's kind of uh in terms of building that team, it's kind of an on the job kind of coming together and making sure that we're all on the same page. And if a if a person kind of sticks to one thing, then we we kind of talk through it, and if there are still issues, then we take it offline and re-explore our mission, vision, values, and and try to get on the same page.

Dr Andrew Greenland 26:47

Thank you. So you talk about your afternoons being more on the operational side and trying to improve your systems and your processes. Is there anything that you've tried that's really bombed and just hasn't worked that you're happy to share?

Dr Tanya Harris 26:59

Bombed. I feel like sometimes you win and sometimes you learn.

Dr Andrew Greenland 27:10

Great framing.

Dr Tanya Harris 27:14

So I wouldn't say bombed. Um I we we have tried some processes in terms of rescheduling of our conferences and patient progression rounds, which have been less successful than other efforts, but it's a learning experience. So, and I try to encourage people uh to take on that mindset. When we change, there's no guarantee it's gonna work, but what we're doing right now is not working, so we got to try, okay? So we try something and then we come together after a month or two and we re-evaluate, and then we shift and we do that for another month or two, and then we re-reevaluate. The problem sometimes is that when we first have a shift, let's say in schedules, people are not happy with that, and I will be honest, any type of change is gonna be stressful, so just expect that, okay. But some people deal with it better than others, and some people don't, and some people are more vocal about it, and it's tough trying to get them to understand that yes, we understand that this is stressful, try to adapt, okay, and then let's get your feedback in a month or two, write it all down, and we'll go through it together, okay. It's a continuous process where we're trying to improve, okay. We're never the best that we can be, but we keep on trying, okay, and we gotta try. That's what medicine is about. What we do now is vastly different from a hundred years ago where you got cocaine for a toothache, okay. We gotta change, and we gotta focus on what's best practices now and how can we get there. So buy-in is is difficult, and it's something I I deal with, and our team deals with frequently. Um, but I feel like as we go along with it, the trust is gained, and people understand that their voice will be heard if they don't like something, and we take it into account and we try to do what's best for everybody or as many people as possible. Um, and that's important and that helps.

Bottlenecks Beyond Insurance Coverage

Dr Andrew Greenland 29:50

Thank you. So you talked about many of the successes and the the value of your round that you do in the morning, the comprehensive round. What are the um the challenges and bottlenecks that are most impactful in your work right now? Insurance aside, and we've we've talked about that.

Dr Tanya Harris 30:06

Okay, so yes, insurance, and then um the the lack of knowledge in terms of what we do. Okay, so again, if the patient comes in and has an injury or illness and they don't know that we have those services, they might leave without understanding that they can they can access that. Same with the providers. They are treat they're worried about treating the patient in their field, they don't know that their options, other options for treatment, they don't know to send them to us. So I have to, as part of my directorship duties, go out and educate other people. And I meet up with the internists, I meet up with the surgeons. Um, we have an outreach uh consultant in another hospital who does a lot of education, she's great. Um, so we focus on all that, um, the education part uh and the advocacy um as part of what we do at our level. Uh another issue, kind of piggybacking on insurance, is the lack thereof. Okay. Um I have worked in overseas. Okay, you've worked in the UK, I've worked in New Zealand, and I can tell you when I was CMO in New Zealand, I was very impressed with their medical system. It's very different from the US, maybe. So in the US, you have private insurance for younger folks, and then one patient when people hit 65, they uh have access to Medicare. Okay, so which is a type of universal coverage, whereas in New Zealand they had universal coverage for all, and that includes visitors to the country. How great is that? Okay, but they also had the dual aspect, which means they also had private insurance, and because everybody had baseline catch-all insurance to begin with, the price for private insurances was so much more reasonable. When I was there, I was paying $35 a month for private good private insurance. And I wish that our country, the US, would try to come together and look at other options. It doesn't have to be one or the other, it can be both. We can have a dual system, but that's gonna take a lot more work than what I can do. Hopefully, our board can advocate, hopefully, other boards can advocate. But these are things that I would like to see in the future for our country to work toward because it is heartbreaking when someone comes in with a catastrophic stroke in their 50s and they don't have any insurance. Okay, that that is very hard to get around. We try to work on charity services, but ultimately this is a person who's gonna need long-term care and it's gonna push them into bankruptcy.

Dr Andrew Greenland 33:35

Well, I don't know how um the flow works in your hospital. Um is it a nice steady flow throughout the year? But I was just wondering if you had a sudden surge of patients needing rehab next week, what would happen? Would anything break? How would you handle it?

Dr Tanya Harris 33:53

So we only have so many beds. We try to take as many as we can and we try to fill our fill to capacity, okay? If the patient couldn't get in, they'd get on a wait list. But in the meantime, the hospitals typically have some therapists on the acute care side, PTOT speech. Okay, it's not nearly as aggressive as what we can offer here, but they can get some rehab there at most institutions, not all institutions, but most institutions. So they can at least start their the recovery process with them, but they really need someone to advocate for them. And a lot of acute care hospitals don't have a rehab doctor to kind of guide the patients on what should and the therapists on what should be done. Um, so they're kind of siloed a bit. It is it's a problem, and uh, I guess you can say it's a bottleneck in our field. Um, I would like to grow our field. When I was in New Zealand, I I grew the residency program there 50%. I'd like to grow PM and R residencies here in our state, in our states in the US, um, so that we have uh more of a presence throughout the system.

Dr Andrew Greenland 35:23

We've given you magic wand. If you could fix one thing tomorrow in your hospital or the wider world of PMR, what would that be?

Dr Tanya Harris 35:35

So I'm gonna go beyond just PM and R. I'm just gonna go the medical system in general, and that would be some sort of universal coverage. The number one cause of bankruptcy in the US is for medical reasons. Doesn't matter how hard you've worked, how much you put away, but something unforeseen as that causing you to lose all your money and basically be in the poorhouse, that's that's that's uh that's gutting uh for us in this country. So that is one thing I I support. And again, we already have that through Medicare. I would like that option to be available for all. And again, that doesn't mean nixing the private care. I think they can coexist. That's what I would wish for.

Dr Andrew Greenland 36:28

Really, really clear. So looking ahead, where would you like to um be in the next six to 12 months? Either in the in the field that you're in, the hospital you're in, your sort of personal work within this field, where would you where would you like to go in the next 12 months?

Dr Tanya Harris 36:43

So I I have been in this field for a bit. I finished residency in 2006. So 20 years of independent practice. I've been in different settings. I had my own outpatient setting. I've done out uh inpatient uh exclusively. I've done a mix of both. I've done telehealth, I was a CMO overseas. Um but ultimately uh I want to stay here. This is the the best place I've been. It's not the highest position I've been, but it's the most fulfilling. I get to work in the trenches as I mentioned before. I I thoroughly enjoy that, but I also enjoy shaping care. So um I get to do both at the patient level and at the system level. And so my goal is to stay here to uh expand uh education and understanding of what we do in the hospital level and then across different hospitals, so system level, um, and to have more of a presence across our state. We are one of three polytrauma, level one polytrauma uh rehab units, and uh a lot of people don't understand um how spectacular our services are. So I I would like to uh help people gain an understanding of our services, um, and that's my focus is the education part. I think we're making great uh headway in terms of uh patient care. Um change in mobility and uh self-care scores are uh on par and sometimes better than the region. We would like to be better than the national averages, so uh we're making good progress on our unit and our trajectory is good. Um, so we're gonna keep that up and we're going to uh also work on reach out, reaching out to other disciplines.

What She Would Do Differently

Dr Andrew Greenland 39:02

Brilliant. And finally, if you were starting again today, or starting your career again today, would you approach anything differently with everything that you now know?

Dr Tanya Harris 39:10

Oh my gosh. Yes. So I started my own medical practice straight out of residency. Why? Because I always wanted it. That was my lifelong goal. Um, I started medicine when I was when I was very young. And in the back of my mind, I tend to be a problem solver. Okay, what can I do to make things better? And then, oh, okay, if I did it my way, this is what I would do. And but I did not realize the insurance aspects, and and that is something that was not really brought up to me or may I was not aware of when I was in training. It when I was in training, it was about um the patient care, okay, not access to that care. So I thought I I knew enough to care for the patients, and that it would be easier, I guess, to get them that care. And I just did not realize the roadblocks that insurance put up. So I I had my own practice for seven years, and every bit of it was through gritted teeth. And I don't, I hate to say this, but um I don't recommend going into private practice for most doctors out there. It is so time consuming. Um it's like going to, and I understand that I I spent a lot of time working with insurances, even as an employed physiatrist, but it's even worse in private practice, and you don't have someone to get your back uh in private practice. So that is something I I would have done different. I I just it's hard because it was a lifelong dream, and I realized it wasn't for me very quick. I probably would have gotten out quicker uh from private practice uh rather than slog through seven years fighting an uphill battle when my energy could have been focused more toward patient care and system changes.

Dr Andrew Greenland 41:25

And with that, Tanya, I'd love to thank you so much for joining today. It's been such an incredibly insightful conversation. Really appreciate your honesty about the the day-to-day realities of having to fight just to get the patients the care that they need. And I hope that this podcast, in its small way, will help to spread awareness and um you know improve advocacy. But thank you so much. It's been a pleasure.

Dr Tanya Harris 41:44

It was a pleasure for me. Thank you, Dr. Greenland.