Osteopathic Medicine and the Path for one DO with 4 Kids!

Dr. Ryan Gray: The Premed Years, session number 106.

Hello and welcome back to the Medical School Headquarters Podcast; where we believe that collaboration, not competition, is key to your premed success. I am your host, Dr. Ryan Gray, and in this podcast we share with you stories, encouragement and information that you need to know to help guide you on your path to becoming a physician.Our guest today is Dr. Anita Showalter. She’s the Assistant Dean of Clinical Education at Pacific Northwest University of Health Sciences. An osteopathic medical school in the state of Washington. Today we’re going to talk about her path to medicine which included some pushback from her parents when she told them she was interested in becoming a physician. Her starting undergrad on a nursing track and taking a detour to have not one but four children, and ultimately deciding to go back and accomplish her dream of becoming a physician with the support of her husband. We talk a lot about the osteopathic philosophy and some myths associated with DOs and so much more.

Before we get into the interview I want to remind you to check out www.FreeMCATGift.com to download our free thirty page guide with tips to help you maximize your MCAT score. Again that’s www.FreeMCATGift.com.

Alright, let’s get started with the interview. Anita, welcome to the show. Thanks for joining us.

Dr. Showalter: Thank you for asking me to participate.

Dr. Ryan Gray: So I want to start with what you currently do now, and then we’re going to go way back in time to how this all started.

Dr. Showalter: Okay. My current position is Assistant Dean of Clinical Education at Pacific Northwest University of Health Science College of Osteopathic Medicine. And what that means is I’m in charge of third and fourth year student rotations at our College of Osteopathic Medicine. And I also teach women’s health, obstetrics and gynecology.

Dr. Ryan Gray: Amazing. So are you a DO yourself?

Dr. Showalter: I am a DO.

Interest in Medical School and Pushback

Dr. Ryan Gray: Okay. So that’s where you are now, I want to go back to how you started this journey. Were you always intent on becoming a physician?

Dr. Showalter: I was always super interested in medicine starting from when I was a little girl I remember looking at the world book encyclopedia back in the day before computers, there were actually pages of transparencies that you could build the body and take a look on the inside and I thought that was really amazing, and I’d spend hours looking at it. My parents were raised in very conservative circles and women didn’t go into professions like medicine in their thinking, and I had in mind I was going to become a nurse. After I got into high school I started thinking, ‘You know, I might be able to do more than this,’ but when I first talked about medicine, my mom kind of discouraged me and it looked like a pretty big impossible dream at the time. So I kind of put it on a shelf until actually after I got married and when I got pregnant with my first baby, I was totally fascinated with the process of pregnancy and growing a little one inside of your body. And I really liked learning about the physiology of how that happened. And through my own birthing experiences, decided what I really wanted to do was help other women have amazing birth experiences, and that the best way to do that would be for me to go to medical school, not become a nurse or a nurse midwife, but really fully train myself to help women in that process.

Dr. Ryan Gray: Wow, how far along were you in the nursing program before you made this switch?

Dr. Showalter: Oh I got a whole year through it.

Dr. Ryan Gray: Okay, so not too invested.

Dr. Showalter: Not very invested, just enough to know where to find the great books to learn more about what was going on.

Dr. Ryan Gray: And when you went back to your mom, and I’m assuming your dad, and said, “I’m having a baby, and I want to be a doctor.” They were obviously kind of poo-poo’ing this to begin with, now you want to be a physician and have a family. How did they respond to that?

Dr. Showalter: Well actually I didn’t break the news to them until after four babies.

Dr. Ryan Gray: That you wanted to be a physician?

Dr. Showalter: That I wanted to be a physician, and actually the way my husband tells the story is he said, “Childbirth was her hobby,” and when he decided we’d had enough of our own, he wanted to send me to medical school so that I could practice on other women and stop having babies myself. So anyway-

Dr. Ryan Gray: He understands that he was part of this equation.

Dr. Showalter: Uh, yes he does. So I went to my mother and at this point in time my youngest child was I think about three or four years old. And I said, “I’m seriously thinking about medical school,” and I honestly didn’t know what she was going to say. And she looked at me and she said, “You know, you’ve been there for your babies when they really needed you, now it’s time to follow your heart.” And of course we both cried and I was so pleased to have her support, and my dad was the silent type, he wasn’t very expressive about what he thought. But I found out after I started medical school that he was telling all of his friends about what his daughter was doing, and how proud he was that I was pursuing my dream.

Dr. Ryan Gray: That’s awesome. How did you- between having this realization that you want to be a physician, and then three more babies later, how did you wait that long? What were you doing in the interim maybe to prepare yourself, were you starting to research? What were you doing?

Exploring Options

Dr. Showalter: I was doing a lot of research first on what options were available, what professions were available to assist women in childbirth. So I looked just at nursing; did I want to be a floor nurse and just help women when they were in labor? I looked at midwifery; did I want to be a certified nurse midwife which is- you get a nursing degree first and then you go back to get education specifically in the practice of obstetrics. But most states require certified nurse midwives to work under the supervision of a physician. There’s lay midwives that just apprentice under someone and then help women in birth. But the final decision for me was I wanted to be fully competent to take care of a woman from start to finish, even if her pregnancy got complicated. And so going into medicine and doing the full residency was the best way to make that happen.

Dr. Ryan Gray: Okay, that makes sense. As you started on this path, how did you know where to go to get your undergrad degree and start on the actual path?

Dr. Showalter: Well we lived in a town that had a private college- actually it was where I started nursing school, was at the private college. And they had an amazing premed program that had a very high percentage of students successfully gaining entrance into medical school. So I told my husband it only makes sense for me to go back here to do my undergrad training, and we sat down and worked out a budget and he suggested that I would do much better at the branch of the state university, which was within driving distance. And I was living in Indiana at the time and that would have been Indiana University at South Bend. Of course Notre Dame was just down the street, that was also out of reach of our budget. So I ended up at a branch campus that was noted for their education and business degrees. And I thought I’m taking a second class route to this, right? Because I should be where they’re known for their sciences. But what I found out in this smaller branch campus is I had professors that were very invested in seeing us succeed. And our science classes were actually kind of small so it was like getting one-on-one tutoring from guys that could write me great letters of recommendation when it came time to apply for medical school. So it ended up being for my benefit, although I would not have been able to realize that starting out.

Dr. Ryan Gray: And I’m glad you came to that conclusion, because a lot of nontraditional students listen to this, and they’re in very similar situations where they look at their budget and they go, “This ‘higher end’ school is out of reach for me, so I’ll settle,” and what ends up happening is what happened with you, is you get more of a relationship with your professors, more of a relationship with the other premed students, and I think in the end you are better for it.

Dr. Showalter: Absolutely. And I know we spend a lot of time worrying about our futures, but generally doors open for us that are the ones we need to walk through.

Dr. Ryan Gray: I like it. So you go to this branch campus, and you obviously do your premed classes. How was that going back into your undergrad studies as a mother of four children, as a wife? How did you handle all of that?

Importance of Support Systems

Dr. Showalter: Well what I found was in the beginning I was concerned about my ability to really handle the curriculum because I had never been a 4.0 student. I’d been a good student, but not a 4.0 student. And as a nontraditional student I felt it was in my interest to do as well as possible in the undergrad classes. But I found because I was so motivated to do well, that the grades came much easier than I expected them to. I was working hard, but I was able to do it. And I would look around at the eighteen and nineteen year olds that didn’t have any responsibilities except taking these classes, and they didn’t take it very seriously. So it was easy for me to set myself apart as the student that was going to succeed and to get the professor’s attention for their assistance as well. So there was a lot of juggling to be done, but I knew that that was going to be the story of my life for a while. And we went into this as a family effort. It was- I had my husband’s full support to move forward. It would have been very difficult and not wise to move forward without his full support. So we found ways to make it work, and to get through those classes until I was ready to apply to medical school.

Dr. Ryan Gray: I did an interview recently with another nontraditional student who started off as a minister. And during the interview he said, “I’ve had three rules, or three levels of how I wanted to graduate medical school.’ He’s like- he said, ‘I wanted to graduate medical school happily married,’ was his number one goal. His backup goal was, ‘I want to graduate medical school married.’ And his third goal was, ‘I want to be married.’ So I think he had a very similar tact as you did of going in as a family unit and having the support from his wife. It was funny.

Dr. Showalter: Yes. Well I often thought during the process, I was really glad that we had a long established relationship, and we knew how to work together because there were plenty of challenges and times that we looked at each other and said, ‘Gee we’re really glad we have a track record because we’d be really asking what we’re doing if we hadn’t.’

Dr. Ryan Gray: Yeah, that’s good. So you’re killing your premed classes because you understood why you were there and you had that motivation and then you had the support behind you. Where did you come to the conclusion that- or maybe you didn’t and it was just all luck, that you wanted to be a DO versus an MD?

DO Versus MD

Dr. Showalter: Actually I knew that the two professions existed, but I didn’t really know much about osteopathic medicine until I took my MCAT. And one of the osteopathic schools sent me a brochure and I looked at it- and that was the first time I had read the osteopathic philosophy. And I thought, ‘Boy, this really speaks to the kind of physician I want to be, and how I want to approach learning the practice of medicine.’ So that was the first time that I really considered being a DO instead of an MD, and I ended up applying to both osteopathic and allopathic schools, and then got acceptances at both, so I had a choice which way I wanted to go.

Dr. Ryan Gray: Okay. And let’s kind of rewind a little bit. You said it was the first time that you read the DO philosophy. In your words, what would you say that DO philosophy is?

DO Philosophy

Dr. Showalter: The philosophy is that the body was designed with wisdom to heal and function in the manner that it was intended. And that the physician’s primary role is to assist the body to a state of health. So the direction of the philosophy is you look for ways to help a patient become healthier as opposed to looking for disease and stomping it out. Now to make a patient healthier, you will sometimes look for disease, but you will also look at other lifestyle issues and look at the whole person; emotionally, spiritually, physically, to figure out how to help them reach their goals. Now many MDs approach patient care exactly the same way. I was attracted to osteopathic medicine because it was actually in the fabric of the philosophy from where you start.

Dr. Ryan Gray: Okay. And so you obviously chose that path, and it sounds like you are enjoying being a DO. But right now- or let’s go back. You decided, obviously based on your experiences with your own children that you sounds like wanted to be an OB-GYN, and that’s what you ended up going to residency for, correct?

Dr. Showalter: Exactly.

Dr. Ryan Gray: So in my mind- and I’ve said this before, that I came across- it’s an osteopathic- I can’t think of the word now. A pathologist osteopathic society. I said I don’t know how you manipulate dead people, but it’s kind of interesting. How do you integrate- obviously the DO philosophy, yes. But one of the big things with DO that as a premed student the difference we see is the OMM or OMT.

Dr. Showalter: Right.

Dr. Ryan Gray: The manipulation. How do you integrate that into an OB-GYN practice, or maybe some other practices that students may be thinking about?

Integrating Manipulation

Dr. Showalter: Well women who are pregnant tend to have a lot of discomfort from their growing bellies and the growing strain on their backs. And osteopathic manipulation has a lot of techniques that can help with those common discomforts of pregnancy. So you can do some very simple treatments during your routine prenatal visits that will help the patient be more comfortable. So I don’t just tell them, ‘Well I’m sorry but back pain is real common in pregnancy, so you have to learn to live with it.’ I can tell them, ‘Let’s see what we can do about that because I may be able to help you.’ And I’ve had a number of patients tell me that they were much more comfortable during their pregnancies under my care, than they had been under routine prenatal care. Then when you come to the gynecologic patient, there’s a lot of patients- if it’s not just your routine annual exam and pap test, they’re probably coming to you with some discomfort or pain. There’s many times when that pain might be musculoskeletal and a technique that I know might be able to eliminate that pain without a lot of ultrasounds, CT scans, surgeries, diagnostic tests; I may be able to fix that and have that patient walk out pain free. And I’ll tell you what, as a physician, that just really makes me happy when I’m able to help a patient in that way.

Dr. Ryan Gray: So that’s OB, from your experience obviously you’re working with medical students among all ranges of specialties and helping them with their clerkships. How would you integrate the DO philosophy and the manipulation into some other practices that maybe we don’t think about on a day-to-day basis?

Dr. Showalter: Well in pediatrics, doing some manipulation techniques on babies’ heads, necks and backs can help them with breastfeeding, can help with earaches otitis media. There have been some real nice studies on that. Can help them with reflux when the babies are spitting up a lot. So in pediatrics those are kinds of things that you can do. In orthopedics there are things that you can do even if there’s a fracture, there are techniques that you can do that are very gentle that help with swelling and discomfort, help the healing process happen faster. With surgery, there are techniques that aid in the healing process, make the patients need less medication for pain, have fewer complications after a procedure. And I don’t know what a pathologist would do that would be different.

Dr. Ryan Gray: Alright, good. You’re on the same page as me.

Dr. Showalter: Yeah. Except if they ever had to talk to a patient, their patient approach might be different because of their training.

Dr. Ryan Gray: Yes, okay. There’s one thing we can think about.

Dr. Showalter: Yes. There’s one thing there.

Dr. Ryan Gray: Alright. So I want to talk a little bit more broadly about osteopathic medicine. Because I think there’s still a lot of misconception about what it is, what it isn’t, and really what students maybe should be looking into, and ones that maybe shouldn’t.

Dr. Showalter: Uh huh.

Truth About DO Schools

Dr. Ryan Gray: One of the biggest things as a premed student, everybody kind of knows Student Doctor Network and the website there. And if you go on that website, you’ll more than likely come across posts from students saying, ‘These are my grades, this is my MCAT score, these are the schools that I’m thinking about going to and applying to. What do you think?’ And nine times out of ten, somebody will say, ‘Your grades aren’t good enough to get into an MD school; apply to a DO school.’ What do you think about when you see that or hear that?

Dr. Showalter: Well it’s actually true. But I’ll tell you why it’s true and why I’m fine with that. And that is that osteopathic schools weigh the characteristics that they want to see in a student differently than some other schools do. Now I do know of MD schools that have stopped publishing the GPA and MCAT to the admissions committee, because they want the admissions committee to weight the students on their personality and characteristics. So there is a baseline intelligence and ability that you need to be successful in medical school. But above that, we’re most concerned with who you are as a person, what drives you to be a physician, what are your values? So we’re not looking for the top score, we’re looking for an adequate score and then we’re looking for who you are. So I have heard that explained that, well DO schools take less qualified students than MD schools. I don’t consider that less qualified. I consider that what we’re looking for. So- and there’s other MD schools that agree with that. So we’re not the only ones that are changing that focus from who scores the top to who scores enough, and then who are you?

Dr. Ryan Gray: So in other words- I’ll paraphrase it. It’s when somebody says, ‘You’re not smart enough to get into a DO school,’ that’s what you disagree with.

Dr. Showalter: Yes.

Dr. Ryan Gray: You’re saying we’re looking at you differently than an MD school.

Dr. Showalter: That was very nicely stated.

Dr. Ryan Gray: Okay. And one of the biggest things if you’re listening to this and you don’t understand, that the DO application calculates grades differently as well. So an MD application, an AMCAS application, your grades might be lower than a DO application because of those as well.

Dr. Showalter: And if I may also add, we will look at the timing of those grades. So if we have someone that hit their freshman year of college, struggled, didn’t do real well in a couple courses, and then found their footing and really nailed it after that, we’ll forgive them for that first year and take a little lower GPA because they’ve shown the ability to adjust, adapt, correct, and they have shown the capability of handling the more strenuous curriculum. So that’s another way that we’ll look at a lower GPA and be okay with it.

Dr. Ryan Gray: Why do you think that nontraditional students seem to graduate towards osteopathic schools?

Osteopathic Medicine

Dr. Showalter: Well, one of the reasons is the life experiences that they’ve had may make their values different. For example if you are very concerned what everybody thinks about you, and those rumors are out there that, ‘Well you know they take students that aren’t as well qualified.’ If you care about that, you’re not going to apply to DO school. If you’re a nontraditional student and your values are lying at different places, then you’re going to be more likely to consider that. So I think that’s one of the reasons nontraditional students are more likely to apply. I think another reason is that- not all MD schools, but some MD schools really don’t want the nontraditionals students. They want somebody who’s just marched through their training and continue on. So you see some schools where the average age is lower because they’re not taking someone who’s taken a break and then come back. I believe just like with me, when you’ve got that break and real life experiences, it makes you more focused when you come back to reach that goal, and we see that as a plus in our students.

Dr. Ryan Gray: I agree, that’s great. What are some of the biggest myths that you see around osteopathic medicine that premeds may still see?

Dr. Showalter: Well one is that we take less qualified- it’s how you define qualified student. There are some techniques that we learn that until you develop the palpatory skills to be able to feel what’s happening that looks like voodoo. It’s not really, there’s a physiologic basis to every technique that we use in osteopathic manipulation, and there are studies to support every one. But to the novice hand, to the novice eye, it may seem like this can’t really be happening.

Dr. Ryan Gray: That’s a funny one. Let me ask you this as a follow-up to that. A lot of people will compare chiropractic medicine to osteopathic manipulation. What are some of the similarities or differences between those?

Dr. Showalter: Some of the techniques- actually many of the techniques that they come from understanding the physiology of the body. And it comes from a philosophy that if you correct the structure of the body that the body’s healing potentials can get to where they need to be and the patient can obtain a state of health. So those techniques would be similar, the philosophy from that perspective is similar. The difference is that DOs have been fully trained in all aspects of physiology, immunology, all of the biosciences, and are trained to make diagnoses of the whole body, not just the musculoskeletal system. Now chiropractic is trained to look for those organic diseases that may be presenting as a musculoskeletal problem, but then they aren’t trained to treat that, they have to refer that someplace else. DOs can treat in the manual medicine model or with pharmacology, surgery. We are fully licensed physicians in all fifty states and that would be where the difference is.

Dr. Ryan Gray: For a nontraditional, or even a traditional premed student out there, what advice would you have for him or her as they begin this journey?

Advice from Dr. Anita Showalter

Dr. Showalter: My initial advice would be to make sure that your family is supportive because I like what your friend had said about staying married. At the end of the day, those people that are most important to us are still most important to us, and you have to have room in your life and include them in your plans to be truly successful in all aspects of your career and your choices. It’s important to spend some time thinking about what kind of physician you want to be at the end of your training, and what medical schools can help you become that? It’s not just about getting in, it’s about getting to a place that will help you really reach your end goals. And we hope that your goal is more than just becoming a physician. It’s hard to predict how you’re really going to respond to the training because for myself, you know those years that I was working hard in undergrad, I still had full responsibilities at home, I was involved in the community and my church, and I thought when we transitioned to medical school and that was my only responsibility, I thought, ‘How hard can it really be compared to what I’ve just done?’ And the answer was it was harder. And you just can’t believe it until you get there. So I really needed that family support to really free me up to study and reach my goals, and you can’t underestimate that.

Dr. Ryan Gray: That’s awesome. It was harder than raising four kids and being a wife, and being in the community, and being involved in church?

Dr. Showalter: Uh, yeah it was.

Dr. Ryan Gray: I would agree, though I wasn’t raising four kids at the time. So I want to go back to something you said at the very beginning about your parents almost pushing you away from medicine at the beginning, and then go back to your graduation day. Were they able to share in that with you?

Dr. Showalter: They were and my dad was proud as a peacock. They were living- I had moved to Ohio to medical school, they were living in Indiana and they made the trip. And it was just a really special day. I think I cried the whole day long, because I couldn’t believe that we had actually pulled it off and I was at the- I was marking the end of that part of my journey. So yeah, it was a really special time.

Final Thoughts

Dr. Ryan Gray: Alright again that was Dr. Anita Showalter. She shared with us a lot of similar things that you as a nontraditional student, many of you out there nontraditional students, and even as traditional students; you struggle with having kids as a traditional student, even if you’re on the same timeline of being an undergrad and straight into medical school with a child which is crazy but a lot of people do it. It’s crazy as in a lot of work, but it’s doable. I think as a nontraditional student if you are one, you can take a lot of what Dr. Showalter talks about with going from one level to the next level to the next level, and it’s kind of getting progressively harder and thinking about what you may need to do in preparing for those next levels, and ultimately having the support of a spouse. If you don’t have a spouse, having the support of a family. If you don’t have close family nearby, having the support of somebody in the community whether it’s a friend, whether it’s a church group, whatever it may be. Having that support is key, without a doubt. We’ve heard that over and over and over again on many of these interviews talking to some nontraditional students that are going back to become a medical student and become a physician; having that family support is huge, or having that support in general is huge.

So hopefully you took a lot of interesting things not only from her path as a physician, but from the osteopathic philosophy as a whole, and understanding a little bit more what osteopaths do and what they are and what their philosophy is, and why ultimately in my mind there- yes, maybe there is some difference in thinking if an MD doesn’t want to think that way, but ultimately go to a DO, go to an MD school, at the end of the day you’re a physician treating patients which is what hopefully we’re all in this to do.

Alright I want to thank a couple people for leaving us five star ratings and reviews. NigerianGirl008 says, ‘I am blessed, this podcast has been a huge blessing in my premed journey.’ And J_French says, ‘The absolute best premed podcast on iTunes.’ He says, ‘I’ve spent many hours driving this semester to visit my girlfriend who lives four hours away.’ And J_French started from the beginning and is now nearing episode thirty, which is awesome. Hopefully you’re staying awake as you’re listening to this podcast. And then AKnontrad says, ‘Invaluable wealth of knowledge,’ and says, ‘I wish this resource existed when I was in undergrad.’ I wonder where you are now, are you still in undergrad? Maybe. Email me, let me know.

You can email me, Ryan@medicalschoolhq.net if you have any questions. If you have any thoughts on topics for new shows, if you think you’d be a great guest, let me know. We’re always looking for good guest.

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Alright come say hi to me on Twitter, I’m @MedicalSchoolHQ, and I’ve been loving seeing people posting pictures on Twitter, where they listen to the podcast. We’ve gotten many pictures of steering wheels and traffic. I’m a little concerned a lot of people are sending pictures- it looks like while they’re driving. So don’t worry about taking picture while you’re driving, you can park and take a picture, it’s the same effect. I don’t want to be the cause of any accidents. So send us a picture, where do you listen to us? Where are you listening to this podcast right now, but don’t take a picture right now if you’re driving. If that makes sense.

Alright I hope you got a lot of great information out of today’s podcast. Before we get going I want to remind you that if you are struggling on your path, if you don’t have the support that you need whether you’re a nontraditional student or you’re a student at a large university and just don’t have the support that you think you need, you don’t have that safe environment to go to; go check out the Academy. Go to www.JoinTheAcademy.net, where Allison and I hold monthly office hours to talk to students, we have a community- a non-anonymous community where students can go and ask questions without any sort of trolls coming and leaving some bad information. We’re actually going to close the doors for a little while, I don’t know when we’re going to reopen but for the next couple weeks, probably mid-December or at the end of December we’re going to close the doors to the Academy and not let anybody else sign up, because we want to work closely with the people that we have in there now. And as of now, as I’m recording this right now in the beginning of December, we’ve had at least five students get into medical school this application cycle. Several of them on their first try applying, and one student who has applied three or four times and he just found out he’s going to be a medical student next year and he’s psyched about it, and that’s Brian – good job Brian. But here’s Melissa, one of the students that got in this year talking about the Academy.

Melissa: This is such a wonderful thing you guys have put together. I mean I can see- even just in the design and what you’re adding, just how much effort has gone into it, I think it’s beautiful. I mean as we were doing this, I kind of could imagine myself a few years down the road being a part of it and helping people who are kind of going through what I’m going through now and vice versa. So this is awesome.

Dr. Ryan Gray: And now she doesn’t have to think about it because she is accepted into medical school and will be starting next year. And she- all of the students that are getting into medical school now get a free membership from here on out to stick around and help the rest of us- help the other premeds that are coming through, help them on their journey. So it’s not just me talking, it’s other students that are going through it, offering their advice as they go through it. Listen to Grace talk about the office hours, and what they’ve meant to her.

Grace: And I watched some of the office hours to the Academy and just- I don’t know, I guess it just makes me more determined to become a doctor because you guys make it seem more like possible, I guess. And it doesn’t seem like an impossible dream.

Dr. Ryan Gray: It is not impossible and I hope that’s something you’ve all learned from listening to these podcasts, all 106 now, that if you want to be a physician, if you truly are doing this for the right reasons. Which means wanting to treat patients and make a difference in patients’ lives, and not in it because you want the respect that comes with being a physician, you’re not in it because you want the money that comes with being a physician, you’re not in it because you think the hours are great to being a physician- I don’t know if anybody thinks that. But if you do, then you might be wrong. If you’re in it for the right reasons, then it’s possible because when you have your mind set on that goal, the path is okay. It’s rough, but you know that the goal is worth it.

So go check out the Academy, go to www.JoinTheAcademy.net for the next couple weeks as we record this at the beginning of December, 2014. We will remain open, after that we will be closed for sign up lists when we reopen again in the future. Again, www.JoinTheAcademy.net.

And as always, I hope you join us next time here at the Medical School Headquarters.