Matt Sherrer, MD (Host 1): Welcome to this edition of The Fresh Flow Podcast. Mitchell, we are in the presence of royalty today. We're going to have to behave. We got our AACD boss here, so you're going to have to keep it together. You think you can pull that off?

Mitchell Tsai, MD (Host 2): As long as it guarantees funding for another season, I think we could do that.

Host 1: So, I got to ask you, I realized as I was looking at my Fresh Flow calendar over here, we're pushing up on 20 episodes, man. What's the big take home about podcasting for you thus far? What's the lesson learned at this point?

Host 2: So, I guess, start small. When you pitched this idea, I don't know, two years ago, I will admit I don't have a social media presence, and it's been a learning experience as we go. Again, like you said, the fun part is finding the individuals that are sort of pushing the frontier of not just our specialty as anesthesiologists, but sort of the perioperative space to figure out how we can do things differently, and that's been an adventure.

Host 1: And you get to just hang out and talk to cool people, which is the best part of all it.

Host 2: Speaking of cool people, today, our guest, I get the pleasure of introducing an individual that I've known for probably over a decade now. We have Dr. Drew Franklin, I think he is born and bred Vanderbilt, residency, fellowship. And he stayed on at that enterprise and he is moved up the chain of command up there. And more importantly, he's the current president, as you said, Matt, of the Association of Anesthesia Clinical Directors. And we're here to tell him also that he will be taking over this podcast after the end of this episode. So, Drew, without further ado, welcome.

Andrew Franklin, MD, MBA, FASA: All right. Well, thanks Matt and Mitch. I don't remember reading that part in the fine print, Mitch, so I'm not sure that I'll be able to do that. Well, I'm certainly in the presence of royalty myself. Both of you all have done and it's just an incredible job with this podcast. I really was shocked to see how well this has gone and how high quality the production and everything has been. So, great job to the both of you and UAB for sponsoring this, and all the folks behind the scenes. Happy to be here.

Host 1: Yeah. Well, glad to have you, man. I will say I've kind of been shocked too. It's been a blast. I came up with this idea and pitched it to you guys, and you all are cool enough to say yes. So, thank you for the approval and for getting us going. And since we're talking about AACD, let's talk about AACD, man. It's my favorite group that I'm involved with. It's my favorite meeting of the year by far. You're our new president. You've kind of seen the organization for the past few years where we've been. You've seen where we are presently. And where do you want us to go? What's your plan? What would you like to see AACD become?

Andrew Franklin, MD, MBA, FASA: Yeah. Thanks, Matt. Well, I've got big shoes to follow here. As most of you know, Mitchell was our immediate past president. He is, you know, the Yoda to my Grogu for sure, if we want to draw comparisons here. And so, Mitch has been an amazing asset to the AACD for a long time, and he's done amazing things for the organization.

And kind of like you said, Matt, AACD is my favorite subspecialty meeting to go to and group to hang out with. I was introduced to AACD, I think, it's, yeah, about eight or nine years ago, Mitch, where Jason Lane, who is our friend and introduced me and asked me to give a speech at the AACD. I believe that was in San Antonio and came in and I was absolutely shocked. I'd never heard of the AACD before. It was a small group of very talented individuals. Fantastic meeting, very well run. And there's just the discussions that happens after every session is what I think the most just unique aspect of the organization.

So, loved it. I fell into kind of the leadership ladder for this, if you will. You know, I had the opportunity to lead a couple of the conferences, put them together, and really learned how to put those big conferences together, and then had the pleasure of serving as vice president to Mitchell and take over the reins here. And so, hopefully, I won't break anything that you build here.

So, as far as thinking about the next two years, I think the AACD is truly in an amazing spot right now. I think the people that we have in the organization and the board members and the leadership is truly at a point where we can explode as an organization. And I think it's a fine line that we have to cross. I think that we don't want to get so big, as it drowns out kind of the personal touch of the meeting. But we do want to get some more specialized individuals within AACD. My vision is when we think about Perioperative Medicine, and really our annual meeting is called the Perioperative Leadership Summit, and we all know that the perioperative portion of any hospital system is not just anesthesiologist. So, you mentioned Peter Nichol earlier, who is a surgeon that's come to our meeting for the past two or three years now. And his perspective on things is truly refreshing. I'd love to see other folks, nursing managers, some of our non-physician C-suite folks like COO, CFOs of big hospital systems, and what they think about Perioperative Medicine and the perioperative space. So, that's kind of a vision of mine.

 I think any organization like this is dependent upon its income and staying afloat and having a great perioperative meeting every year. And so, looking for additional revenue streams as both of you know. We have a social media presence now. We have a website. We've got some fantastic sponsors. And so, I think growing that is going to be an important part of keeping this organization strong for years to come.

Host 2: So, Drew, I think it's been a pleasure just watching you sort of grow up in this organization. And for a while, there was a large Vanderbilt presence, and I think the national meeting we had probably four or five years ago in Nashville, it was clear that you had a network at Vanderbilt University. You've grown up in that enterprise, and it's consolidated. It's gotten bigger. With the growth of the AACD, we know we're going to see growing pains, right? So, what lessons have you learned from working with surgeons and nurses that are going to help the AACD?

Andrew Franklin, MD, MBA, FASA: Yeah. So, Mitch mentioned that I've been at Vanderbilt for a long time. I think people are starting to refer to me when they introduced me at grand rounds and stuff as a Vanderbilt lifer. And that's sort of my tagline now. And so, yeah, I've been at Vanderbilt for 20 years now.

I did internship, residency, fellowship, and I've been on faculty now for 15 years. And so, I certainly have seen our department and our division grow and change significantly over those past 20 years. And really, Vanderbilt as a whole has slowly started to phagocytize middle Tennessee, and really Tennessee as a whole. We're starting to push some of the state boundaries as well.

And so, the growing pains is always interesting to see. I think, as we grow, one thing that's been interesting for me to watch is there's certainly economies of scale that we can get when we grow larger as an organization, we're able to reduce average unit costs of care for patients. We're able to streamline things like our electronic medical record, and so we all speak the same language. We have to build additional revenue streams. So, I think those are the positive things that I've seen as Vanderbilt's grown. You can also see diseconomies of scale and sort of diminishing returns as well as you start to grow, if you take over centers that need a lot of repairs or need a lot of things done to them to make them a valuable asset to Vanderbilt as a whole. And we've seen that with different areas as well.

I think a big thing is staffing. And so, Matt and I were talking about it a little bit. As we grow, it's important for us to staff, right? And so, just because we take over another 25 anesthetizing locations doesn't mean that we can make 25 CRNAs and 10 anesthesiologists appear out of nowhere. So if you guys know a hidden storage vault somewhere in the middle of the country where they store lots of anesthesiologists and CRNAs, let us know because we need a couple dozen more to keep the engine going.

So to come back to your question, as far as I think when you've been at an institution for a long time, it's all about the relationships that you have. And so, when you build relationships with individuals, you know them, you know their spouses, you watch their kids grow up. When there's a need, when there's an ask, you are almost like you're asking a friend. And so, I think that's the biggest leverage point for staying in an organization for a long period of time, and same for us, you know? And so when we have people that I've worked with for a long time to say, "Hey Drew, this is really something that we need to work on." And so, I think that's the best part of staying in an organization for a long time, is really the relationships that you cultivate over a long period of time.

Host 2: I teach my medical students the basic precepts of leadership is that someone's willing to listen to you. And, you know, I took that from Sinek. It's just that somebody decided to listen to you and they felt that what you were talking about was really, really important.

Host 1: So, kudos to you. I am sorry, Mitch, what were you saying? I wasn't listening. Tough crowd. Tough crowd. No. Drew, you and I share kind of passion for value creation in healthcare. We wrote together on it, right? The Icarus Paradox article. We talked about Anesthesiology, thinking about moving away from just being a cost center into creating value and creating return on investment.

One of your quotes along the path of us writing that together I loved, and I've still used, and I do give you props whenever I use it, I give you kind of a shout out, but you said that ERAS, enhanced recovery, was the pearl inside the PSH, perioperative surgical home oyster. And I thought that was brilliant. As we think about creating value in healthcare, besides that vault of anesthesia providers that we can unearth maybe, how do we do it? What should our specialty be looking for as far as value creation in the future?

Andrew Franklin, MD, MBA, FASA: Yeah. You know, Matt, I think we both share-- and Mitch as well-- we share our love for Simon Sinek. His most recent book, the Infinite Game, really struck a chord with me. I thought it was a fantastic read. For those listeners that haven't read it, definitely go check it out. It definitely puts things into perspective, not just for the healthcare field, but just life in general. So, it's a great read, definitely pick it up. There's a lot of videos on YouTube as well. So, Simon Sinek is a great guy.

I think, from our standpoint, whenever Matt goes out and shops for his newest Maserati, he never buys the standard package, right? He always goes for the premium package. So, we, as anesthesiologists, we sort of command a premium salary. And so, a lot of academic departments are being subsidized by their university systems. There's a lot of financial subsidies that we get as anesthesiologists. And I think the standard package for an anesthesiologist, which is the basic radio and all those kinds of things, is us taking patients to the OR putting them to sleep, waking them up and sending them home at some point. And I think that's the standard package. And so, when Matt goes for the Bose 16 speakers surround sound in his new Maserati, that comes with a cost. And I think if we're going to look at that premium package as anesthesiologist, we have to think about what else we bring to the hospital system. And so, I think the AACD really talks a lot about that. And so, we sort of started with OR efficiency, OR management. And we've really grown past that thinking that without Perioperative Medicine, the surgical home like you mentioned, Matt, and then Enhanced Recovery After Surgery, which is really the highlight of my career so far.

And so, if we're able to get patients out of the hospital quicker with less complications, all of those things, we're returning value for us as an anesthesiologist. And we can really justify the premium costs that we provide or that we ask for from the hospitals. And so, I'll tell you a story about when we launched our second ERAS pathway at Vanderbilt. And so, since the beginning of time, at Vanderbilt Children's Hospital when children came in to get Nuss procedure, which is a repair of pectus excavatum where your chest is sort of caved in and you have to fix that. These kids got epidural catheters and they stayed in the hospital for five days since the beginning of time.

And so, I gave a grand rounds to our Pediatric Surgery colleagues. And I said, "Why can't we cut it down to three days, just because we said we're going to, and maybe we'll add something like gabapentin to it?" And literally, they all laughed at me. They said, "There is no way you're getting these patients out the door in three days." And I just give it a go. And so, we just told our patients, "We expect that you go home in three days," right? And so, they get grandma, grandpa, and everybody else to take care of the other kids for three days. They get everything teed up and they're gone in three days. And so, we've cut that time down just by setting expectations and some basic multimodal stuff. And now, these kids are going home on post-op day one with the introduction of cryoablation, things like that. So, that is a return on investment. And so, if we're commanding a premium sort of price as physicians in the hospital, we've cut down the length of stay in our pectus excavatum patients by four days. And so, you think about the opportunity costs involved in putting another patient in that surgical room, in that surgical bed postoperatively in the revenue generated.

So, those are the things that, I think, is going to set us apart from the standard anesthesiologist to kind of the premium anesthesiologist. And so, that in addition to additional revenue streams, thinking about places like NORA, maybe our GI colleagues are doing their own sort of moderate sedations to their GI cases. And maybe anesthesiologists can do it more efficiently and safer, right? And so, let's take that model to our C-suite and see if that's something that we can use, and bring in additional revenue streams. So, those are the ways that I think make us anesthesiologists in the 21st century.

Host 1: And that leadership you just talked about, it didn't happen without what you talked about earlier, which is relationships. They would've just laughed at you and said, "We're not even going to try this." But because they knew you and they respected you, right? Those relationships that you had formed were able to actually say, "No, let's just give it a run," right? And let's do it, and then let's make it happen. So, it goes back to relationships again.

Host 2: So Drew, one of the conversations that I think has changed over the last 15, 20 years is that we've moved from a conversation of labor subsidies to sort of skin in the game. You are putting forth what your capabilities are as an anesthesiologist, as a Medical Director of Pediatrics, right? To basically provide better care for your patients and to show that you create value.

We've talked about the marketplace, we've talked about the workforce shortage. I think the workforce shortage is more Acute and Cardiac and Pediatric specialties. So, one, what's your perspective? How do we change that conversation at the national level? And then, two, how does the AACD sort of address the ongoing issues in these specialties?

Andrew Franklin, MD, MBA, FASA: Yeah. Thanks, Mitch. I'm a big believer in the free market. I always kind of quote Ian Malcolm in Jurassic Park where he says nature will find a way. And so, I think free markets are kind of the same way as well. And I think we're seeing sort of Adam Smith's invisible hand in the anesthesia markets right now. There have been a lot of folks that have looked at the data for doing a fellowship compared to just going out into the working field and making that additional year of income. And if you just took that income and put it in an ETF, like VOO, the growth of that throughout your career is going to be much better than doing a fellowship.

So like you said, Mitch, I think in the past three or four years, I've seen a lot fewer of our residents have any interest in doing fellowships. I think with the growth of some of the big salaries that can be earned in private practice, a lot of the subsidies that are being given to academic practice. They say, "Well, why would I do another year, when I can just make these 15 sacks of gold next month?" Right? And so, I think that's challenging for us. And so, I think the way that we do that is we've seen a drop in both cardiac and pediatric anesthesia fellowship spots that are filled, right? And so, for our own institution, we've had four fellows for most of my time here. This next year, we only have two fellows. And so, being a top pediatric fellowship across the country, that was challenging for us to see. And so, we just had a lower pool of applicants. And we only filled two of our spots. So, how do we combat that? How do we address that shortage? I think, we have to start early. And I think we have to always think about the fact that our residents and our trainees, not just our resident physicians, but also our nurse anesthetists, our training, anesthesiologists assistants that are with us, they watch us, they watch what we say, they watch how we behave, they watch how we treat each other. And it's not just our skill at putting in a piece of plastic down the throat. It's like how we go about our day I think is important. And so, they watch that. And so I think that's important, for us to be role models to our younger generation to say, "Wow, this pediatric anesthesiologist, he has a great sort of collegial relationship with his surgeons and his nurses. They help our kids. They help them during induction. This is just a great atmosphere, "right? And I think that's what sells us. And so, just saying that doing a Peds fellowship or a Cardiac fellowship or whatever else, Critical Care is going to pay benefits for you twenty years down your career is probably not something that's going to resonate with our residents. But when they see that we have a better sort of lifestyle, we have a better kind of day-to-day practice, I think that's what's going to get them interested in doing our subspecialty.

And then, also thinking about down the road just a little bit, thinking about things like fulfillment. What is your mission in life? So for me, my mission in life is to ease pain and suffering in children, and that's important for me. And that's what I've dedicated my life to. And despite all of the slings and arrows and whirlwinds that we have to deal with in Academic Medicine and just the pressures that we deal with, I always come back to that core. And so, I think sharing that with our trainees is important as well. And so, thinking about your lifetime kind of sort of happiness and your personal wellness and your relationships with your loved ones and your kids, and all of those things need to be taken into consideration as well when you think about lifestyle and whether or not you do a fellowship.

Host 2: I have a large growing number of young colleagues. And when they join the department, I always remind them that they have two jobs. The first job is to do what you need to do to earn your paycheck. The second job is to figure out what you want to do with the rest of your life. And that to me, as an academic anesthesiologist, is the more interesting job. How do we explore, how do we find the possibilities, the avenues so that you can become what you want to become? And again, that's the fun part of staying in Academic Medicine.

Host 1: Drew, when I hear you talk about just the perspective on career and life in general, I hear wisdom. And you mentioned Simon Sinek. I hear a guy who's pursuing your just cause, right? You know what your North Star is, you know your why. You're also involved in professional development at Vanderbilt a little bit, right? So, you get to kind of mentor people along, which I agree with. Mitch is really the fun part of this. This is the best part of what we do. What would Drew today tell Drew,-- what, how many years have you been out? Sixteen, something like that. I mean , what would you tell your younger-- yeah. Mitch is doing hand signals. "He's older than that, man." What you tell yourself fresh out of residency, if you could have your perspective right now?

Andrew Franklin, MD, MBA, FASA: Yeah, good question, Matt. I'm going to back up and just kind of elaborate a little bit on what Mitch said earlier. One of my best friends from medical school, John Gleason, is an executive at Prisma Health, and he had the honor of giving the graduation speech to the graduating medical school in South Carolina.

And I listened to that and he's a great guy. I've known him for a long time. And he tells a story about three guys that are digging a ditch, right? Three guys are digging a ditch in the hot South Carolina sun. He walks up to him and says, "What are you doing?" He asks the first guy, and the first guy says, "I'm digging a ditch." He asked the second guy, "What are you doing?" He says, "I'm making a living." The third guy says, "i'm building a cathedral." And so, that kind of resonated with me a little bit, right? And so when you think about the practice of medicine, we do all of those things, right? And so, you can have the mindset of, "Well, I'm just kind of putting this kid to sleep and hoping he wakes back up at some point." Or you can say, "I'm just doing this to get a paycheck and go home." Or you can say, "Taking care of this child or this patient to the best of ability allows. He or she to go back to his family, and have a prosperous life." That's the cathedral that you're building, right? So, that's the way I kind of think about my North Star.

And that's sort of what I think about our trainees, is to do this, not just to do it and not just to have a paycheck, but know that this is someone's son, daughter, uncle, aunt, grandfather, and that's their cathedral. And so, you are building this cathedral, you're caring for it. And I think that's special. I think for you, Matt, thinking about my various hats that I've held during my-- what did you say? Fifty-five years at Vanderbilt, something like that?

Host 1: Yeah, 274 years.

Andrew Franklin, MD, MBA, FASA: Yeah, exactly. Yeah. Yeah. I just turned 300 years. I'm on the social security roles, you know at 300 years. So, I think life is interesting along Academic Medicine. I think as you travel along your career, there are opportunities that you seek. There are opportunities that sort of just land on your lap. And then, there are opportunities that are just sort of thrown at you and they stick to you because no one else wants to do them or is able to do them at the time.

And so, you know, I've done all of those things. And I think that's sort of a plug for Academic Medicine, is to say what I did 15 years ago, is not really what I do right now. And what I do 10 years from now, if I'm still at Vanderbilt, it'll be very different than what I do right now. So, interests come and go. The needs of the department, the needs of the institution change. And I think that's good.

I think the key is to continue to improve yourself. So, I think pushing the boundaries of your comfort zone allows you to grow as a physician and as a human being. And so, when I first started out, my chairman at that time, actually my division chief, Ira Landsman. When I told him I was interested in doing pediatric pain management, he said, "Okay. As soon as I was done, he said, "Okay, I want you to work in the peds pain clinic too." And I about passed out on the floor. I said, "I don't know anything about peds pain clinic." "Okay, well I signed you up for it. They're going to get you your credentials. You're going to start next week." So, that was terrifying to me. And so, I did pain clinic for 10 years of my life. And it was one of the most rewarding things that I've ever done. So, taking care of children with sickle cell, oncologic disease, all kinds of chronic pain disorders. Something that I knew little to nothing about, and just kind of train myself and learn from people across the country. And hopefully I've done well with those kids. And then, kind of like Kenny Rogers says, you got to know when to hold them, when to fold them, when to walk away, and when to run, we've got a couple of great colleagues in the pediatric pain clinic now that are better than I'll ever be in the pain clinic, and I knew it was time to walk away. And so, I stepped away from clinic in my role as leader of that clinic in order for my junior colleagues to take that baton and run with it.

 And I think that's also important as you take on leadership roles, is to know when it's the time to walk away and when there's junior colleagues that will do a wonderful job and will have a different perspective, and can really move that baton into new territory. That's an important leadership.

Host 2: So for our audience members, Drew wasn't talking about his pediatric pain clinic. He was actually talking about the Association of Anesthesia Clinical Directors. So, I'm really excited to see what happens in these next two years.

Host 1: Drew, I got another question for you, man. Anytime I see somebody come across our screen here that you think that your MD's going to be your final degree, right? That's the pinnacle. And then, you get out and you go, man, I need to learn a bit more. And you did an MBA, right? I did. Mitch did a management degree as well. How did it change your perspective? How did it change the way you kind of look at your world, your daily work, your daily interactions? How did it change you?

Andrew Franklin, MD, MBA, FASA: Yeah. You know, I think I get that, question a lot from our trainees and junior faculty that are interested in picking up a Master's. And the best piece of advice I could give for anyone interested in picking up a Master's degree, whether it's an MPH or an MBA, is to know exactly why you want to do it, and be able to write down five things that you want to accomplish in very, very specific ways.

 I think just doing an MBA, so you've got three additional letters behind your name, is going to make you miserable. It certainly it's a very challenging thing to do. I didn't do the executive MBA. I did the standard MBA through George Washington. And so, I would spend my day kind of running the board, get home at 6:00 PM and then have to write a paper about how to properly merger two oil fields in Japan, right? That was due the next morning at 6:00 AM. And so, I saw my wife and kids for a total of maybe 20 minutes during two years, and certainly pushed my marriage to the point of combustion. And so, it's very difficult. And so, unless you've got at least 20 to 25 hours every week to devote at least to an MBA, I can't really speak for an MPH, but I don't think you should pursue it. And so, just pursuing it to say, "Hey, this is going to be great for me down the road, I think, is not a great reason to do it.

Number two, I think just having an MBA or any type of a management degree does not automatically make you a leader. I think if you are a physician or have any level of seniority within the health system, you're a leader. And so, that's something that I tell my junior colleagues that may have a little junior residents that may have a day where they weren't as professional as they needed to be. I would say that just because you have MD or DO behind your name, you're a leader in the operating room, in the perioperative theater. And so, with leadership, you have to have positivity. You have to consistency, you got to have accountability, right? And so, those things are expected in you as a leader. And so, I don't think that you need a fancy degree behind your name to have all of those traits. And so, I think you can do all of that yourself.

 The other thing the reason I pursued my management degree was to really learn how to do change management well. And so, when I had some kind of initial leadership roles within our department, I tried to make things happen. And I thought that if I started running really fast, that everybody would start running with me just because I had a fancy title. And I learned that wasn't the case. And so, a couple of things that I tried to do and change within our organization just kind of flopped. I read a couple of articles and things. And I said, you know, I want to learn this language of business. And so, that's the thing about the MBA, is that they study acquisitions and mergers and change management and all of that stuff. Like we study GLP-1s and statins and all that kind of stuff. And so, that was just shocking to me as they studied this with such depth. That was great for me.

And so that was my goal, was to really come back to Vanderbilt Children's. It's to start our Perioperative Medicine program in our Enhanced Recovery Program, and really learning the basic tenets of Lean Six Sigma, other change management strategies, PDSA cycles, and learn how to do it well. And that really taught me that I need to run at a pace that others feel comfortable running with. And to periodically check to make sure that people are running with you and that you're not running ahead of everyone else.

And so, I think that's an important takeaway. I think the last thing kind of about leadership and getting some type of a management degree is really thinking about what you want to do with that degree 10 years from now, 15 years from now, is also going to be important. So for me, I had a very discreet thing that I wanted to try to accomplish. And, you know, I think thinking about how you can do that in the future, because as you learn the language, there are opportunities where you can change things in the future and change your career trajectory of thinking about that before you jump into that is going to be important as well.

Host 2: So, I don't know about you guys, but I'm still figuring out what I'm doing with my management degree. But no, I think our specialty sort of self-selects for tinkerers, right? People that are willing to experiment and push the edges. And so, going back to the previous question that Matt asked, I would tell your younger self, if I had the opportunity to time travel back and talk to you, I would tell you, "You have nothing to worry about, Drew. You're going to figure it out." And I think we are taught to figure it out on the fly. And most of us manage to do it quite well, and that applies to more things than just what we do in the operating room. And so, the opportunities are always there.

Andrew Franklin, MD, MBA, FASA: Yeah, thanks, Mitch, for reminding me that I never answered Matt's question there.

Host 1: You are on podcast where we wander all over the place, brother. You're in a good company here.

Andrew Franklin, MD, MBA, FASA: So if I was going to look back 15 years from now, I would say that everything happens for a reason. I think, if you are pursuing something and things don't work out, or you have a project that sort of flops, see that as a win in and of itself. You've learned from that. And then, when the next time comes around for you to do something similar, you know where the pitfalls are, you know where the mistakes are that you made.

And so, I think, I would tell myself and other junior colleagues that don't let things that haven't gone right in your career sort of torpedo you. Think about how you can grow from that. And in the end, it always just kind of works its way out. I haven't done this thankfully in my career to a great extent. But the last thing is to-- and this should be pretty basic-- but just be nice to everybody. Never burn any bridges. Even if it's a junior trainee that you think you may never see again, don't yell at them because he or she didn't tape the tube rod. That's something that, you know, I think is important. Because you never know who will turn up 10 years from now. You know, anesthesia is a small field. Like pediatrics or cardiac or whatever, it becomes even smaller. And then, when you get into a small group like AACD, it's even smaller. So, you will see the same handful of people over and over. So, I think never burn bridges. Always try to amend any wrongs that you've done or others have done to you because I think that will pay off for you at some point down the road. And if not, it's just the right thing to do.

Host 1: A lot of wisdom there, Mitch. I think our organization is in good hands for the next few years. What do you think?

Host 2: I agree.

Host 1: And I also think that we've realized that of the three of us on here, Dr. Franklin has the best radio podcast voice of all of us. So, we should learn from that and keep that in mind for the future, right?

Host 2: Agree.

Andrew Franklin, MD, MBA, FASA: Well, okay. Well, Mitch did try to talk me into doing these future podcasts and maybe I will. Let me think it.

Host 2: We can write it into the bylaws.

Host 1: That's right, Drew, this has been fun, man. I've always used your pearl in the oyster quote. Now, I'm going to use the cathedral one, and I'm going to give you a shout out for that one. That was good stuff. I hope a lot of our trainees listen to this. There's a lot of wisdom that you've imparted here. So, clearly, the AACD is in good hands, and looking forward to our next few years. It's going to be a blast, man. Thanks for coming on, and thanks for hanging out with us today.

Andrew Franklin, MD, MBA, FASA: Matt, Mitch, you've done a great job. You guys have done an extraordinary job with this. And again, thanks to UAB and Luke and anyone else that make this possible. So, thanks again.

Host 1: All right. Thanks guys. This has been fun. Thank you to everyone for tuning in. We'll catch you on the next one.