Pamela Stahl and Dr. Julie Shulz Spill the Tea on Price Transparency in Clinical Lab Testing

[00:00:00] Welcome to the HITea With Grace podcast where we spill the tea on HIT. I'm honored to welcome

[00:00:10] Pamela Stahl and Dr. Julie Schultz from Avalon Healthcare Solutions. Thanks for joining me

[00:00:16] today, ladies.

[00:00:17] Hi.

[00:00:18] So great to have you here. So to start, I'll have each of you share the career path

[00:00:22] that brought you to Avalon. So Pamela, let's have you start as the president of

[00:00:27] the company.

[00:00:28] Sure. So thank you for asking. I have I like to say I have 30 years of health care

[00:00:34] leadership experience, although it's really my whole life.

[00:00:37] I'm a doctor's kid. My father is retired now, but was a family practice physician

[00:00:42] with a subspecialty in geriatrics in a small town in Nebraska.

[00:00:46] So I grew up with our dinner table conversations being about the patients he cared

[00:00:50] for in that small town. And of course, as his oldest daughter, I still think he's

[00:00:54] no. Sorry, Julie, to say this, but I still think he's the best doctor in the entire

[00:00:58] country and always was because he cared so much for his patients.

[00:01:00] I grew up thinking I was going to be a doctor.

[00:01:03] And as I did research, cancer research in college and things like that, and

[00:01:07] then realized, you know what? I just don't think that's what I really want to

[00:01:10] do. And I ended up going into pharma.

[00:01:12] My dad recommended to me.

[00:01:14] I remember saying, you know, Dad, having that hard conversation, I'm sorry,

[00:01:17] Dad, I don't think I want to be a doctor.

[00:01:19] And then I don't know what I want to do.

[00:01:21] And he's like, sales create and pharma sales.

[00:01:24] And I said, well, I don't know what that is.

[00:01:26] What should I do? And he said, and he told me about it.

[00:01:30] And I said, what are your favorite companies?

[00:01:31] And in that time period, it was Merck, Marion and Merrell Dow.

[00:01:34] And Merck was America's most admired company.

[00:01:36] So I said, that's what I want. I'm going for number one.

[00:01:38] So I started my career in pharma sales and about half my career is pharma.

[00:01:42] The other half of my career is payer.

[00:01:45] So I spent about 12 years at United Health Care.

[00:01:48] I spent about four years at Anthem, Elevance.

[00:01:51] I've run a couple of health plans and I've started a couple of little companies.

[00:01:55] And I've been in big companies, little companies, and I found my way to Avalon.

[00:01:59] I'll answer one more thing and then I'll stop talking about this.

[00:02:02] But with Avalon, what drew me here?

[00:02:05] Well, when I ran the health plans that I ran,

[00:02:08] lab spend was something that certainly I saw.

[00:02:12] I noticed in my P&L, I noticed it trending.

[00:02:16] But it's such a small, it's only three to five percent of total health care spending.

[00:02:21] So it was small and a lot of it was routine testing.

[00:02:24] So high volume, low cost.

[00:02:25] There wasn't a heck of a lot I felt I could do about it.

[00:02:28] And so I would see the trend and feel like it just kind of is what it is.

[00:02:31] So when I learned about Avalon and I saw that there was a company

[00:02:34] that actually built to tackle that problem,

[00:02:38] I was intrigued and the rest is history.

[00:02:39] And now I'm here.

[00:02:41] That's awesome. Oh, what an interesting past from pharma to payer

[00:02:45] to health care technology in this wonderful space.

[00:02:48] It's really awesome to have you here. Can't wait to learn from you.

[00:02:50] And then Dr. Schultz, I'd love to hear from you a little bit

[00:02:52] about your career path that brought you to Avalon.

[00:02:55] Yeah, absolutely. So I'm a physician by education.

[00:02:58] I did an MD and MPH at Northwestern,

[00:03:01] although I then took sort of an unusual turn and that I didn't practice.

[00:03:05] I went initially into management consulting

[00:03:07] and have been at a series of health care startups throughout my career.

[00:03:12] All of everything that I've worked on has been,

[00:03:14] especially in the product setting, has been focused on helping physicians

[00:03:18] do their best to provide quality care to their patients.

[00:03:20] And so making sure that they're following the guidelines,

[00:03:23] had the tools they need to provide evidence based care

[00:03:26] and have the tools they need to navigate a very,

[00:03:28] very complicated care pathway for their patients.

[00:03:32] And similarly, that's what that's what attracted me to Avalon.

[00:03:36] As we say, sciences are a true north.

[00:03:38] We're really taking the guidelines, the evidence

[00:03:40] and applying that to lab care and not just

[00:03:45] not just the going to get the test in itself, also the decision making

[00:03:48] of which tests are appropriate. How do you interpret the tests?

[00:03:51] What is the next best action to do based on the lab test results?

[00:03:56] So really excited to be here to talk to you about that

[00:03:58] and how we see that changing.

[00:04:00] Thank you so much, Dr. Schultz. I appreciate you being on here.

[00:04:03] So, Pam, let's kind of start talking about what the heck is happening

[00:04:06] in the lab world. You know, we're hearing stories of corruption,

[00:04:09] mismanagement.

[00:04:11] How can technology kind of reshape the landscape of lab testing,

[00:04:15] particularly addressing some of the ethical challenges

[00:04:18] happening within the industry? We'll just dive right in it.

[00:04:22] Here's a simple answer to that very big question, right?

[00:04:25] But maybe some context and start some context.

[00:04:27] So there are 14 billion clinical lab tests performed every single year.

[00:04:31] 14 billion. If you think about it as a patient, right?

[00:04:34] Think of a time you went to the doctor

[00:04:36] that you didn't have lab tests performed, right?

[00:04:38] Every time you go to the doctor, some lab tests.

[00:04:40] I think I don't know, Julie, is it 100 percent of the time

[00:04:42] you go to the doctor, you have a lab test?

[00:04:43] Almost. I think that's true.

[00:04:45] So 14 billion lab tests are done every year.

[00:04:48] And those lab tests drive 70 percent of clinical decisions.

[00:04:53] And again, if you think about yourself as a patient,

[00:04:56] I guess I never really thought about it that way.

[00:04:58] You go in, you have a urinalysis, you have your blood drawn

[00:05:01] and you know your doctor's using them.

[00:05:02] But when you think about how critically important

[00:05:05] the results and management of those tests are in terms of your health,

[00:05:09] well-being and outcomes, I guess I just most people don't really

[00:05:13] put that importance on it because it's such a routine thing that you do.

[00:05:18] So given that that there are the volume is so high

[00:05:23] and it happens so much.

[00:05:24] So what's going on in the in the landscape?

[00:05:27] Well, 85 percent of the tests are repeated after normal results.

[00:05:31] So that means, you know, clinicians aren't quite sure

[00:05:33] how to interpret what they did.

[00:05:35] So they get redone.

[00:05:38] The waste caused by something called panel stuffing is driving.

[00:05:44] It has an impact of two dollars p.m. p.m., which is significant.

[00:05:48] So what is panel stuffing?

[00:05:49] Well, if you think about, you know, the marketplace for other goods

[00:05:53] that you buy, whether it be Kansas soda or popcorn or whatever.

[00:05:58] If you go and instead of buy one, you can buy ten.

[00:06:02] And the cost is impact.

[00:06:03] You can buy ten and maybe get a little bit of a discount or whatever.

[00:06:05] In labs, they do something called panel stuffing where you might need five

[00:06:09] lab tests, but they're going to package that with 15 other tests

[00:06:13] and charge for the other 15 tests.

[00:06:15] So before you know it, there were 20 20 tests done on your blood sample,

[00:06:19] 15 of which you didn't need in order to the doctor even realize

[00:06:22] that they ordered.

[00:06:23] And guess what? That cost is passed through the system and charged.

[00:06:27] So that's happening.

[00:06:29] In addition, look, lab testing, we all know, was so critically

[00:06:32] important during Covid, right?

[00:06:34] Thank God for lab testing.

[00:06:36] But what happened during that time period is all these independent labs,

[00:06:39] all these labs sprung up to to meet the need

[00:06:45] and take advantage of that opportunity.

[00:06:47] All mostly hopefully good.

[00:06:49] Well, now we've got this glut of labs out there

[00:06:53] that are all set up and operating and looking for opportunities

[00:06:56] to drive volume through those through their businesses.

[00:06:59] And so now there are just so many labs out there doing tests

[00:07:01] and way more than needed. So.

[00:07:05] That's that's what's going on.

[00:07:06] Oh, and then let me add this to and Julie, you can speak to this,

[00:07:09] but you look at the genetic testing space, right?

[00:07:11] So there's an explosion of genetic tests, 10 new tests.

[00:07:14] So there's what's the statistic on that?

[00:07:16] How many I think there's one hundred and seventy five thousand

[00:07:18] genetic tests out on the market today with 10 new ones every single day.

[00:07:22] And there aren't enough CPT codes, which is what doctors use to

[00:07:26] or the providers used to bill for the tests.

[00:07:28] There aren't enough.

[00:07:29] The system's not keeping up with that increase in tests.

[00:07:33] And so therefore there's not specificity in the coding

[00:07:37] and therefore not specific specificity in the payment.

[00:07:40] And therefore, if not managed, everything gets paid for.

[00:07:45] And so those genetic tests are important

[00:07:48] because it's going to lead to better precision medicine.

[00:07:50] But the payment and management has not kept up.

[00:07:54] So basically, it's a big mess.

[00:07:56] You're telling me.

[00:07:58] Wow. Yeah.

[00:07:59] Opportunity for management, for sure.

[00:08:01] Absolutely. You know, Dr.

[00:08:03] Schultz, from a medical kind of perspective,

[00:08:06] how do you see labs contributing to population health initiatives?

[00:08:10] And once they're managed properly, what role should they be playing

[00:08:14] in preventative care and how can management help assist that?

[00:08:18] Yeah, well, as Pam mentioned, lab testing drives so much of care, right?

[00:08:23] Even if it's a small part of spend.

[00:08:26] And a lot of that isn't is getting wasted.

[00:08:28] And I think what what's also interesting is that lab testing

[00:08:31] is getting so much more complex.

[00:08:33] Physicians have don't necessarily get training in genetics, for example.

[00:08:39] And even if they do, the ability to try to keep up with the literature,

[00:08:42] with the new tests that are being offered and the way to interpret them.

[00:08:45] You almost need a subspecialty or need to be on your computer every day

[00:08:50] reading the literature to keep up.

[00:08:51] And so we really need tools and technology, if you will,

[00:08:57] that really help provide physicians that clinical decision support of.

[00:09:01] As I mentioned before, first of all, just picking the right test.

[00:09:05] But then secondly, interpreting that test, for example,

[00:09:09] just a common test that I'm sure everyone listening has had before

[00:09:14] a comprehensive metabolic panel is going to be a screening test

[00:09:17] for a lot of things.

[00:09:18] But one of the things that it screens for is chronic kidney disease.

[00:09:21] And unfortunately, even though many of all of us have had this test,

[00:09:25] we still see that 90 percent of chronic kidney disease

[00:09:27] patients are undiagnosed.

[00:09:29] And that happens because there's multiple results

[00:09:33] that come back as part of this panel.

[00:09:35] And physicians don't necessarily key in to something

[00:09:38] that's a little bit off or they don't necessarily see the trend

[00:09:42] that is occurring over time.

[00:09:44] And so this is a great place where technology analytics

[00:09:47] can help identify these patients and service them.

[00:09:50] So that then not not only can the physician interpret the test

[00:09:54] and make sure the patient gets appropriately diagnosed,

[00:09:57] but also the the recommendations, the next best action

[00:10:00] of what to do based on the test can be complicated as well.

[00:10:03] And so some labs have gotten much better at providing

[00:10:07] really sophisticated education to clinicians

[00:10:11] and to patients in the reports to help them

[00:10:13] in terms of what they're going to be doing next.

[00:10:15] But again, that's another great place for technology to come in

[00:10:18] and suggest to the physician based on the evidence,

[00:10:21] based on the guidelines, what the next best action should be,

[00:10:23] whether that's treatment or additional testing.

[00:10:27] Really interesting.

[00:10:28] It's so interesting to think about labs from that perspective

[00:10:31] of how can they improve care overall, generally,

[00:10:34] you know, in the general health of populations.

[00:10:37] Pam, I've heard a lot about price transparency in this space,

[00:10:40] and I know that you're a huge advocate for that.

[00:10:43] Can you kind of speak to what can be done

[00:10:44] to promote some price transparency in lab services

[00:10:48] so people know what they have to pay and payers know

[00:10:50] what they have to pay and everybody knows what's being paid?

[00:10:54] Yeah, well, so again, let's put some context to that.

[00:10:57] So I don't think I certainly as a consumer didn't know

[00:11:00] the disparity, disparate, disparate.

[00:11:03] What's the word I'm looking for?

[00:11:04] The difference in price is depending on where you go to have your lab test.

[00:11:07] Right. So if you have the same general health panel done

[00:11:11] at an independent lab, the cost is twenty seven dollars.

[00:11:15] That same general health panel done in a physician's office is thirty five dollars.

[00:11:19] OK, so seven dollars.

[00:11:21] I don't know if that's going to matter to some and less to others.

[00:11:25] Hospital if that same test is done as a hospital in a hospital

[00:11:29] outpatient lab, it's one hundred and fifty seven dollars.

[00:11:31] So five hundred and seventy five percent more expensive

[00:11:35] at a hospital outpatient lab versus the independent lab.

[00:11:40] So there is need for price transparency.

[00:11:42] There's need for people to know what they're paying and for health plans

[00:11:45] to know Congress and regulators and consumer groups have been trying

[00:11:49] for years to get some something moving to increase transparency.

[00:11:56] There was recently a transparency and coverage.

[00:11:58] Final rule is a good start.

[00:12:00] So that's that's finally there.

[00:12:02] I think companies like Avalon, I think, do a good job

[00:12:06] and are continuing to make sure there's exposure

[00:12:09] to the difference of the people know.

[00:12:11] I also think health plans and employers are going to have to continue to push.

[00:12:15] The employers care the most.

[00:12:16] Providers aren't going to make a change unless they're pushed

[00:12:18] by the people who are actually paying them to to deliver the service.

[00:12:23] So I think it's all of us together doing what we can

[00:12:26] to expose the differences in pricing so that people know.

[00:12:30] By the way, if you think about like in the drug

[00:12:32] on the drug side, you know, health pens put into place tiered pricing for drugs.

[00:12:36] Now that at least then as a member, if you have your health

[00:12:40] insurance card as a member, you at least are aware you have some

[00:12:45] idea that you should think about, do I get my

[00:12:49] accept this branded drug versus another drug because you know

[00:12:51] that your out of pocket cost is going to be different.

[00:12:53] So there's a lot of conversation about whether that should be happening

[00:12:56] in the lab space as well.

[00:12:58] Interesting. And Dr.

[00:12:59] Schultz, from the experience of you being in the lab

[00:13:02] and being a health care provider, how can the lab

[00:13:05] and health care provider collaborate more effectively

[00:13:08] to make sure patients are informed about the costs associated

[00:13:12] with their lab tests before they're conducted instead of after the fact

[00:13:14] when they see the villain or shocked?

[00:13:17] Yeah. And unfortunately, there's really very little collaboration

[00:13:19] at all right now.

[00:13:20] So this is an area that's just right for opportunity.

[00:13:24] Some of the things that I've seen that work really well.

[00:13:27] And I should mention it's not just as simple as communicating the price,

[00:13:31] figuring out what the price is and what the patient is actually going to pay

[00:13:35] is extraordinarily complicated because, first of all,

[00:13:38] you don't know how much of their deductible they've met.

[00:13:41] There might be some preventive tests that that would not go on

[00:13:45] that a patient would have no cost sharing for as a result

[00:13:49] of it being a preventive test.

[00:13:51] And so making sure that patient meet that criteria is at that right test.

[00:13:55] And then on top of that, a lot of labs offer siding skills

[00:13:59] for patients who perhaps can't afford the test.

[00:14:03] They offered a reduced price that they need certain income thresholds

[00:14:07] to put all of that together.

[00:14:09] And it's almost impossible to actually tell a patient

[00:14:11] how much they need to pay for a test today right here.

[00:14:15] So some of the tools that I've seen that work really

[00:14:18] that can help this problem is first having portals

[00:14:22] where someone can log in and very quickly see if the patient

[00:14:25] has met their deductible, enter some information and spit out the price.

[00:14:28] Great place for technology because it's a it's very cumbersome

[00:14:31] for an individual to track down all of that information.

[00:14:35] Secondly, making sure that the providers are collecting

[00:14:39] the necessary information for patients to meet those sliding scales,

[00:14:43] if necessary.

[00:14:45] I think that's really, really important because the last thing

[00:14:48] you want to do is tell a patient a price.

[00:14:51] And sometimes folks want to kind of overestimate

[00:14:54] because they don't want them to be to get a surprise bill.

[00:14:56] But then what you have happened is that the patient declines

[00:14:59] testing that they actually need because they're afraid that they can't afford it.

[00:15:03] And so making sure that you're educating the patient on why this

[00:15:07] information is important and how you're going to make sure

[00:15:09] that you're going to get the test for them at an affordable rate.

[00:15:13] Again, all of these things can be really facilitated by technology,

[00:15:18] by training and scripting.

[00:15:19] And I don't know, maybe even there will be something in generative

[00:15:22] AI that helps educate patients on

[00:15:25] on the pricing and selection of their health tests.

[00:15:28] A huge opportunity for tech disruption here, it sounds like.

[00:15:31] I mean, and and really, it's going to be a mix of people

[00:15:35] and systems shifting a little bit to make that shift happen

[00:15:38] in a place where it really needs to ethically happen, not just,

[00:15:41] you know, logistically, but in an ethical sense, too.

[00:15:45] Pam, I'd love to hear what you've been hearing in the space

[00:15:48] about what barriers there are to widespread adoption of,

[00:15:52] you know, price transparency practices like this.

[00:15:55] What is keeping people back from making these changes

[00:15:58] and how can they be overcome?

[00:16:00] Yeah, I mean, it's hard because it's a cost center or it's a price.

[00:16:04] It's a revenue center, revenue generating opportunity. Right.

[00:16:06] So but transparency is absolutely worth pursuing.

[00:16:09] As a matter of fact, there was a 2022 study in Health Economics Review

[00:16:13] that concluded that hospital price transparency

[00:16:16] reduced the price of laboratory and imaging tests

[00:16:19] except for offices and services.

[00:16:21] So but why is it happening?

[00:16:23] Well, hospitals charge more for tests because they have higher overhead

[00:16:26] and because they can. Right.

[00:16:28] Another contributor is health systems practice of buying

[00:16:31] independent physician groups and billing subsequent tests done there.

[00:16:36] The same as if they were performed at a hospital

[00:16:37] and tacking on a facility charge.

[00:16:39] So physicians in those

[00:16:42] practices are often instructed by their new owners to keep testing in house.

[00:16:47] So, you know, as I talked about before, what can be done about it?

[00:16:50] I think we've got to keep talking about it.

[00:16:52] We've got to help consumers be aware and encourage employers

[00:16:56] and the payers of services to take action.

[00:17:00] Do you have anything to add to that, Dr.

[00:17:01] Schultz, because I feel like you probably have a lot of feelings

[00:17:04] on what barriers keep people back from really making changes

[00:17:07] that need to happen here?

[00:17:09] Yeah, that's a great question.

[00:17:11] When I think about it, you know, I get multiple times a week.

[00:17:15] I get a phone call from a friend, a colleague, someone I know saying,

[00:17:19] Hey, do I need this test?

[00:17:22] Do I need this? How do I interpret this?

[00:17:24] There's clearly just such a huge gap.

[00:17:27] And so, you know, I don't know that I have that much more,

[00:17:30] you know, to add to what Pam has said other than,

[00:17:33] you know, I think we all feel this and experience it.

[00:17:36] And we just really need those tools to be able to actually price

[00:17:39] compare and not just price compare on the single test,

[00:17:41] but maybe there's alternative tests that we should be having instead

[00:17:45] and understanding kind of the groupings of tests or their clinical utility

[00:17:50] and comparing not just with the prices, but what is the test

[00:17:53] that the patient should actually be having?

[00:17:56] Interesting, interesting.

[00:17:57] Pam, you know, what ethical considerations should labs be prioritizing now

[00:18:01] as they're implementing new technologies and new services

[00:18:04] in the health care sector as they're hopefully coming into the next generation?

[00:18:08] That's what we're hoping for, right? The next gen lab.

[00:18:11] What what ethical things should they be considering

[00:18:14] as they're making these big leaps?

[00:18:16] Yeah, I mean, I would hope that.

[00:18:20] That these labs, as they are coming up with new tests

[00:18:23] and by the way, many of many labs do this, they absolutely do this,

[00:18:27] but that they're looking for true labs that will improve

[00:18:32] the outcomes and care for the people that we all serve and that you start there.

[00:18:37] And it isn't bringing additional tests to market

[00:18:40] where there's already a whole bunch of the same tests.

[00:18:43] So it's just another test of the same to add into the system.

[00:18:46] But it's truly they're working to improve care for people

[00:18:51] in the genetic space that they're identifying tests that will enable greater precision.

[00:18:56] Yeah, you take someone with cancer, right?

[00:18:58] Let's let's get better precise tests that enable people

[00:19:01] to get on the right chemotherapeutic agent in the beginning

[00:19:04] the first time so that their outcomes are better.

[00:19:07] You know, and that may be mom and apple pie, but that's what I would hope.

[00:19:10] I mean, there are so many tests out there and so many tests being developed.

[00:19:14] I think we all owe it to ourselves again as consumers and patients,

[00:19:18] but also to all the people we serve that we are

[00:19:21] we are endeavoring to improve health care over time and not just add

[00:19:25] add to the mix. Absolutely. Amen to that.

[00:19:29] I think we all agree with you, Dr.

[00:19:31] Schultz. I'm wondering, you know, as you know, somebody

[00:19:34] that's worked in labs has this great public health background

[00:19:38] as a provider by training.

[00:19:40] How do you envision the future of lab testing evolving

[00:19:42] to better serve those population health goals that we have as, you know, and

[00:19:46] and improving the health of communities and also maintaining

[00:19:50] ethical standards like Pam just mentioned?

[00:19:54] Yeah, I think, first of all, we have to just have tremendous empathy

[00:19:57] for our providers who are at, you know, extraordinary burnout levels

[00:20:02] who are expected to do truly heroic things on a daily basis.

[00:20:05] And so we have to be really thoughtful about how can we support them?

[00:20:09] How can we help them do what's best for their patients

[00:20:11] in a way that doesn't create extra work and in a way that

[00:20:15] that that fits more seamlessly into their practice.

[00:20:18] And so I really see, again, because the explosion of information,

[00:20:23] the number and types of molecular diagnostic tests is

[00:20:27] is increasing so rapidly.

[00:20:28] We have to be able to have sort of smart tools,

[00:20:32] clinical decision support tools for physicians

[00:20:35] to know exactly what they need to do for their patients.

[00:20:38] That can also be extending that to the broader team.

[00:20:40] Physicians don't necessarily have to do everything.

[00:20:43] Can we can we include pharmacists, community health workers,

[00:20:47] other other members sort of within the health care ecosystem

[00:20:50] that can help out and help patients get educated about

[00:20:54] about what they need to do?

[00:20:57] The last thing I would say is a little bit to what Pam was saying,

[00:21:00] not just adding another me to test, but really looking at where

[00:21:03] those gaps in care are, where are there gaps in survival?

[00:21:07] Where are there where are there treatment delays?

[00:21:10] How can lab testing specifically address some of those outcomes?

[00:21:14] Not just sort of a technical outcome that you might see in a lab,

[00:21:18] but how does it actually affect patient oriented outcomes?

[00:21:21] Then the day is what we're trying to to fix.

[00:21:24] So, you know, really focusing on the right things,

[00:21:26] the right targets in technology and development.

[00:21:29] But again, I think there's just such an opportunity

[00:21:33] for clinical decision support, suggestion, AIDS and analytics

[00:21:37] to really help physicians do the best job they can for their patients.

[00:21:41] Fascinating, so fascinating.

[00:21:42] This is a space that I'm so thrilled to be knowing more about.

[00:21:45] And I'm sure all of our listeners are as well.

[00:21:47] So thanks to you both. Now, let's dive into your personal lives.

[00:21:50] I'd love to hear a little bit about you as leaders.

[00:21:54] Pam, let's start with you.

[00:21:55] What are some habits that you have as a successful leader

[00:21:58] of Avalon Health Care Solutions making big impacts in the lab world now?

[00:22:03] What are some things that you do on a daily basis

[00:22:05] to work your best and make a difference?

[00:22:06] Do you have habits or mantras or things that you do as a leader

[00:22:11] that keep you on your A game?

[00:22:15] So I, I think of it this way.

[00:22:19] What would I tell myself if I can talk to my younger self,

[00:22:23] what would I tell myself now to do? Right.

[00:22:25] And I don't know if it's a habit or a behavior.

[00:22:28] You know, some of these things that have been working for 30 years.

[00:22:30] So I don't even know what those habits are anymore,

[00:22:33] because it's just what I do.

[00:22:34] But if I could go back and tell my younger self something,

[00:22:37] I would say as a specifically as a woman,

[00:22:40] but as a woman in health care, have confidence, trust, trust,

[00:22:46] trust yourself, trust your gut.

[00:22:48] Don't question your competence and speak up, I guess.

[00:22:52] I think of my younger self the always feeling a little bit like

[00:22:55] I don't I don't know that I'm this.

[00:22:57] I don't know if I'm the smartest person in the room.

[00:22:59] I don't know if my idea is right.

[00:23:00] And I think I hesitated more than I wish I would have.

[00:23:03] So I would say be confident, speak up better to speak up and be wrong

[00:23:07] than not speak up at all.

[00:23:08] And so for all those young girls who are out there

[00:23:10] starting to build their careers like my daughter's 28 building her career.

[00:23:15] That's the thing I tell her all the time.

[00:23:16] Don't hesitate. Speak up.

[00:23:17] You can always course correct.

[00:23:19] So that's what I would say. So encouraging.

[00:23:21] And it's so true. Why do we do that when we do have the best ideas?

[00:23:25] Why would we hold back and let somebody else say them first?

[00:23:28] Dr. Schultz, what about you?

[00:23:30] What would you tell your younger self if you could kind of

[00:23:33] think back and say something to them?

[00:23:34] And do you have any habits or things that you do to keep you on your A game?

[00:23:38] Yeah, I think I would certainly is something I do today

[00:23:42] and I had to start doing once I became a mom was just scheduling

[00:23:45] and setting time aside for myself.

[00:23:47] Otherwise, it quickly, you know, between work and other obligations

[00:23:51] and my daughter, all of a sudden, I have just no time left in the day.

[00:23:54] So I have to do that.

[00:23:56] And I wish I would have done that, you know, and been more diligent about it

[00:23:58] when I was younger rather than just,

[00:24:02] you know, staying up all hours and

[00:24:05] and working way, way, way too much.

[00:24:08] I think similarly, I think sleep is something that I always protect

[00:24:11] and I really try not to let that ever,

[00:24:15] you know, to get to get in the way of things.

[00:24:18] That's that's also something I have to schedule time for.

[00:24:21] But I think also picking up on the theme of of confidence.

[00:24:25] I mean, I think back to there's so many times where I cringed

[00:24:28] where I thought I didn't know what I was talking about

[00:24:30] and I knew way more about it than anyone else in the room.

[00:24:33] And and so it's hard.

[00:24:35] I think you can always be confident, always just ask questions

[00:24:38] if you don't know,

[00:24:40] you know, trying to kind of learn as much as you can.

[00:24:43] And, you know, for example, I think about when I took sort of

[00:24:46] an untraditional path in medicine, a lot of folks

[00:24:50] in medical school weren't really didn't understand what I was doing.

[00:24:53] Weren't that supportive?

[00:24:55] I could have just listened to them.

[00:24:56] I would have been kind of very unhappy, but I talked to as many people

[00:25:00] as I could find as many physicians who had kind of taken this

[00:25:02] untraditional path.

[00:25:04] And ultimately, I was like, well, if all these 40 people are saying

[00:25:07] that this is a work for them and you can do X, Y and Z,

[00:25:12] that ultimately trumped what I might have been hearing

[00:25:15] from the so-called experts in the room.

[00:25:17] So I think, you know, that that confidence is so important

[00:25:21] and really kind of just continuing to ask questions

[00:25:24] and be as smart as you can and do your research,

[00:25:27] because you probably do know more than most of the people in the room.

[00:25:31] I love that. Great advice.

[00:25:33] So, Pamela, I'm wondering, you know.

[00:25:35] Hey, Grace, can I throw in one more thing?

[00:25:36] Oh, yeah, please do.

[00:25:38] I think it's something else that I as I've grown through my career,

[00:25:41] you think about what is enabling a success enabler for me.

[00:25:45] And a big success enabler for me now is my network.

[00:25:49] And I would never have in my younger self would have appreciated

[00:25:53] the power of my network now.

[00:25:57] And there are still people I mentioned I started my career at Merck.

[00:26:00] I have friends from my training class at Merck.

[00:26:03] One of them I called.

[00:26:04] He's now the head of oncology at a huge pharma company.

[00:26:08] And I called him a few weeks ago and connected some Avalon

[00:26:11] people to him about something that we're doing.

[00:26:13] And I yesterday I talked to him.

[00:26:15] I I leverage my network now.

[00:26:18] I bet it's almost daily to touch base, identify talent,

[00:26:24] challenge my thinking, ask about what we're doing here.

[00:26:28] I mean, it is it is it is truly I am so thankful for the network

[00:26:32] I've been able to build both as friends and colleagues.

[00:26:35] And they provide me significant power.

[00:26:38] And that's them, not me. So.

[00:26:40] Hmm. I'm going to challenge our listeners to

[00:26:43] reach out to your network this week, set up a call,

[00:26:47] figure out what can you do to leverage your network better

[00:26:50] to help you level up to the next

[00:26:53] the next part of your career and what you're doing in life.

[00:26:57] Because I think this is a huge thing that we don't really think about.

[00:27:01] We have these great social media opportunities on LinkedIn

[00:27:04] to stay even more connected with our network than ever before.

[00:27:08] And so what are you doing this week and what can you do this week

[00:27:12] to just leverage that network like never before?

[00:27:15] So to finish our conversation off right.

[00:27:17] Where can our listeners find you online?

[00:27:19] Pamela, how do you start?

[00:27:21] Well, so the best place to find me is on LinkedIn.

[00:27:25] And shoot, you're going to ask me how I mean, just look up

[00:27:26] Pamela Stalavalon, you'll find me.

[00:27:28] But I am reasonably active on LinkedIn and that would be the best.

[00:27:32] That would be the best place.

[00:27:33] And Dr. Schultz, what about you?

[00:27:36] Yep, the same thing, LinkedIn.

[00:27:37] And I've another sort of recommendation.

[00:27:40] I mean, I try to really keep that up to date with,

[00:27:42] you know, the positions I'm at, the publications that

[00:27:46] I participated in any sort of recent news.

[00:27:48] So definitely check that out and you can see some of the work

[00:27:50] we're doing on chronic kidney disease.

[00:27:53] That's perfect. Now, before I forget,

[00:27:55] did you happen to bring tea with you today?

[00:27:57] Dr. Schultz, I'd love for you to tell me a story about your mug first.

[00:28:01] So this is my my dog Blanche.

[00:28:05] Unfortunately, she is no longer with us, but a neighbor that we

[00:28:10] live next to back in Chicago.

[00:28:12] Our Blanche and their dog used to play together all of the time.

[00:28:15] So when we moved out here, she painted this these mugs for us

[00:28:20] and then also a little kind of dog treat jar.

[00:28:23] So I'm drinking my coffee.

[00:28:24] It's still early over here in California in my Blanche mug.

[00:28:29] That's so sweet. Oh, what a cute pup.

[00:28:31] How about you, Pamela? Do you have a mug?

[00:28:33] I do. My mug today says happy on it.

[00:28:36] So I have a set of mugs.

[00:28:38] So I like variety and change. I love change.

[00:28:41] I thrive on it.

[00:28:42] And so I can't I don't like to have the same mug.

[00:28:46] So I have on my counter a whole bunch of different mugs.

[00:28:48] And depending on my day, I pick the mug that speaks to me.

[00:28:51] And Dave was like, it's Friday. I'm happy.

[00:28:53] Here's my happy mug.

[00:28:55] That's too good. I just love it.

[00:28:57] Thanks for sharing that with us, both of you.

[00:28:59] And thank you so much for joining us today.

[00:29:02] Thank you, Grace.

[00:29:04] And thanks to you folks for joining us, too.

[00:29:06] Check out the Hi Tea with Grace podcast for more interviews

[00:29:09] with esteemed guests like Pam and Dr. Scholls today. Cheers.

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