Osmosis.org Co-founder & CEO Relies on His Own Learning Platform for Return to Med School

Michael Carrese: Hi everybody, I'm Michael Carrese. You are in for a really special episode of the podcast today as we welcome back Osmosis’ co-founder and Raise the Line host Shiv Gaglani to discuss some very big news for him and for Osmosis. 

He’s joining me today from Baltimore, Maryland where he has started the process of finishing his medical degree at Johns Hopkins, which is something that he put on hold many years ago to start and grow Osmosis. 

And Shiv, I think it would make sense to have you start by explaining your med school experience and why you decided to create Osmosis and then leave Johns Hopkins to grow it?

Shiv Gaglani: Yeah, so some people may be familiar that med school in the US is four years. Typically it's two years preclinical or didactic and two years of clinical. So, there's this natural juncture point in med school between your preclinical and clinical and during that time is when a lot of people leave to do their PhD or maybe they get an MPH or an MBA. That's also typical between your third and fourth year of med school. So for me, the plan was always to leave med school for two years and do my MBA because I actually applied to Hopkins Med and Harvard Business School at the same time in college and got into both. The plan was to do three years of med school at Hopkins, leave, do my two-year MBA and then come back. 

I think Eisenhower said, ‘plans are nothing and planning is everything.’ Mike Tyson also said that everyone has a plan until they get punched in the face. My version of getting punched in the face was in the first couple of weeks at med school, I was like, “Wow, this is a great institution, obviously, at Hopkins. We have great mentors, great researchers, great clinicians. But the way we're teaching people is pretty antiquated.” And that's across all med schools, I found. It's lecture-based, it's passive learning. The professors aren't trained to be educators. Back then, flipped classroom wasn't in the vernacular in medical education -- it was starting to get in the vernacular in K-12 because of Khan Academy -- and I had a background in education. My co-founder, Ryan, who was my anatomy partner, had a background in neuroscience as a PhD. So, we started just kind of wanting to solve our own problem. This was fall 2011, and then we started hacking around and built what would become Osmosis. 

Between our second and third year, we had this natural jumping off point, as I mentioned, where we got into this tech incubator called DreamIt Health, moved to Philadelphia, and started building this company. I still went to business school and did my two years. You've met my mother, Michael. She actually said, “You’ve already kind of dropped out of med school. If you don't go to HBS and finish your MBA, we're gonna have to have a real reckoning here.” So, I went and did it, and it was good advice. 

Michael Carrese: She seems like such a sweet person, but I'm sure there's a ramrod steel backbone there that you have to confront from time to time! (laughs) 

Shiv Gaglani: (laughs) Definitely. I mean, she’s mellowed out over time and she is sweet, but it's well-intentioned advice, and she was right. I mean, HBS was a wonderful experience and really helped us succeed with Osmosis, because actually the first money and advisors I got from that were my business school professors from HBS, and that obviously helped us grow and helped Osmosis reach the stage it's at right now.

So anyways, I went full-time onto Osmosis after business school in 2016, and we grew it basically five years straight. We went from about four employees to over a hundred employees. We went from a couple thousand users and maybe like a handful of med schools that had bought it to now we have over three million registered learners and over 200 institutions all around the world that have used Osmosis. We were acquired by Elsevier a year and a half ago and so that gave me the freedom to go back, because up until then, I was basically the person running Osmosis as CEO.

Now that it's part of such a storied, legacy company that’s been around for 140 years -- fourteen times as long as Osmosis has -- it felt very comfortable handing off the reins for day-to-day management to Derek Apanovitch, who’s our COO and Hillary Acer, who has run our people team and culture team for a long time and basically taking a step back and figuring out what's next. Fortunately, Jan Herzhoff, Elizabeth Munn and Kumsal Bayazit at Elsevier have all been very supportive of my personal goal to go back and finish med school while continuing to kind of consult and be engaged with Elsevier and Osmosis. 

So, I'm not like leaving Osmosis. I’m more just changing my role where I'm not managing anybody and I'm just going diving back into the day-to-day of being a med student. 

Michael Carrese: So, when you look back at all of this, what do you think the key insights were that you and Ryan had about medical education and how you wanted to change it? And have you done it? How would you assess the impact of Osmosis? 

Shiv Gaglani: Yeah, it's a really, really good question. I think the key insights were several. One was that we talk about evidence-based medicine and doing randomized controlled trials and whatnot to make sure we're giving our patients the best treatments and drugs and procedures available. But not many people at the time, again, were talking about evidence-based education. The research was clear on how people learn and how people forget, and how do you get them to get engaged in their education, but professors weren't being taught how to teach. We wanted to bring evidence-based education tools like spaced repetition, test-enhanced learning, memory palaces and flipped classroom to medical education. I think we've all succeeded at doing that, and not just Osmosis but a lot of other companies, many of whom we're friends with, have come up over the past decade as well and have helped create this category. There are many companies and even schools now talking about these concepts. So, I think we succeeded in being one of many helping to change that. 

Number two is we wanted to democratize and improve access to health education. We’ve done that through partnerships with YouTube, which is one of our big partners, providing the type of accessible video content we've created, and also with the CDC, National Organization for Rare Disorders and Year of The Zebra. We've not only created curriculum to help augment or replace parts of medical school, nursing school, PA school, but we've made it available in other languages too, to patients and family members directly. 

That's always been a personal goal of mine. The title of this podcast is Raise the Line -- referring to how do train more healthcare professionals -- but the other part was “flatten the curve,” right? And not just of COVID, but let's flatten the curve of diabetes, let's flatten the curve of hypertension, let's flatten the curve of any preventable chronic disease or infectious disease. A lot of that depends on patient education and engagement. So, I'm very proud that we didn't just go, “Hey, here's your Step 1 study material. Here's your NCLEX study material.” That's obviously important, and we helped students succeed with that, but more broadly, we said, “Okay, here’s great content on COVID, on diabetes and hypertension for patients, for family members, so that hopefully they get more engaged.” It's clear if you look at our YouTube comments -- we’ve got over 250 million views on our YouTube videos -- that patients and family members are learning by Osmosis. So, I think we succeeded with that. 

The third area of insight is captured in the first peer reviewed paper we wrote at Osmosis which was What Can Medical Education Learn from Facebook and Netflix? That was way back in 2014, published in the Annals of Internal Medicine...but don't tell Elsevier, that's not an Elsevier Journal. (laughs)

Michael Carrese: (laughs)

Shiv Gaglani: Fortunately, the Elsevier journal The Lancet is now number one in general medical, and as you know we had its editor, Richard Horton, on the podcast. So, the purpose of that article was talking not just about improved user experiences, but using big data to recommend content, just like Facebook will recommend ads to you based on things you like, or Netflix will say, “Hey, you like this TV show, so you may like this movie.” We wanted to say, “Hey, we know you want to be a cardiologist. Here's some content that you may find relevant that gives you a deeper dive. Here's what your professor does research-wise to give you a deeper dive. Or maybe we think you're a little weak in microbiology, here's some remedial content.” So, doing some personalized recommendations, even asking for confidence level before somebody answered a question. That was novel -- Ryan came up with that -- and now it's like the standard at a bunch of companies. 

Michael Carrese: Just break that down a little bit. So, asking the student or the test taker, “how confident are you about answering this next question?” 

Shiv Gaglani: Yeah. We'd show the question and then to answer it, you'd have to say, “I'm sure, I'm feeling lucky, or no clue.”

Michael Carrese: Gotcha. 

Shiv Gaglani: Right? Because it isn't just about whether you got it right or wrong, it's not binary. Especially in formative assessment, formative testing, where you're learning and testing for learning, it's how confident you are. Because if you say, “I'm sure” -- if you get something wrong, but you are confident about it -- you've got to remediate that right away. Whereas if you have a habit of saying “no clue” but you get it right, even that is not good because it means that in practice, you may practice defensive medicine which is not high value medicine. So, we're trying to calibrate your confidence. We wanted to feed back that type of data to our learners. 

And we fed back to professors how fast their lectures were being watched. We could tell a professor, “You're on average a 1.8x professor. Students watch you at 1.8x speed.” We definitely had some professors who were watched at over 2.5x, too. So, using data to inform education and not just sell more ads was something we were very interested in, and that's become somewhat of the standard. If you look at most medical education companies, they’re using more data, their user experiences are better. Obviously, we're a little biased. We still think Osmosis is ahead of the curve because we got the head start. But those are three examples of things that I think have changed. 

I know that Osmosis is in better hands now because one of the exciting things to me being able to go back to med school is that with people like Adam, who runs our product team, they're shipping things that I wasn't even thinking about because they're closer to the customers. It makes me very proud when we release a new set of content or release a new feature that people are really benefiting from that I had no part in. Because that's ultimately, I think, the goal of any organization, is to outgrow their management team and their CEO so that they can step away and they have succession planning. 

Michael Carrese: You know, one of the things that’s often highlighted about you is a TEDx Talk you gave called Can You Get a Medical Degree Online? And I'm just wondering along those lines, is there a big vision, a big goal about medical education that you want Osmosis to achieve that you haven't yet -- whether it's that or something else? 

Shiv Gaglani: Yeah. I think it all boils down again to getting to as many people as possible. The vision of Osmosis that we’ve talked about for years is the Big Hairy Audacious Goal of educating a billion people by 2025, right? As I said, we've already achieved over 250 million views of our content. Many of those have been viewed by the same people, so we've estimated about just over 50 million unique people have viewed our content. If you count content on Wikipedia that we've put on YouTube and other places, it’s probably more, so we still have a way to go to get to a billion. I think one of the big things will be more partnerships. Just last week for Rare Disease Day, the CEO of YouTube tweeted out about The Year of the Zebra and about Osmosis, which is really cool. That's the number two biggest site in the world, right behind Google.  I think there's more partnerships that'll help us do that. 

We have this great partnership in India, Project ASHA, where over a quarter million community healthcare workers are gonna be learning soon with Osmosis videos on how to provide community healthcare to 90 million plus people in India, and those are in nine different Indian languages. Obviously, I'm Indian and so I'm very proud that this. I have pretty much nothing to do with this project, but it's getting off the ground because of Elsevier and other teammates at Osmosis and the Diffusion Studios team. So, I'm very excited about those kinds of things and kind of watching them. 

The other thing that gets me really excited -- as you know, Michael and anyone who's listened to the Raise the Line podcast -- is all the AI work that's being done. I think in the next three, four years, all of our content will be automatically translated with high fidelity into all these languages. So, anybody, anywhere -- whether you're in Turkmenistan or Trinidad and Tobago -- you're gonna be able to watch Osmosis in your native tongue. I think that's just gonna be done through automation. I think a lot of this is just natural evolution of technology that's gonna help us reach our goals, but we clearly don't want to lose our edge and want to keep innovating on behalf of our learners. 

Michael Carrese: Well, I have no doubt the innovation will keep going. There's a culture of innovation you've created. It's an engine that keeps running, you know? So, on more of a personal level, what is it like to be back in Baltimore. You've just dipped your toe into some classes. Tell us about that experience.?

Shiv Gaglani: Yeah, exactly. I actually forgot how much I missed Baltimore. Baltimore is great. It's very close to Philly, DC and New York, so it's cool to be back on the East Coast and just take a train ride to any of these cities. Many of my favorite restaurants have survived the pandemic -- because I moved out of Baltimore in late 2019 before the pandemic and I haven't been back until February. 

Then it's kind of interesting being the older guy in the class. There are definitely older people in my class and in the classes below and above me, but I started with the class of 2015 at Hopkins. Now, I'm in the class of 2025. One of my new classmates asked me when I started med school. I said, 2011. And she's like, “I was thirteen in 2011.”

Michael Carrese: (laughs) Oh my gosh. 

Shiv Gaglani: (laughs) And that was kind of funny. But then again, we've had people like Lisa Sanders on the podcast who started med school at thirty-seven as opposed to me returning to med school at thirty-four. So, one piece of advice is everyone has a different career. There's no rush to finish med school or any part of the training. As long as you're having a good time doing what you're doing, I think you go for it. 

Let's see...as far as relearning, I’m actually very happy about, one, how much knowledge has stuck because I've used Osmosis along the way, but also because it's like riding a bike. Remembering how to do a surgeon's knot, remembering how to do CPR...these things kind of come back to you. Number two is, I'm using Osmosis day-to-day. 

Michael Carrese: That’s so cool. 

Shiv Gaglani: That's one of the most exciting things about going back to med school is I'm relying on Osmosis as my primary resource to complete medicine. I'm betting my medical degree on it, and I have that much confidence in what we've built that this is my primary resource. So, I'm basically watching a couple hours of Osmosis every week. The closer we get to Step 1 -- which I have to take later this year, most likely -- I'll be watching a couple hours every day, answering our questions, et cetera, et cetera. Fortunately, I've gotten free access to Osmosis. (laughs)

Michael Carrese: (laughs) And also, fortunately, Step 1 is pass/fail now, right? 

Shiv Gaglani: It's pass/fail, so the pressure's a little lower. But even if it wasn't, I think we'd be in good hands because I also have ClinicalKey Student and Complete Anatomy from Elsevier. I'm friends with all the other people who’ve developed other products, but I probably won't use them. So, that's been good. I think overall, it's been affirming. 

I also, Michael, have a small world story. As you know, we like to name drop on this podcast. Your brother taught one of the classes I was auditing on ethics and medical legal cases. So, I got to meet your brother, Dr. Joe Carrese. He was really gracious in letting me into his class.

Michael Carrese: You know, it was kind of a world colliding moment when you sent me the photo of you and Joe together. (laughs)

Shiv Gaglani: (laughs)

Michael Carrese: I've never met you in person, so I'm like, this sort of doesn't seem fair that my brother Joe's meeting you before I get to meet you in person. 

Shiv Gaglani: (laughs) 

Michael Carrese: But yeah, Joe has been affiliated with Hopkins for decades now and has always spoken very highly of it and loves that mix that academic physicians have in their lives --and seek out and obviously enjoy -- which is the teaching piece of it and seeing patients and doing research. And in his case, he's specialized in ethics, as you mentioned. So, that was pretty cool. I hope he's, you know, hard on you. That's all I'm saying. 

Shiv Gaglani: (laughs) 

Michael Carrese: So, what are you thinking about in terms of a specialization because this is sort of the time in med school when you’ve got to start thinking about that. And I guess I'd also like to know, what were you thinking about ten years ago as a specialty, and has that changed? 

Shiv Gaglani: I've met so many friends of mine from the first time I was in med school, even to now, who started thinking, “You know, I'm going to be a psychiatrist” and then they left as a trauma surgeon, right? That seems to be the rule, not the exception, where you come in thinking one thing and then because you have a mentor or because you actually do the rotations, you change course, sometimes 180 degrees. So, I'm not being very committal about what I want to go through. I'm starting with the women's health rotation this summer, but I'm going to leave it to all my electives, courses, clerkships to figure out. 

Initially, I was thinking emergency medicine, largely because I know that I like to create things. I like to go from zero to one and build scalable solutions. Most of the people I know who've done that -- like, if you look at ten different physician entrepreneurs, I would say five to seven of them are emergency medicine -- because they have predictable shift work and they are able to kind of schedule their time. That being said, I don't feel that pressure.

I feel like I could go into any field and because of the entrepreneurial background, figure out a way to make it happen. What currently interests me the most is psych neuro, somewhere in that connection, because what obviously got me interested in Osmosis in the first place is how the brain works, how we can improve the brain's cognition, both through taking different substances, but also technology. That's what Osmosis was built on, these evidence-based educational principles.

And now, as you know, we’ve had people on the podcast talk about artificial intelligence. We've had people talk about psychedelics for mental health. Hopkins has one of the leading centers for psychedelic studies. Many of the most seminal research papers that kind of birthed the psychedelic renaissance have come from Hopkins. Because of that, right now I'm leaning very heavily towards doing an elective with them and figuring that part out -- both for applications to Osmosis and Elsevier and learning and thriving, but also for applications well beyond education. 

Michael Carrese: What about rare diseases, seeing as you've gotten so deep into that? Is that in your future? 

Shiv Gaglani: I'm definitely gonna be working to spot rare disease patients along the way, and we've developed, obviously, a lot of material for them. There's no real specialty where you go just into rare diseases. So, if I choose psych neuro, I’d obviously look for people who have zebra conditions, because that's one of the promises of the “zebras” is when you work with these specific patient groups, it’s so gratifying how much they care and they are model patients because you're throwing them a life preserver in really choppy, stormy waters. But number two, if you do the work on it and are systematic about it, the discoveries you make for that condition could yield discoveries for other, more common conditions, too. So, it's very possible, but I've always been more the scaling person, translational person, as opposed to the bench science person. So, even if I go into a specific rare disease, most likely I'll be on the side of, “Hey, here's some great research that's already been done. Let's make sure that gets to the people who need it,” as opposed to doing the actual bench research on it. 

Michael Carrese: Right, right.  I’m curious... there is kind of an “undercover boss” element to this whole thing because you're using Osmosis, and it makes me wonder if you plan to stay involved in trying to improve medical education and stay in the whole ed tech space. 

Shiv Gaglani: 100%. I mean, you can't turn this off. And I've actually -- since I've been studying with Osmosis already -- our content team has started seeing a lot of chats come in from me where I'm like, “Oh, I love this great video. Thank you for this.” But then sometimes like, “Oh, I see a typo here. Not too nitpicky, but trying to improve it because since I'm going through it anyways, I might as well make it the best project we can. So, there's definitely that. I'm hoping that our content team will release the great upcoming clinical practice series in the order that I would be going in. Not just because of me...

Michael Carrese: (laughs) That'll help you the most? 

Shiv Gaglani: (laughs) Well, actually a bit. That'll help us all the most, (laughs) but yeah, that'll definitely help me get through it. Again, it's a vote of confidence to them and the product they're building that I want to use it to get through medicine. 

Michael Carrese: I'll put a word in for you with the team. (laughs)

Shiv Gaglani: (laughs) I appreciate that. I'll still be on Slack. One other broader kind of note -- and this could be part of the advice I know we're going to talk about -- is I know it's going to be super frustrating. One message I've given to Hopkins, to my classmates, to my parents, now to you, is that while my goal is to go back and finish med school, I only got through two years before, before starting Osmosis.  I'm very happy I went through that path and started Osmosis. So it's very possible that in three months, six months, one year, I say, “Hey, I think this is a better opportunity for my skillset to start this AI company or psychedelic company, or to work with Elsevier and XYZ.” And so it's possible I may not finish and I want that to be clear because people ask me often, “How is it going to be not being the boss anymore? How is it going to be having to study all day, every day again, or doing scut work when someone who's younger than you is telling you to do XYZ.?” I actually think all that stuff is good. Like, I'm very stoic in mind, as you know, and I think it's good practice in taking these emotions that you typically feel and turning them into productive outcomes. 

So, here are two examples of emotions that I want to turn into productive outcomes: one is fear. We did simulations two weeks ago where you enter a room and there's a mannequin baby and you're with five other med students. Then, suddenly, the baby mannequin starts coding. You see the ECG, it's supraventricular tachycardia, which I haven't reviewed in a while. Most med students forgot that that existed because they did the cardiology block a year ago. Obviously in that moment, we're all fearful. We know it's not a real baby, but if that actually happened, it's pretty scary. So, we do the simulation. Unfortunately, the baby didn't make it because none of us knew how to respond. But then we learn, and then the next simulation we save the baby. So, on the other side of fear is growth, right? And that's not just in medicine, but in any capacity. And so I'm gonna be hyper-attuned to the things that make me fearful -- whether it's doing a procedure like placing an IV or taking Step 1 -- and just reminding myself that on the other side of that fear is growth. 

The other piece is frustration. I'm pretty easily frustrated by things. That's part of the entrepreneurial kind of bent. I was really frustrated by how inefficient lectures were, hence, Osmosis. So, I'm gonna be really looking for things that frustrate me. Like, “Why is this EHR so broken? Why are my fellow med students or residents or attendings spending so much time in documentation when chat GPT exists these days?” I’m going to keeping a journal, noting down this emotion of frustration, because on the other side of frustration is opportunity to help make things better.

So, I'm really looking at the two “Fs” -- fear and frustration -- and ways that we can overcome those, which again makes me feel like maybe I’ll only last six months before starting something else, either within Elsevier or outside of it, but my hope is I'll actually finish this time. It'd be very hard to explain to my parents that I'm dropping out. 

Michael Carrese: (laughs) Oh, yeah. I wouldn't want to be the one to tell your mother that. 

Shiv Gaglani: (laughs) It just occurred to me, I’m not sure if there's a betting pool at Osmosis about whether you finish. I might have to start that. 

Shiv Gaglani: (laughs) Please.

Michael Carrese: So as you alluded to, and as our regular listeners know, we always like to end with advice. I think in your case particularly, it’s what advice would you have to the med students and other health professions learners and early career folks with entrepreneurship in mind? What are your big takeaways in that regard? 

Shiv Gaglani: I think people often become very fixed mindset and have an identity of like, “I'm a doctor, I can't be an entrepreneur,” or “I'm a med student, so I have to wait.” Clearly that's not the case. Not just because of me, but there are many other examples of people who left. I think they have this fixed kind of mentality where once you get on a moving walkway, you can't get off of it, and that's sometimes true. Maybe you have to actually drop out of med school. I was fortunate with Hopkins where I could just defer and not have to go back and redo it. But even if I had to go back and redo it, there are people who leave and then go back and finish. I have a friend whose dad finished law school at 79. We've had Lisa Sanders on, we had that gentleman on who was a Buddhist monk for years and then went into medicine. 

I think that's one thing I've learned, even from this podcast, is there's no “linear,” there's no “right,” it's not like grades in college or high school where you have to get an A because there's one way to get to the next step in life. Like, you can zigzag and the career changes.  So, I think that's one thing to remember is you could take an off ramp, come back, et cetera. I'm living proof of that. 

There are two real timeless pieces of advice I like to give people that are not contextual, because all advice is contextual -- should you leave, should you stay -- all that stuff depends on the context and who you are and there's no right or wrong. But the two pieces of advice that I think transcend context are, one, relationships. I just think that building strong relationships and meaningful relationships is always a winning formula for happiness. Because if you have people who support you -- like I've had relationships at Hopkins or Osmosis or Elsevier where we like each other, we respect, we trust -- good things come your way. And vice versa. You just feel happier about the people you're with. Invest in building those relationships. It doesn't have to be hundreds. It could be two, it could be five, it could be one, or it could be hundreds... whatever you're capable of doing. I think building relationships is valuable. 

Number two is reading. I really think what changed the trajectory of Osmosis -- there were a lot of things -- but I think that the period between late 2017 to early 2019 was an explosive year for us, partially because of the compounding and luck and whatnot, but I think a lot of it too, is I started reading a lot during that time. I wrote about this for Forbes, about planning your seed habits, doing strength training and reading a ton of audio books. Some of these books have shaped our culture. They shaped what we're trying to do. They shaped my personal philosophy. I still read a lot. 

Reading is such an easy kind of growth hack. You take someone's life -- like Marcus Aurelius and his decades of experience 2000 years ago -- and automatically add that experience to your life, right? You're getting wiser, but not older. Just read as much as possible. If anybody ever feels lost, just start picking up books, and then the people you read will recommend other books. If you just go down that rabbit hole, like, within a couple of months or maybe less, you'll develop some wisdom that I think will help you with whatever you're facing. Because the problems you're facing, generally, are not unique. There are eight billion people who live now. There have been over 100 billion people who've lived in the world and many of the greatest thinkers have written books that have transcended centuries, have survived for centuries, so the solutions you're looking for are probably in those books. 

Michael Carrese: You're like a poster child for lifelong learning. It's one of the great things about you. You're always so curious. It’s what makes you a great host of this show. I know, Osmosis is a huge legacy to already have as a relatively young person, but it's not anywhere near the end of the legacy you're gonna have. 

And if I could just make one note about Raise the Line, the podcast is a teeny, little piece of what you've accomplished at Osmosis, but it has been just an amazing journey with you on this for three years, and I feel just very, very fortunate to have had the experience to produce it with you. I really think we're doing the audience a service in helping them just sort of get a scan of everything that's going on and what they're stepping into and maybe where they can fit into this new world of healthcare.

So with that, I will just say thanks for allowing me the opportunity to be part of this, and we're all wishing you all the luck in the world on this incredible adventure you're on. 

Shiv Gaglani: Thanks so much, Michael. And you know, the feeling is mutual. I mean, I've launched a lot of initiatives at Osmosis, and I think the podcast is easily one of the best and one of the greatest experiences. I joke with all my teammates that I think I spend the most time with you because I've done so many Raise the Line podcasts. 

Michael Carrese: (laughs) I'm sure the audience is getting tired of all this, so we'll leave it there. But Shiv, again, thanks so much for joining us and sharing your story and your perspective, and good luck down there in Baltimore. 

Shiv Gaglani: Thanks so much, Michael. Take care. 

Michael Carrese: I’m Michael Carrese. Thanks for checking out today's show, and as always, remember to do your part to raise the line and strengthen the healthcare system. We're all in this together.