[Season 6, Episode 4] Global Health Systems & Leadership with Renee Botelho

Welcome to the Health Conscious Podcast, a creation by Sloan Master of Health Administration students at Cornell University. Thanks for tuning in. This podcast explores healthcare trends in today's world. Now please welcome your host Alex Raidel, a second-year MHA student at Cornell. Today on Health Conscious we're excited to welcome a guest who has made remarkable contributions to health care strategy, project activation, and leadership across some of the world's most renowned healthcare organizations, Renee Batello. Renee currently serves as the executive director of program delivery at Dell Medical School at the University of Texas at Austin and has an extensive career spanning leadership roles at institutions like New York Presbyterian Hospital, Mayo Clinic, and Cleveland Clinic. Renee's expertise includes activating state-of-the-art healthcare facilities, implementing innovative healthcare delivery models like hospital at home, and leading strategic planning and enterprise risk management initiatives. Her work has not only driven operational excellence but also transformed how organizations approach patient care and caregiver engagement. Renee holds a master of health administration from the Sloan program and health administration at Cornell University and has received numerous accolades for her leadership including spearheading projects that won the Cleveland Clinic Foundation's CEO award. Today we'll explore her unique insights into project management and activation, her experience working across global healthcare systems, and her thoughts on the future of healthcare delivery. Renee's story is one of resilience innovation and a passion for creating meaningful impact. Welcome to the show, Renee. Thank you. I am really honored to be here. Awesome. And with that I will hand over to Esha and she'll ask you the first couple of questions. Yeah, thank you, Alex. So as Alex mentioned, you completed your MHA with Sloan's program at Cornell. So what initially drew you to healthcare management and how did your time at Sloan as well kind of shape your leadership style and your career ambitions going forward? Yeah, thank you. Thanks, Esha. So I started as an undergrad at Cornell in College of Human Ecology, which is a neat college that has these seven majors that seemingly don't fit together but actually do in a really unique way that once you drink the cool aid, you kind of can never turn back in. It's it's pretty great. But it's the seven majors around the human condition and one of those majors was policy analysis and management. That has now moved into the Brooks school where it's more around public policy. When I was a Cornell undergraduate student, it was primarily focused around microeconomics and policy. And when I started at Cornell in 2011, the Affordable Care Act or Obamacare had just been passed. And even though my undergrad was not meant to be in healthcare policy, overnight all of my policy management and economics professors became healthcare policy focused because this was the biggest kind of new policy in the United States and had broad reaching implications. And so I after a couple of years found that I had known a lot about healthcare policy and I was learning a lot about it. And as I was thinking, well, what do I do with a policy analysis and management degree as much as I've loved it? I looked around a lot of my peers were going into consulting, which just didn't feel like a fit for me. They were going into law school or they were looking at MBA programs and the like. And can't believe I didn't know what I wanted to do. I still don't necessarily know what I want to do. And Cornell is great in that you get to see so many different perspectives and you get to experience all the different schools and colleges. And you have a lot of latitude in that way. But it also means that you become super curious and it's hard to narrow down to what you want to do. So I had a peer at the time who suggested the Sloan program. I knew nothing about it. I knew nothing about Master's Healthcare Administration. But I went and talked to Julie Carmalt who at the time was both a professor and led kind of the recruiting and admissions for the Sloan program and health administration. And it was in that moment, it just kind of clicked. Like I think a lot of folks in my years through Sloan had a similar experience with Julie, but also with the program as a whole where it was like, okay, now I see like a career path and an opportunity and a passion for this, but I didn't know I had. And so that drew me to a Sloan program and I was able to do that in an accelerated fashion with my undergraduate degree. And the question about kind of how did my time there shape my style and my admissions? I think just like Cornell more broadly, the Sloan program gives you so much access to a variety of different disciplines and industries within the healthcare sectors. You get to know pharmaceutical industry or sector rather you get to know consulting healthcare providers, healthcare policy that it gives you such a broad range of topics that you can go into any one of those things. And any one of those things that you go into, you can then ask really well informed questions about that broad view that you may not have seen otherwise. So for me, that was one of the things I definitely took away from the Sloan program. Yeah, that's awesome. And as a first year, I've only been here for a couple months, but I can definitely agree to the the coursework that covers all of the broad aspects of healthcare. And then also the Julie story that you mentioned when I first kind of learned about Sloan's MHA program, a lot of students at the time kind of shared a similar experience with her. So it's definitely nice to hear that. So going more into your time as a research assistant. So while you were at Cornell, you were a research assistant in the Department of Policy Analysis and Management. So how did this experience influence your perspective on healthcare systems and policy? Yeah, another good question. One of the professors I really enjoyed learning from and working with when I was a student as an undergraduate was Dr. Rick Getty's or Professor Rick Getty's who really focused his work on the public sector and public private partnerships for things like wastewater treatment facilities, electrical grids, highways. He has, I believe, gone in front of Congress to testify around the post office or the post service, postal service. So he has broad ranging expertise in a lot of different public policies. And he taught a class that I really enjoyed and appreciated, but I didn't know at the time how much I would appreciate it. It was around corporate governance. And I actually didn't have to prerequisites for the class, but I remember going up to him and saying, I don't have the prerequisites, but this sounds interesting. And he let me stay on. And it really helps form, I would say, a good foundation of how corporations are structured, what their incentives are and how they operate. And for a lot of us who go into big hospital providers, that's not something we automatically think about. But the hospitals I've been privileged to work with, like Cleveland Clinic, like Mayo Clinic, are big corporations as well. And so having that kind of fundamental, like corporate understanding was really helpful. And as I got to know Dr. Geddy's, there was an opportunity to act as a research assistant with him and his team. And specifically around wastewater management and the funding of those programs through private part, private public partnerships. And I, they was so different from health care, but it, I think, helped inform, like, how our health care projects funded is very similar to what we were studying. And these massive sort of public policy and infrastructure policy topics that I would say were super helpful, although different to what I ended up doing around health care. Plus, he was just a great professor to learn from and work with and some of his collaborators as well. Yeah, definitely. I think policy is a huge aspect of health care. I know you mentioned the ACA happening at the time that you were in Sloan. And now we, we learn about that in classes as well. So it's interesting that you have that, that experience. So then following your graduate studies, you took on a graduate student catalyst internship at Freeman White. So what were some of the key insights you gained during that experience that kind of guided your next career steps post graduation? Yeah, this, I was grateful to have joined Freeman White, which, which no longer quite exists, but it was a consulting company within a broader kind of architecture firm. There was only one Sloan before me who had gone through that internship and who worked there and or who works there. There may have been other Sloanies before that had been through their internship, but it wasn't well known. And I felt at the time and if either of you at other times in your early career so far, I have felt this like I felt a little bit behind when everyone was applying for their internships. I was a younger student because I went straight through in an accelerated way from my undergraduate. And like the fall came around and everyone was applying for consulting jobs and inter internships. And I was like, I don't, I feel like I'm totally behind on the timeline here. And I knew very little about like what the options were, what I wanted to do. I was and I still am, I think, just kind of figuring out what I like to to a great extent. So all that means that I saw the, you know, the job description or never the posting for this. And I was like, oh, it seems kind of interesting. And I put my name in the hat and probably didn't totally understand what I was getting myself into. But I loved it. Basically, I was a consultant for a summer with the Freeman White team. And I was able to see a bunch of master facility planning across different hospitals and was actually able to travel with the team actually here to Austin to consult with a hospital system where I'm currently in Austin. And it was really exciting because I got to see architecture, engineering, consulting, master planning, all kind of come into overall strategy for a hospital system and where they want to invest their capital, both to improve current facilities and build new facilities. And what I liked about that was being able to see across clients and see these trends in healthcare. One of the questions we were looking at and I would say thinking about within Freeman White at the time and there continues to be a lot of thought leadership in this spaces. What does like the hospital room of the future look like as more cases are going to outpatient facilities or just outpatient cases. Our patients who are sitting in a hospital bed overnight are probably more sick than they were in the past. There's probably some statistics out there we could get. And so what does that mean for the hospital beds that were designing the hospital rooms that were designing? And there was a theoretical question we were trying to kind of tackle at the time which continues on to this day is like, what is there a space for hospital beds in the future and with hospital at home as an initiative in the US at the moment, you know, there's continued questions about what our hospitals look like in the future. So that was kind of fun to have a summer to question those things. I learned that I'm not sure I loved consulting personally because I felt like removed from what ended up happening in the hospitals. But I loved the broader questions about how you design your master facility plans and how you improve your current facilities while you build new ones and how you use data out there to understand how many hours you'll need in the future and how many beds. So I really enjoyed that and it probably set me up well to end up doing what I've done the last couple of years that I didn't totally appreciate at the time. Yeah, I would definitely say a lot of at least Sloan MHA students kind of go like down the consulting path or the fellowship path. So it's cool that you had that experience in the summer. And then leading into my next question I guess. So you ended up doing your fellowship with Cleveland Clinic post graduating from Sloan. So can you talk a little bit about how that program prepared you for the future leadership roles you've taken and also what stands out maybe as your most significant accomplishment within the fellowship too. Yeah, good question. I have very little idea how I was able to get the Cleveland Clinic administrative fellowship to be fair. It's like when you graduate from school and you're like how and then you look at the current people in the school and you're like how the heck did I get accepted into that school kind of thing. I remember when I was applying looking at the folks who were the current fellows and thinking like they're also accomplished and I just don't know if I'm going to hold a candle to them. Some super grateful that I had that opportunity. I really enjoyed the fellowship. It was intense 12 months, a lot of work. Cleveland Clinic's fellowship is very structured. You get a certain number of quality projects, a certain number of operational projects. And so it gives you this broad view of the healthcare system, which is what I was looking for out of a fellowship because I knew very little going into it. I didn't know where I would want to focus if I did end up working at a hospital. And because of that, you end up working on about 12 projects at a time, which essentially means you have 12 bosses. So it is challenging fellowship, but I would say it's well worth it because you come out after the fellowship feeling accomplished, feeling like you learned a lot. And so for me, I joined Cleveland Clinic as a fellow right when the organization had taken on a lease in a building behind Buckingham Palace in London. And knew very little about it. Obviously, there's a strategic decision internally at Cleveland Clinic and was just kind of getting off the ground. But I kind of put my hat in that I love to work on that if there's an opportunity and a couple of us as fellows had the chance to work on it and support creating a project management office. And so there were a couple of people in Cleveland working on this as a project and a handful of people in London on the ground as consultants working on it. And over the six or seven years, I was at Cleveland Clinic. I have had different roles in Cleveland Clinic London as an entity in a project, which I'm really grateful for. So in the fellowship itself, I would say another significant accomplishment. That is something super specific. But I really enjoyed was doing a lifecycle cost study of different floor types. So, you know, Cleveland Clinic has millions and millions of square feet across their different campuses and hospitals. And if you think about the square footage, that's a lot of cost you're spending not only on maintaining the floor that you have in public and less public areas and in clinical and nonclinical areas, but also selecting that floor type and how much the materials cost. And so there was a really visionary leader across the EBS area, environmental services area for Cleveland Clinic who had the thought that I, he's saying to himself, I feel like my team is maintaining a lot of linoleum floors more often than we should be. And if you went to any nursing unit with the linoleum floor, you saw, it looked like a skating rink because they were putting a ton of wax down on the floors. And his thought was if we put a different type of floor down like rubber, would it change the amount of time and cost that we're spending to maintain it? So we did a study to show or to see rather and it did show that rubber as a type of floor was going to be better on sound, better on the ergonomics for the staff who are standing on it all day. And you don't have to use as much material and time to clean it. And so what was cool about that was then it set the standard for the organization, moving forward in any new build that we would use rubber on the floors. It was really cool when we were building Cleveland Clinic London. I was walking around the construction and just seeing roles and roles of rubber flooring. And there's probably dozens of other people over the years who had implications into that or had interactions into that decision. It was definitely not me as a fellow, but to have a small part of that contribution was pretty cool. Both of those projects sound really interesting. I think, you know, especially being engaged in those as an earlier early career professional too, I can only imagine the learning that you got from that. So thank you for sharing. I'm going to hand it off to Alex who's going to ask a couple more questions, I guess, about your experiences after the fellowship until today. So okay. Yeah. Thank you, Esha. So Renee, one thing I wanted to touch on about Cleveland Clinic London as someone who interned at Cleveland Clinic this summer, we heard about London all the time. So during your time there, you played a pivotal role in activating the outpatient center and at 184 bed hospital. Can you walk the viewers through the challenges of leading such a monumental project during a pandemic and how you achieve success through that? Yeah, absolutely. And Alex, remind me, where did you intern with at Cleveland Clinic? I was in the neurological institute on main campus and then I got to do a lot of like remote projects with the team out in Las Vegas. So it was a lot of fun. Very cool. The neurological institute is currently working on a new building that should be absolutely gorgeous when it's done. Yeah. Yeah, Cleveland Clinic London, I was just so fortunate to have the opportunity to join that team really from the beginning of the project through to our first patient walking through the doors of the outpatient facility in the hospital. Which is so rare in a career ever to have that end to end experience. But also so early in my career, I feel really grateful that I had that opportunity because I think it was really pivotal for me personally and my own development, but also my career growth. I had a couple of different roles over the course of six or seven years from kind of project manager to chief of staff to the CEO, Dr. Brian Donnelly, when we were in London. And then the last role I played before I left was the head of activation, which essentially meant bringing the different teams together so that when we open the hospital, it was on schedule and it was in line with budget as much as possible and that it all went safely. And that was during the pandemic, it was during Brexit. And there were just a lot of changes through that time. I think the executive leadership of Cleveland Clinic Foundation turned over quite a bit in that time as well. We had a new CEO for the organization as a whole and his leadership team changed quite a bit. So the fact that Cleveland Clinic foundations board stood by that project and continue that investment, which was the biggest investment in its 100 year history, I think is something I feel really proud to be a part of as the long term strategic investment into a global brand like Cleveland Clinic. You know, some of the challenges we went from like 10 people in year one, maybe to 1100 people when I left. And so every year we were bringing on lots of new people. And every time you do with that change is the culture. And so trying to keep to the culture we wanted to create in the culture that was a mix of Cleveland Clinic's culture, but also the UK healthcare culture, you know, the United Kingdom has had healthcare organizations that are older than the United States as a country. So there's a lot of history in the UK that we wanted to pull in. But also we didn't want to lose sight of the core culture of Cleveland Clinic foundation. And one of the things I loved was, you know, as an American working with a lot of Brits, we would get a lot of like cynical, you know, I roll sometimes it's the way we say things. You know, Americans will say like, oh, that's awesome or just overly excited about things. And that's not that doesn't tend to be the UK way of expressing yourself. And so we would talk about the culture of Cleveland Clinic and get a lot of like, I don't know, you guys seem like a little bit crazy. But when my UK or English colleagues would go over to Cleveland and then they come back to London, you could just see the slate shifted them. They understood what that culture was about because you felt it in real time at Cleveland Clinic in Cleveland or Florida. And, you know, Alex, you probably have similar experiences in intern. It's just a really special place when you're there. So there were a ton of challenges around culture, speed, trying to recruit that many people. But one of the big things is keeping our culture and developing that through those challenges. Awesome. Thank you for that. Yeah, I would agree. It's definitely a special place. There's a lot going on more than you can keep track of. But it was it was a great environment to grow in and learn a lot for sure. And so I think, you know, kind of transitioning from that. I mean, you moved on from Cleveland Clinic and you joined Mayo Clinic as a director of strategy. So what were some of the major initiatives that you led and how did this role build on your previous experiences from Cleveland Clinic? To your point, Alex, there's so much going on at Cleveland Clinic back domestically and continued growth, you know, internationally, whether it was Abu Dhabi or London. That I could have kept my career at Cleveland Clinic and Ben happy and contributed and felt really grateful. I also felt like if I didn't look external to Cleveland Clinic at that time when the hospital in London was open, I might have missed my chance to learn external organizations. And as much as I love Cleveland Clinic, it is a very specific type of organization with a very specific culture. And I wanted to see what else was out there. So another Cornell Sloan alum Freddie, Terazus, he and I had kept up with one another. And he said, you know, Mayo Clinic's strategy department is growing and we have a really dynamic leader. Would you be interested and looked at a couple of the openings and fell in love with what they were trying to build. And of course, Mayo Clinic is a premier hospital number one in the world. So it's like, why not, you know, throw my hat in the ring. And so applied to the position and was able to to join Mayo Clinic. I mean, it's such an honor. And I really enjoyed working in the strategy team very different than the kind of semi operational role I was having in London when we were standing up. Plus a different operations. But I think having that experience in London helps me to know enough to ask good questions in the director strategy role. And it kind of confirmed to me that the strategy departments as a whole in healthcare providers and hospitals tend to be a little too removed from the day to day work. So what I loved about Mayo Clinic though was I was the strategic business partner to the Rochester practice. So I sat in the operational team meetings and I was in the actual Rochester campus every day when a lot of my colleagues were remote. So I really liked that aspect of it. You know, while I was there, there were a lot of changes to both Mayo Clinic and Mayo Clinic strategy department. The couple of leaders I was hired to either support as a strategy partner or who I reported through ended up leaving or moving to different roles. So it was very different than what I had initially really interviewed for. But what I was grateful for was the chance to see how Mayo Clinic works. Very different organization to a lot. But also very similar to Cleveland Clinic in a lot of ways as well around core mission. And that tri part type aspect of it. Again, another super special place. And then it was good to get some strategy experience that's kind of more core strategy while I was there. And Mayo Clinic was going through strategic planning of bold forward unbound in Rochester, which is a big capital initiative. And so it was great to see how they were moving to the future and what a hospital the future looks like. So I really enjoyed it. Great. Yeah, thank you. I think that's very insightful and I think that gives me a lot to think about too is, you know, you kind of reach a point in your career and you used to start to think what would. What could I learn externally outside of the organization that I was homegrown and so I think that's definitely a good thing to think about. And as you mentioned, so you transferred or moved out of Mayo Clinic and transition to NYP. And then I went back into a director of project management and activation role. So during that time you led the activation of the 1111 Westchester Avenue outpatient building and implemented the hospital at home program. So one, what was your motive or thinking behind transitioning from the strategy role back into an activation role. And then what was it like managing such innovative and large scale projects in New York City at that time. Those are good questions. You know, I think a lot of the opportunities that come our way in this sort of work are through the relationships that you have. And so this one was one where Dr. Brian Donnelly, who had been the CEO, I worked closely with in London, had moved on as currently the chief operating officer of New York Presbyterian Hospital. And there were several new capital initiatives, one being this 1111 Westchester Ave, Inflatory Surgical Center and outpatient building with Columbia doctors. And several other kind of strategic initiatives. I'm from upstate New York close to Cornell. And the opportunity to be a little bit closer to home was enticing. The opportunity to live around New York City was also enticing. I had known and worked in that really admire and love Dr. Donnelly's leadership style. And that was also a motivation. And then on a personal side, I had gotten divorced when I was in Minnesota. And so didn't know anyone in Rochester, Minnesota, which is a small town. And so the opportunity to move to New York was like, okay, yeah, this sounds really exciting. So it was, it was all those factors that led me to go back into this like project management activation role and feel bit closer to like the action of building something new again. And so I enjoyed it. We were working on this really innovative ambulatory surgical center and outpatient clinic that was in an existing building, which was different than London, even though in London, it was an existing building. We pretty much demolished the whole thing from the inside out. This we were really renovating in white planes, New York, just north of New York City. So it was kind of cool to see like a renovation versus a what's called the Greenfield project. And it was with Columbia doctors, which is one of the two academic partners for New York Presbyterian Hospital. And historically Columbia doctors and New York Presbyterian Hospital haven't built as much new capital initiatives over the last couple of years. And so it was an opportunity to be somewhat of a legacy around what we're doing for the future innovation of that space. And then I also lived in Westchester when I was there, just north of New York City and had been, you know, patient myself and seen that there was an opportunity for more access, more providers in this space as well that really were integrated across a bigger healthcare system. So I really enjoyed that. And then the hospital at home program was really interesting. New York Presbyterian Hospital was looking to launch a hospital at home program. And there are a few in New York state, but not that many. And even across the US as a whole, there are only a couple of really well, I shouldn't say a couple, but there are many hospital home programs. There are a couple that are doing it at a really larger scale, mass general, clinical, Mayo Clinic, all come to mind that are doing a relatively larger scale of hospital home. And so it was kind of interesting. It was taking a lot of the skills I had around project management and activation, but transferring it to like a clinic or a digital sort of environment. And how we bring all the things that happen in the brick and mortar facility in a hospital to someone's home, everything from like food, because if they're a hospital patient, you still need to provide them food, even if they're in their home. And how you manage like them getting up in the middle of the night and making sure that the patients are falling. And remote patient monitoring and how you keep track of that data. So there were a lot of aspects to it that I kind of already knew, but was able to put into a different format and then other aspects that I learned. And so anything where I can learn, I feel like is where I'm probably happiest. Sweet, that's a really insightful answer. I hope I can take that into my career and never never be satisfied with where I am and always wanting to learn more. I think that's crucial. And then, you know, to the current, you've recently stepped into your role as executive director of program delivery at Del Medical School. And I know Travis Laird recently became the COO over there. He was someone that I got to talk to quite a bit at Cleveland also, so really valued my time with him. So that's kind of how I became familiar with Del Medical School. But what excites you most about this new position and what impact do you hope to make during your time there? Yeah, good question. So I'm only maybe six or seven weeks into my role at Del Medical School at University of Texas at Austin and loving it so far, but another big move from New York to Texas. And so I'm still like, okay, I just got my driver's license my license plates. I'm still settling in, but it was nice to get my license plates in the longer have that I'm an East Coast target on my car. As I was driving around. So still getting settled, but what attracted me to Del Med was the opportunity to build something new again. And I had worked under Travis for many years at Cleveland Clinic and actually he was one of my first interviews when I was interviewing to become a fellow. And just really admire him and have a lot of gratitude for his development of my career and me as a person can't say enough nice things about Travis. So it was exciting to work with him again. And ultimately work on something brand new. We are building an academic medical center essentially. And we have a space here at the UT Austin campus where we're going to build a new center, which will be a hospital plus a lot of other exciting initiatives on that center. And right now, down medical school is about a 10 year old medical school. It's relatively new. We're about 1500 people. And we want to move to both a medical school and running a hospital. And so it's a big cultural shift to big operational shift. And it's a lot of change a lot of new people over the next five years. And I'm really excited to be part of that and kind of that like uncertainty a lot of work coming up makes me kind of excited. I get maybe a little bored quickly if it's something that's not slightly challenging. So all of that was enticing enough to come down and move to Texas and excited to see where we go. That's awesome. That's awesome. I'm super excited for you. And I hope that you know everything works out and I'm excited to follow your journey and see what see what happens. I guess I'm like a personal note for for myself and other listeners out there. I like to ask as many people this is possible. So when I'm transitioning from a student and I'm going to be in like my first full time role ever as a fellow. What advice do you have for me and for people in my situation who are about to transition, you know, how can we make the most of our fellowship to come out of it and be placed into that managerial role or director role or whatever it might be. And how can I take that year, year and a half period and just learn as much as I possibly can like what advice do you have to be as successful as possible. Yeah, that's a big question, but a good one. I mean, it's just one opinion. So, you know, take with it, Green Assault and make sure that what you're doing is true to you, but I would say what comes to mind for me and I didn't necessarily do all of these things right. And so some of it's in retrospect. I think the number one is relationships. I think are so key and important and as you all, as you both know, but as all the listeners probably know too, health care is such a small world that the folks I interviewed with at other fellowship opportunities. I am still in contact with they've moved on. I've moved on and we are still part of the same network. So I would say focus on relationships as much as you can. And you have such unique opportunity when you're an intern or a fellow that you can say, hey, I'm a fellow. I'm here to learn. You can go out to lunch, coffee with anyone, ask any question and it's totally okay. And even when you're new in your career and not a fellow, you can do that too. So I would prioritize relationships as much as you can get to know people not only on a professional level, but a personal level just makes for a lot more fun. And I think those relationships will just build on themselves over time. I would also say that there's a quote that I love. I think it's attributed to like Louis Pasteur, but it probably has roots far before him that says something today. Let luck find you prepared or something like that. And so you will have so many opportunities currently as a slow and student as a Cornell student, but also as an intern and fellow wherever you are that you'll be so lucky to have these opportunities, but make sure you're working hard in the background so that you could take advantage of those opportunities as much as you can. I mean, go easy on yourself because there's a ton you could do, but you know, when you're meeting someone new for the first time as a fellow, just do 10 minutes of research and kind of get to know their backgrounds that you're coming into the meeting informed you can ask good questions. You know, plan out your agendas in advance, send out notes after the fact, and then like really put your bus foot forward when you're there. And that will speak volumes to your continued reputation because you are starting your reputation somewhere. So I would say yeah, hard work relationships and start that reputation on a positive note because it's such a small world, but also like have fun, go easy on yourself and reach out to slow and alums, but anyone if you need help because we're all more than willing to pitch it and see what we can do if you ever need anything. Thank you that's really good advice I appreciate that I really appreciate the inside about like taking meeting notes and sending them out after like it really you know from things I've heard to similar to yours is like those little things can really make the difference. Yeah, when someone's looking at who do I want on my team so that's that's great. And that whole Sloan network of communication is with something that was really sold to me when I was applying here a couple years ago and it's stood true like no Sloan is ever not been okay having a call or not responded to me so that network is really something I'm going to lean on going forward and I just wanted to give the floor to Esha she wanted to ask you one more question just to kind of round us out. Yeah, so to kind of close out the conversation you know you've shared a lot of great advice from all your diverse experiences a lot of our listeners are early career professionals or even M.A. students so what is something I guess going back to your time with Sloan and I guess your undergraduate graduate time in general what is one thing you wish you knew that you would like to share with our audience. So good question I feel like it's so much it'd be hard to distill it but you know one thing I discovered more recently that I'd love to pass on as a kind of a thought to think about is volunteering. So it's something I feel like I've always had some element of but I haven't spent enough time doing it until recently in New York I spent a couple of hours every week volunteering at horseback riding barn for therapy you know therapy horses and it was such a great opportunity to get out of my head get out of work. And just kind of put myself in someone else's shoes and serve and I think sometimes in the world that we operate in a lot of it is what you can add to your resume and what you can do and show and contribute and move forward and that's all great and I do that as well. But the opportunity to kind of take a step back was just so rewarding personally and I think I learned a lot about the environment I I live in both physically and socially. And the folks that I worked with all need health care because we're all patients at the end of the day so it's good to learn about you know how they access health care and what I can do better as an administrator in a kind of servant leadership role. So it's not something necessarily that you have to do consistently but I think as you move into you know your second year your first year out of school your 10th year out of school just considering like how you can give back in those ways because often you get a lot out of it anyway yourself. But it's something I wish I had started a little bit more I guess dedicated a little bit earlier and now that I have everything pretty much settle here in Austin i'm going to look for an opportunity to do that soon too because I kind of miss it so that's something maybe to think about. Great I love that hopefully I can start to do that to take the first couple of months like you said is kind of get adjusted to new new environment and then you know you can try to focus on things that you're passionate about and start to give back so that's that's great thank you. And also just a huge thank you for this incredible conversation it was amazing I definitely took a lot from it and I know our listeners will too so thank you for making the time for us and we really appreciate it. Well i'm going to make a joke Alex that when you're a fellow your salary is so low with that that's like volunteering but it's it's totally joking it's. You're not wrong you're not wrong I hope it will pay off one day that's what I always hear so hopefully that's the truth. That's right well thank you both for your time in the thoughtful questions it's great to see Sloane is doing well and wish you guys with the best if I can help with anything let me know. 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