Well, good afternoon, everybody. Thank you for being here today. So we're going to go ahead and get started. My name is Aisha Rivera. Again, I want to thank you for being here today, for joining us for this talk. And I'm joined here by my colleague. Hi, Pam Kral. And so we're going to first begin by introducing our talk. If it's not obvious, it's up on the screen. Adapting to the Future, which is a very timely, kind of goes with the theme of the conference. We're going to present to you a framework analysis for analyzing external factors that may impact the field of occupational medicine. Can everybody hear me okay? All right, great. So the first thing we want to do is start with a little disclaimer. The contents of this presentation do not represent the views of our employers. So let's begin by talking a little bit about the field of occupational medicine. And I imagine that if you're here in some way, shape, or form, you're in occupational health. I think it's really important to step back and contrast occupational medicine with other specialties within the house of medicine. When we think about occupational medicine and what we do, we're really focusing on a target organ that is ever changing. So I'm talking about work and workplaces, right? It's not like the heart where the heart has four chambers, four valves for as long as we've known and we've thought about the heart. There may be new procedures, new medications, but it's not like, you know, we're working the same way that we did a hundred years ago, for example, right? And to further visualize that, we have some images here, which are two sort of juxtaposing the workplaces in 1909 and 2020. First thing I want to point your attention to is that they're doing very similar tasks, right? They're working in some kind of textile plant. But look at the workers in 1909. Those are children, right? Look at the worker in 2020. The machines have some similarities, but the worker now, right, this is a much older gentleman performing this task. So we're talking not just about the changing workplace, but also the change in the workforce. And there's been some recognition of this from our colleagues at NIOSH, right, that the rate of change seems to be ever increasing. This is a quote from a 2002 publication, revolutionary changes in the organization of work have far outpaced our understanding of their implications for work life quality and safety and health on the job. And then again, we see in 2020 that these continued developments are just speeding up and the research can't keep up with the pace of all of the technological advances that we're seeing. So we must continually adapt. We have to, I'm going to transition now to Dr. Crawl here. Great. So I think, you know, as we, you know, just saw, we have some unique challenges for our specialty in trying to keep up and to maintain relevance and to adapt to both the changing workplace, the changing nature of work and changing workforces. And it requires kind of the looking both inward on our specialty and how advances in medicine may be applied, but it also requires looking outward at the changes around us. So we have three goals in this talk for you. First, we want to introduce a framework that can be used for considering change. Second, we'd like to build a description of changes that are relevant to occupational medicine kind of in the big picture. And I think you're hearing this throughout this conference in a lot of different ways, but we're going to try to kind of pull that, some of those together. And then last, we, number three, we want to let you have a chance to apply this framework called the PESTLE framework to an area in which you practice to try and kind of build what you would see as a plan for how to adapt to what's going on and what's changing. So as President Eisenhower said, plans are worthless, but planning is everything, right? You can, it's going through the process, I think is what we want to emphasize, helps you think through the issues and be able to at least understand them enough to be able to adapt where you need to. So the PESTLE framework, I must say you'll see this alternately as P-E-S-T-E-L or P-E-S-T-L-E, depending on where you look. But this was initially developed as for corporate strategy and it's an analysis of those external factors that may influence your business. It's often been used in conjunction with the SWOT analysis, so strengths, weaknesses, opportunities and threats, where the opportunities and threats really mainly reflect those external factors that may influence on your business. So the PESTLE framework really, it's very loosely defined, right? It says methodology, but I think I've seen it applied, you know, if you do a look, you'll see it applied many ways to many different things. Everything from, you know, utilities needs to different companies and also in the medical literature, but the first step is really to kind of do a broad intake of what those different external influences are. And from those, figure out which ones are most important to you. And there can be any number of ways that you can get to figuring out what those external drivers are, the external influences are. Industry reviews, news scans, focus groups, you'll see a myriad of ways. And then also for selecting the key drivers, you know, I've seen everything from a matrix to score things out to expert opinion. So there's no set way to do this, but the basic idea is that you do a brainstorming almost of what those external influences are and then you pick out the ones that are most important and you categorize them into the different pestle areas. Then last, if there's a lot of uncertainty and your crystal ball is very murky, then you can go ahead and say, well, it might go this way or this way or this way and here's what we would think about doing in each of those instances. So as an example, with some colleagues, we did this looking at military occupational and environmental medicine. And you can see what we felt were the key drivers there. And when we really talked it through and looked at it, we landed on two areas that we thought were really, really the most important for us moving forward. So it all centered around the changes going on in the military health system and also the possibility that it would change our workforce structure within occupational medicine as a result of that. But we weren't sure. You know, there's still a lot of uncertainty of how that is going to go. So we came up with three different possible future visions, including everything remained unchanged, an increase, so perhaps an increase of folks in uniform, and then finally a decrease. And then we went through and came up with, well, what should happen in each of those areas? So the things that we felt should happen for the status quo also should hold true on either of the other future ways. It was basically ways we could do our own business better within where we are. And then if we were so fortunate as to be able to increase in our uniformed, you can see what we would plan to do. And then if we were faced with decreases, again, you know, what would we have to do to be able to keep moving forward? So that is really an example of potentially using this type of framework to systematically go through and work through those. So next we'll roll into just what we kind of came up with as some potential key drivers. And we chose to just use a news and a literature scan. And I will tell you, there is a lot and a lot and a lot out there when you do a search to look at this stuff. So this is not meant to be all encompassing. This is really meant to get your juices flowing, so to speak, and to have an idea of ideas because we're going to get you to kind of work through doing this analysis for an area where you may work. Or if you don't want to do, if it's something that you've already seen and you want to try out something else, we'll partner you up with someone else to learn about their area. So political, you know, there's a lot going on right now in that realm, particularly in two areas that seem important. The social safety nets and discussion about that with the changing in the workforce to include more contingent work or informal work, non-employee work, you'll hear many different names for it. But basically, you know, not the traditional employee-employer relationship. So social safety nets are definitely one area that we saw a lot of news about. Second, centered around the fact that with the rapid pace of change, what a worker is trained in initially is their training probably will not be enough to get them through their career without needing additional training somewhere down the road. Retraining is a big issue. The half-life of skills now is so short that the perishable nature of training is important as well. Twelve states now have tax credits to employers who will sponsor apprenticeship programs, which is interesting because there had previously been a shift kind of away from the trades, but there's also now the infrastructure bill and additional government investment in infrastructure along with the need for workforce retraining. Those may interact. And then last, kind of on the regulatory and rulemaking, of course, you know, heat hazards and climate change, OSHA has initiated some rulemaking there. Just on the economic, what we saw, again, it comes back to some of the distributed contingent non-employee workforce issues. So all of these will overlap, right? It's not a hard and fast where you might put these. But you know, that and working from home, the strategies to prevent burnout, definitely a key. And then globalization. So globalization has enhanced disparities and disparities especially around the workforce and occupational safety and health is also big. And then one other one. We've moved toward more of a green economy and we have new technologies related to that, but there are also new hazards that can come along with some of these changes in where we are. So this is a wind turbine and this is the nacelle where they do the maintenance part on wind turbines. And there are actually, you know, many new kind of ways to injure yourself with some of these new types of work. I don't think I'd be very good at doing that myself. All right. So we've gotten through the political and economic. Let's talk a little bit about sociocultural. So you know, we talked about the changes workforce in the workforce and you know, child labor back in 1909. Well today, you know, our workforce is definitely shifting. So millennials are now half of our workforce. But not only is that the case and that the generation has shifted, but the range of ages of our workforce has tended to increase as many folks are staying and working into older ages. That has in some ways led to more looking at the overall well-being of employees and trying to keep people gainfully at work into the older ages. Social justice has certainly been a key area, just especially in the last couple of years of increased awareness of inequities is huge. And then finally, burnout and work stress. You know, with COVID-19, it's like the whole, you know, planet is kind of gone through an existential crisis of trying to look in and say, hey, what, you know, what really matters to me? Does my work matter to me? Is this the work that I want to be doing? And, you know, a record number of Americans left the workforce between April and September of 2021. You've seen maybe the term, the great resignation. But you know, it's perhaps beyond that, 40% of workers are reconsidering or thinking about changing their job to look for more flexibility. And then also, well-being programs, 45% of well-being budget increases have been reported to be for mental and emotional wellness programs. So kind of recognizing the amount of stress that is on our workforce is huge. And perhaps interrelated with that is the increase in union activity that we've seen. Perhaps those looking for a better work life. So as I mentioned, that shift away from trades may be ending with more of a move toward apprenticeships and rebuilding the infrastructure. Certainly, that desire for flexible work is there. There is some, you know, suggestion that women and underrepresented persons may be more inclined to want to work from home, to have more control of their workplaces and perhaps avoid, you know, workplace bullying or violence. In the homestretch on these, technological, well, technological is huge, right? You know, everything from artificial intelligence to automation and loss of jobs and the concern for loss of jobs is certainly important. Not just in other fields, but even within medicine, right? You know, automated reading of radiographs, mammograms, the tsunami of data, right? It was estimated there's nine times more data kind of pouring in in the past two years than previously. So the people, the attachment of people to technology, so the metaverse, and then wearable sensors and the internet of things, among many others. If you kind of look within our specialty, I know we're supposed to look at external influences here, but some external things that could make us change, telemedicine and certainly needing to be able to adapt to practice in that realm, and point-of-care ultrasound has been around for a few years, but also picking up speed. So you know, automation kind of back to that fear of potentially losing jobs. On the balance, the public says automation is worse than it is good in this one survey, but then again, if it's to replace a bad job, people are all for it. So there's a little bit of a mixed view on this. All right, so environmental, you know, of course climate change is really at the forefront of so many people's minds today, and you know, you can see a lot about that everywhere. But I would point out, you know, we're developing more and more sophisticated warning systems for environmental assessments for everything from harmful algal blooms to air pollution. So definitely a lot of advances there, and the awareness of the population at large about environmental concerns continues to grow. And last, on the legal front, with this burgeoning amount of data that's available, concerns about privacy and cybercrime are definitely top of the list. So you know, definitely new legislation there again, kind of back to political, but new legislation on data and privacy definitely expected. So I'll hand it off now to Dr. Rivera. Thank you. So we also wanted to pause and get some input from our colleagues, right, because we know that there's not a ton published in the literature about this specific question, because we're really thinking forward about the future and how things are going to change. We wanted to get a sense of what the folks within ACOM thought, and we asked for permission and sent an informal survey to the ACOM sections. We held two focus groups to try to get additional input that way, and hopefully, you know, foster discussion around these topics. We asked five questions in the survey, and we asked four questions during the focus group. So we had a small number of responses, 72 participants distributed among the sections that you see listed here, with the majority being representative from the medical center occupational health section, corporate medicine, and FedMil, and that represented about 54% of the folks who responded. So walking through the survey responses, again, there were simple four questions, and individuals were asked to identify whether the biggest changes coming to OEM fell within a particular category, and you could choose more than one category. As you could see here, most of the folks who responded identified political and economic categories as the areas where they thought the biggest changes would be coming to our specialty. Interestingly, the comments, there were 26 total, and they kind of fell within themes. We tried to group them by themes, kind of challenging, because comments were, they were very different, but it seemed like there were three sort of themes that came up within these comments. One, the need to change or improve funding for residency programs. Two, the idea of the changes to work in the workplace, which sort of, it was interesting because it kind of validated the results from the news and literature scan. And then finally, there were comments around the idea of the polarization and the politization, right, of medicine and science and the devaluing of the expert. Now, when we looked at what folks said for opportunities for OEM, there wasn't really as strong a consensus for categories, but it did seem to flip to environmental and technological. And the comments where folks thought there would be more opportunities or important opportunities for our specialty were centered around total worker health, health, well-being, and sort of the importance of that and how that's been highlighted during sort of the pandemic, right? We've been living in that. It's a reason we haven't seen each other in a couple of years, and everybody's really excited to be here. And then, again, sort of the idea of residency funding and having our voices in the right places so that we can have an increase in visibility. In terms of threats, again, we see sort of this consensus around political and economic being the biggest threats to OEM. At least that was what was felt by the individuals who responded to our survey. We know we had a small sample size, and in no way do we expect this to necessarily reflect everyone's views, right? But it's a place to start. It's not the finish line, and hopefully the beginning of more conversations and future strategic planning for our specialty. And then comments around the devaluing of science, right, and not having a voice at the table. There's also a sense of, are we being replaced not just by non-physician providers, but also artificial intelligence? And robots, et cetera, right? And again, residency funding kind of came up again. And then needs for OEM. There was, again, sort of this consensus around economic being the most important sort of category. And the comments, interestingly, focused on the idea of making sure that we're getting noticed, right, and that we're getting recognized for our contributions as OEM. And then creating alliances, not just within the House of Medicine, but also with other disciplines who may be able to help us sort of better communicate our value. And so when we took these questions to the focus groups, we didn't have a ton of folks come to the focus groups, but it was really interesting. There were four individuals who came to the first focus group and one individual who came to the second focus group. So we grouped the themes, right, that came out of that. And under opportunities, there was some discussion around making sure that everyone can concisely say what OEM does, right, so that there's no question what an occupational environmental medicine or occupational health doctor does. There was also conversation around making it easier for folks to get into occupational medicine. So as you know, there's not really direct entry from medical school into occupational medicine. You gotta go do something else, and then you gotta go figure out how to get into residency after that. And then some conversations around legal changes. And even though initially our scope was for the U.S., we had some Canadian colleagues come, so we wanted to make sure we reflected their voice. There are two changes in workplace bullying and harassment. And I think there's so many social cultural similarities between the U.S. and Canada that's relevant here too. And then opportunities in the space of remote work and telehealth. And actually, I was really happy to see that there's actually a session planned that's gonna be talking about telemedicine and whatnot. In terms of threats, there was conversation around the sustainability of the specialty. If we think about, you know, there are a lot of individuals in occupational medicine who are retiring, and we only have so many residency programs with limited funding. We, on average, graduate two residents per year from the majority of our occupational medicine residency programs. And then thinking about the changing nature of the workplace and the idea of artificial intelligence. Again, it's sort of the possibility of being replaced and that being viewed as a threat. Changes related to the metaverse and how is that going to work with people being attached to tech? Are we gonna have two separate societies? People kind of connected to the metaverse and living next to Snoop Dogg or whatever it is, right? Like if you purchase land in the metaverse or whatever. And then the workforce aging and the challenges around the older worker. And then the generational differences, right? So Dr. Kral mentioned earlier about 50% of the workforce is now comprised of millennials. The oldest millennials are 41. If you go by how Pew categorizes the millennial generation, is anybody born between 1981 and 1996? And then some questions around how workers comp might react to the remote work environment and whether or not those claims are going to be accepted as work-related, et cetera, and how we'll expect to see those things come out in the next few years. And then needs, which I think, you know, it's always important to think about what do we need to do now, right? So that we're ready later. So there were conversations around capacity building and the importance of making sure that, you know, we're not just focusing on folks who are coming out of residency, but also folks who are further along their career in occupational medicine and making sure that they have the skills to be able to keep up with technological advances and things of that nature. And I think that's really important and kind of piggybacks on. It's sort of interesting. I almost feel validated, like the focus groups validated some of the information that we found in the news and literature scan. But Dr. Kral was speaking earlier about the half-life of skills, right? And how, you know, that they're perishable, right? So you need to make sure that, we need to make sure that we're, you know, training and retraining as lifelong learners. I think, you know, we're very familiar with that idea, but really making sure that we're providing the trainings that folks are gonna need to be able to keep up with some of these technological advances. And then working with other disciplines and partnering with other specialties. And so as we transition sort of the third part of our talk, I just kind of want to summarize, you know, some of the points that we've made to this point in the talk before we break off into groups and have you guys do the framework analysis or sort of a very brief framework analysis, right? So the first thing is we want you to kind of walk away with understanding that this tool exists and then really think about how you might be able to implement that in your own practices, right? And so the PESTLE framework is this tool for analyzing external factors to our specialty. It's been used in the corporate world as a way to inform strategy. And then with that, I'm gonna go ahead and sort of describe the instructions for the sort of the interactive piece. So each of you should have a handout. What we would like for you to do is to break into small groups. It doesn't look like there's too many folks here. Initially, we thought that we would do it by row, but since the rows are not full, maybe we'll do by two rows. Does that sound good? Maybe by three row, two rows, let's do two rows. Okay, so you should have groups about four or five people. If possible, if you can stick with a particular industry or sector or if a particular practice, so if you practice in corporate medicine or if you practice in the government, if you can sort of find folks who are similar to you in the type of work setting. And then we want you to work through the exercise of really thinking about what you view as the key drivers for your particular practice setting. And then work through a scenario similar to how Dr. Kral showed you, thinking about the staffing situation and how that might change in the military. And then we'll take volunteers at the end to sort of share what you guys have come up with. And so I'm gonna go ahead and put up the worksheet here and did you have anything else to add? Yeah, just I would say that you can see if you try and apply this to everything, it's very, very broad. So it's a lot easier to apply. That was why we were gonna ask you to try and think about it in either your context or maybe partner up with someone else who works in a different area that you wanna think it through with. Because it's really hard to apply across the entire specialty. It's a lot better to focus it in on maybe your particular industry or your sector that you work in. So let's see, right now it is 4.17. Or sorry, 2.17, so I'm looking at Eastern Standard Time. Little jet lag there. So it's 2.17 Mountain Time, 4.17 Eastern Standard Time for our friends virtually. So if we can sort of regroup in 10 minutes? Yeah, 10 minutes. Okay, all right. So if we can take 10 minutes to kind of work through the abbreviated exercise and then we'll take some volunteers. Okay. All right. I'm gonna go ahead and move the mic a little bit back so it doesn't pop every time you're talking to me. It's okay to have a little bit of distance. Yeah, yeah, thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Oh, great, thanks. Thank you. Thank you. Thank you. Thank you. Thank you. I don't know. I can go a bit off, but okay. Thank you. Okay. I'm gonna put it on the chat. Thank you. Oops. Okay, guys. So we just wanna give you a minute or two to wrap up. It's been about 10 minutes. It's on pause. It's on pause. It's on pause. It's on pause. It's on pause. It's on pause. It's on pause. It's on pause. It's on pause. It's on pause. It's on pause. It's on pause. It's on pause. It's on pause. It's on pause. It's on pause. It's on pause. It's on pause. It's on pause. All right. Well, thank you so much for taking the time to connect with each other by practice area. We want to bring your attention back to the talk and really give us an opportunity to hear from the groups and what you've come up with. So we're not necessarily looking for every group to present and I know that some may be shy and may not want to speak, so we're not gonna put anybody on the spot, but we would love to take some volunteers if anybody wants to maybe walk us through what they came up with. Again, we're not expecting this to be like a publishable. Or even your thoughts in general on thinking these issues through. All right. So we really, so the topic of consideration was telehealth. That was the scope. We really only went down the key driver, so we didn't necessarily explore it further into step two and step three. But I can walk you down more or less where we were. So political, we felt that there is much political interest in expanding access to care, particularly in rural areas or areas that are underserved. We also felt that there is recognition of the changes in workforce dynamics and that telehealth perhaps can capitalize on those changes. Economic, we looked at this in two lenses, one as a provider and then one also as a patient. We felt that certainly for health systems, there's a potential for cost savings with employment of telehealth, particularly if you find, if you're a health system in which you don't have necessarily access to onsite specialists, you can then remote those individuals in. For patients, certainly there is, there's an economic incentive in many ways in that they don't necessarily have to alter their schedule so much to make an appointment. They have access to care from wherever they are. The cost of the visit may be less relative to a visit that's conducted in-house. Social, some perceptions here depends on who you are, whether you're the healthcare provider or you are the individual receiving the care. For a healthcare provider, perception may be this would be really ideal in a way to augment the practice and have greater reach to the scope of individuals that need the service. At the same time, there could be a perception from patients that perhaps that the standard of care is not ideal relative to being inpatient inside a health clinic, being touched and examined as we customarily do with the normal paradigm of medicine. Technology, the question arises whether there's parity in access to different technologies. For example, if you're the patient, do you have Wi-Fi, 5G access, the appropriate cellular phones, laptops, computers, all that sort of thing, video access to receive these telehealth visits. And then also on the healthcare system side, is there adequate equipment and preparation of healthcare staff to use that equipment, acquire the equipment, and do they have the electronic health record to support video telehealth visits? Is that actually tapped in and integrated with diagnostic orderings and prescriptions, the prescription system? Environment, we thought, well, a lot of less people moving around, so maybe helps the carbon footprint. And then also, perhaps you have less infirmed individuals out in social and public potentially transmitting things or where they shouldn't be doing so. And then legal, it's the issue of privacy laws, record keeping, recording laws that are associated with these type of visits. So that's how we kind of broke it down. Like, you got through step one very nicely on that one. Great, so what did you think about going through that as an exercise to kind of think through the different aspects of the topic? It was pretty smooth and very helpful. It helped kind of organize and guide the thoughts. All right, yep. And I'll just say, and also I think that it really facilitated focus in areas that ordinarily we wouldn't be accustomed to reviewing and considering in this type of analysis. Great, thank you. Would another group would like to offer something? Oh, Dr. Mullinax. All right, we don't have quite as much detail as that group, but our analysis we did, so my group of four folks were all in Navy Occupational Medicine, so we did Navy, Oc Med. The key drivers, we said, from the political standpoint is the transition to the Defense Health Agency, which is a really monumental shift in how military medicine does business with the huge effects downstream. The key recommendation there being to make sure that Oc Med has sufficient input at the higher level, that somebody is representing us, that we have kind of adequate stakeholder representation there. Economically, the key drivers we talked about, two things really. One is the cost-cutting mission of DHA, which is Military Medicine General. There's an intense kind of push to cut costs. And then also inflation, which our pay, military pay is not indexed to inflation at all, which creates some potentially skewing of pay toward the uncompetitive side in the military. For social, we kind of came up with something we thought would work, which is kind of, this is kind of Oc Med, I think, in general, but some of the lack of visibility among our medical colleagues of what exactly OEM docs do, which is, I think, it's important for our medical colleagues to be able to advocate for us. So that's always a challenge. Technical, technological key drivers probably, we thought number one for us is the EHR and how we interface with the new, the military has a new EHR called Genesis, which is continuing to be rolled out, really. And then environmental, we thought one of the key drivers is gonna be the fallout and kind of the Navy's response to environmental catastrophes like what happened at Red Hill in Hawaii very recently. And it's unclear, I think, what the long-term response is gonna be to that, whether we kind of beef up public health in response or whether we kind of address it as a one-off and then move forward without structural change. So we didn't really get to the legal category, but that's what we came up with. Thank you, ma'am. Thanks. For you guys, any thoughts on using the tool or recommendations, anything else? You good? Okay, so another comment or help focus? Yeah, help focus. Okay. I'm doing this for this one. I'm just down there, you know. Okay. Anybody else? All right, Dr. Barrett. We can team this, is what Tim's telling me. We initially had a difficulty focusing in on the topic. All four of us are affiliated with the federal government and federal physicians in one capacity. And we ended up going with the federal medicine from an environmental perspective, environmental medicine as an overview. And then from the political side, we talked both about the executive branch and how that changes potentially every four years and then those drivers really guide what the focus is. And then, of course, also the legislatives of the Congress. And Congress is our funders, but also their interests. And talking about right now, environmental medicine is a good place to sit because there's a lot of bills and a lot of interest, both from the executive branch and from Congress right now. And that's driven by community support. So there's a lot of community support as it relates to environmental issues, which we'll get to when we get to social. And your handwriting is actually better than mine, Tim, but I didn't write it, so I'm not sure if I missed something. On the economic, we did talk about inflation as a general topic and how that certainly drives a lot of items. And then budget and the uncertainty of budget year to year. Different agencies have different budgetary constraints or right now, if you're in environmental medicine, it may not be a bad place to be. And then another budget discussion was we plan and then go to people and say, you gotta fund it. And if I get that wrong, please let me know. We didn't talk about societal issues too much, except really in the overview of, environmental issues are important to the community or to the nation right now. And we've talked at other junctures in this conference of the focus on climate change and social justice. And again, those kind of lead to a focus in environmental medicine. In terms of technology, I think we talked primarily about the ability to assess environmental change. And I think from the individual and then from the environmental level and some limitations in being able to assess environmental output or outcomes. We didn't talk about the environmental specifically as an item, because that was the general overview topic. And we didn't specifically talk about legal, though it gets back to, we have the constraints of the federal government system. So, both maybe some advantages, but also the constraints and what we're able to do. Others? I can't read your handwriting. I can't read my handwriting. Okay, so that kind of sums it up. Great, thank you. Thanks. So, a chance to kind of try this out. We've had kind of three groups that were more on the federal military. Anybody have a different spin that wants to give a go? So, we also were kind of slow on startup. And as usual, we're a very disparate group. So, we decided to concentrate on corporate because two of the group is just kind of beginning in Achmed. One is in mining in South Africa, and I had done 20 years with Canadian Pacific, which is based mainly in Canada, but also in the US. So, we didn't talk a lot about political because it varies so much from country to country. And workplace regulations are very different in Canada than the US, and so are environmental regulations. But on the corporate side, with COVID, a lot of companies were hurting. So, there were furloughs and layoffs, and then you're trying to bring people back who haven't worked for a while, and maybe their skills have dropped off. So, how do you assess those? You have to do a new return to work exam, and in some cases, you do. It's also hard to find workers because, as you said, a lot of people have left the workforce. And so, how do you keep the company running? How do you keep the mine running or the trains running when you don't have the workforce you need? But it's essential industry, and you have to keep running. The essential workers that are running the mines and on the trains had to keep working, but the office staff were remote. And so, transitioning back to training, working in the office. Technology, I think, has helped that you can share information more easily. There was always, even before COVID, a lot of training and meetings done remotely, which makes it nice. Environmental, again, it's very different from country to country, so I didn't spend a lot on that. Legal, I think there are some things coming up in the US. Again, EPA's gonna start making workforce exposure limits. So, Council on Governmental Affairs is working with, they're gonna do, I think, 10 or 20 chemicals at a time. And not wait for OSHA to change their PELs, which they haven't forever. So, that's as far as we got. But it was an interesting tool, we just didn't get very far. No, great, I appreciate that, awesome, thank you. It's just a tool you can use to kind of think things through and kind of systematically use it. So, one last group, it's up to you guys, no pressure. You wanna give it a go? I'm a little talker. I heard you had an interesting topic over here. Thank you. We have two, well, I'm in clinical, well, I'm a Director of Medical Operations at Concentra. So, we have community clinics. She works at a community clinic in Loma Linda. TSA, right, Corporate Director and Clinical Consultation. So, we, thank you for your help. Decided to just focus on clinical practice problems. We didn't drill down any more specific in that, and that can include a lot of different topics. But we got to talking about a lot of things, and we only got halfway through step one, so I'll be honest with you. But coming to mind on the clinical practice side is the advancement of the, you just see more advanced practice clinicians than actual physicians in a lot of community practices anymore, both urgent care, and even within our practices as well. Couple things, they've just politically gained more independence in their practice. That can affect a lot of things down the road because we respect and work with our advanced practice clinicians on a daily basis, but we drive, as physicians, we drive the outcomes. So, there's somewhat of a clinical quality piece there. But also, too, even given COVID, and it's a pain point across the board with staffing of clinicians, you can't find physicians anymore hardly willing to work in a community clinic. So, we are having to depend more and more on the advanced practice clinicians. And that does go into the economics of a clinical practice because I'm a Floridian, so given Floridian Florida laws, they are reimbursed less. So, that impacts our bottom line, of course. So, there's that economic impact, and that's somewhat political as well because that is set by state law. So, also, our reimbursement rates are lower in Florida, and they never get raised year over year. They just sort of stay there. So, there's multiple factors when it comes to that. Our clients, too, expect a lot, but don't wanna pay more. So, it's always a bottom line effort with us, trying to increase our value within our clients, but also understanding that leadership, we're not seeing the, you brought up a good point, of medical leadership coming out of residencies. We don't have all the op docs we need. So, that's starting to impact management within the clinics as well. And also, physicians anymore are being managed by non-physicians, and we need to continue to drive the management of clinical quality and outcomes through our physicians. So, that's why I think that we need, and right now, since we're not seeing as many physicians in the clinic, where is that leadership coming from? So, that's about where we got. I could add a few more things in there along the way, but artificial intelligence, you've mentioned that. I do appreciate that, because we are seeing that more and more in our clients, Amazon being one of the biggest proponents of artificial intelligence, and our largest clients. So, we're in talks with them of how that is going to look within our clinical practices, as well as Amazon's getting into medicine, too. So, what does their telehealth platform look like? What is that going to look like in the future? And is it going to be a competition to us as well? Yeah. Fascinating take on it as well. So, yeah, amazing to hear all of the different and diverse views, and kind of, we didn't want everybody to take on the same thing, I think it was the idea that you can apply this in many different ways as a tool to kind of look things through. So, I guess we're about at our time. So, just to kind of wrap it up, let's just, I want to check the chat real quick before I do that. I think we're good, okay. So, just to wrap it up, we offer this out there as a tool. I think planning is really going to be key for us to keep up moving forward. And we'd like to offer that this could be a tool, perhaps sections that have different areas of interest within ACOM kind of grouped by some of those common bonds, could look at potentially doing these types of analyses in more depth and with a little more time to kind of contribute toward perhaps a more global plan to help us in the future. Yeah, and sort of get you thinking about, I think one of the things I said earlier was this is really, hopefully, a starting point for conversation. And we hope that you will take this to dinner or breakfast or lunch or whatever tomorrow and continue to connect with people while you're here. We're pretty early in the conference. We still have a few days. But maybe you could sort of champion a strategic plan within your particular ACOM section. And that can be a living, breathing document that can inform strategy for years to come. Because we don't say, as they say, physician heal thyself. We have to really think about how we're going to confront the challenges and the changes that are here. And as we sort of think about post-COVID, or I don't think COVID's going anywhere within COVID, how are we going to work within the challenges that we have? And so thank you again for coming. We hope that this was a good exercise for you, that it was interactive and fun and an opportunity to connect with each other. And we're available for questions if you have any. And have a great rest of the conference and a great afternoon. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you.

adaptation

occupational medicine

future

framework analysis

external factors

changing nature of work

workplaces

political factors

economic factors

social factors