Won't this work? I have no disclosures. So again, this is going to be a pretty succinct talk today. Really, the goal of this conversation is to engage with you all about your experiences and kind of where we see things headed. Let's try to develop some thought leadership on this topic. So I have to thank Warren. He has such great visual skills, and I really appreciate him contributing to some of these slides. But we wanted to kind of give kind of a contrast between occupational medicine and environmental medicine. So many of us work in occupational medicine. That's our bread and butter. That's what we do for a living. And we've learned to be able to incorporate different members of the safety team who are not necessarily clinicians. We work with industrial hygienists. We work with certified safety professionals. We work with human resources, safety engineers, regulators, and inspectors. And these folks are not considered traditional, quote, doctor people, but we need these people to help us do what we do to take care of injured workers. And working with this interdisciplinary team, we're able to protect the lives and livelihoods of these large population groups. And I mean, honestly, at the same time, we have to look at the larger kind of scope. And clearly, over the last decade or so, there's been growing interest in environmental medicine. And I'm sure many of you heard the announcement that we're going to be our own specialty of occupational and environmental medicine. So how do we bring the E to what we do? So let's talk about that E. What do environmental medicine physicians actually do? It's really kind of the same model as the occupational medicine model that we just mentioned. We have the same players involved. Industrial hygiene, environmental engineers, urban planners, waste managers. And hopefully, in the next decade or so, we're really hoping to kind of provide more opportunities to our up and coming residents who are interested in doing environmental medicine full time. So I went to the Loma Linda website, and they actually have done a pretty good job of kind of providing some information about careers in environmental science, which environmental medicine would fall under. And really trying to highlight what environmental scientists do is critical. We need to set a set of values and objectives about what is within the scope of an environmental scientist. And an environmental medicine physician would be an environmental medicine scientist. So let's look at some workforce data. So this is actually going to be a pretty succinct slide. There's really not much data in this space. And I think it's up to us in occupational and environmental medicine to really try to make some headway in this arena. So I'm going to show you a couple of slides. And then I'm going to show you a couple of slides that are kind of based on what we're looking at. And I'm going to show you a couple of slides that are kind of based on what we're looking at. And then I'm going to show you a couple of slides that are kind of based on what we're looking at. And then I'm going to show you a couple of slides that are kind of based on what we're looking at. And then I'm going to show you a couple of slides that are kind of based on what we're looking at. And they're not really long term in terms of the way that they're set up. So I did some Googling, because clearly that's where I get all my information. And there's a lot of really kind of food for thought when you actually really start to kind of delve into this space. And what do you need to be an environmental health physician? And I happened to go onto this one website. And they kind of provided some decent information, but no mention of ACOM, no mention of any type of medical specialty whatsoever. So I think we really need to kind of put our heads together to figure out how we're going to change this dynamic. Environmental medicine is a full time job. Like I said earlier, just limited positions available for these types of opportunities. And where these opportunities do exist right now, they're within four spheres. I mentioned government, nonprofits, corporate, as well as doing consulting. So let's talk a little bit about the government. So there are opportunities out there. This actually came out recently from the US International Development Finance Corporation. And they actually had announced this back in 2021, where they were looking for a chief climate officer and deputy. So these are positions that are opening up, because clearly these are issues of our day. And we need to be able to develop these roles, so that we're able to combat these topics. And I think this is actually an encouraging development, because government realizes that this is something that we need to address. This is from the California Office of Environmental and Health Hazard Assessment. And again, these are potential jobs that an OEM board-certified position could take on. And I'm from the state of California, and I'm very, very happy to see that there are positions available for those who are interested. So let's take a look at nonprofits. So again, these are opportunities available for positions. But again, science director can kind of fall under two different spheres. You could either be clinician-based, MD, or PhD. Corporate. So I'm not sure if you guys have heard of this title of the chief sustainability officer. And I think the pandemic kind of brought some of these positions to light. Because I think pre-pandemic, there have been some of these positions opening up. But given the current climate that we're in, I feel that there's more and more interest from the millennials, the Gen Zers. They really want to get into this space. And I think Fortune 500 companies that are trying to come to some type of understanding about how to deal with these issues realize the importance of having someone with the credentials to be in this role. So let's talk about consulting. So there are plenty of opportunities in the consulting space, whether folks want to get into consulting with a specific type of company. This is an announcement that is from Exponent, which does a lot of environmental health consulting. I'm not sure if anyone is here from that particular company. But they do offer these types of services. And they have a. How many of you do environmental consulting specifically? OK, one hand. So this is a growing area of interest. I think corporations really are asking and need this type of information, especially as we're trying to navigate through the next decade or two. Clearly, there are climate change related interests and trying to have subject matter expertise in this domain. This is where OEM can really jump in and fill that void. So we're going to talk about a few examples of environmental health areas where having that expertise can really be beneficial for corporations, governments, and nonprofits. So environmental health changes, climate changes are happening. Clearly, this graphic demonstrates what's happening with carbon dioxide levels. And being able to develop that subject matter expertise, like I mentioned, to understand what's happening with our climate, working with climate scientists, working with folks from the climate finance arena, bringing all these perspectives together to develop some type of cohesive analysis, we really have the ability to do this. This is looking at global warming. So this was an analysis done about 10 or so years ago. And if you can look at the dark purple, you can see here that there's actually going to be more arable land in Russia, China, and parts of the United States. And then in parts of sub-Saharan Africa and parts of the southern hemispheres, there's actually going to be less arable land due to climate changes and changes in temperature. So we understand this. We understand the science. And we know that there's actually going to be major changes in populations over the next couple of decades. So again, we have a good understanding of all these different data. And how do we kind of put this all together into a cohesive framework to educate our partners? So clearly, things are continuing to evolve. We know that. I mean, I wish I had a crystal ball and I could predict the future. I can't. But it's really important to look at what's happening with potential changes in climate and how that's going to affect migration patterns over the next 50-plus years. So I mean, if you look at this slide, who knows toxicology? Who knows engineering controls, administrative controls? Who knows emergency response? Who knows PPE? This is our bread and butter, guys. We know this. We know how to do this from the occupational medicine side. How do we translate that into the environmental medicine space? So as a collaboration, we really need to kind of develop those interactions with our colleagues in the sciences, trying to interact with our colleagues in environmental health. How do we kind of develop risk communication messaging to our patients, our general public audience? I mean, these are very pervasive topics that we really kind of need to better understand. And as environmental medicine physicians, it's really imperative. So environmental health doctors, we have a lot of potential here. We are able to kind of take what we know on this planet and hopefully be able to expand it to other realms. This slide is really just focusing on the future. You know, we have aerospace folks who are experts at how do we take what we know about our current environment and being able to apply that to extraterrestrial travel. I mean, these are very, very important topics that do fall within the realm of environmental medicine. This is just a little food for thought, and hopefully we can have some engaging conversations about this. So medical education and environmental medicine. So I'm sure many of you have seen the core competencies that came out in the last year. And there is information about environmental health training for our residents coming through occupational and environmental medicine training. And I can't really see that, but this actually focuses on the specifics with respect to environmental health. I think this is good, but I honestly think we could do better. And I think the millennials and Gen Zers coming through medical school right now, they're going to demand more. And I think hopefully we can take this opportunity to kind of get ideas together about what we think should be in the curriculum. So these are medical specialties that actually have environmental health related topics and content. I just put a couple of these on here. I'm sure there's more. But really developing interactions with our fellow colleagues in these specialties and developing white papers, guidance statements, risk communication messaging to the public. I think this is a great opportunity for us to really interact with our colleagues in these specialties. So what's the future? Full time career prospects in environmental medicine. So this is just a couple of thoughts I jotted down. Clearly, this is an evolving space. And I'm really hoping to kind of gain some more perspectives from you all in terms of how we go about building this environmental health knowledge. So for residents and graduating residents and new attendings, I always tell them to just build your craft and follow your passion. Build up those clinic. Build up the future. You need to spend the time in the clinic. I mean, how many of you guys think that? Yeah. I think having those years spending with patients really kind of made me who I am today. And I think it's an important part of becoming a really good clinician. And really, to be able to kind of build up on this kind of space, it's really important to develop those networks with fellow like-minded colleagues. I mean, I'm so glad I ran into Dr. Silverman and Dr. Gowda. I mean, these guys are amazing people. And they clearly care about environmental medicine. I mean, this actually was something that Dr. Gowda had kind of been thinking about for a long time. And I thought, you know what? She's onto something. And I think we need to be able to cultivate these ideas that are coming our way and really be able to kind of have these types of forums where we can talk about this stuff. So conclusion. So I'm just going to keep this real brief. So right now, at least from my brief review, and I'm sure based on what I'm seeing, there's just not a lot of potential opportunities in environmental medicine, at least for a full-time career. I was on the environmental health section last year. And it became clear to me early on that environmental health as a career was possible. And not only possible, but we needed to start working on it now. Just to put this in perspective, let's take other medical specialties. Cardiology. In the first part of the last century, you couldn't do much with cardiology. You could give digitalis. You could listen to the heart. You couldn't do a whole lot. In the 50s, they started making coronary care units. Then they had interventional cardiology. It became a big specialty where somebody could make good money doing it. Occupational medicine. When I started my practice in the mid-80s, people would say to me, we didn't know you were an occupational therapist. Nobody. It's a really interesting thing for employers instead of using the family doctor down the street. So the same is going to happen with environmental health. Environmental health will become feasible as a career when it is able to solve problems. And some of the problems we can anticipate, and that's the thing that we have to do at this point, anticipate the problems. For example, there's projections that by the latter half of this century, most major cities will be triple in size. Now we have some science that talks about things like urban canyons, what it's like to live in enclosed spaces, having lots of population density. And we can see that this month, if you look at what's happening to the people that are locked down in Shanghai, it's a pretty difficult situation. And maybe having a doctor help with trying to set up a city so that it might have local health care facilities and residential compounds, that it might do different things. Governments are going to ask for help. And if you happen to be able to answer their questions, they'll pay you. Early on, when I was the chair of this section, one of the guys that contacted me, his undergrad degree was in urban planning, and he was an occupational medicine doc. He might have the expertise to help. One of the doctors that's going to be giving a talk later on is now part of the Jersey City Environmental Commission to try to help them with environmental issues. Because cities are dirty places, unless you're in Singapore. And they've got issues, they've got waste, they've got people, they've got proximity. And don't think that this COVID epidemic is the last time that we're going to have these issues. We've actually had an acceleration, whether it's SARS or Zika or whatever. This is going to be an issue. And if we put three times as many people into one space, it's a problem. I also, younger people tend to think globally. And if you're thinking about plastics, for example, and you happen to be able to work with the chemists and do those type of things, we're sending all our plastics overseas to India. There are countries that have tremendous problems with these pollutants, these different things, and their health risks, they may involve the health of the population. So we're going to be putting that underground, or should we figure out ways to use it as a feedstock to make other products? There's research coming out where that may be feasible. Maybe we should have a voice in that, or activity in that. Outer space, I estimate there's probably going to be 10,000 employees working off the planet by 2040, okay? So it's interesting because the more I've read about it, the more it looks like if you send a 20-year-old into outer space and you bring him back at 40, his body will be like a 60-year-old's, whether it's the liver or the immune system, or it's not just loss of bone mass and muscle mass. It affects every organ system. So we monitor truck drivers, we monitor pilots. Who's going to come up with the manual on how to prescreen people going into space and how to monitor them, and how to maintain those environments? Who's going to do it? I think we can do it, but we have to start now. We have to start developing that expertise. Now baby boomers like me, we're not going to be around long enough to see anybody getting really, really wealthy on environmental health, but we can help start the process. I sat down with environmental issues that are out there right now, and there's probably 20 or 30 different career paths for somebody to develop expertise in mixing medicine with some other area of environmental problem. Environments can be grandiose, global, or they can be local, small environments. Who wants to know answers? Federal governments, countries, municipalities, and the public. I think we can be involved in all levels of that, and I think the young people want to be involved in that. It's so exciting to invent a new branch of medicine that doesn't exist yet. We can do it. We can invent a whole new area of medicine, and I think it'll be viable, and I think some people will get very rich doing it. That's my take on it. Great. Thanks. Thank you, Dr. Silverman. Dr. Gowda, did you have any thoughts? I do. Actually, stand up. So I'm Dr. Gowda. For those of you who don't know me, Shilpa Gowda. I'm really grateful to be working with Dr. Barunji and Dr. Silverman. Their passion is very tangible for the subject. I think for a lot of people, they wonder about... ...expertise and exposures in the workplace and the translation of that knowledge, application of that knowledge to the greater environment at large. Anyone who's been paying attention at all probably knows that climate change, environmental issues are becoming a much greater issue than they ever have before. It started as maybe being a niche among certain concerned citizens, but pretty much everyone who has been touched by fires or heat stress or the various...or tornadoes, anything that has happened within recent years is able to see how this field is important. They're worried about the ramifications on their health, their children, their parents. So this problem is becoming more of an issue to the point where the need for this field is increasing, and I do believe, as Dr. Silverman has pointed out, that we are uniquely suited and there is a niche field for that. I think Dr. Barunji's characterization of the various opportunities was very comprehensive, but one other field that I would like to mention that I don't believe that she did is the academic realm, and actually she found out about an opportunity, and I expect more will also develop by way of example, but at University of Miami, which Miami being a region that is affected by climate change, of course, there is a position for an academic environmental medicine physician. So for individuals who are predisposed, who do enjoy research, teaching, and collaborating and are interested in academics anyways, I wanted to point out that environmental medicine is also becoming a realm of academics, so something to look forward and look out for about the fact that if you live in an urban setting and you live in an economically disadvantaged neighborhood and you live on the bottom floor and you live in a place where there are tall buildings, your children are much, much more likely to get asthma than if you live in an area that's more upscale, and all these type of things. So I say start out with a passion, PFAS, whatever you want, and develop an expertise in it. Let people know that you've got that expertise. What they have is they have the problem. If you have the expertise, they'll pay for that because I can imagine mayors, municipal people, they have environmental problems that are only going to get worse. And I think you can train people to be environmental scientists, but they won't have the background that an MD has. So people will pay for it, but first figure out what really rocks your boat, okay, because you can't mow it all. So just become good at something and let people know that you know a lot about it, write papers, talk about it, put out little press releases. We've decided in the environmental section that what we need to do is we need to do some TikToks. So we're going to work on that this year. But in any case, that's what I would encourage you to do. It's a new branch of science, a new branch of medicine. Help us to invent it, really. All right. Thank you, Dr. Silverman and Dr. Gowda. I think we're going to open it up for questions. So if anyone has any questions, actually, you can probably just take this mic out or Dr. Gowda, if you want to go out there and see if anyone has any questions. I'll do a delivery service. Take the show on the road. All right. Thank you. My name is Shlomo Moshe. I'm from Israel. And I wanted to share with you my experience exactly in the same subject, which started 20 years ago. How I decided that I want to have a residency of occupational and environmental medicine. Now, what are the obstacles I came across? The first one, the first question is, where do they get the theoretical knowledge? So I suggested and did two semester course in environmental health. It's now taking place in Tel Aviv University. I'm the chair of the department. The second question was, where do they get the practical knowledge? Now, this is quite difficult questions, because you need a place which is doing environmental monitoring, analyzing the reports, not just theoretical place. So the only places at that time were big companies, but there is a condition. In each unit, you got to have two specialists in occupational medicine, which did not exist at that time. So in another condition, it should be around the country. You can't just have places in the center of the country. One in the north, one in the south, one in the center, and we didn't have a rotation place. This is the second obstacle and tough one. The second one is, how much time the residents will take place in that practical place, the rotation? How much time? And where do you get that time? I said three months. But my mistake was, let's have three months less in internal rotation, which means instead of nine months, six months. It was rejected by the internal specialists, because they wanted physicians to work in their departments on the account of occupational medicine. And the last rejection, maybe not surprising, but it happened, were from the specialist of public health. Now they said, what do you mean you are a specialist in environmental and occupational medicine? We are the specialists in environmental medicine and not you. And of course, I explained that if you are a specialist in epidemiology of cardiac disease, you are not a specialist in cardiology. If you are a specialist in epidemiology of cancer, you don't become a specialist in cancer and oncologist. It didn't help. So after 10 years of struggle, at about 2010, we had a new residency program without the environmental part. And maybe now after your lecture, I will try again, but it happens. We're already specialists. You guys know how to react if you've got a factory that has a chemical spill, right? I mean, that's part of things you might do. But how often do you read in the newspaper about a railroad car that's turned over in a community or something that's been dumped into a river or a hurricane causing some plant to explode? Those are community issues. Why can't you help out those communities with your toxicology knowledge and get paid for it? I think we have a lot of the skills that we need already, and there's nobody else better ready to do emergency response and future planning, engineering controls, administrative controls for municipalities, for people, for environments, all kinds of environments. You already know how to do it. We just have to market it, let people know we can solve their problems. Thank you for your question. I think, again, this is an exciting arena, and I think we here in the room have a lot to say about where do we go from here, and I'm really encouraged to see that you want to be able to start again with environmental medicine in Israel. So hopefully, this is going to be the start of some good conversations about how do we develop these competencies. I had brought up the slide about what the current competencies are with respect to environmental health. Clearly, there's a lot that needs to be done. We have the subject matter expertise to really kind of set those standards for how we want to educate the next generation of OEM clinicians. So hopefully, we can take this opportunity to kind of get that momentum and really start to put thoughts to paper and develop these competencies, develop the standards, and then really trying to educate our fellow colleagues in other specialties. I've actually had the opportunity to reach out to my colleagues in ENT and immunology and allergy, and there's a lot of synergies there. So I think this is a good opportunity to kind of start doing this work. Other questions? Just quickly, environmental health, environmental medicine, occupational health, occupational medicine, I think once you use health, then you compete against all the scientists. Once, if it's more defined towards medicine, it makes it easier for a doctor to then become a specialist in that area. So terminology's important. And just a quick story. I was involved with oil and gas, occupational medicine, and because of that, I got involved with oil spills from ships Shen Neng and stuff in the Bay of Plenty in New Zealand, and Pacific Adventure, I spilled oil all over beaches in Queensland. And this was all free work. People would ask me, media would come to me, and I'd do some reports. And likewise, then I got involved with Gladstone Harbour, where they're building all these plants, and there was dredging, and there were algal blooms, fishermen got sick, fish were dying. Again, this was free work. I did it because I was interested in it, and then a farmer asked me to do a coal case against Ackland Coal, and we won that case. But again, I was a volunteer. I didn't get paid for that. Then a firefighter's asked me to do a drug explosion in a factory that held all these drugs, lab chemicals, and benzenes, and all sorts of acetones and toluenes. And that one I got paid for. Not a lot, but I, and I think one of the issues is doctors are really expensive. If we want to get into this work, we sometimes have to drop our rates a bit, because environmental scientists are cheap. There's lots of them out there. And they're good, they actually know a lot of stuff. Sometimes I feel like, oh God. And that's the other point I'd make, is teams. If you can actually get a, work with, like having an industrial hygienist that works with you. You know, have an environmental health officer. So if they don't have the money, you can use the EHO, and you can, so that's just a thought, that to work in teams and to drop your price a bit, because otherwise we might not get the work. Very good points. Yeah, I just, I had made up some slides. I mean, if an environmental medicine doctor started a consulting company that included some of the other specialties, that would be ideal. As far as charging money, as a consultant, I found that the more you charge, the more, the better they think you are. I mean, don't be afraid to charge, because it makes you really the highest level. So really, that's seriously true. So I mean, I think you said you didn't get paid, but you developed the expertise. You now have marketable expertise that's valuable out there, and the public is terrified. We've created, with the last 20 years, a public that is terrified of the future of this planet. So marketing is not that hard. Other questions? Yes, good morning. Jim Adaris, I'm a resident at Harvard. My question is, are we looking at the US green economy and how we fit into that for the 10 million plus workers that work in that industry and the trillions of dollars that it generates? It seems like we're uniquely qualified from the occupational piece for the workers, but also the environmental piece that the corporations are trying to course correct for the future. So do we have like a working group that's trying to get us more involved in that so that we don't get left behind and then AECOM can have a presence in that US green economy industry? Yeah, join the environmental health section, we're gonna do it. I mean, whether we work for industry or whether we work for government or whether we work for whoever, we've got to develop this market. It's a new, you know, I think there's tremendous potential. And if I came to you today and I said, yeah, there's millions of jobs out there, there's not yet. But based upon the way things are going with people being worried, and you know, really, it's for real, we're really creating major health problems. I think there's potential for a lot of money and a lot of jobs. So, sorry, I'm not as involved, maybe I should be more in the environmental section, but is that actively being looked at right now to consolidate the different lines of effort and to have a streamlined focus on that? Honestly, I'm glad you brought that up because I've been thinking about this. I recently gave a presentation in Boston back in March, looking at the future, and I did mention the green economy, including wind energy. So this is something that's on my radar, and I'm glad that you actually vocalized it. We can definitely create a work group to kind of, you know, delve more into these issues, and we'd love to have you join us. Yeah, maybe I'll talk to you offline afterwards. Sounds great. Thanks. Thank you. Other questions, please. Just more of a comment. I'm one of those physicians that begrudgingly kind of left occupational medicine in the military as an active duty. And at the end of my military career, got involved in a number of environmental investigations to mainly include housing, and for those of us here have been reading some of what's been going on in the military with housing and conditions there. And I was very reticent at that time and didn't feel like I had the experience or knowledge to really dive into some of this work. And so I'd encourage, number one, we are the experts here and have the training in this area. As one of my industrial hygiene colleagues, senior colleague in the military told me, ow, if an OEM physician doesn't get involved with this, who does? Some family practice doctor that has no idea what they're talking about and writes a prescription for a patient, no mold exposure, which we've seen. So, a position was created specifically for an environmental physician at the Navy Marine Corps Public Health Center where I work now as a civilian. And it's been some of the most interesting and enjoyable work that I've ever had. So again, encouraging. Met some colleagues here from Australia that are doing this work and I think they found it enjoyable as well. I would add that once you start this work, you will get called. You may not get paid, but you will get called and you will establish a name and people will have you on speed dial. The second point I wanted to make is that we are the interaction, we are the liaison between the health scientists. So I work with toxicologists, risk assessors, risk communicators, industrial hygienists. They look to me as the conduit or the liaison between the health science fields and the public. So I'd like to bring that up as well. We appreciate your comments. And honestly, I'm very excited to hear about what's happening with that position in the Navy. I work at the VA and Warren and Dr. Gowda and I have been presenting multiple talks at this conference. And I'm sure many of you know about the Burn Pit Registry and the Gulf War Registry. And there's actually a representative from the Environmental Health Registry from the VA here. And we've actually generated a lot of buzz about how do we continue to share our knowledge and expertise when it comes to helping our veterans. And I think this is a really great time because there's a lot of interest in this arena. I work at the VA and I do environmental health exams for veterans. And many of these people have questions and we're the subject matter experts. We really need to kind of develop these standards and develop the skill sets and develop the education to be able to better disseminate this information to not only within our communities, but to the general public because they are craving this knowledge. And like Warren said, I mean, once we start to really disseminate this information through social media, podcasts, TikToks, as Warren said, I think we're gonna be able to get more traction with this topic and people will come to us. And that's really the goal for people to come to us as the subject matter experts. Go ahead, please. I have a comment and I look forward Dr. Silverman to work with you later. Like we were presenting later and we never met, so. But I have a comment to your point about compensation. I put this out there that, you know, attorneys are also involved in these efforts and ask an attorney to charge less or not charge and see what happens, right? So doctors are conditioned, and I say this goes back from medical school into residency to work for free. In fact, sometimes it's frowned upon if you charge money. But I'll give an example of a friend of mine who, he's a painter, but he has a contract to paint all the Starbucks in Manhattan. And he said when he was negotiating, he actually had an agent who told him, well, you're not gonna get the contract because you're not charging enough. You have to charge more. Because to the point is that if you're perceived as a lower value, which is you don't charge money or you don't charge enough, they'll think that you're lower value. So the point is that if we wanna attract new people to enter the field, right? People who are looking at, okay, cardiologists make this much. Thoracic surgeons make this much. To attract people to the field, there has to be compensation. So I think if folks started charging and realizing, okay, that if I charge money, I'll actually get more work and I'll get better work, people would then start charging and reap the benefits of our work because we work hard to get the expertise in order to do this work. Yeah, I was lucky enough to have a practice manager who talked me out of lowering my prices. I think these are very valid points, at least in my experience. I feel that you need to kind of develop your niche. Maybe in the beginning, volunteering for causes I think is the way to go. And as you start to build up that subject matter expertise, attending conferences, connecting with folks from industrial hygiene, environmental health sciences, toxicologists, your name does get out. I mean, the last year or so, I've gotten a lot of people just calling me. I'm like, how do you get my number? But people find out. And once you establish your reputation, focusing on facts, focusing on evidence-based medicine, being transparent, the consults do come. And we have the ability to kind of discern what are cases that are worth our time. And even for those cases that don't necessarily pay immediately, I think just having the foresight to see the potential and developing that relationship into some other means. I never say no, because you never know what an opportunity can turn into, so. So I'm John Holland, and I've been in occupational medicine for 44 years. And I've been fortunate to be in clinical practice, in industrial clinics, and in big medical centers. I spent time at the university doing public, well, I'm from Seattle, before I did my residency, doing some health policy research guidelines for a couple years. And then I had 20 years where my title was consultant, which is, you know, I'm self-employed, I have a professional corporation, and you end up getting, people ask you to do single things, or somebody may ask you to do something that's 20% of your time, or 50% of your time, and then you fill up the rest working at a clinic as not a contract employee. And so, I mean, that's, I think, typical. And so, I was wondering, I'm always curious, what is this? And then I realized, I have been doing environmental medicine, as long with occupational medicine, my whole career, and I think the great thing about our specialty is don't try to separate them. I mean, I think people get into a niche, and you can do two things. But if you're gonna, I had a big community monitoring program for 10 years, I was asked to do about, there was an arsenic, or a copper smelter, right in the middle of Tacoma, that had spewed 100 years of arsenic and let into the soil in about a half a million people. And so, one of the settlement things afterwards from a lawsuit was to have a community monitoring program, and I got chosen to do it. And so, I didn't market that, it's just the way, you know, you're in the community, you speak at the occupational health conferences that are, as you said, industrial hygiene, nursing, and pretty soon, people know you when you get called to do things. And I never saw it, it's just environmental, because the skillset is knowing about lead toxicity. And you aren't gonna be asked questions that the industrial hygienists or environmental scientists can do. They need you, and other people said this, they need you for this. So I think it's the core competencies is what's gonna train you, and then the specific issue, you're gonna have to get up to speed, look at the literature. And if we just think about our literature, you know, most of the literature that talks about environmental exposures was done in workplaces. That's where you get the major exposures, and they're higher. So I think it's great, and I think, but I think, as you keep saying, is our core competencies are really what are gonna teach us. Our advertising is gonna be getting to know people in the community, and basically speaking at conferences, and interacting with colleagues and other disciplines. And so I think it's great to focus on it, but I think we're still, the best thing we can do is be occupational and environmental physicians. And I'm not sure, if you can find a niche that's purely environmental, you know, that's great too. But it's still our core competency. I think we can practice. We've all, as you said, we've all done environmental issues with our customers, our clients. And it's enjoyable, and we like to do it. When somebody calls me from a company and says, what do I do with this sludge? You know, I try to give them an answer. And I'll do the, I'll look up the research, I'll find out what's in it, I'll do it. I think if you wanna make, if you wanna become the world's specialist in offshore oil spills, then you might have to specialize a bit, and you might get paid more for that level of expertise. So I mean, you can do it both ways. I think doing it as part of your occupational medicine practice is great. The diversity of things to do is fun. So just two different ways of doing it. I think, what's the value to a mayor of a city where they've had a major chemical spill? What's the value for him to be able to hand the microphone to you as the environmental doctor when the news people come by? It's gonna be invaluable. He'll be so happy to have you by his side. First of all, thank you for an excellent presentation and offering your viewpoints in different areas within environmental health. My name is Matthew Dinell, I'm from New York, and I'm a physician, physiatrist, preventive medicine physician. My question is, where do you see the trajectory in the next five to 10 years in environmental health, more along the lines of the different areas or focuses that you need to address outside of your organizations, more at the global level, where people can get involved? And to follow up on that question, does the World Health Organization, are there agencies or working groups that are working with physicians internationally? Because we had a doctor here, I believe, from abroad comment on it. Is there collaboration, and if so, what are the names of those organizations or working groups? I would just say that this whole issue is accelerating at an amazing pace, even here at AECOM, at the board meeting the other day, the word environmental came up more times than I think it has in all the years put together. As far as global, yes, there's some really interesting things. Last month, the UNEP had a conference in Nairobi to try to put together a plastics treaty, an international plastics treaty, and there are meetings in Vietnam and other countries as follow up to that. I think I'd love to attend those things. I think if I was really into plastics, I'd love to go, I'd love to network, I'd love to tell them I know something about the chemistry, I'd like to read the literature on the research being done about plastics that you can take apart, put back together again. I would like to be, you know, the guy who knows a lot of stuff, and go to these global things, and meet with these countries. It's the beginning, and I know it's very hard to conceptualize what it's gonna look like in 10 years, but you can invent it, and global opportunities are good. With COVID and all, we've seen globalization right here at this conference that you wouldn't have seen five years ago. It's an amazing change. So opportunities are gonna be there. All right, I think we're at time. Thank you all so much for attending. We appreciate it. 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.

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