So, welcome everyone to TED 7. That means this is the seventh year that AECOM has sponsored TED Talks. Now, how many of you have heard of TED Talks in the larger world? All right, so we've all heard of TED Talks. Well, today we're going to experience AECOM's version of TED Talks. So, I'm Dr. Kent Peterson. I'm one of the members of the AECOM Teaching Academy. We've pulled ourselves together about 10 years ago because we were tired of death by PowerPoint. And we wanted to help speakers be able to give effective presentations, to engage their audiences, to not just talk from their heads, but to talk from their hearts. We founded the Academy, and one of the many activities of the Academy has been these TED Talks. We piloted them in Baltimore with five members of the Academy being the speakers. And for the next six years, we've had young, up-and-coming, emerging leaders volunteer to be trained as TED speakers. They've all gone through a rigorous process. They've been assigned a mentor or coach. And they've also had to work with Dr. Dean Jean and myself. So, we've had three people coaching each of the speakers. It's a multi-month process. People first pick out a topic to speak about, something that's near and dear to their hearts, and something that has a powerful message. Then they have to refine their ideas. What are the great ideas? And if they only had eight minutes, what would be the two or three supporting points that would most emphasize that great idea? Are they going to prepare materials to show? Are they not going to have any materials whatsoever? Are they going to engage the audience? Are they going to sing? Are they going to dance? Are they going to perform? We've had last year someone singing, if you recall. And then how do they deliver? It's one thing to have an idea, to have a crisp presentation, to have beautiful materials that stand on their own and don't put every word you can think of on a slide. But how do you deliver? How can you be present? How can you connect with the audience? So each of our four speakers today have been through a rigorous program. They have survived. They have all grown and learned. And we're extraordinarily proud of them. So we, of course, are required to give disclosure of any commercial conflicts of interest. And we're happy to say that no one has a commercial conflict of interest today. They have nothing but to declare, but they're genius. So what does TED have to do with OEM? Well, we know traditionally TED stands for Technology, Entertainment, and Design. How many would have you known that TED stands for Technology, Entertainment, and Design? But ACOM adapted that. By the way, there are plenty of seats up front. Come on in. Make yourselves at home. But we've changed TED to be Teaching, Education, and Delight. So that's our particular form of TED. Our goal is to help all of us in occupational environmental medicine inspire, persuade, and convince. Because communication is essential to the work of everyone in occupational environmental medicine. We're dealing not only with employees, but supervisors, managers, senior management, a whole variety of healthcare professionals, and people in the community. So it's a core competency. It's a competency from the Accreditation Council for Graduate Medical Education. Every specialty has listed communication as a core competency. And nowhere is it more vital than OEM. So we formed the academy to inspire and teach people skills. The question is, are you born as a great speaker? Or can you, despite stage fright and a mumbling tongue, can you develop step-by-step speaking skills, communication skills, that help you get better and better? And our goal is not to make everyone perfect, but to help everyone, wherever they are, get better and better. We want everyone to go from being good, which we all are, right, to being great and ultimately being outstanding. So we're looking for the transformation of people in their communication and in their presentation. We all start out as novices. We're at the bottom of the rung. And then we get a little better and we're still marginal. If we asked people, well, how did my presentation go, we probably wouldn't be happy with the feedback we got. And then we get good. We get to be excellent. We get to be great. And hopefully, if we work at it, if we care about it, if we practice, if we get feedback, we can become outstanding. Fortunately, Dr. Jean and I edited, with the help of a dozen members of the Teaching Academy, five short videos. They're available on the ACOM website. They talk about the journey to becoming an outstanding presenter and how do you plan and organize a presentation. How do you create artistic materials that say, in one glance, the main point that you want to get across? How do you speak effectively? How do you deliver your presentation in a way that works? And finally, how do you connect with your audience? The most important tip I would give anyone who wants to be a better speaker is know your audience. Engage your audience. Because it's not about you. It's about your audience. And that's something every speaker has to learn. There are many seats in the front row on the right. And we hope you'll, and also on the middle rows on the left. So please come in. Take a seat. Get your body comfortable so you can be open to what you're about to witness. So today we have four TED speakers. Two men. Two women. In the past, we've had mostly physicians. This year we are also adding a physician assistant and a nurse practitioner. So we're going to have more diversity in this year's TED Talks. And that seems appropriate given the timeliness of the subject within the organization. So my colleague, my friend, my compatriot, Dr. Constantine Jean, whom we call Dean, is going to introduce the first two speakers. And then I will introduce the last two speakers. We will end up with a panel. So all of our speakers will come up. We're going to pose some questions to them. And while you're listening, taking in their messages, knowing that they each have an inspiring message to communicate, think about yourself. Do you want to be a TED speaker? Right now we only have about 15 people who have asked to speak. So there's a waiting list. But if you're inspired and you want to do it, let us know. We'll give you our contact information. You can give us a card today. But we want everyone to be a more effective speaker. So thank you. And with that, Dean will introduce our first speaker. To the right. Okay. Well, thanks for coming. Kent went through the process of what it is to become a TED speaker. He didn't mention in addition to learning, working, et cetera, if you become a TED speaker, you will get really pissed off. You'll spend a month putting together the PowerPoint and whatnot, thinking, man, I listened to everything they said, every recommendation. Then they show it, and it's like, well, you know, it could be better. And why don't you get rid of those first two slides and add the one in back to the front and do this and that. And, boy, it's quite remarkable how ticked off they get. Our first speaker is Jayant Eldukar. He is the chief medical officer at Mid-Columbia Medical Center. Go forward to the next slide. And medical director and employee of occupational health, but also is in charge of the whole of all the other specialties as well. And he finally gets to say, in my 20 years of medical practice this year. He's also married to Nilu, his wife of 28 years and has two wonderful sons. He is a practicing physician in addition to doing his administrative work. And he has something really important to say about medical practice. Jayant? Okay. Give me a moment. I'll bring up your slide. All right. There you go. There you are. There's the clicker. Forward and back. Thank you. My life as a practicing physician was turned upside down in spring of 2004. It was my first year as an attending. And it was a Friday afternoon, 4.15, last appointment of the day. I returned to work easy peasy, get to go home for the weekend and enjoy the family and kids. It was 4.15 in the afternoon. Ms. Smith was there. And she was returning back to work after six months of being off. I walked into the room, and as was my usual back then, I had my paper ready to write my notes and finish my note as I was talking to her. And I had my pen, of course. I said, I'll introduce myself. Hi, Ms. Smith. I see you've been off work for a while. What happened? She said, my son was killed. I put my pen away. I said, I'm so sorry. What happened? And she proceeded to tell me that her 32-year-old son had just graduated from the University of Michigan with an MBA. He got his first job. And had come home from work when somebody knocked on his door or his window of the car, brandishing a gun, and said, give me your money. And the son handed the wallet, and the robber shot him four times. Somehow, he survived. And opened his door and slumped to his driveway and started to belly crawl to his front door. The robber saw this, came back, and shot him twice more in the back. Somehow, he survived. Six days later, his mother made that very difficult decision to withdraw him from life support. I composed myself, and I said, I'm so sorry. I offered my condolences. And she just nodded. I started writing my note. Patient's 32-year-old son was shot and killed. I was 32 at the time. All I could get was KI. At that point, my eyes had filled up with tears. And I started sobbing, softly at first, and more intense and more intense. Finally, it was inconsolable. And she, Ms. Smith, just kept looking at me. And I was just crying. My paper was completely wet by that time. And I finally stopped, but blubbered and stammered. I said, I'm offering my apologies because I was crying. She looked at me and she said, don't apologize. This is the most empathy I've gotten from your health care profession in the last six months. I started crying again. She did the most remarkable thing at that point. She got up out of her chair. She said, somebody needs a hug. And she came over, just had me in her arms. I just kept crying at that point on her shoulder. She wouldn't let me go. And I couldn't let her go. Finally stopped. She went back and sat at her chair. I looked up at her again. I said, I'm so sorry for your loss. She had a little smile on her face and she said, thank you. I returned her back to work as of Monday. And she went on. That day, that spring day, I realized that it was okay for me to be showing emotions with my patients. I didn't need that hard facade as a physician. I needed to listen completely and wholly to them. And most importantly, give my time. Not feel rushed. Be rushed. Look rushed. And make them feel rushed. That day, time stood still for a little bit. And I started to become a better physician. I started to have a better understanding. And a much deeper understanding of what it is to be an occupational medicine physician at that. Until that point, I was very efficient. I had short visits. Kept my time. And I got out. With experience. Those visits became longer. And I was a fully engaged physician. And I realized my patients were engaged. They told me their fears. They told me their secrets. Their successes and their failures. And I became a much more meaningful visit with them. And a much better outcome for them. And as it turns out, they're employers. That moment that I had, I've had many now since then. I didn't realize this. My nursing staff, when I started having this over and over again, where I'd spend longer time, they'd said amongst themselves, Oh, elder is having his human moment. So the title. So how do we have these human moments? Well, we put down our pen. We shut down the laptop. We listen to our patients. And we actively engage with them. And I realize I haven't been forwarding my slides. They're all right there. Finally, this is my grandmother and her five grands. The two little ones are myself and my sister. My grandmother immigrated to this country when she was 70 years old. She spoke six languages fluently. English was not one of them. At 70, she took ESL at the community college and learned also from general hospital and one life to live. I got to know the quarter mains and Luke and Laura. But she loved our doctor, Dr. Bond. Dr. Bond was 6'4". She was about 4'10". Dr. Bond would always get down on his stool as low as it would go and sit with her. And sometimes hold her hand and get her story. And in her broken English, she would talk about it. And if he didn't understand, he would ask her to clarify or ask whoever else was there to clarify. And then, interestingly enough, he would ask her, so what would they do in India? And much later on, I realized this was his human moment with my grandmother. My grandmother, she passed away when I was a second year medical student. She had only written one letter in her life and happened to be three days before she passed. And in her broken English, she wrote four lines. The last line was, be a good doctor. She always called Dr. Bond, he's a good doctor, he's a good doctor. Ms. Smith, that day, with that human moment, started my journey to becoming that good doctor. Thank you. Applause Silence Pretty amazing, huh? Our next speaker is Dr. Jerry Strohkorb, like Stroh's beer. I kept mispronouncing it during our initial meetings. He is a fellow in ACOM. He has done occupational and environmental medicine in local, national, and international settings, and is currently based in Houston, Texas. And he's also currently the North American Health and Safety Advisor and Global Medical Advisor for the Kindle Corporation. But he's not here to talk about that. He's going to talk about something much more important to all of us. Jerry? Can't lose this. Have you all ever had a thought of ending your own life? I have. I was driving home from work in June of 2019. I usually enjoy these long, quiet commutes to really process my day and think about life. But on this day, as I was rounding a curb in the road, I had this sudden thought that came to my mind. Why don't you just crash your car into those trees over there and just be done with all this? This thought really shocked me. I had been in a really good place with my chronic depression for 14 years, and I thought I had it well-controlled. About a month earlier, I had been passed over for a job promotion, which was very disappointing. I knew my mood was low, but I didn't realize how far I was sliding back down into that hole. I immediately sought treatment, and it was with this new psychologist that I gained some profound personal insights that really helped me to change my priorities and the course of my life. He asked me some key questions, such as, what is your relationship landscape? I was like, what? I don't know. I had never thought about that before. He actually asked me to map out my friendships based on levels of closeness he called the spheres of intimacy, with good friends or best friends in the middle and then going out from there. The best friends are those people that you connect with at a deeper level on a daily basis. Good friends on a weekly basis. The friendly category is on a monthly basis, and so on. I am an extroverted and social person. I have many friends and colleagues. But when I did my own mapping, it really surprised me. I had no friends in the inner spheres, except for my wonderful spouse. They were all in the acquaintance category. I realized I was really going it alone in life. In the daily grind of my job, career, family, community responsibilities, I had allowed my friendships to fade away. This is a common phenomenon. Like many of you, I had an independent productivity mindset, working long hours, taking care of my family, volunteering in my community, but not cultivating meaningful and effective adult friendships. The fact is, isolation and loneliness are trending up, and at record high levels. 61% of Americans now report feeling lonely. 41% say they have no close friendships. So if everyone is able, if you could just raise your hand for me. Now keep your hand raised only if you have 10 people that you connect with as a friend on a monthly basis. Now keep your hand raised if you have at least five people that you connect with as good friends on a weekly basis. Now keep your hand raised if you have at least one person you connect with at a deeper level on a daily basis. You can see this affects a lot of us. We are, we have a deep human need for love, acceptance, and intimacy from others. We are social creatures, and our very survival depends on it. So I'm sure you're asking, what is close, effective friendship? Well, it is not superficial or guarded, destructive or unsafe. Close, effective friendship is characterized as mutual and authentic, trusting and honest. It is with this friend that you can be truly known and truly loved. They think of your greater good and promote your flourishing and vice versa. And research shows they actually improve your self-esteem scores and life satisfaction scores. So I'm sure you're asking, why is close, effective friendship so important? Because it has a profound impact on our health. Research shows that if you have even one close friendship over the long term, you can add up to eight years to your life. Think about that. The absence of that is the same risk as smoking a pack per day. It is as important as diet and exercise to our health. We as physicians should be prescribing close, effective friendship to our patients and prioritizing it for ourselves. So then the big question is, how? How do you make friends as an adult? When I was a little kid, it was easy. You'd just go to the neighbor's house, knock on the door, say, can Joey come out to play? And then we were friends. It was easy. Admittedly, it is more difficult as an adult. But close, effective friendship is possible with effort. I started by making a list and making a plan. So you saw my original map. From that map, I built a list of possible friendships. And then I started thinking of creative ways that I could connect with people on that list. And I would reassess my list periodically and it would change. I also had to kind of get over my fear and just ask people, just be brave and ask, to go to coffee, go exercise together, go do a fun activity. And then lastly, I really had to think about cultivating friendship over time because relationships aren't instantaneous. They take time to develop. We all know relationships are complex and dynamic. Interactions can vary from person to person. I'm no expert, but I have learned that I can develop closer friendships with these three things. Chemistry just means that I look for people of similar interests and values to me. And people I have natural chemistry with. Time just means I needed to spend more time with people. Research actually shows that it takes 200 hours of time to develop a deeper level of closeness with someone. Vulnerability means that I had to be more mindful as we were getting closer that I'm being more open and real with that person. One example of my being vulnerable, I am also a visual artist. I decided to publish on a public forum an art presentation that I had made. It was a bit vulnerable because I actually discussed some personal struggles that I had as it connected to my art practice. Afterward, there were many people who contacted me to tell me that it had a very positive impact on them, that I was being so honest and vulnerable. And actually, one person contacted me to go to coffee. Since then, we've been meeting on a regular basis and have developed a closer friendship. Had I not been willing to be vulnerable, I would not have made that connection. I started this journey in a desperate place, but I am so glad I learned about friendship. You can see from my maps, I actually started out having no friends in the inner spheres. Now I am cultivating many different friendships at different stages, and they are greatly enriching my life. I encourage you to start your friendship journey today. Look around you. There are many people of a like interest here in occupational medicine. Think of someone you would like to grow closer to. Ask them to coffee or lunch in the next 24 hours. And I would say, start cultivating your new best friendships today. 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. How's it going? Anybody need a seat? There's still some seats at the front row on both sides. We have two more speakers. Come on in. Come sit down. Thank you. So as we move forward to having some non-MDDO speakers, I just want to put out some terminology. You could call it credentialing terminology, but we know that we're living in a multidisciplinary world. And the term APP appears more and more often. So what is an APP? Well there's two ways that ACOM uses it. It's an advanced practice professional or an advanced practice provider. And most of those APPs basically come from nursing or from physician assistants. So in the world of nurse practitioners, there are certified nurse practitioners. There are certified surgical nurse practitioners, family nurse practitioners, psychiatric nurse practitioners. We don't have an OEM nurse practitioner. But there are certifications because these are people, all of whom have at least a master's degree and additional training and credentialing and passed rigorous examinations. Physician assistants originally coming from the Vietnam era of people who were corpsmen and corpswomen who had lots of experience but no training, they became credentialed first at Duke University. I had the good fortune of actually developing the first physician assistant training program in the U.S. Army back in 1972. So now we have certified physician assistants and they also have high level of training. So our next speaker is a PAC, a certified physician assistant. She's had a wide ranging background, married to a Marine, a mother of beautiful children. She's working for a company that keeps expanding called Atrium Health. I met their medical director last night at the reception. And Nicolette is the southeast region director in charge of occupational medicine for Atrium. So I'm going to bring her slide up and you can come on up and welcome Nicolette. Let me tell you about one of the most profound experiences I have had in occupational medicine to date. A 19-year-old Lucia, mother of two, had half of her hand amputated in a paper processing machine. Being a mother of three myself, I can't even imagine what was going through her mind as the plant first responders rushed to the scene to try to help her. This plant had no licensed healthcare professionals on site. They had no health and safety director. And the plant first responders felt completely helpless. They called EMS. It felt like it was hours before they showed up. So this half hand amputation definitely was not handled well in this plant. With no health and safety director and no licensed healthcare professional on site, this place was remote and they couldn't hire anybody. That day, the employee showed up to work. All right, I'm going to punch in. I'm going to do my job. I'm going to punch out. But not today. The story of Lucia rippled through the plant. Everybody was in complete shock. This plant of 1,400 employees had no health and safety director. The regional director and I had worked on another project together locally and he reached out and he said, hey, listen, we need some help. Can you pull in atrium health and let's see what we can do to help fix our safety concerns. So I started looking at the problem. I knew we needed a team approach. But where do you start? This place, it was full of what we call opportunity. Yeah, it was a giant mess, okay? This place is a mess. As we started to pull a team together to look at possible solutions for the safety concerns, we ran into tons of resistance. This particular employer wanted an oem physician. There's not enough oem physicians to even go around. And let's be real, how many oem physicians are raising their hand to work in a rural environment like this plant was in? Then we looked at app's and nurses. We got a number of applicants. None of them had oem experience. When we started to talk to the employer, hey, tell us your budget, there was very little money to throw at the problem. So how do you build an effective oem healthcare team with few experts and very little money? So in this situation, we know nationwide there's not enough physicians, app's, nurses, physical therapists, industrial hygienists to even go around. Staffing for everybody in this room is a day-to-day concern for all of us. So training. The majority of occupational medicine today is delivered by people who are not trained in occupational medicine, and that's the reality. So in this situation, what did we do? Here's how we handled it. We looked at a creative solution, and we chose a hub-and-spoke type solution. At the hub, we had an oem physician consulting for us on difficult cases. We used app's as the spokes to extend that reach. And in this case, with this particular plant, we hired an emergency department nurse, and she served as the tire. She was where the rubber met the road for this particular clinic. Once we got her in place, the employees loved her. They would tell her everything. Though the trust between the employees and the leadership increased. The leadership felt relieved because they had on-site licensed healthcare provider there, not just for emergencies like what happened to Lucia, but for those day-to-day health questions and concerns that would come about. This solution worked. Over the next three to four years, we were able to expand. We are now in four states. We have over 60 clinic locations that perform some version of occupational medicine using this team-type approach. Now, this approach is not unique. Many of you have probably implemented something very similar. What we use is a team approach where everyone felt extremely valued, and we were able to take that and replicate it to the various and unique communities that we wanted to serve. I mentioned a big portion of the resistance was training. Everyone that we bring into our group has a different background. We hired some that were from emergency medicine, some from urgent care, some from cancer institute, and others from labor and delivery. What we did was we trained them. Myself, at the time, and my OCMED nurse, it was just us. We used our collective experience and our training in occupational medicine that we learned on the job as well, and we extended that training to the people we are hiring. We spent the time and we dedicated the energy into teaching them occupational medicine using the resources that we have today. AECOM provided the majority of those resources. We also leaned on NIOSH, OSHA, and more, and actually, I'm looking around the room and many of you answered my phone calls, emails, text messages, and meeting requests to glean from your own experiences. As we came together and we built our team, staying together and working together was our success in how we were able to expand and touch the communities that we needed to serve. We know that teams are built with unique backgrounds and diversity, and that's how we're able to create success if we leverage that. This is some of my team. I'm very proud of them. We work together, but we also consider each other family. We know that out there, there's people from various backgrounds. If we pull them together, this is the answer to the 21st century issues with occupational medicine and the fact that we don't have enough people to go around. If we invest the time and energy into these various backgrounds and train them in occupational medicine, think about how far we could expand our reach. We are also very excited for the OEM Fundamentals course for APPs because it's going to help us train our APPs and standardize how we move them forward in the practice of occupational medicine. So today, which road are we going to choose? Are we going to choose the path to collaboration and success or the path to division and indecisiveness? Occupational medicine as a specialty knows that it takes a team approach to get anything done in the world that we live in. So today, if we take APPs, physicians, physical therapists, occupational therapists, and more, and we line us up shoulder to shoulder with no hierarchy, think about how many amputations like Lucia's that we could prevent. Think about how many rural communities that we could serve. Think about those employers that need us the most, the workers and their families that need us to step in and make sure that they're well enough to work in a workplace or safe enough to continue to work in a workplace. So today, what I'm asking is for all of us in this room to commit to the road to success. Thank you. Thank you. Our fourth speaker, you could call her our cleanup hitter, is Melanie Hayes. And again, she has some of these acronyms that we talked about earlier. She has a doctorate in nurse practitionership. She's an advanced practice RN, and she's a certified family nurse practitioner. She's had a wide variety of experiences in private practice in the military, and now she works with OSHA. She's an advanced practice nurse, nurse practitioner in the Office of Occupational Medicine and Nursing, which are combined in OSHA. She's also co-director of a graduate nurse internship program in the Department of Labor. So we are very happy to have her talking about an interesting topic. Are NPs and PAs a threat to AECOM and to OEM physicians? Welcome, Melanie. There's your coat hanger. Thank you. Thank you. What a timely topic, right? A few weeks ago, I was sitting at my dad's bedside, staring out the window, taking in the beautiful scene, watching as the fog had settled in over the pasture. It was peaceful and quiet, and my dad told me he had decided to stop dialysis. So you can imagine that the next few weeks were emotional times, and quite honestly, I needed a break. So I took to watching the herd of goats from next door. It was really interesting, because every morning, they would file in and section off into groups of three or four around the trees and scratch their heads. And then they'd file off with the front guard and the rear guard, kind of watching the herd, wrangling back in those who had gotten lost and wandered away. And the moms took turns babysitting the kids so that they could each get some very much needed me time. I also noticed that they were butting heads and fighting over turf. And then at other times, they just ignored each other. And it kind of reminded me of how physicians and advanced practice professionals relate to each other. So like many of you in this room, I've had a great opportunity, a lot of great opportunities, to work very closely with physicians in cohesive teams. But I've also seen fighting, and I've seen us ignore each other. So what keeps us from working together? Well, we'll get back to the goats in just a little bit. But for now, we're going to talk about some elephants in the room. And the first one, maybe you heard this, that now advanced practice professionals can get certified in occupational medicine in just 30 hours. Anybody heard that? It is just not true, OK? So a few years ago, recognizing that physicians come to occupational medicine mid-career, not having that basic occupational medicine training in their formal education, AECOM, the experts in occupational medicine, created the Essentials for Physicians course. Now, as APPs are coming to this specialty mid-career, we have the Fundamentals course. It is not a certification program. It is eight modules of basic occupational medicine, information and knowledge needed to practice, 30 CEUs, and participants get a certificate in occupational medicine. 30 CEUs and participants get a certificate of completion, just like AECOM's Essentials course for physicians. This is another one that I hear. I've heard it at this conference. NPs and PAs will take physician jobs. And while that is a legitimate concern, the reality is there aren't enough physicians to go around, and advanced practice professionals are part of the solution. As you've heard, NPs and PAs, by the time we get our license, we've undergone rigorous education, clinical training, we've passed a board certification exam, and we bring translatable skills. And many of us work in areas where there just aren't physicians. For example, 10 years ago, I was hired to run a military occupational medicine clinic. When I started, there was one board certified doc-doc covering five clinics from Key West to Southern Georgia. And yes, she had to train me in occupational medicine. But she was very appreciative of the skills that I brought, because that position had been open for 18 months, and they just could not find a physician to fill it. In the US, we have about 158 million workers and about 3,000 board certified OEM physicians. Many of those are not practicing in direct patient care, as you know. But that leaves one board certified doc-doc for every 52,000 workers. Can you take care of 52,000 workers? I know some of you can. But the problem is only getting worse. Each year since 2019, we've had fewer than 100 board certified newly boarded physicians, and only 35 of those have completed an OCMED residency. And in the next 10 years, 1,500 physicians are expected to retire. We all know this is just not sustainable. When we add all professionals working in occupational medicine, physicians, we have about 10,000. That is fewer than half are board certified in OCMED, but still they dedicate their primary practice to occupational medicine. And we have about 7,000 nurse practitioners and PAs combined. That still leaves us with one professional for about 10,000 workers. Five times better, but it's still a lot of work. And finally, I hear that NPs and PAs will take over AECOM. Let's talk about those numbers. In AECOM, we have about 400 associate members. Those are non-physicians in which the NPs and the PAs are part of that group. So out of about 3,500 members, we make up about 11%. So what do we want from AECOM? We come to AECOM for that expert knowledge in occupational medicine. We need that education and training. Because like many physicians, we come mid-career. We also want to be valued in this organization for the skills that we bring. And finally, we are asking, we've had about four years now, we've had two observers on the board, one NP and one PA. And we're asking for those observers to have a vision for what they want to do in the future. For those observers to have a right to vote, to represent ourselves in the organization for matters that affect advanced practice professionals. But still, two out of about 20 board members were not trying to take over. So where do we go from here? As I look out in this room today, I see many colleagues, mentors, and friends. And I'm excited about what advanced practice professionals and physicians are working together as a team to achieve. Still, we have a long way to go. Still, I know some of you are hesitant. It's clear that there's a shortage of physicians and that advanced practice professionals are part of the team taking care of the workers, both now and will be in the future. It's also clear that misunderstandings, miscommunication, and misinformation is distracting us from our common purpose and our calling. And it's blinding us to solutions that we really need. I know that we can overcome this. We can build more meaningful teams because I know there are already some that are being built and working together. We need to do this by talking to each other, listening, and valuing each other's skills. Look, right now, we can continue with contention or we can work together as a team to create synergy and make ACOM the greatest of all time. The greatest of all time. 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. 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. 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. 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. 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. 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. 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. Thank you. Thank you.

AECOM Teaching Academy

TED Talks

effective presentations

mentorship

occupational environmental medicine

speaking skills

teamwork in occupational medicine

shortage of healthcare providers

collaboration

misconceptions about NPs and PAs