Interview with Dr. Nilesh Dave – Episode 335
Today's podcast episode describes Dr. Nilesh Dave's four-year career transition to health system Chief Medical Officer. We pick up from his previous appearance 4 years ago in Episode 99, as he lists the steps he took on his interesting career journey.
Starting with his role as medical director at a regional Blue Cross Blue Shield subsidiary, he describes the steps he took to land his position as VP for Clinical Effectiveness and CMO for a large hospital system.
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Career Transitions and Leadership Growth
Dr. Nilesh Dave's evolution from medical director to CMO for a health system highlights the importance of diverse skill sets in nonclinical leadership roles:
- Adaptability across domains
- Cross-pollination for innovation
- Strategic thinking
- Learning and adapting to new technologies
Nilesh emphasized that a combination of clinical knowledge, business acumen, and the ability to adapt to new technologies is essential for success in these roles. Some of these skills developed as he pursued additional formal education, including an MBA and executive training in Artificial Intelligence in Health Care at M.I.T.
Navigating Challenges as Health System Chief Medical Officer
Dr. Dave's role as a CMO involved navigating the challenges of a complex healthcare system. It requires a combination of strategic leadership, analytical thinking, effective communication, and collaboration to drive improvements in clinical outcomes and overall system efficiency. He began developing many of these skills in his previous management roles.
Summary
If you're interested in connecting with Dr. Nilesh Dave and exploring more about his insights into nonclinical roles in the healthcare industry, you can reach out to him on LinkedIn. Dr. Dave often shares valuable perspectives on clinical effectiveness and leadership, making his LinkedIn profile a great platform for networking and staying updated on the latest developments in the field. You can find him on LinkedIn by searching for Nilesh B. Dave MD.
NOTE: Look below for a transcript of today's episode.
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Links for Today's Episode:
- Dr. Nilesh Dave's LinkedIn Page
- First Gain Know-How Then Secure an MBA – 099
- The Eight Essential Abilities The CEO Wants In A Chief Medical Officer
- 6 Important Assignments of a Hospital CMO – 218
- How to Become CMO in a Year – 052
- Dr. Debra Blaine's Website
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Transcription PNC Podcast Episode 335
What Makes a Great Health System Chief Medical Officer?
- Interview with Dr. Nilesh Dave
John: I can't believe it's been four years since I last interviewed today's guest. I wanted to have him come back because his nonclinical career has flourished since he was here before. And he's in a leadership position now of a large hospital system, which is awesome. I think he has a lot to share with you all today. With that, let me welcome back Dr. Nilesh Dave. Hello.
Dr. Nilesh Dave: Hi, John. It's great to be back. I'm looking forward to chatting with you over what's been going on over the last four years and hoping that any of your listeners out there will hopefully get some nuggets of information and hopefully that'll help them get to the similar or whatever pathway they're on.
John: I think it's going to help a lot, and I have a lot of questions. But when we last spoke in July of 2019, I think it's okay I can mention you were basically working for one of the regional Blue Cross Blue Shield companies but you're no longer there, obviously. That's why I wanted to have you come back. You've made a couple of different changes and you've also done some other things in between. Why don't you tell us what happened, why you decided to move on and what the next job that you did was that would utilize all of your skills and education?
Dr. Nilesh Dave: Yeah, sure. I'm happy to. When I was working for one of the subsidiaries of Blue Cross Blue Shield, I was outreached by another insurer to join their team. And the resources there that they had in analytics and the opportunity to get involved with more business innovation in that space, as well as population health, was too hard to pass up. And so, I literally had to just drive down the street for that when I took that position and learned a ton. I was never someone who actually liked the utilization management component, and this was a minimal part of the entire role.
A lot of jobs in the nonclinical world will sort of describe themselves as working across a matrix or working across silos, so to speak. And I have to say that doing that transition to the other insurer ended up really teaching me some of those skills that it's not anybody that is above or below you in sort of a hierarchy. It's another department and group, but you've got a common client or something like that. And that's what brings you together in achieving some of the business objectives.
And when I was there COVID was starting up. And so, I was enjoying that role. And then I thought, you know what? I want to maintain my clinical skills. And so, I signed up to do some tele ICU moonlighting shifts. With being in a corporate position and having regular hours, it was not difficult to find time to do a clinical shift.
I started doing that and it was different. It kind of checked off the box of, yeah, it's critical care, and I'm an intensivist by training, but it was in a different way. It was tele ICU. I wanted to learn more about that because things were shifting towards telehealth and certainly COVID accelerated that and made telehealth a more accepted way to also deliver healthcare. And so, I just expanded my skill and exposure to it and signed it up.
And then I guess serendipity is what happened next, because I ended up being asked to oversee that multi-state tele ICU operation. And I almost did a double take when I was asked that because this was an opportunity that aligned my clinical skills. I had gotten a business degree before. I was in charge of quality, metrics and policies for the health system that this was a part of. And so, that had some inroads to my master's in public health I did in between medical school years. It just seemed like this makes complete sense. Like why not do something like this that you can get at all these skill sets in under one roof?
John: That's impressive in a way. But also what was the old saying? What is good luck? It's the combination of preparedness and opportunity. Unless you're open to it and you're prepared, however that preparation occurred, you just never know when you take a new position or volunteer somewhere or whatever, what opportunities might show up. What were you doing there? Just to clarify, I was going to ask you about the location, but it sounds like you did not have to move to take on this new role. You said it was down the street.
Dr. Nilesh Dave: No, in fact the company's headquarters moved from Boston to Dallas. And so, their operations for their tele ICU was also located literally within a block of the other two jobs I had previously. It was just sort of a business park, I guess, and that's why. I didn't have to drive really anywhere else.
John: Another serendipitous thing in the sense that there's a lot of movement out of many states, but Texas is one where there's a lot of movement in. And that includes corporations as well as people.
Dr. Nilesh Dave: That's for sure. Yes.
John: You loop selected a good place to live and grow in your career. That's another thing to keep in mind. Tell us again, at the beginning, before you were doing the moonlighting, before you were heading down this telemedicine service, what were the actual duties that you were doing that were different from what you had been doing earlier in your career?
Dr. Nilesh Dave: At both insurance positions, there was a new program that both insurers had started in terms of a white glove population health management service for employers, employees or members of the insurance. And looking at cost of care, drivers of care, managing and understanding the population of workers and really using your medical knowledge and understanding like, okay you've got diabetes, which is a risk factor for coronary disease, and the folks that work in the different divisions of this company. The company had 400,000 people in the Blue Cross Blue Shield subsidiary that I was overseeing. And so, that was a lot of that population health more so. But when I moved to the other insurer, there was more sort of KPIs, key performance indicator, and data associated with that that we focused on as we were managing.
I was managing three different companies with very disparate populations and risk factors. And so, I had one that employees would be in remote locations building solar farms, wind farms and stadiums, and another that was building nuclear subs and the third in drug development. And these are all employees with different kinds of health problems and some very similar.
But in that second role, there was a lot more of a business focus, a lot more strategy, data-driven analytics, and the opportunity to use that data capability that the company had to think of innovative approaches to some of those problems. And so, when I pivoted away from the Blue Cross Blue Shield position, that's what I got out of that second job.
And that retrospect, I think that set me up pretty well for when I started doing the tele ICU operations across multiple states. We had the same kind of set up. We had a lot of analytics. We were in charge of quality and metrics. We had key performance indicators that we had to meet. The usual ventilator length of stay, ICU length of stay, mortality. That's in the medical clinical world, that's when you're in these sort of hybrid clinical business positions, a lot of those things are what you're looking at. And so, being able to be in that tele ICU position really solidified that. And I was able to leverage then my clinical knowledge as well, knowing what does it take to take care of an ICU patient and translate that into the business side for health system.
John: That's what I think is great about physicians that move into these more executive positions, is that they do have that understanding of the relationship with the patient, the needs of patients, medical terms and all that. And if you can just add the business side of it, to me, it's an ideal situation. I think the companies you've worked for, they've recognized that. They have CMOs and they have physicians in pretty high leadership positions unlike a lot of hospitals. Some large hospitals do, but there are a lot of hospitals out there that the first thing they did when the pandemic hit was get rid of their CMO because it was an expensive position, at least from what I've heard. That's why I think physicians sometimes get frustrated working in a health system, but I think you still have to fight for that. And if your colleagues that are at the hospital recognize that they can hopefully encourage the leadership of the hospital to get more physician leaders like yourself. Tell us the next steps. Anything else you want us to tell us about that position you were just describing? I know after two or three years then you found something new to pursue?
Dr. Nilesh Dave: Yeah. There were a few variables that sort of were in the mix, that the health system where I was doing the tele ICU had some struggles and things that were financially related. And so, the tele ICU program was being contracted and expansion was being halted. And being able to grow in that position, it was pretty clear it was going to be delayed for several years. And a lot of the planning and things that we had at the beginning of when I took it a few years later, that was all sort of cut. And so, at that point, an opportunity at a Dallas based health system, the largest one by footprint, in terms of hospitals and things, was advertising a clinical effectiveness chief medical officer position.
And so, I threw my hat in the ring. And obviously after rounds of interviews and things, they offered me the position. One of the things, my background is a divergent one. When you look at, I'm at a system level. We have a system CMO. In some ways you could say I'm an associate system CMO, but they carved out a different CMO role with different parameters. And my background does not fit the "Hey, I've been in a hospital CMO for years and now transitioning to a system level." I was at a system level with the tele ICU, and in some ways I was the critical care subject matter expert overseeing our tele ICU operations and quality and meeting all those metrics. In some ways, there was some similarity to that CMO role, but I did not follow a traditional pathway. And in fact, I think I was very fortunate to be in a company now that actually appreciated my payer experience and my telehealth experience, which they've never had that background. And they thought that that would be an advantage for them based on the personnel and skillsets that they had which was a nice refreshing thing to hear.
John: When you were looking at the job title, if they posted it as such clinically effective CMO, they could have said chief clinically effective as medical officer or something else, but I've heard the term clinically effectiveness, but I've never heard that applied to a CMO. What were you thinking when you first looked at that?
Dr. Nilesh Dave: I figured that there were probably service lines or clinical service lines that between hospitals, they were probably performing at different levels. And I'm sure I expected that there would probably be similar sized hospitals with similar availability of specialties, but their quality metrics, we're not predictably the same. And so, I was sort of trying to figure out what's driving that? And it turned out that thinking before learning more about the position, the position was a new one that they had. It wasn't one that they had established years ago. They got rid of one position and sort of reformatted it. And so, for them it was also a new thing. And it was not only clinical effectiveness from the way you would think in the service line area, but also risk management, safety, credentialing, medical staff affairs.
I'm also involved in deploying our telehealth strategy. I'm on their AI governance task force, the tele ICU. And I've always been into the tech stuff. And so, now with AI, generative AI and things really versioning and so many platforms and vendors out there trying to get a piece of the pie, we had to create a governance structure, and I helped create a framework and took some time to take a certification course from MIT on AI and healthcare as a way to just compliment that because I knew some, but I didn't think I knew enough. And I just did that on my own while in the role taking classes and things online and learning that stuff. Once I saw some of these other aspects of clinical effectiveness, and it really is just making the clinical engine run, as smoothly as it can, that's what it kind of boils down to now. And it's been a phenomenal experience.
John: Describe some of the things that you do in that role, that are more leadership management and so forth. I think it's difficult sometimes for physicians to understand what it's like to move from that strictly clinically, even if you're the head of a service line or something, to working at the level of let's say a senior VP chief medical officer. But it's going to be different for every system as well. You move from one to another. What does it look like for your system? Who are your peers? Which other senior leaders do you regularly meet with or report to for that matter? That would be interesting to hear how that's structured.
Dr. Nilesh Dave: Yeah. Interesting. I'll add one other point is that when I was in the tele ICU position, I had 40, 50 nurses, and probably the equivalent number of physicians on our internal tele ICU operations. I had a whole team, had administrative folks helping to run the operations, a nursing counterpart, and a few other internal business partners. When I joined my current role, the directive was to get things done working through the business. Other than an administrative assistant who's fantastic, I do not have a hundred person team under me or any of that. That's one big difference that I have already in the job, which was a bit strange to me, based on the projects and things.
But I came to learn through listening to interviews like this, that there are many folks who are in these sort of officer positions that work through the business and get things done. And so, on a day-to-day basis, the folks that I interact with could be other VPs who oversee our hospital channel, for example. We have all our hospitals in a channel. We have an ambulatory channel and telehealth channel. And so, we have VPs that oversee that and a lot of them are nonclinical, business trained background. And so, I work a lot with them on different aspects of my projects. I even will directly collaborate with the COO of the company, and occasionally with the CEO and CFO as well as the strategy officer.
It's not a completely sort of flat organization in that sense, but the opportunities are there, and at times necessary. And I also work with the chief medical officers of each hospital. They don't all report to me. They're sort of a dotted line to myself and my colleague. And so, we collaborate together with them. We work with the chief nursing officers, hospital presidents are sort of in the business channel, but we work with those executives at the local hospital levels and then their sort of system counterparts who are maybe senior VPs or executive VPs or whatever. It's all across the board. I work closely with the VP of care transition management who oversees all of the folks in the hospitals. And so, it really is a pokery of various officers. At all levels, it's not just officers.
John: Yeah. When I was working as a CMO, of course, it was a small, it was a hospital, so it was very contained. But we just say that was a matrix relationship. We knew that if we had something we had to get done, it wasn't that I had to go through another VP. I would just deal with whoever I had to deal with to get it done. And then hopefully we're all on the same page, had sort of the same strategic plan and management plan that we were working on. And so, at that level, you even have to learn how to give up a little bit of something. You have to make someone else's thing work, because it's for the overall improvement of the organization, not your own little fiefdom within it. That sounds really goods.
The other thing that it makes me think about is when going through some of the courses at the AAPL and what I've taught when I've heard from others doing MBAs and so forth, the importance of things like negotiation, communication, persuasion even as a thing. And it's all about doing that rather than there's no such thing really anymore for the most part of just saying, "Okay, I'm the boss, so I'm going to tell you what you're going to do."
Dr. Nilesh Dave: I think that's a great point because one of the things you had mentioned is that a lot of times folks with these opportunities sometimes struggle, and in reflection, I think there's a struggle. Part of the struggle comes from just the language. A lot of us who may be doing day-to-day clinical practice and maybe are involved in some greater hospital initiatives or maybe it's the health systems doing your cardiologist and there's some cardiovascular service line initiative, and you're doing some of that, but being able to translate that into business speak.
And in fact, when I had to do my resume as I was pivoting into the nonclinical world, I think on our last discussion, I had mentioned that it took me a while to understand how to convert "Hey, I set up a system-wide inpatient hospice program." Well, there is another way of saying that on a resume that resonates with the nonclinical business executives that you might end up working with.
And to your point about getting allies and strategizing, it's a lot easier when you have that one patient in that one room and you're talking with different consultants. For one consultant or for a combo, your hand is forced because of the clinical scenario situation and the direction it is going in. And so, you have no choice but to agree and just take care of it. On this side, you know that is going on, but you're doing things system-wide that aren't directly related to that patient and related to operations or strategy, and a lot of that maneuvering, change management negotiating, let me do a solid favor for them now and hopefully that'll be repaid when I'm in dire need of something as well. And I'm not keeping a little notebook of what I've done, but the people you work with, you kind of know, they'll remember and sometimes you have to bring it up. That's a different skillset. I had to learn a lot of it. I wasn't like one of those schmoozers who could easily just do that kind of thing naturally. That's not always the kind of people who can get things done in these roles. There are skills to learn.
John: Yeah. Yeah. If you have a culture where that's the way things are done, it helps, but there's always individual personalities and some people are more forthcoming. I remember I had a director that reported to me, and I loved her dearly, but she may be crazy because if somebody didn't do something they promised like within a week, she'd be like, "It's not my problem. But they said they were going to do it." It's like, no, you have to take responsibility beyond yourself and enable those other people to do what they are supposed to do without being so black and white. That's just another example.
I'm glad you're here because I did have one or two other things I wanted to ask your opinion on, because you have some experience with these things. For example, you did that MPH back while you were in med school or between years or whatever, you did get an MBA and at Kellogg too, I think it was. It's not a community college MBA. And you've done other things. I don't know if you've ever been a member of the AAPL. I'm just wondering your opinion on all of those things, whether there's a prioritization, if someone hasn't done any of them, or what your advice is on deciding on an MBA, deciding on doing an MPH or doing some other things. Like you said that you got some additional training in telemedicine and AI and that kind of thing.
Dr. Nilesh Dave: Yeah. Funny enough, when I was in med school, my desire was to be in infectious diseases. And at the time, I wanted to learn more about epidemiology, biostats and health outcomes. At the time that was the buzzword. And when I did mine at Johns Hopkins, they had a program for with all that, and it was just a one year program. I didn't go into infectious disease but I did learn some skills, especially with the epidemiology and the biostats that from a data analytics perspective, which I would not have predicted back then, ended up helping me out. I pursued that because in the moment it made sense for what I was trying to do.
The business degree, I've been asked and I also hear the question of, "Well, I wanted to do something nonclinical so I better go ahead and get my MBA because that's like a lot of our physician pathway, we've got to get a medical degree, or a doctor of osteopathic medicine degree or something and be able to be that doctor." But here, an MBA is not mandatory. There is the American College of Physician or I forget, Healthcare Executives or something. The ACHE or something.
John: Yes. That's the one that's more for the hospital. ACHE.
Dr. Nilesh Dave: Yeah. There's an MBA like program you can go through there. I did it because I knew I lacked the ability, and when I was doing system-wide stuff as a practicing intensivist, getting involved in some of the health system initiatives, I was having a hard time trying to communicate effectively with nonclinical business leaders. And if anything, I felt like I was just oversimplifying things and as I listened closely in meetings, I saw that there was a gap. And so, I did that.
But at the time, I was not doing it hoping that it's going to open a thousand doors of opportunities. That did not open really any doors right away. Even with an alumni network that was strong in all of that. That was not something that was automatic. You still have to hustle and try to find those opportunities and hope that one thing builds on another and sort of strategize like that. And those skills ultimately will come in handy and they have for me now.
But it's a false way of thinking if getting an additional degree is the gateway to doing things like this. There are plenty of folks that I know that don't have a public health degree or an MBA or Master's in Health Administration, or any of those, that are fantastic leaders. And whether they've done work on the side to learn that stuff, it's possible, I don't know. But it's not necessary.
John: What I'm hearing, it was like the MPH, there was a reason at the time that you did that, and then with the MBA, you were already understanding, I don't know, maybe budgets, maybe financial statements. You had the people you were talking to at that time and you thought, "Okay, this is going to help me to address that need."
Dr. Nilesh Dave: Yes. And I was also at the time thinking a little bit entrepreneurial that maybe I'll sort of do something different on my own. I wanted some of that background and I thought about should I go and pursue a healthcare related MBA or not? And I actually decided conscientiously to not do a healthcare one. I wanted to meet people from all kinds of industries because my background is divergent, my thinking is divergent. I like to cross-pollinate with folks in other industries to have a better innovation mindset. And so, I looked at it that way and chose a program.
John: Yeah. That makes sense. Because I do hear the same thing. "I don't know what I want to do. I want to get out of medicine, so I'm going to get an MBA." And it's like, well, that's a little bit of a shotgun approach in the sense that it doesn't really give you any particular direction. And I think employers too, they're going to be working for someone like a big system or insurance company or pharma. They're going to look at that and say, "Well, it doesn't really fit in any kind of logical step in your career." You just decide one day to get an MBA while you're practicing full-time in family medicine or something. I'm sure those things long-term can benefit in unknown ways as well, but it's a lot of time and money to invest without having necessarily a direction that you're shooting for.
Dr. Nilesh Dave: I wanted to add, especially for the benefit of the listeners, that when I took on this role, and even when I was in my previous role, I had started to work with an executive coach. And at first I was like, "Well, I don't know. Do I really need that? We're all smart and savvy enough. Maybe we can figure this out." But no, emotional intelligence is probably the number one most valuable skill and capability that you need to grow and mature when you're in these types of positions.
And there's frameworks of how to manage workloads and how to have those conversations and negotiating the talking with different folks and trying to not only get the stuff on your table moved forward, but a collaborative project as well. There's skills there, not necessarily soft skills, but there are some hard skills as well that for me, it was something that I thought would play into the brand that I wanted for myself. What I want to be known for and how do I want to execute on that.
An executive coach was something that continues to make sense. I've been working with the same person now on a second year, monthly, before it was more frequently, especially when I was onboarding in this new role at the end of April. I throw that out there just because not everything is in the books. You do need it. You do need sometimes some coaching. Will there be a time where I won't need it? I'm not sure. It just depends.
John: Yeah. Unless you've had a coach like that, you really can't imagine the amount of wisdom that you can get from a coach. And they're kind of like a therapist in a way. They don't just tell you what to do. They get you to generate the "aha" moments and just help you to clarify your thinking. The bottom line is it doesn't make you a better person. Everything you would've maybe eventually learned, I think just happens faster when you're in that situation.
Dr. Nilesh Dave: I agree. And sometimes in the chaos, they can help tell you "Yeah, that's not the way for your role, what it is. You should be really having this resource or support, or you should really be looking at things this way. Or you're now in a position that's different than what you did before." You got to start sort of shifting, to have executive presence or to do those things which are skills to get success.
John: No, it's a really good point. Because we know how we feel in our internal talking to ourselves. When you have someone who's objective and really has no vested interest other than in your success, it's just a different perspective that just really can open your eyes. It reminds me too of something that one of my friends colleagues, advised me, and he was a hospital leader way before I was, and he said, "The next time when you apply for a job at one of these hospital systems or something, you should ask them to provide you with a business or leadership coach as part of your contract." I thought that was a brilliant idea. I never had the chance to implement that, but I thought that is a really good idea.
Dr. Nilesh Dave: Yeah, I agree. I had been told that after a year into the job that my company also provides that.
John: Okay. Nice.
Dr. Nilesh Dave: I was like, "Whoa, really? You guys actually provide that kind of stuff?" I'm very blessed to be in a company that really invests in their own people, with innovation programs for officers and things like that, to really understand the business. That was one of the other things that I went through as I was learning the company. They're like, "Well, we're going to throw you in this program for seven weeks." And I heard from all the strategy leaders, finance leaders, and it kind of fast tracked me in my education of just knowing where am I working at? What have been their goals? Where are they trying to get to? And how do I fit into that? And that's just investing in their people. Not every company does that kind of thing.
John: Yeah. That's awesome. It really is. I think outside of medicine, it's very common for large businesses to invest in coaches for their CEOs and senior leadership team, and even managers sometimes. We're a little bit over time here, but I do want to ask you any thoughts about AI in medicine? It sounded like you have some experience. Is this something we can ignore for a while or do we have to really start to learn about AI if we want to get into clinical or nonclinical future jobs?
Dr. Nilesh Dave: Yeah, I've been involved in my own current job and just reading and talking to different folks in the AI space. I think that some of the takeaways that I would say to answer your question is, one, the physicians and the healthcare teams that learn to work with AI as a tool are going to do better than those who say, "Well, I'm not getting into this. Or maybe reject the idea or think that it's a fad and eventually it'll go away." I don't think it's going to go away.
But with that said, the most important thing is understanding how do you evaluate a proper AI partner for your clinical operations? What they're calling AI, why are they calling it AI? How do they develop it? How do they test it? How is it biased? What's the risk that it can create harm? And that's a lot of the governance, sort of points that we set up. For anyone working in the hospital side, if your health system or your independent hospital doesn't have a governance structure, you need that.
Secondly, you need a framework to evaluate all the different vendors and folks that are going to come at you with, "Hey, we've got this cool thing." And you never know, it could be half baked. And they're just looking for a partner to use data to test it and iterate on it. Well, do you want to be that partner or do you want to wait till it's baked more?
But I think overall it's going to be a very helpful tool. We're using it, we're piling it in our outpatient clinics, especially generative AI. There are ambient AI programs that can listen to in a HIPAA secure fashion physician patient interactions and create a soap note or an APSO note and then you can edit that and clean it up a little bit. But it's screened by human and then sent to you very quickly so you can just focus on talking to the patient and not even need Scribe.
We have it being used in imaging, some of our business side, like revenue cycle. And so, we're looking at that, even looking at programs that will evaluate when patients call a hospital and have a conversation, what's the tonality and what is that doing from a business side? What's the engagement? What are they mad at? What are they telling us that we may not have picked up on? Because it's otherwise done manually. There's some cost savings potentially there, but in all of these, you want to have a governance structure to work through. Because data security is also a very important thing.
Yeah, you should get on to the bandwagon, but carefully I see. With structure, with a framework and see where it can help you the most. I think all these burdens and cumbersome tasks that have been attributed to burnout, there's an opportunity here to reduce some of that. Doing all your notes at the end of the day and all that stuff. There are tools out there that are good.
John: Yeah. Okay. Good to know. We need to embrace it at some point but also to make sure there are ways to monitor it and make sure it's safe and it's secure.
Dr. Nilesh Dave: Absolutely.
John: I really thank you for being here today. I hope the listeners get the same that I got out of it. It's very interesting and it's inspiring and it's also a lot of good points to think about and remember as maybe my listeners are pursuing a career in hospital management or any kind of management or leadership position. I know that we'll probably have some questions for you. I think LinkedIn would probably be the simplest way for people to reach out. I know they can just look up Dr. Nilesh Dave and they're going to find you. If you do have a question, those of you at home listening, then Nilesh can help you out.
Dr. Nilesh Dave: I'm happy to.
John: This has been really good. I'm going to have to catch up with you again in a few years. Maybe I'll have you come back, even maybe a panel on AI. Again, I'm just afraid it's going to become overwhelming very quickly. All right. Thank you very much for being here and with that I'll say goodbye.
Dr. Nilesh Dave: Thank you very much for having me. Happy holidays and happy New Year.
John: Thank you.
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Transcription PNC Podcast Episode 335
What Makes a Great Health System Chief Medical Officer?
- Interview with Dr. Nilesh Dave
John: I can't believe it's been four years since I last interviewed today's guest. I wanted to have him come back because his nonclinical career has flourished since he was here before. And he's in a leadership position now of a large hospital system, which is awesome. I think he has a lot to share with you all today. With that, let me welcome back Dr. Nilesh Dave. Hello.
Dr. Nilesh Dave: Hi, John. It's great to be back. I'm looking forward to chatting with you over what's been going on over the last four years and hoping that any of your listeners out there will hopefully get some nuggets of information and hopefully that'll help them get to the similar or whatever pathway they're on.
John: I think it's going to help a lot, and I have a lot of questions. But when we last spoke in July of 2019, I think it's okay I can mention you were basically working for one of the regional Blue Cross Blue Shield companies but you're no longer there, obviously. That's why I wanted to have you come back. You've made a couple of different changes and you've also done some other things in between. Why don't you tell us what happened, why you decided to move on and what the next job that you did was that would utilize all of your skills and education?
Dr. Nilesh Dave: Yeah, sure. I'm happy to. When I was working for one of the subsidiaries of Blue Cross Blue Shield, I was outreached by another insurer to join their team. And the resources there that they had in analytics and the opportunity to get involved with more business innovation in that space, as well as population health, was too hard to pass up. And so, I literally had to just drive down the street for that when I took that position and learned a ton. I was never someone who actually liked the utilization management component, and this was a minimal part of the entire role.
A lot of jobs in the nonclinical world will sort of describe themselves as working across a matrix or working across silos, so to speak. And I have to say that doing that transition to the other insurer ended up really teaching me some of those skills that it's not anybody that is above or below you in sort of a hierarchy. It's another department and group, but you've got a common client or something like that. And that's what brings you together in achieving some of the business objectives.
And when I was there COVID was starting up. And so, I was enjoying that role. And then I thought, you know what? I want to maintain my clinical skills. And so, I signed up to do some tele ICU moonlighting shifts. With being in a corporate position and having regular hours, it was not difficult to find time to do a clinical shift.
I started doing that and it was different. It kind of checked off the box of, yeah, it's critical care, and I'm an intensivist by training, but it was in a different way. It was tele ICU. I wanted to learn more about that because things were shifting towards telehealth and certainly COVID accelerated that and made telehealth a more accepted way to also deliver healthcare. And so, I just expanded my skill and exposure to it and signed it up.
And then I guess serendipity is what happened next, because I ended up being asked to oversee that multi-state tele ICU operation. And I almost did a double take when I was asked that because this was an opportunity that aligned my clinical skills. I had gotten a business degree before. I was in charge of quality, metrics and policies for the health system that this was a part of. And so, that had some inroads to my master's in public health I did in between medical school years. It just seemed like this makes complete sense. Like why not do something like this that you can get at all these skill sets in under one roof?
John: That's impressive in a way. But also what was the old saying? What is good luck? It's the combination of preparedness and opportunity. Unless you're open to it and you're prepared, however that preparation occurred, you just never know when you take a new position or volunteer somewhere or whatever, what opportunities might show up. What were you doing there? Just to clarify, I was going to ask you about the location, but it sounds like you did not have to move to take on this new role. You said it was down the street.
Dr. Nilesh Dave: No, in fact the company's headquarters moved from Boston to Dallas. And so, their operations for their tele ICU was also located literally within a block of the other two jobs I had previously. It was just sort of a business park, I guess, and that's why. I didn't have to drive really anywhere else.
John: Another serendipitous thing in the sense that there's a lot of movement out of many states, but Texas is one where there's a lot of movement in. And that includes corporations as well as people.
Dr. Nilesh Dave: That's for sure. Yes.
John: You loop selected a good place to live and grow in your career. That's another thing to keep in mind. Tell us again, at the beginning, before you were doing the moonlighting, before you were heading down this telemedicine service, what were the actual duties that you were doing that were different from what you had been doing earlier in your career?
Dr. Nilesh Dave: At both insurance positions, there was a new program that both insurers had started in terms of a white glove population health management service for employers, employees or members of the insurance. And looking at cost of care, drivers of care, managing and understanding the population of workers and really using your medical knowledge and understanding like, okay you've got diabetes, which is a risk factor for coronary disease, and the folks that work in the different divisions of this company. The company had 400,000 people in the Blue Cross Blue Shield subsidiary that I was overseeing. And so, that was a lot of that population health more so. But when I moved to the other insurer, there was more sort of KPIs, key performance indicator, and data associated with that that we focused on as we were managing.
I was managing three different companies with very disparate populations and risk factors. And so, I had one that employees would be in remote locations building solar farms, wind farms and stadiums, and another that was building nuclear subs and the third in drug development. And these are all employees with different kinds of health problems and some very similar.
But in that second role, there was a lot more of a business focus, a lot more strategy, data-driven analytics, and the opportunity to use that data capability that the company had to think of innovative approaches to some of those problems. And so, when I pivoted away from the Blue Cross Blue Shield position, that's what I got out of that second job.
And that retrospect, I think that set me up pretty well for when I started doing the tele ICU operations across multiple states. We had the same kind of set up. We had a lot of analytics. We were in charge of quality and metrics. We had key performance indicators that we had to meet. The usual ventilator length of stay, ICU length of stay, mortality. That's in the medical clinical world, that's when you're in these sort of hybrid clinical business positions, a lot of those things are what you're looking at. And so, being able to be in that tele ICU position really solidified that. And I was able to leverage then my clinical knowledge as well, knowing what does it take to take care of an ICU patient and translate that into the business side for health system.
John: That's what I think is great about physicians that move into these more executive positions, is that they do have that understanding of the relationship with the patient, the needs of patients, medical terms and all that. And if you can just add the business side of it, to me, it's an ideal situation. I think the companies you've worked for, they've recognized that. They have CMOs and they have physicians in pretty high leadership positions unlike a lot of hospitals. Some large hospitals do, but there are a lot of hospitals out there that the first thing they did when the pandemic hit was get rid of their CMO because it was an expensive position, at least from what I've heard. That's why I think physicians sometimes get frustrated working in a health system, but I think you still have to fight for that. And if your colleagues that are at the hospital recognize that they can hopefully encourage the leadership of the hospital to get more physician leaders like yourself. Tell us the next steps. Anything else you want us to tell us about that position you were just describing? I know after two or three years then you found something new to pursue?
Dr. Nilesh Dave: Yeah. There were a few variables that sort of were in the mix, that the health system where I was doing the tele ICU had some struggles and things that were financially related. And so, the tele ICU program was being contracted and expansion was being halted. And being able to grow in that position, it was pretty clear it was going to be delayed for several years. And a lot of the planning and things that we had at the beginning of when I took it a few years later, that was all sort of cut. And so, at that point, an opportunity at a Dallas based health system, the largest one by footprint, in terms of hospitals and things, was advertising a clinical effectiveness chief medical officer position.
And so, I threw my hat in the ring. And obviously after rounds of interviews and things, they offered me the position. One of the things, my background is a divergent one. When you look at, I'm at a system level. We have a system CMO. In some ways you could say I'm an associate system CMO, but they carved out a different CMO role with different parameters. And my background does not fit the "Hey, I've been in a hospital CMO for years and now transitioning to a system level." I was at a system level with the tele ICU, and in some ways I was the critical care subject matter expert overseeing our tele ICU operations and quality and meeting all those metrics. In some ways, there was some similarity to that CMO role, but I did not follow a traditional pathway. And in fact, I think I was very fortunate to be in a company now that actually appreciated my payer experience and my telehealth experience, which they've never had that background. And they thought that that would be an advantage for them based on the personnel and skillsets that they had which was a nice refreshing thing to hear.
John: When you were looking at the job title, if they posted it as such clinically effective CMO, they could have said chief clinically effective as medical officer or something else, but I've heard the term clinically effectiveness, but I've never heard that applied to a CMO. What were you thinking when you first looked at that?
Dr. Nilesh Dave: I figured that there were probably service lines or clinical service lines that between hospitals, they were probably performing at different levels. And I'm sure I expected that there would probably be similar sized hospitals with similar availability of specialties, but their quality metrics, we're not predictably the same. And so, I was sort of trying to figure out what's driving that? And it turned out that thinking before learning more about the position, the position was a new one that they had. It wasn't one that they had established years ago. They got rid of one position and sort of reformatted it. And so, for them it was also a new thing. And it was not only clinical effectiveness from the way you would think in the service line area, but also risk management, safety, credentialing, medical staff affairs.
I'm also involved in deploying our telehealth strategy. I'm on their AI governance task force, the tele ICU. And I've always been into the tech stuff. And so, now with AI, generative AI and things really versioning and so many platforms and vendors out there trying to get a piece of the pie, we had to create a governance structure, and I helped create a framework and took some time to take a certification course from MIT on AI and healthcare as a way to just compliment that because I knew some, but I didn't think I knew enough. And I just did that on my own while in the role taking classes and things online and learning that stuff. Once I saw some of these other aspects of clinical effectiveness, and it really is just making the clinical engine run, as smoothly as it can, that's what it kind of boils down to now. And it's been a phenomenal experience.
John: Describe some of the things that you do in that role, that are more leadership management and so forth. I think it's difficult sometimes for physicians to understand what it's like to move from that strictly clinically, even if you're the head of a service line or something, to working at the level of let's say a senior VP chief medical officer. But it's going to be different for every system as well. You move from one to another. What does it look like for your system? Who are your peers? Which other senior leaders do you regularly meet with or report to for that matter? That would be interesting to hear how that's structured.
Dr. Nilesh Dave: Yeah. Interesting. I'll add one other point is that when I was in the tele ICU position, I had 40, 50 nurses, and probably the equivalent number of physicians on our internal tele ICU operations. I had a whole team, had administrative folks helping to run the operations, a nursing counterpart, and a few other internal business partners. When I joined my current role, the directive was to get things done working through the business. Other than an administrative assistant who's fantastic, I do not have a hundred person team under me or any of that. That's one big difference that I have already in the job, which was a bit strange to me, based on the projects and things.
But I came to learn through listening to interviews like this, that there are many folks who are in these sort of officer positions that work through the business and get things done. And so, on a day-to-day basis, the folks that I interact with could be other VPs who oversee our hospital channel, for example. We have all our hospitals in a channel. We have an ambulatory channel and telehealth channel. And so, we have VPs that oversee that and a lot of them are nonclinical, business trained background. And so, I work a lot with them on different aspects of my projects. I even will directly collaborate with the COO of the company, and occasionally with the CEO and CFO as well as the strategy officer.
It's not a completely sort of flat organization in that sense, but the opportunities are there, and at times necessary. And I also work with the chief medical officers of each hospital. They don't all report to me. They're sort of a dotted line to myself and my colleague. And so, we collaborate together with them. We work with the chief nursing officers, hospital presidents are sort of in the business channel, but we work with those executives at the local hospital levels and then their sort of system counterparts who are maybe senior VPs or executive VPs or whatever. It's all across the board. I work closely with the VP of care transition management who oversees all of the folks in the hospitals. And so, it really is a pokery of various officers. At all levels, it's not just officers.
John: Yeah. When I was working as a CMO, of course, it was a small, it was a hospital, so it was very contained. But we just say that was a matrix relationship. We knew that if we had something we had to get done, it wasn't that I had to go through another VP. I would just deal with whoever I had to deal with to get it done. And then hopefully we're all on the same page, had sort of the same strategic plan and management plan that we were working on. And so, at that level, you even have to learn how to give up a little bit of something. You have to make someone else's thing work, because it's for the overall improvement of the organization, not your own little fiefdom within it. That sounds really goods.
The other thing that it makes me think about is when going through some of the courses at the AAPL and what I've taught when I've heard from others doing MBAs and so forth, the importance of things like negotiation, communication, persuasion even as a thing. And it's all about doing that rather than there's no such thing really anymore for the most part of just saying, "Okay, I'm the boss, so I'm going to tell you what you're going to do."
Dr. Nilesh Dave: I think that's a great point because one of the things you had mentioned is that a lot of times folks with these opportunities sometimes struggle, and in reflection, I think there's a struggle. Part of the struggle comes from just the language. A lot of us who may be doing day-to-day clinical practice and maybe are involved in some greater hospital initiatives or maybe it's the health systems doing your cardiologist and there's some cardiovascular service line initiative, and you're doing some of that, but being able to translate that into business speak.
And in fact, when I had to do my resume as I was pivoting into the nonclinical world, I think on our last discussion, I had mentioned that it took me a while to understand how to convert "Hey, I set up a system-wide inpatient hospice program." Well, there is another way of saying that on a resume that resonates with the nonclinical business executives that you might end up working with.
And to your point about getting allies and strategizing, it's a lot easier when you have that one patient in that one room and you're talking with different consultants. For one consultant or for a combo, your hand is forced because of the clinical scenario situation and the direction it is going in. And so, you have no choice but to agree and just take care of it. On this side, you know that is going on, but you're doing things system-wide that aren't directly related to that patient and related to operations or strategy, and a lot of that maneuvering, change management negotiating, let me do a solid favor for them now and hopefully that'll be repaid when I'm in dire need of something as well. And I'm not keeping a little notebook of what I've done, but the people you work with, you kind of know, they'll remember and sometimes you have to bring it up. That's a different skillset. I had to learn a lot of it. I wasn't like one of those schmoozers who could easily just do that kind of thing naturally. That's not always the kind of people who can get things done in these roles. There are skills to learn.
John: Yeah. Yeah. If you have a culture where that's the way things are done, it helps, but there's always individual personalities and some people are more forthcoming. I remember I had a director that reported to me, and I loved her dearly, but she may be crazy because if somebody didn't do something they promised like within a week, she'd be like, "It's not my problem. But they said they were going to do it." It's like, no, you have to take responsibility beyond yourself and enable those other people to do what they are supposed to do without being so black and white. That's just another example.
I'm glad you're here because I did have one or two other things I wanted to ask your opinion on, because you have some experience with these things. For example, you did that MPH back while you were in med school or between years or whatever, you did get an MBA and at Kellogg too, I think it was. It's not a community college MBA. And you've done other things. I don't know if you've ever been a member of the AAPL. I'm just wondering your opinion on all of those things, whether there's a prioritization, if someone hasn't done any of them, or what your advice is on deciding on an MBA, deciding on doing an MPH or doing some other things. Like you said that you got some additional training in telemedicine and AI and that kind of thing.
Dr. Nilesh Dave: Yeah. Funny enough, when I was in med school, my desire was to be in infectious diseases. And at the time, I wanted to learn more about epidemiology, biostats and health outcomes. At the time that was the buzzword. And when I did mine at Johns Hopkins, they had a program for with all that, and it was just a one year program. I didn't go into infectious disease but I did learn some skills, especially with the epidemiology and the biostats that from a data analytics perspective, which I would not have predicted back then, ended up helping me out. I pursued that because in the moment it made sense for what I was trying to do.
The business degree, I've been asked and I also hear the question of, "Well, I wanted to do something nonclinical so I better go ahead and get my MBA because that's like a lot of our physician pathway, we've got to get a medical degree, or a doctor of osteopathic medicine degree or something and be able to be that doctor." But here, an MBA is not mandatory. There is the American College of Physician or I forget, Healthcare Executives or something. The ACHE or something.
John: Yes. That's the one that's more for the hospital. ACHE.
Dr. Nilesh Dave: Yeah. There's an MBA like program you can go through there. I did it because I knew I lacked the ability, and when I was doing system-wide stuff as a practicing intensivist, getting involved in some of the health system initiatives, I was having a hard time trying to communicate effectively with nonclinical business leaders. And if anything, I felt like I was just oversimplifying things and as I listened closely in meetings, I saw that there was a gap. And so, I did that.
But at the time, I was not doing it hoping that it's going to open a thousand doors of opportunities. That did not open really any doors right away. Even with an alumni network that was strong in all of that. That was not something that was automatic. You still have to hustle and try to find those opportunities and hope that one thing builds on another and sort of strategize like that. And those skills ultimately will come in handy and they have for me now.
But it's a false way of thinking if getting an additional degree is the gateway to doing things like this. There are plenty of folks that I know that don't have a public health degree or an MBA or Master's in Health Administration, or any of those, that are fantastic leaders. And whether they've done work on the side to learn that stuff, it's possible, I don't know. But it's not necessary.
John: What I'm hearing, it was like the MPH, there was a reason at the time that you did that, and then with the MBA, you were already understanding, I don't know, maybe budgets, maybe financial statements. You had the people you were talking to at that time and you thought, "Okay, this is going to help me to address that need."
Dr. Nilesh Dave: Yes. And I was also at the time thinking a little bit entrepreneurial that maybe I'll sort of do something different on my own. I wanted some of that background and I thought about should I go and pursue a healthcare related MBA or not? And I actually decided conscientiously to not do a healthcare one. I wanted to meet people from all kinds of industries because my background is divergent, my thinking is divergent. I like to cross-pollinate with folks in other industries to have a better innovation mindset. And so, I looked at it that way and chose a program.
John: Yeah. That makes sense. Because I do hear the same thing. "I don't know what I want to do. I want to get out of medicine, so I'm going to get an MBA." And it's like, well, that's a little bit of a shotgun approach in the sense that it doesn't really give you any particular direction. And I think employers too, they're going to be working for someone like a big system or insurance company or pharma. They're going to look at that and say, "Well, it doesn't really fit in any kind of logical step in your career." You just decide one day to get an MBA while you're practicing full-time in family medicine or something. I'm sure those things long-term can benefit in unknown ways as well, but it's a lot of time and money to invest without having necessarily a direction that you're shooting for.
Dr. Nilesh Dave: I wanted to add, especially for the benefit of the listeners, that when I took on this role, and even when I was in my previous role, I had started to work with an executive coach. And at first I was like, "Well, I don't know. Do I really need that? We're all smart and savvy enough. Maybe we can figure this out." But no, emotional intelligence is probably the number one most valuable skill and capability that you need to grow and mature when you're in these types of positions.
And there's frameworks of how to manage workloads and how to have those conversations and negotiating the talking with different folks and trying to not only get the stuff on your table moved forward, but a collaborative project as well. There's skills there, not necessarily soft skills, but there are some hard skills as well that for me, it was something that I thought would play into the brand that I wanted for myself. What I want to be known for and how do I want to execute on that.
An executive coach was something that continues to make sense. I've been working with the same person now on a second year, monthly, before it was more frequently, especially when I was onboarding in this new role at the end of April. I throw that out there just because not everything is in the books. You do need it. You do need sometimes some coaching. Will there be a time where I won't need it? I'm not sure. It just depends.
John: Yeah. Unless you've had a coach like that, you really can't imagine the amount of wisdom that you can get from a coach. And they're kind of like a therapist in a way. They don't just tell you what to do. They get you to generate the "aha" moments and just help you to clarify your thinking. The bottom line is it doesn't make you a better person. Everything you would've maybe eventually learned, I think just happens faster when you're in that situation.
Dr. Nilesh Dave: I agree. And sometimes in the chaos, they can help tell you "Yeah, that's not the way for your role, what it is. You should be really having this resource or support, or you should really be looking at things this way. Or you're now in a position that's different than what you did before." You got to start sort of shifting, to have executive presence or to do those things which are skills to get success.
John: No, it's a really good point. Because we know how we feel in our internal talking to ourselves. When you have someone who's objective and really has no vested interest other than in your success, it's just a different perspective that just really can open your eyes. It reminds me too of something that one of my friends colleagues, advised me, and he was a hospital leader way before I was, and he said, "The next time when you apply for a job at one of these hospital systems or something, you should ask them to provide you with a business or leadership coach as part of your contract." I thought that was a brilliant idea. I never had the chance to implement that, but I thought that is a really good idea.
Dr. Nilesh Dave: Yeah, I agree. I had been told that after a year into the job that my company also provides that.
John: Okay. Nice.
Dr. Nilesh Dave: I was like, "Whoa, really? You guys actually provide that kind of stuff?" I'm very blessed to be in a company that really invests in their own people, with innovation programs for officers and things like that, to really understand the business. That was one of the other things that I went through as I was learning the company. They're like, "Well, we're going to throw you in this program for seven weeks." And I heard from all the strategy leaders, finance leaders, and it kind of fast tracked me in my education of just knowing where am I working at? What have been their goals? Where are they trying to get to? And how do I fit into that? And that's just investing in their people. Not every company does that kind of thing.
John: Yeah. That's awesome. It really is. I think outside of medicine, it's very common for large businesses to invest in coaches for their CEOs and senior leadership team, and even managers sometimes. We're a little bit over time here, but I do want to ask you any thoughts about AI in medicine? It sounded like you have some experience. Is this something we can ignore for a while or do we have to really start to learn about AI if we want to get into clinical or nonclinical future jobs?
Dr. Nilesh Dave: Yeah, I've been involved in my own current job and just reading and talking to different folks in the AI space. I think that some of the takeaways that I would say to answer your question is, one, the physicians and the healthcare teams that learn to work with AI as a tool are going to do better than those who say, "Well, I'm not getting into this. Or maybe reject the idea or think that it's a fad and eventually it'll go away." I don't think it's going to go away.
But with that said, the most important thing is understanding how do you evaluate a proper AI partner for your clinical operations? What they're calling AI, why are they calling it AI? How do they develop it? How do they test it? How is it biased? What's the risk that it can create harm? And that's a lot of the governance, sort of points that we set up. For anyone working in the hospital side, if your health system or your independent hospital doesn't have a governance structure, you need that.
Secondly, you need a framework to evaluate all the different vendors and folks that are going to come at you with, "Hey, we've got this cool thing." And you never know, it could be half baked. And they're just looking for a partner to use data to test it and iterate on it. Well, do you want to be that partner or do you want to wait till it's baked more?
But I think overall it's going to be a very helpful tool. We're using it, we're piling it in our outpatient clinics, especially generative AI. There are ambient AI programs that can listen to in a HIPAA secure fashion physician patient interactions and create a soap note or an APSO note and then you can edit that and clean it up a little bit. But it's screened by human and then sent to you very quickly so you can just focus on talking to the patient and not even need Scribe.
We have it being used in imaging, some of our business side, like revenue cycle. And so, we're looking at that, even looking at programs that will evaluate when patients call a hospital and have a conversation, what's the tonality and what is that doing from a business side? What's the engagement? What are they mad at? What are they telling us that we may not have picked up on? Because it's otherwise done manually. There's some cost savings potentially there, but in all of these, you want to have a governance structure to work through. Because data security is also a very important thing.
Yeah, you should get on to the bandwagon, but carefully I see. With structure, with a framework and see where it can help you the most. I think all these burdens and cumbersome tasks that have been attributed to burnout, there's an opportunity here to reduce some of that. Doing all your notes at the end of the day and all that stuff. There are tools out there that are good.
John: Yeah. Okay. Good to know. We need to embrace it at some point but also to make sure there are ways to monitor it and make sure it's safe and it's secure.
Dr. Nilesh Dave: Absolutely.
John: I really thank you for being here today. I hope the listeners get the same that I got out of it. It's very interesting and it's inspiring and it's also a lot of good points to think about and remember as maybe my listeners are pursuing a career in hospital management or any kind of management or leadership position. I know that we'll probably have some questions for you. I think LinkedIn would probably be the simplest way for people to reach out. I know they can just look up Dr. Nilesh Dave and they're going to find you. If you do have a question, those of you at home listening, then Nilesh can help you out.
Dr. Nilesh Dave: I'm happy to.
John: This has been really good. I'm going to have to catch up with you again in a few years. Maybe I'll have you come back, even maybe a panel on AI. Again, I'm just afraid it's going to become overwhelming very quickly. All right. Thank you very much for being here and with that I'll say goodbye.
Dr. Nilesh Dave: Thank you very much for having me. Happy holidays and happy New Year.
John: Thank you.
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