Melina Davis 

Hello, this is Melina Davis, and I'm your host today for the JoyMed podcast. And I'm so happy to say that today on JoyMed, we're joined by Dr. Todd Otten, a board-certified family physician, healthcare leader, and unapologetic challenger of the status quo. 

With more than two decades of experience caring for patients and leading teams, Todd has lived the realities of modern medicine, including the personal toll of burnout and system dysfunction. He's the co-founder of Our Quadruple Aim, a movement centered on improving the patient experience, quality of care, cost, and clinician well-being. He's also the co-author of Ripple of Change, a powerful and honest reflection on burnout and the path forward for healthcare. 

Through his work with Medicine Forward and his advocacy for restoring trust and humanity in medicine, Todd reminds us that real change starts with courage, connection, and the willingness to speak the truth. Welcome, Todd. 

Dr. Todd Otten 

Well, thanks, Melina. Every time I'm on one of these, I hear the intro and I'm like, oh my gosh, who are they talking about? Is it me? 

Melina Davis 

Who is that? Yeah. Well, I'll just share with all the readers that you or listeners, that you and I actually know each other quite well. And I have just really been so happy to know you and get to know you in this space around wellness and well-being. It's been at least over a year, year and a half or more, right? 

Dr. Todd Otten 

Yeah, at least a year and a half, maybe even closer to two at this point. Time tends to fly. And I was going to echo those sentiments too. It's… our developing friendship is a treasure to me, so I'm thrilled to be here. 

Melina Davis 

Me too. I've learned a lot from you and I really, my heart feels better spending time with you. So, I know that listeners today are going to have the same experience with you. I've got a bunch of questions, so I want to dive in. 

For listeners who may be meeting you for the first time, I wanted to ask, how do you usually introduce yourself and not just professionally, but who you are at your core? 

Dr. Todd Otten 

Yeah, I, rarely actually do I say I'm Dr. Hotten outside of professional settings or seeing patients. Usually, I say I'm Todd and just kind of see where the conversation goes, but I think ultimately, I'm a human being just like everybody else. Medicine was my calling and I love it and I'm realizing in CUR 2.0, being an advocate and a challenger of the status quo is kind of where I've landed to a large degree. And I loved the unapologetic component to it because I was joking earlier. I feel like, you know, we need to be vocal. We need to be loud. And we need to be talking and sharing stories and celebrating wins. And pointing out the things that aren't working. So maybe that's a little bit of how I take, I suppose. 

Melina Davis 

I like it. You know, when I met you the first time, I was just struck by you were already an advocate for other people, but you were living that through your own experience. And it really brought me closer to you right away because you just do approach it as a human being. And so many people I find don't think of their doctors as people, not because they're not standing in front of them, but because they are there to talk to them about them, and it can be very different. 

Dr. Todd Otten 

Well, I think you're right. And I think there's at times I think it's important to have that, you know, that structure and that difference in terms of roles. But the reality is, at least in my experience, when you can relate on a human level with somebody, you can really get to the core of the issues, whether that's in patient care, whether that's in trying to make changes, or what have you. 

And so Honestly, I've always defaulted to telling patients, hey, this is a team game, right? Like, I'm the physician, but I'm not at home with you. I'm not forcing a pill down your throat or, you know, doing whatever you need to do to get better, helping you lose weight. And that's just landed so well with people that I've kind of carried on to my role, my different role that I have now in terms of speaking up and trying to stand up for our colleagues who, you know, who need it. You know, they need someone who's local, you know? 

Melina Davis 

Yeah. Well, I want to explore, first so people get to know you, what brought you to medicine and what was it that you loved the most about medicine early in your career and what did you expect it to be like across your life? 

Dr. Todd Otten 

Oh, that probably can be answered in so many different ways depending on the day. You know, I think the first part of it, you know, I always talk about the joy of medicine, like there's a euphoria of caring for other human beings that at times it's almost a little bit difficult to describe unless you've had the pleasure of experiencing it. You know, it's so gratifying. I mean, it's this dopamine hit that you get of helping somebody. It's just incredible. If that were the only part of medicine, delivering medicine and healthcare right now, it would be easy. 

I can't tell you, like, the good days just flowed by, and before you know it, it's the end of the day and everything's done. But unfortunately, as my career has evolved, I've experienced the challenges personally, professionally, through my colleagues, as a leader. 

You know, one point when I got, when I was seeing patients full-time in a fee-for-service capacity, I mean, there were days where I bet more than 50% of what was being talked about was just frustrations from patients. 

Melina Davis 

Right. Yes, I hear that. 

Dr. Todd Otten 

Like holy smokes, we need to get back to your diabetes here a little bit, you know, because I only have so much time, right? So. 

Melina Davis 

Right. 

Dr. Todd Otten 

Yeah. 

Melina Davis 

It can be frustrating no matter who you are in the healthcare system. Just being in it is wearing. 

Dr. Todd Otten 

Yeah, for sure. You know, navigating things, the cause, financial toxicity, you know, the list goes on and on and on for sure. 

Melina Davis 

It's so broken. When did you realize in your experience that medicine wasn't just hard, but frankly, unsustainable? 

Dr. Todd Otten 

I think there were inklings throughout my career, but at the time, maybe you're not as receptive to it because you're just trying to navigate things and get through the day. When I- it was really probably 2019 when I experienced the kind of the full spectrum of burnout that I realized how much was broken. 

But even then, it wasn't until I fast forwarded a couple of years of healing and looking back on those moments that all the little pieces that were contributing to my experience of burnout, you know, the charting, the volumes, the RVUs, leadership issues, you know, the list goes on and on and on. That was, I think that's really when it smacked me in the face, like, oh my goodness, this is not, this isn't what I signed up for at all. 

Melina Davis 

Well, it's a systematic maze of misery versus a personal failure, effectively, right? 

Dr. Todd Otten 

And I was like many of us, I was taught, be more resilient, do more, work harder, push on, stuff it into a box, compartmentalize, and all those things that I learned in medical school, which those tools are important, right? Like, if you're if you're trying to save somebody's life and do CPR or whatever the case may be, you need to be in the moment. But we also need that time to process and heal from those traumatic things. But I honestly, I wasn't taught that. And frankly, I paid the price for it in many ways. 

Melina Davis 

Yeah. When did you realize that it wasn't personal, it was systematic? Help me understand that. 

Dr. Todd Otten 

Oh, man, it was not when I was going through it. I think I was understanding a little bit. It was after some time of reflection, probably a good year or two looking back on that year or two of misery that had been building from a personal perspective and going, oh my gosh, like a lot of this wasn't me. 

This was leadership failures or volume failures or profits over people failures. And the list goes on and on and on. I think actually, when it really hit me the most was probably when I started writing the book, Ripple of Change. And I was kind of having a rough go at the time and I wrote a poem and it was kind of a, really it's kind of a dark look at the underpinnings of primary care. And when I was going through it, I was like, holy smokes, this all played a role in my window of burnout for sure. That's, I think that's when it really hit me. 

Melina Davis 

Well, Ripple of Change is so personal, it's deeply personal. What finally pushed you to want to share your story? Most doctors I know are told not to share, almost. Hold it in, bottle it up. 

Dr. Todd Otten 

Yeah, I realized that wasn't working so well, just stuffing everything into a box. And so, the, you know, the book started really as catharsis for myself, to be honest with you, you know, that poem was first, called Medicine is a Role of Gray. And then I wrote a chapter called Anatomy of Burnout. And that was really a kind of a personal introspective look, I suppose, at how my struggles impacted those concentric circles of people around me. 

And as I started to dig into it, I was like, holy smokes, like as much as I was frustrated and suffering, like my family, my friends, my co-workers, least of which patients were all being negatively impacted by the experience I was having. 

You know, and then the evolution of the book changed when my co-author got involved. Obviously, it became sort of not just my journey through burnout, but his journey through the healthcare maze or mess or whatever you want to call it. And then our combined catharsis is a result of the project. 

Melina Davis 

Well, what's so interesting and unique is your co-author is a former patient. What a radical decision. What led to that moment and why was that so important? 

Dr. Todd Otten 

You know, there was some buildup to that where I had started really pushing back on healthcare administration and some of the decisions that were being made. And there were a few reasons that gave me the courage to do that. I think having gone through burnout and not wanting to go back, some personal things that were in my favor helped me to be a little bit more vocal, for sure. 

Getting him involved was at first an opportunity to try and help him heal. You know, he was suffering with cervical radiculopathy, which is written about in the book. So, there's no HIPAA violations here. But we were struggling. Like, we had tried all kinds of things, injections, physical therapy, different medications, and he was getting depressed as a result. And I, I mean, I'm getting emotional thinking about it. I was running out of ideas for him. 

Melina Davis 

Yeah. 

Dr. Todd Otten 

And I distinctly remember telling him like, two points at this point. One, I said, Joshua, I believe you have to get better, but you have to believe it too. That was huge. And so, then this project came up and I told him about it and I thought, well, maybe he'd be interested, maybe he wants to write, maybe they would help with this healing. And then we had a meeting that lasted like 3 hours, and that's when the whole thing went on to like a different plane of ideas and investment and collaboration for sure. 

Melina Davis 

Well, what a good moment for you two to have a partner in it, to be there with somebody talking and exploring it. I bet that had to be fairly empowering and liberating. 

Dr. Todd Otten 

100%. And I think our shared vulnerability in the project is often missing right now. And I think it's incredibly important that when people are struggling, they, you know, which goes back to a lot of the work you're doing, when you're struggling, you feel vulnerable, that you feel safe to look for help, right? I mean, that's so critically important. 

Melina Davis 

Yeah. Yeah, it is so important. And in medicine, I mean, really, it's hard to be honest about you as a human, not about the patient and the system or others, but about sharing yourself and that vulnerability. But that was just a difficult transom to cross, but an important one for you. 

Dr. Todd Otten 

Yeah, I think there was, you know, there's fear in doing something like this. There's fear of failure, there's fear of what people are going to think of you. But I also felt sort of like I was kind of being guided through the process, honestly, and that I was in a unique position to stand up for not only myself, which was part of this, but also for my colleagues. And that became more and more important to me throughout the writing of the book. And it's even more important now. 

Melina Davis 

Yes. 

Dr. Todd Otten 

As we're working on a documentary. 

Melina Davis 

You have a new project. 

Dr. Todd Otten 

Yeah. Yeah, just one wasn't enough, Melina. I just got to keep going and keep going, right? 

Melina Davis 

Well, I think when I met you at first, I'm pretty sure you and I met in New York. Isn't that right? We met in New York or did somebody introduce us after New York? I can't recall. 

Dr. Todd Otten 

I think, I think, we… so I think I actually know the linchpin to this, so the crux pointed, if you will. So, I think I was there, I flew into New York for like a grand total of like 20 hours to be on Matthew Zachary's podcast and be at the burnout symposium. Met him, Gabe was there, and then I think you came in and everyone's like, the two of you need to connect. 

Melina Davis 

Yes, yes. Because I spoke at that conference and then people were like, you two need to talk to each other. Yeah. 

Dr. Todd Otten 

Yeah. And then we had, you know, we overlapped for a project that unfortunately didn't come to fruition. However, the lessons learned in that, you know, that failed audio documentary were totally leveraged to what's going on now, and I think has allowed us to take Suck It Up Buttercup to just… a different level, or I hope a different level. At least it seems like it's lining up that way anyways. 

Melina Davis 

Oh, it is a whole other level and so many people behind you. But talk about it for a second. What is Suck It Up Buttercup and where are you right now with the project? 

Dr. Todd Otten 

Sure. So the, you know, kind of the 30,000 foot view of the documentary. So it's a it's a feature length documentary that ultimately is intended to pull the curtain back for the American public how greed has or is destroying our healthcare delivery system. 

But it isn't just physicians, it's nurses, it's patients, it's former executives, hospital administrators, a few celebrities are mixed in there. You know, and we feel like we have taken all these voices and put it in a package that the average American can relate to. And so, there's some humor in there. There's some graphic novel comic book sort of stuff in there, which as a comic book kid I love that stuff. 

Melina Davis 

I love it. Yeah. 

Dr. Todd Otten 

So yeah, we're nearing completion and the exclusive screening, if you will, is March 19th of this year. 

Melina Davis 

in Baltimore. 

Dr. Todd Otten 

Yes, ma'am. 

Melina Davis 

Mid-Atlantic. I'm very excited to see what people think of this. Why do you think a visual documentary is the right medium to tell the story instead of another book or audio only or even an academic paper? What is it about this film that you think is going to be so powerful? 

Dr. Todd Otten 

I think it's an opportunity for the average American who is frustrated with health care to get a broad, a broad stroke or picture or depiction of the reality of what's going on behind the scenes. 

I'm not sure you can accomplish that in a short clip or a paper or I mean, you can. I mean, obviously you can accomplish it in those mediums, but to get it to the eyeballs that aren't used to seeing it, I think it requires a little bit different thinking and a little bit different delivery mechanism and that's what we're hoping to do with this with this project. 

But I think, you know, the other part of it is the call to action around it. Like, you probably would, you can relate this point. So, we get kind of, what's the call to action? What's the ROI? What are all these other things? And you know how my… Right. Yeah, my brain is like way down the road thinking about all these other things. And so, the calls to action are really evergreen, unlearning, learned helplessness. Like your voice, your actions, your words matter. What you do matters. Even if it's asking one colleague if they're okay, that matters, right? 

Melina Davis 

It matters. 

Dr. Todd Otten 

Big time. 

Melina Davis 

It matters. 

Dr. Todd Otten 

But then also accelerating an impact network is the other part of this, that, that idea that we're all doing amazing things and the answers are out there, but maybe the right people haven't connected and haven't talked yet. And this hopefully allows for that. 

Melina Davis 

Well, that's one of the things I've watched. You know, our organization is invested in the film and we have really noticed, well, we were kind of early to the game, but what we've seen through the film is how many people you've brought from around the country to be part of the conversation, to be part of bringing it to life, be part of guiding introductions.  

 

And it's almost formed this network and this community as you develop the film, which frankly, we think was really needed. It's normalizing the conversation in a way that is important, but connecting people, accelerating those connections, as you say. I've been really fascinated to watch how you've created community here. 

Dr. Todd Otten 

You know, it's, Melina, it's, thank you and it's interesting, I agree with you. So, the, you know, the, behind the scenes of this project, there's like over 100 positive change agents, obviously, you're included in that, but also, we're up to like, I don't even know how many organizations are on board at this at this point. It's more than 60 at least. And some of them are big organizations, and there's some other very big organizations that we think are going to come on board. And I've thought about this, like all these other little connections and projects that have developed out of this project. It's kind of incredible and speaks to the power of an impact network, like that ability to talk and collaborate and just work towards common goals together. And ideally, we can do this at scale and then get really far upstream is what I would love to see. 

Melina Davis 

Right. And I find that all the people that you've brought to the project and around the project, like there's a little bit of magic happening in different corners of this country around this. And that you and I started today by saying hello before we started recording, just by saying, Oh, have you connected with those people? Cause you really, you need to see what they're doing. 

That magic that's hidden somewhere, we need to find a way to accelerate, but also sort of scale to your point. Even if our small little organizations individually can't do it, somehow that even the idea being carried forward somewhere else in the country is huge, I think. 

Dr. Todd Otten 

I totally agree with you. I think the longer I've been in on this journey of networking and being vocal in advocacy, there are so many just amazing human beings out there in this country that are wanting to do positive things. And to piggyback on that, there's a lot of patients who are looking for an avenue or an outlet of ways they can get involved. 

And ultimately, that's what I really want to see is those millions of patients that are looking for some direction to then have some direction in some capacity or other. I think that's where this will get incredibly disruptive in a positive way. 

Melina Davis 

That's really fun, which is what Matthew Zachary has been wanting to do since you introduced us. That's where his main mind is as a patient. What are some of your favorite stories that you've heard or the ones that have stuck with you through this filming process? 

Dr. Todd Otten 

Wow, there are so many. You know, you interview all these amazing people. And is it the story when we were interviewing Mark Cuban of him letting his guard down a little bit and starting to drop F-bombs about the current state of healthcare and some of the ways forward? 

You know, the power in the story like Betsy Galls about her husband, you know, the power of, and I'm not going to play spoiler here completely, one of the nurses who was assaulted, while she was triaging in the ER. 

I think one of my favorites maybe personal stories that I'll tell a little bit of was me geeking out at one of the interviews. 

So we had the pleasure of interviewing Don Berwick at his house. And, you know, he's a hero to me, he's been talking about this stuff for 30 years. And so, we're going through the interview, and he's just everything and more and at the end I said, "Don, with little of what you know about this project, if he had to come up with a title right here and right now, what would you call this film?" And he said, "solidarity." And I was like immediately transported to like, I joke nerd heaven, I was I was so excited I had him sign my laptop because I had forgotten to bring something for him to sign. It was, that was probably my favorite. 

Melina Davis 

Oh, that's really a fun moment. That's really fun. I love when, you know, when you hear a title like suck it up buttercup it's very provocative a title but there's also some really important empowering conversations that have happened around this, not just sort of drink it in and feel the burden of this with me, help change it, right? 

Dr. Todd Otten 

Totally. Well, as an internal team, that title was offered by the three core creatives right from the beginning, Scott Pressler, Amy Schaub, and John Lotter. And that came as a result of a conversation with the healthcare executive about that clinician said, "just suck it up, buttercup." And we went round and round and round about different titles and ultimately kept coming back to that title. And honestly, it even took me a little while to sort of say, you know what, that is the right title. But I think it speaks to what not only clinicians are going through, but also what patients are going through. 

Melina Davis 

Patients, yes, yes. 

Dr. Todd Otten 

I mean, we're all being told to suck it up, buttercup. 

Melina Davis 

Deal with this. 

Dr. Todd Otten 

Frankly, in the name of profit. 

Melina Davis 

Right, right. Right. Deal with it. It is what it is, right? Is not an okay answer. We can do better. 

Dr. Todd Otten 

Yeah, here I got a dumpster fire right here. 

Melina Davis 

Right. You're so funny. I love it. What do you hope that clinicians will feel after watching the film? !!! 

Dr. Todd Otten 

A lot of things, you know, perhaps most importantly, that they're not alone. I think many are suffering in silence and not sure where to turn for help. We want people to feel empowered. We want them to, frankly, unlearn that learned helplessness that has been woven into the fabric of our healthcare delivery system. So those are just a few things that I hope to see on an individual basis. 

Melina Davis 

Those are huge. And network and impact network. That's one of the most important antidotes to people being isolated and feeling like they have to be quiet. I love that. That's really important. 

Dr. Todd Otten 

Well, I mean, connection mitigates trauma, right? And… 

Melina Davis 

Trauma. 

Dr. Todd Otten 

Trauma is everywhere right now.  You know, there's layers and layers and layers of it depending on what your lens is or where you're at. And we need to be together and work together to unwind this stuff. So. 

Melina Davis 

And believe that it's possible. I mean, in our country, it is possible to build it better. It is possible. 

Dr. Todd Otten 

I agree with you. I mean, goodness gracious, we spend how many trillions of dollars on healthcare delivery? You know, so it's not that the dollars aren't there, it's are they being allocated in the right places? Are they being utilized correctly? Are we delivering the best care that we can? And unfortunately, in many cases, probably not so much and then you get into things with, equity and all these other things that go along with the quintuple aim.  

So much, so much opportunity, but many people see this as such a complex, wicked problem that they feel like their voice doesn't matter. 

Melina Davis 

It's overwhelming.  

Dr. Todd Otten 

Yeah. And when the majority feel that way, it allows the status quo to continue. We want people to move beyond that and say even the littlest of effort when you start to consolidate that, you know, and put those lights together, all of a sudden that becomes very powerful. 

Melina Davis 

That's right. That's right. We spend our days dismantling how it works brick by brick and trying to put it back together. And the more people that are part of doing that and are part of that community, you'll see it at a, I mean, we just have to know it's possible and not be overwhelmed. Yeah. 

Dr. Todd Otten 

Absolutely. I totally agree with you. 

Melina Davis 

Well, what do you hope non-clinicians, people who aren't in the business of healthcare, what do you think that they hope they finally understand about the issues and them in the system?  

Dr. Todd Otten 

Again, lots of potential answers to this question. I think as a physician, a lot of times we're, you know, kind of the forward facing component of the healthcare delivery system and a lot of frustrations or nurses or other types of clinicians are getting the brunt of people's frustration and anger, even in the form of violence at times, and that in and of itself has to change. 

But I think the more we can educate the average American who is enduring some of these things with our healthcare delivery system so they can truly appreciate where the problems lie is part of this. 

Then ideally, once they hopefully understand a little better, we want to activate them so they can get involved with the clinicians, with the physicians, with the leaders, with, the work that you're doing, Melina, to join us to making the change. Because frankly, there's, if you go around the country, the vast majority of people are frustrated in some capacity or another if they've had to deal with the US healthcare delivery system. We need those voices that we need to scale this. We need to scale the ups is really what I want to see. 

Melina Davis 

Yeah, I love that. And you know, it's interesting, I find inside healthcare feels like everybody is charged with arguing with one another and at one another when I think your message I think is so important is that it's come together. Like together, we actually have the strength to fix it and to question it and say no more to the things that are broken and inhumane, frankly. 

Dr. Todd Otten 

I agree with you, and I'm not going to get into specifics 'cause I really don't want to alienate groups when I talk about this stuff. But I joke that occasionally there'll be two organizations who are literally trying to do the exact same thing. 

Melina Davis 

Yes. 

Dr. Todd Otten 

Whose comma in their mission statement is in the wrong spot, so they can't figure out how to work together. And that, those silos are weaponized against us to facilitating change; we have to get over that. We have to learn to agree, to disagree on certain things and move forward for the greater good is really what needs to be happening. 

Melina Davis 

Yeah, I find in our work that frankly, when we sit down with the people we oppose often, we agree on 80, 85% of things. 

Dr. Todd Otten 

Yeah. 

Melina Davis 

So, I'm like, can we just concentrate on those? I mean, that's a lot of ground to cover. Let's just set the 15% aside. Let's just head into what we can work on together. It's like going through butter when you do that. It's an interesting phenomenon. Yeah. 

Dr. Todd Otten 

Well, it makes a lot of sense, and people are always like, what's the solution? And I'm like, I don't have one solution to this problem. 

Melina Davis 

There's not one. Yeah. 

Dr. Todd Otten 

Like, come on. You know, this is a $5 trillion problem right now. How about we focus on something we do agree on and go with that? And then you get some little wins and you get traction. And then people get on board, right? And then it becomes easier to fight bigger battles. 

Melina Davis 

No doubt, no doubt. There is a method. Well, when you look forward to the future of medicine, what gives you hope? 

Dr. Todd Otten 

Some days, maybe not so much. People. 

Melina Davis 

Yeah. 

Dr. Todd Otten 

People give me hope. 

Melina Davis 

Because there are a lot. Yeah. 

Dr. Todd Otten 

There are so many good people out there who are ready and willing and wanting. You know, the work you're doing, the work the Laura Breen Heroes Foundation is doing. You know, Dr. Glaucomflecken and his comedy, you know, that all counts, right? Yeah, it's fun, yeah. And I'm naming a handful of people that are in the doc, but, you know, like a friend of mine, Tina Shaw, she's running for Congress in New Jersey. She's a rock star. 

Melina Davis 

Yeah. 

Dr. Todd Otten 

And if she wins that seat, that's a win, right? 

Melina Davis 

Yeah. 

Dr. Todd Otten 

You know, they have a position in that position wanting to make change. So that's kind of a long-winded way to say that people would give me hope. 

Melina Davis 

I love that too. When you look forward five, 10 years in this movement that we're part of, what do you think success could look like? 

Dr. Todd Otten 

I often go back to, when I'm asked this question, Melina, I often go back to when I did a first interview for the book, Ripple of Change, I actually had kind of a nightmare. Like, what if somebody asked me, like, what does success look like? What does that mean? 'Cause I'm the kind of guy that wants to joke, I joke all the time, boil the ocean. And I realize you cannot boil the ocean by yourself. You need many, many people. But who's to say, if we all don't do a little bit, we can maybe raise the temperature too. That's obviously a metaphor. 

Melina Davis 

Yeah. 

Dr. Todd Otten 

But I think about the quintuple aim, patient experience, so that the vast majority of individuals are not frustrated with healthcare delivery, quality care. I would love to see our life expectancy in this country not going down. I would love to see us not spending nearly 20% of our GDP on healthcare. I wanna see clinician suicide rates lowered. And frankly, I wanna see that everybody has access. Those are some of the things that I would like to see. And obviously those are big, big ticket items that are gonna take a lot of effort. But, you know, with enough people, we can. 

Melina Davis 

Well, and you can see incremental movement in every one of those. 

Dr. Todd Otten 

Yep. 

Melina Davis 

So we could see, to your point, with small wins, short-term wins, lead to midterm, lead to bigger, larger, long-term, right? 

Dr. Todd Otten 

Hundred percent, a hundred percent. So like the work that you're doing in Virginia is so important, and I can't even hazard a guess to how many lives it's saved from not only a clinician perspective, but those clinicians that are doing better, feeling better, not struggling, the better quality of care that you deliver. I mean, that number, it's got to be a big number in terms of impact. 

Melina Davis 

Well, you're kind to say, I will tell you, if we just save one person's life, we feel like we've won. But, you know, it's caring for the human and then breaking apart the part of the system that doesn't work. We fight that fight every day and we're working with other states to do that so that anything learned somewhere else can be applied here and vice versa quickly, because that is the difference, right? That will make the impact multiply faster. And that is our goal. 

Well, we're coming to the end of our time, unfortunately, because I could spend all day with you. But if you could leave our listeners with one truth you wish you'd learned early in your career, what would it be? 

Dr. Todd Otten 

I guess I'm speaking to clinicians when I say this, and I've spoken at some medical schools recently. And I'm not saying this is applicable every circumstance, but learn how to say no. 

Melina Davis 

Big one. Wow. 

Dr. Todd Otten 

Learn how to say no. Learn how to set boundaries. Learn how to care for yourself. Because if you are not doing well, there is no freaking way you're giving your best for your patients. No chance. 

Melina Davis 

Yeah. It's the oxygen mask on yourself first, right? 

Dr. Todd Otten 

Yes, it is. 

Melina Davis 

It's just such an odd thing and we don't teach this really to our first responders, we don't teach it to people in medicine. And it's a really big, big reminder. That's so smart.You're such a joy. I need more time with you. Will you stop working on big projects so we can just hang out? Actually, I don't want to say that. Everybody will get after me. But that's a selfish request. You're doing great work, and I'm so proud of everything you've accomplished and that I get to know you. Thank you, Todd. 

Dr. Todd Otten 

Well, thanks for your support and believing in what we're trying to accomplish. It means the world.