Link to podcast: Navigating the Path to DPC with Dr. Amber Hull
Welcome to DPC Pediatrician. We’re Dr. Phil Boucher and Dr. Marina Capella, two DPC pediatricians who are on a mission to share our love of direct primary care with you. welcome everyone i’d love to introduce you to our guest speaker today her name is
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amber hole she is a do physician with a small practice in las vegas nevada called village pediatrics it’s a little bit of a micro practice and she’ll tell you about how she got into that and what she does she also has a substat called under the white coat
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where she talks a lot about a lot of different issues that she’ll shed some light on. So thank you so much, Dr. Hull, for being with us today. Welcome.
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Thank you so much for the invitation. I’ve been looking forward to talking with you and I love that we’re kind of walking this DPC path, which is very customizable, and I appreciate all the work that you’re doing, empowering physicians to consider this as an option.
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Oh, absolutely. I think it will be a lot of the way of the future. And I love hearing different voices and inviting different physicians to speak about how they’ve made direct pediatric care work for them. So along those lines, I’d love to hear about your path into direct pediatric care and what your life
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looks like now as an owner of Village Pediatrics.
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So my story really started when I became disabled in 2021. I had a pathological femur fracture kind of at the height of COVID and ended up having to have a surgery and then a subsequent surgery. And I spent basically from April until December of that year recovering, learning to walk again,
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like exclusively dedicating myself to recovery from this major injury. And it’s disability will make you sort of reevaluate your priorities in very profound ways. And while I was laid up in bed, I got on my computer and I was like, I can’t go back into working into this system that is
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wreaking havoc on my physical and mental health, right? So I was like, I have to figure out a way that I can do this sustainably, that I can take care of patients the way that is in alignment with my moral compass and how I like to take care of patients,
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but that’s also going to allow me to take care of myself. both physically and mentally. And so I filed for my LLC with the secretary of state’s office here in Nevada and village pediatrics. And I have a very low overhead. I only do house calls. I don’t take insurance. I have a very high touch concierge practice.
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And for some of my families, because they’ve been with me since before my disability, they were like, whenever you start your own practice, let us know we’ll be the first to sign up. And they were. And so I have some families who are on subsidized rates and my rates have gone up
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since I first because demand is there. But I really like that patients and parents text me directly. I get most of my patients will refer to me either by midwives or local OBGYNs. And so most of my patients are under five because my practice is so young. Um,
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Many of those kids came to me while mom was still pregnant.
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Mm-hmm.
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My background, just to sort of like lay that out for you a little bit. When I was a medical student, I thought I wanted to be an OBGYN. So all of my elective rotations and like maternal fetal medicine and GYN oncology and pelvic floor reconstructive surgery and caught babies on the border down in Yuma, Arizona.
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And ultimately there were a lot of OBs who were like, it’s not, if you get sued, it’s when. And if there’s any other specialty that you’re interested in going in, do that. So I didn’t want to be a surgeon. So I ended up going into pediatrics,
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but I still have a lot of interest in sort of the intersection of women’s health, maternal child health, and how women’s health affects the welfare of children. Yeah.
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Yeah.
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All of that being said, I did residency in Baltimore. I did a neonatal, like perinatal fellowship for about a year at OHSU. So I still, again, still that like high risk pregnancy, high complexity kiddos. Ultimately the NICU was not a place for me. It has its challenges. Yes, it does.
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And so I decided to shift my focus to general pediatrics, but now that I have this DPC practice and I get most of my patients during the transition from pregnancy to neonatal, kind of emit this golden little intersection, which is such a gift where I get to help families transition through this introduction to parenting chapter.
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And it just has been amazing.
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Yeah. Amazing. Yeah. That’s really cool. Now you told me a little bit earlier as we were getting to know each other about how you’ve managed to kind of apply some of those interests in women’s health to helping some of the moms that you work with. Tell me a little bit more about that.
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Right. So what I’ve noticed because I only do house calls is that the healthcare system in general does a huge disservice to women and young couples when it comes to preparing them for the magnitude of change, that’s going to happen to their romantic relationship within the context of transition to parenthood. Right. So
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I’ve also been doing a lot of reading and continuing medical education on menopause and perimenopause and the low estrogen state that happens in the postpartum period actually mirrors what happens during menopause. And so have this during pregnancy, these really elevated levels of estrogen and progesterone that after the baby’s delivered, they drop off prolactin goes up,
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which further suppresses estrogen and progesterone. And so in addition to having. Either pelvic floor trauma from delivering a baby vaginally or possibly abdominal trauma from delivering a baby through C-section. You have like hot flashes and night sweats and headaches and joint pain and muscle aches and decreased libido and decreased vaginal lubrication.
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And there may be some level of incontinence due to trauma, but there’s also like from the standpoint of the vaginal tissue, the completion of estrogen and progesterone can cause like vaginal atrophy the same as it doesn’t minimize.
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Yeah.
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Does in patients who have undergone therapy for breast cancer and are on aromatase inhibitors or who have lost one or both ovaries. And so their ability to produce estrogen is decreased. Yeah. In, in the postpartum period, women get, unless there’s some major complication, the OBGYN see them at six weeks and they’re like, okay, great.
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You’re, you’re good to go. Have a nice day. But what so many people don’t realize is that this like, okay, we’ll avoid sexual activity for six weeks after delivering the baby. That’s arbitrary. Right. Like not some sort of like biological marker. That’s just like, okay, you’re ready to go. Yeah.
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And some people are ready to go at like four or six or eight weeks postpartum, but many aren’t. There are physiological reasons for that. In addition to just being like, okay, well, my, my boobs are a source of nutrition now. They’re not a play thing anymore. And I’m just touched out.
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Your hormonal state can affect your desire to be intimate with your partner. not acknowledging and validating that I think leaves a lot of couples like in this sort of state of like where one partner may be feeling rejected or there’s like this sort of like loss of intimacy.
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So in the milieu of we’re not sleeping as much and we’re adjusting to parenting and we’re maybe getting on each other’s nerves because this tiny stranger is in here crying all the time, you also have these very physiologic and medical reasons for there to be a decrease in intimacy and connection, right?
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Those are the kind of things that I feel like it’s important for us, especially as high touch or integrative or direct primary care physicians.
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Yeah.
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create a space or open the conversation. And just like what I do with my moms and my practice is like, how’s your body doing? Like, how are you doing? Like, how are you feeling? Are you still peeing a little bit? Like when you sneeze or laugh? Yeah.
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Right.
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Like recommend pelvic floor physical therapy, or maybe that they go on topical vaginal estrogen until after they’ve weaned and these types of things, because a lot of times patients won’t bring this up. And perimenopause, right? Like 85% of women will have symptoms and like 25% will ask about it.
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And so you have so many patients who will not bring up the fact that they’re having tension in their relationship as a result of these physical symptoms.
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Yeah.
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And we want doctors to bring it up because they don’t know how, and yet we’re never trained in how to have these conversations or how not at all.
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Yeah. Interesting. So once you open that conversation, I mean, I think we’re in a beautiful position as pediatricians and a predominantly female field to connect with moms and to ask those questions, right? If they do open up about some of those challenges related to postpartum hormonal shifts, what do you do? What do you offer them?
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so i very early on in my establishment of this practice i made contact with a pelvic floor physical therapist who specializes in both infant and maternal physical therapy right so she deals with like torticollis and plagiocephaly and feeding problems and neuromuscular things or hypertonicity. And so when we first started working together, she was like, yeah, I,
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I do in-home pelvic floor physical therapy as well. And one of the many things that I learned about the process postpartum is that it’s not just about Kegels, right? Like sometimes within the pelvic floor, there’s a hypertonicity where things are just like really tense and tight. And there may be
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pain or dysfunction related to that, or there may be laxity. So things like incontinence and prolapse and things, it can be hypertonic or it can be low tonic, but recommending, and I, when I have a pregnant family come to me, I recommend they start pelvic floor physical therapy before delivery.
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to learn because there are muscle relaxation techniques and breathing exercises and these types of things that people can utilize during the delivery that will face the risk of trauma At delivery, right? Pelvic floor, physical therapy is a big one. And your audience listening, I would say, look around in your community and see who takes insurance,
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see who comes to the house, see who specializes because a pelvic floor, physical therapist can help with a lot of things. Also peripartum and with crack hip pain or pain with creation and these types of things.
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Yeah.
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So that’s one. And a lot of times it’s just giving people a space to say like, yes, this is an, this is an issue. Like I don’t feel desire. I don’t have libido and he is having a hard time understanding that. So sometimes it’s just a matter of like allowing the parent to be heard. And often,
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if possible, I’ll have these conversations, both prenatally and after the baby’s born with a partner in earshot or in the room. It’s like, right. She is going to go through this. Her body is going to be going through some things for a while. This is a chapter. It’s not the entire book. Right.
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So just having partners recognize that she’s not just like rejecting me.
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Yeah. Right.
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Body transition. And if I’m sensitive to that and make some adaptations and maybe I’m gentle with her, it’s together.
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Uh-huh. Yeah. Speaking of that chapter, that kind of like postpartum chapter of all these hormone shifts and adjusting to a new baby and all of this stuff that happens, how long does that, especially those kind of perimenopausal mimicking symptoms, how long do they typically last for a woman?
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So the definition of postpartum differs, right? So if you ask an OBGYN, they’re like, okay, eight weeks, is considered the postpartum period. That’s when you’re going to see issues related to like hypertension or elevated blood glucose levels. Like some of those physiologic things that were pregnant or that are present during pregnancy,
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like by definition will usually subside by like eight weeks postpartum. But when I talked to my pelvic floor physical therapist colleagues, she was like, Well, once you’re postpartum, you’re always postpartum. Your body will never be the same. Yeah. The good point. And so, but from a post-menopausal state perspective, like hormone perspective, a lot of women,
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their periods will be suppressed as long as they’re breastfeeding. So if you’re breastfeeding. this baby for eight or nine or 12 months or whatever. I’ve, I’ve talked to women who their period will come back before they actually wean the baby, but postpartum hormone suppression can last for many months after the baby. So it’s different for everyone.
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Yeah. What are some of the things that you advise women to do to help with those hormonal shifts? Are there things kind of from a lifestyle perspective, diet, sleep, stress management, supplements, anything that tends to help, even if it doesn’t completely get rid of the problem?
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Right. Absolutely. And I think all of those things are important, especially sleep and just, but the reality of, of our sort of like social situation is that parents are so siloed. Right. There is no village anymore unless you’re paying your village and you have a nanny to come in or childcare, which is very expensive.
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And so I also try to be like, not patronizing to people be like, oh, well make sure you’re getting sleep and make sure you’re exercising and make sure you’re having home cooked meals. Like when these people may just sort of be running on fumes and it really is just the two of them.
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And so I try to be mindful of the family’s circumstances.
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Absolutely.
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If they have aunties and grandparents and friends and community, then that’s great. And I encourage people to lean into that. Like if someone asks you if they can do anything for you or bring you a meal or just sort of like sit in your living room with your baby while you take a shower.
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If someone asks you if they can help you, accept that. Like lean into that. Um, I, with the, with women who are nursing, especially in those early days, I think it’s, it’s hard for them to allow other people to feed the baby, but I do encourage that for either kids or women who are pumping.
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Yes, it’s okay to pump. And yes, it’s okay to let your partner take an overnight feed, because if you can get that, like just five or six hours of like golden sleep, right. You wake up feeling so much more refreshed after six hours of sleep than after three.
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Right. That makes sense.
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Yeah. Those practical considerations really important. And just reminding people again, in a way that’s not patronizing, like this is, it’s going to feel like every day for the rest of your life is going to be like this. Like the, I think the one of the most difficult chapters of parenting is the first two months
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and then like toddlerhood and adolescence. Makes sense. Be a real like, oh my, I wasn’t really like, I didn’t realize how hard this was going to be. So recognizing and validating that and saying this is the first couple of months are going to be really tough. take help where you can and make sure you’re staying hydrated.
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It’s okay to cry. It’s okay to put them down and let them cry. And you cry. Yeah. Humanizing that experience, I think.
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Yeah. I would imagine that some of those hormonal shifts, like definitely affect things like postpartum depression and other mental health. Um, concerns that can manifest in that postpartum period. Can you talk a little bit about how that feeds into those concerns?
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Yeah, absolutely. And I’ll go back to the science because for me, like that’s sort of my like grounding principles, right? And when starting or as I’m doing perimenopausal and menopausal, CME training, it’s like estrogen goes everywhere, right? Like it’s involved in the synapses in your brain and it’s involved in your
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cardiovascular health and your vascular health and your stamina and your strength, not only estrogen and progesterone, but testosterone as well. Women actually produce more testosterone in their body than they produce estrogen.
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So.
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All of these things, it’s like you can get brain fog and you can have memory problems and some women will have just like almost like premenopause or I’m sorry, like premenstrual types of symptoms where you feel like you have a really short fuse. Like my tolerance for nonsense is like non-existent right now. And it’s, yeah.
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of hormone fluctuations and the same can affect postpartum depression and postpartum anxiety and your your mental health is very much intertwined with your your physical health and your relationship with your partner and people i think recognize that murder is the number one cause of death in pregnant and postpartum women murder than die by obstetrical complications.
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Wow.
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So I think there’s a real need to recognize that postpartum mental health can affect relationships and many relationships, romantic relationships will dissolve within the first four years of a number of families that are going through that right now. But. making sure that those, those patients who are struggling with postpartum mental health, I have again,
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folks in my community that I’ve reached out to that I’m like, this person is great. And they specialize in postpartum therapists and talk to your OBGYN. Some people need to be on SSRIs. for a certain period of time. Again, like topical vaginal estrogen is not systemically absorbed. So if there are urogenital changes that the OB prescribes,
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topical estrogen, those types of things, they’re not going to be absorbed systemically. And I don’t really know enough about like hormone therapy, postpartum, and especially in the context of breastfeeding, that’s not really important. house, but when it’s struggling with postpartum depression, I do encourage them a to reach out to a therapist that I already have a
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relationship with and to be in touch with their OBGYN. And typically with those moms too, because I do a lot of like text based and telehealth in my practice, I’ll check in on them and just be like, Hey, I was just thinking about you. Just like, how are you doing? How are you adjusting?
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And they are also working with a pelvic floor physical therapist or a mental health professional that I have a relationship with as professionals sort of like gather around this patient and are checking in with her and communicating with one another to make sure that we can sort of like get her through that chapter.
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Yeah. Gotcha. Yeah.
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So valuable.
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Yeah. I’m curious if there are any dietary interventions that are more evidence-based. For example, do phytoestrogens help during this postpartum period at all or other things that women can do if they do have the bandwidth and kind of the money and the ability to pursue those avenues?
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Yeah, that’s a really interesting question. And I don’t have data on that. I haven’t studied it. I’ll look into it now that you raised the question. Interesting one of sort of like, how can we get these natural compounds to boost at least sort of that may mimic. Yeah. But things like vitamin D supplementation, continuing their prenatal vitamins,
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making sure they’re staying hydrated, sure that they’re avoiding alcohol and substances. And I mean, that seems like it would go without saying, but one of my like big I guess like beefs with the culture at large is this sort of normalization of mommy needs wine or mommy needs vodka.
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Like the normalization of alcoholism is so pervasive in the culture. Yeah, destructive.
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Mm hmm.
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that I just kind of like to check in. And if things, if things are popping up on my radar that like, maybe I need to be checking in about substance use or reliance on cannabis or alcohol or whatever is a self soothing strategy to make sure that I’m checking in
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on those types of things as well in a way that’s not shameful.
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Right.
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And it’s like, let’s make sure that we’re optimizing your health and that’s not going to ultimately come in the way of your relationship partner and your child.
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Excellent. Yeah. So it sounds like in your practice, you kind of open that conversation and you’re able to kind of help moms who might be identifying some of these issues to take steps. So you’re not acting obviously as their provider, but you’re connecting them with resources in the community and
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And it sounds like you have a great referral network with PT and mental health. And I’m guessing obstetricians, gynecologists who can help. How does that referral network work? Or like, how did you even establish those relationships needed to help the moms in this way?
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So this is one of the beautiful things about direct primary care, like getting back to the ties that bind you and I are that when I worked in a insurance-based clinic, seeing six patients an hour is what I was to see crazy. It was just like, go see Cardale.
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And this is where medicine is siloed, like refer out, refer out, refer out, refer out. And then they go and talk to a referral specialist who then goes to talk to insurance company and what have you.
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And yeah.
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since i’ve been doing this on my own it’s like opened up time in my schedule to reach out to other doctors and physical therapists and dentists and mental health professionals and like i even while had a like relationship with an adult toy store like a luxury boozy yeah
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store where i was like i may occasionally send patients in to talk with you about things like the lv which does focus on strengthening of pelvic floor physical health or like the intimate rose which helps with relaxation of the muscles in the pelvic floor like yeah out into the community to say look i i’m an integrative
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direct primary care pediatrician this is these are the patients that i’m trying to help like fostering those relationships has been personally and professionally gratifying to me, but so it helps me like redistribute the labor of caring for kids and their families.
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Yeah. That’s amazing. Yeah. Now, given that you yourself are a cash-based direct pediatric care practice, Do you find that your referral network is also mostly cash-based or do you find parents saying, well, I can pay so much cash, but I need to also use my insurance for these other things. How do you navigate that?
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Kind of both. And there are some families who resources aren’t an issue, which is great, but I kind of have, I have both, right? Like I have a physical therapist that is cash-based and only that goes to the home. She also has an office.
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but I also have reached out to other clinics in town who do take insurance and the same as of mental health professionals and like developmental, the folks who do like the ADOS evaluations. I know of a clinic that is cash only.
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And then I have a couple of other clinics who do those neuropsych evaluations and they do take.
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Nice.
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That’s part of, I feel like so much of what my job is and the structure of this healthcare system, which is just, I could go on an entire soapbox about that. So my job is just helping people navigate the system that I have learned to sort of either work within the system.
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Like these are the options if you work within the system and these are other sort of like subversive ways of accessing like a chest x-ray for cash is like $50 at my imaging center and I have discounts with LabCorp. So if you want to,
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you might get a bill and I don’t know how much it’s going to be for, but if you want to use my discount, it’s going to be this.
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Yeah.
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Learn how to navigate the healthcare system is, I feel like one of the very valuable services that I offer.
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Yeah, absolutely. Wonderful. What would you say, I guess, just sort of circling back to like this whole DPC, you’ve given us some wonderful pearls of wisdom regarding postpartum health. Thank you for that. what are some of the lessons you’ve learned in this like dpc journey for yourself
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maybe three key takeaways about being a dpc pediatrician oh if i would have known
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you were going to ask this question i would have made a list that’s okay i again like coming from the perspective of disability i just i can’t keep lighting myself on fire to keep other people warm and i think as women and as pediatricians like we’re taught to be very
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self-sacrificing right like we’re always putting someone else ahead of us and mothers are the same type of thing right but like if i’m not taking care of myself i can’t take care of other people and so Self-care is probably number one. And I’m much healthier now that I’m practicing in this service model than I was
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when I was practicing in insurance-based care.
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Yeah.
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Another thing is just the healthcare system. And I, I do a lot of writing on Substack about both of these topics, like what it’s practice medicine in this system that is built for profit and on sexual health and women’s health. People can go to my sub stack, which is dr. Amber stock.com. It’s under the white coat.
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If you want to Google it, but learned a lot about how to navigate the healthcare system and that is something that no one ever taught me in medical school like we don’t get any training on the business of medicine or how to manage money or whatever My third thing on that note is I have,
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I have a CPA, I have a bookkeeper and I have a tax person and outsourcing the things that you’re not good at, whether it’s social media or marketing or the money stuff. Look at what resources are available to you that you can afford. Of course, like we’re all small business owners now.
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Yeah.
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And having those people that I trust with the, the business, like the money and business side of things are invaluable. And I’ve learned a lot, but like, I don’t have time to learn tax policy.
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Right. Exactly. Yeah. And I think I am glad you point that out because that is one of the traps that we can fall into. And in the beginning, I wanted to save money. I wanted to try to do as much as I could by myself. And that served me for a little while.
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But I don’t think that my practice would have been sustainable if I had continued to… think I can keep doing it all. So once I reached a certain financial position where I could outsource some of those things, I did that. But I also had to adjust my budget because I had to say, OK, well,
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in order to cover those things, my prices might need to be adjusted. They might need to go up. And that’s part of being a business owner and doing business. And as they like, it takes money to make money. Right. And that’s one of the things I’ve been learning along the way.
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I want to go back to something you said. So you mentioned that now your self-care is so much better than it was in the fee for service world. Now, unfortunately, it took a life event to kind of put you on this path in this direction, but it’s worked out beautifully.
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One of the things that I see sometimes happening, including with myself, is that we carry the same habits of being over from our fee for service life into dpc or we can carry the same things and so we can end up having the intention of making something that’s better but if we don’t really change certain things
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about ourselves we can just recreate the same misery that we were in before i particularly see this when it comes to boundaries so people didn’t really know how to establish boundaries in the fee-for-service world or didn’t have to and then They struggle with that in DPC. How did you figure that out for yourself?
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Cause it sounds like you’re doing a pretty good job with it.
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Yeah. Well, it’s, I think it’s an ongoing thing, right? Like one day at a time. And it took like my first probably whole year in practice. I was just like, I would answer the phone whenever. Yeah. now i have after hours and if it’s urgent please call otherwise i’ll get back to
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you the next morning or what have you yeah but i again as a as a woman and a pediatrician i’m an empath so like this is something that i still very much struggle with and for me i like exercise is critically important to my mental health and i make sure
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that i set aside time for a workout like i don’t start until 10 o’clock in the morning again unless there’s and i use my mornings to like work out and have my coffee and resting and yeah And also, I think there is, especially after COVID,
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there has been this cultural shift where patients will sometimes approach us with a very adversarial, right? And there have been a couple of times where I had to dismiss families from the practice, which is is always difficult to do, but it’s like, yeah, if you’re going to treat me like I’m your adversary and you don’t trust me,
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then this relationship is not going to work. yeah i try to be very like again empathic and sensitive about those types of things but if i am in a doctor patient relationship with someone where i feel like i’m waiting for the other shoe to drop yeah that one false move and they’re going to
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lob a lawsuit at me then i invite those families to to find someone a care provider whose approach is more in alignment with their goals and I think the way that you say that like the way that you roll it out is is
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really important but I’m here to help you like help me help you and if you can’t do that fine then you need to find
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Yeah. And I think it’s really important to kind of pay attention to those signals early on. I have not always been good about that, but if you, I don’t know, I think we all have some sort of inner guidance or intuition that sometimes we just get a weird feeling about a family or a client.
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And that’s not to say that we should like judge them right out the gate, but listen to that. And if you feel like This is not going to be able to be a therapeutic relationship or a healthy relationship. Then do what you need to do early on. I love that you mentioned that.
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Definitely. And I’ve gotten to the point now where my practice is busy. I’m full word of mouth is doing its thing. Like I don’t advertise and I have a wait list. I will have a, like an hour long conversation with a family before they come in to the, make sure that they understand, like,
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this is how I operate. It’s different than what you’ve seen before. This is offering to you. And these are my expectations with respect to respect and communication. And if I’m giving you recommendations, it’s based on sound science. yeah like this is a it’s meant to be a relationship of trust and if that’s not what
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you’re looking for then and so I kind of like interview families before they come into the practice now I couldn’t do that when I first started off but like I’m very blessed that it’s my situation now
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Wonderful. That’s amazing. And I love hearing services. Some people feel like, oh, I have to market heavily or I have to do social media or I have to do this because some other person did that and that’s what worked for them. I love that you are an example of someone for whom it worked without really doing
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some of those things and just relying on word of mouth. There are those of us out there who have done it that way. And it is doable. That’s not to say it’s going to be right for everyone. And it depends on your location, your preexisting relationships in the community, like luck, all of that stuff.
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But thank you for sharing that. I do want to just briefly circle back before we finish to this topic of postpartum health and maternal health. If a pediatrician listening to this wants to learn more like you have through CME about how to help moms navigate the postpartum space, where can they go?
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What are some things that you’ve really enjoyed and that you would recommend to others?
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So I, this past year became a member of the international society for the study of women’s sexual health. There’s also the international society of sex medicine, which I also belong to. And I’m going to be giving a talk at their conference in Atlanta. I’m also, I am giving a talk on like menopause and intimacy, but again,
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there’s so much crossover with postpartum. So I’m giving that talk on December 7th. go to my Substack there’s more information about that there it’s going to be a live zoom and i’ll have the slides and i promise not to do death by powerpoint but yeah
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i’ll give a good overview for both a lay and a clinical audience of these hormonal shifts these are sort of like therapeutic modalities and what have you but those are the two big ones the menopause society Also has a certification program. So those are the resources that I’m drawing on. Dr. Kelly Casperson is a urologist.
37:42
She’s all over social media. So some of your audience may be familiar with her, but she wrote a book and does a podcast called you were not broken. And I’m taking a CME course with her right now about sexual health and menopause and testosterone therapy actually. And.
38:01
she just has a great sense of humor and like a wonderful sex positive approach. to having these conversations within a like a medical context that recognizes the importance of intimacy in our overall physical and mental health which i think at
38:21
the end of the at the end of the day like we’re we are mind body and spirit right yeah our intimate lives and our relationships are an integral part of that
38:33
Yeah, I love that. I love that perspective, too. Well, thank you so much, Dr. Hull, for enlightening us on this topic and for sharing resources and also for talking about your DPC journey. It’s always wonderful to hear how this works in so many different wonderful ways. So thanks for being here.
