Hi, everyone. I'm Dr. Deborah Vennessy, and I'm President-Elect of the American Academy of Physical Medicine and Rehabilitation, otherwise known as AAPMNR. And you're listening to the AAPMNR podcast. I am so excited today because I get to introduce you to someone who has been such an incredible mentor and teacher for me. He's a friend, and we're colleagues, and we also work together and volunteer with the Academy of Physical Medicine and Rehabilitation, Dr. Stuart Weinstein. I also get to introduce you to my new friend and colleague, Dr. Talia Fleming. Talia is a new Associate Editor for the PMNR Journal, and Talia and I are co-hosting the podcast today. Before I formally introduce our honored guest, Dr. Stuart Weinstein, I wondered if Talia could share a little bit about herself with our audience. Great. Thank you so much for having me here, and I'm really excited to be a part of this whole initiative. My name is Talia Fleming. I'm the Medical Director of the Post-COVID Rehabilitation Program and the Stroke Recovery Program at the JFK Johnson Rehabilitation Institute in New Jersey. I'm also a member of the AAPMNR Multidisciplinary PASC Collaborative with a focus on cognitive impairment as well as health equity. My faculty position is a Clinical Associate Professor at Rutgers Robert Wood Johnson Medical School and a Core Assistant Professor at Hackensack Meridian Health School of Medicine. Thank you, Talia. Let me tell you a little bit about my friend and colleague, Dr. Stuart Weinstein. Stuart was originally from New York, and he graduated from New York Medical College. After that, he did his internship in Physical Medicine and Rehabilitation Residency at the University of Washington in Seattle. Stuart worked in private practice for about 15 years before moving over to the University of Washington full-time, and he serves as Clinical Professor in the Department of Rehabilitation Medicine and works in the Outpatient Sports and Spine Clinic. His journey through our Academy of PMNR has included serving as President of PASCR. He was Chair of the Academy Integration Workgroup that reintegrated PASCR back into the Academy, and he designed the original council model, which we just changed recently over into the communities. More importantly, Stu was our Founding Editor-in-Chief for the PMNR Journal, and we fondly refer to that as our purple journal, but I've got mine here, so this is we're talking about it. Fun facts, I hope he doesn't mind that I share this, is that he enjoys writing poetry. He enjoys reading about space and space travel, collecting mechanical wristwatches, and books on baseball, but as I mentioned, we're not going to talk about baseball. We invited Stu here because he's the Guest Editor for a collection of articles that was published in the June issue of our PMNR Journal, and those articles highlight, quote, how COVID-19 informed the future impact of the specialty of physical medicine and rehabilitation throughout the healthcare continuum. This collection of articles, or white paper series, highlights the critical role that physiatry has played in the COVID-19 ongoing pandemic in different clinical settings, and it identifies how well PMNR is well-poised not only to respond to this global pandemic, as well as to an ever-changing healthcare system, but to lead the way to a better model of healthcare delivery in the future. I am super excited about our conversation. Stu, you know that Talia and I have a lot of questions, and wondered if you guys are ready to dig in. Let's go for it, yes. Sweetie. Well, beans, I think that Talia's up first. Yes. Well, Dr. Weinstein, thank you so much for taking time out of your busy schedule. We are thrilled to have you here today with us. For those in our audience who may not know much about our specialty, how do you see the role of physiatry across the healthcare continuum? Well, first of all, I want to thank both of you for having me. It's really an honor to be with you today as well. This is an exciting topic to talk about, the academy and long COVID and caring for patients. It's really fun that we get to do this. Our specialty is called physiatry, as you've said, or physical medicine rehabilitation, or PM&R for short. We are one of the 24 primary medical specialties in the United States that are board certified. Our organization, our specialty started in about 1950. It's a marriage between doctors who are practicing physical medicine, which in these days people would call sports and spine medicine, and doctors who were practicing rehabilitation. In the 1950s, those were really treating soldiers who were coming back from WW2, who had been injured, sometimes very severely injured. That was the marriage of PM&R. Today, we have about 10,000 board certified physiatrists in the United States. Our specialty treats so many different types of medical conditions in patients. We treat people who've had neurological and brain injuries, spinal cord injuries. We're involved in sports medicine at all levels, pain medicine, amputee medicine, cancer rehabilitation, pediatric rehabilitation, and many others. In terms of our clinical reach, we are very expansive. The physiatrists also work across many different types of environments. You can see physiatrists doing consultations in emergency departments, intensive care units. We work in inpatient settings, outpatient settings. Physiatrists work in skilled nursing facilities. They work in long term care facilities. They coordinate home healthcare. You can see the breadth of the specialty, the continuum for this specialty goes across different types of clinical environments, as well as practice environments. We do a lot of different things. Sure do. It's humbling when you talk about all that. When preparing for this, I looked up what white paper means. I don't know if you guys know this, but my definition that I found is a white paper is an authoritative guide that discusses issues on a certain subject, along with the proposed solution for handling them. Then the term white paper came out about after the government color-coded reports to indicate who could access them with the color white referring to public access. I'm sure you knew this too. I did not. I thought it was. I had no idea. Can you talk us through the process of the white paper series? How did you come up with this idea? Yeah, by the way, I didn't know why the definition or the label white paper existed either and found out, like you, that it was really a government issue. That's interesting. Yeah, I think I would rewind the clock back to the first few months of the pandemic. It was so new for us. Our members obviously were being affected. Our patients were being affected. The academy was being affected in every which way. I said to myself and talked to others as well, what can the academy do? What can this specialty do to make an impact on the direction of caring for people in this pandemic? History-wise, we could look back and there was a previous pandemic. Actually, there were several previous pandemics in this country, but the one that probably was the most relevant was the poliomyelitis pandemic that started in the early 1900s and really lasted through the 1950s into the early 1960s. Polio primarily affected the neuromuscular system. People who were afflicted with polio would have weakness in various parts of their bodies, difficulty breathing, mobility issues, and really difficulty functioning. It wasn't quite the same as the coronavirus, as COVID-19, but clearly it was a virus that affected people in many different ways. PMNR really was integral to treating people with poliomyelitis in terms of helping them manage pain, because for people with polio, they did have a lot of pain, helping them regain strength, and really most importantly, helping them regain function to get back to as normal as possible. With that as a background history, we asked ourselves, what would a medical historian, 100 years from now, think if they look back to this time and PMNR didn't take a role, didn't really take a leadership role in trying to be involved with COVID? The answer, of course, was really clear. The answer was, we missed the boat. We had an opportunity to really influence and to help and lead a new phase of healthcare with this pandemic. Given that, it's really a rhetorical question, but given that the answer was really clear, we needed to figure out how that was going to happen. None of us really knew at that point. Again, we're talking about the very beginning of this pandemic. No one really knew where this was heading or exactly what was going to happen, but we knew, I knew, and I think a lot of us believed that PMNR was going to be valuable to the healthcare world in many ways, and as we talked about the continuum of healthcare in many different environments. I reached out to some people in different areas of those continuum that we talked about to gauge interest, to see if people thought the way I thought, that this was really something that we had to do. Everyone I spoke to was super excited about it and really receptive to the idea. Of course, realizing that at that point in their lives, they were already being overwhelmed with day-to-day life. I'm bringing to them this new idea about doing a white paper, which was going to take a lot of effort and a lot of work, but people were interested, and so we said, okay, let's set out and do it. My goal of this white paper, I think, I would summarize really three issues. One is I wanted to demonstrate that PMNR was going to be impactful across that healthcare continuum when we're dealing with COVID-19 and the pandemic. I wanted to demonstrate that physiatrists are kind of like chameleons. We can adapt and we can change when the environment requires us to do that. Clearly, and we can talk about that in this podcast, and you know this as well, and people listening know this, that we really have adapted in many different ways. The third is I wanted to show that physiatry can really be transformational leaders, that we can take chaotic situations, we can take crisis situations, which clearly COVID was, because we are, and we can make a difference because we as a specialty, we as physiatrists, we're comfortable with complexity. We deal with complexity every day of our lives and our patients, and so I was hopeful that that's ultimately what this white paper would bring out, and realizing that all of this was way before long COVID even existed. I mean, this was just the beginning of the pandemic, and we didn't have any clue what was ahead, so that was the start of it. Yeah, that's actually one of my many areas that I highlighted in your introduction about the primary goal of the white paper series, and it looks like there's, what, seven different sections, I think? Yeah, there are seven sections. It's inpatient rehab, skilled nursing, outpatient skilled nursing facilities, outpatient musculoskeletal, outpatient pain. Those are basically four sort of clinical, although skilled nursing and intuition are also environments. We have a chapter on the community of people with disabilities and how COVID impacted and informed that group. We have a chapter or an article on graduate medical education and trainees, and then we have an article on national medical societies and the role that national medical societies should and can play in these types of crises. So it really is across, again, talking about the continuum, it really is across the continuum. Yeah, as I was reading the different articles, you know, I was definitely just impressed with, as you mentioned, all of the different areas. Just the depth and the scope of the whole series really made you feel like it was a whole compilation of a lot of different aspects of what we do, as you mentioned, every single day. And so I felt just the insight to assemble the various clinical perspectives from across the healthcare continuum, and as you mentioned, even into the graduate medical education and into the society, I thought that the medical society, I thought that that was really important and great for everyone to take a listen to and to take advantage of learning more about all of the different areas. What are some of the ways in which physiatrists have shown innovation and agility during the COVID-19 pandemic? Yeah, lots of ways, so many ways, and I really encourage everybody to read this series. We are not going to be able to even sort of get too deep and through the surface of these in this podcast, but there's so much information. One of the things I really wanted to do with this series was to help physiatry reimagine how PM&R can function and be innovative for the future. So it was not just how our specialty reacted to COVID and how we were valuable and effective during the COVID pandemic, which unfortunately still exists today, but it was really as well influencing how we think about the future. And so I would say to that end, there were several common themes or highlights that I can kind of share that I think are really important from the series. One would be that we have demonstrated how physiatrists can manage what I would call patient throughput or the flow of patients throughout the continuum of care. I mean, one thing that has been so obvious and so critical to institutions and hospitals is that the need for beds, the need to deliver care for people who are really sick, which is not to ignore people who don't have COVID because they're sick too and they have issues too, but we had to figure out how to open up space for patients who need ICU beds, who needed really urgent and emerging care. And physiatrists were amazing in terms of helping patients get through the system efficiently and effectively and with results. And so I would say that from acute care to inpatient rehabilitation, to let's say skilled nursing, to home care, to doing outpatient care, physiatrists were there every step of the way. So I think we've demonstrated how we can really help manage this patient flow and throughput and I think that's something that's really going to be important for the future. Another is that we've demonstrated that physiatrists can really influence systems of care at population levels because we are talking now about large groups of patients, not even just the COVID patients, but all our other patients who still needed care and we had to figure out how to deliver it and we had to really modify and develop new systems. So we talk a lot about population health and sort of the future focusing on big groups of people and understanding how to provide value care to big groups. I think this was really a step in that direction. We certainly had opportunities to work with many different stakeholders. And when I say stakeholders, certainly our medical colleagues, but also patients. And we have partnered with patient groups as well. If we talk a little bit about long COVID in the podcast, we can address that. But I think another group that's very important that we were able to partner with was the so-called C-suite, the administrators, the people who run institutions and run hospitals. And I think that they have recognized the great value that physiatry brings partly back to the throughput issue that I talked about, but really to provide the type of care that not too many other specialists can provide. And for example, providing pulmonary rehabilitation care, which has classically been an outpatient type of treatment to bring that into the inpatient world. And who better to do that than physiatrists who work in pulmonary rehabilitation. And that's not to eliminate pulmonologists and respiratory therapists, because we have a lot of colleagues and a lot of other people we work with. But the whole concept of bringing something like pulmonary rehabilitation into a setting that typically it wouldn't be existing in is something unique that we were able to do. And I guess the last thing I would say, just it isn't the last, but it's certainly another highlight, is that we have really figured out the importance of advocating for outpatients. Because the patients who weren't sick enough to be in hospitals, the patients who have musculoskeletal problems, acute ones, the people with chronic pain problems that still need care. Yes, those problems are not life-threatening, but those problems do impact function and quality of life. And those people could not be forgotten. Those patients could not be forgotten. And we had to figure out ways of caring for them and being their advocates in a system that was just a medical system that was being overwhelmed. So to me, if you look at the really big impacts of how physiatry worked through the COVID pandemic in the last year, now, and I think in the future, those are some of the highlights that I think will really carry on and really prove that we are very valuable to the healthcare system. Absolutely. And Stu, you touched on a couple of my favorite articles, aside from yours, but I think the one that, a couple that really touched maybe me more personally was certainly the one about skilled nursing facilities. As Stu knows, my mom is in an assisted living facility because of dementia, and certainly everything kind of closed down. And just reading what those authors talked about, how they had to navigate trying to get into the skilled nursing facility. My mom also developed or caught COVID and ended up in the ICU. And that was challenging just to manage those, being on the other side in regards to face timing and not being able to be there to advocate for her. She did survive and I've been able to see her. So, but that one obviously touched me as well as the disability one. And I just wanted to read you a quote from Tom. He did, Tom Statsenbacher, our executive director, as you mentioned, writes about the National Medical Associations in regards to COVID. And he said, the events of this past year have forced a return to the basic tenets for associations and celebrated the unique and indispensable value to the profession at their core associations, which is what we represent, are a group of people who voluntarily come together to solve common problems, meet common needs, and accomplish common goals. And I guess it makes me think, I'm just thrilled that you decided to do this because this is such an important part of our learning. And I also liked how you used, what did we learn or how did the future lessons learn? And each one was lessons learned from the impacts. Maybe you'll have part two. Were there any findings that surprised you? We didn't really talk about telehealth, but. Well, yeah. I mean, telehealth obviously is such an important part of delivering care through the pandemic. And for those of you listening, Deb is one of the members of the committee working on telehealth and how it may be transforming the future of healthcare. So she knows, she's certainly very interested in that topic and yeah, I think technology itself, using technology to deliver care is pretty amazing. But I'm going to tell you that I think that's really a great segue into your question about surprises. I wouldn't say it's surprises per se, but I think that there were some things that really make you stop and think. And because there are times we take too much for granted. So for example, the article that was written on the impact of COVID on the population of people with disabilities, we have to consider that the consequences of COVID affected the people most vulnerable, the greatest. And for that end, physiatry cares for many people with disabilities. And a lot of the public health policies that were put in place by the government to address the consequences of COVID really were greatly magnified for people with disabilities. Things like social isolation, staying at home, people can't get care. I mean, people already have mobility challenges and they have technology challenges. So they have difficulty managing telehealth if they even own a computer. So some of these issues really impacted our patients with disabilities to a great degree. Clinics that were shut down, limited their ability to get care. Even wearing masks. Patients who have communication challenges and communication disabilities and have to rely on facial expression and even people who lip read, wearing a mask is devastating. And I think that for us as physiatrists, we know a lot about disability. Our patients have disabilities, but sometimes we just take it for granted that they'll get through. And I think that article really, really highlights. And I would tell you, the authors wrote a commentary in that article, which I think is really just so insightful. And that is that we as medical professionals, but we as society need to really combat ableism. And I think we need to make sure that that disability is taught to healthcare professionals, because if it's not taught, then it's not known. So did it surprise me? I wouldn't say it surprised me, but boy, it was eyeopening. And I think it's super important. Yeah, that was one of my favorite articles too. I have several, but that was so good. So good. I had a patient with visual impairments and they were telling me, Dr. Fleming, what do I do? Because the recommendations are don't touch anything because the virus can be on surfaces, but that's how I used to get around. So definitely, we appreciate what you mentioned in terms of bringing that to the forefront and making sure that we're giving a voice to that. Yeah. And my next question might be for both of you guys, and especially you, Talia, but how do you see the role of physical medicine and rehab and the management of long COVID or post-acute sequelae of COVID tasks? Either of you. Talia, you can start if you wish. So, I mean, as mentioned earlier, definitely physiatry is within the whole rehabilitation continuum, from the acute care all the way through outpatient and even in certain areas more in the performance in terms of higher performance activities. I definitely see more and more of how, first of all, we're still getting an idea of what long COVID is, what the treatments are, what the recommendations are, which is why the fact that the academy came together to put the collaborative, the multidisciplinary collaborative was so important. What we were noticing is that there were pockets of people that were doing different things across the country, but it was really important for us to get together, have a time where we can share stories, share successes, as well as challenges, and really make sure that the whole group as a whole progressed forward and got better in terms of how we can treat patients in the future. I know that our first collaborative article is about to be published in the August 2021 for PM&R Journal, and that's the Multidisciplinary Collaborative Consensus Guidance Statement on the Assessment and Treatment of Fatigue. That's one of many topics that will be coming out. But I think this multidisciplinary approach, which we're very comfortable with in physiatry, is that we're going to see more and more models like that and how we can help patients across the spectrum. We know that in long COVID, multiple different systems are being affected. Initially, we thought that this was primarily a pulmonary disease. Now we know that it can affect not only the cardiopulmonary system, the gastrointestinal system, the endocrine system, skin, allergies, renal failure, we're seeing. And so it's going to take a multi-pronged approach to be able to treat this. I always say that every person that comes in to see us has different needs and our approach to treatment is going to be different for them. And in physiatry, we're very comfortable with customizing a treatment plan for each individual patient. So I see more of that as we progress into the future. Yeah, I agree with all of that. If you think about all the different body systems affected by COVID and you heard Talia mention lots of them, and we can add, of course, cognitive deficits and weakness and deconditioning, these are all within the wheelhouse of physiatry. These are the things that we are trained to care for, especially the more chronic ones. And it's true, not every physiatrist in this country will be completely comfortable treating all patients who have long COVID, but we should be able to really assess these patients and guide them and maybe help guide them on their journey to the right place. And as you said earlier on, Deb, and I think Talia, you mentioned you're involved and you started a long COVID clinic where you work. And probably a year ago, there were a handful around the country, and I don't know what the number is today, but I suspect there's probably 100 or more multi and interdisciplinary clinics around the country that see and treat patients with long COVID. And many of those have physiatrists. They're not all physiatrists because clearly these problems require many different types of specialists and colleagues, but that's also what we're great at. We're great at working in teams and working across different specialties. I guess when I think about how is PM&R set to manage people with long COVID or post-acute sequelae of COVID, it's our wheelhouse. It's what we do. Exactly. I wonder if either one of you can kind of backtrack a little bit and talk about the learning collaboratives. Stu and I have had an opportunity to listen in, but for those people that don't really know what the heck we're talking about, if you can just talk a little bit more about that. I think Talia started it. Let me add a few things, maybe from an academy perspective, because as Deb just said, I'm more of an observer. It's a fascinating process. Talia is more in it as a clinician, but this has been such an exciting and an important initiative that was started by the academy. And if we go back and we look at the statistics, the statistics are suggesting that up to 10% of people who have been infected with COVID, even if it wasn't a major infection, even if they didn't even know they had COVID, are going to have some degree of long COVID symptoms. And if you look at the numbers, I mean, today, I think the Johns Hopkins website says over 37 million Americans have been infected with COVID since the beginning. So the numbers for potentially people who have long COVID are really staggering. So January this year, we brought together a small group of physiatrists from a few different institutions to talk about putting together a learning collaborative. It was brought to the board, as Deb knows. We both sit on the board and the board was enthusiastically approving it. And that really started the process. It started with an idea to bring stakeholders across various specialties together. I think initially there were 20 PM&R institutions. I think now there are 85 or more, Talia, tell me if I'm wrong, but I think 85 or more members who are in the collaborative. And it's great because it's physiatry, it's other medical providers, physician providers, it's other rehab professionals who are non-physicians. There are patient groups involved, which is fantastic. We're getting insight from patients that it's invaluable to know that kind of blog called data. It's not necessarily rigorous objective data, but it's the kind of data that we need right now. And so this is, we have lots of input from a lot of different sources and it's really exciting. And I think as Talia said, the groups get together, they discuss the problems, they share experiences, they share treatments. We, it's like a Delphi process where we have consensus on what we want to basically put out to the public. And we're not calling them guidelines because guidelines require more rigorous evidence, which we're so early on in this process with COVID, we don't have that, but these are guidance statements and they're, I think they're going to be incredibly valuable. Yeah. They're amazing. Because as you mentioned, there's neurologists, pulmonologists, what, neuropsych, all the patients. Right. Absolutely. Family medicine is also involved, neuropsychologists, I think you mentioned Dr. Vennessy. So and for me as a clinician, being a part of this has definitely been invaluable. And so being able to, there's several different times when, you know, patients will come to us and they'll say, you know, we've been to these other different specialists. I've been to my primary doctor, I've been to the neurologist, I've been to the pulmonologist, but no one understands the fact that I have this whole constellation of symptoms. Can you help me? And so as physiatrists, we're comfortable with dealing with multi organs, patients that have problems with different organ systems, and we're comfortable with looking at the patient as an entire, as an entire person. But also being part of the collaborative, it's great to have insight from those other subspecialists from the other therapists. And as you mentioned, having the patients, the patient led groups are also invaluable experience because there's oftentimes things that we'll talk about from medical jargon and from the medical perspective. And then they'll raise their hand in the group saying, hey, wait a minute, from the patient perspective, this is what we're seeing. And this is what we're feeling. So it's invaluable to be able to put things together in a way that's going to be useful for really across the nation and really across the globe for other people to be able to help help their patients function better. So it's been an amazing experience. And I really want to congratulate the AAPMNR for their leadership and helping to advance the knowledge in this area. Thank you. Yeah, I think that those are great comments, Talia. And I think the Academy went into this knowing that it wasn't for the fame of the Academy. The goal here was to help patients, to help advance the knowledge of COVID and the treatment of COVID. And we're thrilled as a specialty to be able to start that and lead that. But yes, we know there's so many important people involved. Yes. So Dr. Weinstein, I mentioned the title of the first manuscript, the Multidisciplinary Collaborative Consensus Guidance Statement on the Assessment and Treatment of Fatigue in Post-Acute Sequelae of Past Patients. And that's set to publish in the August 2021 PMNR Journal. So we just want to encourage all of our listeners to download the paper, share the paper with your colleagues, and really apply the information when you're seeing your patients. A lot of work has gone into creating clinically relevant guidance statements, and we really appreciate all the members of the collaborative who volunteer their time to give their clinical expertise. Switching gears a little bit, Dr. Weinstein, I know that as an organization, the AAPMNR has invested a lot in advocacy and legislative action, really at the national level. Can you tell us a little bit more about the Academy efforts? Sure. One of the first things that we did, and this is maybe a few months ago, I think it was in March, the Academy put a call to action that was sent to the Biden administration, to the White House, and to other leading members of Congress, to really prepare. The goal was to help the, or to ask the government to prepare and implement a national crisis plan for Long COVID, because we knew, we knew the direction, we knew the trajectory of Long COVID, and certainly that hasn't changed in the last few months. The call to action asked the administration to develop the infrastructure for caring for patients with Long COVID, both facility infrastructure and funding for these types of clinics at a local level. We emphasize the need for equitable access to care. We know the health inequities in this country exist way before COVID. As we talked about earlier, there are patient groups that really suffer, their suffering is magnified with Long COVID, so we were really asking the government to look at equitable care. The third was to advance the research in Long COVID, and to be able to quickly disseminate the knowledge that we gain, just like the Learning Collaborative is doing. The research is, you know, it's in its early stages, but we want to be able to get the information out to clinicians to be able to use, and so we were asking the government to do that. So I will say that while we didn't get an immediate response, and I think understandably in terms of COVID and vaccination rollout, the government is overwhelmed, but we were in, we were asked to join the Biden Interagency Task Force that was investigating Long COVID, so that was good. We know that a month ago, a few weeks ago, the administration announced that Long COVID would be recognized as a disability, which is absolutely great for people who need disability benefits who cannot function because of the effects of Long COVID. And what's really interesting, and I think great, is that the CDC has had the Academy and the Learning Collaborative on its radar. In fact, I think the CDC sits in on those Learning Collaboratives, and we have been invited to a CDC collaborative or roundtable, or I think it's through your webinar mechanism that's going to be in September. So, you know, we've tried to really push this to have the government, the administration at the highest level recognize the need for caring for people with Long COVID, and we just keep pushing, we just keep advocating. And as you said, Stu, the Academy's efforts are having an impact, as you mentioned. I was looking at my notes, July 26, which was the 31st anniversary of the Americans with Disability Act. So yeah. Go Academy. Yes, yes. We're doing a good job, but there's a lot more to do, you know. So as we talk about what the Academy's doing and all the great things that we're doing as specialty and multi-specialties coming together, how do we increase our awareness about our ability to help patients with PASC and Long COVID? How do we get that message out? Yeah, that's a great question. I think part of it is what we've already talked about. I think that disseminating information from the learning collaborative hopefully will have a trickle-down effect at institutions, at Long COVID clinics. Even the individuals like you who participate will be able to continue to educate the people you work with. So I think the collaborative is certainly one big way to do it. I hope that individual institutions that have these Long COVID multidisciplinary programs will outreach to their communities and help the people in the communities understand what's available for them. We as an Academy will continue to try to educate our members so that they can then treat patients and disseminate information. I think the patient groups will do a great job, and we have I think two or three patient groups in the learning collaborative, and yes, I think that those groups will really be able to disseminate information broadly and widely to help the communities understand what's available. I mentioned the CDC. I think that's another mechanism to disseminate information. So yeah, these are all sort of tied in together, and I just hope that it's a trickle-down effect that continues to spread the information across our country. Yeah, it's exciting. And I think, Talia, all of your work as well as Stu's white paper series will help in regards to sharing information with our patients too and our colleagues. Yes. Cool. So my overall impression of both the PM&R Journal white paper series and the work of the Multidisciplinary PASC has been outstanding and truly remarkable. So just on behalf of all the healthcare providers out there on the front lines, we really thank you for your support. I'm just so proud of my specialty, so proud of our leadership, and just very honored to be a part of this movement that we really are seeing unfolding before our eyes. It's happening in real time. So Dr. Weinstein, as we near the end of our time today, what would you like to share to the next generation of physiatrists that are just starting out on their journey? First of all, I'm going to echo what you just said. I'm super proud of this specialty as well. And it's been an amazing experience in the last year and a half, and I couldn't be happier about just the amount of energy that I've seen all around our specialty. And I will accept your thanks, but I'm going to accept your thanks on behalf of all the members and all the volunteers and the amazing academy staff. That's tireless in terms of what they do to advocate for our members and our patients. So I will accept thanks on their behalf. Yeah, the next generation, I would say that one thing that worries me, even before COVID, but now with COVID, is burnout. I think we have seen the statistics that show that burnout in PM&R has been very high. And I think with the challenges and the anxieties and the frustrations and the difficulties with COVID-19 on all of our lives, not even just our business practices, but our lives, I can see burnout just really becoming more of an issue. So I think that one of my messages would be that this is really the time for us to come together in unity and strength. I think that if we can all come together as a specialty and support each other, I think there's really some value in that. Even though we're a very diverse specialty, and as we talked about early on in this podcast, we're across the entire continuum. Some of us don't even really work together because we're in sort of different ends of the spectrum. I still think that there is unity in being a physiatrist, and I think there's some real strength in that. So trying to fight the burnout is, I think, going to be very important. For me, I think long COVID has sort of highlighted three important things about being a physiatrist. One is that we are doctors of function. We have always been, we always will be. We help people regain and improve their function, and I think as we talked about all the aspects of long COVID, we play a great role in that. I think the second thing, and this is something that I've said a lot when kind of talk about physiatry, is that we have to have a high tolerance for uncertainty in our specialty. We have complex patients, we have difficult challenges, there's not always easy answers, and sometimes there's really not even answers, but yet we have to find a way to have our patients recover as best they can and understand that there's uncertainty, and I think that accepting that and embracing that uncertainty, I think, will make you a stronger physiatrist. And I think the third thing that I would say about learning about physiatry is that I think we sit in this sweet spot, you know, if you think about circles of primary care doctors and specialty care and patients and other allied professionals, I think physiatry sits right in the middle of that, right in the sweet spot, and we are really able to interact with and work with equally effectively all these different types of stakeholders, and I think that that really makes us very unique in medicine, and I think we should be proud of that. I think we play a very special role in what I call the house of medicine, and I think that the younger generation of physiatrists should appreciate that and embrace that and be happy about that. And I guess the final thing I'd say is, and I think Deb talked about this when she talked about the article on the national associations and their role here, I think the young generation needs to know that it's your national societies that are going to advocate for you, especially in times of crisis, and if you can remember that you're a physiatrist first, I think that would really help in terms of keeping us all together and making sure that we are all rolling the boat in the same direction. So that would be my message for the young generation. Awesome. You know, and Stu, I'm going to quote you on one other thing. You write at the end of your article, one COVID-19 learning is for certain. Physiatry will no longer be the best kept secret in the United States health delivery system. True indeed. Well stated. We'll say that again. We're not the, we're not going to be the best kept secret. Not anymore. No. No. All right. Do you guys know why I am so incredibly grateful for both Stu and Talia to be my mentors, my friends, my colleagues. Thank you, Dr. Weinstein. Thank you, Dr. Fleming, for helping us understand all of this better and having a great discussion and conversation about the White Paper series and all of the, I don't know whether it's exciting. That's not the right word, but this challenging time and things that we're doing to make our patients better. Well, I really appreciate the opportunity and thank you both. And it was an honor and keep strong. For those of you who are interested to hear more interviews like this, please check out the complete listing available through the AAPMNR podcast series brought to you by the American Academy of Physical Medicine and Rehabilitation, the primary medical society for the specialty of physical medicine and rehabilitation. Thank you for your time. And one last note, together we are boldly leading the advancement of physiatry's impact throughout healthcare. Bold is how we think about involvement in the evolving healthcare landscape and bold is how we think about our members navigating the challenges of medicine during this incredible time of need. Thank you so much for listening. Thank you guys so much. This has been so fun. Have a great day.

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