Dr Lawrence Loh, CEO of the College of Family Physicians of Canada discusses the 'Crisis in Family Medicine'.
The CFPC's new campaign aims to advocate and bring awareness to the failing primary care systems crumbling across the country and shed light on what actions they believe need to be taken. Join us as we discuss what lead us to this point, the pressures experienced by family physicians and what we can do to start advocating for ourselves to enact systems reform.
Crowfoot Village Family Practice and the Taber Clinic - Case Study Evaluation:
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[Host]: Dr. Jordan Vollrath
[Speaker]: Dr. Lawrence Loh
All right, awesome. So today we are talking to Dr. Lawrence Lowe, the executive director and CEO for the College of Family Physicians of Canada. Dr. Lowe, thank you for joining us and we are chatting about the crisis in family medicine. What is going on? We're all feeling it, we're all feeling the squeeze, everyone's getting more and more burnt out. What is actually going on? What are the problems?
Lawrence Loh (00:25.176)
Well, I think what you're seeing nowadays, Jordan, is, and you can call me Lawrence, by the way, but what we're seeing nowadays, Jordan, is just a reality that is decades of underfunding and a lack of investment in the family medicine and primary care system that has really gotten us to this point. I mean, when you think about some of the ways primary care is structured, some of the way family doctors are compensated.
the supports and resources that are available in the community versus in the acute care system. A lot of those have remained stagnant or flat for the last 30 years. And certainly the thing that pushed everything over the cliff was the pandemic. And so we are long past the point where a stitch in time saves nine. I think we are now at the point where we probably need nine stitches to fix family medicine and the primary care system to get it back to where it needs to be.
both for providers as well as for patients and their access to care.
And what are patients experiencing, you know, looking at things from across the table? What's been the impact on their side?
Lawrence Loh (01:32.152)
Well, I think there's a lot of different impacts that patients have been experiencing, but first and foremost, it starts with access. We know that almost six million Canadians report not having a regular primary care provider or access to a family doctor. We know that many more also report difficulties in accessing someone they may already be attached to. And I think a lot of that really speaks to just the overwhelm and the significant draw in capacity that we're seeing in the post-acute phase of the pandemic.
At the same time, we also know that the patient experience across the continuum, because of the lack of integration of services between providers as well as across a primary care system and together with the acute care system results in things such as tests that go missing, things that get duplicated. And all of this also not just for patients is frustrating, but also results in significant administrative burdens for family doctors in the system.
Well, and so the access problem is widespread. I mean, this has been a huge issue for everywhere across Canada. Maybe if you live right in the downtown core of a metropolis, you're still probably unlikely to be able to have great care and access with a family physician. Why has this gone neglected so long? Why has this been underfunded or unaddressed for so many decades?
Lawrence Loh (02:49.732)
Well, I think, you know, and I, you know, I'll state my bias in the sense that I'm both a family doctor and a public health physician. And I've always commented that these two specialties, when you do your job right, you know, it's actually nothing happens, right? To some extent, public health is about creating the context for healthy conditions in communities. And that's why the work that they do is so vital in keeping people out of health care and the acute care system. And family medicine and primary care is really focused on trying to
ensure that we're keeping people out of the acute care system by caring for them within the community. And that doesn't necessarily garner a lot of attention the way that some of the more acute hospital facing work or hospital based specialty work might do. But the reality is that that's actually where most of the care gets provided. We know, for example, that 70% of care in Alberta is provided by 8% of
family or 8% of funding which goes to family medicine and primary care. And that was actually based on analysis by our Alberta chapter. But it's the same story everywhere. Really what happens is family medicines and family doctors and primary care are so often involved in working out in the community and trying to keep people healthier for longer and really actually relieving the care on the acute care system.
that they're not necessarily front and centre of people's mind when they think about health care and where to actually invest health care resources. But really what it comes down to is the same old saying, you know, an ounce of prevention is worth a pound of cure and family medicine and to an extent, like I said, our siblings in public health, they are the ounce of prevention that are really trying to keep things, keep people healthy in the community.
Why did it take a pandemic to make people actually reevaluate? Why now is this just becoming a priority?
Lawrence Loh (04:41.092)
Well, I think we all know that the pandemic really represented a significant disruption to our society. I think the result of that has been a very significant perturbation of everyone's health and well-being, both physical and respective care that was delayed or deferred as a result of health care systems being overwhelmed, but also as a result of the mental health issues that have been arising out of the collective trauma that we've all undergone.
And so now we are finally at a point where family medicine and primary care underfunded for decades is now dealing with far more complex patients, far more complex presentations, and a really significant burden and demand for healthcare. And we're finding that in between just the lack of resources, the lack of support, the lack of compensation, the administrative burden that has grown over time, together with this...
this overarching challenge of coming out of the post-acute phase of the pandemic, it's really become untenable for many family doctors to continue practicing in the manner that they have been so far.
What happens if things are left unchecked? You know, if we continue on the same trajectory and no significant or meaningful changes are made, what happens to Canadian healthcare at that point?
Lawrence Loh (05:57.772)
Well, I'm less worried about Canadian healthcare, but I'm worried about what it means more for our population, right? And I think if the access challenges don't get addressed, if the supports for family doctors don't get addressed, if a lot of this fragmentation, continuing fragmentation, especially with governments that are substituting roles, rather than having providers work collaboratively in teams doesn't get addressed, then I think the overall health of everyone in Canada is going to suffer because people are not necessarily
quality care that addresses their specific healthcare needs.
And so tell me more about the campaign from the CFPC. What is actually going on right now? What is the goal of sounding the alarm today, here and now? What are we accomplishing?
Lawrence Loh (06:42.436)
Well, I think at the heart of everything, we recognize that there is a significant need to invest in and address the practice conditions that are facing family doctors in order to improve access for patients and the care that patients are receiving. And so the CFPC has been highlighting that family medicine is in crisis. It's really asking people, we know that Canadians love their family doctors. We had a recent survey come out.
that showed that, you know, I think it was something like 80% of Canadians or people that responded in that poll would rather wait a couple more days to see a provider that they knew to see their family doctor rather than being seen by someone that they didn't know. And so we know that attachment is important. We know that people value family medicine, people value primary care, and people understand how important it is to sort of maintaining their health and keeping them out of the acute care system.
So while we sound the alarm, the CFPC is also not just saying there's a problem, but we've also started offering solutions. And we've issued as well a document called the prescription for primary care. And what the prescription for primary care talks about are some really critical changes that if they are actually implemented and stuck to, and there is like a dogged commitment to get through that we can actually improve care for all Canadians, as well as improve, improve working conditions for providers in the system.
And so in terms of those changes, like what are the highlights on there? Like I know that it talks about advocating for fair pay, wanting to, you know, the team-based approach to care and the patient's medical homes. There's a lot of things I actually touched on in that document. Like what are the highlights, I guess, from...
Lawrence Loh (08:22.332)
So the number one thing that we can talk about is definitely team-based care. And so this is the idea right now that people can still be attached to a primary care team in the view of a patient medical home, as we call it, but really it's a team with different providers that really work collaboratively with the same patient panel. I think there's a recognition that you don't necessarily need to have family doctors, seeing every cold that walks through the door, every hypertension check that comes in.
But where family doctors really have the strength and where the burden is, is that they're trying to do all this sort of routine work and care while also dealing with the significant complexity and challenges in the post-acute phase of the pandemic. So we also know that there are many other health professionals that are out there providing primary care that are siloed off from the system right now that also have significant strengths and expertise. For example, physiotherapy with MSK, dieticians when it comes to chronic disease prevention and counseling.
So there is an opportunity to have all these groups come together to create something that's more than the sum of its parts. To create something that is a force multiplier that allows everyone to work at top of scope and to deal with different issues that are faced by a group of patients, while also relieving the burden of any one provider having to care for the full roster. Related to that, if you start moving into team-based care,
you also then need to start compensating family doctors differently. So it's not about volume, it's not about fee for service and getting a whole bunch of people through, but it is about recognizing the really significant skills that you bring at top of scope and compensating appropriately for complexity. And then finally, moving into team-based care also allows you to bring in some relief, both in the forms of coverage, so you can actually just get a break or time away. And I know you folks are very involved in the look-em-scene, for example.
We try, we try.
Lawrence Loh (10:12.736)
Exactly. But then obviously then there's the other part around administrative burden when it comes to if you have a team, you actually can also remove what takes a lot of time away from docs in terms of the forms as well as the running of a business that actually can help to free them up to really focus on that really complex context integration work that family doctors do.
So there's a lot to unpack there. I mean, starting off with the team-based care approach, how do you foresee this playing out? Like for example, pharmacists and their increasing scope seems to be picking up popularity across the country. Here in Alberta, they have the, I think, the broadest scope out of all the provinces. How do you start incorporating the allied healthcare practitioners? Do they need to be working under one roof together? You know, when you think about chiropractic who has their own clinic somewhere or...
at the physiotherapy clinics, how do you actually start integrating everyone into that team-based model?
Lawrence Loh (11:07.312)
I mean, the idea would obviously be if people were co-located under one roof, we know that teams work together when you see each other. And I often like to say even in this virtual world, that there's no better bandwidth than being in person, right? And we all know that seeing people in person, getting to know people, spending time with them, those little subtle cues really helped to build up that team dynamic. But in the absence of being able to do that right now, at the very least, we need to be able to try to figure out, are there digital solutions that could be deployed? For example, addressing, you know, one patient, one record.
I think one of the things that has been challenging with pharmacists being given prescribing privileges in Ontario that we've been challenged by, or at least our members have told us, is that it actually adds burden to the family doctors because what happens is pharmacists will now actually have to reach out to family doctor's offices and say, hey, I've got a patient in front of me, I'm gonna prescribe this med, but I just need to check their lab results on, I just need to check their creatinine because I'm gonna give them something for an uncomplicated UTI and I just need to make sure they're...
So it actually ended up resulting in further fragmentation, further administrative burden, when really the best way to do it is to take all these different resources and we all have the same panel of patients, we all share a panel of patients, we're all sharing the same notes, we're all able to sort of be in quick contact where we need to consult, and there's also an opportunity to direct patients to whoever may be best placed or may be best available to address their specific challenge or issue. So using digital solutions to do that.
you know, coming up with specific agreements to bring teams together, funding it so that there's actually an opportunity for, you know, for people to come in and actually help with the implementation and bring it together teams. And then eventually if co-location works out, that's great. But if not, at the very least, being able to bring down some of those walls between silos.
How has the funding model worked out in Ontario? Cause I know over there, that's like the most commonplace mechanism is, it's not the fee for service, it's the FHO, the FHG, versus here in Alberta, there are a handful of clinics working on a blended cap model and it's by and large fee for service. How has that transition been, or how have things been going with that pay model?
Lawrence Loh (13:16.496)
Well, interestingly, I wouldn't necessarily speak to the model in Ontario, because actually we only have about 30% of people that are in, you know, fits and foes and also working in team-based care. So we're actually hoping that we'll see more of that in a transition in Ontario. But in places such as PPI, which they've actually committed to having every Islander part of a patient medical home, a lot of people have really highlighted that
moving to the new compensation model recognizes complexity. It incentivizes taking care of the people who actually need care, who needs significant bonds of care, and it helps to disincentivize low quality or volume-based care, which can often be picked up or taken on by many different members of the team. So there is an opportunity there for better work-life balance.
and also an opportunity to just really practice in a different way when you move to something like a blended capitation or blended compensation model.
And what are the studies or what's the data showing to support those blended capitation models? Because right off the top, you can imagine, you know, if you're having more complex patients, that's going to increase appointment durations, be able to see less patients over the whole of a day. How does that impact with just the overarching problem of access to care and being able to see a physician in the first place?
Lawrence Loh (14:44.472)
Yeah, it's an interesting question. So I don't have the details or stats with me off the top of my head, but I do know that there was something actually done out in your province with some clinics. I believe they were in Tabor and in Crowfoot. And I understand that by moving to this model, they were actually able to ensure greater equity in the services that were provided. They were actually able to, the people who needed complex care and who needed more regular frequent visits.
we were able to access those more easily. And the whole clinic was able to actually avert healthcare costs within the acute care system, I think to the tune of something like $10 million over eight years, that was something very significant. So I mean, that's something I don't have that study, the name of the study right off the top of my head, but I know we quote it quite often, and it's certainly something we can share with your team, and perhaps you can share with the viewers after the recording's done.
Yeah, absolutely. I mean, it makes total sense, right? Like you can see how that would actually like really help with that collaborative care model. Is this something that needs to just transition like at the drop of a hat and be done overnight or has this, you know, moved to that model something that needs to take place over years, decades? How do you actually get to that point where physicians and teams are operating that way, getting paid that way?
Lawrence Loh (15:59.152)
Well, yeah, absolutely. You know what's funny is that Romano actually recommended moving towards teams in primary care. And to some degrees, family medicine and primary care, if you think about it, we remain the very last frontier for team-based care. Hospitals, long-term care settings, mental health and addictions, clinics, palliative care units and clinics, hospice care, you name it, they all work in teams.
The physicians there don't run a business and they work together with other healthcare providers with a defined patient population. So in some extent family medicine and primary care is far behind, but that's not to say that it's going to or needs to happen at the drop of the hat. I think just small things to start bringing people together, to start optimizing and making care more efficient, right? So, implementing new technological solutions that are actually solutions, not problems.
and really coming up with all sorts of incentives to either bring on staff or to collaborate or to partner. And then in the long run, getting to where we need to go. If we had started after Romano recommended this in 2003, we would have had those decades and we would have maybe gotten somewhere. But I think it's like that old proverb, the best time to plant a tree was yesterday and now is the second best time. So I guess that's why we're raising the alarm now.
So how do you actually enact that type of systemic change when, as you're pointing out, the places that have moved to this team-based model tend to be bigger enterprises or larger organizations where there's like a clear hierarchy of leadership and many, many doctors, many, many nurses working under one facility versus primary care traditionally given in the community, right? You've got one doctor, two doctor, five doctor, 10 doctors. Like...
Maybe it is changing the billing codes to favor that more complex care model because all these independent businesses then are going to adapt to whatever that business code model is, right? They're trying to run their practice. They're trying to keep up with, you know, the pressures and the demands, as well as the suggestions and the recommendations. But if something's not making business sense, you know, it's probably very difficult to actually start changing your practice when it's already stressed.
Lawrence Loh (18:16.12)
Yeah, well, I mean, it's interesting. So to your, I think there's two questions there. So the first one, which is really, how do you drive through change like this? And the second one, which is, well, maybe we could sort of just try to change the current fee for structure service around. I think that if you're gonna change something that drastically in respect of basically getting rid of current billing codes and incentivizing complex care, you might do better to just look at what actually incentivizes complex care rather than sort of tweaking.
tweaking a system that is really challenged as it stands. Because what's to say, you tweak the billing codes now and then some sort of different chronic disease entity emerges or whatnot in the future. And so it's better to really just start to use the right modifiers to ensure that family doctors are paid fairly and compensated fairly for the work on the basis of specific patient characteristics that would make them more likely to seek care rather than having them bill for every service. So it's almost like moving
to the idea of it's moving to the broader idea of taking care of and being a resource to the community rather than being just a service provider that is transactionally engaging. But I think to the first part around how do you shift this paradigm in a policy sense, a lot of it is really just highlighting what happens and remember that not taking a decision is a decision in itself.
So we can continue with the system we have right now, but it is burning out family doctors and providers. Still many of them are not supported by teams, are not a resource to run a business effectively, haven't seen fee codes increase in years, dealing with greater complexity. They're all gonna leave in droves or they're gonna narrow their practice. And we've seen that because a lot of people have started getting away from comprehensive practice because it doesn't pay well and it doesn't necessarily provide the quality of life or the backup that being a hospitalist
in palliative care or being in a more focused practice does. And so what's gonna happen, we need to highlight to policymakers that what's gonna happen is that if the well of family doctors who are providing comprehensive care dries up, if the siloing continues and patients continue to receive fragmented care, then they're still gonna pay for it when actually people start to fall, continue to fall through the cracks and end up overwhelming the hospital and the acute care system. So you're either paying down the line when people show up in your emerges and your ICUs,
Lawrence Loh (20:39.536)
or you invest upfront in really fixing family medicine in the primary care system.
And so changing the billing codes, adding in new billing codes, incentivizing that complex care model, a team-based care model, that'll definitely obviously make a difference to existing family physicians and retention and not retiring early, not tapering down their practice. Are there enough doctors right now that assuming we hit some of these efficiency milestones and increasing that volume of care and better care, are there enough practitioners to get there or do we need to be just funding more residency spots, larger medical schools too?
Lawrence Loh (21:15.212)
Well, it's actually a both and, right? So we need, we definitely need to be having lots more interest in family medicine and really a better practice environment would help to incentivize that. And if they were able to go into all sorts of areas of increased family medicine and practice, I'm sure that would that would help with the overall health human resource strain. But really to your other point around, you know, do we have enough? That's the reason behind team based care. There's a recognition that a solo doc on their own.
versus someone versus one that is part of a team where you can actually deal with the specific needs and the healthcare demands of a patient population through the work of a team is going to hopefully at least reduce or at least limit the need for us to exponent, because this is really not a numbers game. We're not gonna be able to exponentially increase the number of family doctors or training, but we can use our existing resources more wisely.
And what are your thoughts, you know, in terms of the government response to date? Obviously with this new campaign going on, I'm assuming you think that so far it has been insufficient or we wouldn't be sounding alarms, but I mean, the noise from the community, from the medical community seems to be getting louder and louder and louder around these issues. What do you think of what the government has done so far?
Lawrence Loh (22:34.724)
Well, I think there are some bright spots around the country, right? We know, for example, as I mentioned, Prince Edward Island has fully committed to moving to team-based care and blended cat models. And so they've been doing that. Their commitment is to have every Islander attached to a patient medical home in the coming years. And I think that's laudable. And certainly if you're looking at other jurisdictions that have different challenges and different population make-ups.
you know, British Columbia's moved to, you know, a new longitudinal model that actually addresses some of the pain points around administrative care or lack of compensation for education. We know Manitoba is also going that way. Nova Scotia is looking at team-based care again, New Brunswick is. So I think there are a lot of reasons for us to hope, you know, ultimately the devil will be in the details as to how it rolls out, how quickly it rolls out, and whether it actually does end up
greater team-based care, fair remuneration that recognizes complexity, and also addressing the administrative and locum tenants burdens that many family doctors are dealing.
And at the end of the day, who's responsible for fixing the system? Obviously, self-regulated profession with their own governance structures, same with many of the other facets of healthcare professionals, and then in tandem with regional governments, national governments, like where does the bat drop? Who's actually in charge of making some of these deeper rooted changes required?
Lawrence Loh (24:05.312)
Well, it's interesting because I think there are a lot of changes that need to be required. And one thing we haven't touched on, for example, is the need to also really reinvent and transform family medicine training for the future as well. And the College of Family Physicians of Canada is working on coming up with a new integrated curriculum, which will likely be spread out over three years. That is intended to support many of the practice changes that we hope to see.
But I think all of these improvements really require a whole of society response. I think we need patients and the public to be interested and committed, to push their decision makers, to do better and to spend, you know, the dollars where they will help to actually, because ultimately, if you fix the primary care and family medicine challenges that we have today, you'll also be helping the acute care system and hospital care system out. You know, we need federal and...
provincial and local decision makers really to step up at every level to sing from the same song sheet and say we need team-based care, we need digital solutions that support it, we need these new conversation models and then for us as a family physician community as I mentioned, you know, we need to make sure that we're also ensuring that our training meets this new world, the complexity and the challenges, you know, the transition into working with teams through a strengthened residency curriculum. So
I think everyone needs to be doing their part. And I know at least from the conversations I've been having that there's a lot of goodwill and willingness to act on this. I think it's just a matter of coming together and acting now.
But it's good that it's not just a finger pointing exercise, but truly how do we revamp our own house here and going to that three year program versus the two, you know, if you just take it at face value of how is having another delay and adding another year to getting more doctors gonna help with the current crisis? But it sounds like there's gonna be a lot of just like inside change and how we train our family doctors and what their goals are as practitioners in the community.
Lawrence Loh (26:00.92)
Yeah, it's a good opportunity for me to run through a few things as well, which is, you know, there's not going to be a gap year of physicians. So this is meant to be a gradual phase in of new residency standards. And so you'll have a period where there will be some people in three year programs, some people in two year programs, and then just like a DJ fades out one track, you'll fade in the other track, right? So, and so I think that it's important to highlight that because, you know, having a three year program would be supported by team-based care.
because we know that family doctors would be able to learn from other health professionals, learn to work with other health professionals. We also know, for example, that the last time a curriculum was revisited wasn't actually, like to the extent that we're reforming it now, was in 1993 and the world has changed a lot in the last 30 years. So there's a really good opportunity for us to do our part as family doctors to strengthen our curriculum, to ensure that we still make clear our value to society and reassure Canadians.
that the care that they're receiving from us is top-notch. And then similarly, to have that tied into the need for really significant practice supports, reforms, resources, and investments to ensure that those very well-trained grads are going to be supported once they graduate to be able to address the needs and the primary care access challenges that Canadians are facing.
It makes total sense. Well, and so what can the average family physician in the community start doing today? Both in terms of changing their practice to be more in line with that future direction and two, in terms of the campaign, in terms of advocating for ourselves, how can we actually raise that sound level? How can we start getting this into more ears?
Lawrence Loh (27:45.272)
Well, I think the first thing that I would share with every family doctor out there in the midst of this crisis is, tell us your story. I've actually enjoyed, and one of the first things I did when I took on this role as CEO with the CFPC was I went on a listening and learning tour, and I had the opportunity to have coffee chats with many different members across the country, different practice compositions, different backgrounds, different interests. And I had...
Those stories actually have now formed part of our advocacy. We've taken stuff to Parliament Hill and said, you know, a member has been dealing with this just to illustrate what the administrative burden is. So telling your stories, sharing your stories is the first thing. The second thing that I encourage everyone to do is to be involved with the college. I mean, the CFPC is your home. It is your home of family medicine. And while I know that there's always lots of diverse views, lots of different opinions, we are only really a strong.
as the dialogue and debate that occurs around those opinions and for all of us to be within the same tent, recognizing that ultimately we share the same goal, which is how do we advance the specialty of family medicine in service not only of ourselves as family doctors and primary care providers, but also for all of the people that we partner with and the patients that we serve. And then the final thing that I would share is just keep informed. I mean, if you hear of opportunities to meet with...
members of Parliament or members of provincial Parliament, if you hear of opportunities to meet with ourselves as college leadership, you know, if you have interests, for example, in volunteering or being part of different committees to sort of think through some of these solutions, we know that there's always strength in diversity of thought and diversity and opinion, and we really encourage you to get involved where you can, keep in touch with the college, keep in touch with what's happening, and also keep in touch with...
with yourself, your stories, and ultimately take care of yourself. It's difficult times out there.
Where can people find more information specifically on the campaign on the crisis in family medicine?
Lawrence Loh (29:44.068)
So the best place for people to go would be to visit cfpc.ca slash stop waiting. And that basically is our landing page for the crisis in family medicine. We encourage people to share it on social, share it with their family members. We have a letter writing campaign there and we've already had a thousand letters sent through that from both patients as well as providers. So that's really significant for a campaign that's only been running for the last couple of weeks. But really just encouraging people to.
Share cfpc.ca slash stop waiting. And also if you Google our prescription for primary care, or rather the link to that is cfpc.ca slash en slash prescription dash four dash primary dash care. But you can find that on Google. Sharing the prescription for primary care is the solution. Sharing cfpc.ca slash stop waiting highlights the challenge and the problem that faces us.
Are there any talking points you recommend we bring up in terms of when our colleagues approach us, responding to the posts and what they see on social media and the things we're sharing? Either our surgical colleagues, our medicine specialist colleagues, our allied health professional colleagues in the community.
Lawrence Loh (30:54.572)
I've been so grateful actually for our conversations with many other Royal College specialists, as well as our partners at the Royal College. They have actually supported the prescription for primary care. I think there's a recognition. When you start having specialists doing primary care because people can't get in to see a family doctor or are unattached, I think that really makes it real for them as well.
So to the extent that they that at least in this in this moment where we're starting to see spill over into hospital, spill over into Royal College specialists offices, you know their support means everything and being able to highlight and just say yeah let's try to get our let's try to get our family medicine and primary care colleagues a little bit of resource and support. I mean it's been decades plus the pandemic on top that has led to the current crisis and if we can fix that we're really helping health care for everyone patients providers no matter where we sit.
It's all one big connected community, right? And any kind of change here impacts elsewhere. Awesome. Well, Dr. Low, or Lawrence, thank you so much for joining me and sharing your message about the crisis in family practice. And we'll be in touch. I'll definitely make sure to share this with our viewers. And thank you again so much for the time this afternoon. Really appreciate it.
Lawrence Loh (31:50.984)
Absolutely. Yep, totally.
Lawrence Loh (32:08.892)
Thanks to you as well, Jordan, for the opportunity and your interest, and I'm looking forward to continuing our conversation.
Awesome, thank you.