Are locums rates really declining?

[miacomet]

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I am thinking of quitting and doing locums for a bit, mainly for scheduling reasons. I keep seeing posts that locums rates are declining.

Would anyone care to elaborate? Veers? Emergent? Bueller?

 

[BoardingDoc]

Buehler?

Bueller.

 

[miacomet]

And about those locums rates?

 

[BoardingDoc]

And about those locums rates?

I don't do locums, that said the people I know who are haven't been indicating that their rates are getting cut. I know that there has been a significant increase in docs in areas such as Texas where it can now be difficult to find high paying rates in areas near major metro areas. That said, if you're willing to travel for locums work, I suspect you're still going to be finding plenty of high paying opportunities to do so.

All of that said, as I (and many others) have said before, part of what you get paid is what you negotiate. You aren't going to find many places offering you >$300 an hour. There ARE many places that will pay you that much, but you need to ask/tell them to.

 

[miacomet]

I don't do locums, that said the people I know who are haven't been indicating that their rates are getting cut. I know that there has been a significant increase in docs in areas such as Texas where it can now be difficult to find high paying rates in areas near major metro areas. That said, if you're willing to travel for locums work, I suspect you're still going to be finding plenty of high paying opportunities to do so.

All of that said, as I (and many others) have said before, part of what you get paid is what you negotiate. You aren't going to find many places offering you >$300 an hour. There ARE many places that will pay you that much, but you need to ask/tell them to.

Thank you. That's what I figured. Any other thoughts out there?

 

[bikERdoc]

My understanding is that while locums rates aren't falling all that fast (yet), the main companies utilizing locums such as Emcare, can't afford to continue paying the ridiculous rates that some of our forum members continually boast about.

More info: Why Envision Healthcare Corporation Is Collapsing Today

Gotta feed those investors first.

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[bravotwozero]

My understanding is that while locums rates aren't falling all that fast (yet), the main companies utilizing locums such as Emcare, can't afford to continue paying the ridiculous rates that some of our forum members continually boast about.

More info: Why Envision Healthcare Corporation Is Collapsing Today

Gotta feed those investors first.

Sent from my SM-G950U using Tapatalk

Here’s to the collapse of envision healthcare! *toast* *drinks coffee*


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[LaBusqueda]

I wonder if the swell of freelancing docs, and not just EM, will be enough to drive down rates.

I can see a situation soon where all the CMGs will need to change their model to be more of a solely organized locums agency, offer much better rates than they do currently, but nowhere near what they are to agencies or freelancers.

I wonder if the allure of “higher” rates will draw new residency grads like the pied piper. I bet in the near future they staff much easier offering 250/hr as IC which sounds like heaven to a pending graduate. At least it would have to me.


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[LaBusqueda]

teaching residents about billing and reimbursement, showing them what various anonymous EM docs are billing and collecting, should be mandatory. Only then will they truly see how much companies are taking advantage of them.


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[deleted547339]

There’s a reason they pay a lot to travel. Hint, it’s the same reason most places pay more for nights. They suck. No one wants to do them.

I’m a new grad with a family, but I’d rather not travel. I may get credentialed to moonlight, but for less than 3-400/h, I’m not driving or working at a less than ideal workplace.

 

[BelaMedicine]

The rates in my specialty are ridiculously low and I think one of the main reasons is as physicians we take these offers so they continue to low ball us. When I asked one of the recruiters why he was quoting such a crazy low number he said hey there are four other physicians that are willing to take it at this number. 🙁

 

[TooMuchResearch]

The rates in my specialty are ridiculously low and I think one of the main reasons is as physicians we take these offers so they continue to low ball us. When I asked one of the recruiters why he was quoting such a crazy low number he said hey there are four other physicians that are willing to take it at this number. 🙁

Then you thank them for their time. If they were bluffing, they'll contact you with better numbers

 

[Redrox]

Year and a half ago, I looked into doing some Locums in Texas and got an overwhelming list of places and some pretty good rates, ended up not doing it for a variety of reasons.

Looked into doing it last week, checked with Comphealth and Weatherby and got told there was not a single locums position in Texas. Kinda stunning if true.

 

[miacomet]

Year and a half ago, I looked into doing some Locums in Texas and got an overwhelming list of places and some pretty good rates, ended up not doing it for a variety of reasons.

Looked into doing it last week, checked with Comphealth and Weatherby and got told there was not a single locums position in Texas. Kinda stunning if true.

CompHealth and Weatherby have really taken a turn for the worse. I'd shop around, but yes, that is concerning.

 

[Alvarez13]

Year and a half ago, I looked into doing some Locums in Texas and got an overwhelming list of places and some pretty good rates, ended up not doing it for a variety of reasons.

Looked into doing it last week, checked with Comphealth and Weatherby and got told there was not a single locums position in Texas. Kinda stunning if true.

Maybe not as much as there used to be but there are still plenty of locums opportunities in Texas.

 

[RustedFox]

Year and a half ago, I looked into doing some Locums in Texas and got an overwhelming list of places and some pretty good rates, ended up not doing it for a variety of reasons.

Looked into doing it last week, checked with Comphealth and Weatherby and got told there was not a single locums position in Texas. Kinda stunning if true.

Not a single position?
Then why do they keep calling me?

 

[miacomet]

Not a single position?
Then why do they keep calling me?

Those companies specifically? I feel like they have imploded...

 

[OccupyTheED]

Rates aren''t declining. If you accept a subpar rate from a subpar company then yes the rates are lower but there's still good money to be made. Know your worth, and don't accept less than you're looking for. My biggest negotiating chip has been my ability and willingness to walk away from garbage offers.

 

[miacomet]

Rates aren''t declining. If you accept a subpar rate from a subpar company then yes the rates are lower but there's still good money to be made. Know your worth, and don't accept less than you're looking for. My biggest negotiating chip has been my ability and willingness to walk away from garbage offers.

Agreed...but it's harder if others aren't walking.

 

[OccupyTheED]

Agreed...but it's harder if others aren't walking.

Very true, it can be frustrating to watch others display no fundamental understanding of supply and demand and weaken our leverage as a whole.

 

[TooMuchResearch]

Very true, it can be frustrating to watch others display no fundamental understanding of supply and demand and weaken our leverage as a whole.

"$200/hr is so much more than I made in residency. This is awesome."
-Suckers Everywhere

 

[inspirationmd]

Is $265/hr reasonable for 1099? This is a side job to help pay loans off. Its about 100 miles away from my house so I drive and I stay in a hotel. Probably will be doing it for another 2 years to kill loans as long as doesn't cause too many problems at home - think high debt for me and my FM wife. Cover 5 shifts per month with them per contract but sometimes I work more when my schedule permits or tell them some months I need to work less. Because they pretty much let me have the schedule I want and don't work nights due to a couple of dedicated night guys/girls I don't try to play hardball.

Seems reasonable to me but want to get your thoughts.

 

[OccupyTheED]

Is $265/hr reasonable for 1099? This is a side job to help pay loans off. Its about 100 miles away from my house so I drive and I stay in a hotel. Probably will be doing it for another 2 years to kill loans as long as doesn't cause too many problems at home - think high debt for me and my FM wife. Cover 5 shifts per month with them per contract but sometimes I work more when my schedule permits or tell them some months I need to work less. Because they pretty much let me have the schedule I want and don't work nights due to a couple of dedicated night guys/girls I don't try to play hardball.

Seems reasonable to me but want to get your thoughts.

Committing to 5 shifts a month in addition to a full time job seems like a lot of shifts. Its a very decent rate just be sure not to burn yourself out. Not sure what company its through but keep in mind the more desperate they are the more likely they are to give bonuses. I will typically undersell my availability and pick up more if/when bonuses are on the table.

 

[inspirationmd]

Committing to 5 shifts a month in addition to a full time job seems like a lot of shifts. Its a very decent rate just be sure not to burn yourself out. Not sure what company its through but keep in mind the more desperate they are the more likely they are to give bonuses. I will typically undersell my availability and pick up more if/when bonuses are on the table.

Agree 5 shifts is a lot. I'm trying to see how it shakes out and if need be then I'll pull back. Its hard for me to play the hold out game since with a wife and kids I like saying I am working these days and thats it. Its glorified clinic so hasn't been too stressful but I will see how it goes. If it even looks like I'm burning out then adjustments will be made for sure.

 

[TooMuchResearch]

Is $265/hr reasonable for 1099? This is a side job to help pay loans off. Its about 100 miles away from my house so I drive and I stay in a hotel. Probably will be doing it for another 2 years to kill loans as long as doesn't cause too many problems at home - think high debt for me and my FM wife. Cover 5 shifts per month with them per contract but sometimes I work more when my schedule permits or tell them some months I need to work less. Because they pretty much let me have the schedule I want and don't work nights due to a couple of dedicated night guys/girls I don't try to play hardball.

Seems reasonable to me but want to get your thoughts.

Reasonable depending on the job...3 pph and high acuity with a good payor mix? Then it's not a good rate.

1 pph, mixed acuity? Worth it if you're willing to drive and stay in a hotel.

 

[TooMuchResearch]

Agree 5 shifts is a lot. I'm trying to see how it shakes out and if need be then I'll pull back. Its hard for me to play the hold out game since with a wife and kids I like saying I am working these days and thats it. Its glorified clinic so hasn't been too stressful but I will see how it goes. If it even looks like I'm burning out then adjustments will be made for sure.

Also depends on how many hours/shifts your normal "full time" load is.

 

[RustedFox]

Those companies specifically? I feel like they have imploded...

I'll pay more attention next time they call. In general, when the locums folks call me, I say "where?", they say "Texas, Arkansas, Louisiana", and I say: "No. Kthxbye."

 

[Redrox]

I'll pay more attention next time they call. In general, when the locums folks call me, I say "where?", they say "Texas, Arkansas, Louisiana", and I say: "No. Kthxbye."

Phone still rings all the dang time but it's Louisiana, Louusiana, how bout Louisiana ?

 

[namethatsmell]

Phone still rings all the dang time but it's Louisiana, Louusiana, how bout Louisiana ?

I can think of few places worse to do locums than LA.

I've been getting hammered emailed/texted/called to look at Indiana and Cali.

Lately I'm finding about 1/3 of recruiters are pretty quick to go up on the rate when I ask.

 

[Alvarez13]

I'll pay more attention next time they call. In general, when the locums folks call me, I say "where?", they say "Texas, Arkansas, Louisiana", and I say: "No. Kthxbye."

Is the weather too cold for you? 🙂

 

[emergentmd]

Agree 5 shifts is a lot. I'm trying to see how it shakes out and if need be then I'll pull back. Its hard for me to play the hold out game since with a wife and kids I like saying I am working these days and thats it. Its glorified clinic so hasn't been too stressful but I will see how it goes. If it even looks like I'm burning out then adjustments will be made for sure.

Travel time plays a great role on my rate. If i can drive and be back home the same day, i think 265 is reasonable.

If i have to step on a plane or stay overnight or the drive is too long, its 350-400.

 

[RustedFox]

Is the weather too cold for you? 🙂

Lol. Was just in New Orleans with Mrs. Fox for our anniversary. It wasn't cold and we had fun with the riverboats and plantation tours and all; but the French Quarter? No thanks. Smells like urine and the gutterpunks treat it like its their living room. I almost assaulted the aggressive homeless guy after he didn't take "No" for an answer the fourth time and got too close to my wife.

 

[miacomet]

Lol. Was just in New Orleans with Mrs. Fox for our anniversary. It wasn't cold and we had fun with the riverboats and plantation tours and all; but the French Quarter? No thanks. Smells like urine and the gutterpunks treat it like its their living room. I almost assaulted the aggressive homeless guy after he didn't take "No" for an answer the fourth time and got too close to my wife.

And unlike much of the South, Louisiana is a medmal hellhole.

 

[inspirationmd]

about 2 pph. Payer mix sucks. Seems reasonable given this. I will try it for a bit.

I do have another question. Do Locums or regular companies see value in paying EM residency trained and boarded docs a premium compared to non-EM trained MDs? I understand the shortage and recognize that FM/IM trained colleagues in the ED will happen but there is a definite difference in my workflow and theirs and its getting a little old with the RNs finding me for the sicker patients or bringing me EKGs to read because they are not as comfortable with them or "tied up". Especially when I look and see they have seen as few as 1.2 patients per hour (seriously).The things I have noticed at this job have led me to start researching backgrounds and aside from the director it looks like I am the only ABEM BE MD there (hopefully BC after oral boards come out in the next month 🙂 ). Should I approach the company about a rate increase? I don't mean this to be a flame war but if I am genuinely curious about people's experiences on this beyond residency and ABEM/ABOEM propaganda.

Again this job is temporary, serves a purpose, and is overall not bad so I am not looking to bolt. But I do want to make sure I am doing right by myself with respect to the $$$.

 

[jiffywerk]

about 2 pph. Payer mix sucks. Seems reasonable given this. I will try it for a bit.

I do have another question. Do Locums or regular companies see value in paying EM residency trained and boarded docs a premium compared to non-EM trained MDs? I understand the shortage and recognize that FM/IM trained colleagues in the ED will happen but there is a definite difference in my workflow and theirs and its getting a little old with the RNs finding me for the sicker patients or bringing me EKGs to read because they are not as comfortable with them or "tied up". Especially when I look and see they have seen as few as 1.2 patients per hour (seriously).The things I have noticed at this job have led me to start researching backgrounds and aside from the director it looks like I am the only ABEM BE MD there (hopefully BC after oral boards come out in the next month 🙂 ). Should I approach the company about a rate increase? I don't mean this to be a flame war but if I am genuinely curious about people's experiences on this beyond residency and ABEM/ABOEM propaganda.

Again this job is temporary, serves a purpose, and is overall not bad so I am not looking to bolt. But I do want to make sure I am doing right by myself with respect to the $$$.

Most places that can will pay more for EM boarded docs. But many smaller places can't pay the higher rate so pay the same to whoever they can get. Most locums companies group people into different groups based on training, years practice, lawsuits, etc. The higher your group the easier it is to demand a higher rate. I'm sure there are many exceptions to this as some IM/FM docs I have worked with are great practitioners.

 

[miacomet]

I was just quoted $200 an hour for a locums gig. They were not interested in negotiating. I politely declined, explaining I could make more than that at my current job without traveling, or even in UC or perhaps even telehealth, They were not interested in negotiating. Sorry, CompHealth.

 

[emergentmd]

I was just quoted $200 an hour for a locums gig. They were not interested in negotiating. I politely declined, explaining I could make more than that at my current job without traveling, or even in UC or perhaps even telehealth, They were not interested in negotiating. Sorry, CompHealth.

Because someone else will take 200. Move on. If they are more desperate, they will reach out soon.

 

[miacomet]

Because someone else will take 200. Move on. If they are more desperate, they will reach out soon.

Lol. What's funny is that this place has been looking for a month. Not my problem. But I think there is a much more aggressive movement by locums companies to depress rates. Curious if others have experienced this.

 

[sum dude]

I am thinking of quitting and doing locums for a bit, mainly for scheduling reasons. I keep seeing posts that locums rates are declining.

Would anyone care to elaborate? Veers? Emergent? Bueller?

Did anybody here really expect $350+ rates to last for locums? Insurances are reimbursing less, shifting costs to high deductible plans which lower reimbursement and spreads out accounts receivables over several months. Sorry everyone, but the great EM bubble is going to burst. Your best shot is to get a reasonably paying, well-entrenched democratic group that has several hospitals (not one). One hospital groups are toast, and CMG rates will never match the rest of them.

 

[miacomet]

Certainly not with encroachment of midlevels and the expanding pipeline of debt-ridden new grads. I am surprised that locums rates seem to have dropped below permanent rates.

 

[jiffywerk]

Lol. What's funny is that this place has been looking for a month. Not my problem. But I think there is a much more aggressive movement by locums companies to depress rates. Curious if others have experienced this.

I have noticed this with some companies also. I've had a few email me for rates which are lower then what they emailed me for the same thing 6 months ago and when asked about this they say they can't match the old rates as they "don't have the budget for it."

Did anybody here really expect $350+ rates to last for locums? Insurances are reimbursing less, shifting costs to high deductible plans which lower reimbursement and spreads out accounts receivables over several months. Sorry everyone, but the great EM bubble is going to burst. Your best shot is to get a reasonably paying, well-entrenched democratic group that has several hospitals (not one). One hospital groups are toast, and CMG rates will never match the rest of them.

The problem for those who live in large cities is many democratic groups in these cities have a predatory nature and burn through new docs quicker then the CMGs, so that the partners can keep lining their pockets

 

[Makati2008]

Was told the same thing as well.

Year and a half ago, I looked into doing some Locums in Texas and got an overwhelming list of places and some pretty good rates, ended up not doing it for a variety of reasons.

Looked into doing it last week, checked with Comphealth and Weatherby and got told there was not a single locums position in Texas. Kinda stunning if true.

old the

 

[Brigade4Radiant]

Did anybody here really expect $350+ rates to last for locums? Insurances are reimbursing less, shifting costs to high deductible plans which lower reimbursement and spreads out accounts receivables over several months. Sorry everyone, but the great EM bubble is going to burst. Your best shot is to get a reasonably paying, well-entrenched democratic group that has several hospitals (not one). One hospital groups are toast, and CMG rates will never match the rest of them.

Democratic groups are often predatory for new docs (work all holidays and nights for 5 years) and if insurance rates are going down then SDG will go down as well since CMG will likely take over due to the nature of hospitals having to merge to survive.

The EM bubble will burst when the medicine bubble will burst which probably won’t be for 15 years in all honesty. Make your money now and pay off your loans.

 

[southerndoc]

Democratic groups are often predatory for new docs (work all holidays and nights for 5 years) and if insurance rates are going down then SDG will go down as well since CMG will likely take over due to the nature of hospitals having to merge to survive.

The EM bubble will burst when the medicine bubble will burst which probably won’t be for 15 years in all honesty. Make your money now and pay off your loans.

The EM bubble is going to pop in 5-10 years. There are approximately 2300 EM residency positions for PGY-1 with >15 applications for new programs. There are over 23,000 nurse practitioners and 8,000 physician assistants graduating annually. 15% of these traditionally choose emergency medicine. 22 states now allow a nurse practitioner to practice autonomously.

Large insurers are purposefully downcoding charts and not paying providers/emergency visits. Attrition rates for emergency physicians is 1.7% annually, but this has increased in the last few years due to the increasing demands on patient satisfaction, regulatory requirements, etc. This comes from 2010 data.

What I'm getting at here is that there is a big threat on the horizon. NP's will continue to advance to autonomous practice in many states, hospitals may follow a CRNA model and place NP's in emergency departments with emergency physician telemedicine oversight, and there will be a flood of emergency medicine graduates that will likely surpass the attrition rate (currently 40,000 physicians practicing emergency medicine, at 2% annually that's only 800 leaving annually with 2300 entering the market annually).

Salaries will decrease significantly in the next 5-10 years. Even at a 5% attrition rate, we are still flooding the market. Granted, some of these practicing emergency physicians are non-emergency medicine trained physicians, and the overall goal was to provide board-certified emergency physicians to staff those ER's. However, the end result will be an imbalance with supply (too many docs) and demand (too few positions) that will drive down salaries.

 

[GeneralVeers]

I am definitely seeing fewer and fewer job postings at > $300/hr these days.

 

[Money Moniker]

The EM bubble is going to pop in 5-10 years. There are approximately 2300 EM residency positions for PGY-1 with >15 applications for new programs. There are over 23,000 nurse practitioners and 8,000 physician assistants graduating annually. 15% of these traditionally choose emergency medicine. 22 states now allow a nurse practitioner to practice autonomously.

Large insurers are purposefully downcoding charts and not paying providers/emergency visits. Attrition rates for emergency physicians is 1.7% annually, but this has increased in the last few years due to the increasing demands on patient satisfaction, regulatory requirements, etc. This comes from 2010 data.

What I'm getting at here is that there is a big threat on the horizon. NP's will continue to advance to autonomous practice in many states, hospitals may follow a CRNA model and place NP's in emergency departments with emergency physician telemedicine oversight, and there will be a flood of emergency medicine graduates that will likely surpass the attrition rate (currently 40,000 physicians practicing emergency medicine, at 2% annually that's only 800 leaving annually with 2300 entering the market annually).

Salaries will decrease significantly in the next 5-10 years. Even at a 5% attrition rate, we are still flooding the market. Granted, some of these practicing emergency physicians are non-emergency medicine trained physicians, and the overall goal was to provide board-certified emergency physicians to staff those ER's. However, the end result will be an imbalance with supply (too many docs) and demand (too few positions) that will drive down salaries.

The EM bubble is going to pop in 5-10 years. There are approximately 2300 EM residency positions for PGY-1 with >15 applications for new programs. There are over 23,000 nurse practitioners and 8,000 physician assistants graduating annually. 15% of these traditionally choose emergency medicine. 22 states now allow a nurse practitioner to practice autonomously.

Large insurers are purposefully downcoding charts and not paying providers/emergency visits. Attrition rates for emergency physicians is 1.7% annually, but this has increased in the last few years due to the increasing demands on patient satisfaction, regulatory requirements, etc. This comes from 2010 data.

What I'm getting at here is that there is a big threat on the horizon. NP's will continue to advance to autonomous practice in many states, hospitals may follow a CRNA model and place NP's in emergency departments with emergency physician telemedicine oversight, and there will be a flood of emergency medicine graduates that will likely surpass the attrition rate (currently 40,000 physicians practicing emergency medicine, at 2% annually that's only 800 leaving annually with 2300 entering the market annually).

Salaries will decrease significantly in the next 5-10 years. Even at a 5% attrition rate, we are still flooding the market. Granted, some of these practicing emergency physicians are non-emergency medicine trained physicians, and the overall goal was to provide board-certified emergency physicians to staff those ER's. However, the end result will be an imbalance with supply (too many docs) and demand (too few positions) that will drive down salaries.

This is terrifying, particularly since I've agonized over these very same trends you mention and seeing a current attending reinforce them point by point makes it harder to dismiss them as neuroticism.

How bad could things really get? There are a finite number of EDs in the United States and so presumably there are also a finite number of physician shifts required to keep them running. Unlike other specialties, you can't just strike out on your own and set up an outpatient shop as an EM doc so if we ever get to the point where the supply of EM docs exceeds the number of available ED shifts, it'd be game over.

There are 2300 PGY1 spots, soon to be 2500, so that implies a workforce size of 60-70,000 EM docs depending on average career length. There are >30,000 midlevels graduating each year, which works out to about 900,000 midlevels at steady state. If 10% of them want to go into EM that's 90,000, if 20% that's 180,000.

Are there even enough EDs in this country to accommodate anywhere from 150,000 to 220,000 "providers" looking for ED jobs without completely destroying the hourly rates? This sounds like an utter catastrophe happening in slow motion.

 

[RustedFox]

IF YOU BUILD IT....

.... THEY WILL COME

 

[southerndoc]

This sounds like an utter catastrophe happening in slow motion.

It is for emergency medicine salaries, but it's a great thing for staffing emergency departments and controlling insurance costs in an aging population. It depends on your view. Are you an emergency physician wanting to make a dollar, a hospital administrator just needing to staff your ED, or an insurance administrator looking to save a dollar?

 

[namethatsmell]

It is for emergency medicine salaries, but it's a great thing for staffing emergency departments and controlling insurance costs in an aging population. It depends on your view. Are you an emergency physician wanting to make a dollar, a hospital administrator just needing to staff your ED, or an insurance administrator looking to save a dollar?

Skynet, is that you?


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[Arcan57]

This is terrifying, particularly since I've agonized over these very same trends you mention and seeing a current attending reinforce them point by point makes it harder to dismiss them as neuroticism.

How bad could things really get? There are a finite number of EDs in the United States and so presumably there are also a finite number of physician shifts required to keep them running. Unlike other specialties, you can't just strike out on your own and set up an outpatient shop as an EM doc so if we ever get to the point where the supply of EM docs exceeds the number of available ED shifts, it'd be game over.

There are 2300 PGY1 spots, soon to be 2500, so that implies a workforce size of 60-70,000 EM docs depending on average career length. There are >30,000 midlevels graduating each year, which works out to about 900,000 midlevels at steady state. If 10% of them want to go into EM that's 90,000, if 20% that's 180,000.

Are there even enough EDs in this country to accommodate anywhere from 150,000 to 220,000 "providers" looking for ED jobs without completely destroying the hourly rates? This sounds like an utter catastrophe happening in slow motion.

You’re assuming that current trends will continue. EM kinda sucks to do. It’s attractive due to perceived high salary and low workload. In reality most midlevels are getting paid pretty poorly for a relatively high stress environment with crap schedules. A significant number of new grads are biding their time to get out of the ED and into something with a stable schedule. Do you anticipate current level of interest persisting among med students as the perception that a bubble is bursting propagates? The days of walking into a job in a top 10 market while making fat $$$ on day 1 as a new grad may be ending.

In general a bet against EM is a bet for increased rationality, decreased utilization, and a healthier population in the US.