Episode 42, Season 2. Chuck and Chris are joined again by Jeff Stepan and Steve Lanier, two previous fellows both in their second year in hand surgery practice. Jeff and Steve share their experiences starting practice in Chicago, in somewhat different practices. Jeff is at the University of Chicago, Steve at NorthShore. They share insights from their successful symposium at the ASSH: Free Solo: Letting Go of the Rope - Lessons Learned from the First Year in Practice. Finally, both are in the midst of the Boards process- lots of helpful information!
As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu. And thanks to Eric Zhu, aspiring physician and podcast intern.
Survey Link:
Help Chuck and Chris understand better what you like and what we can improve. And be entered for drawing to win a mug! https://bit.ly/349aUvz
Episode 42, Season 2. Chuck and Chris are joined again by Jeff Stepan and Steve Lanier, two previous fellows both in their second year in hand surgery practice. Jeff and Steve share their experiences starting practice in Chicago, in somewhat different practices. Jeff is at the University of Chicago, Steve at NorthShore. They share insights from their successful symposium at the ASSH: Free Solo: Letting Go of the Rope - Lessons Learned from the First Year in Practice. Finally, both are in the midst of the Boards process- lots of helpful information!
As always, thanks to @iampetermartin for the amazing introduction and conclusion music.
theupperhandpodcast.wustl.edu. And thanks to Eric Zhu, aspiring physician and podcast intern.
Survey Link:
Help Chuck and Chris understand better what you like and what we can improve. And be entered for drawing to win a mug! https://bit.ly/349aUvz
Welcome to the upper hand, where Chuck and Chris talk hand surgery.
Chris Dy:We are two hand surgeons at Washington University in St. Louis here to talk about all aspects of hand surgery from technical to personal.
Charles Goldfarb:Thank you for subscribing. Wherever you get your podcasts.
Chris Dy:And be sure to leave a review that helps us get the word out.
Charles Goldfarb:Oh, hey, Chris.
Chris Dy:Hey, Chuck. You sound down.
Charles Goldfarb:Oh, no. Oh, no, I'm just saving my energy. This is gonna be a high energy show.
Chris Dy:Are you pacing yourself already?
Charles Goldfarb:That's what happens when you get older. You got to pace yourself always.
Chris Dy:It's funny. I got a lot of sleep last night. But I feel so tired right now and even had a little caffeine boost at 5pm I still feel tired. I realized it's because I got the booster yesterday.
Charles Goldfarb:Ah. Yep.
Chris Dy:At least that's what, at least that's what I'm telling myself.
Charles Goldfarb:You could have reached that critical age and maybe all downhill from here. Maybe from one day to the next. You're not going to be the same.
Chris Dy:Oh, I don't want to be middle aged Chuck. Not yet. So I'm excited. I'm excited. We have we have a recurring guest episode. And we've got Steve Lanier and Jeff Stepan joining us. Our former fellows and currently both in practice in Chicago. So let's start with Steve remind everybody who you are, and they we'll get to Jeff.
Steve Lanier:Yeah, so I am practicing here in Chicago at NorthShore University Health System in a sort of priva-demic, big hospital system type setting, alum of the WashU program from two years ago, and then did my residency in plastic surgery at Northwestern n Chicago. So happy to be up he e at WashU north with Jeff.
Charles Goldfarb:All right, Jeff.
Jeff Stepan:Yes, I am a hand surgeon at the University of Chicago obviously in academic practice. And I am unlike Steve orthopedic trained, and did my residency training at the Hospital for Special Surgery. So on the south side, now.
Chris Dy:Just just like the HSS practice, I'm sure.
Jeff Stepan:Exactly very similar, in fact, sarcasm there.
Chris Dy:So yeah, one of the things that we talked about before was doing cases that we hadn't seen before. And this came up for me recently at a young patient in his 20s that had some anxiety issues, but unfortunately had a base of T one extra articular relatively transverse fracture that was apex volar, and there was no way those flexor tendons were going to glide past that. I also got the sense that there was no way this this young man was going to tolerate pins. So what are your ways around that? I mean, Steve, would you consider if you didn't want to pin this and you decided this needed surgery? Would you put a plate on this?
Steve Lanier:Um, it depends on how proximal. Like one thing I've done a few times is headless compression screws for this and for similar reasons. People I don't think are going to do well with pins or multiple p one fractures with really swollen hands and I want to move them really quickly. You know, I don't really have enough experience with it yet to really weigh in on my thoughts. But if there's enough substance at the base of P one, I think that's a good option.
Chris Dy:Did you see that a lot in your training? Or did you start that when you went into practice?
Steve Lanier:I did not. I did not do it in training. But it's a technique that people have talked about and flew with. One of my partners does it. So and I watched him do one kind of got some tips from him and then waited for what I thought was, you know, a good patient to do that for.
Charles Goldfarb:Talk to us about your technique. If you are I believe you're talking about maybe a proximal 1/3, or even more proximal fracture, the proximal phalanx. Where do you insert the screw? And what how do you think about it?
Steve Lanier:Right. So if there's I guess there's two ways to do it, I've done both, you can do either to micro headless compression screws as an A frame, those you can insert percutaneously, similar to how you would have a wire so you get your guide wire in place, make a little mini incision, and then drill and insert the screw that way. Or just I've done a arthrotomy of the MP joint, basically volar directed pressure on the base of P one, slide the guidewire in and then put a headless compression screw over that. And I have talked to the patients, you know about the fact that we don't have long term data on whether this causes any arthrosis of the MP joints and that it will cause some swelling, but we're weighing that against the benefits of moving early in a more rigid fixation. So.
Chris Dy:Chuck, how do you approach this kind of case and then we'll get to Jeff's thoughts.
Charles Goldfarb:So I have over the last probably two Maybe when more skilled set of fellows came in, I may have changed my technique. Now I think over the last few years, I have started doing more headless compression screws for metacarpals. For sure I did one yesterday. And you know, it's it's such a pleasure. And I feel fine given that pre dorsal insertion point on the metacarpal head for the retrograde headless compression screws. I have not yet use the same technique for the proximal phalanx. It feels like the screw size to the articular surface ratio is very different. I respect I respect you guys, obviously, but also respect Kathleen McKeon who's down at Andrew sports medicine in Birmingham. And she's an advocate of that technique as well. So I think ultimately, I eventually had to try it. Currently, in if I don't use pins for a transverse fracture, I probably would put a plate on and be happy with it. I've been happy with that for years. Nothing wrong with it at all. Get the patient moving early and not a negative in any way. Although I am intrigued. I'll turn it over to Jeff.
Jeff Stepan:Yeah, I also have not done a headless compressions true for a proximal phalanx fracture although funny stories that are our we have a fellow at University of Chicago and they go up to North Shore and occasionally operate with Dr. Lanier and she actually said how smoothly the case that you did with that dorsal headless compression screw went? So anyways, seems like it seems like it went well, I'm sure you liked it. But I would probably try that if it came across. I have not done one yet. But yeah, been plating, my proximal phalanx fractures, but they have not been transversing clean like that.
Chris Dy:Well this was the right fracture. And I went for it, I did the Lanier technique. And I'll say if I get another one of those that lines up beautifully, and is transverse and there's enough base of P one to sink the headless compression screws into purchase. I'm gonna go for it again, I thought was great. We'll see how they do, obviously, in terms of therapy, but very, very happy with it.
Charles Goldfarb:So again, just clarify for me, and maybe I'm only slow one, but maybe another listener too is also slow. Exactly where did where did you insert the screw? So you describe it as midshaft maybe was a little more proximal, but it used a micro headless compression screw and where did exactly did you insert it?
Chris Dy:So center center on the AP view or PA view. And then on the lateral view, it's kind of at the dorsal third, middle third junction. And in order to do that, you're hyper flexing the MP joint and like Steve described taking your thumb and kind of bringing the proximal phalanx up and dorsally translated, I did it with I put the guidewire in percutaneously and then made a stab incision around it and then drilled while you know retracting away kind of a split in the EDC and then drilled while you know, protecting the EDC and it depending on the implant you used you may run into length issues with the screw I didn't use the the screw specifically designed for the proximal phalanx the micro skewer I used the longest one is a 30. Lo and behold 30 was perfect.
Charles Goldfarb:Did you get compressive bite or is this more of an internal strut?
Chris Dy:Compressive bite so actually was a little nervous. So I went ahead and did one collateral recessed antegrade pin like I normally would, and then was kind of looking at the rotation and got the reductionist perfect as I could before putting the guidewire in, just because I didn't want it to only be an internal strut for my first one at least.
Charles Goldfarb:Nice. I have to say when I do that, first, I'm not going to do it the way you did it. I think that was bold. I am going to open it and not percutaneously do that. But kudos for pulling it off.
Chris Dy:Well, I read somewhere on the the Twittersphere I think is from Jeff's senior partner, Megan Conte Mika who described it being harder if you open it versus the perking it and then opening it. So and then a number of people endorse that comment. So I figured that was the way to go. And no, I do not learn my hand surgery on Twitter. But it was useful.
Charles Goldfarb:Nice. Alright.
Chris Dy:So let's talk about you guys had this great symposium. So not just an ICL, a symposium at the ASSH meeting, call was it called free, solo?
Jeff Stepan:Free solo, that's absolutely right.
Chris Dy:Take us take us through what that? What was that and how-
Charles Goldfarb:Well first set the scene for us. When did it happen? Was it Saturday morning at 6:30am? Or what was the time? What was the audience like? What was the happiness room feel?
Jeff Stepan:Yeah, absolutely. I mean, there was palpable thrill in the room that Saturday Saturday morning at 9:30am Actually not 6am Where I thought would probably be. But I think it went really well. I mean, there were a good amount of people in the audience, obviously, almost mostly trainees. Obviously, as the title of our, of our symposium went, I don't know, Steve, what did you think about the number of people in the room?
Steve Lanier:Yeah, I was, you know, it wasn't full, but more than I anticipated. You know, like Jeff said, some trainees, some people who have mentored one of us and wanted to see us fumble around up there. But it was fun. I think it was well received. We like good feedback. Jeff did a nice job leading us even had snacks for the panelists in case we were hungry, we really appreciate it. So.
Jeff Stepan:Yeah, it was great. I think we pulled it off, we've executed what we wanted to execute whether or not that actually provided useful information to anyone. That's a different story. So.
Charles Goldfarb:So some of the listeners will now hopefully go catch this on the Hand Society. website for those who are not ASSH members or don't have access for whatever reason. Can you give us a high level? summary points? takeaway points for what what you guys demonstrated during the symposium?
Jeff Stepan:Sure, absolutely. Steve, do you want to talk about what you talked about?
Steve Lanier:Yeah. So we each kind of had a different focus, mine was on practice building, and kind of the main point was that you have to take the initiative, no one is going to do it for you. And a lot of the things that, you know, I think a lot of people know, you know, being available, being nice to everyone, kind of finding out what the referral networks are in your system and, and how you fit into that. And just basic things like if someone calls into the phone tree, how do they end up in your clinic and sort of making sure that you're at the end of that chute that's funneling patients, you know, towards hand surgeons. So that was my focus.
Jeff Stepan:And we had, we had a few other panelists, and they, they spoke about setting up your clinic, setting up your operating room. Time, I spoke a little bit about time management and research. And so those were the main highlights there. And it really was geared towards the fellow or the senior resident really about to start practice. And what are the little nitty gritty things that you need to start in the operating room, you have to be prepared for every single case, if you're at an ambulatory center, and they don't have something and you run into a bind, well, then you're not at a large academic center where everything's on on the shelf anymore. So little things like that, I think we really focused on things that you never thought about while you were actually in training.
Chris Dy:Now, Jeff, that's really impressive that you brought snacks. I've been on several panels with Chuck, and he has never brought snacks. So you're already you're already surpassing the expectations of your mentor. Let's just put it that way. So what do you think that, you know, you've learned in the last, you know, few months or six months, you know, the last time we talked was July? What did you learn that you didn't know, back in July? In terms of running a practice? Start with Jeff, I guess.
Jeff Stepan:Yeah, you know, back in July, so what is that about 5 months ago, or so now, four months, um, the clinic is starting to fill up and be a lot more consistently full now than it was in the past. No longer, you know, worrying about the clinics next week that are quite full, they're gonna they're gonna fill up and just kind of go with it. And, and a lot of people are coming back, you know, it's been a year into practice. Now we've done all the non operative management, and patients are eventually, you know, they get the year out of their trigger finger or whatever injection, and they're now starting to come back, and I'm having those second conversations with the patients. And so patients actually are coming back, and I guess we're hopefully happy with the care at first. But it's nice to see the cycle, which you hear about, but until you're a part of it, it can be a little nerve racking.
Steve Lanier:Totally, I would agree with that, you know, starting to see some of the people with thumb CMC arthritis, I've injected, you know, over the past year, come back and looking for other options, you know, finally, have a four corner fusion books after a year in practice. So some of the more you know, elective, so to speak, sort of cases are starting to come as opposed to mostly trauma for me, which is nice.
Jeff Stepan:I would also add that, you know, some of the early work, trying to get my name out there within the university to, you know, say that I'm interested in nerve surgery is starting to pay off and a lot of people are funneling some of those some of those referrals to me that they don't want to deal with, and I'm obviously happy to handle them and so that that's actually been really good and that's been picking up. So.
Steve Lanier:Yeah, I've noticed. So I think maybe I mentioned before that I've given some talks to OTs in the city. And Chris is going to love this, but I gave a talk on ulnar sided wrist pain. And I had a patient come in with a TFCC injury who was referred by an OT who I don't know, who said that she heard me give a talk on this topic. So it's like the first direct evidence I have that that is in some way contributed to building the practice. So.
Chris Dy:Wait, so so the plastic surgery resident that came in saying, I'm really interested in peripheral nerve surgery, is now giving talks on sports and is now doing the sports? Chuck, you win. I give up. I give up.
Charles Goldfarb:Well, I'm, I'm proud of one of you. Congratulations to you. Excellent work. Alright, let me ask, let me just play a little a little game. So CMC arthritis, Steve, you're taking the patient to surgery. What operation are you doing?
Steve Lanier:Internal brace or trapeziectomy with internal brace, to suspend the thumb metacarpal.
Charles Goldfarb:Jeff.
Jeff Stepan:Wow. Some training paid off there. I actually have I've done two now in practice, and actually did a case that I hadn't done before in training that made sense to me. And that is the APL to SER sling with sutures. Because I think it accomplishes the same thing without implant cost. And I think you can get the move in just just as soon. So we'll see.
Chris Dy:So that that brings an interesting point, because we don't do that case here. And how did you prepare for that case? Was it just, you know, I'm confident in my skills? I'll read up on the technique? And how did you kind of go about executing on the hour?
Jeff Stepan:Yeah, absolutely. I mean, I think the the approach to the case is very similar for all obviously, trapeziectomy comes first. And so that's no different than anything we've done before. And, you know, I spoke with, you know, multiple different people about how they do this specific technique. And again, Dr. Conte Mika, who you looked up in the Twitter Twittersphere, you know, told me how she does it. And I talked to a few others who really enjoyed that technique. And, you know, I think I went for it. And it's not complicated. You're just passing suture between two tendons. And I think the complicated thing may be tensioning, the link, but kind of, I guess, just read up on it and did it because I didn't think there was too much more involved than that. I don't think it was as complex as maybe some nerve transfers that maybe get into the cadaver lab first.
Charles Goldfarb:So, you know, we Chris and I are proud of the listenership. You know, we've seen our listenership grow. And, you know, most of the points that we make are not all that subtle. And I don't think you have to listen carefully. But I just want to rewind just a little bit. So we asked Steve, what are you know, what, how would you treat CMC arthritis? And Steve gave a nice, simple answer, and just told us what he did. Jeff gives a different answer, and then has to justify it like a true academician. So I love it, what you had to tells us? And then why you did it, like you're trying to convince Chris and I and maybe you did, that was pretty convincing I have to say.
Jeff Stepan:You know, not like the private practice guys up there, just throwing in implants left and right.
Chris Dy:Shots fired.
Jeff Stepan:Sorry, Was that too much?
Chris Dy:You have to remember where Jeff trained he trained at HSS and Wash U where all we do is talk about stuff. Well, Steve, you brought up an interesting point. And both you did actually that you don't do a lot of the kind of elective bread and butter hand surgery until you're further on in practice. I mean, Chuck, did you walk into a mature practice where you were doing LRTIs Right away? When I started, I didn't do an LRTI During all of board collection, or a thumb CMC surgery, I guess I should say. And I think it was almost another six months after I finished board collection before I did one.
Charles Goldfarb:Yeah, it's a it's a great point. And certainly I think Jeff and Steve's experience mirrored my own many years ago, where patients had to dial the telephone to get into our office with rotary dial, the it gets to the importance of taking call. It does, as you guys both have said, get to the importance of getting your name out there. And a busy practice where you know, some of your partners have mature practices automatically funnels trauma to you. And it is it's an unbelievable feeling when you start to see those patients back which means you know, you had a good conversation with them and the elective stuff comes in. I it took me and I am not exaggerating, maybe I'm a little more of a stressor. It probably took me 10 years to stop worrying about the ebbs and flows of practice, where you know, one clinic I'd had before the next clinic not so full one week of physio or the next week, not I stressed about that I look for problems. And for years, I don't do that anymore. But my goodness, I don't know if you guys are stressing about every little peak and valley.
Steve Lanier:You know, it's interesting that you say that, because, you know, I took a little time off in September for my wedding, and then we went away for 10 days. So it's basically gone. Peaks, and, you know, thanks and ramped up to a pretty steady level. And when I got back, my clinic was empty. And I was like, Well, you know, it's been a good run, I guess I'm done, you know, but because I didn't see patients for a while, so I didn't have anyone really returning as frequently. And then I wasn't, you know, on call. So I didn't have cases lined up. And it took a few weeks after getting back to start to get busy again. And so kind of experiencing that dip, like you said, is is you know, anxiety provoking, to some extent.
Charles Goldfarb:And are you guys either of you using the internet to try to build your practice, whether that be a blog, or making sure your website is robust? Or even Twitter or at this point, is it more face to face and, and just doing the right things on a day to day basis?
Jeff Stepan:I guess I can start and end for me, I have not had the bandwidth to go on social media and put my name out there. You know, we have our University of Chicago website that I have, but I don't have a separate website or separate blog. I do think that that might be the next step in terms of, you know, getting out there a little bit more, especially with some of my interests. But I think more face to face and getting the word out there to individual practitioners has been good so far, but we'll see what the next steps will be.
Steve Lanier:Yeah, similar for me, I'm not a big social media guy to begin with. And I don't use it a lot in my personal life. And so I'm not terribly adept at it. And I've just been focusing on trying to, you know, do a good job with surgery, you know, trying to network with people within the health system. And, you know, if I get to a point where I have the bandwidth, like Jeff says, and I feel like that it might be helpful, both for patients in terms of building a website where people can refer to or building the practice, and maybe something I would consider, but not yet.
Chris Dy:So Steve, you mentioned recently that you're going to be sitting for your oral boards, and maybe next week. What's that? Yeah, What's that process like? It's a little different for orthopedics versus plastics, but I'm pretty sure the stakes are just as high for everybody. And you know, it's a stress inducing as as anything else.
Steve Lanier:Yeah, I mean, definitely. So, you know, it's a two part board certification process. In plastic surgery, there's a written board, which I actually took during fellowship and passed. And then your first nine months, in practice, you collect all of your cases, it's a little different from orthopedics, where you have a little window to get started and then start collecting. So I basically collected data on every case, submitted it to the American Board of Plastic Surgeons, and then they selected eight cases, for me to compile books on with all of the records involved in those cases, pre op pictures, pre op images, post up images, pictures. And then they're basically going to spend a day examining me on those cases asking me why I did what I did, what I would do differently, those sorts of things. And then there's a second day where I have unknown cases, which is going to be seven cases, that could be anything within plastic surgery, which is a very broad field. So it can be cleft lip and palate, someone's ears missing abdominal wall reconstruction. There's always one hand case in there, one token hand case, so I'm prepared for that one, but most of my time has been spent over the last month just refreshing on all of the things that I don't do regularly and and haven't thought about for a few years now.
Charles Goldfarb:Wow, that that is intense. I mean, Jeff's got it way easier. Alright, Jeff, tell the listeners who may not be familiar with the orthopedic board process, how it is working or will work for you.
Jeff Stepan:Absolutely. So similar. There's two parts to it. And the written part is before fellowship for for orthopedists. And so part two is we start case collections similar to Steve, but we start you know, after about six months into practice, and we spent six months collecting cases very similar, and submitting them and so I just submitted my cases a few days ago. And so that was good to have that off my back and no longer you know, worrying maybe about every word and every note quite as much, which is which is nice, takes a little bit of pressure off and a lot of time entering cases into into a website. So So We will see how that goes. I know that the orthopedic oral boards were just a few weeks ago here. And I saw some old friends that took it. And, you know, no one ever feels good after that.
Steve Lanier:So it's in person.
Jeff Stepan:For some people.
Steve Lanier:Ours are via zoom, it's a second. So they started last year, kind of when the pandemic was going stronger, started doing it via zoom. And then the decision was made earlier this year that, that they would continue that at least for this year. You know, previously people go to Arizona and stay at a hotel and, you know, everyone's there at the same time.
Charles Goldfarb:Of course, it's Arizona, of course, it's Arizona, I mean, you're a plastic surgeon, I'm surprised it's not Hawaii, or something.
Chris Dy:So how did how did each of you set up your practices to optimize kind of data collection for board stuff, I'm pretty sure that you had some, some workflows in place to make things easier for when you had to enter data into the computer, as Jeff was saying, start with Steve maybe.
Steve Lanier:Yeah, for sure. I mean, I think, you know, for me, you know, there's a book that details everything that is going to have to be submitted. So I read that book twice, made sure I knew everything I had to collect. And then I kept a spreadsheet with that data. You know, in plastic surgery boards, you know, they scrutinize your billing as well. So I reached out to the billers and coders and let them know that, you know, I usually code for myself in clinic, and then I put suggested codes in my op note. And so I reached out and let them know if there any changes to this, you know, please let me know, so that I'm aware of it. And then you know, they also require photographic documentation for every patient, both pre and three months post op, which doesn't make a lot of sense for carpal tunnel, by the same time I had to make sure these patients are coming back on that time scale, so that I can get appropriate photos, if if those cases were selected. So just kind of knowing what is expected and just kind of staying organized was important.
Jeff Stepan:I think for me a little bit less stressful with, you know, not not the need for photos, but I guess we have our radiographs in terms of, you know, submitting cases and make it a little bit more streamlined for me, it's, you know, you submit your case when you book it. And then on the back end, you have to put in complications, ICD 10 codes, nine, ICD nine and 10 codes and CPT codes. So and so I incorporated my, you know, administrative assistant into actually entering just the basic data. And then after every case, I would go in, you know, so I kept on top of it and enter what I thought were the appropriate CPT codes and the appropriate diagnosis codes into it. And then at the very end, I just went back and went through all of them to make sure we got the good follow up there.
Chris Dy:Chuck is very good at this data entry process. And Chuck, do you still have the now it's probably mythological status, Goldfarb spreadsheet of cases from the last 30 years?
Charles Goldfarb:I do. I do I keep track of my cases to this day, on a very secure platform by you know, all kinds of locks and keys. And yeah, it's incredible. I can tell you, if you said how many approximative corpectomy is have you done, I can tell you in two minutes. It's really remarkable for research. And it's also one of those things that you know, it's just what I do. And it's just part of the process. Before every case, you know, I come in Weiss design my own schedule, so I always have flipped room. So I designed my flip rooms myself, which I think is helpful. I review the cases the morning of go through the electronic medical record, obviously I do the surgeries, and then I record the surgeries. And it really does help imprint things for me is one reason I like it that multi step process. But it is it is a time it does take time, although not all that much. Chris, what do you do?
Chris Dy:So I started a similar process, but I do not have the discipline that you do. So when my nurse hands me the post op packet for the patients, she has my booking sheet before epic, before we had access to Epic on our phones, I would have put the last option or the last office note in there. And then the consent form, if just in case they lose a consent. So then I'll have that in a plastic sleeve. And then I'll take that plastic sleeve and then put it in my office where my secretary will put it into a spreadsheet that I started in wanting to be like Chuck and then realizing I couldn't do it. So at the very least I have a spreadsheet with all of my cases, with the exception of the occasional ortho trauma case that doesn't get you know, put in there. But it is incredibly useful. I've also found it very useful. Somebody asked me how many common perineal nerve releases I've done and all of my cases are in Outlook as well secure of course, but they're in Outlook. So I just quickly type in CPN and then for last For years, the number of cases just pops up, which is very useful. And somebody is asking you, as a younger surgeon, how many deals have you done? You can tell him pretty quickly.
Charles Goldfarb:And you double that number like most surgeons do, or do you give them the actual number?
Chris Dy:Most surgeons actually triple that and I'm feeling I'm feeling that as we try to enroll in our prospective brachial plexus cohort study, in which, you know, some centers just don't do excuse me, all centers do not do as much as they say they do. So, maybe let's finish out with a more fun topic. So Jeff, start with you, and then go to Steve. So how do you have you found a way to keep your sanity through all this? You're obviously very busy. And I know your wife is a surgeon as well. And then, you know, Steve, I know your wife is in medicine as well. So how do you guys you know, take care of yourselves and take care of your family?
Jeff Stepan:That's, that's a good that's a good question. Sometimes I don't know the answer to that how we're surviving. But you know, right now, we just have a dog, no kids, so it makes things a little bit easier for us. And we just communicate, share each other's schedules and making sure that you know, one of us is home when we need to be home and split up all household duties, which is which is difficult because we just moved. Similar to you. But you know, to keep our sanity, you know, we block off every Monday night we play coed soccer together. So that's a very fun activity. And then I have soccer maybe one other nights, night a week. And honestly, that and some exercise, my wife just bought the peloton tread. So she's looking forward to the cold winter here running in our basement.
Charles Goldfarb:Tell me about the move. So you were in an apartment in the city and you are now it sounds like in a home in a suburb?
Jeff Stepan:Kind of Yeah, we were in we were in Streeterville in an apartment, and we are now in Lincoln Park, which is still technically in the city. Just different neighborhood and it's in condominium, but it has its own private entrance. And so it's a it's it's definitely a step up. No longer the views of the of the lake and downtown, but definitely more space, which is what we wanted. So awesome.
Charles Goldfarb:Alright, Steve, catch us up. How do you maintain your sanity?
Steve Lanier:Yeah, I mean, it's been a crazy year. Not just with work, but you know, like, Jeff, we moved, you know, in a wedding, which like, towards the end just sucks all of your time to plan on those last few details. So I'm glad that's over. But then I went immediately into like, into preparing for boards sort of full steam. So I'm looking forward to next year when I can settle into a routine. But you know, one of the things that we did, you know, within the last year is we joined a nice health club that's close to us. I've been leaning on Jeff and Caitlin pretty hard to also join the set health club. But it's just a really nice place to be. I mean, it motivates me to go work out because it's a nice place to be and you know, it's you know, nice sauna, you know, places you can shower before work. You know, places you can get coffee, it's just it feels like I'm pampering myself a little bit. So it kind of gives me that extra motivation that I need to actually maintain consistency with my fitness. So.
Chris Dy:It sounds like our recurring guests are doing great.
Charles Goldfarb:It does. It does. It's so nice to catch up.
Chris Dy:So we have our fellowship applications coming due. Maybe by the time this airs, it'll be within a couple of days. And Dr. Lanier I'll be knocking on your door to help us potentially interview applicants. The alumni room was a huge hit last year. So thank you so much for doing that. And, Jeff, you obviously have a conflict of interest, so you cannot interview our applicants. Thank you for joining us. Hopefully, we'll have you guys on again in a few months. And you can update update us on what's going on in your lives.
Steve Lanier:Awesome. Thank you. This was fun.
Jeff Stepan:Yeah, thanks. Always great to see all of you.
Charles Goldfarb:Hey, Chris, that was fun. Let's do it again real soon.
Chris Dy:Sounds good. Well, be sure to check us out on Twitter@handpodcast. Hey, Chuck, what's your Twitter handle?
Charles Goldfarb:Mine is@congenitalhand. What about you?
Chris Dy:Mine is @ChrisDyMD spelled dy. If you'd like to email us, you can reach us at handpodcast@gmail.com.
Charles Goldfarb:And remember, please subscribe wherever you get your podcasts.
Chris Dy:And be sure to leave a review that helps us get the word out.
Charles Goldfarb:Special thanks to Peter Martin for the amazing music. And remember, keep the upper hand. Come back next time