Podcast: Dr. Diane Russo


This week I sat down with Dr. Diane Russo to discuss public health in optometry and in COVID-19.

You can check out their full conversation here, by searching "EyeCode Media" in your favorite podcast app.


Read the full transcript below:


Christopher Wolfe: [00:00:00] A couple of years ago at the leader summer summit for VOA volunteer meeting. And then one of the things that was really eyeopening to me about that in particular. And you probably don't remember this, but but a, one of the, one of our one of the people there, I'll just broadly state that who I actually respect a lot.

[00:00:20]And in terms of intersectionality probably stands. With more privilege than I would have to say some of the things that may, he may have said to you and I was, and I was surprised, and I can't remember the entire conversation, but what I was surprised by was how immediately like he gave me a pass and I think he gave me a pass maybe because he knows me well, but, but he was pretty hard.

[00:00:45] I dunno if it was you in particular, but if it was women, do you recall that conversation? You may not. That's good if you don't, but, but, but I think that the gist of the conversation was, was sort of women in the profession. And and then I think, I think it was also related to scope in some degree and

[00:01:04] Diane Russo: [00:01:04] have one or two people in my mind, number of conversations with a number of people over the years that have stood out.

[00:01:11] So yeah,

[00:01:12] Christopher Wolfe: [00:01:12] no, that's that, so that's, that was, it was shocking to me because I You know, for whatever privilege I may have. I, I guess I don't have the, probably the privilege that I have would be that I don't have to think about like You know, if I work hard in the profession and I work hard for the profession, then I don't know.

[00:01:33] I guess I've never had to worry. Like if somebody's gonna think I'm, I'm not going to contribute in the right or just assume that I wouldn't contribute. And that was to me, I was like, Whoa, Whoa. Like, like, do you know who you're talking to? Like, like, she's just, she's got a Harvard. Master of public health.

[00:01:51] Like she, she cares about the profession and she is moving towards. I was like, and it was really striking to me, I guess is my point. And I was like, I'm never going to have an Ivy league degree. I'm pretty sure you're not going to have an Ivy league degree. And so then then I guess my point is, is that, that was really striking to me.

[00:02:09] And and you said just now that you've had some conversations like that Does it detract from, from your does it, does it ignite your fire or does it detract from your, your desire to kind of be involved? What, how does that impact you?

[00:02:24] Diane Russo: [00:02:24] Do you remember what comment they made? Like watch that? Cause, I mean, I've had comments

[00:02:30] Christopher Wolfe: [00:02:30] vague in my mind is very vague.

[00:02:32] It was just, I recall that it was, I was shocked.

[00:02:35] Diane Russo: [00:02:35] Hmm. I mean, a lot of the comments that I have that people have made not necessarily directed. At me,

[00:02:43] Christopher Wolfe: [00:02:43] it was a generality.

[00:02:45] Diane Russo: [00:02:45] It's not usually directed at me specifically. Cause most of the conversations that I'm engaged in, I mean, Certainly, I mean, the person that we were talking to didn't necessarily know me, but we were at a volun and AOA volunteer

[00:03:01] Christopher Wolfe: [00:03:01] meetings.

[00:03:02] Diane Russo: [00:03:02] You could venture to guess that I was so they probably shouldn't make a derogatory comment about, you know, female ODI, volunt, AOA volunteers. But you know, a lot of the comments that I hear people make about female ODS is usually about. The propensity for female ODS to go into the profession and then take a step back because they want to have babies.

[00:03:29] And then, you know, it's really just a part-time career choice and I've heard those types of comments made more and more because One of the projects that I'm working on, that I was on a panel discussion for women in optometry at this past Academy. We haven't published the results yet, but we I'm a faculty member, a few faculty members at Necco.

[00:03:53] And I one of my co-investigators Dr. Stacy Lyons and I worked, we teamed up with Jobson to do a survey. They do sort of their yearly income survey. And we wanted to look at income to see if there's a wage gap, a gender wage gap. And we hear that talked about a lot and that's talked about in multiple professions, but when we look at our profession, you know, the data is not really great and it's all survey-based and, you know, even the survey that we did you know, it's.

[00:04:25] People just sort of self-select into doing it, but you have to start somewhere. But what we really wanted to do was trying to compare apples to apples, take the aggregate data. It's so mixed and it doesn't tell the proper story. And I'm sure you know this when you are looking at aggregate data, you're not comparing apples to apples.

[00:04:46] You're comparing different modes of practice, different years of experience, whether you're employed or an owner. Different geographic distributions. And so the data is so muddled that you're not telling the appropriate story. And that bothers me as a researcher because it's not factual and not to manipulate the data, to tell a story that may be advantageous to one group of individuals that I happen to be a part of just because it's advantageous doctor.

[00:05:21] Christopher Wolfe: [00:05:21] Hello, and welcome to Criswell podcast. And I could meet you today. I had a great conversation with Dr. Diane Russo about public health. She has her masters in public health in addition to being an optometrist from Harvard. And so we talked about public health. We talked about women in optometry. We talked about the wage gap within women in optometry.

[00:05:41] And then we talked about COVID. It was a. A really fun conversation for me. I hope you enjoy it as always be sure to subscribe to the podcast, write a review and share it with your friends. That's important. Those who support us, we've been providing my opiate control treatments in our practice for years.

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[00:06:42] Diane Russo: [00:06:42] Rina.

[00:06:44] Christopher Wolfe: [00:06:44] Rina. Yes. Rena was in my, it was my

[00:06:47] Diane Russo: [00:06:47] year. Okay,

[00:06:49] Christopher Wolfe: [00:06:49] great. Yeah. That makes sense. Yes. And Beth was, yeah, Beth was secretary or vice-president or.

[00:06:56] Diane Russo: [00:06:56] Like that. Yeah. Yeah. Blends together. Yeah,

[00:07:01] Christopher Wolfe: [00:07:01] because it really does. So, did you guys get to do anything last night? Is Boston pretty much shut down or

[00:07:09] Diane Russo: [00:07:09] pretty much, you know, I, I worked a 12 hour day in clinic yesterday, and so that was the extent of my celebration, but I took off on Wednesday.

[00:07:20] My husband works for the state, so he had off, so I took off for the day. And so we just celebrated the day early.

[00:07:28] Christopher Wolfe: [00:07:28] Yeah. Nice. So then so tell me about Boston and like, like Is it weird? Like, is it weird to, so they've been pretty much like New York where things have just been completely locked down for the last eight, nine months

[00:07:39] Diane Russo: [00:07:39] more or less?

[00:07:40] Yeah. So I haven't spent, I live outside Boston I'm in Framingham. So I'm like without traffic like 20 to 25 minutes outside Boston sort of just sort of strictly West. And so I really have only gone into Boston. If I'm going to the college, cause I'm on faculty at Necco. So I, if I go there to teach too, like if I'm teaching a lab, cause that's pretty much the only thing we do in person nowadays, go teach the lab and leave.

[00:08:10] And so that's pretty much the only time I go to the college nowadays. Or if I go to clinic, so I work at a community health center. If I go I'll go to the clinic, see patients and then leave. So that's pretty much the only time I've been to Boston with the exception of Sunday, my husband's birthday, we're born four days apart.

[00:08:29]So last Sunday we went into Boston to celebrate, right? And we went out to dinner. We ate, you know, in the North end, which is like their little Italy outside. For the first time since

[00:08:41] Christopher Wolfe: [00:08:41] last time you'd been out

[00:08:44] Diane Russo: [00:08:44] well in Boston. Okay. Well, yeah. I mean, pretty much only like twice we celebrated our anniversary in September.

[00:08:55]Which is sort of making a sound like we're shut in.

[00:08:58] Christopher Wolfe: [00:08:58] Yeah, you are. Yeah.

[00:09:01] Diane Russo: [00:09:01] We leave the house, but we mostly just do like take out and we'll eat in, but we'll like go out to walk and stuff like that, but we pretty much like haven't gone out socially really. But yeah, so we really haven't spent much time in, in Boston, socially at all.

[00:09:18] Since this all started. Wow. I really don't know very much of what it's like. I mean, people were out, but it was so nice that everyone was just mostly spending time outdoors. Right. Yeah.

[00:09:30] Christopher Wolfe: [00:09:30] Yeah. So then, I mean, that's, you know, for us I think, I think it feels a little less unusual, you know, we've I talked to my patients about this a lot is that I'll have you know, I come home and it was really great during, during April, may, June.

[00:09:48] And then it sorta kind of transitioned back in July. The really great part was that we were using and we are now where you're just running around, like I'm running kids from one place to the next. So I get home and we're eating dinner for 15 minutes and then we're going our separate ways, you know? And so it was really awesome to get home, have a cocktail, making a dinner, you know, every night was, you know what, and I love to cook.

[00:10:13] So that was, that was awesome. And we just didn't have stuff to do. You know, we just hung out together. And then, you know, we've sort of let, and this, this happens, you know, you just kind of let everything come back in and that's what we've done. So for the most part, it shows me that I think like our family is pretty well socially distanced.

[00:10:31] I mean, you know, when I start thinking about like, what would I normally do? I'm pretty much doing the stuff I'd normally do. You know, we're we're with our kids. The only weird stuff is like, now that stuff is moving inside, then you know, basketball games are masked up, you know, But for the most part, you know, I, I don't get off of work and then head of the bar, that's not what I do is fine.

[00:10:53] I'm not, I'm not knocking it. That's something I normally do. So it's not, it's not weird to not have that option. And when we go to restaurants, it's not that bad to stick on a mask when we're walking to a table, but you can't even eat it inside.

[00:11:07]Diane Russo: [00:11:07] You can, I think you can. We haven't we haven't eaten in a restaurant.

[00:11:13] Christopher Wolfe: [00:11:13] Yeah.

[00:11:15] Diane Russo: [00:11:15] Yeah.

[00:11:17] Christopher Wolfe: [00:11:17] So I mean that's,

[00:11:21] Diane Russo: [00:11:21] but we haven't, we've chosen that.

[00:11:22] Christopher Wolfe: [00:11:22] Yeah. Yeah. I mean, so we, you know, the restaurants we go to are kind of smaller local restaurants and the, you know, there. There's just a lot of room, you know, so we'll eat inside, but it's been so nice that we've also chosen to eat outside a lot, but, you know, it's, it's just, doesn't feel that weird to me.

[00:11:42] But when I think about like, when I've traveled to Atlanta, I haven't been to like the post since all of the law happened, but you know, Atlanta was really weird. The feeling was really weird. That was back in August and it was like Of Hartford was shut down. Half of the airport was shut down. I don't know.

[00:12:03] It was just, we, does that feel like that to you? Or is it, I mean, normal?

[00:12:07]Diane Russo: [00:12:07] Yeah, I mean, I haven't really gone anywhere. It feels

[00:12:14] Christopher Wolfe: [00:12:14] by nature. You're really liking, having to zoom

[00:12:18] Diane Russo: [00:12:18] more and more like it. Yeah. I mean, we haven't

[00:12:22] Christopher Wolfe: [00:12:22] gotten cats.

[00:12:24] Diane Russo: [00:12:24] No, we don't no pets. We don't have kids. We don't go anywhere. We don't do anything.

[00:12:30]So it's really made us sort of reassess, like how we spend our time. We, we haven't traveled. That is the biggest, I think difference. We travel usually a lot. We've had to cancel a lot of vacations. That is, I think the biggest difference. We usually take several vacations a year. We travel out of the country usually quite a bit So we haven't been able to do that.

[00:12:51] And we usually see our families a lot. I think that's usually how we spend most of our time. My husband's family is in Massachusetts, my family's in Connecticut. And so, you know, we see my husband's family but we usually visit outside. So we went on Wednesday, his parents have a puppy, so we went and played with the puppy in the backyard.

[00:13:10] My family. Now it's a little bit more complicated because they were in Connecticut and now it's classified. It's no longer classified as a low risk state. So if I travel outside, if I traveled to Connecticut, I either have to quarantine when I come back or get tested. So it's a little bit more complicated.

[00:13:28]And especially now as I come. To work. It's that's now going to get in the way of my ability to work. So now I really can't go see my family without complicating my ability to work. So it's a little bit more complicated. So we've had to FaceTime with my family a little bit more. So yeah. So traveling gets it has not been as easy.

[00:13:48] So because of that, we, we haven't really gone anywhere. Wow.

[00:13:53] Christopher Wolfe: [00:13:53] Are you doing anything to your, like for us? One of the things we started working on this summer was. Just kind of revamping our backyard. And and so, because that's kind of, and I've talked to like a lot of the contractors that are working for us and they, they say that it's like, you know, that's what everybody's doing all across the country.

[00:14:11] And I didn't even realize it. I was like, I wasn't even thinking, Oh, well, we're going to do it. Cause that's the place we can spend time with people. But I think sort of naturally just like same thing. We had trips canceled. I hardly ever traveled anymore. And. So it's like, well, we might as well just enjoy the stuff that we've got.

[00:14:29] Are you doing any of that kind of stuff?

[00:14:30] Diane Russo: [00:14:30] Yeah, we did stuff. We we did stuff around the yard, my husband in the spring, like we did the whole front yard cause our lawn was a mess. We did some landscaping. We redid a couple of the rooms in the house. He painted the kitchen. But I feel as though we've.

[00:14:45] Exhausted those options.

[00:14:51] Right? And now we're starting to talk about how we need to discover new hobbies because the winches rolling around. And so, you know, some of those outdoor options are becoming more limited

[00:15:03] Christopher Wolfe: [00:15:03] and you guys could learn how to play bridge.

[00:15:16] You know? Yep. That's awesome. So the last time I think you and I saw each other in person, it was probably a couple of years ago at the leader summer summit for the AOA volunteer meeting. And then one of the things that. Was really eyeopening to me about that in particular. And you probably don't remember this, but but a, one of the, one of our one of the people there, I'll just broadly state that who I actually respect a lot.

[00:15:46]And in terms of intersectionality probably stands with more privilege than I would have to say some of the things that may, he may have said to you and I was, and I was surprised, and I can't remember the entire conversation, but. What I was surprised by was how immediately like he gave me a pass and I think he gave me a pass maybe because he knows me well, but, but he was pretty hard.

[00:16:12] I don't know if it was you in particular, but if it was women, do you recall that conversation? You may not. That's good. If you don't. But, but, but I think that that just conversation was, was sort of women in the profession. And and then I think, I think it was also related to scope in some degree. And

[00:16:31] Diane Russo: [00:16:31] but one or two people in my mind, number of conversations with a number of people over the years that have stood out.

[00:16:38] So

[00:16:39] Christopher Wolfe: [00:16:39] well. No, that's so that's, that was, it was shocking to me because I You know, for whatever privilege I may have. I, I guess I don't have the, probably the privilege that I have would be that I don't have to think about like You know, if, if I work hard in the profession and I work hard for the profession, then I don't know.

[00:17:00] I guess I've never had to worry. Like, is somebody going to think I'm, I'm not going to contribute in the right or just assume that I wouldn't contribute. And that was to me, I was like, Whoa, Whoa. Like, like, do you know who you're talking to? Like, like, she's just, she's got a Harvard. Master of public health.

[00:17:18] Like she, she cares about the profession and she is moving towards it. I was like, and it was really striking to me, I guess is my point. And I was like, I'm never going to have an Ivy league degree. I'm pretty sure you're not going to have an Ivy league degree. And so then then I guess my point is, is that, that was really striking to me.

[00:17:36] And and you said just now that you've had some conversations like that Does it detract from, from your does it, does it ignite your fire or does it detract from your, your desire to kind of be involved? How does that impact you?

[00:17:51] Diane Russo: [00:17:51] Do you remember what comment they made? Like watch that? Cause, I mean, I've had comments

[00:17:57] Christopher Wolfe: [00:17:57] vague.

[00:17:57] I mean, in my mind is very vague. It was just, I recall that it was, I was shocked.

[00:18:02] Diane Russo: [00:18:02] Hmm. I mean, a lot of the comments that I have that people have made not necessarily directed. At me

[00:18:10] Christopher Wolfe: [00:18:10] and it wasn't, it was a generality

[00:18:13] Diane Russo: [00:18:13] directed at me specifically. Cause most of the conversations that I'm engaged in, I mean, Certainly, I mean, the person that we were talking to didn't necessarily know me, but we were at a volun and AOA volunteer

[00:18:28] Christopher Wolfe: [00:18:28] meetings.

[00:18:29] Diane Russo: [00:18:29] You could venture to guess that I was so, you know, they probably shouldn't make a derogatory comment about, you know, female Odie, volun AOA volunteers. But you know, a lot of the comments that I hear people make about female ODS is usually about. The propensity for female ODS to go into the profession and then take a step back because they want to have babies.

[00:18:56] And then, you know, it's really just a part-time career choice and I've heard those types of comments made more and more because One of the projects that I'm working on, that I was on a panel discussion for women in optometry at this past Academy. We haven't published the results yet, but we I'm a faculty member, a few faculty members at Necco.

[00:19:20] And I but one of my co-investigators Dr. Stacy Lyons and I worked, we teamed up with Jobson to do a survey. They do sort of their yearly income survey. And we wanted to look at income to see if there's a wage gap, a gender wage gap. And we hear that talked about a lot and that's talked about in multiple professions, but when we look at our profession, you know, the data is not really great and it's all survey-based and, you know, even the survey that we did you know, it's.

[00:19:52] People just sort of self-select into to doing it, but you have to start somewhere. But what we really wanted to do was trying to compare

[00:19:59] Christopher Wolfe: [00:19:59] apples to apples,

[00:20:01] Diane Russo: [00:20:01] take the aggregate data. It's so mixed and it doesn't tell the proper story. And I'm sure you know this when you are looking at aggregate data, you're not comparing apples to apples.

[00:20:13] You're comparing different modes of practice, different years of experience, whether you're employed or an owner. Different geographic distributions. And so the, the data is so muddled that you're not telling the appropriate story. And that bothers me as a researcher because it's not factual and how to manipulate the data to tell a story that may be advantageous to one group of individuals that I happen to be a part of just because it's advantageous, but not true.

[00:20:46] Christopher Wolfe: [00:20:46] Interesting. So, so here's, here's the thing. I, I I listened to an episode of a podcast when this was very, a very hot topic in the profession. I would say like a year and a half ago, maybe two years ago before all the other hot topics, right. That, that we're onto now. And that is exactly what I thought. I thought.

[00:21:06] Look, if it's the case that Diane Russo owns a practice. And sees patients exactly in the same town as Chris Wolf and sees patients exactly the same, you know, the way you choose to practice is exactly like mine. And I make more than you make garbage, right. Complete garbage, like that should not happen.

[00:21:31] But that is not, I mean, that, that can't be a reality. Like I probably, you know, there's, I, because I choose to, to practice and see patients at a certain number of days a week, and I do other stuff on the other side, like then I would assume that, you know, a female in my town that owns her practice that seeing patients five days a week, probably making a lot more money than I am.

[00:21:52] Because if, if she's billing appropriately, if she's seeing disease patients, if she's, you know, so So I love that you got on to that idea because it is not explored and it's not talked about, it's like, Oh, wage gap, here you go. 23%. I was like, no, no. So then what do you do? How do you get to that number to really know?

[00:22:14] Is it less and what do you do with that information?

[00:22:17] Diane Russo: [00:22:17] It's more, yeah, it's more complicated. So I think that's what we are. We're wanting to start to tease out and to really, I mean, at least start to. Branch into two groups. Okay. Well, let's start looking at employed ODS and owners and then parse out male, female ODS and say, okay, is there a difference?

[00:22:40] And then parse out, how many years have you been in practice? And then let's start looking at the difference in salaries. And so that we, we still haven't we're still analyzing the data.

[00:22:51] Christopher Wolfe: [00:22:51] What's your sense? What's your sense on the data?

[00:22:54]Diane Russo: [00:22:54] So like

[00:22:55] Christopher Wolfe: [00:22:55] if you talk about employed, so let's say employed ODS,

[00:22:58] Diane Russo: [00:22:58] we haven't started digging into well.

[00:23:01] So what I can say preliminarily is that at least with the employed ODS, that there is less of a difference in employed ODS between males and females, when they are first out. For, so for new grads. And so we don't know if we're seeing that initially, because now newer graduating female ODS are now more aware that they need to, like, maybe they know that there is a wage gap or they hear that there's a wage gap and they know that they need to negotiate.

[00:23:42] Whereas maybe they. Previously didn't. No. Like when I, I mean, when I, I didn't actually negotiate salaries for previous jobs that I went for and I was just like,

[00:23:53] Christopher Wolfe: [00:23:53] negotiate the one you've got now.

[00:23:59] Diane Russo: [00:23:59] Right. So, I mean, my, so I was not an, actually a very good position to negotiate. I quit my job before I had another one. And my perspective was, well, this is what I was getting paid. I don't have a job and I need one and I'm not getting paid less than what I was at with my previous job. So that seems pretty good to me.

[00:24:21] Sure.

[00:24:23] Christopher Wolfe: [00:24:23] I think women do that more than men. Do you think women take that position more than men? Because that's sort of what I would do. Like I'm not I'm I think I'm good at understanding my value, like in a healthcare system, but I'm not that good at negotiating, honestly.

[00:24:38] Diane Russo: [00:24:38] Yeah. I mean, I I'm so different now.

[00:24:41] I mean, this is so the current position I'm at, I'm in now I'm at Nicole almost seven years. I'm so in such a different position now than I was seven years ago that. I'm. I would also say I'm worth a whole lot more now than I was seven years ago. So

[00:25:03] Christopher Wolfe: [00:25:03] are you listening?

[00:25:05] Diane Russo: [00:25:05] Oh, Howard knows how much.

[00:25:08] So so I think aside from just my level of understanding of actual negotiation, negotiation techniques, I think I understand a better, I have a better sense of. What my worth is, quote unquote, where and, and understanding what your negotiating position is. So I didn't really negotiate quote unquote for my current position, because I didn't really have a very strong negotiating position going into.

[00:25:35] My current position, whereas, you know, I might've been positioned differently. So, so I think maybe new grads now have perhaps a better understanding things are being talked about more than they perhaps have been in the past. So that may be a little bit different. That's just a hypothesis we are seeing though, again, preliminarily among practice owners, that there is quite a bit of a difference.

[00:26:03] Christopher Wolfe: [00:26:03] Women

[00:26:04] Diane Russo: [00:26:04] make more,

[00:26:04] Christopher Wolfe: [00:26:04] I'm asking

[00:26:07] Diane Russo: [00:26:07] different vastly different among practice owners, male and female practice owner.

[00:26:11] Christopher Wolfe: [00:26:11] Why do you think that is?

[00:26:13] Diane Russo: [00:26:13] That is the big question.

[00:26:15] Christopher Wolfe: [00:26:15] Cause I know I like maybe it's, but I, I, I think about the women practice owners that I engage with a lot and I'm like, they're powerhouses. Their patients liked them better than they

[00:26:27] Diane Russo: [00:26:27] sample size.

[00:26:28] Right. I mean, that's part, it's a small sample size, but also if we if you look at, if I think when we looked at practices that had similar gross revenue, there was also a difference in salary.

[00:26:45] Christopher Wolfe: [00:26:45] Do you think they're, do you think they're This, this is gonna probably sound sexist, but I'd

[00:26:50] Diane Russo: [00:26:50] be curious to get your perspective

[00:26:51] Christopher Wolfe: [00:26:51] because

[00:26:53] Diane Russo: [00:26:53] to me, from

[00:26:53] Christopher Wolfe: [00:26:53] a practice owner.

[00:26:54] Yeah, yeah, no, I mean, do you think that they are more nurturing? So they, they pay their employees more? Do you think they, that it comes back perhaps that they don't want to negotiate as much? Because so their, so their cost of goods are higher. I mean Are they re-investing into the practice. Right? Do they, do they view their practice as a, you know, as a, as a place that over time is going to be worth more if they reinvest more.

[00:27:18] So those would be the kind of questions that I would wonder about if, is it, is there something about, I know we're not supposed to say that, but is there something that women are different than men? Maybe I'm not supposed to say that, but. If we assume that they are, and I believe that women are different than men in, in many better ways.

[00:27:35] Right. And they are way better than us in many ways. And one of those ways might be that they're, they're looking at their practices differently. I mean, I don't know. That's the only thing you could explain what the gross revenue, if their gross revenue is the same or similar, it would have to be one of those things.

[00:27:54] Right.

[00:27:54] Diane Russo: [00:27:54] Right. I mean, that's, these are some of the things that we were talking about because I mean, and we don't have answers cause where at this point again, we're still analyzing the data. And these were just some of the gross, very gross metrics. But we're thinking why, what could possibly be the reason for that?

[00:28:15] Those are some of the things that some of the ideas that we were tossing around, like what are the, some of the business reasons that someone can make, that they would end up themselves taking home less money, but where would, how could they be distributing those funds amongst their employees or business that they themselves, with an end up taking home less money?

[00:28:35] Christopher Wolfe: [00:28:35] Yeah, could it be that? I mean, other thing, if you're asking me for my opinion, it could also be that they're performing, they're providing services that. Cost more to provide, right? Like, like in general, maybe they're not providing, I mean, I, again, I have no idea, but you know, when I would say, if I were looking at two practices and their exact gross, no matter who owned it, like this is completely agnostic to who owned it.

[00:28:58] In fact, the things I'm throwing out would be the things I would think about is like, how would you get that net? Right? What you're paying yourself? How would you get that higher? It would be the things I said, whether it's a male or female, and then it would also be. All right. Well, am I generating you know, a million, we'll just say a million dollars.

[00:29:14] I'm generating a million dollars over here in revenue, but I'm seeing maybe I'm seeing all managed vision care plans. That that requires me to do, to hit that million dollars. Right. You got to see such a high throughput, right? I've got to see so many patients have to have so much staff that all of a sudden what I'm taking home is less as opposed to maybe I'm providing a ton of medical services and a ton of like additional high value services, like scleral lenses, amniotic membranes, ocular surface disease management, you know, with procedure procedures in their myopia management.

[00:29:46] Right. Maybe I'm doing that, right. It doesn't matter if it's a male or female, but if I'm doing all those things, I don't have to see as many patients. Right. So I don't have to have as much support staff and the hi there's, there's less the patients that I am seeing the cost to see those patients, even in cost of goods tends to be lower.

[00:30:05] So those would be the thoughts I would have about if, if that actually helps you tease out those differences between males and females. Thank

[00:30:13] Diane Russo: [00:30:13] you for that. Cause we, one of our, also one of our plans is as we're writing up the manuscript was to pick the brains of some of our business minded colleagues as we write up our discussion,

[00:30:29] because again, part of the discussion is to, to tease out what some of the reasons could be, because that was part of some. Some of the glaring data that we had noticed and just some of the preliminary analysis.

[00:30:41] Christopher Wolfe: [00:30:41] Yeah, that's really interesting. None of this is by the way, what I thought we were going to be talking

[00:30:45] Diane Russo: [00:30:45] about, but

[00:30:46] Christopher Wolfe: [00:30:46] I'm glad we're talking about it.

[00:30:48] Diane Russo: [00:30:48] Actually, a lot of different things. I know I had mentioned to you, I'm like, these are the things I'm going to talk about, but I know it gets very scattered for me.

[00:30:57] Christopher Wolfe: [00:30:57] No, I actually prefer not to have a list of things to talk about. Actually, I think it makes the conversation a lot more fun for me. And hopefully for the people who listen to it, do you Is that just that you, you picked up on that because you're research minded or do you think there actually is a public health kind of underlying public health theme to the difference in, in wage and professional pathways for between men?

[00:31:21] Diane Russo: [00:31:21] Yeah, I'm one of the, so, I mean, I was a women's studies minor in college. So I've always had an interest in sort of gender dynamics. So that sort of underlies a lot of. Personal interests. But one of the things that I have realized as I've formally studied public health, is that you can make most things about public health native enough.

[00:31:48]But certainly workforce dynamics have a role in public health. When you talk about workforce demands and meeting the needs of patients. And when we talk about meeting the needs of our patients and thinking about. When, when we talk about the needs of our patients and what our patients look like, and then what our doctors look like, and we want our doctors to then also look like our patients.

[00:32:18] And reflect the, the demographic of our patients as well. So then we think about workforce projections and needs that also then relates to our patient needs. So I think again, making stretching to think about how you can make many things public, if you get creative enough, now that I think workforce demands needs much creativity to make that.

[00:32:44]Public health relevant. That is sort of how I view this topic as, as relevant to, to the realm of public health.

[00:32:52] Christopher Wolfe: [00:32:52] Do you, so I had a conversation, we, we sort of a little bit skirted around that idea of having. Doctors who look like their patients with when I talked to Adam Ramsey a couple months ago about this.

[00:33:05] Oh, great. Thanks. Did you give me a five star review and, and write a review?

[00:33:12]Anyway, the the, so can you elaborate on that a little bit for me is like, what does the evidence tell us about patient populations who, you know And then yeah, about how that impacts their ability to be adherent, to prescription treatment plans, follow up plans, et

[00:33:30] Diane Russo: [00:33:30] cetera. You know, it, it is interesting.

[00:33:33]There, there is it can be mixed at times some evidence. So certainly there is evidence that supports that patients Want to be treated by doctors that look like them, that there is more an increased likelihood that they will trust doctors that look like them because. They have, are, it may be easier for them to build rapport and have confidence in what they're recommending.

[00:34:05] However it is interesting that, and I I'd have to fact check myself on this because some of this may also be anecdotal, right. That that's not always true. There are certainly instances where patients do have biases against doctors that look like them. And

[00:34:25] Christopher Wolfe: [00:34:25] again, it goes they're sexist or racist or.

[00:34:28] Diane Russo: [00:34:28] Well I'm not, and again, this is where you'd have to fact check me because the, what I've heard on this topic is mostly anecdotal. I don't know the, the origin of the bias and what it's rooted in, but For example one of the anecdotes that I have had heard is from one of my colleagues where there were, I think it was one of the hospitals in Boston and one of the patient populations was.

[00:34:59]I don't remember if it was predominantly Haitian and the hospital then made it a point to specifically hire a Haitian doctor so that they could care for that patient population. And what they found was that the patients did not want to see the Haitian doctor that they had hired, that they wanted to see the white doctors.

[00:35:25]Because they felt that the white doctor was going to provide better care. That was sort of like in what they were. I dunno if it was socialized or like culturally, what they had, what they were was more acceptable to them that they did not want to see the Haitian doctor. And so they hadn't really asked the patients what they wanted.

[00:35:44] They assumed that because the patients were Haitian, that they would want to see the Haitian doctor and that is not actually what they wanted. And so, and again, this is totally anecdotal, but so there, so it's not, you can't always make that assumption, but certainly some. At times that is mixed. You can't make that assumption, but there is also evidence that patients do want to see patients that also look like them.

[00:36:09] Christopher Wolfe: [00:36:09] And is that racist or sexist or biased?

[00:36:14] Diane Russo: [00:36:14] The second, that latter part. Yes. That, that is what the patients want or that we assume that that's what they want.

[00:36:20] Christopher Wolfe: [00:36:20] That that is what they want.

[00:36:22]Diane Russo: [00:36:22] Well, You know, I guess it depends on what I guess it depends on why

[00:36:36] Christopher Wolfe: [00:36:36] do we know why?

[00:36:38] Diane Russo: [00:36:38] Yeah. I don't know. Yeah.

[00:36:40] Christopher Wolfe: [00:36:40] Yeah.

[00:36:41] I mean, I don't know either. I mean, I it's it's, it starts to become an interesting question because

[00:36:46] Diane Russo: [0