MFM Pioneer, Dr. Luissa Kiprono on High-Risk Pregnancy & Telemedicine

Dr. Luissa Kirpono
The Doc Lounge Podcast
MFM Pioneer, Dr. Luissa Kiprono on High-Risk Pregnancy & Telemedicine
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Description

She arrived in the US at 19, spoke no English, and couldn’t go back. Three decades later, Dr. Luissa Kiprono is a maternal-fetal medicine specialist, Air Force veteran, and the founder of a nationwide telemedicine practice rewriting access to high-risk pregnancy care. This one hits different.

What you’ll learn:

  • Why there are only ~1,000 full-time MFM specialists serving 67 million women of fertile age in the US — and what that shortage actually means for patients
  • How TeleMed MFM works in practice: real-time ultrasound review, virtual consultations, and bridging the gap in maternal care deserts
  • What’s driving the US high-risk pregnancy crisis — obesity, advanced maternal age, comorbidities, and the vanishing maternity ward
  • Why women physicians keep getting stuck below the executive ladder — and what succession planning in medicine should actually look like
  • How Dr. Kiprono turned a handwritten memoir (started in Romanian, shelved for 20 years) into an Amazon bestselling book about trauma, resilience, and thriving
  • What fellows and residents choosing a subspecialty need to hear about MFM — the pace, the complexity, and the pull

About the guest: Dr. Luissa Kiprono is a board-certified maternal-fetal medicine specialist, US Air Force veteran, executive MBA, and the founder & CEO of TeleMed MFM, a 100% virtual MFM practice operating nationwide. She is also the author of Push, Then Breathe: Trauma, Triumph, and the Making of an American Doctor — an Amazon bestselling memoir about her journey from communist Romania to American physician and advocate.

About the show: The Doc Lounge Podcast, hosted by Stacey Doyle, is where physicians come to talk shop, swap stories, and figure out what’s next in their careers. Brought to you by Pacific Companies.

👉 Explore physician opportunities: pacificcompanies.com 🎧 Subscribe to the Doc Lounge Podcast wherever you listen 💬 Got a topic you want covered? Drop it in the comments.

Full transcript:

Stacey Doyle (00:01.767)
Welcome back to the DocLounge Podcast where we bring you real conversations with physicians and healthcare leaders shaping the future of care. I’m your host Stacey Doyle, Senior Director of Marketing at Pacific Companies. And today I’m incredibly honored to introduce Dr. Luisa Kiprono. Dr. Kiprono’s story is nothing short of extraordinary from growing up as a refugee in communist Romania, Romania, excuse me, to becoming a maternal fetal medicine specialist here in the US.

Her journey is one of resilience, grit, and purpose. She’s also a US Air Force veteran and the founder and CEO of TeleMed MFM, a nationwide telemedicine practice expanding access to high risk pregnancy care across geographic barriers. Beyond her clinical work, Dr. Kiprono is a powerful advocate for women in medicine and leadership. Through mentorship, speaking, humanitarian missions, and community outreach, she’s helping women not just succeed, but truly thrive.

She’s also the author of the Amazon bestselling memoir, Push, Then Breathe, Trauma, Triumph, and the Making of an American Doctor, where she shares her deeply personal journey from trauma to transformation and her mission to empower others to heal, lead, and rise. Dr. Kiprono, we’re so excited to have you here today. Welcome to the show.

Dr. Luissa K (01:19.96)
Thank you, Stacey. I am honored to be here in front of you and in front of your audience.

Stacey Doyle (01:25.095)
Well, we couldn’t be more excited to have you. love having, hearing from different physicians about how they got into their specialty and how they started. But you really have an incredible journey, obviously, from being a refugee in Romania to where you are today. Tell us a little bit about that.

Dr. Luissa K (01:43.928)
Okay. I will keep it short because that in itself could be a podcast episode, right? So I was born and raised in communist Romania. I came to United States for a two months visit, one month short of the age of 19. Due to some very unfortunate and unforeseen circumstances, I was not allowed to go back to Romania.

So 15 years after I arrived to this country, I succeeded and graduated medical school with a degree of doctor of osteopathy. I was also a recipient, a very proud recipient, I may add, of the US Air Force scholarship program. So pretty much what it is is the Air Force, I…

applied and as a candidate I got accepted and honored to get the full scholarship, which really is a free ride to go to school, medical school. Afterwards, so I decided to do OBGYN as my residency. did a military, a combined military residency in Ohio. I did my payback to the Air Force in Kisler Air Force Base in Mississippi.

And afterwards, I went back to school, went back to training really, and I finished my fellowship in maternal fetal medicine and my master’s in biomedical sciences. So it was a tandem program. So afterwards, I became the medical director of a MFM practice in southern Indiana.

Stacey Doyle (03:29.811)
impressive.

Dr. Luissa K (03:39.086)
for about five years. Then I moved to Texas. So presently I live with my family in San Antonio, Texas. So I’ve been here since 2019. And then was here the corporate director for five years for a large practice. And then due to that practice disclosure, right after COVID, I opened my own practice in telemedicine.

Telemed MFM is 100 % telemedicine platform, virtual platform in high-risk pregnancies, consultation services. Except for procedures for obvious reasons, we do full scope maternal fetal medicine, high-risk pregnancies, consultations, preconception counseling, everything that entails to high-risk pregnancy and high-risk obstetrical care.

Also in 2020, I got my executive MBA from University of Tennessee in Knoxville. So that’s, and then I decided that probably I should stop. I don’t want to have a truly an alphabet soup right after my name. yeah, but I think, you know, it’s too, it’s really Stacy is we always grow and we always evolve. So.

You know, to me, age is just a number. And you know, as long as you feel intrigued and interested to, you know, to thrive and just keep going and discovering new sides of yourself, why not? You know?

Stacey Doyle (05:16.027)
I love that and such an impressive and fascinating background. I wanted to dive a little into, because I know we have lot of fellows and residents that listen, what was really that defining moment when you knew maternal fetal medicine was your calling?

Dr. Luissa K (05:33.976)
So I think it’s really multifactorial and it morphed into it. One, to become a doctor, it always was my dream and my passion since I was a fifth grader. And then, as I, like you said, as I finished my medical school, really my first interest was general surgery.

Okay. And I did my rotation in general surgery and I did not like it. And the reason it was that it was a lot of surgery, but not a lot of patient contact. Okay. So when I say that it’s like, I enjoy the, you know, the counseling part. enjoy it. Don’t take me wrong. When I was in the OR as an OBGYN, I enjoyed it. But when I stepped out of the OR, I really didn’t miss it. Okay.

But when I would step into the labor and delivery unit and I would counsel my patients and my high risk pregnancies as a resident, what as a medical student and learning through the rotations what specialty I may or may not like, I noticed, it’s almost like a draw. mean, somebody says, must be some chemicals in labor and delivery that you guys love it so much. I said, no, it’s like.

To me, obstetrics is like that you hate it or you love it. It can be lukewarm, okay? Because obstetrics is like critical care. It can change in a split second. And you can’t just be like, you know, I’m pondering what could be this? No, you gotta act. It’s very fast paced and you have to, know, listen to your gut, listen to your experience, you know, make sure that you fully, you know,

look and assess your patient and then go with that. You just can’t, you know, take your time. When it comes to high risk pregnancies, I had personally, I had high risk pregnancies myself with my both my my sons. But it is it is a bond that, you know, first of all, as humans, any human being, you know, that’s really our Achilles tendon.

Dr. Luissa K (07:56.23)
We can all boast our riches, our smarts, right, that we are doing great, until something health-wise happens. And then, really, we are just scared and confused. And we do not know what to do next, because we’re so, vulnerable. And when it comes to pregnancy, it is heightened.

I say 10 times over, 20 times over. Why? Because pregnancy outside a wedding, really outside marriage, pregnancy is the most happy or the happiest, the most fulfilling period in a family, but also a woman’s life. So imagine how much it hinges on a woman and on a pregnancy and

on a, you know, to make sure that both, not only baby or not only mom, but both the pregnancy is doing well. The mom is doing great. The baby is safe and it’s growing appropriately. So as I was doing my OB-GYN residency, you know, um, it just was, it was very easy. came very easy to me to take care of regular pregnancies, regular, uh, moms, uh, you know, high, low risk gestations, but

You know, I have this detective kind of brain. that, you know, the more complex that case is, the more it will just draw my attention and I get really, really into it and I want to solve it. I, know, then that’s probably what drew me so much to high risk pregnancy is the rewards are immense. Yes, that is also the not so good news that we have to give. And of course that is.

this downside of my specialty. But just have to also have to put it in perspective, Stacey, because think about this way. We also want to be able to detect easy, not easy, but early, right? You want to detect early whatever that is, whether it’s maternal, but also in utero, because that allows you to prepare yourself and prepare your patient and prepare the care that’s given afterwards. So that proactiveness and the pragmatic

Stacey Doyle (10:00.421)
Mm-hmm.

Dr. Luissa K (10:16.59)
follow through that’s like, okay, well, we got this big ball of lemons. Now, can we make just as best lemonade as we possibly can with it, given the circumstances?

Stacey Doyle (10:31.367)
Well, such an inspiring, obviously, story and background about why you went into the specialty. And I wanted to now kind of pivot because I know you founded Telemed MFM because you wanted to expand access to high risk pregnancy care. Tell us, what was that gap you were seeing that pushed you to build this?

Dr. Luissa K (10:46.36)
Thanks.

Dr. Luissa K (10:52.302)
You know, just to give you some numbers, you know, there are about 37 million women of fertile age in the United States, you know, depending on what data you read, there are only 1,587 maternal fetal medicines specialists in the United States.

I mean, it is a pretty big gap. And now take that. because I always, I teach in telemedicine. just showed up at a lecture, not showed up, but I was invited to give a lecture at Texas Medical Association in Corpus Christi two weeks ago. And I always say this, you you look at the number and say, it’s 1,587.

Okay. Which is only about 12 % more than 10 years ago, but that is all commerce, Stacy. Right. I mean, a lot of, a lot of female physicians work part-time on three quarter of the time. We have people who are part-time because they are retired. They are also locums that don’t really work a hundred percent. Right. They work maybe a week, a month or so forth that are also retired.

MFMs, but they are not yet showing on the census as retired. I would like to venture, although there are no clear numbers, but when I last checked with my society, it’s about a thousand of us. Full time. So you met that. So that impact. Yes. So when, when COVID happened, right, COVID brought about the only, I would say,

Stacey Doyle (12:33.531)
Yes.

Dr. Luissa K (12:43.054)
positive force, if I may say so, into the market and that is telehealth. And it just kind of sped up. So I remember when I got out of fellowship in 2013, I said, God, imagine if we just do virtual visits so we can reach out to further people, we’ll be so much better served. And really COVID

like pushed it further 10 years, I would say a decade. And I really, you know, I feel very strongly in keeping that. And I don’t think you can put the, you know, the toothpaste back in the tube really. It’s kind out because it’s just not telemedicine in MFM. It’s not only in, I don’t know, radiology. It’s not only in family practices, it’s everywhere. Everywhere that we can substitute, we can adjunct to the

brick and mortar clinics to, because that’s what it is. People think like, oh, telemedicine or telehealth is going to replace the traditional brick and mortar visits. No, it’s not. You just become more accessible. You should be changing with the times and adapting and evolving to serve better your patients. Why would I have my patients drive two and a half hours one way?

for a 30 minutes visit. Like even when you are in the town, right? I’ll give an example. And you know this, when you go to the doctor in clinic between leaving your house or your workplace to coming back, it takes about two, two and a half hours. Now virtually 20 minutes on an average, 20 minutes. So that it’s amazing.

Stacey Doyle (14:28.049)
Yeah. Yeah.

Dr. Luissa K (14:32.675)
You don’t have to battle traffic. You don’t have to stress to find parking. You don’t have to stress finding babysitting. Now with MFM, with maternal and fetal medicine, a lot of people ask me, how does it work? How does it work? Because you have ultrasounds. So then the way it works is that, think about this way. You go to your doctor clinic.

and you go in and checked in, get vitalized, the nurse talks to you. So everybody in my clinics are on the ground in a traditional physical clinic except for me. So the maternal and fetal medicine physician shows up through the screen, just like we are right now talking to each other. And I am looking at the ultrasounds in real time.

speaking to my sonographers, my nurses, my MAs, my patients are in the consultation room or in the ultrasound room and they will the cart in with a screen and the video feed and we discuss and we put the plan together. Yeah.

Stacey Doyle (15:40.723)
That’s fantastic. was going to just, when you’re talking through this, I’m assuming that this is giving access to a lot of the underserved or rural communities where there’s no MFMs around.

Dr. Luissa K (15:55.609)
Right. And it’s for the patient. I mean, it’s the benefits are so multifactorial. Think about preconception counseling. Those patients don’t even have to come in. Okay. Those are called video visits. Okay. So what they do is, you know, after they get set up and scheduled, the EMR or the EHR scheduling sends them a link, a video link, and then they check in.

virtually through the help of my MAs. And then you get a message that the patient is in the virtual room and some of are in the break room, in their lunch time, some are in the car parked in the parking lot. of them are in bed. I’m sorry, but that’s true. But to me, it’s like…

Stacey Doyle (16:46.823)
Yeah.

Dr. Luissa K (16:50.779)
It’s the convenience. know, some of them have like two, three kids that they have to, you know, they run. Sometimes I see them there, you know, and they try their best. But again, the alternative is that they may not show up. They cannot show up. The social determinants of health always should be taken into consideration. You know, just because some people can afford, it doesn’t mean everybody can afford. As a matter of fact, quite the contrary. Most of them don’t afford.

Stacey Doyle (17:21.927)
Yeah. Now it sounds like this is such a seamless and amazing process and experience and it’s going to give the care and the treatment plans for anyone that’s high risk, you know, a great solution. Now, what do you do obviously for the birth? How do you coordinate that?

Dr. Luissa K (17:41.039)
So very good question. So remember, I am a consultant at this time. would say 99.1, 99.2 % of at Matrona Phytomedicine specialists do not do deliveries. Not anymore. The shift started changing about 2010. And the reason is that, you know, because some people may say, well, why don’t you guys? Well,

As I say, you cannot be a good OB by night and a great MFM by day. I just can’t think about it. If I have to stand till three in the morning to deliver a baby, you know, and then show up at eight o’clock to take care of a full clinic of high risk pregnancies, how long can I actually sustain that? And am I going to serve my high risk patients well? Because

when you get so chronically exhausted, you don’t really perform. I mean, you forget, you misdiagnose or you misdocument. I mean, it’s just human beings, know, we just can’t keep on going. It’s not like you have a, you know, a Lotus clinic during the day and then, you know, you also deliver at night. I did have a gap, okay, between my MFM training and my OB.

residency, so that was to pay back their military and I did quite a bit of locums as well in the same time. And so I did my full share of call and deliveries and I love delivering. I tell you, was very hard for me to let go of that. you know, kind of, just like it was very hard for me to let go from my GYN because, you know, it’s a skill. took me 40 years to

to learn the skill of GYN surgeries and now I let it go. It’s almost like, to me, it’s like a shame. You it’s like, okay, you put all this work, but you have to make that leap and say, well, and they decide, are you going to be an OB, a GYN or a maternal and fetal medicine specialist? So at this time we don’t deliver, you know, OB hospitalist. That movement really has been extremely helpful for both.

Dr. Luissa K (20:07.893)
MFMs and general OBs. They are working in a 12-hour shift or 24-hour shift and provide services, inpatient services exclusively. really the deliveries, the surpluses, all that is covered by OBs. So the only thing that we have as MFMs in private practice is really amniocentesis.

CVS, which are all genetic diagnostic tests. But again, those numbers went down too, quite significantly because of the non-invasive prenatal testing and screening.

Stacey Doyle (20:51.207)
Makes sense. Well, tell us, what do you think is the biggest challenge right now facing high risk pregnancies in the US?

Dr. Luissa K (21:00.175)
There is two, and they actually feed on each other. One is access to care. And access to care is lower and lower because of the maternal deserts, because of the lack of funding. There is no maternal deserts, meaning that there are counties and counties of hospitals without maternity wards.

So that is huge. Also, the patients are becoming more and more high risk because of the increased comorbidities. have a, you know, we just have a health epidemic in obesity and all the comorbidities to come with it, high blood pressure, diabetes. We also have moms who are older and older when decided to get pregnant after they, you know,

further their careers. And I personally, I was an advanced maternal age mom with both my children and because I had to finish my education and you know, got to make sacrifices. So, but then comes that comes with a price. Because now you are high risk, not only for your age, but with older diagnosis that actually start piling up in any human being as we get older, right?

So, and that on top is genetics because now, you know, you have a high risk for Down syndrome, know, for chromosomal abnormalities, babies, more high risk for having twin gestations, infertility, IVF. So again, remember I said to you, each one of your questions, we can actually do an episode because it’s so multifactorial, it’s so important to make the…

not only the public, but also the young minds that are about to be residents, that are about to choose a career and what to do next and what challenges are facing.

Stacey Doyle (23:05.319)
Well, that is a great segue. I know you’re a strong advocate for women in medicine and leadership. So how do you think we can get more women into that leadership role and have more awareness around these important topics?

Dr. Luissa K (23:19.887)
Yeah, it’s a great question. I think that when it comes to women in leadership, I actually spoke about that in lectures as well, leadership in medicine, also inequalities in physicians, between the gender inequalities in pay. But also not only that, it’s actually how you move up the ladder.

And the problem is that as you move up the executive ladder, the less percentage of female physicians make it. there is, again, there are different reasons. One is because women also have the additional burden. Well, I don’t if it’s a burden, depending how you look at it. You know, that we are carrying children.

We can’t just give it to somebody to carry for nine months unless you want to have a surrogate course. so, you know, having to complete their education, then complete their family, then be able to also operate clinically and then still have time to develop themselves from the executive level or, you know, getting to be able to move up the ladder.

they, know, women physicians do get passed on when it comes to this kind of, positions, or they get stuck in areas that really don’t thrive in. And I’ll give you an example. You know, everybody has its strengths, Stacey. Like for instance, I, my strengths are, you know, clinical executive, but some people’s strengths are more research. Some of them are more teaching. Some of them are more, mentoring. So.

Some of are just purely executive. So if you just take this, you know, this woman, woman clinician and say, Hey, you know, I have this project for you. Do you want to take it? She may take it or chances are she will take it because she doesn’t want to disappoint her boss. But also she may, it may not be a fit for her, but she takes it kind of reluctantly because that’s the, sees that that’s a kind of a segue for her to be able to advance.

Dr. Luissa K (25:46.425)
But if you don’t do something with all your passion, you’re not going to thrive in it. So now you’ve got, it’s almost like reluctantly you do something that, you know, just to kind of do the deed to get you hopefully to the next step. But then it shows in the way, you know, you execute things or it shows in your performance because you’re just not happy.

Why don’t we figure out what is everybody’s strengths? They bring their strengths to the table, not just, know, all comers, whatever you pick and whatever is left to pick will go from there, right? So that’s one. Again, family, it’s big. Age is against us, you know, as we get older, it’s the pressure.

clinical pressure, the fact that we want to advance and it gets harder and harder. And really there is a lot of networking to be done. And if you have, as you go into the subspecialty ladder, like as a maternal care medicine specialist or any subspecialties, there is a stark discrepancy between women versus men.

percentages when it comes there. So for instance, if you have, you in a department, have, you know, 10 MFMs, let’s say, right in a large department and only three are women. Well, and the director is a male physician or male director, then it’s going to be that drive towards the gender. you know, everybody has his strengths, but I think that

We need to lead equally. And yes, nobody was born to be a director or an executive. So I believe in a succession program. Every director, every CEO, every chairman, they should have a succession program or a succession plan. Hey, got in the next three years, these are the people who I have, you know,

Dr. Luissa K (28:00.015)
identified as they have an interest and I think they would be good, you know, to take my place. And I would do with this particular team, I would just give them different opportunities and they will, they will declare themselves. The one that will actually be the best chosen is the one that’s going to show in more than one area. But those things are not, you know, and nothing is thought that way.

It’s like we’re just such a reactive kind of organization when it comes to like when it comes to healthcare, right? We wait until the medical director or the leadership kind of falls apart and then we’re looking for another. what really is the most interesting thing is that they do a nationwide search and

Sometimes it’s good, right? Because you may not have a local candidate. But let me tell you, if there are local candidates, I think that as long as they are, you know, worthy when it comes to the way they deliver as a physician and as a leader, them the right of way. And what happens is they know the system. They know their environment. They know already how to operate. They’re not like a

You like you took a strange duck and you put them in the strange pond. And like they need to learn how, how, you know, what the bathrooms are for us, nevermind what the system is. So, and because I’ve been there, I’ve been there and I know when we moved to San Antonio, I came in as a, as a, just a physician. You know, I had no interest to pick back up a directorship position. And, 10 days after I came, they,

They motivated the director and they asked me to take over. 10 days. And this is a large practice. This is a 52 employee practice. It’s just, and you know, had four hospitals, four clinic, five hospitals, four clinics. And San Antonio is big. It’s 1.2, 1.3 million people. And I was like, for the first six months, let me tell you, I was like, what’s that?

Dr. Luissa K (30:21.663)
Which is what is who and what I mean, it just you have to really, you know, be able to know what what’s your groundwork like. So I think that that’s important to remember secession, you know, plan and also how do you prioritize your candidates. And for women, really, we we have this imposter syndrome as we spoke before I started and we started our talk. It’s like, well, what about if I make a phone myself?

Well, nobody was born knowing everything, so we just have to remember that. Hey, you know what? Next time I learn it, I’ll do it better.

Stacey Doyle (30:59.796)
great advice and great insights of really a new approach of really building out that succession plan as you were talking about. And I wanna have you have time to tell all of our audience members what really, I know you published the book, Push Them Breathe. It’s obviously a personal book for you. Tell us what inspired you to share your story now.

Dr. Luissa K (31:30.65)
So this book, I started writing it about two months after I came to the United States, handwritten in Romanian and didn’t speak any English when I came to America. And then after about three, four pages, I think I wrote, I think about it was half a chapter. I said, you know what, I’m just gonna not write anymore. So I closed.

closed the notebook, I put it aside and it stayed like that until about 2015. And then it started to kind of circle my mind. It was like, you know what, maybe it’s time. What about if I do that? And the reason that I think it took so long is one, because I had a lot of trials and tribulations to get what I had to get and fulfill my dream.

that was, and then family and children. And I was a single parent at the time. It was just too much. So now that I’m starting to kind of settle on a lot of other aspects, said, you know, I think it’s time. And I hired a book coach to help me, you know, stay on track and work on this. I really wanted to put it on paper what I have, I went through, but not only that.

because that is very personal. And like everyone that’s ridden with trauma, are afraid that people are going to think of us less. We are ashamed that this happened to us and how could I have not seen it coming, right? So that idea, and we think that we are just…

alone. Bad things only happen to us and nobody else is going to either have interest to read about it or believe in that. But then I said, you know what, if there is this need to be written, if nothing else, because there are people out there, even if it’s one in a million, that will be able to read this book, take from it my message that we are all meant

Dr. Luissa K (33:49.667)
the thriving life, that we have to deal with our trials and tribulations and we have to overcome them. Because really we have so many possibilities. We are so unique. We are so gifted and we need to take those possibilities and make them into certainties. Because it’s our world and if we don’t do that, we’re just going to survive, Stacey.

But we are not meant to survive. We’re meant to thrive, right? I mean, it’s no fun to just be like, okay, I’m just dragging along for the next 50 years versus, know what? I’ve done what I put my mind, whatever that is, and just accomplish it. Just be proud. And if it’s more victories, it’s a victory.

Stacey Doyle (34:40.446)
Well, that is such a great conclusion. I love your story. It’s so inspirational. And I hope everybody that’s listening has learned a lot and goes and gets the book, Push Then Breathe. So I want to give you an opportunity to let everyone know how they can get the book and how they can get a hold of you and obviously telehealth, excuse me, telemed MFM. So they might want to have a consultant and have you as their future doctor and clinician.

Dr. Luissa K (35:08.301)
Yes. So my practice, you can find my website on telemed, T-E-L-E-M-E-D, M-F-M, Mike, foxtrothmike at gmail.com as my email and as a website telemedmfm.com. My platform and my book and now my foundation, just actually finished.

filing and getting approved for my nonprofit. All this information can be found on my other website, is drluisa.com. So drluisak.com. And I can be reached through the contact form there. My website, my literary website and platform also has my opportunity for you to purchase the signed.

or autographed memoir of mine. that is, I think it’s really to me, it’s really cool to be able to offer my readers to be able to have a signed copy. But also you can find the memoir on Spotify, on Apple, in Amazon, Barnes and Noble’s and so forth. Yeah.

Stacey Doyle (36:30.44)
Thank you so much, Dr. Kiprono. It really was a pleasure having you on today.

Dr. Luissa K (36:35.353)
Thank you, ma’am, any time.

Stacey Doyle (36:37.288)
Thank you so much. Hold on one second.