Bob, how about from you? What's that evolution looked like for you?

So when I got in palliative care through HIV because I was an HIV doctor, when we started our consult service, it was basically me and one other person.

And we saw everybody.

We intentionally saw patients with chronic pain because the health system sucked and no one else would do it.

And if they called us, we would see them.

I think the difference has been, because I don't mind seeing them, I'm a general internist at heart, and so it all felt okay to me.

I think as we became a field with people who came from a fellowship that was a one-year fellowship that had a very specific training about a very specific groups of patients, I think they were quite dysphoric because I was willing to see everybody and we were training our other people who asked for consults to ask them to see patients that weren't the patients they were trained on, that didn't have the skills that they needed to do a good job.

We're just not organized to do it.