Clinical Engineering for the Next Generation
Apr 21, 2022
Danielle McGearyv
Thu, 4/21 11:29AM • 32:38
SUMMARY KEYWORDS
htm, field, people, apprenticeship, danielle, biomedical, presentation, employers, biomed, certifications, event, apprentices, san antonio, healthcare, career changers, absolutely, career, year, industry, students
SPEAKERS
Chyrill Sandrini, Danielle McGeary
Chyrill Sandrini 00:15
Hello everyone and welcome to HTM Insider. I’m Chyrill, MultiMedical systems, the director of surgical services and biomedical solutions. And I’m happy to be the host today because I’m a very special guest, my friend Danielle with AAMI. So Danielle, can you introduce yourself to our viewers and our listeners?
Danielle McGeary 00:35
Yes. Hi. And thank you so much for having me today. I’m super excited to be on with you. And my name is Danielle McGeary. I’m the Vice President of healthcare technology management from AAMI. And prior to working for AAMI, I did do 10 years in the field as a BMET and clinical engineer so so I have worked in the field before as well.
Chyrill Sandrini 00:55
I can remember the first time we met in person, we’ve been following each other on LinkedIn for a long time. And it was at FBS, Florida biomedical society in December. And I guess you had got up at a table and I thought everyone left this table and I sat down, and then you sat down because I was at your table. And we looked at each other. And also, we had that moment of, hey, I know you.
Danielle McGeary 01:19
Yes, I remember that. I remember that moment, specifically. And it was finally great to finally meet you. Because you know, I’ve been following you on LinkedIn for a long time, you’ve been a huge supporter of AAMI. And you know, I always love connecting with other women in the field as well. So it was phenomenal to finally meet you. And you’ve done great work throughout the field with all your education and speaking engagements. So it’s just so nice to actually, you know, connect and know each other now.
Chyrill Sandrini 01:44
I agree. I feel like we’ve fast became friends. And it’s a connection, I really treasure my friends. So need to it’s mutual.
Chyrill Sandrini 01:52
Thank you. So I want to talk about today with you, because you’ve been in the industry, you’ve been turning a wrench. So what’s going on with the attrition rate? Why are we losing so many vomits? And what does that look like from your standpoint? And AAMI standpoint? Yeah,
Danielle McGeary 02:09
I mean, it’s a huge concern in the industry. And I think we’ve all felt it even before taking this position at AAMI, I’m Boston based. And I always had trouble, you know, recruiting, whether it’s at the VA, I did a stint at Aramark, I was at Hartford Hospital before that, it just always seemed that people were retiring, it’s hard to get people to relocate to New England because of the cost of living. So you know, and when I was asked to take this role, part of my job deliverables was to help elevate the profession, but to also help combat the pipeline issues that we’re seeing. And I felt that to my core, because it just living it for so long knowing it’s such a problem. So last year, and 2021, he actually did a demographic survey, to really we knew there was a problem, right? But we needed to be able to, you know, normalize it in the sense that we had data to back up our claim. So we had about 7000 participants in the survey. So this data just covers the 7000 people that we that answered the survey, but 55% of the workforce is over the age of 55, which is huge, you know, that means that we’re going to see a mass exodus of retirees in the next 10 to 15 years. And then you compound that with people not knowing that we’re a profession. You know, kids grow up seeing doctors and nurses and dentists and teachers, you know, things that they see and interact with in their lives. But as clinical engineers, and be mats, you know, we work behind the scenes and health care, and most people take for granted, everything that we do all day long, no one thinks about, you know, where did this physiological monitor come from? You know, you know, why is the network drop? You know, behind it, you know, how did he get there who planned that? You know, what happens when this doesn’t work? No one wants to think of the negative side of healthcare when things don’t go as they should. And
Chyrill Sandrini 04:07
everyone likes to blame when something doesn’t go. Exactly. I
04:11
know, we hear it when it doesn’t, but you know, so you people just take for granted all that goes on behind the scenes in healthcare. So, you know, unless you really know someone that’s in this field, it’s hard to really hear about it. And I think that is really apparent when we look at the beam at an htm specific academic programs in the country, the two year biomedical technology degrees. There is less than 80 left in the country right now. And in the past year alone, another nine have closed due to lack of enrollment. And it’s an issue because we’re seeing more people leaving than coming in. And how do we solve that problem? And AAMI’s done a lot of work to try to help that but, you know, if we go back to that demographic survey As well, we also we want to touch upon diversity, the field is not diverse. Only 9% of the field is female, which I was shocked by that I thought it would have, I knew it wasn’t as high as the male population. But I didn’t think there was that much of a disparity in only 8%, identified as Latin X, and only 7% identified as African American or black. So those statistics are not very good. And I think there’s definitely room for improvement there. And I think, beyond just getting spreading awareness about the field, I think we need to also focus on those demographic areas to get those populations or into the field because it is such, I mean, I couldn’t imagine doing anything else. I love it so much. I think it’s so rewarding. And, and you know, it just really getting that out there.
Chyrill Sandrini 05:59
I agree. Danielle, you know, my youngest daughter recently became a bee met? Yes, yes, she got a paid apprenticeship at banner. And she’s loving it. She’s the only female in the entire shop. But she’s loving it. And I appreciate that you’re such a positive role model for her to follow. I mean, there’s not a lot of females, but females excel in this industry. And they really do they get it.
Danielle McGeary 06:25
Absolutely. And, you know, it was interesting, since you mentioned that 9% of the whole field of that demographic that we surveyed were female, but of the managers, which is a smaller subset, 8% were female. So it was almost equal. So it’s showing that the women who are in the field are moving up into management positions. So there’s a great trajectory, not just for females, but for everyone. But, you know, it’s showing that women are succeeding, the ones that are in the field, and I feel your daughter, for the six years I was at Hartford Hospital, I was the only girl in the shop, you know, but that was all I knew. And everyone I have to say was so kind. I was I started there, as a student, everyone took the time to train me and I wouldn’t be where I am without any of them. So, you know, it’s I’m definitely in hope, I’m sure your daughter seeing the same because the one thing that I’ve seen with the field is how welcoming everyone is and how they want to share their knowledge, and just really make you the best that that you can be.
Chyrill Sandrini 07:21
Yes, I agree. They’re inviting her on golf outings and all other type of fun things to do. They really have wrapped their arms around her. And she’s really excelling because of the the welcoming atmosphere.
Danielle McGeary 07:32
Absolutely. I have to learn to golf because of this. It’s a male dominated environment. So yeah, that’s awesome. So just stay on that
Chyrill Sandrini 07:40
track of education. Right. I know, you know, a lot of the colleges, we had Monty Gonzalez as a guest what what are the, so somebody can Google that they can find a podcast on it now. But I think something that AAMI’s created, and that I’ve used is HTM in a box. Yes. So how can we get more biomed that have kids are in high school and there’s always career days and, you know, come have your parents come to work day, right? How can we use htm in a box? What is it? And how can we get that the word out to more young people Junior High in high school? Yeah, absolutely.
08:17
So, uh, thanks. First and foremost, thanks for using it yourself. I always love when I see pictures of people out presenting it. But for those of you who aren’t familiar with htm in a box, it is a premade presentation by AAMI and the Technology Management Council at AAMI that basically goes over what the HTM field it dives into the two occupations the clinical engineer inBMET, and then the manager and it walks through a day in the life that explains why you’d want to be a BMET. You know what, what HTM professionals do every day on the job. And it’s made in Prezi. So it’s online based so you can do it anywhere where you have an internet connection. And it’s basically like a PowerPoint on steroids. If I had to describe it, and the presentation, it has three presentations embedded with within it, one for young students elementary age, one for middle school and high school students, and a third for adults in college students. So basically what we say in all three presentations is the same but how we deliver that message is different. The elementary school presentation if you haven’t seen it is really useful. It really talks about us as machine doctors how in the dark when the machines get sick, we fix them and nurse them back to health. It relates it back to things that children like, you know, careers that children would understand. So we pull in that doctor and that nurse scenario to understand when people take care of the equipment to and then as you go on, you know for the adults presentation, you know, it talks about salaries, compensation and benefits. It’s certifications. So it really touches upon everything. And the reason why we did this is we know that, you know, htm professionals are so busy, you know, finding time to give a presentation is one thing, but having to sit down and spend hours creating a PowerPoint, or a beautiful presentation takes a lot of time. And we found that a lot of people shy away from doing career days because of that onerous amount of work. So we created it all for you. So you don’t have to do anything. And it’s a standard and clear message across the field. So if you go to ww.me.org, forward slash htm, in a box, it is there it is free, you don’t have to be a member to use it, it is gratis to everyone. And there’s also career brochures on that site that you can print and handout. Amy’s also happy to mail you career brochures gratis. There’s an elementary school one that talks about the machine doctors and then there’s an adult more adult oriented one, there’s also, you know, talking points if you don’t feel as comfortable this going and giving the doing it on the fly. And there’s also tips and scripts, for contacting schools, you know, not everyone feels comfortable, you know, cold calling a school or a boy scout or Girl Scout troop and ask them to give a presentation. So this really scripts it out for you. And we also have an email template if you feel more comfortable emailing. So we’ve basically done all the work for you. It’s all there for free. So what we ask of you is to really get out there and I know, you know, with the pandemic, with schools going virtual, we released this right before the pandemic started. So obviously, it didn’t reach as far as we wanted it to. But, you know, I’ve been doing it virtually I know that the Illinois biomed society, they’ve been doing virtual presentations to their local high school, so you definitely can do it. And like I always say, you know, I’m one person, I can’t get to every high school in the country. But with all of you out there, you can really help make a difference. And through that we can reach more and more people. I agree
Chyrill Sandrini 12:11
100%, Danielle, and what you can use it for, and I’ve done this several times myself is there’s people out there, and especially in the adult sector that need to pivot right? And there may they need to make have a different option. They don’t know what to do and where to go. And you could just give them that right. Or they can even look at it at their own leisure don’t feel like bombarded like it’s a sales pitch or something on them. But they can digest it. And I’ve shared it with parents to show their kids that they don’t know where to go for school. Right? Yeah, they don’t want to go to college, don’t know what they’re gonna do. They love computers, but not what to do with computers. I like fixing things. I hear that and I’m like, I got a career for you. Absolutely. It’s
12:53
great for career changers, anyone with a technical aptitude, a little bit of IT knowledge in the HTM in a box touches upon that. And in the adult presentation, there’s even a section for career changers. We’ve actually Amy’s done a lot of work on with the HSGA, which is the high school guidance counselors Association. And I’ve presented htm in a box to lots of guidance counselors all across the country. And we’re also working with the African bridge network in New England. They’re a network for African immigrants that come over to the United States. And they’re not quite sure what they want to do. And many of them come over with engineering degrees. And so we’ll be presenting to them later in February about a career in htm, and their options out there as well. And we’ve also worked with a group called HOSA, which is the Health Occupation Students Association for future health professionals. So it’s very broad, and we’ve done a lot of work with them as well. And I highly recommend you finding your local HOSA Association, there’s chapters in every state in the country. And every the people the students who join are all interested in a career in health care. So what better like group to, you know, target because they know they want to go into health care, you know, maybe they don’t get into nursing school, or maybe they decide like me that I wanted to be in healthcare, but didn’t want hands on patient care, but you’re not really sure what else your options are. So you know what, it’s definitely great to capitalize off of that. There’s lots of high schools that have hosts a chapter some of you may be HOSA alum in every state has a chapter as well. So definitely find them in try to reach out to them as well.
Chyrill Sandrini 14:34
And if you have more information, I know Danielle is very accessible. Yeah. And when we when we post this, we’ll add your contact information on there. If people don’t know, no, like, what should I do? Or how should I do it? I know you’re there to help.
14:47
Absolutely. We’re always happy to help if you have a huge event. I’ve flown out for stuff to you know, obviously we won’t fly out for like a presentation for 10 people but if you’re at we’ve supported the military in San Antonio, they I’ve done a huge Girl Scout day where there’s 1000s of Girl Scouts there in Texas. We always come and have a presence. We work with them. So, you know, for events like that we also the Health Care Association of the Midwest. They recently did the MD Expo in Kansas City. And they reached out to me and said, you know, we want to get high school students there will you come and, you know, me and Tim quartz presented to them. So it was really exciting to have those high school students there as well. So in also, in San Antonio, will be our AAMI Exchange, which is our national conference this year, we’re looking to do a big high school event there with all the local students in San Antonio. And plus, with a lot of, to your BMET programs down there definitely seems like something worthwhile to do.
Chyrill Sandrini 15:48
100%. And let’s since you brought AAMI up in San Antonio, which I’m so excited about. I’m just just excited. I’m excited to do AAMI again, this will be the first one in a couple years, right? Yes, yes. And to be in San Antonio on the riverwalk What better location, but get to connect with everyone again, it’s such an amazing conference. It’s tell the viewers and listeners, why should I go to AAMI? Do I have to be a biomed? What’s going on?
16:22
AAMI? Yeah, so having seen it from both sides, being in the field, and now working for AAMI. You know, AAMI is just a event that brings everyone together. Everyone in the HTM field and some sterilization folks from all over the country, it’s a great way to network, it’s a great way to educate yourself, see what the latest trends are. See what people your peers are doing in the field, we talk about best practices. There’s all different tracks this year and cybersecurity, Internet of Things, emergency management. And you know, we are just so so excited to be back in person. You know, it’s been two years since we’ve done a live event. And it’ll just be so nice to see everyone again, including yourself, I just think you know, the getting everyone together is just so fabulous. And it’s and if you’re new to the field, it’s a great way to meet people and network and learn. And we do a lot of other events there as well. We’ve done the alligator tank where you can come pitch to our our our gators. Let’s see we have an intern in AI showroom floor, we have a vendor floor. People like MMS are all there, you can come meet the vendors that you work with, check out the newest products. And it’s also a great way for those of you who are certified to get CEUs. If you come, you basically have all the CEUs, you need to maintain your certification for the next renewal window. So it’s a great way to do that. For those of you who are on our committees, we always get our committees together while we’re there, because it’s not often we all get to get together in person. So we’re just so so excited. A lot of people have been asking if it will happen. The answer is yes, we will be there even if like 10 people show up, we will be there. So I’ll be there. So perfect. So we are moving forward. I’ve never been to Texas, so I’m super excited to to be there. And yeah, and just think in, you know, again, thank you to all of our vendors and sponsors as well. We couldn’t do it without all of you. And and our volunteers
Chyrill Sandrini 18:33
is a great conference, you know, what would a person do? If they don’t know about AAMI? How would they find information on the conference? How do they register? area hotels? And you know, can you break that down for our listeners?
Danielle McGeary 18:47
Sure. So if you go to AAMI.org, forward slash events, everything you need to know is there. All of our speakers have been lined up, we’re just working. I think we’ll announce the whole schedule shortly. But there’s multiple hotels associated with the event. And all that information is on our website. You do not need to be a member to come the cost is a little more expensive if you’re not but you can come regardless if you’re a vendor we are always looking for. We still have tables available if you’d like to, you know have a table on our floor. Let’s see. And, and yeah, you can really find everything on our site.
Chyrill Sandrini 19:28
If the site is great, it’s very easy to book and to schedule. I did it myself got my room already secured. Advise the entire team get your rooms booked now. You know the hotels will get busy. So when is AAMI when is when are we going to be in San Antonio? Yeah, it’s
Danielle McGeary 19:44
June 3 through the sixth. I’m sorry. I didn’t see that. Yes, no, it’s the first weekend in June so it’s Friday through Monday. So it’s it’s basically Saturday, Sunday Monday. You’ll see vendor floors will be tons of presentations. We also Amy does As a thank you event, I believe on Saturday night. So that’s always fun, definitely come on out and meet us, we will be there. And yeah, there’s just I just, you know, it’s just such a fun event, I really can’t like stress that enough and lots of great education, lots of leaders in the field will be there. And we’ll be doing roundtables this year, as well with some open discussions, and educational events.
Chyrill Sandrini 20:26
Yeah, I’m looking forward to some of those. They’re always very interesting, when you get the great minds together, that AAMI draws in one room, and to hear their perspective, their ideas that a lot of our solution drivers that’s what biomed are finding a solution to any problem, right?
Danielle McGeary 20:42
I couldn’t have said it better myself. And that’s great. You know, because I do like to say, you know, everything we do at AAMI comes from the field, whether it’s suggestions, ideas, volunteers to execute our, our projects, like I can’t stress enough that we can’t do what we do at AAMI. Without all of you, I am the HTM department at AAMI. I know people think we’re probably huge. But, you know, I really rely on our healthcare technology leadership committee and Technology Management Council and lots of other volunteers. The local htm associations we work closely with, they help us as well. So we just can’t do what we do without all of you. And like I say, the BMET apprenticeship, which I’m sure we’ll talk about in a little bit, came from the alligator team. Well, we called it the shark tank back then. But we had to rebrand for plagiarism reasons. But yes, so. But a lady named Maggie Berkey, who is a beam out in the field and a Technology Management Council Member pitched this idea as a way to combat the pipeline issue with schools closing, and not having as many people coming in as coming out. This gives another avenue an option for people also realizing that not everyone at every point in their life, or ever has the means to go to college. So she pitched this in, I believe Cleveland back in 2019. And everyone bought into it. And we made it come to life due to help over 100 each gem professionals in the field helped develop and make that curriculum. So you know, everything we do is highly vetted through our industry experts. And again, we can’t thank everyone enough because it’s a great example of someone in the field bringing forward an idea and an army of volunteers helping to execute it.
Chyrill Sandrini 22:31
Yes. And women are present. And you brought the apprenticeship and AAMI has a really unique opportunity to merge. The student the biomed with the employer, right, yes. Talk about it.
Danielle McGeary 22:47
Yeah. So for people who aren’t really aware of what apprenticeship is, it’s similar to any other apprenticeship you would see in the country, whether it’s, you know, electricians or winemakers, basically, it and if you will be at the MD Expo in Atlanta, I will be talking all about it and breaking it down for an hour because there’s a lot to it. All the pieces are too awesome. That’ll it’s phenomenal to seeing you everywhere. Yeah, so it’s a great way to combined hands on work experience through competency based learning, and supplemental education. So basically, the minimum requirements for anyone to do this is a GED or high school diploma. The program is made for people for less than two years experience in the field, it was created that you could take anyone basically off the street and make them a beam at one. So we do realize that if you want a trajectory in the field, you do probably need to go back and get a degree at some point. But this is a great entry level point for people into the field. So basically how it works is employers partner with me because we are the sponsor of the apprenticeship. It is a National Apprenticeship. So what that means is we’ve gone through all the paperwork with the Department of Labor. If you want to do this, you don’t need to register with your state, you register with us. I work with the Department of Labor, and we’ve climbed and scale that mountain of paperwork for you and make it easy it is it’s so easy to do it and it opens you up to grant funding as well that you may not have had available and basically it’s a way to train brand new BMETs with no experience or career changers. Maybe they have a little bit of experience from maybe their photocopy, repair it in the past and really train them to a minimum knowledge competency and standard consistently. In at the end when they’re done after the two years. AAMI signs off on them so they get a joint certificate from the Department of Labor and AAMI saying they’ve met all of our minimum requirements. So the biggest challenge We’ve had is we don’t have enough employers. We have over 300 people that have reached out that want to do this to become apprentices. But right now we have 13 employers, and we don’t have enough places to police them all so, but what we’re seeing is there are people interested in the field, we’re creating a pipeline. So if you’re interested in doing this, please reach out to me. At htm@AAMI.org, we can easily get you signed up and ready to go, there is no cost to partner with us. The only cost is you have to pay the employee 40 hours a week, you don’t have to pay for benefits. If you don’t want to, you can hire them as temps, if that makes it easier. And the only other cost is 144 hours of supplemental instruction each year. So all of that has to be cost free to the apprentice. And you can follow your own reimbursement policy. So for instance, there’s two college courses required one in college math in college anatomy and physiology. So you could require them to pay up front and enroll. And if they pass you reimburse them. But once they get the credential, they can’t have any like debt or money out of their pocket. And in the apprenticeship also includes three certifications that they have to do this, the CAPT, which is our newest certifications through AAMI, the IT fundamentals certification through comp, Tia. And finally, the big hurrah at the end is they take and pass the CBT exam, because we want to set them up for success. Part of apprenticeship is you’re required to gain industry recognized credentials as you’re doing it. So those are the credentials and they’re all employer paid. So please reach out, you know, we can fight the pipe between htm in a box, promoting the field, and utilizing the apprenticeship. You know, we can combat the workforce deficit together.
Chyrill Sandrini 26:56
Yeah, you know, turn it around, there has to be something that project you need to go back to make it the river flow, right?
Danielle McGeary 27:02
Absolutely. And I do want to say too, is we do really support the HTM educators as well, all of the educators for the two year biomedical technology programs, we meet quarterly with them, and we’re really trying to help them also promote the field get more students, I’m hoping that the beam out apprenticeship will also be a catalyst for them. Because since it requires two courses, you know, hospitals could partner with those programs pay for those apprentices to take those two courses. And hopefully, they’ll make a relationship and maybe those apprenticeships will apprentices will go back and get a degree after. Yeah, you know, that’s the goal is to create pipelines and get people excited about the field and have them further their education.
Chyrill Sandrini 27:46
I hear the grant process on the other end is pretty easy. It’s not as difficult for the employers to go through that grant process. Because there is a need. I think it’s recognized. And now a couple people have done it. I think that that that’s something that employers need to know more about. So I know that you’re available if they want to ask more questions. Absolutely. Yep.
Danielle McGeary 28:08
And the grant funding does come from states. So that’s why it’s confusing you register nationally. Once you register, we give you your information, your registration number, and then you go to your local workforce development office, and they will help you with grants. And there’s also specific grants for veterans too. So if you hire veterans into the program, you can get funding that way. Nevolo has also stepped up and offered to sponsor the three certifications for the first seven in house HTM departments that partner with us. Wow. Yeah, so if you’re in we, they just realized that some of the in house departments may have trouble funding all of this. So they’re gonna sponsor up to two apprentices at those hospitals that partner so appreciate Niccolo and there’s lots of free education too, if you don’t have a huge budget fluke, biomedical has stepped up and offered their advantage training for apprentices. And I know you mentioned Monty at the College of Biomedical Equipment Technology in Texas. For those two required courses, he’s allowing apprentices to enroll in his in those two classes, even if they’re not a full time student, and he’s offering them 20% off to any of any partner hospitals. So there’s a lot of people that have come forward that can’t you know, physically take an apprentice because they don’t have they don’t employ the nets directly, but that want to help and trying to find ways to make it as less cost burdensome to hospitals, as you know, as possible in it is pretty flexible. You know, we’ve left it pretty scalable and open, like, between the two years you need 70 hours of industry related training, and that’s very vague. So I mean, you could send them to a service school if you’re building your physiological monitoring Tech of the future or an anesthesia school, which obviously is costly. But there’s also lots of free training like through webinars, Fluke biomedical offered some a local htm Association event, a lot of times those are free and no cost. So you depending on your budget, you can scale. I really think anyone can do it. It’s just a matter of talking through the options to make it become a reality. And we’re here to help. I can’t stress that enough. Well, I’ve
Chyrill Sandrini 30:25
enjoyed our time today, I miss you, friend, and seeing you face to face. I’m looking forward to Atlanta and San Antonio. Yes, yes, I can’t wait. So we end every segment of htm insider with a wow word. What is your word of wisdom? Do you have any thing you could share with the group? Daniel
Danielle McGeary 30:44
doesn’t have to be one word.
Chyrill Sandrini 30:46
It doesn’t have to be well, okay,
Danielle McGeary 30:46
wasn’t sure if I was like, sum it up in one. You know, I would just say empathy and passion, I think if the pandemic has showed us anything is that you know, htm professionals are there at a moment’s notice. And we want to do the right thing. And, you know, and I just, I really just want to thank everyone that’s doing all this out on the in the field every day. I know, it’s been a tough few years. But we are here to support you. And you know, and just know that your hard work, your determination, your passion for your patient, patients and in ethics, you know, it just doesn’t go unnoticed. So thank you for all you’re doing out there. And thank you to mms for having me and AAMI on your show. You know, this is so exciting. I’m so happy to be here and very appreciative.
Chyrill Sandrini 31:33
Oh, it’s our pleasure to have you on. I mean, you’re just a bright light in the industry. And I love that empathy and passion. And when you get to know the HTM industry, you know, it’s filled with people with both of those qualities fueled by passion. Wisdom. That’s awesome. It’s so awesome that you share that with us today, Danielle, and thank you again for coming on. Hey, listeners and followers, make sure you follow htm insider on your favorite podcast location, whether it be Spotify, iTunes, and if you have any questions you know, message Danielle arrive Find us on LinkedIn. And we’ll share our contact information. We’re here to help with anything that you want answered. If you have any ideas, send them my way. And maybe you were your idea might be the next segment of htm Insider. So thanks again Danielle.
Danielle McGeary 32:22
Thank you bye
32:23