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Episode 6 afterward: The healthcare staffing crisis is more than a little troubling — So what can we do about it?

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May 12, 2022

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Episode 6 afterward: The healthcare staffing crisis is more than a little troubling — So what can we do about it?

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Justin, Todd and Brittany break down last week’s conversation with Tim Bosse from System One and expand on some key questions: Are outdated medical licensing models contributing to staffing gaps? How can provider organizations create new pathways into clinical care? And what role does consumer behavior have on the burdens facing health systems? They also talk about the relationship between frontline workers’ and leaders’ resignation rates, how staffing agencies can find ideal matches for their clients and why there’s never been a better time to hug your doctor.

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Episode transcript

Justin Steinman:
Definitively Speaking is a Definitive Healthcare Podcast series recorded and produced in Framingham, Massachusetts. To learn more about Healthcare Commercial Intelligence, please visit us at definitivehc.com.

Justin Steinman:
Hello? And welcome to the latest episode of Definitively Speaking, the podcast where we have data driven conversations on the current state of healthcare. I'm Justin Steinman, Chief Marketing Officer at Definitive Healthcare and your host for this podcast. I'm joined today by my friends and colleagues, Brittany and Todd for an afterwards discussion about our last episode, where Todd and I spoke with Tim Bosse Senior Vice President of Talent Solutions at System One. Todd, Brittany, great to see you both again. I love that we're now recording back in person at the lovely Definitive Healthcare headquarters here in Framingham, Massachusetts.

Todd Bellemare:
Absolutely. Very fascinating.

Brittany Morin-Mezzadri:
It's so nice to see your faces.

Justin Steinman:
It is. It's great to see you guys. So let me give you a second to reorient our listeners here. So last episode, we talked to Tim and Tim works at System One, the 25th largest staffing company in the United States and they really focus on recruiting specialized workforces, particularly healthcare is one and Tim's actually the leader of the healthcare practice at System One and he recruits people for roles from nurse leadership to clinical and scientific leadership to physician department leadership.

Justin Steinman:
And Todd, Tim, and I covered a lot of ground on that episode. We talked about the impact of the great resignation, we talked about the growing feeling of burnout in our healthcare workers and we talked interesting for quite a bit time around what healthcare senior executives like the system run managers need to do to retain their workforce. So Todd, get us started what jumped out to you most about that conversation?

Todd Bellemare:
So I think the first thing that jumped out to me was he's a Raven's fan and why are we giving more airtime to a....

Justin Steinman:
I have no idea.

Todd Bellemare:
I'm kidding. So one of the things that he had said, you had asked about the rate of the resignations from the people that are on the frontlines and the management and leadership, and was it seeing them in the same rate and flat out he had no hesitation, he said, "Yes, we are seeing them at the same rate." And that I think when we see or hear about the resignations across the healthcare industry, that we think nurses and physicians and the folks that are dealing with the waves of patients coming in, we don't really think about it from the management and leadership perspective, but to hear that it's like, "Oh, well, yeah, that makes total sense." Because when you think about like, he talked a little bit about the obligation they feel, and even, I think it's probably a little bit of the guilt they feel about the stressors that are happening. And so that stood out to me 100% because I had not really been thinking about it from a management perspective.

Justin Steinman:
Yeah, me too. I had that same thing as I was going through and listening to the Podcast last night to prep for a conversation today, I had forgotten almost about that, he brought that up and it was so interesting and it really is the management leaving is like, "Oh my," so not only we're losing the frontline, we're losing the senior managers and there are other people who are going to have to replace the frontline. I actually felt pretty bad on listening to that Podcast, pretty worried actually.

Todd Bellemare:
Right. So in addition, the thing with the management leaving to me a big part of our discussion was around what are the new normals that we're dealing with, and that is a lot to do with process and procedure for how to manage a department when crises happen. And if you're going to lose the leaders who have learned a ton from those crises, what are you going to do now? Now you're maybe turning to people who don't have as much experience. And again, that rocked my view of it for the moment and I keep on thinking about it, I'm like, "Oh," and you said it makes you nervous, we could talk about that as we go, but yeah, I felt a little nervous after that for sure.

Brittany Morin-Mezzadri:
Yeah, that was definitely surprising because all of the research that I had done and also engaging with our clients has always been about the frontline contributors and our healthcare professionals. So hearing about the movement and resignation of the executives was alarming for sure.

Justin Steinman:
Yeah, he used the word exhaustion multiple times. And if you think about it, we're all coming out of COVID and I think everybody's exhausted by COVID on some level one way or the other. And I don't want to go into the whole COVID path, but I think that this exhaustion level has really impacted the whole healthcare system, and we're heading towards a time as we've talked about with some of our other guests, what we are going to have an increase in demand and a decrease in supply, we're talking millions of shortages of people here in healthcare and it starts to really worry about the people left behind who are going to get stressed out and even more exhausted.

Brittany Morin-Mezzadri:
I think about the frontline workers who COVID aside, just the 55 plus population, who's going to be retiring the next 10 years and all of those providers who are going to be leaving the system or all of those executives who are going to be leaving the system, and there's not a ton of people coming in to replace them in either role.

Todd Bellemare:
Not only that, when you think about the cycle of moving up the chain at a hospital for example, you're going to have some maybe internal medicine folks that might say, well again, I'd like to be an executive now and so as you lose those 55 plus and they start to retire, they're actually maybe more likely to retire earlier now. And again, we already have a shortage from the, if you think of it as like a cycle of going from starting out as a hospitalist then moving into a certain practice and then moving up the chain, if that cycle's not being replaced at the beginning, then your foundation of people is lacking. And so as the top rung moves out, the middle rung moves in the top rung, again, we're not back filling fast enough.

Brittany Morin-Mezzadri:
And one thing that I thought was interesting is you guys had mentioned that when he had brought up, when you ask frontline workers what motivates them, usually it's not the money that's going to be motivating them to stay in the position or why they got into medicine, but I couldn't help but thinking that might be what's preventing them from getting into medicine in the first place. So we don't have a large number of graduates coming out of med school or people being able to pursue med school just because it's so expensive.

Todd Bellemare:
It's expensive. And I was thinking about this and you feel part of the analogy, but it actually works. There's actually a scotch shortage right now too in the country, and you can't just create more scotch, it's got to age for 15 years.

Justin Steinman:
Right.

Todd Bellemare:
We just can't magically snap our fingers and create new doctors, right?

Brittany Morin-Mezzadri:
Right.

Todd Bellemare:
We got to get people who will take organic chemistry in college and then get them to go to med school and then they got to go do their residency and then they got to work their way through, and so we're looking at the shortage and someone like Tim who has to staff people, he doesn't have people to actually staff. And in many regards, he's robbing Peter to pay Paul.

Justin Steinman:
It almost feels at times like there's just not enough people who want to do this job, and you look at all of the things that go into becoming a physician or even an NPE/NPA, whatever it might be, there's the cost to get through college, there's the time spent doing your residency. The time it takes you to actually get to be making money in this role it's [inaudible 00:07:25] day away. Then you start seeing things in the news with people coming into the infectious diseases world with a camera trying to show that something is not the way the media's portraying it, like why would you want to be in that position, and all of these things lead to that.

Justin Steinman:
He had mentioned executives need to try to find any way they can to bear hug those people and keep them, and that only works so well till they finally age out and they want to retire or something. You're never going to get 100% retainment and so therefore what is happening from the bottom up, and he did mention a couple ways of maybe governmental opportunities to try to refill the top of that funnel, not to make it a non-personal thing, but definitely that has to be the way to go for sure.

Brittany Morin-Mezzadri:
One thing that I'm seeing in our conversations with our clients is shift towards NPs and PAs, as opposed to the specialists, it's less time and financially expensive than going to med school for specific specialties. So a lot of our agencies are going towards finding and recruiting and developing NPs and PAs, because they're easier to find and you can still specialize in a particular area, so I'm interested to see how that affects healthcare and the development of, I guess, innovation and different specialties if our workforce is largely coming from NPs and PAs.

Todd Bellemare:
Right. As the old saying, you want to practice at the top of your license. And so I think leveraging NPs and PAs is really critically important because I think that might be one of the shortest ways to getting more folks into the workforce. And it's like the old thing, you only want to go to the major academic hospital in your favorite city, if you're unfortunately in a tier three or a really serious case, if you have a mild illness, don't go to the hospital, go to your local physician's office, so you want to maximize the right level of facility, you want to maximize the right level of physician or provider treating you.

Justin Steinman:
The other thing that I thought was interesting is you talked about this and Todd, you had a lot of perspective on this was the cross licensing and being able to cross state lines like, I work in marketing, I live in Massachusetts, but I could go do marketing in New York City, I could go do marketing in Florida, doesn't really matter to me, and I get that marketing is not medicine and I'm not saving people's lives and stuff like that, I don't have any delusions of grandeur, but what's interesting is we loosened up all of these restrictions around cross licensing in COVID, it worked. We got doctors to where they needed to go and now we're coming out of the pandemic, okay, let's put those restrictive rules back in place, and I'm kind of like why.

Justin Steinman:
He mentioned of course, New York state, how they're working on things like that, and I keep thinking and I've thought of a lot about this after the first Podcast there was state level is not going to work because if you look at even now, when everything has been left up to the states to decide, something even like a Medicaid expansion, the disparities and care across state lines is so huge, you are not going to get the buy-in from every state that someone like New York can do.

Justin Steinman:
Not only from a political will perspective, but from a dollar value perspective, New York's going to put $10 billion into this, how many other states are going to be able to do the same thing? And granted, they're not all going to need to do $10 billion, but it needs to be something on the federal level that allows for again, increased opportunities for students getting in that top of the funnel to go to school, again, cross licensure across states, there has to be a federal mandate that says, "Yes, you can do this, these are the simpler hoops you have to cross as opposed to, Hey, no, this state does it this way and that state does it the other way." It has to just be easier to allow for that movement.

Brittany Morin-Mezzadri:
Let me ask you this, what do you think are the benefits of or did we think were the benefits of these state bound restrictions?

Justin Steinman:
That is a great question. Again, my opinion is there is not a benefit to states being able to make up their own rules on something that is, if somebody has diabetes in Texas versus Idaho, it's the same disease, it's the same treatment pathways, why are we making different rules for a doctor to treat in one state versus the other. Disease doesn't change based on your geography, so-

Brittany Morin-Mezzadri:
And patients aren't bound by state, I can seek care in any state.

Justin Steinman:
Yeah. It's probably and I'll speculate a way out of what I actually know, but hey I'll speculate anyways, because why not. If you look at it's very similar to like law degrees, you only can get licensed in a certain state, and it's almost like, I guess joined the bar in a certain state, you almost could argue it's a relic of a previous time and we were much more geographically centered people, we are less transient and I didn't trust my neighbor over the state border because they're different than I am in. I don't know what those people in Iowa are doing, I'm living in New York city, right? Who knows what they are and the people in Iowa are like, I don't know what this people in New York City, they got no standards.

Justin Steinman:
And so we'll have our own boards for medicine, we'll have our own boards for law and you got to get license or join the bar in our state in order to practice here. And then that might even be a little bit of a financial model because you got to pay to get the license in your state, and so that's money making for the states. But I think we can agree.

Brittany Morin-Mezzadri:
And that's not a good reason.

Justin Steinman:
It's not a good reason. I think this model's probably past this time.

Brittany Morin-Mezzadri:
Interesting.

Todd Bellemare:
No question. And it's almost, you can't have the same model that you do with building codes as for therapeutics or for treating patients, it just makes no sense. It's apples and orange, why are we trying to fit the same model for things that don't fit each other. So Justin, you had mentioned a few times I feel, I have these really alarming stats and I feel like you said it like six times and every time we have these conversations and I read through these things and I re-listen to our conversation, I'm like, yeah, I'm getting pretty alarmed by these things. So it was actually a little bit of a stress inducing re-review of things for sure.

Justin Steinman:
I had the same reaction as well, let's just stress everybody else out again. So one in five physicians, two in five nurses intend to leave their current practice in the next two years. Good Lord. I think, neither side, we've talked a lot about health equity or inequity in these different Podcasts, 60% of the world regions do not have enough healthcare workers to meet the needs of their population. 60% of the world population, good Lord, that's terrifying to me. We are going to have a gap. This was actually one that Tim brought up, I like that Tim brought data to the conversation too, he brought some good data. We're going to have a gap of over 400,000 home health aids. These aren't even people who are NPs, these are people who are going to homes 400,000 there, we're going to have a gap of almost a million nurses.

Justin Steinman:
So yeah, I don't know what to do with all of these stats. I think I'm going to go out and hug my doctor this afternoon and tell him, please don't retire. I think my doctor is probably in his mid 50s, I've been with him for 15 years. For those of who have been following this Podcast, I alluded the fact I hadn't had a physical earlier, I had one recently. I'm good to go.

Brittany Morin-Mezzadri:
Congratulations.

Justin Steinman:
Thank you. I'm not going to die.

Todd Bellemare:
"Practice what you preach."

Justin Steinman:
Practice what I preach. But yeah, I didn't hug him at the last visit, now I'm thinking I probably should hug him and say, thank you, "Keep practicing medicine."

Brittany Morin-Mezzadri:
Listen, our directives to our listeners just get progressively more intimate with your doctors apparently [inaudible 00:14:58] episodes.

Justin Steinman:
Wow. All right. [inaudible 00:15:02] thanks Brittany.

Todd Bellemare:
Yep.

Justin Steinman:
So Brittany, when we were talking earlier, you said to me, "Hey man, staffing's my gig." What did you mean by it?

Brittany Morin-Mezzadri:
Staffing is my bag.

Justin Steinman:
So what is that?

Brittany Morin-Mezzadri:
Yeah, I come from a staffing background. So before definitive healthcare, I was a recruiter and staffing manager at Robert Half and while I didn't staff in the healthcare space, I felt the squeeze of available candidates, I felt the squeeze of employers needing more help than they had access to in the market, and I was recruiting at a time when a lot of folks were gainfully employed and not looking to move around, so I'm grateful for that for them and for the world that we were in at that point. Yeah, recruiting is tough when you're only looking for self-identified candidates and if everyone's resigning, no one wants to be a candidate. So filling these jobs is a challenge.

Todd Bellemare:
For sure. I really liked his idea of a chief talent officer being involved in the healthcare, like for a health system or a hospital or whatever healthcare organization they're working at to create a hybrid approach to do something like this. Because again, even for Definitive Healthcare, for any other organization out there to be able to have a good talent organization, it's different from HR, it is looking for the right people to fill those shoes. And you can't just say, we're going to hire a million recruiters to hire 100 people, none of that makes sense. So if you can leverage some other type of industry standard thing like a recruiting agency, it makes all the difference to ensure that you get that speed to hire down faster, because again, if I'm still alarming at all these stats that one out of five physicians and two out of five nurses thinking to leave in the next two years, good Lord.

Todd Bellemare:
Yeah, we need proactive pieces, the only problem with it is we're already so far behind that if these are all great ideas and it's almost like every health organization has to literally tomorrow go out and make sure you go do this, a great boom for people who are CTOs for sure, but when are we going to see that those steps taking place in more healthcare orgs, taking the plunge in implementing that type of strategy.

Justin Steinman:
Yeah, so we work in a software company, I think all of our listeners know and we have a chief talent officer here and I've spent my whole career working in software, we've always had chief talent officers. And Tim actually mentioned the fact that he said, when we recruit for IT or legal or financial service or engineerings, you hear culture as a word thrown out a lot more than you hear in the Healthcare.

Justin Steinman:
And to some degree you can argue, maybe that's because physicians are a little bit of lone wolfs, I run my own practice, I've got my own cohort of patients and yeah, I'm affiliated with the hospital, but I'm really with the hospital because I need access to their facilities, not because I feel like I'm part of the hospital. And so you're trying to create a chief talent officer, trying to create a culture where the very culture isn't having a culture and that felt very different to me versus we talk all the time about our company culture and how important it is and why we all like to work here and that's retaining. Reason why people stick around here because they like the culture and it wasn't there in Healthcare.

Todd Bellemare:
I think that incentivization for moving to a rural area to work at a rural healthcare clinic or hospital, whatever it might be and culture certainly is an incentive for sure, especially for people who might get burned out in certain large Metro areas and moving to a smaller area for that. I think you mentioned things like the cost of living and real estate and things like that, but the culture piece to be able to go somewhere and not feel like the weight of the world is on your shoulders every single day, that is certainly something that should be played up more, but the idea to take strategies that software companies and other types of companies have used in the past and apply them to the healthcare model, I think it just needs to happen now, like right now. Everybody who might be listening, go out and do that right now.

Brittany Morin-Mezzadri:
Well, let me ask you this, with the numbers looking the way they are, do you think that this is a matter of inefficient culture in talent development or do you think we just don't have enough people?

Justin Steinman:
I think it's we don't have enough people to start with, but then I think about what can we do and that's always what I always come back to because I don't like to be the guy who just moans all the time and complains and this sucks and that suck [inaudible 00:19:36] do anything. Okay, good. But I always think what can we do about that and you guys also know I'm mildly obsessed with this retail model of getting the NPs at CVSs and Walmart and Walgreens and every place else, and I think if we start and we collect people, all of our listeners, plus the three of us in the room here, start going to locations like that, to get some of the care that we might otherwise be going to doctor's offices for or going to hospitals or ERs, everybody balance the burden a little bit, and that might be a way, an action that everybody can take without really changing their lives too much.

Todd Bellemare:
I do think too, like starting to do that, it gives at least the perception among the agencies that will accredit physicians with different specialties and so on, that it has to be an easier way for PAs and NPs to move into an MD role and the easier we can make those pathways, maybe the lesser of the restriction of new doctors in the market and what will become like, "Heck, I say, Brittany, if you do five more medical health claimers reports, you should get your MD." That's how easy it should be.

Brittany Morin-Mezzadri:
It shouldn't be that easy.

Justin Steinman:
It shouldn't be that.

Brittany Morin-Mezzadri:
I assure you it should not be that easy.

Justin Steinman:
I'm going to go with her on that one.

Todd Bellemare:
Right. Hey, I'm trying to come up with ideas and solutions here, Justin.

Justin Steinman:
I love it. I love it, but-

Todd Bellemare:
I am CPR certified.

Justin Steinman:
That's a start.

Todd Bellemare:
[inaudible 00:21:09]

Brittany Morin-Mezzadri:
But you do not want me delivering your medicine.

Todd Bellemare:
[inaudible 00:21:13] delivering it sure, prescribing maybe not.

Brittany Morin-Mezzadri:
Yeah. I'll bring you some Advil. That's fine.

Justin Steinman:
That's good. Yeah. Baby steps. One of the big things and again, the thing that I kept coming back to was the crisis moment that we feel, we're beyond a critical state and people meeting those in the healthcare organization executive branch need to treat it like a crisis. And that means you can't wait for a governmental agency to make a decision, we need to start making even alliances among regional health groups or regional organizations that might have even be competing for talent, there has to be some way to maybe take that New York model and try to nationalize it. And it has to be a groundsel going up, because we mentioned or you had mentioned that the disparities in health for rural areas or through state lines from state line to state line.

Justin Steinman:
So if we were to wait for a governmental agency to say, "Oh yeah, here's what we'll do on a federal level," it's going to be too late. And part of the problem is that most of the people who are in the political class, they're getting their Healthcare, they're not worried about it. Like, "Hey, I see my PCP, what's the big deal," so it has to be from a perspective of the people that are on the frontlines. And I count anybody working at a hospital now as on the frontlines, and those are the people that have to start. And again, they do lobby the government for certain things, but it's more of a "Do now and ask forgiveness later," type situation.

Brittany Morin-Mezzadri:
One thing that I think that clients could do and this is speaking directly to the staffing agencies right now is to create profiles for both your candidates and your companies that you're targeting. Tim had mentioned creating candidate profiles about what drives them, what are their financial, cultural and their academic interests and what motivates them. I would do the same thing for your clients, that way you're making better matches on culture and personality of both your client and your candidate, so that they're more likely to stay around, so that if you can match those rural seeking candidates to rural companies or if you want those hype paced, fast paced, what's the word fast paced?

Todd Bellemare:
Fast paced, called fast-paced, sure.

Brittany Morin-Mezzadri:
Yeah, fast paced environments or high energy academic settings that you're placing the right candidates in the right places. So really evaluating all of your companies and really evaluating all of your candidates that you're making those culture matches.

Justin Steinman:
So, it was like a dating app?

Brittany Morin-Mezzadri:
Yes.

Justin Steinman:
Yeah.

Brittany Morin-Mezzadri:
Yeah.

Justin Steinman:
Side hustle. Always got to have a side hustle?

Brittany Morin-Mezzadri:
Tinder for doctors.

Todd Bellemare:
Oh, I can guarantee that probably already exists. That part needs to be cut probably.

Justin Steinman:
Good. Any parting thoughts and what Tim had to say, "Crisis, do something now, don't wait."

Todd Bellemare:
Yeah.

Brittany Morin-Mezzadri:
Yeah.

Justin Steinman:
And I think own it, right? I think we all have to own it. We can't just point and say, we need more doctors, that's not getting fixed tomorrow.

Todd Bellemare:
Absolutely.

Justin Steinman:
Right? I think we all have to think, what can we do out there to kind of A, take care of yourself as I'll continue to preach to everybody and B, we all need to find the right level of care at the right location. I think that's a key thing that we need to be doing. Don't be afraid to go see the PA at CVS or any of the retail clinics, retail, right? Any retail [inaudible 00:24:32] we are agnostic here.

Todd Bellemare:
100%.

Brittany Morin-Mezzadri:
Any retail location that does not have Brittany as your provider.

Justin Steinman:
Yes, I would agree with that.

Todd Bellemare:
It is key, for sure.

Justin Steinman:
I'm not agnostic on that last point.

Brittany Morin-Mezzadri:
Exactly.

Justin Steinman:
Exactly. Good, good. All right. So that brings us to the end here, this afterwards episode. I want to thank you all for listening to Definitively Speaking, a Definitive Healthcare Podcast. Please join me next week for conversation with Cara McNulty, President of Behavioral Health and Resources for Living at CVS Health. As many of you know, May is mental health awareness month. Cara and I will have a conversation around the importance of mental health and wellbeing and how CVS Health is making mental health as easy to get as treatment for a sprained ankle. If you like what you've heard today, please remember to rate, review and subscribe to the show on Apple, Google, Spotify or wherever you get your Podcasts. To learn more about how healthcare commercial intelligence can support your business, please follow us on Twitter @definitivehc or visit us at definitivehc.com. Until next time, take care and please stay healthy.