A Hire Future in Healthcare Podcast
In this special 8-part series, Association for Advancing Physician and Provider Recruitment (AAPPR) leaders and members sat down with Ubaldo during the 2023 AAPPR Annual Conference in Austin, to talk about:
Best practices in physician and provider recruitment
Onboarding and retention strategies for healthcare organizations
The impact of workforce shortages on healthcare delivery
Diversity, equity, and inclusion in healthcare recruitment
Innovations in healthcare recruitment and hiring
Ubaldo Intro: Welcome to A Higher Future in Healthcare, a special series exploring a growing crisis in healthcare, hiring quality talent to deliver quality care. I'm Ubaldo Ciminieri, your host, and I sit down with some of the industry's top voices in hiring and recruiting to dissect one of healthcare's biggest obstacles in the hopes of learning from each other and sharing that information to help us improve how and who we hire so that we can take better care of the communities and the people we serve. I'm here with Carey Goryl. Welcome. Thank you for joining us. Carey: Thank you. I appreciate it. I'm glad to be here. Ubaldo: So tell us a little bit about you and the organization, and then we'll kind of dive into some questions just about recruiting in general in healthcare. Carey: So my role with the Association for Advancing Physician and Provider Recruitment is I'm their Chief Executive Officer. I have been here with the organization for just over seven years, and our association empowers industry experts in the field of physician and provider recruitment, onboarding, and retention at healthcare organizations. Ubaldo: And how did you, because we had a little bit of a conversation before we started recording about you in general, like how you got into all of these associations. Can you talk a little bit about your background? Because I think it's just fascinating. And it speaks to a point that I want to bring up later. Carey: Oh, sure. Yes. So my background. Originally, I went for a degree and got my master's in social work. I had a lot of mentors who were in the violence against women movement. I wanted to be like them. And so I did a lot of work in the domestic violence and sexual assault work. Eventually, quickly after college, I landed a job at a state coalition. And that state coalition was focused on improving health care response to victims of violence within health care. And that usually falls on the role of a forensic nurse. But most communities about 15 years ago didn't have a forensic nurse, or they had one for an entire county of people, and nobody really knew about it. So my job was to bring the state and enhance state's capacity within individual health care organizations to have someone who was trained and qualified to provide that level of care. Well, that got me noticed by another association, the International Association of Forensic Nurses. And I was hired on as their first staff person. Ubaldo: Interesting. Yeah. Carey: I quickly became the executive director and CEO. I worked there for 10 years. And we, you know, our mission was to help health care address and be a part of addressing victims of violence. Well, then 10 years later, of course, I got recruited by this association. And I've been here since. Ubaldo: So would you say you've been in healthcare without actually being a part of healthcare? Carey: I've never worked in actual healthcare. Ubaldo: Isn't that interesting? What are your thoughts on being an outsider in this particular industry? You're coming from a different, completely different background almost. Carey: One time I heard an author, he wrote The Necessity of Strangers. And that really always resonated with me about the importance of seeking an outside, different perspective. And I will tell you, being in association management, working for associations, there is sometimes a tension that exists in associations. If they're a chief leader, chief staff leader isn't from the profession, sometimes members can feel like, oh, well, this leader doesn't know our work and what we do. I probably have to prove myself a little bit harder than someone who is not from the field. But what I also bring is a background in business management and people resource mobilization. And I will say my background in social work, what I bring is an intense level of empathy, kindness, listening, understanding that crosses all professions. And if we can humanize any profession, sign me up for that. Ubaldo: Yeah, that's a great point. I think it's a great segue into the conversation about recruitment and hiring in health care right now because we're kind of almost sort of at a crossroads. Talk a little bit about your perspective on that. What's going on with hiring and health care right now? Carey: Well, it's a hot topic. It's a hot topic everywhere. And certainly within, you know, whether it is the shortages of nurses, we've had a shortage of physicians for a long time. And the events of the last couple of years have only heightened and exacerbated. And we were already headed towards more retirements from our physicians and providers. And we already were noticing just our aging workforce, not to mention our aging patient population. We've all been watching this nexus coming at us. We're not there yet. And I will say every day, every year, this industry just continues to adjust. It's a slow boil, what we're experiencing right now. Ubaldo: What do you see as the future of hiring and healthcare? Carey: Big question. We have to break most of the rules. Ubaldo: Yeah, right. Carey: We're really going to have to break most of the rules. And we're already starting to do that a little bit. COVID honestly was one of, there are silver linings in any catastrophe. There are certainly silver linings that happened from there where it pushed health care to change its processes. Prior to that, here's a small example. Paper signatures were required on paper documents in 2019. Even though DocuSign or all the similar ones have been around, recruiters spent time walking paper across a campus. And that was quickly addressed when you weren't allowed to walk across campus anymore. Nobody wanted to be in close contact with anybody. So it forced small but powerful innovations. Being able to do interviews, prior to quarantine, physician recruiters and organizations spent a lot of money at every level to fly physicians to do in-person interviews. Because there's just this old belief that you had to see someone in person at every point of the conversation. And so the ability to do virtual interviews, these are just things that had to change. Ubaldo: Right, exactly. Yeah, and I think what's fascinating is we adjusted, like you said. Carey: We did. Ubaldo: But now, do you see a little bit of reverting backwards at all? Carey: Always. Ubaldo: Because, I mean, is it kind of like a rubber band almost? Carey: It is a rubber band. You see it in how we dictate where people work. That we think work is the place and not the activity. And we are focused on the culture of what that means and the communication. You definitely see some rubber banding that happens back there. 2022 was also a difficult year economically. And certainly for health care. I mean, health care operates on razor thin margins on a good year. I know there's been policy changes at the legislative level that also have had their impact on just... Profitability is not a bad word in health care because profitability means reinvestment back into care. And it is people who are delivering care. It's not...the tech is the tool, but it's the people who deliver it. And I want to be careful that the conversation lately has really villainized providers for wanting more compensation. And yes, it puts on stress on an organization, like I said, after we had a not great economic year last year. And forecasts this year are still a little dicey. But I don't want to villainize people for being paid and valued because the work that they're doing, it saves lives. Ubaldo: Right. Well, and there should be a balance. Carey: There should. And I think the solution potentially lies in how we're hiring. Because we want to pay people fairly and we want to pay people for this incredible thing that they're giving to the community, this care. But we also want to make sure that that quality of care is always high. Ubaldo: Yes. And so how do we bridge that gap? Because to your point, I mean, like travel nurses, right, I mean, the costs were exorbitant over the last two years causing... Carey: Still are high...the problem is still high. Ubaldo: Right. So how do you bridge the gap? How do you sort of maintain that, but also align these people with the culture of an organization and the mission and the passion? Because a lot of times these people are coming in and then they're gone. And so there's no connection there. They just come in, they do a service and then they leave. Carey: It really has to be driven a lot of times on providers to seek alignment, to seek to understand, to remain centered. I think that's a lot to ask providers, especially when they're being willing to move around the country and step into places that need extra temporary assistance. It's, yeah, for me, like it's because to your point, right, people want to be paid well, like it's a hard job. We're talking about burnout, mental health. And so there's got to be a balance. There's no reason we couldn't still hire temp workers, but have them be a part of our organization. So how do we bridge that gap? How do we not have to rely so much on outside systems, travel, whatever those things are that cost that much money? How do we build our own version of that? I know there's been some hospital systems that are trying to do that. They're trying. Ubaldo: What's your perspective on that? How do we bridge that gap and still honor the hard work that they're doing and pay them what they deserve to be paid? But we know that every time they're coming in, they're a part of our organization and then their behaviors and their mindset align with our organization. Carey: That's a tough question. I don't know how to align that one. I think because the solution is ten hundred steps before that question. Looking at why are people willing to leave an organization just to come back to it in a temporary capacity? What is that about? And how can we address that issue? We talk in a lot of professions about workplace culture. And earlier today, we were listening to a speaker about just bringing happiness into our work. And I don't know that I see so often healthcare, the culture of healthcare talking about happiness and its workers. It's so sometimes so patient focused that I think it can lose sight of the happiness of their own people. I mean, providers are working with patients who are oftentimes at their worst, at their sickest, at their emotionally most vulnerable, who might not demonstrate great listening skills or communication skills or have any empathy themselves. And we ask providers to be these superheroes at all times. But superheroes also need a lot of care as well. And so how do we align that mission and purpose? I think it starts way back there. Ubaldo: Yeah. That's a great point. Carey: Well, and it's sort of there's this expectation like you have to deliver care. You're here. Right. It's your job. It's your job. You're a doctor. Deliver care. Right. And we forget you to your point. We pay you a lot of money. Right. We want you to be happy. Go do it. Shouldn't you be happy? Ubaldo: Right. But it just seems to me it's so it's…we miss the fact that if they were happier, that care might be better. Carey: Yes. And I think that's why it's great to see at this conference discussions about that, about bringing happiness into it. And how we were our industry as professional in-house recruiters we're small in the whole scheme of things. We hope to influence that. We hope to guide our physician leader counterparts who are making those decisions about ultimately who to hire. We're trying to guide them. We're trying to have really great sourcing and screening processes that really look for the fit of the particular practice or the group that we're hiring for. And we also have to speak truth when there might be a group that is toxic, might have a negative bad player and nobody wants to. It's the big elephant in the room. Oftentimes, it's the recruitment professional who has to say, look, I can't keep recruiting another person to fill this position because you are driving people out. And it becomes a culture issue. It's not a recruitment issue. Retention is not a recruitment issue. It's a culture issue. And we have to…we're going to be taking our part and our role to mitigate those issues. But yes, it's a it's a big job. Ubaldo: How does AAPPR elevate the voices of recruiters? Carey: So, you know, I've talked to others who oftentimes they get a sense that recruiters are just order takers. Right. That's a general stereotype. Yeah. So how do we elevate the voices? Like, what are you all doing to help elevate those voices to be able to have a recruiter be able to say, look, I'm not bringing you anybody else because you're driving them away. Like, we got to fix this first. When I saw AAPPR's mission before I even started and it had the word empower in it. Yeah, I pretty much I was like, I was sold. Empowering people is incredibly difficult. And I do not report that I have any actual control over empowering somebody. But we want to give them tools, knowledge. We want to be their community of cheerleaders. And that's what I love about this organization is that we are we are the fiercest competitors. Everyone in this conference in this room is competing for at some point for the same person. Sure. And at the end of the day, you get a high five, whoever gets that person, because we all know that it's beyond it's bigger than us. And it goes to OK, this community is going to be served. And that is awesome. And we'll just keep looking. So, like, we're the biggest champions and cheerleaders for us. The other thing that AAPPR does is a lot of research. We publish the annual benchmarking report. So it looks at all of the physician and provider searches that happen in a calendar year. Last year, Bureau of Labor Statistics, they estimate that there were just over twenty three thousand physician searches. And in our data set, which our members contribute to, they shared twelve over twelve thousand physician searches with us. So our benchmarking report is the only one of its kind. And what we look at are the different specialties, the time to fill. And we try to examine what are the factors that are impacting time to fill. Time to fill is the point of when the position opens, when the physician or provider signs the contract. We also do research to find out, well, how long does it take for that provider to start work? Minimum, another four months. Ubaldo: Is it really? Carey: It is. Sometimes that is at the physician's request because they're giving proper notice. They don't want to abandon a patient population. So they're giving notice. There's credentialing, licensing, all of those. We're working with states. So there's factors. So if the average, I mean, such a generalization, because it is completely different in regions and specialty, I'm just going to generally say four months to recruit a physician. And that is aggressive. That's great if you found someone in four months and they're not starting for another eight. Ubaldo: I'm sorry. Another four months? So you get eight months. Carey: And so you're using temporary physicians during that time if you really need to provide that care. If your current providers can't supplement. And so we provide all of that data because one of the big things we see of what impacts that time to fill, which bottom line, that's money lost when you don't have a provider, it's administrative responsiveness. The recruiter doesn't make the decision who to hire. It's the executive physician leaders. And in an organization where health care administration gets it, those are power organizations. And those organizations are recruiting within four months or less. And their providers are staying because they understand that recruiters need to be a part of the strategy. They need to be a part of workforce planning. Don't tell the recruiter, I've got someone who's going to be retiring in a month. And expect to get someone. Or we're going to open up this new clinic and I need seven anesthesiologists. And administration does that. So the more that our members are involved in the planning and the forecasting, we're looking at retirements. There's so much data that we have that oftentimes we're not, we just need to be invited. And we're trying to empower our members to ask to be invited. To put their voice in the room. Ubaldo: Absolutely. Well, Carey, this has been awesome. Thank you for the insight. I mean, we could talk about this for hours. Carey: I think so. It'll be fun. Ubaldo: Yeah, let's do it. We'll do another one of these. We'll do many more of these. But thank you. We'll share information about the organization because, again, just what we've seen in just the last 24 hours, the people are here because they want to be here. And they're looking for that voice or they're looking for that reason to be the voice in the organization. And that's huge. That's a great first step. Ubaldo: So thank you for that. Any last words of wisdom? Carey: I will say, well, if anybody wants to be an in-house physician recruiter, we are, I know healthcare is always recruiting, it is always looking. It was something, we were sort of talking about this yesterday. It was people often fall into physician recruitment accidentally. It's not something you get a degree in. But they make it a career by choice. Ubaldo: I love that. I love that. Well, thank you very much. It was a pleasure. Carey: Thank you. Ubaldo Extro: "A Hire Future in Healthcare" is a production of IIA healthcare, a technology organization powered by the interviewIA interview platform designed to help healthcare organizations hire better. Learn more at www.iiahealthcare.com. And in collaboration with AAPPR, the Association for Advancing Physician and Provider Recruitment, the leading authority on physician and provider recruitment and retention. Learn more at www.aappr.org.
Ubaldo Intro: Welcome to A Higher Future in Healthcare, a special series exploring a growing crisis in healthcare, hiring quality talent to deliver quality care. I'm Ubaldo Ciminieri, your host, and I sit down with some of the industry's top voices in hiring and recruiting to dissect one of healthcare's biggest obstacles in the hopes of learning from each other and sharing that information to help us improve how and who we hire so that we can take better care of the communities and the people we serve. I am here with Russ Peal. Hello, how are you, sir? Russ: I'm very well, thank you for having me. Ubaldo: Awesome, thank you for being here. So tell us a little bit about you and your role in the organization and then we'll kind of dive into some general questions about recruiting and hiring in healthcare. Russ: Sounds good. Again, I'm Russ Peal. I am the Director of Workforce Recruitment and Retention for the Veterans Health Administration. My role has been to kind of transform how we go about recruiting and retaining hard-to-find positions, advanced practice providers, kind of a transformative effort that hadn't existed before we showed up, six of us, in 2009. So we've been on the change management, transformational management kind of platform for the last couple of years, and so we've grown immensely and we cover everything from specialized provider recruitment to loan repayment programs, scholarships, all the marketing, media and advertising. You might see commercials. And again, it is the largest integrated healthcare system in the country, serving about nine million veterans across the country. Ubaldo: So it's a huge operation. Russ: Yeah, it's incredible. But it's a great mission, it's a great service. Ubaldo: Why do you think, why wasn't there anything until 2009? Russ: I think there was just a lack of understanding of the unique skill set to recruit specialized providers or to recruit from a scarce, a nationally scarce marketplace. And so historically, it's kind of always been using one of the anchor engines on websites for anyone that wants a federal job or VA job to kind of apply to. The problem is, or the challenge with that is, scarce physicians, advanced practice providers, and they're scarce like that. They're not actually looking for opportunities. Opportunities are looking for them. So it's a different kind of a lack of awareness and what was needed to actually capture that talent and the types of approaches that have been always used, the kind of one size fits all. And we have to kind of really understand that recruiting and connecting with an advanced practice provider, a specialized physician is completely different from connecting and recruiting a non-specialized occupation. Ubaldo: Sure. And are you seeing, what are you seeing in general across hiring and health care right now? Are you seeing similar issues that are still happening in terms of being able to find just physicians? Russ: Yes. And it's been that way for a while now. I mean, it's well documented that the nation is not producing the amount or volume of physicians and advanced practice providers that satisfies the demand for them. It makes everything much more competitive. You've got to be really smart to kind of go after those providers. And I think those that win are those that understand how important it is to really connect with the provider outside of their specialty, outside of their profession. You know, how can we make our opportunities align with the interests of health care providers beyond just them practicing medicine, seeing patients. And that's the thing. And it's honestly what providers are actually looking for. They're looking to be able to say this is where I can see myself. This is where I can see my significant other, my support system and family being a part of this community, not just part of this practice. Ubaldo: Well, and what's interesting about that, and I think what makes recruiting in this industry so much more powerful is oftentimes recruiters are recruiting for a system where they seek care. So it's almost like it's almost like a heavier burden, but also, you know, like this could be my next doctor. Russ: Yes. And in fact, that was kind of our approach. You know, my background is I'm a retired Air Force guy and I spent 13 years recruiting in the Air Force before retiring. I spent almost half of that time recruiting health professionals to wear the uniform to take care of our folks on active duty. Once I retired and went into private industry for a couple of health care systems and a search firm. What attracted me to this pilot that brought me to the VA was that I had been both a recruiter and a patient. And I and my fellow colleagues, we felt we had a vested interest in making sure that the providers that we recruit could actually end up being our providers. Right. That's nothing new to the VA. It's just that you now have a team of specialized recruiters that get their care at the VA that have a different kind of interest in simply not just finding a provider, but finding one that could probably see me. Ubaldo: Right. Absolutely. Well, and talk about that. So I was talking to one of your colleagues last night. Right now, there's an initiative to hire recruiters and was it 115? Russ: Yes. And that's kind of a part of the transformative revolution. There was back in 2008, I believe there was an IBM study they did on operational readiness of the H.A. One of the recommendations on the provider recruitment front 2008 was that we pilot a specialized recruitment operation. Let's say bring some private industry professional physician recruiters to see if we get better outcomes with placing providers than we have with our historical system. Right. And I was a part of that initial six and all of us were veterans. All of us had both uniform recruitment experience and then private sector experience. So what you're seeing today is kind of an evolution of that. I think within the first nine months of us being on board, we recruited approximately 130 providers from the industry, private sector into permanent VA workforce. That definitely accelerated the nationalization of this initiative. It was successful. So we proved in less than a year of a two year pilot that this is something you want to nationalize. So we expanded from six to twenty one. I then became the director of the specialized recruitment operation back in 2011. And we've grown. We've just provided a different type of experience for our hiring managers and clients, for the candidates that we recruit. And it has been relational rather than transactional. Yeah. And that's been the thing. So we've grown. We've added more recruiters. And right now, last year, huge milestone for us. We actually had the specialized physician recruiter role codified as a federal occupation. And that's where this is coming from. So many of our chiefs, HR officers throughout the country are leveraging and partnering with us to help them find and identify and bring on top provider recruitment talent and to give them the results, the service, the outcomes that the 21 of us had been doing. And of course, 21 recruiters for a system that large. So it's historic. We're really proud of what we've been able to do. And it's good to see recruiters that have recently been hired by the VA as specialized provider recruiters. It's what we envision, what we sat down in November of 2010. Yeah, that's incredible. Ubaldo: Is there without giving away the secret sauce? I mean, what is it that you all are doing that you think differentiates you from just maybe the general industry of health care and some of the issues that a lot of hospitals and health care systems are still seeing? Russ: Yeah, I don't know if there's a secret sauce to it. I think it was a secret sauce for our agency because before we showed up, they had never experienced what it was like to work with a specialized recruiter. They're used to working with a professional HR, whether they're specialized or generalists. But that method of talent acquisition is significantly different from the type of work that provider recruiters do. So even as a health care system, operationally, but also from a recruitment standpoint, we experience what our industry colleagues experience in terms of the recruitment challenges. But there's still a market that doesn't support the demand for access to being able to provide healthcare. If there's an advantage I think we have, it may be that roughly 80% or more of all physicians that have practiced in America have migrated through a VA at some point. Ubaldo: Oh, really? Interesting. Russ: So roughly 80% of all physicians. So everyone that is trained in the US understands or had some kind of clinical rotational training through a VA system. Number one. And number two, we're really heavy in research. So there are providers and physicians that are research interested. I mean, I think we have close to seven, don't quote me on that, but I think we have like seven Nobel laureates for medicine. So some of the most significant medical breakthroughs happened, came about with physicians that were VA members, staff of the VA. So we have the same challenge. I don't think it's a secret sauce, but we have the same challenges. We just try to meet our providers where they are and help them see themselves in our system. Ubaldo: What kind of tools or I mean, do you think there's room for AI and tech? Like what are you seeing in kind of, you know, in 2023 that's helping with these efforts? Russ: Well, I certainly understand how much AI and tech has played a role to kind of change the way we actually engage. And it's become the preferable way providers want to be engaged. AI to a certain extent is great, so long as it doesn't completely remove the personal element from recruiting. So AI on the front end to determine that this is kind of a candidate that we can have mutual interest in, to have a conversation is great. It helps us pinpoint some areas of interest that are important to them from a practice and lifestyle standpoint. And how providers now are approaching the whole job search is a little different. It's not always location and how much I'm going to get paid. It's what's the work-life balance with you guys? How is my lifestyle going to benefit being a part of it? They come in lifestyle first. So those things are important. I think when I first got into the recruitment business, it was really all about location, compensation package. Who am I going to be working with? Where they train? I think the pandemic taught us a lot about the value of time and attention to quality of life. And make that the forefront of day to day and not frame everything else around what I'm doing clinically. Ubaldo: Interesting. Is that the common thread between all of the successful candidates that you've brought into the system? Russ: That kind of that passion or work-life balance seeking, mission driven…It's a part of it, I think. It's a significant part of it. And the providers that we've recruited over the years, they're either at the midpoint of their career or they're getting toward the latter part, maybe the last 10, 15 years of their career. And in a lot of cases, in a lot of reports, we have candidates who always wanted to practice medicine in uniform. Ubaldo: Interesting. It was a way of serving, if you will. Russ: So it's not uncommon for us to come around and have candidates that see practicing medicine and taking care of veterans more than anything is their way of serving the country, their way of giving back. They couldn't do it in a uniform, whether it was Air Force, Marines, Army, Navy. But this is kind of how they see themselves giving back to the country. And that's by taking care of America's heroes. We have a unique mission in that regard. And then these are some of the same providers and physicians and specialists that trained in the VA. And so this is almost kind of a coming back home. Ubaldo: How are you – so you mentioned kind of the middle to end career. How are you all addressing, then, the top of the funnel and the new physicians? Are you – like, is there any kind of progress with that on your end? Russ: We're making really significant headway with – and we train roughly 120,000 across health profession specialties a year. Ubaldo: Wow. Russ: Yeah. We are making, since, let's say, 2019, a much more targeted, concerted, intentional effort to really engage those health professions trainees when they enter our system as trainees and begin helping them chart a path into our permanent workforce post-training. Roughly between 80 to 85 percent of all the health professions trainees that migrated to our system surveyed that they've had a most favorable experience. Historically, the challenge has been we didn't aggressively pursue them for placement once they completed training. And that has a lot to do with not having specialized, dedicated recruiters that understand the value of the trainees. We have that now. And we have a system that matches the trainees that migrate into our system with one of our medical centers that is interested in hiring these trainees. Ubaldo: Interesting. Russ: They're going to be in a team-centered practice environment so we wouldn't take a brand-new trainee, put them in a rural location all alone. It's a familiar system with them. We're all on board with electronic medical records technology stuff. So that's – I think we've made significant progress in headway. And I think we're positioned more now than ever to really capitalize on that new, young talent because they've had a taste of what it's like to take care of heroes. And that's what they want to do. So it's just beyond delivering care. It's really about a mission that means a whole lot more. Ubaldo: I love that. Do you get a lot of people reaching out, looking, seeking advice, guidance based on the incredible work that you've done through the VA? Russ: Yeah, we've helped a few other agencies kind of establish similar programs to ours. I know we've worked quite a bit with Indian Health Service, Public Health Service. So they're our friends. They're our colleagues. We do significant work with the Department of Defense, which is the largest federal agency. VA is number two. have programs and systems in place that allow us to collaborate with the DOD, for example, to identify transitioning military members that have clinical specialties or clinical training. So we can kind of identify them when they're maybe 18 months to two years out. Ubaldo: Sure. Russ: And ease the transition, invite the transition. And when they decide to transition into VA from DOD, again, it's continued service. They're just not wearing the uniform every day. Ubaldo: Right. Well, and I imagine that transition, you know, it's almost like, you know, you always hear about college athletes, for example, who don't go on to play professionally. That's a big transition mentally. Russ: Yes. Ubaldo: For people. And so how do you address that kind of mental health aspect of that transition, leaving service as they know it, out of uniform? Russ: We all have it. We all wore the uniform. We never anticipate how it hits us to finally take the uniform off. But this is to them, again, they see it as I'm still serving my country and I'm still serving my country with my comrades. Instead, I'm taking care of them than actually in operations with them. So it's a huge deal. Ubaldo: Yeah, that's powerful. Russ: Very powerful. Ubaldo: Well, Russ, I can't thank you enough for joining us. Russ: Sure. It's been my pleasure, man. Thank you for having me. Ubaldo: Thank you for the insights. Any last words of wisdom for anybody, for everybody out there? Russ: Listen, have a great plan to capture the best talent. Make sure your strategies and activities involve really connecting with providers as humans and making sure that your practice environment in the communities that you've recruit to address the human side of these providers and help them see themselves in your health care system. Ubaldo: Perfect. Thank you. Ubaldo Extro: "A Hire Future in Healthcare" is a production of IIA healthcare, a technology organization powered by the interviewIA interview platform designed to help healthcare organizations hire better. Learn more at www.iiahealthcare.com. And in collaboration with AAPPR, the Association for Advancing Physician and Provider Recruitment, the leading authority on physician and provider recruitment and retention. Learn more at www.aappr.org.
Ubaldo Intro: Welcome to A Higher Future in Healthcare, a special series exploring a growing crisis in healthcare, hiring quality talent to deliver quality care. I'm Ubaldo Ciminieri, your host, and I sit down with some of the industry's top voices in hiring and recruiting to dissect one of healthcare's biggest obstacles in the hopes of learning from each other and sharing that information to help us improve how and who we hire so that we can take better care of the communities and the people we serve. I am here with Marjorie Alexander from ChenMed. Welcome, how are you? Marjorie: Thank you, Ubaldo, I'm doing great. Ubaldo: Awesome. Well, thanks for coming and thanks for being on the show today. Tell us a little bit about ChenMed because I find the history of ChenMed very fascinating and way ahead of its time. Marjorie: ChenMed is a really great organization to work for. I'm very proud to be there. So basically, ChenMed has been around for 30, 35 years, originated in Miami, Florida, and has been able to grow to 15 different states. We have over 125 centers, and basically what we do is we take care of the neediest, poorest, sickest elderly population who are the forgotten ones. They have very complex comorbidities and they don't have the resources to be taken care of. They end up in the hospital, and we all know what happens when people end up in the hospital, especially when they're elderly and poor and can't take care of themselves, they might have food insecurity and things like that. It just goes downhill from there. So we've made it our mission to take care of those individuals that need us the most, to keep them out of the hospital, and to keep them healthy and happy and at home. Ubaldo: So it sounds like, and you mentioned this before we hit record, but ChenMed was founded based on value-based care, which I know now just from insight and experience, because my wife works in healthcare, that value-based care has become critical to, and almost a requirement, I think it's a requirement, as far as how hospitals and health systems treat patients. But you all started from the very beginning with that idea. Can you talk about that? Like why? And the importance of that being the tip of the spear, I think, as you said. Marjorie: Yeah, absolutely. So Dr. James Chen, who's the founder of our organization together with his wife, Mrs. Mary Chen, he actually had an illness. He was diagnosed incorrectly. And the family of doctors, their sons are doctors, cardiologists. Dr. Chen, of course, is a physician. And as a family of doctors, they had such a difficult time navigating through the healthcare system. The diagnosis was erroneous. They couldn't get the answers. They couldn't get the care. And they thought if a family of physicians are having so much trouble getting the care that is needed and being seen, you know, the wait times were outrageous, and even being seen in a timely manner and getting answers, imagine somebody who's not coming from a family of doctors. So they felt they saw a big need and they wanted to do something to help. And it's just incredibly inspiring how the family was able to build their organization just one center at a time and just never losing focus on the mission to keep people out of the hospital and to keep people healthy and happy at home, specifically those that are elderly, sickest, neediest, and poorest population who find it so hard to find the right healthcare and who always end up in the ER, always end up being referred and always end up losing everything because they already have not much to begin with. Ubaldo: Yeah, no, that's incredible. And because also, I mean, just from a life, just from a living perspective, right, to have to constantly go back and forth into a facility or a hospital or urgent care, that's not a life. Marjorie: That's not. Ubaldo: So you have these centers. Is there also kind of a home-based version that keeps them comfortable, like where they are, but that is able to treat them? And what is the effect of that been on their overall health? Marjorie: Yeah, so we open centers in the facilities where we have identified this is where the population that is in most need of us being there, where they're located. And we go there, we pick them up, we help them with everything we can with medication and with bingo, Tai Chi. If they have food insecurity, we take care of that around Thanksgiving time. There might be a turkey. Ubaldo: Right, right. I love it. Marjorie: For them, things like that. So we do everything we possibly can to not only give them their physical health, but also spiritual health and mental health and emotional health. It's so important because it's all tied together. Ubaldo: Absolutely, absolutely. So how does this strategy, how does this mission of your organization impact your hiring? Marjorie: Yeah, it's interesting. When I first learned about ChenMed’s mission, I thought, well, that must be very difficult to hire physicians because we take care of people that are 65 and older. The average age of our patients is 72. Not everybody wants to see only the elderly. You know, family medicine physicians, they want to see cradle to grave. But we've been able to hire quite a large number of very quality mission driven family medicine physicians who are okay only seeing the elderly. Ubaldo: So that was a surprise for me. When you explain what we do, it really goes back to why physicians went into medicine in the first place to keep people out of the hospital, to prevent them from getting sick in the first place versus celebrating how sick somebody is because now we're going to make some money. Marjorie: Right. So if you're able to communicate the mission and the purpose of this way of taking care of patients, people love it. What is there not to love? And that really helps us attract the right kind of people, people that are aligned to our mission and that really want to do the right thing. And so that's very helpful. Ubaldo: What have you seen in the hiring and healthcare in general as a result of COVID, for example, that is causing sort of the issues we're seeing today in terms of maybe talent shortage or, you know, having kind of this temp community where it's costing hospitals and health systems so much more, but they need they need the help? What do you see as the trajectory of hiring in healthcare right now? Marjorie: Yeah, the trajectory is not looking too promising. The looming, dooming physician shortage has been known for many decades. I remember about 15 years ago, I did a presentation on it. So that's, you know, and it was already well known then. And I think that with COVID, people, you know, there's a whole layer of workforce that we're getting close to retiring, that would not have retired if COVID hadn't happened, that ended up retiring, which caused a huge gap in the workforce, not only in healthcare, but also you see it in shops and restaurants. We see it everywhere. We wonder where did these people go? You know, how come there's a shortage of these people? Ubaldo: Right. It's a great question. Where did they all go? Marjorie: So, you know, thinking about this made me realize that there is a large population of, you know, we have the aging and the graying of America. Not only patients are getting older, physicians are getting older. So not only, you know, we have a real struggle because we are losing a lot of physicians just because they retire. And then, of course, you know, when you look at the incoming physicians, very few physicians want to become primary care physicians these days because it doesn't pay as well as specialists. Ubaldo: Interesting. Marjorie: So, you know, we're seeing, I think the statistic, and forgive me if I'm not 100 percent correct, but in America, 75 percent of our physician population is our specialists, 25 percent primary care, where in any other Western country, it's the other way around. 75 percent are primary care and 25 percent specialists. And that makes it very difficult because you have a lot of people to refer to, but you don't have people to take care of the basic needs of people that don't need a specialist, that just need to be taken care of. And that's why it's so hard for people to find a physician or to make an appointment. The wait times are very long. And, you know, supply and demand, you mentioned the cost of temp work. Because of the shortage, there is no lack of supply. There's a high demand. And so those prices are getting higher and higher. Ubaldo: Right. Marjorie: You see it in the travel nurses. You see it in locum physicians. It's just an issue. Ubaldo: How are you all addressing that particular issue? Marjorie: We're trying to use as few locums as possible by finding permanent physicians. And it's so important, especially in value-based care, when you take care of the elderly people, they really want to build that trust with their physicians. And if we have locums coming through, and nothing wrong with a local physician, thank goodness they're available, because we do need people to take care of the patients. But it doesn't help building the trust between the physician and patients. That trust has been broken because physicians don't have time to take care of their patients. It's so quick. There's no eye contact. They're looking at their computer. So the trust is gone, which is why people go to the Internet as well to self-diagnose. Ubaldo: Well, right. And then that becomes an issue. That's interesting. I hadn't thought about that because, you know, we talk a lot about how technology can help, potentially, in the world of recruiting, particularly in healthcare. Because I don't know. It seems to me there hasn't been any innovative solution presented to the recruiting and hiring issue in healthcare. It's just sort of the same old cycle. Why do you think that is? Why do you think there's been a lack of innovation there? Marjorie: You know, it's funny you should mention this. I thought about this about a month ago, and I actually had a conversation with some colleagues from other organizations, and I said, why are we still doing the exact same thing that we did when I started 23 years ago? The only difference is I had a phone book. Now we have Internet. Right. Yes. I had a fax. Believe it or not. No, it's still. And now we have cell phones. Right. But we're doing the exact same thing, which is crazy. I think we, you know, thank goodness we have job boards and we have technology platforms where it's easier to find positions, but it really only replaces the phone book in a way. The fact that we can place ads or post our jobs on, you know, some of our vendors are here from the job boards. I won't mention specific names, which is great, but that replaces putting an ad in a paper when people used to. So we're essentially still doing the same. Right. So why? I don't know if anybody figured out what to do differently. Yeah. No. Why? Why is it? Why is it that we're all fishing in the same pond? Why is it that we don't share more? I mean, there is a great question. There is. Let's say if there's a million positions. Why don't if I don't need a cardiologist, maybe you need one. Why can't we share? Why are we all fighting over these candidates? And it rakes up the prizes, too, because, you know, there's competition. So we have to, you know, sign on bonuses for give a loan and offers. I scratched my head at that question. Yes. It's a lot. And I think that's a big reason that healthcare is close to finding itself at a crossroads in this country. Ubaldo: Would you agree that there's one way where healthcare goes where we're in trouble and there's one way where it gets better? I've heard we're very close. What do you think are the steps that need to happen just in general? Marjorie: Get us on the right path. So there are a few things that would be very helpful. And of course, we're already seeing an uptick in nurse practitioners, physician assistants, which is very helpful. I mean, there's multiple schools that have opened. I have, I actually did all my pre qualifications to become a physician assistant at some point and had to change during due to a live event. So that's something that I'm interested in in looking at. So I know that there are more physician assistants, more nurse practitioners. You know, the whole idea that, you know, here is a perfectly wonderful physician from another country. We make it so difficult for these physicians to come and work here while we need them so badly. And we make it so difficult to come read 30. Why 30? Why can we only get 30 in the state? Why not 100? Right. You know, there is this need. So I think we need to address this in a legislative type of way, political type of way to get some last change and some policies changed, national and also state policies. And then also the issue of we have plenty of people that want to become a physician, but we don't have the slots. We don't have the medical schools. We don't have the residency programs. So if we could increase the incoming, the top of the funnel for pre-med students coming into the to the mill of how to become a physician, that would be wonderful. And we have to make it more attractive for people to choose primary care versus becoming a specialist. Right. Absolutely. That pay gap is too big. Ubaldo: Yeah. Interesting. Well, this has been fascinating, Marjorie. I really appreciate the insight and any last words of wisdom? Marjorie: I would challenge anybody in healthcare to just not live with the status quo and to keep thinking it's our responsibility as a society to figure out how to change the broken system that we're in. I strongly believe value-based care is the future because we can't keep up with the rising cost of healthcare. People lose their houses the moment they get admitted to the hospital. It's insane. They've worked their whole life for a house and they lose it. So it's all of our responsibility to to find solutions for this. Ubaldo: Awesome. Thank you so much. It's been a pleasure. Really appreciate it. Marjorie: Thank you for having me. Ubaldo Extro: "A Hire Future in Healthcare" is a production of IIA healthcare, a technology organization powered by the interviewIA interview platform designed to help healthcare organizations hire better. Learn more at www.iiahealthcare.com. And in collaboration with AAPPR, the Association for Advancing Physician and Provider Recruitment, the leading authority on physician and provider recruitment and retention. Learn more at www.aappr.org.
Ubaldo Intro: Welcome to A Higher Future in Healthcare, a special series exploring a growing crisis in healthcare, hiring quality talent to deliver quality care. I'm Ubaldo Ciminieri, your host, and I sit down with some of the industry's top voices in hiring and recruiting to dissect one of healthcare's biggest obstacles in the hopes of learning from each other and sharing that information to help us improve how and who we hire so that we can take better care of the communities and the people we serve. I am here with Mandy Gingras, right? Okay, we were talking about that. I love names because my name is Ubaldo Ciminieri, but there's like 30 different ways to say it. So it's always fun. I appreciate that. Yeah, yeah, it's great. So it's great to meet you. Thank you for being here. Mandi: It's my pleasure. Ubaldo: Tell us a little bit about 3RNet. Mandi: Thank you for the introduction. I love it. My name is Mandy Gingras. As you said, I am the Director of Education for 3RNet. We are the Rural Recruitment and Retention Network. Long name, long title. But basically, we are a nonprofit organization. We are a member association. So we are made up of a network of members across the U.S. So we are nationwide. We have a member network in every single state that represents and supports the rural and underserved. So we have really rural areas. We have underserved areas. We have urban underserved. We're made up of our members who can be primary care offices. They might be primary care associations, state offices of rural health. We have Indian Health Services are also members. We're unique in every single state. We run a job board that helps to connect the network coordinators work to connect candidates who are healthcare professionals. They could be physicians. They might be advanced practitioners, behavioral health specialists, nurses, any type of healthcare professional are candidates within our database. But our network coordinators work to connect candidates that healthcare professionals that might be interested in working in underserved or rural areas across the U.S. And they work to connect those with facilities, the safety net practices, which might be federally qualified health centers. They might be rural health clinics, critical access hospitals, community mental health centers, all types of nonprofit and underserved type facilities. Ubaldo: Well, and I imagine because of COVID a lot of that, there's a spotlight on the underserved, the underrepresented, because just, just from some of the work and conversations that we've had in the past, you know, it's people don't see themselves sort of represented in the general healthcare. Right? So there has to be some way or there has to be this amazing network, it sounds like, of people where, for example, the black community, like they don't necessarily consider going to therapists who don't look like them because they don't. There's not a connection there necessarily. So have you seen in the last couple of years, have you seen kind of an explosion in that type of access where more and more people are feeling more and more comfortable to seek help and whatever that means in terms of health? Mandi: Exactly. So, multi-layers and definitely one of the things that we've seen typically coming out of COVID is more an awareness of, especially from candidates, of they want to, there's more purpose, they want more meaning in their work. So, they are looking for organizations that are socially equitable that are more diverse, and that like you said they want to work for a company where they see others that look like them or that might be able to culturally connect with them and have similarities. So it's not really something new in the workforce but I think it's been heightened. Since COVID it's definitely more on the forefront, it's definitely something that's really driven by the younger generations, the gen Z's the, the millennials there. They're very consciously aware of bias in the workplace, and in with employers in general so it's definitely something that 3RNET is focused on just like all other healthcare organizations across the country and something that we really embed in our training and as we're out and talking with the different healthcare communities across the US is, you need to be, you need to have a diverse workforce to be competitive in today's work environment. Ubaldo: So speaking of that and kind of going into healthcare and hiring, what do you see as the future of hiring in healthcare? Mandi: I think it's going to be good communication, you have to have really strong communication between your leadership and your staff and all employees, everyone is included in that staff. Without that good communication you're not going to be successful, you have to have that communication, you have to be able to tailor the work to how your employees want to work, everyone sees happiness in different ways, everyone sees diversity in different ways, you have to, you have to communicate with each other and find out what is it that makes this person happy what satisfies them when they come to work every day and what satisfies this person might not be the motivation motivators for this particular employee so you have to have that open line of communication you have to have leaders in place that understand that, and that really work hard to find out what is what are the drivers what are those motivators, and how can I satisfy, not me personally I have don't have to go out and do all of that, all that work and we as an organization, meet everyone's individual specific needs to make sure that we're diverse across the generations across the ethnicities and the cultures all of that. Ubaldo: That's, that's so important and you know if anything I think what we've learned over the last couple years, particularly with, you know, the, the temp workers in healthcare, I think you lose that mission driven passion right or that alignment, because you have so many people who are just, you know, doing it for the money in a sense because they were making what, three four times what they could have made before COVID, for example. And so, you know how, because I know that there's a lot of hospitals and health systems that maybe still feel stuck in that having to hire from that pool of candidates. How do you see healthcare kind of coming out of that, getting to your point of hiring people who are mission aligned, who maybe they're still temp workers but, but they're aligned with the organization and they want to be there? And, you know, they're getting to know the teams they're working with. Because again, you know, that communication if you don't have that fundamental understanding of each other when you're going into surgery that could cause issues to care. Right. I mean, how do you see that? Mandi: The doctors are getting there. It's, it's definitely a challenge and I know a lot of hospitals, it's something that they have to fight with every single day, because they're, it's a bandaid fix it. There is a shrinking pool of candidates to choose from, and a lot of candidates have gotten onto that, you know, the travel nurses, the locums physicians. And yes, it can help you in the interim, it's really really expensive so you know, like you said it's the cost, but you know patients need to be seen and services have to be provided. And if you know, recruitment doesn't happen overnight recruitment can take, depending on who you're recruiting for and where you're recruiting. You can be recruiting for a physician for one to two years sometimes longer if you're in a really remote rural area and you don't have this huge recruitment budget to help you, you know, get out and find candidates. Sometimes you’re forced to go with the locums you know there, you don't have a lot of other options. So it can be a challenge and, you know, to see through to the other side I think you just have to, you have to keep at it you have to stay at it you have to unveil every stone and really make sure that your recruitment strategy is really robust. You can't rely on your branding alone to draw candidates to come to you. You really do have to investigate and really try new things within your recruitment strategies. And, you know, if it's worked for you in the past doesn't necessarily mean it's going to work into the future you have to be willing and open to investigate and try what new things and new technologies you might be able to use to help you with that process and to get through that recruitment phase. Ubaldo: Do you do you think there's kind of a maybe a lack of innovation currently in recruiting and and what is that? What, you know, what do we attribute that to because we sort of talked about this a little bit, bandwidth and things, but how do recruiting teams and hiring teams get to that point, you know, looking for the innovation? Mandi: There, there are a lot of options out there and available to people, I think it really comes down to what your budget can afford. Sure. But also being in the know, if you don't know about the innovations, you're never going to try them. I think it takes networking to really understand and be able to talk about what are the tools that exist, and who's using what what's working for you and really kind of collaborating with your with your partners and other organizations to find out what are they doing to solve their, their issues, is it something that can help my team, and really just getting the word out about the different innovations and new technologies that are available and AI and there's just so many. There's so many things that are available and everybody's on their phones now everyone is, you know, logged on and has access to these tools but if you don't know about them you obviously can't utilize them. Ubaldo: Yeah, awareness is key. Absolutely. Is there a compliance to aspect all of this to, to healthcare hiring, because you know it's you train and certify people right and there's a lot of certification programs that you know certifications are critical part of the evaluation process for many roles in healthcare. Is there a compliance piece here that makes that that impacts hiring in a way that we don't see in other industries? Mandi: Well certainly in healthcare there's a lot more certification there's a lot more education and training and things that that go along with that for for given reasons. The position is nationwide but there are a lot of specialties within healthcare that that certification process can look different state by state. Sure, so that creates a lot of challenges that is something that is very, very common in behavioral health specialties that a lot of certifications and licensure it's not reciprocal from state to state so that leads you know to a whole host of challenges along the way. I certainly agree there, there definitely can be a lot more hoops to have to to jump through in the healthcare industry. Yeah, I just, it just feels like there's so much stacked against a lot of these are and there's dark roles and there's a lot of things, and non-competes have become, I mean there's so many different facets of that and there's even with compensation in different states have different rules about pay transparency. Ubaldo: Yeah, right. And there's just so many different players and things that affect recruitment in general. Yeah, that's interesting. Do you see 3RNET as being maybe like a feeder program because what you all are doing is quite amazing right you're, you're, you're finding these people who are mission driven? You're training them you're certifying them. Is there any aspect to your strategy where those people then move from kind of these underrepresented underserved communities into kind of more, more standard hospital health systems, you know, is there a path there that you see? Mandi: Hopefully one of our guiding principles is recruiting for retention. Sure, so our, our philosophy is teaching facilities to recruit for the long term to have mindful recruiting, where you are planting those seeds and hopefully, because recruiting one is expensive, and it's time consuming. Yes, it can take a really long time for rural area to recruit a physician to their, their community, and they're really well needed right in that community. And it, it really impacts the community, if a physician is to leave that organization or to go to a more urban area or a larger hospital system. So it really makes a huge impact so one of the things that we really try to instill and really kind of complete the message is that you need to hire for, or make all attempts to hire for that long term. So really invest in that onboarding process, make sure you have a really well rooted recruitment plan. So that when you do find a physician that can come into your community, you work really hard to get them instilled and fostered into the community, so that they feel that sense of belonging and if you're hiring a J one candidate that you're really working hard to make sure that they feel welcomed into the community, and that you're helping them to find the resources and connect with the community, so that they can, you know, their family is satisfied in their community their spouse is able to make friends and connect in the community to help them feel that they're belonging that they want to stay in your community. So that's one of the things that we really kind of strive for. Ubaldo: Yeah, no, that's great. There are aspects of your program that focus on burnout and mental health as well, I imagine, that work. Mandi: Absolutely, because that all plays into retention strategies is huge and that's part of that. Not just thinking about it as an afterthought after you bring someone on but in the beginning process retention should be built right into your recruitment plan, you need a budget for retention, and you need satisfaction surveys, stay interviews and it doesn't just happen once a year you have to have regular communication, regular touch ins to make sure that you know your new staff that you bring in, are their expectations being met, are their needs being met. Is there anything that they're not finding that they're looking for you need to kind of think three steps ahead and never take for granted that just because someone is here today doesn't mean that they're thinking, you know, that they're not going to have your plan might be they want to be somewhere else so you always have to know what their goals are and make sure that you can align with their goals. Ubaldo: Yeah, fantastic. Well, Mandi, it's been a pleasure. Thank you very much for the insight and we'll share information about you and 3RNET, along with, along with this episode, so thank you very much. Any last words of wisdom? Mandi: Well, thank you for your time, it's definitely a pleasure and diversity, and on the forefront, it's something that everyone has to pay attention to so it's a great topic to be focusing on and interviewing so I appreciate that you invited me to share my thoughts on it today and it's been a pleasure meeting you. Ubaldo Extro: "A Hire Future in Healthcare" is a production of IIA healthcare, a technology organization powered by the interviewIA interview platform designed to help healthcare organizations hire better. Learn more at www.iiahealthcare.com. And in collaboration with AAPPR, the Association for Advancing Physician and Provider Recruitment, the leading authority on physician and provider recruitment and retention. Learn more at www.aappr.org.
Ubaldo Intro: Welcome to A Higher Future in Healthcare, a special series exploring a growing crisis in healthcare, hiring quality talent to deliver quality care. I'm Ubaldo Ciminieri, your host, and I sit down with some of the industry's top voices in hiring and recruiting to dissect one of healthcare's biggest obstacles in the hopes of learning from each other and sharing that information to help us improve how and who we hire so that we can take better care of the communities and the people we serve. I'm here with Kip Aiken. Great to meet you. Thanks for coming on the show. How are you? Kip: Yeah, I'm great. Thank you. It's a fantastic conference. I appreciate the time. Ubaldo: Yeah, yeah. Well, we can talk a little bit about the AAPPR conference in a second, because it is, I've heard, you know, it's just the community here, especially around recruitment in healthcare, is powerful and I think much needed. But talk about you, your position, your organization first. It's good to know you a little bit. Kip: Sure. So I'm Kip Aitken, as you mentioned. I'm the director of physician recruitment at CGH Medical Center in Sterling, Illinois. We're in the northwest corner of Illinois. Local population there is about 15,000, is the population of Sterling. So we're a small town. We're an independent community hospital. Our goal is to be an independent community hospital for as long as we can. We feel like that's the best way to deliver healthcare to our patients. So I'm kind of unique compared to a lot of the other recruiters that are here who maybe work for big multi-state organizations or multi-hospital organizations. We have really essentially one site, one hospital, one main clinic, and some of the smaller towns around some satellite clinics, but we're just a one location place. Ubaldo: And so how does that impact your recruiting efforts as far as, you know, are you still looking all over the U.S. and, you know, having conversations about physicians and their families moving to Sterling? Like, what does that look like? Kip: We are looking anywhere where there is somebody who has a reason to move to Sterling and a reason to stay in Sterling. Those are the two most important criteria that we have. And that could be a number of things. It could be the parents want to raise their children in a small Midwestern town. It could be one of the parents was raised in a small Midwestern town. It could be they've done all their training in New York City and are just tired of it and want a change. There are a number of reasons why people would want to come to Sterling, but that's our absolute primary reason that we're looking to hire somebody. Ubaldo: And what what are some of the obstacles you've run into, particularly, you know, as a you know, because of covid, for example, like, what are some of the things that you're running into right now? Kip: The biggest obstacles, just numbers. You know, there over over 90 percent of Americans live in a metropolitan area, whether it's urban or suburban. And doctors are no different. So so when you when you're looking at a population of doctors that you're trying to approach, there's a very small percentage of them that are interested in small town living, even though I was a big town guy and became a small town guy. And there are a lot of advantages. That's a difficult selling point. So that's the biggest issue, I would say. I would say the second biggest relates to getting somebody on site for an interview. Once somebody understands that that they can come visit and they do visit, they're typically surprised about what the quality of life is like in a smaller town. And a lot of misconception. So those are two of my larger obstacles. Ubaldo: Gotcha. How do you go about describing that life? You know, what have you found to be successful in terms because I imagine there are a lot of healthcare systems who are doing the same thing, right? They're trying to convince people to move not just themselves, but their entire family this new place. What have you found to be the most successful in terms of communicating what life is like there? Kip: Frankly, I tell them my story. I say, you know, I'm a guy who was born and raised in Pittsburgh, Pennsylvania, and my wife was born and raised in St. Louis. We spent the first 10 years of our marriage in the Chicago suburbs. We thought moving to a small town was something we do for just a brief time. It was going to be a three or four year thing until our daughter got an age when she was going to start in the education system. And then we moved to another suburban location. And lo and behold, four years in the economy went in the tank. My job got eliminated. I said to my wife, I can look for work anywhere. Where do you want to go? She said, you know, it's starting to feel like home. And so here we are 17 years later, completely ingrained in the community. So I share my story because I think it's relevant. I walked a mile in their shoes. I'm asking them to do exactly what I did. Give it a try. Come to a small town and see how it works out. And then, of course, I can share stories of physicians who chose a similar path, who also were not from a small town, but I thought this seemed like a good fit for them. Ubaldo: And are you are the candidates you're finding? Are they what's kind of the trend line? Are they kind of middle to end of career, like looking for that settle down? Are you also getting kind of younger physicians who are looking maybe for the same? Kip: We struggle with a younger physician, especially especially now as I just thought. In fact, I just came out of our presentation where they're talking about details and factors and attributes of the millennial physician that are all graduating. And we're just not particularly attractive to what they're looking for. They want to come out. And one of the things we learned is they want mentors. They want to come and be part of a big medical staff. Well, we're a small hospital, a small medical staff. They're not going to have a lot of partners to either help them with call, which helps with life, life and work balance. And it also prevents them from having like kind of a mentor to run ideas by. You know, so it's it's a challenge for us to be attractive to the younger physician. So we do find people who maybe are more mid-career and later who have maybe had a job or two realize that, you know, maybe where they chose isn't the right long term fit. There are some fundamental things wrong with the organization. It's just not the right fit for them. And then they then they find us and they find the things a little bit different out where we are. Ubaldo: Are what have you heard, you know, especially at a conference like this, right? Are there any does it spark any ideas for you, like kind of innovative ways to reach a different audience? And are you looking for different audiences throughout your recruiting efforts? Kip: You know, I'm not really looking for a different audience. I think one of the one of the things that I learned throughout my career and it's reinforced by this conference is that your culture of your organization and the culture of where you are located is the culture and you're not going to change that in a year or two. So if our culture is not really one that is open to sort of what a younger physician is looking for, we can't change who we are in the hopes of attracting that person. So I think I think really what gets reinforced at a conference like this is be true to who you are, understand who you are, and then don't waste your time looking for people who aren't going to fit in well with who you are. Ubaldo: Amen to that. Yeah, I completely agree. You know, I think because I think what and I think this goes for any organization really is a lot of times the difficulty comes out of not knowing who you are as an organization and realizing that every company is a different company. You know, this war on talent conversation just never made sense to me because the best architect, the top architect, for example, in engineering at Google isn't going to be the best architect at Twitter, for example, right, because it's different culture. And so I imagine, yeah, absolutely. The same thing applies. And I love that that, you know, that's a big part of getting to the right people's first way you got to know who you are, define what you're looking for, and then put that message out there. Kip: And I'm going to kind of add on to that. I am blessed with my particular situation that we're not in a hyper competitive environment where there are different hospital systems that are constantly vying for patients. And I'm not measured on the volume of candidates that I bring in. I'm really I'm really measured on the quality of the people that bring in and what good a fit it is. So it's not like I need to bring in four people a month for an interview to prove to my management that I'm actually doing something. They know that I'm doing something and they would much rather me bring them four good candidates a year than four lousy candidates every month just to prove that I'm doing something. So again, part of our culture, you know, that's how it affects me personally, though. Ubaldo: Well, and there's an intentionality there that I also think to your point, you know, a lot of recruiting teams, there's like a weird pressure there or, you know, just numbers or goals that don't make sense. But it sounds like you all are really approaching it with intentionality that that frankly is needed, you know, and it kind of circles back to what I said at the very beginning. Kip: We're looking for somebody who has a reason to come to Sterling and a reason to stay in Sterling. So it does me no good to bring a multitude of candidates who have no reason to come other than we have a job and they need a job. Ubaldo: No, it has to be deeper than that. For sure. What do you see for the future of hiring for healthcare? What do you see in the next few years? Because I feel like, you know, I talked to a lot of people about kind of in this weird spot right now where we're not quite at the crossroads, but, you know, healthcare could go one way or the other at some point in the future. And how do we avoid the bad path, if you will? Kip: I am by no means an expert in this, you know, I’m absolutely not. And I'm in the minority in my opinion, but my opinion is that healthcare isn't going to change all that much. I think the root of healthcare is the relationship between a physician and a patient. OK, so maybe, you know, there's going to be more NPs and PAs and less physicians. Fine. We can quibble about definitions. But at the end of the day, it's about a relationship between a physician and a patient. And I think healthcare is always going to be about that relationship. Now, will there be more reliance on tele services? Yeah, likely likely so. So I think technology as it continues to improve will, of course, affect healthcare, just like it affects anything. But I don't think the root thing, that relationship between a physician and a patient is really ever going to change. Ubaldo: Maybe it's just more about taking that and emphasizing that more in every part of every operation throughout the organization, particularly hiring and interviewing, to pinpoint that, because, yeah, I think you're right. We're human. We can't forget that. And sometimes technology will be put in place to replace that humanity that's, to your point, necessary. Kip: And I don't think it replaces the humanity. I think it shouldn't. It should enhance the humanity. Ubaldo: I agree. Totally agree. Right. There should be a support. It can support and guide people. Kip: So, again, back to this all circles back to the culture of an organization. If the culture of an organization is we want to try to eliminate as many onsite doctors as we can because we're going to replace them with all this telemedicine, well, no, that's going to that's destined for failure. But if the culture of the organization is well we understand that we're having trouble attracting the volume of physicians that we need to our location, so we're going to have to expand into alternative ways of providing healthcare to our patients, but we want to make sure we do it in a way that's going to preserve that relationship between the patient and the physician, well, now you've set up you've set up a recipe for success instead of a recipe for disaster. Ubaldo: Awesome. Well, I can't thank you enough for the conversation, Kip. This has been amazing. Any last words of wisdom to throw out there to this great community at AAPPR in particular? Kip: Words of wisdom. I am a positive guy by nature. And I say just be positive. Things are going to happen every day that are both good and bad. But your reaction to them is what's going to make the day great or not so good. I don't tell anybody have a good day. I tell everybody to make it a great day because your response to the stimuli that you encounter in the day or what's going to make it great. That's going to what's going to make the difference. Ubaldo: Great way to end it. Thank you very much. Kip: Thank you. My pleasure. Ubaldo Extro: "A Hire Future in Healthcare" is a production of IIA healthcare, a technology organization powered by the interviewIA interview platform designed to help healthcare organizations hire better. Learn more at www.iiahealthcare.com. And in collaboration with AAPPR, the Association for Advancing Physician and Provider Recruitment, the leading authority on physician and provider recruitment and retention. Learn more at www.aappr.org.
Ubaldo Intro: Welcome to A Higher Future in Healthcare, a special series exploring a growing crisis in healthcare, hiring quality talent to deliver quality care. I'm Ubaldo Ciminieri, your host, and I sit down with some of the industry's top voices in hiring and recruiting to dissect one of healthcare's biggest obstacles in the hopes of learning from each other and sharing that information to help us improve how and who we hire so that we can take better care of the communities and the people we serve. I'm here with Kelli Cameron. Thank you for joining us on the podcast. Kelli: Absolutely. My privilege. Ubaldo: Talk to me a little bit about you, your background, your role, and the organization, and then we can dive into some kind of recruiting and hiring and healthcare questions. Kelli: Sure. Well, I'll start with my current role. I'm the Senior Director of Faculty and APP Recruitment for the Medical College of Wisconsin, which also includes all of the physicians who practice in the community with Freidert Health and also Children's Wisconsin. So we are very active in our recruitment. We try to do as much as possible in-house. So we have a team of 14. And we have the opportunity to work with the best and brightest, not only the clinical professionals, but also researchers and the teachers of our future physicians. It’s really exciting. Ubaldo: Where are you recruiting and sourcing from mainly? Is it Wisconsin or are you looking all over? Kelli: We look nationally. There's a lot of people who grow up in the Midwest who want to get other experiences for their education and training, and maybe they want to live and experience other states, too. And then at some point, a lot of people in the Midwest like to come back to the Midwest. And so we really recruit nationally. And we do have some international candidates as well for certain positions that are really unique. So it's – and we do – I mean, obviously, all the normal job advertisements and things, but we do a lot of, like, headhunting and just active outreach to potential candidates. Ubaldo: What are the obstacles you're facing right now? I mean, given the last couple of years, I think just in general, right, hiring and recruiting have been struck with many blows, many obstacles. What are you all facing right now? Kelli: I'd say some of the bigger challenges. I mean, obviously, everyone's challenge with certain specialties. You know, there's never enough psychiatrists, for example. And there's a growing need, obviously, with, you know, the opportunities with mental health. And so there's a bigger demand, and there's a shortage of those positions already. So that continues to be a challenge. But we really have stretched ourselves to say, like, how do we recruit differently in the sense that, you know, we – it's not necessarily the first person we want to hire. We want to hire the best. And so not necessarily just hiring the person you know, but doing that active recruitment. And by doing that, we've put together some very intentional diversity recruitment plans to say, how are we going to reach different audiences that may not even know about us? Maybe they've never been to Wisconsin or heard about Milwaukee and, you know, experienced what it's like to be in the Midwest. And so really trying to engage people who, you know, who may not be familiar with us to learn more. Ubaldo: How are you all defining diversity and inclusion and all that thing, that strategy? How are you defining that specifically? Kelli: We have a lot of different definitions depending on, you know, what audience, what specialty, what we're looking for. You know, we have, you know, particular veterans, for example. A lot of the physicians who are – who work at the Veterans Hospital in Milwaukee are actually employed by us. And so we're always looking for veterans. Gender diversity is extremely important to us. It's interesting by specialty. There are some specialties where, you know, females are the predominant gender. And so, you know, we look at it by specialty there. We're also obviously looking at race and ethnicity. We know that if we can recruit more diverse physicians who look like our patients, patients are more likely to get the health care they need, that they can have that trusted relationship. And so we really look at it – it depends. I guess the long answer and the short answer. And just making sure that our physician population looks like our community, because we know we can better advance health care in the Wisconsin, you know, area with more diverse physicians. Ubaldo: Did that change because of COVID for you all, or was that always something – because you don't hear that a lot. But I think it's such a powerful statement and a powerful criteria, because you're right. Like, people don't necessarily want to go seek care from somebody who they don't think will understand them as a person culturally. So did that become more powerful of a thing for you all after COVID? Kelli: You know, we have a whole office that really looks at the inclusion challenges, I think, in health care and some of the disparities that exist, and a lot of it's historical. And so COVID really exposed some of those things and brought a more – I'd say a greater awareness to some of the historical challenges and issues that certain populations face with vaccines, for example. And so I think it became a stronger awareness to that, but I don't necessarily think it changed it. It's always been a need, and it's something that we're very committed to in the Milwaukee market and beyond. We really stretched now from the scene in Kenosha in southern Wisconsin all the way up to Green Bay and over to western Wisconsin. So it's a major commitment to our state. Ubaldo: Is the community really vocal about that? Like, do you hear from them often on the things that they're – that they want to see more people like them reflected throughout the system? Kelli: Yeah, I think we've been partners for a long time. And so it's really not about us and them. It's really about, you know, how do we continue to strengthen that partnership? And so many, you know, especially in recruitment, let's say, like, people expect you need to have these hiring goals or you need to do this thing, but they don't change their behaviors, right? And they don't build the relationships. They don't build the trust. And this is not a transaction, right? This is a long-term effort. And so that's how we really approached not only our recruiting, but also how we have our partnerships in the community, is that it's not about us doing one thing, you doing another, and informing each other. It's really about working collaboratively together to advance, you know, each of the goals. Ubaldo: I love that because – and I've heard that a lot – that recruiting, it isn't transactional. And that there is a power within healthcare recruiting that goes beyond just finding a new physician. How do you – do you all talk about that a lot as a team? Like, how do you ensure that everybody on the team is, you know, on the same page about, look, this is, you know, we're hiring people to change their lives, to change the lives of our community, to change our lives. How do you make sure that that mission is always kind of at the forefront of your – what you're doing as a team? Kelli: Yeah, I'm very fortunate. We have an amazing team. I have 20 years of experience, but everyone else on the team brings, you know, five to 30 years of experience. And I – you know, I think we really focus our conversations and our Recruiter Connection meetings about, you know, what we're hearing. You know, what are we hearing from candidates? What are we hearing from the teams that we're partnering with? And trying to identify what are those themes and how does it change what we do? So how do we make our interview process more inclusive? And, you know, even some of the things that we can't necessarily control, we know, you know, it's not just about a job. It's about do people feel at home in the community that they're exploring that job? So what does the entire process look like to say, you know, do I feel comfortable, you know, going to, you know, for a walk? Do I know where I can pray? Do I know where I can get my hair done? Where can I bank at? You know, the education system, will my family be accepted here? And so we truly have expanded our recruitment process to say, you know, we're recruiting the entire individual, not just their clinical expertise. And then sometimes it's their entire family that we're recruiting. And so we've tried to share some of our best practices within our team because there's so much work to be done in that area, too. Ubaldo: Yeah. Do you have any good kind of just tips or tricks for the interview process specifically? You mentioned that, like how do you create a more inclusive interview process? Kelli: So there's a number of different things that we've been doing. Obviously, just some training of the people who are involved in the interviews. So the clinicians, the leaders about, you know, things like unconscious bias. But we've also expanded, like, how do we review CVs and looking at, you know, what types of experience or education they have and challenging the hiring teams to say, what are the most critical things for this position? And so sometimes you start a search and people think and the team says we need somebody with 10 years of experience and this and that. And by showing them a diverse pool of candidates, they actually realize that their first thought of what was ideal is different after they've had a chance to, you know, explore a pool of candidates that really shows them different experiences and backgrounds. Ubaldo: That's a great point. Yeah. Kelli: And so we've done a lot of things with the candidates to engage them early on in the process to find out, you know, more about them personally and giving them an opportunity to share without also respecting their privacy, you know, giving them an opportunity to tell us what they want and giving them that experience to share, but also not making them feel like they have to share either. Ubaldo: What, what are some of your kind of maybe your final thoughts? Like if you, you know, words of wisdom, if you will, for the industry, you know, because I think everybody here at this conference, AAPPR, are really trying to figure out like how do we avoid a potential, you know, problem in the future where we don't, we never fix this talent problem, right? Like we don't have enough people. So how do we do that? Like, what are your thoughts on this community and how do recruiters kind of empower themselves to really be a part of the solution? Kelli: I think, you know, continued learning is just key. This is a really challenging field. I'm finishing my PhD right now. I'm focused on position recruitment and looking at like the career choices that residents and fellows take, make after completing their training. But like those learnings that I'm having now, I've just opened my mind to so many other things. And it, you know, I think it's really my piece of advice probably to always be curious and to take the time to, I think we're in such a demanding, very busy field, but just take the time to build that relationship with each candidate, because it will, it will save you time in the long run. And, you know, ultimately when you have a successful recruitment, successful hire, so, you know, don't get too caught up in the busy stuff to realize the most important things are the relationships. Ubaldo: Perfect way to end it. Thank you so much. It was a pleasure. Kelli: Yes, thank you. Ubaldo Extro: "A Hire Future in Healthcare" is a production of IIA healthcare, a technology organization powered by the interviewIA interview platform designed to help healthcare organizations hire better. Learn more at www.iiahealthcare.com. And in collaboration with AAPPR, the Association for Advancing Physician and Provider Recruitment, the leading authority on physician and provider recruitment and retention. Learn more at www.aappr.org.
Ubaldo Intro: Welcome to A Higher Future in Healthcare, a special series exploring a growing crisis in healthcare, hiring quality talent to deliver quality care. I'm Ubaldo Ciminieri, your host, and I sit down with some of the industry's top voices in hiring and recruiting to dissect one of healthcare's biggest obstacles in the hopes of learning from each other and sharing that information to help us improve how and who we hire so that we can take better care of the communities and the people we serve. I want to welcome Candace Butler to the show. Candace, how are you? Candace: Good, how are you? Ubaldo: I'm doing really well, doing really, really well. Thank you for taking the time to do this with us. You know, we're really excited to have a conversation about hiring and healthcare and particularly from your point of view, but I want to start out with, first of all, tell everybody who you are. Candace: Sure, and thank you for the opportunity to be on the podcast today. I'm also very excited as well. Hello listeners. My name is Candace Butler. I am a division director for a staffing company. I've been in the healthcare space about 26 years. I am also a public author. I've done pretty much anything, every gamut, so IT, medical coding, staffing, training, implementation. Also sat in the diversity chair. So I've done a lot of work around retention, onboarding processes, helping our clients with not only their travel needs, but also in the direct hire needs as well. Very nice to be here. Ubaldo: Wonderful. Yeah, you've done it all. So tell me a little bit about kind of your experience and what you've learned throughout that experience, specifically as it relates to hiring and healthcare. Like what are some of the big takeaways for you? Candace: There are large candidate pools for positions. They are definitely large candidate pools. We have a lot of very educated, skilled and qualified candidates, which is a great thing. But however, the bad thing is, are we really tapping into those areas, not only to get current needs, but future needs as well? Ubaldo: And so let's talk about the future for a second. Based on that, what are you seeing as the future of hiring and healthcare? Candace: Being able to go into those demographic areas that normally don't think that they can be in those type of positions. So we do college recruitment. What about high school recruitment programs? What about mentorship programs? Because I know as I was a child, people always asked what I wanted to be. And I never really could answer because there were so many different things that I didn't know that was out there. So what I wanted to be changed a few times because I didn't have the opportunity to see those things that could actually exist. You cannot really make an assessment of what you want to be if you don't know what you can be. Ubaldo: Yeah, that's such an interesting point. And so you're really focused on bringing these disparate candidate pools, which you're saying are generational. We should be going back even further from what's present right now. So you're really working to educate what, to your point, a very valid candidate pool, which are these younger generations. Because I feel like, tell me if I'm wrong here, but are there paths into healthcare roles for people who don't necessarily go to college, but can get certified? Are there many paths for these younger generations? Candace: There are quite a few paths, yes. And even in those paths, that person can work in that position and work toward the next part of the path that they choose to. For example, a certified nurse aide, you could actually, you only have to be like 17 years old in some states to get a certified nursing assistant license or even a medical assistant license that can lead to an LVN role, which can lead to an RN role, nurse practitioner. So there's a lot of different pathways available for people just to even get started in healthcare. Ubaldo: Wow, that's interesting. And so how does a hospital or a health system, who has to hire right now, how do they need to shift their mindset as it relates to hiring and candidate pools and everything we just talked about? How can they shift their mindset to start making an impact now, making those hires that they have to make now, but also planning for a better future, building a better system or a better process to ensure that they're always hiring when they need to? Candace: Great question. The first thing I would say is break the mold. And I've also worked in HR myself in different areas. They have a certain pathway. We have to do it this way, or we have to do it this way. Or why do you do, some of my questions are, why do you do this this way? Well, that's what we've always done. So what we've always done, especially in this society, will definitely keep us unemployed and missing all those great people that are out there. So first I say break the mold. Look for creative ways, strategic ways to bring in candidates, school recruitment is one of those ways. Bringing in a staffing agency like myself is another creative way. Look at your retention practices at your hospital. Look at using your current candidate, your current employees to recruit other people with family, friends, those things. Getting out in the community, in different communities, looking for people. A lot of times people are very qualified for the positions, but they can never get in the door. So making sure that your hiring practices are encompassing all ethnicities, whether Black, White, Hispanic, LGBTQIJ, those different things. So really just stepping, breaking the mold and really stepping out of the box. Ubaldo: And you did a great talk at the AAPPR conference in Austin this year about diversity, equity and inclusion. And you just mentioned a little bit about that. How important is DEI to the future of hiring and healthcare? Candace: If we do not only have a conversation about DEI, but the actual actions and keep that continuously, if we do not, we are decreasing our candidate pool more and more. And so part of the conversation, the presentation that I was grateful and humbled to be able to talk about at the conference with physician recruitment is that we have to become advocates and allies in order to work for the bigger goal. The bigger goal is patient healthcare. We want to make sure that our patients have the staff to take care of them. we also want to make sure that our staff feel empowered and supported. And we want our CEOs and CFOs not to be worried about staffing. They can worry about expansion and community and other projects. But right now, the most, the number one ticket is retention and staffing. So you have CEOs, CFOs, COOs, they're having to focus on staffing where there's so much more that their time can be utilized to. Ubaldo: Yeah, that’s a great point. And I often try to get at the root of an issue like that. What is preventing these leaders from doing the work that they should be doing? And I think it comes down to the fact that we're human, and we all have biases. And if we don't address those, we can't move forward in the right way. And so you talk a little bit about authenticity and a willingness to change. What does that look like, to your point earlier, if a hospital system is truly going to take action, how do they go about doing that, starting with the root cause of the issue? Candace: Accountability. So accountability, saying, because it's kind of like that, we know that there are issues, but we don't want to speak to them, right? So being able to speak, okay, there is an issue. That's the first part. The second part is, okay, how do we come up with solutions for this issue? A lot of times we get stuck in the problem, and the injury should be more on the solution. And it is a willingness to actually be a part of the solution. It takes both sides of the spectrum. In my presentation at AAPPR, I presented with Cecilia Jerome, who is a physician recruiter. Our conversation started with just trying to find her some staff. And then we started talking about, I felt comfortable to talk about some of my challenges as an African American woman leader. She opened up about some of her challenges about being a white woman leader who's been in leadership for a long time. And what we realized is we have a lot of commonalities. And we also both want changes in those areas. When we became allies, we were both very open and transparent with each other in the things that we felt. And we took those things to come up with different creative solutions to make sure that we had everyone who was considered not only brought to the table, but actually considered at the table and was best for patient care. Ubaldo: Well, and I think that's exactly the point, the patient care. We always talk about quality of hire is a direct impact on the quality of care. And if we are not, as hospitals, as health systems, as caregivers, focused on providing the best care possible to our communities of patients, then what are we doing? Why are we doing it? We’re not. And I think the last couple of years, and correct me if I'm wrong, but I think we've seen a lack of quality of care because of hiring or having to find temporary workers who don't align with our mission as an organization. And so they just pop in and out. And they don't necessarily, they're just there for a paycheck. And I don't mean that to sound disparaging at all. But what I'm trying to say is that there's a lack of mission there. There's a lack of alignment with the passion of that particular community. Candace: And I totally agree with you. And to that point, so we bring in a local person or a temporary person because we have this urgent need, but I will tell you in the last two years, we're seeing more people go to the ER versus going to a family practice because it's a different doctor every time they come in. And it's a doctor who does not look like us or understand our needs and our concerns and issues. We always talk about in healthcare about saving money. Everybody is about saving money, saving cost. And one of the ways that we can do that and we can utilize DEI is making sure that we have qualified people that look like our community in those spaces so that I, as a African American woman, will go to a doctor who looks like me or a doctor that understands my community, understands my issues versus me just going when I'm sick to your doctor, you know, because there's no community care. So we're spending millions of dollars in emergency room care where that money could really be saved if we had people that look like us to make it comfortable for us to go see doctors. I was told growing up, only go see the doctor when you're sick. They don't understand. They don't understand our concerns. And plus we were taught as African Americans that if we went to the doctor, we were considered weak and we were already looked at as a weak to society. So we definitely didn't go to the doctor. And that's why you see the high rates of diabetes and cancer and we didn't go get that printed image of care because we didn't feel comfortable to go get that printed image of care. And when we go to other places, there's definitely a difference. And I could just speak for myself. I have noticed differences in when I go to different offices. One of the reasons that my children do not have names that can make them easily identifiable is just for that because I have also seen based on someone's name, the person has to wait like an hour or two to see the doctor and you see people who came in later than you get treated before you. Ubaldo: Right. Absolutely. Yeah, I know that man that's powerful because I mean ultimately this it's very it's emotional right. It's human beings. Candace: These things are very emotional and you know there's a let's not even forget about the whole mental health aspect of this. So we suffer a lot and not just only African American but brown in general. I have several friends and colleagues and we have conversations around mental health PSTD a lot of things that we suffer in silence because if we open up and say something then we're considered weak. Another point that I also want to bring in and I will speak from my own experience. I was taught to be 10 times better 10 times stronger but 10 times more humbler. So most people that are in any type of role in corporate America, they can actually do way more because they're way more qualified because we're taught to be there to even get through the door. Harvard Business Review did a very interesting article about a year ago, the scene where they are now putting black CEOs in corporations and noticing those corporation growth, their financial growth. And one of the comments in that article states that most time when you put people, black people who are in corporate America in those C-level positions, they've already been doing the work for 10 or 15 or 15 years or more because they had to overly work to even get in the door to even get into a lower level role. And it's very sad but a very true statement even for myself. Ubaldo: Yeah, it's, oh man, we could talk on this for days. Yeah, I think, well, I guess as a final point, what are the next steps for people to take? Candace: The next steps to take is there's a couple of things here. First we're going to be accountable. Next we're going to put an action plan and put people that are a part of the people who have experienced the problems into those action plans. You need those opinions. You need those expertise. You also have to have people who have not experienced it and they're trying to understand it. So it's a coming together of the minds, right? And both parties have to be open because on the other side of that, there are some people they just don't know because they've not been exposed or been taught those different things. So it's the coming together of that. It's getting that buy-in, not just doing surveys, but also having qualitative and quantitative data asking people because a lot of times people are not going to answer surveys truthfully because they don't want to be singled out. I'll give you a brief example. I am the first person of color in my organization in a leadership role. There's surveys coming around asking certain questions. I did not feel comfortable answering because they would have been able to figure out that it's that person. It's not hard to play process of elimination when you don't have a pool to eliminate, if that makes sense. So we must look at qualitative and quantitative data, bringing people in that are a part of that. And everybody has to be on the mindset of continuous change. DEI is not just a one-stop fix it, band-aid button, okay, it goes away in a year. No, it has to be continual. It has to be intentional. It has to be impactful. And it takes hard work. Hard work is hard work. But the benefits of it, not only from financial, but for morale and for the nation as a whole is very impactful. There are several studies that are showing bringing people of diverse minds and cultures, especially in technology, healthcare, has impact and actually jump-set a lot of technology, a lot of things that we have in today's society. End up with an implementation plan, putting it into place, having stop points and checking and making sure things are going on and making it a continuous and a lifelong process. Will it go perfect all at first? No, it will not. But we have to get back up, learn from those failures and keep striving and going and making those changes. Ubaldo: Well, and I can't think of a better way to end our conversation. Thank you, Candace, so much. This was so insightful. We really, really appreciate it. Candace: Thank you for having me. Ubaldo Extro: "A Hire Future in Healthcare" is a production of IIA healthcare, a technology organization powered by the interviewIA interview platform designed to help healthcare organizations hire better. Learn more at www.iiahealthcare.com. And in collaboration with AAPPR, the Association for Advancing Physician and Provider Recruitment, the leading authority on physician and provider recruitment and retention. Learn more at www.aappr.org.
Ubaldo Intro: Welcome to A Higher Future in Healthcare, a special series exploring a growing crisis in healthcare, hiring quality talent to deliver quality care. I'm Ubaldo Ciminieri, your host, and I sit down with some of the industry's top voices in hiring and recruiting to dissect one of healthcare's biggest obstacles in the hopes of learning from each other and sharing that information to help us improve how and who we hire so that we can take better care of the communities and the people we serve. I am here with Andrea Leland. Welcome to the show. Thank you for coming. How are you? Andrea: I'm good. Thank you for having me. Ubaldo: Absolutely. So tell us a little bit about you, your background, Dartmouth Health, and then we'll dive into a conversation about recruitment and hiring in healthcare. Andrea: Okay. So Dartmouth Health is a large hospital system, academic health system, level one trauma center in Lebanon, New Hampshire, which is really rural New Hampshire when you think cows and farms, and we are definitely in that part of New England, which is a beautiful place to live and work, but we are a health system. We have other hospitals throughout the state, and even into more, I would say, urban living in the southern part when you get near the Massachusetts border. We have a couple hospitals that are in great college communities, Cheshire Medical Center in Keene, and some affiliate hospitals that are definitely within the Lebanon area of the Upper Valley. So we support six hospitals and two ambulatory surgery centers and 30 ambulatory clinics throughout New Hampshire and in Vermont. Ubaldo: And how did you get into the role you're in today? Because as you said before we hit record, you've been there for 19 years, and you kind of ended up in physician recruitment. How did that happen? What was that journey? Andrea: Yes, in the industry we joke and say no one decides they're going to be a physician recruiter. That's not their career aspiration, but people tend to fall into it and stay there. And so I started after getting an MBA in healthcare working in the president's office managing faculty appointments, the academic side for the clinic, and really grew to love working with the physician population. And so I kind of cut my teeth in my first post-grad school job and ended up staying there for a while before I went into the medical staff side, which is credentialing, privileging, and commercial enrollment. And so continued to work with the provider population and enjoyed that, did that for almost a decade, and decided I was ready for a change. And we worked so closely with recruitment. I had a colleague who convinced me to give it a try, and I fell in love. I loved using that expertise I'd built for several years in the provider space and then making connections with great providers and talking about opportunities to really provide quality patient care in the community where I live and where my family receives care. So I had a vested personal interest too, not just a professional interest. Ubaldo: And why? Because I've heard that before, that recruiters don't end up, they don't seek that out, but they sort of end up there. Why do you think that is? Andrea: That's a really good question. I'm not sure I know the answer, but I will say that once people start in that profession, you find that you're part of a much larger group of individuals that truly collaborate and share best practices and will help you. And that's really cool. I've been in a few other industries where it wasn't quite that same tight-knit group. There's a lot of shared resources. You'd think we'd all be competing with each other, which we are to a degree, but there's just so much knowledge being shared and support and understanding of the challenges, the frustrations you have. I think really when you go into provider recruitment and you find that you are successful, it encourages you to continue. But you can only be successful if you truly understand the challenges and the barriers that you're facing, and you can help to remove those to be successful. So it's not, most recruitment jobs are very transactional. You post a job, somebody applies, you process by sending to a hiring manager, maybe you have a brief email exchange or conversation. Physician recruiters are completely different. We develop a rapport and a relationship with you as a candidate. We get to know you. We get to know the needs of your family, because most people are relocating. So it's a long process. It's not a quick, you apply, you hire, you start. It can be anywhere up to two years when you start talking with a provider before they make the decision to come and sign with you. Ubaldo: Well, and you have a very vested interest in making sure that the people you're bringing to your health system match that mission and passion, because like you said earlier, your family is seeking care there, right? So talk a little bit about that, because that's, again, different too from other industries. I mean, this is someplace where you're helping to hire the people who are going to care for you and your family. Andrea: That's right. It is certainly having that personal vested interest makes it a lot more authentic what you do, the conversations you have. And on both sides too, because as somebody who receives healthcare, I'm able to tell them my experience not only as an employee of that healthcare system, but as a patient. And so I shared earlier, but I have a child with special needs, and it's really nice to be part of a system that I can easily navigate, that his primary care providers know all his specialty providers on a first name basis. And I'm not driving into large cities, dealing with parking, paying for hotel rooms overnight. You know, I can get that in a small rural area of New Hampshire, pick my son up three miles away from the medical center, bring him in. So I appreciate that from a perspective of being a patient. But I also want to make sure the people we're bringing on board are going to be the best of the best to provide that care that my family and other families in our community needs. Ubaldo: Yeah. What does your team do to ensure that everybody who's evaluating these positions is on the same page in terms of exactly what you're looking for? Like, what are those criteria that are required to be successful at Dartmouth Health? Andrea: I think you hit on it earlier when you said a shared vision mission. You really want people who care. This is certainly a job, but it's your life. And it's important to make sure that you bring people into your organization who care about providing quality patient care, who care about making connections with patients and other employees. It's not just a come in, punch a clock and leave. These people dedicate their lives to this profession. And so it's in everyone's best interest to find people who align with your vision, your mission, and your goals of your organization. Ubaldo: What are the biggest obstacles you're facing right now in terms of recruitment? Andrea: Position shortages. I will definitely say the active market has really been smaller than it's ever been. It's more competitive than it's ever been. You primarily have new grads leaving training that are looking for positions. The higher experience providers is a lot more challenging than it's ever been. And it's competitive. So it's no longer your, for us, it was our Ivy League academic game that was a big draw. That's not enough anymore. We're competing not just on compensation, but on quality of life benefits like vacation time, loan forgiveness, flexible scheduling, job sharing. And not all healthcare systems have the ability to truly flex with some of those things. It's a lot harder than it's ever been because there's more competition than there's ever been. And there's a smaller pool of candidates. Ubaldo: How are you addressing the competition piece? Andrea: Well, I don't want to give away all my secrets. I think it's definitely something we're still learning. And being able to pivot and adapt and see what's working, what's not working. It's really challenging to do that. But we try to really sell that work-life balance, the beautiful four-season living, no sales tax, no income tax. There are some great benefits, too, of working for a nonprofit academic system. If I have a provider who wants to make a really high salary, we might not be the best fit for them. So it's really finding people who align with what they're seeking, and it's not just about the salary. So selling those other aspects are really what helped to set us apart from competition. Ubaldo: What do you see as sort of the future of hiring? Not necessarily just for Dartmouth, but for the healthcare industry in general? Andrea: I think it's going to get harder and harder over time. I think we all did not expect to be where we are now. But I continue to see the AAMC has provided a lot of information and statistics on the physician shortage, the great resignation, and looking at what the future looks like in 2030 and 2040. It's really scary. Ubaldo: Yeah, why? What are the key indicators that we should be concerned about? Andrea: I'm not a subject matter expert on this, but a lot of what I've read is just showing that there are more people leaving the workforce in the provider space than are entering the workspace. And my anecdotal thoughts on it are more that people entering the workforce are not as productive as people leaving. It takes time. So you almost need to hire one and a half to two people to fill a retiring physician who's built an impressive productive practice over a career. Ubaldo: Absolutely. So how close, you mentioned 2030, 2040, but how close do you think we are to that crossroads where things could go fairly bad, healthcare-wise? Andrea: We're feeling it already. I think we've seen across the nation a huge impact just in primary care and trying to establish care with your primary care doctor. Panels are full. There are no open panels. There's long wait lists. Access is a huge issue, more I think in that space than in specialty care. And so I think that we'll have to be creative as we build a workforce. There's going to need to be more initiatives on workforce development. And how can we get people at a much younger point in their life to consider a profession in medicine? We've seen states like New York offer medical school for tuition coverage. We'll start to see more programs that may be funded at the state or federal level to help encourage that, to combat those shortages. I don't know if it will be enough and if it will be quick enough because we always tend to be reactive. And so the more proactive we can be at these initiatives will make a difference. But I think we're already kind of behind the eight ball there. Ubaldo: Yeah, I've kind of heard the same thing, particularly in the fact that maybe that there aren't enough even spots, right? Like residency spots or programs like you're talking about. There just aren't enough physically, if we think about it that way, to fill the top of the funnel. Andrea: There's less people desiring to go into academic medicine. So as an academic health system, we have to have providers to train medical students, residents, and fellows. So if you don't have faculty, clinical faculty, that are able to teach and willing to join your workforce to do that role, then the spots are going to continue to be limited. Yeah, absolutely. And it seems a little scary. Ubaldo: What does an organization like AAPPR provide that can sort of give us a little bit of light on innovation or technology? What kind of things are there through an organization like this or kind of in general that if we start adopting now, maybe we can speed things up a little bit? Andrea: AAPPR is fantastic at providing benchmarking data. They do an annual report, and that's the type of information that helps your leadership to make decisions on resources you need, on change you need to happen. And so they provide you the tools to kind of help your cause at a local level. Ubaldo: And I think also just an incredible high number of people in your profession who share their creative solutions. Again, we talked about that. Andrea: There's just such camaraderie and collaboration that we're constantly learning from each other. And that's unheard of, I think, for people to be so forthcoming with those best practices and so supportive. There's so many webinars, educational content, conferences, and then there's quite a few AAPPR subgroups that are for your region. And so I live in New England. We have a New England group that also provides that at a more geographic level. Ubaldo: Okay, that's great. So, yeah, in essence, I guess I see AAPPR's giving voice to recruiters who often don't feel like they can. And I know you all, you in particular, have talked about you making that voice for yourself, like you're standing up. But there are a lot of recruiters who maybe don't feel like they have kind of that ability to do that. And so what's your advice for them? How do they stand up and say, look, I can't keep bringing you candidates, for example, if you're going to treat them this way and they're going to leave because of the environment that we've created for them? How can a recruiter just stand up and say something like that? Andrea: It starts with building credibility and rapport. When you have that basic trust with the people you're working with on a regular basis and that credibility, they will listen to you. If you try to go in and share that feedback without that baseline, having that rapport and being credible, you won't make movement forward. And so I think that's something that my team has done really well over time. And we try to help new people coming into our team to really learn those cornerstone steps for how do you become a trusted business partner? You're not just a recruiter. You're not just somebody in HR or on the provider recruitment team. You're part of that team. Maybe it's radiology. You're part of the radiology service line. You are their trusted business partner who's going to help bring providers to them. It goes both ways, but until you prove to them that you're credible and you have that rapport, you're not going to make progress. Ubaldo: And I imagine that's where maybe the benchmarking data that you talked about becomes really helpful in that situation. Because if you can walk in with that data and say, look, here's how this applies to us, you can start to build that, at least that credibility and thought leadership. And look, I have this information here that's going to help us hire better. Andrea: Absolutely. And they give you the tools and so much education on how to do that. Maybe you're somebody who doesn't have experience speaking with leadership at a high level. Or you're somebody who struggles to find your voice. AAPPR gives you that educational content to help you grow and mature within that, not just on how to recruit a physician, but how to be a trusted business partner. Ubaldo: I love it. I love it. Well, I can't thank you enough, Andrea. Thank you so much for your time. Any last words of wisdom? Andrea: Don't give up. Hang in there. It's worth it. I think this is one of those jobs that you truly find such validation. And it is an incredible job that if you give up, you miss the rewards and the benefits. And so it's like a roller coaster. Some days you're on high and some days you're low. But you just kind of ride them out and you surround yourself with people who will help you get through those moments. Ubaldo: Awesome. Well, thank you very much. I really appreciate it. Ubaldo Extro: "A Hire Future in Healthcare" is a production of IIA healthcare, a technology organization powered by the interviewIA interview platform designed to help healthcare organizations hire better. Learn more at www.iiahealthcare.com. And in collaboration with AAPPR, the Association for Advancing Physician and Provider Recruitment, the leading authority on physician and provider recruitment and retention. Learn more at www.aappr.org.