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.