The Recruitment of Healthcare Workers with Creston Tate| E. 53

Episode Introduction  

Demand for urgent care has intensified since 2020. In this episode, Jim Cagliostro, VIE’s Clinical Operations Performance Improvement Expert, interviewed Creston Tate to explore the impact of the pandemic, the growing demand for urgent care facilities, the reasons behind the ‘’Great Resignation’’, and the need to adapt to a shrinking talent pool.  

Show Topics  

‘’My experience grew, my appreciation for medicine grew, my appreciation for the urgent care world, I call it the episodic world of medicine really grew too. There's clearly a huge gap in care for this particular type of patient that isn't being provided in the outpatient world. I did that for 17 years and just about six years ago, I transitioned into more of an outpatient urgent care directorship through my current healthcare system and have really enjoyed the growth that we have had, which is probably somewhere around the 12 to 13% growth rate per year in urgent care. As we started with five and now we're opening up our 15th urgent care this year with record volumes. I've seen it in the inpatient world, in the emergency room, and now I'm seeing it in the outpatient world and I'm bringing it all together and it's been fun to see that happen…..With the influx of patients to emergency departments and the overcrowding of EDs and wait times, perhaps some of your listeners have actually unfortunately experienced a 10 or 12-hour wait in emergency departments, it's just not fun. It's been estimated that even up to 50 to 60% of ED visits could have been handled outside of the emergency department, if the resources were there. I think that's where urgent cares and primary care providers can step in, if there's enough providers and enough access available for that. I've seen a huge switch. I know that for us, we open 12 hours a day. I think if we opened 18, we would have just as big a volume as we do now, if not larger.’’ 

06:08 How the ‘’Great Resignation’’ affects patients.  

Creston explained the difference between unfilled jobs in the healthcare sector versus vacancies in retail.  

‘’Whether you go to a restaurant or you go to a convenience store, it seems like there's a paucity of workers. Despite the published low unemployment rate, it does seem like there's a lot of jobs that just aren't being filled. You take that for what it's worth, but clearly healthcare, maybe isn't affected more as far as numbers, but what I will say, Jim, is that healthcare is affected more impactfully because it is an essential piece of our fabric. If we don't have the right number of healthcare workers, people's health suffers. If we don't have enough people working at a Walmart, well, you might just have to search around for something a little longer yourself or wait in line a little bit longer, or maybe the shelves aren't stocked as readily as you would like them to be. The impact there is certainly felt more if somebody can't get their diabetic medication or their follow-up or their blood work or that CAT scan that they've been looking for to follow that tumor, than if somebody is simply shopping for material goods. I do agree with you, the resignation as it's been called, we've seen it. We certainly in our healthcare system have seen it tremendously. What I will say is that we haven't seen a tremendous loss of... And again, I'll speak from my own personal experience. In the urgent cares that I work in I don't think we've had a huge number of people leave healthcare. We have had a number of them switch out of urgent care, which has been inundated with complex patients, probably more complex than we should see, and also sicker patients. Going through the pandemic and gowning up with gloves and masks and goggles and all this paraphernalia to try to protect our healthcare workers, it has been quite a ride for our providers and our staff.  Quite frankly, I think the burnout rate is really more just fatigue. They're just tired of this continual ask to see patients who are sicker and sicker and they don't feel as though perhaps they're getting reimbursed for the higher level of risk that they're taking compared to rest of society.’’ 

10:16 Reimbursement and the Walmart/Amazon challenge.  

Creston said the higher salaries offered by Walmart and Amazon make it difficult for healthcare organizations to compete in attracting talent.  

‘’One of the greatest challenges in healthcare is going to be the big box store. Whether you look at the Walmarts or you look at the Amazons out there that just bought up one medical and 125 stores, which were like healthcare facilities that they bought up. Now there's going to be a challenge of trying to retain our own employees when maybe someone like Amazon could offer them more dollars per hour. You thin out the potential pool of good healthcare workers, even greater when that kind of thing occurs. Again, that's big business. I understand that. Their goal is to try to provide better healthcare to more people in a more efficient and cost-effective way. Whether or not they succeed in that, I don't know, but you have that. Then you also have the challenge of other very wealthy companies who are offering $17 or $18 or $19 an hour as a startup when we're looking for medical assistants that typically are $17/16.50 an hour. They may not go into medical assistant work. Instead, they're going to take another job because it pays $3 to $4 an hour because inflation is causing them to make those decisions for their family so that they can feed their family. We're seeing perhaps the same number of workers who are being thinned out and perhaps pulled away from healthcare that once maybe in the past would have considered healthcare to go into as a stable job.’’ 

12:40 Flexible schedules are essential to attract the right people. 

Creston commented that healthcare must adapt to candidate needs to fill the gaps in the workforce. 

‘’When I went into medicine, when I got hired by that first company to work family medicine, I worked hard and I came in on Saturdays and I took call. I didn't complain. I double and triple booked. It was all that sort of thing, because it was kind of expected perhaps at that time. When we interview candidates now for positions, I had to put that own bias aside and I had to say, "If I see a candidate who is really a strong candidate for us, that I want to get on our team, I may have to think a little bit outside the box and say, 'Okay, I have a 25 or a 28-year-old mother who's perhaps an RN who we want to hire because she is just fantastic. Her skill set is great. Her fit and personality is perfect for our team. I have to figure out a way that I'm going to have her on our team.'" It may be that I have to work my schedule a little bit differently because of her because she has a family and she has other things that are balancing her life a little differently than perhaps I would have back in those days. I would have to also think about healthcare. How can we give her the hours that she needs so that she can help us and also provide the healthcare for her family that she needs? I think there's a lot of ways in which I think we, as leaders of these larger companies have to start thinking ways of adapting to the needs of our workers today. If I were to simply say, "Well, that's just not the way we've done things." I probably wouldn't find anybody to work for me because we have to work around people's schedules today.’’ 

17:44 The shrinking candidate pool. 

Creston stated that numbers of available candidates have fallen significantly since Covid.  

‘’Prior to 2020, for any given opportunity to work as a provider or staff member for us, we would have five to seven candidates. Now we have about three. Our qualifications perhaps haven't changed too much, but we've had to sometimes look a little bit deeper, maybe ask a little bit different type of question to the three candidates that we may only get and say, "Okay. Well, we're only going to get three for this position because we need to get somebody relatively soon, who is the best one out of these three?" I think that's been a little bit more difficult for us. I guess, we don't have... Obviously the larger the pool, the better you can say, "Okay. This is the perfect person." When your pool is narrowed, you sometimes have to take chances and sometimes our chances are right on and we thought, "Boy, I thought you were going to be a question mark, but you have turned out to be an amazing provider." We've had to do that. Our number of candidates typically is much smaller now to find the best fit. One thing that we've also changed and really try to do more of is we try to involve our providers a little bit more in that interview process, meaning that the leaders will do the initial interview and then we bring that candidate back and we have them spend six or eight hours in our site. It's volunteer hours, but we tell them, "Listen, it may be worth it for you to make sure that you are working in the right place for you. We like you, but we want to make sure that you like the site, that you like the people that you're working with. Because if you sense there's going to be tension here, we would rather you know that at the very beginning of your employment, and we can address those issues if that's going to be the case." 

23:12 Ensuring safety means urgent care sites may close temporarily 

Creston said that the struggle to hire staff makes it difficult to guarantee high quality care.  

‘’One of the recent articles I've read talked about, where is the biggest fright in healthcare today? Again, in my urgent care world, number one 58% of people said hiring medical assistants and rad techs. There are crucial positions that we need in our healthcare system that there just isn't enough people out there to get. We say the pool is very dry and it's frustrating because we have actually had to close a couple of our sites on certain days, strictly because we didn't have the right support. We want to make sure that we provide the safest care and also the most compassionate care, but also do it in a way that we're not burning out and we're not frustrating our providers. It wouldn't be fair for me, Jim, if you were working for me and I said, "Jim, I know there's normally three staff members and two docs working today, but unfortunately you're the only person on, so you're going to have to carry the load for three people and we only have one doc too so you're probably going to have long wait times today." You're already defeated even before the day starts. That becomes very difficult and we have to boost each other up. We have to just carry the torch for each other because I think that if we don't look for ways in which we can solve some of these healthcare crisis issues with staffing, that's going to be the demise of a lot of good healthcare. A lot of people let their health go during COVID and we're seeing sicker and sicker patients because they couldn't get this or they couldn't get that. Or maybe they were afraid to go out, and some still are afraid to go out and get care.’’ 

Show Links 

Connect with Jim Cagliostro on LinkedIn 

Connect with Creston Tate on LinkedIn 

Check out VIE Healthcare Consulting 

You’ll Also Hear: 

From family medicine to the ER: how Creston’s previous experience equipped him for his role in urgent care  

The ‘’Great Resignation’’ in numbers. ‘’According to some of their reports, the healthcare industry has lost an estimated 20% of its workforce, including 30% of nurses.,,, in 2022, nearly 1.7 million people have quit their healthcare jobs…. Then a recent survey of a thousand healthcare professionals showed that 28% had quit a job because of burnout.’’ 

Why Covid is affecting career choice when it comes to healthcare. ‘’ Three years ago, we didn't have as much of that concern that they're going to take something home and infect their family.’’ 

The cultural shift: from ‘’lifers’’ to frequent job changers. How a change in perspective means employees move jobs every three to five years.  

The one sign that indicates your candidate has done their pre-interview preparation. 

Adapting to change: the growing number of ‘’greenies’’ in the healthcare sector. ‘’A physician's assistant is a classic example. Physician assistants oftentimes come through their medical career. They have that PA degree when they get out, but some of them have never stepped foot in an office before.’’