1 00:00:01,679 --> 00:00:04,240 Every year, Becker's annual meeting brings health care 2 00:00:04,240 --> 00:00:06,799 leaders together to unpack the most pressing issues 3 00:00:06,799 --> 00:00:07,779 facing the industry. 4 00:00:08,160 --> 00:00:10,980 And every year, those conversations shift in profound 5 00:00:11,039 --> 00:00:12,419 and unexpected ways. 6 00:00:12,785 --> 00:00:15,025 This April, more than 3,500 7 00:00:15,025 --> 00:00:17,204 healthcare executives will return to Chicago 8 00:00:17,505 --> 00:00:19,445 for Becker's sixteenth annual meeting. 9 00:00:19,824 --> 00:00:22,785 Seven ninety five elite speakers will offer new 10 00:00:22,785 --> 00:00:25,809 lessons, new case studies, and predictions about what 11 00:00:25,809 --> 00:00:26,550 comes next. 12 00:00:26,850 --> 00:00:29,109 Join us April 13 through the sixteenth. 13 00:00:29,489 --> 00:00:33,969 For the agenda and event details, visit beckershospitalreview.com 14 00:00:33,969 --> 00:00:35,809 and click on the events tab in the 15 00:00:35,809 --> 00:00:36,629 upper right. 16 00:00:38,064 --> 00:00:40,945 This is Scott Becker with the Beckers Health 17 00:00:40,945 --> 00:00:41,684 Care podcast. 18 00:00:42,384 --> 00:00:44,465 We're thrilled to be joined by somebody who 19 00:00:44,465 --> 00:00:46,644 is at both a brilliant leader herself 20 00:00:47,104 --> 00:00:49,045 and at a magnificent health system, 21 00:00:50,144 --> 00:00:52,405 running and driving one of the most important 22 00:00:52,464 --> 00:00:53,880 areas in health care today. 23 00:00:54,679 --> 00:00:56,620 We're joined today by Heather Esola, 24 00:00:57,320 --> 00:00:59,260 and Heather is the vice president 25 00:00:59,640 --> 00:01:02,679 of physician assistant services at Mount Sinai Health 26 00:01:02,679 --> 00:01:03,179 System. 27 00:01:03,960 --> 00:01:06,439 Heather, we'll talk today about the role of 28 00:01:06,439 --> 00:01:06,939 physician 29 00:01:07,265 --> 00:01:09,265 assistants, the growth of importance in this in 30 00:01:09,265 --> 00:01:11,185 our in our daunting health care supply and 31 00:01:11,185 --> 00:01:12,165 demand environment, 32 00:01:12,545 --> 00:01:14,864 and a lot more. Can you take a 33 00:01:14,864 --> 00:01:16,864 moment and introduce yourself and tell us a 34 00:01:16,864 --> 00:01:19,185 bit about yourself and your career and also 35 00:01:19,185 --> 00:01:21,344 about Mount Sinai Health System, which really needs 36 00:01:21,344 --> 00:01:22,864 no introduction, but tell us a little bit 37 00:01:22,864 --> 00:01:25,320 about both. Yeah. Well, thank you for having 38 00:01:25,320 --> 00:01:28,439 me. It's wonderful to be able to speak 39 00:01:28,439 --> 00:01:29,659 about this topic 40 00:01:30,120 --> 00:01:32,939 and how it interrelates into our larger ecosystems 41 00:01:33,159 --> 00:01:34,600 of health care. I think we all have 42 00:01:34,600 --> 00:01:36,965 to be thinking about that now going forward. 43 00:01:38,225 --> 00:01:39,844 As far as me, my history, 44 00:01:40,625 --> 00:01:41,685 I started out 45 00:01:42,305 --> 00:01:45,525 about twenty years ago now in community medicine. 46 00:01:46,385 --> 00:01:49,424 I did HIV and hepatitis c work, when 47 00:01:49,424 --> 00:01:51,125 I came fresh out of school, 48 00:01:51,840 --> 00:01:54,480 and then found a liking towards women's health 49 00:01:54,480 --> 00:01:57,620 through that. I joined Mount Sinai Health System 50 00:01:58,000 --> 00:01:59,620 and their OB GYN department 51 00:02:00,239 --> 00:02:02,480 couple years into my career and have stayed 52 00:02:02,480 --> 00:02:04,799 ever since. I've been moving and grooving through 53 00:02:04,799 --> 00:02:06,855 the health system in different roles and different 54 00:02:08,135 --> 00:02:11,014 leadership positions, all while really supporting the work 55 00:02:11,014 --> 00:02:11,594 of advanced practice 56 00:02:12,855 --> 00:02:15,435 providers, specifically for PAs under me, 57 00:02:15,935 --> 00:02:16,435 and, 58 00:02:16,935 --> 00:02:17,995 was the first, 59 00:02:18,615 --> 00:02:21,034 director of PA services for the health system, 60 00:02:21,094 --> 00:02:22,235 inaugural position. 61 00:02:23,469 --> 00:02:24,370 COVID happened 62 00:02:24,750 --> 00:02:27,969 that really elevated the role of having, 63 00:02:28,830 --> 00:02:31,550 PAs and NPs in executive roles to help 64 00:02:31,550 --> 00:02:33,169 system management orientation, 65 00:02:33,469 --> 00:02:35,534 strategy operations, and since then, 66 00:02:36,175 --> 00:02:38,335 has really blossomed into what we have now 67 00:02:38,335 --> 00:02:40,594 as a center for advanced practice providers 68 00:02:41,135 --> 00:02:43,715 and everything that follows underneath that for strategy 69 00:02:43,775 --> 00:02:46,254 operations, retention. You name it, we do it 70 00:02:46,254 --> 00:02:47,715 for advanced practice providers. 71 00:02:48,709 --> 00:02:50,789 And talk about the evolution from being a 72 00:02:50,789 --> 00:02:52,250 physician assistant yourself 73 00:02:52,709 --> 00:02:54,469 to to now sort of vice president of 74 00:02:54,469 --> 00:02:55,930 physician assistant services 75 00:02:56,549 --> 00:02:58,870 in that that development. I know you've also 76 00:02:58,870 --> 00:03:00,489 gone back to do an MBA, 77 00:03:01,405 --> 00:03:04,444 constant self improvement and learning. But talk about 78 00:03:04,444 --> 00:03:05,905 that movement from practicing 79 00:03:06,764 --> 00:03:07,504 to leading 80 00:03:08,125 --> 00:03:09,724 and some of the evolution in that for 81 00:03:09,724 --> 00:03:10,224 yourself. 82 00:03:10,764 --> 00:03:11,264 Sure. 83 00:03:12,044 --> 00:03:13,710 I was always a doer, 84 00:03:14,250 --> 00:03:15,689 and I always knew I wanted to be 85 00:03:15,689 --> 00:03:17,550 a PA, and that was abnormal 86 00:03:17,849 --> 00:03:18,349 twenty 87 00:03:18,650 --> 00:03:20,729 some now, you know, more than that, twenty 88 00:03:20,729 --> 00:03:22,030 five, thirty years ago. 89 00:03:22,569 --> 00:03:25,389 Not many people were going into the workforce 90 00:03:25,665 --> 00:03:27,125 as wanting to be a PA. 91 00:03:28,145 --> 00:03:31,104 So coming out, I knew my place, but 92 00:03:31,104 --> 00:03:34,145 then I was always interested in how something 93 00:03:34,145 --> 00:03:34,645 works 94 00:03:35,264 --> 00:03:38,224 and how practices work and how all of 95 00:03:38,224 --> 00:03:39,500 the staff are interrelated. 96 00:03:40,199 --> 00:03:42,039 So very early when I was even in 97 00:03:42,039 --> 00:03:43,979 community medicine, I was doing the interdisciplinary 98 00:03:44,519 --> 00:03:47,019 workshops. I was doing community teaching. 99 00:03:47,319 --> 00:03:49,819 It was being a provider, but then also 100 00:03:50,280 --> 00:03:52,604 being involved in all these other systems and 101 00:03:52,604 --> 00:03:54,465 operations that make health care tick. 102 00:03:55,324 --> 00:03:57,745 When I moved into Mount Sinai Health System, 103 00:03:58,284 --> 00:04:00,865 I really got a feel for the academic 104 00:04:01,004 --> 00:04:01,824 health center, 105 00:04:03,085 --> 00:04:04,711 all the layers that are within it and 106 00:04:04,711 --> 00:04:05,585 was really intrigued by all of it. So 107 00:04:10,039 --> 00:04:12,379 centric care, but in order to have 108 00:04:12,680 --> 00:04:14,219 great patient care delivery, 109 00:04:14,599 --> 00:04:17,319 there's about 70 other processes that have to 110 00:04:17,319 --> 00:04:19,019 happen before you see a patient, 111 00:04:19,319 --> 00:04:20,139 and I loved 112 00:04:20,495 --> 00:04:22,194 figuring that all out. So, 113 00:04:22,974 --> 00:04:25,375 it started very simply on the floors of 114 00:04:25,375 --> 00:04:28,115 doing, like, throughput and policy management 115 00:04:28,574 --> 00:04:30,814 and just really pet projects that I took 116 00:04:30,814 --> 00:04:33,294 a liking to and wanted to get done 117 00:04:33,294 --> 00:04:34,914 for the betterment of the practice, 118 00:04:35,670 --> 00:04:38,550 which led into me becoming the clinical director 119 00:04:38,550 --> 00:04:39,689 for OB GYN, 120 00:04:40,389 --> 00:04:42,569 at our Mount Sinai Hospital campus. 121 00:04:43,189 --> 00:04:45,430 And then that led into me saying, hey. 122 00:04:45,430 --> 00:04:46,569 There's gotta be 123 00:04:47,189 --> 00:04:49,529 more than this for other APPs. 124 00:04:49,990 --> 00:04:52,194 A lot of APPs have this, 125 00:04:53,555 --> 00:04:56,194 ability to see the the things that we're 126 00:04:56,194 --> 00:04:58,194 doing in health care above and below and 127 00:04:58,194 --> 00:04:58,935 to the sides. 128 00:04:59,314 --> 00:05:01,735 We're a great middleman. We see everything. 129 00:05:02,435 --> 00:05:04,729 So that makes us great at strategy and 130 00:05:04,729 --> 00:05:05,229 operations. 131 00:05:05,769 --> 00:05:07,289 So I took that and brought that to 132 00:05:07,289 --> 00:05:08,189 the health system 133 00:05:08,649 --> 00:05:09,709 and really proposed 134 00:05:10,089 --> 00:05:12,509 way back this is back in 2016. 135 00:05:13,209 --> 00:05:15,689 Listen. We can really do something with this 136 00:05:15,689 --> 00:05:17,769 large workforce. I don't even know how many 137 00:05:17,769 --> 00:05:20,305 there are of us here. That's one problem. 138 00:05:20,305 --> 00:05:22,064 So maybe we should figure that out, and 139 00:05:22,064 --> 00:05:23,205 maybe we should see 140 00:05:23,745 --> 00:05:24,725 how we can 141 00:05:25,105 --> 00:05:25,605 emphasize, 142 00:05:26,064 --> 00:05:26,564 grow, 143 00:05:27,024 --> 00:05:28,324 and use this workforce 144 00:05:28,705 --> 00:05:30,865 to the ability instead of having it siloed 145 00:05:30,865 --> 00:05:33,444 in all these departments under individual physicians. 146 00:05:33,919 --> 00:05:35,519 And that was really the going rate and 147 00:05:35,519 --> 00:05:36,899 then when COVID happened 148 00:05:37,279 --> 00:05:39,759 there was an absolute need because now you 149 00:05:39,759 --> 00:05:41,860 needed to move an entire workforce 150 00:05:42,879 --> 00:05:45,855 and the beauty of having NPs and PAs 151 00:05:46,014 --> 00:05:47,475 is the general boarding. 152 00:05:47,855 --> 00:05:50,574 So they're not specialty specific. So now you 153 00:05:50,574 --> 00:05:51,395 have this 154 00:05:51,855 --> 00:05:54,675 movement of workforce that answers disruption. 155 00:05:55,055 --> 00:05:56,814 So if we needed that, we still need 156 00:05:56,814 --> 00:05:57,795 it to this day. 157 00:05:58,979 --> 00:05:59,479 Just 158 00:05:59,939 --> 00:06:02,819 a fantastic, and what a fantastic career, Heather, 159 00:06:02,819 --> 00:06:03,560 in perspective. 160 00:06:04,419 --> 00:06:06,120 The the the future going forward, 161 00:06:06,500 --> 00:06:08,360 projections show we're already 162 00:06:08,740 --> 00:06:11,160 incredibly short of primary care physicians. 163 00:06:12,604 --> 00:06:15,644 We're developing nurses in PAs at a much 164 00:06:15,644 --> 00:06:18,464 better rate than we are physicians. 165 00:06:19,404 --> 00:06:21,564 What does the future of primary care look 166 00:06:21,564 --> 00:06:22,064 like? 167 00:06:22,524 --> 00:06:24,064 Is it likely to be 168 00:06:24,600 --> 00:06:26,779 a a large percentage 169 00:06:27,160 --> 00:06:28,540 conducted by PAs? 170 00:06:29,240 --> 00:06:31,000 And, I mean, we're already seeing a ton 171 00:06:31,000 --> 00:06:32,040 of that. What do we have to do 172 00:06:32,040 --> 00:06:33,740 to make sure that that goes great? 173 00:06:34,199 --> 00:06:36,860 Any thoughts on the future of primary care? 174 00:06:37,000 --> 00:06:39,800 Is it PA driven, MP driven versus doctor 175 00:06:39,800 --> 00:06:40,300 driven? 176 00:06:40,625 --> 00:06:42,004 Is it a mix of those? 177 00:06:42,384 --> 00:06:43,425 And what do we have to do to 178 00:06:43,425 --> 00:06:44,404 make sure it goes 179 00:06:44,785 --> 00:06:47,125 great? Yeah. I think it's a true collaborative 180 00:06:47,185 --> 00:06:47,685 model. 181 00:06:48,225 --> 00:06:48,725 You 182 00:06:49,425 --> 00:06:52,485 don't have excellence of care unless you have 183 00:06:53,185 --> 00:06:53,685 physicians. 184 00:06:54,145 --> 00:06:55,045 Right? And 185 00:06:55,819 --> 00:06:58,459 PAAs and NPs will take their charge from 186 00:06:58,459 --> 00:06:59,439 physician leadership. 187 00:07:00,539 --> 00:07:02,300 And it also goes state by state. So 188 00:07:02,300 --> 00:07:03,439 every state is 189 00:07:03,979 --> 00:07:06,300 is going to think of these rules differently. 190 00:07:06,300 --> 00:07:09,105 So in New York where we are, we 191 00:07:09,105 --> 00:07:11,345 have a lot of full practice ability. So 192 00:07:11,345 --> 00:07:13,504 NPs can open their own practices. So that's 193 00:07:13,504 --> 00:07:15,425 one thing. But other states, that's not true. 194 00:07:15,425 --> 00:07:16,785 So it really is gonna be a state 195 00:07:16,785 --> 00:07:17,764 by state answer. 196 00:07:18,305 --> 00:07:19,125 But, generally, 197 00:07:20,384 --> 00:07:22,805 team based practice is where it's gonna be. 198 00:07:23,149 --> 00:07:24,129 If you have 199 00:07:24,509 --> 00:07:25,250 a physician 200 00:07:25,709 --> 00:07:27,310 and an NP and a PA or a 201 00:07:27,310 --> 00:07:29,389 physician and two PAs, however you make up 202 00:07:29,389 --> 00:07:30,209 that model, 203 00:07:30,589 --> 00:07:31,729 those three people 204 00:07:32,189 --> 00:07:34,909 can take care of 10 times the amount 205 00:07:34,909 --> 00:07:36,769 of people if just one of them did. 206 00:07:36,990 --> 00:07:40,365 So really taking care of a population within 207 00:07:40,365 --> 00:07:41,024 a practice. 208 00:07:41,644 --> 00:07:42,305 And then 209 00:07:42,844 --> 00:07:45,245 the answer everyone loves giving is top of 210 00:07:45,245 --> 00:07:46,625 licensed care, but 211 00:07:47,084 --> 00:07:48,844 that's a very easy thing to say. It's 212 00:07:48,844 --> 00:07:50,865 a really hard thing to do in practice. 213 00:07:52,050 --> 00:07:53,990 So are they seeing patients independently? 214 00:07:54,529 --> 00:07:56,149 Do they have their own schedules? 215 00:07:56,769 --> 00:07:59,750 Do they have the similar medical staff privileges 216 00:08:00,129 --> 00:08:02,209 as your physicians do in their scope of 217 00:08:02,209 --> 00:08:02,709 practice 218 00:08:03,009 --> 00:08:04,310 so they can do everything 219 00:08:04,745 --> 00:08:07,085 that they're able to and competent for. 220 00:08:07,464 --> 00:08:09,145 And then are we measuring it? Are we 221 00:08:09,145 --> 00:08:11,485 measuring the right things? It's not just revenue. 222 00:08:11,785 --> 00:08:14,045 It could just be that, you know, we're 223 00:08:14,105 --> 00:08:16,925 improving our throughput. We have better patient retention. 224 00:08:17,305 --> 00:08:19,865 There's all these knock on effects that I 225 00:08:19,865 --> 00:08:22,889 think people skim over, but what APPs are 226 00:08:22,889 --> 00:08:24,970 really good at. They're getting the patients in. 227 00:08:24,970 --> 00:08:26,670 They're improving the patient experience. 228 00:08:27,209 --> 00:08:29,689 They're keeping the longevity of the practice. They 229 00:08:29,689 --> 00:08:30,829 hold up the volume. 230 00:08:31,449 --> 00:08:33,565 It really is a collaborative sport, and I 231 00:08:33,565 --> 00:08:35,245 think we just all need to move in 232 00:08:35,245 --> 00:08:36,784 that direction to efficiently 233 00:08:37,565 --> 00:08:40,044 care for a large population. There's not enough 234 00:08:40,044 --> 00:08:40,705 of us. 235 00:08:41,565 --> 00:08:43,644 No. I think that's exactly right, and the 236 00:08:43,644 --> 00:08:46,125 supply and demand issues are daunting. And I 237 00:08:46,125 --> 00:08:47,904 love what you said about top of license. 238 00:08:48,389 --> 00:08:50,710 Yes. It's very important, but it's simple to 239 00:08:50,710 --> 00:08:51,990 stay, and there's a lot more to it 240 00:08:51,990 --> 00:08:52,730 than that. 241 00:08:53,110 --> 00:08:56,889 Just like physicians, PAs, there's different state rules. 242 00:08:56,950 --> 00:08:59,750 There's different qualifications for different people depending on 243 00:08:59,750 --> 00:09:01,269 how great they are, what they do, and 244 00:09:01,269 --> 00:09:02,629 what does that mean in terms of top 245 00:09:02,629 --> 00:09:03,930 of license and so forth. 246 00:09:04,845 --> 00:09:05,884 How is PA 247 00:09:06,684 --> 00:09:07,585 it seems like 248 00:09:08,365 --> 00:09:10,365 when I have a PA for my treatment 249 00:09:10,365 --> 00:09:10,865 today, 250 00:09:11,404 --> 00:09:13,884 when I go to urgent care, I go 251 00:09:13,884 --> 00:09:15,825 to the doctor, I go to the orthopedic, 252 00:09:16,845 --> 00:09:19,809 it seems today that the category of PAs 253 00:09:19,809 --> 00:09:21,110 that I am seeing 254 00:09:21,649 --> 00:09:23,429 seem really well trained, 255 00:09:24,129 --> 00:09:27,029 and and and really productive and really helpful. 256 00:09:28,529 --> 00:09:30,470 What does it take to make that consistent 257 00:09:30,610 --> 00:09:31,669 throughout the universe 258 00:09:32,235 --> 00:09:34,554 to where I mean, physician quality is, of 259 00:09:34,554 --> 00:09:35,054 course, 260 00:09:35,754 --> 00:09:38,315 like any professional quality, it depends on the 261 00:09:38,315 --> 00:09:40,235 day and is all over the board. Some 262 00:09:40,235 --> 00:09:43,134 are fantastic. Some are okay. The same with 263 00:09:43,595 --> 00:09:47,039 podcasters, lawyers, publishers, any business you're in. Some 264 00:09:47,039 --> 00:09:48,419 are great, some are not. 265 00:09:49,200 --> 00:09:50,019 How do you 266 00:09:50,399 --> 00:09:52,480 I'm having great experience with the PAZDC. I 267 00:09:52,480 --> 00:09:53,919 quite frankly have great experience with the doctors 268 00:09:53,919 --> 00:09:55,679 I see too. But but how do we 269 00:09:55,679 --> 00:09:57,679 make that more standardized and more uniform? Is 270 00:09:57,679 --> 00:09:58,740 there is there a 271 00:09:59,120 --> 00:10:00,259 a thought on that? 272 00:10:01,554 --> 00:10:03,075 I think some of this is in the 273 00:10:03,075 --> 00:10:03,575 way 274 00:10:04,674 --> 00:10:05,654 we're trained, 275 00:10:06,034 --> 00:10:08,214 and the the programs 276 00:10:08,595 --> 00:10:11,315 that are in existence today do a very 277 00:10:11,315 --> 00:10:12,534 good job of 278 00:10:12,995 --> 00:10:14,054 making sure 279 00:10:14,899 --> 00:10:17,320 the PAs and the NPs that are graduating 280 00:10:17,860 --> 00:10:19,480 are clinically competent 281 00:10:20,340 --> 00:10:22,179 and in a place where they have a 282 00:10:22,179 --> 00:10:24,580 great starting point for day one on the 283 00:10:24,580 --> 00:10:25,080 job. 284 00:10:25,460 --> 00:10:27,934 But from that point on, it really 285 00:10:28,475 --> 00:10:31,215 is the work of the practice, the physicians, 286 00:10:32,235 --> 00:10:33,054 the institutions, 287 00:10:33,434 --> 00:10:35,695 the systems that they're part of to 288 00:10:36,075 --> 00:10:37,754 really do what a lot of people call 289 00:10:37,754 --> 00:10:39,215 as transition to practice. 290 00:10:39,929 --> 00:10:42,410 And that transition to practice, those first two, 291 00:10:42,410 --> 00:10:44,830 three years that someone is out and working, 292 00:10:45,290 --> 00:10:47,070 because we don't have residency, 293 00:10:47,850 --> 00:10:50,730 those are our most moldable times. So all 294 00:10:50,730 --> 00:10:52,725 of the good behaviors of 295 00:10:53,204 --> 00:10:54,264 patient experience, 296 00:10:54,725 --> 00:10:55,865 bedside care, 297 00:10:56,324 --> 00:10:57,704 how you care for patients, 298 00:10:58,084 --> 00:10:59,704 how you're critically thinking, 299 00:11:00,164 --> 00:11:02,644 how you're putting those differential diagnoses, and then 300 00:11:02,644 --> 00:11:04,404 how you tie it into everything is all 301 00:11:04,404 --> 00:11:07,125 around how supportive of a work environment you're 302 00:11:07,125 --> 00:11:07,590 in. 303 00:11:08,550 --> 00:11:11,769 So as more institutions and more practices 304 00:11:13,029 --> 00:11:15,910 embrace EPPs, it does have to come with 305 00:11:15,910 --> 00:11:16,490 a level 306 00:11:17,509 --> 00:11:19,529 of systems, processes, educations 307 00:11:20,105 --> 00:11:21,644 to support that workforce. 308 00:11:22,345 --> 00:11:24,184 So you'll get a good PA or NP 309 00:11:24,184 --> 00:11:26,445 if they're well supported, well educated, 310 00:11:26,985 --> 00:11:28,365 have access to CME, 311 00:11:29,065 --> 00:11:31,884 have, you know, a great ability with their 312 00:11:32,345 --> 00:11:33,629 HR, and they feel like 313 00:11:34,669 --> 00:11:36,930 they're in a good position. It's it's all 314 00:11:36,930 --> 00:11:37,629 of those things that make an employee shine. 315 00:11:37,629 --> 00:11:39,090 Right? And then that translates 316 00:11:39,710 --> 00:11:42,110 to great patient care. So it's a very 317 00:11:42,110 --> 00:11:44,529 complex answer, but it really is about 318 00:11:44,910 --> 00:11:46,210 embracing the profession, 319 00:11:46,750 --> 00:11:47,889 knowing specifically 320 00:11:48,509 --> 00:11:48,601 what the job description is, and then supporting 321 00:11:48,601 --> 00:11:49,330 that job description in whatever way the system 322 00:11:50,485 --> 00:11:52,884 and then supporting that job description in whatever 323 00:11:52,884 --> 00:11:54,264 way the system can. 324 00:11:55,605 --> 00:11:57,524 Fantastic. And and let me ask you one 325 00:11:57,524 --> 00:11:58,264 more question, 326 00:11:58,964 --> 00:12:00,664 before I let you go. Heather, 327 00:12:01,204 --> 00:12:03,625 talk about this year, 2026. 328 00:12:03,960 --> 00:12:05,800 What are you most focused and excited about 329 00:12:05,800 --> 00:12:06,540 this year? 330 00:12:07,800 --> 00:12:11,500 I am most excited about fine tuning 331 00:12:12,600 --> 00:12:15,899 that top of license answer. We've started to 332 00:12:16,679 --> 00:12:19,100 dabble with it in the last year, but 333 00:12:19,434 --> 00:12:22,235 on a very large scale, so we're talking 334 00:12:22,235 --> 00:12:25,434 about seven hospitals and and all of their 335 00:12:25,434 --> 00:12:28,014 faculty practices and ambulatory practices, 336 00:12:28,795 --> 00:12:30,254 how can we make 337 00:12:30,875 --> 00:12:33,215 this workforce and other workforces 338 00:12:34,389 --> 00:12:36,809 be the most efficient and sustainable 339 00:12:37,190 --> 00:12:39,509 for our changing health care. And I think 340 00:12:39,509 --> 00:12:41,529 we're really breaking into that. So 341 00:12:41,990 --> 00:12:43,750 what are the things that are the items 342 00:12:43,750 --> 00:12:46,149 and goals and our balanced scorecard of the 343 00:12:46,149 --> 00:12:48,554 health system that are reflected 344 00:12:48,855 --> 00:12:50,774 in the APP workforce. And I don't think 345 00:12:50,774 --> 00:12:52,455 a lot of people have done that on 346 00:12:52,455 --> 00:12:54,774 a such a large scale. So I'm really 347 00:12:54,774 --> 00:12:56,634 excited to break into that and 348 00:12:58,134 --> 00:12:59,115 come up with 349 00:12:59,495 --> 00:13:00,649 a play book, really, 350 00:13:01,110 --> 00:13:03,929 of how to do this APP workforce 351 00:13:04,709 --> 00:13:07,049 in a way that it's going to answer 352 00:13:07,190 --> 00:13:09,909 our resiliency in health care and how we 353 00:13:09,909 --> 00:13:11,909 can be innovative and then how can we 354 00:13:11,909 --> 00:13:14,169 be efficient with the person power we have. 355 00:13:15,065 --> 00:13:16,585 Thank you. No. I I I love that, 356 00:13:16,585 --> 00:13:18,985 and and I quite frankly love your entire 357 00:13:18,985 --> 00:13:21,965 career and career trajectory from PA 358 00:13:22,504 --> 00:13:23,245 to leadership 359 00:13:23,625 --> 00:13:25,625 to to just a broad thinker on all 360 00:13:25,625 --> 00:13:27,325 these issues. It's really remarkable. 361 00:13:27,785 --> 00:13:28,764 Thank you. Heather, 362 00:13:29,384 --> 00:13:30,639 it it it really is. I I I 363 00:13:30,639 --> 00:13:32,399 wanna thank you for joining us on the 364 00:13:32,399 --> 00:13:34,339 Becker's HealthCare podcast today. 365 00:13:34,639 --> 00:13:36,320 Truly, you've you you you're in one of 366 00:13:36,320 --> 00:13:37,839 those roles, and you're one of those people 367 00:13:37,839 --> 00:13:39,759 that that's really one of the solutions to 368 00:13:39,759 --> 00:13:41,360 where health care is going and where it 369 00:13:41,360 --> 00:13:43,279 has to go. So thank you for all 370 00:13:43,279 --> 00:13:44,861 you do, and thank you for joining us. 371 00:13:45,101 --> 00:13:47,281 Thank you. Appreciate it. Thanks for having me.