1 00:00:00,080 --> 00:00:02,480 Welcome to Becker's Healthcare Podcast. I'm Chris Sosa, 2 00:00:02,480 --> 00:00:04,080 your host, and I'm thrilled to be joined 3 00:00:04,080 --> 00:00:06,319 today by doctor Gautam Rao. He's the Jack 4 00:00:06,319 --> 00:00:08,559 Medallie professor and chairman for the department of 5 00:00:08,559 --> 00:00:11,519 family medicine and community health at University Hospitals 6 00:00:11,519 --> 00:00:13,939 of Cleveland and Case Western Reserve University. 7 00:00:14,404 --> 00:00:17,524 He's also the chief clinician experience officer for 8 00:00:17,524 --> 00:00:20,004 University Hospitals Health System and editor in chief 9 00:00:20,004 --> 00:00:21,064 of Family Practice. 10 00:00:21,524 --> 00:00:23,304 Gautam, thank you for joining us today. 11 00:00:23,684 --> 00:00:25,364 Thank you, Chris. Thanks so much for having 12 00:00:25,364 --> 00:00:25,864 me. 13 00:00:26,324 --> 00:00:28,324 Gautam, for those in our audience who may 14 00:00:28,324 --> 00:00:30,000 not be familiar with you and your work, 15 00:00:30,160 --> 00:00:32,000 could you just please introduce yourself and tell 16 00:00:32,000 --> 00:00:33,460 us a little bit about your background? 17 00:00:33,840 --> 00:00:35,520 Yeah. So first and foremost, I am a 18 00:00:35,520 --> 00:00:38,159 family physician, have been one for, I guess, 19 00:00:38,159 --> 00:00:40,659 twenty nine years or so. Started my career 20 00:00:40,799 --> 00:00:43,380 after residency in rural Northern Ontario, 21 00:00:44,034 --> 00:00:46,594 then came to Pittsburgh, Pennsylvania, where I did 22 00:00:46,594 --> 00:00:49,494 a fellowship in faculty development and research methods, 23 00:00:50,274 --> 00:00:53,234 and really became been an academic family physician 24 00:00:53,234 --> 00:00:56,594 ever since, that point, but also practicing family 25 00:00:56,594 --> 00:00:57,655 medicine regularly. 26 00:00:58,250 --> 00:01:00,329 I'm also an obesity medicine physician. I was 27 00:01:00,329 --> 00:01:03,129 one of the first, physicians board certified in 28 00:01:03,129 --> 00:01:05,150 that, in that particular subspecialty. 29 00:01:06,170 --> 00:01:09,049 I'm a health services researcher with with, with 30 00:01:09,049 --> 00:01:11,689 a long well, many years in in the 31 00:01:11,689 --> 00:01:13,635 field, actually. I won't tell you how many, 32 00:01:13,954 --> 00:01:16,834 But, but, I've served on study sections and 33 00:01:16,834 --> 00:01:18,775 received funding from major agencies. 34 00:01:19,395 --> 00:01:21,795 I've I'm pretty experienced with medical editing, and 35 00:01:21,795 --> 00:01:23,795 I also serve on the US Preventive Services 36 00:01:23,795 --> 00:01:24,615 Task Force. 37 00:01:25,475 --> 00:01:27,155 Gautam, you certainly wear a lot of hats, 38 00:01:27,155 --> 00:01:29,620 and that's also very impressive and very important 39 00:01:29,620 --> 00:01:32,099 to all all your colleagues, I'm sure. We've 40 00:01:32,099 --> 00:01:34,180 got you on the podcast today to discuss, 41 00:01:34,500 --> 00:01:35,480 recruiting physicians. 42 00:01:35,939 --> 00:01:37,540 It was part of the issue of family 43 00:01:37,540 --> 00:01:39,799 practice, which again, you're the editor of that 44 00:01:39,939 --> 00:01:42,525 publication. So first question I have for you 45 00:01:42,525 --> 00:01:44,284 on that topic is simply, what are the 46 00:01:44,284 --> 00:01:47,325 challenges that university hospitals and the other organizations 47 00:01:47,325 --> 00:01:49,484 for which you work? What are the challenges 48 00:01:49,484 --> 00:01:51,885 you face in recruiting physicians to primary care 49 00:01:51,885 --> 00:01:52,625 in specifics? 50 00:01:53,165 --> 00:01:54,930 Yeah. So, you know, there are there are 51 00:01:54,930 --> 00:01:57,729 unique challenges to every health care system, Chris. 52 00:01:57,729 --> 00:01:59,649 There's no no doubt about it. But I 53 00:01:59,649 --> 00:02:02,129 think globally, we all have the same problem. 54 00:02:02,129 --> 00:02:03,729 And that's what struck me when we put 55 00:02:03,729 --> 00:02:06,049 together this issue. It's not just an American 56 00:02:06,049 --> 00:02:07,810 problem or a North American problem. This is 57 00:02:07,810 --> 00:02:09,284 a problem in Europe. It's a problem in 58 00:02:09,284 --> 00:02:11,284 Asia. It's a problem in many, many parts 59 00:02:11,284 --> 00:02:11,864 of the 60 00:02:12,164 --> 00:02:14,664 world. Uniquely, as the chair of the department, 61 00:02:14,724 --> 00:02:17,764 I am responsible for recruiting primary care physicians 62 00:02:17,764 --> 00:02:18,584 to our department. 63 00:02:18,965 --> 00:02:21,284 And I realize that we face a number 64 00:02:21,284 --> 00:02:23,759 of headwinds in the sense that they can 65 00:02:23,759 --> 00:02:26,159 pretty much go anywhere they want. And, they've 66 00:02:26,159 --> 00:02:28,959 got lots of opportunities out there. And unless 67 00:02:28,959 --> 00:02:31,519 there's a really strong connection to, to our 68 00:02:31,519 --> 00:02:33,039 system, and I think we do a wonderful 69 00:02:33,039 --> 00:02:35,055 job in recruitment and, and 70 00:02:38,094 --> 00:02:39,854 and everything else that a physician might be 71 00:02:39,854 --> 00:02:42,834 looking for. It's very competitive. There's simply 72 00:02:43,375 --> 00:02:46,435 so much demand and so few physicians available. 73 00:02:47,310 --> 00:02:49,069 And that's common to to many other health 74 00:02:49,069 --> 00:02:51,069 care systems, not just in Cleveland, but across 75 00:02:51,069 --> 00:02:52,930 the country and around the world as well. 76 00:02:53,790 --> 00:02:56,050 And, Gautam, when you look at how competitive 77 00:02:56,909 --> 00:02:57,969 the field is, 78 00:02:58,590 --> 00:03:01,754 what is it that helps university hospitals or 79 00:03:01,754 --> 00:03:03,854 any other health systems stand out then? 80 00:03:04,474 --> 00:03:06,555 Yeah. So I think there's there's different things, 81 00:03:06,555 --> 00:03:08,794 Chris, that have come up in putting together 82 00:03:08,794 --> 00:03:10,955 this issue. So when I asked when I 83 00:03:10,955 --> 00:03:12,635 put together the call for papers, I was 84 00:03:12,635 --> 00:03:14,155 very open minded. I didn't know what to 85 00:03:14,155 --> 00:03:16,580 expect. As long as you have an interesting 86 00:03:16,639 --> 00:03:19,300 idea for expanding the primary care workforce, 87 00:03:19,759 --> 00:03:21,039 send me the paper. I'll take a look 88 00:03:21,039 --> 00:03:22,400 at it. And if I think it's promising, 89 00:03:22,400 --> 00:03:23,919 we'll send it out for review and get 90 00:03:23,919 --> 00:03:26,000 some feedback and maybe and of of course, 91 00:03:26,000 --> 00:03:28,245 a very small proportion are actually published 92 00:03:28,724 --> 00:03:29,864 because it is competitive. 93 00:03:30,405 --> 00:03:31,864 But I think that that, 94 00:03:32,564 --> 00:03:34,424 some of the the things that 95 00:03:34,884 --> 00:03:36,965 we found in the issue are things that 96 00:03:36,965 --> 00:03:39,384 we're trying to do here at university hospitals 97 00:03:39,604 --> 00:03:40,344 as well 98 00:03:40,860 --> 00:03:43,500 and is to provide something that's a little 99 00:03:43,500 --> 00:03:45,340 bit interesting. So there's a and, yeah, as 100 00:03:45,340 --> 00:03:47,500 a chief clinician experience officer, which in other 101 00:03:47,500 --> 00:03:49,180 systems, I know you're with Becker's, they call 102 00:03:49,180 --> 00:03:51,099 wellness officer, but it's a it's a similar 103 00:03:51,099 --> 00:03:53,739 sort of thing. There's an age old adage 104 00:03:53,739 --> 00:03:55,655 that if you give a physician 105 00:03:56,115 --> 00:03:58,995 the opportunity to pursue what they're truly passionate 106 00:03:58,995 --> 00:04:00,854 about 20% of the time, 107 00:04:01,155 --> 00:04:03,395 they will won't mind doing the other 80%. 108 00:04:03,395 --> 00:04:05,395 That may be less interesting and that applies 109 00:04:05,395 --> 00:04:07,335 across specialties. If you have a gastroenterologist 110 00:04:07,715 --> 00:04:08,694 who loves pancreatitis 111 00:04:09,379 --> 00:04:12,099 and you give him pancreatitis clinic, maybe half 112 00:04:12,099 --> 00:04:13,939 day or full day a week, he'll do 113 00:04:13,939 --> 00:04:14,840 all the endoscopies 114 00:04:15,139 --> 00:04:16,819 and other things that may not be of 115 00:04:16,819 --> 00:04:19,459 that in much interest. Family physicians are no 116 00:04:19,459 --> 00:04:22,180 different. Primary care physicians in other disciplines like 117 00:04:22,180 --> 00:04:25,045 OBGYN, pediatrics, general internal medicine are no different. 118 00:04:25,045 --> 00:04:27,764 They have their passions. I'm very passionate about 119 00:04:27,764 --> 00:04:31,285 mitigating cardiovascular risk and obesity treatment. There are 120 00:04:31,285 --> 00:04:33,365 others in my department who are passionate about 121 00:04:33,365 --> 00:04:36,105 addiction medicine, for example, others in geriatrics. 122 00:04:37,120 --> 00:04:38,020 The LGBTQ, 123 00:04:39,120 --> 00:04:41,040 health care service line is in my department. 124 00:04:41,040 --> 00:04:42,879 We have a woman who's very passionate about 125 00:04:42,879 --> 00:04:45,199 caring for those communities. And if she has 126 00:04:45,199 --> 00:04:45,939 that opportunity 127 00:04:46,319 --> 00:04:48,480 one or two days a week, the routine 128 00:04:48,480 --> 00:04:50,879 primary care becomes more interesting. So that's something 129 00:04:50,879 --> 00:04:52,845 we would promise people when they when they 130 00:04:52,845 --> 00:04:54,285 come here, we can make your life a 131 00:04:54,285 --> 00:04:55,425 little bit more interesting. 132 00:04:55,884 --> 00:04:58,605 That, I think, is what distinguishes us from 133 00:04:58,605 --> 00:05:00,865 other places that are struggling to recruit. 134 00:05:01,485 --> 00:05:02,944 Other places can recruit 135 00:05:03,564 --> 00:05:05,105 by offering larger, 136 00:05:05,805 --> 00:05:07,584 financial compensation packages, 137 00:05:07,979 --> 00:05:08,959 and that's great. 138 00:05:09,339 --> 00:05:11,500 I think that's something that some people might 139 00:05:11,500 --> 00:05:14,399 be looking for. There's loan repayments, of course. 140 00:05:15,180 --> 00:05:17,579 There are other approaches that kind of, you 141 00:05:17,579 --> 00:05:20,160 know, look at the pipeline of of potential 142 00:05:20,220 --> 00:05:22,539 students who might be interested in family medicine 143 00:05:22,539 --> 00:05:24,365 starting a little bit further back. 144 00:05:24,824 --> 00:05:26,425 I think all of those are great. Some 145 00:05:26,425 --> 00:05:28,504 of the ideas we came that came through 146 00:05:28,504 --> 00:05:29,245 the issue 147 00:05:29,704 --> 00:05:32,504 reflect those fundamental ideas that have been around 148 00:05:32,504 --> 00:05:34,685 a long time. But I will say this, 149 00:05:35,144 --> 00:05:37,225 the definition of insanity is doing the same 150 00:05:37,225 --> 00:05:39,120 thing over and over again and expecting different 151 00:05:39,120 --> 00:05:41,439 results. Right? So I think we have to 152 00:05:41,439 --> 00:05:43,540 make primary care more interesting. 153 00:05:44,000 --> 00:05:46,000 You know, not paying more because that doesn't 154 00:05:46,000 --> 00:05:47,779 seem to really do much and will never 155 00:05:48,079 --> 00:05:49,680 pay as much as some of the other 156 00:05:49,680 --> 00:05:50,180 subspecialties 157 00:05:50,959 --> 00:05:53,055 or not trying to convince people at a 158 00:05:53,055 --> 00:05:54,495 very young age that this is the direction 159 00:05:54,495 --> 00:05:55,774 they need to go in because they may 160 00:05:55,774 --> 00:05:57,774 not choose to. But how about just making 161 00:05:57,774 --> 00:05:59,935 the actual job more interesting? That that's that's 162 00:05:59,935 --> 00:06:00,595 my approach. 163 00:06:02,175 --> 00:06:04,735 Gautam, the 20% number that you hit on, 164 00:06:04,735 --> 00:06:07,074 and I'm I'm glad you mentioned the emotional 165 00:06:08,339 --> 00:06:08,839 components 166 00:06:09,300 --> 00:06:09,800 of 167 00:06:10,180 --> 00:06:10,680 recruiting 168 00:06:11,220 --> 00:06:14,120 physicians. So how did that number, come about? 169 00:06:14,660 --> 00:06:16,740 Well, that's been that's been around for a 170 00:06:16,740 --> 00:06:18,680 very long time. So I I circulate 171 00:06:18,980 --> 00:06:20,199 in in the wellness, 172 00:06:21,425 --> 00:06:24,224 communities of every health system. As you know, 173 00:06:24,224 --> 00:06:26,785 burnout became a big issue about six or 174 00:06:26,785 --> 00:06:28,785 seven years ago, and it really accelerated during 175 00:06:28,785 --> 00:06:29,444 the pandemic. 176 00:06:29,824 --> 00:06:31,264 And, you know, you can remember the scenes 177 00:06:31,264 --> 00:06:33,685 from New York City where health care workers 178 00:06:33,745 --> 00:06:36,339 are really, really working far too hard and 179 00:06:36,339 --> 00:06:37,800 and suffering some psychological 180 00:06:38,100 --> 00:06:38,600 crises. 181 00:06:39,220 --> 00:06:41,620 So when you when you attend meetings, you 182 00:06:41,620 --> 00:06:42,839 will generally find 183 00:06:43,379 --> 00:06:43,779 that, 184 00:06:44,259 --> 00:06:47,139 that that twenty percent number is is thrown 185 00:06:47,139 --> 00:06:49,995 about. Now there's no evidence that it's actually 186 00:06:49,995 --> 00:06:51,915 actual number. And when you meet with a 187 00:06:51,915 --> 00:06:53,995 potential recruit, they might ask for more, or 188 00:06:53,995 --> 00:06:55,595 they might be absolutely thrilled and say I 189 00:06:55,595 --> 00:06:57,754 was only expecting a half day where I 190 00:06:57,754 --> 00:06:58,894 could pursue something 191 00:06:59,194 --> 00:07:01,834 that that brings me more joy than my 192 00:07:01,834 --> 00:07:02,814 regular job. 193 00:07:03,199 --> 00:07:05,839 And I've tested that 20 number among our 194 00:07:05,839 --> 00:07:08,000 recruits, and it seems to be about spot 195 00:07:08,000 --> 00:07:09,060 on for people. 196 00:07:09,919 --> 00:07:12,899 It's not possible, Chris, to allow someone 197 00:07:13,360 --> 00:07:15,839 obesity medicine is a good example because I 198 00:07:15,839 --> 00:07:17,360 I as I said, I do I do 199 00:07:17,360 --> 00:07:20,204 that 20% of the time, my myself personally. 200 00:07:20,665 --> 00:07:23,464 And there are some physicians out there who 201 00:07:23,464 --> 00:07:24,845 say, I really like this. 202 00:07:25,225 --> 00:07:26,904 Can I do that full time? And the 203 00:07:26,904 --> 00:07:29,384 answer as a department chair is no because 204 00:07:29,384 --> 00:07:31,305 we we need you to do regular family 205 00:07:31,545 --> 00:07:34,000 you know, regular primary care as well. But 206 00:07:34,000 --> 00:07:35,199 for a lot of the people who are 207 00:07:35,279 --> 00:07:37,759 have that particular board certification, they're happy with 208 00:07:37,759 --> 00:07:39,520 a day, perhaps a little bit more a 209 00:07:39,520 --> 00:07:42,000 week. So so that's that's that's that's my 210 00:07:42,000 --> 00:07:43,139 experience with it. 211 00:07:43,920 --> 00:07:46,080 Got you. Thank you, Gautam, for laying out 212 00:07:46,080 --> 00:07:48,980 how that experience has gone in your 213 00:07:49,435 --> 00:07:51,834 circles. Right? I think it helps to, our 214 00:07:51,834 --> 00:07:53,455 audience to relate to all of that. 215 00:07:53,915 --> 00:07:56,235 You've mentioned a little bit about how your 216 00:07:56,235 --> 00:07:58,475 role will evolve, but is there anything else 217 00:07:58,475 --> 00:08:00,314 you want to mention about how it's going 218 00:08:00,314 --> 00:08:02,394 to change over the next eighteen months or 219 00:08:02,394 --> 00:08:02,894 so? 220 00:08:03,439 --> 00:08:05,120 Yeah. There's a lot of things. So as 221 00:08:05,120 --> 00:08:07,680 I as I mentioned at the outset, I'm 222 00:08:07,680 --> 00:08:10,819 a health services researcher. I'm passionate about improving 223 00:08:10,959 --> 00:08:12,579 how we deliver care. 224 00:08:13,040 --> 00:08:15,360 We started all kinds of innovations here even 225 00:08:15,360 --> 00:08:17,279 here at University Hospital. One is an on 226 00:08:17,279 --> 00:08:19,060 demand primary care clinic. 227 00:08:19,705 --> 00:08:22,425 It's an old, old fashioned idea. I can 228 00:08:22,425 --> 00:08:24,584 remember in when I was a resident in 229 00:08:24,584 --> 00:08:27,305 Toronto, there were some very much older physicians 230 00:08:27,305 --> 00:08:29,064 who were experimenting with and that is there's 231 00:08:29,064 --> 00:08:29,725 no appointments. 232 00:08:31,064 --> 00:08:33,419 If you arrive before a certain time, your 233 00:08:33,419 --> 00:08:35,019 doctor will see you. You might have to 234 00:08:35,019 --> 00:08:37,659 wait, but the doctor will see you. And 235 00:08:37,659 --> 00:08:39,580 people say, well, what if see someone's waiting 236 00:08:39,580 --> 00:08:41,039 for two hours? He goes, well, 237 00:08:41,740 --> 00:08:43,500 that's okay as long as they know they 238 00:08:43,500 --> 00:08:44,940 have to wait. I mean, they're they're they're 239 00:08:44,940 --> 00:08:46,220 going to be a little annoyed. But they're 240 00:08:46,220 --> 00:08:48,195 really annoyed if you're running behind and they're 241 00:08:48,195 --> 00:08:49,634 waiting for two hours. They had an appointment 242 00:08:49,634 --> 00:08:51,235 at 03:00 and you don't see them till 243 00:08:51,235 --> 00:08:51,735 five. 244 00:08:52,115 --> 00:08:54,195 So that was just one very simple idea 245 00:08:54,195 --> 00:08:56,195 that we started. So how we deliver care 246 00:08:56,195 --> 00:08:58,674 is something I'm passionate about. So over the 247 00:08:58,674 --> 00:09:01,529 next eighteen months, Chris, I think that what 248 00:09:01,529 --> 00:09:03,610 we are trying to do is incorporate more 249 00:09:03,610 --> 00:09:07,450 artificial intelligence based tools into primary care, and 250 00:09:07,450 --> 00:09:09,470 you hear a lot of hype around it. 251 00:09:10,250 --> 00:09:12,009 The most useful tool is the one that 252 00:09:12,009 --> 00:09:13,549 people actually use. 253 00:09:14,125 --> 00:09:16,605 So in our medical obesity treatment program, for 254 00:09:16,605 --> 00:09:19,884 example, where we are very much overloaded with 255 00:09:19,884 --> 00:09:20,384 patients, 256 00:09:20,684 --> 00:09:22,605 we can't see them often enough, we can't 257 00:09:22,605 --> 00:09:25,504 support them in between appointments, we have developed 258 00:09:25,565 --> 00:09:28,704 an AI based health coaching tool that substitutes 259 00:09:29,289 --> 00:09:31,610 counseling for me and and the behavioral counselor 260 00:09:31,610 --> 00:09:33,850 as well. In addition to that, even just 261 00:09:33,850 --> 00:09:36,090 in routine primary care, there is AI based 262 00:09:36,090 --> 00:09:37,309 scribes, for example, 263 00:09:37,690 --> 00:09:40,410 AI based tools that can help summarize provide 264 00:09:40,410 --> 00:09:42,934 summary notes, And, also, this the same sort 265 00:09:42,934 --> 00:09:45,654 of counseling tool that can provide reminders and, 266 00:09:45,654 --> 00:09:46,934 you know, if you have a patient who's 267 00:09:46,934 --> 00:09:48,774 trying to quit smoking, for example, they can 268 00:09:48,774 --> 00:09:51,014 provide counseling and guidance there. So that's definitely 269 00:09:51,014 --> 00:09:52,934 within the next eighteen months is going to 270 00:09:52,934 --> 00:09:55,115 be a big part of what we do. 271 00:09:55,254 --> 00:09:56,714 We also want to 272 00:09:57,080 --> 00:09:57,580 formally 273 00:09:58,040 --> 00:10:00,620 create a new primary care center 274 00:10:01,000 --> 00:10:02,540 at university hospitals. 275 00:10:02,919 --> 00:10:04,620 And this is in the works. We have, 276 00:10:05,399 --> 00:10:08,620 the physical space is being renovated right now. 277 00:10:09,815 --> 00:10:12,875 And what I would expect is those physicians 278 00:10:13,095 --> 00:10:14,715 who choose to work there 279 00:10:15,095 --> 00:10:17,195 will have that 20% opportunity. 280 00:10:17,975 --> 00:10:20,134 And if they have an innovative idea for 281 00:10:20,134 --> 00:10:22,134 how to improve primary care, let's say it's 282 00:10:22,134 --> 00:10:24,169 somebody who says, you know, why don't we 283 00:10:24,169 --> 00:10:26,649 bring in all of our older patients who 284 00:10:26,649 --> 00:10:28,970 need Medicare wellness visits in on the same 285 00:10:28,970 --> 00:10:29,470 day? 286 00:10:30,009 --> 00:10:32,409 That way, we all get experience with it. 287 00:10:32,649 --> 00:10:34,329 They all have the same expectations, and some 288 00:10:34,329 --> 00:10:36,169 of the counseling we provide could even be 289 00:10:36,169 --> 00:10:37,709 provided to them as a group. 290 00:10:38,125 --> 00:10:40,524 Okay. Well, that's an interesting idea. It's not 291 00:10:40,524 --> 00:10:42,285 my idea, but we'll see. We'll give it 292 00:10:42,285 --> 00:10:44,285 a try. And if it works, we'll try 293 00:10:44,285 --> 00:10:45,805 it again and try it again, and that 294 00:10:45,805 --> 00:10:48,125 becomes a new innovation that we, 295 00:10:49,004 --> 00:10:51,485 that we incorporate into our daily routine. So 296 00:10:51,485 --> 00:10:53,085 the innovation center, you would have to be 297 00:10:53,085 --> 00:10:54,620 an innovator. You can't just come in, see 298 00:10:54,620 --> 00:10:56,559 your patients go home, and forget about it. 299 00:10:56,700 --> 00:10:57,980 It would it would have that. And I 300 00:10:57,980 --> 00:11:00,940 think that will appeal to a small but 301 00:11:00,940 --> 00:11:04,160 important subset of potential recruits as well. 302 00:11:04,779 --> 00:11:06,480 And, Gautam, you mentioned how 303 00:11:07,100 --> 00:11:07,840 not just 304 00:11:08,514 --> 00:11:10,855 health systems and hospitals in The US are 305 00:11:11,074 --> 00:11:12,695 dealing with this issue but 306 00:11:13,074 --> 00:11:15,875 globally. Right? Yes. So what and not everyone 307 00:11:15,875 --> 00:11:18,595 has the same resources. Not everyone has the 308 00:11:18,595 --> 00:11:21,095 same sort of, patient makeup etcetera. 309 00:11:21,440 --> 00:11:23,360 But what advice would you give to peers 310 00:11:23,360 --> 00:11:25,620 who are struggling with similar challenges? 311 00:11:26,159 --> 00:11:27,919 Yeah. It's a it's a great question. And 312 00:11:27,919 --> 00:11:30,480 you're right. The challenges are are unique in 313 00:11:30,480 --> 00:11:32,320 different parts of the world. I'm originally from 314 00:11:32,320 --> 00:11:34,320 Canada, and the challenges are pretty similar to 315 00:11:34,320 --> 00:11:34,720 here. But, 316 00:11:35,504 --> 00:11:37,024 we heard through our, 317 00:11:37,904 --> 00:11:38,804 special issue 318 00:11:39,184 --> 00:11:41,585 from, for example, physician working in Gaza right 319 00:11:41,585 --> 00:11:42,085 now, 320 00:11:42,625 --> 00:11:44,865 others working in Eastern Europe and in The 321 00:11:44,865 --> 00:11:47,279 Middle East and and in Sub Saharan Africa. 322 00:11:48,480 --> 00:11:50,720 I think that the challenge they face in 323 00:11:50,720 --> 00:11:53,360 recruiting in those environments, sometimes it's just a 324 00:11:53,360 --> 00:11:54,259 matter of resources, 325 00:11:55,840 --> 00:11:58,980 a very limited number of educational facilities, 326 00:11:59,360 --> 00:11:59,860 schools. 327 00:12:00,284 --> 00:12:02,445 And those physicians, they want the biggest bang 328 00:12:02,445 --> 00:12:04,304 for their buck, so they often will leave 329 00:12:04,445 --> 00:12:06,544 or they won't practice primary care, or they'll 330 00:12:06,845 --> 00:12:09,004 they'll come to they'll leave the country, which 331 00:12:09,004 --> 00:12:11,084 happens quite often. So that's a huge challenge 332 00:12:11,084 --> 00:12:13,164 we heard about as well. But I think 333 00:12:13,164 --> 00:12:14,464 that what 334 00:12:15,009 --> 00:12:16,610 stood out to me in some of our 335 00:12:16,610 --> 00:12:18,209 submissions, Chris, is a lot of people are 336 00:12:18,209 --> 00:12:20,370 struggling to I wanna make this interesting. When 337 00:12:20,370 --> 00:12:21,970 I have a student in my office who's 338 00:12:21,970 --> 00:12:23,990 seeing how I practice primary care, 339 00:12:24,449 --> 00:12:25,329 I think that, 340 00:12:25,970 --> 00:12:27,649 you know, I can make it interesting for 341 00:12:27,649 --> 00:12:30,664 them to show, for example, I I had 342 00:12:30,664 --> 00:12:32,585 a student who was interested in in primary 343 00:12:32,585 --> 00:12:34,904 care, and now she's definitely interested. But, you 344 00:12:34,904 --> 00:12:36,365 know, I I I met with 345 00:12:37,144 --> 00:12:39,065 a a a woman who had lost her 346 00:12:39,065 --> 00:12:40,985 son. The son was 60, and and and 347 00:12:40,985 --> 00:12:42,664 the lady in question was in her early 348 00:12:42,664 --> 00:12:44,809 eighties. And she completely broke down. 349 00:12:45,190 --> 00:12:47,589 And I felt for her. And my young 350 00:12:47,589 --> 00:12:49,269 student said, is this what you do every 351 00:12:49,269 --> 00:12:51,190 day? And I said, that's an important part 352 00:12:51,190 --> 00:12:52,309 of what I do. I do a lot 353 00:12:52,309 --> 00:12:53,509 of things. I do a lot of things 354 00:12:53,509 --> 00:12:55,750 I don't necessarily like to do, signing off 355 00:12:55,750 --> 00:12:57,615 on refills and that sort of thing that 356 00:12:57,934 --> 00:13:00,975 nobody especially likes. And that really struck her, 357 00:13:01,294 --> 00:13:03,294 that sort of human connection that we have. 358 00:13:03,294 --> 00:13:04,894 So what stood out to me is if 359 00:13:04,894 --> 00:13:06,894 you can show that, and that's the the 360 00:13:06,894 --> 00:13:09,475 most the simplest and easiest and most inexpensive 361 00:13:09,695 --> 00:13:10,195 idea 362 00:13:10,539 --> 00:13:13,019 that I think our colleagues overseas can can 363 00:13:13,019 --> 00:13:13,519 probably, 364 00:13:14,779 --> 00:13:15,279 promote. 365 00:13:16,059 --> 00:13:18,299 They, they will they will be able to 366 00:13:18,299 --> 00:13:20,379 meet the challenges. They actually do a more 367 00:13:20,379 --> 00:13:22,620 successful job in Britain, for example. They have 368 00:13:22,620 --> 00:13:25,654 less trouble recruiting, primary care physicians 369 00:13:26,034 --> 00:13:28,434 than we do. So, and that has to 370 00:13:28,434 --> 00:13:30,355 do with some structural issues. But they still 371 00:13:30,355 --> 00:13:32,595 have that issue of, gosh, boy, wouldn't it 372 00:13:32,595 --> 00:13:34,995 be great to be an interventional radiologist or 373 00:13:34,995 --> 00:13:37,074 something else? Isn't that interesting? Well, this can 374 00:13:37,074 --> 00:13:39,000 also be interesting. You just need the right 375 00:13:39,080 --> 00:13:39,580 exposure. 376 00:13:40,360 --> 00:13:43,159 Yeah. I think that's really powerful, Gautam, what 377 00:13:43,159 --> 00:13:45,240 you just pointed out that it it seems 378 00:13:45,240 --> 00:13:48,519 as a very simple thing, but just being 379 00:13:48,519 --> 00:13:51,019 able to show colleagues, potential colleagues, how interesting 380 00:13:51,705 --> 00:13:54,024 that your job is, it's obviously goes a 381 00:13:54,024 --> 00:13:55,644 long way. Thank you for sharing that. 382 00:13:56,345 --> 00:13:58,425 Lastly, Gautam, I simply wanna ask you, and 383 00:13:58,425 --> 00:14:00,264 this is a two part question, at insert 384 00:14:00,264 --> 00:14:02,665 in whatever manner you see fit. Sure. What 385 00:14:02,665 --> 00:14:04,825 are you excited about right now, and what 386 00:14:04,825 --> 00:14:05,805 makes you nervous? 387 00:14:06,840 --> 00:14:07,240 Yeah. 388 00:14:07,960 --> 00:14:08,460 Well, 389 00:14:09,160 --> 00:14:11,080 I think what makes me nervous, I think, 390 00:14:11,080 --> 00:14:13,980 is is the uncertainty that we as physicians 391 00:14:14,039 --> 00:14:17,639 and academic physicians and as researchers face in 392 00:14:17,639 --> 00:14:18,139 general 393 00:14:18,644 --> 00:14:18,884 with, 394 00:14:19,685 --> 00:14:20,185 changes, 395 00:14:21,445 --> 00:14:22,665 in in in the federal, 396 00:14:23,365 --> 00:14:26,245 system overall in terms of funding for Medicaid, 397 00:14:26,245 --> 00:14:26,985 for example. 398 00:14:27,524 --> 00:14:30,024 The vast majority of my patients have Medicaid, 399 00:14:30,085 --> 00:14:32,404 and I fear that they're going to lose 400 00:14:32,404 --> 00:14:34,379 their insurance or they're not gonna qualify, 401 00:14:34,940 --> 00:14:36,860 or they're not gonna submit their paperwork in 402 00:14:36,860 --> 00:14:38,559 time. Most of my patients are elderly. 403 00:14:38,940 --> 00:14:41,259 They live in poor areas, poor communities here 404 00:14:41,259 --> 00:14:41,919 in Cleveland. 405 00:14:42,379 --> 00:14:44,620 Their potential to keep up with things like 406 00:14:44,620 --> 00:14:46,779 that is is pretty limited. So I I 407 00:14:46,779 --> 00:14:48,460 fear that they're just gonna fall through the 408 00:14:48,460 --> 00:14:48,855 cracks. 409 00:14:49,574 --> 00:14:49,975 And, 410 00:14:50,454 --> 00:14:52,294 many of them have chronic illnesses which will 411 00:14:52,294 --> 00:14:54,534 simply get worse. So that is that is 412 00:14:54,534 --> 00:14:57,334 something I anticipate. And similarly, I think, Chris, 413 00:14:57,334 --> 00:14:59,414 in terms of as a researcher, funding on 414 00:14:59,414 --> 00:15:01,574 the federal level has been very uncertain. So 415 00:15:01,574 --> 00:15:04,290 I'm the incoming chair of the health information 416 00:15:04,509 --> 00:15:05,009 technology 417 00:15:05,389 --> 00:15:07,250 research study section at AHRQ, 418 00:15:07,870 --> 00:15:09,870 and our meetings have been on hold for 419 00:15:09,870 --> 00:15:11,790 some time just because the the future is 420 00:15:11,790 --> 00:15:14,190 so uncertain this year. I'm hoping we come 421 00:15:14,190 --> 00:15:16,269 to some sort of resolution on some of 422 00:15:16,269 --> 00:15:17,250 those key issues. 423 00:15:18,414 --> 00:15:20,414 That those are things that I fear. Now, 424 00:15:20,414 --> 00:15:21,855 what gets me excited is a lot of 425 00:15:21,855 --> 00:15:23,695 other things. I told you about the potential 426 00:15:23,695 --> 00:15:24,514 for AI 427 00:15:24,894 --> 00:15:27,454 health coaching, not just for obesity, but for 428 00:15:27,454 --> 00:15:29,934 a large number of other other problems as 429 00:15:29,934 --> 00:15:33,649 well. I've had a lot of exciting conversations 430 00:15:34,110 --> 00:15:35,809 with potential recruits 431 00:15:36,429 --> 00:15:38,210 who kinda fall into the same, 432 00:15:39,309 --> 00:15:41,070 same categories I spoke to you about. They're 433 00:15:41,070 --> 00:15:43,070 excited about one thing in particular. I I 434 00:15:43,149 --> 00:15:45,309 we're recruiting this one woman who's very excited 435 00:15:45,309 --> 00:15:46,610 about caring for the poor 436 00:15:47,355 --> 00:15:48,095 and especially, 437 00:15:48,955 --> 00:15:51,274 poor children with disabilities. And that's that's her 438 00:15:51,355 --> 00:15:52,875 she's an advocate in that area. And I 439 00:15:52,875 --> 00:15:55,274 said, wow. Okay. Of course. Yes, please. You 440 00:15:55,274 --> 00:15:57,034 know? And she that's those are the kinds 441 00:15:57,034 --> 00:15:58,735 of people that I think are emerging. 442 00:15:59,195 --> 00:16:00,634 And if you put the word out there 443 00:16:00,634 --> 00:16:02,779 that there are exciting things going on at 444 00:16:02,779 --> 00:16:05,179 and I think that's definitely true, we'll be 445 00:16:05,179 --> 00:16:07,259 able to recruit some additional people as well. 446 00:16:07,259 --> 00:16:08,620 So those are some of the things that 447 00:16:08,620 --> 00:16:10,480 that really excite me going forward. 448 00:16:11,259 --> 00:16:13,019 Both. And we covered a ton of ground 449 00:16:13,019 --> 00:16:15,019 in just what seemed like a very short 450 00:16:15,019 --> 00:16:16,559 conversation to me. 451 00:16:16,875 --> 00:16:18,735 That's all the time we have for today. 452 00:16:18,875 --> 00:16:21,035 But thank you again for allowing us to 453 00:16:21,035 --> 00:16:22,794 to have your insights and share those with 454 00:16:22,794 --> 00:16:24,794 our audience, and I can't wait till the 455 00:16:24,794 --> 00:16:27,115 next time our pass goes. Alright. Thank you 456 00:16:27,115 --> 00:16:28,975 so much, Chris. Have a wonderful afternoon.