On this episode of Healthcare Americana, Christopher Habig, CEO of Freedom Healthworks, is joined by Ryan Lee, Co-Founder & CEO of HireMe Healthcare. Together, they dive into the pressing issue of healthcare clinician treatment, with a particular focus on nurses and their startling turnover rate within the industry. With the backdrop of the COVID-19 pandemic, they explore the immense challenges nurses faced and why many are now leaving the hospital system and even the profession entirely. Through their conversation, you’ll gain a profound understanding of the indispensable role nurses play in healthcare, as well as a closer look at the bureaucratic inefficiencies that have impeded their ability to deliver exceptional care.

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 Christopher Habig: Welcome to Healthcare Americana. Coming to you from the FreedomDoc Studios. I am your host, Christopher Habig, CEO and co-founder of Freedom Healthworks. This is a podcast for the 99% of people who get care in America. We talk to innovative clinicians, policymakers, patients, caregivers, executives, and advocates who are fed up with the status quo and have a desire to change it. We take you behind the scenes with people across America that are putting patients first and restoring trust in American healthcare.

I like to zero in on a lot of those topics I bring up during that introduction, specifically, this episode about restoring trust in American healthcare. A lot of the headlines we see right now are talking about provider shortages, physician shortages, nurse shortages, and a lot of hospitals are being lambasted, really, for the inability to contain cost, and a lot of them point fingers at this problem, “Well, we can’t hire nurses. We don’t have staffing. We can’t keep wings of the hospitals open. We’re only able to operate at X percent of capacity rather than full,” which has all types of trickle-down problems for that hospital, but bottom line is a lot of them are pointing to labor problems, labor shortage problems.

Today’s guest is going to walk us through exactly what’s going on with the industry. Please, welcome Ryan Lee, the co-founder and CEO at HireMe Healthcare. Ryan, welcome to Healthcare Americana.

Ryan Lee: Thank you, Chris. It’s an honor to be here today.

Christopher: As I said during my introduction, there seems to be all types of labor problems in healthcare. In your company, HireMe Healthcare, you’re looking to alleviate that, at least from a nursing standpoint but read us through really what’s going on in the industry just as a whole, just that really 30,000, or if you want to go up to, some people say, the 100,000-foot view, what is going on in healthcare where we are really seeing an inability of large systems to contain costs?

Ryan: Yeah, a lot of that comes from the labor budget. The operating costs, it comes out to 40%, and on average, and it’s a combination of things. It’s the changing nature of the work environment in the post-COVID world. It’s also an actual talent shortage. That’s as old as time. One of the best places to start in any situation is the beginning. There’s literature out there dating, describing nursing staffing shortages back to the time of Florence Nightingale. Some of the studies looking at the problems that are causing this shortage, they date back towards– Some of these studies come from the beginning of the 21st century.

One of the most telling ones for me was a study from 2001 talking about how there’s a high turnover, a high fill rate, a high vacancy rate. These are the problems we’re seeing today. Although we’re seeing them, it’s a self-perpetuating cycle that’s greatly exacerbated them to what they’ve become today. COVID was an accelerant, but it was already a tinderbox before that. What COVID really did was expose a lot of these things and also obviously contributed to burnout. You and I have spoken offline about how both sides have been vilified in the process.

There was the period where we went on with our healthcare heroes and giving pizza parties and all of these things that were intended to reward our nurses. As shocking as it is, the pizza party approach did not work to keeping them around, and we’ve witnessed a spike in turnover. That spike has fortunately reduced from almost 30% at the end of, well, the labeled pandemic era. We’re hearing about a COVID resurgence right now, so is it truly ever over? We have seen a reduction now to 22% range nationwide. A lot of this just comes– If I could really summarize it in one sentence, it’s a self-perpetuating vicious cycle here where there’s talent that is hard to find, which leads to shortages.

One of the reasons HireMe Healthcare was founded, my co-founder, Trey, was working at a major hospital system and seeing this firsthand where just through corporate policies alone, it took 30 to 45 days to fill a position, and nurses only have to give two weeks, so that automatically creates a shortage every single time a nurse leaves. That doesn’t even factor in the fill rate, or as they now have labeled it, the Recruitment Difficulty Index for RNs, which at the time HireMe was founded was around 90 days. Right now, it’s closer to 95. It’s moved up into 120 in certain specialties like med-surg. You have these shortages which lead to very difficult-to-manage nurse-to-patient ratios for our clinicians.

That leads to major stresses on the wellbeing and mental health of our nurses, which in turn leads to burnout, and burnout is one of the greatest leading causes of turnover in any profession. Bedside burnout is a next level of it that we can’t understand not practicing at the bedside. It’s this staffing shortage that causes burnout, that leads to more turnover, that then leads to a greater shortage. It’s a terrifying spiral we’re witnessing,

Christopher: It seems like it is relatively recently, and I know that there’s always going to be a supply and demand equation here when their demand for labor outstrips supply, then wages naturally rise. In my opinion, just looking over the last few years, it’s like we got through COVID, and then all of a sudden, that workforce just poof, just gone. Where did everybody go?

Ryan: A large amount left the profession entirely. Nurses are also looking for alternative careers. We’ve seen a major surge in remote nurse jobs. They can fill tasks such as just coming in to handle discharge and certain things that help with the efficiency of the process. We’ve seen a lot leave the bedside to take on different things they can do. We’ve seen nurses trying to race to school nursing jobs, just whatever it takes to get out of the hospitals. This is largely attributed to the mental health strain that studies have shown to be significantly greater in a hospital setting. We lost over 100,00 nurses last year.

Christopher: Just left the profession completely, or just left the hospital setting?

Ryan: Left the profession completely. Certain hospitals have turned over, when you start combining specialties and turnover, you can start seeing turnover rates over 100% which is something I didn’t understand until getting into this field because how can you turn over more than 100%, but when you’re flipping over an entire unit and then some in the course of a year, that contributes to those annual turnover rates just moving on and out.

Christopher: Trying to find root causes, what is going on here? Is it that they’re just unhappy with the work-life balance, they’re unhappy with the schedule, they are unhappy with pay? Give us some of those top two or three reasons why a nurse after going through school and being educated into nursing will look at that and say, “You know what? I don’t like this anymore. I’m going to go do something else.”

Ryan: It’s all of those things, for starters. We’ve seen that just increasing salary by amounts that are, I don’t want to call them negligible, but they’re not great amounts, but just increasing salary alone has not been enough to stop this diaspora we have going on. It’s about pay and compensation in part. Honestly, a lot of that came from watching what happened with the travel nurse bubble, where travel nurses come in, and you’re sitting there, imagine just being 10 years in a clinic, 10 years in your unit, putting in time dealing with already strained nurse to patient ratios, and then you’re sitting there training someone who doesn’t know where the gloves are even.

Fantastic clinicians still need to know the protocols of each new unit and each new facility they work for. You’re training these people knowing they’re making three times what you’re making. That led to just disgruntled feelings. A lot of it has to do with nurse-to-patient ratios, which it advisably should be 1:4. We’ve seen them double, sometimes four times that, and trying to take care of that many patients.

Most nurses that I speak with, when you ask what their main reason for being in nursing is, it is to care for people. When the ability to care for people to the extent that is necessary to ensure proper outcomes, to ensure patient satisfaction, when that’s stripped away from a caregiver, that leads to additional strain. It’s just like, “I can’t do this anymore. I can’t take care of people the way that I’m supposed to.”

Christopher: I’m always slow to assess blame, a lot of situations, and I think a lot of learning opportunities can come out of just taking a breath, not having some knee-jerk reaction to this, but, to me, this feels like a result of poor management decisions, lack of leadership in many hospitals. They’re abusing their people and driving them out of business. Am I missing something?

Ryan: It comes down to the cost-saving component that you mentioned earlier. Hospitals are strained at a budget. When they see how big of a chunk labor takes, they just immediately can look at this in a vacuum. Not every hospital’s doing this, and a lot are doing above and beyond. It’s not just to blame the management side. There’s just a broken trust in the system. There’s stories of nurses taking sign-on bonuses looking at the time necessary for that bonus to manifest and then leaving right afterwards to go chase another sign-on bonus. It’s two sides feeling betrayed by the other, and there’s a lot of just a lot of unsettled feelings in there.

It’s hard to save on costs when so much was spent on travel, so much was spent on on PPE and other emergency measures taken during COVID, and then trying to recover from that while being understaffed, and like you mentioned, having to shut down wings of hospitals and certain other things that are shutting down sources of revenue. I wish we could easily just point and say, “This is poorly mismanaged, this is how it should be managed,” and then we can make the problem go away but there’s so much nuance in it that it’s still largely indeterminable what every aspect that needs to be changed is.

Christopher: People who work at HireMe Healthcare, which I love how you describe it, a matchmaking healthcare organization, and you match the the organizations and the talent, and that’s where your system really, really, really thrives. What do you see when somebody says, you get a great candidate and they’re like, “Oh, I definitely don’t want to go work for that hospital. Yes, I want to go work for this one over here.” Are there any lessons to be drawn from that that can make these organizations more attractive to the applicants and the people that you interact with?

Ryan: The best place to get these answers, and this is what I can encourage all healthcare employers to consider is speaking more to the nurses. Not picking on hospitals here, it’s just where the bulk of the exodus is coming from, and where a bulk of watching hospitals shut down, larger hospitals that can survive closing wings. Talking to the nurses, and the CNO can often be a great spokesperson, but it’s really hard for the nurses as a collective unit to get their messages and their needs to the people that can actually do something about it.

We, as sitting in here in the middle between these two, having a marketplace with nurses on one side and employers on the other, we like to try to be a credible voice between the two and say, “Don’t kill the messenger. This is what our nurses are telling us. This is where we’re finding a competing hospital in a given city to see more demand for X reason or Y reason.” The nurses know what they’re upset about.

There are a lot of great influencers and other prominent nurse voices out there, you can find them on LinkedIn, various channels of social media, that are putting these problems in the forefront of everything they post and they say, and they are telling us what they want to see differently done, how they want to be treated. That they want their well-being to be factored into employment considerations, but they’re far and away the best place to go to find this information. I think employers could certainly benefit from lending more of an ear.

Christopher: How does HireMe, when a nurse comes up to them and says, “Yes, I’m going to create a profile on here,” what’s that matchmaking process? Hoof, it’s not even that hard to say, I don’t know why I can’t get it out here. What does that matchmaking process look like because I’m fascinated from this. In my mind, I’m like, “Oh okay, everybody runs through recruiting costs.” That is something that we hear a lot of hospitals are like, “I have to invest so much money in recruiting doctors and nurses, and I never get my return back.” My rebuttal is that, well, every business out there has recruiting costs. What makes this so much different where you’re able to connect the two sides to appease both parties?

Ryan: It’s looking at the human behind both sides, the person behind the resume and the person or people or unit behind the job description and trying to find a way to bring that to the forefront, and that’s what we empower our technology to do. We look for qualitative aspects as well. Our matching algorithm was designed with nurse jobs and nurses in mind to match based on certain traits, on the level of necessity of certain components of a job description. It ranks candidates for the employer side, and then we give the employer a certain part in there to really give an opportunity to sell themselves on the work environment and pitch to the nurse.

We encourage not to use the cliches we see on every job description. Don’t say, “Coming to work here is like joining a family.” No, it’s not. By the time you spend years on a unit, that unit becomes your family, but going to work for a major entity is not going to feel like the warm embrace of a small nuclear family right off the bat. We really give a chance there for employers to say, “What is it about X, Y, or Z hospital? What is it about this clinic, about this practice that should entice a nurse?”

Really, to filter, in a way, matchmaking also implies the inverse, the negative side of matchmaking. There’s nurses that want to see someone say, “This is where you can come hustle. This is where it’s going to be an intense floor, where people thrive in high-energy environments.” That’s going to turn some nurses off, but it’s also going to have some others say, “You know what? That’s exactly what I’m looking for. I’m the only nurse in an independent practice for the last 10 years, and I’m getting bored.”

On the contrary of that, you have the opposite, where you can say, “This is a more laid-back environment,” and certain other components that just appeal to the person on each side. That’s where HireMe sits and that’s what our technology is tailored and we continue to develop. Our roadmap has a lot of beautiful components on it in the near future that continue to focus on this, the humanizing of the process.

Christopher: We’re going to take a quick break here from our fantastic sponsor, FreedomDoc, before we come back with the second part of our show with Ryan Lee. Physician burnout is a killer that’s driving our best and brightest out of medicine. The only solution to burnout is to be your own boss. Easiest way to be your own boss is to join the FreedomDoc physician network. FreedomDoc is a unified consumer brand, and we will fully finance your practice so you can enjoy a healthier lifestyle, take better care of patients, and spend more time with your family. You focus on patients, FreedomDoc focuses on your practice. So, if you’re ready to be your own boss, visit our website, FreedomDoc.care to learn more and schedule a consultation with one of our experts, FreedomDoc – Accessible Concierge Healthcare.

We are back with Ryan Lee, the co-founder, CEO of HireMe Healthcare. Ryan, we spent a lot of time trying to address really what the nursing shortage root causes are. Where did everybody go? We see it a lot. We deal a lot with physicians, and physicians are being driven out of healthcare completely.

People are leaving the profession entirely. They very much point the finger at the administration, insurance bureaucracies, overhead, all that kind of stuff. They’re like, “I can’t even be a doctor anymore.” Do you see a lot of that in nursing, or is there something else that we didn’t talk about earlier that is pulling on the time and pulling on attention from nurses, where they’re saying, “You know what? I can’t go into work anymore because I have obligations elsewhere?”

Ryan: Yes, you hear it from both. I was on a podcast last week and talking about operational inefficiencies in healthcare, and I interviewed a doc right beforehand, and I said, “If there’s one thing you can speak to about the operational inefficiencies, what would you say?” They said, “Too much administrative red tape by people who have never worked at the bedside.” You hear a lot of that from the nursing side too. It’s finger-pointing. That’s what we talk about that trust needs to be reestablished in the system because both sides point the finger at the other.

Nurses are abandoning their ship. The administration is abandoning their nurses, is treating us like cogs in a system or dollar figures on a bottom line. There’s enough truth to this across the nation that it’s really easy to say that that’s just what the problem is. The solution here is not nurses stick around no matter how awful it is, because you can’t ask that of people. The nurses are human beings, and very, very passionate human beings. A large portion of them are two on the Enneagram, if you’re familiar with that test. It’s people that are devoted to helping other people. It’s really hard to blame them for wanting to leave the profession.

I can’t say I wouldn’t myself, if I even had the tenacity to get into it in the first place. Administration, it’s easy to say everything is their fault. There are things out of their control that contribute to this. One of the root causes we didn’t get to in the first half is the education pipeline. That there’s not enough talent teaching at schools. There’s not enough faculty for the number of qualified applicants, despite all the press around how difficult it is to be a nurse and how all the nurses are wanting to flee. One study recently said up to 53% are considering leaving in the next year. First of all, goodbye healthcare system if that happens. We should probably address this, and frankly, quite quickly.

Christopher: There’s a lot of alarming numbers when it relates to people to take care of us. I totally agree there. An interesting nugget I learned coming right out of COVID was that so many nurses left to take care of families. I thought that was just really, really interesting. I’m like, “Wow, that’s amazing.” Because we saw a collapse of the childcare industry, which then had direct consequences into the collapse of the nursing labor industry. I’m like, “Wow, there’s so many just different little things that have an impact on different, I guess, supply chains of talent.”

I’m curious if you’re seeing any nurses on the ones who you’re all able to match make and get them back into there, were they taking time off? Do you see, do you run into anything like that where they just needed to take a pause or focus on different areas in there and say, “I’m excited to get back into taking care of people again?”

Ryan: We have seen some take time off and come back. We’ve seen a lot go into travel, and for the the original reasons for travel, not what COVID made it, where it was almost a necessity to make what you really should be making as a nurse. It’s not terribly uncommon that people left and then decided to come back. You need that break. I burn out in this job, and I just took a week and went to Austria and came back refreshed and ready to go. Sometimes, that little pause is what can reignite your fire to be able to keep doing what you do despite how difficult it can be at times.

We have seen a lot of that movement into home health and certain other things outside of bedside care in a facility. You think about that logic, if I’m going to get screamed at by a patient, I might as well get screamed at by one patient all the time that I come to grow a strong bond with than by the 12 that I’m charged with taking care of who feel like I’m neglecting them because I have 11 other patients. It makes sense that a lot of that movement would happen, and we sure have seen it, Chris.

Christopher: That is a very interesting aspect of it, is really the workplace abuse, not from your bosses, but from the people that you’re starting to take care of. I got some very interesting theories as our listeners know about how healthcare should be paid for. It’s not really that murky, it’s the people who need healthcare should be able to pay it, but they need to pay a fair price for it rather than having just, “Hey, I want whatever this little card in my wallet gets me.”

I think there’s a big disconnect when people are either abusing their nurses or doctors. You hear it all the time, and if it’s a mental thing where somebody’s just not there, my heart goes out to them, but I think a lot of that results in, they don’t know who’s paying the bills, and a lot of times, they never even see the bills, they never see the payers, and so it becomes this weird little relationship where you walk in and, “I think I should get a service fit for a king because my insurance is paying you all this stuff, and this is what I think I get.”

When in reality, it’s just not the case, and that’s impossible to provide. There’s definitely a disconnect in consumers of healthcare, payers of healthcare, and the people who actually provide the service. I think you see that a lot when you hear those really sad stories of patients lashing out at their healthcare providers.

Ryan: Absolutely. May I ask with the approaches you have, do you see value-based care playing along to the desired outcome you see there?

Christopher: Totally depends how you define value-based healthcare.

Ryan: Yes, fair.

Christopher: I’ve heard a few different definitions. We can go like 1984 Orwellian level, like value-based healthcare has nothing to do with what those words together actually mean, and then we can go the opposite way where someone actually takes that with a grain of salt and says, “This is the value that I’m bringing you.” It goes to more of a pricing strategy. I’m a big fan of value pricing strategies, so if that’s what somebody in healthcare says, we’re going to price based on value-based policies, great.

If it is a hospital saying that, “We are trying this new value-based healthcare,” and that just means that I can’t suffer a readmission to my hospital, so once I discharge a patient, I either need that patient to get healthy or I need that patient to die, or else I get penalized, I have a big problem with that.

Ryan: Absolutely. Circling back, one of the things that nurse staffing is directly correlated with, by numerous studies, amongst the many both patient outcomes and efficiency measures is readmission rate. Proper staffing deals directly into length of stay, deals directly into readmission rates. It goes all the way to contribute towards a decrease with appropriate nurse staffing or evidence-based staffing levels being met and hospital-acquired infections and cardiac arrest and numerous in failure to rescues.

All this stuff is directly impacted. It’s causal. There’s enough science and data behind it to show. You would think that that is something that healthcare organizations would take notice of and say, “How can we impact massive part of our budget? Let’s invest into what we already feel we’re paying too much in, which is labor and see what happens.” Because hospital-acquired infections, that’s nationwide, that’s tens of billions of dollars. If I’ve seen one that said it was over $100 billion a year.

Christopher: Wow.

Ryan: Lost to that, so.

Christopher: Wow.

Ryan: Costly endeavors.

Christopher: Yes. There’s all little buzzwords being thrown around right now, and it’s just like, okay guys. A lot of it’s just tied to maximizing revenue coming from third-party payers. I think that’s where a lot of the finger-pointing needs to go because you take, what you just talked about from a large budget line from a staffing standpoint, a labor standpoint, and I’d be curious to run those time-motion studies and just say how much of this is spent on administration work that has nothing to do with patient care, but has a lot to do with revenue maximization-

Ryan: Right.

Christopher: -in order for that hospital to try to claw back anything and everything that they possibly can, even if it is relevant for that patient’s care. It’s this funny little waterfall that I always like to think about when somebody walks in that door as a patient presents, all these little things start to go and what do you end up with? You, usually, end up with a patient who is disillusioned with their entire system.

You end up with doctors who feel that they cannot make their best care decisions because they’re restricted to some type of formulary or some type of codes that the hospital prefers over others, and you’re stuck with nurses who have to be that intermediary to make sure that the doctors’ orders are followed and to make sure that the patient has somewhat of a reasonably nice experience under their care.

I can totally see how that hospital environment has just gotten so murky, I guess, on what the priorities really are. I guess that really comes down to it, Ryan, it’s just like, I don’t know if I’m a nurse, I’m like, “What are my priorities walking in there every single day?” Is it to keep people alive? Is it to earn the hospital money? Is it to be happy?

Ryan: To survive myself.

Christopher: [laughs] Where do you even go? It’s an unenvious position to be in for anybody out there.

Ryan: Yes. Think about how much of a patient experience is nurse-facing versus doctor-facing as well. That’s so much time. They’re having to be the bearer of certain news, and they’re having to– A patient all they see. I do wonder, Chris, I wonder, that got me thinking of all this talk, you mentioned the expectations of a broken system when everyone from the news to– I’ve heard a lot of healthcare leaders and execs in hospital systems start out a speech or the like and say, “The healthcare system, which by the way is broken,” and go on like that. How many times when we just hammer this into the head of whose patients? All of us. We’re all hearing this all the time.

Then you go into a system, you’re expecting it to be broken. Any one thing that goes wrong, you’re going to be potentially more on edge, who are you going to scream at? Who’s the most likely person you’re going to interact with next? You’re going to yell it and take it out on the nurse who’s probably just heard it from a patient in one of their– Let’s just stick with this 1 to 12 ratio that probably just heard it from one of their other 12 patients in the last hour. They bear the brunt of a lot of that. I do wonder how much the overall negative spin on the healthcare system that everyone’s talking about is impacting patients’ thoughts going in.

Christopher: Probably a lot. I would be at risk if I didn’t counter that the healthcare system in the US is not broken. There is so much money being made, it’s just who’s making it is the biggest question, and we know, right?

Ryan: We do provide a phenomenal quality of care too.

Christopher: We have the best doctors and nurses in the world. That is near undebatable. It’s how we pay for it and all the things. It’s the money. That’s the biggest thing that people consider to be broken. I’m always very careful, especially coming from a direct care world that we had to separate healthcare from the way it is paid, the business of it.

Ryan: Absolutely.

Christopher: Once we do that, then we realize that holy cow, the federal government pretty much has a monopoly on how things are bought and paid for in the United States. Hmm, that could be a problem right there, that things are so consolidated right now, there is no free market in there to be able to fully buy and purchase services and to be able to switch. That’s one of the hallmarks of driving costs down, driving access up. If I got a bad experience at my restaurant over here, I’m not going to eat there for a while. When we talk to hospitals and they quote prices as, you know, percent of Medicare, I’m like, “You got to be kidding me.”

Ryan: Right?

Christopher: The federal government’s just establishing this arbitrary price, and then you’re going to tie it to that even though I’m in Indianapolis and they’re in Washington DC. I joke, it’s like, imagine, starting a coffee shop, and you know, Ryan, I’m going to charge you 115% of what Starbucks charges, and you’re like, “What the hell is that? That doesn’t make any sense at all.”


Christopher: There’s a lot of wood to chop there, so to speak, but it’s always the way things are paid. That becomes an administrative burden on people who are squarely focused on just trying to save people’s lives. Ryan, last question here for you. I’m going to make you the billboard tzar of the United States, so you can go out there and you got the power to put any message you want to up on the billboards. Everybody’s going to see them, but you only have a small message because people are driving by at 90 miles an hour. What do you put on those billboards?

Ryan: Billboards to encourage human behavior or particularly pertaining to the topics of today?

Christopher: It’s your answer.

Ryan: All right. Best way to take care of others is to take care of yourself first.

Christopher: Very altruistic. I like it. Ryan Lee, co-founder, CEO of HireMe Healthcare. Ryan, thank you for joining us here on Healthcare Americana.

Ryan: Thank you, Chris. It’s been a pleasure.

Christopher: That’s going to do it for this episode of Healthcare Americana. If you haven’t yet, be sure to subscribe to the show on your favorite podcast platform. Check us out online at HealthcareAmericana.com. To catch previous episodes, subscribe to our mailing list and visit our online store. Once again, I am your host, Christopher Habig. Thanks for listening.

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Christopher: Hi again everyone, this is Chris. At Healthcare Americana we’re always on the lookout for great stories to tell in the healthcare industry, and we’d like to hear yours. Check out HealthcareAmericana.com and send us your ideas for episodes, or if you’d like to be a guest. Thanks again for listening. Hope you enjoy it.

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