May 28, 2025 • 30 mins
Dr. Darren Haskell sits down with host Jason Edwards to share his unique perspective as both a practicing internist and Chief Medical Officer at St. Luke's Hospital. Their conversation cuts to the heart of healthcare's most pressing challenges while offering a glimpse into promising solutions on the horizon.
Dr. Haskell represents a vanishing breed of physicians who still follow their patients from the office to the hospital bedside. "It's just the way I was trained," he explains, noting how patients appreciate seeing a familiar face during vulnerable moments. This continuity of care, once standard practice, has largely disappeared as medicine has become more specialized and fragmented.
The demands on primary care physicians have reached staggering levels. One eye-opening study revealed that delivering guideline-directed preventive care would require 29 hours per day for a physician with a standard patient panel – an impossibility on our 24-hour planet. This reality has transformed primary care into "a team sport," requiring nurses, medical assistants, and advanced practice providers working in concert.
Technology offers both challenges and solutions. While electronic health records initially pulled physicians' attention away from patients, Dr. Haskell is now piloting AI-powered voice recognition software that transcribes patient conversations, allowing doctors to maintain eye contact instead of typing notes. "It gets that visit back to being much more what I remember from my training – that human-human connection," he shares.
The conversation takes a sobering turn when discussing physician shortages. The St. Louis region currently faces a deficit of 324 primary care physicians, projected to grow significantly as baby boomers require more complex care. Dr. Haskell predicts "market disruptors" will redefine how primary care is delivered, likely through team-based approaches and technology integration.
Despite these challenges, medicine remains profoundly rewarding. "There are very few professions where you get that feeling, that feedback from people that you've helped," Dr. Haskell reflects. For those considering medical careers, he advises understanding the commitment but emphasizes the incomparable satisfaction that comes from making a difference in patients' lives.
Ready to hear more insights from healthcare leaders? Subscribe to Doc Discussions for conversations that explore medicine's most pressing challenges and inspiring innovations.
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Episode Transcript
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Speaker 1 (00:00):
Hello, this is Jason Edwards and this is Doc
Discussions.
I'm here with Darren Haskell.
Darren, how are you doing today?
Speaker 2 (00:05):
Doing great.
Jason, Thanks for having me on.
Speaker 1 (00:07):
Thank you for coming Now, Darren.
You're a primary care provider,but you're also the chief
medical officer of the hospital,Is that correct?
Speaker 2 (00:12):
Yes, it is.
I still practice traditionalinternal medicine so I still go
in route on my own patients atthe hospital, try to make it to
a few meetings, go over, seepatients in the office and then
I get roped into the admin workthe second half of the day.
Speaker 1 (00:25):
You're the iron man.
Most doctors who are primarycare providers do not see their
patients in the hospital, but Ithink that makes you unique.
Why do you do that?
Speaker 2 (00:36):
It's just the way I was trained.
It's how I started practicing.
It was kind of the expectationwhen I was in training.
That was just the way you didthings and because I kept doing
it for a longer and longerperiod of time, it kind of
became a calling card.
I have a lot of patients thatsee me right now that are still
on my panel specifically becausethat's the kind of care
experience they were looking for.
And for some patients it stillmakes a big difference when
(00:58):
they're sick and they're in thehospital.
They really appreciate thatfamiliar face coming through the
door being able to help explainthings to them.
Speaker 1 (01:06):
No doubt about it, no doubt.
And there was a period of timewhere that was kind of the
standard and maybe 15 years orso that fell out of place and a
lot of patients have hadproblems with that.
Now the hospitalists will takecare of the patients most of the
time.
But I know from mutual patients, I know you know your patients
very well and you have a fairlylarge patient population.
(01:27):
How many people are youtreating in general or roughly
speaking?
Speaker 2 (01:29):
So before I started admin work, I had a panel of
about 5,900 patients.
Now it's just a little bitunder 3,000.
Yeah, so that's incredible.
Speaker 1 (01:37):
And so you obviously have to have some efficiency
within your practice to be ableto do that Well, and you were
talking about the hospitals.
Speaker 2 (01:46):
I've been blessed.
I'm very well tied in with ourhospitals group.
They've been very good to me.
I'm the last person in my callgroup who still sees their own
inpatients, so if I need to havea weekend off or something, dr
Liu and his team have been verygracious that I can call them up
and say hey guys, I'm going tobe out of town, do you mind?
(02:08):
And they're more than happy tohelp take care of those patients
.
It's the only thing that makesit a practical option for me
still.
So I've got to say that's beenone of the things that's key to
it.
And then and I think this isgoing to be true for most people
who practice primary care,whether or not they go to the
hospital see their own patientsAny more.
Primary care is really a teamsport and you have to get the
infrastructure built around you,the team around you, to help
you do what you need to do.
There was a paper that waspublished about a year and a
(02:30):
half almost two years ago now.
It was from John Hopkins and theUniversity of Chicago, and they
showed that for a physicianwith a standard-sized patient
panel which is about 2,000patients in their model that
they put together, it wasestimated for that primary care
provider to just deliverguideline directed care so just
to do the things you're expectedto do for your patients
(02:52):
according to current healthguidelines and that's before
anybody gets sick, before theyreally have a problem or need
you it would take 29 hours perday on average for them to do
that.
That doesn't really line up withthe way our planet rotates.
So you know, if you don't havethe right team with you, it's an
impossibility.
(03:12):
They looked at the teams thatthey had deployed at those two
institutions and those are, youknow, world-class healthcare
institutions and even with theirsystems that they have in place
as far as NP support, nursingsupport, et cetera, they still
were estimating it was taking 22hours per day to take care of a
standard-sized panel.
That's incredible.
So when you look at that,really with the demands that we
(03:34):
place on our physicians and alot of this came about in the
era of the EHR and really dataand metric-centric medicine,
that's electronic health-records yeah electronic health
records.
We really are putting more andmore demands on those frontline
providers, and so we really needthat team around them to help
to get that done.
It's no longer feasible for onedoctor to handle every single
(03:58):
aspect of that patient's care bythemselves.
You really do need a team.
Speaker 1 (04:02):
And so it makes me think of two things here, and
you say that one is that StLuke's is it was regarded to the
physicians is kind of a smallfamily.
We all know each other fairlywell and so I think that helps
with some of the handoffs is youcan call somebody who's a
friend or who you've eaten lunchwith in the doctor's lounge and
say, hey, can you help me here?
And the other thing is whatI've noticed with your practice
is it seems like a lot of yourpatients you've know very well
(04:25):
over the years, and so you don'thave to dive as deep into the
chart to kind of know what'sgoing on with them, because
you're familiar with their case.
Speaker 2 (04:32):
One of the unique things about our institution is
the length of tenure that a lotof our staff have here.
It's a very, very friendlyplace to practice.
It's a very unique atmosphere.
People tend to come out here,they start practicing here and
they realize they don't want topractice anywhere else.
So you'll find a lot of ourphysicians that have been in the
same practice for 10, 15, 20.
I've been in the same practicefor 23 years.
(04:53):
Dr Heichel's been in practicefor 43 years in his location.
So those are not uncommonstories around here and that
does allow us to be veryfamiliar with the patients.
You mentioned how things arevery collegial here.
I think it's a very uniqueopportunity to tell us to
interview candidates when theycome in.
If I need something done acutelyfor a patient, I'm calling a
(05:16):
friend of mine.
I can remember a case not toolong ago where I sent you a
message early in the morning.
I had a patient who'd beenadmitted with what we thought
initially was something totallydifferent.
When I saw him in the morning,we realized he had a patient
who'd been admitted with what wethought initially was something
totally different.
When I saw him in the morning,we realized he had a spinal cord
compression.
It looked like it was going tobe malignancy and within 15
minutes he'd been seen byradiation, oncology and
neurosurgery and the oncologistwas there about 30 minutes after
(05:36):
that.
So that's a very unique way topractice.
These are all people I knowpersonally, so I was able to
just put out a blast message andsay hey guys, here's a problem.
It was a Friday, everybodywanted to get home and didn't
want to get dragged into acomplicated case.
But these are people who knowthat around here we really put
the patients first and qualityof our care first, and they they
(05:57):
rose to the occasion and it'sbecause of that collegiality.
You know it's different ifyou're a large and personal
institution.
You happen to get the fellowwho's on call and they may or
may not get around to it for afew hours and certainly the
attending is not the one that'sshowing up in that room and
seeing that patient.
So I think it's one of thethings that makes St Luke's a
very unique place to practice.
Speaker 1 (06:18):
Yeah, I agree.
I mean, if I get a call fromsomebody who I've never met
before, I mean we all have.
I think there's aninstitutional standard.
And then I think, individually,we all have high standards, but
it's just a little bitdifferent if it's somebody I
know and they're saying, jason,I need you to see this person.
And sure you know, we have arelationship, we've got a
(06:38):
reputation that we that's a twoway street that we both want to
uphold and a standard of carethat you want to be known for.
And I do think that makes adifference.
I really do.
So you're now the chief medicalofficer, you're a primary care
provider for 20-some-odd years,and then you, I think two things
(07:00):
.
It's insane to go intoadministration.
I mean, if you want somebody tocomplain to you all the time,
go into administration.
But I also think and I mightanswer your question for you but
so I was thinking well, whywould somebody want to go into
this?
But I think it's a role thatyou're, that you're that you've
been very effective in, and isit, did you see?
(07:24):
Like, hey, there's a need hereand I think I can make a big
difference and that's why I wantto do it, because it's a
challenge going into this role.
Speaker 2 (07:31):
It's a challenge and it's a different challenge.
I'd been doing the same thingas a primary care physician.
You know at that point that Ifirst stepped into this role.
I'd been doing that for about24 years and this was presented
to me it was early on in theCOVID pandemic.
At that point Bill Campbell wasthe head of our medical group
and he was clearly, because ofhis role also as the head of our
(07:54):
infectious disease department,very, very busy dealing with
what needed to be handled withCOVID.
Our current CEO at that pointasked me to start assuming some
additional roles.
And it's largely because I'vealways been very outspoken as an
advocate, especially for ourprimary care physicians.
I've volunteered on a lot ofcommittees, spent a lot of time
(08:14):
putting in my input, becauseI've always felt that as a
physician, especially as we'vegone through the transformation
of our industry, moving intoelectronic records and some of
those things If you aren'twilling to speak up and have
your voice heard, you're justgoing to get run over by the new
system when it gets put in.
Yeah, so I was approached totake on more and more of these
(08:35):
roles.
Eventually I was approachedabout taking this position and
at that point, I was alreadydoing a lot of the work.
I went home to discuss it withmy wife, and she said well,
you're already doing 80% of it.
They might as well give you thejob description, and maybe
they'll even pay you for doingsome of it.
So, at that point, the mostdifficult part of that
(08:56):
transition, though, wasdownsizing my practice.
Now, like you pointed out, youget to know your patients.
That was a very, very difficultprocess to work through.
I was very fortunate.
I have some wonderful partnerswho are more than willing to
take on quite a bit of that load, and then we also have a lot of
other good primary carephysicians in our system who
were able to step up, and wemade sure that everybody was
(09:17):
linked up with somebody whocould fulfill their needs.
Speaker 1 (09:20):
Yeah, you're right.
I mean the patients are a partof our lives and you care about
them and I think sometimes maybethe patients underestimate how
important they are for us.
You know they give meaning toour lives and it would be very
hard to say like I can only seethese patients and I can't,
because you know you're going todisappoint people.
Speaker 2 (09:39):
You definitely disappoint people.
But as doctors we're all kindof codependent with our patients
.
Speaker 1 (09:43):
You definitely disappoint people, but as
doctors we're all kind ofcodependent with our patients.
Speaker 2 (09:46):
Yeah, that's true.
There's most of us who got intothis at some point.
There is that idea that I'mdoing this because of the
feeling it gives me.
I realized early on I hadinitially thought I wanted to be
a surgeon of some type and Idid my first few rotations in
medical school and that was fun.
I enjoyed being in the OR andeverything.
But it was really when I hit mymedicine.
Rotation is at the VA hospital.
(10:06):
I still remember the firstpatient I was on call overnight.
It made me this old guy late atnight.
He was really sick and hestarts telling me stories about
being in the battle of the bulgeand I was just blown away and I
was like that is so cool andthat was really.
I decided that's what reallyexcites me about medicine is
getting to know these people andthen having that long-term
relationship.
I have families right now whereI'm taking care of three
(10:26):
generations of a family and youknow that kind of experience is
very gratifying.
As physicians we really thriveon getting that positive
feedback from our patients.
You know, when you've helpedsomebody they come back and see
you and they tell you what itmeans to you.
You take care of somebody.
You know I'm going to go intoyour world in oncology.
You get them through amalignancy and then you see them
for a follow-up visit and theytell you about the new grandbaby
(10:48):
they got to meet because theywere able to make it through the
acute phase of their illness.
Those are the things that makeyou thrive.
Speaker 1 (10:53):
Yeah, yeah, it gives meaning to our lives, for sure,
and it's the hug here and there,it's that kind of stuff and I
often think, too a long, longtime from now.
It's hard to walk away fromthat and retire, and that's what
you see.
You see a lot of doctors who'vebeen around here a long time
and are still going strong andfor whatever it's worth.
(11:14):
There's pretty solid data onthe longer you work, the longer
you live, and so I'm a fan ofthat.
I think that's a win-win allthe way around.
Speaker 2 (11:23):
It is a win-win and I think for us I was pointing out
how long-tenured some of ourstaff are I think it's a very
valuable thing for us as aninstitution.
It helps to perpetuate theculture of the institution.
As I pointed out earlier, we'rea unique place to practice and
to work as a patient.
It's a unique environment tocome and get care and people
(11:44):
who've been here for a long timehave really, you know, they've
soaked in that culture andthey're the ones that can kind
of pass that on to the youngergeneration when they come along.
That's always one of ourchallenges now that I'm doing
this administrative role.
We like to try to find apractice and we like to try to
slide a younger provider insomeplace where there's a couple
of people who are reallyseasoned and have been here and
they've been part of the teamfor a while.
It, you know, there'sopportunities out there in
(12:07):
community and one of we have acouple of places that we're
looking at right now and thehard thing is it's like it's
hard to put just young peopleout there by themselves who
haven't been with somebody.
That's part of that culture.
So it's always a bit of abalancing act.
But you know that's one of thegreat things about where we are
(12:30):
at St Luke's is we really dohave a unique culture and we've
got a really good group ofpeople who are very, very
adamant about carrying thatculture on, and I think it's one
of the things that will help usbe successful in the future.
Speaker 1 (12:36):
Yeah, I couldn't agree more.
So three concepts I want totalk about that you've kind of
touched on that I think would beuseful for people who are maybe
not in medicine.
One is I think it's good for tohave people that you work with
(12:57):
of different ages.
I think it's good for the olderperson.
They can teach us like whatTikTok or whatever is, and then
the younger people can learnfrom the older people.
Um, the second thing is you weresaying that you were on uh
boards and meetings.
Uh, you know, before you tookon this role and um, and you
were, you were vocal Um.
(13:17):
And one thing I think that'strue, this is for young people
is, um, when you're in a groupof people at a meeting or
something like that and youspeak up, you there's a high
probability that whatever yousay will be kind of dumb, but
you also have a good chance ofbringing a new idea because you
(13:38):
have a slightly differentperspective.
But in my mind I think most ofthe things that I've said you
know, ultimately I'm like, ah,that wasn't the smartest thing
in the world, but I still thinkit's good to have young people
or younger people on committeesand in meetings to give their
opinion, even though you knowmost of their ideas won't be
great.
Speaker 2 (13:58):
Well, they need to.
We also and I think this istrue in a lot of industries
beyond just medicine.
There's a very distinctgenerational divide in what
people are looking for from workand what their expectations are
as far as their work-lifebalance.
That's something we hear fromevery young candidate that comes
out and interviews with us now,yeah, and if, as you're
(14:18):
entering the workforce, if youexpect something different than
what you see right now, you haveto be willing to advocate for
yourself.
And if what you're bringingforth seems silly or odd to some
people, there are other peoplein that room that it resonates
with.
Yeah, and so you know, weencourage all of our physicians
when we bring them in.
We really encourage people allacross our clinical continuum to
(14:39):
get involved in committees, bevocal advocates.
Everybody should be an advocatefor their patient, but you need
to be an advocate for yourselfand your colleagues as well.
That's one of the other nicethings about an institution this
size.
We're not a large impersonalbureaucracy.
We're not spread largeimpersonal bureaucracy.
We're not spread acrossmultiple states.
If we need something for ourclinic, our practice, if we need
(15:00):
something for our patients, wecan get a hold of the decision
makers very easily.
We can get ourselves onto thecommittees that make these
decisions, establish policiesand do those things.
Here we're always asking forvolunteers, and so, for any of
the physicians who happen tohear this, this is a call to get
as involved as you can, becauseeverybody has a slightly
(15:20):
different approach to practiceand what you may offer, what you
may say, might not resonatewith one provider, but there are
other people that are going tosay, yeah, I'd like to try that.
Or, you know, that sounds likea problem I've run into, and so
always feel free to speak up.
Everybody should be willing todo that.
You spend too many hours atwork not to have your voice
heard if it's affecting youthrough your workday.
Speaker 1 (15:41):
Yeah, I totally agree .
You got one life to live andyou know you, you, you know in a
very professional way.
It's it's good to heareverybody's perspective and and
and that's how we learn and growand evolve as an institution
and that's how companies getbetter and are able to kind of
change with the times.
Don't want to change too muchwith the times, but you have to
(16:04):
have some change.
Speaker 2 (16:05):
You have to be responsive.
I mean you and I have both beendoing this long enough.
We've seen a lot of changesfrom when we first came out of
training.
Medicine's a much differentfield than it was, and it will
continue to change, I think,when some of the things that
we're really going to seestarting to impact us over the
next few years.
We're already starting to toyaround with it right now, but
how AI is going to impact thework that we do it's going to
(16:25):
vary from field to field, butthere's going to be some pretty
dramatic changes in ourworkflows and what our day looks
like.
Speaker 1 (16:32):
Yeah.
So that kind of leads me to mynext question how are we going
to leverage technology to helpus give more efficient care and
better care in the future?
Are there some specific thingswe have on the horizon?
Speaker 2 (16:43):
Well, there's even some very simple old-school
technologies that we've beenworking on deploying.
We've been going through aprocess here at St Luke's we had
, as our medical group evolved,it had really been just kind of
an agglomeration that hadoccurred over time.
Individual practices had beenadded on.
We never really sought to, youknow, be uniform in our approach
(17:06):
to how a patient interactedwith us, what the experience
looked like.
We've even just something assimple as putting in a unified
phone system across all of ourpractices and getting very set
routines as far as how phonesare answered, how messages are
conveyed to providers, thosetypes of things.
We're working through thatprocess right now.
(17:26):
No one had taken that challengeon.
It's just been over the lastyear and a half that we've
really started to tackle some ofthat part of things.
So old school technologies canstill be better deployed.
But then we are looking at howwe deploy very new technologies.
We're working right now througha pilot project with Nuance.
Those are the people who doDragon voice recognition
(17:47):
software.
They have a product called DAXand they have a newer one that's
actually going to be coming outvery shortly, called DAX
CoPilot, which allows thephysicians, as we're in an
encounter with a patient.
It's an AI-empowered voicerecognition software.
I'm piloting I'm one of the 13physicians we have in the pilot
right now and I can sit down inmy office with my patient, take
(18:12):
my phone out it acts as amicrophone sit it on the table,
we get their permission, ofcourse, and then the two of us
can just talk.
I'm no longer typing on thekeyboard while I'm in the room
with the patient.
That's so nice.
And at the end I step out andthere's a little lag time right
now because they do have a humanwho goes over and just make
sure there's no major errorsfrom the computer, but about an
(18:33):
hour, hour and a half later sure, there's no major errors from
the computer, but about an hour,hour and a half later the text
of that encounter comes into myinbox.
I get a chance to look at it,go through it, you can edit it
if you need to, and then mynote's done.
So it simplifies the process,gets us back to having a
conversation in the room withthe patient rather than worrying
about how many clicks we'rehitting as we're having that
encounter.
So it's a more organicexperience, more organic
(18:54):
experience, and I think this isone of those things when we look
at physician burnout anddissatisfaction.
One of the things that's beenan issue ever since the
Affordable Care Act came out andwe really were all pushed into
electronic records wasphysicians are very tired of
spending more time looking atthe screen than they are looking
at their patients.
Yeah, and it gets that visitback to being a much more what I
(19:18):
remember when I was in mytraining that human connection,
that sitting in a room having aface-to-face conversation with a
patient rather than lookingprimarily at your computer
screen.
So I think there's some verypromising things with what
technology can bring to us.
We're very fortunate theelectronic record that we use,
cerner.
Cerner was recently purchasedby Oracle, which is one of the
(19:39):
largest technology companies inthe country, and they're really
bringing a lot of their toolsinto this.
Oracle is one of the mostadvanced AI platforms available
in the country right now.
They're a world leader as faras their technology for those
types of products, as well astheir security products, et
cetera.
So we should have a much moresecure which is very important
(20:02):
in this day and age when we hearabout all these other
healthcare organizations thatget hacked but also a very
technology forward, veryuser-friendly experience.
So there's a lot that we standto benefit from in the near
future with that relationship.
Speaker 1 (20:16):
That's exciting.
That's exciting, darren.
I've always looked up to you asa physician and as a father,
and so I want to ask you onelast question.
To young people who are in,maybe, high school or college,
who are looking at going intomedicine, what advice would you
(20:39):
give them?
I know I'm putting you on thespot here, but what advice?
Speaker 2 (20:42):
would you give them?
It's pertinent.
I have a son who startedcollege last year and he says he
wants to do medicine.
So we've had a few of thesediscussions.
I think that it is a long roadstill to get through medical
school, through residency,fellowship, and then get into
practice and establish yourself.
You really have to have themindset that can put up with
that kind of delayedgratification.
(21:03):
If you do, the payoffs areenormous.
We were talking a moment agoabout the rewards we get from
our professional livesprofessional lives.
There are very few professionswhere you get that feeling, that
feedback from people thatyou've helped, that you've saved
their lives, you allowed themto live long enough to see their
grandkid born, I mean.
(21:24):
Those kinds of things I don'tthink you can even put a dollar
value on.
And so those are still thethings that if that's the
experience that you want and ifyou're really driven to do
something that puts you in arole to really help people, then
it's something you shouldcertainly consider.
But you also have to go into itrealizing you're going to give
(21:44):
up a lot of weekends, you'regoing to give a lot of long
nights of work and stuff.
It is a difficult process toget there.
If you can do that, it's wellworth it.
It's kind of like running amarathon.
You have to have that mindsetthat this is not a sprint.
I'm really committed for thelong haul here.
Speaker 1 (22:01):
Yeah, yeah.
It's kind of like a growthstock where there's all this
work that goes into it.
There's no payout for years andyears and years, but typically
it's like a company thatnobody's heard of for 10 years
and they've been working likedogs, and then all it's.
It's like a company that thatnobody's heard of.
For 10 years they've beenworking like dogs and then all
of a sudden they have an initialpublic offering and then all
(22:21):
you know they say, oh my gosh,these guys are millionaires
overnight.
Well, they worked 10 years toget there chat, gpt chat gpt, st
louis's own, yes, um, altman,uh, sam, altman, um.
So, looking into the future, wehave um a couple things
happening, I I think, but tellme if I'm wrong.
One is I think patients arebecoming more and more sicker,
(22:43):
or at least their medicalsituation is more complex, and
that has, I think, kind ofbecome more complex over time,
and then also for variousreasons, we have less primary
care doctors, and can you kindof touch on those things?
Speaker 2 (23:04):
Oh two, you know unique but also conjoined issues
.
So, yeah, patients that we seeare getting sicker.
We're going through ademographic change in this
country.
You know, the largestgeneration of baby boomers have
all just kind of aged into theretirement age range now and, as
we know, especially for most ofthe medically complex chronic
(23:25):
conditions, these thingsaccumulate over the lifespan.
So as people age they get moreand more of these problems.
We recently had a consultingfirm that we looked at to do our
physician needs analysis, helpus with our recruiting plan and
those types of things, and whatwe really, what they forecast
and this is based upon nationaldata is the patients that we see
, the ones that get admitted tothe hospital, the ones even that
(23:47):
come into our clinics.
We can expect more and morecomplex patients.
So that's just a trend of ouraging population.
In addition to that, the carethat we deliver is becoming
increasingly technically complex.
Just because we're gettingbetter at this.
We don't have patients whosuccumb early in life to simple
(24:07):
things that we now can treat andprevent.
They live longer and then we'regoing to care for them through
that rest of that time span.
You were talking about theshorter primary care physicians.
I'm going to refer back to thatphysician needs analysis we
looked at.
Currently in the St Louisregion we're 324 primary care
physicians short.
In two more years it's going tobe over 529 primary care
(24:28):
physicians short Some of theitems that we discussed earlier.
The workload for primary carehas become astronomical.
There's been an increasingtendency across a lot of the
industry to push non-physiciantasks to the physician the
workload as far as insuranceforms and calls and prior
(24:51):
authorizations and those typesof things and those are also big
job dissatisfiers.
We were talking earlier aboutwhat really rewards physicians.
We like to be in an exam roomwith our patient.
We like to have thathuman-human connection.
The more time we spend clickingon administrative tasks, the
less satisfied we are as we gothrough our day and through our
work.
So it's a challenge.
(25:13):
I think we're going to seemarket disruptors that are going
to redefine how primary caregets delivered.
We are already seeing atendency towards that, as we're
seeing the rise of certaindifferent types of health plans
Medicare Advantage plans andthose types of things.
We're seeing changes in howphysicians are compensated and
rewarded.
(25:33):
We're seeing evolutions as faras team building.
We alluded to that earlier.
I really do think we're goingto get to a point where most
primary care physicians have oneor two nurse practitioners that
work directly with them orphysician assistants, and
they're going to be much more ateam delivering care rather than
an individual provider.
So right now, when we look atthe people graduating and coming
(25:57):
out of medical school and outof their residencies, we're just
not seeing enough people tofill vacancies in primary care
just not seeing enough people tofill vacancies in primary care.
You know it'll be interestingto see how much of an imperative
is placed on that by largerpowers than us.
You know we did see some recentchanges in the CMS codes as far
as those get updated every year, and there are some very unique
(26:20):
things in this year's plan thathelped reward primary care
physicians a little bit more.
It's a drop in the bucket, butall those types of things do
help.
So market forces may help, butI think we're going to see
changes in workflows and workpatterns.
The model of primary care isgoing to change because no one
has yet figured out the secretsauce.
For how do you get enoughprimary care physicians?
(26:41):
Everybody's looking for them.
There just aren't enough ofthem coming out every year.
Speaker 1 (26:45):
Physicians- Everybody's looking for them.
They're just not enough of themcoming out every year.
Yeah, I, I, from somebody who'snot a primary care physician I
think, um, I think it's a grind.
You know, to me it seems like agrind.
It's just seeing a lot ofpatients every day.
It's a, it's a lot Um, it, um.
People are attracted tospecialize, to different
specialties, and so they don'tstay in the primary care.
At the end of their trainingthey go into a specialty.
(27:06):
But and then you know, the babyboomers are a large generation.
Gen X is a smaller generation.
The millennials are children ofthe baby boomers.
And so did I get that?
Yeah, and so, and so that'sgoing to be a larger generation.
But the problem with that isthey are more concerned about
work-life balance.
Speaker 2 (27:22):
Well, it's going to be a larger generation than Gen
X, but it's not as large as thebaby boomers, and so we still
are going to be facing ademographic shortage, and so
we're still going to bechallenged.
And that's not just forphysicians, but when we look at
nursing staff, when we look at.
Speaker 1 (27:37):
MAs, when we look at everybody, auto mechanics, you
know yeah, there's a reason whythere's so many Help London
signs out, it's going to createso much pressure that there will
be an incentive, like you said,for a market disruptor, whether
it's technology.
But we have to leveragesomething.
The one thing we do have is,you know, the United States is a
(28:02):
very attractive place forforeign medical grads and that's
good for the United States.
It's bad, it's a brain drain onthese other countries that are
less sophisticated.
But I have to imagine that weincrease the amount of foreign
medical grads that come over asprimary care providers.
(28:22):
That's kind of an easier thingto do.
I think you would think itwould be, but we still, even
with people who want to doprimary care providers, that's
kind of an easier thing to do.
Speaker 2 (28:26):
I think you would think it would be, but we still.
Even with people who want to doprimary care, it always
confounds me we still haveissues getting visas and things
like that for them, and sothere's larger political forces
that are going to determine howsuccessful that is.
This is where I think, like Isaid, I think we're going to see
changes in the model of howprimary care is delivered, but I
(28:47):
also think this is wherethere's tremendous opportunity
to leverage technology.
We have to keep the physiciansworking as physicians and
helping them to really operateat the top of their license.
We need to take some of thatload off of them.
As far as preparing prior authsand things like that, and that
is the type of thing that if yougive a computer the data to
churn through which, now thatwe've been in electronic records
(29:09):
for long enough, the databaseis there you should be able to
train a machine to do some ofthat work.
And if we can offload some ofthat and get people back to
doing what they got intomedicine to do, I think then
you've improved.
Physician satisfaction makes ita more appealing position for
someone to fill, and it willtake time.
This is a project over years,but I do think there's promise
(29:32):
for this to change what medicinelooks like.
Speaker 1 (29:35):
Yeah, and that could be a true win-win for the
patient and the physician.
Yeah for sure.
Yeah, well, darren, thanks somuch for joining us.
This has been a real pleasureand I hope you come back
sometime.
Speaker 2 (29:45):
Very good.
Well, I had a great time, Jason.
Hello, this is Jason Edwards and this is Doc
Discussions.
I'm here with Darren Haskell.
Darren, how are you doing today?
Speaker 2 (00:05):
Doing great.
Jason, Thanks for having me on.
Speaker 1 (00:07):
Thank you for coming Now, Darren.
You're a primary care provider,but you're also the chief
medical officer of the hospital,Is that correct?
Speaker 2 (00:12):
Yes, it is.
I still practice traditionalinternal medicine so I still go
in route on my own patients atthe hospital, try to make it to
a few meetings, go over, seepatients in the office and then
I get roped into the admin workthe second half of the day.
Speaker 1 (00:25):
You're the iron man.
Most doctors who are primarycare providers do not see their
patients in the hospital, but Ithink that makes you unique.
Why do you do that?
Speaker 2 (00:36):
It's just the way I was trained.
It's how I started practicing.
It was kind of the expectationwhen I was in training.
That was just the way you didthings and because I kept doing
it for a longer and longerperiod of time, it kind of
became a calling card.
I have a lot of patients thatsee me right now that are still
on my panel specifically becausethat's the kind of care
experience they were looking for.
And for some patients it stillmakes a big difference when
(00:58):
they're sick and they're in thehospital.
They really appreciate thatfamiliar face coming through the
door being able to help explainthings to them.
Speaker 1 (01:06):
No doubt about it, no doubt.
And there was a period of timewhere that was kind of the
standard and maybe 15 years orso that fell out of place and a
lot of patients have hadproblems with that.
Now the hospitalists will takecare of the patients most of the
time.
But I know from mutual patients, I know you know your patients
very well and you have a fairlylarge patient population.
(01:27):
How many people are youtreating in general or roughly
speaking?
Speaker 2 (01:29):
So before I started admin work, I had a panel of
about 5,900 patients.
Now it's just a little bitunder 3,000.
Yeah, so that's incredible.
Speaker 1 (01:37):
And so you obviously have to have some efficiency
within your practice to be ableto do that Well, and you were
talking about the hospitals.
Speaker 2 (01:46):
I've been blessed.
I'm very well tied in with ourhospitals group.
They've been very good to me.
I'm the last person in my callgroup who still sees their own
inpatients, so if I need to havea weekend off or something, dr
Liu and his team have been verygracious that I can call them up
and say hey guys, I'm going tobe out of town, do you mind?
(02:08):
And they're more than happy tohelp take care of those patients
.
It's the only thing that makesit a practical option for me
still.
So I've got to say that's beenone of the things that's key to
it.
And then and I think this isgoing to be true for most people
who practice primary care,whether or not they go to the
hospital see their own patientsAny more.
Primary care is really a teamsport and you have to get the
infrastructure built around you,the team around you, to help
you do what you need to do.
There was a paper that waspublished about a year and a
(02:30):
half almost two years ago now.
It was from John Hopkins and theUniversity of Chicago, and they
showed that for a physicianwith a standard-sized patient
panel which is about 2,000patients in their model that
they put together, it wasestimated for that primary care
provider to just deliverguideline directed care so just
to do the things you're expectedto do for your patients
(02:52):
according to current healthguidelines and that's before
anybody gets sick, before theyreally have a problem or need
you it would take 29 hours perday on average for them to do
that.
That doesn't really line up withthe way our planet rotates.
So you know, if you don't havethe right team with you, it's an
impossibility.
(03:12):
They looked at the teams thatthey had deployed at those two
institutions and those are, youknow, world-class healthcare
institutions and even with theirsystems that they have in place
as far as NP support, nursingsupport, et cetera, they still
were estimating it was taking 22hours per day to take care of a
standard-sized panel.
That's incredible.
So when you look at that,really with the demands that we
(03:34):
place on our physicians and alot of this came about in the
era of the EHR and really dataand metric-centric medicine,
that's electronic health-records yeah electronic health
records.
We really are putting more andmore demands on those frontline
providers, and so we really needthat team around them to help
to get that done.
It's no longer feasible for onedoctor to handle every single
(03:58):
aspect of that patient's care bythemselves.
You really do need a team.
Speaker 1 (04:02):
And so it makes me think of two things here, and
you say that one is that StLuke's is it was regarded to the
physicians is kind of a smallfamily.
We all know each other fairlywell and so I think that helps
with some of the handoffs is youcan call somebody who's a
friend or who you've eaten lunchwith in the doctor's lounge and
say, hey, can you help me here?
And the other thing is whatI've noticed with your practice
is it seems like a lot of yourpatients you've know very well
(04:25):
over the years, and so you don'thave to dive as deep into the
chart to kind of know what'sgoing on with them, because
you're familiar with their case.
Speaker 2 (04:32):
One of the unique things about our institution is
the length of tenure that a lotof our staff have here.
It's a very, very friendlyplace to practice.
It's a very unique atmosphere.
People tend to come out here,they start practicing here and
they realize they don't want topractice anywhere else.
So you'll find a lot of ourphysicians that have been in the
same practice for 10, 15, 20.
I've been in the same practicefor 23 years.
(04:53):
Dr Heichel's been in practicefor 43 years in his location.
So those are not uncommonstories around here and that
does allow us to be veryfamiliar with the patients.
You mentioned how things arevery collegial here.
I think it's a very uniqueopportunity to tell us to
interview candidates when theycome in.
If I need something done acutelyfor a patient, I'm calling a
(05:16):
friend of mine.
I can remember a case not toolong ago where I sent you a
message early in the morning.
I had a patient who'd beenadmitted with what we thought
initially was something totallydifferent.
When I saw him in the morning,we realized he had a patient
who'd been admitted with what wethought initially was something
totally different.
When I saw him in the morning,we realized he had a spinal cord
compression.
It looked like it was going tobe malignancy and within 15
minutes he'd been seen byradiation, oncology and
neurosurgery and the oncologistwas there about 30 minutes after
(05:36):
that.
So that's a very unique way topractice.
These are all people I knowpersonally, so I was able to
just put out a blast message andsay hey guys, here's a problem.
It was a Friday, everybodywanted to get home and didn't
want to get dragged into acomplicated case.
But these are people who knowthat around here we really put
the patients first and qualityof our care first, and they they
(05:57):
rose to the occasion and it'sbecause of that collegiality.
You know it's different ifyou're a large and personal
institution.
You happen to get the fellowwho's on call and they may or
may not get around to it for afew hours and certainly the
attending is not the one that'sshowing up in that room and
seeing that patient.
So I think it's one of thethings that makes St Luke's a
very unique place to practice.
Speaker 1 (06:18):
Yeah, I agree.
I mean, if I get a call fromsomebody who I've never met
before, I mean we all have.
I think there's aninstitutional standard.
And then I think, individually,we all have high standards, but
it's just a little bitdifferent if it's somebody I
know and they're saying, jason,I need you to see this person.
And sure you know, we have arelationship, we've got a
(06:38):
reputation that we that's a twoway street that we both want to
uphold and a standard of carethat you want to be known for.
And I do think that makes adifference.
I really do.
So you're now the chief medicalofficer, you're a primary care
provider for 20-some-odd years,and then you, I think two things
(07:00):
.
It's insane to go intoadministration.
I mean, if you want somebody tocomplain to you all the time,
go into administration.
But I also think and I mightanswer your question for you but
so I was thinking well, whywould somebody want to go into
this?
But I think it's a role thatyou're, that you're that you've
been very effective in, and isit, did you see?
(07:24):
Like, hey, there's a need hereand I think I can make a big
difference and that's why I wantto do it, because it's a
challenge going into this role.
Speaker 2 (07:31):
It's a challenge and it's a different challenge.
I'd been doing the same thingas a primary care physician.
You know at that point that Ifirst stepped into this role.
I'd been doing that for about24 years and this was presented
to me it was early on in theCOVID pandemic.
At that point Bill Campbell wasthe head of our medical group
and he was clearly, because ofhis role also as the head of our
(07:54):
infectious disease department,very, very busy dealing with
what needed to be handled withCOVID.
Our current CEO at that pointasked me to start assuming some
additional roles.
And it's largely because I'vealways been very outspoken as an
advocate, especially for ourprimary care physicians.
I've volunteered on a lot ofcommittees, spent a lot of time
(08:14):
putting in my input, becauseI've always felt that as a
physician, especially as we'vegone through the transformation
of our industry, moving intoelectronic records and some of
those things If you aren'twilling to speak up and have
your voice heard, you're justgoing to get run over by the new
system when it gets put in.
Yeah, so I was approached totake on more and more of these
(08:35):
roles.
Eventually I was approachedabout taking this position and
at that point, I was alreadydoing a lot of the work.
I went home to discuss it withmy wife, and she said well,
you're already doing 80% of it.
They might as well give you thejob description, and maybe
they'll even pay you for doingsome of it.
So, at that point, the mostdifficult part of that
(08:56):
transition, though, wasdownsizing my practice.
Now, like you pointed out, youget to know your patients.
That was a very, very difficultprocess to work through.
I was very fortunate.
I have some wonderful partnerswho are more than willing to
take on quite a bit of that load, and then we also have a lot of
other good primary carephysicians in our system who
were able to step up, and wemade sure that everybody was
(09:17):
linked up with somebody whocould fulfill their needs.
Speaker 1 (09:20):
Yeah, you're right.
I mean the patients are a partof our lives and you care about
them and I think sometimes maybethe patients underestimate how
important they are for us.
You know they give meaning toour lives and it would be very
hard to say like I can only seethese patients and I can't,
because you know you're going todisappoint people.
Speaker 2 (09:39):
You definitely disappoint people.
But as doctors we're all kindof codependent with our patients
.
Speaker 1 (09:43):
You definitely disappoint people, but as
doctors we're all kind ofcodependent with our patients.
Speaker 2 (09:46):
Yeah, that's true.
There's most of us who got intothis at some point.
There is that idea that I'mdoing this because of the
feeling it gives me.
I realized early on I hadinitially thought I wanted to be
a surgeon of some type and Idid my first few rotations in
medical school and that was fun.
I enjoyed being in the OR andeverything.
But it was really when I hit mymedicine.
Rotation is at the VA hospital.
(10:06):
I still remember the firstpatient I was on call overnight.
It made me this old guy late atnight.
He was really sick and hestarts telling me stories about
being in the battle of the bulgeand I was just blown away and I
was like that is so cool andthat was really.
I decided that's what reallyexcites me about medicine is
getting to know these people andthen having that long-term
relationship.
I have families right now whereI'm taking care of three
(10:26):
generations of a family and youknow that kind of experience is
very gratifying.
As physicians we really thriveon getting that positive
feedback from our patients.
You know, when you've helpedsomebody they come back and see
you and they tell you what itmeans to you.
You take care of somebody.
You know I'm going to go intoyour world in oncology.
You get them through amalignancy and then you see them
for a follow-up visit and theytell you about the new grandbaby
(10:48):
they got to meet because theywere able to make it through the
acute phase of their illness.
Those are the things that makeyou thrive.
Speaker 1 (10:53):
Yeah, yeah, it gives meaning to our lives, for sure,
and it's the hug here and there,it's that kind of stuff and I
often think, too a long, longtime from now.
It's hard to walk away fromthat and retire, and that's what
you see.
You see a lot of doctors who'vebeen around here a long time
and are still going strong andfor whatever it's worth.
(11:14):
There's pretty solid data onthe longer you work, the longer
you live, and so I'm a fan ofthat.
I think that's a win-win allthe way around.
Speaker 2 (11:23):
It is a win-win and I think for us I was pointing out
how long-tenured some of ourstaff are I think it's a very
valuable thing for us as aninstitution.
It helps to perpetuate theculture of the institution.
As I pointed out earlier, we'rea unique place to practice and
to work as a patient.
It's a unique environment tocome and get care and people
(11:44):
who've been here for a long timehave really, you know, they've
soaked in that culture andthey're the ones that can kind
of pass that on to the youngergeneration when they come along.
That's always one of ourchallenges now that I'm doing
this administrative role.
We like to try to find apractice and we like to try to
slide a younger provider insomeplace where there's a couple
of people who are reallyseasoned and have been here and
they've been part of the teamfor a while.
It, you know, there'sopportunities out there in
(12:07):
community and one of we have acouple of places that we're
looking at right now and thehard thing is it's like it's
hard to put just young peopleout there by themselves who
haven't been with somebody.
That's part of that culture.
So it's always a bit of abalancing act.
But you know that's one of thegreat things about where we are
(12:30):
at St Luke's is we really dohave a unique culture and we've
got a really good group ofpeople who are very, very
adamant about carrying thatculture on, and I think it's one
of the things that will help usbe successful in the future.
Speaker 1 (12:36):
Yeah, I couldn't agree more.
So three concepts I want totalk about that you've kind of
touched on that I think would beuseful for people who are maybe
not in medicine.
One is I think it's good for tohave people that you work with
(12:57):
of different ages.
I think it's good for the olderperson.
They can teach us like whatTikTok or whatever is, and then
the younger people can learnfrom the older people.
Um, the second thing is you weresaying that you were on uh
boards and meetings.
Uh, you know, before you tookon this role and um, and you
were, you were vocal Um.
(13:17):
And one thing I think that'strue, this is for young people
is, um, when you're in a groupof people at a meeting or
something like that and youspeak up, you there's a high
probability that whatever yousay will be kind of dumb, but
you also have a good chance ofbringing a new idea because you
(13:38):
have a slightly differentperspective.
But in my mind I think most ofthe things that I've said you
know, ultimately I'm like, ah,that wasn't the smartest thing
in the world, but I still thinkit's good to have young people
or younger people on committeesand in meetings to give their
opinion, even though you knowmost of their ideas won't be
great.
Speaker 2 (13:58):
Well, they need to.
We also and I think this istrue in a lot of industries
beyond just medicine.
There's a very distinctgenerational divide in what
people are looking for from workand what their expectations are
as far as their work-lifebalance.
That's something we hear fromevery young candidate that comes
out and interviews with us now,yeah, and if, as you're
(14:18):
entering the workforce, if youexpect something different than
what you see right now, you haveto be willing to advocate for
yourself.
And if what you're bringingforth seems silly or odd to some
people, there are other peoplein that room that it resonates
with.
Yeah, and so you know, weencourage all of our physicians
when we bring them in.
We really encourage people allacross our clinical continuum to
(14:39):
get involved in committees, bevocal advocates.
Everybody should be an advocatefor their patient, but you need
to be an advocate for yourselfand your colleagues as well.
That's one of the other nicethings about an institution this
size.
We're not a large impersonalbureaucracy.
We're not spread largeimpersonal bureaucracy.
We're not spread acrossmultiple states.
If we need something for ourclinic, our practice, if we need
(15:00):
something for our patients, wecan get a hold of the decision
makers very easily.
We can get ourselves onto thecommittees that make these
decisions, establish policiesand do those things.
Here we're always asking forvolunteers, and so, for any of
the physicians who happen tohear this, this is a call to get
as involved as you can, becauseeverybody has a slightly
(15:20):
different approach to practiceand what you may offer, what you
may say, might not resonatewith one provider, but there are
other people that are going tosay, yeah, I'd like to try that.
Or, you know, that sounds likea problem I've run into, and so
always feel free to speak up.
Everybody should be willing todo that.
You spend too many hours atwork not to have your voice
heard if it's affecting youthrough your workday.
Speaker 1 (15:41):
Yeah, I totally agree .
You got one life to live andyou know you, you, you know in a
very professional way.
It's it's good to heareverybody's perspective and and
and that's how we learn and growand evolve as an institution
and that's how companies getbetter and are able to kind of
change with the times.
Don't want to change too muchwith the times, but you have to
(16:04):
have some change.
Speaker 2 (16:05):
You have to be responsive.
I mean you and I have both beendoing this long enough.
We've seen a lot of changesfrom when we first came out of
training.
Medicine's a much differentfield than it was, and it will
continue to change, I think,when some of the things that
we're really going to seestarting to impact us over the
next few years.
We're already starting to toyaround with it right now, but
how AI is going to impact thework that we do it's going to
(16:25):
vary from field to field, butthere's going to be some pretty
dramatic changes in ourworkflows and what our day looks
like.
Speaker 1 (16:32):
Yeah.
So that kind of leads me to mynext question how are we going
to leverage technology to helpus give more efficient care and
better care in the future?
Are there some specific thingswe have on the horizon?
Speaker 2 (16:43):
Well, there's even some very simple old-school
technologies that we've beenworking on deploying.
We've been going through aprocess here at St Luke's we had
, as our medical group evolved,it had really been just kind of
an agglomeration that hadoccurred over time.
Individual practices had beenadded on.
We never really sought to, youknow, be uniform in our approach
(17:06):
to how a patient interactedwith us, what the experience
looked like.
We've even just something assimple as putting in a unified
phone system across all of ourpractices and getting very set
routines as far as how phonesare answered, how messages are
conveyed to providers, thosetypes of things.
We're working through thatprocess right now.
(17:26):
No one had taken that challengeon.
It's just been over the lastyear and a half that we've
really started to tackle some ofthat part of things.
So old school technologies canstill be better deployed.
But then we are looking at howwe deploy very new technologies.
We're working right now througha pilot project with Nuance.
Those are the people who doDragon voice recognition
(17:47):
software.
They have a product called DAXand they have a newer one that's
actually going to be coming outvery shortly, called DAX
CoPilot, which allows thephysicians, as we're in an
encounter with a patient.
It's an AI-empowered voicerecognition software.
I'm piloting I'm one of the 13physicians we have in the pilot
right now and I can sit down inmy office with my patient, take
(18:12):
my phone out it acts as amicrophone sit it on the table,
we get their permission, ofcourse, and then the two of us
can just talk.
I'm no longer typing on thekeyboard while I'm in the room
with the patient.
That's so nice.
And at the end I step out andthere's a little lag time right
now because they do have a humanwho goes over and just make
sure there's no major errorsfrom the computer, but about an
(18:33):
hour, hour and a half later sure, there's no major errors from
the computer, but about an hour,hour and a half later the text
of that encounter comes into myinbox.
I get a chance to look at it,go through it, you can edit it
if you need to, and then mynote's done.
So it simplifies the process,gets us back to having a
conversation in the room withthe patient rather than worrying
about how many clicks we'rehitting as we're having that
encounter.
So it's a more organicexperience, more organic
(18:54):
experience, and I think this isone of those things when we look
at physician burnout anddissatisfaction.
One of the things that's beenan issue ever since the
Affordable Care Act came out andwe really were all pushed into
electronic records wasphysicians are very tired of
spending more time looking atthe screen than they are looking
at their patients.
Yeah, and it gets that visitback to being a much more what I
(19:18):
remember when I was in mytraining that human connection,
that sitting in a room having aface-to-face conversation with a
patient rather than lookingprimarily at your computer
screen.
So I think there's some verypromising things with what
technology can bring to us.
We're very fortunate theelectronic record that we use,
cerner.
Cerner was recently purchasedby Oracle, which is one of the
(19:39):
largest technology companies inthe country, and they're really
bringing a lot of their toolsinto this.
Oracle is one of the mostadvanced AI platforms available
in the country right now.
They're a world leader as faras their technology for those
types of products, as well astheir security products, et
cetera.
So we should have a much moresecure which is very important
(20:02):
in this day and age when we hearabout all these other
healthcare organizations thatget hacked but also a very
technology forward, veryuser-friendly experience.
So there's a lot that we standto benefit from in the near
future with that relationship.
Speaker 1 (20:16):
That's exciting.
That's exciting, darren.
I've always looked up to you asa physician and as a father,
and so I want to ask you onelast question.
To young people who are in,maybe, high school or college,
who are looking at going intomedicine, what advice would you
(20:39):
give them?
I know I'm putting you on thespot here, but what advice?
Speaker 2 (20:42):
would you give them?
It's pertinent.
I have a son who startedcollege last year and he says he
wants to do medicine.
So we've had a few of thesediscussions.
I think that it is a long roadstill to get through medical
school, through residency,fellowship, and then get into
practice and establish yourself.
You really have to have themindset that can put up with
that kind of delayedgratification.
(21:03):
If you do, the payoffs areenormous.
We were talking a moment agoabout the rewards we get from
our professional livesprofessional lives.
There are very few professionswhere you get that feeling, that
feedback from people thatyou've helped, that you've saved
their lives, you allowed themto live long enough to see their
grandkid born, I mean.
(21:24):
Those kinds of things I don'tthink you can even put a dollar
value on.
And so those are still thethings that if that's the
experience that you want and ifyou're really driven to do
something that puts you in arole to really help people, then
it's something you shouldcertainly consider.
But you also have to go into itrealizing you're going to give
(21:44):
up a lot of weekends, you'regoing to give a lot of long
nights of work and stuff.
It is a difficult process toget there.
If you can do that, it's wellworth it.
It's kind of like running amarathon.
You have to have that mindsetthat this is not a sprint.
I'm really committed for thelong haul here.
Speaker 1 (22:01):
Yeah, yeah.
It's kind of like a growthstock where there's all this
work that goes into it.
There's no payout for years andyears and years, but typically
it's like a company thatnobody's heard of for 10 years
and they've been working likedogs, and then all it's.
It's like a company that thatnobody's heard of.
For 10 years they've beenworking like dogs and then all
of a sudden they have an initialpublic offering and then all
(22:21):
you know they say, oh my gosh,these guys are millionaires
overnight.
Well, they worked 10 years toget there chat, gpt chat gpt, st
louis's own, yes, um, altman,uh, sam, altman, um.
So, looking into the future, wehave um a couple things
happening, I I think, but tellme if I'm wrong.
One is I think patients arebecoming more and more sicker,
(22:43):
or at least their medicalsituation is more complex, and
that has, I think, kind ofbecome more complex over time,
and then also for variousreasons, we have less primary
care doctors, and can you kindof touch on those things?
Speaker 2 (23:04):
Oh two, you know unique but also conjoined issues
.
So, yeah, patients that we seeare getting sicker.
We're going through ademographic change in this
country.
You know, the largestgeneration of baby boomers have
all just kind of aged into theretirement age range now and, as
we know, especially for most ofthe medically complex chronic
(23:25):
conditions, these thingsaccumulate over the lifespan.
So as people age they get moreand more of these problems.
We recently had a consultingfirm that we looked at to do our
physician needs analysis, helpus with our recruiting plan and
those types of things, and whatwe really, what they forecast
and this is based upon nationaldata is the patients that we see
, the ones that get admitted tothe hospital, the ones even that
(23:47):
come into our clinics.
We can expect more and morecomplex patients.
So that's just a trend of ouraging population.
In addition to that, the carethat we deliver is becoming
increasingly technically complex.
Just because we're gettingbetter at this.
We don't have patients whosuccumb early in life to simple
(24:07):
things that we now can treat andprevent.
They live longer and then we'regoing to care for them through
that rest of that time span.
You were talking about theshorter primary care physicians.
I'm going to refer back to thatphysician needs analysis we
looked at.
Currently in the St Louisregion we're 324 primary care
physicians short.
In two more years it's going tobe over 529 primary care
(24:28):
physicians short Some of theitems that we discussed earlier.
The workload for primary carehas become astronomical.
There's been an increasingtendency across a lot of the
industry to push non-physiciantasks to the physician the
workload as far as insuranceforms and calls and prior
(24:51):
authorizations and those typesof things and those are also big
job dissatisfiers.
We were talking earlier aboutwhat really rewards physicians.
We like to be in an exam roomwith our patient.
We like to have thathuman-human connection.
The more time we spend clickingon administrative tasks, the
less satisfied we are as we gothrough our day and through our
work.
So it's a challenge.
(25:13):
I think we're going to seemarket disruptors that are going
to redefine how primary caregets delivered.
We are already seeing atendency towards that, as we're
seeing the rise of certaindifferent types of health plans
Medicare Advantage plans andthose types of things.
We're seeing changes in howphysicians are compensated and
rewarded.
(25:33):
We're seeing evolutions as faras team building.
We alluded to that earlier.
I really do think we're goingto get to a point where most
primary care physicians have oneor two nurse practitioners that
work directly with them orphysician assistants, and
they're going to be much more ateam delivering care rather than
an individual provider.
So right now, when we look atthe people graduating and coming
(25:57):
out of medical school and outof their residencies, we're just
not seeing enough people tofill vacancies in primary care
just not seeing enough people tofill vacancies in primary care.
You know it'll be interestingto see how much of an imperative
is placed on that by largerpowers than us.
You know we did see some recentchanges in the CMS codes as far
as those get updated every year, and there are some very unique
(26:20):
things in this year's plan thathelped reward primary care
physicians a little bit more.
It's a drop in the bucket, butall those types of things do
help.
So market forces may help, butI think we're going to see
changes in workflows and workpatterns.
The model of primary care isgoing to change because no one
has yet figured out the secretsauce.
For how do you get enoughprimary care physicians?
(26:41):
Everybody's looking for them.
There just aren't enough ofthem coming out every year.
Speaker 1 (26:45):
Physicians- Everybody's looking for them.
They're just not enough of themcoming out every year.
Yeah, I, I, from somebody who'snot a primary care physician I
think, um, I think it's a grind.
You know, to me it seems like agrind.
It's just seeing a lot ofpatients every day.
It's a, it's a lot Um, it, um.
People are attracted tospecialize, to different
specialties, and so they don'tstay in the primary care.
At the end of their trainingthey go into a specialty.
(27:06):
But and then you know, the babyboomers are a large generation.
Gen X is a smaller generation.
The millennials are children ofthe baby boomers.
And so did I get that?
Yeah, and so, and so that'sgoing to be a larger generation.
But the problem with that isthey are more concerned about
work-life balance.
Speaker 2 (27:22):
Well, it's going to be a larger generation than Gen
X, but it's not as large as thebaby boomers, and so we still
are going to be facing ademographic shortage, and so
we're still going to bechallenged.
And that's not just forphysicians, but when we look at
nursing staff, when we look at.
Speaker 1 (27:37):
MAs, when we look at everybody, auto mechanics, you
know yeah, there's a reason whythere's so many Help London
signs out, it's going to createso much pressure that there will
be an incentive, like you said,for a market disruptor, whether
it's technology.
But we have to leveragesomething.
The one thing we do have is,you know, the United States is a
(28:02):
very attractive place forforeign medical grads and that's
good for the United States.
It's bad, it's a brain drain onthese other countries that are
less sophisticated.
But I have to imagine that weincrease the amount of foreign
medical grads that come over asprimary care providers.
(28:22):
That's kind of an easier thingto do.
I think you would think itwould be, but we still, even
with people who want to doprimary care providers, that's
kind of an easier thing to do.
Speaker 2 (28:26):
I think you would think it would be, but we still.
Even with people who want to doprimary care, it always
confounds me we still haveissues getting visas and things
like that for them, and sothere's larger political forces
that are going to determine howsuccessful that is.
This is where I think, like Isaid, I think we're going to see
changes in the model of howprimary care is delivered, but I
(28:47):
also think this is wherethere's tremendous opportunity
to leverage technology.
We have to keep the physiciansworking as physicians and
helping them to really operateat the top of their license.
We need to take some of thatload off of them.
As far as preparing prior authsand things like that, and that
is the type of thing that if yougive a computer the data to
churn through which, now thatwe've been in electronic records
(29:09):
for long enough, the databaseis there you should be able to
train a machine to do some ofthat work.
And if we can offload some ofthat and get people back to
doing what they got intomedicine to do, I think then
you've improved.
Physician satisfaction makes ita more appealing position for
someone to fill, and it willtake time.
This is a project over years,but I do think there's promise
(29:32):
for this to change what medicinelooks like.
Speaker 1 (29:35):
Yeah, and that could be a true win-win for the
patient and the physician.
Yeah for sure.
Yeah, well, darren, thanks somuch for joining us.
This has been a real pleasureand I hope you come back
sometime.
Speaker 2 (29:45):
Very good.
Well, I had a great time, Jason.
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