Rosemarie Aznavorian 0:00
We should be worried, and we need to be acutely aware, and you know, not be judgmental about it when you're talking to the patient. That's what's really important.

Austin Littrell 0:17
Welcome to off the chart, a business and medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Luttrell. I'm the associate editor of medical economics, and I'd like to thank you for joining us today before we get started. Just a quick note, physicians practice will be hosting practice Academy's new practice management track on Thursday, March 19. The Virtual Learning Experience is designed for physicians and practice administrators looking for practical, real world strategies to strengthen operations, improve performance and build more resilient practices. Speakers include otter Spielberg of MGMA, Bronson Cox of encoda, Justin Lamb of cool blue, VA and Mark Herzog of Vera dine. You can register today by clicking the link in the show notes or by going to registration. DOT physicians practice.com, that's said in today's episode, I sat down with Rosemary asnavorian, Executive Vice President and Chief Clinical Officer and MedPro healthcare staff. We talked about how staffing shortages are affecting patient access and day to day care, why hospitals are feeling the strained as experienced staff retire and patients grow sicker, and how longer wait times are actually pushing some patients towards AI tools. Rosemary also shares practical staffing approaches, including her 8010 time model, and why long term workforce planning is critical for practices and health systems. So rosemary, thank you again for joining us today, and let's get into the episode.

Rosemarie Aznavorian 1:42
You Hello everyone. I'm Dr Rose Marie asna borian. I'm the Executive Vice President and the Chief Clinical Officer here at MedPro healthcare staffing. We provide supplemental staffing to facilities, whether they're standalone or part of healthcare systems, and also freestanding labs, but we primarily, we have two service lines within our organization. The first is probably what the facilities are very much used to, which are considered domestic travelers, which are like 13 week traveling nurses or 13 week traveling radiology technicians that come in and help supplement the hospitals when they have the need. And then the other side of our service lines are the international staffing, which is primarily what I oversee, where we bring in foreign educated professionals from other countries that meet United States criteria for clinical practice to help provide a long term workforce solution, versus an every 13 week turnover. And the goal of that is for them to join the staff as their core staff when they're complete.

Austin Littrell 2:42
From what you're seeing, how directly are staffing shortages translating into longer wait times or lost continuity of care for patients?

Rosemarie Aznavorian 2:50
Oh, significantly, significantly. So there's a couple of pieces here. The first is, if you have reviewed or have interested in reading the Institute of Medicine report on the Future of Nursing. The first one was done way back in 2010 and the second one was done five years later, and really painted a picture that was going to be significantly impacting patients receiving care going forward. And that's for a number of reasons. The first is nursing school enrollment is significantly lower, so we are producing less nurses coming out of the nursing programs. A lot of us are aging out where we're getting ready to retire. And you know, the pandemic actually helped to increase the number of early retirements. And when those experienced nurses leave, they take with them all their experience in caring for nuclear patients. And also the patients are getting more sick and are higher acute which means they're waiting further to actually access care. So that's one part of it. When the hospitals are not staffed the way that they should be, based upon not only the volume of patients, but the acuity and how sick the patients are, what happens is the nurses are stretched very thin, and therefore it runs the risk of a few things. The first is there could be missed care, care that wasn't able to be delivered because there wasn't time where there was a sicker patient taking up that nurse's time. Also, if the nurses are being asked to work overtime, they can have workforce fatigue, which could also lend to medical errors and then significantly increasing wait times, whether it's in the emergency department waiting for care, or if they happen to come to the ER, they're waiting longer times to go to the operating room to get their surgery and longer times to get their tests done. So that immediately impacts the level of care that's provided, you know, but also with the hospitals in terms of their financial pressures, with insurance company reimbursement being less optimal than what the hospitals would like it to be, and the cost of care is continuing to go up, so all of those factors coming together have created a perfect storm.

Austin Littrell 4:53
So when those appointments are delayed or unavailable because of these shortages, are clinicians actually hearing patients say that. They've turned to tools like the recently released chat GPT health, or Amazon health, AI and kind of in what context there,

Rosemarie Aznavorian 5:07
sure they're doing a number of things to avoid going to their physicians office if they can even get a reasonably timed appointment or urgent care or er, they're using AI to self diagnose, which, many times, can have misguided information. It might tell them their information is not a cardiac related issue when it could be cardiac related issue because there's so many signs and symptoms that mimic one another that requires a clinician to actually do a clinical assessment, because sometimes they present differently than what they actually are. That's the first piece. The advantage of the AI is that there are questions that helps to educate the patients that they should be asking their physicians or their care providers to make sure that they have a full, detailed clinical assessment and related to their care and what the treatments could be and what the potential complications could be. So there's positives and negatives to it.

Austin Littrell 6:04
Where are clinicians most often encountering patients who say that they've used these tools because they couldn't get timely care? I mean, is this particularly in these kind of, you know, hospital dead zones, these these hospital deserts, rural settings, safety net clinics, or is it in larger outpatient practices?

Rosemarie Aznavorian 6:21
Actually, it's all of those. You hit them all. So let's talk about the rural rural communities are many times underserved in terms of care providers and the financial impact of having to receive care. They might be not insured or underinsured, or they might not have the ability to pay those co payments. So they're waiting and waiting and waiting. So that's one component of it. The other component is in the larger facilities, because everybody's going, you know, they wait until it's too late to be seen by a physician or urgent care, and they're sick enough that they have to go through the emergency department, which is overwhelming the ers. So in terms of staffing, many times, the emergency departments are very tightly staffed. The critical care units are tightly staffed. And the operating rooms.

Austin Littrell 7:09
Are there particular specialties, I guess. Also, I know we talked about those, you know, where in settings, I guess. But are there different specialties? Or, again, care settings where staffing shortages are more strongly pushing patients towards, you know, this AI based guidance,

Rosemarie Aznavorian 7:26
I wouldn't say that the facilities are pushed or specialties are pushing them towards AI. It's really more how easily accessed it is now versus how it might have been previously, and how common it is now. So their patients are self diagnosing, which is not always the best thing to do, because, like I mentioned before, symptoms may be mimicking one thing, and you're getting misguided information from chat GPT. So somewhere along the way, preventative care is probably the most critical piece, if they can maintain their health by either seeing their primary care physician, or, if they're in an underserved community, meeting with their nurse practitioner providers. That would be helpful so that they can get ahead of what the challenges are, because many of the rural areas have underdiagnosed hypertension, diabetes, all of those things that really don't show signs and symptoms until they're really to the point where it's impacting their activities of daily living.

Austin Littrell 8:27
How worried should clinicians be about patients using these Gen AI tools as a substitute for access to care, rather than a supplement to it?

Rosemarie Aznavorian 8:34
We should be worried, and we need to be acutely aware. And many times, you know, physician patients will come into their position, or come into the emergency room and saying, Well, I check, check GPT, and I've done X, Y and Z, and this is what it's telling me it is. And if the diagnosis is actually different, it can sometimes cause some dismay with the patient, because they're going to be receiving care that they weren't expecting to receive. But we need to be aware and, you know, not be judgmental about it when you're talking to the patients. That's what's really important, because they were trying to find information surrounding what their clinical problem might be, so that they can either a possibly manage it at home and avoid an emergency room or an urgent care visit. But just to not be judgmental when you're asking questions.

Speaker 1 9:30
Hey there. Keith Reynolds here and welcome to the p2 management minute in just 60 seconds, we deliver proven, real world tactics you can plug into your practice today, whether that means speeding up check in lifting staff morale or nudging patient satisfaction north. No theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom. They come from you got a clever workflow, hack, an employee engagement win, or a lesson learned the hard way, I want to feature it. Shoot me. An email at K Reynolds at MGH life sciences.com with your topic, quick outline or even a smartphone clip, we'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next p2 management minute.

Austin Littrell 10:21
So a recent report said that more than 5% of all messages sent to chat GPT, at least in the last year, are about health care. Does that reflect unmet clinical needs? Is that patient frustrations? Or do you think that's more about you know, patients are simply curious about

Rosemarie Aznavorian 10:36
their health. Probably one of all three, you hit the nail on the head so curious about their own care, because if they happen to receive a lab report since the invention of the electronic health record, many times results might be posted to the electronic health record or posted to the laboratory portals when they get their blood work done Ahead of interpretation by the provider, so they may start checking my blood level. Is this in a certain area? Well, what does this mean? And then they go down the rabbit hole. You know, that's one part of it. The other part of it is they do try to find alternative methods of treatment. If I'm being told that I need to, for example, have my gallbladder out. What does that mean? Are there different ways to manage that? Is that a full operation? Could that be done by robotics? Is there any information or anything I can do diet wise or medication wise to avoid the surgery? So it's it does have an education component to it, which is a good thing, so that you have an educated patient when they come. But it also can be detrimental if they only use that as their guidance. Sure.

Austin Littrell 11:45
Could you talk about the risks that this trend poses for clinicians and practices, especially when patients are acting on that? AI advice before they've ever seen a physician

Rosemarie Aznavorian 11:56
misdiagnosis, patients can self diagnose, and like I mentioned, it can be the wrong diagnosis, or they could try treatments that are over the counter, that may actually not work, or potentially contraindicate what their problem is and cause side effects related to that. So like I mentioned, it's a good educational tool, and I think that nurses, who are again rated the most respected profession. I think it's 15 or 20 years running that we need to help the patients take the helm. You know, they are in charge of their care, but we need to provide them with with that information so they can make the appropriate decision for themselves.

Austin Littrell 12:36
Looking ahead over the next few years, do you see Staffing Solutions is one of the most immediate ways to slow this shift towards AI health advice. Or is patient reliance on these tools kind of now baked in.

Rosemarie Aznavorian 12:50
Staffing is really, really critical, because, as I mentioned earlier, if they do not have the number of nurses that they need to care for the patients based upon acuity, and it's not necessarily related to ratios. Some states do have ratios. You need one nurse for X amount of patients that you're on. But more importantly is how sick the patients are, or the acuity of the patient, because you may have 10 patients on a nursing unit, and they all might be getting ready to be discharged, so that's less care that has to be delivered. But then again, if you're on a unit that the patients are a little bit sicker, or they're post op, or they've just been transferred out of ICU, or they're being monitored on a heart monitor through telemetry, that's going to require more nurses. However, those 10 patients, if you have four telemetry patients and six getting ready to be discharged, you might need less nurses because of the acuity of the patients, but again, if they are treating themselves before they get there, or attempting to treat themselves, they're going to be sicker when they show up. Therefore, you're going to wind up needing more nurses to care for those patients, because how acutely ill they are.

Austin Littrell 13:51
Absolutely Is there anything that we haven't discussed so far that you think we might have glossed over or missed?

Rosemarie Aznavorian 13:57
It's important for facilities to take a look at healthcare staffing companies as a consultant arm and how we can help. You know, I've been a nurse for 47 years, and was a chief nursing officer for a very large healthcare system in Texas for 10 years. So I've been on that side of the house, and I actually use now, I mentioned that pro because I'm here now, but I actually use med Pro as part of my long term workforce solution. One of the items that I coined in one of my publications is the 8010 10 rule. So 80% of the hospital staff should be their own staff, which could include full time staff, part time staff, per diem staff or like a float pool. Another 10% should be from the international side of the world, because those nurses or medical technologists are there with you for 36 months. So they actually come become part of your core staffing. So they're dedicated to the mission, vision and values of the organization. And then the other 10% should be. Those 13 week assignments, like we talked about, either they have a number of people on FMLA that they just need that 13 week filled, or they've recruited a new physician and they've got a new service line that they're bringing in that they need additional help. Or they might have opened a new tower and they have to staff it until they hire their own staff. So you know, if all the stars align, 8010 10 works. But if a facility has a significant amount of vacancies, they might only have 65% of their own staff. Then how much international staff do you need for your long term solution, and how much do you need for short term so it's really taking a look at that staff, healthcare staffing companies can partner. Part of the reason why, when I moved back to Florida and I came to work for MedPro is that we are clinician, living clinician run. Our CEO is a nurse. There's myself and my counterpart, Patty Jeffries, the other ADP. We're all nurses, and we've all been in leadership positions in the hospital. So we understand the financial pressures, we understand the acuity, and we understand the operational decisions that have to be made with a lot of flexibility for staff coming in and out, and to really look at healthcare staffing companies really as a consultative approach versus I don't want to necessarily spend the money to not have my own staff there, because what's the risk if you don't have enough nurses there, or you don't have Enough medical technologists there, you won't have the revenue because you can't provide the care for the patients. So it's really a vicious cycle. Sometimes, do you spend the money to have additional staff, or do you not? And then what happens? Missed care, risk management falls. Patient outcomes, no morbidity and mortality. And of course, again, the accrediting bodies such as commission or CMS, you know, come in and the state come in and take a look at the level of care that's being delivered. So there's a lot at risk if you're not providing the appropriate amount of staffing. Great.

Austin Littrell 16:58
Well, rosemary, thank you so much for taking the time this afternoon.

Rosemarie Aznavorian 17:01
I greatly appreciate it. Thank you again, once again,

Austin Littrell 17:15
that was a conversation with Rosemary asnavorian, Executive Vice President and Chief Clinical Officer at MedPro healthcare staffing on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show and ask that you please subscribe so you don't miss the next episode, and don't forget, physicians practice will be hosting practice academies through practice management track on Thursday March 19, featuring practical, actionable education for physicians and practice administrators. You can register today by clicking the link in the show notes or by going to registration.physicianspractice.com as always, be sure to check back on Monday and Thursday mornings for the latest conversations with experts, sharing strategies, stories and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts. Also, if you like the best stories that medical economics and physicians practice published delivered straight to your email six days of the week, subscribe to our newsletters at medical economics.com and physicians practice.com. Off the chart, a business and medicine podcast is executive produced by Chris mazzolini and Keith Reynolds and produced by Austin Luttrell. Medical economics and physicians practice are both members of the mjh Life Sciences family. Thank you. You.