- [Voice-Over] This program is made possible in part by the Wright Centers for Community Health and Graduate Medical Education, WVIA, in partnership with the Wright Centers for Community Health and Graduate Medical Education presents Conversations for the Common Good: Civil Discourse, Civic Engagement, Shaping Tomorrow's Health Workforce.

And now moderator, Tracey Matisak.

- Hello everyone, welcome to Conversations for the Common Good, Shaping Tomorrow's Health Workforce, brought to you by the Wright Center for Community Health and WVIA, I'm Tracey Matisak.

Pennsylvania, like the rest of the nation, is facing an alarming and urgent shortage of healthcare workers, and at a time when healthcare professionals are needed more than ever.

This time next year, Pennsylvania is estimated to have a shortfall of 20,000 nurses alone.

By the spring of 2028, projections show an overall shortage of 100,000 healthcare workers nationwide.

With the growing needs of an aging population and rising rates of chronic diseases, the timing couldn't be worse.

The greatest impact will be on rural communities and long-term care centers, as well as behavioral and maternal child health providers.

So why such a shortage, and what is it likely to mean locally, and what's being done to address it?

For that and more, we turn to our expert panel.

Dr. Linda Thomas Hemak is president and CEO of the Wright Centers for Community Health and Graduate Medical Education, quintuple board certified in internal medicine, pediatrics, obesity medicine, addiction medicine and nutrition.

Dr. Thomas-Hemak is actively working to address the nation's primary care physician shortage, and related healthcare challenges.

Also joining us is Pennsylvania State Representative Bridget M. Kosierowski, who represents the 114th Legislative District.

She is the first woman to represent Lackawanna County in the General Assembly.

In more than 50 years.

Representative Kosierowski has spent her professional life in the healthcare sector working as a registered nurse, and her legislative priorities include preserving and enhancing healthcare services for all.

In addition, we have Dr. Katie Pittelli, president and CEO of Johnson College, northeast Pennsylvania's only technical college.

Johnson College prepares its students for a number of careers, including entry level positions in healthcare.

In 2023, Johnson College opened its first satellite campus in Hazelton.

And finally, Jill Avery-Stoss, president of the Institute, a nonprofit organization specializing in community-based research and analytics throughout northeastern Pennsylvania.

Jill has been involved in multiple aspects of The Institute's mission, from data collection and management, to marketing, fundraising, and other executive leadership functions.

As president, Jill is responsible for the institute's day-to-day operations, client relations, and project management.

So welcome and thanks to you all.

Jill, I'd like to begin with you, and I'd like you to help us kind of set the table for this conversation in establishing how big a shortage we're talking about.

We have already mentioned that this time next year, Pennsylvania is expected to have a shortage of 20,000 nurses alone.

Can you give us a sense of what the overall shortage looks like for northeast PA, and in which sector of healthcare the shortage is greatest?

- The shortage really spans the entire spectrum of healthcare.

There's really no area that is untouched.

We certainly need those nurses, LPNs, RNs, nursing assistants, medical assistants.

There's shortages, there's demand for pharmacists and all sorts of technicians, above and beyond all else though, the shortage in the personal care and home healthcare sectors are just astronomical.

There's demand for thousands and thousands of personal care aides and home health workers.

That shortage is expected to grow about 19% in the next decade, and that growth is only surpassed actually by growth in demand for nurse practitioners.

So they are kind of neck and neck, nurses and home health and personal care aides are most substantial.

- Well, right, and when you talk about nurses and you talk about home healthcare, long-term care, we've got an aging population, which makes that all the more urgent.

- Exactly.

Exactly.

We have an aging population and it's basic math.

There really just aren't as many people entering the workforce as there are retiring from the workforce.

So that is in part where the shortage comes from.

- And we wanna talk in a little bit about why we're seeing the shortage, and some of those factors that you mentioned, that are leading to that.

Dr. Thomas, wanna share some information that you all provided to us from the Wright Center, that really kind of drives home the point about how significant the shortage is locally.

You shared a chart with us that shows how many patients there are for each primary care doctor, dentist, and mental health professional around the area.

And we wanna zero in particularly on Lackawanna, Luzerne, and Susquehanna counties, because they are all federally designated, medically underserved areas.

And when you look at...

I'm thinking about Susquehanna county in particular, and I'm looking at my notes here.

For example, 2,700 plus people for every primary care doctor, 2,700 patients.

4,700 plus for every dentist.

What does that look like, practically speaking, for the people who live in those communities?

- I think that it's very clear that we have a national shortage.

And northeastern Pennsylvania is not immune to that shortage.

And we've got a lot of disparities across our region.

If you actually look at the per population physician presence, I want to think that all of us, the hospitals here in the community, our attachment to a new medical school, and also the Wright Center for Graduate Medical Education are part of the reason that Lackawanna and Luzerne College are a little bit closer to the mean for the nation.

But we feel an enormous responsibility, because we are the border to what we consider watershed communities- - And what does that mean?

Watershed communities?

- The watershed communities are... You know, I'm from the borough of Jermyn, okay?

That's a borough of 1200 people.

That happens to be the birthplace of first aid.

When I came back and I set practice up in Jermyn, okay?

I had an opportunity to admit patients to four smaller community hospitals, okay?

The Mid-Valley Hospital, Marion Community, St. Joseph's, Mid-Valley Community.

And in my 20 year career, all four of them have shuttered their doors, okay?

And somebody recently asked me, what happens when a hospital closes?

What happens when a hospital closes is that nonprofit entities need to lean into the crisis, increase and expand your capacity and your skillsets to fill the void, hopefully, to absorb the jobs that are lost in those communities.

Because healthcare is a part of our knowledge-based economy.

They're good jobs, they're living wage jobs, right?

Attached to a pension and health benefits.

And so we have a regional crisis.

We have a national crisis, but we certainly have a regional crisis.

And I think that all of the institutions that I think of, which are our anchoring institutions, the Wright Center, the Institute, Johnson College, the University of Scranton, Marywood, you know, all of our institutions have a regional presence.

They host students from every one of the counties in northeastern Pennsylvania.

And collectively, we have a significant problem, because there are people living in rural communities with ratios that I looked at of one to 4,000, okay?

For physicians.

One to 6,000 for dentists.

And, you know, so to me that's a reality.

That is an accelerant of bringing forward this conversation about what is gonna happen to our children?

What kind of access are our families gonna have?

And it's even scarier, I think, because the current industries are destabilizing, and going through massive change, massive change.

- Well, and you think about, just from a practical standpoint, for patients, right?

Much longer wait times to see a medical professional, difficulty maybe accessing, maybe they've gotta travel farther to see a physician.

So there is no upside for the patient, but for organizations that are working to fill those gaps, as the Wright Center has been doing.

Dr. Pittelli, as I mentioned earlier, you know, the timing for all of this couldn't be worse.

We've been talking about, you know, not only an aging population, but also an increasing prevalence of chronic illnesses.

Can you speak a little bit to, you know, some of those dynamics in the region that have brought us to where we are?

I mean, we've touched on a couple of them.

- Sure.

- But kind of, what got us here?

- Yeah, so as mentioned, definitely the aging population.

But as, you know, we also discussed, there's a lot of people in all these fields, high-demand fields, that are retiring, and people are not having children at the pace in which they used to.

So we simply can't keep up with the demand in all these fields, healthcare and in other fields.

And what we hear too, from prospective, you know, students that are maybe trying to change careers, there's a lot of burnout in these fields, and they're scared sometimes to go into them, especially on the other side of COVID.

And we get a lot of questions about flexibility.

What's the flexibility like in these fields, you know, when it comes to childcare, or if they're taking care of their own aging parents, they wanna know what the schedule's gonna be like, and is there flexibility in these fields?

- One of the things too that I saw was that there are in many places, shortages of faculty, for instance, in nursing schools, and some institutions having to turn away qualified, prospective students because they just don't have the faculty or the facilities.

- Yeah, faculty, and I think for us clinical sites as well, you know, for us, we look at radiologic technology.

We have a wait list of 30 plus students right now, we can take up to 26.

And I mean, that wait list is deep, and it all comes down to the number of clinical sites that are available for students.

- Yeah.

Representative Kosierowski, in addition, of course, to representing the 114th legislative district, which includes part of Lackawanna County.

You are also a nurse.

So you have been in the trenches and you know this well.

And of course, as I've mentioned, we're experiencing not only a shortage of nursing... You know, nurses, but of course, we talked about the shortage of faculty members as well, and one of the things that I thought was really interesting is that there is also a shortage of preceptors.

Can you explain what a preceptor is and why that shortage contributes to the problem?

- Sure, and thank you, Tracy, for hosting us tonight, because I sit here with these women who... We have lots of challenges in the Commonwealth, but I feel like we are here with some solution solvers, right?

That's the most important thing.

And you touched upon quite a few things in your intro that challenge us here, and certainly in healthcare in the commonwealth, the aging population and the recruitment and the retention, and to be able to train as a nurse.

You know, I trained as a nurse in 1994 in Philadelphia, and I'll never forget my preceptor.

She was amazing, but my preceptor was also a woman that had a lot of clinical experience.

She had been a bedside nurse for a long time, and she was able to also be paid a little bit more to be the preceptor.

So there's incentives there that I think the best...

The best teachers in healthcare are those that have served bedside, have served in their specialties.

And when you graduate from your school, to be able to be under a preceptor is an essential, to be able to practice your skill.

Unfortunately, now there's such a shortage, I feel like I should put my scrubs back on and go be a nurse, 'cause I feel like we have... We do have such a workforce shortage, but to these nurses coming outta nursing school, getting onto the floor, they need them so desperately, they're kind of training them up as quickly as they can, and kind of giving them a patient assignment, right?

I had the privilege of having a preceptor for three months before I was sent off on my own.

That doesn't happen anymore because of the shortage.

And then Katie, you know, spoke about burnout, spoke about just the fear of going into healthcare, because I think COVID exposed so many, so many cracks in the healthcare system that people left, people got out of there.

And I think that as we're aging, as we have more acutely ill patients, as patients or people are living longer lives, they need healthcare, and they need access to be able to live in their own homes, live longer lives with better care.

And I think it's harder to recruit and retain those specialists.

We have to do better.

My role as a representative in Pennsylvania, there's lots of legislation we can push forth.

One of them being preceptorships, one of them being better, longer hours for hospitals to be able to... Lots of nurses and lots of nursing students are adult learners.

They come to school later in the day, they have to do their training later the day.

They're not the traditional 7:00 AM student, right?

So we have to be able to have that access for them, and I think we're working on things like that.

The administration under the leadership of Josh Shapiro, he gets it, he's laser focused on this.

And I think that that's a bonus to us here in the Commonwealth, that we can make this better.

- And I wanna talk to you about that legislation in a little bit, but before I get to that, as someone who has been in the trenches as a nurse, you know, when you think about a critical shortage of nurses and the important functions that they perform, can you just speak from your own experience about what that looks like when you are a nurse and you are working in a situation where there are just not enough of you to go around, to give patients the kind of care that you need to give them?

- Well, I mentioned about the patients that are now in-house, and the doctor can probably... And those in the audience that are physicians and nurses, that they're sicker.

Patients are admitted when they're sicker.

A lot of people are able to, you know, be cared for in outpatient centers, long-term care, maybe at home.

But when you're sick and you're in-house in the hospital, you need usually like at least one to one nursing, if not two or three.

The ratios are outrageous.

You're going into these hospitals now, and these nurses are given an assignment with four or five patients.

When I had four or five patients, in 1994 where I worked, my patients weren't as sick as they are now.

And I think that's a huge challenge to have to juggle what they have to juggle, and no doubt, when you're faced with that kind of assignment, you know, you do have that burnout.

You don't wanna do that kind of work anymore.

You don't feel supported.

You don't have the resources.

And I think that has actually driven more of our bedside.

That's really, when I think about the workforce shortage, it's that bedside in-house inpatient nurse.

And I think I'm an advocate for everybody that graduates from nursing school, should go work in a hospital for one year before you go off to do something else.

Whether you go off to become a nurse practitioner, a nurse anesthesia, you know, any other kind of field that you wanna get into... Don't run against me, but, you know, a run for politics, whatever it may be.

I think that there is a special training that goes along with working in a hospital, at direct bedside care.

- Yeah, it's the boots on the ground.

- It really is, yeah.

- Right, yeah.

Jill, clearly it is not just northeast Pennsylvania that is contending with the shortage.

We talked about how it is a national problem, but I'm curious how we stack up here in northeast Pennsylvania.

How do we stack up to the rest of the state in terms of the shortage we're seeing, and to the rest of the country for that matter?

- Well, the trends here generally do mirror trends statewide and nationally.

So in a sense, well directly, I mean, we are very much competing with communities and regions throughout the nation to try to attract workers here.

So that's a really massive undertaking.

But in terms of those trends, although they kind of mirror national figures, it's a little bit more nuanced than that, because proportionally, our aging population is a little bit larger than a lot of other communities.

We rely significantly and economically on our healthcare sector, it's a very important part of our regional economy, whereas other regions might rely on theirs a little bit more or less.

And so we do have alignment in terms of sheer numbers, but the nuances are very different, and we're unique in a lot of ways.

- Yeah, and talk about kind of who we're competing with.

What are some of the other factors that might be, you know, considered, in order to make northeast Pennsylvania a more competitive region for that talent?

- Well, at the surface level of course, we have to think about competitive wages and benefits packages and things like that.

But there's so much more to think about in the broader ecosystem, so to speak.

Do we have the housing stock available to accommodate, really, the workers that we're asking for?

Do we have childcare providers to be able to assist healthcare workers?

And we have to remember that healthcare is not always a nine to five job.

We're working off hours or on weekends, and so do we have the capacity to accommodate that?

Do we have the infrastructure, transportation in rural areas, even things like entertainment and recreation are really meaningful to make Northeastern Pennsylvania desirable, and a place to really wanna be.

- Yeah, and how are we doing in that respect?

I mean, do you have a sense of what needs to be done, or what areas maybe need the most work, in terms of making this a more attractive region for healthcare professionals?

- I think we're doing okay, but those challenges are persistent.

We still really are struggling with housing, which is also, of course, a national issue, so is childcare.

We've come a long way in terms of transportation.

But that one is very persistent, especially for people in rural areas.

It's the public transportation system, but even households with personal vehicles, proportionally, we have a larger share of households who rely on just one vehicle, than a lot of other areas, and so they are sharing.

Those vehicles might not be well maintained.

They might not be reliable all of the time.

So that also contributes to productivity and retention at work.

- Yeah, Dr. Thomas, when we think about healthcare, you know, typically what comes to mind is doctor's offices, hospitals, but of course a big piece of that is nursing home care.

We talked about long-term care just a moment ago, particularly in communities with aging populations.

I wonder if you could speak to the unique challenges then, that nursing homes, that long-term care facilities face, in light of these kinds of, these times when not only do we have a shortage of nurses, but you said in an earlier meeting, you talked about the shortage of people in geriatrics at a time when it's so needed.

What does that tell us about what is required to provide quality care for an older population?

- So I think it goes way beyond one venue.

So nursing homes...

Excuse me, nursing homes are one part of the continuum of care.

Rehabilitation facilities are another, transitional care units, where you go after a major injury or trauma or a hip fracture, prior to actually getting independent again, to be able to go home.

And honestly, just the traditional house call.

And you know, what happens in the environment of your own home where we can bring healthcare to you, which is really where most patients would prefer they be.

I think across the whole continuum, the acute hospitals, the rehab hospitals, the transitional, the nursing homes, they are all feeling the crisis, and they're all feeling the workforce shortage.

And it's very challenging to get the healthcare workforce back in the environment mind frame of, you're gonna go to all of these locations.

When I first came into practice, I was a primary care doctor.

That meant I went to the hospital, I rounded on the patients, I went to our office, we opened the doors, it was open access, you came if you needed something.

Then we ran to the nursing homes on our midday, okay?

At the end of the day, we'd wrap it up with a couple house calls, and we'd call it a day, start the whole thing over.

That got very complicated very quickly, because, you know, we had multiple hospital systems, as I mentioned, you know?

And it's not that efficient for a doctor to go all the way to hospital, to see two patients or one patient.

So the efficiency drove the change.

And you know, primary care disappeared from hospital settings.

But frankly, that's where our patients are sickest, and where they want us most for our relationships with them.

So I think, what does it look like?

It looks like staffing crises and shortages and burnout and turnover every day.

So when you see the gaps in nurses, it's not 'cause we're not producing them.

- Yeah.

- It's because we're producing them and bringing them in, and the system is not supporting their retention.

And that preceptor with all that longevity and all that experience, right?

Is not there to protect them as much as to train them, right?

'Cause those preceptors, they protected you.

And a lot of them, they trained me, right?

You wanna be a strong doctor, learn how to work with a strong charge nurse in a hospital.

So I think what you said about nurses, doctors should go right to the hospital settings too, and have to be there.

That's where patients are sickest, right?

I think that a lot of the solutions that are coming are not only through participatory citizenship, and all hands on the deck, and figuring out who can do what as the system is evolving and changing.

I also think that artificial intelligence is gonna come in, it's gonna help us, right?

It's gonna help us to reimagine, because if we're really successful, we need the hospitals to thrive in the paradox, while we're trying to shrink the need for them.

- Yeah.

- Because patients are healthier and living in their homes, right?

- So how do you see AI being a factor here?

- I think it's gonna bring us efficiency when it's used for the right purposes.

And I think when it's developed by the actual people in the trenches delivering the services to help build the efficiency that they need to survive in what is a time-based, volume driven industry, regardless of how many people tell you, it's moving in a value-based direction.

The reality is, is they're still living in 15 block or 20 minute block schedules.

- Yeah.

- Right?

Some patients come in and when the patients come in, they need a lot more than 20 minutes.

And the provider staff, the doctors, the nurses, the community health workers, they wanna give the patient what they need.

And part of the burnout is to be in the moral debacle of rationing your time, right?

And how do you prioritize?

So I think artificial intelligence is gonna come in, and in the right hands, it's gonna help us to re-engineer, redesign some of the systems, and it's gonna give us that flexibility that we need, to get more personalized and tailored, to give patients what they need.

Because honestly, some people come in and they don't need the whole 15 minutes, and they would prefer they be in and out in 10, and they're upset when they have to wait longer.

So, you know, artificial intelligence is gonna help us with time management, and I think through provider input and consumer driven expectations are gonna be crucial in those equations.

Crucial in that utility.

- Yeah.

- What the patients want.

- So this is a good time to talk about the Wright Center and the ways in which the Wright Center is helping to address this shortage.

Because I think that for many people locally, you think of the Wright Center and you think of, "This is a place where you go to see a doctor."

But it's also a place that is training doctors and other healthcare professionals.

So talk about how the Wright Center is really helping to solve this problem.

- I think that part of the beauty of the Wright Center is that we have a dual mission to, you know, improve the health and welfare of our community.

And part of that mission integrates sustainable workforce development, to be sure that if we're offering you a service, there's a succession plan and a sustainability to that service.

So, you know, I personally don't think that you can really care for your patients if you aren't imagining your succession plan, right?

If you're really a primary care doctor and you've got a panel assigned to you of 1700 or 2000 patients, it can't all be dependent on you.

It's gotta be team-based, right?

It's gotta be systematized, right?

We all know that, you know, being a hero isn't leading.

The anecdotal days of when I can call the hospital, and through relationships get the levers that I needed to pull to get patients.

Those relationships and levers aren't gonna be the same with corporatization of what's going on in healthcare.

We're gonna have to depend on the systems, and we're gonna have to have systems of seamlessly managing those patient care transitions.

So I think one of the beautiful things about the Wright Center is that it builds succession planning in its model.

We're training the future, and we try to explain to the people of northeastern Pennsylvania and everywhere, you own the Wright Center, you own the Wright Center, so come on this journey with us and own the development of your workforce, because that future workforce is who may take care of your children, right?

So I think that's part of the beauty of the Wright Center.

I will tell you that when I looked at those graphs, I had a moment to close my eyes and look at the graphs.

I really do believe that, you know, the Wright Center has been around for 50 years.

We've trained over 1100 doctors.

That's a lot of impact, right?

Many of those doctors are still here in northeastern Pennsylvania, serving the public.

And so I think the Wright Center can be a solution for workforce development.

We couldn't do it without our academic institutions like Johnson and Wilkes and Marywood and Lackawanna College and Luzerne College and Wilkes University.

Like we couldn't do it without those colleges and without those students, but I think the magic of the Wright Center is, I go to work every day, and over the course of a year, I see 250 students from all your institutions, and I look in their eyes and it restores my hope and faith in the future of healthcare and our economy.

- Dr. Pittelli, I wanna ask you kind of a two-part question because we've talked about barriers to entry, and surely you are well familiar with that in your work at Johnson College.

So I'd like to hear from your perspective what some of the barriers are, and then tell us about Johnson College, and the ways that you are also working to address this problem.

- Yeah, so I mean, we hear all of the barriers that have been mentioned from, you know, students and prospective students, transportation, housing, childcare, a lot of food insecurity.

That's definitely on the rise.

So something that we've done is implement what we call a special program.

It's a wonderful partnership.

It's called RISE, Readiness In Skilled Employment.

It's in partnership with The Institute, another wonderful nonprofit, United Neighborhood Centers, the McGowan Family Fund.

And it takes, you know, all of us working together, looking at these students as a whole person, understanding that they're coming with barriers.

And we understand at Johnson College that they can't focus on their education when they have all of this tremendous weight on their shoulders, and sometimes they don't know where their next meal is gonna come from, you know, for themselves or their family.

So we work with them with some intense case management, and get them the help that they need.

We try to take those barriers away.

We connect them with other nonprofits in the community so that they can then focus on their education.

And when they get the skills, it's not just about that first, you know, placement, you know, job placement, which is very important, but we really wanna look at their upward mobility, that they're in a career where they're gonna see upward mobility for themselves and their family.

- Yeah, the hope is that it's like a launching pad, right?

And onto more training, to more skills.

- Right.

- To further professional development.

- Yes.

- Yeah.

- Yeah.

- Representative Kosierowski, you mentioned Governor Shapiro and the $5 million nursing shortage assistance program that he proposed.

It would cover tuition costs, as I understand it, for nursing students who commit to working in Pennsylvania hospitals for three years after graduation.

What's the status of the legislation at this point?

- So it's June in Pennsylvania, and that's the budget, the month of the budget.

So I was in Harrisburg today.

So I think that there's an appetite to be supportive.

I think that that money set aside is something we talked about recruitment, the statistics that Jill talks about, the challenges that the students face, that Katie's speaking about, the specialties that are coming out of 1100, physicians that are coming from the Wright Center.

I mean, these are things that obviously need funding.

All of this, whether it be transportation, food insecurity, childcare, housing, it all comes with help from funding.

And we, in the Pennsylvania state budget, have those kind of finances ready to be distributed.

And I think under the leadership of our governor and the Senate and the House, I think when we talk about healthcare, it doesn't really matter if you're red or you're blue.

You know, everybody needs healthcare.

So I think it's something that there is an ability to move forward, but that $5 million that was mentioned in the budget address, I think that's something that we will move forward with, we will support, and it will be available for those nursing students.

Now, that's the criteria, right?

You wanna come to stay here in Pennsylvania with us, we'll help you with your tuition, and these are the kinds of things that we have to do to continue to recruit and retain our nurses to come.

Long-term care is hard to work in.

When you wanna work as a nurse, I will be honest with you, long-term care is something that takes a special kind of empathy and patience.

I always say it's very easy, actually fun to feed and clothe and change an infant.

But when you have a patient that has Alzheimer's, dementia in their eighties and nineties, combative, and this is no fault of their own, it's the disease process.

You have to make sure your nurses are trained, they're compensated, they have an ability to understand the disease process.

Because unfortunately, you know, in the Department of Aging, we hear lots of things about abuse, and people that are taken advantage of.

And it's because sometimes we are not doing our best to get people that really want to work in that field, understand that field.

You know, gerontology, training the physicians there.

I mean, we have an aging population here that deserve to be taken care of with dignity.

And I think that's the most important thing we can do as healthcare professionals, and we in the state should be able to support that.

- Dr. Thomas, do you think that that is why there is a shortage of people in geriatrics, because of the unique challenges that are part of that kind of work?

Or what do you think is behind that shortage?

- I think that's a complex question.

So I think that I will say that one of the things about a graduate medical education safety net consortium, that's where, you know, the Wright Center pools the resources for the generation of a physician public resources, okay?

That come from Medicare and/or the state Medicaid, and then put it together with the health center resources to provide essential services.

When we do that, we try to stay in the domain of...

If we do programmatic development, we first and foremost go to, is this a program that the community needs?

So we got involved with that very early, probably over five years ago now, with all of the projections, compliments of the institute, and said, "Clearly, we need geriatricians."

As soon as you do that, you go out to the nation, and you look at the geriatric fellowships, and they were frankly, not filling, okay?

So that tells you that there's something about the employment and the industry and how they value the geriatrician.

And back to what I said, which is a volume, time-driven place, okay?

To be a geriatrician, you cannot live off an every 15 minute schedule.

- Right.

- But that's what the business and the industry is built on.

So the first thing we said is, we have to elevate the role of the geriatrician.

We have to put the geriatrician above all the primary care doctors so that that geriatrician can be force multiplying their impact and helping all the primary care doctors take better care of the geriatric patients, right?

So, kind of changing the model of what does it mean to be a geriatrician?

Because soon enough, when you're doing a workforce development program that's driven by the needs of the people, the needs of the community, the common good, you find yourself in the paradox of, where do you get the faculty, right?

Because there's already a shortage.

So now you're trying to develop a program to address a shortage, but you need the faculty, that are the eye of the shortage that you're trying to address.

- Yeah.

It's a vicious cycle.

- Right.

So you've gotta do asset maps, you've gotta go, you've gotta look for, where are your friends?

Where are the strengths of our community, right?

Telespond is down there as the senior advocacy center.

It's a wonderful place that cares for 30 geriatric aging population with memory impairment, usually in Telespond every day.

Go there, get the asset map, go to the Area for the Aging.

Very fortunately, our Area for the Aging director is now the, you know, Secretary of Aging for the state of Pennsylvania, right?

Connect all the dots, and then reach out in the nation, and see that the Institute for Healthcare Improvement is calling communities to come forward to co-create age-friendly health systems.

Join the IHI campaign, learn from other communities, look at best practice, right?

All of a sudden you get outreaches then, because you're in the conversations, you're going to the national conversations, you're participating, you get the call from UCLA, be part of our Alzheimer's dementia unit network across the country, right?

Bringing us into conversations with the likes of UCLA and Johns Hopkins, learning in those national spaces.

But at the end of the day, right?

To train a geriatrician, you've gotta have the current workforce in the game, top of their game, right?

With skill sets, compassion, the heart, they wanna do it, and they're willing to make the house call, right?

'Cause if you don't, you can't solve the problem.

So it's calling everyone in to be a part of it, because people really respond when you call them to something noble, out of having to ration their time to give patients what they need.

They don't like working in those systems that are pressuring them like that.

- It's not why you go to medical school, right?

Let's take a couple of questions from our audience, because we have given our audience an opportunity to submit some questions for our panelists, and we've got some good ones here.

So the first one is, "How are you reaching K to 12 potential workforce, and helping to enhance the potential pipeline?"

So we're going all the way back and thinking about exposing school-aged children to healthcare professions and how we spark interest there.

And I would direct that to any of you who would like to take that one on.

- I can start with that one.

So a couple things that we do.

So we have an industry fast track program, where students can... That have an interest in any field, can start taking college level classes while they're still in high school.

So we expose that to them, you know, fairly early.

We also have, I would say three mobile labs.

One that's STEM related, one that's building trades related, but one, through a wonderful grant and support through the Moses Taylor Foundation, is focused on healthcare careers.

And we take that out to community events, into schools, and do a lot of programming to raise awareness through that.

And we also use them to do a number of summer camps as well, again, to raise interest, and raise awareness with our younger generation.

- Yeah, important to start early.

- Yes.

- Another question says, how can non-medical volunteers, like family members for instance, play as advocates for healthcare and healthcare workers?

So, you know, from people who are concerned about their loved ones, wanna make sure that they're getting quality care, not only are they concerned about their family member, but concerned that the healthcare worker who's taking care of them, is well equipped to do that.

So I direct that to whoever would like to take a crack at that.

- Yeah, I think that's something that we should very well touch upon, is that healthcare worker, especially those being able...

It's a goal to be able to age at home, right?

So that's the golden way, to be able to live out your years at home.

But when you need care and you need a direct care worker, though sometimes they also have to be paid attention to, because they do... You know, they can burn out family themselves, can also take care of their family.

But when you're living in a sandwich generation, you know, you've got your own children now, you're taking care of your parent, your aging parent, and you have a job, and you have to leave that job, there is a pathway for us to be able to support them through payments made to them to be able to do that home care.

In the long run, you know what?

It saves the state money when you're not being admitted into long-term care, and having to go on to programs like Medicaid or Medicare, and use it that way to have to stay in long-term care.

So I think that there's ways that we have to do better at educating people on how that can happen, how we can support them, and make sure that people are able to age at home.

Our secretary, Jason Kavulich, of aging, he's got a 10 year plan, and he's a huge advocate of being able to use resources to be able to keep people and age at home and be able to stay in their loved one's care.

- Yeah, Dr. Katie, this sounds like a good one for you.

The question is, "Are there job opportunities in the healthcare field that don't require a doctorate degree?"

Because I think most of us think we've gotta go to school for a lot of years to do this.

- Yeah, yeah.

So our programs are all two year or two year associate degrees or one year certificate.

So on the two year side, we have radiologic technology, physical therapist assistant and biomedical equipment technology, which I feel is the unsung hero of the healthcare field.

And then on the certificate side, we have medical assistant, we have MRI, CT, pharmacy tech and medical records.

And all again, are in demand, you know, you can stack your credentials, you know, if you wanna get started, you can start with one of those one year certificates, and then if you like it and wanna, you know, pick something different, you can then stack and come back for a two year degree, and then maybe go on for, you know, a four year degree and beyond, but there's a lot of opportunities.

- [Bridget] Healthcare is teamwork.

It's teamwork, right?

- Absolutely.

- From the prep that Katie's students coming out of the door, to nurses, to doctors, it's teamwork.

- Yeah.

- And there's a void in all of them, so to be able to launch any of these specialties is very well needed.

- And I just wanna say, like as a physician in a medical home, one of the ways to address the provider shortage is to get the staffing right, okay?

By bringing on first generation healthcare workforce with an associate degree, or one of your medical assistants into our environment, because their presence, when they're well trained, generates capacity for the nurse, generates capacity for the doctor.

So there is capacity enrichment through teaming.

And I just wanna say, like, I think these questions are so related, because as a pediatrician, I think we need to embrace every teachable moment, because I think the most powerful engagement strategy is through exposure of the user.

And so every time I walk in the room with a child as a pediatrician, I imagine myself dream mapping with them, where they can choose any member of our team to emulate.

And I can tell you that a lot of those children are now, 35 of them, you know, around the Wright Center right now doing summer internships, choosing a capstone project, spending time with many different members of the provider teams, but also spending time with marketing, right?

The marketing department enriches the capacity of our provider teams when they can take over online scheduling for people who have the skills to online schedule.

If people online schedule, that makes us much more likely to actually get a human on the phone when you call the Wright Center, when you don't have the it tech skills.

So like, there are so many capacity enrichments through teaming.

And you know, it's funny, because someone comes and donates, you know, it's July next month, so you know, Christmas in July, right?

And they donate toys.

And someone left me these small dolls to give to children and their doctors.

(group laughing) And the most amazing part is, the name of the little doll is Dr. Linda.

So there was a joke in it, but I've walked into the room with children and I've given those to three year olds, right?

I'm looking for my succession plan.

- Yeah.

- I'm looking to dream map with your kids, okay?

Who wouldn't want your daughter or son to come work in the healthcare industry?

It's such a noble profession, right?

And the interns, so like building those and in school-based environments, right?

Like the long-view solution for healthcare is to partner prevention with school-based environments.

- Right.

- To get in there to prevent the mental health crisis, to prevent the gang related violence, to prevent, you know, the adolescent suicide, to prevent the unintended pregnancy, to prevent the obesity epidemic, right?

We have to build those partnerships and those bridges with the school districts.

And we have superintendents right now running some of our school districts, who are really in the long-view.

They're in the long game.

They care about the welfare of the children.

They're reaching out to the Wright Center, they wanna partner, they wanna find solutions, they wanna build the health curriculums.

And then you're coming, and I think the other agency, I have to put a plug in for them, is we partner with the Area Health Education Center, and you know, they're federally funded and they host so many healthcare job fairs with all of the local institutions.

They do a lot of work with Katie.

I know they're very close to the institute, but they're constantly outreaching with their AHEC scholars, opportunities for seniors who might be interested in a healthcare career.

They cover the cost of the, you know, Princeton reviews or however that goes for the MedCAT.

Like, there's so many opportunities.

- There's a lot of- - And other organizations.

- It takes a village, at the end of the day, right?

It takes- - It's gonna take all us.

- And it's a team effort, and Dr. Thomas, to the point about medical training, one of the barriers for aspiring doctors is the sheer cost of medical school, right?

The loans that you have to take out, to say nothing of malpractice insurance later on.

But is there any conversation around working on that aspect of the problem, and making medical school more accessible financially?

Because you may have some very talented young people, but it is just prohibitive from a financial standpoint if you're not getting some sort of scholarship to pursue medicine.

- We've done a lot of innovation in the space of hometown scholar pipelines that bring children from economically disadvantaged backgrounds through the system with manageable debts and even landing them in positions working in nonprofit entities or federally qualified health centers, where they're actually eligible for loan forgiveness.

So we're very grateful for programs like the National Health Service Scholar, and even the loan forgiveness programs for the state.

There's been special loan forgiveness for substance use disorder, and serving in underserved settings.

And so we've done a lot of work on bringing children from economically disadvantaged backgrounds.

I personally had a significant amount of debt when I finished, okay?

I was 44 when I paid it off, okay?

- Yeah.

- I was 44 with three children when I finally just paid off my tuition debt, okay?

So I feel for those conversations, I'm very interested in modeling.

I do think that the healthcare delivery system is going through a lot of disorienting dilemmas, figuring out how to invest in their future workforce so that the investment is there for the students, and the cost of the educational programming is not in the backpack of that student, because it gets heavy.

- Yeah.

- Very heavy.

- Jill, are there areas, according to the research that you do, are we seeing growth in any area of healthcare right now?

Or is it shortages across the board?

- It's pretty much shortages across the board.

They are of course more severe in some occupations than in others, but there's need everywhere.

I think, I mean, maybe some orthodontists, they might be doing a little bit better, but it's across the board, there's shortages everywhere, and there's more opportunities even, that the industry itself is just growing broadly.

So not only are there fewer people coming into it, but they have more options, so it's kind of dispersing them as well.

- Yeah, Representative Kosierowski, I was surprised to learn that workplace violence is more prevalent in the healthcare industry than in any other industry, according to one of your colleagues, actually, in the legislature.

Can you shed a little bit more light on that, and also on the legislation that is currently in the works to address it?

- Yeah, so we do have a piece of legislation to address this, but when you think about workplace violence and you think about how and why it happens, you know, we talked about shortage, right?

So when there's a shortage, there's not a nurse or a doctor or a specialist that you need.

You're stressed when you're in a hospital, certainly in an emergency room, and everybody knows here, the wait time that we have in emergency rooms as we're closing hospitals, as we're closing access.

So you're stressed, you're afraid, you're waiting, you have no answers, and unfortunately, that leads sometimes to an explosive situation.

And unfortunately, it's physical, and there's lots of nurses across the... A lot of the burnout comes from situations that have happened to healthcare providers from physical violence.

I've talked to healthcare providers across the commonwealth, who have been spit at, hit at.

I mean, we heard the tragedy that happened out west, where the gentleman arrived to an ICU with a handgun and shot at the healthcare providers.

You know, but what led him, he or she, to that?

We have mental health crisis, right?

We have access to weapons.

We have a situation where people are stressed and bad things are happening, usually in an emergency room situation.

So that's a combination, that the legislation that we have in the Commonwealth to push forward because of...

Specifically for workplace violence, we're trying to recruit and retain people to come work in healthcare, and this is happening.

So it's another barrier.

It's just a piece of legislation that really, for training, for safety, to make sure there's an an ability for people to talk about it, to tell what's happening, to not get to that elevation where there is an ability to make the workplace safe.

You don't wanna go to work in a hospital and be afraid of being beat up or shot or locked in rooms or... You know, the stories I've heard across the Commonwealth are outrageous that this is happening.

But unfortunately, it goes back to the workforce shortage, it goes back to wait time, it goes back to access.

You know, you said one of my favorite words, preventative care.

Preventative care, preventative, preventative.

We don't do enough of that because there's a shortage, and people usually take the path of least resistance.

And if you can't get to the doctor and you can't get through and you can't... You give up, and, you know, "I'm not dealing with this, I'm not going to get my scan, my insurance doesn't cover it.

I can't get an appointment.

I can't see my specialist for three months, I'm not waiting."

And a lot of times, sometimes something, you know, accumulates, it comes to a crisis.

You end up in an emergency room setting, or you're getting bad news, and that unfortunately happens because of just human nature.

So that's what we're trying to, you know, address in the legislation.

But also, when you talk about workplace violence, it is another huge barrier to recruit people to come and work in those settings.

- If there were one thing, and I'm interested to hear what each of you think very briefly, but if there were just one thing that you think we need to do, that would have the greatest impact in addressing this healthcare worker shortage, whether it's doctors, nurses, you know, medical assistants, whatever it might be, what would be the most impactful thing that you think that we could do?

And Jill, I'll start with you.

- Collaborate.

It is way too vast and far too nuanced for any specific organization or industry or any entity, to really address it alone.

So kind of, the collective impact concept is essential.

And so we need to combine our capacities, not duplicate efforts, avoid fragmentation and work together.

- Yeah.

- Yeah.

I would say, you know, the same, partnership.

And, you know, I would also say, when it comes to the industry, just looking at that flexibility, how can we get creative inside of this so that we can, you know, hopefully attract more people to the workforce.

- Certainly what they just both said, but I think the nobleness of this career, this was something that people really wanted to do.

They were proud.

Nursing is one of the most trusted professions.

Being a physician, being a healthcare provider gave people a lot of pride, and I think that's what we have to try to, you know, redo with people when they're trying to choose a career.

- Yeah.

Dr. Thomas?

- I agree with all of that, and if I had to say one word, humanize it.

Humanize it, okay?

Because, you know, it might not be a crisis that we don't have a pediatric unit in Lackawanna County till it's your grandchild, okay?

Who needs basic fluids and antibiotics, right?

It may not be your problem that we lost our inpatient psychiatric hospitals until it's your child or you're adolescent, right?

We've gotta humanize all of this, and we've got to put humanity in front of profit margins.

- Well, and as Representative Kosierowski said, everybody needs healthcare, right?

You might not need it today, but it might be you or your loved one who's in need of that doctor or that facility tomorrow.

And to your point, you know, thinking about the humanity behind all of this is so important.

What would you say to a young person who might be considering a career in healthcare, to encourage them to pursue that path.

Whether it's, you know, to be a medical assistant or to become an MD?

What words of encouragement might you all have for a young person who is, you know, kind of thinking about taking that on?

Jill, what would you say?

- I would encourage them to gather and absorb as much information as possible.

There's a lot of resources, a lot of support available to help people learn and navigate different kinds of career.

Whether we call them career pathways or lattices or jungle gyms, I've heard.

There's a lot of opportunities there.

So just absorb as much information and try different things as possible.

- Yeah.

- Great.

- I would say, you know, don't be afraid to, you know, start small.

As I mentioned earlier, there's a lot of opportunities, a lot of great, you know, higher ed institutions in this region.

So don't be afraid to start with a one year program and, you know, get your feet wet, see if you like it, and then go on and stack your credentials.

A lot of times wonderful employers will then pay as you move on to further your education.

So that's, you know...

I would encourage that, and I would also look for an institution where there's an opportunity to shadow and sit in on classes, so they can kind of get a feel for what the program is going to be like, and what the field is going to be like.

- Certainly the opportunities are there.

I mean, I have four kids that I'm launching out of the door.

I'd like them to have a job.

So you can definitely get a job in healthcare these days.

There's lots of openings.

- You'll never be outta work.

- Definitely, you'll get a job.

But there are also so many...

I tell kids all the time, look at... You can do lots of different things in medicine, medical field, whether it be research or hands-on, but the doors' open.

There's lots of different doors that open if you choose this pathway, because it's a field that you'll have lots of different ways to grow.

And I think that here in Pennsylvania, we do need to do better at getting better at having more opportunities in school.

You know, there's wait lists for all of our specialties, nursing, doctors.

So I think we have a... That's a pathway that I think they can be proud of too.

- Yeah.

Dr. Thomas?

- It's really hard.

That's awesome.

What would I tell them?

I'd tell them healthcare is an incredible, awesome profession to serve humanity, right?

Dream big.

- Yeah.

- And we need you.

- There you go.

- We need you.

And so in your eyes, we see a hopeful future.

- Well, I think that is a wonderful note for us to end our conversation on.

We are just about out of time, but I just want to extend our thanks to our panelists, Dr. Linda Thomas-Hemak, State Representative Bridget Kosierowski, Dr. Katie Pittelli, and Jill Avery-Stoss.

Special thanks to the Wright Center for co-sponsoring this conversation.

For all of us at WVIA, I'm Tracey Matisak.

Thanks so much for watching.

- [Voice-Over] This program is made possible in part by the Wright Centers for Community Health and Graduate Medical Education.