Episode Transcript
Alan Helgeson:
“Reimagining Rural Health,” a podcast series brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high-quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.
In this episode, Ann Nachtigal with Sanford Health News talks with Dr. Zeke Emanuel, oncologist, vice provost of Global Initiatives, Levy University professor, Perelman School of Medicine and the Wharton School, University of Pennsylvania. Dr. Emanuel joins as a keynote speaker at the 2023 Summit on the Future of Rural Health Care with the topic: Reinventing America’s health care workforce.
Ann Nachtigal (host):
Zeke Emanuel, thank you so much for joining us. We’re really excited to have this room of thought leaders here to talk about rural health care. First question for you is: What do you think are the three top opportunities when it comes to building a stronger workforce?
Dr. Zeke Emanuel:
Well, the most important thing is to make sure the workforce does meaningful work and are invested in their work and the mission that they’re doing.
One of our big problems in health care is that we have too much nonsense and paperwork that has no meaning, right? I mean, doctors go into medicine to take care of patients. Nurses go into medicine to take care of patients. Doing paperwork is not their primary goal. It really makes them sort of upset and depressed because they’re not doing the thing that they care about. And so I think figuring out how to make more high-value activities. The patient care, the patient connection is critical.
I’m an oncologist. The one of the reasons I went into oncology is it’s a critical moment for people in their lives. They’re making big, big life-changing decisions. They’ve just been hit by a truck. They’re exploring their values, what’s really important to them. You get close. That’s what’s meaningful in patient care. That’s why we went in to become doctors. And you know, if what you’re doing is filling out billing forms or filling out quality forms or just filling out forms and updating the EHR, that’s not meaningful. And so we have to figure out how to make it most meaningful for health care providers to actually do the thing that they came into the professions to do.
Ann Nachtigal (host):
You know, I did see that kind of goes to the article that you put in JAMA, co-authoring this article on reassessing the data on whether there actually was a physician shortage. And you talk to you know, what are some of those opportunities that we can look at? So I thought that was really interesting. Where do you think we’ve made progress when it comes to workforce issues?
Dr. Zeke Emanuel:
Well, during COVID, we’ve slipped, right? Unfortunately, we haven’t made a lot of progress because we’ve overworked our doctors. Initially there was a lot of praise for our health care professionals who were really going above and beyond but I think, you know, eventually you can only do that so long. You can sustain a sprint only so long. And then you need support.
And we’re seeing with, you know, strikes at Kaiser and other actions, unionization, that people are upset by the system. And I think one of the important things is: it’s really a system issue. We have to figure out, us leaders have to figure out how we can get back to doing what people care about.
I would say figuring out or thinking about the patient experience has been very, very important. And obviously the labor issues are very important to all leaders. So I’m hoping that as we look forward, we can, you know, how do we reduce our administrative burden? There’s a lot of things we can do. Yes, it’s a complicated situation with payers and providers and all the rest, but there are things we can do to reduce the administrative burden.
How can we actually get patients, you know, have our interactions so that whatever’s easiest for the patient works also for the doctors? Like, you know, we have yet to really fully integrate virtual care and can we make that work? Can we make home care work?
I also, I’m really excited about some possibilities regarding AI and using the phone to actually deliver therapeutic interventions. And I think that’s also going to make a huge difference when we can bring in, again, we have to look, I think, at technology as our friends not as our enemy. A lot of people worry that technology’s going to take over or going to eliminate our jobs. Well, I don’t think so. You know, the history of technology has allowed us to do more and augment what we do best.
"Technology cannot be a substitute for the social connection." Dr. Zeke Emanuel
Ann Nachtigal (host):
You know, you mentioned COVID-19 and how that was so hard. And I think really what’s come out of that, at least in terms for Sanford Health, and I think a lot of other health care organizations, is really focusing on the well-being of our caregivers. Right? And if, you know, we talk about patient experience, well, the caregiver has to be in a good space in order to deliver great care, right?
Dr. Zeke Emanuel:
Oh, absolutely. And so that’s a huge part of it. We know that if you have burned out doctors and nurses, you have more mistakes. You have people who are disengaged from actually providing care. It’s terrible caregiving. Right?
You know, my father was a pediatrician in Chicago when I was growing up. He used to work maddening hours, 75 a week. He would, you know, every other weekend he was on call, Mondays and Thursdays, he actually was in the office till 9:00 p.m. But he was totally happy, totally fulfilled. Why? Because he was making a difference to patients. And that, I mean, we have to remember the importance of that kind of meaning driving us.
Almost all of us, we’re happy in two, you know, happiness is critical. One is social connections bonding. And I think, again, this is an area that we could do more to think about, and having meaning in your life. Doing what you set out to do to make the world a better place. But I do think this issue of social connection. I didn’t emphasize it, but it’s probably useful to emphasize here.
One of the problems I think is, you know, we used to have doctors’ lounges at hospitals. I remember going in with my father and grabbing doughnuts in the doctor’s lounge and things. You know, talking to his peers and complaining of course about the administrators and the leadership. Swapping sports stories. That kind of bonding is really, really important. We know it’s important, but for a lot of reasons that has actually decreased in health care among the workers and increasing that social bonding, not through artificial things like happy hours, but regular things.
So when I look back at, you know, the time I was working like a dog, internship, in residency … what helped? Well, the midnight meal where all the residents would come together for half hour.
Ann Nachtigal (host):
Shared experiences.
Dr. Zeke Emanuel:
Exactly. Yes. Shared experiences. Yes. Moan about this. Talk about good things that were happening to you. Right. That social relationship, even if it wasn’t deep with all, each of those people is really, really important to your happiness and your sense of, you know, this is a group. You know? We know this from the military, right? I mean, what do people fight for while they fight for their buddies? And that buddy system actually has been used at some medical centers creating buddies.
Ann Nachtigal (host):
Nice.
Dr. Zeke Emanuel:
To actually bolster that social connection. So I think those are some of the things we need to think about as leaders of health care to help our workers.
Ann Nachtigal (host):
Yeah. And you talk a little bit about AI, right? And I know technology, there’s such great opportunity particular in rural America.
Dr. Zeke Emanuel:
Oh, it’s critical to rural health. Critical.
Ann Nachtigal (host):
Right. And we could really lead that way for if rural America can do it, everybody else can. Right. But the balance of using that technology, does that make us more disconnected? You just talked about the importance of social connections.
Dr. Zeke Emanuel:
So technology cannot be a substitute for the social connection. You still need to have the bond. You still need to know the patient and know what’s important to them. But over the course of treating a patient, you know, there are going to be times when it’s better to do it in the house. There are going to be times where, you know, sending someone to the patient is going to be better.
And once you know someone, once you have a relationship with someone, talking to them on the phone or talking to them over Zoom, that’s easy. That’s still bonding. I think that the issue is you do need a base of face-to-face in-person relationships? That is never going away from health care. No.
Ann Nachtigal (host):
Basic human connection. Yes. We are running out of time.
Dr. Zeke Emanuel:
Sorry, I’ve been long-winded. I apologize.
Ann Nachtigal (host):
No, you’ve been great. It’s super. I just want to end with one last question and that is really what excites you the most about the future of rural health care?
Dr. Zeke Emanuel:
What excites me the most? I think that this kind of summit is actually quite important. And what you said about we in rural health should be innovative.
Rural health has, let’s be honest, has always been a sort of afterthought. We’ve been focused on the big high-tech hospitals and major metropolitan areas. And it hasn’t been, well, they’re doing things in rural health or rural health is pioneering this issue. Like, how do we integrate all this technology so we can actually get to our patients who live 120 miles away and can’t come in every day for whatever it is, physical therapy.
I think the fact that rural health is asking the big questions and trying to use all the available tools we have, like technology, to actually address those issues is critical because if rural health can, you know, use the technology and for example, address the mental health crisis in America, that can be adapted in lots of other places.
And I think it’s not, you know, these problems aren’t unique to rural health, as we’ve learned. And so your rural health can be just as pioneering as the big behemoths in center city. And I speak of working at Penn with our behemoth academic health center, we can be innovative, but so can rural health and that I think is a very different place we’ve seen rural health compared to the last hundred years, honestly.
Ann Nachtigal (host):
Embrace being able to be nimble. Right?
Dr. Zeke Emanuel:
Well, nimble and also innovative, right? I mean, there’s no reason that innovation has to live only in New York, Boston, San Francisco.
Ann Nachtigal (host):
Yeah. Absolutely. Zeke Emanuel, thank you so much for joining us today at the Summit on the Future of Rural Health. We appreciate you.
Dr. Zeke Emanuel:
My honor. Thank you for the interview.
Alan Helgeson:
You’ve been listening to Reimagining Rural Health, a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health Series on Apple, Spotify, and news.sanfordhealth.org.
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Posted In Leadership in Health Care, News, Rural Health, Virtual Care
