(bright soft music) - [Announcer] Funding for "Utah Insight" is made possible by viewers like you.

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- [Liz] Next on "Utah Insight," the state of Utah's healthcare system in a COVID-19 world.

- It's really going from what you love to, "I cannot do it, not one more day."

- Hear from professionals working on the front lines during the pandemic to those who are just starting out in their medical careers.

Plus learn what the state is doing now to make sure your healthcare needs are met in the future.

Welcome to "Utah Insight."

I'm your host, Liz Adeola.

While COVID-19 hospitalization numbers are low, the need for trained healthcare workers still remains high in Utah and across the nation.

Just take a look at Utah's turnover rate in nursing.

You can see it right here on the screen.

The Utah Medical Education Council shared its latest findings, which show that a record number of nurses left their employers in the second quarter of 2020.

That's more than 3,100 nurses in Utah leaving their jobs, a 39% increase from the same time period in 2019.

Now I know a lot of people will point to the Great Resignation and pandemic burnout, but there is so much more at play here, and we have a panel of medical professionals joining us now to weigh in, and I can't wait to get into this discussion.

First, I want to introduce Clark Ruttinger, the director of the new Utah Health Workforce Information Center.

Dr. Terri Hunter is an experienced nurse who is also the president of the Utah Organization of Nurse Leaders, and Dr. Richard A. Ferguson is the chief medical officer at Health Choice Utah.

Dr. Ferguson is also the president and founder of Black Physicians of Utah.

Welcome all, and thank you so much for being here.

Terri, can you start things off by just painting a picture of what it was like working before the pandemic versus during the pandemic?

- Sure.

I think before the pandemic, I would describe things as we were getting used to the change management.

We were working on best practices and standardization and cost savings and most of the things that would help reduce cost to the community and make nurses' lives and our care providers a good atmosphere to work in.

The pandemic caused an instant change for us, and the focus quickly turned into personal protective equipment and making sure that our caregivers are safe, making sure we are standing up the capability to test and take care of these patients.

If you can remember, we got a little bit of a heads up from New York and really set out the expectation that this could happen to us and we should be prepared, so instantly became working under that emergency process where we have a command center going from a system and facility level and rapid changes and rapid instructions coming through from the CDC to follow through with.

So lots of change, lots of stress, and all of a sudden, a simple walking into a patient's room required a full process of donning and doffing off personal protective, and so our caregivers were stretched just to do their basic duties.

- And you also spoke a little bit about how it changed the interaction between the caregivers and the patients had to change as well.

- Exactly, and visitors that weren't allowed to be in there, and so masking happened instantaneously.

We had to do a lot of communication by phone to family and to partners that weren't able to be there with their patients, and so that added a lot of complexity to communication for providers and for nursing staff.

- And Dr. Ferguson, not only did you work in the ER during the pandemic, you were also on the front lines in a lot of the hotspots during this time as well.

Can you talk about your experience?

- Yeah, I would say probably the one that is most prominent for my memory is I think we all remember when Governor Cuomo was saying, "We need doctors.

We need nurses.

Please come to New York City."

And I answered that call and I went out for about three and a half weeks to the Billy Jean King field hospital there.

And while there, you had a lot of experts that were coming from all over the nation, ED docs, anesthesiologists, intensive care physicians.

We all came with one single purpose, one, to try to save as many lives or stabilize people while we were there all while taking in new information on how to treat this virus that we knew very little about.

But also, I was there with the mindset of, "What am I gonna bring back to Utah?

What can I bring back to my physician colleagues and peers upon returning?"

Then also I practiced in northern Minnesota as well.

So I had city experience and then also understood the shortages that were very apparent in the rural areas of northern Minnesota when I worked in that emergency room.

- Well talk also about what you did bring back to Utah, what you learned from being a part of those experiences.

- I would have to say the biggest thing was trying to get people to understand hydroxychloroquine was not an effective treatment and that we ne needed to try to compel many of our primary care physicians because there was a lot of fear, and it clearly not proving yet to be wholly ineffective.

We tried to do our best to put the word out, messaging, "This is not how you start."

Proning was very much early on in favor of changing positions so people could reduce the amount of edema within their lungs as when they had moderate to severe COVID, and also coming back to dispel myths on what isn't going to work.

And so I came back and tried to not only speak to my physician colleagues but to the public as well by some appearances on the Latino radio stations here to definitely dispel the myths and encourage mask wearing.

- And Clark, a lot of people have called you the lead data guru on all things medical and in the healthcare workforce here in Utah.

What kind of changes stood out to you during this time period?

- Yeah, when the pandemic started, I had the privilege of being the board president for the National Forum for State Nursing Workforce Centers.

So I was literally watching my colleagues in 38 different states who track the nursing workforce and advocate for nursing workforce policy as they were dealing with the pandemic and having to stop doing research with me so they could go man clinical time and deal with hospital issues.

And so it was a unique experience, I think, to sit and watch this happen and certainly stressful to see.

I think what everybody started to realize was that the pandemic showed a light on the need for really modernizing our analysis systems across the country.

I call it joining the 21st century because frankly, we're still using things technically that were invented in the 20th century, and there's a lot of modern tools that can be used that can be pulled in from industry, and it's a matter of paying attention to those and learning how to translate them into use in this field.

- Yeah, and speaking of data, I wanna call your attention to a number that I got from the Utah Nursing Workforce Information Center's latest report.

In 2020, 37,743 nurses held licenses in the state of Utah, but more are needed.

I spoke with Teresa Garrett with the Utah nursing Consortium who shared that there are between 3,500 and 4,000 job openings currently for nurses here in Utah but not enough qualified nurses to fill those roles.

What are your thoughts on hearing that number?

I'm gonna go to you.

- First thing is we need to get upstream.

We need to attract people to healthcare.

We need to attract 'em to nursing.

We need to be able to leverage tools so that when they come in with less experience, that we're able to get them up to an expert level quickly.

We need to leverage technology and things that can help make sure that nurses stay safe, like how they administer meds with barcode administration or monitors that can interpret things so that it will support those new grads.

But really need to get upstream to the youth and help 'em to see what a fun world and what connecting to a why, a purpose of serving people and having a profession in nursing could do.

We recently took a robot, a surgical robot, over to the local high school and let the youth participate in playing with this robot, and they were unwrapping candy bar wrappers.

And you could see lights coming on in these kids that probably never imagined a healthcare profession, but we need to tap into that young.

We need to tap into the diversity that's among our state and attract those people who maybe didn't think that they could go to nursing school, that they could be in healthcare.

Help them do steps towards that through our technical colleges and programs that help get 'em into systems that have tuition and things that can help support 'em.

But it's not gonna be a solution.

It's gonna be many, many little solutions that are gonna contribute to meeting our needs of being able to get who we need in the workforce.

- I really agree with Terri Hunter, or sorry for saying your full name there, Terri.

There's a lot of systemic factors here.

We have to consider that 30% of our nursing workforce is within 10 years of retirement, and how do we replace that great amount of knowledge, that institutional knowledge and institutional memory that's leaving?

Not to mention massive amounts of migration that's been happening from travel nursing and new entrants?

There's a massive population of nurses coming in, but these are inexperienced nurses that need to be trained and need to gain the experience and the knowledge that's being lost.

- I think what we can't miss, though, is there is a strong desire for many in Utah to go into nursing.

But if there's not enough spots for them to train and faculty to train them, we can attract as many, having exposing nursing to young kids throughout the valley, but if they don't have a place to go, they're gonna probably go somewhere else or not consider nursing 'cause they'll just be rejected 'cause there's just not enough spots.

But then we also have to come to the real attention that I'm sure we'll address later is we have to make sure that nursing remains a welcoming field.

It's more than just aging out of why nurses were leaving, which I'm sure you'll get into.

- Exactly.

No, and- - Has to be a welcoming place.

- Exactly.

- Absolutely.

- And I think the pandemic probably just made that go a lot faster.

We talk about the Great Resignation, but it's real.

We saw a huge number of nurses over the age of 55 that left the workforce that we've been planning on for years that of having this, and then having that instantaneously happen really caused a shortage of the bedside caregivers, and this work can be very hard and demanding, and we are focusing on wellbeing, on balancing work life, on flexibility in schedules and our workplaces, allowing some virtual, looking after what could be done to help support from a family perspective and childcare, anything we can do to help support our nurses, to make things flow better for their life and help them to be more resilient in what we're doing, I think.

- Yeah, absolutely, and experts say the ratio of primary care physicians to the population is pretty low in Utah, an issue that is amplified for medically underserved communities.

"Utah Insight"'s RaeAnn Christensen shows us how a program at the University of Utah prepares and encourages medical students to answer the call for increased services.

(flags flap in wind) - I am an immigrant.

My family moved to actually to Utah, to Salt Lake when I was seven years old from Mexico, and I got really sick around that same time.

We didn't have very much money, we didn't have insurance, and my mom was really worried about me, so she took me down to the 4th Street Clinic 'cause she heard that's where people that didn't have insurance or money could get help.

- [RaeAnn] These are some of the memories that led Moroni Lopez to go to medical school.

- From that moment on, I've always thought that I wanted to do something like that and to give back to the community that I came from.

- [RaeAnn] Part of his education includes helping those who may not always receive proper care.

The Tribal Rural Underserved Medical Education, or TRUE, is a fairly new program at the University of Utah.

Medical students observe firsthand the roles providers and community health organizations play in ensuring health and wellness for everyone.

Dr. Aaron Bia from the Navajo nation helps mentor the students.

He says it gives them invaluable experience in indigenous medicine and rural experiences.

- You can teach other medical students who are not from the area to really highlight the fact that there are challenges in medicine, that rural medicine is a very different aspect of life.

Sometimes you're the only clinician there, and a lot of your patients and resources really depend on you to be that rural doctor to really know everything.

- [RaeAnn] Once he's done with his residency, he says he hopes to bring his medical skills back home.

- I was one of those kids that said I wanted to go to medical school when I was younger.

I had a great inspiration from my grandfather, who is a Navajo traditional healer, be that Navajo provider that we didn't have much when I was growing up.

- [RaeAnn] TRUE is going on its second year, and Dr. David Sandweiss is the program director.

- Utah is ranked pretty low in primary care provider to population ratio, and we know that that's gonna be getting worse over the next few years as primary care providers in underserved communities and particular rural communities age out, and we need to fill those slots with docs.

- [RaeAnn] Dr. Ivette Lopez is with the Public Health Department of Family and Preventive Medicine with the University of Utah.

- I think that the proportion of minority physicians to what is needed is way below.

- [RaeAnn] She's working with the community health workers to hopefully bridge the gap of underserved communities.

- When the services are delivered in a one-size-fits-all way, it doesn't work because one size doesn't fit all, does it?

We need to make sure that each population is taken care of, not just some.

- [RaeAnn] The future Dr. Moroni Lopez will be doing his part to help build that bridge over health inequities.

- For me to be able to go in and work with my community, have somebody that looks like them, that talks like them, I'm fluent in Spanish, to have the level of training that the school gives to me and then to be able to bring that to these communities, it's like a full circle for me.

- [RaeAnn] And he's not the only one in his family to do so.

- My mom actually is about to graduate from nursing school.

(laughs) Yeah.

She's got five kids.

After my youngest brother was in high school, she started going back to school at Salt Lake Community College, and she's the one person that's constantly just pushing to go into healthcare, and she beat me to it, but (laughs) I'm very happy she did.

- For "Utah Insight," I'm RaeAnn Christensen.

- [Man] One.

- And we asked viewers to share their thoughts on how COVID-19 impacted the healthcare system.

Here's a little bit of what Steve Williams had to say.

"I've lost several friends to COVID and had several friends and relatives get it and spent time in the hospital.

I think it was handled very well.

Information was constantly changing, but COVID was new and a bit unexpected.

Now that it's been around two years, things are better.

At least to me, it is."

And we also got this comment from Dalene who said this.

"What we have done to our healthcare workers is unconscionable and also unsustainable.

Understaffing has a direct effect on the care those who went into healthcare to help and serve are able to provide and has a direct impact on anyone who ends up in the ER."

Terri, what do comments like those stir up inside you?

- It hurts.

It hurts my heart 'cause I see it.

I haven't been on the floor other than to support for years, but I am out there looking into their eyes as they've lost patients, as they're scared for their own health, and she's absolutely correct.

It's unsustainable.

We've got to make the frontline a place where we, and we actually have been working really hard.

We've had counseling.

We call it employee assistance that we have increased to make sure that they're there to support after hard situations, but she's very right.

This is unsustainable and we need to be able to be kind.

Workplace violence and violence towards healthcare workers is astronomical right now, one of the top national issues that are going on on top of the hard work that they're doing for sick patients.

And I think we need to work together as a community in healthcare and as patients and families to support our healthcare workers this way.

- Yeah, and so many sometimes can end up feeling like they're all alone in this and that they're siloed, but there are different organizations helping out medical workers.

Dr. Ferguson, you launched an organization here in Utah.

Can you talk about that?

- Yeah.

- So the Black Physicians of Utah I created because it's even more isolating being a black doctor in Utah, particularly when I was with Intermountain.

I was the only black physician I saw for three years, and that was just within the urgent care setting, which they have dozens of providers.

And often, even when I was in the hospital space, I would never run into anyone.

So I could understand if may not have received possibly fair treatment or have an outlet or even fellowship where I have someone with that similar cultural background, that could lead to me often leaving Utah.

So I felt creating the organization not only by representation to address health inequities 'cause it has been shown in several studies, many studies for some time, that if a black patient receives care from a black provider, they often have a better outcome.

And often, I feel that can be taught to our non-BIPOC providers as well.

So I created it just for a big reason of, one, fellowship.

So I know that we're here, but let's create a place where we can meet each other and unify but also to create a future path for young students that want to become physicians that might have never been introduced to that before and then as well a big point for increasing trust within the black community because there's a reason why we were severely impacted by the pandemic often more than any other ethnodemographic within the nation, and part of that is trusting and seeking healthcare, and that's what Black Physicians of Utah is trying to change.

- Yeah, and RaeAnn's story showcasing the next generation of medical workers, of doctors who are willing to go to southern Utah and help some of those rural communities and be a part of the rural communities, not only just there to serve them as doctors but also to live there and to experience the culture and be a part of the culture.

Clark, what were your thoughts after seeing that story?

- Yeah, that was really great.

They're doing really great work.

They're trying to increase a pathway to residency programs in the state for Native Americans, so that's direly needed.

Really, my thoughts are that the healthcare industry is in competition with every other industry for pipelining students into it.

And so if there's a shortage, it needs to start at that bottom level.

We need to build pathways so that students can come into healthcare rather than, in Utah, the tech industry.

The other thing is that as Utah's population grows, one of the fastest growing in the nation still, if we don't provide more training opportunities to produce doctors and nurses and every other type of healthcare provider here in Utah, then we increasingly compete with the nation to get these providers to come here to meet the needs of our fastest growing population.

- And what I'd probably bring up is that there's already been, so this has been a known problem for a while.

Ever since there's been a moratorium on residency positions since 1992, we have this, at the bottom, the bases coming up more and more med students 'cause more and more med schools are opening, just like Noorda College of Osteopathic Medicine in Utah County.

But if we're not able to have more residency positions, we're not able to put more doctors into the workforce, and at least this past legislative period, let me just get the number right here, HB0295, the Physician Workforce Grant Program that Governor Cox was able to put through is gonna increase the number of residency positions for medical students to go into so that we can keep students or our doctors within the state 'cause often, 80% of the time, where you do your residency is where you stay.

So if we're gonna address our workforce, we have to create more residency positions.

- Absolutely, and I reached out to the president of the Utah Nursing Association, Andrew Nydegger, who, while researching this issue, and he had this to say about burnout.

He says it's the biggest issue that's challenging the nursing industry and that they're facing today, sharing that, "It is easy to get burned out when you don't see an end to anything, but when you're a change agent and you embrace that, it makes a big difference."

And Terri, that made me think of you, Dr. Hunter, because you talked about your plans of what you hope to do in Washington after you retire.

- (laughs) Yeah, I finished my doctorate degree last year, and I thought, "When I get done with industry, I wanna go help change our health system," but you're absolutely right.

The promotion of wellbeing for these nurses, I said a little bit ago, we've got to help them be resilient and help them to be strong emotionally, physically, and they need to be healthy as well.

But helping them through shared governance and ownership to really put their teeth into their work and make it connecting to why they went into nursing and what they're doing, not just being a robot to conduct orders all the time, but really using it as their art and their practice.

- It's almost time to wrap up, and so I wanna get some final thoughts.

Clark, what are your thoughts on the solution to this issue, or moving forward, what is the state planning to do?

- Yeah, moving forward, my office was just, I think we had some important legislation passed this last session in terms of integrating a survey that I've collected for 20 years with the license process.

So every license professional will gather a detailed supplemental survey about their practice habits, their demographics, and their setting and specialty and practice location.

And that way we can better model where we're deficient, where we're really short in supply in relation to population health needs rather than just using a simple ratio that doesn't really tell us how providers practice or how efficient they are.

- [Liz] And Dr. Hunter?

- I think we have the same issue as the physicians.

We've gotta get more nursing instructors.

We've gotta continue to open those spots up for training and make it possible to get people into the workforce and continue to innovate and be creative about our jobs, what they look like, crafting them to meet the needs of both our nurses and our patients and our providers.

- [Liz] And Dr. Ferguson?

- I would say I'd probably have three points to make here.

One, to piggyback off for Dr. Hunter, there's a recent bill addressing a resident shortage that passed the House, I wanna say back in March.

If that can go through the Senate, that will create additional 2,000 more spots in residency.

But also, we need to make sure that we are able to change the work culture within medicine, and part of that will lead to increased retention, make sure that you feel included, wanted, welcomed, that you don't have to feel bad for taking a sick day.

And that's the culture that needs attained at the higher administration level.

We shouldn't in the US have to feel compelled to go to work sick for risk of losing a job or feeding our family.

And then also to address primary care shortages, 'cause Utah's in the top five, it's going to be incentivizing students to go into primary care, and right now, medicine is not structured or incentivized that way.

So part of it's gonna be increasing in those residency spots for primary care, peds, OBGYN, family medicine, but then also making sure that they're not indebted so much that they won't even consider that path and also making sure that their medical education is tied to them being placed in an at-need area.

And so that's where I think we can do that in the next two years and that can make a difference.

And then I guess probably lastly is maybe trying to allow a pathway for those with J-1 visas for medical grads 'cause we're an aging population.

The docs are aging, too.

The nurses, as you noted, are aging.

We have to have folks that are gonna be there to take care of us.

- All right.

Well, thank you all for sharing your thoughts, and thank you for being here today.

We have more resources on our website at PBSutah.org for anyone who feels alone in this journey or wants to get in contact with some of the organizations that you heard here on the show.

Coming up next week, we're gonna be talking about the school to prison pipeline, and we have our question for you for that week that will be on our PBS Utah Facebook page.

You can sound off using the methods on your screen, and you just might hear your comment or question shared on the show.

And for those who have already shared, I wanna thank you for connecting with us.

We'll see you again next week.

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