AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts in medicine on COVID-19, medical education, advocacy issues, burnout, vaccines and more.
Featured topic and speakers
Does California have a doctor shortage? Are residency spots increasing? Why are recruitment strategies important in healthcare? Can AI improve health care?
The president and CEO of Sutter Health, Warner Thomas, discusses the importance of effective physician recruitment and doctor retention strategies, the future of AI in health care and the need to add more medical residency spots for the next generation of medical students. AMA Chief Experience Officer Todd Unger hosts.
- The AMA is your powerful ally, focused on addressing the issues important to you, so you can focus on what matters most—patients. We will meet this challenge together. Join us.
- Learn more about the AMA Health System Program.
- Learn more about our AMA advocacy priorities, including:
- Reforming Medicare payment
- Fighting scope creep
- Fixing prior authorization
- Reducing physician burnout
- Making technology work for physicians
Speaker
- Warner Thomas, president and CEO, Sutter Health
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Today, we're talking about the comprehensive approach that Sutter Health is taking to address the physician shortage. I'm joined today by the president and CEO of Sutter Health, Warner Thomas, in Sacramento, California. I'm Todd Unger, AMA's chief experience officer in Chicago. Warner, we're glad to have you back today.
Thomas: Hey, Todd, great to be with you. And thanks for the opportunity to come and chat with you today.
Unger: Well, the physician shortage is something we talk a lot about, and there's no easy answer here, of course, on the mind of every health system leader. At Sutter Health, you're addressing this issue on multiple fronts, starting in medical school. What can you tell us about that?
Thomas: Yeah, I would say, first of all, as we kind of think about physician shortage, I would say, if you look at California's about 37,000 physicians short of kind of where we need to be. And obviously, with the aging of our physician base kind of throughout the country, anticipate that will be exacerbated over the next several years.
So one of the things we did last year is we launched a multiphased approach to expand our graduate medical education at Sutter Health, growing from about 220 residents and fellows with a plan to grow to nearly 1,000 by 2030. Some of that is expanding existing programs, like at our Sutter Roseville in Roseville, California. Some of that is expanding and building new programs, like at Sutter Alta Bates in Oakland or Sutter Memorial Medical Center in Modesto. Those are two new programs that we're starting.
So it's really a combination of the two of expansion of existing programs, growing new programs. And I would say primarily, initially, in a lot of primary care areas, but at the same time want to focus on specialty areas and expanding specialty capabilities as well, because we have shortages in a variety of different areas, and we're looking to grow our centers of excellence. So really trying to align our GME strategy around what we want to do in our center of excellence strategy as well.
Unger: Do you think this—I guess, it's pipeline management, so to speak, kind of really building up through residency programs like you're talking about. Is that kind of new thinking to address the physician shortage?
Thomas: Well, I think it's something that's critically important. I mean, I think it's something that is new here at Sutter Health, certainly. Certainly, when I spent a number of years at Ochsner Health in New Orleans working with our chief academic officer, Leo Swaney there, definitely worked to expand the program there. We're doing the same thing here at Sutter Health.
And I would say it's one of the strategies. I mean, certainly, we're recruiting across the country, but we have to build the pipeline. And Lindsay Mazotti, who is really our physician leader and our graduate medical education and training areas, Leon Clark, who's also leading that, they work as a dyad partnership in those areas. They're driving a lot of these efforts. So expanding these capabilities is going to be important in the future. I think it is a pipeline initiative.
I think, frankly, all health systems should be trying to lean in and do this in a very robust way. We have so many people coming out of medical school that we just don't have enough residency slots. So we definitely view this as a way to secure more physicians here at Sutter Health. We know that physicians, about 70% of them, work within 70 miles of where they finished their terminal training. So we do think is a great way to build the pipeline and to build the growth of our physician groups really throughout Sutter Health.
And then you mentioned the medical school situation. I would say that we continue to explore that. If you look at Northern California, our market is 13 million people. We definitely are undersized with the number of medical school slots in Northern California compared to the population. And we're a net exporter of students kind of outside of Northern California.
So we are looking to kind of figure the right medical school partnership. We would like to do this in a strategic partnership and are evaluating that. Nothing imminent at this point, but certainly, another important pipeline initiative for the future.
Unger: Now in addition to the pipeline, you talked about, obviously, recruitment as a very important element of this. And I'm curious, How has the thinking changed around recruitment given the shortage that we're seeing right now?
Thomas: Well, I think it's just become very, very competitive. We're fortunate that we've actually—have done a very nice job. We have eight medical groups who are our partners because California has the corporal practice of medicine. So we need to work in partnership with our medical groups.
They've done an extremely good job recruiting and building their medical groups. Our physician turnover is at all time lows, 2% across all of our medical groups, which is, frankly, astounding for the great work they're doing. And we see a high percentage of offers accepted. About 90% of the offers we make—or our medical groups make for physician positions in those groups are accepted. So we've been fortunate there.
And I think part of it is people believe in where we're going at Sutter Health, and believe in the leadership and the capability of our medical groups. And frankly, people want to work at a place where they see that they can make a difference, that it's growing, it's expanding, it's expanding its impact. And those are many of the things that we're doing here at Sutter Health.
Unger: I want to dig in a little bit to that amazing retention rate that you talked about. I think, if I understood that, around 98%, which is very, very high. What's the secret to retaining your physicians?
Thomas: Yeah. So, I mean, you should talk to our medical groups who are in it each and every day. But I would say it's communication, it's creating a sense of belonging, it's working on DE&I and having people feel like they're included in what they're doing. It's belief in the future and understanding where the organization is going. It's having a strong health system partner, which I think Sutter Health has been a strong health system partner to our medical groups.
And I think having a really strong physician leaders, and physician leaders that are transparent, that are communicating, that are talking about the future and addressing the challenges day to day. I would also say that we're doing a lot of work around how we can use technology to improve the challenge of managing the in basket and the challenge of documentation in the medical group and with our office—our office visits and whatnot.
So we have a technology, Abridge, that we're using in our clinics now. We're looking to expand that. We're on the Epic platform. We use their augmented response program for a lot of our in basket messaging, and that's continuing to improve and get better. So I think it's a number of things, but it's really just about working hard every day to connect with people and to have people feel like they belong and are part of something bigger.
Unger: So when you look at everything that you're doing today, and you mentioned also technology, How do you think that we're going to lessen the impact of the physician shortage over the long term?
Thomas: Well, I think a couple of things. I think we have to make practicing, documenting and using technology easier. And I think we've got a lot of efforts, as I mentioned, going on there. And Laura Wilt, our chief digital officer, one of the things she's working with our physician leaders on is, how we reduce work, the number of hours, both inside the day and outside of the day, in the evening hours or weekends.
So a lot of work being done to simplify and make the system easier to use, building technology and tools that are going to make that easier to use, so that we really focus on how we reduce fractional quitting and keep more people closer to a full time FTE in our practices. But I do think over time, AI and how we use generative AI to essentially work alongside our physicians, whether they be radiologists or our primary care or other physicians in the office around tools like Abridge.
I think these are going to be critically important for the future to make the challenge of practicing medicine really sustainable and really continue to make it an easier or sustainable situation for our physicians.
Unger: Now a lot of this sounds like—I mean, there is a huge necessity, obviously, that's driving a level of innovation. Do you think that's actually going to kind of shape health care in the future as a result of this as we adapt?
Thomas: I do think the technology that we're—I mean, we're just in the early, early stages of how the new technologies can impact our ability to take care of patients in the future, and impact our ability for our physicians and clinicians to work in the practice each and every day. So I think that that's going to continue to evolve. I mean, you saw with the Epic users group this year, all the new AI tools that were coming out as part of this latest Epic release.
And so I just think that's going to continue to accelerate. And I'm optimistic that these tools will make it easier, not harder, for our physicians and other clinicians. And so that's really the plan for the future.
Unger: Now a lot of times, we get new technology, but of course, there are all the other things that go along with making that technology work—people, operations. How are you approaching that part of the job?
Thomas: Well, I think—once again, I think that we need to make sure that technologies are more intuitive and easier for folks to use. I mean, whether it's our online portal systems for our patients or remote patient management for chronic disease or just how we stay connected to our patients or how we make it easier in our exam rooms or whatnot for our physicians and clinicians. So I think it's—it's interesting, when you use your app for United Airlines or you use your app for Amazon or whatnot, nobody taught you how to use it. You just—it was intuitive, right? And you were able to use it.
And I think that's what we have to think about in health care. Like our apps that we build, our applications that we have, need to be more intuitive so people can use them. And so I think we're evolving and getting there. And one of the things we find is our patients that we're digitally connected to are—their satisfaction levels are two times higher than folks that are not digitally connected to us.
I mean, they use different parts of our systems at a much higher rate than people that are not digitally connected. So there's a lot of reasons to do this. But at the end of the day, it has to be sustainable for our physicians and clinicians. And that's a lot of the work we're doing every day to make that an easier situation for them.
Unger: Those are just excellent comments and terrific insight, Warner. Thank you so much for joining us and sharing all the work that you're doing on this critical issue. Like Sutter Health, the AMA is addressing the physician shortage on multiple fronts, including our work to reduce physician burnout. To support that work, become an AMA member at ama-assn.org/join.
That wraps up today's episode and we'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
Subscribe to AMA Update
Get videos with expert opinions from the AMA on the most important health care topics affecting physicians, residents, medical students and patients—delivered to your inbox.
