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We dive into the evolving health care landscape with Jamie Babcock, a health care executive. We’ll explore the growing demand for skilled providers and the critical clinician shortage projected by the Health Resources and Service Administration and the U.S. Chamber of Commerce. Jamie shares insights on innovative strategies that health care leaders can employ to address these challenges, emphasizing the importance of interdisciplinary care teams. Discover how home-based care, supported by field responders, advanced practice practitioners, and telehealth technology, can optimize patient outcomes and ensure high-quality care.

Jamie Babcock is a health care executive.

She discusses the KevinMD article, “Interdisciplinary care teams play a pivotal role in mitigating the clinician shortage.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Jamie Babcock. She’s a health care executive. Today’s KevinMD article is “Interdisciplinary care teams play a pivotal role in mitigating the clinician shortage.” Jamie, welcome to the show.

Jamie Babcock: Hi, thanks so much for having me. Glad to be here with you.

Kevin Pho: So let’s start by briefly sharing your story and journey.

Jamie Babcock: Sure, yeah, thanks. So I’ve been in the health care space for almost 20 years, and so it’s been a lot of fun to see that evolve. Started as an RN, and currently I’m a licensed adult nurse practitioner, but I’ve been in more of the clinical ops space here for the last ten years or so.

And I spent some time at Optum in their I-SNP space, which was great. I love that population, and really got my passion going behind the elderly, the complex, the aging population. I mean, they’re just a really underserved, underutilized group of people that need our help, and I really fell in love with that population. And I was there for a long time, had a great experience.

And I joined MyLaurel here about six months ago to lead their clinical operations and care services, providing acute care in the home, and again serving that population of the elderly and the frail, the complex. And here I am today. It’s kind of been a whirlwind of a little bit of everything, but it’s been great, it’s been a lot of fun.

Kevin Pho: All right. So let’s talk about your KevinMD article. Interested in hearing your perspective from the worldview of industry. “Interdisciplinary care teams play a pivotal role in mitigating the clinician shortage.” Now for those of you who didn’t get a chance to read that article, tell us what it’s about.

Jamie Babcock: Yeah, you know, especially coming out of COVID, right, we’ve all seen these shortages in health care, and it kind of led all of us to look at, how do we mitigate this? There’s not going to be enough nurses, we know that. The physician shortage is very real. We see a paramedic shortage that’s very real, and it spans across all of us. So how do we all work together, and how do we get each other practicing at the top of our license so we can fill these gaps?

You know, I think we spent a lot of time saying, oh, a nurse can do this part and a paramedic can do this part, but don’t cross. And I think as a society, a culture, we have to evolve, and it is going to take all the pieces of the puzzle to fill the gaps that we’re seeing in health care right now. And I think that includes our EMTs, our paramedics, our nurses, LPNs, RNs. We need everyone coming to the table.

And it’s really just looking at, how do we come to the table, build this team where we all have a piece of it? And we have to make sure we’re not another fragmentation of the health care system, where we say, yep, nurse can do this, paramedic does this, we’re not going to blend. We have to. And I think that’s where we have to get as a culture from a health care perspective, and just in our ecosystem, of utilizing all of the resources to meet these patients where they are.

You know, unfortunately I think we see a lot of times people end up in the ED unnecessarily, because, well, a paramedic can’t do that in the home, a nurse can’t do that in the home, or something like that. We’ve got to tear down these barriers. That’s how I think we’re going to solve this shortage. And really it’s where a lot of my passion lies, especially as I see these patients that are elderly and frail. They don’t need to be in the ED, and it’s not where they need to be treated. And I think getting everyone at the table, and all the disciplines at the table, that’s how we move the needle in closing the gaps in health care.

Kevin Pho: Yeah, so before we talk about some of those solutions, just give us some context. Why is health care so siloed in the first place? What are some of the reasons behind that?

Jamie Babcock: I think that’s such a good question, and it’s one I’ve been diving into a lot. And I think it’s, unfortunately, sometimes there’s a politically charged agenda behind things. It’s just part of how things have come. There’s a lot of money and dollars, and health care has a lot of money and dollars that’s just flowing in and out. And when we had the staff and we had an abundance of nurses and all of those things, it wasn’t as big of an issue.

But now we start to see, there’s a nurse association here, or a paramedic, or a physician, and it’s like, we really got to tear that down. And we can’t segregate ourselves, we need to be one health care ecosystem where we’re pooling our resources depending on where those patients are at.

And I think it’s going to take a lot of lobbying, I think it’s going to take a lot of advocacy, painting the broader picture of how we all fit in here together. There is enough to do for every discipline, right? And I think we’ve just let ourselves get really like, well, we’re nurses, and we’re home health, and we’re this. We’ve got to tear that down. There needs to be a lot of advocacy to tear it down, and where we are just one big ecosystem that works together.

Kevin Pho: So tell us an example or a story where one of the frail members of our society, someone with chronic diseases, someone who is elderly, ended up in the emergency department because of that silo. What would that look like? What’s an example of that?

Jamie Babcock: Yeah, you know, I think we see it in a lot of different states, different regulations. But there’s some states where nurses can’t provide a certain level of care in the home, because it’s just a regulation that’s in place. So that instead of being able to treat a patient there and maybe do a hands-on assessment, which sometimes they can’t even do a hands-on assessment in the home, they’re going to have to go to the ED.

You know, you find out it’s really, let’s just say a basic pneumonia that could be treated with a PO antibiotic or something, but they end up in the ED and they sit there for hours.

You know, there’s times where paramedics are just incredibly smart, they’re highly trained, they know sick. And there’s times they get in a home and their hands are tied. If they can’t, let’s just say they can’t take an order from a nurse practitioner or a physician associate, right, they can’t, it’s regulation, they can’t. So their hands are tied, and because of that we’re sending that patient to the ED.

And it’s just unfortunate. It’s almost like a self-imposed, right, from a cultural, societal perspective, that we’ve put these regulations in place that tie the hands of these wonderful, highly trained professionals just because of regulation.

Kevin Pho: So tell us your vision. What would that interdisciplinary care team look like if you ran our health care system?

Jamie Babcock: Yeah, I don’t know if we have enough time for this, Kevin. But so, my vision, what I would love is we take down the barriers around all of these disciplines. You know, and we know obviously paramedics are trained one way and physicians are trained one way, and we all have a space in it, but there has to be a place where we all work together.

And if a paramedic is in a home, or home health is there with an RN, they need to be able to help coordinate and quarterback that care, without there being stipulations on, oh, you cross this border, you can’t take an order from a physician associate, but next door you can. So we need to tear it down. I think we’ve just let ourselves get way too segmented, and those are the pieces that have to come down.

And you know, I like the associations, because nursing has a specific practice that they follow, and physicians and things like that. But at the end of the day there needs to be one health care, and here’s how we’re all working, and those all roll up into the same system. Right now it almost feels like nurses roll up over here, and physicians roll up here, NPs roll up here, and it needs to roll up into one big hierarchy where we’re all working together, and have our specialties, and you’re just utilizing these precious resources that we don’t have enough of. Let’s use them all to the top of their license.

Kevin Pho: Now, is it purely a matter of regulation? If politically we can remove some of these regulations that prevent people from operating at the top of their licenses, would a lot of the obstacles that we mentioned go away?

Jamie Babcock: You know, I think a lot of them would go away, right, removing some of these obstacles and regulations within the states. I do. I think it would have to be a big cultural shift, because we’ve gone on this road for so long and down this path, and it would have to be almost unwinding it and retraining ourselves how to think differently about the health care system and the ecosystem of resources that we have at our fingertips.

So you know, talk about change management, right? It would be a pretty big change management lift. But truly we’ve got all of these resources, and how do we all use them to work in the right scope of practice? And I think it does start with taking down the barriers of, whether it’s who they can take orders from, independent practice, whatever that might be. But that would be step one, is how we start and really opening up the doors.

So everyone, it’s about being at the top of your license, and having that across all the states. You know, just because you live somewhere and we have a different regulation here, that’s unfortunate, right, you don’t receive the same level of care or can’t access that. So I think that’s where we’d start.

Kevin Pho: So in your advocacy to remove some of these regulations, are you encountering any pushback from these individual organizations that prefer the status quo?

Jamie Babcock: Oh yes. I think health care is interesting, right? There’s two parts of it. There’s part of it that’s very fundamental, it’s very, I hate to say old school, but kind of set in our ways, like this is how we’ve done it, we’re going to keep doing it. And the thing is, health care has changed so much. You could even just say in five years, with COVID, health care has changed so much that we have got to evolve. And I think that’s where we’re still stuck a little bit. We need to look forward, right? What does five years, ten years look like? And that’s what we need to be working on now.

So when you start putting these ideas out there, there’s a little bit of like, oh, that’s not what we do, that’s not how we’ve done it. And you’re right, it’s not, but we’ve got some major changes to make to move this forward and ensure we’re in good shape when you and I need care when we’re older. We have a lot of work to do.

So I think, you know, we talk about change management, it’s about getting people out of the today and starting to look at five, ten years down the road, and what do we need to do today to be prepared for tomorrow. And it starts with really seeing this big picture, and understanding there is room for all of us at the table. You know, expanding the scope of a paramedic or an NP isn’t going to impede anything that another discipline might be doing. It’s actually freeing you up to practice at the top of your license, right?

So it’s going to be a lot of change management, I think, and seeing this bigger picture of getting out of the today space, or, well, that’s how we did it yesterday. Like, we’re in a very different world than we were yesterday.

Kevin Pho: Now, you mentioned home-based care a few times. Tell us how home-based care can alleviate some of the clinician shortages that we’re seeing.

Jamie Babcock: Yeah, you know, I think home-based care, it’s interesting, you can do so much in the home. There’s so much, I mean, with technology. And it’s another evolution piece, right, where ten years ago we couldn’t do point of care labs like we do today. Like now you can get point of care, you can do ultrasound and EKG, I mean, everything point of care. And you can treat patients where they are.

And think about it, they’re comfortable, their family is there, you actually get to see their home environment. The things you learn about being in someone’s home and identifying really the root causes of what sends them to the ED, that experience alone is second to none. You know, those are things you don’t learn when they’re in the ED. And you find out that they only take their Lasix when they can get to the kitchen and get the bottle off. You know, it’s just little things you pick up on.

So I just think that home-based care, a lot of care can be provided there, and it prevents those patients from going to the emergency department. Or people that are coming in with heart attacks and strokes and things that are really serious and time sensitive, they can get that care more timely if we can keep these patients at home that really are more stable and can be treated there.

I think there’s a lot to be done. You see it, right, hospital at home, you’re starting to get that rolling, that’s got a lot of attention. And it’s because you can do so much in the home. And where we come in, providing acute care in the home, you can treat a lot of things in the home. You can give a liter of fluids or IV antibiotics or Lasix or something like that, and that’s all they need. You know, you get in the hospital and you sit there for nine to 12 hours in the ED, and that doesn’t work.

So I think it’s a huge opportunity, and really where we have to drive. But again, it’s removing some of those barriers from the licensure of different disciplines to really be able to do that and implement it everywhere.

Kevin Pho: Right. So why don’t you paint a picture for us. So let’s go back to that scenario we talked about earlier, where that patient had to go to the emergency department because of our siloed health care system. Now let’s shift that scenario and tell us about your ideal scenario, where we have an interdisciplinary team like you describe. What would that look like in that scenario, just from a practical basis?

Jamie Babcock: Yeah, I mean, ideal, take everything apart, what would be ideal is you get a paramedic in that home that knows how to assess acuity very quickly, they know sick. You can telehealth in a physician, whether that’s an ER physician, a hospitalist, an internist, whatever their discipline might be, telehealth them in. And with all of the technology today too, right, they can plug in and get heart tones and lung sounds and do all of that there.

That physician should be able to give an order to a paramedic that, yes, they absolutely need a dose of Lasix or steroids or whatever it might be. We can set that patient up, they’re good to go, they’re stable. And then I can send an RN out the next day to do a physical assessment, hands-on assessment. We know they’re stabilized, we know what their plan of care is. If we need to change it, let’s telehealth the doctor back in with that RN, and we can treat that patient again if we need to.

But it’s almost like that paramedic comes in, it helps stabilize, does that high level assessment, physician comes in, RN comes in, and then we get them into a telephonic phase where we can follow them. And if we need to pull in social work, you know, I think social work is terribly underutilized in the space, especially with SDOH gaps that we see, so bring in social work.

But it just gets all these disciplines, and at the end of the day you’re going to look and you’ll say, we’ve had a paramedic, we’ve had an RN, we’ve had a social worker, a physician, all involved in this care, being able to treat them in home, and they’re safe, it’s effective, and we kept them there. But it really has to happen when you can have all of those disciplines working together, because right now there’s just some fragmentation there.

Kevin Pho: We’re talking to Jamie Babcock. She’s a health care executive. Today’s KevinMD article is “Interdisciplinary care teams play a pivotal role in mitigating the clinician shortage.” Jamie, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.

Jamie Babcock: Yeah, you know, I would just say, we all have such a platform, and I feel a responsibility to our patients. And you know, I hope someone advocates for us when we get there. And advocating for those patients that can’t advocate for themselves, and how do we put them first, and put, whether it’s politics and regulations, we have to put that stuff aside and really think about the patients and how do we drive this greater vision of health care.

And I ask, if you have a platform and you have a way, use your voice. And those patients that we serve usually don’t have the voice that we do, and we have the opportunity to disrupt the patterns that we’re seeing in health care, and how do we better utilize our resources without the politics involved and all the regulations.

So I think the biggest thing is just use your voice, and advocate for those that can’t advocate for themselves. And we all know what needs to be done, it just is going to take a big push from a lot of us to make it happen. But I think we can do it. I think we’re going to have to do it as we continue to move forward, and really think about what five years, ten years looks like for us.

Kevin Pho: Jamie, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Jamie Babcock: Yeah, thanks for having me. It’s a pleasure.