Episode 84

How to Solve the Clinician Shortage

with Nick Turkal, M.D.

November 3, 2022

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Nick Turkal, M.D.
CEO, The Center for Health Education and Access

Nick Turkal, M.D. is CEO of the Center for Health Education and Access. He is also a practicing palliative care physician. Dr. Turkal serves on several Boards of Directors including the Burrell College of Osteopathic Medicine, the Idaho College of Osteopathic Medicine, and the Crisis Prevention Institute. Previously, he was President and Chief Executive Officer of Aurora Health Care. Dr. Turkal received a bachelor’s in Biology and an M.D. from Creighton University.


It is the beginning of a national model to create a pipeline of healthcare providers for urban and rural, underserved communities.



[00:00:00] Gary Bisbee, Ph.D.: Good morning, Nick, and welcome.

[00:00:02] Nick Turkal, M.D.: Good morning, Gary. Great to see you.

[00:00:04] Gary Bisbee, Ph.D.: We’re pleased to have you at this microphone for sure. Nick, congratulations on creating the Center for Health Education and Access. Can you share with us for those who may not be familiar, a little bit more information about the center?

[00:00:20] Nick Turkal, M.D.: Sure. This is a new venture that started earlier in 2022. And it is the beginning of a national model to create a pipeline of healthcare providers for urban and rural underserved communities. We’re starting with two osteopathic medical schools. One in New Mexico, one in Idaho, and plan to build from there. But one of the things that I think is important is the concept of a national model. We have problems with pipeline for healthcare providers virtually everywhere. So we’d like to use a medical school platform to navigate into a better way to supply communities with clinicians that they need in the.

[00:01:06] Gary Bisbee, Ph.D.: So how’s the center being funded?

[00:01:10] Nick Turkal, M.D.: We have two funding sources, two partners that own the two medical schools that, that I mentioned. That would be the Rice University Endowment Fund. Which invests in various things around the country. And TPG TPGs Rise Fund, which is their social impact investing fund is two great partners. Educational background, investment and healthcare background coming together to say, We have a problem nationally, we think we can solve it better together. So they funded the Center for Health Education and. As a means of helping to grow the schools and then look at other potential areas of healthcare for investment.

[00:01:52] Gary Bisbee, Ph.D.: So Nick, is there an emphasis here on primary care in terms of the stool?

[00:01:57] Nick Turkal, M.D.: There is and I might talk a little bit about osteopathic schools. There, there are probably people in the country that don’t understand the difference between osteopathic and alopathic education. And as of. There’s actually very little difference if you roll back 20 years. Osteopathic education focused heavily on manipulation and techniques of laying the hands on and helping people feel better that way. That’s still a part of osteopathic education, but every other aspect looks exactly like an allopathic school. And over time, the residency match, graduate medical education match has now combined for osteopathic and allopathic physicians, so there’s virtually no discernible difference in the way people are educat. But there are a couple of important differences. Osteopathic physicians are much more likely to go into primary care specialties, and from our two schools at this point, over 60% of the students enter primary care residency programs after graduation. So that is definitely an emphasis. The other thing that’s important to know is osteopathic. Physicians now account for 25% of the graduates nationally every year. So if you look at combined US, MD, and do graduates, 25% are osteopathic. So very large growth in the last 10 to 15 years of osteopathic education and really helps to create a pipeline for other communities that need primary. The problem and the whole purpose of the center is to link the areas in need with the right students so that it’s a much more intentional approach to saying, If you have an interest in rural medicine, then let’s make sure. Part of your training is rural based medicine, so you really know what you’re getting into, what it feels like to be a doctor in a rural c.

[00:04:13] Gary Bisbee, Ph.D.: So Nick, you mentioned 60% of the DO grads go into primary care. Is that because people interested in primary care tend to select the DO programs or is that because. Of their curriculum and the programs.

[00:04:27] Nick Turkal, M.D.: It’s a bit of a, this’ll be a bit of a complicated answer because I think it’s one of those multifactoral things. Historically, osteopaths tend to go into primary care. Much more than MD physicians, so there’s a historical basis. So some of the students that are attracted to osteopathic schools are more likely to choose primary care because they know that history. Sometimes it’s a family legacy issue. Sometimes it is what’s in your community that you’re exposed to. But yeah, there’s a bias of students who have more of an interest in primary care. Second aspect would be how we interview students and we. Selectively look for people who have a higher interest in primary care, understanding that many people in the end will choose a specialty. We don’t wanna be exclusively primary care, but that is part of our focus. Then the third part, and maybe one of the differences in the education. Of MDs and osteopaths. Osteopathic physicians have a long tradition of training in smaller and rural communities, so there’s more exposure to primary care than there may be at a traditional academic medical center. So all those things together mean much more likely to have primary care focus for the students that, that we train and we really, we try to foster.

[00:05:54] Gary Bisbee, Ph.D.: Yep. Back to the center for a moment. So how do you think about the growth strategy of the center, Nick?

[00:06:01] Nick Turkal, M.D.: So there are so here has been my belief and Gary, you’ve known me for a long time, and my belief is if you have a quality product and you’re doing something that betters what we’re doing in healthcare in general, then you ought to find a way to grow it. So we have a couple of. Strategies that are particularly important for the center? First and foremost, what I spend a lot of my time on right now is partnerships with major health systems. If you look at the training of medical students, they do very well if they’re trained in a large integrated delivery system. Often stay there for residency and then practice in those communities. So creating a pipeline, Is one way we do that. The more partners we have in major health systems, the more we can expand our class size at each school. The other strategy. Number two would be additional locations. So the Burrell College, Osteopathic Medicine in Las Cruces, New Mexico. That’s the major campus. We’re starting an additional location in Florida, in Melbourne, which is a relatively underserved area for physicians right now, and especially for training. So we’re going to have in partnership with Florida. A hundred students per year located in Florida, we’ll recruit them from Florida, send them back to Florida for their clinical experience and ultimately see that they’ll practice there. So that would be strategy too. Third strategy is that I’m very interested in expanding what we do at the. Beyond the two medical schools. So we’re actively looking right now at other potential partners or investments across the country in health science, universities and other areas of healthcare. Cuz I talked to my colleagues in healthcare across the country. We know there’s a clearer crisis in nursing right now, but there are many other aspects. Of healthcare and health sciences that we need to beef up and create more of. So this model that we’re using for the two schools, we’re going to expand into other areas like nursing PA programs, nurse practitioner, physical therapy, occupational therapy, to begin to have a very robust pipeline. Again, for rural and urban underserved communities. And Gary, one other thing I should mention when I talk about the center, because this is part of what we are committed to the US healthcare system and medical schools in general have not done a great job at recruitment of underrepresented minorities. And then returning some individuals to the communities they came from. That sort of pipeline is what we’re working on. And if you look at our school in New Mexico, we have between 25 and 30% of the class every year as underrepresented minorities. One could argue that’s still not enough, but it is one of the best statistics in the country. So as we look for partners we are looking for. Partner health systems that wanna create this pipeline from their community to return back to the community.

[00:09:25] Gary Bisbee, Ph.D.: Yep. This is all good, Nick. Very exciting stuff and not at all surprising that you’re leading the charge here. Do you expect to invest in. Other medical schools. I know you said invest in certain health sciences programs, but how about other medical schools? Will you be investing there?

[00:09:45] Nick Turkal, M.D.: Yes. I think there. Definitely an interest in investment in other medical schools. One of the interesting things, Gary, I should probably talk about is this whole issue of how you create or fund medical schools. And because these are these two schools Idaho College of Osteopathic Medicine and Burrell College, they’re both investor owned. People sometimes don’t understand why that happens or what’s good about that. A little bit about that. To answer your question in both Idaho and New Mexico where there are, there’s a painful lack of physicians in rural communities. Both of these schools were started as public private partnerships. One with New Mexico State, the other, with Idaho State with the idea that there simply was not enough public. To create a medical school, but they’ve got a need for physicians. So we would be very interested in investing in other schools as well, or helping people create schools where there is just a desperate need for physicians and folks have to be a, a bit patient because once you start this pipeline, it’s a number of years till you get the product. But we’re looking for partnership that are in it for the long.

[00:11:00] Gary Bisbee, Ph.D.: In your point, both those schools are associated with or connected to a university, and I think accreditation basically comes through the university. So this is a well founded and has a lot of standards connected to it,

[00:11:15] Nick Turkal, M.D.: We have there are a number of ways that we’re accredited. One is through Coca, which is the accrediting agency for osteopathic schools.

[00:11:24] Gary Bisbee, Ph.D.: but,

[00:11:25] Nick Turkal, M.D.: both are accredited that way. And then we’re doing some partnership programs in health science with the two state universities that I mentioned under their accreditation umbrella. And I, you know, I think that’s, I important to know, to think about partnerships for the future. We don’t have to go it alone. There are many ways to create health professions and the more we partner effectively, the more people we’re going.

[00:11:50] Gary Bisbee, Ph.D.: . This is all good. As I mentioned, Nick, and we’d love to have you back periodically to give us an update on the center and how things are proceeding. Certainly much needed. Turning to you for a moment. You’re right, we’ve known each other for a long time. What all are you doing? Are you still practicing a bit in addition to the center?

[00:12:09] Nick Turkal, M.D.: Sure. So I’m one of those folks that failed retirement miserably . It’s about three years since I left Advocate aur. And I find myself now working full-time again, which is good. I’m able to choose things that have a purpose that are important to me. So I’m on a couple of boards. I’m on the board of Creighton University, which was my alma mater. I’ve helped them with their medical school strategy, and in fact, we created a second medical school in Phoenix with Creighton that just opened this year. So it’s, it you’ll see the pattern here. Pipeline and, you know, how do we make healthcare better? So I’m, I’ve been on the Creighton board for some time and enjoy that very much. Keeps me connected with higher educat. I’m also on the board of cpi, Crisis Prevention Institute, which is a national company located in Milwaukee, Wisconsin. This company does deescalation training primarily for nurses, behavioral health workers and teachers, the uptick in workplace violence. Particularly in healthcare is just in incredibly frightening. So training people, whether it’s nurses or someone in loss prevention on how to deescalate a difficult situation is far preferable to some of the other outcomes that we’re seeing. So that’s the second board I. I’m I’m a advisor to a couple of companies that are in the tech world. Loman Technologies. We’re creating a home monitoring cardiac device to help prevent atrial fibrillation, congestive heart failure, so pushing care into the home. You’ll see I’m a little I’ve got my fingers in a number of things, but the fourth and very important thing I’m doing, I did return to the bed. And I’m practicing palliative care physician at an inpatient hospice. This was my area of focus in teaching when I was a University of Wisconsin faculty. Something I’ve been passionate about and clearly if we’re gonna solve the problems in healthcare, we have to address end of life care. And ju just an aside on that, Gary advice for any healthcare leaders that, that. One of the things I believe I could have or should have done differently is sabbatical. During the time I was CEO at Aurora, I think, you know, five, six years into that period of time, it would’ve been great as a someone with a clinical background to go and spend three months or six months doing frontline clinical care under. What it’s like for frontline providers. I always did a bit of practice as ceo, but it was a very small percent. So I’m working on a paper now that focuses on the idea of ceo sabbaticals.

[00:15:07] Gary Bisbee, Ph.D.: So during your time in large health systems, you were chief medical officer, chief operating Officer, then ceo. Of a couple of health systems for a long time. But looking back on it, other than the idea of the sabbatical for the ceo, what learnings did you take away from being in large health systems for that length of time in various different positions in the health system,

[00:15:34] Nick Turkal, M.D.: That that list could be long, but let me, Yeah. Hit a couple of things that I think were particularly important. Whatever your position is in a healthcare care system, building the right team around you is absolutely critical. And I would say that for many of us in healthcare systems, that team building may happen a little more slowly than it ought to because today we have to be very adaptable in healthcare. So I think for any healthcare leader building the. Team around them is incredibly important and lesson number two is everything you do ought to have a purpose. You know, so why? Why are you there? Why are you driven to be a healthcare leader? Is it around better access for patients, better quality of care, integration of care? You know, I think everybody needs their personal purpose and they need to then apply that to their possess. . And then I would the final thing is I always tried to select people for my team that were very much committed to the organization and its purpose first, rather than their professional their professional advancement. And I do think that makes a differe.

[00:16:54] Gary Bisbee, Ph.D.: So Nick, thinking about the pandemic and the effects of Covid on hospitals, Caregivers how have physicians managed through this process? We certainly have heard a lot of stories about stress, PTSD, and so on. What’s your view of how physicians have worked through the the situation?

[00:17:16] Nick Turkal, M.D.: I think it’s been quite variable depending on specialty and experience, but every physician that I know that was actively involved in the care of a lot of patients with c. Has expressed how much they’ve had fatigue, how much burnout, how much disappointment that we were not able to get our hands around this pandemic a little more quickly. And sadly, in a number of cases, it’s led to people saying, I, you know, I can’t be an intensivist anymore. I have to do something else. I have to retire, I have to shift career goals. , That would’ve been the end of my response six months ago, I would say. Now, as I talk to people and we’re getting a little farther away, hopefully for a while from the big surges you see the resilience coming out and people leaning back in and feeling better about what they’re doing. So I’m overall encouraged with physicians. I’m much less encouraged. When I talk with nurses and look at the data on nurses across the country we really have a crisis. And just as an aside, Gary, I’ll tell you my daughter is a nursing manager for a large health system and it. It’s incredibly important to listen to her, what it’s like on the front line, to be unable to fill positions, to have to close beds because you don’t have enough nurses, and to worry about how you’re going to stretch that workforce far enough and still provide quality care. So I think where we’re seeing a crisis is really in the nursing area. And that is twofold. One on the one hand for nurses who are towards retirement age, there’s, there are just a flood of people retiring or going into non-clinical roles. I don’t think that we can necessarily change that on the early side. Nurses who are entering the workforce or have been in the workforce for 10. Are much more likely to say. What I’ve learned in this pandemic is I want flexibility and I want flexibility in my hours and how I work. I’m tired, you know, I could work really hard for a while, but I can’t do that. I can’t do extra shifts for another two or three years. So we see people going to staffing agencies because they. Work intensely during the year and have part of the summer off when their kids are out of school or they can travel if they want and have flexibility. I think the challenge for health systems now is to say, how do you capture the hearts and minds of nurses and want them to stay with the system around your purpose, around your mission, and how do you create the flexibility? To make sure that they are getting what they need from their career. So some of this is a, you know, millennial or Gen Z issue that we’re not, we haven’t been adaptable enough as health systems. And I think one of the re one of the results of the pandemic is we blame all the nursing stuff on the pandemic. I actually think it’s much more generational. and it’s an opportunity for health systems to say we have to look at employment in a different way.

[00:20:49] Gary Bisbee, Ph.D.: Nick, this has been a terrific interview as expected. Thank you very much. Two questions if I could. What advice do you give for young people who are interested in medicine or perhaps interested in nursing?

[00:21:02] Nick Turkal, M.D.: That is an easy one. I really consistently tell people to go for it. One thing that I know for sure is that people in this country and around the world are gonna need healthcare and they’re gonna need good providers who are committed to it for the right reasons. So I’m very high on encouragement of getting people into health professions, and thankfully there is a lot of.

[00:21:30] Gary Bisbee, Ph.D.: Second question would be for up and coming healthcare leaders in a health system or perhaps another health type organization, what advice do you have for these early stage leaders?

[00:21:43] Nick Turkal, M.D.: Yeah, I’ve, I coach or counsel a lot of early stage leaders. One of the things I recommend to them is patients. Difficult to be patient as you’re working into leadership positions, but I encourage them to be patient with themselves to understand that they’re making a difference at what level, whatever level of the organization they are. They are making a difference in some way for the patients that are being taken care of, and they have to keep that in mind. Keep the purpose in mind, and finally use whatever position you have to learn how to. Really great teams really quickly cuz the pace of healthcare is going to continue to accelerate and we’ve gotta get innovative people thinking of different ways to deliver care.

[00:22:31] Gary Bisbee, Ph.D.: Yep. Said Nick. Thank you very much and we look forward to seeing progress out of the center. Great idea.

[00:22:38] Nick Turkal, M.D.: Thank you. I’ll be back with you. Take care.

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