Doc Discussions with Dr. Jason Edwards
THIS is the podcast you have been looking for! "Doc Discussions" are just what the title says they are: physicians from a wide range of specialties, talking about relevant, up-to-date medical topics, not to mention tips on habits to help you live your best life. Your host, Jason Edwards, MD, is a board-certified radiation oncologist with a PhD in cellular and integrative physiology at St. Luke's Hospital in St. Louis, Missouri. Dr. Edwards explores not only diseases but also suggests techniques to optimize mental and physical health for a long and good life. Real people. Real advice. Real good. This is Doc Discussions, with Dr. Jason Edwards!
Doc Discussions with Dr. Jason Edwards
Primary Care Evolution: Technology, Teams, and Transforming Healthcare
Dr. Darren Haskell sits down with host Jason Edwards to share his unique perspective as both a practicing internist and Chief Medical Officer at St. Luke's Hospital. Their conversation cuts to the heart of healthcare's most pressing challenges while offering a glimpse into promising solutions on the horizon.
Dr. Haskell represents a vanishing breed of physicians who still follow their patients from the office to the hospital bedside. "It's just the way I was trained," he explains, noting how patients appreciate seeing a familiar face during vulnerable moments. This continuity of care, once standard practice, has largely disappeared as medicine has become more specialized and fragmented.
The demands on primary care physicians have reached staggering levels. One eye-opening study revealed that delivering guideline-directed preventive care would require 29 hours per day for a physician with a standard patient panel – an impossibility on our 24-hour planet. This reality has transformed primary care into "a team sport," requiring nurses, medical assistants, and advanced practice providers working in concert.
Technology offers both challenges and solutions. While electronic health records initially pulled physicians' attention away from patients, Dr. Haskell is now piloting AI-powered voice recognition software that transcribes patient conversations, allowing doctors to maintain eye contact instead of typing notes. "It gets that visit back to being much more what I remember from my training – that human-human connection," he shares.
The conversation takes a sobering turn when discussing physician shortages. The St. Louis region currently faces a deficit of 324 primary care physicians, projected to grow significantly as baby boomers require more complex care. Dr. Haskell predicts "market disruptors" will redefine how primary care is delivered, likely through team-based approaches and technology integration.
Despite these challenges, medicine remains profoundly rewarding. "There are very few professions where you get that feeling, that feedback from people that you've helped," Dr. Haskell reflects. For those considering medical careers, he advises understanding the commitment but emphasizes the incomparable satisfaction that comes from making a difference in patients' lives.
Ready to hear more insights from healthcare leaders? Subscribe to Doc Discussions for conversations that explore medicine's most pressing challenges and inspiring innovations.
Hello, this is Jason Edwards and this is Doc Discussions. I'm here with Darren Haskell. Darren, how are you doing today?
Speaker 2:Doing great. Jason, Thanks for having me on.
Speaker 1:Thank you for coming Now, Darren. You're a primary care provider, but you're also the chief medical officer of the hospital, Is that correct?
Speaker 2:Yes, it is. I still practice traditional internal medicine so I still go in route on my own patients at the hospital, try to make it to a few meetings, go over, see patients in the office and then I get roped into the admin work the second half of the day.
Speaker 1:You're the iron man. Most doctors who are primary care providers do not see their patients in the hospital, but I think that makes you unique. Why do you do that?
Speaker 2:It's just the way I was trained. It's how I started practicing. It was kind of the expectation when I was in training. That was just the way you did things and because I kept doing it for a longer and longer period of time, it kind of became a calling card. I have a lot of patients that see me right now that are still on my panel specifically because that's the kind of care experience they were looking for. And for some patients it still makes a big difference when they're sick and they're in the hospital. They really appreciate that familiar face coming through the door being able to help explain things to them.
Speaker 1:No doubt about it, no doubt. And there was a period of time where that was kind of the standard and maybe 15 years or so that fell out of place and a lot of patients have had problems with that. Now the hospitalists will take care of the patients most of the time. But I know from mutual patients, I know you know your patients very well and you have a fairly large patient population. How many people are you treating in general or roughly speaking?
Speaker 2:So before I started admin work, I had a panel of about 5,900 patients. Now it's just a little bit under 3,000. Yeah, so that's incredible.
Speaker 1:And so you obviously have to have some efficiency within your practice to be able to do that Well, and you were talking about the hospitals.
Speaker 2:I've been blessed. I'm very well tied in with our hospitals group. They've been very good to me. I'm the last person in my call group who still sees their own inpatients, so if I need to have a weekend off or something, dr Liu and his team have been very gracious that I can call them up and say hey guys, I'm going to be out of town, do you mind? And they're more than happy to help take care of those patients. It's the only thing that makes it a practical option for me still. So I've got to say that's been one of the things that's key to it. And then and I think this is going to be true for most people who practice primary care, whether or not they go to the hospital see their own patients Any more.
Speaker 2:Primary care is really a team sport and you have to get the infrastructure built around you, the team around you, to help you do what you need to do.
Speaker 2:There was a paper that was published about a year and a half almost two years ago now.
Speaker 2:It was from John Hopkins and the University of Chicago, and they showed that for a physician with a standard-sized patient panel which is about 2,000 patients in their model that they put together, it was estimated for that primary care provider to just deliver guideline directed care so just to do the things you're expected to do for your patients according to current health guidelines and that's before anybody gets sick, before they really have a problem or need you it would take 29 hours per day on average for them to do that.
Speaker 2:That doesn't really line up with the way our planet rotates. So you know, if you don't have the right team with you, it's an impossibility. They looked at the teams that they had deployed at those two institutions and those are, you know, world-class healthcare institutions and even with their systems that they have in place as far as NP support, nursing support, et cetera, they still were estimating it was taking 22 hours per day to take care of a standard-sized panel. That's incredible. So when you look at that, really with the demands that we place on our physicians and a lot of this came about in the era of the EHR and really data and metric-centric medicine, that's electronic health- records yeah electronic health records.
Speaker 2:We really are putting more and more demands on those frontline providers, and so we really need that team around them to help to get that done. It's no longer feasible for one doctor to handle every single aspect of that patient's care by themselves. You really do need a team.
Speaker 1:And so it makes me think of two things here, and you say that one is that St Luke's is it was regarded to the physicians is kind of a small family. We all know each other fairly well and so I think that helps with some of the handoffs is you can call somebody who's a friend or who you've eaten lunch with in the doctor's lounge and say, hey, can you help me here? And the other thing is what I've noticed with your practice is it seems like a lot of your patients you've know very well over the years, and so you don't have to dive as deep into the chart to kind of know what's going on with them, because you're familiar with their case.
Speaker 2:One of the unique things about our institution is the length of tenure that a lot of our staff have here. It's a very, very friendly place to practice. It's a very unique atmosphere. People tend to come out here, they start practicing here and they realize they don't want to practice anywhere else. So you'll find a lot of our physicians that have been in the same practice for 10, 15, 20. I've been in the same practice for 23 years. Dr Heichel's been in practice for 43 years in his location. So those are not uncommon stories around here and that does allow us to be very familiar with the patients. You mentioned how things are very collegial here. I think it's a very unique opportunity to tell us to interview candidates when they come in.
Speaker 2:If I need something done acutely for a patient, I'm calling a friend of mine. I can remember a case not too long ago where I sent you a message early in the morning. I had a patient who'd been admitted with what we thought initially was something totally different. When I saw him in the morning, we realized he had a patient who'd been admitted with what we thought initially was something totally different. When I saw him in the morning, we realized he had a spinal cord compression. It looked like it was going to be malignancy and within 15 minutes he'd been seen by radiation, oncology and neurosurgery and the oncologist was there about 30 minutes after that.
Speaker 2:So that's a very unique way to practice. These are all people I know personally, so I was able to just put out a blast message and say hey guys, here's a problem. It was a Friday, everybody wanted to get home and didn't want to get dragged into a complicated case. But these are people who know that around here we really put the patients first and quality of our care first, and they they rose to the occasion and it's because of that collegiality. You know it's different if you're a large and personal institution. You happen to get the fellow who's on call and they may or may not get around to it for a few hours and certainly the attending is not the one that's showing up in that room and seeing that patient. So I think it's one of the things that makes St Luke's a very unique place to practice.
Speaker 1:Yeah, I agree. I mean, if I get a call from somebody who I've never met before, I mean we all have. I think there's an institutional standard. And then I think, individually, we all have high standards, but it's just a little bit different if it's somebody I know and they're saying, jason, I need you to see this person. And sure you know, we have a relationship, we've got a reputation that we that's a two way street that we both want to uphold and a standard of care that you want to be known for. And I do think that makes a difference. I really do.
Speaker 1:So you're now the chief medical officer, you're a primary care provider for 20-some-odd years, and then you, I think two things. It's insane to go into administration. I mean, if you want somebody to complain to you all the time, go into administration. But I also think and I might answer your question for you but so I was thinking well, why would somebody want to go into this? But I think it's a role that you're, that you're that you've been very effective in, and is it, did you see? Like, hey, there's a need here and I think I can make a big difference and that's why I want to do it, because it's a challenge going into this role.
Speaker 2:It's a challenge and it's a different challenge. I'd been doing the same thing as a primary care physician. You know at that point that I first stepped into this role. I'd been doing that for about 24 years and this was presented to me it was early on in the COVID pandemic. At that point Bill Campbell was the head of our medical group and he was clearly, because of his role also as the head of our infectious disease department, very, very busy dealing with what needed to be handled with COVID.
Speaker 2:Our current CEO at that point asked me to start assuming some additional roles. And it's largely because I've always been very outspoken as an advocate, especially for our primary care physicians. I've volunteered on a lot of committees, spent a lot of time putting in my input, because I've always felt that as a physician, especially as we've gone through the transformation of our industry, moving into electronic records and some of those things If you aren't willing to speak up and have your voice heard, you're just going to get run over by the new system when it gets put in. Yeah, so I was approached to take on more and more of these roles.
Speaker 2:Eventually I was approached about taking this position and at that point, I was already doing a lot of the work. I went home to discuss it with my wife, and she said well, you're already doing 80% of it. They might as well give you the job description, and maybe they'll even pay you for doing some of it. So, at that point, the most difficult part of that transition, though, was downsizing my practice. Now, like you pointed out, you get to know your patients. That was a very, very difficult process to work through. I was very fortunate. I have some wonderful partners who are more than willing to take on quite a bit of that load, and then we also have a lot of other good primary care physicians in our system who were able to step up, and we made sure that everybody was linked up with somebody who could fulfill their needs.
Speaker 1:Yeah, you're right. I mean the patients are a part of our lives and you care about them and I think sometimes maybe the patients underestimate how important they are for us. You know they give meaning to our lives and it would be very hard to say like I can only see these patients and I can't, because you know you're going to disappoint people.
Speaker 2:You definitely disappoint people. But as doctors we're all kind of codependent with our patients.
Speaker 1:You definitely disappoint people, but as doctors we're all kind of codependent with our patients.
Speaker 2:Yeah, that's true. There's most of us who got into this at some point. There is that idea that I'm doing this because of the feeling it gives me. I realized early on I had initially thought I wanted to be a surgeon of some type and I did my first few rotations in medical school and that was fun. I enjoyed being in the OR and everything. But it was really when I hit my medicine. Rotation is at the VA hospital.
Speaker 2:I still remember the first patient I was on call overnight. It made me this old guy late at night. He was really sick and he starts telling me stories about being in the battle of the bulge and I was just blown away and I was like that is so cool and that was really. I decided that's what really excites me about medicine is getting to know these people and then having that long-term relationship. I have families right now where I'm taking care of three generations of a family and you know that kind of experience is very gratifying. As physicians we really thrive on getting that positive feedback from our patients. You know, when you've helped somebody they come back and see you and they tell you what it means to you. You take care of somebody. You know I'm going to go into your world in oncology. You get them through a malignancy and then you see them for a follow-up visit and they tell you about the new grandbaby they got to meet because they were able to make it through the acute phase of their illness.
Speaker 2:Those are the things that make you thrive.
Speaker 1:Yeah, yeah, it gives meaning to our lives, for sure, and it's the hug here and there, it's that kind of stuff and I often think, too a long, long time from now. It's hard to walk away from that and retire, and that's what you see. You see a lot of doctors who've been around here a long time and are still going strong and for whatever it's worth. There's pretty solid data on the longer you work, the longer you live, and so I'm a fan of that. I think that's a win-win all the way around.
Speaker 2:It is a win-win and I think for us I was pointing out how long-tenured some of our staff are I think it's a very valuable thing for us as an institution. It helps to perpetuate the culture of the institution. As I pointed out earlier, we're a unique place to practice and to work as a patient. It's a unique environment to come and get care and people who've been here for a long time have really, you know, they've soaked in that culture and they're the ones that can kind of pass that on to the younger generation when they come along.
Speaker 2:That's always one of our challenges now that I'm doing this administrative role. We like to try to find a practice and we like to try to slide a younger provider in someplace where there's a couple of people who are really seasoned and have been here and they've been part of the team for a while. It, you know, there's opportunities out there in community and one of we have a couple of places that we're looking at right now and the hard thing is it's like it's hard to put just young people out there by themselves who haven't been with somebody. That's part of that culture. So it's always a bit of a balancing act. But you know that's one of the great things about where we are at St Luke's is we really do have a unique culture and we've got a really good group of people who are very, very adamant about carrying that culture on, and I think it's one of the things that will help us be successful in the future.
Speaker 1:Yeah, I couldn't agree more. So three concepts I want to talk about that you've kind of touched on that I think would be useful for people who are maybe not in medicine. One is I think it's good for to have people that you work with of different ages. I think it's good for the older person. They can teach us like what TikTok or whatever is, and then the younger people can learn from the older people.
Speaker 1:Um, the second thing is you were saying that you were on uh boards and meetings. Uh, you know, before you took on this role and um, and you were, you were vocal Um. And one thing I think that's true, this is for young people is, um, when you're in a group of people at a meeting or something like that and you speak up, you there's a high probability that whatever you say will be kind of dumb, but you also have a good chance of bringing a new idea because you have a slightly different perspective. But in my mind I think most of the things that I've said you know, ultimately I'm like, ah, that wasn't the smartest thing in the world, but I still think it's good to have young people or younger people on committees and in meetings to give their opinion, even though you know most of their ideas won't be great.
Speaker 2:Well, they need to. We also and I think this is true in a lot of industries beyond just medicine. There's a very distinct generational divide in what people are looking for from work and what their expectations are as far as their work-life balance. That's something we hear from every young candidate that comes out and interviews with us now, yeah, and if, as you're entering the workforce, if you expect something different than what you see right now, you have to be willing to advocate for yourself. And if what you're bringing forth seems silly or odd to some people, there are other people in that room that it resonates with. Yeah, and so you know, we encourage all of our physicians when we bring them in. We really encourage people all across our clinical continuum to get involved in committees, be vocal advocates. Everybody should be an advocate for their patient, but you need to be an advocate for yourself and your colleagues as well. That's one of the other nice things about an institution this size.
Speaker 2:We're not a large impersonal bureaucracy. We're not spread large impersonal bureaucracy. We're not spread across multiple states. If we need something for our clinic, our practice, if we need something for our patients, we can get a hold of the decision makers very easily. We can get ourselves onto the committees that make these decisions, establish policies and do those things. Here we're always asking for volunteers, and so, for any of the physicians who happen to hear this, this is a call to get as involved as you can, because everybody has a slightly different approach to practice and what you may offer, what you may say, might not resonate with one provider, but there are other people that are going to say, yeah, I'd like to try that. Or, you know, that sounds like a problem I've run into, and so always feel free to speak up. Everybody should be willing to do that. You spend too many hours at work not to have your voice heard if it's affecting you through your workday.
Speaker 1:Yeah, I totally agree. You got one life to live and you know you, you, you know in a very professional way. It's it's good to hear everybody's perspective and and and that's how we learn and grow and evolve as an institution and that's how companies get better and are able to kind of change with the times. Don't want to change too much with the times, but you have to have some change.
Speaker 2:You have to be responsive.
Speaker 2:I mean you and I have both been doing this long enough. We've seen a lot of changes from when we first came out of training. Medicine's a much different field than it was, and it will continue to change, I think, when some of the things that we're really going to see starting to impact us over the next few years. We're already starting to toy around with it right now, but how AI is going to impact the work that we do it's going to vary from field to field, but there's going to be some pretty dramatic changes in our workflows and what our day looks like.
Speaker 1:Yeah. So that kind of leads me to my next question how are we going to leverage technology to help us give more efficient care and better care in the future? Are there some specific things we have on the horizon?
Speaker 2:Well, there's even some very simple old-school technologies that we've been working on deploying. We've been going through a process here at St Luke's we had, as our medical group evolved, it had really been just kind of an agglomeration that had occurred over time. Individual practices had been added on. We never really sought to, you know, be uniform in our approach to how a patient interacted with us, what the experience looked like. We've even just something as simple as putting in a unified phone system across all of our practices and getting very set routines as far as how phones are answered, how messages are conveyed to providers, those types of things. We're working through that process right now. No one had taken that challenge on. It's just been over the last year and a half that we've really started to tackle some of that part of things. So old school technologies can still be better deployed. But then we are looking at how we deploy very new technologies.
Speaker 2:We're working right now through a pilot project with Nuance. Those are the people who do Dragon voice recognition software. They have a product called DAX and they have a newer one that's actually going to be coming out very shortly, called DAX CoPilot, which allows the physicians, as we're in an encounter with a patient. It's an AI-empowered voice recognition software. I'm piloting I'm one of the 13 physicians we have in the pilot right now and I can sit down in my office with my patient, take my phone out it acts as a microphone sit it on the table, we get their permission, of course, and then the two of us can just talk. I'm no longer typing on the keyboard while I'm in the room with the patient. That's so nice. And at the end I step out and there's a little lag time right now because they do have a human who goes over and just make sure there's no major errors from the computer, but about an hour, hour and a half later sure, there's no major errors from the computer, but about an hour, hour and a half later the text of that encounter comes into my inbox. I get a chance to look at it, go through it, you can edit it if you need to, and then my note's done.
Speaker 2:So it simplifies the process, gets us back to having a conversation in the room with the patient rather than worrying about how many clicks we're hitting as we're having that encounter. So it's a more organic experience, more organic experience, and I think this is one of those things when we look at physician burnout and dissatisfaction. One of the things that's been an issue ever since the Affordable Care Act came out and we really were all pushed into electronic records was physicians are very tired of spending more time looking at the screen than they are looking at their patients. Yeah, and it gets that visit back to being a much more what I remember when I was in my training that human connection, that sitting in a room having a face-to-face conversation with a patient rather than looking primarily at your computer screen. So I think there's some very promising things with what technology can bring to us.
Speaker 2:We're very fortunate the electronic record that we use, cerner. Cerner was recently purchased by Oracle, which is one of the largest technology companies in the country, and they're really bringing a lot of their tools into this. Oracle is one of the most advanced AI platforms available in the country right now. They're a world leader as far as their technology for those types of products, as well as their security products, et cetera. So we should have a much more secure which is very important in this day and age when we hear about all these other healthcare organizations that get hacked but also a very technology forward, very user-friendly experience. So there's a lot that we stand to benefit from in the near future with that relationship.
Speaker 1:That's exciting. That's exciting, darren. I've always looked up to you as a physician and as a father, and so I want to ask you one last question. To young people who are in, maybe, high school or college, who are looking at going into medicine, what advice would you give them? I know I'm putting you on the spot here, but what advice?
Speaker 2:would you give them? It's pertinent. I have a son who started college last year and he says he wants to do medicine. So we've had a few of these discussions.
Speaker 2:I think that it is a long road still to get through medical school, through residency, fellowship, and then get into practice and establish yourself. You really have to have the mindset that can put up with that kind of delayed gratification. If you do, the payoffs are enormous. We were talking a moment ago about the rewards we get from our professional lives professional lives. There are very few professions where you get that feeling, that feedback from people that you've helped, that you've saved their lives, you allowed them to live long enough to see their grandkid born, I mean. Those kinds of things I don't think you can even put a dollar value on.
Speaker 2:And so those are still the things that if that's the experience that you want and if you're really driven to do something that puts you in a role to really help people, then it's something you should certainly consider. But you also have to go into it realizing you're going to give up a lot of weekends, you're going to give a lot of long nights of work and stuff. It is a difficult process to get there. If you can do that, it's well worth it. It's kind of like running a marathon. You have to have that mindset that this is not a sprint. I'm really committed for the long haul here.
Speaker 1:Yeah, yeah. It's kind of like a growth stock where there's all this work that goes into it. There's no payout for years and years and years, but typically it's like a company that nobody's heard of for 10 years and they've been working like dogs, and then all it's. It's like a company that that nobody's heard of. For 10 years they've been working like dogs and then all of a sudden they have an initial public offering and then all you know they say, oh my gosh, these guys are millionaires overnight. Well, they worked 10 years to get there chat, gpt chat gpt, st louis's own, yes, um, altman, uh, sam, altman, um.
Speaker 1:So, looking into the future, we have um a couple things happening, I I think, but tell me if I'm wrong. One is I think patients are becoming more and more sicker, or at least their medical situation is more complex, and that has, I think, kind of become more complex over time, and then also for various reasons, we have less primary care doctors, and can you kind of touch on those things?
Speaker 2:Oh two, you know unique but also conjoined issues. So, yeah, patients that we see are getting sicker. We're going through a demographic change in this country. You know, the largest generation of baby boomers have all just kind of aged into the retirement age range now and, as we know, especially for most of the medically complex chronic conditions, these things accumulate over the lifespan. So as people age they get more and more of these problems. We recently had a consulting firm that we looked at to do our physician needs analysis, help us with our recruiting plan and those types of things, and what we really, what they forecast and this is based upon national data is the patients that we see, the ones that get admitted to the hospital, the ones even that come into our clinics. We can expect more and more complex patients. So that's just a trend of our aging population. In addition to that, the care that we deliver is becoming increasingly technically complex. Just because we're getting better at this. We don't have patients who succumb early in life to simple things that we now can treat and prevent. They live longer and then we're going to care for them through that rest of that time span.
Speaker 2:You were talking about the shorter primary care physicians. I'm going to refer back to that physician needs analysis we looked at. Currently in the St Louis region we're 324 primary care physicians short. In two more years it's going to be over 529 primary care physicians short Some of the items that we discussed earlier.
Speaker 2:The workload for primary care has become astronomical. There's been an increasing tendency across a lot of the industry to push non-physician tasks to the physician the workload as far as insurance forms and calls and prior authorizations and those types of things and those are also big job dissatisfiers. We were talking earlier about what really rewards physicians. We like to be in an exam room with our patient. We like to have that human-human connection. The more time we spend clicking on administrative tasks, the less satisfied we are as we go through our day and through our work. So it's a challenge.
Speaker 2:I think we're going to see market disruptors that are going to redefine how primary care gets delivered. We are already seeing a tendency towards that, as we're seeing the rise of certain different types of health plans Medicare Advantage plans and those types of things. We're seeing changes in how physicians are compensated and rewarded. We're seeing evolutions as far as team building. We alluded to that earlier. I really do think we're going to get to a point where most primary care physicians have one or two nurse practitioners that work directly with them or physician assistants, and they're going to be much more a team delivering care rather than an individual provider.
Speaker 2:So right now, when we look at the people graduating and coming out of medical school and out of their residencies, we're just not seeing enough people to fill vacancies in primary care just not seeing enough people to fill vacancies in primary care. You know it'll be interesting to see how much of an imperative is placed on that by larger powers than us. You know we did see some recent changes in the CMS codes as far as those get updated every year, and there are some very unique things in this year's plan that helped reward primary care physicians a little bit more. It's a drop in the bucket, but all those types of things do help. So market forces may help, but I think we're going to see changes in workflows and work patterns. The model of primary care is going to change because no one has yet figured out the secret sauce. For how do you get enough primary care physicians? Everybody's looking for them. There just aren't enough of them coming out every year.
Speaker 1:Physicians- Everybody's looking for them. They're just not enough of them coming out every year. Yeah, I, I, from somebody who's not a primary care physician I think, um, I think it's a grind. You know, to me it seems like a grind. It's just seeing a lot of patients every day. It's a, it's a lot Um, it, um. People are attracted to specialize, to different specialties, and so they don't stay in the primary care. At the end of their training they go into a specialty. But and then you know, the baby boomers are a large generation. Gen X is a smaller generation. The millennials are children of the baby boomers. And so did I get that? Yeah, and so, and so that's going to be a larger generation. But the problem with that is they are more concerned about work-life balance.
Speaker 2:Well, it's going to be a larger generation than Gen X, but it's not as large as the baby boomers, and so we still are going to be facing a demographic shortage, and so we're still going to be challenged. And that's not just for physicians, but when we look at nursing staff, when we look at.
Speaker 1:MAs, when we look at everybody, auto mechanics, you know yeah, there's a reason why there's so many Help London signs out, it's going to create so much pressure that there will be an incentive, like you said, for a market disruptor, whether it's technology. But we have to leverage something. The one thing we do have is, you know, the United States is a very attractive place for foreign medical grads and that's good for the United States. It's bad, it's a brain drain on these other countries that are less sophisticated. But I have to imagine that we increase the amount of foreign medical grads that come over as primary care providers. That's kind of an easier thing to do. I think you would think it would be, but we still, even with people who want to do primary care providers, that's kind of an easier thing to do.
Speaker 2:I think you would think it would be, but we still.
Speaker 2:Even with people who want to do primary care, it always confounds me we still have issues getting visas and things like that for them, and so there's larger political forces that are going to determine how successful that is.
Speaker 2:This is where I think, like I said, I think we're going to see changes in the model of how primary care is delivered, but I also think this is where there's tremendous opportunity to leverage technology. We have to keep the physicians working as physicians and helping them to really operate at the top of their license. We need to take some of that load off of them. As far as preparing prior auths and things like that, and that is the type of thing that if you give a computer the data to churn through which, now that we've been in electronic records for long enough, the database is there you should be able to train a machine to do some of that work. And if we can offload some of that and get people back to doing what they got into medicine to do, I think then you've improved. Physician satisfaction makes it a more appealing position for someone to fill, and it will take time. This is a project over years, but I do think there's promise for this to change what medicine looks like.
Speaker 1:Yeah, and that could be a true win-win for the patient and the physician. Yeah for sure. Yeah, well, darren, thanks so much for joining us. This has been a real pleasure and I hope you come back sometime.
Speaker 2:Very good. Well, I had a great time, Jason.