Latest / Here to Serve - A United Regional Podcast / Charity Gilmore, Director of Primary Care Services for URPG
Transcript
- United Regional: Welcome to Here to Serve, a UNITA Regional podcast. I'm your host, Ryan Graves. My favorite part of being the director of patient experience at UNITA Regional is the incredible people that I meet and work with on a daily basis. And I want you to meet them too. Join us to meet the people behind the badge and to highlight those who are here to serve. Well, good morning, Charity, and welcome to the Here to Serve podcast. It's an honor to have you today. Yes, thank you for having me. So let's just at the beginning just find out who you are and what your role is at United Regional. Hi, yeah. So I am our director for primary care services at United Regional Physician Group. so I have family medicine, internal medicine, and the Care Plus Clinic. Okay, family medicine, internal medicine, and care plus. Yeah. Okay. I know you guys have had some restructure and things lately, so I'm always trying to keep it straight of who's who's got what now. So that's good. how long have you been at Unina Regional? I just celebrated fifteen years. Fifteen years. Yeah. and you started at the bedside as a nurse, I believe. Is that right? P was it PCU? Yep. Eight Center. Eight Center, okay. Brand new nurse. What did you did you do anything before that for a career before you came to the United Region? I did. I was a pharmacy tech for about eight years. And then I was kind of an office manager for a local construction company until I decided to go to school. What like gave you the push into to nursing? gosh. Probably so my son, my middle son Mason, kinda got us thrown into the healthcare world when we didn't really necessarily want to be there. We found out right before he was born that he only had one kidney. jeez. And thought he was going to be in renal failure. gosh. So I had to have him in Fort Worth and luckily everything was great. He was the biggest baby in the NICU. Uhhuh. But the next six years of his life was in and out of doctors' offices, procedures, medicine specialist. We found out real quick Mason wasn't real important to the kidney doctor because he wasn't in renal failure. but as a mom I didn't want him to get to that point. That was kind of what we'd been told our job was was do the labs, keep him healthy. When he was three, he started having kidney stones. And and so I was constantly researching how to keep him healthy, how to avoid kidney stones. We would get our labs done here at we had a local pediatrician that was great. But working with a specialist down in Fort Worth, I was always a nurse practitioner that we would talk to and very difficult to get a hold of. And over a couple of years he was kinda getting worse and worse and we were getting more worried. And so one day I called the office and and kinda long story short, this nurse practitioner told me if I lived in Fort Worth and got my labs done there, he might be healthier and they would could take more care of him. Yeah. And hung up on me. my gosh. And I remember sitting there like Because I live in Wichita Falls, I can't get the care of my son needs. Like that doesn't make sense. his nurse at that time, she had overheard the conversation. She called me right back and she said, I am so sorry. Yeah. I'm sending you your medical records. Go get a second opinion. Okay. Wow. And and so we did, but in that in that moment I'm like, I need to know more. I'm gonna have to advocate for my kid. I need to know more. I don't wanna be this dumb, ignorant parent. And I'd already kind of been thinking about doing something different. Okay and I just remember in that moment that kind of sealed it for me. I wanted to be able to advocate for my family and know more and I signed up for nursing school I think a week later. Vernon. Okay. Awesome. Well that's a I mean, what a great reason. Yeah. Yeah. And well, this will didn't plan on going here yet, but this is gonna tie in big time to I know some of what we're talk about today is I mean to be told, Well, if you lived in Fort Worth or Dallas, then you could you know, you you probably son probably be healthier like, Man, that is just Yeah. So upsetting, travesty. And one of the things that drives us is going, our patients should be able to get the care they need here. and it's and you've lived it, so I know that's gotta drive you, you've lived multiple times I think, throughout your life of having to go back and forth for care. Yeah. And so you've got a personal tie in to go we want our people to be able to stay here. Yeah, we want to be and we can. We have everything we need here. I mean obviously some of the pediatric stuffs you might have to go out of town for. Yeah. but that's all it all it's cracked up to be. You know, we have great services and resources here. How's your son now? he is twenty three, healthy. We got that second opinion. He never had another kidney stone. We just needed someone to listen to us. Yeah. he's great, big, healthy. I love it. Great guy. Yeah. And you went to nursing school and so now you you had no you you knew the system moving forward too that helps. I did. I knew what to advocate for, knew what to ask for. Yeah. and knew how to teach other people how to ask questions and not be afraid to speak up and ask your doctor or the nurses for the help that you need. Well, and it worked out perfect too. Worked out well for me because you were a PCU nurse. how many years did you do that? Almost three. Three years. and I was over the patient advocacy department at the time and we needed we needed another person. So you came and worked in the patient advocacy office after that. And it was great 'cause you had that internal drive of advocating for your son and then for others. And so how many how many years did you spend in that office? Do you remember three. Almost three. Okay. and then if I recall from there you went out to URP G but what I don't remember which position you took at URP. I was the practice manager for Care Plus. Okay, Care Plus practice manager. and I'm still you know, I'm still not over that. I'm still better about I knew that was gonna come up. Yeah, I'm still better about Johnny and Michael and Maria stealing one of our advocates away. I I totally kidding on that all in good fun and we were we were happy to see you get to grow, of course. and and then from there, Care Plus tell me about that role. What did that look like? How long were you there? so Care Plus, when I first started in Care Plus we were five days a week and I think the first thing Johnny said was, Charity, go get it seven days a week. We need offer more access. And so we got that done pretty quick and then we only had two providers. We quickly grew to I think four or five. a couple of years down the line I shifted over and took on family med and internal med and then kinda just grew that for a little bit and then COVID hit and of course all the things we did at URP G for primary care through that. And then I guess I've been in the director role for almost three years now. So you've been director for almost three years. I am a three year person. I didn't notice that. Yeah. Huh. I'm like, what's next? Let's play. well, you can't leave. first of all. but yeah, it's interesting the care plus going from five to seven days, you know. That was one of those things that was huge for our community. And I when I say for our community, I also mean just for my family. Yeah. Because I mean we use care plus like crazy, right? Why my family uses Care Plus so much it's and I've Johnny and I talked about this when we was on here, but I think Care Plus and now Ortho Express. Yeah. Are some of the most consumer centric things that we have because it's like you can get quick, easy access most of the time same day, you know. and for sure if it's e visit, like within minutes, you know, you've got a visit. I can do drive-through testing. it's such a blessing for my family. we use it like crazy. and so to go from having that five days a week, 'cause it may to seven I can tell you with having three kids, they never get sick. At a convenient time, Monday through Friday. You know, it's always six fifty five, Saturday night. That's exactly right. It's gonna be like it's weird time. That's like if you you got your you you know, maybe a a pediatrician on call who can only do so much and you got the emergency department, right? And that's your choice. man, the having the care plus was a total game changer for us. And so and going from five to seven days a week and expanding those hours and it's just incredible. So yeah, okay. So now director, you guys an in a a very similar route of Johnny says, Hey, we're five days a week, I'm gonna get you seven days a week. you had another similar experience, I believe, with access at at primary care, right? So talk to me about I don't know, was it a year maybe when when Corey got here, that's the time of the time frame in my mind. So we're looking at just about a year, maybe a year and a half. How far out if I'm a new patient, And I moved to the community, or maybe I'm I I'm at a different facility and I say, I want a doctor at URPG, I wanna establish primary care. How long would it take me from making that first phone call to getting in to see that doctor at that time? If you had called in March of last year at URPG for family med or you would have been told there was no internal med access. For family med you would have been told eighteen months. Eighteen months. Eighteen months for a new patient appointment. Wow. Mm-hmm. So imagine moving to I mean And I think this is what happened to Corey. Right? Our CEO moved to the community and goes hand in established for the doctor. Or like, hey, we'll get you into I see you next year. I hope that for the next eighteen months your health is okay because we'll see you in 18 months. and it's not because we don't want to see you, it's not because we don't care about you. We literally did not. We were completely full at capacity to be able to do that. And so I don't know if people realize just how big of a problem that is. Let's talk about what to enunciate why that's such a problem. Let's talk about why is primary care so important. Like if I go, why because we're you know, as an advocate office, how many times a patient calls and I go, Hey, who's your primary doctor? And they go, I don't have one. And I go, first thing we gotta do is get you a primary doctor. Let's talk about why. Why why is that such a big deal? Your primary care is kind of the hub of your health care. They're gonna be the hub of the will of everything. a lot of things like if you need a referral to a specialist, most times your insurance requires PCP referral. even a healthy person n needs that primary care just to have an established relationship, check in once or twice a year, you know, doing your your labs to make sure everything looks okay. just because when or if a catastrophe happens, you're gonna need that PCP to to direct where you need to go and get into the doors that you're gonna need to get through. No, you're you're exactly right. And and the preventative things too, right? I think that's one of the huge things in healthcare that we try to push is if we don't want to be sick care, right? We want to be healthcare. Exactly. Your PCP, the emergency department is sick care. Care plus is sick care, right? You're something's wrong with you and you're coming in. With primary care, you don't have to have anything wrong with you. it is establishing a relationship. And then they're gonna say, hey, here's the things we need do proactively to keep you healthy, make sure you stay healthy. And not only, you know, I ca I love Dr. I I'm with Dr. Russell, but one of his things is not just keep you healthy, but how do you thri like how do we get you thriving? Like how do we make you better than you are and and you feeling your best, right? Proactively feeling good. and so I think that's so important because I think there's so many people that misunderstand the purpose of care plus in the emergency department. If you are using CarePlus or the emergency department as your primary care, you are going to be disappointed. Exactly. Right. if you come into the emergency department, they are going to treat whatever is acute and when I s and I say acutely, that's a term we use in healthcare, but let me say it maybe for a non healthcare person, whatever is emergently wrong with you. In that moment. In that moment, whatever is emergently wrong, they're gonna fix that thing. They may not even fix it. They may just get it to a point where it is safe for you to go home. Exactly. Right. And then you are gonna be referred to your PC. Your PC your primary care are an appropriate specialist at that time. And if you don't have a primary care who knows you, who knows your history, who and then and that also I think just as importantly, that you trust. Absolutely. I need to get to know this. I can't I can see an emergency department doctor and you know, go, hey, I feel pretty good about this guy or gal, right? But I don't know them. I've met them for thirty minutes. If it's my primary doctor And I've established I should I trust that person with my life because over the last few years we've gotten to know each other, that they know me, I know them, I know their family, my family, you know, you've got that trust and rapport. And so I'm making a big deal about this, but it's for a reason. It's that if you don't have a PCP, a primary care provider, you need one because they are you said it well, the hub. and then when something does go wrong, you've got that person that you trust that that knows you, that can help guide you. and help keep you healthy. And so if it's a eighteen month wait to person, that's very disheartening, right? It was not something we were proud of. But yeah. And and if if you're already in it, so many people don't they don't call till they're in a crisis. Exactly. Now I'm in a healthcare crisis and I need a and I need a PCP and we go, I'm so sorry. Yeah. So thank God it's not there anymore. It is so much better now. Where where are we at now? we're sitting about fifty days. Fifty days. Yeah. Okay. So maybe two months, sometime sooner. So much better. Right? So much better. And it's just gonna get better as well. You guys are still working and bringing that down, but but you know, eighteen months to fifty days is a whole different ball game. I know a lot went into that over the last, you know, year. talk to me about what you guys did and what are the challenges. Wha you know, maybe let's start there. What were the ch why was it eighteen months? What were the challenges, right? That So eighteen months. So we had a few providers leave the community. had a couple of providers that maybe just weren't the good fit. and what happens when a provider leaves is they leave a panel of fifteen hundred to two thousand patients that we reabsorbed within our existing group. Yeah. And so that's what really cut ties for the new patients. We try to take care of the ones that were within the group first. but with recruiting, primary care access across the nation is difficult. It's already tough. Finding a primary care physician to practice is just there there's not that many out there anymore. and then getting them to come to Wichita Falls and they're like, What is Wichita Falls? Where's Wichita Falls, Texas? And so that was probably the difficult part was getting our name out there, letting them know who we were and figuring out how to get them to want to come to our community. Yeah. Well, yeah, if you think about it most providers if they're not from here, right? Which is one of the things we've focused on is like, hey, well let's we we like homegrown folks. But if they're not from here, if you're born and raised in, you know, I don't know, Illinois or something. You have no clue where Wichita Falls is. You've never heard of Wichita Falls taxes. Right. it's never, you know, most people have it. And so to get to they're not graduating going, you where I'm gonna go as soon as I get out of school I'm gonna go to Wichita Falls. No, it's not on their radar. But if we can if we if with they can let if we can let them see us and they come to visit and they see what we have to offer and the the community and you know that's that's when they'll come and say so y you guys had to do a lot of work of getting out there. We really amped up our recruiting. did so many interviews last year. I feel like I became a salesman man. Selling URP G selling Wichita Falls, selling our team and Natalie and Johnny and I did so many interviews and we would do a teams interview and then if we felt like it was a good fit, we would bring them in and they would come in and Tour the community, tour our buildings, but ultimately we also set them up, we pretty much do peer reviews for our physicians. Yeah. Just like we do with our nurses. my physicians choose the team. It's not administration chosen. Right. So we bring them in and they lunch, supper, spend some time with the existing physicians, and and then that's how we pick who joins the team. So I l I love that charity. And the only thing worse than not having A doctor would be having the wrong doctor. Exactly. And I will tell you, Ryan, there were times we interviewed people with an eighteen month wait list that we passed on. Right. And that's hard, but ultimately you're welcome. Yeah. Ultimately we it had to be the right fit for the community, for the team, for patients. So we we couldn't we weren't just gonna fill a spot. No, it's I'm I'm so grateful for that because it you know, once you have the wrong person here it's it's that's it's a whole nother plethora of problems we don't have to get into. And that's not that just wait for physicians, it's any yeah, you know, it's anybody. that's why you when you're hiring, you have to do your due diligence and do your best to get the right people in the right fit. Absolutely. But the stakes are very high with a provider. You know, it's people's lives. It is. And it's very important. So thank you guys for for all the work you did on that. to to bring that down. So anything else other than just primary the big thing was just recruiting? Recruitment and then kind of what we did because we were still trying to take new patients last year. So we did a lot of in-house things. So what could we do to take off of the physicians so they could potentially see more? The ones that maybe didn't have capacity at the time. And one of the things a lot of people don't know about primary care is there's a lot of administrative burden. When I talk about PCPB in the hub. They're literally the center of that pa each patient's healthcare. And there is tons of paperwork that goes with that. Tons of faxes, labs, referrals. There's just so much coming at them at once. And so we really dived in internally to what could we take off of their plate to do for them that didn't have to be done by the physician so they could see more patients. So we implemented things like nurse led Medicare wellness visits, because those can be done by a registered nurse. And so we have an RN that does some of our Medicare wellness visits for the patients. They love her. It's worked out really well. But that freed up like for Dr. Russell and some of the other patients to see more same day patients or new patients. Yeah. And so that opened up some access. we also brought in additional team members to what we call the in-basket in healthcare. That's where all the stuff comes, the patient messages and things like that. And so their job is to strictly triage that. for the providers so they can spend less time in their basket and more time and that freed up one of our physicians to open her panel again and start seeing new patients. So as much as we could do internally to support existing providers. So let me take this off your plate, you go see more patients. Yeah. That's really what we focused on. Mm-hmm. That makes sense. and I notice too you guys have it's n you know, I don't wanna give a the wrong impression, somebody out there hears us and goes, cool, I can just schedule my doc anytime I want, but you guys do have self-scheduling. We do. Right. And that's worked out for me several times. It's so nice if if if you know I want to see my provider and you know maybe I've got a sore throat or whatever. I always check because instead of going to Care Plus, my doctor might actually be open today at one o'clock. And I've had more than a few times I was able to pop in and see my doctor on the same day. Like there's nowhere out there you can do that that you're going to see your primary care doctor on a same day visit. Like that just doesn't really exist in today's world. I know, you know, back in the good old days or whatever. But in today's healthcare system, not as often, but it still exists. It still exists. It's really cool. and especially if you're dependent on who your provider is, many of them will have, you know, nurse practitioners or mid levels as well. And so many times you can see one of those folks and you get you get to know them as well. Like for for it's David, right? I've gotten to know David just as much as I've gotten to know my my doctor because he he works with him and and so it's a it's a great a great system that that takes healthcare the the nature of the beast in today's world is extremely complex. and what you guys are doing to make your the provider more accessible in a much faster way is is is well it's life changing for sure. and it's and it's what's right for the community. So You mentioned there anything else before I move on from that? Any other things that was the main just so it sounded like the two big things were one, we just got really heavy on recruiting, right? Heavy on recruiting. And then also worked did a lot of work to just make it more efficient and give patients faster access and doctors more more time at the bedside. That and probably the other thing we really focused on this last year too was leaning in on on training advanced practice providers. That's another big deal we worked on last year. Our community we're fortunate to have a lot of advanced practice providers. but they're all new. Right. And so, you know, there's a big learning curve coming out of school and so we really leaned into and developed a mentorship for new APPs. Okay. And we did that in family medicine and care plus. What's that look like? Yeah. So they're paired with another existing advanced practice provider who's very experienced and that they're that's their person. And they work side by side and that experienced advanced practice provider kind of determines when where they're ready to turn loose and start seeing a couple of patients here and a couple here. and just we've seen just having them have that person to go to and route down the hall their confidence and skill set just escalates a lot more fast. That makes perfect sense. Makes perfect sense that they're gonna they're definitely something we'll continue to do. Yeah. Reminds me of the nurse intern program, you know, on the nursing side of it is is we're seeing these nurses come along so much faster. And I'm I'm always a little green with envy 'cause I'm like, that was not my experience. No, no. No, sorry. It did not my experience long ago. But they've done a good job of going, Hey, we can make this nursing we can get nurses up to speed and make better nurses faster by, you know, giving them basically Yeah, that's pretty much what we're doing there. We want them to feel confident and comfortable to practice medicine and have a person. So And that ext and again When you add that mid level, it extends the amount of patients we can see and extends the provider. So it's it's a great thing. Awesome. Well, Any, you said you think that that number's only gonna get better. So what's that look like? what are what what are you excited about? It's gonna get better. Doctor Page joined us this week. He started seeing new patients yesterday. I'm excited about him. Yes. I just met him very briefly. Yeah, he's great. I've I had a you maybe he'll see this. I haven't got to actually shake his hand and I just passed by an orientation and and saw a picture of him and I told Tony who was doing orientation, I said, Man, he's got a he's got a mighty beard. Like that's a beard right there. It's a man's beard. And then Tony hung out with him for a little bit and goes, Man, he was a really great guy. I'm like, dude, if he's got a great personality with that beard, the sky's the limit. He's gonna he's gonna do great. So I'm excited about that. Poor guy we had his welcome lunch the other day and I think everybody complimented him more on his beard than than welcoming which all so it's a good beard. Yeah, but he's a great addition to our team. but I'm gonna onboard five more four family med and one internal med before the end of the year. Incredible. So that that lead time's gonna look amazing by the end of the year. Yeah. How many I know th there's a there's a curve where they have to we ramp them up. They don't take full patient low day one, right? But on average, what is a PC P how many patients are they seeing? every one of them is different. it's one of the things we really with h recruitment was physician autonomy. You can be as busy as you want. Right. or if you're just more lifestyle balance. if you want to slow down a little bit, you can. We're just we're we just build the schedule. that makes perfect sense for them. But on average, probably sixteen to twenty a day. A day. So what's that come out? I'm terrible at math. What's that come out to you? Like for a for Wha how many patients does somebody end up like owning? Like, hey, this doctor has this many patients. gosh. Okay. On a panel, so we call it panel size. So let me I guess that's where I was going with this is for every doctor we bring in That's fifteen hundred on on average, right? Yeah. If fifteen hundred is more patients in the in the community that has access. And you're bringing on how many more? Five more doctors? Okay. So that's that's that's a big number. Like that's really cool. every time we bring somebody on, that's fifteen hundred more people in our community that have a primary care doctor, that have access to it. So and we're still recruiting. We've already signed contracts for next year. So we'll keep recruiting. That's awesome. I and I think I think it's worth saying, Johnny and I talked about this a a good bit when he was here, but I just want to reiterate. I know a lot of people think, man, I bet every time you bring a physician on, you're just patting your bottom line by bringing these doctors on. and what people don't understand is like you gotta you gotta understand br bringing on doctors doesn't make us money, right? And sometimes it costs us money. So it's a family medicine doesn't make money. It's not a big money maker. This is truly because the community needs it, right? and I'm not saying we don't try to make money with United Regional. We're not for profit. you are, but we need to make money to stay in business, right? So I'm not trying to say we don't try to make money. But I the cynic would go, well of course you want to bring more doctors and you want to make money. Bringing in doctors doesn't make us money. By the time we do all the things we need to do, we're happy if we could break even but we're doing we do this because if we don't bring in primary care doctors, it hurts the community. We lose Not only do we do we lose patients, but we just literally lose community members. People will move. They will leave the community if they can't get the care they need. As the person told you, if you just move up here, we could take better care of your son. There's a lot of people that are going, okay, I'll just move. Right. You said no, I'm gonna go to nursing school. but a lot of people would have just gone, I guess I gotta move, right? that is a real thing when you when you do that. So it just it's so helpful, it's so important to the health of this community that you guys are doing what you're doing. So Yeah, and not even just this community. I mean, you think about all the rural communities surrounding us. We serve a big circle. So many around us. We have people driving from Bowie and Oklahoma, all over the place looking for primary care access. Yeah, our our I think our service area is bigger than some states. and it's it's it's it's incredible the amount of people that drive to us and depend on us. And so thank you and your team. if they're if and I know healthcare is hard sometimes, right? There's certain days where you're like, what are we doing? just I hope your team sees this to know like gosh, you guys are making a huge difference like for this community. at the I know sometimes in the in the micro level in the middle of it, you don't always feel that, but in the big picture, huge difference being made here. So thank you and your team and for all you guys are doing. So we have a great team too. They're great people. Yeah, great URPG's got it going on. any anything you want to share before we wrap up today? No, not that I thank thank you for having me. Awesome. It's awesome to have you. Thank you for all you all you do for the organization and it's been been cool to get to talk to you and cool to catch up. Yeah, good to see you again.