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I’m excited to launch the first episode of The New Future of Work (TM) Podcast with a very special guest, Dr. Gabe Charbonneau. Gabe is a rural family physician and high-tech entrepreneur. He is a founder of Medicine Forward and the co-founder of Fluent Systems, an EHR automation software company. He serves as EHR faculty at Practicing Excellence and has been a physician advisor to the AI scribe companies, Tenor and Saykara. He is also the passionate creator of the #FightBurnout movement on social media, and FightBurnout.org. Gabe lives and practices in Stevensville, Montana.

We had a wonderful discussion, here a few of my favorite comments:

“You’re not allowed to complain about a broken system if you’re not willing to do anything about it. We all need to realize that we can’t sit still and wait for someone else to fix it anymore. So get out of your seat and get involved in something.”

“When you start showing up, you find where you fit and and where you can help, and can hopefully be a voice for good and improving things.”

“I’m an accomplice in a broken healthcare system, fighting to transform it.”

During the show, we referenced two organizations, Buurtzorg, the home health company based in The Netherlands that operates from a very different model, and Orchid Health which is a group of Rural Health Clinics in Oregon that is structured around four pillars, the first of which is their people.

Gabe also referenced BurnoutIndex.org, a tool for measuring burnout.

You can contact Gabe on Twitter @GabrielDane, or visit his organization’s websites at www.MedicineForward.org and www.FightBurnout.org.

Listen and subscribe on Apple Podcasts, Spotify and wherever you usually find your podcasts.

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Show Transcript (Transcribed using AI – please excuse any errors):

Monica (00:04):

Thank you so much for joining us here today. I’m really excited to have a very special guest. Dr. Gabe Charbonneau is a rural family physician and high-tech entrepreneur. He’s the co-founder of Fluent Systems, which is an EHR automation software company, and he serves as faculty at Practicing Excellence. He’s also been a physician advisor to the AI scribe companies Tenor and Saykara, and he’s passionate about fighting burnout and actually created a movement on social media at fightburnout.org. Gabe lives in practices in Stevensville, Montana. So Gabe, thank you so much for being with us here today. I’m really excited to talk to you about the new future of work and what you’re seeing in the healthcare industry today. As we get started, maybe we could just start off by having you tell us a little bit about your story and how you got started.

Gabe (01:03):

Yes. Thank you so much for having me Monica. It’s, it’s really fun to do a podcast with such a good friend and someone who I look up to so much as a positive force in this world of trying to make things better for everybody. So yeah, I’m a family doctor in Stevensville Montana, and I usually start my story at the beginning of my doctor journey. So the first time that I realized I was interested in medicine happened when I was about six years old and I had this rash on my body that neither I or my mom knew what it was. And she took me to our local family doctor and he had exactly the things that I needed for care. I mean, he was gentle and kind but he also knew what he was doing and immediately put me and my mom at ease, quickly named what it was that I had, which was not a serious thing at all.

Gabe (02:07):

It was Maluma, which is a super common childhood rash. But the way that he cared for me left this indelible mark of, oh, there’s something special going on here. And it took me a while to realize that that was one of the big things that really imprinted on me about why I became interested in medicine. Reflecting on where we are today and, and what I would like to see more of it really was that whole package of his, his humanity and the way that he cared for me. And there were, there were no distractions in the way, there was no computer in the room at that time. There were no misaligned incentives trying to get him to do something other than just take care of me and my mom. And that’s become more and more clear about how special and important that is. And so has really become part of my guiding what guides me to want to fight for. And also a lot of other people too, are realizing that, Hey, that that’s a super important part. This relationship, the human doctor, patient relationship is such a precious part of what we do. And so, so that was the beginning. And then I went to, oh, did you

Monica (03:27):

I was gonna say, I love that story and I could totally see you bringing that type of, kind of warmth and caring and energy into the work that you do with patients. And also the work that you’re doing now at medicine forward. So go ahead and continue with your story.

Gabe (03:45):

Okay. Yeah, yeah. So it, it is so, so fast forward. So I went to medical school in Utah and then residency in Spokane and then worked in this community health clinic in Spokane for a few years after graduating. And, and that experience was really hard. I experienced burnout, I would say for the first time in, in that job back then, I didn’t have the word for it. Burnout wasn’t talked about so much, but it definitely was burnout. My wife and I actually both practiced there and she and I felt like it was just total survival most of the time. And then I guess the other thing is, is that I have always been a computer person. And so in that job, I was always trying to figure out things that might make it a little bit better.

Gabe (04:34):

So even then I started tinkering with stuff that might make our, our back then web based, very slow EMR work, a little better. And so I, I played around with some macro software and text expansion and built all the shortcuts I could trying to make this impossible job doable. And, and then then we moved to Montana, which is where, where I am now. And then we had the big go live with the major EHRs. And I met a fellow physician that was our partner in the clinic and he, and I hit it off quickly. And we’re, we’re both sort of these people interested in being problem solvers when you were presented with a big challenge. And we came at it from slightly different angles, but we challenged each other to build tools, sort of like the ones I made in my first job that would make things better. And so we just, we, we jumped right into making a lot of macros and eventually made a company that was all about macros for doctors, like basically add on software to the EHR where you could add buttons to the interface that would do whole series of things that were more like how a, how a physician would intuitively think. Because I’m so I’m sure you’ve heard, there’s nothing intuitive about the EHR. Not

Monica (05:53):

At all.

Gabe (05:53):

So, yeah. And that was, that was a lot of learning. One of the things that I learned is that that you can, you can build a product that you think solves the problems, but you, but getting it to be implemented and interface with the healthcare system is a whole other challenge. So we built this, this very custom thing that a lot of doctors loved, but we couldn’t figure out actually how to get it to, to fit inside of healthcare systems so that it could get any kind of significant traction. And then I took a little bit of a, as I was still interested in how technology could maybe make things more human. And I got interested in the voice AI idea, and that’s how I got into working with tenor. And then also S the, the way that I got into the fight burnout stuff was actually that I kept running into similar and similar problems that it was like okay, why is it so hard to fix things and, and improve it?

Gabe (06:56):

Yeah. And what the, what the thing that came to me was that I don’t really have the answers, but what I know for sure is I’ve met a lot of really wonderful people inside of medicine and healthcare who are very motivated to create this better world. And we don’t quite know how to do it. So I made this t-shirt that I know you’ve seen that the design is the design is a Phoenix raising the rod of medicine out of the flames, as a symbolism for that, as people we can overcome hard challenges because it, it, you know, if we don’t know how to technically do it today, it doesn’t mean that we’re not gonna figure it out. How many times in history have people had incredible challenges that it seemed like there was no way to solve it.

Gabe (07:41):

And then the right circumstance happen, you get the right people together and, and amazing things happen. And I just, I, I have to believe that that’s possible for getting unstuck in healthcare as well. And that led me to getting involved with some other, other friends through that project. Yeah. I started giving that shirt out to people that I thought were doing inspiring work and got connected with Eric Topol and a few other interesting leaders in medicine. And there was this interest in creating a new doctor’s organization that was really about standing up for the human doctor patient relationship. So that’s been a huge part of my volunteer work for the last three years. And I think that’s part of what we’re gonna talk about today.

Monica (08:26):

Yeah. So that’s medicine forward that you’re referencing there at the end, and yes. You have such a fascinating journey and we actually connected a number of years ago at the time when you were developing the EHR interfaces. And you participated in a rural medicine hackathon that I helped to organize. And so you’ve been doing innovation and kind of testing out new things for a long time in the healthcare system.

Gabe (08:53):

Yes. And I have to say thank you to you for, for doing that because when we were first starting out trying to create software, I had never created a company or really built any significant technology. I played around a lot. We made an iPhone game about diabetes with, with our son, but I had never made anything that I thought could be like a serious commercial software thing that might be disruptive of like, you know, the current ways of doing stuff. And you brought MIT to Missoula. And I was like, okay, I have to go to that. <Laugh> what is that?

Monica (09:25):

Everyone thought I was crazy <laugh>

Gabe (09:27):

I did not think you were crazy. I was like, there are not that many things where I just have to like clear my schedule and make sure I go to that. Not even knowing for sure what it’s all about, cuz I’d never been to a hackathon before, but I just knew that the energy of this was like something that was worth paying attention to, and it was totally it was to totally amazing. I mean we could go into some of the things that I really loved about that, but the, just the, the creativity of people and the some of the things that I learned about how you could get groups to work together and sort of organically create ideas and then sort of work through those and, and, and bring, you know, people from a place like MIT, where they’re on the leading edge of technology to like our little Montana to talk about it and try and help us. I just thought was so cool.

Monica (10:16):

That was amazing experience. One of the things that I think is so interesting is bringing together kind of the diverse perspectives from different fields to try to solve kind of a shared problem. So I’m really glad you were able to participate in that with me, and I’m glad we were able to get connected. But one thing that really kind of stood out to me about your story is talking about experiencing burnout in your career in actually when you were in your residency kind of early on, is that something that’s pretty typical of physicians during their training and or practice that you see?

Gabe (10:57):

Yeah. Well, okay. So I will give the best answer to this that I can I, I don’t think there’s anyone who goes through residency and thinks that it’s that’s easy. It’s, it’s usually one of the crucibles of life. It’s one of the hardest things that you go through. I think for a long time, people really knew what to expect with residency. And so there wasn’t necessarily a mismatch between your expectations and, and what it was. It was like, okay, there are gonna be these long hours and it’s gonna be grueling and I’m gonna sleep at the hospital a lot. And I’m gonna be challenged in ways that are beyond my comfort zone, but like other people have gone before me and done this and, you know, I’ve made it this far. I probably can do it. Yeah. And so, so the it’s not that there has never been burnout, but I think one of the things that’s come up is that burnout often happens when there’s a mismatch between people’s expectations and what happens.

Gabe (11:54):

Interesting. And yeah, and I think more and more since I’ve graduated and moved on, I been hearing about elevated levels of burnout throughout the entire education spectrum, even from the beginnings of medical school. One of my friends did a, did a research study on medical student burnout. He was really inspired to do that because he lost a, a friend who died by suicide and found really compelling information about that in medical school, burnout is already a huge problem. And some of the some of the things that seem to be linked to that in drivers and the we’re just in a really weird time right now. I mean, in some ways we have made so much technological progress, but in other ways we’ve got like, mm-hmm, <affirmative> lots of layers of bureaucracy and things that aren’t really about doing your work and do create that mismatch between your expectations of what you should be doing versus what you’re actually find yourself doing.

Gabe (12:53):

So as an example some of, some of my doctor, friends who are a little bit older or retired say that they don’t remember burnout being as much of a problem when they went through training, but they went through well before there was any kind of work hour restrictions. So it was like, you know, it’s not just like how hard people are working, not saying that, that means that was a good idea. Yeah. But just that, like, you know, the, the, the level of burnout has actually risen and it’s not entirely about how much we’re working. That’s a factor, but it’s not the whole story.

Monica (13:27):

That’s fascinating. Well, when you think about your kind of origin story about going to your family practice doctor and having that one-on-one encounter, that was so meaningful healthcare has kind of come a long way from that time in healthcare. And, you know, do you get to have those kind of moments in your practice today still?

Gabe (13:49):

Yes. And I have to work hard to intentionally see if I can make that happen more often. I’m on the same treadmill everybody else is. So I, I work at a large hospital system and I, you know, I think we do it as well as anyone’s doing right now in our current system, but I am on a treadmill of production and have short amounts of time for visits and lots of requirements of boxes that need to be checked for every visit that are driven by the incentives. And we can’t seem to figure out how to, how to change that. I do a few things on purpose that I think, give me more time to connect. So, and back to an earlier part of the story, so like the voice AI we’ve been piloting yeah.

Gabe (14:38):

Voice AI software. We’re now on our two, our second version of that, with the idea that instead of spending time typing in the exam room, you can just have a natural conversation and that all gets captured and then transcribed and structured into your, into your notes. And that actually, that has been really helpful. I, I made a rule for myself pretty early on with the EMR that I was only gonna use the computer in the exam room. If it actually like made me a better doctor and that I wasn’t gonna turn it on as the first thing or log into it as the first thing that I did so interesting. So even though you’ve got limited time, I, I walk in and the first thing is about, is about connecting and making eye contact and trying to trying to ask a question about how someone is doing, and then not interrupt right away, which there’s, you know, you probably know the research that doctors are horrible at this. Like we <laugh>, we can’t wait to jump in and say something <laugh>

Monica (15:36):

So get to the problem so I can

Gabe (15:37):

Fix it. Yeah. But also the, the flip side of that is that if you let people just speak, they often tell you important clues to their story and what’s going on. That helps you find what you need to do most to, to, to help them medically at that visit. And so it’s, it doesn’t help you to interrupt <laugh>. So anyway, those things, and then I have to give a shout out to the team that I work with is outstanding. I mean, beyond remarkable in terms of the ways that they help me to, so that I’m not the one doing a lot of the one of the movements that I love, the name of is get rid of stupid stuff. Oh, my nursing team does a lot of stupid stuff for me. Wow. But I know that a lot of people don’t have that that privilege. And so I feel a little bit guilty, but also very lucky.

Monica (16:27):

Yeah. I’m sure that makes a huge difference because and it sounds like you’ve been able to kind of cope with working in healthcare still, even with all of the challenges with the pandemic and mm-hmm <affirmative> other physicians are experiencing burnout, that sort of thing. One of the things I wanted to ask you about was a study that I read from the AMA recently about what they’ve learned about COVID burnout and the doctor shortage. And they’re talking about more than 3,200, almost 3,300 physicians have left healthcare and left the workforce in just the past couple of years. And what they’re finding is that employees in general are a little bit slow at returning to the workforce post pandemic, especially in healthcare, but doctors specifically have been very slow the ones that have left to return to the workforce. So why do you think that is you think that’s the kind of the bureaucracy that you mentioned and, and the difference in those expectations or what are the factors?

Gabe (17:30):

Yes. Well, okay. So, I mean, this is I, I am not an expert on this, but I can tell you what my experience is. And also friends of mine and, and what they describe. And I, and you know, that my wife is also a family doctor. So we have lots of conversations about these things. The, the, the practice, especially of primary care was unsustainable even before the pandemic happened. And so I just got done telling you the things that I do to try and stand up for a little bit of humanity, but I’m, I can’t say that my job is easy or that there aren’t times when I still actually get some burnout symptoms myself, in fact, I track it <laugh> every Thursday I do a burnout survey and I’ve been doing that off and on for a few years.

Gabe (18:17):

And because once I got interested in burnout, I’m like, you gotta, you have to learn about this, right? Like, what are, what, what can I learn? And I’m sort of a learn by doing person. That was how the, like, building software thing happened too. And I found that like, burnout is not a static thing. There’s a lot that affects burnout. So this last week I had very low levels of burnout and part of it, I can name a few things that made a difference. Mm-Hmm, <affirmative> things were going smoothly in our clinic. We don’t have any major kind of disruptors of kind of what’s going, like, sometimes there’ll be a big tidal wave of challenges that just make everything hard. And we’re, we’re all stressed all at once, all understaffed. But we had, we had our regular staff we didn’t have any major fires happening and no, like existential threats that we might not be able to stay open.

Gabe (19:07):

<Laugh> like, those are all huge things. Yeah. And also it’s summer, and it’s beautiful and I’ve been riding my bike to work, and that actually has had a protective effect for me. And then the other thing that I haven’t brought up is I, I work part-time and have for the last 12 years. So I worked three days a week instead of four days a week. We started doing that when our youngest son was born and I, I never went back and I just, I wanna highlight that, like, you know, this exit, like for, so I talked about the expectation mismatch, but the other thing is like, if you think of burnout as like you, you’re a human battery of sorts. Yeah. And as you do this work and it’s really grinding on you, and there’s all these challenges layered on top of challenges, it like drains the battery and it keeps draining the battery.

Gabe (19:56):

And if you get too much drainage of the battery without enough recharging of the battery, that’s when, like you don’t come back from the burnout. And I think that’s what COVID and all these other social stressors have really done is like, mm-hmm <affirmative>. So doctors have been these people that are used to just like pushing ourselves really hard and yeah. You know, through all kinds of crazy stuff, medical school, residency, overnight shifts for too many hours, you know, <laugh> not going to the bathroom when you need to all this stuff. Yeah. But like, at some point you just can’t push yourself beyond anymore. And that, and, and you know, not all the, not all the challenges with COVID have been that it’s been more hours. Some of it has been that it’s emotionally, hugely challenging. You know, people who have philosophical or political beliefs that are like making it hard to care for, for them right.

Gabe (20:47):

Or for your community. And like, you know, so you show up to try and help people. And the first thing that you have to do is actually like deescalate someone, who’s throwing a temper tantrum in your waiting room because they don’t want to wear a mask. And it’s like, traumatizing your front desk. Who’s trying to help you. Yeah. Right. Those kinds of those kinds of things. And it’s, you know, it’s just like when society has all these pressures going on, on top of this already, like pressure cooker, right. Or battery that’s running on empty. Like you just, it does not surprise me about that. The exit and people not wanting to come back. Another thing is doctors are smart people and, and we’re waking up and realizing like, well, I’m pretty smart. And that person over there, like isn’t necessarily smarter or hard, harder working than me in this other industry. Why am I putting myself through this again? I mean, I do care about people, but this is crazy.

Monica (21:40):

Yeah. At some point the personal cost for what they’re doing is, is too high. So a couple questions come to mind. One is I was curious and I’m thinking our listeners might be curious too, about what type of burnout survey do you take every week? And that sounds like an amazing practice, cuz I’m one, that’s also suffered from burnout a few times in my career and it kind of sneaks up on you if you’re not paying attention and then, then it’s hard to come back from it.

Gabe (22:08):

Yeah. Well I’ve so I’ve tried a lot of ’em I’ve done the, the Maslak index, which is sort of the gold standard that one you have to pay for a copy of it and score it by hand. There are a few things that will sort of automate that for you, but I, yeah. It was a little bit too much work for me and didn’t also provide an easy way to track it. So I, so I’ve done that a few times, but then I, then I started playing with things that might be simpler. Mm-Hmm <affirmative> there’s a mini Z burnout thing that, that that’s easy and has a lot less questions. But the thing that I discovered, which is was actually not created for healthcare it started us, this website, burnoutindex.org, and it was actually for the it industry and it’s this little startup in Brazil called Yerbo.

Gabe (22:59):

And I just loved how simple they made it and they made a lot of their things that they put together, very evidence based. And it didn’t seem like it mattered that I wasn’t in the it industry, I just sort of ignored that question because the results seemed to be very like they were, they, they weren’t occupation specific. They, you know, that was just their target sort of customer. And so I still use that and they have a little slack plugin that pings me whatever day of the week you want it pings me and asks me these questions. And then it creates this graph over time of my burnout risk and also my level of engagement at work. And then I just reflect on that.

Monica (23:41):

Wow. That’s awesome. I’ll make sure to share that link in the comments below the show, but what a great resource. And one other question that kind of came to mind as you were talking too, is with the physicians leaving, there’s gotta be even more of a shortage. We were already facing kind of a physician and medical staff shortage prior to the pandemic, but now with even more physicians leaving, that’s gotta increase the burnout. And just kind of the, the stress on the providers that remain. Are you starting to see some of that as well?

Gabe (24:16):

Yes. And that, that trend is really alarming and, and as far as like common interest that you and I have of, of sort of future thinking and how can we, how can we, co-create a better future, right. I have become obsessed with how can you make primary care, a great place to work? Because to me there’s an overwhelming amount of evidence that yeah. That thriving primary care is actually a, a huge foundational component of a well-functioning healthcare system across the wor world. There’s lots of data to back that up. Yeah. That that primary care doctors being around improves people’s health and reduces all kinds of things. We don’t want like hospital admissions, if there’s enough of us. And and, and, and I mean, that’s my, I know I’m biased because that’s what I chose to do. Yeah.

Gabe (25:08):

But I chose to do that because I believed it had the potential for this widespread impact at the local level and, and our communities need great primary care physicians. And so yes, I’m, I’m alarmed by that trend. And also, I think we’ve gotta channel that energy into saying like, how can we deconstruct this broken primary care workplace and rebuild something that actually works? I, I don’t think that’s impossible. In fact, you and I both know someone very well in, in rural Oregon, who’s, who’s been working on that Orion and orchid health. And that still is one of the highlights for me. In fact, I have talked to multiple people in Montana about like, what would it take to get this modeled going here? That includes insurance and starting to talk to the Montana medical association and people in the business world and even just, you know, sort of surveying my friends who practice about like, would you be interested in this and what would need to happen for it to take place? And really the core of Orchid as far as what I figured out is that they put their money where their mouth is for putting wellbeing as the first priority. Not the second, not the third, not the fourth. The number one priority is people’s wellbeing. And absolutely, I, I think that, that, that is the future that we need to fight for where human, human, flourishing human wellbeing is our top priority. And the other things can only happen if we are getting that right.

Monica (26:42):

I love that. And I loved how you posed the question about how can we make primary care, basically a great place to be. Because I think that so many healthcare administrators are going about it the wrong way. Like, I hear a lot of questions, like, how do we recruit, or how do we retain employees those types of questions. But instead of asking those kind of questions, they should be asking, how do we become a desirable place to see how do we become a workplace where our employees can thrive and serve our patients and where they want to work? So I think taking that, you know, kind of flipping the question really helps come up with the right answers. And yes, you know, some earlier in my career, one of my roles was leading a national transforming clinical practices initiative where we really focused on primary care. So, you know, even healthcare payers know the importance of primary care because that’s where everything starts wellness and prevention and keeping people healthy and keeping people out of the emergency room. So it seems like there’d be a lot of incentives to make this happen. You know, that there’s a lot of alignment.

Gabe (27:55):

Absolutely. And I think it’s, it’s interesting that the, the, the story that you just shared about kind of people’s questions that they want to ask versus asking different or better questions and yeah. And, and one thing that Orion had that I think is really important and special, and maybe why this hasn’t bubbled up other places is he was 21 years old when he started a primary care company and had no background in healthcare. He truly had beginner’s mind. Yeah. Like we’re all looking at it from the perspective of like what it already is and all the rules and constraints of what we think it has to be. Right. And he started this thing with the question of like, well, this is a huge problem. And I want to create a social business to make a big difference. And so everything was on the table and we’ve gotta start looking at stuff like everything is on the table.

Gabe (28:43):

And yeah, and we’re not, we’re not doing that yet. I have a few other thoughts I wanna make sure to, to get in, get in there. So a trend you talked about the trend of like people leaving primary care. Yeah. Back to burnout. One of the, one of the trends has been consolidation where lots of people are going from private practice to being employed mm-hmm <affirmative>, and that is not unrelated to burnout. So more and more studies show that private practices are much more likely to have lower levels of burnout and, and a huge factor. There is the level of control or voice that you have in, in your practice. Right. And so I, the way that I see it, we either need to shift incentives. So it becomes reasonable again, to have small private practices, because a lot of doctors choose medicine because we want to have autonomy.

Gabe (29:28):

Yeah. We want to be able to lead. We want to be able to right. Be in charge of something. Cool. and that’s not happening a lot of times in our, in our big systems or our big systems have to like start dismantling the hierarchy that says that, like, all the stuff comes from the top and you people who are like in the bottom, just do what you’re told and make widgets all day and right. We’re not listening to you enough. So, so my feeling is in the near term, it’s gonna be upstarts like orchid that create, if you can create a better workplace that people are gonna notice and say, Hey, I’m gonna go work there because I’m not gonna get burned out every day. If you don’t get paid less, they actually pay at the higher end of, for community health centers on purpose.

Gabe (30:15):

So it’s not like lower pay for like the same kind of a clinic would be where they are. And, and you can have wellbeing baked into the operating system of the place that you work as the top priority. Like, I mean, once that starts happening, who’s not gonna leave the incumbents and go work there. And so the choices are either that like big hospital systems are just gonna throw up their hands and say, we’re gonna let other people take over primary care, cuz clearly like they’re able to solve this and we’re not, or they’re gonna have to make some of those changes. Those fundamental changes that haven’t happened yet.

Monica (30:50):

I agree completely. I think more and more people in general are looking for more work life balance, you know the pandemic did change a lot of things for us because we were able to spend more time with our families and see how life could be if we weren’t, you know, constantly going places and doing things. And yeah, so that there seems to be a trend toward people wanting more and more of that work life balance, including physicians and wanting to really be able to be more involved in the process and not just being, like you mentioned, producing widgets and a hug on the wheel. And one of the factors has to be, you know, this week we were sharing some articles back and forth and one of those articles showed the trajectory an increase of administrators compared to physicians over the last 20 years. And I’ll, I’ll share a link to it in the comments, but essentially the number of administrators in healthcare has just exploded while the number of physicians has remained pretty consistent. And so you have this huge layer of administration over this small layer of physicians. Yeah. And it’s just continuing to grow. I think it was something like 10 administrators to every one physician, something like that. Yeah,

Gabe (32:07):

Yeah. Right. And it, and it, it just, I mean, if it, if it continues the way that it’s going, it really highlights where some of the incentives must be mismatched because yeah, because here we have this healthcare system that in so many ways isn’t working, it’s very expensive compared to the outcomes that we get. And we’ve got more and more bureaucracy who are people who are, and this is where I wanna choose my words carefully because a lot of, I love a lot of the administrators that I know. Yeah, sure. But they don’t, they don’t directly provide care. And so that’s, that’s one problem. And also they have this power over dynamic. And so it’s not, they’re not equals, there’s not the people who are the clinical teams, the doctors, the nurse practitioners, PAs nurses, front desk don’t really have a real seat at the table. And so there’s these, these kind of structural incentives that are like really, really making it difficult for people right now. And that’s some of what I would like to help unpack back to what I think is interesting about Orchid. I ask, I ask this question of like, well, how do you guys, how do you guys pay the bills? And one of Orion’s answers is we’re, we’re very light on administration. Well, how do you, how do you do that? Yeah. <Laugh>

Monica (33:29):

Yeah,

Gabe (33:29):

Right. Like, so they I mean, they’re, they’re relatively small at this point, like four clinics, but they, I mean, they get all their administrative work done. Part of it is, is that they, they don’t have so much like absolute, like what people’s roles, roles are or titles, I guess they’ve got, they’ve got roles and he’s gonna be better at describing the language, but, you know, they, they figured out a way to not create this administrative bloat because one of their priorities is they they’ve got to, in addition to caring about wellbeing, be financially sustainable. And so when you try and mash those things together, you’ve gotta get creative.

Monica (34:06):

Yeah. I’m sure that that’s the major factor. And as a result, I think that it gives opportunity for the clinical staff to be more involved in the leadership and development as well, which also has gotta seem like it would help increase job satisfaction if you’ve got a role in helping to create what’s gonna happen versus, you know, the top down model of being told, this is how we’re gonna do it type of, well,

Gabe (34:31):

One of the, one of the radical ideas that Orion and I came up with is and this might sound crazy, but I think you’ve gotta sometimes have wild and crazy ideas when you’re talking about future thinking and moonshot thinking is to get rid of the concept of having an administrator at all. Yeah. As in, like, there are no administrators and and this, and I’ll explain what I mean by that, but that you change it from there being clinical teams and administrative teams and all these power dynamics power over versus being on the same team, working for the same kinds of goals and administration in bureaucracy become service to care. So we came up with this concept of administration as a service. And so, wow. No one is an administrator. Yeah. You could have a healthcare organization that has zero administrators.

Gabe (35:19):

Yeah. So you, all of a sudden, like that changes the whole dynamic of how people interact. And so then you have the care delivery team, but then we also were getting kind of having fun with it and thinking like, well then the people that do things like billing, or, you know, figuring out this or that sort of logistic thing of how the business works called that maybe like the care enabling team, but there like the language change changes the intention of the whole thing. And like putting us aligned that we’re working towards the same things rather than like, you know, there’s the, this team and this team and they actually are fighting a lot and therefore not getting anything done sounds like Congress <laugh>

Monica (35:57):

Right. Well, I love that suggestion and I could totally see healthcare moving in that direction. And what you’re talking about has some resemblance to the BOR model mm-hmm <affirmative> in the Netherlands, BOR is a, a home health agency that was developed around these kind of self-managing teams. And I don’t know if it’s structured in the way you’re, you’re talking about, but the administrative kind of support role. But it, it sounds very similar.

Gabe (36:28):

Yeah. I, I know, and I, I share that interest in Buurtzorg too, and I hope that people who don’t know about them will, will definitely check it out. I just think there’s so much to be learned from these like interesting organizations doing things differently in other, other parts of the world. And Buurtzorg has just come up in so many different books we’ve shared and read over the past few years as like this super cool different model that is all about empowering people. Yeah, so like care teams sort of autonomously form in local areas to meet and need. And they pull for resources that they need rather than having like a central agency tell ’em like, here’s your standard issue of all the things that you need to get your job done? That’s that’s not at all how it works, which is like, I think so many of us in the states can’t even imagine working <laugh> in a, in a system like that, but it sounds so exciting. Like, I mean, if we could figure out a way to transplant that here and, and try it out, like, I mean, sign me up. I would be a volunteer to, to try it out and pilot it for sure.

Monica (37:32):

Me too. I’ll make sure to put a link to Buurtzorg in the, in the show notes as well. So the Buurtzorg model is really interesting and is certainly one thing we could look at, but one question I have for you is do you think that we’re ever gonna go back to the way things were before the pandemic mm-hmm <affirmative> and if not, what are some things that we can do kind of going forward to make the workplace a little bit better in healthcare?

Gabe (38:01):

<Laugh> great question. So the first thing that I thought of is like, be careful making predictions because we’re almost always wrong

Monica (38:10):

<Laugh>. Yeah, exactly.

Gabe (38:12):

And so this, like, could we go back to the way things were before the pandemic? It seems unlikely. I mean, it, it it’s been a collective trauma. Yeah. And I don’t think people go back to the way things were before, before, after going through a big trauma. So it feels very unlikely to me that things will be the same. Some things are losses. I, I think we’re, you know, it’s like hard things like a grieving process for things that were the way they were before. And now it’s not like that anymore. And I, and so some, some shared grief about those losses sure. Some, some things are like we’re being pushed to, to be innovative and creative and try new things that we wouldn’t have, like all the people that have been able to, to do work from home.

Gabe (39:01):

And I mean, that’s a whole huge conversation about what that means, but yes, it wouldn’t even been possible to try it out before the pandemic. And so we’ve, we’ve really learned to push the envelope on being adaptive and some neat technologies have really emerged as things that like, okay, we we’re gonna, this is something there’s something there that’s worth leaning more into and learning more about. And so well we’re in this time of a lot of stress right now. Yeah. My I’m an optimist by nature. And so that, I don’t, again, I don’t know if you should trust my predictions or if I should even make them, but the world that I want to live in gets better from here. And that we are, you know, we’re in this sort of dark era where there’s a lot of stress and strain.

Gabe (39:56):

Technology’s not living up to its potential. You know, we’ve got social media that like connects us all, but mm-hmm <affirmative> but influence us and polarizes us in all these negative ways. And the business model of it with it being funded by advertising may, may just be bad for our society. But it doesn’t mean that it has to stay that way. I mean, there’s a lot of people that are realizing that that problem exists. Like part of the thing is change has really accelerated, like our rate of like learning change is accelerated. And I actually wanna flip the question back to you because I know you have an interest in spiral dynamics and say, yeah, what, what do you think, hang on my robot vacuum is turning on. I’m gonna stop that.

Monica (40:35):

<Laugh> <laugh> well, I think we’re gonna definitely see more robots in the workplace. So

Gabe (40:41):

<Laugh>, I know that was on, that was on cue. I actually love robot vacuums, by the way, like I’ve, I’ve geeked out on playing around with like what they can and can’t do. And awesome. Yeah. Anyway, but the <laugh> what never been interrupted on a zoom call by that before you the dog or the kids or phone call or the doorbell now it’s the robots.

Monica (41:02):

It was very timely

Gabe (41:03):

<Laugh> it was really time. It was really timely. Yeah, but so I think what I was talking about is how the accelerated rate of change with just how much is happening in society. And we tend to see so much of, like, what’s not working our outdated laws, our polarization, our EHR that is so cumbersome and horrible to use. And we think like, is this it, like, we’ve learned all these things and ended up in this like black hole of <laugh> like nothing can work and it’s just gonna get worse. I, I can’t believe that that

Monica (41:38):

We’re gonna see, I can’t either, but I’m an optimist too.

Gabe (41:41):

<Laugh> yeah. Climate change. I mean, the I’ll, I’ll give an example of things that I didn’t expect. So I just got an e-bike when I was talking about riding a bike to work. So I you know, I’ve known for a long time that fossil fuels are not like gonna be the way that we keep going for transportation, but I wasn’t quite in the market for an electric car, although, and I came out to Oregon. Last time one of our friends had an electric car and of course that was lots of fun. Oh, neat. And it was it was maybe a more affordable model. So I got excited. And then I had another friend in Bozeman who posted on Twitter about how he got this e-bike and he was surprised about how accessible it made, like getting around town. And I was like, I was like, you know, an e-bike is a lot less expensive than an electric car <laugh> oh,

Monica (42:27):

Yeah,

Gabe (42:28):

Yeah. And so I had so much fun sort of learning about them and I got this bike that like you know, I, I, my goal is for this summer and as long as I can to ride it to work which has proved to be like, you know, dabbling in this, like what would a world without transportation with fossil fuels be like, yeah. And also it gets me outside and I’ve been enjoying like getting a little bit more vitamin D and slowing down just a little bit. It’s actually remarkably fast, but slowing down a little bit from being in a car, you’re much more aware of like, yeah, what’s going on around you. And my mood has been boosted from that. So anyways, I sound like I’m a salesperson for e-bike, but the, the point is like, like these ways that you don’t see coming where things might get a little bit better as you’re like, moving on your way to this future.

Monica (43:16):

Yeah. Just tapping into those and being open to doing things in different ways, even outside of the workplace. For sure.

Gabe (43:23):

Yeah.

Monica (43:25):

So Gabe, we’re getting close to our time here, but I do wanna ask you, like, what is one action item that people can take away from this to kinda help reduce burnout in healthcare, but in the workplace in general and make things a little bit better going forward?

Gabe (43:42):

Okay. Well, you, you, I’m sure you know, that I have more than one thing that I’d like to say <laugh>. But, but I, but I think that the thing I’m gonna say that brings it together is to find a group of people. If, if this speaks to you that this is important, find a group of people that’s working on something and get involved. And so you know, the group that I’m involved in are nonprofit medicine forward. Like we, we are working on advocacy right now. Our focus is on prior authorization. It’s like one of the main dysfunctions in our legacy healthcare system. Right. And, but I, I think the thing is, is like, we, we can’t wait for other people to come and fix problems for us. Like it’s, it’s time to get involved in things that speak to you that are important to you.

Gabe (44:30):

And sometimes people say, I, you know, I have doctor friends who will say like, advocacy is not my thing. my job is hard enough to show up and see patients. That’s what I signed up for. And, yeah, I push back at this point and say, you’re not allowed to complain about a broken system if you’re not willing to do anything about it at this point in time. And we all need to realize that, like we’re beyond the, we can’t sit still and, and wait for someone else to fix it anymore. So get out of your seat and get involved in something. And it doesn’t have, I mean, there, there’re simple things like voting, talking to people who are in positions of power and business and politics. And I never thought I would be doing that, but I have found myself just naturally having conversations with people because that’s what happens when you start showing up is that like you, you find where you fit and where you can help hopefully be a voice for, for good and improving things and not letting us stay stuck in a black hole.

Gabe (45:33):

<Laugh>

Monica (45:34):

That is such good advice. And it reminds me, what is the, the kind of tagline on your Twitter account again?

Gabe (45:41):

Oh, <laugh> that I’m an accomplice in a broken healthcare system. Yeah. Inviting to transform it.

Monica (45:47):

<Laugh> exactly. Cause we all are, especially if we’re not gonna, you know, you know, take some type of action and help move things forward, for sure. We’re accomplished

Gabe (45:56):

That’s there. That is there as a reminder to me that as long as I work in this system, that I am in a way and accomplice, and that actually was so freeing once I, once I was able to say that it, it sounds a little sort of weird at first to some people I think, but it’s totally true. I am, I am part of the problem. Not intentionally, but I, I, you know, I show up and contribute. We

Monica (46:19):

Are

Gabe (46:20):

<Laugh>. Yeah. Yeah. And I, and I don’t want to keep doing that.

Monica (46:24):

We have to choose to be part of the solution, I think.

Gabe (46:27):

Yes, absolutely.

Monica (46:28):

So, so speaking of your Twitter, Gabe, where can we connect with you online, your Twitter and website and those types of things?

Gabe (46:37):

So the place where I really want people to connect is medicine.org. Great. I, we have a, a free newsletter for anyone, whether doctors or anyone, even outside of healthcare, who’s interested in this can subscribe and can see what’s going on with our organization. And one of the things as it, as it’s meant to be a conversation. So if you have something to say about these things, you can reply to the newsletter and we’re small enough at this point in time that you’re, you’re, you’re gonna be heard and you might be responded to, or brought into the group if you’d like to get involved. So that would be the first place on Twitter. It’s at Gabriel Dane, like a great Dane. And yeah, I that’s the place I’m most active on social media and then fight burnout.org. If you wanna see the t-shirts that we were talking about earlier.

Monica (47:30):

Great. And can people still get the t-shirts? Are they available?

Gabe (47:33):

You can order them there’s a link to get them from Teespring, they’ll print one up and ship it to you. And proceeds are actually donated to Medicine Forward for the nonprofit work and advocacy. And the other thing is I still periodically will send them to someone if I think they’re doing something really inspiring. So that’s my challenge to someone listening to this is like, do something that knocks my socks off about burnout and you’ll for sure get a shirt.

Monica (48:01):

Oh, I love that. That’s a great challenge. So. All right. Well, thank you so much for being with us here today and I’ll, I’ll post those links in the comments below as well. So thanks Gabe, and keep, keep doing what you’re doing.

Gabe (48:16):

<Laugh> thank you, Monica. I, it was a lot of fun and it was great to catch up,

Monica (48:21):

Talk to you soon.