Susan Salka, AMN Healthcare CEO on growing $5mm company to $2bn

Susan Salka, AMN Healthcare CEO on growing $5mm company to $2bn

Today I’m joined by Susan Salka, CEO AMN Healthcare Services. The largest healthcare staffing company in the nation. Susan joined AMN when it was just 18 employees. Rising through the ranks, she now runs this $2.5 billion company that leads the nation in placing nurses, physicians, and other healthcare personnel. She’s also an advocate for promoting women in leadership and in the boardroom. And has implemented a bottom-up approach to increase diversity at all levels of AMN. Susan shares with us today her thoughts on clinician burnout, changes we need to make in our healthcare education system to address physician and nursing shortages, and how her company is evolving to meet growing workforce demands.

Bill Frist:                       Welcome to A Second Opinion Podcast, where we are rethinking American health. I’m your host, Senator Bill Frist. To make sense of all the dynamic perspectives in healthcare, you need a trusted source engaging at the intersection of policy, medicine and innovation. You need A Second Opinion, a podcast where it all comes together.

Bill Frist:                       Today I’m joined by Susan Salka, CEO AMN Healthcare Services. The largest healthcare staffing company in the nation. Susan joined AMN when it was just 18 employees. Rising through the ranks, she now runs this $2.5 billion company that leads the nation in placing nurses, physicians, and other healthcare personnel. She’s also an advocate for promoting women in leadership and in the boardroom. And has implemented a bottom-up approach to increase diversity at all levels of AMN.

Bill Frist:                       Susan shares with us today her thoughts on clinician burnout, changes we need to make in our healthcare education system to address physician and nursing shortages, and how her company is evolving to meet growing workforce demands. And now please join me and our guest for A Second Opinion.

Bill Frist:                       Susan, AMN, it’s the nation’s largest healthcare staffing firm, it’s the largest travel nurse firm, it’s the largest allied healthcare staffing firm. It’s big in its workforce. What is AMN, and what do you do?

Susan Salka:                  First of all, thank you for the opportunity to sit down with you and talk about a subject that I know is very near and dear to both of our hearts.

Bill Frist:                       Yeah, thank you.

Susan Salka:                  So, I appreciate it. So what we do every day is really help healthcare organizations make sure that they have the right person in the right place at the right time. And that sounds simple, but as we know, the war on talent is extreme today and it’s going to get harder. And in healthcare, it’s particularly important, and you know this, probably even better than I do. It’s critical that you have the right skills, the right competency, the right compassion, the right attitude. So, how do we do that?

Susan Salka:                  We, as you pointed out, are a staffing company, we recruit nurses, doctors, allied professionals, healthcare leaders, revenue cycle professionals on both a contingent temporary basis, but also we are one of the largest permanent placement firms for those different skills. On top of that, we are also the largest provider of workforce solutions. And this is where we can help our clients to reduce waste, create efficiencies in the way that they staff, but also do a better job of predicting what their staffing needs are going to be and scheduling people.

Susan Salka:                  And that all helps ensure that they do have that right person in the right place, and they’re not scrambling at the last minute. And as you can imagine, it provides for a much better patient experience, and a much better outcome.

Bill Frist:                       Yeah. Just from my own patient experience over the years, I realized increasingly the sort of empathy part of care and care delivery is a critical, we know that. But you know what great technology is never going to be replaced? It’ll be facilitated, it’ll be helped along, but what you’re involved with, which is that human connection, when people are sick, when people have a problem, when people cry out for help, when people are scared, that person and the first person you think of typically is a nurse, or a doctor, or somebody who is there. The shortage though is there. And the numbers, and we’ll recite some of the numbers, but everybody knows whether it’s nurses, primary care physicians, allied personnel who facilitate the patient, the individual interaction with the caregiver. And there’s a huge shortage. Can you put that in perspective [inaudible 00:04:21]?

Susan Salka:                  Sure. So the shortages are driven from a couple of different macro drivers. One is just the aging population in general. Americans are getting older, and in fact, one of the statistics that really startled me is that by 2030, we will have more people over the age of 65 than under 18. What startles me even more is I’m going to be one of them. But-

Bill Frist:                       Yeah, [crosstalk 00:04:44], but that’s fine.

Susan Salka:                  … I want to make sure that for you, and for me and others, that we have the workforce to take care of them. But the problem is that, healthcare professionals are also aging. I think a lot of folks don’t know that half of nurses are over 50 today, and by the time they’re in their early to mid 50s, they start wanting to retire from patient bedside care. They might go on to do other things, but they often leave the patient bedside.

Susan Salka:                  Physicians as well are aging, and they can generally work later into their career, but we’re going to be hitting this tipping point in the next five to seven years, when we’ll actually have more people retiring from healthcare than are coming through the front end. And part of that is the education system, for nurses in particular, not having enough slots in schools to create and educate our future nursing workforce.

Bill Frist:                       Stop, I want you to continue down the list, but on that, why is that? And the same thing with medical schools, they’re controlled how many people graduate, people don’t realize that, but our audience very much looks at the policy, as well as the health, as well as innovation. And why is there a policy that restricts the number of nurses being [crosstalk 00:06:01]?

Susan Salka:                  Well, in the case of nurses, it’s not policy as much as dollars. In order to educate nurses, you must have the schools, which cost money, and often they’re subsidized. But also, you have to have the clinical lab space. And we turn away over 50,000 qualified candidates from nursing schools every year as a country. So we could be increasing our nursing workforce of the future, but it’s limited by that school bottleneck. Part of it also is the faculty. We don’t have enough nurse educators. And those that are becoming nurse educators, often want to work in teaching at the graduate level, or they themselves want to become nurse practitioners, or physician assistants, which is wonderful, but it does limit the number of faculty that’s there to teach the nurses.

Susan Salka:                  On the physician side, it’s the medical schools. But the residency programs, as you well know, is the bigger bottleneck. We’ve hardly added any new residency slots for new physicians in the last three decades. And that is absolutely a policy issue that could be addressed. Another side issue is immigration. We don’t have enough new talent coming in from other countries that could help alleviate some of the shortage. Now, certainly we do have some phenomenal foreign educated physicians and nurses that come into the country, but it’s a drop in the bucket compared to what we need.

Susan Salka:                  So if you fast forward into 2030, 2035, we’ll be short somewhere between 120, and 130,000 physicians. A lot of those are primary care, but also a lot of specialty physicians and surgeons, such as yourself. And so, that’s going to be a tremendous constraint on the healthcare system. In nursing, it’s even worse. Nursing, depending upon the study you look at, it can be between 150 and 300,000 nurses that we will need, that we’ll be short actually. And that’s all coming at a time when our country needs those clinicians most.

Bill Frist:                       And what do you see is the role of technology? We hear, we see in its infancy really things like telemedicine, which will be helpful. But do you see technology being able to fill in some of this shortage that all of the predictions state exactly what you, a huge, huge shortage that will affect patient care. What is that role of technology?

Susan Salka:                  It can absolutely help. So you mentioned telehealth, which has already been evolving over the last couple of decades. And I think it’s picking up more steam. Now a lot of really fantastic tech companies, emerging companies, companies you’ve been involved with that are bringing some interesting innovation to the market. And we actually think it’s a great opportunity for AMN, because we have this immense workforce, we have the largest talent pool across the country of clinicians that want to work remotely. In fact, we get requests all the time from our clinicians.

Susan Salka:                  And so we work with some telehealth organizations today, but we think that’s going to continue to emerge over time. And it’s going to be not just a nice to have, it will be a necessity in order to be able to provide care for patients and give that access that we need particularly in rural areas, but it’s also going to be needed in urban areas. I think probably our millennials of today are going to even prefer to work through technology in many ways. So I think you’ll see faster adoption both by healthcare providers, but also by consumers themselves.

Bill Frist:                       When you introduce technology to a workforce, and you’re dealing with hundreds of thousands of people in the healthcare workforce, how threatening is it? I know in the telemedicine world, where I’m familiar to put a physician for the first time before a camera and say, “I’ve got to interact with the patient through a camera,” it’s intimidating. There is a barrier there, it’s different. Or I’ve got to do my consults over a telephone, where I can’t see, or touch, or feel the patient. Now, we’re asking nurses to take iPads or tablets into the home to do checklist, and allied personnel. Do you find it threatening or do you find it people are pretty adaptive and receptive to that?

Susan Salka:                  I think the healthcare workforce is more and more adaptive every day. They see it is the only way we’re going to be able to provide that, that access to care as I stated. But also it’s just the reality of how they’re probably doing things in their personal lives. We all work with technology, whether it be to do our banking, or even make our healthcare appointments. So it’s being I think, it’s being introduced in a way into our personal lives that probably also makes it more palatable in our work lives.

Bill Frist:                       People are more accustomed to it. [crosstalk 00:11:01].

Susan Salka:                  Yeah. And let’s face it, with half the workforce being millennial workers, particularly in healthcare, it’s the way they’re accustomed to doing things. So I think that will also continue the adoption.

Bill Frist:                       I get a lot of feedback from our podcast from viewers asking more about burnout. We’re talking about the shortage, and we talked about the pipeline coming in and the restriction there, and the earlier natural retirement from physicians, huge burnout. Are you seeing that across the spectrum of patient care?

Susan Salka:                  We absolutely are. In fact, we’ve recently done some research to survey nurses about burnout. And last year a physician survey. And across the board we saw increases in frustration with the job, but also just burnout to the extent where they’re thinking about leaving the profession, or retiring early. And there, as you well know, been several other studies that have supported this. And they range from burnout of a third to 50% of the nursing and physician workforce down to maybe 15. But whatever the number is, it’s extreme, and it’s exactly what we hear from our clients and from our clinicians as we’re placing them.

Susan Salka:                  Part of the issue is under staffing. I think a lot of healthcare organizations are trying to do things to create better work/life balance, and throw in some interesting things like concierge services, or you can work one day a week from home, which is not … I’m sorry, one day a month from home, hard to do that as a nurse if you’re doing one day a week. But it still isn’t enough. Or if we just pay you a bonus.

Susan Salka:                  But our clinicians aren’t saying they want more money necessarily. I mean, I’m sure everybody would like more money.

Bill Frist:                       Yeah, I think you’re right.

Susan Salka:                  But what they want is to be able to have the time to care for the patients in a way that they feel is going to delivery a quality experience and quality outcome. They want to be able to use their technical skills, but also their compassion. And when they’re being asked to take on more patients than they feel is safe, or compromises the quality of care in any way, they push back. And that’s when you see high burnout lead to turnover, which leads to vacancies. And right now, we’re at about the highest watermark we’ve ever seen in this country in terms of vacancies.

Bill Frist:                       So, I can see for your staffing standpoint, you’re called in all the time to fill these gaps that are created. On the flip side of that, are you able to do anything with your thousands and thousands of nurses to prevent them from becoming burned out? Is there any programs that you have, or continuing education, or some sort of balance, or say you can’t work too many hours, what sort of things can you do?

Susan Salka:                  Yeah. Well, our nurses work an average of about 37 hours a week. But I’m sure those 37 hours are quite intense. So, I don’t think they necessarily want to work more, we don’t really incent them to work more, we leave that up to them. But we do provide a variety of continuing education programs. But then also wellness programs for our clinicians. Through our health and medical programs we provide some wellness opportunities for them to get involved in things like meditation, and mindfulness, you’re promoting exercise, and good nutrition. I’m pretty sure our clients are doing many of the same things. But in the case of our clients, they’re in a situation where they have patients coming in the door that need care.

Susan Salka:                  So while they want to provide programs to support their clinicians to be healthier, the reality is, when the patient walks in the door, they need to be cared for. So, they’ll ask the clinician to work more overtime, to take and more patients. And it’s hard to get out of that vicious cycle unless you have more staff.

Bill Frist:                       When you place, again, I know you’re all over the place, but when you place a nurse somewhere, on average, how long do they stay?

Susan Salka:                  Three months is a typical assignment. But about half of our clinicians will extend where they are and take another three month assignment, or extend for another maybe six to eight weeks. So we often have clinicians that decide that they want to stay permanently, and they convert, which is great. We take that as a good sign that we really have done our job well.

Bill Frist:                       Yeah, you got good people right there.

Susan Salka:                  Everybody wins. We always want to make sure that we’re balancing meeting our clients’ needs and finding them great people and we know they want to recruit some of them permanently. But remember, the clinicians also are pursuing their personal professional goals, and that might not always include staying at that facility. They’ve come to us because perhaps they weren’t getting that fulfillment professionally or personally where they were. And so we can provide them with an opportunity to travel around the country, work at some amazing facilities, Vanderbilt, or NYU, or New York Presbyterian, or a Kaiser facility. They can build their skills, be a part of amazing teams, either learn things or teach things while they’re there, have a great personal experience and then after three months they can move on to the next great adventure.

Bill Frist:                       I introduced our discussion with you largest, largest, largest. How big are you?

Susan Salka:                  Our revenues are a little under $2.5 billion. So we are the largest within our industry. But I tell our team all the time. Being the largest doesn’t have to mean that you’re the best. We need to be the best before we’re the largest. And so, we’re always looking at how we can think about delivering more value to our clients and our clinicians. You and I talked earlier about our strategy of growth, and it’s really been a combination of organic growth and delivering to our clients and our clinicians every single day. And as they’ve grown, we’ve been able to grow with them. But we’ve also done acquisitions. We’ve done about 26 acquisitions.

Bill Frist:                       Over how long a period?

Susan Salka:                  Over 30 years.

Bill Frist:                       How many billions of dollars was it when you started?

Susan Salka:                  Well, I-

Bill Frist:                       When you first walked in the door.

Susan Salka:                  It wasn’t billions, it was about 5 million.

Bill Frist:                       $5 million.

Susan Salka:                  I was employee number 19.

Bill Frist:                       Number 19.

Susan Salka:                  And I’m celebrating 30 years with the company in February.

Bill Frist:                       So, where did it start? You walked in the door when you were three years old, if they know when … when you were young, and just go ahead and tell me a little bit about your life story, because it is quite remarkable the fact that you took a very small company and now you’re [inaudible] being is an amazing, amazing size. But it’s a big thing, in 50 states, and beyond, you’re touching so many people every day, every day, in the most intimate parts of their lives, which is the best part of the story.

Susan Salka:                  I agree.

Bill Frist:                       So, you walked in the door, what did you do and how did you get to where you got? I know it’s other people who pushed you all the way there. But tell the story.

Susan Salka:                  Absolutely. It’s always a team effort as you know. When I started, I’m again employee number 19. I was the head of finance, which basically meant cook, dishwasher, whatever, and I kept the books.

Bill Frist:                       [crosstalk 00:18:34].

Susan Salka:                  So, you do a little bit of everything.

Bill Frist:                       Debit and credit.

Susan Salka:                  And our industry was really just growing and emerging at that time. And I think this is actually a great lesson for emerging businesses today. This is a story of a cottage industry that grew up and began to serve clients in a more complex, sophisticated way. But we had to be willing to change and evolve along with it, both as a company and as individuals. I was head of finance, which basically meant I did everything accounting and finance.

Bill Frist:                       What year was this and where were you?

Susan Salka:                  1990. And it was in San Diego.

Bill Frist:                       And what was the name of the company?

Susan Salka:                  It was American Mobile Nurses.

Bill Frist:                       Yeah, AMN.

Susan Salka:                  AMN, which is where the AMN comes from. A lot of people don’t know that. And I had grown up in Nebraska actually before that, in a small little town, and had just been in San Diego for about two years and found my way to AMN just through a set of fate and circumstances.

Bill Frist:                       Were you in healthcare before?

Susan Salka:                  I was, when I graduated college, I worked for a little bit in Nebraska and then I packed my car and had dreams for going out to California to find what my future was.

Bill Frist:                       [inaudible 00:19:47].

Susan Salka:                  And I landed in San Diego. And fortunately got picked up by a wonderful company called Hybritech, that was being bought by Eli Lilly at the time. And I was just a financial grunt, as you would say, and when the CEO and the CFO left after the integration, they took me with them to start a venture capital firm. So we started six different companies. They were all-

Bill Frist:                       They all went bankrupt?

Susan Salka:                  No, they actually were, five were great successes. Pyxis is one, you’re probably familiar with Pyxis.

Bill Frist:                       Sure. Yeah.

Susan Salka:                  And Amylin Pharmaceuticals and Biosite. So I had the good fortune-

Bill Frist:                       I hope you bought a little stock in them for some [crosstalk 00:20:26].

Susan Salka:                  Well, I was fortunate to be a part of their early stages.

Bill Frist:                       So, from the venture capital.

Susan Salka:                  I joined AMN, because they decided they didn’t want to raise another fund. And we just happened to be in the same building as this little staffing company. And the owners, which were a husband and wife team, asked me to join them. I thought why not? I seem to really be intrigued with healthcare. Although I’d only been introduced to the biotech side of it, and this was services. So I joined them. And the industry grew, we grew, and you really just had to wear a lot of hats and be willing to say, “Oh, I’ll do that, I’ll do that, I’ll do that.” Even though I didn’t necessarily have experience or skills. I was 25 years old, what did I know?

Susan Salka:                  But as the company grew, it gave me opportunities to learn new things, and grow along with it. I still remember a particular meeting I had with a client, I think I was about two years in. And this was a real turning point for me. Because I’d seen it up until then as a business that we were building, but I was visiting a client. Usually, you go in and you meet with the client in their office, or in a conference room, at the hospital, some place.

Susan Salka:                  And this particular client, which was actually here in the DC area, said, “Let’s go out on the floor, I want to show you what your nurses do to make an impact for us.” And she walked me around, and I got to meet all of our nurses that were working. But more importantly, I got to see firsthand the important impact that they were making and what they had to deal with every day. It gave me a whole new appreciation for the importance of the work that we did.

Susan Salka:                  And we often say every patient is somebody’s mother, brother, sister, father, child. And you fast forward 25 years later, and that patient was my father that was in the hospital. And it ended up that an AMN nurse was caring for him. And she was amazing. She was competent. She looked like she was 16, but she was experienced and extremely competent, and very compassionate, and very caring. And I thought, “Wow, this is really where it matters.” Even when you think you have a passion for the business, when you add that personal experience and element to it, it just takes things to a whole new level.

Bill Frist:                       That’s a really good lesson, I think, again for people listening and for me and others, is that immersion, and allowing your employees, and your staff, and your family to really be immersed and to see the impact that they’re having, especially in the healthcare. Of all of the scores of podcasts we do, [inaudible] underlying thematic almost and everybody emerges at, if you have a career in health, or healthcare wellbeing, you have a huge mission, and you have a real advantage other people in life just don’t have because if you make the connection, you know you’re touching some other lives, and in your business where you have this sort of network of people going out every single day, I know it’s gratifying.

Bill Frist:                       Your success is really remarkable. And I hear all the time. But it’s not really fair to say why is that. What underlying, for people who are listening, was she lucky? No, because you had to keep moving your way to the top. And yes, you keep, you mentioned there’s this current behind you of growth in the field itself. But what a little bit deeper than that do you explain your success when you talk to younger people when they say why?

Susan Salka:                  I do think it starts with having a passion for what you do, and you’re right, healthcare just innately brings that particular purpose and passion. But you have to believe it in your heart. And your team has to see that you are sincere, and that you believe it. And you need to talk about it all the time. And even when you yourself need to reignite that passion, you find ways to do that, and never forget what you’re doing what you do. And why it matters so much. So that personal connection and passion is just so important. Another would be the culture of the company and the team that you work with. I wouldn’t be here after 30 years if I didn’t think we had an amazing culture. Yes, it’s talented people, but it’s so much more than that. It’s people who have great values, and ethics, and share a common passion. And you have to be willing to go above and beyond, because our work is hard.

Susan Salka:                  We’re supporting clinicians in hospitals who have even harder work. So you have to be willing to always go that extra mile, and pour yourself into it. And if you don’t, you’re probably going to think the rest of us are crazy, and it’s not going to be as much fun, you won’t feel like you fit in. So I tell that to people joining our company and the industry all the time. And then you have to be willing to persevere. Things will get in your way. They’ll get in the way of serving our clients or our clinicians. Sometimes they’re external issues, sometimes they’re self-imposed. You have to be willing to endure through and persevere through those challenges as a team, but also as an individual.

Bill Frist:                       How much is luck and how much of it’s hard work?

Susan Salka:                  It’s like 99% hard work. And you can have luck, but you have to be willing to persevere through that luck, see it as an opportunity, and as they say, it’s that door that opens, but are you willing to step through it? And we talk a lot, at AMN, about getting uncomfortable and persevering. When you feel uncomfortable, and maybe even a little bit scared, that’s when some really interesting thins are about to happen.

Bill Frist:                       It’s like you’re sensitized.

Susan Salka:                  It is.

Bill Frist:                       All your sensitivities are ready and receptive.

Susan Salka:                  Yeah. And you learn the most when you go through those challenges, and you come out the other side stronger with probably more character and oftentimes more caring too, because you see the impact of those challenges on other people too.

Bill Frist:                       Yeah, and the empathy that just brought forward from it. In my 20 years in medicine, which I loved, and that is the foundation for everything that I do, in healthcare there are probably 80% women, if you really looked at all of health and healthcare. In my medical school class, it was probably 25% women. But today, it’s probably 55%-60% in most medical schools. Last week I was at the biggest healthcare conference, and many private equity, investment bankers, 7,000 people, and there were probably 5% women.

Susan Salka:                  I was one of them.

Bill Frist:                       Yes, exactly. And then, the United States Senate, you mentioned, we’re in Washington DC now, and half a mile away is the State Capitol, and when I was majority leader there, in 100 elected officials, there were a handful of women. Yet, in countries in South America, and Latin America, if you look at their state legislators is 60% women. I say all that really building up to this big issue, which you have been such an articulate clear minded spokesperson on, and that is the value of having more women in the boardroom, in leadership positions. It falls under diversity, it falls under all sorts of nomenclatures. But the big thing is having this richness of ideas and discussion, and the productivity, the results. Take that and run with it a little bit about this whole issue of women in leadership. What can be done? The need for things to be done.

Susan Salka:                  Yeah. Thank you for shining such an important light on the issue, because we haven’t made as much progress as we could and should have. I think a lot of people for years were saying, “Oh, we’re making progress.” But actually, if you look at just the top Fortune 1,000 companies, we actually have gone backwards. There are now less female CEOs than there were just 10 years ago. I’m one of the top 25, and we used to have about five more. So that just shows you how few there are. And it’s not just public companies, it’s private companies, it’s healthcare organizations, and it’s not just at the C-suite, it’s in boardrooms as well.

Susan Salka:                  The average public company now has about 20% female representation on their board. At AMN we have 44%, I’m very proud of that, but why is that? Why aren’t we making more progress? And some of it has to do with needing more women to be in the C-suite jobs, because that’s usually where boards look to-

Bill Frist:                       [inaudible 00:29:42].

Susan Salka:                  … right. So, boards have to be willing to look beyond the traditional, obvious, “Oh, I want a CEO on my board.” Right?

Bill Frist:                       Yeah, or the CFO.

Susan Salka:                  Because if they start there, they’re automatically limiting themselves. So to be open to other positions in other backgrounds. So, a CFO, or a CIO, or Chief Experience Office, or a Chief Nursing Executive, what are the other talents and experiences that would bring richness to the boardroom? And we need more and more of that diversity. And it goes far beyond just women. It’s really diversity of thought, it’s diversity of age, diversity in ethnicity, all forms and types of diversity will bring a more holistic approach and decision making to a company, but also to the boardroom. So, how can we help make that happen?

Susan Salka:                  Certainly I think continuing to shine a light on the issue, but wherever possible, when you are in a position of leadership, on a board, or in any kind of leadership role, that you’re looking at your own diversity within your organization and saying, “Are we really happy with where we are?” You can set goals and set metrics, but sometimes I think it just stares you in the face. And you don’t even need to know what a number is, it just doesn’t look right.

Susan Salka:                  And so, putting together diversity metrics for your leadership team, but all the way through your ranks. A few of the things that we do at AMN to help ensure this happens is we used some filters around gender diversity, and ethnicity for things like promotions. Let’s look at everybody we promoted this year. And how do the numbers fall out? If they look different than our general population, or what we want them to be, why is that? Is there unintended bias? Fortunately, there isn’t the case with us, we have some really good numbers, but we want to make sure that we continue to look at them. And then as we’re thinking about recruiting from outside the company, how do we think about infusing diversity into our leadership ranks?

Susan Salka:                  We have a key talent program, as many companies do of our size, where we have development programs to help prepare our future senior leaders. When we look at the 20 people in key talent, are they a diverse group of people? Are they just, do they all look alike? [inaudible] have the same experiences. I also think in our particular industry, staffing and recruitment, we have a really great opportunity to help our clients by ensuring that when we do work for them, to recruit for permanent positions in particular, but it’s true a bit in contingent, that we are putting forth a diverse slate of candidates whether they ask for it or not.

Susan Salka:                  So how can we use our resources and our touchpoints with our clients to make sure they know we are there to help them around issues of diversity and inclusion? So, I know I strayed a little bit from the female executive, but it’s everything. So I think every leadership look at where are my opportunities? So, I’ve given a challenge to all of my leaders across all of our different businesses to say, tell us how you can help our clients to achieve their diversity goals.

Bill Frist:                       It is, I’m on too many, but four public company boards, and literally every board, if it’s on the nomination committee, or the selection committee, every meeting begins with an, how can we increase our female … diversity [inaudible 00:33:30], as you’re saying, but the numbers. And I think your example of what AMN has done at really starting it [inaudible] vertically coming all the way through. And I think your point about recruiting from not the traditional means is just so critical because even the search firms, when you come in and say, “I need this sort of person with this experience, that would sit in a CEO type position.” And that’s just not going to be possible from a numerical standpoint.

Bill Frist:                       I want to switch to one final topic, and there are so many things we could talk about to go on. But there’s something that I noticed, because I’ve heard about and heard you speak on it, and I know it’s a part of your fabric in terms of what you do. But people ask me all the time about the mission trips that I’ve done over the years. And when I was here in the senate, a lot of the legislation I wrote ended up being on experiences that I had overseas. HIV/AIDS, and PEPFAR, and president Bush emergency program for HIV/AIDS, and malaria and tuberculosis. And it really, in part, came from experiences that I had in talking to other people, lots of different people. But those stories that I could tell my colleagues of people on the ground.

Bill Frist:                       Tell me about what AMN does in Guatemala, because people ask all the time. I’m a corporation, I don’t understand it, I don’t know how to do it, I don’t know the advantages of it. But tell me the AMN story.

Susan Salka:                  Thank you for asking. The work we do in Guatemala is one of the thing I’m most proud of for AMN, but actually also for me it’s been life changing. We started going down to Guatemala about eight years ago as part of a broader medical mission where we take nurses and physicians and other healthcare professionals to the most impoverished areas of the country to provide clinic medical care, but also we set up a surgery center and do, in one week, we do about 150 surgeries and see about 1,000 patients. Look at me, I’m saying we, as if I’m doing the surgeries. But I do go, in fact, I’ve gone every year. And my husband usually joins me.

Susan Salka:                  And those of us that are not clinicians go out into the hills, into the homes of the indigenous people, and we install water filters and stoves to try to get to the root cause of many of the medical issues, but also economic issues. Because women have to go collect firewood, and they have to tend to the stove, the fire pit is what they used before we installed a stove to get the smoke out. And so they can’t go to work, they can’t go to school, the children end up having to drop out of school. So I could go on and on but you get the picture.

Susan Salka:                  This is meant to be a holistic and sustainable program. So we’re not only coming in and helping with medical issues, but we’re really getting to many of the root causes. And it is, for us, one of the most amazing opportunities to come together with our clinicians and we bring corporate team members down to be a part of the stoving team. And we get to work side by side on one common mission. It’s really hard to find those opportunities to create that kind of experience. And it really, for our organization, not just the people who’ve gone, but the whole organization, it’s become a cornerstone of our work in the community. And even for the individuals that don’t go down to Guatemala with us, because we can’t take everybody, it becomes a symbol to them of what can be done when we come together with our time, our talents and our resources. And it reminds us that we can do more.

Susan Salka:                  We can do more in our own local communities. Yes, we’re thrilled to go to Guatemala, and help the wonderful warm families down there, and we’re proud of that work. But we’ve got work to do right in our own backyards and in the US. So it’s a huge part of the AMN culture. We have a particular saying which is, “Make an impact.” And also know your impact. Every day know what impact that you’re making. So we use every opportunity to do that.

Susan Salka:                  So, I often have leaders ask me, “How can I get involved in something like that?” And I was admittedly a little bit scared when we first thought about going down there. But fortunately we found a great organization to plug into. I would suggest to try to start something from scratch, and there are lots of great organizations, the group we work with is International Esperanza Project, and they specifically focus on Guatemala. So they have an infrastructure. And we’re able to provide people and resources and other ways by getting other companies involved.

Susan Salka:                  And then, I would say also get involved yourself personally. If there’s a leader, a CEO, or senior executive of a company that wants to do this, call me. I’d be more than happy to talk about it. Because I had fears about my team going down there, I had concerns myself personally. And once I went for the first time, I realized we must do this.

Bill Frist:                       Yeah. It is, this sort of mission trip, people are scared to do it, they’re uncomfortable, they don’t know who to make that first call to. I think the fact that you’ve done it, and embedded that in your culture, is a great manifestation of A, the opportunity, but B, that whole acceleration of culture, and understanding, and empathy, which are the basic values of AMN, but any healthcare entity that’s out there. It changed my life, I mentioned the impact on the United States Senate, but I’ve probably done 20 mission trips with the same groups to 14 different countries, and operated throughout. And literally, I keep going back, in a very selfish way, you’re helping other people, in a selfish way because of the growth that it creates within you. I guess, we need to bring things into a close just because that clock keeps ticking.

Susan Salka:                  No.

Bill Frist:                       But look forward to having you back on. We ended on culture, we started there in the early part of your story just because of I’ve read so much about you, and know it that early on, when you were in your 20s, you were identified and basically promoted and recognized because of your commitment to culture. And being a role model for others, and inspiring them in ways that gets the best out of them. But again more important, helping hundreds, thousands, millions of people around this country. And then, I think it’s appropriate we end on the story of Guatemala, because it’s just another manifestation of the importance of culture and your emphasis of culture. And when I asked you how you made from a $5 million to a $2.5 billion company, I think it does come back to you, your commitment and lifting other people up through that culture of caring and generosity. Thank you so much, Susan, [crosstalk 00:40:32].

Susan Salka:                  Thank you.

Bill Frist:                       I appreciate it. Thank you.

Susan Salka:                  Thank you, appreciate it. Thank you very much.

Bill Frist:                       You just finished listening to the conversation Susan and I had shortly before the COVID-19 pandemic hit the United States. Now, Susan is joining us remotely to give us an update on how AMN Healthcare Services is stepping up to respond.

Susan Salka:                  I wanted to share some of the things that we’re doing to support our healthcare organization clients, our clinicians and healthcare professionals, and our team members. We are providing the clinicians that are often coming in to help in the midst of this crisis. We’re also providing technology. This is just a representation of a few of the things that we’re doing. As an example, I mentioned the technologies that we have built and acquired over time. We’ve been able to work with many of the state associations and some of our hospital clients to very quickly implement an open talent marketplace so that hundreds of healthcare staffing organizations can submit their candidates and get those individuals placed quickly. Even if it’s not us.

Susan Salka:                  We may place just a small percentage of that. But we were able to bring technology to bear, so that they can very quickly launch, in this case of New York as an example, a statewide float pool that’s being managed by the New York Hospital Association. We have also been able to quickly add in some scheduling technologies so that our clients can quickly open additional units. Or in the case of the temporary facilities and ACSs, quickly mobilize these offsite care settings. We can provide technology for the staffing and scheduling. We can provide the interpretation services. We can provide the healthcare leaders, the physicians, the nurses. There are so many components that we can bring together. I wouldn’t say it’s completely turnkey, but as you can imagine, in many cases, the organizations that are standing this up haven’t done this before. None of us have actually had to do this to this magnitude for ever.

Susan Salka:                  And so, we’re working together with them to bring all of our resources to bear to try to help navigate that quickly. And I’ve been so proud of how state organizations, and healthcare organizations, and our organization and industry have come together to very quickly stand up and equip these facilities, particularly from a workforce and a technology standpoint. We’ve mobilized over 5,000 clinicians, specifically just for COVID demand over the last three weeks. Within the organization, we of course place many more people than that. But this is just specific to COVID.

Susan Salka:                  And then, just finally, we can real time track where the hotspots are from a staffing perspective. I know there’s lots of data out there about the patients themselves, but we can often get another view, another filter by looking at where demand is growing the most. And that could give you a little bit of a precursor into where the next hotspot is going to be. And as we think about licensure as an example, and the need to get people moved from one state to another, it can help us get ahead of that with our clients if we start to see demand growing in a new region.

Susan Salka:                  So, that’s just very few things that we’re doing for healthcare and in collaboration with healthcare organizations. It’s been, first of all, very inspiring to see how many clinicians have raised their hand and said, “I want to help.” Certainly they’re doing that locally, within their own local ecosystem. But we put out a nationwide ask for individuals that want to offer their talents and services, and we’ve had over 25,000 clinicians ask to be contacted to be deployed into some situation. And we’ve obviously not placed all of those, but it just shows the level of dedication that these individuals have in wanting to jump in and help. While many people are trying to hide from the virus as we should, we need to stay home and keep ourselves safe, these are the individuals that are running towards the fire, and running towards the crisis.

Bill Frist:                       This episode of A Second Opinion was produced by Todd Schlosser, the Motus Creative Group and Snapshot Interactive. You can subscribe to A Second Opinion on Apple Podcasts, or wherever you’re listening right now. And be sure to rate and review A Second Opinion so we can continue to bring you great content. You can get more information about the show and our guest and sponsors at A Second Opinion broadcast from Nashville, Tennessee, the nation’s Silicon Valley of health services, where we engage at the intersection of policy, medicine, and innovation.