As Health Systems expand through acquisition and development, scaling clinical teams becomes increasingly difficult. MUSC Health System has bought twelve new hospitals across the state. It uses technology like Virtual Cockpit and Rad Companion to virtually scan across the state to create efficiencies in its clinical workforce. While the technology is in place, it is also important to have a deep pipeline of clinicians, so they have partnered with the city of Charleston and the Charleston County School board to fund six graduates each year to a local college for full-ride scholarships to medical programs like a lab, rad tech, pharmacy, and medical assistants and nursing. Join us for a deep dive into these programs with Ron McKee, System Administrative Office for MUSC Health.
From Automation to Community Collaboration - Staffing the Hospital of the Future
Megan Antonelli: Hi, welcome back to Health Impact. We are here today with Ron McKee. He is the system and administrative officer at M U S C Health. And we met back in 2019 in person in New York at the Digital Medicine conference. It was actually the last in-person event we did before the pandemic happened.
So it's great to see you Ron. Thanks for being here today. Good to see
Ron McKee: you. . So
Megan Antonelli: it's been it's been a long few years there, right? It's been, you know, long. Three years. What, tell me what you've been up to. Tell me about how your roles changed. I think you were over at, at Hopkins then, so you've had a move and a new role.
So tell me about that.
Ron McKee: Sure. So I actually came right in the heart of the pandemic. Perfect time to make a transition to the Medical University of South Carolina to do a system administrative officer role of our imaging services. So, M U S C owns 14 hospitals. They were trying to integrate across the health system.
So it was really a good opportunity for me, creative opportunity for me, and I really get back to my roots, which is being back down south where I, where I belong. So Hopkins was an amazing place, but little too cold for me.
Megan Antonelli: Yeah, I bet, I bet that that's nice. And then I know you have a new role coming up.
You wanna talk, tell us a little bit about.
Ron McKee: Sure. So I'll be transitioning into our Columbia market, which is three different hospitals in the capital of state South Carolina. We have three hospitals there that we just merged with about a year ago that are in transition, and they're looking for a new chief operating officer.
So I'll be taking a COO role of that market probably over the next 30 days, making that transition. But if we're gonna be honest, it'll probably be a six month transition. So, multiple feet and multiple different pots right now. So it's a lot of work, but it's, it's.
Megan Antonelli: Fun. That's exciting. Congratulations.
Thanks. And are you, do you still do clinical work at all or completely administrative, you know, in the, in the operations side?
Ron McKee: Yeah. I've been probably completely operations now for about 15 years, so, okay. I made the transition. Obviously the, the height of covid, we all did what we needed to do and, you know, got into the weeds and really helped out put on some gloves and moved patients and did what we needed to do when we were short staffed.
But for the most part, I, I sit in an office and do meetings and, and planning and budgets and more purely administration. . Right.
Megan Antonelli: And now with the I know you had mentioned that S M U S C had done, you know, they've done a lot of expansion over the last couple of years. Tell us a little bit about how that's impacted your role and internally, I mean, with the pandemic and with.
Obviously we're in the midst of the, you know, great resignation that is impacting healthcare you know, in numerous ways. Tell us a little bit about what, how that's been and, and how the integration has, has helped and, and you know, what the things you've been working on.
Ron McKee: Sure. So to be honest with you, in the last three years we were.
I came on board when we had just bought M U S C, Florence, M u s C, Lancaster, Marianna Chester, four hospitals kind of in the upstate of South Carolina. Mm-hmm. , they already had transition plans to purchase the three hospitals in Columbia, in four hospitals in our like Merle's Inlet, Myrtle Beach area.
So, That all happened since I've been here. So we moved into that transition and I think just like every great organization they're trying to expand to improve their footprint, to take care of their patients. So we pretty much covered the entire state and we're getting ready to make another transaction here soon.
It will help us with that. I will say that Covid kind of put a huge damper on a lot of our growth. We, we have bought a lot of hospitals but we're trying to staff 14 hospitals and compete against ourselves and compete against other hospitals in our markets for staffing. And in full transparency, I think it's probably been, in my 26 years, it's probably been the hardest I've ever had to, to recruit and to bring in staff.
I actually gave a lecture on this not long ago, and Barcelona, Spain talking about, A problem that we're having with staffing. And I was on stage with somebody from Ireland, Germany, great Britain, and obviously the US and we are all talking about the same problem. So it's not a South Carolina problem, it's not a North Carolina problem.
It's not a US problem, it's a nationwide problem. Mm-hmm. . And really what happened is, I think most of us know, especially in the us, we had the baby boomers that really were. Big part of our workforce and those folks were getting ready to transition over a 10 year time, which is fine because you have an influx of students coming in.
Right. So those, the students are a pipeline in, we got the baby moves going out, it's spread over 10 years. We can make it work. Mm-hmm. . Covid happens now we can't make it work because what did they do to shut the schools down for a solid 18 months? So the pipeline of folks coming in weren't coming in and the people that wanted to leave, they're now a statistic.
Cuz if you remember when Covid first came out, who was it affecting? The baby boomers, the older generation. Mm-hmm. So those folks decided instead of retiring over 10 years, let's do it over the next three months. So we had probably 23% of our workforce across the state in imaging. Retire and no one coming in.
So now you have a big mass exodus cuz people are trying to travel, they're trying to make e extra money because they know that everybody's short. So people are taking traveler's jobs so that even put a more hindrance on it. So it's been rough. It's been a very, very difficult last three years. And I will tell you.
M U S C didn't shut down when everybody else shut down with the pandemic. We were opening up imaging centers and we were doing it the right way. We didn't have one issue with people getting covid and mm-hmm. . But we kept our we kept our surgeries going. We kept our outpatient centers in April.
Everybody else was shut down. We were still moving. So, it's been interesting, but we've had to repurpose and move people in different places. Right. Well
Megan Antonelli: that's really interesting, especially you know, just globally that it, it. You know, an issue. Were they, from that perspective, were, were they, was the issue the same?
I mean, were the, were the reason of the, of the issue happening the same, the challenges that they were ha having with staffing? Or were there differences between the, the source of the problem?
Ron McKee: Pretty, pretty much across the board it was the exact same problem I think. Wow. The one difference that I did see between us and Ireland, which was a big difference, was the way their payer model is and the way they pay their people.
It's more based off of like a Canadian setup where people all get healthcare. Everybody's streamlined the same way. Which made their pay a little bit lower than ours, so. Mm-hmm. , we have specialty care here. We have surgery centers here. Whether you wanna work at I'll leave names out of it, but if you wanna leave it work at one of the best organizations in the, in the US you might make a little more money than if you're working in a small rural hospital.
So, over there, it doesn't matter, you know, the, the payment model's the same. Everybody needs care. I think the toughest part was with the fee for service and the way we do healthcare. , it's still a business, and over there it's a necessity and people are just on waiting list. I mean, they have six, seven month waiting lists to get things in.
So the least amount of staff they have just makes that waiting list even longer, which makes their healthcare worse, so Right. Definitely a difference in that point, but I, from the most point, we're in the same boat. .
Megan Antonelli: Right. So we, and that, that makes sense. I mean, and it's, it's crazy to think about, but it is, it's certainly a global issue and something that was, you know, I mean the staffing shortage certainly with nurses and primary care doc, you know, was very you know, that problem was.
You know, in the, in the news and, and of, of before the pandemic and then with the pandemic coming, you know, it just all became critical. And obviously we've been looking at technology as a way to help and, and, you know, sort of solve this problem for a long time. What are the, you know, for you guys, what are the things that we're, we're working to help alleviate some of these strains on the.
Ron McKee: So one of the coolest things M u C has a partnership with Siemens Healthcare and they have a technology called Virtual Cockpit. So to me as a, as a child, and I'm dating myself here, but as a child, I used to watch Star Trek and things of that nature, and they wave a wand and everybody got taken care of, and they knew exactly what the problem was.
We're almost getting to that point where that technology's here, so we have the ability to sit in Charleston. And in our Columbia market, pick a hospital. I'm gonna stay with Columbia since I'm the new COO there. I'm gonna push that one . But we have the ability at Columbia Northeast, which is 150 bed hospital in, in northeast of, in Columbia, one, Mr.
Scanner, one tech. So they need to do advanced cardiac there. They can't do advanced cardiac because the tech doesn't know how to do the advanced cardiac. And what you don't, you don't want a tech doing, you know, if they're gonna do three cardiacs. You don't want that one person learning on three a month because they're never gonna keep the skillset there.
You had to do something over and over. It's repetition. Mm-hmm. . So what we ended up doing is we partnered with Siemens to bring in virtual cockpit, and what that does is it allows the tech to sit pH physically sit. in Charleston and remotely scan into their magnet. They can, the text still stays there, gets the patient on the table, and then a camera comes up just like you and I are on right now, and virtually talks to the patient and says, this is what we're gonna do.
My counterpart here is gonna walk you through the process. Then the patient gets down on the table, the scanner gets turned over to somebody in Charles. In Charleston, they're physically running the scanner, they're running the sequences, they're doing the scan. Mm-hmm. . And then at the end they look at the technologist once again virtually and say, I'm done.
I'm gonna turn the camera back over to you. So the magnet goes back to that tech onsite. They take care of the patient, they get the patient squared away and they let 'em go home. But this prevents that person have to come from Charleston for training or us to have to go there. Or even better, the patient doesn't have to physically drive two hours to Charleston to get a scan that we can.
a minute from their house, so mm-hmm. , we have the ability to go to any one of our 14 hospitals and pipe in with virtual cockpit. So it has helped us. We've actually normally would staff two MRI techs at a time. We don't have to do that. We can do tech assistance now with an MRI tech, so it's a lesser cost.
So it's, it's saved us on expenses and allowed us to give that high level of performance all across the state by sitting in Charleston. Wow,
Megan Antonelli: that's amazing. And I, you know, I've heard about a lot about it and a lot about you know, sort of different integrations and uses of the virtual cockpit, but that's, it's so interesting to hear in terms of just the You know that the tech is there and, and that the, you know, over the camera that they're doing it.
Now, where does the in terms of the readings and the analysis, and I mean, where is that all happening? Is that centralized? Where's the, where's the physician sitting or the radiologist sitting to, to do the, that? Have you been able to reduce staffing on that side of things or less
Ron McKee: so. That's a great question.
So the radiologists still stay in the Columbia market. . Anytime you do any type of contrast, Mr. Ct, even in Endo, you have to have a physician on standby because if you administer a contrast and that patient has a reaction, you want the doctor to be there to take care of the patient. So, , those room reads can be done anywhere throughout the state.
We do remote reads. We have people reading in Charleston and Florence. We have people in Florence reading in Charleston reads. We have specialty read docs, so our neuro docs, M s K docs, Orthodox. So they all have different type of specialties and they can be pumped to those docs, but there's always a physician standing by in, in the, in the department.
But our cardiac rates are done in Charleston with our cardiac specialist.
Megan Antonelli: Right. And so it sounds, I mean, That's incredibly powerful In terms of you know, the, the tech and, and being able to, you know, reach those, those markets. What are some of the shortcomings? Like what is, are there things that you wish it, it did better?
Or are there areas that you're continuing to work on and, and to improve?
Ron McKee: So I will tell you, I think one of the biggest things that you don't think about when you're doing things is the budget per se. So, you know, we built this in, we did everything. We're gonna do all these different types of studies, neuro, m s, K but there's different types of software.
So in cardiology you need a certain set of software parameters to, to be able to read cardiac. We also need the setup so that you can. Manipulate the data, I guess is the best way to say that, so that you can actually transition to heart and different sequences. And we have found, well we wanna do cardiac in that market, but we don't have the software, proper software on the, on the magnet.
So we have to upgrade that software. That's been our downside. We know we built in, cuz it's new. I think we're the first people, well may, maybe the second person on the east coast that does virtual cockpit. Mm-hmm. , I think it's done up, I don't wanna quote anybody, but it's, I've done up north. But I will say that.
When it's new, you kind of have to go through the bumps and the bruises of things that you didn't think of, and we didn't think about, Hey, we need cardiac software for each one of those magnets, and that's not cheap. It can be anywhere from, you know, 40 to $200,000. Now the offset of it's fine and in the long run you're gonna need it anyways, but it's just.
When you don't budget for it, there's nothing worse than going back to the CFO F and saying, Hey, we forgot something. Right? So no one, no leader wants to tell the CFO that you can only do that, especially not now, no . So, yeah, I would say that's been our biggest downside with it. But for the most part it's been pretty exciting.
It's, it's really, yeah. Cool technology. That's great.
Megan Antonelli: I mean, I, I know, you know, personally, we, I live in Hermosa Beach, so, LA is far, anything in LA is far right. So when you get, when we have to get our imaging done, it's, you know, always an hour to two to get there and get back. So it's a long, it's a long to, so to save that for the patients is a real experience improvement.
So That's great. But you talked a little bit about. The, the staffing and you know, obviously that, that's solving it a bit. But when you, when it comes to kind of that clinician pipeline and what you guys are doing to, to kind of get ahead of that now that the pandemic is not quite over, but it's, you know, we're moving past it.
What are some of the things that you guys have done to, to kind of build that pipeline back up?
Ron McKee: Honestly, the pipeline never went away. It actually. I wanna say built up. So we, we've had, like in that market, the cardiacs, we had probably a month and a half worth of cardiacs that we really needed to do.
So it's really just ramping up extra time on weekends and evenings where we can focus just on cardiac, cause cardiac scans take a little bit longer. You know, not to get nerdy, but. If we did a abdomen mri, it's quick, but if you do a full cardiac, it could be a little bit longer of a sequence and it's not something you wanna rush, right?
There's movements. So you wanna make sure you get what you need done. So we really had to build out almost like an or. We've had to build out block times and just load those up and, and then make sure we have the tech sitting in Charleston and make sure we have the tech sitting. They are maybe a nurse depending on what studies we're doing.
So it's really being efficient with your time has really been what we've had to do because. Truly the volume's always been there, right? Like when Covid happened. I think that was the biggest thing. I don't know who said it, but it was somebody across, if it was one of the, the politicians or for this physicians nationally that said, just because there's a pandemic here, people are still sick, like.
That didn't go anywhere. And honestly, in my mind, and really a lot of the physician's mind, it just got worse because people prevented themself from coming into the hospital. So a minor heart issue has now turned into a major heart issue, right? And probably for the next two to three years, we're gonna be playing catch up with all these major diseases that people just ignored.
But you know, it's gonna, it's, that's where the pipeline is, the pipeline's there. Right. Really just making sure we have the bodies and staff to do the work and, and quality work.
Megan Antonelli: Right. So, to that though, in terms of the clinicians and the, and the techs and getting them, you know, into you know, hiring and staffing, what are some of the things that you've done?
Ron McKee: So, different approach. Sorry. So I wouldn't say no. Interesting stuff. I would say that we. We have gotten very creative. So in the past, I think 26 years of doing this now, 10, 15 years ago, the, the local schools, community colleges, tech schools would call you to send their students in. And you know, you'd fight it a little bit like, gosh, we don't need any more students.
We already got one here. Now we're all fighting over the relationships with the schools because there's a huge shortage. Just to give you an example, X-ray programs and ultrasound programs, they may start with 24 people in their program because they don't wanna get it so big. Start with 50, 60 people because you can't teach that much healthcare to somebody.
So they'll start with 24 to 30 people. They usually only graduate about 12 to 16 because of the washout. People realize how hard it is, and it's a lot of work. It's usually, it's really a four year degree condensed into two years. So they're just cramming a lot of material. And if they don't have the manpower, I mean the, the bandwidth to take care of that, they just usually wash out and then they end up with a half class.
So what we've done to be strategic, we've done a few things. We have relationships with 12 schools throughout the state of south. We all sit on different boards. So I sit on two college boards here in Charleston. And then my regional director of Columbia sits on a board there. My director of radiology and Florence sits on two boards up in Net market.
So we all sit on different boards to create relationships with the colleges, but we're, we really got creative is. I don't think he'll mind me bringing him up. His name is Eric Mack and he works for me. He's also just stepped down, but he's for the, like the last decade or so, been the Charleston School Board President Uhhuh
He helped us on his way out of retiring from the school board president. He helped us create a relationship all the way down to the high schools. So what we've done is we've budgeted FTEs with a full-time employee into our budget, and then that money goes back to the city of Charles. Into the high schools to act as funding and scholarships back into the high schools.
The, the high schools have partnered with the colleges, and the colleges are partnering with the high school and the university. So what we're doing is it's three people all bringing in one relationship and we're doing it in underserved areas where they might not be able to afford going to. The per income of the family is is very low.
So college is probably, unless they get straight A's and get scholarships, they're not gonna get these opportunities. And we allow the school board to go ahead and put in kind of like a. Dream essay, I wanna be in healthcare. We go recruit, and then they put in for it. And then we pay for their college education.
And then they're guaranteed job jobs with us at the Medical University of South Carolina. So we've actually started from just taking all the college students. We've realized there's a competitor in this, in this market. And we had 19 vacancies. We have 732 employees just in imaging alone. So we had 19 vacancies and the people across the street had five vacancies.
They're a lot smaller organization, but there was only 16 graduating in a class. So even if we hired. All of them. We still didn't have enough to fill both of our jobs, so we decided we gotta get creative. So that's why we've gone down to the high school level Now. We've built kind of like a full, as you would call, pipeline for the next decade or so, because they're gonna be taking 'em all the way from high school up.
Yeah. That's
Megan Antonelli: amazing. That's great. And I think you know, as we talk about some of these problems and we, we often talk about the technology solutions, you know, but this is a community solution. It's a partnership solution, and it, it really gets at the heart of, you know, what the system system really needs.
And it also you know, it sounds like there's a. Effort to create equity and connection with the community. So there's that, you know, sort of branding and, and relationship there. So that's great. I'm curious just cause, you know, I wanted to be a doctor too, and I got into it, and working in a hospital and thought, no, you know, I'll go into events
Right now even, you know, I've got kids and the idea, you know, what's the interest level? Is there excitement there you know, at the high school and college level, or are they like, no way, I'm gonna be an influencer. .
Ron McKee: Yeah. You know, I have a child that tells me he's gonna be an influencer anyways. I will tell you that.
It's not the way it used to be. So, I'm dating myself, but when I first came into healthcare it was very, I want just be blind. It was very, super sexy. Like there was money involved in it. You were saving lives. I mean, they had er shows on it. There was even funny shows like Scrubs. There was all these different shows based on healthcare and a lot of people wanted to get in.
He. It paid very well. You know, when I first started, if I needed something, I remember I was a very low level manager and I said, gosh, I need this new piece of equipment, and it was $50,000. Now, just keep in mind, 20 years ago, $50,000 would probably be closer to a hundred now 90 to a hundred thousand dollars, and my boss was like, all right, go ahead, buy it.
and like literally wrote a check that day for almost a hundred thousand dollars piece of equipment. Now it's like, if I need to buy a stapler, they're like, well, have we priced out the best stapler, ? And it's really to that point. So Medicaid and Medicare reimbursements were very lofty 20, 30 years ago, even 15 years ago, and things got tighter.
probably around, you know, Obamacare, 2008, 2010 in Medicaid. Medicare rates dropped almost 40, 50%. So, which means the revenue coming into the hospital dropped that much. Physicians used to make millions of dollars a year, and now there's a lot of physicians that make less than directors of radiology.
You know, there's just, they don't make the money that they used to make. It's really not moving in the same direction, which means. . Let's think about it from these young folks. Do I wanna be an influencer and make a lot of money sitting here in front of my computer talking about a product? Or do I want to go into an area where we've got covid, we've got blood, I've gotta change bed pans.
There's, it's not, it's, it's gone from super sexy to super scary and I think a lot of folks are straying away from that. A lot harder to recruit. Now. You really have to work pretty hard now when, if you go to the community colleges where they're already into the program, your commute is, or you're, you're committing something different like you're committing culture, family which is what M U S C is all about, creating a family and a culture where you can go to work, you feel like you're at home, but when you go to the schools, you gotta make it.
Oh, you're changing lives. You're saving lives, so you really do have to change the way you talk to 'em about recruitment. So yeah, for sure. Yeah, I don't think it's the same as when we were younger. Yeah, it's definitely not for sure.
Megan Antonelli: I love
Ron McKee: scrubs. Yeah, that
Megan Antonelli: was a good show. It was a good show, , but we did, we had really good healthcare shows back then.
But yeah, it has changed and I think you know, but I, and I always say this, you know, and this is where I, I cuz I get frustrated with healthcare a lot and the slowness of change, but, you know, Even from the you know, whether you're on pharma or the payer side, or government or policy, people that get into healthcare get into it because they do, you know, they, they do wanna save lives and they do wanna change, change the, the way people are cared for and, and improve that.
So it all comes from a good place and good people. So there is, there is a good selling point, you know, it still has. Still has the that to it. So, but to that we always like, you know, health impact. That's our, that's our, our, our thing is making an impact. So we always like to ask our folks you know, what is that one big problem?
If you could fix one big thing in healthcare, you know, what would it be? If you had the, the wish, the xprize, the. The Star Trek
Ron McKee: Magic wand. I, I would say, I would say stability. I think I already mentioned we have staffing issues, right? So it, a lot of the things that we're getting now is multiple generations where they see that if they, you know, when, when I was younger it was.
If you were loyal, that was a good thing. You spent, you spent eight to 10 years in organization when you were looking at somebody's resume or cv, you were like, this is the person I want. And now, you know, not so much. You're looking at the three to five year window. Now if somebody goes somewhere every 16 months, that's when you start to get nervous.
But I mean, a prime example is me. I've been here for three years and now they've said, okay, we want you to go to another role. Now I'm staying with the same company. But once again, it's a different role and I think there is. Just like any sports team, right? Like I'm a huge Carolina Panther fan and they have zero structure with their coach.
Their coach has been a revolving door. The quarterback's been a revolving door. So the only way to really grow a program is to have structure, and we don't have that in healthcare anymore. People are going into organizations staying a year or two years, and then they go across the street for $3 more an hour, and then guess what?
Two years later they come back to the organization. Cuz now that organization's paying $3 an hour and we. We, we just need some stability across our globe really. And, and what we pay our folks, what they're getting out of it. So people stay at an organization cause of the organization, not cuz of the dollar.
So I would say, right, if I had a magic wand, I would, I, we wish we could just have a little more stability in our, in our workplace. .
Megan Antonelli: That's great. I, you know, I like that. And I, you know, I think I don't, I was, you know, with New Year's, the, with New Year's coming in resolutions, I was just reading someone who was saying, what's your word of the year?
You know? And stability is a good one because there has, I mean, certainly over the last two years, the instability has been a lot. And just, I mean, as you know, as we do kind of going through and, and. Trying to bring people together and you see how much people have moved and whether they've moved across the street or across the country.
People really are moving a lot and that does impact the stability of an organization and the strength of it. Cuz it, that's what it comes down to. So that, that's great. I, I like that. And I like it as a, as sort of a theme to think of and, and to end on. But thank you so much for being here. It's so good to see you.
And I'm. Excited for your vacation that's coming up, but I hope that we'll be able to see you in person soon. Yeah. At one of our events. Great. Well, thanks so much, John. Take care. And thank you everyone for listening.