Transitions in the Health Care Workforce: Opportunity Occupations and AI

Nishesh Chalise: Good morning, everyone. Thank you so much for being here nice and early. Hope you all got a chance to grab some food and coffee and water. If not, feel free to go back and get food and some coffee.

So anyways, welcome. Welcome to the Federal Reserve Bank of St. Louis. Today, we are really excited about this event, Dialogue with the Fed: Transitions in the Health Care Workforce, Opportunity Occupations and AI. There’s a lot. There’s a lot going on here. We’ll talk about opportunity occupations, AI, workforce strategies-- a lot to learn.

My name is Nishesh Chalise. I’m a senior manager for the community development research team here at the Fed. If you had looked at your programming, you probably saw that Seema Sheth was going to be the moderator. So, instead of a dynamic, charismatic person, you get me. I don’t know what you did to deserve this, but here we are.

Happy holidays.

[LAUGHTER]

We’re so glad you could join us, and there’s more folks trickling into our online audience to hear about this.

In a few moments, I will turn the mic over to Nicole Summers-Gabr, who will give the morning’s presentation. Following that presentation, we’ll have our esteemed panelists join us and we’ll have a discussion, and then we’ll also open it up for a Q&A with the virtual audience and everybody in person.

We have three guests for our panel-- Sondra Davis, Chief Human Resources Officer-- do you want to wave; yes, thank you-- Dr. Alexander Garza, Chief Community Health Officer with SSM Health; and Jess Walker, HR business partner with University of Arkansas for Medical Sciences, Northwest Regional Campus and regional programs.

A few housekeeping things. This is one of my favorite things to do. So if you want an exit, there’s one behind you. There’s one in front of you. So choose the one that is closest to you.

In the coming days, you’ll get an email with a link that has a survey about how this programming went. Please do fill out that survey. We really value the feedback that you give us. We use it to plan and design the programming for upcoming events.

During the Q&A, if you are in person, and if you have a question, just raise your hand. There are mics in this room. They will pick up your voice. If you need a microphone, there will be folks with handheld microphones in the room. If you are joining us virtually, please submit your questions through the Zoom’s Q&A. And we have Ellen here who is monitoring the questions, and she will relay them to me. We may not get to all the questions. We may have to tweak the wording for clarity. But please do submit your questions. We want to hear from you.

OK. So now, I’d like to introduce Nicole Summers-Gabr, who is going to present her findings from this health care report. She is a senior researcher on-- I should all know this, but I’m going to read it anyways-- served as a senior researcher on the community development research team here. She examines economic conditions through the lens of youth employment and rural communities, with special focus on health care workforce changes, the impact of health care and labor force on workforce participation, and support for young workers.

With a PhD in experimental psychology from Saint Louis University, Nicole previously directed the social innovation initiatives at Southern Illinois University School of Medicine, where she built community coalitions supporting adolescent mental health and rural health care partnerships. Her research has been presented internationally and featured in Psychology Today and on public radio programs.

Please join me in welcoming Nicole.

[APPLAUSE]

Nicole Summers-Gabr: Thank you, everybody, who came out today. And thank you everybody who’s joined us online. I’m so excited to share this research with you.

If you’ve followed any of the work that I have done within the past year, what’s really exciting about today is that we have new data that was just released December 5, so I highly doubt you have seen it published anywhere else, and it’s able to expand on basically the line of work that we’ve been doing in a direct response to questions that we’ve gotten from the community.

Now, before I get too excited and share that data with you, a little disclaimer-- the views expressed here are my own and do not necessarily represent the Federal Reserve of St. Louis or the Board of Governors.

If you’re interested in some of that work we did earlier today, there’s a couple of links here for you to those articles. This data is up through 2023, but what’s really interesting about this is if you like these topics, we have state-level numbers, which we’ll not be sharing during today’s presentation for the sake of time. And then within state, we have different geographies based on metro, metro-adjacent, and non-metro-adjacent communities. And I’ll show those again at the end.

So just a brief overview of what I’m going to share today. First, I’m going to just set the tone for why are hospitals important to the economy. Then I’m going to dive into two lines of research. The first one is around opportunity occupations, and I’ll explain what that means in just a minute; and then the second line of work is around AI in the health workforce. And then I’ll give you a sneak peek into what we have coming for 2026.

So hospitals are incredibly important to the economy. They are what are considered anchor institutions. And they serve not only as a major employer, but they attract a lot of investment.

And if you’re interested in how important hospitals are to your local economy, the Federal Reserve, the Philly Fed, actually created this really cool dashboard called the Anchor Economy Dashboard. It’s a free tool, and it tells you basically what the economic contribution is of hospitals and universities to both metro and non-metro areas.

So an example of one of the pieces of data that I pulled from there, in St. Louis, by 2019, 82,000 people were employed locally by hospitals, which generated over $6 billion of income. And if you look at a more non-metro part of Southeast Missouri, it employs about close to 7,000 individuals and generates over $420 million in income.

Now, hospitals, of course, employ a lot of people directly, but their economic impacts trickle in other ways. First is through an indirect means, and that the institution itself purchases a lot of goods and services locally within that economy, such as cleaning supplies, and car rentals, and maybe hiring an advertisement agency.

And then in addition to that, there’s an induced economic impact by the people that are employed by that institution, and any kind of services that they might purchase, such as through the grocery or retail or stores or restaurants, those jobs are sustained and grown based on those who are employed locally.

Now, within the health care space, a lot of jobs certainly require years and years of schooling, more than 10 years of schooling, but within hospitals, there’s a subset of jobs, and these jobs are called opportunity occupations. And these jobs require less than four years of college experience, usually one to two years, but pay above the median wage, which, in 2024, was close to $50,000.

Now, opportunity occupations can certainly be found in every industry, but what makes them very unique about the health care space is that these are jobs that often come with separate benefits, such as a retirement and health insurance.

And so for young adults that are interested in pursuing careers that might give them a stable livelihood, that don’t require a lot of investment in terms of schooling, or for people who are interested in reskilling, opportunity occupations are a really interesting pathway.

Some examples of opportunity occupations within the health care space include a respiratory therapist, radiology technician, LPN, registered nurse, which I know sometimes they require four-year degrees, but there are also two-year-degree pathways, pharmacy technician, and laboratory technician.

Now what’s also very quite interesting is that there’s high demand within these jobs because they’re facing a lot of different shortages. And that’s not due to one particular reason, but it’s so many different things that are coming to head. Part of it is due to an aging workforce.

So for instance, in terms of nursing, in the next 10 years, about 1 in 3 nurses are going to be eligible for retirement. In addition to that, we’ve seen some changes in program offerings due to various reasons. So there’s been a reduction in LPN programs just due to changes in hiring practices, and there’s also been some reductions in pharmacy technician programs due to enrollment challenges, but this has also exacerbated the shortage.

Then in addition to that, there are some challenges around the work environment conditions. With these shortages, this creates a higher workload. Workers also experience more burnout. And then there are some challenges about working in the health care industry, such as workplace violence, that can make it really hard to retain employees.

If you look at the instances of assault that health care workers face, it’s actually higher than that of police officers or prison guards. And in addition to all of that, then we have COVID, which just brought everything to a head and exacerbated all of these issues, and we see even greater ratios between nurses and patients, as well as other health care professionals.

So what I was really interested in terms of opportunity occupations was two things: first, understanding how these occupations have changed from pre-COVID until more recently; and then second, how have we seen that demand differ based on metro proximity. So hospitals based in metro areas, and then those that are close to metro areas-- adjacent, we would say, but still in non-metro communities, and then those that are furthest away from metro areas.

And all of the data that I’ll be sharing with you today comes from the American Hospital Association’s Annual Survey. And for the most recent year, 2024, for the variables that we were interested in, there was close to 3,000 responses, if that helps put it into context.

And then the variables that I’ve pulled for analysis were looking at full-time openings for each of these opportunity occupations. And then there are some separate variables around AI, which I’ll describe a little bit later in my presentation today. And then to look at that geography based on metro proximity, that all comes from the USDA’s Rural Urban Continuum Code.

So to begin with, if we look at the growth in these different occupations, something that I want to draw your attention to, first and foremost, and this is growth from 2019 to 2024, is that for all the occupations that we had data on, there has been growth, which is great. And this is looking at hospitals that have at least one opening for each of these positions.

The next thing I want to draw your attention to is that around 50% of hospitals had some kind of listing for a radiology technician and an LPN. And while we did not see the same demand for our RNs in terms of growth, that does not mean that the demand is not there.

So, if we hone in on 2024 data, this is looking at what share of hospitals had an opening for a given position, and for RNs, almost 94% of hospitals had an opening, which means that the demand is both high and sustained over time, although it’s still quite noteworthy that around 50% of hospitals had openings for the remaining positions, except for pharmacy technicians.

Now the next interesting trend I want to draw your attention to is if you have followed any of the work that we’ve been producing this past year, we have talked about the surging demand in respiratory therapists, and this has been a big topic that a lot of people have talked about that we’ve seen not just during the time of COVID, but it’s something that has been trending even prior to that due to a lot of growth in the field.

But with the data from 2024 that we recently received, we’ve actually seen a pullback. So we’ve seen growth, we’re in 2019, about 37% of hospitals had at least one posting for a full-time position, and then that just kept growing, growing, growing until 2023 where it was about 84% of hospitals, but now we’ve seen a pullback. It’s still higher demand than what was seen prior to COVID, but it’s not still on that same exponential growth trajectory.

Now we can take that data and we can disaggregate it based on metro proximity to understand the trends on how these jobs are in rural and urban environments. So the first trend I want to draw your attention to is that basically for all non-nursing positions, the further away a hospital is from a metro area, the more growth that we’ve seen in demand for those occupations.

Then, when we look at a snapshot of data from 2024, we see a reverse trend. While we’ve seen more growth in rural communities, still, those more metro areas have higher demand overall.

And so in terms of trends that we’ve seen around opportunity occupations, there’s three things that I want to highlight. First, that regardless of the opportunity occupation, we have seen growing demand from hospitals also regardless of geography, but that demand is still greater in metro areas compared to non-metro areas.

And then the third thing that I wanted to highlight is this new trend that we’re seeing around respiratory therapists. And while there is still demand there that’s higher than pre-pandemic levels, it has pulled back quite a bit compared to 2022 and 2023.

Now so far, as I’ve been talking about opportunity occupations and jobs in the health care space, it seems like the demand for these occupations is linear. It just keeps going up and up and up. But that doesn’t mean that there isn’t disruptions in the workforce. There are certainly disruptions that are out there. And one of those disruptions that a lot of people are talking about is AI.

And the big question that I’ve had posed to me by a lot of people is, what is AI going to mean for the health care space? What is it going to mean for jobs? I know a big concern from many people is that it is going to replace jobs.

And while I would love to have some fantastic data where I could model and give you those answers, we’re simply not at that place yet from the data that I’ve seen because we need to take a step back and first understand to what extent are hospitals actually employing this technology, and how are they employing this technology, and that’s one of the things that I’ve really worked on within this past year.

But within this past year, a lot of the data we had access to was AI from a more administrative sense. And what we have for you today is a snapshot of also data from a clinical sense. And so that leads me into this other line of work that I’ve been producing quite a bit this year, which is understanding how AI is used in the health care workforce.

So it’s really important for us to think about AI’s impact from an economical stance because of the investment that is involved. So if we look at a snapshot of the investment from 2023, around $6 billion were invested in the U.S. and almost $20 billion were invested globally. And that’s projected, within the next 10 years or less, to be about $200 billion within the U.S. and over $600 billion globally.

Another thing that’s really important to consider in this is that just because all of this investment is being made does not mean that all communities are going to reap the benefits equally, if there is a benefit involved in employing AI. And rural communities face a lot of challenges when it comes to changes like this or trying to change their infrastructure.

For one, they already struggle with a rural urban-digital divide, but then also, rural hospitals do face a lot of budget constraints with the national median operating margin being around 1% and already around 43-- or sorry, 46% of rural hospitals operating in the red, and over 400 hospitals at the risk for closure based on models that have been produced.

And so when we’re thinking about introducing a completely new disruptive technology, something that might involve reskilling workers or improving the existing infrastructure, it’s going to be really challenging to do that in rural communities if they are already just trying to keep the doors open. And my clicker has paused. All right.

So what this leads me into investigating is, first, understanding the share of hospitals that are using AI and how they’re using it both from a business standpoint and from a clinical standpoint. Then understanding-- this is new-- the stage of adoption that hospitals are in.

Up to this point, the way that we’ve looked at how AI has been employed from a medical space has just simply, are they using it or are they not? Black and white. But it’s not like that. Any kind of technology, anything new, there’s going to be basically a gradation of that adoption. And that’s something new that we have to share with you today. And then lastly, what we’re going to do is then look at how this adoption differs based on metro proximity.

So within this data set, there are six different variables around business use cases and eight different variables around clinical use cases, and I’ll explain what some of those look like in just a little bit. But what I first wanted to do is just look at a very, very high level, collapsing all of the data for business cases and clinical cases, and just create these in a binary stance: are they using it in a business way or are they using it in a clinical way, yes or no?

And the first thing that I found is that, well, yes, regardless of geographic location, they’re employing it in both ways, but something that I found was very interesting is that it’s more commonly used for clinical use cases right now than it is for business use cases, which is very different from the trends and from the feedback that we’ve been hearing from the community.

And I think something that’s also interesting to highlight here is when we’re looking at a very high level, and while this data does not directly match the data I had in 2023 because the variables are rewritten to be a bit more specific, if we’re looking at it in a general sense, it’s employed more in non-metro areas in 2024, we have seen growth compared to what it was in 2023.

Now in terms of what is a business use case, it’s something that’s going to improve the business workflows. So I won’t share all of the variables today for the sake of time, but that’s something I hope to share in 2026 as we roll out more of this data, but I wanted to at least give you guys a snapshot because I have been asked quite a bit about these specific use cases.

So two of the variables that I pulled for you is, first: revenue cycle management. So what this means is using AI to help them with their billing. And then the second one is basically handling staff schedules. And the first pattern that I want to draw your attention to is what we see, and if you’re able to read that, online and in the back, we’re looking at that gradation of adoption.

So basically, are you not implementing it altogether? Are you exploring the different technologies that are out there? Are you actually piloting, testing those technologies? Are you expanding and building it up into your business or do you have it fully integrated into your operations?

So this is looking at AI in a much deeper sense. And what you can see is that an overwhelming proportion of hospitals are still very, very much in that exploratory phase, with only a small percentage, between 3% to 5% depending on the item, have it fully integrated into operations.

Now this is looking at the data basically at a national scope, basically collapsed across metro and non-metro areas, but we can disaggregate this further, and the same sort of trends emerge where you see this much larger share still in this exploratory phase, and just a small percentage based on that fully integrated phase.

I do think what’s interesting to point out here is that, for instance, if you’re looking at the way that billing is handled by AI, there’s very little differences between non-metro and metro areas. They’re exploring these technologies basically to the same extent, but it is still not at that point of being fully employed in rural areas.

Now some examples of how we have it from a clinical stance, AI-assisted diagnostics-- so that’s being able to read the different scans and being able to diagnose or assist in diagnosing conditions, and then AI-assisted surgeries. And we see this same sort of pattern emerging where the largest share of hospitals is still very much in this exploratory phase, not even testing that technology, and just a small percentage is fully employing it.

Although I do think it’s interesting to note that basically, 1 in 10 hospitals are using it already for diagnostics. And that same trend really continues to maintain itself when we look at the differences between metro and non-metro areas.

So for metro-adjacent communities, it’s 9.6%. For those that are not adjacent to metro areas, it’s 9%. So we’re still really close to basically that 1 in 10 hospitals fully integrating this into their systems. But when it comes to AI-assisted surgeries, it’s still very much in the exploratory phase.

So in terms of trends, the things that I want to recap on, is what we have seen, and the most recent data that was just released this month, is that as of 2024, contrary to popular belief, actually, AI is being employed more for clinical reasons than it is for business use cases. But that employment is still very, very exploratory, with just a small percentage fully integrating it, with a maximum of about 15% or less depending on the use case that we’re considering.

But what I do want to note is that even though rural hospitals are using it to a lesser extent, they are actually catching up.

Like I said, if you compare this most recent data to what we have in some of the publications that came out earlier this year, but also, if you’re just looking at that high level where we collapse things across all business variables and all clinical variables, in terms of non-metro areas, about 1 in 3 hospitals were using it for clinical purposes and around 2 in 5 were using it for business purposes.

So what do we have coming in 2026? We are going to have more data on different types of use cases. As I said, I could only give you a snapshot for the sake of time of what we had today. We’re also going to have a completely new data set coming in that will dive into AI even in a deeper sense.

And then something that I didn’t get to share with you today, but I’m really excited about in terms of data, is challenges that hospitals are facing in AI that can prohibit their adoption, whether it being able to train their staff and upskill their staff or being able to afford it.

Or another really interesting example that I found is, is the community trusting and accepting of this technology? Because just because you have the funds, just because you have the staff that can work with it, if the patients aren’t willing to accept it, then it’s going to be really hard to fully integrate.

And then the last thing-- and this is something that you’re going to be able to find more details in, and we’re going to hear from our lovely panel on, is around workforce strategies.

So in that report around opportunity occupations, if you go in there, we have different types of strategies that are being employed by hospitals over time, but we also have some new data that just came in around workforce strategies to see if they’re able to pull in workers this way, such as through tuition reimbursement, workplace violence de-escalation trainings and programs, well-being programs, and transition to practice programs. So we’re excited to have some more data come out about that later in 2026.

And once again, if you’re interested in any of the research we’ve produced earlier this year, here are the QR codes. And I didn’t put this in my slides, but I was just mulling over things on my way here, and I have some other tools that I want to give you guys just in case you’re interested.

I hope you guys are all super big health care fans like I am, but if you’re just here for the opportunity occupations component and you’re interested, what does this look like in other industries? The Fed has developed a lot of great tools to answer this.

So the first tool is the Occupational Mobility Explorer. And what this does is you can type in basically any kind of occupation, wherever it is across the country, and it can show you how you get to that job, and then once you get that job, where you can progress from there. So it’s a pathways explorer. So you can take some of the ones that I’ve shared with you today, or you can take ones outside of the health care space.

The other tool that I would like to share with you is the Occupational Mobility Monitor, and this is a data tool that can tell you what share of opportunity occupations there are in your metro or non-metro area. And we can also follow up after this with those links if you struggle to find them.

And if you’re really interested in some of these topics, I encourage you to follow us on social media or to sign up for emails, and you’ll be able to get that newest data that we’re going to release later this year. Thank you so much for your time today.

[APPLAUSE]

Nishesh Chalise: Thank you, Nicole. That was a lot of great information. I hope you have questions for her later. I would like to formally ask the panelists to join and Nicole as well. And I’m going to introduce some of our panelists as they are finding their way to the seat, just to let you know what a treat you have in front of you.

So Sondra Davis serves as the chief human resources officer for North Mississippi Health Services. She is responsible for managing recruitment, retention, education, employee health, compensation, and benefits for organization’s employees. She has more than 20 years of experience in varied settings, with most of the experience in rural health care market. So she’s going to really provide you with that employer perspective, the hospital’s perspective.

Dr. Alexander Garza is a health executive and a retired US Army Reserve Colonel, who served as the incident commander for the St. Louis Metropolitan pandemic task force during the COVID-19 pandemic. He serves as the chief community health officer for SSM Health. His current work is focused on deepening the SSM Health’s focus on social determinants of health, equity, and social justice, as well as supporting the work of SSM Health’s transition to population health.

Jess Walker serves as a human resources business partner at the University of Arkansas for Medical Sciences, Northwest Regional Campus, where she leads strategic workforce planning, employee relations, and talent development initiatives. With over 15 years of health experience, she has been instrumental in developing career ladders, workforce pipelines, and community partnerships to address health care talent shortages in Northwest Arkansas.

I’m going to make my way up there, but round of applause for our panelists.

[APPLAUSE]

Does this one work? This one-- let’s see. Technology is on our side today. Nicole, thank you so much for your presentation. I’m going to start with a quick question.

I don’t know if you have this information top of your mind, but I was just curious, listening to you talk about opportunity occupations in health care, do you have a sense of how they compare to other industries, like manufacturing or infrastructure, in terms of wages? And just curious. I don’t know if you have the numbers on that.

Nicole Summers-Gabr: Thank you, Nishesh, for your question. I do not have those numbers at the top of my head. The first thing that I would encourage everybody to do is go to that explorer that I shared earlier.

But I think the other thing that I would like to draw attention to and I mentioned earlier is what’s very unique about opportunity occupations in the health care space is the benefits that come with them. So there are certainly a lot of great jobs out there, that somebody can get training with one or two years of experience. They can get a great salary. But it doesn’t necessarily mean that those jobs will come with benefits, like health insurance or a 401(k), which is something that typically health care jobs will come with.

Chalise: Thank you. Thank you so much. So I’m going to open with a very broad, level-setting question to all our panelists. And take this opportunity to also maybe add a little bit of context about your organization and your work as well.

So the question is: Nicole shared us a lot about opportunity occupations, AI, and even a little bit about workforce strategies, which she delves much deeper into her report. How are these things playing out at your institution?

Alexander Garza: Great. Thank you. Yeah so with workforce-- and I think most of the panel would agree and I think in Nicole’s paper shared, that it’s extremely challenging for the workforce right now, to recruit the workforce, across the board. And so that means you need to come up with different strategies on how you’re going to improve the pipeline and recruit, both of which Nicole touched on.

And so that comes through various forms. So whether that is paying for school for people to achieve some of these certifications and other requirements for fulfilling these job requirements, so we have various apprenticeship programs and things like that, or where we partner with community educators to provide those or some of them that we have in house to provide the education that leads to a certification that leads to a job.

And so there’s different pathways that we use. Our organization is spread across four different states: Missouri, Wisconsin, Illinois, and Oklahoma. And each of those, they’re a little bit different, but the challenges are similar.

With AI, it’s really, I think, in its very beginning phases right now, again, as I think was displayed in the report. And you have to think of AI in health care, not that there’s going to be robots coming into your room, but it’s operating in the background, particularly with the software that health care uses.

So it’s not that health care is developing AI. It’s the systems that we employ that are developing AI that then we bring into the health care system. But it’s in its very beginning phases right now. The simple one is ambient listening for our providers that records the note, brings it into the electronic health record, and then does its various things with artificial intelligence.

Sondra Davis: Thank you for the question. Our organization is a 7,000, almost 7,500 person organization. We’re headquartered in Tupelo, Mississippi, and we have a hub-and-spoke model. So we have a large care center in Tupelo and then community hospitals, and we would be considered non-metro. So we’re in that rural space.

And it’s playing out very much like you shared. I think one of the things that we are seeing is our focus on retention. So recruitment is traditionally very difficult in those rural areas. So our focus has really been on retaining those that we have and then figuring out those ways to fill those pipelines, whether it’s partnerships or whatever.

I think, related to AI, one of the things that I hope to see is that continual growth in the clinical. But, Nicole, as you continue to do your research, I think those business processes and that AI on the business side will continue to grow. Typically, that’s another large investment that organizations have to make to deploy that AI. But things like in workforce management, so using a skills cloud to find that talent, either within your organization or outside, that deploys technology and AI to really do that, and I think that will be something that we see on the business side in the future, along with the things that you shared.

Jess Walker: Can you guys hear me? OK. So very similar to Sondra’s answer. So UAMS, we’re very similar setup. We have a central hub. Our headquarters in Little Rock, and then we are all throughout the state. So everything outside of Little Rock is regional programs, including our second campus in Northwest Arkansas.

But similar to what you said, Sondra, is, how do we not only attract new talent but retain the talent that we have? And what opportunities can we give our current employees that are maybe in entry-level positions like housekeeping or in nutrition services or even our we call them access representatives or patient care representatives who are your registrars, where they’re checking you in, answering the phone?

Can we give them opportunities for career advancement via partnerships with community colleges or other nonprofit organizations so that we can provide stepping stones into a health career that will allow them to have upward mobility and have more financial stability for them and their families? Which is what some of my projects have been focusing on in Northwest Arkansas. And we’ll get into those in a little bit.

In regards to AI, I actually went to an AI workshop in health care, for workforce health care. And it was very interesting. Primarily, there’s so much AI can do on the clinical side and on the business side that we just haven’t-- we’re not there yet because we’re still trying to see, "well, is this going to work?"

And to Sondra’s point earlier when we were talking, get the bugs worked out of it before we implement something. So there’s a bunch of startups. Some of them are in Northwest Arkansas. We have a startup hub by the University of Arkansas.

And a lot of it has been not only, how can we get AI to help us with patient phone calls? How can we get them to maybe review medical records? If you’re referring a patient to another specialist, you now have to manually go through all of that. There’s a nurse or a medical assistant that goes through all of that and gives the cliff notes to the provider, and then they review them.

But what if AI is implemented? There is a company doing that, exploring that. Same with billing and coding, primarily coding, because all those ICD-9/10 codes are making sure that those reflect the notes. So there’s a ton of different things, I think, that are happening, but they’re in the startup phases and not really been implemented to, again, see, where is it going to lead? And what is the cost associated to that to be implemented to the whole health care organization?

Chalise: Thank you. That was fantastic to get us started. We’ve been hearing about shortages, labor shortages, for a long time after COVID. I think every industry leader was talking about it.

But in health care, I feel like it almost started even before the pandemic. And it continues to here. I think you all just mentioned a little bit about labor shortages. Could you tell us a little bit on the supply side of things, what are some of the barriers? What do you think are some of the drivers of these shortages?

Walker: I’ll go first, if that’s OK?

Chalise: Yes.

Walker: So in my 15 years in health care, I actually used to do patient care at the bedside. I used to work in the hospital, both inpatient and outpatient. And a lot of it has been-- Nicole posted up there that health workers do get assaulted by patients more so than police officers do.

And that is 100% accurate. So that is a big factor as to why a lot of the workforce has been leaving even prior to COVID. I think COVID just accelerated that just because of what COVID was. Everybody lived through that. We lost a lot of health care workers for that.

It’s not only that. So it’s also not only physical assault, it’s verbal assault. I have been cussed out a whole lot when I was working in the hospital, understandably so.

There are courses and trainings that your employer can give you in regards to that. But if you look at a nurse or if you look at a health care worker and they have been dedicating their life to this for 20-plus years, it becomes a strain, understandably so. So a lot of that emphasized it, and I think COVID just was the bubble that burst it for a lot of health care workers that decided to retire early or maybe even pivoted into a completely different career outside of health care.

One of my positions as an administrator, I was in a private practice, and I actually hired a medical assistant. This is just an anecdote. But she was a registered respiratory therapist. She graduated and was a respiratory therapist for a year and a half.

But it was during COVID, and she told me when I hired her, she’s like, nope, because that was my question. I’m like, "you’re a respiratory therapist. Why do you want to be a medical assistant?" And she explained that having to work through COVID was a really big thing for her, and she just needed to step away from the bedside and deliver a different kind of patient care for her own well-being.

Davis: I would say yes to all of the things that you’ve shared. In our organization, we say that COVID was just the accelerant that got dumped on the workforce. We’ve always had nursing shortages. We’ve always had those shortages. But it just became very apparent during COVID.

Post COVID, I think those challenges grew for some of the reasons that you noted. And don’t quote me on these numbers, but I know that during COVID, the number of tax ID numbers for businesses applied for grew exponentially. So our teammates were leaving our organization, but they were also leaving health care.

They found other ways to sustain themselves, whatever that might be and for whatever reasons. And so they have not been necessarily coming back into the workforce. So that workforce participation rate has really been challenging us as well.

I read data from early-- I think, it was the early 2023-24 sometime, that even the birthrate, though it’s going up, we’re not going to be out of this supply-and-demand issue for a while. So we have all of these factors. Health care is sometimes difficult.

So that’s why we’ve been focusing on retention to really think about, how do we keep folks with us? But then how do we also create opportunities for them to grow within our organization? And so it’s been a challenge, but I think that we’re figuring out ways to be creative, to find pathways to encourage folks to look for opportunities.

And I do think that AI is helping us. In our organization, we’re trying to redesign how we deliver care. So how do we make it easier to be at the bedside? How do we use virtual nursing? How do we use these things that really help us keep folks and extend someone’s career? Particularly in virtual nursing, where a nurse who’s been at the bedside who cannot do that any longer, doesn’t want to do that, we have now a way to harness all of that experience and knowledge through a virtual nursing setup.

So they can still deliver care, but in a very different way and support our teams on the floor. So trying to be very creative in the way that we solve these workforce issues.

Garza: I’ll just add a couple of things. So agree with everything that’s been said. The workforce shortage was there before COVID, so that was nothing new. As was mentioned, it just became worse.

One of the other things, though, in my opinion, is there’s tremendous strain on the health care system in the United States right now. Well, there has been for a while. So you saw some of the metrics that were in that report, where the operating margins for health care systems are extremely slim.

The majority of the rural ones are in the red. I’ll tell you, it’s even difficult for urban facilities to operate with any sort of income margin. And so what does that do? That creates a lot of stress within the system as well.

And if you think about some of the longer-term projections, so there’s fewer kids graduating from high school now, going into university for these sorts of jobs. There’s intense competition, especially at the entry level.

And with policies creating more stress in the health care system, so if you’re going to have a decrease in your insurance rate in Medicaid, that’s going to put strain on the health care system because it’s going to increase charity care.

So all of these things compound onto the stress of the clinician. They just do. And if you have fewer clinicians going into the business because, if changes in education policy to help pay for education for nurses, for physicians, who are already understaffed, all of these things are compounding. And then the day-to-day stress of just managing through your workload makes that even worse.

So that’s to say there’s micro things. There’s meso things. And there’s macro things, all of which are negative, that are impacting the health system, that are driving a lot of the things that you see on the street.

AI can do a piece. It can help desaturate the clinician. But it’s never going to replace the clinician. At the end of the day, health care is a high human-touch endeavor, and you’re never going to be able to replace that.

So as much as we see the promise for AI, it’s mostly on the background of helping the clinician be a little bit more effective and efficient. But it’s not going to create another clinician.

Chalise: So what I’m hearing is that this stress of the work impacts all levels in a clinical setting, from somebody like a respiratory health person to a clinician. Does that sound right, that nobody is immune to immune to the stress? [INAUDIBLE] You also mentioned that I think all of your organization serves a large geographical area that maybe touches the metro, nonmetro.

Could you talk a little bit about-- I think you were already talking about urban and rural differences. But would love to hear how either the shortage piece or the AI piece or even the opportunity occupation part, how does that play out in urban and rural settings? Or what have you perceived?

Davis: So I think the urban and rural, so we’re in the rural. Related to the AI piece, I think it can be very helpful to us in terms of, again, finding ways to utilize the individuals we have or that we can recruit to take some of that work.

So I keep saying around the AI revolution, where does the human potential and human value shine? And it’s really about taking off those menial tasks that we can do over and over and give the individuals that we have-- you can call it meaningful work or whatever, but where does that value show up? And how do we optimize that?

To your point, we’re not going to create another clinician or another registrar or another HR person, but we can support their work. And so I do think, at least in the rural area, we are looking for ways to find more opportunities, one to support, obviously, cost. So we want to make sure we get all the reimbursement that we’re due so that we can support the organization with those very slim margins.

But I also think it’s finding ways to maybe through the rural health care transformation-- I don’t know if we were going to bring this up. But there are dollars for workforce in there. And so how can we bring some of that money into these spaces to support more tuition reimbursement or more connections and partnerships with our local community colleges, for those opportunity jobs where we don’t have to have that four-year degree?

So I think we have a lot of work ahead of us but that we can be creative in some of those spaces is With the dollars that we have and maybe the potential of some additional dollars to support that.

Garza: I’m just going to say ditto to all of that Sondra just said because she just answered everything perfectly, I think.

I would just add, I think the other thing that AI brings is-- so if you think about how AI works, it takes a large amount of data, sifts through it, digests it, and gives you its impression of what it thinks is in the data. And so as was mentioned, when you’re going through a patient’s chart, so I’m old enough to remember when we still dictated charts, and you’d have to go through to do a discharge summary and look through hundreds of pages of data in order to make an intelligible report.

Well, AI can do that now in minutes. And so that then allows the clinician free time to just use the summary to understand what’s going on with the patient. So that helps out tremendously.

But I think it also can then provide clues for diagnostics. So instead of having to rely as much on the specialty quaternary center to think about some of these cases, it can allow the clinician then to broaden their aperture as well about, hey, this is what I need to be thinking about. This is what I need to be ordering.

And that gives a benefit, I think, to those rural communities too. We serve both urban and rural communities.

And so those are a couple of different things that AI can bring to those rural facilities. There’s other more traditional things, like teleclinical services and things like that to keep patients at home in their home community rather than coming into the cities and things like that. But those are just some applications that you can use for AI.

Chalise: Thank you. We talked a little bit about the problem side of the labor shortage. Jess, I’m coming to you with this. Have you, in your 15 years of experience, what are some of the innovative, education, and training pathways that you are seeing right now that you believe can address some of these challenges, any interesting models?

Walker: Great question because this is right up my alley. So besides all of the HR-related work that I do, some of my passion projects that I’ve initiated in the campus have been to the point of, how can I retain, to Sondra’s point earlier, retain the talent that we do have?

Maybe we do have people that just don’t have the opportunity. Maybe we have a housekeeper that would be a great nurse, but due to socioeconomic limitations or family obligations, they just don’t have that opportunity. It hasn’t been provided to them.

So something that I initiated was created apprenticeships for different career paths. So I created the framework, and I’m going into different roles right now. So one of the first ones that we did is medical assistants.

So I opened it up to everybody on the campus, anybody that would be interested in going to a medical assistant course and being certified, nationally certified. I had so many responses. Primarily the big takeaway for me was-- my question to them was, if you want to advance in health care, what are some of the boundaries that are hindering you from doing so?

A lot of it is financial. Some of it is kids. So I partnered with an organization, a nonprofit organization, in Northwest Arkansas, to get grant funding to be able to provide the training for free.

And our educational partner is very flexible with us, and they change the training days to a couple days a week after hours. And they also provide daycare services for our students, and that is being utilized. So kiddos play with other kiddos there while mom and dad are doing their coursework, doing their homework.

Once they’re done with the course, they’re eligible to sit for the national exam, and they get two tries because not everybody is going to pass on the first try. A lot of people get test anxiety. But once they do that, then we go into the internship model of it or the apprenticeship model of it, and we provide that hands-on training and that clinical experience by assigning that employee, that’s also a student, a mentor.

So we’ll be assigning a seasoned, knowledgeable mentor to that newcomer to hands-on bedside patient care so that they can put their knowledge into practice because a lot of that, because of COVID, we went virtual, which is great. We were able to do that. But I don’t know if you guys have found that a lot of the employees that came out of that virtual learning environment are lacking some of the bedside manners.

And that is learned. That can be learned. But it used to be learned in the course. So we are finding that, and that is one way that we’re mitigating that is by assigning a mentor and having that person maybe provide some feedback to bedside manners while also implementing their learned knowledge of the course.

Another thing that we’re doing is, once they finish their apprenticeship, now they’re welcome to apply for that position full time. And now they have that increase in financial stability because they get an increase in pay. So I focused in the entry-level positions first because that’s where the need is for my experience has been.

But now I’m focused in other positions. There’s a shortage, like Nicole said, in other positions like lab tech and pharmacy tech and X-ray tech that we’re seeing. But in my little corner in Northwest Arkansas, we’re seeing a shortage in surgical techs and scrub techs as well and sterile processing technicians too.

So I am going to take my framework and now offer those courses to my employees. And I’m actually in talks with a couple of the community colleges around us and with Chet [Dr. Chett Daniel] at Crowder College to see how can we partner with some of these colleges in the area so that we can go to the students and talk to them about, hey, you’re getting close to your clinical hours.

We would love to have you do your clinical rotations and pay for you to have your clinical rotations as part of the internship or the apprenticeship model of that so that we can have that funnel and that pipeline back to our organization or our region so that we can retain those talented employees.

Chalise: Thank you. Even when I don’t try to talk about apprenticeships, it comes up. It comes up somehow. Yeah, I was going to come to you.

Davis: I was just going to add. I think, Jess, you said something that’s really important. So we have workforce participation, lower than what we’d expect, but there are a lot of other issues that cause individuals to not.

And you mentioned daycare. Especially in rural communities, finding daycare or things that prohibit somebody from coming into the workforce is a huge challenge as well. And so trying to even solve some of those, so at our main campus, we have a daycare center. And that is the number one benefit that people want, is a place for their child to be cared for because it’s not available in the community.

We have a lot of daycare, but there’s just more need for daycare especially for younger children, babies. So there are other barriers that are creating some of these workforce issues that have to be solved as well, not just what the job looks like when it gets when we get to health care.

Garza: I’ll just add a couple of things. So at SSM, we do a lot of those same things, where we target those entry-level workers. And you can pick any word and put tech behind it, and there’s going to be a shortage of it.

So a couple of things, exactly what they were talking about, there’s a lot of socioeconomic issues that are behind a lot of these things. And so what we switched to was a prepaid tuition. So a lot of people will do reimburse tuition, but that means the employee has to upfront the cost. And a lot of times they don’t have those dollars sitting around where they can plunk them down and then go to school.

And so you prepay the tuition, so that then they can go to school. Then you pay them to do the work so that they don’t have to then essentially work two jobs in order to get that second certification. So you pay them to do their clinical shifts. You prepay their tuition, all of those different things.

It helps secure them on that path to that stable job that would otherwise be really out of reach for issues outside of education. It’s all of those which, I would put a plug, is related to health as well.

But that leads me. I was talking with our chief nursing executive, and she said, really, what this is we probably need to rethink secondary education as well. So instead of people going through high school just to get through high school, have them think about, should this be a vocational aspect to high school?

Because what happens now is people will graduate from high school. Then they get an entry-level job. And then it’s incumbent upon the health care system to start working with these people to get them up to that next level, where, if you started in secondary education, to put them on that vocational path so that they graduated from high school with an ability to then enter into the workforce with some professional certification that would, first of all, improve their income.

It would improve the ability for health care to recruit some of these individuals. And I think it’s better offer for everybody from if you look at it from a socioeconomic perspective.

Walker: I’m just going to chime in to what he just said. So that is so true. So my executive recruiter and I, Kayla-- she is awesome, just a quick plug for her. She actually goes to a lot of the high schools in our area, and I went to one of the events at the high schools with her like a month ago or so.

And it’s a innovation school in Springdale. And their seniors graduate with their LPN. They have the opportunity to finish their high school diploma, but at the same time, they then take college-level courses at the local community college for their LPN.

So they are eligible to sit for the board so that they can get their LPN license. And in talking to a bunch of these upcoming seniors that are going to be graduating and even some of the freshmen that we talked to, they just know that they want to be in health care because they’ve either gone to the doctor or they broke a bone and they had to have surgery and blah, blah, blah.

And they have a bird’s eye view of, oh, hey, maybe I want to do this. Or what if I do this? Or this looks interesting.

A lot of the time, those freshmen or even those sophomores that you’re talking to, they just know they want to do health care. They don’t know what they want to do. Some of them do have a very level head on their shoulders.

One of them I talked wants to be a microbiologist. She already figured it out. She has a plan. But in talking with her, she didn’t know she could stay local. She didn’t know the medical school was right there, just blocks away from her. She thought she had to move hours away from family and from her support system.

But all of that to say, if we can have these conversations, if recruiters can have these conversations with our high schoolers at a time where they are thinking about, where am I going to invest my time in college, in a degree that is going to set me up financially to give me that upward mobility for myself and my future family? instead of, I’m going to invest my time and money in this degree and then all of that to do clinical rotations and then figure out, I don’t want to do this, because that does happen.

I’ve had friends in college that realized that a little too late. But I think it’s very important if we can have those conversations with kiddos. And if more schools can be in partnership with community colleges or either vocational or technical schools to be able to get a licensure like an LPN, you are one step ahead of your peers.

And a lot of colleges and community colleges, universities have bridge programs. So you can take your LPN and then take a bridge to get your RN, get your full RN license. From there, if you want to keep going, you can take another bridge. Like us at UAMS Northwest regional campus, we have the bridge to the accelerated nursing program, and you get your BSN in, I believe, it’s 18 months. So that was all I was going to say. Thanks.

Summers-Gabr: There we go. I’m good. I wasn’t trying to rush you.

But I just wanted to add. So if you go back to that report we wrote on opportunity occupations, one of the most interesting areas for growth in terms of workforce strategies is that there is more need around partnerships and developing interest in health care careers for high school, middle school, and even elementary school. And there’s a lot of great work that I have heard about going on within our district.

One of the other organizations that I’ll be working with later in 2026 is Kentucky Health Force, and they focus mostly and rural Indiana and Kentucky. And they actually have these-- they’re not quite buses. It’s almost like these semis that are completely specked out to look like a hospital once you go inside.

And the sides of them open up. And you see hospital beds, and you see all of this equipment. And they go around, and they have a partnership with at least nine different schools to teach the kids about what occupations are out there.

A lot of people know what a nurse is and what a nurse does. But some of these other occupations, like a respiratory technician, what do they do? And how can we expect somebody in middle school or high school to even know that that’s an option?

So it’s great that they can actually go out on the road. And in addition to that, they will have certain times of the year where they can offer certifications to students. But I think that there are really two battles when we’re talking about addressing the health care workforce shortages.

Yes, it is a battle to get people the training that they need. But I think it’s an even bigger battle to keep them in the door. So I think both things have to be talked about concurrently.

It is about getting people trained up. But how can we maintain the workers, make sure that burnout is addressed and that their mental health is stabilized? And one of the last things I kind of want to bring up before I turn it back over to Nishesh is one of the interesting things, to bring AI back into this conversation, is ways that it might be able to be leveraged.

I think this is one of-- I’m not here to say that AI is good or bad. I think we’re not there yet to make a determination. I think it has some potential to really help the health care workforce with burnout if health care workers, instead of spending a long time writing all of these patient notes and paying attention to all of these details, which I think, if you look at the numbers, it’s something like 40% of their time is writing clinical notes.

And if they can leverage AI to help with that, and then they can actually just sit back and breathe and actually have more face time with the patient and take the time that’s needed. Is that something that could potentially help address burnout? I think that’s one of the ways that it could help, and I would love to see other ways that this technology could be addressed to improve the quality of lives of health care workers.

Chalise: Thank you. I have one follow-up question with Sondra, but then I’m going to open it up to the audience. Please have your questions ready. And again, if you’re online, submit your questions in the Zoom’s Q&A section.

So what Jess shared earlier, I’m still thinking about it because you shared a lot about partnerships, how you are partnering with different organizations. How do you, as an employer, on the employer side or your institution, think about or approach partnerships with community colleges, educational institutions, or even workforce nonprofit organizations? How do you approach that kind of partnerships?

Davis: Well, partnerships for us are critical. And I think the challenge, at least in our area, is, really, how do we look at those partnerships? Because we sometimes do get a little overwhelmed because everybody wants to use this as a clinical site. All of those opportunities require clinical sites.

So we have to think about, how can we manage that? Because that’s a huge part of burnout. We love our students. Don’t get me wrong.

But they have to be partnered with somebody. Their instructor is there. But there’s also other nurses there. And so we have to be thoughtful about that.

I think those partnerships, though, have to change a little bit. You alluded to what those look like. So yes, we want to be a clinical site, but there’s also other things.

So how do we train a surg tech? If there’s not a surg tech program in our area, then we have to bring that in house. And how do we do that?

So I think our partnerships are going to change a little bit and I think for the better, certainly with nonprofit organizations. And I know I keep going back to workforce opportunities, maybe through health care, the rural health care transformation. That’s very important to us because we’re in those rural areas.

And so how do we now think about or build different partnerships? So we work with our high schools. We have an internship program for our high schoolers. We have volunteer programs to expose them. So we have all of those things.

And yet it’s not quite enough yet. So I think, again, those partnerships may look a little different. And yes, the clinical pieces are important.

I’ll just be honest. We’re struggling even to find accountants, HR folks, IT folks. So it’s even, how do we partner with some of these nonclinical opportunities and professions that don’t always necessarily require a degree either to support our organization? We’re a business. So we have to have all of those functions to be able to run.

Chalise: Do you want to add anything to it?

Garza: Yeah, we always ask ourselves, should we build it or buy it? And so some of the things make more sense to build. Some of the technician programs we bring in house because we have the expertise. We have the bandwidth, and it just makes economic sense for us.

Other things, not so much, and that’s when you partner with community colleges or a four-year university. There are other programs. We partner with Chamberlain University to help build up our pipeline of nursing students.

And so it’s a healthy balance where it makes sense. You can build where it doesn’t. You need a partner? You want to make sure you get the right partner who has the same values as you do and has a robust education product.

But there’s people in our industry that have full-time jobs that that’s what they do, is they look for those pathways. And that’s because of the challenge that we have in front of us.

Chalise: Thank you. Opening up for any questions? Yes, back there, two questions.

Audience Member #1: Good morning. Thank you all for your insight. So I have a question coming from a nontraditional sense.

So for the people who are entrepreneurs or for the people who are looking to pivot industries, you mentioned burnout. And so my question is, could you provide more context in terms of the disparity or the shortage when there are people who are maybe trying to get into health care but they might not take the positions that they are qualified for and they might pursue the positions that they may be considered overqualified for, maybe for a supplemental income, maybe just to recalibrate but to continue to maintain income?

So I can understand that there would be that I guess, maybe that clash between the people who you are trying to invest and build up versus the people who might be overqualified, who should take those higher positions and may want the lower positions that the younger people would maybe be better fit for ideally for growth. But could you speak more to that in terms of overqualification and the shortage that you are speaking about?

Garza: So I’m trying to understand the context of your question. Are you talking about career ladders and things like that? Or are you talking about bringing people in from the outside rather than build from the inside?

So if you could just give me an example, that will help.

Audience Member #1: OK. For example, me as a scientist and also as an entrepreneur, technically, when I look at a job position, I could apply to be a scientist, and I’m going to look at that job description. I also know my responsibilities as an entrepreneur and all that comes with that, so me understanding my responsibilities both as a professional, as an entrepreneur, and as a corporate individual, I know basically my boundaries and what I have time for.

So I’m looking at what I’m willing to allot in terms of my time and energy. I would apply more for a technician role. Although I might be overqualified for a technician role.

And so I meet a lot of people who are maybe overqualified for certain positions, but they don’t have maybe the capacity or the time for the responsibilities of those roles. And they are willing to go for the lesser role to suit their life for what they need at that point in time.

Summers-Gabr: All right, just one more follow-up question, and then I think we’re going to get there. I think what you’re trying to say-- and please correct me if I’m wrong-- is you’re trying to ask, what if somebody is at a point in their life where they could be doing a lot of different jobs but they don’t have the capacity to do some of the ones that might be a more progressive in their career?

So are there barriers? Or are there any kind of challenges with them taking some more entry-level jobs? Is that where you’re getting at?

Audience Member #1: I know a lot of people who are looking into the medical and health care industries. And they are qualified, but they are not looking for the positions in which they’re qualified for. So how is it still a shortage when there are young people who are coming in but there are also other people who might be vying for those same positions, those lower-tier positions, that the younger people are vying for?

I can see the disparity maybe as you go up. But for those mid tier and entry-level positions, I’m still trying to see, where is that shortage?

Summers-Gabr: OK. I think, while I’m not in the hiring space, there are a lot of challenges that I know that face, we can say, young adults or just in general in terms of the workforce. And I would love to hear more from our panel to see maybe what challenges you face in terms of hiring.

So one of the ones that I could mention that I know from the data-- because we’ve done quite a bit around disconnected youth that are young adults that are neither working nor in school, and maybe they really need a job, maybe they’re qualified to find a job, but they just can’t for some reason.

And one of the biggest barriers actually is having a criminal record. So statistically, if we’re looking at the data out there, around one in three individuals have an experience with the criminal justice system, and that serves as a major barrier for them being able to get sustainable employment. But I’m hoping this is getting toward you’re saying, what are some of those barriers that people are facing, but I would love to hear more from our panel.

Davis: So I’ll just say this. So we get lots and lots of applications. And to your point, sometimes folks are overqualified for the role that they’re applying for.

And I think the challenge for a hiring manager is, when we bring somebody in, we want to invest in them, we’re going to train them, we’re going to get them oriented and ready to go.

And when you have a highly qualified individual, maybe to your point, they’re overqualified, in the back of the manager’s mind is, how long are they going to be with me? How long are they going to stay? Is this really what they want to do?

Because I see they have these other skills. They’re qualified to do these other things. How long are they going to be here so that I can invest and grow and know that I’m going to have continuity in whatever role it might be? I think that may be what you’re getting at.

So oftentimes managers may not hire-- and I’m just speaking very generally here-- so may not hire somebody who’s overqualified because they think about, to be very honest, what’s the return on that investment? How long are they going to be with me so that I can train and grow and have consistency of coverage for whatever?

Let’s talk about a surg tech because we depend on those individuals every single day in the surgery space. So how long are they going to be with me before they want to move and go somewhere else? I’m not sure if that’s what you’re getting at, but it is often challenging for managers, for hiring managers, to make those decisions around qualifications and skills.

Chalise: And after the event, maybe it’s a conversation that you can have and clarify further. I’m going to go just to see if there is online question, and given the time, this might be the last question we can answer.

Ellen Amato (St. Louis Fed): I’ll speak quickly. So we had quite a few questions, some really great questions, so hopefully we can do a little bit of follow up after the fact.

But given our conversations around this earlier, I just wanted to touch base about, are there other incentives, like tax credits or state policies, that help promote apprenticeships with employers? I know you’ve spoken about apprenticeships before, so I was just wondering what might be available in that space.

Garza: Yeah, there are. It varies from state to state. So in each of our different locations, it varies. But there’s certainly different governmental programs or grants or other sorts of things that can supplement apprenticeship programs.

Walker: That’s exactly what I was going to say. So our nonprofit organization that we work with, they’re the ones that find those grant dollars, and they can either be state or federal grant dollars to cover the tuition for the courses that the employee is going to go through.

And then there are stipulations with that apprenticeship since it is an apprenticeship, it does have to be registered with the Department of Labor as well. And we have to meet certain criteria for that employee to be an actual apprenticeship.

Chalise: Last one.

Audience Member #2: Do any of you-- and these are probably lower-class jobs that you still need to run the hospital, have any of your organizations looked at the demand for immigration into the United States and the ability for people who want to come into the United States to obtain a job, one possibly with benefits, but then also, while they’re there, you can retain that employee long enough so that the employee could earn credits to then gain what they’re really looking for long term, and that is citizenship into the United States.

Have any of your organizations used the problems that we’re having in immigration? And I realize it’s a federal policy, but what are your thoughts about that?

Walker: I’ll take this one real quick. So we do have an internal immigration department at UAMS. From my understanding, a lot of the positions that we hire that require like an H-1B visa, those are more research or faculty-level positions that take months, if not maybe almost a year, to get the process going for that.

So we do have several of those positions throughout the organization, but they take a while for that to go through. And then we do also have an external law firm that we have a vendor who assists us with that process in the event that we do have that employee that wants to move on to that next step.

Garza: I’m not as familiar with those entry-level positions in immigration, if anybody’s looked at that. The one I’m most familiar with is the visa program bringing in more technical and professional staff, yeah, and that which is a challenged. It’s a lot of work.

Audience Member #2: [INAUDIBLE]

Garza: Yeah, yeah, yeah.

Audience Member #2: Really, really [INAUDIBLE].

Garza: Well, don’t forget. There’s a physician shortage in this country too. So we’ve got challenges all over, for sure.

Walker: Can I just add-- quick question--

Chalise: Yeah, we should really be ending, but just I’m going to give you the last comment. Looks like you’re ready to say something.

Walker: To the point there, a lot of those H-1B visas that we have to sponsor are at a higher level, faculty, physicians, researchers, that kind of stuff. We do have staff at entry-level positions on campus that are residents, so they have their green card holders, and we do assist them with that process as well. So in the event that they have to go back to a port of entry or something like that, we do work with them in their department so that they can facilitate that and get that renewed.

Chalise: Thank you so much. I’m sure our panelists will hang out like a few more minutes if you have extra questions that they can answer. But thank you so much for being here. Thank you for everybody who was online. Thank you, Nicole, for a wonderful presentation.

Please do remember you’ll get an email. Fill out that survey. But thank you so much for being here.

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