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Q&A
H+H staffing changes and efforts to retain physicians
0:40:57
·
7 min
Council Member Narcisse inquires about H+H staffing changes, particularly the increase in registered nurses and decrease in physician positions. Dr. Katz discusses efforts to retain physicians and address working conditions.
- H+H has successfully hired over 3,000 nurses to replace temporary contract nurses
- Decrease in physician positions due to movement from city line to Pagni line
- Discussion of competitive salaries and the importance of mission-driven work
- Challenges in making physician jobs more manageable and reducing administrative burdens
Mercedes Narcisse
0:40:57
H and H overall headcount has increased by 2,128 position when comparing the third quarter of fiscal twenty twenty five with the fourth quarter of fiscal twenty twenty four, the largest increase is in registered nurses, I'm not complaining there, with six or nine additional budgeting position.
0:41:19
There has also been a decrease of nine physicians positions.
0:41:25
What is HNA's current overall vacancy rate?
Mitchell Katz
0:41:31
So yes, we so appreciate you as the highest ranking nurse in the city.
0:41:39
We have
Mercedes Narcisse
0:41:40
I don't know about all that.
0:41:41
I'm not doing hands on anymore.
0:41:43
A nurse is
Mitchell Katz
0:41:44
a nurse.
0:41:44
It's a spirit, not a procedure.
0:41:48
We're very pleased to have our own nurses rather than registry nurses.
0:41:54
And I thank city council for advocating for fair and equitable wages for nurses.
0:42:03
Because without that we could not have possibly done this.
0:42:06
And we worked closely with OMB and they helped us to get a fair contract with the result that we now are able to hire our own nurses.
0:42:20
The reason you see a decrease in the physicians is only that they have moved from the city line to the Pagni line because it's preferred by most of the doctors.
0:42:32
We generally give people at some of the hospitals like Kings a choice.
0:42:37
They can be on either line.
0:42:39
We're anxious to recruit doctors.
0:42:42
But there's no absolute decrease.
0:42:44
Overall, we are taking care of more people than we have taken care of in recent history.
0:42:51
And we have more doctors and nurses than we ever have.
Mercedes Narcisse
0:42:54
I appreciate that.
0:42:55
Do you anticipate any major increases or decreases for any of the headcount categories in the fourth quarter of fiscal twenty twenty five?
0:43:03
What about in fiscal twenty twenty six?
Mitchell Katz
0:43:06
Not in the fourth quarter of twenty twenty five.
0:43:09
I think what happens beyond that is gonna depend on what that Medicaid final Medicaid budget does and how the state handles how much of the losses they need to push down to the counties.
Mercedes Narcisse
0:43:24
What efforts is HNH making to ensure that the system retains a sufficient number of physicians?
Mitchell Katz
0:43:32
We we recruit hard.
0:43:34
Our Our salaries are comparable
Mercedes Narcisse
0:43:39
Nice to hear.
Mitchell Katz
0:43:40
Other safety net systems.
0:43:43
We're comparable to the private sector.
Carrie Hawkes
0:43:46
Okay.
Mitchell Katz
0:43:48
But, you know, we are blessed with many physicians who remember taking their immigrant parents to health and hospitals, and made a commitment that they would give back by working at health and hospitals.
0:44:03
Generally, you know, as a rule of thumb, my thing is that people will work for 80% of the salary.
0:44:11
The 20% can be mission, but they won't work for 40% of the salary.
0:44:16
So you have to be in the ballpark.
0:44:19
We will never be the the highest payer.
0:44:23
And I tell people when I recruit, if you want the highest salary, you're the wrong person for health and hospitals.
0:44:28
Don't come work to us because you want the highest salary.
0:44:31
That's that's not who we are.
0:44:33
Come work for us because you'll have a comparable salary and you'll go to bed every night knowing that you were taking care of people who really needed you.
0:44:42
And I think that that has to be the the health and hospital transaction.
Mercedes Narcisse
0:44:47
Yeah.
0:44:48
I got it because that's why they didn't pay me much either.
Mitchell Katz
0:44:51
No.
0:44:54
An equal underpayer.
Mercedes Narcisse
0:44:56
Yeah.
0:44:57
But I enjoy it, like you said.
0:44:59
It's a passion.
0:45:01
It's a calling, but we have to pay the bill too.
0:45:04
How is H and H working to support its physician in relation to the demanding working conditions they face?
Mitchell Katz
0:45:14
Yeah, it's fascinating question because in the forty years I've practiced medicine, the world has changed, right?
0:45:22
In the forty years ago, it was shut up and do your job.
0:45:27
Doctors shouldn't be emotional.
0:45:28
I remember being told when I was crying about a patient I knew quite well who was dying of cancer, remember being told by the senior doctor that I was being too emotional.
0:45:40
Right, I mean that was the idea.
0:45:44
The idea was no emotion, do your job, come to work, you're sick, come to work.
0:45:50
And we now recognize why that's inappropriate.
0:45:56
And, you know, it's taken a while for the systems to figure out how do we help people in very stressful jobs, and what is the right answer?
0:46:08
And some of the first answers were probably wrong.
0:46:11
A lot of the first answers were okay, well we should have yoga classes and meditation.
0:46:17
And those things are good.
0:46:19
But it doesn't help if you make the job stressful and then say, okay, for the next hour we're gonna do yoga.
0:46:26
And then you go back to something really stressful.
0:46:28
I think people realize that's not the answer.
0:46:31
The answer is you have to make the whole job doable.
0:46:35
Right.
0:46:35
And then if the person wants to go to yoga after work, they can go to yoga.
0:46:39
But it isn't about taking breaks from things that are stressful.
0:46:43
It's about making the job doable.
0:46:46
And you know this from doctors have a lot of responsibilities.
0:46:52
All the orders legally have to always be signed by doctors.
0:46:58
And it puts burden on doctors to do things that often really are not even doctor jobs.
0:47:06
As a primary care doctor, I have to sign off every request for durable medical equipment for patients in the outpatient.
0:47:20
Why?
0:47:22
All of these patients have a physical therapist.
0:47:25
They have a home nurse.
0:47:28
But the rules say that a physician must sign off.
0:47:33
And so we put huge requirements on doctors to do things that are often not medical and it causes a lot of stress to doctors.
Mercedes Narcisse
0:47:43
True that.
0:47:44
So why can't the physical therapist do that and the doctor write it in a note and the physical therapy can actually send the patient one with that?
Mitchell Katz
0:47:53
Because the regs don't allow it.
0:47:56
Anyway, that's another You are correct about what would be The ideal.
0:48:01
Same, one of the ones I always found fascinating is nutrition notes have to be signed off by the doctor.
0:48:07
You know how little most doctors know about nutrition.
Mercedes Narcisse
0:48:11
Yeah.
Mitchell Katz
0:48:11
So what does it mean that a PhD level nutritionist figures out the calorie counts and the correct diet and then I sign off on it?