Physician Health

The physician shortage and how Sanford Health is addressing it with Bill Gassen, president and CEO


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Bill Gassen, president and CEO of Sanford Health, joins us for the first episode in our new “What Keeps Me Up” series, where we talk with health care leaders about the one thing that’s keeping them up and what they’re doing about it. Bill shares his concerns about the challenges facing the health care workforce and talks the investments and innovations Sanford Health is making to address those challenges. AMA Chief Experience Officer Todd Unger hosts.


  • Bill Gassen, president and CEO, Sanford Health

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Unger: Hello and welcome to the AMA Update video and podcast. This is the first episode in our new What Keeps Me Up series, where we'll talk with health care leaders about the one thing that's keeping them up and what they're doing about it. Our first guest is Bill Gassen, the president and CEO of Sanford Health. I'm Todd Unger, AMA's chief experience officer. Bill, welcome.

Gassen: Thanks, Todd. It's a pleasure to be with you here today.

Unger: Well, thanks for being our first guest in this new series, and let's dive right in. Bill, what is the number one thing that is keeping you up these days, and why?

Gassen: Without question, it'd be the workforce. I, like most of my colleagues across the country, have been for the last few years and certainly will be for the foreseeable future, focused on our workforce right now. You know, right now, if you think about the challenges that we've been facing here over the last couple of years, a lot of it really does center on how do we do a better job of not only recruiting in the best and the brightest into health care, but then, at the same time, doing a really good job of taking great care of our caregivers, today, to make sure that we're retaining that workforce today into the future.

And for us, we think that it's a whole myriad of different approaches to be able to do that, to make sure that we can continue to provide the care that's necessary into the future. And that's really wrapping around our caregivers to make sure that they know how much they're valued, that they understand that we are going to prioritize the work that they do, both today, as well as that which they're going to do into the future. And how do we start working harder to be able to take some of those redundant tasks out of their workflows to allow them to do the things that they really got into medicine to do, to be able to interact with and to be able to care for our patients? And we see that as one of our chief challenges and opportunities right now.

Unger: Well, I'm going to guess that a lot of folks in your position would have the same answer, because these past few years have taken a heavy toll on the physician workforce, as well as the rest of the team. Tell us a little bit about how this problem has been impacting your work at Sanford and what steps you're taking right now to address the concern.

Gassen: Yeah, specifically, from our physician perspective, to really look at our physicians, to understand that, again, they got into medicine to be able to care for patients, to be able to bring cures, to be able to bring comfort to their patients who they have a chance to see. And then we know that, in the world in which they're serving today, right now, they spend more time than they desire to be in front of a computer. So if I think about conversations that we're having day in and day out with our clinicians right now, in particular, with our physicians, it's how do I be able to free up more time to be able to spend more time in front of our patients, to be able to do the things that went into medicine to be able to do, to be able to bring those cures and that comfort to them as opposed to spending as much time as they have right now in front of the computer and doing tasks that are not rewarding to them and they know that aren't as rewarding to their patients right now?

So for us, a couple of things that we're really trying to do right now as it relates to the physician workforce is to really be able to double down on our investments in the innovation space. We announced recently, at Sanford Health, a $350 million initiative around virtual care, and at the end of the day, that's figuring out how do we not change what we do. But let's change how we do that. And when we think about how do we change what we do, it's how do we return more time in every single day for our physicians to be able to spend more quality time in front of their patients.

And as we know right now, we're faced with a significant workforce shortage and in particular as it relates to our physicians right now. And one of the ways that we're looking at that is how do we enable them to do more with less and by extending them by using virtual care, we think, will be a way to do that to be able to especially reach into the rural communities. Right now, two-thirds of the patients who we serve at Sanford health come to us from rural communities, so we want to make sure that we're extending the best and the brightest from a primary care perspective, from a specialty, from a subspecialty perspective into these rural communities.

And by being able to lean into the innovative technologies with virtual care, that's going to enable us to do that, so that those physicians who are able to treat and meet with patients right now in more of our urban communities can do that as well in those rural communities. The other way is to come alongside those physicians to let them know that we know right now that they're burdened right now. We know that they're stressed, that, right now, there aren't enough physicians, so we've also doubled down with another $300 million investment in graduate medical education.

We've decided to expand and to invest in that, so that we can continue to bring along the best and brightest, have them trained with us at Sanford Health, have them go out then and see what it's like to live and practice in these rural communities and to fall in love with them, like so many of our providers have done today. So through that, we believe that that's going to enable us to build out that workforce that we have today into the future, because we know that about 40% of those who trained with us stay with us. And we think that that's very important as we wrap around the physicians we have, today, enable them with the best technology that's available to be able to expand the care that they provide and then bring alongside new partners to train with them, to come to practice with them, and help sustain them into the future.

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Unger: That's over $600 million worth of investment. I love the objective, which is what we hear from physicians, which is spend more time with patients not looking into a computer. When you think of all the work that you've done toward that end, what's the biggest challenge that you've had to overcome so far?

Gassen: You know, really, for right now, when we think about the challenges that are in front of us, fortunately, for us, especially at Sanford Health, our physicians want to do the right thing. There is no question as it relates to their passion, as it relates to their drive to be able to do these things, but it's helping to come alongside them to help wrap around all those right services, all the right investments. So a big part of that is listening to our physicians and going to them and saying, help us diagnose what the challenges are and then help us develop those solutions. One of the ways that we're doing that is helping to address physician burnout, and through a number of our different programs, everything from our new orientation for how do we bring new physicians into the organization, how do we make sure that they're aware of the resources that we have, how do we help them better inform the resources that they believe we need to go into the future, and then also making sure that we look at these individuals and understand that not only are they world class scientists and physicians, but they're also leaders.

By their nature, we find that our physicians are some of the best and brightest leaders that we have out there. So we've been very intentional about creating programs, like a Sanford Rises program, that helps bring in a cohort of our physicians on an annual basis to train with us, to help develop those leadership skills and then help deploy them. And for us at Sanford Health, we think that it's not only deploying them within their specialty, not only deploying them within their group or their practice or department, but also more broadly across the organization as we continue to expand physician leadership in its role and its importance at Sanford Health within broadly in the community. We want to make sure that our physicians find themselves to the extent that their schedules will allow them, both personally and professionally, to serve on boards, to be seen as leaders and fixtures of the community, and then also be able to do that on a state and a national level as they help guide and direct the practice moving forward and into the future.

Unger: What a great program in Sanford Rises. I think you've had a chance to talk with one of your colleagues about that before, getting physicians at the table, giving them the kind of leadership resources and training so important to address a lot of these technology problems that started by not having that in the first place. Bill, I'm curious. In addition to all the work that you're doing at Sanford Health, when you think about the broader landscape of medicine, what changes do you feel need to happen to address the issue that you're talking about?

Gassen: Right now, I believe that our most powerful weapon to be able to transform the way in which we do the work that we're doing today is by harnessing technology by doing it in a way that we've not yet been able to do in health care. Much has been said. We've talked with you and your organization much about this, as well, and did so recently at our conference on rural health care, that, today, the investments that have been made in technology, a lot of those have been heavily indexed in the EHR and albeit good investments.

They've not yet returned in the way that we'd like to see them. The way in which we've seen them drive down some of those redundancies, to take some of the duplication out of our work, and to really allow those, as we've talked about at the start here, to really work at the top of their license, to do that which delivers the most joy and the most value for them. And I firmly believe that by harnessing technology in the right way, that's going to allow us to do that by helping, again, to bring physicians to the table, to help them design those solutions, and to think about the way in which we do that.

Recently, at Stanford, we had the opportunity to participate in a program, in a cohort of individuals, 27 different health systems, a mix between providers and payers across this country to help voluntarily develop what are going to be the rules of the road, what are going to be the ways in which we responsibly use our large language models. How do we leverage artificial intelligence to a way that delivers a greater value for our patients and for our clinicians who are providing that care each and every day? And by doing that, by coming around and determining these are the things that we need to make sure that people know, that we're committed to providing safe and responsible care for our patients, our physicians know that.

That's top of mind every day, whether it's using a stethoscope, whether it's using the EHR, or whether it's using a large language model. Our physicians always have the best interest of our patients in mind. That doesn't change when the technology changes, but we want to make sure that that's very clear, that our patients know, that they understand that we're committed to that, that they understand we're committed to transparency, that when we're utilizing these technologies, we're doing those in a way that they can know and understand why we're using it, what purposes they're being used for. And I think that's very, very important and to make sure that we enable our physicians with that knowledge, that they know and understand what's behind the scenes, what's helping to develop these algorithms, so that they know, do they apply to my patients?

Might I want to utilize those in a different way going forward? And that's why we believe, at Sanford, one of the most important ways when it comes to clinical application is that there be that physician in the loop, that as we're going forward and we're innovating in this space, as we're leveraging these new technologies, we make sure that we do that still guided and directed by our physicians. At the end of the day, it's one of the greatest things that we have here in health care is that relationship between the patient and the physician remains sacred, and we want to make sure that stays in place, both today and moving forward.

Unger: Well, that's quite a gamut from stethoscope to algorithm and AI that you have to cover, but I love your approach, and thank you for the great work that Sanford is doing to support physicians and patients. That's it for today's AMA Update. If you enjoyed this discussion, you can support more programming like it by becoming an AMA member at

Bill, thanks so much for joining us today. We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at Thanks for joining us today, and please, take care.

Gassen: Thanks, Todd.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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