Ever Onward Podcast

The Future of Care with Dave McFadyen | Ever Onward - Ep. 85

• Ahlquist. • Season 1 • Episode 85

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Dave McFadyen believes in the power of local roots. 

As President and CEO of Trinity Health’s West Region — which includes Saint Alphonsus Health System and Saint Agnes Medical Center — this Boise native brings over 25 years of healthcare leadership experience to some of the industry’s most complex challenges.

In this episode, we explore the current realities facing healthcare in Idaho and beyond. From balancing fee-for-service models with value-based care to launching neighborhood care centers that bring services within 15 minutes of every patient’s home, McFadyen shares how St. Al’s is building the future of accessible, community-centered healthcare.

He addresses Idaho’s physician shortage and the promising new Graduate Medical Education program that recently welcomed its first residents — a crucial step in keeping future doctors in the state. We also dig into cutting-edge AI tools like the DAX system that are reshaping both patient care and provider experience.

But innovation isn’t without obstacles. McFadyen explains how recent Medicaid funding changes and Idaho’s transition to a managed care model could jeopardize essential resources for vulnerable populations.

Don’t miss this honest, insightful conversation with one of the key voices shaping the future of healthcare in Idaho.


Guest Bio:

David McFadyen is the President and CEO of Trinity Health’s West Region, which includes Saint Alphonsus Health System and Saint Agnes Medical Center. A proud Boise native and “local kid,” Dave earned his undergraduate degree from Boise State University and an MBA from Northwest Nazarene University. He is also a Fellow with the American College of Healthcare Executives.

With nearly 25 years in healthcare leadership across Southeast Idaho, Dave has held executive roles at West Valley Medical Center, St. Luke’s, and Saint Alphonsus. Throughout his career, he has led the development of new facilities, launched vital healthcare services, and championed provider recruitment — all with the goal of improving access to world-class care close to home.

Dave is an active community leader, serving on the boards of the Idaho Hospital Association, Boise State University Foundation, American Hospital Association’s Regional Policy Board, the Boise Metro Chamber, and various other local organizations.

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Speaker 1:

Today on the Ever Onward podcast, we have Dave McFadden. He's the president and CEO of Trinity Boise State for his undergraduate and then has been in health care for 25 years in Southwest Idaho 11 years at West Valley Medical Center in Caldwell, 10 years at St Luke's and now five years with St Al's. And now he is the big guy taking over for huge, by the way, shoes to fill Odette Bolano. I can't wait to catch up today with Dave McFadden, ceo of St Al's. Prior to our conversation with Dave, I'll do an all-quist update with my partner, holt Haga. Holt, we had a little topic to talk about in our all-quist update today. Yeah, I think it's important. It plays on a sensitivity that I have which, listen, I'm in an office with all these killers and young guys that are in their early 40s and I'm pushing 60 now and so sometimes I get sensitive and I poke my head in your office and I said, man, you young guys don't listen to us old guys anymore.

Speaker 1:

But I will tell you, like one of it's a quick story. But when I was training in emergency medicine in Tucson Arizona, one of my attending physician was Frank Walter, and this guy is a legend. A legend. He is by far and away the just kind of sheer intelligence, one of the smartest guys you've ever been around, and he would school you on everything.

Speaker 1:

I mean, every moment was a teaching moment and when you would go to present a patient to him because in the ER what you do is you'd go see two or three patients and then before, as a resident, before you could start a treatment plan, you had to go find Frank, dr Walter, sit him down and say, hey, this is patient A, this is this, this is what I want to do, and most of your attendings, like most of them, would say great, yeah, go for it.

Speaker 1:

They wouldn't even half the time you think, are you even listening to me? And Frank, every time would look at you and say wisdom comes from bad experiences and bad experiences come from lack of wisdom. Let's go see the patient and, as a resident, it would piss you off because you'd like, hey, I've got this person in here that I think has got this easy thing. I just want to go treat him. And hey, I've got this person in here that I think's got this easy thing, I just want to go treat him and he would walk in the room and you'd walk with him and half the time you're rolling your eyes like, okay, here we go, let's go through it.

Speaker 1:

And then when he walked in the room, he'd start off the same way how are you doing? And he would kind of do his thing. And you know what I learned a lot. You learned a lot because I'd like, oh, I missed that, or I didn't ask that, or man, why did he? Oh, you know what I mean and so you know, I just think about that a lot and as I've gotten older, now I'm saying, hey, what is there to learn here, Especially as our economy's changed so quickly and technology's changing now is what can we learn from the past to help us?

Speaker 1:

Anyway that was a short way of telling you that the other day.

Speaker 2:

No, I was feeling a little Well and I think you know, I don't know Younger guys. I hope I think our generation still is like you know, we're students. Like I can, I've, I've attributed a lot of my success just to, like you know learning. Just, you're always learning Right, but, but, um, but I just thought it was an interesting comment because I see it and I hate to like point the finger at the generation below me, cause I'm sure it's you know, my generation too, but um, the value of, of learning from you know guys like you, tom, you've been like an incredible mentor to me and everybody else in the office right, we made a lot of mistakes, right, when you learn and they they're deep.

Speaker 1:

Yeah, you know we're now. We went through the great recession. Yeah, you were. You were still like.

Speaker 2:

I was still skiing. I think I was like skiing a mobile run in Park City.

Speaker 1:

You were still on the US ski team. Like you know having to spend your you.

Speaker 2:

You know having to spend your time in Argentina, I wasn't in the fetal position under my desk, so you go through that one and then you go through, you know, this last one.

Speaker 1:

It's been very different, this last kind of slowdown, but you go through those and you learn a lot.

Speaker 2:

The message is important, though, like it is, because it's so easy to sort of to not understand the value of the guys who have been doing this for a very long time, and I'm more talking to the young, like the crew that's early 20s, trying to figure out what do I want to do.

Speaker 1:

Are you starting to feel like an old guy? Now? I'm feeling like an old guy because I'm 42.

Speaker 2:

So you know, I think I am one of those old guys now.

Speaker 1:

Do you know how mad that makes a guy that's almost 60? How like you so you're feeling old.

Speaker 2:

But I just want to say, because I think it's important, because I see it every single day is that when we look at a lot of projects let me just give an example of this. So we look at a lot of real estate, right, a ton of real estate and I was on my Google Earth the other day and I was deleting all of our pins, all the pins that I had, and I'm like, well, we didn't do these projects, so I deleted them. I did like 30 pins. I'm like, wow, that's, we looked at a lot of stuff and those are things that we actually really looked at. There's all the other things that we look at and just pass, pass, pass. But but when, when you look at a piece of real estate and it's part of the reason, it's a large reason, part of the napkin say this project works or it doesn't, there's always the landmines and the claymores that will happen, and then all the ones we think are going to work.

Speaker 1:

then you're like okay, now where are the other landmines? But you're kind of constantly saying, okay, what are what are the? You're thinking with the end in mind, right?

Speaker 2:

Yeah, and you're backing in pretty quickly to okay, what are all the things that need to make this thing work?

Speaker 1:

Yeah, but the young like, unless you have that experience, you'll go chase this down and what we're experiencing right now, like this week, I've probably had three different people in here that are young folks that have gotten into trouble, that have come in and said, hey, do you want to take over a project? Right, yeah, and I sit down with them and I understand how it happened. Yeah, and I sit down with them and I understand how it happened.

Speaker 2:

Yeah, and I get it. Here's where you. Yeah, here's where it started.

Speaker 1:

I completely understand it. And you know, some of them might give us a chance to kind of partner and help out, and some of them you're like, hey, man, it's going to be a tough lesson to learn. But your point's very well taken, which is, and you know what, there is no replacement. The replacement for developing wisdom, if it's not bad experience, is listening. Those are your two options. Yeah, right, frank would tell you that, right, right, right, dr Walter would say either we go have a bad experience and you learn, or you learn something from me. Yeah, and man, wherever you are, frank, love you man, yeah your lessons.

Speaker 1:

It's been great. Thanks, holt, thanks everybody, thanks for having me. Dave, thanks for coming on. You bet this will be fun.

Speaker 3:

Yeah, it's been a little while it has been. It has been.

Speaker 1:

How are things out there?

Speaker 3:

You know we're moving and shaking. You know changing the way we're doing things and trying to adapt to what's coming at us.

Speaker 1:

I honestly can't wait until we've been kind of heads down and busy in what we do, but healthcare, healthcare. I think with the change in the administration and then challenges here locally like, is it just?

Speaker 3:

crazy right now. You know, I think healthcare is always somewhat crazy yeah. We're adapting to clinical environment, changes in policy, changes in new technology, reimbursement, but it feels like it's moving faster than ever.

Speaker 1:

Yeah, yeah. What do you see as the big? Some of the biggest challenges you're facing right?

Speaker 3:

now, you know, I think adapting to the new legislation, both at the state level and national levels, can be key. Most of that won't roll out for two, three years, and so we're, we're in the phase of learning. You know what does this mean for Idaho? What does it mean for healthcare?

Speaker 1:

Can I ask so? So one of the questions I've been dying to have you on to talk.

Speaker 3:

I just get a couple of questions because if you go back, I'm old Dave, I've been doing this a long time and you know you go back in in.

Speaker 1:

You know what I would, as an old guy, call it the good old days where you know you had a doctor and a patient relationship. It was really pretty straightforward, right. I mean, in the 90s it was pretty straightforward. You had very few layers between the provider, the hospital, the surgery center, wherever you're getting your care and the physician, and there was a lot of real accountability Shoot. I go back to my days. You had a paper chart and at the end of the chart you would lift it up and you would list out the things you're billing for and the physician. I would do that and then I would turn that in and I was very tied to billing. I knew what was going on. I could have a patient come in and tell me what did happen. We had professional courtesy, we call it. So if you had a fellow doctor that came in with their family, you could say, hey, I want to write off my services and I knew exactly what it was costing, right.

Speaker 1:

And then there was this transition to where it got bigger and it got harder. And then Obamacare passed and when it passed, I remember I remember having lengthy discussions that, um, does this really fix much? Because it really didn't go socialized right, where you kind of had a two tiered system where the government just kind of came in and then you had private insurance. And it's a misconception to everyone that thinks that, like, if you have socialized medicine, you just have socialized medicine. In every country that has socialized medicine they have two-tiered system right, they have private not.

Speaker 1:

But when it came in it kind of did, it kind of went down the middle yeah. So then you had, you know, pbms on the pharmacy side. You had all these intermediate things that happen on the medical side Right, complex, complex yeah. And so then you had this. What I would say is this bloating of kind of like regulation that kind of came in and so now it got really complicated. Then there was this hope for me, because then you had like value-based care. So then, shoot, it's probably been 10 years for this.

Speaker 1:

At least yeah, you go back 10, maybe 15 years and then we're like, hey, we're going to change the way we do healthcare Because a long, long time ago, when the blues started, it was first time insurance was introduced, fee for service. We have this revolutionary idea where we're going to have this, we're going to pay people to keep people healthy, and that was the whole new thing. And it's this value-based care thing. And that was the whole new thing. And it's this value-based care thing. And it's complicated, but if you take care of patients and if you check all these boxes, then and their outcomes are good, and it all sounded great.

Speaker 2:

It was really hard to do, though. I mean it's really really hard to do.

Speaker 1:

It sounds good, but but then then it was kind of like uh, I describe it like you got your feet in two canoes, because you still have a whole bunch of people over in this canoe that are that are fee for service, and you got a whole bunch of people over in this canoe that are that are value-based care reimbursement. And you're trying to figure out how to do both and and. But I thought, oh, at some point we're going to transition and get out of that, and then, and then what Cause? It seems like we're in the, then what? But we're still there.

Speaker 3:

We're still there, yeah, and I think we're trying to figure it out. What I'm excited about, though, is, I think, value-based care, and the premise behind that is still real. How do we take really complex patients that utilize a lot of healthcare and cost a lot to the whole system? How do we keep them out of that environment? Yeah, and so you know, st Alphonse's, we are standing up clinics with extra resources and identifying those patients, whether they're commercial or Medicare Advantage or Medicaid, so that we can redirect them to these clinics where they may be seen three times a week.

Speaker 1:

But your whole goal is, hey, let's keep these guys, keep them out of the ER, keep them out of the inpatient setting. Because when you look at like a patient like let's say, you have a 5,000 employee company, at like a patient, like, let's say, you have a 5,000 employee company, at the end of the year you can get. I remember when I helped it was not West 8th, it was a Meridian School District back in the day but Linda Clark and they pulled up all. It was blinded to who the patients were, but they pulled up the consumption of healthcare. It was shocking to me.

Speaker 3:

It was the first time as a doctor I'd ever looked at like a very big organization, but it's, it's really five to ten percent of that panel.

Speaker 1:

That eats up 90 of the health care potentially, yeah, at least 80. Yeah, it's incredible and so so we can't stop that. That is, you keep them healthier and and and uh, it helps them right. In theory, it should be good for them. So what are you? What are you doing? So what we're excited about is is we think about, and it's newer, for In theory, it should be good for them. So what are you doing.

Speaker 3:

So what we're excited about is we think about and it's newer for St Alphonsus Over the last couple of years we've been wading into taking on that risk or value-based care models, and so one of those things is making sure as we bring on those panels of patients, understanding who's in that 5,000 panel group, identifying those patients and working with them to get them into these clinics. And the first clinic will open up in Caldwell this fall at our new center out there on the freeway. So really excited about that and Dr Yakeley is going to help us.

Speaker 3:

We have pharmacy, case management, social work, resource managers that can help them get the kind of care they need. Do they need pharmaceuticals? Do they need housing support? What's their access to healthy foods? So all those things that we can try. Over time go from three visits a week down to two and eventually down to one and then monthly. It's amazing, and that's what we want to do.

Speaker 1:

I think that's good for the community. That facility is awesome. It's beautiful. I hadn't seen it for a few months and I was out there. We have everything right next to it there at North Ranch and I'm like, oh wow, that thing is coming together.

Speaker 3:

It looks so good. It's a footprint. We're going to use that same model. So we have urgent care, primary care, specialty care, imaging and lab and we're purposely not putting in an ER. We want urgent care. How do we develop centers that are low cost, close to home, so smart are we want urgent care? Yeah, how do we develop centers that are low cost, close to home, so smart? And we have this vision if we're within 10, no more than 15 minutes where you live, yeah, that's ideal. So that center is going to go in. We have another one planned for north meridian, out towards highway 16, that new development. Another one in south meridian and then really filling in the community with access to primary care, because the last thing we want to do is drive patients to ERs, drive patients to inpatient care.

Speaker 1:

We want to close the home and afford it and in theory, dave, I mean like that's always been the hopeful model, right, right, I mean I think when we started Salter, then that was kind of like that was kind of when we bought it and then that was part of the plan and it just didn't ever happen. But that makes a lot of sense, right. Having accessible healthcare to primary care, keeping people healthy the whole idea. It's become harder. How hard is it to access care right now?

Speaker 3:

Do you know within your system, we have pretty good access. I think the challenge is, if you want a certain provider in the primary care side, it may be harder to get into certain ones because their panels are so full. We have enough new providers that if you want to see a primary care physician, we can get you in. Oh good, navigating that is still a challenge, and one of the things we're doing is creating a new navigation system. Good, this next year. You and I are the same way. You have a friend yeah, I can't get in. You call me and I can make a few phone calls, help connect people and we get them in, and so we want to create that same experience for any patient in the Valley. One number Call this number and we'll help get you in and we'll navigate that for you.

Speaker 1:

So that's in design and development too, isn't that one of the you know, I think as well, we've part of. It is just dealing with growth, incredible growth. And you have, you know, if you go back 20 years, we were already talking about, 20 years ago, physician shortages in Idaho, and then 10 years it was getting worse. And so you think about, you are already challenged in Idaho for primary care. It's just always been a need. And now you have this explosive growth. But by anyone's prediction, no one ever anticipated this. And now you just have Micron.

Speaker 1:

I mean, it wasn't just the first time, now it's the second one, and I think everyone's just like what does this mean to us? It's exciting and a little scary. Yeah, it's really exciting, but very scary. That's great. And so I think you've seen I mean I have people call me all the time hey, can you help me get in here? I've called, I can't get in, or whatever, and I think some of it is navigation, because I think if they get pointed in the right direction then it works. But it's like sometimes, just so I'm really glad you're doing that. Tell me more about that.

Speaker 3:

So that's step one. We're opening up our first GME clinic.

Speaker 2:

Oh great.

Speaker 3:

Post medical school going into residency, and so we're going to have six residents starting just started. July 1 in Napa. I plan to get to 24 residents over the next couple of years. I didn't know that. That's fantastic, and the really exciting thing is four of those six came from ICOM, right here in the Valley, and so keeping our students here close to home, building a pathway.

Speaker 1:

Well, and people don't realize that that residents stay where they train. So I don't know what the percentage is nowadays, but it just makes sense that you fall in love with the community. If you're already building your family, your life, you have this known thing so. So it's critical.

Speaker 3:

It always has been, I think we're usually 50th, 49th in the country for primary care. Yeah, so we have to do this.

Speaker 2:

Yeah, so really excited to get that kicked off.

Speaker 3:

Yeah, and it's um, it's good for local kids. You know, and as we work with the legislature, we got to make sure we have a good deal program and a good MD program in the state and creating the residency slots. We can't just have medical.

Speaker 1:

How has the legislature been in receptiveness to medical Well, a couple of different buckets. I'm going to ask you and I know we're going to try not to get, but but like it do they understand the medical education, lack of primary care, lack of access, or that they've been helpful?

Speaker 3:

I think we're trying to educate and we're trying. It's a complex system, yeah, and I think a lot of elected officials if you don't spend time there, um, don't quite understand how how it works. How is the deal school different than MD? How do the slots work? What does that mean when they go to residency? And so I'm you know, I think through the committees that the governor has helped stand up and the right experts, creating the right documents, the right white papers to help educate is key. We have a lot of work, I think, to still do there this next year to ensure that when they make a decision around funding and partners and those things, it it's connected to what's going to help Idaho retain future physicians, cause we can't just have medical schools. If we don't have the residency slots, they'll go to medical school and, like you just said, they're going to go off to residency somewhere.

Speaker 1:

It's actually more and they won't stay. It's more important actually. I mean like if you didn't know how it worked, it's actually like in the level of critical need. It's above it, it totally is yeah, yeah.

Speaker 3:

Well, you think how it is right you go to residency, meet someone, start, start a family. Yeah, you like where you're at, you don't move, you don't move.

Speaker 1:

Yeah well, that's, that's great. And so then then, um, I don't, I you know, I don't know if you know, uh, all of the implications, but how you know, with the big beautiful bill passing and and what it did to medicaid and work requirements, have you guys already drilled into what that means for idaho?

Speaker 3:

we're still assessing, I think, our initial assessments. There are different parts to the bill that we still need to unpack, but a few key components, one being that our state just decided to go from a value-based care model for Medicaid to a managed care model over the next three years. Our legislature voted on that. Couldn't be worse timing because with that change those payment mechanisms from the federation federal government changes, uh, between a vco model versus the medicare I'm just sitting here thinking about how I mean that is a dramatic.

Speaker 1:

That's like taking the titanic and saying go the other way, go that way.

Speaker 3:

Yeah, so, because you've been planning forever the value-based model for that patient population, which is a high cost pay, and there's several hundred million dollars that comes to the state of Idaho from the federal federal government to help offset the losses of Medicaid here in the state and that gets dispersed across rural hospitals to hospitals like San Alphonsus In the new model under managed care, insurance companies will take accountability for managing those lives and then working with us. But the payment mechanism from the federal government will change under this new bill and Idaho, I think, will lose more than any other state in the country that we can tell based on what happened there, and so unfortunately they didn't at this point address that for Idaho, so I'm not sure where that's going to yet we have to see. Based on just today's model, we expect San Alphonsus could lose $35 million a year and funding that comes in to offset Medicaid Just because of a funding mechanism change.

Speaker 3:

Yeah, and, like I said, that's a really early number. We've got a lot to unpack.

Speaker 1:

But whatever it is, the point is that these decisions make huge impacts downstream and you're clipping along just trying to take care of people.

Speaker 3:

Right, it doesn't change how many sick people are coming to you and people think that's just money coming to the hospital through a check. That $35 million is not just that. What it is is those patients on Medicaid expansion that won't have coverage in the future. So what's going to happen is they're not going to see their primary care doctor.

Speaker 3:

They're going to wait longer, eventually end up in the ER, be really sick, don't have access to meds, and so then there's going to be this really big cost of care for an inpatient stay, er stays, and we're going to have to just write that off. It's a bad debt, and so that's where that loss comes in.

Speaker 1:

It's not like it's just a check coming from the federal government for Medicaid reimbursement, right. And the other thing that's always been interesting to me with, like indigent care or whatever it's like, you pay for it now or you pay for it later. You're never eliminating the need to pay for it, it's just how you're going to pay for it and the sooner the better. I mean you would think. The other thing you know I haven't listened.

Speaker 1:

Well, the Robert F Kennedy thing has been interesting for me because I'm like a Western you are right, neanderthal and a lot of the stuff. When you first hear some of even the medical stuff he talks about, I think still some of it is kind of out there, but a lot of it and then you go back to his thing on wellness and all this. So I think, going in, I'm like I'm hopeful that someone might be able to go back there. But the issue is you've got this machine right, this thing that is just cranking along. Changes have deep implications that affect people's lives today, right. Have deep implications that affect people's lives today, right. And how do you make adjustments that don't have unintended consequences or unforced errors that are potentially very difficult?

Speaker 3:

to overcome. Yeah, I think really what's happened with this bill is it's pushing all that back to the state level. The federal government's pretty much saying we're out of funding Medicaid for the expansion population for the most part, right, those that really need Medicaid are still going to have Medicaid, and so the states are going to each have to figure out what to do. What do we do? And in the past, even here in Idaho, before Medicaid expansion, the counties had County funds, indigent funds, those all sunset right as we went to Medicaid expansion.

Speaker 1:

So let's talk a little bit about that the way it always worked is counties had some funding that came from the state, multiple levels of funding. Yeah, and it was just. You know they and, by the way, there was a ton of pressure on that.

Speaker 2:

I don't want anyone to think like these excess funds?

Speaker 3:

That wasn't easy either, but at the county level.

Speaker 1:

They were making decisions. Okay, how are we going to use these indigent funds to help our little community hospitals? I mean it was I would sit in those meetings like with those rural hospitals and go, oh my gosh, how do you make this work? So it was not like you had excess dollars, but those funds are now gone because the Medicaid dollars came in that said, hey, now this is how we're going to take again. You're just shifting the way you're taking care of the same patient population, absolutely.

Speaker 3:

Wow, yeah, so you know a lot of work to do the next couple of years. I do believe, though and at St Alphonse's we're committed to this If we focus on the right things, we'll figure that stuff out as we go. What I mean by that is we have high-acuity specialty care for when you really really need it, so you don't have to travel to the University of Utah or UW. That keeps people close to home, that lowers the cost for the insurance companies, right, and so we're focused on that. And then these access points we're talking about. That's going to be key to creating that right care continuum with the right cost structure.

Speaker 3:

And then I think, as we partner with the state, we have to partner to solve this. It can't just be us against them, it has to be us getting creative and finding solutions. So I do worry for critical access hospitals. I think you know the large systems have more ways to help manage some of that risk. It's going to hurt and it's going to slow down new services or investments in certain areas, but critical access hospitals are already just right on the edge.

Speaker 1:

Let's talk a little bit about that. So within well, if you go back to the way hospitals are funded, they get reimbursement rates for Medicareare and medicaid that are federally, and then there's these fee schedules that it's supposed to help price fixing, but ultimately you end up with these master fee schedules that have to be driven by something, and they're often driven by these federal rates. That's a probably yeah, you tell me when I say something that's completely off. And then what happened is, um, in critical access hospitals or rural hospitals, they already have a hard enough time keeping their doors open and they are critical. They're critical in a lot of ways. The name is I mean, you've got these little hospitals that feed healthcare to a lot of people.

Speaker 1:

The one I'm most familiar with when I started going part-time from the ER, I would go to Weezer Memorial. Oh yeah, and I worked there for three years. I'd do a 24-hour shift on Fridays, yep, and I thought I could do this forever and then I realized I couldn't, but I loved it. But that's a critical access hospital, so I know a lot about that one. But they would get reimbursed at 100% right, that was their deal, right structure of cost structure, and so that was helpful to them. But even with that, it was always hard right. It was always just right there, right there, like they're on the edge always of how do we stay open and how do we provide these services. And and so your point is, like any change, it's a big problem for you because changes are hard, but for if you're a critical access possible that was already on the edge it does not take much to Not much 1%, half a percent, Absolutely, I mean.

Speaker 3:

So we have a Baker city is critical access hospital in our system and same thing I mean we usually are either right at break even or losing a little bit, and you know we've made tough decisions out there around closing services OB was one of those, you know, a couple of years ago and especially as we came out of the pandemic, and I'm committed to trying to find a way to try to bring back those services. I think if you live in these small communities and you're two hours away from a Boise or five hours away to a Portland, I can't imagine not having access to basic services, and so we're committed to trying to figure that out.

Speaker 1:

And, to be clear, one of the things that I sometimes I get in conversations with people and I'm like, well, you wouldn't know this, but we're talking basic services, right, because the system's already set up from Baker. If you come in and you have a heart attack, you have a stroke, you have something that's serious, you pretty much get stabilized and get air transported to a higher level of service. So that's already built into the system. We're talking just basic stuff that you Basic general surgery, basic general surgery, delivering babies, delivering yeah, just basic, basic stuff.

Speaker 1:

And I would say from the like all my years there at Weezer I'm guessing a little bit here, but you know, probably once every other shift I would have to fly someone out from the thing, but most of the time we took care of with that little community, almost everything that came in somehow some way.

Speaker 1:

So you go back to cost, and why I like bringing it up is think about that. It was just a little teeny ER with a little teeny community of physicians, but you were taking most of the problems that happened in that catchment area and saying, hey, we're going to figure out how to take care of these patients and do it amongst ourselves. That's very different than if you don't have those things and now, well, one people are not going to get care. So those things that they just get, you know, they're going to wait too long. Most healthcare problems, like a urinary tract infection in an older person, a skin infection in an older person, the longer you let it go, the harder it is to treat and the sicker you get right. So we'll take diabetes, I mean any illness. There is hypertension, it is primary care, it is prevention, and then it is having early access to early treatment that ends up dramatically reducing costs, reducing the cost.

Speaker 3:

Even in small communities, even in small communities, if not more important, yeah, if not more important.

Speaker 3:

So we're committed to that. But we got to have partners with our physicians as well. You know there's a lot of work happening out there in Baker city with our family physicians, because family doctors, they Family doctors. They practice inpatient medicine, they practice in the clinic, sometimes in the ER, sometimes they do endoscopy. And if you don't have them then you've got to fly in a hospitalist internal medicine doctor that's just there for a 12-hour, 24-hour shift and that's expensive and that's not somebody that lives in the community. I love the family physicians in our rural communities. Many of them grew up there. They're part of the community. You see them at church. You see them they're out playing soccer with your kids.

Speaker 1:

I will, I will tell you like and this is gonna sound like another old guy thing, I don't know why like I'm on this old guy kick maybe. So I'm almost 60 days, yeah, but it's like I, I remember like when I came out of residency in the 90s, right and and and we would well. First of all I would moonlight a lot because when you're you're so poor and you're just like someone will pay me 50 bucks an hour to go. You'd go, I work my tail off.

Speaker 1:

But these grizzled family docs, male and female, that just did everything you would go from. You're just these people that that was their life. They took care of people and come what may time of day, and it just always blew me away. You know, you're just these people that that was their life. They took care of people and in come what may time of day, and it just always blew me away. I was like very humbling, like you know, doc, so and so it just does everything for everybody. Yeah, you, you don't realize, as they age out, you get a new breed of doctor coming in with a separate like one. They probably weren't from the community. Two, they're not signing up for 80 hour weeks, 60 hour weeks, and so it's not a one-to-one replacement for those folks.

Speaker 3:

No, I'll go back to the residency then. Yeah, it's so important that we have residencies in the West. So think about this yeah, with individuals that want to live that lifestyle, especially in the real setting, and we keep our own and keep our own.

Speaker 1:

You're more likely to have an Idaho resident that goes to an Idaho school and then, most importantly, an Idaho residency that then stays in an Idaho community. That is that's irreplaceable. Irreplaceable that having someone come in from outside that's here for two or three years and leave and kind of bounces around. It's recruitment and retention.

Speaker 3:

It totally is. And in Baker City, I think half the doctors out there either lived there or grew up there and they came back, yeah, took care of that community, and so you know. You're so right. In the larger settings we're having to go to shift work because the doctors don't want to work those long shifts, they don't want to be on call at the end of a long clinic day, and so that's adding cost to us. We're having to adapt to the new physician models and it's also creating shortages. Oh yeah, because in the past Just a numbers game. It's a numbers game.

Speaker 1:

Yeah, gosh, we jumped right into it.

Speaker 2:

We did.

Speaker 1:

Which is fine. You're a local guy man, yeah. Yeah, Grew up here, stuck around and I know you spent. So you spent like 10 years at West Valley, is that right?

Speaker 3:

11 years, 11 years at West.

Speaker 1:

Valley. And then some time at St Luke's About 10 years almost, yeah, and that's where I got to know you pretty well there. And then when you went to St Al's, you've like been pretty well there. And then when you went to St Al's, you've been Dave, let's be honest man you've been like this rising star that everyone's like I wonder where this guy's going to end up. And then you end up going over to St Al's and working with Odette and then trying to fill those shoes, following those small shoes.

Speaker 3:

Big, small shoes.

Speaker 1:

Yeah, I had the total privilege and honor to getting pretty close to her and consider her a dear friend and mentor, and you get to come in and take over for her. So how's that been?

Speaker 3:

It's been incredible and just backing up for a minute, it's been such an honor and a privilege to get to serve in a community and I've always had this passion for health care. My dad was in the hospital a lot as a young kid so I feel comfortable in the hospital so I wanted to somehow end up in healthcare. I thought I was going to go the clinical route. It wasn't the right fit for me. My brother's a NP for a pulmonary group over in Bend, oregon, so we both have kind of that passion. Never thought I could do it here locally. You know it was at West Valley and an incredible learning experience. They're part HCA, they know how to operate hospitals and thought I'd have to move around the country and had this opportunity to go over to St Luke's at one point, which was a great experience too. I've got a lot of friends over there, done a lot of good work. Thought I was leaving the community again right before the pandemic and I love telling the story.

Speaker 3:

When were you at St Luke's? So I was there. I think I started right around 2010, 2011 through 2020. So you still had Jeff Taylor. Oh yeah, gary.

Speaker 1:

Fletcher Jeff Taylor John Key. Was Gary still there?

Speaker 2:

Gary's still there yeah, yeah, man, I have such fond memories of you.

Speaker 1:

Know how it might be too nostalgic. They may not be as awesome as I think they are, but I think back to you know you got Gary Fletcher, icon, icon, dahlberg and then Jeff Taylor. Jeff Taylor is kind of like the Wizard of Oz, absolutely. Yeah, he really kind of is. He's not your typical CFO and he's super humble behind the scenes, but you think of all this stuff and you got to work with all of them. By the way, I've tried to get him on this podcast.

Speaker 2:

Get him over here. He's like, I'm not, I'm like. I can't do that, I'm like, so you're going to have to twist his arm, so you're with those guys.

Speaker 1:

Yeah, and then Learned a lot.

Speaker 3:

And we built a lot of amazing things yeah, good things for this community. And so I thought I was leaving you know it's been 10 and thought I was going to leave again, and my wife didn't want to leave, right, she's got roots here. I got roots here. Both went to high school together. That's how we met.

Speaker 1:

She went to high school too, yeah.

Speaker 3:

So we went to Boise State and we've been all through the Valley and we love this area. Yeah, but it's tough when you're trying to grow a. If you'll leave me alone, I'll call Odette, so I called her and Andy Costantino, who had only been there a year running. The Boise Hospital for them had just given notice and it worked out great. It was a God thing in a lot of ways, because had I left in February, march of 2020, going into the pandemic which I had no idea was going to happen would have been awful for my family, and so getting to stay local and work with Odette was just an incredible opportunity. And you know, odette and Chris had a great relationship. Yeah, they did, you know, and I think me, coming over to, I've known Chris and that team over there a long time. I feel like really good relationships and throughout the pandemic, that was key, that we partnered and took care of this community.

Speaker 1:

To be clear, it wasn't always that way. I mean there was some serious rivalries. I remember when I got here in the 90s and shortly after I got here all the neonatal docs all picked up and left and went over to St Al's at one time.

Speaker 3:

There's been some shifts there's already cardiology stuff going on.

Speaker 1:

So it's nice that in a community like ours with only really two major well, hha has been very important in Kane County, but but it's the two, it's the two of you that there is a relationship.

Speaker 3:

Yeah, and it's important and that was great Like during the pandemic.

Speaker 1:

The collaboration was really impressive and that's what we need.

Speaker 3:

You know we have to compete. Yeah, that's important, but we need two healthy health systems to care for this community. So that's in a good spot, but wouldn't an opportunity, though, to work for Odette? You know, um, she's an operator through and through and she was the right fit for St Al's, for this community during the pandemic and, um, for all of us. You know, we worked good 18 months without taking a day off, whether you're administrative or physicians, um, an incredible time. But I saw her, I saw so many around us rise to the occasion and just do what was needed. So, yeah, like you said, great opportunity to work for Odette. I wasn't sure I was going to step into the role or wanted to even apply for it. Tell me about that.

Speaker 1:

So, before we leave her tenaciously, her Absolutely A lot of drive. It was super awesome. You know, just, uh, you know, cause you, you, you meet all sorts of people that you look up to that end up being your mentors, and they all have different qualities, but, but, but, like I learned a lot from Odette, yeah, yeah, and mostly just kind of this fearless confidence of just hey, I'm going to do the right thing, she knew how to cut through it, I'm going to cut through the BS and I'm going to do the right thing.

Speaker 1:

She knew how to cut through it, I'm going to cut through the BS and I'm going to do the right thing all the time.

Speaker 3:

And not just in the hospital. She was on various boards served in the community and same thing, yeah, made an impact.

Speaker 1:

And humbly confident. It's kind of like one of those lead, always use words when needed, just really really learned a lot, so that had to be incredible. But then she's leaving and you apply yeah, how's it?

Speaker 3:

been. It's been great. You know we're very different leaders. Yeah, the things her and I really aligned on and connected on was operations, you know, running really efficient, high quality operations in the hospital. So that was fun to work together with her, with her on those things and and we did that and we have that base already.

Speaker 3:

You know me being a kid growing up in the community, my focus is shifting a little bit. We got those operations. We have high, high Q to care, but it's all that stuff I just spoke to earlier around really creating access at a low cost point for our community and partnering with payers and businesses to figure out how do we do that for this Valley Because, as you know, I mean the cost of living is just going through the roof and so if you're in that middle income to lower income, it's hard just to have housing, put food on the table, let alone figure out your healthcare, and so I want to try and help figure out how to solve that. You know there's lots of factors besides just government payers. We've got rising costs, tariffs, inflation, wage cost pressures, but I'm committed to the pressure. How do we do that Everywhere?

Speaker 1:

Yeah, yeah, well, I commend you. I mean that's if you think about, if you think about a family budget, right, and just where. Well, I, here's a story from yesterday. We started a little thing with operation military blessings. We do a lot with them and and Tom Wessel is an unbelievable guy but he found out that they were very short on diapers and formula for the L1, the level one military families, who are 39% of them are food insecure, think about that.

Speaker 1:

So we had this little press conference here yesterday, like, think about that. But so we had this little press conference here yesterday and I told alex I said, hey, run over and grab for, go over and grab, um, some diapers and some formula for the table. And she came back and I said how much was that? It had to be like she's like it was 400 bucks. So so my point is like and you think about, yeah, diapers, formula, car, just the inflation we've had, and then on top of that you put healthcare costs, however you're trying to figure it out as a family there are a lot of pressures when you think about that young family the kids out at the baseball field falls down whatever happens.

Speaker 3:

Whatever happens, you end up in the ER. That's a $2,500 to $3,000's a 2500 to 3000 3500 bill. Urgent care at least is maybe less than 300.

Speaker 1:

yeah, right, so that's why those helping create the right access it's awesome we can't change all the costs right, we can't change no, but you can't get them to the right level of care, right spot and and it should help the ers, by the way, too where, where you've got an aging, the other thing that's happening. You know this better name what anyone is you have an aging population. You have sicker people. I talk to my old partners now and it's like how are you doing? And they're like good, but remember the good old days where you would have one or two really sick people and then you'd have this big population of kind of healthy people that are coming in for it.

Speaker 3:

It's now just sick people, sick people, and we're seeing that in the hospital post pandemic. You know we took a lot of surgeries out of the hospitals during the pandemic and we tried to figure out how to do them out patient, which that was always a trend, yeah, for years. But the pandemic sped that up so we had to reshape our boise hospitals inpatient beds so we have very little inpatient orthopedics now. We had a whole floor of orthopedics before, 30 some beds. They're sending people home like same day. Same day you go have a hip and you're like hey yeah, it's incredible but it's also it's advanced technology

Speaker 3:

right, very much. High acuity centers. Yeah, I mean, I don't doubt in the near future you're hardly going to have a general medical surgical for bed.

Speaker 1:

It's all going to be high acuity, critical care, telemetry, step down how are we doing demographically here with our aging population and and do you worry? I mean you know it's funny because you heard a lot about it like 15 years ago Everyone was worried about, hey, the boomers and the demographics, and hey, here it's coming and I think the pandemic hit and it sucked up all the oxygen and then there's just all this other stuff that. But I was actually thinking the other day I'm like it's been, you know, or we're getting closer, and if you look at those curves, it happens, we're experiencing it.

Speaker 3:

Is it? Is it happening? Already there's a few things that are happening in the Valley. One we have that aging demographic. That's also who's moving into the Valley, yeah, and it's interesting kind of that 55 to 65, fairly well-off individual. They're needing lots of knee because they're active. Yeah, knees, spine surgeries, pts. So we have that kind of population. I am that type of guy. We'd like to have fun. We're out mountain biking.

Speaker 3:

We're horseback riding, atvs, whatever it is, but they have a pretty high utilization of healthcare. So that's one population. Then that's right. When you get into Medicare age they're still just as active. And so I know for both health systems speaking for ours we're seeing a shift from that commercial age group into more of a Medicare age group, which also has impacts because that reimbursement rate is so different. Oh, I hadn't ever thought of that. That's occurring.

Speaker 3:

And at the same time you have and I get why you have, you know, the physician-owned surgery centers and some. So those centers pulling out that commercial population. So the hospitals are trying to really figure out how do we manage that. And you know, for us we did open up our own surgery center that is an ASC, that is reimbursed at an ASC level versus a hospital based level. And I think that's key as we keep thinking about that cost structure. But with the demographic changes we got to keep adjusting for that and figure out how do we, how do we come around, because it is changing. And then you look at our birth rates in the valley the rates are staying, are actually decreasing, but the number's pretty flat. So you'd think with all this population growth we should have a lot more babies coming in.

Speaker 3:

There's a lot, not a lot more babies because of that people aren't making babies like they did no, and so we have to keep adapting. What type of services do we need? So we need more nephrology, urology, pulmonary medicine to help with an aging population.

Speaker 1:

Talk a little bit about physician recruitment in the different specialties where you see some of the greatest needs or the hardest specialties to recruit.

Speaker 3:

It's really primary care, is it? We've done pretty good with most specialties. The one specialty would be neurology. That's been a tough one here and nationally.

Speaker 3:

I mean a lot of organizations look into J-1s or some other way to bring in some out-of-country experience. Outside of that, we've done fairly well. Sometimes it takes a while, but primary care is a national problem, but here especially so. That's why that GME program we talked about is important. You don't want to dive too deep into the women's health topic, right, there's a lot to unpack there, but OB and women's health is a big problem for the state to ensure we have that access. So we've got to keep working on that one to try and get us to a point that we can ensure access to care there.

Speaker 1:

Yeah, I mean it's probably a whole episode because there's just so much going on with it. And go back to the primary care thing. Is there anything like people listening to this should know or could help with, because ultimately that becomes a problem? And, by the way, we got the CEO of the largest or second largest you know hospital here in the Valley here. Can you imagine if we were talking to anyone in rural ish Idaho, like don't even take rural, but like if you just go that next tier down, they gotta be just you know, really hurting for me.

Speaker 3:

Yeah, you know, um, support from the state's always important. Think about if you're a family doctor. Though you come out, you have debt, several hundred thousand dollars, and those physicians don't make what a specialist makes. Got young families and so they're trying to figure out where do I go and how do I make that happen. And then you come to Boise, who used to have a low cost of living, so it made it even easier to bring in these primary care doctors.

Speaker 1:

Man. It used to be so easy to recruit.

Speaker 3:

So much easier.

Speaker 1:

We'd interview our groups and they'd come here and wherever they came from, they're like, oh great, you have the outdoors, you have the culture, you have the river, you have this heritage, family, everything you have here. And then it's like was it inexpensive to buy a house? And now it's like, not, it's not. You're on the other end of it.

Speaker 3:

We've had to create housing stipend programs for nursing and physicians I mean even specialists who make very good incomes come to Valley and like this is incredible for what I have to pay for a house versus even other parts of the country now. So it's a new dynamic we're dealing with. When we recruit here, it's people that want to be here or used to live here, so we have the primary care investment we just can't stop. Or used to live here, so we have the primary care investment. We just can't stop. We have some pretty big, bold goals at Al's to recruit into the Valley and retain for sure any of the ones coming out of residency, because our local residents are incredible and we can't lose one.

Speaker 1:

I have a couple other. I just looked down and it's 1043 already AI. So if you could tell a quick story, and then I'm'm gonna ask you because I I have a. I have a friend of mine who's brilliant, uh, his name's fahim rahim and he's a. He's a nephrologist over in pocatello. Incredible story because he comes over to america, him and his brother, nahim rahim, and they have like a few hundred bucks. They land in new york and the story it's a true story. They look at a map saying where don't we have any nephrologists? And this was like 25 years ago and the, the place in the country 25 years ago with the fewest and with the largest encampment area and no nephrologist was pocatello. So they come to pocatello and they set up their life, so and they're incredible human beings, entrepreneurs. But he calls me a year and a half ago and he's like I have got this company I'm starting as the next big thing and he talked about he's doing an AI company for nephrologists, so pretty tied down. But I want to get there and I'm like, well, hey, I'm like I don't even know. I better know how to spell AI. So I'm just like, tell me more about this. But it uses. So his technology it's now launching.

Speaker 1:

Now Nephrolytics is the name of the company, but it uses three forms of AI. So the first one and this has been in development for years, but first one is you walk into the room, the physician lets the patient know, hey, I'm going to be recording our conversation, and then they're pretty good about knowing that they're. This is normal. The one thing that you don't realize is there's when you walk into a room, because you're already thinking this way history of present illness. You have to ask all these questions anyway. So then they ask the questions. The recorder is catching it all. It's auto charting the entire interaction with the patient. So then that's done so that when he, when, when you go to uh chart, that in theory is all done already.

Speaker 1:

The second part of the ai is because nephrology is so uh data driven you know what are your labs doing, you know how are they compared to your last labs as they track your creatinine and all the other stuff that that's been done before the visit so that all auto uploads into the, into the chart, and gives a big giant summary note that's already written of hey, mrs jones has been had a. You know this is what's happening with her and this is so, that's done. Yep, and then the third thing which is like blew my mind is now. It says okay, mrs jones has all this stuff, this history has been loaded. Here's where her new thing is. It takes in what. What's happening with her now, all the vital signs, everything here is the treatment recommendations for mrs jones, based on all of the data and man. I'm like this is cool, amazing, yeah, so are you seeing kind of similar things on all fronts?

Speaker 3:

absolutely, absolutely. So. We use a program called DAX. We've been piloting here locally DAX it's called DAX D-A-X-E, okay, and basically it's the same thing Active listening While the physician we've been trying it with our primary care doctors listens, does the same, creates the note. Doc can go into a quick summary. We think providers can. What we're seeing is anywhere from about three patients more per day, or it takes care of their pillow time at night. We call it right. You're close for the day, taking away those two hours of documentation. So that's working amazing and we're rolling that out through the whole group. We've used AI for a couple of years now on imaging studies to, because as you come in for whatever study, it may be for a certain purpose, you know the radiologist tries to check for anything, but they're moving through hundreds of images. So the ai technology basically scans through every image and if something flags, it sends it back to the radiologist to look at it, typically looking for cancers or those types of things and then if they see example is you?

Speaker 1:

you come in because you think you broke your rib. I shoot a checks x-ray and I and say, oh, you didn't break your rib, or you did break your rib. That chest x-ray has all the other data of oh, there's a nodule in the left upper lobe CT scans, x-rays. Oh, wow, that's cool.

Speaker 3:

So then that way at least somebody can make an informed decision. Do they want to seek additional care? And so that's amazing technology, because then are putting the power back to the patient and the provider, and they may not have known or caught things. So that's amazing technology. You know, on the inpatient side we're going to start testing it the same way with nurses, because think how much time nurses spend documenting, actually caring for their patients at the bedside, and so if that active listening technology can be used to get them back to the bedside and just being, you want to?

Speaker 1:

know what I love more about it, because the old guy thing again, like there was a dramatic change. So we used to have like training, like for all the new docs, like hey, grab a stool, sit down, scooch up to the patient, like, look them in the eye, have a conversation with them, right. And then you had all of a sudden this change where you would wheel in a cart, right, and you went from hey, dave, I'm here to take care of you to Looking at the computer right, and you went from hey, hey, dave, I'm here to take care of you to looking at the computer. Hey, when was the last time you were in? Yeah, and it just changed everything. So the one thing that that fahim was saying is the nice thing about this is now you're back to engaging. I mean, think about this. You're now back to talking to a patient again.

Speaker 1:

So it's, it's awesome, awesome technology yeah, how much do you think it's going to save if you guys you guys have to know this because you're so smart as you get through this FTE crunch and kind of the future of medicine. Has anyone done studies on the efficiencies and what it may mean to the overall cost of care?

Speaker 3:

I think it's cost of care and it's staffing, because we're all struggling with staffing, so it's both being more effective, more efficient with our time. So we need less physicians, less nurses, to fill the future need because, as that aging population, we're going to need more care, so that's going to help, I think, adjust for some of that. I don't know the numbers off the top of my head, but absolutely. But I'd say it is better, absolutely better. The other thing that I think is pretty exciting is so much of the healthcare cost is in billing and all that back-end process work too, and AI should be able to help automate the vast majority of all that coding documentation, versus having individuals have to scrub charts, figure out how to code it, and it should be more accurate, too, as it flows right out the system, and then there's just a review audit process.

Speaker 3:

I'm excited about that to reduce that cost as well just so we can help streamline that process in the future. That's great. A dream would be the pairs do the same thing, we actually collaborate. It's a really nice process instead of the back and forth that can occur, right.

Speaker 1:

But pipe dreams pipe dreams, yeah that, that that layer, that tension, that healthy tension, that, whatever you want to call it, is, uh, you know it's always been part of it, but uh, ever, uh, ever changing, right, ever changing. Yeah, yeah, um, how has this been working for Trinity?

Speaker 3:

You know, um, people say all the time you kind of hate working for a large national company. Um, trinity is not that way. Um, if you ever get the chance to sit down with the senior leadership at Trinity, we're based out of Michigan, just just outside of detroit and livonia. Um, you know, we're catholic based, faith-based organization and salt of the earth just incredible people.

Speaker 1:

So I'll tell you a quick story. I got to go there with odette, did you okay? So we went back and met with their top brass and went into the conference room and and, um, very nice people, um. The one negative for them is they were all Detroit baseball fans.

Speaker 2:

It was like the start of the season.

Speaker 3:

They'd already lost all their mojo right. They're pretty proud back there with their sports teams Sports teams.

Speaker 1:

But we get in there and we sit down and the first thing they said was who wants to take a mission minute? And I wasn't ready for that. And what was cool about it is I'm trying to remember the name of the the ceo, but very impressive, um, very impressive, yeah, mike. But he looked at us and said, hey, would one of you like to do the mission minute today? And by sheer luck, sheer luck that morning was the meridian mayor's prayer breakfast and I gave, I gave the thought there, so I'm like you, like polished it off. He was impressed, but I didn't ever tell him. It's just because I just did it this morning.

Speaker 1:

Anyway, it was really cool. It was awesome that the first 15 minutes of that meeting was talking about patient care, talking about why we do this, talking about, hey, this is service-based. It was really I mean, I'm not just we walked out of there and I'm like, oh yeah, just genuine, I mean we're going in and there's no reason that that could have been part of the meeting and we spent the first 15 minutes kind of level, setting on why we're doing what we do, absolutely.

Speaker 3:

I was blown away. You meet with our teams here locally. You'll get that sense right. That's who we are, that's our passion, our mission, um.

Speaker 3:

But when you have that at the home office team, the system office team, it penetrates all the work that we do and how we make decisions.

Speaker 3:

And when we're making tough decisions, you know, we, we, we call it discernment process and we, we look at it from all angles, not just financial. What's it mean for our communities? And so to have that support from them is incredible, um, and to have a national presence we have over a hundred hospitals nationally, so I can pick up the phone, talk to a friend in New York or Florida and say, hey, I'm dealing with this problem, you have any ideas? And we get together as a CEO team. There's 12 of us that report up into the system office every two weeks. Uh, we get together four to six times a year in person, uh, spend several days together just brainstorming what's happening across the country and how can we bring that back to our local markets to help make improvements and, uh, investments, and so that's, that's unique and special and we're all aligned. I mean you can go to our Florida hospitals and you'd experience the same type of culture and passion, which is pretty cool.

Speaker 1:

And then as a consumer of healthcare here with you guys, I mean what great experiences. Yeah, I've had incredible clinicians, some heart stuff going on for the last few years and man, it's been great. It's been the highest quality care. We're really blessed, aren't we? Dave, very blessed For our size community. We're done for our size community.

Speaker 3:

Man, we're blessed. Well, and, as you know, you draw that circle around Boise. We're one of the most remote communities in the country, especially in health care, as it relates to how far do I have to get to get to an academic center and we are the most remote and so you know St Alice has been committed over the last decade to really bringing in those specialists so you don't have to go to Utah and we have them and they love being here and they're part of the community and we don't want to ever have to use them. But to know they're there and we have that backstop is well hey, buddy, you're a tremendous leader.

Speaker 1:

they're lucky to have you and it's going to be wonderful to watch you shape healthcare here, and we're lucky that a local kid is passionate here in your own community to be the CEO of a giant organization. How many employees do you have?

Speaker 3:

here, so between here and our Fresno hospital about 9,000. Yeah, 7,500 here locally.

Speaker 1:

Wow, 7,500. Well, we're in good hands, thank you. Thank you for what you do and we wanted to have you on, since you took over, to just talk healthcare and this was good and I just really appreciate you, man. Yeah.

Speaker 3:

Thank you, thanks for the opportunity. Thanks, good to see you. Thanks everybody.