Alexi Nazem is a Harvard and Yale-trained physician and the co-founder of an interesting and quite useful healthcare company called Nomad Health. Nomad has created a digital platform that helps healthcare professionals (doctors and nurses) looking for work connect with healthcare facilities (hospitals, clinics, offices) looking for staff without the need to go through a third-party recruiter or broker. The focus is on filling positions on a temporary basis (locum tenens), but some people find permanent jobs as well.
I invited Alexi to join me via podcast so I could learn more about the company. You can listen to the podcast here: httpss://www.blogtalkradio.com/docweighsin/2018/02/14/solving-clinician-shortages-with-nomad-health. Or, if you prefer, you can read the interview (transcribed, condensed, and edited for readability) below:
Pat: Let’s start by having you describe what is the problem that you’re trying to solve with Nomad?
Alexi: Sure. So, as you probably, and many of your listeners, know very well, there is a huge shortage of clinicians in the United States. There’s just not enough doctors and nurses to take care of everybody in the country or, at least, we’re not using the resources we have appropriately. One of the solutions that that has been used for the last several decades is using freelancing doctors, nurses, and other types of clinicians.
Unfortunately, the way in which those clinicians find jobs, and healthcare institutions that are looking to fill positions hire them, has been so broken, requiring a third-party staffing agency broker. And, these brokers are totally reliant on paper, fax, and phone. It’s just so antiquated.
So, that’s the problem that we set out to solve with Nomad just under two years ago. It started out just for doctors and just in a couple of states. In the last almost two years, we’ve expanded to include nurses into the mix and have extended to over a dozen states across the country.
Licensing and quality
Pat: So, that raises an interesting issue of cross-state licensing. Although nurses have a lot of reciprocity in their licensing, most doctors have a license in only one or maybe two states. How are you dealing with getting these Nomads the licenses that they need?
Alexi: That’s a great question. As you know doctors and nurses must have a license to practice medicine in that state, unlike a driver’s license where you can use your New York driver’s license and cross the border and drive in New Jersey. That is a barrier to the movement of healthcare professionals.
One of the cool things about Nomad and how it helps with the licensing stuff is that Nomad is a direct marketplace. Healthcare institutions post jobs onto the platform. They describe exactly what they’re looking for including the location, time, date, nature of the work, how much they’re willing to pay, all of that kind of stuff. It is an extraordinary amount of detail that’s never shared through the third-party broker system. Similarly, physicians and nurses post up their interest, availability, background, and qualifications. What Nomad does is do matching intelligently.
We help connect that New York internal medicine doctor who has five years of experience and speaks Spanish with the jobs on the platform that are looking for that specific skill set. So, the way in which we deal with the licensing problem first and foremost is actually finding the right key for every lock. We find a doctor or nurse who already has the necessary license when we can. But if there is a doctor or nurse who wants to take the job and is perfect except for the fact that they don’t have that license, our technology makes it super easy to upload and share with all of the necessary documents for credentialing and also for licensing. We assist with those processes and speed them up as much as possible.
Pat: Some states are notoriously slow in getting doctors licensed. Has that created a problem for you?
Alexi: Some states are really fast and some states really slow. That’s why our first approach to this problem is not to try to re-license people, but rather to find a doctor or nurse who is already qualified to work in that state. Unfortunately, there’s no amount of technology and innovation that Nomad can bring to the table that will change the amount of time that it takes some state governments to issue licenses. Perhaps, down the line, it’s something that we can have a big impact on but that’s not the key problem we’re trying to solve today. For now, we are going upstream and saying, let’s make the right matches, let’s put those New York doctors with those New York jobs.
Pat: How do you make sure that your clinicians are actually good clinicians and they aren’t Nomads because they’re bouncing from job to job? How do you make sure that they are properly credentialed? Is that something that Nomad does or is that something you outsource to a third party or do you leave it up to the hiring facility to do?
Alexi: We care a ton about the quality of the people on our platform. We do our own vetting of all the candidates that come onto the platform and then we share the responsibility of doing the credentialing with the facilities that end up hiring them. A lot of healthcare organizations view the credentialing process as a really important step for them to verify the quality on their own. We can do all of the credentialing; we built the technology to do it and, in fact, we do it. But ultimately, the healthcare facilities want to do some of it themselves just so that it’s a final quality check. The simple answer to your question is we care a ton about quality. We do our own vetting and sometimes it’s duplicate the work that the facilities do but that’s okay because we do it with super whiz-bang modern technology. So, it takes us very little time and money to do.
Who uses Nomad?
Pat: What kind of facilities do you work with?
Alexi: We work with all kinds of healthcare employers—from the largest healthcare systems to the smallest one-person clinic. There is value in what we provide for all kinds of employers. Ultimately, all of them need to hire doctors and nurses so our value is apparent to all of them. We’re building tools to make sure that it’s functional for both sides of the equation. we’ve helped place doctors in clinics so that the primary care doctor can take a vacation and all the way up to helping the largest health centers in the country staff the emergency room that’s experiencing excessive volume.
Pat: Have you done any inquiries into why these doctors and nurses choose to have this Nomad kind of practice as opposed to hanging out a shingle or getting a job full-time job in a clinic or a hospital. What is it about them that makes them open to having this kind of work?
Alexi: That’s a great question and the answer is actually multi-fold. Different people do this for different reasons. In fact, different people do it in different ways. Some people are doing this as a full-time job. They are going from gig to gig to gig. They daisy-chain them and this is all that they do. The majority of doctors who do this kind of freelance work do it in addition to their full-time job. Whereas the nurses who use our platform are often doing this daisy chain model of work for a couple of years at a time.
The motivations are quite different for different people, but I think overall you can say a couple of things. Number one is that this is a great way to make extra money. The financial flexibility it provides is really important, especially for younger doctors and nurses who are trying to pay down student debt or start a family or buy a house. People towards the end of their career view this as an easy way to continue practicing and still keep their hand in medicine without having to commit to 80 hours a week and being stressed out because they are working so hard. Regardless of what that primary motivation is—whether its financial or freedom or whatever—it’s a really great way of answering the noble call of medicine and be at the patient’s bedside. Nomad reduces the friction of getting to the bedside and taking care of patients. That’s what all doctors and all nurses love. We just make it easy for them to do that.
Pat: That’s great! So now, let’s talk about the numbers. How many docs and nurses do you have across all the states that you’re in? And approximately how many facilities do you serve? And, what can you share about your revenue model?
Alexi: We are a baby company but we are making a big impact for punching above our weight. Our network is growing really quickly. There are now over 30,000 clinicians actively using our platform. We’re working with over a thousand healthcare employers to hire clinicians.
The revenue model is very simple. Our number one principle is that we want to be transparent and easy. That’s unlike the way that the staffing agencies are today. So, there is no way to know what a staffing agency is charging, what their margins are. None of that stuff. It’s just opaque. For us, we’re right up front, we say, we charge 15% as a commission. That’s about half the price of what the agencies charge. We’ve been able to figure out what the agencies charge. Sometimes, it’s even less than half the price.
Let’s say a doctor is working at $100 an hour. That means that the healthcare facility is paying the doctor $115 an hour. The money is paid to us. We keep 15 of those dollars and give the rest to the doctor. We manage all the payments. Healthcare facilities are saving 20% to 40% or higher when they work with Nomad. It’s a win-win-win because we’re making money, the healthcare facility is filling a critical need, and the doctor or nurse is making extra money—and it’s more through us than if they went through an agency.
Pat: Let’s close by having you tell us about your long-range plans. Are you aiming to have eventually a nationwide coverage or, maybe even global domination? Where will the company be in in five years?
Alexi: So, clearly going nationwide is a goal of ours. We’d love to be serving all 50 states if not by the end of this year, then by 2019. We would also like to expand our services to include more types of clinicians. Doctors and nurses are clearly very important to the healthcare system but there is a whole host of other types of clinicians, such as allied health professionals, advanced practice providers, and others, that we think would benefit from this service. And, there are many healthcare institutions that would benefit from having them use it as well. Ultimately, we’d like this to be the marketplace for healthcare jobs—any kind of job for any type of clinician, short term, long term, on-site, off-site, clinical, non-clinical. We want to help clinicians maximize the value of their skill set regardless of what skills they have, whether they are doctors or nurses or other types of clinicians. We want to keep growing because what we are doing is working. We want to offer our service to more people in more places.
Pat: That sounds like global domination to me! This really is a great service for docs, nurses, eventually other clinicians, and for the healthcare facilities that need to hire them. Thank you not only for joining us, but also for the work that you do.
Patricia Salber, MD, MBA
Patricia Salber, MD, MBA is the Founder. CEO, and Editor-in-Chief of The Doctor Weighs In (TDWI). Founded in 2005 as a single-author blog, it has evolved into a multi-authored, multi-media health information site with a global audience. She has worked hard to ensure that TDWI is a trusted resource for health information on a wide variety of health topics. Moreover, Dr. Salber is widely acknowledged as an important contributor to the health information space, including having been honored by LinkedIn as one of ten Top Voices in Healthcare in both 2017 and 2018.
Dr. Salber has a long list of peer-reviewed publications as well as publications in trade and popular press. She has published two books, the latest being “Connected Health: Improving Care, Safety, and Efficiency with Wearables and IoT solutions. She has hosted podcasts and video interviews with many well-known healthcare experts and innovators. Spreading the word about health and healthcare innovation is her passion.
She attended the University of California Berkeley for her undergraduate and graduate studies and UC San Francisco for medical school, internal medicine residency, and endocrine fellowship. She also completed a Pew Fellowship in Health Policy at the affiliated Institute for Health Policy Studies. She earned an MBA with a health focus at the University of California Irvine.
She joined Kaiser Permanente (KP)where she practiced emergency medicine as a board-certified internist and emergency physician before moving into administration. She served as the first Physician Director for National Accounts at the Permanente Federation. And, also served as the lead on a dedicated Kaiser Permanente-General Motors team to help GM with its managed care strategy. GM was the largest private purchaser of healthcare in the world at that time. After leaving KP, she worked as a physician executive in a number of health plans, including serving as EVP and Chief Medical Officer at Universal American.
She consults and/or advises a wide variety of organizations including digital start-ups such as CliniOps, My Safety Nest, and Doctor Base (acquired). She currently consults with Duty First Consulting as well as Faegre, Drinker, Biddle, and Reath, LLP.
Pat serves on the Board of Trustees of MedShare, a global humanitarian organization. She chairs the organization’s Development Committee and she also chairs MedShare's Western Regional Council.
Dr. Salber is married and lives with her husband and dog in beautiful Marin County in California. She has three grown children and two granddaughters with whom she loves to travel.