Hospitals In Focus

New Doctors Caring for Their Hometowns Plus Making the Rounds: From Firefighter to Nurse of the Year


Our country is facing a doctor shortage of nearly 124,000 physicians in just 2 years and the impact on patient access could be devastating. The problem is especially acute in economically disadvantaged areas, like California’s Inland Empire which is comprised of San Bernadino and Riverside Counties east of Los Angeles. The Inland Empire is also now the home of the California University of Science and Medicine, a unique institution built on a public private partnership. CUSM was created to promote health equity by training the next generation of caregivers in their own community by the Prime Healthcare Foundation. The school just graduated its very first class of doctors last month and Chip wanted to learn more about the school and the graduates. Joining Chip is Dr. Paul Lyons, President of CUSM and Dean of the school of Medicine.

Then at 18:51 hear our latest Making the Rounds from Paddi Juliano, the Nurse of the Year at Lakewood Ranch Medical Center – a Universal Health Services hospital in Florida. Paddi knew she wanted to be in a helping profession since a young age and dreamed of being a Buffalo, New York Firefighter! She achieved her dream and then transitioned into nursing after moving to Florida.

Tune into hear Paddi tell us her story of caregiving and what her profession means to her.

Speaker 1 (00:06):

Welcome to Hospitals in Focus from the Federation of American Hospitals. Here’s your host Chip Kahn.

Chip Kahn (00:15):

There is a looming crisis in many neighborhoods across the nation, a shortage of patient access to physician care. It’s part of a larger problem throughout healthcare as caregivers across the care continuum are in short supply. The latest research shows that as demand for care from aging baby boomers increases, we could see an estimated shortfall of as many as 124,000 physicians in just two years.

Chip Kahn (00:44):

This problem is especially acute in economically disadvantaged neighborhoods, often with majority minority populations. The Prime Healthcare Foundation started by Dr. Prem Reddy, the chairman, CEO, and president of Prime Healthcare, recognized this issue and set out to change this reality for one community east of Los Angeles, a community known as the Inland Empire. The Foundation founded the California University of Science and Medicine with a primary purpose to address the nationwide physician shortage, promote health equity, and train the next generation of caregivers to serve disadvantaged communities.

Chip Kahn (01:29):

Here today, to discuss this effort to meet the goal of this new university is its President and Dean of Medicine. Dr. Paul Lyons. Thank you so much for joining us today, Paul.

Dr. Paul Lyons (01:42):

Thank you so much for having me, Chip.

Chip Kahn (01:44):

Let’s start with a question about the community, Paul. Could you describe the Inland Empire, including its pressing and unique health needs?

Dr. Paul Lyons (01:53):

Absolutely. So the Inland Empire region of Southern California is predominantly two large inland counties, San Bernardino County and Riverside County. Those counties face a number of challenges, economic challenges, educational challenges, and healthcare challenges.

Dr. Paul Lyons (02:13):

Those healthcare challenges include such things as a shortage of physicians in almost all disciplines, shortage of other health professionals to meet the ancillary health needs of the individuals who live in this region. And the impact of that is that Riverside and San Bernardino County often find themselves with less than ideal health outcomes, including high rates of such diseases as diabetes, heart disease, liver disease, and mental illness.

Dr. Paul Lyons (02:42):

This is all in the context of a region that’s economically distressed. San Bernardino county, for instance, is by many measures the second poorest city in the nation.

Chip Kahn (02:54):

Gosh. So many issues, and Dr. Reddy identified all of these that you’ve described. So in terms of the establishment of CUSM with its mission to serve this kind of community, what happened from there once it was identified?

Dr. Paul Lyons (03:11):

Well, I think it’s important to recognize the vision of Dr. Reddy, who is essentially a lifelong resident of this region. And so his understanding, deep understanding, of the needs of this region are based really on his lived experience as a practicing physician in this region.

Dr. Paul Lyons (03:28):

He recognized that we needed access to educational and economic opportunities in this region. We needed to produce a workforce of physicians who were specifically trained to understand and respond to the needs of this region. And he saw the problem, saw a solution, and proposed the California University of Science and Medicine.

Dr. Paul Lyons (03:52):

Since that time, and it’s been just about a decade since that first dream was laid out, we’ve worked very hard to bring that dream into reality, which today I’m very pleased to say is where we stand. The California University of Science and Medicine, one of the youngest and newest health science universities in the nation is a reality in Colton, California, right here in the heart of inland Southern California. And it enrolls students in an MD program, so future physicians, as well as a master’s level program to help position students for a variety of professional choices in the health professions.

Chip Kahn (04:34):

You know, one of the unique aspects of the university is that it is a public-private partnership between the foundation and the County of San Bernardino, as well as the City of Colton. Can you talk a bit about this partnership and how it developed?

Dr. Paul Lyons (04:50):

Well, it’s been an absolutely critical partnership in the success of the university. So the needs, obviously, of this region are multifaceted and require that we have all hands on deck to help address the many critical issues that are facing this region. The particular uniqueness of California University of Science and Medicine is that it is a university founded in direct partnership between the County of San Bernardino, the Prime Healthcare Foundation, Arrowhead Regional Medical Center, which is the San Bernardino County county hospital facility, and the City of Colton. All key players in this region with strong reasons to be committed to improving access to healthcare, to expanding the healthcare workforce of the region. And with a strong reason to be focused on the health and wellness of the residents of this region. It’s been absolutely foundational to the success of this school.

Chip Kahn (05:53):

A moment ago, Paul, you mentioned the degrees that the university offers. Why did you choose this set of curriculum and degrees?

Dr. Paul Lyons (06:03):

There are a number of pressing needs in this region. First and foremost, as you mentioned in your introduction, we face a critical shortage of practicing physicians. And not only do we already face a shortage in this region as well as nationwide, but in this region a significant proportion of the practicing physicians are within five to 10 years of retirement age. So we’re facing an even larger deficit in the next decade. And so we chose the MD degree as a direct response to the shortage of practicing physicians.

Dr. Paul Lyons (06:39):

But there are a number of issues related to training health professionals for this region. First, not every student who would make an excellent physician has all of the academic background that they need to be a competitive candidate and a successful student in the study of medicine. And secondly, not every student with an interest in health professions wants to go to medical school, but perhaps wants to be a dentist, or wants to be a nurse, or wants to be a respiratory therapist. And they too need scientific background before they’re good candidates for those programs as well.

Dr. Paul Lyons (07:15):

So we chose to produce an MD program as a direct response to the physician shortage, and a master’s in biological sciences to allow students to be prepared for a variety of professional opportunities across the healthcare delivery spectrum.

Chip Kahn (07:33):

Paul, as you know, research suggests that the strongest factor determining where a new physician decides to practice is where they come from originally, where their residency was, and the kind of community that they’re already accustomed to. I know CUSM is really focusing on this issue of recruitment and keeping the physicians that you train in the community. How is this going, and what’s your plan?

Dr. Paul Lyons (08:03):

You are exactly right. There are three basic factors that you can leverage to help predict or create physicians who are likely to stay in this region. The first factor, as you mentioned, is where did that student grow up? What is their region of origin? And so we at CUSM recruit our students with a specific eye to students who are residents of this region. Because we know, having grown up here, they are predictably more likely to end up here when they go into practice. So about 40% of our student body comes from communities in this region. And that’s critical factor number one.

Dr. Paul Lyons (08:46):

The second critical factor is where you complete your training, which in medicine is your residency or subspecialty training. So we work with our partners, including Arrowhead Regional Medical Center, the Prime Healthcare hospitals of this region and other healthcare delivery systems that provide residency training in this region to ensure that the residency training opportunities of this region meet the desired residency training opportunities of our graduates, so that they are more likely to choose residencies in this region.

Dr. Paul Lyons (09:22):

Then the third factor, which is how do you draw them back if they choose to go someplace else to train. And in that regard, we have established in conjunction with a number of key partners, including Inland Empire Health Plan, scholarships that provide full ride scholarships to CUSM for the entirety of their four years of training in exchange for returning to practice in this region for five years following the completion of their training.

Dr. Paul Lyons (09:54):

Now we are early in the lifespan of this university, but so far all indicators are that these three factors are going to turn out to be significantly impactful in where our graduates choose to practice.

Chip Kahn (10:10):

Paul, you’ve observed medical students for years, obviously in this post and earlier posts. Can you talk a bit about the motivations of medical students today and maybe what sets them apart from earlier generations of medical students?

Dr. Paul Lyons (10:28):

Well, it’s interesting because in many ways, of course, they are exactly the heirs of the historical tradition of medicine. These are students with a strong interest in the health and wellness of their communities. They have a strong focus on the needs of their patients. They are giving and caring individuals. They are deep thinkers. They want to be grounded in cutting-edge science, and they have a strong commitment to providing cutting-edge care. And that I think is exactly in keeping with the long arc of medical tradition.

Dr. Paul Lyons (11:03):

But they are also children of a generation that grew up, for instance, in an entirely digital age. And they are very comfortable with the integration of technology and digital access to information, and alternative methods for communication into their learning and into their practice. So as one concrete example, when COVID required that we move our instruction into the virtual space, they were able to pivot almost without hesitation into that environment, which feels very comfortable to them.

Dr. Paul Lyons (11:40):

I believe this is going to create a generation of physicians who are consistently practicing in the way that medicine historically has, but delivering that care in new and unique ways that are particularly suited and tailored to the communities in which they’re practicing.

Chip Kahn (12:00):

You know, Paul, obviously the issue of health equity is a main theme in the development of your program. And it’s a theme, obviously, throughout medical training today in all parts of the country. Can you talk about the ways in which patients will be served differently by this generation of physicians that are going to receive in their training, probably a different focus regarding this issue of equity?

Dr. Paul Lyons (12:27):

So I think that’s an excellent question, because I do believe that this generation of medical students takes issues of community centeredness and equity very seriously. We at CUSM are doing a number of things to address that. One is, as I noted, we are actually drawing our future physicians from these communities. So they are rooted in these communities, in the behavior patterns, in the challenges and the opportunities of the region, because they grew up here.

Dr. Paul Lyons (12:55):

We’ve also developed a hands-on interactive and experiential curriculum that requires our students to engage with the sorts of issues that are impactful on patient wellbeing. Issues of economic challenges, transportation challenges, environmental challenges, the impact of poverty on wellness, the impact of access on the ability to get care when it’s needed, and the impact of not being able to access care on your overall health and wellness when you finally do have access.

Dr. Paul Lyons (13:33):

And our students leave our medical school fully ready, I believe, to help engage where their patients are, to help them bridge the gaps and to sort of access care in ways that are helpful and meaningful to them in their own communities.

Chip Kahn (13:54):

Paul, I’m sure it’s exciting for you that we are in the midst of the point in time when you’re graduating your first medical school class. Where are they going for their residencies? Are they headed to any Prime Healthcare hospitals? And are they going to stay in the area?

Dr. Paul Lyons (14:12):

That’s a great question. So you are absolutely right. We have just had our first graduating class from CUSM School of Medicine. And it is, in fact, an extraordinarily exciting time. Really the culmination, or the first down payment, if you will, on the dream that Dr. Reddy had when he first set out to establish this school.

Dr. Paul Lyons (14:33):

So we graduated 62 students in our inaugural class. About 60% of those students are staying in California. About 40% of those students will stay in Southern California. And about 20% of those students will stay in programs, residency training programs, right here in inland Southern California. I anticipate as the years pass that number will rise. But I think that one out of every five of our graduates choosing to do their residency training in this region is really a significant and important development for our region.

Dr. Paul Lyons (15:13):

I’m pleased to say that complement of residents who are staying in the region includes students who are at Arrowhead Regional Medical Center, our key county training site, as well as Prime Healthcare hospitals as well. So I think the public-private partnership that underpins the entire enterprise is beginning to see the fruits of their labor with these students who are choosing to train in their healthcare systems.

Chip Kahn (15:45):

Paul, sort of to close out, you’ve really described this unique model of school started by Dr. Reddy, who really understands the community. I guess I have sort of a bifurcated question here. One, one of the primary needs of every community is primary and behavioral healthcare, and I know there’s shortages in that area. Is what CUSM doing going to help us there? And second, is this a model that is replicable and scalable in other areas of the country?

Dr. Paul Lyons (16:24):

So I believe that CUSM actually has a lot of potential as a replicable model across the country as the idea of a public-private partnership with a tight focus on regional needs in the building of the curriculum and the recruiting of students. And I believe that it would be appealing in many settings based on what we are seeing as the outcomes from our first four years in operations.

Dr. Paul Lyons (16:54):

So if you look at our graduating class, the ones who have just walked across our stage, and will start their residencies in the summer. Their choices of specialties match up almost perfectly with the highest areas of need in our region. I’ll give you just a couple of examples.

Dr. Paul Lyons (17:16):

Mental healthcare and behavioral health is one of the most pressing needs in our region, and we had 13 graduates from our inaugural class go into psychiatry. Primary care, as you mentioned, is another absolutely pressing need. And we had 11 of our graduating class choose primary care as their discipline of choice. And third, frontline access has been, especially over the last two years, painfully obvious as a need for our communities. And about 10 of our graduates chose emergency medicine as their residency training choice.

Dr. Paul Lyons (17:57):

So, yes, I believe this is actually a profoundly important model with implications for many communities across the nation. And I believe that the outcomes of this model are likely to be deeply impactful in the communities where they would be established.

Chip Kahn (18:17):

Paul, thank you for sharing today your excitement and enthusiasm about, in a sense, this great achievement of this medical school class graduating. We all look to the future of great things for CUSM, and just thank you for your service. Really appreciate you being with us today.

Dr. Paul Lyons (18:37):

It’s entirely my pleasure. Thank you so much for helping us to tell the story.

Speaker 1 (18:45):

And now making the rounds, the stories of frontline caregivers in their own words.

Paddi Juliano (18:51):

Hi, my name’s Paddi Juliano. I’m a registered nurse at Lakewood Ranch Medical Center here in sunny Lakewood Ranch, Florida. I actually did probably about 15, 17 years in the emergency department, and then I also kind of spread my wings, so I’m a cath lab nurse. I work for surgery in the pre-admission department. I’m also the employee health nurse here at Lakewood Ranch. So that’s the beautiful thing about having a nursing degree and being a nurse, is there’s a variety of areas that you can work in.

Paddi Juliano (19:25):

So why I became a nurse. So at a very young age, I knew that I always wanted to be in a profession to help others. It just was in my nature to be there for people when they needed help. It was always a dream of mine to become a Buffalo firefighter, probably since the age of three. I just knew that I worked well in emergent situations, and I knew that I could be there for people.

Paddi Juliano (19:48):

So fast forward, that dream did come true. I became a firefighter and I also went back to college and earned my EMT paramedic license. So that’s, I guess, when I really got exposed to the medical field and healthcare, and I knew that was my calling. That’s when I knew that I needed to work in the medical field and become a nurse.

Paddi Juliano (20:10):

So fast forward, we moved to Florida from Buffalo, New York, and I got my degree from the State College of Florida in nursing, and my career began. It was the best decision that I ever made with the help of my husband’s support. It was not easy, but knowing the impact that I could make on other people’s lives and even the impact for myself is just unmeasurable. It’s such a passion of mine to help others when they’re in need, and so best thing. I love every aspect of being a nurse.

Paddi Juliano (20:45):

Being a firefighter, and then transitioning to a nurse, very similar. You know, you’re running into the fire. When I worked as an ER nurse, you’re running into an emergent situation. So you’ve got to be aware, and you have to really critically think. So those skills are just something that I just have always had no matter what, whether it’s saving someone from a burning building, to saving someone’s life by doing CPR. They just go hand in hand. I think that adrenaline of helping someone in that those types of situations was just really something that I’m good at, and that I’m glad I’m able to do.

Paddi Juliano (21:31):

Oh, my goodness. Being named nurse of the year this year at Lakewood Ranch Medical Center was such an honor. I was so shocked, had no idea. And just what an amazing feeling to be recognized by your colleagues for such an honor. The staff here at Lakewood Ranch is so amazing. You know, we’ve had a few rough years these past few years, and I just felt that I needed to step up and help my coworkers in any capacity that I could. Love my job and every aspect of it. And there’s no way that we could survive the day-to-day struggles that we’ve had as nurses and techs and housekeeping and every single department here. You know, it definitely takes a team. So I definitely give this honor to my team, the nurses that I work with. And just honored.

Paddi Juliano (22:23):

You know, patients come back into your life. About six, seven years ago, I met a patient and just yesterday I got flowers from him. He saw that I was Nurse of the Year on Instagram, or Facebook, or something that I had this award a couple weeks ago. And he sent me these beautiful roses yesterday. It kind of makes me want to cry because it was so sweet. And he said “to the most kind and compassionate nurse of the year ever. Peter and Wilma” Pete, his wife.

Paddi Juliano (22:53):

So it means a lot to me to be recognized for something that I’m so passionate about. And what timing that I got these flowers yesterday out of the blue. It really does. It’s really the patients. That’s why you do what you do, I think, is the patients.

Paddi Juliano (23:10):

So I’ve worked for UHS, Lakewood Ranch is part of UHS system. And boy, during these last few years, we’ve had such support from this organization. Lakewood Ranch Medical Center is a one of our smaller hospitals. We’re a family, so we’re very close knit. So we definitely work close together. But we’ve had the support of our organization throughout all of this as far as supplies, just needing extra staff, extra hours to be able to accomplish what we needed to. I’ve worked at a few different organizations and I could say that UHS definitely has a strong commitment to their employees as far as listening to them and really achieving and working with all the different staff to achieve what we needed to take care of our patients.

Paddi Juliano (24:03):

So the most unexpected part of my job that I love doing is being an advocate for my patients. I guess I truly never knew like what being a patient advocate is. You know, you learned it in school during nursing school and everything, but until I really experienced it for my myself. And you experience it again and again being a nurse.

Paddi Juliano (24:24):

I did receive a letter that I’ve saved for years. Again, from a patient at the emergency department when I was working. And the letter states that, “Paddi is the woman responsible for saving my life. I came into the ER not feeling right. I will never forget the attention she paid to all I had to say. Although the initial EKG did not show anything abnormal. Paddi encouraged me to share how I was feeling, to listen to my body, and to stay put. After that, I met with several doctors in the ER, things moved quickly as I was diagnosed with a PE. Paddi took the time to listen to care and to help me. Had she been dismissive, I would’ve gone home and might not have survived. She continued to check in on me that night and during the week when I was in the hospital. She is a genuine, kind, and caring woman and an incredible RN. Connie W.”

Paddi Juliano (25:19):

So it’s those things. And you don’t need the letters, or the recognition, or anything like that because you know how you change people’s lives. But just receiving letters and cards of appreciation, really it’s unexpected and it just adds to the love of my job as a nurse.

Paddi Juliano (25:39):

We have a lot of students here that we mentor. And I get that question asked a lot as far as why should I become a nurse? I truly encourage them, especially with the shortage that we have now, and there’s such a need for this profession. You know, there’s so much opportunity. And if you’ve got that inkling, if you’ve got the passion to want to help people, it’s such a tremendous field to get into.

Paddi Juliano (26:06):

There’s so many opportunities. You can work in so many different areas. You can work in surgery, emergency departments. You can work in doctor’s offices. The reward is so great, and there’s always going to be a job available. No matter what field of nursing you’re interested in, there’s always a need, especially more so now than ever. The shortage is just, I mean, we see it here in Florida. It’s just unimaginable.And to be able to want to help people and get into the nursing field, I truly encourage and support anyone that wants to do that. You have the power to make a difference in someone’s life, and not only will you do that, but it’ll be a difference in your life too.

Paddi Juliano (26:56):

One thing that I just want to add, one of my favorite shows is This Is Us, and it’s so super sad that it’s ending. I always think about, God, when I leave this job. I just can’t fathom ever leaving nursing. But a quote that touched my heart and that I will always think of when I do eventually leave is, “The way I see it if something makes you sad when it ends, it must have been pretty wonderful when it was happening.”

Speaker 1 (27:25):

Thanks for listening to Hospitals in Focus from the Federation of American Hospitals. Learn more @fah.org. Follow the Federation on social media @FAHHospitals. And follow Chip @ChipKahn. Please rate, review, and subscribe to Hospitals in Focus. Join us next time for more in-depth conversations with healthcare leaders.