>> i'm sorry, i don't know enough about nursing, i have no comment. >> i don't know much about the agency but i am aware that we have a shortage of nurses so there is a supply issue but clearly -- [inaudible] has to do with a shortage of nurses, hospitals competing among themselves even within the same city. >> thank you. i had a chance to visit a medical care center in alabama in the residency program, they are doing a great job down there. travel agencies have always been

with us, i think for decades so it's not new i think of a fellow a certain role most of the time, as a portion of people who like that lifestyle of traveling to different organizations and they play a vital role when not in coven times in the same way. when there is a shortage of people in one area or another of the hospital where we have an issue, where i have an issue is when we lose valuable experienced nurses from positions because that position is no longer tenable position offered is no longer tenable because it's understaffed for a long time were under resourced and people are frustrated. i think the issue is to support our organizations and making the environment for nursingn practe brothers thinking about patient workload and the others to make the organization replace nurses want to commit to today, i don't think people likely give up our

satisfying practice as a nurse to do travel nursing but i think the agencies play a role on an ongoing basis, cover through everything. state policy i think can sometimes aggravate, in my state of connecticut takes action to a group of people during the covid pandemic to not have to rely only on nurses or pas to get vaccines and dental hygienists, podiatrists able to be trained and additional certification so i think we need to always look at these things from a variety of perspectives but the court is to make this practice where they are in their communities. >> thank you. >> this role of questions, i'm

sure you are aware -- i should have said this earlier, we do have a virtual hearing, labilateral hearing, we now have senator rosen from nevada arm virtual so she's next.ha >> thank you for holding this important hearing today and thank you to the witnesses for everything you do being here with us. it's important we lower barriers for providers, telecare providers with advanced training such as physicians and dentists, they have to complete residency training in order to care for patients. they often exit training with significant student loan debt and that is made worse by the fact that interest accrues while still in training, they are not actually in practice and it creates additional financial barriers for providers,

otherwise interest in serving patients in rural areas or underserved areas all across the country. all 17 counties in nevada are designated and health professional shortage areas and health outcomes are likely to be worse among minority residents in urban centers so improving to address our nation, doctor shortage, we have to do more not only to encourage providers to serve in rural and underserved communities but also reduce brother existing therapist and why i work on bipartisan legislation centers to allow for medical and dental residents into deferment, on their student loans whilerm serving medical dental internships of residency in the programs. as someone who founded america's

first nurse practitioner residency program, pausing student loan interest during residency helps provide flexibility serving patients in rural underserved areas, what you think the federal government should be looking at to make it easier for us to get good quality healthcare we need all across this nation? >> thank you for that question and i will tell you facing the mountain of debt as your coming into your residency program is a daunting challenge for providers still in their training phase. what you have proposed, pausing student loan interest during residency is what i would call a pragmatic reasonable thing that probably makes a big difference for people. i think the issue that influences people's choice of when i practice, the state of

nevada example so that's pragmatic in a useful idea. i want to say that's part of a constellation of strategies we have here in the u.s. can be expanded to make its easier for people to tackle training choose practice based on where they want to serve and where their passion is. when i was an undergraduate student earning my bachelors a long time ago, i worked off my student loan through a repayment program as a rural public health nurse and i chose cap to go back to the school and become a nurse practitioner. i was taken into the national health service corps which had be obligated. ifn service who sent me to what was then a community health centerll on main street and middletown, i think 47 years of practice is a pretty good return on this investment on those

loans and this is what we see in my own organization, many people with decades of experience started in community health service and underserved areas because they had help from something like federal loan repayment or national health service so this is one more tool to help people. >> that great because i want to build on this because it's not only this area overall, physicians, dentists, nurse practitioners and the like, especially in my state, we have a shortage of specialties so we have underserved communities and particularly rural front tier communities and they haveha to t especially care so i am currently working on legislation tong create a program for specialists for patients in rural areas so can you speak about maybe the challenges of

primary care providers in trying to bring specialists maybe virtually or in person, telehealth, we have to have people to refer them to and what do youha think we can do to help with that. >> thank you. a few moments ago i address the issue of what we can do with primary care specialists, that which can be done by primary care often in consultation with a specialist, not a specialist necessarily directly is a very important piece and we've done the research and it's clear it's becoming a best practice for the people who really need to see the specialist and others can be done between specialists in primary care providers. telehealth has been a huge benefit and it is true in rural areas even in urban areas we've all seen how difficult it can be

to connect primary care providers and specialists how much additional double work you canch eliminate if you connect with people virtually as opposed erto in person but beyond that e need the training programs for specialists and they should have experience in caring for people in rural andnd underserved communities and preparing for all populations. one thing we know about training, where you train has a lot to do with where you practice. if you even have o a part of yor training experience in a rural area and underserved communities with underserved populations, there's a greater chance we call it imprinting and continuing to care for that population and remaining in the area so like everything we are talking about today, there is not one strategy, there are multiple strategies and we need to embrace all of it. in terms of training and

financial support and making sure we get the right people to the right providers. >> i couldn't agree more, addressing the workforce shortage across the spectrum broadbandg based care from telehealth in my professionals all along the way, all of it makes a difference in matters and i'm trying to work on getting this so i appreciate your being here today thank you, my time is up. >> thank you, senator rosen. >> you call it imprinting, i call it marrying a local. >> that works, to. >> it's my observation uncle sam or the wife tells him to. i rarely start off with a personal incident but i am today because something so powerful in my experience and professional life, as many of you may know, a

physician who worked in a public hospital for the uninsured over 25 years, there's a woman who was african-american, her nickname was olive, she started off as an lpn or even medical assistant maybe. went back to school part-time and became city lpn. went back to school and continued her education and s became an rn. kept going back to school and then caught her masters in nursing and when the nurse supervisor and clinic retired, she took her place. it is a great success story for her personally but it demonstrates to her children in a community the power of education aside from giving crackerjack nursing supervisor. although i have not seen her since her high school was literally blown up, that's the

facility and was, he just started. he did an incredibly job in care of patient. i am in favor of creating this opportunity for folks who perhaps would be the first in their family to go to school but there are other issues. i am the author of the john lewis national institute for minorityno health research and endowment revitalizationen act that would revitalize research endowment program at the national institute minority health and health disparities. our ep was established to assist minority serving institutions with low endowment to develop institutional capacity to successfully compete for funding with their nonminority school counterpart. savior college of pharmacy has

been a beneficiary of the program, can you talk about the challenges universities face in trying to be more competitive for federal research dollars and revitalizing the program would be important to our nation? >> this program which was caused years ago, the resource by which we develop where we need to encounter -- >> facility is as important as facultyy. >> i mentioned putting a facility for hiv but the equipment, it is a variety of areas in the computer systems,

one needs to be able to compete with those in understanding the resource at those schools not separate from thosera programs. students enter faculty in the research programs as undergraduates in their second year. likewise, it's about the practice on the discipline and they become -- that is between higher ed and secondary school. >> the role model is somebody successfully doing s research, i have a professor who inspired me became a delivery specialist because of a couple of them, the two of them were so remarkable, i wanted to be like them. >> one becomes a junior

colleague. it readies them for going into a specialty school or a program. the students were falling into that truck also. ramsey students from a pharmacist going into what was traditional, also who are taking the clinical sector programs in some hospitals so they are at the highest level. >> i mentioned earlier a family friend, they went to the pharmacy school from missouri but that waser when the opportunity was not available forit african-americans. after going to the pharmacy school in california and

practice in california large pediatric practice in l.a., thank you and i healed. >> thank you, senator cassidy. i think we have times, let's call it a lightning round, maybe that's inappropriate but i think wewe do have a few questions. was going to ask about projections we've been hearing from everybody about critical needs to start growing our healthcare workforce yesterday, the key is to do it now and we need to make it easier for those who don't have experience to break in to the field and set of creating barriers and making it

expand. we part a variety of peoplewe mentioned that this last hour and a half. you have an unique experience because you came in as an entry-level assistant and begin your career in nursing. what is your experience and what you think might be applicable, useful for other institutions and healthcare providers looking workforce and provide, become a conduit for people coming in to the profession. >> thank you for the question. one ofne the unique situations that i recruit within our organization because number one, somebody already has made the decision for for it and the other thing would focus on his development and growth within

the system so we recruit through the process of this program and i facilitate and coach them -- how do i want to say it? a c connection so is the way to grow our own, they know our culture and our mission so we found out through other conversations this model works for us and it's already there from our staff. they go through the training and upon graduation, they are already trained rate event 85% so soon as they graduate, they pass their exams and ready to start working as soon as i

complete theon program. that's a huge benefit for staff and nursing s staff because one thing we encourages to work at the top of your license so this is the way the medical assistance working with them for a while can support providers and nurses and continue on. about the highd schoolin students in the summer signs academy, 500 kids to participate in our cross-section of biology and math. >> chemistry. >> yeah. how do you reach out to find the students? are they all from louisiana or

around the country? >> the majority within louisiana but some from around the country, a significant numberbu because they have a long history. a high number go on to college, many do not go there but many go to a college. funding has been a challenge because we found dollars we have for the foundation dollars when we cannot because they are not accessible through funding programs that we normally have, that is one part of getting students early in their education to consider the signs and exposed to that. what we also do is academies, robotics academies, work done on weekends is when we capture the imagination of young people. for science and health, students

discover their passions early in life. there great musicians of 18 or 19, scientists and clinicians as well, catching them before high school is fundamental so getting that imagination can be in this pathway. older students maybe three or four years older, it's important especially given if you're coming from families ortu colles known in this family has attended college which in our campuses, it's in the high 30s, 43% ofs, students. >> amazing. thank you for the and i'll turn it over. >> thank you, mr. chairman. i'm going to circle back to the industry structure again and my question is for doctor.

years ago we had a lot more hospitals especially in rural areas. currently when you look at the healthcare dollars, 30% give or take of hospitals, 30% give or take practitioners, 15 to 20%, and insurance. as the stakeholders who pay the bills in the country, any company that does not -- other than a healthcare company, it would be the rest of us d employers the transparency ise even when you can self-insure has been challenging. the other thing is you have fewer options, fewer and fewer hospitals that control a lot of these markets and even fewer insurance companies. getting workforce in to the

nursing side of it, how difficult is it now when it comes to the fact that unless you have a clinic or doing your own thing which oftentimes rules and regulations don't make it as easy as it should be, how difficultic is it to be a nurse practitioner not only with training and the cost talking terms of the new structure with the fact that you are working fore a hospital, doctors complain about often used their own businesses, would you want to comment on that box. >> thank you for the opportunity and it's something i've been thinking about quite a bit recently in part because is an area within the practice of nurse practitioners going in to entrepreneurial practice on their own network set up to support them and when it reminded me of his there probably is the rightth place fr everybody, right?

for me it's a structure like a community health center that takes it out regardless of insurance, comprehend the care, there is a trade-off around how much you do individually and how much is organizational policy but the policies might up in the direction of the values it should, it's a plus not a minus for me. for other people think independent entrepreneurial group nurse practitioner practice is the right structure rfor them. i think people have to think critically about their employer and right employer is an employer who winds up with your mission, vision and values for your own career and i think people are becoming much more savvy about the kind of people and organization structure they want to practice in and employers beware no matter how big your healthcare system is, you cannot run it without expert people to care for the patients. emerging legislation around transparency and billing, no

surprise billing, we say in community health center, they are the must have a because they are often paying out of pocket as people fully on a chart, it's just part of a fair economy in which we make clear what the prices are make sure people understand m the deals it is trp for the people who work in them as well as people who receive care. >> thank you, next question, indiana visited last week, i was shocked it was only the second one in the u.s. and the other in oklahoma city and this is a group of surgeons who didn't like the idea there only employment opportunity is for a huge corporation. they had a vision of their own and increasingly difficult to do. here is what caught me. they will be cash only surgical outpatient center and i said

what about inpatient? there's so many regulations and doctors to do that, you couldn't even get thege first base. listen to this on her gallbladder operation, and indiana, the rate between insurance and hospitals is 22000. if you come into the system and you have no insurance, 32000. they'll do it for $8000 and that ilwill be the same proportionaly on a lot of surgical procedures. that is entrepreneurialism, that's what we've got to do before we spend more federal dollars in terms of fixing the system. what you think when it comes to breaking the system apart, how important is it to fix healthcare in general? >> extremely important because as far as i know, studies have shown the practices have better outcomes and does a lot of broken parts of the healthcare market but this is one where

prices charged don't necessarily reflect the services provided, the outcome of the services in the amount of time they reflect insurance that they are allowed to build so it is in many ways broken and one thing that could be done is the federal government has a lot of programs in charge of payment rates to allow for innovation and flexibility. we've seen doctors and other practitioners who want to move toward autonomy and not just going by the h books of what thy are told they can charge and what services they can or can't provide being free to practice others on the private sector not encumbered by these burdens imposed on the healthcare sector. >> i view practitioners doctors about the same way as farmers and they a. it's so much different than what used to be and whenever we get industries to concentrated, the consumer never ends up being in the best place. on that note although i think we

are probably sent spend a couple of hours asking questions but i suspect you have other things in your schedule. so i guess that will and are hearing for today, let me thank you all, i can't remember a more interestingg panel with such clear translation of your experiences and lives and viable testimony we will take going forward. if there are other senators watching at home with questions or from their office, i shouldn't make jokes about virtual hearings, questions for the record will be due in ten business days, february 4 10:00.

the hearing recordhe remain open until ten wish to submit additional materials for the record. the house committeeee -- shortly s127 nude to markup pending nominations and betting on tuesday february 15 10:00 for a hearingg on supporting quality workforce developing opportunitieso and innovation ad address barriers to employment. thank you again for your excellent work today and we stand unturned. >> thank you so much. >> thank you. >> we take you live to the u.s. capitol for the senate is about to gather in on this monday afternoon. lawmakers tend to take up postal service reform legislation today. action on the bill could be delayed due to a minor clerical error. this week the senate will vote

to extend government funding through march 11 to avoid a shutdown on friday. the court consider the nomination of doctor robert head of the fda for a second time. live coverage of the u.s. senate here on c-span2. ... chaplain, dr. barry black will lead the senate in prayer. the chaplain: let us pray. almighty god, lord of history, if a sparrow does not fall without your knowledge, certainly the issues facing our senate concern you. your word assures us that in everything you are working for the good of those who love you. may