Alexi Nazem, Co-Founder and CEO at Nomad Health, on Technology’s Impact on the Staffing Industry

The Staffing Show · Alexi Nazem, Co-Founder and CEO at Nomad Health, on Technology’s Impact on the Staffing Industry

 

David Folwell: Hello everyone. Thank you for joining us for another episode of The Staffing Show. Today I am super excited to be joined by Alexi Nazem, who is the co-founder and CEO at Nomad Health. Alexi, thanks for being on the show today. Super excited to have you here.

Alexi Nazem: Thanks so much, Dave. It’s really a pleasure to be here. Thank you for inviting me. Looking forward to our conversation.

Folwell: Absolutely. To kick things off, could you give a brief introduction to who you are and how you got into the staffing industry?

Nazem: Sure. Today I am the co-founder and CEO of Nomad Health, which is a healthcare staffing technology company. My story for getting into this space started about seven years ago when we started the company. I am a physician by training and have been recruited a lot, especially by locums agencies over my career. And about seven years ago when we started the company, became much more aware of this industry because the level of recruitment started to step up. And some of my co-founders were also physicians, were in the same position. And we recognized the opportunity that lay here. It’s, as you know, a very manual industry with a lot of opacity, a lot of inefficient and somewhat cumbersome experiences for both sides of the transaction, the healthcare systems, and for the clinicians. And so we were intrigued by the low quality of the experience that was then current and the opportunities to improve it with technology and a few other of our points of view. That’s how we got drawn into the space actually solving a problem that we experienced ourselves.

Folwell: And so did you actually work as a locum tenen for staffing agency?

Nazem: I did, actually. I did once it was — I’ll tell you — a heck of an experience. The actual work was phenomenal. When I finally got on site, it was great. The other clinicians were fantastic, the doctors, the nurses, the hospital, the patients, it was so rewarding. I actually really enjoyed being able to go somewhere that really needed me to be there. It was the entire experience of getting there that was really, unexpectedly, not great. The canonical story of this company, it took me 10 months to organize a job that I ended up only doing for a few days. It was a variety of things that led to that, but it was the fact that I had to talk with six or seven different agencies and nobody was particularly upfront about what opportunities they had and where and when and all that kind of stuff.

So you end up having to spend a lot of time on the phone just discovering the opportunities. And then once you even raise your hand, you say, “Oh, I want to do this one or that one,” you are then confronted with hundreds of pages of paperwork. One of the other things that I ended up having to do was I applied to a couple of jobs. One of the ones I had to fill out a 94-page paper application by hand and my printer or whatever, automatically prints out on double-sided paper. So I filled it out that way and I sent it in by mail, which was interesting in….

Folwell: Oh my god.

Nazem: …2015, which is not the dark ages. So I sent it in by mail, and they told me, “We don’t accept double-sided, you have to redo this on single-sided paper.” That was the state of the industry when I was engaged, and it was those kinds of experiences and a few other things which I won’t even get into, they were just, I’m sure pretty typical for many of the listeners on this podcast. Those were the things that made me realize, “Gosh, there is such a lag between what’s happening in staffing, at least in healthcare staffing, and everything else in our life.” When I actually did that locums job, I booked my flight on Kayak, I stayed at an Airbnb, I took an Uber from the airport to the Airbnb. It’s super easy. All that stuff, bing, bang, boom on my phone, easy, done, and meanwhile took months and lots of paper to get the actual job. So that’s why we said, “Hey, we can bring some of this tech into this space and make things a lot better for everybody.”

Folwell: That’s awesome. And just to give our listeners a perspective. I know you guys have raised, I think it was over $200 million if I saw it correctly. Tell me a little bit about the size and growth of Nomad Health.

Nazem: We are a company that’s been chugging along and growing nicely. We have raised a couple hundred million dollars over a long period of time, so not all in one fell swoop. And it’s been to support a very high level of growth. We have about 300,000 clinicians on our platform, staffing thousands and thousands of them every month. So it is a large-scale platform at this point. We’re not the largest company in this space. There are some that are bigger than us, but I think we’ll one day get there.

Folwell: Awesome. So you’re on a path to be the largest healthcare staff agency.

Nazem: Eventually. I don’t know when. I don’t think that the folks that are bigger than us are going to just sit idly by, and this is not a competition really. I just think the way that our company is built is meant for scale. It’s actually one of, I think, the key differences between the way a technology-driven company like ours operates and the way that a traditional staffing agency, which is more people-powered, operates. There are economies of scale for a technology-driven business. And so it actually makes sense for us, and it becomes easier to operate the larger we get. And so because of that natural tendency, I think it’s, while not an inevitability, I think a high likelihood that we continue to grow to be very large and start to appear as large or larger than some of the people ahead of us on the league.

Folwell: And with that, so I mean it sounds like you saw the inefficiencies, you went after, you’re like, “Hey, let’s do this a better way.” What are some of the specific challenges that you’re solving with Nomad Health? How are you guys doing this differently? What’s the approach?

Nazem: I think the single biggest difference about our company has nothing to do with the fact that we’re using technology, but where we place our greatest focus. This is a two-sided marketplace. On one side are the clinicians and on the other side are the healthcare facilities that hire them. And they are both extremely important. No transaction can happen without both of them. However, I think unlike many other companies, or at least the way that it felt to me as a clinician, most companies didn’t seem to prioritize the needs of the clinician. And from day one, this is a company that was built by clinicians for clinicians to solve problems that clinicians have. And it doesn’t mean that we’re not trying to also be attentive to the needs of the client side of the market, the demand side of the market, but we recognize that this is a market that has undersupply, not enough clinicians, and over demand, too many open roles.

So the real opportunity is to win the supply side. So that means creating an experience that is from a user-friendliness point of view, from a financial point of view, from a timeliness point of view, superior for the clinician. And that’s where we have, I think, really differentiated ourselves. And I like to think that we’ve brought the market along with us in some ways. Won’t claim that we invented everything, but I think that there has been a pretty strong tact towards improved candidate experience over the last several years. And again, not just because of us, but I think just the availability of technology, changing desires and needs of clinicians and just consumers in general is pulling the whole market in that direction. And that’s where we went right away. I think was the big difference.

Now, obviously, technology has really enabled us to do that. There’s a lot of things you can’t do vis-à-vis candidate experience without a more high-tech solution. A lot of it has to be self-service and transparent. And a lot of those things require, or at least the expectations of the consumer are, that they require a technology-driven solution. So the equivalent of shopping for a flight on Kayak or Expedia is hard to replicate in the staffing space without also a technology solution. So I think the “how” is the tech, but the “what” is real primary focus on providing high-quality clinician experience.

Folwell: And I think that we’ve all seen the shift towards talent having all of the control right now, right? It’s like they get to choose who they work with. Bullhorn was just on a few weeks ago, I don’t remember their exact set, but they started to call it the same abandoned cart problem that you have on Amazon or any other checkout system exists for staffing agencies. And it exists the in a way that if people aren’t having a good experience with their application process, filling out a 90-page document, whatever that may be, that people have enough other options that they’ll just stop doing it and go somewhere else.

So people are really looking for the easiest and best candidate experience from there as they’re going through it. Do you have any specific examples of things that you have done that have been meaningful for your growth? It sounds like one, shifting as a strategy focusing towards the talent out of the gate before a lot of people were doing that. But are there things that you’ve implemented along the line where you’re like, “Oh, we did this, we did self-service in certain areas.” Anything on that front that you’re able to share?

Nazem: Yeah, certainly. There’s quite a bit. And before diving into specific examples, I just want to build on what you just said about the abandoned cart and all that kind of stuff. Not only does that cause people who are activated in the market, these clinicians are activated in the market, to switch. That high friction of a poor candidate experience also keeps some people completely out. So when we’re dealing with a national crisis of undersupply of clinicians, we want to do everything possible to make it easy to take advantage of the excess capacity in the system. If somebody wants to do short-term work as a clinician, we should make it really easy for them to do because that adds hours to the capacity of the system. If the first thing that they get when they arrive is a 94-page application that they have to fill out single-sided on paper and mail it in, the chances are a lot of people are not going to do it. 

And so I think while that won’t solve the totality of the healthcare staffing crisis, it will help a little bit and every little bit counts. So I think friction is not only a business necessity, it’s just like an industrial necessity, a societal necessity that we do everything possible to eliminate friction in the system. But you asked for some specific examples. So a lot of the stuff that we’ve done vis-à-vis candidate experience, in retrospect, don’t feel like rocket science, but they were pretty new when we did them in our space. So I think one of the biggest differences was we were transparent about pricing from day one.

So one of the hardest things to discover, at least in my own experience when I was shopping for locums jobs, was what will you get paid and where? Where will you work? It was, “I’ve got jobs in Denver, give me a call”, and then you’ll spend 20 minutes on the phone before you find out that they have one job at this hospital and pays this much and it’s at this location. We said right away, “Here it is. Here’s everything. Here’s the name of the facility, the shifts that you’ll work, here’s the pay. Here is it broken down by taxable and non-taxable. This is the shift. This is what other people say about the hospital”.

Folwell: And you guys started doing that seven years ago. Out of the gate you were having pay rates on that.

Nazem: Out the gate.

Folwell: People are still afraid to do it.

Nazem: Our perspective was this is not like a trade secret.

Folwell: You’re going to get there anyways.

Nazem: Yeah. So we said, that was one thing. And it’s also by the way, absolutely necessary to create self-service. You can’t have a self-service opaque platform. That was one thing. Another thing that we did was, again, in service of self-service is that we’ve done a lot to build out the behind-the-scenes technology to do all the appropriate vetting and credentialing. And so that improves the candidate experience because right up front we are telling people exactly what they’re going to need to be able to demonstrate that they have the qualification to do to get a job. And then we have the tooling on the back end to show them whether or not they are qualified and to help them figure out how they could demonstrate that they’re qualified so that people don’t waste a lot of time on things that they can’t do and vice versa that clients aren’t getting a bunch of candidates that aren’t going to be satisfactory.

I think that improves candidate experience because it eliminates a lot of these round trips of whatever phone calls, emails, faxes, whatever the case may be. It’s a, right up front, this is it. Same thing on the client side right up front, this is it. So it’s first time, right? And that is actually really, really important for experience perspective and efficiency perspective, a cost perspective. And so we’ve invested a tremendous amount of that capital that we’ve raised in building all the systems necessary to do that.

Folwell: So it sounds like you’ve standardized the credentialing side of things in a way that it’s great for the clinicians. It’s also great for the clients. How does that work with different client needs? And then when you go across states as well?

Nazem: So I wish I could say that we’ve created a credentialing standard. I think that’s one of the big missing pieces of the healthcare ecosystem right now. As I said before, we got to do everything as an industry, as a society to eliminate friction. One of the big friction points is the snowflake nature of credentialing. Every single hospital, every single state has a completely different, not completely different, but their own variation of exactly the same thing.

Folwell: Their nuanced version of it.

Nazem: So it’s like a distinction without a difference. And that is creating a tremendous amount of overhead costs in both time and money. And so getting rid of that would be very, very valuable. But given that this is the system that we live in, what we’ve done as a company is to build all the technology that allows us to leapfrog over that stuff. So that complexity doesn’t need to be managed by a person. It’s managed by technology. So all of the rule sets for all of the facilities, for all the different types of jobs, for all the states, whatever are ingested into our platform. We have the ability to do that because you have thousands and thousands of previous transactions.

You know all the nuances in the corner cases and just takes a long time to discover all those, but also to then build them into the technology. But that is the big area that we’ve focused on. Not just on the literal credentialing, but also all of the requirement and candidate matching and vetting and stuff like that. So they’re all part of the same story, but they happen at different times in the process, but they’re essentially using the same core technology that we’ve built.

Folwell: I don’t know if you’ll be open to sharing this or not, but when it comes to as you’re growing your platform and this focus on the talent experience, are you going as far as measuring conversion rates and your funnel and getting super technical? Are you looking at it from that perspective?

Nazem: Well, so I said the thing, strategically, that makes us very different as a company is our focus on the clinician. I think what practically, logistically, makes us a very different company is that we are a data-driven company. Literally everything is measured because we want to introduce optimizations wherever possible to make the experience, the cost, the speed, everything better. And the old axiom in operations is what isn’t measured, isn’t managed. So we want to be able to measure and manage everything so that we can optimize everything. So yes, we are very, very focused on that.

Folwell: Any KPIs that you’re open to sharing? Any key ones? Put you on the spot.

Nazem: No, I mean look, they’re all very important. And depending on what’s going on in the market or what is particularly relevant or working well or not well in our business, that becomes the key performance indicator. But I think ultimately we care about our ability to process efficiently. Volume is important, but efficiency I think is even more important because efficiency is what then creates the ability to drive and handle a lot of volume. I was trying to say, I think that’s where the economies of scale come from. It’s that focus on underlying efficiency. So those are the things that we really treasure and focus on very closely.

Folwell: Yeah, that makes sense. And one thing that I talk with a lot of staffing agency owners about is the structure of their team. And frequently I look at staffing agencies. My own perspective is that most are not putting enough into marketing or digital, but I’m pretty biased because I had a digital marketing agency previously. But how many people are on your team on the digital side of things or the marketing side? Does that actually….

Nazem: Well, our entire company’s digital, so I say 100% of the staff is, but in terms of marketing, it’s less than a dozen people. It’s not a huge marketing organization, but they’re a powerful group, and they can get a lot done. I mean the modern tools that exist are really phenomenal, and you can have a very broad impact on a per-person basis. I think the other thing that’s very important to say is that the best marketing is a great product. If you have something that works better, people will want to use it, and they will tell their colleagues that this is great. So we have a huge amount of just organic growth. And our marketing budget hasn’t really grown all that much in seven years. It has been very, very minimal. Both because that group is very effective and because we’ve also built a better mouse trap and people want to use it.

Folwell: Yeah, that’s great. With that, so you’ve talked a little bit about a couple of the benefits that the healthcare workers get, being transparency into what’s going on, an easier onboarding experience it sounds like. Are there any other reasons why healthcare workers choose you?

Nazem: Well, I think some of the stuff about the transparency is….

Folwell: Those are clear reasons enough, yeah. I’m just digging deeper.

Nazem: The other thing is that because we are more efficient, we don’t have to charge as much in commission to be a profitable, functioning company. So relative to the other agencies, we’re able to pay our clinicians more, substantially more. So that’s also a benefit. That’s not the reason that people end up choosing this or that job. We often see people picking a job that pays less, but having the ability to be in control and which one they choose is also really important. So not only are we transparent about a single job, we are transparent about all of the jobs that you can do. So instead of calling up a single agent and seeing only the two or three jobs that they have that might be relevant to you as a clinician, on Nomad, you can literally engage with thousands of jobs and choose the one that’s the best fit for you. 

So that’s I think another reason that people like working with us. And then I’ll say also, we treat them very well. As much as we use a lot of technology, we have a big focus on what we call our Nomad Navigators. So people who are there for you, this clinical and professional support available around the clock to support you as you are on assignment. And that makes a difference when you’re a traveling clinician, far from home and it’s your support system and all this kind of stuff. And it might be two o’clock in the morning, and you got floated to a unit that you felt uncomfortable on. You need to be able to talk to somebody about that, and we’re there for you. And I think that also matters. So there’s all these technical things, it’s faster, it’s cheaper, it’s better, it’s transparent, all this….

Folwell: Yeah, the human side.

Nazem: But the end of the day is a people business, too. And so being able to focus on that and create those human connections is very important, too.

Folwell: That makes a lot of sense. Do you guys even have traditional recruiters at all?

Nazem: Zero.

Folwell: Zero recruiters on a traditional model. So zero is the high-paid, commission, reaching out.

Nazem: That’s a huge source of our cost savings is that all of that stuff that the recruiters are doing to source and qualify candidates to sell them on a position, that’s being done by our technology. So we’re sending them emails and push notifications on our app and text messages based on what their previous experience and interest and stated preference and all that kind of stuff is. And then they’re coming to the site or to the app, and they’re seeing this job or that job and sorting and filtering by the way that they want. So they’re recruiting themselves. We tell them, “Hey, this job, this facility, this is what people say about it. Or 47 previous Nomads have worked here, and it’s paying 8% more than other emergency medicine jobs across the country. But it’s less….”

Folwell: You even give them the benchmarks on what this is.

Nazem: But everything.

Folwell: So you no even need to go to Glassdoor and do the research.

Nazem: Nothing.

Folwell: So yeah, it’s like, hey, it’s all here.

Nazem: We don’t want you to leave because we want to give everything you need to know so you can make a decision on your own. Therefore, not need a recruiter. If you’re a nurse, you’re a respiratory therapist, whatever you are, you shouldn’t be spending time thinking about this. You should be at the bedside taking care of a patient because that’s what you are uniquely qualified to do. So we try to take off all that cognitive load, and we say, “Here’s everything you need to know. We’re going to make it really easy for you to do the thing that you want to do. We’re empowering you to do the thing that you want to do”. That not only creates a better experience, but it also makes it a better business for us to run because we don’t need to have thousands of recruiters that cost a lot of money, frankly.

Folwell: It costs a lot of money and then one recruiter leaves and the book of business might go with them. There’s also that. Yeah, so that’s like….

Nazem: That’s another important thing really. Yeah, the mobility of the whole thing.

Folwell: With that, you call it the traveler companion, is that right?

Nazem: No, the Navigators.

Folwell: Navigators. Traveler Navigators. So are they building one-to-one relationships? Is it a support team or how do you structure that?

Nazem: You have an actual person.

Folwell: You get your person that takes you through the entire process, so is guiding you through.

Nazem: Now obviously, those people aren’t awake 24 hours a day, seven days a week. So….

Folwell: You have a backup.

Nazem: If it’s an off time or something, you might catch someone else, but you have a primary point of contact.

Folwell: That’s really awesome. It sounds like you have a pretty solid disruption into the traditional staffing model and it’s working well. So it’s great to hear about. With that, shift gears and zoom out just a little bit. I know we’re going through some really interesting times. I feel like since the start of the pandemic till today, the volatility in travel and healthcare staffing generally has been pretty high. But what are you seeing right now in healthcare staffing and where do you see things going?

Nazem: Well, I think that it’s the multi-billion-dollar question right now. I think the short answer is that what has driven the need for healthcare staffing is not going away. And what has driven the need for healthcare staffing are things that are not the pandemic. Basically what you have here is a growing demand for healthcare services, mostly driven by an aging population. People over the age of 65 require about three times as much healthcare services as people under the age of 65. And the baby boom generation is turning 65 at the rate of over 10,000 people a day. And that’s going to keep happening for years. So basically the rate of growth of demand is accelerating. Meanwhile, our ability to grow the suppliers of that care, the nurses, the doctors, the therapists, all of the different types of clinicians is not keeping pace with that growth.

What has driven the need for healthcare staffing is not going away.

In fact, we are even barely keeping up with a replacement rate. So what you’re seeing is a widening gap between supply and demand in the healthcare industry. And that is why the need for staffing is growing because the temporary workers can help fill the gaps. They will not fill 100% of the gaps. So this is not the entirety of the solution, but it’s why the volume of usage is going up, why the price of usage is going up. It was accelerated by the pandemic for sure, but it wasn’t created by the pandemic. So even after the “last case of COVID”, unfortunately there’ll never be a last case of COVID. Even when it really, really, really cools down, which it is starting to, the drivers of what’s causing this market to explode in size are not going away.

Folwell: And I think that demand and supply gap and healthcare is like this is going to be a problem for the foreseeable future. When I think of Nomad, I used to think of travel nursing, and now I know you guys are all verticals now, right?

Nazem: We staff nurses in travel positions and allied health professionals in travel positions. So we don’t do….

Folwell: Okay, so you’re doing some travel nursing and then travel allied.

Nazem: Yes, exactly.

Folwell: Yep. Okay. And are you seeing that across both? Same demand, or are there differences?

Nazem: I mean obviously there’s some variations, but by and large, all clinicians are undersupply. So yes, I think the simple answer is yes, we’re seeing it everywhere.

Folwell: And what are you seeing right now? I just had a conversation the other day with another healthcare staff agency. They were talking about pay rates and how volatility through the pandemic, things returning to a new normal maybe. What are you seeing on that front?

Nazem: We are definitely on the downslope from the peak pay rates that we saw in the first quarter of 2022. We’re still well above where we were in the pre-pandemic period, but I don’t think anyone believes, myself included, that the pay rates will return to that pre-pandemic level. I think that they are going to level off 20 to 30% higher than they were previously. There’s a lot of reasons for that. But….

Folwell: Inflation.

Nazem: Yeah, inflation is obviously playing a role. There was accelerated departures of clinicians from the workforce. Some estimates say that about one in five healthcare workers left the profession theoretically, permanently in the last two years. So that was a lot faster than the rate of retirement prior to the pandemic and certainly what was expected in that two years. So there’s a lot of things driving the price up.

One other thing that was driving the price up, I think, I don’t have any proof for it, and I’m not a registered economist or anything, but the fact that there was so much federal funding to healthcare systems during the pandemic for COVID-related needs was artificially driving prices up too, because there was a higher willingness to pay. So there was a little bit of an arms race. There’s been probably an underpayment of staff nurses and staff clinicians. And that gap was revealed by what the willingness to pay for temporary clinicians was. And so now that has naturally brought up the costs of the pay rates for the staff clinicians so that they don’t leave. So there’s a lot of economic support for driving the prices up. I do think though there is still some room to go down from where we are, but like I said, I don’t think we’re going to get down to pre-pandemic levels.

Folwell: That all makes sense. And back on the supply and demand side of things, obviously reducing friction in the process is going to help get more people to work, but you can’t create more people, and you can’t create more people that are trained with the right certifications to get a job. Are there other things that could be done from a systemic level or at a higher level to actually help bridge that gap in a better way?

Nazem: There are certainly other things, and there have to be other things. I have often said that there are three solutions to the staffing problem. One is workforce allocation, one is workforce multiplication, and then the third is workforce automation. So allocation is what we in the staffing industry are all doing. Can we better allocate the resources that we already have? Can we reduce the friction to draw more of that latent capacity into the system? Can we staff reliably so that not every healthcare facility needs to hire full-time staff to their greatest need? Even though the needs vary throughout the year, you shouldn’t be staffing to your peak census. So can we just allocate better, make the best use of the resources that we already have. So that’s a big part of the solution. Second part of the solution I think we’ve seen a lot of over the last couple of years, and it’s a great thing, which is the multiplication —  allowing the resources we have to do more in the same unit of time.

There are three solutions to the staffing problem. One is workforce allocation, one is workforce multiplication, and then the third is workforce automation.

So telemedicine is a perfect example of this where a single clinician sitting in one location can see patients all over the country. A lot has to change in order to enable that. I think what was helpful during the pandemic was the lifting of some of these state-by-state licensure rules. There was some insurance stuff that happened around creating parity for reimbursement for telemedicine and in-person visits. There were some sort of regulatory blockades that were lifted that will help also fill some of the gap. And then the final thing, which I think is a little bit further off, is what I call workforce automation. And that’s where we use artificial intelligence, point of care support.

Essentially, clinical augmentation and clinical replacement will be very necessary. I think probably a lot of what people do in healthcare today doesn’t need to be done by any person. And if we can offload some of those lower cognitive tasks to AI or frankly even higher challenging tasks, but if they could be done appropriately by smart machines, we get almost infinite scalability and solve a lot of our problems. So there’s a lot of changes that need to happen in my opinion over the next couple of decades, but it’s a necessity at this point.

Folwell: It’s super insightful. And with that, and this is a big question as well, where do you think healthcare staffing, what do you think it’ll look like five years, 10 years from now? Obviously, there’s a lot that needs to be done on the healthcare side as a whole, but where do you see the staffing space going?

Nazem: My perspective on this is encapsulated by the simple fact that I started a company in this space that’s technology-driven, which is I think that the needs and desires of clinicians and clients are much more going in this technology direction. So self-service, transparency, low cost, high efficiency, high speed. And so I think you can expect the healthcare staffing industry to look a lot like the travel industry, like Expedia, Kayak, et cetera. That transformation that they went through in the 90s and early 2000s is what we’re undergoing right now in healthcare staffing. And so I think it’s not going to be precisely the same, but it will be a lot the same in that there’s going to be a lot of consolidation. I think over 2,000 healthcare staffing agencies now of a variety of sizes. And I think that’s going to consolidate down into a small handful of large platforms that are technology-driven, I think.

I also believe that there is going to be an increased utilization of temporary staff. It’s going to become a more common way, not the most common way, but a more common way for clinicians to deliver their clinical skills. It is just a demographic change where the millennial and later generations are more interested in, first of all, just more changes. They’re not going to work in one place for 30 years. But also this concept of gig work has permeated almost the entire economy. And I think it’s going to take greater hold here in healthcare as well. So let’s say 5% of workers in a clinical institution today are temporary staff. Maybe it’ll be 8% or 10% going forward. But I think with the advent of more efficient technology-driven systems, it will become easier for people to participate and we can then actually take advantage of their interest in doing that.

Folwell: Yeah, absolutely. I think the travel industry is going all the way back to one of the most relevant paradigms to look at when you see what’s happening in staffing. I come from that industry, so I spent a lot of time looking at how it went and looking at what Booking.com and Expedia, and some of the big players do. And it seems like the most relevant comparison. Obviously, there’s a lot more touchpoints. So it’s I think maybe a harder problem to solve in some ways. But it’ll be interesting to see if there’s the winner take all model or if it’s how the audience gets segmented out and goes forward.

Nazem: We will see. But I do think that there’s going to be a lot of consolidation and basically what we’re doing is solving an information asymmetry problem. When there is information asymmetry, you need an agent. That’s why travel agents were very valuable before. Not everyone had to connect at the airline or whatever, so you needed to go through someone who knew how to do that. But then technology enabled us to break down those information barriers. And now your point is exactly right, is more complex and the information asymmetry is more substantial in healthcare staffing, but the technology has advanced, and the opportunities to break down barriers and the ability to break down barriers has also advanced. So that’s exactly what’s happening here.

Folwell: That’s awesome and a great way to explain it. With all of that, we’ve talked a lot about your technology. One thing where I’m just very intrigued by is you were a doctor before, and now you’re running a massive tech startup. What’s that change been like for you? What are some of the challenges and learnings you’ve had along the way?

Nazem: Oh gosh. Well, I have to say I’ve enjoyed both of my careers. I love taking care of patients. It’s such a rewarding thing to do. And in many ways I haven’t had to give that up even though I had to actually hang up my stethoscope and I don’t see patients on a regular basis anymore. Ultimately, the impact of the work that I’m doing now is thankfully still impacting patients. We’re putting thousands of clinicians at the bedside, taking care of millions of patients. And that’s very rewarding in the sense that the breadth of impact is greater, but obviously the proximity is less. I don’t build those one-to-one patient relationships. I do miss those. So that has been one challenge. One change is just the emotional journey that I’ve had to go on there. But in exchange, I’ve also gotten to build relationships with several hundred really great people in our company.

And to feel like we’re being very creative and working on something that matters at a time that really matters. And it became even more meaningful over the last few years where healthcare staffing became front and center. There are tons of things that I had to learn that I didn’t know before. Lots of leadership lessons, lots of basic building-a-company-type lessons, but it’s been a really thrilling journey. And I wouldn’t say anything that was challenging was upsetting. It was just challenging in the positive sense where I was like, “Wow, that’s cool. I get to learn this new thing.” And that was what I always loved about medicine, was the opportunity to just keep learning new things. And gosh, there is no better place to learn a lot of new things than running a startup company, building it from zero to where we are.

Folwell: You get to learn at a pace that most people will never understand.

Nazem: I don’t know about that from a comparison point of view. But at least for me, it’s been really fun. In a single day, I might do something with our product and engineering teams and then with marketing and then with legal, and then deal with the client. And the context switching is really, really rapid fire, but also what makes it so cool and exciting.

Folwell: Yeah, it’s never boring. So with that, I’m going to jump into the last section of the questions and some personal questions that I ask all of our guests. In the last five years, what new belief, behavior, or habit has most improved your life?

Nazem: Oh my goodness. Maybe not what you’re going for, but so in the last five years, I’ve become a parent.

Folwell: Oh, awesome. Congrats.

Nazem: Yeah, that was the best thing that’s happened in the last five years. But being the parent to a toddler means that I’m now a morning person. So I used to be a night owl. I love being up at night. I was very productive at night, even took a lot of nocturnst jobs as a doctor, but I have become an early morning person now. It’s not unusual to see me up at 5:30, 6:00 in the morning. This would’ve been shocking to anybody who knew me as a younger person, but I actually really like the mornings, and it’s been a very, very productive new life schedule. So I suppose that’s more than the behaviors that I’ve adopted.

Folwell: Love it. And you had a kid, and I think there’s a lot of new behaviors that come along with that.

Nazem: Oh my god, honestly, that’s the biggest change. And I think for me, I always felt in my professional life I was in service of others. That was the wonderful thing about being a doctor. But now in my personal life, my needs are secondary to my wife’s needs and my child’s needs. It’s a really great feeling. It gives you a lot of purpose. When you’re in it just for yourself, when you’re a single person, literally single, you have no children, no partner, you are literally selfish. And it feels weird to be selfish, but it’s also unguided. But you have other people who are either saying or demonstrating what their needs are and to be able to serve those feels really good.

Folwell: That’s great. What is one of the best or most worthwhile investments you’ve ever made? Could be an investment of money, time, energy, et cetera.

Nazem: I’ve been very fortunate in my life to get to do a lot of that kind of stuff. I’d say one of the things that’s been the most rewarding has been the investment in colleagues, professionals, who are earlier in their career than me. So the opportunity to mentor has been really, really great. Whether it was when I was a practicing clinician and teaching the next generation of med students and residents, or now getting to talk with people who want to start a company or make the transition from being a clinician to a business person.

Those are the conversations when they pop up on my calendar, I say, “Oh gosh, I’m really looking forward to this chat today.” And then it has a long-term impact. It’s literally an investment in it. They’ve always been very small. I can’t claim credit for all the great successes that they’ve had, but to even just get a window onto those people’s lives and say, “Oh, I saw what you were doing five years ago now look at what you’re doing. It’s so amazing. I’m so happy for you. I’m very proud of you”, and all that kind of stuff. So those investments have been, I think, the best.

Folwell: I love that. And what is the book or books you’ve given most as a gift and why?

Nazem: Well, lately I’ve been giving a lot of gifts of children’s books, so all of my friends are having children. Goodnight Moon is a classic.

Folwell: Goodnight Moon. That’s the one?

Nazem: I don’t think I have a single one, honestly. I wish I had better. Whatever I’ve reading lately and then I send it to a whole bunch of people and more….

Folwell: More prescriptive, identifying the book for that person or the book at the time you’re reading.

Nazem: Yeah, exactly. I don’t think there’s one single piece of advice for everybody.

Folwell: And then how has a failure or apparent failure set you up for later success?

Nazem: That’s an interesting question. I think probably, I’ll say it more generically, one of the big lessons of building a startup company where it’s from zero is that there are no processes, no procedures, no strategy, nothing when you start. And that means that the likelihood of having big and small failures is very high, unlike plugging into…in my previous career as a clinician, I worked in an organization that had like 50,000 employees and has been around for 150 years. And so there is a way to do literally everything.

The chance of having some massive failure or any failure is limited. But in a startup where everything is born out of your own mind, the chance that you get it right every time is very low. So I’ve had a bunch of small and big failures along the way. So this is not a very specific answer, but what I’m trying to say is that the biggest learning has been to insist that I identify and learn from the failures. It’s very easy to say, “Oh gosh, that really screwed up. And okay, whatever. That happened”.

Folwell: Keep moving forward.

Nazem: Let’s do the next thing. But actually taking the time to examine the failure. We even do it formally with postmortems and trying to understand root cause analysis and things like that, because if it happened once, it can happen again. And there’s something to learn from it. That’s more like operational and technical procedures. But then even things like, we didn’t hire the right person. What happened? Why did that happen? Those kinds of failures happen all the time when you’re growing a company. And so I think the biggest learning is to not let any failure go by. Lean into it. It’s going to be very uncomfortable. It’s very uncomfortable, I’ll tell you, but just let’s go relive it and figure out what we could have done better. So we do it better the next time.

I think the biggest learning is to not let any failure go by. Lean into it. It’s going to be very uncomfortable.

Folwell: Great answer. And with that, I just wanted to know if you had any closing comments, anything else you’d like to share with the audience?

Nazem: Oh gosh. Well, that sounds like the audience of this podcast is very much in the same world and mind space that I am. I think that, as I said at the very beginning, I don’t think this is as much a competition as it is a cooperative environment where we’re really all trying to make something better. At least in the healthcare staffing space, what we are doing matters. It actually makes a difference in people’s lives and the extent possible. I think it’s very important for us to try to advance the industry and not only look out for our own corporate commercial interests, but rather, ultimately, think about the greater good, which will ultimately serve us as businesses as well. I mentioned to you in the beginning this concept of somewhere along the way in our conversation, credentialing standards or something like that, or licensing standards. That’s something that is not immediately valuable to all of us.

It would take effort. It requires a whole bunch of people to be coordinated, and plenty of us benefit from the frictions introduced by something like this. But setting aside our pecuniary, near-term, small needs, thinking about big stuff like that is something that we should try to do as an industry because it will make our lives better. But more importantly, it’ll make our end customers, our patients’ lives a lot better. And so I would really hope that we can somehow figure out how to do that. Big ask, but I think worthwhile in the end.

Folwell: Great insights today Alexi. Really enjoyed having you on the show. Thank you so much for joining.

Nazem: Thank you, Dave.