(emphatic music) (lively music) (lively music ends) - Hello, I'm Kathleen Bade.

Welcome to this episode of "Working Forward," where we're shedding light on real-world workforce obstacles and opportunities to spark awareness and potential solutions.

Arizona is facing a significant shortage of nurses and physician assistants in the medical field, and for many medic veterans who could fill the shortage gap, finding a civilian healthcare job is difficult to say the least.

A major obstacle lies in veterans needing accreditation and certifications in various medical fields despite having life-saving skills learned in extreme environments, in combat fields or makeshift hospitals.

In the WorkingNation film, we're showcasing a short documentary, "The Path Home," which examines military veterans navigating the challenging transition from combat medics to civilian healthcare providers.

A retired special operations medic opens up about his relentless pursuit to work in the healthcare field and what it costs him.

Take a look.

- [Ronald Reagan] Words alone cannot express our gratitude to the brave men and women who took on the task of protecting our country from foreign threats and aggression.

President Coolidge once said, "The nation which forgets its defenders will be itself forgotten."

Nothing is more important to the soul of America than remembering and honoring those who gave of themselves so that we might enjoy the fruits of peace and liberty.

(sentimental music) - For me, it, I believe this program would've made a big difference.

I'm actually separated from my wife right now, will end up divorced, I'm sure, and she's a super good person, was a fantastic mom.

She raised those kids all by herself.

I missed a lot of milestones in their lives.

I'm a retired special forces medic.

I did that for 32 years, and then I was accepted into Stanford PA school.

It was not free and I had to pay for everything myself.

I could afford a apartment in San Diego for my wife and kids.

No way to afford two apartments, so I lived in a tent.

Every evening after school, I would take my backpack, go to the medical library, study for a few hours, then once it was dark, I would take my backpack, go to a park to a hidden area, set up my tent, sleep for the night, get up before the sun had come up, take down my tent, go back to campus, work out in the gym, take a shower, and start all over again, so that's probably the big difference it would've made for me personally.

I would still be married to her 'cause this, me spending our entire life savings and going into debt too?

That was a lot of added stress to an already stressful situation.

(solemn music) - So, the special operations medic to PA program started as an idea about a decade ago, and I was sitting in the emergency department working at our busy level-one trauma center with a talented elite special operations medic, and he had done such a great job.

I asked him, "What are you gonna do with your future?

Are you gonna become a physician?

A physician assistant?"

And he said no, and I asked him why, and he said, "Because I'm gonna have a kid that's 10 years old.

I can't afford to go back and being a student and I can't spend two or three years in school in my 40s," and it was a very reasonable response, but as a ER physician, and especially where we have massive shortages in staffing, all I could think of is, "What a waste.

We have got to do something better."

You know, U.S. healthcare is facing several crises, but the most dramatic one is human resources and people.

We have literally 200,000 nurses short per year.

We have 50,000 to 100,000 physicians that we're short.

- What we would like to do is take special operations medics that are already working at the top of their game, but we're giving them the capabilities to actually have a civilian equivalency to do exactly what they're doing right now.

We're giving 'em the capability to have a lot higher level of education, and then what we're doing is we're setting these individuals up for success when they leave the military.

We're giving them the ability to immediately jump into the civilian workforce and immediately make a difference, as opposed to spending three to five years working on prerequisites, and then going to school, and then going into the civilian setting.

- So, the individual medic gains skills, becomes a better medic, can take care of their unit mates more effectively, and then can have a high-paying, high-quality, high-value job when they get out of the military.

The military gets a far better trained medic who can become a better educator, a better medic in these complex environments where they're operating, and then the U.S. health system gets a supply of well-trained, highly qualified individuals.

The special operations medics have committed a big chunk of their lives to becoming the best medical providers, best soldiers, sailors, and marines that the world has to offer.

- So, we are trained to do not only medicine inside of our military operational environment, but also humanitarian aid missions.

- And so, these individuals, when they come back and they go to physician assistant school or nursing school, they bring this life experience that is often missing in someone who has taken a more traditional path, and we've created these medics who we trust with providing trauma care and saving their lives in these environments all around the world, and then we bring this individual back and we say, "They're not good enough to take care of your child who just got in a car crash in the street," and, like, I think that's ridiculous.

I think that if we have an individual who's willing and trained to care for someone in the most remote parts of the world, that I want that individual by my side.

When I'm in the trauma bay taking care of your son or daughter who's been shot, or your son or daughter who's in a car crash, I want that person next to me who has put in a chest tube in the mountains, who has given a blood transfusion while under fire.

These are the type of people that will help save lives on our streets and I think it's absolutely crazy we're not putting 'em to use.

(solemn music) And so what we did is we started with the health systems, and we went to Atrium Health and a few other health systems and said, "Will you agree to hire these individuals?"

and we had a bunch of private sector hospitals say, "Yes, we want these people to come work for us.

We think that these special operation medics will make great nurses, great physician assistants.

We want them in our health systems as leaders."

We then went to physician assistant schools and medical schools and we said, "Can you train these people?"

and they said, "Well, if people are gonna hire them, for sure we can train 'em," and so we worked with Congress to get this put into the 2018 John McCain National Defense Authorization Act, and then we worked with the Department of Defense to try to get it authorized, and we were able to get one individual through the pilot program who's done a tremendous job, and now we're looking to try to see if we can get it funded and actually implemented across the Department of Defense.

When Congress actually put a section into the National Defense Authorization Act, it was exciting.

It was also later on, a little bit of a realistic moment.

We thought we'd made it.

We thought, "Oh, it's a bill now, so now it's a thing, now it's real, now it has to be done," so it was a good educational moment for us to move beyond our excitement to actually see how the government works.

My wife and the wife of my colleague, Justin, who worked on this for eight years with me, referred to this as our Moby Dick, and this is the white whale that he and I have been chasing for eight years now, and yet we've only gotten one individual through the program.

And so, the challenge is, how do you shape massive bureaucracies to be more nimble and to change their way they're doing business?

My call to action here is it's time to appropriate funds for the program.

So, if you've been a medic for 20 years in the military and you can take the board exam or you can take the licensing exam and pass it?

Well, we should figure out a way to get you to accelerate to be a nurse or accelerate to be a physician assistant because it's the right thing to do for the medic, it's the right thing to do for our war fighters, and it's the right thing to do for the people in our communities back home.

- Thank you for joining us for this episode of "Working Forward" and the premiere of the short film, "The Path Home."

Now, even though Bill's story is what many medic veterans face, as you also saw, Dr. Callaway is championing to change the narrative of how veterans can reach their dreams of transitioning into civilian healthcare, and it's also happening right here in Arizona.

Jessie Milaski is a veteran and medical student at the Mayo Clinic Alix School of Medicine.

Dr. Pierre Noel is a hematologist and the director of the Mayo Clinic Military Medicine Program, as well as a veteran.

And also joining the conversation is Joan Lynch, one of the executive producers of the film and an advocate for veterans.

So, Joan, let's start with you because I found this documentary mind-blowing that this is even an issue, so how did you discover it, this huge disconnect?

- Sure, so I'm the daughter of a veteran.

My father served in Vietnam.

Came back and went to school in the G.I.

Bill, which we're all familiar with, and I was, you know, a big fan of the G.I.

Bill, and one Christmas, as we always do, I, you know, adopted a military family veteran, six kids, and this gentleman had served three tours as a special operations medic, and he was in coding school, and we're having a conversation.

I was talking to his wife and I said, "I don't understand why he's not in the healthcare field," and she said, "Oh, that's not an option for us," and we started to dig into what was going on with the G.I.

Bill, and no, he's coming home after serving for 15 years, and who's gonna pay for the food and who's gonna, you know, pay for the rent and all of these things.

Things I had not considered, because most of us assume they come home, you go to school, everything's sort of taken care of, but most of these medics are coming back after 10+ years with families, and so we started digging in.

I got to meet Dave Callaway, and seven years ago, we started on this path to dig into this topic, and I've just been absolutely fascinated by the work that needs to happen to get these folks into the medical field 'cause we need them.

- Yeah.

How would you measure the progress so far?

- You know, I think as Dave said in the film, it's really challenging, and one of the challenges, as we know, is that the education system is very separate from the government and the military, and so the language that they've spoken are different, and those are set up, in a lot of ways, intentionally.

You know, there's a million dollars that goes into training these folks, Dave's a part of that down in Charlotte, and they wanna keep them in.

These are valuable men and women doing this job, and so there really wasn't a lot of incentive for the military to set it up for their folks to have that much training and then want to leave and go out and get a job that perhaps paid more or, you know, you're in different areas and you're not on call the way that the military is.

So, I would say it's still a big challenge, and that's being nice.

(panelists laugh) - And I think, Dr. Noel, you described it as, that the military and the medical schools are kind of silos, and explain what you meant by that.

- Well, I think the priorities are a little bit different, and I think also communication between both and the realization of the obstacles is not necessarily shared between the two entities, and I think that David Callaway has made a tremendous dent into this and trying to make people conscious of the challenges faced by the medics trying to transition into the medical profession.

- All right, and Jessie, you had two tours in Afghanistan as a combat medic.

You came back here, a former Army Ranger.

Thank you for your service, and also a veteran, Dr. Noel, so thank you for your service as well.

Talk about that road.

What was that like for you, your experience, your attempt to get on this path home and get into medical school?

- Yeah, it was a long road.

You know, it's been some time, and kinda looking back at the obstacles, I kinda break it down into a few categories.

I think the first one was really, I call it, like, a paper wall, you know, meaning that I had the qualifications, the skills.

I didn't have the right piece of paper.

- [Kathleen] What's the right piece of paper?

- Yeah, the degree, certificate.

Some qualification, right, and I went to a school, a nice community college in Upstate New York when I got out, and I wanted to get credit for anatomy, right?

We have an anatomy lab, there's cadavers.

It's a very intense course.

They wouldn't budge.

I asked to test out, they said no, and so I had to take Anatomy I, Anatomy II, you know, so that's a year essentially.

- And that costs money.

- It costs money, and really, you know, I had the G.I.

Bill, which was great, but more importantly, it costs time, and, you know, not to toot my own horn, right, but I took those courses and I got almost 100% in each one, right, and it's not to say I'm the smartest person ever.

It's more to say I was qualified.

Clearly, I had the experience, I had the education, but I didn't have the right piece of paper and it wasn't accredited at the time, and it's better now.

Medics going through that course get some college credit, but yeah, at the time, that was a huge, huge barrier for me, and really, the second one was employment.

So, at the time, we didn't get certified as a paramedic.

I wanted to work as a paramedic in New York.

I submitted everything to New York State from the military and they said, "We don't know what this is.

We can't help you."

- So, speaking different languages.

- Completely different languages, and to your point, it's siloed, right?

We have all these qualifications, but the civilian world had no idea.

- So, you could patch someone up with bullet holes in the middle of a field somewhere, but you couldn't put a bandaid on somebody on a city street.

- Correct, and luckily, there was a little good luck in there in that I was in Georgia at Fort Benning, and Georgia at the time would give you a paramedic certification if you were an active duty special operations medic, so I got that as a "just in case" type of thing, and New York recognized that on the condition that I did a full refresher course, and, you know, as a young, cocky ranger, "I don't need to take a refresher course.

You know, I've done all this stuff," but it did.

It humbled me, right, because you are proficient, you're highly trained, but you're not managing diabetes, you know, a lot of the civilian kind of issues.

So, it was good.

It was good that I did that, but it was a short kind of a bridge course versus repeating the entire paramedic education over again, so I think programs like that, you know, courses that can bridge the gap with some understanding can be very helpful versus starting from scratch.

I would never have done it.

I would not start paramedic school over again.

It wasn't my goal.

- And Dr. Noel, why is Mayo, such an institution with such esteem, you know, and reputation, investing in military medics like it is?

- Well, I think the medics are at the tip of the spear and they're the first one to encounter military casualties and injured soldiers, so I think that they're the frontline and I think that that's, and frequently, they're not, we don't invest sufficiently in the frontline, and I think that, having been, you know, in the military myself, I recognize the importance of the medics and what they do, and where they interact with the patients, and then they interact in an area frequently which is very dangerous, and they interact in the first few seconds following the injury, so their level of proficiency will dictate the outcome of the casualty downstream, so I think it's extremely important to invest in that direction.

- And tell us about the program itself that's in our own backyard here in Arizona, because it's quite unique and you kind of bridge that special operation, special forces operation medics into medical school.

- Right, so the program was started about, you know, 14 years ago, and the, what we did is we were in close communication with the military commands, understood the needs and the requirements, and then we decided not to duplicate the excellent training available in the military, but instead to bridge the gaps and to augment the training the medics did receive in the military.

So, because of this, we focused on areas such as prolonged field care.

What if you can't get the casualty out of the combat zone?

What if you have to stay with the casualty for three days?

How do you manage that?

- I would think all these real-world experiences like Jessie had out in the field, I mean, how do you even teach that in medical school to people who haven't been in the military that they can work under such incredible stress?

- Correct, but a lot of the challenges in training medical students, medics, PAs, and physicians is to provide them the nuts and bolt of doing either a surgical procedure or addressing a medical emergency.

If the context in which you deliver care makes things more complicated, but if you don't know the nuts and bolts, it doesn't matter what context you're working in.

So, as you mentioned, they worked in a very challenging context, but they need to have the nuts and bolts in order to be able to function in that environment and that's what our program offers, and we do this free of charge to the military units.

- And that's what needs to be underlined, right?

Free of charge.

- And it's a benefactor-funded program where we have benefactors funding this entirely, and we also have a program that Jessie benefited from, which is funded by the Leona Helmsley Foundation, where we take special operation medics who transition out of the military and want a career in healthcare, and we provide them a fellowship and pay a salary and benefit for them to be able to do this and make themselves competitive to get into medical school, PA school, or the career in healthcare of their choice.

- And Joan, I see you nodding along a lot because you're so passionate about this subject, so what do you want people to take away from this film?

- Well, I think as we went through COVID, what did we learn?

We need more people.

We respect frontline workers.

We need people in healthcare.

Rural areas, we have a real gap.

We've talked about it a lot.

Here in Arizona, as you talked about, there's a need for more people in the medical field, and it is one of the areas in employment that is growing, and yet we're not making it easy for these folks to transition in, so, I mean, I think there's a psychological effect when people come back, as you know, veterans come back, but in this particular case, what I'm passionate about is you have an incredible amount of skill, and now you're being told that that doesn't count for anything, and you've saved lives.

That doesn't count for anything.

So, it is humbling.

It is tragic.

There's addiction, there's suicide, there's all of these things for folks that came back who literally saved lives, and so I think if we look at it from the perspective of, our communities need these people in these roles.

How do we transition into it, and that means programs like yours, working with the community, bringing these folks out, but it doesn't make any sense for our country to pay to train these men and women to bring them back and then to not use them.

- And Jessie, let's bring you back in on this 'cause it's just not your mission to become a doctor yourself, but helping to clear the runway for other veterans that Joan was just talking about who follow in your footsteps is also your passion, and it's led to a non-profit that you're a part of.

Talk about that.

- Yeah, absolutely, and before I do, I think because you mentioned COVID, I have kind of a case study in exactly what you're talking about.

So, early spring 2020, I had been working overseas for a couple months at a time, and there was kind of a holding pattern because of travel was restricted.

My friend called me up, my friend Ricky, and he said, "Hey, can you be in Manhattan next week?

We're setting up a field hospital."

Kind of a crazy phone call, but I knew him, I trusted him.

I said, "Yeah, sure.

Whatever you need."

So, a retired military physician, she had just recently retired, Dr. Missy Gibbons, was looking for a way to help.

You know, COVID was hitting New York City hard.

She just didn't know.

She didn't really have a plan.

She just wanted to go and help.

She partnered with New York Presbyterian Hospital to set up a COVID field hospital in the Columbia University soccer stadium, and the plan was to staff it primarily with special operations medics and other medics from all the branches.

So, long story short, went up there, staffed this entire hospital with, you know, about 80% special operations medics, but we had Army, Air Force, Navy corpsman, everybody there, most of which who hadn't worked in a traditional hospital setting, and due to the emergency declaration in the state, we were able to do a little bit more than normal, right?

I was credentialed as an actual nurse at the time.

And so we ran this field hospital.

We treated hundreds of patients.

There were no bad outcomes.

Let off the pressure from, you know, the hospitals in New York at the time.

- So, you could fill that gap at that moment in history.

- Correct, but the red tape was cut, right?

Because of that emergency declaration, we were able to use our skills, and I think the most important thing there was, you know, the military, especially the special operations community, you're trained to be comfortable being uncomfortable, right?

We had this kind of insurmountable task.

"How do I build a field hospital?

What do I do?

How does this work?

How do I drop meds from this machine I've never used?"

But, you know, just like in combat, you figure it out, right?

You solve the problem, and that's what we did, right?

No one was panicking, - [Kathleen] That expertise came in very handy.

- Yeah, and you know, there's this virus we didn't know much about at the time.

We're wearing head-to-toe protective equipment.

There's a lot of uncertainty, but the amount of people who, we had to turn people away there were so many.

The amount of people who just ran towards the problem willing to fix it was amazing.

- And that was a wonderful example of how this should and could work in terms of filling those shortages and those gaps.

So, tell me more about your special operations forces to medical school non-profit.

- Yeah, yeah.

So, Special Operations Forces to School of Medicine, or SOFtoSOM for short, it started organically.

It started as a group chat between myself and some colleagues that were applying to medical school at the time.

If you look up, "How do I get into medical school?"

the information you'll find is really geared towards college students.

There isn't information, "How do I translate this long career in the military as a medic into something digestible in the civilian world?"

and so we just bounced ideas off each other.

"How did you answer this?

What resources are you using?"

And we were all successful, luckily.

We all got into medical school, and then more people joined the group chat, and eventually the decision was made to formalize it.

We said, "Hey, I think we can help a lot of people here," so we organized everything, created the non-profit, and since then, you know, we've been very successful with mentoring.

We offer application prep, help with essays, we provide some financial support to the application process, which is very costly, and really, our goal is to harness the unique culture of SOF, special operations forces, excellence to create the next generation of physician leaders.

You know, you have to realize, the qualities that the SOF community selects for, so adaptability, intelligence, calmness under pressure, leadership, right?

Those are the very characteristics that make an excellent physician.

- Well, thank you for helping to map out "The Path Home."

This has been a great conversation, and we wanna thank Jessie Milaski, Dr. Pierre Noel, and Joan Lynch for having this eye-opening and necessary conversation, and we hope it will spark more change to get medic veterans into the healthcare system that desperately needs more nurses, doctors, and physician assistants.

I'm Kathleen Bade.

Thank you for watching this episode of "Working Forward."

(spirited music)