A cardiology program is backed up. Patients are waiting weeks for appointments. Clinicians feel stretched. Leadership starts discussing recruitment.
That sequence plays out across healthcare every day. Yet when Dr. Pamela Ograbisz, vice president of clinical operations at locumtenens.com, is called into those situations, she often finds herself examining something other than staffing levels. She starts with intake processes, referral pathways, message routing, clinical roles, and the ways patients move through a system. In many cases, the problem reveals itself long before anyone reaches the clinician whose schedule appears fully booked.
"Many times when I look at it, it's the access points," Ograbisz said. "How are patients getting to you and how are you funneling them through your criteria for getting them from point A to point B?"
That observation became the foundation of a recent conversation between Daniel Williams, senior editor and host of the MGMA Insights Podcast, Dr. Ograbisz, and Dr. Jamie Threatt, telehealth program director at locumtenens.com. While physician shortages, APP utilization, burnout, and telehealth all entered the discussion, the thread connecting them was straightforward: healthcare organizations often focus on capacity without first examining how work moves through the organization.
Looking at the Work Before Adding More People
After 27 years as a cardiothoracic nurse practitioner, Ograbisz has watched advanced practice providers become a standard part of healthcare delivery. What continues to vary, she said, is how organizations deploy them. "Now, there's not a hospital system or a clinic across the country that's not utilizing advanced practice providers," she said. "I don't think everyone's using them as wisely or as effectively as they could."
That distinction becomes especially important in specialties facing physician shortages and growing demand. Ograbisz pointed to diabetes care, infectious disease, and maternal health as examples where physician-APP teams could help expand access. "We could utilize and better position physician and APP teams to increase access," she said.
Those conversations frequently lead to questions about task ownership. Screening patients, routing messages, managing intake workflows, and handling certain follow-up responsibilities do not always require a physician. Ograbisz challenged leaders to think carefully about who is doing which work. "Why couldn't you screen all of your patients through either utilizing AI now, but also with telehealth screeners?" she asked. "Why are we not utilizing nurses more effectively in that opportunity?" She added: "We do not need someone who can write a prescription to do any of that."
Designing Around the People Doing the Work
Ograbisz repeatedly returned to a lesson she learned as a clinician: new initiatives rarely succeed when the people expected to carry them out are left out of the discussion. She remembers programs arriving with little input from the physicians, nurses, and staff members who would ultimately be responsible for making them work.
"We have both been on the receiving end of admin coming down and saying, 'Hey, by the way, we're gonna deploy this program, and have fun,'" she said. "No one ever asked us what we thought or gathered our input."
Her approach begins with conversations that extend beyond physicians and executives. Nurse practitioners, physician associates, nurses, technical staff, and patients all interact with different parts of the workflow. The same principle applies to employees who are rarely included in planning meetings. "If we're not talking to folks who clean the rooms and deliver the tray tables, we're also missing the boat because it takes everybody to make it run," she said.
Organizations often hope that successful programs can be replicated with minimal modification. Ograbisz sees things differently. "What I build for hospital A is I guarantee you not what I will build for hospital B," she said. "They could be similar, but every hospital has their own flavor." The details matter, from patient demographics and referral patterns to staffing models and local workflows. As for implementation, her advice was memorable and direct: "If you don't get the nurses' buy-in, you're cooked."
What Patients Experience and Clinicians Carry
Threatt's clinical career spans emergency medicine, trauma, neurology, pulmonary critical care, and telehealth. Working across those settings gave her a view of how patients move through a health system and how different departments connect, or fail to connect, with one another.
"I think the genesis of the problem is that we've developed, or health systems in general have developed their subspecialty care and their virtual care services completely siloed," she said.
Patients experience the consequences in practical ways. In some specialties, that means long waits for appointments. "We have even in large metro areas, we have some specialty lines where you've got six months of wait times," Threatt said. Communication can be equally frustrating when messages move between portals, schedulers, nursing staff, and clinical teams. "Are the messages and the communication tools patients are provided with, are they landing on the right person's desk?" she asked.
For clinicians, the same workflow problems can create a different set of pressures. Administrative tasks accumulate. Delays trigger additional follow-up work. Staff members spend time tracking information that should move more easily through the system. "We're being asked to do more with less," Threatt said. "Inefficiency, we know, leads to that big buzzword that we're all talking about is clinician burnout." When reviewing workflows, one question consistently guides her thinking: "What can an APP do that right now a physician is doing?"
Telehealth's Role in Expanding Capacity
Threatt's earliest experience with telehealth came through telestroke programs, where virtual specialist access has been part of care delivery for decades. "We've been doing telestroke for over 30 years now," she said. "It's an integrated part of ER and neurology care."
That experience continues to shape how she evaluates access challenges. Some patients face transportation barriers. Others have mobility limitations, limited caregiver support, or lengthy trips to see a specialist. "How are we not thinking about how difficult it is for my geriatric patient who's oxygen dependent and doesn't have family local?" Threatt asked. "Why are we not considering telehealth for that lower-risk opportunity?"
For leaders evaluating where telehealth might fit, she suggested looking closely at specialties with extended wait times, positions that remain difficult to fill, and departments experiencing persistent turnover. "I would look at your service lines that have the longest wait times, or those job requisitions that have been the hardest for your talent acquisition folks to fill," she said. Then she posed a question many organizations may find uncomfortably relevant: "Are your carts and cameras sitting in a closet somewhere collecting dust?"
Listen Before You Redesign
Asked where leaders should begin when a service line is struggling, Ograbisz did not start with staffing plans, technology investments, or financial targets. Her recommendation centered on understanding how clinicians and staff describe the problem.
"Listen," she said.
Then she became more specific. "Listen to your clinicians. Call a meeting, ask the hard questions, ask what's broken, and get it from the source." Operational metrics, patient surveys, productivity reports, and financial measures all have value, she said, but they should be evaluated alongside the people who interact with the workflow every day. "By all means, please use your numbers and your factors and your outcomes and all of those pieces," she said, "but start with your clinician base."
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