Creating a Better Way to Hire Nurses: Dr. Iman Abuzeid, Co-Founder and CEO of Incredible Health

Dr. Rishi Desai: Hi, I'm Dr. Rishi Desai. The U.S. was facing a shortage of 1 million nurses before the pandemic, a problem that's likely to get worse given an expected exodus of nurses from the profession over the coming year. Now as they scramble to find permanent replacements, a growing number of hospitals are turning to a hiring platform called Incredible Health, which matches their needs with the right nurses and basically shortens the hiring process.

Dr. Iman Abuzeid, the co-founder and CEO of Incredible Health, is here today to explain how the system works and to discuss her take on healthcare workforce challenges emerging from the pandemic. Trained as a physician, she transitioned to a career in product management at health tech startups before launching Incredible Health in 2017. Thank you so much for being with us today.

Dr. Iman Abuzeid: Thank you so much for having me.

Dr. Rishi Desai: Your background is fascinating. I'm curious to rewind a bit and learn what got you interested in medicine in the first place.

Dr. Iman Abuzeid: I'm from a family of doctors. I think that's what gets a lot of us interested in medicine. Both my dad and my two older brothers are surgeons, and they all still practice. So when it was time to figure out what to do, I was like, "Okay let me just do what they did," and went into medicine. 

During med school, I realized that one-on-one patient care—it's great, it's wonderful. Working as a doctor is a great career. But I really wanted to have an impact on a larger scale, and that was hard to do with just one-on-one patient care.

That was one of the reasons I eventually transitioned to technology. Because the amazing thing about technology is you can write some code and it can have an impact on hundreds of thousands or millions of people. I always strived to have a bigger impact after med school.

Dr. Rishi Desai: Was that change—moving from the clinical side to the business side of health care—was that difficult or was that challenging in some ways?

Dr. Iman Abuzeid: Well, it was challenging in some ways and my dad wasn't super thrilled with my decision. But the actual transition itself wasn't too bad. I went into management consulting as a next step after medical school, doing operations and strategy at places like McKinsey. Then I did my MBA out at Wharton, at UPenn in Philadelphia, which was a great experience and got me even more exposed to entrepreneurship. Then I moved out to the Bay Area and that's when I got into health tech startups.

I joined an early-stage healthcare technology company as a product manager, and that's where I learned to work with software engineers and data scientists and designers, and what it takes to launch a software product and grow business in healthcare and in health tech specifically.

Dr. Rishi Desai: So I'm curious: You obviously went through medical school, you got an MBA, you've been working with startups and you spoke about coding. You basically had to learn, maybe three, four, give, six times as much as you initially set out to learn to get your MD.

What has it been like learning a whole new vertical from scratch not just once, but multiple times in your professional journey?

Dr. Iman Abuzeid: That's a great question. Honestly, it's very exciting to me and very motivating to learn and to grow skills. I often say that there's usually only one of three things you can truly optimize for in your career. Number one is cash. Just run after cash as much as you can. The second is skills and learning. And then the third is lifestyle. Each job only truly optimizes for one of those, and you're going to compromise on some of the other two. 

I think I'm someone who really thrives and optimizes on skills and learning. High growth startups and early-stage healthcare technology really optimizes for that and that's something that I pursued, and it is very motivating for me.

Dr. Rishi Desai: I've never ever heard it laid out that way. Let me see if I got this right: Money, skills and learning, and the third category was lifestyle. Is that right?

Dr. Iman Abuzeid: Correct. So if you want lifestyle, you should go work at Google or a big company where you're clocking in and clocking out, 9 to 5. But it's really 11 to 3 when they're actually doing real work. So that's optimizing lifestyle.

Cash is some of the finance professions. To some extent, some of these larger public tech companies too. But you're absolutely going to compromise on skills and learning because they're just not moving as fast, right?

And then the third category is skills and learning. If you start a company or if you join an early-stage company, you're absolutely optimizing for skills and learning.

Dr. Rishi Desai: So I'm imagining a lot of the HR folks in the audience perking up their ears, specifically the ones at Google. But I'm curious to know, when you hire, how does that fit into your hiring set of questions? Like what kind of folks do you like to hire at Incredible and how do you suss out people that are like-minded and want exactly what you just said - - skills and learning?

Dr. Iman Abuzeid: It's a great question. We have a very clear set of values at Incredible Health that we documented and wrote down when we were just two co-founders, frankly. We're now a team of 65 and growing. The values are really the operating system of the company, and they're how we work together. They're also certainly part of hiring, they're part of employee onboarding, they're part of performance management too.

And just to name a couple: One of them is commitment to learning. Does that individual have that intellectual curiosity? Are they committed to learning and continuing to improve? Another one is customer obsession. Do whatever you can to delight customers. Everyone is accountable to that value, even if you're not in a customer facing role. Another one is speed: Move as quickly as humanly possible. One of the main competitive advantages you have as a start-up is you can move faster than anyone else in the market. So those are a few examples of some of the things that we're evaluating and we design interview questions to assess several of our company values.

Dr. Rishi Desai: Now walk me back. You mentioned you're a co-founder. You and your co-founder at some point -- I'm just imagining you sitting in a coffee shop or an apartment or whatever -- and thinking about this problem that you see in front of you. Describe that problem to me and how you and your co-founder thought that Incredible Health might be a good solution.

Dr. Iman Abuzeid:  My co-founder is Rome Portlock. He's a software engineer, went to MIT. The way we thought about this is, as I mentioned, a lot of my family members and a lot of my friends are practicing doctors, surgeons and they were often complaining about understaffing. These complaints have been going on for years and I'd hear them in family conversations and so on.

At the same time, Rome Portlock has several family members that are nurses, and they were saying "I'm experienced and I'm qualified, and I apply a 10, 15 places—I usually don't even hear back. And if I hear back, it takes several months." And we're like, "Okay, this doesn't make any sense." 

Healthcare is the biggest labor sector in the country. It also is the labor sector with the biggest shortages, as you mentioned at the top of this show. That doesn't add up. People should be hired very rapidly and very efficiently. Once we dug into it, we realized that the technology, the processes, the tools that hospital and health systems and the healthcare industry in general uses to hire just hasn't really changed since the late '90s. We figured there has to be a better way—a faster more efficient, more scalable way to hire and that's how Incredible Health started.

Dr. Rishi Desai: I can imagine a less ambitious duo saying, "Well wait, you have a nurse in your family. My family members were looking for help. Let's just introduce them and call it a day." Instead, you built this incredible platform. What is the experience like for nurses that use your platform? What is their day-to-day experience?

Dr. Iman Abuzeid: Great question. Incredible Health—we're the fastest-growing venture-backed career marketplace for healthcare workers in the U.S. today and our mission is to help healthcare professionals live better lives and help them find and do their best work. We care deeply about the experience that healthcare workers are having on the platform. And we are starting with nurses. For a nurse on this platform, when they create a profile on the Incredible Health site, they sit back and relax. It's the employers that are applying to them instead of them applying to the employers.

As you can imagine, the nurses absolutely love that experience, right? Because you don't have to do very much. It's employers coming to you, instead of you consistently applying, and so on. You can see a lot our reviews on Facebook and Google. They're publicly available, and you can see the candidate experience on the platform is phenomenal.

Essentially, they can get their job in 20 days or less. I think our platform average right now is 13 days. We're talking about a permanent job, with benefits and so on at a top employer in the U.S. So, it's really a fantastic experience for nurses.

Dr. Rishi Desai: So let's say a mean of 13 days or median of 13 days, right now, for a nurse to get a job with benefits. What was the state like, prior to 2017, prior to Incredible? What is the state of affairs for that same metric off of the platform? What does your average nurse have to deal with?

Dr. Iman Abuzeid: It takes 80 days on average to fill a permanent nurse position in the U.S. today—particularly one that is specialized or experienced. That is just too long. A lot of that has to do with the fact that there is a shortage, right? The competition for talent is very intense. But there's also a great deal of inefficiency and there's three key things that we do to really eliminate that inefficiency.

Number one, we have the employers apply to the talent instead of the other way around. Number two, we've automated the screening of the talent. We've integrated with databases and APIs and so on, to ensure that we are pre-vetting and pre-screening all talent on our platform and serving up very high-quality talent to the employers.

Then the third thing is our custom matching algorithms. For every employer we work with, we are creating customized matching algorithms. Let's say you are a recruiter at Johns Hopkins, right? Or Stanford Healthcare. You login, and you don't want to see 100 nurses. When you log in, you only want to see, you know, 10 or 15 that are the exact right fit for you for what you're looking for at that time.

Same thing for a nurse. Let's say you're a highly sought-after I.C.U. nurse or O.R. nurse. You do not want to hear from 100 employers. You want to hear from four or five that are the exact right fit for you. That's what the custom matching algorithms enable. They're enabling a highly customized experience. The end result of all that is hiring happening, guaranteed, in 20 days or less instead of 80 days or longer. On average, we are saving every single facility at least $2 million because they are able to hire faster instead of spending on contract workers or on overtime or on HR costs, frankly, because their units are understaffed.

Dr. Rishi Desai: Yeah, that makes a lot of sense. I kind of jokingly mentioned our HR folks in the audience perking up. But it sounds like what you're essentially doing is creating a mechanism by which HR is centralized instead of having to be redone at each hospital and oftentimes done not as effectively or maybe as efficiently. Is that right?

Dr. Iman Abuzeid: That's exactly right. It is HR teams and nursing leaders that are the end users of our platform. And yeah, they're very busy too. They're understaffed themselves. The average nurse recruiter at a hospital is trying to fill anywhere from 80 to 120 jobs at any given time. That is very, very difficult to do if all you’re armed with is just a job board and you're sifting through all these applicants manually.

The benefit of Incredible Health is we're automating the screening and the matching. It is saving a considerable amount of time and effort for these HR teams to hire in a scalable manner and in a much faster way too.

Dr. Rishi Desai: Of course, you had a lot of growth before COVID hit. Now that COVID is here, I'm curious how it has affected your business model?

Dr. Iman Abuzeid: COVID has really accelerated our business. I mean COVID has been terrible for the U.S. Healthcare System. It's also been terrible for healthcare workers, which we can talk about in a moment. But for us as a company it has accelerated us and what we've seen is very dramatic growth. We just hit a milestone recently, actually: 60% of the best hospitals on the U.S. News & World Report list use Incredible Health.

We've seen very rapid expansion across 14 states, where we're live. We'll be in 18 states in a few weeks. We'll be in the entire country by early next year. We work with over 350 hospitals and health systems across the country now, including top ones like Johns Hopkins, like HCA, Stanford, Kaiser Permanente, Cedar Sinai, and many others. 

We’ve also seen very rapid growth in our revenue. Some metrics I can share: In the last 18 months—so this is looking at pre-COVID—from fall of 2019 until today, we've seen 1,000% increase in our revenue. We've seen an 800% increase in nurses joining our platform, and a 500% increase in nurses finding jobs on the platform too.

Dr. Rishi Desai: Wow, it's hard to even wrap one's head around 1,000% increase. Did you expect that with COVID hitting? Or is this sort of like, you saw that growth happening anyway and then COVID really didn't slow it down? I'm curious if the fact that there was more need meant more people turned online to staff these positions, or was it kind of happening anyway?

Dr. Iman Abuzeid: There were a few things that were happening all at the same time when COVID hit. I think initially when COVID first impacted the U.S. in say, March 2020, we saw hiring slow down, right? A lot of surgeries were canceled, and hospital executives just didn't know what to expect and they just sort of froze everything. But within a matter of three months or so, it all came back and in fact, it came back with a pretty intense backlog that they needed to fill.

So we've seen a few trends happen in the last 12 months, and we've published a lot of this data. We published a COVID-19 study, both when the pandemic first hit in March 2020, and did a study again in March 2021 to see what the impact was a year on. First, we've seen record-breaking levels of nurse turnover, which is not good. Before COVID, the national average for nurse turnover was about 18%. It's now gone up to about 21%, as nurses are leaving the nurse workforce, permanently in some cases, taking advantage of things like early retirement. They've also seen record levels of fatigue and burnout and so they've just quit the profession permanently, which is not great. The other thing that has happened is demand for nursing has increased on our platform by, gosh, close to 200% and in certain specialties like ICU and OR, it's been even more than that.

What's driving that demand for nurses is not just COVID. Our demand for healthcare as a country keeps going up. Our population is aging, and the demographics of the country are such that the demand on the healthcare system keeps going up, and our supply of workers is simply is not keeping up. Those were some of the key differences that we've seen and I'm happy to chat more about the intense levels of stress, anxiety, and depression, that health care workers experienced during the pandemic that also contributed to the turnover.

Dr. Rishi Desai: You know, you've spoken obviously very eloquently about nursing. I'm curious if Incredible is planning to move into allied health professions—other segments of the healthcare field?

Dr. Iman Abuzeid: Yeah, we do have plans to. Our goal is to be the category-defining, market-leading company in healthcare labor. The truth is, we want to take it all, eventually. But you have to be very systematic and focused when you're growing a high-growth startup because you have to ensure customer delight the entire time.

So, we're very focused on nurses and acute care hospitals and health systems right now. We probably won't start adding allied health professions and doctors until next year, likely in 2022 and beyond, because we really want to make sure this is a phenomenal experience for nurses on the platform as well as acute care hospitals and health systems.

Dr. Rishi Desai: You know, we're a teaching company, and we love to fill knowledge gaps. Obviously, you've worked across so many different industries and sectors. As you've worked across these different industries, have you seen any interesting pieces of miscommunication or misunderstandings between industries where -- because you've been able to sit at so many different tables -- you are able to act as a translator for maybe, medicine to business, or business to tech? Anything along those lines that you would be able to illustrate for us?

Dr. Iman Abuzeid: Yeah, absolutely. I think one of the superpowers you can have as a founder—especially a founder of a high-growth startup—is you can connect the dots. And connecting the dots can be, like you mentioned, connecting the dots between industries. Some of the inspiration around the Incredible Health product itself in terms of how we differentiate ourselves is very heavily influenced by tech.

I mean the other group of workers in this country that is highly sought after is software engineers and there are models out there for software engineers that inspired us, that we can use and apply to health care workers as well. For example, employers applying to the talent, instead of the other way around, right?

Another thing that we've really looked at and benefited from is the composition of our team. The benefit of having our entire product and marketing team—like all of them—not come from healthcare backgrounds. They come from fintech. They come from transportation tech. They come from e-commerce and social media, and so on. We've really benefited from having the diverse background of our team, because what those team members are doing is they're pulling best practices, insights, from other industries and applying them to healthcare. That's been a huge benefit to us as well.

Dr. Rishi Desai: That makes a lot of sense. There are so many students and early-career health professionals in our audience, and they're probably listening to you and thinking, "Oh my gosh, what an amazing journey, how in the world would I emulate that?" Or "how could I do something similar to that?" What advice would you give to a student coming out of clinical practice today?

Dr. Iman Abuzeid: Probably the number one thing is the world is your oyster. I mean the amazing thing about living and working in the U.S. is the amazing range of opportunities that we have at our disposal. If you are willing to work hard and you have a certain set of skills—like healthcare or medicine being one—your options are actually quite wide. Always consider multiple career opportunities, and think clearly about what it is that you want to achieve from your career.

I mentioned at the beginning how I just wanted to optimize for skills and learning. I also have a value—it's just an opinion—that entrepreneurship is the epitome of what you can do with a career in business. Now, you might have other values and other goals. So, think clearly about what those goals are—your personal goals for your career—and then work backwards: What are the steps that you need to take to in order to get there?

The other thing is just to acknowledge and understand that it is a long journey. It does require an intense amount of work. From the time I decided, "Hey, I want to start a business one day in health tech," to the time when I actually did it: That was like a 10-year span of collecting not just skills, but also growing my network, relocating to the right location, and so on. So just acknowledging that it's a journey and it's a process, and there's no such thing as immediate gratification, frankly, is pretty important. One other thing I want to mention, that's related to the topic you mentioned earlier around connecting the dots between industries is: We need to understand that the world we're operating in is evolving so rapidly. There's a breakdown happening between industries.

I'll give you an example, just from Incredible Health. In our early days, we were the place where a nurse finds his or her job. We've evolved to be the place where they manage their career. What that means for us is we offer things like free continuing education for every single nurse in the country, completely for free. That's accredited in all 50 states, which they need to renew and activate their licenses. We offer things like free salary estimators. We have a community for nurses embedded in our iOS and Android apps where they can get advice from each other and it's an exclusive community just for nurses.

The way we're looking at this is: How can we have a career-long or lifelong-relationship with healthcare workers that's not just restricted to the hiring product itself? That could be things like education, like community, and like social media, so on. You can start to break down these artificial boundaries in order to create an amazing experience and to drive a lot of value for users.

Dr. Rishi Desai: That makes a lot of sense. And I think, based on just hearing you speak, it's very clear that you care so deeply about the user experience on your platform and thinking critically about what they want and need.

Dr. Iman Abuzeid: Absolutely. I mean, you're a doctor as well. Healthcare workers, they're some of the most overworked and underappreciated workers in this country. Hands down. Whether they’re a doctor, a pharmacist, a nurse, a physical therapist, whatever. They are working crazy long hours and they are usually very underappreciated, compared to other industries like tech for example.

I want our product and our service and our company overall to be creating delightful experiences for this group of workers, because this is not what this group of workers is accustomed to. They don't have lots of amazing products that are delightful. It's actually a very, very narrow set. If you can just achieve that, then I'm happy.

Dr. Rishi Desai: And probably your family as well, since they're all in the field, and probably have found delight in your product also.

Dr. Iman Abuzeid: Yeah, absolutely.

Dr. Rishi Desai: Well listen, thank you so much for sharing your story—what an incredible journey you've been on—and for sharing that wisdom with us.

Dr. Iman Abuzeid: Thank you so much for having me. This has been fun.

Dr. Rishi Desai: I'm Rishi Desai. Thanks for checking out today's show. Remember to do your part to flatten the curve and raise line. We're all in this together.