Iman Abuzeid, MD, CEO & Co-Founder of Incredible Health, on helping healthcare workers find and do their best work
In this episode, I sat down with Iman Abuzeid, MD, CEO and Co-Founder of Incredible Health. Founded in 2017, Incredible Health, the highest valued tech-enabled career marketplace in healthcare, transforms the hiring process for both nurses and health systems. In August 2022, Incredible Health raised an $80M Series B round led by Base10 Partners. The company partners with over 600 top health systems across the country, has over 10,000 nurses joining its platform every single week, and has reduced the average timeline for hiring a nurse from 82 days to less than 14.
Iman and I discuss:
- Her background in medicine and how she became a startup founder in the healthcare ecosystem
- The current nurse staffing crisis that’s on track to leave the US 1M nurses short by the end of 2023 and how we got here
- How Incredible Health is reducing nurse burnout, improving retention, and empowering hospitals to set up their nursing workforces for career advancement
- Iman’s evolution as a leader and how she has invested in herself and her team to keep up with the company’s growth
Beginning — 7:35: Iman’s background & starting Incredible Health
- Iman’s story: Iman and I began our conversation discussing her upbringing. She’s originally from Sudan and lived in several countries including the UK and Saudi Arabia before immigrating to the US at age 24. She comes from a family of doctors, so she assumed at a young age that she would follow in those footsteps. However, she realized after medical school that although she enjoyed 1:1 patient care, she wanted to make an impact at scale. So Iman decided not to pursue residency and instead went into management consulting. She found that she enjoyed learning about hospital operations and strategy. This was Iman’s first foray into business, and from here, she decided to get her MBA at Wharton. There, she got even more exposure to entrepreneurship, and after school, she moved to the Bay Area to work at an early-stage healthcare tech startup as a product manager. In this role, she worked with software engineers, data scientists, and designers, and learned what it takes to build and scale a healthcare software product. Iman highlighted that in each of these periods of her life, she gained new skills that set her up to be a successful entrepreneur. The other common theme across her career is healthcare. Iman is passionate about the industry and specifically building solutions that positively impact patients and healthcare workers on a wider level.
I would say the common theme [in my career] is healthcare. I am passionate about healthcare…changing the lives of healthcare workers and having an impact on patients as scale.
- Incredible Health overview: Iman shared a detailed overview of her company: Incredible Health is the fastest-growing, highest valued ($1.65B) venture-backed career marketplace for healthcare workers in the US. The company’s mission is to help healthcare professionals live better lives and find their best work. Iman walked through some of the value her platform delivers to various stakeholders:
- For hospitals: hire high-quality nurses in less than 14 days compared to the industry average of 82 days, and save at least $2M per year per hospital location by reducing temporary labor, overtime, and HR costs
- For nurses: enjoy at least a 15% increase in salary and a 15% reduction in commute time, as over one-third of permanent nurses are relocating to a different state
When making matches between nurses and hospitals, the company’s algorithms consider over 70 specialties and 50 skills. Over 600 hospitals nationally, including major health systems like HCA, Tenet, Stanford, Johns Hopkins, and Kaiser Permanente, are Incredible Health customers.
7:35–31:07: Supporting healthcare workers and hospitals
- Nursing shortage: Iman spent a few minutes explaining four main reasons for the current US nursing shortage:
- Although the number of applicants to nursing school is at an all time high, there are very long admissions wait lists because we lack capacity in nursing schools. As a result, we’re unable to produce enough nurses.
- There’s an insufficient number of hospital training programs for new graduate nurses. In an Incredible Health survey, 79% of new nurse respondents reported feeling overloaded or overwhelmed during their onboarding process and noted inefficient training systems as another common challenge.
- A lot of nurses are retiring. Today, the average age of a hospital nurse is 52 years old, and about 25% of nurses are expected to retire in the next three years
- We have a problem with nurses leaving the profession permanently. Annual nurse turnover is at about 20%, and since the pandemic, more nurses are leaving the profession permanently. Over the next 12 months, about 25% of nurses are considering leaving the profession due to burnout and stress.
- Responding to COVID: Iman shared how she and her team had to move very quickly when the pandemic started since it deeply affected both sides of their marketplace — nurses and hospitals. The company’s product strategy evolved rapidly, and they started offering free continuing education for every single nurse in the US so they could quickly get accredited and renew their licenses. They also launched a pandemic hiring suite for employers to allow them to hire even more rapidly and started publishing reports on the state of the nursing workforce using internal data. One of the company’s more recent findings was that 34% of nurses are considering leaving the profession by the end of 2022. Other data indicated vaccine hesitancy among the nursing workforce, which we saw early in vaccine distribution. Incredible Health was the first entity to report on this now well-observed phenomenon.
- Temporary nurses: In response to my question about where Iman sees the temporary nursing trend going, she said that she sees permanent workers as core to the healthcare workforce. 95% of healthcare workers are permanent, and hospitals see temporary workers as truly temporary and to be used in only acute situations. Therefore, in order to best serve its customers, Incredible Health is focused on serving permanent workers. There are three main reasons hospitals prefer hiring permanent workers:
- temporary workers are expensive, costing at least 2–3x more than a permanent worker. This of course eats into a hospital’s bottom line.
- temporary workers can create internal cultural issues. Issues of unfairness arise because permanent and temporary nurses do the same work but are paid different rates.
- Third, quality of care suffers. The more temporary nurses employed, the lower quality of care institutions and patients can expect to deliver.
In summary, Iman sees temporary nurses as a band-aid solution. People find stability in a permanent job, and people crave stability. During the pandemic, the presence of temporary nurses increased from 5% to 8%-10%, but we’re already starting to see this come down as the pandemic subsides.
- Matching technology: I asked Iman to share more about what makes a strong match between a nurse and a hospital. There are two main categories to consider:
- What are the nurse’s preferences? This includes location, professional development, why they’re leaving their current job, and what they want to do next.
- What is the nurse’s actual experience? This includes skills, licenses, certifications, and years of experience.
Incredible Health makes matches based on 90 different data points, and the matching gets smarter and smarter over time with machine learning. What the company originally thought made a strong hire has evolved, and their technology can now predict who will result in a strong hire. For example, they’ve learned that showing the current location of the nurse actually leads to more bias because recruiters paid less attention to nurses who lived further away. This was despite the fact that many nurses had expressed a strong desire to relocate or to be located near said hospital. As a result, Iman and her team have removed elements like current location from nurses’ profiles. She sees these sorts of learnings as a major differentiator for Incredible Health and an important value driver in the market.
- Nurse retention: Iman explained that not only does Incredible Health play an important part in helping hospitals find nurses to hire, but it also helps retain them. It’s estimated that a hospital loses $40k for every nurse they lose, equating to $4-$6M in nursing turnover annually. To help address this, Incredible Health has launched what it calls its nurse retention suite of products and tools. Hospitals that use these have a 15% higher retention rate at the one year mark than ones that don’t. The company has found that the main reason nurses leave their jobs is they’re looking for career advancement opportunities, which could mean a desire to receive more specialized training or move into management. The second most common reason for departing is wanting more flexible schedules. Before the pandemic, nurses usually worked three days a week in 12 hour shifts, and most roles were full-time. However, that’s not what the talent wants anymore. To meet these new preferences, hospitals are offering more flexible scheduling options. Incredible Health is also spending a lot of time helping hospitals keep up with nursing needs such as helping them build up their career development initiatives. Iman is seeing hospitals invest more into training programs, leadership development, and documenting nursing career mobility paths. She’s seen that the ones making these investments are winning in terms of nurse hiring and retention.
- Healthcare worker burnout: Iman shared that she sees the present day as one of the most hopeful in the history of US healthcare because the topic of healthcare worker burnout is receiving real attention. Market forces are also driving change, leading to solutions receiving increasingly more attention. 65% of new nurse graduates report feeling burnout in their first six months of employment, but we know some things work in combating this. Investing more in job training, ensuring that units are fully and appropriately staffed, and having comprehensive career advancement programs can help reduce burnout. Incredible Health has specific features and tools for new graduates to help them get the resources they need. For example, every nurse on the platform gets access to talent advocates who are like career coaches.
- Reaching nurses on social media: Iman explained why social media platforms like TikTok are critical parts of Incredible Health’s strategy: it’s where nurses, especially the younger generation, spend their time. Being present there and an active part of the conversation has become a competitive advantage for the company. Also, hospitals have very strict marketing policies, so they can’t do the level of creativity that Incredible Health can on social media. Iman further clarified that social media is not just about marketing, but it’s also a place to educate and share information. She concluded saying that any tech company with a consumer bend must make social media a facet of their business strategy.
31:07–37:43: Incredible Health’s future
- Expanding to new healthcare roles and institutions: Iman reiterated that Incredible Health’s vision is to help healthcare professionals live better, and its mission is to help them find and do their best work. In order to define the category and be the market leader for all healthcare labor, they have to operate in all segments of healthcare. The company is taking a very focused approach to growth. In the next year, it’s focused on geographic expansion. After that, Iman wants to support more healthcare roles beyond nurses — doctors, physical therapists, respiratory therapists, etc. — because there are many different healthcare professions that can benefit from a product like this. Institution-wise, beyond hospitals, Incredible Health can partner with urgent care, surgical centers, skilled nursing facilities, and more. The ultimate goal is to take it all. Iman also shared that the company’s goal is to IPO, but it has to be very systematic and focused in its growth to do this successfully.
- Product development: Iman shared that when thinking about product expansion to other roles and settings, a lot of facets of the current product and customers are generalizable. Desire for career advancement, work-life balance, and higher pay are quite prevalent among all healthcare professionals. On the employer side, the financial toll healthcare facilities face as a result of staffing shortages is also a fairly universal experience. Therefore, free continuing education, salary estimators, and the platform’s community element can be used to support other healthcare roles. However, despite similarities across healthcare roles, there are also nuanced differences. For example, the requirements for matching and screening will vary by role. Therefore, the company plans to do additional R&D work to figure out what works best for each role and employer type.
- Building a profitable business: Iman shared that Incredible Health is cash flow positive, and she emphasized the importance of having a well thought out financial strategy in driving overall success for a high-growth startup. It’s essential to figure out the business’ unit economics early on as opposed to delaying it until later. Unit economics that work are the basis for building a generally profitable model. The way a company structures its enterprise agreements also matters. For example, Incredible Health receives upfront payments, which help with cash flow.
37:43 — End: Founder experience
- Leadership style: Iman described her leadership style as direct and transparent. She is a systems thinker and tries to understand the underlying problem before crafting solutions. That said, her leadership style has evolved over time. In Incredible Health’s early years, she felt like she was operating more like a COO than CEO because of her orientation to tasks and details, but as the company has grown, she has had to focus more on leveraging the vision and mission to communicate with her team. She also feels that her job changes every two to three months. After all, in the last five years, the team has gone from two to 200+ employees and experienced more than 400% revenue growth last year. Running this size of company requires a completely different set of skills, so she’s invested heavily in her professional development, including career coaching and mental health support.
My leadership style at its core is very direct and transparent, almost to a fault…I’m much more of a systems thinker…trying to understand the underlying problems before we start crafting solutions. And that’s really what drive teams and leaders towards as well.
- Building a growth-minded culture: In response to my question about how Incredible Health is building a culture where employees feel supported and fulfilled, similar to how the company supports nurses and their hospital partners, Iman shared that the company’s values are its operating system. They define how people work together and make decisions, who’s hired, and are a part of onboarding and performance reviews. One company value is customer obsession — what can you do to delight users — and another is speed, to move as quickly as humanly possible — which is a key competitive advantage for a high-growth startup. Acting on these values has been critical to retaining the team and attracting top talent.
For those that are considering starting a digital health company, please realize and appreciate that the number one most important thing you’ve got to figure out is your business model…It’s not your product. It’s not who your team is. It’s not all these other aspects, which are important too, but your most important is your business model.
- Advice for starting a company: According to Iman, the number one most important thing the founder of a healthcare technology company needs to figure out is the company’s business model. Early on, this is more important than the product and team. US healthcare is convoluted, especially when it comes to how the money flows, so deciding how you’re first going to make money, and then figuring out a product that’s at least 10x better than anything else that’s out there is absolutely critical.