In this episode of the Russo Edge, Scott Becker, founder and publisher of Becker’s Healthcare, joins host Solomon Wilcots to explore the new realities shaping hospitals and health systems across the country. Drawing from daily conversations with executives on the front lines, Scott offers a clear view of how they are navigating a more complex, resource-constrained environment while continuing to deliver patient care at scale.
Solomon Wilcots: Welcome to the Russo Edge. I’m your host, Solomon Wilcots. And today we’re taking a closer look at the forces putting pressure on hospitals and what they mean for companies trying to grow alongside them.
Joining us is Scott Becker, founder and publisher of Becker’s Healthcare. Scott has a sharp view into the forces driving hospital decision-making from reimbursement and insurer behavior to access, staffing, and the broader business realities facing the system. He also brings the perspective of someone who has built businesses, invested across healthcare, and watched the system evolve from multiple angles. Most of Scott’s work sits on the provider side of healthcare, where he closely follows industry trends, hospital pressures, and the business realities shaping the system.
Scott, welcome to the Russo Edge. Great to have you on with us today.
Scott Becker: Solomon, what a pleasure to visit with you. You’re one of my heroes. I’m so excited to be here and a huge fan and excited to talk about healthcare and all the things we’re seeing in healthcare. So, thank you so much for having me.
Solomon Wilcots: Well, thank you for taking the time. For our listeners, let’s inform them a little bit who may not know some of the things that you’re going to give us, such as maybe the quick version of what you do and how you found your way into healthcare.
Scott Becker: Scott Becker, I’m a publisher of a set of media properties called Becker’s Healthcare. At Becker’s Healthcare, our core audiences are hospitals and health systems, health IT, then we’ve got areas and lines around payers, around pharmacy, lots of others.
We’ve got our big annual meeting coming up in April where you’ll have President Bush speaking, Mark Cuban speaking, Fernando Mendoza, the recent Heisman Trophy candidate. Troy Aikman. [Note: Becker’s 16th Annual meeting was April 13-16, 2026] We’re heavy this year on Texans and athletes as keynote speakers, but we also have thousands of healthcare executives there trying to get a sense of what’s going on in healthcare right now, where are the opportunities, what are the challenges, and more. And just a fantastic networking event where we’ll have five, six thousand people there to visit about all things healthcare.
So, Solomon, thrilled to be with you. I started back to healthcare like 30 years ago, and we’ve grown into a great team and a great audience. Great audience and you got to love it.
Solomon Wilcots: You have a great list of speakers and a lot of informed people who are helping our audiences have a greater understanding of what’s taking place in healthcare now I know you talk with leaders across the country every single day. So, what vantage point does that give you maybe that other people are missing?
Scott Becker: No, I think the job of sort of leading major health systems today is just a complicated job. You’ve got relatively fixed reimbursement going up just a little bit at most. You’ve got expenses that are going up. You’ve tremendous staffing challenges. There’s a huge shortage of nurses and doctors in our country. We’re doing a much better job on accelerating the development of nurses.
But on the physician side, we’re way, way behind. You’ve got the adoption of technology in different places, trying to figure out how that fits into the ecosystem. Leverage technology you’ve got this great challenge trying to leverage great talent and great technology to improve healthcare. I had a chance last week to sit down with the CEO of the largest not for profit faith-based system in the country common spirit as well as the chair of the long-term CEO of The American Hospital Association. And just a constant sort of reimbursement. Pressures. With inflation pressures-at the same time lots of change. But a lot that’s really going great as well.
The Biggest Pressures on Hospitals
Solomon Wilcots: If you had to name Scott, maybe three, two or three factors putting most of the pressure on hospitals today, what would they be?
Scott Becker: Yeah, I think you’ve got this incredible supply-demand challenge where not enough physicians to staff hospitals. When you see throughout the country labor and delivery units closing, and you’ve seen 30 or 40 of those close down in the last year, that’s not because hospitals want to close those down. It’s because they can’t staff them well to ensure that they can do deliveries well. And that part of it, that supply and demand, OB-GYN is just one small example of it. But supply and demand is throughout the country. You’ve got a million physicians or so, 350 million people in our country. The numbers increasingly don’t work with an aging population. I’d say that’s one.
Second, you’ve got the large-scale efforts to adapt artificial intelligence and technology into the workflow and try and figure out how we better leverage sort of talent so that we can deliver care to the 350 million people and aging growing populations. You’ve got that. That’s the next thing is the implementation of technology.
The third thing is in healthcare; we’ve always talked about what is known as the triple aim, this concept of quality, cost and access. And in some ways, access is more and more challenging. And really for the reason we’ve said, supply and demand, just not enough people to take care of people and not enough in the specialties to take care of challenging patients. Cost is absurd. We’ve got about $30,000 for a family of four for cost. Average family in America makes $70,000, $80,000. Those numbers just don’t work. And then quality, it’s very hard to keep quality up when we don’t have enough access, and costs are going through the roof, where there’s not enough doctors.
What you’ve got is more people are going directly to the telehealth providers on these things. And it takes a huge burden off the system that people are going outside of the traditional system to get their drugs, to get to their medicals, with their GLP-1s, all kinds of other pharmaceuticals, all kinds other care.
So, you know, quality is sort of bending in the wrong direction, costs not going in the right direction. And when the access is challenging, so we look at those things, those things are constantly in the minds of healthcare leadership. And healthcare leadership does a great job of sort of with all this noise, all these challenges playing through and trying to make it all work and deliver great care to our nation.
Why Access to Healthcare Is Still Getting Harder
Solomon Wilcots: Yeah, you just talked about having access. When people, Scott, tend to think about access, they do so and they think about it in terms of where care is available. But it is also about whether patients can get to the right doctor at the right time when they need that help. So how should leaders be thinking about access today?
Scott Becker: Those days are really coming to an end. There’s just not enough primary care to provide primary care how we did it a generation ago. The good news is there are a million different workarounds today and that people are starting to access. For example, if people had to go to hospitals and health systems for the primary care doctor for GLP-1’s today, for the other medications that you could outline, those doctors would be just swamped. What you’ve got is more people are going directly to the telehealth providers on these things. And it takes a huge burden off the system that people are going outside of the traditional system to get their drugs, to get to their medicals, with their GLP-1s, all kinds of other pharmaceuticals, all kinds other care.
The second thing is emergency departments again are totally packed, and we’ve got more people moving to urgent cares and other access points just as the emergency care system just gets overwhelmed.
The third thing is on the specialty system; we have this debacle because while there are substitutes for primary care physicians, it is not ideal. We all prefer having our primary care doctor, but people are doing a fantastic job between the mix of ChatGPT and PAs and nurse practitioners. But what you cannot replace is when you’ve got a rare form of cancer, it is very hard to replace that and that is needed for the clearest, cleanest diagnosis, the clearness, cleanness care platform and planning with a PA, just very hard to do. We’re just not there.
And so what you see is, and I’m of the age where you have more and more friends that are dying of different types of cancer, and you find that bench, even at the greatest health systems in the country, in terms of rare forms of cancer or in terms just general oncology, is much less deep than we’d like it to be. I mean, you’re a former football player. It’s like going into a game with one quarterback and nobody on the bench. Increasingly, that’s what you’ve got. You’ve got a receiving corps that’s only got two oncologists on it. You know, you need four, so your quarterback’s got choices.
Washington, Policy, and the Supply Problem
Solomon Wilcots: Well, it’s good stuff. And I mean, you have some good answers for access and some of the challenges that exist in that area. Now from Washington, what should the industry be paying attention to right now? And what out there serves as a distraction that represents mostly.
Scott Becker: Sure, sure. So, Washington is really fixing healthcare. I think it’s been largely broken for a long time. And that’s on the right and the left. So, we’re not taking shots of the Republicans, not taking the shots of Democrats. On the Democratic side, they often say, we need coverage for all. And coverage for Medicare for all is a great platitude. And I quite frankly don’t disagree with it. And most of us want to see everybody have coverage. But talking about coverage for all. Without talking about the supply problem, it is literally like writing a check you can’t cash.
On the other side of the equation, they talk about letting the free market fix it. And again, the reality is the stupidest political slogan I saw a few years ago was to get the government out of my Medicare. And the reason I say it’s so stupid is, Medicare is a government program. That’s right. Half of all healthcare today is governmental, when you include Medicare and Medicaid. You really have a mixed system. It’s not. Not truly capitalist, not truly this, not really that. The government is a huge part of healthcare and it’s not going to change. And so, what you see on both sides is Washington’s sort of broken. They’ve got to focus on the real problem. How do we fix supply and demand?
When I saw a couple of weeks ago, Congress grilling the payer CEOs, the payer leadership in D.C., you’ve got really two groups, Congress and the payers, that have created a tremendous amount healthcare inflation. By pouring a tremendous amount of dollars through the payers, then you’ve got the Congress yelling at the payors about it, but the payers are really responding to a problem that they and Congress created jointly. And that has led to tremendous healthcare inflation as well.
So, Washington’s somewhat broken on healthcare. The best CEOs that I talk to, day in and day out, do a tremendous job of trying to filter out the noise of Washington. You can’t avoid it and everybody’s got big political arms even at huge health systems whether it be AHA or indirectly, but the best CEOs really do a fantastic job of focusing on okay how do we take care of the population we have today? How do we provide better care? How do you make sure we’re doing great quality? And they’re really mission focused and they’re able to filter out some of the noise because the noise is overwhelming. I mean the amount of noise out there is overwhelming and having to constantly come and focus on what can you and not do.
Solomon Wilcots: Really great answers. You shed light on some of the problems that exist in the space. Before we get to the buying process, how are reimbursement pressures and tighter hospital economics changing the way leadership teams are setting their priorities?
Scott Becker: Yeah, I think systems are getting better at being intentional and focused. And, you know, if I look at the old days’ General Electric (GE), when GE was a great company and not a knock-on GE. But when they were a great company, they did this really good job of periodically culling the number of vendors they worked with and being less and more intentional and less opportunistic.
And so, when I look at great leaders, they do a great job of saying. Okay, we really want to improve our surgery line. We’re really going to invest money in that area. We really want it to become great in orthopedics. So, we are going to hire a bunch of orthopedists and make sure they’re well equipped for what they’re doing. I mean, you see so much of the building today in health systems around oncology, orthopedic, cardiovascular, and being very intentional about whether it’s a device, whether it is new pharmaceutical improvements, about where they’re going to target their efforts and where they are going to focus their efforts. It’s much like everything, when you get a system or leadership that’s willing to try every new thing, every new module, every app, this may sound good theoretically, but it’s a horrible strategy.
And the ones that are doing really well are just very, very intentional about their supply chain, they’re very intentional with their vendors and how they work with their vendors, how they’re trying to work with best in class, but not also be working with 3,000 different vendors, but I would say intentionality is a big part of it.
What Emerging Companies Need to Prove
Solomon Wilcots: Wow, really good stuff. And when a large health system evaluates a new partner or even a product or technology, what has changed most in the buying process itself?
Scott Becker: I think when I look at what’s changed most is that at the end of the day, the sophistication of buying compared to where it was. For example, in the old days, you worked with a single hospital that had a buying person and might have multiple different buying people. They might have someone buying in this service line, in that service line, and in that service line.
Now, big systems are much more organized. You’re going to go through a procurement system. If you’re selling into a system. The larger the system, the longer the process, the more complicated. And so, you do have so many companies trying to build first round small, midsize customers and health systems versus the large ones. But I think the thing that changed the most is the sort of sophistication, the complexity, the filtering, the trying to keep people out versus keep people in. But, and so you have to be, it’s still even with all that, very relationship driven. Yes, there’s a lot of electronics and technology involved in buying but still is very relationship-driven. And the same thing as always, people don’t want to buy, even if you’re a $40 billion system, you don’t let 4,000 different vendors if you could avoid it, you want a handful.
Those relationships become very important. And if you want to go deep with systems, you need to have deep relationships. But I’d say the biggest thing, to go back to your question, Solomon, is the intentionality and the sophistication of buying and deciding who to partner with and who you’re going to work with.
Solomon Wilcots: What does a hospital leadership team need to hear now? Or maybe what do they need to know from a newer or a smaller company before it takes that relationship very seriously?
Scott Becker: Yeah, I think what happens is it’s a great, great question. And I think it’s very much not too different than how it’s always been, is that at the end of the day, if you’re a small, mid-size company, you’ve got to develop champions within that system that are very excited about what you’re doing and really see it as a difference maker and worth making an effort to do so. And a lot of that is you talk about everything we do, you could do all the advertising you want, and you could do all the things you want to do.
But someone’s got to buy into this is a solution that really makes sense for this system and somebody that in that system has really got to champion it. And at the end of the day, you can do a million different things, but it really does still come back to is there someone at the system that’s really excited about what you’re doing and willing to test it, willing to talk about it, willing to look at it.
if you’re a small, mid-size company, you’ve got to develop champions within that system that are very excited about what you’re doing and really see it as a difference maker and worth making an effort to do so.
And I don’t think there’s a lot of shortcuts. I think at the end of the day, everybody and their brother says that I have a pilot. I want; can you just get me into a hospital? Hospitals don’t want to pilot things for free or not because its resources, time and energy. And you know, so many people have a great idea, but you’ve got to have an idea that’s impactful enough that people see a clear use case on and it’s got to have a champion in the system. Someone’s got to see this is really of benefit to what we’re doing.
Solomon Wilcots: Scott, if you were advising a smaller company trying to break into a large healthcare system today, what is the first move you would have them make and what are some of the mistakes that you would want to kind of caution to make sure that you were able to get those things out of the way?
Scott Becker: Sure, no, I think it’s a great, great question. I think what happens is, generally, most sophisticated systems don’t want to work, don’t want to be the first at something. They don’t want to be the first of something. So really, typically, if you’re building something, you’ve got to get some customers, somebody that’s using your product, your system, whatever you’re doing, somebody’s got to be using it.
That often starts, even the hugest venture capital funds have turned to this concept. We’re often going to have to start with small and mid-sized customers while you’re really developing relationships with larger systems. You have to sort of do both at the same time is get yourself out the door, get going, and be talking to large systems. The other thing is there are ultimately very few shortcuts to actual one-on-one conversations.
What to Watch in the Next 12 to 24 Months
Solomon Wilcots: That proof of concept is always good, particularly when you have people you work with who can attest to it. As you look ahead, Scott, to the near future, say the next 12 to 24 months. What should the industry be paying close attention to?
Scott Becker: Yeah, no, I think the industry, and it depends where you’re talking about, sort of the life sciences industry, the device industry, the biotech industry, selling into health systems, that sort of is, they have to know their use case better than anybody else knows their use case so that they can talk about it with systems, talk about with people. I mean, a lot of it comes down to, we think the best, best businesspeople really know their own business well. When I think about a case where we were on the phone recently with a company that has a good product and can’t quite explain their use case to a system as to why their system, why a health system really needs this product. And that’s a very tough spot to be in because if you can’t understand it yourself, why this is a great benefit, then someone buying from you is going to have a very hard time understanding why this was really useful, it really moves the needle.
Then from a health-system perspective, I think the health system leadership, a lot of us in our country, is doing a tremendous job of trying to stay focused on care delivery. In a very challenging and changing time. You know, there’s so much noise coming out of D.C., so much out of the payers, so much noise about changes and reimbursement, but I think health system leaders are doing a remarkable job of staying focused on the core of what they do in a challenging time.
Solomon Wilcots: Before we let you go, what area do you see may be the most reason for optimism? Where can you point us to and say, wow, this is something to really get excited about?
Scott Becker: Yeah, I would say I point out a couple of things. First is, we did this incredible job the last couple of years as a nation, not me, but the nation of improving the acceleration of how we develop nurses and nursing talent. We’re creating 200,000 nurses a year today. We’re moving through the pipeline. They’re starting it a year now. And that’s an amazing improvement from a few years ago when we were a million short nurses. That’s an in fact, there’s an article in the Wall Street Journal today or yesterday about nursing is the new route to prosperity in the country. It’s sort of the new middle class, instead of being an auto worker from a generation ago, people are nurses, but that’s an amazing thing.
The other thing that I think that is optimistic and the beauty of healthcare, Solomon, every one of us is a consumer. We sort of see these changes ourselves, but in the old days I had to go to the doctor because I wanted to get this medicine or do this or do that. Now a lot of that stuff’s low-hanging fruit and I’m either getting it on telehealth or I’m getting it from urgent care, I’m getting it someplace. And this does a huge amount to take the burden off some of the systems. The system has been overburdened. The ERs are overburdened; the doctors are overburdened. And then if we could translate these two things that we’ve done on sort of taking pressure off the system, improving nurse development, if we can get to the next step, which is actually improving the development of specialists so that we have more and more specialists dealing with the harder and harder problems, we would start to really be making progress again.
And I think a lot of it is around supply and demand. I think that there’s a lot of this we would say capitalism doesn’t work, but there’s lot where it is working, where you’re seeing so many of these things that are going on, that are taking pressure off the system that a year or two ago, I would have been much less optimistic that there are ways to do this.
Because we’ve got this huge growing country, an aging country, lots of need. I mean, when you look at all the negativity, the flip side is. We’re the third largest country in the world after India and China, and we are decades ahead of them in providing care to our population. It’s not that India and China aren’t doing fantastic in science and research and development, but as far as actually taking care of our very large population, it’s imperfect. But we’re doing a very good job compared to those two countries. And it’s not, and there are lots of challenges here. But I’m optimistic that there are more solutions that are starting to make a difference and a dent in it, and then just having to reallocate talent and the best and brightest. To some of the hardest problems would be a great move in the right direction.
Solomon Wilcots: A big thank you to Scott Becker for joining us and for sharing a clear-eyed view of the pressures shaping healthcare right now from patient access and policy, hospital economics, and what leaders really need to understand to navigate what’s coming next. I’m Solomon Wilcots, and this is the Russo Edge. Thank you for joining, everyone.
The Russo Edge Podcast is hosted by Solomon Wilcots and features candid conversations at the intersection of biotech, healthcare, and innovation, spotlighting leaders, scientists, and investors moving medicine forward. The following transcript has been edited for clarity.
