The PIE: How has AMOpportunities developed over the last eight years?

Kyle Swinsky: Eight years ago it really was about access for healthcare training for international students. They had a difficult time getting into required clinical education, which is on the job learning; what life is like in the medical specialities.

The access issue was that while international education was growing in the medical sector, these students had issues accessing the US market. They would go to schools abroad, but want to practise here. 27% of US physicians are internationally trained, 41% of primary care in the US is also internationally trained. When we saw this first hand, we pretty much set up a marketplace – like Airbnb – where students could apply seamlessly to hundreds of sites across the country, and we were recruiting physicians that were willing to teach.

We dealt with the logistics, getting them here, housing and building our own student experience over the first few years. Since then, it’s really gone to more of an institutional platform where, originally it was helping students individually, but now schools also have the same challenges. The evolution really has been with an access problem at all times, where students and especially healthcare have a problem finding the on the job training and connecting.

“We see 27% of our physician workforce coming from abroad”

And I think it’s really that experiential learning that we’re seeing, all the STEM sciences where the typical four years is not just enough. The main reason healthcare really saw this first was four of the top 10 paying jobs in the US were in healthcare and being an international student, they see that career potential. That’s why we see 27% of our physician workforce coming from abroad. In the last two years, we’ve helped more US students as well.

The PIE: How do these access problems themselves manifest?

KS: The problems stems from this gap in availability. If every doctor had a shadow, looking at our figures, it’s less than 10% that we’re seeing in utilisation, right? What we have learnt is there’s this bottleneck on the administration of the education itself. So when we’re going into a hospital, convincing the health system to open their doors to the international population, students and trainees, a lot of times at first they say we have enough students right now, but then we’ll say, ‘well, you have 1,000 doctors, we have 30 students’. What’s holding that back? We have to do credentials, orientation – all this extra work that AMO is pretty much providing as a turnkey solution – student experience, all of the onboarding, the credentialing, the software, the background check and things like immunisations.

And then we also have our operations to help our sites get the students in. It’s really that challenge – there’s a lot more capacity than what systems are seeing – our job is to convince them to open their doors.

The PIE: What have the intricacies of dealing with travel and placement and such been like for you during the pandemic?

KS: I think the problems we saw pre-pandemic were only exacerbated. Schools are seeing record enrolment that only increased during the pandemic. So a lot of people went back to healthcare school and then we saw a lot of the clinical training shut down because there weren’t enough resources in the healthcare system to even accommodate students. AMO was at the forefront, where 2020 and 2021 were growth years for us. It was smaller in 2020, and then last year we doubled in terms of number of students that we saw compared to pre-pandemic. It was a real shift where 25% of our students last year were on virtual training. I don’t think that’s going away. We’ve had over 560 students now join for virtual rotations, where originally it was an access problem to get them to travel.

“What we’re seeing right now is the vast majority of schools doubled their enrolments during the pandemic”

I think now we’re starting to see that telemedicine is a new area and it is a big growth piece for us. What’s ahead right now is the healthcare shortage is looming – we all know we need even more healthcare workers than we did pre-pandemic, and the only way we can get more is if we can address this training shortage. It really is about unlocking more training to grow. It’s really sad to see how many schools are running into bottlenecks. What we’re seeing right now is the vast majority of schools doubled their enrolments during the pandemic, but we know that they don’t have enough clinics in the next two years. So the problem was here before, but I think the only solution is creating more training and lowering the costs to get these students into the training.

The PIE: Where are your students generally coming from? Has it changed over the years?

KS: I would say that the typical markets that we see are still the list of where the US positions come from – India, Pakistan, Brazil and a few other pockets in Europe and Asia. But I think what we have seen is it’s come a little closer to home to Canada and Mexico, because they had an easier time getting into the US after the pandemic.

We recently forged a significant amount of new partnerships with schools in Mexico, and I think that was something really unique. At the moment it’s about who can get in the country – visa processing times have been a bottleneck in Pakistan right now, and India has been more apt to virtual training than Pakistan. Currency devaluations and other political things can influence how we see markets shift internationally. China had an interesting spike last year when they reopened, especially to tourism. Our entry into the Chinese market was more recent, only around three or four years ago. The lockdowns have been a little more restrictive on travel, but it’s definitely a really ripe virtual market for us. The virtual programming is really aligned with what the Chinese education market wants.

Brazil’s uptake was a tailwind from pre-pandemic interest. Our director of partnerships was actually stuck in Brazil during the pandemic, and it was because there was so much demand and he had a tour of multiple schools lined up. The universities definitely want more international exchange and the leadership level.

The PIE: Are you travelling out to pitch in person or is it mostly virtual?

KS: Our travel plans don’t begin until summer this year, so we keep rolling with virtual because it really benefits the students. The students don’t have to go to an in-person fair to see AMO – they can just sign in while they’re studying.

We used to travel in-person to the schools, thinking in-person was important to get that relationship. But I think right now we’re going to continue with mostly virtual presentations. As long as attendance sees over 100 per presentation and that attendance is engaged, we usually see 30 minutes of Q&A afterwards. I think the school administration likes it too because deans can pop in when they’d like to. We’ve expanded our virtual reach, going to multiple schools at a time virtually, and sometimes have our physicians attend these presentations. We also have former trainees attend, and it gives those attendees the opportunity to hear from a student just like them about what their rotation was like. It just really helps us with the great growth that we’ve had even in the midst of a pandemic.

The PIE: What’s your projection and aim for the market over the next few years?

KS: We have to open more doors. We go around the country speaking to healthcare bosses about how to strategise getting rid of that shortage – 160,000 healthcare workers. The first strategy is really creating more training for the international scholars we work with. The second is the technology with our virtual training. The third is actually going after more healthcare universities and nursing the markets – we have 800 medical schools on AMO right now, and students from a little over 90 countries.

“Connecting them to the job has always been such a tough thing for any university in the US to do”

You know, we spent the last eight years really thinking about the access for international students – what we’re seeing is the demand coin flip where health systems want access to them much more than ever. Every health system we talk to, they’re more apt to opening their doors – they really want to work there versus just train there. I would say by end of the year, there will be more on that – the international schools do so well with training the students, but connecting them to the job has always been such a tough thing for any university in the US to do. So I think that connecting to the job is something that we’ll look more towards that.