A report found that Houston has only 3.35 health care workers for every 100 residents. Getty Images

Houston may be home to the world's largest medical center, but a new study indicates the region is also home to one of the lowest rates of health care workers among major U.S. metro areas.

The study, released by credit-building loan platform Self, shows the Houston metro area has 3.35 health care workers for every 100 residents. That places Houston at No. 10 on the study's list of the major metro areas (at least 1 million residents) with the lowest share of health care workers per capita, including doctors, nurses, and therapists.

The only other major metro area in Texas sitting toward the bottom rung of the ladder is Austin, with 3.17 health care workers per 100 residents. That puts Austin at No. 4 for the lowest rate of health care workers among major metro areas.

Houston's ranking in the Self study is juxtaposed with the city's status as a world-famous health care hub. Over 106,000 people work at the more than 60 institutions within the Texas Medical Center, which includes the University of Texas MD Anderson Cancer Center, Texas Children's Hospital, and the Baylor College of Medicine.

The 1,345-acre medical complex pumps an estimated $25 billion a year into the regional economy.

Despite Houston's stature as a medical magnet, the metro area is witnessing an escalating shortage of doctors and nurses.

A 2016 report from the Texas Department of State Health Services envisions the supply of registered nurses (RNs) — the largest group of nursing professionals — will climb 38 percent from 2015 to 2030 in the Gulf Coast public health region, compared with a 60.5 percent surge in demand. That equates to a projected shortage of 13,877 RNs in 2030. The Gulf Coast region includes the Houston area.

From 2017 to 2030, the supply of primary care physicians in the Gulf Coast region will increase 19.8 percent while demand will spike 27.5 percent, according to a 2018 report from the Texas Department of State Health Services. Ten years from now, the region will suffer a shortage of 694 primary care physicians, the report predicts.

In a 2019 survey commissioned by the Texas Medical Center Health Policy Institute, about 90 percent of primary care physicians across the country predicted a shortage in their field within five years. Seventy-eight of specialty physicians anticipated a shortage of specialists.

On the consumer side, the survey found 19 percent of patients reported difficulty scheduling an initial visit with a primary care physician, and 15 percent ran into trouble setting up a new visit with a specialist.

"The best way to tell if we have a doctor shortage is by asking patients whether they can easily get an appointment," Dr. Arthur "Tim" Garson Jr., director of the Texas Medical Center Health Policy Institute in Houston, said in a 2019 release. "For now, they overwhelmingly say 'yes.'"

By 2030, Texas will experience the third largest shortage of physicians among the states (20,420 jobs), according to a study published in 2020 in the journal Human Resources for Health. Only California and Florida will see worse shortages, the study predicts. The physician shortage in Texas is being driven by a growing population, an aging population and an aging pool of doctors, according to the study.

Noting the country's growing and aging population, a study published in 2019 by the Association of American Medical Colleges predicts the U.S. confronts a shortage of up to 121,900 physicians by 2032.

The looming national shortage of RNs is also acute.

The country's RN workforce is projected to grow from 2.9 million in 2016 to 3.4 million in 2026, or 15 percent, according to the U.S. Bureau of Labor Statistics. However, the bureau predicts the need for another 203,700 RNs each year from 2016 through 2026 to fill newly created positions and to replace retiring nurses.

"With patient care growing more complex, ensuring a sufficient RN workforce is not merely a matter of how many nurses are needed, but rather an issue of preparing an adequate number of nurses with the right level of education to meet health care demands," Ann Cary, dean of the Marieb College of Health and Human Services at Florida Gulf Coast University, said in a 2019 release

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Efficient referrals from doctor to doctor could save a life, so this Houston company is setting out to create a network of medical professionals all accessible in an app. Getty Images

Houston-based company is connecting the dots on patient referrals

Diagnosing doctors

When your doctor recommends that you visit another practitioner, it's only natural that you trust the suggestion. But it's one case in which your physician isn't always an expert. Married doctors Justin Bird, an orthopedic surgeon, and Terri-Ann Samuels, a specialist in female pelvic medicine and reconstructive surgery, have long noted that patients are often referred incorrectly.

No big deal, right? Just go to another doctor. But not everyone has that luxury. Bird and Samuels never intended to start their own company. But when Bird lost a patient due to faulty referrals, they knew something had to be done.

"He believes that if she hadn't been bounced around from doctor to doctor, they could have saved her life," says Chris E. Staffel, chief operating officer of Patients We Share, the app that the couple created to fix the broken aspect of the health care system.

In 2015, Bird and Samuels began their company when they were shocked to realize that such an app didn't already exist.

"They started working with physicians around the country who said, 'We really, really need this,' and they also invested in it," recounts Staffel. From those friends, they built a physician advisory board of 15 investors.

Prescribing growth
The project was accepted into Johnson & Johnson's incubator, JLABS in 2016, then TMCx's digital startup program in the spring of 2018.

"They started realizing it was gaining momentum and realized they needed to have business people on board," says Staffel.

They hired Michael Antonoff, a Rice University M.B.A., as CEO. He invited former classmate Staffel to join as COO. Having come from a background in oil and gas, Staffel jumped at the chance to try her hand in a different industry.

With new business clout behind PWS, the company is growing quickly. Currently, PWS is entering its next seed round of $2.5 million that will allow the company to pay salaries of new team members and bring some tech development in-house. Until now, the making of the app itself has been outsourced to Mobisoft Infotech, a company based in Houston and India, which has worked on many projects at the Texas Medical Center. Local Black + Grey Studio is responsible for the design.

PWS has been working with both those teams in recent months to get a prototype app ready for launch. Currently, 100 physicians around the country are part of an invite-only pilot program. Soon, Staffel hopes to allow early adopter doctors who haven't been invited to enroll in the program for free. It will likely be in 2020 that patients will start joining the community, too.

How it works
An index of all the providers on the app allows doctors to easily find practitioners in a particular specialty. But there's more to it. Detailed profiles contribute to machine learning that assures the optimal match every time. Patient reviews will also play a role.

Though referrals were the impetus for the creation of PWS, it may be even more important as a communication tool between doctors, fellow clinicians (anyone from nurse practitioners to physical therapists may be invited to join), and patients. Staffel says participants in the pilot program are already using the messaging system to compare notes on cases, even sending photos from surgery to consult on patient issues.

The app's encryption means that it's HIPAA-compliant. Patients provide permission to discuss their cases via the app. And they can be confident of the quality of care they'll receive. Likely, the app will remain largely invite-only, and everyone who joins will share their National Provider Identifier licenses to be vetted against the federal database.

Doctors will communicate directly with patients through the app, but will also share resources digitally. Instead of making copy after copy of information about post-surgical care, for instance, the physician need only press a button to share a link.

Eventually, the goal is for PWS to be used not just nationally, but internationally, not just by individuals, but by whole hospital systems. A world in which doctors can compare notes around globe could be a little safer for us all.

Houston-based Memorial Hermann could soon be part of one of the largest health care networks in Texas. Photo via memorialhermann.org

2 major Texas hospital systems merge with service and innovation in mind

2 for 1

Two powerhouse medical centers have decided to team up to become one of the largest health care systems in Texas.

Houston-based Memorial Hermann Health System and Dallas-based Baylor Scott & White Health's board members signed a letter of intent to merge and create a combined system, according to an October 1 press release. A definitive agreement is expected to be complete in 2019.

"Together, we believe we will be able to accelerate our commitments to make care more consumer centric; grow our capabilities to manage the health of populations; and bend the unsustainable healthcare cost curve in the state," says Chuck Stokes, president and CEO of Memorial Hermann, in the release. "Through this combined system, we have a unique opportunity to reinvent healthcare and make a profound difference in the lives of millions of Texans."

The two systems together have over 68 hospital campuses, 1,100 care delivery sites, almost 14,000 physicians, and serve almost 10 million patients each year, according to the release.

The combined organization will operate under a unified board, led by Ross McKnight, the current chair of the Baylor Scott & White Holdings Board of Trustees. A vice chair will be selected by Memorial Hermann and will serve as the chair after McKnight's two-year term.

Jim Hinton, current CEO of Baylor Scott & White, will be the CEO. Stokes will serve in the proposed office of the CEO, along with current Baylor Scott & White president, Pete McCanna.

"Baylor Scott & White was founded as a Christian ministry more than 100 years ago; ever since, it has advanced health and driven change in North and Central Texas," McKnight says in the release. "This proposed combination starts the next chapter in the legacies of service and innovation for both systems. It will not only make a positive difference in the lives of millions here, it will become a national model."

Both organizations will maintain their brands and names locally. Executive and support staff will be based in the cities where the two entities currently have operations: Austin, Dallas, Houston, and Temple.

"This is about two mission-driven organizations — both committed to making safe, high-quality healthcare more convenient and affordable — building something transformative together," Hinton says in the release. "We must lead the change in our industry, while insisting we continue to fulfill our unwavering commitments to meeting the needs of all Texans."

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CultureMap Emails are Awesome

Houston is the 4th best U.S. city for Black professionals, report finds

Black History Month

In acknowledgement of Black History Month 2024, a new report compiled by Black employees at online rental marketplace Apartment List has ranked Houston the No. 4 best U.S. city for Black professionals.

Apartment List reviewed 76 cities across four major categories to determine the rankings: community and representation; economic opportunity; housing opportunity; and business environment.

Houston earned a score of 63.01 out of a total 100 points, making it the second-highest-ranked city in Texas for Black professionals, behind San Antonio (No. 3).

The city earned top-10 rankings in three out of the four main categories:

  • No. 3 – Business environment
  • No. 4 – Community and representation
  • No. 10 – Economic opportunity
  • No. 21 – Housing opportunity

Houston is commended for its strong Black business environment and economy, but there is some room for improvement when it comes to housing. Similarly to Apartment List's 2022 report – which also placed Houston at No. 4 – a little less than half (44 percent) of all Black Houston households are spending over 30 percent of their income on housing, which has increased two percent since 2019.

Houston has a larger Black population than San Antonio, at 19 percent, but its Black population share is overall lower than other cities in the top 10.

"Furthermore, the community is well-represented in some critical occupations: 20 percent of teachers are Black, as are 21 percent of doctors," the report said. "Houston is also home to the HBCU Texas Southern University, helping a job market when the median Black income is several thousand dollars above average."

Houston also has the highest rate of Black-owned businesses in the entire state, at 18 percent.

"From the Mitochondria Gallery to Ten Skyncare and Wisdom’s Vegan Bakery, Houston has it all!" the report said.

Here's how Houston stacked up in other metrics:

  • Black homeownership: 42 percent
  • Black lawyers: 14 percent
  • Black managers: 14 percent

Elsewhere in Texas
Texas cities dominated the overall top 10. San Antonio ranked just above Houston, with Dallas (No. 6) and Austin (No. 7) not too far behind.

San Antonio came in less than 2.5 points ahead of Houston with a total score of 65.44 points. The report praised San Antonio's scores across its economic opportunity (No. 2), housing opportunity (No. 7), and community and representation (No. 10). The city ranked No. 20 for its Black business environment.

But like Houston, San Antonio also fell behind in its Black homeownership rates, according to the study.

"While the Black homeownership rate is higher than average at 44 percent, the homeownership gap (Black homeownership rate - non-Black homeownership rate) quite low at -19 percent," the report's author wrote. "Perhaps this could be explained by San Antonio’s overall homeownership rate, which is also lower than the state’s average. Additionally, the lower homeownership gap could explain the cost burden rate also being lower than average at 41 percent."

The top 10 cities for Black professionals are:

  • No. 1 – Washington, D.C.
  • No. 2 – Atlanta, Georgia
  • No. 3 – San Antonio, Texas
  • No. 4 – Houston, Texas
  • No. 5 – Palm Bay, Florida
  • No. 6 – Dallas, Texas
  • No. 7 – Austin, Texas
  • No. 8 – Colorado Springs, Colorado
  • No. 9 – Lakeland, Florida
  • No. 10 – Charlotte, North Carolina
The full report and its methodology can be found on apartmentlist.com.

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This article originally ran on CultureMap.

Houston expert: Can Houston replicate and surpass the success of Silicon Valley?

guest column

Anyone who knows me knows, as a Houston Startup Founder, I often muse about the still developing potential for startups in Houston, especially considering the amount of industry here, subject matter expertise, capital, and size.

For example, Houston is No. 2 in the country for Fortune 500 Companies — with 26 Bayou City companies on the list — behind only NYC, which has 47 ranked corporations, according to Fortune.

Considering layoffs, fund closings, and down rounds, things aren’t all that peachy in San Francisco for the first time in a long time, and despite being a Berkeley native, I’m rooting for Houston now that I’m a transplant.

Let’s start by looking at some stats.

While we’re not No. 1 in all areas, I believe we have the building blocks to be a major player in startups, and in tech (and not just energy and space tech). How? If the best predictor of future success is history, why not use the template of the GOAT of all startup cities: San Francisco and YCombinator. Sorry fellow founders – you’ve heard me talk about this repeatedly.

YCombinator is considered the GOAT of Startup Accelerators/Incubators based on:

  1. The Startup success rate: I’ve heard it’s as high as 75 percent (vs. the national average of 5 to 10 percent) Arc Search says 50 percent of YC Co’s fail within 12 years – not shabby.
  2. Their startup-to-unicorn ratio: 5 to 7 percent of YC startups become unicorns depending on the source — according to an Arc Search search (if you haven’t tried Arc Search do – super cool).
  3. Their network.

YC also parlayed that success into a "YC Startup School" offering:

  1. Free weekly lessons by YC partners — sometimes featuring unicorn alumni
  2. A document and video Library (YC SAFE, etc)
  3. Startup perks for students (AWS cloud credits, etc.)
  4. YC co-founder matching to help founders meet co-founders

Finally, there’s the over $80 billion in returns, according to Arc search, they’ve generated since their 2005 inception with a total of 4,000 companies in their portfolio at over $600 billion in value. So GOAT? Well just for perspective there were a jaw-dropping 18,000 startups in startup school the year I participated – so GOAT indeed.

So how do they do it? Based on anecdotal evidence, their winning formula is said to be the following well-oiled process:

  1. Bring over 282 startups (the number in last cohort) to San Francisco for 90 days to prototype, refine the product, and land on the go-to-market strategy. This includes a pre-seed YC SAFE investment of a phased $500,000 commitment for a fixed min 7 percent of equity, plus more equity at the next round’s valuation, according to YC.
  2. Over 50 percent of the latest cohort were idea stage and heavily AI focused.
  3. Traction day: inter-portfolio traction the company. YC has over 4,000 portfolio companies who can and do sign up for each other’s companies products because “they’re told to."
  4. Get beta testers and test from YC portfolio companies and YC network.
  5. If they see the traction scales to a massively scalable business, they lead the seed round and get this: schedule and attend the VC meetings with the founders.
  6. They create a "fear of missing out" mentality on Sand Hill Road as they casually mention who they’re meeting with next.
  7. They block competitors in the sector by getting the top VC’s to co-invest with then in the seed so competitors are locked out of the A list VC funding market, who then are up against the most well-funded and buzzed about players in the space.

If what I've seen is true, within a six-month period a startup idea is prototyped, tested, pivoted, launched, tractioned, seeded, and juiced for scale with people who can ‘make’ the company all in their corner, if not already on their board.

So how on earth can Houston best this?

  1. We have a massive amount of businesses — around 200,000 — and people — an estimated 7.3 million and growing.
  2. We have capital in search of an identity beyond oil.
  3. Our Fortune 500 companies that are hiring consultants for things that startups here that can do for free, quicker, and for a fraction of the extended cost.
  4. We have a growing base of tech talent for potential machine learning and artificial intelligence talent
  5. A sudden shot at the increasingly laid off big tech engineers.
  6. We have more accelerators and incubators.

What do we need to pull it off?

  1. An organized well-oiled YC-like process
  2. An inter-Houston traction process
  3. An "Adopt a Startup" program where local companies are willing to beta test and iterate with emerging startup products
  4. We have more accelerators but the cohorts are small — average five to 10 per cohort.
  5. Strategic pre-seed funding, possibly with corporate partners (who can make the company by being a client) and who de-risk the investment.
  6. Companies here to use Houston startup’s products first when they’re launched.
  7. A forum to match companies’ projects or labs groups etc., to startups who can solve them.
  8. A process in place to pull all these pieces together in an organized, structured sequence.

There is one thing missing in the list: there has to be an entity or a person who wants to make this happen. Someone who sees all the pieces, and has the desire, energy and clout to make it happen; and we all know this is the hardest part. And so for now, our hopes of besting YC may be up in the air as well.

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Jo Clark is the founder of Circle.ooo, a Houston-based tech startup that's streamlining events management.

New Houston venture studio emerges to target early-stage hardtech, energy transition startups

funding the future

The way Doug Lee looks at it, there are two areas within the energy transition attracting capital. With his new venture studio, he hopes to target an often overlooked area that's critical for driving forward net-zero goals.

Lee describes investment activity taking place in the digital and software world — early stage technology that's looking to make the industry smarter. But, on the other end of the spectrum, investment activity can be found on massive infrastructure projects.

While both areas need funding, Lee has started his new venture studio, Flathead Forge, to target early-stage hardtech technologies.

“We are really getting at the early stage companies that are trying to develop technologies at the intersection of legacy industries that we believe can become more sustainable and the energy transition — where we are going. It’s not an ‘if’ or ‘or’ — we believe these things intersect,” he tells EnergyCapital.

Specifically, Lee's expertise is within the water and industrial gas space. For around 15 years, he's made investments in this area, which he describes as crucial to the energy transition.

“Almost every energy transition technology that you can point to has some critical dependency on water or gas,” he says. “We believe that if we don’t solve for those things, the other projects won’t survive.”

Lee, and his brother, Dave, are evolving their family office to adopt a venture studio model. They also sold off Azoto Energy, a Canadian oilfield nitrogen cryogenic services business, in December.

“We ourselves are going through a transition like our energy is going through a transition,” he says. “We are transitioning into a single family office into a venture studio. By doing so, we want to focus all of our access and resources into this focus.”

At this point, Flathead Forge has seven portfolio companies and around 15 corporations they are working with to identify their needs and potential opportunities. Lee says he's gearing up to secure a $100 million fund.

Flathead also has 40 advisers and mentors, which Lee calls sherpas — a nod to the Flathead Valley region in Montana, which inspired the firm's name.

“We’re going to help you carry up, we’re going to tie ourselves to the same rope as you, and if you fall off the mountain, we’re falling off with you,” Lee says of his hands-on approach, which he says sets Flathead apart from other studios.

Another thing that's differentiating Flathead Forge from its competition — it's dedication to giving back.

“We’ve set aside a quarter of our carried interest for scholarships and grants,” Lee says.

The funds will go to scholarships for future engineers interested in the energy transition, as well as grants for researchers studying high-potential technologies.

“We’re putting our own money where our mouth is,” Lee says of his thesis for Flathead Forge.

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This article originally ran on EnergyCapital.