A staffing crisis that could get worse

When I started this newsletter a few weeks ago, I asked readers to identify some of the biggest issues in health care these days. In dozens of comments, there was one theme that emerged — and that’s the staffing crisis. No bigger issue seems to have captured the attention of health care leaders than how to meet the intense, unrelenting demand for their services, particularly at a time when the current workforce is burnt out and fed up.

The truism throughout the COVID-19 pandemic has been that hospitals can always add more beds, but they can’t just conjure up enough nurses, doctors and other allied health professionals to staff those beds.?

Throughout the crisis, hospitals have implemented a range of strategies to meet demand, such as:

• bringing in travel nurses or other outside clinicians,
• canceling elective procedures and reassigning staff to covid units,
• enlisting the help of medical military personnel,?
• coordinating with other regional medical centers, and
• loosening quarantine and isolation protocols so clinicians who were exposed, or even diagnosed, with covid can continue to work.

Yet even before the pandemic, there was growing evidence that staffing shortages and higher patient loads per nurse contribute to higher mortality rates. There’s no reason to think that covid has been an exception to those findings, and nursing leaders have been sounding the alarm.??

But today’s clinicians aren’t just thinking about the next covid surge; they’re also worried about the future. If the crisis is pushing young clinicians away from health care careers, what will that mean for an industry that’s already under immense strain??

It’s not just ICU and emergency departments that are worried either. More than 58% of obstetricians cited nursing shortages as their top patient safety concern in a survey of 1,130 OBs that was recently released by the Ob Hospitalist Group.

Here’s what health care professionals on LinkedIn are saying about staffing shortages this week:?

#HardCases: When hospitals become overwhelmed during covid waves, doctors start to stray from the usual playbook.

It’s not hard to imagine that strained emergency rooms and overflowing intensive care units would prompt physicians to make different — and difficult — decisions about who to admit for inpatient care. And in this week’s Hard Cases piece, Dr. David Kim, an executive at Providence, got to see firsthand how those decisions are made. Kim, a family medicine physician, spent a shift volunteering in the health system’s fever clinic. An elderly patient with covid came into the clinic with an oxygen saturation level that had dropped to a concerning level. What happened next probably wouldn’t surprise anyone who’s had a similar experience weighing clinical judgment against the reality of an overloaded hospital. Read his piece here.

To what extent does ICU capacity impact who gets admitted? Weigh in below.

#HealthcareRecruitment: Is the COVID-19 crisis pushing young clinicians out of health care?

Dr. Gerald Harmon, president of the American Medical Association, fears that may be the case, laying out his argument in an opinion piece for Stat. And in a post on LinkedIn, he adds that “ALL healthcare workers are emotionally and physically stressed in this continuing pandemic.”

That sentiment was echoed by Dr. Bonnie Clipper, formerly of the American Nurses Association:

The urgency to bring new people into the profession will only intensify as doctors and nurses start to retire. Nearly half of nurses are over the age of 50, while doctors in their 60s account for about 20% of the workforce.

What would you advise young people considering health care careers these days? Let me know in the comments and I may feature some of your answers in an upcoming edition.

#VirtualCare: It's pretty clear that telemedicine is here to stay. Patients like it, and so do doctors. It's convenient, the no-show rate tends to be lower, and it opens up the potential to treat a greater number of people. But does that mean the same clinicians will do both virtual and in-person appointments?

Take the poll of the week below. And if you're seeing patients virtually, how do you plan to incorporate remote visits into your practice going forward?