Hospitals, urgent care facilities, clinics, and imaging centers throughout the United States are experiencing staffing issues. Since the COVID-19 pandemic, costs have reached new highs as institutions are forced to staff their facilities with temporary health professionals due to rising turnover, fluctuations in demand, and evolving appreciations for work-life balance. These temporary, or “locums,” physicians, mid-level administrators, travel nurses, therapists, and technicians are paid many multiples more than regular staff. Frequently, existing long-term employees feel undervalued in relation to these temporary workers and some resign to join the rapidly expanding pool of locums healthcare workers while others seek out early retirement.
This burgeoning crisis has greatly affected the bottom line of healthcare facilities, with many of the country’s leading hospital centers posting massive losses. Institutions were already operating at the margins prior to 2020, but the pandemic only increased demands from facilities while also producing skyrocketing expenses. Even more detrimental to the public is the closing of smaller hospitals and community-based clinics, especially in rural and underserved areas. These centers had even less financial buffer to survive through financial hardship. This trend has created health care deserts, significantly impacting maternal care and emergency medicine, among other critical areas of patient care.
This staffing crisis is leading to ongoing delays related to boarding in emergency departments, prolonged admission to hospitals, and delayed elective and emergent surgeries. Each of these contributes to adverse outcomes, morbidity, and mortality. Accordingly, quality of care is affected. Over the last few years, there has been a rise in medical errors. The Joint Commission, a major agency that monitors hospitals and health facilities, reported a 19% rise in adverse events in 2022. After several decades of creating a safety culture in health care, this is a chilling statistic. Staffing with temporary workers may play a significant and expanding role in this negative trend. Logically, temporary workers may lack an intrinsic team dynamic or familiarity with institutional resources and quality assurance practices, allowing mistakes to fall through the cracks. Several decades of developing team-based approaches, where roles are clearly defined and providers are familiar with protocols and optimal approaches for specific disease entities, are now at threat. Moreover, burnout is known to increase medical errors, and the pandemic has only worsened provider well-being via increased time at work and emotional stress.
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Health care administrators were ill-prepared to deal with a lack of full-time staff and have yet to find a solution, even though we are three years removed from the pandemic’s onset. Each spring, new graduates from professional programs typically join hospitals. This is not the case post-pandemic, as many health professionals now join staffing agencies which provide various institutions with contract-based temporary work. New staff receive financial rewards of increased pay, flexibility that improves work-life balance, and many other perks such as housing and travel support. We have watched as health care consultants try to encourage facilities to answer staffing needs with colorful posters, virtual nursing tools, gig economy processes, and other ideas. These may work in other industries, but health care requires special considerations as facilities lack the same profitability and providers face risks from direct patient contact. So how can the healthcare leaders address staffing issues and provide excellent care? We propose several simple ideas that require no consultants and are based on common sense.
Raise salaries by ten to twenty percent. Inflation has decayed the value of earned dollars over the last few years. In particular, physicians earn significantly less than they did earlier this century when adjusted for inflation. Similarly, nurses feel that their salaries have not kept up with their rising educational demands and work hour requirements. Resident physicians at several hospitals have considered unionization to combat the rising time demands, subpar benefits and parental leave protections, and inadequate financial compensation. When equated for hours worked, resident physicians, who have completed over eight years of higher education, earn under $25 per hour and often struggle to make ends meet. Employees are less likely to leave a facility and more likely to improve the quality of their work if they feel valued by the management. Why reward locums with several multiples of hourly wage when you can develop a loyal workforce?
Provide in-house 24/7 child care staff. Many individuals entering health care are young individuals who may be starting families. Yet many providers are forced to work well over 40 hours per week. Quality child care is a great perk, both financially and emotionally for staff. Staff will appreciate onsite care that is safe for their children. It also has the benefit that parents can visit children during breaks. This easy cost-effective idea will be a major recruitment magnet and retention tool which can concurrently fight burnout.
Flexible scheduling. Particularly applicable to medical residency programs, couples may take advantage of flex scheduling to align shifts and increasing quality personal time. Nurses and other staff may also appreciate flex scheduling as it will help improve their workflow and maximize efficiency. Early retirees may return for part-time employment if they can develop schedules that complement their lifestyle. As we face significant impending shortages across health professions, this can offer a valuable stopgap. Data has shown that staff perform better and report improved mental health when they have time to cope with the many challenges inherent to health care. Allowing health care workers to work on their own terms may be a major way to address burnout and improve patient outcomes while recovering much of the staff that we have lost in recent years.
Re-engineer the electronic medical record. Reducing the amount of time providers spend on screen time can optimize efficiency and reduce mental health detriments. Working with patients is typically the primary motivation behind individuals’ entry into the health professions. Many providers report feeling like data entry clerks with diminishing human connection to patients. Moreover, they are often forced to spend their few evening hours at home completing patient charting responsibilities instead of being present with family. Daily routine tasks on the electronic medical record must be decreased or rerouted to other specialized staff who can optimize the physician’s time. This can save money for institutions and allow providers to see more patients while also feeling more fulfilled.
Invest in provider support. Administrators may increase hiring of advanced practice providers, medical scribes, and support staff so that each employee may focus on their skillset, hence improving efficiency and outcomes for the whole team. Physicians, APPs, and nurses each report improved work satisfaction when relevant support staff are present. Moreover, this investment by administration can ultimately lead to increased revenue and reduced staff turnover.
American healthcare has undergone significant changes after the pandemic. To recover it is important to invest our time and money towards initiatives which will create a sustainable system that optimizes public health and preventative care for all people. Our system today is not well-prepared to serve an aging, growing population, and creative, evidence-based solutions are needed to reduce costs, prevent shortages, and ensure that quality care is accessible to all.
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