Oct 26, 2023 - Health

Warning signs for the U.S. health system are piling up

Animated illustration of a caduceus with the wings flying away, the snakes slithering away, and the stick falling.

Illustration: Brendan Lynch/Axios

Staffing shortages, more dangerous workplaces, aging physicians and the increasing politicization of medicine: The warning signs for America's burned-out health care workforce are all there.

Why it matters: A strained health care system may be heading in a dangerous direction in the pandemic's aftermath, according to new data points and a blunt warning from the head of the nation's leading medical association.

  • "The physician shortage that we have long feared — and warned was on the horizon — is here. It's an urgent crisis, hitting every corner of this country," American Medical Association president Jesse Ehrenfeld said Wednesday at a National Press Club event.
  • "Imagine walking into an emergency room in your moment of crisis, in desperate need of a physician's care, and finding no one there to take care of you," he added. "That's what we're up against."

The big picture: Since the pandemic, hospitals and health systems have struggled to attract and retain enough staff, and emboldened workers are taking labor actions to demand better pay and safer conditions. Some appear to be leaving the industry altogether.

  • Patients are having a harder time getting appointments, data suggests, and further shortages will only compound delays in the system.
  • An aging country means demand for care will likely go up, while the ranks of care providers diminish. Nearly half of practicing U.S. physicians are older than 55.

By the numbers: Two-thirds of respondents to a recent Kaufman Hall survey of hospitals, health systems and medical groups said that staffing shortages have forced them to run at less than full capacity at some point over the past year.

  • 63% said they are struggling to meet patients' demand for care at the doctors' practices that they own, and nearly a third said patients' concerns and complaints about access to this care are increasing.
  • On the other hand, most said their use of contract labor — an expensive way of meeting demand for care — has decreased.

Between the lines: A combination of demographic factors, political changes and pandemic-era mental health challenges have led to today's workforce problems.

  • More than 13% of health care workers last year reported harassment, such as threats or verbal abuse, compared to just over 6% in 2018, according to a Centers for Disease Control and Prevention report this week. Some 44% of health care workers wanted to look for a new job last year.
  • The AMA recorded the highest-ever level of doctor burnout during the pandemic.
  • The factors driving doctors away from the field, in Ehrenfeld's view, are many: rising hostility to health workers, increasing industry consolidation, unsustainable Medicare payment and "criminalization" of the profession through state bans on abortion and gender-affirming care.
  • He said it will take big changes to save the profession, including: reducing administrative burden, allowing more foreign doctors to practice here, and making it easier for doctors to take care of their mental health without fear of jeopardizing their careers.

Ehrenfeld offered a grim portrait of the future under the current trajectory. He predicted more doctors would close their practices or cut back hours, be forced to rely on old technology, reduce support staff or limit how many Medicare patients they see.

  • "Either way, it's patients who suffer," he said.
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