I recently had the opportunity to catch up with a physician colleague who reports that she left her position at one facility due to workplace strife and dissatisfaction, and took another position as a temporary step to maintain financial stability while evaluating when and where to go next. However, shortly after her move, her new healthcare facility was bought out by a private equity company.
She noted that since the buy-out, the new "owners" have instituted changes in her healthcare workplace that she feels are an improvement, leaving her more satisfied with this new position. She now plans to stay at this facility, at least for a while, and see how conditions continue to evolve. I have since spoken with three others (one physician and two nurses) who have migrated to that facility and also report improved workplace conditions.
Now, a sample size of four and short-term changes do not make for a good "survey," but these conversations gave me pause.
What if, in this age of a severely declining supply of doctors, nurses, and other critical healthcare workers, and against a rising surge in demand for these highly-skilled and trained individuals, some healthcare facilities made similar efforts to identify, improve, or "fix" the multiple workplace problems currently plaguing healthcare? This could apply to all types of facilities, be they locally-owned, corporate, private-equity, or newer "mega-company" entries into the healthcare marketplace like Amazon-One Medical. If successful with these "fixes," could they not outcompete other facilities in attracting healthcare workers ("internal customers" if you prefer that term) that refuse or are slow to change?
What Issues Need Fixing to Keep People in the Healthcare Workplace?
Surveys and reports suggest the list of issues is endless. Some claim "toxic" workplaces with uncaring or outright predatory administrations and detached corporate/equity ownership. Many more emphasize the overwhelming overwork for frontline workers; increasing hostility, abuse, and violence from patients and families during this politicized pandemic; and feelings of loss of input and ability to advocate for patients in an era of an evolving "assembly line" system of healthcare. This is often coupled with fear of job loss for speaking out about these issues or about depression or mental stress. For some, this stress stems from an increase in administrative workloads, including accelerating preauthorization demands. Some studies suggest it takes over 27 hours/day for primary care doctors to adequately complete their required tasks.
What Happens if We Don't Fix the Healthcare Workplace?
We know that during this great "migration" the healthcare workplace continues to lose workers, especially hands-on, frontline workers. Surveys tell us that over a half million workers left the healthcare workplace from 2020 to 2021. This exodus is reportedly continuing, with almost one in five U.S. healthcare workers leaving healthcare since the beginning of the pandemic -- that's over 4 million workers! -- with nurses currently reported as leaving healthcare at a rate of nearly one in three. Another report estimates an average of 194,500 unfilled nurse jobs through 2030. We are also told that there will be an estimated shortfall of between 37,800 and 124,000 physicians by 2034.
Yet another study shows that, without significant workplace changes, up to 47% of healthcare workers may leave the profession by 2025. By early 2022, nearly a quarter of U.S. hospitals already were reporting critical staffing shortages, and this number is rising.
With over 40 million U.S. workers in all professions leaving their jobs in this last year, it's clear that workers are more and more willing and able to migrate away from jobs they don't like!
Meanwhile, more than half of U.S. hospitals are expected to lose money this year, due in significant part to the exponentially accelerating expenses of attempting to fill critical healthcare worker positions, as they increasingly turn to short-term traveling nurses, "locums" physicians, and other transient healthcare workers -- if they can even get or afford them. This along with lost revenues from unstaffed beds may make many facilities unable to service their patients (external customers) in a timely fashion.
Where Does Competition Come Into Play?
The current conditions in the healthcare workplace and the increasing willingness and ability of healthcare workers to migrate creates a "seller's market" for doctors, nurses, and other in-demand workers. The term "internal customer" for these healthcare worker-consumers is a good one because these workers can "vote with their feet" and migrate to greener pastures for jobs that better serve their needs.
With an increasingly scarce resource -- doctors, nurses, and other essential healthcare workers -- hospitals and care facilities would be wise to consider healthcare workers as "internal consumers," and seriously evaluate how improvements in their facility workplace conditions could improve the experience for their "internal customers" and customers (patients) alike.
For facilities that can get it right and address and repair their workplace conditions -- thus providing a more attractive workplace environment -- they can outcompete other less worker-attractive facilities for this increasingly scarce resource, better attracting and retaining critical workers to their facility. The results of such improvements include (for their internal customers) a happier and more stable workforce less likely to move. For patients and families (external customers), they will get a better in-hospital and/or clinical experience, and improved clinical outcomes with happier patients and families. This will attract more "external customers" to these facilities. This competitive difference would, in turn, encourage other facilities to make similar improvements if they want to stay competitive and in business.
Perhaps I'm being over simplistic, but would it not be a wise business move for "smart" healthcare companies to do what it takes to better attract and retain good workers and improve outcomes for our patients?
Harry Severance, MD, is an adjunct assistant professor in the department of medicine at Duke University School of Medicine in Durham, North Carolina.