“We don’t have enough doctors. We don’t have enough nurses. We don’t have enough psychologists or counselors for addiction. We don’t have enough pharmacists,” bemoaned Vermont Senator Bernie Sanders in a recent CNN interview. He’s spot on – we do have a healthcare staffing crisis on our hands. But what happens all too often in Washington is that when lawmakers ring alarm bells, they forget they created the problems in the first place.
On May 11th, the Covid-19 Public Health Emergency (PHE) officially ended. Thankfully the worst of the pandemic is now behind us. But we cannot forget one horrible legacy it left in its wake — namely the treatment nurses and other health care professionals received while working 24/7 often to the point of exhaustion, risking their lives, and that of their loved ones, to care for critically ill patients. As I opined in this column, we all witnessed what happened to many of them who, once hailed as heroes, were unceremoniously fired from their jobs.
One of those nurses, who didn’t want to get the vaccine out of concern for a previous stroke she had suffered, recently lamented: “I did love my job. It was something that was really in me, in my heart. It was what I did my whole nursing career. So, to get forced out was a huge life changing circumstance for me.”
These weren’t suicide bombers. Political expediency, the lack of science-based decisions and the unwillingness to consider individual health circumstances with respect to vaccine hesitancy was quite problematic, both for our nation’s leaders and for the physical and mental health of the country. Although top health experts continued to question many of the decisions around vaccine mandates and other health protocols that were put in place, employee terminations at major hospitals and health systems did not stop – even after the worst of the disease had subsided. While the pandemic certainly accelerated the depletion of our clinical workforce, with burnout, age and other factors coming into play, that exodus started long before Covid.
In a recent column, I explained why primary care physicians (PCPs), the most critical providers in the healthcare delivery system, are being sidelined today. It’s due, in large part, to a “test more, treat more, consume more” healthcare-based payment system that has disincentivized and punished them for doing their number one job: spending the time needed with each patient in order to get an accurate diagnosis.
And, even though the nation’s largest payer, the Centers for Medicare and Medicaid Services (CMS), has been trying for 40 years to achieve better health outcomes for patients at lower cost, their attempts at reforms have failed, both at connecting payment to outcomes and fostering the all-important patient-physician relationship. The reason? CMS has caved to immense pressure from powerful lobby groups that represent health systems fiercely resistant to change. Fed up with trying to figure out complex billing codes and the onerous and time-consuming task of filling out reimbursement paperwork, many physicians have decided the squeeze just isn’t worth the juice anymore.
There are certainly no easy solutions to fix a broken healthcare system that is expensive, inefficient, and confusing to navigate, but government incompetence has only made matters worse.
This month, the State Department announced a freeze on the processing of EB-3 work visas for foreign-born nurses coming to the United States. These registered nurses (RNs), who comprise 16% of the U.S. nursing workforce, have historically played a critical role in support of healthcare delivery-especially in times of shortages.
An “administrative backlog” is to blame for the predicament, but it begs a larger question. How is it that we can send 1,500 active-duty troops to the U.S.-Mexico Border to support an overwhelmed Department of Homeland Security in an administrative capacity but the government can’t find the personnel to process green cards for nurses who are in great demand right now?
As one Marine Corps veteran who served on the border remarked “this deployment isn’t “a serious plan,” and “insults our troops and fails to fix the problem.” Beyond the border, the government is going to pump $80 billion into the IRS, which includes plans to boost the agency workforce by 87,000. It’s clear that something is seriously amiss with regard to our priorities.
Of the green card moratorium, one executive of an organization representing nonprofit aging services providers said “without staff, there is no care.” The head of the American Association of International Healthcare Recruitment added that this situation “is dire for our hospitals, who have become more dependent on this workforce.” In addition to clinical staff shortages, another major crisis looms large that also could have been avoided.
One of the pandemic’s other painful legacies that bears reinforcing is that ignoring social determinants of health (SDOH) left millions of Americans with serious underlying conditions highly susceptible to the ravages of the virus. With more than 1 million American deaths and more than 6 million hospitalizations reported to date, we have all paid a high price for that decision. And, when you think now about the influx of migrants coming to our borders, a perfect storm is brewing that is already testing a healthcare delivery system under severe financial and operational duress.
Dr. Marc Siegel of NYU Langone Health painted a troubling picture. “Those regions at the border are medically underserved to begin with.” He added, “There are no doctors. There are no nurses. There’s a tremendous amount of obesity and diabetes…Then we’re talking about things like tuberculosis, where two-thirds of the foreign cases come across that border. We can’t treat them.”
Senator Sanders has a $200 billion plan to help rescue a sinking ship, including $60 billion to grow the healthcare workforce. But history has taught us that what legislators and regulators fail to realize when it comes to “fixes,” is that amid a flurry of new laws and mandates, sometimes less is more. The same can be said for massive new federal spending.
Sadly, no amount of funding will bring our departed and once cherished healthcare workforce back. As Sanders and company sit in bewilderment, wondering what has gone so wrong that our healthcare delivery system is lying in critical condition, they might want to start with some serious introspection. Until then, doctors, nurses and patients alike will continue to rush to the emergency room exit doors.
Some 40 years ago, President Ronald Reagan said “I think you all know that I’ve always felt the nine most terrifying words in the English language are: I’m from the Government, and I’m here to help.” Those prophetic words still ring true today. It’s scary to think about the journey that has gotten us to this point and what may lie ahead.
Senator Sanders was also right when he said “we’re really not prepared” for the next pandemic. But, amid the morass we now find ourselves in, continued missteps and lack of foresight in preparing for storms that were predictable, our legacy can’t be “Our Deepest Thanks To All Of You — Our Heroes…Now You’re Fired.”