No One on Duty: Will Healthcare Be in Jeopardy in 2020?

Medically Reviewed by Gary D. Vogin, MD
From the WebMD Archives

Feb. 21, 2001 -- Elissa Passiment has spent the entire morning on the phone with home-care nursing agencies. Her mother is critically ill, and Passiment desperately needs a nurse's aide to provide some very basic personal care.

"We went through all the city agencies," says Passiment, calling WebMD from her office in Bethesda, Md. "They're all having trouble filling that level of position."

A crisis is brewing in America's health care industry -- one that could threaten the care your family receives in a hospital intensive care unit, emergency room, and -- with the trend toward outpatient care -- at home. There simply are not enough nurses, technologists, or other health care professionals to fill all the vacant positions.

"I know it's been hard to recruit good nursing aides and good techs," Mary Foley, MS, RN, president of the American Nurses Association, tells WebMD. "If you can make $10-$15 an hour working in a store, you may not want to take care of someone who is old and sick. It's hard work."

A shortage exists, too, among registered nurses -- those who care for the very sickest patients. For instance, Maryland has a 15% vacancy rate in its hospitals; in Georgia, it's at 13%. Those nurses are also leaving for better-paying, less-stressful careers elsewhere.

"It's a serious issue," Michael Jellinek, MD, a senior vice president at Massachusetts General Hospital in Boston, tells WebMD. "Across the country, I'm hearing about shortages in nursing, that it's been hard to recruit technicians to do mammography, MRI, CT scans -- the more sophisticated technical positions."

"We're very, very concerned," says Passiment, who heads the American Society of Clinical Laboratory Science, a professional organization for laboratory technologists. "If we cannot address this problem, access to care will definitely be compromised 20 years from now. It's a grim picture, to be honest."

In the field of radiology alone, there's a 28% vacancy rate across the country for skilled technologists, says Gerri Sharp, RTR, director of radiology medical imaging services at Piedmont Hospital in Atlanta. "The volume of diagnostic imaging tests being ordered is getting higher and higher, and if you're short-staffed it breeds more stress, longer hours."

Such shortages affect an entire hospital, especially the emergency room, Sharp tells WebMD.

"Because of the managed care environment, we are seeing more people coming into the ER as their first source of access," she says. "Of course, that puts more pressure on staff trying to take care of those who are critically ill and really need the ER."

Just last week, a handful of the nation's health care leaders met with members of Congress to address these issues. Their mission: to draw attention to the immediate and long-term repercussions of these labor force shortages. The American Hospital Association -- which represents the nation's nearly 5,000 hospitals and health systems -- has also launched a blue-ribbon commission.

It's a complex problem with no easy answers, industry leaders say.

The aging "baby boom" generation is creating more demand for healthcare services, says James Bentley, senior vice president for strategic policy planning at the American Hospital Association. However, the size of the workforce has decreased steadily -- with no end in sight.

Predictions made at the Congressional hearing were startling: While the nation will need 1.7 million nurses by 2020, just over 600,000 will be available.

People aren't drawn to health care as a profession, not like they were 20 or 30 years ago, says Bentley.

"In the 1960s, when baby boomers started entering the workforce, health care was attractive as a career. In a manufacturing economy, we were high-tech. Now we're in an information economy, and many people perceive us as low-tech. Right or wrong, that's how they perceive us. If you think of this as hands-on care, touching sick people, you have a different view than if you see this as the wired ICU."

Hospital employment, once viewed as stable, now faces looming mergers, closures, and downsizing, says Bentley. And while nursing was once one of the few careers open to women, that's all changed.

Other things that have changed: There's not so much "emotional compensation" for health care workers as patients' hospital stays have shortened. There's much more emphasis on documentation and paperwork. The "24/7/365 world" of health care also makes it less attractive.

Another problem, says Passiment: The healthcare workforce is aging.

"The majority of people working in health care today entered the profession in the 1970s and 80s," she says. "The median age in our profession is 47. That means 50% of practitioners are over age 47, and retirement is looming for all of them."

If the shortage problem is not stemmed, your healthcare in the year 2020 will likely be much different. Among the changes:

  • Elective surgeries will get deferred. Hospitals will begin offering fewer services. More patient care units will be closed down in hospitals. "I am not one of those who thinks we're going to wind up with a treadmill, rat-race kind of hospital environment," says Bentley. "I think nurses will simply leave the profession in increasing numbers, saying this just isn't worth it. They will look for other opportunities. Hospitals will have to change the work environment or limit the number of patients they can handle."
  • Hospital pharmacies would have to reduce services and cut back staffing schedules. "There will be no other alternative," says Charles Myers, RPH, MS, MBA, vice president of professional and scientific affairs for the American Society of Health-System Pharmacists. "We feel that every pharmacy in every hospital should be staffed 24 hours a day, but that won't be possible. There's a good deal of worry about this, that if the shortages become any worse, it could impact patient care. Lots of our members are starting to say, 'We're feeling very, very concerned.'"
  • Outpatient support services will deteriorate. "It's really going to fall on the "nexters," or whatever you want to call the next generation," says Passiment. "They're going to find themselves in a caretaker role that is remarkably different than what the baby boomers are finding with their parents. They're not going to have the support services they need when they need them."
  • The possibilities of the human genome project would not be realized. "The mapping of the genome project has such incredible potential for our future," Passiment tells WebMD, "but it's the laboratory technologists who will help make that happen. If all those people are not in place, the advances will not be made. We will not be better off than we are today. We will just be marking time."

So what's being done?

"I don't want to feed the fever of frightening people," Foley tells WebMD. "We see the warning signs. Now let's gather our resources. The public needs to say that putting my family and me at risk is not acceptable."

She's firing up nursing leaders across the country, getting them to recruit more nurses and address short-term hospital problems -- like adding more staffing and equipment on patient care units. Providing specialty training and better pay is also a critical piece of the puzzle, says Foley.

"The hospital industry has not invested well in giving nurses specialty training," Foley tells WebMD. "We have a backlog of nurses who have not been prepared for critical care units, emergency care, labor and delivery, and surgery. All they need is a stipend to cover living expenses, and they do very, very well. They stay employed rather than move on. They can really contribute their many years of expert nursing instead of running around, trying to keep the Band-Aids on."

At Massachusetts General, Jellinek says, "We've paid a lot of attention to this. Our nurse vacancy rate is pretty low and our nurse retention rate is pretty high."

Other hospitals can learn from what's helped Massachusetts General: Bringing on temporary workers to shore up nursing units when necessary. Establishing training programs through local community colleges. Setting up internal education programs to help people build career paths. Giving bonuses to employees who bring on a friend. Getting high school and college students involved in internships. Accepting welfare-to-work programs. Providing opportunities to work in suburban hospitals, to alleviate commuting hassles.

Massachusetts General also puts a lot of emphasis on cultivating good morale, says Jellinek. The philosophy: "Once we have someone, we don't want to lose them when they advance in their career. We want to facilitate that advance."

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