Will Healthcare Survive The Great Resignation?

The Great Resignation has come for healthcare. Here’s what we should do about it.

Since the pandemic began in early 2020, US healthcare has lost almost a half million workers. This has created a smaller healthcare labor force, just as the demand for healthcare services is higher than ever. Out of the remaining workers, almost 1 in 5 report being in new positions since the pandemic began.

These numbers suggest that most of the 18% of workers who recently quit switched to a new job (and likely got a higher wage). But clearly hundreds of thousands of healthcare workers just left the workforce entirely.

Healthcare is a team sport

Out of a total of 22 million healthcare workers, the loss of a half million people wouldn’t normally be catastrophic. But overlaid on top of the pandemic, this loss has made a difficult situation much worse.

If you work in the hospital, you’ve seen the effects of the Great Resignation. The same ICU nurse that used to watch over just one or two sick patients a shift has now been asked to watch more patients during the pandemic. The scrub techs and CRNAs are all being asked to stay overtime to cover cases. And the physicians are being asked to see more patients and do more with less.

In my own hospital, I’ve seen the turnover rates of workers increase everywhere from the OR to the clinic. The baseline quit rate is now higher, with some opting for early retirement and others finding new jobs that offer better work-life balance or compensation.

What about physicians?

Amongst my physician colleagues, I noticed that the pandemic accelerated the timeline of those who were already on the cusp of retirement.  There was a wave of retirements a couple of months into the pandemic.

The rest of us stuck around to see what developed.  While there hasn’t been a mass exodus of doctors leaving medicine, that doesn’t mean that physicians have been spared from damage.

As a surgeon, I now feel a permanent sense of disorientation and whiplash from the past year. With every new spike or ebb in Covid cases, our ORs are either on the brink of government induced shutdown or creaking under the strain of massive suppressed demand.

Chin up, shoulders back

At first glance, you might think that doctors are approaching the pandemic with the same “chin up, shoulders back” mentality that permeates American medical training. But if you probe a little deeper, there are widespread feelings of exhaustion, moral distress, and high levels of burnout.

I’m not immune to these feelings either. Lately, I’ve noticed myself questioning my faith in the basic goodness of human nature. Anti-vaxxers were initially amusing, but now I realize that a lot of people in the United States share these misguided opinions. Now the phrase “anti-vaxxer” incites in me a smoldering sense of outrage and disappointment. Because of this movement, I often worry that vaccination rates will never rise high enough to prevent more Covid surges.

This pandemic-induced malaise permeates much of my day to day and adds an extra dose of friction to every patient encounter. And there’s only so much my current employer can do to mitigate this feeling. Resilience training and gratitude lunches are helpful, but only go so far.

Quit medicine?  

In my personal circles, I know of a handful of early career physicians who’ve jumped ship. One started a coaching business. The others started real estate businesses. By and large, they seem busy and content outside of medicine.  

However, I believe that these entrepreneurs are the exception to the rule. Most physicians aren’t going to leave their jobs for their side gigs. I bet most will stay in their current jobs, despite the stress of the pandemic and the increased corporatization of medicine. 

Because at the end of the day, I think most of us like what we do. Sure, we could do without the angry patients and the life-or-death stress. But we get to help people in their times of need. So if given the choice, I think most health care workers will continue on doing what they do best.

There’s something wrong in our industry

Unfortunately, all is not well in our industry. The current state of healthcare in our country seems more and more like a dystopian movie script. Instead of the efficient, high quality care that was promised to us, we have a quagmire of red tape, prior authorizations, and documentation.

Historically, American workers eventually figure out when an industry is offering a bum deal. Through organized labor or via simple employment choices, abused workers eventually start looking elsewhere for better opportunities and careers.

When it comes to healthcare, it would be disastrous if the labor force stopped supplying the necessary amount of doctors, nurses, and all the other essential healthcare workers. Unfortunately, this is exactly what’s happening.

We cannot spare any more healthcare workers

From the vantage of my administrative duties, I know firsthand that our hospitals are groaning from the challenges of employee retention and the constant turnstile of training people. Anecdotally, it seems that half of all healthcare staff we bring on board are gone within a few short months. Some are headed back to school to pivot away from their old jobs. Others are just fed up with their job and are counting on the tight labor market to provide new job openings with higher pay and greater flexibility.

When it comes to physicians, we can’t take any more attrition. In my own field of urologic surgery, for example, we are already in a severe shortage situation. A third of the urologists in our country are 65 years of age or older. If you assume many of these urologists will call it quits soon, there’s a projected labor shortage of more than 1600 urologists within the next 4 years! The US only trains 357 urologists a year, so this shortfall is a big problem.

For physicians overall, the numbers are even more striking. Some estimates put the overall physician shortfall at 124,000 by 2034. Given that the average amount of time to train new physicians ranges from 8-15 years, this is a crisis that needs to be addressed right now.

So what is American healthcare to do?  

Just as the pandemic has driven a revolution in remote work, it’s also a perfect time for the healthcare industry to change for the better. Here’s what needs to be done:

  1. Retain our current healthcare workers with competitive salaries and benefits
  2. Improve the pathways through the medical education system
  3. Move healthcare towards an efficient and centralized system that emphasizes preventative care

In addition to securing competitive pay, we also need to redefine what it means for a position to be a “good job.” The discussion can’t just be centered around salary anymore. A better job in the future will include good benefits such as paid maternity/paternity leave. It will have a reasonable expectation of productivity with ample hands to share the load. It will have a safe work environment where the focus is not just on customer satisfaction and excellent patient care, but also on the satisfaction of its workforce.

Medical education, especially for our doctors, can be incredibly costly. This keeps many from ever starting down the road of medicine. It also warps the practice of medicine after graduation from training. It can be hard to make objective decisions with $300,000 of student loan debt in the back of your mind. It’s perhaps a rational argument that doctors make enough money to pay their debt back with time, but there is a significant variation in physician pay that I think is under-recognized. A surgeon will find it easier to pay back that debt as compared to a primary care physician.

And after just five years as an attending physician, it is so apparent to me that the delivery of healthcare in America is incredibly flawed. The relationship of our insurance companies to the actual practice of medicine is a mess. It would be comical, if only it didn’t have such negative consequences for our nation. From delays in care delivery to the victimization of the under-insured via price gouging, examples of our broken system abound.

The practice of medicine in the US is also often criticized for treating the consequences of chronic health conditions, as opposed to investing in the prevention of the conditions in the first place. There has been much written about this in the past, and there are a lot of great suggestions out there to fix our system. Until we actually do so, we are all complicit.

Healthcare workers also need greater financial strength

I’d be remiss if I didn’t also discuss the need for another element: better financial strength. A worker that exists paycheck to paycheck is a captive worker, and captives cannot drive change.

So healthcare workers need to be good stewards of their money to have the financial strength to move on from jobs that aren’t meeting their needs. While this might not sound great from the perspective of the employer, I believe that financially stable workers are better workers.

More financial strength means healthcare workers will have better health, more reliable cars, and more stable home lives. This all translates into a better quality worker. And with time, employers will be forced to create the types of jobs that are attractive to all workers, not just those who need a paycheck.

Doctors also need financial strength

This reasoning also applies to physicians.

I sometimes mention that the high income of physicians is their super power. (It certainly makes it easier to do things like invest in real estate.) But a high income is no good if you don’t save any of your money. In this situation, you’re still a captive to your job. The only difference is that your handcuffs are golden.

If you doubt that this is a real phenomenon, look at this:

The Medscape Physician Wealth and Debt Report 2019 showed that about 25% of physicians are worth under $1 million by the time they hit their 60s. For one of the highest paid job categories out there, I find this pretty startling. 

Medscape Physician Wealth and Debt Report 2019

Most Americans think that you need about $1.7 million in the bank to comfortably retire. So there are a lot of doctors out there nearing retirement age that can’t afford to retire.

But what if doctors and other healthcare workers were in great financial shape?

Don’t know where to start to get your finances in order? Read this post: How to Save, Invest, and Become Rich

The message to American healthcare: shape up or ship out

Physicians and other healthcare workers are driven away from medicine when they’re forced to work harder and longer than they desire, and when too much of their time is spent performing medical documentation rather than providing patient care. This situation, combined with lack of financial strength, causes a toxic environment where only two options exist: continue in a toxic job or quit entirely and pivot careers.

If we had more healthcare workers that were financially strong, the power would be in the hands of the workers and physicians. They could more easily push back against harsh work environments, with the confidence that comes from their financial strength.  

There is now ample evidence that our medical system is causing an epidemic of burnout. In the past, there seemed to be no real motivation for our system to change for the better. It’s my hope that the Great Resignation plus more financial empowerment will yield the spark needed to finally change American healthcare for the better.

Conclusion

The Great Resignation has come for healthcare in America.  While the pandemic might have been the straw that broke the camel’s back, healthcare has been unhealthy for quite some time.

Let’s refocus American healthcare towards a system of excellence for both our patients and our healthcare workers. And let’s create a generation of financially empowered workers and physicians to change the system for the better.  

–TDD

Do you agree or am I missing the boat? Please comment below!

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Richard Tavares Bosshardt

Daniel, I enjoy your posts and admire your mindful approach to life and finances. I wish you well. I am one of those surgeons on the cusp of retirement (one year from now) and have, fortunately, done well with my planning. I will not be rich, but will be comfortable and reasonably secure. I read this post because the title caught my eye. I disagree with you on your stance on “anti-vaxxers”. The term has come to encompass all who refuse to be vaccinated for any reason. I have followed the pandemic as close as any physician. I chose to forego vaccination early on because of distrust of the process and reporting for these new vaccines. I am not anti-vax. I get the flu shot annually. All my children were vaccinated according to schedules and my grandchildren were as well, with my approval of my children’s choices. I recovered uneventfully from Covid at 69 3 months ago. I am fully immunized with the antibody levels to prove it yet considered “unvaccinated” and rolled into that group. I have enough reason to believe that my risks from being vaccinated now are as high, if not higher, for possibly serious adverse effects, as from secondary Covid. Before you paint all unvaccinated people as “anti-vaxxers”, you need to see this in a more nuanced, scientific manner. I am ardently oppposed to mandates. We are no longer in crisis. Hospitals are not overwhelmed. We have treatment protocols for Covid, just as for flu. I believe that sentient adults should have to right to decide for themselves what to do regarding vaccination. That should be respected. The concept that we should force the entire population, including children, to be vaccinated to “save even a single life” is medically ludicrous. Covid will be with us from now on and we learn to live with it or not. I will not live my life masked and socially distanced and I will not give my civil liberties to the any government mandate that has no justification. Sorry for the long harangue. I admire what you do and wish you well.
Rick Bosshardt, MD, FACS

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steveark
4 months ago

In our small southern state we’ve seen two new Osteopath medical schools start up to go along with our one traditional medical school. I can only assume this is happening everywhere and the number of new graduating doctors is soon to increase greatly with the increasing number of DO’s. Add to that the fact that APN’s and PA’s are also taking over the role of family practice doctors everywhere and I think we are going to have plenty of physicians and the shortages are going to be in the technician and nursing ranks. We could even have an oversupply of doctors. In a similar cost saving move hospitals are replacing RN’s and LPN’s with CNA’s only requiring a year or two of community college, if that. I think the adaptation is already underway to a less expensive albeit lesser trained medical provider supply.

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