Is your hospital ready for the impending care crisis?

The answer is no.  Your hospital can't handle the patients it has now.  Healthcare is an industry awash in demand with limited supply (doctors and nurses), and a price not directly paid by the consumer.  If you have a handle on basic economics, you know this means that there is a shortage of available healthcare in our nation, also known as rationing.  That's not a political statement -- its a factual one.  Rationing or shortage means that people have to wait in line for a resource, and man, do we have to wait in line at the emergency room.  The problem is so bad that hospitals use their ER wait time as a selling point.  This problem is about to get much, much worse. 

Limited Supply: Clinician Shortages

Heather Janiszewski Goodin, MScN, RN painted a perfect picture of the impending nursing shortage in this article published in the Journal of Advanced Nursing in 2003.  The nursing workforce is largely made up of aging baby boomers (the same ones about to slam the healthcare system) and there aren't enough young nursing students coming through the pipeline to fill the empty spots.  This is a very serious problem we are facing indeed, given that the Bureau of Labor projects the number of open nursing positions to be 1.05 million by 2022.

That's not even the worst part; doctorally prepared nursing professors are also retiring too quickly to be replaced -- seriously crippling the capacity to produce enough qualified RNs to fill those 1.05 million open positions.

A less talked about but equally dire situation is an impending physician shortage.  It's true that new medical schools are popping up around the country, but residency positions are stagnant.  These positions (funded by Medicare) control how many fully trained doctors are produced by the US every year.  

             Graphic via @HFNewsTweet 

             Graphic via @HFNewsTweet 

If residency position growth remains stagnant, a shortfall of 46,100 to 90,400 physicians could appear by 2025. 

High Demand: Baby boomers and the aca

With the introduction of the Affordable Care Act, the demand on the health system is going up.  According to HHS, approximately 11 million people have been newly insured by the ACA and Health Care Marketplace.  The goal is to provide health plans to all uninsured Americans -- meaning 42 million new patients.  

This is already putting too much strain on the available infrastructure -- 75% of emergency physicians are reporting increased ED volumes.  

Source 

Over 80% of these same physicians believe that their emergency departments are not prepared for this increase in volume, and 40% say it is taking a negative toll on quality of care and patient safety.  The increased volumes potentially caused by the ACA don't even come close to baby boomer healthcare usage.

According to the 2010 Census Brief "The Older Population", the "leading edge" of the generation turned 65 in 2011.  The 65 year and older population is at 40.3 million and is growing at a faster rate than the total US population.  This rapidly growing generation is in its hockey stick period healthcare utilization.  That means they are using healthcare more often than they ever have, much more often than any other age group.  This combination of a massive population with a massive usage of healthcare (weeks in the hospital, LTC facilities, increased primary care visits) accounts for a 14% overall increase in healthcare demand by 2025.

Healthcare "Rationing"

Most people dislike this phrase.  Well, if there are 2 doctors in the ER and 100 patients, someone is going to stand in line.  Triage dictates who gets seen first, so the line for some patients can get longer and longer as more emergent patients enter the ER.

Long waits cause patients to leave the ED, ambulances to get diverted, and so on.

That's why hospitals must fix their capacity problems.  You want people to get the health care they need (at your hospital!) -- so you must increase supply to meet the demand.

Unfortunately, is impossible for the healthcare system to build enough capacity to handle all these patients.  I don't mean capacity in terms of new hospitals and facilities, but in terms of clinicians.  It is beyond the power of a single hospital to fix the supply and demand problems we face, but we can change how we react to these problems.  

To learn more about no cost changes to manufacture capacity at your hospital, read our tips on fixing a crowded Emergency Department