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Will Healthcare's Staffing Shortage Ever End? · CareTalk: Healthcare. Unfiltered.

• 0:00
  Will the healthcare staffing crisis ever end?
• 0:03
  We were talking about shortages five years ago and then, then things went really crazy during the pandemic.
• 0:08
  But even as a lot of the economy has returned to normal, healthcare workers are still in very short supply.
• 0:15
  So do we have to just wait a little bit longer or is the shortage of healthcare workers going to be with us forever?
• 0:28
  Welcome to Care Talk America's home for incisive debate about healthcare, business, and policy.
• 0:33
  I'm David Williams, president of Health Business Group.
• 0:36
  I'm John Driscoll, the president of Walgreens Health Summer's here, and it's time to choose what to read during those lazy days on the beach.
• 0:44
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• 1:14
  So, David, David, David, this is not a new topic.
• 1:19
  How big a problem is the healthcare shortage?
• 1:22
  Healthcare staffing shortage.
• 1:24
  It's a real problem.
• 1:25
  John, I was speaking to, uh, one of the leaders of a statewide healthcare, uh, statewide Health and Hospital Association earlier this week, and she told me there are unfilled jobs in every department in a hospital.
• 1:35
  Any kind of a nurse, physician, also administrator, support cafeteria.
• 1:40
  It's really, it's, it's pervasive.
• 1:43
  And they say at about a million physicians that are out there, the American Association of uh, medical Colleges says something like 124,000 shortage, uh, within a few years, including 50,000 primary care docs, uh, nurses that we talked about.
• 1:58
  It's, it's, it's worse than that because really it's not, Well, there's just under a million, you know, active people with active license.
• 2:05
  In the US only about 686,000 are actually practicing.
• 2:10
  And so you're really looking at, you know, with a hundred thousand looking to leave a pretty material hit.
• 2:17
  And, and the con the, the social context here ain't great.
• 2:21
  Because of the baby boom.
• 2:22
  You've got 10,000 people turning Medicare eligible age 65 every year.
• 2:27
  We're not gonna ask you your age, David, and that, that, that, that, that brings with it a bolus of chronic conditions as America goes from fit to fat and we continue to have.
• 2:40
  Rapidly growing problem with diabetes and coronary heart disease.
• 2:45
  The two most dangerous things that are happening that is, you're even more likely to have that as older ages.
• 2:52
  We need pandemic, really burned a lot of folks out.
• 2:57
  John, you love to blame the old people, and I certainly deserve their degree of blame, especially those having birthdays.
• 3:02
  Happy birthday, not, you know.
• 3:04
  But there's also, we gotta blame the youngsters too, John, because there's a, a lot of, uh, the youth that are having trouble, uh, mental health issues, uh, some, you know, summing from the pandemic.
• 3:14
  And then at the really early age, John, there is a big increase in the number of autism diagnoses.
• 3:19
  Those folks are gonna need more care and more behavioral health.
• 3:22
  Up 50%.
• 3:24
  Now, I don't know how, whether that's that's really an explosion in autism or we're really getting better at diagnosing it.
• 3:31
  But what that all speaks to is the social burden of healthcare.
• 3:36
  And ultimately, all of us wanna be cared by humans.
• 3:39
  Well, most of us.
• 3:40
  Maybe you're hope, happy with the robot, David, US care about that.
• 3:45
  Let's, let's about nursing's.
• 3:48
  Nurses, you know, in, in the country, and a substantial proportion of them wanna retire and get out of the profession because they're having to deal with more and more demand because of the, the, the, when you, you don't have enough staffing in hospitals or in ambulatory care areas, what happens is that the nurses who are there end up having to do more work.
• 4:11
  And then it's, it's sort of a do loop.
• 4:14
  Yeah, that sucks.
• 4:16
  You know, it sounds pretty bad.
• 4:17
  And you know, one of the problems they have actually of training new nurses is some people wanna go to nursing school, but you know, being, they don't pay the nursing faculty enough, you can make, you know, double or triple just working as a nurse.
• 4:27
  Exactly.
• 4:28
  I mean, the problem with the shortage is it's perverse economics because nurse wages have gone up at a time when the difference between a nurse, teacher and nurse.
• 4:40
  Is to your 0.2 to three x.
• 4:42
  And while we are in a crisis of needing nurses, we don't have enough slots in nursing schools because of that, and also because of the, the way things are chartered and accredited.
• 4:52
  But just in the last few years, we've turned away eight, over 80,000.
• 4:57
  David candidates to become nursing just cause there weren't enough slots.
• 5:01
  So let's, let's talk a, a little bit more about, you know, let's throw more, a couple more problems on the heat before we start talking about solutions.
• 5:08
  So, you know, there's another problem too, which is reduced immigration.
• 5:11
  Used to have more nurses that were, you know, coming in as, as immigrants.
• 5:15
  You've also got people living longer.
• 5:16
  You know, how dare they Not just turning 65 John, but keeping going.
• 5:20
  Uh, you know, for, uh, for a while.
• 5:23
  Um, and so you've got stay on that side too.
• 5:25
  Stay, stay, stay on that immigration point because that's really a major problem.
• 5:31
  We've got actually a solution for allowing workers to, United States used to have ability to get bipartisan agreement to bring in doctors and nurses from other parts of the world.
• 5:45
  We happen to be the employer of choice for healthcare workers around the world.
• 5:49
  Cause we pay more than anybody else and it's a pretty decent place to live the United States of America.
• 5:53
  And yet, and yet we can't get bipartisan agreement.
• 5:57
  There are estimates of hundreds of thousands of doctors and nurses in who are qualified, trained, and in some cases have been in practice for a while.
• 6:05
  Would love to move.
• 6:06
  And we just can't move the, we can't move the, the structural impediments to allowing them.
• 6:12
  But I, I do think that we're getting to a point, a breaking point.
• 6:14
  David, you look at Ochsner Health's system, one of the leading health systems in, in, uh, new Orleans, you know, they had a thousand openings, a massive system.
• 6:24
  It's a small number of openings, but they had to closes.
• 6:30
  That demand shrinking capacity to care.
• 6:33
  I do think some of these things are gonna ha or will move.
• 6:36
  Alright.
• 6:37
  I mean, the one other thing too, John, is a low birth rate.
• 6:39
  If we don't have immigration now, and I know you've done your part and I've done my part, I don't have planning to have any more kids.
• 6:43
  You don't have to, you know, you don't have to make it official here on the, uh, on the Care Talk podcast.
• 6:47
  But, uh, you know, that's another solution, Mel, we'll say.
• 6:50
  I'll, I'll let you take the fifth on that as long as the constitution's still in, not, hasn't been suspended.
• 6:54
  So let's talk about, that's enough about problem John.
• 6:56
  How about some solutions?
• 6:57
  What can be done?
• 6:58
  What's being done?
• 6:59
  I, I think that there's a, I mean, one of the most interesting aspects of Generat ai.
• 7:05
  Is, you know, not the stuff you read about, but the stuff that really can solve substantial problems.
• 7:10
  An enormous amount of money is spent and time is spent, and labor time is spent on office work, on documentation, on reconciliation.
• 7:20
  And those are, those are rules driven problems where if you can get them into a generative AI context, you could actually train a model to solve those problems faster.
• 7:31
  I think there's a big opportunity for generative AI and AI in general in the diagnosis area where they could be augmenting the good work of doctors and nurses and being a tool at the fingertips.
• 7:44
  So if you think about back office, Diagnosis.
• 7:48
  I think that, uh, al artificial intelligence can really meaningful care and scale it and potentially actually help extend the.
• 8:01
  That makes sense.
• 8:02
  John, you know, the thing about generative ai of course, is it can, uh, hallucinate.
• 8:05
  Uh, and so maybe that's what, you know, that's what maybe some of these claims processing needs.
• 8:09
  I, I saw an article in the Wall Street Journal, John, they're talking about in Silicon Valley, the big thing is psychedelics too.
• 8:14
  So it may not just, not just the generative AI that's hall you make you in the midst of a silly point.
• 8:20
  You make important most this reconciliation.
• 8:31
  You can train those models based on activity you've currently got.
• 8:34
  You're not asking it to, you know, write, write a, write a sonet for you.
• 8:38
  Um, and so you can test it, you can, you can actually test what the model creates against what the people with a conventional computer can create.
• 8:47
  And that's how you actually train these models and put guardrails around.
• 8:52
  Its diagnosis isn't.
• 8:58
  The nurse or the doctor, but in the same physician.
• 9:03
  Were modestly trained, trained around specific diagnosis and skills.
• 9:10
  We.
• 9:11
  You know, physician extenders that are, that are, that are, that are, that are, that are software based.
• 9:15
  I mean, I, I think that's very doable.
• 9:17
  I mean, you don't have to get into R2D2 category.
• 9:19
  Yeah.
• 9:19
  Uh, uh, Dave, actually, your, your robotic friend.
• 9:23
  I was, get into that.
• 9:24
  I was gonna get into that.
• 9:25
  John, like one of those things I could have like an extender from my arm as well.
• 9:28
  I could like, you know, go over and I could stretch and I could reach a patient without even have to walk to their room.
• 9:32
  But John, one of the things that actually, you know, hospitals, unlike some other businesses, Have actually, they've had to stay open.
• 9:38
  They've had to solve the problem on a short term basis.
• 9:41
  They, you can't just close an emergency room down and say, yeah, I couldn't find enough staff.
• 9:44
  You know that, that's a very extreme thing.
• 9:47
  So what have they done?
• 9:47
  Well, they've had travel nurses and that's been, you know, like triple Well that's a disaster's, a travel nurses, well, because the travel nurses basically your filling the industry grew up sort capacity nursing, like if you.
• 10:04
  The Tulsa hospital would hire someone for a couple of months, and so by definition they would pay a lot more.
• 10:10
  Cause you're asking someone to travel, it's on demand, and so you, the, uh, it's sort of an emergency.
• 10:16
  Well, during the, the, the public health emergency and the covid epidemic, what happened is that became normal course, and it systematically increased the costs of nurses mean typical nurse costs for hospital.
• 10:31
  Over the last few years are up 60 to 80% because of the demand on nurses.
• 10:36
  But the rates for travel nurses, those capacity, those folks who kinda extended the capacity of hospitals have gone up up six to seven x or six to 700%.
• 10:46
  And so, and, and inevitably when that happens, it becomes a good business.
• 10:50
  So investors followed in and they're trying to, trying to get more nurses to leave their jobs and travel, which creates more slots.
• 10:58
  I mean, so it's, uh, it's, it's, it's it's demand for investment machine actually creating more demand for itself.
• 11:09
  It's, again, it's a, it's a, it's a doom loop, and I think there's, there are ways around it by paying nurses fairly and giving them really stable jobs.
• 11:17
  I mean, I, I think that what this speaks to is the hospitals and care system needing to figure out better ways to care for doctors and nurses because they don't feel well cared for.
• 11:27
  They don't feel, uh, I.
• 11:30
  Respect and connection and, and inevitably in a crisis that's gonna happen.
• 11:34
  But, um, you know, this, this has gotta start with, uh, uh, the, with leadership and management of hospitals.
• 11:41
  The other thing, David, is the job has gotten harder.
• 11:43
  I mean, there are violent incidents every day in nearly every city hospital in America.
• 11:48
  And that was not true before the public health emergency.
• 11:52
  John, there are, there's another rule for, uh, technology here.
• 11:55
  You know, one of the big issues, uh, for nurses and other healthcare professionals has been staffing.
• 12:00
  You know, staffing is a, is actually remarkably complex, uh, from even just a mathematical standpoint and nevermind sort of the relationships and, you know, such and such needs to be here for an appointment, whatever.
• 12:10
  Um, but that's actually something that has been addressed in other industries, like in transportation.
• 12:15
  If you think about, you know, the ability to call an Uber, uh, or Lyft, um, on demand, so, It's similar, some of the same technologies are actually starting to be used in hospitals.
• 12:25
  Uh, instead of just saying like, here's my rigid shift and here's your schedule, uh, for the week, that's something that can be done.
• 12:30
  So that's happening even now.
• 12:32
  Um, longer term, you know, there are some things that can be done to sort of expand the supply.
• 12:37
  And I know some of the hospital associations are trying to actually encourage more people to go into healthcare.
• 12:42
  Uh, there are government permits.
• 12:43
  There's but there's, but there's not enough slots, David.
• 12:45
  I mean, you've got, you know, you don't have enough residency programs.
• 12:48
  Cause those are, those are the training programs after medical school that lead to that, that are the actual practice of doctors.
• 12:54
  And that's because it's funded by Medicare, which is running outta money.
• 12:58
  You don't have enough slots in nursing schools cause there aren't enough professors.
• 13:01
  I mean, if, if the government's really gonna get involved here, they've really gotta make a systematic investment.
• 13:06
  You know, by, uh, I think that, that, you know, we we're gonna be losing a material amount of doctors and nurses by 2030, and that's a massive problem.
• 13:16
  All right, John, well, so you won't let me do, you won't let me tick off the run of the mill solution.
• 13:20
  Should we go a little more radical?
• 13:22
  Sure.
• 13:23
  All right.
• 13:23
  So one thing is, you know, so I, you know, I, I've been reading the Wall Street Journal, John, I can't afford the subscription anymore, so I must have just seen a copy on a bus bench or something.
• 13:30
  But in addition to the, uh, article, article about, uh, the psychedelics, I saw something about people working until their eighties.
• 13:37
  And, uh, in somebody cases to their nineties.
• 13:40
  And I think that the, um, you know, they could, we should raise the retirement age and get people to, you know, hang, don't get the idea that you have to stop working when you're 60 or, or 65.
• 13:49
  Let people continue working.
• 13:50
  That's, that, that's an okay.
• 13:51
  David, that's a, that's a patch.
• 13:52
  I mean, it's, it's sort of like paying nurses a little bit more to, to not leave the workforce.
• 13:56
  Like we need to systematically increase the number of nurses and doctors cuz we've got an older population.
• 14:02
  And we gotta do it through some combination of increasing the number of resources to.
• 14:10
  I think improving our immigration policy, we could, we could, even, the amount of debt also that a lot of doctors and nurses have in order to get educated is insane.
• 14:19
  We need to, we could easily make being a doctor, uh, a a lot more affordable, which could actually help encourage more and more particularly diverse populations to pick it as a career.
• 14:34
  We're not gonna, our healthcare costs will go up if we don't care for the most vulnerable among us.
• 14:40
  And so I, I think this is a critical structural problem.
• 14:43
  And you can have all your gray-haired friends be, you know, I, I don't want them doing surgery on me day.
• 14:49
  Um, but I think that, that, that will help.
• 14:52
  But it's a, it's a modest patch for a major problem.
• 14:56
  Well, John, another thing, I know you hate drugs, but one thing if we don't need staffed for someone to, you know, to take a pill and you know, for example, some of these weight loss drugs, if a lot of the chronic illnesses are caused by people being overweight, maybe we should be pushing everybody to be on a weight loss drug, and then maybe that'll reduce the need for healthcare staff.
• 15:12
  Take care of 'em.
• 15:12
  Dave.
• 15:13
  Hey.
• 15:13
  Hey Dave.
• 15:14
  You're just bouncing among the wall off the walls here, like Ozempic, Maro, like we don't know the long term effect of the GLP ones.
• 15:21
  These drugs that are, that are.
• 15:23
  Lose a lot of weight fast.
• 15:25
  I mean, fefe could too.
• 15:26
  I mean, let's, let's hit the pause button on this.
• 15:28
  Everybody is using it as a lifestyle drug when it was really meant for people who were morbidly obese and, and, and, you know, and, and, and were clinically in a situation where you had to take that drug.
• 15:39
  I'm, I'm really nervous about, um, the popular explosion of ozempic categories, the GLP show, great results.
• 15:53
  Great weight loss drug shown great short term results and most them corollary challenges.
• 15:58
  So I don't think that's a solution and it just, It.
• 16:02
  Um, you know, honestly, that's a pathetic idea.
• 16:05
  All right.
• 16:05
  I got another one, John.
• 16:07
  Okay.
• 16:07
  All right.
• 16:08
  Ultra processed foods.
• 16:10
  So a big problem is what people eat.
• 16:12
  Okay?
• 16:12
  Totally.
• 16:13
  If you go back to eat and go Hunter gather stuff, now you're talking, now you're talking my language.
• 16:16
  I mean, if you think about this, the, the, the, the we in the farm bill.
• 16:21
  Every couple of years authorize a bill that subsidizes the worst kinds of, you know, corn.
• 16:27
  And so I, things that actually keep that, that bring the cost down of things like sugar and corn that are directly related to our diabetes problem.
• 16:37
  There are, there are the most of the major, uh, pain points in our healthcare system, coronary heart disease and diabetes, are directly related to diet diet.
• 16:49
  I think we, we saw when people talk about diet, lifestyle, it's really diet.
• 16:53
  I mean, and people don't know what they don't know.
• 16:55
  I mean, we don't actually invest in, although CMMI is starting to invest in, um, programs in diet related diet sensitive chronic disease, which are all the major chronic diseases.
• 17:07
  Um, you know, uh, my wife's company nourished so.
• 17:18
  Changing the curve of premature birth.
• 17:21
  I mean, there are, there are, they're seeing results in with coronary heart disease.
• 17:26
  And these are possible, but we need to government funding the wrong subsidies in agriculture that create, uh, big, wrong problems in our healthcare system.
• 17:38
  John, we don't normally break news on this, uh, on this show.
• 17:41
  However, I think you have, you've just indirectly said that you are not gonna be the 57th.
• 17:45
  Uh, Candidate for the Republican nomination for president with what you just said about Iowa and corn.
• 17:51
  So, uh, all right.
• 17:52
  You heard it here first.
• 17:53
  So John, the other thing is, let's just finish it up and talk about, you know, we're talking about the US and we have talked about immigration as a solution, but immigration to the US of healthcare workers is a problem for people in other countries.
• 18:05
  You know, they have the healthcare staffing shortages too.
• 18:08
  What do you think about that?
• 18:10
  I, you, I to our problems honestly ought.
• 18:15
  Willing to educate the world, but we need to solve the problems in front of us.
• 18:19
  And I think that that's, that's, that's job one.
• 18:22
  Once we solve our problems, I think should extend the reach, education, and support.
• 18:29
  And we can do that largely through the, the, the best medical education, the best medical schools and educational system, the road, which is in the us.
• 18:37
  But we have to solve this problem, David, or it's gonna directly relate to the, it's gonna directly relate to, um, lifespan in the us.
• 18:46
  I mean, it's, it's that, it's that, it's that it's that critical.
• 18:49
  Well, that's it for yet another episode of Care Talk.
• 18:51
  Do you have a topic that you'd like John and me to discuss on this show, uh, some important healthcare business or policy issue that we've neglected or you just wanna hear more about?
• 19:00
  We'd love to hear from you.
• 19:02
  Drop a note to me, david@caretalkpodcast.com.
• 19:06
  If we use your idea, we will say hi.
• 19:08
  On the show, wanna thank you and even send you something special from the Ki Talk merch store.
• 19:14
  I'm David Williams, president of Health Business Group and not a candidate for any office.
• 19:19
  And I'm John Driscoll, the president of Walgreens Health.
• 19:22
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