Latest / Becker’s Healthcare Podcast / Healthcare Workforce Shortages and the Financial Strain Threatening Care Delivery with Dr. Harry Severance

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Healthcare Workforce Shortages and the Financial Strain Threatening Care Delivery with Dr. Harry Severance · Becker’s Healthcare Podcast

• 0:00
  Hello, and welcome to the Becker's Healthcare Podcast.
• 0:02
  My name is Chanel Banger. And today, I
• 0:04
  have the pleasure of speaking with doctor Harry
• 0:05
  Severance,
• 0:06
  a brilliant healthcare strategist who joins the podcast
• 0:09
  today to share insights into some daunting statistics
• 0:12
  surrounding provider nursing shortages,
• 0:15
  advice for leaders, and a bit more. Doctor
• 0:17
  Severance, thank you so much for joining me
• 0:18
  today.
• 0:20
  Glad to be here. Glad to be able
• 0:22
  to speak to these critical issues in our
• 0:24
  health care workplace.
• 0:25
  Great to have you. And to get us
• 0:27
  started, could you please introduce yourself and tell
• 0:30
  us a bit about your background and work
• 0:31
  in health care? Sure.
• 0:34
  I'm,
• 0:35
  I guess I'd call my politely mature physician.
• 0:39
  I've been providing clinical care for several decades.
• 0:42
  Over the past, I'd say decade or more,
• 0:44
  I've also,
• 0:45
  I've been
• 0:46
  a healthcare strategist, nationally
• 0:49
  recognized, I advise
• 0:51
  several organizations
• 0:52
  on these critical issues that are impacting
• 0:55
  our health care system, our delivery system,
• 0:59
  the whole health care gamut as a whole.
• 1:02
  Got it. Got it. And now getting into
• 1:03
  those critical issues, can you speak on
• 1:06
  some of the statistics and what's going on
• 1:08
  with the shortages of clinicians, nurses, and other
• 1:11
  health care leaders?
• 1:12
  Sure. Absolutely.
• 1:14
  As we all know, there are multiple
• 1:16
  disruptors
• 1:18
  engaging
• 1:18
  our health care system, our delivery system. And
• 1:22
  one of the most critical
• 1:23
  is our ongoing loss
• 1:26
  of hands on health care workers, our doctors,
• 1:28
  our mid levels, our nurses, our respiratory and
• 1:30
  physical care. All of those that provide care
• 1:34
  to you when you show up
• 1:36
  for seeking health care, we're losing those numbers.
• 1:39
  One of the critical early numbers,
• 1:42
  2021,
• 1:43
  we lost approximately 20%
• 1:46
  of all hands on health care workers in
• 1:48
  this country
• 1:49
  left health care delivery.
• 1:51
  Now granted,
• 1:52
  that was
• 1:54
  mainly due to the COVID epidemic,
• 1:56
  but the problem is those workers have not
• 1:59
  returned.
• 2:00
  And then this year, another,
• 2:03
  additional twenty five percent of physicians,
• 2:07
  twenty five percent
• 2:08
  have either already
• 2:10
  quit this in the past eighteen months
• 2:13
  or are in
• 2:14
  planning stages of leaving health care. And many
• 2:18
  of these
• 2:19
  are not retirement aid, not the classic. I'm
• 2:22
  talking about people in early mid career, their
• 2:26
  late thirties, early forties.
• 2:28
  I've seen this at the hospitals where I
• 2:31
  personally work, where I've seen physicians who are
• 2:34
  burned out,
• 2:36
  other
• 2:36
  factors,
• 2:37
  but they're leaving health care, either they're taking
• 2:40
  early retirement
• 2:41
  or they're migrating
• 2:43
  into new careers.
• 2:45
  And like I said, I've seen this myself
• 2:47
  personally,
• 2:48
  Even more startling and concerning,
• 2:51
  I believe,
• 2:53
  is what's happening with our bright young minds,
• 2:56
  our future of health care and health care
• 2:58
  delivery.
• 2:59
  There was a study published in 2023
• 3:02
  where they looked at over 8,000 they interviewed
• 3:05
  over 8,000
• 3:07
  medical and nursing students.
• 3:09
  They found just under twenty five percent of
• 3:12
  medical students, twenty four point nine percent,
• 3:15
  said they were quitting medical school.
• 3:18
  They were leaving and going into other careers.
• 3:21
  Another sixty one percent
• 3:23
  of medical and nursing students said, well, you
• 3:26
  know, we're already in this. We're gonna complete
• 3:28
  our degree,
• 3:29
  but we will never see a patient.
• 3:32
  And when asked why, the most common response
• 3:35
  was
• 3:36
  for these medical and nursing students who are
• 3:38
  now
• 3:39
  out in our health care workplaces
• 3:42
  as learners
• 3:43
  seeing what's going on, they said the abuses,
• 3:46
  the toxicity,
• 3:48
  the burnout, the violence
• 3:50
  were all things that said this is not
• 3:52
  a career I want to go into,
• 3:54
  and they're leaving to do something else.
• 3:57
  Even more concerning, I believe, for the long
• 4:00
  term is our young even younger brightest minds.
• 4:04
  And I published multiple
• 4:05
  case reports for interviews I've done
• 4:08
  on this where you see,
• 4:10
  high school and college students
• 4:13
  now increasingly
• 4:14
  turning away
• 4:15
  even at that younger age from health care
• 4:17
  careers.
• 4:18
  And when I ask them, they point out
• 4:20
  to me there are many, many more careers
• 4:23
  that are much more lucrative,
• 4:25
  much, much less debt ridden,
• 4:28
  much less abusive and toxic. So again, they're
• 4:31
  being drawn away
• 4:32
  into what seemed to be increasingly
• 4:35
  more attractive careers. So again, just,
• 4:39
  worsening the ongoing shortage.
• 4:41
  This in a time
• 4:43
  where we have 76,000,000
• 4:45
  baby boomers
• 4:46
  that are needing increasing, increasing care.
• 4:50
  Estimates are in the next ten years,
• 4:53
  we will be a 186,000
• 4:56
  physicians short
• 4:58
  in this country. And that doesn't fully encompass
• 5:01
  encompass this baby boomer bubble. Equal or greater
• 5:05
  number of nurses, mid levels, and others. So
• 5:08
  it's critical factor. How this
• 5:10
  impacts not only is that a huge problem
• 5:13
  for patient access
• 5:15
  in a country where we always see already
• 5:17
  see the most expensive health care worldwide,
• 5:20
  but with the poorest clinical outcomes.
• 5:23
  But I see this, our hospitals
• 5:26
  are having to shut down
• 5:28
  delivery systems
• 5:29
  of whole service lines. Hospitals at which I
• 5:32
  currently work have recently had to shut down
• 5:35
  some of their service lines in their
• 5:37
  their surgical specialties
• 5:39
  because in one case, in a surgical subspecialty,
• 5:43
  the last surgeon
• 5:45
  that offered that service retired in his mid
• 5:47
  forties is retiring at the end of this
• 5:49
  month. And so they can no longer offer
• 5:52
  that service line. Other hospitals in this community
• 5:56
  are facing similar, and this is a nationwide
• 5:58
  problem
• 5:59
  where
• 6:00
  the pipeline
• 6:01
  of doctors, mid levels, nurses, and there are
• 6:05
  huge numbers of physicians, physician, nursing, other they're
• 6:10
  going unfilled.
• 6:11
  So hospitals are not able to provide the
• 6:13
  service. They're not able to keep beds open.
• 6:15
  They're not able to keep their OR running.
• 6:17
  These are huge revenue losses for these hospitals.
• 6:21
  So these are all the impacts
• 6:23
  both from the patient access
• 6:26
  problem and also the financial side for the
• 6:29
  hospitals that are trying to provide services.
• 6:33
  Absolutely. Yeah. This is all daunting and very
• 6:35
  concerning, and this is all happening right now.
• 6:37
  What do you think this is gonna lead
• 6:39
  to? And can you talk more on the
• 6:41
  financial side of things as well?
• 6:43
  Yes. There's two more points.
• 6:45
  Like I said, there are multiple, multiple,
• 6:49
  disrupting issues impacting
• 6:51
  our whole system,
• 6:53
  especially the health care delivery component.
• 6:55
  But the two other major
• 6:58
  factors impacting that I think
• 7:00
  have the capability
• 7:01
  of of bringing the system to its knees
• 7:05
  in rapid fashion,
• 7:06
  and they are directly linked.
• 7:08
  Point number two of the three
• 7:11
  is that
• 7:12
  recent, I believe, a study in 2023
• 7:16
  that's been reviewed and the numbers are correct.
• 7:20
  Thirty five percent
• 7:22
  of American citizens,
• 7:24
  and I'm talking about the American citizens, not
• 7:28
  illegals or other. But 35% of American citizens
• 7:32
  no longer have health insurance. They can't afford
• 7:34
  it. That if you realize 35%,
• 7:37
  that's 15 points south of half of the
• 7:41
  citizen
• 7:42
  population of this whole country,
• 7:44
  yet they still
• 7:46
  show up needing health care. They have no
• 7:49
  health insurance, so they're not getting preventative care.
• 7:52
  So they show up in increasing numbers at
• 7:54
  our hospitals and emergency departments, usually sicker because
• 7:58
  they haven't gotten the preventative care they need,
• 8:02
  requiring more extensive care, more extensive admissions,
• 8:07
  huger hospital bills that, again, they can't pay
• 8:10
  because they don't have insurance.
• 8:13
  We know that
• 8:14
  the single largest reason
• 8:17
  for personal bankruptcy filings in this country is
• 8:20
  unpayable medical bills.
• 8:22
  That in thirty five percent number, economists say,
• 8:25
  are getting worse.
• 8:27
  The most
• 8:28
  single reason for that
• 8:30
  is the current this year's legislation,
• 8:33
  I believe it's called the big beautiful bill,
• 8:35
  the slang for it. But in that legislation,
• 8:39
  with the cutbacks and subsidies for the Affordable
• 8:42
  Care Act, that covers
• 8:44
  upwards of 20,000,000
• 8:45
  working Americans.
• 8:47
  Also, the cutbacks and those that,
• 8:50
  are eligible for Medicare and Medicaid,
• 8:53
  economists again say that thirty five percent number
• 8:56
  of Americans
• 8:58
  without health care insurance, that's will rise to
• 9:01
  forty to forty one percent.
• 9:04
  That means
• 9:05
  that's just under half of the whole population
• 9:08
  of this whole country
• 9:10
  do not have health insurance.
• 9:12
  So from a hospital
• 9:15
  or health care facility standpoint,
• 9:18
  what what kind of business do you have
• 9:21
  when the services you provide
• 9:24
  can't be paid for by almost half of
• 9:27
  the people that utilize your services?
• 9:29
  Would you open a business
• 9:31
  when you know that half of your clients
• 9:34
  are gonna use your services but can't pay
• 9:36
  for them?
• 9:37
  Which comes to point number three, and that
• 9:40
  is,
• 9:41
  again, another recent study showed just that fact.
• 9:44
  That nationwide,
• 9:46
  on an average, only 48%
• 9:48
  of hospital bills are being paid for.
• 9:52
  48%,
• 9:53
  that's less than half. Again, what business can
• 9:56
  survive
• 9:57
  when half of your bills for services that
• 10:00
  you're required to provide
• 10:02
  can't be paid for.
• 10:03
  So, again, I would suggest that
• 10:06
  the the patient
• 10:08
  access
• 10:09
  standpoint
• 10:10
  is huge,
• 10:12
  and we see the quality
• 10:14
  of of
• 10:15
  American lives
• 10:17
  going south
• 10:18
  as they cannot afford and can't access health
• 10:21
  care, get sicker and sicker, and then can't
• 10:23
  pay for the care that they deliver.
• 10:26
  But from a financial standpoint,
• 10:29
  what system can survive
• 10:31
  under those insurmountable
• 10:33
  odds? So, again, I say,
• 10:36
  though,
• 10:37
  I believe many of our health care leaders
• 10:39
  and stakeholders
• 10:40
  have the mistaken belief that health care is
• 10:43
  stable.
• 10:44
  We've spent
• 10:46
  a hundred and fifty how many years everybody
• 10:49
  that's alive today
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  has grown up surrounded by health care, and
• 10:53
  no one can really fantasize
• 10:56
  that they would wake up one morning with
• 10:58
  out an available health care system.
• 11:00
  But on under these unsustainable
• 11:04
  circumstances,
• 11:05
  I fear that we're gonna see major collapses
• 11:08
  in
• 11:09
  much of our health care system. We know
• 11:12
  that
• 11:12
  the most recent figures, which I believe Becker's
• 11:15
  has published on several times,
• 11:18
  759
• 11:20
  hospitals in this country
• 11:22
  have failed their financial stress test and are
• 11:24
  at imminent risk of closure.
• 11:27
  Another 146
• 11:28
  have already closed or ceased inpatient operations
• 11:32
  due to all these travails that I was
• 11:34
  have been talking about.
• 11:36
  Currently,
• 11:37
  most of those hospitals are rural,
• 11:39
  but we see this expanding into urban areas
• 11:43
  and even looking at
• 11:45
  big,
• 11:46
  referral
• 11:47
  critical care access hospitals. So again, we're starting
• 11:50
  to see the impact
• 11:52
  of the financial side
• 11:54
  of of this huge problem,
• 11:57
  of health care delivery.
• 11:59
  And, again, I think we will unfortunately see
• 12:01
  this phenomenon expand.
• 12:04
  Absolutely. Absolutely. And now we've laid out all
• 12:06
  the issues. Do you I know we don't
• 12:08
  have much time, but if you could summarize
• 12:11
  maybe a few quick points or some advice
• 12:14
  for leaders on what they can do now
• 12:15
  to help with this problem.
• 12:17
  Well, as I said, unfortunately,
• 12:19
  I see.
• 12:20
  And when I go to the halls of
• 12:21
  Congress or speak to health care leaderships,
• 12:25
  I see
• 12:26
  our major stakeholders
• 12:29
  in in the that insurance industry, big pharma,
• 12:32
  corporate health care, our legislative leaders,
• 12:35
  think they all believe
• 12:37
  that, again, they can't imagine
• 12:40
  waking up one morning without an intact health
• 12:43
  care system.
• 12:44
  And this is something,
• 12:46
  you know, we could discuss at a different
• 12:48
  why they why this belief is so pervasive,
• 12:52
  but they just can't imagine. So they believe
• 12:55
  that, there are other issues they can come
• 12:57
  back to this later.
• 12:59
  I'm not so sure with the with
• 13:02
  the economics. I've just mentioned that this is
• 13:05
  the case.
• 13:06
  But the problem
• 13:07
  I see is that
• 13:09
  our health care stakeholders, instead of working collaboratively
• 13:14
  to try to go in the system is
• 13:16
  fixable
• 13:17
  if our health care leaders would work collaboratively.
• 13:20
  But right now, they seem to each be
• 13:23
  focused on
• 13:24
  market share, on gaining additional profit,
• 13:28
  and the health care pie is only so
• 13:31
  big.
• 13:33
  So, if one stakeholder,
• 13:35
  says make mine a double,
• 13:38
  they want a double piece of pie, they
• 13:40
  mainly have to take that from another stakeholder.
• 13:43
  So what we see
• 13:45
  are the different stakeholders in health care fighting
• 13:48
  each other oppositionally
• 13:49
  for market share and a bigger piece of
• 13:51
  the pie rather than working collaboratively to try
• 13:54
  to fix the system.
• 13:56
  That has to change or the system will
• 13:59
  crash.
• 14:00
  Got it. Got it. Well, doctor Severns, I
• 14:02
  wanna thank you for your time today and
• 14:03
  for shedding light on all these important issues.
• 14:06
  But before I let you go, is there
• 14:07
  anything else you wanna leave listeners with?
• 14:09
  The one other thing,
• 14:12
  when we look at the
• 14:14
  condition of half of the population of this
• 14:17
  country, half of our citizens
• 14:20
  do not have health care insurance,
• 14:22
  it brings up the question of
• 14:24
  should there be some type of national universal
• 14:27
  health care coverage?
• 14:29
  And that is a politically,
• 14:33
  landmine
• 14:35
  grenade explosive issue.
• 14:37
  But when we talk about,
• 14:39
  do we want to keep the hospitals and
• 14:42
  health care facilities
• 14:43
  in this country financially
• 14:45
  viable
• 14:46
  and open
• 14:47
  for health care delivery?
• 14:48
  It's something we have to look at and
• 14:51
  consider.
• 14:52
  Got it. Got it. Well, that's a great
• 14:53
  note. And, doctor Severance, I wanna thank you
• 14:55
  once again for your time today and for
• 14:57
  sharing these insights on the Becker's Healthcare podcast.
• 14:59
  Thank you so much.
• 15:01
  Alright. Thank you so much.