An Iron Law of Health Care

For years before the onset of the global pandemic in 2020, health-care administrators had been confronting—and clamoring about—a looming shortage of physicians and nurses. 

In some ways, their concerns were no different that those of peers in construction, manufacturing and even white-collar jobs in financial and professional jobs—talent was hard to come by, and often, just as hard to retain.

Then came COVID.

Furious spikes in hospital admissions sprouted around the nation as a killer virus made its way through the population in the spring of 2020, culminating in a nearly unprecedented winter surge. In the Kansas City area, that  meant COVID-19 patients were accounting for nearly 30 percent of staffed hospital beds during the peaks—industry metrics suggest that hitting 15-18 percent would be sufficient to classify such an outbreak as a crisis-level event.

To the surprise of none in healthcare, hospital employment was quickly challenged. Burnout, patient overload and the simple stress of working around a virus you might bring home to your own family—all of it contributed to a mass exodus in the ranks of health-care workers nationally. In 2022, industry analysts say, that health care was losing 500,000 workers a month.

Interestingly enough, in the Kansas City market, the numbers of physicians, nurses and employees overall have bucked that trend—all were up in 2022 over where they were a decade earlier. Bodies in the trenches, as it were, has not been the issue for executives here as it has for their peers nationwide. The bigger crisis comes from bodies in the beds.

While the overall numbers of employees rose just more than 18.5 percent at the 30 largest hospitals in this market (with slightly smaller increases for physicians and nurses), the numbers of licensed beds surged more than 25 percent. The number of patients topped even that, rising better than 28 percent. 

Not all of what’s been stressing the work force here has been the result of COVID-19. The average age of a working American in 2021 was 41.7 years; in health care, it was just shy of 50 years. A retiring Baby Boomer cohort has been stressing the provider ranks for more than a decade; the pandemic stress—and opportunities created for far more lucrative compensation in the nursing profession—took the challenge to a new level.

The most effective arrow in the quiver for most has been to make sure the organizational culture supports the broader goal of improving patient outcomes. It was just so at the University of Kansas Hospital, said Kansas City division president Tammy Peterman.

“In the midst of a pandemic, we cared for patients from every state in the U.S., every county in Kansas and 109 of 114 counties in Missouri,” she noted. “We set a record of caring for over 343,000 unique patients. Our patient satisfaction ranked us in the top decile of hospitals across the country. Our mortality index was in the top 7 percent of comprehensive academic medical centers across the country—469 fewer deaths than expected—and our turnover was half the national average for health care.”

The biggest challenge for her institution, she says, is “always about people—retaining the best and hiring the best.”

She and her peers will need to cling tight to that approach.

Elsevier Health, an academic publishing division of a Dutch conglomerate, has done deep research that shows that nearly half of those the U.S. healthcare work force—47 percent—plan to leave their positions by 2025. Even more alarming, 90 percent of nurses responding to a November 2021 survey said they were considering leaving within the next year.

The latter was a reflection of increased job stress. The Journal of General Internal Medicine, in fact, conducted a study that showed health-care workers were nearly as traumatized by COVID as U.S. service personnel in combat zones since September 2001.”

The stress on hospitals, hasn’t been driven solely by patient-care demands—a Hospital IQ survey showed that 43 percent of nurses responding said they were being burdened with tasks like cleaning units, securing supplies and clerical duties. 

If there’s a bright spot for health-care executives in the leadership role, it’s that they have a stronger revenue base to draw on in the battle for talent. 

The largest hospitals in the Kansas City region collectively brought in $18.5 billion in 2012 revenues, the equivalent of about $24 billion in this inflationary era. But overall revenues for those same 30 institutions have more than doubled that real-dollar figure, which hit $53 billion in 2021 and is likely to go even higher once the books are closed on 2022.

Another saving grace for hospital staffing has been the use of telemed technologies and a huge surge in outpatient visits over the past decade. The latter have gone from roughly 4.5 million in 2012 to nearly 6.4 million in 2021—an increase of nearly 41 percent.