Rising to the Challenge

For years, health-care executives nationwide have been crushing the “repeat” button on the alarm sounding about a provider shortage at both the physician and nursing levels.

Dive into the data for most of the medical centers within the Kansas City region, and you’ll quickly learn that they aren’t crying wolf.

In the 10 years between 2011 and 2021, hospital records show, the volume of patient admissions has surged nearly 25 percent—while their aggregate physician ranks have fallen by more than 10 percent, and the nursing cohort has been more than decimated, down more than 17 percent.

As a result, the number of patient admissions per physician is up nearly 40 percent, and the workload for nurses has risen by more than half. It was never a good situation heading into that decade; closing out that run with punishing waves of pandemic-era admissions has only made things worse.

That can’t help but levy an emotional toll on those providers, and emerging metrics are beginning to assess that weight. A study published by the Mayo Clinic this past spring found that over roughly that same 10-year period:

• A 38.6 percent increase in average emotional exhaustion scores among physicians.

• 62.8% of physicians reported at least one manifestation of burnout last year—a huge jump over the first pandemic year in 2020 when the figure was 38.2 percent.

• And the rate of satisfaction with work-life integration fell by more than one-third, from 46.1 percent in 2020 to 30.2 percent last year, with a 6.1 percent increase in the number of self-reported cases of depression.

Those figures become even more dire, hospital executives say, when one considers that the demand for in-patient services will only increase over the next 20 years as the Baby Boomers push into their end-of-life care needs, as the lingering threat of a resurgent pandemic comes in new waves, and as the bill comes due with a wider population suffering from epidemic-level cases of diabetes and obesity. 

At North Kansas City Hospital, CEO Steve Reintjes synthesizes the situation in two words: “It’s severe,” says Reintjes, a physician himself. “Nurse and physician labor shortages are impacting the entire health-care industry. Missouri has a staff nurse vacancy rate of 14.5 percent. Regarding physician shortages, recruiting psychiatrists, endocrinologists and rheumatologists is a significant challenge for us. We are not alone in this challenge.”

Sam Huenergardt, chief executive at AdventHealth Shawnee Mission, says there is no doubt the region is in the throes of a provider shortage. “Some specialties have enough patient demand that it can take a few weeks for new patients to get an appointment, and many of our Primary Care providers have full patient panels,” he said. “The nursing shortage is even more significant—we have a much greater demand for registered nurses, particularly in the inpatient hospital setting, than we do a supply.”  

With nursing in particular, two factors emerged on the winds that brought the COVID-19 virus to America’s shores. 

“We are seeing our orientation full every week, and many of those new hires are registered nurses, but it isn’t enough,” Huenergardt says. “We still have a need for registered nurses across all departments. There are a few factors getting in the way—one being burnout impacting experienced nurses and discouraging students from going into nursing roles. Another is pay—with travel-nursing opportunities and local competition for talent; we are paying significantly more for nursing positions than we were in 2019.”

The latter issue, hospital executives say, is a human-capital challenge that poses long-term threats to carefully constructed cultures. If the urgent need for nurses—today—compels an organization to triple its historic rate card for those services, staff nurses who have fought the good fight might chafe at the inequities. Hospitals have rewarded their staff with significant raises, but not many have trebled down.

“The nursing situation is a crisis now,” says Robert Simari, vice chancellor at the University of Kansas School of Medicine. “The nursing shortage cannot be neutralized simply by training more nurses. There is not enough space or available faculty to meet the crisis. The nursing crisis must be met by focusing on the retention and health of current nurses in the field in addition to training as many nurses as we can.”

So . . . How to Fix It?

For Keith Zimmerman, who moved to Kansas City over the summer to lead a marketing-leading operation with eight regional hospitals, “there is no simple or fast solution.” Compounding the challenge, he said, “much of Missouri and Kansas is designated a primary-care Health Professional Shortage Area by the federal government.” While HCA Midwest is not immune to this, he says, it is making progress in improving employee retention and gains in recruiting staff—an overall 20 percent decrease in employee turnover and a 20 increase in recruitment this year.

How? With a multi-pronged approach that, on the physician side, Zimmerman says, “includes starting early, by partnering with colleges, universities and high schools to teach, train and fund a pipeline of future workers, while exposing our youth to the vast array of health-care jobs available.”  On the nursing side, Zimmerman points to HCA Midwest Health’s long-term strategic partnership with Research College of Nursing, which he says, “supports the region with a larger talent pool of baccalaureate and master’s prepared nurses, while also allowing students access to premier clinical experience.”

Additional initiatives include enhancing scholarships for nursing students, increasing dedicated nursing education units across health-care facilities, and drawing students and clinical expertise from the HCA Healthcare organization. “By growing a pipeline of nurses, developing our workforce, and providing career ladder opportunities for advancement,” he said, “we are stabilizing the health care’s short- and long-term workforce.”

As the daily census of patients with COVID-19 issues continues to ebb, chief nursing officer Rachel Pepper deals with the staffing aftermath for the University of Kansas Health System, which operates the biggest stand-alone medical center in the region. 

“We have seen some improvement in recent months,” Pepper says. “During the acute phase of the pandemic, people stepped away from the work setting for a variety of reasons—to take care of children or home needs, to perform in a traveling position, to take a break from health care, and other reasons. Some of these people are returning to work now.”

Beyond that, she says, “people are thinking about all of the roles and settings in health care they can choose to serve in.  If full-time employment doesn’t work for you, there are part-time options. As well, people can transition between care settings—inpatient, ambulatory, peri-operative, and others, to provide a change in their work routine, without leaving health care.”

Huenergardt says AdventHealth has been compelled to get “really creative to recruit from new sources—we even had a nurse leader recently travel with other AdventHealth delegates to Puerto Rico to attract some nursing graduates to the Midwest. We also are reaching as far down as high school and middle school to engage young people in the variety of health-care careers available and encourage them to pursue that path.”

At the K-12 level, AdventHealth partners with the Blue Valley and Shawnee Mission school districts, as it does with Johnson County Community College and Ottawa University, having acquired that exurban town’s hospital in 2018. “We have worked with the refugee community in Kansas City, Kansas, on workforce opportunities,” Huenergardt said, and “we’ve implemented a number of new benefits in the last couple years—including student loan reimbursement, continuing education, career pathing, and leadership development. We are also focusing more than ever on the physical and mental health of our team members.”

Refilling the Pipeline

With the sands running out on the demographic hourglass, medical schools are working overtime to meet the challenge and produce a robust supply of new physicians.

Marc Hahn is CEO at Kansas City University, now the largest medical school program in Missouri as measured by graduating class size and the sixth largest nationwide. Part of the strategy to meet the need involves an extended geographical reach. 

“We’ve been in the northeast neighborhood of Kansas City’s urban core for 106 years, but in 2017, we opened a second campus in Joplin, which is more rural, and started to focus on rural access. With two classes of graduates now through that channel, KCU is studying other program enhancements.

“We looked at what the other challenges are there in the area, and one was behavioral health,” Hahn said. “In 2017, in Kansas City, we started a doctoral in clinical psychology to address those needs. Those are so great no one school can even address them as far as behavioral health care. We also studied the Joplin region and made a determination three years ago in studying access to care and oral health care. If you draw a radius around Joplin, 100 miles out into four states, every single county in that radius, every county, has a dental health professional shortage area, and oral health greatly impacts general health.”

In response, KCU is starting a dental school in Joplin and is beginning to interview students for classes there starting next summer.

Medical schools, Simari says, have been more than holding their own for a generation. The numbers of new graduates, per se, aren’t the issue.

“During the last 20 years, there has been a dramatic increase in the number of medical school graduates due to new and expanding allopathic and osteopathic medical schools,” Simari says. “That means approximately a 30 percent increase in the number of medical-school graduates.”

The challenge, he says, is what comes after. “Graduate medical education, or residencies, have not increased at the same rate, so the gridlock is the number of doctors able to be trained in a residency,” Simari says. “While legislation has been brought forward at a national level, there have been no major changes in how residency slots are funded or developed in the last few decades.” 

Like KCU, the KU school has looked across the state for redress.

“During the last 15 years, we have increased class sizes as well as added a four-year campus in Salina and expanded our campus in Wichita from a two- to four-year campus,” Simari says. “Considering whether to expand further is a complex decision that also hinges on available clinical learning environments. Our current clinical learning environment includes students from UMKC and KCU, so any solution needs to take into consideration the number of clinical learners.”

On the policy end, Huenergardt also lasers in on the need to streamline licensure and credentialing in all states: “If you’re licensed in one, make it easier to use your license in a neighboring state,” he says. Beyond that, “we also have work to do on our visa process and legal immigration system. We have nurses here now who can’t get visas extended or work authorization renewed, and nurses in other countries who want to come here, but the system is incredibly slow to get them in place.”

None of this, executives say, should suggest that this is a matter for the health-care and medical-education complexes to resolve on their own.

“Communities and health-care systems also share the responsibility to recruit physicians,” Simari says. “Physicians who are finishing their residencies have options as to where they will go to practice. It is up to the hospital, community, city, or region to make it attractive for the physician to practice there.”