Shortage of Doctors and Nurses Signals Public Health Crisis

By SAM URETSKY

The University of Southern California said it well: “The health care provider shortage is more than an inconvenience, it’s a public health crisis. And it has been building since before the COVID-19 pandemic. Health care staffing shortages lead to poor patient outcomes that can include hospital-acquired infections, patient falls and increased chances of death, according to the American Association of Colleges of Nursing. Provider shortages in certain areas mean that large swaths of the population don’t have enough doctors or nurses to provide them with emergency care, treat their chronic illnesses or deliver their babies.”

The American Hospital Association published a report stating that “hospitals and health systems continue to face intense pressure on staff and resources while also dealing with rising expenses for supplies, drugs and equipment, as well as for the workforce. Left unaddressed, these financial challenges have the potential to jeopardize access to essential health care services for patients. The trends are expected to continue through 2022, with losses in the billions of dollars for hospitals and health systems, resulting in the most financially difficult year for the field since the beginning of the COVID-19 pandemic in early 2020.” (Final figures for 2022 aren’t available but it doesn’t look good.)

The worst cases are in rural hospitals in low-income areas, particularly those in the states which failed to expand Medicaid under the Affordable Care Act – and things will only grow worse with the expiration of the COVID-19 Medicaid expansion in April. During the pandemic, Medicaid enrollment increased and the uninsured rate dropped largely due to continuous enrollment. Once Medicaid disenrollments resume, the number of people who are uninsured is expected to increase rising more steeply in non-expansion states. In expansion states, because all adults with incomes up to 138% of the federal poverty level (FPL) are eligible for Medicaid, many current enrollees will remain eligible even if their incomes have risen. However, in non-expansion states, with eligibility thresholds often quite low and largely limited to parents, a conservative estimate has been 15 million people without any form of health insurance.

It’s estimated that in New York City, 125 hospitals have closed since the year 2000 – although in some cases the small community hospitals have been bought or merged into larger medical centers so that the major centers can add to their approved bed capacity. Still, other hospitals have had a different fate:

• Park West Hospital, 170 West 76th St, Manhattan – now co-op apartments.

• Parkchester General Hospital, 1424 Parker Street, the Bronx – replaced by townhouses.

• Parkway Hospital, Manhattan, 123 West 110 Street – now apartments.

The Jackson, Miss. Clarion Ledger headlined “More than half of rural hospitals in Mississippi at risk of closing, health officer says.” State Health Officer Daniel Edney said 38 rural hospitals are at risk of closing, about 54% of the total. Mississippi is the poorest state in the continental United States, with a poverty rate close to 20%. Only Puerto Rico has a higher poverty level.

Considering that NYC has a number of quality medical schools (Cornell, Columbia, Mount Sinai, NYU) and other schools for the healthcare professions, this decline in the availability of services is dramatic. The problem, of course, is money. The average MD graduates medical school with $200,000 in debt. One remote possibility is to add money (lots of it) to the Defense Budget, to expand the Defense Health Program which offers scholarships in Medical (including Osteopathy), Dental, Veterinary, Nursing, Counseling and Clinical Psychology, and Optometry.

The Army has a web site (https://www.goarmy.com/careers-and-jobs/specialty-careers/health-care/amedd-scholarship.html) which offers “LAUNCH YOUR MEDICAL CAREER WITH ZERO OR LITTLE DEBT” and yes, it does require a term of service the military, but from a political viewpoint the House might be willing to toss a billion or so to the defense budget – as long as it’s not for social welfare programs. As Robert Goodloe Harper might have said “Millions for defense, but not one cent for tribute nursing education.”

Sam Uretsky is a writer and pharmacist living in Louisville, Ky. Email sdu01@outlook.com.

From The Progressive Populist, May 1, 2023

Populist.com