Healthcare workers on strike
Also: Envision's other challenge; NP/PA scope of practice; please report to the flight deck; and new players in health care delivery
Top of the week
Healthcare workers exerting their power
Since 2021 there have been 85 strikes by healthcare workers and social assistance workers in the U.S. There’s no question that the Covid pandemic exacerbated growing frustrations by workers. However, now that we find ourselves in a post-pandemic period, large numbers of health care workers remain unsatisfied.
So far in 2023, there have been 7 strikes by healthcare workers in the U.S. Multiple provoking factors exist including dissatisfaction with pay, insufficient staffing, and working conditions. However, don’t think this is limited to just nurses. Resident doctors in Queens, NY went on strike last month. They have experienced less pay versus their counterparts in other hospitals.
The threat of a strike alone has proved to be fruitful for some healthcare workers. Look at what New York nurses achieved. They improved pay and working conditions by way of improved nurse- to- patient ratios. Oregon nurses also threatened to strike, but successful negotiations averted it. They also scored better wages and improved working conditions.
We all know that clinician burnout is on the rise. Everybody is being asked to do more with less. Providers are incurring increased risk in the ED because hospital staffing and resources do not adequately support the ED. As providers become increasingly unhappy with their quality of working conditions, they also witness employers spending big bucks on temporary help or on big recruitment bonuses for new providers. It is interesting that some employers are willing to do this versus raising pay for their current staff: the backbone of their team. EM providers are the revenue producing members of an EM staffing company. They generate wealth for companies. Collectively, EM providers possess a tremendous amount of power.
However, this power can only be realized when maximum transparency of the business is achieved. EM providers should feel comfortable that their compensation package is a fair proportion of the revenue they produce. Obviously providers could not expect wages so high such that it bankrupts the staffing company; that’s counter productive. I dont believe, however, that a contributing factor for Envision’s bankruptcy was that average EM provider wages were too high.
Yes, tremendous amount of money was spent on temporary help, and bonuses to cover shifts that could just not be staffed. Yes, the Covid pandemic pushed some providers out of EM for an extended temporary period, or perhaps permanently. Yes, lots of recruiting money had to be offered to fill staffing holes. This, however, is more a result of how the staff is managed and how their quality of work experience is shaped.
Example: the word “team” is frequently invoked by staffing company employers. I know what you’re doing for the team. You’re walking into admission/transfer patient holds in your ED with little to no space to see the multitude of angry patients in the waiting room. You’re running out to the waiting room and practicing medicine in less than desirable conditions. You’re incurring increased medical - legal risk by signing up for patients in the waiting room and entering orders; but orders don’t get executed. This is a quality of work problem for providers. Is the staffing company maximizing efforts and pressure with the host facility to correct their nursing staff deficits?
We know there are different provider compensation models. There are are some good ones and great ones out there. When staffing companies decide not to have either a 401k plan with employer contributions or some sort of profit-sharing plan, what is the message to providers? Is the message, “When we as a staffing company experience financial struggles, then everybody (providers included) may have to share the burden. When we as a staffing company do well, only we, the staffing company do well; not the revenue generators - providers. Does this relationship make a provider feel like they are truly part of a team?
Employers have got to be willing to listen carefully and frequently to the revenue generators of their wealth. It is not sufficient to simply hold staff meetings and hold town halls. They must sincerely consider provider concerns and complaints about working conditions and compensation. Employers must find ways to produce measurable corrective actions that address provider concerns and complaints. They must be prepared to make some concessions. Quiet quitting is a real thing and very concerning for any organization, especially an ED. The mere threat of labor stoppages like the stories above can light a match of emotion that is difficult to contain and manage. An actual labor stoppage of just a few days could be catastrophic; nobody wants that. Reasonable minds should be able to find common ground well before even the thought of a strike develops. Full and consistent transparency is essential. Measurable employer action that addresses providers’ concerns and complaints is a must.
Emergency Medicine
Envison’s bankruptcy won’t stop lawsuit
It appears that the American Academy of Emergency Medicine physician group will continue to pursue a lawsuit against Envision. AAEM filed suit in 2021 against the big EM staffing company. The suit alleged that Envision violated a California state law prohibiting corporations from practicing medicine. Envision filed bankruptcy last month, and the original trial date for the lawsuit has now been postponed.
Is the ED on the wrong side of the tracks?
The European Society of Emergency Medicine conducted a survey that finds neither clinicians nor patients feel safe in the ED. Clinicians feel that understaffing contributes to the problem. Patients feel that clinicians are rude and angry.
When both patients and health care professionals are feeling unsafe in the ED, I fear that frustrations and conflicts will increase. We are already seeing a rise in violence in the ED. Insufficient staffing is a provoking factor common to both staff and patients. Hospital systems and ED staffing groups are charged with the duty to stabilize staffing teams. In many situations, there are sufficient financial resources to stabilize staffing. However, is money being responsibly distributed and applied?
House of Medicine
Scope of practice debate continues
Over 235 organizations make the argument for increasing patient access to care. A bill was introduced in the US House of Representatives that allows NPs & PAs to increase patient access to care. Specific patients who would benefit from this bill are diabetics who need special shoes; Medicare patients who are in need of specialty care; and patients in need of acute hospitalization.
Iowa PAs increase autonomy
Select PAs in Iowa will no longer require physician supervision to practice medicine. Why? Because Iowa leaders acknowledge a provider shortage in rural area. PAs will be required to have had a minimum of 2 years of supervision before they are allowed to practice without supervision.
Over half of Iowa’s PAs practice in rural areas. This bill increases the chances that folks living in remote areas have a better chance to receive medical care. How important are NPs & PAs to the health care team? What is the quality of care?
Keep in mind that in April 2021, an ACEP presentation described the NP/PA role as valuable in the ED. Most importantly, NP/ PA practice was described as having similar high quality as that of physicians. It appears that states are identifying solutions to their own health care problems. It looks like each state will have to develop its own solution to the physician shortage.
Flight medical kits need an update
American air travel usage is coming back to pre-pandemic level. You will likely have an increased chance of being asked to respond to an in-flight medical urgency/emergency.
The current status of emergency medical kits on airlines is not satisfactory. Check out this article that discusses specifics of emergency medical kits on airplanes. Having equipment is one thing. The quality of the equipment is another.
Hospitals, health systems, and more
Look who’s joining the healthcare delivery game
While EM staffing companies and some health systems find themselves struggling or failing financially, other organizations are looking to capture healthcare delivery markets.
Goole and Microsoft are working to improve how healthcare is delivered. CVS is trying to own a lane in healthcare also. CVS has purchased 2 healthcare organizations who employ over 10,000 physicians and other providers.
Walmart has opened 3 more clinics this month in Florida. The company targeted 3 Florida cities in great need of healthcare Servies. This adds to the over 30 clinics it has opened in 4 other states.
The Good stuff
Check out this story about Micki Lyons, DNP, MSN. As a COO she proves how versatile NPs can be in addressing needs of rural medicine. Way to go, Micki!
Read about Briana Dewitt, a Physician Assistant who has dedicated her life helping patients while she manages her own cystic fibrosis. Briana is a great example of the resiliency PAs bring to the table.
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