WASHINGTON — More doctors and nurses on staff and in the pipeline are needed to help alleviate workforce shortages that have existed in healthcare for years and got much worse during the COVID-19 pandemic, witnesses said at a House hearing Wednesday.
“Only a few weeks ago, a nurse in charge of my emergency department told me she was 10 nurses short for the evening and therefore forced to reduce services,” Megan Ranney, MD, an emergency physician at Rhode Island Hospital, said during a hearing on the pandemic’s effects on frontline healthcare workers held by the House Energy & Commerce Oversight and Investigations Subcommittee. “She said, ‘I’ve been begging people to stay all day long — offering double time and double incentives — but the nursing staff is too burned out.'”
During COVID surges, “many hospitals have had to resort to extreme measures, calling in the National Guard and shutting down so-called elective procedures to try to save space for true emergencies like strokes and traumas,” Ranney said, adding that rural hospitals have been disproportionately affected. “Even with these steps, they are unable to care for patients in a timely manner.”
Workforce Burnout and Lack of Capacity
Tawanda Austin, MSN, RN, chief nursing officer at Emory University Hospital Midtown in Atlanta, told a story from when she was rounding in her hospital’s ICU at the end of 2020. “[One nurse] took me to four patients’ rooms. We stood on the outside of each of those rooms peering through the glass windows, and she explained to me how severely ill each of those patients were. And she outlined the numerous medications and complex therapies they each were receiving.”
“She paused and said in her best clinical estimation that not a single one of those patients would survive,” Austin continued. “She wanted me to experience in just those few minutes what it was like to be on the front line — how devastating it was to do everything possible to save a patient’s life, only to lose them in the end. I remember feeling deflated because as a leader, it’s my duty to support, to help find solutions to problems, to offer comfort when it’s needed. But I didn’t feel that that was enough in that moment.”
Democrats on the subcommittee also bemoaned the problem. “We must find a way to ensure these critical workers have the support they need,” said subcommittee chair Diana DeGette (D-Colo.). “Of course, the cascading impacts of COVID-19 do not stop with the workforce alone. The COVID-19 surges due to new variant waves have led to significant capacity constraints within hospitals. And when hospitals are overwhelmed, patient care can suffer. Heart attacks, car accidents, and other emergencies don’t stop for COVID-19.”
“There’s no single solution to these challenges, but we do have the tools to help alleviate some of these concerns today,” she added. “The most effective way to fight the pandemic and lessen the burden on our healthcare system is for eligible Americans who have not gotten the COVID-19 vaccine to get vaccinated … Unvaccinated adults are an astounding 41 times more likely to die from COVID-19 than those who have been fully vaccinated and boosted.”
On the other hand, Rep. Morgan Griffith (R-Va.), the subcommittee’s ranking member, said that although he personally had been vaccinated and was in favor of vaccines, vaccine mandates at hospitals “made people choose between personal choice or their livelihood, which we know made existing problems in recruiting and retaining healthcare workers in rural areas worse … Healthcare workers have been fired for non-compliance, and some have resigned or quit. In a rural hospital, the loss of staff is not only noticeable, but very damaging.”
Rep. Frank Pallone (D-N.J.), chair of the full Energy & Commerce Committee, lamented the continuing vaccine hesitancy, noting that “today in the U.S., only 69% of eligible Americans are fully vaccinated, and just 45% have gotten a booster dose,” he said. “And, as different variants have emerged, hospital capacity has, at times, surpassed the number of staffed beds available. This week, more than 75% of ICU beds in hospitals across the United States remain occupied despite the fact that the Omicron wave has crested.”
Hesitancy Among Pregnant Patients
Laura Riley, MD, obstetrician and gynecologist-in-chief at New York Presbyterian Hospital in New York City, expressed concern about vaccine hesitancy among her pregnant patients. “Equity must be a focus of pandemic preparedness and response,” she said. “When the pandemic first began, we worried based on our experience with flu, that COVID-19 may be worse in pregnant individuals. Those fears were confirmed as we found that they are at increased risk of severe illness and death.”
However, “despite this evidence and urgent calls from the medical community, pregnant and lactating individuals were initially excluded from COVID-19 vaccine trials and continue to be excluded from therapeutic trials,” Riley said. “That meant that when the vaccines became available, we had very little data on their safety in pregnancy, resulting in confusion and fueling misinformation.”
“Unfortunately, vaccine hesitancy remains today,” Riley concluded. “These routine exclusions of pregnant and lactating individuals from research, presumably for their protection, leaves them disproportionately vulnerable and may have, in this instance, contributed to avoidable loss of life. As we reflect on the pandemic and lessons learned, it is past time to shift the narrative on research in this population. Instead of protecting them from research, we should be protecting them through research.”
Better Incentives, More Data, More Primary Care
Rep. Michael Burgess, MD (R-Texas), commented that even in the midst of provider shortages, the federal government continues to cut providers’ pay within the Medicare Physician Fee Schedule. “Do you think if we as a committee would spend the time addressing issues like provider pay, that would help some of the workforce issues and the burnout issues?” he asked Riley.
“I suspect yes,” Riley said. “People want and deserve to be compensated for the work that they do.”
Ranney emphasized the need for better data on the pandemic. “Important pieces of data are still missing — things like actual numbers of staffed beds at hospitals,” she said. “The lack of data related to race and ethnicity are particularly glaring.” She also highlighted supply chain issues: “Although early PPE [personal protective equipment] shortages have resolved, we face new and worsening problems with key tests, therapeutics, and equipment for both COVID- and non-COVID-related care … We’re forced to substitute one preferred medication or treatment for another, and sometimes there is no substitute. This directly hurts patients.”
Lucy McBride, MD, an internist here, said that “What I see people needing most is access to a trusted primary care provider, something that 80 million Americans do not have, particularly in rural and poverty-stricken urban areas. Really COVID-19 is an outpatient disease,” since most patients don’t end up in the hospital, and “more than ever, people need a trusted medical provider to receive fact-based, nuanced medical advice.”
Not only do patients need their primary care physicians to help manage their underlying medical conditions, “they need a place to help apply broad public health advice to their unique lived experience and situation,” she said, adding that she has spent many hours on the phone with patients who wonder which vaccine they should get or whether they need a booster. “There’s no better role for primary care than in a global health crisis.”
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