5 Trends in Hospital Staffing for the Next Five Years

As 2011 approaches, hospitals are preparing for massive physician and nurse shortages. Here David Alexander, president of healthcare staffing firm Soliant, discusses five trends that will affect healthcare staffing over the next few years.

1. Increased use of nurse practitioners, physician assistants, CRNAs and midwives.
In 2011, 32 million Americans will have health insurance for the first time. Mr. Alexander says this will mean a massive increase in patient volume for primary care providers, as patients who previously visited the emergency room for non-emergency situations will be more likely to consult a family practitioner instead. "This is really going to overload those family practitioners," he says. "We have to figure out how to get more assistants doing the jobs of nurses, more nurses doing the jobs of nurse practitioners and more nurse practitioners doing the jobs of doctors."

This staffing change may mean the end of the traditional physician office visit. "The day of walking in and seeing your doctor firsthand may be gone," says Mr. Alexander. "You may be seeing someone with a lot less education." Though physician shortages may eventually be solved by attracting more students to medical school, that solution is at least ten years away because of the length of physician training.

2. Increased use of hospitalists. According to Mr. Alexander, the number of hospitalists has increased from 700 in 1996 to just over 30,000 today. This soaring jump makes hospitalist medicine the fastest growing medical specialty, especially as primary care physicians choose hospitalist medicine over private practice because of declining reimbursements. "Data shows that hospitalists improve efficiency, provide better outcomes and decrease the length of stay," Mr. Alexander says. "Especially when the length of stay is cut, that's a huge financial incentive for hospitals."

As health reform laws require more Americans to have healthcare, he says, the average family practice physician will be overburdened by patients and unable to make his or her traditional rounds in the hospital. Hospitals will increasingly use hospitalists to fill this shortage and provide quality care without the burden of moving back and forth from the office to the hospital.

3. More retail clinics. Retail clinics are medical clinics located within larger retail outlets that are usually staffed by nurse practitioners and supervised by an off-site physician. Retail clinics focus either on urgent care or routine preventative services, such as immunizations, and often provide service without appointments for lower prices. The facilities also tend to be open on nights and weekends, like the retail outlets where they are located.

"If you have an even larger number of people who are going to see the doctor, what if you could move them into the retail establishment that people are already visiting?" Mr. Alexander says. "They can go past frozen food and toiletries and visit the clinic, very similar to the pharmacies that exist in stores like Target and Wal-Mart now." The thought is that retail clinics could decrease the burden on emergency rooms, provide faster, cheaper care for patients and use a single clinician as a front desk staffer and medical assistant too.

4. Nurses and physicians staying in the workforce longer.
According to Mr. Alexander, the current retirement age for nurses is around 46 years old. With the impending shortage of nurses and physicians, healthcare facilities will have to figure out how to keep providers in their roles for up to an additional 10 years. Because of a shortage of educators in medical colleges, around 50,000 qualified applicants were turned down from nursing schools last year. "We've got to get the providers that are already educated to either stay in the workforce or come back to the workforce," he says. "We need to make jobs that meet those people where they are. We need to have flexible jobs for mothers and homemakers and make it appealing."

He says this means more flexible staffing. Instead of the traditional long work weeks for nurses and physicians, hospitals may have to look at staffing models that give people 20-hour work weeks. "We need to puzzle together a workforce, because long term, the shortage numbers are crazy," he says. "Twenty years ago, we'd go overseas and bring in a bunch of nurses from England or bring in nurses from India or the Philippines. Now, we're dealing with a global nurse and physician shortage, and it's becoming more expensive to bring in international help. We've got to find the providers at home."

5. Increased demand for physicians in certain specialties and locations. The level of demand for physicians depends on geographic region as well as specialty, Mr. Alexander says. While the entire country will feel the shortage, the effects will be most pronounced in rural communities and specialties like family practice, urology, gastroenterology and general surgery. Rural communities will suffer because qualified physicians are less likely to want to live there, and family practice will suffer as physicians move away from declining reimbursements to more lucrative specialties.

Mr. Alexander says he, along with many experts in his field, cannot predict the solution. "Hospitals will have a tough go," he says. "They're going to be asked to do more with less. They already have razor-thin margins, and now they have to raise wages to attract people into the workforce."

Learn more about Soliant.

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