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Thursday, Aug. 8, 2002

More than 126,000 nursing positions remain unfilled. The shortage has become so severe it is endangering the lives of patients and is a primary reason for overcrowding in emergency departments and cancellation of surgeries, according to a report by an Experts Roundtable panel convened by the Joint Commission on the Accreditation of Healthcare Organizations.

Society for Thoracic Surgeons recently warned that a shortage of heart surgeons looms within a few years. A survey of hospitals found pharmacists, X-ray technicians and therapists are leaving at such an alarming rate it already is affecting the quality of care patients receive.

Joan Luciano, a senior managing consultant with the Boston human resources consulting firm Drake Beam Morin, who conducted the hospital survey, said there is enough of a shortage of qualified people at hospitals that the general public should be concerned, particularly in light of the aging population.

'Serious Retention Issues'

One reason for the shortages is that "hospitals have serious retention issues," Luciano told United Press International. The survey, which included 44 hospitals, found those hospitals lost 18 percent to 22 percent of their pharmacists, radiologists and therapists in 2001. This is significantly higher than other industries, which have average attrition rates of 13 percent to 15 percent, she said.

Amy Lee, a spokeswoman for American Hospital Association, told UPI the situation is "something that hospitals have well been aware of." Hospitals are taking steps to "become employers of choice" and are employing strategies to retain staff, she said.

Hospitals also might be losing doctors and surgeons at the same rate. The hospitals involved in the survey told Luciano they did not track doctors, so "we just don't know ... but the situation with doctors and surgeons could be the same" as with the other health workers, she said.

'Crisis'

At least one type of surgical specialty appears to be in trouble as well. Kevin Accola, a heart surgeon at Florida Hospital in Orlando and chairman of the health policy workforce for Society of Thoracic Surgeons, told UPI although the shortage of heart surgeons would not become apparent for three to six years, "it's a crisis now. There have to be changes now."

This is because it takes eight to 10 years to train heart surgeons, and there already are drops in residency applications, Accola said. There were not enough applicants to fill all the available heart surgical resident spots last year. General surgery residencies, the program surgeons must complete prior to specializing in heart surgery, also were left unfilled.

"So basically, we're ending up with less and less available people," Accola said, and "the implication is that we're going to have a crisis in access to heart surgeons."

There will not be enough surgeons to perform operations for bypasses, lung cancer and other heart and lung surgeries, he said. The situation likely will be compounded by the aging Baby Boomers and the fact that people are living longer, so there will be an increased need for these types of surgeries, he said.

"People should be concerned" about the shortages, Mohammad Akhter of American Public Health Association told UPI. The shortages have significant potential to affect quality of care, he said.

Cutting Costs

Akhter said the shortages are a result of HMOs and managed care companies attempting to cut costs and staff. This has placed an "excessive demand" on health workers, which coupled with low salaries has deterred young people from entering these fields.

Congress, which "has not been kind" to the health industry, needs to take a comprehensive look at this situation, Akhter said. This year, Congress increased funding for nursing schools to spur people to enter that field, but the same needs to be done for other health specializations, he said.

Accola also said Congress must step in and address the issue. One change he said he would like to see is an increase in Medicare reimbursement. This has been cut almost 40 percent since 1997 and has created a situation where "someone gets paid more to work on my roof at home than I do to do a heart procedure," Accola said.

The Joint Commission Roundtable concluded solutions to the nursing shortage must involve transforming the nursing workplace, increasing enrollment in nursing training programs and paying financial incentives to spur health care organizations to lay out necessary expenditures for high quality nursing care.

"Failure to address this problem aggressively is likely to result in increased deaths, complications, lengths-of-stay, and other undesirable patient outcomes," the roundtable said in a written statement.

No Shortage of Lawyers

Another issue is soaring costs of malpractice insurance and doctors being forced out of business by costly lawsuits. Obstetricians have been hit particularly hard, and in some parts of the country pregnant women cannot find a doctor.

In Jackson, Miss., President Bush noted Wednesday "an explosion of medical malpractice litigation" that has caused many communities to lose family practice doctors, obstetricians and gynecologists.

Medical liability insurance rates for Mississippi doctors who deliver babies have soared 20 percent to 400 percent in the last year.

Nevada Gov. Kenny Guinn signed into law Wednesday a bill that limits jury awards in most medical malpractice cases, in hopes of ending an insurance crisis that temporarily closed the state's top trauma center.

The law caps "pain and suffering" awards at $350,000. The limit could be waived if a jury found gross negligence or a judge found "clear and convincing" evidence warranting a higher award, the Associated Press reported. The law takes effect Oct. 1.

Copyright 2002 by United Press International.

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