We’ve all heard the parable of the boiling frog. If you put a frog into boiling water, it will jump out. But if you place it in tepid water and slowly raise the temperature, you get a boiled frog. The frog from this story would have likely avoided a career in specialties boiling over with pandemic chaos (see: emergency medicine) but may have found a false sense of comfort in the hot springs of anesthesiology.
There is a ubiquitous staffing shortage in our field of medicine: an estimated shortage of about 3,800 anesthesiologists, representing a 9.85% shortage of physicians with projections, if current trends continue, to a shortage of 4,500 physicians (asamonitor.pub/3U1iSPt). Job postings on popular sites such as GasWorks or Indeed have increased dramatically. Brazen recruiters are bombarding existing staff members with endless text messages and voicemails for job openings at nearly every corner of the country. While relative compensation has increased (30% since 2015) over the past couple of years, many chiefs still struggle to keep cases staffed (asamonitor.pub/3BbL09L). Two things are to blame for the dearth in physician anesthesiologists: the pandemic and a relentless increase in volume.
First, the pandemic did not create health care staffing shortages, but the impact is worsened because of it. Even before coronavirus, we were met with extraordinary and overwhelming challenges. The exodus of 2020 amplified these issues. Remaining staff have been affected by callouts and mandatory quarantines. A predictable case backlog has increased demand for afterhours and weekend care. This burden has fallen on a skeletonized workforce pushed to the brink. These same staffing woes have been replicated in virtually every area of the hospital.
Second, our post-pandemic world is one defined by more sites, more volume, and more work. This, coupled with a shrinking workforce, leads to an inevitable conclusion that there is an undeniable risk of burnout. Young physicians – who we wrote in a previous Monitor article are part of the “burnout generation” – are generally not excited about working in the capacity that is needed. Most young physicians are not practice owners, and most will be employees for the duration of their careers. They are unable to realize many of the fiduciary gains from their increased workload. They have young families, student loans, and only the beginnings of retirement savings. As work hours slowly creep up, physician attrition leaves increased demand on the remaining staff. Amy Vinson, MD, chair of the ASA Committee on Physician Well-Being, warns that “the situation can spiral out of control” for departments. There seems to be a trend of increased desire for practices with a better lifestyle schedule.
The appropriate intervention is up for debate. While some say this is simply a game of employment “musical chairs” that will self-resolve, others have noted an exodus of physicians that bemoan their lack of sense of control of their work-life balance. For any progress to be made on this issue, all stakeholders must agree that we have a problem. Even believers of the musical-chair theory must agree that our current struggles will continue to be propagated until we make meaningful changes to our workplace.
We will need to be innovative to survive in the modern health care world. Creative staffing models that emphasize flexibility seem to have the most popular appeal. Flexible systems can allow groups to recruit and retain valued physicians who want to control how much (or when) they work and are willing to adjust their incomes accordingly. More importantly, they can allow all physicians to feel that they have more control over their work-life balance, thereby improving job satisfaction. Many successful groups incentivize after-hours or weekend work so aggressively that the demand outpaces supply. Offering part-time work with proportional call is also an option to recruit a broader workforce while meeting the clinical needs of a busy practice. No matter the solution, it will take administrative-level assistance.
Hospital administrators need to take some ownership of staffing shortages. All parties should embrace a set of aligned incentives. If you can successfully present your practice as a well-organized and motivated group, you are likely to curry more favor. Hospital leadership needs to see you as their best chance to keep pace with the perioperative needs of patients. Effective recruitment will likely involve resources that the hospital can provide. If that resource is money, you will need to present a well-thought-out request. Help with locums? Bigger call stipends? If your average $/unit is below average, get that fact into the discussion.
Money is, of course, not always what potential staff is looking for. A way of improving hiring and retention of staff is also to expand benefits offered outside of what is traditionally considered. For large corporations/academic institutions, for example, offering housing, child care, or group insurance to all staff would be a way of massively increasing compensation without increasing salary. Some of these expenses, like housing, could be considered investments and may be tax deductible for the employer. Courier or concierge services are also some examples of hospital-provided benefits that appeal to physicians from households with two working parents.
In the face of staff shortages, we need to nurture a strong sense of gratitude. When compared to a couple of years ago, we are working harder for our patients. We spend more hours at the bedside, we deal with increased stress, and share our grief with fewer and fewer coworkers. Despite this, we should be grateful. Grateful to have a noble job. Grateful of the positives that have come with growth. Grateful for creative staffing solutions. We must endeavor to obtain a clearer visibility of clinician stress and burnout.
We must act decisively to stay ahead of our staffing shortages. While the frog in warm water might have met an unfortunate ending, our practices don’t have to. With the proper attention to our staff and our patients, we can still right our course. After all, everybody knows that a watched pot never boils.
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