Staffing Crunch Threatens Healthcare

John Commins, for HealthLeaders Media, September 22, 2008

"If you build it, they will come." That immortal line from the novel and movie "Field of Dreams" applies to baseball ghosts and Iowa cornfields, not necessarily to hospitals.

A recent story in the L.A. Times should send a shudder down the spine of any healthcare human resources professional already feeling the effects of the nation's physician and nurse staffing crunch.

The University of Southern California School of Medicine has raised concerns that a brand new county hospital set to open on Oct. 17 won't have enough staff to handle the caseload. In a letter to Los Angeles County officials, USC Med School Dean Carmen A. Puliafito, MD, warned of "an impending patient safety crisis" at the 600-bed County-USC Medical Center, which Puliafito says "will not be able to operate safely with the current staffing available," the Times reports.

In his letter Puliafito noted that nine emergency department physicians at the existing and soon-to-close County-USC hospital have left since January for better-paying jobs, along with eight nurse practitioners and physicians assistants, none of whom have been replaced.

LA County CEO William T. Fujioka assured the Times that the issue is being addressed. "There will be no jeopardy whatsoever to our patient-care programs. We're going to work with them toward filling the positions," he said.

I want to believe Mr. Fujioka. I'm sure he is an honorable man. But I really wonder if he's checked the market lately for emergency department physicians and support staff, especially for a lower-paying, safety net hospital with a high caseload of indigents and uninsured.

The new County-USC is built for 137 emergency department beds, but only 87 will be staffed. That won't help waiting times and certainly indicates that staffing will be an issue, despite the county's best assurances.

Remember, one out of three practicing physicians in the United States is more than 55 years old, and they're expecting to retire within the next 10 to 15 years. The nation's medical schools will have to beef up enrollment by about 17% by 2012. It'll help, but it's not enough to cover the potential loss of one-third of the physician work force. Depending on who's doing the estimating, the United States will be short anywhere from 24,000 to 200,000 physicians by 2020.

Relax, we're told. We'll just have to rely more upon "physician extenders" like nurse practitioners and physicians' assistants to carry more of the load. The people who tell us that clearly haven't tried to recruit nurses lately.

Be prepared to read a lot more stories about physician and nursing staff shortages in the coming months and years, as the full effect of the healthcare staffing crisis makes itself known to the general public.

John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at

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