Post-covid, hospitals still battle doctor, nursing shortages

As the pandemic has made its way out, hospitals now are facing and addressing other pressing concerns.

“In South Florida specifically … we’re experiencing cancer incidence rates rising by about 12% by the end of the decade,” said Gino R. Santorio,

president and chief executive officer of Mount Sinai Medical Center in Miami Beach. “That really requires more physicians and services needed to meet that demand. This past October we broke ground on the Braman Comprehensive Cancer Center, and so that state-of-the-art facility will continue to offer some of the same and next day appointments that patients are seeking.”

“But in general, in terms of the state, and really federally as well, there is a shortage of physicians projected,” Mr. Santorio said. “That’s something that I think all healthcare institutions contend with, and it’s going to probably follow hospitals into the next decade as being a challenge.”

In 2021, research by the Florida Hospital Association and the Safety Net Hospital Alliance of Florida projected Florida to be short by 17,924 physicians by 2035 if trends continued. Additionally, Florida is projected to face an overall shortage of 59,000 nurses by 2035, according to another association analysis.

However, hospitals are facing the shortage from the root and continue to welcome healthcare professionals.

“Nurse shortages are certainly something that all hospitals are contending with; that projection is real,” said Mr. Santorio. “Over the last several years, health systems and universities have worked together along with the state to put some plans in place to try to reduce that delta, and we started to see the impact of that already, and so I think that … we’re doing a better job to meet that demand than we were a few years ago. Our nursing turnover rates have stabilized in hospitals in the state of Florida.”

“At this point,” he said, “we’re singularly focused on growing the next generation of nurses and some of these additional programs that we’ve implemented by partnering with our local universities and colleges, I think is really paying off. I think we’ll double down on that and hopefully that will help to address the shortage.”

Other hospitals have noticed a shortage in more healthcare providers and have taken similar steps in aiding the shortage as they partner with colleges and universities.

“I would say there’s a shortage of all healthcare: doctors, nurses and techs, and so that is a challenge,” said Carlos A. Migoya, president and chief executive officer of Jackson Health System. “It’s a challenge that started with covid and continues, and I don’t see it slowing down…. What we’ve been doing is really we’ve partnered up with Miami Dade College and FIU where we basically are providing scholarships and jobs to people that are going into the healthcare field, predominantly nursing and tech.”

This allows the hospital to help scholarship receivers financially as they receive a full scholarship on tuition and books, said Mr. Migoya. “At the same time, they get a job as they’re going to school, whether it’s a part-time job or a full-time job, depending on the situation with each individual, and of course at the end, they get a full-time job with us.”

Aside from the physician shortage, said Mr. Santorio, primary care is a major concern for many. “I think that timely payments is certainly a challenge.

Hospitals, if you look at Medicare Advantage plans, 48% of payments are going beyond 90 days. So, when hospitals perform the work with all of these enhanced pressures that we’re experiencing and we don’t get paid for greater than 90 days, that creates a significant issue for all hospitals. I think that really meeting the community needs for health care is really top of mind in terms of what we focus on here at Mount Sinai.”

Financial issues have also taken a stake in hospitals.

“The fact is that revenues have been fairly flat,” said Mr. Migoya. “Medicare, Medicaid, to private payers, no one is looking to pay any more for what current services are, and at the same time through the inflation and inflationary rates that we’ve got for the last year or two, the costs have gone up dramatically. Obviously, compensation to be able to keep up with the market, as well as supplies, pharmaceuticals and everything else have gone up a lot. Our margins have really narrowed.”

An increase in the cost of medical supplies and staff has also played a role.

“The increase in both staff costs and supplies over the last three years has been monumental and that has not come down,” said Mr. Santorio. “Now that said, the rate of inflation has leveled off compared to the sharp increases we were seeing over the last couple of years, but those rates have pretty much permanently reset, which has been a major problem for hospitals, particularly in the not-for-profit sector margins have really diminished precipitously over the last four years.”

“Supplies for pharmaceuticals have also increased dramatically and continue to,” said Mr. Migoya.

Cost of living is taken into account by hospitals as they aim to retain health care providers.

“The cost of living continues to be the story in terms of the barrier, if you will, for folks to continue to stay in the area, from a worker standpoint,” said Jesse Gabuat, chief nursing officer, HCA Florida Aventura Hospital. “That is something that we continue to stay connected in terms of what’s the cost of living, especially around here in Aventura that we are sensitive to when it comes to retaining and attracting folks … and I think that goes for the whole South Florida region.”

Because of Florida’s seasonality, many snowbirds visit the South Florida area. This also plays a role in hospitals.

Snowbirds increase the volume in hospitals, said Mr. Gabuat. The anticipated number of patients during the winter months is expected to increase, he said. “We’re prepared to make sure that we have enough resources to be able to take care of them and in addition to that, this is also our flu season.

And looking at the seasonality of our snowbirds and the flu season, which coincide, those two factors … increase our volumes.”

Respiratory viruses are being looked at, said Dr. Bhavarth Shukla, UHealth’s medical director for infection control and associate professor, Division of Infectious Diseases. Many people became familiar with covid, however prior to the pandemic there were respiratory viruses circulating in different parts of the country, especially during the winter.

These viruses have come back over the last few years, said Dr. Shukla. Some of the viruses include Influenza and parainfluenza, “and there’s a whole library of respiratory viruses that are out there that circulate during the winter months. During the pandemic, we had done a lot of work and trying to predict when we were going to see these cases of covid emerge and some of those models that we created, we’re basically trying to work on adapting to all respiratory viruses, so that we can get a better idea when those viruses may circulate and when we may expect to see more patients coming in with those symptoms and requiring hospital care.”

Another area being looked at is multi-drug-resistant organisms, said Dr. Shukla. What resistant bacteria is in the community and what measure must be taken to identify them are of “the type of work that many people have been working on nationally, prior to the pandemic, but I think since we saw some increases in the past few years, more people are looking at that as well.”

Tropical mosquito-borne diseases are being looked into, said Dr. Shukla. “This is a specific issue to Florida. More dengue cases, for example, have been reported in the past couple of years.”

As future health concerns are being addressed and explored, covid continues to impact the healthcare field.

Although covid has diminished, said Mr. Migoya, “we still have a fair amount of patients with covid in the hospital. That continues to be a challenge for us and people don’t understand that there is still a level of covid out there; not to the degrees that it was … two or three years ago, but there is still a challenge out there, and right now covid and the flu are two of the biggest challenges that we’re seeing as far as patients coming in through the door with complexities.”

As the aging population in Florida continues to grow, hospitals feel the effects.

“The state of Florida has the second-highest over-65 population in the country,” said Mr. Santorio. “That absolutely has impacted the demand on health care, because an aging population is really the largest consumer of healthcare services, that demographic…. Part of our strategic plan has identified that several years ago, which is why we’re really focused on specifically opening this Braman Comprehensive Cancer Center, setting up the new site in Westchester, opening our PACE [Program of All-Inclusive Care for the Elderly] center, and hiring a slew of additional primary care and specialty care physicians.”

The Westchester site, said Mr. Santorio, “will be opening in the fall of 2025. A state-of-the-art four-story building, starting with our freestanding emergency center there. We’ll include a full suite of diagnostics.

“We’ll be a Baker Act receiving facility as well over there. That is in an area that’s significantly underserved. A lot of density there. I think it’s sorely needed in the community, and we’re excited to bring our brand to the people in Westchester as well.”

The PACE center started about six months ago is beneficial for the elders in Hialeah, said Mr. Santorio. “It’s a full-risk type center where we are responsible for all of the care. There’s no out-of-pocket expenses for seniors over 55 who need a skilled nursing level of care, and we think that’s going to be a major benefit towards helping individuals live at home longer without having to be admitted to a nursing home.”

Some hospitals are experiencing the effects of the aging population through their employees.

“It’s affecting it from a standpoint of workforce,” said Mr. Migoya. “As a lot of our older employees retire and obviously, the newer younger people, there’s not as many. As the baby boomers have retired, there’s a big retirement group but as far as the health care challenge, most people that are at that age have Medicare, so therefore, actually from a compensation standpoint, they’re fully covered. We haven’t seen that much of an influx yet of older people coming into our place.

“Being a public hospital,”Mr. Migoya said, “we obviously provide care for all people that have insurance or not, and we do have a big influx of illegal aliens that have actually come through the emergency room that we have been taking care of. That has been a challenge for us.”