Top Disruptors within Our Healthcare Systems

Why they are bringing the system down

A recent article [1] highlights another hospital closure and the burden that this denial-of-access “meltdown” places upon the state, adjacent hospital systems, and patients – noting that “patients are going to die” as a result.

Another report notes that over 630 U. S. rural hospitals are at immediate or high risk of closure in the US [2] – with more closures coming – and not just limited to rural areas! [3] A Forbes magazine article [4] reviews the severe financial burdens facing many hospital systems and foresees many more upcoming closures.

ADVERTISEMENT

Some experts now predict an evolving crisis and probable collapse of large portions of our current healthcare system [5] – if stabilizing efforts are not accelerated. Meanwhile, a months-long investigation into private equity involvement in healthcare revealed a playbook in which hospitals in low-income neighborhoods are shuttered – while executives walk away with tens of millions of dollars. [6]

This, at the same time as reports of toxic, abusive, and violent healthcare workplaces abound – and we hear that up to 20% of the hands-on healthcare workforce (four – five million workers) have left healthcare for safer, less abusive workplaces.

U.S. healthcare is now ranked by many (including a majority of patients themselves) as the worst in all industrialized nations.

ADVERTISEMENT

There are those who still say that these ‘disruptors’ were brought on by the COVID pandemic and will now fade away (“just give it time”)?

Certainly the pandemic has played a role in the disruption and destabilizing of our healthcare systems – and future pandemic preparedness must now factor in these long-term effects to our society, healthcare delivery, economic, supply chain, and other critical systems.[7]

However, the issues racking our healthcare systems were present and accelerating long before the COVID crisis – and have continued to worsen throughout and since the pandemic.

ADVERTISEMENT

What are these 18 critical destabilizing issues?

1. World’s most expensive healthcare – but – quality ranked as ‘poor’!

“The U.S. spends more on healthcare than any other developed nation, with healthcare spending projected to reach a staggering $6.2 trillion by 2028. It’s $4.3 trillion now – yet consumers are increasingly unhappy!” A new Gallup poll [8] shows that for the first time less than 50% of U. S. consumers rate our health care as ‘excellent’ or even ‘good’ – and over 20% rated it as ‘poor!’ Meanwhile another Gallup poll [9] notes that 38% of Americans delayed needed healthcare in 2022 due to high costs.[10] This is up from 26% in 2021 and the highest number in Gallup’s 22 years of tracking – with many pundits predicting a dire forecast ahead [4] for our healthcare delivery systems.

2. Worst health outcomes among high-income countries – decreased access to timely effective healthcare:

Since 2011 The United States has placed last among high-income, industrialized nations – having the greatest number of preventable deaths [11] – that could potentially have been avoided by timely access to effective health care. In a just-released 2023 report,[12] while “the U.S. continues to spend more on healthcare than any other high-income country, yet we have the lowest life expectancy at birth and the highest rate of persons with multiple chronic diseases.”

3. Prescription drug prices continue to rise – reduced availabilities accelerate:

“Americans spend more on prescription drugs — average costs are about $1,300 per person per year — than anyone else in the world.” And these costs continue to rise [13]!  – even with Congress making some moves to allow Medicare to negotiate some medication drug prices for Medicare patients. However, many patients will not see any benefits from this legislation as more and more critical and essential medications become financially out of reach.[14] Meanwhile, more and more drugs, from critical, lifesaving cancer [15] to cardiac meds [16] and even many common, generic medications [17], are in shorter supply [18], or increasingly unavailable. [19]

ADVERTISEMENT

4. Disintegrating conditions within our healthcare workplaces – increasing oppositional attitudes – accelerated worker departures:

With huge numbers of ‘hands-on’ healthcare workers – (some saying as much as 20% of our current U.S. healthcare labor force – that’s 4 – 5 million workers[20]) abandoning healthcare[21] for  other professions[22], in the past 2 years — while reporting ‘toxic’ workplaces, including record levels of work-related depression{23], ‘burnout’ [24], demoralization [25], PTSD [26], overwhelming workloads [27], that continue to expand, [28], rising verbal and physical abuse from all sectors[29], workplace violence, assaults and worker deaths [30], – and the lowest levels of job satisfaction [31] among all major workforce industries. Labor statistics continue to confirm ongoing healthcare departures – with over 500,000 additional healthcare workers voluntarily leaving their jobs in 1 recent month alone (May 2023). [32]

A 2022 report [33] found that over 117,000 physicians left the healthcare workforce in one year – (2021) – alone representing ~ 10% of the current U.S. physicians labor force [34].  And, this exodus continues. [35]

As workplace conditions worsen – there is a growing chasm [36, 37] between healthcare workers (doctors, mid-levels, nurses and other ‘hands-on’ patient care employees) and “supervising” administrator/managers. Many manager teams are increasingly distant and isolated (frequently by system design) from the employees they ‘supervise’ – and are, at many facilities, indoctrinated with anti-worker attitudes and kept in their peer-group teams for a majority of the working day. [36, 37]

There are also reports of increasingly corporate, multi-hospital senior management boards stating that doctors and nurses are seen as oppositional and an obstruction to generating profits in healthcare. [36, 37]

5. “Moral Injury” – An increasing thereat to clinical healthcare workers – and to patients:

Accelerating moral injury [38] is becoming an increasing threat [39] to physicians and other healthcare workers. “Moral injury occurs when our ethical code is violated.”  For physicians, moral injury often occurs [40] when they are forced to sacrifice patients’ well-being for efficiency or profit. “For example, being scheduled to see too many patients daily to provide quality care – or be pressured to prescribe unnecessary tests and treatments.” [41]

In the healthcare workplace where physicians are now predominately employees – clinical management decisions are increasingly being made by the cadres of non-clinical manager/administrative teams that now dominate healthcare workplaces (3,200% increase). [42] Physicians increasingly find themselves forced to acquiesce to care and decision pathways that they feel are not optimal or possibly harmful to patients.

However, physicians still remain legally responsible for these clinical actions – even when they did not make the decision – as in most legal jurisdictions – only clinically ‘licensed’ doctors, mid-levels, or nurses – can be named as primary targets for malpractice actions.

Physicians who object are told that they can always leave. But, in most jurisdictions, employee non-compete clauses [43] prevent employee physicians from migrating to any close-locale workplace. Thus, they are frequently faced with the option of acquiescing or leaving healthcare. Many are now leaving [44] – thus further contributing to the increasing shortfall in U. S. physicians.

Meanwhile, patient suffer further from these profit-motivated clinical decisions – increasingly made by non-clinical management.

6. Violence, abuse, & assaults – rising physical dangers in the healthcare clinical workplace:

Greater incidences of violence, assaults, injuries, and deaths [45] are now being reported in healthcare workplaces, than in any other workplace setting in the U.S.  75% of all workplace assaults occur in healthcare [46], and healthcare workers are five times more likely to suffer workplace violence than workers in any other U.S. industry. [47] Data from Press Ganey [48] notes more than 5,000 nurses were assaulted on the job in the second quarter of 2022 alone, and the numbers are likely much higher as healthcare assaults are generally underreported. These reported numbers equate to more than two nursing personnel assaulted every hour, 57 per day, 1,739 per month. A recent law enforcement report [49] warns the AMA to prepare for increasing assaults upon physicians.

Thus, another reason for departures from the healthcare workplace by doctors [50], nurses [51], and other workers now looking for a safer place to work where they feel more secure in knowing they will not be killed or severely injured “just because you show up for work”! [47]

7. The Specter of the Toxic, Abusive, Unsafe Workplace – The Responsive Rise of Unionization :

Unaddressed abusive, increasingly violent, and unsafe, ‘toxic’ workplaces have led to accelerating unionization movements [36]  among the types  of healthcare workers who are legally allowed to unionize. Nursing unions by 2022 represented 230,000 nurses across the united states.[52]  This is 20% of RNs and 10% of LPNs/LVNs. A 2022 NLRB decision [53] now allows ‘employed’ physicians, APRN;s and PA’s [54] to hold elections on unionizing. Recent reports indicate that unionization is gaining traction [55] among eligible physicians.

But not all healthcare workers are legally allowed to unionize.[56] Many others are just leaving! [22]

8. Inadequate numbers of doctors and nurses being trained and licensed:

There is a critical and worsening shortage of doctors[57], and nurses.[58]  Our U. S. physician and nursing training programs are currently not producing enough ‘licensed’ doctors [59] and nurses [60], to even keep up with current demands [61], and far less than the significantly increased needs [62] arising as our population bubble (baby boomers) ages and faces increasing healthcare issues, especially as many of our currently licensed doctors [63], and nurses are leaving healthcare for other careers! [64]

We have historically imported many doctors and nurses from other countries [65] – leaving the financial burden of their training to these other countries.  But with a worldwide worker crisis accelerating – other countries are now outcompeting us for these foreign medical graduates. Meanwhile, nearly half of all currently working U.S. physicians are 55 or older [66] , with some medical specialties having between 60-90⁺% of physicians at greater than 55 years of age. [67]  This shortfall impact is worst in primary care specialties.[68]

Our Congress continues to grapple with the healthcare workforce shortage – but thus far no solutions have been reached. [69]

9. Impossible-to-Complete healthcare workloads:

Healthcare workers are facing impossible-to-complete work overloads. One study [70] documents that it takes primary care physicians 26.7 hours each day to adequately (per standards) complete all their daily clinical tasks – to meet all minimum guideline-directed care. Workloads for nurses and other ‘hands-on’ workers are equivalent or worse.  These loads are made even more overwhelming [71] by increasing shortages of these workers –  as many leave healthcare for other professions.

References:

1. Jakob Emerson & Erica Carbajal, ‘Patients are going to die’: Hospital access meltdown in Central California leaves officials in search of solutions. Becker’s Hospital Review, Jan 19, 2023. ‘Patients are going to die’: Hospital access meltdown in Central California leaves officials in search of solutions (beckershospitalreview.com)
2. Marcus Robertson, 631 hospitals at risk of closure, state by state. Becker’s Hospital CFO Report. Jan 3, 2023. https://www.beckershospitalreview.com/finance/631-hospitals-at-risk-of-closure-state-by-state.html
3. Harry W Severance, “631 hospitals at risk of closure, state by state”. LinkedIn, Jan 6, 2023. https://www.linkedin.com/feed/update/urn:li:activity:7017219042918756352/
4. Rita Numerof, A Dire Forecast Lies Ahead for U.S. Healthcare Delivery in Distress, And Change Isn’t Waiting For A Sinking Ship To Right Itself. Forbes, Jan 17, 2023.  A Dire Forecast Lies Ahead For U.S. Healthcare Delivery In Distress, And Change Isn’t Waiting For A Sinking Ship To Right Itself (forbes.com)
5. ROBERT GLATTER, PETER PAPADAKOS, AND YASH SHAH, The Coming Collapse of the U.S. Health Care System. Time, Jan 10, 2023. The Coming Collapse of the U.S. Health Care System | Time
6. Michael DePeau-Wilson, “Hospitals Close While Execs Made Millions; Prestigious Group Took Sackler Money”. MedPage-today, April 26, 2023.  Hospitals Close While Execs Made Millions; Prestigious Group Took Sackler Money | MedPage Today
7. Harry W Severance, “COVID-19 can offer some silver linings”. Emergency Physicians Monthly , Feb 2, 2021. COVID-19 can offer some silver linings (epmonthly.com)
8. Lydia Saad, “Americans Sour on U.S. Healthcare Quality.” Gallup, Jan 19, 2023. Americans Sour on U.S. Healthcare Quality (gallup.com)
9. Megan Brenan, “Record High in U.S. Put Off Medical Care Due to Cost in 2022”. Gallup, Jan 17, 2023. Record High in U.S. Put Off Medical Care Due to Cost in 2022 (gallup.com)
10. Jakob Emerson and Molly Gamble, “Healthcare’s affordability problem is about to get worse.” Becker’s Hospital CFO Report. June 16, 2023. Healthcare’s affordability problem is about to get worse (beckershospitalreview.com)
11. The Commonwealth fund, New Study: “S. Ranks Last Among High-Income Nations on Preventable Deaths, Lagging Behind as Others Improve More Rapidly”. Sept 23, 2011. New Study: U.S. Ranks Last Among High-Income Nations on Preventable Deaths, Lagging Behind as Others Improve More Rapidly | Commonwealth Fund
12. The Commonwealth fund, “S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes ”. Jan 31, 2023. U.S. Health Care from a Global Perspective, 2022 | Commonwealth Fund
13. Robert Langreth, “Why Prescription Drug Prices in the US Are So High”. Bloomberg, July 19, 2022. Why Prescription Drug Prices in the US Are So High – Bloomberg
14. Emily Hutto, “How Patent Thickets Keep Cheaper Drugs Off the Market”. MedPaage-Today, Feb 3, 2023. How Patent Thickets Keep Cheaper Drugs Off the Market | MedPage Today
15. Britney Heimuli, ‘This is the worst I’ve ever seen’ — Chemotherapy drug record shortage puts patients at risk. Yahoo News, June 7, 2023. ‘This is the worst I’ve ever seen’ — Chemotherapy drug record shortage puts patients at risk (yahoo.com)
16. Erik Swain, Michael Ganio, Patricia Nale, “Shortages affect availability of some drugs used in emergent cardiac care”. Cardiology Today, July 13, 2023. Shortages affect availability of some drugs used in emergent cardiac care (healio.com)
17. KAITLIN VOGEL, These 22 Medications Are in Short Supply—Is Yours on the List? Parade, Jan 27, 2023. 22 Medication Shortages: List of Drugs – Parade: Entertainment, Recipes, Health, Life, Holidays
18. Deidre McPhillips, Nearly all hospital pharmacists say drug shortages are negatively impacting care; a third say impacts are ‘critical’. CNN Health, Aug 10, 2023. Drug shortages: Nearly all hospital pharmacists say shortages are negatively impacting care; a third say impacts are ‘critical’ | CNN
19. Jen Christensen, New drug shortages in the US increased nearly 30% in 2022, Senate report finds. CNN Health, March 22, 2023. New drug shortages in the US increased nearly 30% in 2022, Senate report finds | CNN
20. Harry Severance, “Isn’t It a Seller’s Market for Healthcare Professionals? – Competition for a scarce resource (providers) could improve the workplace.” MedPage-Today, Oct 12, 2022. Isn’t It a Seller’s Market for Healthcare Professionals? | MedPage Today
21. Deb Gordon, , Amid the Great Resignation… Forbes Magazine , May 17, 2022. Amid Healthcare’s Great Resignation, Burned Out Workers Are Pursuing Flexibility And Passion (forbes.com)
22. Harry Severance, MD, “Should You Stay or Should You Go?” EP Monthly, June21, 2022. Should You Stay or Should You Go? | Emergency Physicians Monthly (epmonthly.com)
23. JESSICA STILLMAN, A Toxic Workplace Triples Your Risk of Depression, a New Study Finds. INC, July 28, 2021. A Toxic Workplace Triples Your Risk of Depression, a New Study Finds | Inc.com
24. Harry W Severance, MD, ‘Burnout’ and the Healthcare Workplace. EP Monthly, Aug 5, 2022. ‘Burnout’ and the Healthcare Workplace (epmonthly.com)
25. Eric Reinhart, Doctors Aren’t Burned Out From Overwork. We’re Demoralized by Our Health System. The NY Times, Feb 5, 2023, Opinion | Doctors Aren’t Burned Out From Overwork. We’re Demoralized by Our Health System. – The New York Times (nytimes.com)
26. Lazarus A. Traumatized by practice: PTSD in physicians. J Med Pract Manage. 2014 Sep-Oct;30(2):131-4. PMID: 25807606. Traumatized by practice: PTSD in physicians – PubMed (nih.gov)
27. Devon McPhee, Primary care doctors would need more than 24 hours in a day to provide recommended care. U Chicago News, April 11, 2022, Primary care doctors would need more than 24 hours in a day to provide recommended care | University of Chicago News (uchicago.edu)
28. Harry Severance, MD. Yet Another Issue Is Disrupting the Healthcare Workplace. MedPage-Today. Jan 10, 2023. Yet Another Issue Is Disrupting the Healthcare Workplace | MedPage Today
29. Harry Severance, The financial hit to healthcare has sparked a period of transition. Here’s what experts think will happen next. LinkedIn, March 2023, https://www.linkedin.com/feed/update/urn:li:activity:7073108319468486656/
30. Giancarlo Toledanes, The Other Epidemic: Violence Against Healthcare Workers. Medscape, Aug 30, 2021. The Other Epidemic: Violence Against Healthcare Workers (medscape.com)
31. Annie Burky, Healthcare ranked lowest for employee satisfaction, Qualtrics survey finds. Fierce Healthcare, Jan 19, 2023. Healthcare ranked lowest for employee satisfaction, survey finds (fiercehealthcare.com)
32. Molly Gamble, Healthcare workers keep calling it quits. Becker’s Hospital Review. July 6, 2023. Healthcare workers keep calling it quits (beckershospitalreview.com)
33. Mari Devereaux, Why so many doctors are quitting. Advisory Board, July 18, 2023. Why so many doctors are quitting (advisory.com)
34. Federation of State Medical Baords (FSMB), FSMB Census of Licensed Physicians in the United States, 2020. JOURNAL of MEDICAL REGULATION VOL 107, N O 2 |, 2021. 2020-physician-census.pdf (fsmb.org)
35. Tanya Albert Henry, Medicine’s great resignation? 1 in 5 doctors plan exit in 2 years. AMA News, Jan 18, 2022. Medicine’s great resignation? 1 in 5 doctors plan exit in 2 years | American Medical Association (ama-assn.org)
36. Harry Severance, MD. A Manager’s Perspective on Healthcare Unionization — Her response was not at all what I expected. MedPage-Today, June 11, 2023. A Manager’s Perspective on Healthcare Unionization | MedPage Today
37. Harry Severance, MD. Suits vs Scrubs: The Evolving Healthcare Workplace — The patient pays the ultimate price. MedPage-Today, April 19, 2023. Suits vs Scrubs: The Evolving Healthcare Workplace | MedPage Today
38. Simon G. Talbot and Wendy Dean, Physicians aren’t ‘burning out.’ They’re suffering from moral injur STAT, July 26, 2018. Physicians aren’t ‘burning out.’ They’re suffering from moral injury – STAT (statnews.com)
39. Čartolovni A, Stolt M, Scott PA, Suhonen R. Moral injury in healthcare professionals: A scoping review and discussion. Nurs Ethics. 2021 Aug;28(5):590-602. doi: 10.1177/0969733020966776. Epub 2021 Jan 11. PMID: 33427020; PMCID: PMC8366182. Moral injury in healthcare professionals: A scoping review and discussion – PubMed (nih.gov)
40. TOMI MITCHELL, I will not sell my soul to modern medicine: Curing physician moral injury. com, Sept 23, 2022. I will not sell my soul to modern medicine: Curing physician moral injury (kevinmd.com)
41. BEN KORNITZER, MD, Physician burnout is a threat, no different from the spread of a virus—here’s how to fix it. com, July 15, 2023. Ben Kornitzer, MD | KevinMD.com
42. Joe Cantlupe, Expert Forum: The rise (and rise) of the healthcare administrator. Athena Health, Nov 7, 2017. Number of healthcare administrators explodes since 1970 | athenahealth
43. Kimberly Ruppel and Christopher Rya, PHYSICIAN NON-COMPETE AGREEMENTS: WHAT YOU SHOULD KNOW. Health Law Blog, Feb 24, 2022. Physician Non-Compete Agreements: What You Should Know – DW Health Law Blog (dickinson-wright.com)
44. Harry Severance, MD. Yet Another Issue Is Disrupting the Healthcare Workplace. MedPage-Today, Jan 10, 2023. Yet Another Issue Is Disrupting the Healthcare Workplace | MedPage Today
45. Yash B. Shah, Violence in the Workplace: The Hidden Dangers of a Medical Career. Medscape, Feb 25, 2022. The Hidden Dangers of a Medical Career (medscape.com)
46. Wallace Stephens, Violence Against Healthcare Workers: A Rising Epidemic.  AJMC. May 12, 2019. Violence Against Healthcare Workers: A Rising Epidemic (ajmc.com)
47. Harry Severance, MD. The escalating violence in health care workplaces: a critical problem facing the nation’s health care system. com, June 2, 2023. The escalating violence in health care workplaces: a critical problem facing the nation’s health care system (kevinmd.com)
48. CAROL DAVIS, 5,217 NURSES WERE ASSAULTED ON THE JOB JUST IN Q2 2022. Health leaders media, SEPTEMBER 12, 2022. 5,217 Nurses Were Assaulted on the Job Just in Q2 2022 | HealthLeaders Media
49. Claire Wallace, Police officers warn physicians to be prepared among growing patient attacks. Becker’s Physician Leadership. July 18th, 2023. Police officers warn physicians to be prepared among growing patient attacks (beckersphysicianleadership.com)
50. Christine Lehmann, Hospital Shootings Have Doctors Worried About Their Personal Safety. Medscape, June 12, 2023. Hospital Shootings Have Doctors Worried About Their Safety (medscape.com)
51. Erica Carbajal, Nurse stabbed at Massachusetts hospital: Police. Becker’s Hospital Review. June 13th, 2023. Nurse stabbed at Massachusetts hospital: Police (beckershospitalreview.com)
52. Shari Berg, A Comprehensive Guide of State-by-State Nursing Unions. Incredible Health, Feb 14 2022. A Comprehensive Guide of State-by-State Nursing Unions | Incredible Health
53. David M Sack, Doctors Are Reluctant to Unionize. Why? com, June 26, 2023. Doximity
54. Maura Mastrony, Claire Pariano, Jason Stanevich, Following the Doctor’s Orders: NLRB Decision Prescribes Union Election for Physicians. JDSupra, April 12, 2022. Following the Doctor’s Orders: NLRB Decision Prescribes Union Election for Physicians | Littler – JDSupra
55. Kelly Gooch, Unionization gaining traction among physicians. Becker’s Hospital Review, August 4th, 2023. Unionization gaining traction among physicians (beckershospitalreview.com)
56. The Natioonal Law Review, Doctors, Unions, and Protected Activity. August 28, 2023, Volume XIII, Number 240. Doctors, Unions, and Protected Activity | The National Law Review (natlawreview.com)
57. Andis Robeznieks, Doctor shortages are here—and they’ll get worse if we don’t act fast. AMA News, APR 13, 2022. Doctor shortages are here—and they’ll get worse if we don’t act fast | American Medical Association (ama-assn.org)
58. Dropstat, The Nursing Shortage: Causes, Consequences, and Cures. The Nursing Shortage: Causes, Effects & Cures | DropStat
59. Michael Nedelman, Why doesn’t the US train more doctors? CNN Health, March 14, 2017. Why doesn’t the US train more doctors? | CNN
60. Jacob Kupietzky, It’s Not Just A Shortage Of Nurses But Of Training And Understanding. Forbes, Nov 29, 2021. It’s Not Just A Shortage Of Nurses But Of Training And Understanding (forbes.com)
61. Derek Thompson, Why America Has So Few Doctors. The Atlantic, FEBRUARY 14, 2022. Why America Has So Few Doctors – The Atlantic
62. Harry W Severance, MD. The Great Healthcare Exodus – Physician Shortage – Critical Changes are Needed!. LinkedIn, August 2022, https://www.linkedin.com/feed/update/urn:li:activity:6923692910936829952/
63. Lorna Collier, 7 Reasons Doctors Are Leaving Medicin Healthgrades, July 28, 2023. 7 Reasons Doctors Are Leaving Medicine | Healthgrades for Professionals
64. Ed Yong, WHY HEALTH-CARE WORKERS ARE QUITTING IN DROVES. The Atlantic, NOVEMBER 16, 2021. Why Health-Care Workers Are Quitting in Droves – The Atlantic
65. Joyce Frieden, Are There Too Many Foreign-Born Docs in the U.S.? Maybe, Maybe Not. MedPage-Today. February 16, 2022. Are There Too Many Foreign-Born Docs in the U.S.? Maybe, Maybe Not | MedPage Today
66. Mariah Taylor, 47% of physicians are 55 or older: 8 things to know about the physician workforce. Becker’s Hospital Review. January 17th, 2023. 47% of physicians are 55 or older: 8 things to know about the physician workforce (beckershospitalreview.com)
67. Linda Beattie, Physician Shortages in Medical Specialties in 2021: An Inside Look. AMN Healthcare, March 16, 2021. Physician Shortages in Medical Specialties in 2021 | Merritt Hawkins
68. ELAINE K. HOWLEY, The U.S. Physician Shortage Is Only Going to Get Worse. Here Are Potential Solutions. Time, July 25, 2022, There’s a Physician Shortage In the U.S. Here’s Why | Time
69. Joyce Frieden, What Should Be Done About the Health Workforce Shortage? MedPage-Today, February 16, 2023. What Should Be Done About the Health Workforce Shortage? | MedPage Today
70. Heather Landi, Primary care docs need 27 hours a day to provide guideline-based care, study finds. Fierce Healthcare, Aug 23, 2022. Doctors need 27 hours a day to provide recommended care: study (fiercehealthcare.com)
71. Lauren Dixon, Challenges of the Health Care Worker Shortage. Medium – Talent Economy, Nov 29, 2017. Challenges of the Health Care Worker Shortage | by Lauren Dixon | Medium