The Downside of Healthcare Reform: Doctor Shortages, Deadly Nursing Strikes

Health policy experts and medical societies are concerned about a shortage of primary care physicians, which will be even worse when the Affordable Care Act unleashes an estimated 32 million newly insured patients on the healthcare system. And if you're wondering what effects that might have on hospitals, a new study of striking hospital nurses suggests that the short-term result won't be pretty.

The study, led by MIT professor Jonathan Gruber (ironically, a cheerleader for reform), shows that nurse strikes at New York hospitals over 20 years led to an increase in mortality and readmissions. During the study period, deaths in the hospital rose 19.4 percent, and readmissions jumped 6.5 percent for patients treated during the strikes.

How does that relate to the physician shortage? Well, here's the current situation: There are now more than 30,000 hospitalists -- doctors who coordinate the specialists that typically care for hospitalized patients -- practicing in over 3,300 hospitals. That's generally good news for patient care, but it also means that the majority of primary-care doctors -- who are far more numerous than hospitalists -- no longer practice in the hospital.

At the same time, many specialists would rather stay in the office or work in their ambulatory surgery centers than go to the hospital, where they're more likely to be treating nonpaying patients. So hospitals are paying these non-attending physicians extra to come in when they're needed. Overall, physicians are already in short supply in many institutions. And if the nurses go on strike... you get the picture.

In an interview with the Philadelphia Inquirer, Gruber said that he wasn't surprised by the results of his study. "I've seen how vital nurses are to hospital production," he said, adding that replacement nurses don't seem to fill the void.

The issue is especially pertinent in Philadelphia, where the 1,500 nurses at Temple University Hospital are in the second week of a strike. Other nurse strikes may follow in Minnesota and Massachusetts. And, in the wake of a merger of three nurse unions into a new entity that represents 150,000 nurses, more strikes are likely.

Meanwhile, the nation may see a shortage of 160,000 physicians by 2025, according to the American Association of Medical Colleges' Center for Workforce Studies. Even after considering the international medical graduates who fill many residency slots, there will be a shortfall of 46,000 primary-care doctors and 41,000 general surgeons. The shortfall of surgeons will have a marked impact on access to basic hospital procedures, and the paucity of medical specialists on the wards will put more pressure on hospitalists, who, in turn, will lean more on the ward nurses.

So what is to be done? Well, until 1974, a federal law prohibited nurses from going on strike. Perhaps that statute needs to be reinstated. The nurse unions will scream bloody murder, but other professionals such as firefighters, police officers, and teachers are already forbidden from striking. When patient lives are at stake, maybe the right to strike should take second place.

But if nurses can't strike, physicians should not be free to pursue maximum financial gain outside the hospital. Hospital staffs should adopt bylaws requiring physicians to be on call as a prerequisite for hospital privileges. After all, what's good for the goose is good for the gander.

Image supplied courtesy of the AFL-CIO at Flickr.