In what ways may staff, physician shortages impact resident education?
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Challenges with staffing impact education
The COVID-19 pandemic has had significant disruption in health care.
Elective and nonemergent care was impacted for 12 to 15 months and represented significant “lost opportunity” to all in medical, nursing and allied health education. Many students went without direct patient contact and experiences for more than 1 year. The gradual reopening of the economy has led to inflationary pressures and workforce disruption.
Altogether, the hospital subsector’s workforce has decreased nearly 90,000 people since March 2020, according to preliminary November 2022 data from the U.S. Bureau of Labor Statistics. Among nurses, the American Nurses Association expects there will be more than 100,000 registered nursing jobs available annually by next year.
The current workforce shortage in the health care industry is having ripple effects into the education segment. With respect to resident education, hospitals and large clinics are facing staffing challenges in nursing, patient technicians and administrative workers that have led to cutbacks in elective clinic and OR schedules. This leads to higher “service” demands by the residents and decreased direct patient contact and surgical experiences. With compressed surgical availability in hospitals, surgeons are taking more complex cases into the outpatient surgery center environment where students and residents often do not have privileges. Educators remain concerned over the potential lasting impact on the current generation of students and residents.
- Reference:
- Muoio D. 2022 forecast: 5 trends that will make or break healthcare’s labor shortages. https://www.fiercehealthcare.com/hospitals/these-5-trends-will-shape-healthcare-s-labor-shortages-2022-and-beyond. Published Dec. 22, 2021. Accessed May 2, 2022.
Charles A. Bush-Joseph, MD, is a professor in the department of orthopedic surgery at Rush University Medical Center in Chicago and an Orthopedics Today Editorial Board Member.
Workforce shortage may cause burnout, lower satisfaction
The health care industry’s staffing shortage crisis has had clear consequences for patient care delivery and efficiency. Less understood is how these shortages impact quality of care, patient safety and resident education.
Training residents takes time, patience, dedication and an acceptance that the clinical day will likely be prolonged. The educational process is time above and beyond regular clinical obligations. Staffing shortages lead to a new dynamic for attending physicians in the clinic and the OR, with inconsistency in patient care and staff unfamiliar with usual protocols, which makes us less inclined to spend extra time on education. With substantial staff turnover, it is onerous to train new team members. When and if staff do return to the work setting, they are often overwhelmed.
With physician absences, we are being asked to manage issues outside of our normal areas of expertise. When our clinics are beyond maximum capacity, we are less likely to teach, draw diagrams or demonstrate anatomical or clinical exam findings because we are already behind schedule. Residents desire better work/life balance, and they also do not want to be in clinic until after 6 p.m. They may simply wish to get through the large patient list, consequently asking fewer probing questions on diagnoses, exams or treatment options.
Shortages lead to more work for residents. For example, we have an amazing advanced practice provider team who manages the floor patients and will occasionally see ED consults to enable residents to remain in the OR during the day. When we do not have a full team, residents will be called to the floor to talk with families, change dressings, place orders, evaluate an extremity and see consults — all things that would have previously been managed by an advanced practice provider.
Finally, staff shortages lead to burnout in physicians who do not always recognize it in themselves, but is reflected in their everyday behavior, which negatively impacts the teaching process. Shortages in staff impacts morale overall, which can lead to less job satisfaction, less enthusiastic teachers/mentors, fatigue and even higher instances of patient errors. When exhausted, attendings are not always eager to participate in early morning didactics, evening journal clubs or fully engage in virtual conferences. Staffing shortages must be addressed to improve the overall resident educational experience.
- Reference:
- Robeznieks A. What we’ve learned about COVID-19. Burnout and the doctor shortage. www.ama-assn.org/practice-management/sustainability/what-we-ve-learned-about-covid-19-burnout-and-doctor-shortage. Published May 4, 2022. Accessed May 9, 2022.
Julie B. Samora, MD, PhD, is the medical director of safety at Nationwide Children’s Hospital in Columbus, Ohio.
Workforce shortage impacts everyone
We are all impacted by the current staff and physician shortages. Residents, unfortunately, now have more ‘service’ responsibilities, including patient transport and blood draws, that take them away from more educational opportunities. Post-graduate year ones and junior residents have less support and, therefore, more responsibilities/work to complete before seeing consults or getting to the OR, which is a critical component of their clinical education. There have also frequently been fewer ORs running due to staffing shortages and more cancellations and, therefore, a lower volume of orthopedic elective cases, which has impacted operative volume and experience and possibly delayed the process and progression of graduated autonomy. Faculty are also impacted by the staff/physician shortages and may face challenges finding OR time. The lack of flexibility can detract from time available for dedicated teaching in resident didactics or participation in labs or journal club. Finally, there are more procedures going late at night as there is less staff to complete urgent cases during the day and that may detract from optimal learning opportunities and pose challenges to duty-hour compliance.
Dawn LaPorte, MD, is an orthopedic hand surgeon at Johns Hopkins Health Care & Surgery Center of Green Spring Station in Lutherville, Maryland, and professor of orthopedic surgery at Johns Hopkins University School of Medicine in Baltimore.
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