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Looming Shortage of Nurses

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    The Atlantic, February 3, 2019: The U.S. Is Running Out of Nurses

    Th United States has a current shortage of nurses, and the problem is only going to get worse as more and more baby boomers age and need more care in their senior years.

    "According to the Bureau of Labor Statistics, 1.2 million vacancies will emerge for registered nurses between 2014 and 2022.* By 2025, the shortfall is expected to be “more than twice as large as any nurse shortage experienced since the introduction of Medicare and Medicaid in the mid-1960s."

    While "nearly 155,000 new nursing graduates entered the workforce in 2015, the nursing-education system hasn’t kept pace.... According to an American Association of Colleges of Nursing report, “U.S. nursing schools turned away 79,659 qualified applicants from baccalaureate and graduate nursing programs in 2012 due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints.” Once again, aging is a factor: Many nursing faculty members are approaching retirement, but without them, nursing schools can’t expand their cohorts."

    Having spent two stints in the hospital in the last 10 years, I can attest to how valuable nurses are in tending to patients' needs. And as a 72 year old senior, I do worry about care in the future for all the retiring baby boomers, and that includes many senior nurses who are also retiring. With all the talk of Medicare for all, I see less campaign discussion of the shortage of not only nurses but also doctors and other specialists. Much like the trends in Climate Change, we can see and measure the problem looming in the immediate and longer term future, but our capitalist system is too short sighted to make major changes until the problem is in our laps.

    We can implement Medicare for all, but be prepared for rationing of medical services. It certainly will happen, with or without Medicare for all.

    Meanwhile Trump would rather spend tons of money building the wall than pumping that money into expanding college training of nurses and doctors.

    Just saying...

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    Hi Schmidt,

    I remember 14 years ago my now wife was thinking about going to nursing school but their standards were so high there was no way she could get in without redoing a lot of school. She got her undergrad instead in psychology.

    Today, Texas allows "well qualified" two-year community colleges to operate 4 year BSN programs. The tuition cost is half of university programs.

    Anyways, there is a real labor constraint. There is a real budget of X amount in hours of nursing labor available at any given point based on the full employment of available nurses. While we need more nurses, we waste a lot of that real budget with inefficiencies.

    And we need to find ways to improve public health so that Americans are not so sick in the first place. No matter the financing system, healthcare is going to cost a lot because we need so much of it. And it's going to eat up a lot of our real budgets.

    The federal government can afford financially to provide as much healthcare as the Nation can provide.

    We need to stay laser focused on the real budgets and real deficits, and not let the fake news peddled by Democrats and Republicans about government budget deficits prevent us from doing stuff about real problems.

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    My sister retired from nursing a little more than a year ago, after spending more than 40 years in the profession, and her wife retired about a year later.

    Our daughter graduated from an accelerated nursing masters program from the University of Arizona in August, and it was a BRUTAL program. Kelly really busted her butt, and managed to get a 4.0 grade average for her efforts. 2 job offers quickly followed, and her starting salary was higher than the average teacher salary in Arizona. Naturally, her student loan debt is a bit scary.

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    The problems are real and serious. An aging population means the needs will continue to increase. Perhaps incentives need to be put into place to broaden the workforce. It's a challenge that must be addressed. Perhaps potus should have a committee appointed to find workable solutions as it will affect all Americans. No dollars for the elected leader so it's probably priority number 658.
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    This is a very real and very serious problem that most Americans haven't spent a second thinking about.

    Ten thousand baby boomers turn 65 every day and that is going to continue until the early 2030's. If we're starting to experience a shortage of qualified nurses now, just imagine the chronic shortage we'll have in 5, 10, and 15 years. It's scary to think about.

    Donald supporters will cringe when I say this, but a massive number of qualified medical professionals will need to emigrate here in the coming years if we're going to meet the ever increasing medical demands of an aging population. It can correspond with a massive government investment in nursing and medical institutions, but that will take years, if not decades, to produce results.

    In the meantime, we're going to have to open up our arms and bring in a whole bunch of nurses from abroad who can help with the current nursing shortage crisis. I'm well aware that's the last thing Donald will ever do, but it's the only answer if we want immediate results.

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    It's not just nurses either, there's a critical shortage of caregivers too.

    My wife is a part time caregiver and almost as soon as a new caregiver is hired, they end up quitting a few weeks after being hired. It's because there's a shortage of caregivers who right now are being jammed with more days and hours than they can handle, so they end up quitting. My wife is thinking of quitting too, but there's not that many jobs out there that she's qualified for.

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    I won't pretend to have any answers, but clearly the problem has a lot to do with the income nurses make vs the hard work required to do the job, and I suspect a high level of burn out. They have to be on their best behavior while caring for sick people, who may in turn, maybe abusive and difficult to deal with.

    In a perfect world, these professionals would be the highest respected and highest paid of all possible professions, thus like firemen, people would be lining up to be in the profession, and only those who do not meet a high bar are accepted.

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    New York Times, November 7, 2016: A Doctor Shortage? Let’s Take a Closer Look

    This New York Times article from 2016 says that we could do a much better job at organizing and administering to the existing community of doctors, nurses, nurse practitioners, care givers and such.

    "The system isn’t undermanned, it said: It’s inefficient. We rely too heavily on physicians and not enough on midlevel practitioners, like physician assistants and nurse practitioners, especially because evidence supports they are just as effective in primary care settings. We don’t account for advances in technology, like telehealth and new drugs and devices that lessen the burden on physician visits to maintain health."

    Well yes we could make more efficient use of our existing medical staff, but what the article suggests is that nurses can do many of the tasks that physicians now do. But if we have a nurse shortage, then that just pushes the problem down the line.

    The other problem is the geographic distribution of doctors and nurses. Rural areas are suffering from a lack of medical professionals and facilities at all levels, and the problem is being exasperated by the fact that these areas are being served by aging doctors and nurses who themselves are retiring in large numbers. Small towns in decline are not attractive to young doctors and nurses who, fresh out of school, are burdened by debt.

    While politicians are selling the idea of free college for all, I would be more in favor of free or highly subsidized education for people who want to enter the medical profession. I think we have enough MBAs in the world so why give them free education? We need more doctors, nurses and care givers for the growing needs of the baby boomer retirement community.

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    So I still work in physician staffing and ER program management. My wife is a travel nurse recruiter.

    There is all kinds of frictions that prevent full or maximum employment of healthcare providers, and the efficient use of that labor is a whole separate issue with its own problems.

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    New York Times, March 4, 2019: Nursing Homes Are Closing Across Rural America, Scattering Residents

    The NYT article discusses some of the heart breaking individual cases for many who live in rural America. Finding a nursing home close to where family and friends live is increasingly difficult because many of them are closing for lack of trained staff and profitability.

    "More than 440 rural nursing homes have closed or merged over the last decade, according to the Cowles Research Group, which tracks long-term care, and each closure scattered patients like seeds in the wind."

    "Home health aides can be scarce and unaffordable to hire around the clock. The few senior-citizen apartments have waiting lists. Adult children have long since moved away to bigger cities."

    The reasons for the closings include failure to meet health and safety standards, but the majority are financial -- changing health care policies that now encourage people to choose independent and assisted living or stay in their own homes with help from caregivers. That in itself should be considered a positive, but as occupancy rates in the nursing homes fall and more of their patients' long term care is covered by Medicaid, they lose money.

    In South Dakota, a conservative state, nursing homes are being shut down or are losing money because the majority of their residents rely on Medicaid. They lose about $58 per day for each resident because of stingy reimbursement rates. At those low reimbursement rates, the nursing homes cannot find staff that will accept the low-paying work of caring for frail residents and remain profitable.

    I mention this because Bernie's Medicare for All provides for long term care with expanded Medicaid, but the states will still be expected to share in the costs. However, one of the selling features of MFA is to cut salaries and fees of the healthcare providers to be more in line with existing Medicare and Medicaid reimbursement rates. For those nursing homes now providing long term care for the more profitable private patients, those patients will instead be covered under MFA cost more private patients. All patients will be covered by Medicaid.

    For us baby boomer generation the problem will only get worse, but maybe not for those of us living in urban environments. I can foresee in the urban environment where many of these nursing homes will become private, essentially opting out of "Berniecare" and not accepting Medicaid patients at all. That would leave the few Medicaid nursing homes like those in rural areas as low cost operations with inadequate staff.

    The obvious solution is to increase the Medicaid reimbursement rates, but under Sanders MFA increasing the fees will be difficult when at the same time under the new system administrators will be charged with keeping costs under control as promised by Bernie.

    I don't know if Sanders has considered this trend, but I do know that he feels that the healthcare industry itself is too profitable and part of his many selling points is to rein in the costs of health care providers. Making a profit on health care is essentially seen as obscene. He has said that on many occasions.