Healthcare in the United States has a staffing issue. After close to two years of pandemic, multiple factors have pushed our critical systems to the brink of collapse.

In a matter of weeks, omicron has become the dominant variant in the United States. New York City is reporting a four-fold increase in hospitalizations of children under the age of 18. The variant accounts 90% of the cases in some parts of the country, CDC director Dr. Rochelle Walensky said on December 22, and makes up more than 73% of the cases in the United States. The majority of those hospitalized are unvaccinated. Unvaccinated people are 10 times more likely to get Covid-19 and 20 times more likely to die from the virus when compared to a person who is fully vaccinated and received their booster, according to CDC data collected in November when delta was the dominant variant.

As the impact of holiday gatherings hits, officials and experts warn of an unmanageable crush of patients and potentially catastrophic staffing shortages.

“This is a big concern,” said Marcus Plescia, the chief medical officer at the Association of State and Territorial Health Officials. “This is a highly contagious variant, and we really think it could cause significant issues with the workforce.”

There is not a single state in the nation that can make the claim that they have enough healthcare workers. 13 states have critical shortages of nurses, doctors, and other staff, according to the Department of Health and Human Services. Among the hardest hit are:

• Vermont, where 53% of hospitals report critical shortages and residents traveling out of state for care
• 52% in New Mexico reported critical staffing shortages on Saturday
• In Washington state, ICUs are at 97% to 100% capacity and less than 30 pediatric inpatient beds are available in the western part of the state
• In western New York state, multiple counties are reporting crisis-staffing issues, with Wyoming County declaring a state of emergency

Joseph McTernan, CEO of the Wyoming County Community Health System said in a statement: “With COVID infection rates again spiking in our community, we need all hands on deck to both care for the increasing number of patients being admitted for care while addressing the burden of increased costs required to provide this care.  These challenges have only compounded since WCCH is now one of the 32 New York hospitals with fewer than 10 percent bed capacity requiring us to suspend elective surgeries."

The American College of Emergency Physicians (ACEP) issued a plea this week for a "collaborative effort" to solve the nursing shortage.

The organization said that it is "very concerned that nursing shortages in emergency departments can complicate patient access to care and add to incredible levels of stress already on physician-led care teams," according to a press release.

ACEP's press release stated that with fewer nurses available in the emergency department, team members are clocking extra hours, caring for more patients, and stretched to take on additional clinical and nonclinical duties.

"I am hearing from colleagues from Washington state to Michigan to New York that this is the worst they have seen since the beginning of the pandemic," ACEP President Gillian Schmitz, MD said. "Everyone available is filling gaps as best they can, but the current path for many frontline workers is not sustainable," she said in the release.

Altogether, the hospital sub-sector’s workforce has dipped nearly 90,000 people since March of 2020, according to preliminary November data from the U.S. Bureau of Labor Statistics. Among nurses alone, the American Nurses Association expects there will be more than 100,000 registered nursing jobs available annually by next year.

A report by human-resources firm Mercer this year estimated a shortfall of 3.2 million lower-wage workers, such as nursing assistants and home health aides, by 2026.

Hospitals taking financial hits - staffing firms accused of gouging

The costs of recruitment and retention are pushing some hospital and healthcare systems to the brink of collapse. “This is like survival stakes,” said Steven Shill, head of the health-care practice at advisory firm BDO USA. Winners are “whoever’s highest on the food chain and who has the biggest checkbook.” The staffing companies - agencies that provide nurses and other staff on a temporary basis - are “really, really, really gouging hospitals.”

In a letter to US COVID-19 Response Team Coordinator, Mr. Jeffrey Zients, Sens. Mark Kelly (D-Ariz.) and Bill Cassidy, MD (R-La.), and Reps. Doris Matsui (D-Calif.) and David B. McKinley (R-W.Va.) raised the issue of price gouging, and asked the fed to take action.

We are writing to inquire about the extreme prices being reported for nurse staffing agencies from hospitals in our states, and the concern that certain staffing agencies may be taking advantage of these difficult circumstances to increase their profits at the expense of patients and the hospitals that treat them.

They asked for an investigation by "one or more of the federal agencies with competition and consumer protection authority" to find any evidence of anti-competitive price patterns, price collusion, higher pay for nurses as a result of the rate increases, and impact on rural and underserved areas, among other questions.

Among the steps being urged by lawmakers:

• Is this activity the product of anticompetitive activity?
• What is the ownership structure of these staffing agencies and is there evidence of price collusion or other anti-competitive pricing patterns?
• Does this activity violate consumer protection laws?
• Are these increased rates translating to higher pay for contract nurses?
• What impact have these price increases had on rural and underserved areas?
• Have nurse staffing agencies increased their own percentage of profit during the COVID-19 pandemic? If so, by how much?
• How much of the COVID-19 relief funds are directly or indirectly going to pay these contracts?
• How may the 100% cost share for FEMA reimbursement be contributing to the ability of the staffing agencies to extract higher payment?

Kelly Rakowski, chief operating officer for strategic talent solutions at AMN Healthcare, which says it's the nation's largest healthcare staffing agency, wrote in an email to MedPage Today in a general response that its "pricing is agreed upon directly with our healthcare organization clients. Inflationary pressures and demand are driving up the wages needed to attract clinicians to open positions. Any price increases are driven primarily by the compensation that goes directly to healthcare practitioners."

Massachusetts and Minnesota currently are the only two states with existing pricing limits on staffing agencies. That wasn’t enough to fully insulate providers in Massachusetts, where demand is so great that the caps were recently raised by an average of 23.5%.

In Connecticut, Gov. Ned Lamont’s (D) March 2020 public health emergency declaration triggered a statute prohibiting profiteering during emergencies. Violations are considered an unfair or deceptive practice and violators can be fined by the state Department of Consumer Protection and the Office of the Attorney General.

The New York State Health Care Facilities Association took the issue of inflated agency pricing to state lawmakers even before vaccine mandates drove a new round of staffing losses, but leaders there are still watching costs mount.

Rural hospitals are being hit particularly hard. In an interview with Becker Healthcare Review, Patrick Sharp, CEO of Durango, Colorado-based Mercy Hospital said: "The Great Resignation has created unprecedented financial challenges. We've witnessed many hospital professionals retire or leave the healthcare industry during the pandemic due to fatigue, stress, public opinion and the incredibly difficult work. At the same time, national resources like staffing agencies or traveling nurses have not been as readily available as they may have been in "non pandemic" times."

Nurses at rural hospitals are paid an average of $70,000 a year or just over $1,200 a week, according to ZipRecruiter. But some staffing agencies such as Nomad Health are offering travel nurse positions with a $5,044 a week salary. White Glove Placement, another nursing staffing agency, offers placements that pay anywhere between $5,800 and $5,900 a week. Health care hiring site Vivian lists several travel nurse assignments that pay up to $9,562 a week.

The CDC is taking steps to alleviate some of those staffing shortages.

Earlier this week, CDC Director Walensky said the agency is looking at data to see if it will ease the CDC's current COVID-19 isolation guidelines for healthcare workers.

Those who have tested positive for COVID-19 and are asymptomatic can return to work after seven days with a negative test. The CDC says that time can be cut down even more if there are staffing shortages.

If they’ve been exposed, but haven’t tested positive, healthcare workers who have received all recommended COVID-19 vaccine doses, including a booster, do not need to quarantine at home.

“As the healthcare community prepares for an anticipated surge in patients due to Omicron, CDC is updating our recommendations to reflect what we know about infection and exposure in the context of vaccination and booster doses. Our goal is to keep healthcare personnel and patients safe, and to address and prevent undue burden on our healthcare facilities. Our priority, remains prevention - and I strongly encourage all healthcare personnel to get vaccinated and boosted," Walensky said in a statement.

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