"Clinician of the Future Report" Part 1
- Hannah Todd
- Mar 20, 2022
- 5 min read
In my last post, I talked about research which shows that people with a compassionate outlook are better able to decrease the physiologic stress response by accessing social support. In health care (and actually just life), stressful situations abound. During the course of my career, I’ve been cursed out by patients, managed emergency medical situations, had patients fall, and been covered in probably every possible bodily fluid. I’ve been reprimanded for doing the ethically right thing, and I have been sent into meetings with superiors to speak truth to power even when we all knew nothing would change. Without the support, humor, and friendship of my coworkers, I certainly would be in a different job by now. Accessing social support as a health care worker is a critical survival mechanism. And, right now, health care workers need every possible survival mechanism because the situation is dire. A report published on March 15, 2022 (5 days prior to this post) found that, by 2025, up to 75% of global health care providers will have left the medical field.
This report[1], which I will also link under the research tab, is a global assessment of the state of health care workers, performed by Elsevier, entitled “Clinician of the Future: 2022 Report”. This article from Forbes[2] summarizes it well if you don’t want to read a zillion pages of data. The data was compiled by interviewing 2,838 clinicians in 111 different countries. The report found 4 main areas for improvement if the whole world wants to avoid the impending provider shortage. These areas include:
1) Addressing clinician burnout
2) The impact of digital health and technology
3) The evolving skill set for providers
4) A focus on prevention
I believe that training providers in compassionate care from the outset and changing workplace culture in hospitals, nursing/rehab centers, and outpatient clinics can alleviate some of the pressures in each of these areas. Over the next few weeks, I want to dissect each of these areas for improvement, each in its own post. Today, I want to relate two personal stories illustrating the health care environment that I have experienced as a provider – stories that I believe encapsulate some of the issues addressed in the study.
The first story relates directly to clinician burnout. It was my first year as a physical therapist, and it was employee appreciation week. Because health care administration likes to celebrate staff is with “jeans days” and food (rather than by making changes that might actually lead to employee retention), we were having a cookout themed jeans day with lunch provided. But, at 10 am, the lights went out in our facility. Patients were panicking, patients’ families had questions, and none of us could do our jobs because the internet doesn’t work without power and all documentation happens online. Employees scrambled to make sure that everyone on supplemental oxygen had access either to an oxygen tank or to a concentrator connected to the emergency generator. Somehow, the administration team was nowhere to be found.
Finally, after about an hour with no power and no answers, a maintenance man came into the therapy gym, doubled over in laughter. Apparently this was a scheduled power outage that no one had been informed about. This maintenance man only found out because he was able to ask the building administrator. The administrator whom he found outside in the parking lot. Wearing a sombrero. Grilling burgers and listening to music. For employee appreciation week. During an 8 hour power outage. Needless to say, no one felt appreciated. We felt angry that no one had been informed about the power outage scheduled to last all day. We felt embarrassed directing family members to go complain to the man grilling in the parking lot wearing a sombrero. We felt stressed because we would have to play catch up the next day. We felt utterly dumbfounded that someone had actually planned this fiasco and didn’t see any problems. One free lunch didn’t make up for all that chaos. The situation was laughably absurd, but also burnout inducing.
The second story was burnout inducing in the way of total system failure. One of my patients had suffered a stroke, and she had severe impairments. Her entire left side was flaccid, and she was a very large, relatively immobile woman at baseline. She had lived alone prior to her injury, and therefore would require intensive therapy in order to even have a chance at returning home. Her particular insurance required therapy updates every 4 days in order to demonstrate “continued skilled need” (i.e. to demonstrate that she couldn’t just go home with home health), so I called them with updates every 4 days to inform them of her very slow progress, which was further impeded by medical complications. I spoke to the same insurance representative every time. I’m sure she was speaking from a script, but it was jarring every time to have her ask me why we hadn’t attempted stairs, since this patient still required 2 person maximal assist just to sit up in bed. Thankfully, the patient was never denied a 4 day extension of services.
About 30 days into her recovery, the patient received a very upsetting update from our facility’s social worker. The patient’s insurance company contacted her to say that the patient’s insurance coverage had expired 2 months prior to her stroke. This put the patient on the hook for a 6 figure bill between her hospitalization and rehab stay. To put it mildly, the patient was furious. She felt duped and abandoned, never mind panicked about affording the care she very much needed. The social worker helped her work through options, applying for Medicare/Medicaid services, and made the nightmare situation not quite so dire. I don’t actually know what happened to this patient.
Years later, I still think of this situation every time I have to contact a patient’s insurance company. I had called this patient’s insurance every 4 days for a month. Whose chart was the representative looking at when she supposedly extended coverage for my patient? How does something like this even happen? Don’t they have a computer system that indicates who is insured and who isn’t? And what could I possibly have done differently??
I am looking forward to reading through this global survey of providers and relating it to my own experiences. Stories like these show that, even pre-pandemic, the health care system was broken. People should not fall through the cracks. Management and administration should be working WITH their staff, not grilling in a parking lot while busy clinicians have to manage a building wide power outage. These situations are burnout inducing. Thankfully, we can rely on our coworkers to diffuse some of the stress with commiseration and kindness, but everyone has a breaking point. Stay tuned for some proactive solutions.
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