Recently, we took our infant son for a checkup and immunization. At the end of the visit, which was upbeat as usual, filled with baby giggles and chitchat about starting solid foods, teething and sleeping through the night, our pediatrician told us that she’s been laid off as a part of the health system’s cost-cutting measures. We were shocked.
Dr. B has built a great rapport with us since our son was born. She’s showed sharp clinical judgment and gentle compassion, and shared pearls of wisdom about child development that increased our confidence as parents. She’s one of two — and the only female — pediatrician employed by the health system within 30 miles of Springfield. More than the logistical frustration about needing a provider, we felt sad to lose such a positive influence in our son’s life and someone we’d grown to trust and respect.
The decision was a surprise to Dr. B as well. Three years ago, she moved here after residency in Iowa, aspiring for a productive career. Now, unable to stay without a job, she’s selling her house and leaving Central Illinois altogether.
The COVID-19 pandemic has been financially damaging for health care organizations. When the first wave of infections hit, elective procedures and outpatient visits were canceled, abruptly halting the revenue engine of hospitals and physician groups. Surgeries and routine care have resumed since re-opening, but institutions continue to operate at reduced capacity because of government mandates on hospital vacancy levels, efforts to conserve personal protective equipment, and patients’ cautionary avoidance. Hospitals and health systems in the U.S. are projected to lose more than $323 billion in 2020.
To combat the bleeding balance sheet, health care organizations must contain costs. Almost all have implemented hiring freezes and over half have furloughed or laid off non-clinical workers. One in five have reduced clinical staff. Even though COVID-19 cases and deaths keep climbing, more than 1.4 million health care jobs have been cut in the past seven months.
The financial pain is felt across the board (e.g., Mayo Clinic will be negative $2 billion this year), but it’s especially crippling for community hospitals and clinics that were already operating with thin margins. At least 37 hospitals have closed or filed for bankruptcy since March — nearly all in rural areas, and many are critical access facilities for their communities. Income for primary care practices has decreased $67,000 per physician, totaling a nationwide loss of $15 billion. Many solo practitioners and independent groups have shut their doors permanently.
Provider shortage and frequent turnover have been a long-standing problem in small town America. The number of doctors per capita in rural areas is roughly a third of that in urban areas. Rural doctors are considerably older; 70% are over 55 years old. There’re significant shortages in primary care, general surgery, psychiatry, and dentistry. Many types of specialists simply don’t exist. Two-thirds of the Health Professional Shortage Areas designated by the Health Resources and Services Administration are rural, including the bulk of Central and Southern Illinois.
Rural communities struggle to recruit and retain providers because medical schools, residencies, and other health training programs are concentrated in metropolitan areas and the majority of new graduates prefer to stay in urban centers. Some health care organizations have supported initiatives to entice students who grew up in the community to return to their roots (e.g., by promising to pay off their educational debt). Others have relied on foreign medical graduates (doctors trained outside of the U.S) who are less picky about geographical location. This route is at the mercy of shifting immigration policies. So, facilities serving rural America are stuck between needing the providers to stay open and not having enough resources to keep them. Our communities hang precariously with one retirement, denied visa, or job change away from losing their only care option.
The pandemic is accelerating the restructuring of the health care workforce. Rural-urban disparity is widening. Solo physicians and small groups are disappearing. Hospitals and health systems are merging, creating regional monopolies with centralized governance that will redistribute resources to boost efficiency. We can’t yet visualize what may evolve out of this round of marketplace natural selection, but one thing is clear — as patients, we’ll be on the receiving end of the brunt of it.
Qing Yang and Kevin Parker are a married couple and live in Springfield. Dr. Yang received her medical degree from Yale University School of Medicine and completed residency training at Massachusetts General Hospital. She is an anesthesiologist at HSHS Medical Group. Parker has helped formulate and administer public policy at various city and state governments around the country. He is formerly the group chief information officer for education with the Illinois Department of Innovation and Technology. This column is not intended to substitute for professional medical advice, diagnosis or treatment. The opinions are those of the writers and do not represent the views of their employers.