Originally published by our sister publication, Anesthesiology News

It is 8 a.m. and we are starting a heart transplant on a 56-year-old college professor. The scrub nurse volunteers that she has never done a transplant. The cardiac perfusionist has never used this brand of machine. You, the anesthesiologist, do not recognize the CRNA, who is having problems turning on the anesthesia machine and finding certain drugs.

The transplant takes twice as long as predicted, and you are glad to then head up to the ICU. When you reach your unit, you realize you do not know any of the bedside staff. The critical care pharmacist is new, and someone tells you there is no echo tech on Sunday. Your friend the ICU doctor informs you that the advanced practice provider covering nights has never done cardiac care; she used to work in a neuro ICU in California.

A Bad TV Show?

This has been a very stressful day that makes you ponder early retirement versus the satisfaction of working with a great team of colleagues, all focused on the same goal: ideal, efficient patient care.

You may think this is a nightmare or the plot of a bad MD TV show, but it is not. This is the new post–COVID-19 pandemic staffing reality. For a multitude of reasons that have been observed before—burnout, refusal to get vaccines, fear of working closely with patients—there is now a nationwide healthcare staffing crisis. It affects all levels of hospitals, from internationally known university hospitals to the smallest rural critical need facility.

Hospital administrators are now forced to rely on staffing agencies to fill their facilities with rotating short-term professionals. But this stopgap bandage only leads to bigger, more negative issues. The use of locums staff creates an even larger problem because it affects long-term experienced staff in a very negative way. For example, your loyal nursing staff who served bravely during the pandemic realizes that nurses with temporary IDs are making several multiples of their salaries and are, in some cases, even getting free apartments and rental cars. This staffing change only embitters individuals and makes them question why they are not being rewarded. It is easy to understand how this staffing pattern makes hospital staff leave and join staffing agencies. Friends from multiple large cities inform me that staff from hospital A now are working at hospital B, and staff from hospital B are working at hospital A for multiples of their normal salaries.

Trouble Ahead

This dependency on locums staff reaches all levels of health professionals: from attending physicians to pathology to lab techs. This “new model” has completely destroyed what is in my mind the greatest advance in healthcare, the multidisciplinary team that provides the highest quality and safest care. We have spent years training and working together as teams. We do team simulations and go to multidisciplinary meetings sponsored by our professional societies. The organized training programs, mentorship and social relationships have all been lost, as our staff has migrated to become temporary contract staff with no loyalty to the organization.

In this post-pandemic world, I see a real danger to morale, professional satisfaction and patient care as staffing is evolving to a system that is dependent on transient staff. I also believe that this dependency on contract staff has affected the financial health of well-established hospitals and eroded the bottom line to dangerous levels, which may lead to the collapse of healthcare.

You would think that this crisis would be “breaking news” on all media outlets; but, for whatever reason, our general population has not realized that we have entered a spiral of destruction that will erase all the progress in patient care we have made in the last 30 years.

We need to speak up and work to develop solutions for this growing crisis. From the smallest hospital to the national government, we need to work together to support the goal of getting the best staffing for the highest level of patient care leading to the highest level of personal satisfaction. If not, we will continue to see massive staff losses and a fall in individuals joining the professions with a decaying, poorly funded healthcare infrastructure.

Papadakos is a member of the Anesthesiology News editorial advisory board.