ER Wait Times Are Reaching Crisis Levels
Massachusetts’s worker shortage is especially pronounced in the healthcare sector. What can be done to address it?
Dahlia Lyss
Despite the state’s top ranking in healthcare by the US News and World Report, area hospitals are facing dire circumstances as Massachusetts’s worker shortage has hit the healthcare industry especially hard.
Across Massachusetts, patients have been known to languish in ERs for more than 20 hours, according to the Boston Globe. In some cases, patients simply give up and leave before seeing a doctor.
Hospital executives worry that excessive ER wait times will prevent people from receiving urgent care. Others fret that overworked doctors and nurses will miss important symptoms while diagnosing a patient because they’re so rushed.
As the winter approaches, will they be able to properly care for patients battling the flu and COVID on top of their strained caseloads?
Massachusetts’s worker shortage
By September 2022, there were twice as many job openings in the state as there were job-seekers, according to a report by the Massachusetts Taxpayers Foundation.
A perfect storm of conditions has contributed to the state’s shrinking workforce. The population is aging and retiring, while the birth rate is declining, suggesting that without intervention, the worker shortage will continue.
College enrollment in Massachusetts is declining as well, according to MassINC, which warns that the number of students completing high school and college degrees will likely decrease by 30 percent.
During the pandemic, the high cost of living created an exodus of workers to neighboring New England states, the Massachusetts Taxpayers Foundation President Eileen McAnneny told the Boston Herald, and that trend is likely to continue.
All of these factors have left Massachusetts hospitals with 20,000 job openings, including 14 percent of unfilled nursing positions.
The state’s worker shortage “is disastrous in the healthcare sector,” said Michael Curry, the CEO of Massachusetts League of Community Health Centers on Boston Public Radio.
But the healthcare sector has been chronically understaffed for some time, claims Katie Murphy, president of the Massachusetts Nursing Association. Pre-pandemic, hospitals relied on mandatory overtime to staff their departments, which contributed to high levels of burnout among nurses. Facing low wages and severe stress during the pandemic, many nurses have chosen to retire or leave the field.
Enrollment is also down at nursing schools, suggesting that understaffing in medical offices will persist if it is not met with serious intervention.
“People will vote with their feet and walk out the door, Murphy says. “You have to provide more staff so you don’t have this ridiculous patient load.”
“The buck stops here, at hospitals,” Dr. Eric Dickson, chief executive at UMass Memorial Health told the Boston Globe. While smaller healthcare facilities can decrease the number of people they serve or the kinds of services that they provide, Dickson says, hospitals need to continue providing emergency lifesaving care to patients, regardless of worker shortages.
As other healthcare facilities reduce their caseloads, they place additional stress on hospitals. “Everyone else can do a calculation and decide if they can be open,” Dickson says. “Hospitals can’t. The patients don’t stop coming to the ER. That’s why you’re seeing the hospitals in particular in such bad shape right now.”
Behavioral healthcare has been hit especially hard, forcing some psychiatric departments to decrease their caseload by 20 percent. Lacking a place for psychiatric patients, some hospitals have kept them in emergency rooms until a space opens in an inpatient facility.
On a daily basis, close to 25 percent of emergency department beds have been occupied by patients awaiting behavioral care, according to the Massachusetts Health and Hospital. Occasionally, all ER beds in some hospitals were occupied by such patients.
Some experts predict that the situation will only get worse. People who postponed doctor visits during the pandemic often require longer stays at the hospital as their situation has worsened due to a lack of timely care, according to the Massachusetts Health and Hospitals October 2022 report.
To stay open, the state’s hospitals have turned to expensive staffing alternatives, such as travel nurses. Payments to travel nurse staffing costs increased 234 percent from March 2019 to March 2022. Hospitals are on track to spend a whopping $1 billion on travel nurse salaries this year alone.
While state and federal governments provided aid to hospitals during the pandemic, Massachusetts hospitals still reported $2.5 billion in losses.
In November 2022, the Baker Administration implemented a new loan forgiveness program specifically for healthcare workers, ranging from physicians to nurses and mental health professionals. The state legislature recently established the Massachusetts Behavioral Health Advisory Commission, led by State Senator Julian Cyr and State Representative Adrian Maduro, to address the current healthcare workforce crisis.
Healthcare professionals say they will need much more. A report from the Blue Cross Blue Shield of Massachusetts listed “Mitigating Critical Health Care Worker Shortages” as one of its top five issues that must be addressed by the incoming governor.
Staffing shortages might be here to stay, Governor Baker said in an address at the Massachusetts Association of Health Plans Conference in October, stressing that it is unclear if the industry will ever return to what it looked like before the pandemic.
Massachusetts’s incoming governor, Maura Healey, has yet to share her plan for addressing this growing crisis. While on the campaign trail, she noted that addressing the staffing shortage in hospitals “is a huge need” but has not spoken about how she believes the problem should be addressed.