Monday, October 4, 2010

Will healthcare be a byproduct of our math illiteracy?

OK, so when I was in practice I pretty much worked every day, including weekends, even when not on call, and can attest to the burn-out potential of this life-style. My "day off" meant that I only spent eight hours in the hospital, instead of the customary twelve to fourteen. My infant son cried when I picked him up because he did not know who I was, there was little time for such mundane pleasures as doing laundry or going grocery shopping, and bedtime reading consisted of two-to-three lines of printed text swimming on a page until the book collapsed on my chest to the accompaniment of my snoring. But let's assume that I am just a wimp, and that most of my peers can take such schedule in stride.

A propos this, I came upon this column by Peter Orszag in the Sunday Times regarding the need to increase hospital efficiencies by keeping hospitals operating 100% 24/7, including the weekends. He cites not only the financial upsides of this arrangement -- basically taking advantage of spreading many of a center's fixed costs over more days of operation -- but also the potential for improving patient safety and quality of care. What I am curious about is what it means for clinicians. Doing the mental math, when the pie size increases without a commensurate rise in the pie consumers, each pie eater has to then eat a bigger piece of the pie. This is certainly a welcome quandary  when it comes to my mother's-in-law apple pie, but for the healthcare system it is a horse of an entirely different color. The growth of the healthcare delivery pie must mean an increase in physician and staff work hours, correct? By about 40%, right? Unless of course we can increase the ranks by the equivalent 40% to share the burden.

So up until now I am pretty clear on the math. Here is where confusion begins to creep in. Being a healthcare researcher, I am keenly aware of the projections of shortages for many medical specialties. But most contradictory for the Orszag plan is the monumental shorfall of hospital nursing staff, estimated to reach over 1 million by year 2020! And similar sitution holds for pharmacists, respiratory therapists, etc., just look at some of the annual reports from the American Hospital Association. Given these dire prediction, how do we implement the Orzsag plan? Do we just ask the present personnel to give up all of their free time entirely? What do we think will happen then? Especially as they watch their professions get increasingly more commoditized and their incomes shrink?

And if these conflicting ideas are not enough, there is this headline in today's amednews: "2010 could end up as worst year for hospital layoffs". OK, I will pause for a moment to let it sink in. The story goes on
As of August, 8,233 employees had been affected by mass layoffs at hospitals. Continuing at this rate, 12,349 hospital employees would be cut in mass layoffs by the end of 2010. That would be the second-highest loss recorded by the BLS since 2000, second only to 13,282 in 2005 -- with 8,687 of those jobs lost because of hospitals shut down because of damage from Hurricane Katrina.
In 2009, 11,757 hospital employees lost their jobs through mass layoffs, according to the BLS.
OK, so what am I not seeing? Orzsag is a smart economist, but if even he cannot do this math, how can our embattled public with poor math literacy and even less understanding of the intricacies of our Byzantine healthcare bureaucracy get it?

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