FindingMar 31, 2020

Surge Capacity of the US Healthcare Workforce

Joshua Gottlieb, Neale Mahoney
By increasing workloads to 60 hours per week, the US healthcare workforce can provide 60% more care from nurses and respiratory therapists, but only 16% more care from physicians.
Chart
Physicians & Surgeons — Surge Clinician-Shifts (Per Week Per 100k)

Epidemiological models predict that COVID-19 will generate extraordinary demand for medical care, raising questions about whether the US healthcare system has sufficient capital (ventilators and ICU beds) and labor (doctors, nurses and other healthcare workers) to provide needed care.[1] To gauge the surge capacity of the US healthcare workforce, the authors calculate how much additional care could be provided if clinicians increased their workloads to 60 hours per week.[2] They use data from the 2015-2017 American Community Survey, which surveys 1% of the US population each year, and records workers’ occupation and weekly hours.[3]

The table below shows national-level statistics, with a focus on three occupations: physicians, registered nurses, and respiratory therapists, who provide intubation and ventilation management for COVID-19 patients with breathing difficulties.[4] The US has 237 physicians per 100,000 people, who work the equivalent of 4.3 12-hour shifts per week, and thus provide 1,022 clinician-shifts per 100,000 people per week. If physicians increased their capacity to 60 hours, or five 12-hour shifts, per week, they could provide an additional 163 clinician-shifts, or 16% more care. Registered nurses provide a baseline of 2,111 clinician-shifts per 100,000 people per week. Because they work fewer hours at baseline, they could increase their capacity by an additional 1,276 clinician-shifts per 100,000 people or 60% by working five shifts per week. Respiratory therapists’ surge capacity is proportionally similar.

Surge capacity varies substantially by region. Physician surge capacity, measured in clinician-shifts per 100,000 people per week, is nearly twice as large in the Northeast as the Midwest or Deep South. Surge capacity for registered nurses is highest in the Midwest, and lowest in the Southwest. Respiratory therapist surge capacity is highest in the Great Plains and the South. The Southwest has relative low surge capacity for all three occupations.

Some clinicians have the training to care for COVID-19 patients. Others could be cross-trained to provide this care. Even clinicians who are not appropriate for cross-training can fill in for coworkers who have been shifted to COVID-19 care, as could retired workers who have training and experience but have higher COVID-19 mortality risk.[5] As some states have already started doing,[6] easing licensing restrictions can give hospitals the flexibility to better cope with this unprecedented spike in demand.

 


[1] Ferguson, Neil M., et al. March 16, 2020. “Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand.” London: Imperial College COVID19 Response Team.
[2] The authors choose 60 hours because this is the average amount that physicians report working per week during the ages when they are in training.  This training is notorious for requiring long hours, but these hours are apparently manageable for a period of months or a few years.
[3] The authors restrict their analysis to those working in hospitals and physicians’ offices, as these industries are most relevant for COVID-19 care.
[4] Data on additional occupations are shown in the Appendix.
[5] https://khn.org/news/help-wanted-retired-doctors-and-nurses-don-scrubs-again-in-coronavirus-fight/
[6] E.g., https://malegislature.gov/Bills/191/S2615 and http://www.op.nysed.gov/COVID-19Volunteers.html