Staffing shortages are a pressing issue for all physician specialists, but they impact certain specialties in different ways.
For orthopedic surgeons, backups in ORs caused by other, emergent procedures are proving to have harmful effects for musculoskeletal patient procedures.
Becker’s connected with two specialists to discuss how staffing shortages are impacting patient care today.
Ask Orthopedic Surgeons is a weekly series of questions posed to orthopedic surgeons around the country about clinical, business and policy issues affecting spine care. Becker’s invites all orthopedic surgeon and specialist responses.
Next question: If you could give one piece of advice to a resident starting in orthopedics today, what would it be?
Please send responses to Claire Wallace at cwallace@beckershealthcare.com by 5 p.m. CDT Friday, June 6.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: How are staffing shortages affecting your OR efficiency or patient care?
James Chen, MD. Orthopedic Surgeon at DISC Sports & Spine Center (Newport Beach, Calif.): Fortunately, working with an institution that promotes a positive culture with a focus on procedure-specific patient care has allowed us to retain the majority of our staff. In my experience, this has been one of the more valuable aspects of the ambulatory surgery space, as it promotes an enjoyable work environment for my staff, my patients and me.
Daniel Davis, MD. Orthopedic Surgeon, Shoulder and Elbow Specialist at Rothman Orthopaedics (Philadelphia): Healthcare delivery in the U.S. is a demanding profession undertaken by skilled groups of nurses, physicians, therapists, technicians and many other individuals who dedicate their lives to taking care of the sick and infirmed among us. Working in the healthcare field has always been demanding on those individuals involved both physically and mentally. This has never been truer than it is today. As the “baby boom” generation enters into their 70’s and 80’s the demand for healthcare needs for a larger aging population puts a stress on a system that was not necessarily designed for that capacity. The large demand is coupled with increasing burnout of the healthcare workforce which can be attributed to increased non-clinical responsibilities, insurance oversight, pandemic stress, and other regulations which strip providers of their usual practitioner-patient relationship. These two unique occurrences have led to significant shortages of healthcare providers available to treat increasing patient demand.
The issue of staffing shortages is felt in many areas of healthcare, but especially the orthopedic operating space.
Orthopedic surgery is a unique and satisfying branch of medicine in which patients present with significant life altering, but usually non-life threatening injuries. Therefore, time to the operating room for an acute orthopaedic injury like a hip fracture is considered urgent, but not emergent. Using the example of a geriatric hip fracture, best practices suggest that patients should be treated within 24 to 48 hours of presenting to the hospital to minimize the time spent immobilized in bed to reduce the risk of blood clots, decubitus ulcers and muscle atrophy. During this time, the patient is also able to be optimized from a cardiopulmonary standpoint, so they can safely undergo anesthesia.
Historically, most hospitals developed a hip fracture program where a patient could be admitted from the ER, optimized by internal medicine and/or cardiology, surgically treated by orthopaedics, and mobilized with physical therapy. All within 24-48 hours. Strains on the system in recent years have challenged the ability to complete this care cycle in the same period. Emergency rooms are overflowing with patients, hospitalists are burdened with too many patients to admit, and operating rooms are not fully staffed. This final point leads to OR charge nurses and surgeons deciding which patients’ operations are the most urgent and trying to complete them in the most appropriate order.
Inevitably, surgeries are delayed and patients are left waiting. The answer to this dilemma is not simple. It is a function of time, money and human resources. Identifying the problem is the first step and all parties involved need to work in a team effort to maximize patient care and outcomes.
