The wave of increasing hospital closures and service line cutbacks continues to sweep the United States.

A recent article documents 56 additional U.S. hospitals that are closing clinical departments or ending or reducing services. Cited are issues of “shoring up finances,” “staffing shortages,” or “focusing on more in-demand services” as driving forces.¹ This adds to the more than 640 (mostly rural) hospitals that recently failed financial stress tests and are adjudged to be at imminent risk of closing.²

Of these 56 additional hospitals, many are not rural; thus, this specter is expanding. One of the chief reasons cited, again, is inability to obtain adequate numbers of doctors, nurses, and other health care workers to keep service lines open, and thus inability to generate adequate revenues to stay afloat.

Conditions in the Workplace

More than 20 percent of our health care workforce left health care in the last two years, and 10 percent of all practicing U.S. physicians quit in 2021 alone.^3,4 This exodus is largely due to disintegrating conditions in many of our nation’s health care workplaces, conditions that include: marginalization, denigration, evolving oppositional attitudes that increasingly divide clinical workers and their administrations (“suits versus scrubs”), unobtainable and overwhelming workloads and administrative demands, increasing corporatization and private equity “sell-offs” of health care systems, increasing corporate boardroom isolation (by choice) from those who work clinically, almost no remaining health care corporate leaders with any clinical background, federal laws that increasingly prevent physicians and other clinically practicing leaders from participating in health care-system business decision-making, escalating moral injury, and accelerating unchecked violence against health care workers, all leading to increasingly toxic workplace conditions.^5–13

Failures to Act

Health care has now been declared last for employee satisfaction among all U.S. industries, and the most dangerous of all U.S. workplace professions.^14,15 There are pathways available to repair and correct these workplace issues, but our leaders have so far failed to act.

Thus unchecked, health care workplaces will continue to remain toxic, and more doctors, nurses and other health care workers will continue to exit, leading to increasing numbers of hospitals and facilities closing or cutting back on critical services, thus expanding the disintegration of health care delivery and the further decline of our whole health care system.

Dr. Severance is a clinically practicing physician, an educator, and researcher.

References

1. Cass A. 56 hospitals closing departments or ending services. Becker’s Hospital CFO report website. Published September 15, 2023. Accessed December 8, 2023.
2. Tucker, N. 631 rural hospitals at risk of closure by state. Becker’s Hospital CFO report website. Published November 3, 2022. Accessed December 8, 2023.
3. Yong, E. Why health-care workers are quitting in droves. The Atlantic website. Published November 16, 2021. Accessed December 8, 2023.
4. Mensik, H. Over 200,000 healthcare workers quit jobs last year. Healthcaredive website. Published October 26, 2022. Accessed December 8, 2023.
5. Newitt, P. Physicians have become marginalized. Here’s how young physicians can change this. Becker’s ASC Review website. Published July 21, 2023. Accessed December 8, 2023.
6. Severance H. Suits vs scrubs: The evolving healthcare workplace. Medpage Today website. Published April 19, 2023. Accessed December 8, 2023.
7. Payerchin R. Primary care physicians have 26.7 hours of work per eight-hour shift. Medical Economics website. Published August 22, 2022. Accessed December 8, 2023.
8. Severance, H. Yet another issue is disrupting the healthcare workplace. Medpage Today website. Published January 10, 2023. Accessed December 8, 2023.
9. Cabbabe, E. The fall of the patient-doctor bond: How corporate medicine is changing health care. Medpage Today’s KevinMD website. Published February 15, 2023. Accessed December 8, 2023.
10. Ehrenfeld, JM. End restrictions on physician-owned hospitals to expand quality care. AMA website. Published August 10, 2023. Accessed December 8, 2023.
11. Watson PW, Norman SB, Maguen S, et al. Moral injury in health care workers. U.S. Department of Veterans Affairs website. Accessed December 8, 2023.
12. Severance H. The escalating violence in health care workplaces: a critical problem facing the nation’s health care system. Medpage Today’s KevinMD website. Published June 2, 2023. Accessed December 8, 2023.
13. Naveed S. Red-flag warning: When is it time to leave a toxic healthcare workplace? MDLinx website. Published November 11, 2022. Accessed December 8, 2023.
14. Burkie A. Healthcare ranked lowest for employee satisfaction, Qualtrics survey finds. Fierce healthcare website. Published January 19, 2023. Accessed December 8, 2023.
15. Kurter HL. Healthcare remains America’s most dangerous profession due to workplace violence. Forbes website. Published November 24, 2019. Accessed December 8, 2023.