Hospital occupancy demands are projected to substantially increase over the next seven years from 75 percent to 85 percent.¹ There are many reasons for this increasing demand, including the aging “Baby Boomer bubble.” However, the increasing demand is occurring during a period when hospitals are “going the other way.”

A growing numbers of U.S. hospitals are closing inpatient beds for a variety of reasons, including inability to find staff to keep those beds open, resulting in a worsening crisis and evolving bed shortage.^1,2 From May 2023 to April 2024, “staffed” hospital beds have decreased from 802,000 to 674,000 nationwide. All this is occurring as increasing numbers of current doctors, nurses, health care workers, and other bright young minds turn away from “hands-on” health care to seek other professions.³

What Does This Mean?

Boarding of hospital patients in emergency departments (EDs) will increase and worsen. Boarding is when “admitted” patients are placed in stretchers or beds in ED or hospital hallways, lobbies, waiting rooms, or other areas because of the lack of available inpatient beds. Patients may “reside” there for hours, days, or even their entire “inpatient” hospital stay.

EDs, the last “open door” to the hospital, will become further overrun and overwhelmed, struggling to adequately care for both ED and an increasing numbers of these “admitted” patients. EDs—the last bastion in the “safety net” of the U.S. health care system—continue to unravel.

With trust in the health care system already at an all-time low, patients will become even more outraged and disaffected at these continually worsening conditions, adding to already increasing costs, perceived worsening service, delays, and access denials.^4-6 Assaults and violence toward the “system” will continue and accelerate, but will most frequently continue to target those who are the most “accessible,”, “vulnerable,” and “convenient:”—health care workers in the ED.⁷

Health care is already recognized as the most dangerous profession in the United States because of assaults and violence, with health care workers five times more likely to be assaulted on the job than any other U.S. profession.^8,9

A Vicious Cycle

Meanwhile, hospitals and health care systems, increasingly corporate and owing “fealty” to shareholders and bondholders, are being pushed more than ever to “show a profit” and cut costs. They will, in turn, continue to push doctors, nurses, and other workers left in the system to increase productivity and volume. This will occur while providing them with fewer resources, thus, further overwhelming and disheartening those workers who are left staffing our EDs, clinics, and hospitals.

All of this will invariably lead to further defections, as more doctors, nurses, and other workers continue to abandon health care and seek professions and workplaces that are safer and less abusive. This migration includes bright young minds who are increasingly turning away from health care for more attractive, less debt-ridden, and safer careers.¹⁰

The result of these evolving conditions will be a vicious cycle of continued worker exits, leading to even greater lack of patient access, accelerated resource, and staffing limitations, further system and facility operational issues and closures resulting in continued worsening system conditions and further exits. And so forth.

The cycle will continue unless major health care stakeholders, currently seemingly more focused on squeezing profits from the system, start to work collaboratively on improving patient access and outcomes, and health care worker conditions versus oppositionally competing with each other for greater market share and a bigger piece of the health care pie. There are pathways to reset and repair the system, if stakeholders work together.^11,12 To fail to collaborate and begin working together to improve the U.S. health care system will rapidly lead to an overall system failure.⁶

Dr. Severance is a long-time member of ACEP, a health care strategist and researcher, consultant/advisor to several organizations and agencies on health care delivery, preparedness, and workplace/workforce clinical and economics issues. The opinions expressed are his alone, and do not necessarily represent opinions or stances of his employers or affiliates. 

References

1. Leuchter RK, Delarmente BA, Vangala S, et al. Health care staffing shortages and potential national hospital bed shortage. JAMA Netw Open. 2025;8(2):e2460645.
2. Severance HW. More hospitals are closing. Why? ACEP Now. 2024;43(1):9.
3. Owens C. The health care workforce crisis is already here. https://www.axios.com/2024/06/07/health-care-worker-shortages-us-crisis. Published June 7, 2024. Accessed June 6, 2025.
4. Rodriguez A. Healthcare trust has hit an all-time low, according to report. AJMC. https://www.ajmc.com/view/healthcare-trust-has-hit-an-all-time-low-according-to-report. Published September 30, 2017. Accessed June 6, 2025.
5. Severance H. Violence in health care: Why doctors and nurses are leaving. https://kevinmd.com/2025/03/violence-in-health-care-why-doctors-and-nurses-are-leaving.html. Published March 7, 2025. Accessed June 6, 2025.
6. Severance H. Economic ‘shrinkflation’ strikes healthcare. MedPageToday. https://www.medpagetoday.com/opinion/second-opinions/113697?trw=no. Published January 8, 2025. Accessed June 6, 2025.
7. Zahn M. UnitedHealthcare CEO killing sparks hostility by some toward chief executives. ABC News. https://abcnews.go.com/Business/unitedhealthcare-ceo-killing-sparks-hostility-chief-executives/story?id=116676754. Published December 12, 2024. Accessed June 6, 2025.
8. Kurter HL. Healthcare remains America’s most dangerous profession due to workplace violence. Forbes. https://www.forbes.com/sites/heidilynnekurter/2019/11/24/healthcare-remains-americas-most-dangerous-profession–due-to-workplace-violence-yet-hr-1309-bill-doesnt-stand-a-chance/. Published November 24, 2019. Accessed June 6, 2025.
9. Yang J. What’s behind an alarming rise in violent incidents in health care facilities. PBS News Weekend. https://www.pbs.org/newshour/show/whats-behind-an-alarming-rise-in-violent-incidents-in-health-care-facilities. Published September 17, 2023. Accessed June 6, 2025.
10. Advisory Board. Daily Briefing. 25% of US medical students are thinking of quitting. Why? https://www.advisory.com/daily-briefing/2023/11/09/medical-students. Published November 9, 2023. Accessed June 6, 2025.
11. Health Care Reform: Duties & Responsibilities of Stakeholders. Saint Joseph’s University. Institute of Clinical Bioethics. https://www.sju.edu/centers/icb/blog/health-care-reform-duties-and-responsibilities-of-the-stakeholders. Accessed June 6, 2025.
12. Severance HW. the ‘oppositional’ conundrum disrupting our current healthcare system. Emergency Physicians Monthly. https://epmonthly.com/article/the-oppositional-conundrum-disrupting-our-current-healthcare-system/. Published December 16, 2024. Accessed June 6, 2025.