I’m watching the numbers. In the hospitals where I work, in Southern Appalachia, ERs are holding far too many patients and inpatient floors and ICUs are completely full. Patients are leaving without being seen. That is, they check into the ER for illness or injury, get weary of the two to six hour wait, and just go home. Although we used to say, with some snark, ‘well if they were that sick they’d have stayed.’ Not so fast! People who leave are sometimes just so sick they don’t want to sit in that crazy waiting room any longer.

In addition, we’re holding people. That is, they get admitted and have to stay in the ER since they’re too sick to go home, can’t get transferred and there aren’t any inpatient beds. At least they’re safe, right? Wrong! At least according to research published in the BMJ:

Part of the problem, of course, is nursing shortages. The article is interesting, but especially intriguing to me is the rate at which new grads leave their first jobs. What are we doing wrong?

Of course, we’ve lost a LOT of physicians, nurse practitioners and physician assistants in the last couple of years. That makes it tough to get care, especially in underserved areas in rural or inner city America. These folks are not easily replaced.

Along the same lines, the impending physician shortage will not be pretty.

Maybe we may need to make the medical school process a teensy, weensy bit less MISERABLE and less financially burdensome. Maybe we need to make it more friendly for women who don’t want to have to choose between being amazing physicians and being amazing mothers. What if we just have an option to stretch it out? Give them some breathing room so that they don’t feel like they’re causing a problem, or less professional, if they want to take a couple more years to finish school or residency?

Also, there are plenty of potentially great physicians out there who just don’t groove on calculus or organic chemistry. Let’s find other markers to predict success. I’ve met excellent chemists who navigated medical school but were awful at the bedside.

However many folks we have to do the jobs of patient care, we need facilities in which to provide care. But particularly in rural America, hospitals are closing at an alarming rate. For those in remote areas, several things will happen, unless industry and government work together (and pay me an excellent consulting fee…) and find solutions. 1) the poor and marginalized will just neglect their health. They can barely get a ride down the street to the health department or closed ER. They won’t go hours to another town. 2) people in need of care who can afford it will go hours away and they will then fill already struggling hospitals, since their own local hospitals have been closed. Places where they might have received care for relatively common problems. The article below highlights the closures of rural hospitals.

So we’ve got work to do.

In the next week or so I’ll suggest some fixes that I’ve mulled around for a while. If you have any ideas, please feel free to drop them in the comments.

Just a word in advance. I know that some folks think the answer is nationalized healthcare, and maybe it is. But I don’t really trust industry not to find a way to make itself crazy rich under a nationalized system. Government and business in the US are just too inextricably connected. And I don’t know that nationalized systems did much better during the pandemic than others. Not saying it can’t work, that’s just my concern.

Have a nice weekend,






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