Andy Larsen: As COVID enters the endemic phase, another crisis still looms

Even before the pandemic, the shortage of doctors and nurses was alarming — and that problem is only going to grow unless we take measures to change it.

(Francisco Kjolseth | The Salt Lake Tribune) Utah artist Heather Olsen, left, talks with Intermountain Healthcare nurse Maria Black on Monday, April 5, 2021, in Murray. The U.S. will need more doctors and nurses as the coronavirus becomes endemic.

The coronavirus becoming endemic does not mean the end of the coronavirus.

People sometimes misunderstand that. They see “end” in the word, and it’s so easy to think that means the end of our long international nightmare. But, unfortunately, the coronavirus is here to stay. It’s a mutating virus that will continue to sicken people, hospitalize them, and kill them from here on out. Much, much fewer than it has recently, hopefully, but it’s not going away.

So, in that context, we have to start thinking about our “new normal” and what to do about it. In particular, we have to confront the fact that we will need more nurses and more doctors.

That there’s a shortage of these medical professionals is hardly a surprise. You’ve seen the stories about hospitals at and above capacity during the pandemic. And you also probably know that the physical beds aren’t the main problem here. The limiting factor is staffing the hospitals. While we note that the coronavirus is here to stay, we also have to note that this problem isn’t going away, either.

Let’s dig in to the expected problem. In the “endemic,” how much more disease can we expect? What will that mean for our doctor and nursing shortages? And let’s talk solutions, too: How can we address this problem?

Additional disease in endemic periods

For maybe the first time ever, the flu might actually be a good analog to the coronavirus when it comes to endemicity.

With the flu, we have a relatively low baseline level of disease, but pretty reliable annual waves of sickness that occur every winter. These waves cause significant sickness and death — not coronavirus-pandemic levels of sickness and death, but still enough that it places a burden on our health care system.

In most winters, we have multiple circulating strains, but generally one or two that are pretty dominant. Flu vaccination helps minimize the risk, especially for those who are elderly or have comorbidities. Sometimes, new disruptive variants emerge — like the 2009 swine flu pandemic — and cases and deaths go way up.

Coronavirus endemicity could look fairly similar, but because getting the flu doesn’t prevent you from getting the coronavirus or vice versa, the coronavirus disease burden will stack on top of the flu waves. In some months and years, new strains of the virus will emerge, just as omicron did, and target people who already had the disease. But even in periods with no new variant, the coronavirus will find pockets of people to infect among those with waning natural or immunological immunity.

This is essentially what’s happened with another coronavirus, the OC43 coronavirus that very likely caused the Russian flu pandemic of 1889. There’s reason to think that our coronavirus is likely to be more severe than OC43 moving forward, but that’s the template. In other words, it means more sickness and more hospitalizations than we were used to in the pre-2020 world.

Estimated doctor and nursing shortage

The additional disease burden is an obvious reason we’ll need more doctors and nurses. But, truthfully, we were already projected to have a shortage before the pandemic.

In a study completed by 2019, the Association of American Medical Colleges estimated a shortage of between 37,800 and 124,000 physicians by 2034. Of course, the medical colleges are going to have a bias in saying that we need more doctors, but their rationale is sound: An increase in old people is going to require an increase in doctors, because old people need more medical attention than young people. Between 2019 and 2034, there’s going to be a projected 42.4% jump in people age 65 and above, compared to a 10% increase in overall population growth.

Included in all of those old people: doctors. They say that more than 40% of current doctors will hit age 65 in the next decade. That means retirement. So you have a growing population of people needing more treatment, and a shrinking group of people to treat them.

Nurses, too, are older than you might expect. The average age of an American nurse is 50. Some 43% of nurses said in a recent survey that they were considering leaving the profession, many due to the difficult conditions of treating overburdened hospitals — and bad treatment from their patients.

For nurses who stick around, there’s a big opportunity in becoming a traveling nurse. NBC News reported that a nurse at a rural hospital might make $1,200 a week; a traveling nurse willing to meet high pockets of demand around America might make $5,000 to $10,000 a week.

The concept of traveling nurses makes sense. Demand varies in different parts of the country, especially as outbreaks ebb and flow in cities and states. It’s good that they exist. But higher demand for traveling nurses does lower the number of bedrock nurses in each location, and the rising wages for everyone reduces the amount of money hospitals have to throw at the problem.

So higher costs could stretch treatment thinner. Labor costs alone per patient rose 14% at hospitals in 2021, even as the number of employees at hospitals dropped 4%.

Ideas to fix it

Crisis is a word that’s thrown around too often, but it fits here. Honestly, a doctor shortage is probably just as important as a food shortage. Just as people can’t survive without food, people can’t survive without timely, quality, medical treatment.

And just like with our food supply, we probably have to incentivize production. In 2020, the U.S. sent $46 billion to farmers to subsidize farming and food production; in fact, it was 40% of farm profits that year. That number was inflated due to pandemic bailouts, but our government does subsidize food production annually in a big way.

What we’re looking to create now are trained people, not products. It’s a bit harder to do. But there are steps we can take.

First, we can encourage doctors-in-training to immigrate to the U.S. and to stay here after their schooling. Currently, J-1 visas require prospective doctors to return to their home countries after finishing their residency in the U.S., but a program called Conrad 30 allows each state to choose 30 doctors to stay if they serve medically underserved communities for three years. Frankly, 30 doctors per state isn’t going to cut it. We need more. A lot more.

We also could use Medicare to fund more physicians. Right now, there’s a legal cap. The proposed Resident Physician Shortage Reduction Act of 2021 in Congress essentially would pay for an additional 2,000 doctors per year for the next seven years starting in 2023, or a total of 14,000 doctors. This, again, doesn’t solve the problem, but it’s better than doing nothing.

Obviously, we need to incentivize more people to go to medical and nursing schools. Could loan or grants send more students down a medical path? Furthermore, we need to increase the number of people who can teach at those schools. Is there a way to turn all of those retiring doctors and nurses into educators, even if part time, through incentives?

I don’t pretend to have all of the answers here. Heck, I’ll take ideas in the comments below. But it is encouraging that it feels like progress is possible; this isn’t one of those hot-button issues in which political inaction is baked in. It’s something we can make societal progress on.

We will, though, have to recognize it as a problem. In short, the new normal needs new nurses.

Andy Larsen is a data columnist for The Salt Lake Tribune. You can reach him at alarsen@sltrib.com.