What Happened, What You Missed: May 15-19, 2023 

GAO Report Shows Impact of Non-Compete Agreements on Health Care Workers 

Many health care workers face restrictions on changing jobs due to non-compete agreements (NCAs), according to a new report from the Government Accountability Office (GAO).  More than 57% of health care and social assistance workers employers surveyed in 2022 by the GAO reported that they use NCAs for at least some of their workers.  To compile the report, GAO surveyed 446 private sector employers and 25 state attorney general offices.  Among the reasons health care employees cited in the report for requiring NCAs are the protection of intellectual property and trade secrets, and minimization of turnover.  The report’s release comes as the Federal Trade Commission (FTC) works to finalize rulemaking that could bar many employers from imposing NCAs on workers.  While health care providers say NCAs are necessary to retain workers, health care workers say the agreements limit career growth.  

McCarthy Speaks Positively on Debt Ceiling Negotiations amid Concerns 

Speaker Kevin McCarthy (R-CA) spoke of recent debt talks with the White House in a more favorable light, saying he sees “the path that we could come through.”  McCarthy also remarked that top negotiators could reach an agreement in principle by this weekend.  However, signs that negotiations are moving forward have sparked concerns from some House Republicans, particularly Freedom Caucus members who say they won’t support any agreement to raise the debt ceiling without significant budget cuts.  Similarly, several Democratic members of Congress reacted negatively to news that President Joe Biden could be open to enhanced Medicaid work requirements as part of a possible deal.  For instance, House Democratic Leader Hakeem Jefferies characterized changes to work requirements as a “nonstarter.” 

Biden Nominates Bertagnolli to Lead NIH 

President Joe Biden announced his intent to nominate National Cancer Institute (NCI) Director Dr. Monica Bertagnolli to be the Director of the National Institutes of Health.  News broke last month that the administration was close to nominating the NCI chief for the top job at NIH.  However, several issues caused the administration to delay a final decision on Bertagnolli, including Rochelle Walensky’s unexpected resignation as Director of the Center for Disease Control and Prevention and concerns from Sen. Bernie Sanders (I-VT) on the NCI Director’s commitment to lowering drug prices.  Bertagnolli will now face Senate confirmation hearings this summer that will likely focus on several contentious issues, including NIH funding amid a difficult budgetary environment, the origins of COVID-19, and the pandemic response.  A Wyoming native, Bertagnolli was the chief of surgical oncology at Dana-Farber Brigham Cancer Center before becoming the NCI chief in October 2022. 

Appeals Court Preserves ACA’s Preventative Coverage Requirements 

Employers are still required to fully cover the cost of specified preventive health care services, according to a US Court of Appeals for the Firth Circuit order issued on Monday.  The order overturns a March 2023 ruling by Judge Reed O’Connor of the Federal District Court for the Northern District of Texas that would have eliminated coverage of most preventive health care services mandated by the Affordable Care Act (ACA).  Some 100 million people use ACA-covered preventative health services each year, which range from screenings for cancer and depression to drugs that prevent HIV transmission.  O’Connor, who ruled the ACA to be unconstitutional in a 2018 decision, argued that the US Preventative Services Task Force does not have the constitutional authority to determine which health care services should be considered preventative.  The appeals court’s order will remain in effect while the case works through the appeals process 

Gallup: Depression Rates at All-Time High 

The percentage of American adults who have been diagnosed or treated for depression reached a record high in 2023, according to a new poll from Gallup.  The poll found 29% of US adults report being diagnosed with depression at some point during their lifetimes, a nearly 20% increase from 2015.  Additionally, the survey found more than 17% of adults were either have or are currently being treated for depression.  According to the poll, women and young adults saw depression rise at higher rates compared to other groups.  While depression had been rising in the US for the past several years, researchers say the impact of the COVID-19 pandemic on social isolation, loneliness, and psychological exhaustion has likely played a role in boosting depression diagnoses and treatment.  To conduct the poll, Gallup surveyed 5,167 adults between February 21-28. 

ICYMI: Portrait of Former Speaker Paul Ryan Unveiled at Capitol 

Key members of Congress gathered in the Capitol’s Statuary Hall on Wednesday for a ceremony to unveil a portrait of former Speaker Paul Ryan (R-WI).  First elected to Congress, Ryan served as speaker from 2015-2019, where he played a pivotal role in enacting major tax reform legislation.  The event was attended by fellow former Speakers Nancy Pelosi (D-CA), Newt Gingrich (R-GA) and John Boehner (R-OH).  Current Speaker Kevin McCarthy (R-CA) also attended to provide brief remarks on Ryan’s commitment to addressing the national debt, which is timely given McCarthy’s role in negotiations to raise the debt ceiling.   

Can Veterans Fix the Health Care Workforce Shortage?

Military servicemembers have stepped up throughout the course of the COVID-19 pandemic to care for a surge in patients, administer tests, and provide vaccinations.  Meanwhile, civilian health care professions like nurses and paramedics are facing severe workforce shortages for the foreseeable future. Therefore, it begs to ask the question: could military medical personnel transition to the civilian world to help address gaps in the health care workforce?

Military medical personnel, in brief: The US armed forces have over 73,000 enlisted medical personnel, including Army and Air Force medics and Navy corpsmen.  All medics and corpsmen receive three months of specialized medical training and have continuing education requirement throughout their enlistment.  Medics and corpsmen who specialize in physical therapy, dental care, radiology, and other specialties are required to complete additional training that can last up to one year

The issue – civilian shortages: Nearly all health care professions face staffing shortages that have been exacerbated by the COVID-19 pandemic.  As an example, the American Hospital Association (AHA) estimates that the US needs more than 200,000 new nurses each year to keep up with a rising population of seniors and replace nurses existing currently in the workforce.  Emergency medical services (EMS) agencies across the nation are also struggling to fill positions for emergency medical technicians (EMTs) and paramedics.   

Let’s jump into the discussion – can former medics and corpsmen be a solution to the care health care workforce shortage?  The closest equivalent civilian jobs where medics and corpsmen can apply their skills are as EMTs and paramedics, but many veterans find the transition challenging due to a lack of accreditation standards.

  • State EMS agencies have requirements that returning service members have difficulty meeting, like paying fees or undergoing background checks.  Some states have particularly onerous requirements, like requiring sponsorship from an EMS office before granting a license.
  • EMT certification usually has college coursework requirements, but many colleges don’t know how to interpret training and experience from military transcripts, meaning veterans usually have to spend time and money on repeat coursework.

Possible fixes: To help transition veterans into the health care workforce, specifically as EMTs or paramedics, advocates are calling on state EMT agencies to develop policies to apply military experience to licensing standards.  The Army has also been requiring its medics in recent years to maintain a National Registry of Emergency Medical Technicians (NREMT) certification, which can ease the transition to becoming a civilian EMT.  Furthermore, pilot programs such as program that the Lansing Community College currently offers,  which provides specialized training for former enlisted military medical personnel who wish to become paramedics, could serve as a national model for similar programs. 

Travel Nurses Come to the Rescue, but at What Cost?

When it’s a global pandemic and you’re facing a shortage of health care workers, who you gonna call? Travel nurses.  This has been the answer for many health care providers, as travel nurses temporarily fill in gaps where there is a shortage of staff nurses. As the pandemic has changed how businesses operate, how will this impact the future for travel nurses and providers?

Why be a travel nurse?  Compared to staff nurses, travel nurses receive better compensation and attractive benefits like housing and per diem.  Many nurses are attracted to this lifestyle for the ability to travel and the opportunity to help pay off the cost of their nursing education.  Staffing agencies, not health care facilities, employ travel nurses and place them with providers.

Supply and Demand

The market for travel nurses was hot even before the COVID-19 pandemic due to an aging US population and other public health crisis like the opioid epidemic.  And now the pandemic has driven the demand for travel nurses even higher.  A recent poll of hospital executives by Avant Healthcare Professionals found 90% of respondents used travel nurses in 2020, compared to less than 60% in 2019.  Increasing demand has caused compensation for travel nurses to rise in tandem, with contracts for some front-line workers reaching $10,000 per week.

Travel nurses still face plenty of challenges.  Throughout the pandemic, both travel nurses and staff nurses have struggled to make do with a shortage of personal protective equipment, experienced burnout, and encountered emotional trauma from treating seriously ill COVID patients.  Problems have gotten so bad that many nurses are considering leaving the professional altogether.  Plus, since a great deal of travel nurses are geographically separated from family and friends, they lack the emotional support networks that are more readily available to their staff nurse counterparts. 

There are downsides for providers, too.  Sure, travel nurses can alleviate staffing shortages at hospitals and nursing homes, but they can create headaches of their own.

  • Cost.  Higher compensation for travel nurses means higher labor costs for providers, which includes an extra cost of paying a commission to the staffing agency.  And don’t forget, many providers have already been facing financial pressures of their own during the pandemic.
  • Competition.  Some nurses employed with hospitals and long-term care facilities are leaving their jobs to pursue more lucrative opportunities as travel nurses, exacerbating the industry’s workforce shortage.   Staff nurses who train travel nurses new to a health care provider may also find themselves frustrated with the fact that they are making less money than their trainees, causing morale to fall and potentially providing another reason for staff nurses to seek greener pastures.
  • The rural factor.  Larger hospitals near metropolitan areas are better able to weather staff shortages due to their more robust financial position, which allows them to afford travel nurses.  Plus, the higher staff sizes of hospitals in urban and suburban areas means they’re not as severely affected by a couple of unfilled nursing positions.  However, it’s a different story for rural health care providers, where just a shortage of just a few nurses can make a big difference on providing care.Additionally, smaller rural hospitals cannot afford to pay nurses as competitive of a salary as their larger, urban counterparts, meaning they’re at greater risk of losing nurses to better-paying travel roles. 

Still, travel nurses aren’t going away anytime soon.  Even when the pandemic ends, an aging population will continue to drive up demand,  while a growing number of nurses retiring, made worse by the public health emergency, will leave many positions unfilled.  Although projections vary widely across the country, many states face a projected shortfall of thousands of nurses by 2030, impacting the amount and quality of care a provider can provide.  While travel nurses may be an imperfect solution, health care providers will have no choice but to fill staffing shortages with temporary workers for the years to come.