Is hospital staffing a valid problem with the US healthcare system to discuss in interviews?

[notmycupoftea]

I posted this on reddit but also wanted to get some adcom's input on this! @Goro @LizzyM @Moko and any others!

I'm preparing for an upcoming interview, and one of the common questions this school asks is "what is the biggest problem facing healthcare today and how would you solve it?" On a personal level, I work in an understaffed ER, and our entire hospital has only 2/3 the staff we need. I was going to talk about how patients are waiting upwards of 16 hours to be seen in the ER, and then they'll wait sometimes 2-3 days just to get a bed upstairs. Also, we just don't have enough staff to care for all our patients. I've worked shifts before where a trauma comes in and consumes a lot of our staff and then one of our other patients tries to get out of bed when we're not there, falls, and injures themselves pretty badly. I can't help but feel like a more adequate staffing and/or cross-training employees to be able to help out understaffed departments could help prevent these situations and give patients the quality care they deserve.

Anywho...I feel like I could talk passionately about this and justify it reasonably well. Would this be a valid response to this question? Or would I be better off to discuss a lack of healthcare access in rural and/or underserved communities?

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[GoSpursGo]

Either of these would be valid responses. What you need to be careful about is the "how" part of the question to make sure you don't sound naive. I think you can say just about anything, just make sure you couch it with qualifiers like, "Obviously this is a multifactorial problem and I don't have all the answers, but one way I might try to address the problem is..."

 

[LizzyM]

I like that your response draws on your personal experience as an employee. Can the hospital afford to hire more staff but can’t find qualified applicants or is it a money problem? How would you solve either of those underlying issues?

 

[Rachapkis]

I offer a counterpoint to Lizzy M (who admittedly is wiser and knows more than I do): While this seems like a valid issue to discuss, I believe that there are larger healthcare issues facing the country (e.g., spiraling healthcare costs; lack of insurance coverage; disparities in access to care and outcomes negatively affecting poorer and minority populations; etc.) I mention this because you would not want to be perceived as focusing myopically on issues that affect you personally.

 

[notmycupoftea]

I like that your response draws on your personal experience as an employee. Can the hospital afford to hire more staff but can’t find qualified applicants or is it a money problem? How would you solve either of those underlying issues?

Well, the particular healthcare system I work for is one of the largest in my region, and they have plenty of resources. They have no issue finding qualified employees, but our most qualified nurses often join travel agencies for increased pay and a better work-life balance. It's definitely more complicated than a simple fix, but I feel that hiring more employees to reduce nurses' workloads and increasing their pay would help retain staff; both of these are well within my hospital's limits, but administration just has not been letting us do that. It's just hard to see the quality of patient care suffer due to an issue with our staffing...not to mention that the patient care team is ever-changing with 80% of our nurses being travelers, so there aren't many opportunities to build a consistent team.

 

[Goro]

I offer a counterpoint to Lizzy M (who admittedly is wiser and knows more than I do): While this seems like a valid issue to discuss, I believe that there are larger healthcare issues facing the country (e.g., spiraling healthcare costs; lack of insurance coverage; disparities in access to care and outcomes negatively affecting poorer and minority populations; etc.) I mention this because you would not want to be perceived as focusing myopically on issues that affect you personally.

This is my view. They're a bigger issues facing American Healthcare.

 

[notmycupoftea]

This is my view. They're a bigger issues facing American Healthcare.

Okay. Thank you all for your feedback. My ER is surrounded by rural communities; as such, most families we care for are from rural areas. I also feel like I could talk well about healthcare access for these individuals and reflect on personal patient encounters.

 

[LizzyM]

Spiraling healthcare costs are an issue for individuals and for society as a whole but sometimes what makes things interesting is getting a perspective from the front lines. Patients falling and being seriously injured because there aren't enough staff present is a problem that gets to the bigger issue of staffing, which comes around to the issue of costs and continuity when a system depends on traveling nurses.

OP, if you want to go with this, preface it with, "I don't know if this is the biggest problem, but one that keeps me up at night is...." understaffed rural hospitals. Believe me, you will be memorable, and in a good way.

 

[GoSpursGo]

I offer a counterpoint to Lizzy M (who admittedly is wiser and knows more than I do): While this seems like a valid issue to discuss, I believe that there are larger healthcare issues facing the country (e.g., spiraling healthcare costs; lack of insurance coverage; disparities in access to care and outcomes negatively affecting poorer and minority populations; etc.) I mention this because you would not want to be perceived as focusing myopically on issues that affect you personally.

I think we're all talking about symptoms surrounding the same underlying problem--healthcare costs too much and is inaccessible to large swaths of the population. One way this manifests is that hospitals are run like businesses, they try to skate by with the bare minimum staffing, and as a result patients who ARE able to get care receive suboptimal care.

There is no "right" answer to this question. I think any rational answer that is well-justified will be received well.

 

[IlDestriero]

That answer is fine and true. Is it the biggest problem? No, but it’s a big problem and you have a good perspective. You’re not going to fail the interview because you don’t mention the exact same 3 answers that everyone else gives.

 

[Mr.Smile12]

Becoming a Student Doctor - HPSA has a topic outline which includes information on a number of external and internal challenges to health care and society.

There is no one simple answer, but giving one that goes beyond personal observation requires more insight for a more impressive answer. Granted, current medical and health professional students don't have this depth either. That can be discussed as a separate problem in health professional education.

 

[Rector]

Attending intensivist here, does some research and writing on crisis standards of care and disaster planning. While some of the other posters here have mentioned that there may be more important issues facing healthcare in the US, this is definitely in the top ten issues. The pandemic has had a dramatic affect on staffing of EDs, ICUs, and acute care generally, most especially in nurses but physicians, RTs, and others as well. So I think this is a great topic to mention, given your personal perspective. You can certainly couch it in broad terms like some others have mentioned (e.g., "while it is hard for me to say what the single greatest issue, one issue that I see with regularity is..."). This problem ties into issues of access to care, health equity, and quality of care as well.

There are a number of excellent articles out there to review that may offer some perspective and inform your discussion. An excellent place to start is the US Surgeon General's report on clinician burnout, which addresses the need to conserve the workforce post-pandemic:

Health Worker Burnout

Our health depends on the well-being of our health workforce. Let’s take care of those who are always there to care for us.

www.hhs.gov