Hospital Staffing Shortages Will Hold Back Growth in Cardiac Electrophysiology Procedures in 2023

EP Lab Digest. 2023;23(1):6.

Dear Readers,

The COVID-19 pandemic has created global stresses on health care systems. By overwhelming hospitals with sick patients, altering daily hospital operations, and creating a national divide over vaccinations, the pandemic has pressed hard on health care workers. Over the past couple of years, health care workers have gone from being heroes to being disillusioned and worn down. While most doctors, nurses, and staff have stayed with their current employers, doing their best every day to make sure their patients receive excellent care, about 18% have quit.¹ This mass departure by nurses and other health care workers, in addition to overall unemployment rates in the United States, has resulted in a national hospital labor shortage.

The increased reliance by hospitals on contract travel nurses has caused hospital labor costs to skyrocket. According to the American Hospital Association in May 2022,² based on a report by Kaufman Hall,³ “the median labor expense per discharge has increased by more than one-third since 2019, with the median wage rate for contract nurses over 3 times higher than for employed nurses.” For example, a recently graduated pediatric intensive care unit nurse at a local pediatric hospital in Chicago is paid about $1200 per week compared to an experienced contract nurse in the same role, who is paid $6000 per week. The impact of the pandemic on staffing has resulted in not only challenges filling vacant positions, but also budget cuts and hiring freezes. Hospital administrators are either unable or unwilling to pay for additional staffing due to rising personnel costs—even for programs that have the potential for significant revenue growth.

These hospital staffing shortages come at a time when hospitals, electrophysiologists, and health care companies have become accustomed to substantial growth in several heart rhythm procedures, including catheter ablation and left atrial appendage closure (LAAC) for patients with atrial fibrillation (AF). This growth has been driven by an increase in the prevalence of AF, greater awareness, expanded indications based on clinical trial data, and better catheters and devices. Industry leaders project continued growth in LAAC procedures. One recent report from September 2022 showed that the estimated global LAAC market size will increase from $0.9 billion in 2019 to about $2 billion by 2024.⁴ But can this growth continue in the current hospital labor environment?

The COVID-19 pandemic has created a national nursing shortage and an increase in hospital labor costs. The volume of hospital-based heart rhythm procedures, such as AF ablation and LAAC procedures, will not be able to grow unless hospital and electrophysiology lab staffing shortages improve. The most significant factor that will impede LAAC growth will not be low facility capacity, insufficient patient or physician awareness, or scheduling limitations, it will be inadequate hospital staffing. Hospitals and manufacturers of the devices used during these procedures should consider this factor when projecting future procedural and revenue growth. 

Disclosures: Dr Knight has served as a paid consultant to AltaThera, manufacturer of IV sotalol. He has also served as a paid consultant to Medtronic, the sponsor of the EV ICD study, served on the EV ICD Steering Committee, and was an investigator in the trial. In addition, he has served as a consultant, speaker, investigator, and/or has received EP fellowship grant support from Abbott, AtriCure, Baylis Medical, Biosense Webster, Biotronik, Boston Scientific, CVRx, Medtronic, Philips, and Sanofi; he has no equity or ownership in any of these companies.

References

1. Galvin G. Nearly 1 in 5 health care workers have quit their jobs during the pandemic. Morning Consult. October 4, 2021. Accessed December 12, 2022. https://morningconsult.com/2021/10/04/health-care-workers-series-part-2-workforce/

2. Report: Labor costs driving hospital expenses up, margins down. American Hospital Association. May 11, 2022. Accessed December 12, 2022. https://www.aha.org/news/headline/2022-05-11-report-labor-costs-driving-hospital-expenses-margins-down

3. The financial effects of hospital workforce dislocation. A special workforce edition of the National Hospital Flash Report. Kaufman Hall. May 2022. Accessed December 12, 2022. https://www.kaufmanhall.com/sites/default/files/2022-05/KH-NHFR-Special-Report-2.pdf

4. Welcome: TCT 2022 investor update. Boston Scientific. September 18, 2022. Accessed December 12, 2022. https://investors.bostonscientific.com/~/media/Files/B/Boston-Scientific-IR-V3/TCT%20Investor%20Meeting%20FINAL.pdf