When patients seek medical care from their primary care provider, they may not consider the 6-week wait time until their appointment. Across the United States, policymakers are concerned that the supply of physicians is not enough to meet the nationwide demand for care. Many regions do not have enough primary care providers to meet the needs of the local population. While there has been research examining the impact of the primary care provider shortage, there has not been an analysis of how the shortage affects hospital quality outcomes.
The physician shortage is often discussed in policy as a significant factor contributing to poorer population health, but the shortage of nurses in acute care settings is also important for improving health. Nurse practitioners are already compensating for the lack of primary care providers in the field. However, there is not a comparable position that stops the flow of registered nurses leaving bedside care.
The causes for the shortage of primary care providers and nurses have some overlapping characteristics. Physicians and nurses are overworked, understaffed, and suffer from burn-out in their emotionally and physically taxing careers. Primary care providers are in short supply partially due to the practice being paid less than other specialties. A factor unique to the nursing shortage is the lack of nurses in higher education, partially because of depressed wages for nurse preceptors, leading to limited spots in higher education to educate more nurses.
The study examined how the primary care provider shortage affected hospital quality outcomes for the year 2023 in Indiana. Alongside primary care providers, registered nurses were measured as an important factor involved in hospital care quality. Ratios of comparing providers and nurses to the population of the hospital county were used to standardize population size differences. Other relevant clinical factors gathered for this study, such as Medicare reimbursements, vaccination rates, and designated healthcare provider shortage areas were considered for their influence over hospital care quality. The outcome variable used to measure hospital care quality was cases of clostridium difficile in each hospital. Clostridium difficile (c. diff) is a hospital acquired infection, meaning that the disease only circulates in the sterile environment of healthcare settings. It is not possible to be infected with a hospital acquired infection outside of a hospital and the infections are used as a benchmark determining the quality of care that the hospital spends to prevent and contain infections.
The results of the regression model found a negative correlation between registered nurses and incidents of c. difficile, meaning that cases of c. diff decreased when the nurse-population ratio increased. There was no significant correlation found between primary-care provider ratios and cases of c. diff, indicating that hospitals in areas with a higher or lower number of primary care providers are not relevant to the quality of care delivered by the hospital.
In conclusion, proper nurse-patient staffing ratios are vital for ensuring that each patient receives enough individual, quality care. Ideally, a 4:1 nurse-patient ratio is the gold standard for delivering good bedside care. Burnout and the demanding nature of nursing leads to higher-than-average turnover in the field. Bedside nursing is an area of focus when addressing the labor shortage of RNs in hospitals, so changing incentives and focusing on nursing recruitment could produce meaningful increases in hospital care quality. Better communication between hospital departments and staff could aid in the prevention and treatment of HAIs, leading to overall improved hospital care outcomes.
Alexa Weber is a senior at the O’Neill School of Public and Environmental Affairs, majoring in Healthcare Management and Policy with a minor in Business. Her Honors Thesis is “The Primary Care Physician Shortage: Are Hospitals Losing Quality Alongside Quantity?” She plans to pursue an education in nursing after graduation.
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