The pandemic exposed the myriad inefficiencies and shortcomings of healthcare that workers have long managed to live with. Megan Ranney, MD, a practicing emergency medicine physician, thought the crisis would fuel the resources and political will to finally repair the system.
"But now, I worry that the fixes are not going to come," she wrote in a Jan. 21 op-ed for The Washington Post.
Dr. Ranney, who is also associate dean for strategy and innovation at Brown University School of Public Health in Providence, R.I., said she was usually able to do her job well pre-pandemic: work with her team to quickly stabilize a patient, create trust with them and their family, arrive at a clear diagnosis and therapeutic plan, and decide what is needed to keep them from coming back.
Now, arriving at her shift in the emergency department "feels a bit like entering a disaster zone." It's a long game of catch up, with more than 50 patients in the waiting room needing to be seen. "It has become nearly impossible for us to take the right care of the right patient at the right time," Dr. Ranney wrote.
"Emergency departments and hospitals have worked on a thin edge for a decade. We have been the last resort for mental health and dental care; we have routinely asked nurses, doctors and techs to work overtime during swells of trauma patients or influenza; we have tolerated threats and violence against our co-workers in the name of providing care. We have served as the safety net for a broken system. But with the serial surges of [COVID-19], we simply can't do it anymore."
Exacerbating the physician's frustration is that solutions — tactical, complex and big-picture — to fix and rebuild are known. A few proposed by Dr. Ranney: Subsidize the training of more staff across all levels of the system — from unit assistants to certified nursing assistants to physicians — and provide emotional and financial support for those who have stayed. Set up a public health emergency response system that is robustly funded, based on accurate data and resilient. Ensure people can access care when and where they need it, and that our testing infrastructure, telehealth system and home-care network are intact.
"Ultimately, we also need to change the system's incentives, so that prevention of a hospital stay is valued as much as end-stage treatment is," she wrote.
Read Dr. Ranney's op-ed in full here.