Gender Pay Gap Tops $36K for New Physicians

A new study has found that male physicians earn more than their female counterparts, even at the onset of their career.

A new study, which was released ahead of print by Health Affairs, shows a growing disparity in pay between new male and female physicians.

For the study, researchers collected data between 1999 and 2017 from graduating residents from the New York Survey of Residents Completing Training from the Center for Health Workforce Studies of the University of Albany, State University. Using that data, the researchers found that, over that time period, the average starting compensation for men was $235,044 and $198,426 for women, a difference of more than $36,000. They also discovered that the gap widened over time, increasing from $7,700 in 1999.

While part of the pay gap could be explained due to analyzed variables—chosen specialty (40-55%), number of job offers (2-9%), hours worked (up to 7%), and work-life balance preferences (less than 1%)—researchers could not entirely explain the disparity.

“While it is apparent that women say they place a greater premium on control over work-life balance factors, this difference does not appear to explain the observed starting salary difference, conditional on other factors,” the researchers wrote. “There may nevertheless exist workplace biases, whether intentional or unintentional, that differentially affect women irrespective of their individual stated preferences for work-life balance.”

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

When The Nurse Is Stretched Too Thin

Nurses can be pushed to the breaking point, driven to the precipice of burnout, compassion fatigue, and utter defeat. But there is another way.

From Nurse Keith’s Digital Doorway

In all likelihood, we can all readily agree that nursing is not for the faint of heart. Nurses in many different settings can be pushed to the breaking point, driven to the precipice of burnout, compassion fatigue, and utter defeat. But there is indeed another way.

Nurses are often seen as strong figures who can tend to the sick, stand on their feet for hours on end, simultaneously care for multiple critical patients, and document it all like a pro. Many years ago, I wrote about the Sisyphean nature of nursing, a topic I should probably revisit sooner than later.

We can think of the nurse as Sisyphus, pushing a boulder uphill with no hopes of tomorrow being any different. We can also consider the metaphor of the elastic band stretched beyond its capacity. Our breaking points are individual, as are the events or circumstances that will trigger our breakdown or moment of snapping.

What’s Your Capacity?

Nurses, it’s up to you to determine for yourself what your capacity for stress and unhappiness really is. No one on the outside can really tell you what you should or shouldn’t be feeling on the inside. Your ability to determine your own capacity is part of your emotional intelligence and your personal insight into the workings of your own psyche.

The nurse who brags that she can face any challenge or work any number of shifts without blinking an eye is probably lying — either to you, or to herself. We’ve all probably encountered those highly seasoned nurses — some would derogatorily label them as “Old Battle Axes” — who, for all intents and purposes, seem impervious to all negativity or stress. Their jaded outward personalities probably belie what may be going on inside of them; they may actually so far gone, they can’t even feel their own feelings. This is the opposite of emotional intelligence.

Nurse, you need to determine your own capacity for every aspect of your work environment and professional experience:

  • How many hours can you work in any given week and still feel somewhat functional and human at home?
  • How much bullying and aberrant behavior are you willing to tolerate without taking action?
  • Is there a type of negative workplace culture that you feel you could actually work in without it impacting you in damaging ways?
  • What level of dysfunctional management is permissible?
  • How little teamwork and collaboration is accepted in your workplace?
  • What other areas of your work life are you able or unable to tolerate?

Why Do You Stay?

If your workplace leaves much to be desired, one of the initial questions to ask yourself is, “Why do I stay?” If you’re only staying because of the money, that’s probably not going to seem like enough as symptoms of stress-based illness begin to arise, or you’re just too depressed and despondent to take any action whatsoever.

You may be caught in a moment of simply feeling too beaten up by your work to even consider making a change. This type of ennui and loss of energy to create change in your life can have dire consequences, especially if you’re tolerating bullying, the sabotaging of your patient care by colleagues (we know this happens, folks), or other behaviors that put your license — and your patients — at risk.

Remaining in a job that’s killing you is not recommended, nor is it mentally, physically, or emotionally healthy. Some might even say it can be spiritually damaging to stay in work that doesn’t feed your heart and soul and/or detracts from your self-esteem and self-worth.

Determining why you’re choosing to stay may reveal very clearly that you have every reason to leave. How much are you willing to take? When will you put your foot down and say, “no more”?

Cultivating Nurse Resilience

Nurse resilience comes in many forms. Your resilience may come from cultivating the courage and ability to speak up to managers and executive and share your opinions about your workplace, or stand up for nurses on the receiving end of bullying and aggression.

Resilience may come from a variety of sources, including but not limited to:

  • Engaging the services of a counselor or therapist to help you navigate the challenges of your professional life
  • Using career coaching as a means to discover what you love about your career and how to instigate healthy change
  • Speaking with supportive colleagues, friends, or family
  • Studying meditation, yoga, mindfulness, Reiki, or other modalities
  • Take a course on cultivating emotional intelligence
  • Guard your time off and use it wisely in the interest of self-care and personal wellness
  • Turn to faith leaders for support and wise counsel
  • Focus on your physical health and well-being
  • Allow yourself to explore new career paths and professional options
  • Finding and strengthening your most resilient self is essential to counteracting those moments, days, weeks, months, or even years when you’re stretched too thin and come dangerously close to reaching your breaking point.

Why allow yourself to get to the point of snapping from the strain? Why not cultivate resilience, as well as strategies for surviving and thriving rather than tolerating what’s unhealthy? No one can do this work for you, but you can enlist the help of those who can make the journey easier.

Push Back

If your work is like pushing a rock uphill day after day, something has to give. Are you going to push back against unsafe staffing and high nurse-patient ratios? Will you join the union and seek greater protection from poor management? Will you speak up and call the unit bully on her horrible behavior? Are you going to say “no” the next time you’re asked to cover yet another extra shift?

How you push back is up to you, but push back you must. When the going gets tough, your job is to build up your resilience, take action, and push back against what is making your miserable. The ultimate push back may be giving your notice, and that is sometimes the only way. However, if you’re dedicated to your workplace and want to fight the good fight, enlist courageous colleagues willing to stand by your side.

When you’re stretched too thin, it’s time for action. When you’re pushed beyond your limit, recognize what those limits really are and how to protect them from ever being threatened again.

Staying may work, or it may be impossible. Leaving may be the only way out, or there may be other solutions. If you’re experiencing the cognitive dissonance of workplace demands beyond your capacity to meet those demands, it’s time to consider your options.

Don’t allow your well-being, health, and happiness to be compromised by your work. This profession of nursing should feed your soul, pay your bills, and bring you fulfillment and positive self regard. If something else is happening in your work life and career, it’s time for a new plan and a new lease on life.


Keith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind NurseKeith.com and the well-known nursing blog, Digital Doorway. Please visit his online platforms and reach out for his support when you need it most.

Keith is the host of The Nurse Keith Show, his solo podcast focused on career advice and inspiration for nurses. From 2012 until its sunset in 2017, Keith co-hosted RNFMRadio, a groundbreaking nursing podcast.

A widely published nurse writer, Keith is the author of Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century and Aspire to be Inspired: Creating a Nursing Career That Matters. He has contributed chapters to a number of books related to the nursing profession. Keith has written for Nurse.com, Nurse.org, MultiBriefs News Service, LPNtoBSNOnline, StaffGarden, AUSMed, American Sentinel University, Black Doctor, Diabetes Lifestyle, the ANA blog, American Nurse Today, NursingCE.com, Working Nurse Magazine, and other online and print publications.

Mr. Carlson brings a plethora of experience as a nurse thought leader, keynote speaker, online nurse personality, social media influencer, podcaster, holistic career coach, writer, and well-known nurse entrepreneur. He lives in Santa Fe, New Mexico with his lovely and talented wife, Mary Rives, and their adorable and remarkably intelligent cat, George. (You can find George on Instagram by using the hashtag #georgethecatsantafe.)

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Nearly Half of 2020’s “Best Jobs” Are in Healthcare

46 of the 100 “Best Jobs” for 2020 are in healthcare, meaning now is certainly a great time to work in the industry. See which jobs made the list here.

There is no denying it; now is a great time to work in healthcare.

U.S. News & World Report has released their oft-anticipated annual list of 100 Best Jobs for 2020 and, without a doubt, the healthcare industry is the clear winner. Of the 100 to be named best overall—which were measured on multiple components, including median salary, unemployment rate, 10-year growth volume, 10-year growth percentage, future job prospects, stress level, and work-life balance—46 of them are in healthcare, making it the most popular industry to be included on the list.

See which jobs made the list below.

2. Dentist
3. Physician Assistant
4. Orthodontist
5. Nurse Practitioner
7. Physician
8. Speech-Language Pathologist
9. Oral and Maxillofacial Surgeon
10. Veterinarian
13. Registered Nurse
15. Physical Therapist
16. Optometrist
17. Anesthesiologist
17. Obstetrician and Gynecologist
17. Surgeon
21. Nurse Anesthetist
22. Pediatrician
24. Dental Hygienist
25. Genetic Counselor
26. Physical Therapist Assistant
28. Occupational Therapist
34. Psychiatrist
37. Home Health Aide
40. Respiratory Therapist
41. Diagnostic Medical Sonographer
47. Podiatrist
52. Medical Assistant
55. Medical Records Technician
56. Prosthodontist
58. Veterinary Technologist and Technician
61. Orthotist and Prosthetist
62. Personal Care Aide
64. Massage Therapist
66. Dental Assistant
69. Physical Therapist Aide
70. Occupational Therapy Assistant
75. Radiologic Technologist
76. MRI Technologist
77. Chiropractor
82. Nurse Midwife
83. Phlebotomist
88. Dietitian and Nutritionist
89. Ophthalmic Medical Technician
90. Clinical Laboratory Technician
91. Licensed Practical and Licensed Vocational Nurse
97. Optician
99. Esthetician and Skincare Specialist

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

The Highest Paying U.S. Metro Areas for PTs, OTs, & SLPs

Want to make top pay as a PT, OT, or SLP? You might want to consider looking for a job in one of these high-paying metro areas.

While the average annual salaries of PTs, OTs, and SLPS—$87,930, $84,270, and $77,510 respectively—are typically considered high-paying, salaries can vary based on location, due to cost of living and other factors.

If your 2020 job search has you considering a change in location, be it across the state or across the country, knowing which areas offer the highest pay can help you decide your next move.

Take a look at the top metro areas offering the highest average annual salaries for PTs, OTs, and SLPs as determined by the U.S. Bureau of Labor and Statistics.

Highest Paying Metro Areas – Physical Therapists

  1. Ames, IA – $118,870
  2. Great Falls, MT – $116,580
  3. Las Vegas-Henderson-Paradise, NV – $115,240
  4. Yuma, AZ – $114,850
  5. Bakersfield, CA – $114,170
  6. McAllen-Edinburg-Mission, TX – $112,500
  7. Prescott, AZ – $110,960
  8. Ithaca, NY – $110,620
  9. Morristown, TN – $108,340
  10. Santa Cruz-Watsonville, CA – $107,960

Highest Paying Metro Areas – Occupational Therapists

  1. Las Vegas-Henderson-Paradise, NV – $108,190
  2. Vallejo-Fairfield, CA – $106,270
  3. San Francisco-Oakland-Hayward, CA – $104,580
  4. Hattiesburg, MS – $104,250
  5. Santa Maria-Santa Barbara, CA – $103,120
  6. Visalia-Porterville, CA – $102,540
  7. Santa Cruz-Watsonville, CA – $102,480
  8. McAllen-Edinburg-Mission, TX – $101,800
  9. Salinas, CA – $101,680
  10. Tyler, TX – $101,410

Highest Paying Metro Areas – Speech-Language Pathologists

  1. Napa, CA – $106,620
  2. Jackson, MI – $105,130
  3. San Francisco-Oakland-Hayward, CA – $103,890
  4. Vallejo-Fairfield, CA – $103,030
  5. Tulsa, OK – $102,680
  6. Wichita Falls, TX – $102,540
  7. Chico, CA – $101,990
  8. Battle Creek, MI – $101,810
  9. Gainesville, FL – $101,750
  10. Santa Cruz-Watsonville, CA – $101,380

Ready to start your search for a higher paying job? Click here.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

The Highest Paying U.S. Metro Areas for Physicians

Want to earn more than the average annual physician salary of $208,000? You might want to look for a job in these metro locations offering top pay.

Physician salaries are typically considered some of the highest across the United States, with average annual salaries ranking at or above $208,000. However, pay can vary quite a bit in different cities across the country, due to cost of living and other factors, including specialty.

If your 2020 job search has you considering a change in location, be it across the state or across the country, knowing which areas offer the highest pay can help you decide your next move.

Take a look at the top ten metro areas offering the highest average annual salaries for Family and General Practitioners, Internists, Pediatricians, and Surgeons as determined by the U.S. Bureau of Labor and Statistics.

Family and General Practitioners

  1. Sheboygan, WI – $288,770
  2. Appleton, WI – $287,050
  3. Lafayette, LA – $285,350
  4. Jacksonville, NC – $282,770
  5. Rockford, IL – $281,470
  6. Portsmouth, NH-ME – $280,310
  7. Mobile, AL – $279,310
  8. Knoxville, TN – $278,300
  9. Hilton Head Island-Bluffton-Beaufort, SC – $277,290
  10. Gulfport-Biloxi-Pascagoula, MS – $275,660

Internists

  1. Sioux Falls, SD – $291,360
  2. Tulsa, OK – $286,500
  3. Greenville-Anderson-Mauldin, SC – $276,410
  4. Orlando-Kissimmee-Sanford, FL – $273,690
  5. Richmond, VA – $269,200
  6. Albuquerque, NM – $262,050
  7. Omaha-Council Bluffs, NE-IA – $261,990
  8. New Haven, CT – $257,100
  9. Albany-Schenectady-Troy, NY – $256,900
  10. Las Vegas-Henderson-Paradise, NV – $256,490

Pediatricians

  1. Montgomery, AL – $285,070
  2. Jackson, MS – $283,960
  3. Killeen-Temple, TX – $275,000
  4. Madison, WI – $274,720
  5. St. Louis, MO-IL – $271,230
  6. Eugene, OR – $267,860
  7. Salt Lake City, UT – $265,080
  8. Milwaukee-Waukesha-West Allis, WI – $264,320
  9. Las Vegas-Henderson-Paradise, NV – $261,890
  10. Anchorage, AK – $258,830

Surgeons

  1. Greenville, NC – $289,460
  2. Winchester, VA-WV – $287,960
  3. Cincinnati, OH-KY-IN – $287,850
  4. Champaign-Urbana, IL – $287,630
  5. San Jose-Sunnyvale-Santa Clara, CA – $287,390
  6. Bowling Green, KY – $286,530
  7. Bloomington, IL – $286,270
  8. New Orleans-Metairie, LA – $286,090
  9. Omaha-Council Bluffs, NE-IA – $285,890
  10. Grand Junction, CO – $285,760

Ready to start your search for a higher paying job? Click here.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

The Highest Paying U.S. Metro Areas for Nurses

If your 2020 job search has you considering a change of scenery, you may want to consider these metro areas offering top pay for nurses.

If your 2020 job search has you thinking of a change of scenery, you may want to consider taking a job in California. While the cost of living in some areas of the state can be above the national average, all of the top ten highest paying metro areas happen to be located within the state lines, as well. In fact, out of more than 500 metro locations, nineteen of the top twenty are located there—the only non-California area to rank that high was Honolulu, Hawaii in 16th place.

Take a look at the top ten metro areas offering the highest average annual salaries for nurses as determined by the U.S. Bureau of Labor and Statistics—as well as some high-ranking cities not in California, all offering above the national average annual RN salary of $71,730.

Highest Paying Metro Areas for Nurses

1. Salinas, CA – $131,710
2. San Francisco-Oakland-Hayward, CA – $128,990
3. San Jose-Sunnyvale-Santa Clara, CA – $128,610
4. Santa Cruz-Watsonville, CA – $127,440
5. Sacramento-Roseville-Arden-Arcade, CA – $120,530
6. Vallejo-Fairfield, CA – $115,900
7. Stockton-Lodi, CA – $111,140
8. Napa, CA – $106,060
9. Modesto, CA – $106,040
10. Santa Maria-Santa Barbara, CA – $104,680

Honorable Mentions (Not In California)

16. Urban Honolulu, HI – $99,600
22. Boston-Cambridge-Nashua, MA-NH – $95,270
24. Portland-Vancouver-Hillsboro, OR-WA – $93,570
29. Danbury, CT – $91,680
30. New York-Newark-Jersey City, NY-NJ-PA – $91,160
31. Eugene, OR – $90,850
32. Kahului-Wailuku-Lahaina, HI – $89,290
35. Salem, OR – $88,460
36. Anchorage, AK – $88,170
37. Bend-Redmond, OR – $88,100

Thinking of relocating? Start your job search now by clicking here.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

The Highest Paying U.S. Metro Areas for NPs and PAs

If your 2020 job search has you considering a change in location, knowing which areas offer the highest pay can help you decide your next move.

Nurse Practitioner and Physician Assistant salaries are typically considered high-paying across the United States, with median annual salaries ranking above $100,000 for both positions. However, salaries can differ quite a bit in cities across the country, due to cost of living and other factors.

If your 2020 job search has you considering a change in location, be it across the state or across the country, knowing which areas offer the highest pay can help you decide your next move.

Take a look at the top ten metro areas offering the highest average annual salaries for NPs and PAs below.

Highest Paying Metro Areas – Nurse Practitioners

  1. New Bedford, MA – $156,980
  2. San Francisco-Oakland-Hayward, CA – $150,790
  3. Spokane-Spokane Valley, WA – $148,440
  4. Sumter, SC – $145,890
  5. Vallejo-Fairfield, CA – $145,400
  6. Leominster-Gardner, MA – $145,020
  7. Yuma, AZ – $142,650
  8. Rochester, MN – $142,640
  9. Palm Bay-Melbourne-Titusville, FL – $141,800
  10. Bridgeport-Stamford-Norwalk, CT – $141,460

Highest Paying Metro Areas – Physician Assistants

  1. Danbury, CT – $146,000
  2. Salinas, CA – $145,700
  3. Visalia-Porterville, CA – $141,400
  4. Olympia-Tumwater, WA – $139,770
  5. Spokane-Spokane Valley, WA – $138,900
  6. Greenville-Anderson-Mauldin, SC – $137,670
  7. Leominster-Gardner, MA – $135,550
  8. Homosassa Springs, FL – $133,850
  9. Santa Cruz-Watsonville, CA – $133,660
  10. New Bern, NC – $132,640

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Debt and the DPT

While it is a topic that has plenty of anecdotal evidence, a study has now been conducted on the oftentimes crippling debt burden of physical therapists.

While it is a topic that has plenty of anecdotal evidence, a study has now been conducted on the oftentimes crippling debt burden of physical therapists.

The small-scale study, which was authored by Steven Ambler, PT, DPT, MPH, PhD, surveyed members of the Florida Physical Therapy Association’s Early Professional Special Interest Group, all of whom were entry-level PTs practicing in Florida. The respondents, of which there were 86, answered questions relating to income, amount of debt held, and clinical practice choices. The study found that PTs who held a DPT most frequently reported debt ranging from $100,000 to $124,999, while the average salary of respondents was $69,328—a 197% debt to income ratio—and that PTs spend, on average, 22% of their monthly income on loan repayment.

The debt-to-income ratio identified by the study was more than double the estimated average ratio for family medicine physicians, who average a debt-to-income ratio of 80-90%, and also surpassed the average debt-to-income ratio for veterinarians, which is often estimated at 160-180%.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Nurses Rank Highest in Honesty, Ethics

Well done, nurses. For the 18th year in a row, Americans have named you as the most honest and ethical professionals in the country.

For the 18th year in a row, Americans have ranked nurses as the most honest profession, according an annual poll conducted by Gallup.

The poll, which asks Americans to rank the honesty and ethical standards of people in various professions, found that 85% of Americans rate nurses as having “high” or “very high” honesty and ethical standards, yet again outpacing every other profession.

Nurses have consistently ranked higher than all other professions, receiving 84% of the vote in 2018, 82% in 2017, and 84% in 2016. However, they are not the only medical professionals Americans rate highly, with doctors (65%), pharmacists (64%), and dentists (61%) all ranking in the top five this year, and none of the medical professions included in the poll ranked outside of the top ten.

This year, the least honest professions according to Americans were car salespeople (9%), members of Congress (12%), and Senators (13%).

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Nurse Practitioners and Physicians Behind the 8-Ball

Due, in part, to their compassionate nature and dedication to their patients, MDs, NPs, and other overworked healthcare professionals have found themselves in an impossible position, with few options for relief.

From Nurse Keith’s Digital Doorway

On June 8, 2019, an excellent article was published in the New York Times that clearly stated something I’ve been thinking about for quite some time. The article was titled, “The Business of Health Care Depends on Exploiting Doctors and Nurses“, and the subtitle was “One resource seems infinite and free: the professionalism of caregivers“. It was written by Dr. Danielle Ofri, a physician at Bellevue Hospital in New York City.

The article outlines the ways in which healthcare providers are exploited for their compassion and dedication to patients in terms of being asked to see more patients and do more work than is humanly possible without any additional remuneration or compensation. While the writer focused on MDs and NPs, in my opinion this is an across-the-board cancer eating away at the quality of our healthcare system and the mental health and well-being of our providers.

This disturbing trend is apparent in the lives of so many nurse practitioners I’ve encountered, including dear friends, colleagues, and career coaching clients, and is especially apparent in those who work in primary care. The complaints I hear often concern NPs being forced to see dozens of complicated patients per day with only 15 minutes allotted per visit. With sicker patients, complex comorbities, and other factors that make care more time-consuming and complicated, our frontline medical providers are put in an impossible situation with only one certain outcome: provider burnout and the compromising of patient care.

Ethics, Practice, and the Hard Reality

The aforementioned New York Times article begins thus:

You are at your daughter’s recital and you get a call that your elderly patient’s son needs to talk to you urgently. A colleague has a family emergency and the hospital needs you to work a double shift. Your patient’s M.R.I. isn’t covered and the only option is for you to call the insurance company and argue it out. You’re only allotted 15 minutes for a visit, but your patient’s medical needs require 45.

These quandaries are standard issue for doctors and nurses. Luckily, the response is usually standard issue as well: An overwhelming majority do the right thing for their patients, even at a high personal cost.

We healthcare providers are ethical creatures by dint of our education and perhaps our human nature as individuals given to caregiving. The medical or nursing oaths we take are to do harm and provide the best possible care for those patients in our charge; so, in the words of Dr. Ofri:

If doctors and nurses clocked out when their paid hours were finished, the effect on patients would be calamitous. Doctors and nurses know this, which is why they don’t shirk. The system knows it, too, and takes advantage.

The reality of medical and nursing care is far beyond what the corporate bean counters will acknowledge. When healthcare is corporatized to such an egregious level based on nothing but the financial bottom line, productivity becomes the keystone of every aspect of patient care, not to mention so-called “patient satisfaction”.

But what happens when providers are so burned out that they cannot provide the care they’re ethically bound to deliver? What about provider satisfaction? Do those watching the flow of money care that approximately 400 American physicians commit suicide per year? We don’t have accurate data on the number of nurse suicides, but we readily assume that this is an issue facing nurses and APRNs as well. How far does this calculation need to go before we notice and actually do something about it?

As Dr. Ofri points out, the EMR has revolutionized healthcare and few of us would voluntarily choose to revert to paper charts. However, the dark side of the EMR is that we can be forced to work from home because we now have 24/7 access to patient records.

In fact, per a recent article in the Annals of Family Medicine, for every hour of direct physician-based patient care (or APRN-driven care, I may add), two hours are needed for accurate documentations in an EMR. So where do those 15 minutes figure in this dastardly and cynical calculation of how long it takes to perform and document high-quality patient care? In fact, those 15 minutes mean nothing in the scheme of things because precious few visits actually take only that amount of time.

Stress, burnout, and compassion fatigue in medical providers and nurses inevitably leads to stress-related illness, provider attrition, suicide, and other negative outcomes. With a shortage of primary care physicians and nurses in many areas of the country — especially where vulnerable populations are concerned — we cannot afford such a hemorrhage of talent and skill. In fact, it’s killing us.

Would Other Professionals Put Up With It?

If construction workers (who, by the way, experience far fewer on-the-job injuries than nurses due to strictly held safety standards) were asked to work three hours of unpaid overtime a night in order to document their work, what would they say and do? They’d probably tell you to stick your documentation where the sun doesn’t shine and then go on strike against their employer for unfair labor practices.

The New York Times article illustrates it thus:

In a factory, if 30 percent more items were suddenly dropped onto an assembly line, the process would grind to a halt. Imagine a plumber or a lawyer doing 30 percent more work without billing for it. But in health care there is a wondrous elasticity — you can keep adding work and magically it all somehow gets done. The nurse won’t take a lunch break if the ward is short of staff members. The doctor will “squeeze in” the extra patients.

For doctors, nurse practitioners, midwives, nurses, and others in the healthcare ecosystem, we continually show up, do our best, work hours after we’re no longer paid, and otherwise sacrifice ourselves on the altar of patient care because patient abandonment is serious and we would never put our patients at risk because we feel overworked, even though the reality is that our patients are indeed at risk exactly because of the workloads we silently accept.

How many other professions do something similar? Perhaps teachers, who spend enormous amounts of their own money (despite comparatively low pay) on classroom supplies since school systems in the U.S. provide precious little for them to work with in order to provide high-quality educational experiences for the students who they’re ethically bound to educate.

Medical providers save lives, keep patients on track, treat both acute and chronic diseases, perform surgeries, and contribute enormously to the greater public good. While pop stars and sports figures earn multi-million dollar salaries for entertaining us (an important societal role, of course), those who put their own mental and physical health on the line to save and heal others are expected to do the impossible day in and day out for comparatively little compensation. In my book, the musicians and athletes should trade salaries with medical providers, but we know that will never happen. And when an athlete has to play an extra game or match without compensation, we’d see how long that would last before a revolution took place.

Solutions Must Exist

At face value, this situation seems untenable and intractable. The corporatization of healthcare will continue apace, more and more will be demanded of our NPs, RNs, and MDs, and we’ll continue to lose good people.

The notion of the “triple bottom line” is one concept that more healthcare institutions could adopt, and that means taking into consideration people, planet, and profits. While this may be anathema to those who watch the healthcare money flow, this is one way to humanize the way we deal with such a highly valuable workforce.

And while hospitals focus so terribly much on patient satisfaction scores in order to secure Medicare reimbursement, whatever happened to provider and employee satisfaction? Doesn’t the Center for Medicare and Medicaid Services (CMS) understand that burned-out nurses, NPs, surgeons, and physicians actually contribute to worse patient satisfaction? And what if employee satisfaction scores impacted Medicare reimbursement? How the accountants and executives might scramble to keep those providers happy.

This overly corporatized healthcare infrastructure is strangling the system and hobbling good clinicians who can’t take the strain. Yes, we can bill, bill, bill for those reimbursements, but when that final “bill” arrives and we realize that outcomes are plummeting and our employees are being driven away, perhaps then we’ll see the light and begin to brainstorm solutions.

The New York Times article concludes:

The health care system needs to be restructured to reflect the realities of patient care. From 1975 to 2010, the number of health care administrators increased 3,200 percent. There are now roughly 10 administrators for every doctor. If we converted even half of those salary lines to additional nurses and doctors, we might have enough clinical staff members to handle the work. Health care is about taking care of patients, not paperwork.

Those at the top need to think about the ramifications of their decisions. Counting on nurses and doctors to suck it up because you know they won’t walk away from their patients is not just bad strategy. It’s bad medicine.


Keith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind NurseKeith.com and the well-known nursing blog, Digital Doorway. Please visit his online platforms and reach out for his support when you need it most.

Keith is the host of The Nurse Keith Show, his solo podcast focused on career advice and inspiration for nurses. From 2012 until its sunset in 2017, Keith co-hosted RNFMRadio, a groundbreaking nursing podcast.

A widely published nurse writer, Keith is the author of Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century and Aspire to be Inspired: Creating a Nursing Career That Matters. He has contributed chapters to a number of books related to the nursing profession. Keith has written for Nurse.com, Nurse.org, MultiBriefs News Service, LPNtoBSNOnline, StaffGarden, AUSMed, American Sentinel University, Black Doctor, Diabetes Lifestyle, the ANA blog, NursingCE.com, American Nurse Today, Working Nurse Magazine, and other online and print publications.

Mr. Carlson brings a plethora of experience as a nurse thought leader, keynote speaker, online nurse personality, social media influencer, podcaster, holistic career coach, writer, and well-known nurse entrepreneur. He lives in Santa Fe, New Mexico with his lovely and talented wife, Mary Rives, and his adorable and remarkably intelligent cat, George.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.