The concept of "rural" and "isolated" means very different things depending on where in the country you are, so I'll preface my answer saying that I staff a rural hospital but in the population-dense region of the
Census-designated northeast.
I just want to be clear that my version of "rural" can't compete with Nebraska's version of "rural".
But I mention this because I've integrated myself "into" the hospital more than is normally possible, and there are significantly fewer variables to consider, because of the small/rural size. Basically, I control a lot more and have access to a lot more information than I would otherwise.
Yes, we have absolutely been struggling for the past few months. We would estimate starting in December 2022 is when we really noticed the uptick.
It's not the Radiologists, as others have said, though their workloads are higher than years past.
1) Equipment. This is more specific to my hospital but I know I'm not alone. For a certain type of diagnostic scan, there wasn't an investment made in the machines, so the equipment availability is a constraint.
2) The Boomers, aka "Silver Tsunami". The next decade is the final, huge push of the increase in the 65+ crowd. Unfortunately, it's a "one two punch". I've noticed a huge amount of Boomer staff retiring (which has been a trend for years, of course). So you have senior staff, with a ton of institutional knowledge (even if they're "bad" at their job) leaving, not being replaced, and then becoming patients themselves. In terms of cancer incidence alone, I've seen projected increases of 9-12% over the next 5 years.
3) Along the "retiring" line - staffing. The pandemic drove people out of their existing jobs in healthcare. Some people left entirely. But - and this is what we saw a lot in RadOnc - people realized the abuse they were taking. LOOKING AT YOU, CERTAIN WELL-KNOWN ACADEMIC INSTITUTIONS. On the doctor side, we've seen a lot of job hopping. But on the allied health/support staff side, you saw not only job hopping but also the rise of travel agencies. There's just so much human psychology to unpack here, but basically, there are huge staffing issues and workflow disruptions.
4) Pent-up pandemic demand. As the masking mandates end, the PHE declared over, people who were putting things off are finally coming in. It's not the disaster influx we worried about, but it's putting more stress on the system.
5) Economics. We've had to spend a ton on travel agencies. We've "lost" a lot of money on investments. We've also lost a lot on the operational side. You could get a PhD in healthcare economics of course, and what's going on, but the take home is the vast majority of hospitals posted losses. This is making them fearful and/or unable to invest in solutions to help what we're seeing.
For months now, this has consumed my personal and professional life. Given the size, scope, and nature of the "causes" of these observed "effects" - it's going to get worse before it gets better. At my hospital, we have energetic admin/leadership that actually understand the issues and have more strategic vision than most. Even here, even trying to actively address these issues with unusually smart people - it will likely take us another 2 or 3 years to "fix" this.
In summary: you're not alone. Buckle up.
