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As Hospitals Lose Revenue, More Than A Million Health Care Workers Lose Jobs


Here's something counterintuitive. Millions of people are being laid off - we know this. You would think that the one group that would be safe from layoffs are health care workers, but that's not the case. Across the country, many people who work in hospitals are having their hours cut or they're losing their jobs altogether. What is going on?

NPR's Leila Fadel and reporter Will Stone in Seattle have been looking into it. Hi, you guys.



KING: Will, let me start with you. With everything that is going on right now, why would hospitals be cutting people's hours and laying them off?

STONE: The pandemic has totally disrupted the business of health care, from big private hospitals to small community ones. You have most in-person doctor's visits canceled and many non-urgent so-called elective procedures were stopped. Add in the fact that fewer patients overall are coming into emergency rooms and you have a situation where hospitals have fewer patients and are losing some of their biggest sources of revenue. In fact, consumer health care spending fell 18% in the first three months of the year.

KING: And the knock-on effect of that is that people who work in hospitals are losing their jobs.

STONE: That's right. Many are losing work - some permanently, others temporarily. I spoke to Shawn Reed (ph) who's an ER nurse on the east side of Washington state. Her hospital has scaled back ER staffing to the bare minimum, and they're asking nurses like her to take furloughs.

SHAWN REED: Basically, if our volumes don't pick up, then we have to really look at how we're staffed. We're trying to avoid layoffs and we're trying to keep people working. And so when I look at, like, a nurse that we've only had for, you know, maybe a year or two who's pregnant with her third child and I know that she's going to need hours now, I'm willing to fall on that sword to make sure that she can get hours.

STONE: When we spoke, Reed had lost four out of her six shifts that week, and she says she just can't afford to do that long-term, even though she understands why it's happening. Another nurse in the Seattle area told me he's now driving four hours away to pick up extra shifts because the hospital where he usually works, a place that was busy with coronavirus, is now cutting their hours.

KING: Absolutely extraordinary. And Leila, I know that you talked to a nurse at a hospital that laid off more than 300 people last week. That's an astonishing number.

FADEL: Yeah, that was at Palomar Health in north San Diego County. And basically, when you lose hundreds of people, the workload doesn't significantly change. So that work then lands on those that are still there, people like Sue Phillips (ph), a critical care trauma and rapid response nurse. At her hospital, the orthopedic technicians were laid off, so they aren't there to set up traction on a hospital bed. That's a pulley system that slowly lifts and moves the broken body part.

SUE PHILLIPS: The operating room staff was bare-bones staffed, so there wasn't enough people to assist the physician. So that patient's care, to me, was delayed - and expecting us to set up a traction on a bed when we had never done that before.

FADEL: She says she was really worried that she'd make a mistake. So it's just added stress when it's already such a stressful time for health care workers. Phillips has also given up on seeing her grandkids and is isolating herself from her husband at home so she doesn't get them sick because she's working with COVID-19 patients every day.

KING: A lot of anxiety. Will, I remember when this pandemic started just a couple months ago and the anxiety then was that hospitals just would not have enough doctors and nurses. Is that still a concern, or has that completely changed?

STONE: Actually, in many places, that narrative has flipped. Some have said, hey, we were on the front lines, sometimes in risky situations without enough masks or protective gear and now we're worried about our jobs and paying our rent. The U.S. shed more than 40,000 health care jobs in March. Rozetta Ludwigsen (ph) is a nurse who works at a small hospital north of Seattle. She's gone from working a 40-hour week to only a few days a month. She's in her mid-60s, and actually, before this pandemic hit, she was hoping to retire in the coming year.

ROZETTA LUDWIGSEN: I don't know if that's going to happen at all. I don't know if I'm going to have to stay another year. That's not something I wanted to do. You know, the longer I work the more I fear that I'm going to end up with something and I'm not going to enjoy my retirement. So (laughter)...

STONE: She finds it ironic that not too long ago there were calls for nurses and doctors to come out of retirement. Now she's not sure she'll be able to retire as soon as she'd like.

KING: So we have two groups of people here. We have people dealing with the trauma of being laid off, and we have people who are still working. Leila, for the people who are still working, what does this mean for them?

FADEL: Well, basically less staffing means nurses in ERs, ICUs, they're taking on all kinds of extra tasks to make up for those layoffs or furloughs. In one Detroit area hospital, I spoke to Fatima Hashem (ph). She's an ER nurse. She works with COVID-19 patients every day. So she's helping treat them. She's FaceTiming their families. She's being their support system. And now, because some of the cleaning and maintenance people have been laid off...

FATIMA HASHEM: We are going in and cleaning these rooms up, you know, getting them ready for the next patient.

FADEL: So that means she's changing sheets, sweeping, taking out trash. And Hashem says the people who worked as patient advocates or in guest relations are also mostly gone, so she's arranging rides for patients through insurance, bringing people coffee and warm blankets. One nurse I spoke to in California, Amy Erb (ph), describes her and other nurses' jobs in the midst of layoffs and reduced hours like this.

AMY ERB: Kind of jack of all trades at this point. You know, we're being nurses; we're being environmental services; we're phlebotomists drawing labs; we're being, you know, social workers; we're being psychologists. We're taking all of this on. And you know, we do that to some extent every day, but it's been very much exacerbated by this crisis.

KING: You know, Leila, we've seen so much support for health care workers - people calling them heroes, people sending them food and, when they can, equipment. When you talk to these folks, are they telling you that that's helpful?

FADEL: Well, I mean, people - they love the support of handmade signs, the food deliveries, the applause. But they're also really frustrated. This is a terrifying time for health care workers. One nurse I spoke to in the Detroit area says she spent the first month of this pandemic crying every night because she was scared because of the shortage of protective gear. But she was also grieving because she's working with patients who are really sick or dying alone because of COVID-19. And now she's worried about her job. So they want more. They want protective gear and job security.

KING: So if we pull back here, Will, I guess the big question is - is there any fix?

STONE: Things are already changing in some places as hospitals ease into elective procedures again. That will bring in money and get some people back to work. Congress has also come up with some funding, but industry groups say that's still not enough. Even in New York City, where the hospitals were swamped, the situation is calming down. And one head ER doctor there says some hospitals are now looking at their finances and wondering if they can stay afloat.

KING: Sounds like a long way to go. Reporter Will Stone in Seattle and NPR's Leila Fadel in Los Angeles. Thank you both. We appreciate your reporting.

FADEL: Thank you.

STONE: Thank you.

(SOUNDBITE OF PENSEES' "LUNAMOTH") Transcript provided by NPR, Copyright NPR.

Leila Fadel is a national correspondent for NPR based in Los Angeles, covering issues of culture, diversity, and race.
Meg Anderson is an editor on NPR's Investigations team, where she shapes the team's groundbreaking work for radio, digital and social platforms. She served as a producer on the Peabody Award-winning series Lost Mothers, which investigated the high rate of maternal mortality in the United States. She also does her own original reporting for the team, including the series Heat and Health in American Cities, which won multiple awards, and the story of a COVID-19 outbreak in a Black community and the systemic factors at play. She also completed a fellowship as a local reporter for WAMU, the public radio station for Washington, D.C. Before joining the Investigations team, she worked on NPR's politics desk, education desk and on Morning Edition. Her roots are in the Midwest, where she graduated with a Master's degree from Northwestern University's Medill School of Journalism.
Robert Benincasa is a computer-assisted reporting producer in NPR's Investigations Unit.