Five trends for health systems in 2023

Ronald Grifka, MD
_{University of Michigan Health-West}

The old adage that health care is recession-proof will face a major challenge in 2023. Existing forces, including the exodus of talent from the health care profession and patients with advanced-stage disease returning to the clinic for the first time in several years, will only continue into the new year against a potentially bleak economic backdrop.

Expect larger trends shaping the future of work to permeate the health care industry next year. Global business leaders are anticipating an influx of jobs that simply haven’t existed before, a result of the anticipated need to integrate emerging technologies alongside tasks traditionally reserved for humans; consider the need for an IT department 40 years ago compared to now, as personal computers dominate office cubicles. Therein lies the need for health care organizations to recruit smart, adaptable students into the profession to meet tomorrow’s needs.

Adaptability and flexibility underscore nearly every major trend facing the health care industry in 2023.

Staffing challenges

According to one recent poll of health care organization employees, staffing was the top challenge for 58% of respondents, even ahead of expenses and revenues. Around the country, human resources departments are working overtime to retain the staff that remained through the two-year COVID-19 pandemic period in which 20% of health care employees reportedly left the workforce, including 30% of nurses. Health care isn’t alone facing staff shortages, but the 24/7/365 need for medical care only allows for so much flexibility. Losing workers to competing jobs with the ability to work remotely for higher pay presents health care employers with a real quandary.

Emphasizing flexibility wherever possible is not a catch-all solution, though it will be critical to minimizing the outflow of workers. Many health care jobs can be tailored for remote work, along with avoiding night and weekend shifts week after week. Allowing employees to work from home reduces their gasoline expenses, saves them time spent in traffic, and in some cases might allow them to save on childcare. The more flexible an organization can be in providing remote work, the greater their success.

New competition

During the Great Depression and World War II, a new form of health care delivery arose out of the need to provide for the uninsured shipyard, dam and aqueduct workers in the western United States. This legacy company, Kaiser Permanente, (KP), now serves more than 12 million members in eight states, making it the largest managed care organization in the U.S.

Future entrants into the health care industry are not assured the same degree of success as KP, as the new, large investments in health care by Amazon, Walmart, and CVS cannot be ignored. Each of these companies has the revenue streams to support their health care initiatives. Their for-profit financial models do not support the additional imperatives of medical teaching and research, without which the field of medicine cannot improve. Yet university and academic medical centers, which have supported medicine for decades, might be competing against these financial juggernauts for patients – and workers. The potential for industry disruption is high.

Delayed screenings

During the COVID-19 pandemic, seemingly healthy patients were more likely to skip routine screening exams because they did not feel comfortable entering clinical settings, or they were explicitly discouraged from coming in for check-ups. Mammograms, colonoscopies, and prostate screenings (just to name a few) were not performed. Now, as patients return for check-ups, the consequences of these missed exams are being noted. We are diagnosing increasing numbers of advanced-stage cancers, heart disease, diabetes, and other diseases that would have been more successfully treated had they been detected sooner.

Around the world, these consequences will be widespread. The number of severely ill patients will rise. CT scans, MRI studies, biopsies and other advanced-care measures will be needed with greater frequency. More aggressive medical and surgical therapies will be needed – and at a higher cost. Health care facilities will face increased strain, specialty drug prescriptions will escalate, and ensuring fair access to these limited resources will take center stage.

New technology

Fortunately, the news isn’t all bad. With new technologies comes the promise of better treatment options for many patients. MRI and CT technologies, for example, now offer faster speeds and higher image resolutions than previous equipment. Also, the imaging equipment is more widely available than ever before. When a health care facility purchases a new MRI or CT machine, it need not replace the older machine, whose image resolution might be suitable for diagnosing less complicated health issues. The newer machines can be used for more complex diagnoses, and this additional imaging equipment can help expedite evaluating more patients.

Most innovations are more expensive than their predecessors. Against the backdrop of the critical labor shortage, legacy health care institutions can help offset declines in their labor force by investing in new technologies.

Focus on the next generation

Practicing medicine is an incredibly rewarding and gratifying profession. To develop the next generation of the highest quality physicians, nurses, technicians, and other medical staff, the profession needs to put its best foot forward to recruit the most brilliant minds in 2023 and beyond, knowing the competition from other sectors will only make it more challenging.

This task is easier said than done. With the current generation, emphasizing workplace flexibility will be key. Medical students, wondering whether working 12-hour days are right for them, want to be assured that they will not be sentenced to a lifetime of grueling shifts. While the shifts might be longer and more demanding for younger workers as they develop experience, health care institutions can offer better work-life balance as the staff advances in their careers. The ideal path might provide flexibility such that early-career physicians and nurses perform surgery and other procedures that require being on-call nights and weekends – then, as they advance in career, transition to hospital shifts or clinic work, where the urgent on-call requirements are less common.

Ronald Grifka, MD, is the chief medical officer and chief clinical quality officer for University of Michigan Health-West, where he oversees and provides leadership and medical education to more than 500 physicians. He is a fellow of the American Academy of Pediatrics, the American College of Cardiology, and the Society of Cardiac Angiography and Intervention.