October 5, 2020

3 predictions for the future of work in health care

It’s been over six months since the COVID-19 pandemic first entered broad public awareness in the US.  In the ensuing time, conversations about systemic racism have rightly entered the mainstream (and I hope we can remember that for those whose awareness of this issue is new, or newly heightened, privilege is the reason).  Our society is also more divided politically and economically than at any time since the Civil War era, and unrest is simmering.  Everything is changing, and all our assumptions about our society are on the table.

During this time, I have been able to continue working as a coach (and to work from home, where I am relatively safe), and to recognize that many have not had the same privilege.  I have also been privileged and humbled to be a witness to the true crises many of my clients are facing.  Through this time, I have often wondered if I would have the strength and courage they have had (short answer, I don’t think I would).  While I won’t share specific or identifiable features of client stories here, I want to describe some of the common and recurrent themes I have noticed from the coach’s chair. These themes have led me to three predictions about the future of work and the choices I believe people will make. Since I coach primarily in health care, my predictions are specifically targeted to this industry.

Theme #1:  People like and want to maintain the new level of time they have been able to spend with family at home.  This crosses gender, racial and other boundaries.

While many of us feel socially isolated and are spending less time with friends, we are getting to spend more time among those we live with — for better or worse.  This may mean we feel stifled at times and in need of space to ourselves, but it also means we are enjoying rituals like eating more meals together at home (Learn about the scientific and sociologic benefits, and check out the Family Dinner Project to get in on this trend).  What I’m learning from my clients is that they are grateful for this time at home with those they love, and it’s one of the few silver linings they see in this year.  They are loathe to give it up.

My prediction:  People will be less likely to tolerate work schedules that interfere with family time.  Once the workplace stabilizes a bit, people will remain less willing to tolerate 3-4 evening meetings per week, or routine early-morning meetings.  Workplaces that assume folks will have meetings before or after reasonable hours so that revenue and productivity in the normal workday do not suffer — common in health care — will have to adjust.  It may take some time.  After all, many professionals are worried about keeping their jobs at the moment, let alone improving them.  But the shift will come.

Theme #2:  People recognize that the measures and metrics for productivity against which they are judged against are not sustainable for them as human beings. They also recognize that their organizations have not caught up with their understanding of this.

Many health care employers are struggling to recoup lost revenue from the spring, when COVID-19 led them to put patient care on hold.  It did not take long before employers began telling employees and professional staff that they would have to work harder and longer than ever once the doors reopened in order to make up for the lost revenue.  And these employees and staff learned that, even if they worked harder and longer, they were still likely to see pay cuts.  The result is significant demoralization among the health care workforce, and this experience has undermined trust in the systems and organizations of medicine.

My prediction:  Health care professionals and employees will begin pushing back against assumptions that the profit models in health care are still valid, and there will be a significant erosion of the goodwill and the moral assumptions health care systems depend on from their staff in order to sustain these profit models.  Clinicians in particular will be less likely to buy into the systems that depend upon moral injury and a loyalty to their duty to care.   They will still believe in that duty, but will be less likely to deploy it in the service of existing business assumptions. I suspect it will take a few years, but everyone will need to come to terms with the idea that the business model will have to change.

Theme #3:  People are questioning the assumptions and agreements they have made about work and their careers. This is leading to a rising tide of discussion about changing jobs, roles, employers or even careers.

I have witnessed at least two previous eras of health care professionals threatening to leave the profession en masse.  One of these occurred in the late 1980s and early 1990s as the health care reimbursement system transitioned to incorporate the relative value unit (RVU) into business models.  The second was in the late 2000s and early 2010s as the Affordable Care Act came into existence and reimbursement models again shifted, this time toward value-based care.

This time is different.  It’s not reimbursement that is driving health care professionals to consider leaving.  Already feeling the relentless focus on productivity, uncompensated administrative work and burnout, health care workers were deemed “essential workers” and thrown into a crisis.  All the while, they had to manage all the demands the rest of us face (homeschooling children, protecting older family members, safeguarding their own health, getting groceries in a pandemic.)  Add in being told to work harder for less?  In some cases without even the most basic safety equipment needed?

It’s simply too much.  Far too much.  And so it’s no surprise that my clients have been saying, “I used to think it was bad, but now, it’s impossible.”  They are considering finding a different balance of clinical vs. administrative … finding a new employer … even leaving medicine entirely.  And they are doing so in higher numbers than I have ever seen in three decades of work in the field.  They know they will have to figure out how to exit their current situations, and that it’s not quite stable enough for them to do so now, but it is coming.

My prediction:  In the next 12-24 months, we will see a shift of health care professionals into different working arrangements, or out of their profession completely, at a level we have never seen.  The transition is coming.  Frustration has given way to determination, and to a level of strategic planning and thinking that I have never seen in my years as a coach.  Health care professionals are ready to make a plan and implement it wisely, to the benefit of themselves and those they love.  Health care workforce planners will need to take this trend into account, or they may very well find themselves without the people and clinical expertise to deliver on their business goals.

Another silver lining

It would be easy to believe after reading this that I am a pessimist.  But these transitions actually give me hope.  As this opinion piece in the New York Times last year notes, the US health care business model depends upon the willingness of its workers to accept, believe in and contribute to the overall production model that undergirds the industry.

The piling-on of crises this year (on the backs of already weary professionals) is leading many in health care to see that they may in fact have a choice.  They can choose family.  They can choose personal time.  And they may choose a new professional calling in some instances.  It will not be easy, but it is possible.  But I believe they will also with this questioning bring about healthy change – in the business model, and in the human experience of being a professional in the health care system.

My clients are leading the way.  I bow in deep gratitude to them for what they are doing.

Your predictions

What are your thoughts on where the experience of the pandemic will take the health care professions?  Drop a comment below or feel free to share your thoughts on social media.

Last updated October 6, 2020

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