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Employer Resources / Locum Tenens / How NYC Hospitals Budgeted During a Pandemic

As one of the earliest pandemic hot spots in the country, NYC hospitals had to find ways to reduce fixed costs while managing historic levels of demand.

In these unprecedented times for healthcare, one response is surprisingly normal. Hospitals are responding to COVID-19 like any other employer. They've reduced fixed spending levels, and shifted to variable costs wherever possible.

Early estimates warned that hospitals could lose between $8,000 and $40,000 per COVID-19 case on average. Yet even in areas which manage to escape the worst pandemic effects, the costs of PPE and crisis preparation are through the roof.

What's worse, this crisis has caused revenue sources to disappear. And the unpredictable nature of the situation requires funds to be reserved for potential emergencies. COVID-19 has created an extraordinary need for flexibility in hospital budgeting.

For hospitals outside of major health systems struggling with low margins, budgets have been pushed to the brink. One small New York hospital is projecting an unexpected $17 million loss between March and May, offset by only $3.1 million in CARES Act funds.

New York City hospitals were the first to adapt to the new normal, even before federal aid arrived. How did NYC hospitals convert high percentages of fixed spending into variable costs, while preparing for an ongoing surge? 

Relentless Workforce Management Before and During the Storm

An April RAND report identified staffing constraints as a major COVID challenge. Contingency staffing was prescribed as the budgetary and logistical cure.

Forward-thinking NYC hospitals eased their transition to flexible costs even earlier. These health systems converted full-time contract positions to temporary generalist roles as the crisis loomed. This was better than revisiting contracts in the middle of an emergency.

Most NYC employers met with new outsourcing partners before they were hit hard. As they saw their peer institutions begin to strain, they looked for staffing partners who provided fast tools, flexible contracts and extra support during the hiring process.

Even with online systems that speed up onboarding, the decision to hire can take some time. Successful NYC health systems actively and continuously interviewed and sourced generalist doctors from multiple channels to meet unknown needs.

Have Flexible Midlevel Staffing to Deal With the Surge

NYC hospitals with many staff were still caught flat-footed as entire float pools got sick. While flagship NYC hospitals were able to maintain high standards of care during periods of unusual patient volume, all health systems struggled to maintain acceptable nurse-to-patient ratios during the pandemic.

During the initial surge, a singleminded focus on assigning staff to COVID cases can help stretch the pool of available providers. Successful hospitals worked to add additional midlevels, as they could never be prepared enough. 

Locum Tenens Hires Are Still Available for Preparedness

At DirectShifts, we were gratified to see hundreds of locums doctors who were willing to travel into an active outbreak. One of our biggest challenges during the local COVID-19 peak was simply managing the overwhelming volunteer response.

The existing travel pool of locums hospitalists is large enough that needs across the country can still be met. Additionally, changing medical priorities have shifted many specialty doctors into hospitalist roles.

Make Competitive Offers to Specialty Clinicians

Due to the specific characteristics of COVID-19, CRNAs and RRTs are the stars of the hour. Smart healthcare employers across the country are searching for any available CRNAs and RRTs using attractive and specific job offers. 

The demand for RRTs is severe enough that every area in the country is effectively a hot spot for them.

DirectShifts was able to place several CRNAs and RRTs, but only in very desirable roles. These positions will be in exceptionally high demand for years to come.

Telehealth Expansion Doesn't Require Local Clinicians

The pandemic has brought on the long-predicted acceleration of telemedicine. Even in the middle of COVID-19, health systems launched new telehealth portals. Federal funds and rule-cutting supported the demand for in-home services. 

Of course, clinicians with the appropriate state license (especially for larger states) can be found anywhere in the country. Cast your net far and wide to bring on qualified staff.

We think that a clinician job board is the best way to build your telehealth practice. You'll know the practitioners are 1099 employees and tech-savvy, too.


To financially weather the pandemic, healthcare employers came to DirectShifts for help writing and executing flexible staffing contracts. Sign up here or email to learn more.

Post by DirectShifts Team
July 9, 2020


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