Editor’s note: The health sciences librarians and healthcare professionals we work with are on the front lines responding to the COVID-19 pandemic. We are honored to be able to bring you some of their accounts about what those efforts look like.

Clinical Support: As Losses Mount, US Hospitals Furlough Librarians with Other Hospital Staff

Copyright by and used with permission of the Medical Library Association.

Trow VM. Clinical support: as losses mount, US hospitals furlough librarians with other hospital staff. MLAConnect [Internet]. 2020 May 14.<https://www.mlanet.org/blog/clinical-support-as-losses-mount-us-hospitals-furlough-librarians-with-other-hospital-staff>. (Member log in required). Accessed 2020 May 26.

State of hospitals

In mid-March—as the Centers for Disease Control and Prevention (CDC) issued recommendations to cancel non-emergency, nonessential medical, surgical, and dental procedures during the COVID-19 pandemic—many US hospitals entered a related crisis: one of income and cash flow. From sea to shining sea, large and small hospitals of all types went into a rapid and steep “financial free-fall,” according to one hospital association executive [1]. Cutting lucrative elective surgeries and procedures “is like trying to fly the airplane without first-class seats,” says Robert Field, a Drexel public health law professor [2].

Surging costs to increase COVID-19 patient capacity and purchase overpriced pandemic supplies and equipment sent many hospitals into the red and left them critically short of cash to meet payroll and debt obligations [3, 4]. Within weeks, a cascade of hospital staff reductions swept across the country. Senior hospital management and human resources departments targeted nonessential or nonclinical support staff with a variety of cost-cutting measures, including forced vacation time, furloughs, salary cuts, and even layoffs [5]. Some hospitals have instituted hiring freezes, delayed merit increases, and halted construction projects. Many have imposed cuts across the board, reducing hours of both frontline employees and managers, affecting 10%–20% of all staff. Some hospitals have asked senior staff and physicians to take pay cuts for the duration of the COVID-19 pandemic and possibly beyond [6]. Not all employees have exited voluntarily or even involuntarily. At least one nurses union (New York State Nurses Association) has challenged the furloughs and volunteered instead to transfer to hot spots, which allows them to keep their benefits and collect salaries from hospitals where they assist [7].

Effect on hospital librarians

Not surprisingly, most hospital librarians have fallen into the nonessential or nonclinical support categories. Starting in mid-March, many librarians were told by their managers to furlough support staff, reduce hours, consider using vacation leave, or choose some combination thereof for six weeks to as long as four months. Many hospital librarians now find themselves going solo, working two or three days a week, alternating one week on and one week off, or working onsite, remotely, or both. Fortunately, few respondents who were contacted for this report had gone completely off their institutions’ payrolls. In some cases, the “reduction in force” decision-making process was more transparent than in others, and some librarians were able to negotiate with their supervisors. Librarians who reported to a medical education department or a research unit also seemed to have fared better than those who reported to other administrative divisions.

Many librarians are soldiering on now, continuing to fill DOCLINE requests, paying bills, and managing requests, while waiting to be called back to full staffing and full-time employment. Though many have been forced to cut their workload, all remain committed to service. Doesn’t it seem counterintuitive to cut information support during a pandemic generated by a newly discovered virus about which there still is so much to learn? The irony of cutting library support in the middle of an unprecedented national health emergency surely is not lost on health care professionals and medical library personnel.

Everyone who was contacted for this report has been assured that these new conditions are temporary and that their hospitals hope to “return to normal,” with target dates spanning the summer months. However, it is not surprising that many librarians are worried about what that future “normal” will look like because the precise course of this pandemic remains difficult to predict and continues to challenge the best statistical efforts. Could furloughs now lead to more cuts in the future or even permanent layoffs if the pandemic lingers or resurges? Once the crisis abates, will hospitals struggle to recover in an economy devastated by COVID-19?

Implications for the health care industry

The many inequities and disparities in health care delivery that this crisis has exposed are only amplified in the “unhealthy” business models and profit-seeking strategies that dominate the health care industry today. It has been suggested that one in four rural hospitals was facing bankruptcy before the onset of COVID-19 [8, 9]. This economic catastrophe could strike a permanent blow.

However, the problem is not just one of rural versus urban institutions. According to Boston Consulting Group, even before this crisis, many hospitals were “operating with single-digit margins, a lack of significant reserves, limited debt capacity, and low occupancy” [10]. Health care has changed radically in the last ten years. Hospitals now must rely on revenues from pricey elective procedures to subsidize other areas like intensive care units. Many are encumbered with high debt, and others are completely reliant on Medicare and Medicaid reimbursements to survive [11–13]. Yet hospital executives typically rank among the highest paid in any industry, and health care costs for consumers continue to increase. What is wrong with this picture? Will this crisis force a restructuring of hospital services? And if so, what could such changes mean for those of us who provide support to clinicians, their patients, and the surrounding community?

References

1. Rubin O, Kim SR. In the middle of the coronavirus crisis, some hospitals fear financial ruin. ABC News [Internet]. 30 Mar 2020 [cited 12 May 2020].

2. Rushing E, Laughlin J. Philly-area hospitals furlough employees as coronavirus prep depletes revenue. The Inquirer [Internet]. 7 Apr 2020 [cited 12 May 2020].

3. Harris S, Sondel J, Schneider GS. Cash-starved hospitals and doctor groups cut staff amid pandemic. Washington Post [Internet]. 9 Apr 2020 [cited 12 May 2020].

4. Mulder JT. Syracuse, other regional hospitals furlough 1,665 workers amid coronavirus pandemic. Syracuse.com [Internet]. 15 Apr 2020 [cited 12 May 2020].

5. Paavola A. 221 hospitals furloughing workers in response to COVID-19. Becker’s Hospital CFO Report [Internet]. 7 Apr 2020 [cited 12 May 2020].

6. Gabler E, Montague Z, Ashford G. During a pandemic, an unanticipated problem: out-of-work health workers. N Y Times [Internet]. 15 Apr 2020 [cited 12 May 2020].

7. Roth AN. Coronavirus: nurses at Utica Hospital could face layoffs. Observer-Dispatch [Internet]. 28 Apr 2020 [cited 12 May 2020].

8. Scott D. Hospitals are laying o workers in the middle of the coronavirus pandemic. Vox [Internet]. 8 Apr 2020 [cited 12 May 2020].

9. Mosley D, Debehnke D. 2020 Rural hospital sustainability index. Guidehouse: Insights & Experience [Internet]. 8 Apr 2020 [cited 12 May 2020].

10. Saxena S, Spencer B, Taylor N, Desmond C. Covid-19 is stressing the finances of even the strongest U.S. health systems [Internet]. Boston Consulting Group; Apr 2020 [cited 12 May 2020].

11. Byho M, producer. Why American hospitals are in critical condition [Internet]. Bloomberg News; 24 Apr 2020 [cited 12 May 2020].

12. Kanarek J, Gladstone J. Outlook for US for-profit hospitals changed to negative on coronavirus outbreak [Internet]. Moody’s Investor Service; 20 Mar 2020 [cited 12 May 2020].

13. Shulkin D. CNN Hospitals were struggling before the pandemic: now they face financial disaster. CNN Business Perspective [Internet]. 22 Apr 2020 [cited 12 May 2020].

Submitted by Virginia Marie Trow, Hunter-Rice Health Sciences Library, Samaritan Medical Center, Watertown, NY; edited by Laurie Schwing

Note: The following librarians contributed to this article: Andrea Ball, MultiCare Institute for Research & Innovation, MultiCare Health System, Tacoma, WA; Lindsey Gillespie, Sacramento Regional Medical Library, Dignity Health, Rancho Cordova, CA; Tonia Harris, Health Sciences Library, Spartanburg Regional Healthcare System, Spartanburg, SC; Judith J. Kammerer, AHIP, Owen Medical Library, Saint Agnes Medical Center, Fresno, CA; Deb Knippel, George E. Magnin Medical Library, Marshfield Clinic Health System, Marshfield, WI; Elizabeth Laera, AHIP, McMahon-Sibley Medical Library, Princeton Baptist Medical Center, Birmingham, AL; Halyna Liszczynskyj, Medical Library, St. Elizabeth Medical Center, Utica, NY; Mary Beth McAteer, AHIP, Medical Library, Virginia Mason Medical Center, Seattle, WA; Alexandra Short, AHIP, Library Services, Reading Hospital/Tower Health, Reading, PA; Rosemarie Kazda Taylor, AHIP, Library Services, Wilkes-Barre General Hospital, Wilkes-Barre, PA; Donna Winkelman, Health Sciences Resource Center, Glens Falls Hospital, Glens Falls, NY.