On March 2, the House Energy and Commerce Subcommittee on Oversight and Investigations held a hearing titled, “Lessons from the Frontline: COVID-19’s Impact on American Health Care.” The hearing provided frontline workers with the opportunity to both share and reflect on their experiences caring for patients during the pandemic, as well as provide recommendations as to how the nation can prepare to face future public health emergencies.
In his opening statement, committee Chair Frank Pallone (D-N.J.) discussed the inordinate strain that the COVID-19 pandemic, and the highly virulent omicron variant, has placed on the nation’s health care system. Pallone reflected upon how the COVID-19 surges have overwhelmed health systems, resulting in “overload, burnout, and increased anxiety or depression” among health care workers, as well as delayed and foregone care for patients.
Pallone also highlighted the efforts of Congress and the Biden administration to address these challenges through billions of dollars in funding through the American Rescue Plan and CARES Act. He concluded by noting key provisions of the Build Back Better Act (H.R. 5376) that will expand and enhance the nation’s health care workforce. AAMC President and CEO David J. Skorton, MD, and Chief Public Policy Officer Karen Fisher, JD, previously issued a statement commending the Build Back Better Act’s proposed investments in graduate medical education, including the creation of 4,000 new Medicare-supported GME positions and the establishment of the Pathways to Practice Training Program, which would strengthen and diversify the nation’s mental health workforce.
Echoing Pallone’s comments, subcommittee Chair Diana DeGette (D-Colo.) discussed the immense impact of the COVID-19 pandemic and related mental health challenges on the nation’s health care workforce capacity. DeGette discussed how “workforce strains and capacity challenges further compound historical inequities and health disparities,” calling on Congress and the Biden administration to invest in health care workforce and system support. She concluded, “As a nation, we’ve relied on health care workers to bear a significant burden these last two years ... We owe a debt of gratitude for their leadership and sacrifices.”
Subcommittee Ranking Member Morgan Griffith (R-Va.) reflected on the need to collect lessons learned from the COVID-19 pandemic to enhance future emergency preparedness. Griffith highlighted the opportunity that the pandemic gave providers to pursue “creative solutions” in health care, such as telehealth flexibilities, at-home patient monitoring, and expanded scope of practice for pharmacists to administer COVID-19 vaccines.
The subcommittee heard from Megan Ranney, MD, MPH, an emergency physician and professor of Emergency Medicine at Rhode Island Hospital and the academic dean of the School of Public Health at Brown University. In her testimony, Ranney warned against the premature declaration of the pandemic’s conclusion and instead encouraged the subcommittee to view this moment as “a respite and a moment to address the many problems that got us here in the first place.”
Responding to questions about the role of vaccine mandates for health care providers, Ranney juxtaposed her own hospital’s experiences with staffing shortages against national statistics, which report that nearly one in five health care workers have quit since the onset of the pandemic. Ranney ascribed this high rate of attrition to “moral injury” resulting from health care providers’ inability to adequately care for their patients, emotional distress, workplace violence, retirement, and finally, a tendency for support staff to gravitate towards highly paid “travelers’ positions.” To address these challenges, Ranney made several recommendations such as expanded access to behavioral health support for health care workers. Ranney voiced her support for the recently passed Lorna Breen Health Care Provider Protection Act (H.R. 1667), which was endorsed by the AAMC [refer to Washington Highlights, March 12, 2021] and additionally highlighted the need for enhanced employment protections for providers who seek out care.
The subcommittee also heard from Tawanda Austin, MSN, RN, chief nursing officer at Emory University Hospital Midtown. Austin reflected upon her own experience working as a nurse at the frontline of the COVID-19 pandemic. Austin noted the “additional strain” that the pandemic has imposed on nurses, such as “personal protective equipment that is cumbersome to put on and take off,” the mental stress of watching one’s patients deteriorate, and verbal attacks from patients for implementing COVID-19 safety protocols.
Austin called on Congress to increase the health care workforce by “fund[ing] pathways for more young people to enter the medical and nursing fields.” In addition, Austin shared Ranney’s concerns about the impact of travelers’ positions on the larger health care system, asking Congress to “rein in the predatory practices of these [travel-nursing] agencies so that America’s hospitals remain financially viable.” In late January, nearly 200 members of the House of Representatives, led by Reps. Peter Welch (D-Vt.) and Griffith, sent a letter to White House COVID-19 Response Coordinator Jeffrey Zients requesting action to investigate the potentially anti-competitive activity of some nurse staffing agencies [refer to Washington Highlights, Jan. 28].
The subcommittee heard from Laura Riley, MD, obstetrician and gynecologist-in-chief at New York-Presbyterian/Weill Cornell Medical Center and chair of the Department of Obstetrics and Gynecology at Weill Cornell Medicine. In her testimony, Riley noted the depleting impact the pandemic has had on the physician workforce, particularly among those who identify as women and people of color, who “bear a disproportionate amount of childcare burdens.” Speaking from her own experience as an obstetrician-gynecologist, Riley observed that under team-based care delivery models, “when staffing levels drop and members of the team are missing, that can have a negative impact on patient care.” To address these challenges, Riley recommended “greater investment in and training of health care professionals and efforts to diversify our health care workforce,” as well as extended telehealth flexibilities.
Riley concluded by reflecting on the exclusion of pregnant and lactating individuals from COVID-19 vaccine and therapeutic trials and how this decision “fueled the proliferation of misinformation on the safety of vaccines in pregnancy.” To address this issue, Riley recommended that federal agencies prioritize the inclusion of pregnant and lactating individuals in future clinical trials.