BUSINESS

The Great Resignation

One-third of nurses plan to leave their jobs by the end of the year, citing burnout and compensation as the main reasons (link).

The Deets
Staffing firm Incredible Health analyzed hiring data of over 400,000 nurses and surveyed nurses more than 2,500 nurses to see how nurses are faring in year two of the pandemic.

• Incentives. On average, hospitals increased signing bonuses by 162% over the past year, instead of increasing salaries. Texas hospitals, for example, doubled their signing bonuses on average from $5,800 to $10,700 in 2021.
• Travel Nurses. Seventy-seven percent of hospital-employed nurses reported seeing an increase in the number of travel nurses, and one-third reported subsequent culture changes on the floors. Eighty-six percent of hospital-employed nurses cited compensation differences as the leading cause of dissatisfaction with travel nurses.
• The Exodus. One-third of nurses said it’s very likely they quit their role by the end of 2022 because of burnout and poor compensation. Here’s where nurses plan on going after they leave:

My Thoughts
Nationwide labor shortages of nurses have forced hospitals to either address the root cause of the labor shortage problem (burnout, compensation) or cover it with a bandaid (contract with travel nurse agencies). Many hospitals have chosen the latter option, which has jacked up labor costs compared to pre-pandemic numbers (link). While offering higher signing bonuses seems nice, I think it’s just an empty gesture when considering the value nurses bring to patients.

Joining a travel nursing agency, though, is quite attractive. These companies may pay 2x-4x the salary nurses are making as hospital employees and allow nurses to choose when they want to work (link). As I go from OR to OR on my surgery clerkship, I chat with the scrub techs and nurses, most of whom are part of travel staffing agencies. While anecdotal, these travel techs and nurses love their roles much more than those they had before (hospital-employed) because of the increased compensation and schedule flexibility. So it’s no surprise to me that a quarter of the nurses who plan on leaving their roles want to work for a travel agency.

While contracting with travel nursing agencies is a quick (but expensive) fix for the nursing shortages hospitals face, I worry about patient care and efficiencies. With hospital-employed nurses, it’s easier to build a patient-centered culture since nurses are constantly working together and are familiar with the standard of care at the hospital, compared to nurses cycling in and out of the hospital. From an operational standpoint, the influx and efflux of nurses take a toll on efficiencies. In the OR, for example, travel nurses/techs are more unfamiliar with the OR flow and what different surgeons like for various procedures, two operational components that, when done right, can significantly streamline OR time and turnover.

👋 If you’re a nurse, tell me about your experience as a hospital-employed nurse or travel nurse by emailing me here. 

HEALTH TECH

Still Trending: Telemental Health

Telemental health isn’t going anywhere (link). While telehealth visits outside of mental healthcare trend towards pre-pandemic levels, telemental health visits are holding steady.

The Deets

At the peak of the pandemic, mental health and substance use disorder visits made up 40% of all telehealth visits, while other visits made up around 10%. As Covid-19 prevention improved with vaccines and masks, patients returned to in-person visits. But, telemental health use continues to remain strong.

The spike in telemental health use hints at the high demand for mental health services. During the pandemic, three out of 10 U.S. adults reported depression or anxiety symptoms, compared to one out 10 U.S. adults pre-pandemic (link). Telemental health allows patients to more easily access mental health providers and do so from the comfort of their homes.

The government has also made it easier for providers to hop on board the telemental health train (link). Medicare’s final physician fee schedule for 2022 permanently removed previous geographic restrictions for telemental health services, allowing patients to receive care from their home vs. going to another healthcare facility as was done before. Additionally, nearly all states expanded telehealth coverage for their Medicaid programs.

Big Picture

Digital mental health funding skyrocketed last year, making up $5.1B of healthcare’s $29.1B venture funding (link). Just 5 years ago, only $0.5B was invested into mental health. Who are the telemental health companies receiving the most funding (link)?

• Ginger (recently merged with Headspace)
• Lyra Health
• Ro

My Thoughts
The telemental health trend is strong, and it’s now or never to hop on board. If you’re a mental health provider, subscribe to a telehealth platform; if you’re a patient, find a telemental health therapist; if you’re an investor, invest in a telehealth startup. 

BUSINESS

The First BRCA-Targeting Breast Cancer Drug

The FDA approved the first and only breast cancer drug Lynparza, which targets BRCA mutations (link). The drug, made by AstraZeneca and Merck, may reshape the role of BRCA testing in patients with breast cancer.

The Deets
The FDA green-lighted Lynparza after clinical trial results showed a 42% reduction in the risk of invasive breast cancer recurrence, secondary cancer or death in patients on Lynparza vs. placebo at around 2.5 years follow up (link). The most recent results show a 32% reduction in death vs. placebo—quite promising. Lynparza is a PARP inhibitor and works by damaging the DNA strands in tumor cells, causing cell death.

The drug is approved as an add-on treatment for patients with BRCA-mutated HER2-negative high-risk early breast cancer who have already been treated with chemotherapy either before or after surgery. No other breast cancer drug on the market targets BRCA mutations, making Lynparza’s approval a potential game-changer for treatment and genetic testing.

While many women with breast cancer have wanted genetic testing, they seldom have received it. Knowing whether you were BRCA-positive or negative wouldn’t change the treatment plan since there were no drugs targeting the mutated gene until now (link).

The Future is Precision
The future of cancer therapy is precision medicine, where physicians treat their patients with drugs that specifically target proteins on cancer cells or DNA mutations found through genetic testing (link). Generally, go-to treatment for many cancers has been surgical removal of the cancer and chemotherapy/radiation. Chemotherapy drugs are non-specific and wreak havoc on all of your cells, not just cancer cells, hence why precision medicine is the future. Lucky for us, the future is already here—there are several precision-type drugs on the market to treat breast cancer, in addition to Lynparza:

• Merck’s Keytruda, for triple-negative breast cancer.
• Eli Lilly’s Verzanio, for HR-positive, HER2-negative breast cancer.
• Roche’s Tecentriq, for triple-negative breast cancer.
• And may more… (link).

OUTSIDE THE HUDDLE

• The American Medical Association is launching “In Full Health”, an initiative to promote equity among industry-driven innovation.
• CVS Health filed a trademark for their virtual offerings, making them the latest company attempting to mark their territory in the metaverse.
• The NIH is now conducting a clinical trial of mRNA vaccines for HIV. Fauci says the success of the Covid-19 mRNA vaccines paved the way for new applications like this.
• Humira, AbbVie’s well know anti-inflammatory drug, is reaching the end of its run. But it was a good run. A $200B run to be exact.
• Pfizer requested an emergency use authorization for a second booster for those 65 and up. Shortly thereafter, Moderna one-upped them by asking for approval of a second booster for all adults.
• Texas legislators want to stop companies like Citigroup from covering travel expenses for employees who go to other states for abortions.