Solution 4: Further increase funding to bolster the nursing pipeline

U.S. nursing schools turned away 80,407 qualified applicants in 2019 due to a lack of faculty, education space, and resources.9 Simultaneously, the median age of registered nurse faculty is 52 years, suggesting a wave of near-term retirements that will further diminish capacity to train new nurses.10 Increased funding is necessary to ensure each class includes the maximal number of qualified applicants. 

On October 3, 2022, the Department of Labor announced $80 million in funding to expand the nursing pipeline through the Nursing Expansion Grant Program. This included multiple pathways: the nurse education professional track to increase the number of clinical and vocational nursing instructors; the nursing career pathway track to train frontline health care professionals; and special grants to support accelerated learning and expanded access to clinical residencies and specialty care rotations.11 While these are steps in the right direction, the U.S. Bureau of Labor Statistics projects that more than 275,000 additional nurses are needed from 2020 to 2030.¹² That $80 million is less than $300 per needed nurse. More funding is needed.

Solution 5: Fund emergency physicians to manage population health, thereby reducing ED volume through innovative care delivery and payment models

If there’s one thing we’ve learned from the pandemic, novel technologies can improve our ability to manage patients remotely. Telemedicine is already being used to change how low-acuity patients are cared for, with off-site physicians diverting patients to the right setting. But these programs are primarily local. It’s time to create payment models to expand them. Expanding these models would allow ED physicians to embrace our role as “available-ists.” It would also enhance our ability to impact population health and reduce total cost of care. Additionally, pre-ED telehealth, post-ED telehealth, and other programs that address frequent use are effective ways for ED physicians to improve patient safety, increase efficiency, and unload hospitals of patient care that may be better delivered in other settings.

One innovative way to do this would be by changing the way that ED physicians get paid, moving to capitated payment models or global budgets that EDs could opt into. Traditional fee-for-service makes telehealth and frequent-user programs more challenging to fund. Global budget pilots would need to keep ED physicians whole and provide additional resources for real population health activity led by ED physicians. Global budgets may be the long-term solution to bridge the funding gap for emergency medicine’s participation in population health.