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soft infrastructure bills the delegates and the u.s. virgin islands democrat stacy and republican congressman. watch c-span's "washington journal" live at seven eastern tuesday morning. be sure to join the discussion with your phone calls, facebook comments, facebook messages and tweets. >> doctor brian miller assistant professor of medicine at johns hopkins university school of medicine as an intern us in joining us this morning in particular to focus on the looming doctor shortage in the u.s. and the burnout that is been caused by doctors, nurses and other health professionals on the covid 19 pandemic. bryant miller what welcome to "washington journal" but. >> thank you for having me. >> the pandemic was declared in march of 2020 by the pandemic obviously continues in searches with the delta variant. first of all defined for us the term burn out means, at least to you and how much are

we seeing of it in the united states? >> i think burnout is the loss of personalization or loss of connection to your work and the loss of the sense of meaning. i think most studies show one half to one third of physicians are having burnout even before the pandemic. >> how is that expressed? are they considering moving to another career? >> that's a good question. it means people are disconnected from the day per the thinkingsi about leaving the profession. they're thinking about changing to an administrative role. really, burnout came before the pandemic. as i said it's a long-standing issue exacerbated by the pandemic. what happens is you're going through your day, you're trying to be there, be empathetic be sympathetic, you're engaging in a bunch of administrative tasks.

most of the time is not seeing patients. the fewew minutes when you do spend time with patients you are not there to fully support them. >> this is supposed to be an issuance not just a demand on time and the number of hours you have to put in at a hospital, a clinic, or the patient's anywhere but the emotional effects of the pandemic. >> absolutely. i can say my colleagues and i have seen hundreds of peoplere die, each of us over the past almost two years now. it takes a toll on you. you can think about it, if you work two weeks a month and a hospital withho an 84 hour work week and send that you are working four weeks a a month you do not have time to decompress pretty do not have time to recharge. you don't have time to reconnect with yourself, your friends, your family, your colleagues let alone your patients. >> let's look at the potential shortage in the medical field. especially among doctors.

and the report by the american medical colleges according to new data they say the united n states could see an estimated shortage between 37800. [inaudible] including shortfalls in both primary and specialty care, is that driven by what we are seeing in this pandemic? is that because of that or has that been the pipeline to begin with? >> i think that has been in the pipeline pretty think it's worse and because of the pandemic partially because of how we use physicians but we don't use them as clinicians we use them as administrative machines. so the consequent you go through four years of medical school, three -- ten years of postgraduate training and sacrifice most of your 20s and 30s in this nobleur pursuit to helping others. and then you show up and find out most of your work is documentation. and then a global pandemic shows up. i would say the problem is they are and it's been made

much worse. in fact when i was a resident some of my colleagues were already planning their retirement. >> you are not only a policy researcher and eight practicing hospitalist you're also in internist. so what is your day like? >> i work in a hospital one -- two weeks per month. when i work on shift 87 days in a row. i worked the night shift which is the hard shift. i show up, admit patients, address patient issues as they come up. in my nonclinical weeks i work with policy group about 15 people serve as a resource for regulators and members of congress and their staff. >> our guest doctor brian mello john hopkins university school of medicine here to talk about the burnout among medical workers because of covid and the potential looming shortage of doctors nationwide (202)748-8000 for

the land : eastern and central time zone for (202)748-8001 for the mountain and pacific and for medicalal professionals that line is 027-48-8002. we love to hear from you how your doing these past 18 months or more of what your level of burnout may m or may not be? doctor miller a report by kaiser health news published in the "washington post" a survey they did. about three inlt ten healthcare workers say they have considered no longer working in healthcare. is that a higher number than we have seen before? >> i would say that's relatively higher. part of it is the loss of sense of control that comes from the pandemic. people already feltt burned out and outem of touch. the pandemic made it worse is your demand is increased. and part of it is physicians cannot change and control the practice environments. make it better for patients and physicians. for example physicians cannot open hospitals and build a

medicare program that is actually illegal. >> what is the impact of hospitals and clinics closing in places in rural areas in particular. they are far fewer than they have had before. >> yes, as these clinics close in hospitals in rural areas people lose access to the regular doctor. pray they lose access to specialty care. they lose access to the hub and spoke system serving people in rural communities and sending them to areas for comp get it care like transplants or cancer care. the clinical staff nurses, pharmacists when the facility closes either find new work or they move. that labor force is gone. >> as a practicing internist, what new skills have you had -- of a lot more serious

conversations with patients. wewe have to be a lot more aware of patients who can decompensate rather quickly. patients in the hospital covid, one moment toca find the next minute they can be heading towards the intensive care unit. it's very scary franklin rick. >> covid 19 patients fill hospitals, healthcare workers fight fear and exhaustion, here we go again. as the delta variant began to rise, late in the summer this year, what was your reaction? >> part of myy reaction is a lot of this was avoidable. i've encouraged people and i encourage everybody to get vaccinatedev. it's now a preventable disease. the second thing is if physicians and other clinicians or more in control of our healthcare system would be in a lot better place.

>> was go to work callers are line for medical professionals (202)748-8002 but otherwise it central eastern time zone (202)748-8000 and pacific 202. >> and june as a medical professional on that line go ahead june. >> good morning. >> good morning. >> thank you c-span for taking my call. i am a senior citizen i am still working in the healthcare profession. i am training the frontline workers. but i have seen over the years is shortages of healthcare professionals, shortages of doctors. what i have seen over the years is that the agencies they are not putting the funds where they shouldd go. when there is funding that

goes too the upper level of the profession. not to the people who need to be trained to becomebe professionals. the united states healthcare system is very selective. if you look at the types of people that are in the profession you are looking at the same entitled people, june you know who w the doctors will be, you know who the nurses are going to be. you know how hospitals employed certified nursing assistants. those nursing assistants sometimes work in hospitals for many, many years, where is the wherewithal to educate at the very bottom of the healthcare system and elevate those two the level of professionals that are needed? >> go ahead. >> i just wanted to add, i started out in chicago at

michael reese hospital. the united states will import nurses but they willor not train them. i j have seen more filipino nurses imported to take jobs away from people who could be trained for those jobs. so there is a lot of issues around healthcare that needs to be addressed. i salute those frontline workers. i keep seeing the same problems, there is a shortage. what can we do about the shortages? >> thank you for yourr insight, june. >> so first of all thank you for speaking out. i appreciate your efforts and appreciate you asking these questions. and i appreciate your work. two things really come to mind. we talk about a shortage of professionals. one thing we can do is expand the scope of scope of practice for nurse practitioners so we can allow them in areas where it is appropriate to practice

with fewer barriers. that can help combat the physician shortage. think the second question you brought up which is an excellent question is how do we take people and pull them up? how do we migratepe people up to the healthcare system as practitioners? the best example for that is thee retail industry. i think about someone i once heard jim donaldson is a ceo of starbucks started out as a bag boy in a grocery store and worked his way up slowly over time with training and experience. that is something health systems and frankly don't do a better job of and should do a better job of. >> you said expanding the scope of practice for nurse practitioner for example, how is that done? ist that done on the state level is that something doctors with the american medical association would do? >> the american medical association byme disagrees with

me on this it's definitely done at the state level through legislative intervention in the state legislature in partnership with the governor addressing the nursing scope of practice. if usually through a nurses practice act. >> a comment on twitter from odie who said i've spoken with several people in healthcare, a lot of them if not all say the corporatization of the hospital itself is driving them away. less profitable hospitals are closing and people are being laid off. this is leaving communities without quality healthcare, what is your view? >> i absently agree. i think the corporatization of the care delivery in general is a problem. it takes away those who care for patients, pharmacists, nurses nurse practitioners it takesie them away from the bedside. takes them away from the control of that relationship between the practitioner and the bedside. now if you want to create a

change in the hospital have to go through committees you have to go through layers of administrators and it's very hard to change how facilities work. i think that corporatization you end up as a clinician as a number and spreadsheet versus a patient. >> also a question for you from jim on twitter said doctor miller, what percent of applicants to medical school are accepted? why do we have more medical schools ever facing a doctor shortage? >> that is an excellent question. he was run half of applicants to medical school get into a medical school. in terms of expanding the supply of medical school md or do, osteopathic medical schools are being built and opened from the supplies are growing for an. >> again we touched on this earlier in our conversation the projected shortage ofve physicians by the american association of medical colleges by 2034 the numbers

between 18,048,000 primary care physician 16000 and 30,000 surgical specialists in between 14,049,000 medical and other non- primary specialty physicians. in dandridge, tennessee stephanie is next up, good morning. >> good morning how are you today? >> host: find thank you. >> caller: i don't have a question i have a a comment. i agree with covid it being here in the doctors andg nurses being overwhelmed with it. but the shortages themselves are due to the mandate. we do not need to be forced into doing something we don't want to do. they were our first-line heroes. now they are being treated like trash. point-blankk simple. if biden glints arts doctors

and nurses seen as a lift this mandate. this is uncalledth for. that is all i have to say, thank you. >> doctor miller, along that line new york is implementing as a medical mandate new york preps for with mandate the governor said she's prepared to call in medical training guards retirees and others outside c of new york to address potential staffing shortages caused by the approaching vaccine mandate for healthcare workers in that state, new yorkrk state. >> i think this brings up several important points. first, as a country we thought covid vaccines and results in the end of covid. we would all be fine and go home and continue at her normal lives. we look back at prior generations lookpo at smallpox, it will look at polio, smallpox took25 over 25 years of

sustained effort to eradicate world wide i believe was eradicated in 1979. polio through the 40s and 50s it took eventually two vaccines one delta 1965 and it took ten to 15 years to eradicate polio. i think part of this is about her expectations about covid are frankly unrealistic. we have to accept the fact it will have localized outbreaks and we have to manage accordingly. then in terms of public health messaging and vaccine mandates, largely we have fallen on our o face. we should be messaging on the bus, on the internet, on tv everywhere but getting h vaccinated how it's important and something we can do to serve our country. i have not seen that unified message however frankly. i think that is one of the problems.

that is why the government has unfortunately resorted to mandates, which i disagree with. i think that private businesses should be allowed to make that choice forms themselves. >> will hear from john on the independent mind i'm sorry jim is from wilmington, illinois go ahead john. >> hi how are you doing there. have a question about the polling of the doctors who treat chronic paine patients we have seen over a thousand doctors leave the practice because of the war waged against them due to donald trump's opioid commission. threatening every doctor in town pharmaceutical people overwriting doctors were not going to fill prescriptions and people like myself who have myopathy and wonder what we're to do about this aspect? it is killed over 2 million americans in the last four and a half years and no one seems to talk about this. can you give me a little insight on that? might wife being a nurse

practitioner has told me if i want to get treatment i have to live in order to get the pain medicines that i need to function after being poisoned can you get meal insight? >> thank you. think that is a good question. you highlight thege challenge of the elk opioid epidemic. it is a local issue it's a state issue it's a federal issue. i think what we have to do is we have to have a whole person approach to pain. i think that takes time and that takes funding. and right now i don't think physicians have time to adequately treat pain patients. i think you are right. i think that is something that needs to be addressed. >> let's hear from kathleen and st. john's hill, new york. you are on a doctor miller go ahead. >> okay, my concern is i think the reason you have a shortage of doctors is because for many

years the american medical association had restricted the number of students that could go into medical school and who they are. like they want equality for everyone going intoo the schools. and sometimes they have left out students who deserved to be there for cap the intellectual ability and they have not been able to qualify. now,, maybe i am wrong but i'm a retired nurse teacher and i worked in hospitals for years. that is what we saw early on. >> okay doctor miller thoughts? >> guest: i would say the profession has worked to expand the number of medical schools. were seeing a lot of medical schools open the southeast and texas. i think you are right you hit on the important point that diversity, and opportunity in the medical profession probably is not been what it should be pretty think expanding that supply allows

that opportunity pretty think that is something we should continue to support in addition to the corresponding ways to drive down the cost of medical education for their programs people are considering having it for years be the norms for certain medical schools in certain training pathways which would save a whole year of tuition. i think we should look to expand those opportunities in addition to expand the scope of practice in some areas of practice like primary care equivalent professions in terms of cost and quality is like nurse practitioners or physician p p assistants. >> host: you mentioned covid being endemic in our society as a disease. a question for you from jim in texas on vaccines. he's is natural or acquired, what percentage of the u.s. is protected, is containment a rational approach or don't some clinicians disagree? >> i think that is an

excellent question. i think our initial strategy with covid is if we vaccinate the population, the disease would largely go away and we would have containment. i don't think that is realistic as we are now approaching two years in entreating covid for most two years. think vaccination is something that will help with potential containment. this will have localized outbreaks as we are seeing in states like idaho and also we have seen in florida. in other states covid is not as much of an issue. so instead of being a national issue it's become a distinctly local issue. covid will eventually change to an annual booster or a multi- shot a regiment that will bring you a lifetime protection for. >> a couple more calls would go to anthony and milford, pennsylvaniaia welcome. >> caller: yes, sir. i have a quick question for doctor miller. i was wondering, and new york

city mayor de blasio passed a law we have to be vaccinated to go sit in a restaurant. you need to beat vaccinated to go into a gym. what i don'the understand is my mother is in a nursing home. how is it they don't make it mandatory to be vaccinated. they keep saying it's mandatory but it's not mandatory. they check to see if they've got the virus but it's not mandatory that they are vaccinated like it's a mandatory to be in a restaurant. i don't understand that being that they are around elderly people. maybe somebody can enlighten me with that answer print appreciate your time and have a great day. >> thank you. i think that is an excellent question. a lot of nursing home chains are looking at making if they have not already, the covid vaccine mandatory. a lot of hospitals and health systems have done that for the exact same concerns. i think that change is going to happen and is happening.

splint let me ask about crisis standards of care. this issue popping up across the country, they write the rationing of medical care has become a reality in some parts of the united states as a delta variant drives a new wave of coronavirus cases pushing hospitals to the brink, alaska and idaho have acclimated statewide crisis standards of care which health systems can prioritize patients for scarce resources based likely on their likelihood of survival and denied the treatment. their decisions affect covid and uncovered patients and healthcare providers in montana ahtro elnashar crisis standards as mobile a wise governor this month released health workers from liability to ration care. is a lot of this being driven by the fact there are shortages of healthcare workers and there is this healthcare worker burnout happening? >> what is itho driven by

shortages, a lot of it driven by burnout and he mentioned alaskan idaho the suit to rural states. there is a problem there's a very limited supply of rural clinics and rural hospitals. in some people don't have the flexibility in the labor and facility supply that's needed for something like a f pandemic. if wer had allowed opportunities for expansion of nurse practitioners scope of care practice are we allowed physicians to own, operate and build hospitals, he might be in a better place today. those are not be all and all solutions but those are things we could have changed or could change as i think about future pandemics. >> fidel calling from connecticut good morning. >> good morning. on to say hello to the rest of the american people. you guys are great. doctor miller, my question for

you, you mentioned additional supply of osteopaths or doctors from certain types of schools. my experience has been a lot of the vaccine movement comes from doctors advising folks, talking about things like leaky gut and things that are suspect. can you educate me about why you are confident supply will be beneficial? >> i think that is an excellent question. i think there has been a division and i think that gap has been bridged. i personally have not heard or seen physicians making those claims being of one training or another. i do think osteopaths offer an important opportunity to fill needed gaps in areas like hospital medicine, primary care, general surgery and other areas.

>> is hear from west liberty, kentucky. gary is on the line, go ahead. >> yes. >> garrett make sure you mute your volume on your television and then go ahead withhe your question or comment. >> right now? >> go-ahead big. >> yes. gary got to mute the volume on the tv and go ahead with your comment. >> caller: my question is they say there's a shortage of doctors and nurses, i know a lot of people in thehe profession of the medical field. the reason i know a lot of them are quitting as they're being to take the covid shots and they're all single clicked their profession before they take the covid shot. i know ofha a lot of doctors and nurses who have already quit and there's more who are going to quit. but what i cannot understand is if you are vaccinated, what

threat do you have? if anyone has a threat from co- good the vaccinated are considered super breeders they carry the bed. what threat is it to those who haven't taken the shot customer. >> art gary will get a response from her guests. >> so vaccination prevents largely death and hospitalization. it does not necessarily have absolute you can still get the infection rates the harm the vaccine perfect protects us from. the amount of physicians and nurses who will eventually refuse the vaccine is small. especially in light of the fact i was in the majority of the health systems in thesy u.s. require that we get the flu vaccine annually. i expect that requirement from private hospitals and health systems to get the covid vaccine will eventually be a national requirement from hospitals and health systems.

>> the kaiser family foundation has a tracker of deaths per day the causes of deaths per day in the united states been the number one causes heart disease in 2000, 50 average deaths per day, 1600 per day by cancer, from co- vivid 700 deaths per day, accidents 550 and stroke four and 50. on her medical professionals line, martha is next up in pittsburgh, good morning. >> caller: good morning. i work in the medical field for 50 years. i worked in x-ray all 50 years i was a medical transcriptionist. people don't realize in the medical field everyone who works in a hospital hasad a job to do. you just have to do your job.

but everyone that works in the hospital has a specific thing they do. everyone is important. i don't care other whether you clean your nurse, doctor, technician, whatever. and in x-ray you connect withdo all of the doctors in the hospital. everybody's going to have an x-ray atan some time mammogram or whatever. you have to have knowledge and for 50 years i could be working right now. so when doctor miller any thoughts customer.re >> oh one ivi appreciate 50 years of service.

this brings up an important point that allowing flexibility in labor supply and training people in hospitals to boot do different roles and provide an opportunity to do that the hospital industry, if we look at its economic performance has had on average for every year i've been alive, which is over 30 years approaching 40, has had zero two at times negative labor productivity growth. meeting on average for every year t the labor is a hospital has been as productive as before or less productive than they were the air before. that is atypical for any industry. as a part of the next largely of and health systems are monopolies to them unlimited competitionie. as a consequence, clinicians and other workers have limited choice where they can work and the clinical practice environment hasn't really changed much in 30 or 40 years because we have lost that

innovation care delivery. we have lost that opportunity for flexibility and creativity to benefit patients. >> question for me for mark on twitterr. he says would eight merit-based immigration program help at the doctor shortage? >> well, it depends upon how you define marriage. i do think we already allow provide pathways for immigrants to participate and join the medical profession, e at what age and stage are they coming to? they provide equivalent care many times to what average american trains provide for. >> are going to oak hill, west virginia, earnestine hello there. >> goodd morning. i have a statement. i turned the tv on and heard a

physician, a caller asking doctor miller about osteopathic doctors. i worked in a hospital that was next to the west virginia school of osteopathic medicine. i find them just as qualified as an md. my personal physician happens to be a doctor of osteopathic medicine. i have full confidence in those physicians. plus i was understanding when the doctors of osteopathic medicine take theirme internship they are alongside medical physicians and hospitals that offer internships to physicians. and so i see no difference really between osteopathic physicians and mds. and i will say that i have been a dietitian for 67 years. and i work with both.

that is my statement thank you. thank you for your hard years and efforts as a patient myself. i've seen mds and do's and they have been excellent. i have a question for doctor miller about the overall covid burnout and shortage in a way. my math tells me roughly that we are talking 670,000 deaths let's rounded up to a million for exercise. we have three to 60 million people inn this country, if 1%, 1 million of 100 million is 1%, 200 million is 2% of 60 we are down to somewhere less

than half of 1% deaths from this. the potential of being 80 years old were down significantly instruction of the entire economy for the efforts to help so many people that are marginalized and age voids. >> that's an excellent question. between public health policy which has become abundantly clear. in terms of a death as a

patient, as a physician as a family member, any death is absolutely depression and heart wrenching for in my heartt goes out to anyone whose family, friends, coworkers have passed away from covid. it's absolutely devastating. that being said have to weigh the benefits and risks of her intervention rate with lockdown and some certain stances have exacerbated substance abuse they've exacerbated depression, anxiety, childhood suicide attempts. in the future after carefully considering the public health policy decisions we also have to consider unintended consequences and economic effects too. >> on top of that we put out cold t it is number three cause of daily deaths, 780. this is something brand-new

that's basically less than two years old in terms of cause of death. no matter what it was it with text or tax the medical system. >> absolutely pay that's a testament to the fact that covid is here to stay. we have to figure out a way to manage it. and asav a country we have not made that transition. we are sewn or fight or response almost two years in. we need to have a long-term plan going forward to manage covid. >> let's get warmer call her terry in wellsville pennsylvania go ahead bring. >> hey good morning to gentleman. i just wanted to make a couple comments here. so hear me out. i have worked in the construction field all of my life. i remember back in the 80s with health insurance then big problems back then. i am thinking it might still be interfering with it to this day because of malpractice

insurance, it is awful expensive. and then with these costs in rural areas they need the insurance to while in order for you to be able to purchase that insurance you need to have a horrendous amount of business because of the cost structure i would be willing to bet. in my third comment is, i was in the hospital here on friday. i went in to have surgery and had to go in the hospital i was in an outpatient building. they transferred me to the hospital because of mild complications but they wanted to doubt the eyes, cross the tease and make healthy when i left there. and i cannot believe what they told me in their about the

people, us, society what i was hearing people say. there was a child and next to me that had cancer and they trying to tell him to drink water and do some walking. and he flat out refused. and then i heard a couple other people talking that i don't want to get into, but that's all i have disabled. >> all right terry, any thoughts? >> first of all, i'm sorry to hear you had complications on your surgery. i'm glad it sounds like your home and on the mend and able to talk to us. so good to hear that. i think you bring up a couple points which are important. one is that public insurance does not pay hospitals very well. medicaid rates are not a sustainable business for

practice or hospital. as we think about expanding medicaid we have to be careful and realize insurance is not equal access to care. i think the caller also brought up an appointment point about sponsored health insurance for that's we have to provide opportunities for small businesses to think aboutt other ways and other mechanisms to ensure their employees be. >> assistant professor of medicine, internist at john hopkins, university school of medicine at john hopkins hospital but thank you so much being with us this morning too. >> thank you for having me. hert joined next white house reporter for the washington examiner catherine doyle is here with us to talk about not only that but the president was busy over the week and. he and his staff and aides talking to lawmakers about the votes coming up this week. tell us about separate. >> thank you so much for having me