One of the themes that has emerged out of the COVID-19 outbreak and subsequent response has been the flexing of labor's muscle in a way we have not seen in many years. Citing potential harms to teachers and staff and the need for plentiful PPE and improved ventilation systems, the National Education Association, state chapters like the California Teacher's Association as well as county level groups like the Fairfax County, VA Federation of Teachers have organized against in-person instruction until as late as fall 2021.
The knock-on affect of school learning models that are either exclusively remote or hybrid is a disproportionate impact on jobs dominated by women, who according to several surveys are bearing the brunt of managing what amounts to home schooling. Aside from teaching, health care is one such occupation. Over 90% of nurses are women.
No surprise that a Lancet study in April determined that about 15-20% of the U.S. health care labor force would be unable to meet child care needs by relying on a non-working adult or older siblings (i.e. free child care support in the home).
Some portion of that 15-20% without ready access to childcare are able to improvise using day care centers where open, friends, learning pods, employers, etc. Others are simply limiting shifts or scheduling them when child care can be provided. The result, according to two recent surveys, is a drag on capacity for health care providers. Most affected appears to be outpatient services as the staffing priority has become higher acuity patients in need of acute care.
For THC, with 16% of inpatient beds and 10% of ASC ORs located in California, the challenge to fully staff all operations will be daunting in the face of extended remote school learning models throughout California. Complicating things are the mandatory nursing ratios for most health care services in the state. Michigan, where THC has about 10% of inpatient beds is taking a similar approach as California when it comes to the wide latitude given teacher union demands for extended periods for remote learning.
HCA's ability to maneuver through labor challenges is significantly better given their concentration of beds in Texas and Florida, two right-to work states headed by governors anxious to return their constitutents to normalcy. HCA's financial flexibility, in part due to fewer labor headwinds, makes its return of CARES Act money sensible, in contrast to THC which is lobbying for guidance that reverses their reversal of $70 million.
The obvious winner in a labor shortage, however idiosyncratic , is going to be the nurse staffing companies like AMN, CCRN and privately held CHG Healthcare which can smooth out the labor disruptions. AMN's long tenure in California should certainly help them support the need there.
An end to remote learning does not appear to be in the cards until January, although research from public health and education organization is getting more adamant that it is worse for public health than in-person instruction. With the holidays looming, however, it seems unlikely there will be much movement on the issue so both 3Q and 4Q are going to be impacted.
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