New York City’s public hospital system is losing major money, due in part to how much it’s spending on hiring temporary nurses to cover for full-time staff who left during the COVID-19 pandemic. Separately, the city's health department is facing a steep staffing shortage for similar reasons.
The expense of temporary staffing is contributing to a projected $144 million operating deficit this fiscal year, Dr. Mitchell Katz, president and CEO of NYC Health + Hospitals, said at a City Council hearing on the hospital budget on Tuesday. He added that delayed payments from the federal government are also a factor.
Asked what the solution is to the city’s health care staffing woes, Katz unexpectedly agreed with the New York State Nurses Association that public hospital nurses should get paid as much as their private-sector counterparts. But whether City Hall will budget for the increase and accede to NYSNA’s demands in ongoing contract negotiations remains to be seen.
Nurses hired through staffing agencies typically get paid more than permanent staff, and there are currently about 2,000 of these temp nurses working across the 11-hospital system, Katz said. He added that burnout stemming from the pandemic is making it difficult to hold onto permanent nurses working in hospital emergency departments, intensive care units and surgical units.
This challenge has also contributed to staffing shortages at private hospitals citywide, partially fueling recent strikes at Mount Sinai and Montefiore. But Katz said public hospitals face particular disadvantages.
“It’s not surprising that a number of nurses felt exhausted, retired early, or felt they wanted to do a reduced caseload,” Katz said. “The fact that our compensation and benefits have lagged behind the private systems has also caused us a problem.”
NYSNA says travel and temp nurses get paid two to three times as much as permanent NYC Health + Hospitals staff. Asked how much they’re making at Tuesday’s hearing, Katz did not provide a figure but noted that the temp nurses themselves are not taking home the full amount the health system pays, since staffing agencies also charge a fee.
There’s a middle person getting a large cut of the money.
“There’s a middle person getting a large cut of the money,” Katz said.
NYSNA has estimated that, after the raises many private-sector nurses won in recent contract negotiations, the gap between what they earn as new graduates and what NYC Health + Hospitals nurses earn is about $19,000. The starting salary at NYC Health + Hospitals is $84,744, while the average in the private sector is $104,598, according to Kristi Barnes, a spokesperson for NYSNA.
NYC Health + Hospitals did not respond to questions from Gothamist about how much money temp nurses get paid on average, or how much the city is spending on hiring them in total.
But Katz said at the hearing that he is hopeful that NYC Health + Hospitals can drive down the cost of temporary nurses to zero in the next fiscal year. He also testified that he supported the nurses union’s proposal for how to do that. He said closing the pay gap between public and private hospitals was necessary for the city to recruit – and hold onto – nursing staff.
“Even though people love our mission and the fact that we have the best mission in town, they’re not going to stay with us if there’s too large a difference in salary,” Katz said. “The good thing is we have a vehicle to solve this. The city is in active negotiations with NYSNA.”
Katz himself isn’t at the negotiating table. The Health + Hospitals bargaining committee consists of other public hospital executives and city officials. Still, some nurses say the CEO’s statements are encouraging.
Medical personnel outside of NYC Health + Hospitals/Lincoln in the Bronx during the early days of the COVID-19 response. Pandemic burnout has triggered staffing shortages in the public hospital system as well as the city’s health department.
“The city should listen to the leader of NYC Health + Hospitals,” Kristle Simms-Murphy, a nurse at Jacobi Medical Center in the Bronx, told Gothamist.
Barnes, from NYSNA, said the union has estimated that the city could close the gap for less than what it is currently spending on temp staffing. But NYSNA is still waiting for an official estimate of the cost of the parity proposal from NYC Health + Hospitals. The city hospital system did not respond to a request for comment on the potential cost.
Staffing challenges are cropping up in other parts of the health care workforce, including New York City’s Department of Health and Mental Hygiene. The agency currently has 600 vacancies, representing about 10% of the department’s budgeted positions for this fiscal year, NYC Health Commissioner Dr. Ashwin Vasan testified at a separate health budget hearing Tuesday. He also cited pandemic burnout for his department’s staffing woes.
“Our entire agency, the entire public health workforce, has been shorn of staff due to the strain of the last three years,” Vasan said.
That’s not a sustainable way to work.
He added that for two-and-a-half of those years, about 4,000 of his staff had been involved in the city’s emergency COVID-19 response, taking on additional duties on top of their regular work. “That means calls at 6 a.m., up to midnight, seven days a week sometimes at the height of the emergency,” Vasan explained. “That’s not a sustainable way to work. And so it’s not a surprise that some people have left the workforce.”
Vasan said the city seeks to address the issue through workplace mental health and wellness initiatives and greater flexibility around remote work – something Mayor Eric Adams previously balked at but conceded to in recent contract negotiations with the union DC 37.
However, Adams has also proposed saving money through a “vacancy reduction initiative” that would require the city health department to cut about 400 jobs, according to the city comptroller. Vasan said at the hearing he would try to avoid cutting jobs that are essential to city services. He said he must also prioritize which jobs to hire for and then get approval from the City Office of Management and Budget.
