Medical offices and pharmacies are rotating staff to different locations, and we have to wonder how this benefits patients.

Healthcare, as we have known it over the past few decades, is undergoing significant changes, and all of them will affect how we receive our care and from whom it will come. The changes will not only be seen in hospitals but also in individual physician practices and major pharmacy chains, and they relate to staffing, fee schedules, and shortages of people in the professions.

I filled my medication prescriptions for decades at a local CVS pharmacy, but I had to change to another pharmacy when I was told CVS no longer would be carrying my medication. For a brief period, I went to a Walgreens who stocked the medication, but it was in an undesirable area regarding parking and the people hanging around the strip mall.

When I inquired, after a few months, I was told that my former CVS would be carrying my medication, and I transferred back. It’s in a mall with adequate parking and no questionable people hanging around. But then I encountered another problem.

Although I had seen the same pharmacist refilling my prescriptions month after month, I was suddenly told that she would no longer be working in that location and would work at another one. I thought this might be more convenient for her, so I let it go. But then I noticed that the pharmacist who replaced her, who is there a few days a week, was also replaced by a rotating group of two other pharmacists.

While I found them all cooperative in meeting my needs, it was disconcerting to have to deal with different people and to fill in any history I had of concern for any of my medications. What's more, I always had to leave a phone message and could not speak directly to a pharmacist. Trust is essential in any pharmacist relationship, and it felt uncomfortable having to deal with three different pharmacists and never knowing who would be on duty on any day.

The Changing World of Staffing

Now, I am faced with an additional challenge, and I understand that this is a direction in which healthcare will progress in the years to come: staff shuffling and rescheduling. Once my regular internist decided to retire, I had to find someone to take his place.

The practice where he worked was purchased by the local hospital, and the physicians at that location are now shuffled weekly to at least three other locations. One works at my location only one day a week, and then is sent to other offices during the week. If you find this disconcerting, as I do, perhaps we need to begin to rethink our relationships with healthcare.

I also wondered if there was any relationship between this reshuffling and the hospital chains opening small emergency care offices in several towns in my area. My town has at least three from two different hospitals.

An additional note is needed here. The medical offices that I have considered failed to meet ADA requirements for exam tables and lavatories regarding height, automatic door openers, and doorway openings. Anyone with a disability in terms of mobility will find this quite challenging and, maybe, make them feel like a second-class citizen.

As I have discovered, it has been difficult to make appointments with certain specialists, and some have indicated that you will have to wait one year for an appointment. Others, who are only a few years out of their residencies, have openings. For me, real-world experience is my highest priority, and someone recently out of their residency doesn't entirely fill that for me.

The newest physician with whom I've had an appointment, was shocked when she looked at my weight data. I had weighed myself that morning and told her what it was. Unfortunately, no one in that medical practice had weighed me for probably two years and so I had given them an incorrect weight.

The weight I gave the woman this morning was 20 pounds different and, of course, she immediately jumped to thinking that I had either a thyroid disorder, or I was in the midst of cancer. No reassurance I offered, and also the information that no one had weighed me, seemed to settle her concern. She wanted to schedule me for imaging of my thyroid, but I refused, again, telling her that no one had weighed me. Incidentally, three months previously she ordered a blood level for a T3/T4 and they were both normal. Finally, I did prevail and made another appointment in three months.

How had no one ever weighed me? Let's just say that no one had ever taken my respiration, my temperature, and sometimes, not even my blood pressure. In my chart, however, everything was listed as having been taken and noted. These were all wellness visits.

Will I be a regular patient for this young woman? I'm wondering that myself since I note that she appears to be about three months pregnant.

Of course, I also don't want a healthcare professional who doesn't understand that it is time for them to retire because they have cognitive impairments. Yes, I encountered an eminent professional who ultimately returned to a highly prestigious medical center in a major American city and left her prior office. This has not resolved the issue of impairment.

When a lab is specifically ordered (and I underline ordered) by a physician to do two specific tests and the tech knows a single sample can’t be used for both, it’s trouble time. The physician insisted she did not tell the lab to do that. I was present with another person when she repeatedly indicated that, if the lab refused to do it, they were to say she insisted it be done that way.

When the results came back and she was asked to interpret them, she said, simply, "I don't know what they mean." Would you be comfortable as a patient of a physician like that? And she trains residents in her specialty.

The Outlook in Healthcare

The winds of change are blowing fiercely in the healthcare community and consolidation, staff changes, financial arrangements, and even emergency rooms are being affected. Of course, we know that those with little to no insurance use the emergency room as their primary site for care, and when they close, what is left for them? And, besides emergency rooms, what about charity care? Is charity still in the healthcare ethos?

Some clues about what the future may hold came from an extensive study of 60 C-suite executives. In 2025, 44% of healthcare CEOs who took the survey said they could change their plans because of regulatory uncertainty. Legislation and programs that the 119th Congress must resolve may have far-reaching consequences for healthcare systems, individuals, and health insurance policies. It is important to keep an eye on the consequences at the federal, state, and local levels because they will most certainly change throughout 2025. One of the major concerns that remains, despite any legislative changes, is that of staff shortages.

On a national level, staffing shortages are expected to worsen an impending crisis that has been predicted for quite some time. An analysis from 2021 by industry market analytic businesses estimates that in 2025, the United States will be short over 446,000 home health aides, 95,000 nursing assistants, 98,700 medical and lab technologists and technicians, and about 29,000 nurse practitioners.

Is it a question of people not choosing these professions or of the healthcare industry not funding staffing as we see it needs? Also, are salaries meeting the financial needs of people who might be considering these careers? The questions are many, and resolving them will mean that creativity must be tapped. Artificial intelligence and new technology may pick up some of the slack, but there is still a need for genuine, hands-on care.

As the number of people 65 and older continues to rise, so will the demand for healthcare services. From 54 million in 2019 to over 80 million in 2040, the number of individuals aged 65 and older is expected to soar, according to the Department of Health and Human Services. More than 40% of school-aged children and adolescents have at least one chronic health condition, representing a significant increase in the prevalence of chronic illnesses among younger individuals and children.

Pharmacies, too, are faced with staffing issues as well as others, including the issue of upskilling current staff. New computer programs and input methods will place greater emphasis on technical skills, which personnel once thought was someone else's job.

Increasing medication costs, severe prescription shortages, and substantial staff burnout caused by increasing workloads are unprecedented issues that pharmacies are facing. To keep up patient care, increase efficiency, and remain financially viable in the face of these problems, we need wiser techniques and creative solutions.

The way forward is not clear, and bit-by-bit solutions may provide temporary relief, but what about the long-term? When there is insufficient medical staff entering the field, and the patient population is increasing, how does this affect care? As I have noted, it can be a rude awakening to a new level of stress regarding healthcare for patients.