Healthcare Workforce Shortages and the Financial Strain Threatening Care Delivery with Dr. Harry Severance

Summary

Podcast Summary
Becker’s Healthcare Podcast — “Healthcare Workforce Shortages and the Financial Strain Threatening Care Delivery”
Guest: Dr. Harry Severance
Host: Chanel Bunger (Becker's Healthcare)
Date: December 28, 2025

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Episode Overview

This episode addresses the critical workforce shortages and financial crises plaguing the U.S. healthcare system, with insights from Dr. Harry Severance, a seasoned physician and renowned healthcare strategist. Dr. Severance discusses startling data on provider and nursing attrition, the cascading impacts on care delivery, and the dire financial realities threatening hospitals nationwide. He also offers candid advice for leaders and raises pointed questions about the future viability of American healthcare.

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Key Discussion Points & Insights

Dr. Severance’s Background

• Decades-long clinical career and current work as a healthcare strategist. (00:33)
• Advises organizations on systemic challenges affecting U.S. healthcare delivery. (00:33-01:02)

Workforce Shortages: Alarming Statistics & Causes

• Post-COVID Exodus:
  • “In 2021, we lost approximately 20% of all hands-on healthcare workers in this country…those workers have not returned.” (B, 01:24)
• Physician Attrition:
  • “Another additional 25% of physicians…have either already quit in the past 18 months or are in planning stages of leaving health care. And many of these are not retirement age…people in early mid-career, their late 30s, early 40s.” (B, 01:47)
• Emerging Generational Impact:
  • Medical/nursing student exodus:
    • “Just under 25% of medical students…said they were quitting medical school, they were leaving and going into other careers. Another 61%…said…we will never see a patient.” (B, 02:29)
    • Reasons: “The abuses, the toxicity, the burnout, the violence…they’re leaving to do something else.” (B, 02:54)
  • Fewer high school and college students are pursuing healthcare, favoring more lucrative, less burdensome paths. (B, 03:29)
• Aging Population Pressure:
  • “In the next 10 years, we will be 186,000 physicians short in this country…equivalent or greater numbers of nurses, midlevels and others.” (B, 04:17)

Impact on Care Delivery & Patient Access

• Hospitals unable to fill positions, shut down service lines, and limit care:
  • “Hospitals at which I currently work have recently had to shut down some of their service lines in their surgical specialties…” (B, 05:08)
  • Example: A surgical subspecialty shut down after last surgeon retired in his mid-40s. (B, 05:21)
• Nationwide issue: Pipeline for new clinicians is drying up. (05:44)
• Consequences: Loss of access, reduced services, empty beds, and major revenue losses. (06:14-06:31)
• Summary:
  • “These are all the impacts both from the patient access problem and also the financial side for the hospitals that are trying to provide services.” (B, 06:31)

Financial Strain on Healthcare System

• Rising Uninsured Rate:
  • “35% of American citizens no longer have health insurance…They can’t afford it.” (B, 06:58)
  • Projected to rise: “Economists say that 35% number…will rise to 40 to 41%.” (B, 09:03)
• Impact: Uninsured patients delay care, show up sicker, resulting in higher costs and unpaid bills.
  • “Single largest reason for personal bankruptcy filings…is unpayable medical bills.” (B, 08:16)
• Hospital Reimbursement Crisis:
  • “On average, only 48% of hospital bills are being paid for. 48%. That’s less than half.” (B, 10:27)
• Hospital Closures:
  • “The most recent figures…759 hospitals in this country have failed their financial stress tests and are at imminent risk of closure. Another 146 have already closed or ceased inpatient operations…” (B, 11:38)
• Consequences: Quality of lives declining; the system’s financial underpinnings are unsustainable.

Root Causes & Systemic Response

• Stakeholder Fragmentation:
  • “Our healthcare stakeholders…seem to each be focused on market share, on gaining additional profit…if one stakeholder says, make mine a double, they want a double piece of pie. They mainly have to take that from another stakeholder.” (B, 12:51)
  • Lack of collaborative solution-finding among insurers, pharma, corporate healthcare, and legislators.
• Warning:
  • “That has to change or the system will crash.” (B, 13:48)

Advice for Leaders

• Immediate Need for Collaboration:
  • “The system is fixable if our healthcare leaders would work collaboratively…rather than working oppositionally for market share and a bigger piece of the pie.” (B, 12:46)
• Systemic Risk Awareness:
  • “Many of our healthcare leaders and stakeholders have the mistaken belief that healthcare is stable…on under these unsustainable circumstances, I fear that we’re going to see major collapses in much of our healthcare system.” (B, 10:57)

Final Thought: Universal Healthcare?

• Dr. Severance on the “unthinkable”:
  • Raises the provocative question: Should the U.S. consider universal coverage to keep facilities open and viable?
    • “It brings up the question of should there be some type of national, universal health care coverage? …when we talk about do we want to keep hospitals and healthcare facilities in this country financially viable…it's something we have to look at and consider.” (B, 14:16)

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Notable Quotes & Memorable Moments

• On the scale of provider attrition:
  • “We lost approximately 20% of all hands-on healthcare workers in this country…Another 25% of physicians…planning to leave…and many are early-mid career.” (B, 01:24, 01:47)
• On medical students’ disillusionment:
  • “The abuses, the toxicity, the burnout, the violence were all things that said, ‘This is not a career I want to go into,’ and they’re leaving.” (B, 02:54)
• On community impact:
  • “Hospitals at which I currently work have had to shut down some of their service lines in their surgical specialties…because the last surgeon…is retiring in his mid-40s.” (B, 05:08)
• On the unpayable ledger:
  • “On average, only 48% of hospital bills are being paid for. 48%. That’s less than half.” (B, 10:27)
• On the urgent need for action:
  • “That has to change or the system will crash.” (B, 13:48)
• On universal coverage:
  • “Should there be some type of national universal health care coverage?…it’s something we have to look at and consider.” (B, 14:16)

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Timestamps for Key Segments

| Timestamp | Segment | |-----------|-----------------------------------------------------------| | 00:33 | Dr. Severance’s background and expertise | | 01:12 | Workforce shortages: statistics, causes, generational impact | | 02:29 | Medical student/nursing student exodus | | 03:29 | High school/college pipeline problems | | 04:17 | Physician/nurse shortage projections | | 05:08 | Service line shutdowns and community impact | | 06:43 | Rising uninsured rates and financial crisis | | 08:16 | Medical debt and personal bankruptcy | | 10:27 | Unpaid hospital bills and systemic viability | | 11:38 | Hospital closures and risks | | 12:17 | Advice for leaders, need for collaboration | | 13:48 | Systemic risk and warning to stakeholders | | 14:16 | Question of universal health coverage |

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Summary in a Nutshell:
Dr. Severance paints a sobering picture of American healthcare in freefall—clinician flight, student disillusionment, surging uninsured rates, and financial collapse loom large. His central message: Only unprecedented collaboration and honest systemic reform can avert disaster, and no solution—not even universal coverage—should be off the table.

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Transcript

[A]

Hello and welcome to the Becker's Healthcare Podcast. My name is Chanel Bunger and today I have the pleasure of speaking with Dr. Harry Severance, a brilliant healthcare strategist who joins the podcast today to share insights into some daunting statistics surrounding provider nursing shortages, advice for leaders, and a bit more. Dr. Severance, thank you so much for joining me today.

[B]

Glad to be here, glad to be able to speak to these critical issues in our healthcare workplace.

[A]

Great to have you and to get us started. Could you please introduce yourself and tell us a bit about your background and work in healthcare?

[B]

Sure. I'm, I guess I'd call my politely mature physician. I've been providing clinical care for several decades. Over the past, I'd say decade or more. I've also, I've been a healthcare strategist, nationally recognized. I advise several organizations on these critical issues that are impacting our healthcare system, our delivery system, the whole healthcare gamut as a whole.

[A]

Got it, Got it. And now getting into those critical issues, can you speak on some of the statistics and what's going on with the shortages of clinicians, nurses and other healthcare leaders?

[B]

Sure, absolutely. As we all know, there are multiple disruptors engaging our healthcare system, our delivery system. And one of the most critical is our ongoing loss of hands on healthcare workers. Our doctors, our mid levels, our nurses, our respiratory and physical therapy, all of those that provide care to you when you show up for seeking health care. We're losing those numbers. One of the critical early numbers, 2021, we lost approximately 20% of all hands on healthcare workers in this country left healthcare delivery. Now granted that was mainly due to the COVID epidemic, but the problem is those workers have not returned. And then this year, another additional 25% of physicians, 25% have either already quit this in the past 18 months or are in planning stages of leaving health care. And many of these are not retirement aid. Not the classic, I'm talking about people in early mid career, their late 30s, early 40s. I've seen this at the hospitals where I personally work, where I've seen physicians who are burned out, other factors, but they are leaving healthcare. Either they're taking early retirement or they're migrating into new careers. And like I said, I've seen this myself personally. Even more startling and concerning, I believe, is what's happening with our bright young minds, our future of healthcare and healthcare delivery. There was a study published in 2023 where they looked at over 8,000. They interviewed over 8,000 medical and nursing students. They found just under 25% of medical students, 24.9% said they were quitting medical school, they were leaving and going into other careers. Another 61% of medical and nursing students said, well, you know, we're already in this, we're going to complete our degree, but we will never see a patient. And when asked why, the most common response was for these medical and nursing students who are now out in our healthcare workplaces as learners, seeing what's going on, they said the abuses, the toxicity, the burnout, the violence were all things that said, this is not a career I want to go into and they're leaving to do something else. Even more concerning, I believe for the long term is our young, even younger, brightest minds. And I've published multiple case reports from interviews I've done on this where you see high school and college students now increasingly turning away, even at that younger age, from health care careers. And when I ask them, they point out to me there are many, many more careers that are much more lucrative, much, much less debt ridden, much less abusive and toxic. So again, they're being drawn away into what seem to be increasingly more attractive careers. So again, just worsening the ongoing shortage of this. In a time where we have 76 million baby boomers that are needing increasing, increasing care, estimates are in the next 10 years we will be 186,000 physicians short in this country. And that doesn't fully encompass this baby boomer bubble. Equal or greater number of nurses, mid levels and others. So it's critical factor how this impacts, not only is that a huge problem for patient access in a country where we always see already see the most expensive healthcare worldwide, but with the poorest clinical outcomes. But I see this, our hospitals are having to shut down delivery systems, whole service lines. Hospitals at which I currently work have recently had to shut down some of their service lines in their server, their surgical specialties because in one case in a surgical subspecialty, the last surgeon that offered that service retired in his mid-40s, is retiring at the end of this month. And so they can no longer offer that service line. Other hospitals in this community are facing similar and this is a nationwide problem where the pipeline of doctors, mid levels, nurses, there are huge numbers of physicians, physician, nursing, other that are going unfilled. So hospitals are not able to provide the service, they're not able to keep beds open, they're not able to keep their or running. These are huge revenue losses for these hospitals. So these are all the impacts both from the patient access problem and also the financial side for the Hospitals that are trying to provide services.

[A]

Absolutely. Yeah. This is all daunting and very concerning and this is all happening right now. What do you think this is going to lead to? And can you talk more on the financial side of things as well?

[B]

Yes. There's two more points. Like I said, there are multiple, multiple disrupting issues impacting our whole system, especially the healthcare delivery component. But the two other major factors impacting that I think have the capability of bringing the system to its knees in rapid fashion. And they are directly linked. Point number two of the three is that recent, I believe a study in 2023 that's been reviewed and the numbers are correct, 35% of American citizens, and I'm talking about American citizens, not illegals or other, but 35% of American citizens no longer have health insurance. They can't afford it. That if you realize 35%, that's 15 points south of half of the citizen population of this whole country. Yet they still show up needing health care. They have no health insurance, so they're not getting preventative care. So they show up in increasing numbers at our hospitals and emergency departments, usually sicker because they haven't gotten the preventative care they need, requiring more extensive care, more extensive admissions, huger hospital bills that again, they can't pay because they don't have insurance. We know that the single largest reason for personal bankruptcy filings in this country is unpayable medical bills that 35% number, economists say are getting worse. The most single reason for that is the current, this year's legislation. I believe it's called the big beautiful bill, the slang for it. But in that legislation, with the cutbacks and subsidies for the Affordable Care act, that covers upwards of 20 million working Americans, also the cutbacks and those that are eligible for Medicare and Medicaid, economists again say that 35% number of Americans without health care insurance, that will rise to 40 to 41%. That means that's just under half of the whole population of this whole country do not have health insurance. So from a hospital or healthcare facility standpoint, what, what kind of business do you have when the services you provide can't be paid for by almost half of the people that utilize your services? Would you open a business when you know that half of your clients are going to use your services but can't pay for them? Which comes to point number three, and that is again, another recent study showed just that fact, that nationwide on an average only 48% of hospital bills are being paid for. 48%. That's less than half. Again, what business can survive when half of your bills for services that you're required to provide can't be paid for? So again, I would suggest that the patient access standpoint is huge and we see the quality of American lives going south as they cannot afford and can't access health care, get sicker and sicker, and then can't pay for the care that they deliver. But from a financial standpoint, what system can survive under those insurmountable odds? So again, I say, though I believe many of our healthcare leaders and stakeholders have the mistaken belief that healthcare is stable. We've spent 150, how many years. Everybody that's alive today has grown up surrounded by healthcare and no one can really fantasize that they would wake up one morning without an available healthcare system. But on under these unsustainable circumstances, I fear that we're going to see major collapses in much of our health care system. We know that the most recent figures, which I believe Beckers has published on several times, 759 hospitals in this country have failed their financial stress tests and are at imminent risk of closure. Another 146have already closed or ceased inpatient operations due to all these prevails that I've been talking about. Currently most of those hospitals are rural, but we see this expanding into urban areas and even looking at big referral, critical care access hospitals. So again, we're starting to see the impact of the financial side of this huge problem of healthcare delivery. And again, I think we will unfortunately see this phenomenon expand.

[A]

Absolutely, absolutely. And now we've laid out all the issues. Do you, I know we don't have much time, but if you could summarize maybe a few quick points or some advice for leaders on what they can do now to help with this problem.

[B]

Well, as I said, unfortunately. I see. And when I go to the halls of Congress or speak to healthcare leaderships, I see our major stakeholders and that insurance industry, big pharma, corporate health care, our legislative leaders, I think they all believe that. Again, they can't imagine waking up one morning without an intact healthcare system. And this is something you know, we could discuss at a different why they why this belief is so pervasive, but they just can't imagine. So they believe that there are other issues. They can come back to this later. I'm not so sure with the economics I've just mentioned that this is the case. But the problem I see is that our healthcare stakeholders, instead of working collaboratively to try to go in the system is fixable if our healthcare leaders would work collaboratively. But right now they seem to each be focused on market share, on gaining additional profit, and the healthcare pie is only so big. So if one stakeholder says, make mine a double, they want a double piece of pie. They mainly have to take that from another stakeholder. So what we see are the different stakeholders in healthcare fighting each other oppositionally for market share and a bigger piece of the pie rather than working collaboratively to try to fix the system. That has to change or the system will crash.

[A]

Got it? Got it. Well, Dr. Severance, I want to thank you for your time today and for shedding light on all these important issues. But before I let you go, is there anything else you want to leave listeners with?

[B]

The one other thing. When we look at the condition of half of the population of this country, half of our citizens do not have health care insurance, it brings up the question of should there be some type of national universal health care coverage? And that is a politically landmine grenade explosive issue. But when we talk about do we want to keep the hospitals and health care facilities in this country financially viable and open for healthcare delivery, it's something we have to look at and can set.

[A]

Got it. Got it. Well, that's a great note to end on. Dr. Severance, I want to thank you once again for your time today and for sharing these insights on the Becker's Healthcare podcast. Thank you so much.

[B]

All right. Thank you so much.