By Farzon A. Nahvi, M.D.
The Washington Post, February 8, 2023
For many health-care workers watching the Super Bowl in recent years, the hardest hits have often come not during gameplay but in the commercial breaks.
Emergency rooms across the country have become chronically overcrowded and understaffed. Hospitals often claim they don’t have the funds to hire more employees to meet the urgent needs of patients. Yet in between Super Bowl advertisements for Flamin’ Hot Cheetos and Bud Light Seltzer Hard Soda, it’s now commonplace to see commercials for institutions such as the University of Rochester Medical Center, NYU Langone Health and Inspira Health.
To understand why this situation is so troublesome, we must first appreciate the stakes: Hospital crowding, which gets worse when institutions are understaffed, is a national problem — and a deadly one. Multiple studies have demonstrated that overcrowding is directly associated with an increase in patient mortality.
To make matters worse, a 2016 report by the American College of Emergency Physicians found that over 90 percent of American emergency rooms are routinely crowded; that number has only increased since then. If you’ve been to an emergency room recently, the overwhelming odds are that it was packed. As a result, your chances of dying were higher than they should have been.
Given what’s at stake, one would assume that hospitals would invest in a solution: If they were to simply hire more staff, the ratio of patients to nurses and doctors would be lowered — and lives would be saved.
But hospitals have been doing the opposite.
A recent investigation by the New York Times revealed that many American hospitals have spent years pursuing an “industrywide movement” of keeping labor costs low by wringing “more work out of fewer employees.” Indeed, hospital administrators often measure success by determining how much they can lower operating expenses by reducing the number of “employees per occupied bed.” In other words, low staffing levels are not a result of the coronavirus pandemic, staff burnout or a tight labor market — they are a business model.
Simultaneously, as hospitals save money by cutting staffing, hospital marketing budgets have skyrocketed. According to a report in the Journal of the American Medical Association, between 2004 and 2016, direct-to-consumer advertising by hospitals and health-care systems jumped 74 percent to $1.4 billion per year.
A brief stroll through New York City reveals billboards in Times Square, posters on bus stops and in subway stations, illuminated signs on city taxis, and newsstands full of magazines flush with advertisements for local hospitals. Prime-time TV slots feature ads from cancer centers and children’s hospitals. And beyond simply advertising during the Super Bowl, health-care systems have become official corporate partners of the Super Bowl.
As hospitals invest liberally in marketing while tightening their wallets when it comes to bedside patient care, it’s hard to view the billions spent on ads as anything other than waste.
Many hospital executives would say that deciding whether to spend on advertising or patient care presents a false choice. They would insist that marketing is a necessary operating expense that a modern hospital must invest in to succeed. This argument is often referred to as “no margin, no mission” — a shorthand way of saying that for a hospital to perform good work, it must first generate the money with which to do so.
On the surface, this argument seems reasonable. But when hospital wings are closing because of staffing shortages, nurses are being asked to attend to more than four to five times the patients they can safely care for, and firefighters and the National Guard are stepping in to provide what hospitals themselves are failing to, can it really be argued that spending on television commercials remains a necessity?
If spending on advertisements is nonnegotiable but hiring enough nurses to save patients’ lives isn’t, who is our health-care system truly serving? At what point can it be said that this system has lost its way and the margin has, in fact, become the mission?
Legislators in several states, including Massachusetts, Oregon and Washington, are trying to rectify the situation by considering legislation that would mandate safe staffing ratios. Predictably, hospital lobbying organizations say they “strongly oppose” these legislative attempts, citing the “financial burden” of higher operating costs that such laws would impose.
In light of these claims, these bills should go a step further. They should also ban hospitals from engaging in costly direct-to-consumer advertising. What better way to save billions of dollars to offset the “financial burden” of hiring more lifesaving medical personnel?
The Super Bowl provides us with a clarifying lens. It is American television’s most watched event and its most expensive airtime, and the very idea of hospitals advertising during the game is symbolic. It heralds an era when it’s no longer unusual for enormous amounts of money to be frivolously spent faster than a single touchdown play, while at the same time nurses are going on strike to demand safe staffing levels for their patients.
So when people see any TV commercial or billboard highlighting a hospital system’s quality of care, then walk into that same hospital system’s emergency room only to find it dangerously overcrowded and understaffed, it is worth connecting the dots. Imagine how many lives would be saved if only we were to take the bold step of demanding that our health-care dollars be spent on actual health care.
Dr. Farzon A. Nahvi is an emergency medicine physician, the author of “Code Gray: Death, Life, and Uncertainty in the ER,” and a member of Physicians for a National Health Program.
