It’s been a long few years. For many of us, the Covid-19 era has brought a number of serious challenges in the healthcare industry, from burnout to staffing issues to financial hurdles—not to mention several public health emergencies happening all at once. While I hope we’re turning a corner on the 2020s frenzy (yes, that’s how historians will fondly reflect on this time), I’m happy you’re here. Welcome to Healthcare Brew.

Our publication will explore this trillion-dollar industry at a critical point in American medicine. People are disillusioned with the healthcare system, but rely on it more than ever. Employment in the healthcare sector is projected to grow about 13% between 2021 and 2031—faster than the average for many other occupations. We’re here to help you make sense of our complex healthcare system, from understanding the flow of capital that affects bottom lines and services rendered to decisions that impact the nation at large.

In future issues, we’re excited to dig deep into issues such as healthcare technology, women’s health and maternal mortality, and cannabis’s changing role in medicine and society. I hope you’ll keep reading with us for these subjects and more.

We don’t shrink from nuance. Instead, we’ll get to the heart of problems and answer the big, burning question: Why does this matter to you, the healthcare professional? Your time is valuable, and your role is vital—we want to ensure that you feel smarter and better informed after reading our coverage. Our newsletter will hit your inboxes on Mondays and Wednesdays to start. Hopefully, you’ll have some fun with us along the way.

I’m Amanda Eisenberg, editor of Healthcare Brew. I previously served as the New York City healthcare reporter for Politico. Also on our team is Los Angeles-based Maia Anderson, formerly of Insider, and Indianapolis-based Michael Schroeder, formerly of US News & World Report. Together, we’re ready to give you sweeping healthcare coverage from coast to coast.

But we can’t do it without you. Hit us up, whether that’s in our DMs—we’re on LinkedIn and on Instagram and Twitter @HealthcareBrew—or our inboxes, and share your stories stat.—AE

Do you work in healthcare or have information about the industry that we should know? Email [email protected] or DM @aeis17 on Twitter. For completely confidential conversations, ask Amanda for her number on Signal.

Gig work has become a major disruptor for one of the most stable healthcare gigs: nursing.

During the height of the pandemic, hospitals used what Deirdre Baggot, a former nurse who now works as a healthcare consultant at the firm Oliver Wyman, called a “shotgun approach” with hiring gig workers. Baggot explained that essentially, hospitals were hiring huge numbers of on-demand workers, sometimes more than necessary, because of the sudden massive spike in demand and inability to predict when surges would take place.

“You couldn’t really anticipate demand, so you placed a big order for gig workers, maybe more than you needed, because you were worried about…having a shortfall. And we didn’t have the level of precision that we needed,” Baggot said.

Hospitals are spending more on nursing labor: Hospitals relied on gig nursing way more post-pandemic—travel nurses worked less than 4% of all hospital nursing hours in January 2019, but more than 23% by January 2022, according to data from analytics firm Syntellis Performance Solutions cited by the trade group American Hospital Association (AHA).

Is gig nursing in healthcare sustainable? Experts say yes, but significant changes need to take place in how hospitals utilize travel nurses.

“A lot of hospitals that are struggling now [are] not because we have travel nurses, it’s the amount of travelers that they have,” said Katie Boston-Leary, director of nursing programs for the American Nurses Association. Keep reading here.—MA

Chime in: Is your system building out an in-house staffing agency? Are there other roles that require this kind of creative problem solving? Reply to this email, or tweet us @healthcarebrew with your thoughts.

Hospitals this year are seeing more red than black as growing financial challenges, like spiked labor costs and inflation on medical supplies, puts them on pace to have the worst financial performance into the pandemic thus far.

More than half of hospitals (53% of more than 900 sampled) are projected to have negative margins by the end of the year, compared to 39% in 2019, according to a September report from management consulting firm Kaufman Hall, on behalf of AHA.

The firm put the median operating margin for hospitals at about -1%, which could mean service cuts, and for more vulnerable hospitals, including rural ones, closing their doors.

But why is the financial outlook so bleak for hospitals? A few factors are conspiring.

Labor costs: The top reasons hospitals are struggling financially in 2022 are “labor, labor, and labor,” said Kevin Holloran, senior director at Fitch Ratings. The healthcare labor shortage doesn’t just extend to nurses, but across the board.

Rising supply prices: Blame inflation. AHA reported that the “costs for energy, resins, cotton, and most metals surged in excess of 30%” between fall 2020 and early 2022.

Sicker patients, longer stays: Intensive care units across the country were overwhelmed with Covid-19 patients at the outset of the pandemic, but more recently hospitals have been caring for sicker non-Covid patients, said Aaron Wesolowski, AHA’s vice president for policy research and analytics. Keep reading here.—MS

Do you work in healthcare or have information about the industry that we should know? Email [email protected] or DM @MikeSchroederIN on Twitter. For completely confidential conversations, ask Michael for his number on Signal.

Today’s top healthcare reads.

Stat: In instances of child abuse, the parents are the perpetrators four out of five times. (The Cut)

Quote: “We are so baby focused. Once the baby is here, it’s almost like the mother is discarded. Like a Reese's Peanut Butter Cup.”—Karen Sheffield-Abdullah, a North Carolina nurse-midwife, on how overlooked issues can result in maternal mortality (NPR)

Read: Sizeism greatly affects how people with anorexia are able to qualify for and receive treatment. (the New York Times)

Midnights: “Wow can’t believe four whole songs on Taylor Swift’s new album are about the US healthcare system.”—Emma Wager, Kaiser Family Foundation policy analyst, on Taylor Swift’s 10th studio drop