What drives perfusionists away from a program is rarely one bad case or one difficult stretch. It's the slow grind of chronic understaffing: call schedules that never let up, PTO requests that get denied or guilt-tripped into cancellation, and the sense that there's no slack anywhere in the system to absorb a sick day, a leave, or a busy month.

Interestingly, the one lever that can help fix that is also the one everyone's been trained to view with suspicion: supplemental staffing. It often tends to get a bad reputation across healthcare, treated like a band-aid, a sign that a program is struggling, or even a threat to the people already on staff. 

Some of that comes from how supplemental staffing usually gets introduced: as a last resort, called in only once a department is already in crisis, so it becomes associated with the crisis itself rather than with the relief it's providing. Some of it is that bringing in outside help can feel like an implicit judgment on the people already doing the job, as if the existing team wasn't good enough or hard-working enough to keep up on its own. 

But used well, flexible and on-demand perfusion coverage isn't competition for the core team. Rather, it’s what protects them from the conditions that make them quit in the first place.

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Understaffing is the real threat

Perfusion programs run on thin margins of people. Most departments are staffed to cover routine volume, which can easily crumble when unexpected things happen. The most common culprits are:

• OR surges, when several complex cases land in the same week and there's no way to add coverage without someone picking up extra hours.
• ECMO coverage and ECMO surges, where a single long run or several active patients at once can consume the staffing capacity a program was counting on for everything else.
• PTO, when time off is technically on the books but there's no one to cover it, so requests get delayed, denied, or withdrawn.
• Parental leave, a predictable multi-week or multi-month gap that still tends to get treated as something the remaining staff have to absorb.
• Illness and other unplanned absences, where a program has no runway to prepare and ends up scrambling in real time.

Together, these add up to the same root issue: a program with no flexibility built into its staffing model.

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What the skepticism gets wrong

Once you factor in the ways understaffing wears a core team down, leads to burnout, and eventually pushes people to leave, most of the reasons supplemental staffing gets treated with suspicion stop making sense. 

In reality, a flexible staffing plan is best understood as an investment and a piece of infrastructure, one that, with the right onboarding in place, can absorb the surges and unpredictabilities inherent in healthcare.

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An investment, not an expense

It's easy to look at the per-shift rate for supplemental coverage as a standalone line item and treat that number as the whole cost picture. But a budget line is only part of the story. The other side includes the cost of a perfusionist who burns out and leaves, the cost of recruiting and training a replacement, and the cost of having to delay or cancel OR cases or transfer ECMO patients to another facility because there wasn't enough staff to cover them. Weighed against that, bringing in flexible coverage during a surge or a leave is what keeps a program running at full capacity, and running at full capacity is worth paying for.

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Infrastructure, not a last resort

A flexible staffing partnership works best as something already in place before it's needed. The plan and the relationship should be set up ahead of time, so when a surge hits, a leave comes up, or a program needs backup in a pinch, there's already someone to call instead of scrambling to build that relationship from scratch. 

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An onboarding problem, not a trust problem

A supplemental perfusionist covering a surge or a leave doesn't need years of history with a program to competently run a case or a shift. Running the pump safely, managing the circuit, and responding to whatever the case throws at them comes down to training and experience, the same clinical competency any perfusionist carries with them from program to program. 

What actually differs from site to site is the administrative layer: where supplies are kept, how a specific team communicates, which surgeon prefers what during a case. That's what onboarding is for, and it's a normal part of bringing on staff of any kind, one most programs can easily handle. 

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A volume problem, not a performance problem

Healthcare doesn't run on a predictable schedule. No matter how well a program plans its staffing, it can't account for every curveball or predict exactly what a given week will bring. That unpredictability is the reason a backup plan matters, a plan B or C that a program can call on when reality doesn't match the schedule.

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The case for a backup plan

When flexible staffing is built in as a standing part of the schedule, the whole program runs more steadily. A perfusionist puts in for a week of PTO and the shift gets covered, without delay, a guilt trip, or anyone treating the request as an inconvenience. Parental leave doesn't turn into a countdown the rest of the team dreads, because coverage for that leave was arranged before it started. An illness or a sudden family emergency gets absorbed seamlessly, without a string of phone calls trying to find someone available on short notice.

It's perfectly reasonable to expect an uninterrupted vacation, a call schedule that's manageable, and weeks that don't always run into overtime. None of that is out of reach, it just takes the foresight to plan ahead and have that coverage already in place before it's needed. When built this way, flexible staffing becomes part of the same system that keeps a program's best people around. 

So, what's the backup plan? And if there isn't one, is that worth what it can cost the core staff in burnout and eventually turnover?

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