An Unhealthy Commute: The Transit Challenges Facing New York City’s Healthcare Sector

Report - January 2018

An Unhealthy Commute: The Transit Challenges Facing New York City’s Healthcare Sector

Subway and bus service in the four boroughs outside Manhattan has not kept pace with massive increases in the number of healthcare employees living and working there. By partnering with hospitals and other health providers, New York City can develop solutions befitting the city’s world-class healthcare system and ensure that this critical source of employment and opportunity can continue to grow.

by Arlene Weintraub

Tags: transportation boroughs healthcare

A number of pressing challenges and threats face New York City’s healthcare sector, including the uncertain fate of the Affordable Care Act. But the industry with more jobs than any other across the city is increasingly coping with a serious problem closer to home: severe shortcomings in the transit system. New Yorkers working in healthcare jobs have the longest commutes of any industry, and their commutes have been getting far worse. Moreover, the industry’s transit challenges are affecting far more New Yorkers today, following a decade in which the healthcare sector added more than 140,000 jobs in the city—roughly 80 percent of them in the four boroughs outside of Manhattan. These nightmarish commutes have become routine, contributing to an increasingly poor quality of life for the many low- and middle-income New Yorkers who work in the sector, while also leading to higher turnover for employers in the industry and negatively affecting quality of care at hospitals, nursing homes, and urgent care centers. 

As this report details, the problem largely stems from two factors: inadequate transit options for people working in the four boroughs outside Manhattan and a badly neglected bus system. Addressing these two related issues would boost the healthcare sector overall and help tackle one of the biggest problems facing New York City today and in the decade to come. A combined effort to solve the transit problems bedeviling the healthcare sector would help make the boroughs a more competitive environment for businesses to grow, strengthen the city’s economy, and improve quality of life for millions of New York’s workers. 

Make it a priority to improve transit service in the four boroughs outside Manhattan.
New York City’s transit system has not even come close to keeping pace with the rapid growth in the number of people living and working in the four boroughs outside Manhattan. It’s time to change that. The MTA needs to make a bold new commitment to improving transit service in the Bronx, Brooklyn, Queens, and Staten Island. This should include new investments that increase the frequency of subway and bus service, as well as new efforts to address some of the biggest gaps in transit service. Top city and state officials—including Governor Cuomo, Mayor de Blasio, and members of both the City Council and State Legislature—need to make this a priority as well, and commit new funds that enable the MTA to take these steps. 

To be sure, the city’s subway system requires significant new public investment simply to address the rampant delays and overcrowding issues that are now regularly disrupting service in the five boroughs. But it would be a mistake and missed opportunity to only focus on addressing these core transit infrastructure problems. MTA leaders and New York’s top policymakers must also prioritize investments that improve transit service for New Yorkers who live and work in the boroughs outside of Manhattan—including the 319,000 healthcare employees who live in the Bronx, Brooklyn, Queens, and Staten Island. 

Support congestion pricing to create a sustainable, dedicated revenue stream to invest in transit gaps.
New York City’s transit system desperately needs a dedicated revenue stream if it is going to make a bold new commitment to improving transit service in the four boroughs outside of Manhattan. The governor’s Fix NYC proposal would do just that. All state legislators from the five boroughs should get behind Fix NYC, a congestion-pricing plan that offers a fair balance between revenues raised from Manhattan residents and from residents of the other four boroughs, while directing crucial investment to improve service beyond Manhattan and fix transit gaps. The revenue generated— estimated at more than $1.7 billion annually—should be used to invest in transit improvements across all five boroughs, including bolstering the MTA Capital Plan and creating a Transit Gap Investment Fund. 

Improve and expand bus service. 
For so many of those working in New York City’s healthcare sector—and for the New Yorkers who take more than 2.5 million daily bus rides—buses remain the only viable transit option. This wouldn’t be a problem if the city’s bus system was up to par. But it’s not even close. Throughout the city, buses are unreliable and slow. They don’t run frequently enough, and transferring from one bus to another is rarely efficient. Additionally, too many routes simply haven’t been updated to align with the actual commutes that working New Yorkers take today within their own borough or from one borough to another. New York’s top policymakers and transportation officials need to make improving and expanding the city’s bus network a higher priority. Specifically, they should commit to the following steps: 

  • Launch a Bus Rescue Plan to improve the speed and reliability of bus service.
    For hundreds of thousands of workers in the boroughs outside Manhattan, especially the masses of workers in the booming healthcare sector, commuting by bus can be agonizing. When buses fall behind schedule and bunch together, the result can be long waits even at rush hour and even longer gaps at night. For commuters who rely on multiple buses, like many workers in eastern Queens and southern Brooklyn, the transfers are rarely coordinated, leading to unexpected delays and overcrowding as riders pack the bus stops waiting for their next ride. Even though bus ridership has fallen over the past 15 years, ridership is up on most of the routes serving major healthcare employers—especially those in the boroughs outside Manhattan. For these thousands of workers, relief can only come in the form of faster and more reliable bus service. 

    To tackle these system-wide problems, the MTA and DOT should move quickly to implement a host of best practices that have demonstrated results in other cities and systems. Strategies should include adding new routes between population centers and job hubs, redesigning indirect routes, breaking up overly long routes, and rightsizing the distance between bus stops. In addition, an improved boarding process—including a tap-and-go fare collection system and all-door boarding for all routes—could dramatically reduce the wait at each stop. Lastly, the MTA should work with DOT to implement more dedicated bus lanes that can dramatically speed up bus travel on crowded streets. Both new and existing lanes also need to be properly enforced to ensure that lanes remain clear and violators are fined. 
  • Implement new ideas to keep buses on schedule, improve multi-bus commutes, and close service gaps.
    For commuters who depend on buses, the posted schedules are considered wishful thinking. Healthcare workers interviewed for this study described frustration over the fundamental unpredictability of bus service, which forces stressed workers to allocate the maximum possible time to their commutes on the assumption that something will always go wrong.  The problem stems from the fact that once a bus falls off schedule, it almost never recovers, resulting in buses that are chronically late, bunched together, or poorly coordinated. To fix this problem, the role of the bus dispatcher needs to change. Dispatchers should be empowered to intervene when buses fall behind schedule, working with drivers to modify service based on real-time location data, and tasked with ensuring that connections and transfers are efficiently coordinated to improve the reliability of multi-bus commutes. The MTA has taken one major step forward over the past year by equipping its entire bus fleet with signal priority capability, so that buses can benefit from optimized traffic signal coordination along busy routes. Now DOT needs to prioritize rolling out this feature along as many routes as possible, starting with a goal of at least ten routes over the next year. 
  • Expand Select Bus Service in the boroughs.
    The most cost-effective way to increase mass transit access and improve bus service is through the expansion of Select Bus Service, New York City’s version of bus rapid transit. For workers traveling from affordable neighborhoods on the periphery of the city to jobs that are often located on the opposite side of a borough or in an adjacent one, bus rapid transit could significantly shorten and improve commutes that are often among the worst in the city.  That’s why it’s so essential for the MTA and DOT to make good on their promise to complete the 20 future SBS routes first outlined in 2009, while continuing to develop proposals for additional routes. Today, the city has just 15 SBS corridors, of which there are just two in Brooklyn and three in Queens. None of those five corridors provide crucial crosstown service. In October 2017, the 30 Center for an Urban Future New York City Department of Transportation announced plans to expand SBS along 21 new routes, including several that would provide much-needed crosstown service in Brooklyn and Queens. The MTA should work closely with the city to implement these routes and set a goal of completing at least seven by 2020.
  • Apply the lessons of the MTA’s Staten Island bus overhaul to other areas of the city. 
    The MTA’s ambitious plan for Staten Island, set for implementation in 2018, marks the first major reimagining of bus routes in decades. The plan includes four crucial components that could be broadly applicable to other parts of the city. First, the plan will divide the network into two routes serving either Lower Manhattan or Midtown, reducing redundancy and increasing clarity for commuters. The plan will also eliminate underused stops while boosting frequency of buses on a smaller number of routes. In addition, the plan streamlines all routes in Staten Island, using highways instead of local roads wherever possible. The MTA should choose three other areas for a similar reimagining, with a focus on the neighborhoods that are most reliant on bus travel. At the same time, the MTA needs to prioritize the second phase of the Staten Island redesign, which is intended to improve local bus service within the borough and will be essential for addressing the transit challenges facing Staten Island’s healthcare employers and workforce. 
  • Rethink and redesign the bus network.
    Despite massive changes in the city and its economy over the past several decades, much of the bus route network mirrors the trolley lines laid out in the mid-20th century and hasn’t changed since the 1980s. To modernize the bus network, the MTA needs to determine how and where the current bus system is failing and redesign as needed. The MTA should develop plans to redesign the bus network to focus on speed, efficiency, and coverage— a strategy that can lead to an increase in ridership while bridging some of the city’s worst transit gaps. Houston offers a model of a highly successful, full-scale redesign, which transformed a peak-oriented radial network into a high-frequency, 24/7 grid.   

Create a healthcare-transit working group to identify and solve transit challenges. 
The pressing transit challenges facing workers in the healthcare sector demonstrate the disconnect between transit planning and the needs of the city’s economy. The city and state should convene a working group—comprised of the MTA, DOT, major healthcare employers, and the largest healthcare unions—to understand the transit issues facing healthcare workers and employers and develop plans to address these issues with targeted improvements to the transit network. As part of DOT’s Citywide Transit Plan, the department should partner with hospitals and other health providers to better understand how the city’s half-million healthcare workers use the transit system. Armed with this information, transit officials can better plan additions and enhancements to both subway and bus service that will alleviate problems for the city’s largest sector. This model could then be applied to other key industries across New York City that face significant transit challenges, such as the educational services sector. 

Improve transit options for night-shift workers.
The MTA should work with health providers to determine when the demand for bus service by workers on night shifts is high, and which routes carry large numbers of passengers at those times. From there, schedules could be enhanced to provide more frequent pick-ups and drop-offs along routes that directly serve hospitals, urgent care centers, and nursing homes, as well as better coordination at popular transfer points. The MTA should also consider surveying home health agencies to determine where the need for more frequent bus service at off-hours is the highest, and then make scheduling changes to fill in the gaps. 

Explore strategies to target the needs of home health aides.
This report makes clear that home health aides suffer some of the longest and most challenging commutes of any workers in New York City, with serious consequences for the workers themselves and the quality of care they can provide. With more than 100,000 new jobs created in the past decade alone and a growing population of older adults, home health will continue to be a major component of the healthcare ecosystem for decades to come. The MTA and city transportation officials should work with representatives of the home health industry and unions to better understand the needs of workers and employers in the sector and develop specific interventions that could help improve these brutal commutes. Transit officials could consider forming partnerships with carshare and on-demand transit services, leveraging the existing paratransit system, and creating specialized shuttle services along high-demand routes, among other options.

Make transit more affordable for low-income workers.
The cost of commuting has become a major burden for low-income workers, particularly for those in the healthcare sector—such as home health aides—who routinely face difficult commutes involving multiple modes of transportation. The rollout of a “contactless” MetroCard in 2018 offers a crucial opportunity to shift toward a more equitable model for fares. The MTA should implement a capped payment structure, which would address the issue that wealthy commuters consistently pay less per ride than the city’s poorest workers. This happens because many low-income commuters can’t afford the upfront cost of weekly and monthly MetroCards, which come with a significant discount. In a capped system, pay-as-you-go cards are tracked each time they are used, and the total cost is capped at the price of a weekly or monthly pass. If a user exceeds the cost of a weekly pass through individual rides, the system automatically refunds the difference to the user’s bank or credit account. The MTA should build in backend processing capacity for the next-generation MetroCard, to allow for a more flexible system to be implemented. 

Be better prepared for weather emergencies.
If buses and elevated subway lines must be shut down during heavy snow or rainstorms, the MTA should provide alternate transit options for healthcare workers. MTA and DOT researchers should work hand-in-hand with administrators in the healthcare sector to establish emergency travel plans, such as shuttle buses from working subway stops to nearby hospitals. The MTA’s recently announced division focused on weather issues should make contingency planning for the healthcare sector a priority and partner with healthcare employers to understand their needs in the event of weather emergencies. 

One option would be to establish emergency corridors that could be used to create healthcare shuttle services during emergencies. DOT should consider piloting such a corridor along Bedpan Alley on the east side of Manhattan or from Grand Concourse to Lincoln Hospital and Montefiore Medical Center in the Bronx. These routes could be plowed early in the case of a snowstorm and opened only to registered vans operated by healthcare providers with the right equipment to handle severe weather conditions. Healthcare employers can do their part, too. In addition to improving planning for getting front-line employees to work when large parts of the transit system shut down, employers should also consider implementing work-at-home policies for administrative and other non-medical staff during weather emergencies.

Invest in technology to help health workers track and plan their commutes and improve communication.
As with other key sectors of the economy, one problem for transit planners is that most healthcare employers are not keeping track of their commuting patterns. To help job centers participate in transit planning, the city could develop and pilot an app that would make it easy for administrators and workers to track commuting distances, modes, and times for their employees. In addition, workers report that a lack of consistent information from the MTA makes it difficult to cope with service interruptions. Despite advances such as WiFi service on subway trains, the MTA app, and subway countdown clocks, most health workers we spoke to report that they don’t have enough advance notice to plan an alternate route to work when something goes wrong on their bus or subway. The MTA should work to improve communication between subway operators, bus drivers, and dispatchers. That will allow conductors and drivers to provide better information to passengers about what’s causing the delays, and what alternate routes they should consider. 

Pursue the next generation of transit expansion across all five boroughs.
New York City’s transit system needs substantial investment just to achieve a state of good repair, but policymakers and transit planners should think beyond a rescue plan. By bonding a portion of the revenue generated by Move NY, the city can raise billions for forward-thinking transit system expansion that better integrates all five boroughs. Ideas could include the proposed Triboro line, which would connect the Bronx, Queens, and Brooklyn; real bus rapid transit along dedicated cross-county bus lanes; LIRR-to-subway conversion along underutilized tracks in Brooklyn and Queens; and new service options for Long Island and the Hudson Valley to better integrate New York City to regional transit networks.

This research was made possible by TransitCenter

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