Headlines about how worker shortages are impacting businesses across the nation—from your favorite drive-thru to retail stores to manufacturing plants and running out of substitute teachers—are constant. COVID-19 continues to disrupt life throughout the U.S. The shortage within health services, however, is possibly most pervasive across the entire job landscape, dominating headlines and forcing states, as well as Congress, to take notice.
A sampling of headlines from earlier this month:
- Boston Herald (2/5): Nurses struggle with staffing shortages, low pay as colleagues leave in droves
- Axios (2/8): Fixing the health-care worker shortage
- Becker’s Hospital Review (2/11): Hospitals plead with Congress to tackle workforce shortages
- WXAX3 – CBS (Vermont)(2/14): Home health care worker shortage leaves families in a bind
- U.S. Army (2/15): Utah National Guard supports hospitals facing COVID surge
If you saw the jobs report released earlier this month, the employment situation is starting to look more positive: The unemployment rate is at 4%, down from a peak of 14.7% in April of 2020, and non-farm payrolls jumped by 467,000 in January. Through the months of COVID-19, however, health care and social services saw one of the largest drops in employment. According to the January release from the Bureau of Labor Statistics, employment in health care trended up for the month but is “down by 378,000, or 2.3 percent, from its level in February 2020.” With emergency department visits rising prior to the pandemic—up more than 60% since 1997—and hospitals still crowded with COVID-19 patients, what does this say about the future of health care in the U.S.?
According to the Association of American Medical Colleges, the U.S. is facing a shortage of up to 124,000 physicians by 2034, both in primary and specialty care. Nursing is facing its own challenges: Reports project that over 1 million new registered nurses will be needed by 2030.
Between December 2020 and December 2021, health care added 63,300 jobs—a 0.4% increase. While some might look at that number and say, “But it went up!” the answer isn’t as promising as you might think: As Modern Healthcare’s piece points out, that number pales in comparison to the year before the pandemic when there was a 2.1% increase. While the health care workforce issues have gained national attention thanks to COVID-19, the shortage has been in the making for a while.
In a National Academy of Sciences (NAS) workshop on the oncology workforce in 2009, concerns about a shortage of physicians, nurses, and health care professionals were evident even then. From NAS: “Many health specialties, including oncology, currently report a shortage of physicians. Despite an expected 21% increase in medical school enrollments between 2002 and 2012, the number of residencies has only increased 8% over the past five years.” The summary continues, “According to a 2005 survey of surgical residents, over 50% planned on pursuing subspecialty training, and only 15% planned on entering the workforce as a general surgeon.”
So why is there a shortage? Much of the answer is the aging U.S. population. Baby Boomers need more medical care and advancements in medicine are causing the population to live longer. In addition, many physicians and nurses are approaching retirement age, the average nurse is 50 years old. Complicating the matter is that many physicians choose to specialize in a certain field; while it helps the population with access to specialized care, it also leaves a dearth of primary care physicians.
It’s not just aging physicians being unable to keep up with an ever-growing aging population: Fatigue, both mental and physical, especially in the height of the pandemic, has caused health care workers to reconsider their role in the industry. According to a Morning Consult poll released last year, 1 in 4 health care workers considered leaving their job since COVID-19 spread to the U.S. in January 2020, with 14% of respondents saying they were considering leaving the health care industry altogether.
According to the Bureau of Labor Statistics, registered nurses totaled almost 3.1 million in 2019 and had projected openings of about 194,500 each year, on average, to replace those who transfer to other occupations or retire. Another estimate from the American Association of Colleges of Nursing suggests that the U.S. will need more than 200,000 new nurses each year through 2026. Nursing school enrollment is growing—up 5.6% from 2019 to 2020—but not enough to meet the demand.
A new Health Affairs study looking at nurse employment during the first 15 months of the pandemic finds that not only did nursing employment decrease—20% for licensed practical nurses (LPNs), 10% for nursing aids or assistants (NAs), and 1% for registered nurses (RNs)—but health care organizations couldn’t hire the number of nurses they needed during COVID-19 because of nursing workforce constraints.
Nursing homes and nursing care facilities also have felt the impact. The Peterson-KFF Health System Tracker notes that “employment had been growing in every health service industry between 2017 and early 2020 except for nursing care facilities.”
Urban and rural communities have borne the brunt of these shortages. In rural areas, some small hospitals have closed or shut down services in recent years, partly because they haven’t been able to attract and retain doctors, nurses, and other clinicians. Despite loan forgiveness and other incentives, clinicians are hesitant to venture into unknown territory, remaining instead in areas of the country where they were raised or trained. And many of those who do go to rural areas don’t stay long.
Across the country, clinician complaints have historically landed on payment for services, but the problem goes far beyond money. Indeed, caring for patients during the pandemic has drawn attention to quality of life, mental health, physical health, and safety issues. During the pandemic, hospital nurses, for example, have routinely worked long hours to cover for sick colleagues, donned uncomfortable PPE, and been exposed to an unpredictable virus.
BPC’s April 2020 report, Confronting Rural America’s Health Care Crisis, demonstrates how workforce shortages can impact a community—particularly rural communities, which are especially hard hit by shortages. While urban areas have 53 primary care physicians for every 100,000 people, rural areas have only 40 primary care physicians to care for the same number of people. The numbers are similar for nurse practitioners, physician assistants, and dentists. For specialists, the discrepancy is alarming. While urban areas have 263 specialists per 100,000 people, rural areas struggle with only 30 specialists.
Part of the problem is aging. Nearly one-third of primary care providers in rural areas were older than 56 in 2009. Because rural communities rely heavily on primary care clinicians, it is troublesome that only 12% of medical students are entering primary care residencies, and most of those graduates will not choose rural America as their home.
Fast forward to the pandemic: Rural hospital CEOs tell BPC that the nursing exodus is leaving them in dire straits. Many rural hospitals already experience year over year losses and even if they don’t close, many are considering ceasing important services, such as obstetrics and maternal care, if they haven’t already done so. While some hospitals are already struggling to make ends meet, one rural hospital CEO indicated that the nursing shortage is costing them an additional $2 to $3 million a year because they must pay for travel nurses, which costs them two to three times more than staff nurses.
To stem the effects of the shortages, states as well as hospitals across the country are trying to attract workers and improve their staffing situations. Gov. Kathy Hochul (D-NY) last month announced her plan to grow New York’s health workforce through higher wages, retention payments, and expanded access to training and education. Gov. Tim Walz (D-MN) made January “Health Care Month” in an effort to draw attention to the open health care positions across Minnesota. Other states like Idaho, Utah, and Wisconsin are calling on the National Guard to help fill the gaps.
Meanwhile, hospitals in the U.S. are turning to recruiting, not just within the borders of the United States but also abroad. According to a recent piece in NPR, administrators in Billings, MT, have “contracts with two dozen nurses from the Philippines, Thailand, Kenya, Ghana, and Nigeria.”
While states are taking notice, advocates are urging them to do even more. In New Mexico, a state that saw nursing shortages before the onset of COVID-19, activists and even editorial boards are encouraging the governor and state legislature to go beyond their initial $15 million investment in the issue and in the process, work toward a long-term solution to the problem.
Traveling nurses, additional money for nursing programs, the National Guard: the shortages in health care coupled with the pandemic have forced hospitals and states to scramble and do what they can to fill the void. But these shortages have a broad impact on patients and communities across the country and if not addressed, could lead to drastic cuts in care and be a detriment to overall public health in the future. So, what’s the long-term, sustainable solution? Stay tuned: BPC’s health team is working on a new project to better inform future decisions made by Congress, state legislatures, and hospitals across the U.S. to improve the health care workforce. BPC will also host discussions exploring the scope and nature of nursing workforce shortages, as well as potential solutions to the workforce shortages.
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