The State of the Health Care Worker Shortage

Health care work needs a check-up.

An aging population and expanding health care coverage means there are more patients to care for, but the supply of workers is struggling to keep up. Additionally, some areas of specialty and nursing will soon see the providers retiring en masse.

This narrative of the talent shortage mirrors issues the broader workforce faces, but there are unique challenges to health care work.

The Association of American Medical Colleges expects a shortage of at least 40,800 physicians by 2030, but this could be as high as 104,900, according to their March press release.

Nursing, in particular, is feeling strained. As noted in Nursing Economic$’s “State of the Registered Nurse Workforce as a New Era of Health Reform Emerges,” registered nurses, or RNs, could see a 35 percent increase by 2030, but this will not be uniform in all areas of the United States as some rural areas already struggle to access care. One-third of nurses are baby boomers, who will retire by 2030, taking their knowledge with them.

The influence of these shortages is already being felt, and failure to repair the divide between supply and demand will likely be felt in industries outside of health care.

“As we see these shortages becoming more acute, it will affect not only the health care system, but it affects the health of a city or of a community,” said Dr. Janis Orlowski, chief health care officer at the Washington, D.C.-based AAMC, which is a membership organization and not-for-profit organization that administers the Medical College Admission Test, or MCAT.

“I think that health care is really one of the basic building blocks for a strong and economically viable community,” Orlowski added. “So you want to have housing; you want to have good schools; you want to have good health care.” Areas with poor or insufficient health care access aren’t as economically viable as those that have strong health care systems, Orlowski said. Health care is a basic structural need for a strong community, which includes the business community.

Problems With Providers

Shortages of health care workers lead to burnout for overworked physicians and nurses, as well as decreased health outcomes for patients, said Dr. Peter Alperin, vice president of connectivity solutions at San Francisco-based Doximity, a social network and directory for health care professionals.

To replace these workers takes time. “It’s not renewable in the same way as other jobs and professions are,” Alperin said. It can take two to four years to become a registered nurse or nurse practitioner and nine or more years to become a doctor or surgeon.

Licensing and credentialing provide another hurdle for those in health care. States manage their credentialing requirements separately, meaning that a doctor trained in one state would have to retrain in another, as well as become credentialed at a specific hospital. “That’s a big roadblock,” Alperin said.

Fortunately, there is work being done toward solutions to these issues.

Solutions to the Stress

First, some states are coming together to repair the credentialing issue, Alperin said. Creating a reciprocity of licensure can facilitate movement of doctors and nurses. Some states are also changing their laws so nurse practitioners can have prescribing capability and practice outside the supervision of a physician.

Second, technology is moving in to fill some of the talent gaps. Social networks and job search engines, such as Alperin’s Doximity, aim to connect candidates with the appropriate positions, Alperin said. Also, telehealth, or systems that connect doctors and patients online, helps remote communities have greater access to health care. Artificial intelligence will also disrupt the medical world, as this technology is likely to help with warning signs that a patient could soon be sick, Alperin said.

Similar to other businesses, freelancers help hospitals care for increased workloads, said Abigail Tremble, president of Randstad Healthcare, a health care staffing firm based in Atlanta. However, data can work to a hospital’s advantage. “The more proactively you can plan labor and workforce, the better off you are,” Tremble said.

Hospitals face higher talent costs when they have to employ a traveling, temporary medical staff or pay full-time workers overtime to meet patient needs. The more that these institutions can use data to recognize the patterns in patient flow, the better.

Also, hospitals can use a broader mix of talent, which could include a combination of full-time staff, travelers and contingent workers aiming for full-time employment, Tremble said. Contingent workers provide an opportunity to ensure that they’re a match to the organization, without the hospital having to commit too soon or if the budget isn’t available to bring them on full time.

“One pill to save all” is unrealistic, Tremble said. There needs to be a combination of solutions to meet staffing goals.

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Graduation levels from nursing schools are rising, yet medical institutions feel pinched in finding experienced workers. “It begs the question: Is there really a shortage, or is there a shortage of nurses that already have two years of experience?” Tremble asked. Nurses can’t get jobs without experience, and hospitals need experienced workers.

“At some point, we’ve got to create some compromise,” Tremble said. As a result, hospitals should partner with local nursing schools and be more open-minded in hiring nurses with little experience. “If the talent pool doesn’t exist but the demand is there, we have to figure find a way to create the talent pool,” Tremble said. The way to do so is to bridge the gap between educational and medical institutions on the local levels.

Finally, health care policy needs to align to industry demands. There’s a delicate balance of managing patient flow, meeting patient needs and workers being reimbursed for their services. “We’ve got to get some stabilization around health care policy. There’s a lot that’s up in the air,” Tremble said.

In 1997, Congress capped the number of Medicare-funded medical residency slots at 1996 levels. However, this cap has not kept up with the demand for doctors, creating a bottleneck when physicians seek their residency. There’s a need and responsibility at local, state and federal government levels to participate and plan for an adequate physician workforce, AAMC’s Orlowski said.

Despite these challenges, medical school applications remain strong, Orlowski said. People still see this as a promising profession in which they can participate. “The future is bright for anyone who is interested in becoming a physician,” Orlowski said.

Correction: A previous version of this story mischaracterized the Graduate Medical Education funding cap. The story has been updated.

Lauren Dixon is an associate editor at Talent Economy. To comment, email editor@talenteconomy.io.