No quick and easy answers for health care workforce shortages

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Workforce shortages are evident, but experts said there are no easy remedies to current employment issues across the U.S. health care system.

On Nov. 16, KFF hosted “The Health Care Workforce Under Pressure: Strikes, Shortages, and Staffing Requirements,” as part of its regular Health Wonk Shop webinars with panels to discuss current issues in health care.

Is there a workforce shortage in health care? The answer is not a simple yes or no, said Bianca Frogner, director of the University of Washington Center for Health Workforce Studies, and professor in UW’s Department of Family Medicine.

“I think generally, there is a broad perception among employers that we have a shortage but we really have to ask, where? For whom? But what purpose are we having a health workforce shortage?” she said. “I think we certainly feel a lot of stress in the primary care space. I think we're feeling a lot of stress in the behavioral health space, as well as the long-term care space. So, we have many sectors of the health care industry that are certainly feeling a crunch of trying to find workers to fill the slots. As well as, then we have like a maldistribution problem of different areas of the country also struggling to find workers to fill the slots that they need, particularly in rural areas and underserved communities.”

Nurses in need

McKinsey & Co. and the American Nurses Foundation conducted a survey this year that found 56% of nurses are experiencing symptoms of burnout – “an unacceptable state,” said Gretchen Berlin, a registered nurse and McKinsey senior partner.

Among other findings:

• About 20% of nurses indicated they changed positions in the past six months
• About 39% of nurses indicated they were likely to leave their current positions in the next six months. That was up to about 41% of nurses who provide direct care to patients.

In earlier surveys, figures of 25% to 30% of nurses wanting to leave were shocking; but that has remained consistent and now industry watchers have gotten used to it, Berlin said.

American employers cannot expect an influx of foreign-born workers to fill in gaps. Burnout has become a global issue, with health care workers in other developed countries having similar feelings as those in the United States, Berlin said.

“And at the end of the day, what we're seeing folks say they want, is a safe work environment, some work life balance, a workload that they feel they can successfully deliver on a daily basis, and that's been consistent across time as well as across geographies,” Berlin said.

Long-term care

The COVID-19 pandemic disproportionately affected the long-term care workforce, said Alice Burns, PhD, associate director of KFF’s Program on Medicaid and the Uninsured.

The job requires skills from changing catheters to preparing food. Medicare and private health insurance generally don’t pay for long-term care, so payment comes from Medicaid and people paying out of pocket, Burns said. That pushes down payment rates, which in turn pushes down wages, so long-term care workers may be earning $15 an hour, the say pay they could make at a much less physically and mentally demanding job at a department store or coffee shop, Burns said.

Meanwhile, the administration of President Joe Biden has proposed minimum requirements for registered nurses and nurse’s aides. Facilities would have three to five years to comply, and there would be broad hardship exemptions, Burns said.

Based on those requirements, currently fewer than one in five facilities would meet the minimums, Burns said.

“Nurse facilities might need to pay more, to certainly have more staff and to attract more staff,” said KFF Executive Vice President for Health Policy Larry Levitt, the webinar moderator. “You know, where would the money come from to pay for that?”

“So, that is the question, right?” Burns said. States have been using COVID-19 pandemic funding to develop innovative strategies to help. Increasing pay is part of it, but workers also have responded to newly created career ladders and opportunities for advancement.

“You know, making these jobs a place people want to be,” Burns said.

Competing for workers

Hospitals also have looked at staff-to-patient ratios, with an eye toward quality, and those do help to make sure patients get high-quality care, Frogner said.

“But the problem is, where’s the supply of workers when you put those ratios into play?” Frogner said. The three panelists noted hospitals, nursing homes, ambulatory settings all compete for workers.

It is possible that more people could enter training programs for nursing. Pay is a factor, Berlin said, but it also is important to have meaningful work in a positive environment. The trauma of the COVID-19 pandemic, and more current reports about workplace violence in emergency departments and other care settings, may be deterrents to new workers, she said.