By Michael Ollove
Last week, top Hawaii officials received an urgent warning: If they didn’t act, the state would lose the services of hundreds of health care workers who have been essential in confronting the COVID-19 pandemic.
The state had not extended a waiver of licensing requirements that had been in place for the past two years, noted Hilton Raethel, head of the Healthcare Association of Hawaii, which represents the state’s hospitals, skilled nursing centers, assisted living facilities and hospices.
“This will place a materially increased burden on our existing workforce which has been stretched and strained dramatically during the pandemic, and we risk losing even more of our current permanent workforce which will have a significant impact on the ability of our hospitals and other healthcare institutions,” Raethel wrote to state officials.
Even if the state takes that key step, Raethel said in an interview, the underlying crisis in health care will continue. There simply aren’t enough workers of all types—doctors, nurses, respiratory therapists, lab techs, behavioral health specialists, medical assistants—to fill vacancies, not only in Hawaii, but also across the country.
“Workforce in health care is an issue of national significance and is reaching a crisis in many parts of the country,” said Akin Demehin, director of policy at the American Hospital Association trade group. “Leading up to the pandemic there were already significant workforce challenges. The pandemic has amplified them, stemming from fatigue after wave after successive waves of patients.”
The lack of workers has become so dire that at least 20 governors this year directly addressed the situation in their state of the state speeches, proposing a range of policy fixes, according to the National Academy for State Health Policy, a nonpartisan forum of state health policymakers.
That’s a significant change, said Hemi Tewarson, head of the academy, who until recently was a health policy expert at the National Governors Association. There have long been shortages of certain health care workers, she said, but governors instead have focused on issues such as opioid misuse, prescription drug prices and mental health.
That changed this year, as governors talked about boosting recruitment efforts, loosening licensing requirements, expanding training programs and raising providers’ pay, either directly or by increasing Medicaid reimbursements.
Rural and some economically distressed urban areas, which have harder times attracting health care workers, dominate lists of regions federal officials consider “health professional shortage areas.”
“We just have increased difficulty in recruiting and attracting folks who want to live and work in a rural area,” said Craig Thompson, CEO of Golden Valley Memorial Healthcare, a rural Missouri health system more than an hour from Kansas City.
In 2021, the job vacancy rate in Missouri hospitals was over 20%, according to Dave Dillon, a spokesperson for the Missouri Hospital Association. This year, that’s expected to rise to 25% for all hospital medical disciplines, including doctors, respiratory therapists, dieticians and medical assistants, he said.
Similar crises have been building in many states.
Exhaustion and Burnout
Exhaustion and burnout have taken an enormous toll on the health care workforce during the COVID-19 crisis. Nearly 20% of health care workers quit their jobs during the pandemic, and a third of those remaining acknowledged that they’ve thought about quitting, according to a survey by Morning Consult, a marketing research firm.
But the shortage didn’t start with the pandemic and won’t end with it.
In 2019, the United States had nearly 20,000 fewer doctors than required to meet the country’s health care needs, according to an estimate by the Association of American Medical Colleges, which analyzes the physician workforce. At the current rate, the group said, that gap could grow as high as 124,000 by 2034, including a shortage of as many as 48,000 primary care doctors.
“Within the next 10 years, two of every five physicians in the workforce will be 65 or older,” said Michael Dill, the group’s workforce studies director.
Meanwhile, the population also is aging and requiring more health care. “Just when we need physicians more, we will have a large cohort of physicians reaching retirement age,” he said. There aren’t enough physicians in training to replace them.
Similarly, the average age of employed registered nurses climbed from nearly 43 to nearly 48 between 2000 and 2018, and nearly half are now over 50, according to the University of St. Augustine for Health Sciences in Florida.
The U.S. Bureau of Labor Statistics estimates that each year through 2030, there will be nearly 195,000 vacancies for registered nurses. The St. Augustine report says that the profession isn’t producing registered nurses fast enough to meet the demand.
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