There's no quick fix and no single solution. A long-term approach needs to focus on these technology, administrative, credentialing and legislative solutions.
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As a nation, we are faced with a critical health care worker shortage that requires both immediate and long-term solutions. The current climate in many hospitals and clinics in the United States is dire.
This predicament wasn't created by the overwhelming impact of the COVID-19 pandemic on the health care system. The public health crisis did exacerbate existing problems, but it also provided stakeholders with an opportunity to examine areas of weakness so we can address them before the situation worsens.
There is no quick fix to the health care worker shortage and no single solution. A multi-faceted approach should encompass these major pillars:
The Numbers and the Reasons
By 2034, studies estimate that the United States will have 134,000 fewer physicians than it needs. These shortages are across the board in primary care, surgical specialties, medical specialties and other departments.
The main reasons: Older physicians are retiring out of the field and the U.S. population is aging. More than 10,000 people a day turn age 65 and these older years are when most health care utilization occurs. Plus, because the barriers to accessing health care have been reduced in recent years, we're seeing more Americans reaching out for care.
Shortages in nursing are also projecting. The reasons are the same as physician, and also because it is hard to find enough educators and bandwidth at facilities for rotations and on-site training.
Another factor: The trend toward remote work is luring more employees out of health care, a field that requires mostly on-site work. In fact, half of all employees and more than two-thirds of white-collar employees are working remotely in some capacity now.
To combat these nursing shortages, many health care providers have turned to the short-term solution of hiring traveling nurses. However, traveling nurses are often paid as much as 10 times their local counterparts, exacerbating a climate of feeling underpaid and underappreciated on the part of the nursing workforce. This is further deteriorating an already delicate climate of mistrust among hospital staff and administrators.
Pillar I: Technology Solutions
More telemedicine. One potentially positive impact of the pandemic was that both health care providers and patients became much more comfortable with telemedicine. Importantly, two-thirds of clinicians now say they prefer virtual-only or hybrid treatment settings—a big increase from before the pandemic. Giving clinicians this option can help with retention efforts.
Virtual hospitals can also relieve the doctor shortage, particularly in rural and underserved areas, allowing for physician-led treatment in areas where many patients often don't get to see a general practitioner.
Patients are on board as well, with 88 percent of Americans saying they would prefer to keep telehealth as an option after the pandemic.
More robotics. A number of studies reveal that robotics can help reduce surgeon fatigue, which can prevent surgeon burnout and improve retention. In 2019, 60 percent of non-metropolitan counties in the U.S. were without an active general surgeon. Teleoperated robotics could fill in the gap and increase health care equity in underserved populations.
In addition, the majority of nursing home and assisted living communities are short-staffed. Robotic work aides can perform tasks such as fetching equipment, transporting medication and transferring patients.
Pillar II: Administrative Solutions
Health care providers can take several administrative steps to help solve the worker shortage, including:
Increase staff diversity at all levels. According to the Association of American Medical Colleges, females account for only 36 percent of physicians, but 51 percent of the U.S. population. Black individuals comprise only 5 percent of physicians but 13 percent of the U.S. population, and Hispanic individuals account for 6 percent of physicians but 19 percent of the U.S. population. Seventy-five percent of nurse practitioners, physical therapists and occupational therapists are white, while white people comprise only 60 percent of the U.S. population.
Diversity has an effect even before a medical worker enters the field. Data has shown students who study within a diverse student body and faculty make better doctors. And a study by McKinsey & Co. ("Why Diversity Matters") found gender-diverse companies are 15 percent more likely to outperform companies that are not gender diverse, and ethnically diverse companies are 35 percent more likely to outperform companies with minimal diversity.
Offer more flexible scheduling. The majority of health care workers who report feelings of burnout are in the early stages of their careers (ages 30-39), and women are twice as likely to report burnout as men. With many women shouldering the burden of at-home childcare and household care duties, flexible scheduling contributes to attracting and keeping female workers.
A comparison study for flexible and standard scheduling published by ScienceDirect revealed that 55.4 percent of care providers who were given flexible scheduling reported greater work satisfaction and 50 percent reported experiencing better quality of life and a significant improvement in perception of control over their workload and work-related stress as compared to those with standard scheduling.
Ramp up health care worker wellness to include burnout and post-traumatic stress disorder programs. To retain health care workers (and try to lure back those who left the field due to burnout), hospitals need to dedicate resources to wellness programs that focus on preventing burnout and addressing pandemic-related PTSD. For example, Mount Sinai Health Systems opened a Center for Stress, Resilience and Personal Growth in response to the elevated stress on health care workers during the pandemic. Mout Sinai estimates that 25 percent to 40 percent of first responders and health care workers experienced PTSD as a result of the pandemic.
Establish and adhere to nurse staffing minimums. According to research in ScienceDirect, for every patient added to a nurse's workload, there is a 7 percent increase in risk-adjusted mortality following general surgery, in addition to causing undue stress on overworked nurses. Moreover, understaffing actually increases hospital costs, often resulting in extended patient stays, additional treatments or surgeries and readmissions.
Hospital administrators need to win back the trust of patients and health care workers by honoring minimal nurse/patient ratios. A study by JAMA Surgery showed hospitals that adhere to ideal minimal nurse/patient ratios produce better patient outcomes for the same or less cost than hospitals with high nurse/patient ratios.
Pillar III: Credentialing Solutions
The shelf life of current skill sets in the health care industry is about five years or less. Here are some solutions related to credentialing that can help address the issue:
Make use of micro-credentialing. We have been overly focused on the top-of-license issues, and now have lost critical help at the licensed practical nurse (LPN) and lower technician levels. Micro-credentialing poses a viable solution.
Within the health care ecosystem--as jobs require multiple skill sets--it is increasingly important for workers to possess varied skills. Previously, individuals could find success as specialists or generalists. The workplace of the future demands individuals become "versatilists," possessing deep knowledge of a wide breadth of topics. Micro-credentials allow individuals to demonstrate competence in a variety of areas and to update existing skills or obtain new skills or knowledge. They can help address critical skills gaps for health care workers and create a culture of continuous learning that can prevent organizations from perpetually struggling to find workers with relevant skills.
Micro-credentialing also empowers health care workers to have more flexibility in their career paths, increasing job satisfaction and retention. The programs are more affordable and shorter than formal trainings, and workers can learn on their own time.
Allow more international medical graduates to practice in the United States. There are 270,000 internationally-trained immigrant health care professionals in the United States. Internationally-trained doctors are more likely to serve in impoverished and minority communities, areas that typically lack sufficient physician staff. However, internationally-trained health care workers face many impediments to practicing in the U.S.
Facing health care worker shortages during the pandemic, many states eased licensing requirements to allow internationally-trained health care workers to fill critical roles. Given the continuing health care worker crisis, more states should begin implementing similar policies.
Address the physician shortage. 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.
To increase the number of practicing physicians in areas where there are shortages, hospitals can:
Implement licensing that's valid countrywide. Many states relaxed licensing requirements during the pandemic to enable out-of-staters to practice within their borders. This not only made it easier for hospitals in need to fill their ranks with clinicians from areas that weren't as severely impacted, but it also allowed clinicians more flexibility and mobility. Flexible state licensing combined with telehealth and virtual care allows hospitals to redistribute health care practitioners to areas where they are needed.
Pillar IV: Legislative Solutions
The fourth solution to solve the health care worker shortage revolves around legislative solutions at the federal, state and local levels, including:
More preventive measures through public health campaigns. The worst of the workforce resignations have been in the acute-care setting. Many hospitals are overwhelmed due, in part, to ineffective public health outreach that would prevent patients from needing acute care. Legislators can improve the effectiveness of public health outreach by:
Increase state funding of nursing programs. The U.S. Bureau of Labor Statistics estimates that each year through 2030, there will be nearly 195,000 vacancies for registered nursing positions. In response to this crisis, several governors—including those in Alaska, Georgia, Hawaii, Maine, New Mexico and Oklahoma—proposed expanding education programs to train more nurses. Others have pushed for higher compensation for health care workers and new apprenticeship programs for high school students.
Expand affordable health care to prevent acute disease. Expanding services like Medicaid and Medicare can be an effective way to do this. For example, a 2019 study found that Medicaid expansion was associated with 19,200 fewer deaths among older low-income adults from 2013 to 2017, while 15,600 preventable deaths occurred in states that did not expand Medicaid. And since the Affordable Care Act was implemented, 20 million fewer Americans are uninsured.
Permanently increase public health budgets. More than three-quarters of clinicians believe that policymakers should make permanent the current reimbursement changes created in response to the pandemic. According to a 2021 article by Haitham Bashier in the National Library of Medicine, "The pandemic has persuaded and forced the governments to inject much-needed funds into the health system. ... However, the government needs to create a permanent budget cap exemption mechanism for public health functions that are critical to prevent, detect, and respond to infectious diseases. This mechanism is a potential road for stable and increased funding for public health for the long term."
It's time we start tackling some of these issues to improve our health care system and support our health care workers and patients with the best possible public health policies, use of available technology, administrative support and revision of an outdated credentialing system. A better health care system equals a better working environment for the workforce of the future.
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