A few weeks ago I posted about High Impact Changes in the Healthcare Environment, suggesting that there were six major, emerging trends that providers would most likely have to adapt to. Those trends included things such as the movement away from fee-for-service toward pay-for-performance reimbursement systems, and a growing emphasis on integrated care.
A longtime member of our senior care advisory board offered a comment on that post, saying that while she agreed with the forecast about these six trends, she felt that the list omitted something equally important, which she summarized as “workforce shortages at all levels of healthcare.” She noted that these shortages have worsened in the past several years, and provided a very informative document from the Minnesota Center for Rural Policy and Development, Long-term Care Workforce Challenges in Rural Minnesota. Her comments and the document she passed along made me wonder whether this problem is unique to the senior care sector in Minnesota, how generalized such workforce shortages might be, and whether they show up across many clinical professions and in all areas of the country.
Health care workforce shortage data by job role
I did some digging, and I’ll summarize what I’ve learned about some of the high-level answers to the questions posed above. The questions may be simple, but the answers are a bit more nuanced and complex:
Nurses: HRSA, which is part of the US Department of Health and Human Services, maintains a data-rich, publically accessible site with vast amounts of profession-specific and geographically indexed information about workforce projections and projected shortages, among other things. These data point out that national trends can obscure important state and local trends that may not align with the national picture.
For example, according to HRSA, the national projections of a nursing surplus between the years 2012-2025 mask imbalances at the state level. For 16 states, the availability of nurses will not meet demand.
The same sort of pattern holds true for LPNs, where 22 states will see a gap between demand for LPNs and the availability of LPNs, despite a national surplus. HRSA notes that changes in job roles associated with delivery system changes may also impact the need-to- availability ratios. In rural areas, gaps can also be pronounced – for example, where there is a preference for home-based care, but where the distances may not easily support such client preferences.
Primary Care Physicians: The same HRSA site reports that “if the system for delivering primary care in 2020 were to remain fundamentally the same as today, there will be a projected shortage of 20,400 primary care physicians. Under a scenario in which primary care nurse practitioners (NPs) and physician assistants (PAs) are fully integrated into health care delivery, such as patient-centered medical homes that emphasize team-based care, the projected shortage of primary care practitioners in 2020 could be somewhat alleviated.” HRSA points out that “aging, population growth and increased demand because of more universal insurance coverage are likely to be the main drivers of this projected primary care provider shortage.”
Other Clinical Professions: This HRSA site maps the geographic provider-to-population ratios of a number of clinical professions and lets you make state-by-state and county-by county comparisons. HRSA maintains and develops minimum data sets (MDS) to support reports such as this. The MDS currently covers 13 professions, such as licensed professional counselors, pharmacists, occupational therapists, physical therapists and others.
Direct Support Professionals: This term and similar ones (such as direct care provider, personal care aide, and so on) are broad terms that sometimes refer to staff in the intellectual and developmental disabilities sector, often working in residential settings. The term can also refer to nursing assistants or nurse aides, home health aides, home care aides and personal care workers and personal service attendants in other settings. I have seen estimates suggesting that as much as 80% of the hands-on care that patients in long term care and other community settings receive are provided by these categories of staff.
Although the data for this large group of staff (more than 4 million such staff in the US as of 2012) are not as detailed or as current as the data that HRSA prepares for the traditional licensed clinical professions, there are forecasts of future shortages. A February 2014 New York Times blog post from Judith Graham reports that direct care workers will become the largest occupation in the United States, surpassing the number of retail salespeople. Graham notes that 1.3 million new staff will be required by 2020, but that there are many formidable obstacles to meeting that demand, including low wages, limited benefits, and very high turnover.
Healthcare staffing shortages today
Population data tables are one thing, but what do managers at hospitals and healthcare systems think about whether and how the shortages size up today in the services that they operate?
While there may be debates in the literature about shortages, according to the recent AMN Healthcare Clinical Workforce Survey, on the ground today there isn’t much debate. According to the survey, “78 percent of hospital executives surveyed say they’re seeing a physician shortage now, while 66 percent say there’s a shortage of nurses, 50 percent say a shortages of nurse practitioners and physician assistants, and 43 percent note a shortage of allied healthcare professionals.”
Vacancy rates in these categories are running as high as 18%. Where in 2009, only 24 percent of those surveyed said that clinical staffing is a top priority, this rose to 70 percent in 2013. Staffing costs, capacity to handle new patients driven by ACA changes, clinical staff turnover and current vacancies were all cited as concerns by the vast majority of respondents.
I want to again thank our contributor who offered this addition to the six major trends post. Based on available data, it seems pretty evident that presence and the scale of shortages differ by the state and community we are looking at, as well as by which professions and job categories we are talking about.
That said, the data say to me that this is more than an outlier problem in a small number of unique communities. Rather, there are and will likely continue be significant shortages in a number of states and local communities in the years ahead. And since we have evidence that staffing shortages and turnover can lead to quality problems, this is indeed a trend worth paying attention to.
We’d love your perspectives. In the comments, let us know your answers to these questions:
- What interventions do you think can impact the number of people who choose these professions?
- Which workforce recruitment and retention and support strategies can make a difference?
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