The health care workforce crisis is already here
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Illustration: Maura Losch/Axios
Demoralized doctors and nurses are leaving the field, hospitals are sounding the alarm about workforce shortages and employees are increasingly unionizing and even going on strike in high-profile disputes with their employers.
Why it matters: Dire forecasts of health care worker shortages often look to a decade or more from now, but the pandemic — and its ongoing fallout — has already ushered in a volatile era of dissatisfied workers and understaffed health care facilities.
- Some workers and experts say understaffing is, in some cases, the result of intentional cost cutting. Regardless, patients' access to care and the quality of that care are at risk.
- "There are 83 million Americans today who don't have access to primary care," said Jesse Ehrenfeld, president of the American Medical Association. "The problem is here. It's acute in rural parts of the country, it's acute in underserved communities."
The big picture: Complaints about understaffing, administrative burdens and inadequate wages aren't new, but they are getting much louder — and more health workers are leaving their jobs or cutting back their hours.
- "Like so many other things in the world, the pandemic just made this stuff super obvious. For a lot of physicians, the treadmill got harder," said Joanne Spetz, director of UCSF's Philip R. Lee Institute for Health Policy Studies.
- And the pandemic itself triggered a spike in burnout and poor mental health among the workers who bore the brunt of its impact.
- "The pandemic led a lot of people to say, honestly, for lack of a better way to say it, 'Oh hell no,'" Spetz said.
All of this is accelerating two major trends: There aren't enough health care workers, at least in some sectors or parts of the country, and too many of the ones who are left are miserable.
By the numbers: Nearly half of physicians say they're burned out, and 20% say they're depressed, according to Medscape's annual survey.
- In another survey by Doximity, a social networking site for doctors, 4 in 5 physicians said they're overworked, and 3 in 5 said they're considering retiring early, looking for another job or changing careers.
- Nursing home and elderly care employment took a particularly steep dive during the first couple of years of the pandemic, and unlike hospital, outpatient or physician office employment, remains far below pre-pandemic levels.
- And overall, employment across the sector remains below pre-pandemic trends, per KFF.
The intrigue: Some of the top reasons nurses give for leaving their employer — other than planned retirement — are burnout, emotional exhaustion and insufficient staffing, which the authors of a recent JAMA Network Open study called "systemic features of their employer."
- That presents a glaring issue: Nurses leaving the workforce over staffing concerns inherently leads to worse staffing issues if they're not replaced.
- "It's just huge risk for death spiral," Spetz said.
What we're watching: Some of this is coming to a head over the Biden administration's new requirement that nursing homes maintain minimum staffing ratios.
- The administration and its allies — including AARP- and Service Employees International Union-affiliated nursing home workers — claim that the rule ensures safe conditions in nursing homes and will improve patient care.
- Opponents, which include the long-term care industry, say that staffing shortages and costs make the regulation impossible to comply with, and they are pushing for Congress to block it.
But the idea of staffing ratios isn't new. California has mandated nurse-to-patient ratios in hospitals for decades, and national nurse associations are pushing for similar requirements at the federal level.
- "Politically, having a mandated staffing ratio has been a huge hot potato," Spetz said.
