Analyze: States scramble to address the shortage of health workers



This week high-ranking Hawaii officials were given a dire warning. If they don’t take action, the state could not provide thousands of health professionals who are essential to combating the COVID-19 epidemic.

The state has not granted the waiver of licensing requirements, which had been in place for two years, said Hilton Raethel, head of the Healthcare Association of Hawaii, which represents Hawaii’s hospitals and 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 addressed state officials.

If the state does not take the necessary step, she told me in an interview, the health crisis that is causing it in care will persist. There aren’t enough health professionals of all kinds–doctors, nurses, respiratory therapists, lab techs, behavioral health professionals, medical assistants — to fill the vacancies, not just in Hawaii but also across the nation.

“Workforce in health care is an issue of national significance and is reaching a crisis in many parts of the country,” said Akin Demehin, the director of policy for the American Hospital Association trade group. “Leading towards the pandemic there are already major issues with the workforce. The pandemic has increased these, due to fatigue that has accompanied wave after rounds of the patient.”

The situation of workers not being employed has become so severe that more than 20 governors in the past year addressed the issue directly during their states of state addresses, offering a range of policies to address the issue as per the National Academy for State Health Policy which is a non-partisan group of state health policymakers.

According to Hemi Tewarson, director of the academy, it’s a significant change. Tewarson was until recently a health policy specialist in the National Governors Association. There has been a long-running shortage of certain health workers. However, she added, governors have instead focused on issues related to the misuse of opioids, prescription drug prices, and mental health.

This year, things changed when governors talked about increasing the recruitment process, easing license requirements and expanding education programs, and increasing provider salaries either directly or by raising Medicaid reimbursements.

Rural and economically weak urban areas, which have a more challenging time attracting health professionals, top the list of sites that federal officials view as “health professional shortage areas.”

“We just have increased difficulty recruiting and attracting folks who want to live and work in a rural area,” said Craig Thompson, Golden Valley Memorial Healthcare CEO. This rural Missouri health facility is located about an hour away from Kansas City.

In 2024, the vacant rate in Missouri hospitals was greater than 20 percent, according to Dave Dillon, a spokesperson for the Missouri Hospital Association. In the coming year, it’s likely to climb to 25 percent for all hospital medical specialties, including respiratory therapists, doctors, medical assistants, and dieticians, Dillon explained.

Similar crises are developing across many states.

Burnout and exhaustion

Burnout and exhaustion are high costs on the health healthcare workforce during the COVID-19 epidemic. According to a survey conducted by Morning Consult, a marketing research company, around 20 percent of health workers quit their jobs during the outbreak. Nearly three-quarters of them admitted to thinking about leaving.

The shortage did not begin with the pandemic, so it’s unlikely to stop because of it.

In 2019, The United States had nearly 20,000 doctors, less than the number needed to meet the nation’s medical requirements, according to an estimate made by the Association of American Medical Colleges, which analyzes the doctor workforce. At the current pace, they said this gap could get up to 124,000 by 2034. That includes the shortage of as high as 48,000 primary-care doctors.

“Within the next ten years, two of every five physicians in the workforce will be 65 or older,” stated Michael Dill, the group’s director of studies on the workforce.

In addition, the population is aging and will require more healthcare. “Just when we need physicians more, we will have a large cohort of physicians reaching retirement age,” said Dr. A. There aren’t enough doctors in training to take their place.

In the same way, the age average of registered nurses who were employed grew from 43 to 48 between 2000 and the year 2018, and nearly half are in the 50s as per research from the University of St. Augustine for Health Sciences in Florida.

The U.S. Bureau of Labor Statistics estimates that every year from now until 2030, there will be more than 195,000 nursing jobs available for registered nurses. The St. Augustine report says that the nursing profession isn’t producing nurses with enough speed to meet the need.

National Nurses United, a professional union with 175,000 members across the country, claims that most states have sufficient nurses to meet the demands. However, the policies regarding staffing and safety at hospitals can reduce the number of nurses willing to fill vacant positions.

“Hospitals often declare a nursing shortage when they don’t have the will to hire more nurses or to change the conditions which are unattractive to nurses,” for example, the safety protocols or the delegating of the responsibility to people who are certified and licensed, according to Michelle Mahon, the organization’s assistant director of nursing practice.

A registered nurse working in an area of medical-surgical care in Kansas City’s Research Medical Center, Zo Schmidt, said the hospital’s ratio of nurses to patients by a percentage from 4-to-1 to 6:1 earlier during the pandemic. This can have dire consequences for certain patients. “I am aware of patients still alive since I saw four patients on that day which I’m not sure would be alive had I had had six.

“We aren’t afraid to work to the max. What really kills us, and why nurses have left is that we don’t feel that we’ve done our best to help the nurses, as we’re only given two hands and are able to accomplish so much in the course of a single day.”

Research Medical Center Research Medical Center did not respond before publication to a question about staffing.

There is also a deficiency of nursing professors to train new nurses. As Raethel explained, one reason is that nursing schools do not pay teachers the same amount as nurses earn while on the job. He noted that private schools in Hawaii provide nursing instructors with a salary of $80,000, whereas the typical wage for registered nurses working in a hospital is $105,000.

Dr. Tochi Iroku-Malize, incoming president of the American Academy of Family Physicians, said doctors are being financially squeezed–mainly primary care doctors, who are reimbursed at lower rates than specialists. “Health care payment needs to be restructured, so people want to enter primary care,” Iroku Maize, a doctor on Long Island.

This contradicts the findings that Dill from the Association of American Medical Colleges stated in his report. “We’ve looked at it repeatedly over the years and found no evidence that economic factors keep down the supply of physicians in the United States,” Dill stated. However, he acknowledged that Medicaid’s poor reimbursement rates might deter some doctors from seeing patients with lower incomes and thereby hindering access to medical care.

Proposals of Governors

Many governors, such as those from Alabama, Colorado, Maine, New York, Wisconsin, and New York, have advocated for higher healthcare workers’ compensation.

In the state address of her state speech, Democratic Gov. Janet Mills in Maine cited the state’s commitment of 600 million dollars in federal and state funds to boost Medicaid reimbursement rates. This will increase the amount paid to physicians who treat low-income patients. She suggested spending an additional $50 million.

New York Gov. Kathy Hochul, another Democrat, suggested the $10 billion expenditure on the health workforce to boost the Medicaid reimbursement rate, give incentives to retain frontline medical professionals, and expand the number of people who go to health healthcare. It is believed that the New York legislature is discussing the possibility of a more significant amount of financial commitment.

Governors from Alaska, Georgia, Hawaii, Maine, New Mexico, and Oklahoma suggested expanding their educational programs to help train nurses and other medical professionals. For example, Georgia Republican Gov. Brian Kemp has said that he is including the sum of millions in his budget plan to further train nurses and expand the medical residency slot. In the future, he added that the aim is to grow the number of health workers by 1,300.

Alaska Republican Gov. Mike Dunleavy cited a state grant of $2.1 million to educate and keep nursing faculty.

In Iowa, Republican Gov. Kim Reynolds announced a new apprenticeship program for high school students, which will allow students to become certified nurses assistants before graduating.


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