In one of this issue’s cover stories, I discuss a variety of different approaches to boost the number of nursing school graduates in the United States.
At the very beginning of the story, I reference a projection that the U.S. will be short 260,000 nurses by 2025. That estimate came initially from an article in the July/August 2009 issue of Health Affairs by Professor Peter Buerhaus of the Vanderbilt University School of Nursing.
While a quarter million plus is a pretty large number, Buerhaus now believes that his estimates were likely too low, and a recent report on U.S. healthcare workforce shortages by CSC’s Walter Zywiak suggests that nursing shortages are only the tip of the iceberg.
The United States could be heading toward a full-blown healthcare workforce crisis.
Zywiak notes that, prior to healthcare reform, there was general agreement among industry observers that the U.S. would have 124,000 too few physicians by 2025. With the addition of 32 million people to the insurance rolls after the implementation of federal reform measures, the physician shortage will rise to 155,000.
Add this projected lack of physicians to the expected shortage of nurses, and many healthcare organizations will have a real problem finding enough caregivers to staff their facilities.
But the pain doesn’t end there.
The CSC report cites projected shortages of 250,000 public health workers and 1.1 million paraprofessional direct-care workers by 2020. Another study by the Delta Dental Plans Association predicts that the number of U.S. dentists will decline by almost 4 percent between 2012 and 2019.
As the number of new providers shrinks, demand is rising.
The National Center for Health Statistics projects that the number of annual physician visits in the United States will increase 82 percent by 2030. By that same year, according to the Robert Wood Johnson Foundation, half the American population will have one or more chronic conditions and “studies have shown that patients with chronic disease average more than twice as many physician visits per year as patients without a chronic condition.”
In the CSC study, Zywiak highlights some healthcare workforce expansion initiatives in the federal Affordable Care Act, which he says have the “potential for significant impact.”
However, the health reform initiatives are directed primarily at boosting incentives for primary care and limited other specialties, as well as enhancing educational programs and student incentives, and expanding nursing opportunities. These steps are simply not comprehensive enough.
Zywiak notes that reform does little to help mid-level provider advocates “who face inconsistent state regulations and physician resistance,” and emphasizes patient-centered medical home programs that expand the roles of already short-staffed primary care physicians.
If healthcare workforce trends continue to move in a negative direction, and the current reform legislation does not do enough to help, it will fall to healthcare delivery systems themselves to retain and recruit more workers.
But what steps to take?
“Talent Optimization,” a recent report by API Healthcare, recommends that healthcare delivery organizations make employee retention a priority. API says hospitals and other institutions must “figure out how to increase retention among their newest employees while at the same time deciding out how to replace their rapidly aging workforce.”
While a good salary is an essential ingredient to successful employee retention, API notes that – at least in regard to nurses – it’s not the only factor. The report details the importance of flexible scheduling, mentorship opportunities, low patient-to-RN ratios and a “manager they can depend on.”
These are great proposals for healthcare employee retention, even beyond nursing. But, as the CSC report points out, it’s going to take time to implement adequate long-term solutions industry wide. Increasing educational capacity, training more professionals, improving workflows and changing reimbursement models cannot be done successfully overnight.
But implementing initiatives that make the work lives of nurses, physicians, mid-level providers and other employees happy is a good way to begin.