The health care workforce crisis is already here


Healthcare professionals, including doctors and nurses, are exiting the field, precipitating workforce shortages in hospitals and prompting employees to increasingly unionize and engage in high-profile disputes with employers. This trend highlights the urgency of healthcare worker shortages that were projected for the future but are now manifest due to the pandemic's lingering effects. Some assert that understaffing is a consequence of deliberate cost-cutting measures, although this leads to compromised patient care access and quality. "There are 83 million Americans today who don't have access to primary care," notes Jesse Ehrenfeld, president of the American Medical Association. These issues are particularly acute in rural and underserved areas.

Complaints about understaffing, excessive administrative duties, and inadequate wages are not new; they have merely intensified, leading more healthcare workers to leave their positions or reduce their hours. According to Joanne Spetz, director of UCSF's Philip R. Lee Institute for Health Policy Studies, "The pandemic made these issues starkly evident. For many physicians, the workload became increasingly unbearable". The pandemic also exacerbated burnout and mental health issues among frontline workers. "Many people reached a breaking point, thinking, 'Oh hell no,'" added Spetz .

Two trends are accelerating: an insufficient number of healthcare workers and widespread dissatisfaction among those remaining. Nearly half of physicians report burnout, and 20% experience depression, according to Medscape's annual survey. Doximity's survey reveals that 80% of physicians feel overworked, and 60% contemplate early retirement, career changes, or new jobs. Nursing home and elderly care employment plummeted during the pandemic and has yet to recover to pre-pandemic levels, per KFF.

Many nurses cite burnout, emotional exhaustion, and insufficient staffing—termed "systemic features" of their employers—as top reasons for leaving, according to a JAMA Network Open study. This presents a critical issue as departing nurses exacerbate staffing shortages if not replaced. Spetz warns of a "huge risk for a death spiral".

Attention is now focused on the Biden administration's mandate for minimum staffing ratios in nursing homes, a regulatory move seen by supporters, including AARP and SEIU-affiliated nursing home workers, as a way to ensure safe, high-quality care. However, opponents argue that existing staffing shortages and associated costs render compliance impractical, advocating for congressional intervention to block the rule . California has maintained nurse-to-patient ratios for years, and national nurse associations are lobbying for similar federal mandates. Spetz remarks, "Politically, mandated staffing ratios have been contentious".

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