Shortages in Healthcare

Although there has been an existing nursing shortage in the U.S, the shortage came into the spotlight in 2012. Now it is projected that within eight years, over 1 million new registered nurses (RNs) will be needed to meet healthcare demands in the U.S (https://www.healthline.com/health/nursing-shortage). That seems like an embellished number, but it is not.

“According to the Bureau of Labor Statistics, more than 14.3 million people are employed in the healthcare industry, and it’s projected that 3.2 million new healthcare related jobs will be created over the next 8 years… Healthcare is one of the highest growth industries in the entire world” (https://www.careerprofiles.info/growing-healthcare-industry.html).The physician shortage started in the early 2,000s. Within ten years, the United States will see a shortage of nearly 122,000 physicians – not just in primary care but also specialty areas such as surgery (https://www.aamc.org/news-insights/press-releases/new-aamc-report-confirms-growing-physician-shortage).
      
The reasons for the nursing and physician shortages are partly due to those leaving the professions, but there is also an increased demand for healthcare services. We have more people in need of healthcare because the baby boomers (America’s largest generation) are getting older. Advances in medical technology offer more healthcare options and people are seeking these services, as they add to longevity and the quality of life. The Affordable Care Act has improved access to health care. Retirement is one factor for the shortage, but so is burnout and lack of support, particularly with COVID. Thus, there are more positions opening up, but even the previously occupied positions are not being filled, leaving the public with substantial shortages.
      
Unique to the nursing profession is the wide span of education, and shortages exist in all the below-noted categories. In addition to people not entering the field (or simply not enough), there is a shortage of nursing educators, which forces schools to restrict enrollment.

• LPNs (licensed practical nurses) have one-year of education
• RNs (registered nurses) can practice with just an associate (two-year) degree and in some places nursing diploma programs are still in practice. Many RNs continue on for a bachelor’s degree and the profession’s goal is that at least 80% of RNs carry this out, but only 64% of RNs hold a bachelor’s degree
• Nurse anesthetists, advance practice nurses (nurse practitioners and clinical nurse specialists), and nurse midwives all have graduate degrees (a master’s program)
• Aside from the nursing profession, but an important addendum are CNAs (certified nursing assistants).There has been a long-term shortage in this field. This is the fastest growing occupation in healthcare with a projected increase of 8% within the next decade (https://learn.org/articles/What_is_the_Employment_Outlook_for_a_Certified_Nursing_Assistant_CNA.html)
  

Nurses don’t just work at the bedside in hospitals; there are numerous settings: nursing education, nursing administration, legal nursing, health insurance industry, healthcare consulting, school nursing, long-term care, home-based nursing, public health nursing, nurses in research, telehealth nursing, and varied outpatient facilities (urgent care centers, rehabilitation, physician offices and clinics, etc.)
    
Unique to the medical profession is the residency program. Once medical students complete their education (eight years), they become a medical doctor (MD) or doctor of osteopathy(DO) and must enter a residency program before they can legally practice medicine.
      
There is a system called “matching,” which is carried out through The National Resident Matching Program. This program places a doctor in a residency program; the residency program aligns with the field of interest, such as surgery, internal medicine, radiology, etc. Residency programs are three to seven years in length, depending on the specialty. That means that doctors train for a minimum of 11 to 15 years because many physicians choose to enter a fellowship and do research as part of their practice, which adds additional years of training. For example, some neurosurgeons train for 17 years before they practice in their field.
      
Although there are various reasons that students might not match, one reason is that there are not enough residency slots in this country. This residency unavailability is because of funding restrictions. The Medicare program provides funds for residencies at $10 billion each year (https://www.globenewswire.com/en/news-release/2020/11/20/2130671/0/en/Residents-Medical-Combating-Shortage-In-Residency-Positions-In-The-US.html).
      
Up until the end of 2020, we experienced almost 25 years of a freeze on federal funding for graduate medical education. Finally, Congress passed legislation (effective 2021) to fund an additional 1,000 postgraduate residency programs. However, this process was long overdue and will take time to implement. The 1,000 additional slots still leaves out the 7,000 to 10,000 medical students graduating each year, who do not match to a residency program. That means we have graduates emerging from medical schools, who are MDs and DOs, but cannot practice medicine (https://www.sgu.edu/news-and-events/new-residency-slots-approved-by-congress-what-it-means-for-medical-students/)
    
What do shortages mean in the healthcare industry? We know shortages result in overworked staff. Staffing shortages in the health field compromise the delivery of care, leaving the public with long wait times; increased medical errors, especially with medications; and overall poorer health outcomes; and sadly, increased mortality rates.
    
There are strategies to restore the workforce in healthcare:

1. Promote public health and preventative care (the outcome is that we have a healthier nation, which lowers the need for medical services).
2. Utilize more online degrees to make education more accessible. Of course clinical training is not online, but classroom work can be.
3. Encourage policy changes within human resource departments in order to promote systems for locating personnel, offering on-the-job training, and making it accessible to enter the healthcare field.
4. Improve databases to develop better systems of record-keeping and communication, promote collaboration, and streamline healthcare services. This results in more efficient time for everyone in the healthcare field.
5. Give Healthcare Workers a Voice in Shaping Legislation and Policies since healthcare workers are the most qualified to make decisions about how to change their industry for the better. It is the healthcare worker that should be advising government lawmakers and industry leaders, not the other way around. If doctors and nurses (and others in the field) were taking the lead, we would have more effective clinical settings. (https://onlinenursing.duq.edu/post-master-certificates/shortage-of-healthcare-workers/)
   

Charlotte Michos is a clinical nurse specialist who values personal-centered care and serves as a Healthcare Consultant in helping others make informed decisions. For more information, email her or call (845) 548-5980.