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The United States continues to face an unprecedented health care workforce shortage at the end of 2022. As a result, we have seen a recent increase in federal and state legislative activity aimed at addressing this shortage. Multiple states have passed new laws or proposed legislation, Congress has introduced a bill aimed at transparency around nursing agency payment patterns, and lawmakers have pressured the Federal Trade Commission (FTC) and the White House’s COVID-19 Response Team to launch investigations of price gouging by nurse recruitment agencies.
The Massachusetts Health and Hospital Association (MHA) recently released a study that raises similar concerns about the health care workforce shortage in Massachusetts. The study, titled “Acute Crisis: How Workforce Shortages Affect Access and Costs,” provided a clear overview of the challenges facing the health care workforce in Massachusetts, citing staff shortages, increased labor costs and capacity constraints.
According to the MHA study, there are currently about 19,000 open emergency room hospital positions in Massachusetts. These vacancies exist in practice areas and disciplines including nursing, behavioral health, technicians, laboratory staff and clinical support staff. MHA reported an average vacancy rate for these positions of 17.2%. Nurses face some of the highest vacancy rates, with 56% of vacancies specifically for licensed practical nurses. Mental health workers and technicians have 32% vacancies and there are 35% vacancies for pulmonary function technicians.
The national health worker shortage started early during the Covid-19 pandemic. According to US News & World Report, approximately 1.5 million health care jobs were lost in the first two months of the pandemic, and those jobs have not returned to pre-pandemic levels. In a letter to the US House of Representatives in March 2022, the American Hospital Association (AHA) addressed the growing workforce shortage, reporting that: (i) 500,000 nurses will leave the workforce in 2022; (ii) 23% of hospitals operate with critical staff shortages; and (iii) 95% of health facilities had to hire staff from labor contract firms. In September 2021, the American Nurses Association (ANA) wrote a letter to Secretary Becerra at the US Department of Health and Human Services calling for immediate action to combat the national nursing shortage. The letter detailed the impact of the then-new Covid-19 Delta variant, the nursing shortage in various states and proposed policy solutions.
Labor costs and capacity constraints
This workforce shortage is reportedly placing a heavy financial burden on Massachusetts hospitals. As mentioned in the MHA study, on average 70% of hospital overhead costs are spent on labor costs, but the combined effects of Covid-19, health care provider burnout and health care providers leaving the profession, hospitals have to spend even more money to maintain staff and maintain safe work levels for patients. Hospitals are spending more on sign-on bonuses and retention packages than before the pandemic and relying more on travel nurses. The MHA reports that in fiscal year 2022, Massachusetts hospitals spent $445 million on traveling nurses, a significant jump from the $133 million spent in fiscal year 2019.
The AHA letter states that average hourly rates for traveling nurses at the nation’s hospitals have more than tripled since January 2019. Some hospitals are paying rates as high as $240 an hour or more to retain traveling nurses. In addition to labor shortages and increased costs, hospitals are struggling to meet patient needs. Emergency room wait times are higher than normal, and patients waiting to be discharged from post-acute care facilities face long waits, sometimes as long as 30 days, according to the MHA study.
The MHA has recommended steps that stakeholders can take to ease tensions at both the state and federal levels. These steps include:
- providing additional federal funding to hospitals and related providers,
- investing in training for behavioral health, substance use disorder and trauma response workers,
- launching nationwide campaigns to promote entry into the health workforce with direct links to employment, education and training,
- maintaining flexibility for public emergencies at the state and federal level that allows for telehealth capabilities, and
- adopting stronger workplace protections against violence against healthcare workers.
The AHA suggested that we focus on recruitment and diversity in the health care workforce by:
- lifting the residency limit for Medicare-funded physicians,
- providing loan forgiveness and scholarships,
- promoting the relaxation of work visas for foreign-trained nurses,
- increasing support for nursing schools and educators and
- providing behavioral health funding to address, prevent and treat burnout.
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