Ignoring Shortages Will Shortchange Health Care Reform

While the debate grows hotter about how Americans will be insured and where the money to pay for it will come from, there’s little talk about how our already stretched health work force will care for the newly insured. We already know that there is a health care work force shortage now and that it will grow as our population ages. To truly reform health care and ensure safe, high quality service for everyone, the issue of training more workers needs to be addressed.

Most of the proposals currently under consideration pay little more than lip service to the issue. There are provisions to reform Graduate Medical Education, the system that pays for physician residencies, to provide for more primary care physicians. While the country is suffering from a shortage of primary care physicians, the shortage of nurses, pharmacists, physical therapists, technicians, and other skilled health care workers is just as dire.

What is needed is a truly comprehensive plan to address the need for more health care workers. At the very least, a state level plan should be developed that includes measurable goals and makes accountability clear. Without a road map, we are bound to take a wrong turn. In fact, millions of dollars and thousands of hours have already been invested in addressing the shortage. In Washington, we’ve doubled the number of nursing graduates over the last five years. Still, we know even this tremendous progress is inadequate to meet demand. Why? Because a number of organizations are working on the issue in an uncoordinated way and no one is accountable for results. Washington State does have the benefit of the
Workforce Training and Education Coordinating Board to help coordinate efforts here. But on a national level, efforts are duplicated. Time is spent reinventing methods for one segment of the industry that have already been proven effective in another.

Only the Senate HELP Committee’s Affordable Health Choices Act calls for a comprehensive plan at the national level as part of health reform. Hopefully, as the reform proposals move forward, a plan to staff the hospitals and health care facilities to provide care for the millions of newly insured patients is included. If the plan will not be developed at the national level, then Washington State needs to develop its own. Otherwise, we can be sure that the health work force shortage will only be exacerbated, and fears of long waits for care may be come reality.

A Temporary Lull?

The Health Work Force Institute was created in 2004 to address the coming health work force shortage. A huge increase in demand for health care as the baby boomers age, coupled with a large wave of retirements from the health care industry made for the perfect storm. No one could foresee the economic storm that hit the U.S. in the fall of 2008. Almost overnight, hospitals saw vacancy rates drop as retirements were delayed and staffing cut back.

Over the past seven years, the Institute has conducted an annual survey of hospitals in Washington State. Every year, vacancy rates moved up in positions ranging from Certified Nursing Assistants to specialized physicians. The trend continued through the fall surveying in 2008, but anecdotally, we anticipate a lull in the trend. Who could have imagined a year ago that nurses would even be struggling to find work?

A recent study published on the Health Affairs website, by Peter Buerhaus of Vanderbilt University School of Nursing, makes the case that the lull is only temporary. The shortage of nurses, and other health care workers, will come back with a vengeance in the next decade with the eventual retirement of the baby boomers.

Buerhaus and his co-authors make another interesting point. Over the past two years, younger nurses have been entering the work force at a much higher rate than predicted. This means the severity and the timing of the nursing shortage may change. While this might have been a bellwether for the end of nursing shortage, the current economic situation has derailed progress.

Currently, newly graduated nurses are reporting difficulty finding employment. Hospitals, and other health care facilities, are still hiring nurses, but have significantly reduced positions available for newly minted nurses.What remains to be seen is what will happen to these new nurses and will this impact the reputation health care positions have gained as well paying with available employment?