State Legislators Step Up Efforts To Deal With Rising Healthcare Staffing Shortages

On May 23, 2022, U.S. Surgeon General Dr. Vivek Murthy sounded a national alarm about the urgent need to address a systemic healthcare problem in America. We must come to grips with a surge in health worker burnout and resignations, he warned, or the consequences will be dramatic for all Americans in the next decade.

“The nation’s health depends on the well-being of our health workforce,” he said. “Confronting the long-standing drivers of burnout among our health workers must be a top national priority. And if we fail to act, we will place our nation’s health at risk.”

The statistics are ominous:

• Nearly one in five of America’s healthcare workers left the field during the COVID-19 crisis and more say they are planning to exit soon;
• The American Hospital Association reports that at least 23 percent of U.S. hospitals have experienced a critical staffing shortage since February 2020;
• With more than half a million nurses expected to retire by the end of 2022, the U.S. Bureau of Labor Statistics projects the need for 1.1 million new registered nurses;
• The U.S. faces a projected national shortage of more than 3 million low-wage healthcare workers over the next five years; and
• The Association of American Medical College forecasts a shortage of nearly 140,000 physicians by 2033.

And while the specific numbers may vary depending on who is issuing the forecast and which geographic region is involved, the problem is very real.

“The unions have one way of counting and the hospitals have another way of counting, so the size of the shortage varies depending on the source,” said Diana Dooley, the former California Secretary of Health and Human Services, who has worked extensively in the healthcare industry as a lawyer and association executive. “But I don’t think anyone disagrees that we have a healthcare staffing shortage in America that must be addressed.”

Dooley made her remarks during a recent State Net Hot Topic Series Webinar, where she was joined by fellow panelists Hemi Tewarson, executive director of the National Academy for State Health Policy, and Joanne Spetz, director of the Institute for Health Policy Studies at U.C. San Francisco. The program was moderated by Rich Ehisen, managing editor of State Net Capitol Journal, a LexisNexis publication that covers state public policy issues and trends nationwide.

The panelists noted that the healthcare worker shortage is pervasive and nationwide, but that it is particularly serious in rural communities.

“There are some nuances to why we have shortages in one healthcare job or another, but a persistent and consistent problem is the urban-rural divide,” said Spetz. “We face challenges across all healthcare workers categories with recruiting health professionals to work in many rural areas.”

Ehisen noted that, based on a recent uptick in policy proposals, the situation has clearly captured the attention of both state and federal lawmakers. So, what are legislators and regulators doing about this national problem?

“Our research indicates that 20 governors addressed the healthcare worker shortage at some point during their 2022 State of the State addresses,” said Tewarson. “I think that was significant. Every state is having some level of challenge and it really seems to be reflected in their leadership.”

Indeed, the State Net legislative and regulatory tracking database shows that at least 20 states — including New York, Illinois, Georgia, Vermont and New Jersey — and the District of Columbia have introduced health workforce bills this year.

Meanwhile, the National Governors Association recently announced the launch of a six-month, multi-state program collaboration aimed at addressing the healthcare workforce shortage. The initiative is being led by California, Colorado, Wyoming and Missouri, with 10 additional states serving as satellite members.

All three panelists agreed there are some excellent ideas being proposed to tackle the problem, but the staffing shortage is so widespread that it will likely require a level of innovation that could challenge lawmakers and their traditional positions.

“We need to think creatively about how to solve this problem and not just rely on the old levers we’ve pulled in the past,” said Tewarson. “For example, this is going to require public-private partnerships that involve the federal government, state governments and the private sector.”

It may also force everyone to think about the existing models for healthcare delivery and which professionals are permitted to provide different levels of care to patients, said the experts.

“There are so many ways that we can provide healthcare differently, but the existing model creates franchises that are difficult to upset,” said Dooley. “We need to think creatively about how care is delivered if we’re going to address the staffing problem.”

For example, Spetz noted there are some innovative ways to integrate care and introduce alternative healthcare workers by rethinking certain licensing requirements and scopes of practice. These types of solutions are promising but they are often opposed by entrenched healthcare labor unions that resist changes to the workforce ground rules.

Regardless of which legislative and regulatory changes are made, however, the experts warned that our national ability to resolve the healthcare staffing shortages will ultimately come down to how effectively these changes are implemented by healthcare organizations.

“Well-intentioned legislation can always get undermined by ill-intentioned actors,” said Spetz. “In addition to good policy, we also need good management.”

Watch a recorded playback of the State Net webinar, “Addressing America’s Healthcare Worker Shortage,” to learn more about this growing national challenge and the various strategies that state legislators are pursuing to alleviate staffing problems.