The United States continues to face an unprecedented shortage of healthcare personnel in late 2022. As a result, we have seen a recent increase federal and state legislative activity focused on addressing these deficiencies. Several states have passed new laws or legislative proposals, Congress has introduced a bill aimed at transparency on the payment models of nursing staffing agencies, and lawmakers have urged the Federal Trade Commission (FTC) and the White House COVID-19 Response Team to open investigations into price fraud by nursing staffing agencies.
The Massachusetts Health and Hospital Association (MHA) recently released a survey raising similar concerns about the shortage of health care workers in Massachusetts. The survey, titled An Acute Crisis: How Labor Shortages Affect Access and Costsprovided a clear overview of the challenges facing the healthcare workforce in Massachusetts, citing staff shortages, rising labor costs and capacity constraints.
According to the MHA survey, there are currently approximately 19,000 acute hospital jobs open across 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%. Nurse practitioners are facing one of the highest vacancy rates, with a 56% vacancy rate specifically for licensed practice nurses. Mental health workers and technicians have a 32% vacancy rate and there is a 35% vacancy rate for lung function technicians.
The nationwide shortage of healthcare workers began early during the Covid-19 pandemic. According to US News and World ReportApproximately 1.5 million healthcare jobs were lost in the first two months of the pandemic, and the number of jobs has 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 by reporting that: (i) 500,000 nurses will leave the workforce in 2022; (ii) 23% of hospitals operate with a severe staff shortage; and (iii) 95% of healthcare facilities had to hire staff from contract firms. In September 2021, the The American Nurses Association (ANA) has written a letter to Secretary Becerra at the United States Department of Health and Human Services urging immediate action to combat the nationwide nurse shortage. The letter detailed the impact of the then-new Delta variant of Covid-19, the shortage of nurses in various states, and proposed policy solutions.
Labor costs and capacity constraints
These workforce shortages are reportedly placing a large financial burden on Massachusetts hospitals. As indicated in the MHA survey, on average, 70% of hospital overheads are spent on labor costs, but the combined effects of Covid-19, healthcare worker burnout and healthcare workers leaving the profession, hospitals are having to spend even more money to retain staff and maintain safe operating levels for patients. Hospitals are spending more on access bonuses and retention packages than before the pandemic, and are relying more on travel nurses. MHA reports that in fiscal 2022, Massachusetts hospitals spent $445 million on travel nurses, a significant jump from the $133 million spent in fiscal 2019.
The AHA letter said median hourly rates for travel nurses at national hospitals have more than tripled since January 2019. Some hospitals pay rates as high as $240 per hour or more to retain travel nurses. In addition to workforce shortages and rising costs, hospitals are struggling to meet patient needs. Wait times in emergency departments are longer than usual, and patients awaiting discharge in post-acute care facilities face long waits, sometimes up to 30 days, according to the MHA survey.
The MHA has recommended steps stakeholders can take to ease the strain at both the state and federal levels. These steps include:
- provide additional federal funding to affiliated hospitals and providers,
- invest in training for behavioral health, substance use disorder, and trauma-responsive workers,
- launch statewide campaigns to encourage entry into the health workforce with direct links to employment, education and training,
- maintain state and federal public emergency flexibilities that allow for telehealth capabilities e
- pass stronger workplace protections for violence against health care workers.
The AHA has suggested focusing on recruiting and diversity in the health workforce:
- lifting the limit on Medicare-funded medical residencies,
- providing loan forgiveness and scholarships,
- encourage work visa waiver for overseas trained nurses,
- increase support for nursing schools and educators, e
- provide behavioral health funding to address, prevent and treat burnout.