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Review: Healthcare Staffing Shortage: A Storm Develops

Roy Vera, RT, MBA  VIS Medical
Nov 2006
Healthcare's Staffing Shortage: A Storm Develops
By Susan Nowakowski, for HealthLeaders News, Apr. 12, 2006

The healthcare staffing shortage is like a Category 5 hurricane looming on the horizon.
Everyone can see it coming, but no one knows how to stop it.

Congress, a number of think tanks, academic institutions, and government agencies are
examining and proposing solutions for many other problems facing healthcare--from Medicare
and malpractice reform to better access for the uninsured. Nonetheless, the dearth of doctors,
nurses, and other healthcare professionals remains unaddressed and threatens the quality of
healthcare delivery in the United States.

The scope and impact of projected clinical professional shortages have yet to be fully assessed
or recognized. Certainly in nursing it has been widely conceded for years that a shortage already
exists. But not all areas of the country have felt the shortage equally. California, Florida, and
other states with large metro centers have experienced a disproportionate shortage of nurses
relative to states with more rural populations. With physicians, the inverse has long been true.
More populous states generally have higher physician-to-population ratios than predominately
rural ones.

These patterns are changing, however, as shortages become more pervasive. A recent survey
by our affiliate company, Merritt, Hawkins & Associates, indicates that 98 percent of large
hospitals, most of which are in metro areas, are recruiting physicians, compared to 75 percent of
smaller hospitals, which generally are in rural areas. The fact is demand for healthcare
professionals is increasing today virtually independent of geographic region.
Current projections indicate a deficit of 200,000 physicians and 800,000 nurses in the U.S. by
the year 2020. Clinical provider shortages are not limited to the United States. Indeed, much of
the industrialized world is experiencing a shortage of physicians, nurses and other health
professionals. The Philippines--long an exporter of nurses--is being joined by countries like
India, China, and other developing nations that are seeking to fill the growing demand for
healthcare professionals in Europe and the U.S. In the new global economy, the quest for
healthcare workers is becoming an increasingly important component to the well being of many
countries.

It is particularly telling that where the U.S. is concerned the flow of labor is no longer entirely one-
way. For the first time, Britain, Australia, and other English-speaking countries are starting to vie
for U.S. nurses and are even casting their gaze on U.S. physicians.
So far U.S. healthcare organizations have been able to cope with staffing shortages by
demanding longer hours from staff, loading more patients on existing staff, and contracting with
temporary healthcare professionals. Many clinical disciplines within healthcare have become
increasingly mobile in recent years, as staffing shortages have allowed more nurses and
physicians to choose temporary or long-term assignments throughout the U.S. and abroad. But
temporary and contract labor can be only a supplement to permanent staff and cannot fill all the
gaps that exist today--much less solve staffing problem for the future.

The situation is serious, but not desperate--yet. To date, most people are willing to wait the
several weeks or months it often takes to see a medical specialist. Not everyone is so patient.
The number of visits to hospital emergency rooms keeps rising, and at least one study shows
that an increasing number of ED visits are made by insured patients. Once at the ED, everyone
must be seen, but even here the issue is not so simple. Hospitals are finding it difficult to secure
medical specialists willing to cover the ED. A national survey by The Schumacher Group shows
that in the last year 57 percent of hospitals have had to divert patients to other facilities due to
the lack of medical specialty coverage in the ED. In the same survey, 42 percent of hospitals
indicated that lack of specialty coverage in the ED poses a “significant risk” to patients at their
facilities.

The increasingly limited access to healthcare workers leaves little or no room for surges in the
demand for healthcare services. Considerable attention and money have been devoted to
emergency and national pandemic preparedness. These measures, however, will do little good
in the event of a disaster or pandemic if there are not enough healthcare workers to tend to the
injured or sick.

Hospitals, healthcare providers, policy analysts, academics, and the healthcare staffing industry
need to coalesce and become more vocal on this issue. To this end, our firm has committed to
help fund the creation of a new organization to bring together clinical supply experts and other
interested parties to raise awareness of the shortage of healthcare professionals and propose
tactics to address the problem.

As with most challenges in healthcare, solutions to the staffing shortage will depend on the
allocation of resources. Currently there is a cap on the number of medical residency programs
funded through CMS. This cap must be raised. It will take millions--or even billions--of dollars to
increase the number of trained physicians. Money also will need to be allocated to expand
training programs for nurses and other healthcare workers.
More funding will require political will, which can be influenced by raised voices and coherent,
data-driven arguments. The time to act is now. There is no doubt the storm is coming, and only
an equally powerful response today can prepare us to cope with these future challenges.
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