The United States continues to face an unprecedented shortage of healthcare workers at the end of 2022. As a result, we have seen a recent increase in the federal and state legislative activity focused on addressing these shortages. Several states passed new laws or proposed legislation, Congress introduced a bill aimed at transparency around nurse staffing agency payment models, and lawmakers pressed the Federal Trade Commission (FTC) and the White House COVID-19 Response Team to open investigations into price gouging by nurse recruitment agencies.
The Massachusetts Health and Hospital Association (MHA) recently released a survey raising similar concerns about healthcare worker shortages in Massachusetts. The survey, titled An Acute Crisis: How Labor Shortages Affect Access and Costsprovided insight into the challenges facing the healthcare workforce in Massachusetts, citing staffing shortages, rising labor costs and capacity constraints.
Labor shortages
According to the MHA survey, there are currently approximately 19,000 vacancies in acute care hospitals in Massachusetts. These vacancies exist in all practice areas and disciplines, including nursing, behavioral health, technicians, laboratory staff and clinical support staff. The MHA reported a median vacancy rate for these positions of 17.2%. Nurses face one of the highest percentages of vacancies, with a 56% vacancy rate specifically for licensed practical nurses. Mental health workers and technicians have a 32% vacancy rate and there is a 35% vacancy rate for pulmonary function technicians.
National healthcare worker shortages began early during the Covid-19 pandemic. According US News and World Report, approximately 1.5 million healthcare jobs were lost in the first two months of the pandemic and these job numbers have not returned to pre-pandemic levels. In a letter to the United States House of Representatives in March 2022, the American Hospital Association (AHA) responded to growing labor shortages by reporting that: (i) 500,000 nurses will leave the workforce in 2022; (ii) 23% of hospitals are operating with a critical shortage of staff; and (iii) 95% of health facilities had to hire staff from subcontracting companies. In September 2021, the The American Nurses Association (ANA) wrote a letter to Secretary Becerra of the U.S. Department of Health and Human Services, calling for immediate action to address the national nursing shortage. The letter detailed the impact of the then new variant Covid-19 Delta, nursing shortages in various states and offered policy solutions.
Labor costs and capacity constraints
These labor shortages would place a heavy financial burden on hospitals in Massachusetts. As noted in the MHA survey, on average, 70% of hospital overhead is spent on labor costs, but the cumulative effects of Covid-19, healthcare provider burnout and with healthcare providers leaving the profession, hospitals must spend even more money to retain staff and maintain safe levels of operation for patients. Hospitals are spending more than before the pandemic on sign-on bonuses and retention packages and relying more on traveling nurses. The MHA reports that in fiscal year 2022, hospitals in Massachusetts spent $445 million on traveling nurses, a significant jump from the $133 million spent in fiscal year 2019.
The AHA letter said median hourly rates for traveling nurses at national hospitals had more than tripled since January 2019. Some hospitals are paying up to $240 an hour or more to retain traveling nurses. In addition to labor shortages and rising costs, hospitals are struggling to meet patient needs. Emergency room wait times are higher than normal and patients awaiting discharge to post-acute care facilities face long waits, up to 30 days at times, survey finds MHA.
Proposed policies
The MHA has recommended steps that stakeholders can take to ease the pressure at the state and federal levels. These steps include:
- provide additional federal funding to hospitals and affiliated providers,
- investing in training for behavioral health, substance use disorders and trauma-reactive workers,
- launch statewide campaigns to encourage entry into the healthcare workforce with direct links to employment, education and training,
- maintain public emergency flexibilities at the state and federal levels that allow for telehealth capabilities, and
- enact stronger workplace protections against violence against healthcare workers.
The AHA suggested focusing on healthcare workforce recruitment and diversity by:
- lift the limit on medical residences funded by Medicare,
- grant debt forgiveness and scholarships,
- encourage the reduction of work visas for nurses trained abroad,
- increase support for nursing schools and teachers, and
- behavioral health funding to treat, prevent and treat burnout.
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