You've seen it in the headlines: Our country will face a shortage of more than 1 million doctors and nurses in the coming years. But the frightening problem goes far beyond this.
The United States also needs more than 3.2 million additional health care workers in other roles — including medical assistants, home health aides, and nursing assistants — within the next 5 years to meet demand. Ten thousand baby boomers age into Medicare every single day, only adding to the growing demand for health services.
How our country arrived at this point is complex. Employee burnout and fewer new workers entering the field are significant factors. Burnout was a problem even prior to the COVID-19 pandemic. Today, burnout rates range from 40% to 70%, and resignation rates are rising across the health care industry. At the same time, there are simply not nearly enough people pursuing careers in health care.
For America to build and retain the workforce to serve our growing health care needs, our lawmakers must apply 3 strategies.
Labor shortages and burnout are often worse in communities experiencing health disparities, which are historically communities of color, lower-income communities, and rural communities.
These communities not only need more health care workers, they would also significantly benefit from (and, frankly, deserve) a workforce that reflects the demographic and social characteristics of the population. Volumes of research show the importance of this.
For patients, having doctors and other clinicians who, through lived experience or learned cultural competence, share or understand their background is critical. Being cared for by someone who can relate to patients and stand in their shoes is essential to building the necessary trust to improve health. For workers, a staff that appropriately reflects the community with which they identify can help address feelings of isolation, misunderstanding, and burnout.
At Kaiser Permanente, we’re providing clinical education opportunities to address the workforce shortage, with a focus on health equity.
Specifically, we focus on the exorbitant cost of education and the daunting educational time commitment — issues that especially impact people coming from underserved communities, where resources to invest in the future are often limited or unavailable.
Congress has a critical role to play in helping to grow and diversify the workforce. Specific policy opportunities include increased federal funding for clinical training programs and physician residency slots, and ensuring these training programs and residency slots are in diverse and underserved communities. Congress’s move to fund 1,000 more residency slots in the Consolidated Appropriations Act of 2021 with priority for hospitals serving underserved communities, and to fund 200 more residency slots in the Consolidated Appropriations Act of 2023 is a good start.
Policymakers at the state and federal level should expand funding for training programs, tuition assistance, and loan forgiveness programs that diversify and increase the linguistic capabilities of the health workforce. The Substance Abuse and Mental Health Services Administration’s Minority Fellowship Program is a good example.
A focus on new hiring is not enough. America must build a larger, more diverse health care workforce while executing on strategies that support teamwork and flexibility.
America may be facing a doctor shortage, but that problem can be partly mitigated if health care organizations free up doctors’ time from tasks that others can perform to allow more patients to be seen more quickly. Examples are when pharmacists help patients review their medications or when nonclinical staff members help patients stay on track with a care plan. Several studies suggest that care approaches like these also reduce clinician burnout.
Because of our integrated care model, Kaiser Permanente already implements this team-based approach at scale. But we need policymakers to understand and support this approach, so they can advance legislation that fosters, not hampers, health care professionals working together, and individuals practicing at the top of their licenses — that is, to highest extent of their education, training, and experience.
Meanwhile, regulators responsible for professional licensure could be more flexible in their training requirements. Doing so would allow more health care professionals to practice sooner, and would create more opportunities for those who do not have the time or money to enable them to pursue extended training.
For example, in California, associate clinical social workers are issued licenses after they have received their master’s degree. People with these limited licenses can work, in a more narrow and supervised role, while earning their required clinical hours. We encourage other states to explore approaches that accelerate hiring while maintaining safety and quality.
Flexibility in how, where, and when care is provided is key to reducing clinician burnout, increasing patient access, and creating higher-quality outcomes.
For example, expanding the use of telehealth can reduce clinical staffing loads and enable more flexible scheduling for staff.
Telehealth adoption skyrocketed during the COVID-19 pandemic thanks to temporary federal policy changes that are set to expire in 2024. Policymakers should make these telehealth policies permanent, especially policies that ensure phone-only visits are covered for people without reliable internet access.
A focus on new hiring is not enough. America must build a larger, more diverse health care workforce while executing on strategies that support teamwork and flexibility. If we do, we will not only recover from the disruption of the pandemic, we will meet the needs and expectations of patients — both the groups who had been accustomed to the best of the U.S. health system, and those who deserve but have been denied that experience in the past.