Training bottlenecks, uneven distribution of certain providers and expected regulation are adding roadblocks to efforts to tackle pervasive staffing shortages throughout healthcare.
The National Center for Health Workforce Analysis predicts that by 2036 the industry will have shortages of more than 68,000 primary care physicians, 62,400 psychologists, 42,100 psychiatrists, 6,600 obstetrician-gynecologists and 33,100 family medicine physicians, in addition to deficits of other specialties.
Related: Healthcare jobs go unfilled even as demand for care increases
Here’s a snapshot of workforce challenges the industry is facing.
Physician specialties want more residency slots
Some specialties are feeling the labor shortages more acutely than others.
“Psychiatry, radiology, neurology and pathology are the specialties most impacted,” said Jesse Ehrenfeld, president of the American Medical Association. “But we have tremendous gaps in primary care. We estimate that 83 million people in the U.S. live in an area without access to a primary care physician, and that means family medicine, pediatricians, OB-GYNs, internal medicine doctors.”
Other shortages include psychologists, psychiatrists, social workers and anesthesiologists.
Medicare funding supports around 90,000 resident positions nationwide, and more than 17,000 additional residency slots are financed by states, hospitals, grants or other sources, according to data from the Association of American Medical Colleges. Internal medicine and family medicine have the most residency slots.
Last year, CMS added the first 200 Medicare-funded graduate medical education slots out of 1,000 that are planned for the next four years as authorized by the 2021 Consolidated Appropriations Act. The residency slots were the first additions since 1996.
Bipartisan legislation introduced in Congress early last year would expand the number of Medicare-supported medical residency positions by 14,000 over seven years. However, the legislation's future is unclear. The legislation sits on Congress' House Energy and Commerce Subcommittee on Health, with 172 bipartisan cosponsors, but some advocates don't expect it will pass this year.
Rural areas lack emergency, family medicine physicians
Emergency physicians are in short supply in rural and less populated areas. The shortage is exacerbated by the fact that they have to take on other duties because of a lack of specialty physicians in those areas, said Dr. Aisha Terry, president of American College of Emergency Physicians.
“Oftentimes when you train in your specialty, you tend to remain in the same geographical area after you finish your training,” Terry said. “And the reality is that the majority of emergency medicine training programs are in metropolitan areas or cities that are more highly populated.”
Family medicine practices in rural areas face the same problem. Though more than 15% of Americans live in rural areas, only 10% of doctors practice in those communities, according to data from the Health Resources and Services Administration. While many of these are primary care physicians, the overall shortage of physicians puts extra pressure on family medicine doctors to care for sicker patients.
As a result, more medically underserved and rural communities have sought funding for teaching health center residency programs to help build their local physician workforces.
Under HRSA’s Teaching Health Center Graduate Medical Education program, healthcare facilities receive a payment for each resident to cover training costs, including the resident’s salary and benefits. In 2022, HRSA supported 38 family medicine residency programs and the graduation of 173 residents.
Funding for the HRSA program would be increased and extended through the end of the year by a recent funding package.
Post-acute care staff recruitment, retention efforts struggle
Nursing homes need more than 130,000 workers to return to their pre-pandemic 2019 workforce level, according to the American Health Care Association/National Center for Assisted Living.
Despite offering increased wages to recruit and retain staff, 95% of post-acute facilities are still having trouble hiring workers, the association found.
CMS’ looming proposed minimum staffing standard could further exacerbate the staffing shortages. The proposed rule, issued in September, would require nursing homes to have enough clinical workers to provide a minimum of three hours of nursing care per resident, per day, while having a registered nurse on duty at all times.
“We can’t create more workers out of thin air,” the American Health Care Association/National Center for Assisted Living said in a statement. “So, the staffing mandate will only force nursing homes to limit admissions or close entirely, making it harder for seniors to find the long term care they need.”
The association has turned to Congress for help with provisions for loan forgiveness, affordable housing and clinical training grants that would help attract more caregivers to the profession. Additionally the American Health Care Association/National Center for Assisted Living is supporting bipartisan bills which would allow international doctors, nurses, and their families to recapture unused visas from previous fiscal years.
Nursing shortage exacerbated by lack of faculty
About 100,000 nurses have left the profession due to pandemic stressors, workplace violence and higher-paying opportunities in other industries, said Jennifer Mensik Kennedy, president of the American Nurses Association.
By 2031, the U.S. is expected to face a shortage of 195,400 nurses, according to the Bureau of Labor Statistics.
One contributing factor is colleges of skilled nursing turning away potential students due to a lack of teaching staff. In 2021, U.S. nursing schools rejected nearly 92,000 qualified applications for baccalaureate and graduate programs, citing an insufficient number of faculty, according to the American Association of Colleges of Nursing.
Certified nursing assistants in particular have struggled to undergo certification training due to a lack of qualified instructors available to teach the courses.
To recruit and retain more nursing school faculty, the American Nurses Association, and others, are proposing federal grants to increase professors’ salaries. Other initiatives, like HRSA's Nurse Faculty Loan Program, offer student loan repayment or cancelation options for graduate students pursuing nursing faculty careers.
