Background and issueHospital leaders continue to be concerned with issues related to the need to enhance development of the health care workforce. For many years, hospitals have warned of a growing shortage of nurses and physicians and the challenges it presents for hospitals treating patients in the future.
With the wide expansion of insurance coverage under the Affordable Care Act (ACA) as well the looming wave of the baby boomer generation aging and requiring greater levels of healthcare services, the question becomes: Who will provide that needed care? The increasing demands will put greater pressure on a system that already is facing shortages of many key care providers including general practice doctors, nurses, nonphysician practitioners and others. It is imperative to expand the country’s health care workforce, both for today and in the long term. But we will have to overcome obstacles to build this work force.
The health care workforce of doctors, nurses and other caregivers is composed of caring, dedicated and highly trained individuals. The growing shortage of such professionals makes providing the high level of care expected by patients more challenging for hospitals. If such professionals are not found to relieve and replace the current level of doctors and nurses, hospitals will be forced to rely on their staffs for more shifts and longer hours. When facing a shortage of qualified professional caregivers, working conditions become more challenging and morale is damaged without appropriate staffing levels.
Hospitals and health systems face two continuing and related challenges as leaders work to ensure they have an appropriately trained and sufficient work force to provide high quality care to the patients and communities they serve: resources and supply.
On the resource side, hospitals continue to face a growing gap between the cost of care and public and private reimbursement to provide that care. Hospital leaders are constantly looking for ways to reduce costs without adversely impacting the quality of care provided to their patients. It is estimated that nearly 60 percent of hospital expenditures are attributable to employee and staff wages and benefits–more than any other expense. And there are additional costs associated with recruitment, training and administration of this highly specialized work force.
In terms of supply, there is a large and growing body of research that indicates clearly that the number of needed physicians, nurses and other healthcare professionals is not keeping pace with the expected demand. Hospitals face a growing shortage of these trained professionals essential to effective, high-quality patient care. A 2015 study by the AAMC projects that the country will face a shortage of 46,000-90,000 physicians by 2025. At the same time, the Bureau of Labor Statistics projects that by that 526,800 more nurses will be needed by 2022.
Current statusTeaching hospitals across the country continue to work to provide opportunities to train highly skilled physicians. While they seek to train the next class of physicians, cuts to reimbursement and regulatory challenges continue to make it difficult to train the necessary numbers for a skilled medical workforce. Similarly with nurses, hospitals continue to work closely with nursing schools, colleges and universities, and high schools to encourage students to consider health care as a profession and to recruit potential staff. National and state hospital associations work with Congress and the federal government each year to allow foreign-born physicians and nurses and others to come to the United States to work in our hospitals. But it is widely recognized that more must be done.
Some progress made with two recent federal initiatives focused on the health care workforce. The first was the American Reinvestment and Recovery Act (ARRA), which took steps to strengthen the health care workforce. The second is the Affordable Care Act (ACA). Both include provisions to address workforce challenges.
The stimulus bill included $500 million to support programs like the National Health Services Corps (NHSC), which places providers–including doctors and nurses–in underserved communities. The legislation also provides some support for existing workforce programs–Title VII and Title VIII of the Public Health Services Act, which are important for education and training of the next generation of doctors and nurses.
The ACA creates a National Health Care Workforce Commission to develop a comprehensive and coordinated national strategy to address workforce shortages and encourage training in key areas. To increase the supply of health care workers, ACA provides higher loan amounts and more flexible loan repayment programs for primary care physicians, nursing and allied health professionals and the public health workforce. It also supports current health care workers by providing funding for a variety of programs, many aimed at increasing workforce diversity.
In addition, the law helps to encourage physicians to enter into primary care, recognizing primary care’s role in keeping Americans healthy and avoiding costly complications, by providing 10 percent payment bonuses for five years to physicians in health professional shortage areas who devote more than 60 percent of their practices to primary care.
While the efforts in ARRA and ACA were steps in the right direction, more still needs to be done to promote building the workforce necessary to deliver a high quality of care.
Our positionThere is a growing recognition in Congress and the Administration that more needs to be done to address the health care workforce shortage. And we applaud the steps already taken to improve the available supply of trained health care professionals.
However, hospitals must have the resources necessary to recruit and retain nursing and other medical staff needed to provide high quality care to their patients. Due to the growing challenges of the aging baby boomer population, creating a decreased labor supply to serve a population in greater need of services, hospitals must have adequate and improved reimbursement in order to address their work force needs.
We support the hospital community’s call for the following:
Increasing the number of residency positions available to train physicians at teaching hospitals.
Ensuring stable and sustainable funding for Graduate Medical Education.
Increased federal funding for Nursing Workforce Development programs
Increased funding for Health Professions Training, including allied health, under the jurisdiction of HRSA
Additional funding for the NHSC, restoration of funding for the Centers of Excellence and Health Careers Opportunity programs
Additional funding for the Children’s Hospital Graduate Medical Education program
What we are doingVizient works each day with our members to help them reduce costs associated with medical supplies and equipment, freeing resources to allow them to hire, train and retain physicians, nursing and other medical staff needed to maintain quality care. The legacy University Healthsystem Consortium, which is now part of Vizient, provides a dedicated focus on identifying solutions and leveraging data to serve our nation’s academic medical centers and ensure they have the ability to continue training the next generation of physicians.
We are working with national and state hospital and health care organizations to ensure hospitals are positioned to take full advantage of workforce provisions included in the Affordable Care Act and other applicable laws.
We also continue to offer our members quality workforce educational programs, such as the Vizient Clinical Improvement Services. The program is focused on medical-surgical patient management and the patient experience. Research shows that when nurses spend an average of 60 to 70 percent of their time in direct patient care, outcomes are dramatically improved. To achieve this result, nurses, medical staff and administration must work collaboratively to improve culture and processes, which in turn will provide better outcomes and higher patient satisfaction.