Rob Preston | Content Director | January 2023
The US healthcare industry is experiencing a severe shortage of workers at every level—a crisis worsened by the COVID-19 pandemic. The American Hospital Association estimates that the industry will face a shortage of up to 124,000 physicians by 2033. Meanwhile, it will need to hire at least 200,000 nurses a year to meet rising demands. Among support personnel, a shortage of home health aides is most acute.
One study projects that if US workforce trends continue, more than 6.5 million healthcare professionals will permanently leave their positions by 2026, while only 1.9 million will step in to replace them, leaving a national industry shortage of more than 4 million workers. Here’s a deeper breakdown of the root causes of the healthcare worker shortage, including which professions face the largest shortfalls in the US and what steps the industry can take to mitigate these shortages.
The reasons for the US healthcare staffing shortages are complex and varied. A major factor is demographics: People are living longer, requiring more medical attention as they do, while members of the aging healthcare workforce are starting to retire faster than they can be replaced.
Other reasons include burnout (overworked employees are leaving the profession at an accelerating rate); the rise in chronic conditions such as diabetes, heart disease, cancer, and Alzheimer’s disease (leading to overextended staff at hospitals and long-term care facilities); and the nation’s inability to produce enough doctors and nurses to meet growing demand (partly because of faculty shortages at nursing and medical schools). Shortages of certain kinds of healthcare practitioners, such as nurses and certified nursing assistants, are also due to the relatively low compensation levels and relatively high job demands and education requirements in those fields.
Every type of medical professional is in short supply—including doctors, nurses, administrators, aides, assistants, and techs—but some professions are facing a more critical shortage than others.
Physician shortages vary by specialty. The biggest shortfalls tend to be in fields where compensation levels are relatively low while the rigors of the job are high. Infectious disease physicians, primary care doctors, and pediatricians, for example, tend to make less money and work longer, less predictable hours than dermatologists, radiologists, and plastic surgeons, and thus are in shorter supply relative to demand, explains Dr. James Willig, a physician who specializes in infectious diseases and clinical informatics at the University of Alabama at Birmingham.
Meanwhile, the aging population (more on that below) is starting to overwhelm the supply of cardiologists, orthopedic and vascular surgeons, neurologists, rheumatologists, pulmonologists, and other geriatric specialists, many of whom are aging out of their professions themselves.
McKinsey predicts the US could see a shortfall of 200,000 to 450,000 registered nurses (RNs) available for direct patient care by 2025. In their March 2022 Frontline Workforce Survey, 29% of RN respondents indicated they were likely to leave their current role providing direct patient care, and of those, 15% said they intended to leave the profession entirely.
Many nurses are reconsidering the profession because of burnout and/or insufficient pay. Others are moving on to seek career opportunities in new or related fields, such as consulting, insurance, teaching, or human resources. Although enrollment in nursing programs is on the rise, it still isn’t sufficient to meet growing demands.
At the low end of the healthcare pay spectrum are residential and nursing home health aides. As the population ages, demand for these workers is outpacing supply. A 2021 study by industry market analytics firm Mercer estimated that the US will have a shortage of about 446,000 home health aides by 2025, with rapid turnover a particular problem.
Less of a problem in the US, the shortage of midwives to assist with childbirth is most severe in low-income countries. The State of the World’s Midwifery 2021 report puts the current worldwide shortage at 900,000—a critical shortfall considering an estimated 4.3 million lives could be saved annually by 2035 were midwife coverage universally available.
US hospitals, clinics, medical practices, and other healthcare providers were experiencing worker shortages long before COVID-19 put additional stress on the system. The industry’s labor shortages are a function of a variety of overlapping trends, including the following:
Clinicians’ typical workdays—marked by long hours, a frenetic pace, emotional duress, deadline pressures, and high-impact decisions—put them at a high risk of burning out. Study after study finds that up to half of doctors and nurses report feeling stressed, and those rates soared during the pandemic. The burden of administrative work, such as having to constantly update electronic health records, is yet another cause of burnout. The long-term effect is that burned-out doctors, nurses, and support staff are more likely to leave their professions or provide substandard care, threatening patient safety and care quality.
According to 2021 population estimates by the U.S. Census Bureau, the median age in the United States has increased by 3.4 years since 2000, with the largest single-year gain (of 0.3 years) coming in 2021, bringing the median age to 38.8 years. As people live longer, they require more medical attention, particularly ongoing services to treat chronic diseases such as heart disease, diabetes, and most forms of cancer. Meanwhile, doctors and nurses are starting to retire faster than they’re being replaced. The average age of a doctor in the US is 48; for a nurse, it’s 44, according to an analysis of US census data by job site Zippia.
One major factor contributing to the shortage of clinicians is the lack of qualified faculty members to train and educate them, especially at nursing schools. A report by the American Association of Colleges of Nursing (AACN) found that US nursing schools turned away 91,938 qualified applicants for undergraduate and graduate nursing programs in 2021, mainly because of an insufficient number of faculty and clinical training sites. A separate AACN survey released in October 2022 identified a total of 2,166 full-time faculty vacancies at 909 US nursing schools across the country. Beyond needing to fill the vacancies, the nursing schools also cited the need to create an additional 128 faculty positions to meet rising student demand.
Compared with the general population of workers, healthcare practitioners are paid well—in the US, that means an average annual salary of $70,000-plus for experienced nurses and six-figure multiples for doctors, with physician specialists at the high end of the earnings spectrum. But the cost, academic rigor, and time commitment of a medical education continue to discourage many from entering medical fields in the first place. For doctors, the fully loaded costs of an undergraduate and med school education can exceed half a million dollars, and that education can take 11 years to complete when the required internship and residency are factored in. Other, nonmedical professions require a smaller up-front investment and promise higher pay for less stressful work.
Healthcare providers whose human resources are stretched thin need to implement creative strategies to do more with less while creating a work environment that promotes collaboration and instills loyalty.
Internet access is now available in or within reach of most homes in the US, making basic health consultation and remote health monitoring services accessible to wider segments of the population while also making it easier for overloaded practitioners and facilities to serve more patients. At the same time, some healthcare groups are offering their doctors and nurses the option of working remotely for part of their schedules, an incentive for those who might have considered leaving the profession because of family or other responsibilities at home. Telehealth also has the added benefits of being more cost-effective for providers and more convenient for many patients. Plus, it’s safer for caregivers and patients alike amid infectious disease breakouts.
By giving employees more of a voice in the organization, healthcare employers create a workplace environment that builds loyalty and engagement—the type of environment that attracts the best and brightest people and encourages them to stay. Such employers field regular employee surveys and seek feedback on ways to improve the organization. They also connect employees with one another—and, where desired, with professional counselors—for advice and support developing their careers, coping with stress, and dealing with other personal and professional matters. These organizations recognize the mental health risks that confront healthcare workers and the professional pressure they face to hide their mental health problems; they provide awareness and support programs to reduce these risks.
Nurse practitioners and physician assistants are already taking on many of the responsibilities that were once the exclusive domain of fully credentialed MDs, such as diagnosing patient conditions and prescribing medications. Healthcare systems are also training and educating caregivers to take on different or more-specialized critical care and other responsibilities on short notice. Meanwhile, some of the hands-on care and time-consuming jobs once left to nurses—for example, drawing patients’ blood, giving them IVs, bathing and feeding them, and taking care of certain administrative tasks—can also be delegated to less credentialed workers, notes Catherine “CJ” Robison, a former nurse and current health innovation scientist at Oracle.
Finding skilled doctors, nurses, technicians, and other scarce healthcare professionals isn’t as simple as posting job ads on Indeed. Identifying and attracting people likely to slot well into your organization’s culture requires a customized search conducted by specialized headhunters with the support of the latest AI-based recruiting tools.
To promote a healthier work-life balance, some healthcare employers are offering their practitioners and support staff flexible schedules, including staggered start times and overlapping shifts. They’re even allowing some people to set their own schedules or work from home part of the time.
Expanding the pool of doctors, nurses, and other healthcare professionals will require a national effort—starting at the primary and secondary school levels—to develop programs that encourage underrepresented demographic groups to pursue a course of study and ultimately a career in those fields. As an example, one promising program started by three hospital groups in Chicago offers high school students in economically depressed communities free training and the guarantee of a job interview for entry-level positions.
In nursing, the most glaring underrepresented demographic continues to be men: 86% of US nurses are women and only 14% are men. However, gender representation is more balanced among doctors in the US, where 54.2% are women and 45.8% are men, according to the job site Zippia. Gender pay gaps exist for both fields. Among nurses, women make $67,730 to men’s $71,323; among doctors, women make $156,400 to men’s $186,646.
In terms of race, in the US, doctors and nurses are predominantly white, and many other populations are underrepresented, according to Zippia.
For doctors, the breakdown by race is as follows:
For nurses, the breakdown by race is as follows:
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US hospitals, clinics, medical practices, and other healthcare providers were experiencing worker shortages long before COVID-19. But the pandemic put considerable additional stresses on the healthcare system, exacerbating worker shortages as burned-out doctors, nurses, and other frontline workers left the profession.
There’s no magic pill; the reasons for the staffing crisis are highly complex. Alleviating the crisis will require a combination of education reform, government policy initiatives, new healthcare provider operating models, and technology-driven human resources best practices.
The healthcare worker shortage isn’t just a provider HR issue. It’s also a public health priority. Numerous studies have shown that improving clinician-to-patient ratios improves patient outcomes and leads to fewer adverse events, complications, and hospital readmissions. One recent study found that each additional patient per nurse is associated with a 12% higher chance of in-hospital mortality.