Pennsylvania hospitals and health systems provide safe, quality health care and health evaluation services to millions of people each year. But a growing personnel shortage in our nursing and health care workforce could threaten everyone’s ability to receive the quality health care they expect and deserve.
The Healthy Me PA community is involved in an active discussion on the issue, considering the many walks of life our members come from—patients and families, hospitals and policymakers, and doctors and nurses themselves. There are many factors that add up to shortages that are detrimental to the health of everyone in the state.
In Pennsylvania, we have an aging population. By 2025, more than one in five residents will be 65 or older, according to projections from the U.S. Census and the Pennsylvania State Data Center. Our older residents will continue to need increased medical attention, long-term care, and help with daily living activities.
Plus, we have an overall increase in demand for care because the Affordable Care Act provided health insurance to many Pennsylvanians, enabling them to use its preventive care benefits. Additionally, as society has better understood the need to treat mental and behavioral health disorders, the demand for specialty providers has increased.
The issue by the numbers
There is a mountain of predictions about the shortages ready to beset the health care workforce in Pennsylvania and across the country. A quick snapshot shows:
- The U.S. will need to hire 2.3 million new health care workers by 2025..
- By 2030, Pennsylvania will face a registered nurse shortage of 4,000.
- By 2022, the number of registered nurse vacancies in the U.S. is expected to reach 1.2 million.
- Just to maintain current rates of utilization, Pennsylvania will need an additional 1,039 primary care physicians by 2030.
- Nearly half of Pennsylvania counties have no psychiatrist, and advocates note other mental and behavioral health specialists are in short supply as well.
Taken together, all of these points can lead to longer wait times for appointments, delayed care, and long-distance travel to see specialists. Patients in these situations often find themselves with more serious medical problems when they eventually can receive care, and our hospital emergency rooms are under increased strain to treat people when they feel they have nowhere else to turn.
There are many reasons we face these projected hurdles. Although there was a 3.7 percent enrollment increase in entry-level baccalaureate programs in nursing in 2018, it was not enough to meet the demand. However, U.S. nursing schools face finite resources, capacity, and staff. They turned away more than 75,000 qualified applicants from baccalaureate and graduate nursing programs in 2018, citing not just budget restraints but insufficient faculty, clinical sites, classroom space, and clinical preceptors, who are experienced practitioners who provide supervision during clinical practice.
To compound the problem, the U.S. Health Resources and Services Administration projects that more than 1 million registered nurses will reach retirement age within 10 to 15 years.
Medical doctor difficulties
In 2017, only one in six medical school graduates chose a primary care residency even though, by 2025, one-third of today’s primary care doctors will be older than 65 and preparing to retire. Part of the reason lies in the enormous debt medical students typically acquire during their education, leading them to pursue higher-paying specialties.
Although U.S. medical school enrollments have increased 52 percent since 2002, thanks in part to 29 new accredited medical schools and 17 new schools of osteopathic medicine opening in the period, residency training slots have increased only 1 percent a year. Congress has capped federally supported residency training slots for more than 20 years. That limits how many medical school graduates can take additional training before they can practice medicine.
Addressing the need
Hospitals and health systems across Pennsylvania have turned to novel ways to meet their workforce needs, particularly with nurses. These have included offering signing bonuses, loan forgiveness, and tuition breaks, and recruiting personnel long before they graduate from their training. But if our health care system is to meet the community’s needs, it’s clear we need policy changes, not just inventive recruiting practices.
As a community, Healthy Me PA has advocated for allowing certified nurse practitioners to practice to the full scope of their licenses without the need for physician supervision as a partial response to our current and projected shortages. We’ve encouraged our education, regulatory, and health care communities to develop the education programs to keep a steady stream of qualified workers entering the system. We support team-based models of care, which are models of flexibility that today’s health care demands.
Join the debate
Healthy Me PA members engage in ongoing discussions aimed at developing workable approaches to this health care difficulty, which has the potential to grow far more serious. Add your voice to the conversation to help us improve the health of all Pennsylvanians.