By Jennifer Larson, contributor

Jan. 20, 2010 - It goes without saying that you can't provide healthcare or run a hospital or clinic without staff. And yet, experts predict that shortages of healthcare personnel will continue and perhaps even worsen over the next few years.
 
Factors putting a strain on the healthcare workforce include:

• The advent of healthcare reform could add as many as 30 million additional people to the insurance rolls, which would drive up demand for healthcare.
  
• The general population is continuing to age, which also is likely to increase the demand for healthcare.
  
• There are not enough physicians, particularly primary care doctors, in the pipeline to address the growing need.
  
• The nursing shortage, which eased a bit in some areas because of the recession, could return to the critical level as soon as this year, depending on the pace of the economic recovery.
  
• The allied health professions are also experiencing shortages, although not as well publicized as the doctor and nurse shortages. 

Unlike many other industries, the healthcare sector is projected to continue growing. The federal Bureau of Labor Statistics released a report in December 2009 that projected an additional four million jobs will be created in the healthcare and social assistance fields during the period from 2008 to 2018.
 
That means that many healthcare organizations may be scrambling to fill vacancies and to develop creative and efficient strategies to deliver patient care.
 
Physician shortages
 
The ongoing shortage of primary care physicians is well-documented, caused in part by fewer people choosing to enter the primary care field when they begin their careers in medicine. According to the Association of American Medical Colleges (AAMC), the number of medical school graduates choosing a career in family medicine has dropped off sharply in the last seven or eight years. That trend is corroborated by the American College of Physicians, which reported in late 2008 that the number of medical school graduates choosing a residency in a primary care area such as internal medicine declined by half over the last decade.

While the supply of primary care doctors appears to be shrinking, there is an increasing demand for their services.
 
"Essentially, it's going to get worse before it gets better," said Edward Salsberg, senior director for the AAMC's Center for Workforce Studies, which closely monitors the physician workforce. "We think the shortages are really going to be systematic and much worse in the future."
 
The physician workforce is also aging, so the public can expect that many working doctors in the baby boomer generation will begin to retire shortly. But the general population is also growing older. Those people will need more healthcare services--not just from primary care physicians, but also from a number of specialists in fields such as geriatrics, oncology and cardiology, Salsberg said.
 
Nursing shortages 

The recession has had a temporary positive effect on the nursing shortage in the United States. Some nurses who would have otherwise retired stayed in their jobs, while others returned to work or increased their hours. But workforce experts say the phenomenon is temporary; not enough resources have yet been invested in long-term strategies that would truly reverse the shortage. 

So the shortage is likely to continue--and worsen. Research led by Peter Buerhaus, Ph.D., RN, director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University, has projected that the nursing shortage may grow to 260,000 registered nurses by 2025, as reported in the July 2009 issue of Health Affairs.

"The recession has eased up some of the acute shortage, but we know that's not going to make a big difference in the longer term," said Matthew McHugh, Ph.D., RN, an assistant professor of nursing and a faculty member at the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.

He noted that while many nurses nearing retirement age have delayed their retirement because their spouses may have lost their jobs during the economic downturn, that's also a temporary phenomenon--not one that can be relied on to address long-term shortages. Once the recession finally eases, many of those baby boomer nurses may leave their jobs. Meanwhile, the general population will continue to age and will probably need even more nursing care.
 
What can be done? 
 
With these ominous forecasts, hospitals and healthcare organizations need to be proactive in planning for the future.
 
That may be especially true for hospitals. The American Medical News, which is affiliated with the American Medical Association, recently published a report that the number of doctors and other professionals hired by medical practices is likely to grow much faster than hospital employment over the next eight years.
 
Hospitals will face growing competition for physicians, Salsberg said, which could result in some price escalation. Leaders will be expected to make the best and most efficient use of the physicians and resources that they have, and to design contingent plans to cover gaps.

"If you combine that pressure [to cut costs] with increasing demand, we think that hopefully there will be a period of innovation around the design and delivery of services," he said.

This might involve making greater use of interdisciplinary teams that include nurse practitioners and physician assistants. It makes sense, Salsberg said, to let people use their skills up to their capabilities, from a cost standpoint and a quality standpoint.
  
"We think more needs to be done to prepare physicians and health professionals to actually practice collaboratively, which seems to be the most rational way of providing services," he said.
 
McHugh hopes that hospitals will put more effort into developing and maintaining better practice environments for nurses, which could aid in retention. He has been conducting research that shows that acute care settings tend to have higher dissatisfaction and burnout rates, which leads to higher turnover. Efforts that contribute to a more satisfied nurse workforce with more autonomy, better nurse-physician relationships, and leadership roles for nurses could play a role in reversing that trend.

Expanding the capacity of nursing schools is another essential element in preparing the workforce for coming changes, according to McHugh, especially if the healthcare system evolves to the point where it needs more advanced practice nurses. There will be a need to educate even more nurses, and capacity would continue to be a problem.

"That's a really big sticking point," he noted.

While workforce experts acknowledge the limits of the healthcare reform legislation, many believe it has the potential to help the country's current situation. Like others who are concerned about the ongoing nursing shortage, McHugh will be monitoring the status of additional funding for nursing education contained within the legislation.

Salsberg noted that reform needs to provide communities with enough workers and tools to actually cover the additional patients who will be seeking assistance, and to do it well. Otherwise, he said, there could be significant access problems in the future.

"There will be challenges, but I have confidence in the healthcare delivery system that they can come up with innovative solutions if the environment is supportive of that, like accountable care organizations," Salsberg said. 
 
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