Healthcare Staff Shortages?

Here’s what hospital and healthcare system managers think is happening

Healthcare workforce researchers and analysts have been arguing for the past couple of years over whether a dire physician shortage will materialize as predicted. Similarly, some are expecting a severe nursing shortage, but others insist the shortage may not turn out to be as bad as originally expected.

What do managers at hospitals and healthcare systems think? They’re telling a different story, according to the recent AMN Healthcare Clinical Workforce Survey.

First, the research and analysis: The Association of American Medical Colleges estimates a shortage of 45,000 primary care doctors and 46,000 surgeons and medical specialists by 2020, due in part to increased numbers of older people (who need more care) and the addition of millions of people with health insurance from the Affordable Care Act (ACA). Some analysts say the shortages can be avoided through new models of team-based care that rely on non-physician clinicians—such as nurse practitioners and physician assistants—for primary care. A RAND Corp. study maintained that this strategy could reduce the physician shortage by more than half.

Meanwhile, the status of nursing supply and demand remains uncertain. For years, experts have warned about looming nursing shortages. However, an article in the New England Journal of Medicine last year declared that these shortages have failed to materialize. At the same time, the article said future demand is uncertain. For example, a growing demand for nurse practitioners to fill the shortages of physicians may cause a shortage of nurse practitioners.

While these debates rage, many healthcare executives say they are seeing shortages of physicians, nurses, and allied health professionals right now. The AMN Clinical Workforce Survey found that 78 percent of hospital executives surveyed say they’re seeing a physician shortage now, while 66 percent say there’s a shortage of nurses, 50 percent say a shortages of nurse practitioners and physician assistants, and 43 percent note a shortage of allied healthcare professionals.

Executives report an average of nearly 18 percent vacancy rates for physicians at their facilities, 17 percent vacancy rates for nurses, 15 percent for nurse practitioners and physician assistants, and 13 percent for allied healthcare professionals. All or nearly all said that they consider such vacancies rates to be high for their facilities.

In the survey, taken in 2013, more than 70 percent said that clinical staffing is a top priority. In the same survey in 2009, only 24 percent said the same thing, showing that concern about staffing hospitals with adequate numbers and quality of clinicians has increased nearly threefold in four years. Clearly, troubling changes are afoot for healthcare workforce management.

The AMN survey showed percentages of executives who said they were “extremely concerned” or “somewhat concerned” about the following clinical staffing issues:

• Capacity to handle new patients from ACA: 78 percent
• Clinical turnover: 80 percent
• Clinical staff vacancies: 83 percent
• Clinical staffing costs: 92 percent.

Nearly two-thirds of all executives said that they will need more physicians and nurses at their facilities, while more than half said they will need more nurse practitioners and physician assistants. About half of hospital executives said they expect to increase the number of physicians, nurse practitioners, and physician assistants in the next six months. Compared to the 2009 survey, executives plan to add physicians at about the same rate, though the rate at which they intend to add nurses and allied health professionals is increasing.

One critical area of clinical staffing is the transformation from volume-based financial incentives for clinicians—how many patients seen and procedures done— to value-based metrics such as patient outcomes, reduced readmissions, patient satisfaction scores, adherence to treatment guidelines, and other measurements. More than 43 percent of executives responding to the AMN survey said that they are now compensating physicians in part through such value-based metrics. Compensation based on quality for nurses is growing at a slower rate.

One method that hospitals can use to contain costs and increase efficiency is a management innovation that’s common in other industries but new to healthcare: managed services programs (MSP). MSPs deliver one source of management and billing for multiple healthcare staffing providers. Many hospitals have dozens of such providers for clinical practitioners. The survey showed that approximately 10 percent of executives responding to the survey already are using MSPs, while another 10 percent said they are planning to do so in the future.