Short Falls: Staff vacancies perceived high when quality workers needed most

December 2, 2013


Staff vacancies are perceived high when quality workers are needed the most.

By Susan Salka


Health policy makers and researchers have recently been having a healthy theoretical debate about shortages of nurses, physicians and allied health professionals. Some predict dire shortfalls over the next two decades, while others question whether they will actually materialize, arguing that new models of patient care can dramatically reduce the problem. 

But healthcare leaders on the front lines today have a different view because they are dealing with the practical realities. They see the supply and demand of clinicians as an immediate problem, which they expect to get significantly worse in the near future. Projections about how new patient-care paradigms should reduce shortages in the future apparently offer little comfort. 


AMN Healthcare's recently published 2013 Clinical Workforce Survey asked hospital executives nationwide about clinical staffing trends they are facing at their facilities. More than 70 percent rated the staffing of physicians, nurses, nurse practitioners and physician assistants as a high priority in 2013, compared to only 24 percent of hospital executives who rated staffing these professionals as a high priority in AMN Healthcare's 2009 workforce survey. 

According to the survey, 78 percent of hospital executives believe there is a current shortage of physicians nationwide, 66 percent believe there is a shortage of nurses, and 50 percent believe there is a shortage of advanced practitioners.

In addition, hospital executives responding to the 2013 survey reported considerably higher vacancy rates for clinical professionals at their hospitals than those surveyed in 2009. Hospital executives reported a 17.6 percent vacancy rate for physicians at their facilities in 2013, compared to a 10.7 percent vacancy rate four years ago. An even larger growth in rates was reported for nurses, with nurse vacancies rising to 17 percent in 2013 from only 5.5 percent in 2009. The vacancy rate reported for allied professionals also showed significant growth, rising to 13.3 percent in 2013 from only 4.6 percent in 2009.

In other findings, the survey indicates that more than 65 percent of hospital executives believe the influx of patients newly insured through the Affordable Care Act (ACA) will increase the need for physicians at their facilities, while more than 63 percent said the ACA will increase the need for nurse practitioners and physician assistants.

These trends are a cause for anxiety, and understandably so. More than 80 percent of survey respondents say they are extremely or somewhat concerned about clinical staff vacancies, while a similar percentage worries that their facility will not have the clinical capacity to handle the influx of patients newly insured through healthcare reform. Nearly all respondents - 93 percent - say they're concerned about clinical staffing costs in the future.

Healthcare is in such a state of transformation, buffeted by so many cross-currents of governmental policies and market and social forces, that it's not surprising healthcare leaders are deeply concerned about staffing. The addition of millions of new patients through the ACA and an improving economy providing people with more resources to seek healthcare are only two of the pressures on the healthcare workforce. Another critical aspect is the aging of the clinical workforce, which may lead to a spike in retirements, and the aging of the populance, which translates into greater demand for care, particularly for chronic conditions. On top of this, training and education for clinicians has remained relatively static, particularly for physicians, while the population has grown and aged. 

The demand for clinicians is very real, and healthcare executives and managers are feeling it now. If shortages - particularly for physicians - grow as predicted by many researchers and analysis, then the current pinch healthcare leaders are experiencing could turn into a serious challenge in the next few years. 

New team-based patient care models - such as patient-centered medical homes, nurse-managed health centers and various types of accountable care organizations - are expected to result in better distribution and utilization of the clinical workforce. Allowing nurse practitioners, physician assistants, and certain allied health professionals to practice at the top of their licenses could reduce the workload on physicians. 

However, developing and implementing new patient care models nationwide will bring about a complicated and lengthy period of adjustment. Healthcare is an extremely complex industry; transforming patient care isn't like retooling an auto assembly line for next year's models. Innovative workforce and staffing solutions will be imperative to solve workforce challenges as health systems navigate the turbulence of this historic era in American healthcare.