Clinician Shortages Not Abating, Health Executives Report

By Debra Wood, RN, contributor

December 18, 2013 - Just as the country faces an aging population, needing more health services, and the Affordable Care Act provides medical coverage for more Americans, a shortage of physicians and other clinicians continues as a concern, according to the AMN Healthcare 2013 Clinical Workforce Survey.

AMN CEO Susan Salka: clinician shortages will grow more acute.
AMN Healthcare CEO Susan Salka says that clinician shortages will become more acute due to the aging population, more patients gaining health coverage through Obamacare and pending retirements in the clinical workforce.

“A shortage creates multiple issues that all come down to the patient,” said AMN Healthcare President and Chief Executive Officer Susan Salka. “If you do not have enough clinicians, it restricts access to care. Doctors, for example, either do not take more patients or they take patients, and everyone waits longer.”

Additionally, she said, quality becomes adversely affected when clinicians are stretched to care for more patients than they can safely handle.

“It’s been proven that there’s a direct correlation between the number of patients a nurse is responsible for and patient outcomes,” Salka said. “It creates worse outcomes and increased mortality rates.”

AMN’s 2013 Clinical Workforce Survey found that 78 percent of hospital executives report a nationwide physician shortage exists, 66 percent believe there’s a shortage of nurses, and half think a shortage of advanced practitioners is here.

“Some people have the misperception that there hasn’t been much of a shortage, which was aided a bit by the economy,” Salka continued. “Nurses and doctors were staying put, not leaving their jobs due to the economic security. But as the economy improves you see more movement.”

AMN sent the survey to 5,000 randomly selected hospital chief executive officers, chief financial officers, department heads and others. Hospital executives attending the 2013 American Hospital Association (AHA) annual meeting and those attending the 2013 annual meeting of the Healthcare Financial Management Association (HFMA) also completed surveys.

The executives were asked to assess the clinical workforce challenges facing their facilities within the context of the workforce supply and demand trends. More than 42 percent of the 166 survey responses came from executives at hospitals with 201 beds or more, so large facilities were over represented.

More than 70 percent of the respondents ranked clinical staffing a top strategic priority, up substantially from 23.9 percent in AMN’s 2009 survey. Cost of staffing was ranked as a top concern, followed by physician/hospital alignment, the move toward quality-based compensation for clinical professionals and clinical staff vacancies.

Forty-two percent of physicians at the surveyed executives’ hospitals are directly employed, and 43 percent of their physicians are paid at least in part for achieving quality outcomes. Only 7.9 percent of nurses are paid based on quality outcomes.

The respondents reported current vacancy rates are approaching 18 percent for physicians and 17 percent for nurses, higher than reported in the 2009 survey, which showed a 10.7 percent physician vacancy rate and a 5.5 percent nursing vacancy rate. The allied professionals’ vacancy rate also increased, up 13.3 percent in 2013 from 4.6 percent in 2009.

Salka anticipates the problem of clinician shortages will become more acute as the population ages and needs more healthcare services, more people obtain coverage as a result of the Affordable Care Act, and aging clinicians retire. 

“The growth in nurse supply will slow down, because the new supply will not make up for the number of retirees,” Salka said.

The hospital executives who responded to the survey said they expect an influx of patients newly insured through the Affordable Care Act will increase the need for physicians at their facilities, 63 percent thought the law will increase the need for nurses, and more than 52 percent said it will increase the need for nurse practitioners and physician assistants.

The physician shortages have resulted in decreased access to care, according to 36 percent of respondents, while 17.2 percent felt nursing shortages have compromised care and 17.1 percent indicated nurse practitioner and physician assistant shortages have had that effect. Despite the shortages, however, the majority of institutions have managed to maintain access to services in their areas.

More than 70 percent of the healthcare executives surveyed rated the staffing of physicians, nurses, nurse practitioners and physician assistants as a high priority in 2013, compared to only 23.9 percent of the 2009 respondents.

Hospital executives consider physicians the most difficult type of clinical professional to recruit, followed by nurses, nurse practitioners and physician assistants and allied health professionals.

During the six months prior to the survey, respondents indicated that they had added physicians and physician extenders, but were keeping the number of nurses and allied professionals the same. And in the coming six months, they expected to again increase physicians and extenders but keep the level of nurses and allied professionals the same.

To deal with the shortages, clinicians will need to work to their maximum skill set and educational capability, Salka said. Team-based care will become more common.

Additionally, nursing schools and medical schools have increased enrollments. But residency slots remain a bottleneck. 

Despite the physician shortage, only 27.9 percent of the teaching hospitals plan to add primary care residency positions, and 20.9 percent will add specialty care residency positions, according to the AMN survey. The facilities listed insufficient funds as the prime reason for not adding residency slots.

More than half of the respondents said their facility is not using a managed services provider to manage multiple staffing agency providers, and nearly a quarter of them said they were not familiar with such providers.

“We are seeing more desire by hospitals and health care systems to partner with organizations like AMN,” Salka said. “We’ve seen more of an opportunity for workforce solutions.”

She explained that with a managed services provider agreement, AMN will work with the organization to look ahead and create innovative solutions for finding permanent staff and for contingent staffing. The company becomes accountable for adequately staffing the facility, and can help improve fill rates and generate cost savings through greater efficiency. AMN continually looks for new, client-specific solutions.

“We have a national database and relationships with nurses and doctors,” Salka said. “Why not leverage that from us to make sure they are getting the right talent when they need it?”

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