Economics states that the law of supply and demand is a theory, and that it explains the interaction between the sellers of a resource and the buyers for that resource. In health care it is the number of providers to the number of patients. With a shortfall of medical providers there will then be a shortfall of care. Unfortunately, in medicine we cannot increase prices to produce more care. We have to increase the supply of workers.
Hospital and other health care workers are burned out due to COVID-19, with physician burnout being a problem prior to COVID. It was estimated that physicians were twice as likely to experience burnout. Across the nation front-line workers in general have been challenged by even higher levels of stress, caused by systemic changes to care delivery and exacerbated by the COVID-19 pandemic.1
About half of this physician population has also reported depression and suicidal ideation due to COVID. The New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons conducted a three-wave study which assessed clinical symptoms and moral injury among 350 health care workers (HCWs) at baseline, 30, and 90 days between September and December 2020. It was found that there were high levels of moral injury associated with a range of psychopathology including suicidal ideation, especially among health care workers self-reporting COVID-19 exposure.2
A Medscape survey was also released in October 2021 and the results were as follows: two percent of physicians said they were considering a nonclinical job, and of those, 58% said they would do so within the next three years. 34% said it was because of burnout, and 20% said it was because they were working too many hours.3
According to a White Coat Investor article, a physician was quoted as saying “You have physicians, you have nurses, dropping out, retiring early, leaving practice, changing jobs,” Dr. Dharam Kaushik, a urologist at the University of Texas Health, San Antonio, told Morning Consult. “You’re experiencing loss of manpower in a field that was already short on manpower before the pandemic hit.”4
Another critical factor in the supply chain is the “Baby Boomer”. Baby Boomers make up a large percentage of the current workforce. The U.S. Census Bureau states that the “65-and-older population has grown rapidly since 2010, driven by the aging of Baby Boomers born between 1946 and 1964. The 65-and-older population grew by over a third (34.2% or 13,787,044) during the past decade, and by 3.2% (1,688,924) from 2018 to 2019.5 The US Census also reported that by 2020 the number of people over the age of 65 would outnumber those under age 5, and that by 2050 the ratio of young-to-old will double (15.6 percent compared to 7.2 percent).6
In 2017, it was estimated that 43% of the physician workforce are baby boomers. That means practicing doctors 55 and older.7 With the ratio of baby boomers to the population, loosing 43% of the physician workforce is a severe issue that can negatively impact the healthcare workforce. In December 2020, the Association of American Medical Colleges (AAMC) published that the United States could see an estimated shortage of between 54,100 and 139,000 physicians, including shortfalls in both primary and specialty care, by 2033.8
Nursing is facing the same problems. According to the American Association of Colleges of Nursing (AACN), the U.S. is projected to experience a shortage of registered nurses (RNs) that is expected to intensify as baby boomers retire. Many Boomers are already retiring, leaving less staff to care for patients and teach new nurses. “The RN workforce is expected to grow from 3 million in 2019 to 3.3 million in 2029, an increase of 221,900 or 7%.” The Bureau of Labor Statistics also projects 175,900 openings for RNs each year through 2029 due to nurse retirements and nurses leaving the workforce. Nurses have left the workforce due to the stress of the pandemic, staff cuts, and other factors such as increased workload and longer work hours.9
The nursing shortage is also happening around the world. The World Health Organization (WHO) predicts the world will be short 5.7 million nurses by 2030. Currently traveling nurses and nurses from other countries are contracted and come to the United States to work. If there is a worldwide nursing shortage, the U.S. will have no other countries to find contract nurses. Research also shows that with less skilled nurses there is an increased rate of error, shortcuts, and other risk factors.10
Compounded is the issue with Baby Boomers. As they age, they will need increased care. As the population is getting older the U.S. will be facing more sick patients with increased demand for medical care, hospitalization, rehabilitation, personal care, and other medical needs. Medicare would be overwhelmed. Rural and underserved areas are already affected by the workforce shortage, increased older population, hospital closures, and access issues. Rural health will be affected greatly.11
On a positive note, according to an article in AAMC, there has been a record high number of medical school applicants and enrollment. An estimated 17.8% for the 2021-22 school year, with a historical increase among underrepresented minorities, according to new data from AAMC.12 Also, in December 2020, the Fiscal Year 2021 omnibus spending bill, the Consolidated Appropriations Act of 2021 (CAA), was signed into law. This law will allot money to higher education which extends to Graduate Medical Education (GME). GME is a hospital sponsored or based training program for physicians. The Centers for Medicare and Medicaid (CMS) is the largest funder of GME. CMS will distribute 1,000 new residency slots, within a five-year span, to qualifying hospitals.13
Under the CCA financial assistance will also be awarded to the National Service Corps and Community Health Centers. The National Service Corps helps to increase the primary care workforce. They assist with loan repayment and other support.14
As the pandemic continues, and health care workers continue to leave the workforce, its only a matter of time before health care breaks down completely in rural and urban areas of the U.S. To have a future in health care, facilities must act now to keep their staff.
