The Great Healthcare Worker Exodus

Doctors and nurses are increasingly leaving the field, hospitals are raising alarms about workforce shortages, and employees are unionizing and striking in high-profile disputes with their employers.

While predictions of healthcare worker shortages often focus on the distant future, the pandemic and its aftermath have already created a volatile situation with dissatisfied workers and understaffed facilities.

Some believe that understaffing is partly due to intentional cost-cutting measures. Regardless, this impacts patient access and the quality of care.

"There are 83 million Americans today who don't have access to primary care," Jesse Ehrenfeld, president of the American Medical Association told Axios. "The problem is here. It's acute in rural parts of the country, it's acute in underserved communities."

In 2023, 65 percent of rural areas had a shortage of primary care physicians, according to a report by the Health Resources and Services Administration. More than 15 percent of Americans — about 46 million — live in rural areas, but only 10 percent of doctors practice in these communities, many of whom are primary care and family physicians.

Nationwide, the shortage of healthcare workers has significant financial implications for hospitals and healthcare systems, leading to increased labor costs and operational challenges. Hospitals have reported significant declines in employment, further straining the remaining workforce.

Shortages Projected

According to the 2024 State of Nursing survey, the nation may experience a shortage of 200,000 to 450,000 nurses by 2025. This gap is driven by high levels of burnout, increased workloads, and a significant number of nurses planning to leave the profession by 2027 due to stress and retirement.

Additionally, there is an expected shortfall of up to 86,000 physicians by 2036, according to the Association of American Medical Colleges, which projects the shortage will be driven by an aging physician workforce and an increasing number of retirements, coupled with a growing demand for healthcare services as the general population ages.

The AAMC says the projected shortage includes deficits in both primary care (17,800 to 48,000 physicians) and non-primary care specialties like surgery and medical specialties (21,000 to 77,100 physicians). The Association cautions that without continued investment to fund more residency positions, the projected shortfalls will be larger than the latest 86,000 estimate.

The Residency Pipeline

After graduating from medical school, new physicians must complete a residency program of 3-7 years to receive advanced training in their chosen specialty like surgery, pediatrics, internal medicine, etc.

Residency positions are accredited training roles offered at teaching hospitals, medical centers, and other clinical sites that allow residents to practice medicine under the supervision of fully licensed physicians.

The number of residency positions available each year is limited and funded primarily by the Centers for Medicare & Medicaid Services (CMS) through Graduate Medical Education (GME) payments to teaching hospitals.

There is an ongoing shortage of residency positions compared to the number of graduating medical students, which contributes to the projected physician shortage in the U.S. The AAMC has called for increasing federal support to fund more residency positions as a key strategy to grow the physician workforce pipeline.

Complaints about understaffing, administrative burdens, and inadequate wages are not new, but they are growing louder, with more healthcare workers leaving their jobs or reducing their hours.

The pandemic led to increased workloads, stress, and difficult working conditions for healthcare workers, contributing to higher levels of burnout, job dissatisfaction, and workforce exits.

"The pandemic just made these issues super obvious. For many physicians, the treadmill got harder," Joanne Spetz, director of UCSF's Philip R. Lee Institute for Health Policy Studies, told Axios.

Burnout a Problem

The pandemic also triggered increased burnout and poor mental health among healthcare workers who bore the brunt of its impact. An estimated 3,272 physicians in direct patient care left the workforce between January 2019 and October 2021, with continuous increases in physician turnover over time during the pandemic period

"The pandemic led a lot of people to say, 'Oh hell no,'" Spetz added.

Nearly half of physicians report burnout, and 20 percent report depression, according to Medscape's annual survey. A Doximity survey found that four in five physicians feel overworked, and three in five are considering early retirement, seeking another job, or changing careers.

Employment in nursing homes and elderly care saw a sharp decline during the first years of the pandemic and remains significantly below pre-pandemic levels, unlike employment in hospitals, outpatient facilities, or physician offices, according to the Kaiser Family Foundation, a non-profit organization focused on national health issues.

"It's just huge risk for a death spiral," Spetz noted.

According to the study published in JAMA Network Open, burnout, emotional exhaustion, and insufficient staffing were among the top reasons nurses cited for leaving healthcare employment between 2018 and 2021, aside from planned retirement.

Key Findings:

• Burnout or emotional exhaustion was cited by 26 percent of nurses as a major contributing factor for leaving healthcare employment.
• Insufficient staffing was cited by 21 percent of nurses as a top reason for leaving.
• Among retired nurses, 41 percent ended healthcare employment for reasons other than planned retirement, with burnout (22 percent) and insufficient staffing (18 percent) being leading factors.
• Other top factors included family obligations (18 percent), concerns related to COVID-19, and unsafe working conditions.

Beyond physicians and nurses, there are shortages in other healthcare professions, including home health aides and nurse practitioners.

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