It's not all doom and gloom!
Mercer, a Marsh McClellan company, recently released a fascinating study of the healthcare workforce and projected supply v demand changes in it over the next 5 years. Mercer posits "a total supply of 18.6 million healthcare workers in 2028, an increase of over one and a half million people from 2023. That looks reassuring on the surface, yet during the same period the need for these workers will grow to around 18.7 million."
In practical terms, what does this mean?
The bad news: taken as a whole, the US healthcare workforce — described in this report as a total combination of physicians, nurse practitioners, RN’s, nursing aides, and home health aides — will be “short” about 100,000 personnel by 2028. Of this sum, the single largest group of personnel, nurse aides, will also constitute the preponderance of the shortage: 73,000 (73% of the total). Mercer finds that only 13 states are expected to meet or exceed future demand for NA's.
The good news: in a series of maps, Mercer differentiates states that are projected to have either surpluses or shortages by specific job category. Take the much-discussed RN shortage. Mercer finds that at a national level, "supply (of RN's) is projected to outpace demand with an estimated overall surplus [emphasis added] of nearly 30,000 RNs by 2028." While there is likely to be a net national surplus of RN's, Mercer projects the tri-state area of New York, New Jersey, and Connecticut will face a shortfall of over 16,000 RN's. With respect to physicians, Massachusetts shows a net surplus of MD's at 1,375 but a shortage of 512 pediatricians; Ohio is projected to have a net surplus of 222 MD's but a shortage of 148 pediatricians; and Illinois shows a surplus of 834 physicians but a shortfall of 614 family medicine docs.
To these interesting geographic and occupational variations, Mercer offers a well considered 4-part solution:
1) Understand your specific supply/demand risks by occupation and (setting).
2) Strengthen your pipeline.
3) Retain existing talent.
4) Lower demand.
My colleague, Paul DeChant, MD, MBA, and I concur with recommendations #1 and #2 but want to call additional attention to recommendations #3 and #4.
As virtually every reader of these blogs knows -- and as Mercer highlights -- staff burnout is a key driver of staff turnover. While the burnout epidemic is widely appreciated, the solutions typically adopted by hospitals and health systems -- ie, offering personal resilience services and wellness benefits -- have a negligible impact on reducing burnout. Indeed, organizations that promote these services -- rather than tackling the conditions in the workplace that actually cause burnout -- run the risk of creating still more resentment, cynicism, and misalignment with the c-suite vis-a-vis front-line caregivers. By lowering demand (#4), what Mercer means is identifying tasks that can be "automated, redistributed to other roles, and/or eliminated." Fine. Unfortunately, we observe that too many hospitals and health systems are relying on the promise of AI to "lower demand" which, with rare exceptions, will not actually resolve inherently problematic workflows, outdated policies and practices, and/or unnecessary steps.
Solutions for Hospitals, Health Systems, and Medical Group Practices: Leadership-Driven Changes
The locus for curing clinician burnout and staffing shortages runs through the C-suite. Here are examples of leadership-driven changes to the workplace that my colleague Paul DeChant, MD, MBA and I often recommend:
> Regard clinicians as knowledge workers who are given significant latitude to make clinical decisions without unnecessary administrative encumbrances or delays
> Consistently apply one or more of the improvement sciences (Lean, Six Sigma, operations research, agile, design thinking) in consultation with front-line staff to improve workflow and reduce delays, waste, inefficiency, and job skill mismatches
> Expect all leaders, but especially senior executives, to do periodic job shadowing of front-line staff (where observing and deep listening are emphasized) in lieu of "rounding" (a largely ineffectual, if widely practiced activity)
> Create and require leader standard work (LSW)
> Develop and deploy a sophisticated, deeply ingrained, and rigorous daily management system (DMS) supported by visual display boards or monitors
> Judiciously invest in AI/ML solutions -- selected, tested, and endorsed by front-line staff -- that eliminate or at least markedly reduce data entry, administrative requirements, and/or repetitive tasks that are non-value add
> Support near-continuous optimization and remediation of the EHR (there's no such thing as "it's all set")
> Get rid of superfluous or outdated policies, procedures, redundant approvals, and other stupid stuff (GROSS)
Ready to transform your hospital or workplace?
Are you frustrated by adversarial relationships between front-line clinicians and senior leadership? Organizational Wellbeing Solutions was formed to enable senior leaders to identify the specific drivers of clinician burnout in their organization; and to support leaders in designing and executing a comprehensive plan to stop clinician burnout, increase retention, and improve operating results. A hallmark of our consultancy is correcting the all-too-frequent distrust and alienation clinicians feel toward the C-Suite generally and the CEO in particular. Let us help you help your organization and its clinicians develop a more trusting, aligned, and productive working relationship.
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