Online Marketplace

 

Advertise here

Changing Healthcare Workforce

Bruce Butterfield, CAE, APR, David McKenzie, CAE, Matthew Katz, MS

The current and foreseeable shortage of physicians and other healthcare workers has some of its roots in declining birthrates a generation ago. Consequently, the “Gen X” generation, born after 1964, is the smallest generational cohort – 46 million compared with 77 million Baby Boomers and nearly 80 million Millennials (the children of the Boomers, born after 1980). This smaller cohort means that college enrollments are on a slide that will continue through the second decade of the 21st Century. While the U.S. Department of Health and Human Services (HHS) says that the number of full-time physicians will increase by about 12 percent between 2005 and 2020, demand for them will be nearly double that as a result of the size and health care needs of the Baby Boom generation.

As a result, the U.S. must rely increasingly on a foreign-born and foreign-trained healthcare workforce at a time when post 9/11 security concerns and current economic conditions make it difficult to enter and work in America. Legal and administrative costs of obtaining a permanent work visa can approach $20,000 with no guarantee of being granted, and the Immigration and Naturalization Service sends home nearly half-a-million foreign-born. Other Western countries face the same skills shortage but impose fewer immigration restrictions, which puts the U.S. at a great disadvantage in attracting these workers.

Trends:

• Due to sharp cuts in medical school support in response to the projected oversupply of physicians in the late 1970s, no new medical schools were opened in the U.S. from 1982 to 2005. With the domestic supply of new doctors fixed, while a larger and older patient population continued to demand more care, much of the increase in the supply of physicians has come from outside the U.S. Today, nearly a quarter of all practicing licensed surgeons in the U.S are foreign born and educated or U.S. citizens trained abroad.

• According to American Medical Association (AMA) estimates, a third of all “active physicians,” those who work 20 or more hours per week, will be 55 years old or older by 2010 (1) . By 2020, their share of total active physicians will top 40%. Although physicians tend to retire later than most workers (more than 40% of all male doctors between the ages of 70 and 75 are still in the workforce, compared to only 20 percent of all male workers), older physicians are also more likely to work fewer hours. Because of this factor the number of full-time equivalents (FTEs) practicing physicians is actually lower than these numbers would suggest.
  
  Until now, the number of recent medical school graduates and immigrants with medical degrees had offset declines from retirements. The U.S. Department of Health and Human Services (HHS) expects the balance will tip in the next decade as the acceleration in retirements will outnumber medical school graduates whose numbers have changed little from year to year since the 1982 establishment of a moratorium on new medical schools in the U.S. due to the anticipated surplus of doctors.

• In addition, the growing proportion of women physicians is expected to exacerbate the doctor shortage. The proportion of new medical school graduates who are women has risen from just ten percent in 1980 to close to half of all graduates today. So far, women have exhibited a tendency to retire slightly sooner, spend fewer hours providing patient care, and are less likely to work in rural areas (2) . As their share of the over-55 workforce grows from one in eight today to one in four by 2020, the rate of retirements is expected to accelerate.

• These projections by HHS are alarming in their stark contrast to anticipated increases in demand. The aging of the population, overall economic growth, and anticipated medical breakthroughs and technological advances are expected to increase the demand for medical services well in excess of supply trends.

• While much angst has been expressed about the loss of U.S. jobs, the healthcare sector continues to be strong with an unemployment rate of 3.1 percent (3). Chronic shortages of nurses continue unabated. The HHS estimates that by 2020 the number of registered nurses will have fallen short of demand by 29% or 800,000 unfilled positions. According to Nursing Management magazine, 55% of nurses plan to retire between 2011 and 2020. Meanwhile, the U.S. Bureau of Labor Statistics (BLS) projects that one million new and replacement nurses will be needed by 2016.
  
  Additional strain on nursing availability is coming from the explosion of retail medicine. While nurses often question long hours and poor working conditions in hospitals, medical clinics in pharmacy locations and other retail locations, headed by nurse practitioners, give nurses regular hours and significant autonomy depending on state scope of practice laws.

• Another consequence of the growing labor shortage is the expanded scope of practice for health care professionals as a means of addressing access-to-care problems. Nurse practitioners, physical and occupational therapists, and other allied health care professionals are growing in independence from physicians’ oversight.
  
  Allied health care practitioners are outpacing higher specialties two or three to one. This means that there will be even keener competition across health care disciplines for skilled workers. Several states have passed legislation allowing pharmacists limited ability to evaluate and manage drug regimens as well as dispense drugs. These non-physician professionals may be perceived as competition to some private practice physicians but are increasingly being utilized and valued in large organized medical practice settings.
  

• According to the Bureau of Labor Statistics (BLS) employment projections, professionals are increasingly becoming employees of or contractors to multidisciplinary practices while health care professionals and paraprofessionals are becoming independent entrepreneurs and business owners.

• Interestingly, a dynamic cross-border flow of medical labor is emerging. While the Caribbean is a major exporter of physicians and nurses to the U.S., it is a major importer of physicians from the Middle East (4). This “trade” in medical providers, supported by private investment and public development policies, is beginning to lead to regional specializations. South and Central America are developing several centers of excellence in cosmetic surgery and dentistry.

• East Asia and India are focusing on becoming the provider of choice for various treatments of heart disease and other circulatory diseases. The Scandinavian countries already have established a reputation for excellence in geriatrics. Japan, not surprisingly because of its fast-aging population, is also becoming a key resource in community-based elder care. This trend in specialization may be too new to fully assess how it may influence future labor flows.

• Cross-border trade in health care services will balloon, according to the World Health Organization (WHO), which estimates that it will reach $1.25 trillion before the end of the next decade. Part of that increase will be in medical travel, which is expected to double by 2012 and is beginning to be covered by insurers.
  

1American Medical Association (AMA), Physicians Characteristics and Distribution in the United States, 2001 & U.S. Bureau of the Census, Current Population Survey, 2001

2The Forbes Group, Plotting the Future of Cytopathology, May 2007

3U.S. Bureau of Labor Statistics, TABLE: Unemployed persons by occupation, industry, and duration of employment, March 2009

4Migration Information Source, The Global Tug-of-War for Health Care Workers, December 2004