The continuing COVID-19 pandemic is hastening the retirement of many health care providers. The United States now faces acute shortages of physicians, nurses, and medical assistants, putting medical practices in an unprecedented situation.New data published by the Association of American Medical Colleges (AAMC) revealed there could be an estimated shortage of 54,100 to 139,000 physicians in both primary and specialty care by 2033. The association’s sixth annual study, The Complexities of Physician Supply and Demand: Projections from 2018-2033, was conducted prior to the COVID-19 pandemic.
The analysis included supply and demand scenarios and was updated with the latest information on trends in health care delivery and the state of the health care workforce.From 2018 to 2033, the US population is projected to grow by 10.4% from about 327 million to 361 million. The US population under age 18 is projected to increase by 3.9%, while the population aged 65 or older is projected to grow by 45.1% by 2033, according to the report.
“The baby boomers need the help now and they are living longer,” said Frank F. Brabec, MBA, founder and CEO of Brabec Healthcare Management Inc., Indio, California. “So they are going to stay in that space and need health care for a long period of time. We are not keeping up. There is a need to ramp up for the increasing demand.”
Older Physicians Calling It Quits
The pandemic has accelerated the number of clinicians retiring, he said. It is now most pronounced in specific regions of the country, with rural areas in the most critical situation. “A lot of people said, ‘Okay I am done now.’ As a result, there is less supply and more demand, and now we see hospitals are offering more in terms of compensation,” said Brabec, who is also an independent consultant for the Medical Group Management Association (MGMA).
The analysis showed that more than 2 out of 5 currently active physicians will be aged 65 or older within the next decade. Physician shortages were already apparent before the pandemic. A public opinion poll conducted in September 2019 by Public Opinion Strategies for the AAMC found that 35% of voters said they had trouble finding a doctor in the past 2 or 3 years. This was a 10-point jump from when the question was asked in 2015.
“I think people are leaving in droves,” said Dave Carpenter, MS, chief executive officer of Minnesota Urology, the largest independent urology medical group in the upper Midwest. “There are more people leaving healthcare because this whole pandemic has scared them.”
Candidates in Short Supply
Finding physicians can be especially challenging this year because fellowship programs during the pandemic slowed down. “So, there are fewer candidates to draw from,” Brabec said. “There was already a shortage of doctors and nurses. With the pandemic, 80,000 nursing students were unable to train last year due to money, space, and personnel, and that is going to leave a mark.”
In a May 6 MGMA Stat poll, 88% of health care leaders responded that they are having difficulty recruiting medical assistants, and several studies showed that large percentages of nurses are either considering or planning to leave their position. “You can feel the ground moving under our feet. Workers have leverage now when it comes to where they work and how they work. Many new employees are requesting hybrid work models,” Carpenter said.
Never before has there been such a focus in health care on finding and retaining workers, according to Carpenter. “When you’ve got 40% turnover, you may be spending close to a million dollars in terms of hard and soft costs,” said Carpenter, who is a current member of the board of directors for the Large Urology Group Practice Association.
During the first 6 months of this year, Carpenter was meeting virtually with other urologic practices about recruiting and training employees. It is now necessary to shift wages for positions that present recruitment challenges. “Right-sizing your workers who have been there is an issue. If you have loyal employees, you have to be careful navigating when you have signing bonuses,” Carpenter said.
It is common now to pay $500 to $1,500 signing bonuses depending on the position and the demand. At some medical practices, staff members who refer somebody for a position and that person is hired will receive $500 if the new hire stays 6 months. “We are shaking the trees, going to schools to try to get clinical assistants. The problem is there are fewer of them coming out of school,” Carpenter said.
Novel Approaches to Staff Retention
Loan forgiveness is common as are a host of other perks. A medical practice in the southern United States recently bought a beach house as a tool for acquiring and retaining good staff. “The employees can reserve it and use the beach house for a certain amount of days based on the number of years with the company and based on their level of seniority,” Carpenter said. “Everyone is trying something novel.”
Brabec said the biggest problem he sees in many medical practices is that they do not define their mission. Subsequently, the staff just think their day is a bunch of tasks and they get a paycheck. “It is much easier to retain employees when they feel like they are part of a team, like a baseball team. They have to feel they matter, and so it means they have to be listened to,” Brabec said.
Open communication and empowerment are the keys. Carole Ann Norman, who manages a large nephrology practice in Columbia, South Carolina, said optimal benefit packages should comprise employee benefits such as health, dental, life, and long-term disability insurance.
Most incentive packages now include coverage for all costs associated with the position, such as malpractice insurance and license renewal. Norman’s group covers memberships to professional medical organizations and allows time off for continuing medical education that does not count against their personal time off.