AHA Comments on the RFI on the Drivers of Health Care Workforce Shortages and Solutions

March 20, 2023

Dear Chairman Sanders and Ranking Member Cassidy, M.D.:

On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) appreciates the opportunity to respond to your Request for Information (RFI) on the drivers of health care workforce shortages, as well as potential solutions. The AHA applauds your intention to develop bipartisan legislation to remedy health care workforce shortages.

SUSTAINING THE HEALTH CARE WORKFORCE

Health care careers are often a calling, and a qualified, engaged and diverse workforce is at the heart of America’s health care system. However, long building structural changes within the health care workforce, combined with the profound toll of the COVID-19 pandemic, have left hospitals and health systems, including post-acute and behavioral health care providers, facing a national staffing emergency that could jeopardize access to high-quality, equitable care for patients and the communities they serve.

Prior to the COVID-19 pandemic, hospitals were already facing significant challenges that were making it difficult to sustain, build and retain the health care workforce. In 2017, the majority of our nursing workforce was close to retirement, with more than half aged 50 and older, and almost 30% aged 60 and older. Yet, nursing schools had to turn away over 90,000 qualified applicants in 2021, according to the American Association of Colleges of Nursing, due to lack of faculty and training sites. Hospitals faced similar demographic trends for physicians, with data from the Association of American Medical Colleges indicating that one-third of practicing physicians will reach retirement age over the next decade. Hospitals also were reporting significant shortages of allied health and behavioral health professionals. On top of this, clinicians reported feelings of extreme stress and anxiety on the job. A National Academy of Medicine report indicated that between 35% and 54% of U.S. nurses and physicians had symptoms of burnout, which it characterizes as high emotional exhaustion, cynicism and a low sense of personal accomplishment from work.

Unfortunately, the COVID-19 pandemic only served to deepen and accelerate the health care’s workforce challenges. A 2021 survey from the Kaiser Family Foundation-Washington Post found that nearly 60% of health care workers had experienced a decline in their mental health as a result of their work during the pandemic, and nearly 30% had considered leaving their profession altogether. In addition, a survey by AHA’s American Organization for Nursing Leadership found that one of the top challenges and reasons for health care staffing shortages reported by nurses was “emotional health and well-being of staff.”

The result of these mounting pressures on the health care workforce has created a historic workforce crisis complete with real-time short-term staffing shortages and a daunting long-range picture of an unfulfilled talent pipeline. Just within the week of March 9, Department of Health and Human Services (HHS) data showed that 601 hospitals (or 16.3% of reporting hospitals) anticipated a critical staffing shortage. In addition, projections from the Bureau of Labor Statistics estimate U.S. health care organizations will have to fill more than 203,000 open nursing positions every year until 2031. There also are significant projected shortages of physicians and allied health and behavioral health care providers, which will likely be felt even more strongly in areas serving structurally marginalized urban and rural communities. This also has resulted in a 20.8% increase in total labor expenses from 2019 to 2022, according to Syntellis Performance Solutions 2023 CFO Outlook for Healthcare.¹

More details on our comments and recommendations are available in the PDF below.

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¹ https://www.syntellis.com/resources/report/cfo-outlook-healthcare