Staff shortages — The root cause of the problem

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The general employee exodus following the COVID-19 pandemic has been referred to as “The Great Resignation.” The resulting shortage has affected the health care profession and will ultimately affect the care that physicians provide their patients. Many medical practices and hospitals need to fill positions, placing stress on the existing staff. This article will discuss the health care shortage, and the second article in this series will describe possible solutions.

Employee turnover, which includes physicians, nurses and allied health care professionals, is one of the costliest challenges in health care and threatens to worsen as the demand for care exceeds the supply of workers. If a practice only focuses on employee retention, it will experience understaffing, financial insolvency, deterioration in patient satisfaction, reduced online reputation, increased malpractice claims, increased absenteeism and perhaps a negative impact on patient outcomes.

The sobering statistics of the shortage of health care workers

• About 1 in 5 health care workers have left medicine since the pandemic began.
• Since the pandemic started, 18% have quit, 12% have been laid off, and 31% have considered leaving.
• In 2022, nearly 1.7 million people quit their health care jobs – equivalent to almost 3% of the health care workforce.
• It is estimated that the cost to replace a health care employee averages the amount of a year's salary for that position.

8 Reasons for employee departure from health care

1. Concerns about health care administration and leadership

During the pandemic, employees worked erratic schedules with mandatory overtime. Fitting available square pegs into shift holes resulted in some good employees being turned off to the health care profession. Unfavorable shifts may be unavoidable, but flexibility and timely communication from office managers and other health care administrators can make a difference. A lack of consideration by leaders is a sign of disrespect toward health care workers. Providers aren't exiting the field because they can't handle their jobs – they're quitting because they can't handle being unable to do their jobs.

2. Lack of recognition

Health care workers often complain about not being valued by management. They know they play an essential role in the health care system. Yet, doctors, office managers and hospital administrators tend to undervalue their work. This underappreciation may spill over to the workers developing expectations that patients need to appreciate their extra work and challenging conditions. Health care workers do not expect to be thanked for every task they perform. Still, employees want to be recognized as valuable health care team members. But if the rationale behind an award, such as “employee of the month,” or a perk, such as a convenient parking space, isn’t well explained, those rewards are meaningless to employees.

3. Lack of advancement opportunities

This is another management deficit for health care workers. They often don't want to remain in their current position even if it is highly specialized. Many practices need to offer more opportunities for advancement or a path to get there. These opportunities can mean more to employees than better pay or compensation packages. Employees are leaving the profession because they desire more from their current role. With the flexibility of their medical background and knowledge, many employees can realize their income potential in a related field, not clinical medicine.

4. Burnout

Before the pandemic, between 35% and 54% of U.S. nurses and physicians experienced one or more symptoms of burnout. Now, burnout has increased in frequency, resulting in mental and physical issues for workers, so more health care employees are leaving the field. A recent survey of 1,000 health care professionals showed that 28% quit a job because of burnout.

5. Work-life balance issues

Many employees are evaluating their work-life balance, contemplating why they continue to clock into a job that does not fit their desired lifestyle. Medicine is a great career, but it may not be worth the time away from home compared with other professions. Allowing more time away from work can provide workers the clarity to figure out what they want their careers to look like.

The pandemic allowed many health care providers to work remotely, and now many are deciding they want a position, even if it is in another area or profession, that will enable them to work in such a way. Childcare is a significant concern for some employees. Depending on a worker’s family situation, it might make more sense for one parent to stay home or work part time.

A health care career can be exhausting. The exhaustion makes it easy to lose sight of why men and women entered this profession. When employees can't take care of themselves, they find it harder to care for others.

6. Mental health issues

Medicine is a mentally exhausting career. Many employees are put into difficult situations and often have little time to process or cope with work-related stress. Over time, it can take a toll on the employee's mental well-being, and the person may leave the health care profession. For many health care employees, it is often difficult to seek guidance or help if they are struggling.

7. Employer prioritization of profits before patients

Health care workers need help justifying situations where profits are prioritized before patients. Most health care workers enter medicine as a calling and are idealistic and altruistic. They want to help patients, and their inability to adequately do so takes a toll on them.

I have noted disappointment in middle-aged and older physicians who are employed by hospitals or large medical groups. In these settings, their productivity is measured in relative value units, and they are told how many patients they need to see in an hour or day to reach quotas set by their employer.

Many health care workers believe their employers fail to look out for their best interests and the interests of the patients. Instead, they complain that the employers only care about the monthly profit and loss spreadsheet. Providers aren't exiting the field because they can't handle their jobs – they're quitting because they can't handle being unable to do their jobs.

8. Salary dissatisfaction

A medical career is gratifying, and doctors and other health care workers can earn a lot of money. Still, an outside offer of more money is sometimes the only reason a worker leaves the health care profession. In some areas of the country, employees must work multiple jobs to make ends meet. The low pay and high student debt overwhelm many people who wanted to be health care workers. Some are making moves that could allow for a more sustainable career that pays more than their health care salary.

Bottom line: The health care industry's workforce shortage is a significant problem. If one-third to one-half of nurses and physicians express their intentions to reduce their work hours and work part-time or leave, there won’t be enough staff to meet patients' needs.

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.