States Can Shape the Future of the Healthcare Workforce

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Issue Areas

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A recent Mercer report raises concerns about the future of our healthcare workforce, which is projected to have shortages in several clinical professions in 2028. What does this information mean, and how can we change these projections to ensure we retain and replenish our healthcare workforce?

This projected shortage means patients will experience longer wait times, fewer healthcare facilities due to minimum staffing requirements, and that patients will have less time with their healthcare providers.

The report also raises several unanswered questions beyond the toll these shortages will impose on patients. First, given the significant growth in several areas of the healthcare workforce, how can we have such a shortage? For example, the number of RNs in the U.S. has increased from 2.5 RNs per 1,000 people in 1960 to 9.5 per 1,000 in 2020—a 280 percent increase. The number of physicians has also grown from 1.3 per 1,000 in 1960 to 2.9 per 1,000 in 2020, a 120 percent increase. If this workforce has increased this dramatically, why is there a shortage of healthcare workers?

The overall shortage is due to several factors. The demand for healthcare in America is higher than it was in the past. Significant medical knowledge and technological advances have allowed individuals, especially those with chronic conditions, to live longer. Coupled with the demographic shift occurring as the baby boomer generation ages, more Americans are entering the most healthcare-consuming stage of life.

In addition to the increased proportion of the older American population consuming healthcare, younger Americans are demanding more healthcare, primarily due to unhealthy lifestyles. The obesity rate in America has increased from 13 percent in 1960 to 42 percent in 2020. These demographic conditions have increased the prevalence of chronic health conditions like diabetes, heart disease, and some cancers. Due to the increased advancements, there has been increased specialization in the healthcare workforce, reducing overall productivity.

Finally, a higher percentage of RNs and physicians who are not practicing full-time or are retired are likely included in the overall supply numbers, which quietly exacerbates and likely underestimates the workforce shortage.

To this end, state leaders and policymakers should consider addressing these projected demand increases and corresponding shortages using a multifaceted policy approach to ensure a strong and healthy healthcare workforce in the future. Below are a few different strategies that states can consider as they seek to mitigate workforce shortages:

• Increase the number of practicing physicians. States should consider changing regulations to allow international physicians to practice in their state. Ironically, states that have recently passed legislation to create a pathway for international physicians are those that already have a surplus. This could indicate that some states are taking proactive steps to retain a stable physician workforce. However, this does not mean the workforce is appropriately distributed, nor does it consider the distribution of specialties to meet the demand for healthcare. Even those open-minded states should keep their focus on policies to increase the healthcare workforce through increased competition and remove unnecessary regulatory and licensing burdens.

• Enact policies that allow healthcare workers at all levels to practice at the highest level of their training. This would minimize the scope of practice regulations that serve more to protect the bottom line of certain professions than to serve patients. Enable healthcare workers like nurses, pharmacists, and others to practice at full capacity, with the understanding that specific responsibilities require additional training.

• Minimize regulations that impede innovation. Consider more regulatory freedom for innovation and identify ways to free up capacity to allow clinical experts to focus on clinical tasks. For example, AI can help lower administrative costs and ensure clinicians spend as much time as possible with patients. States should also remove barriers to accessing telehealth. During the pandemic, there were notable increases in physician productivity through telemedicine. Studies have shown that telemedicine can increase access and allow physicians and other clinicians to see more patients in less time, particularly in primary care and mental health services. States can minimize restrictions to practicing across state lines—such as simply requiring the registration of clinicians in good standing in the state where they will offer telehealth.

States can take robust policy approaches to mitigate forecasted shortages in the healthcare workforce. 2028 seems far away, but the time to act is now. Healthcare professional training takes at least two years; many professionals train for nearly a decade. States can and must act now to develop strategies to increase capacity for future healthcare employees, thereby taking immediate action to better the lives of their people.