Researchers: The COVID-19 Pandemic Is Intensifying Existing Workforce Shortages

Might the COVID-19 pandemic exacerbate already-existing challenges for the leaders of patient care organizations across the United States? Healthcare researchers are thinking that that might in fact be the case.

Healthcare researchers Eli M. Cahan, Lisa B. Levine, M.D., and William W. Chin, M.D. on Oct. 29 published a “Perspective” op-ed in The New England Journal of Medicine online. In “The Human Touch—Addressing Health Care’s Workforce Problem amid the Pandemic,” looking at some of the challenges already facing healthcare leaders, that the pandemic appears now to be intensifying. The authors are affiliated with the Stanford University School of Medicine, Stanford, CA, and New York University School of Medicine, New York (Cahan); the MAVEN Project, San Francisco (Levine); and Harvard Medical School, Boston (Chin).

While acknowledging the innovations taking place because of the pandemic—including of course, “Covid-19 diagnostics, therapeutics, and vaccines,” which are being developed “at pandemic speed,” as well as the pioneering of “technological solutions for triage, prognostication, and allocation of constrained health system resources (such as intensive care beds),” they see warning signs in a key area.

“Indeed,” the article’s authors write, “in the weeks and months after this prediction, health facilities throughout the country — including hospitals, clinics, nursing homes, and rehabilitation centers — have faced substantial workforce shortages. Using data from Fastaff Travel Nursing, a national emergency health care workforce staffing company, we found that the company’s order volume (the number of nurses requested by health systems) was 2 to 14 times as high between March 2 and April 6, 2020, as it was at the beginning of February 2020 — and more than 7 times as high, on average, as it was during the same period in 2019. These pressures were clearly observed in New York State, where, at the end of March, Governor Andrew Cuomo issued an urgent plea for help to medical workers from less affected areas of the country.”

Indeed, the authors note, “As Covid-19 has spread throughout the United States, regions with lower population densities have faced similar workforce gaps. Such gaps may be particularly severe in lower-resourced hot spots: Fastaff data illustrate that some states, including Louisiana, Michigan, and Arizona, have had especially acute needs for emergency workforce support in recent months. Staffing needs in these regions have been far higher than needs in previous years,” they note. “Harsh health care delivery conditions during the pandemic threaten to exacerbate these shortages. The combination of infection risk, physical exhaustion, and mental burnout is putting immense strain on hospital workers. To the extent that projections suggest that the pandemic will persist well into 2021, workers in other parts of the health care system will probably be increasingly affected, as more patients with Covid-19 are cared for in subacute care and ambulatory care settings.”

Importantly, the researchers state, “A plan for addressing the pandemic that is premised on expanding health care innovations alone — without ensuring that there are clinicians capable of incorporating such innovations into patient care — is therefore unlikely to be successful. Problems are especially likely to arise if such a plan overlooks nonhospital settings, since durably suppressing the virus requires victories on all fronts to prevent its persistence in some communities even as it is eradicated in others.”

Among the researchers’ recommendations: making use of volunteer corps of healthcare workers, including retired physicians and medical students; creating and exploiting registries of lay volunteers for such tasks as contact tracing; easing licensing restrictions, to allow clinicians to move more easily across state lines; and even facilitating the mobilization of National Guard members to help with tasks such as data entry and management, distribution of essential supplies, and transportation of the bodies of deceased patients.

Still, the article’s authors recommend that “a national platform that permits monitoring and allocation of the health care workforce in a harmonized way,” be created. “This type of platform will be especially useful as expansion of the public health workforce outside acute care settings becomes increasingly crucial to the country’s recovery and amid potential surges of Covid-19 cases,” they note. “As of September 9, 2020, a George Washington University team calculated that 240,000 contact tracers alone would be needed to curb the pandemic in the United States.”

And, they note, “The importance of matching supply with local needs is ongoing and may only grow as caseloads increase throughout the country. These platforms can collectively function as a throw blanket over the patchwork quilt — a cohesive second layer filling the gaps seen at the primary layer of state emergency responses to workforce shortages.”