America’s healthcare staffing shortage is a nationwide crisis
By John F. Di Capua, MD, NAPA CEO
The effects of COVID-19 hang heavy in hospitals and ambulatory centers across the nation—not in the form of sickness but in staffing. There are simply not enough providers to manage the caseloads. While not the only health profession facing a serious workforce shortage, anesthesia is prominent in this new reality because of the critical role it plays in surgical care. Without anesthesia, there is no surgery. Without enough anesthesia professionals, patient care suffers, and unfortunately, the health and wellness of our providers suffer too.
The Association of American Medical Colleges forecasts dire shortfalls into 2034, with primary care staffing shortages of 17,800 to 48,000 physicians and shortages of 21,000 to 77,000 for non-primary care physicians. Specialty care may see a 35,600-physician shortfall, including more than 12,000 anesthesiologists. Today, the U.S. Bureau of Labor Statistics marks the national anesthesiologist unemployment rate at less than 0.5%, and the national unemployment rate for certified nurse anesthetists (CRNAs) at less than 1%.
Important nursing staff who contribute greatly to the workings of health facilities also face startling shortages. According to a May 2022 assessment by McKinsey & Company, “By 2025, we estimate the United States may have a gap of between 200,000 to 450,000 nurses available for direct patient care, equating to a 10 to 20% gap. To meet this demand, the United States would need to more than double the number of new graduates entering and staying in the nursing workforce every year for the next three years straight.”
Broad-scale challenges
There are two profound consequences for our nation as a whole working with fewer healthcare providers than it requires. The first is access to care. Today’s shortage is going to get worse before it gets better. It is already resulting in hospital coverage issues, in all areas of the country, but especially lower income and rural geographics. And I predict soon—maybe even in 2023—there is going to be a national debate over these access problems as patients are less able to get immediate treatments for serious conditions such as cancer or quality care for a traumatic or emergency event.
A second lingering harm of this widespread staffing shortage is the toll it takes on the remaining clinical workforce staffing these facilities, which has come to be known as “burnout.” In the early 1970s, American psychologist Herbert Freudenberger, PhD, began normalizing the term “burnout,” which he considered, “the extinction of motivation or incentive, especially where one’s devotion to a cause or relationship fails to produce the desired results.” Burnout is recognized by the World Health Organization’s International Classification of Diseases (11th Edition), classified as an occupational phenomenon, not a medical condition.
Even before the pandemic, health system CEOs across the U.S. called burnout a public health crisis. The pandemic worsened this problem in extraordinary ways. A February 2021 report by the U.S. Department of Health and Human Services’ Inspector General cited healthcare staff working longer hours, extra shifts, and mandatory overtime. In addition to posing quality and safety risks for patients, this intense strain places a daunting emotional and physical burden on our essential healthcare professionals.
Contributing factors
The pandemic is not fully to blame for the nation’s staffing hardships, as countless studies have shown. Some of the reasons behind the supply-and-demand gap are the result of positive factors, such as humans living longer and life-prolonging medical innovations that contribute to our growing senior population. Additionally, advancements in regional anesthesia and techniques have moved thousands of surgical procedures outside of the hospital and into ambulatory settings. This creates greater efficiency of care and increases patient satisfaction; however, it also expands the number of locations requiring highly trained staff, especially anesthesia clinicians.
While new graduates are completing their education every year, the pace is simply not fast enough. This is compounded by increased retirement rates in the profession. A decade ago, the publication ANESTHESIOLOGY reported on the aging population of anesthesia professionals, with most in the field over the age of 50. The COVID-19 pandemic accelerated retirements. Filling the gap created by retirements is made more difficult by the necessary time commitment of becoming an anesthesia professional: physician anesthesiologist training requires more than eight years in medical school and residency, CRNA training requires a three-year nursing doctorate, and certified anesthesiologist assistant training requires a two-year master’s degree.
Solutions
The first step toward solving this crisis is to care for those who work the frontlines of healthcare every day. At NAPA, we stress strong local leadership and collaborative cultures. We also develop our people from within to train future leaders of tomorrow. Additionally, we provide career flexibility to support work-life integration, not just work-life balance.
Moreover, NAPA is supporting efforts to expand the number of individuals in training, including investments in programs such as Diversity CRNA and the creation of more residency programs, including our tremendously successful program at Vassar Brothers Medical Center. Many health systems already have the tools and resources in place to provide greater placement opportunities for residents. According to the American Society of Anesthesiologists, today’s budding physicians interested in the field of anesthesia have a 99.6% match rate. Essentially any medical resident who is interested in anesthesia has a place. But we need to create more places for them, which is something NAPA is actively working to offer. Not only will it close the nation’s staffing gap long-term, but it is also an immediate short-term solution to our current crisis, allowing trained anesthesia professionals to step up to the bedside and help provide care today.