Growing Healthcare Staffing Shortages Could Spell Public Health Disaster

Nurses, doctors and other healthcare workers are quitting their jobs, walking out en masse to strike, choosing specialties for a better work-life balance, or simply opting out of the healthcare industry altogether. 

And this isn’t just a frustrating inconvenience. It’s a looming public health crisis, according to new research. 

A study published in JAMA Internal Medicine in August suggests half as many internal medicine resident doctors are electing to become primary care physicians — the go-to doctors for everyday healthcare — than they did about 10 years ago. 

The overall shortage of doctors across specialties in the United States could reach 124,000 by 2034, according to the 2023 Physicians Thrive compensation report.

Additionally, by 2027, almost one million registered nurses in the U.S. are estimated to leave the healthcare workforce due to “stress, burnout and retirement,” according to a study in April led by the National Council of State Boards of Nursing (NCSBN).

These healthcare workers often serve as the linchpins of Americans’ well-being. But as their recruitment numbers and retention rates dwindle, and healthcare demands outweigh the supply, the implications could be serious — and put people’s lives at risk.

Overworked, underpaid and stressed out

“I think there is definitely some burnout,” Lauren Block, M.D., M.P.H., a general internist and researcher at the Feinstein Institutes for Medical Research who led the JAMA Internal Medicine study, tells The Messenger. “I think the finances further compound that.”

According to Dr. Block, the salary discrepancy for doctors in training choosing to become a general primary care physician or a hospitalist — a doctor who cares for patients admitted to a hospital — versus other medical specialties, such as cardiology or surgery, is huge. 

For example, in-demand specialists such as cardiologists and orthopedic and plastic surgeons are more likely to net annual salaries well over $500,000. In contrast, primary care doctors make about half that amount — an average of $255,000 —  according to the 2023 Medscape Physician Compensation report. 

Add to that the average medical school loan, which hovers around $200,000.  Next, add in the lost opportunity cost from three or more required years of grueling medical residency training, during which residents are paid an average salary of $64,000 for what can amount to 80-hour work weeks.

It’s not hard to understand why the dissatisfaction seems to be mounting. 

“Residents are coming out of training with debt and financial obligations,” Dr. Block notes. She says it is enticing to choose a specialty that pays better and guarantees better work-life balance “as opposed to primary care where your patients are your patients, whether you're in the office or not.” 

Increasing threats of workplace violence

For nurses, unsafe staffing ratios, low pay and toxic workplace problems are key concerns motivating them to leave the profession, especially bedside nursing, in droves. 

In the Pittsburgh Wage Study published last month, researchers conducted focus groups with 45 current and former Pittsburgh hospital workers to gain insight into the challenges they face. 

A common complaint revolves around non-medical hospital administrators tamping down on what healthcare workers can — and can’t — do. 

“My biggest thing is expectation versus reality. A lot of the administrators who exercise their expectations for specific job functions, do not actually tend to know what's going on in that job function to be able to appropriately guide workers,” one anonymous hospital worker from the focus group said in the study. 

The study suggests hiring hospital administrators with past “patient care experience” would be more suited for the role. In other words, hiring administrators who have previously worked as healthcare workers in some capacity, such as doctors or nurses. 

To add to the problem of burnout and stress, nursing unions say the pay is not enough for many to make ends meet, especially in high-cost-of-living areas, such as California.

Last week, over 1,000 healthcare workers rallied outside Kaiser Permanente’s headquarters in Oakland. Kaiser’s union workers demanded a pay raise of 7% to meet the region's living costs and an increase in hiring. According to the U.S. Bureau of Labor Statistics, the median annual wage for registered nurses was $81,220 in May 2022.

In addition to low wages, healthcare workers are increasingly subjected to violence, which takes a toll on their mental health. From verbal threats and hostility from patients or coworkers to actual physical attacks, such as grabbing, spitting, or assault, healthcare workers now confront violence at alarming rates. 

According to the World Health Organization, up to 38% of healthcare workers face violence at some point in their careers.

A long-term problem

Low staffing numbers within a hospital or nursing home typically mean fewer healthcare workers look after more patients than they can safely handle. The problem isn’t new, but it’s getting worse each year. 

Moreover, the COVID-19 pandemic pushed the healthcare system to its breaking point. As more nurses threaten to leave the field, the staffing shortages “will become a greater crisis and threaten patient populations if solutions are not enacted immediately,” Maryann Alexander, Ph.D., R.N., NCSBN’s chief officer of nursing regulation said in a statement.

With healthcare workers teetering on burnout, many are opting to leave bedside patient care for more lucrative, low-stress opportunities. 

"There are a lot of virtual nursing positions emerging, a lot of remote case management positions, insurance companies are hiring more nurses than ever,” Tracey Moffatt, R.N., the chief nursing officer at Ochsner Health in New Orleans, told Fox News. 

In fact, 73% of those surveyed in the Pittsburgh Wage Study noted they left their hospital jobs due to staffing shortages.

This leaves those in charge of direct patient care unable to provide quality care and at risk of making deadly medical errors and misdiagnoses. Plus, it adds more barriers to accessing basic healthcare needs for the community. 

This could result in astronomical wait times whether you’re at the ER, trying to see your primary care physician for a run-of-the-mill cough or cold, or hoping to get specialized hospital care for chronic health problems. This may prove to be especially problematic for an aging population. By 2030, all baby boomers will be older than 65, according to the U.S. Census Bureau.  

"The public needs to understand, needs to truly know what happens if the patient is in an unsafe assignment, is in an over ratio assignment, their family deserves to know. I deserve to know my loved one isn't in a safe environment,” one of the anonymous focus group members from the Pittsburgh Wage Study said.

"I know of patients who shouldn't have died that have died because we have been understaffed. So we need to do something about it and change it now,” another participant added. 

“There is an urgent opportunity today for health care systems, policymakers, regulators, and academic leaders to coalesce and enact solutions that will spur positive systemic evolution to address these challenges and maximize patient protection in care into the future,” Dr. Alexander said.