The Clinician Shortage Crisis

The United States is facing a clinician shortage that is projected to get much worse. The Association of American Medical Colleges estimates that the United States could have a shortage of between 37,800 and 124,00 physicians by 2034. Another study predicts the U.S. will need to hire at least 200,000 nurses per year to meet the demand. These shortages could have dire consequences and negatively impact population health in the decades to come, exacerbating current inequitable access to care. Understanding the clinician shortages can help health care leaders address the problem from the source.  

Physician Shortage 

One of the major reasons for the projected physician shortage in the United States is the increase in demand. Population growth and longer life expectancies drive the demand for more physician services. The longer life expectancy coupled with population growth means more people need health care. Additionally, older people are more likely to manage chronic comorbidities, requiring more intensive care and more of physicians’ time.  

The supply of practicing physicians is not keeping pace with the demand. More than 40% of active physicians in the United States will be 65 or older within the next decade, and as these physicians retire, it decreases the amount of practicing physicians available. While it is promising that the number of medical school graduates has increased significantly over the last two decades, residency training spots have not kept up, leaving thousands of graduates without residencies, hindering their ability to become fully licensed physicians. One of the reasons for the insufficient number of residency spots is the 1997 Balanced Budget Act, which capped the number of residents that could receive graduate medical education funding from the Centers of Medicare & Medicaid Services (CMS). Some hospitals self-fund portions of their residency slots, but this is unsustainable over time. The number of actively practicing physicians is stagnating because of the capped number of residency slots, while the demand for physician services continues to grow.   

Nurse Shortage 

In September of 2021, the American Nurses Association called for the Department of Health and Human Services (HHS) to declare the nursing staffing shortage a national crisis, and rightfully so. In 2020, 26% of Registered Nurses (RNs) between the ages of 55 and 64 said they plan to leave the field in the next two years. A recent McKinsey study found that 22% of nurses said they may leave their current position within the next year. And a 2021 study by the Washington Center for Nursing and Survey Information Analytics found that 22% of nurses surveyed have left nursing indefinitely.  

Nursing has always been a hard position. Nurses have historically received low wages and little respect for their knowledge, skills, and demanding work. However, the pandemic has only made things worse. Many nurses are experiencing high workloads with insufficient staffing, inadequate protective equipment, increased workplace violence, and trauma from the influx of COVID-19 patients. 

Nurses leaving the profession is not the only problem. In 2019, American nursing schools turned away over 80,000 qualified applicants from baccalaureate and graduate programs because of an insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget. Nursing school faculty are given low salaries that do not align with their educational backgrounds, making recruiting challenging. With the increased demand for health services, higher number of nurses leaving the field, and the inability to train more nurses, it is no surprise the shortage is worsening.  

Burnout and Clinician Shortages 

One factor often overlooked in the health care worker shortage is burnout. Increased clinician burnout may cause health care workers to reduce their hours, retire early, or leave the field. A 2018 study of RNs found that among nurses that left their latest employment position, 31.5% left because of burnout. This study was done prior to COVID-19, meaning that the number of nurses leaving healthcare due to burnout may be even higher now.  

Physician burnout is also exacerbating the health care worker shortage. Physicians experiencing burnout are more likely to reduce their work hours or leave the profession than their peers. This is concerning, as a recent survey found that 61% of physicians experienced burnout during the pandemic. 

So, how substantial of an impact does burnout have on the physician shortage? A study from Mayo Clinic found that the increase in burnout between 2011 and 2014 translated into approximately a 1% reduction of the U.S. physician workforce, not including physicians who retired early or pursued nonmedical careers because of burnout. This loss is comparable to eliminating the graduating class of seven U.S. medical schools. With the increased burnout rates in 2021, it is harrowing to think about how the pandemic could impact the physician workforce.  

Addressing the Shortages

One of the best ways to address the clinician shortage is to fix the systemic problems contributing to it. This could include better pay, fewer working hours, ample protection from illness and physical harm, improved parental leave policies, time off and sick pay, providing childcare, addressing bias, and much more. We need to change the system to heal the healers and end this crisis.  

Another way to address the clinician shortages is to fix problems with medical education. Providing more funding for nursing faculty could create more spots for nursing students, increasing the number of nurses available to work. For physicians, it's important to create more residency spots for graduating medical students. In 2020, Congress added 1,000 new Medicare-supported graduate medical education positions, and in 2021 there was a bill introduced to Congress that would add 2,000 federally supported medical residency positions a year for seven years. Government funding and policy could greatly improve graduate medical education and grow the health care workforce.  

Policy change could also help reduce restrictions that health care workers born outside the U.S. face. Recent studies show that 29% of physicians and 15% of RNs in the United States were born outside of the country. Congressional policies to expedite visas for highly trained health professionals could combat the shortage, providing a rapid fix for desperate times, such as during COVID-19 surges. Additionally, providing protection for these professionals who are trained in the United States but still have a visa status could help reduce the risk and fear of deportation.  

The increased demand for health services is not changing, so we need to change the number of clinicians available to treat people. This is a call on health care leaders to address the clinician shortage now, before it is too late.  

By Tristan Dooley