h.risher@verizon.net<\/a> explaining the problem and any innovative practices adopted to address the problem. You may be quoted in the book.<\/p>\nIn 2022 the consulting firm, McKinsey, collaborated with the National Association of State Chief Administrators (NASCA) to conduct a study of post-pandemic employment problems in state government. \u00a0The results were summarized in a recently released report, \u201cBridging talent gaps in state government: A postpandemic priority for CAOs\u201d.<\/p>\n
The study was triggered by the \u201cacute talent gap . . . affecting all functions\u201d. The authors cite BLS data showing \u201cState and local government job openings rose by more than 150,000 between June 2021 and June 2022, while hiring rates remained stagnant.\u201d\u00a0 [State job data are not reported separately.]<\/p>\n
But that actually understates the vacancy problem. \u00a0Job openings in state and local government have been increasing steadily since the 2008\/09 recession.\u00a0 At the end of 2010 the BLS reported the job vacancy total was 223,000; immediately before the COVID crisis, January 2020, the total was 629,000.\u00a0 In the most recent report for February 2023, the total was 857,000. \u00a0<\/p>\n
Vacancies are affecting agencies at all levels of government, but the problem, from the report, is \u201cparticularly acute in healthcare, law enforcement, corrections, IT, and engineering. These talent challenges resulted in critical resource shortages that have restricted various government services.\u201d \u00a0<\/p>\n
There can be no disagreement on the importance of those occupational groups. However, they represent very different staffing challenges. IT and engineering specialists are in high demand, with rising salaries. Public agencies are in direct competition with private employers for these specialists. Corrections is somewhat unique since many state prisons were purposedly constructed away from highly populated areas where the local residents are aging and young people moving away to find better career opportunities. \u00a0Law enforcement is confronted by a different problem, a report from the Justice Department states, \u201cyoung people and their families are often conflicted about the value of law enforcement careers\u201d.<\/p>\n
The Shortage of Healthcare Workers is a True Crisis<\/h4>\n
The labor market for health care specialists combines those problems and adds two important considerations \u2013 the growing medical needs of an ageing population and those providing care are required to have special education and training. \u00a0Private and public employers are all competing for qualfied applicants from the same talent pool. The heightened daily demands of the COVID crisis made all health-related workers more important, but the physical and emotional toll triggered heavy resignations \u2013 \u201cSurvey Shows 47% Of U.S. Healthcare Workers Plan To Leave Their Positions By 2025 — of badly needed workers.<\/p>\n
COVID-related health problems may be ending but the future of the healthcare workforce is expected to get increasingly more critical. That was captured in a headline on a healthcare website as this was drafted, \u201c’Crisis’ looms as 800,000 more nurses plan to exit workforce by 2027.\u201d\u00a0<\/p>\n
The article starts with, \u201cThe critical nursing shortage in the United States is going to get worse \u2014 much worse . . . [In addition to the] approximately 100,000 nurses left the workforce during the pandemic . . . Combined, the total equates to one-fifth of the 4.5 million nurses in the workforce today.\u201d<\/p>\n
A 2019 study found the median age of Registered Nurses was 52; nurses aged 65 years or older account for 19 percent of the RN workforce. In a 2020 survey, more than one-fifth of all nurse respondents replied positively when asked if they plan to retire in the next 5 years.<\/p>\n
A healthcare executive was quoted in another recent column, \u201c”We’ve had a healthcare workforce crisis in this country for a long time. It pre-dated COVID.”<\/p>\n
The BLS reports employment data for roughly 60 \u201chealth care and social assistance\u201d occupations. The reports include 47 job titles that focus on physical health, ranging from Athletic Trainers to Veterinary Technologists and Technicians. The many physician specialties are a single grouping, Physicians and Surgeons. \u00a0Additionally, there are mental health occupations, including Psychologists and Mental Health Counselors, along with several occupations similar to Social Workers.\u00a0<\/p>\n
BLS started reporting vacancy data separately for this group of occupations in 2011 when the total stood at 552,000 unfilled jobs. In January 2020 the total was 1.17 million.\u00a0 The pandemic has since taken its toll. \u00a0In February 2022 the vacancy total was 1.98 million \u2013 almost 4 times the total in 2011.\u00a0 As a percentage of the total employed in these jobs, that was roughly 9 percent.\u00a0 The latest data show vacancies declined slightly to 1.68 million and 7.4 percent — but that is “very high” compared to the average of 4.2 percent in the nine-year period before the pandemic.<\/p>\n
But more importantly, for anyone concerned with the future of health care, is that analyses show the growth in employment for these occupations will be above average. That\u2019s attributable to the ageing population. \u00a0Home health and personal care aide jobs, as an example, will increase 25 percent by 2031.\u00a0 That will require over 900,000 additional workers.\u00a0 Social workers are projected to increase by 64,000.<\/p>\n
This is at a time when the U.S. scores significantly below other comparable countries on measures of health (e.g., increased longevity). \u00a0But we spend far more money per person on healthcare than those countries.\u00a0 An OECD study of member countries found spending was more than twice as much per person.<\/p>\n
The national data are eye-opening but fail to show the impact of the vacancies on health care in local communities.\u00a0 Community-level analyses are important because the need for care along with the quality of care is related to the income, age and racial mix of the local population. Wealthy, suburban areas typically have highly regarded medical centers. \u00a0There are also large areas that \u201cdon\u2019t have enough doctors or nurses to provide [residents] with emergency care, treat their chronic illnesses or deliver their babies\u201d \u2013 and that was before the COVID crisis.<\/p>\n
The lack of qualfied workers is especially acute in rural areas. More than 60 percent of the health professional shortage areas are located in rural or partially rural areas.\u00a0 A count in April 2020 found 218 counties with no resident physician.<\/p>\n
The vacancies in healthcare differ from virtually all but a handful of government jobs (e.g., police) in that medical problems need to be diagnosed and care provided as soon as possible. \u00a0Now, the growing staffing crisis is lengthening the time for diagnosis and treatment of health problems.\u00a0 That adds to the cost of treatment as well as the severity of the problems. Data on individuals unable to secure timely treatment is not readily available.<\/p>\n
[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ _builder_version=”4.16″ background_color=”#f7f7f4″ custom_margin=”-641px|||||” custom_padding=”0px||0px|||” global_colors_info=”{}”][\/et_pb_section][et_pb_section fb_built=”1″ admin_label=”Section” _builder_version=”4.16″ custom_padding=”0px||0px|” global_colors_info=”{}”][et_pb_row column_structure=”2_3,1_3″ use_custom_gutter=”on” gutter_width=”1″ make_equal=”on” column_padding_mobile=”on” module_class=” et_pb_row_fullwidth” _builder_version=”4.16″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” width=”100%” width_tablet=”100%” width_phone=”” width_last_edited=”on|desktop” max_width=”100%” max_width_tablet=”100%” max_width_phone=”” max_width_last_edited=”on|desktop” custom_padding=”0px||0px|” make_fullwidth=”on” custom_width_px=”680px” global_colors_info=”{}”][et_pb_column type=”2_3″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_image src=”https:\/\/www.careersingovernment.com\/tools\/wp-content\/uploads\/2023\/04\/3-3.jpeg” title_text=”Medical,Technology,On,2021,Target,Set,Goals,Achievement,New,Year” show_bottom_space=”off” force_fullwidth=”on” align_tablet=”center” align_phone=”” align_last_edited=”on|desktop” _builder_version=”4.20.0″ custom_margin=”-1px|||||” animation=”off” global_colors_info=”{}”][\/et_pb_image][\/et_pb_column][et_pb_column type=”1_3″ _builder_version=”4.16″ background_color=”#efefe9″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_image src=”https:\/\/www.careersingovernment.com\/tools\/wp-content\/uploads\/2023\/04\/2-3.jpeg” alt=”video presentation” title_text=”Shot,Of,Attractive,Young,Afro,Female,Doctor,Talking,Working,With” show_bottom_space=”off” force_fullwidth=”on” align_tablet=”center” align_phone=”” align_last_edited=”on|desktop” _builder_version=”4.20.0″ animation=”off” global_colors_info=”{}”][\/et_pb_image][et_pb_text disabled_on=”off|off|” _builder_version=”4.20.0″ text_font=”PT Serif||||” text_text_color=”#818178″ text_font_size=”24″ text_line_height=”1.4em” background_size=”initial” background_position=”top_left” background_repeat=”repeat” text_orientation=”center” module_alignment=”center” custom_margin=”5.7%|10%||10%||” custom_margin_tablet=”|10%||10%” custom_margin_phone=”” custom_margin_last_edited=”on|desktop” text_font_size_tablet=”” text_font_size_phone=”” text_font_size_last_edited=”on|phone” global_colors_info=”{}”]<\/p>\n
In the absence of a national health system, state and local leaders can create coordinated but independent care providers that better suit today\u2019s health needs. \u00a0<\/p>\n
[\/et_pb_text][et_pb_text _builder_version=”4.16″ text_font=”PT Sans|on|||” text_text_color=”#888888″ text_font_size=”12″ text_letter_spacing=”2px” text_line_height=”1.2em” background_size=”initial” background_position=”top_left” background_repeat=”repeat” text_orientation=”center” module_alignment=”center” custom_margin=”20px||20%|” custom_margin_tablet=”20px|||” custom_margin_phone=”” custom_margin_last_edited=”on|tablet” global_colors_info=”{}”]HOWARD RISHER[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row use_custom_gutter=”on” gutter_width=”4″ column_padding_mobile=”on” custom_padding_last_edited=”on|tablet” admin_label=”row” _builder_version=”4.16″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” max_width=”1200px” custom_padding=”0px||0px|” custom_padding_tablet=”0px|||” custom_padding_phone=”” use_custom_width=”on” custom_width_px=”1200px” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text _builder_version=”4.21.0″ text_font=”PT Serif||||” text_text_color=”#363636″ text_font_size=”20″ text_line_height=”1.4em” background_size=”initial” background_position=”top_left” background_repeat=”repeat” custom_margin=”19px||0px|||” custom_margin_tablet=”40px||0px|” custom_margin_phone=”” custom_margin_last_edited=”on|tablet” text_font_size_tablet=”” text_font_size_phone=”” text_font_size_last_edited=”on|tablet” global_colors_info=”{}”]<\/p>\n
Employers Competing for Talent in Local Labor Pools<\/h4>\n
The U.S. is the only developed country that has not created a national health care system. Instead, each state has a somewhat different mix of inter-linked agencies, including county and city\/town health services. Additionally, there are thousands of local for-profit and public medical and care facilities.<\/p>\n
A common thread is that the purpose \u2013 promoting and protecting the health of residents — and the services provided are essentially the same across the country \u2013 although that depends on specialists in the area.\u00a0 Another common thread is that the occupations represented in each state\u2019s health care workforce are the same, regardless of the infrastructure.<\/p>\n
A key issue relevant to several of the highest head count occupations is that public agencies are competing directly for talent with private hospitals and a growing mix of private medical care facilities (e.g., urgent care clinics, nursing homes, rehab centers, hospice homes, etc.). \u00a0Private employers have far more flexibility to respond to competitive practices, including pay increases.<\/p>\n
Civil service systems place public employers at a disadvantage.\u00a0 When they were created decades ago, the goal was to insure equity and rely on non-political, standardized personnel practices.\u00a0 That \u2018works\u2019 for occupations unique to government but agencies are at a decided disadvantage in hiring high demand talent.\u00a0 Technology jobs illustrate the obvious problem.<\/p>\n
The federal government addressed the problem in the 1990s.\u00a0 Previously, the federal government relied on a uniform salary schedule across the country – the General Schedule – to pay white collar employees.\u00a0 Passage of the Federal Employee Pay Comparability Act of 1990 (FEPCA) introduced locality pay, which raised salaries in larger urban areas.<\/p>\n
The report to OPM supporting the legislation also included a recommendation to create a separate pay system for healthcare workers.\u00a0 It took a few years but later in the decade Congress acted to allow the Department of Veterans Affairs to create separate, local pay schedules for workers in a number of direct care occupations (nurses, physical therapists, etc) working in VA hospitals. \u00a0FEPCA also permits \u201cspecial rates\u201d for high demand, specialized jobs (i.e., technology).\u00a0 [Note: I managed the study and worked with OPM to support passage of FEPCA.]<\/p>\n
The change is based on recognition that the labor markets for nurses as well as workers in support healthcare occupations are local. Job applicants tend to live within a reasonable commuting distance of hiring facilities.\u00a0 Local health care facilities, private and public, are competing for talent from limited, local talent pools. That explains why pay surveys are conducted in over 100 city and regional labor markets.<\/p>\n
In other industry groups, worker shortages and high demand normally drive-up competing salaries. \u00a0The markets for hourly and lower-level white collar jobs are locally defined. Companies can respond quickly to competitor pay increases, raising prices to cover the added costs. Today, although there were large increases in 2022 \u2013 averaging roughly 6% for those who stayed in their jobs — recent layoffs and a possible recession have slowed pay increases.<\/p>\n
In health care, with revenues limited by government funding and insurance payments, increased payroll costs have created financial problems. Pay increases have continued \u2013 it\u2019s a virtually universal response to staffing problems \u2013 but the cost increases are triggering financial problems and forcing hospital closures and cutbacks in services.<\/p>\n
(Note: The costs of turnover include the nonproductive time of workers who get involved in hiring and onboarding along with new hire training time.\u00a0 There is an added cost when vacancies impede operations.).<\/p>\n
Leadership is Needed<\/h4>\n
The staffing problem is projected to get worse going forward.\u00a0 Its demographics \u2013 Baby Boomers reaching retirement age and a smaller group of young workers starting their careers \u2013 combined with the continuing resignations triggered initially by the COVID crisis. In that reality, employers trying to hire are doing little more than trading workers.<\/p>\n
Government has to assume a leadership role. Federal, state and local agencies are major employers of healthcare workers, provide significant funding to both public and private employers, and have the lead in sponsoring research. \u00a0COVID triggered billions in federal funding, including an additional $100 million in late 2021 to address the vacancy problem. “Our health care workers have worked tirelessly to save lives throughout this pandemic and now it’s our turn to invest in them,” HHS Secretary Xavier Becerra said in a statement.\u00a0 But despite the \u2018investment\u2019 vacancies continue to increase.<\/p>\n
The Secretary is right of course, but to increase the workforce the investment has to be more than money.\u00a0 The solution to this crisis is not simple but it is straightforward \u2013 (1) attracting greater numbers of young people to careers in healthcare, (2) improving the work experience to retain talent, and (3) enticing those who left healthcare to return to jobs in their fields.<\/p>\n
There are proven practices. Amazon offers 2,000 books on \u201cimproving work experience.\u201d\u00a0 The employers identified as \u2018The Great Places to Work in Health Care\u2019 are places to look for answers.\u00a0 But the core problem \u2013 building the workforce needed to fill vacancies and address the nation\u2019s healthcare needs \u2013 requires new strategies, beyond what\u2019s dictated by civil service systems. Ideally the changes should be consistent across states to minimize unproductive competition. Teachers and police have had separate personnel systems for decades. \u00a0It\u2019s the only practical answer for healthcare.<\/p>\n
Recommended Actions<\/h4>\n\n- The competitive markets for health specialists call for separate workforce management policies and practices, and new pay systems \u2013 the same solution that helped VA medical centers. Salary increases are not going to solve the staffing problems but public employers need the flexibility in separate HR systems to compete in local markets. It\u2019s a textbook solution but the resistance is likely to be strong.<\/li>\n
- Increased pay is needed to attract and retain faculty for nurse training. Nursing colleges \u201cturned away 80,407 applicants in 2019-2020 due to lack of capacity\u201d, according to the American Association of Colleges of Nursing.\u00a0 This is an \u201ceasy fix\u201d and should be a priority. It\u2019s best addressed at the state level.\u00a0 Adequate funding is important to attract instructors for other healthcare specialists as well.<\/li>\n
- States could also reduce the importance of pay by reporting market pay levels by location across the state.\u00a0 Transparent or open pay policies have gained attention recently and would minimize competition and emphasize \u2018fair pay\u2019. That effectively creates \u2018level playing fields.\u2019<\/li>\n
- Surveys show flexible scheduling is possibly more important than pay.\u00a0 That could be part time, shorter hours, paid leave or vacation time.\u00a0 Schedules could change from week to week. It\u2019s especially important to help employees affected by burnout.\u00a0 Local managers will need the authority to change schedules to meet employee needs as well as software to facilitate scheduling.<\/li>\n
- Surveys also show career development opportunities will help with retaining and attracting experienced applicants. Defining clear career pathways along with credentialing requirements will help employees plan for their future.\u00a0 Colleges will benefit from funding for required programs.<\/li>\n
- Relying on regular employee meetings \u2013 Employee Resource Groups (ERGs) \u2013 to discuss work management problems and develop solutions to build commitment.\u00a0 Years ago, nurses started recognizing Magnet hospitals where management \u201cvalues nursing talent . . . These hospitals attract the best and brightest nurses.\u201d The idea could become a state sponsored practice.<\/li>\n
- States (as well as cities and counties) could build internal consulting teams to work with local health employers to improve work management practices and create better places to work. \u00a0It would be useful to develop analytically backed systems to assess needs and new practices.<\/li>\n
- States could develop local reserves, much like the military reserves, of experienced care providers who could be called upon to fill in on short notice, with pay of course, when local hospitals experience unusually high patient demands.<\/li>\n
- The pandemic has increased the importance of home-based diagnosis and care. Employees working away from their \u2018home\u2019 facility require different supervision.\u00a0 Managers and supervisors need to be supportive and ready to coach workers in addressing individual health needs.<\/li>\n
- History imposed the separate administrative structure of counties, townships, cities and towns. Costs could be reduced by creating cross-jurisdiction administrative offices, making it possible to eliminate or combine functions while shifting budget money to add care providers.<\/li>\n
- Analytical systems are needed to help to inform health priorities, satisfy reporting requirements, and support practitioners in diagnosing and developing treatment plans.\u00a0 Supportive technology has a heightened importance in home care.\u00a0 Relying on technology is a major change in practice.<\/li>\n
- State and local leaders can also play a role in drawing public attention to how vacancy problems are impacting health services in their areas. Drawing attention to the problems and building support for change is an essential early step. \u00a0Regular publication of progress is likely to be a key.<\/li>\n
- A goal in adopting new practices is to make it attractive for workers who left healthcare to return. They are often a forgotten resource.\u00a0 Its less costly and they can be productive far sooner.<\/li>\n<\/ul>\n
In the absence of a national health system, state and local leaders can create coordinated but independent care providers that better suit today\u2019s health needs. \u00a0Tackling the workforce crisis is an essential step.<\/p>\n
<\/p>\n
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Vacancies are affecting agencies at all levels of government, but the problem, from the report, is \u201cparticularly acute in healthcare.<\/p>\n","protected":false},"author":3346,"featured_media":44433,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","_cbd_carousel_blocks":"[]","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[13],"tags":[35],"class_list":["post-44430","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-about-gov","tag-government-trends"],"acf":[],"yoast_head":"\n
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