Keepers Of A Healthy Heartland: Strategies For Building A Robust Health Care Workforce

Anu Chatterjee, Jackson Li, Dave Shideler

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As the world emerges from the COVID-19 pandemic, it is keenly aware of the importance of our health care infrastructure to protect and treat disease, and the pandemic particularly worsened the vulnerability of the health care system to a lack of workforce. Several related studies focus on the more educated components of the health care workforce (i.e., doctors and nurses), but little attention has been paid to the allied and supporting health care workers, which captures a major segment of workers in this industry. An insufficient number of allied and supporting health care workers currently exists, and, while this trend is not new, the additional strain and stress brought on by COVID-19 has elevated the visibility of this issue. In this report, Heartland Forward researchers present data, insights and strategies for addressing this critical component of our nation’s health care infrastructure.

Several key factors have contributed to growth in our nation’s health care industry: increasingly unhealthy lifestyles and subsequent increases in chronic diseases, expanded health insurance coverage provided through the Affordable Care Act (ACA), and a rapidly aging population. It is important to note that an aging population is not just a demand factor because of additional care needs, but also a supply factor: the baby boomer generation, the largest portion of the U.S. population, is at retirement age, and the pandemic pushed some who had planned to continue working to retire. So, in addition to rising demand, retirement of health care workers became a key contributor to the staffing shortfall.

While allied and supporting workers represent a broad segment of the health care workforce, this report focuses on 10 specific occupations (including two nonphysician positions that are not part of the allied and support occupation categories) that characterize the challenges regions are facing and the solutions they are trying: medical assistants, phlebotomists, home health and personal care aides, licensed practical and licensed vocational nurses (LPNs), health information coders, registered nurses, surgical technologists, diagnostic medical sonographers, radiologic technologists and clinical lab technologists. These are analyzed within the regional contexts of five fastgrowing regions in the heartland: Austin-Round RockGeorgetown, Texas; Fayetteville-Springdale-Rogers, Ark.; Nashville-Davidson-Murfreesboro-Franklin, Tenn.; Durant, Okla.; and Oxford, Miss. The health care workforce crisis seems to be universal; however, fast-growing cities present unique opportunities to contribute to community vitality while seeking new and promising ways to grow its health care ranks.

Four challenges arose across the 10 occupations and five regions:

  1. Awareness. Many potential employees don’t know about the career and professional growth opportunities in these health care roles.
  2. Education. Educational infrastructure isn’t sufficient to expand training; specifically, there are not enough instructors and clinical learning opportunities are lacking.
  3. Incentive. Inadequate pay, benefits, transportation, child care and job satisfaction make it difficult to attract and retain workers.
  4. Pipeline. Coordination is lacking among the fragmented pipelines that supply workers.

Eight policy strategies to overcome these challenges were identified through interviews with experts on the five regions. These strategies are:

  1. Create strong partnerships across the entire ecosystem for an inclusive outreach effort that builds awareness about the opportunities in health care.
  2. Create comprehensive pathways for opportunity and career growth.
  3. Build an adequate supply of qualified health care educators by improving salaries and other benefits.
  4. Increase flexibility around training opportunities by utilizing technology and novel educational practices.
  5. Provide more clinical opportunities for students and trainees through externships, internships, simulations and coordinated efforts.
  6. Provide flexible benefits that are tailored to the needs of targeted recruits.
  7. Offer clinical rotations and cross-training with more pay and less monotony.
  8. Connect the dots by coordinating efforts.
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