Smart Policies Can Help Address the Health-care Workforce Challenge
Over the next decade, two million new job opportunities in the nation’s health-care sector are projected – along with an annual need for 1.9 million workers to replace those leaving the profession due to retirement or career change. Right now, not enough workers are available to fill all these positions. As a larger portion of the American population ages, and the subsequent need for care grows, the supply of new workers coming through the workforce pipeline has not grown sufficiently to meet the demand.
This challenge looms heavily in communities with severe health issues. In Northeastern Pennsylvania, for instance, deaths due to cancer and heart disease exceed statewide averages. Cigarette smoking and chronic drinking surpass statewide rates as well, and the region is home to 123 mental health care shortage areas (where just 40.9% of mental health needs are satisfied). It also faces a growing physician shortage and a tremendous demand for nurses.
Northeastern Pennsylvania’s home-health workforce is especially distressed, with need for home-health and personal-care aides most desperate. Throughout the next decade, home health care is expected to see 13,713 job openings in Lackawanna and Luzerne Counties, including more than 1,800 newly created jobs. One major obstacle to filling those positions: median annual wages of home health and personal care aides are staggeringly low, at $26,600 – about 12% lower than health-care support occupations overall and 45% lower than the median wage for all occupations.
Northeastern Pennsylvania is home to a vibrant education infrastructure and an abundance of health-care programming, but the region struggles to retain graduates. After earning their degrees, many students return home or to markets where the pay is higher. Other areas in Pennsylvania – especially rural communities – face the same problems.
Some promising efforts to mitigate the health-care workforce shortage are underway. Pennsylvania has joined the Nurse Licensure Compact, which may help make the state more attractive to nursing graduates. According to the National Council of State Boards of Nursing, the compact “allows a nurse to have one multistate license with the ability to practice in the home state and other compact states.” Two legislative bills (SB 397 and SB 398) would expand the purview of physician assistants and increase the number of assistants a physician may supervise, offering greater flexibility for providers.
Recently enacted legislation will support staffing and accountability in skilled nursing facilities. HB 1421, which Gov. Tom Wolf signed in July, boosts Medicaid reimbursement rates to help facilities meet staffing needs, while requiring those facilities to spend at least 70% of their costs on resident care. Raising and maintaining competitive Medicaid reimbursement rates will allow for wages that appeal to potential workers while also enabling older or disabled adults to remain in the comfort of their homes instead of costlier congregate-care settings. This issue is particularly critical because wage growth in industries like retail and warehousing have made these occupations more attractive than home health-care jobs.
The Teaching Health Center Graduate Medical Education (THCGME) program is a promising tool for bolstering the supply of primary-care physicians. Pennsylvania’s Health Resources and Services Administration oversees the program, which supports primary-care residency training in community-based settings, such as federally qualified health centers (FQHC). Evidence suggests that the THCGME program effectively alleviates medical workforce shortages in underserved communities. The Wright Center for Graduate Medical Education champions an FQHC lookalike program in Northeastern Pennsylvania.
Many gaps remain to fill. When it comes to behavioral health-care needs, for instance – particularly in nontraditional settings, such as county-level base-service units and correctional facilities – creation and expansion of loan-repayment programs could go a long way to encourage workforce participation. Contingent loan-repayment opportunities and training stipends have been shown to support retention, and the reauthorization of the Workforce Innovation and Opportunity Act through 2028 could open doors to new and innovative options. If implemented, the legislation would fuel training and employment programs, workforce investment (including for young workers), and possibilities for public-private partnerships, among other provisions.
Communities throughout Pennsylvania and across the nation must act strategically and diligently to ensure quality care for their members. Here in Northeastern Pennsylvania, the health-care sector is an economic powerhouse, one likely to shape education and workforce-development efforts as well as labor market activities far into the future. Prudent policymaking will merge available resources with timely solutions.
Jill Avery-Stoss is the Director of Operations at The Institute for Public Policy and Economic Development, a community-based research organization in Northeastern Pennsylvania.