The health care worker shortage is getting very real as postponed procedures, hospital bed shortages and the scarcity of specialists become the new normal. Many hope this crunch will dissipate along with COVID-19, but this perfect storm has been in the works for decades. With the goal of achieving the best health outcomes, it is essential health care consumers understand what’s truly at stake and how Iowa’s policy makers and stakeholders are working to prepare.
Conspicuous by their absence from Iowa political leaders’ top priorities for 2022 are legitimate plans to address health care worker shortages. Demography is destiny, and once 79 million boomers arrived, there was bound to be an inordinate number of seniors 70 years later. The dependency ratio of a population is the number of young and old residents for every 100 persons aged 18 to 64 (the workers). Credit the boomers for a record-setting ratio of 82 in the 1960s. As the cohort of potential workers declines, Iowa's dependency ratio is slated to reach 78 by 2030. Look around: Every industry with growth over the past 50 years now finds a large portion of its workforce exiting. That includes education, law enforcement, skilled trades and the travel industry.
Say hello to the Great Health Care Resignation of 2021 and Beyond. Among affected industries, health care is served a double demographic blow: Demand for its services mounts just as the pool of employees shrinks. Furthermore, the pandemic has devastated health care workers. Burnout is reflected in a recent survey showing many plan to leave their current areas of practice by the end of 2022 (yes, this year):
For every 10 physicians now practicing there will be eight.
For every 10 nurses there will be six.
Setting aside the continuing risks of rural hospital closings, is Iowa prepared for what’s coming? We’re ranked 45th for our provider-to-patient ratio, and Iowa Workforce Development projects we should be growing the number of doctors by 160 every year to cover exits and increased demand. That's not going too well. From 2010 to 2020, we gained an average of only 33 physicians per year, and in 2021 — wait for it — the total dropped by 241. Do we need to train more doctors? Perhaps, but I also know that of those who complete residencies in Iowa, less than half stay to practice here. That’s a life-altering brain drain.
The nationwide nursing sector needs to grow by 276,800 jobs before 2031. Being ranked 48th in the nation for nurses’ pay will not help in filling the 2,500 positions we need to add every year to offset Iowa’s losses and growth — on top of the unanticipated vacancies we now have. At the same time, although there are enough classroom seats for those who apply, the number of RN and LPN graduates are down. I’m sorry, but all this does not add up to “being ahead of the curve.”
The largest category, home health and personal care aides, is found in hospitals, care facilities and home settings. Nationwide, there is a projected need for an additional 1.1 million jobs by 2030. For its share, Iowa must staff 9,000 additional caregiver jobs annually to cover exits and increased demand. Just to be clear, every health-care-related profession has similar forecasts, such as dentists, physician assistants, technicians, therapists, administrators and social workers, to name just a few.
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I think one has to work to overlook these unmistakable obstacles to present and future access, and the requisite systemic adjustments are solely in the hands of our policymakers and stakeholders. For constituents, what’s left is to raise our expectations for long overdue leadership while becoming fully engaged health care consumers and advocates. Likewise, it will fall to Iowa’s towns, faith communities, advocacy groups and even neighborhoods to step forward and demand the assistance required to help residents make efficient use of available resources. Iowa’s aging population will swell until at least 2060, and denial is not a planning strategy.
There is much we would wish for Iowa. As important as growth is to our state’s future, be assured that every person or business considering Iowa as a new home will place access to quality health care as a top priority. Health care access rests on the foundation of an empowered and self-sustaining workforce, and we cannot afford to court expansion at the cost of safeguarding Iowans’ well being. Time is of the essence.
Jo Kline, a patients' rights advocate and attorney, is the author of "Patient or Pawn?: Epic fails in health care, the approaching perfect storm and strategies for self-preservation." www.JoKline.net.
This article originally appeared on Des Moines Register: Opinion: Iowa health care worker shortage demands more urgent action