Healthcare workforce shortages will continue growing

For the report, Mercer used publicly available data, as well as data from Lightcast, to determine projected changes to the U.S. healthcare labor market by 2028. Researchers analyzed data by state and metro and micro statistical areas.

By 2028, the United States is projected to have a shortage of 100,000 healthcare workers, or around 0.6% fewer than needed . However, not all states will see shortages. Some states, including California, Pennsylvania, Texas, Minnesota, and Washington, will all see surpluses of healthcare workers.

The states that will see the largest projected shortages are New York, New Jersey, Tennessee, Massachusetts, and Georgia.

The report also looked at projected shortages based on different healthcare professions. Although there is expected to be a moderate surplus of physicians at a national level by 2028, certain states, including California, Texas, and New York, are expected to see large shortages. 

Regarding nurse practitioners (NPs), almost every state will see a shortage by 2028, with California and New York seeing the largest shortages. According to the report, the combined impact of physician and NP shortages in these states could lead to significant disruptions to preventive care for patients.

When it comes to RNs, there is a projected surplus of almost 30,000 workers by 2028. However, the surplus varies by state, and some states, including New York, Massachusetts, Kentucky, and Tennessee, are expected to see shortages in the several thousands.

Advisory Board's Allyson Paiewonsky noted that while a projected surplus of 30,000 RNs is welcome news, it's crucial to look beyond the surface of these projections. "The numbers don't take into account where RNs are choosing to work now or four years from now. This projected surplus won't be evenly felt across all RN employers," Paiewonsky said.  

"We're noticing a significant trend of RNs moving into nonhospital settings. Employers that can offer competitive compensation and more favorable work hours are attracting RNs, while those with demanding workloads, less desirable hours, and lower pay are finding it increasingly difficult to recruit and retain nursing talent," Paiewonsky added. "We're looking at a landscape where certain healthcare settings, particularly skilled nursing facilities and hospitals, will continue to experience shortages, while other settings may see an influx of RNs seeking better working conditions."

The report also found that there will be significant shortage of nursing assistants (NAs), which make up 8% of the total U.S. healthcare workforce and 40% of healthcare support occupations. By 2028, there will be a shortage of over 73,000 NAs. Only 13 states are expected to either meet or exceed future demand for the occupation.

According to Paiewonsky, certified nursing assistant (CNA) workforce instability triggers a ripple effect across all nursing roles. "Without sufficient CNAs, RNs become the catch-all for all unmet work by other members of the care team — both forcing them to work below license and increasing an already high RN workload."

"Because of structural issues with the CNA role, including high workload and low wages, CNAs typically leave an organization after one year," Paiewonsky said. "Providers typically prioritize the rapid backfill of CNA vacancies over improving CNA retention. But if providers don't prioritize CNA staffing, they risk facing challenging retention efforts across their entire nursing staff," she added.

Home health and personal care aides (HHAs), which represent almost a quarter of the total U.S. healthcare workforce and over 50% of healthcare support occupations, are projected to have a surplus of almost 48,000 workers by 2028. However, like before, the number of workers will vary significantly by state. Some states, like California and Texas, will have significant surpluses, while others, like North Carolina and New York, will have significant deficits.

4 ways to strengthen the healthcare workforce

To help healthcare organizations tackle workforce challenges, Mercer outlined four tips for the future:

1. Understand specific supply/demand risks by occupation and department

"Determine where the greatest risks of not filling vacant positions promptly lie, as prolonged vacancies can jeopardize the continued delivery of quality healthcare," Mercer writes. "Some occupations are more critical than others and will call for special attention and investment."

2. Strengthen your worker pipeline

Mercer recommends organizations rethink their usual sourcing and recruitment strategies, including by expanding their talent catchment area, internal training, and graduate pipeline. Since some states will have surpluses of workers, it will be important to know where the surpluses will be for recruitment.

Organizations should also consider building talent internally through training, development, and certification programs. Partnering with local universities and trade schools for training can also be successful.

3. Improve retention of existing talent

Because staff attrition is often due to burnout, healthcare systems need to ensure the well-being of their current employees. Some ways to do this include offering better pay and benefits, schedule flexibility, career growth opportunities, and more. Organizations will also need to monitor the marketplace to remain competitive.

4. Decrease demand

Organizations should work to reduce the number of people needed for hard-to-fill roles. This can be done through technology or job redesign.

"By identifying tasks that can be automated, redistributed (to other roles), and eliminated, healthcare systems can mitigate or eliminate the inefficiencies and frustrations reported by healthcare workers and promote job satisfaction," Mercer writes.

Advisory Board's workforce resources

For more insight into workforce issues, check out these Advisory Board resources:

This expert insight describes five ongoing challenges of the workforce crisis, as well as what leaders can do to address them. Similarly, this expert commentary explains how workforce challenges continue to be a top issue for executives and offers four steps on how to mitigate them.

Separately, this expert insight outlines three underlying causes of nurse recruitment and retention challenges. We also ran a survey of nursing leaders, combined with additional research and external literature, to develop recommendations on how to stabilize the nursing workforce.

To retain physician talent, this expert insight explains current trends in the physician workforce and what organizations can do to ensure long-term loyalty. Another expert insight describes a two-step framework for assessing physician need in a community, while this research explains how you can become a physician employer of choice.

You can also read our take on how technology can help solve the workforce crisis by reducing burnout, turnover, and understaffing — and ultimately lead to long-term sustainability. (Goldman, Axios, 9/5; Mercer report, accessed 9/5)