By Gerry Smith

For much of his life, Justin Cooper’s mother was his caregiver. But she was recently hospitalized, and Cooper, who is 41 and has muscular dystrophy, can’t find enough home health aides to fill the void. Unable to hire someone who can stay late on weekends to help him get into bed, he often sleeps in his wheelchair, causing his legs to swell and develop pressure sores. “It’s been a struggle finding people who can come in at specific hours to help,” says Cooper, who lives in Chicago. “It’s not a good situation.”

America is in dire need of more health-care workers. There are shortages throughout the system, from doctors and nurses in hospital emergency rooms to aides who work in the homes of seniors and people with disabilities. The crisis has been brewing for years as aging baby boomers put unprecedented strain on the health-care system. The Covid-19 pandemic has only magnified the problem.

About 100,000 registered nurses left the workforce in the past two years because of stress, burnout and retirement, and more than 610,000 others plan to leave by 2027 for those reasons, according to a study in April by the National Council of State Boards of Nursing. Many nurses felt “emotionally drained,” “used up” or “at the end of the rope,” the study found. Almost half of employees in state and local public-health agencies left their jobs from 2017 to 2021. The number of home care workers per 100 Medicaid participants receiving health services decreased 11.6% from 2013 to 2019, according to another study. And by 2034, the US could see a shortage of as many as 124,000 doctors.

“This is a national emergency that requires urgent attention from multiple stakeholders, including policymakers and hospitals,” says Akin Demehin, senior director of quality and patient safety policy at the American Hospital Association.

Staffing problems continue to cut into the profits of health-care providers. Without enough nurses during the pandemic, companies such as HCA Healthcare Inc. and Tenet Healthcare Corp. were forced to rely on more expensive contract workers. They are trying to hire more full-time nurses, in part by offering higher pay.

“The structural shortages in the market from a labor perspective haven’t just disappeared as we move from ’22 to ’23,” Tenet Chief Executive Officer Saum Sutaria said on an April earnings call. “And so contract labor is still an important resource.”

Inside hospitals, short-staffed emergency departments have “been brought to a breaking point,” according to a letter sent from more than 30 health-care groups to the White House in November. The organizations and members of Congress have called on the Biden administration to address boarding—when patients languish in emergency departments for days, weeks or months because of staffing shortages in nursing homes or other parts of the hospital where they need to be transferred to receive care. In some cases, patients have died while waiting for 10 hours or more to be seen by a doctor.

The pipeline of reinforcements appears to be slowing: Last year, emergency medicine saw its first major decrease in students applying for residency positions. “Medical students have picked up on the chaos within the emergency medicine physician community—and it’s making them less interested in entering our specialty,” a group of emergency medicine professors and physicians wrote in March on the medical and science news website Stat.

Emergency departments have “become deadlocked,” says Aisha Terry, president-elect of the American College of Emergency Physicians. “That means the stroke or heart attack in the waiting room has to continue to wait.”

More than half of nursing homes have limited admissions because they’re understaffed. Meanwhile, home health-care providers turn away more than 25% of referred patients because of staff shortages, according to a report in March from two industry groups titled The Home Care Workforce Crisis.

Home health-care agencies have long struggled to find workers—and to keep them, in an industry with 64% staff turnover in the first year of employment. The job is hard. The pay is low. And the demand is exploding, with the number of Americans age 85 or older expected to approach 5 million by 2030. But the pandemic created new challenges. Fearing the spread of Covid, many people moved family members from nursing homes to home health care, further straining an understaffed industry, according to Joe Pecora, president of the Home Healthcare Workers of America. Immigration restrictions enacted during the pandemic slowed the arrival of new workers, who are mostly immigrant women, says David Totaro, chief government affairs officer at Bayada Home Health Care Inc., one of the largest companies in the industry.

Hospitals are keeping patients longer, often because many of the places they would normally send them—rehabilitation centers, nursing homes or psychiatric hospitals—can’t accept new patients, since they’re dealing with their own staffing issues. The average length of stay in hospitals was 19% higher in 2022 than it was in 2019, according to Strata Decision Technology, a health-care technology and consulting firm. That means added costs for hospitals, because they don’t get reimbursed by Medicare for those extra days.

Shacreya Lee’s son, Brave, was born prematurely by four months. After 11 months in the hospital, including more than 20 surgeries, he was finally ready this spring to go home. But Brave had to spend an extra six weeks in the hospital before Lee and her husband, who live in Isanti, Minnesota, could find home health-care workers for enough hours to look after their child. Lee still struggles to find a home health aide who can come to her house. She’s had to teach herself how to use complex medical devices, including his ventilator. “I’ve had to learn every single thing these medical professionals do, because that’s what it takes to keep my son alive when they’re not here,” she says.

Many other countries, including Canada, France, Japan and the UK, are grappling with health-care worker shortages. But some nations have more doctors and nurses per capita. The US has about 35 doctors per 10,000 people, according to the World Health Organization. Sweden has around 70.

The pandemic exposed the fraying of the US’s health-care workforce but also made Americans more aware of the work done by doctors, nurses and other medical personnel. Now could be the moment to build up reinforcements, says the American Hospital Association’s Demehin. “There is a lot more attention to this issue now than there was a few years ago,” he says. “Everyone now is acutely aware of just how much our health-care workforce has stepped up to the plate the last few years.”

Health-care providers and lawmakers have proposed a range of ideas to address the problem. Hospitals may have some nurses work remotely via telemedicine, freeing up bedside nurses for other tasks. In April, Tennessee passed a law making it easier for doctors trained outside the US to obtain medical licenses. The following month, New Hampshire said it plans to stop holding psychiatric patients in hospital emergency departments by 2025 by expanding funding for community-based health centers, among other strategies. And on July 27, Senators Ron Wyden, a Democrat from Oregon, and Bernie Sanders, an independent from Vermont, who chair committees responsible for health-care policy, said they plan to introduce legislation this fall to expand such programs as the National Health Service Corps, which provides scholarships and loan repayment for primary-care providers in underserved areas and whose funding is set to expire in September.

The senators said they also want to increase funding for medical residency programs, with dedicated slots in locations where doctor shortages exist, and encourage health-care providers to partner with schools to train more nurses, among other professionals. “Addressing health-care workforce shortages across the country is going to require fresh, big-league ideas that leave no stone unturned,” they said in a statement.