HISTORY

It is widely recognized that America's demand for health care is expected to balloon over the next 20 years due to the aging of the Baby Boom cohort.  Even though the first wave of Baby Boomers has yet to retire, the health care system is already experiencing the strain of increased demand for services. The Bureau of Labor Statistics (BLS) predicts that by 2016, 19 million health care and social assistance workers will be needed. Of these, BLS projects a need for 3 million nurses by 2016, a 23.5 percent increase in 10 years.   According to the Health Resources and Services Administration (HRSA), the U.S. is already experiencing a nursing shortage, with a shortfall of approximately 168,000 nurses in 2003. By 2020 this national shortage is projected to increase to more than 1 million nurses. HRSA also projects that over the next 15 years, requirements for physician services will grow faster than supply—especially for specialist services and specialties that predominately serve the elderly.

Shortages that are caused by dramatically increased demand are coupled in some cases with decreased supply of qualified medical personnel.  Nursing and pharmacy are commonly known to be experiencing shortages; however, they are not alone. Other health care fields experiencing shortages include radiography, clinical lab science, occupational therapy, physical therapy, and health aides.

While the overall supply of pharmacists has increased in the past decade, the unprecedented demand for pharmacists and their services has not been met by the currently available supply.  The number of retail prescriptions dispensed per year in the United States increased 44 percent between 1992 and 1999, from 1.9 billion in 1992 to 2.8 billion in 1999.  The estimated annual number of prescriptions filled per pharmacist in retail pharmacies grew from 17,400 in 1992 to 22,900 in 1999, an increase of 32 percent.
Hospitals have experienced growth in demand for pharmacists, due to the increased complexity of medication therapy and the need for proper drug selection, dosing, monitoring, and management of the entire drug process. A 2001 study by the American Hospital Association found a 21 percent hospital pharmacist vacancy rate.  This study also reflected high vacancies for radiology technicians (18 percent), lab technicians (12 percent), and registered nurses (12 percent).

Many nurses now work longer hours and see greater demand for services. In contrast to the situation with pharmacists, the rate of nurses entering the workforce is slowing.  According to the American Organization of Nurse Executives, within 10 years, more than 40 percent of nurses will be over age 50.  Meanwhile, enrollment rates in nursing programs have declined by 41 percent, leading some nursing schools to close their doors altogether. Nursing education programs face shortages in personnel, also.  Though enrollment in baccalaureate nursing programs grew 5 percent in 2007, 30,709

qualified applicants were turned away due to a shortage of faculty and other resources, according to the American Association of Colleges of Nursing.

Clinical labs have begun to see similar issues.  Although the Bureau of Labor Statistics projects the need for 9,000 new lab tech graduates annually to meet demand, there are currently only 4,900 annual graduates.

Regions of the country have begun seeing a shortage of physicians, as well.  The shortage is particularly severe in high-risk specialties such as surgical and obstetrical care.  In fact, nearly half of America’s counties lack an obstetrician.  In the case of obstetrical care, the shortage is caused by dramatic increases in liability insurance, causing many physicians to stop practicing or eliminate high-risk procedures. The shortage in high-risk specialties will only continue as recent studies of medical students have shown that almost half of students factor in high liability premiums when considering their specialty of choice.

At the state and national level, legislators have taken notice.  Bipartisan congressional efforts have resulted in some incremental legislation to provide additional funding, primarily for nurse recruitment and education. Appropriations legislation for FY 2008 included more than $156 million for nursing programs including nurse training, advanced education nursing, nurse practice and retention, and diversity. The bill also included an increase of $45 million over FY 2007 for workforce development programs.

More than half of the states have enacted legislation to address workforce shortage issues through a variety of mechanisms, including scholarship and loan forgiveness programs.  Nine states, plus the District of Columbia, have passed legislation or regulations attempting to address nurse staffing ratios. States in which staffing legislation has been enacted include: California, Florida, Illinois, New Jersey, Oregon, Rhode Island, Texas, and Vermont (laws in Maine and D.C. were waived).  While only California has a law that requires specific nurse-to-patient staffing ratios, many states require hospitals to develop staffing plans.  Such bills are on the rise, with seven state legislatures introducing staffing ration legislation in 2007.  Similar bills could appear in Congress if more states adopt these types of provisions.

Congress has taken some past actions to address the workforce shortage.  In August 2006, the “Carl D. Perkins Career and Technical Education Improvement Act” (P.L. 109-597) was signed into law with significant support in the House and Senate.  The legislation aims to enhance career development and technical programs of study, strengthen the transition from secondary to postsecondary education, and increase the role that states and local communities play in career development for all students.  Congressman Mike Castle (R-DE) championed this bill in the House, citing the importance of ensuring students have the skills necessary to enter the workforce or continue studies at an institution of higher learning.  Congressman Castle has strongly supported developing interest in math and science curriculum at an early age.

The House Education and Workforce Select Education Subcommittee focused on health care worker shortages, specifically nursing. In 2005, the full committee and the House approved the “College Access and Opportunity Act” (H.R. 609), but the Senate took no action on the bill.  Over the summer of 2006, the House Education and Workforce Committee also focused on determining the impact of U.S. immigration policy on the American workforce by holding hearings regarding the issue. 

The “Nurse Reinvestment Act” passed both houses of Congress and was signed into law by President Bush on August 1, 2002 (P.L. 107-205). This legislation authorized funding for nursing education, scholarships, loan repayment programs, and public service announcements to promote the nursing profession. Congress appropriated funding to implement these programs in February 2003, January 2004, and December 2005.  Applications to apply for these programs are available through the Health Resources and Services Administration (HRSA). However, current funding levels continue to fail to meet the need.  In FY 2005, HRSA was forced to turn away 82 percent of the applicants for the Nurse Education Loan Repayment Program (NELRP) and 98 percent of applicants for the Nursing Scholarship Program due to lack of funding. 
A similar program for pharmacists, the “Pharmacy Education Aid Act,” passed the Senate (S. 1806) during both the 107th and 108th Congresses, but this legislation has never been considered by the House.

Senator Maria Cantwell (D-WA) introduced the “Allied Health Reinvestment Act,” (S. 605) in 2007. The act seeks to provide incentives and funding for individuals to seek and complete high-quality allied health education and training.  Though the legislation has eight cosponsors, no action has been taken.  Similar legislation was introduced in previous Congresses, but never considered by the House or Senate.

Several departments of the executive branch have addressed the workforce shortage issue. Both the Department of Labor and Department of Health and Human Services have issued grants aimed at reducing health care workforce shortages. In addition, in February 2002, HHS and the U.S. Department of Education launched a program to promote health profession careers, particularly nursing, to school children.

The private sector has also played an important role in addressing the issue of the nursing shortage.  For example, Johnson & Johnson launched a campaign called Discover Nursing which includes nursing scholarships and public awareness about careers in nursing. At the local level many communities have launched increasing efforts along these lines.


THE FUTURE
 
An examination of health care workforce issues is likely to continue in 2008.  Indeed, while continuing to fund nurse education and development initiatives, both the House and Senate Appropriations Committees have expressed grave concerns regarding the coming nursing shortage. 
 
Although Congress has taken some action to authorize assistance, legislation to support recruitment and retention programs for all areas experiencing shortages has yet to make it through both houses of Congress. And many current programs lack critical funding. However, despite the need, continued budgetary concerns in 2008 make it unlikely that large-scale funding will become available in the short term.

The shortage of qualified medical personnel has many impacts.  Funding spent on recruitment of health care workers is not available for expanding new technologies that increase health care quality.  In the same way, the regulatory burden faced by providers ties up valuable resources that could be used on workforce shortages.

As the health care fields experiencing shortages continue to grow, Congress should consider taking a broader perspective to assisting the health care industry as a whole, particularly given the impact that workforce shortages have on the quality of medical care.  Perhaps the solution will come from other initiatives in the health care arena centered on improving patient safety and quality. However, in the meantime, more and more communities that simply cannot wait for Congress to act may develop their own solutions and stop-gap measures to keep hospital wings and emergency rooms open.