(BigifTrue) — The pandemic shone a light on essential health care workers like nursing assistants and home health aides, but these jobs remain poorly paid and difficult to fill.
Yet the coronavirus is calling more Americans to the health field, including those hoping to find reliable work after a layoff in another industry. Medical schools say they are receiving more applications, and interest in taking the entrance exam is up.
Before the pandemic, the United States faced a growing shortage of health care workers. The shortage, which has affected positions from home health aides to nurses and doctors, arose in part because of retirement-age workers leaving the field and an increased health care demand as baby boomers age.
The health care industry’s staffing shortages include lower-wage positions, like certified nursing assistants (CNA), personal care attendants and home health aides.
Home health aides and certified nursing assistants are known as direct care workers. According to the Paraprofessional Healthcare Institute, 15% of these workers live in poverty, and 42% receive some kind of public assistance. Almost 7 million Americans are direct care workers, about a third of whom are Black and about 90% of whom are women.
To address the nursing assistant shortage in Wausau, Wisconsin, the nonprofit health system Aspirus and Northcentral Technical College started a new program that pays participants to train to become certified nursing assistants.
“A lot of people work full time and they don’t have time to go to school, or they can’t do night classes because they have kids,” said Aaron Schoepke, talent delivery specialist for Aspirus. “Us paying them to go through this program is going to bring us a whole group of people that maybe put it off for five years because they didn’t have the opportunity.”
Schoepke also points out that hiring more health care workers in any position reduces the burden on employees as a whole.
“Adding to the staffing is going to be huge for the already-employed CNAs and staff, (registered nurses), physicians,” he said. “It’s going to help out everybody, because we’re going to have more staff in the hospital.”
Marlene Roberts, dean of health sciences at Northcentral, said that students in her program haven’t been deterred by the pandemic.
“I think one of the positives (of the pandemic is that it) has really created, I think, some momentum in individuals who maybe thought about it before, and now they really do want to make a difference, and they see an impact immediately as to what they can accomplish,” Roberts said.
Schoepke said that a large number of applications for the program are from people who have already had a career in another field and may have been laid off during the pandemic.
“They are sick of sitting behind a desk and want to help people,” he said. “I’ve had a lot of people with 15 years of experience as an office worker that now want to get out and help the community.”
Reilly Davis, a nursing student at Northcentral, said the pandemic never caused him to waver on his commitment to enter the field.
“I love a good challenge,” he said. “I’m doing this not for myself but for others, and I’m not going to abandon them because of something I can’t see.”
But Davis said he has engaged with many other nurses and nursing students who feel differently.
“I’ve been able to take part in a few discussions amongst my peers throughout the United States, and it seems like a lot of people are looking at completely switching their careers and completely getting out of nursing in general, which is insane, because it’s one of those things that takes a lot of time to get into and a lot of effort and a lot of money,” he said. “A couple of my classmates have expressed concerns about what it’s going to be like moving forward.”
A flux in supply and demand for home health aides
The pandemic worsened a shortage of home health aides, a lower-wage and often less-respected type of health care worker. The home health space was already predicted to experience a workforce gap of 446,3000 workers by 2025 because of the United States’ aging population, according to an analysis from the asset management firm Mercer.
A quarter of home health aides are immigrants, according to the Paraprofessional Healthcare Institute. William A. Dombi, president of the National Association for Home Care and Hospice, said that policies limiting immigration have led to a dwindling number of home health aides.
“In March of this year, there was, I think, a bit of panic among the lower-wage workforce,” Dombi said. “With that category of worker, there was early panic and diminution of staff available for that workforce primarily because there was concern about whether the employers … had the protective equipment that was necessary.”
Dombi added that home health aides often felt insecure when their employers didn’t have a plan in place to control infection.
There was also a brief reduction in demand for home health aides, as clients worried about workers bringing the virus into their homes. But this was quickly reversed as people started avoiding group care settings in favor of home health care.
Now demand for home aides is huge, Dombi said, creating a caregiver shortage.
“On one side of it, you’re going to have people unwilling to take this job because of a continued fear of having virus transmission to them as a worker,” he said. “At the same time, this workforce has demonstrated themselves to be heroes, and as such, has gotten fairly positive play in the media. We see the respect level for this workforce increasing, but it remains a hard job. It remains a low-paid job.”
On paper, the current demand for health care workers obscures the actual need. It doesn’t reflect that people of color in the United States face more obstacles when trying to access health care resources, and many minorities remain much less likely than whites to be insured.
The Association of American Medical Colleges reported that if these underserved populations had equal access to health care, it would create a demand for about 74,000 to 145,000 physicians.
“What if people of color accessed their physicians at the same rate that the white population did?” asked Dr. Janis Orlowski, chief health care officer for the Association of American Medical Colleges. “And also, what if people who are in rural communities and people who are uninsured were also to have similar access? It’s not just the number of the current workforce and how we sustain it. I really think we need to ask ourselves, ‘How many doctors do we need so that everyone has equitable access?’”
Some hospitals lack enough workers to treat covid patients
An Association of American Medical Colleges report released in June estimates that by 2033, the United States will face a shortage of about 54,000 to 139,000 physicians.
The pandemic has left its mark on this issue. Hospitals are stretched thin with an influx of patients, especially in rural communities. Not only do hospitals need to find physical space for the additional patients, but they need trained medical staff to attend to them. When facing a surge of covid patients, many hospitals don’t have enough workers with the right skills and experience to properly care for them.
In Tulsa, Oklahoma, Ascension St. John Medical Center has made several adjustments to deal with staffing challenges, the Tulsa World reported. The hospital created nurse teams, where a trained ICU nurse can rotate with two others who aren’t trained in critical care. The idea is for the ICU nurse to train the team members, who in turn lessen the workload.
The hospital also started training shift workers to take care of tasks that don’t require medical training, which has given nurses and nursing assistants more time for patient care.
According to the Association of American Medical Colleges, some physicians are retiring early, and the pandemic has interrupted education for many working toward careers in health care fields.
But it’s not all bad news, Orlowski said.
“We were initially concerned that with the difficulties that health care workers have experienced during covid-19, that people may express less interest, but quite frankly it’s the reverse,” she said. “We’re seeing a huge surge in the interest for medical school.”
Orlowski said that medical school attendance is expected to rise about 2% next year.
“But the big thing that we’re seeing,” she said, “is an 18% increase in the number of applicants (to medical school) … We are also seeing an increase in the number of individuals interested in taking the MCAT, the medical college admissions testing examination.”
This increase has been referred to as “the Fauci effect,” as it is believed to be inspired by the media coverage and heroism of medical workers like Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
While increased interest in medical school is a positive trend that will ultimately help bridge the physician shortage, it takes about ten years to train a doctor, so we won’t see these impacts immediately. Orlowski also said that we don’t yet have enough data on how many physicians have died from covid.
And some are expected to leave the workforce because of burnout.
“We are concerned that the stress just from the last 10 months may have an impact,” Orlowski said. “Really, I think it will take a good year for us to sort through the true impact of covid-19.”
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