End Mandates, Ease Debt to Attract Healthcare Workers: Experts

Easing the national shortage of health care workers will require relief for student loans, more money for research and training, and eliminating COVID vaccine mandates, experts recently told a U.S. Senate subcommittee.

"There is no doubt that during the pandemic, health care workers have worked tirelessly on the front lines and faced, in many circumstances, unimaginable challenges," Sen. John Hickenlooper, D-CO, said during the subcommittee hearing last Thursday. "However, the critical needs of the health care workforce were here before and will extend well beyond COVID unless we act."

A recent study projects a shortage of 124,00 doctors by 2034, up to 48,000 of which are primary care doctors.

"If we're going to make a dent in these daunting estimates, we need to get started now," said Hickenlooper, chairman of the Senate Committee on Health, Education, Labor and Pensions' Subcommittee on Employment and Workplace Safety.

The study, from the Association of American Medical Colleges, found that the primary drivers of the health care workforce shortage will be population growth, including a projected 42.4% increase in adults over the age of 65, which increases demand in specialties that mainly care for older people. Also, more than 40% of doctors will reach traditional retirement age in the next decade.

The pandemic has worsened  shortages. A Morning Consult survey in October found that 18% of health care workers quit during the pandemic and 31% of those who continued in their jobs have considered leaving. Most of the departures were caused by the "pandemic, insufficient pay or opportunities and burnout."

Several hospitals said that COVID vaccine mandates cost them only about 1%-2% of their workforce. For example, Northwell Health, the largest hospital system in New York, said in October it fired 1,400 unvaccinated workers — or 2% of its staff — and became "100% vaccinated."

But Rachel Greszler, a research fellow at the conservative Heritage Foundation, told the congressional panel that 2% is "an enormous number if you multiply that across potentially 14 million workers."

Although the Supreme Court struck down the Biden administration's sweeping workplace vaccine mandate in January, it allowed the Centers for Medicare and Medicaid Services vaccine mandate to stand. After the court decision, attorneys general of 16 states filed a complaint seeking to block the health care worker mandate.

Much of the hearing focused on ways to increase the number of students pursuing medical careers.

Xavier University President Reynold Verret, PhD, underscored the importance of having a diverse health care workforce because it is "critical to provide equitable health outcomes" and builds trust in the system. He noted that "a few historically Black institutions produce a great percentage of the diversity in health and STEM."

To increase workforce diversity, Verret suggested doubling the Pell grant for low-income students, investing $5 billion to expand Title III grant programs, and reviving President Joe Biden's proposal to provide 2  years of subsidized tuition for students at historically black colleges and universities (HBCUs) and minority-serving institutions.

Sen. Jacky Rosen, D-NV, noted student loan debt is a burden for many health care professionals entering the industry and highlighted her proposal to pause student loan interest accrual during residency programs.

"In order to improve health outcomes, to address our nation's doctor shortage, we have to do more not only to encourage providers to serve in rural and underserved communities, but also to reduce those existing barriers," she said.

The Biden administration announced in November it would allocate $1.5 billion from the American Rescue Plan for scholarship and loan repayment programs to expand health care access in underserved communities and diversify the workforce.

In addition to making education accessible, one expert witness said there must be opportunities for postgraduate education such as residency programs for nurse practitioners, particularly as NPs continue to fill more primary care roles.

"Research indicates that nurse practitioner graduates of postgraduate training programs remain in primary care and underserved practices at higher rates, compared to national averages," said Margaret Flinter, PhD, senior vice president and clinical director at Community Health Center Inc.

Members of Congress have introduced several bills to address the health care worker shortage, though most have not made any progress in the last year.

More recently, three subcommittee members — Sens. Tina Smith, D-MN, Susan Collins, R-ME, and Lisa Murkowski, R-AK — along with Sen. Cory Booker, D-NJ, introduced legislation in January that would reauthorize and fund the Public Health Workforce Loan Repayment Program for the next 3 fiscal years. If passed, eligible people working in a state, local, or tribal public health department could receive up to $35,000 in loan repayment help per year of service.

"By opening up doors for loan repayment assistance, expanding eligibility requirements, and ensuring greater equity among geographic regions, we can help ensure all Americans have greater access to the care they need and deserve," Murkowski said in a news release.

Sources:

U.S. Senate Committee on Health, Education, Labor and Pensions, Subcommittee on Employment and Workplace Safety: "Recruiting, Revitalizing & Diversifying: Examining the Health Care Workforce Shortage."

Association of American Medical Colleges: "AAMC Report Reinforces Mounting Physician Shortage."

Morning Consult: "Nearly 1 in 5 Health Care Workers Have Quit Their Jobs During the Pandemic."

Fierce Healthcare: "How many employees have hospitals lost to vaccine mandates? Here are the numbers so far."
U.S. District Court, Western District of Louisiana, Monroe Division: "Civil Action No. 3:21-cv-03970," filed Feb. 4, 2022.

GovTrack.us: "S. 3506: Strengthening the Public Health Workforce Act."

Smith.Senate.gov: "U.S. Senators Tina Smith, Susan Collins, Cory Booker, and Lisa Murkowski Introduce Bipartisan Legislation to Rebuild Public Health Workforce Amidst Shortages."