Healthcare systems throughout the country face numerous challenges in maintaining a sufficient number of workers to meet patient needs. Stakeholders discussed efforts aiming to address those challenges at the 2024 Michigan State of Reform Health Policy Conference this month.
Katie Pontifex—associate executive director of healthcare policy, practice, and strategic initiatives at the Michigan Nurses Association—said workforce shortages affect patient safety.
“It all circles back to patient safety,” Pontifex said. “Increased workload leads to burnout. In the absence of nurses to provide care for patients, you’re adding more patients to the nurse, (and) the patient’s not getting the quality care they need and deserve in order to get back home. We’re seeing readmission rates go up. We’re seeing our nurses getting burned out. They’re leaving the profession. That’s leading to continued workforce issues. Quality of care suffers. Recruitment is an issue.”
Laura Appel, executive vice president of government relations and public policy at the Michigan Health & Hospital Association (MHA), said the COVID-19 pandemic exacerbated workforce challenges in hospitals.
“When we don’t have enough people able to operate the hospital, we have to cut back on what’s available,” Appel said. “We’re past the (COVID) peak, and I think most hospitals have been able to return to having most of their beds online. But we have hospitals that had dozens of beds that were unable to be operated because we simply didn’t have the staff to be able to accept patients.”
The issue was not unique to hospitals, Appel noted, as post-acute care facilities were greatly impacted as well.
“Our friends in the post-acute system probably had as great a problem with the workforce as hospitals, if not more so. Their rate of departure of staff during COVID was higher than ours. It meant they had fewer beds as well. So folks ended up lingering in the hospital in an acute-care bed because they (couldn’t) get into a post-acute care bed. And that’s where access to care really suffers. We’re over the worst of it, but this is a problem that persists.”
— Appel
Health Management Associates Managing Principal Dave Schneider, who moderated the panel, noted that Michigan’s aging population affects the workforce as well.
“The reality is people are aging out of the workforce faster than they’re aging into it,” Schneider said. “Our society is aging, which is also putting more demand on the healthcare system. It’s a pressing issue today. It is a daily crisis for our delivery system. We can’t fix the aging population that fast. So it’s a matter of short-term and long-term solutions. How do you balance that?”
Appel noted that MHA’s MI Hospital Careers program could help address the state’s aging workforce conundrum. The program aims to ensure college and high school students know about healthcare workforce opportunities.
“It helps people understand that this is a career they belong in,” Appel said. “That it’s not specific to clinical work. There’s a place for everyone in the healthcare workforce. And there’s a career ladder to go along with that.”
Michigan Health Council President and CEO Craig Donahue said the council is also focused on attracting students to the healthcare workforce. Its MIDOCs program aims to expand graduate medical education residency positions in select specialties to recruit and retain physicians in underserved areas of the state.
“We’re working with schools and managing a process where they’re expanding residency slots. Like MHA, we’re experimenting and working on different aspects of the health workforce across the continuum. We’re working on coordinating the effort. An example is the pathways work that started. Everyone I speak to is developing a pathway program of their own. Can we make it consistent?
At the end of the day, students and consumers need to understand what it’s going to do for them in terms of following that path and where it will end. And there needs to be some consistency there. We need to coordinate the effort so it’s not disparate pieces working separately all the time. We need to get it together so we’re all rowing in the same direction.”
— Donahue
North Country Community Mental Health CEO Brian Babbitt highlighted several initiatives the organization has implemented to supplement its workforce.
“We have sign-on bonuses, referral bonuses, (and) retention bonuses,” Babbitt said. “We participate in all the student loan programs we can participate in. We offer tuition reimbursement programs specific to the organization. We’ve implemented eight internships. We figured out how to do advanced contingent offers to lock up those interns if they want to be employed long-term, and it’s a good fit. Those are all things that did not exist pre-COVID.”
Pontifex said bonuses are a big draw for nurses when they’re looking for jobs.
“When we’re negotiating for wage increases to attract nurses, especially for our rural hospitals—who are lower-paid (in) that continuum—we’re looking for those retention bonuses, those recruitment bonuses, (and) tuition assistance to get them back into school to further their education,” Pontifex said.
Babbitt noted that North Country’s medical director is a child psychiatrist who teamed up with Pine Rest—a nonprofit behavioral health provider based in Grand Rapids—to train fellows in child psychiatry.
“She trains three fellows a year for child psychiatry,” Babbitt said. “So we get three extra fully-licensed psychiatrists one day a week. (It) increases our capacity to see children, and hopefully in the long run, (will) increase the number of child psychiatrists that are available in Michigan.”