Tennessee healthcare stakeholders combat workforce shortage with education and community health workers, but pay remains an issue


Maddie McCarthy


Healthcare experts and stakeholders discussed the workforce shortage, burnout, and ways to address it at the 2023 Tennessee State of Reform Conference in November.

The Tennessee Hospital Association (THA) predicts that by 2035, the state will have a shortage of over 15,000 healthcare workers. Registered nursing is expected to have the largest shortage.

Simone Stewart, M.Ed., CCSP, GCDF-I, provider workforce development director with Wellpoint (previously Amerigroup) Tennessee, identified burnout as a major contributing factor to the current shortage. 

Stewart said this is specifically an issue among caregivers and direct support professionals. Direct support professionals assist people with disabilities, which may include transportation, medication administration, helping them find employment, and advocacy. 

“Direct support professional work, caregiver work, is not for the faint of heart,” Stewart said. “These people chose to support our members for a long period of time, so that’s where we’re seeing a lot of burnout.”

Turnover, she said, is a problem that exacerbates this burnout. She explained that when healthcare workers leave their positions at high rates, those who stay have to bear a heavier burden and in turn burn out themselves.

Ray Coe, president of the Tennessee Nurses Association, noted that high turnover rates also contribute to financial issues hospitals are facing.

“After COVID, some facilities are running at 27% turnover. And more importantly, the facilities are paying $50 thousand to $100 thousand to replace these folks. I’m not talking of travelers; I’m talking about replacing them full time. When you’re talking about the experience and the skill you need in an emergency room or an operating room or an ICU—that’s not cheap.”

— Coe

Tennessee has had the second highest number of hospital closures in the country since 2010. Thirteen of the 16 closures have been rural hospitals

Jim Lancaster, MD, regional chief medical officer at Main Street Health, discussed his concern for primary care worker burnout. 

“Four of the top six specialties that have [the] highest risk and ratings for burnout are primary care: pediatrics, family practice, internal medicine, and OBGYNs,” Lancaster said.

The study he cited, published by the American Medical Association, also identified emergency medicine and hospital medicine workers as the other two specialties that carry the highest risk of burnout in the country.

Lancaster said a majority of the bureaucratic burden falls on these primary care physicians. They have to manage a myriad of issues, including helping their patients navigate other health factors like social determinants of health, within short appointment times. They are not being supported or compensated enough. He said extra revenue is needed for primary care.

Julie Griffin, vice president of government affairs at the Tennessee Medical Association, discussed the relationship between having a stable healthcare system with having a more successful local economy. This is especially important to consider in rural areas.

“Having physicians in rural communities is the cornerstone for bringing businesses into those communities as well,” Griffin said. “Most businesses, when they’re looking at relocating, they look at relocating in places where there is a solid healthcare foundation.”

Another concern in rural communities is that the primary care physicians they do have are part of the aging population, Lancaster said. 

Those who are of retirement age but want to stay in their positions may choose to leave anyway because of the high stressors intensified by the shortage.

“When burnout sets in, they just say, ‘I’ve had enough,’ and retire,” Coe said.

Rural health facilities have a harder time recruiting workers, so they may end up unable to adequately replace physicians who retire.

“If you don’t have primary care in your rural town, you’re not going to have a hospital.”

— Lancaster

Griffin also highlighted the work that needs to be done for the behavioral health workforce. 

“We need to grow psychiatric services regardless of whether it’s rural or urban,” she said. “Behavioral health is severely understaffed.”

Amy Richardson, chief community health officer at Siloam Health (also representing the Tennessee Community Health Worker Association), discussed how community health workers (CHW) are one of the resources that can help lessen the burden of a workforce shortage.

“[With the] community based workforce, you’re drawing from the community itself, so positions like community health workers, peer specialists and doulas are known in the community already,” Richardson said. “… They are often known and trusted by community members themselves and it really helps move health upstream and address some of those conditions that then allow the specialists to focus on their specialties.”

She said CHWs may also be able to improve telehealth services because they can act as a liaison between providers and specialists so the patient feels more connected, as telehealth can feel impersonal.

Education is another factor that can help inspire and recruit future healthcare workers, and expand the scope of current employees.

Andrew Burnett, vice president of workforce strategies and rural health at THA, suggested that hospitals look at non-clinical staff and, when possible, support their education in a clinical role.

“[They can say], ‘Here’s a pathway. We’ll help develop you into whatever you want to do, whether it’s imaging, whether it’s nursing, it doesn’t matter,’” Burnett said. “But we do need these clinical roles and if you have an interest, we’ll help develop you.”

He also emphasized the need for proper reimbursement for students working towards a licensed position. For example, he said people working in some kind of non-medical capacity require full-time payment in order to be trained and licensed.

Richardson emphasized that pay continues to be a top issue among the workforce. She discussed the need for fair, equal pay, and the ability for workers to grow and have control over where people want their careers to go.

“It’s not just getting people in. It’s keeping them in the health sector.”

— Richardson

John Cunningham, director of healthcare partnerships at Nashville State Community College, discussed the education of younger generations and said the healthcare sector needs to show them different career possibilities within the field.

“At our White Bridge campus, we hosted seven high schools, health sciences [schools] specifically,” Cunningham said. “From a workforce perspective, we shared what we have going on in the workforce … it was a real academic push.”

This exposure to the field can direct students to the position that’s the right fit for them within healthcare, based on what works for them and what they are interested in.

Through her role at Wellpoint Tennessee, Stewart acts as another resource for provider agencies who need help with strengthening their workforce.

“We offer a lot of services for provider agencies who are looking to attract, select, and retain direct support professionals and caregivers to support members across Tennessee,” Stewart said. 

Wellpoint conducts regular calls for TennCare CHOICES and Employment and Community First CHOICES providers, where they can join the workforce development team and learn more about strategies for successful recruitment and retention.

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