The workforce remains a challenge for states across multiple health and public sector professions. NASHP’s 2023 Annual Conference offered an opportunity to take a step back and understand the national trends in the labor market broadly and for the health care workforce. The plenary included discussion of key challenges and promising strategies.
For this session, NASHP Executive Director Hemi Tewarson was joined by:
- Stuart Andreason, Managing Director, Workforce Innovation, the Burning Glass Institute
- Erin Fraher, Associate Professor, Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine
- Eugene Heslin, First Deputy Commissioner and Chief Medical Officer, New York State Department of Health
- Cecilia Oregón, Executive Director, Kaiser Permanente Institute for Health Policy
Related Blogs: State Strategies to Address Workforce Challenges
Labor Market
Stuart Andreason provided an overview of the current labor market, as well as specifics about the experience of the health care sector. Overall, the labor market remains tight, with layoffs being limited primarily to the tech sector. Demand remains strong while high wages have not lured workers back to the workforce. Job growth in general may be slowing down, but positive growth in the labor market is being driven by the health care sector and is expected to remain higher than normal through 2023.
In addition, the working aged population is shrinking, creating long-term workforce shortage trends that are here to stay. The COVID-19 pandemic has had lasting impacts, including long-COVID resulting in more sick days, skyrocketing rates of depression leading to more workers on short- or-long term disability, and a shift to remote working. Wages are increasing, but productivity is declining and there are real benefits and incentives to change jobs in the current market.
Jobs are evolving, requiring new skills across domains. For example, some skills are becoming automated, shifting the jobs from executing those tasks to managing the automation and working with technology. Since 2016, 37 percent of skills have been replaced by automation for jobs with the average amount of disruption. In some sectors, up to 76 percent of requested skills have changed. Workers have needed training and preparation to incorporate artificial intelligence and technological tools into their work.
Churn in the health care workforce predominantly looks like switching between similar occupations or switching employers within the same occupation. We see transitions out of the field mostly with entry-level workers. There is the least amount of churn for higher demand occupations and those that require more specialized training. Addressing churn for entry-level workers can look like creating stepping stones, opportunities for upward mobility, and opportunities to transition these individuals into more specialized roles.
As states and employers are looking for ways to attract new talent to address workforce shortages, they can look for hidden pockets of talent and ways to support transitions into the roles that need filling, while minimizing the impact of those transitions. For example, transitioning a medical assistant to a registered nurse requires a variety of new skills and training. However, a home health aide may already have many skills related to nursing. Overall, recruiting and retaining talent means being creative. Employers also can support workers by creating steppingstones and career ladders.
Health Workforce
Erin Fraher, Eugene Heslin, and Cecilia Oregón joined Hemi Tewarson and Stuart Andreason for a panel discussion on the health workforce. The conversation focused on the following areas:
Power and Importance of Data
Data is critical to identifying workforce shortages and identifying possible solutions. Important data points include what workforce is affected, whether the shortage is localized or across the whole state, and if there is a specific skill set or skill level that is affected, such as experienced versus entry-level workers. Speakers emphasized that this data must be used to inform policy and programs. It is crucial for identifying priorities, determining return on investment, and evaluating success to define best practices.
Building a Workforce for Health
States and employers are making investments to build a workforce for health that includes the traditional health workforce and new and expanded types of professionals. The panel emphasized the following points:
- Coordinating across various health and human services agencies and offices and with the labor agency is important to strategically approach shortages.
- Investments in education, including stipends, scholarships, and loan repayments in addition to investment in education and training programs themselves, remain a common approach.
- The diversity of the workforce and pursuing a workforce with connections to the communities and individuals they serve is a growing priority.
- States and employers are building pathways for entering priority jobs. Some begin with high school students, while others identify individuals in adjacent fields who may be looking to make a change.
- Since the COVID-19 pandemic, there has been a major growth in community health worker jobs and other community-based workforces such as doulas, peers, and direct care workers. States and employers are considering how to define these workforce sectors, what certification and training requirements might look like, and how to collect data on a workforce that traditionally is not licensed. (See NASHP’s work on community health workers, doulas and midwives, and direct care workers for additional information).
- Recent Medicaid Section 1115 Demonstration Waivers include new opportunities for investments in workforce and infrastructure, in particular related to supporting health-related social needs and community-based organizations. This provides an opportunity to bolster data collection and sharing.
Combatting Churn and Prioritizing Retention
Increasingly, states and employers have identified retaining talent as a major challenge and top priority. They are attempting to do so by:
- Increasing salaries and Medicaid reimbursement for priority jobs
- Creating upward career paths
- Continuing education, training, mentorship, and support
Health workforce is expected to continue to be a challenge for states in the coming years. NASHP will continue to support states in their efforts to identify and address shortages.
