Hospital Labor Shortages Debuts as Top Concern for CEOs

Hospital labor shortages, including nurse and technician shortages, were the top concern for CEOs last year, a spot that was previously held by financial challenges every year since 2004.

Hospital labor shortages replaced financial challenges as the top concern for hospitals in 2021, according to data from the American College of Healthcare Executives (ACHE).

“This is the first time since 2004 that financial challenges has moved from the most significant challenge to the second position,” Deborah J. Bowen, president and chief executive officer of ACHE, stated in the press release. “Both long- and short-term solutions are needed to address the shortages in critical front-line staff shown in our study to ensure hospitals have workforces that can meet the demands for safe, high-quality care both today and in the future.”

The survey results consisted of responses from 310 chief executive officers of community hospitals. ACHE asked the respondents to rank 11 hospital issues in order of how much they impact their facility. In addition, the CEOs pointed to specific areas of concern within each issue.  Personnel shortages of all types were the biggest concern for the hospitals, with a top spot ranking of 1.6. The lowest numbers indicated the greatest concerns, ACHE noted. Within personnel shortages, the majority of respondents (94 percent) cited the shortage of registered nurses as a concern. Eighty-five percent were concerned with medical and lab technician shortages, followed by 67 percent who were concerned about therapist shortages.

The results revealed that hospitals are also worried about the shortage of primary care physicians, physician specialists, and physician extenders, including physician assistants, nurse practitioners, and certified nurse midwives. Financial challenges and patient safety and quality placed second and third on the list of pressing concerns, with rankings of 4.1 and 5.0, respectively.

In the 2019 version of the survey, financial challenges were the most significant concern among hospital CEOs and received a 2.8 ranking. Although the spot was overtaken by personnel challenges last year, hospitals still voiced concerns about finances. Nearly 90 percent of the respondents said that the increasing costs for staff and supplies were an area of concern. Around half of the CEOs cited reducing operating costs and Medicaid reimbursement—including adequacy and timeliness of payment—as concerns regarding finances.

Within the concern of patient safety and quality, high prices and insufficient reimbursement for medication was the most pressing worry, with 45 percent of respondents identifying it as an area of concern. Participants also identified redesigning care processes and engaging physicians in improving the culture of quality and safety as concerns. The coronavirus pandemic has undoubtedly been a driving force behind the increased concern for personnel shortages.

Hospitals faced particularly significant shortages during surges of COVID-19. For example, in November 2020, HHS data revealed that 22 percent of hospitals were facing staffing shortages.

Additionally, a September 2021 survey found that more than half of nursing homes and assisted living facilities were experiencing moderate- or high-level staffing shortages.

As the pandemic continues, hospital labor shortages will likely remain a concern, especially as states can now enforce CMS’ COVID-19 vaccine mandate for healthcare workers. Hospital and health system leaders have voiced their concern about the mandate, fearing that it could exacerbate staffing shortages.

Experts have predicted that the country could see a physician shortage of 37,800 to 124,000 primary and specialty care doctors by 2034. According to Bowen, stakeholders must consider solutions of all sizes to address the workforce shortages plaguing hospitals across the country. “Longer term solutions include increasing the pipeline of staff to these positions, as well as organization-level efforts to increase staff retention,” Bowen said. “More immediate solutions include supporting and developing all staff, building staff resilience, and exploring alternative models of care.”

On a federal level, Vice President Harris recently announced a $1.5 billion investment that will help address the healthcare workforce shortages in underserved communities.