With the continuing rise in the number of coronavirus cases across the United States and many other countries, the conversation is increasingly turning to an anticipated shortage of hospital beds and hospital equipment. A Harvard University study shows that if 50% of all currently occupied hospital beds were emptied and sizable percentages of Americans were infected, the country would need at least three times more beds to care for everyone. James Lawler, an infectious disease doctor at the University of Nebraska Medical Center, forecasted in a recent presentation to hospital insiders that the U.S. may eventually have as many as 96 million cases, resulting in 4.8 million hospitalizations. While recent media reports are focusing on the availability of hospital beds and hospital equipment, both of which are valid concerns, the far greater looming healthcare disaster is the gaping shortage of doctors and nurses.
The facts are that there were not enough doctors and nurses before the coronavirus hit, and as the current pandemic continues to roll on, the real impact of the shortage of professional care givers will be exposed to the great dismay and shock of all Americans.
The American Hospital Association (AHA) in its 2019 Health Care Talent Scan reported that the U.S. will need to hire 2.3 million new healthcare workers by 2025. You can download the report here. The Bureau of Labor Statistics reports that there were approximately twice as many healthcare job openings than hires in 2018 and the gap will persist as there will be 1.3 million job openings annually through to 2026.
Even before the coronavirus pandemic, it was estimated that 200,000 nursing positions would be unfilled at hospitals across the country this year. Further, the confluence of an aging workforce and an aging population is pointing towards more than one million nurses retiring in the next ten years at the exact same time that an aging population with increasingly complex health needs is exploding.
Hiring experienced foreign educated nurses is a strategy that U.S. healthcare employers are implementing in an effort to cope with the increasingly urgent shortage of nurses. This is not a new strategy as foreign educated health professionals have been a vital part of the U.S. healthcare workforce for decades. However, just at the time when the need for these valuable healthcare providers is greater than ever before, the draconian way in which U.S. immigration laws allocate visas is actually blocking timely healthcare immigration.
Today there are thousands of fully qualified nurses who have been approved for U.S. green cards but who are not in the U.S. because of “visa retrogression”. “Visa retrogression” is when a fully qualified visa applicant has to wait for a visa to become available because the EB-3 visa category is oversubscribed. Emergency legislation has been drafted to address this urgent matter. This legislation prioritizes fully qualified nurses by utilizing a portion of the tens of thousands of visas that have been authorized by Congress but have gone unused in the past because of prior administration’s bureaucratic delays and inefficiencies. The current legislative proposal allows all fully-qualified foreign-educated nurses to have their visas granted, if they are in the immigration processing queue now through September 30, 2020. This legislation does not add visas to the overall visa quotas or take visas from any other occupation.
The limited ability of U.S. health employers to directly hire in-demand foreign educated health professionals results not only in a decreased capacity to provide care, but it also dramatically contributes to hospitals engaging in a no-win bidding war for talent that ultimately only results in dramatically increased healthcare costs. Hospitals are now calling for $100 billion in funding from the federal government to cover increased coronavirus related costs – a large portion of which are being driven by soaring overtime, contract and travel labor. Some employers are offering nurses up to $100/hour with contract nurse labor fees ranging from $120 to $180 per hour and more.
What is not yet known is how widely the virus will spread among doctors and nurses who are working on the front lines in clinics and hospitals. Infections among front line healthcare providers are increasing more quickly than in the general population already. “We all suspect it’s the tip of the iceberg,” said Liam Yore, a board member of the Washington state chapter of the American College of Emergency Physicians. “The risk to our health-care workers is one of the great vulnerabilities of our healthcare system in an epidemic like this,” he said. “Most ERs and healthcare systems are running at capacity in normal times.” Doctors, nurses and other hospital workers say their anxiety levels are rising as they hear not just about medical workers in Italy and China falling sick, but now an increasing number of U.S. health workers as well.
As Congress continues to formulate appropriate responses to the personal, societal and economic implications of the current pandemic, it is imperative that solutions to the shortage of doctors and nurses be given the highest priority including using the immigration system to increase the number of experienced care providers available to care for Americans. The time is now for Congress to set aside rancorous partisan divides, and to take decisive action to make visas available to qualified nurses and other healthcare professionals.
The current crisis should also serve as a wake-up call regarding the massive projected shortages predicted across the healthcare sector in the next decade. The alarms being raised now should not be forgotten when the pandemic subsides and a sense of normalcy returns to everyday life. The projected shortages of the future will be chronic and not something that will pass as this pandemic will. It is imperative that healthcare leaders embrace their workforce planning from a perspective of national supply and demand and get away from ‘robbing Peter to pay Paul’ recruitment practices of today.
Concerns around the availability of hospital beds, equipment and supplies will quickly become secondary concerns if those requiring hospitalization lack proper care because there is no one to provide it.