The nation’s healthcare workforce still is trying to recover from the COVID-19 pandemic nearly three years after it began as labor shortages stress hospitals and clinicians, spurring increased burnout among staff ranging from nurses to executives.
In addition, healthcare workers across the country have waged strikes to gain higher pay and optimal staffing conditions in employment contracts, while resident physicians increasingly have been involved in labor organizing.
These labor trends will continue posing challenges to health systems this year as facilities work to get back to pre-pandemic operations and stem labor costs that rose last year, experts say.
Ongoing staffing shortages and use of temporary labor
Staffing shortages are expected to continue this year, especially among nurses, as widespread burnout and increased turnover hits the sector. Shortages have led to ongoing use of costly contract labor to fill labor gaps even as severe COVID-19 hospitalization rates have declined.
In December, the national average weekly pay rate for travel nurses was $3,173, according to data from nurse staffing platform Vivian Health. That’s up from $1,894 in January 2020.
High rates are expected to remain fairly static this year, said Tim Needham, senior vice president of revenue at Vivian Health.
Without another COVID wave, demand for contract labor costs this year should normalize at about 60% higher than 2019 levels, Jefferies analysts said in January healthcare equities brief.
Persistent heightened labor costs are posing financial challenges for systems. Although some are boosting permanent staff pay to attract needed workers, many have still been unable to curb soaring labor costs.
“The cost differential between full-time staff and then contracted staff is continuing to put pressure on health systems to reassess their full-time employee compensation packages,” Needham said.
An increase in organizing among residents and interns
Healthcare workers in all roles have been active on the labor front throughout the pandemic in an effort to improve working conditions.
While nurses have long been the face of union activity, resident physician organizing has picked up in recent years, according to the Committee of Residents and Interns, a branch of Service Employees International Union.
The fast-growing union representing doctors in training had five election wins in 2022, four in 2021, one in 2020 and two in 2019, according to CIR-SEIU. It currently represents about 25,000 members.
Organizing for doctors in training is expected to continue in the new year, with residents at Montefiore Medical Center in New York and Lifelong Medical Care in San Francisco currently entering an election for union representation, according to the union.
Last year, residents at three Los Angeles County hospitals and one Oakland, California-based hospital authorized strikes, though both groups reached deals with the systems beforehand and averted a work stoppage.
Strike threats from resident physicians are particularly tricky for hospitals because residents are more difficult to replace than nurses. Additionally, resident physician strikes threaten a facility's ability to keep operations afloat in the event of a walkout, said John August, director of healthcare labor relations at Cornell’s School of Industrial and Labor Relations.
Like nurses and other healthcare workers, unionized residents are pushing for better pay and adequate work support.
“Doctors are feeling that they've kind of turned a corner — for many years, they felt that their power and influence was being reduced due to consolidation of health systems and reimbursement systems and technology,” August said.
Burnout, turnover hits executives
Reports first pointed to burnout hitting nurses and physicians as healthcare workers reporting feeling stressed and emotionally exhausted.
Now, even healthcare executives are reporting symptoms of burnout, leading some to consider career changes.
A December study from consulting firm WittKieffer found that nearly 75% of surveyed healthcare executives reported feeling burned out during the last six months of 2022, compared to 60% of respondents who reported burnout symptoms in 2018.
The survey, which included responses from 233 healthcare executives, also found that executives felt significantly less productive and unable to overcome challenges at work, and were less determined to make an impact in their careers.
Increased overall burnout in the sector may lead to greater executive turnover, an effect which has been recorded among nurses.
Still, a number of executives currently leaving their posts likely delayed retirement in order to weather their organizations through the pandemic, according to Rachel Polhemus, a senior partner at WittKieffer's Healthcare Practice.
“Each wave presented a different set of factors that really created an element of ‘I'm ready to step away and let a new leader come in and lead,’” Polhemus said.
Additionally, replacing executives could prove trickier post-pandemic.
“The skill sets and competencies organizations are looking for in executives are different than they were pre-COVID,” Polhemus said.
Hospitals are placing added value on candidates with past experience in executive roles dealing with crisis management during the pandemic, Polhemus said, adding that job-seeking candidates also are looking at how organizations fared through the pandemic when deciding whether or not to accept offers.