AHA Exec: 'Workforce Is the Number One Concern for Hospitals Across the Country'

The hospital association says it is focusing advocacy on workplace violence, Medicare residency slots, the nursing shortage, and workforce diversity.

Strengthening the healthcare workforce is one of the top priorities of the American Hospital Association's advocacy agenda for 2023.

Health systems and hospitals are facing workforce shortages across the full spectrum of their employees. In addition to a well-recognized shortage of nurses nationwide, health systems and hospitals are struggling to fill openings among physicians, technicians, and other job positions.

The American Hospital Association recently released the organization's 2023 advocacy agenda. In addition to strengthening the healthcare workforce, the AHA is targeting three other areas: ensuring access to care and providing financial relief; advancing quality, equity, and transformation; and enacting regulatory and administrative relief.

A pair of AHA executives spoke with HealthLeaders today about the organization's focus on strengthening the healthcare workforce. "Workforce is the Number One concern for hospitals across the country," says Priscilla Ross, executive director of executive branch relations and senior director of federal relations.

Addressing workplace violence

She says addressing workplace violence and intimidation is a key focal point for the AHA.

"Over the past few years and during the coronavirus pandemic, we have seen a sharp increase in the number of violent incidents at hospitals, particularly physical attacks on staff. It is demoralizing. It harms the quality of care because providers must spend time focusing on deflecting attacks and recovering from attacks, rather than focusing on patient care. It has become a big issue across the board. It is something we hear about from our hospitals on a consistent basis," she says.

Workplace violence and intimidation is taking a heavy toll on staff members, Ross says. "In addition to being demoralizing, workplace violence makes staff fearful of dealing with patients. It is causing stress, burnout, and prompting staff to decide they do not want to practice in a hospital setting anymore."

Increasing Medicare residency slots

The AHA is also focusing on increasing the number of residency slots eligible for Medicare funding to address physician shortages, she says.

"We have seen estimates that the physician shortage is going to reach 124,000 physicians within the next 10 years. That is going to jeopardize access to care in communities across our nation. The Medicare Graduate Medical Education program was created at Medicare's inception in 1965 to ensure that Medicare beneficiaries had access to providers. Congress decided that the Medicare program would play a role in funding graduate medical education. Unfortunately, back in the Balanced Budget Act of 1997, Congress decided to freeze the number of Medicare-funded residency slots to about 90,000 slots," Ross says.

The AHA has supported federal legislation that has been bipartisan and bicameral for several years that would add a significant number of Medicare-funded residency slots to the program, she says. "The most recent bill in the last Congress was the bipartisan Resident Physician Shortage Reduction Act, which would have added 14,000 new residency slots over seven years. We need to have additional funding so that communities can have an adequate number of physicians."

Tackling the nursing shortage

The AHA also plans to support measures that would help address the nursing shortage, says Akin Demehin, senior director of quality and patient safety. "The nursing shortage did not happen overnight. There have been structural shifts and demographic shifts in the nursing workforce. Prior to the COVID-19 pandemic, about half of nurses were age 50 and over, and about 30% were age 60 and over. So, just from that perspective, there was a need to replace the portion of the nursing workforce that was approaching retirement age. The pandemic served as a profound accelerant, with nurses facing wave after wave of COVID patients, experiencing increased incidences of violence, and many readying for the next phase of their lives in retirement."

Several efforts can increase the nursing workforce, he says. "The first is investing in faculty for training nurses. Nursing faculty are in significant shortage, so much so that about 80,000 applicants to nursing schools who were qualified to attend nursing school had to be turned away, in large part because there were not enough faculty to train them. We have supported legislation to help address the faculty shortage—the Future Advancement of Academic Nursing Act.

There are also short-term actions targeting regulation that could bolster the nursing workforce, Demehin says.

"We need to look critically at the range of regulations that affect nursing workload and increase burden without necessarily adding value in terms of quality of care. There were some flexibilities granted during the pandemic's public health emergency that were very helpful for the nursing workforce. For example, we would like to see changes to the discharge planning requirements that are administratively intense but are not necessarily leading to the better transitions in care that were the original intent. Another example is doing away with Medicare requirements around advanced practice nurses that are more restrictive than state laws—that could be a step forward in encouraging flexibility in the nursing workforce," he says.

Boosting healthcare worker diversity

The AHA is also planning to support efforts to increase diversity in the healthcare workforce.

Ross says the AHA has been supporting federal legislation that would boost diversity in the physician workforce.

"In the last Congress, there was a part of the Build Back Better Act called Pathways to Practice that established 1,000 new fully funded medical school scholarships for medical school or post-baccalaureate studies for people who came from disadvantaged backgrounds, rural areas, were the first in their families to attend college, or graduates of historically black colleges and universities. In addition to tuition, Pathways to Practice provided a stipend for students. It would have taken great strides toward increasing diversity for those who find pursuing a medical career out of reach. It passed in the House, but it did not make it through the Senate," she says.

The AHA is supporting work at the local level to promote diversity throughout the healthcare workforce, Demehin says. "What we hear from AHA members about their diversity work above and beyond the physician workforce is that the work takes place at the local level through partnerships with local schools and colleges to create linkages for those who are considering health professions as a career. Members are reaching out in intentional ways to diverse communities to encourage them to work in the healthcare field. Ultimately, improving diversity can help us take better care of the communities that we serve."

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