The Health Workforce Gap: A Mounting Crisis for the Inland Empire and Beyond

The world, the United States, and especially rural communities and communities of color such as California’s Inland Empire, are facing a health workforce shortage that is only expected to grow worse over the coming decade. While it’s easy to suggest fixes that seem simple (hire more nurses!), this issue is complex and woven through interconnected shortages and inequities that have impacts far beyond the obvious.

The Health Workforce Shortage is Dire

The shortage of qualified healthcare workers will look different in different settings.: 

What Roles are Most In-Demand in the Health Workforce?

There are shortages across the spectrum of healthcare, but what’s important to know is that healthcare encompasses a wide swath of careers beyond doctors and nurses. There is unprecedented demand for physical therapy aides, home health aides, pharmacy techs, phlebotomists, and medical assistants. 

Staff Shortages and Overtime are Unsustainable

It isn’t hard to find evidence of the ongoing crisis in healthcare. This year saw strikes across the industry, with Kaiser Permanente nurses, ER technicians, and pharmacists participated in a three-day strike Oct. 4-6 that resulted in a 21% raise in wages over the next four years. CVS and Walgreens saw a similar walkout with working conditions cited as the cause. In fact, twenty-two separate healthcare strikes were reported this year in the United States, all of them citing staffing and concern for reduced patient care as the reasons.

In California, the situation is worse than in some other parts of the country. A recent report on CapRadio noted “the nation is facing a health care shortage decades in the making, and the situation in California is especially dire. Projections show the state could be short 44,000 registered nurses by 2030. Approximately 35% of physicians in the state are over 60 years old.“

What Caused the Inland Empire’s Health Workforce Shortage? 

Geography is One Part of The Inland Empire’s Health Workforce Problem

The Inland Empire and California’s Central Valley both struggle to train and retain healthcare workers. According to Jeff Oxendine, MPH, MBA, who is a health executive, educator and consultant who founded and runs Health Career Connection (HCC), “The Inland Empire and the Central Valley are two of the fastest growing regions in California. And they are the two areas that have the lowest per capita health workforce. It’s also a challenge to recruit and retain people in these areas that reflect the diversity and language capabilities of these regions.” 

Those born in these regions who ultimately pursue healthcare often leave to choose bigger cities like Los Angeles, San Diego, or California to practice. The other issue is that there are simply not as many medical schools and training programs in these regions to produce the workforce needed. 

Repercussions of the Covid-19 Pandemic on the Health Workforce

There is no denying the devastating consequences that 2020’s pandemic wrought on those in the healthcare field. Burnout was a very real issue, leading to more healthcare workers leaving the field than at any time in recent memory. The lack of full-time nursing staff led to an increase in competition for traveling nurses, and hospitals without deep pockets or attractive locations could simply not compete with the bonuses and high weekly salaries being offered in other places. 

Reimbursement Declines Exacerbate the Problem

Cliff Daniels, Senior VP / Chief Strategy & Integration Officer at USC Arcadia hospital and the current board chairman for Reach Out noted, “While our costs are rising for hospitals at 12-15% per year, our reimbursement rate rises at maybe zero to two percent per year. You can visualize that graph. It’s unsustainable.” 

Reimbursement is the payment that a hospital, healthcare provider, diagnostic facility, or other healthcare provider receives from insurance plans for providing service. The 1997 Balanced Budget Act (BBA) kicked off an enormous shift in the way Medicare reimbursed healthcare. 

Though the topic of healthcare reimbursement is extremely complex, some studies suggest that “the BBA may have exacerbated the nursing shortage, because nurse workload increased at high and medium Medicare pressure hospitals and, thus, likely increased nurse dissatisfaction and burnout. The BBA may have resulted in slower growth of nurse wages, and existing nurses were unlikely to be compensated for the additional workload. In addition, slower growth in wages makes the field less attractive to new entrants and may have accelerated the use of temporary nurses in hospital settings.”

Balancing Short & Long-Term Solutions to the Health Workforce Shortage

One of the ways the state of California has found to incentivize health workers to stay is by offering various incentives. Jeff says, “Now the state is investing hundreds of millions of dollars to get people into the pathway to go into those professions and with loan repayment, with scholarships, those kinds of things, but it’s still a drop in the bucket compared to what the immediate and long-term needs are.” And while reimbursement for school and scholarships certainly work, the funding available isn’t bottomless and these programs ultimately increase the cost of care. At some point, we’ll need a longer-term solution. 

The Future Lies in Training for the Health Workforce

Jeff notes that the two greatest factors influencing where a physician chooses to practice are: where he/she is from, and where he/she does residency. It makes sense then that building more residency programs in underserved areas would help, since this would allow retention of locals who understand the culture and community where they train. 

An additional strategy is to secure more scholarships to fund healthcare education within underrepresented populations. Jeff points out that it’s difficult for those without significant resources to enter healthcare because of the schooling required and the cost associated. This clearly disfavors those from lower income backgrounds, and contributes to the lack of representation many populations see in their healthcare providers. 

That said, there are numerous areas of healthcare that don’t require the years of education or the cost associated with becoming a doctor. Unfortunately, many people who might enter the health workforce in one of these areas aren’t aware that these jobs and the need to fill them exist. 

The Long-Term Solution to the Health Workforce Crisis

The most sustainable and effective solution to the workforce shortage is to begin filling the pipeline earlier. Cliff and Jeff agree that critical exposure to the variety of potential health care careers must occur in middle school. 

Jeff explains, “I’ve assessed these programs for over 20 years now, and the best ones include a combination of academic support and helping with things like study skills and notetaking to help students be successful. Having health career exposure that includes work-based learning, internships, or project work or shadowing” can lead to interest in health careers. 

Why K-12 Health Pathway Programs Work

Jeff and Cliff both talk about the benefits of funneling middle school students into what they call Health Pathways programs, like the work-based learning program and Moving in New Directions program Reach Out offers. It’s been demonstrated that kids who are exposed to careers in the sciences early are more likely to choose careers in those fields. A study in the STEM Education journal notes that:

“exposure of students to STEM careers can enhance their interest in pursuing careers involving science, technology, engineering, and mathematics.” 

Giving kids the opportunity to understand the full range of available health care careers early gives them more choices as they make decisions about their future through the high school years. This is especially important for kids from diverse backgrounds who may not feel “seen” in the current healthcare system and therefore hadn’t considered the field for themselves. Being exposed not just to a variety of potential careers, but also to a range of professionals within those jobs can change the landscape of what working in healthcare looks like. 

A More Diverse Health Workforce Means Better Care

“California is facing a health workforce crisis. There are not enough health workers to meet the needs of its increasingly diverse, growing, and aging population, and the situation is worsening. Shortages exist across professions and geographies, with sizeable urban and rural underserved populations. Additionally, although the state population is becoming increasingly diverse, the current health workforce doesn’t reflect these demographic shifts. For example, in 2019, 39% of Californians identified as Latinx, but only 14% of medical school matriculants and 6% of active patient care physicians in California were Latinx.” (Source: CA Healthcare Foundation)

Recruiting early and from traditionally underrepresented populations and regions makes sense in other ways too. There is an increasing focus in hospitals on cultural competency, something many healthcare organizations are paying consultants to train. If the makeup of the health workforce more closely matched the population served, there is a potential for better cultural competency without the need to bring in outside consultants to train this. 

Keys to a Successful Health Pathways Program in K-12 Schools

As organizations like Reach Out partner with healthcare organizations and work to counter the effects of the health workforce shortage, one of the critical aspects of curriculum planning will be based on an honest evaluation of current needs. As Dr. Shermineh Davari, Director for Reach Out’s Inland Health Profession Consortium points out, “We need to be innovative and consider what it is now that students actually need. We collect both qualitative and quantitative data through our learning and evaluation department in order to adapt to current needs and provide the best training and services possible.”

Pathways programs must be directly connected to the organizations they feed in order to ensure that their programs are providing training that prepares participants for the evolving requirements of various health professions.  

The Pipeline Cannot Leak

The entire goal of exposing children as early as elementary and middle school to the variety of health care professions is to capture their interest early and then build on that interest as they grow in order to hopefully help them enter the workforce. That means that having a fantastic middle school program isn’t enough. Once a student moves on to high school, the program must be there to continue to support the student’s interest and meet their needs in terms of curriculum and preparation. 

Ideally, this begins with a program like Reach Out’s work-based learning program, which exposes children in middle school and high school to health careers. In college, programs like those offered by Health Career Connection, Jeff Oxendine’s non-profit, expose students to networking opportunities, internships, and training that lead directly to entrance into healthcare fields. When programs like these are supported in diverse communities, they lead directly to a more diverse health workforce. 

“Part of why I focus on health workforce and diversity issues is because everybody wins,” Jeff says. “The health organizations get the qualified diverse employees they need, and people get education, which leads to all kinds of other benefits. It’s an economic development solution.”

Health Pathways Programs Can Solve the Health Workforce Issue

Jeff points out that there is no need to reinvent the wheel when it comes to working to build a good health pathway program into schools. Teachers and administrators are burdened enough without having to try to figure out how to create these programs. Instead, he suggests districts partner with existing and proven programs like Reach Out’s work-based learning program. 

“Reach Out is trying in every way we can to provide opportunities and resources for students,” Dr. Davari notes. “Through hands-on direct services for high school students and teachers, providing internships, side visits, bringing in career speakers, and offering coaching, we strive to create hands-on experiences to help bring exposure to health care careers.” 

Reach Out also offers training for Community Health Workers, a career field that Jeff and Cliff agree is gaining in both demand and impact, and is an excellent opportunity for someone entrenched in their community who really wants to make a difference. 

Bringing in a health pathways program is something all school districts in the state of California should be considering to help provide diverse opportunities for their student populations and to help offset the dire health workforce shortage the state is facing. 

For more information about how Reach Out can help build a health pathways program at your school, contact us.

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