In 2017, I wrote an article about healthcare staffing shortages in New Mexico, based upon what we knew then, five years ago. Since then, I’ve been involved in many projects and written multiple reports about this issue. It’s a lot worse now. New Mexico’s healthcare shortages are more severe than many other areas of the country. These are exacerbated by many of our state’s Social Determinants of Health, including poverty, race and ethnicity, and the fast-growing older adult population.1 Back then, I wrote that the staffing shortages in our state are worse than national averages, and those trends have become worse, and have been exacerbated by Covid as well as lack of competitive wages and salaries for many positions. It’s also become worse with the growing divide between rural and urban communities, rural and urban regions, and competition for professionals with other states.
A study by UNM using 2015 data, and presented in November 2016 to the Legislative Health and Human Services Committee, noted healthcare workforce shortages in NM as a whole, especially in less-populated counties. New Mexico faces both healthcare staffing shortages now, and projected for the next few decades. Healthcare also represents a top area for economic growth, according to reports from the NM Department of Workforce Solutions. These trends seem counterintuitive, however, they both exist, creating interesting challenges for providers.
These trends are so much more serious now, in 2022. Some large healthcare systems are working at 70% capacity. Having a 30% vacancy rate and frequent turnover represents severe challenges to a system’s ongoing sustainability and viability. Some school districts have faced a very high turnover rate among principals and teachers. Senior Centers are finding challenges in filling frontline positions because many local businesses have increased salaries to fill positions, which pull staff away from all of the lower paying positions.
When agencies, providers and government systems are facing this level of staffing challenge, it limits what they can do. Things fall between the cracks even when staff are stretching to do more and work longer hours. As turnover increases and staffing levels drop below 80%, staff become increasingly stressed out and the system less responsive and able to integrate change and respond to community needs (which is essential during this period of substantial change related to Covid, climate and economic recovery). When staffing levels are low and turnover high, it makes it hard for the system itself to absorb and integrate staff changes, systemic or structural issues, and manage the impact of our current complex level of change.
Con Alma Health Equity Funder Had Tackled This Issue
The Con Alma Health Foundation has been deeply concerned about this issue as it relates to both staffing shortages and underrepresentation of Hispanics and Native Americans within the current and projected workforce. Con Alma has conducted research and published reports on the state’s health care shortages, and identified the following as key issues impacting health shortages:
- Pipeline shortages in key health faculty positions at colleges and universities;
- Lack of close alignment between education programs and available jobs;
- Limited loan repayment assistance and/or incentives for newly graduated health professionals who face repayment of large student loans;
- Special challenges faced by rural communities;
- Significant levels of retirement of professionals during the coming decade;
- Low level of racial and ethnic diversity among health care professionals;
- Small cohort of young adults moving into the workforce, and its impact on health and allied health education, training, recruitment and placement;
- Funding and policy challenges (2).
Current and Future Picture of the Healthcare Workforce
The health care workforce that is retiring now and in the next decade is primarily male and white. It is not representative of the diverse population of the state. This workforce is not being replaced by enough new professionals with either the numbers or the diversity needed to provide adequate health care in the future. The NM Department of Workforce Solutions annual reports over the past few years show a significant increase in the percentage of healthcare related jobs, going from 10% in 2002, to a level of 16.1% in 2015. Nationwide, the healthcare industry is projected to represent 20 percent of all jobs by 2024, and New Mexico may well have a higher percentage of healthcare jobs. highest level of overall growth in a sector of the economy in the County. Continued growth is expected for the coming years, projected to be 28.8 percent growth between 2010 and 2020. “Behavioral Health Policy” and “Aging Policy” include two recent studies by CHI for DOH. They were authored by Susan Wilger and me and address workforce recruitment and retention issues with (1) an analysis of problems with silos in training and certification; (2) lack of alignment between training and certification and provider needs, funding sources and program and services provided, especially in rural areas; (3) fragmentation among funding sources and their requirements; and (4) difficulties that many providers face with Medicaid contracting and billing. 3
Shortages Amid a Picture of Significant Growth in the Healthcare Sector
Significant health care growth and substantial shortages are happening at the same time because much of the growth has come in the subsectors of health care that are in: a) private pay areas serving middle-income to high-income residents; b) home health care providers with low wage jobs for proprietary companies creating profits by minimizing worker pay; and c) the health insurance industry with thousands of jobs created due to Medicaid expansion and the ACA Health Information Exchange. These factors have little impact upon HPSAs, as most of these staff are in nonprofit and government sectors, which have been experiencing reductions in both staffing and funding. Even with overall growth in the healthcare industry, significant gaps in targeted areas have the most impact for those serving primarily low and limited income populations which are high priorities for the State of New Mexico.
A series of studies by the NM Legislative Finance Committee (LFC), the Legislative Workforce Committee and others (4) suggest that even though there are healthcare shortages as outlined by HRSA, some of the gap issues could be addressed, at least in part, through more carefully delivered care, utilizing a range of strategies targeted to different types of patient needs and utilizing resources more effectively. In other words, patients with chronic conditions, hospital high utilizers, and people with other challenging conditions (1% of patients utilizing 22% of healthcare resources) require much more intensive, ongoing contact. However, those who are healthy need a different, less intensive level of care. (5)
All of the issues mentioned above are especially acute in rural areas and for smaller agencies and providers.
A major challenge for the next decade in New Mexico is our ability to successfully address the education, training, recruitment and retention needs of our state and communities, and a diverse workforce. This is especially true for rural and frontier health areas, communities with a high proportions of poor and near-poor, and those significant minority-majority populations. The retirements represent part of the “Silver Tsunami,” which is a very fast-moving trend.