The health care work force in the US had huge turnover at the start of the Covid-19 pandemic but seems to be getting back to prepandemic levels, although it’s not there yet, according to a new study.
The study, published Friday in the journal JAMA Health Forum, found that recovery has largely been uneven.
Researchers from the University of Washington and the University of Minnesota compared turnover rates between April-December 2020 and January-October 2021, using records from the US Current Population Survey, along with records from the US Census and the Bureau of Labor Statistics. They looked at records on 125,717 health care workers.
When hospitals postponed elective surgeries and clinics closed during the first peak of the pandemic, about 1.5 million health care workers lost their jobs, other research has shown. Most jobs returned by fall 2020. But by next year, the health care employment rate was still 2.7% below prepandemic levels.
The researchers note that because of the way they did this study, they were not able to directly link work force exits to Covid-19.
Turnover rates peaked in the first part of the pandemic, but the work force largely recovered in the second period studied, with the exception of doctors and people who worked in long-term care facilities.
Turnover rates also varied by demographics. More health care workers – men and women – with young children left the work force. The rate was higher among women.
The turnover rates among American Indians, Alaskan Natives and Pacific Islanders were higher than among other races. Black and Latino workers experienced the slowest job recovery rates in the second period studied. The people least likely to leave were White workers.
Turnover also varied by position, with aides and assistants most likely to leave their jobs throughout the pandemic.
The researchers were unable to address specifically why people were quitting, but study co-author Janette Dill, an associate professor in the Division of Health Policy and Management at the School of Public Health at the University of Minnesota, had some ideas.
Wages may be part of the problem. She points to the high turnover rates in long-term care as an example.
“Long-term care is a sector that is largely paid for by Medicaid, and Medicaid has pretty low reimbursement rates, and so consequently, the wages in long-term care are pretty low. So there are lots of reasons people would want to leave long-term care, ”Dill said.
Problems in that part of the health care industry predate the pandemic, but the pandemic made them much worse, she said.
“I interviewed a worker recently who told me that she could get a job at Target that paid $ 2 more an hour than her health care job. Who could blame her for leaving? ” Dill said. “Long-term care has a lot of pressure from retail right now that just pays better.”
The Biden administration also raised the amount of money people could get while on unemployment, which may also have played a role in people leaving jobs that did not pay well.
It may also be an issue of risk.
Black and Latino workers tend to work more as aides and assistants, Dill noted, occupations that are at significant risk of infection and had far less access to protective gear, particularly at the start of the pandemic. Those communities also have had a disproportionate number of Covid-19 cases.
White workers were more concentrated in technician, therapist, physician and registered nurse positions, where people were a little better able to protect themselves.
Burnout and a lack of child care may also be to blame.
April Kapu, president of the American Association of Nurse Practitioners, said her group has been following the work force issue closely.
Turnover and retention have been a serious concern, she said. “I think the pandemic really highlighted much of what was already there,” said Kapu, who was not involved in the new research. “We have a lot of work to do in the area of mental health and supporting the mental health of our health care workers.”
The Dr. Lorna Breen Health Care Provider Protection Act, which President Biden signed into law in March, is one step in that direction, she said. It authorizes grants for programs that offer behavioral health services for front-line health care workers.
The act was named for a New York City emergency room doctor who died by suicide in 2020. She had been working 18-hour days and treating an onslaught of Covid-19 patients at the start of the pandemic.
Kapu said more funds are also needed to increase the work force in general and to pay for education so more people can go into the health care profession.
One of the study’s findings that may not be able to be explained by wages is the high level of physicians who left their jobs. The rate is lower than any of the other positions, but the number of doctors leaving the health care sector has stayed high, compared with 2019, and it is unusual.
“Physicians rarely leave their jobs,” Dill said. “It does seem to indicate that there is some dissatisfaction in the physician work force and the work force is not recovering to the same levels of the prepandemic period.”
Tracking turnover in health care is going to be critical to determining where retention efforts should be focused.
“Waiting too long to understand these issues may further elongate the consequences of the Covid-19 pandemic,” the study says.