How Can We Fix the Health Care Workforce Shortage?

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The health care worker shortage is one of the defining challenges facing medicine today, affecting everything from worker burnout to access to care. We spoke with Joanne Spetz, PhD, director of UCSF’s Philip R. Lee 
Institute for Health Policy Studies, to find out what’s causing the shortage — and how to solve it.

What factors are driving the shortage?

It’s not a uniform issue, and the factors vary. In some health care professions and parts of the United States, there is no shortage, but rural regions worldwide consistently face shortages. A series of trends has converged over the past seven or eight years, including the aging of baby boomers. Their medical needs are rising at the same time as many boomers who work in health care are retiring.

The COVID pandemic also contributed, due to burnout and workplace stress, although those effects do seem to have calmed down. Additionally, some training programs took a hiatus from admitting cohorts, and some students took extra time to finish.

What are the biggest economic forces shaping the workforce right now?

The rising cost of health care is a concern, and efforts to control spending by federal and state governments are another driver. For example, HR1, the so-called Big Beautiful Bill, will enact significant cuts to Medicaid. For many health care organizations, this will substantially constrain their revenues and their ability to hire staff.

Inflation is also putting pressure on organizations and workers, especially those in jobs that don’t require a license. If you’re an unlicensed nursing assistant, for example, your pay is often not much above minimum wage, and you have little career trajectory unless you go back to school. That becomes a real challenge for recruiting and retaining people.

Value-based payment rewards health outcomes over volume, creating both the room and the incentive for true team-based care.

Joanne Spetz, PhD

Is the situation throughout the industry or in specific practice areas?

Primary care often faces shortages. Primary care physicians typically earn less than specialists, and research has documented that the combination of lower salaries and high medical school debt can steer doctors toward specialty training. The United States has also long relied on international medical graduates to help fill primary care gaps, but recent immigration policies may make that harder.

Geriatrics also faces ongoing shortages, as do licensed and certified occupations, such as occupational therapy and clinical laboratory jobs. Entry-level jobs in the long-term care field are another trouble spot. Turnover rates are extremely high, while demand is rising because of the aging population.

How do patients experience shortages?

It can be difficult to get an appointment with a primary care provider, even in cities like Boston, which has one of the highest numbers of doctors per capita. It’s often worse in rural communities. If you’re on Medicaid or have really high copayments, finding affordable care gets more and more difficult.

People also see it as delays in the emergency department (ED) and boarding in the ED because there aren’t enough beds in other units. And it can be hard to get appropriate assisted living or nursing home placements or to find a home care aide.

What is UCSF doing to better understand and address these challenges?

UCSF conducts research that informs health workforce policy and planning, looking at its supply, demand, and stresses as well as at barriers to growth and factors driving burnout. The Healthforce Center at UCSF, which I’ve been affiliated with since I joined the faculty 25 years ago, leads much of that work. We collaborate with the California Department of Health Care Access and Information, the state medical board, and other health professions boards to advance state and federal investments in the workforce.

Additionally, UCSF has programs to generate job opportunities for people in our local community. They provide training in clerical and administrative health system roles and health IT support, as well as accelerated pathways to becoming medical assistants, phlebotomists, or EKG techs.

What would a more stable, sustainable workforce look like, and how would it improve patient experiences?

Professionals in the field would feel well supported with reasonable workloads, adequate support staff, and enough colleagues to prevent burnout. Turnover rates would be low, and entry-level jobs would have viable career pathways.

Patients would get timely care that goes beyond emergency department diagnosis and treatment, including help navigating the broader range of services they need after discharge.

Patients would also have team-based care customized to the clinical setting and their individual needs. One model is the patient-centered medical home, pioneered by UCSF’s Department of Family and Community Medicine, which brings together a physician, an advanced practice nurse, RNs, and medical assistants to provide coordinated, proactive care. Each team member offers specialized skills. For example, one medical assistant might use the electronic health records system to flag patients due for monitoring, while another might connect people to community nutrition programs.

What will it take to get us to where we should be?

We need two big changes. First, health care financing must shift to a value-based payment structure. The current fee-for-service model pays physicians per procedure, incentivizing doctors to do everything themselves rather than delegate to a broader team. Value-based payment rewards health outcomes over volume, creating both the room and the incentive for true team-based care. Second, we must eliminate the term “unskilled” for jobs without formal degrees, creating viable career pathways so these workers get the respect and reward they deserve.