Workforce Shortage Solutions

The health care industry is currently facing a severe workforce shortage. Coupled with the increased challenges of inflation, hospital closures in rural areas and increased pressure and burnout among workers, the shortage is causing industry leaders, health care educators and the business community to look for ways to fill the gap.

There are currently 20% fewer staffed beds in hospitals nationwide today than in August 2020, and more than 130 rural hospitals have closed since 2010. In West Virginia, hospitals have a capacity of 6,700 beds, yet in August 2022, only 4,750 of those were staffed, according to Jim Kaufman, president and CEO of the West Virginia Hospital Association.

“When rural communities lose a hospital, they struggle with convincing other businesses and families to live in rural communities following its loss,” says Jared Phalen, attorney at Dinsmore & Shohl LLP’s Charleston office. “Additionally, businesses that work adjacent to or in connection with rural hospitals, such as food, laundry services and construction, also find it harder to maintain viability after losing one of their main business partners.”

West Virginia is also facing shortages among primary care, mental health, emergency medical services, nursing staff, dental health professionals and technician roles, mostly impacting low-income and vulnerable areas in the state, according to Cynthia Persily, Ph.D., vice chancellor for health sciences at the West Virginia Higher Education Policy Commission (WVHEPC).

While about 20% of Americans live in rural areas, nearly one-tenth of physicians practice in them, and the government projects a shortage of more than 20,000 primary care physicians in rural areas by 2025, according to Phalen.

“Workforce shortages can increase the wait time to be seen for a health problem, decrease access to services—especially in rural areas—and strain the existing systems, such as emergency rooms when patients cannot access care for chronic conditions in their local areas,” Persily says. “If patients cannot access care due to workforce shortages, their conditions can worsen until untoward events occur.”

To maintain quality of care, hospitals have had to shift how they offer services, prioritizing emergency responses over scheduled treatments, which significantly impacts those whose care was delayed and increases work for the staff left, leading to stress and burnout.

Leslie Bicksler, vice president of human resources at the West Virginia School of Osteopathic Medicine (WVSOM), explains that while physicians are often driven by a sincere desire to help their patients, many factors result in physician burnout or a desire to seek employment outside of the state, including benefits and pay that are not competitive, a poorly trained or insufficient workforce, inefficient technology and entities that dictate by cost.

“We can increase physician retention in West Virginia by systematically addressing these issues with a team approach, giving physicians a seat at the table as we address complex multisystem issues,” Bicksler says.

Kaufman also says that insurance providers are another challenge on an already complex issue. Public Employee Insurance Agency (PEIA) covers 230,000 West Virginians; however, the insurance pays out-of-state hospitals five times more than in-state hospitals for the same services—putting West Virginia providers at a disadvantage because out-of-state providers can offer higher pay to workers.

“While we are increasing the pipeline of health care professionals, we need to ensure we keep them in West Virginia with the ability to offer fair compensation, which leads back to payment issues and more specifically the need for PEIA to pay West Virginia hospitals similar to how they pay out-of-state hospitals,” Kaufman says.

Organizations and providers throughout the state are working to address the impacts of the current workforce shortage. Hospital mergers—or the combining of hospitals or hospital systems—including the recent Vandalia Health merger, provide benefits to both health organizations and the patients they serve.

“Mergers enable hospitals to improve clinical care, lower costs, upgrade facilities and offer new and higher quality services,” Kaufman says. “Hospitals and health professionals have long worked to improve patient outcomes and lower provider costs by reducing fragmentation in the delivery of health care. Mergers can be the most effective means to accomplish these goals.”

New facilities, including the WVU Medicine Children’s Hospital, have opened, meaning West Virginians can now access care in-state rather than having to travel to larger areas.

“The new WVU Medicine Children’s Hospital will not only allow services that previously went to Pennsylvania, Ohio or Maryland to stay in West Virginia, making it easier on families, but it will help grow services that will in turn help recruit providers and researchers, which translates into greater opportunity in the future,” Kaufman says.

The state’s three medical schools are focusing on addressing this issue through training and resources.

For example, the Marshall University Joan C. Edwards School of Medicine has established programs focused on creating a clear pathway to medical school for West Virginia’s top-performing high school students, minority students and Marshall undergraduates.

The school has nearly doubled its residency and fellowship positions. As of July 2022, there are 260 residents and fellows training in 25 different specialties at the university—the most in the school’s 40-year history. This year, nearly half of the school’s graduating class was matched to residency programs in West Virginia.

“This is significant because we know that physicians who train here are more likely to ultimately practice here,” says Bobby Miller, M.D., interim dean at Marshall University Joan C. Edwards School of Medicine.

The West Virginia University (WVU) School of Medicine offers the largest quantity and specialty variety of graduate medical education training opportunities in the state, currently offering more than 55 Accreditation Council for Graduate Medical Education-approved residency programs and fellowships.

At WVSOM—the state’s largest medical school—nearly 200 new physicians graduate each year, and, as of 2019, 850 graduates were practicing in West Virginia, according to President James Nemitz, Ph.D.

“We know there’s a scarcity of health care workers in the state; in fact, it’s one of the reasons WVSOM was created,” Nemitz says. “Fifty years ago, our founders recognized a growing need for doctors in West Virginia, and the school has worked hard to live up to the expectations established by those visionary medical leaders.”

Keeping Physicians in West Virginia

West Virginia has the highest ratio of medical students per 100,000 people in the nation, according to a 2022 report from the Association of American Medical Colleges. However, many of those students complete residencies outside the state, and physicians tend to stay within a 100-mile radius of where they complete their residency.

In an attempt to support and increase the rural workforce in the state, programs like WVU Medicine’s Rural Scholars Program and Marshall University’s Rural Health Initiative are aiming to place interested physicians in rural areas.

WVSOM prioritizes admissions of rural students and requires students to work in rural settings for part of their clinical training. WVSOM’s Rural Health Initiative program allows students to participate in an enhanced rural and underserved primary care curriculum that addresses the specific health challenges often accompanying rural industries. The initiative offers the Rural Physician Scholar­ship Program to students who are committed to serving in underserved areas of the state.

The Choose West Virginia Practice Program offers nonresident West Virginia medical students a tuition waiver for the cost difference between in-state and out-of-state tuition. Recipients of this opportunity must agree to practice in a primary care or shortage specialty in the state for at least one year.

The U.S. Department of Health and Human Services Health Resources and Services Administration awards the National Health Service Corps Scholarship to students pursuing a career in primary health. Recipients commit to practicing in a community with limited access to care for one year of service for each year the scholarship is awarded, with a two-year minimum commitment.

Many experts agree that an important part of encouraging physicians to practice in West Virginia is loan repayment.

“Communities could also look for ways to incentivize physicians to commit to practicing in that area with programs that offer loan forgiveness or loan repayment based on serving a certain number of years in the area,” says Norman Ferrari, M.D., chief academic officer for physician medical education and vice dean at the WVU School of Medicine. “This could potentially help with the redistribution of workforce with the hope that when those years of service are complete, the physicians continue to practice in these communities where they’ve put down roots.”

Miller says it’s important when recruiting physicians to the state to highlight all that the community has to offer in terms of lifestyle and family.

“It’s just as important that we showcase all that West Virginia has to offer so that the entire family can picture a life here,” Miller says.

Additionally, the state has implemented programs to help address health care challenges that impact the workforce shortage, including an expansion of training opportunities and financial support for hospitals.

Governor Jim Justice launched the Saving Our Care initiative in September 2021 to provide staffing assistance and financial help to hospitals and long-term care facilities. In 2022, the governor invested in the nursing workforce and emergency medical services expansion projects to expand training opportunities, increase retention and provide incentives to attract new providers to the state. Through funding from the nursing workforce initiative, the West Virginia Board of Nursing launched an online early career nurse support group to facilitate resilience and prevent early exit from jobs.

Additionally, the National Governors Association, Office of the Governor, West Virginia Development Office and WVHEPC are participating with 14 other states to share health care workforce best practices.

“With a focus on nursing, physicians, direct care workers and the behavioral health workforce, we are learning from other states and adapting strategies to our own needs,” Persily says. “Collaboratives like these allow us to accelerate our learning and the implementation of strategies in our state.”

In 2016, West Virginia broadened the legal scope of practice for nurse practitioners and in 2021, the governor signed into law Senate Bill 714, allowing more physician assistants to find a physician to partner with so they can operate a rural clinic.

“The goal of these pieces of legislation is to allow health care workers who are not physicians to open practices in rural areas and provide services that they are qualified for such as preventive care and yearly checkups,” Phalen says.

Miller says it isn’t only up to the health care industry to address these issues and increasing awareness needs to start young.

“Truly addressing the labor shortage is not something that happens in isolation—it’s K-12, higher education, professional schools, businesses and community organizations coming together to ensure that West Virginia children know what opportunities are available to them and understand the path to reach their goals,” Miller says.

Kaufman says that every sector of the health care industry—down to the patient—needs to do what it can to address the state’s current health care challenges.

“Because of hospital staff shortages, we need everyone to do their part and ensure we make the best use of limited resources,” Kaufman says. “Everyone making efforts to improve their own health long-term is also needed. As our population ages and there are limited health care professionals, we all need to do our part.”