Supply and Demand for Nurses Essay Paper

SHORTAGE OF PHYSICIANS

Many health specialties, including oncology, currently report a shortage of physicians. Despite an expected 21 percent increase in medical school enrollments between 2002 and 2012, the number of residencies has only increased 8 percent over the past 5 years (Salsberg et al., 2008). Dr. Bajorin, in particular, stressed the increasing lack of general surgeons who are involved in cancer care. Significant numbers of surgeons are subspecializing. Supply and Demand for Nurses Essay Paper    According to a 2005 survey of surgical residents, over 50 percent planned on pursuing subspecialty training, and only 15 percent planned on entering the workforce as a general surgeon (Incorvaia et al., 2005). Liability issues have also been problematic for general surgeons, who are confronting high insurance premiums. This is especially true in states that do not cap financial awards of malpractice lawsuits, which leads to physicians altering or limiting their practice due to the threat of being sued (MMS, 2007; Thorpe, 2004).Supply and Demand for Nurses Essay Paper

Using a methodology for making projections developed by the Health Resources and Services Administration, Mr. Salsberg and his colleagues projected that by 2025 there will be a shortage of between 124,000 and 160,000 full-time physicians, after considering a variety of scenarios for future supply and demand (see Figure 1) (AAMC, 2008). Even with an expansion of graduate medical education (GME) training positions, the demand will still exceed the supply of physicians in this model (see Figure 2). “We could have a terrible crisis,” said Mr. Salsberg.Supply and Demand for Nurses Essay Paper

Mr. Salsberg added, given that the expected shortage of physicians is not likely to be substantially relieved by newly trained physicians alone, it is important to think about strategies that will ensure access to quality care. “As the difference between supply and demand grows, people will lose access to needed services, and both care and quality can drop. The other reality is that underserved communities are likely to feel the shortage the most because the wealthy communities are clearly likely to outbid poor communities for limited resources,” he said.Supply and Demand for Nurses Essay Paper

SHORTAGE OF NURSES

The current and predicted future shortage of nurses is also problematic. Dr. Peter Buerhaus, the Valere Potter Distinguished Professor of Nursing and Director of the Center for Interdisciplinary Health Workforce Studies, the Institute for Medicine and Public Health, Vanderbilt University Medical Center, reported that there is an ongoing shortage of nurses that began in 1998. This is the longest lasting shortage of nurses in over half a century, and was sparked by a lack of supply (i.e., too few nurses entering the workforce) rather than by an increasing demand for nursing services. Supply and Demand for Nurses Essay Paper  In 2002, the vacancy rates for nursing positions were as high as 13 percent, and currently are estimated to be roughly 8 percent or lower (AHA, 2007; Buerhaus et al., 2005b). The Bureau of Labor Statistics data predicts that close to a million new nurses will be needed over the next decade, both to fill new jobs and to replace vacancies resulting from retiring nurses (see Figure 3) (Martiniano, 2008).Supply and Demand for Nurses Essay Paper

However, Dr. Buerhaus stated that he expects nurse vacancy rates to drop with the current economic slump, based on his analyses of the registered nurse (RN) labor market. He discussed a number of trends in RN employment, including the fact that higher wages usually induce more RNs to enter the workforce and work longer hours. In addition, a bigger stimulus for RNs entering the workforce is what he called the RNs’ “household wealth,” which is driven largely by the nurses’ spouses’ earnings. Since three out of four RNs are married, changes in RNs’ spouses’ economic well-being can greatly impact RNs’ decisions to enter or leave the workforce (Buerhaus et al., 2007b).Supply and Demand for Nurses Essay Paper

When overall employment and earnings are up in the United States, nurses tend to work fewer hours or retreat altogether from the workforce. However, when there is high unemployment, RNs are more inclined to work, and to work long hours. “As this economy continues to unravel, and if unemployment goes up, which most economists are predicting, you’re going to have another surge of RN employment eliminating whatever excess capacity there is,” Dr. Buerhaus said.Supply and Demand for Nurses Essay Paper

The elimination of the current nursing shortage, due to the poor economic situation, does not mean the nursing shortage crisis is solved, Dr. Buerhaus cautioned. There are many long-term factors that suggest that the supply of future nurses is inadequate and faces potential problems. These include the fact that many currently practicing nurses are older and that there is an increasing proportion of foreign-born nurses who U.S. hospitals sponsor on work visas. In 2012, the largest age group of RNs will be between 50 and 60 years old (Buerhaus et al., 2008).Supply and Demand for Nurses Essay Paper   Many of these older nurses are expected to retire by 2025. The older nurses that remain will have experienced years of lifting and pulling patients, and other physical strains that are likely to foster frequent injuries. The long recovery periods required for healing these types of injuries will further decrease nurse workforce supply, according to Dr. Buerhaus. As a result, Dr. Buerhaus predicts the supply of nurses will increase for the next several years, but starting around 2015, when many nurses opt for retirement, the supply of nurses will level off. He projects a shortage of 500,000 full-time nurses in 2025 (Buerhaus et al., 2008).Supply and Demand for Nurses Essay Paper

The predicted shortage of nurses developing midway through the next decade will probably foster an increasing number of foreign-born and -educated RNs, Dr. Buerhaus pointed out. This can be problematic and affect the quality of nursing care as nursing errors and mistakes are often related to failures in communication. Although foreign-born nurses may pass an English language test (i.e., TOEFL—Test of English as a Foreign Language), they may not detect cultural nuances and nonverbal cues. However, Dr. Buerhaus added that there are no data to document that this is a problem. Currently, foreign-born and -educated RNs comprise 15 percent of the nursing workforce in the United States (Buerhaus et al., 2008). Supply and Demand for Nurses Essay Paper  Dr. Buerhaus suggested that researchers should explore how increasing this number may affect the quality of care. Ms. Pamela Malloy, the End-of-Life Nursing Education Consortium Project Director at the American Association of Colleges of Nursing (AACN), added that the evidence does show that foreign-born nurses who do not have English as their primary language do not tend to do well on the state board exams.Supply and Demand for Nurses Essay Paper

Contributing to the shortage of nurses is a lack of faculty to train them. For example, to be qualified to teach nursing at the undergraduate level, a Masters in Nursing is required. Dr. Kathi Mooney, Professor at the University of Utah College of Nursing, noted that the AACN data indicate that there were over 40,000 qualified applicants to colleges of nursing denied admission in 2007. The primary reason cited for such denials was a faculty shortage. A recent AACN survey also found that 85 percent of nursing schools have faculty vacancies or need more faculty members but do not have a budget to pay them (AACN, 2007). Most openings for nursing faculty are for doctoral candidates. Despite the need for Ph.D. nursing faculty, the 2007 Ph.D. enrollment in nursing was up by less than 1 percent from pervious years (AACN, 2008b).Supply and Demand for Nurses Essay Paper

Convincing nurses to pursue Ph.D. degrees is difficult, Dr. Mooney noted, because doctorate- or even masters-level prepared nurses in clinical positions can earn a significantly higher salary in health care administration or as nurse practitioners (NPs) than they can as faculty. Other reasons cited for a lack of nursing faculty in the AACN survey were difficulties in finding faculty with the right qualifications or specialty mix, and problems finding faculty willing or able to conduct research (AACN, 2007). Also a substantial contributor to the shrinking of nursing faculty is the aging of current nursing professors. The average age of doctorate-level faculty in nursing is 53.5 years, whereas the average age of doctorate-level faculty holding the rank of professor is 59 years (AACN, 2008a). Compounding the problem is the fact that nursing faculty tend to retire early, with AACN data showing 62.5 as the average age of nursing faculty retirement (see Figure 4) (Berlin and Sechrist, 2002).Supply and Demand for Nurses Essay Paper

SHORTAGE OF ALLIED HEALTH CARE PROFESSIONALS

Dr. Michael Ahearn, Dean of the University of Texas M. D. Anderson Cancer Center’s School of Health Sciences, presented data to show that laboratory and radiology technicians (the allied health care workforce) also face a current and future workforce shortage, and the shortage may be even greater than the shortage of physicians and nurses detailed by others. In 2001, Tommy Thompson, Secretary of the U.S. Supply and Demand for Nurses Essay Paper   Department of Health and Human Services (HHS), declared that the shortage of allied health care workers was a greater menace to the delivery of health care than the well-publicized nursing shortage (Hillborne, 2008). He added that Edward O’Neil, the Director of the Center for Health Professions, claimed that “as important as shortages in nursing, pharmacy, medicine, and even dentistry might become, they will fail to reach the depth of the looming crisis in the allied health workforce” (Center for the Health Professions, 2008).Supply and Demand for Nurses Essay Paper

Allied health professionals compose 60 percent of the health care workforce, and despite this large number, laboratories nationwide are experiencing a shortage of qualified technologists (Health Workforce Solutions, 2007; Passiment, 2006). The Bureau of Labor Statistics projects that by 2015, the United States will need 81,000 additional clinical laboratory technologists to replace retiring staff, and another 68,000 to fill newly created positions (see Figure 5) (Hillborne, 2008). With fewer than 4,700 current graduates from combined laboratory science programs, the number of annual graduates will have to be increased three- to four-fold to meet the estimated demands in these professions, Dr. Ahearn noted.Supply and Demand for Nurses Essay Paper

Unfortunately, there are inadequate numbers of allied health care education programs. Between 1970 and 2005, there has been a significant decline in both the number of education programs for health technologists as well as the number of graduates from such programs in the United States. A 70 percent decline in the numbers of health technology programs in the United States since 1975 has left only 240 operational at the present time, according to Dr. Ahearn. This is an insufficient number to train the rapidly retiring workforce (Anderson, 2007). The American Society for Clinical Pathology claims that the laboratory personnel labor force is aging 78 percent faster than the general U.S. labor market, because the pace of younger, newly trained, laboratory personnel entering the workforce has slowed significantly (ASCP, 2004).Supply and Demand for Nurses Essay Paper

In addition, currently there are fewer than 40 accredited cytotechnology training programs in the United States (ASCP, 2008), graduating fewer than 270 technologists annually. This number falls far short of even replacing the attrition rate reported for this particular profession. Similarly, there are only six cytogenetic technology training programs in the nation, and they graduate fewer than 41 students annually. Despite the expanding role that molecular genetic technology is playing in both diagnostic clinical and research laboratories, at the present time, there are only 6 accredited genetic technician academic programs in the United States, with an annual output of 60 graduates (NAACLS, 2008). Also, listed on the “endangered list” of allied health professions are baccalaureate degree programs in diagnostic imaging, radiation therapy, and health dosimetry, Dr. Ahearn noted (JRCERT, 2009).Supply and Demand for Nurses Essay Paper

There also will be a shortage of imaging technologists soon. Despite the increasing complexity of imaging procedures, which has created a demand for better-prepared technologists, the American Society of Radiologic Technologists reports that if the current academic enrollment, attrition, and graduation levels remain constant, there will be a 14 percent shortage of even entry-level imaging personnel by as early as 2012 (ASRT, 2005). Additionally, there are only 6 accredited academic health dosimetry programs in the nation, with a total annual output of only 55 graduates, which means that all of the other dosimetrists are trained on the job with variable levels of instruction, Dr. Ahearn said (JRCERT, 2009).Supply and Demand for Nurses Essay Paper