As a nation, we are faced with a critical health care worker shortage that needs both immediate and long-term solutions. Everyone is affected by healthcare: as citizens whose health and that of our loved ones is affected by how well our healthcare system is functioning; as healthcare staff who are facing increasing levels of burnout and lack of motivation to work within a broken system; as healthcare administrators whose job it is to optimize resources to ensure that patients receive comprehensive and equitable care and that healthcare workers receive the support they need to thrive in a safe working environment; to legislators whose job it is to create practices and policies that allow the healthcare system to achieve these goals.

1. The Workforce of the Future as it Applies to the U.S.
Healthcare System
Ben Frasier – July, 2022
Context
As a nation, we are faced with a critical health care worker
shortage that needs both immediate and long-term solutions.
Everyone is affected by healthcare: as citizens whose health
and that of our loved ones is affected by how well our
healthcare system is functioning; as healthcare staff who are
facing increasing levels of burnout and lack of motivation to
work within a broken system; as healthcare administrators
whose job it is to optimize resources to ensure that patients
receive comprehensive and equitable care and that healthcare
workers receive the support they need to thrive in a safe
working environment; to legislators whose job it is to create
practices and policies that allow the healthcare system to
achieve these goals.
It is an erroneous assumption that the overwhelm and stress
of the COVID-19 pandemic created the problems in our
healthcare system. What the pandemic did was exacerbate
existing problems and provide stakeholders with an
opportunity to examine areas of weakness so that we can
address them before the situation worsens.
The current climate in many hospitals and clinics in the U.S. is
dire. In addition to staff being overworked and overwhelmed,
a short-term solution many facilities have adopted has been
hiring traveling nurses. Traveling nurses are often paid as
much as 10x their local counterparts, exacerbating a climate of
feeling underpaid and underappreciated on the part of the
nursing workforce who feel the resources should be used to
improve working conditions for local staff and further
deteriorating an already delicate climate of mistrust among
hospital staff and administrators as narrated in a widely
watched interview with nurses with NY Times reporters.

2. Healthcare workforce shortage background in numbers

4. An approach to healthcare workforce shortage
The focus of this paper will be on the effects of unfavorable healthcare workforce demographics, legislation and hospital policies,
combined with an aging population that has created pressure to fulfill critical skill sets within our healthcare system and explore
solutions to the current healthcare crisis in the U.S. through four main pillars: 1) technology; 2) administrative measures; 3) credentials
and licensing and; 4) legislature.
Pillar synopsis
I. Technology can address shortages, relieve practitioner burnout and improve patient care particularly in underserved
populations through telemedicine, virtual hospitals and robotics.
II. Administrative measures can address healthcare worker job satisfaction through increasing diversity in the healthcare
workforce offering flexible hours, increasing the range of health care worker wellness programs to include PTSD from the
Covid-19 pandemic and establishing and adhering to ideal nurse/patient ratios.
III. Lack of credentialed workers can be addressed through micro-credentialing, loosening restrictions on international
healthcare professionals who wish to practice in the U.S and addressing the physician shortage.
IV. Legislative measures can be taken to adopt a holistic approach to wellness through public education, increasing access to
affordable health care and making the pandemic reimbursements permanent.

5. Solutions to the Healthcare Workforce Shortage in the U.S.
I. Technological solutions
The solution Background and benefits Implementation challenges and models
Telemedicine and
Virtual hospitals
• 2 in 3 clinicians reported that they prefer
virtual-only or hybrid treatment settings. This is
a big jump from before the pandemic. (7)
• Patients are onboard as well with 88% of
Americans stating that they would prefer to
keep telehealth as an option even after the
pandemic is over. (8)
• Virtual hospitals can stem the doctor shortage,
particularly in rural and underserved areas,
allowing for physician-led treatment in areas
where many patients often don’t get to see a
general practitioner.
• 76% of clinicians think virtual care should be
taught in medical school and advanced nursing
programs. (7)
• 63% of clinicians believe that virtual primary
care will surpass in-person care within five years
(2027) (7)
• Inconvenient or unreliable transportation can
interfere with consistent access to health care,
potentially contributing to negative health
outcomes. Studies have shown that lack of
transportation can lead to patients, especially
those from vulnerable populations, delaying or
• Virtual hospitals are a great solution in theory,
but in reality, there are a number of potential
downsides and challenges to implementation
such as:
o Patient access to and ability to use the
necessary technology (wifi, messaging
platforms, video platforms and apps)
o The need to have on-site technical
support and training for health care
staff.
o Patients relying on virtual care when a
personal visit is needed. (10)
• A survey of 400 doctors and nurses, 46%
said they felt inadequately trained in virtual
care. (7)
• A study by University of Texas MD
Anderson Cancer Center (MDACC) and
Texas A&M University’s Mays Business
School lays out a comprehensive blueprint
on how to successfully implement virtual
care practices through DIBS
(Documentation, Integration, Best Practices
and Support). (11)

6. skipping medication, rescheduling or missing
appointments, and postponing care.
Transportation barriers and residential
segregation are also associated with late-stage
presentation of certain medical conditions (e.g.,
breast cancer). (9)
Robotics • A number of studies reveal that robotics reduce
surgeon fatigue, preventing burnout among
surgeons and reducing risk to patients.
• In 2019, 60% of non-metropolitan counties in
the US were without an active general surgeon.
Teleoperated robotics could fill in the gap and
increase healthcare equity in underserved
populations.
• The majority of nursing home and assisted living
communities in the U.S. are short-staffed and
unable to successfully recruit needed staff to fill
their ranks. Robotic work aides can perform
tasks such as fetching equipment, transporting
medication and specimens, transferring patients
between beds, chairs, toilets and showers.
• Robots can also be effective in providing
conversation and companionship to stem the
effects of loneliness and isolation and promote
well-being.
• Studies have shown how robotic assistants in
nursing homes in Japan, the nation with the
• The challenges of adopting robotics lie
primarily with the cost. They are still an
expensive solution.
• In Japan, legislators implemented policies
to stimulate innovation in the area of
medical robotics and incentives to hospitals
and care facilities who adopted them. (12)

7. largest percentage of elderly population in the
world, have filled in gaps in the healthcare
workforce, and increased the ability of nursing
home administrators to offer flexible contracts
to nursing staff, reducing burnout and
increasing retention overall. (12)

8. II. Administrative solutions
The Solution Background and Benefits Implementation challenges and models
Increase staff
diversity at all levels
Diversity, Equity and Inclusion (DEI) has become a
buzzword for employers and DEI related job postings
increased from May to September 2020 by 123%. (13)
However, there’s distance to go from a buzzword to an
integrated approach to staffing.
• Males comprise only 9.4% of registered
nurses, but 49% of U.S. population
• Whites comprise 80.6% of nurses, but
only 60% of the U.S. population
According to the Association of American Medical
Colleges:
• Females comprise only 36% of physicians,
but 51% of U.S population
• Blacks comprise only 5% of physicians,
but 13% of U.S. population
• Hispanics comprise only 6% of physicians,
but 19% of U.S. population
• Whites comprise 75% of Nurse
Practitioners, Physical Therapists and
Occupational Therapists, but only 60% of U.S.
population
• Harvard .H. Chan School of Public Health
published an article that encourages health
care centers to consider the following
factors around integrating a more diverse
work culture:
1. Understand the mission and purpose of
the organization, and the mission and
purpose of the office within that
framework. Make sure to ask: Why are
we doing this work? And how does it
actually impact our organization?
2. Consider the metaphorical “seat at the
table” of this person or group. How do
they integrate into the rest of the
leadership structure? Is there an
identified place for them? Do they have
a voice and authority? Are they able to
make policy changes? How much
autonomy do they have?
3. Think about how organizational
infrastructure can support these
changes. What does the rest of the
organization look like? How are changes
implemented? Is there a long-term plan

9. Disparities in healthcare outcomes by ethnicity are
unfortunately a real problem. For
examples, studies have shown that:
• African-American women with breast
cancer are 67 percent more likely to die from
the disease than are Caucasian women.
• The mortality rate for African-American
infants is almost 5 times greater than it is for
white children.
• Hispanic and African American youth are
substantially more likely to die from diabetes
than white populations.
• Even when controlling for access-related
factors, such as patients’ insurance status and
income, some racial and ethnic minority
groups are still more likely to receive lower-
quality health care.
It can be inferred that one of several reasons for these
disparities may be tied to a lack of diversity in
healthcare. According to a report by the U.S.
Department of Health and Human Services:
• Hispanic populations are significantly
underrepresented in all of the occupations in
Health Diagnosing and Treating Practitioners
occupations.
• Among Non-Hispanics, Blacks are
underrepresented in all occupations, except
among Dieticians and Nutritionists (15.0
percent), and Respiratory Therapists (12.8
percent).
(and financial resources) to sustain DEI
work? Is there a culture change that
should occur as a part of this work to be
multiculturally supportive?
4. Define what success looks like. What
are the easy, short-term wins that can
help demonstrate that this work is
worth doing—and what are the
medium-to-long-term goals? If these
efforts are not working, what changes
need to be made and how?
5. What resources are available? How
much is the organization investing in DEI
initiatives? (13)
• Provo College’s diversity piece offers proof
that wherever diversity is encouraged and
cultivated, businesses (hospitals included)
perform significantly better:
• A study by the firm McKinsey and
Company entitled “Why Diversity
Matters” found that gender-diverse
companies are 15% more likely to
outperform those non-gender-diverse
companies, and ethnically diverse
companies are 35% more likely to
outperform companies with minimal
diversity.

10. • Asians are underrepresented Speech–
Language Pathologists (2.2 percent), and
Advanced Practice Registered Nurses (APRN)
(4.1 percent).
• American Indians and Alaska Natives are
underrepresented in all occupations except
Physician Assistants, and have the lowest
representation among Physicians and
Dentists (0.1 percent in each occupation).
(14)
• Diversity even has an effect before a
medical worker enters the field. Studies
have shown that students who study
within a diverse student body and faculty
make better doctors.
• “We argue that student diversity in
medical education is a key component in
creating a physician workforce that can
best meet the needs of an increasingly
diverse population and could be a tool in
helping to end disparities in health and
healthcare,” said coauthor Paul Wimmers,
an assistant professor at the David Geffen
School of Medicine at UCLA.
• There are also findings that support the
position that racial diversity in higher
education is associated with measurable,
positive educational benefits. (14)
Offer flexible
scheduling
• 50% of clinicians said the number one thing they
would change about their jobs was the
administrative burden The second most cited
change was flexible work schedules (29%) Both
of these complaints reflect a high valuation on
time as a factor in job satisfaction. (7)
• The majority of health care workers who report
feelings of burnout are in the early stages of their
careers (ages 30-39) and women are twice as
likely to report burnout as men. (15)
• A comparison study for flexible and
standard scheduling published by
ScienceDirect revealed that 55.4% of care
providers who were given flexible
scheduling reported greater work
satisfaction, 50% reported experiencing
better quality of life and significant
improvement in perception of control over
workload and work-related stress as

11. • The pandemic response has been gender-
regressive with many women shouldering the
burden of at-home childcare and household care
duties. Flexible scheduling contributes to
attracting and keeping female workers who may
be juggling childcare and work. (16)
• Flexible scheduling empowers healthcare
workers to find better work/life balance,
contributing to higher job satisfaction and
retention. (15)
compared to those with standard
scheduling. (15)
• In the UK, the NHS People Plan for 2020/21
included flexible work scheduling as
imperitive to retaining staff, with dozens of
studies cited to the benefit of flexible
scheduling for several categories of
healthcare workers: “To become a modern
and model employer, we must build on the
flexible working changes that are emerging
through COVID-19. This is crucial for
retaining the talent that we have across the
NHS. Between 2011 and 2018 more than
56,000 people left NHS employment citing
work-life balance as the reason. We cannot
afford to lose any more of our people.” (16)
Ramp up health care
worker wellness to
include PTSD
programs
• Hospitals and healthcare centers are way ahead
of the curve as compared to other industries in
terms of adopting wellness and stress-resilience
programs for staff members including practices
like mindfulness, yoga, meditation and other
stress-reducing practices and this was true
before the pandemic. Here are stats from a 2017
Workplace Health in America Survey conducted
by the Center for Disease Control:
• In order to get health care workers that left
the field to come back and to retain those
who stayed, hospitals need to dedicate
resources to giving them the support they
need including wellness programs that
focus on preventing burnout and
addressing PTSD.
• In response to the elevated stress on
healthcare workers of the Covid-19
pandemic, Mount Sinai opened a Center for

12. o 83% of hospitals in the United States provide
workplace wellness programs, compared to
46% of all employers.
o 63% of the hospitals offer health screenings,
also known as biometrics, compared to 27%
of all employers.
o 31% of the hospitals provide health coaches,
compared to 5% of all employers.
o 56% of the hospitals have stress-
management programs, compared to 20% of
all employers.
o 55% of the hospitals offer counseling to help
employees stop smoking, compared to 16%
of all employers. (17)
• The pandemic created exponential stress levels
among healthcare workers that needs to be
addressed in kind to retain staff and stem the
drain. Factors such as handling empathy fatigue,
managing covid misinformation, and combating
patient mistrust as well as witnessing high rates
of mortality and being continually understaffed
have caused thousands of healthcare workers to
leave their jobs:
33 percent of clinicians see burnout as the most
significant threat to healthcare organizations,
more so than financial issues (28%) or staffing
shortages (20%) (7)
Stress, Resilience and Personal Growth.
Dennis S. Charney, MD, the Anne and Joel
Ehrenkranz Dean of the Icahn School of
Medicine at Mount Sinai and President for
Academic Affairs for the Mount Sinai Health
System had this to say about the program’s
goals:
“…We estimate 25 to 40 percent of first
responders and health care workers will
experience PTSD as a result of COVID-19.
The success of this program in
understanding and addressing PTSD among
Mount Sinai’s health workers will inform
future efforts to refine, scale up, and adapt
to care for our patients and their families in
the communities we serve but also to
better support health professionals at
institutions throughout our nation and the
world,” Dr. Charney says. “Ultimately, we
hope it becomes a model for enhancing
psychological resilience in frontline health
care workers exposed to COVID-19, thus
ensuring that health care systems nationally
and internationally continue to deliver
outstanding patient-centered care
whatever challenges the future may bring.”
(18)

13. Establish and adhere
to nurse staffing
minimums
• There is a direct correlation between nurse
staffing and patient mortality. Each one patient
added to a nurse's workload is associated with a 7
percent increase in risk-adjusted mortality following
general surgery. (19)
• In addition to compromised patient care, when
nurses’ patient load is too high, it causes undue
stress on them as they have to make critical
decisions about which patients to attend to and
in what order where an error in judgement or
inability to get to a patient on time can result in
patient death. Zo Schmidt, a registered nurse in a
medical-surgical unit at Kansas City’s Research
Medical Center, said the hospital increased the ratio
of patients to nurses from 4-to-1 to 6-to-1 early in the
pandemic, which has had dire consequences for some
patients. “I know there are patients who are alive
now because I had four patients that day, who I don’t
think would be alive if I had six.” (20)
• The logic that hospitals use for creating high
nurse/patient ratios is to cut costs. In fact,
understaffing increases hospital costs. When
patient care is insufficient, it may result in
extended patient stay, additional treatments or
surgeries, readmissions and other complications
that end up adding more costs and
• Hospital administrators need to win back the
trust of patients and health care workers by
establishing and honoring minimal
nurse/patient staffing requirements. A study by
JAMA Surgery showed that hospitals who
establish and adhere to ideal minimal
nurse/patient ratios produce better patient
outcomes for the same or less than hospitals
with high nurse/patient ratios with 40% less
patients being admitted to costly intensive care
units. (19)
• As of March 2022, 16 states currently
address nurse staffing in hospitals through
either laws or regulations:
o Hospital-based: Eight states with
committees comprised of at least
50% direct care nurses: CT, IL, NV,
NY, OH, OR, TX, WA. One state
where a Chief Nursing Officer
develops a core staffing plan: MN.
o Nurse to patient ratios/standards.
Two states: CA, MA
o Disclosure and/or reporting
requirements. Five states: IL, NJ, NY,
RI, VT (21)

14. compromising both staff and patient well-being.
(19)

15. III. Credentialing solutions
The Solution Background and Benefits Implementation challenges and models
Make use of micro-
credentialing • The shelf life of current skill sets is about 5 years
or less
• We have been overly focused on top-of-license
issues, and now we have lost critical help at the
LPN & lower technician levels
• The pandemic curbed nursing school
enrollments
• There are not enough instructors for nursing
programs
• Micro-credentialing can address many of these
issues:
o Micro-credentialing addresses critical skills
gaps for health care workers.
o It also takes the onus off health care
organizations to invest in training for
employees who may then leave to join
another organization.
o It creates a culture of continuous learning
that can prevent organizations from
perpetually struggling to fill in shortages of
workers with relevant skills.
• An example of how micro-credentialing can
fill in critical skills gaps at a low cost to the
healthcare worker and can be gained in a
short time period:
In late 2020, The American Association of
Critical-Care Nurses (AACN) launched a
micro-credential for nurses and healthcare
workers providing direct care for critically ill
patients with COVID-19, making it the first
professional nursing organization to offer a
micro-credential.
“Since the onset of COVID-19, nurses have
looked to AACN for best practice
recommendations, clinical guidelines,
staffing models and emotional support. This
micro-credential responds to the need to
validate the knowledge required to care for
patients with COVID-19,” said Connie
Barden, AACN’s chief clinical officer. “As the
coronavirus continues to have a significant
impact, hospitals need well-educated staff
they can trust to provide safe care to
critically ill patients with COVID-19. This
micro-credential will help to substantiate
that knowledge base.”

16. o It empowers health care workers to have
more flexibility in their career paths,
increasing job satisfaction and retention.
o The programs are short (a few weeks or
sometimes less), affordable and workers can
learn in their own time. (22)
• Within the healthcare ecosystem, as jobs
become “hybridized and require multiple skill
sets” it is increasingly important for workers to
possess varied skillsets. Previously individuals
could find success in the workplace as
“specialists,” possessing deep knowledge on
only a narrow scope of topics, or “generalists,”
with a more shallow understanding of a wide
variety of topics. The workplace of the future
demands individuals become “versatilists,”
possessing deep knowledge of a wide breadth
of topics. Micro-credentials allow individuals to
demonstrate competence in a variety of areas,
and to update existing or obtain new skills or
knowledge. (23)
“COVID-19 Pulmonary and Ventilator Care”
micro-credential is a 38-question exam that
is designed to validate the entry-level
knowledge of direct care clinicians who
provide pulmonary and ventilator care to
patients with COVID-19. The test plan for
the exam is based on content from AACN’s
free course “COVID-19 Pulmonary, ARDS
and Ventilator Resources.”
All medical professionals are eligible to take
the online exam in order to receive the
“COVID-19 Pulmonary and Ventilator Care”
micro-credential, which includes:
• Validation by AACN, a trusted provider and
resource.
• No distinct eligibility requirements.
• An online verification tool for current and
potential employers.
Individuals can purchase and complete the
exam online, on their own schedule,
conveniently from a home computer or
mobile device.
“COVID-19 Pulmonary and Ventilator Care”
micro-credential exam fees:
• AACN Member - $30
• AACN Nonmember - $45 (24)

17. Facilitate international
medical graduates to
practice in the United
States
• There are ~270,000 foreign-trained immigrant
healthcare professionals in the U.S. (25)
• 25% of all doctors in the U.S. are foreign-
trained.
• Foreign-trained doctors are more likely to serve
in impoverished and minority communities,
areas that typically lack sufficient physician
staff.
• U.S. immigration policies impede foreign-
trained doctors from legally living and practicing
in the U.S., cutting off a workforce that could
stem hospital shortages.
• Even when living legally in the U.S., foreign-
trained clinicians have to overcome many
obstacles to obtain licensing to practice in the
U.S. Many have to repeat years of coursework
and spend tens of thousands of dollars or more
studying at American institutions in order to
meet the licensing requirements. (26)
• Facing healthcare worker shortages during
the pandemic led to a change in attitude
towards allowing foreign-trained health
care workers to practice in U.S. hospitals:
“A handful of states are easing certain
licensing requirements, creating programs
for foreign-trained doctors to work
alongside U.S.-trained ones, reserving
residency spots for immigrant health
workers and providing help, sometimes
including financial aid, for those working to
get a U.S. license. States hope the efforts
can not only get medical providers to more
places where they are needed—particularly
underserved rural and urban areas—but
also lead to more professionals who speak
the same language as and are culturally
attuned to those they treat in an ever more
diverse America.” (25)
• Indiana recently passed HEA 1003 whose
main objective is to curb the state’s
projected nursing shortage of 5,000 nurses
by 2031. The law will stimulate enrollment
in nursing courses by allowing for more
flexibility for students to complete nursing
courses, including allowing foreign students

18. to complete nursing courses in the state.
(27)
Work on addressing
the physician shortage
• In 2019, the United States had nearly 20,000
fewer doctors than required to meet the
country’s health care needs, according to an
estimate by the Association of American
Medical Colleges, which analyzes the physician
workforce. At the current rate, the group said,
that gap could grow as high as 124,000 by 2034,
including a shortage of as many as 48,000
primary care doctors. “Within the next 10 years,
two of every five physicians in the workforce
will be 65 or older,” said Michael Dill, the
group’s workforce studies director. Meanwhile,
the population also is aging and requiring more
health care. “Just when we need physicians
more, we will have a large cohort of physicians
reaching retirement age,” he said. There aren’t
enough physicians in training to replace them.
(20)
• A popular solution to the physician shortage has
been to utilize physician’s assistants and nurses.
According to the AMA, using nurses rather than
physicians leads to more tests and consultations
than if the patient had been seen by a physician.
This ends up being more costly, rather than
saving money and compromises patient care:
• In addition to facilitating the legalization
and licensing of foreign-trained doctors as
discussed in the box above, there are other
measures that can be taken to expand the
number of practicing physicians in areas
where there are shortages according to a
publication by the AMA:
o Expand GME slots.
o Offer loan forgiveness for practicing
in shortage areas
o Initiate programs that encourage
students from shortage areas to
pursue medical careers.
o Expand the use of telehealth.
• Christine Bishof, MD, said using
teleneurology and telenephrology services
has worked out well at the two Central
Illinois facilities where she practices
emergency medicine: OSF Heart of Mary
Medical Center in Urbana, and OSF Sacred
Heart Medical Center in Danville. “It’s really
been fantastic,” said Dr. Bishof, an AMA
member and speaker of the Illinois State
Medical Society. “It has really improved our
ability to manage patients who need those
consultive services,” she added. “It’s as easy

19. “The AMA is deeply concerned with the notion
that patients in rural and underserved areas,
often a vulnerable and medically complex
population, should settle for care from a health
care provider with a fraction of the education
and clinical training of physicians,” says an AMA
Advocacy Resource Center issue brief, “Access
to Care” (PDF, members only). “All patients,
regardless of ZIP code, deserve care led by a
physician,” the brief adds, noting that
“physician-led care is equitable care.” (28)
as rolling the robot in the room and the
specialists log on, do their assessments, and
they’re able to give us feedback in real
time. I think it’s very viable.” (28)
Implement licensing
that’s valid country-
wide
• Flexible state licensing combined with
telehealth and virtual hospitals allows hospitals
to redistribute healthcare practitioners to areas
where they are needed.
• 58% of health care workers want to be licensed
in more states. (7)
• Many states relaxed licensing requirements
during the pandemic to enable out-of-
staters to practice within their borders. This
not only made it easier for hospitals in need
to fill their ranks with clinicians from areas
that weren’t as severely impacted, but it
also allowed clinicians more flexibility and
mobility. Hochul and Republican Gov. Kristi
Noem of South Dakota want to make those
changes permanent to attract more providers.
Vermont Republican Gov. Phil Scott signed a
law allowing medical providers licensed in other
states to continue telemedicine services for
Vermont patients. And Pritzker and Democratic
Gov. Jared Polis of Colorado have considered
eliminating licensing fees for health care
workers. (20)

20. IV. Legislative solutions
The Solution Background and Benefits Implementation challenges and models
Preventive measures
through public health
campaigns
• As seen with the Covid-19 pandemic, the need
for consistent and humanized information is
paramount to gaining public trust and allow
health care workers to do their jobs,
effectively preventing the spread of infectious
disease. The same is true for public health
messages in general. While the Covid-19
pandemic pushed public health authorities to
utilize non-traditional tools such as AI, apps
and social media to track the disease, answer
questions and spread information, the same
efforts can be made to address public health
issues in non-crisis mode.
• The worst of the workforce resignations have
been in the acute-care setting. Many hospitals
are overwhelmed due in part to ineffective
public health outreach that would prevent
patients from needing acute care.
• In terms of the culture of our health system as
a whole, there is no reward for creating the
absence of disease. Much of our health system
can be summed up as “wait until you get sick,
• Making wellness incentives and programs
part of company cultures on a broader
scale can help to improve employee health
and stimulate healthy lifestyle practices
that prevent disease. (30)
• Expanding wellness and health campaigns
in schools, educating children and families
on healthy lifestyle choices, including diet,
exercise, mental health and wellness are
important measures in preventing disease.
(31)
• The state of Georgia implemented a
program called Growing Fit which offered
comprehensive health education toolkits
and staff trainings to 302 schools to combat
child obesity and promote early childhood
health and wellness. (32)
• Billboards are great, AI is better. Dollars
spent on public health outreach campaigns
can optimize their effectiveness through
the strategic use of AI and personalized

21. then we care for you.” If we can figure out the
wellness side of equation, this may help with
the shortage side of the equation.
• By eliminating behavior-related risk factors, ~
40% of all cancer-related cases and ~80% of all
heart diseases, diabetes and stroke could be
prevented. (29)
messaging, engaging cultural influencers
and understanding behavioral theories. (29)
Increase state funding of
nursing programs
“The average age of employed registered
nurses climbed from nearly 43 to nearly 48 between
2000 and 2018, and nearly half are now over 50,
according to the University of St. Augustine for Health
Sciences in Florida.
The U.S. Bureau of Labor Statistics estimates that
each year through 2030, there will be nearly 195,000
vacancies for registered nurses. The St. Augustine
report says that the profession isn’t producing
registered nurses fast enough to meet the demand.”
(20)
“Several governors, including those in Alabama,
Colorado, Maine, New York and Wisconsin, have
pushed for higher compensation for health care
workers.
In her state of the state address, Democratic Gov.
Janet Mills in Maine cited the state’s investment of
$600 million in state and federal funds to raise
Medicaid reimbursement rates, which would
increase payment to doctors who see low-income
patients. She proposed spending $50 million more.
New York Gov. Kathy Hochul, another Democrat,
proposed making a $10 billion, multiyear
investment in the health care workforce to raise
the Medicaid reimbursement rate, provide
retention bonuses to frontline medical providers
and increase the pipeline of those going into health
care. The New York legislature is discussing an
even higher financial commitment.

22. Governors in Alaska, Georgia, Hawaii, Maine, New
Mexico and Oklahoma proposed expanding
education programs to train more nurses and other
medical providers. Georgia Republican Gov. Brian
Kemp, for example, said he was including millions
of dollars in his budget proposal to train more
nurses and add medical residency slots. Over time,
he said, the goal is to increase the health care
workforce by 1,300.
Alaska Republican Gov. Mike Dunleavy cited a state
grant of $2.1 million to train and retain nursing
faculty.
In Iowa, Republican Gov. Kim Reynolds announced
a new apprenticeship program for high school
students that would enable them to become
certified nursing assistants before they graduated.
Reynolds, Hochul and Democrats J.B. Pritzker of
Illinois and Daniel McKee of Rhode Island pledged
additional scholarships, tuition reimbursement or
loan forgiveness for students training in health
care, particularly for those who stay to practice in
those states.” (20)
Expanding affordable
health care prevents
acute disease
• The Affordable Care Act (Obamacare),
Medicaid, Medicare depend on preventive
care to lower costs.
• Expanding affordable health services like
Medicaid and Medicare works. A Health
Affairs study conducted in 2018 found a
40% increase in diabetes prescriptions

23. • Hospital care accounts for 1/3 of health care
costs in the U.S. (33)
• Affordable healthcare allows more people to
access health care providers for non-acute
problems, giving an opportunity for healthcare
providers to catch conditions early and provide
solutions to prevent the condition from
reaching a critical point that would require
more extensive treatment and hospitalization.
• Affordable access to these and other services
can significantly impact long-term health care
and prevent the onset of acute diseases:
-Annual physicals
-Gynecological visits
-Allergy medications
-Insulin
-Colonoscopies and mammograms
-Screenings for high blood pressure and high
cholesterol
being filled in states that had expanded
Medicaid with no increase found in states
that had not expanded Medicaid. (34)
• According to a 2019 study, Medicaid
expansion was associated with 19,200
fewer deaths among older low-income
adults from 2013 to 2017; 15,600
preventable deaths occurred in states that
did not expand Medicaid.
• Essential health benefits help disabled
people access necessary services. Prior to
the ACA, 45 percent of individual market
plans did not cover SUD services and 38
percent did not cover mental health care.
Following ACA implementation, people with
mental health conditions became
significantly less likely to report unmet
need due to cost of mental health care.
• About one-quarter to one-third of new
enrollees under Medicaid expansion are
children.
• 20 million fewer Americans are uninsured
since the Affordable Care Act was
implemented. (35)
Permanent increase in
public health budgets
• 77% of clinicians believe policymakers should
make the current reimbursement changes that
were created in response to the pandemic
permanent. (7)
• “The pandemic has persuaded and forced
the governments to inject much-needed
funds into the health system. The health
system has seen the allocation of

24. unprecedented amounts of finances that
have the potential to change the whole
outlook of the health system, making it
stronger and more responsive to the needs
of populations. However, the government
needs to create a permanent budget cap
exemption mechanism for public health
functions that are critical to prevent,
detect, and respond to infectious diseases.
This mechanism is a potential road for
stable and increased funding for public
health for the long term.” (36)
Conclusion
There is no quick fix to the healthcare worker shortage and no single solution. A multi-faceted approach that encompasses the major
pillars outlined above can bring benefits to healthcare workers and patients as evidenced in the implementation examples. Likewise,
a solution that solves one problem also indirectly solves others. For example, by facilitating the licensing for foreign-trained healthcare
workers, hospitals can fill their thinning ranks of physicians and incorporate more diversity into their institutions. By focusing on
preventive medicine, we can lower the percentages of acute patients and remove the strain on that overtaxed, understaffed and costly
sector of healthcare. Virtual hospitals and telemedicine make flexible scheduling more feasible, alleviating stress for nursing staff and
increasing access to vulnerable populations. Given the domino effect that one solution can have on others, it’s time we start tackling
some of these issues to improve our healthcare system and support our healthcare workers and patients with the best possible public
health policies, use of available technology, administrative support and revision of an outdated credentialing system. A better
healthcare system equals a better working environment for the workforce of the future.

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