Healthcare workers (image used under license from shutterstock.com)

WPTF Staff

The healthcare workforce ecosystem has seen some improvement in North Carolina, but are changes happening quick enough to meet future demand?  A new workforce report from RTI International shares the latest healthcare employment trends in our state. 

Tatyana Kelly, Senior Vice President of Planning, Strategy and Member Services with the North Carolina Healthcare Association (NCHA), says the Association commissioned RTI International to survey hospitals to assess the current workforce landscape. Workforce shortages existed before the COVID-19 pandemic, but the last few years has seen lingering challenges and added pressures, including exponential growth in labor costs, and a need to use travel nurses to help staff their facilities.

According to the NCHA, hospitals and health systems in North Carolina directly create about 268,000 jobs, support 515,000 jobs and generate $29 billion in wages, salaries, and benefits. The group also says that during the period from October 2022 to October 2023, total healthcare employment increased by 6%, while vacancies dropped by 17%, indicating a positive shift in the workforce landscape.

North Carolina hospitals have increased employment faster than the national average and all neighboring states in the Southeast during the last decade. North Carolina’s hospitals added more than 23,000 jobs between 2012 and 2022, a compound annual growth rate of 1.1%, which was faster than the growth nationwide of 0.8%. North Carolina hospitals grew their staff roughly 50% faster than Georgia, double the pace in Virginia, three times faster than Tennessee, and four times faster than South Carolina.

Nursing and residential care facilities, however, have lost more than 15,000 positions in the last few years — a loss that is more than twice as severe as the national average or any neighboring state.  Ambulatory care services, which means outpatient care, has increased employment since 2012, but at a slower rate than neighboring states. And employment in home healthcare services has declined each year since 2018.

Operational constraints hinder wage increases and benefit enhancements in nursing and residential care facilities – in general, it has been harder for them to compete with wages and benefits that non-healthcare employers offer. 

To help attract and retain workers, hospitals and health systems have not only increased their wages, but they are also offering new benefits to help improve workers’ quality of life, reduce feelings of burnout, and more. Healthcare providers have boosted pay for some frontline occupations to attract and retain talent. 

Wage gains between 2019 and 2022 were faster than the state median for several key healthcare occupations including orderlies, nursing assistants, registered nurses, healthcare support workers, and physician assistants.  There is significant wage competition from other healthcare systems and with employers in the broader private sector, particularly for occupations at the low end of the wage scale. 

Wage competition at the bottom of the income scale has been intense with food service occupations, farming, fishing, and forestry occupations, and personal care and service occupations all seeing stronger wage gains between 2019 and 2022 than healthcare support occupations. 

It still takes a long time to hire several key frontline occupations like medical assistants and nursing assistants. The average hiring process over the last six months took 60 days or longer and was even more extended for some key frontline positions.

Also, employee absenteeism reported due to childcare and transportation issues has increased. The dramatic increase in the cost of necessities like housing, transportation, and food have created financial burdens that can undermine workforce participation, particularly for people at the lower end of the wage scale. lack of accessibility in the private-sector supply of childcare, elder care, and housing further frustrates employees’ ability to work. Caring for others in their household is stressing people’s ability to work.

The report underscores the need for more healthcare workers, especially nurses. People over 65 were just 12% of the state’s population in 2000 but are expected to account for 20% of state residents by 2035. North Carolina’s healthcare workforce isn’t growing fast enough to keep up with a growing and aging population. 

By 2030, North Carolina is expected to face a shortage of over 9,000 registered nurses, with the majority of shortages occurring in hospitals particularly intense shortages are anticipated in in the Wake Region and Northwestern parts of the state, which may see a larger rise in the aging population.

Medicaid expansion has increased the need for healthcare workers by 20,000 positions. This need will be concentrated in rural parts of the state where more people rely on Medicaid. Finally, there is an increased demand for workers in behavioral health care, for all ages of North Carolinians. 

Addressing workforce challenges requires an all-in approachwith various stakeholders, including healthcare providers, educators, government agencies, and advocacy groups, collaborating on initiatives to address North Carolina’s healthcare staffing needs.

North Carolina is fortunate to be home to renowned medical schools, universities and community colleges building a pipeline of physicians, nurses, and other healthcare professionals to care for our growing and aging population.

There has been a significant increase in the number of nursing bachelor’s degrees awarded in the last decade, but the number of associate degrees has been essentially flat. This is a particular indicator we can be working on. 

Inadequate pay is causing some nursing instructors to leave the classroom. Hospitals, like UNC Health Wayne in Goldsboro, are stepping up to help. They are paying the salary and benefits of one clinical nursing instructor at Wayne Community College for five years, to help ensure their community has the workforce pipeline they need. 

There is growing recognition that we cannot simply educate our way out of this problem. Addressing issues like pay, barriers like childcare and housing costs, and using technology like telehealth to augment the capacity of bedside staff also will be part of the solution.

The population numbers are against us – there are fewer workers in future generations. We will have to work smarter, not harder, to help fill that gap. 

Healthcare providers, the business community, educators, and workforce professionals are increasingly aligned on the need to solve North Carolina’s healthcare staffing needs. Examples include:

• A partnership between Davidson-Davie Community College and Atrium Health Wake Forest Baptist on the first registered nursing apprenticeship program in North Carolina — offers on-the-job training while attending school. 
• A similar pre-apprenticeship program is offered to high school students through a partnership with Surry-Yadkin Works and Northern Regional Hospital and Hugh Chatham Hospital.
• Atrium Health, Bloomberg Philanthropies and Charlotte-Mecklenburg Schools are launching a new early college program that will help prepare students for careers in health care.
• Business initiatives like NC Chamber’s NC Health Talent Alliance and NCWorks with the Department of Commerce are examples of cross-sector partnership. 
• The UNC system, the NC Center on the Workforce for Health, NC Community College System, North Carolina Area Health Education Centers (AHECs) and North Carolina Institute for Medicine are collaborating to develop a roadmap for graduating more nurses in North Carolina.
• North Carolina’s lawmakers have also appropriated money in the budget to help with pipeline building. 
• Government support like loan forgiveness programs, funding for community college programs, AHEC training hubs, play a crucial role in addressing workforce challenges.

For more information or to read the report from RTI and learn more about how hospitals are developing the next generation of healthcare professionals in the workforce section of NCHealthcare.org.

This interview was sponsored by the North Carolina Healthcare Association (NCHA) and facilitated through a partnership between the North Carolina News Network, WPTF, and NCHA. Tatyana Kelly, CHC, is the Senior Vice President for planning, Strategy & member services of the North Carolina Healthcare Association. Kristine Bellino is the Vice President of News and Information Programming for Curtis Media Group.  Stephanie Strickland of the North Carolina Healthcare Association also contributed to this article.

You can listen to the full conversation here.