Report: 1 in 10 hospital jobs vacant amid increasing retirements, patient demand

Hospital industry leaders warn Wisconsin’s health care workforce is already in “critical condition” as the state’s aging population continues to need more care.

The Wisconsin Hospital Association’s annual workforce report uses state and federal data, as well as information from the state’s hospitals, to outline the challenges facing the industry.

This year’s report found that 1 in 10 positions at hospitals are vacant, representing almost 10,000 vacancies statewide. 

Ann Zenk, WHA’s senior vice president of workforce and clinical practice, presented the findings to a bipartisan group of legislators at the state Capitol on Thursday. She said this year’s findings come after the challenges of the COVID-19 pandemic.

“Our workforce, which was very critical in 2022, very pressured in 2021, isn’t getting much better,” Zenk told lawmakers. “It’s still in critical condition … If you have a staff of five and one person’s out, you feel that and we’re feeling that in multiple professions in our workforce.”

She said similar to other industries, the worst vacancy rates at hospitals are in frontline technical positions, such as licensed practical nurses, nursing assistants and respiratory therapists.

Hospitals are still seeing high rates of employee turnover, a national trend in 2021 and 2022 referred to as “the Great Resignation.” But Zenk said the new report shows those rates have stabilized instead of continuing to grow. She said the retirement of employees in the Baby Boomer generation represents a much bigger problem for the industry.

“We still have several components of our health care workforce where 1 in 5 or more — for LPNs it’s 1 in 4 — are gonna hit retirement soon,” she said.

Zenk told lawmakers that the health care industry has to find ways to grow the workforce faster to make up for retirements, a challenge facing other industries in the state. 

But she said the state’s aging population means hospitals will not be able to grow fast enough to keep up with increasing demand for care.

“Age 65 plus far outweighs the demand on health care and health care expenditures,” she said. “So we’ve got growing demands on a shrinking pool of workers.”

Aging population impacting demands for care

The WHA report shows this demographic shift is already impacting the level of care hospitals need to provide. For the first time in more than a decade, outpatient visits in Wisconsin did not increase from the previous year in 2022, the most recent data available. But inpatient days continued to climb, reaching levels 6 percent higher than what was seen pre-pandemic.

Zenk said patient lengths of stay in hospitals have also increased as the availability of nursing home beds has declined. 

“Every day, there’s hundreds of people waiting in Wisconsin hospitals for post-acute care,” she said. “They don’t need hospital care. But because they’re in the hospital, we have to provide hospital care and that takes workforce energy, time and effort, and it comes at a cost with no reimbursement (from Medicare).”

Wisconsin patients are also being affected by shortages in primary care. National data cited by WHA shows 63 percent of clinics and health systems struggle to meet demand for care and patients are waiting 25 percent longer to see their primary care provider.

Zenk said Wisconsin has seen growing migration of doctors into the state, which has been helped by state investments in creating more training opportunities for new physicians. And she said the state has also seen progress in the registered nurse workforce.

“The median age of nurses is decreasing,” she said. “We are being successful in getting new entrants into the field. The question is, Is it fast enough? … And the other question is how do we support a younger nursing workforce?”

She said some hospitals are embracing nurse residencies or more intense orientations to support new graduate learning from experienced colleagues who may be close to retirement age.

Financial pressures place additional burden on hospitals

The continued workforce shortage comes as hospitals are facing increasing financial stress, said Eric Borgerding, WHA’s president and CEO.

“The cost of delivering health care continues to skyrocket,” Borgerding said at the briefing. “The inflationary pressures on everything from drugs and supplies, but especially … labor, the workforce, which for some hospitals constitutes about 60 percent of their operating budgets.”

Borgerding said the mix of patient insurance types at Wisconsin hospitals has also changed, with Medicare representing a higher percentage of patients. 

In 2010, the federal health insurance program for older adults represented 42.2 percent of a hospital’s payer mix while commercial insurance plans made up 38 percent. In 2023, patients with commercial insurance had declined to under 32 percent while Medicare patients grew to nearly 50 percent.

“The more Medicare and Medicaid that a hospital has, particularly Wisconsin’s nonprofit hospitals, the greater the loss is from those programs from a reimbursement perspective,” Borgerding said, pointing out that the federal public insurance programs do not reimburse hospitals for the actual cost of providing care to patients.

With “the silver tsunami” of Baby Boomer retirements continuing until at least 2030, WHA identified several areas where action is needed. The report calls for creating and expanding training for the most in-demand workers. Zenk said many frontline positions like LPNS or CNAs only require a one- or two-year degree.

The report also calls for reducing regulatory and administrative burdens and supporting the use of technology in hospitals like telehealth and robotics to increase efficiency.