The past several months have seen thousands of hospitals announce COVID-19 vaccination requirements for staff and clinicians as a condition of employment.
Although controversial, the policies picked up steam when Pfizer and BioNTech’s Comirnaty received a full regulatory approval. Mandate announcements really kicked into gear when the Biden administration made workforce vaccination a requirement for Medicare and Medicaid participation — a legally contentious decision that was ultimately upheld by the U.S. Supreme Court.
In 25 states and territories that were unaffected by legal stays, CMS said in December that eligible healthcare providers must have a COVID-19 vaccination policy in place with all staff having received at least one dose of a vaccine, a pending or approved qualifying exemption, or a temporary delay as recommended by the Centers for Disease Control and Prevention (CDC) by Jan. 27.
By Feb. 28, those same facilities must also have the entirety of their staffs fully vaccinated, approved for an exemption or recognized as having a CDC-recommended delay. CMS defined a completed vaccine series as one dose of a single-dose vaccine or all doses of a multiple-dose vaccine series, with no mention of booster shots.
CMS also issued an updated guidance on Jan. 14 for 24 states that fought the policy in courts, outlining the same workforce vaccination requirements with compliance deadlines of Feb. 14 and March 15.
Most health system leaders and professional organizations have been supportive of the requirement, with some describing vaccination as “the logical fulfillment of the ethical commitment of all healthcare workers to put patients as well as residents of long-term care facilities first.”
However, some executives and industry figures have warned that mandates might place provider organizations in a bind as disgruntled employees choose to walk away rather than comply.
“As a practical matter, this policy may result in exacerbating the severe workforce shortage problems that currently exist,” American Hospital Association President and CEO Rick Pollack said in a Sept. 9 statement.
Arkansas’ Community Hospital Executive Director James Magee said Sept. 22 that his 25-bed rural facility would not require COVID-19 vaccinations. He stressed that staffing issues and the fear of losing too many nurses were major factors in the decision.
“Mandating that really works a hard step on the smaller hospitals because we don’t have an extra pool of nurses to draw from out there,” he told local news group KAIT.
Some industry figures have pushed back on staffing fears. Ezekiel J. Emanuel, M.D., vice provost for global initiatives at the University of Pennsylvania and a former White House health policy adviser, pointed to the limited workforce fallout among the summer’s early movers as an acceptable loss for workforce-wide coverage.
“If you look at healthcare systems that have actually mandated this, they’ve retained over 99% of their workforce,” he said in support of the mandates during an August press event. “Their workforce does go along when the employer requires it.”
As some provider organizations and states reach their first deadlines for partial or full vaccination, more reports are trickling out on just how many employees hospitals and health systems are losing to vaccine mandates.
Fierce Healthcare will update this list as more deadlines are reached and hospitals share their numbers.
Advocate Aurora Health has terminated 440 employees who were not vaccinated for COVID-19. These employees, half of whom worked part time, represent less than 1% of the system's roughly 75,000 workers.
Albany Med has reportedly suspended 204 of its more than 11,000 employees as of Sept. 28. They have a week to comply before facing termination.
Baystate Health suspended 145 workers who missed an Oct. 1 deadline and ultimately fired 90 who remained noncompliant by a secondary Oct. 15 deadline. It employs nearly 12,000 people.
Beaumont Health has seen 70 vaccine-related resignations and has another 370 suspended employees who missed an Oct. 18 vaccination deadline, the system said. The suspended staff have until Nov. 16 to enter compliance before being terminated. Beaumont Health employs about 33,000 people, roughly 2,300 of whom the system said were granted an exemption to the vaccination mandate.
Centra Health lost 36 caregivers to its vaccination requirement. Five were terminated while 31 resigned voluntarily. The organization told press that the departures account for less than a percent of its total workforce and do not impact its staffing.
Central Maine Healthcare has seen 84 resignations and has 250 employees with no vaccination records as of Oct. 11. The provider said it will be temporarily suspending some services and has been in contact with the governor's office for support. The state's COVID-19 vaccination mandate for healthcare staff goes into effect at the end of October.
CHI Memorial said that less than 1% of its roughly 4,600 employees had resigned due to the vaccine requirement as of three days before it took effect.
ChristianaCare President and CEO Janice Nevin, M.D., wrote in a Sept. 27 blog post that the system's vaccination policy resulted in the loss of approximately 150 employees, the equivalent of fewer than 90 full-time employees. Fewer than 48 full-time equivalents provided direct patient care and fewer than 12 full-time equivalents were nurses. Nevin also noted that ChristianaCare, which employed 13,412 during 2020, had also hired more than 200 caregivers during the last month alone.
Clark Fork Valley Hospital in Montana reportedly lost 1% of its staff shortly after February's federal deadline. The rural hospital has just over 100 employees.
CoxHealth CEO and President Steve Edwards tweeted that 64 of his company's 12,500 employees (0.51%) chose not to be vaccinated and were discharged.
Crouse Hospital terminated 45 employees who did not meet the state's COVID-19 vaccine requirement. It employs roughly 3,100 people.
Esperanza Health Centers, a five-clinic network of community health centers in Chicago, reportedly lost two of its 311 employees. Notably, Esperanza did not allow for religious exemptions.
Henry Ford Health System reported on Oct. 5 that about 400 employees had voluntarily resigned due to the vaccination requirement, representing about 1% of the system's total workforce. Another 1,900, about 6%, had received medical or religious exemptions. The Detroit-based provider also noted that new hires "are already offsetting those team members who resigned."
Hospital for Special Surgery in New York lost 18 out of 5,000 employees to vaccine resignations and terminations.
Houston Methodist, the first to announce a vaccine mandate, said it had 153 resignations or terminations among its roughly 26,000-person workforce.
Indiana University Health had 125 of its 35,800 employees resign from their jobs due to the vaccine requirement. A spokesperson told Fierce Healthcare on Sept. 23 that many were part-time workers and that the departures were the equivalent of 61 full-time employees.
Inova Health dropped 89 of its 20,000-person workforce due to noncompliance with its Sept.1 vaccination requirement.
Kaiser Permanente announced that "just over" 2,200 employees from its nationwide workforce of roughly 240,000 had not met its vaccine requirement and were placed on administrative leave as of Oct. 4. The nonprofit said that the tally is declining daily, as suspended employees have until Dec. 1 to enter compliance and return to work.
Lewis County Health System said it has seen 30 resignations as of Sept. 11 in the wake of announcing its vaccine mandate and as a result has been forced to pause maternal health services. At that time, 165 of the provider’s unvaccinated staff had not yet indicated whether they would comply or leave the single-hospital system. Lewis County Health System employs about 650 people and will see its mandate go into effect Sept. 27.
Maimonides Medical Center said it had 35 terminations tied to vaccination requirements. It employee 6,500, an additional 100 of which were claiming religious exemption as of mid-October.
MaineHealth representative Caroline Cornish told Fierce Healthcare that 58 out of its team of 23,000 had resigned and cited the vaccination requirement among their reasons, as of Sept. 24.
Mayo Clinic reportedly fired 700 employees on Jan. 4 who did not comply with its COVID-19 vaccination policy. This represents just under 1% of Mayo Clinic's total of 73,000 employees. The system said that those who were let go will be able to reapply for job openings should they receive vaccines in the future.
Med Center Health said it had fired 180 employees from its workforce of roughly 3,800 who had not been vaccinated by Sept. 1. It also highlighted the hiring of 178 vaccinated employees who would begin within a week of the firings.
Medical University of South Carolina Health fired five employees who had not met its June 30 vaccination or exemption deadline. It employs more than 17,000 people.
Mercy announced that it terminated about 2% of its 40,000-person workforce—roughly 800 people. These firings came after a 28-day unpaid suspension period for those who were not in compliance with the policy announced in July.
MetroHealth reportedly terminated four of its nearly 7,800 employees due to its vaccine mandate. Another 13 decided to retire or leave the organization.
Mohawk Valley Health System announced on Sept. 28 that New York's mandate led 180 employees, about 5% of the workforce, to separate from the system. This has increased its vacancy rate from 13.7% to 17.5%. The system also noted that other unvaccinated employees have been placed on unpaid leave and have until Oct. 9 to receive a vaccine and return to their position. Hospital services are still operating at both of the system's campuses, although service delays and other limitations will be likely going forward.
Mount Sinai Health System has reportedly lost 1% of its 42,000-person workforce who chose not to be vaccinated.
NYC Health + Hospitals has about 2,500 unvaccinated workers, about 5% of its 43,000 staff, that has not met the state's vaccination requirement.
NewYork-Presbyterian had "fewer than 250" team members who did not comply with a Sept. 22 vaccination mandate and "no longer work" at the organization, according to a statement provided to Fierce Healthcare. The system said it has achieved more than 99% compliance among its 48,000 employees and affiliated doctors and will see no interruptions in care due to the mandate.
Northern Light Health representative Karen Cashman told Fierce Healthcare that, as of Sept. 24, 89 employees had left the system due to its COVID-19 vaccine mandate. As of a Sept. 15 news conference, 91% of the system’s more than 12,000 employees had been vaccinated.
Northwell Health has reportedly fired about 1,400 one week after New York's vaccine mandate went into effect. This also includes at least two dozen employees at the manager level or above that did not receive COVID-19 vaccines by a prior internal deadline. It employed more than 76,000 workers.
Novant Health has fired more than 175 employees who were not compliant with its COVID-19 vaccination requirement. The system said Sept. 21 that it had initially suspended about 375 of its more than 35,000 total employees due to vaccination noncompliance. Nearly 200 of those employees became compliant during the five-day suspension period and avoided termination.
NYU Langone has reportedly terminated 75 employees out of its 40,000-person staff.
Ochsner Health announced in early December that roughly 280 employees out of its nearly 30,000-person workforce were leaving the organization due to its vaccination policy. The Louisiana-based system said that about 180 of those are pro re nata employees who were working on an as-needed basis.
Olean General Hospital said it had seen 11 resignations ahead of New York’s Sept. 27 deadline for a first dose. As of Sept. 14, more than 250 of its 840 employees had not been vaccinated.
Richmond University Medical Center had a dozen resignations but did not disclose other terminations. It employs about 2,000 people.
Riverside Healthcare gave 40 employees who were not in compliance with its vaccination requirement after a two-week suspension the axe. It employs about 2,900 people.
RWJBarnabas Health has terminated 118 employees who did not meet its Oct. 15 vaccination deadline, with the remaining 99.7% of its 35,000-person workforce either receiving the vaccination or an exemption. The system had previously announced back in July the firing of six employees at the supervisor level who had not complied with a requirement for upper staff to be vaccinated by June 30.
Rush University Medical Center has nearly 100 employees in jeopardy of termination due to vaccination requirement noncompliance, as of an Oct. 20 report.
Samaritan Medical Center in New York said it terminated 28 employees who did not comply with the state's vaccine requirements after a two-week suspension. It employs over 2,000 people.
Shriners Hospital for Children in Louisiana reportedly fired over a dozen employees who chose not to be vaccinated before a Dec. 6 deadline.
Southcoast Health, a Massachusetts-based system, fired 216 medical workers who did not comply with its vaccine mandate, the Herald News reports. Southcoast employees roughly 7,500 people.
Southern Illinois Healthcare let go of 220 people who did not meet its vaccination requirement. It employs more than 3,700 according to its website.
St. Claire Regional Medical Center said it had fired 23 staff who had refused vaccination. A spokesperson reportedly said these employees were a combination of full-time, part-time and pro re nata employees and represented “less than 1%" of its total workforce.
St. Joseph's Health in Syracuse fired 78 of its 3,810 employees who did not meet New York's statewide vaccination deadline. They were among 122 who were suspended and given until Oct. 8 to receive a vaccine or be fired.
St. Luke Community Healthcare, a 25-bed rural facility in Montana, reportedly lost three employees within a week of the government's February 2022 vaccination deadline.
St. Luke's University Health Network said that 68 full-time employees and 87 part-time or per diem employees had decided against vaccination and resigned as of its Sept. 25 deadline. Additionally, 668 had received a medical exemption, religious exemption or a temporary deferral and will undergo weekly testing. St. Luke's employs about 17,000 people.
St. Peter's Health Partners has suspended 322 unvaccinated employees out of its 11,000-plus workforce, as of Sept. 28. Those employees have until Oct. 8 to become compliant.
Sturdy Memorial Hospital, in Massachusetts, reportedly fired 33 employees who did not meet its vaccination mandate. This represents about 1.6% of its 2,044-person workforce.
Tidelands Health had just a single employee out of 2,010 who did not comply with its mandate and chose to resign.
Three Rivers Hospital, a rural facility in Eastern Washington, said that it let go of six out of its 129 employees, all of whom were per diem staff.
Truman Medical Centers/University Health saw 39 resignations among its workforce of roughly 5,000 due to a COVID-19 vaccination mandate.
UCHealth said that 119 out of its 26,500-person work did not receive COVID-19 vaccine or an exemption by the Colorado system's Oct. 1 deadline. A spokesperson said that those employees are welcome to reapply for their positions should they later receive the vaccine.
UMass Memorial Health let roughly 200 employees go after they missed a Dec. 1 vaccination deadline. The system employs about 15,000 people.
UNC Health has already seen 70 of its roughly 30,000 workers resign over a COVID-19 vaccination mandate originally scheduled for Sept. 21 but now delayed to Nov. 2. About 900 were still unvaccinated as of late September.
University of Vermont Health Network reported Sept. 28 that it had 30 mandate-related departures across three of its facilities—16 resignations at Alice Hyde Medical Center, 12 terminations at Champlain Valley Physicians Hospital and two resignations at Elizabethtown Community Hospital. These losses have compounded with a rash of non-vaccine-related resignations and hour reductions have led some of the system's hospitals to recruit travel nurses and postpone inpatient surgical procedures for at least one week.
Upstate University Hospital suspended or terminated 113 employees who did not meet New York's statewide deadline, as of a Sept. 30 report. Some of those workers will be able to return to their jobs if they receive a vaccine. The Syracuse provider employs more than 6,600 people.
Valley Health System in West Virginia, Maryland and Virginia reportedly lost 3% of its over 6,000-person staff.
Virtua Health said it had 120 of its 14,000 employees choose to resign over the five-hospital system's vaccine requirement. The South Jersey provider said that 98% of its remaining workforce is vaccinated, with the remainder receiving exemptions.
Wilson Medical Center in Kansas told press that three of its roughly 180 chose to quit over vaccine mandates with "several" others seeking exemptions.
Yale New Haven Health System saw 94 departures among the 225 employees who had been suspended over its vaccination requirement. The Connecticut system employs more than 28,000 people, more than 700 of whom were granted exemptions and will see weekly testing.