Long-term care settings, physicians missed out on 2021's gradual healthcare workforce recovery

Widespread healthcare workforce exits seen during the pandemic’s initial peak in 2020 “largely recovered” through October 2021 with the exception of long-term care workers and physicians, according to a recently published study of federal labor data.

“The findings of this national cross-sectional study suggest that, despite continued elevated turnover rates among healthcare workers since the start of the COVID-19 pandemic, many groups are on track to recover,” researchers from the University of Washington and the University of Minnesota wrote in JAMA Health Forum. “This study does not suggest mass exits by any particular profession, although growing turnover rates among physicians do support concerns about burnout.”

Among the study’s sample of more than 125,000 healthcare workers, healthcare turnover rates averaged 3.2% during the 15 months prior to the pandemic, increased to 5.6% on average between April and December 2020 and then dipped back down to an average of 3.7% between January and October of 2021, the researchers wrote.

Turnover was consistently lower in hospitals than in all other healthcare settings, whereas workers in ambulatory care settings had both the largest turnover rate increase from April through December 2020 and the greatest recovery from January through October 2021.

Long-term care was the only setting where turnover increased following the pandemic’s onset and then worsened in 2021.

Across all types of healthcare occupations, turnover rates increased with the onset of the pandemic and still remained above pre-pandemic levels, according to the study.

Health aide and assistant turnover, which was already higher than that of other healthcare employment categories prior to the pandemic, saw the largest peak at over 7% on average between April and December 2020 before recovering to about 6.5% on average during most of 2021.

Physicians were the only employment category to see turnover increases during both post-pandemic periods although these workers’ rates were consistently the lowest of the sample and remained below 2% throughout the study period.

Researchers also flagged the slow recovery among licensed practical/vocational nurses (LPNs/LVNs) during 2021 as an area of potential long-term concern.

“Long-term care workers warrant attention given their persistently high and increasing exit rates,” they wrote. “Health aides and assistants and LPNs/LVNs may be key groups for targeted attention, particularly if they work in [long-term care] where they remain in high demand.”

The researchers’ investigation was based on data from the Current Population Survey, a monthly, nationwide household poll jointly conducted by the U.S. Census Bureau and the U.S. Bureau of Labor Statistics.

Beyond job titles, the analysis spotted a higher rate of turnover among healthcare workers with children under 5 years of age, women and those belonging to American Indian/Alaska Native/Pacific Islander races or ethnicities.

Asian healthcare workers reported the highest increase in turnover between April and December 2020, when they nearly reached an average rate of 8%, followed by strong recovery to less than 5% during the subsequent period in 2021. Healthcare job recovery between January and October 2021 was slowest among Black and Latino workers.

“As numerous media headlines have pointed out, women, particularly those with young children, have experienced the largest share of the COVID-19−related job losses,” the researchers wrote. “Healthcare, a field that is predominately composed of women, many of whom are of historically marginalized racial and ethnic groups, is no different.”

The researchers notred healthcare worker turnover rates during the pandemic have “mostly” been workforce exits rather than unemployment, particularly during 2020.

Noting that their analysis did not include specific responses on whether COVID-19 played a direct role in an individual’s ability to work, they called for further exploration on whether burnout, job quality or other factors are primarily contributing to healthcare workforce turnover and departures.

“Waiting too long to understand these issues may further elongate the consequences of the COVID-19 pandemic,” they wrote.