Healthcare workforce rebounding, but not in long-term care

Turnover rates are moving closer to levels before the COVID-19 pandemic, a new study finds. But the recovery isn’t consistent among all groups.

Many healthcare workers left their jobs during the COVID-19 pandemic, but many of those positions have since been filled, a new study shows.

However, the recovery in the healthcare industry has been uneven, with turnover being particularly persistent in the long-term care sector, according to the study, published on JAMA Health Forum.

Doctors also had higher rates of turnover as the pandemic progressed, reinforcing reports of burnout taking a toll on physicians.

Women and healthcare workers with young children were also more likely to leave the workforce. Healthcare workers with lower wages were also more likely to have left the workforce than those who earned more.

Still, many healthcare professions are seeing a bounceback, the study found.

“This study does not suggest mass exits by any particular profession, although growing turnover rates among physicians do support concerns about burnout,” the authors wrote.

The study examined more than 125,000 healthcare workers and compared turnover before the arrival of the coronavirus (January 2019-March 2020), the first nine months of the pandemic (April 2020-December 2020), and January-October 2021).

Here are some key takeaways from the study.

Long-term care workers

Turnover was the highest among workers in long-term care settings and also continued to rise throughout the pandemic. Hospitals and ambulatory care providers saw an uptick in people leaving their jobs in 2020, but both saw a substantial drop in turnover rates in 2021.

Staffing shortages in the long-term care industry have been well-documented, but they merit attention since turnover is rising.

“Given the high demand for long-term care workers, targeted attention is needed to recruit job-seeking health care workers and to retain those currently in these jobs to lessen turnover,” the authors wrote.

Leaving the labor force

Across the healthcare industry, the turnover rate was dominated by employees leaving the labor force, as opposed to those who lost jobs and were aiming to find work, the study suggests.

The survey defined unemployment as those who weren’t working but available to work and had searched for a job in the previous four weeks. Workers were considered to have left the labor force if they weren’t working and hadn’t looked for a job in four weeks.

Unemployment rates were higher in the latter part of the pandemic, the study notes. It’s unclear if workers were opting to stay unemployed until they could find a desirable job, perhaps with better pay or working conditions.

“For those exiting the labor force, further work is needed to understand whether workers are involuntarily leaving their jobs and may be marginally attached workers who would like a job only if the circumstances are right,” the authors wrote.

Physicians

Doctors had low overall turnover rates compared to some other segments of healthcare workers. But physicians were the only occupational group in the study that continued turnover increases over time.

Nurses

Turnover rates among licensed practical nurses and licensed vocational nurses rose sharply in the pandemic, but they have been slow to recover, the study found.

Unemployment among registered nurses increased in 2020 after the emergence of the coronavirus, but turnover among RNs dropped close to pre-pandemic levels in 2021, the study found.

Women

Women were more likely to exit healthcare jobs than men throughout the pandemic.

Women with young children had especially high turnover, the study found. However, the authors note male and female healthcare workers with young children were more likely to exit jobs than other healthcare workers, and had slower recovery.

Women in a variety of healthcare professions have left jobs or scaled back hours. Some women doctors reduced hours during the pandemic to care for children.

Minority groups

Workers who identified as American Indian, Alaska Native, or Pacific Islander had consistently high turnover, the study found.

Black and Latino healthcare workers saw a spike in job losses during the first nine months of the pandemic, but had a slow recovery in 2021, the study found. Asian workers had the highest increase in turnover from April 2020 through December 2020, but had largely returned to pre-pandemic levels in 2021. 

Aides and assistants

Workers employed as healthcare aides and assistants had high turnover rates and a slower recovery. Many aides and assistants are members of marginalized racial groups and also had young children, the authors noted.

The study found a four-fold difference in turnover rates among health aides or assistants compared with doctors.

Bianca Frogner, a professor of family medicine at the University of Washington, was the lead author of the study. Janette Dill, an associate professor of health policy and management at the University of Minnesota, co-authored the piece.