National View: Make health care stronger by training more providers

Last year my 24-year-old daughter, Annabel, decided to go into nursing after earning a bachelor’s degree in another field. She’s now in a master’s program and well on her way to becoming a nurse and probably a nurse practitioner after that.

But watching her navigate the complex, inefficient pathways into the profession led us both to a disturbing realization: The system seems designed more to keep people out than to recruit and train the nurses and other health care professionals our nation needs.

America’s health care system today is short at least 15,000 primary care physicians, 200,000 medical technologists, and 400,000 home health care aides. America needs to train at least 225,000 RNs each year for the next decade just to maintain today’s staffing ratios. But the country’s nursing schools produced only 155,000 graduates last year, a level that’s remained flat for a decade.

These figures imply that America’s nursing shortage will almost surely exceed 1 million RNs by 2033, amounting to a 20%-plus shortfall at the average hospital.

Stepping up America’s training of new nurses and other health care professionals offers one of the best avenues for expanding economic opportunity at a large scale.

Health care offers particularly attractive opportunities for military veterans. More than 10,000 veterans leave the armed forces annually with military health care training. About four of every five veterans with this experience don’t have a degree or credential recognized in civilian workplaces and would benefit from streamlined pathways to serve as EMTs, med techs, and in other vital roles.

Another group is immigrants with degrees or credentials earned in their country of origin. More than 165,000 immigrants trained abroad in relevant occupations aren’t working in health care today due to difficulties transferring foreign-earned credentials to the U.S. health care system.

Developing health care talent at the scale America needs calls for a three-pronged strategy.

First, Congress and state legislatures should fund significant capacity expansion at schools of nursing and other health care occupations. U.S. nursing schools turn away more than 90,000 qualified applicants each year, according to a report by the American Association of Colleges of Nursing. The chief hurdles to accepting more students are shortages of instructors, facilities, and clinical rotation opportunities.

Congress subsidizes nursing education at levels of just under $2,000 per new nurse, or about 3% to 4% of the all-in cost of training RNs. In contrast, Congress invests more than $500,000 in educating each new doctor.

Second, America must build better pathways into nursing schools and other training programs.

In Annabel’s case, it didn’t make sense to attend nursing school in our home state because the state universities would have treated her as a first-year college student and required numerous extraneous prerequisites. She found that only a handful of highly selective private universities offer programs for people in her position.

All states should create fast-track programs to ease on ramps for people who’ve earned degrees in other fields, whether they’re pivoting to health care early in their career or later in life. This means directing public nursing and allied health schools to develop targeted programs and harmonize prerequisite requirements.

In addition, states and employers should work together to build more seamless pathways for existing nurses and other health care professionals to move to higher levels of training, either through full-time study or part-time while working. Training levels make a difference.

Third, decision-makers at every level should focus on improving work cultures for nurses and other health care professionals. The epidemic of nurse resignations during the COVID-19 crisis illuminated the substandard working conditions millions of frontline caregivers face.

Hospitals can increase retention rates considerably, studies show, by giving nurses more voice in hospital leadership, increasing professional development opportunities, and building more collaborative cultures — for instance, by having physicians and nurses go on rounds together. Lightening excessive workloads is, in turn, one of the best steps employers can take to keep overburdened professionals in the health care sector.

Expanding America’s health care workforce represents an achievable double-bottom-line proposition. It would help ensure the quality care Americans need in coming decades and increase economic opportunity for millions of people.

The United States has countless individuals with the talent, temperament, and idealism to become difference-makers in American health care. We should welcome them in.

J.H. Cullum Clark is director of the Bush Institute-Southern Methodist University Economic Growth Initiative in Dallas.