Labor shortages in the U.S. health care workforce have been widely documented, with projected shortalls of more than 180 000 physicians and 200.000 registered nurses in the next decade. Burnout, poor working conditions and inadequate wages frequently are cited as key drivers of these shortages.
A recent study reported in JAMA Network adds financial hardship to this list of contributing factors. Researchers evaluated rates of poverty, food insecurity and housing instability among U.S. health care workers. Rates of financial hardship varied by occupational group:
- Direct care/support workers reported the highest rates of financial hardship across all measures, including poverty (9.6%), food insecurity (24.5%) and housing instability (13.6%).
- For nurses, other diagnosing/treating practitioners and health technologists/technicians, poverty rates ranged from 1.8% to 3.6%; food insecurity rates ranged from 5.4% to 11.4%; and housing instability rates ranged from 3.3% to 7.1%.
- Physicians and surgeons reported the lowest rates of all three categories.
Direct care/support occupations were associated with poverty, while health technologist/technician and direct care/support occupations were associated with food insecurity. Health technologist/technician and direct care/support occupations also were associated with housing instability. The likelihood of financial hardship was greatest among direct care/support workers.
Survey respondents included 6,905 health care workers, including 562 physicians/surgeons, 1,704 nurses, 1,123 other diagnosing/treating practitioners, 968 health technologists/technicians and 2,548 direct care/health care support workers. Occupational groups differed on most characteristics. Direct care/support workers reported the lowest personal and family incomes and included the highest proportion of Hispanic and non-Hispanic Black individuals.
Most health care workers are already struggling with challenging job conditions, previous research found. Eighty percent report that staffing and resource shortages are at least somewhat problematic, and 75% report issues with stress and burnout. The new data on financial hardship intensifies concerns about the sector's ability to retain essential personnel.
“Significant rates of financial hardship exist among U.S. health care workers,” the report concluded. “At least one measure of food insecurity was reported by 1 in 4 direct care/support workers and 1 in 10 health technologists/technicians. These rates exceed prior reports, perhaps reflecting worsening hardship.
“Certain health care workers’ wages may not be sufficient to meet basic needs. Significant inequities in the health workforce composition were detected. Racial and ethnic minority groups were disproportionately represented in low-wage, direct care/support occupations, raising critical questions about the ethics and sustainability of current work arrangements.”
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