COVID-19 transformed California’s health care system. With it came increased safety protocols, a strained and exhausted workforce, supply shortages, and exponential growth in virtual care. An unexpected silver lining is the finding that practices offering telehealth services and work-from-home options have higher health care workforce retention rates.
Employee retention rates measure a practice’s ability to keep its employees. Turnover is time-consuming and costly for your practice under any circumstances. It poses a greater burden during a severe health professional shortage. By improving retention rates, your practice can reap many benefits:
- More consistent productivity
- Better-managed patient satisfaction
- Improved employee morale
- Fewer recruitment/hiring/training costs
- Increased employee engagement
- Increased appeal to potential candidates
The California Telehealth Resource Center (CTRC) has been serving California patients and providers for more than 15 years, working tirelessly to help you optimize virtual care. In this post, we take a deep dive into the role of telehealth in improving workforce retention, taking into consideration the many factors that may influence the data.
By the Numbers: Impacts of COVID-19 on California Providers
To understand the current state of California’s health care worker shortage, we must acknowledge the role of the pandemic in exacerbating preexisting shortages.
What first began as a staffing issue in rural parts of the state quickly became a full-blown shortage with the onset of the pandemic. The health care sector has lost nearly half a million workers since February 2020, and new data suggests that of those leaving the workforce 18% of health care workers have quit, and 12% have been laid off.
According to a data brief from The American Hospital Association, 3 in 10 healthcare workers have considered leaving their profession due to the COVID-19 pandemic, and 6 in 10 claimed that pandemic-related stressors have negatively impacted their mental health. Without a plan of action to address these issues, providers will likely continue to face retention challenges. An analysis of Emsi data suggests that by 2026, there will be a critical shortage of 3.2 million health care workers if action is not taken.
The Registered Nurse (RN) Shortage
A University of California San Francisco Health Workforce Research Center survey found career registered nurses (RNs) leaving the field in significant numbers with many more intending to retire or quit within the next couple of years. Pre-pandemic, between 40% and 50% of nurses ages 65 and older were active in the workforce. By late 2020, the percentage of working nurses over the age of 65 decreased to 33%. There was also a notable drop in the percentage of working nurses between ages 55 and 64.
Anecdotal evidence provided by the RNs who participated in the survey revealed that personal health and safety concerns related to the pandemic were among the top reasons for leaving.
To better understand California’s nursing shortage, we have embedded an interactive map from California Health and Human Services (CHHS).
The Primary Care Provider (PCP) Shortage
In addition to the shortage of RNs, there are also significant PCP shortages in many counties across the country.
According to a report from the Healthforce Center at the University of California, San Francisco, California is facing a severe shortage of primary care clinicians and will continue to over the years. The report outlined a need for more drastic measures, stating that the current proposed legislation is neither, “…holistic or extensive enough to deal with the projected shortage.”
For a more in-depth breakdown, reference the interactive map provided by California Health and Human Services.
The Specialty Care Provider Shortage
In 2019, the Association of American Medical Colleges (AAMC) projected a shortage of between 37,800 to 124,000 physicians by 2034, with the most significant disparities among specialists.
Projected Specialty Care Shortages by 2034: The Numbers
Surgical Specialties – Between 15,800 and 30,200 physicians
Medical Specialties – Between 3,800 and 13,400 physicians
Other Specialties – Between 10,300 and 35,600 physicians
The pandemic magnified the specialty care provider shortage in ways that continue to impact California residents across the state. A Los Angeles Times article found L.A.’s most underserved patients wait an average of 89 days—nearly three months—to see a specialist. Many have complex medical issues, and long delays to care can adversely impact their health. A study of the relationship between wait times for mental health services and outcomes found longer wait times to be significantly associated with poorer patient outcomes. Related research demonstrates a direct correlation between longer wait times and higher levels of patient dissatisfaction.
5 Ways Telehealth Can Improve Health Care Worker Retention
California’s health sector faces significant worker shortages and retention issues caused in part by burnout related to the pandemic. Unless we make changes to our health care system, Californians will continue to face challenges accessing the appropriate care at the right time.
To address this problem, we have compiled five ways telehealth can improve health care worker retention.
1. Telehealth Makes Rural Health Care Work More Accessible.
According to the World Health Organization, approximately half of the world’s population lives in rural and remote areas. However, most health care workers reside in cities, creating inequitable access to care in rural areas. Though this disparity existed prior to the pandemic, issues related to COVID-19 exacerbated barriers to access impacting rural parts of the state.
California’s estimated population in 2021 was 39,237,836 people with 863,273 living in rural areas. Although rural Californians make up only 2.2% of the total population, lack of access to quality care is a pressing issue we must address.
How do we encourage health care workers based in urban centers to serve patients living in rural areas? Telehealth enables providers to furnish patient care across the state from the comfort of their own home.
Effective telehealth systems provide overworked and understaffed rural clinics avenues to explore alternative staffing models. For instance, a survey of 400 clinicians found that 58% expressed interest in getting licensed to practice in additional states, and 2 in 3 prefer virtual-only or hybrid work. Enabling clinicians to work remotely can expand the potential pool of candidates available to serve rural areas.
Many telehealth programs permit advanced practice clinicians, technicians, and other health care workers to practice at the top of their license under the remote supervision of a physician or other clinician. Depending on the telehealth model, supervising physicians may watch a live video feed, review patient records, or communicate with rural staff via telephone. These arrangements enable physicians to care for more patients over a shorter period, thereby reducing the need for additional staff. Conservatively, telemedicine technologies such as video visits enable a physician to see an additional four patients daily.
2. Telehealth Can Help Mitigate Employee Burnout.
The pandemic has highlighted the need for more robust solutions to protect the mental health of our health care workforce. A survey of 36,000 clinicians across the country revealed a startling prevalence of burn out, anxiety, and depression. A study published less than a year into the pandemic found one in three physicians experiencing burnout at any given time.
What is burnout?
First recognized in the 1970s, burnout is a psychological syndrome resulting from chronic exposure to work-related stress. Common features include tendencies toward a cynical or negative outlook, listlessness, detachment, and subpar performance.
Why does burnout matter?
Health care workers are at increased risk for experiencing burnout.
According to a comprehensive survey of 400 clinicians, 33% believe it is the number one threat to healthcare organizations, surpassing other commonly reported issues such as financial challenges and staffing shortages.
Burnout may have significant negative personal consequences, such as substance abuse, broken relationships, and even suicide. Furthermore, burnout can lead to negative professional consequences such as decreased patient satisfaction, reduced quality of care, and greater potential for medical errors.
In addition to these serious potential consequences, burnout is fundamentally tied to provider turnover. It is estimated that the costs associated with replacing a departing provider and onboarding a new one is in excess of $1 million.
Although telehealth is not a definitive solution to burnout, it has the potential to help mitigate its effects.
A robust telehealth system allows health care workers experiencing burnout to work from home, avoiding the chaotic atmosphere common to many health centers, a time-consuming commute, and other environmental stressors they may face outside the home. In fact, a survey of 400 clinicians found that 64% preferred to treat patients in virtual-only or hybrid settings. Additionally, 58% of the clinicians believe that there will be a greater volume of virtual visits for primary care needs than in-person visits within the next five years.
3. Telehealth Provides At-Risk Medical Workers Peace of Mind.
The University of California San Francisco study mentioned earlier in this post notes that COVID-19 had a direct impact on nurses ages 55 and older leaving the field for early retirement. If personal or familial safety concerns contributed to their decision—as many in the study claimed—these highly-experienced RNs might potentially be persuaded to return to the workforce if they could work from home or a secure office.
Offering providers the option of delivering care via telehealth services can provide peace of mind to those who may be at elevated risk for COVID-19 complications or have at-risk family members.
4. Telehealth Allows for Flexibility.
While some specialties may not be able to conduct every appointment virtually, there is much room for flexibility. Many practices have implemented a hybrid approach allowing them to see certain patients in person, limiting employee exposure to COVID-19 while still providing the proper level of care.
Furthermore, this approach may seem appealing to the 64% of physicians who have come to prefer working from home some days while returning to an office on others.
5. Remote Patient Monitoring (RPM) Makes Chronic Disease Management Easier on Both the Patient and Provider.
Remote patient monitoring (RPM) makes use of a host of digital medical technologies such as a wireless blood pressure cuff and continuous glucose monitor that patients use at home to capture and transmit continuous streams of biometric data. Often, these devices are directly integrated into the EHR, enabling providers to easily visualize trends in values on a dashboard. RPM extends care beyond the clinic walls, enabling providers to monitor patients between office visits. At the slightest change in a trendline, a provider can contact the patient to make slight adjustments to the care plan. This approach can lead to more timely, personalized interventions in lower-acuity settings.
How can RPM improve the day-to-day lives of health care workers?
- RPM can provide physicians near-real-time access to patient data, thus decreasing the time in which potential patient setbacks or problems are noticed.
- It allows patients to receive swift care in the event of an unexpected issue, therefore preventing problems from escalating.
- It gives clinicians a better understanding of which patients need care the most, allowing them to work within a schedule that prioritizes those who need immediate care while still monitoring other patients.
The California Telehealth Resource Center: Your Telehealth Experts
The implementation of a robust telehealth system can be daunting. CTRC is here to help! We offer unbiased insights, no-cost educational tools, resources, and consultative services tailored to meet your clinic’s unique needs.
Seeking Support to Implement Telehealth in Your Practice?
The CTRC team assists thousands of providers and patients annually. We have extensive experience supporting the health care safety net, rural and urban providers, and patients and families throughout California who might otherwise be unable to access quality health care due to geographic isolation, language and cultural barriers, lack of insurance, disability, homelessness, and other factors.
How CTRC Can Help
CTRC assists California practices with professional support, telehealth system management, guidance and toolkits, sample forms, and more. Throughout the year, CTRC hosts virtual conferences, workshops, and trainings to keep you up to date on the latest telehealth insights and advances.
Limitations and Barriers
It is essential to acknowledge that there are limitations and multilevel barriers to telehealth spanning from individual patient care to health systems to policy. CTRC understands that telehealth is not feasible for delivering care under every circumstance to every patient. It is crucial to assess each situation for suitability for telehealth. Many clinics opt to implement hybrid services, which can offer an array of options to accommodate those who need to be seen in person and those who may not.
When it comes to virtual care, patients without access to a stable internet connection, basic technological literacy, or adequate technology can fall through the cracks. To ensure equity in telehealth services, it is critical to design telehealth tools and workflows to address a broad range of needs. For assistance to create more equitable telehealth services within your practice, contact the California Telehealth Resource Center at (877) 590-8144 or CalTRC@ochin.org.