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Michael Seraskeris*

«The Shortage of Health Professionals Worldwide – A Modern Human Resources Management Challenge»

October 2022

 

During the last 40 years a significant global shortage in the number of health professionals of all specialties (Physicians, General Practitioners, nurses, laboratory technicians) recorded in absolute and relative figures. Given the growing demand for consumption of health services, this shortage has a serious impact on the very functioning of health systems worldwide.

 

The reasons of the shortage should be attributed primarily to the disproportionately increasing demand for health services, which is generally generated by major factors such as population ageing, diseases related to our modern life patterns, increase of scientific specialization, assignment of large percentage of health professionals to Geriatrics, Physical Medicine, Rehabilitation and chronical diseases.

 

In all European countries, scarcity of health personnel in absolute figures could not be met by non-European residents, due to linguistic constraints, as for example in England every non-European individual has to take such a hard examination in order to certify English language command, that even native British could hardly pass!

 

The phenomenon has already reached alarming dimensions. Researchers predict that as in the United States and the United Kingdom that really seem to suffer, the rest of the developed countries will follow the same path, concluding to shutdown of health units. It is really a severe staffing crisis, not just one of many other problems.

 

Lack of younger employees in the US or UK is estimated at least 20% (twenty percent), many of them prefer working in retail stores rather than in hospitals or other health-care providers. Human Resources Administrators experience substantial pressure, as open positions remain at unchanged status for many months during each year. Same findings recorded in other European countries, with the Germans and the Scandinavian countries looking mainly for Physicians, while France and Austria for nurses. With healthcare professionals keep fleeing every day, deciding to keep working hard, but wherever else (supermarkets, hairdressing salons, factories, hospitality), to fill this 20% gap, we may normally need two decades!

 

Last, but not least, patients may suffer inadequate care, as severe staffing shortage, push some health care providers to break the rules, especially in care homes and other small facilities. Especially in the UK, staff shortages rose by 52% during the Covid-19 pandemic, while in other European countries a 25-35% is already recorded.

 

What about results delivered every day? Average waiting time out of the Acute & Emergency departments almost doubled, while surgery waiting lists also registering new negative records by extending waiting periods.

 

Covid-19 was the most recent occasion to re-emerge the problem, but the main cause of it, is sought in our own life-patterns, which have turned the attention of young generations to any other professional specializations than the health-related. Governments during the last 4 decades insist to promote mainly studies such as business administration, marketing, information technology, tourism or even arts, rather than healthcare.

 

Will we be stronger in the short run, as pandemic seems coming to an end? No, definitely not, as patients prohibited to approach hospitals or primary care facilities now return in droves, many of them with tumors that left unattended for more than 2 years. And this means off course, that we are probably at a worse condition than when pandemic started.

 

Health occupations seem to offer more disadvantages than incentives, most important of them are:

 

1. Disproportionately higher job risks compared to those of other jobs, in relation to the salaries and benefits healthcare workers receive. Average hourly pay in independent care homes in England is 9.01 pounds, while Starbucks baristas earn over 10 an hour and Amazon warehouse workers earn a basic wage of 10-12 an hour.
2. Demanding shifts at nights, working weekends and last-minute shift changes.
3. Especially during the Covid-19 period, permanent personnel in many countries did not take annual vacation or regular day-offs for more than a year, while in some countries, a year and a half.
4. Lower sense of professional recognition compared to other much-advertised disciplines, especially among nurses.
5. Demanding family issues such as baby-sitting and other kind of support children need like attending school events or participating to family events.
6. Increased sense of "pressure" from the community members, (patients, family members, hospital procedures, emergencies), leading to increased absenteeism and low personnel morale.
7. Lower opportunities for on-going training, in-house or external.
8. As medical and nursing personnel becomes more and more necessary, opportunities for further career development in other positions such as administration positions, seems in our days, more-or-less impossible.
9. Occupational risks such as infection from Covid or professional burn-out tend to sky-rocket. New or chronical occupational stress incidents seem to be unstoppable, while family violence incidents, are dramatically increased.
10. Burdened epidemiological patterns of chronical patients and increased despair among vulnerable population group members, affect negatively moral of health professionals.
11. Modern human resources management methods and training opportunities like time management, people management, stress management, team building, diversity affairs training, are reduced to minimums, instead of increasing in these tough times.
12. Cultural, as well as linguistic constraints among employees of different origins, generate communication problems among health professionals.

 

On the other hand, this crisis is self-feeding, as -given the lack of health professionals- existing workers are called to undertake more duties on behalf of their absent colleagues, resulting in the overload with more responsibilities and consequently, increasing working hours. Due to the lack of new hired employees, hospital demographics are turning “red”, as current employees growing-up without timely replacement.

 

European governments, have-to recognize the priority of the issue in order-to deal with it on a long-term basis. Change in the standards that must be noted in principle, in-order-for the health professions regain a competitive status, requires the cooperation of the Ministries of Health, Labor and Education across all European countries.

 

But what has-to be done, starting “yesterday”, as “tomorrow” will be very late?

 

1. Developed countries have-to recognize and therefore, re-prioritize healthcare professions. Healthcare personnel should be recognized as “humanity agents”, not just professionals, not just health “technicians”, as their role is one of the most critical for our life status.
2. Review all kinds of incentives (financial and other) that are currently provided to health professionals, in order-to make them competitive to those of other sectors.
3. Acknowledge that “praise is better than raise”, as many health providers tend to insist imposing orders rather than asking for the collaboration of health personnel, in other words, health management in many countries of the world still insist on disciplinary actions instead of providing personnel with the organization’s vision and call them for fully alignment with it. This is one of the most impressive findings, as health organizations are by default based on teamwork, and they had to be more sensitive as well as progressive, on state-of-the-art people management techniques.
4. Apply modern methods of management and evaluation of human resources in order-to support career planning with scientific methods, professional development, organized training of health professionals, in-order to support their professional aspirations.
5. Provide health professionals with knowledge, by introducing courses in economics, management, health law, etc. in-order health professionals to acquire a broader scientific sense of their professional field and above all, to acquire more skills so that they do not feel isolated from serious decisions.
6. We have-to provide health personnel with psychological support in-order to train everyone to administer occupational stress and violence, concluding to life-balancing coaching.
7. Admit that telling the truth, is always critical: we have-to prepare students to the real working conditions. It is observed that the majority of those who leave the profession for good, are among those recently entered the labor market, so we have-to keep younger personnel in the system, by promoting engagement with it, and this is a critical human resources management challenge.
8. Covid-19 found society more-or less unprepared. We have-to review and renew our crisis schedules, prepare the society to act -not only react-, and train general population to follow health maintenance schedules, not just asking health personnel to solve every problem and restore everything to its prior condition. People starved for freedom, but hundreds of millions of people worldwide did not realize on-time, that health providers cannot guarantee well-being, they only facilitate it!
9.  In any case physicians and nurses tend to compete, this could be attributed to the traditional training programs they followed and/or the working conditions they experienced. There are more to be done towards this phenomenon, the most important, to give both sides the opportunity to manage collaborative efforts with each other, conduct common research, attend common training sessions so to improve practice environments.
10. Yes, nurses in our modern times, are scientists, not only patient helpers as they were 130 years ago. We have-to promote scientific research within their community, as researchers must remain in the healthcare organizations environment and stop pursuing an academic position in order-to escape from working pressure. Healthcare organizations are by-definition, “learning environments”.
11. We have-to introduce or enhance mentoring, as traditionally, it is normal for doctors and nurses with many years of experience, while looking for promotions and recognition, to “forget” transmitting their fine art to the younger, because they keep working in extended shifts with many responsibilities.
12. Exploit all opportunities the internet can provide, and they are numerous. Any healthcare professional could -even during working shifts- connect to a short University lesson and attend it for a while, just to change the scene and get some refreshing impressions, like looking out of the window.
13. Especially for hospitals, we have-to lower the patient-to healthcare professional ratio, by enhancing primary care providers. Hospitals are the tougher employers, thus the less desirable by younger candidates, where job dissatisfaction due to the work-overload, concludes to less engagement and higher resign statistics.
14. Last, but not least, “give power to the people”! The more they know about their job environment, the more they feel safe, satisfied and engaged. We have-to provide them with power, authority, control of the economics, so to give them a clear path to their self-completion. Our times need more leaders and less managers, as-well-as, more managers than administrators.

 

Most of the proposals presented above need 2 prerequisites: money and better human resources management. Not so self-explained for many countries that pay low salaries to doctors and nurses, when at the same time pay much better other occupations like banking, information technology etc., while human resources management and leadership are understated.

 

To me personally, and I guess to the most of you, remains still unexplained how we (as a society) managed to underestimate both, health sector salaries and modern management methods. Supermarkets, where I served at the beginning of my career 30 years ago, were preparing a significant percentage of their employees, and definitely 100% of their management members, with leadership training courses, repeatedly delivered year by year, already during more than the last 40 years. To managers and employees achieving annual targets, every reputable retailer still pays a very good bonus.

 

But why we “fortified” supermarkets by modern management methods, while omitted to do as such in healthcare, the cornerstone of our society’s well-being along with education? It seems that we underestimated critical risk factors, as we were so absorbed by the challenge to make more money, take more education, find a better job, travel to interesting places.

 

Bernard Couchner, Doctor and former Health Secretary of France, in a book he wrote before the year 2000, predicted that within the next 40 years, a major pandemic will threaten to destroy the fundamentals of our civilization. 30 years later, with this prediction almost confirmed, and the whole planet steel suffering, let’s bear in mind that, how lucky we were, when from the first moment, millions of health workers, stood for all the other billions of confused people.

 

As the Chinese General Sun Tzu 1.500 years ago, mentioned in the book “The Art of War”: “as a leader, if you embrace your soldiers and treat them like if they were your beloved sons, they would be willing even to die for you”. Human Resources Managers understand that the triumph of management is life -not death off course- but all of us must conclude to the same result: as a society, we have-to treat healthcare personnel as they are our beloved sons, our beloved daughters, not just employees getting paid for what they do!

 

This is the most dynamic challenge as healthcare personnel is the only glue our society’s broken health pattern needs, in-order to keep going to what we all care for: TOMORROW!

 

*M. Seraskeris: BSc in Business Administration, MSc in Health Economics, Managing Director of the Etoloakarnania Group of Public Hospitals and Rehabilitation Institutions.