Using US Census Bureau state unemployment insurance data, researchers from Johns Hopkins University documented a significant job turnover among healthcare workers (HCWs) during the COVID-19 pandemic, which suggests long-term implications for the US healthcare sector.
The study was published today in JAMA Health Forum and is based on data collected from January 2018 through December 2021. The researchers assessed job exit and entry data quarterly.
In quarter 1 of 2020, approximately 18.8 million people (14.6 million women [77.6%] and 4.2 million men [22.4%]) were working in the healthcare sector in the study sample.
Arkansas, Mississippi, and Tennessee were not included in the study.
In 2018, the average healthcare worker exit rate per quarter was 5.9 percentage points. In the first quarter of 2020 it climbed to 8.0 percentage points (95% confidence interval [CI], 7.7 to 8.3).
Though quarter 1 of 2020 saw the highest exit rate, the percentage remained high throughout the study period, with an exit rate of 7.7 (95% CI, 7.4 to 7.9) percentage points in quarter 4 of 2021.
More left for unemployment early in pandemic
Reasons for exiting the healthcare workforce differed across the study period. In quarters 1 and 2 of 2020, most workers exited the job and entered unemployment. By late 2021, the reason was to switch to a different job sector.
In 2020, 5.7 percentage points were attributable to people exiting into nonemployment compared with a baseline mean of 3.2 percentage points per quarter in 2018, a 78% increase, the authors noted.
In quarter 4 of 2021, the last quarter assessed, the exit rate of healthcare workers into unemployment was 4.0 percentage points (95% CI, 3.8 to 4.3), a 25% increase from baseline, and the exit rate into a non-healthcare sector was 3.6 percentage points (95% CI, 3.5 to 3.7), a 38% increase, the authors found.
By the end of 2021, there were an increase in entrants to the healthcare sector. However, the entry into the sector came mostly from unemployed workers, suggesting that healthcare organizations after the pandemic subsided are operating with more staff with less experience than in the prepandemic period, the authors note.
In 2020, states in the Northeast region saw the greatest increases in health care worker exit rates.
The investigators also found geographical differences in exit rates. In the early part of the pandemic, more New England states reported exit due to nonemployment. In 2021, the exit due to unemployment increased in the South and West.
"In 2020, states in the Northeast region saw the greatest increases in health care worker exit rates vs their prepandemic mean values, comprising 8 of the top 10 states with the largest increases in health care worker exit rates," the authors wrote.
Overall, the study findings suggest workforce turnover may pose "substantial costs for both organizations and patients, as it implies potentially disrupted continuity of care and fewer staff with industry- and firm-specific experience," the authors concluded.
