Palliative Care Faces Staffing Shortages as 'Workforce Valley' Looms

Unless new policies are adopted, a steady decline in the number of palliative care physicians is expected for the next 14 years.

The palliative care workforce is stretched thin and staffing shortages will worsen dramatically unless lawmakers and healthcare organizations adopt new policies, according to research published this week.

When palliative care teams are integrated into the care of the seriously ill, evidence shows improved outcomes for patients, caregivers, and healthcare organizations. There are already shortages of palliative care clinicians, and rapid growth of the older adult population is expected to increase demand for palliative care services.

There are about 7,600 physicians who are board certified in the specialty level practice of hospice and palliative medicine.

Staffing shortages forecast
 

The research published today in Health Affairs is based on survey data collected from more than 2,000 palliative care professionals and features several key findings:

• Risk factors for intent to leave the field early include being a nonphysician clinician, symptoms of burnout, and poor work-life balance.
   
• About 40% of the palliative care physician workforce was 56 or older, which is expected to increase retirements in the next decade.
   
• Unless new policies are adopted, the wave of retirements combined with early departures from the field will result in a steady decline of palliative care physicians over the next 14 years. Under this "workforce valley" scenario, the number of physicians bottoms out at 6,600 in 2033 and does not recover to the 2019 level until 2045.
   
• Patient-to-physician ratios are expected to worsen for at least 25 years. This year, there are about 800 Medicare beneficiaries eligible for palliative care for every board-certified physician. Unless new policies are adopted, there will be more than 1,300 eligible beneficiaries for every palliative care physician in 2038.
   
• About one-third of the survey respondents reported they were burned out, and burnout was associated with 1.40 times higher odds of intending to leave the field early.
   
• Compared to survey respondents reporting a good work-life balance, palliative care professionals with poor work-life balance had 1.36 higher odds of intending to leave early.
   
• Adopting new policies to expand training opportunities and reduce burnout would reduce the worst depth of the expected workforce valley to about 7,400 palliative care physicians in 2024. Under these new policies, the estimated number of physicians would double the 2019 level, increasing to more than 16,000 in 2059.

"Our modeling revealed an impending 'workforce valley,' with declining physician numbers that will not recover to the current level until 2045, absent policy change. However, sustained growth in the number of fellowship positions over ten years could reverse the worsening workforce shortage," the Health Affairs researchers wrote.

Policy recommendations
 

The study authors recommend five policy changes at the legislative and healthcare organization level to address palliative care workforce shortages.

1. Legislation: Passage of the Palliative Care and Hospice Education and Training Act, which was reintroduced in the House of Representatives in January. Provisions of the legislation include fostering physician leaders with palliative care academic career development awards to provide salary support and funding for training centers.

2. Education funding: Expansion of funding for palliative care training should include increased Medicare graduate education support for palliative medicine physician fellowships. To encourage a team approach to palliative care that maximizes physician effectiveness, federal funding should also support increased educational opportunities for nonphysician palliative care professionals.

3. Research: Workforce shortages are expected among nonphysician palliative care specialists including nurses, social workers, and chaplaincy professionals. Research should examine the composition of these disciplines and their workforce needs.

4. Reimbursement: Current payment models such as fee-for-service Medicare are structured to reimburse the services of palliative care physicians and advanced practice professionals. New payment models should be structured to provide reimbursement to interdisciplinary teams.

5. Burnout: Although the prevalence of burnout among palliative care team members surveyed for this study was relatively low compared to other specialties, the forecast of worsening staff shortages raises the likelihood of higher burnout rates. Policy makers and healthcare organization officials should pursue policies that ease burnout and promote resilience.