As the United States battles through the COVID-19 pandemic, hospitals around the country have quickly begun running out of available doctors and nurses to support the demands of patients who contracted virus.1,2 At least 25 states throughout the country are facing physician shortages, and a recent study found that more than one-third of hospitals in Mississippi, New Mexico, and Louisiana are running out of staff entirely.1,2
Though the shortages can in part be attributed to the overwhelming number of patients with COVID-19 in hospitals — and the fact that nurses and doctors themselves are falling sick or quarantining following virus exposure — this isn’t the only reason. Many areas throughout the country, particularly rural areas, were facing shortages of healthcare providers before the pandemic began.
Rural Areas Facing Healthcare Provider Shortages
A poll by National Public Radio, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health in 2018 found that 1 out of every 4 people living in rural areas were unable to access the healthcare they needed.3 Almost one-fourth of those surveyed said healthcare locations were too far away or difficult to get to from where they live.3
The shortage of doctors and nurses in rural areas may be related to the lack of accessible resources and medical technology as well as the lower salaries offered in these areas compared to their urban and suburban counterparts.4 In a recent survey, only 1% of doctors in their final year of medical school indicated they want to live in communities with populations under 10,000; only 2% wanted to live in towns of 25,000 citizens or fewer.4
The Western-most area of the United States, which consists of rural deserts and rolling plains, is forecasted to have the greatest physician shortage ratio by 2030 (69 physician jobs per 100,000 people) whereas the Northeast will have a surplus of 50 physician jobs per 100,000 people.2
Where and Why Clinicians Are Moving
A study of junior-level doctors found that those with high levels of professional expectations and prestige preferred to practice in an urban location.5 Over the past decade, the United States has seen more clinicians moving to cities that offer higher salaries, such as Boston, Los Angeles, New York, Minneapolis, Houston, and Chicago.5 After years of education that resulted in thousands of dollars in student loan debt, many doctors are reluctant to give up the opportunities available to them in the city to move to areas with fewer options for personal and professional growth.
Salary isn’t the only reason clinicians are moving to urban areas. Physician shortages exist in non-urban areas due to limited housing options, unappealing geography, lack of professional opportunities, plus additional factors:
- Hospitals in cities are more likely to be connected to a university system that offers more specific, specialty-focused training;
- Clinical research endeavors are more easily attained;
- Lifestyle choices are more abundant.
Conversely, nurses are moving to areas that promise more work-life balance and lower cost of living; a survey conducted by Nurse.com found that a higher number of nurses are moving to Florida and North Carolina.6 Reasons for moving to Florida include the warmer climate, no state income tax, and spacious property for lower out-of-pocket cost.6 North Carolina is an attractive state for nurses because the state boasts over 23 nationally recognized healthcare systems. The business climate of North Carolina is also booming due to increased opportunities in finance, research, technology, innovation, and education.6
COVID-19 Causing HCPs to Move
COVID-19 relocation has also applied to doctors and nurses throughout the country.7 Many clinicians from more rural areas fled to COVID-19 hot spots such as New York to assist in the fight against the virus; now, however, these cities are facing mass shortages as the number of patients with COVID-19 in these areas are increasing. Hospitals across the country have had to recruit physicians from much farther geographic locations than they would typically in order to staff their inpatient units.7
Not only has COVID-19 caused clinicians to move across the county, the pandemic has also inspired some to move across the world. The pandemic has brought to light many of the holes in the U.S healthcare system, and some clinicians felt inspired to take this time to practice medicine in other parts of the world, such as New Zealand, where advanced scientific knowledge and progressive ideals have resulted in the lowest rates COVID-19-related deaths in the world.8
Physician Specialties in Growing Demand
Clinicians who practice in specialty areas are in particularly high demand throughout the country.9 As the COVID-19 pandemic slows, a growing need is emerging for primary care physicians, psychiatrists, OB/GYNs, dermatologists, nurse practitioners, radiologists, cardiologists, and neurologists.9 According to the New England Journal of Medicine, the demand for psychiatrists, urologists, surgeons, and neurologists will grow significantly by 2025.9 Many of these specialists are moving to states in the northeast as they have the highest concentration of academic teaching and research hospitals.9
Closing the Gaps: Attracting HCPs to Areas of Need
Given the urgent need for HCPs — particularly in rural areas and areas with a higher concentration of underserved populations — universities and hospitals must address this gap when advising clinicians on where to continue their practice. Offering a high salary is one way to attract clinicians, but it’s not the only method to promote HCP relocation. Highlighting training and advancement opportunities, emphasizing the need for specialty clinicians as the pandemic slows, and increasing the number of medical programs offered in rural areas of the United States are ways to attract and secure trained clinicians in areas where they are needed most.
- Goldhill O. ‘People are going to die’: Hospitals in half the states are facing a massive staffing shortage as Covid-19 surges. STAT news website. Published November 19, 2020. Accessed February 25, 2021. https://www.statnews.com/2020/11/19/covid19-hospitals-in-half-the-states-facing-massive-staffing-shortage/.
- Zhang X, Lin D, Pforsich H, Lin VW. Physician workforce in the United States of America: forecasting nationwide shortages. Hum Resour Health. 2020;18(1):8.
- Harvard T.H. Chan School of Public Health. Life in Rural America: Part II. NPR/Robert Wood Johnson Foundation/Harvard School of Public Health. Published May 1, 2019. Accessed February 25, 2021. https://media.npr.org/documents/2019/may/NPR-RWJF-HARVARDRuralPollPart2.pdf
- 2019 Survey of Final-Year Medical Residents. Merrit Hawkins. Published May 14, 2019. Accessed February 25, 2021. https://www.merritthawkins.com/trends-and-insights/article/surveys/2019-Survey-of-Final-Year-Medical-Residents/.
- The Future of Nursing: Best Cities and States to Work. Drexel University Online. Accessed February 25, 2021. https://www.online.drexel.edu/nursing-today-and-tomorrow.aspx.
- Kingma M. Nurses on the move: a global overview. Health Serv Res. 2007;42(3 Pt 2):1281-1298.
- About a fifth of U.S. adults moved due to COVID-19 or know someone who did. Pewresearch.org. Published July 6, 2020. Accessed February 25, 2021. https://www.pewresearch.org/fact-tank/2020/07/06/about-a-fifth-of-u-s-adults-moved-due-to-covid-19-or-know-someone-who-did/.
- Grahan-McLay C. ‘I love this country’: US doctors head to New Zealand as cure for America’s ills. The Guardian. Published October 15, 2020. Accessed February 25, 2021. https://www.theguardian.com/world/2020/oct/16/i-love-this-country-us-doctors-head-to-new-zealand-as-cure-for-americas-ills.
- Darves B. Physician Shortage Spikes Demand in Several Specialties. New England Journal of Medicine Career Center. Published November 30, 2017. Accessed February 4, 2021. https://www.nejmcareercenter.org/article/physician-shortage-spikes-demand-in-several-specialties-/.