Health care leaders are trying to find new ways to retain and recruit employees as the workforce shortage, which started in 2020, worsens nationwide. There are no clear answers to the labor shortage, and in Massachusetts, health care professionals say it’s going to take more than one solution to figure it out.

In state hospitals alone, around 19,000 acute care positions are unfilled and more than 70% of the average hospital dollar is going toward labor costs — “wages, benefits and purchased services” — according to an October report from the Massachusetts Health and Hospital Association. Travel labor expenses — for out-of-state employees that keep hospitals running — are projected to reach $1 billion, the association predicts.

The report outlines its own series of potential answers, which includes additional spending and various methods to attract new workers, but solutions will need to extend beyond acute care.

Labor advocates like Maralishia Aho, regional communications manager for 1199SEIU, which represents hundreds of Massachusetts health care employees, said change must start with wages.

“It requires all stakeholders to be at the table and ... centering workers’ voices in that discussion,” Aho explained. “One of the easiest things we can say is talking about paying people more.”

Health care workers might have been labeled “heroes” during the COVID-19 pandemic, Aho said, but more action is necessary. In particular, she said low-wage workers — in-home caretakers and others not necessarily in the hospital setting — need to be remembered, because the entire field is being affected, not just doctors and nurses.

“Many have been burned out who have been struggling and are not paid adequately to thrive outside of work, and can go to a less stressful job, like at a Target or somewhere where they can make the same amount of pay, unfortunately,” Aho commented.

For behavioral health, Diane Gould, president and CEO of Advocates, a human and social service nonprofit in Framingham, said employees are “really struggling.”

Gould said workforce salaries need to be “front and center” in the conversation, and reimbursement rates are an important component of pay. Oftentimes, she said potential student loan debt — about $200,000 for the average public medical school student, according to the Association of American Medical Colleges — drives health worker hopefuls away from the industry.

“The work that our people and our staff do is critically important,” Gould said. “Health care is the backbone of the health and well-being of the commonwealth.”

Remedies in pipeline

Sen. Julian Cyr, D-Truro, Senate chair for the Legislature’s Committee on Mental Health, Substance Use and Recovery, said he believes “funding is essential,” and the state has already made appropriations, but their outcome is yet to be seen.

“It’s going to take some time for that to take root,” Cyr said.

Recruitment also takes time, Cyr added, and even in the best-case scenario, training often takes two years.

“You can’t conjure a psych nurse,” Cyr said. “So even though we desperately need psychiatric nurses and providers across the spectrum, it’s not that it can be done swiftly.”

In the meantime, patients in mental health crisis are being sent to emergency rooms, when hospitals already have their own staffing issues. Lown Institute Senior Fellow Paul Hattis said these types of domino effects are common because the health care system is so interwoven.

“Even if things get better for the hospitals, if a nursing home can’t get enough staff, they can’t admit the patient from the hospital,” Hattis explained. “It backs up.”

Hattis, a former member of the state’s Health Policy Commission, added that hospitals don’t have enough money to increase wages and other labor costs, so the state has stepped in to provide some funding. Most recently, around $350 million from the economic development bill went toward hospitals, but that only helps for the immediate future.

“The long-term solution is about pipeline issues,” Hattis said, which includes recruiting more employees and providing mobility paths for current workers.

Policy changes

Patricia Noga, vice president of clinical affairs for the Massachusetts Health and Hospital Association, said the short-term must include supporting the existing workers.

“You almost need to customize your approach given the needs of the individual worker,” Noga said. “Looking at the other things in their lives that affect their work. I mean, can we assist with child care? What about transportation? What about parking? What about financial advice and guidance that they may need?”

Kenneth White, dean of the School of Nursing at the MGH Institute of Health Professions, said the pandemic, retirement of the baby boomer generation, and increased patient need all combined to create the “perfect storm.”

White, also the president of the American Academy of Nursing, said it’s impossible to gauge when the shortage might improve, but “it would be hastened if we had more government policy that would support this issue.”

A step in the right direction, he said, is for the Department of Labor to institute a program it’s currently considering that will provide student nurses with the opportunity for more clinical placements, which are essential for learning.

He called this just “a drop in the bucket,” though, and said, as with behavioral health and other areas, the government needs to provide funding, particularly for loan reimbursements.

“I think there’s a lot that can be done on the policy front to expedite these changes,” White said.

Sam Melnick, chief communications officer with the Massachusetts Health and Hospital Association, said the organization has released a toolkit that includes case studies in Massachusetts hospitals. The goal, he added, is to provide resources for health leaders as they chart a path forward.

“Every hospital is doing something innovative right now to address these issues,” Melnick said.

Ultimately, Noga said, the labor issues are not confined to the pandemic and with so many efforts going into solving the issue, results and result assessment are not going to be immediately apparent.

“We’ve got to see how a lot of these interventions and innovations shake out over time,” Noga explained. “It’s almost like you’ve got to kind of wait and see every five years, where are we? See where we are and where we’re going to be going next.”

Melissa Ellin writes from the Boston University Statehouse Program.

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