Anecdotal evidence suggests that healthcare employers have faced increased difficulty recruiting and retaining staff in the wake of the COVID-19 pandemic. The authors of a new study say empirical research is needed to understand the magnitude and persistence of these changes, and whether they have disproportionate implications for certain types of workers or regions of the country.

Shen, et al. (2024) sought to quantify the number of workers exiting from and entering into the health care workforce before and after the pandemic and to examine variations over time and across states and worker demographics.

This cohort study used U.S. Census Bureau state unemployment insurance data on job-to-job flows in the continental U.S. to construct state-level quarterly exit and entry rates for the healthcare industry from January 2018 through December 2021 (Arkansas, Mississippi, and Tennessee were omitted due to missing data). An event study design was used to compute quarterly mean adjusted rates of job exit from and entry into the healthcare sector as defined by the North American Industry Classification System. Data were examined from January to June 2023.

In quarter 1 of 2020, there were approximately 18.8 million people (14.6 million females [77.6%]) working in the healthcare sector in our sample. The exit rate for healthcare workers increased at the onset of the pandemic, from a baseline quarterly mean of 5.9 percentage points in 2018 to 8.0 (95% CI, 7.7-8.3) percentage points in quarter 1 of 2020.

Exit rates remained higher than baseline levels through quarter 4 of 2021, when the healthcare exit rate was 7.7 (95% CI, 7.4-7.9) percentage points higher than the 2018 baseline. In quarter 1 of 2020, the increase in healthcare worker exit rates was dominated by an increase in workers exiting to nonemployment (78% increase compared with baseline); in contrast, by quarter 4 of 2021, the exit rate was dominated by workers exiting to employment in non–health care sectors (38% increase compared with baseline). Entry rates into healthcare also increased in the post-pandemic period, from 6.2 percentage points at baseline to 7.7 percentage points (95% CI, 7.4-7.9 percentage points) in the last quarter of 2021, suggesting increased turnover of healthcare staff. Compared with pre-pandemic job flows, the share of workers exiting healthcare after the pandemic who were female was disproportionately larger, and the shares of workers entering healthcare who were female or Black was disproportionately smaller.

Results of this cohort study suggest a substantial and persistent increase in healthcare workforce turnover after the pandemic, which may have long-lasting implications for workers’ willingness to remain in healthcare jobs. Policymakers and healthcare organizations may need to act to prevent further losses of experienced staff.

Reference: Shen K, et al. Job Flows Into and Out of Health Care Before and After the COVID-19 Pandemic. JAMA Health Forum. 2024;5(1):e234964. doi:10.1001/jamahealthforum.2023.4964