THERE ARE AN estimated 19,000 unfilled positions in Massachusetts acute care hospitals, according to a new report by a trade association representing the hospitals.  

For more than a year, health care providers have been complaining of staffing shortages. There is a generally tight labor market nationwide. Hospitals have been hit particularly hard by pandemic-related burnout and retirements, due to the stress of caring for so many patients who have COVID or were affected by its collateral consequences and are suffering due to mental health problems or delayed care. Numerous reports have chronicled the reasons behind health care worker shortages: health care workers get sick and miss work; they leave hospital work for better paid or more flexible traveling or temporary positions; and some were fired due to COVID vaccine mandates. 

The latest report by the Massachusetts Health and Hospital Association puts stark numbers on the enormity of the crisis and focuses on how it is affecting the hospitals. Stress on hospitals trickles down to patients through long waits or reduced access to services.  

“We’re starting to hear more about long wait times, people who leave without being seen,” said Steve Walsh, president and CEO of the Massachusetts Health and Hospital Association. 

The Massachusetts Health and Hospital Association surveyed hospitals this summer about vacancy rates for 47 positions in clinical work and operations. It got responses from 37 hospitals that represent 70 percent of the state’s total hospital employment. Respondents identified 6,650 vacancies. The 47 positions that the survey asked about account for fewer than half of all hospital roles, and the association extrapolated that across all positions and all hospitals to come up with the estimate of approximately 19,000 vacancies.  

By far the highest vacancy rate in the report was for licensed practical nurses, an entry level nursing position, where 56 percent of positions were open. There were vacancy rates of 30 percent or higher for several other positions: home health aides, sitters (who monitor mental health patients), mental health workers/technicians, and pulmonary function technicians. There were vacancy rates of at least 25 percent for infection control nurses, nurse-midwives, social workers, psychologists, paramedics, and surgical technicians. The median vacancy rate across all positions was 17.2 percent. 

While in many industries, vacant job positions would mean lower costs, that is not necessarily the case for hospitals since many of those jobs need to be filled with temporary labor. The report says that hospitals turn to “traveler agencies” to provide temporary nurses at much higher costs. The rate paid for travel nurses is now 90 percent higher, on average, than it was pre-pandemic. Hospitals reported spending $445 million on temporary registered nurses in the first six months of fiscal 2022. 

The report warns that staffing shortages are leading to capacity constraints, since patient demand is also up. Patients who delayed care during the pandemic are arriving with more severe illnesses. Right now, doctors are reporting an uptick in traditional winter illnesses like RSV and flu. More patients are dealing with mental health issues. Because of capacity challenges at other health care facilities, patients are stuck in emergency departments waiting for an inpatient psychiatric bed or in inpatient units waiting for a spot in a nursing home or rehabilitation center. 

Walsh said the problem is threefold: the workforce shortage leads to capacity challenges, then hospitals overpay for labor, leading to fiscal instability. “Those three things are putting incredible stress on the system, and it’s probably going to get worse before it gets better,” he said. 

The association argues that focus is needed on increasing the pipeline of new workers, increasing training and loan forgiveness for health care professionals, giving hospitals financial assistance, and investing in new models of care like telehealth and at-home care.