The Changing and Challenging Times for Michigan's Healthcare Workplace
It’s happened to all of us in recent years. We head out in the morning to stop at our corner coffee shop only to find it “Closed. Short staffed.” Or we wait six weeks for an appointment to get our car’s brakes replaced because the mechanic “just can’t find techs to show up every day.” Or an evening out is derailed when we find our favorite restaurant is only open Wednesday through Saturday now because they can’t staff the kitchen.
The pandemic’s lasting impact touches almost every part of our lives. While the experiences listed above represent inconveniences for each of us—especially when compared to real loss of life and health suffered by so many—the effect COVID-19 has had on Michigan’s workforce is real.
Workforce trends that had been emerging for years—aging baby boomers and new attitudes toward work from millennials, to name just a couple—were accelerated and exacerbated during COVID-19, and these realities are dramatically impacting healthcare.
Shay Raleigh, MPH, Executive Director of Great Lakes Physicians Organization in Midland, MI, said the most common challenge facing his and his colleagues are staff turnover, staff burnout, and stiff competition with health systems over wages and benefits.
“Not having adequate resources at a practice level and seeing different staff regularly are real challenges that are impacting patient care,” Raleigh said.
So, what to do? What is the current status of Michigan’s healthcare workforce? How did COVID-19 change this status? What can leaders in Michigan’s healthcare sector do to attract and, maybe more importantly, retain good staff in these changing and challenging times?
Michigan Medicine went to an expert to find out.
Michigan Medicine: Jodi, thank you very much for taking the time to talk with us today. Can you start by talking a little bit about the current labor market in Michigan? What are employers facing?
Jodi Schafer: Of course. Thank you for reaching out on this important issue.
Let me start here. There’s something called the labor participation rate, and this is a figure that has been measured for many, many years. Michigan’s labor participation rate has never been stellar, and right now it sits at 60%. Sixty percent of folks who are eligible to be working in Michigan are actually in our workforce.
MM: How does that compare historically and to other states?
JS: Michigan ranks 40th in the nation for the worst labor participation rate. It’s not great. If we look back at participation rates of the past, we reached a peak of around 68% back in the 2000s, and of course, it dropped off the table completely during the pandemic.
Generally speaking, when we’re in a period of a recession, we see our labor participation rate drop. Oftentimes that’s because there aren’t the available jobs for people, but in this case that’s not true. We have more openings than we have people to fill them. That’s where employers are really feeling the crunch.
This is something that has been trending for a number of years, but COVID-19 just sort of pushed it over the edge. We’ve had many individuals voluntarily choose to exit the workforce during COVID-19 because perhaps they had childcare needs that they didn’t have when schools were open. Or someone with young ones at home trying to help them with online learning. Or maybe their childcare center closed down.
Add to that what we call the “sandwich generation.” Individuals who are still raising children and also have parents or family members who are aging to a point where they also need care. Oftentimes, it falls to a person who is of working age, the prime folks we want in our workforce, having to juggle those two competing needs. And as a result, some of them step out of the workforce completely, or scale back hours from full-time to part-time. And this kind of personal situation is not going away.
MM: Where have the workers gone? Is this “sandwich generation” the biggest contributor to the supply problem? Or are there other places workers have gone?
JS: It’s part of it. You have some people voluntarily opting out of the workforce altogether or opting out of full-time hours. You have other individuals who are working, but they’re not working in Michigan.
Michigan has long been considered an exporter of talent. We have a decline in our net population growth and that’s been going on for years. And right now, of those who are leaving our state, their median age is 30, and 45% of them have a college degree. The ability to work remotely has really impacted this trend. In many industries where work was historically done in person but could be done remotely, COVID-19 really pushed that remote work option. This isn’t so much the case in healthcare because many jobs by their nature are face-to-face and in-person jobs, but there are more remote type opportunities for healthcare employers now than there ever have been before, with telehealth and some of the administrative functions able to be done remotely.
MM: How much of this was exacerbated by COVID-19 and its challenges?
JS: In Michigan specifically, we have 191,000 fewer people in our workforce post-COVID-19 as compared to our pre-COVID-19 numbers. COVID-19 absolutely pushed this. And of those 191,000, a significant proportion are women, millennials, Black, indigenous, and people of color. Part of that was for the childcare and dependent care reasons we talked about before. Also, when you think about the types of businesses that were shuttered during COVID-19, a lot of them employed those demographic groups in higher percentages. And not all of them have returned to the workforce or if they have, they haven’t returned full-time. And that’s a trend that we are seeing, and I don’t think that’s going away.
COVID-19 also accelerated some changing attitudes around work among the millennial and Gen Z generations. These generations don’t seem to have the same intentional focus on planning for the future that their parents had. People are wanting to work much more flexible schedules. Maybe they want to piece together two part-time jobs, because it gives them the flexibility to do the things in their personal life that they want to do.
Opportunities for remote work, expanded dramatically as a result of COVID-19, also greatly contributed to this idea of “working to live, not living to work.” So now, where before you might have needed one baby boomer to fill a role that was traditionally a 40-plus hours a week, an employer may be hard pressed to find one millennial or Gen Z who wants to work a traditional 40-plus hours a week.
MM: Healthcare employees were literally on the front lines of the COVID-19 pandemic and are exhausted and fatigued by it. What are you seeing as far as the status of the mental health of the current healthcare workforce?
JS: There was a recent Fisher Phillips survey that came out, and while it was not specific to healthcare, I think it’s exacerbated in healthcare for all the “front-line” reasons you just said. The survey looked at all industries and found 43% of employers have seen a spike in Americans with Disabilities requests for accommodations for mental health related reasons since the pandemic started.
And then, another portion of that same survey said 51% of employers said they have fielded reports of burnout or mental fatigue, while 46% said they faced higher turnover rates, and 34% said they faced higher absenteeism rates during the last two years. This is real. It’s real across all industries, but it’s especially poignant in healthcare, and you’ve seen it with folks who are doing front-line, direct patient care.
MM: How are you seeing these workforce trends impacting healthcare, because many healthcare jobs don’t have the ability to be remote and also have rigorous physical demands and long hours that may be less appealing to some people now?
JS: So, when you look at the number of applicants to four-year nursing programs, applicants actually increased by 1.5% in 2020. But when you compare that against the two prior years, the increases were north of 4% and 8%. So, it’s slowing, and I think it points again to the shift from, “What sort of job do I want to pursue?” to, “What sort of life do I want to have?” The rigors of work, how much I get paid to do the work, and what trade-off do I have to make for that pay are absolutely part of the equation.
We also have a very savvy up-and-coming workforce. Information is more readily available than it ever has been before. And there’s no taboo on sharing that information. I mean, it used to be considered in poor taste to tell somebody how much money you made or ask someone what they make. That is not the case anymore. We also have websites like Glassdoor where current employees and past employees can go on and easily leave reviews of their experience. As a culture, we are now becoming more and more used to looking at reviews, doing our research before we decide not only is it a job we want to do, but if I do decide I want to do this job, do I want to do it for this employer? Choice is really prevalent right now, especially in the healthcare sector, and we have a very savvy workforce making the most of their choices.
MM: When you talk with employers, what is their greater concern, attracting new employees or retaining current employees?
JS: Right now, I think there is a lot of focus on the recruiting side of things, because that’s where employers are feeling the pinch. But when you ask me what is their greater concern, I would put my money on retention strategies over recruitment strategies, because if you don’t have a culture that people want to be a part of, you’re going to lose them as quickly as you can hire them.
Also, we have this impending brain drain. We have an aging population and are at the tail end of the baby boomer generation leaving the workforce. We can’t keep relying on them. We’ve got to figure out ways to pass institutional knowledge down. And that doesn’t happen in the course of weeks or months, that’s years. And so, once you finally have that well-trained staff that understands who you are as a business or practice and your patients, you know them by name, you’ve got some history, the cost of losing that employee is exponentially higher than the cost of losing somebody that’s only been with you for six weeks.
MM: So, once you’ve found that employee, what are you seeing out there that people are doing to retain that good employee? What can a practice do to make the work culture one that people want to stay and be a part of?
JS: There was a McKinsey study that was recently looking at this retention piece. What can you do to retain those individuals knowing that the work is hard? And they listed several findings and recommendations. The first had to do with adapting a blame-free environment, where you can share incidents or ethical emergency issues and challenges and advice, without fear of retribution or disciplinary action or blame.
Another had to do with involving the team in management decisions. Creating more of a, “Here’s the issue, how do we address this together?” environment. Involving your front-line workers in some of those issues that might have historically been kept behind closed doors.
Another idea focused on creating opportunities for those front-line workers to have someone to talk to before a shift, during a shift, after shift, more on that mental health side. Somebody that they could go to to help them process the demands of that particular day, to decompress, to create some more resiliency.
Lastly, structuring multidisciplinary teams for employee support where you’ve got not just your healthcare professionals, but social professionals, occupational health, psychologists, spiritual counselors. Just like we do with patient care, where you have this interdisciplinary team to really address all of the patient’s needs, applying that same approach to supporting your workforce.
MM: Given the demographic trends and shifting attitudes toward work, combined with the ongoing effects of the pandemic, what are some strategies people are using to find good employees?
JS: It is very difficult right now because there are only so many people to pick from. As an employer, you’re either trying to entice folks to stay in the workforce who may be eligible to retire, or maybe getting courted away by other, more lucrative opportunities. You’re having to do short term adjustments, either to pay or benefits, to the work schedule, whatever you can to try to keep who you’ve got, and to turn the heads of the few remaining folks that you can try to pull in, especially in your clinical positions.
For longer-term strategies, I think we need to start looking at a few things. One, organizations have to start, if they’re not already, developing very strong relationships with training programs in their area. I’ve seen employers be very successful in partnering with local programs, so that they are a site for those clinical rotations. And then, for the employer, you have to dedicate staff to making sure that student has a really good experience in your place of work. Relationships with training programs is a big one. People can start doing that now.
I also think there are opportunities to grow your own talent pipelines. And we’ve not done a lot of this historically, because we’ve been relying on the “post and pray” method. There were enough folks out in the workforce that we could usually get somebody to respond to our online ad. That’s not true anymore. For the last year, I’ve been on my soapbox saying you’ve got to go back to old school tactics in terms of pipeline development. And I’m talking about co-op type programs. I think about the different roles within your practice that don’t require a specific license where you can train on the job. And how do you connect with potential job seekers who don’t even know that’s a job they should be considering right now?
Much like this idea of connecting with training programs, I also think there should be connections happening with the local high schools. There are student organizations like the Health Occupation Student Association. Many schools have that program, and if your local school doesn’t, could you partner with an educator in a school to get it up and running? This gives you an opportunity to get in front of students and talk about healthcare professions and create opportunities for them to come shadow in your office.
MM: Thank you for your time and expertise, Jodi. I wanted to wrap up with one last question. To a physician or a practice manager or someone who’s involved in trying to deal with this challenge every day, what do you want to leave with them as they read this?
JS: I would say, “You’re not alone.” We are all in this boat together. And that’s rare, I think. There are times when an industry feels like they’re bearing the brunt of something on the workforce side, but COVID-19 really leveled that playing field, and we are all in this boat together, regardless of industry.
There may be ideas, strategies, resources that are in play now that you could learn from someone else. It goes back to this idea of we’re more connected now than ever, but sometimes when you’re in the middle of it, it certainly doesn’t feel that way. It can feel like you’re on an island. It can feel like you are the only one. And so, I would say reaching out to other professionals, whether that’s connecting through MSMS, for example, to get in touch with other practice managers that you could talk to and bounce ideas off.
There are more resources available to help you than there have been before. But you’ve got to be head up, eyes open, looking, asking the questions so that you can take advantage. You’re not alone.