This entry in the Nonprofit Journal Project kicks off a series of articles about how Michigan health care professionals are responding to the state's health care workforce shortage. It is made possible with funding from the Michigan Health Endowment Fund.

Like the rest of the nation, Michigan faces challenges in staffing its health care workforce. The nonprofit Michigan Health Council's (MHC) recently released Michigan Healthcare Workforce Index found that nearly all of the 36 Michigan health care occupations it analyzed are projecting workforce shortages between now and 2032.

"There are many health care workforce challenges in Michigan right now — a general shortage of health professionals and health care workers across multiple professions," says Melanie Brim, former president and CEO of MHC. 
 
Occupations without statewide shortages are expected to have shortages in rural areas. Nurse practitioners are projected to have the lowest shortage, dental assistants the highest. Positions with fewer educational requirements are likely to experience high shortages due to low wages. Mental health occupations – from community health workers to psychologists – face immense shortages as well as competitive wage challenges.
 
Brim points out several causes for these challenges. Michigan's population is aging. The number of Michiganders requiring care is increasing because more are older. And more people are reaching retirement and exiting health care careers. Brim herself retired from the MHC in December.
Melanie Brim.
"There are fewer younger people to replace us," Brim says. "There's also competition for that younger workforce. As kids are coming out of high school and going into college, there are many career opportunities for people who are interested in STEM education, science, and technology. Health care is competing against technology, against engineering, and against a lot of other things. When kids look for a career, health care is not necessarily at the top of their list."
 
Turnover rates among nurses and direct care workers are also alarming. Brim says many new nurses expect more mentoring or onboarding as they start their careers, but are instead quickly thrown into caring for patients. She says that leads to a lot of attrition within nurses' first year or two on the job.
 
"It's just more than they can do," Brim says. "So they are increasingly leaving the nursing profession, not just leaving a job."
 
Brim notes that the number of faculty training the health care workforce is declining as well. Again, many are near or at retirement age, the investment in a requisite PhD is high, and clinical positions may pay much more.
 
"If you're going to spend six years getting your PhD to not make as much money as your colleagues in the care environment, why would you?" Brim asks.
 
Another factor she cites is the treatment health care professionals received during the height of the COVID-19 pandemic.
 
"They saw what happened during COVID. They can be really turned off because it was scary," Brim says. "There's been a lot of speculation. Would it drive people away from professions? Or would it pull them in because they saw the wonderful things that health care workers did during COVID?"
 
Michigan's rural regions face worst workforce shortfalls
 
Many of these issues are heightened in rural Michigan. Paige Recker, access to care manager for the Michigan Center for Rural Health, says COVID exacerbated rural health care workforce shortages, especially among nurses who worked long hours and experienced verbal and physical assaults. But overall, she says a number of systemic issues contribute, as well.
Paige Recker.
"It is a multitude of things. There was a shortage even in 2019," Recker says. "We're just not seeing a lot of individuals going into the health care fields."

Recker shares that rural hospitals and clinics are experiencing a shortage of surgical, pharmacy, and radiology technicians. These shortages have caused some health care facilities to reduce hours, merge with other facilities, or shut down, as was the case for Corewell Health Spectrum Kelsey Hospital in Lakeview. As a result, rural Michiganders seeking care have to travel even further.

In addition, fewer young people are going to college for health care certification programs and associate degrees because of the time and money needed to pursue a field offering a non-competitive wage. And those completing programs at all levels often are more interested in working in urban rather than rural settings.

"A lot of students just aren't prepared to work in a rural setting," Recker says.

Behavioral health workforce lagging need
 
Behavioral health is another area of heightened need in Michigan. Recker sees a growing need for bachelor's- and master's-level behavioral health professionals, social workers, psychologists, and psychiatrists in Michigan's rural areas.

"In one northern Michigan area, I think there's one psychologist," she says. "And I've heard from our colleagues that it's a six-month waiting list for a new patient to see him."
Pennie Foster-Fishman.
Dr. Pennie Foster-Fishman, project leader for the Northwest Michigan Community Health Innovation Region Behavioral Health Initiative, adds that a growing youth mental health crisis is creating a particularly acute need for mental health professionals.

"There's a lot of attention, and rightly so, being focused on making sure that we have professionals across all levels in the system that are certified, trained, and adept," she says.  

While the reasons for mental health workforce shortages are multifaceted, she says improving state policies like certification and licensure requirements could attract more providers.
 
"We have two choices: either grow our own pipeline internally or recruit more effectively from outside of our state," Foster-Fishman says. "At the state level, we need to systematically assess the number of graduate students we currently have across all of our universities. How might we best enlist them? What can we do to incentivize the next generation of students to go into the field?"
 
Another issue to be addressed at the state level is Michigan's Medicaid pay rates for behavioral health care, which are significantly lower than surrounding states.
 
"This makes it very difficult to attract and recruit staff in agencies who rely on these payment plans as their pay scales are significantly lower," Foster-Fishman says. "And it makes it very difficult to retain staff, as they are recruited into positions that can pay higher. Overall, this contributes significantly to health inequity and a lack of parity in behavioral health in Michigan."
 
Solutions in the works
 
While sounding the alarm on workforce shortages, Brim, Foster-Fishman, and Recker express hope that solutions are in the works. In the behavioral health field, Recker mentions that the Michigan legislature has introduced the Social Work Licensure Modernization Act, which could remove the Master of Social Work (MSW) examination requirement and restructure licensing so it's not as difficult for MSW degree holders to start working in their field. Encouraging young people to seek an MSW degree could help turn around the behavioral health workforce shortage.

"An MSW is a very flexible degree for lots of opportunities," Foster-Fishman says. "They can work in a lot of different types of providing organizations, from hospitals and agencies to schools, nonprofits, as well as have their own private practice."

Because the health care workforce falls short in equitably representing the state's diverse population, Brim supports creating programs as early as middle school to recruit students of color to health care careers.
 
"Our goal should be that the demographics of the workforce mirror the demographics of our population. We are nowhere close to that," Brim says. "We know from research that people have better outcomes when they have providers who look like them, speak like them."
 
Another solution is to improve the onboarding process so new nurses and other health care professionals don't burn out when they've only barely begun. In addition, efforts to re-recruit people back to the workforce could help stem the shortage.
 
"I had two providers, physicians who are younger than me, who retired in 2020 and early '21," Brim says. "I know it had to do with the frustration with trying to practice in that environment."
 
Training, recruiting, and paying a competitive living wage to peer support specialists and community health workers could also shore up the growing workforce shortage.
 
"They provide support when it's needed and where it's needed," Foster-Fishman says. "We can think about how to create policy and legislation that can expand the role they play in our state. Other states, like California, have already taken action in that way."

Recker would like to see more paid internships and paid clinical rotations in rural areas so that people enrolled in all levels of health care education could afford to move to a rural location to complete these aspects of their training.
 
Grants like those provided by the Michigan Primary Care Association, and student loan forgiveness programs like the Michigan State Loan Repayment Program and the National Health Sciences Corps Loan Repayment Program, could bring more upper-level health care professionals into the field. And career pipelines that attract people to entry-level health careers with potential for growth into better-paying positions could also stem the shortage.

"I think there's a lot of great initiatives, and hopefully, in 2024, we'll see more," Recker says.

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Melanie Brim photos by Roxanne Frith. All other photos courtesy of the subjects.