By Jolene Cleaver
Is there a nursing and physician shortage across Central New York and the Mohawk Valley?
Hospital system leaders in the region say, “yes.”
But the reasons why are complicated.
According to data by the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services, as of Sept. 27, in select Central New York counties based on local populations, Herkimer County needs 4.83 full time primary care workers; Madison County needs 4.82; Oneida County needs 18.58; Oswego County needs 7.35 and Onondaga County needs 17.95.
These data points represent the number of full-time equivalent practitioners needed in the health professional shortage area so that it will achieve the population to practitioner target ratio.
When it comes to medical care shortages, patients are sounding off and some have found their own solutions.
“Finding a good doctor in itself is a huge hurdle and then you find one and don’t like them but you just deal because who wants to go through that process again? … I would say start with your insurance, but even their resource lists aren’t updated,” said one Mohawk Valley woman in a social media post.
However, while data can point to immediate needs, healthcare officials say finding a long-term solution requires more analysis.
“Anecdotally we have heard that the staffing shortages are being felt across the state, but are certainly more significant in some areas [more of the rural areas] than others. Factors that are impacting staffing numbers include the aging and retirement of the nursing workforce, limited capacities in nursing education pipeline due to lack of clinical placement sites and lack of nursing faculty, the stress on the nursing workforce post COVID causing nurses to leave the profession,” said Jeanine Santelli, executive director of American Nurses Association, New York, in a statement.
The nursing shortage issue is not new.
A December 2023 release by the NYS Nurses Association notes: “Decades of underfunding and staffing shortages across New York have plunged the state’s healthcare workforce into crisis, requiring healthcare workers to push themselves past the point of exhaustion, working mandatory overtime with skeleton crews. Meanwhile, hospitals throughout the state are having to work with negative or unsustainable operating budgets, incentivizing the further reduction of healthcare workers, exacerbating short staffing, worsening quality of care and further destabilizing the workforce. In New York state, only 53% of actively licensed nurses are actively working as nurses, demonstrating that the state is facing more of a shortage of good healthcare jobs than healthcare workers themselves.”
Getting to the ‘why?’
In recent interviews, hospital leaders spoke to staffing challenges for both the nursing and primary care physicians in their systems.
Charleen Ryan, interim chief nursing officer at the Syracuse-seated St. Joseph’s Health system said in a statement:
“…We are lucky to have St. Joseph’s College of Nursing because it acts as a pipeline for those looking to pursue a degree in nursing. It offers traditional and non traditional programs, tuition assistance, and flexible schedules. Students undergo on-site training and preparation so once they complete their schooling they can immediately join the St. Joseph’s Health team.
“Our talent acquisition team works hard to find creative ways to reach nursing candidates. There are sign-on bonuses and other incentives; team members regularly visit local colleges that graduate nurses; we attend in-person and virtual job fairs and think outside the box as much as possible to reach nursing candidates. We have added to our talent acquisition team and started our own travel nursing program.”
Physician Michael Trevisani, interim chief medical officer, St. Joseph’s Health Hospital, added:
“St. Joseph’s has been committed to providing training for family medicine residents in Central New York for nearly 60 years. We are home to one of the original six family medicine residencies nationally and have a strong retention rate of our graduates to St. Joseph’s and the CNY region. St. Joseph’s also hosts a transitional year residency [for doctors pursuing training in fields such as radiology, dermatology, radiation oncology, etc.], a family medicine-surgical OB fellowship, as well as a general practice dental residency.
“St. Joseph’s is a clinical training site for dozens of graduate medical education programs across New York state (and beyond) for nurse practitioners, physician assistants, medical students, perfusionists, registered nurse anesthetists, midwives, marriage and family therapists, etc.
“In addition, we engage physician recruitment firms to get the message out and screen for possible applicants. Our outreach program includes advertising in specialty medical journals about the practice opportunities offered at St. Joseph’s Health. At times we also engage staffing firms to contract with physicians for shorter periods of time in particular physician-need areas. Telehealth is also utilized to tap into the expertise of physicians who do not live in our area but are licensed by New York state.”
Elsewhere around the region
In the Cooperstown-based Bassett Healthcare Network, there is a nursing and doctor shortage, officials there said.
In a recent interview, Bassett officials talked regional perspective, noting that the reality of medical staff shortages — such as nursing — are often not always what people think.
There, shortages mostly translate to in-patient care nurses.
Compounding the issue is that there are simply not enough nurses, and many seeking an education for nursing are on a waitlist because there are not enough instructors for nursing educational programs.
To the crew at Bassett, getting a nursing degree can open the door for numerous possibilities.
Once someone graduates a nursing program, “Some are going right on to further education or seeking a specialty,” said Melanie Craig, director of nursing at Bassett.
There’s also a split in this issue across the state in how urban nurses and rural nurses are working. Nurses can hop from hospital to hospital in an urban setting. However, in rural communities, they are looking at advancement opportunities, Craig said.
Fostering the next generation
In an example of creating a long-term supply and fostering a growth strategy in local healthcare professionals, work at Bassett Healthcare includes teaming with high schools and foundations to find students who are interested in medicine and foster their path to a career in medicine.
Bassett engages in a practice transition accreditation program (PTAP), which is a yearlong nursing residency program; a pipeline of sorts.
Right now, there are 40-50 graduates of the program every year, which constitutes a drop in enrollment numbers in the wake still rippling from COVID-19. At one time, there would have been double the number of students in any given year.
“Without educators, nursing programs are really paralyzed,” Craig said, pointing out issues that Bassett officials also said include teaching being cost-prohibitive for many instructors.
Also after the pandemic, some questioned whether they wanted to remain in the field after apparent burnouts. So, some left and then there were diminishing class sizes. And now, many nurses are seeking spots in the critical care, ICU and dialysis specialties.
In the Bassett network, despite the nursing shortages, the picture is not all gloom and doom and shouldn’t be cause for alarm if there is ever a large-scale health event. Bassett officials point to events such as COVID-19 as proof that when there is a catastrophe, the nursing community steps up.
At the Mohawk Valley Health System in Utica, the picture is very similar. As people live longer, there is an increasing demand for healthcare leading to a “very acute issue in central New York with an aging population and a lack of nursing and doctors,” said Darlene Stromstad, MVHS president.
The picture at Rome Health is similar, and so when it comes to the recruitment and retention of nurses. Rome Health has implemented strategies to prepare and support new nurses as they transition from the classroom to the bedside, according to the hospital.
“At Rome Health, we created the nurse extern program for senior student nurses to foster resiliency and clinical excellence,” said Chief Nursing Officer-VP Clinical Services Ashley Edwards, MSN, RN, NE-BC. “Physical and emotional burnout are lead contributors to newly licensed nurse turnover. Job stress, lack of support, inadequate training, work-life balance and low job satisfaction all contribute to burnout.”
“Retention rates double for new nurses that participate in the extern program,” Edwards said, citing retention rates of 80 to 100 percent since 2021 for externs. “At Rome Health, we are committed to setting people up for success and fostering ongoing professional development throughout their career.”
The challenges of attracting talent
At Rome Health, student nurses are hired to work as patient care technicians throughout the health care organization and there are tuition reimbursement opportunities for those meeting certain criteria.
“When the student nurse externs begin their senior year of nursing school, they receive an increase in pay and participate in monthly education sessions with the transitions to practice director. This includes communication, delegation and resiliency skills, didactic training and individualized support,” notes a statement.
When it comes to attracting nurses and physicians to the region, hospital systems are finding themselves doing a bit of promotion of the area above and beyond the job.
Hospital officials say there’s sometimes more to recruitment than educational offerings.
“This part of New York is very beautiful,” MVHS’s Stromstad said. “When you recruit, you spend a lot of time trying to recruit people to the area.”
The recruitment challenge can also be impacted by generational differences.
Stromstad said that younger generations are more open to being fluid and traveling. Nurses from older generations were more prone to stay in a position for decades.
Looking even more broadly, while rural medical physicians are hard to get, Stromstad said, there are medical residencies, but specialties like OB-GYN are hard to recruit doctors for.
In a solution, MVHS began its physician residency program in 1975 and that program continues to grow today. Also helping to create a pipeline of providers is the hospital system’s St. Elizabeth’s College of Nursing. If they stay for three years after graduation, their tuition gets waived.
“We have a lot of travel nurses coming in,” Stromstad said. “We have a stronger staff, but now we are more reliant on travel nurses, which at any point in time, can be about 20% of the nursing staff at the hospital.”
Travel nursing has also become even more commonplace in the years since COVID-19.
The benefit of travel nursing is it is an opportunity to have a broader experience by working in different communities with different needs, as well as elevated pay. Travel nurses typically stay in a location from 13 weeks to a year.
Still, despite the staffing challenges, the hospital systems all reported they are making progress and achieving upward growth for their communities.
New York state healthcare shortage solutions
In addition to hospital systems positioning themselves to grow the next generation of healthcare professionals, the state is also stepping in.
In recent months, New York Gov. Kathy Hochul announced select workforce investment organizations would receive awards totaling up to $646 million over the next three years to implement the career pathways training program, to recruit and train thousands of new health, mental health and social care workers across New York.