The Covid pandemic has exacerbated those shortages due to illness, death and despair among health professionals. JL
APM Research Labs report:
By 2032, the U.S. will face a shortage of up to 122,000 physicians. The need for nurses is even more dire—the country will have to hire at least 200,000 nurses per year to meet increased demand. Based on these guidelines, as of July, 2021 95% of U.S. counties had communities considered shortage areas. When looking at instances where the entire county is a shortage area, the proportion remains a majority, at 60%. Among nonmetropolitan counties, the proportion is even higher—68% of counties are entirely HPSAs.Across the country, communities are being affected by a shortage of health professionals, including primary care physicians, registered nurses, mental health professionals and more. By 2032, the U.S. will face a shortage of up to 122,000 physicians, according to the American Hospital Association. The need for nurses is even more dire—the country will have to hire at least 200,000 nurses per year to meet increased demand and replace retirees.
The federal government’s Health Resources and Services Administration classifies areas with fewer than one primary care provider for every 3,500 residents as Health Professional Shortage Areas (HPSA). Based on these guidelines, as of July, 2021 95% of U.S. counties had communities that are considered shortage areas. When looking at instances where the entire county is a shortage area, the proportion remains a majority, at 60%. Among nonmetropolitan counties, the proportion is even higher—68% of counties are entirely HPSAs.
As is the case for its hospital closures and uninsured rates, Texas stands out when it comes to the prevalence of its HPSAs. Only five Texas counties—four of which are metropolitan—have a sufficient number of primary care physicians for their populations based on the federal guideline. A stunning 82% of Texas counties are entirely shortage areas, meaning there is fewer than one primary care physician for every 3,500 residents in the county. The situation in Texas has worsened since 2019—99 more counties identify as primary care provider shortage areas this year than did so two years ago.
Workforce shortage has been documented as a major cause of hospital closures, especially in rural areas. According to the American Hospital Association, fewer than 10% of U.S. physicians practice in rural communities even though almost one-fifth of the national population lives in those areas. In Texas, 21 out of its 24 rural hospital closures since 2005 were located in counties that are entirely shortage areas in 2021.
The COVID-19 pandemic has likely exacerbated the already desperate situation. As a result of stress, trauma and burnout, many health care workers have been struggling to continue to do their job. A recent Washington Post-Kaiser Family Foundation survey found that nearly 30% of health care workers are considering leaving their profession and 60% said the pandemic had a negative impact on their mental health. Among registered nurses, the nationwide turnover rate has already been on the rise, climbing to 18.7% in 2020—nearly 3 percentage points higher than the previous year’s rate.
Even relatively early in the pandemic, in August, 2020, the Texas Department of Health estimated a statewide shortage of 29,000 registered nurses and 64,000 physicians, leaving one in every 10 of each positions unfilled. Further, the department projected that these shortages would only worsen over the next 12 years such that the state could be facing a 16% shortage of registered nurses and a 13% shortage of physicians by the year 2032.
Funding health care through hospital districts
Hospital districts are geographic regions in which residents pay to fund a local hospital, typically through property or sales taxes. These districts can provide communities with a recurring health care funding mechanism for its poorest populations, especially for those who are underinsured or without health insurance.
Voters in the area hold the power to both create and dissolve their local hospital districts. Creating a district generally springs from a community’s desire for better access to health care, while opposition tends to stem from residents’ reluctance to raise taxes. In 2015, Bowie Memorial Hospital in Montague County closed after residents voted down an effort to create a hospital district that would have raised taxes by 17 cents per $100 of home value, or $170 per year on a $100,000 home.
But hospital districts do not always guarantee financial stability for the facilities they support. In some cases hospitals in these districts have closed—like Hamlin Memorial Hospital in the Hamlin Hospital District—but taxes continue to be collected.
The APM Research Lab identified 140 hospital districts that submitted property tax records to the Texas Comptroller of Public Accounts as of 2020. The borders of many hospital districts align with county boundaries, though this is not always the case. Some counties have multiple hospital districts—Jones County, for instance, has three—while other hospital districts may cross county lines, like Big Bend Regional Hospital District.
While Texas’ hospital districts offer a unique approach to funding health care, little research appears to exist on their efficacy. Hospital districts operate in roughly half of all states, though none have as many as Texas. Use of these districts by other states does not appear to have grown in recent years. However, 38 states and the District of Columbia have opted to increase funding for low-income health care through Medicaid expansion, an approach that Texas has not adopted.
The future of rural hospitals in Texas and across the U.S. remains uncertain. In March, President Joe Biden signed a $1.9 trillion COVID-19 package that includes $8.5 billion for rural hospitals. Reps. Tom Reed (R-NY) and Terri Sewell (D-AL) also recently introduced the Rural Hospital Support Act, which may help level the playing field for hospitals in small and isolated communities in comparison to their larger counterparts.
In the meantime, rural hospitals are doing what they can to serve their communities.
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