Health care employment and the current economic recession.

NCMed J July/August 2009, Volume 70, Number 4 efore the economic downturn hit North Carolina, many stakeholders had voiced concerns about whether the supply of health professionals in the state was adequate to meet growing demand. In 2007, the North Carolina Institute of Medicine issued a report indicating that the supply of physicians, nurse practitioners, physician assistants, and certified nursemidwiveswasnot keeping pacewith population growth and that significant inequities existed in the distribution of providers across the state. In 2008, the North Carolina Hospital Association (NCHA) reported that its member hospitals had over 8,000 vacant positions, more than half of which were for nurses. Then, in a relatively sharp turn of events, and as the North Carolina labor market began to feel the effects of the recession in the fall of 2008, news reports began to emerge about hospitals implementing hiring freezes and recent nurse graduates finding it increasingly difficult to find jobs. The new economic reality caused speculation that the recession had “solved” North Carolina’s health workforce shortages. However, despite numerous anecdotal reports that the demand for health care workers had slackened and supply had increased, little empirical evidence existed documenting that the downturn in the economy had in fact caused a decline in health care employment. There is extensive literature detailing the link between economicexpansionand increases inhealthcareemployment. Analyses have found that for every 1% increase in gross domestic product (GDP), health care employment rises by 1.2%, and health care utilization increases by 1.5%.However, while there is ample evidence of a relationship between economic expansion and increases in health care employment, less documented is the effect that a recession has on the employment prospects for physicians, nurses, and other health professionals. Does health care employment decrease in response to economic downturns at the same rate that it increases in response to economic upswings? Is the effect immediate or lagged? This commentary briefly summarizes what is known about the effect of the economic downturn on the supply of health professionals in North Carolina. The key message is that if North Carolina policymakers refrain from making decisions based on short-term economic trends, we can use this time as a unique opportunity to thoughtfully plan for, and build, a future supply of health professionals who are well-distributed across the state.