The U.S. is facing a severe and growing shortage of healthcare professionals, with more than 124,000 doctors and 450,000 nurses projected to be missing from the workforce by 2027, according to projections published in November 2024 by the National Center for Health Workforce Analysis.
The number represents doctors who work 40 hours a week across all specialties. The outlook for registered nurses and licensed practical nurses working full time is even worse, with deficits of 307,010 and 146,710 predicted respectively in 2027.
As aging populations strain demand and burnout thins the ranks, many hospitals — particularly in rural areas — are turning to short-term staffing solutions, including Locum Tenens physicians and traveling nurses.
While staffing challenges are not new, the problem has been exacerbated in recent years by a variety of factors, including an increased need for care to serve an aging population, training hurdles, and of course clinician burnout exacerbated by the COVID-19 pandemic, which led some to leave the profession, and in other cases to accept more lucrative travel employment, especially nurses.
Michael (Mick) Krasner, M.D., co-chief medical officer and vice president of education at EmPRO Insurance Company, said to help bridge the gaps, healthcare institutions such as hospitals, rehabilitation and long-term care facilities, especially those in rural areas facing budgetary constraints, have increased their reliance on Locum Tenens physicians and traveling nursing staff to fill short- and long-term needs.
The early 2000s in particular started seeing more shortages, with the release of multiple state and national assessments of the physician workforce, Krasner said, with the concerns mainly centered on the supply of primary care physicians.
Then during the pandemic, many health professionals, especially in the nursing professions, began looking at taking more control over their short-term futures, given the longer-term uncertainties, he added.
“If you do not have a family and are free to travel, it can be a very lucrative prospect, given that the financial incentives are greater,” Krasner said. “It is not unusual for traveling nurses to earn six-figure incomes.”
Krasner said while bringing in short-term employees can help institutions solve shortage issues, it can also increase risk and liability.
“Medicine is more and more a team sport,” said Krasner, who is also professor emeritus at the University of Rochester School of Medicine & Dentistry. “Whether a primary care provider or a surgeon, the individual professional is part of a team where clear and effective communication between members who understand the local institutional policies and protocols directly correlates with higher quality outcomes and lower risk.”
Krasner added that when a professional is brought in from an outside agency, there is a necessary learning process to understand local policies, protocols, and team workflows, which often differ from location to location.
“An outside clinician, unversed in institutional procedures and culture, can introduce risks that compromise the team’s ability to deliver optimal care,” he said. “This, in turn, can translate into increased liability for both the provider and the institution.”
Litigation trends related to shortages
Amanda Speier, partner in the litigation and dispute resolution department at Atlanta-based Taylor Duma, identified a number of litigation trends related to the shortages.
“I am seeing an increase in negligent supervision claims,” she said. “The lawsuits argue that a negative outcome was related to a lack of supervision by one provider over another or the facility over staff generally. If a plaintiff’s attorney finds out for example that a physician was supervising more mid-levels than he or she was supposed to, an argument can be made that the facility is poorly run.”
While these suits are not new, Speier said they have grown because of staffing shortages.
She added that she is also seeing claims for vicarious liability against physicians based on mid-level provider conduct.
“Most states have some type of supervisory requirements,” Speier said.
In Georgia, for example, physicians who supervise nurse practitioners are only required to review 10% of the person’s charts, with some exceptions, she said.
“We are seeing claims against physicians where the doctor may not have seen the patient or authorized the care provided by the mid-level provider,” Speier said. “Agency arguments to establish vicarious liability is an area of Georgia law that remains unsettled and whenever something is unsettled, you will see claims.”
Additionally, she noted a disconnect in which jurors are awarding big verdicts against their local hospitals.
“I think there’s a feeling that the outcome of these cases will not affect them,” Speier said. “The reality is that high verdicts cause local hospitals to close.”
The big picture, she said, is that healthcare entities are doing what they can to address staffing shortages and trying to make it work.
“As long as these measures are reasonable, we can defend them in court,” Speier said.
