The Healthcare Workforce Brief: A Newsletter for Decision-Makers and Policy Makers

The healthcare system in the US is on unstable ground and, wave after wave, leaders are trying to solve one urgent issue before the next one surfaces. 

Nurses are burning out faster than new nurses are being trained, and the agencies they rely on for backup bill at elevated rates that the hospital budget cannot absorb. The international recruitment pipeline that facilities might once have leaned on runs on backlogs that stretch into years. Sign-on bonuses posted to attract permanent staff from other facilities create regional shortages elsewhere, and the wage differential between permanent staff and new/agency hires is incentivising otherwise settled clinicians to get on the move in the middle of financial cycles with shrinking operating margins. 

This is the chaos. The decisions arriving on healthcare leaders’ desks right now look like workforce decisions that could be solved through conventional frameworks: the right agency, the right signing bonus, the right job board, the right recruiter. But this has become a game of whack-a-mole. 

A Systemic Problem No Single Solution Can Fix

The Healthcare Workforce Brief exists to do one thing. In each new edition, the publication will discuss one pressing issue in each newsletter and explore how it connects to the wider systemic failures in healthcare workforce and recruiting. Through our experience as healthcare executives, administrators and researchers, we have discovered that leaders who treat this system as a series of transactions make little progress. Leaders who treat workforce management as a procurement problem and workforce decisions as tactical moves get lost in the chaos.

We see workforce management as a structural problem and workforce decisions as system design. Rather than relying on the status quo, we will examine the evidence from peer-reviewed and other credible publications, identify the structural ceilings built into the system, explore the solutions and options available, and equip decision-makers with the knowledge required to create sustainable pathways forward. This will be a twice-per-week examination of evidence, mechanisms, and implications, written for the people who are trying to run and manage sustainable facilities, not those just trying to survive the next quarterly review.

Key Focus Areas – The Pilot Season

The first season of this newsletter looks at healthcare workforce and recruiting from an economic lens as a labor market in distress. A typical labor market can be understood through pricing (wages), rarity of skills (supply), demand (the facilities and their actions), and external factors (regulators, third-party actors, etc.) Some of the highlights we will examine include:

1. Pricing: The Direct Cost of Labor and Talent Replacement

The dollar weight of recruitment and retention is not a single budget line. It is a system of interlocking drivers, and the drivers interact in somewhat predictable ways. Treating them as a list of independent variables misses the mechanism. Current hourly wages influence the ability to retain staff, the attractiveness of agency work to clinicians, the cost of agency backfill, the level of bonuses, and more.

2. Why the Supply Side Cannot Flex

In a typical labor market, sustained demand can eventually attract additional workers. Healthcare’s supply constraints make that adjustment far slower and more limited. Even if every cost pressure were resolved tomorrow, the underlying supply deficit would still be widening. Domestic schools are turning away qualified applications at volumes that exceed smaller graduating cohorts. The international channel is open on paper but throttled in practice, with country-specific backlogs stretching for years. The supply side is the structural reason the market does not self-correct.

3. Individual Corrective Action: Successes and Failures

In any competitive labor market, individual actors try to out-compete other active members to gain an advantage. Individual facilities and organizations have tried to increase permanent hires, agency conversion, and job board volume through do-it-yourself recruitment or via recruitment agencies. Each of these addresses a surface symptom, can be successful in certain settings, and has unique failure points. None of them addresses the system. The Pilot Season will examine which fixes earn their place and which extend the problem they were meant to solve.

4. External Market Influences

The decisions that move the needle are not all made inside the active labor market. The policy environment, the visa backlog, the regulatory ceiling, the employer brand, and the partnerships a hospital builds all determine whether the market can recover or whether it stays dysfunctional. The actions of third-party actors, specifically per-diem and travel agencies, skew the market for reasons unrelated to healthcare.

Decisions That Move the Needle

“Over the next 20 years, the average age of RNs will increase, & the size of the workforce will plateau as large numbers of RNs retire” – Journal of the American Medical Association.

Nothing rings truer regarding the current state of the US healthcare labor market. Except, that citation is a forecast made in 2008. It was true then, and it remains true now.

This publication is here to expose the hidden costs in a system littered with misincentives, examine the solutions that may seem difficult or inconvenient right now, and investigate which are sustainable and worth implementing. The decisions being struggled with today are the decisions that will be struggled with in a decade, by the same organizations, with the same budget pressures, with the same talent pipeline. If the systemic forces are not managed strategically, the budget cycle will keep absorbing them as line items.

The evidence is in the public record. Our analysis will be presented twice weekly. The corrective measures sit with decision-makers and policymakers, with the recruitment and staffing agencies that shape the market, and with every facility whose workforce decisions are still defended as isolated transactions rather than as elements of the system working against sustainability but focused on short-term non-clinical profits to the detriment of your facility, your patients, your clinicians, and your bottom line.

Subscribe to and follow The Healthcare Workforce Brief. The first issue of the Pilot Season goes out on Friday, August 21st.

When the next workforce problem arrives, will you treat it as another vacancy to fill, or as a system to fix?