States and medical organizations are taking steps to prevent health care workforce shortages, which could emerge because those on the front lines are among the most at risk for contracting COVID-19. Loosening licensure requirements is a big part of these efforts in many states.
Half of the U.S. residents exposed to confirmed COVID-19 cases were health care workers, according to Centers for Disease Control and Prevention data issued last week.
“This trend will accelerate in the coming weeks and months, as health care workers increasingly come into contact with patients with COVID-19 and shortages of masks and other personal protective equipment worsen,” reads a Health Affairs post published Wednesday. “New infections among health care workers may skyrocket.”
In an effort to ease some workforce shortage concerns, Vice President Mike Pence announced an emergency order Wednesday requiring the Department of Health and Human Services to move toward allowing physicians to practice across state lines. Some states have already taken steps toward easing licensing restrictions for providers, and the federal move could make it easier to focus resources on areas that have been especially hard hit.
Last week, South Carolina medical and nursing boards expedited the process for out-of-state physicians, physician assistants and respiratory care practitioners to get licensed in the state for 90 days.
“The ability to expedite this licensure process gives us greater assurance that we will have the medical health professionals and resources we need in order to keep South Carolinians safe,” said Republican Gov. Henry McMaster.
This week, Colorado also announced licensing changes. The state’s Division of Professions and Occupations under the Department of Regulatory Agencies said Wednesday that it would begin temporarily expediting licensing to stem workforce issues.
The move would allow for late renewals and reinstatements of licenses during the emergency, expand the scope of practice for nurses and physician assistants, and allow pharmacists to administer vaccines.
“This virus will put a strain on our systems and health care worker heroes on the front lines of this battle,” said Democratic Colorado Gov. Jared Polis, adding that the changes will help cut through red tape on medical licensing.
Experts warn that recruiting retired physicians and nurses onto the front lines, which is under consideration in several states and on the federal level, could be dangerous.
Janis Orlowski, chief health care officer for the Association of American Medical Colleges, told reporters on a call Thursday that the group has discussed expanding the workforce to retired providers with multiple federal agencies.
“The problem with bringing retired physicians and nurses back in is that, first of all, that they are at an age where the morbidity and mortality of this disease is higher, and they may not have recent training,” she said. “The question is, how can we bring people up to speed and bring them in?”
She added that retired providers could fill roles in ways that don’t require direct care for COVID-19 patients.
Utilizing existing professionals
Medical students, residents and pharmacists are all looking at ways to increase their involvement in combating the pandemic.
The National Association of Chain Drug Stores this week wrote to congressional leaders and Pence asking them to consider implementing a policy that would give pharmacists status as medical providers for Medicare drugs that are typically administered in a doctor's office.
“Establishing pharmacists as providers in Medicare Part B can further bolster an important access point for care for those afflicted by COVID-19 as well as supplement a national health care system that may be severely overtaxed by the response to the virus,” the letter reads. “The Secretary should authorize that pharmacists be recognized as providers under Medicare Part B subject to state scope of practice laws in order to assist in the response to the COVID-19 outbreak.”
The AAMC said schools are looking at creative ways to expand the workforce.
“Initially, some of the discussions ... had to do with licensing, had to do with the use of telehealth; those are all being addressed right now. The other issue that we have been talking about is making sure that all professionals are practicing at the top of their license,” said Orlowski, meaning providers perform duties that use the full extent of their training.
Medical students may conduct follow-up calls on post-operative patients or staff phone lines for people seeking COVID-19 information, or check in by phone with self-quarantined patients.
“Our schools are continuing to evolve and develop new, really meaningful ways for our students to contribute,” said Alison Whelan, chief medical education officer for AAMC. She said schools are looking to balance teaching clinical care with public safety.
The strategies may soon have to evolve.
“There are portions of our country that are beyond that containment and are really facing a surge, and we recognize that if there is a surge of cases potentially combined with limited health care professionals because they are either quarantined or ill, that there may need to be a rethinking of how to use medical students and bringing them back to the front lines,” she said. “We are working with our medical schools on developing principles and guidelines for this.”
Problems persist nationwide providing care workers with personal protective equipment, or PPE, which is in short supply. Hospitals are currently trying to limit the number of providers in direct contact with COVID-19 patients to preserve resources.
Hospitals are trying to preserve PPEs such as masks while still providing care, but they may need to increase the number of providers on the front lines.
“It will definitely be a local decision,” said Whelan, adding that it will need to balance the issues of critical care, public health safety, and the individual safety of the health care provider. “As we have talked to our colleagues across the country, it’s very clear that what circumstances we are doing depends on the local problems with what they are experiencing.”