Will the RN workforce weather the retirement of the boomers?

David Auerbach, PhD6/11/2015

http://healthworkforcestudies.com/

2

The baby boom bulge

3

1973

1975

1977

1979

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

2015

2017

2019

0

500

1000

1500

2000

2500

3000

Forecast of Total RN FTEs (2000-2020) vs. 'Re-quirements' (HRSA), with 90% confidence intervals

Forecast

Actual

Requirements

Year

FT

Es

(in

th

ou

sa

nd

s)

In 2000, we had forecast RNs would peak in 2012

Buerhaus, PI, Staiger DO, and David Auerbach, “Implications of a rapidly aging registered nurse workforce,” Journal of The American Medical Association (JAMA), 238 (22), June 14, 2000

4

Then nursing school enrollment surged…

Buerhaus, PI, Staiger DO, and David Auerbach, “The Rapid Growth of Graduates from Associate, Baccalaureate andGraduate Programs in Nursing,” Nursing Economics, 2015

Number of nursing degrees awarded, by type

5

1973

1975

1977

1979

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

2015

2017

2019

0

500

1000

1500

2000

2500

3000

Forecast of Total RN FTEs (standard scenario) vs. 'Requirements' (HRSA)

Forecast

Actual

Requirements

data to 2013

Year

FT

Es

(in

th

ou

sa

nd

s)

…As did total RN supply

6

But demand has now ratcheted up as well

1973

1975

1977

1979

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

2015

2017

2019

2021

2023

2025

2027

2029

0

500

1,000

1,500

2,000

2,500

3,000

3,500

Forecast

Actual

Requirements

New demand

Year

FT

Es

(in

th

ou

sa

nd

s)

HRSA (2014) newdemand estimate and projection

*HRSA (2014) 2012 demand estimate was adjusted to match our 2012 FTE RN count

21% growth3.27m

7

1m RNs over 50, but surging enrollment

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-690

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

1983199320032013

Age

Nu

mb

er

of

FT

E R

Ns

8

Will new entry outpace retirements to reach 3.27m RNs in 2025?

•Little uncertainty on retirement

•New entry is the bigger question

9

In our most recent forecast, we were uncertain whether enrolment surge would continue

David I. Auerbach et al. Health Aff 2011;30:2286-2292

©2011 by Project HOPE - The People-to-People Health Foundation, Inc.

10

Propensity to become an RN for birth year(1955=1.0)

1924

1927

1930

1933

1936

1939

1942

1945

1948

1951

1954

1957

1960

1963

1966

1969

1972

1975

1978

1981

1984

1987

1990

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

Prev forecast(2 scenarios)

New forecast

11

Annual NCLEX-RN test takers

12

New forecast assumptions

•Future cohorts will be of similar population-adjusted size as most recently observed (1986-1990 birth years

•Age patterns will reflect recent delayed retirement trends*

Auerbach, David I., Peter I. Buerhaus, and Douglas O. Staiger. "Registered Nurses Are Delaying Retirement, A Shift That Has Contributed To Recent Growth In The Nurse Workforce." Health Affairs (2014): 10-1377.

13

Supply forecast: 3.14m in 2025

-

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

Shortage ~100,000 RNs

HRSA demand est.

1979-2004: 2.8% ann. growth

2004-2013: 3.1% ann. growth

2013-2030: 1.2% ann. growth

14

Workforce dynamics, past and projected

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

2015

2017

2019

2021

2023

2025

2027

2029

0

20000

40000

60000

80000

100000

120000

140000

en-try

exit

projected

Entry, e.g.: start with RNs age 23-49 in 2012. Compare to RNs age 24-50 in 2013 (same cohort). Add in 23 yr olds in 2013.

15

Age distribution of RN workforce

1985 2000 2015 (proj) 2030 (proj)37.9 42.5 44.4 43.9

-

200,000

400,000

600,000

800,000

1,000,000

1,200,000

20s30s40s50s60s

YearAverage age

16

Conclusion

•Assuming new entry continues at recent levels, supply growth will outpace retirements

– Workforce will continue to grow, in absolute numbers, and per-capita

•Net growth will be slower than in prior periods– And not quite enough to reach HRSA’s demand

estimate• ~100,000, or 3% shortfall in 2025

17

Comparison to HRSA supply estimate

•110-120,000 ‘entry’ per year between 2014 and 2025

– Leaves shortage of ~100,000 RNs by 2025

•HRSA supply model, in contrast assumes ~150,000 entry per year

– Based on domestic NCLEX test-takers– Results in surplus of ~300,000

18

Attrition from test-takers

Domestic NCLEX test-takers FTE RNs

+ Internationally-educated RNs- Never pass test

- Never become licensed

- Work part time (~20%)

- Never work in nursing (~10%)

19

Observed workforce: 2007-2013

-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

Test-takers

850,000

270,000

Retirements

580,000

370,000

Expected net increase

Actual net increase

20

Extensions

•How does the supply/demand story vary regionally

•How have ACOs and delivery system reforms affected RN workforce

– Numbers– Hospital/ambulatory– Earnings overall and by setting

•Do we have the ‘right’ supply of skills, competencies

21

Thank you

• Peter I. Buerhaus, Douglas O. Staiger, Christine M. Friedman

• Center for Interdisciplinary Health Workforce Studies

• Http://healthworkforcestudies.com– Annual (MDs, NPs, PAs, MAs) and quarterly

(RNs) workforce data• Earnings, employment, work setting, hours

– Issue briefs and other publications

22

23

Percent of RN workforce with >= Master’s degree

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

24

>1,000,000 RNs over age 50 today(36% of workforce)

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

-

200,000

400,000

600,000

800,000

1,000,000

1,200,000

FTE RNs, by age group

FTEs, age 50+

FTEs, age 35-49

FTEs, age 21-34

Year