A new Wisconsin Hospital Association report finds continued challenges for hospitals seeking health care workers. In this January 2024 photo, an information screen for visitors at Sauk Prairie Hospital displays a recruiting message directed at health care workers. (Photo by Erik Gunn/Wisconsin Examiner)

As more Wisconsinites need more hospital care, the supply of health care workers to provide that care remains slim — and to change that outlook will take concerted effort, according to a new report released Monday.

“Wisconsin’s health care workforce must grow faster,” says the 2025 Wisconsin Health Care Workforce Report, produced by the Wisconsin Hospital Association (WHA).

“Health care employers are working hard to retain current employees, re-recruit those who left for what they thought might be greener pastures and attract new talent to health care fields in Wisconsin,” the report states.

The report finds some glimmers of improvement and promising pathways for hospitals to further address their need for more trained staff. Over the last two years hospital job vacancies have fallen slightly and employment has increased.

But filling jobs remains a challenge and will remain that way for years, the report states. It suggests  a combination of strategies to overcome current trends.

Some of the strategies involve  how hospitals themselves structure jobs and hiring practices. But the report contends other sectors — government, educational institutions, and the insurance companies and government programs that pay the lion’s share of health care bills — will also need to shift their policies.

Reimbursement rates are not keeping up with increased costs as hospitals and other providers weather rising payroll and supply expenses, for example, the report finds.

By far the dominant contributor to the workforce challenges hospitals and health systems face, however, is demographic, according to the report. Wisconsinites continue to get collectively older.

“Only Wisconsin’s population over 65 has grown between the 2010 and 2020 census,” said Ann Zenk, senior vice president of workforce and clinical practice for the hospital association. The working-age population ages 18 to 65 decreased in that same period.

Those younger than 40 go to the hospital once a year on average. From ages 40 to 65 that ticks up to three times a year. After 65, “it doubles to six visits a year,” Zenk  said.

“As we age, we need more health care,” she said. “That is going to be a double challenge for hospitals because our available workers are a smaller pool and our demand is even greater.”

The population preparing to enter the workforce — people ages 19 and younger — “is not large enough to replace retiring baby boomers,” the report states. “Growing the health care workforce needed to respond to this demographic challenge will require increasing in-migration, ensuring access to career pathways and increasing interest in hospital careers.”

That starts with giving students in high school or even earlier “the opportunity to have exposure — you’re walking in the shoes of what it’s like to be a health care professional,” Zenk said.

Then there’s the education process itself — “making sure that educational pathways remain accessible,” Zenk said. The report urges policymakers not to add requirements to training programs that would make them longer, more complex or more expensive.

One promising training innovation, said Zenk, is the use of an apprenticeship program to prepare new registered nurses, pioneered in the last few years in Wisconsin by UW Health and the state Department of Workforce Development.

While the program stretches over four years for the equivalent of a two-year associate degree, she said, it also allows the participating students to “earn while you learn.” The concept is being expanded to prepare respiratory therapists.

The report also identifies generational shifts in what people expect from their jobs. Zenk said addressing demands for more flexible and family-friendly schedules can make it possible to hire and retain more successfully. But those changes may also mean demand for even more personnel.

“So where you need a roster of 10 nurses, you need 15 now to cover the exact same shift,” Zenk said.

The report also sees technology offering some relief.

Some of that might be replacing people for tasks such as registering at the front desk for a medical visit, Zenk said. But another example is monitoring equipment that could go home with a patient and be checked remotely, with nurses and clinicians visiting the patient at home every day, she observed.

Zenk said some regulations in health care can be reexamined and streamlined without endangering safety or the quality of care.

Physician assistants, for example, collaborate with and are overseen by a medical doctor. Zenk said in the past a physician could supervise no more than four PAs. That has since been relaxed, making it less burdensome for both doctor and PA alike, she said.

Zenk said another form of regulation has gotten worse, however: When health insurers interpose an increasing number of steps for them to sign off on the care a doctor or hospital provides.

“That requires staff to make those phone calls or enter that data, or requires physicians to document more and more and more to justify the care that they want to provide and that the patient needs,” she said.

She’s seen insurer-driven requirements increase in the last five years.

“That’s a major tug-of-war on clinicians’ time,” Zenk said, “and for patients also very frustrating.”

In the end, however, there’s no single silver bullet to resolve what is likely to be a persistent challenge for hospitals or their employees.

“There’s no one answer. We’re more than likely not going to be able to grow ourselves out of this one fast enough,” Zenk said. “But anything we can do to grow the workforce faster is going to help.”