Abstract
BACKGROUND: While the COVID-19 pandemic undoubtedly catalyzed healthcare workforce challenges, alone it does not explain ongoing workforce shortages. This study examines how broader economic trends and industry competition may influence worker movement in and out of healthcare. This analysis aims to (1) examine healthcare worker leaver rates over time, (2) quantify the strength of the relationship between national unemployment and healthcare worker leaver rates, and (3) describe variation in this relationship by worker characteristics. METHODS: This observational, repeated cross-sectional study used nationally representative data from the 2003-2022 Annual Social and Economic Supplement of the Current Population Survey. Respondents are adult US civilian individuals employed in the healthcare industry. For each year, we defined healthcare leavers as individuals in healthcare-specific occupations who reported exiting the healthcare industry between the prior and current year, including workers who (1) changed industry, termed "industry leavers", (2) left the labor market, or (3) became unemployed. We compared healthcare leaver rates among healthcare workers to unemployment rates for all US workers with particular focus on industry leavers. Leaver rates were analyzed by worker sociodemographic and occupational characteristics. RESULTS: Healthcare industry leaver rates had a moderate negative correlation with the US unemployment rate (r=-0.58, p = 0.007) and unemployment rates in several competing industries of professional services (r=-0.61, p = 0.005) and retail (r=-0.58, p = 0.008), but weaker insignificant negative correlations with hospitality (r=-0.29, p = 0.215) and educational services unemployment (r=-0.21, p = 0.375). Weak to moderate negative correlations were noted between the US unemployment rate and industry leaver rates of workers in high (r=-0.32, p = 0.169) and medium (r=-0.52, p = 0.020) education groups, while industry leaver rates in low education groups had a stronger negative correlation with the unemployment rate (r=-0.60, p = 0.005). CONCLUSIONS: The easing of pandemic-era stresses on healthcare has not resolved healthcare workforce shortages. The findings of this study on historical employment trends suggest that when overall unemployment remains low, healthcare employers may struggle to recruit and retain workers due to competition from other sectors. Findings suggest that healthcare employers should take a long-range, cyclical view of worker shortages by tailoring their workforce strategies to current economic conditions while planning for the next cycle.