Inpatient care will always remain a focus of healthcare’s staffing challenges. But the next hiring boom is just as likely to strike beyond the hospital’s walls, whether it’s a shopping-plaza clinic, an assisted living facility, or even a patient’s living room.
As a recent report from Staffing Industry Analysts highlights, ambulatory care employment is poised for a period of rapid growth that is bound to test healthcare organizations’ ability to attract and retain talent. Across the ambulatory sector—which encompasses clinics, physician practices, behavioral health providers, home health agencies, senior housing operators, and school districts—employment will grow by an estimated 12.2% by 2034, or more than four times the projected growth in hospital employment.
It’s a strong sign that tomorrow’s healthcare staffing challenges won’t look like today’s, and that healthcare leaders will need to level up their ambulatory care staffing strategies to compete. Otherwise, worker shortfalls could spin into access-of-care issues.
“Healthcare staffing leaders are no longer asking whether care is moving beyond the hospital,” the SIA report says, “but rather whether their business is built to support the settings where healthcare employment is growing.”
The fastest growing sectors of ambulatory care staffing growth
Physician practices will continue to be the largest driver of ambulatory care staffing demand, due to the sheer number of practices. Yet, employment in these practices is expected to grow by just under 7% by 2034. Significantly faster growth rate is projected for offices of mental health practitioners (26%), therapy offices (23%), outpatient care centers (19%) and home healthcare services (20%).
The ambulatory care roles forecast to see the highest growth loosely mirror the places where they work. Advanced practice registered nurses and physician assistants, in high demand in ambulatory settings, are projected to see employment growth of 34% and 20%, respectively. Strong growth is also expected for behavioral health counselors (17%) and home health and personal care aids (17%). Therapy fields will see steady employment growth: 11% for physical therapists, 14% for occupational therapists, and 15% for speech therapists.
What's driving the growth in ambulatory care staffing needs
The looming staffing crisis in ambulatory care staffing shouldn’t come as a complete shock. Demographic and population health trends have been building for years: an aging population, a high burden of chronic diseases that are increasingly managed outside the hospital, and surging demand for mental health services in a country where 137 million people live in a mental health shortage area.
Meanwhile, where healthcare services are delivered has also changed. Patient care has increasingly moved to lower-acuity settings, reserving expensive hospital beds for the most complex cases and lengthier stays. By 2035, outpatient cancer volumes are expected to rise by 18%, while inpatient cancer volumes remain flat. Similarly, more high-acuity procedures have moved from the hospital to ambulatory surgery centers. Now, these facilities must compete against hospitals for more specialized staff. Not surprisingly, one in four ASCs identify staffing challenges as the number-one issue.
In addition, more healthcare services are being delivered in the home, whether it’s traditional home-care or post-acute care that once took place in a hospital.
These and other similar trends are expected to continue pushing more patients into the ambulatory setting. Overall adult outpatient volumes are expected to grow by 18% in the next decade, while inpatient adult volumes will increase by just 5%.
Ambulatory care staffing shortages hurt patient access, staff morale, and the bottom line
Hospitals seek to staff themselves to manage fluctuations in patient volume, and because of their size they can often shift staff resources to fill in unexpected gaps. Outpatient facilities, on the other hand, are more sensitive to staffing shortfalls. Operating with an unfilled medical assistant role can limit the number of patients that physicians can see in a day, restricting revenue. Having an open position for an MRI technologist can cause bottlenecks in patient care, with imaging studies delayed or canceled. In nursing homes, too few nursing assistants makes it harder to get residents toileted, bathed, dressed, and fed on schedule.
Like all staffing shortages, it can spin into a self-perpetuating cycle: low staffing hurts morale, which leads more staff members to defect, which further limits access to care, and so on.
Healthcare leaders need ambulatory care staffing strategies now to avoid access-of-care emergencies later
As the saying goes, what got you here won’t get you there. Relying on a hospital-hiring model to fill ambulatory care staffing needs won’t get the job done. Go-to strategies to fill hospital workforce gaps, like hiring travel nurses, typically aren’t an option for many roles in the ambulatory setting, because the candidate pool is less likely to relocate. Filling roles often means finding talent from a narrower recruitment radius, and competing head to head with other employers in your backyard.
Whether you’re part of an integrated health system, operating a small network of facilities looking for a stable staffing model, or have a standalone facility, it’s time to take stock of the hiring challenges you are likely to face in the ambulatory setting and set your strategy.
As the NSI report highlights, it takes specialized capabilities and knowledge needed to successfully staff in certain ambulatory settings. The approach should take into account the nuances of each role type, the care setting, and the markets in which you operate.
- Home health. Adequate home care staffing isn’t solely about having the right numbers of workers, but increasing productivity. Effective scheduling and keeping visits grouped together geographically ensures that travelling home health workers see the most patients with the least time behind the wheel.
- Therapy practices require recruiters who understand discipline-specific licensing requirements. They also often keep extended hours to fit with patients’ schedules, which means flexible staffing is important.
- Behavioral health centers may deliver care through telehealth to patients in multiple states. Expertise in such models is key.
- Physician practices are becoming more consolidated, meaning that staffing programs often need to support multiple sites or manage float pools.
In short, workforce strategies to improve ambulatory care staffing often need to deliver value in ways that go beyond placing employees. The more they can integrate technology, ensure compliance, and enhance productivity, the more value they can deliver to healthcare organizations.
Frequently asked questions about ambulatory care staffing challenges
What settings are considered ambulatory care?
Ambulatory care covers a wide range of settings that include outpatient clinics, physician practices, behavioral health providers, home health agencies, senior housing operators, and school districts.
Why should healthcare leaders pay greater attention to ambulatory care staffing challenges?
Employment growth in ambulatory care is expected to grow from 8.8 million today to 9.9 million by 2034, according to a recent report. That’s an increase of over 12%, which is more than four times the rate of growth projected in hospitals.
What is driving the increase in ambulatory care staffing needs?
Less intensive services that were once delivered in the hospital are now being delivered in ambulatory settings. There is also just greater demand for outpatient services as the U.S . population gets older, more patients live with multiple chronic diseases, and people seek support for mental health conditions.
How should healthcare organizations try to avoid worker shortages in ambulatory care staffing?
The strategies will vary widely—not just by the type of facility and role but by other factors. Market patterns, such as whether there are large networks of practices in a region, can dramatically alter the approach to ensuring a stable workforce, for example.
What should healthcare leaders look for in a workforce solution in ambulatory care?
No matter the role or the care setting, look for a workforce solution that understands the nuances of your organization, your workforce needs, and your local market. You may want a partner that does more than place employees, but can also help address your other needs, whether it be productivity, compliance, technology, or something else.
