by Dan O'Donnell, Anita Nambiar, Eric Hammons

To read the daily headlines, the casual observer might think America’s clinical workforce worries began with COVID-19. But as every healthcare professional knows, the root problems existed long before the pandemic. COVID-19 exacerbated longstanding systemic issues, including inequities based on gender, racial and socio-economic bias.  

The pandemic brought things to a breaking point, leading to “the great resignation” of thousands of physicians, nurses, and other clinicians nationwide. According to a recent 2021 study of 20,000 respondents in 124 U.S. healthcare institutions, the clinical attrition is at an all-time high, with one in five doctors planning to exit within two years. The report sounds a sobering alarm: “The U.S. healthcare workforce is in peril. If even one-third to one-half of nurses and physicians carry out their expressed intensions to cut back or leave, we won’t have enough staff to meet the needs of patients.1

At the same time, the bar to attract and retain clinical professionals has changed irrevocably, and growing expectations around diversity, equity and inclusion (DEI) are part of the reason. A 2021 Press Ganey study of 118 health systems and 410,00 healthcare workers underscores the outsize influence DEI has on retention: “Healthcare organizations had twice as many employees at risk of leaving if the workforce perceived diversity and equity weren’t prioritized versus workforces that do." 2

What does DEI mean to clinical professionals?  ​

At a minimum, it means the assurance of equitable pay and paths to career advancement. It means a supportive culture that reflects, and rewards, their mission-driven sense of purpose. It means greater autonomy and respect for the highly skilled work they do. It means employers care about their emotional and mental health as they work long hours in often-overwhelmed facilities. And, as the pandemic wanes, it means that “getting back to normal” isn’t where they want to go.  ​

How did healthcare get here? ​

The medical profession’s long, systemic history of hierarchy plus gender and racial bias’ impact on equitable opportunities for advancement begins in medical school. Restrictive and unequal entrance requirements and opportunities for advancement disproportionately impact women and people of color.3,4

Evidence shows that male-dominated surgical specialties have higher status than primary care—especially in pediatrics, where most clinicians are women. A JAMA review of ~43,000 Implicit Association Test records and a cross-sectional study of 131 surgeons notes that “healthcare professionals and surgeons hold implicit and explicit biases associating men with ‘careers and surgery’ and women with ‘family and family medicine.’" 5 This can be seen in the reduction of pay parity for women: “… lack of transparency, pay models that value male work patterns and, more recently, the pandemic’s toll, mean women physicians still earn 72 cents on the dollar compared with their male peers. And that gap has widened during the past five years." 6< Compounded​ by constant reminders of inequality and exhausted from scrambling to prove their value, while managing disproportionate share of domestic duties has absolutely discouraged women from selecting more demanding surgical specialties, creating an endless loop because there aren’t enough new female surgeon entries to demand change.  ​

These biases and inequities contribute to a rate of burnout among clinical professionals that is higher for women, people of color, and those in lower-paid clinical areas. And the results are even more dire than valued clinicians leaving their profession; suicide is a growing tragedy across the clinical spectrum, especially among female physicians who are 46% more likely to die by suicide than women in general.7

Where do we go from here?  ​

The red light is flashing. In order for healthcare organizations to compete for the clinical professionals they must have an effective clinical workforce strategy—with DEI as a strategic pillar. ​

No clinical workforce strategy is complete without DEI ​

Most large healthcare systems have some level of workforce strategy for attracting and retaining clinicians, but many have yet to incorporate DEI in measurable ways. Many healthcare systems have yet to fully absorb DEI’s growing influence on their reputation and future reimbursement. As the industry shifts to value-based care, equity is an issue payers are scrutinizing across patient populations and healthcare workforces. Investors and other key stakeholders see DEI as part of a healthcare organization’s Environmental, Social and Governance (ESG) performance, which is of rising importance in the shift toward risk-averse investment in sustainable companies. ​

We believe DEI is so critical to healthcare organizations, and if your organization aims to attract and keep talented, in-demand clinicians, you simply can’t get where you want to go without it.  ​

Based on our work with dozens of healthcare leaders around the country, here are a few proven essentials for using DEI to drive an effective workforce strategy. ​

Make it meaningful ​

According to the Press Ganey study of healthcare workers, one of the main reasons they are most at risk of leaving their jobs is if “they don’t feel their work is meaningful." 2  Even during the pandemic, lack of meaning outweighs stress on the job as a reason for leaving. ​

Making DEI a pillar of your clinical workforce strategy is a powerful way to instill meaning that matters to clinicians—and it’s a process. That requires knowing what matters to them. You may want to conduct formal and informal surveys of various clinical groups. Reach out to nursing leads and other frontline managers who understand their people best and can point out specific things they need that can help them do their best work. Create situations where people feel safe being candid. Find ways to communicate that diverse perspectives are encouraged, heard, and incorporated into policies and initiatives. ​

Once you have those diverse perspectives, DEI can help in the important work of segmenting your clinical workforce strategy. Each individual has their own unique needs and experiences. An effective workforce strategy is built on understanding where there are commonalities, where there are differences, and when to go beyond one-to-many tactics to include one-to-few and one-to-one tactics.  ​

For example, you might find new and better ways to tailor benefits to individual needs. The clinical workforce’s current and future needs go beyond compensation-only approaches to consider unique arrangements or benefits that create understanding and a demonstration of support from their employer (e.g. adding a childcare benefit). Aligning benefit options with individual priorities not only adds tangible value to compensation; it shows understanding and respect. ​

Scheduling is a hot issue that many healthcare systems are individualizing in order to keep their clinical professionals, especially women. Inflexible work hours are contributing to the exodus of female nurses and physicians. Many female physicians, who make up 33 percent of all U.S. physicians, no longer want to work full-time.8 Healthcare systems that make it possible for clinicians to have greater flexibility and control over their schedules give them a highly valued reason to stay.  ​

DEI is just as valuable to recruitment efforts as it is to retention. For the foreseeable future, it’s an employees’ job market in healthcare. As clinicians become increasingly selective about where they work, diversity, equity and inclusion are increasingly important to attracting them. DEI can help build and burnish your reputation as an employer of choice.  ​

Clear DEI-driven policies for internal mobility, leadership opportunities, mentorships and sponsorships create an environment of fair and equitable advancement. Sharing these policies upfront can assure potential recruits, as well as your existing workforce, that promotions are based on consistent, measurable assessments and standards. ​

DEI Milestones

Make it sustainable ​

We see DEI playing anincreasingly important role in retention, which is key to an organization’s sustainability. Clinical workforces are more diverse than ever, and people stay in workplaces where they feel they belong and are treated equitably.  ​

Indeed, diversity is so important to job satisfaction and retention that it’s increasingly called out at the C-level with the addition of Chief Diversity Officers. Some healthcare systems are also adding Chief Wellness Officers (CWOs), an indicator of how important wellness is to job satisfaction and retention. CWOs focus on helping clinical staff members deal with many of the unique issues they face—including emotional trauma, making friends outside their all-absorbing jobs, and having a healthy family life at the end of an intense shift. CWOs can help audit and mitigate the risk of losing clinicians to burnout by addressing issues before they end careers and erode resource capacity. ​

DEI-related workforce strategies must come from the top in order to be successful and sustainable. While valuable input for DEI initiatives can and should bubble up from the bottom, the change-making needs to be prioritized at the very top of the organization. Leadership needs to understand the underlying issues and actively drive bold, actionable solutions. Without strong leadership on DEI, people won’t take it seriously.  ​

Sustainable DEI initiatives need to be ingrained in goals, bonuses, and whatever other incentives that will make change successful in your organization. Like other essential changes in healthcare, such as patient privacy laws and IT security, DEI must be an unequivocal mandate at the top that’s supported by board-level engagement, clear governance, policy-level changes, and measurement strategies that track progress. Leaders at all levels of the organization must be accountable for DEI goals within their sphere of control.  ​

 

The bottom line on DEI: Do it right; do it now ​

DEI is not optional; it’s existential. It is the solution to systemic problems that will only grow in scale and risk if left unaddressed. Healthcare organizations that want to be employers of choice are taking steps now to make DEI a pillar of their clinical workforce strategy. Meanwhile, those that drag their feet will lose valued clinical professionals, market share and revenue—risking their reputation and becoming vulnerable to buy-outs. ​

With the onerous demands on every healthcare organization’s time, attention and resources, it may never feel like the best time to start. But there is a right time: right now. Your healthcare leadership doesn’t need to go it alone. Point B brings the expertise, empathy, and bandwidth to move your organization forward with a DEI-driven clinical workforce strategy that protects your most important asset: your people.

 

Sources

(1) https://www.mcpiqojournal.org/article/S2542-4548(21)00126-0/fulltext

(2) https://www.pressganey.com/about-us/news/press-ganey-uncovers-impact-diversity-equity-on-retention

(3) https://www.degruyter.com/document/doi/10.1515/jom-2020-0212/html?lang=en

(4) https://www.aamc.org/data-reports/students-residents/interactive-data/2021-facts-applicants-and-matriculants-data

(5) https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2737309

(6) https://www.modernhealthcare.com/physician-compensation/transparency-key-pay-parity

(7) https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2762468

(8) https://hbr.org/2022/01/why-so-many-women-physicians-are-quitting