Healthcare staffing shortages have persisted since World War II, but in the last 25 years, the problem has escalated dramatically. Apart from the brief reprieve during the 2006-2008 financial crisis, there have consistently been more open positions than there are qualified candidates to fill them — especially in nursing.

By the early 2000s, media reports were already highlighting severe shortages, and despite nearly 10% national unemployment by 2010, the demand for nurses still far outpaced supply. The question of why there aren’t enough nurses has lingered for years. Now, in 2024, the situation remains as critical as ever. But to understand why it’s been so difficult to solve, we need to dig into the core factors driving this ongoing shortage.

Supply and Demand Imbalance

At its core, the nursing shortage is a result of a persistent imbalance between supply and demand. The reality is simple: There are more open positions than qualified nurses. Healthcare providers are not just grappling with recruitment challenges — they face a systemic workforce shortage. When demand increases in an environment with a limited supply, costs inevitably rise. Labor now accounts for more than 50% of hospital expenses, making staffing shortages a significant driver of higher healthcare costs.

The Education System Can’t Keep Pace

While the US education system has made strides in training more nurses, it still falls short of meeting the growing demand. From 2019 to 2021, the number of registered nurses (RNs) in the US grew five times faster than the population overall. However, the demand for nurses continues to outpace this growth, increasing by an average of 6% each year, while the rate of new graduates only increases by 3% annually. We’re playing catch-up in a game where demand is outstripping supply.

International Recruitment Helps, But Only So Much

One solution has been international recruitment. Today, one in six RNs working in the US was educated abroad. Many healthcare providers have turned to this strategy to bolster their workforce. However, outdated US immigration policies severely limit the potential of this approach. Strict visa caps that don’t reflect the current labor market mean employers often have to wait one to three years for international recruits to arrive. Reforming the immigration system to align with healthcare market needs could be a significant step toward closing this gap.

Taking the Work to Where the Workers Are

Given the persistent supply and demand imbalance, coupled with the fact that we can’t produce enough graduates or bring in enough internationally trained nurses, healthcare employers are now exploring a new option — taking the work to the workers. Thanks to the widespread adoption of remote work and video technology, it’s possible to have clinical and administrative work done by highly qualified professionals outside the US.

The healthcare insurance industry is already leading the way, with major providers employing tens of thousands of clinical and non-clinical workers abroad. This strategy could offer a much-needed solution to ease the strain caused by staffing shortages in the US healthcare system.

Addressing the Crisis

The path forward must tackle key issues while preparing for new challenges like the declining birthrate and aging population. Graduating more nurses is crucial, but with US college enrollments set to drop 15% by 2025, recruiting foreign students will be essential.

Modernizing the US immigration system to align with labor needs is also critical, allowing more healthcare workers when unemployment is low.

The most impactful solution may be leveraging a global, tech-enabled workforce of clinicians and support staff to fill positions from abroad.

To prevent this crisis from worsening, policymakers, educators and healthcare providers must take immediate action to boost the workforce supply. With healthcare demand only increasing, the urgency for comprehensive, long-term solutions has never been greater.