Changes in Employment in the US Health Care Workforce, 2016-2022

Nguyen, Thuy; Whaley, Christopher; Simon, Kosali I.; Cantor, Jonathan

doi:10.1001/jama.2023.18932

Cited by 5 publications

(2 citation statements)

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“…The J2J data also did not include finer detail on industries beyond the 2-digit NAICS codes or information on worker occupations; therefore, we were unable to examine differences in job flows across different health care settings. Given the heterogeneity of the health care workforce and findings from other studies reporting differing implications of the pandemic for different industries within health care, the present analysis highlights the potential benefits of publishing more granular data for industry and/or occupation categories.…”

Section: Discussionmentioning

confidence: 87%

Job Flows Into and Out of Health Care Before and After the COVID-19 Pandemic

Shen,

Eddelbuettel,

Eisenberg

2024

JAMA Health Forum

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ImportanceAnecdotal evidence suggests that health care employers have faced increased difficulty recruiting and retaining staff in the wake of the COVID-19 pandemic. Empirical research is needed to understand the magnitude and persistence of these changes, and whether they have disproportionate implications for certain types of workers or regions of the country.ObjectiveTo quantify the number of workers exiting from and entering into the health care workforce before and after the pandemic and to examine variations over time and across states and worker demographics.Design, Setting, and ParticipantsThis cohort study used US Census Bureau state unemployment insurance data on job-to-job flows in the continental US to construct state-level quarterly exit and entry rates for the health care industry from January 2018 through December 2021 (Arkansas, Mississippi, and Tennessee were omitted due to missing data). An event study design was used to compute quarterly mean adjusted rates of job exit from and entry into the health care sector as defined by the North American Industry Classification System. Data were examined from January to June 2023.ExposureThe COVID-19 pandemic.Main Outcomes and MeasuresThe main outcomes were the mean adjusted health care worker exit and entry rates in each quarter by state and by worker demographics (age, gender, race and ethnicity, and education level).ResultsIn quarter 1 of 2020, there were approximately 18.8 million people (14.6 million females [77.6%]) working in the health care sector in our sample. The exit rate for health care workers increased at the onset of the pandemic, from a baseline quarterly mean of 5.9 percentage points in 2018 to 8.0 (95% CI, 7.7-8.3) percentage points in quarter 1 of 2020. Exit rates remained higher than baseline levels through quarter 4 of 2021, when the health care exit rate was 7.7 (95% CI, 7.4-7.9) percentage points higher than the 2018 baseline. In quarter 1 of 2020, the increase in health care worker exit rates was dominated by an increase in workers exiting to nonemployment (78% increase compared with baseline); in contrast, by quarter 4 of 2021, the exit rate was dominated by workers exiting to employment in non–health care sectors (38% increase compared with baseline). Entry rates into health care also increased in the postpandemic period, from 6.2 percentage points at baseline to 7.7 percentage points (95% CI, 7.4-7.9 percentage points) in the last quarter of 2021, suggesting increased turnover of health care staff. Compared with prepandemic job flows, the share of workers exiting health care after the pandemic who were female was disproportionately larger, and the shares of workers entering health care who were female or Black was disproportionately smaller.Conclusions and RelevanceResults of this cohort study suggest a substantial and persistent increase in health care workforce turnover after the pandemic, which may have long-lasting implications for workers’ willingness to remain in health care jobs. Policymakers and health care organizations may need to act to prevent further losses of experienced staff.

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Section: Discussionmentioning

confidence: 87%

Job Flows Into and Out of Health Care Before and After the COVID-19 Pandemic

Shen,

Eddelbuettel,

Eisenberg

2024

JAMA Health Forum

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“…It is unlikely that the observed increases in psychotropic medication prescribing were the consequence of increased screening and management of mood and anxiety disorders in children and adolescents after the pandemic, as availability of mental health services did not increase despite the development of telemedicine. 41 Likewise, during the study period, there were no new psychotropic medications with a pediatric marketing authorization in France. Therefore, our findings likely reflect the actual mental health needs of children and adolescents after the onset of the pandemic, whether pre-existing or newly emerged.…”

Section: Discussionmentioning

confidence: 99%

Psychotropic Medication Prescribing for Children and Adolescents After the Onset of the COVID-19 Pandemic

Valtuille,

Acquaviva,

Trebossen

et al. 2024

JAMA Netw Open

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ImportanceNumerous studies have provided evidence for the negative associations of the COVID-19 pandemic with mental health, but data on the use of psychotropic medication in children and adolescents after the onset of the COVID-19 pandemic are lacking.ObjectiveTo assess the rates and trends of psychotropic medication prescribing before and over the 2 years after the onset of the COVID-19 pandemic in children and adolescents in France.Design, Setting, and ParticipantsThis cross-sectional study used nationwide interrupted time-series analysis of outpatient drug dispensing data from the IQVIA X-ponent database. All 8 839 143 psychotropic medication prescriptions dispensed to children (6 to 11 years of age) and adolescents (12 to 17 years of age) between January 2016 and May 2022 in France were retrieved and analyzed.ExposureOnset of COVID-19 pandemic.Main outcomes and MeasuresMonthly rates of psychotropic medication prescriptions per 1000 children and adolescents were analyzed using a quasi-Poisson regression before and after the pandemic onset (March 2020), and percentage changes in rates and trends were assessed. After the pandemic onset, rate ratios (RRs) were calculated between estimated and expected monthly prescription rates. Analyses were stratified by psychotropic medication class (antipsychotic, anxiolytic, hypnotic and sedative, antidepressant, and psychostimulant) and age group (children, adolescents).ResultsIn total, 8 839 143 psychotropic medication prescriptions were analyzed, 5 884 819 [66.6%] for adolescents and 2 954 324 [33.4%] for children. In January 2016, the estimated rate of monthly psychotropic medication prescriptions was 9.9 per 1000 children and adolescents, with the prepandemic rate increasing by 0.4% per month (95% CI, 0.3%-0.4%). In March 2020, the monthly prescription rate dropped by 11.5% (95% CI, −17.7% to −4.9%). During the 2 years following the pandemic onset, the trend changed significantly, and the prescription rate increased by 1.3% per month (95% CI, 1.2%-1.5%), reaching 16.1 per 1000 children and adolescents in May 2022. Monthly rates of psychotropic medication prescriptions exceeded the expected rates by 11% (RR, 1.11 [95% CI, 1.08-1.14]). Increases in prescribing trends were observed for all psychotropic medication classes after the pandemic onset but were substantial for anxiolytics, hypnotics and sedatives, and antidepressants. Prescription rates rose above those expected for all psychotropic medication classes except psychostimulants (RR, 1.12 [95% CI, 1.09-1.15] in adolescents and 1.06 [95% CI, 1.05-1.07] in children for antipsychotics; RR, 1.30 [95% CI, 1.25-1.35] in adolescents and 1.11 [95% CI, 1.09-1.12] in children for anxiolytics; RR, 2.50 [95% CI, 2.23-2.77] in adolescents and 1.40 [95% CI, 1.30-1.50] in children for hypnotics and sedatives; RR, 1.38 [95% CI, 1.29-1.47] in adolescents and 1.23 [95% CI, 1.20-1.25] in children for antidepressants; and RR, 0.97 [95% CI, 0.95-0.98] in adolescents and 1.02 [95% CI, 1.00-1.04] in children for psychostimulants). Changes were more pronounced among adolescents than children.Conclusions and RelevanceThese findings suggest that prescribing of psychotropic medications for children and adolescents in France significantly and persistently increased after the COVID-19 pandemic onset. Future research should identify underlying determinants to improve psychological trajectories in young people.

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