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  • Writer's pictureAli Epstein

COVID-19 and the Changing Healthcare Workforce: A Three-Year Snapshot of the Pandemic’s Impact


Research cover page titled A Three-Year Snapshot of The Pandemic's Impact

COVID-19 and the Changing Massachusetts Healthcare Workforce: A Three-Year Snapshot of the Pandemic’s Impact


By Ali Epstein and Kerry McKittrick



OVERVIEW

COVID-19 brought unprecedented instability to the healthcare labor market nationally and in Massachusetts, especially across three critical occupational categories: nursing, direct care, and behavioral health. Since we started our work with the Massachusetts Healthcare Collaborative in the summer of 2020, some of the short-term stresses have subsided. However, the healthcare workforce has continued to face supply and demand misalignments on a local, state, and national scale.


The pandemic stirred disruptions that resulted in a significant reshuffling of workers, also known as the “Great Resignation,” during which the healthcare industry lost droves of workers. According to the Bureau of Labor Statistics, in November 2021 alone, 626,000 workers in healthcare and social assistance left their jobs. This trend has continued, though somewhat lessened. From July 2022 to November 2022, roughly 500,000 workers in health care and social assistance left their jobs each month. Meanwhile, there have been predictions of critical staffing shortages in healthcare in the near future. A number of these jobs are projected to be among the fastest growing professions nationwide over the next decade, due in large part to escalating demand for healthcare workers as the country ages.


Our research seeks to understand the shifts within the healthcare workforce that resulted from the pandemic. We find that:

  • Unemployment insurance claims in healthcare roles returned to pre-pandemic levels by the end of 2021.

  • In 2022, demand, as measured by job postings, surged to all-time highs for nursing occupations, with noticeable increases in demand for behavioral health and direct care workers, although there are regional differences.

  • All three critical occupations–nursing, direct care, and behavioral health– experienced wage growth to varying degrees by the end of 2022, nationally and in Massachusetts.


METHODOLOGY

This analysis spans a three-year time period, from January 2019 through December 2022. All data, unless otherwise noted, is sourced from Lightcast or the U.S. Department of Labor’s Office of Unemployment Insurance (OUI). Each occupational category is composed of multiple occupations aligned with standard and BLS occupational definitions.


Table A. Healthcare and Social Assistance Occupational Classifications

​Healthcare and Social Assistance Industry

Healthcare Support Occupations

Direct Care

  • Home Health and Personal Aides

  • Nursing Assistants

Community and Social Service Occupations

Behavioral Health

  • Substance Abuse, Behavioral Disorders,and Mental Health Counselors

  • Mental Health and Substance Abuse Social Workers

Healthcare Practitioners and Technical Occupations

Nursing

  • Registered Nurses

  • Nurse Practitioners

  • Licensed Professional and Vocational Nurses

  • Nurse Anesthetists

  • Nurse Midwives

This table shows the breakdown of occupations in the Healthcare and Social Assistance Industry, isolating the occupations of interest. The occupations narrow from more general to more granular as the table moves from left to right.


We compared unemployment insurance (UI) and job postings data to determine trends in labor supply and demand. However, there are differences in the classification of occupations between the UI and job postings data. The UI data uses broad classifications that capture more occupations than those we were interested in analyzing (the second column in Table A), whereas Lightcast job postings data gets more granular (the fourth column in Table A), which allowed us to narrow in on our occupations of focus. Despite this limitation, we believe that these datasets provide a meaningful indication of the tremendous impact of the COVID-19 pandemic on the healthcare workforce in Massachusetts and across the country.



UNEMPLOYMENT TRENDS

At the onset of the pandemic, UI claims in the healthcare industry spiked. Jobs in the Healthcare Practitioner and Technical (we refer to this as “nursing”) occupations experienced the least amount of disruption, with a quick return to “normal” levels after UI claims peaked in May 2020. Healthcare Support (we refer to this as “direct care”) and Community and Social Services (we refer to this as “behavioral health”) occupations took longer to return to “normal” levels. By the end of 2021–following the early pandemic surge–UI claims in healthcare roles across all healthcare occupations in Massachusetts and across the U.S. returned to pre-pandemic levels.


Chart 1. Unemployment Insurance Claims for Occupations in the Healthcare and Social Assistance Industry in the United States and Massachusetts


THE EFFECTS OF THE COVID-19 PANDEMIC ON NURSING OCCUPATIONS

The labor market for nurses remained extremely tight up until the end of 2022, in both Massachusetts and across the country. Looking nationally, data shows that, despite initial setbacks in hiring at the onset of the pandemic, demand for workers in nursing occupations intensified beginning in the late summer of 2020. Despite a noticeable drop in postings in September 2021, postings rebounded and peaked in March 2022—and have remained relatively high compared to the past three years.


In Massachusetts, job postings in nursing occupations followed a similar upward trajectory. However, job postings for nursing occupations in Massachusetts increased at a much higher volume than they did nationally–almost doubling (95.2 percent increase) between January 2019 and December 2022–compared to a national increase of approximately 77.8 percent. Similar to the national trend, Massachusetts experienced a dip in job postings in September 2021. Unlike national trendlines, Massachusetts sustained a second dip in job postings between August 2022 and October 2022 before increasing again in the last two months of 2022.


Chart 2. Unique Job Postings in Nursing Occupations in the U.S.

Chart 3. Unique Job Postings in Nursing Occupations in the Massachusetts

In the month preceding the pandemic, the median advertised annual salaries for nurses nationally and in Massachusetts was $82,368 and $75,712 respectively. However, the advertised annual salaries hit all-time lows in September 2020–while hospitals were still being flooded with patients. In the U.S., the average advertised annual salary dropped by almost almost 22 percent to $64,448. Massachusetts experienced a similar trend, sustaining a 9.5 percent drop to $68,544. However, despite these reported short-term decreases, the median advertised wage has overall increased between February 2020 and December 2022—rising by 13.1 percent nationally and 56.1 percent in Massachusetts, soaring to all-time highs of $93,120 in the U.S. and $118,208 in Massachusetts.


EFFECTS OF THE COVID-19 PANDEMIC ON DIRECT CARE OCCUPATIONS

During the 2019-2022 period, direct care job postings in Massachusetts tracked similarly to national trendlines. There were two major peaks between the Spring of 2021 and 2022, but there were also short periods of declines in demand. In September 2021, both national and state data showed a drop in job postings–at the same time that job postings dropped for nursing occupations. However, the demand for workers in direct care jobs quickly recovered.


Despite the growth in direct care occupations from 2021 until the summer of 2022, the U.S. and Massachusetts experienced noticeable declines in the number of job postings towards the end of 2022, with the U.S. sustaining a 20.5 percent decrease and Massachusetts experiencing a 25 percent decline between May and December 2022. Job postings in Massachusetts have returned to pre-pandemic levels (8,702 job postings in February 2020 versus 7,576 job postings in December 2022) even though there are projections that demand for home health and personal care aides will increase in the next 10 years.


Chart 4. Unique Job Postings in Direct Care Occupations in the U.S.

Chart 5. Unique Job Postings in Direct Care Occupations in Massachusetts

As noted in our prior research, salaries in direct care occupations tend to be considerably less than nursing and behavioral health occupations. In January 2019, before the pandemic, Massachusetts had a similar median advertised salary as the national median ($27,500 in Massachusetts versus $27,100 in the U.S.) even though Massachusetts is one of the most expensive states to live in. Since the pandemic hit, advertised salaries have grown nationally (25.5 percent) and in Massachusetts (38.1 percent). As of December 2022, Massachusetts had a higher median advertised salary ($37,824) than the national median ($34,000); however, wage growth trends differed across the regions.


Prior to the pandemic, the national median advertised wage growth was stagnant – it wasn’t until November 2020 that advertised wages started to increase. Unlike national wage growth, most advertised wage growth in Massachusetts occurred prior to the pandemic, in 2019. In fact, advertised wage growth in Massachusetts was stagnant throughout most of the pandemic, hovering around $35,500 until as recently as March 2022, when the median advertised wage suddenly began to increase again.


EFFECTS OF THE COVID-19 PANDEMIC ON BEHAVIORAL HEALTH OCCUPATIONS

Behavioral health job postings went largely unchanged throughout 2020, both nationally and in Massachusetts; however, job postings in behavioral health occupations began to increase quickly in late 2020 into the spring of 2021 (43 percent nationally and 27 percent in Massachusetts between January and May 2021). The growing demand for behavioral health workers may be tied to the reported rise in mental health challenges, in large part a result of the pandemic. In both regions, job postings plateaued from September 2021 to January 2022, then experienced gains from January 2022 to July 2022 (17 percent increase in job postings during this time period nationally versus 39.8 percent increase in MA). Since July 2022, there have been noticeable decreases in job postings in behavioral health jobs, both nationally (17.5 percent decrease) and in Massachusetts (30 percent decrease).


Chart 6. Unique Job Postings in Behavioral Health Occupations in the U.S.

Chart 7. Unique Job Postings in Behavioral Health Occupations in Massachusetts

As we noted above, Massachusetts is one of the costliest states to live in. Yet, the median advertised salary in behavioral health occupations in Massachusetts was much lower than the U.S. median in February 2020 ($38,080 versus $46,784 nationally). However, the advertised median salary in Massachusetts grew much faster than the U.S. median (44.9 percent v. 19.7 percent) from February 2020 to December 2022. As of December 2022, the advertised median salary for behavioral health workers was $55,168 in Massachusetts and $56,000 in the U.S.


CONCLUSION

As the world has adjusted to a “new normal” in the wake of the pandemic, UI claims in healthcare roles have largely returned to pre-pandemic levels. However, job demand for healthcare workers has surged. Despite initial decreases in job postings during the early days of the pandemic, job postings increased to all-time highs nationally and in Massachusetts, and in most of the healthcare occupations that we analyzed. The three occupations that we analyzed have also seen considerable advertised wage growth in Massachusetts and across the country.


UI and job postings data provide initial insights into the impact of the COVID-19 pandemic on the healthcare industry. As we move forward, additional data on demand, attrition, and earnings should be collected and analyzed to understand the full effects.


In the meantime, states are adapting to the tremendous change by introducing policies and programs that provide vital support to healthcare workers. In our next post, we highlight examples of different states that have attempted to address these workforce challenges.


 

ACKNOWLEDGEMENTS

This post would not have been possible without the research efforts of Saty Rao and Katie Mimini. We would also like to thank the Massachusetts Healthcare Collaborative for their support on this research. Additionally, we would like to thank Lightcast, formerly Burning Glass Technologies, for providing access to their data throughout this project, enhancing the depth and quality of this research.


The views expressed in this paper are the sole responsibility of the authors and not meant to represent the views of the Harvard Kennedy School or Harvard University.


Please direct inquiries to: Kerry McKittrick (kerry_mckittrick@gse.harvard.edu)


ABOUT THE PROJECT ON WORKFORCE AT HARVARD

The Project on Workforce is an interdisciplinary, collaborative project between the Harvard Kennedy School’s Malcolm Wiener Center for Social Policy, the Harvard Business School Managing the Future of Work Project, and the Harvard Graduate School of Education. The Project produces and catalyzes basic and applied research at the intersection of education and labor markets for leaders in business, education, and policy. The Project’s research aims to help shape a postsecondary system of the future that creates more and better pathways to economic mobility and forges smoother transitions between education and careers. Learn more at www.pw.hks.harvard.edu.


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