Health Care Turnover Significant Among Ambulatory Setting, Assistant/Aide Workers During COVID-19

Bianca K. Frogner, PhD

Turnover rates were 4 times greater among health aides or assistants than physicians in the US during the COVID-19 pandemic, according to new observational cross-sectional study data.

The new findings from a survey of full-time health care employees highlights the significant setbacks incurred among the workforce at the time of significant strain brought on faculty and their resources during the pandemic.

Bianca K. Frogner, PhD, of the Center for Health Workforce Studies at the University of Washington School of Medicine, and Janette S. Dill, PhD, MPH, of the Division of Health Policy and Management at the University of Minnesota School of Public Health, sought to identify which health care workers were at the greatest risk of leaving their field during COVID-19.

“Despite calls to retrain and redeploy them, approximately 1.5 million health care workers lost their jobs during the first peak of the pandemic (April 2020) when clinics closed temporarily and hospitals postponed surgeries to prevent the spread of the SARS-CoV-2 virus,” investigators wrote. “Although most of those jobs returned by the fall of 2020 and the job market continued to improve, as of November 2021 health care employment was still 2.7% lower than prepandemic levels.”

As investigators noted, previous assessment into the healthcare workforce during the pandemic has focused on the totality of open and filled positions—not the type of positions themselves. Their assessment considered survey data from Current Population Survey (CPS) to identify which health care workers either lost or left their jobs during COVID-19, who was at greatest risk of leaving the workforce, and whether they were currently searching for work.

“This study sets the stage for future workforce tracking, as well as for guiding the development of targeted policies to support retention and re-employment efforts,” they wrote.

Frogner and Dill defined health care workforce exits, or turnovers, as a worker’s response to the nationally representative CPS as being unemployed or out of the labor force in a month subsequent to when they previously reported being actively employed in the health care workforce. They estimated the probability of turnover by a logistic regression model controlling for occupation, health care setting, female sex, having a child <5 years old in the household, race and ethnicity, age, citizenship status, marital status, having less than a bachelor’s degree education, living in a metropolitan area, identifier for those reporting employment status at the first peak of COVID-19, and select interaction terms with time periods.

Investigators identified 1 pre-pandemic period for observation (January 2019 – March 2020), as well as 2 post=periods (April – December 2020, January – October 2021). Data were analyzed from March 2021 through January 2022.

The observed population included 125,717 health care workers. Mean participant age was 42.3 years old; 77.0% were women, and 67.4% were White. The average turnover rate during the pre-period was 3.2%; the rate raised to 5.6% in post-period 1 during 2020, then lowered to 3.7% in post-period 2 in 2021.

By profession, turnover rates were peaked for each of aides/assistants, technicians, and registered nurses during post-period 1. Turnover rates exceeded 6% for aides and assistants in post-period 1; though it decreased in post-period 2, it remained 1.3 percentage points greater than from the pre-pandemic period.

Though physicians had the lowest turnover rate among the observed professions, they were the only group to report continuous increase in overall turnover rates through post-period 2.

By setting, ambulatory care health care workers had the greatest turnover rate in post-period 1, exceeding 6%. Similarly to physicians, long-term care facility workers reported a continued increase in turnover rates from pre-period to post-period 2.

By sex and household status, women with children <5 years old in their home reported a nearly twice greater turnover rate in post-period 1 than men who did not have a young child in their home.

And by race and ethnicity, Asian health care workers reported a nearly 8% turnover rate in post-period 1—nearly twice the rate of White health care workers. All races and ethnicities reported decreases in turnover rates in post-period 2.

Frogner and Dill concluded that while many observed health care groups are on track to recover from early COVID-19 turnover rates, specific fields including long-term care workers and health aides/assistants may warrant focused efforts to recover their vital workforce. What’s more, the significant loss of women—particularly those with young children—is a burden on a field predominately reliant on female workers.

“With ongoing concerns about burnout leading to early retirement, particularly among nurses, continuing to track turnover among health care workers will be critical to determining our future focus, whether it should be on job placement, retention, or quality (eg, higher wages, improved benefits),” investigators concluded. “In addition, it is critical that we distinguish between terminations, resignations, and those exiting the labor force. Waiting too long to understand these issues may further elongate the consequences of the COVID-19 pandemic.”

The study, “Tracking Turnover Among Health Care Workers During the COVID-19 Pandemic,” was published online in JAMA Health Forum.