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April 20, 2015
July 5, 2022


The medical staffing industry has experienced robust growth since the 1970's, and this pace has only strengthened in recent years.  According to Staffing Industry Analysts, the healthcare staffing market grew by six percent in 2014 and is expected to exceed seven percent growth in 2015 to reach a capitalization of $11.1 billion.  There are numerous factors which are driving this high paced growth including an aging America population, widening channels for professional entry, and implementation of the Affordable Care Act.

While the supply of medical professionals shrinks, the need for them has only burgeoned.  As almost 12 million people have acquired health insurance or Medicare coverage through ACA, many of these new patients will increase the demands on physicians and medical professionals of all specialties in the coming years. An additional 40 million people will also exceed age 65 by 2050, further burdening an already overstretched physician workforce.

Physician Supply and Demand

As the cornerstone of the healthcare industry, physicians of all specialties will only grow in demand as more people become insured.  Unfortunately, this demand will be difficult to meet as more of the physician workforce enters retirement, decrease clinical hours or opt for less burdensome non-clinical specialties. According to the Rural Health Research Center, almost 25% of the primary care physician workforce is nearing the age for retirement.  This number may actually be low, as almost 60% of physicians say they know a colleague who is preparing to retire.

Furthermore, many doctors are leaving the profession due to dissatisfaction with working conditions.  The introduction of the Affordable Care Act has also ushered in a number of unpleasant burdens.  Physicians in all specialties are experiencing a surge in patient caseloads.  This is coupled with onerous paperwork for multiple agencies which diminishes time spent with patients. 

This situation is further complicated by an environment of organizational consolidation.  Many small practices are joining larger Accountable Care Organizations (ACO) in an effort to mitigate risk and obtain governmental financial incentives.  This, however, is also curtailing the freedom that many physicians have enjoyed heretofore. Entering an employment situation with many ACO's has also limited salary growth, as they are often structured on quantity of visits rather than quality of care.

The Association of American Medical Colleges estimates that the U.S. will have a shortage of 90,000 physicians by 2025.  This immense need for physicians in all specialties will spur intense participation in the locum tenens and permanent staffing market. 

Nursing Shortage is a Serious Challenge

The U.S. Department of Labor reports that the Registered Nurse profession should grow from 2.71 million in 2012 to 3.24 million by 2022, with a need for 1.05 million RN's to replace and fill new positions during this period.  A study by Dr. Peter Bauhaus predicts that the nation will have a deficit of almost 260,000 RN's by 2025.

Despite this increasing demand for RN's, the infrastructure for educating and training these vital medical professionals is woefully inadequate.  There is a serious need for more educators, classroom space and clinical instructors to prepare nursing students. Like physicians, a significant segment of the RN workforce is nearing retirement.  In 2013, almost 55% of the RN population was 50 years or older.

These systemic issues are also exacerbated by an increasingly difficult work environment.  A study in Journal of the American Medical Association found that the vast majority of nurses felt the impending shortage will add stress, diminish quality of care and contribute to a mass exodus from the profession.

Nurse Practitioner Demand is Expected to Skyrocket

Many regions in the U.S. are already suffering from a shortage of physicians.  These primarily rural populations rely upon Nurse Practitioners (NP) to offer primary care treatment.  The U.S. Department of Health and Human Services predicts that the 55,400 NP's in 2010 should expand to 72,100 by 2020.  The Affordable Care Act also allocated almost $200 million to training hospitals to prepare more NP's.  While this growth should be sufficient to satisfy need for NP's within the current national healthcare system, there are external forces which could drive demand.

Among the most important of the restrictions is the legal framework which limits the professional scope of NP's. Although 31 states still impose constraints like direct physician oversight, many states have lifted these restrictions, thereby allowing NP's to provide almost all of the services a primary care physician might.  The lower cost of employing Nurse Practitioners has also made them more attractive to ACO's. 

Ultimately, the need for additional medical caregivers throughout the country is likely to surpass any additional supply of NP's.  With a greater number of rural residents joining Medicare, the demand for locum tenens and permanent NP placements should grow considerably.  It is quite likely that the staffing market for this particular profession will be dependent upon the regional circumstances.

Physician Assistant  is a High Growth Profession

Like its twin healthcare extender profession Nurse Practitioners, Physician Assistants are experiencing a surge in numbers as well as booming demand.  The U.S. Department of Labor predicts this profession will grow by 39% in coming years making it the second fastest medical profession in the nation.  PA's face similar hurdles as NP's in terms of professional autonomy, but this is likely to change in the coming years as more states dismantle these legislative constraints.

Although there is a burgeoning number of PA's due to shorter education and less onerous training requirements, there is also surging interest in hiring these professionals.  Almost all PA's receive employment offers prior to completing their education due to the widespread recognition that PA's are among the most cost effective hires in the industry. This has led to mass hires by ACO's and health related companies like Walgreens and CVS.  Coupled with a desire for PA's in many of the most underserved regions in the U.S., there should be unrelenting demand for locum tenens and permanent placement of Physicians Assistants into the foreseeable future. 


Article written by:

Jim Chandler, CFA

President & CFO, Health Carousel Locum Tenens