Clinical workforce shortages are keeping hospital executives up at night, according to a survey from AMN Healthcare. Seventy-eight percent believe there is a shortage of physicians nationwide, 66 percent believe there is a shortage of nurses and 50 percent believe there is a shortage of advanced practitioners.

Additionally, hospital leaders report an average physician vacancy rate of 18 percent, a nurse vacancy rate of 17 percent and advanced practitioner vacancy rate of 15 percent. The improving economy is only one factor behind the vacancy rates, according to the survey report. A growing demand for services, an aging clinical workforce and the impact of health reform also are driving shortages.

Hospital executives are concerned about meeting the needs of patients newly insured through the Affordable Care Act. More than 65 percent say the newly insured will increase the need for physicians at their facilities, 63 percent say it will increase the need for nurses and 52 percent say it will increase the need for advanced practitioners. More than 36 percent of respondents say that access to care in their areas has been compromised due to physician shortages, 17 percent say access to care has been compromised due to nurse shortages, and 17 percent say advanced practitioner shortages compromised access to care.

Filling these open positions is a top strategic priority, more than 70 percent of hospital executives say, and nearly 70 percent say physicians are difficult to recruit, while 40 percent and 36 percent say nurses and advanced practitioners, respectively, are hard to recruit.

Hospital employment of physicians is common, despite executive leaders' reporting cost as their primary clinical staffing concern. Executives reported that 42 percent of the physician staff is employed. Additionally, more than 43 percent of executives say they pay physicians based on quality and outcomes metrics.

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