Lawmakers should streamline regulations so more people can work
By JULIE GRACE | March 23, 2020
Even before the onset of the COVID-19 crisis, Wisconsin was experiencing a worker shortage in critical healthcare professions. Given predictions that patients could quickly overwhelm the healthcare system, policymakers should act quickly to streamline regulations that make it difficult for healthcare workers to get licensed in the Badger State.
Take certified nursing aides (CNAs), for instance, who serve on the frontlines at nursing homes and long-term care facilities.
One out of four direct caregiver positions in Wisconsin’s nursing homes and assisted-living facilities are currently vacant, according to a statewide survey of providers that was released in February. That translates into more than 20,000 job openings in long-term care facilities.
One-third of survey respondents said they were unable to admit new residents or tenants because of unfilled jobs; more than 40% of providers face caregiver vacancy rates of greater than 25%.
In Wisconsin, CNAs are required to complete 120 hours of training to secure a state license. Our neighboring states of Minnesota, Michigan and Iowa, as well as federal rules, require only 75 hours.
“It absolutely puts us at a competitive disadvantage relative to other communities,” says John Sauer, president and CEO of LeadingAge Wisconsin, a membership organization for senior care providers and associations.
“It’s also a barrier when you’re asking someone to pay their own training and testing costs. Asking them to go another 45 hours on their own dime is unreasonable if they know other states don’t require the same commitment,” he adds.
The demand for CNAs, meanwhile, could jump 48% from 2015 to 2030, largely due to a growing elderly population, according to the U.S. Department of Health and Human Services.
“It’s clear to me that the number one issue facing the state is finding qualified, trained people to fill positions,” says state Rep. Warren Petryk (R-Town of Washington), who authored a bipartisan bill to bring Wisconsin’s CNA requirement in line with that of the federal government. The bill passed the Legislature in January but was vetoed by Gov. Tony Evers.
“The people who lose out are the most vulnerable in our society,” Petryk adds.
What’s best for the patient
Wisconsin lawmakers should also look at expanding the scope of practice for physician assistants (PAs) in order to address a growing shortage of primary care physicians. According to a report from the Wisconsin Council on Medical Education & Workforce, the state will face a shortage of 745 primary care physicians by 2035.
Legislation introduced this session by state Sens. Dale Kooyenga (R-Brookfield) and Kathy Bernier (R-Chippewa Falls) would help address this impending shortage by reducing barriers for physician assistants — who perform many similar duties as doctors and often work collaboratively with them.
“Since I’m a ‘rural’ senator, I recognize the importance of getting people in rural communities adequate healthcare,” says Bernier. “We have to be fluid, more flexible, and think outside of the box.
“Our PAs and nurses want the very same thing that doctors want, and that’s what’s best for the patient. They know when they need to call a doctor for advice,” she says.
Bernier believes that this law could help during the COVID-19 crisis by allowing doctors to delegate more authority to PAs. Despite bipartisan support, the bill was never scheduled for a vote.
State Sen. Dave Hansen (D-Green Bay), a co-author of the bill, echoes this sentiment.
“I’m not sure what the impact would be, other than to say a real concern with this pandemic is that we have enough healthcare workers throughout the state and in these smaller and rural communities — not only to address COVID-19 cases but also ongoing day-to-day health care and medical issues not related to the virus,” he says.
Higher requirements, greater shortages
Mounting evidence shows the connection between occupational regulations and worker shortages.
Licensing reduces labor supply by 17% to 27%, according to a 2018 study by the University of Chicago.
Research also has found that the higher the requirements to enter a field, especially compared to similar-paying jobs or to the same job in other states, the less likely someone is to pursue it.
“Policymakers may feel that it is important to license these professions, but there are important costs — shortages may arise and some citizens may be unable to access any care at all,” says Ed Timmons, professor of economics and director of the Knee Center for the Study of Occupational Regulation at Saint Francis University.
One option that would help address current and future workforce needs is for the state to offer temporary licenses for qualified applicants so they can begin working while their applications are being processed. Proposed legislation from Sen. Kooyenga and state Sen. LaTonya Johnson (D-Milwaukee) would allow temporary licenses, but the bill hasn’t received a vote in either chamber of the Legislature.
Reforms in other states
In response to the COVID-19 crisis, other states have enacted broader reforms aimed at reducing regulatory burdens for healthcare and other workers. Massachusetts Gov. Charlie Baker recently announced the state would allow medical professionals and nurses from other states “to get licensed in Massachusetts in one day.”
New Jersey passed a similar law this week that allows all out-of-state licensed professionals to practice there on an expedited basis without paying any fees.
Colorado, Texas, Washington, South Carolina, Maryland, Mississippi and Tennessee all passed similar measures recently.
Even before COVID-19 was an issue, Arizona passed the most encompassing reform, known as “universal licensure recognition,” that allows people from out-of-state to work there more easily. If someone is in good standing and has practiced in another state for more than a year, they can get a license to work in Arizona. More than 750 professionals obtained licenses in the 10 months since the measure became law, according to analysis by the Goldwater Institute.
As a result, Arizona is best equipped for quickly licensing healthcare professionals who have recently moved to the state. This is in stark contrast to the process experienced by many professionals who move to Wisconsin.
Wisconsin faced worker shortages in healthcare professions months ago, but COVID-19 is sure to exacerbate the problem. Wisconsin legislators should move swiftly to lower licensing and regulatory burdens on professionals because lives may literally depend on it.
Julie Grace is a Badger Institute policy analyst. Permission to reprint is granted as long as the author and Badger Institute are properly cited.