JEFFERSON CITY, MO. — In the past decade, nearly 20 Missouri hospitals have closed, leaving 50 rural counties without a hospital. 

All but one of the state’s counties are in a health professional shortage. In a new report released by the Department of Health and Senior Services (DHSS), rural communities have an increasing aging population and a greater need for health care workers. The head of DHSS said it’s going to take years to resolve the workforce crisis in health care.”

“It shouldn’t be dependent on your place and your location—where you were born or where you chose to live, about whether or not you get health care,” DHSS Director Paula Nickelson said. “It really should be equitable for everybody.”

In a state that has a shortage of primary care doctors, it’s even harder for rural Missourians to access health care services. 

“I always tell people we’re about two decades before we resolve the workforce crisis within health care and public health,” Nickelson said. “Everybody wants a magic bullet and there isn’t one. It’s such a complex issue that has occurred over time. It’s a layering of policies, both federal and state.”

According to the MHA’s 2023 Workforce Report, the statewide turnover rate in 2022 was 23.1% while in 2021 it was 24.7%. The vacancy rate among the majority of health care positions included in the report in 2021 was 17% and in 2022 it was 14.8%. Before the pandemic in 2019, the turnover rate was 19.8% and the vacancy rate was 9.5%. Dillon said there’s a big problem that lies within education. Nickelson said it had already become a problem before the pandemic. 

“With COVID, people were deciding to make other life choices and burnt out from COVID, Nickelson said. “We really have a crisis.”

The report says an additional 64 full-time positions are needed to accommodate all the nursing school applicants who are qualified for admission. That’s not including the 100 nursing educators expected to retire within the next five years. 

The vacancy rate for staff nurses in 2022 was 17.4% compared to 19.8% in 2021. The turnover rate also decreased, from 22.1% in 2021 to 19.4% in 2022. 

Roughly a third of Missourians who live in rural counties have to travel 30 miles to the nearest hospital, according to the state’s latest rural health report. The report also found that heart disease is the leading cause of death in those communities. 

“2020-2021 were the first two years in the history of our collecting the data where we had more deaths than births in Missouri,” Andy said. 

The state is making investments in health care by extending Medicaid coverage for new moms from 60 days to one year after giving birth. The General Assembly passed another law this year lifting restrictions on advanced practice registered nurses (APRNs). Previously, APRNs were required to be in a collaborative practice agreement, which means nurse practitioners have a physician nearby to do their job. With these restrictions lifted, it’s expected patients will have better access to healthcare.

Even with these new initiatives, Gov. Mike Parson said there’s more to be done. 

“I think your telehealth, telemedicine, trying to put more money in that arena to take it to rural Missouri,” Parson said. “That’s not going to change; that health care demand is going to be there and we’ve got to face it, and we’ve got to work on getting it better.”

Nickelson said that within the next two years, the state health department will unveil a proposal to invest in preventative care. 

“Over 50% of our public health agencies can’t do basic public health care, so until we address prevention in public health on the early end, we will never get ahead of the escalating cost of acute care and long-term care,” Nickelson said. 

The MHA report shows that southeast and south-central Missouri have the most troubling rates of turnover. The state currently has roughly 33,000 nurses working in hospitals, with an additional 7,000 vacant nurse positions

Other professions with the highest employee turnover in hospitals include environmental services, food service workers and pharmacy technicians. 

Another initiative the state is offering to grow the health care industry is loan repayment programs for public health and mental health professionals. Visit DHSS’s website for more information on the load repayments. 

There are also millions of dollars coming into the state to help combat the physician shortage in rural areas. The Rural Scholars Program at the University of Missouri School of Medicine is in place to encourage young Missourians from rural backgrounds to pursue medical school. The $16 million grant will be used to fund scholarships for students. 

Since the program started nearly three decades ago, nearly 50% of students who graduated are now practicing physicians in rural Missouri.