An Approach to Addressing Health Care Workforce Shortages

Nationally, hospitals and universities employ almost 10 million people (PDF), with the majority in hospitals. From 2004 to 2019, overall employment in higher education and health care (PDF), or “eds and meds,” grew 30.4% across the U.S. and 28.3% across the seven states that make up the Eighth Federal Reserve District. (The Eighth District covers all of Arkansas, most of Missouri, and parts of Illinois, Indiana, Kentucky, Mississippi and Tennessee.)

Among Eighth District states, Indiana (37.3%) had the most employment growth in eds and meds between 2004 and 2019, and Mississippi (11.8%) had the least. (See the table below.) In 2023, there were 975,441 jobs in hospitals across Eighth District states. Hospitals are one of the six largest employers across the U.S., but among the top five employers in five of the Eighth District states.

Besides being a large employer, hospitals often offer attractive jobs that can provide benefits like a 401(k) plan and health insurance. While many positions in hospitals demand higher education, a subset of jobs do not require a bachelor’s degree but pay above the U.S. median wage. Such jobs are known as opportunity occupations, and the St. Louis Fed’s Community Development team recently released a report on this topic.

Opportunity occupations in health care include licensed practical nurse, registered nurse and radiology technician. One specialty particularly in demand is that of respiratory therapist. The remainder of this blog post will examine the role of respiratory therapists, explore increasing demand in the field, and share an example of how the health care workforce shortage is being addressed in Arkansas.

What Does a Respiratory Therapist Do? Are Hospitals Hiring?

Respiratory therapists assess, diagnose and treat lung and breathing disorders across age groups from newborns to seniors. While an associate degree is generally sufficient for entry into the field, some employers may require a bachelor’s degree. Additionally, most states mandate licensure. Recent estimates from the U.S. Bureau of Labor Statistics indicate almost 140,000 people work in this occupation. Nationally, the median, or typical, salary for respiratory therapists was $80,450 in 2024. This occupation is expected to grow 12% between 2023 and 2034, compared with 3% for all occupations. That would mean adding almost 17,000 jobs by 2034.

Nationally, the proportion of hospitals with at least one vacancy for a full-time respiratory therapist grew 124.1% from 2019 to 2023. In Eighth District states, that growth was 134.9%.  In 2023, 84% of hospitals nationally and 85% of hospitals in Eighth District states had at least one full-time vacancy. (See the figure below.) Data disaggregated by Eighth District state and metro and nonmetro hospitals can be found in our report.

The Proportion of Hospitals with a Respiratory Therapist Vacancy Has Grown in All Eighth District States

SOURCES: American Hospital Association and author’s calculations.

Why the Increased Demand for Respiratory Therapists?

Respiratory therapy emerged as a profession in the 1940s (PDF) and grew alongside scientific and technological advances. Respiratory therapy services became a specialty that could be leveraged for long-term health management, as well as a revenue generator for hospitals. The field’s increasingly documented scientific basis, financial contribution to hospitals, and alignment with the trend toward long-term disease prevention and management increased demand for the profession.

Alarm about a potential shortage of respiratory therapists was raised as early as the 2000s. Colleges were graduating respiratory therapists in insufficient numbers, and the average age of practitioners was 40, indicating an impending wave of retirements in the 2020s. Not only would people be exiting the workforce, but demand was expected to surge because baby boomers would tax the medical system as chronic diseases in that cohort became more prevalent. Amid this increasing need, health care workers facing burnout, retirements and the respiratory nature of COVID-19 exacerbated the worker shortage.

One strategy that hospitals are using to maintain and grow the health care workforce is to form partnerships with career technical schools and community colleges to create a pipeline of new employees. In 2023, 80.2% of U.S. hospitals and 82.2% of hospitals in Eighth District states had a partnership with a community college or career technical school, as our report states. Of the seven Eighth District states, only Arkansas—at 62.2%—had fewer than 4 in 5 hospitals with such partnerships in place. These data suggest partnerships around building the health care workforce are less common in Arkansas; however, there are recent innovations.

An Example of Collaborative Workforce Development in Arkansas

As of 2023, over 35% of Arkansas hospitals lacked partnerships with career technical schools and community colleges, creating an opportunity to form alliances around fields like respiratory therapy. In 2024, there were 1,470 respiratory therapists in Arkansas, which is only 1.08% of the total across the U.S. (See the table above.) The median wage earned by Arkansas respiratory therapists was nearly $68,000 in 2024, and even those earning in the lowest 10th percentile still made $52,470, which is over the national median wage.

One example of a workforce development partnership program that has emerged and been expanding since the COVID-19 pandemic is led by Upskill NWA in northwest Arkansas. The partnership program works to help fill the area’s need for respiratory therapists, licensed practical nurses, registered nurses, radiology imaging technicians and, soon, medical lab technicians. Upskill NWA, a nationally recognized nonprofit, has five academic partners: NorthWest Arkansas Community College, Northwest Technical Institute, University of Arkansas for Medical Sciences, University of Arkansas and Crowder College. In 2023, the Excellerate Foundation and Upskill NWA received the U.S. Department of Housing and Urban Development Secretary’s Award for Public-Philanthropic Partnerships.

The partnership program’s approach includes covering costs and matching low-income students with area employers. Residents of Benton, Madison and Washington counties in Arkansas are eligible, and applicants must have a household income lower than 80% of the area median income, which for a family of four is $81,450 in 2025. In the program, students can earn a certificate, associate degree or bachelor’s degree in a variety of occupations. The program covers all education costs, including tuition, books, required equipment and licensing exam fees. The program also assigns a “career navigator” who connects program participants with critically needed “wraparound” services to overcome challenges that may normally prevent students from learning and working, including child care, transportation and nutrition assistance. When students finish their education, they receive job placement assistance and complete a two-year commitment to work at a regional hospital employer. This collaboration is still relatively new, but over 370 students have been enrolled. So far, 87 people have graduated, with a placement rate of 90%.

Looking toward the Future

With more than 100 hospitals and over 80 colleges and universities, Arkansas is a prime candidate for partnership opportunities. However, once more workers are trained, it will be equally important to keep them in the workforce. Our recent report also delves into other strategies hospitals are using to maintain their workforces, including talent development, leadership succession and retention initiatives. The American Hospital Association has also started collecting data around expanded strategies, including employee wellness and violence de-escalation programs (health care workers experience a greater likelihood of assault than police officers or prison guards do (PDF), according to one source).

With 50% of rural Arkansas hospitals vulnerable to closure, addressing workforce shortages and retaining workers are just two tactics among many for hospitals to remain economic anchors. Nevertheless, novel approaches to funding mechanisms and technology adoption might be essential to retain workers, even though these specific solutions could vary significantly by community.