Where Have All the Healthcare Workers Gone? Examining Healthcare Worker Internal Migration and Its Impact on Community Health in the United States

Abstract

The COVID-19 pandemic has highlighted the significance of healthcare professionals' spatial distribution and geographical mobility. While health equity research typically focuses on patient barriers, the location of healthcare providers also affects accessibility and community health outcomes. Using multiple sources of public and proprietary data and grouping geographic units to groups of Public-Use Microdata Areas (MIGPUMAs), logistic regression models are employed to examine factors related to internal migration patterns of different healthcare occupational groups. Maps are generated by calculating the Local Indicator of Spatial Association (LISA) to demonstrate spatial clusters of healthcare worker internal migration. A cross-sectional spatial autoregressive model with autoregressive disturbances is employed to consider the spatial dependency of characteristics in neighboring areas affecting healthcare worker migration flows. Additionally, conceptualizing healthcare worker migration destinations as a network formed by professional connections facilitated by teaching hospitals, network positions are calculated for MIGPUMAs that have at least one teaching hospital and experience healthcare workers' in-migration. Subsequently, regression analysis is conducted to assess the impact of localities’ migration network positions on local health outcome, highlighting the significance of attracting and retaining healthcare workers for communities. Gaining insights into the destinations of healthcare workers, the factors associated with their migration, and its impact on community health can provide valuable guidance to policymakers and stakeholders in the healthcare industry for effectively addressing healthcare workforce mobility and meeting community healthcare needs.