(The Center Square) – Pennsylvania's health care workers face days, weeks, and months of paperwork delays before they’re legally allowed to work. Dozens of other states, however, have avoided such problems.
State officials tout some improvements in the process, but point to staffing shortages as the culprit.
The Senate Consumer Protection and Professional Licensure Committee met on Monday and heard impassioned pleas from health care groups on the need to find a legislative fix to a longstanding licensing problem.
“Every day that goes by – and where the state fails to approve the license – is a day lost of productivity for the individual, the employer, and the commonwealth,” said Sen. Lisa Boscola, D-Bethlehem. “For too long in Pennsylvania, we have been failing professionals, and in particular the medical field … the legislature needs to do better.”
The stress and complications of the pandemic worsened licensing delays and sparked early retirements from existing nurses and doctors, said Mike Quinn, the CEO of Chestnut Ridge Counseling. He said licenses have taken four months to get approved.
“Each of our nurse practitioners sees about 50 new patients every month. These practitioners being delayed three or four months equates to about 2,000 patients or individuals seeking help that are getting no help,” Quinn said.
Pursuing a license can be a brutal, kafkaesque experience.
Ray D’Ambrosio of BAYADA Home Health Care told the story of Sabine, a night nurse who moved to Pennsylvania from New York. To get a license in Pennsylvania, the licensing board needed her transcript from nursing school. However, the institution shut down after she finished the program.
“Through home detective work, our office was able to get a hold of a woman who worked in admissions at the school that was already closed. We were lucky enough to get that woman to send us a copy of the transcript,” D’Ambrosio said. “We thought we had accomplished the impossible. We sent the transcript to Sabine to send to the board. Sadly, she was informed that the board would not accept it being submitted from Sabine – it must be submitted by the school, which unfortunately doesn't exist.”
Sabine eventually got her license a week before her temporary permit expired – after a family member of one of her patients got involved, who happened to work in the Pennsylvania Department of Labor “who called and got things moving,” D’Ambrosio said.
The delays aren’t just a pain for a few unlucky people or small health care centers. Licensing setbacks are widespread.
“Nurses in Pennsylvania are experiencing longer wait times for their licenses than in neighboring states. In 2022, the median processing time for an LPN endorsement in Pennsylvania was 126 days – compared to a median of around 50 days in 30 other states,” D’Ambrosio said.
“In 2022, nearly 20% of the physicians we hired at St. Luke’s experienced licensing delays,” said Sarah Biggs, assistant vice president of talent acquisition at St. Luke’s University Health Network.
When nursing schools attract students, if graduates can’t quickly join the workforce, they might leave the commonwealth for a place that doesn’t legally stop them from working a job for which they’re qualified.
“Our nursing school – we graduate 60-80 nurses per graduating class … and we retain 75-85% of those nurses … but it doesn’t do a darn thing if we can’t get them licensed,” Biggs said.
Biggs argued that more funding for the licensing process needs to ensure improvements such as redesigning web portals and better call center capabilities to respond to problems that prospective health care workers have.
Kalonji Johnson, deputy secretary for Regulatory Programs at the Department of State, noted that officials are in the process of drafting a request for proposals to upgrade the existing application system to avoid common pitfalls and make it more user-friendly. In September 2022, the department changed policy to allow in-state nursing school graduates to test and receive temporary practice permits.
They’re also focused on filling empty seats.
“Over 50% of the positions at the Board of Nursing are vacant, as well as over 40% of the positions at the State Medical Board,” Johnson said. “Since starting with the Department, Acting Secretary (Al) Schmidt has made filling these positions a priority for the agency.”
State officials and health care professionals didn’t disagree on where the problems were. What’s needed now, they say, is action.
“I’m not sure the state ever caught up with the volume of licensure delays when the pandemic hit,” Biggs said. “I think it is just perpetuating itself here – which is why we have to draw a line in the sand and say ‘OK, enough’s enough, and we’re all going to work together, we’re going to figure out how to make this better.’”