In March 2020, when Congress enacted the country’s first-ever federal paid sick time and child care leave policy, it carved millions of people out of the law’s guarantees, including one group that the nation was simultaneously hailing as heroes: health care workers.
The law, which was in place from April to December 2020, provided eligible workers up to 80 hours of paid sick leave to address COVID, and 10 additional weeks of child care leave for COVID-related interruptions. The law excluded large companies and their employees, and had rules that allowed very small companies to deny child care leave to their workers. An additional carveout for health care workers and first responders meant that an employer could claim hardship and deny a request for sick leave or child care leave, without any proof required.
This exemption sent the message that health care workers were so “essential” that they could be forced to care for others even when they and their families had needs of their own.
Even before COVID-19, turnover in the health care workforce was a concern. During the pandemic, the stress on health care workers, especially women, was profound. After COVID, substantial shares of workers reported burnout and said they were considering leaving the health care profession—and women were more likely than men to say they might find other work.
Now, the United States is in the midst of a health care workforce crisis, caused in part by the inability of nurses, physicians, and other caregivers to care for themselves and their families. The stability and quality of the health care sector, which is overwhelmingly comprised of women workers, and the country, depends on addressing this challenge.
There is no silver bullet that can create better quality jobs across the entire health care industry, but public investments in child care, higher wages for the lowest paid workers, and paid leave for all would go a long way—and would even contribute to economic growth in the process.
Child care for health care workers is a major issue—more than in other sectors because of the disproportionate shareof family caregiving that women do. A 2022 study of nurses and teachers found that 11 percent of workers reported that child care issues affected their ability to work compared to 6 percent of workers in other industries. Women nurses and teachers were 54 percent more likely than men to report that child care affected their ability to work.
On-site child care—with hours that reflect the long, irregular shifts that nurses and other health care workers must work—is one solution. But on-site child care arrangements can be tenuous. Earlier this year, a major health care center in Nebraska announced it would close its child care center, causing concerns that the shutdown would further exacerbate worker shortages.
And not all health care workers work in a facility that can support a child care center, or work in a facility at all. Which is why creating universal access to high-quality, affordable child care, and improving the quality of child care jobs is so critical.
Fair, family-supporting wages are also important, and workers in direct care jobs, like personal care and home health aides, face particular precarity. Those who work full-time receive average wages of just over $600 per week, or just over $15 per hour for 40 hours per week of work. Immigrant, Black, Latine, and Asian workers comprise substantial shares of this workforce, and often face circumstances at home and on the job that are more difficult than those of white workers. Workers who cannot afford to support themselves and their families—much less pay others to care for their families while they, in turn, care for others—are more likely to leave the field entirely, causing care challenges for family members who need to work and care gaps for patients.
Direct care workers, like millions of other U.S. workers, also often have both children and older adults or loved ones with disabilities to care for. Yet they are extremely unlikely to have paid sick time or paid family and medical leaveunless they live in one of the minority of states that guarantees one or both of these policies. And even if they are in the right state, they may not get paid sick time or paid leave because of eligibility rules.
Paid leave policies are also essential for patients and their families, covering time they need away from work to deal with their health (an argument the American Academy of Pediatrics has made to federal lawmakers). Physicians would also benefit from these programs. While they have more access to paid and unpaid leave, they face often unreasonable expectations about training, hours, and shifts that make work and family incompatible. Women now represent more than half of medical school students but they make up just 37 percent of active physicians in the United States.
A recent American Board of Medical Specialties policy offering parental leave to medical residents is a good start. But these leaves are relatively short, may be unpaid, and do not extend to other family caregiving needs. Access to and utilization of leave by female and male physicians are uneven nationwide due to both policy gaps and cultural professional norms.
Family-friendly job schedules, flexible work, job-sharing arrangements, and access to child and elder care—on a gender-equal basis—are also important in order to mitigate bias and encourage the use of these arrangements.
A vibrant, healthy, and well-supported health care workforce is in everyone’s interest. At some point, we all need emergency care, preventive care, or assistance with ongoing or serious acute conditions, and health professionals are our first call. Communities, businesses, and the economy also benefit when we are all healthy.
Those who care for us deserve to be able to manage their personal and professional lives with dignity because essential health care workers are human. Practices and policies must reflect and honor their humanity.