Closing the Palliative Care Workforce Gap Through State Lawmaking: A Survey of Legislation 2010-2023.

Abstract

The field of palliative care faces a critical workforce shortage that jeopardizes its capacity to deliver quality care to patients with serious illness. While there have been efforts to address these shortages through policymaking at the federal level, less attention has been paid to potential state levers. Determine what state policies have been introduced or enacted to address the palliative care workforce gap. Assess whether there are any promising policies states can implement, whether based on current state practice in palliative care or from state action to address the workforce shortage in other fields. A unique dataset was assembled containing state legislation-both enacted laws and introduced bills-from 2010 through 2023. Relevant bills and laws were classified into eight categories. To confirm the efficacy of our review, we conducted a validation of all gathered data for the period 2010-2023. From 2010 to 2023, we identified 723 bills and laws pertaining to palliative care. Of those, fourteen related in whole or in part to the workforce (representing 2% of the total), with five becoming law, representing a pass rate of 36%. Fifty-five legislative entries pertained to clinical skill-building (comprising 7.6% of bills or laws from 2010 to 2023), with 17 becoming law, representing a pass rate of 31%. Taken together, these efforts represented a minority (9.5%) of state legislative action during the study period. Additional state policies are needed to close the palliative care workforce gap. Lessons from fields such as behavioral health and primary care can help inform future action.