The current crisis in healthcare isn’t just about staffing shortages or pandemic stress — it’s the product of decades of misaligned incentives, structural choices, and short-term decision-making that favored profits, convenience, and emergency fixes over stable, skilled internal teams.
Across North America, we see three interwoven forces shaping the system:
Economic Incentives: Agencies, contractors, and short-term staffing solutions profit from turnover and instability, while hospitals often underinvest in permanent staff.
Structural Decisions: Longer shifts, non-union hospitals, and administrative policies created environments where burnout and rational self-protection became inevitable.
Policy & Oversight Gaps: Political cycles, financial pressures, and misaligned funding decisions have repeatedly prioritized short-term cost control over long-term workforce sustainability.
The result: individually rational decisions — hospitals seeking coverage, agencies seeking contracts, governments seeking cost control, clinicians seeking safety and fair compensation — collectively destabilized the system. Collapse can appear inevitable.
But this isn’t the whole story. Across North America, a counter-movement is emerging: healthcare systems are recognizing that staffing isn’t just a labor problem — it’s a belonging problem. Programs that prioritize team cohesion, clinician wellbeing, and internal retention are proving that sustainable, high-quality care is possible.
This blog explores both the historical roots of instability and the growing solutions that offer hope for a transformed, resilient healthcare system.
How Misaligned Incentives Created Structural Collapse
The honest answer is that there is rarely a single coordinated conspiracy. But there are competing incentives inside healthcare that unintentionally benefit from ongoing instability. Healthcare systems are shaped by economics, policy, labor markets, and institutional momentum. When these forces pull in different directions, something more troubling can happen.
Misaligned incentives don’t just allow collapse to happen — they actively suppress proactive solutions, keeping the system stuck in crisis mode.
Did you get that? Collapse isn’t accidental. It’s structurally supported.
The Agency Staffing Economy Has Become Its Own Industry
Over the past decade, healthcare staffing has grown into a multi-billion-dollar sector. Companies such as AMN Healthcare, Aya Healthcare, and Cross Country Healthcare, among many others, operate large national recruitment infrastructures. Their business model depends on:
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- Persistent shortages
- Rapid turnover
- Hospitals needing urgent replacements
The economic tension is clear: hospitals need stability, while staffing companies profit from shortages. If hospitals retained staff at high levels, agency demand would dramatically decline. Now that hospital leadership is mobilizing around long-term workforce solutions, these incentives are starting to collide.
Does that mean these organizations want healthcare to fail? I have a hard time answering that one because structually, their growth is tied to instability. But they filled a critical need during crisis periods, so we have to give them a high five for that. If hospitals suddenly retained staff at high levels, agency demand would dramatically decline.
Short Political Cycles vs Long Workforce Solutions
Healthcare workforce reform requires 5–10 year planning horizons:
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- education pipelines,
- mentorship,
- culture transformation,
- leadership development,
- retention programs.
Political systems, however, operate on election cycles. Policies that are tied to Medicare and Medicaid often prioritize immediate cost containment rather than long-term workforce investment. By cutting reimbursement rates, you can produce visible savings fairly quickly but building a positive health workforce culture takes a bit longer to see results.
This mismatch between political cycles and workforce solutions creates a structural problem: leaders are rewarded for short-term fixes rather than systemic stabilization. On top of that, innovative forward-thinking solutions take time to find a way in further delaying workforce stabilization.
Decades of Warnings Ignored
The workforce crisis didn’t appear overnight. There have been many PhD dissertation examining nurse burnout identified excessive shift lengths as a key driver and recommended reducing them. It took twenty-five years before meaningful policy attention emerged through initiatives developed within Health Canada, including a national retention toolkit. The guidance echoed what frontline clinicians already knew — but implementation remained limited.
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- 1994 – the Canadian Nurses Association highlighted chronic overtime, unsafe staffing ratios, and escalating burnout, calling for retention-focused workforce strategies.
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- Early 2000s – workforce studies connected to the Ontario Hospital Association again documented the same drivers of instability.
Each time the problem was identified. Each time the recommendations were clear. And each time the system largely carried on.
Example: The founder & CEO of The ProMind Experience met with Health Canada’s Chief Nursing Officer, Dr. Leigh Chapman, and was told that our work couldn’t engage the system because it was “for-profit,” even though AI and other technologies are developed in the private sector.These contradictions reveal how proactive workforce solutions are often blocked when they challenge institutional pathways.
Financialisation of Healthcare
Healthcare increasingly intersects with:
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- private equity investment,
- hospital consolidation, and
- corporate management structures.
Large systems must balance patient care, workforce wellbeing, debt obligations, shareholder expectations, and expansion strategies. In financially pressured environments, labour becomes one of the few adjustable variables. Temporary staffing provides flexibility that permanent workforce investments do not. The system begins optimizing for operational survival, not workforce health.
The Workforce Response: Rational Self-Protection
Travel nursing has existed for decades, offering incentives for nurses to relocate temporarily to regions with predictable shortages. Assignments were often long-term, and agencies handled administrative support including licensing, immigration, and credential verification. This is not the issue now.
As hospitals shifted toward non-union models and tighter staffing, clinicians faced:
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- Forced overtime
- Missed breaks
- Abrupt schedule changes
- Termination without cause
Slightly higher wages or small bonuses initially appeared attractive but revealed structural costs over time. Clinicians moved into agency or travel contracts or left hospital employment altogether.
Higher pay for fewer obligations became a logical adaptation. What looks like abandonment is often collective self-protection, which reinforces a cycle: departures → agency reliance → higher costs → less retention investment → burnout → more departures.
At the outset, we may say “No single actor designed this loop,” yet many operate successfully within it. Consequences are unsustainable, especially when taxpay
Why Collapse Can Appear Inevitable
Let’s look back at the scene of the crime. The first structural shift in frontline work began in the late 1970s, when hospitals facing national nursing shortages moved away from traditional three eight‑hour shifts toward two 12‑hour shifts per day. This change was introduced to reduce handover overlaps and improve continuity of care, and it was marketed as a staffing solution and recruitment incentive during periods of workforce scarcity.
Initially, longer shifts were presented as a way to give nurses more days off, and many clinicians were supportive. Over time, however, extended hours became the norm. Research has shown that 12‑hour shifts are associated with burnout, job dissatisfaction, intention to leave, and higher cardiovascular risk compared with shorter shifts — outcomes linked to the instability the system now faces.
Labour movements fought to protect workers through collective bargaining, limiting forced overtime and securing breaks. Over the following decades, pushback against unions grew, and more hospitals adopted non‑union models with weaker protections and stronger administrative control. As a result, workforce-strengthening solutions such enforced rest periods, manageable schedules, and retention investments were sidelined, while short-term fixes that benefited select financial interests were “allowed in”, embedding the conditions for collapse into the very structure of nursing work.
COVID – Policy Impact on the Workforce
During the COVID‑19 era, vaccine mandates across states and health systems intersected with an already strained workforce, and in many cases hundreds of healthcare workers resigned or were terminated for not complying with those policies.
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- Kaiser Permanente: ~2,200 employees on administrative leave
- Houston Methodist: 153 resignations or terminations
- Henry Ford Health System: ~400 voluntary resignations tied to a vaccine requirements
- British Columbia: ~ 2,496 healthcare workers terminated for failing to comply with a vaccine mandate in 2022
- Across Canada: 10,000 healthcare workers on unpaid leave
Vaccine mandates intersected with an already fragile workforce. As we can see, hundreds of thousands of clinicians were removed from active service across multiple states and provinces at the worst possible moment. The point was never “vaccinated or not”; the point was that the system’s frontline capacity was deliberately or inadvertently reduced at a moment when hospitals needed it most.
The result? Turnover spiked, agency reliance skyrocketed, and chronic instability became the default state of healthcare. Source
Who benefits most? Not patients, not clinicians. Actors profiting from chronic chaos: staffing agencies, flexible large health systems, and financial elites invested in privatization and consolidation. Permanent crisis directs resources toward short-term solutions rather than structural healing.
Hospitals sought coverage. Agencies sought contracts. Governments sought cost control. Clinicians sought safety and fair compensation. Individually rational decisions, in aggregate, destabilized the system. From the outside, collapse seems inevitable — and if you look at the historical incentives and policy impacts, even intentional. Individually logical decisions can collectively destabilize the system.
But the good news: Individually logical decisions can also collectively stabilize it!
The Quiet Counter-Movement Is Emerging
Collapse isn’t inevitable. Across North America, health systems are prioritizing:
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- Retention over recruitment,
- Workplace culture,
- Psychological safety,
- Interdisciplinary community,
- Clinician loyalty.
Forward-thinking organizations are realizing staffing is not fundamentally a labour problem; it is a belonging problem. Programs like The ProMind Experience are already part of this tide, helping hospitals rebuild community, professional identity, and resilience within their workforce.
The power is shifting back to the key decision-makers who care about their communities, not just short-term profits or reactive solutions. Momentum is growing: shorter shifts, sustainable staffing, and structural support are becoming possible. Clinicians who were once disillusioned are beginning to see pathways back into the system.
Three Competing Healthcare Futures
The deeper issue isn’t whether anyone actively wants healthcare to collapse. It’s about who benefits when the system is kept reactive instead of redesigned. Today, oligarchic interests profit from instability. While hospitals struggle with staffing and clinicians burn out, enormous resources flow toward short-term solutions that protect financial interests rather than workforce strength.
When taxpayers are aware and engaged, they can demand that federal dollars support clinicians with fair wages and safe conditions instead of subsidizing inefficiency or profit-driven staffing models. This shifts incentives in real time and reinforces accountability.
The healthcare landscape over the next decade will be shaped by three competing futures:
Crisis Continuation
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- Systems remain reactive
- Oligarchic interests profit from instability
- Burnout and turnover remain high
- Non-union facilities suppress workforce and communities
Partial Reform
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- Some hospitals adopt retention-focused “strategies”
- Improvements are patchy, constrained by finances and policy
- Solutions are internal, constrained by finances and policy
- Staff may receive illusions of control but remain under pressure
- Hospitals still lacking a system of improving retention
Transformational Movement
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- Hospitals prioritize people over technology or short-term fixes
- Teams function as living communities
- Professional belonging and mentorship flourish
- Reliance on agency staffing decreases; no longer the norm
- Cohesive teams reduce errors, burnout, and turnover
- Relational capital – trust, empathy, collaboration – builds cultural capital (Bourdieu, 1986)
- Programs like The ProMind Experience exemplify this shift, helping hospitals invest in workforce wellbeing and professional identity
- Hospitals become true communities of healing
Call To Action: A Movement Is Already Underway
Across North America, clinicians, patients, and concerned citizens have already begun raising this issue with policymakers. Many have started contacting their local Congress members to ensure that federal healthcare dollars are used in ways that strengthen the workforce rather than deepen the current cycle of instability.
Everyone has a role in influencing policy and funding. You can add your voice by contacting your local Congress member and making it clear that federal dollars should:
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- Support stable internal teams,
- Ensure fair wages,
- Maintain safe staffing conditions instead of inflated agency contracts,
- Invest in clinician wellbeing and retention that improves quality of care, reduces errors, and strengthens community health.
At the same time, policymakers must begin prioritizing structural, scalable solutions that address the root causes of workforce instability. This means advocating for policies that:
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- Focus on programs and initiatives that are truly structural, innovative, and scalable.
- Advocate for integrated workforce solutions, that supports long range resilience, empowered professional identity, and team cohesion within hospitals.
- Align programs and policies with federal and provincial funding that incentivize long-term workforce stability rather than short-term staffing fixes.
Professional associations and unions alone are insufficient — they cannot drive systemic policy or workforce protections at scale. In some cases, conflicts of interest may unintentionally perpetuate the very cycle they aim to fix.
Stop allowing taxpayer dollars to fund small, isolated projects that deliver only short-term, superficial fixes. The healthcare workforce crisis requires investments and solutions capable of transforming the system itself.
The goal is clear:
Build resilient, self-sustaining hospital communities where clinicians thrive, turnover is reduced, emergency staffing reliance diminishes, and care quality improves. These are the solutions that structurally reshape healthcare for the long term.
If you would like to participate, use the attached template to contact your local Congress member. Copy, paste, and send — and become part of the growing effort to shift federal and state policy toward funding long-term workforce stability instead of short-term emergency responses.