Health Policy

Caring Does Not Pay


Things are tough all over the job market.  With a jobless rate at 3.5%, and with millions of people who left the job market in 2020 opting to not return to work, employers are having a hard time finding workers.  Your favorite restaurant or retail store probably has a “Help Wanted” sign out.  Checking your bag for a flight has never been more problematic, in large part  due to staffing issues.  Even tech companies are having trouble hiring.

But I want to focus on a crisis in hiring for three industries that take care of some of our most vulnerable populations – teaching, child care, and nursing.  It seems that what we say we want for our kids and the sick isn’t at all what we actually do to ensure that.  


Let’s start with teaching.  The Washington Post declared last week that we have a “catastrophic teacher shortage.”  Do a google search on “teacher shortage” and then pick whatever state you want; chances are, you’ll find a result for it.

“I have never seen it this bad,” Dan Domenech, executive director of the School Superintendents Association, told the WaPo. “Right now it’s number one on the list of issues that are concerning school districts.”  

States are being “creative” about filling these gaps.  Arizona is allowing schools to hire college students who are still working on their degree, and Florida is allowing veterans to teach even if they lack a bachelor’s degree.  As Andrew Spar, president of the Florida Education Association, told WaPo, “I think we all appreciate what our military veterans have done for our country in terms of protecting our freedoms both here and abroad.  But just because you were in the military does not mean you will be a great teacher.”

As for the cause of the shortage, WaPo noted:

Experts point to a confluence of factors including pandemic-induced teacher exhaustion, low pay and some educators’ sense that politicians and parents — and sometimes their own school board members — have little respect for their profession amid an escalating educational culture war that has seen many districts and states pass policies and laws restricting what teachers can say about U.S. history, race, racism, gender and sexual orientation, as well as LGBTQ issues.

“The political situation in the United States, combined with legitimate aftereffects of covid, has created this shortage,” Randi Weingarten, president of the American Federation of Teachers, told WaPo. “This shortage is contrived.”

Teaching used to be a highly respected, decently paid profession, especially when women didn’t have many other professional options (it still is 76% female), but we’ve somehow allowed it to become an underpaid (the median salary is $51,000), under-resourced (94% of public school teachers spend their own money on school supplies), under-appreciated (the U.S. ranks 16th in the world for how it values teaching relative to other professions) job.  

But, hey, it’s all about the kids, right?


Speaking of kids, the child care industry is in a state of collapse.  As Elliot Haspel put it in The Atlantic,  “America’s fragile child-care equilibrium has shattered…Demand is high, but supply is woefully low.”

Compared to pre-pandemic, there are between 85,000 and 120,000 fewer jobs, some 16,000 programs are estimated to have closed, and yet remaining programs struggle to find workers – perhaps because median pay hovers around $13/hour.  Eighty percent of programs report staffing shortages, largely due to the low compensation.

That’s not to say that child care is cheap, of course; just the opposite.  Required staffing ratios and other regulations make child care exceedingly expensive for parents.  The average cost of daycare is about $220 per child per week, or about $1,000 per month.  That’s 10% of the median income for a married couple, and 35% for a single parent.

It’s a problem for the economy generally.  Rochelle Wilcox, CEO of a network of child care centers in Louisiana, told US News & World Report: “We are hand in hand with the economy, and we are just not respected as such. … Doctors, lawyers, nurses, sanitation workers – none of those people can go to work if they don’t have anywhere to put their children.” 

Mr. Haspel pointed out: 

It must be noted that these low wages are paid to a workforce that is almost entirely women and disproportionately women of color. The workforce’s low pay cannot be disentangled from complex societal questions of who’s responsible for providing care and whether care work is both valuable and worthy of respect. 

He’s got that right.


Speaking of care, if you want a crisis, look no further than nursing.  The New York Times proclaimed: “In the flood of resignations, retirements and shortages that have redefined workplaces across industries these past two years, nothing has been as dramatic or as consequential as the shifts taking place in nursing.”  

Once again, this disproportionately impacts women; 86% of U.S. nurses are women.   

How about this: a 2021 survey found that 90% of hospital nurses are considering leaving in the next year.  The pandemic is a major but not the only reason; nurses are overworked, face too many administrative burdens, and feel too much of their work is unnecessarily manual. 

“What hospital leaders must take away from this data is that much of your nursing staff has an eye on the door,” said Shawn Sefton, Chief Nursing Officer and VP Client Operations at Hospital IQ. “…the frightening reality is that come 2022, hospitals will reach a novel level of short-staffed, and it will have horrendous repercussions on our health system and the patients reliant on it.” Well, we’re in 2022, and Ms. Sefton was right.

According to polls, nursing is the most respected profession, and has been for the last twenty years.  When you’re in that hospital bed, she’s mostly likely the one who comforts you.  Unfortunately, she’s also the one who doesn’t come as fast as you’d like, because she’s got too many other patients, she’s the one probably tired from long shifts, and she’s the one who has been yelled at (or worse) by anti-vaxxers, disagreeable patients, or even supercilious physicians.   

It’s a credit to the profession that any of the nurses stay.  


We say we value education.  We say we love children. We say that nurses are angels.  We’re think that we’re a caring people. We just don’t treat the people in the jobs that demonstrate those values as though those were true, and a large part of me wonders the extent to which that is because they are mostly women.   

 Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented, and now regular THCB contributor.