Healthcare Workforce at the Brink | Baby Boomers Turn 80

The Dual Crisis: Workforce Shortage Meets Growing Demand

This article is part one of a series on the Consequences and Impact on Healthcare as Baby Boomers turn 80. Click here to learn more about the series.

• Baby Boomers are turning 80 and entering old age with more chronic conditions and a higher need for care

• The healthcare workforce is expected to face significant shortages of workers that care for the elderly, and the shortages are poised to continue to 2045, by which all of the Baby Boomers will have reached their 80’s

• Education and current workplace environments will make replacing and retaining healthcare workers increasingly difficult

Turning 80 was once a rare milestone. Today, it is becoming common, and that shift is about to test the limits of Michigan’s healthcare system.

This year (2026), the first Baby Boomers turn 80. By 2031, the proportion of Michigan’s Baby Boomers aged 85+ will surge, making the state’s seniors older and more in need of care overall.

Fig. 1.

Fig. 1. Adapted from: Alan Leach, “The Future of Michigan Seniors: How Baby Boomers are Reshaping the 65+ Population”, Michigan Center for Data and Analytics, 2026, fig. 1, https://www.michigan.gov/mcda/population/michigan-population-analysis/2026/03/02/baby-boomers-65plus.

Growing old should be something to celebrate; a testament to medical advancements. Instead, some call it the “silver tsunami.” 

Why? The Baby Boomers aren’t just living longer; they’re arriving at old age sicker than prior generations. The Baby Boomers entering their 80s are also arriving with multiple chronic conditions (MCCs) that they’ve been living with for 9 to 11 years on average. 

Managing those MCCs requires an average of 5 to 10 providers annually. Adults 65+ already have 20% more doctor visits, 3 times as many hospitalizations, and longer hospital stays. Seniors 85+ incur double the Medicare spending of those 65 to 74.   

The retirement of the Baby Boomer generation already strains Michigan’s healthcare workforce. The looming—and very near—2031 cliff begs the question: “Who will provide the additional care needed to support the greatest influx of very old Michiganders?”

Not all healthcare roles will be strained equally. MHC Insight analyzed Michigan’s “older adult care frontline” through 2045, when the entire Baby Boomer generation will have aged into their 80s, to determine where the stress points will be. 

Who’s Missing | Occupation-by-Occupation Analysis

MHC Insight analyzed 22 occupations essential to older adult care, including Home Health and Personal Aides, Nursing Assistants, Primary Care and Specialty Physicians, Nurse Practitioners, and more (full list in Table 1). 

We calculated shortage projections through 2045, when all Baby Boomers will have reached 80, then grouped occupations into three categories for analysis and comparison: point-of-care, primary care, and specialists. 

Shortages (or surpluses) for each occupation were calculated by subtracting the number of new graduates (employees able to fill jobs) from the projected number of job openings in 10 and 20 years. The number of graduates was derived from the average of educational completions in the past 5 years (2020-2024). This completion data was available for all occupations through the National Center for Education Statistics (NCES)’s Integrated Postsecondary Education Data System (IPEDS) dataset (accessed via Lightcast). Since Physicians are required to complete residencies and additional training for some specialties, we used the average of residency completions in the past five years, multiplied by the average Physician retention rate for Michigan across specialties (53.1%) in lieu of medical school completion (data from Accreditation Council for Graduate Medical Education (ACGME) census). For job openings for 2025-2035 and 2025-2045, Lightcast’s “Openings” figure was used, which accounts for both new growth in each occupation and replacements for individuals exiting the workforce. For additional information on how MHC calculates shortage estimates, please refer to the 2025 Michigan Healthcare Workforce Index, where we utilize the same data sources and a similar methodology.

Where Demand Outpaces Supply

Most occupations can’t keep up with demand. 15 of the 22 occupations analyzed face shortages through 2045.

Table 1: 10- and 20-Year Projected Workforce Shortages and Surpluses by Occupation in Michigan

Point-of-Care Occupations
Occupation	10-year shortage or surplus	20-year shortage or surplus
Community Health Workers (CHW)	152	304
Home Health and Personal Care Aides	165,115	330,230
Nursing Assistants	56,382	112,764
Primary Care Occupations
Occupation	10-year shortage or surplus	20-year shortage or surplus
Pharmacists	920	1,840
Registered Nurses (RN)	725	1,450
Nurse Practitioners (NP)	1,755	3,510
Primary Care Physicians* (PCP)	366	732
Physician Assistants	720	1,440
Specialist Occupations
Occupation	10-year shortage or surplus	20-year shortage or surplus
Anesthesiologists	297	595
Cardiologists	21	42
Dermatologists	16	32
Emergency Medicine Physicians	361	722
Neurologists	41	82
Ophthalmologists (except Pediatric)	7	14
Physicians, All Other	3,356	6,713
Podiatrists	169	338
Psychiatrists	44	88
Radiologists	1	2
Specialty Physicians Total	3,422	6,844
Audiologists	6	13
Occupational Therapists	150	300
Physical Therapists	950	1,900
Optometrists	531	1,062
*Primary Care Physicians are defined here as a combination of Family Medicine Physicians and General Internal Medicine Physicians. However, some Physicians categorized under “Physicians, All Other” also practice in primary care, which means the projected shortage of Primary Care Physicians is likely higher than reported. Due to limitations in BLS SOC coding, it is not possible to accurately identify or include the number of “Physicians, All Other” who work in primary care. Therefore, they are excluded from these estimates.

Point-of-Care Occupations

Who will help older adults every day?

Home Health and Personal Care Aides and Nursing Assistants face catastrophic shortages; 330,230 and 112,764 workers, respectively, by 2045. With projections also showing Community Health Worker shortages, every point-of-care occupation will be strained. 

These workers are often the first to notice early warning signs, like new confusion, swelling, or breathing problems, prompting follow-up with primary care providers and helping reduce ER visits. For many older adults, these workers are the difference between staying stable at home, which is often the preferred care setting and significantly cheaper than facility-based care, and experiencing a crisis that leads to hospitalization.

Shortages in the point-of-care workforce are already causing senior care crises. Bridge Michigan reports that workforce shortages in long-term care have fueled abuse, neglect, and exploitation of seniors. Many of the hardest-to-fill positions are Home Health and Personal Care Aides and Nursing Assistants. 

As Baby Boomer healthcare demand is set to explode, the question is not whether shortages of point-of-care occupations matter: it is who will fill the positions that are already chronically vacant.

Primary Care Occupations 

Who will catch problems, coordinate care, and manage chronic disease?

RNs are projected to remain in surplus by 2045, but shortages are expected for Primary Care Physicians (PCPs), Pharmacists, Nurse Practitioners (NPs), and Physician Assistants (PAs).

Those shortages matter. PCPs are the cornerstone of healthcare, responsible for assessing, diagnosing, and referring patients, and access to primary care is consistently linked to better health outcomes and longer lives.

For Baby Boomers, the shortage is especially troubling. They already visit the doctor more often and will need ongoing PCP oversight to manage MCCs. Yet PCPs are already stretched thin: with appointment slots that often last just 15 to 30 minutes, there is not nearly enough time for the kind of preventive, guideline-driven care patients with complex needs require. One cross-sectional study found that truly delivering that level of care would require an impossible 27 hours of work in a single 8-hour day. The result is less time with each patient, more strain on PCPs, and fewer openings for people seeking care.

The consequences are not abstract. Baby Boomers without access to a PCP are more likely to experience complications such as strokes, heart attacks, dialysis, and preventable ER visits, all outcomes that regular primary care can help avoid.

The strain extends beyond PCPs. For Baby Boomers taking multiple medications, Pharmacists are essential for preventing dangerous drug interactions. With 44% of adults age 65 and older taking five or more medications and 15.1% taking 10 or more, medication expertise is critical to safe care.

Michigan seniors are already feeling the effects of reduced access to pharmacies. Rite Aid’s bankruptcy and the closure of several CVS and Walgreens locations have increased the patient-to-pharmacist burden, reaching as high as one Pharmacist for every 1,526 patients in Michigan’s Upper Peninsula. Longer travel distances for prescription pickup, combined with busier, more burned-out Pharmacists, can lead to skipped medications, delayed refills, and increased medication risk. For a generation already managing MCCs, further loss of pharmacy access is greatly concerning.

Fewer NPs and PAs also threaten access to primary care, especially in rural and underserved communities where fewer PCPs practice. These professionals help fill gaps in routine care, manage chronic conditions, and extend access for older adults who need ongoing monitoring and treatment. Research shows that NPs are more likely to practice in rural areas and improve access for vulnerable populations. Similarly, PAs are more likely than Physicians to work in underserved areas, with a significant share practicing in Health Professional Shortage Areas (HPSAs) or rural communities. Additional research also shows that, compared with Physicians, NPs and PAs provide less costly care and reduce the use of acute care services.

A shortage of these gap-filling professionals would mean more reliance on already scarce PCPs for routine care at best, and even further reduced access to primary care for the most vulnerable at worst.

Even where primary care remains accessible in more populated urban areas, rural communities already facing shortages may see greater PCP burnout, longer waits, shorter visits, and weaker coordination between primary care and specialists.

And that assumes Baby Boomers can access specialists at all. 

Specialist Occupations 

Who will help people keep functioning and independent?

As Baby Boomers age with MCCs, they will rely more on specialists to preserve mobility, function, and independence. The challenge is that specialist supply is not keeping pace with demand.

MHC Insight analyzed 14 specialist occupations, 10 of which are specialty Physicians. While some individual Physician specialties are projected to have surpluses, the specialty Physician workforce as a whole is still projected to face a substantial shortage of 3,422 providers by 2045. In practice, that means aging Baby Boomers face two barriers: whether a specialist is available and whether they can access that care.

Managing MCCs often requires care from many Physicians, and that can create transportation barriers, delayed treatment, and unmet needs. At the same time, specialty care is not evenly distributed. Urban areas tend to have more resources and more specialists, while rural and low-resource communities are often left with fewer providers and less access overall. 

The effect of shortages in specialty Physician occupations will be even more severe in rural Michigan, where specialty care is already harder to obtain. Seniors may face longer waits for appointments, longer travel distances, and delayed follow-up for chronic conditions. For older adults already living with MCCs, postponed care can increase the risk of complications, readmissions, and preventable declines in health. As Baby Boomers continue to age into higher-need years, the gap between urban and rural aging will become even more pronounced, as those without adequate care may experience a sharp decline in independence, quality of life, and lifespan. 

Of the non-Physician specialist occupations reviewed, three of the four are expected to have shortages. Occupational Therapists (OTs), Physical Therapists (PTs), and Optometrists are projected to face shortages of 300, 1,900, and 1,062 workers, respectively, by 2045.

These professionals are critical to older adults’ quality of life. OTs help patients maintain independence in daily activities. PTs do more than improve movement; they help older adults walk, balance, sit, and maintain key functions like bladder, bowel, and breathing control. Optometrists are crucial for detecting early eye problems and preserving vision through glasses or low-vision rehabilitation. Each is essential to safe aging in the least restrictive setting possible. 

Michigan’s Program of All-Inclusive Care for the Elderly (PACE) highlights that access to OTs and PTs helps older adults age in place. Optometrists also contribute to independence and quality of life by reducing vision-related falls.

When these specialists are in short supply, older adults can face longer waits for care and slower recovery. Together, shortages in these occupations result in a loss of function that, for many, means moving into long-term care facilities that are already stretched thin. 

However, to fully understand the scale of the workforce challenge, it is not enough to look at demand and shortages. We must also examine how long it will take for renewed efforts to replace workers and strengthen talent pipelines to see returns on their investments. 

Educational Pipeline and the Time to Replace or Educate New Workers

The healthcare industry is racing against the clock to replace retiring workers and train new talent to fill the gaps. While advocates, industry leaders, government, and educators search for solutions, they face one fixed reality: time is not on their side.

There is a significant difference in the training and education requirements across healthcare occupations, making some positions easier to fill than others.

Fortunately, the occupations slated to have the worst shortages, Home Health and Personal Care Aides, and Nursing Assistants, have only a 75-hour education and training requirement. And, with a 14-week training and education course for Community Health Workers, the point-of-care workforce is best positioned to quickly fill care gaps. However, while education is short, these occupations have historically struggled to fill open positions and experience high turnover rates.

There are multiple reasons for this high turnover: low wages, lack of benefits, few career and upskilling pathways, inconsistent hours, and lack of respect for the profession. Without massive systemic overhauls, these factors will likely continue to inhibit the growth of point-of-care occupations, even as more Baby Boomers seek care to remain at home and long-term care homes compete to fill open positions. 

The reverse is true for the primary care and specialist occupations. These roles are better paid, offer benefits, have more consistent hours, and command greater respect. But replacing and growing the workforce takes years, not weeks or months.

Long training pipelines make it especially difficult to fill primary care and specialist shortages. NPs and OTs typically need six years of education; PTs and PAs need seven; Pharmacists need eight. Even in the best-case scenario, Physicians require at least 11 years, and some specialties take longer.

That delay matters because the 2031 Boomer cliff will arrive before many new workers can enter practice. By the time they are trained and certified, demand will already be at record levels. 

Another challenge whose impact has yet to be realized is the shrinking pool of future school-aged children who will ultimately feed into healthcare career paths. As reported by Bridge Michigan, Michigan births decreased to 99,000 in 2024, down from an annual average of 137,081 from 1980 to 2006. Without the replenishment of younger generations to replace and balance out the very old, workforce strains are likely to continue well into the future. 

That raises an additional concern: whether burnout, job stress, and workplace violence will shorten the careers of the workers the system is depending on to close the gap. COVID-19 offers a warning. When demand surged and staffing lagged, healthcare workers experienced higher burnout, more depression and anxiety, and many considered leaving the profession. Patients felt the effects too, including poorer outcomes, medical errors, and reduced access to care.

The lesson from COVID-19 is clear: the system needs to adjust so that early-career professionals are equipped and supported to remain in their roles to meet the rising demands of the Baby Boomers. 

Looking Ahead

Healthcare is navigating turbulent terrain: Michigan has the 13th-oldest population; healthcare demand from the Baby Boomers is rising; yet the healthcare workforce is thinning, and the system is not built to absorb what comes next. 

In the next article, we’ll look at what it means to turn 80 in a fragmented care system, and how transportation, housing, and family caregiving shape whether older adults can stay healthy and independent.