Health Care Workforce Shortages Implications for Public Health

1. Health Care Workforce ShortagesImplications for Public Health Rediscovering the Roots of Public Health November 4, 2001 Beth Mertz Project Director Center for the Health Professions

2. Our mission is to assist health care professionals, health professions schools, care delivery organizations and public policy makers respond to the challenges of educating and managing a health care workforce capable of improving the health and well being of people and their communities.

3. Health Workforce Centers California http://futurehealth.ucsf.edu/cchws.html New York http://chws.albany.edu/chws.html Washington http://www.fammed.washington.edu/chws/index.html Illinois http://www.uic.edu/sph/ichws/ Funded by the National Center for Health Workforce Information and Analysis, Bureau of the Health Professions, HRSA

4. Outline • General Trends impacting the Health Care Workforce • The Public Health Workforce • National Data • State Studies • Profession Specific Examples • Pew Recommendations • Future Directions

5. Present Outlook • General workforce issues affecting all sectors of the economy • Aging workforce • Technical skill gap • Diversity disparity • Displacement of traditional pathways of employment • Values of next generation • Inadequate education/work integration

6. Winds that are blowing... • A national crisis is looming for health workforce but it has as much to do with lack of innovation, as it does with shortages of workers • Three key trends • Changing Demographics • Technological Innovation • Change to market driven health • system

7. The workforce is changing… Are you ready for the next generation? • Age: Great depression/WWII era workers, Baby Boomers, and Generation X all see the world from a different vantage point • Race: Moving from a majority culture (1995), to diversity (2005), to multicultural (2025) • Gender: Dramatic expansion of career opportunities for women over past 30 years, not restricted to nursing and teaching

8. Technology Driven Changes Biomedical • US Investment in basic and applied biomedical sciences leads the world • The next generation of technology promises to reduce cost, move care to ambulatory settings, and improve outcomes

9. Health care is a knowledge based service enterprise Consumers are increasingly technology savvy Technology Driven Changes Information • Technological changes in • health care are likely to • increase the demand for • skilled labor

10. How to balance the tradition of individualism with the needs of: Population health System outcomes Broader social needs Balance of equity and choice Changes needed: Public understanding and expectation Legal framework Financing system Provider expectations Funded and deployed public system Market Pressures

11. Workforce implications • Workforce expenditures represent the major costs to systems • Increasing pressure to reduce/streamline personnel costs • Competence of providers, whether technical, cultural, clinical, is key to system success • Mal-distribution of services • Forecasting future needs is difficult but necessary, for the pipeline is long

12. Medicine: Nursing: Dentistry: Allied Health: General state of workforce shortages across health professions Public Health??

13. Public Health Workforce Data • US employment census information • Local / State Surveys or Reporting • National Association of City and County Health Organizations (NACCHO) • US Office of Personnel Management • Equal Opportunity Employment Commission (EEO-4) • Professional Associations • Information from: • BHPr (2001) “The Public Health Workforce: Enumeration 2000” HRSA. • Turnock and Hutchison (2000) “The Local Public Health Workforce” Illinois Center for Health Workforce Studies. • Mertz and Finocchio (1999) “A Snapshot of California’s Local Public Health Department” California Center for Health Workforce Studies.

14. Practicalities* Range of workers? Level of specificity? Data source? Time period? Data Issues* Quality and specificity Classification schemes Counting Unclassified Workers The Public Health Workforce: Enumeration 2000 *BHPr (2001) “The Public Health Workforce: Enumeration 2000” HRSA.

15. Findings • Physicians are small part of PH workforce • Epidemiologists are less than 1% of workforce • PHNs are largest professional group • Have most accurate numbers on lab professionals and nutritionists • Professional and leadership of PH is influenced by the number and quality of technical and administrative support

16. Oregon PH Workforce Data • Only data reported were from EEO-4 Categorization

17. Western States Study Rural PH has higher per capita spending, but relies mostly on PHNs Similar per capita supply of PH workers Low turnover, but difficult to fill vacant positions Recruitment of Professional staff with previous experience or format training is a challenge Varying amount of support staff Nursing core of staff, more diversity in urban regions Rural Public Health Workforce *Data from two reports done by WWAMI Center for Health Workforce Studies And a third from the Illinois Center for Health Workforce Studies

18. Urban and Rural Composition of the PH Workforce *Data from two reports done by WWAMI Center for Health Workforce Studies And a third from the Illinois Center for Health Workforce Studies

19. Low Ratio Unevenly distributed Diverse Large urban / rural differences Little data Hospitals Illinois and California *Data from reports done by the Illinois Center for Health Workforce Studies and And the California Center for Health Workforce Studies

20. Augmenting a limited PH workforce Lessons from recent studies show: • Collaborations with local hospitals and other services to ensure population coverage are successful • Volunteers play a key role in provision of PH • Leadership in creating and maintaining partnerships is key • Focus on strengths as a way to build relationships and attract new talent • Composition of staff and aspects of organizational structure may be more important influences on core functions than pure quantity of workers

21. War for Talent • Comprehensive issue in health care • Demand for specialized, skilled workers coupled with push for cost reduction • Health care consumers growing while providers are shrinking

22. Public Health Nursing: Staff • Average age is greater than that of RNs >45 • Most had worked >16 yrs and most with the same employer • 48% very satisfied • Work 37 hrs/week on average • 45% worked in MCAH with primarily female clients, 40% of clients don’t speak English • Interventions focused at family level (case mgmt) and community. Felt more prepared for family level work than community or system level work

23. Public Health Nursing: Managers • 50% supervise general PHN programs, only 32% on MCH (compared to majority of staff PHNs) • 50% had been in position from 1-5 years • 75% satisfied with their position • 75% indicated funding for services had not kept pace with inflation • 65% indicated wages had not kept pace with inflation

24. Forecasting PHN needs

25. Mental Health Workforce • Includes advanced practice nurses, psychiatric technicians, social workers, licensed counselors, psychologists and psychiatrists • Currently little to no workforce data on non-physician practitioners in this field • Licensing and certification requirements vary per state & numerous states do not offer reciprocity to non-physicians

26. Mental Health Workforce • A growing need for these providers because of changing laws concerning substance abuse and the treatment of non-institutionalized, child & adolescent, long-term care, and elderly users of services • Currently little to no emphasis on geriatric training for mental health providers although there is a critical need for this • Insurance limitations & legislative mandates put a heavy burden on the public sector to provide mental health services

27. Dental Public Health • There significant shortage of oral health services, particularly in rural communities • Dental public health measures are essential if we are to stop the epidemic of oral diseases in children currently manifesting • The primary care system is not prepared to deal with oral health issues • There are more barriers to obtaining dental care and fewer people have dental insurance than medical care or insurance

28. Oral Health Workforce Shortages Two Strategies 1) Increase the number of dentists and allied dental professionals who will serve underserved populations 2) Redefine the oral health care workforce and expand roles of all practitioners as appropriate

29. Redefining the Oral Health Care Workforce • Interdisciplinary models for care delivery exist • Expand roles of non-oral health professionals to assist in prevention, referrals and oral health education • Easiest to reach underserved populations in existing settings (primary care clinics, WIC offices, schools) • Many barriers as professional boundaries and traditional modes of practice are change averse

30. Diversifying:Shifting your Perspective • Update your concept on future pools of workers, i.e., for nurses, pool may include allied health workers as well as young people • Research on values and goals of new workers to understand how to recruit them into health careers • Educators and employers work together to design work and learning environments that integrate these findings

31. Diversity Strategies

32. Workplace and Professions Changes • Replicate the best of innovative approaches which have demonstrated success • Mentoring, volunteering • Develop career pathways across professions • Focus on early and sustained education in health careers, flexible pathways • Facilitate life-long learning

33. Strategic Recommendations • Change professional training to meet the demands of the new health care system • Ensure that the health profession workforce reflects the diversity of the nation’s population • Require interdisciplinary competence in all health professionals • Continue to move education into ambulatory practice • Encourage public service of all health professional students and graduates Pew Health Professions Commission “Recreating Health Professions Practice For a New Century: Fourth Report of the Pew Health Professions Commission “

34. Recommendations for Public Health • Each state should undertake a broad assessment of its public health workforce in order to facilitate workforce planning and training • Public health schools and departments should develop certification and continuing education programs to help providers upgrade and maintain their competence Pew Health Professions Commission “Recreating Health Professions Practice For a New Century: Fourth Report of the Pew Health Professions Commission “

35. Recommendations for Public Health • Public health curricula and training in both schools and individual programs should expose students to, and prepare them for, the multiple sectors in which public health services are delivered • Public health departments, schools and professions should urge other professions and organizations in assessing and promoting the public’s health. • Public health schools, program and departments should focus some of their resources on training lay health workers and community residents to understand the mission of public health and equip them the basic competence to accomplish this mission Pew Health Professions Commission “Recreating Health Professions Practice For a New Century: Fourth Report of the Pew Health Professions Commission “

36. Continuum of Responses High Start Over Complexity Reinvent Improve Scramble Low Short Time Long

37. Future Directions • Scramble • Buy more workers, threaten action, study the issue, 4 color brochures and ads, sign-on bonuses, debate the problem • Improve existing processes to fit today’s challenges • Adjust education, improve management, engage workers in problem solving, collaborate, fund tuition scholarships, distance learning, mentor programs

38. Future Directions • Reinvent the fundamental properties of work, education, and professional organization • Experiment with new models, diversify, lower the wall between education and work/practice, integrate • Start Over • Community integration, collaborative partnerships, new care delivery models based on patient needs and wants, new professional and practice models, cultural competency, technology adoption • ACT!

39. Useful Responses • Move this issue to the strategic level • Assume partnerships will be necessary • Look for balance of short and long-term goals • Look for creative options • Create sustainable workplace

40. Parting Shots • Most change is PSYCHOLOGICAL • Partnerships are ABSOLUTELY necessary • Important that we NOT enfranchise the status quo “The doctors of the future will give no medicine, rather they will interest their patients in care of the human frame, in diet, and in the cause and prevention of disease” --Albert Einstein

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