Health Workforce Vacancies in Arkansas

1. Health WorkforceVacancies in Arkansas Ann B. Bynum, Ed.D.1, Cathy A. Irwin, Ph.D., R.N.2 Zoran Bursac, Ph.D., M.P.H.3 Jimie Jarry, B.A.2 1University of Arkansas for Medical Sciences (UAMS), Regional Programs, Center for Rural Health, Center for Distance Health 2UAMS, Center for Rural Health 3UAMS, Faye W. Bozeman College of Public Health, Biostatistics

2. Objectives • Explain the study purpose, research design/procedures, and instrument used in this study. • Identify the current and expected workforce vacancies within the next 5 years for 90 health professionals in Arkansas by type of health care facility, regions in Arkansas and in Pulaski County. • Describe the conclusions and implications for health professions education, clinical practice, and future research.

3. Background • Arkansas is facing a growing shortage of health care workers: Expected to worsen as the baby boomers retire • Increased demand for health care services in Arkansas • Growing total populations • Increased elderly and ethnic minority populations • Fewer uninsured patients as a result of health care reform initiatives

4. Background Additional factors contributing to the shortage of health professions: • Unfavorable work environments • More satisfying alternative job opportunities • Financial constraints with current recession • Limitations in faculty, laboratory space, and clinical training sites for health education programs

5. Background • Geographic maldistribution of health professionals must be addressed for solving shortages of health professionals in Arkansas. • Decline in the number of students choosing primary care careers • Problems with recruitment and retention of primary care providers in rural areas • Low compensation • Rising malpractice premiums • Professional isolation • Limited time off • Scarcity of jobs for spouses

6. Impact of Workforce Shortages on Quality of Care • Insufficient numbers and quality of health care professionals can affect the ability of health care facilities to meet the needs of their communities. • National surveys of registered nurses (N = 657), physicians (N = 445), and hospital executives (N = 364) in 2004-2005 demonstrated that nursing shortages in hospitals had an impact on hospital capacity: • Reduced available hospital beds (56%-78%) • Delayed discharges (50%-69%) • Increased wait time for surgery (45%-68%) • Discontinued patient care programs (20%-49%)

7. Impact of Workforce Shortages on Patient Outcomes Results from a survey of U.S. hospitals from 11 states (N = 799) demonstrated strong relationships between nurse staffing variables and patient outcomes: • Urinary tract infection • Pneumonia • Length of hospital stay • Upper gastrointestinal bleeding • Shock • Failure to rescue (death rate related to hospital complications)

8. Impact of Workforce Shortages on Health Status • Shortages of health professionals can affect the health status Arkansas residents. • In 2009, Arkansas ranked 40th in the nation for health status. • Adequate numbers of health care professionals are needed to address the causes of preventable, premature deaths and to promote continued improvement in the health status of Arkansans.

9. Purpose of the Study Assessed health workforce vacancies for 90 health professionals in Arkansas by type of health care facility, regions in Arkansas, and in Pulaski County

10. Purpose of the Study The following categories of health professions were assessed for current employment vacancies during 2011 and expected employment vacancies within the next 5 years: • Primary care physicians • Physician specialists • Nursing • Allied health professions • Pharmacists • Dentists

11. Facilities Surveyed • Hospitals • Nursing homes • Medical clinics • County health units • Community health centers • Area Health Education Center (AHEC) clinics • Dentist offices • Pharmacies • Ambulance services • Home health care services

12. Regions of Arkansas

13. Significance of the Study • Results may be used to provide data for planning educational programs for health care in Arkansas. • Planning for a supply of health professionals that will meet the demand • Determine the needs of rural areas for health professionals • Plan strategies in clinical practice and health professions education for solving workforce shortages in Arkansas

14. Methods • Cross-sectional survey design • Measured current health workforce vacancies and expected vacancies within the next 5 years for 90 health professionals • Other descriptive variables: Type of health care facility, regions in Arkansas, and Pulaski County • Data collection during March-July, 2011

15. Study Population • Total Population size = 4,212 • Directors of the human resources department, administrators, and office managers • Hospitals, n = 111 • Nursing homes, n = 246 • Medical clinics, n = 2,180 • County health units, n = 102 • Community Health Centers and dental clinics, n = 74 • AHEC clinics, n = 8 • Dentist offices, n = 865 • Pharmacies, n = 395 • Ambulance services, n = 62 • Home health care services, n = 169

16. Procedures • Completed survey instrument via paper (mailed survey) or on-line via a website • Mailed reminder postcard after short time • Mailed second questionnaire after sufficient response time • Follow-up with nonrespondents via telephone: Reminded to complete the mailed or Web-based survey • Telephone reminder followed the second mailed survey, 2.5 weeks after the mailing • Three reminder calls were made to nonrespondents • If the questionnaire was lost, address of web survey was emailed or a replacement questionnaire was emailed or faxed.

17. Procedures • Each survey instrument was assigned a code number to identify respondents with facility. • Code numbers linked facility to zip codes. • Zip codes were used to obtain the variable for region in Arkansas and county in which each facility was located. • Zip code-based population statistics were used to determine the size of the community in which each facility was located. • Web addresses and personal identification numbers (PINs) for population members to complete the on-line survey—Assured that each population member took the survey only once

18. Instrument • Vacancy survey instrument: Evaluated current and expected vacancies for 90 health professionals • Eight survey instruments: Include health professionals that are employed in these types of health care facilities • Hospitals • Nursing homes • Medical clinics • AHEC clinics, Community Health Centers, and county health units • Dentist offices • Pharmacies • Ambulance services • Home health care services

19. Instrument • Vacancy survey was adapted from the 8-item vacancy survey developed by the Idaho Rural Health Education Center • Survey was revised to include vacancies for 63 additional health professionals and expected vacancies within the next 5 years. • Vacancy survey includes 3-11 items that assess current and expected vacancies for: primary care physicians (4 specialties); physician specialists (30 specialties); dentists; nursing (10 professions); allied health professions (42 professions); and pharmacy (4 professions). • Participants responded to each item by listing the number of vacancies for each health professional.

20. Data Analysis • Data were entered and analyzed in the Statistical Package for the Social Sciences (SPSS), Version 15 and SASv9.2 • Cross tabulations: Counted the number of vacancies for each health professional by type of health care facility, Arkansas regions, and in Pulaski County • Frequencies of the data were evaluated for duplicate physicians’ vacancies in medical clinics and hospitals.

21. Data Analysis • Current and expected vacancies for health professions in the study population (N = 4,212 facilities) were extrapolated from the current and expected vacancies that were reported in the survey. • Calculated by multiplying the number of current and expected vacancies for each health profession within each facility type by a constant multiplier to adjust for nonrespondents • Each multiplier was specific to a facility type. • Multiplier was a ratio of the total number of surveyed facilities for each facility type and the number of respondents for each facility type

22. Data Analysis • Determined health professionals that are currently under-produced and over-produced • Calculated by subtracting the number of current vacancies for health professions in the study population from the number of graduates in 2010-2011

23. Sample of Respondents for Facilities Facility TypeSample Size Response Rate • Hospitals 68 61.26% • Nursing homes 90 36.59% • Medical clinics 568 26.06% • County health units 102 100.00% • Community Health Centers, 58 78.38% dental clinics • AHEC clinics 8 100.00% • Dentist offices 389 44.97% • Pharmacies 181 45.82% • Ambulance services 35 56.45% • Home health care services 40 23.67% • Total Sample 1,539 36.54%

24. Results: Current and Expected Vacancies for Health Professions • Extrapolated vacancies: Total of 7,021 current and 23,893 expected vacancies for nursing, allied health, and pharmacy professions; and for primary care physicians and dentists • Physician specialists had 317 current and 456 expected vacancies. • Allied health professions had the highest number of current (4,335) and expected (16,468) vacancies.

25. Current and Expected Vacancies for Nursing Professions Nursing had 1,970 current vacancies and 5,675 expected vacancies.

26. Current and Expected Vacancies for Nursing Professions

31. Current and Expected Vacancies for Allied Health Professions Allied health professions had a total of 4,335 current and 16,468 expected vacancies.

32. Current and Expected Vacancies for Allied Health Professions

33. Current and Expected Vacancies for Allied Health Professions

34. Current and Expected Vacancies for Allied Health Professions

42. Current and Expected Vacancies for Primary Care Physicians Primary care physicians had a total of 514 current and 860 expected vacancies.

43. Current and Expected Vacancies for Primary Care Physicians

48. Current and Expected Vacancies for Physician Specialists Physician specialists had a total of 317 current and 456 expected vacancies.

49. Current and Expected Vacancies for Physician Specialists

50. Current and Expected Vacancies for Physician Specialists