Health Workforce Trends and Policy in Nevada and the United States

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1 Health Workforce Trends and Policy in Nevada and the United States Tabor Griswold, PhD Health Services Research Analyst Office of Statewide Initiatives University of Nevada School of Medicine CHS Fall 2015 September 21,

2 Overview Presenting Nevada s Health Care System Overview of the Major Inputs Forces Affecting Supply Discussion Forces Affecting Demand Discussion Forces Affecting Shortages Discussion 2

3 Nevada s Health Workforce 109,898 total jobs or 9.9% of the civilian workforce in Nevada 31,495 other jobs in health care industries (29.5% of the health workforce) 21,804 health care jobs in other industry sectors (19.8% of the health workforce) 55,677 health care jobs in health care industries (50.7% of the health workforce) Health Care Industries Ambulatory Health Care Services Hospitals Nursing and Residential Care Facilities Health Care Industry Jobs in Nevada: 88,094 Health Care Occupations Health Diagnosing and Treating Practitioners Health Technologist and Technicians Healthcare Support Occupations Health Care Occupation Jobs in Nevada: 77,481 Source: Nevada Department of Employment, Training, and Rehabilitation (2012). 3

4 Forces Affecting Health Care Demographic change The economy ACA, health insurance coverage expansions Population health Health care system change Science and technological change State and federal policy 4

5 Forces Affecting Health Workforce Supply Higher education programs and capacity K-12 education pipeline Health professions licensing and regulation State policy and budget esp. funding for higher education health education programs Federal policy esp. support for health workforce education and training 5

6 Health Workforce Demand 6

7 Health Workforce Demand in Nevada Health sector has experienced modest employment gains since 2007 Population growth and aging, as well as ACArelated insurance coverage expansions will generate above average demand for health care workers in Nevada Overall growth in health care employment (16.3%) is projected to exceed the average for all occupations in Nevada (11.6%) through

8 Health Care Employment in Nevada 2005 to 2014 Number of Jobs (Thousands) Health Care and Social Assistance Ambulatory Health Care Services Hospitals Source: Nevada Department of Employment, Training, and Rehabilitation (2014).

9 Health Care Employment in Las Vegas 2005 to 2014 Number of Jobs (Thousands) Health Care and Social Assistance Ambulatory Health Care Services Hospitals Source: Nevada Department of Employment, Training, and Rehabilitation (2014).

10 Projected Demand for Health Care Workers by Industry in Nevada through 2020 Ambulatory Care: 7,778 jobs (+14.9%) Offices of physicians: 2,468 jobs (+8.3%) Home health care services: 1,643 jobs (+34.9) Hospitals: 3,168 jobs (+10.4%) Nursing Homes and Residential Care Facilities: 2,581 jobs (24.4%) All Health Care Industries: + 13,527 jobs (+16.3%) 10

11 High Demand Health Occupations in Nevada Annual Opening through 2020 Registered nurses (RNs): 610 job openings Home health aides: 211 Nursing assistants: 140 Medical assistants: 137 Medical secretaries: 108 Licensed practical nurses (LPNs): 98 Pharmacists: 86 11

12 High Demand Health Occupations in Nevada Annual Opening through 2020 Dental assistants: 84 job openings Pharmacy technicians: 82 Massage therapists: 92 Child, family, and school social workers: 80 Primary care physicians: 74 Fitness trainers and aerobics instructors: 72 Medical and health services managers: 70 12

13 High Demand Health Occupations in Nevada Eleven high demand health care occupations are ranked among the top 100 occupations in Nevada with the largest projected employment growth through 2020 Growing demand for health services will generate nearly 3,000 jobs for registered nurses and 1,500 jobs for home health aides by

14 High Demand Health Occupations in Nevada 20 of the top 35 high demand health care occupations possess an average annual salary greater than average annual salary of $41,497 for all occupations in Nevada 22 require a post-secondary degree for licensure in the State of Nevada 14

15 Health Workforce Supply 15

16 Health Workforce Supply in Nevada Steady growth in the number of licensed health professionals Treading water in the number of licensed health professionals per capita Severe health workforce shortages compounded by an aging health workforce and ensuing ACArelated demand Persistent specialty shortages and geographic maldistribution of physicians and most other health professionals 16

17 Number of Licensed Allopathic Physicians (MDs) per 100,000 Population in Nevada 2002 to Metropolitan North 200 Metropolitan South Rural and Frontier Northeast 100 Rural and Frontier Northwest 50 Rural and Frontier South Nevada Total Source: Nevada State Board of Medical Examiners (2002, 2004, 2006, 2008, 2010, 2012), Nevada State Demographer s Office (2002, 2004, 2006, 2008, 2010, 2012). 17

18 Number of Licensed Registered Nurses (RNs) per 100,000 Population in Nevada 2002 to Metropolitan North Metropolitan South Rural and Frontier Northeast Rural and Frontier Northwest Rural and Frontier South Nevada Total Source: Nevada State Board of Nursing (2002, 2004, 2006, 2008, 2010, 2012), Nevada State Demographer s Office (2002, 2004, 2006, 2008, 2010, 2012). 18

19 Physician Workforce Rankings Physicians, MDs 45 th among US states Physicians, DOs 18 th Physicians, MD & DO 45 th Patient Care Physicians 44 th Primary Care Physicians 46 th Patient Care Primary Care Physicians 46 th Residents & Fellows 46 th Residents & Fellows in Primary Care 46 th Source: American Medical Association (2012), O Leary Morgan and Morgan (2012), National Center for the Analysis of Healthcare Data (2012). 19

20 Physician Workforce by Medical Specialty General and Family Practitioners 46 th Pediatricians 46 rd Obstetricians and Gynecologists 40 th Ophthalmologists 48 nd Orthopedic Surgeons 51 st General Surgeons 51 st Specialty Surgeons 51 st Source: American Medical Association (2012), O Leary Morgan and Morgan (2012), National Center for the Analysis of Healthcare Data (2012). 20

21 Health Workforce Rankings Nursing Number of Licensed Nurses per 100,000 Population Registered Nurses 50 th Nurse Practitioners 41 st Clinical Nurse Specialists 26 th Certified Nurse Midwives 44 th Certified Nurse Anesthetists 51 st Licensed Practical Nurses 49 th Source: CQ Press Health Care State Rankings (2011). 21

22 Health Workforce Rankings Other Health Professionals Number of Actively Licensed Health Professionals per 100,000 Population Dentists 31 st Dental Hygienists 40 th EMTs and Paramedics 45 th Optometrists 49 th Pharmacists 34 th Physical Therapists 47 th Physician Assistants in Clinical Practice 37 th Psychologists 47 th Source: CQ Press Health Care State Rankings (2011). 22

23 Primary Care Number of MDs per 100,000 Population Family Medicine General Practice Internal Medicine Pediatrics OB/Gyn Nevada Mountain Region US Source: AMA. Physician Characteristics and Distribution in the US (2014). 23

24 Medical and Surgical Specialties Number of MDs per 100,000 Population General Surgery Orthopedic Surgery Cardiovascular Disease GI Psychiatry Nevada Mountain Region US Source: AMA. Physician Characteristics and Distribution in the US (2014). 24

25 SHORTAGES 25

26 Recap of Policy Levers to Address Health Workforce Shortages in Nevada Higher education programs and capacity esp. public program and opportunities K-12 education pipeline Health professions licensing and regulation State policy and budget esp. funding for higher education health education programs Federal policy esp. support for health workforce education and training 26

27 Primary Care Workforce Shortages in Nevada Most regions of rural and frontier Nevada are primary care HPSAs 142,500 rural residents (51%) live in a primary care HPSA 816,000 urban residents (32%) live in a primary care HPSA, including 612,000 residents of Clark County 27

28 28

29 Physician and Primary Care Workforce 2014 Number per 100,000 Population Profession Rural & Frontier Urban Nevada Allopathic Physicians (MD) Adv Practitioners of Nursing (APN) Osteopathic Physicians (DO) Physician Assistants (PA) Primary Care Physicians (MD & DO) Source: See references for Tables 4.6 through 4.42 in Nevada Rural and Frontier Health Data Book 2015, p. 212, Table 4.48.

30 Dental Care Workforce Shortages in Nevada Most regions of rural and frontier Nevada are dental care HPSAs 145,500 rural residents (51%) live in a dental care HPSA 758,000 urban residents (32%) live in a dental care HPSA, including 613,000 residents of Clark County 30

31 Oral Health Care Workforce 2014 Number per 100,000 Population Profession Rural & Frontier Urban Nevada Dentists Dental Hygienists Source: See references for Tables 4.6 through 4.42 in Nevada Rural and Frontier Health Data Book 2015, p. 212, Table 4.48.

32 Mental Care Workforce Shortages in Nevada All regions of rural and frontier Nevada are mental care HPSAs 286,000 rural residents (100%) live in a mental care HPSA 1.2 million urban residents (31%) live in a mental care HPSA, including 737,000 residents of Clark County (31%) 32

33 Mental and Behavioral Health Workforce 2014 Number per 100,000 Population Profession Rural & Frontier Urban Nevada Alcohol, Drug, & Gambling Counselors Marriage & Family Therapists Psychiatrists Psychologists Social Workers (LSWs) Source: See references for Tables 4.6 through 4.42 in Nevada Rural and Frontier Health Data Book 2015, p. 212, Table 4.48.

34 County Profile Reports for Nevada Data from the Nevada Rural and Frontier Health Data Book Seventh Edition Demographic, economic, health, workforce, resources data about 286,000 rural residents and 1.2 million urban residents 34

35 Recap of Policy Levers to Address Health Workforce Shortages in Nevada and the US Higher education programs and capacity K-12 education pipeline Health professions licensing and regulation State policy and budget esp. funding for higher education health education programs, UME, loan repayment and forgiveness policy Federal policy esp. support for health workforce education and training, GME 35

36 Tabor Griswold, PhD Health Services Research Analyst Office of Statewide Initiatives University of Nevada School of Medicine (775)

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