ALLIED HEALTH OCCUPATIONS
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1 ALLIED HEALTH OCCUPATIONS INLAND EMPIRE REGION ENVIRONMENTAL SCAN JULY 2008 CENTER OF EXCELLENCE, INLAND EMPIRE San Bernardino Community College District 114 S. Del Rosa Drive, San Bernardino, CA (909) INFORM CONNECT ADVANCE Initiative of
2 Table of Contents Table of Contents... 2 Executive Summary... 3 Introduction... 4 The Allied Health Industry: A Definition... 6 Industry Overview: California & the Inland Empire... 6 Occupational Overview... 9 Employer Needs and Challenges...10 Continuing Education Units...11 The Current College & ROP Response...11 Apprenticeship Programs...14 Recommendations...15 Conclusion...17 Additional References...18 Appendices A How to Utilize this Report...19 B Allied Health Jobs Across California Regions C Inland Empire: Top 5 Comparison...22 D Regional Occupational Projection Data...23 E Occupational Profiles...29 F Occupational Wages by Education...41 G Overview of Previous Labor Market Information Studies/Reports...42 H GIS MAP: Inland Empire Allied Health Employers...46 I Continuing Education Unit (CEU) Information...47 J List of Allied Health Associations...49 K Allied Health Accrediting Agencies...50 L CCC & ROP Program Offerings
3 There is a projected increase of 15.44% in new allied healthcare job openings in the Inland Empire by This exceeds state-wide growth projections at 10% as well as the national growth projection of 14%. - EMSI Complete Employment, (September 2007) Executive Summary The allied healthcare industry is a vital component of California s health care system and accounts for nearly 60% of health care occupations. 1 San Bernardino & Riverside Counties, like the rest of California and the United States, are experiencing a severe shortage of qualified allied healthcare professionals. This crisis is a result of a combination of factors which includes an aging workforce, limited availability of resources to train the workforce, a shortage of allied health educators and clinical sites, and evolving techniques which affect needed skills in workers. Several occupations are experiencing rapidly changing technology that requires advanced training or re-training. This report is designed to serve the following purposes: 1. Provide community colleges in the Inland Empire with data reflecting the allied healthcare industry s workforce needs. 2. Provide colleges in the region with recommendations to address the gaps in the allied healthcare workforce. Allied healthcare occupations are projected to produce nearly 29,500 job openings in the Inland Empire by 2012, indicating an increase of employment at 15.44%. 2 Approximately 30% of this anticipated growth is from replacement jobs. While replacement jobs are not an indicator of industry growth, the number of projected replacement jobs in the region will have a significant bearing on workforce needs in the allied healthcare industry. Based upon each occupation s projected growth, educational requirements and ability to provide a living wage, there are fourteen occupations that warrant immediate attention. Some of these occupations have zero (or only one or two) colleges or ROPs currently providing training programs to satisfy the need for the entire Inland Empire. According to these regional program completion statistics, we are only satisfying 77.6% of the industry s needs. A clear and urgent need for qualified allied healthcare personnel in the region exists. An aging workforce, increasingly specialized occupations, patients requiring a higher level of care, and a diverse population are further driving this need. Community colleges and the allied healthcare industry can use the findings presented in this report to collaboratively address current and future gaps in the workforce. There are several key recommendations for the community colleges in the region including: providing additional sections of allied health core courses, providing continuing education courses for incumbent workers, increasing collaboration to identify the best suited responders, identifying and convening local allied healthcare employers, and exploring creative solutions to barriers in program development. 1 Health Workforce Solutions 2 EMSI Complete Employment Data 3
4 Introduction This report explores Allied Health occupations within San Bernardino & Riverside Counties (the Inland Empire Region) to identify the fastest growing and highest in-demand occupations and compare them with existing educational and training programs offered by the ten regional Community Colleges and four Regional Occupational Programs (ROP) listed in Table 1. Our goal is to assist community college administration in strategic decision-making regarding future educational and training programs that would best serve our regional and local communities. Table 1: Community Colleges & ROPs Located in the Inland Empire College Location Baldy View ROP Rancho Cucamonga Barstow College Barstow Chaffey College Rancho Cucamonga College of the Desert Palm Desert Colton-Redlands-Yucaipa ROP Redlands Copper Mountain College Joshua Tree Crafton Hills College Yucaipa Mt. San Jacinto College San Jacinto Palo Verde College Blythe Riverside City College, RCCD Riverside Riverside County Office of Riverside Education CTE/ROP San Bernardino County ROP San Bernardino San Bernardino Valley College San Bernardino Victor Valley College Victorville There are approximately 68 total occupations in the field of allied healthcare recognized by the Bureau of Labor Statistics (of which only 24 require a bachelor s degree). Based on labor market information (which includes contractors, sole-proprietors and small businesses) this report focuses on those allied health occupations that will provide the greatest number of new and replacement jobs over the next five years. 3 Those occupations include the following: Dental assistants Dental hygienists Emergency medical technicians & paramedics Licensed vocational nurses Massage Therapists Medical assistants Medical records and health information technicians Pharmacy technicians Psychiatric Technician Radiologic technologists and technicians 3 This report contains information that was compiled from the InfoUSA employer listings and analyzed with the help of Environmental System Research Institute s (ESRI) GIS software application. Occupational and industry projections data were provided by Economic Modeling Specialists Inc. (EMSI). A complete list of references and data sources is located in the Appendix. 4
5 Registered nurses Respiratory therapists Collectively, these 12 occupations are projected to produce nearly 22,000 new and replacement jobs over the next five years in the Inland Empire region. Education levels suggested or required for these occupations range from training to degrees, including short-term or moderate term on-the-job training, certificates, and Associate degrees. Given the high number of occupations requiring an Associate degree or less, the community colleges and ROPs will play a major role in educating this workforce for future industry needs within the Inland Empire region. 5
6 The Allied Health Industry: A Definition A technical definition of the allied healthcare workforce does not reveal the complexity of the industry. An allied healthcare professional is one whose highly specialized skills provide diagnostic, therapeutic, and informational and support services directly and indirectly to patients in health care delivery settings. 4 Some professions require little or no education, others require certificates, Associate degrees, or Bachelor s degrees and above. Some of the occupations impose California licensing requirements on practitioners. In a study prepared for the California Business Roundtable and the Campaign for College Opportunity in 2006, the authors found that among all industries, health care is the sector that requires the most Associate s degrees and certificates amongst its workforce. 5 This suggests that community colleges, in partnership with local ROPs, are the major providers of a trained health care workforce. The community college system will therefore be central in addressing any shortage of allied healthcare professionals both now and in the future. Industry Overview: California & the Inland Empire California In California, the healthcare industry is recognized as a major economic force with revenue exceeding $1 billion annually. 6 The California Employment Development Department statewide estimates reveal that among the top 40 fastest growing occupations over the next six years, 11 of those occupations are in the allied healthcare industry. 7 Statewide, there are approximately 16,510 new job openings in the allied healthcare field annually. 8 Of these, approximately 22% (3,700 annually) occur in the Inland Empire. The allied healthcare industry is a vital component of California s health care system and accounts for nearly 60% of healthcare occupations. 9 The Inland Empire, like the rest of California and the United States, is experiencing a severe shortage of qualified allied healthcare professionals. This shortage results from a combination of factors including an aging workforce, limited availability of resources to train the workforce, a shortage of allied health educators and clinical sites, and evolving techniques which affect needed skills in workers. Several occupations are experiencing rapidly changing technology that requires advanced training or re-training. Additionally, many occupations now require certification or licensure that was not required in the past. Allied healthcare occupations are located in a variety of firms, such as hospitals, fitness gyms, schools and medical offices. 4 Ruzek, J.Y. et al, The Hidden Health Care Workforce: Recognizing, Understanding and improving the Allied and Auxiliary Workforce, Center for the Health Professions, University of California, San Francisco, July Fountain, R. and Cosgrove, M. Keeping California s Edge: The Growing Demand for Highly Educated Workers. CSU Sacramento, April US Census Bureau, 2002 Economic Census 7 EDD, Fastest Growing Occupations, , 8 LMI Employment Projections 9 Health Workforce Solutions 6
7 Although California has begun addressing the recognized nursing shortage with funding and legislation, recent reports project that there will also be a growing shortage of allied healthcare professionals. Several demographic factors will heighten this growing shortage: California s population is expected to outpace that of the entire United States, growing by nearly 30% by Within the state, the fastest growing group are residents over the age of As the population grows, the diversity of that population increases as well. And finally, the allied healthcare workforce is aging and will require replacements within the next five years. The average age of nurses is nearly 50 years old today and some healthcare workforce categories have an average age of well over Within this larger context, increasing diversity within the Allied Health field in California is a statewide goal by strategic partners and the educational sector. Although not a primary focus of this report, the Center of Excellence notes the importance of the goal and its predominance in the research literature on Allied Health. For example, currently Whites and Asians represent the largest portion of the state s workforce for professions with high barriers to entry. Recent estimates indicate that roughly 9 out every 10 physicians, dentists, and pharmacists in California is either White or Asian. Conversely, among entry-level and healthcare support occupations (where opportunity is greatest) 1 in 3 workers is Hispanic or Latino and proportional representation of African Americans is nearly twice its size in the working age population. 12 Community colleges aspiring to fill the state s pipeline of allied heath workers must be cognizant of the current and required diversity within the workforce. Seven reports were commissioned by The California Endowment to foster a more comprehensive, evidenced-based understanding of the issues, challenges, and opportunities associated with efforts to increase workforce diversity in health professions. 13 The reports include current demographic trends, interviews with educational institutions, 33 exemplary model practices, and pipeline recommendations. The reports are recommended and are available at The Inland Empire The Inland Empire region is faced with projections of workforce need that outpace both the state and national figures; third in demand within California following the heavily populated Los Angeles and San Francisco regions (see Appendix B). Allied health occupations that are represented by industry clusters including ambulatory health care services, hospitals, nursing and residential care facilities, and social assistance accounted for 150,321 jobs in the Inland Empire in Allied health occupations are population serving which means the sector s size correlates with population growth. In looking at the region s demographics, the number of Inland Empire residents between the ages 10 Health Workforce Solutions and the Campaign for College Opportunity, Closing the Health Workforce Gap in California: The Education Imperative, November Health Workforce Solutions and the Campaign for College Opportunity, Closing the Health Workforcte Gap in California: The Education Imperative, November For more information regarding the impact our aging population will have on the healthcare sector, review the Institute of Medicine s 2008 report, Retooling for n Aging America: Building the Health Care Workforce 12 Diversity in California s Health Professions: Current Status & Emerging Trends (March 2008), UCSF Center for Health Professionals - 7
8 of 55 and 69 is expected to double by This growing, and aging, population heavily contributes to the 2012 projection of Allied Health occupations reflecting an increase of 23,212 jobs during this time period. Table 2: Job Projections and Total Change in Allied Healthcare Clusters Basic Information 2007 Industry Jobs 150, Industry Jobs 173,533 Total Change 23,212 Total % Change 15.44% 2006 Average Earnings/Worker (EPW) $45,103 Employment data and projections in this industry cluster show that the Inland Empire will experience a larger percentage growth than either the state or the nation. Table 3: Regional, State and National Job Projections Description 2007 Jobs 2012 Jobs Change % Change EPW Regional Total 150, ,533 23,212 15% $45,103 State Total 1,778,247 1,957, ,867 10% $51,848 National Total 18,474,059 21,077,639 2,603,580 14% $44,979 Source: EMSI Complete Employment - September Johnson, Hans, Reed, Deborah and Hayes, Joseph. The Inland Empire in Public Policy Institute of California, April
9 Occupational Overview Fifty one percent (51%) of regional allied healthcare services are provided in the offices of physicians (except mental health specialists) and dentists. Other health practitioners - ranging from podiatrists to mental health practitioners - provide another 21.3% of the services. In terms of future workforce needs, the industry make-up will require a workforce that can provide medical, dental and financial support services in both the short-term and long-term for practitioner offices. According to the absolute change (rather than growth percentage), the occupations that are projected to experience the largest increase in new positions over the next five years in the Inland Empire are registered nurses, medical assistants and dental assistants. Table 4: Inland Empire Projections Description 2007 Jobs 2012 Jobs Change % Change Registered nurses 20,919 24,606 3,687 18% Medical assistants 8,240 10,129 1,889 23% Dental assistants 3,698 4, % Source: EMSI Other methods of analyzing the workforce include reviewing the occupations that currently are the largest, or those that are the fastest growing by percentage. It may also be instructive to break them down by educational requirements. The top five occupations sorted by each of these different criteria are presented in Appendix C. The Center of Excellence also analyzed 68 Healthcare Occupations based on numbers of new and replacement jobs. For each occupation, the chart indicates educational requirements, those providing a living wage within the region, and those expected to grow at a rate that could warrant adding additional programs (See Appendix D). Of the occupations examined, twleve met the following selection criteria warranting further investigation and consideration: 1) curriculum and employment requirements must be relevant for community college instruction; 2) occupation must have a projected growth of 50+ per year (300+ over six years) to substantiate offering a program; and 3) must pay a living wage for the region. Those twelve, in alphabetical order, are: Dental assistants Dental hygienists Emergency medical technicians & paramedics Licensed vocational nurses Massage Therapists Medical assistants Medical records and health information technicians Pharmacy technicians Psychiatric Technician Radiologic technologists and technicians Registered nurses Respiratory therapists These twelve occupations will produce nearly 22,000 jobs over the next 5 years in the Inland Empire. Since the data indicate that these occupations provide the greatest number of new and replacement jobs among all others in Allied Health, this is where any institutional resources would be best focused. To further illustrate the need surrounding these selected allied healthcare occupations, data highlighting employment projections for the region and by county (both San Bernardino & Riverside) are included in Appendix D. By looking at the data for each county as well as for the Inland Empire as a whole, colleges can best determine which institution should respond to meet the local and regional needs. 9
10 Occupation Descriptions Appendix E includes a profile of each of the twelve specific occupations within the allied healthcare industry that are projected to have significant need for new and replacement workers in the Inland Empire. Each occupational overview contains a brief description, educational and/or licensure requirements, a table of those community colleges and Regional Occupational Programs (ROPs) that provide the necessary programs, as well as a career ladder diagram. A listing of allied healthcare occupations sorted by education and training requirements, including Inland Empire median hourly wage, is presented in Appendix F. Employer Needs and Challenges Allied healthcare employers report increasing difficulty in hiring trained and licensed allied healthcare workers. In a recent article in The Business Press, it was reported that a supervisory pharmacist position at Riverside County Regional Medical Center has been vacant for more than three years. The hospital advertised, manned recruitment booths, recruited through national associations, and received no resumes or For a clinical pharmacist in the inland valley, it takes about a year to fill Zee Currie, Pharmacy Director, Riverside County Regional Medical Center inquiries. 14 The pending retirement of the aging workforce further exacerbates this problem. 15 Employers increasingly look to community colleges to produce a sufficient number of skilled workers in allied health occupations. The Inland Empire Center of Excellence worked with the Economic Development Agencies in Riverside and San Bernardino Counties and the Desert Region 9 Tech Prep Consortium to develop a survey instrument to validate employment projections in the top Allied Health occupations and to obtain clinical site commitments for these occupations. The first phase of the project included an overview of all existing labor market studies in Allied Health to inform our questionnaire and approach (see Appendix G). At the conclusion of the project, fifty employers were surveyed (25 in each county) resulting in the following key findings: The survey validated that the most frequently mentioned Allied Health occupations needed in the future were Medical Assistants, Certified Nursing Assistants (CNA s) and Dental Assistants/Dental Hygienists. Of the top Allied Health occupations, all except Respiratory Therapists and Pharmacy Technicians were mentioned as key occupations. Employers in both the Riverside and San Bernardino County surveys cited an oversupply of Pharmacy Technicians. 16 Interns need to be trained longer, with more hands on experience and frequent supervision at intern training sites. 17 While few employers indicated an oversupply of Medical Assistants, Dental Assistants and CNA s, some employers stated that there is an undersupply of well-trained workers. This underscores the need for high training standards, which may be a point of differentiation from proprietary schools. 14 Health Care Help Wanted (December 17, 2007), The Business Press, p Allied Health Employment Trends and Opportunities for the Central Valley Region, Center of Excellence, Central Valley Region, February 19, This does not necessarily mean that these occupations are not in demand. It may be a result of the persons that were interviewed (for example, in large hospitals we found that different people are assigned to hire specific occupations). 17 To help address this concern, the COE recommends looking into the exemplary 240 hour internship program coordinated by COPE at 10
11 This suggests that details about program training standards are important to include in marketing materials geared for Allied Health employers. Employer Geography The map in Appendix H illustrates where the allied healthcare employers are located throughout the region. This analysis identified businesses and firms that fall within three North American Industry Classification System codes: 621 Ambulatory Health Care Services Including dentist & doctor s offices, family planning centers, medical labs and diagnostic imaging centers 622 Hospitals Including children s hospitals as well as psychiatric & substance abuse facilities 623 Nursing & Residential Care Facilities Including mental health halfway houses, residential drug addiction rehabilitation facilities, assisted-living facilities, & orphanages The analysis identified 7,153 Allied Health related businesses within the region: 6,284 Ambulatory Health Care Services firms; 170 within the hospital classification; and 699 Nursing & Residential Care Facilities. As expected, most employers are clustered in the larger cities of both San Bernardino and Riverside counties. Community colleges in the region can use this map as a visual representation of where allied healthcare organizations are located in relation to the college. Furthermore, the Center of Excellence can provide contact information for these employers upon request to aid in expanding advisory groups, identifying clinical placement locations, and further validating employment needs. Continuing Education Units Demand for continuing education units is, and will remain, high due to the sheer size, growth, and projected turnover within the Allied Health workforce. Appendix D illustrates the projected need and significant turnover of regional incumbent workers. In looking just at the top five occupations that require Continuing Education Units (CEUs) there will be 47,931 workers in the Inland Empire in 2012 that require CEUs on a rotating bi-annual basis. This growth represents an opportunity for the community colleges, however competition for this market is fierce especially in regards to on-line offerings. 18 Appendix I contains information about the CEU requirements for five emerging occupations (Paramedics/EMTs, Respiratory Therapists, Nurses, Radiologic Technologists, and Certified Medical Assistants). Appendix J lists all the relevant allied health associations & Appendix K lists the corresponding accrediting agencies for contact regarding CEU requirements. The Current College & ROP Response Based on employment projections (as identified in Appendix D), in the Inland Empire there are 3,713 new and replacement job openings on average per year for the twelve occupations covered in this report. Table 5 shows that in 2007, program completions in these occupational areas contributed only 2, On-line providers nationwide can gain the state s approval for offering CEU modules online at an inexpensive price. In fact, any quick internet search will confirm that there are hundreds of firms offering on-line CEU credit for these occupations. The community college s primary competition for on-line offerings regionally would seem to be RC Educational Consulting Services, Inc. located in Riverside, CA: But obviously with on-line courses, geographical proximity doesn t really matter for the student/practitioner. 11
12 students (new workers) into the workforce. Community colleges are training and educating only 54.9% of the industry needs. ROP programs are satisfying an additional 22.7% of the need. Proprietary schools provide workers in many of the occupational areas; however, it is obvious that the community colleges must systematically address the remaining 22.4% projected workforce gap within our regional allied healthcare industry. Table 5: Allied Health Program Completions in the Inland Empire Occupation 19 Number of Program Completions Community Colleges 20 ROP 21 Average Number of Job Openings Annually Gap Dental assistants (232) Dental hygienists (98) Emergency medical technicians and paramedics Healthcare support workers, all other (134) Healthcare technologists and technicians, all others (63) Licensed vocational nurse (88) Massage therapists (91) Medical assistants (Clinical) (FO) (B Office) (Admin) Medical records and health information technician (69) Pharmacy technician Psychiatric technician Radiologic Technologists and technicians (46) Registered nurses (744) Respiratory Therapists TOTAL 2, , (828) 19 This table includes the occupational categories of Healthcare support workers, all other and Healthcare technologists and technicians, all others. These categories are used within statewide labor market information for occupations that can not be clearly classified into existing SOC titled occupations. Often these all other categories represent emerging or employer specific occupations with a wide range of characteristics that should be counted in a workforce gap analysis but are difficult for educational institutions to specifically train for. 20 Inland Empire community College data was extracted from the IPEDS database of the National Center for Education Statistics. (Fall 2006 &Spring 2007 semesters). 21 Numbers reflect the four regional ROP programs academic year graduation statistics. 22 Note that EMT training or certification is a pre-requisite for entrance into fire academies, pre-med programs, emergency room technician programs and non-medical positions in warehouses and plant facilities. Also, 6 months of EMT experience is required for acceptance into a paramedic program. Therefore, the high number of completions in the EMT/paramedics category is misleading because the rate is related to other occupational requirements and not solely to entrance to these two occupational categories. 12
13 This table illustrates that community colleges are producing significantly fewer graduates than there are job openings in the fastest growing occupations listed. Appendix L lists all Allied Health educational programs, and related training programs, provided by the region s community college and ROP programs. Community College Issues There are significant challenges within the educational structure that impact the ability of community colleges to supply these needed allied healthcare professionals. They include: Programs that produce the majority of these professionals are expensive to develop and run in the community college environment. These programs have large start-up costs, especially those that require specialized equipment. These costs are not covered by State funding and are rarely recouped after start-up. Most importantly, the state pays the same amount per student whether they are in a general educational class with 55 students or in a nursing clinical that is only allowed to have 10 students per instructor because of licensing regulations. In the state funding environment for higher education, community colleges must balance these imperatives in their planning. A lack of faculty greatly impacts the ability of a community college to plan and develop course offerings. Trained allied health professionals can earn a higher income in the many environments in which they can practice their profession. Community college teaching salaries cannot compete in the allied health professional marketplace. Also impacting planning are the constraints related to facilities and technology that further complicate the ability to provide courses and necessary prerequisites. Specialized equipment for training and educational purposes can be extremely expensive and state funding for these purposes is minimal. The needs are so obvious and so huge. If something is not done and done quickly, we will push ourselves into a crisis Wolde-Ad Isaac, Dean of Health Sciences, Riverside Community College District, Moreno Valley Campus. High attrition rates in allied healthcare programs are common. Many variables can attribute to the problem: inadequate preparatory skills, lack of awareness/understanding about the variety and scope of Allied Health occupations, an inability to navigate the educational system, use of the lottery system to admit students, and limited student support services are known to impact graduation rates. Studies also cite changing licensure requirements, limited awareness of various allied healthcare professions, and the lack of consistent workforce data as factors that impact the supply of qualified professionals. 23 A community college system resource for aiding the Inland Empire community colleges in developing programs in allied healthcare is the Orange/Inland Empire Regional Health Occupations Resource Center (RHORC). Regionally located at Golden West College in Huntington Beach, the RHORC promotes quality education and workforce training in health care delivery. As part of its Health Initiative, The Orange/Inland Empire RHORC is focusing on faculty development including creative teaching strategies and use of technology in the classroom to possibly improve student retention. The RHORC is also coordinating the development of an online clinical placement system to address the problem of insufficient clinical placements in the region that limits the development of certain allied healthcare programs. The RHORC also has a number of resources available for download, including 23 Health Workforce Solutions, pp
14 completed DACUMs (Developing A CUrriculuM) 24 for a number of occupations on their website: Apprenticeship Programs No regional community college currently offers a state-approved apprenticeship program for any allied health occupation. However, the opportunity exists for regional colleges to partner with local employers to utilize this training option. Apprenticeship is the oldest type of education that models a mentoring type of program. Apprenticeship courses are designed for indentured apprentices under the Shelly-Maloney California Apprenticeship Standards Act. State-approved apprentices are employees that are selected by the employer to be in a professional development program that is 2 years or more in duration. It could be for LVNs training to become RNs, for secretaries training to become psychiatric techs, etc. Any profession, trade or craft that can be learned well thorough on-the-job training with a mentor, coupled with very structured course/lab work that is related to their job, is appropriate for an apprenticeship program. Since Allied Health occupations are very specific in their function, apprenticeship programs have proved to be a very effective way to enhance and upgrade a current employee s existing healthcare skills and medical knowledge. The program is comprised of two parts: 1) hands-on training overseen by a qualified instructor and 2) classroom instruction that is related and supplemental to their work. The most frequent structure in apprenticeships, especially for technicians such as psychiatric techs and healthcare techs, is that the employee spends 28 hours on the job and 12 hours in classroom per week - while getting 40 hours of pay and all their employee benefits. However, the apprenticeship program is very flexible. In some apprenticeship programs employees only take 3-4 hours of classes/training a week. The supplemental classroom instruction can occur on the employer s site, on the college campus, in a training center, any other educational entity, or any hybrid thereof so long as all parties agree. 25 The employer signs a contract with the college district each committing to the negotiated terms for the duration of the curriculum/program. Joint Apprenticeship committees administering each program are composed of representation from labor, management, the California State Division of Apprenticeship Standards, and a particular college. Apprenticeship is a line item in the state budget and assuming the budget is fully-funded, $5.06/hour for every 50 minute hour that the apprentice is in class is sent to the coordinating community college district (on a monthly basis, based on attendance sheets). Where the money goes then depends on who does the education/training. If the employer contracts and agrees to provide services (training) they need to become adjunct faculty and the district needs to monitor the 24 DACUMs ((Developing A CUrriculuM) is an innovative approach to occupational/job analysis developed by The Ohio State University and is utilized nationally. It has proven to be a very effective method of quickly determining, at relatively low cost, the competencies or tasks that must be performed by persons employed in a given job or occupational area. Deceptively simple, DACUM can produce a complete occupational analysis in just two days with 7-10 panel members who actually perform or have direct involvement with the occupation. 25 The three parties to an apprenticeship program include 1) the program sponsor which is the employer, 2) the board of trustees of the local community college district and 3) the CCC Board of Governors via Barry Noonan in the Chancellor s Office. 14
15 curriculum and ensure the training/education meets required guidelines. In this situation, according to Chancellor s Office representative Barry Noonan, generally what happens is that the district keeps 15% and sends 85% of the funds to the employer that is providing the training. Foothill De Anza Community College District is a great example of this model having received $2.3 million last fiscal year with no programs taught on campus (that s a $345,000 profit for the District simply for coordinating the programs!). However, know that the structure is all negotiated in the contract and the percentages can vary. If the employer is not providing any training/services and they are all occurring on the college campus (similar to Rancho Santiago Community College District who receives approximately $3.2 million a year) then a much larger percentage is retained by the college. Currently, this program is coordinated through the California Community Colleges System Office by Barry Noonan (bnoonan@cccco.edu) and he is happy to address any questions and work with the colleges to establish an apprenticeship program at your district. Recommendations Building upon their existing partnerships with the allied healthcare industry employers, the community colleges must open a discussion of the challenges that the educational system faces in meeting the industry needs. The Center of Excellence would like to offer several recommendations for consideration. These recommendations can serve as a starting point and road map for colleges to address the allied healthcare employment crisis that exists and is growing on a daily basis. Provide additional sections of allied health core courses Provide Continuing Education courses for incumbent workers Increase collaboration amongst colleges in the Inland Empire to identify colleges with an interest to respond Identify and convene local allied healthcare employers (including the exploration of apprenticeships). Explore creative solutions to barriers in program development Provide additional sections of allied health core courses Anatomy and physiology, biology, medical terminology, chemistry, and others serve as core health courses for nursing and dental programs and as prerequisites to courses in many other allied health programs. Colleges report that there are typically waiting lists for sections of these core courses. If there are not enough of the prerequisite courses available, the development or expansion of allied health programs will be severely impacted by the bottleneck effect of students waiting for prerequisites. Provide continuing education courses for incumbent workers Many Allied Health occupations require Continuing Education Units (CEUs) on a rotating basis. While there are many providers of various in-person and on-line courses available, there is an opportunity for community colleges (community education or contract education divisions) to explore local offerings and their related costs. The community college system is a perfect delivery agent for CEUs especially for nurses, EMTs, paramedics, respiratory therapists, radiological technicians, and certified medical assistants. 15
16 Increase collaboration amongst colleges in the Inland Empire to identify colleges with an interest to respond With the projected shortage of trained workers across California, it is unreasonable to believe each college can address this situation individually. To make the largest impact and maximize existing resources, colleges in the Inland Empire should approach the crisis as a region rather than by individual college. Key representatives from each college can convene and identify the allied health programs most needed based upon labor market shortages, local employer concentration, and campus climates enabling rapid response. For example, there is a need for massage therapists in the Inland Empire and no colleges in the region currently offer a massage therapist program. Moreover, our region only offers one dental hygienist program. Based on projected need, one or two of the colleges in the region could work together, share the cost of developing the program, and begin offering courses on behalf of the region. Identify and convene local allied healthcare employers Colleges in the Inland Empire currently benefit from partnerships with allied healthcare employers. By developing new partnerships or strengthening existing partnerships, colleges can maximize the use of clinical sites and share costs. Through the identification and convening of local allied healthcare employers, colleges and employers can use the data in this report to begin conversations on program development as a region. Employers, as well as educators, have a preconceived notion regarding apprenticeship programs. Some employers in the healthcare field may not understand that this is a viable option for our existing regional pipeline challenges. Colleges should better understand the roles, obligations and benefits of Apprenticeship programs and in turn explain them to local employers. An apprenticeship program may not be the best solution for every occupation within every environment, but the program is ideal to address many of the aforementioned challenges and barriers within the industry. The Desert Region Tech Prep Collaborative has explored the possibility of a regional Allied Health Advisory Board. However, our large geographical spread as a region prohibits this from working as effectively as desired. As a viable alternative, the group has developed ways to align conversations and future survey work so that they could be combined and compared. For example, standard labor market questions have been developed to allow for regional synthesis. Many of the hospitals in the region have the equipment in place to allow students to receive training. Colleges can work with employers to develop a shared use of the facility or clinical time for students. By providing access to equipment already in place, these partners help allay the costs of developing and implementing a new or expanded program and may actually speed the opening of new programs. Additionally, employers may be able to provide release time for employees to serve as instructors for allied healthcare courses. The results would be highly beneficial for colleges, employers, and 16
17 students while sharing some of the costs of developing a new program. However, strong partnerships are required before engaging in such discussions. Industry partners could help community colleges with the high cost of allied healthcare programs through innovative working arrangements, monetary contributions and supportive advocacy to increase funding for high priority programs like health care education. These processes will strengthen colleges strategic partnerships with businesses in the allied healthcare industry to maximize use of clinical and teaching resources. Convening employers would also allow for colleges to be responsive to industry needs in program development while at the same time working together to collaborate and strategically implement programs that will have the largest impact on the allied healthcare workforce. Explore creative solutions to barriers in program development There are many strategies and solutions that can be used to overcome barriers and develop new programs. One approach for the colleges may be to pilot programs through contract education and community education programs. Piloting a new program in this manner allows the program to grow before approving curriculum through the Academic Senate and state approval process. College of the Desert developed its pharmacy technician program as a fee-based, not-for-credit certificate program allowing students to qualify for State certification. In the future, they have the option to institutionalize the curriculum as a full college program. A second approach is to develop a regional strategy among the colleges for allied health program and resource development. Using this report, the Desert Regional Consortium can identify the regional educational needs, collaborate with ROPs in sequencing all Allied Health related offerings, determine how many programs are warranted and which colleges will respond to specific occupational needs, and collaboratively design programs designed to serve the entire region and not just a single District s service area. Conclusion Community colleges in the Inland Empire have a unique opportunity to be the solution to a growing crisis in the allied health care industry. As the provider of the majority of trained allied healthcare professionals needed to help solve the growing healthcare crisis in the nation, community colleges are positioned to be the educational solution to this looming workforce problem. This report is the beginning of a bigger discussion of needs and priorities. Industry partners can identify emerging occupations and help colleges plan for new programs. Current curriculum will be an essential element of meeting industry needs and industry partners can be at the table to provide expertise in this effort. Innovative solutions to unforeseen problems can be proffered and implemented with the continuing efficiencies of extended relationships already in place. Partnerships and associations can work to assess needs, overcome barriers and create solutions to address the workforce problem in this region. Community colleges are best positioned to educate new workers, replacement workers and incumbent workers for the allied healthcare industry. They can play an integral role in helping to alleviate a crisis and impact their surrounding community and the State with their efforts. 17
18 Additional References In addition to the sources cited in report footnotes, the following references were used in developing this report, its Appendices, and/or its corresponding presentation: Access to Career Ladders at U.S. Community Colleges, American Association of Community Colleges, California Community Colleges Statewide Health Occupations Directory, California State EDD, LMID, Career Prep System, Closing the Health Workforce Gap in California: The Education Imperative, Health Workforce Solutions, November Economic Modeling Specialists, Inc. (EMSI) Complete Data, Environmental Systems Research Institute (ESRI) Business Analyst Software Health Care Help Wanted (December 17, 2007), The Business Press, p.11. Quotes from Zee Currie (p.10) and Wolde-Ad Isaac (p.13) extracted from this article. Health Care Industry: Identifying and Addressing Workforce Challenges, by Alexander, Wegner, and Associates, U.S. Department of Labor, February Health Professions Education Data Book , American Medical Association The Career Ladder Mapping Project, Shirley Ware Education Center, SEIU, Local 250 AFL-CIO, December 2002 U.S. Bureau of Labor Statistics, U.S. Bureau of the Census, 2002 Economic Census U.S. Department of Education, National Center for Education Statistics, U.S. Department of Labor ETA Occupational Outlook, 18
19 Appendix A How to Utilize this Report About the Centers of Excellence The Centers of Excellence (COE) are part of the California Community College s Economic and Workforce Development Network. The regional COEs are focused on building the capacity of the community colleges in the area of economic and workforce development to enhance their ability to deliver education and training services to businesses and workers in high growth industries, new technologies, and other clusters of opportunities. Centers provide market intelligence regarding workforce trends, increase awareness and visibility about the colleges economic and workforce development programs and services, and strategically develop partnerships with business and industry. How to Use This Environmental Scan Report The Centers of Excellence have undertaken Environmental Scanning to provide targeted and valuable information to community colleges on high growth industries and occupations. This report is intended to assist the decision-making process of California community college administrators and planners in addressing local and regional workforce needs and emerging job opportunities in the workplace as they relate to college programs. The information contained in this report can be used to guide program offerings, strengthen grant applications, and support other economic and workforce development efforts. This report is designed to provide current industry data that will: Define potential strategic opportunities relative to an industry s emerging trends and occupational workforce needs; Influence and inform local college program planning and resource development; and Promote a future-oriented and market responsive way of thinking among stakeholders. Important Disclaimer All representations included in this Environmental Scan product/study have been produced from a secondary review of publicly and/or privately available data and/or research reports. Efforts have been made to qualify and validate the accuracy of the data and the reported findings. The purpose of the Environmental Scan is to assist the California Community Colleges to respond to emerging market needs for workforce performance improvement. However, neither the Business and Workforce Performance Improvement Centers of Excellence, COE host college or California Community Colleges Chancellor s Office are responsible for applications or decisions made by recipient community colleges or their representatives based upon this study including components or recommendations. Additional Information The Centers of Excellence are funded in part by the Chancellor s Office, California Community Colleges, Economic and Workforce Development Program. The total grant amount (grant number for $150,000 and for $205,000) represents compensation for multiple documents or written reports through the Inland Empire Center of Excellence. Our mission is to strengthen California s workforce and advance economic growth through education, training and job development. 19
20 EMSI Data Source and Calculations State Data Sources EMSI uses state data from the following agencies: California Labor Market Information Department. Industry Projections Data In order to capture a complete picture of industry employment, EMSI basically combines covered employment data from Quarterly Census of Employment and Wages (QCEW) produced by the Department of Labor with total employment data in Regional Economic Information System (REIS) published by the Bureau of Economic Analysis (BEA), augmented with County Business Patterns (CBP) and Nonemployer Statistics (NES) published by the U.S. Census Bureau. Projections are based on the latest available EMSI industry data combined with past trends in each industry and the industry growth rates in national projections (Bureau of Labor Statistics) and states' own projections, where available. Occupational Projections Data Organizing regional employment information by occupation provides a workforce-oriented view of the regional economy. EMSI's occupation data are based on EMSI's industry data and regional staffing patterns taken from the Occupational Employment Statistics program (U.S. Bureau of Labor Statistics). Wage information is partially derived from the American Community Survey. The occupation-to-program (SOC-to-CIP) crosswalk is based on one from the U.S. Department of Education, with customizations by EMSI. Educational Attainment Data EMSI's educational attainment numbers are based on Census 1990, Census 2000, the Current Population Survey, and EMSI's demographic data. By combining these sources, EMSI interpolates for missing years and projects data at the county level. Educational attainment data cover only the population aged 25 years or more and indicate the highest level achieved. InfoUSA Data Source and Calculations Number of Employees The infousa database carries Location employment number, which was used in this report to calculate employment by NAICS codes for the top ten industries lists. Location employment is available on 98% of the businesses and is largely obtained through the telephone verification process. It represents the number of employees at that location of the business. Volunteers are only included when there are no paid employees. Approximately 27% of the above mentioned 98% carry a modeled employment number rather than a verified number. When an employment number cannot be verified through the telephone interview process, a model is applied to estimate the employment size. The model considers whether or not the business is part of a larger family such as McDonalds, Wal-Mart, etc. If so, a modeled employment figure, which was designed for that specific chain, is applied. The location of the business (metro area with 50,000 or more in population versus a rural area) is also considered in this process. If the business is not part of a chain, the employment model will estimate their employment using the business' primary SIC Code. The employment model includes information regarding each 4-digit SIC Code, actual employment sizes and a metro versus rural designation. If the employment model is applied to a professional individual, the modeled employment number represents the estimated support staff. 20
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