The Current and Future Supply and Demand For The Health Workforce in the US

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1 The Current and Future Supply and Demand For The Health Workforce in the US Edward Salsberg, MPA Director, National Center for Health Workforce Analysis Department of Health and Human Services Health Resources and Services Administration Bureau of Health Professions For the Health of Texas Workshop February 28, 2011 Austin, TX

2 Overview The Framework for Health Workforce Planning National Health Employment Trends The Expected Shortage The Change Imperative Implications

3 Key National Health Workforce Questions 1. Will there be enough physicians, nurses and other health workers? If not: What can we do to increase the supply? What can we do to get these workers to the highest need areas? What can we do to make better use of physicians and other health professionals? 2. What can we do to assure access? 3. What can be done to slow the increase in costs?

4 The New National Health Workforce Infrastructure National Health Care Workforce Commission National Center for Health Workforce Analysis State Health Care Workforce Development Grantees Health Care Workforce Assessment

5 The US Approach to Health Workforce Planning Focus on data collection, analysis, and research Widespread dissemination of data, analyses, and information Federal-state partnerships Increasing attention to evaluation and longitudinal tracking Inter-professional planning and strategies

6 National Center for Health Workforce Analysis: Approach and Activities Build on existing sources of data including from professional associations, states, and federal agencies Build national capacity for data collection and analysis including within professional associations and states Develop and promote a national uniform minimum data set Support research to better understand current and future workforce needs and dynamics

7 Workforce Challenges General shortages health personnel including physicians and nurses; some specific concerns: Primary Care; Chronic and Long Term Care; Behavioral Health Mal-distribution of existing workforce Barriers to health personnel working at the top of their competency Increasing need for workforce diversity Implementing inter-professional education and practice Planning for an uncertain future

8 National Health Employment Trends

9 Hospitals Employ More Than One- Third of Health Care Workers Health Care Employment by Setting Other Ambulatory Home Health 8% 19% Hospitals 34% Offices of Physicians 17% 22% Nursing & Residential Care Facilities Source: Altarum Institute, Health Market Insights from the BLS January 2011 Employment Data.

10 : Health Care Jobs Far Outpace the Economy Total U.S. employment grew by 3.7% across ; health care employment grew 30.1% Hospitals experienced slower employment growth than other healthcare settings Employment Growth By Setting, % 51.3% 50% 40% 31.0% 30% 20% 19.8% 14.3% 15.4% 10% 0% Ambulatory Practitioner Home Care Hospitals, Nursing Care Care Offices Public & Facilities Private Source: Center for Workforce Studies, SUNY Albany Analysis of BLS data.

11 Even in Recession, Healthcare Jobs Grew Though hospitals added the largest absolute number of jobs, growth on a percent basis lagged behind Hospitals added 33,600 jobs across the last year; in contrast, physician offices added 26,000 Growth in Healthcare Employment by Setting, Jan Jan % 5.3% 4.3% 4.0% 2.1% 2.0% 0.7% 1.1% 0.0% Hospitals Offices of Outpatient Care Home Health Nursing and Physicians Centers Care Services Residential Care Facilities Source: Altarum Institute, Health Market Insights from the BLS January 2011 Employment Data.

12 Demand for Health Care Occupations Will Continue to Grow Projected Increase, Occupational therapist assistants Pharmacy technicians Physical therapist assistants Dental assistants Physical therapist aides Medical scientists (ex. epidemiologists) Home health aides 30% 30% 31% 31% 33% 34% 36% 36% 36% 39% 40% 46% 50% 0% 10% 20% 30% 40% 50% 60% Source: Bureau of Labor Statistics Monthly Labor Review, November 2009.

13 The Expected Shortage

14 Drivers of Future Demands for Services Population growth U.S. Population to grow by ~30 million in the next decade 1 Aging of the Population; concomitant increase in major/chronic illness and subsequent demand 2 Baby boom generation Medical advances and successes 2 Life Style factors 3 Increase in chronic diseases Insurance coverage expansion 4 1 U.S. Census Bureau Projections of the Population and Components of Change for the United States: 2010 to Bureau of Labor Statistics Career Guide to Industries, : Healthcare 3 CDC Chronic Diseases and Health Promotion 4 Affordable Care Act

15 Most Major Illnesses Very Age Sensitive Cancer Incidence Rates (per 100k pop.) by Age, Female Age Group Data present age-specific invasive cancer incidence rates (new cases per 100,000 pop.) for the United Sates, Source: AAMC Center for Workforce Studies analysis of National Cancer Institute, SEER Cancer Statistics Review, (published 2009).

16 The Expansion of Insurance Coverage is Likely to Have a Significant Impact in Texas Texas 25.7% New Mexico Florida Nevada Arizona 22.8% 21.3% 19.9% 19.6% Vermont Wisconsin Minnesota Hawaii 9.6% 9.6% 8.7% 8.2% The States with the Highest and Lowest Rates of Un-insured, 2009 Massachusetts 5.0% 0% 5% 10% 15% 20% 25% 30% Source: Current Population Survey (Prepared by NCHWA, February 2011)

17 Visit Rate By Insurance Type, 2007 Source: AAMC Center for Workforce Studies analysis of 2007 NAMCS and NHAMCS Public Use Data File (primary expected source of payment variable), Summary Health Statistics for the U.S. Population: National Health Interview Survey, 2007.

18 Drivers of Future Physician Supply Slow increase in GME positions An aging physician workforce Life style and gender mix Productivity impacted by team structure (PAs, NPs), service delivery mechanisms, HIT/EMR Source: Michael J. Dill & Edward S. Salsberg. The Complexities of Physician Supply and Demand : Projections Through 2025 ( AAMC November 2008).

19 The Change Imperative

20 The Change Imperative Unsustainable cost increases Health workforce shortages New models of care: accountable care organizations (ACOs), patient-centered medical homes New approaches to financing including bundled payments Increasing consumer involvement Dynamic and expanding role of HIT Source: National Center for Health Workforce Analysis

21 Percentage of total U.S. expenditures 10% of the Pop Account for 60% of the Costs! 100% 80% 60% 40% Percent of Health Care Expenditures Accounted for By Top Spenders, % 59.5% 44.0% 95.7% 20% 0% 18.7% Top 1% Top 5% Top 10% Top 25% Top 50% Percentage of the Population, by Spending Bracket Source: AAMC Center for Workforce Studies analysis of Cohen, S.B., Rohde, F. (2009)The Concentration in Health Expenditures over a Two Year Time Interval, Estimates for the U.S. Population, MEPS Statistical Brief #244. Figure One. (U.S. civilian non-institutionalized population).

22 FTE Physicians 950,000 Most Plausible Scenario 900, , ,000 Most plausible demand Shortage: 159, , ,000 Most plausible supply 650, Projections do not take into account health reform Assumes: a rise in utilization rates; shift in work schedules; an increase in productivity; moderate growth in GME (27,600 new residents/year) Source: Michael J. Dill & Edward S. Salsberg. The Complexities of Physician Supply and Demand : Projections Through 2025 ( AAMC November 2008).

23 Number of NPs Growing Rapidly 10,000 Growth in NP Graduates, ,000 9,200 NP Graduates 8,000 7,000 6,000 7,089 6,765 6,580 6,346 6,182 6,504 7,095 7,469 8,418 5, Source: American Association of Colleges of Nursing Annual Surveys

24 Newly Licensed PAs Number of PAs of Growing Rapidly 6,500 Newly Licensed PAs, ,000 5,823 5,500 5,215 5,000 4,500 4,000 4,051 4,235 4,009 4,337 4,512 4,393 4,654 4,989 5,243 3,500 Source: National Commission on Certification of Physician Assistants Certified Physician Assistant Population Trends (PA-Cs)

25 Workforce Composition: The Growth of Non-Physician Clinicians 10 9 Direct Patient Care Providers by Type, Supply and Production Physicians PAs/NPs 1 0 Currently Practicing New Providers/Year Source: National Center for Health Workforce Analysis

26 Use of Hospitalists Is Increasing Percent of Internal Medicine Physicians Who Are Hospitalists, by Age 30.0% 27.0% 25.0% 21.5% 20.0% 15.0% 10.0% 5.0% 14.3% 6.0% 8.3% 2.5% 10.3% 5.0% 0.0% < 40 yrs yrs yrs 60+ yrs General Internal Medicine Internal Medicine Subspecialists Source: AAMC 2009 Physician Survey on Primary Care

27 Possible Members of the Health Care Team of the Future Physicians Nurse practitioners Physician assistants Psychologists Optometrists Registered Nurses Pharmacists Case Managers Nutritionists/Dieticians Physical Therapists Community Health Workers And more

28 Implications Cost pressures and shortages will encourage innovation and systems redesign Strong incentives to make better use of existing workforce Shift to team-based care and inter-professional practice Shift care to lower cost settings Source: National Center for Health Workforce Analysis

29 Implications (2) Increasing competition for practitioners Closer alignment of education and practice Pressure to reduce time and cost of education Need for better health workforce data and information Source: National Center for Health Workforce Analysis

30 Relevant Federal Programs and Policies Increased funding for health professions education and training Expansion of National Health Service Corp and community health centers Support for service delivery innovations National Center for Health Workforce Analysis State Health Care Workforce Development Grantees Encouragement of inter-professional teams

31 Contact Information Edward Salsberg, MPA Director, National Center for Health Workforce Analysis