Minnesota s Primary Care Provider Shortage Strategies to Grow the Primary Care Workforce

Transcription

1 Minnesota s Primary Care Provider Shortage Strategies to Grow the Primary Care Workforce Minnesota s Primary Care Workforce Planning Grant FINAL REPORT December 2011 Governor s Workforce Development Council P o l i c y S o l u t i o n s t h a t W o r k f o r M i n n e s o t a

2 about the primary Care workforce planning grant The Governor s Workforce Development Council (GWDC) formed the Steering Committee for the Primary Care Workforce to apply for and implement a one-year, $150,000 planning grant from the Health Resources and Services Administration. The Steering Committee was chaired by GWDC member Laura Beeth, System Director of Talent Acquisition for Fairview Health Services. The grant was implemented between September 2010 and September Steering Committee members Laura Beeth, Chair Edward Reynoso Macaran Baird Mary Rothchild Barbara Brandt Jennifer Schaubach Valerie DeFor Mark Schoenbaum David Etzwiler Richard Smestad Jane Foote Dan Smith Ann Gibson Susan Speetzen Jill Myers Table of Contents Executive Summary...page 1 Needs Assessment....page 3 Goals and Strategies.....page 11 Endnotes...page 17 Committee Staff Bryan F. Lindsley, GWDC Executive Director acknowledgements This report is the collaborative work of the GWDC s Primary Care Workforce Steering Committee. The GWDC acknowledges the following individuals, in addition to countless other stakeholders, who contributed their time and expertise to the planning process. Laura Beeth, System Director of Talent Acquisition for Fairview Health Services, chaired the Steering Committee and served as the primary representative of the GWDC. Bryan Lindsley, GWDC Executive Director, served as grant manager and lead staff to the Steering Committee. Valerie DeFor, Director of Statewide Healthcare Education Industry Partnerships for HealthForce Minnesota, helped write the grant application and served as principal author of the final report. Mark Schoenbaum, Director of Minnesota Office of Rural Health and Primary Care, guided the application to the grant and facilitated policy development. Jill Myers, Supervisor of Health Care Workforce Analysis Program at the Department of Health, helped write the grant application. HealthForce Minnesota provided project management. Rebecca Radcliffe arranged and facilitated constituent meetings and collected input. Nick Maryns, GWDC Senior Policy Analyst, designed and formatted the report. about the governor S workforce development CounCil The GWDC is at the center of a number of initiatives that are addressing the needs of Minnesota and its economy. The council develops policy recommendations, oversees Minnesota s workforce development system, and convenes workforce partners around strategic goals and initiatives to ensure that businesses have the skilled workers they need to compete in the global economy. mandate and membership As Minnesota s state Workforce Investment Board, the GWDC is mandated and funded by Section 111 of the federal Workforce Investment Act of 1998 and further defined by Minnesota Statutes, section 116L.665. Council membership is dictated by state statute to include the following sectors: business and industry, communitybased organizations, education, local government, organized labor, state agencies, and the state legislature. v2

3 Executive Summary Minnesota is projected to face a shortage of primary care providers in the next ten years. In response to primary care workforce shortages across the country, and with the passage of the Affordable Care Act, the Health Resources and Services Administration (HRSA) allocated funds to support primary care workforce planning on a statewide basis. The funds were released via a competitive grants process which required states to submit an application responsive to the goals of the agency. Each state had a single eligible applicant in Minnesota, the identified applicant was the Governor s Workforce Development Council (GWDC). Minnesota s application was submitted in July 2010 and notification of funding was received on September 24, PurPose The purpose of the planning grant was to:» Identify and engage all Minnesota healthcare workforce stakeholders in a new and comprehensive workforce planning effort,» Analyze existing workforce data and develop plans and strategies to collect additional data and information, and» Develop a comprehensive plan which will, when implemented, ensure an increase of percent in full-time primary care professionals over the next ten years. Definition Primary care providers do not operate in isolation but are instead part of a much larger team of allied health professionals, specialty practitioners, and support personnel. For purposes of this planning grant, HRSA encouraged states to use a more narrow definition of primary care and to focus on physicians (family practitioners), physician assistants, and nurse practitioners. Minnesota needs multiple strategies to increase the number of primary care providers in the state. Process Led by the Primary Care Workforce Steering Committee established by the GWDC and chaired by GWDC member Laura Beeth, the planning process began in October A regional meeting approach was determined to be the best way to gain input into the plan from across Minnesota. The regional meetings also allowed for unique regional needs and concerns to be expressed. In addition to the regional meetings, constituent meetings were held to gain input on specific disciplines. Over 750 people attended 21 regional and constituent meetings to provide input into the creation of the Primary Care Workforce Report. Formal meetings featured an overview of the current supply and demand of primary care physicians, advanced nurse practitioners, and physician assistants, as well as educational capacity and demographic highlights. Attendees ranged from consumers to CEOs, community Governor s Workforce Development Council 1

4 health workers to city planning officials, physicians to pharmacists, and educators to EMTs. Attendees were asked to respond to three questions: 1. What changes/developments in primary care (positive and negative) do we know will occur for certain in the next ten years? 2. What changes/developments in primary care (positive and negative) might catch us by surprise? This report and input from regional meetings can be found at 3. What ideas/strategies/programs/initiatives/training options, et cetera, will help increase the availability of primary care practitioners by ten percent or more in the next ten years? Input from attendees, which can be found online at PrimaryCareGrantInput.pdf, can be summarized in four major categories: 1) population changes and needs, 2) higher education challenges, 3) provider changes and needs, and 4) healthcare delivery changes and needs. Attendees pointed out the increased rate of aging in rural communities and warned that the healthcare needs of seniors may be difficult to address in some communities. Some communities are seeing significant growth in minority populations. High rates of uninsured plague some areas. Many healthcare training programs are at capacity in Minnesota, largely because of a shortage in clinical training sites especially in rural areas. Securing preceptors, who often work longer days and accept lower wages, is difficult. Colleges and universities are confronted with reduced student readiness, and tuition assistance and job placement are key issues for healthcare education stakeholders in Minnesota. Healthcare providers in rural Minnesota are also aging at a greater rate than providers in the metro area. Regional meeting participants talked of difficulties with recruitment, especially for specialists such as general surgeons, obstetricians (or family practice physicians providing obstetric services), and mental health professionals. Emerging healthcare professionals such as community health workers and community paramedics are projected to have a positive impact on access to health care, especially in rural and urban underserved areas. Regional meeting participants also talked about changes in the healthcare delivery system. The medical home model is gaining traction in Minnesota, and with it a stronger integration of primary care and other services (especially mental health and pharmacy). Minnesota s health reform efforts are leading a focus on health status, health outcomes and disparities. Health information technology and telehealth continue to help improve and shape access to patient information and services. In addition to meetings, there were key informant interviews with many healthcare experts within the state. These interviews allowed more in-depth discussion with content experts. A website was also created to solicit other input and to share input received. Utilizing all the information gathered, Minnesota s HRSA Primary Care Workforce Plan of 2012 was drafted and forwarded to the Steering Committee for approval. The Steering Committee approved the report s recommendations on September 19, 2011 and the final report was submitted to HRSA. While no additional funding from HRSA is currently available to implement the strategies outlined in this plan, it is hoped that this report and its recommendations will serve as a valuable resource for Minnesota. 2 Primary Care Workforce Planning Grant Draft Report

5 Needs Assessment Minnesota has a plethora of data related to its healthcare workforce. Data sources include state agencies, associations, licensure boards, and educational institutions, among others. These data provide a picture of the state s healthcare workforce needs. demographics Evaluating data from the Census, the State Demographer, and the Department of Health, it becomes clear that Minnesota s population is aging and increasingly diverse. Aging Minnesota s population continues to grow older. Between 2000 and 2030, the portion of the state s population that is 65 and older is expected to increase from 12 percent to 24 percent. This is the fastest-growing age group in Minnesota, and the people in this group use far more physician services than their younger counterparts. 1 The next most rapidly growing age group includes those over 85 years. This trend is disproportionately affecting rural Minnesota. As of 2007, only 10 percent of the population was 65 and older in the seven-county metro area compared to counties beyond the Twin Cities region where 15 percent of the population was 65 years and older. Minnesota s population continues to grow older. Between 2000 and 2030, the portion of the state s population that is 65 and older is expected to increase from 12 percent to 24 percent. Diversity Minnesota s composition in terms of race, ethnicity, and nationality is also changing dramatically. In 2005, 11.8 percent of all refugees entering the United States arrived in Minnesota. Forty percent of all immigrants to Minnesota in 2005 came from Africa; 28 percent came from Asia. 2 Minnesota is home to the United States largest population of Somali residents (approximately 29,000), and has the ninth largest population of African immigrants nationally. Minnesota has the second largest Hmong immigrant population in the United States. The greatest increase has occurred among the Hispanic/Latino population, which grew from 53,884 to 143,382 (166 percent) during the 1990s. 3 According to the State Demographer s office, Minnesota ranked among the states with the most rapid growth in the Hispanic/Latino population. According to the 2000 Census, 81,074 Minnesotans identified themselves as American Indian or Alaskan Native alone or in combination with other races. Twenty-three percent (18,397) of American Indians in Minnesota live on one of the 14 reservations or associated trust lands in the state. Governor s Workforce Development Council 3

6 growth Minnesota s population is expected to continue to grow in size and diversity over the next several decades, and accessible healthcare services are likely to be a quality of life consideration for new residents arriving in Minnesota. The State Demographer s office has projected that Minnesota s population will grow to over 6 million by Most of the growth is projected to come from continued migration from other states and countries. Recent national health rankings suggest that Minnesota s status as a leader in health is in jeopardy; in overall rankings, the state has fallen from first in 2006 to sixth in health outcomes and disparities Recent national health rankings suggest that Minnesota s status as a leader in health is in jeopardy; in overall rankings, the state has fallen from first in 2006 to sixth in Although Minnesota ranks first in outcomes, its ranking in the determinants of health has fallen to seventh. Minnesota s generally high health status rankings hide significant health disparities, especially among minority populations.» African Americans in Minnesota are 63 percent more likely to experience premature death than Whites.» Residents in non-urban areas in Minnesota are 31 percent more likely to experience premature death than residents in the fringe counties of large metropolitan areas. 5» A report published by the Commonwealth Fund in 2007 rated Minnesota 38th overall in equity rankings in health care. This poor ranking was a result of large disparities among minority groups, specifically Asian Americans and Native Americans living in both urban and rural areas. 6» From , infant mortality for White infants in Minnesota was 4.4 per 1,000 births. The rate for African American infants was 9.2. The rate for Native American infants was healthcare workforce According to the Health Resources and Services Administration s State Health Workforce Profiles 7, selected highlights regarding Minnesota s health workforce include:» More than 250,300 people were employed in the health sector in This represents 9.6 percent of Minnesota s total workforce, and is above the national rate of 8.8 percent.» More than 9,500 physicians were actively practicing in Minnesota in 2000, equating to 194 physicians per 100,000 residents. This ration is slightly lower than the national ratio of 198.» In 2000, Minnesota had 76 active primary care physicians per 100,000 residents, higher than the national rate of 69.» Medical schools in Minnesota graduated 275 new physicians in » There were 711 physician assistants practicing in Minnesota in 2000, which was equal to the national rate of 14.4 physician assistants per 100,000 residents. 4 Primary Care Workforce Planning Grant Draft Report

7 » There were more than 54,900 licensed registered nurses in Minnesota in 2000, with more than 47,000 employed in nursing. There were registered nurses per 100,000 residents in 2000.» In 2000, there were 1,208 nurse practitioners, equal to 24.5 per 100,000 residents. This was below the national rate of 33.7.» There were 3,522 dentists, 3,410 dental hygienists, and 4,620 dental assistants practicing in Minnesota in All per capita ratios were above national rates.» There were 462 psychiatrists, 2,950 psychologists, and 11,620 social workers in Minnesota in health provider ShortageS Over the last six years, the healthcare industry has witnessed workforce shortages in a number of occupations. These shortages have lessened with the onset of recession in 2007, though health care was not hit as hard as most other sectors of the economy. The healthcare industry as a whole had 5,850 vacancies during the fourth quarter of 2009, with a median starting wage of $11.18 an hour. Nearly one in five jobs openings in Minnesota was in the healthcare industry. 8 Health professional workforce shortages exist throughout the state. As of July 2010, 52.9 percent of Minnesota counties carried a full or partial Health Professionals Shortage Area (HPSA) designation in primary care, 80.5 percent in mental health, and 49.4 percent in dentistry. 9 minnesota health professional Shortage areas (hpsa) and medically underserved areas (mua) Shortage area designation Primary Care HPSA (7/10) Dental Care HPSA (7/10) Mental Health HPSA (7/10) number of full County designations number of partial County designations total designations/ total Counties percent designations / % / % / % MUA (7/10) / % primary Care physicians A physician providing primary care is typically the first point of consultation for a patient; primary care is ongoing, rather than episodic. Roughly half of active physicians in Twin Cities Area counties are trained in primary care disciplines. Primary care accounts for a larger share of the physician workforce in other parts of the state, with the exception of Olmsted County (home of the Mayo Clinic), where only 28 percent of physicians report a primary care specialty. The percentage of physicians in primary care is highest in the most agricultural, least urbanized parts of the state: the Southwest, Northwest and North Central regions. percent of physicians in primary Care Statewide 50.9% Twin Cities Area 50.3% St. Cloud Area 62.9% Olmsted County 28.0% Southeastern Minnesota 67.4% Mankato Area 54.5% Willmar Area 76.0% Southwestern Minnesota 83.2% West Central Minnesota 71.9% Northwestern Minnesota 83.3% North Central Minnesota 73.4% Northeastern Minnesota 61.1% Governor s Workforce Development Council 5

8 physician assistants Growth in the number of physician assistants has greatly outpaced growth in physicians. In July 2009, Minnesota had 1,371 licensed physician assistants, nearly three times the number 10 years earlier. In comparison, the number of licensed physicians increased only 28 percent from 1999 to As a result, the ratio of licensed physicians to physician assistants fell from 32 to 14 between 1999 and registered nurses and nurse practitioners As of June 2008, Minnesota had 77,950 licensed registered nurses (RN), a 19 percent increase since Not all of these RNs are actively working in Minnesota; some are retired or not working as RNs, and some work or practice in other states. Based on survey responses and licensing data from the Minnesota Board of Nursing, the Office of Rural Health and Primary Care estimates about 56,700 RNs were practicing at least part time at Minnesota practice sites in Using the July 1, 2007 population estimate for Minnesota, 56,700 RNs equate to 1,091 active RNs per 100,000 people. 10 The Minnesota Department of Employment and Economic Development projects a 23.8 percent increase in registered nursing jobs between 2009 and The Minnesota Department of Employment and Economic Development projects a 23.8 percent increase in registered nursing jobs between 2009 and nurse PrActitioners About five percent of registered nurses report practicing in a certified advanced practice category. About half of these were nurse practitioners, followed by registered nurse anesthetists, clinical nurse specialists and nurse-midwives. Nurse 80,000 60,000 40,000 20,000 73,790 projected Change in minnesota s working population (age 15 to 64), 2010 to ,580 45, ,000-21,350 6 Primary Care Workforce Planning Grant Draft Report

9 practitioners and clinical nurse specialists are certified in a number of specialty areas.» The most common specialty areas among nurse practitioners were family nursing (30 percent), adult nursing (27 percent), women s health (15 percent), gerontology (15 percent) and pediatrics (14 percent).» The most common specialty areas among clinical nurse specialists were adult psychiatric/mental health nursing (27 percent) and medical-surgical nursing (23 percent). aging healthcare workforce Minnesota s State Demographer projects the working age population (15 to 64 years of age) of Minnesota to grow at about 2.5 percent between 2010 and Then, by 2015, workforce growth will slow dramatically as members of the baby boomer generation, currently the largest share of the workforce, begin to retire (see chart on page 6). For individuals considered to be in the prime of their working life (age 25 to 44) labor force growth is projected to increase between 2010 and 2035, but at declining rates. Overall, the largest growth in the labor force between 2010 and 2035 will be for individuals aged 65 and over, with a growth rate above 120 percent. 11 The aging population has significant implications for the healthcare industry in Minnesota. While the demand for healthcare services will increase, the healthcare industry will see significant retirements and fewer people entering the workforce. The age distribution of Minnesota s primary care providers shows approximately 30 percent of nurse practitioners and family physicians are 55 or older. 40% 30% age distribution of minnesota s primary Care providers Physician Assistants Median Age = 38 N=1,323 Family Physicians Median Age = 48 N=2,599 Nursing Practitioners Median Age = 51 N=2,180 The aging population has significant implications for the healthcare industry in Minnesota. While the demand for healthcare services will increase, the healthcare industry will see significant retirements and fewer people entering the workforce. 20% 10% 0% < 35 years years years years > 65 years Governor s Workforce Development Council 7

10 The median age of many key healthcare professionals practicing in Minnesota also points toward an aging healthcare workforce, particularly for nurse practitioners. 12» Family Physicians, median age 48» Nurse Practitioners, median age 51» Physician Assistants, median age 38 Of particular concern is the number of practicing healthcare professionals under 35 who plan to stop practicing in Minnesota. When replying to questions about practice longevity on the optional survey that accompanies license renewal, 19 percent of Minnesota s practicing physicians statewide said they plan to stop practicing in Minnesota within the next five years. Twenty six percent of physicians located in rural areas plan to discontinue their practice in the same time period. The following table demonstrates responses from key professional types. Of particular concern is the number of practicing healthcare professionals under the age of 35 who plan to stop practicing in Minnesota. 13 percentage of practicing providers with plans to Stop practicing in mn within 5 or fewer Years (2008 data) Statewide metro micro rural <35 Years old Physicians Registered Nurses educational CapaCitY Minnesota has two publically-funded systems of higher education: the University of Minnesota (U of M) and the Minnesota State Colleges and Universities (MnSCU). In addition, Minnesota has many private colleges which play important roles in the education of healthcare professionals. When looking at healthcare awards (based on CIP Code 51), it is clear that MnSCU educates the majority of baccalaureate and sub-baccalaureate graduates, and the U of M and private colleges educate a large percentage of graduate degree students. Sector Less than 2-Year Other Public 2-Year Private 2-Year Private 4-Year # of inst. minnesota ipeds Completions by Sector fiscal Year 2008 Subbacc. healthcare awards bacc. grad. total % of total total awards total % of total % 1, % % % 9 1, , % 2, % ,583 3, % 28, % MnSCU 35 8, , % 34, % U of M ,276 1, % 14, % total 76 9,885 2,125 3,065 15, % 81, % 8 Primary Care Workforce Planning Grant Draft Report

11 the university of MinnesotA The University of Minnesota (U of M) is the only public higher education system with the authority to educate physicians, dentists, pharmacists and other post-graduate degrees including any doctor of philosophy. The U of M has a large baccalaureate nursing program and confers advanced practice nursing degrees. The Medical School includes more than 920 medical students and more than 800 residents and fellows, along with 1,600 Medical School faculty physicians and scientists. The University has a nationally-recognized rural physician program which admits 55 students each year. Students study two years in Duluth before transferring to the Twin Cities to complete their M.D. More than half of graduates who enter through the Duluth program enter family practice residencies. The U of M s School of Nursing confers Bachelor of Science in Nursing (B.S.N.), Master of Nursing (M.N.), post-master s Doctor of Nursing Practice (D.N.P.), and doctor of philosophy (Ph.D.). The School s 2009 enrollment was 460 pre-licensure, 56 professional, and 336 graduate students. From 2009 to 2010, the University increased its enrollment in advanced practice nursing from 55 to 108, an increase of 96 percent. Minnesota s Area Health Education Center (AHEC) supports the U of M s health professions schools by building on programs that place and support health profession students in rural clinical locations throughout the state. There are five regional AHECs in Minnesota with an additional AHEC planned for southeastern Minnesota in Each AHEC has a unique role based on its region and the directives of its independent board. university of minnesota enrollment in advanced practice nursing programs, program total Adult Geriatric NP Geriatric CNS Family NP Informatics Integrated Health Health Systems Admin Nurse Midwife Pediatric CNS Pediatric NP Psychiatric CNS Public Health Public Health/ Adolescent Women s Health NP Adult CNS total matriculates MinnesotA state colleges AnD universities Minnesota State Colleges and Universities (MnSCU) is the largest public higher education system in Minnesota. With 7 state universities and 25 community and technical colleges located in 54 communities throughout the state, MnSCU provides geographic access to healthcare programs ranging from certificates to Doctor of Nursing Practice. MnSCU graduates approximately 70 percent of Minnesota s new nurses each year and has significantly increased its capacity over the past 10 years in response to the nursing workforce needs of Minnesota s providers. In addition, MnSCU graduates approximately 50 percent of Minnesota s allied health students each year. MinnesotA s PrivAte colleges Minnesota s private colleges are integral to educating Minnesota s future healthcare workforce. Augsburg College has the only physician assistant program in Minnesota with a historical class size of 22 (note: this has increased through this grant planning process and period to 30 students, an increase of 36 percent). It has recently been announced that St. Catherine University intends to start a physician assistant program which will have capacity to enroll 20 students. The College of St. Scholastica, St. Catherine University, Bethel College, and Augsburg College graduated approximately 25 percent of Minnesota s post-master s students in 2009 (see chart on page 10). Governor s Workforce Development Council 9

12 2009 post-baccalaureate nursing awards School master s degree post-master s Certificate doctor s degree total WSU Scholastica St. Kate s Moorhead Mankato Metro UMN Bethel Augsburg total Note: Excludes Walden University, which reports data in Minnesota but whose students are predominently located outside Minnesota. 10 Primary Care Workforce Planning Grant Draft Report

13 Goals and Strategies The target goal associated with this planning grant and process was straightforward and focused: to achieve an increase of 10 to 25 percent of primary care providers by 2022 This equates to the following increases: 2009 baseline 10% 25% Physician 3, Nurse Practitioner 2, Physician Assistant 1, total 7, ,805 Specific strategies for each discipline are outlined below. Strategies range from expanding successful Minnesota initiatives and models to redesign of curricula to expanding programs. Clearly the success of these strategies hinge on a variety of factors. In today s economy, with state and federal budgets constrained and future reductions expected, the ability to access the financial resources required to increase the primary care workforce is uncertain. So while increased educational capacity, recruitment, and retention of providers is a part of the puzzle, Minnesota is leading the nation with reforms to keep its population healthier and reduce the demand for health care services. The development of healthcare homes in Minnesota is part of the ground-breaking federal health reform legislation passed in May The legislation includes payment to primary care providers for partnering with patients and families to provide coordination of care. The healthcare home model is an approach to primary care in which primary care providers, families, and patients work in partnership to improve health outcomes and quality of life for individuals with chronic health conditions. The use of healthcare homes will enable Minnesotans to receive interprofessional, high-quality care in a delivery model which does not rely as heavily on the primary care provider. While increased educational capacity, recruitment, and retention of providers is a part of the puzzle, Minnesota is leading the nation with reforms to keep its population healthier and reduce the demand for health care services. Historically, hospitals, clinics, and other healthcare employers have been able to fund workforce development initiatives, but these funds have been severely reduced in recent years. The requirement that financial resources show a return on investment is a challenge for workforce development projects that need to be measured over several years rather than a short-term budget period. As reimbursement to providers is expected to remain a target for cost-cutting, this financial pressure is not likely to ease in the near future. Governor s Workforce Development Council 11

14 So while the future is uncertain, it is important to identify and address primary care workforce issues through this comprehensive planning process. Strategies range from expanding successful Minnesota initiatives and models to redesign of curricula to expanding programs. physicians The University of Minnesota is one of the top three schools in the country in producing primary care physicians. Its commitment to primary and rural care is well-known and unquestioned. There are several categories of strategies, however, that could have some impact on the primary care workforce. financial/alignment 1. Bridge the compensation gap between primary care providers and those in specialty roles to encourage students to choose primary care. (Primary care providers, particularly physicians, are paid significantly less than those in specialty roles.) 2. Advocate for payment equity in state and federal healthcare payments. (Minnesota providers are reimbursed less than their counterparts in the rest of the country, even while being recognized for providing care of the highest-quality.) 3. Advocate for reinstatement of reduced Medical Education Research Cost funds which were reduced in Minnesota s current biennium budget. curriculum 4. Integrate primary care content into the medical school curriculum whenever possible. 5. Integrate community-based research and health equity concepts into residency programs. 6. Support the summer externship program in family practice for first and second year medical students. 7. Grow the Rural Physician Associate Program (RPAP) through replication at the Mayo Medical School. 8. Identify financial support for the MetroPAP program so that it can expand its capacity to give students experience in primary care to underserved populations. 9. Develop mentorship programs for students with practicing or retired primary care physicians. 10. Support interprofessional education and care delivery models. external factors/recruitment 11. Make increased use of loan forgiveness and employer-based sponsorships and sign-on bonuses to attract new physicians to high-need vacancies and areas. 12. Increase the number of foreign-certified physicians obtaining Minnesota licensure. This includes support for the Preparation for Residency Program, a seven-month training program that works to improve the competitiveness of foreign-certified physicians when applying for residency slots. 12 Primary Care Workforce Planning Grant Draft Report

15 13. Increase efforts to use the full 30 J1 Visa waiver slots available each year. 14. Maximize the establishment of healthcare homes in Minnesota to extend the reach/impact of all primary care providers. 15. Recruit osteopathic and allopathic physicians from outside Minnesota to fill vacancies. 16. Establish partnerships such as the Future Doctors program and the Fairview Health Services/St. Olaf College collaboration to support and encourage students to enter primary care. 17. Utilize mentoring programs that begin in middle school. experiential/residency ProgrAM capacity 18. Increase financial support to maintain and grow primary care residency programs, especially when hospitals are under increased financial pressure. (One of the most limiting factors in medical education is the availability of residency programs/slots. This bottleneck hampers growth of programs including traditional medical education and foreign-certified physicians who must complete a residency program.) physician assistants The expanded use of physician assistants will be critical to the provision of primary care in the future. The only PA program in Minnesota is located at Augsburg College. This program recently increased its enrollment from 22 to 30 students. A second program is being planned at St. Catherine University. Strategies to support PA programs, increase utilization, and emphasize primary care are outlined. ProgrAM capacity/support 1. Encourage programs to utilize clinical experience scheduling technology (StudentMax) to increase scheduling efficiency and to identify additional clinical site opportunities. 2. Support the planned program at St. Catherine University through provision of clinical education, student referral, and integration into the healthcare education community. 3. Establish a primary care-focused PA program in greater Minnesota within the public college and university system. The expanded use of physician assistants will be critical to the provision of primary care in the future. 4. Provide housing support for students choosing a clinical experience in Greater Minnesota. utilization 5. Conduct a survey to learn more about the utilization of physician assistants in Minnesota including their use within family practice physician offices. 6. Establish a consulting team to educate providers on use of physician assistants. 7. Improve marketing of the profession to the public and potential students. 8. Recruit former Minnesota graduates back to practice in Minnesota. Governor s Workforce Development Council 13

16 PriMAry care/specialty focus 9. Integrate primary care focus/content into curricula to encourage more graduates to choose primary care roles. 10. Develop more roles and opportunities for PA practice in various settings, especially primary care and behavioral health. nurse practitioners There are a number of initiatives underway in Minnesota which will increase the number of nurse practitioner graduates. One of the most recent is the designation of the Minnesota Action Coalition by the Future for Nursing: Call for Action initiative supported by the Robert Wood Johnson Foundation and AARP. The purpose of the Action Coalition is to implement the Institute of Medicine (IOM) Future of Nursing recommendations. Other strategies are centered around curriculum, external factors, and experiential learning. curriculum 1. Consistent with the IOM Future of Nursing recommendations, increase the ease with which students can progress along a seamless pathway from practical nursing through doctoral education. 2. Revisit admission requirements to admit more rural and underrepresented students who are most likely to work in high-need settings. 3. Strategically identify placement of programs such as the 2-year NP mobility program to meet community needs. external factors 4. Recruit RNs and other employees in long-term care settings to become Geriatrics NPs. 5. Remove scope of practice limitations. 6. Develop funding streams to place a Geriatric Nurse Practitioner in every long term care facility to hasten workforce and system redesign and reduce demand. experiential learning 7. Increase clinical training capacity through improved coordination between sites and educational programs. Implement with technology (StudentMax) and dedicated staff at a central location, and at education programs and employers. 8. Utilize Health Care Homes as clinical/internship sites for nursing students to highlight primary care and nursing s role in primary care. 9. Explore different models of clinical precepting such as a two-to-one student-to-preceptor model to double the number of clinical placements. other ConSiderationS Recognizing that the number of primary care practitioners is not the sole indicator of a highly-effective healthcare system, several other goals were identified as critical to ensuring that Minnesota has the healthcare workforce it needs in the future. 14 Primary Care Workforce Planning Grant Draft Report

17 DAtA collection While Minnesota has a vast array of data related to healthcare work, it is located in multiple organizations, collected for different time frames, general in nature when more detailed would be beneficial, and inconsistent among data sources. Therefore, a strong need exists for a coordinated health workforce planning effort to bring focus, transparency, and clarity to this critical future workforce need. Strategies to increase data accessibility and usability include: 1. Create an ongoing healthcare data task force to identify data gaps, needs, and comparability. 2. Improve response to the surveys that accompany license renewal of many health disciplines. 3. Implement licensure or other registration requirements for additional, critical health disciplines. 4. Continue participation in data standardization efforts through licensure boards and the federal government. 5. Create a data clearinghouse or centralized point of contact for healthcare workforce-related data questions/needs. AllieD health Primary care providers are part of a healthcare workforce that consists of many other professionals, including specialists, registered nurses, support staff, and allied health disciplines. It is imperative that the entire workforce be highly-skilled and appropriately utilized. 1. Establish an incumbent worker career pathway program to advance workers from low-skilled to high-skilled healthcare roles. 2. Integrate allied health programs into the clinical education scheduling database (StudentMax). 3. Conduct allied health workforce studies to identify areas of greatest need. recruitment/retention/career exploration All sectors of the economy are competing for a shrinking pool of working-age adults. The healthcare sector needs to actively encourage students and adults to choose this sector. In addition, retention of employees is a critical factor in sustaining the workforce. Primary care providers are part of a healthcare workforce that consists of many other professionals. It is imperative that the entire workforce be highly-skilled and appropriately utilized. 1. Support pre-employment healthcare academies to prepare individuals for health careers. 2. Develop a Careers in Aging Services campaign to recruit individuals into careers in caring for the elderly. 3. Develop an employee recognition program to reward stellar employees. 4. Hold a Provider Wellness Conference to prevent burn-out and emphasize self-care. 5. Actively pursue HRSA Health Care Occupations Program (HCOP) grants to recruit students into NP, PA and APN programs. Governor s Workforce Development Council 15

18 6. Utilize to support career exploration to all age groups. 7. Work within elementary and secondary schools to showcase healthcare careers. 8. Establish longitudinal mentoring and support programs for students. rural needs Access to appropriate, timely, and high-quality care for all Minnesotans regardless of where they live is necessary to ensure a healthy citizenry. 1. Develop housing support mechanisms for students in rural clinical sites. 2. Publicize National Health Service Corps loan repayment options. 3. Utilize rural FQHCs and federally-qualified rural health clinics for clinical rotations. 4. Advocate for additional rural FQHCs in Minnesota. Diversity As Minnesota continues to become increasingly diverse and research continues to show improved health outcomes from a diverse workforce, it is important that Minnesota has a supportive and effective educational system and work environments. 1. Hold statewide conferences to identify and share best practices related to the education of diverse students. 2. Establish forums for discussion of issues related to healthcare diversity. 3. Work within communities to support selection of and success in health careers. financial The financial pressures are well-known. In addition to the financial strategy recommendations outlined above, there are other steps that could be taken to shore up financial resources. 1. Maintain and grow loan forgiveness programs for primary care providers. 2. Healthcare programs are among the most expensive programs in higher education. Support for these programs is imperative. next StepS/ConCluSion While no additional funding is currently available to implement the strategies outlined in this plan, the expertise and partnerships within Minnesota s healthcare workforce community will work to implement these strategies as resources become available. The plan will continue to serve as a resource for the state and will be reviewed and updated as needed. 16 Primary Care Workforce Planning Grant Draft Report

19 Endnotes 1 Demographics of an Aging Population, Minnesota Department of Health, Fall Eliminating Health Disparities Legislative Report, Minnesota Department of Health, January Minnesota Demographers Office (1990) and 2000 US Census 4 America s Health Ratings: A Call to Action for People and Their Communities. United Health Foundation, Ibid. 6 Ibid. 7 State Health Workforce Profiles, Highlights (Minnesota). National Center for Health Workforce Analysis, Health Resources and Services Administration. Retrieved from bhpr.hrsa.gov/healthworkforce/reports/statesummaries/minnesota.htm July 7, Ibid. 9 Office of Rural Health and Primary Care, Minnesota Department of Health. 10 Minnesota s Registered Nurses Facts and Data Office of Rural Health and Primary Care, Minnesota Department of Health. Retrieved from divs/orhpc/pubs/workforce/rn08.pdf on July 12, Healthcare Industry in Minnesota. Minnesota Department of Employment and Economic Development, June Office of Rural Health and Primary Care, Minnesota Department of Health, July Ibid. Governor s Workforce Development Council 17

20 P o l i c y S o l u t i o n s t h a t W o r k f o r M i n n e s o t a Visit to download more GWDC publications P o l i c y A d v i s o r y August 2011 Smart Investments Real Results The Governor s Workforce Development Council Return on Investment Initiative Sixteen Ideas for Strengthening Minnesota s Workforce Governor s Workforce Development Council P o l i c y S o l u t i o n s t h a t W o r k f o r M i n n e s o t a Governor s Workforce Development Council The Governor s Workforce Development Council is developing a standardized return on investment methodology that can be applied to workforce employment and training programs across the state, starting with those administered or funded by the State of Minnesota. This document provides an overview of this ongoing initiative. Measuring return on investment will help Minnesotans understand how workforce programs benefit the state. It will enable policy makers to make smarter decisions about state investments and help service providers learn from and improve their results. All Hands on Deck Sixteen Ideas for Strengthening Minnesota s Workforce Working to Close the Skills Gap The GWDC s 2011 WorkForce Center Report Smart Investments, Real Results An Overview of the GWDC s Return on Investment Initiative