The Changing Landscape of Health Professions Education Reasons and Probable Results Harold P. Jones, Ph.D. Stephen N. Collier, Ph.D.
The Changing Health Workforce Health Reform Trends in Health Care and Health Professions Education What Will the Health Landscape Look Like In: 3 5 years 5 10 years 10 20 years y How will this affect allied health?
Health System Characteristics Ambiguity Uncertainty Complexity
Democrats, realizing the success of the President's "Cash For Clunkers" rebate program, have revamped a major portion of their National Health Care Plan. President Obama, Speaker Pelosi, and Sen. Reed are expected to make this major announcement at a joint news conference later this week. I have obtained an advanced copy of the proposal which is named... "CASH FOR CODGERS" and it works like this... Couples wishing to access health care funds in order to pay for the delivery of a child will be required to turn in one old person. The amount the government grants them will be fixed according to a sliding scale. Older and more prescription p dependent codgers will garner the highest amounts. Special "Bonuses" will be paid for those submitting codgers in targeted groups, such as smokers, alcohol drinkers, persons 10 pounds over their government prescribed weight, and any member of the Republican Party. Smaller bonuses will be given for codgers who consume beef, soda, fried foods, potato chips, lattes, whole milk, dairy products, bacon, Brussels sprouts, or Girl Scout Cookies. All codgers will be rendered totally useless via toxic injection. This will insure that they are not secretly resold or their body parts harvested to keep other codgers in repair. Remember you heard it here first...
People sometimes say we have an irrational health care system, but the health system behaves the way it is rewarded d to behave
The Changing Health Workforce
Health Professions BLS Projections (thousands of jobs) Occupation Employment Number Total job openings due to growth Percent Change 2006 2016 and net replacement, 2006-16 2000-10 2002-12 2004-14 2006-16 Clin Lab Technologists & Technicians 319 362 92 17.0 19.3 22.7 13.6 Dental Hygienists 167 217 82 37.1 43.1 43.33 30.1 Dieticians & Nutritionists 57 62 19 15.2 17.8 18.3 8.6 Home Health Aides 787 1,171 454 47.3 48.1 56.0 48.7 Medical Assistants 417 565 199 57.0 58.9 52.1 35.4 Med Records & Health Info 170 200 76 49.0 46.8 28.9 17.8 Technicians Occupational Therapists 99 122 37 33.9 35.2 33.6 23.1 Pharmacists 243 296 53 24.3 30.1 24.6 21.7 Physical Therapists 173 220 68 33.3 35.3 36.7 27.1 Physician Assistants 66 83 27 53.5 48.9 49.6 27.0 Physicians & Surgeons 633 723 204 17.9 19.5 24.0 14.2 Radiologic Technologists & Technicians 196 226 56 23.1 22.9 23.2 15.1 Registered Nurses 2,505 3,092 1,001 25.6 27.3 29.4 23.4 Respiratory Therapists 102 126 38 34.8 34.8 28.4 22.6 Speech-Language Pathologists 110 121 33 39.2 27.2 14.6 10.6 Table prepared by Stephen N Collier based on data frombureauof LaborStatistics: Occupational Employment Table prepared by Stephen N. Collier based on data from Bureau of Labor Statistics: Occupational Employment Projections to 2016, Monthly Labor Review November 2007, and counterpart articles November 2001 and February 2004 and November 2005.
Workplace personnel needs change more rapidly than educational programs can respond a local personnel need is identified Program planning occurs (6 mos 1year) Hiring a programdirector director, accreditation, curriculum development, faculty hiring (1 2 years) Program implementation (2 years) First graduates (4 or more yrs from identification)
The Current Work Environment: growing or declining?
Recruitment and Retention
Questions? Discussion about this section
Health Reform
Health Reform What does the President want to accomplish, and why? What t has been happening in the debate? Tactics used by groups opposed to health reform Three possible outcomes and their implications --substantial reform --status quo --marginal change
What does the President want health reform to emphasize and accomplish? Cost: reduce, contain, or at least slow the increasing cost of health and health insurance -- (There is enough money in the system but we need to use current resources more wisely; reduce unnecessary tests & procedures; evidence based medicine) Access: Universal health coverage-- ( This will reduce uncompensated care and create atmosphere to introduce controls on system especially if coverages are similar and competitive) Quality: Standardized patient protocols driven by comparative effectiveness research supported by better health IT (the electronic health record) will provide better results at lower costs But they all tie to cost
OECD vital statistics data 2006
Average Annual Premiums for Single and Family Coverage, 1999-2009 1999 $2,196 $5,791 Single Coverage 2000 $2,471* $6,438* Family Coverage 2001 $2,689* $7,061* 2002 2003 2004 $3,083* $3,383* $3,695* $8,003* $9,068* $9,950* 2005 $4,024* $10,880* 2006 $4,242* $11,480* 2007 2008 $4,479* $4,704* $12,106* $12,680* 2009 $4,824 $13,375* $0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 $16,000 * Estimate is statistically different from estimate for the previous year shown (p<.05). Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2009.
Possible Factors Impacting Costs Insurance Tax System Income Fee for Service # of Providers Provider mix Malpractice Physician Payment
After stimulus wanes, gaps could approximate 4% of spending, or $70 billion, even under the Low Gap Scenario Source: Don Boyd (Rockefeller Institute of Government), 2009
After stimulus wanes, gaps could approach 7% of spending or $120 billion under the High Gap scenario slide 26 Source: Don Boyd (Rockefeller Institute of Government), 2009
Apparent Strategy Change the rules and the way we play the game will follow Align Financing Align Human Resources Development Efforts Align Policy Efforts Demonstrate Successful Approaches
f If you want to understand health care, just follow the money Howard Houser, Ph.D.
The current health reform initiatives are focused largely on financing the money rather than the health care workforce However, the financing has implications for the health care workforce, including allied health
Possible Factors Impacting Costs Insurance Tax System Income Fee for Service # of Providers Provider mix Malpractice Physician Payment Unneeded Procedures/Tests
So what is being proposed to control spending? Expand Medicaid Expand CHIP Create Insurance Collectives with Price Restraints Penalize Elective Uninsured Incentivize Businesses (carrot & stick) Standard Package (content) Guaranteed Insurability No Pre-Existing Conditions Ability to Transfer Between Plans Preventive P Care Incentives & Hospice Services & Disease Management Expanding Health IT Comparative Effectiveness Research Its Focus (limiting unnecessary procedures, tests alternate delivery models and personnel staffing patterns) The Institute GME Changes GME Changes Expanded Roles Funding Initiatives Related to Other Bills (DOL ARRA HRSA)
Health Reform What has been happening in the debate? Tactics used by groups opposed to health reform
The Public Reaction to Health Reform Underlying support for greater emphasis on primary care, prevention, and health information systems However, concern about (1) trustworthiness of health care products, providers, and sources of health information; (2) privacy and confidentiality of medical records; (3) consumers capacity forgreaterresponsibility responsibility to make health care decisions; and (4) ability to choose providers and treatment options
According to Edward Foote*, the American legal and political system is based on the following deeply rooted principles i The intrinsic importance of the INDIVIDUAL The importance of FREEDOM for individuals A concomitant distrust and FEAR OF BIGNESS and monopoly The concept of EQUALITY among individuals Ironically, perhaps, a DISTRUST OF GOVERNMENT * Red (Tape), White (Sheets) and Blue (Cross), An American Dilemma, presentation to the Association of Academic Health Centers, 1978.
Three possible outcomes and their implications substantial reform status quo marginal change
LIKELY FEATURES OF A REFORMED SYSTEM Universal access Gatekeepers More control on treatment t tregimens Limitations on utilization and rollout of new technologies Salary compressions and restraints Greater emphasis on management of chronic conditions and disabilities Greater emphasis on prevention and community health
Questions? Discussion about this section
Trends in Health Care and Health Professions Education existing factors that are increasing i in influence
Health Information Technology
Bifurcation of the Workforce higher and lower training levels
Increased curriculum requirements and credit hours Adding more technical skills for a broader scope of practice 22 nd level l of practice (e.g., IOM recommendations informatics, team practice, evidence based practice, etc.)
Turnover and Workforce Attrition (particularly at lower pay levels) els)
Credentialing Increased importance at all levels, but especially at the lower levels and short term certificate training (e.g., home health aides, etc)
Technology (many different types and impacts) home monitoring clinical simulation telemedicine i
The Culture of Higher Education is Changing including Health Professions Education
The College of 2020 Chronicle Research Services The traditional model of college is changing More online, part time, time, attend multiple universities, start and stop, & lower cost alternatives Higher enrollment levels in community colleges and for profit institutions Learning from the for profits: start courses and programs at multiple times throughout the year Convenience is what students seek
Distance Education for Clinically Oriented Educational Programs Didactic instruction online (including simulation) Preceptor directed clinical education apprenticeship p training
For Profit (proprietary) Education in the Health Professions
What campuses have the largest enrollment? University of Phoenix (online) 165,373 Ohio State Univ. (main campus) 51,818 Miami Dade College 51,329 Arizona State Univ. at Tempe 51,234 University of Florida 50,912
Hospital/Health System Based Degree Education
Scarcity of US U.S. students with adequate science and math skills to enter allied health hprograms
Globalization More international students Taking U.S. US allied health programs abroad Medical tourism
Globalization More international students Taking U.S. US allied health programs abroad Medical tourism
Healthcare Cost Comparison 300,000 274,395 Estimate in $ 250,000 200,000 150,000 210,000 100,000 69,991 75,399 82,646 98,618 108,127 50,000 0 40,832 Mastectomy 9,633 10,500 11,000 13,667 12,333 Knee replacement 7,167 14,000 11,000 Hip replacement Gastric bypass Angioplasty Spinal fusion Heart bypass Heart valve replacement US Price Avg (Ind Thai Sing) www.ncpa.org/pub/st/st304
Top Ten Hot Spots for Medical Tourism 2008 Deloitte Development LLC
Questions? Discussion about this section
What Will the Health Landscape Look Like In: 3-5 years 5-10 years 10-20 years How will this affect allied health?
What will the health landscape look like in 3 5 years? Continued turbulence in many areas, particularly in economic recovery & state tax revenues Retirement delays & part time employment Low job vacancies; grads have trouble finding jobs leading to declining i enrollments Technology: remote monitoring, etc Inclusion of health technology doesn t go smoothly For profit and hospital HPE programs increase Telemedicine remains constricted
What will the health landscape look like in 5 10 years? Economy stabilizes; wave of retirements Large job vacancies Insufficient educational program capacity PA and NP increases in primary care Simulated clinical experiences required for accreditation Distance education for clinical professions Electronic health records
What will the health landscape look like in 10 20 years? Physician practice changes due to improved clinical algorithms Genomics has large impact on clinical practice, but patents slow adoption Allied health continues bifurication: many at lower levels (but IT competent) and fewer at higher levels Public becomes more involved in self care Expansion of over the counter lab tests and analytical tools for the public
Questions/Discussion Harold P. Jones, Ph.D., Dean and Professor jonesh@uab.edu (205) 934 5149 Stephen N. Collier, Ph.D., Professor & Director Office of Health Professions Education and Workforce Development colliers@uab.edu (205) 934 3383 School of Health Professions School of Health Professions University of Alabama at Birmingham