health workforce trends

In recent years, a variety of trends have emerged that have implications for the health workforce in the southeast region of the US. The Southeast Regional Center for Health Workforce Studies is examining these trends and has summarized observations of the relevant issues and their potential or real impact on the health workforce.

Institutions experience cyclical shortages of skilled technicians and therapists
Racial and ethnic disparities continue to exist between primary care providers and populations they serve
Nursing shortage will continue to be an issue
Surgical workforce shortages
Better integration of health workforce policy with broader labor policy
Geriatric health workforce issues
Testing potential solutions to the impending physician shortage
Expansion of medical schools could provide opportunity for post-education public service

This approach is being tested in North Carolina to address potential shortages in the state’s allied health workforce. Statewide activities are focusing on increasing access to education so that radiologic professionals may become faculty/educators to help meet anticipated growing demand. A consortium was organized of major state training institutions to standardize BS radiological science education while maintaining the unique qualities of programs at various campuses. This model may serve as an example of how to cope with similar faculty shortages for training other allied health professions.

Sources:
Dyson S, Fraher E, Wilkins B, Smith L. 2003. Scanning the Radiologic Sciences Workforce in North Carolina. Chapel Hill, North Carolina. The Council for Allied Health in North Carolina, July 2003.

Renner J. 2004. Distance Learning BS Degree Consortium Program in Radiologic Science. Council of Allied Health in North Carolina, presentation at September 1, 2004 meeting.
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Racial and ethnic disparities continue to exist between primary care providers and populations they serve
This issue cuts across all primary care providers, including physicians, nurses, nurse practitioners, physician assistants and nurse midwives. While blacks, Hispanics, and Native Americans represented 6 percent of U.S. physicians in 2001, their representation within the general population was 25.7 percent.

Research indicates that individuals may have preferences for specific racial or ethnic backgrounds of their health care professional and that the care they receive may be more efficacious depending on the match of race and ethnicity. This may be more common for certain populations, such as older African Americans or Hispanics. In addition, the perception of trust between a patient and his/her provider is a more important characteristic for African American patients than patients of other racial and ethnic groups. Lack of trust is correlated with voluntary disenrollment from primary care. To what extent these disparities impact health outcomes and employment patterns needs to be examined.

Sources:
Reede JY. 2003. A recurring theme: the need for minority physicians. Health Affairs 22 (4):91-93.

Petersen LA. 2002. Racial differences in trust: reaping what we have sown? Medical Care 40 (2):81-88.

Howard DL, Konrad TR, Stevens C, Porter CQ. 2001. Physician-patient racial matching, effectiveness of care, use of services, and patient satisfaction. Research on Aging 23 (1):83-108.
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Nursing shortage will continue to be an issue
Shortages are projected for nursing faculty due to the aging of the existing nursing faculty and impending retirements. A special survey conducted by the American Association of Colleges of Nursing (AACN) indicated lack of full-time faculty as the reason for not accepting 41.7% of 5,283 qualified applicants to baccalaureate, master’s, and doctoral nursing programs. The AACN survey, in a national sample of 220 schools, also indicated a vacancy rate of 7.4% for full-time nursing faculty positions. A southeast regional study by the Council on Collegiate Education for Nursing in 2002 found vacancy rates of 5.7% for full- and part-time faculty positions in associate degree, baccalaureate, and graduate programs.

Multiple programs exist that require service commitments in exchange for scholarships and loan repayments for nurses. These programs are supported at both the national and state levels. In order to aid recruitment and retention in the nursing workforce, the relationship between these funding mechanisms needs to be clarified in order to maximize program effectiveness and efficiency. Further study is needed on the age structure of the nursing workforce to better understand how nurses migrate within the nursing profession.

A recent study indicates signs that the US nurse labor force market may be strengthening. Analysis of annual RN employment and earnings shows increases in wages and numbers of nurses for certain sectors in 2001-2003 data. Trends reported by SE Regional Center Advisory Board member Peter Buerhaus and colleagues include; (1) older nurses who left the workforce are returning, (2) employment of foreign-born RNs continues to expand, (3) fast growth is occurring in the number of younger US-born RNs, (4) faster increases in the number of associate versus baccalaureate degree nurses and (5) rising numbers of men in the nurse workforce, with a larger proportion of older rather than younger men. While there may appear to be a short-term strengthening of the nursing workforce, these short-term improvements have not eliminated the nursing shortage, which continues to be a long-term concern.

Sources:
American Association of Colleges of Nursing. 2003. Faculty Shortages in Baccalaureate and Graduate Nursing Programs: Scope of the Problem and Strategies for Expanding the Supply.
http://www.aacn.nche.edu/Publications/WhitePapers/FacultyShortages.htm

Williams BG, Hodges LC. 2002. Southern Regional Education Board Study Indicates Serious Shortage of Nursing Faculty, report by the Council on Collegiate Education for Nursing.
http://www.sreb.org/programs/nursing/publications/NursingFacultyShortage.asp

Buerhaus PI, Staiger DO, Auerbach DI. 2004. New signs of a strengthening US Nurse labor market? Health Affairs Web Exclusive, November 17, 2004.
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Surgical workforce shortages
There is a potential for an emerging shortage of surgeons in the United States, as the aging population grows and the production of new surgeons remains stable. Surgical workforce shortages have already become critical in certain parts of the US, such as in rural hospitals. Further research is needed to assess overall access to surgical resources and analyze to what degree federal programs support the distribution of the surgical workforce.

Source: Powell AC, McAneny D, Hirsch EF. 2003. Trends in general surgery workforce data. The American Journal of Surgery 188 (1):1-8.
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Better integration of health workforce policy with broader labor policy
The Workforce Investment Act provides funding to states to train workers for new careers including healthcare. State and local Workforce Investment Boards organize and coordinate activities at the local level. A focus in some states has been to retrain unemployed workers from one industry, such as textiles, for careers in emergency care or nursing. Cooperation between state AHECs and Workforce Investment Boards could enhance this effort but will require better use of data from the Department of Labor (DOL) to track the career entry exit and pathways of health sector employees. An ongoing interagency agreement between DHHS and DOL (such as the recent collaboration on the direct care workforce) to monitor health workforce issues and to exchange data for mutual benefit should be developed.

Source: U.S. Department of Labor Employment & Training Administration, 2004. "Local Solutions with National Applications to Address Health Care Industry Labor Shortages." http://www.doleta.gov/BRG/IndProf/Health.cfm
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Geriatric health workforce issues
The health workforce providing care to the nation’s aging population is growing. There are new professional roles and approaches to caregiving for the elderly that are being tested and implemented. These new professions and care structures need to be studied to determine their impact on cost-effectiveness as well as quality of care.
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Testing potential solutions to the impending physician shortage
The emerging consensus about an impending physician shortage raises the question of how to avoid the expected shortfall. This can be done through three mechanisms: (1) increasing the size and diversity of the pool of applicants and expanding the class size of US medical schools; (2) increasing the use of qualified non-physician practitioners, including nurse practitioners, physician assistants and certified nurse midwives; and (3) maintaining opportunities for qualified International Medical Graduates to practice in the US, especially in underserved and linguistically compatible communities.
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Expansion of medical schools could provide opportunity for post-education public service
The expansion of medical schools will be expensive and costs can be borne by a mix of public (federal/state) and private sources. Students may be faced with higher tuition and could incur greater indebtedness. This may present an opportunity to achieve public goals of providing health care to underserved communities by expanding the range and volume of support for service-connected scholarship and loan programs for medical students.
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