Healthcare Workforce Opportunities and Challenges Linda Cragin, MassAHEC Network UMass Medical School

1. Healthcare Workforce Opportunities and Challenges Linda Cragin, MassAHEC Network UMass Medical School

2. AHEC: Area Health Education Center • New Hampshire AHEC ProgramRosemary Orgren, PhD, DirectorDartmouth Medical School603-653-0851E-mail: rosemary.orgren@dartmouth.eduhttp://www.dartmouth.edu/~ahechome/ • AHEC of Rhode IslandRob Trachtenberg, Assoc. DirectorWarren Alpert Medical School /Brown U. 401-863-2621E-mail: Robert_Trachtenberg@brown.eduhttp://med.brown.edu/ahec/ • UVM College of Medicine AHEC Program Elizabeth Cote, Program DirectorUniversity of Vermont, College of Medicine, 802-656-2179E-mail: elizabeth.cote@uvm.eduhttp://www.VTAHEC.org • Connecticut AHEC ProgramPetra Clark-Dufner, Associate DirectorUniversity of Connecticut860-679-7971E-mail: clarkdufner@uchc.eduhttp://ctahec.uchc.edu • Maine AHEC NetworkMark Ruggiero, MHS, DirectorUniversity of New England207-221-4462E-mail: mruggiero@une.eduhttp://www.une.edu/com/ahec/ • MassAHEC NetworkLinda Cragin, DirectorUMass Medical School508-856-4303E-mail: Linda.cragin@umassmed.eduhttp://www.umassmed.edu/ahec

3. Health Care Workforce Issues • Changes in Population • Health Care Disparities • Workforce Diversity • Aging and Chronic Conditions • Training and Education • Primary Care • Health Care Delivery Sites • New Models of Care • Pipelines • Youth • Certificates • Faculty

4. Health Care Disparities • Massachusetts ranks 7th in the country for the number of immigrants/refugees1. Children of Immigrants/Total Children: • NH and CT both 56% change • Maine -7% and VT -18%2 1) Office of Immigration Studies 2) Kaiser State Health Facts

5. Health Care Disparities • Languages In March 2005, Massachusetts Public Schools reported112 different primary languages. MA DOE

6. Access for Minority Patients Racial and ethnic minority health care professionals are significantly more likely than their white peers to serve minority and medically underserved communities… …African Americans, American Indians and Alaska Natives, many Hispanic/Latino populations, and some Asian American (e.g., Hmong and other Southeast Asians) and Pacific Islander groups (e.g., Native Hawaiians) are grossly underrepresentedamong the nation’s health professionals. In the Nation's Compelling Interest: Ensuring Diversity in the Health Care Workforce/IOM

7. Imbalance in Workforce Diversity In Connecticut, while Blacks and Hispanics make up morethan 18% of the population: • Less than 5% of doctors and 8% dentists are Black and Hispanic. • Less than 8% of RNs are Black and Hispanic. With only 2% representation there is a particular shortage of Hispanic RNs. • More than 32% of health aides are minority women. University of Massachusetts Boston/US DOL and Census

8. Aging • Of the population: • Maine: 15.1% of the population over the age of 65 • US: 12.8% (US Census, 2008) • Of the workforce (HRSA):

9. Obesity Trends* Among U.S. AdultsBRFSS,1990, 1999, 2008 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 1999 1990 2008 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% http://www.cdc.gov/obesity/data/trends.html

10. Result: Workforce Shortages

11. Training and Education “Primary Care that is squarely centered on each patient’s individual needs is the only hope for fixing the broken US healthcare system.” Paul Grundy, MD, IBM director of Healthcare, Technology and Strategic Planning. Healthcare IT News by Richard Pizzi, Associate Editor 10/15/07

12. Enrollment: • Enrollment in both new and existing U.S. medical schools increases: • First-year enrollment in the nation's medical schools rose in 2009 by 2 percent over 2008 to nearly 18,400 students. • Four new U.S. medical schools in 2009 • 12 existing medical schools expanded their 2009 class size by 7 percent (Tufts, UMass, Dartmouth) AAMC

13. Massachusetts: • More physicians per capita than any other state… • Highest per capita health care costs in the world… • Shortage of primary care physicians…

15. Shift in health care delivery sites

16. New Models of Care • Patient Centered Medical Home • Chronic Care Management Systems • Self-managed Care (Stanford Model) • Transitions Management

17. All require a differently trained workforce… • Leadership skills • Team Building skills • Communication skills • Patient Activation skills • QI/QA knowledge

18. Why Health Career Pipelines? • Employment growth 2004-2014: • 3.6 million new wage and salary jobs • 19% of all new wage and salary jobs • Wage and salary employment • projected to increase 27% through 2014 compared to 14% for all industries combined • Many of the occupations projected to grow the fastest are in the health care industry: • home health aides projected to increase by 56% • medical assistants by 52% • physician assistants by 50% • physical therapist assistants by 44% U.S. Bureau of Labor Statistics

19. Pipelines… • Youth Career Exploration • School curriculum • After school, summer programs • HOSA: Health Occupations Students of America • High School to College Pipelines • College to Graduate Pipelines

20. Certificates • Medical Interpreter • - MassAHEC: 60 hour course • Community Health Worker/Patient Navigator/Outreach Workers • - MassAHEC: 45 hour course • Advanced skills training

21. The biggest challenge: Faculty Association of Academic Health Centers (2007): • 94% of CEOs declared faculty shortages to be a problem in at least one health professions school. • 69% -shortages across the entire institution. • Factors: • Low level of interest • Heavy faculty workloads • Disparities in salaries between academia and private practice • Cost of education and incidence of debt

22. DOL announces $220 million competition to fund programs that prepare workers for careers in health care industry • Pipeline: Recruitment and Retention The industry is currently seeking to increase the available labor pool of health care employees. To attract new employees to the health care industry, industry employers are focusing recruitment from non-traditional labor pools. Increasing the diversity of workers and reducing turnover rates is also of concern. • Skill Development Industry employers are focused on preparing entry-level workers for positions in health care. Efforts also include the expansion of access to training for incumbent workers and fulfilling workforce needs in targeted and specialized skill areas. • Capacity of Education and Training Providers To meet the training and recruitment needs of health care employees, the industry is seeking to expand the numbers of academic and clinical instructors and facilities and resources to facilitate training. The industry is working to align employer requirements and curriculum to fulfill more adequately the needs of health care employers. U.S. Dept of Labor

23. What does it mean for you?

24. Job Security…