Jean Moore, Director Center for Health Workforce Studies School of Public Health, SUNY at Albany

1. Health Workforce Planning in New York: Where are We?Where Do We Need to Go?Presentation to the Health Workforce Development SubcommitteeDecember 15, 2010 Jean Moore, Director Center for Health Workforce StudiesSchool of Public Health, SUNY at Albany http://chws.albany.edu Better Information for Better Outcomes Center for Health Workforce Studies December 2010

2. Health Care Reform 2010 • Service delivery provisions designed to • Expand access to care • Improve efficiency of care • Improve quality of care • Workforce related provisions designed to: • Support health workforce planning and policy making • Increase support for careers in health care, particularly to improve health workforce diversity and to address workforce shortages Center for Health Workforce Studies December 2010

3. What Changes With Health Reform? • Shift of focus for the health care delivery system to primary and preventive care • Emphasis on effective management of chronic diseases • Emerging models of care, such as the patient-centered medical home • Increased attention to quality and cost effectiveness • Rewards for efficiency and quality, penalties for inefficiency and poor quality care Center for Health Workforce Studies December 2010

4. Primary Care Related Provisions • National Health Service Corps expansion and improvements • Medicare Incentive Payments to PCPs • 2-Year Increase in Medicaid Payments to PCPs • Primary Care Extension Program • Medical Homes: Medicare • Medical Homes: Medicaid • Grants to Develop/Expand Primary Care Residency Programs • Teaching Health Centers • Grants for Family Nurse Practitioner Training Programs • Rural Physician Training • Revised HRSA Health Professions Student Loan Guidelines • Geriatric Workforce Development • Distribution of Unused Medicare GME Positions • Eliminate regulatory barriers to training in ambulatory sites • Reauthorize the AHEC program • School-based Health Centers • Nurse Managed Health Clinics (NMHC) • Independence at Home Demonstration Program Center for Health Workforce Studies December 2010

5. What Are the Workforce Implications of Health Reform? • Demand for primary care providers will increase, likely beyond available capacity • Physicians, Nurse Practitioners, Physician Assistants • Demand for other workers in ambulatory settings will also rise • Registered Nurses, Licensed Practical Nurses, Medical Assistants • Chronic disease management programs will drive increased demand for certified diabetes educators, certified asthma educators, social workers, nutritionists, health educators Center for Health Workforce Studies December 2010

6. What Do We Know About New York’s Health Workforce? Center for Health Workforce Studies December 2010

7. Center’s Current Health Workforce Tracking Activities • Re-registration surveys: • Physicians • Registered Nurses • Dentists • Dental Hygienists • In 2011, adding: NPs, PAs, Midwives • Annual resident exit survey • Annual survey of nursing deans and directors • Annual health worker demand surveys: • Hospitals, nursing homes, home care agencies, clinics Center for Health Workforce Studies December 2010

8. Health Care Employment Is Important to the State’s Economy Employment Growth in New York State, 1990 - 2008, (Standardized to 1990) NYS DOL, ES 202

9. Since 2003, RN Graduations Have Been Steadily Increasing in the State Registered Nursing Graduations in New York State, 1996-2010 Center for Health Workforce Studies December 2010

10. Impacts of the Economic Downturn Slower job growth Delays in expansions/investments Health information technology New services Staffing cuts Easing of current health workforce shortages Center for Health Workforce Studies December 2010

11. Which Health Workers Are Hardest to Recruit and Retain in New York? In a 2009 survey of hospitals, nursing homes and home health agencies in the state, occupations that posed the most difficulty were: Experienced registered nurses Clinical laboratory technicians and technologists Physical therapists Occupational therapists Licensed practical nurses Certified nurse aides Center for Health Workforce Studies December 2010

12. Variable Growth in the Regional Supply of Active Patient Care Physician FTEs in NY Between 2002 and 2008 Center for Health Workforce Studies December 2010

13. Primary Care Health Professional Shortage Areas in New York Center for Health Workforce Studies December 2010

14. Less than Half of New Physicians Stay in New York after Completing Training Percent of new physicians with confirmed practice plans in New York Data are not available for 2004 and 2006 Center for Health Workforce Studies December 2010

15. New Physicians From New York Are More Likely to Stay in New York Percent of new physicians with confirmed practice plans in New York by high school location and medical school location, 2009 Center for Health Workforce Studies December 2010

16. What Are the Jobs of the Future? Selected Health Occupations with the Largest Projected Job Need in the U.S. between 2008 and 2018 Sources: U.S. Department of Labor, Bureau of Labor Statistics, National Employment Matrix, employment by industry, occupation, and percent distribution, 2008 and projected 2018. Center for Health Workforce Studies December 2010

17. Where Are the Jobs of the Future? Projected Average Annual Job Growth in Selected Health Settings in the U.S. 1998-2008 and 2008-2018 Sources: U.S. Department of Labor, Bureau of Labor Statistics, National Employment Matrix, employment by industry, occupation, and percent distribution, 2008 and projected 2018. Center for Health Workforce Studies December 2010

18. Are We Training a Health Workforce for the Future? Interdisciplinary collaboration Team based care New roles and responsibilities Different settings, e.g., home care and ambulatory care More technology Focus on chronic disease management Geriatrics Cultural competence Center for Health Workforce Studies December 2010

19. Opportunity For Developing and Strengthening Health Workforce Planning Infrastructure in New York Enhance health workforce monitoring system Increase the number of health professions surveyed at re-registration Strengthen the primary care focus of the monitoring system Systematically disseminate monitoring results to key stakeholders Establish and support regional coalitions to actively engage in health workforce planning Center for Health Workforce Studies December 2010

20. Health Workforce Planning: What? • Health needs of the population and the services required • Current health workforce supply and distribution • Current and future supply/demand gaps • Profession-specific • Specialty-specific • Geographic • New workers and/or new skill sets needed • Evaluation of the relative effectiveness of different workforce configurations Center for Health Workforce Studies December 2010

21. Health Workforce Planning: Who? • Governmental agencies, e.g., DOL, DOH, SED, SUNY • Health planning entities, e.g., Health Systems Agencies, Rural Health Networks • Foundations • Educators • Health worker labor unions • Providers, e.g., hospitals, nursing homes, home care, clinics, physician offices, public health • Professions, e.g., medicine, nursing, allied health • AHECs • Researchers • Consumers Center for Health Workforce Studies December 2010

22. Health Workforce Planning: How? • Use the health workforce monitoring system to • Systematically identify shortage areas in primary care, dental, mental health, and nursing • Develop regional planning networks: • To review the data and information from the monitoring system relevant to their region • To develop plans to address most pressing current and future workforce needs Center for Health Workforce Studies December 2010

23. Looking Ahead: Sustainability Use federal resources as seed money to support infrastructure development for health workforce planning in New York Strengthen the health workforce monitoring system Engage stakeholders committed to participation in regional planning networks Use health workforce data and information to inform decisions and to support the development of state and local programs and policies Evaluate the impacts of these efforts on the health of the population in the state Center for Health Workforce Studies December 2010