Presentation Transcript

1. 96:642Innovation, Business, & Law Colloquium

   Workforce Initiatives to Ensure an Adequate Supply of Health Care Providers Carol A. Watson, PhD, RN Clinical Professor, College of Nursing
2. Today’s Topics Current and future health care workforce PPACA policies to support and expand workforce
3. About Me Nurse for 40 years Worked in various roles in health care—staff nurse, nurse director, nurse educator, and nurse executive Prior to current position was the Senior Vice President of Clinical Services and Chief Nursing Officer at Mercy Medical Center, Cedar Rapids (1987-2008) In previous position had administrative responsibility for nursing & all other clinical services, except Radiology & Dietary, across the care continuum President, American Organization of Nurse Executives in 2008
4. Why Do We Care? Before PPACA, there were current workforce shortages and even greater workforce shortages projected in the next 10 – 15 years. PPACA will add an estimated 32 million more insured individuals to an already strained health care system from a workforce perspective Our current health care delivery models are not sustainable
5. Where Do Shortages Exist? Shortages are prevalent in most areas of the U.S. and for most health care practitioner roles and many support and administrative roles This presentation will focus on 3 groups: Physicians Nurses IT
6. Physician Workforce Educational preparation of physicians: Undergraduate degree Graduate degree Residency in specialty area Fellowship in subspecialty area Total education can take up to 15+ years
7. Current Physician Workforce In 2008 254.5 active physicians /100,000 population with 219.6 physicians active in patient care/100,000 population High of 405.4 active physicians/100,000 in Massachusetts & low of 174.2 in Mississippi ; 316.2 physicians active in patient care to low of 159.2 States with the highest number of physicians are concentrated in the northeast Source: The Physician Workforce, HRSA, 2008
8. Primary Care 79.4 primary care physicians active in patient care/100,000 population High of 111.4 in Vermont and low of 57.5 in Utah Distribution of primary care physicians is very similar to the distribution of all physicians Primary care definition: family medicine, general practice, geriatric medicine, internal medicine, and pediatrics
9. Other Demographics Female: 28.9% Graduates of international medical schools: 24.2% Age: 24.7% age 60 years or older
10. Growth of Medical Student & Residents Between 1999 and 2008: Number of students enrolled in medical or osteopathic schools increased by 16.2 % Number of residents and fellows in ACGME programs increased by 10.5%.
11. Physician Workforce Projections The supply of active physicians under age 75 is expected to increase 16.5% from 2005 to 2020. But, the aging of the population will contribute to a 22 % increase in demand for physician services between 2005 and 2020 and will create the highest demand among specialties that predominantly serve the elderly (e.g., cardiology, internal medicine, and most surgical specialties).
12. Physician Workforce Projection Overall, the demand for physician services is growing faster than supply.  Without an increase in number of new graduates from U.S. medical schools we cannot to provide the same level of health care unless: the health care system becomes more efficient at delivering care traditionally provided by physicians; reduces demand for physician services through improved science, technology, or use of other inputs to care; or becomes more dependent on foreign-trained physicians.
13. Iowa Physician Workforce In 2005, active physicians was 167/100,000 population Growth rate of physician population projected to exceed the growth rate of the Iowa population for the next ten years with a net gain of 71 physicians/year Supply trend of primary care physicians (family medicine, general internal medicine, & general pediatrics) is increasing The mean and median age is 48 years, which is younger than nation’s physician population Gender: 78% male; 22% female International medical graduates: 15% Source: The Iowa Physician Workforce Report, CCOM, 2007
14. Nurse Workforce Educational preparation Basic preparation is as a registered nurse (RN) Associate Degree: 2 years Diploma: 3 years Baccalaureate: 4 years Advanced preparation Moving from masters preparation to doctoral preparation by 2015 Preparation as Nurse Practitioner (NP), Certified Registered Nurse Anesthetist (CRNA), Nurse Midwife (CNM), Nurse Educator, Nurse Researcher, Nurse Executive
15. How Many Nurses? In 2008, according to HRSA, the nation has: 3.06 million registered nurses Increase of 5.3% over the last four years More RNs than ever before but still not enough by 2025, the nation faces a shortage of 250,000 nurses The Registered Nurse Population, HRSA,2010.
16. Growing Number of Nurses Per Person The number of nurses in the United States is growing faster than the general population. In 2004, the nation had 825 nurses per 100,000 By 2008, that had increased to 854 nurses per 100,000 85% are employed in nursing positions Range is from 598/100,000 in Utah to 1,273/100,000 in North Dakota; The New England region has more nurses/100,000 people than any other region of the country; the Pacific region has the fewest.
17. Other Demographics 83.2% are white, non-Hispanic 93.4% are female Average is 47.0 years, representing a stabilization after many years of large increases in average age Nearly 45 percent of RNs were 50 years of age or older 5.6% internationally educated 5.2% are advanced nurse practitioners (NP: 3.8%; CRNA: 1.1%, & CNM: 0.3%
18. Nurse Practitioners Over 135,000 nurse practitioners (NPs) practicing in U.S. 20% of NPs practice in rural or frontier settings 66% of NPs practice in at least one primary care site; Average NP is female (94.6%) and 48 years old; she has been in practice for 10.5 years as a family NP (49%) AANP, 2010 (www.aanp.org)
19. Iowa Nurses In 2009, 43,851 RNs (1,457/100,000) 48% are > 58 years old; 29% <38 years old Between 8/1/08-7/31/08: 2,584 new RN graduates ~1,500 ARNPs in Iowa or 49.9/100,000 Source: Trends in Nursing in Iowa, IBON, 2009
20. Massachusetts Experience Study of working age adults 18-64 between 2006 & 2008 The newly eligible more likely to have physician visit with a total increase of 5.7% Multiple physician visits rose 5.1% Likelihood of preventive care increased by 6.5% Much of the gains in physician visits occurred in Year 2 Dental care increased by 7.8% Strongest gains were for lower-income adults <300% poverty Increases in health care use from Fall 2007 to Fall 2008 coupled with: 20% reported they were told physician offices or clinics were not accepting patients with their type of coverage or new patients (both primary & specialty care) Access more difficult in areas with lower provider supply No decrease in use of EDs for non-emergency conditions from the pre-reform levels Source: Long & Masi, Access & Affordability, Health Affairs, 2009
21. Health Information Technology Projected need for 35,000 – 50,000 more HIT workers in the next 5-10 years or ~50% increase over the current HIT workforce The Office of the National Coordinator for Health Information Technology recently released the regulations that hospitals & physician clinics must meet to “better manage patient care through secure use and sharing of health information. Health IT is the use of electronic health records (EHRs) instead of paper medical records to maintain health information. These regulations are referred to as meaningful use These regulations include bonuses for those who meet the criteria or penalties for those who fail to meet the criteria Source: U.S. Healthcare Workforce Shortages: HIT Staff, HIMSS, 2010
22. Questions?