dshs.state.tx/CHS/hprc/

1. Demographic Review of the Texas Health Professions Workforce Health Professions Resource Center Center for Health Statistics Texas Department of State Health Services Brian King, Program Director, HPRC http://www.dshs.state.tx.us/CHS/hprc/

2. Texas Race/Ethnicity and Gender Demographics 2000 2008 Male 49.6% 50.1 % Female 50.4% 49.9 % 2000 Data from US Census 2008 Data from the Texas State Data Center, Migration Scenario 2, 9/2/06 Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

3. Direct Patient Care PhysiciansFacts at a Glance – 2008 Direct Patient Care Physicians: Total – 38,387 White 65.0% Black 4.7% Hispanic 11.6% Other 18.7% Male 74.3% Female 25.7% Providers/100,000 Population: Texas 158.8 Border Urban 106.7 Non-Border Urban 176.7 Border Rural 50.1 Non-Border Rural 91.2 Number of counties with no Direct Patient Care Physicians – 25 DPC Physicians per 100,000 Population DPC Physicians: Median Ages Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

4. Primary Care PhysiciansFacts at a Glance – 2008 Primary Care Physicians: Total – 16,528 White 58.3% Black 6.3% Hispanic 14.4% Other 21.1% Male 64.9% Female 35.1% Providers/100,000 Population: Texas 68.4 Border Urban 52.8 Non-Border Urban 72.7 Border Rural 35.4 Non-Border Rural 55.0 Number of counties with no Primary Care Physicians – 27 PC Physicians per 100,000 Population PC Physicians: Median Ages Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

5. Primary Care Physician Demographic Trends Race/Ethnicity Trendspercent of total Supply Ratio Trends by Race/Ethnicity Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

6. Ratio needed to qualify – 3,500:1 Texas 2009 ratio – 1,478:1 Physician Distribution –A Type of Shortage! As of April 2009 there were 118 Whole County Health Profession Shortage Areas (HPSAs) for primary care, and 109 sub-county geographic or special population HPSAs in Texas. Whole county HPSAs are predominately in rural counties and sub-county HPSAs are predominately in urban counties. 5,245,681 people lived in HPSAs. More people live in Partial County HPSAs than Whole County HPSAs It was estimated that 542 primary care physicians would have been needed to alleviate the mal-distribution. 2009 Harris Ratio with 3,059 physicians = 1,313:1 # Physicians for 3,500:1 ratio = 1,146 Harris could lose 1,913 physicians and not qualify as shortage area Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 5, 2009

7. Examples of Mal-distribution • There are several cases in Texas where counties of similar size have very different supply • (in 2008): • Nolan County had 15,813 people and 14 physicians for a ratio of 1,130:1 • Karnes County had 15,969 people but only 4 physicians for a ratio of 3,992:1   • Burnet County had 42,252 people and 33 physicians for a ratio of 1,280:1 • Waller County had 42,816 people but only 3 physicians for a ratio of 14,192:1 - the highest ratio in the state  • Angelina County had 84,171 people and 68 physicians, for a ratio of 1,238:1 • Orange County had 84,937 people and 28 physicians, for a ratio of 3,033:1 • There were 27 counties with no physicians, the largest being Duval County with 13,756 people. • Terrell County was the smallest county with a physician, population 1,101.

8. Physician Assistant Facts – 2008 Physician Assistants: Total – 4,191 White 73.2% Black 6.0% Hispanic 14.0% Other 6.8% Male 41.7% Female 58.3% Providers/100,000 Population: Texas 17.3 Border Urban 13.5 Non-Border Urban 18.5 Border Rural 16.0 Non-Border Rural 12.8 Number of counties with no Physician Assistants – 63 Physician Assistants per 100,000 Population Females became the majority in 2002 Physician Assistants: Median Ages Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

9. Physician Assistant Demographic Trends Race/Ethnicity Trendspercent of total Supply Ratio Trends by Race/Ethnicity Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

10. Feminization of Workforce • Studies show: • Females work fewer hours than Males, and are more likely to work part-time • Females often take more leave, but often retire later in life • Females tend to spend more time with patients, but then see fewer patients • Females less likely to practice in Rural areas • May need more supply to counter fewer FTEs Note: Some licensing boards in Texas do not collect information on Gender http://www.dshs.state.tx.us/CHS/hprc/ Publications

11. General Dentist* Facts – 2008 *Excludes specialists Dentists: Total – 8,987 No race/ethnicity data available; in the future should be collected by new Minimum Data Set Male 73.3% Female 26.7% Providers/100,000 Population: Texas 37.2 Border Urban 16.5 Non-Border Urban 41.8 Border Rural 11.9 Non-Border Rural 25.3 Number of counties with no Dentists – 46 General Dentists per 100,000 Population General Dentists: Median Ages Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

12. Dental Health Professional Shortage Areas As of January 1, 2009 there were 82 Whole County Dental Health Profession Shortage Areas (HPSAs), and 50 sub-county geographic or special population HPSAs in Texas. Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 6, 2009

13. Minimum Data Set • In 2007, the 80th Session of the Legislature passed Senate Bill 29, which calls for the creation of a Minimum Data Set for the collection of information on health professionals by the Statewide Health Coordinating Council (SHCC). • Purpose: • To standardize the types of information collected by the various health professions licensing boards, and to allow the SHCC, through HPRC, to gather more information on practice location, gender, age, and race/ethnicity. • Limitations: • Providers are not required to provide demographic data • Legislation does not cover all professions • Delays for some professions in collecting data • (only approximately 55% covered, although others may voluntarily submit data; • approximately 65% of professions expected to provide demographic data; • most of those that aren’t covered or that will be delayed are Allied Health professions and Mental Health professions)

14. Registered Nurse Facts - 2008 Registered Nurses: Total – 162,304 White 71.0% Black 8.3% Hispanic 9.8% Other 10.9% Male 10.1% Female 89.9% Providers/100,000 Population: Texas 671.3 Border Urban 483.1 Non-Border Urban 730.9 Border Rural 230.6 Non-Border Rural 470.1 Number of counties with no Registered Nurses – 3 Registered Nurses per 100,000 Population Registered Nurse: Median Ages Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

15. Registered Nurse Demographic Trends Race/Ethnicity Trendspercent of total Supply Ratio Trends by Race/Ethnicity Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

16. Pharmacist Facts - 2008 Pharmacists: Total – 18,623 White 59.8% Black 13.5% Hispanic 8.6% Other 18.0% Male 49.6% Female 50.4% Providers/100,000 Population: Texas 77.0 Border Urban 42.7 Non-Border Urban 84.9 Border Rural 31.5 Non-Border Rural 56.4 Number of counties with no Pharmacists – 27 Pharmacists per 100,000 Population Pharmacist: Median Ages Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

17. Mental Health Professions Licensed Professional Counselors Licensed Chemical Dependency Counselors Marriage and Family Therapists Psychiatric Nurses Psychiatrists Psychologists Social Workers

18. Mental Health Professions • Higher Median Ages than other professions, and median ages increasing at a faster rate • Supply ratios decreasing – and not just supply ratios but actual numbers for some professions

19. Texas Psychiatrist Facts – 2008 Psychiatrists: Total – 1,617 White 65.6% Black 3.8% Hispanic 12.3% Other 18.2% Male 63.5% Female 36.5% Providers/100,000 Population: Texas 6.7 Border Urban 2.6 Non-Border Urban 7.8 Border Rural 1.0 Non-Border Rural 3.3 Number of counties with no Psychiatrists – 171 Psychiatrists per 100,000 Population Psychiatrist: Median Ages Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

20. Mental HealthHealth Professional Shortage Areas As of March 10, 2009 there were 172 whole county Health Profession Shortage Areas (HPSAs) for mental health, and 12 sub-county geographic or special population HPSAs in Texas. Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 6, 2009

21. Mental Health Professions - Loss in Numbers Licensed Chemical Dependency Counselors Marriage and Family Therapists Psychiatric Nurses Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

22. Mental Health Professions – Median Age Trends Licensed Professional Counselors Licensed Chemical Dependency Counselors Marriage and Family Therapists Psychiatric Nurses Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

23. Public Health Workforce Surveys • Collected information from: • Local Health Departments • Federally Qualified Health Centers • Health and Human Services Enterprise Agencies: • Department of State Health Services • Department of Aging and Disability Services • Texas Health and Human Services Commission • Department of Family and Protective Services • Department of Aging and Rehabilitative Services

24. Public Health WorkforceSummary of Surveys • 13,063 Currently Staffed FTEs • Largest Professions: • Nursing – 4,173.0 • Registered Nurses – 2,371.5 • Licensed Vocational Nurses – 1,801.5 • Mental Health Workers – 3,541.0 • Psychiatric Nursing Aides, Psychiatric Nursing Assistants – 2,775.0 • Social Workers, licensed and unlicensed – 332.0 • Psychological Associates – 186.0 • Psychiatrists – 132.5 • Psychologists – 68.5 • Psychological Assistants – 10.0 • Other – 37.0 • Other Professions: • Environmental Health Workers/Engineers/Sanitarians – 650.5 • Public Health Technicians – 602.5 • Physicians (not including Psychiatrists) – 523.0 • Nutritionists and Dietitians – 344.0 • Dentists – 162.0 Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

25. Public Health Workforce – Vacancies 2,003.8 Vacant FTEs – 13.3% Vacancy Rate Professions with the most Vacant FTEs: Additional FTEs Desired if Budgets Allowed - 857 • Registered Nurses – 692.8 • Other Mental Health Workers – 278.5 • Licensed Vocational Nurses – 206.9 • Public Health Technicians – 170.0 • Physicians – 117.8 Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

26. Demographic Review of the Texas Health Professions Workforce Health Professions Resource Center Center for Health Statistics Texas Department of State Health Services Brian King, Program Director, HPRC http://www.dshs.state.tx.us/CHS/hprc/