Topics

1. Topics • Classifying the Workload • Every Man’s Interest • The Supply of Healthcare Labor • Issues and Trends “Every man’s interest would prompt him to seek the advantageous, and to shun the disadvantageous employment.” Adam Smith

2. Classifying the Workload • Rate healthcare tasks by • Frequency • Complexity • Specialized knowledge required • Diagnostic complexity • Rate healthcare professions by • Ability to perform along each of these dimensions • Time and expense of acquiring expertise • Legal constraints on authority to act

3. Every Man’s Interest “The whole of the advantages and disadvantages of the different employments of labour and stock must, in the same neighbourhood, be either perfectly equal or continually tending to equality. If in the same neighbourhood, there was any employment evidently either more or less advantageous than the rest, so many people would crowd into it in the one case, and so many would desert it in the other, that its advantages would soon return to the level of other employments. This at least would be the case in a society where things were left to follow their natural course, where there was perfect liberty, and where every man was perfectly free both to chuse what occupation he thought proper, and to change it as often as he thought proper. Every man’s interest would prompt him to seek the advantageous, and to shun the disadvantageous employment.” Adam Smith, The Wealth of Nations, Chapter 10, 1776

4. Every Man’s Interest (cont.) • Trends in Healthcare Labor • The text identifies huge historical trends in the growth of the healthcare labor force • Healthcare work consistently grows faster than overall employment over a 50-year period • 58% growth from 1983—2002 • 13.2% growth from 2000—2004 while overall employment growth was only at 1.7%

5. Every Man’s Interest (cont.) • Trends in Healthcare Labor (cont.) • The Bureau of Labor Statistics (BLS) predicts the top 30 occupations for growth from 2008-2018 • Registered Nurses is #1 (582,000) • Healthcare professions 3 of the top 5 • Healthcare professions 4 of the top 10 • …and 6 of the top 30 • Many other growth professions work in HC • IT workers (2 professions) • Receptionists, managers, clerks (6)

6. Every Man’s Interest (cont.) • What are the drivers of the increased demand for HC workers? • What trends do we see in the distribution of the demand? • What additional exogenous shocks could disrupt existing patterns and trends?

7. Every Man’s Interest (cont.) • Five workforce factors (p. 324) • Demographics • Education • HC Delivery System • Shifts to/from managed care • Economic System • Context • Culture • Gov’t policy • Political trends • Identify the relative speed of change for each factor

8. Every Man’s Interest (cont.) • Distribution of the HC workforce • Geographic distribution • Specialty distribution • What have been the trends in the distribution of physicians between primary care and specialty care? • What accounts for the swings?

9. Supply of HC Labor • Measurement Issues • Review the discussion in the middle and last paragraphs on p. 324 • See how a conclusion was drawn from a data sample that did not reflect the overall population • Review all statistical reports for hidden issues • Some issues identify important underlying but hidden trends • Some are misleading • Look for issues that hint at what the future holds

10. Supply of HC Labor (cont.) • Measurement Issues (cont.) • What does increasing average ages of nurses imply? • Look at issues relative to workforce numbers vs. hours worked on pp. 326-7 • Look at value and cautions of using educational enrollments as an indicator of supply • Do healthcare workers reflect the generally healthier population? • What are the implications of this? • How would you investigate the impact?

11. GroupPresentation#1 Supply of HC Labor (cont.) • Physician Supply • The book does not mention changes in the educational system to produce more physicians • How responsive do you think this is? • What is the role of foreign medical graduates • To the US healthcare system? • To the systems in countries of origin? • What are all of the factors that influence the demand for physicians in general? • Indicate whether influence is positive or negative

12. GroupPresentation#3 Supply of HC Labor (cont.) • Physician Supply (cont.) • What factors affect… • …distribution by specialty? • …distribution by ethnic background? • …geographic distribution? • What special challenges affect the supply of primary care physicians? • What are the impacts on… • …patients? • …the healthcare system overall?

13. Supply of HC Labor (cont.) • Nursing • Key profession for leveraging the physician’s time • Provide skilled medical services not at the level of the physician • Increased education for Nurse Practitioners increase range of tasks and further frees physician time • Nurses have an incredible variety of working conditions

14. Supply of HC Labor (cont.) • Nursing (cont.) • #1 highest growing occupation 2008-2018 • BLS reports 582,000 new nurses needed (22%) • Expected shortfall of 340,000 nurses by 2020 • Lower pay • Difficult work conditions • Too few training programs • Some programs established to increase number of nurses but funding remains an issue

15. Supply of HC Labor (cont.) • Nursing (cont.) • Nursing has huge disparities in demographic composition compared to the rest of the population • Nursing has seen cyclical shortages and interesting systemic responses • Nursing workforce more responsive to the market than the physician workforce • Shortage of nursing faculty is now a huge bottleneck

16. Supply of HC Labor (cont.) • Non-physician practitioners • PAs, Nurse Practitioners, Certified Nurse Midwifes • Sometimes referred to as physician extenders • Work under the (sometimes loose) supervision of a physician • Have differing treatment and prescription authority by specialty and state • Differing educational requirements, also by state • Patients often report increased satisfaction with NPs and PAs than with physicians • Why do you think?

17. Supply of HC Labor (cont.) • Allied Health Professionals • A dizzying variety of specialty professions not requiring an MD have developed • Often related to specific medical technologies • All have specific domain-related knowledge • Some may practice independently • Speech Therapist • Occupational or Physical Therapist • Some support a physician or other professional

18. GroupPresentation#2 Supply of HC Labor (cont.) • Healthcare Support Staff • The healthcare system relies on a huge variety of support staff characterized by • Degree of medical skills needed • Overall level of education needed • Salary and working conditions

19. Supply of HC Labor (cont.) • Health Service Administrators • These are the managers of health service organizations • Hospitals and clinics • Medical offices or groups • Heavily business and process focused • Often have a holistic view of the organization, though not of specific medical techniques • Must anticipate changes

20. Supply of HC Labor (cont.) • Health Service Administrators (cont.) • Senior HSAs must coordinate the work of and allocate resources to medical professionals, including physicians • Incredibly challenging work • Many educational paths to the field • Specialty degrees • Business degrees • Wide variety of work environments

21. Issues and Trends • What are the issues in healthcare workforce in developing countries? • What are the limitations of policy on the healthcare workforce? • What do we actually have? • What do we actually need? • How do we get there? • What are the available avenues for implementing policy?