Virginia’s Healthcare Workforce Healthcare Workforce Data Center Dianne Reynolds-Cane, MD Director Virginia Department of Health Professions VHWDA Stakeholder Meeting Richmond, Virginia December 4, 2013

New DHP Licensees Licensees12/31/200911/14/2013 Difference Physician (MD & DO) 34,43738,5924,155 Registered Nurses 91,694102,56310,869 Total Licensees (all DHP professions 319,467377,17257,705

Healthcare Workforce Data Center A Program of the Virginia Department of Health Professions Survey regulated health professionals during renewal period Every March: Assisted Living Facility Administrators Dental Hygienists Dentists Nursing Home Administrators Every June: Clinical Psychologists Licensed Professional Counselors June, Odd Years Licensed Clinical Social Workers Every December Audiologists Pharmacists Pharmacy Technicians Speech-Language Pathologists December, Odd Years Physician Assistants† December, Even Years Doctors of Osteopathy† Medical Doctors† Physical Therapists Physical Therapy Assistants Every August* Certified Nurse Aides Licensed Practical Nurses Nurse Practitioners** Registered Nurses Reports Available at: Updates on our blog:

Agenda Survey Report Findings Medicaid Workforce Mapping Packet AHEC Regional Reports Work In Progress Take Away

SURVEY REPORT FINDINGS

Practitioner Distribution Supply HWDC periodic survey reports Metro areas, towns, rural areas NP and PA surveys for 2012 have been released Demand Geospatial Innovations VHHA Healthcare Workforce Strategic Planning Task Force HRSA National Model

NP and PA Healthcare Practitioners Physician Assistants –1,891 in Workforce –1,775 FTEs –Median Age: 37 Nurse Practitioners –6,056 in Workforce –6,435 FTEs Half became NPs after Y2000

NP Scope of Practice Introduced by Virginia Council of Nurse Practitioners and Medical Society of Virginia, HB346 includes: Elimination of supervisory language– NP’s practice in collaboration and consultation Collaboration and consultation within Patient Care Teams (3) –“Patient Care Team” means a multidisciplinary team of health care providers actively functioning as a unit with the management and leadership of one or more patient care team physicians for the purpose of providing and delivering health care to a patient or group of patients Patient Care Team Physician who actively provides “leadership and management” NO requirement for MD to regularly practice at the same location Collaboration and consultation may be via telemedicine Ratios increased from 4:1 to 6:1 Periodic review of patient records, no requirements for site visits

PHYSICIANS

Snapshot of Virginia’s Physician Workforce Council on Virginia’s Future Regions 2012NorthernEastern Hampton Roads ValleyCentralSouthside West Central SouthwestVirginia Physicians4, , , , ,168 Primary Care 2, , , ,922 Percent Primary Care 42%60%34%44%33%49%36%56%40% Primary Care Physicians per 100,000 residents Note: Regional estimates do not include physicians whose primary work location is outside of Virginia, or who worked in several localities/locum tenens or whose location could not be determined. Virginia totals do include these physicians.

Southside Virginia has a high proportion of uninsured adults and a low number of physician FTEs per resident.

Projected Virginia Physician Shortages to 2030 –Source: Virginia Healthcare Workforce Data Center Analysis. Forecasts performed by the Lewin Group

PHYSICIAN EDUCATION AND TRAINING

Medical Schools 2010 (Matriculants, class of 2014)Projected Class Size Project Earliest OpeningNote Eastern Virginia118 UVA148 VCU-School of Medicine (40 new slots) Projected to expand to 250. New Medical School Building opened this year. Edward Via Virginia College of Osteopathic Medicine 189 Data available on VCOM website Virginia Tech Carilion School of Medicine was first year Liberty University School of Osteopathic Medicine Seems on track King College Osteopathic School of Medicine expanding to Facing some delays Martinsville College of Henricopolis Has provisional accreditation from LCME. Annual Slots697 Up to 1,238 Projected class size includes 748 current slots+490 projected slots

2012 Physician Survey Results Medical Education and Residencies Graduated from Virginia medical schools: 20% (23%) Completed residencies in Virginia: 27% (30%) Virginia Retains (unchanged): 35% of its Medical School Graduates 39% of its Residents Workforce Demographics Work full-time : 83% (85%) Work primarily in patient care: 86% Work in primary care specialties: 42% (39%) ( )2010 Survey Results

Education and Training EducationVirginia Border State VA & Bordering NY & PA RegionalInternational High School20%12%32%15%47%20% Undergraduate19%16%35%14%49%17% Medical School20%18%38%13%51%21% Residency27%23%50%17%67%NA Regional: Virginia Washington DC New York Pennsylvania Maryland North Carolina The AAMC has committed to increasing the number of Medical School slots by 30% over 2002 numbers by US Medical Students did not have a residency by the end of match week this year.* *Rebecca Greenberg, AAMC Reporter, April 2013.

Geriatrics-Virginia Physicians Physician Workforce ABMS-Certified Subspecialtists in Virginia: Family Medicine Internal Medicine Psychiatry Total: 221 Self-Designated Geriatric Specialists: 894 (2010) Virginia Geriatric Training Programs University of Virginia Virginia Commonwealth University Eastern Virginia Medical School Carilion Clinic.

Specialties Specialty Board- Certified Self-Designated Internal Medicine*20%14% Family Medicine*9%14% Pediatrics*8%9% Psych/Neurology6% Radiology4%<5% Anesthesiology4%6% Emergency Medicine4%8% OBGYN*<4%5% *Primary Care42%

MEDICAID WORKFORCE MAPPING

Open for Business Program Physicians accepting payment type Physicians accepting new patients (with insurance type) Medicare67%59% Medicaid61%53%

Medicaid Distribution NP and PA

AHEC Regional Reports

Blue Ridge AHEC Region

Northern Virginia AHEC Region StatisticAudiologistsPharmacist Pharmacy Technician Physical Therapists Physical Therapy Assistants Speech- Language Pathologists Physician Assistant Response Rate (Renewals)80%84%66%79%71%73%76% Workforce Licensees1012,1162,5341, , Full-Time Equivalency Units991,3651,5711, , Licensees per FTE Expect to retire within 10 Years19%16%14%16%18%21%NA Demographics % Female96%71%75%81%83%98%43%81% Median Age Rural Childhood16%17% 19%16%NA Urban Childhood9%30%33%15%17%13%NA Employment Characteristics Median Income $70,001- $80,000 $ $60.00(hrly) $ $15.00(hrly) $70,000- $79,999 $ $33.00(hrly) $60,0001-$70,000$150k-$175kNA Satisfied99%88% 97% 94%NA Experienced Employment Instability in past 12 months 1%23%50%37%10%21%NA Employed over 2 years61% 54%59%63%65%NA Work Setting (Primary Work Site) Private Practice24%5%†6%*†32%23%*25%71%52% Hospital or Health System7%24%16%14%9%11%13%26% Long-Term Care0%1% 12%26%8%12%0% Federal Government4% 2%5%2%NA Northern Virginia AHEC Region

WORK IN PROGRESS

Telemedicine Mandated for reimbursement in state regulated private market (SB675-Wampler 2010) Virginia Medicaid has reimbused telemedicine since 2003 Certified telemedicine technologist training is being developed at New College Institute Begins 2014 Partially funded by the VHWDA

Military Credentialing and Licensing House Bill 1535 (2011) Physicians and other officer-level professions can be licensed through endorsement from other states. Enlisted-level occupations require extensive, professional-level cross- walking and gap analyses in comparison with civilian health professional licensure. In response to Delegate Stolle’s request and upon request to participate in the DoD multi-agency Task force on Military Credentialing, DHP has been contributing to this analysis since March 2012.

National Governors Association NGA-supported participation in the Veterans Licensing and Certification Policy Academy NGA-supported Statewide Plan to reduce prescription drug abuse in Virginia

Take Home Demographics Women represent more than half of the healthcare workforce in several professions and in the younger physician age cohorts Nearly 25% of several healthcare professionals expect to retire in 10 years Education and Training Retention of medical school grads and residents is essentially unchanged from 2010 While Virginia medical school slots are increasing, residency slots are essentially unchanged

Take Home About half of Virginia’s physicians are educated and trained in bordering or nearby states Workforce Mal-distribution Many practitioner to population ratios are highest in some urban areas and near employers such as hospitals and long term care facilities. Legislation such as HB346 and HB1501 enable efficiencies through patient care teams, collaborative care, and healthcare related IT to ease the burden of care carried by too few physicians.

Take Home Practice Related Group, solo, and hospital practice sites are most common Most physicians who accept Medicaid and Medicare are accepting new patients. Top Priorities Enabling civilian licensing of veterans and spouses DHP continues to collaborate with legislators and stakeholders to provide data to help determine supply and demand of Virginia’s healthcare workforce in Virginia

9960 Mayland Drive Suite 300 Henrico, Virginia Thank You! Perimeter Center Office