Health Workforce Vacancies in Arkansas Ann B. Bynum, Ed.D. 1, Cathy A. Irwin, Ph.D., R.N. 2 Zoran Bursac, Ph.D., M.P.H. 3 Jimie Jarry, B.A. 2 1 University of Arkansas for Medical Sciences (UAMS), Regional Programs, Center for Rural Health, Center for Distance Health 2 UAMS, Center for Rural Health 3 UAMS, Faye W. Bozeman College of Public Health, Biostatistics

Objectives 1. Explain the study purpose, research design/procedures, and instrument used in this study. 2. Identify the current and expected workforce vacancies within the next 5 years for 90 health professionals in Arkansas by type of health care facility, regions in Arkansas and in Pulaski County. 3. Describe the conclusions and implications for health professions education, clinical practice, and future research.

Background Arkansas is facing a growing shortage of health Arkansas is facing a growing shortage of health care workers: Expected to worsen as the baby boomers retire Increased demand for health care services in Increased demand for health care services inArkansas Growing total populations Growing total populations Increased elderly and ethnic minority populations Increased elderly and ethnic minority populations Fewer uninsured patients as a result of health care reform initiatives Fewer uninsured patients as a result of health care reform initiatives

Background Additional factors contributing to the shortage of health professions: Unfavorable work environments Unfavorable work environments More satisfying alternative job opportunities More satisfying alternative job opportunities Financial constraints with current recession Financial constraints with current recession Limitations in faculty, laboratory space, and clinical training sites for health education programs Limitations in faculty, laboratory space, and clinical training sites for health education programs

Background Geographic maldistribution of health professionals must be addressed for solving shortages of health professionals in Arkansas. Geographic maldistribution of health professionals must be addressed for solving shortages of health professionals in Arkansas. Decline in the number of students choosing primary care careers Decline in the number of students choosing primary care careers Problems with recruitment and retention of primary care providers in rural areas Problems with recruitment and retention of primary care providers in rural areas Low compensation Low compensation Rising malpractice premiums Rising malpractice premiums Professional isolation Professional isolation Limited time off Limited time off Scarcity of jobs for spouses Scarcity of jobs for spouses

Impact of Workforce Shortages on Quality of Care Insufficient numbers and quality of health care professionals can affect the ability of health care facilities to meet the needs of their communities. Insufficient numbers and quality of health care professionals can affect the ability of health care facilities to meet the needs of their communities. National surveys of registered nurses (N = 657), physicians (N = 445), and hospital executives (N = 364) in demonstrated that nursing shortages in hospitals had an impact on hospital capacity: National surveys of registered nurses (N = 657), physicians (N = 445), and hospital executives (N = 364) in demonstrated that nursing shortages in hospitals had an impact on hospital capacity: Reduced available hospital beds (56%-78%) Reduced available hospital beds (56%-78%) Delayed discharges (50%-69%) Delayed discharges (50%-69%) Increased wait time for surgery (45%-68%) Increased wait time for surgery (45%-68%) Discontinued patient care programs (20%- 49%) Discontinued patient care programs (20%- 49%)

Impact of Workforce Shortages on Patient Outcomes Results from a survey of U.S. hospitals from 11 states (N = 799) demonstrated strong relationships between nurse staffing variables and patient outcomes: Urinary tract infection Urinary tract infection Pneumonia Pneumonia Length of hospital stay Length of hospital stay Upper gastrointestinal bleeding Upper gastrointestinal bleeding Shock Shock Failure to rescue (death rate related to hospital complications) Failure to rescue (death rate related to hospital complications)

Impact of Workforce Shortages on Health Status Shortages of health professionals can affect the health status Arkansas residents. Shortages of health professionals can affect the health status Arkansas residents. In 2009, Arkansas ranked 40th in the nation for health status. In 2009, Arkansas ranked 40th in the nation for health status. Adequate numbers of health care professionals are needed to address the causes of preventable, premature deaths and to promote continued improvement in the health status of Arkansans. Adequate numbers of health care professionals are needed to address the causes of preventable, premature deaths and to promote continued improvement in the health status of Arkansans.

Purpose of the Study Assessed health workforce vacancies for 90 health professionals in Arkansas by type of health care facility, regions in Arkansas, and in Pulaski County

Purpose of the Study The following categories of health professions were assessed for current employment vacancies during 2011 and expected employment vacancies within the next 5 years: Primary care physicians Primary care physicians Physician specialists Physician specialists Nursing Nursing Allied health professions Allied health professions Pharmacists Pharmacists Dentists Dentists

Facilities Surveyed Hospitals Hospitals Nursing homes Nursing homes Medical clinics Medical clinics County health units County health units Community health centers Community health centers Area Health Education Center (AHEC) clinics Area Health Education Center (AHEC) clinics Dentist offices Dentist offices Pharmacies Pharmacies Ambulance services Ambulance services Home health care services Home health care services

Regions of Arkansas

Significance of the Study Results may be used to provide data for planning educational programs for health care in Arkansas. Results may be used to provide data for planning educational programs for health care in Arkansas. Planning for a supply of health professionals that will meet the demand Planning for a supply of health professionals that will meet the demand Determine the needs of rural areas for health professionals Determine the needs of rural areas for health professionals Plan strategies in clinical practice and health professions education for solving workforce shortages in Arkansas Plan strategies in clinical practice and health professions education for solving workforce shortages in Arkansas

Methods Cross-sectional survey design Cross-sectional survey design Measured current health workforce vacancies and expected vacancies within the next 5 years for 90 health professionals Measured current health workforce vacancies and expected vacancies within the next 5 years for 90 health professionals Other descriptive variables: Type of health care facility, regions in Arkansas, and Pulaski County Other descriptive variables: Type of health care facility, regions in Arkansas, and Pulaski County Data collection during March-July, 2011 Data collection during March-July, 2011

Study Population Total Population size = 4,212 Total Population size = 4,212 Directors of the human resources department, administrators, and office managers Directors of the human resources department, administrators, and office managers Hospitals, n = 111 Hospitals, n = 111 Nursing homes, n = 246 Nursing homes, n = 246 Medical clinics, n = 2,180 Medical clinics, n = 2,180 County health units, n = 102 County health units, n = 102 Community Health Centers and dental clinics, n = 74 Community Health Centers and dental clinics, n = 74 AHEC clinics, n = 8 AHEC clinics, n = 8 Dentist offices, n = 865 Dentist offices, n = 865 Pharmacies, n = 395 Pharmacies, n = 395 Ambulance services, n = 62 Ambulance services, n = 62 Home health care services, n = 169 Home health care services, n = 169

Procedures Completed survey instrument via paper (mailed survey) or on-line via a website Completed survey instrument via paper (mailed survey) or on-line via a website Mailed reminder postcard after short time Mailed reminder postcard after short time Mailed second questionnaire after sufficient response time Mailed second questionnaire after sufficient response time Follow-up with nonrespondents via telephone: Reminded to complete the mailed or Web-based survey Follow-up with nonrespondents via telephone: Reminded to complete the mailed or Web-based survey Telephone reminder followed the second mailed survey, 2.5 weeks after the mailing Telephone reminder followed the second mailed survey, 2.5 weeks after the mailing Three reminder calls were made to nonrespondents Three reminder calls were made to nonrespondents If the questionnaire was lost, address of web survey was ed or a replacement questionnaire was ed or faxed. If the questionnaire was lost, address of web survey was ed or a replacement questionnaire was ed or faxed.

Procedures Each survey instrument was assigned a code number to identify respondents with facility. Each survey instrument was assigned a code number to identify respondents with facility. Code numbers linked facility to zip codes. Code numbers linked facility to zip codes. Zip codes were used to obtain the variable for region in Arkansas and county in which each facility was located. Zip codes were used to obtain the variable for region in Arkansas and county in which each facility was located. Zip code-based population statistics were used to determine the size of the community in which each facility was located. Zip code-based population statistics were used to determine the size of the community in which each facility was located. Web addresses and personal identification numbers (PINs) for population members to complete the on-line survey—Assured that each population member took the survey only once Web addresses and personal identification numbers (PINs) for population members to complete the on-line survey—Assured that each population member took the survey only once

Instrument Vacancy survey instrument: Evaluated current and expected vacancies for 90 health professionals Vacancy survey instrument: Evaluated current and expected vacancies for 90 health professionals Eight survey instruments: Include health professionals that are employed in these types of health care facilities Eight survey instruments: Include health professionals that are employed in these types of health care facilities Hospitals Hospitals Nursing homes Nursing homes Medical clinics Medical clinics AHEC clinics, Community Health Centers, and county health units AHEC clinics, Community Health Centers, and county health units Dentist offices Dentist offices Pharmacies Pharmacies Ambulance services Ambulance services Home health care services Home health care services

Instrument Vacancy survey was adapted from the 8-item vacancy survey developed by the Idaho Rural Health Education Center Vacancy survey was adapted from the 8-item vacancy survey developed by the Idaho Rural Health Education Center Survey was revised to include vacancies for 63 additional health professionals and expected vacancies within the next 5 years. Survey was revised to include vacancies for 63 additional health professionals and expected vacancies within the next 5 years. Vacancy survey includes 3-11 items that assess current and expected vacancies for: primary care physicians (4 specialties); physician specialists (30 specialties); dentists; nursing (10 professions); allied health professions (42 professions); and pharmacy (4 professions). Vacancy survey includes 3-11 items that assess current and expected vacancies for: primary care physicians (4 specialties); physician specialists (30 specialties); dentists; nursing (10 professions); allied health professions (42 professions); and pharmacy (4 professions). Participants responded to each item by listing the number of vacancies for each health professional. Participants responded to each item by listing the number of vacancies for each health professional.

Data Analysis Data were entered and analyzed in the Statistical Package for the Social Sciences (SPSS), Version 15 and SASv9.2 Data were entered and analyzed in the Statistical Package for the Social Sciences (SPSS), Version 15 and SASv9.2 Cross tabulations: Counted the number of vacancies for each health professional by type of health care facility, Arkansas regions, and in Pulaski County Cross tabulations: Counted the number of vacancies for each health professional by type of health care facility, Arkansas regions, and in Pulaski County Frequencies of the data were evaluated for duplicate physicians’ vacancies in medical clinics and hospitals. Frequencies of the data were evaluated for duplicate physicians’ vacancies in medical clinics and hospitals.

Data Analysis Current and expected vacancies for health professions in the study population (N = 4,212 facilities) were extrapolated from the current and expected vacancies that were reported in the survey. Current and expected vacancies for health professions in the study population (N = 4,212 facilities) were extrapolated from the current and expected vacancies that were reported in the survey. Calculated by multiplying the number of current and expected vacancies for each health profession within each facility type by a constant multiplier to adjust for nonrespondents Calculated by multiplying the number of current and expected vacancies for each health profession within each facility type by a constant multiplier to adjust for nonrespondents Each multiplier was specific to a facility type. Each multiplier was specific to a facility type. Multiplier was a ratio of the total number of surveyed facilities for each facility type and the number of respondents for each facility type Multiplier was a ratio of the total number of surveyed facilities for each facility type and the number of respondents for each facility type

Data Analysis Determined health professionals that are currently under-produced and over- produced Determined health professionals that are currently under-produced and over- produced Calculated by subtracting the number of current vacancies for health professions in the study population from the number of graduates in Calculated by subtracting the number of current vacancies for health professions in the study population from the number of graduates in

Sample of Respondents for Facilities Facility TypeSample Size Response Rate Hospitals % Hospitals % Nursing homes % Nursing homes % Medical clinics % Medical clinics % County health units % County health units % Community Health Centers, % Community Health Centers, % dental clinics dental clinics AHEC clinics % AHEC clinics % Dentist offices % Dentist offices % Pharmacies % Pharmacies % Ambulance services % Ambulance services % Home health care services % Home health care services % Total Sample 1, % Total Sample 1, %

Results: Current and Expected Vacancies for Health Professions Extrapolated vacancies: Total of 7,021 current and 23,893 expected vacancies for nursing, allied health, and pharmacy professions; and for primary care physicians and dentists Extrapolated vacancies: Total of 7,021 current and 23,893 expected vacancies for nursing, allied health, and pharmacy professions; and for primary care physicians and dentists Physician specialists had 317 current and 456 expected vacancies. Physician specialists had 317 current and 456 expected vacancies. Allied health professions had the highest number of current (4,335) and expected (16,468) vacancies. Allied health professions had the highest number of current (4,335) and expected (16,468) vacancies.

Current and Expected Vacancies for Nursing Professions Nursing had 1,970 current vacancies and 5,675 expected vacancies.

Current and Expected Vacancies for Nursing Professions

Current and Expected Vacancies for Allied Health Professions Allied health professions had a total of 4,335 current and 16,468 expected vacancies.

Current and Expected Vacancies for Allied Health Professions

Current and Expected Vacancies for Primary Care Physicians Primary care physicians had a total of 514 current and 860 expected vacancies.

Current and Expected Vacancies for Primary Care Physicians

Current and Expected Vacancies for Physician Specialists Physician specialists had a total of 317 current and 456 expected vacancies.

Current and Expected Vacancies for Physician Specialists

Vacancies for Physician Specialists by Facility Type Current Vacancies Medical Clinic, 142 Medical Clinic, 142 Medical Hospital, 170 Medical Hospital, 170 Psych. Hospital, 3 Psych. Hospital, 3 Rehab. Hospital, 2 Rehab. Hospital, 2 Expected Vacancies Medical Clinic, 199 Medical Clinic, 199 Medical Hospital, 253 Medical Hospital, 253 Psych. Hospital, 5 Psych. Hospital, 5 Rehab. Hospital, 2 Rehab. Hospital, 2

Vacancies for Physician Specialists by Region Current VacanciesExpected Vacancies Delta 1520 Delta 1520 Little Rock 4357 Little Rock 4357 North Central 3792 North Central 3792 Northeast 5885 Northeast 5885 Northwest 5051 Northwest 5051 South Arkansas 4 4 South Arkansas 4 4 South Central 6483 South Central 6483 Southwest 2 8 Southwest 2 8 West 4459 West 4459

Current and Expected Vacancies for Dentists The total number of current vacancies for dentists = 131. The total number of expected vacancies for dentists = 372

Current and Expected Vacancies for Dentists

Vacancies for Dentists by Facility Type Current Vacancies Community Health Clinic, 32 Community Health Clinic, 32 Dental Office, 99 Dental Office, 99 Expected Vacancies Community Health Clinic, 48 Community Health Clinic, 48 Dental Office, 324 Dental Office, 324

Vacancies for Dentists by Region Current Vacancies Expected Vacancies Delta 1940 Little Rock 1846 North Central 819 Northeast 1347 Northwest 2678 South AR11 South Central 1124 Southwest 418 West 3290

Current and Expected Vacancies for Pharmacists The total number of current vacancies for pharmacists = 71. The total number of expected vacancies for pharmacists = 518

Current and Expected Vacancies for Pharmacists

Vacancies for Pharmacists by Facility Type Current Vacancies Expected Vac AHEC Clinic 2 Community Health 1 6 Medical Clinic 4 23 Medical Hospital Pharmacy51342 Psych Hosp. 6 Rehab Hosp. 2 5

Vacancies for Pharmacists by Region Current VacanciesExpected Vacancies Delta613 Little Rock828 North Central 1052 Northeast 1189 Northwest54 South AR425 South Central 1380 Southwest243 West

Results: Arkansas Selected Healthcare Workforce Needs Under-Production of Health Professionals: Family Practice -235 Family Practice -235 Physical Therapist -227 Physical Therapist -227 Occupational Therapist -225 Occupational Therapist -225 Dental Assistant -129 Dental Assistant -129 Advanced Practice Nurse -120 Advanced Practice Nurse -120 Internal Medicine -85 Internal Medicine -85 Certified Medical Assistant -85 Certified Medical Assistant -85 Certified Nurse Assistant -85 Certified Nurse Assistant -85 Dietary Aide -70 Dietary Aide -70 Licensed Physical Therapy Assistant -69 Licensed Physical Therapy Assistant -69 Physician Assistant -38 Physician Assistant -38 Pediatrics -67 Pediatrics -67

Results: Arkansas Selected Healthcare Workforce Needs Under-Production of Health Professionals: Certified Occupational Therapy Assist. -52 Certified Occupational Therapy Assist. -52 EMT – 41 EMT – 41 Psychologist, Doctoral Prepared -35 Psychologist, Doctoral Prepared -35 Physical Med./Rehab -34 Physical Med./Rehab -34 Obstetrics/Gynecology -34 Obstetrics/Gynecology -34 Psychiatry -30 Psychiatry -30 Neurology -19 Neurology -19 Orthopedic Surgery -17 Orthopedic Surgery -17 Medical Lab Tech. -16 Medical Lab Tech. -16 Urology -15 Urology -15 Neurosurgery -7 Neurosurgery -7

Conclusions There were a total of 7,021 current vacancies for nursing, allied health, and pharmacy professions; and for primary care physicians and dentists. There were a total of 7,021 current vacancies for nursing, allied health, and pharmacy professions; and for primary care physicians and dentists. There were a total of 23,893 expected vacancies for nursing, allied health, and pharmacy professions; and for primary care physicians and dentists. There were a total of 23,893 expected vacancies for nursing, allied health, and pharmacy professions; and for primary care physicians and dentists. Allied health professions had the highest number of current vacancies (4,335) and expected vacancies (16,468). Allied health professions had the highest number of current vacancies (4,335) and expected vacancies (16,468). Nursing had 1,970 current vacancies and 5,675 expected vacancies. Nursing had 1,970 current vacancies and 5,675 expected vacancies.

Conclusions Primary care physicians had a total of 514 current and 860 expected vacancies. Primary care physicians had a total of 514 current and 860 expected vacancies. Family Practice physicians had the highest number of current (282) and expected (473) vacancies. Family Practice physicians had the highest number of current (282) and expected (473) vacancies. There were a total of 317 current vacancies for physician specialists and Psychiatry had the highest number of current vacancies (42). There were a total of 317 current vacancies for physician specialists and Psychiatry had the highest number of current vacancies (42). Physician specialists had 456 expected vacancies and Hospitalists had the highest number of expected vacancies (47). Physician specialists had 456 expected vacancies and Hospitalists had the highest number of expected vacancies (47).

Recommendations Patient-Centered Medical Home (PCMH) provides strategies for addressing the shortages of health professions in Arkansas. Patient-Centered Medical Home (PCMH) provides strategies for addressing the shortages of health professions in Arkansas. Involves health professionals working in care teams to improve efficiency in the delivery of health care and patients’ access to care Involves health professionals working in care teams to improve efficiency in the delivery of health care and patients’ access to care Rural setting clinical training—Increased training for disadvantaged students and improved perception of rural practice Rural setting clinical training—Increased training for disadvantaged students and improved perception of rural practice Increased recruitment and retention of health professionals in rural areas Increased recruitment and retention of health professionals in rural areas Telemedicine, school telehealth programs, and the use of Advanced Practice Nurses Telemedicine, school telehealth programs, and the use of Advanced Practice Nurses Increased wages, job flexibility; improved job satisfaction, and mentorship programs Increased wages, job flexibility; improved job satisfaction, and mentorship programs

Recommendations Apprenticeships, early and sustained education in health careers, flexible pathways to facilitate career development Apprenticeships, early and sustained education in health careers, flexible pathways to facilitate career development Financial support, academic enrichment, tutorials for admissions preparations, and motivational programs Financial support, academic enrichment, tutorials for admissions preparations, and motivational programs Recruit new faculty to replace the aging faculty Recruit new faculty to replace the aging faculty Improved physical facilities and clinical placements for health professions education Improved physical facilities and clinical placements for health professions education Improved salaries for health professions faculty Improved salaries for health professions faculty Partnering with private entities, federal agencies, health professional training programs, and hospitals to share facilities and provide funding for student loans and scholarships Partnering with private entities, federal agencies, health professional training programs, and hospitals to share facilities and provide funding for student loans and scholarships

Implications for Future Research  Decrease nonrespondents  Yearly assessment of current, expected vacancies for health professions  Assess impact of health workforce shortages in AR on quality of healthcare, patient outcomes  Examine job satisfaction