Innovative Solutions in Tough Times: Tackling the Health Care HIT Workforce Crises

We Will Inform You About: Northern Virginia Health Care Workforce Alliance PricewaterhouseCoopers Study GWBOT Health Care Task Force NoVaHealthFORCE Strategies & Action Plan GWBOT Study Recommendations Northern Virginia Workforce Investment Board

Northern Virginia Health Care Workforce Alliance

Why the Northern Virginia Health Care Workforce Alliance ? Regional health care worker shortage Current regional shortage obvious but not quantified Projections call for worker demand to continue growing over next 30 years Current capacity of training & education system inadequate to meet projected demands

What is the Northern Virginia Health Care Workforce Alliance ? Private sector, business, government, community, health care and educational leaders Mission: establish a long-term, business-driven, sustainable strategy to address the Northern Virginia health care worker shortage

Outcome: A Business-driven Sustainable Strategy Concept of “business-driven” is key Businesses must see themselves as having a vested interest Health care workforce shortage must be seen as more than a hospital problem

Outcome: A Business-driven Sustainable Strategy Solution must provide upward mobility for “New Americans” and underemployed The solution must address workforce utilization in health care industry Solution must be self-perpetuating and out-live the Alliance

What Did The Alliance Do: Commissioned PricewaterHouseCooper Study Develop comprehensive regional strategies Changed Name to NoVaHealthForce

PricewaterhouseCoopers Study

The Health Care Workforce Shortage: An Analysis of the Scope and Impact

PricewaterhouseCoopers was engaged by the Northern Virginia Health Care Workforce Alliance, a Coalition of business, academic, and community leaders to: Identify the issues Analyze the scope and impact of the health care workforce shortage on Northern Virginia.

Objectives and Approach The objectives were to identify: current and future Northern Virginia health care workforce needs for 24 selected health care professions current and future gaps in the health care workforce and the driving forces leading to these gaps training and education, recruitment, and retention best practices within Northern Virginia and other regions of the country. The approach included: a quantifiable independent survey of a sample of health care providers in Northern Virginia interviews with local health care providers, academic institutions and economic development authorities a literature search

Health Care Professions Studied Professions Studied RNsNursing Aides Medical Records/ HIT Dental Assistants Medical and Nurse ManagersHome Health Aides Dental HygienistsEMTs/Paramedics Radiologic TechsLPNs Physical TherapistsPhysical Therapist Assistants Occupations TherapistsRespiratory Therapists CT Scanning TechsMedical and Lab Technologists MRI TechsSpeech Language Pathologists Pharmacy TechsPharmacists Surgical TechnologistsMedical and Lab Techs PhlebotomistsSurgical Techs

 Demographics pose specific challenges and solutions: High growth rate Low unemployment rate Highly educated High levels of employment High salaries (comparatively) Ethnically diverse Large percent of foreign born Growing focus on life sciences Large information technology focus Northern Virginia is a Dynamic Community

Advancement Intellectual Property Protection Private Capital/Gov. Funding Technology/Science Discovery Research Government National Institutes of Health National Science Foundation Defense Advanced Research Projects Agency Private Sector Think Tanks Technology Councils IT Industry Pharmaceutical Industry Life Sciences Industry University Academic Medical Centers Teaching Hospitals Specialty Research Health Sciences Community Colleges/Universities Technical Schools High Schools Education Graduate Schools Entrepreneurial Spirit “The greater DC Metro Area and Northern Virginia are poised to be the one of the world’s primary centers of biotechnology. The region sits at a crossroads between world class education and research with a foundation of drivers to advance discovery and the implementation of new technologies.” -- President - Large Northern Virginia Medical Technology Foundation Northern Virginia: A Medical and Health Care Information Technology Incubator

A shortage of health care workers exists in Northern Virginia Estimated shortage of about 2,800 professionals in the 24 occupational categories Average vacancy rate of about 10 percent Without interventions, vacancy rate is anticipated to grow to over 41% by 2020 Key Findings

Key Findings (cont) Anticipated vacancy percentages are estimated to range from % depending on the profession RNs dominate the current and projected shortage, with more than 1,000 current vacancies Other hard hit professions are medical records and health information technicians and imaging The forecasted growth will continue to put immense strain on the availability of health care workers through Without interventions, vacancies will increase to 16,600 positions with a total demand of over 40,000 positions

Future Demand is High Occupation Current Employment Current Shortage Current Demand Demand 2010 Demand 2020 Estimated Shortage 2010 Estimated Shortage 2020 Registered nurses (includes CRNAs, nurse practitioners and nurse midwives) 9,100 1,000 10,100 12,100 15,400 3,0006,300 Nursing aides, orderlies, certified nurse assistants, attendants 3, ,500 4,300 5,400 1,1002,200 Medical records and health info technicians 1, ,500 1,900 2, ,200 Dental assistants 1, ,120 1,400 1, Medical and nurse managers 1, ,200 1,300 1, Note: “Estimated Shortage” calculation assumes no change related to increased retirements, etc. Current and Estimated Demand by Health Care Occupation Through 2020

Vacancies Could Increase by 2020 Without Intervention Anticipated Growth in Vacancy Rates for Select Occupations 2004 Vacancy Rate 2010 Estimated Vacancy Rate 2020 Estimated Vacancy Rate

Other Key Findings Access to health care, quality of care, and quality of life may be negatively affected as a result of the shortages Increased demand for services due to the aging population Concurrent aging of the health care workforce and resultant retirements Shortage of nursing and allied health profession faculty, schools, and clinical experience sites and the inability to find replacements

Other Key Findings (cont) Concurrent aging of clinical faculty and the resultant retirements Difficulties with having market competitive salaries for clinical faculty Nature of the profession Low unemployment rates and high cost of living

All of the Northern Virginia hospitals surveyed expected to either retain their current workforce or hire additional workers. Nine hospitals reported that they would grow their health care workforce in the year ahead. Hospitals Expect Biggest Future Difficulties in Hiring Staff Change in Workforce Needs for Hospitals Source: PwC Analysis of Northern Virginia Workforce Survey Number of responses

Gaps Will Be Exacerbated by Lower Supply Occupation Current Vacancy Rate Expected Increase Demand ( ) Future Demand Scenario Registered nurses10%51%More than 1,000 vacancies currently; retirements expected to widen the gap; shortages could lead to more burn-out and raise current vacancies rates. Nursing administration7%51% Occupational therapist16%51%Large vacancy rate combined with drop in graduates could affect access to therapy. Physical therapist17%51% Physical therapist asst.26%65% Dental hygienist4%64%Trend toward more hygienists per dentist leads to more demand for these positions. Medical records/info tech 11%64%Coders and other IT professionals currently in short supply. As hospitals and clinics move to electronic medical records, need for coders may slow, but demand for other IT professionals will increase. Occupations with High Demand and Low Supply

Medical Records and Health Information Technicians Rising health care demand Increased scrutiny of medical documentation Continued emphasis on the electronic medical record Growth will be primarily distributed among physician offices/clinics, hospitals, and long-term care facilities Increased demand for medical records technicians will be fueled by:

Medical Records and Health Information Technicians (cont) Third-party payers and government regulators are expected to add to the demand Issues with quality of the available medical records staff surfaced repeatedly in the interviews

More Medical Records/IT Technicians Will Be Needed 1,200 Positions Medical Records and Health Info Technicians Additional Demand for Workers (Current and Future) An 11% shortage of medical records technicians or 172 open positions was reported. To eliminate the shortage and keep up with anticipated demand and population growth, Northern Virginia will need to add over 363 technicians by 2010 and another 675 by An average of seven medical records technicians graduated each year from colleges between 1999 and At this graduation rate, an additional 49 technicians will be added to the workforce by 2010, 314 below market demand estimates. Current Supply Current Gap Additional Gap by 2010 Additional Gap by 2020

Lack of awareness about certain occupations While students may be aware of what a nurse or pharmacist does, many are not familiar with the role of a surgical technologist, speech pathologist or CT scanner. Misconception about the occupations Students don’t realize that many health care careers are “high-tech.” Said one hospital executive: “Technology is a large aspect of health care jobs and will continue to increase. This is not a particular awareness that students or teachers have.” Low pay While some positions pay well, many lower-level jobs pay poorly. Poor hours These are “labor intensive jobs with too much responsibility and unattractive work hours.” High turnover High turnover becomes a self- fulfilling prophesy. Most employers interviewed cited burnout as a common problem. Often, other workers must take up the slack when their co- workers quit. This burns them out and leads to more turnover. When asked about the consequences of vacancies, one employer said: “Nursing staff must work more hours.” Inability to Retain Occupation Awareness Access to Training Many training programs are at capacity “There will be a critical shortage of faculty as the programs scale up. Presently there is a serious faculty constraint,” said one education leader. A shortage of clinical training sites is a critical element in increasing the number of nursing and allied health student graduates. Educators said that more of their students are foreign-speaking. Providing instructors in a multiplicity of languages is expensive and difficult. Recruitment and Retention Challenges

Education and Training n Providing health care training to persons new to health care or encouraging advanced training to persons inside of health care. Most programs achieve this through free training and education, paid training and internship opportunities, and accelerated training programs. Recruitment n Initiatives aimed at recruiting new workers into the field of health care. Strategies include awareness programs, enhanced benefits, loan forgiveness, increased marketing of health care careers, and flexible work hours. Focus on English as a Second Language. Retention n Retention tools often include innovative benefits such as employee driven scheduling, development of clinical specialist and manager positions, market rate adjustments, career ladders, child care job satisfaction, focus on the over-40 worker among others. n Specific challenges are retaining the experienced employees who are so important in training and mentoring the less experienced employees. Without mentors, the less experienced professionals are apt to leave. n Creative compensation. Workforce Best Practices

 Expand best practices:  Create awareness of the professions  Provide specialized training and on-site training  Focus on retention and job satisfaction  Encourage new innovative ways to provide health care services  Develop a synergy among the health care providers, the educational institutions, and the economic development authorities and workforce planning commissions No. Virginia Health Care Providers Adopt Innovative Ways to Maintain a Strong Health Care Workforce

Greater Washington Board of Trade Health Care Task Force

Who Cares? Report Objectives 1. Review national health care workforce shortages and strategies to address them. 2. Assess Greater Washington’s health care workforce shortages, current workforce training efforts, and best practices. 3. Develop recommendations to strengthen Greater Washington’s health care workforce.

Greater Washington: The Region Northern Virginia - Arlington, Fairfax, Fauquier, Loudoun, Prince William, Stafford and Spotsylvania (7 counties); Alexandria, Fairfax City, Falls Church, Leesburg, Manassas, Manassas Park, Fredericksburg, Vint Hill (7 cities) Suburban Maryland - Anne Arundel, Calvert, Charles, Frederick, Howard, Montgomery, Prince George’s and Saint Mary’s (8 counties). Washington, DC

Methodology  Gathered Primary and Secondary Data (i.e. Bureau of Labor Statistics, Dept. of Labor Occupational Employment Statistics, Maryland Higher Education Commission and State Commission on Higher Education for Virginia, survey Data, etc.)  Conducted Interviews and focus groups with over 40 individuals throughout the region from the business, government, academic, and nonprofit sectors.  Identified 23 occupations in high demand, required less than B.A. degree, potential for career ladders.

Educational Supply & Industry Demand  Scan of public and private 2- and 4-year institutions and private education/training providers in targeted area.  Graduate numbers are based on data from MHEC and SCHEV and self-reported data from individual institutions.  Data on number of graduates is only an estimate for this scan; they should be systemically validated in future studies.

Washington PMSA: Top 10 Occupational Projections (By Annual Total Openings) Health Care-Related Occupations Projected Employment 2010 Estimated Annual Percent Change Annual Total Openings Registered Nurses43,8591.8%1,461 Nursing, Aides, Orderlies, and Attendants 21,8562.2%655 Licensed Practical and Licensed Vocational Nurses 12,3022.0%482 Medical Assistants7,4743.8%371 Dental Assistants6,0753.2%242 Home Health Aides5,7083.1%203 Pharmacy Technicians4,5282.8%197 Dental Hygienists3,7843.1%141 Medical Records and Health Information Technicians 2,8783.3%126 Medical and Clinical Laboratory Technologists 3,7140.9%111

Greater Washington Health Care Workforce: Educational Supply & Industry Demand Health-care Related Occupations Projected Annual Openings # of Programs in Region Estimated Annual # of Graduates Notes RNs1,461 DC: 10 MD: 19 VA: 7 1,444 Mix of offerings, AssociatesLPN  BSN, and MSN Nursing Aides, Orderlies, and Attendants 655 DC: 4 MD: 11 VA: Mostly non- credit certificate; Private career schools LPNs482 DC: 6 MD: 6 VA: Certificate; Private career schools; Decentralized data collection

Greater Washington Health Care Workforce: Educational Supply & Industry Demand Health-care Related Occupations Projected Annual Openings # of Programs in Region Estimated Annual # of Graduates Notes Medical Assistants 371 DC: 1 MD: 12 VA: Certificate; Private career schools; Decentraliz ed data collection Home Health Aides 203 DC: 2 MD: 2 VA: Certificate and non- credit certificate level Private Career Schools Pharmacy Technicians 197 DC: 0 MD: 4 VA: 1 33+Certificate

Greater Washington Health Care Workforce: Educational Supply & Industry Demand Health-care Related Occupations Projected Annual Openings # of Programs in Region Estimated Annual # of Graduates Notes Dental Hygienists141 DC: 1 MD: 1 VA: Associate and Bachelor’s degrees Medical Records & Health Information Technology 126 DC: 4 MD: 8 VA: Mixed educational offerings, but most are at certificate level Medical and Clinical Lab Technologists 111 DC: 1 MD: 1 VA: 1 ? All programs are Bachelor ’ s degrees

NoVaHealthFORCE Strategies and Action Plan

NoVaHealthForce Strategies: Goal 1: Increase capacity within the health care education and training system Goal 2: Develop and sustain an ongoing supply of persons interested in entering health care career fields Goal 3: Nurture Innovation

NoVaHealthFORCE Action Plan: Action plan developed by eight working groups Working groups consisted of stakeholders from: education, healthcare industry, local, state and federal government, social service agencies and economic development authorities

Capacity: Address the lack of nursing and allied health faculty Address the need for additional clinical training sites and clinical faculty

Capacity (cont): Address the projected increasing population in the western and southern portions of Northern Virginia. Ensure optimal resource utilization to increase capacity and output of Northern Virginia educational health care institutions.

Pipeline: Increase awareness of the healthcare career fields Improve healthcare career preparedness in the school systems Provide upward mobility opportunities Facilitate foreign trained healthcare personnel to enter the workforce

Innovation: Enhance the adoption in Northern Virginia of Information Technology Harness the potential of the healthcare consumer Create innovative approaches in healthcare human resource management

Innovation (cont): Nurture the career fields of tomorrow Develop a forum to share best practices Designate an organization to coordinate the implementation of these actions

Greater Washington Board of Trade Study Recommendation

Study Recommendations Raise Awareness: Educate stakeholders throughout Greater Washington regarding health care workforce challenges, issues, and potential ways to solve them. Convene the Region: Provide a forum for all stakeholders to address the region’s health care workforce shortage. Advocate for Change: Develop a policy agenda that supports regional efforts to increase recruitment, training, and retention of health care workers.

Next Steps Working to develop a cross-sector, regional initiative to create a robust, sustainable health care workforce. Hold a series of focus groups with providers, educational/training institutions, workforce investment agencies, and social service organizations to garner input, build support. (Fall 2005)

The Role of the Northern Virginia Workforce Investment Board in Responding to Our Regional Healthcare Workforce Shortage

Goal of the Public Workforce Investment System and Local Workforce Boards To support business hiring and workforce retention needs To increase the employment, retention, and earnings of participants, and increase occupational skill attainment by participants As a result, the quality of the regional and national workforce will improve and enhance the productivity and competitiveness of the nation

Structure of The Public Workforce System 643 state and local Workforce Investment Boards (WIBs) appointed by local elected officials, chaired by business leader Each board has a majority business membership (51% ) and includes public workforce partners Overseen nationally by the U.S. Department of Labor and funded primarily by the Workforce Investment Act

Local WIBs: Composition Established in each local workforce investment area Appointed by the Chief Local Elected Officials (LEOs) using criteria established by Governor and State Board Chair must be private sector/business 17 mandatory public partners must also provide services at the Career Center

Roles of Local Workforce Investment Boards (WIBs) Administer and operate the local public employment and training system Convene public partners (MOU’s) & businesses to create coordinated responses to the community’s workforce issues Operate nationwide network of One-Stop Career Centers

NOVA One Stop Employment Centers

NOVA Workforce Board Vision and Mission Vision: A region where every business can attract and retain highly skilled workers and where every worker gains the skills they need to become employable. Mission: A system that is demand-side led, meeting business demands for a highly skilled workforce and assisting business in sustaining economic growth. The system offers world-class preparations to every Northern Virginia resident throughout his or her lifetime.

Our Region’s Unemployment Challenge As of June 2005

Northern Virginia Public Utilization of One-Stop Centers NVWIB has experienced continued strong public utilization of One Stop Centers throughout region. While data represents multiple visits, it offers an order of magnitude ‘snapshot’ of Center use ,018 50,513 49,063 One Stop Centers offer universal access to the public, in addition to specific employment services for eligible job seekers.

NOVA Workforce Board Policy Direction NVWIB sets policy in areas including: –Local area’s workforce investment strategic plan –Developing budget to carry out duties of WIB –Coordinate workforce investment with economic development –Promote private sector involvement –Select One-Stop Center Operators –Appoint Youth Council Members along with Chief Elected Officials –Identify eligible training providers –Provide program oversight –Negotiate local program performance measures

Value of Local Workforce Boards Sets strategic direction for use of public workforce resources Creates the infrastructure of the network of approximately 3,000 One-Stops throughout U.S. Access to political leadership, training and other human capital resources Board can be a neutral convener that represents key community partners addressing workforce development in a community Can leverage strategic resources for workforce development and training

How Can Healthcare Businesses Engage Their Local Workforce Boards? Make a tangible “ask” for resources and support Create a Value proposition – share data Volunteer to serve on the Local Workforce Board of Directors Help local elected officials understand what systematic and policy changes are needed to support local healthcare business workforce needs

Share case studies and best practices with private sector members Publish and disseminate business testimonials about the value to the business bottom line Show you understand the big picture of workforce development Know the difference between operations and policy- making How Can Healthcare Businesses Engage Their Local Workforce Boards?

Opportunities to Link with the Region’s Economic Development Initiatives Federal WIA funding can be utilized to support new business attraction and existing business retention. Moreover, the Healthcare Industry is identified as a National High Growth Industry: –Worker Training Grants (ITA’s) –On-The-Job Training (OJT) Wage Subsidies –Incumbent Worker Training Grants –Regional and National Labor Market Data

Online Resources To Link Your Business With Free Workforce Services –National Association of Workforce Boards –U.S. Department of Labor One Stop Center Directory –U.S. Department of Labor Workforce One Initiative –NOVA HealthForce –Northern Virginia Workforce Investment Board

For More Information David Hunn Executive Director NOVA Workforce Investment Board (703) (703) (fax)

Conclusion

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