Health Workforce Assessment Hawaii Island Kelley Withy, MD, PhD Hawaii/Pacific Basin AHEC UH JABSOM 10/26/07

We know we don’t have enough providers, but how bad is it? How do we quantify it? Where is the greatest need? What kind of providers do we need? What do we do to solve the problems? How do we know if what we are doing is working?

Methods for assessing workforce Since 2002, 15 state and three national studies (including HRSA) have been performed all demonstrating medical shortages Most states use licensure data to assess supply Some states survey providers Less states use focus groups, statewide meetings or community informants For demand most states and HRSA use provider to population ratios

Definitions Supply-What we have –Number of bodies –Number of full time equivalents (FTE) –Productivity Demand-What we want –Need-what we think the area would need based on assumptions –Utilization-what is actually used

Hawaii Picture Licensing data has mailing addresses only Center for Nursing surveys nurses HHIC researching physician characteristics HPCA surveys CHCs DOH tracks shortages and HPSA designations NHHSP surveys their graduates SHPDA surveys hospitals DOL follows trends in employment rates Schools and professional associations contact folks

Hawaii workforce research NO SINGLE SOURCE for workforce information and analysis Hawaii Health Workforce Hui formed in 2003 is a collaboration between Hawaii Departments of Health and Labor, Primary Care Association, Native Hawaiian Health Scholarship program, University of Hawaii, State Health Planning and Development, Rural Health Association, Hawaii Health Service Corporation Human Resources Department, FM Residency program, and many more.

Hawaii Health Workforce Collaborative Vision: We envision a healthcare system in Hawaii with a full complement of health care workers distributed to meet the health needs of the entire state. Mission statement: Improve access to and quality of healthcare in Hawaii by identifying unmet health workforce needs and developing solutions.

Hawaii Health Workforce Assessment Collaborative effort supported by Shipper’s Wharf Trust and Act 219, Session Laws of Hawaii, 2007 Identify the location, specialty and FTE of all licensed health professionals working in Hawaii

Licensed medical specialties to be assessed Audiology Dental Hygienist Dentist Emergency Medical Technician Marriage and Family Counselor Medical Doctor Doctor of Osteopathy Mental Health Counselor Occupational Therapist OptometristPharmacist Physical Therapist Physician assistant PodiatristPsychologist Social Worker Speech Pathology

Activities (cont) Estimate present utilization for licensed health workers based on utilization rates by insured individuals Use this to estimate present and future need for services

Assessing demand Number of visits to different types of providers by zip code for insured patients Extrapolate to entire population taking into account age and gender Convert this to number of FTEs for each type of provider Compare with supply numbers

Activities (Con’t) Identify gaps in health workforce Project future need and supply Research possible solutions

Future supply and demand Review trends in number of visits and number of providers Develop a model that takes into account population specifics of Hawaii including pattern of illness, geographic barriers, Project findings out through 2020 Assess changes every year to see if our projection model is accurate

Physician Shortage

Finding Providers on Hawaii Island Licensees with Big Island zip codes Insurance provider lists Hospital privilege lists Offices, groups, associations Yellow pages Internet Contacting community members and providers Contacting offices by phone for confirmation

Preliminary Estimate of Providers on Hawaii Island NeedSupply* Allergy/immun21.15 Cardiology115.9 Dermatology52.3 Endocrinology20 Ear/Nose/Thrt51.6 Gastro64.6 Heme Onc 51.6

Infectious Ds 20.0 Nephrology31.15 Neurology6.5 Obstetrics/Gyn2014 Ophthalmology66.05 Orthopedics Psych Pulmonary41.55 Rheumatology20 Primary care 11599

Mapping of results Zip code map demarcated as closely as possible to judicial districts: created 8 regions Population mapped and approximated to 2007 (increase 15%) Provider need estimated using WWAMI numbers Existing providers from licensure list

**Preliminary Results

Possible solutions??? Immediate –Enhanced recruitment using diverse incentives: Financial: pay, signing bonuses, malpractice, loan repayment Housing, mentoring, jobs for spouse, web based schooling, community involvement –Increase fly over providers –Telemedicine –Health insurance reform

Intermediate (5 yr) Employment model group to serve all areas and/or specialty clinic creation Scholarship and loan repayment Increase size of training programs Family Medicine and other training programs in rural areas The advanced medical home (a care coordination model) Reforming reimbursement policies to create financial incentives for improving quality and efficiency Decreased regulatory restraints and paperwork Tort reform

Long term (5-10 years) Pipeline Rural health interest groups Magnet schools Enrichment programs Mentoring (continuous student support) Selective school admission policies Scholarship/loan repayment Magnet hospitals –i.e. neuro

Just Imagine… Coordinated no-cost system for advertising Web based promotional materials Save funds for interviewing a large selection for providers interested in rural practice through advertising Have them visit and learn about community Community chooses best candidate Incentives-financial, housing, malpractice, loan repayment, etc. Professional community established, all necessary supplies and facilities available

Just imagine… Pleasant working environment, telemedicine and specialist support Caring for patients is a collaborative team effort All necessary facilities are available Community involves provider in community life Provider feels a part of the community Gets married Connections for spouse and educational supplementation for kids Provider lives happily ever after And so does the community Provider and community train the future providers…

Just imagine… Promising students in your community nurtured, mentored, receive additional education and career experiences and have preferential admission to health professions schools with scholarships Training continues in the rural areas where they came from They are rewarded for returning and staying in the rural areas (loan repayment, practice resources, professional family, healthcare team, community acceptance)

Factors Impacting supply Changes in training programs Life style choices of providers including hours of work, retirement patterns Aging of the health care workforce Varying levels of productivity depending on teamwork, use of technology, work satisfaction, family responsibilities, etc Increase in non-patient care activities

Factors influencing demand Population growth and aging Increasing rates of utilization Economic growth Medical advancements National investment in healthcare Changes in delivery system, insurance and financing including changes in managed care Cost containment efforts