Health Professions Workforce TPHA Ben G. Raimer, MD, MA, FAAP Chairman, Statewide Health Coordinating Council Senior Vice President, Health Policy The University of Texas Medical Branch Professor of Pediatrics, Family Medicine, and PM&CH April 23, 2010

Statewide Health Coordinating Council 2 17 member Governor Appointed Council Chapters 104 & 105 of the Health and Safety Code; updated by HB 1716 (Maxey, 75 th legislative session) Development of the State Health Plan with focus on health care workforce planning 6 Year Planning Cycle with Biennial Updates

Projected Population of Texas to 2040 Source: Texas State Data Center Population Projections millions 3

7 Projected Percent Change in Total Population in Texas Counties,

Data, Needs Assessment and Training 5 Legislature passed into law new requirements for regulatory boards to provide licensure data on an annual basis to the Health Professions Resource Center Some regulatory boards: –Lack the technology to comply with creation of the Minimum Data Set that permits HPRC analysis –Do not track several key professionals in the health care delivery enumeration Enumeration of the health professions workforce and use of the Minimum Data Set by all the professions remains crucial if Texas is to understand its future workforce demands A comprehensive assessment of the Texas population is needed to assess the needs and plan for the development of its health professions workforce

PRIMARY CARE PHYSICIANS PER CAPITA (2008) Texas leads the nation in population growth Texas ranks 42nd among 50 states in the ratio of physicians to population and 47th in ratio of nurses to population From 2000 to 2008, the Texas physician supply grew 21% while the number of Texans grew 19% Shortages and Maldistribution 6

7 There is a shortage of all health professions in Texas with the exception of LVNs Physicians, registered nurses, physical therapists, clinical laboratory scientists, occupational therapists, pharmacists, dentists, audiologists, and other health care professionals all number LESS per 100,000 population than the national averages In addition, the supply of health professionals in rural and border areas is even far LESS than it is in urban and non-border areas 73 percent of the counties in Texas are designated Health Professions Shortage Areas The most severe shortages in the health professions are in the area of mental health services

Shortages and Maldistribution Physicians in Direct Patient Care IncreasePercent Primary Care15,37416,8301, Specialist19,55822,5442, Total34,93239,3744, Population (Millions) Source: Tabulation of Texas Medical Board, Physician Licensure Database; Database maintained and supplied by Department of State Health Services, Center for Health Statistics, Health Professions Resource Center The number of specialist physicians is growing faster than the State’s Population. The number of primary care physicians is not. 8

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Shortages and Maldistribution 13

Health Profession Diversity Texas has created programs to direct qualified minority students into the health professions Texas medical and nursing schools now boast some of the most diverse student body populations in the nation Outreach into the Latino student community continues to be a priority –36% of the 2007 Texas population is Hispanic –Only 14.5% of Texas physician and dental students are Hispanic –Only 13% of doctors in practice in Texas are Hispanic Texas must have systems in place that provide individuals from these important sub-populations the opportunities to seriously consider health care as a career, and they must also have the opportunities that lead to their successful application, entrance and graduation from health professions training 14

Aging of the Workforce As the Texas population ages, so does the health professions workforce, but even more so The static size of entering classes causes disproportionate aging phenomena among the health care workforce Faculty in the state’s health professions schools, especially nursing faculty, also are older than comparable groups With an increased desire for retirement, both the numbers of professionals in active practice as well as those in university teaching positions are also decreasing dramatically The average age for a Marriage and Family Therapist in Texas is 60 years 15

Specific Shortages and Special Programs Mental Health Professionals Dentists Pharmacists Mid-wives Clinical Laboratory Scientists Radiology Technologists Geneticists Physical Therapists Physician Assistants Pediatric Specialists Gerontologists Public Health Professionals 16

Technology Health care professionals need new skill sets to utilize: Telemedicine Electronic Medical Record Digital Technology in Imaging Automation of Laboratory Diagnostics Pharmacy Management Systems Adoption of the preceding applications can address some geographic disadvantages as well as improve the quality and costs related to delivery of health care services 17

Educational Models Tele-technology for teaching, monitoring and mentoring students’ educational progress Preparing professionals to practice in a redesigned delivery model with a focus on the education, prevention, and management of chronic disease –The most productive impact on the shortage of health care professionals –Health care professionals must adopt new skill sets to address an increased demand for longevity, wellness, and performance –The health care team of the future must focus its efforts on using knowledge and skills acquired through education and training at the right place, the right time, and the right cost 18

Texas - Mexico Border Issues 19 Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, May 28, 2008 Primary Care Physician Supply Ratios – 2007 by Border and Non-Border Counties

Health Disparities / Chronic Diseases 20 Health Disparities –Differences in mortality and morbidity rates are significant among racial and ethnic groups in Texas, across geographic boundaries, and between urban and rural areas –Disparities impact population productivity and add to the overall costs of health care –Access to mental health services is most disparate among African-American and Hispanic populations Chronic Diseases –Chronic Diseases such as diabetes, hypertension, cancer, heart failure and asthma affect thousands of Texans –Prevention and management of patients with chronic illness has the potential to save Texans millions of dollars in health care costs –Behavioral Health

Health Professional Shortage Areas for Mental Health Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 6, 2009 As of March 10, 2009 there were 172 whole county Health Profession Shortage Areas (HPSAs) for mental health, and 12 sub-county geographic or special population HPSAs in Texas 21

Health Profession Action Plan Assure that every Texan has access to local health care services for wellness, prevention, acute care, chronic care, behavioral health services, and specialty services Assure that Texas has a culturally competent, linguistically appropriate, and state-of-the art trained health professions workforce that utilizes evidence-based decision making to assure that Texans receive quality, safe health care at reasonable costs Assure that the Texas health professions infrastructure has access to state-of-the-art electronic health records, telemedicine services, and decision support services that set the highest standards for health care delivery Assure that no Texan goes without prevention and educational services related to wellness and chronic disease management 22

Preparing the Health Profession Workforce Sustain those state programs that have demonstrated a positive impact on the recruitment of students into the professions –JAMP –T-STEM Sustain scholarship and loan repayment programs for health professionals electing to practice in underserved areas Assure that diversity and cultural / language competencies are valued in the long-term development of Texas’ workforce Sustain and expand community programs through AHEC and ORCA that provide student mentoring and career development in the health professions Expand the training of Community Health Workers 23

Workforce Requirements for Health Reform Expand Graduate Medical Education (GME) programs –Primary Care –Specialty Care Expand the graduation rates of nursing and allied health science professionals Expand the number of behavioral health professionals Create innovative models for health care delivery –Inter-professional teams for management of chronic disease –Re-visit scope of practice standards for advanced practice nurses and physician assistance –Re-visit scope of practice for psychologists, MSWs and other mental health professionals –Expand the services available to patients through community health centers (FQHCs) Incent professionals who elect to practice in underserved areas –Scholarships, loan repayment –Preferential reimbursement 24