1. ALASKA HEALTH WORKFORCE COALITION & THE 2012 HEALTH WORKFORCE VACANCY STUDY Presentation to: House Health, Education and Social Services Committee of the State of Alaska Legislature March 18, 2014 Kathy Craft, Alaska Health Workforce Coalition Katy Branch, Alaska Area Health Education Centers (AHEC)

2. Alaska Health Workforce Coalition LEADERSHIP 2 Industry ASHNHA AHEC ABHA Alaska Primary Care Association Alaska Native Tribal Health Consortium Alaska Workforce Investment Board State of Alaska The Trust University of Alaska DHSS DOLWD DEED

3. 3 Coalition Approach Advance Occupatioanal Priorities Monitor Plan Results Health Workforce Data Create and maintain an integrated strategic and implementation plan Define and lead selected initiatives Prioritize, advocate, and monitor Compile, maintain and use Health Workforce Plan Alaska’s Health Workforce Adequate & Qualified Systems Change and Capacity Building

4. Action Agenda 2012-2015 4 Occupational Priorities Primary Care Providers Direct Care Workers Behavioral Health Clinicians Physical Therapists Nurses (Specialists, Educators) Pharmacists Systems Change and Capacity Building Health Profession Loan Repayment and Incentive Programs Training and Professional Development Aligning regulatory policies that impact the health workforce Engage and prepare Alaskan youth for health careers Health workforce recruiting Health workforce data

5. Action Agenda Scorecard – December 2013 Quarterly review of the Action Agenda Scorecard conducted by the AHWC 12 Priorities Each with 2-6 Objectives Each Objective has clear outcomes, champions, and a target date for completion 5 Possible New Initiative 2016 - 2018 3 Completed12 On track21 Not on track; need to address 6 Will not achieve; target goal missed 1

6. AHWC Successes Legislative Loan Repayment and Incentives (HB78) bill passed Nurse Practitioner program funding Physical Therapist/Physical Therapist Assistant programs funding Funding for Perioperative Nursing program Other Results Perioperative cohort graduation API funding for joint position with UAA Established bi-annual meetings between School of Nursing and ASHNHA CNOs AADSC website revised; now links to DOLWD sites Data needs and improvement opportunities determined Health Program of Study framework and implementation supported by grants from DOLWD/AWIB 6

7. 2014 Advocacy Items Alaska Area Health Education Center (AHEC) Professional Development and Training Complex Behavior Collaborative College Dual Enrollment for Tech-Prep Programs Patient Centered Medical Home (PCMH) Board of Nursing Support for CNAs 7

8. 2012 ALASKA HEALTH WORKFORCE VACANCY STUDY 8

9. Partners and Credits Advisory Team Organizations and Funders University of Alaska Anchorage – Office of Health Programs Development, Alaska Center for Rural Health, AHEC, School of Allied Health, and School of Nursing Alaska Mental Health Trust Authority State of Alaska, Office of Rural Health Vacancy Study Project Team Leads Katy Branch, Director, UAA, Alaska Center for Rural Health, AHEC Rosyland Frazier, Research Associate, UAA, Institute for Social and Economic Research (ISER) Alexandra Hill, Research Associate, UAA, ISER Dean Rasmussen, Economist (retired), Department of Labor and Workforce Development, Research & Analysis (DOL/WD) Todd Mosher, Economist, DOL/WD 9

10. What is a Vacancy Rate? A vacancy rate is the percentage of total, budgeted positions that are open at a particular point in time You can read them as: In the 2012 study, for every 100 [insert specific occupation] positions, you could expect ## to be vacant. One measure of industry demand Indicator of occupational need Should be considered with other factors, such as projected growth in occupation, changing care delivery paradigms, turnover and/or aging workforce 10

11. Utility and Relevancy of Vacancy Data Informing Policy Decisions Describing Alaska’s health workforce climate in grant applications and reporting Indication of program impact or success Resource Allocation 2007 – Doubling of Medical Student Admissions & the UA Health Academic Plan 2009 – Doubling the PA-C Admissions 2010 – Alaska Health Workforce Plan 2012 – Coalition’s Action Agenda 2012 - Clinical Rotations funding distribution within AHEC 11

12. BACKGROUND AND STRUCTURE FOR 2012

13. Goals of the 2012 HWVS Goal 1: Make data set comparable with other statewide and federal data Crosswalked occupations with Standardized Occupation Classification (SOC) codes from Department of Labor; Utilized NAICS system for organization categories; Utilized DOL/WD Labor Market regions Goal 2: Standardize data collection framework and methodology to allow trending analysis in the future Goal 3: Make sure the data is accurate; acceptable to industry experts 13

14. Strategy - Alaska Standardized Health Occupations Taxonomy Organized by Occupation major- and sub-categories 10 major categories of health occupations; 157 occupations Defines individual occupations by scope of work and includes: Typical Minimum Education Requirements Crosswalk to over 8K job titles Cross listing of SOC code Served as the foundation for the 2012 Health Workforce Vacancy Study 14

15. A Data-Lover’s Dream 15

16. Vacancy Study Questions Asked for each occupation: How many total positions do you have? Number of positions, NOT Full-time Equivalents (FTE) Currently filled Currently vacant, actively recruiting Currently vacant, not-actively recruiting Of the currently filled positions, how many are filled by travelers, locums, temporary, contract, relief, or pool employees that you would PREFER to have filled by a regular employee? How many positions require prior work experience in addition to any training/education you require? How long have you been trying to fill the position that has been open the longest? 1=Less than 30 days 2=30 to 59 days 3=60 to 89 days 4=90 or more days 5=Constantly recruiting 16 Total # of Vacancies

17. Vacancy Study Questions Asked overall, not by each occupation What are the top two reasons for not being able to fill or hire positions at your organization? What are the top two reasons for not being able to retain employees at your organization? 17

18. SAMPLE & RESPONSE RATES OVERVIEW 18

19. Sample & Responses by Region 19 Sample & Response Rate by Labor Region Region Total Respondents Total Non- ResponseTotal Response Rate by Region North34235760% Rural Interior21103168% Southwest36175368% Gulf Coast - Rural Southcentral59349363% Rural Southeast752810373% Fairbanks61329366% Anchorage/Mat-Su24012536566% Juneau68259373% Health Education Inst.1441878% Statewide Aggregate60829890667%

20. Health Workers by Region 20 Health Workers Captured by Sample by Labor Region Region Total Respondents Total Non- ResponseTotal % Captured in Data North947255120278.8% Rural Interior2047928372.1% Southwest1334163149789.1% Gulf Coast - Rural Southcentral3040679371981.7% Rural Southeast1890193208390.7% Fairbanks2129878300770.8% Anchorage/Mat-Su1432143871870876.6% Juneau1585150173591.4% Statewide Aggregate2545067843223479.0%

21. Sample & Response by Organization 21 Sample & Response Rate by Organization Type Total Respondents Total Non- ResponseTotal Response Rate by Org. Type Offices of Physicians1005615664% Offices of Dentists853111673% Offices of Other Health Practitioners62339565% Home Health Care Services13 2650% Other Ambulatory Health Care Services52116383% Health Education Institutions1441878% Hospitals1331681% Non Health Organization1589625462% Nursing and Residential Care Facilities53278066% Social Assistance46196571% State Government1251771% Statewide Aggregate60829890667%

22. RESULTS OF THE STUDY 22

23. 23 Statewide Aggregate: Vacancy Rate for Occupations with Over 500 Positions Occupational Title Sampled Positions Estimated Total Statewide Positions Estimated Total Statewide Vacancies Estimated Statewide Vacancy Rate Registered Nurses (General RN)283245523087% Personal Care Aides and Assistants266141593518% Certified Nursing Assistants (CNA)1539259035314% Medical Secretaries6251623714% Medical Assistants5491066555% Dental Assistants429979384% Behavioral Health Case Managers and Care Coordinators67097214115% Registered Nurses, All Other Specialties568858546% Pharmacy Technicians513836344% All Other Healthcare-specific Managers, Directors and Supervisor440817314% Healthcare Billing Clerks and Technicians420805344% Emergency Medical Technicians (EMT)44072411416% Physical Therapists27169214221% Dentists249688172% Pharmacists423671345% Mental and Behavioral Health Clinicians and Counselors417666528% Operations Managers and Officers, Healthcare-specific293665183% Dental Hygienists226619213% Licensed Practical Nurses (LPN)315577234% General Practitioners and Family Physicians3555766511% Community Health Aide/Practitioners (CHA, CHA/P)33557310318% All Other Health Information Occupations3185666411% Physician Assistants (PA-C)303527509% Home Health Aides332526357% Firefighters, EMT or ETT Certified290516245%

24. 24 Mental and Behavioral Health and Related Occupations (compiled) Rural vs Urban: Vacancy rate for Category Total PositionsTotal VacanciesVacancy Rates Occupational Title Rural Urban Rural Urban Rural Urban Behavioral Health Case Managers and Care Coordinators336636509115%14% Behavioral Health Clinical Associates146173142510%14% Behavioral Health Directors and Supervisors87173899%5% Clinical Psychologists311344813%6% Counseling Psychologists21552210%4% Marriage and Family Therapists510105-5% Mental and Behavioral Health Clinicians and Counselors223442262512%6% Psychiatric Nurse Practitioners088014-16% Psychiatric Nurses1118022-19% Psychiatrists137921715%22% Rehabilitation Counselors111803-17% Substance Use Disorder Counselors6624782312%9% All Other Behavioral Health Counselors16816035421%3% Grand Total1108242414924813%10%

25. 25 Physician and Surgeons - Occupation Detail by Specialty by Rural / Urban Total Estimated Positions Total Estimated VacanciesVacancy Rates Occupational Title grouped by Subcategory Rural Urban Rural Urban Rural Urban Physicians and Surgeons41217476511416%7% Anesthesiologists8951313%3% Emergency Physicians431749021%- General Internists172902-7% General Practitioners and Family Physicians223352471821%5% Hospitalists39306-6% Obstetricians and Gynecologists141641117% Ophthalmologists05501-2% Pediatricians191343616%4% Psychiatrists137921715%22% Radiologists15123157%4% Surgeons4615805-3% All Other Specialty Physicians112911409%14% Other Related Practitioners52158162%4% Acupuncturists31900-- Chiropractors177802-3% Naturopaths2141250%14% Optometrists303502-6% Podiatrists01200-- Grand Total46419056612014%6%

26. 26 Nursing (subset): Estimated Vacancy rates by Specialty by Rural / Urban Total Positions Total Vacancies Vacancy Rates Occupational Title grouped by Subcategory Rural Urban Rural Urban Rural Urban Advanced Practice Nurses (extracted) Family Nurse Practitioners246247412817%11% Registered Nurses (Except Advanced Practice Nurses)1640621515748910%8% Case Management Nurses112273222520%9% Critical Care Nurses (CCU)362883538%18% Emergency Room Nurses (ER)1022469209%8% Geriatric Nurses552305%- Nurse Managers (patient care setting)1242707246%9% Obstetric Nurses493261302%9% Perioperative Nurses5222993817% Psychiatric Nurses1118022-19% Public Health Nurses84798910%11% Registered Nurses (General RN)9083644852249%6% Registered Nurses, All Other Specialties11774010449%6% Vocational Nurses13144712 9%3% Licensed Practical Nurses (LPN)13144712 9%3% Grand Total2074727221757410%8%

27. Tribal Health Occupations (extracted) - Estimated Vacancy Rates by Rural / Urban Total Estimated Positions Total Estimated Vacancies Estimated Vacancy Rates Occupational Title grouped by Subcategory Rural Urban Rural Urban Rural Urban Community Health Community Health Aide/Practitioners (CHA, CHA/P)5723102118%33% Allied Dental Workers Dental Health Aide Therapists48210021%- Behavioral, Mental Health, and Rehabilitation Counselors Behavioral Health Aides (BHA) including Village Counselors962518219%8% Community Health Workers Community Health Representatives (Indian Health Services)61529915%17% 27

28. 28 SHARP II - Tier I Professions Estimated Vacancy Rates Total Estimated Positions Total Estimated Vacancies Estimated Vacancy Rates Occupational Title grouped by Category Rural Urban Rural Urban Rural Urban General Practitioners and Family Physicians223352471821%5% Pediatricians191343616%4% Dentists1235631068%1% Pharmacists15751614219%4%

29. 29 SHARP II - Tier II Professions Estimated Vacancy Rates Total Estimated Positions Total Estimated Vacancies Estimated Vacancy Rates Occupational Title grouped by Category Rural Urban Rural Urban Rural Urban Physician Assistants (PA-C)189340351619%5% Family Nurse Practitioners246247412817%11% Registered Nurses, All Other Specialties11774010449%6% Dental Hygienists1145063193%4% Clinical Psychologists311344813%6% Counseling Psychologists21552210%4% Clinical Social Workers26624515%8% Physical Therapists1575354310027%19%

30. Reasons for not Hiring Employees RuralUrban 30

31. Reasons for not Retaining employees RuralUrban 31

32. KEY FINDINGS 32

33. Executive Summary - Data Key occupations experience significant disparity in the health workforce distribution in rural locations, especially in primary care occupations Overall, behavioral and mental health categories show the highest concentration of occupations with estimated vacancy rates of greater than 10% Nursing specialties tend to have higher vacancy rates than general nurses Occupations with training programs in Alaska tend to have lower estimated vacancy rates 33

34. Executive Summary – Recommendations Invest in programs with demonstrated effectiveness in “Growing Our Own” to nurture Alaska’s youth into health careers; Increase training availability and residency seats in under-represented fields and emphasize rural practice; Retain statewide loan repayment programs that drive recruitment to health profession shortage areas; capitalize on federal initiative to expand similar programs; Expand professional development and training opportunities for existing health workforce; Develop strategies to support provider retention i.e. housing, schools improvement, targeted job marketing Promote ongoing statewide partnerships and collaborations for health workforce planning 34

35. Questions and further discussion… Contact Katy Branch, Director Alaska Center for Rural Health, Alaska’s AHEC kebranch@uaa.alaska.edu 907-786-6705 office 35