1. U.S. Health Workforce Trends and Developments Julie Sochalski, PhD, RN Director, Division of Nursing Department of Health and Human Services Health Resources and Services Administration Bureau of Health Professions National Governors Association September 13, 2011 Arlington, VA

2. Overview The Framework for Health Workforce Assessment National Health Care Employment Trends Implications of Current Trends 2

3. 3 The Framework for Health Workforce Assessment

4. 4 Key National Health Workforce Questions 1.Will there be enough physicians, nurses and other health workers to ensure access? 2.What can we do to increase the supply of health professionals? 3.What can we do to combat maldistribution? 4.What can we do to make better use of all health care workers?

5. 5 ACA Programs and Policies Increased funding for health professions training Expansion of National Health Service Corp and community health centers Support for service delivery innovations and new models of care New models of reimbursement including bundled payments CMS Innovations Center National Center for Health Workforce Analysis

6. 6 The US Approach to Health Workforce Assessment Focus on data collection, analysis, and research Widespread dissemination of data, analyses, and information Federal-state partnerships Increasing attention to evaluation and longitudinal tracking

7. 7 National Center for Health Workforce Analysis : Approach and Activities Build on existing sources of data including from professional associations, states, and federal agencies Strengthen national and state capacity for data collection and analysis including within professional associations and states Develop and promote a national uniform minimum data set Support research to better understand current and future workforce needs and dynamics

8. 8 Workforce Challenges General shortages predicted of health personnel including physicians and nurses Specific areas of concern: Primary Care Chronic and Long Term Care Behavioral Health Oral health Maldistribution of existing workforce Increasing need for workforce diversity Implementing inter-professional education and practice

9. 9 Federal Workforce Roles National data collection and analysis Development of data collection guidelines Identification of national trends and needs Projections of national supply/demand/needs Development of comparative state data Federal programs to fill gaps, i.e., Title VII Medicare reimbursement/payment policies

10. 10 State Health Workforce Roles State supported education and training Licensure and regulation of practitioners State labor department - tracking employment and workforce needs (LMI Directors) Regulation of service delivery State and local public health services Scholarships and loan repayment State Medicaid policies

11. 11 A Federal – State Partnership National Center for Health Workforce Analysis will provide data and information on the health workforce States are in the best position to identify their priority needs and understand their local resources The National Center and states can build an effective partnership

12. 12 Public-Private Partnerships Strong body of health workforce research exists currently in professional associations and academic venues NCHWA seeks to synthesize, build on, and improve current body of work through collaborative efforts Public-private partnerships are an efficient and effective way to develop national health workforce data and information

13. 13 National Health Care Employment Trends

14. 14 18.6 Million Americans Work in Health Care 1 BLS defines the health sector to include ambulatory health care services, hospitals, nursing and residential care facilities, and social assistance. Health Facility Employment (13.7M) Health Professionals (14.5M) 4.1 million non-health professionals in health sector 1 4.9 million health professionals outside the health sector 1 9.6 million health professionals in health sector 1 18.6 million people work in health care Source:U.S. Bureau of Labor Statistics (BLS), “Occupational Projections: 2008-2018”; analysis performed by The Albany Center for Health Workforce Studies and published in: “Health Care Employment Projections: An Analysis of Bureau of Labor Statistics Occupational Projections, 2008-2018.”

15. 15 Possible Members of the Health Care Team of the Future Physicians Nurse practitioners Physician assistants Psychologists Optometrists Registered Nurses Pharmacists Case Managers Nutritionists/Dieticians Physical Therapists Community Health Workers …And more

16. 16 The Change Imperative Unsustainable cost increases Health workforce shortages New models of care: accountable care organizations (ACOs), patient-centered medical homes New models of financial reimbursement, including bundled payments Increasing consumer involvement Dynamic and expanding role of HIT Source: National Center for Health Workforce Analysis

17. 17 Drivers of Future Demands for Services  Population growth U.S. Population to grow by ~30 million in the next decade 1  Aging of the Population; concomitant increase in major/chronic illness and subsequent demand 2 Baby boom generation  Medical advances and successes 2  Increased incidence of chronic diseases 3  Insurance coverage expansion 4 1 U.S. Census Bureau “Projections of the Population and Components of Change for the United States: 2010 to 2050” 2 Bureau of Labor Statistics “Career Guide to Industries, 2010-2011: Healthcare” 3 CDC “Chronic Diseases and Health Promotion” 4 Affordable Care Act

18. 18 Hospital 1 Employment by Occupation, May 2009 CategoryRoleTotal Jobs All 5,174,240 Healthcare Practitioner and Technical Occupations 2,763,970 Pharmacists57,230 Physicians, All177,610 Physician Assistants18,330 Registered Nurses1,492,000 Physical Therapists47,960 Respiratory Therapists83,130 Medical and Clinical Laboratory Techs168,640 Radiologic Technologists and Technicians127,820 Pharmacy Technicians55,950 Licensed Practical and Licensed Vocational Nurses158,390 Medical Records and Health Information Technicians63,620 Healthcare Support Occupations 646,110 Nursing Aides, Orderlies, and Attendants396,360 PT Aides and Assistants26,160 Medical Assistants60,910 Source:BLS May 2009 National Industry-Specific Occupational Employment and Wage Estimates 1 General Medical and Surgical Hospitals. 19

19. Health Care Projected to Grow The following health care professions are projected to add highest number of jobs between 2008 and 2018: –Registered nurses (581,500) –Home health aides (460,900) –Personal and home care aides (375,800) –Nursing aides, orderlies, and attendants (276,000) –Medical assistants (163,900) –Licensed practical and licensed vocational nurses (155,600) Source: Bureau of Labor Statistics Monthly Labor Review, November 2009.

20. 20 Aide and Assistant Demand Predicted to Rise Source: Bureau of Labor Statistics Monthly Labor Review, November 2009. Projected Increase, 2008 - 2018

21. 21 Even in Recession, Healthcare Jobs Grew Hospitals added largest absolute number of jobs, though growth rate lowest among major employers Hospitals added 33,600 jobs across the last year and physician offices added 26,000 Source: Altarum Institute, Health Market Insights from the BLS January 2011 Employment Data. Growth in Healthcare Employment by Setting, Jan. 2010 - Jan. 2011

22. 22 Implications of Recent Trends Cost pressures and shortages will encourage innovation and systems redesign Strong incentives to make better use of current workforce and allow health personnel to work at top of their license Shift to team-based care and inter-professional practice Shift care to lower cost settings and workers Source: National Center for Health Workforce Analysis