1. The U.S. Health Workforce: A National Perspective Edward Salsberg, MPA Director, National Center for Health Workforce Analysis U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Professions Maine Health Workforce Forum 2011 Summit October 18, 2011 Orono, ME

2. 2 Overview Framework for Health Workforce Analysis The Changing U.S. Health Workforce Partnerships for Analysis Conclusions

3. 3 Major Developments and Trends Demand rising as the US population is growing and aging Health care reform to add insurance coverage for more than 30 million people and improve coverage for million Health workforce shortages predicted Unsustainable cost increases: health care expenditures at 18.1% of the GDP as of August 2011 Concern with inefficiencies and potential overuse Increasing interest in identifying ways to improve efficiency and health outcomes Pressure to make better use of existing health care workers

4. 4 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 Mal-distribution of existing workforce Increasing need for workforce diversity Developing comprehensive data to inform health workforce decisions

5. 5 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

6. 6 National Center for Health Workforce Analysis 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

7. 7 The Changing U.S. Health Workforce

8. 8 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.”

9. 9 2000-2008: Health Care Jobs Far Outpace the Economy Total U.S. employment grew by 3.7% across 2000–2008; health care employment grew 30.1% Hospitals experienced slower employment growth than other healthcare settings Source: Center for Workforce Studies, SUNY Albany Analysis of BLS data. Employment Growth By Setting, 2000-2008

10. 10 Even in Recession, Health Care Jobs Grew Hospitals added the largest absolute number of jobs, but jobs in outpatient care centers grew by the largest percent Hospitals added 33,600 jobs across the last year; in contrast, 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

11. 11 Occupations with the Largest Projected Job Growth 1, 2008-2018 Source: BLS Employment Projections, “Occupations with the Largest Job Growth, 2008 and Projected 2018” http://www.bls.gov/emp/ep_table_104.htm. Registered nurses Licensed practical and vocational nurses Nursing aides, orderlies, and attendants Home health aides Medical assistants Physicians and surgeons 1 Occupations identified by the BLS as adding the highest number of jobs between 2008 and 2018.

12. 12 Workforce Composition: Growth of PAs/NPs Compared to Physicians Source: National Center for Health Workforce Analysis Ratio of Types of Direct Patient Care Providers, Supply and Production Providers

13. 13 Team for Comprehensive Care Physicians Nurse practitioners Physician assistants Psychologists Optometrists Registered Nurses Pharmacists Case Managers Nutritionists/Dieticians Physical Therapists Community Health Workers …And more

14. 14 Partnerships for Data and Analysis

15. 15 A Federal – State Partnership The National Center for Health Workforce Analysis will provide data, tools, information and guidance on the health workforce trends and developments States are in the best position to identify their priority needs and understand their local resources The National Center and state stakeholders can build an effective partnership

16. 16 Federal-State Partnerships Related to Health Workforce HRSA programs State Offices of Rural Health State Primary Care Offices Area Health Education Centers Department of Labor programs Labor Market Information activities Workforce Investment Boards

17. 17 The Importance of Collaboration The National Center will develop and compile data on the health workforce in collaboration with other federal agencies and states and through contracts We will work with and collaborate with HRSA grantees and programs We need the HRSA-supported programs within each state to collaborate and assist each other We need to build on existing resources and expertise

18. 18 Health Professions Minimum Data Set (MDS) Extensive data collected across the health workforce but comparisons across states and professions difficult or not possible due to variations in approach to data collection MDS seeks to develop comparable data across health professions, locations and time Building on existing efforts is the most cost-effective approach to collecting the needed data State licensure boards are in the best position to support this endeavor

19. 19 Future for the Health Professions Workforce Demand for health services is growing Cost pressures and shortages will encourage innovation and systems redesign Will need to find better ways to use health workers via inter-professional care models Will need data, analysis and research to inform decision-making and ensure access Collaboration between HRSA and the programs we fund will improve the effectiveness of our efforts and programs

20. 20 Innovations Are Likely Pressure to do more with less 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

21. 21 Contact Information Edward Salsberg, MPA Director, National Center for Health Workforce Analysis 301-443-9355 esalsberg@hrsa.gov