1. Classifying the Workload Every Man’s Interest
ISM 3005 Course Introduction
Topics
Classifying the Workload
Every Man’s Interest
The Supply of Healthcare Labor
Issues and Trends
“Every man’s interest would prompt him to seek the advantageous, and to shun the disadvantageous employment.”
Adam Smith 2

2. Classifying the Workload
Rate healthcare tasks by
Frequency
Complexity
Specialized knowledge required
Diagnostic complexity
Rate healthcare professions by
Ability to perform along each of these dimensions
Time and expense of acquiring expertise
Legal constraints on authority to act

3. Every Man’s Interest
“The whole of the advantages and disadvantages of the different employments of labour and stock must, in the same neighbourhood, be either perfectly equal or continually tending to equality. If in the same neighbourhood, there was any employment evidently either more or less advantageous than the rest, so many people would crowd into it in the one case, and so many would desert it in the other, that its advantages would soon return to the level of other employments. This at least would be the case in a society where things were left to follow their natural course, where there was perfect liberty, and where every man was perfectly free both to chuse what occupation he thought proper, and to change it as often as he thought proper. Every man’s interest would prompt him to seek the advantageous, and to shun the disadvantageous employment.”
Adam Smith, The Wealth of Nations, Chapter 10, 1776

4. Every Man’s Interest (cont.)
Trends in Healthcare Labor
The text identifies huge historical trends in the growth of the healthcare labor force
Healthcare work consistently grows faster than overall employment over a 50-year period
58% growth from 1983—2002
13.2% growth from 2000—2004 while overall employment growth was only at 1.7%

5. Every Man’s Interest (cont.)
Trends in Healthcare Labor (cont.)
The Bureau of Labor Statistics (BLS) predicts the top 30 occupations for growth from
Registered Nurses is #1 (582,000)
Healthcare professions 3 of the top 5
Healthcare professions 4 of the top 10
…and 6 of the top 30
Many other growth professions work in HC
IT workers (2 professions)
Receptionists, managers, clerks (6)

6. Every Man’s Interest (cont.)
What are the drivers of the increased demand for HC workers?
What trends do we see in the distribution of the demand?
What additional exogenous shocks could disrupt existing patterns and trends?

7. Every Man’s Interest (cont.)
Five workforce factors (p. 324)
Demographics
Education
HC Delivery System
Shifts to/from managed care
Economic System
Context
Culture • Gov’t policy
Political trends
Identify the relative speed of change for each factor

8. Every Man’s Interest (cont.)
Distribution of the HC workforce
Geographic distribution
Specialty distribution
What have been the trends in the distribution of physicians between primary care and specialty care?
What accounts for the swings?

9. Supply of HC Labor
Measurement Issues
Review the discussion in the middle and last paragraphs on p. 324
See how a conclusion was drawn from a data sample that did not reflect the overall population
Review all statistical reports for hidden issues
Some issues identify important underlying but hidden trends
Some are misleading
Look for issues that hint at what the future holds

10. Supply of HC Labor (cont.)
Measurement Issues (cont.)
What does increasing average ages of nurses imply?
Look at issues relative to workforce numbers vs. hours worked on pp
Look at value and cautions of using educational enrollments as an indicator of supply
Do healthcare workers reflect the generally healthier population?
What are the implications of this?
How would you investigate the impact?

11. Supply of HC Labor (cont.)
Group Presentation #1
Supply of HC Labor (cont.)
Physician Supply
The book does not mention changes in the educational system to produce more physicians
How responsive do you think this is?
What is the role of foreign medical graduates
To the US healthcare system?
To the systems in countries of origin?
What are all of the factors that influence the demand for physicians in general?
Indicate whether influence is positive or negative

12. Supply of HC Labor (cont.)
Group Presentation #3
Supply of HC Labor (cont.)
Physician Supply (cont.)
What factors affect…
…distribution by specialty?
…distribution by ethnic background?
…geographic distribution?
What special challenges affect the supply of primary care physicians?
What are the impacts on…
…patients?
…the healthcare system overall?

13. Supply of HC Labor (cont.)
Nursing
Key profession for leveraging the physician’s time
Provide skilled medical services not at the level of the physician
Increased education for Nurse Practitioners increase range of tasks and further frees physician time
Nurses have an incredible variety of working conditions

14. Supply of HC Labor (cont.)
Nursing (cont.)
#1 highest growing occupation
BLS reports 582,000 new nurses needed (22%)
Expected shortfall of 340,000 nurses by 2020
Lower pay
Difficult work conditions
Too few training programs
Some programs established to increase number of nurses but funding remains an issue

15. Supply of HC Labor (cont.)
Nursing (cont.)
Nursing has huge disparities in demographic composition compared to the rest of the population
Nursing has seen cyclical shortages and interesting systemic responses
Nursing workforce more responsive to the market than the physician workforce
Shortage of nursing faculty is now a huge bottleneck

16. Supply of HC Labor (cont.)
Non-physician practitioners
PAs, Nurse Practitioners, Certified Nurse Midwifes
Sometimes referred to as physician extenders
Work under the (sometimes loose) supervision of a physician
Have differing treatment and prescription authority by specialty and state
Differing educational requirements, also by state
Patients often report increased satisfaction with NPs and PAs than with physicians
Why do you think?

17. Supply of HC Labor (cont.)
Allied Health Professionals
A dizzying variety of specialty professions not requiring an MD have developed
Often related to specific medical technologies
All have specific domain-related knowledge
Some may practice independently
Speech Therapist
Occupational or Physical Therapist
Some support a physician or other professional

18. Supply of HC Labor (cont.)
Group Presentation #2
Supply of HC Labor (cont.)
Healthcare Support Staff
The healthcare system relies on a huge variety of support staff characterized by
Degree of medical skills needed
Overall level of education needed
Salary and working conditions

19. Supply of HC Labor (cont.)
Health Service Administrators
These are the managers of health service organizations
Hospitals and clinics
Medical offices or groups
Heavily business and process focused
Often have a holistic view of the organization, though not of specific medical techniques
Must anticipate changes

20. Supply of HC Labor (cont.)
Health Service Administrators (cont.)
Senior HSAs must coordinate the work of and allocate resources to medical professionals, including physicians
Incredibly challenging work
Many educational paths to the field
Specialty degrees
Business degrees
Wide variety of work environments

21. Issues and Trends
What are the issues in healthcare workforce in developing countries?
What are the limitations of policy on the healthcare workforce?
What do we actually have?
What do we actually need?
How do we get there?
What are the available avenues for implementing policy?