1. Competition, Challenges and Mixed Signals in the Health Workforce Family Impact Seminar, East Lansing, MI May 7, 2013 Stephen N. Collier, Ph.D. Professor Emeritus University of Alabama at Birmingham

2. Overview Mixed Signals National Health Workforce Data: Current and Future Competition in Health Care and the Health Workforce Challenges facing Policymakers Policy Considerations

3. Mixed Signals

7. Healthcare Retirement Rates (largest decline in retirement rates among all workforce sectors of the U.S. economy) Percent of healthcare workforce retired within 12 months 2004-20072009-2010 approx 4% 1.55% Source: The Conference Board, as reported by John Commins in Health Leaders Media, May 25, 2011

9. Occupation EmploymentChange Total job openings due to growth and net replacements, 2010-2020 Number Percent 20102020 Total, all occupations 143,068163,53720,46914.354,787 Community and social services occupations (21- 0000) 2,4032,98558224.21,098 Education, training and library occupations (25- 0000) 9,19410,5971,40415.33,398 Healthcare practitioners and technical occupations (29-0000) 7,7999,8192,02025.93,591 Healthcare support occupations (31-0000) 4,1905,6341,44434.52,042 Sales and related occupations (41-0000) 14,91616,7851,86912.56,454 Office and administrative support occupations (43- 0000)22,60324,9382,33610.37,450 Installation, maintenance, and repair occupations (49-0000) 5,4296,22980014.72,026 Production occupations (51-0000) 8,5948,9513574.22,231 U.S. Workforce Employment 2010-2020 Numbers listed are in thousands of jobs Source: table prepared by Stephen N. Collier using data from the Bureau of Labor Statistics: Occupational employment projections to 2020, Occupational Outlook Quarterly, Winter 2011-12, Bureau of Labor Statistics.

10. Occupation EmploymentChange Total job openings due to growth and net replacements, 2010-2020 Number Percent 20102020 Total, all occupations143,068163,53720,46914.354,787 Healthcare practitioners & technical occupations7,7999,8192,02025.93,591 Healthcare support occupation4,1905,6341,44434.52,042 Physicians and surgeons69185916824.2305 Registered nurses2,7373,44971226.01,207 Occupational therapists1091453633.557 Physical therapists1992767739.0101 Physician assistants841082429.541 Speech-language pathologists1231522923.452 Athletic trainers1824630.012 Medical & clinical lab technologists1691892011.352 Medical & clinical lab technicians1611852414.755 Dental hygienists1822506837.7105 Radiologic technologists and technicians2202816127.895 Respiratory therapists1131443127.753 Home health aides1,0181,72470669.4838 Medical assistants52869016230.9244 Source: table prepared by Stephen N. Collier using data from the Bureau of Labor Statistics: Occupational employment projections to 2020, Occupational Outlook Quarterly, Winter 2011-12, Bureau of Labor Statistics. Health Workforce Employment 2010-2020 Numbers listed are in thousands of jobs

15. Health Reform

17. Affordable Care Act passed March 2010 Features: 32 million newly covered by insurance by 2019 Accountable care organizations Bundled payments Medical home CMS reduction in physician payment Insurance reforms

21. Competition

24. Oklahoma: Governor’s Council for Workforce and Economic Development (2006 ) “As one of Oklahoma’s most important industries, healthcare continues to be a key element in the state’s ability to recruit and retain new and expanding businesses…In 2004, health care was the second largest employing industry in Oklahoma, comprising 14% of the state’s total employment

25. Source: The Emerging Policy Triangle: Economic Development, Workforce Development, and Education Dennis Jones and Patrick Kelley, National Center for Higher Education Management Systems, 2007

26. Challenges

28. Bitter Pill: Why Medical Bills Are Killing Us, Steven Brill, Time Magazine, March 4, 2013

29. Average Annual Premiums for Single and Family Coverage, 1999-2009 * Estimate is statistically different from estimate for the previous year shown (p<.05). Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2009.

30. The Changing Healthcare Workforce Why do educational institutions sometimes seem slow to react to employers expressed need for healthcare graduates?

31. Workplace personnel needs change more rapidly than educational programs can respond a local personnel need is identified Program planning occurs (6 mos-1year) Hiring a program director, accreditation, curriculum development, faculty hiring (1-2 years) Program implementation (2 years) First graduates (4 or more yrs from identification)

32. Policy Considerations

36. Strategies to Influence the Distribution of Physicians 1. Provide more residency training in the state and in rural areas 2. Increase scholarship and loan forgiveness programs 3. Establish an equitable reimbursement system for rural practice 4. Give preferential admission to residents of rural areas 5. Include rural preceptorships and emphasis on prevention 6. Support Area Health Education Centers and primary care residencies associated with them 7. Review and revise licensure acts relating to physician assistants and nurse practitioners 8. Provide support to community recruitment and retention efforts Stephen N. Collier, Influencing the Distribution of Physicians: Manpower Policy Strategies, Southern Regional Education Board, Atlanta, GA 1978

39. Data & Information Sources—Federal Government Bureau of Labor Statistics (Dept of Labor) Bureau of Labor Statistics (Dept of Labor) National Center for Health Workforce Analysis (HRSA) National Center for Health Workforce Analysis (HRSA) Census Bureau (& American FactFinder) Census Bureau (& American FactFinder) HRSA Geospacial Data Warehouse HRSA Geospacial Data Warehouse National Center for Education Statistics National Center for Education Statistics National Center for Health Statistics (CDC) National Center for Health Statistics (CDC)

41. Questions/Contact Stephen N. Collier, Ph.D., Professor Emeritus & Former Director (2003-13) Office of Health Professions Education and Workforce Development University of Alabama at Birmingham colliers@uab.educolliers@uab.edu (205) 790-8931