Workforce Issues

1
Workforce Issues

• M6920
• March 21, 2000

2
Some questions about providers and workforce

• What is the role of a professional?
• Who is a "provider?
• How many should we have?
• How how much will they be rewarded?

?????????
3
Defining professionals

• Special body of knowledge
• Control over education and qualifications
• Limited entry into field
• Social recognition

4
Is nursing a profession?

• Classics clergy, law, medicine
• Yes
• controls education
• limited entry to field
• social recognition
• personal professional ethic

5
Maybe its not a profession..

• social recognition limited
• only partial practice independence
• most are wage workers
• gender perception issues
• competition with more prestigious fields

6
Workforce or providers?

• Workforce is the classic labor market term
• Provider is a term of art from payment systems
• Independent billing has recognized MD, DO, DDS
• Others are seen as either
• institutional staffing
• secondary practitioners

7
For both physicians and nurses

• Content and volume of education has grown
• Cycles of excess and shortage occur
• related to employment shifts
• related to age groups
• related to educational policy
• Public expectation changes

8
Physician questions have dominated

• Because of the cost of preparation
• Because of their primacy in the cost and access
  equation
• Mechanisms have included
• Residency support (Medicare)
• Enrollment support (HRSA)
• Policy on IMGs

9
International medical graduates

• 18,000 US graduates for 24,000 residency
  positions
• IMGs are 25 of licensed physicians. . .
• but 50 of HHC residents and
• 75 of 392 residents at Lincoln Hospital (Bronx)

10
Some current questions

• What is the role of the specialist?
• What proportion of practitioners should be
  specialists?
• How do we support the academic research machine?

?????????
11
Nurse questions

• Usually stimulated by shortage of hospital staff
  nurses
• Population ratio has grown 366/100K (1970) to
  697/100K (1991)
• Responses have included
• Changes in length/type of education
• International recruitment
• Enrollment support (school student)
• Salary changes

12
Some current nursing workforce issues

• use of assistive personnel
• definition of differentiated practice
• compression of advanced practice nurses
• relationship to vulnerable populations

13
Geographic distribution

• The range of practitioner to population is
  extremely variable
• US 22.4/10,000 in 1997
• Regional range
• New England 30.4
• West South Central 18.3

14
Physican/population ratio
Health US, 1999
NE
Mid Atlantic
South Atlantic
E N Central
W N Central
E S Central
Pacific
W S Central
Mountain
15
Health Profession/ Population Ratio
per 100,000 population Health US, 1999
16
Distribution of Nurses
Per 100,000 population Health US, 1999
1,272,900 nurses 1980
17
Impact of hospital closure shorter stays

• 300,000 displaced nurses
• 1.2 out of 1.9 million nurses work in hospitals
• Home health has doubled
• Out patient settings have grown 15

18
Diversity in Medical Students
1990 65,163 1994 66,629
19
Diversity in Nursing Students
1990 221,170 1994 270,228
20
Types of nurses, 1996
Health US, 1999
2,161,700 Nurses
21
Nurses in New York State, 1996

• 96 FEMALE
• Average age 47
• in 1983 it was 40
• 36 over 50
• Average age by type of education
• BSN 42
• DIPLOMA 52
• AD 44

22
Ethnicity of New York Nurses, 1996
23
New York State Mean Salaries (late 1990s)

• CRNA 67,200
• CEO 60,000
• Midwife 56,700
• Dean 54,600
• DIR/DP 54,100

• Head Nrs 44,500
• NP 43,400
• CNS 42,100
• STAFF 34,900
• Faculty 33,800

24
Salaries, cont.

• Asian 46,700Black
  45,900Puerto Rican 43,800Other
  Hispanic 43,400Native American
  34,400White 33,300
• By region of state
• Range 48,900 TO 25,200

25
Licensing, certification and credentialing

• License is a state issued verification of minimal
  competence
• Certification is a verification of specialty
  competence
• Credentialing is verification by employing or
  reimbursing institution

26
Institutional licensure

• Enormous increase in number of licensed or
  registered groups may rekindle this debate
• The employer would be held responsible for hiring
  people with the right skills for each job
• Current credentialing approaches may stimulate

27
Consumer protection or control of competition?

• Limit number licensed?
• Require certification?
• Extend credentialing process?
• Expand disciplinary actions?