Health Workforce Assessment Hawaii Island

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Health Workforce Assessment Hawaii Island

• Kelley Withy, MD, PhD
• Hawaii/Pacific Basin AHEC
• UH JABSOM
• 10/26/07

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We know we dont have enough providers, but how
bad is it?

• How do we quantify it?
• Where is the greatest need?
• What kind of providers do we need?
• What do we do to solve the problems?
• How do we know if what we are doing is working?

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Methods for assessing workforce

• Since 2002, 15 state and three national studies
  (including HRSA) have been performed all
  demonstrating medical shortages
• Most states use licensure data to assess supply
• Some states survey providers
• Less states use focus groups, statewide meetings
  or community informants
• For demand most states and HRSA use provider to
  population ratios

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Definitions

• Supply-What we have
• Number of bodies
• Number of full time equivalents (FTE)
• Productivity
• Demand-What we want
• Need-what we think the area would need based on
  assumptions
• Utilization-what is actually used

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Hawaii Picture

• Licensing data has mailing addresses only
• Center for Nursing surveys nurses
• HHIC researching physician characteristics
• HPCA surveys CHCs
• DOH tracks shortages and HPSA designations
• NHHSP surveys their graduates
• SHPDA surveys hospitals
• DOL follows trends in employment rates
• Schools and professional associations contact
  folks

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Hawaii workforce research

• NO SINGLE SOURCE for workforce information and
  analysis
• Hawaii Health Workforce Hui formed in 2003 is a
  collaboration between Hawaii Departments of
  Health and Labor, Primary Care Association,
  Native Hawaiian Health Scholarship program,
  University of Hawaii, State Health Planning and
  Development, Rural Health Association, Hawaii
  Health Service Corporation Human Resources
  Department, FM Residency program, and many more.

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Hawaii Health Workforce Collaborative

• Vision We envision a healthcare system in
  Hawaii with a full complement of health care
  workers distributed to meet the health needs of
  the entire state.
• Mission statement Improve access to and quality
  of healthcare in Hawaii by identifying unmet
  health workforce needs and developing solutions.

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Hawaii Health Workforce Assessment

• Collaborative effort supported by Shippers Wharf
  Trust and Act 219, Session Laws of Hawaii, 2007
• Identify the location, specialty and FTE of all
  licensed health professionals working in Hawaii

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Licensed medical specialties to be assessed

• Audiology
• Dental Hygienist
• Dentist
• Emergency Medical Technician
• Marriage and Family Counselor
• Medical Doctor
• Doctor of Osteopathy
• Mental Health Counselor

• Occupational Therapist
• Optometrist
• Pharmacist
• Physical Therapist
• Physician assistant
• Podiatrist
• Psychologist
• Social Worker
• Speech Pathology

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Activities (cont)

• Estimate present utilization for licensed health
  workers based on utilization rates by insured
  individuals
• Use this to estimate present and future need for
  services

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Assessing demand

• Number of visits to different types of providers
  by zip code for insured patients
• Extrapolate to entire population taking into
  account age and gender
• Convert this to number of FTEs for each type of
  provider
• Compare with supply numbers

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Activities (Cont)

• Identify gaps in health workforce
• Project future need and supply
• Research possible solutions

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Future supply and demand

• Review trends in number of visits and number of
  providers
• Develop a model that takes into account
  population specifics of Hawaii including pattern
  of illness, geographic barriers,
• Project findings out through 2020
• Assess changes every year to see if our
  projection model is accurate

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Physician Shortage
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Finding Providers on Hawaii Island

• Licensees with Big Island zip codes
• Insurance provider lists
• Hospital privilege lists
• Offices, groups, associations
• Yellow pages
• Internet
• Contacting community members and providers
• Contacting offices by phone for confirmation

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Preliminary Estimate of Providers on Hawaii Island
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Mapping of results

• Zip code map demarcated as closely as possible to
  judicial districts created 8 regions
• Population mapped and approximated to 2007
  (increase 15)
• Provider need estimated using WWAMI numbers
• Existing providers from licensure list

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Preliminary Results
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Possible solutions???

• Immediate
• Enhanced recruitment using diverse incentives
• Financial pay, signing bonuses, malpractice,
  loan repayment
• Housing, mentoring, jobs for spouse, web based
  schooling, community involvement
• Increase fly over providers
• Telemedicine
• Health insurance reform

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Intermediate (5 yr)

• Employment model group to serve all areas and/or
  specialty clinic creation
• Scholarship and loan repayment
• Increase size of training programs
• Family Medicine and other training programs in
  rural areas
• The advanced medical home (a care coordination
  model)
• Reforming reimbursement policies to create
  financial incentives for improving quality and
  efficiency
• Decreased regulatory restraints and paperwork
• Tort reform

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Long term (5-10 years)

• Pipeline
• Rural health interest groups Magnet schools
• Enrichment programs
• Mentoring (continuous student support)
• Selective school admission policies
• Scholarship/loan repayment
• Magnet hospitals
• i.e. neuro

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Just Imagine

• Coordinated no-cost system for advertising
• Web based promotional materials
• Save funds for interviewing a large selection for
  providers interested in rural practice through
  advertising
• Have them visit and learn about community
• Community chooses best candidate
• Incentives-financial, housing, malpractice, loan
  repayment, etc.
• Professional community established, all necessary
  supplies and facilities available

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Just imagine

• Pleasant working environment, telemedicine and
  specialist support
• Caring for patients is a collaborative team
  effort
• All necessary facilities are available
• Community involves provider in community life
• Provider feels a part of the community
• Gets married
• Connections for spouse and educational
  supplementation for kids
• Provider lives happily ever after
• And so does the community
• Provider and community train the future providers

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Just imagine

• Promising students in your community nurtured,
  mentored, receive additional education and career
  experiences and have preferential admission to
  health professions schools with scholarships
• Training continues in the rural areas where they
  came from
• They are rewarded for returning and staying in
  the rural areas (loan repayment, practice
  resources, professional family, healthcare team,
  community acceptance)

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Factors Impacting supply

• Changes in training programs
• Life style choices of providers including hours
  of work, retirement patterns
• Aging of the health care workforce
• Varying levels of productivity depending on
  teamwork, use of technology, work satisfaction,
  family responsibilities, etc
• Increase in non-patient care activities

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Factors influencing demand

• Population growth and aging
• Increasing rates of utilization
• Economic growth
• Medical advancements
• National investment in healthcare
• Changes in delivery system, insurance and
  financing including changes in managed care
• Cost containment efforts