Health Reform Commission

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Health Reform Commission

• Workforce Workgroup Recommendation Presentation

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Agenda

• Workforce Workgroup Objective
• 2006 2007 General Assembly Session Results
• Why Should the Commonwealth Care
• Factors Affecting Workforce
• Process for Developing Recommendations
• Current Situation
• Recommendations

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Workforce Workgroup Objective

• This workgroup must bring together the many
  existing studies about Virginias healthcare
  workforce and identify professions with critical
  shortages or anticipated shortages. The workgroup
  is tasked with examining models from other states
  to develop a strategy to improve the capacity,
  skills, and number of healthcare professionals in
  Virginia. Recommendations should focus not only
  on bringing people to the professions, but
  improving the capacity of educational
  institutions to meet growing demand for services
  provided by these professionals. The workgroup
  will focus on several professions, including the
  long-term care workforce, which is critical to
  any recommendations made by the Long Term Care
  and Consumer Choices workgroup.

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2006 2007 General Assembly Session Results

• 2007 GA Results
• Targeted Nurse Faculty Salary Increases (10)
• 200,000 in Nursing (Faculty) Scholarships
• 500,000 in Mental Health Residency Slots
  (Psychiatry and Psychology)
• 2006 GA Results
• Healthcare Workforce Task Force (1.5M FY 2007
  and FY 2008)

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Nursing Workforce
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Why should the Commonwealth care? Nurses

• Research tells us the availability and competence
  of RNs to provide health related services will
  affect cost, quality and access to health
  services in all sectors of the US health system
• According to JCAHO, in 2002, inadequate nurse
  staffing factored into 24 of cases (n1609)
  involving patient safety events

Source Dr. PJ Maddox Presentation to the
Workgroup
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Factors Affecting Workforce - Nurses

• Aging effects
• Average age of the nurse is 45
• Within 10 years 40 of working RNs will be 50
  years or older
• In 1985, 25 of nurses were under age 30. Today
  lt9 are under age 30.
• The average age of new RN grads has been steadily
  increasing for all program types (Across the U.S.
  the average age is 30)
• Retirement
• 30-40 of RNs and LPNs in baby boomer age plan to
  retire in next 7-10 years
• Nursing Education
• RN education programs are well distributed across
  Commonwealth
• More than 6,000 students enrolled
• In 2003 schools turned away more than 1,300
  qualified applicants
• Yet, in some programs, close to 50 of students
  fail to graduate
• Difficulty hiring and retaining faculty due to
  salaries not being competitive with the private
  sector
• Nursing programs expensive to operate (110
  faculty to student ratio)
• Average age of faculty RNs in BS and higher
  programs across the U.S. is 50.4

Source Virginia Board of Nursing (9/2006) HRSA
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Factors Affecting Workforce - Nurses

• What is driving the gaps between supply and
  demand?
• Virginias population is growing, contributing to
  demand for services.
• More people are living longer, requiring more
  health care
• Young people interested in becoming nurses are
  unable to get into school
• Older nurses are retiring
• Faculty are aging faster than healthcare provider
  RNs
• Nurses are leaving nursing for other
  opportunities.

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Process For Developing Recommendations Nurses

• Reviewed a variety of reports that the state has
  pulled together over the years
• All of the recommendations from the reports were
  compiled into one matrix resulting in a total of
  62 strategies
• A subgroup of nurses on the workgroup held a
  conference call to edit/change the matrix
• Developed three overarching goals
• Increase supply of RNs in the state by additional
  900 nurses per year
• Accurately measure the progress towards
  increasing supply and decreasing demand
• Manage demand for RNs in acute care settings
• From this developed top 5 recommendations

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Current Situation Nurses

• Virginia ranks 40th in per capita supply of RNs
• Registered Nurses (RNs) 83,814 (includes
  multi-state compact)
• Advanced level practice nurses 4,648
• Licenses Practical Nurses (LPNs) 27,540

Source Virginia Board of Nursing (9/2006)
Condition of Nursing and Nursing Education in
the Commonwealth (SCHEV, 2004)
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Recommendations Nursing
lt1M 1M - lt5M 5M - lt10M
10M - lt25M gt25M
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Recommendations Nursing
lt1M 1M - lt5M 5M - lt10M
10M - lt25M gt25M
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Recommendations - Nursing
lt1M 1M - lt5M 5M - lt10M
10M - lt25M gt25M
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Physician Workforce
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Why should the Commonwealth care? Physicians

• 75 of Virginia physicians were not trained in
  Virginia (net importer)
• Although Virginia educates about the national
  average of medical students per population, only
  about 36 of Virginias medical students end up
  practicing in Virginia
• Meaning 64 of Virginia educated physicians
  practice elsewhere (low retention rate).
• As for IMGs, only about 17 of Virginia
  physicians are IMGs
• Virginia is very reliant on physicians educated
  in US medical schools other than those in
  Virginia.

Source Dr. Steven Mick Presentation to the
Workgroup
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Factors Affecting Workforce - Physicians

• Aging effects
• In 1985, 117,000 physicians where 55
• In 2005, this number increased to 252,000
• Retirement
• Currently increasing from 10 to 20 over the
  next 10 years
• 1/3 of 50 say they would retire if could afford
  to
• Over time there has been a significant increase
  for physician demand
• The uninsured comprise nearly 20 of the U.S.
  population.
• This population uses half as much services
• Covering this population would require a 10
  increase of physicians
• Medicine is more complex than ever
• Lifestyle factors
• Want more family and personal time
• More women in the field, who typically work 16
  less than their male counterparts
• Productivity
• Electronic health records and IT solutions
  promises to increase physician workforce
  (although this has not yet been seen)

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Factors Affecting Workforce Physicians

• What is driving the gaps between supply and
  demand?
• Population growth
• Aging of the population
• Life Style factors
• Public expectations
• Economic growth of the nation
• National investment in health care interventions
• What factors will affect future supply?
• Medical school production (MD, DO)
• International migration and IMG policies
• GME positions
• Aging of physician workforce retirement
• Gender and generational differences/Lifestyle
  choices of physicians
• Changing practice patterns
• Productivity changes (i.e. NPs/PAs, IT)

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Process For Developing Recommendations
Physicians

• Reviewed a variety of reports from the AAMC,
  HRSA, and other states
• Worked with the co-chair to compile
  recommendations into one matrix resulting in a
  total of 33 strategies
• Developed three overarching goals
• Accurately measure the progress towards
  increasing supply and decreasing demand
• Increase supply of physicians in the state
• Decrease demand by improving quality of work life
  and maximizing efficiency and expertise of
  physicians
• From this developed top 5 recommendations

AAMC Association of American Medical Colleges
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Current Situation - Physicians

• By 2020, HRSA / Lewin estimates 31,900 physician
  shortage (other studies say up to 191,000)
• In Virginia, by 2015 it is estimated that there
  will be a physician shortage of 1500-1600
• In the U.S. there are 245.6 264 physicians per
  100,000 population
• When comparing the US to other countries there is
  a significant difference
• Median 326/100,000 (Germany)
• High 448/100,000 Greece
• Low 130/100,000 Korea
• Australia, New Zealand, United Kingdom, and
  Canada
• All lt 264 (UK 201)
• All in process of doubling of physicians
• In Virginia this number is 228.6 240 per
  100,000

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Current Situation Physicians

• Current Supply of Physicians across the U.S.
• MD production from Medical Schools flat
• 16,000 6,000 International Medical Graduates
  who enter residency 22,000 first year residents
• DO production 3,000
• Projected to increase to 5,000 by 2015
• Current Supply of Physicians in Virginia

Source Deans of Medical/Osteopathic Schools
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Recommendations Physicians
lt1M 1M - lt5M 5M - lt10M
10M - lt25M gt25M
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Recommendations Physicians
lt1M 1M - lt5M 5M - lt10M
10M - lt25M gt25M
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Recommendations Physicians
lt1M 1M - lt5M 5M - lt10M
10M - lt25M gt25M
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Nursing Support Workforce
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Why should the Commonwealth care? Nursing
Support

• Nursing Support staff (including CNAs, home care
  aides, personal care attendants, personal support
  providers, etc.) are vital to the care provided
  in extended care facilities, home health, and
  other settings outside hospitals.
• The health care industry must compete with other
  industries that offer comparable wages, upward
  mobility, better hours and less stress.
• In the disability community, lack of caregivers
  means lack of services and support for people
  with disabilities, thus stalling the progress of
  community integration and resulting in prolonged
  institutionalization and additional cost.
• The Virginia Employment Commission anticipates
  19,211 new direct-care jobs will be created by
  2014, a 38 increase over the number of positions
  held in 2004

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Factors Affecting Workforce Nursing Support

• High turnover, which often exceeds 100, is a
  significant problem
• Factors driving turnover Poor Wages
• Today 1 in 12 low-wage jobs
• 2010 1 in 10 low-wage jobs

Source U.S. Bureau of Labor Statistics (BLS),
Occupational Employment Statistics May 2005
(Washington, DC U.S. Bureau of Labor Statistics
May 2006).
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Factors Affecting Workforce Nursing Support

• Factors driving turnover - Benefits
• Direct care workers are uninsured at a rate 50
  higher than the general population
• One in four nursing home workers lack coverage
• Two in five home care workers lack coverage
• Many with insurance have high out-of-pocket costs
  and minimal benefit plans
• Factors driving turnover - Lack of career ladders
• Limited training and career advancement
• Factors driving turnover difficult working
  conditions
• Erratic schedules
• Dirty work

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Process For Developing Recommendations Nursing
Support

• Reviewed a variety of reports, met with various
  stakeholders and stakeholder groups, received
  memo from LTC Workgroup
• Worked with the co-chair to compile
  recommendations into one matrix resulting in a
  total of 26 strategies
• Developed three overarching goals
• Increase supply of Nursing Support Workers in the
  state
• Accurately measure the progress towards
  increasing supply and decreasing demand
• Manage demand for Nursing Support Workers
• From this developed top 3 recommendations

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Current Situation Nursing Support

• Current Supply of Nursing Support Workforce
• Personal Care Assistants 8,160
• Home Health Aides 10,360
• Certified Nursing Assistants, Orderlies,
  Attendants 29,610
• Do not have future data projections on workforce
  gaps in any of these areas
• Very limited data for policy development
• Current projected numbers of persons with
  disabilities needing LTC by service setting
• Vital signs of direct-care workforce
• Estimated demand for workers by setting
  occupation
• Availability of family caregivers (paid/unpaid)
• Who are the employers? How are they changing?

Source US Bureau of Labor Statistics, 2005
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Recommendations Nursing Support
lt1M 1M - lt5M 5M - lt10M
10M - lt25M gt25M
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Recommendations Nursing Support
lt1M 1M - lt5M 5M - lt10M
10M - lt25M gt25M
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For the Entire Workforce
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Recommendations All Areas
lt1M 1M - lt5M 5M - lt10M
10M - lt25M gt25M
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Recommendations All Areas
lt1M 1M - lt5M 5M - lt10M
10M - lt25M gt25M