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Health Care Workforce Shortages Implications for Public Health


Health Care Workforce Shortages Implications for Public Health Rediscovering the Roots of Public Health November 4, 2001 Beth Mertz Project Director – PowerPoint PPT presentation

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Title: Health Care Workforce Shortages Implications for Public Health

Health Care Workforce ShortagesImplications for
Public Health
  • Rediscovering the Roots of Public Health
  • November 4, 2001
  • Beth Mertz
  • Project Director
  • Center for the Health Professions

Our mission is to assist health care
professionals, health professions schools, care
delivery organizations and public policy makers
respond to the challenges of educating and
managing a health care workforce capable of
improving the health and well being of people and
their communities.
Health Workforce Centers
  • California
  • http//

Funded by the National Center for Health
Workforce Information and Analysis, Bureau of the
Health Professions, HRSA
  • Illinois
  • http//
  • New York
  • http//
  • Washington
  • http//

  • General Trends impacting the Health Care
  • The Public Health Workforce
  • National Data
  • State Studies
  • Profession Specific Examples
  • Pew Recommendations
  • Future Directions

Present Outlook
  • General workforce issues affecting all sectors of
    the economy
  • Aging workforce
  • Technical skill gap
  • Diversity disparity
  • Displacement of traditional pathways of
  • Values of next generation
  • Inadequate education/work integration

Winds that are blowing...
  • A national crisis is looming for health workforce
    but it has as much to do with lack of innovation,
    as it does with shortages of workers
  • Three key trends
  • Changing Demographics
  • Technological Innovation
  • Change to market driven health
  • system

The workforce is changing Are you ready for the
next generation?
  • Age Great depression/WWII era workers, Baby
    Boomers, and Generation X all see the world from
    a different vantage point
  • Race Moving from a majority culture (1995), to
    diversity (2005), to multicultural (2025)
  • Gender Dramatic expansion of career
    opportunities for women over past 30 years, not
    restricted to nursing and teaching

Technology Driven Changes
  • Biomedical
  • US Investment in basic and applied biomedical
    sciences leads the world
  • The next generation of technology promises to
    reduce cost, move care to ambulatory settings,
    and improve outcomes

Technology Driven Changes
  • Health care is a knowledge based service
  • Consumers are increasingly technology savvy
  • Technological changes in
  • health care are likely to
  • increase the demand for
  • skilled labor

Market Pressures
  • How to balance
  • the tradition of individualism with
  • the needs of
  • Population health
  • System outcomes
  • Broader social needs
  • Balance of equity and choice
  • Changes needed
  • Public understanding and expectation
  • Legal framework
  • Financing system
  • Provider expectations
  • Funded and deployed public system

Workforce implications
  • Workforce expenditures represent the major costs
    to systems
  • Increasing pressure to reduce/streamline
    personnel costs
  • Competence of providers, whether technical,
    cultural, clinical, is key to system success
  • Mal-distribution of services
  • Forecasting future needs is difficult but
    necessary, for the pipeline is long

General state of workforce shortages across
health professions
  • Medicine
  • Nursing
  • Dentistry
  • Allied Health

Public Health??
Public Health Workforce Data
  • US employment census information
  • Local / State Surveys or Reporting
  • National Association of City and County Health
    Organizations (NACCHO)
  • US Office of Personnel Management
  • Equal Opportunity Employment Commission (EEO-4)
  • Professional Associations
  • Information from
  • BHPr (2001) The Public Health Workforce
    Enumeration 2000 HRSA.
  • Turnock and Hutchison (2000) The Local Public
    Health Workforce Illinois Center for Health
    Workforce Studies.
  • Mertz and Finocchio (1999) A Snapshot of
    Californias Local Public Health Department
    California Center for Health Workforce Studies.

The Public Health Workforce Enumeration 2000
  • Data Issues
  • Quality and specificity
  • Classification schemes
  • Counting
  • Unclassified Workers
  • Practicalities
  • Range of workers?
  • Level of specificity?
  • Data source?
  • Time period?

BHPr (2001) The Public Health Workforce
Enumeration 2000 HRSA.
  • Physicians are small part of PH workforce
  • Epidemiologists are less than 1 of workforce
  • PHNs are largest professional group
  • Have most accurate numbers on lab professionals
    and nutritionists
  • Professional and leadership of PH is influenced
    by the number and quality of technical and
    administrative support

Oregon PH Workforce Data
  • Only data reported were from EEO-4 Categorization

Rural Public Health Workforce
  • Western States Study
  • Rural PH has higher per capita spending, but
    relies mostly on PHNs
  • Similar per capita supply of PH workers
  • Low turnover, but difficult to fill vacant
  • Recruitment of Professional staff with previous
    experience or format training is a challenge
  • Varying amount of support staff
  • Nursing core of staff, more diversity in urban

Data from two reports done by WWAMI Center for
Health Workforce Studies And a third from the
Illinois Center for Health Workforce Studies
Urban and Rural Composition of the PH Workforce
Data from two reports done by WWAMI Center for
Health Workforce Studies And a third from the
Illinois Center for Health Workforce Studies
Illinois and California
  • Large urban / rural differences
  • Little data
  • Hospitals
  • Low Ratio
  • Unevenly distributed
  • Diverse

Data from reports done by the Illinois Center
for Health Workforce Studies and And the
California Center for Health Workforce Studies
Augmenting a limited PH workforce
  • Lessons from recent studies show
  • Collaborations with local hospitals and other
    services to ensure population coverage are
  • Volunteers play a key role in provision of PH
  • Leadership in creating and maintaining
    partnerships is key
  • Focus on strengths as a way to build
    relationships and attract new talent
  • Composition of staff and aspects of
    organizational structure may be more important
    influences on core functions than pure quantity
    of workers

War for Talent
  • Comprehensive issue in health care
  • Demand for specialized, skilled workers coupled
    with push for cost reduction
  • Health care consumers growing while providers are

Public Health Nursing Staff
  • Average age is greater than that of RNs gt45
  • Most had worked gt16 yrs and most with the same
  • 48 very satisfied
  • Work 37 hrs/week on average
  • 45 worked in MCAH with primarily female clients,
    40 of clients dont speak English
  • Interventions focused at family level (case mgmt)
    and community. Felt more prepared for family
    level work than community or system level work

Public Health Nursing Managers
  • 50 supervise general PHN programs, only 32 on
    MCH (compared to majority of staff PHNs)
  • 50 had been in position from 1-5 years
  • 75 satisfied with their position
  • 75 indicated funding for services had not kept
    pace with inflation
  • 65 indicated wages had not kept pace with

Forecasting PHN needs
Increase No Change Decrease
Change in Positions in past 5 years 40 30 30
Change in proportion of PHNs to other providers 25 25 40
Change predicted proportion of PHNs in future 20 25 25
Mental Health Workforce
  • Includes advanced practice nurses, psychiatric
    technicians, social workers, licensed counselors,
    psychologists and psychiatrists
  • Currently little to no workforce data on
    non-physician practitioners in this field
  • Licensing and certification requirements vary per
    state numerous states do not offer reciprocity
    to non-physicians

Mental Health Workforce
  • A growing need for these providers because of
    changing laws concerning substance abuse and the
    treatment of non-institutionalized, child
    adolescent, long-term care, and elderly users of
  • Currently little to no emphasis on geriatric
    training for mental health providers although
    there is a critical need for this
  • Insurance limitations legislative mandates put
    a heavy burden on the public sector to provide
    mental health services

Dental Public Health
  • There significant shortage of oral health
    services, particularly in rural communities
  • Dental public health measures are essential if we
    are to stop the epidemic of oral diseases in
    children currently manifesting
  • The primary care system is not prepared to deal
    with oral health issues
  • There are more barriers to obtaining dental care
    and fewer people have dental insurance than
    medical care or insurance

Oral Health Workforce Shortages
  • Two Strategies
  • 1) Increase the number of dentists and allied
    dental professionals who will serve underserved
  • 2) Redefine the oral health care workforce and
    expand roles of all practitioners as appropriate

Redefining the Oral Health Care Workforce
  • Interdisciplinary models for
  • care delivery exist
  • Expand roles of non-oral health professionals to
    assist in prevention, referrals and oral health
  • Easiest to reach underserved populations in
    existing settings (primary care clinics, WIC
    offices, schools)
  • Many barriers as professional boundaries and
    traditional modes of practice are change averse

DiversifyingShifting your Perspective
  • Update your concept on future pools of workers,
    i.e., for nurses, pool may include allied health
    workers as well as young people
  • Research on values and goals of new workers to
    understand how to recruit them into health
  • Educators and employers work together to design
    work and learning environments that integrate
    these findings

Diversity Strategies
Strategy Definition
Mentoring Explicit mentoring programs pairing students with either professionals, faculty or more advanced students for social support, academic and career guidance
Financial Support Scholarships, loans, or loan repayment
Academic Support Academic enrichment, tutorials or admissions preparations
Psychosocial Support Counseling, motivational programs or peer groups to assist students in social adjustment
Professional Opportunities Internships, apprenticeships, information dissemination to expose students to health careers
Workplace and Professions Changes
  • Replicate the best of innovative approaches which
    have demonstrated success
  • Mentoring, volunteering
  • Develop career pathways across professions
  • Focus on early and sustained education in health
    careers, flexible pathways
  • Facilitate life-long learning

Strategic Recommendations
  • Change professional training to meet the demands
    of the new health care system
  • Ensure that the health profession workforce
    reflects the diversity of the nations population
  • Require interdisciplinary competence in all
    health professionals
  • Continue to move education into ambulatory
  • Encourage public service of all health
    professional students and graduates

Pew Health Professions Commission Recreating
Health Professions Practice For a New Century
Fourth Report of the Pew Health Professions
Recommendations for Public Health
  • Each state should undertake a broad assessment of
    its public health workforce in order to
    facilitate workforce planning and training
  • Public health schools and departments should
    develop certification and continuing education
    programs to help providers upgrade and maintain
    their competence

Pew Health Professions Commission Recreating
Health Professions Practice For a New Century
Fourth Report of the Pew Health Professions
Recommendations for Public Health
  • Public health curricula and training in both
    schools and individual programs should expose
    students to, and prepare them for, the multiple
    sectors in which public health services are
  • Public health departments, schools and
    professions should urge other professions and
    organizations in assessing and promoting the
    publics health.
  • Public health schools, program and departments
    should focus some of their resources on training
    lay health workers and community residents to
    understand the mission of public health and equip
    them the basic competence to accomplish this

Pew Health Professions Commission Recreating
Health Professions Practice For a New Century
Fourth Report of the Pew Health Professions
Continuum of Responses
Start Over
Future Directions
  • Scramble
  • Buy more workers, threaten action, study the
    issue, 4 color brochures and ads, sign-on
    bonuses, debate the problem
  • Improve existing processes to fit todays
  • Adjust education, improve management, engage
    workers in problem solving, collaborate, fund
    tuition scholarships, distance learning, mentor

Future Directions
  • Reinvent the fundamental properties of work,
    education, and professional organization
  • Experiment with new models, diversify, lower the
    wall between education and work/practice,
  • Start Over
  • Community integration, collaborative
    partnerships, new care delivery models based on
    patient needs and wants, new professional and
    practice models, cultural competency, technology
  • ACT!

Useful Responses
  • Move this issue to the strategic level
  • Assume partnerships will be necessary
  • Look for balance of short and long-term goals
  • Look for creative options
  • Create sustainable workplace

Parting Shots
  • Most change is PSYCHOLOGICAL
  • Partnerships are ABSOLUTELY necessary
  • Important that we NOT enfranchise the status quo

The doctors of the future will give no medicine,
rather they will interest their patients in care
of the human frame, in diet, and in the cause and
prevention of disease --Albert Einstein
3333 California Street, Suite 410 San Francisco,
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