center for health workforce studies december 2010 health workforce planning in new york: where are...

Center for Health Workforce StudiesDecember 2010

Health Workforce Planning in New York: Where are We?

Where Do We Need to Go?

Presentation to the Health Workforce Development Subcommittee

December 15, 2010

Jean Moore, DirectorCenter for Health Workforce Studies

School of Public Health, SUNY at Albanyhttp://chws.albany.edu

Better Information for Better Outcomes


Health Care Reform 2010

Service delivery provisions designed to Expand access to care Improve efficiency of care Improve quality of care

Workforce related provisions designed to: Support health workforce planning and policy

making Increase support for careers in health care,

particularly to improve health workforce diversity and to address workforce shortages


What Changes With Health Reform?

Shift of focus for the health care delivery system to primary and preventive care

Emphasis on effective management of chronic diseases

Emerging models of care, such as the patient-centered medical home

Increased attention to quality and cost effectiveness Rewards for efficiency and quality, penalties

for inefficiency and poor quality care


Primary Care Related Provisions


What Are the Workforce Implications of Health Reform? Demand for primary care providers will

increase, likely beyond available capacity Physicians, Nurse Practitioners, Physician

Assistants Demand for other workers in ambulatory

settings will also rise Registered Nurses, Licensed Practical

Nurses, Medical Assistants Chronic disease management programs will

drive increased demand for certified diabetes educators, certified asthma educators, social workers, nutritionists, health educators


What Do We Know About New York’s Health Workforce?


Re-registration surveys: Physicians Registered Nurses Dentists Dental Hygienists In 2011, adding: NPs, PAs, Midwives

Annual resident exit survey Annual survey of nursing deans and directors Annual health worker demand surveys:

Hospitals, nursing homes, home care agencies, clinics

Center’s Current Health Workforce Tracking Activities

Employment Growth in New York State, 1990 - 2008, (Standardized to 1990)

80

90

100

110

120

130

140

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Per

cent

Gro

wth

Health Care Employment Non Health Care Employment

NYS DOL, ES 202

Health Care Employment Is Important to the State’s Economy


Since 2003, RN Graduations Have Been Steadily Increasing in the

State

0

2,000

4,000

6,000

8,000

10,000

1996 1997 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

# o

f R

N G

rad

uat

ion

s

Associate

Bachelor's

Total

Registered Nursing Graduations in New York State, 1996-2010


Impacts of the Economic Downturn

Slower job growth Delays in expansions/investments

Health information technology New services

Staffing cuts Easing of current health workforce

shortages


Which Health Workers Are Hardest to Recruit and Retain in New York?

In a 2009 survey of hospitals, nursing homes and home health agencies in the state, occupations that posed the most difficulty were: Experienced registered nurses Clinical laboratory technicians and technologists Physical therapists Occupational therapists Licensed practical nurses Certified nurse aides


Variable Growth in the Regional Supply of Active Patient Care Physician FTEs in NY Between 2002 and 2008

Region 2008 Supply 2002 - 2008

ChangeCapital District 2,403 9.4%Central NY 1,615 4.7%Finger Lakes 2,593 5.6%Hudson Valley 6,001 9.5%Long Island 8,243 10.6%Mohawk Valley 901 1.4%New York City 24,489 9.7%North Country 538 8.7%Southern Tier 1,224 3.6%Western NY 2,812 2.0%


Primary Care Health Professional Shortage Areas in New York


Less than Half of New Physicians Stay in New York after Completing Training

52% 53%49% 49% 49% 48%

45% 46%

54%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Percent of new physicians with confirmed practice plans in New York

Data are not available for 2004 and 2006


New Physicians From New York Are More Likely to Stay in New York

81%73%

63%

43%

33%26%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NYHS andNYMGs

NY IMGs Non-NYHSand NYMGs

OtherUSMGs

OtherUSIMGs

ForeignIMGs

Percent of new physicians with confirmed practice plans in New York by high school location and medical school location, 2009


What Are the Jobs of the Future?

Sources: U.S. Department of Labor, Bureau of Labor Statistics, National Employment Matrix, employment by industry, occupation, and percent distribution, 2008 and projected 2018.

Selected Health

Occupations with the Largest

Projected Job Need in the

U.S. between 2008 and

2018 99.8

125.5

163.9

144.1

155.6

276.0

375.8

460.9

581.5

105.6

457.5

91.8

102.0

146.3

235.7

116.4

53.9

63.5

82.2

55.4

0 100 200 300 400 500 600 700 800 900 1,000 1,100

Dental Assistants

Pharmacy technicians

Medical Secretaries

Medical Assistants

Physicians & Surgeons

Licensed Practical Nurses

Nursing Aides, Orderlies, & Attendants

Personal & Home Care Aides

Home Health Aides

Registered Nurses

In ThousandsNew Jobs Replacements


Where Are the Jobs of the Future?

Projected Average Annual Job Growth in Selected Health Settings in the U.S.

1998-2008 and 2008-2018

Sources: U.S. Department of Labor, Bureau of Labor Statistics, National Employment Matrix, employment by industry, occupation, and percent distribution, 2008 and projected 2018.

3.8%

2.8%

1.8%1.6%

1.1%

2.3%

3.0%

3.9%

0%

1%

2%

3%

4%

5%

Home Health Care Office of HealthPractitioners

Nursing andResidential Care

Facilities

Hospitals

1998 - 2008 2008 - 2018


Are We Training a Health Workforce for the Future?

Interdisciplinary collaboration

Team based care

New roles and responsibilities

Different settings, e.g., home care and ambulatory care

More technology

Focus on chronic disease management

Geriatrics

Cultural competence


Opportunity For Developing and Strengthening Health Workforce Planning

Infrastructure in New York

Enhance health workforce monitoring system

Increase the number of health professions surveyed at re-registration

Strengthen the primary care focus of the monitoring system

Systematically disseminate monitoring results to key stakeholders

Establish and support regional coalitions to actively engage in health workforce planning


Health Workforce Planning: What?

Health needs of the population and the services required

Current health workforce supply and distribution Current and future supply/demand gaps

Profession-specific Specialty-specific Geographic

New workers and/or new skill sets needed Evaluation of the relative effectiveness of different

workforce configurations


Health Workforce Planning: Who?

Governmental agencies, e.g., DOL, DOH, SED, SUNY Health planning entities, e.g., Health Systems

Agencies, Rural Health Networks Foundations Educators Health worker labor unions Providers, e.g., hospitals, nursing homes, home care,

clinics, physician offices, public health Professions, e.g., medicine, nursing, allied health AHECs Researchers Consumers


Health Workforce Planning: How?

Use the health workforce monitoring system to Systematically identify shortage areas in

primary care, dental, mental health, and nursing

Develop regional planning networks: To review the data and information from the

monitoring system relevant to their region To develop plans to address most pressing

current and future workforce needs


Looking Ahead: Sustainability

Use federal resources as seed money to support infrastructure development for health workforce planning in New York

Strengthen the health workforce monitoring system

Engage stakeholders committed to participation in regional planning networks

Use health workforce data and information to inform decisions and to support the development of state and local programs and policies

Evaluate the impacts of these efforts on the health of the population in the state

center for health workforce studies december 2010 health workforce planning in new york: where are...

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