workforce summary

7/27/2019 Workforce Summary

1/11

Angela ChouMontana Office of Rural Health/Area Health Education Center

Health Care Workforce Summary

Nationally, the health care workforce shortage is as real as it ever was. In Montana, theshortage is even more serious. Five type of health professions have been identified ascritical to the future of Montanas health care: nurses, physicians, dentists, pharmacists,and technicians (laboratory and radiological). The following represents national andstatewide trends concerning the above professions.

Dentists:

National:

The dentist shortage is extremely critical, especially in rural areas. The U.S. Department

of Health and Human Services says that: There are more than 31 million people living in designated shortage areas, and

that about 4,650 dentists are needed to provide the proper level of care.Currently, there are only about 4,000 dental school graduates annually(USDHHS, ADA, 2003).

Also, there are predictions that the number of dental school graduates will fall over thenext decade since the number of dentists per 100,000 U.S. population has continued tofall since 1990 (ADHA, 2004). More qualified applicants will also be denied from dentalschool because of a severe shortage of dental school faculty (there are currently morethan 350 vacant faculty positions), who are pursuing higher-paying occupations

(Tomkins, 2003).

Nationally, the number of dentists per 100,000 U.S. population is expected to declinefrom 63.6 (in 2000), to 52.7 by 2020 (ADHA, 2004).

Number of Dentists per 100,000 U.S. population 2000-

2020

63.6

52.7

0

10

20

30

40

50

60

70

2000 2020

Sources: ADA, ADHA;http://www.adha.org/media/releases/archives/2004/070804_adhp.htm
http://www.adha.org/media/releases/archives/2004/070804_adhp.htmhttp://www.adha.org/media/releases/archives/2004/070804_adhp.htmhttp://www.adha.org/media/releases/archives/2004/070804_adhp.htm


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Major issues concerning the dentist workforce shortage:

Of about 152,000 active dentists, more than 33% of them are older than 55.

(ADA, 2003)

Currently, there isless than one full-time equivalent dentist per 4,000-5,000

people. (ADHA, 2004)

Montana:

The Department of Public Health and Human Services, along with the Montana DentalAssociation, conducted a survey of the Montana Dental Workforce in 2001i, and found:

70% of Montana dentists are older than 45; 26.7% are older than 55.

In 2000, Montana had 51.9 dentists per 100,000 compared with the national

average of 63.6 (ADA, US Bureau of the Census, 2000).

Montana experienced a 16.9% drop in the dentist to population ratio.

35 of 56 Montana counties are designated health professional shortage areas,

and some counties have no dentists.

Number of Dentists per 100,000 U.S. population in

2000 (Montana vs. National Average)

Montana

National

0

20

40

60

80

Source: Addressing the Dental Workforce in Montana: Regional Initiative in Dental Education (RIDE) Program

Age of Montana Dentists

(as stated in 2001 survey)

70%

26.70%

3%

45 yrs or older

55 yrs or older


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The following is a map that represents the states dental health professional shortageareas:

Imaging/Radiology Technicians:

National:

While data on the shortage of imaging/radiology technicians is not nearly as plentiful asthat of the nursing shortage, it is still apparent that this profession is on the verge of ashortage crisis.Applied Radiology documents the extreme present need in radiology andfound that:

21% of hospitals surveyed are reporting severe shortages with average

vacancy rates of above 20% (Applied Radiology, 2002).

The American Hospital Association (AHA) published a study in 2001: There was a 15.3% national vacancy rate for imaging technologists and

technicians, and that the vacancy rate in the western region of the U.S. wascloser to 17% (AHA, 2001).


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The U.S. Bureau of Labor Statistics estimates that the national need for radiologytechnologists and technicians will increase almost 15% by 2010:

Need for Radiology Technicians and Technologists

2000-2010

21%

35%

0%

5%

10%

15%

20%

25%

30%

35%

40%

2000 2010

Source:Applied Radiology;http://www.amicas.com/what/news/clippings/Applied%20Radiology%207.02.doc

Montana:

Montana is already experiencing a severe shortage, and has already been contractingradiology services to other states, and even other countries. In Montana, the shortage ofimaging/radiology technicians will also be compounded by the lack of educationalprograms geared towards radiology.

Laboratory Technicians:

National:

The importance of lab technicians may be downplayed, but this profession is certainlycrucial to health care. In a survey conducted by AFT Healthcare, 64% of the hospitalsthat participated reported an inadequate number of lab workers. The AHA did its ownstudy and found the vacancy rate for lab technicians to be around 12%.

Various organizations present data that shows the extent of the shortage of clinicallaboratory technicians:

There are a projected 7,000 new jobs each year in this profession with an

additional 5,000 vacancies due to those leaving the field.ii

Employment is expected to grow to 348,000 by 2010 (BHPR, HRSA, 2002).

From 1995-2000, there was a -29% change in the number of clinical laboratory

technician graduates (BHPR, HRSA, 2002).

There was a -42.5% change in the number of medical laboratory technician and

technologist education programs (BHPR, HRSA, 2002).
http://www.amicas.com/what/news/clippings/Applied%20Radiology%207.02.dochttp://www.amicas.com/what/news/clippings/Applied%20Radiology%207.02.dochttp://www.amicas.com/what/news/clippings/Applied%20Radiology%207.02.doc


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Clinical Laboratory Worker Job Growth

2000-2010

295,000

348,000

260,000

270,000

280,000

290,000

300,000

310,000

320,000

330,000

340,000

350,000

360,000

2000 2010

Source: BHPR, HRSA; http://www.phppo.cdc.gov/CLIAC/pdf/Addenda/cliac0902/Grover0902N.pdf

Change in Medical Laboratory Technologist and Technician Education Programs

1985-2000

1985 1990 1995 2000 % Change1985-2000

MedicalLaboratoryTechnologists

584 420 357 255 -56.3%

MedicalLaboratory

Technicians

281 256 260 242 -13.9%

Total 865 676 617 497 -42.5%Source: BHPR, HRSA; http://www.phppo.cdc.gov/CLIAC/pdf/Addenda/cliac0902/Grover0902N.pdf

Montana:

In a survey conducted by the Clinical Laboratory Managers Association in 2002ii, thefollowing data was reported:

The average age of a clinical laboratory scientist (CLS) is 45.

There is a 12% vacancy rate in Montana.

Of 72 labs surveyed, 44 had three or less CLS in their lab.

Montana has 68% of clinical laboratory professionals compared to the national

average. (Center for Health Professions at UCSF)

The shortage of laboratory personnel will dwarf the shortage of nurses in

Montana.

While there are programs preparing students for CLS educational opportunities, they areonly affiliated with the Montana university system (undergraduate curricula exists atMontana State University, University of Montana, and Montana State University-
http://www.phppo.cdc.gov/CLIAC/pdf/Addenda/cliac0902/Grover0902N.pdfhttp://www.phppo.cdc.gov/CLIAC/pdf/Addenda/cliac0902/Grover0902N.pdfhttp://www.phppo.cdc.gov/CLIAC/pdf/Addenda/cliac0902/Grover0902N.pdfhttp://www.phppo.cdc.gov/CLIAC/pdf/Addenda/cliac0902/Grover0902N.pdf


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Billings). The universities participate in a collaborative effort with out-of-stateinstitutions, and because the students are out-of-state for their training, the state suffersbecause it cannot retain nearly enough graduates:ii

Out of 11 graduates from MSU in 2006, only one said she would return to

Montana.

Nursing:

National:

The nursing shortage is perhaps the most discussed problem in health care at the presenttime. Health care systems nationwide are scrambling to find solutions to ease the shortageoccurring now, and to find ways to address the daunting amount of nurses who will beneeded in the long-term. The Human Resources and Services Administration (HRSA)estimates that:

About 800,000 more registered nurses (RNs) will be needed by 2020 to

adequately meet demand(HRSA, 2006). 40% of the workforce will be older than 50 and nearing retirement in 2010, and

that as of now, the percentage of nurses under the age of 30 is dropping(HRSA,2006).

Also, according to a survey conducted by AFT Healthcare, more than 20% of

nurses who responded to the survey said that they were planning on leaving theprofession within five years for reasons other than retirement(AFT, 2003).

There will be a 12%, 20%, and 29% national shortage of RNs in 2010, 2015, and

2020, respectively (HRSA, 2006).

Various organizations have published data concerning the nursing shortage, and while

there are slight discrepancies, there is a unanimous agreement that the nursing shortagewill only continue to get worse.

A report by the American Association of Colleges of Nursing (AACN) predicts thatthere will be a need of more than one million new and replacement nurses by 2012.However, this gap will be hard to fill due to the relatively low number of nursinggraduates. More people are applying to nursing school and being enrolled, but morequalified applicants are also being turned away due to a shortage of faculty, lack ofclinical sites, budget constraints, etc. According to the AACN, 32,797 qualifiedapplicants were denied from entry-level baccalaureate nursing programs in 2004,

compared with the more than 11,000 qualified applicants who were turned away in

2003.


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HRSA Projecte d National Nursing Shortages (shown as

percentages) for 2010, 2015, 2020

12%

20%

29%

0%

5%

10%

15%

20%

25%

30%

35%

2010 2015 2020

Source: HRSA;http://bhpr.hrsa.gov/nursing/2003NELRPNSPRTC/Chapter2.htm

A majority of registered nurses are employed by hospitals (60%), and hospitalsnationwide are experiencing alarming vacancy rates. The AHA published a report thatstated:

Over one in seven hospitals reported an RN vacancy rate of over 20% (AHA,

2001).

RN vacancy rates will exceed 15% in the next two years (AHA, 2001).

The AACN published a similar report, stating that about 126,000 nurses are presentlyneeded in order to fill vacancies at hospitals, and that 75% of all hospital vacancies arefor nurses.

Montana:

The following graph is a synopsis of data compiled by HRSA that examines the projectedsupply and demand of registered nurses in Montana from 2000 to 2020. Other stateprojections may be found at:

http://bhpr.hrsa.gov/healthworkforce/reports/behindrnprojections/behindshortage.htm
http://bhpr.hrsa.gov/nursing/2003NELRPNSPRTC/Chapter2.htmhttp://bhpr.hrsa.gov/nursing/2003NELRPNSPRTC/Chapter2.htmhttp://bhpr.hrsa.gov/healthworkforce/reports/behindrnprojections/behindshortage.htmhttp://bhpr.hrsa.gov/nursing/2003NELRPNSPRTC/Chapter2.htmhttp://bhpr.hrsa.gov/healthworkforce/reports/behindrnprojections/behindshortage.htm


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Registered Nurses Supply vs. Demand

Montana Projections: 2000-2020

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

2000 2005 2010 2015 2020

SUPPLY

DEMAND

Source: HRSA;http://bhpr.hrsa.gov/healthworkforce/reports/behindrnprojections/behindshortage.htm

According to the Western Interstate Commission for Higher Education (WICHE),nursing is one of Montanas fastest growing jobs, and that nursing will see a 33%increase in its need. WICHE estimates that approximately 4,300 registered nurses willneed to be hired for new posts and to replace those leaving the field (WICHE, 2005).

Pharmacists:

National:

As the baby boomers age, they will rely more heavily on prescription medication. TheHealthcare Leadership Council reports:

The number of retail prescriptions filled per year in the U.S. increased

approximately 44% between 1992 and 1999 (from 1.9 billion to 2.8 billion), andthat number is expected to only increase (Healthcare Leadership Council, 2006).

The American Society of Health-System Pharmacists (ASHP) conducted a survey andfound that more than half of pharmacy directors stated that the general lack ofpharmacists have Delayed expansion of pharmacy programs and services into new areasand have resulted in reduction of services so that staff could be re-deployed or reassigned

to cover other areas (ASHP, 2003). The need for pharmacists is clearly critical.

Even with such a dramatic increase in the amount of prescription medication beingdispensed, there is still an extremely strong demand for pharmacists. A 2001 AHA studyreported a 21% hospital pharmacist vacancy rate. HRSA reports that pharmacy vacancyrates in the Federal sector are on the rise, and that some Department of Veterans Affairsand Native American health centers (5 in Montana) have some facilities with less thanhalf of their authorized pharmacist positions filled (HRSA, 2000).
http://bhpr.hrsa.gov/healthworkforce/reports/behindrnprojections/behindshortage.htmhttp://bhpr.hrsa.gov/healthworkforce/reports/behindrnprojections/behindshortage.htmhttp://bhpr.hrsa.gov/healthworkforce/reports/behindrnprojections/behindshortage.htm


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Montana:

In Montana, this is one of the fastest growing professions, and the number of pharmacistsis expected to grow 41% by 2012 (WICHE, 2005).

Physicians:

National:

Even though data has shown that about 20,000 doctors have entered the workforceannually for the past 20 years, there is still growing concern about a physician shortage.More doctors are choosing more specialized fields within medicine (i.e. anesthesiology,surgery, etc.), or are pursuing dual degrees (MD/MBA, MD/JD, MD/MPH) and are notpracticing medicine. While specialized doctors continue to increase, those in the moregeneral fields (family medicine and primary care) continue to decline. The NationalResidency Matching Program showed:

From 1997-2002, the number of physicians pursuing residencies inanesthesiology, radiology, and dermatology increased 288%, 95%, and 39%,respectivelythose pursuing family practice and general surgery declined by40% and 28%, respectively (Cejka, 2005).

HRSA has projected:

There will be a 51,000-228,000 physician shortage by 2020 (HRSA, 2003).

Physician requirements would increase about 28%, or around 996,400 doctors,

by 2020 (HRSA, 2003).

One part of the explanation for the shortage projection is that, currently, of

836,000 physicians, a third are older than 55 (HRSA, 2003).

Montana:

In Montana, the need for physicians is substantial. There is no official medical school inthe state, and the only medical education offered is through the WWAMI (Washington,Wyoming, Alaska, Montana, Idaho) program, which is run by the University ofWashington. Because of this, Montana undergraduate students experience a severedisadvantage compared to other undergraduates in pursuing medical education:

Currently, there is one slot (for medical school) per 46,000 people in Montana

the national average is one slot per 17,400. iii

Because of the limited number of slots for Montana students to participate in

WWAMI, only about 1 in 3 qualified applicants are accepted. iii

It will be difficult to replace those Montana physicians who will be leaving the workforcein the upcoming years, since 41% of Montanas physicians are already older than55.iiiEven with about 40% of Montana WWAMI graduates returning to practice in thestate and 50% of total WWAMI graduates choosing to practice in Montana, there is still asevere need for physicians.iii The state already has two incentive programs in place toattract physicians to practice in rural areas:


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TheMontana Rural Physician Incentive Program (MRPIP) offers up to $45,000

in debt repayment to physicians who practice in rural Montana areas for at leastfive years. The program has experienced an 85% retention rate. iii

TheRural Physicians Creditgives physicians practicing in an area without a 60

bed hospital within a 30-mile radius up to a $5,000 tax deduction against state

tax liability for up to four years.iii

Even with these programs in place, they cannot compete with other state programs,which, on average, offer about $20,000 per year for four years. iii

The following represents the primary care Health Professionals Shortage Areas (HPSAs)in Montana:


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i Mouradian, Wendy. Addressing the Dental Workforce in Montana: Regional Initiative in Dental Education (RIDE)Program. University of Washington, 2006.ii Letter from Barbara Hudson, MS, CLS and Tim Ford, Ph.D to John Van Zytveld, Ph.D. Clinical Laboratory ScienceTraining Program within the Montana University System. 1-2. June 5, 2006. (copy on file with Author).iii Lipp-Sirota, Emily et al. Recommendations to the Montana Board of Regents Regarding Physician Education andIncentives in the State. March 2, 2006.

Online Data Sources:

ProfessionSource WebsitesDentistsADHA:http://www.ahda.org/media/releases/archives/2004/070804.htmPoynteronline (Tomkins Article): http://www.poynter.org/column.asp?id=2&aid=49010Imaging/RadiologyTechniciansApplied Radiology:http://www.amicas.com/what/news/clippings/Applied%20Radiology%207.02.docThe Center for the Health Professions (UCSF):

http://www.futurehealth.ucsf.edu/pdf_files/Diagnos_Imaging_Brief2.pdfLab TechniciansAFT Healthcare:http://www.aft.org/pubs-reports/healthcare/Vanishing-Nurse.pdf

BHPR, HRSA:http://www.phppo.cdc.gov/CLIAC/pdf/Addenda/cliac0902/Grover0902N.pdf

Healthcare Leadership Council:http://www.hlc.org/html/background6.htmlNursingAACC:http://www.aacc.nche.edu/Content/NavigationMenu/HotIssues/Nursing/Facts[1].pdf

AACN:http://www.aacn.nche.edu/Media/FactSheets/NursingShortage.htm

AFT Healthcare:http://www.aft.org/pubs-reports/healthcare/Vanishing-Nurse.pdf

AHA:http://www.aha.org/aha/key_issues/workforce/resources/Content/FcgWorkforceReport.pdf

HRSA:http://bhpr.hrsa.gov/nursing/2003NELRPNSPRTC/Chapter2.htmhttp://bhpr.hrsa.gov/healthworkforce/reports/changedemo/default.htm

WICHE:http://www.wiche.edu/Workforce/mt-05.pdfPharmacistsASHP:http://www.ashp.org/practicemanager/StaffSurvey2003.pdf

Healthcare Leadership Council:http://www.hlc.org/html/background6.html

HRSA:http://bhpr.hrsa.gov/healthworkforce/reports/pharmacist.htm

WICHE:http://www.wiche.edu/Workforce/mt-05.pdfPhysiciansAMA:http://www.ama-assn.org/amednews/site/free/prsa0620.htm

Cejka Search:http://www.cejkasearch.com/news/physician_recruitment_woes_of_medical_groups.htm

HRSA:http://bhpr.hrsa.gov/healthworkforce/reports/changedemo/default.htm
http://www.poynter.org/column.asp?id=2&aid=49010http://www.amicas.com/what/news/clippings/Applied%20http://www.futurehealth.ucsf.edu/pdf_files/Diagnos_Imaging_Brief2.pdfhttp://www.aft.org/pubs-reports/healthcare/Vanishing-Nurse.pdfhttp://www.phppo.cdc.gov/CLIAC/pdf/Addenda/cliac0902/Grover0902N.pdfhttp://www.aacc.nche.edu/Content/NavigationMenu/HotIssues/Nursing/Facts%5B1%5D.pdfhttp://www.aacn.nche.edu/Media/FactSheets/NursingShortage.htmhttp://www.aft.org/pubs-reports/healthcare/Vanishing-Nurse.pdfhttp://www.aha.org/aha/key_issues/workforce/resources/Content/FcgWorkforceReport.pdfhttp://bhpr.hrsa.gov/nursing/2003NELRPNSPRTC/Chapter2.htmhttp://bhpr.hrsa.gov/healthworkforce/reports/changedemo/default.htmhttp://www.ashp.org/practicemanager/StaffSurvey2003.pdfhttp://bhpr.hrsa.gov/healthworkforce/reports/pharmacist.htmhttp://www.ama-assn.org/amednews/site/free/prsa0620.htmhttp://www.cejkasearch.com/news/physician_recruitment_woes_of_http://www.poynter.org/column.asp?id=2&aid=49010http://www.amicas.com/what/news/clippings/Applied%20http://www.futurehealth.ucsf.edu/pdf_files/Diagnos_Imaging_Brief2.pdfhttp://www.aft.org/pubs-reports/healthcare/Vanishing-Nurse.pdfhttp://www.phppo.cdc.gov/CLIAC/pdf/Addenda/cliac0902/Grover0902N.pdfhttp://www.aacc.nche.edu/Content/NavigationMenu/HotIssues/Nursing/Facts%5B1%5D.pdfhttp://www.aacn.nche.edu/Media/FactSheets/NursingShortage.htmhttp://www.aft.org/pubs-reports/healthcare/Vanishing-Nurse.pdfhttp://www.aha.org/aha/key_issues/workforce/resources/Content/FcgWorkforceReport.pdfhttp://bhpr.hrsa.gov/nursing/2003NELRPNSPRTC/Chapter2.htmhttp://bhpr.hrsa.gov/healthworkforce/reports/changedemo/default.htmhttp://www.ashp.org/practicemanager/StaffSurvey2003.pdfhttp://bhpr.hrsa.gov/healthworkforce/reports/pharmacist.htmhttp://www.ama-assn.org/amednews/site/free/prsa0620.htmhttp://www.cejkasearch.com/news/physician_recruitment_woes_of_

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