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Health Workforce Trends and Policy in Nevada and the United States

Tabor Griswold, PhD

Health Services Research Analyst

Office of Statewide Initiatives

University of Nevada School of Medicine

CHS Fall 2015

September 21, 2015

1

Overview

• Presenting Nevada’s Health Care System

• Overview of the Major Inputs

• Forces Affecting Supply

• Discussion

• Forces Affecting Demand

• Discussion

• Forces Affecting Shortages

• Discussion

2

Nevada’s Health Workforce

3

Health Care Industries

Health Care Industry Jobs in Nevada: 88,094

Health Care Occupations

Health Care Occupation Jobs in Nevada: 77,481

55,677 health care jobs in health care industries(50.7% of the health workforce)

31,495 other jobs in health care industries(29.5% of the health workforce)

21,804 health care jobs in other industry sectors(19.8% of the health workforce)

Source: Nevada Department of Employment, Training, and Rehabilitation (2012).

109,898 total jobs or 9.9% of the civilian workforce in Nevada

· Health Diagnosing and Treating Practitioners

· Health Technologist and Technicians

· Healthcare Support Occupations

· Ambulatory Health Care Services

· Hospitals

· Nursing and Residential Care Facilities

• Demographic change

• The economy

• ACA, health insurance coverage expansions

• Population health

• Health care system change

• Science and technological change

• State and federal policy

4

Forces Affecting Health Care

Forces Affecting Health Workforce Supply

• Higher education programs and capacity

• K-12 education pipeline

• Health professions licensing and regulation

• State policy and budget – esp. funding for higher education health education programs

• Federal policy – esp. support for health workforce education and training

5

Health Workforce Demand

6

Health Workforce Demand in Nevada

• Health sector has experienced modest employment gains since 2007

• Population growth and aging, as well as ACA-related insurance coverage expansions will generate above average demand for health care workers in Nevada

• Overall growth in health care employment (16.3%) is projected to exceed the average for all occupations in Nevada (11.6%) through 2020

7

Health Care Employment in Nevada – 2005 to 2014

Number of Jobs (Thousands)

77.4 79.984.0

87.0 89.1 91.0 92.895.6 97.1 99.9

3… 37.7 38.8 39.9 40.7 41.4 41.8 42.9 43.8 45.2

20.1 20.6 21.6 22.4 22.7 23.4 23.9 24.4 24.2 24.9

0.0

20.0

40.0

60.0

80.0

100.0

Health Care and Social Assistance Ambulatory Health Care Services Hospitals

2006 2007 2008 2009 2010 2011 2012 2013

Source: Nevada Department of Employment, Training, and Rehabilitation (2014).

2005

Health Care Employment in Las Vegas – 2005 to 2014

Number of Jobs (Thousands)

51.854.0

56.759.2 60.6 61.9

63.766.5 68.2 69.1

24.8 26.4 27.2 28.1 28.7 29.6 30.2 31.2 32.2 33.2

12.4 12.8 13.7 14.6 15.0 15.2 15.5 16.0 16.2 16.8

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Health Care and Social Assistance Ambulatory Health Care Services Hospitals

2005 2006 2007 2008 2009 2010 2012 2013

Source: Nevada Department of Employment, Training, and Rehabilitation (2014).

2011

Projected Demand for Health Care Workers by Industry in Nevada through 2020

• Ambulatory Care: 7,778 jobs (+14.9%)

– Offices of physicians: 2,468 jobs (+8.3%)

– Home health care services: 1,643 jobs (+34.9)

• Hospitals: 3,168 jobs (+10.4%)

• Nursing Homes and Residential Care Facilities: 2,581 jobs (24.4%)

All Health Care Industries: + 13,527 jobs (+16.3%)

10

High Demand Health Occupations in Nevada – Annual Opening through 2020

• Registered nurses (RNs): 610 job openings

• Home health aides: 211

• Nursing assistants: 140

• Medical assistants: 137

• Medical secretaries: 108

• Licensed practical nurses (LPNs): 98

• Pharmacists: 86

11

High Demand Health Occupations in Nevada – Annual Opening through 2020

• Dental assistants: 84 job openings

• Pharmacy technicians: 82

• Massage therapists: 92

• Child, family, and school social workers: 80

• Primary care physicians: 74

• Fitness trainers and aerobics instructors: 72

• Medical and health services managers: 70

12

High Demand Health Occupations in Nevada

• Eleven “high demand” health care occupations are ranked among the top 100 occupations in Nevada with the largest projected employment growth through 2020

• Growing demand for health services will generate nearly 3,000 jobs for registered nurses and 1,500 jobs for home health aides by 2020

13

High Demand Health Occupations in Nevada

• 20 of the top 35 “high demand” health care occupations possess an average annual salary greater than average annual salary of $41,497 for all occupations in Nevada

• 22 require a post-secondary degree for licensure in the State of Nevada

14

Health Workforce Supply

15

Health Workforce Supply in Nevada

• Steady growth in the number of licensed health professionals

• “Treading water” in the number of licensed health professionals per capita

• Severe health workforce shortages compounded by an aging health workforce and ensuing ACA-related demand

• Persistent specialty shortages and geographic maldistribution of physicians and most other health professionals

16

17

160.7150.0 154.9 159.1

170.0 171.3

0

50

100

150

200

250

2002 2004 2006 2008 2010 2012

Metropolitan North

Metropolitan South

Rural and Frontier Northeast

Rural and Frontier Northwest

Rural and Frontier South

Nevada Total

Number of Licensed Allopathic Physicians (MDs) per 100,000 Population in Nevada – 2002 to 2012

Source: Nevada State Board of Medical Examiners (2002, 2004, 2006, 2008, 2010, 2012), Nevada State Demographer’s Office (2002, 2004, 2006, 2008, 2010, 2012).

18

592.7 579.6612.5

637.4

704.5734.9

250

500

750

1000

2002 2004 2006 2008 2010 2012

Metropolitan North

Metropolitan South

Rural and Frontier Northeast

Rural and Frontier Northwest

Rural and Frontier South

Nevada Total

Number of Licensed Registered Nurses (RNs) per 100,000 Population in Nevada – 2002 to 2012

Source: Nevada State Board of Nursing (2002, 2004, 2006, 2008, 2010, 2012), Nevada State Demographer’s Office (2002, 2004, 2006, 2008, 2010, 2012).

Physician Workforce Rankings

• Physicians, MDs – 45th among US states

• Physicians, DOs – 18th

• Physicians , MD & DO – 45th

• Patient Care Physicians – 44th

• Primary Care Physicians – 46th

• Patient Care Primary Care Physicians – 46th

• Residents & Fellows – 46th

• Residents & Fellows in Primary Care – 46th

19

Source: American Medical Association (2012), O’Leary Morgan and Morgan (2012), National Center for the Analysis of Healthcare Data (2012).

Physician Workforce by Medical Specialty

• General and Family Practitioners – 46th

• Pediatricians – 46rd

• Obstetricians and Gynecologists – 40th

• Ophthalmologists – 48nd

• Orthopedic Surgeons – 51st

• General Surgeons – 51st

• Specialty Surgeons – 51st

20

Source: American Medical Association (2012), O’Leary Morgan and Morgan (2012), National Center for the Analysis of Healthcare Data (2012).

Health Workforce Rankings – NursingNumber of Licensed Nurses per 100,000 Population

• Registered Nurses – 50th

• Nurse Practitioners – 41st

• Clinical Nurse Specialists – 26th

• Certified Nurse Midwives – 44th

• Certified Nurse Anesthetists – 51st

• Licensed Practical Nurses – 49th

Source: CQ Press Health Care State Rankings (2011).

21

Health Workforce Rankings –Other Health Professionals

Number of Actively Licensed Health Professionals per 100,000 Population

• Dentists – 31st

• Dental Hygienists – 40th

• EMTs and Paramedics – 45th

• Optometrists – 49th

• Pharmacists – 34th

• Physical Therapists – 47th

• Physician Assistants in Clinical Practice –37th

• Psychologists – 47th

Source: CQ Press Health Care State Rankings (2011).

22

Primary CareNumber of MDs per 100,000 Population – 2012

20.6

1.4

39.8

13.89.9

31.0

1.4

39.6

20.6

11.9

29.1

2.2

54.4

25.7

13.9

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Family Medicine General Practice Internal Medicine Pediatrics OB/Gyn

Nevada Mountain Region US

Source: AMA. Physician Characteristics and Distribution in the US (2014).

23

Medical and Surgical SpecialtiesNumber of MDs per 100,000 Population – 2012

8.2

5.34.9

2.7

6.5

9.9

8.1

5.0

3.4

12.112.0

8.27.4

4.4

12.7

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

General Surgery Orthopedic Surgery CardiovascularDisease

GI Psychiatry

Nevada Mountain Region US

Source: AMA. Physician Characteristics and Distribution in the US (2014).

24

25

SHORTAGES

Recap of Policy Levers to Address Health Workforce Shortages in Nevada

• Higher education programs and capacity –esp. public program and opportunities

• K-12 education pipeline

• Health professions licensing and regulation

• State policy and budget – esp. funding for higher education health education programs

• Federal policy – esp. support for health workforce education and training

26

Primary CareWorkforce Shortages

in Nevada

• Most regions of rural and frontier Nevada are primary care HPSAs

• 142,500 rural residents (51%) live in a primary care HPSA

• 816,000 urban residents (32%) live in a primary care HPSA, including 612,000 residents of Clark County

27

28

Physician and Primary Care Workforce – 2014Number per 100,000 Population

Source: See references for Tables 4.6 through 4.42 in Nevada Rural and Frontier Health Data Book 2015, p. 212, Table 4.48.

ProfessionRural &Frontier

Urban Nevada

Allopathic Physicians (MD) 72.8 183.4 172.3

Adv Practitioners of Nursing (APN) 19.7 33.2 31.9

Osteopathic Physicians (DO) 15.8 21.6 21.0

Physician Assistants (PA) 14.1 20.9 20.2

Primary Care Physicians (MD & DO) 49.6 90.4 86.3

Dental CareWorkforce Shortages

in Nevada

• Most regions of rural and frontier Nevada are dental care HPSAs

• 145,500 rural residents (51%) live in a dental care HPSA

• 758,000 urban residents (32%) live in a dental care HPSA, including 613,000 residents of Clark County

30

Oral Health Care Workforce – 2014Number per 100,000 Population

Source: See references for Tables 4.6 through 4.42 in Nevada Rural and Frontier Health Data Book 2015, p. 212, Table 4.48.

ProfessionRural &Frontier

Urban Nevada

Dentists 38.0 56.8 54.9

Dental Hygienists 36.6 37.1 37.0

Mental CareWorkforce Shortages

in Nevada

• All regions of rural and frontier Nevada are mental care HPSAs

• 286,000 rural residents (100%) live in a mental care HPSA

• 1.2 million urban residents (31%) live in a mental care HPSA, including 737,000 residents of Clark County (31%)

32

Mental and Behavioral Health Workforce – 2014Number per 100,000 Population

Source: See references for Tables 4.6 through 4.42 in Nevada Rural and Frontier Health Data Book 2015, p. 212, Table 4.48.

ProfessionRural &Frontier

Urban Nevada

Alcohol, Drug, & Gambling Counselors 55.5 42.0 43.4

Marriage & Family Therapists 17.3 25.1 24.3

Psychiatrists 0.7 7.0 6.4

Psychologists 6.0 14.0 13.2

Social Workers (LSWs) 27.1 40.9 39.5

County Profile Reportsfor Nevada

• Data from the Nevada Rural and Frontier Health Data Book –Seventh Edition

• Demographic, economic, health, workforce, resources data about 286,000 rural residents and 1.2 million urban residents

34

Recap of Policy Levers to Address Health Workforce Shortages in Nevada and the US

• Higher education programs and capacity

• K-12 education pipeline

• Health professions licensing and regulation

• State policy and budget – esp. funding for higher education health education programs, UME, loan repayment and forgiveness policy

• Federal policy – esp. support for health workforce education and training, GME

35

Tabor Griswold, PhDHealth Services Research Analyst

Office of Statewide InitiativesUniversity of Nevada School of Medicine

(775) 682-8475 tgriswold@medicine.nevada.edu

http://www.medicine.nevada.edu/statewide/