Addressing “Stress” in the Health Addressing “Stress” in the Health Care WorkforceCare Workforce

((Human Resources for HealthHuman Resources for Health))

Thomas C. RickettsThomas C. RickettsThe University of North CarolinaThe University of North Carolina

Workforce Problems and Workforce Problems and SolutionsSolutions

The problems are usually defined as The problems are usually defined as NationalNational (e.g. a national shortage of (e.g. a national shortage of nurses).nurses).

The impacts are very The impacts are very LocalLocal (a facility (a facility cannot operate effectively, care is cannot operate effectively, care is not available).not available).

States and Institutions States and Institutions are often left are often left to find the solutions.to find the solutions.

Current Research in HRHCurrent Research in HRH

To verify the national situation and To verify the national situation and interpret it. Stress = Shortageinterpret it. Stress = ShortageShortage of numbersShortage of prestigeShortage of organization

““Inconvenient Truths” from EconomicsInconvenient Truths” from EconomicsThe same work can be done by different

professionsThere are less expensive ways to prepare

professionals

Uncomfortable truths conflict with...Uncomfortable truths conflict with...

Practice Acts for Healing ArtsPractice Acts for Healing Arts(a.k.a. “Fighting Words”)

Professional IdentitiesProfessional IdentitiesCommitment, compassion

Awkward occupational impulsesAwkward occupational impulsesHypercredentialismGrowing fluidity in labor markets

Old line of Research ProductsOld line of Research Products

Shortage of Numbers and Shortage of Numbers and organization (EngagedResearch®)organization (EngagedResearch®)

Shortage of Prestige Shortage of Prestige (AdvocacyResearch©)(AdvocacyResearch©)

Inconvenient (and frankly ugly) Inconvenient (and frankly ugly) Truths (PureResearch™)Truths (PureResearch™)

New, Needed Product LineNew, Needed Product Line

© ® ™

The missing dataThe missing data

Regularly collected inventories that Regularly collected inventories that yield timely projections of supply yield timely projections of supply and needand need

Rhetoricof Shortage

Reliability of Data

The missing policyThe missing policy

Support for independent, ongoing, Support for independent, ongoing, longitudinal research capacity in longitudinal research capacity in health workforce.health workforce.

Yes, money.Yes, money.

Questions we need to getQuestions we need to get(and sometimes do)(and sometimes do)

What is the proper mix of _______ What is the proper mix of _______ necessary to provide ______ ?necessary to provide ______ ?Practitioners .... Access; Services ..... Cost-effective CareProviders .... Capacity to Meet Demand

How will directly paying ______ affect How will directly paying ______ affect ______?______?Nurses .... Overall CostsOther professionals .... Access to Care

Questions we always getQuestions we always getWhat will a _________ cost?What will a _________ cost?

Medical SchoolDental SchoolExpanded Ph.D. Nursing Program

Part of our SiloResearch™Product Line

Questions that are emergingQuestions that are emerging

Is there a “BIG TENT” for health workforce Is there a “BIG TENT” for health workforce policy making policy making And, by extension, research.

Example Example TITLE VIITITLE VII support to health support to health workforceworkforce

NOWNOW: a mix of related programs with little : a mix of related programs with little ability to show impact.ability to show impact.

FUTUREFUTURE: Coordinated policy with : Coordinated policy with measurable outputs and impacts.measurable outputs and impacts.

The Political Economy of The Political Economy of Underservice in the Safety NetUnderservice in the Safety Net

Current system depends on rigid Current system depends on rigid definition of local underservicedefinition of local underservice

Underservice is in demand....!Underservice is in demand....!RESEARCH Question: How can we RESEARCH Question: How can we

optimally allocate resources?optimally allocate resources?Safety netSystem and organization

Questions I wish we would ask...Questions I wish we would ask...

Can we train for Can we train for efficiencyefficiency as well as as well as we train for we train for proficiencyproficiency

What makes an What makes an interdisciplinaryinterdisciplinary team work well?team work well?

How can we evaluate programs like How can we evaluate programs like Title VII and VIII in a Title VII and VIII in a Fair and Fair and Balanced™Balanced™ way. way.

And the kickers...And the kickers...

Who actually Who actually takes care of takes care of sick people?sick people?

Who actually Who actually keeps people keeps people well?well?

First steps to wisdomFirst steps to wisdom

How many practitioners are there?How many practitioners are there?When do they enter and leave When do they enter and leave

practice?practice?Where do they practice?Where do they practice?What do they practice?What do they practice?

finfin

Components of Change, Physicians, Components of Change, Physicians, 2001-20052001-2005

New to file1,681

(status change 480newly licensed 1,201)

2001 Supply16,392

Left File1,304

2002 total16,769

Net gain 377

New to file1,563

(status change 508newly licensed 1,055)

2002 Supply16,769

Left File1,242

2003 total17,090

Net gain 384

Source: NC Health Professions Data System, with data provided by the North Carolina Medical Board.Note: Newly licensed physicians are those who are new to file with a license date in the current or previous year. Status change physicians are those who were licensed in NC in an earlier year but were either inactive or active out of state in the previous year.

New to file1,413

(status change 480newly licensed 933)

2003 Supply17,090

Left File1,154

2004 total17,349

Net gain 259

New to file1,550

(status change 667newly licensed 883)

2004 Supply17,349

Left File1,004

2005 total17,895

Net gain 546

10

12

14

16

18

20

22

Year

2005

2007

2009

2011

2013

2015

2017

2019

2021

2023

2025

2027

2029

Year

Pro

vid

er P

er 1

0,00

0 P

op

ula

tio

n

Baseline, not age-adj

Baseline

Medical Grads + 30%

Recruitment + 15%

Projections: PhysiciansProjections: Physicians

15

17

19

21

23

25

27

2004

2006

2008

2010

2012

2014

2016

2018

2020

2022

2024

2026

2028

2030

Year

Pro

vid

ers

Pe

r 1

0,0

00

Po

pu

lati

on

Baseline (High)

Baseline (Low)

NPC Educ + 15%

Projections: All PractitionersProjections: All Practitioners

Birth States of NC Physicians, 2003Birth States of NC Physicians, 2003n=17,315*n=17,315*

SC522

GA434

OH691

IL450

VA614

NY1498

NJ485

PA872

Source: AMA Masterfile, December 31, 2003. Note: Birthplace was unknown for 476 physicians. Percentages are based on 16,839 physicians for whom birthplace data were available. 2,668 physicians practicing in NC were born outside of the U.S. (16% of total).

NC301618%

NC301618%

Where NC Physicians went to Where NC Physicians went to Medical School, 2003 Medical School, 2003

n = 17,315n = 17,315

Source: AMA Masterfile, December 31, 2003. Note: 2,303 physicians practicing in NC went to medical schools outside the U.S. (13% of total).

SC524

GA520

OH652

IL430

VA807

NY900

PA817

TX435

NC477128%

NC477128%

TN463

Where NC Physicians Received Residency Where NC Physicians Received Residency Training, 2003Training, 2003

n=17,315* Licensed North Carolina physiciansn=17,315* Licensed North Carolina physicians

NC584635%

NC584635%

SC598GA

462

OH631

VA828

NY1082

PA859

FL508

TX563

CA489

Source: AMA Masterfile, December 31, 2003. Note: Residency information was missing for 606 physicians. Percentages are based on 16,709 physicians for whom data were available.

39% of NC Medical 39% of NC Medical Students and 49% of NC Students and 49% of NC Post-graduate Trainees Post-graduate Trainees Remain in the State Remain in the State

NC39% / 49%retention

NC39% / 49%retention

SCGA

FL

TX

CA

TN

VA

NY

Source: AMA Masterfile, December 31, 2003.