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Health Workforce Assessment Health Workforce Assessment Hawaii Island Hawaii Island
Kelley Withy, MD, PhDKelley Withy, MD, PhDHawaii/Pacific Basin AHECHawaii/Pacific Basin AHEC
UH JABSOMUH JABSOM10/26/0710/26/07
We know we don’t have enough We know we don’t have enough providers, but how bad is it?providers, but how bad is it?
How do we quantify it?How do we quantify it?
Where is the greatest need?Where is the greatest need?
What kind of providers do we need?What kind of providers do we need?
What do we do to solve the problems? What do we do to solve the problems?
How do we know if what we are doing is How do we know if what we are doing is working?working?
Methods for assessing workforceMethods for assessing workforce
Since 2002, 15 state and three national studies Since 2002, 15 state and three national studies (including HRSA) have been performed all (including HRSA) have been performed all demonstrating medical shortagesdemonstrating medical shortages
Most states use licensure data to assess supplyMost states use licensure data to assess supply
Some states survey providersSome states survey providers
Less states use focus groups, statewide Less states use focus groups, statewide meetings or community informantsmeetings or community informants
For demand most states and HRSA use provider For demand most states and HRSA use provider to population ratiosto population ratios
DefinitionsDefinitions
Supply-What we haveSupply-What we have– Number of bodiesNumber of bodies– Number of full time equivalents (FTE)Number of full time equivalents (FTE)– Productivity Productivity
Demand-What we wantDemand-What we want– Need-what we think the area would need Need-what we think the area would need
based on assumptionsbased on assumptions– Utilization-what is actually usedUtilization-what is actually used
Hawaii PictureHawaii Picture
Licensing data has mailing addresses onlyLicensing data has mailing addresses onlyCenter for Nursing surveys nursesCenter for Nursing surveys nursesHHIC researching physician characteristicsHHIC researching physician characteristicsHPCA surveys CHCsHPCA surveys CHCsDOH tracks shortages and HPSA designationsDOH tracks shortages and HPSA designationsNHHSP surveys their graduatesNHHSP surveys their graduatesSHPDA surveys hospitalsSHPDA surveys hospitalsDOL follows trends in employment rates DOL follows trends in employment rates Schools and professional associations contact Schools and professional associations contact folksfolks
Hawaii workforce researchHawaii workforce research
NO SINGLE SOURCE for workforce information NO SINGLE SOURCE for workforce information and analysisand analysisHawaii Health Workforce Hui formed in 2003 is a Hawaii Health Workforce Hui formed in 2003 is a collaboration between Hawaii Departments of collaboration between Hawaii Departments of Health and Labor, Primary Care Association, Health and Labor, Primary Care Association, Native Hawaiian Health Scholarship program, Native Hawaiian Health Scholarship program, University of Hawaii, State Health Planning and University of Hawaii, State Health Planning and Development, Rural Health Association, Hawaii Development, Rural Health Association, Hawaii Health Service Corporation Human Resources Health Service Corporation Human Resources Department, FM Residency program, and many Department, FM Residency program, and many more.more.
Hawaii Health Workforce Hawaii Health Workforce CollaborativeCollaborative
Vision: We envision a healthcare system in Vision: We envision a healthcare system in Hawaii with a full complement of health care Hawaii with a full complement of health care workers distributed to meet the health needs of workers distributed to meet the health needs of the entire state. the entire state.
Mission statement: Improve access to and quality Mission statement: Improve access to and quality of healthcare in Hawaii by identifying unmet of healthcare in Hawaii by identifying unmet health workforce needs and developing solutions.health workforce needs and developing solutions.
Hawaii Health Workforce Hawaii Health Workforce AssessmentAssessment
Collaborative effort supported by Shipper’s Collaborative effort supported by Shipper’s Wharf Trust and Act 219, Session Laws of Wharf Trust and Act 219, Session Laws of Hawaii, 2007 Hawaii, 2007
Identify the location, specialty and FTE of Identify the location, specialty and FTE of all licensed health professionals working in all licensed health professionals working in HawaiiHawaii
Licensed medical specialties to be Licensed medical specialties to be assessedassessed
AudiologyAudiologyDental HygienistDental HygienistDentistDentistEmergency Medical Emergency Medical TechnicianTechnicianMarriage and Family Marriage and Family CounselorCounselorMedical DoctorMedical DoctorDoctor of OsteopathyDoctor of OsteopathyMental Health Mental Health CounselorCounselor
Occupational Occupational TherapistTherapistOptometristOptometristPharmacistPharmacistPhysical TherapistPhysical TherapistPhysician assistantPhysician assistantPodiatristPodiatristPsychologistPsychologistSocial WorkerSocial WorkerSpeech PathologySpeech Pathology
Activities (cont)Activities (cont)
Estimate present utilization for licensed Estimate present utilization for licensed health workers based on utilization rates health workers based on utilization rates by insured individualsby insured individuals
Use this to estimate present and future Use this to estimate present and future need for servicesneed for services
Assessing demandAssessing demand
Number of visits to different types of Number of visits to different types of providers by zip code for insured patientsproviders by zip code for insured patients
Extrapolate to entire population taking into Extrapolate to entire population taking into account age and genderaccount age and gender
Convert this to number of FTEs for each Convert this to number of FTEs for each type of providertype of provider
Compare with supply numbersCompare with supply numbers
Activities (Con’t)Activities (Con’t)
Identify gaps in health workforceIdentify gaps in health workforce
Project future need and supplyProject future need and supply
Research possible solutionsResearch possible solutions
Future supply and demandFuture supply and demand
Review trends in number of visits and Review trends in number of visits and number of providersnumber of providers
Develop a model that takes into account Develop a model that takes into account population specifics of Hawaii including population specifics of Hawaii including pattern of illness, geographic barriers, pattern of illness, geographic barriers,
Project findings out through 2020Project findings out through 2020
Assess changes every year to see if our Assess changes every year to see if our projection model is accurateprojection model is accurate
Physician ShortagePhysician Shortage
772,000749,400
921,200
809,100
680,500
-
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
1,000,000
2005 2010 2015 2020 2025 2030
Year
FT
E P
hy
sic
ian
s (
ex
cl.
resi
de
nts
)
Baseline Supply Baseline Demand
Finding Providers on Hawaii IslandFinding Providers on Hawaii Island
Licensees with Big Island zip codesLicensees with Big Island zip codes
Insurance provider listsInsurance provider lists
Hospital privilege listsHospital privilege lists
Offices, groups, associationsOffices, groups, associations
Yellow pagesYellow pages
InternetInternet
Contacting community members and providersContacting community members and providers
Contacting offices by phone for confirmationContacting offices by phone for confirmation
PreliminaryPreliminary Estimate of Providers Estimate of Providers on Hawaii Islandon Hawaii Island
NeedNeed Supply*Supply*
Allergy/immunAllergy/immun 22 1.151.15
CardiologyCardiology 1111 5.95.9
DermatologyDermatology 55 2.32.3
EndocrinologyEndocrinology 22 00
Ear/Nose/ThrtEar/Nose/Thrt 55 1.61.6
GastroGastro 66 4.64.6
Heme OncHeme Onc 55 1.61.6
Infectious DsInfectious Ds 22 0.00.0
NephrologyNephrology 33 1.151.15
NeurologyNeurology 66 .5.5
Obstetrics/GynObstetrics/Gyn 2020 1414
OphthalmologyOphthalmology 66 6.056.05
OrthopedicsOrthopedics 1111 1.551.55
PsychPsych 2020 19.4519.45
PulmonaryPulmonary 44 1.551.55
RheumatologyRheumatology 22 00
Primary carePrimary care 115115 9999
Mapping of resultsMapping of results
Zip code map demarcated as closely as Zip code map demarcated as closely as possible to judicial districts: created 8 possible to judicial districts: created 8 regionsregions
Population mapped and approximated to Population mapped and approximated to 2007 (increase 15%)2007 (increase 15%)
Provider need estimated using WWAMI Provider need estimated using WWAMI numbersnumbers
Existing providers from licensure listExisting providers from licensure list
**Preliminary Results
Possible solutions???Possible solutions???
ImmediateImmediate– Enhanced recruitment using diverse Enhanced recruitment using diverse
incentives: incentives: Financial: pay, signing bonuses, malpractice, loan Financial: pay, signing bonuses, malpractice, loan repaymentrepaymentHousing, mentoring, jobs for spouse, web based Housing, mentoring, jobs for spouse, web based schooling, community involvementschooling, community involvement
– Increase fly over providersIncrease fly over providers– TelemedicineTelemedicine– Health insurance reformHealth insurance reform
Intermediate (5 yr)Intermediate (5 yr)
Employment model group to serve all areas Employment model group to serve all areas and/or specialty clinic creationand/or specialty clinic creationScholarship and loan repaymentScholarship and loan repaymentIncrease size of training programsIncrease size of training programsFamily Medicine and other training programs in Family Medicine and other training programs in rural areasrural areasThe advanced medical home (a care The advanced medical home (a care coordination model) coordination model) Reforming reimbursement policies to create Reforming reimbursement policies to create financial incentives for improving quality and financial incentives for improving quality and efficiencyefficiencyDecreased regulatory restraints and paperworkDecreased regulatory restraints and paperworkTort reformTort reform
Long term (5-10 years)Long term (5-10 years)
Pipeline Pipeline Rural health interest groups Magnet schoolsRural health interest groups Magnet schools
Enrichment programsEnrichment programs
Mentoring (continuous student support)Mentoring (continuous student support)
Selective school admission policiesSelective school admission policies
Scholarship/loan repaymentScholarship/loan repayment
Magnet hospitalsMagnet hospitals– i.e. neuroi.e. neuro
Just Imagine…Just Imagine…
Coordinated no-cost system for advertisingCoordinated no-cost system for advertisingWeb based promotional materialsWeb based promotional materialsSave funds for interviewing a large selection for Save funds for interviewing a large selection for providers interested in rural practice through providers interested in rural practice through advertisingadvertisingHave them visit and learn about communityHave them visit and learn about communityCommunity chooses best candidateCommunity chooses best candidateIncentives-financial, housing, malpractice, loan Incentives-financial, housing, malpractice, loan repayment, etc.repayment, etc.Professional community established, all Professional community established, all necessary supplies and facilities availablenecessary supplies and facilities available
Just imagine…Just imagine…
Pleasant working environment, telemedicine and Pleasant working environment, telemedicine and specialist supportspecialist supportCaring for patients is a collaborative team effortCaring for patients is a collaborative team effortAll necessary facilities are availableAll necessary facilities are availableCommunity involves provider in community lifeCommunity involves provider in community lifeProvider feels a part of the communityProvider feels a part of the communityGets marriedGets marriedConnections for spouse and educational Connections for spouse and educational supplementation for kidssupplementation for kidsProvider lives happily ever afterProvider lives happily ever afterAnd so does the communityAnd so does the communityProvider and community train the future providers…Provider and community train the future providers…
Just imagine…Just imagine…
Promising students in your community nurtured, Promising students in your community nurtured, mentored, receive additional education and mentored, receive additional education and career experiences and have preferential career experiences and have preferential admission to health professions schools with admission to health professions schools with scholarshipsscholarshipsTraining continues in the rural areas where they Training continues in the rural areas where they came fromcame fromThey are rewarded for returning and staying in They are rewarded for returning and staying in the rural areas (loan repayment, practice the rural areas (loan repayment, practice resources, professional family, healthcare team, resources, professional family, healthcare team, community acceptance)community acceptance)
Factors Impacting supplyFactors Impacting supply
Changes in training programs
Life style choices of providers including hours of work, retirement patterns
Aging of the health care workforce
Varying levels of productivity depending on teamwork, use of technology, work satisfaction, family responsibilities, etc
Increase in non-patient care activities
Factors influencing demandFactors influencing demand
Population growth and agingPopulation growth and aging
Increasing rates of utilizationIncreasing rates of utilization
Economic growthEconomic growth
Medical advancementsMedical advancements
National investment in healthcareNational investment in healthcare
Changes in delivery system, insurance and Changes in delivery system, insurance and financing including changes in managed carefinancing including changes in managed care
Cost containment effortsCost containment efforts