Kathy Arney

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Sheps Center Program on Health Workforce Research and Policy < enews_workforce@unc.edu> Thursday, February 22, 2018 7:03 AM Kathy Arney February 2018 Sheps Workforce Newsletter

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Twenty counties in North Carolina have relatively few primary care physicians and three have none. Twenty-six counties are without a general surgeon, which is problematic for access to surgical care and the financial viability of rural hospitals. Recent closures of obstetric units will likely increase drive times for deliveries in some counties and the state faces a persistent shortage and maldistribution of behavioral health providers. The Program on Health Workforce Research and Policy is dedicated to producing these types of data and other research needed to inform state health workforce policy decisions. Our Program has a long history of engaging with legislators, state officials, educators, employers and other stakeholders working to improve access to health care providers. This newsletter highlights recent state health policy work our team has conducted including our efforts, in collaboration with the NC AHEC Program, to track the workforce outcomes of physician training programs in North Carolina.

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PHYSICIANS COMPLETING RESIDENCY IN THE STATE ARE NOT PRACTICING IN NEEDED LOCATIONS OR SPECIALTIES

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Evaluating the Workforce Outcomes of North Carolina's Medical Education Programs North Carolina Session Law 2017-57, Section 11 J.2, the Current Operations Appropriations Act of 2017, directed the North Carolina Department of Health and Human Services (DHHS) and The University of North Carolina (UNC) to assess the degree to which physician training programs in North Carolina meet the healthcare needs of North Carolina's citizens. The Program on Health Workforce Research and Policy conducted the analysis and reported findings to the Joint Legislative Oversight Committee on Health and Human Services and the Joint Legislative Education Oversight Committee on February 12, 2017.

Key findings: • While some GME programs

are producing the workforce needed to meet population health needs, many are not Of graduates who completed training between 2008-2011, 42% remained in NC and only 3% were in practice in rural North Carolina as of 2016.

Active Licensed NC Physicians by Medical School Location, 1990-2016

70% '1 005% Other US, Canada. and PUerto Rico (USMGs)

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, 60% '1

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40% j I 316%

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, ~4% The majority (61 5°A) of 20% 1 n·,5592 . ° I" International Medical Graduates (IMGL-15 1% physicians in active practice 7!%~, __ ---------- 10% ,II n=3.689 in North Carolina in 2016 •.

i n=840 I T ;~;~- -, I ~~~~~,rg~~~t;~;~~::~ ~~~~~'OO5 ;;;-'~o~-~3 state's physician workforce has declined from 31.6% in 1990 to 23,4% in 2016. During that same period the percent of the physician workforce made up of physicians who completed medical school outside the US nearly doubled from 7,9% to 15.1% of the workforce.

•

Access the reports and presentation:

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• Workforce Outcomes of North Carolina Medical School Graduates: A Report to the Joint Legislative Oversight Committee on Health and Human Services and the Joint Legislative Education Oversight Committee

• The Workforce Outcomes of Physicians Completing Residency Programs in North Carolina

• North Carolina's Physician Training Programs Are Not Producing the Workforce Needed to Meet Population Health Needs (presentation)

Workforce Outcomes of Medical Students featured in New England Journal of Medicine

Since the 1990s, the Program on Health Workforce Research and Policy, in collaboration with the NC AHEC Program, has tracked the workforce outcomes of medical students five years after graduation. These data were featured in John Iglehart's February 1, 2018 NEJM article on "The challenging quest to improve rural health care." The article notes that five years after graduation in 2010, only 67 (16%) of 415 graduates from NC medical schools were primary care physicians in North Carolina and only 11 (3%) had taken up practice in rural areas of the state.

Transitioning from Old Data Book to New Data Visualization

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After 37years, in 2017 we said goodbye to our traditional North Carolina Health Professions Data Book and introduced our online Health Professions Data System Visualization. The new tool allows users to visualize, query and download county-level data on 19 licensed health professions, including counts, ratios per 10,000 population, race, sex, and age. This tool gives state policy makers the ability to access and customize the data needed to inform policy makers' efforts to improve access to care

If you miss the non-workforce data contained in the old Data Books, check out the North Carolina Institute of Medicine's North Carolina County Health Profiles, an interactive map and downloadable dataset that contains more than 50 variables, including demographics, access to care, health status and determinants of health.

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News

Julie Spero Named Director of the NC Health Professions Data System

We are pleased to announce that Julie Spero, MSPH, was named Director of the North Carolina Health Professions Data System (HPDS). Julie has been a Research Associate with the Program on Health Workforce Research and Policy for more than five years. During that time, she has led studies on medical school and physician residency workforce outcomes, and on the supply, distribution, diversity, education and practice characteristics of physicians, physician assistants, dentists, pharmacists, optometrists, chiropractors, and other professions. These reports, as well as other data, maps and charts, are available to the public on the Program's interactive NC HPDS website. Julie serves as the team's point person for legislators, state officials, licensure boards, and other state policy makers.

New Articles

• Domino M, Lin C, Morrissey J, Ellis A, Fraher EP, Richman E, Thomas K, Prinstein M. Are Psychologists an Answer to Rural Mental Health Workforce Shortages?: Exploring Opportunities and Constraints. In press at Journal of Rural Health.

• Fraher E. The Value of Workforce Data in Shaping Nursing Workforce Policy: A Case Study from North Carolina. Nursing Outlook. 2017; 65(2): 154-161.

• Richman EL, Lombardi BM, Zerden L. The Accountable Care Workforce: Bridging the Health Divide in North Carolina. North Carolina Medical Journal. 2017;78(4):262-266

Upcoming and recent state-focused presentations

• March 19, 2018: Erin Fraher will present to the North Carolina Legislative Health Policy Fellows, at the NC Institute of Medicine.

Recent Presentations.'

• Brandt B, Fraher E. Toward a System Where Workforce Planning, Education and Practice are Designed around Patients, Populations and Communities, Not Professions. Blending the Blues: A Collaboration with IPE4UNC and Duke AHEAD. UNC School of Nursing. February 21,2018.

• Fraher E, Spero J, Evan G. North Carolina's Physician Training Programs Are Not Producing the Workforce Needed to Meet Population Health Needs. North Carolina General Assembly, Joint Oversight Subcommittee on Medical Education Programs and Medical Residency Programs. February 12, 2018.

• Spero J. The Dentist Workforce in NC: Distribution, Diversity, and Educating the Future Workforce. Campbell University Rural Oral Health Summit. February 10, 2018

• Spero J, Fraher E. Health Workforce Trends and Challenges in North Carolina and the United States. North Carolina Statewide AHEC Conference. December 7,2017.

• Galloway E. Developing Interactive Data Visualizations for State Workforce Planning and Policy. North Carolina Statewide AHEC Conference. December 7,2017.

• Richman E, Zerden L, Lombardi B. The Accountable Care Workforce in North Carolina. North Carolina Statewide AHEC Conference. December 7, 2017.

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• Spero J, Fraher E. Health Workforce Trends and Challenges in North Carolina and the United States. Rural Hospital Conference of the Carolinas. November 9, 2017.

• Galloway E. Developing Interactive Data Visualizations for State Workforce Planning and Policy. North Carolina AHEC Directors Meeting. November 1,2017.

• Galloway E, Fraher E. Developing Data Visualizations for Health Workforce Data. Webinar. Health Workforce Technical Assistance Center. September 26, 2017.

• Fraher E. Nursing Workforce Models: What We Can Learn from State and National Efforts (and the Kiwis). Keynote presentation. National Forum of State Nursing Workforce Centers. Denver, CO, June 8, 2017.

• Spero J, Burgette J, Fraher E, Galloway E, Gaul K, Ricketts T. NC's Oral Health Workforce: Distribution, Diversity and Access to Care. NC Dental Public Health Education Conference. May 10, 2017.

• Galloway E. Developing Interactive Data Visualizations for State Workforce Planning and Policy. 13th Annual AAMC Health Workforce Research Conference. Washington, DC. May 4,2017.

Upcoming seminars Our Health Workforce Seminar Series, with support from Carolina Seminars, brings together a diverse group of academic scholars, students, practicing health professionals, and policy experts from around the country to discuss health workforce policy and planning. Previous speakers have included state and Federal legislators, national researchers, international health workforce planners, AHECs, educators and health professionals. Topics have included behavioral health, interprofessional education and practice, new and emerging models of care, using data to inform policy, the VA Healthcare System and health professions education.

The next seminar is scheduled from 12:00-1:30 pm on March 7th at the Sheps Center. The topic will be "Interprofessional Mental Health Teams at the Veteran's Health Administration: Roles of Occupational Therapists, Social Workers, Psychologists, and Chaplains."

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