Health Care WorkforceIssues for Rural California

The California State Rural Health Association Meeting

Beth Mertz

December 5, 2006

Allied Health

The Allied Health Workforce in California- Critical Issues

• Many allied health professions projected to reach or have reached critical shortages

• Lack of awareness/visibility/advocacy for allied professions

• Lack of reliable data on supply and demand• Like other health professions, California lags

behind the U.S. in proportion of allied health workers to population in :– Allied health technical occupations– Allied health support occupations

145.69

148.92

121.70

110.33

113.18

113.87

154.54

0.00 20.00 40.00 60.00 80.00 100.00 120.00 140.00 160.00

2003 Total Employment per 10,000: Select Allied Health Practitioner & Technical Occupations

(SOC 29-0000)Source: Occupational Employment Survey

United States

California

Fresno Central State

Greater Los Angeles

San Diego Border

San Francisco Bay Area

Sacramento North State

85.34

80.93

93.16

73.31

69.18

75.14

97.23

0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 90.00 100.00

2003 Total Employment per 10,000: Select Allied Health Support Occupations (SOC 31-0000)

Source: Occupational Employment Survey

United States

California

Fresno Central State

Greater Los Angeles

San Diego Border

San Francisco Bay Area

Sacramento North State

High Demand OccupationsSource: Conversations with RHORC Directors

• Radiological Technicians & Technologists

• Pharmacy Technicians

• Respiratory Therapists

• Medical Laboratory Technicians & Technologists

• Medical Assistants

• Physical Therapy Assistants

Challenges for the Allied Health Workforce in Rural California

• Access to educational programs is limited; maps show that programs in high demand allied health professions are concentrated in the state’s urban areas.

• Distance education and e-learning has made some progress but much more needs to be done

Mental Health

Mental Health Workforce• Demand and distribution of workforce

– 54% of providers employed in Bay Area and Los Angeles, only 9% in North county and Central Valley regions

– Statewide by 2010, demand for services may grow 16%-30%, absence of comprehensive workforce and education/graduation data make it difficult to assess California’s ability to produce enough

• Rural communities are less competitive in hiring/retaining qualified personnel– In California, mental health providers were only made

eligible for NHSC loan programs in late 2002

• Psyche Techs – Innovative solution to some shortages

• LVN trained in specialty

Pharmacy

Trends in Pharmacy

Employment Settings• 55% - Community

Pharmacy (i.e. Walgreens)

• 25% - Hospitals• 14% - Other

community settings• 13% - Independent

Settings

Ratio Pharmacists per 100,000 Population

Year 1973 1991 1998

CA 52.8 70.9 51.3

US 54.7 68.1 65.9

California Pharmacy Graduates

450460470480490500

1995 1996 1997 1998 1999From McRee, T (2002) “Pharmacy Staffing: A silent but critical concern” UCSFCenter for the Health Professions.

Pharmacy Policy Issues

• Rural communities are simply less competitive for pharmacy employment due to smaller economies of scale, yet have a larger over 65 population which is in most need of pharmaceuticals

• Staffing shortages result in limiting services, increasing job dissatisfaction and stress, and potential for errors impacting patient safety

• Very limited pharmacy availability in FQHC and community settings, difficulties educating, recruiting and retaining staff in these systems

Dentistry

Dentist-to-Population Ranges

Non-ShortageShortageNo Dentists

MSSAs with a Shortage of Primary Care Dentists: California Counties, 1998

Oral Health Workforce• General shortage in rural

communities• Policies must move

beyond loan repayment, not sustainable for long term needs

• Private practice model difficult to sustain in rural areas, this will only get worse as dental incomes rise

• Community clinics have difficulty staffing

MSSANumber of

MSSAs

Mean Population of

MSSA

Mean # of Dentists/5,000

Population

Percent at “Shortage”

Level (<1/5,000)

Rural 211 27,088 1.8 ( 66) 31.3%

Urban 276 104,594 3.1 (31) 11.2%

*MSSA=Medical Service Study Area- Rational service area for the delivery of health care services

From: Mertz et al. “The Geographic Distribution of Dentists in California” Center for California Health Workforce Studies, UCSF. January 2000

Nursing

RN-to-Population Ratios, January, 2006

400-500 RNs/100,000

500-650 RNs/100,000

650-800 RNs/100,000

800-1000 RNs/100,000

More than 1000 RNs/100,000

Under 400 RNs/100,000

Nursing Issues in Rural California

• Rural nurses are older and will retire sooner– 31% of rural nurses are age 55+– 26% of urban nurses are age 55+

• There is not enough growth of new nurses in rural counties– There are not many nursing education programs in

rural counties– General trend of young people migrating out of rural

regions

• Solutions?– Distance education & video conferencing of education– Scholarships for students to travel for school

Physicians

Physicians to 100,000 US Population,1970-2000

0

50

100

150

200

250

300

1970 1975 1980 1985 1990 1995 2000

Source: BHPr/HRSA Source: BHPr/HRSA FactbookFactbook 2002 2002

100,000 MDs 65,000 active, patient-care MDs Access-limiting Mal-distribution

California, 2000

Themes

• Market driven health care solutions tend to disadvantage rural communities

• Staffing issues will dominant the health care landscape for years to come, critical shortages of allied health, pharmacists and nurses, maldistribution of mental health, dentists and physicians

• Public health & safety net left to fill the gap are under resourced

• Technology & revamped educational programs may be where innovations & solutions arise to meet the needs of rural communities

Center for the Health ProfessionsUniversity of California, San Francisco

3333 California Street, Suite 410San Francisco, CA 94118

bmertz@thecenter.ucsf.eduhttp://futurehealth.ucsf.edu

415-502-7934