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

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)

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