The Current and Future Supply and
Demand For The Health Workforce in
the US
Edward Salsberg, MPA
Director, National Center for Health Workforce Analysis
Department of Health and Human Services Health Resources and Services Administration
Bureau of Health Professions
For the Health of Texas Workshop
February 28, 2011 Austin, TX
Overview
• The Framework for Health Workforce “Planning” • National Health Employment Trends
• The Expected Shortage • The Change Imperative • Implications
Key National Health
Workforce Questions
1. Will there be enough physicians, nurses and other health workers? If not:
• What can we do to increase the supply?
• What can we do to get these workers to the highest
need areas?
• What can we do to make better use of physicians
and other health professionals?
2. What can we do to assure access?
3. What can be done to slow the increase in costs?
The New National Health
Workforce Infrastructure
National Health Care Workforce Commission National Center for Health Workforce Analysis State Health Care Workforce Development
Grantees
The US Approach to Health
Workforce “Planning”
Focus on data collection, analysis, and research Widespread dissemination of data, analyses,
and information
Federal-state partnerships
Increasing attention to evaluation and longitudinal tracking
National Center for Health Workforce Analysis: Approach and Activities
Build on existing sources of data including from professional associations, states, and federal agencies
Build national capacity for data collection and
analysis including within professional associations and states
Develop and promote a national uniform minimum data set
Support research to better understand current and future workforce needs and dynamics
Workforce Challenges
• General shortages health personnel including physicians and nurses; some specific concerns:
• Primary Care; Chronic and Long Term Care; Behavioral Health
• Mal-distribution of existing workforce
• Barriers to health personnel working at the top of their competency
• Increasing need for workforce diversity
• Implementing inter-professional education and practice
National Health Employment
Trends
Hospitals Employ More Than
One-Third of Health Care Workers
Health Care Employment by Setting
Source: Altarum Institute, Health Market Insights from the BLS January 2011 Employment Data.
34%
22% 17%
8%
19% Hospitals
Nursing & Residential Care Facilities Offices of Physicians Home Health Other Ambulatory
31.0% 19.8% 51.3% 14.3% 15.4% 0% 10% 20% 30% 40% 50% 60% Ambulatory Care Practitioner Offices
Home Care Hospitals, Public &
Private
Nursing Care Facilities
2000-2008: Health Care Jobs
Far Outpace the Economy
• Total U.S. employment grew by 3.7% across 2000–2008; health care employment grew 30.1%
• Hospitals experienced slower employment growth than other healthcare settings
Source: Center for Workforce Studies, SUNY Albany Analysis of BLS data.
Employment Growth By Setting, 2000-2008
Even in Recession, Healthcare Jobs Grew
0.7% 1.1% 5.3% 4.3% 2.1% 0.0% 2.0% 4.0% 6.0% Hospitals Offices of Physicians Outpatient Care Centers Home Health Care Services Nursing and Residential Care Facilities• Though hospitals added the largest absolute number of jobs, growth on a percent basis lagged behind
• Hospitals added 33,600 jobs across the last year; in contrast, physician offices
added 26,000
Source: Altarum Institute, Health Market Insights from the BLS January 2011 Employment Data.
Growth in Healthcare Employment by Setting, Jan. 2010 - Jan. 2011
Demand for Health Care
Occupations Will Continue to Grow
Source: Bureau of Labor Statistics Monthly Labor Review, November 2009. 50% 46% 40% 39% 36% 36% 36% 34% 33% 31% 31% 30% 30% 0% 10% 20% 30% 40% 50% 60%
Home health aides Medical scientists (ex. epidemiologists) Physical therapist aides Dental assistants Physical therapist assistants Pharmacy technicians Occupational therapist assistants
Drivers of Future Demands for Services
Population growth
• U.S. Population to grow by ~30 million in the next decade1
Aging of the Population; concomitant increase in
major/chronic illness and subsequent demand2
• Baby boom generation
Medical advances and successes2
Life Style factors3
• Increase in chronic diseases
Insurance coverage expansion4
1U.S. Census Bureau “Projections of the Population and Components of Change for the United States: 2010 to 2050” 2Bureau of Labor Statistics “Career Guide to Industries, 2010-2011: Healthcare”
3CDC “Chronic Diseases and Health Promotion” 4Affordable Care Act
Most Major Illnesses Very Age Sensitive
Data present age-specific invasive cancer incidence rates (new cases per 100,000 pop.) for the United Sates, 2002-2006. Source: AAMC Center for Workforce Studies analysis of National Cancer Institute, SEER Cancer Statistics Review, 1975-2006 (published 2009).
Age Group
Female
Cancer Incidence Rates (per 100k pop.) by Age, 2002-2006
The Expansion of Insurance Coverage is
Likely to Have a Significant Impact in Texas
5.0% 8.2% 8.7% 9.6% 9.6% 19.6% 19.9% 21.3% 22.8% 25.7% 0% 5% 10% 15% 20% 25% 30% Massachusetts Hawaii Minnesota Wisconsin Vermont Arizona Nevada Florida New Mexico Texas
Source: Current Population Survey (Prepared by NCHWA, February 2011) The States with the Highest and Lowest Rates of Un-insured, 2009
Visit Rate By Insurance Type, 2007
Source: AAMC Center for Workforce Studies analysis of 2007 NAMCS and NHAMCS Public Use Data File (primary expected source of payment variable), Summary Health Statistics for the U.S.
Drivers of Future Physician Supply
• Slow increase in GME positions • An aging physician workforce • Life style and gender mix
• Productivity impacted by team structure (PAs, NPs), service delivery mechanisms, HIT/EMR
Source: Michael J. Dill & Edward S. Salsberg. The Complexities of Physician Supply and Demand : Projections Through 2025 ( AAMC November 2008).
The Change Imperative
• Unsustainable cost increases • Health workforce shortages
• New models of care: accountable care
organizations (ACOs), patient-centered medical homes
• New approaches to financing including bundled payments
• Increasing consumer involvement • Dynamic and expanding role of HIT
10% of the Pop Account for 60% of the Costs!
18.7% 44.0% 59.5% 81.9% 95.7% 0% 20% 40% 60% 80% 100%Top 1% Top 5% Top 10% Top 25% Top 50%
Perc ent ag e of t ot al U .S. ex penditures
Percent of Health Care Expenditures Accounted for By Top Spenders, 2005 – 2006
Source: AAMC Center for Workforce Studies analysis of Cohen, S.B., Rohde, F. (2009)The Concentration in Health Expenditures
over a Two Year Time Interval, Estimates for the U.S. Population, 2005–2006. MEPS Statistical Brief #244. Figure One. (U.S.
civilian non-institutionalized population).
650,000 700,000 750,000 800,000 850,000 900,000 950,000 2005 2010 2015 2020 2025 FT E Ph ys ic ia ns
Most plausible demand
Most plausible supply
Shortage: 159,300
Most Plausible Scenario
Source: Michael J. Dill & Edward S. Salsberg. The Complexities of Physician Supply and Demand : Projections Through 2025 ( AAMC November 2008).
• Projections do not take into account health reform
• Assumes: a rise in utilization rates; shift in work schedules; an increase in productivity; moderate growth in GME (27,600 new residents/year)
Number of NPs Growing Rapidly
7,089 6,765 6,580 6,346 6,182 6,504 7,095 7,469 8,418 9,200 5,000 6,000 7,000 8,000 9,000 10,000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009Source: American Association of Colleges of Nursing 2000-2009 Annual Surveys
Growth in NP Graduates, 2000 - 2009 N P G raduates
Number of PAs of Growing Rapidly
Source: National Commission on Certification of Physician Assistants “Certified Physician Assistant Population Trends (PA-Cs)”
Newly Licensed PAs, 2000 - 2010
4,051 4,235 4,009 4,337 4,512 4,393 4,654 4,989 5,215 5,243 5,823 3,500 4,000 4,500 5,000 5,500 6,000 6,500 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 N ew ly Lic ens ed PAs
Workforce Composition:
The Growth of Non-Physician Clinicians
Source: National Center for Health Workforce Analysis
Direct Patient Care Providers by Type, Supply and Production
9 5 2 3 0 1 2 3 4 5 6 7 8 9 10
Currently Practicing New Providers/Year
Physicians PAs/NPs
Use of Hospitalists Is Increasing
Source: AAMC 2009 Physician Survey on Primary Care
27.0% 21.5% 8.3% 10.3% 14.3% 6.0% 2.5% 5.0% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%
< 40 yrs 40-49 yrs 50-59 yrs 60+ yrs
General Internal Medicine Internal Medicine Subspecialists
Percent of Internal Medicine Physicians Who Are Hospitalists, by Age
Possible Members of the
Health Care Team of the Future
Physicians Nurse practitioners Physician assistants Psychologists Optometrists Registered Nurses Pharmacists Case Managers Nutritionists/Dieticians Physical Therapists
Community Health Workers …And more
Implications
• Cost pressures and shortages will encourage innovation and systems redesign
• Strong incentives to make better use of existing workforce
• Shift to team-based care and inter-professional practice
• Shift care to lower cost settings
Implications
(2)• Increasing competition for practitioners
• Closer alignment of education and practice
• Pressure to reduce time and cost of education • Need for better health workforce data and
information
Relevant Federal Programs and Policies
Increased funding for health professionseducation and training
Expansion of National Health Service Corp and community health centers
Support for service delivery innovations
National Center for Health Workforce Analysis State Health Care Workforce Development
Grantees