The Health Care Workforce Challenge
Barbara S. BrownVirginia Hospital &
Healthcare Association
Drivers of Demand
• Population: Xers 28% fewer; VA 13th
• Economics: proxy education/covered
• Technology
PP&ACA Major Provisions
• Coverage
• Delivery System
• Insurance Market
Key Provisions• Major coverage expansions
– Virginia Medicaid enrollment to increase by 300,000 to 400,000 in 2014
– Exchanges to provide new coverage options
• Insurance market – – no pre-existing; – individual mandate; – % premium for patient care
Key Provisions
• Delivery sys reforms - numerous pilot tests– Greater focus on care
coordination, disease management
– Value-based purchasing (readmissions)
– ACOs– Bundling
Co-evolution of delivery system & payment reforms
7
Technologic Advances
• Most common reason for being in hospital?
• Three most expensive hospitalizations?
• Inpatient vs. Ambulatory Surgery
• Self test
Better Data• Track supply: BON-48% plan
to retire in 10 yrs—2003• Demand and supply analysis
—2004• Link to econ growth:
NoVAHealth Force Coalition--2005
• DHP Workforce Center --2009
2008 DHP Findings
MDs: 29,500 MDs; 70% (20,650) in VA> 23% trained here33% 55 yrs or older; 33% 45 to 54 yrs
RNs: 70% work in VA; > 80% work FTsupply & demand matched until health reform20% indicate they will retire in 3-5 yrs
VA. RN Supply and Demand FTE per 100,000
Population
300
400
500
600
700
800
900
2000 2005 2010 2015 2020
FT
E R
Ns
pe
r 1
00
,00
0 P
op
ula
tio
n
Virginia Demand Virginia Supply U.S. Demand U.S. Supply
Data Source: National Center for Health Workforce Analysis, BHPr, HRSA
Data Source: Virginia NDM projections, CHPRE
Virginia RN Demand by Region
2000-2020
0
5,000
10,000
15,000
20,000
25,000
2000 2005 2010 2015 2020
Blue
Central
Hampton
Northern
Roanoke
Southwest
Unfilled Demand for RNs in Adjacent States and
U.S.
0%
10%
20%
30%
40%
50%
60%
VA DC MD WV NC U.S.
Un
fille
d D
em
an
d f
or
RN
s
2000 2005 2010 2015 2020
Data Source: National Center for Health Workforce Analysis, BHPr, HRSA
2020 Virginia RN Projections … What they Mean
• RN Supply will have to increase by 60% to meet needed demand
• Need between 2600 and 3100 newly licensed RNs each year; Double # newly licensed by 2011
• Current drop in vacancies?
Not Just Nurses
• Top 5 fastest growing occupations: Med Asst, Phys. Ther. Aides; Medical Records/HI techs, Occup. Ther. Asst; Dental Assist.
• Top 5 with most annual openings:
• RNs, NAs, LPNs, Med. Asst, Dental Assist.
Realities of Educational System
• Paid for enrollment not graduates• Application process• Expansion issue re: courses &
facilities• Tuition covers <50% of cost of
educating a nurse• Find ways to include military with
medical training• Appeal to men and minorities• Age of faculty
Data Source: SCHEV Nursing Salary Study 2002
Virginia Full Time Faculty Mean Age by Region
49.071 49.47 50.6648.01
45
54.04
0
10
20
30
40
50
60
Blue Ridge Central Hampton Roads Northern Roanoke Southw estern
Opportunity and Competition
• Health workforce jobs are secure; demand continues to grow
• Need for midlevel practitioners• More emphasis on rehabilitation,
coordination, data/electronics• Need to shorten the timeline-
start process in high school• Competition for education will
remain high
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