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  • Here we have just a few of the core issues associated with building capacity in the Allied Health professions.
  • Total employment here refers to selected Allied Hlth professions. Certain occupations that fall under the SOC 29-0000 grouping have been excluded from this analysis.
  • Total employment here refers to selected Allied Hlth professions. Certain occupations that fall under the SOC 31-0000 grouping have been excluded from this analysis.
  • In conversations with several of the Regional Health Occupations Resource Center directors around the state, these are some of the Allied Health occupations that they feel have very high demand.
  • Key Points: Rural communities have less quality and quantity of appropriate treatment Lack of specialty treatment facilities, mental health services often provided by untrained medical personnel in primary care or emergency settings Lower rates of medical insurance, insufficient coverage for mental health treatment, less access to pharmaceutical services Very few of most skilled providers - 52% of rural counties has no psychiatrist; 83% has fewer than 10 psychologists; only 3 rural counties have an advanced practice psychiatric nurse (practitioner or CNS) Realignment policy and higher population of publicly-insured patients raises cost of mental health care services for rural and less-populated counties The economies of scale (recruitment/retention) issue applies equally to MH providers - especially most-skilled psychiatrists, psychologists and advanced practice psych nurses. A terrible effect of this is that in rural counties, they cannot attract department and program heads who often are required to have these degrees (or phd's in social work), so programs go without leadership for years or positions are reverted back/surrendered to county HR departments because the positions remain vacant for so long. In 4 rural counties, the costs and administrative demands of providing MH services has been so great, the counties finally just contracted out their entire MH department functions to private companies. At this time, there is debate whether this will be a trend in CA or across the US. This has serious implications for quality & integration of services and continuity of care. psyche techs are a unique case though and interesting solution in rural areas– own professions, LVN’s with specialty training in psyche, community college level, partnerships between cc’s and state psyche hospitals – going to be used to staff California youth authority facilities, can be used to fill nurse staffing positions since they are LVNs even though they are psyche techs. Creative solution to fill niche that needed help, concentrated in south central counties where state mental hospitals are
  • Key Points: Ratio used to determine shortage is 5000:1, which may be inadequate in reality. Since 1998 the population has grown at a greater rate than the dentist supply meaning that this map is probably conservative in its estimates of shortages One trend, for CHCs to expand dental services, is working toward more geographic diversity. However, while CHCs may expand the physical capacity, they may not be able to attract staff.
  • Key Points: While medical staff are difficult to place in rural communities, dental staff are even more difficult. This is partially due to the private practice model of dentistry which is basically a cottage industry still. Taking advantage of economies of scale is more difficult for rural health care systems, but there is no “system” of dentistry outside the community clinics that functions well to take care of poor or publicly insured patients, or people who live in remote locations. Explain MSSA. While only 11% of rural communities have a shortage of providers, 31% of rural communities do, and also have a lower overall ratio of providers to population


  • 1. Health Care Workforce Issues for Rural California The California State Rural Health Association Meeting Beth Mertz December 5, 2006
  • 2. Allied Health
  • 3. 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
  • 4.  
  • 5.  
  • 6. High Demand Occupations Source: Conversations with RHORC Directors
    • Radiological Technicians & Technologists
    • Pharmacy Technicians
    • Respiratory Therapists
    • Medical Laboratory Technicians & Technologists
    • Medical Assistants
    • Physical Therapy Assistants
  • 7. 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
  • 8. Mental Health
  • 9. 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
  • 10. Pharmacy
  • 11. Trends in Pharmacy
    • Employment Settings
    • 55% - Community Pharmacy (i.e. Walgreens)
    • 25% - Hospitals
    • 14% - Other community settings
    • 13% - Independent Settings
    From McRee, T (2002) “Pharmacy Staffing: A silent but critical concern” UCSF Center for the Health Professions. 65.9 68.1 54.7 US 51.3 70.9 52.8 CA 1998 1991 1973 Year Ratio Pharmacists per 100,000 Population
  • 12. 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
  • 13. Dentistry
  • 14. MSSAs with a Shortage of Primary Care Dentists: California Counties, 1998
  • 15. 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
    *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
  • 16. Nursing
  • 17. 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
  • 18. 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
  • 19. Physicians
  • 20. Physicians to 100,000 US Population, 1970-2000
    • Source: BHPr/HRSA Factbook 2002
  • 21.  
  • 22.
    • 100,000 MDs
    • 65,000 active, patient-care MDs
    • Access-limiting
    • Mal-distribution
    California, 2000
  • 23. 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
  • 24. Center for the Health Professions University of California, San Francisco 3333 California Street, Suite 410 San Francisco, CA 94118 [email_address] http://futurehealth.ucsf.edu 415-502-7934