Health Care Workforce
Issues for Rural California
The California State Rural Health
Association Meeting
Beth Mertz
Decembe...
Allied Health
The Allied Health Workforce in
California- Critical Issues
• Many allied health professions projected to
reach or have rea...
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 Emplo...
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 Emp...
High Demand Occupations
Source: Conversations with RHORC Directors
• Radiological Technicians & Technologists
• Pharmacy T...
Challenges for the Allied Health
Workforce in Rural California
• Access to educational programs is limited;
maps show that...
Mental Health
Mental Health Workforce
• Demand and distribution of workforce
– 54% of providers employed in Bay Area and Los
Angeles, on...
Pharmacy
Trends in Pharmacy
Employment Settings
• 55% - Community
Pharmacy (i.e.
Walgreens)
• 25% - Hospitals
• 14% - Other
communi...
Pharmacy Policy Issues
• Rural communities are simply less competitive
for pharmacy employment due to smaller
economies of...
Dentistry
Dentist-to-Population Ranges
Non-Shortage
Shortage
No Dentists
MSSAs
with a
Shortage of
Primary
Care
Dentists:
California
...
Oral Health Workforce
• General shortage in rural
communities
• Policies must move
beyond loan repayment,
not sustainable ...
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
Mo...
Nursing Issues in Rural California
• Rural nurses are older and will retire sooner
– 31% of rural nurses are age 55+
– 26%...
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/H...
 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 he...
Center for the Health Professions
University of California, San Francisco
3333 California Street, Suite 410
San Francisco,...
Health Care Workforce Issues for Rural California
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Health Care Workforce Issues for Rural California

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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
  • Health Care Workforce Issues for Rural California

    1. 1. Health Care Workforce Issues for Rural California The California State Rural Health Association Meeting Beth Mertz December 5, 2006
    2. 2. Allied Health
    3. 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. 4. 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
    5. 5. 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
    6. 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. 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. 8. Mental Health
    9. 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. 10. Pharmacy
    11. 11. 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 450 460 470 480 490 500 1995 1996 1997 1998 1999 From McRee, T (2002) “Pharmacy Staffing: A silent but critical concern” UCSF Center for the Health Professions.
    12. 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. 13. Dentistry
    14. 14. Dentist-to-Population Ranges Non-Shortage Shortage No Dentists MSSAs with a Shortage of Primary Care Dentists: California Counties, 1998
    15. 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 Number 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
    16. 16. Nursing
    17. 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. 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. 19. Physicians
    20. 20. Physicians to 100,000 US Population, 1970-2000 0 50 100 150 200 250 300 1970 1975 1980 1985 1990 1995 2000 Source: BHPr/HRSASource: BHPr/HRSA FactbookFactbook 20022002
    21. 21.  100,000 MDs  65,000 active, patient-care MDs  Access-limiting  Mal- distribution California, 2000
    22. 22. 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
    23. 23. Center for the Health Professions University of California, San Francisco 3333 California Street, Suite 410 San Francisco, CA 94118 bmertz@thecenter.ucsf.edu http://futurehealth.ucsf.edu 415-502-7934
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