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Policy makers across the United States are facing budget shortfalls. Looking at ways to cut costs, trim health care budgets, reduce Medicaid reimbursements. How can allied health Deans, Program Directors, AHECs and others get on the state and national legislative agenda? Need to frame allied health workforce issues in the context of economic development.
And Healthcare Jobs are Particularly Important to Rural Economy Health care jobs are replacing manufacturing employment in rural areas Between 1990 and 2004, manufacturing employment in rural counties in NC declined by 35% But… Healthcare and social assistance jobs increased by 89%
Driven by economic recession and the decline of North Carolina’s traditional industries, the state’s total workforce actually contracted by 2 percent between 1999 and 2004 ( Table 2 ). Absent significant growth in health care employment during this period, the state’s total workforce would have declined by over 3 percent instead of 2 percent. [i] The total number of health care jobs increased by over 14 percent in the last five years and this growth was largely attributable to the increase in allied health jobs. [i] Bureau of Labor Statistics. Occupational Employment Statistics. State Cross-Industry Estimates: 1998-2003. URL: http://www.bls.gov/oes/. Accessed 4/26/05.
Note: other occupations include chiropractors, dentists, optometrists, pharmacists and podiatrists.
Other includes Chiropractors Dentists Optometrists Pharmacists Podiatrists
While economic data point to the increasing importance of allied health jobs to the state and national economy, relatively little comprehensive or recent national data exist on the supply and distribution of allied health workers. Data from 2000 show that across the nation, consistent disparities exist between rural and urban areas in the ratio of providers to population. Table 4 presents the number of providers per 10,000 population for metropolitan and non-metropolitan counties in the United States for selected allied health professions and the ratio of providers per 10,000 population in metropolitan to non-metropolitan areas. The data show that emergency medical technicians and paramedics are the best distributed, with 2.6 providers per 10,000 population in metropolitan areas to every one provider in non-metropolitan areas. Audiologists are the least well distributed, with nearly 6 providers per 10,000 population in metropolitan areas to every one provider in rural areas. Table 4 also illustrates the greater utilization of assistive personnel (e.g. occupational therapy assistants and physical therapy assistants and aides) in rural areas relative to urban areas and this trend is one that was reflected in the data collected on the physical therapy workforce in North Carolina (Konrad). Physical therapy assistants are more likely to be employed in rural counties and they are also projected to be one of the fastest growing professions by percentage change in North Carolina between 2000 and 2012 (North Carolina Employment and Security Commission). Notably, of the top 10 fastest growing professions in North Carolina, 8 are allied health professions and 7 are assistive professions (medical assistants, occupational therapy aides, dental hygienists, dental assistants, physical therapy assistants, medical records and health information technicians and respiratory therapy technicians). These trends suggest that the skill mix of the allied health workforce is different in rural and underserved areas and that strong growth in the supply of assistive personnel is likely to continue into the future. (Erin, the assistant and aide programs for PT, OT are all in CC environments, most of which are in non-metro areas. Given that most of these students want to practice close to where they received their training accounts for their being in those areas by choice.)
Allied health professionals settle near to where they complete their education. The result is that the ratio of providers to population is greatest around educational institutions and training facilities (i.e. major medical centers and universities). This finding is important because a key issue for workforce planning relates to the extent to which policies under the control of state policy makers can affect the size, composition, and distribution of the allied health workforce. Planning of new educational and training programs needs to take into account that rural and underserved areas of the state face lower practitioner-to-population ratios and would be good places to start new programs. Students who are drawn from these local communities are likely to stay and practice there after graduation. The retention of instate students after graduation is an important measure because it gives policy makers an idea of the return on investment for money spent on supporting allied health education. Table 5 shows that retention rates for allied health students trained in North Carolina range from 54 percent to 86 percent, with most professions retaining nearly three-quarters of students instate after graduation.
The ratios obscure the fact that there is likely a high amount of variation between educational programs within a given allied health profession in their ability to fill available slots. This variation is due to program location, reputation, availability of qualified applicants, degree of competition from other training programs and availability of clinical sites in which to place students.
Attrition from education programs is a major issue confronting the allied health workforce and it is costly to both the educational system and the student. Difficulty to get attrition data from educational institutions Why such high attrition? Academic under-preparedness Motivation and commitment issues Students unprepared for reality of working with body fluids, night and weekend work and physical demands Financial difficulties NC community college system developing consistent definition of attrition and has identified “model” programs to identify factors that lead to a greater than 70% retention rate.
Happens because of lack of coordination between ed and employer and also short training periods. Wave is longer for RNs and even longer for MDs
The State of Allied Health:
The State of Allied Health: An Overview of Issues and Opportunities Facing the Allied Health Workforce Erin P. Fraher, MPP Aaron McKethan Katie Gaul, M.A. Association of Schools of Allied Health Professions October 19, 2005
The State of Allied Health <ul><li>Purpose is to provide an overview of issues and opportunities for the allied health workforce </li></ul><ul><ul><li>Why should policy makers care about the allied health workforce? </li></ul></ul><ul><ul><li>What do we know about workforce challenges? </li></ul></ul><ul><ul><li>What opportunities exist for future growth and collaboration? </li></ul></ul>Report summarizes 6 years of workforce studies that have been a collaborative effort of: Council for Allied Health in North Carolina
Why Should Policy Makers Care About the Allied Health Workforce?
Economic Restructuring Underway <ul><li>Major decline in manufacturing employment due to: </li></ul><ul><ul><li>International competition </li></ul></ul><ul><ul><li>Increased use of technology and improved productivity in domestic manufacturing sector </li></ul></ul><ul><ul><li>Recent economic recession </li></ul></ul><ul><li>But… </li></ul><ul><li>Growth in service occupations, including health care </li></ul>
Manufacturing and Health Care and Social Assistance Employment, N.C., 1990-2004 0 100 200 300 400 500 600 700 800 900 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Employment (000s) Manufacturing Health Care and Social Assistance
Healthcare and Allied Health Jobs Grew While Overall Employment Contracted 1999 2004 % Growth (1999- 2003) Total N.C. Employment 3,801,670 3,722,700 -2.1% Healthcare Jobs 251,550 294,870 14.3% Allied Health Jobs 76,590 121,300 19.9% Total State, Healthcare and Allied Health Employment, North Carolina, 1999-2004 Source: Bureau of Labor Statistics. Occupational Employment Statistics. State Cross-Industry Estimates: 1998-2003. URL: http://www.bls.gov/oes/. Accessed 4/26/05.
Allied health driving growth in the larger health care sector <ul><li>Over 42% of total job growth in the health care sector between 1999-2003 was due to growth of allied health jobs. </li></ul><ul><li>Between 1999-2003, job growth in allied health outpaced growth in: </li></ul><ul><ul><li>NC’s total workforce by 22.4% </li></ul></ul><ul><ul><li>broader health care sector by 5.5% </li></ul></ul>
Health Care Jobs in North Carolina, 2003 Total Health Care Jobs = 267,170 Nurse aides, orderlies and attendants 26.5% Allied Health Professions 35.2% Physicians 3.2% RNs 25.3% LPNs 6.5% Other 3.4%
Hourly and Annual Wages for Selected North Carolina Occupations, 2003 Occupation Hourly Mean Wage Annual Mean Wage Physicians $73.55 $152,978 RNs $23.50 $48,870 LPNs $15.84 $32,940 Nursing aides, orderlies, and attendants $9.00 $18,716 Allied health professions $17.03 $35,428 Other healthcare occupations $48.39 $100,640 All Occupations (North Carolina) $16.17 $33,630 Source: U.S. Bureau of Labor Statistics, Occupational Employment Statistics (2003). URL: http://www.bls.gov/oes/. Accessed 4/26/05.
Allied health jobs projected to grow <ul><li>Allied health jobs represent a stable and relatively profitable employment sector </li></ul><ul><ul><li>Relatively less vulnerable to international competition </li></ul></ul><ul><ul><li>More resilient to economic recession </li></ul></ul><ul><ul><li>Not as susceptible to outsourcing trends seen in manufacturing and other sectors </li></ul></ul><ul><li>Allied health projected to add 28,570 jobs between 2000 and 2010—a 36% increase over 2000 employment. </li></ul>
Now that we have policy makers’ attention…. what do we tell them?
Policymakers Want to Know: <ul><li>How many allied health professionals are practicing? </li></ul><ul><li>Are we producing too many, too few or the right number of professionals? </li></ul><ul><li>Are the types and locations of educational programs appropriate? </li></ul><ul><li>How will new technologies change the demand for certain skills within the allied health professions? </li></ul><ul><li>Are changes in licensure/certification requirements, scope of practice regulations or practice acts needed? </li></ul>
Allied Health Workforce Studies <ul><li>Completed 6 workforce studies </li></ul>Health Information Management 2002 Speech-Language Pathology 2001 Physical Therapy 2000
Allied Health Workforce Studies <ul><li>Completed 6 workforce studies </li></ul>Clinical Lab Sciences 2004 Radiological Sciences 2003 Respiratory Care 2004
Allied Health Workforce Studies <ul><li>Vacancy report completed in 2005 </li></ul><ul><li>What have we learned? </li></ul>
Persistent Rural/Urban Disparities Emergency Medical Techs & Paramedics 2.65 Occup Therapy Assistants 2.74 Phys Therapy Assistants/Aides 3.20 Radiologic Therapists 3.59 Diagnostic Technicians 3.76 Medical Records Technicians 3.82 Respiratory Therapists 4.01 Speech-Language Pathologists 4.44 Recreational Therapists 4.48 Physical Therapists 4.98 Clinic Lab Technicians 5.13 Massage Therapists 5.34 Occupational Therapists 5.59 Audiologists 5.91 Source: Area Resource File (ARF) 2004 Release (National Center for Health Workforce Analysis, Bureau of Health Professions, HRSA, DHHS) United States, 2000 Ratio of Providers in Metropolitan to Non-Metropolitan Counties, Most evenly distributed Least evenly distributed
Allied health workers cluster near training institutions. Retention of students is high Source: Allied Health Workforce Reports Percent of Students Remaining Instate After Graduating from a North Carolina Educational Program, Select Allied Health Professions, 2000-2004 Health Information Technology 86% Radiologic Technology/Medical Imaging 84% Health Information Administration 77% Radiation Therapy 76% Physical Therapist Assistant 75% Nuclear Medicine Technology 75% Speech-Language Pathology 69% Physical Therapy 54%
2004 ASAHP Survey Highlights Application and Enrollment Issues Programs with Fewer than Half Slots Filled Health Information Management, Rehabilitation Counseling Programs under 90% Capacity Cytotechnology, Speech-Language Pathology/Aud., Medical Technology, Occupational Therapy, Respiratory Therapist, Dental Hygiene, Nuclear Medicine Technology, Diagnostic Medical Sonography, Physical Therapy Programs at or above Capacity Physician Assistant, Respiratory Therapy Technician, Radiography, Radiation Therapy Technology, Dietetics
Attrition is a Problem <ul><li>North Carolina community college attrition rates vary from 0-80% </li></ul><ul><li>High degree of variability in attrition rates between educational programs and types of allied health training programs in N.C.: </li></ul><ul><ul><li>10% for medical technologist versus 47% for medical laboratory technician </li></ul></ul><ul><ul><li>30% for respiratory therapy programs </li></ul></ul><ul><ul><li>13-23% for radiation therapy and 22% for radiologic technology programs </li></ul></ul>
Faculty Recruitment and Retention Issues <ul><li>Faculty salaries cannot compete with clinical salaries </li></ul><ul><li>Increasing accreditation standards require faculty to have advanced degree. Some faculty prefer to return to clinical practice or retire. </li></ul><ul><li>Faculty shortages constrict future supply by reducing number of individuals able to teach courses and supervise clinical placements: </li></ul><ul><ul><li>Almost two-thirds of respiratory programs and one-third of medical laboratory programs couldn’t find enough individuals to supervise clinical rotations </li></ul></ul><ul><ul><li>Nearly half of respiratory therapy programs and one-third of medical technologist programs couldn’t find enough faculty to teach coursework. </li></ul></ul>
Clinical Placements <ul><li>Lack of clinical sites is chief complaint of some educational institutions but… </li></ul><ul><li>Not all sites are being used….better communication needed between educational institutions and employers. </li></ul><ul><li>Clinical education is expensive. National: average cost to student of in-state two-year associate degree in allied health = $5,000, average cost to community college = $35,000 (AMA). </li></ul><ul><li>North Carolina State Board of Community Colleges has asked legislature (H.B. 573) to declare allied health programs high cost. </li></ul>
What Do We Tell Policymakers? <ul><li>Allied health workforce important to local, state and national economy </li></ul><ul><li>Investments in the allied health workforce pay large and immediate dividends due to high retention rates </li></ul><ul><li>Investments needed because allied health educational programs face serious challenges: </li></ul><ul><ul><li>Too few applicants </li></ul></ul><ul><ul><li>Too few qualified applicants </li></ul></ul><ul><ul><li>Attrition </li></ul></ul><ul><ul><li>Faculty shortages </li></ul></ul><ul><ul><li>Lack of clinical placements </li></ul></ul>
<ul><li>How can you improve allied health workforce planning in your state, province, country? </li></ul>
Lesson 1. Improve Data Collection and Workforce Surveillance <ul><li>No data, no way to frame argument for allied health </li></ul><ul><li>Educational institutions and professional associations need to collect more and better data </li></ul>
<ul><li>Workforce data need to be put in context of current budget shortfalls and framed in an economic context </li></ul><ul><li>Data need to be disseminated to: </li></ul><ul><ul><li>legislators </li></ul></ul><ul><ul><li>university and community college systems to assist in educational program planning efforts and initiatives </li></ul></ul><ul><ul><li>AHECs and Regional Workforce Planning Groups to be used in collaborative workforce planning initiatives involving educators, employers, local workforce development boards </li></ul></ul>Lesson 2. Data Need to Be Framed in Economic Context and Disseminated
<ul><li>N.C. Council for Allied Health: </li></ul><ul><li>develops, nurtures, and sustains solid partnerships with employers, practitioners and educators </li></ul><ul><li>provides forum for discussions of difficult professional issues: </li></ul><ul><ul><li>Between competing HIM credentialing organizations about development of minimum educational qualifications </li></ul></ul><ul><ul><li>Between SLP licensure board and school employers about differences in licensing requirements </li></ul></ul><ul><li>uses data to identify and address local/regional/state workforce shortages </li></ul>Lesson 3. Better Allied Health Workforce Planning Infrastructure Needed
Current Allied Health Supply Cycle Allied health professions time supply Ideal intervention point Typical intervention point
Ideal Allied Health Supply Cycle Allied health professions Typical intervention point time supply Ideal intervention point
<ul><li>Erin P. Fraher </li></ul><ul><li>Research Fellow </li></ul><ul><li>Cecil G. Sheps Center for HSR </li></ul><ul><li>UNC-CH </li></ul><ul><li>919-966-5012 </li></ul><ul><li>[email_address] </li></ul>Questions?