Health Workforce Vacancies in
Arkansas
Ann B. Bynum, Ed.D.1,
Cathy A. Irwin, Ph.D., R.N.2
Zoran Bursac, Ph.D., M.P.H.3
Jimie Jarry, B.A.2
1University
of Arkansas for Medical
Sciences (UAMS), Regional Programs,
Center for Rural Health, Center for
Distance Health
2UAMS, Center for Rural Health
3UAMS, Faye W. Bozeman College of
Public Health, Biostatistics
Objectives
1.
2.
3.
Explain the study purpose, research
design/procedures, and instrument used in this
study.
Identify the current and expected workforce
vacancies within the next 5 years for 90 health
professionals in Arkansas by type of health
care facility, regions in Arkansas and in Pulaski
County.
Describe the conclusions and implications for
health professions education, clinical practice,
and future research.
Background
Arkansas is facing a growing shortage of health
care workers: Expected to worsen as the baby
boomers retire

Increased demand for health care services in
Arkansas
 Growing total populations
 Increased elderly and ethnic minority
populations
 Fewer uninsured patients as a result of health
care reform initiatives

Background
Additional factors contributing to the
shortage of health professions:
 Unfavorable work environments
 More satisfying alternative job
opportunities
 Financial constraints with current
recession
 Limitations in faculty, laboratory space,
and clinical training sites for health
education programs
Background


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Geographic maldistribution of health
professionals must be addressed for solving
shortages of health professionals in Arkansas.
Decline in the number of students choosing
primary care careers
Problems with recruitment and retention of
primary care providers in rural areas
 Low compensation
 Rising malpractice premiums
 Professional isolation
 Limited time off
 Scarcity of jobs for spouses
Impact of Workforce Shortages on
Quality of Care

Insufficient numbers and quality of health care
professionals can affect the ability of health care
facilities to meet the needs of their communities.

National surveys of registered nurses (N = 657),
physicians (N = 445), and hospital executives
(N = 364) in 2004-2005 demonstrated that
nursing shortages in hospitals had an impact on
hospital capacity:
 Reduced available hospital beds (56%-78%)
 Delayed discharges (50%-69%)
 Increased wait time for surgery (45%-68%)
 Discontinued patient care programs (20%49%)
Impact of Workforce Shortages on
Patient Outcomes
Results from a survey of U.S. hospitals from 11
states (N = 799) demonstrated strong relationships
between nurse staffing variables and patient
outcomes:
 Urinary tract infection
 Pneumonia
 Length of hospital stay
 Upper gastrointestinal bleeding
 Shock
 Failure to rescue (death rate related to hospital
complications)
Impact of Workforce Shortages on
Health Status

Shortages of health professionals can affect the
health status Arkansas residents.

In 2009, Arkansas ranked 40th in the nation for
health status.

Adequate numbers of health care professionals
are needed to address the causes of
preventable, premature deaths and to promote
continued improvement in the health status of
Arkansans.
Purpose of the Study
Assessed health workforce vacancies
for 90 health professionals in
Arkansas by type of health care
facility, regions in Arkansas, and in
Pulaski County
Purpose of the Study
The following categories of health professions
were assessed for current employment vacancies
during 2011 and expected employment vacancies
within the next 5 years:
 Primary care physicians
 Physician specialists
 Nursing
 Allied health professions
 Pharmacists
 Dentists
Facilities Surveyed




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
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
Hospitals
Nursing homes
Medical clinics
County health units
Community health centers
Area Health Education Center (AHEC)
clinics
Dentist offices
Pharmacies
Ambulance services
Home health care services
Regions of Arkansas
Significance of the Study




Results may be used to provide data for
planning educational programs for health care in
Arkansas.
Planning for a supply of health professionals that
will meet the demand
Determine the needs of rural areas for health
professionals
Plan strategies in clinical practice and health
professions education for solving workforce
shortages in Arkansas
Methods




Cross-sectional survey design
Measured current health workforce
vacancies and expected vacancies within
the next 5 years for 90 health
professionals
Other descriptive variables: Type of health
care facility, regions in Arkansas, and
Pulaski County
Data collection during March-July, 2011
Study Population

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Total Population size = 4,212
Directors of the human resources department,
administrators, and office managers
Hospitals, n = 111
Nursing homes, n = 246
Medical clinics, n = 2,180
County health units, n = 102
Community Health Centers and dental clinics, n = 74
AHEC clinics, n = 8
Dentist offices, n = 865
Pharmacies, n = 395
Ambulance services, n = 62
Home health care services, n = 169
Procedures







Completed survey instrument via paper (mailed
survey) or on-line via a website
Mailed reminder postcard after short time
Mailed second questionnaire after sufficient
response time
Follow-up with nonrespondents via telephone:
Reminded to complete the mailed or Web-based
survey
Telephone reminder followed the second mailed
survey, 2.5 weeks after the mailing
Three reminder calls were made to
nonrespondents
If the questionnaire was lost, address of web
survey was emailed or a replacement
questionnaire was emailed or faxed.
Procedures



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
Each survey instrument was assigned a code
number to identify respondents with facility.
Code numbers linked facility to zip codes.
Zip codes were used to obtain the variable for
region in Arkansas and county in which each
facility was located.
Zip code-based population statistics were used
to determine the size of the community in which
each facility was located.
Web addresses and personal identification
numbers (PINs) for population members to
complete the on-line survey—Assured that each
population member took the survey only once
Instrument


Vacancy survey instrument: Evaluated current
and expected vacancies for 90 health
professionals
Eight survey instruments: Include health
professionals that are employed in these types
of health care facilities
 Hospitals
 Nursing homes
 Medical clinics
 AHEC clinics, Community Health Centers,
and county health units
 Dentist offices
 Pharmacies
 Ambulance services
 Home health care services
Instrument




Vacancy survey was adapted from the 8-item
vacancy survey developed by the Idaho Rural
Health Education Center
Survey was revised to include vacancies for 63
additional health professionals and expected
vacancies within the next 5 years.
Vacancy survey includes 3-11 items that assess
current and expected vacancies for: primary
care physicians (4 specialties); physician
specialists (30 specialties); dentists; nursing (10
professions); allied health professions (42
professions); and pharmacy (4 professions).
Participants responded to each item by listing
the number of vacancies for each health
professional.
Data Analysis

Data were entered and analyzed in the
Statistical Package for the Social Sciences
(SPSS), Version 15 and SASv9.2

Cross tabulations: Counted the number of
vacancies for each health professional by type of
health care facility, Arkansas regions, and in
Pulaski County

Frequencies of the data were evaluated for
duplicate physicians’ vacancies in medical
clinics and hospitals.
Data Analysis

Current and expected vacancies for health
professions in the study population (N = 4,212
facilities) were extrapolated from the current and
expected vacancies that were reported in the
survey.
 Calculated by multiplying the number of
current and expected vacancies for each
health profession within each facility type by a
constant multiplier to adjust for
nonrespondents
 Each multiplier was specific to a facility type.
 Multiplier was a ratio of the total number of
surveyed facilities for each facility type and
the number of respondents for each facility
type
Data Analysis


Determined health professionals that are
currently under-produced and overproduced
Calculated by subtracting the number of
current vacancies for health professions in
the study population from the number of
graduates in 2010-2011
Sample of Respondents for Facilities
Facility Type

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
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Sample Size
Hospitals
68
Nursing homes
90
Medical clinics
568
County health units
102
Community Health Centers,
58
dental clinics
AHEC clinics
8
Dentist offices
389
Pharmacies
181
Ambulance services
35
Home health care services
40
Total Sample
1,539
Response Rate
61.26%
36.59%
26.06%
100.00%
78.38%
100.00%
44.97%
45.82%
56.45%
23.67%
36.54%
Results: Current and Expected
Vacancies for Health Professions



Extrapolated vacancies: Total of 7,021 current
and 23,893 expected vacancies for nursing,
allied health, and pharmacy professions; and for
primary care physicians and dentists
Physician specialists had 317 current and 456
expected vacancies.
Allied health professions had the highest
number of current (4,335) and expected
(16,468) vacancies.
Current and Expected Vacancies
for Nursing Professions
Nursing had 1,970 current vacancies
and 5,675 expected vacancies.
Current and Expected Vacancies for
Nursing Professions
2500
Current
5 Year
2000
1500
1000
500
0
LPN
ADN Diploma
BSN
APN
Licensed Practical Nurse
A ss ociate Diploma Nurse
Bachelor of Science in Nursing
A dv anced Practical Nurse
Current Nursing Vacancies by Facility Type
800
715
700
622
600
500
400
283
300
243
200
100
9
17
40
37
0
AHEC
Community
Health
County
Health
Clinic
Home
Health
Medical
Clinic
Medical
Hospital
Nursing
Home
Psych
Hospital
5
Rehab
Hospital
Expected Vacancies for Nursing by Facility Type
2000
1817
1800
1640
1600
1400
1200
948
1000
800
672
600
400
200
259
18
213
85
23
0
AHEC
Community
Health
County
Health
Clinic
Home
Health
Medical
Clinic
Medical
Hospital
Nursing
Home
Psych
Hospital
Rehab
Hospital
Current Vacancies for Nursing by Region
440
450
400
319
350
302
300
250
194
200
216
207
157
150
100
80
55
50
0
Delta
Little Rock
North
Central
Northeast
Northw est
South
Arkansas
South
Central
Southw est
West
Expected Vacancies for Nursing by Region
1662
1800
1600
1400
1200
1000
800
566
600
400
200
906
783
689
568
196
187
117
0
Delta
Little
Rock
North Northeast Northwest South
Central
Arkansas
South Southwest
Central
West
Current and Expected Vacancies
for Allied Health Professions
Allied health professions had a total
of 4,335 current and 16,468 expected
vacancies.
Socal Worker
Current
Physical
Therapist
Occupational
Therapist
Licensed Physical
Therapy Assistant
Environmental
Services
Dietary Aide
Dental Assistant
Current and Expected Vacancies for
Allied Health Professions
900
800
5 Year
700
600
500
400
300
200
100
0
0
Phlebotomist
Cert.
Occupational
Ther. Assistant
Current
EMT
EMP Paramedic
Dental
Hygienist
Cert. Mdical
Assistant
Audiology and
Speech Pathology
Current and Expected Vacancies for
Allied Health Professions
400
350
5 Year
300
250
200
150
100
50
0
Surgical Tech
Registered
Respiratory Tech
Current
Radiologic Tech
Psychiatric Aide
Physician
Assistant
Medical
Technologist
Opthalmic
Technologist
Mdical
Records Tech
Medical
Laboratory Tech
Licensed Counselor
Health information
Systems Tech
Activities Aide
Current and Expected Vacancies for
Allied Health Professions
300
250
5 Year
200
150
100
50
Current and Expected Vacancies for Allied Health
Professions
5660
6000
5000
4000
3000
2000
1751
1429
339
1000
0
Cert. Nurse
Assistant
Home Health
Aide
Current
5 Year
Current and Expected Vacancies for Allied Health
Professions
60
56
50
40
40
32
30
27
20
10 9
0
Diagn. Med.
Sonographer
5
Nuclear Med.
Tech.
12
9
3
Biomed.
Instrument Tech.
8
0
2
Cytotechnologist
EMT
Intermediate
Health Educator
Current
5 Year
Current and Expected Vacancies for Allied Health
Professions
80
68
70
60
50 46
40
30
20
10
0
Psychologist,
Doctoral
Prep.
76
72
43 45
38
28
6 3
Psychologist,
Master's
Prep.
Radiation
Therapist
Cert.
Respiratory
Therapist
Registered
Dietitian
Current
5 Year
Current Vacancies for Allied Health Professions
by Facility Type
1600
1463
1400
1200
959
1000
786
800
629
600
400
200
0
1
AHEC
135
234
91
23
Ambulance Community
Health
Dental
Office
Home
Health
Medical
Clinic
Medical
Hospital
14
Nursing Psychiatric Rehab
Home
Hospital Hospital
Expected Vacancies for Allied Health Professions
by Facility Type
5000
4044
4000
4137
3791
3000
2601
2000
1009
1000
0
14
AHEC
376
Ambulance
86
Community
Health
411
2
County
Health
Clinic
Dental
Office
Home
Health
Medical
Clinic
Medical
Hospital
Nursing
Home
Psychiatric
Hospital
44
Rehab
Hospital
Current Vacancies for Allied Health Professions
by Region
900
800
700
600
500
400
300 243
200
100
0
Delta
878
792
676
564
454
419
166
Little Rock
North
Central
Northeast Northwest
South
Arkansas
143
South
Central
Southwest
West
Expected Vacancies for Allied Health
Professions by Region
4419
4500
4000
3672
3500
3000
2466
2500
1956
2000
1500
1000
500
1548
1398
456
277
278
0
Delta
Little Rock
North
Central
Northeast
Northw est
South
Arkansas
South
Central
Southw est
West
Current and Expected Vacancies for
Primary Care Physicians
Primary care physicians had a total of
514 current and 860 expected
vacancies.
Current and Expected Vacancies for
Primary Care Physicians
500
Current
5 Year
450
400
350
300
250
200
150
100
50
0
Family
Practice
Inte rnal
Medicine
Pediatrics
OBGYN
Current Vacancies for Primary Care Physicians by Facility Type
328
350
300
250
200
158
150
100
50
2
20
5
0
AHEC
Community
Health
Medical
Clinic
Medical
Hospital
Nursing
Home
Expected Vacancies for Primary Care Physicians by
Facility Type
600
537
500
400
300
223
200
100
8
62
30
0
AHEC
Community
Health
Medical
Clinic
Medical
Hospital
Nursing
Home
Current Vacancies for Primary Care Physicians by
Region
120
110
94
100
79
80
61
60
40
41
46
39
29
16
20
0
Delta
Little Rock
North
Central
Northeast
Northw est
South
Arkansas
South
Central
Southw est
West
Expected Vacancies for Primary Care Physicians by
Region
144
160
148
137
140
120
101
100
80
60
48
100
65
61
57
40
20
0
Delta
Little Rock
North
Central
Northeast
Northw est
South
Arkansas
South
Central
Southw est
West
Current and Expected Vacancies for
Physician Specialists
Physician specialists had a total of 317
current and 456 expected vacancies.
0
Nuclear Med
Current
Neurosurgery
Neurology
Nephrology
Neonatology
Intensivist
Hospitalist
Geriatrics
Gastroenterology
Endocrinology
Emergency Med
Dermatology
Cardiology
Anesthesiology
Allergist
Current and Expected Vacancies for
Physician Specialists
50
45
5 Year
40
35
30
25
20
15
10
5
Other
Current
Urology
Thoracic Surgery
Surgery
Rheumatology
Radiology Diag
Pulmonary
Psychiatry
Physical Med
Pathology
Pain Med
Otolaryngology
Orthopedic Surgery
Ophthalmology
Oncology
Current and Expected Vacancies for
Physician Specialists
50
45
5 Year
40
35
30
25
20
15
10
5
0
Vacancies for Physician Specialists by
Facility Type
Current Vacancies
 Medical Clinic, 142
 Medical Hospital, 170
 Psych. Hospital, 3
 Rehab. Hospital, 2
Expected Vacancies
 Medical Clinic, 199
 Medical Hospital, 253
 Psych. Hospital, 5
 Rehab. Hospital, 2
Vacancies for Physician Specialists by
Region
Current Vacancies
 Delta
15
 Little Rock
43
 North Central 37
 Northeast
58
 Northwest
50
 South Arkansas 4
 South Central 64
 Southwest
2
 West
44
Expected Vacancies
20
57
92
85
51
4
83
8
59
Current and Expected Vacancies for
Dentists
The total number of current vacancies
for dentists = 131.
The total number of expected
vacancies for dentists = 372
Current and Expected Vacancies for
Dentists
400
Current
350
300
250
200
150
100
50
0
Dentists
5 Year
Vacancies for Dentists by Facility
Type
Current Vacancies
 Community Health Clinic, 32
 Dental Office, 99
Expected Vacancies
 Community Health Clinic, 48
 Dental Office, 324
Vacancies for Dentists by Region
Current Vacancies
Delta
19
Little Rock
18
North Central
8
Northeast
13
Northwest
26
South AR
South Central 11
Southwest
4
West
32
Expected Vacancies
40
46
19
47
78
11
24
18
90
Current and Expected Vacancies
for Pharmacists
The total number of current vacancies
for pharmacists = 71.
The total number of expected
vacancies for pharmacists = 518
Current and Expected Vacancies for
Pharmacists
450
Current
5 Year
400
350
300
250
200
150
100
50
0
Certified Pharm Tech
PharmD
Vacancies for Pharmacists by
Facility Type
Current Vacancies
AHEC Clinic
Community Health 1
Medical Clinic
4
Medical Hospital
13
Pharmacy
51
Psych Hosp.
Rehab Hosp.
2
Expected Vac
2
6
23
135
342
6
5
Vacancies for Pharmacists by
Region
Current Vacancies
Delta
6
Little Rock
8
North Central 10
Northeast
11
Northwest
South AR
4
South Central 13
Southwest
2
West
17
Expected Vacancies
13
28
52
89
54
25
80
43
135
Results: Arkansas Selected
Healthcare Workforce Needs
Under-Production of Health Professionals:
 Family Practice -235
 Physical Therapist -227
 Occupational Therapist -225
 Dental Assistant -129
 Advanced Practice Nurse -120
 Internal Medicine -85
 Certified Medical Assistant -85
 Certified Nurse Assistant -85
 Dietary Aide -70
 Licensed Physical Therapy Assistant -69
 Physician Assistant -38
 Pediatrics -67
Results: Arkansas Selected
Healthcare Workforce Needs
Under-Production of Health Professionals:
 Certified Occupational Therapy Assist. -52
 EMT – 41
 Psychologist, Doctoral Prepared -35
 Physical Med./Rehab -34
 Obstetrics/Gynecology -34
 Psychiatry -30
 Neurology -19
 Orthopedic Surgery -17
 Medical Lab Tech. -16
 Urology -15
 Neurosurgery -7
Conclusions
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There were a total of 7,021 current vacancies for
nursing, allied health, and pharmacy
professions; and for primary care physicians and
dentists.
There were a total of 23,893 expected vacancies
for nursing, allied health, and pharmacy
professions; and for primary care physicians and
dentists.
Allied health professions had the highest
number of current vacancies (4,335) and
expected vacancies (16,468).
Nursing had 1,970 current vacancies and 5,675
expected vacancies.
Conclusions
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Primary care physicians had a total of 514
current and 860 expected vacancies.
Family Practice physicians had the highest
number of current (282) and expected
(473) vacancies.
There were a total of 317 current
vacancies for physician specialists and
Psychiatry had the highest number of
current vacancies (42).
Physician specialists had 456 expected
vacancies and Hospitalists had the highest
number of expected vacancies (47).
Recommendations

Patient-Centered Medical Home (PCMH)
provides strategies for addressing the shortages
of health professions in Arkansas.



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Involves health professionals working in care teams
to improve efficiency in the delivery of health care and
patients’ access to care
Rural setting clinical training—Increased training
for disadvantaged students and improved
perception of rural practice
Increased recruitment and retention of health
professionals in rural areas
Telemedicine, school telehealth programs, and
the use of Advanced Practice Nurses
Increased wages, job flexibility; improved job
satisfaction, and mentorship programs
Recommendations






Apprenticeships, early and sustained education
in health careers, flexible pathways to facilitate
career development
Financial support, academic enrichment,
tutorials for admissions preparations, and
motivational programs
Recruit new faculty to replace the aging faculty
Improved physical facilities and clinical
placements for health professions education
Improved salaries for health professions faculty
Partnering with private entities, federal agencies,
health professional training programs, and
hospitals to share facilities and provide funding
for student loans and scholarships
Implications for Future Research




Decrease nonrespondents
Yearly assessment of current, expected
vacancies for health professions
Assess impact of health workforce
shortages in AR on quality of
healthcare, patient outcomes
Examine job satisfaction