Shortages of Health Professionals in
Indiana
Terrell W. Zollinger, DrPH
Professor, Department of Public Health
IU School of Medicine
IU Bowen Research Center
Indiana AHEC Program
Indiana Center for Health Workforce Studies
Overview
 What does “shortage” mean?
 How do we determine if there is a shortage?
 What are the driving forces?
 Do we have shortages in Indiana?
 So what?
 Are there solutions?
What does “shortage” mean?
 Technically, a shortage occurs when DEMAND is
greater than the SUPPLY
 For the healthcare workforce, we are concerned
when access to health care is a barrier because:
 There are no local providers of the health care needed
 The local providers can’t provide the care needed
because:
 They are too busy with existing patients and it will take too
long to get an appointment
 The patient has insurance that the provider won’t accept
How do we determine if there is a
shortage?
 “Supply” method – compare the ratio in the area with
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the recommended ratio per 100,000 population
“Demand” method – count the unfilled positions in the
area
“Opinion” method – perceived need for health
professionals
“Barrier” method – survey population to determine if
access to specific types of care is a barrier
“Health Status” method – compare health status
measures in the area that should be affected by access to
providers to a standard or ideal value of health status
(e.g. Low rates of first trimester entry into prenatal care,
high rates of hospital admissions for preventable causes)
Others…
Forces driving demand
 Growth of the Indiana population
 18% growth from 1980 to 2010
 Aging of the Indiana population
 Those over age 65 will double by 2030
 Those over age 65 make twice as many physician visits compared to
those under age 65
 Major and chronic illnesses are much more prevalent among those over
age 65
 Public expectations
 Baby boomers have more resources
 Baby boomers have higher expectations and value health care
 Rates of obesity and the resultant diseases, such as diabetes,
are rising very fast
 Advances in medicine will likely increase service demand
Forces driving supply
 Low growth of health professions training programs
 Aging of the health professions workforce – partial and full
retirements
 Gender and generational differences in hours spent providing
care
 Federal and state policies restrict immigration of foreign
trained health professionals
Do we have shortages in Indiana?
Where do we stand?
 Half (54%) of Indiana counties are designated as Medically
Underserved Areas in whole or in part
 38% of Indiana counties are designated Mental Health
Professional Shortage Areas representing 1,097,313
individuals or 17.5% of the state’s population
 30% of Indiana counties are designated Primary Care Health
Professional Shortage Areas, compromising 836,638
individuals or 13.4% of the state’s population
 14% of Indiana counties are designated Dental Health
Professional Shortage Areas, affecting 505,696 individuals or
8.1% of the state’s population
Shortages of Dentists Based on Supply –
of General Dentists:
ByShortages
Region (recommended
is US average)
NWI
380
AHEC Region
NEI
360
SE/SCI
258
MICI
234
WCI
109
SWI
108
0
50
100
150
200
Number of Dentists needed
1,449 Total
250
300
350
400
Public health burden
 Higher health care costs
 Worse health outcomes, including premature deaths
 Lack of continuity in patient care
 Preventable emergency department visits and
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hospitalizations
Lower quality of life
Loss of productivity
Increased health insurance premiums, co-pays, deductibles
Increased costs to produce goods and services  passed on
Expand training capacity
 Increase number of training programs and class sizes
 Increase in remote teaching technologies
 Increasing “teaching faculty” numbers, including part-time
and adjunct teaching faculty
 Increasing “teaching faculty” pay for critical health care
training programs
Redesign training programs
 Revise admission criteria to favor applicants with factors
predictive of choosing primary care and practicing in areas of
need
 Establish rural and community-based health training
programs and clinical rotations for primary care
professionals
 Require clinical training experiences in rural and urban
inner-city primary care, medically underserved settings for
health care students
Focus on recruitment and retention
 Offer financial aid incentives for health care students and
professionals who commit to serving in areas of need
 Increase awareness of recruitment programs
 Expand efforts to support the ability of providers to continue
practicing in areas of need
 Enhance payment for preventive/primary care, particularly
to underserved populations
Thanks…