Competition, Challenges and Mixed
Signals in the Health Workforce
Family Impact Seminar, East Lansing, MI
May 7, 2013
Stephen N. Collier, Ph.D.
Professor Emeritus
University of Alabama at Birmingham
Overview
Mixed Signals
National Health Workforce Data: Current and Future
Competition in Health Care and the Health Workforce
Challenges facing Policymakers
Policy Considerations
Mixed Signals
Healthcare Retirement Rates
(largest decline in retirement rates among all workforce
sectors of the U.S. economy)
Percent of healthcare workforce retired within 12 months
2004-2007
approx 4%
2009-2010
1.55%
Source: The Conference Board, as reported by John Commins in Health
Leaders Media, May 25, 2011
U.S. Workforce Employment 2010-2020
Numbers listed are in thousands of jobs
Employment
Change
2010
2020
Number
Percent
Total job openings
due to growth and
net replacements,
2010-2020
143,068
163,537
20,469
14.3
54,787
2,403
2,985
582
24.2
1,098
9,194
10,597
1,404
15.3
3,398
7,799
9,819
2,020
25.9
3,591
Healthcare support occupations (31-0000)
4,190
5,634
1,444
34.5
2,042
Sales and related occupations (41-0000)
Office and administrative support occupations (430000)
Installation, maintenance, and repair occupations
(49-0000)
14,916
16,785
1,869
12.5
6,454
22,603
24,938
2,336
10.3
7,450
5,429
6,229
800
14.7
2,026
Production occupations (51-0000)
8,594
8,951
357
4.2
2,231
Number
Occupation
Total, all occupations
Community and social services occupations (210000)
Education, training and library occupations (250000)
Healthcare practitioners and technical occupations
(29-0000)
Source: table prepared by Stephen N. Collier using data from the Bureau of Labor Statistics: Occupational
employment projections to 2020, Occupational Outlook Quarterly, Winter 2011-12, Bureau of Labor Statistics.
Health Workforce Employment 2010-2020
Numbers listed are in thousands of jobs
Employment
Number
2020
Total job
openings due to
growth and net
replacements,
Number Percent 2010-2020
Change
Occupation
2010
Total, all occupations
Healthcare practitioners & technical
occupations
143,068 163,537 20,469
14.3
54,787
7,799
9,819
2,020
25.9
3,591
Healthcare support occupation
4,190
5,634
1,444
34.5
2,042
Physicians and surgeons
691
859
168
24.2
305
Registered nurses
2,737
3,449
712
26.0
1,207
Occupational therapists
109
145
36
33.5
57
Physical therapists
199
276
77
39.0
101
Physician assistants
84
108
24
29.5
41
Speech-language pathologists
123
152
29
23.4
52
Athletic trainers
18
24
6
30.0
12
Medical & clinical lab technologists
169
189
20
11.3
52
Medical & clinical lab technicians
161
185
24
14.7
55
Dental hygienists
182
250
68
37.7
105
Radiologic technologists and technicians
220
281
61
27.8
95
Respiratory therapists
113
144
31
27.7
53
Home health aides
1,018
1,724
706
69.4
838
Medical assistants
528
690
162
30.9
244
Source: table prepared by Stephen N. Collier using data from the Bureau of
Labor Statistics: Occupational employment projections to 2020, Occupational
Outlook Quarterly, Winter 2011-12, Bureau of Labor Statistics.
Health Reform
Affordable Care Act
passed March 2010
Features:
• 32 million newly covered by insurance by
2019
• Accountable care organizations
• Bundled payments
• Medical home
• CMS reduction in physician payment
• Insurance reforms
Competition
Oklahoma: Governor’s Council for Workforce and
Economic Development (2006)
• “As one of Oklahoma’s most important
industries, healthcare continues to be a key
element in the state’s ability to recruit and
retain new and expanding businesses…In
2004, health care was the second largest
employing industry in Oklahoma, comprising
14% of the state’s total employment
•
•
Source: The Emerging Policy Triangle: Economic Development, Workforce Development, and Education
Dennis Jones and Patrick Kelley, National Center for Higher Education Management Systems, 2007
Challenges
Bitter Pill: Why Medical Bills Are Killing Us,
Steven Brill, Time Magazine, March 4, 2013
Average Annual Premiums for Single and
Family Coverage, 1999-2009
$2,196
1999
$2,471*
2000
$7,061*
$3,083*
2002
Family Coverage
$6,438*
$2,689*
2001
Single Coverage
$5,791
$8,003*
$3,383*
2003
$9,068*
$3,695*
2004
$9,950*
$4,024*
2005
$10,880*
$4,242*
2006
$11,480*
$4,479*
2007
$12,106*
$4,704*
2008
$12,680*
$4,824
2009
$0
$2,000
$4,000
$6,000
$13,375*
$8,000
$10,000
* Estimate is statistically different from estimate for the previous year shown (p<.05).
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2009.
$12,000
$14,000
$16,000
The Changing Healthcare Workforce
Why do educational institutions sometimes
seem slow to react to employers expressed
need for healthcare graduates?
Workplace personnel needs change more rapidly than
educational programs can respond
• a local personnel need is identified
• Program planning occurs (6 mos-1year)
• Hiring a program director, accreditation, curriculum
development, faculty hiring (1-2 years)
• Program implementation (2 years)
• First graduates (4 or more yrs from identification)
Policy Considerations
Strategies to Influence the Distribution of Physicians
1.
2.
3.
4.
5.
6.
Provide more residency training in the state and in rural areas
Increase scholarship and loan forgiveness programs
Establish an equitable reimbursement system for rural practice
Give preferential admission to residents of rural areas
Include rural preceptorships and emphasis on prevention
Support Area Health Education Centers and primary care
residencies associated with them
7. Review and revise licensure acts relating to physician assistants
and nurse practitioners
8. Provide support to community recruitment and retention efforts
Stephen N. Collier, Influencing the Distribution of Physicians: Manpower Policy
Strategies, Southern Regional Education Board, Atlanta, GA 1978
Data & Information Sources—Federal
Government
• Bureau of Labor Statistics (Dept of Labor)
• National Center for Health Workforce Analysis
(HRSA)
• Census Bureau (& American FactFinder)
• HRSA Geospacial Data Warehouse
• National Center for Education Statistics
• National Center for Health Statistics (CDC)
Questions/Contact
Stephen N. Collier, Ph.D.,
Professor Emeritus
& Former Director (2003-13)
Office of Health Professions Education
and Workforce Development
University of Alabama at Birmingham
colliers@uab.edu (205) 790-8931