health workforce assessment hawaii island

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Health Workforce Health Workforce Assessment Assessment Hawaii Island Hawaii Island Kelley Withy, MD, PhD Kelley Withy, MD, PhD Hawaii/Pacific Basin AHEC Hawaii/Pacific Basin AHEC UH JABSOM UH JABSOM 10/26/07 10/26/07

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Page 1: Health Workforce Assessment Hawaii Island

Health Workforce Assessment Health Workforce Assessment Hawaii Island Hawaii Island

Kelley Withy, MD, PhDKelley Withy, MD, PhDHawaii/Pacific Basin AHECHawaii/Pacific Basin AHEC

UH JABSOMUH JABSOM10/26/0710/26/07

Page 2: Health Workforce Assessment Hawaii Island

We know we don’t have enough We know we don’t have enough providers, but how bad is it?providers, but how bad is it?

How do we quantify it?How do we quantify it?Where is the greatest need?Where is the greatest need?What kind of providers do we need?What kind of providers do we need?What do we do to solve the problems? What do we do to solve the problems? How do we know if what we are doing is How do we know if what we are doing is working?working?

Page 3: Health Workforce Assessment Hawaii Island

Methods for assessing workforceMethods for assessing workforce

Since 2002, 15 state and three national studies Since 2002, 15 state and three national studies (including HRSA) have been performed all (including HRSA) have been performed all demonstrating medical shortagesdemonstrating medical shortagesMost states use licensure data to assess supplyMost states use licensure data to assess supplySome states survey providersSome states survey providersLess states use focus groups, statewide Less states use focus groups, statewide meetings or community informantsmeetings or community informantsFor demand most states and HRSA use provider For demand most states and HRSA use provider to population ratiosto population ratios

Page 4: Health Workforce Assessment Hawaii Island

DefinitionsDefinitions

Supply-What we haveSupply-What we have– Number of bodiesNumber of bodies– Number of full time equivalents (FTE)Number of full time equivalents (FTE)– Productivity Productivity

Demand-What we wantDemand-What we want– Need-what we think the area would need Need-what we think the area would need

based on assumptionsbased on assumptions– Utilization-what is actually usedUtilization-what is actually used

Page 5: Health Workforce Assessment Hawaii Island

Hawaii PictureHawaii PictureLicensing data has mailing addresses onlyLicensing data has mailing addresses onlyCenter for Nursing surveys nursesCenter for Nursing surveys nursesHHIC researching physician characteristicsHHIC researching physician characteristicsHPCA surveys CHCsHPCA surveys CHCsDOH tracks shortages and HPSA designationsDOH tracks shortages and HPSA designationsNHHSP surveys their graduatesNHHSP surveys their graduatesSHPDA surveys hospitalsSHPDA surveys hospitalsDOL follows trends in employment rates DOL follows trends in employment rates Schools and professional associations contact Schools and professional associations contact folksfolks

Page 6: Health Workforce Assessment Hawaii Island

Hawaii workforce researchHawaii workforce research

NO SINGLE SOURCE for workforce information NO SINGLE SOURCE for workforce information and analysisand analysisHawaii Health Workforce Hui formed in 2003 is a Hawaii Health Workforce Hui formed in 2003 is a collaboration between Hawaii Departments of collaboration between Hawaii Departments of Health and Labor, Primary Care Association, Health and Labor, Primary Care Association, Native Hawaiian Health Scholarship program, Native Hawaiian Health Scholarship program, University of Hawaii, State Health Planning and University of Hawaii, State Health Planning and Development, Rural Health Association, Hawaii Development, Rural Health Association, Hawaii Health Service Corporation Human Resources Health Service Corporation Human Resources Department, FM Residency program, and many Department, FM Residency program, and many more.more.

Page 7: Health Workforce Assessment Hawaii Island

Hawaii Health Workforce Hawaii Health Workforce CollaborativeCollaborative

Vision: We envision a healthcare system in Vision: We envision a healthcare system in Hawaii with a full complement of health care Hawaii with a full complement of health care workers distributed to meet the health needs of workers distributed to meet the health needs of the entire state. the entire state.

Mission statement: Improve access to and quality Mission statement: Improve access to and quality of healthcare in Hawaii by identifying unmet of healthcare in Hawaii by identifying unmet health workforce needs and developing solutions.health workforce needs and developing solutions.

Page 8: Health Workforce Assessment Hawaii Island

Hawaii Health Workforce Hawaii Health Workforce AssessmentAssessment

Collaborative effort supported by Shipper’s Collaborative effort supported by Shipper’s Wharf Trust and Act 219, Session Laws of Wharf Trust and Act 219, Session Laws of Hawaii, 2007 Hawaii, 2007

Identify the location, specialty and FTE of Identify the location, specialty and FTE of all licensed health professionals working in all licensed health professionals working in HawaiiHawaii

Page 9: Health Workforce Assessment Hawaii Island

Licensed medical specialties to be Licensed medical specialties to be assessedassessed

AudiologyAudiologyDental HygienistDental HygienistDentistDentistEmergency Medical Emergency Medical TechnicianTechnicianMarriage and Family Marriage and Family CounselorCounselorMedical DoctorMedical DoctorDoctor of OsteopathyDoctor of OsteopathyMental Health Mental Health CounselorCounselor

Occupational Occupational TherapistTherapistOptometristOptometristPharmacistPharmacistPhysical TherapistPhysical TherapistPhysician assistantPhysician assistantPodiatristPodiatristPsychologistPsychologistSocial WorkerSocial WorkerSpeech PathologySpeech Pathology

Page 10: Health Workforce Assessment Hawaii Island

Activities (cont)Activities (cont)

Estimate present utilization for licensed Estimate present utilization for licensed health workers based on utilization rates health workers based on utilization rates by insured individualsby insured individuals

Use this to estimate present and future Use this to estimate present and future need for servicesneed for services

Page 11: Health Workforce Assessment Hawaii Island

Assessing demandAssessing demand

Number of visits to different types of Number of visits to different types of providers by zip code for insured patientsproviders by zip code for insured patientsExtrapolate to entire population taking into Extrapolate to entire population taking into account age and genderaccount age and genderConvert this to number of FTEs for each Convert this to number of FTEs for each type of providertype of providerCompare with supply numbersCompare with supply numbers

Page 12: Health Workforce Assessment Hawaii Island

Activities (Con’t)Activities (Con’t)

Identify gaps in health workforceIdentify gaps in health workforce

Project future need and supplyProject future need and supply

Research possible solutionsResearch possible solutions

Page 13: Health Workforce Assessment Hawaii Island

Future supply and demandFuture supply and demand

Review trends in number of visits and Review trends in number of visits and number of providersnumber of providersDevelop a model that takes into account Develop a model that takes into account population specifics of Hawaii including population specifics of Hawaii including pattern of illness, geographic barriers, pattern of illness, geographic barriers, Project findings out through 2020Project findings out through 2020Assess changes every year to see if our Assess changes every year to see if our projection model is accurateprojection model is accurate

Page 14: Health Workforce Assessment Hawaii Island

Physician ShortagePhysician Shortage

772,000749,400

921,200

809,100

680,500

-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

1,000,000

2005 2010 2015 2020 2025 2030

Year

FTE

Phys

icia

ns (e

xcl.

resi

dent

s)

Baseline Supply Baseline Demand

Page 15: Health Workforce Assessment Hawaii Island
Page 16: Health Workforce Assessment Hawaii Island

Finding Providers on Hawaii IslandFinding Providers on Hawaii Island

Licensees with Big Island zip codesLicensees with Big Island zip codesInsurance provider listsInsurance provider listsHospital privilege listsHospital privilege listsOffices, groups, associationsOffices, groups, associationsYellow pagesYellow pagesInternetInternetContacting community members and providersContacting community members and providersContacting offices by phone for confirmationContacting offices by phone for confirmation

Page 17: Health Workforce Assessment Hawaii Island

PreliminaryPreliminary Estimate of Providers Estimate of Providers on Hawaii Islandon Hawaii Island

NeedNeed Supply*Supply*Allergy/immunAllergy/immun 22 1.151.15CardiologyCardiology 1111 5.95.9DermatologyDermatology 55 2.32.3EndocrinologyEndocrinology 22 00Ear/Nose/ThrtEar/Nose/Thrt 55 1.61.6GastroGastro 66 4.64.6Heme OncHeme Onc 55 1.61.6

Page 18: Health Workforce Assessment Hawaii Island

Infectious DsInfectious Ds 22 0.00.0NephrologyNephrology 33 1.151.15NeurologyNeurology 66 .5.5Obstetrics/GynObstetrics/Gyn 2020 1414OphthalmologyOphthalmology 66 6.056.05OrthopedicsOrthopedics 1111 1.551.55PsychPsych 2020 19.4519.45PulmonaryPulmonary 44 1.551.55RheumatologyRheumatology 22 00Primary carePrimary care 115115 9999

Page 19: Health Workforce Assessment Hawaii Island

Mapping of resultsMapping of results

Zip code map demarcated as closely as Zip code map demarcated as closely as possible to judicial districts: created 8 possible to judicial districts: created 8 regionsregionsPopulation mapped and approximated to Population mapped and approximated to 2007 (increase 15%)2007 (increase 15%)Provider need estimated using WWAMI Provider need estimated using WWAMI numbersnumbersExisting providers from licensure listExisting providers from licensure list

Page 20: Health Workforce Assessment Hawaii Island
Page 21: Health Workforce Assessment Hawaii Island
Page 22: Health Workforce Assessment Hawaii Island

**Preliminary Results

Page 23: Health Workforce Assessment Hawaii Island

Possible solutions???Possible solutions???

ImmediateImmediate– Enhanced recruitment using diverse Enhanced recruitment using diverse

incentives: incentives: Financial: pay, signing bonuses, malpractice, loan Financial: pay, signing bonuses, malpractice, loan repaymentrepaymentHousing, mentoring, jobs for spouse, web based Housing, mentoring, jobs for spouse, web based schooling, community involvementschooling, community involvement

– Increase fly over providersIncrease fly over providers– TelemedicineTelemedicine– Health insurance reformHealth insurance reform

Page 24: Health Workforce Assessment Hawaii Island
Page 25: Health Workforce Assessment Hawaii Island

Intermediate (5 yr)Intermediate (5 yr)Employment model group to serve all areas Employment model group to serve all areas and/or specialty clinic creationand/or specialty clinic creationScholarship and loan repaymentScholarship and loan repaymentIncrease size of training programsIncrease size of training programsFamily Medicine and other training programs in Family Medicine and other training programs in rural areasrural areasThe advanced medical home (a care The advanced medical home (a care coordination model) coordination model) Reforming reimbursement policies to create Reforming reimbursement policies to create financial incentives for improving quality and financial incentives for improving quality and efficiencyefficiencyDecreased regulatory restraints and paperworkDecreased regulatory restraints and paperworkTort reformTort reform

Page 26: Health Workforce Assessment Hawaii Island
Page 27: Health Workforce Assessment Hawaii Island

Long term (5-10 years)Long term (5-10 years)

Pipeline Pipeline Rural health interest groups Magnet schoolsRural health interest groups Magnet schoolsEnrichment programsEnrichment programsMentoring (continuous student support)Mentoring (continuous student support)Selective school admission policiesSelective school admission policiesScholarship/loan repaymentScholarship/loan repayment

Magnet hospitalsMagnet hospitals– i.e. neuroi.e. neuro

Page 28: Health Workforce Assessment Hawaii Island

Just Imagine…Just Imagine…Coordinated no-cost system for advertisingCoordinated no-cost system for advertisingWeb based promotional materialsWeb based promotional materialsSave funds for interviewing a large selection for Save funds for interviewing a large selection for providers interested in rural practice through providers interested in rural practice through advertisingadvertisingHave them visit and learn about communityHave them visit and learn about communityCommunity chooses best candidateCommunity chooses best candidateIncentives-financial, housing, malpractice, loan Incentives-financial, housing, malpractice, loan repayment, etc.repayment, etc.Professional community established, all Professional community established, all necessary supplies and facilities availablenecessary supplies and facilities available

Page 29: Health Workforce Assessment Hawaii Island

Just imagine…Just imagine…Pleasant working environment, telemedicine and Pleasant working environment, telemedicine and specialist supportspecialist supportCaring for patients is a collaborative team effortCaring for patients is a collaborative team effortAll necessary facilities are availableAll necessary facilities are availableCommunity involves provider in community lifeCommunity involves provider in community lifeProvider feels a part of the communityProvider feels a part of the communityGets marriedGets marriedConnections for spouse and educational Connections for spouse and educational supplementation for kidssupplementation for kidsProvider lives happily ever afterProvider lives happily ever afterAnd so does the communityAnd so does the communityProvider and community train the future providers…Provider and community train the future providers…

Page 30: Health Workforce Assessment Hawaii Island

Just imagine…Just imagine…

Promising students in your community nurtured, Promising students in your community nurtured, mentored, receive additional education and mentored, receive additional education and career experiences and have preferential career experiences and have preferential admission to health professions schools with admission to health professions schools with scholarshipsscholarshipsTraining continues in the rural areas where they Training continues in the rural areas where they came fromcame fromThey are rewarded for returning and staying in They are rewarded for returning and staying in the rural areas (loan repayment, practice the rural areas (loan repayment, practice resources, professional family, healthcare team, resources, professional family, healthcare team, community acceptance)community acceptance)

Page 31: Health Workforce Assessment Hawaii Island
Page 32: Health Workforce Assessment Hawaii Island
Page 33: Health Workforce Assessment Hawaii Island

Factors Impacting supplyFactors Impacting supply

Changes in training programsLife style choices of providers including hours of work, retirement patternsAging of the health care workforceVarying levels of productivity depending on teamwork, use of technology, work satisfaction, family responsibilities, etcIncrease in non-patient care activities

Page 34: Health Workforce Assessment Hawaii Island

Factors influencing demandFactors influencing demand

Population growth and agingPopulation growth and agingIncreasing rates of utilizationIncreasing rates of utilizationEconomic growthEconomic growthMedical advancementsMedical advancementsNational investment in healthcareNational investment in healthcareChanges in delivery system, insurance and Changes in delivery system, insurance and financing including changes in managed carefinancing including changes in managed careCost containment effortsCost containment efforts