SurveyofHealthCareEmployersinArizona:MaricopaCountyCommunityHealthCenters,2015

July26,2016Preparedby:LelaChuJoanneSpetz,PhDUniversityofCalifornia,SanFrancisco3333CaliforniaStreet,Suite265SanFrancisco,CA94118ThisstudyissupportedbyVitalystHealthFoundationofArizonaandtheCityofPhoenix.AnyviewspresentedinthisreportdonotnecessarilyreflecttheopinionsorpositionsofVitalystHealthFoundationortheCityofPhoenix.

PREFACE

SurveyBackgroundThisreportsummarizesthefindingsfromasurveyoffederally-qualifiedcommunityhealthcenters(CHCs)inArizonaconductedfromsummertofallof2015.ThisisthefirstsurveyofMaricopaCountyCHCemployersandprovidesanopportunitytoevaluateoveralldemandforhealthcareworkersinthecounty.ThedataobtainedinthissurveyrevealthevariationinthedemandforhealthcareworkerswithinMaricopaCounty.

SummaryofFindingsThe2015SurveyofHealthCareEmployersinArizona:MaricopaCountyCommunityHealthCentersfoundthatthereisaperceptionofshortageforallphysicians(exceptinPediatrics),psychologists,nursepractitioners,licensedpracticalnurses,pharmacytechnicians,coders,promotoras,andradiologytechnologists.Generally,thelabormarketwasreportedasbeingmoreinbalancewiththesupplyavailableforallotheroccupations,includingregisterednurses,medicalassistants,pharmacists,andsocialworkers.Vacancyratesforfull-timepositionswere28percentforinternalmedicinephysicians,pediatricians,andphysicianassistants.

CHCsreportedthatemploymentincreasedoverthepastyearformanyoccupations,includingpediatricians,obstetricians/gynecologists,familymedicinephysicians,nursepractitioners,physicianassistants,psychologists,andcarenavigators.However,mostindicatednoemploymentchangesinthepastyearforregisterednurses,pharmacists,socialworkers,andmedicalassistants.Increasesinemploymentwerereportedtobeinfluencedbyincreasesinpatientvolumeandlessturnoverandgreaterretentionofstaff.

Over77percentofCHCsindicatedtheyhadcreatednewjobclassificationsovertheprioryear,mostofteninrolesrelatedtocarecoordinationandhealthcoaching.

NearlyallCHCsreportedexpectationsthatemploymentformanyoccupationswouldincreaseoverthenextthreeyears,includingforpsychologists,physiciansininternalmedicine,pediatrics,andobstetrics/gynecology,nursepractitioners,andmedicalassistants.Themostfrequentlyreportedreasonsforexpectedincreasesinemploymentwereanticipatedincreasesinpatientvolume,andplannedgrowthinfacilitysize.

CHCswereaskedtodescribehowconcernedtheyfeltaboutaseriesoffactorsthatmightaffecttheadequacyoftheirCHC’sworkforce.CHCsoftenreportedthattheywereextremelyconcernedabouttheimpactofpotentialstatebudgetcutstoMedicaidandreimbursementlevelsdropping.TheimpactoftheexpansioninhealthinsurancecoveragewasreportedassomewhatconcerningbymostCHCs.CHCsindicatedverylittleconcernoftheirworkforceadequacybeingimpactedbypopulationgrowthandagingintheregion.

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©2016 Vitalyst Health Foundation. Find the full report here: http://goo.gl/UOgrsD

A survey of Arizona health care employers was conducted by the University of California, San Francisco (UCSF) in the spring of 2016. The survey captured responses from 59% of the Community Health Centers (CHCs) in Maricopa County. Overall survey results indicate:

Respondents revealed a SHORTAGE for:• Physicians (except in Pediatrics)• Psychologists• Licensed Practical Nurses• Pharmacists• Pharmacy Technicians• Coders

Employment INCREASED over the past year for many occupations, including:

• Pediatricians• Obstetricians/Gynecologists• Family Medicine Physicians• Nurse Practitioners• Promotoras

• Laboratory Technologists• Radiology Technologists

Generally, IN BALANCE are:• Registered Nurses• Medical Assistants• Social Workers• Community Health Workers

DEMAND for MEDICAL STAFF

PROJECTED EMPLOYMENT NEEDSNearly all Community Health Centers expect that employment for many

occupations will increase over the next three years, including:

PHYSICIANSIN INTERNAL

MEDICINE

PHYSICIANSIN PEDIATRICS

PHYSICIANSIN OBSTETRICS/

GYNECOLOGY

MEDICAL ASSITANTS

Licensed Practical Nurses

Coders

Radiology Technologists Physicians – Psychiatry

Physicians – Internal Medicine Psychologists Pharmacy Technicians, Laboratory Technologists/TechniciansPromotoras, Community Health Workers, Care NavigatorsPhysicians – Family MedicinePhysicians – Obstetrics/Gynecology, PharmacistsRegistered Nurses, Physicians – Geriatrics, Physicians – Other, Social Workers

Physicians – Pediatrics

Nurse Practitioners

Care Coordinators, Physician Assistants

Medical Assistants

LABOR MARKET DEMAND FOR LONG-TERM CARE FACILITIES IN MARICOPA COUNTY

HIGH DEMAND:DIFFICULT TO FILL OPEN POSITIONS

DEMAND IS IN BALANCE

WITH SUPPLY

DEMAND IS MUCH LESS THAN SUPPLY

of Community Health Centers reported that they had created NEW JOB CLASSIFICATIONS over the past year, specifically in the roles of Care Coordination and Health Coaching.

Maricopa County Healthcare WorkforceCommunity Health Centers, 2016

80%

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TABLEOFCONTENTS

PREFACE.......................................................................................................................................................2

SurveyBackground..........................................................................................................................2

SummaryofFindings.......................................................................................................................2

VisualSummary...............................................................................................................................3

TABLEOFCONTENTS....................................................................................................................................4

LISTOFTABLES.............................................................................................................................................5

LISTOFFIGURES...........................................................................................................................................6

BACKGROUND:HEALTHWORKERDEMANDINARIZONA............................................................................7

SurveyParticipationandDataAnalysis...........................................................................................9

FINDINGS....................................................................................................................................................10

PerceptionofLaborMarketConditions........................................................................................10

CurrentEmploymentofStaff........................................................................................................15

CurrentVacancies.........................................................................................................................16

ChangesExperiencedInthePastYear..........................................................................................16

RNEmployment............................................................................................................................19

EmploymentExpectationsfortheNextThreeYears....................................................................20

CONCLUSIONS............................................................................................................................................24

ACKNOWLEDGEMENTS..............................................................................................................................25

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LISTOFTABLES

Table1.PerceptionoflabormarketdemandbycommunityhealthclinicsinMaricopaCounty,2015....13

Table2.AveragerankingofoveralllabormarketdemandacrossMaricopaCounty,2015......................14

Table3.Numberofcurrentstaff(headcount)byposition,asofMay1,2015..........................................15

Table4.Employmentchangesinthepastyear,byposition,2015............................................................17

Table5.Supportforstaffworkingtowarddegreesorcertification,2015.................................................18

Table6.CurrentlyemployedBSN-preparedregisterednurses,2015........................................................20

Table7.Expectationsforemploymentinthenextthreeyears,2015.......................................................21

Table8.Plannednewjobclassificationsinthenexttwoyears,2015.......................................................22

Table9.Impactonadequacyoncommunityhealthcenter’sworkforce,2015.........................................23

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LISTOFFIGURES

Figure1.DistributionofrespondingcommunityhealthcentersvsFederallyQualifiedHealthCentersin

MaricopaCounty,byrural/non-ruralgeographiclocation,2015........................................................10

Figure2.Perceptionofphysician,NP,PA,andpsychologistlabormarketdemandbycommunityclinicsin

MaricopaCounty,2015.......................................................................................................................11

Figure3.PerceptionofclinicstafflabormarketdemandbycommunityclinicsinMaricopaCounty,2015

.............................................................................................................................................................12

Figure4.Vacancyratesbyposition,May1,2015......................................................................................16

Figure5.Employmentchangesinthepastyear,byposition,2015...........................................................17

Figure6.Creationofnewjobclassificationsinthepastyear,2015..........................................................18

Figure7.Requirementsforregisterednursingemployment,2015...........................................................19

Figure8.Expectationsforemploymentinthenextthreeyears,2015......................................................21

Figure9.Impactonadequacyoncommunityhealthcenter’sworkforce,2015........................................22

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BACKGROUND:HEALTHWORKERDEMANDINARIZONA

Arizona,alongwiththerestofthenation,experiencedadeepeconomicrecessionstartinginDecember2007andasloweconomicrecoverysincemid-2009.Whilethestate’seconomyhasbeenrecovering,therehavebeensignificantchangesinhealthcarefinancinganddelivery.ThestaterestoredandexpandedMedicaidcoverage,andtheimplementationoftheAffordableCareAct(ACA)of2010expandedprivatehealthinsuranceaccesstothousandsinthestate.TheACAcontainsprovisionsthatarespurringanincreasedemphasisontheintegrationofcare,providinghigh-valuecare,andconsideringpopulationhealthbroadly.Inaddition,Arizonafacesanagingpopulation,withincreasingratesofchronicconditionsanddisabilities.1

Thesefactorsaredrivingdemandgrowthforhealthcareworkersacrossthestate.Overthepastdecade,employmentgrewinallthehealthoccupationsinArizona,from75,490in2004to135,070in2013.2Shortagesofmanyhealthworkershavebeenreportedinrecentyears,includingforphysicians,andsurveyresearchhasrevealedthatphysiciansarethemostdifficulthealthprofessionaltorecruit,followedbynursepractitionersandphysicianassistants.3

NursingshortagesalsoareasignificantconcernforArizona.TheU.S.BureauofHealthWorkforce(BHW)projectsthatArizonawillneed87,200registerednurses(RNs)by2025,butsupplywillbeonly59,100RNs,producingashortfallof32percent.BHWalsoforecastsashortfallof9,590licensedpracticalnurses(LPNs),whichisabout50percentofanticipateddemand.4Inaddition,theArizonaBoardofNursinghasexpressedconcernthattoosmallashareofArizona’sRNshavebaccalaureate-leveleducation–in2012,only54percenthadabachelor’sorhigherdegreeinanyfield,notnecessarilyinnursing,incontrasttotherecommendationoftheInstituteofMedicinethat80percentofallnursesholdabachelor’sorhigherdegreeby2020.5

Otherhealthcareoccupationsalsoarefacingsubstantialgrowthindemand.About47,000newjobsareexpectedinthealliedhealthprofessionsbetween2013and2020,withthegreatestgrowthprojectedforpersonalcareaides,medicalrecordsandhealthinformationtechnicians,emergencymedicaltechniciansandparamedics,medicalandhealthservicesmanagers,medicalassistants,andpharmacytechnicians.TheAffordableCareAct’sprovisionsalsoareexpectedtospurgrowthinemerging

1Borns,Kristin,andVanPelt,Kim.HealthWorkforce,HealthyEconomy.ArizonaHealthFuturesPolicyPrimer,December2014.2DatafromtheArizonaDepartmentofAdministration,reportedinIrvine,Jane,andWilliamG.Johnson,AlliedHealthNeedsAssessment.Phoenix,AZ:MaricopaCommunityColleges.May14,2015.3Tabor,Joe,NickJennings,LindsayKohler,BillDegnan,HowardEng,DougCampos-Outcalt,andDanDerksen.ArizonaCenterforRuralHealth2015SupplyandDemandStudyofArizonaHealthPractitionersandProfessionals.Tucson,AZ:UniversityofArizona.February2016.4BureauofHealthWorkforce,HealthResourcesandServicesAdministration,U.S.DepartmentofHealthandHumanServices.TheFutureoftheNursingWorkforce:NationalandState-LevelProjections,2012-2025.Rockville,MD:U.S.DepartmentofHealthandHumanServices.December2014.5Randolph,PamelaK.ArizonaStateBoardofNursingSummaryandAnalysisofAnnualReportsfromArizonaNursingEducationProgramsCalendarYear2012.ArizonaStateBoardofNursing.2012.

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occupations,suchasexpandedfunctiondentalassistants,communitydentalhealthcoordinators,healthandtransitioncoaches,communityhealthworkers,andintegratedcarecasemanagers.6

ThechallengeofmeetinganticipateddemandforhealthcareworkersismademorecomplexbythesignificantgeographicvariationfoundinArizona.ThestatehasoneofthelargestmetropolitanareasintheUnitedStatesandsomeofthemostruralareasinthecountry.7Thenumbersofphysicians,physicianassistants,nursepractitioners,RNs,andpharmacistsper100,000peoplearesubstantiallyhigherinurbansettingsofArizonathanruralsettings.8

TounderstandtheimpactofArizona’sagingpopulation,growinginsurancecoverage,andchangingdeliverysystemoncurrentandfutureneedsforhealthcareworkers,theVitalystHealthFoundationandCityofPhoenixcommissionedtheUniversityofCalifornia,SanFrancisco(UCSF),tosurveyhospitals,communityhealthcenters,long-termcarefacilities,andhomehealthagenciesinArizona.Separatesurveysweresenttoeachtypeofhealthcaredeliveryorganization,includingquestionsaboutemployment,vacancies,perceptionsofthelabormarket,anticipatedchangesindemand,andreasonsforfuturechanges.Together,thesesurveysaredesignedtodevelopanaccurateandup-to-dateunderstandingofthedemandforhealthcareworkersinArizona.

6Irvine,Jane,andWilliamG.Johnson,AlliedHealthNeedsAssessment.Phoenix,AZ:MaricopaCommunityColleges.May14,2015.7Borns,Kristin,andVanPelt,Kim.HealthWorkforce,HealthyEconomy.ArizonaHealthFuturesPolicyPrimer,December2014.8Tabor,Joe,NickJennings,LindsayKohler,BillDegnan,HowardEng,DougCampos-Outcalt,andDanDerksen.ArizonaCenterforRuralHealth2015SupplyandDemandStudyofArizonaHealthPractitionersandProfessionals.Tucson,AZ:UniversityofArizona.February2016.

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SURVEYMETHODS

TheSurveyofHealthCareEmployersinArizona:CommunityHealthCenterswasoneoffoursurveyinstrumentsbasedonthequestionnaireusedbytheUniversityofCalifornia,SanFrancisco(UCSF)intheSurveyofNurseEmployers.WithinputfromanAdvisoryCommitteeconvenedbyVitalystHealthFoundationandCityofPhoenix,asurveyinstrumentwasdesignedforeachsettingtomeettheresearchgoalsoftheFoundation,andtounderstandcurrentandfuturehiringneedsofhealthcareemployersinArizona,includinghospitals,homehealthagencies,communityhealthcenters,andlong-termcarefacilities.ThesurveysweredesignedtoprovideasnapshotofthecurrentworkforceinArizona,andthechallengesoftraining,recruiting,andretaininganadequateworkforce.TheSurveyofHealthCareEmployersinArizona:CommunityHealthCenterswasstructuredforhumanresourcesdirectorsinclinicsettingstoprovidedataonstaffing,includingcurrentheadcountsandvacancies,aswellastheirperceptionsofthelabormarket,expectationsforhiring,andthecharacteristicsoftheirnewRNgraduateresidencyprograms.

ThesurveywaspostedonlinefollowingapprovalbytheUCSFCommitteeonHumanResearch.SurveyemailsweresenttoallhumanresourcesdirectorsprovidedbytheVitalystHealthFoundationandtheCityofPhoenix.TheinvitationfromUCSFincludedalinktotheonlineversionofthesurvey,aswellasafillable-PDFformthatcouldbecompletedbytherespondentandreturnedtoUCSFviaemailorfax.Facilitieswerecontactedwithfollow-upemailsandtelephonecalls,bothbyUCSFandmembersoftheAdvisoryCommittee,toencourageparticipation.

Thisreport,theSurveyofHealthCareEmployersinArizona:MaricopaCountyCommunityHealthCenters,2015focusesspecificallyonthehealthcentersinMaricopaCounty.

SurveyParticipationandDataAnalysis TheSurveyofHealthCareEmployersinArizona:CommunityHealthCenterselicited4uniqueresponsesinMaricopaCounty,representing13federally-qualifiedhealthcenters(FQHC)and22totalreportedclinics.Thesetotalsrepresentapproximately61.9percentofthetotalnumberoffederallyqualifiedhealthcentersinMaricopaCounty.9

Throughoutthereportweprovidethenumberoffacilityresponses(N)representedbythestatisticsintablesandfigures.Thenumberofresponsesreflectsthefactthatinsomecasesthedatarepresentmultiplecommunityhealthcenter(CHC)facilities.

9FederallyQualifiedHealthCenterswereidentifiedusingtheArizonaDepartmentofHealthServiceslicensedfacilitieslistingdatabase.

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Figure1comparesthedistributionofsurveyrespondentswithCHCsinthecountybasedonwhetherornotthegeographiclocationofthefacilityisconsideredrural.10Urbanfacilitiesareunderrepresentedinthedata.

Figure1.DistributionofrespondingcommunityhealthcentersvsFederallyQualifiedHealthCentersinMaricopaCounty,byrural/non-ruralgeographiclocation,2015

FINDINGS

PerceptionofLaborMarketConditionsCHCswereaskedtoreporttheirperceptionoflabormarketconditionsforCHCstaffintheirregion,usingarankorderscaleof1to5.Ascoreof“1”indicatedthatdemandforstaffwasmuchlessthantheavailablesupply,whileascoreof“5”indicatedhighdemandforstaffanddifficultyfillingopenpositions.Figures2and3,andTable1,comparethereportedresultsofoveralllabormarketconditionsforCHCstaffinfall2015.

Demandforphysicianswasreportedasbeinghigh(difficulttofillopenpositions)orsomewhathigh(somedifficultyfillingopenpositions)formanyspecialtiesqueriedinthesurvey.Allrespondentsreportedhighorsomewhathighdemandforinternalmedicinephysiciansandpsychiatrists.Nearlyhalfreportedhighorsomewhathighdemandforfamilymedicinephysicians,and41.6percentreportedhighorsomewhathighdemandforobstetrics/gynecology.Thelabormarketwasperceivedasbalancedforpediatriciansby91.7percentofrespondents;forobstetrics/gynecologyby58.3percent;andforfamilymedicineby53.8percent.

Demandforotherhighly-traineddirect-careprovidersvaried.Allfourrespondentsthatindicatedtheyhirepsychologistsreportedthatmarket-widedemandwassomewhathighforpsychologists.Nearly39percentofrespondentsreportedthatdemandfornursepractitioners(NPs)washighorsomewhathigh,butoverhalfreportedthattherewassomewhatgreatersupplyofNPsthandemandintheirarea.Just

10Theruralvs.non-ruralstatusofafacilitywasdeterminedusingthe2010Rural-UrbanCommutingAreacodesandthecommunityhealthcenter’szipcode.Formoreinformationsee:http://depts.washington.edu/uwruca/

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13

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10

15

20

25

Rural Non-rural Total

Clinics

SurveyRespondents

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overelevenpercentofrespondentsindicatedthattheyfacedhighmarketdemandforphysicianassistants,butmorethan77percentindicatedthatsupplywassomewhatgreaterthandemand.

Demandforregisterednurses(RNs)wasreportedassomewhathighby36.4percentofCHCs,andinbalancewithsupplybyallotherCHCs.OnlyoneCHCreportedthatitemployedLicensedPracticalNurses(LPNs),andthisCHCindicatedthatitperceiveddemandasmuchhigherthansupply.

MostCHCs(63.6%)indicatedthatsupplyanddemandwerebalancedforpharmacists,butoverone-thirdindicatedthattheyhadsomedifficultyfillingopenpharmacistpositions.AllfourCHCsthatemploypharmacytechniciansindicatedthathadsomedifficultyfillingopenpositions.

ManyCHCsemploycommunityhealthworkers(CHWs),licensedclinicalsocialworkers(LCSWs),promotoras,carecoordinators,andcarenavigators.Therecanbeoverlapintherolesofindividualswiththesejobtitles,aswellaswiththerolesofRNsandLPNs.FiveCHCsindicatedtheyemployCHWs,ofwhichfourindicatedthattheyfacedsomedifficultyfillingopenpositionsandoneperceivedthatsupplyanddemandwerebalanced.MorethanhalfofrespondentsperceivedsupplyanddemandtobeinbalanceforLCSWs(58.3%),and33.3percenthadatleastsomedifficultyfillingopenLCSWpositions.OfthefiveCHCsthatemploypromotoras,fourindicatedthattheyhadsomedifficultyfillingopenpositions,whileoneperceivedabalancedmarket.MostCHCs(58.3%)perceivedthatsupplywasgreaterthandemandforcarecoordinators,while80percentreportedthattheyhadsomedifficultyfillingcarenavigatorpositions.

Figure2.Perceptionofphysician,NP,PA,andpsychologistlabormarketdemandbycommunityclinicsinMaricopaCounty,2015

0% 20% 40% 60% 80% 100%

Physicians- familymedicine

Physicians- internalmedicine

Physicians- pediatrics

Physicians-…

Physicians- geriatrics

Physicians- psychiatry

Physicians- other

Psychologists

NursePractitioners(NP)

PhysicianAssistants(PA)

Highdemand:Muchdifficultyfillingopenpositions

Somedifficultyfillingopenpositions

Demandinbalancewithsupply

Demandislessthansupply

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FourofthefiveCHCsthatemploycodersindicatedthatthereishighdemandandmuchdifficultyfillingopenpositionsforthisoccupationwhileoneperceivedsupplyanddemandtobeinbalance.AllCHCsthatemployradiologytechnologistsindicatedthatdemandwashighorsomewhathigh.

Figure3.PerceptionofclinicstafflabormarketdemandbycommunityclinicsinMaricopaCounty,2015

0% 20% 40% 60% 80% 100%

RegisteredNurses(RN)

LicensedPracticalNurses(LPN)

MedicalAssistants

Pharmacists

PharmacyTechnicians

CommunityHealthWorkers

SocialWorkers(LCSW)

Promotoras

CareCoordinators

CareNavigators

Coders

RadiologyTechnologists

Highdemand:Muchdifficultyfillingopenpositions

Somedifficultyfillingopenpositions

Demandinbalancewithsupply

Demandislessthansupply

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Table1.PerceptionoflabormarketdemandbycommunityhealthclinicsinMaricopaCounty,2015PerceptionoflabormarketdemandinMaricopaCounty,2015

Highdemand Somedifficulty

fillingpositions Demandisinbalancewithsupply Demandisless

thansupply Demandismuchlessthansupply Responses

Description # % # % # % # % # % #Physicians-familymedicine 1 7.7 5 38.5 7 53.8

0 0

0 0 13

Physicians-internalmedicine 1 8.3

11 91.7

0 0

0 0

0 0

12

Physicians-pediatrics 1 8.3

0 0

11 91.7

0 0

0 0

12Physicians-obstetrics/gynecology 1 8.3

4 33.3

7 58.3

0 0

0 0

12

Physicians-geriatrics 1 20

0 0

4 80

0 0

0 0

5Physicians-psychiatry 1 20

4 80

0 0

0 0

0 0

5

Physicians-other 1 20

0 0

4 80

0 0

0 0

5Psychologists 0 0

4 100

0 0

0 0

0 0

4

RegisteredNurses(RN) 0 0

4 36.4

7 63.6

0 0

0 0

11NursePractitioners(NP) 1 7.7

4 30.8

1 7.7

7 53.8

0 0

13

LicensedPracticalNurses(LPN) 1 100

0 0

0 0

0 0

0 0

1

PhysicianAssistants(PA) 1 11.1

0 0

1 11.1

7 77.8

0 0

9MedicalAssistants 1 7.7

0 0

5 38.5

0 0

7 53.8

13

CommunityHealthWorkers 0 0

4 80

1 20

0 0

0 0

5SocialWorkers(LCSW) 0 0

4 33.3

7 58.3

1 8.3

0 0

12

Promotoras 0 0

4 80

1 20

0 0

0 0

5CareCoordinators 0 0

4 33.3

1 8.3

7 58.3

0 0

12

CareNavigators 0 0

4 80

1 20

0 0

0 0

5Coders 4 80

0 0

1 20

0 0

0 0

5

RadiologyTechnologists 1 20

4 80

0 0

0 0

0 0

5Pharmacists 0 0

4 36.4

7 63.6

0 0

0 0

11

PharmacyTechnicians 0 0 4 100 0 0 0 0 0 0 4Note:percentagesmaynotsumto100%duetorounding.

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Table2summarizestheoverallcharacterizationofthelabormarketacrossMaricopaCountybyCHCsin2015.Aresponseindicating“highdemand”wasscoredasa5,andaresponseof“demandismuchlessthansupply”wasscoredasa1.Theaveragescoreprovidesanoverviewoftheperceptionoflabormarketconditionsbyposition,withhigherscoresindicatinggreaterdemandrelativetosupply.

StrongdemandwasreportedbyCHCsforcertainpositionsincomparisontothesupplyavailable,withanaveragescoreof4ormore,fornearlyallphysicianpositions(exceptpediatrics),psychologists,licensedpracticalnurses,pharmacytechnicians,coders,andradiologytechnologists.

Thelabormarketwasreportedasbeingmoreinbalancewiththesupplyavailableforallotheroccupations,withthelowestaveragescorebeing3.0formedicalassistants,carecoordinators,andLCSWs.

Table2.AveragerankingofoveralllabormarketdemandacrossMaricopaCounty,2015

PerceptionoflabormarketdemandinMaricopaCounty,2015

AveragerankinginMaricopaCounty Responses

Description #

Physicians-familymedicine 4.0

13 Physicians-internalmedicine 4.3

12

Physicians-pediatrics

3.7

12

Physicians-obstetrics/gynecology4.0

12

Physicians-geriatrics 4.0

5Physicians-psychiatry 4.5

5

Physicians-other 4.0

5Psychologists 4.0

4

RegisteredNurses(RN) 3.5

11NursePractitioners(NP) 3.5

13

LicensedPracticalNurses(LPN) 5.0

1PhysicianAssistants(PA) 3.3

9

MedicalAssistants 3.0

13CommunityHealthWorkers 3.5

5

SocialWorkers(LCSW) 3.0

12Promotoras 3.5

5

CareCoordinators 3.0

12CareNavigators 3.5

5

Coders 4.0

5RadiologyTechnologists 4.5

5

Pharmacists 3.5

11PharmacyTechnicians 4.0 4

Note:1indicatesthatdemandismuchlessthansupply;5indicatesthatdemandismuchgreaterthansupply.(Lowernumbersindicategreatersurplus.)

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CurrentEmploymentofStaffTable3presentstotalcurrentemploymentbyCHCpositionandthedistributionofemploymentbyfull-timeversuspart-timestatus.Thereiswidevariationinfull-timeversuspart-timeemploymentacrossthedifferenttypesofpositions.

RespondingCHCsreportedtotalcurrentemploymentof34physicians.CHCswereaskedtodifferentiatebetweenphysiciansindifferentspecialties,withphysiciansinfamilymedicinerepresentingover44percentofallemployedphysicians.Physiciansinobstetrics/gynecology,internalmedicine,andfamilymedicinearemuchmorelikelytoworkfull-timethanphysiciansinpediatrics.

Morethanhalfofradiologytechnologists,andallCNMs/Promotorasworkpart-time.

Onaverage,CHCsdefinedfull-timeemploymentas38hoursperweek.

Table3.Numberofcurrentstaff(headcount)byposition,asofMay1,2015

Full-time Part-time*

Description Headcount %oftotal Headcount %oftotal Total

Physicians-familymedicine 11 73.3

4 26.7

15Physicians-internalmedicine 4 80.0

1 20.0

5

Physicians-pediatrics 4 57.1

3 42.9

7Physicians-obstetrics/gynecology 7 100.0

0 0.0

7

RegisteredNurses(RN) 9 100.0

0 0.0

9NursePractitioners(NP) 11 100.0

0 0.0

11

NurseMidwives(CNM) 0 0.0

2 100.0

2PhysicianAssistants(PA) 2 100.0

0 0.0

2

Certifiednursingassistants 1 100.0

0 0.0

1MedicalAssistants 64 100.0

0 0.0

64

CommunityHealthWorkers 1 100.0

0 0.0

1SocialWorkers(LCSW) 5 100.0

0 0.0

5

Promotoras 0 0.0

1 100.0

1CareCoordinators 8 88.9

1 11.1

9

Coders 1 100.0

0 0.0

1RadiologyTechnologists 1 33.3

2 66.7

3

Pharmacists 1 100.0 0 0.0 1

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CurrentVacanciesFigure4presentsvacancyratesbypositionasofMay1,2015.ThehighestvacancyrateswithinCHCswerereportedforphysicianassistants(50.0%),physiciansspecializinginpediatrics(30.0%),andphysiciansspecializingininternalmedicine(28.6%).Figure4.Vacancyratesbyposition,May1,2015

ChangesExperiencedInthePastYearCHCswereaskedaboutchangesinstaffemploymentlevelsduringthepastyear.Figure5andTable4showthatmanyCHCsreportedincreasedemploymentforcertainpositions,includingphysiciansspecializinginpediatrics(100%),psychologists(100%),carenavigators(100%),physiciansspecializinginobstetricsandgynecology(91.7%)andfamilymedicine(84.6%),physicianassistants(87.5%),andnursepractitioners(84.6%).

Respondentsreporteddecreasedemploymentfornooccupations.

Positionsforwhichahighshareofrespondentsreportsnoemploymentchangesinthepastyearincludedphysiciansspecializingininternalmedicine(100%),registerednurses(100%),pharmacists(100%),radiologytechnologists(100%),carecoordinators(66.7%),andsocialworkers(66.7%),

15.8%

28.6%

30.0%

22.2%

20.0%

25.0%

50.0%

8.1%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%

Physicians- familymedicine

Physicians- internalmedicine

Physicians- pediatrics

Physicians- obstetrics/gynecology

NursePractitioners(NP)

LicensedPracticalNurses(LPN)

PhysicianAssistants(PA)

MedicalAssistants

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Figure5.Employmentchangesinthepastyear,byposition,2015

Table4.Employmentchangesinthepastyear,byposition,2015 DifficultyRecruitingComparedtoLastYear

DecreasedEmployment IncreasedEmployment

Nochange Responses

Position # % # % # % # Physicians-familymedicine 0 0

11 84.6

2 15.4

13 Physicians-internal

medicine 0 0 0 0 7 100 7 Physicians-pediatrics 0 0

11 100

0 0

11 Physicians-

obstetrics/gynecology 0 0

11 91.7

1 8.3

12 Psychologists 0 0

4 100

0 0

4 RegisteredNurses(RN) 0 0

0 0

8 100

8 NursePractitioners(NP) 0 0

11 84.6

2 15.4

13 PhysicianAssistants(PA) 0 0

7 87.5

1 12.5

8 MedicalAssistants 0 0

5 38.5

8 61.5

13 CommunityHealthWorkers 0 0

4 80

1 20

5

SocialWorkers(LCSW) 0 0

4 33.3

8 66.7

12Promotoras 0 0

4 80

1 20

5

CareCoordinators 0 0

4 33.3

8 66.7

12CareNavigators 0 0

4 100

0 0

4

Coders 0 0

4 80

1 20

5RadiologyTechnologists 0 0

0 0

1 100

1

Pharmacists 0 0 0 0 7 100 7

0% 20% 40% 60% 80% 100%

Physicians- familymedicinePhysicians- internalmedicine

Physicians- pediatricsPhysicians-…

PsychologistsNursePractitioners(NP)PhysicianAssistants(PA)RegisteredNurses(RN)

MedicalAssistantsPharmacists

CommunityHealthWorkersSocialWorkers(LCSW)

PromotorasCareCoordinatorsCareNavigators

CodersRadiologyTechnologists

Decreasedemployment

Nochange

Increasedemployment

18

CHCswereaskedaboutothertypesofenvironmentalchangesexperiencedoverthepastyearthatmayhaveaffectedemployment.HalfofCHCsreportedanincreaseinpatientvolumeinthepastyear,and38.4percentreportedlessturnoverandgreaterretentionofstaff.

CHCswereaskedtoreportwhethertheyhadcreatednewjobclassificationsoverthepastyear.Figure6showsthatin2015,77.8percentofCHCsindicatedtheyhadcreatednewjobclassificationsinthepastyear.Themostfrequentlyreportednewjobclassificationswererelatedtocarecoordinationandhealthcoaching.

Figure6.Creationofnewjobclassificationsinthepastyear,2015

Note:Numberofobservations=9

CHCswereaskedaboutthetypesofsupportprovidedtoemployedstaffwhoareenrolledinadegreeprogram,orworkingtowardacertification(Table5).Nearly85percentofCHCsofferedtuitionreimbursementinsupportofemployedstaffseekinganadditionaldegree.Lesscommonwastheprovisionofpaidtimeoffforcoursework(7.7%).Over15percentoftherespondingCHCsreportedallowingcurrentstafftotakeunpaidtimeoffforcoursework.

Table5.Supportforstaffworkingtowarddegreesorcertification,2015

Description # %

Tuitionreimbursement 11 84.6Paidtimeoffforcoursework 1 7.7Approveduseofunpaidtimeoffforcoursework 2 15.4None 0 0Other 0 0Totalresponses 13 --

77.8%

22.2%

Newjobclassifications

Nonewjobclassifications

19

CHCsthatprovidedtuitionreimbursementwereaskedaboutthemaximumbenefitpaidperemployeeperyear.Allreportedofferingbetween$2000and$2500peryear.

CHCswerealsoaskedtodescribethemostimportantcompetencygapstheyencountered.Themostcommonoccupationswithcompetencygapswere:medicalassistants,andlesscommonly,nursepractitioners,physicianassistants,andradiologytechnicians.Themostfrequentlycitedcompetencygapfortheseoccupationswashavingthenecessaryexperience,followedbybilingualfluency.

RNEmployment

AspresentedinFigure7,approximately89percentofCHCsreportedhavingaminimumexperiencerequirementforRNstobehired.TheseCHCsreportedhavingarequirementof1to24monthsofpreviousexperiencetobehiredintoageneralstaffRNposition.Approximately89percentofCHCsalsorequiredminimumexperienceinprimary/ambulatorycare.Over77percentofCHCsindicatedthatabaccalaureatedegreeisrequired.Over22percentofCHCsreportedrequiringasecondlanguagefortheirRNemployees,but77.8percentindicatedthatitwasapreference.OftheseCHCs,Spanishwasreportedasthepreferredlanguage.

Figure7.Requirementsforregisterednursingemployment,2015

Note:Numberofobservations=9

RespondentswereaskedtoreporttheshareofRNscurrentlyemployedintheirCHCpreparedatthebaccalaureatelevel.NearlyallCHCsreportedthatBSN-preparednursesrepresent75to100percentofallemployedRNsintheirfacility(Table6).Approximately8.3percentofrespondentsindicatedthatRNsholdingaBSNdegreeaccountedforlessthan50percentoftheirregisterednursingstaff.

88.9%

88.9%

77.8%

77.8%

22.2%

0% 20% 40% 60% 80% 100%

Minimumexperiencerequirement

Minimumexperienceinprimarycare/ambulatorycarerequirement

Baccalaureatedegreerequired

Secondlanguagepreferred

Secondlanguagerequired

20

Table6.CurrentlyemployedBSN-preparedregisterednurses,2015

ShareofemployedRNswithaBSN(%) # %

0–50percent 1 8.3 75–100percent 12 91.7 Total 13 100.0

CHCswereaskedwhethernewhiresthatdonothaveabaccalaureatedegreearerequiredtocompleteaBSNdegreeand,ifso,howmuchtimetheyhavetocompleteit.Over77percentofCHCsrequirenewlyhiredemployeesthatdon’talreadyholdaBSNtoobtainone.ForthoseCHCsthathavethisrequirement,atimetableofapproximately1yearwasreported.PerhapsbecauseofthepreferencefornewlyhiredRNstrainedbelowthebaccalaureateleveltoobtainaBSN,over87percentofallCHCsreportedthatRNswhodonothaveaBSNmayexperiencelimitsonbeingpromotedbeyondstaffnursepositions.

ThereisaperceptionamongincumbentRNseducatedbelowthebaccalaureatelevelthattheBSNdegreehasnopotentialtoincreaseearnings.11However,thedatasuggeststhismightnotbeaccurateinArizonaCHCs,asover87.5percentofCHCsreportedthattheirorganizationdifferentiatessalarybydegree.Incontrast,only12.5percentdifferentiatesalarybasedonadvancedcertifications(e.g.criticalcare,peri-operative,oncology).

CHCswereaskedwhethertheysponsorclinicalresidencyprogramsfornewgraduateswhoarenotguaranteedtobehired.12NoneoftheCHCsreportedhavingaresidencyprogram.However,88.9percentofrespondentsreportedhavingsomekindoforientationprogramfornewlyhiredRNs.Alloftheseonboardingprogramsarefewerthan10weeksinlength.

EmploymentExpectationsfortheNextThreeYearsCHCswereaskedtoreportonexpectationsforemploymentoverthenextthreeyears.Figure8andTable7showthatCHCsreportedexpectationsofincreasedemploymentforseveralpositions,includingpsychologists(100%),physiciansininternalmedicine(91.7%),pediatrics(91.7%),obstetrics/gynecology(92.3%),andfamilymedicine(91.7%),nursepractitioners(92.3%),andmedicalassistants(92.3%).Allcentersexpectednochangeforphysicianassistants,communityhealthworkers,promotoras,andradiologytechnologists.

Themostfrequentlyreportedreasonsforexpectedemploymentchangesoverthenextthreeyearswereincreasedfacilitysizeandincreasedpatientvolume.

Theonlypositionwithexpecteddecreasesinemploymentwaspharmacists.

11Bates,T,Chu,L,Keane,D,Spetz,J.SurveyofNursingEmployersinCalifornia,Fall2013.SanFrancisco,CA:PhilipR.LeeInstituteforHealthPolicyStudies,UniversityofCalifornia,SanFrancisco.August5,2014.12Thisquestionwasrestructuredin2014todistinguishon-boardingprogramsusedtoeducatenewRNgraduateemployeesfromprogramsthatofferwithnopromiseofemployment.Thus,comparisonswithprioryearscannotbemade.

21

Figure8.Expectationsforemploymentinthenextthreeyears,2015

Table7.Expectationsforemploymentinthenextthreeyears,2015

Expectationsforemploymentinthenext3years

DecreasedEmployment IncreasedEmployment No

change Responses

Position # % # % # % # Physicians-familymedicine 0 0.0

5 83.3

1 16.7

6

Physicians-internalmedicine 0 0.0

11 91.7

1 8.3

12

Physicians-pediatrics 0 0.0

11 91.7

1 8.3

12Physicians-

obstetrics/gynecology 0 0.0

11 91.7

1 8.3

12Psychologists 0 0.0

4 100.0

0 0.0

4

RegisteredNurses(RN) 0 0.0

8 80.0

2 20.0

10NursePractitioners(NP) 0 0.0

12 92.3

1 7.7

13

Physicianassistants 0 0.0

0 0.0

8 100.0

8MedicalAssistants 0 0.0

12 92.3

1 7.7

13

CommunityHealthWorkers 0 0.0

0 0.0

1 100.0

1SocialWorkers(LCSW) 0 0.0

7 87.5

1 12.5

8

Promotoras 0 0.0

0 0.0

1 100.0

1CareCoordinators 0 0.0

7 87.5

1 12.5

8

RadiologyTechnologists 0 0.0

0 0.0

1 100.0

1Pharmacists 7 100.0 0 0.0 0 0.0 7

0% 20% 40% 60% 80% 100%

Physicians- familymedicinePhysicians- internalmedicine

Physicians- pediatricsPhysicians- obstetrics/gynecology

PsychologistsNursePractitioners(NP)PhysicianAssistants(PA)RegisteredNurses(RN)

MedicalAssistantsPharmacists

CommunityHealthWorkersSocialWorkers(LCSW)

PromotorasCareCoordinators

RadiologyTechnologists

Decreasedemployment Nochange Increasedemployment

22

Table8showsthat100percentofCHCsdonotanticipatethecreationofnewjobclassificationsinthenexttwoyears.Notethat80percentofCHCsreportedthattheycreatednewjobclassificationsoverthepastyear.ThissuggeststhatCHCsbelievethattheoccupationstheypresentlyemploycanmeetcareneeds.

Table8.Plannednewjobclassificationsinthenexttwoyears,2015

2015

Description # %

Newjobclassifications 0 0 Nonewjobclassifications 9 100 Responses 9 100

CHCswereaskedtodescribehowconcernedtheyfeltaboutaseriesofstatementsontheadequacyoftheirCHC’sworkforce(Figure9andTable9).OfextremeconcerntoCHCswastheimpactofpotentialstatebudgetcutstoMedicaid(88.9%)andreimbursementlevelsdropping(100%).Thoughmeetingthebehavioralhealthneedsofpatientswasreportedasanextremeconcernby22.2percentoftherespondents,77.8percentwerenotatallconcerned.Theimpactoftheexpansioninhealthinsurancecoveragewasreportedassomewhatconcerningto77.8percentofCHCs.TheimpactofanagingworkforcewithinafacilitywasreportedasnotatallconcerningbymostCHCs(88.9%),andextremelyconcerningtoonly11.1percentofrespondents.CHCsindicatednoconcernfortheirworkforceadequacybeingimpactedbypopulationgrowth,andagingintheregion(88.9%).

Figure9.Impactonadequacyoncommunityhealthcenter’sworkforce,2015

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Aginghealthcareworkforcewithinfacility

Populationgrowthinregion

Populationaginginregion

Culturaldiversity

Linguisticcapabilities

Impactoftheexpansioninhealthinsurancecoverage

ImpactofpotentialstatebudgetcutstoMedicaid

Staffleavesofabsence

Disabilityaccommodationsand/orphysicallimitations…

Behavioralhealthneedsofpatients

Reimbursementlevelsdropping

Increasingdesireofworkerstobeonapart-time…

Changingemploymentgoalsofnewworkers(e.g.,…

Notatallconcerned Slightlyconcerned Somewhatconcerned Moderatelyconcerned Extremelyconcerned

23

Table9.Impactonadequacyoncommunityhealthcenter’sworkforce,2015Impactonadequacyofhospital'sworkforce

Notatall

concerned

Slightly

concerned

Somewhat

concerned

Moderately

concerned

Extremely

concerned Responses

Description # % # % # % # % # % #

Aginghealthcareworkforcewithin

facility8 88.9 0 0 0 0

0 0

1 11.1 9

Populationgrowthinregion 8 88.9

0 0

1 11.1

0 0

0 0

9

Populationaginginregion 8 88.9

0 0

0 0

0 0

1 11.1

9

Culturaldiversity 8 88.9

0 0

0 0

1 11.1

0 0

9

Linguisticcapabilities 8 88.9

0 0

0 0

1 11.1

0 0

9

Impactoftheexpansioninhealth

insurancecoverage0 0

1 11.1

7 77.8

0 0

1 11.1

9

Impactofpotentialstatebudgetcuts

toMedicaid0 0

0 0

1 11.1

0 0

8 88.9

9

Staffleavesofabsence 8 88.9

0 0

0 0

0 0

1 11.1

9

Disabilityaccommodationsand/or

physicallimitationsofstaff8 88.9

0 0

0 0

0 0

1 11.1

9

Behavioralhealthneedsofpatients 7 77.8

0 0

0 0

0 0

2 22.2

9

Reimbursementlevelsdropping 0 0

0 0

0 0

0 0

9 100

9

Increasingdesireofworkerstobeon

apart-timeschedule8 88.9

0 0

0 0

0 0

1 11.1

9

Changingemploymentgoalsofnew

workers(e.g.,Millennials)8 88.9 0 0 0 0 0 0 1 11.1 9

24

CONCLUSIONS

LabormarketconditionsfacedbyMaricopacountycommunityhealthcenters(CHCs)indicateshortagesfornearlyallphysicianspecialties,psychologists,nursepractitioners,licensedpracticalnurses,

pharmacytechnicians,coders,promotoras,andradiologytechnologists.Thelabormarketwasreportedasbeingmoreinbalancewiththesupplyavailableforallotheroccupations,includingregisterednurses,

medicalassistants,pharmacists,andsocialworkers.Over77percentofCHCsindicatedtheyhadcreatednewjobclassificationsoverthelastyear,mostofteninrolesrelatedtocarecoordinationandhealth

coaching.

CHCsexpressedconcernaboutanumberofenvironmentalfactors,particularlytheimpactofpotential

statebudgetcutstoMedicaidandreimbursementlevelsdropping.TheimpactoftheexpansioninhealthinsurancecoveragewasreportedassomewhatconcerningbymostCHCs.

ThedevelopmentofnewroleswithinCHCs,suchascarecoordinatorsandhealthcoaches,willrequire

neweducationalprogramsandadditionaltrainingformanyworkers.Employersshouldcontinuetoinvestintheeducationoftheirincumbentstaffthroughtuitionreimbursementandflexiblescheduling,

andcanworkwithlocalcollegesanduniversitiestoensuretheneededskillsarebeingtaught.

CHCswillneedadequateresourcestocontinuetoemployadequatenumbersofphysicians,nurse

practitioners,andphysicianassistantstomeetcareneeds.TheseoccupationsareknowntobechallengingtorecruitformostCHCs.Althoughthissurveydidnotprovidesufficientdatatoassessthe

labormarketfacedbyruralCHCs,priorresearchhasdemonstratedthattheyfaceevenmoredifficultyrecruitingcareproviders.Arizona’shealthprofessionaleducationprogramswillneedtomaintaintheir

preparationofnewphysicians,nursepractitioners,pharmacists,andphysicianassistants.

25

ACKNOWLEDGEMENTS

ThecollaborationoftheAdvisoryCommitteeconvenedbyVitalystHealthFoundation,theCityofPhoenix,andtheGreaterPhoenixChamberofCommercewasimportanttothedevelopmentofthe

surveyquestionnaireandconductingofthesurvey.WespecificallythankClaudiaWhiteheadforherwork.

ThisstudybenefittedfromtheworkofMatthewWilliamsandKatieHarrarwhoassistedwithreviewingthedatabase,makingtelephonecallstoincreaseresponserates,reviewingdata,andfindingcontact

informationforArizonaCHCs.EditorialreviewbyGinachukwuAmahandIgorGeynisgreatlyappreciated.