The Current and Future Supply and

Demand For The Health Workforce in

the US

Edward Salsberg, MPA

Director, National Center for Health Workforce Analysis Department of Health and Human Services

Health Resources and Services Administration

Bureau of Health Professions

For the Health of Texas Workshop February 28, 2011

Austin, TX

Overview

• The Framework for Health Workforce “Planning”

• National Health Employment Trends

• The Expected Shortage

• The Change Imperative

• Implications

Key National Health

Workforce Questions

1. Will there be enough physicians, nurses and

other health workers? If not:

• What can we do to increase the supply?

• What can we do to get these workers to the highest

need areas?

• What can we do to make better use of physicians

and other health professionals?

2. What can we do to assure access?

3. What can be done to slow the increase in

costs?

The New National Health

Workforce Infrastructure

National Health Care Workforce Commission

National Center for Health Workforce Analysis

State Health Care Workforce Development Grantees

Health Care Workforce Assessment

The US Approach to Health

Workforce “Planning”

Focus on data collection, analysis, and research

Widespread dissemination of data, analyses,

and information

Federal-state partnerships

Increasing attention to evaluation and

longitudinal tracking

Inter-professional planning and strategies

National Center for Health Workforce Analysis:

Approach and Activities

Build on existing sources of data including from

professional associations, states, and federal

agencies

Build national capacity for data collection and

analysis including within professional associations

and states

Develop and promote a national uniform minimum

data set

Support research to better understand current and

future workforce needs and dynamics

Workforce Challenges

• General shortages health personnel including

physicians and nurses; some specific concerns: • Primary Care; Chronic and Long Term Care; Behavioral Health

• Mal-distribution of existing workforce

• Barriers to health personnel working at the top of

their competency

• Increasing need for workforce diversity

• Implementing inter-professional education

and practice

• Planning for an uncertain future

National Health Employment

Trends

Hospitals Employ More Than One-

Third of Health Care Workers

Health Care Employment by Setting

Source: Altarum Institute, Health Market Insights from the BLS January 2011 Employment Data.

34%

22% 17%

8%

19% Hospitals

Nursing & Residential

Care Facilities

Offices of

Physicians

Home Health

Other

Ambulatory

31.0%

19.8%

51.3%

14.3% 15.4%

0%

10%

20%

30%

40%

50%

60%

Ambulatory

Care

Practitioner

Offices

Home Care Hospitals,

Public &

Private

Nursing Care

Facilities

2000-2008: Health Care Jobs

Far Outpace the Economy • Total U.S. employment grew by 3.7% across 2000–2008; health care

employment grew 30.1%

• Hospitals experienced slower employment growth than other

healthcare settings

Source: Center for Workforce Studies, SUNY Albany Analysis of BLS data.

Employment Growth By Setting,

2000-2008

Even in Recession, Healthcare Jobs Grew

0.7% 1.1%

5.3% 4.3%

2.1%

0.0%

2.0%

4.0%

6.0%

Hospitals Offices of

Physicians

Outpatient Care

Centers

Home Health

Care Services

Nursing and

Residential Care

Facilities

• Though hospitals added the largest absolute number of jobs, growth on a

percent basis lagged behind

• Hospitals added 33,600 jobs across the last year; in contrast, physician offices

added 26,000

Source: Altarum Institute, Health Market Insights from the BLS January 2011 Employment Data.

Growth in Healthcare Employment by Setting,

Jan. 2010 - Jan. 2011

Demand for Health Care

Occupations Will Continue to Grow

Source: Bureau of Labor Statistics Monthly Labor

Review, November 2009.

50%

46%

40%

39%

36%

36%

36%

34%

33%

31%

31%

30%

30%

0% 10% 20% 30% 40% 50% 60%

Home health aides

Medical scientists (ex. epidemiologists)

Physical therapist aides

Dental assistants

Physical therapist assistants

Pharmacy technicians

Occupational therapist assistants

Projected Increase, 2008 - 2018

The Expected Shortage

Drivers of Future Demands for Services

Population growth

• U.S. Population to grow by ~30 million in the next decade1

Aging of the Population; concomitant increase in

major/chronic illness and subsequent demand2

• Baby boom generation

Medical advances and successes2

Life Style factors3

• Increase in chronic diseases

Insurance coverage expansion4

1U.S. Census Bureau “Projections of the Population and Components of Change for the United States: 2010 to 2050” 2Bureau of Labor Statistics “Career Guide to Industries, 2010-2011: Healthcare” 3CDC “Chronic Diseases and Health Promotion” 4Affordable Care Act

Most Major Illnesses Very Age Sensitive

Data present age-specific invasive cancer incidence rates (new cases per 100,000 pop.) for the United Sates, 2002-2006.

Source: AAMC Center for Workforce Studies analysis of National Cancer Institute, SEER Cancer Statistics Review, 1975-2006

(published 2009).

Age Group

Female

Cancer Incidence Rates (per 100k pop.)

by Age, 2002-2006

The Expansion of Insurance Coverage is

Likely to Have a Significant Impact in Texas

5.0%

8.2%

8.7%

9.6%

9.6%

19.6%

19.9%

21.3%

22.8%

25.7%

0% 5% 10% 15% 20% 25% 30%

Massachusetts

Hawaii

Minnesota

Wisconsin

Vermont

Arizona

Nevada

Florida

New Mexico

Texas

Source: Current Population Survey (Prepared by NCHWA, February 2011)

The States with the Highest and

Lowest Rates of Un-insured, 2009

Visit Rate By Insurance Type, 2007

Source: AAMC Center for Workforce Studies analysis of 2007 NAMCS and NHAMCS Public Use

Data File (primary expected source of payment variable), Summary Health Statistics for the U.S.

Population: National Health Interview Survey, 2007.

Drivers of Future Physician Supply

• Slow increase in GME positions

• An aging physician workforce

• Life style and gender mix

• Productivity impacted by team structure (PAs, NPs),

service delivery mechanisms, HIT/EMR

Source: Michael J. Dill & Edward S. Salsberg. The Complexities of Physician Supply and Demand : Projections Through 2025 ( AAMC November 2008).

The Change Imperative

The Change Imperative

• Unsustainable cost increases

• Health workforce shortages

• New models of care: accountable care

organizations (ACOs), patient-centered medical

homes

• New approaches to financing including bundled

payments

• Increasing consumer involvement

• Dynamic and expanding role of HIT

Source: National Center for Health Workforce Analysis

10% of the Pop Account for 60% of the Costs!

18.7%

44.0%

59.5%

81.9%

95.7%

0%

20%

40%

60%

80%

100%

Top 1% Top 5% Top 10% Top 25% Top 50%

Pe

rce

nta

ge

of to

tal U

.S. e

xp

en

ditu

res

Percent of Health Care Expenditures Accounted for

By Top Spenders, 2005 – 2006

Source: AAMC Center for Workforce Studies analysis of Cohen, S.B., Rohde, F. (2009)The Concentration in Health Expenditures

over a Two Year Time Interval, Estimates for the U.S. Population, 2005–2006. MEPS Statistical Brief #244. Figure One. (U.S.

civilian non-institutionalized population).

Percentage of the Population, by Spending Bracket

650,000

700,000

750,000

800,000

850,000

900,000

950,000

2005 2010 2015 2020 2025

FTE

Phy

sici

ans

Most plausible demand

Most plausible supply

Shortage:

159,300

Most Plausible Scenario

Source: Michael J. Dill & Edward S. Salsberg. The Complexities of Physician Supply and Demand : Projections Through 2025 ( AAMC November 2008).

• Projections do not take into account health reform

• Assumes: a rise in utilization rates; shift in work schedules; an

increase in productivity; moderate growth in GME (27,600 new

residents/year)

Number of NPs Growing Rapidly

7,089 6,765

6,580 6,346

6,182 6,504

7,095

7,469

8,418

9,200

5,000

6,000

7,000

8,000

9,000

10,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Source: American Association of Colleges of Nursing 2000-2009 Annual Surveys

Growth in NP Graduates, 2000 - 2009

NP

Gra

duate

s

Number of PAs of Growing Rapidly

Source: National Commission on Certification of Physician Assistants

“Certified Physician Assistant Population Trends (PA-Cs)”

Newly Licensed PAs, 2000 - 2010

4,051

4,235

4,009

4,337

4,512

4,393

4,654 4,989

5,215

5,243

5,823

3,500

4,000

4,500

5,000

5,500

6,000

6,500

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Ne

wly

Lic

en

se

d P

As

Workforce Composition:

The Growth of Non-Physician Clinicians

Source: National Center for Health Workforce Analysis

Direct Patient Care Providers by Type,

Supply and Production 9

5

2

3

0

1

2

3

4

5

6

7

8

9

10

Currently Practicing New Providers/Year

Physicians

PAs/NPs

Use of Hospitalists Is Increasing

Source: AAMC 2009 Physician Survey on Primary Care

27.0%

21.5%

8.3% 10.3%

14.3%

6.0%

2.5% 5.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

< 40 yrs 40-49 yrs 50-59 yrs 60+ yrs

General Internal Medicine Internal Medicine Subspecialists

Percent of Internal Medicine Physicians Who

Are Hospitalists, by Age

Possible Members of the

Health Care Team of the Future Physicians

Nurse practitioners

Physician assistants

Psychologists

Optometrists

Registered Nurses

Pharmacists

Case Managers

Nutritionists/Dieticians

Physical Therapists

Community Health Workers

…And more

Implications

• Cost pressures and shortages will encourage innovation and systems redesign

• Strong incentives to make better use of existing workforce

• Shift to team-based care and inter-professional practice

• Shift care to lower cost settings

Source: National Center for Health Workforce Analysis

Implications (2)

• Increasing competition for practitioners

• Closer alignment of education and practice

• Pressure to reduce time and cost of education

• Need for better health workforce data and information

Source: National Center for Health Workforce Analysis

Relevant Federal Programs and Policies

Increased funding for health professions

education and training

Expansion of National Health Service Corp and

community health centers

Support for service delivery innovations

National Center for Health Workforce Analysis

State Health Care Workforce Development

Grantees

Encouragement of inter-professional teams

Contact Information

Edward Salsberg, MPA

Director, National Center for Health

Workforce Analysis

301-443-9355

esalsberg@hrsa.gov