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Workforce Issues. M6920 October 30, 2001. Goals for discussion. Understand how professionals are thought about generally Understand some major issues about health professionals Increase sensitivity to licensure issues. Evolution of work force. Healers exist in every culture

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workforce issues

Workforce Issues

M6920

October 30, 2001

goals for discussion
Goals for discussion
  • Understand how professionals are thought about generally
  • Understand some major issues about health professionals
  • Increase sensitivity to licensure issues

M6920, Fall, 2001

evolution of work force
Evolution of work force
  • Healers exist in every culture
  • Healing associated with religious system
  • Enlightenment began Western separation

M6920, Fall, 2001

policy questions about the health workforce
Policy questions about the health workforce
  • What is the role of a professional?
  • Who is a "provider”?
  • How do we know they are “safe”?
  • How many should we have?

?????????

M6920, Fall, 2001

professionals or providers
Professionals or providers?
  • Workforce is labor market term
  • Provider is a term of art from payment systems
    • Independent billing has generally recognized MD, DO, DDS
  • Others generally seen as either
    • institutional staffing
    • secondary practitioners

M6920, Fall, 2001

defining professionals
Defining professionals
  • Special body of knowledge
  • Control over education and qualifications
  • Limited entry into field
  • Social recognition

M6920, Fall, 2001

for all health professionals
For all health professionals
  • Content and volume of education has grown
  • Cycles of excess and shortage occur
    • related to employment shifts
    • related to age groups
    • related to educational policy
  • Public expectations have changed

M6920, Fall, 2001

predicting supply and demand
Supply factors

delivery system (wages, benefits)

education system (capacity)

economic system (unemployment)

demographics of profession (age, gender, etc)

Demand factors

delivery system (technology, acuity)

economic system (reimbursement)

education system (faculty)

population demographics (age, epidemiology)

Predicting supply and demand

Dumpe et al 1992 Forecasting the Nursing Workforce

Nursing Economic$ 16:4 (170-9)

M6920, Fall, 2001

geographic distribution
Geographic distribution
  • The range of practitioner to population is extremely variable
  • US: 22.4/10,000 in 1997
  • Regional range:
    • New England 30.4
    • West South Central 18.3

M6920, Fall, 2001

health profession population ratio
Health Profession/ Population Ratio*

*per 100,000 population

Health US, 1999

M6920, Fall, 2001

interprofessional issues
Interprofessional Issues
  • Socialization
  • Actual and perceived power
  • Economic competition

M6920, Fall, 2001

physician questions have dominated
Physician questions have dominated
  • Because of the cost of preparation
  • Because of their primacy in the cost and access equation
  • Mechanisms have included
    • Residency support (Medicare)
    • Enrollment support (HRSA)
    • Policy on IMG’s

M6920, Fall, 2001

physician population ratio
Physician/population ratio*

*Health US, 1999

NE

Mid

Atlantic

South

Atlantic

E N

Central

W N

Central

E S

Central

Pacific

W S

Central

Mountain

M6920, Fall, 2001

physician supply in nyc
Physician Supply in NYC

Denise Soffel, United Hospital Fund

M6920, Fall, 2001

diversity in medical students
Diversity in Medical Students

1990: 65,163

1994: 66,629

M6920, Fall, 2001

international medical graduates
International medical graduates
  • 18,000 US graduates for 24,000 residency positions
  • IMG’s are ~25% of licensed physicians. . .
  • but 50% of HHC residents and
  • 75% of 392 residents at Lincoln Hospital (Bronx)

M6920, Fall, 2001

ethics of international movement
Ethics of international movement
  • Beneficence
    • better care in underserved US areas
  • Non-malfeasance
    • Drain from neediest countries
    • Specialty interests not needed
  • Autonomy
  • Social Justice

M6920, Fall, 2001

some current questions
Some current questions:
  • What is the role of the specialist?
  • What proportion of practitioners should be specialists?
  • How do we support the academic research machine?

?????????

M6920, Fall, 2001

is nursing a profession
Is nursing a profession?
  • Classics: clergy, law, medicine
  • Yes:
    • controls education
    • limited entry to field
    • social recognition
    • personal professional ethic

M6920, Fall, 2001

maybe not
Maybe not. . .
  • social recognition limited
  • only partial practice independence
  • most are wage workers
  • gender perception issues
  • competition with more prestigious fields

M6920, Fall, 2001

distribution of nurses
Distribution of Nurses*

*Per 100,000 population

Health US, 1999

1,272,900 nurses

1980

M6920, Fall, 2001

types of nurses 1996
Types of nurses, 1996*

*Health US, 1999

2,161,700 Nurses

M6920, Fall, 2001

aging out of nurses
Aging out of nurses

Buerhaus, Steiger, Auerhach JAMA 283:22

M6920, Fall, 2001

nurse questions
Nurse questions
  • Shortage focus: hospital staff
  • Population ratio has grown: 366/100K (1970) to 697/100K (1991)
  • Responses have included
    • Changes in length/type of education
    • International recruitment
    • Enrollment support (school & student)
    • Salary changes

M6920, Fall, 2001

intensity of nursing
Intensity of nursing
  • Prior to 1975, number of beds and nurses roughly parallel, with a few less nurses than beds
  • Since then, number of nurses has risen dramatically while beds decrease

M6920, Fall, 2001

impact of hospital closure shorter stays
Impact of hospital closure & shorter stays
  • up to 300,000 displaced nurses
  • 1.2 out of 1.9 million nurses work in hospitals
  • Home health has doubled
  • Out patient settings have grown 15%

M6920, Fall, 2001

international graduates
International graduates
  • Nursing Relief for Disadvantaged Areas Act of 1999
  • 500 nurses may enter for up to 3 years
      • at least 190 beds
      • in Health Professions Shortage Area
      • 35% days Medicare; 28% Medicaid
  • originally only 14 facilities nationwide qualified

M6920, Fall, 2001

some current nursing workforce issues
Some current nursing workforce issues
  • use of assistive personnel
  • use of contract personnel
  • differentiated practice
  • compression of advanced practice nurses
  • relationship to vulnerable populations
  • anticipated shrinkage

M6920, Fall, 2001

turnover issues
Turnover issues
  • Stability associated with
    • older staff
    • higher income staff
    • longer tenure
  • Turnover associated with
    • tension
    • limited organizational commitment
    • supervisor’s behavior

M6920, Fall, 2001

nursing programs in ny
Nursing Programs in NY
  • Graduate: 25
  • Baccalaureate: 45
  • AD: 57

M6920, Fall, 2001

diversity in nursing students
Diversity in Nursing Students

1990: 221,170

1994: 270,228

M6920, Fall, 2001

nurses in new york state 1996
Nurses in New York State, 1996
  • 96% FEMALE
  • Average age 47
    • in 1983 it was 40
    • 36% over 50
  • Average age by type of education
    • BSN 42
    • DIPLOMA 52
    • AD 44

M6920, Fall, 2001

new york state mean salaries late 1990 s
CRNA 67,200

CEO 60,000

Midwife 56,700

Dean 54,600

DIR/DP 54,100

Head Nrs 44,500

NP 43,400

CNS 42,100

STAFF 34,900

Faculty 33,800

New York State Mean Salaries (late 1990’s)

$$$$$

M6920, Fall, 2001

salaries cont
Salaries, cont.
  • Asian 46,700Black 45,900Puerto Rican 43,800Other Hispanic 43,400Native American 34,400White 33,300
  • By region of state
    • Range 48,900 TO 25,200

M6920, Fall, 2001

public health workforce
Public health workforce
  • Multiple disciplines
  • Multiple routes of entry
  • Multiple settings
  • Overlapping job duties
  • Confusion among
    • profession
    • setting
    • passion

M6920, Fall, 2001

ratio of ph workers to population
Ratio of PH workers to population

(by region)

*preliminary data

consumer protection or control of competition
Consumer protection or control of competition?
  • Limit number licensed?
  • Require certification?
  • Extend credentialing process?
  • Expand disciplinary actions?

M6920, Fall, 2001

licensing certification and credentialing
Licensing, certification and credentialing
  • License is a state issued assurance of minimal competence
  • Certification is a verification of specialty competence
  • Credentialing is verification by employing or reimbursing institution

M6920, Fall, 2001

professional licensure
Professional licensure
  • Provides validation in community
  • Affects ability to earn
  • Once gained, fiercely protected
  • Very confusing in interdisciplinary practice settings

M6920, Fall, 2001

licensing board discipline
Denial

Applicant never granted a license

Revoke

Licensee loses practice privilege

Voluntary surrender

Licensee agrees to quit practice

Suspend

License put on hold (time certain or open-ended)

Probation

Can practice with special conditions

Licensing board discipline

M6920, Fall, 2001

institutional licensure
Institutional licensure
  • Enormous increase in number of licensed or registered groups may rekindle this debate
  • The employer would be held responsible for hiring people with the right skills for each job
  • Current credentialing approaches may stimulate

M6920, Fall, 2001

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