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Health Workforce
Demographic and socioeconomic changes are already reshaping the nation and will dramatically impact the healthcare system….and may overwhelm efforts to address the health workforce in a timely and comprehensive manner. The problem…calls for us to educate the public, harmonize standards, increase access and funding for education, improve working conditions, invest in technology, update our infrastructure, and rethink the way we conduct research on the workforce.
Steven A. Wartman, MD, PhD, MACP
AAHC President and CEO
Out of Order, Out of Time: The State of the Nation’s Health Workforce is a report undertaken by the Association of Academic Health Centers (AAHC) to focus attention on the critical need for a new, collaborative, coordinated, national health workforce planning initiative. The report’s seven chapters include more than 40 findings that document what is “out of order” with respect to the nation’s health workforce, as well as the looming social and economic forces that leave no time for further delay before the problems get dramatically worse.
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The Academic Health Centers Role
Academic health centers are uniquely qualified to take a leadership role to resolve health workforce issues. These institutions:
- Educate a major portion of the nation’s health professionals are educated in their schools;
- Connect education and research to patient care, which ultimately depends on the health workforce;
- Drive economic development in local communities, states, regions, and the nation; and
- Provide the cross-cutting, collaborative leadership necessary to facilitate the transformative changes so urgently needed.
Defining the Health Workforce
Health workforce, in general, comprises the many individuals (with and without professional degrees) who are required to deliver healthcare in the complex patient care environment. Out of Order, Out of Time focus on practitioners with post-secondary education degrees.
Current Health Workforce Policy
- There has been little regard for shared goals or an enduring vision.
- U.S. health workforce policy is currently defined mostly by its deficiency, dysfunction, and confusion.
- There is no coherent overarching health workforce policy.
- U.S. attempts at rational health workforce policy planning have been short-lived, narrowly focused, or characterized by incrementalism due to a decentralized decision-making system that promoted and accommodated groups with disparate interests.
Economic Impact of Workforce
Evidence of Shortages
Rising Demand for Health Services
Faculty Shortages
Physician Workforce Makeup
Workforce Diversity
Schools and Enrollment
Financing Medical Education
Student Debt
Key Facts about the Health Workforce
Economic Impact of Workforce
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The health sector now accounts for 15 percent of our nation’s economy and the health workforce accounts for approximately 11 percent of the total US workforce.
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The Bureau of Labor Statistics projects that by 2014, one of every five new jobs will be in health care.
Evidence of Shortages
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The World Health Organization’s World Health Report 2006: Working Together for Health revealed an estimated worldwide shortage of almost 4.3 million physicians, nurses, midwives, and other health personnel.
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An early 2007 projection anticipates a shortfall of 340,000 registered nurses by 2020.
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Dentist-to-population ratios have been dropping for the past decade and are expected to decline further, to a rate of 52-55 dentists per 100,000 people by 2020.
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The Health Resources and Services Administration (HRSA) estimates that approximately 50 million Americans live in underserved areas.
Rising Demand for Health Services
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In 2011, the first of the Baby Boomers will turn 65. By 2030, the proportion of Americans who are over 65 years old will be one in five, compared to one in eight today. The over-85 population is expected to increase by 40 percent between now and 2015, and to grow even more quickly from then until 2050. The population of the “oldest old,” those who are over 85 years old, is expected to more than triple by 2050.
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Almost one half of Americans take at least one prescription medication.
Faculty Shortages
Worsening faculty shortages in academic health centers are threatening the nation’s health professions educational infrastructure. The AAHC finds that 94 percent of CEOs think faculty shortages are a problem in at least one health professions school, and 69 percent think that these shortages are a problem for the entire institution.(more...)
States Lack Clear Agenda to Avoid Health Workforce Crises
The AAHC finds that states lack comprehensive and coordinated long-term planning for the health workforce and thus are ill-prepared to address an emerging national health workforce crisis.
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more...)
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The American Association of Colleges of Nursing (AACN) found that more than 32,000 qualified- applicants to baccalaureate nursing programs were rejected in 2006. Over 70 percent of the nursing schools responding to an AACN survey pointed to faculty shortages as a reason for not accepting all qualified applicants into their nursing programs. The same survey shows a national nurse faculty vacancy rate of 7.9 percent, or approximately two faculty vacancies per school, with most of the vacancies requiring a doctoral degree.
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The American Dental Education Association (ADEA) reports that between 2004 and 2005, the number of full-time faculty vacancies in U.S. dental schools increased by 50 percent, rising from 250 to 374, the highest number in over a decade.
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A November 2006 survey by the American Association of Colleges of Pharmacy (AACP) found an average of more than five faculty vacancies per school of pharmacy, the vast majority of which were for full-time positions.
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As just one example within allied health, the American Society of Radiologic Technologists recently reported that over 67 percent of directors of educational programs for radiographers, radiation therapists, and nuclear medicine technologists expressed difficulty recruiting faculty members.
Physician Workforce Makeup
- The proportion of US allopathic medical school graduates planning careers in primary care decreased from 53.4 percent in 1997 to 35.1 percent in 2004.
- Median income for primary care physicians increased by 9.9% from 2000 to 2004, compared with a 15.8% increase in income for specialists.
- International medical graduate students represent 25 percent of all new physicians who enter residency and almost a quarter of all practicing physicians in the US.
Workforce Diversity
- In 1970, women comprised only 7.6% of the physician workforce and were practically absent from dentistry. However, between 1995 and 2005, female enrollments rose from 36.7 percent to 44.3 percent in dental school, 42.7 percent to 48.5 percent in medical school, and 63.8 percent to 64.2 percent in pharmacy school.
- In 2003-2004, women were the majority of all applicants to medical school for first time ever, and women are close to achieving parity in enrollment.
- Women comprise only 16 percent of professionally active dentists, 26 percent of physicians, and 46 percent of pharmacists.
- Notwithstanding some successful targeted recruitment campaigns, only 5.7 percent of nurses in 2004 were male, only a slight increase from 5 percent in 1996.
- A 2002 study found that male nurses have higher dropout rates in nursing school, are nearly twice as likely as females to leave nursing within four years of graduation, and tend to have lower job satisfaction.
- African Americans, Hispanic Americans, and American Indians (who collectively now make up more than a quarter of the US population) are underrepresented in the health workforce, constituting just 9 percent of nurses, 6 percent of physicians, and 5 percent of dentists, and are similarly underrepresented among health professions faculties.
Schools and Enrollment
- Many medical schools are taking steps to implement the Association of American Medical Colleges’ call for a 30 percent increase in enrollment.
- Osteopathic medical education has grown from five institutions in 1968 to 23 in 2007, with three new provisionally accredited schools having begun to enroll students in the fall of 2007.
- Six new schools of pharmacy opened between 2004 and 2006, and at least nine more are expected to open by 2010.
Financing Medical Education
- The Congressional Budget Office (CBO) estimates that Medicare will provide a total of $8.4 billion in Graduate Medical Education (GME) payments to hospitals in fiscal year 2007.
- The number of Medicare-funded GME slots has not increased since the enactment of the Balanced Budget Act of 1997, which included a provision freezing the number of slots at 1996 levels.
- A 2000 study found that forty-five states and the District of Columbia made GME payments under Medicaid, and estimated total Medicaid GME payments in 1998 at $2.3-2.4 billion.
Student Debt
- The average debt for medical students graduating in 2006 was $130,571—an 8.5 percent increase over the previous year.
- Over the last 20 years, medical school tuition has outpaced gains in physician income, and median debt from medical school rose 150 percent in constant dollars between 1984 and 2004.
- The average debt for dental students graduating in 2005 was $162,155, a 14.5 percent increase over the previous year.