Who is Entering and Who is Leaving Healthcare, and Why Do We Care? Bianca K. Frogner, PhD, Associate Professor Director of Center for Health Workforce Studies Department of Family Medicine Ground Rounds November 4, 2015 Seattle, WA
Topics • Recent activities at UW CHWS • Health spending and health workforce • Health workforce trends • Digging deeper: Long-term care exit and entry trends
Recent Activities at UW Center for Health Workforce Studies (UW CHWS)
UW CHWS Website: http://depts.washington.edu/uwchws
Recent HRSA Funding The UW CHWS became one of 6 HRSA-funded Health Workforce Research Centers in Fall 2014 with award of a $1.4 million, three year competitive collaborative agreement grant. The following studies of the allied health workforce are supported during the first 2 years of the award: Year 1: 1. Characteristics of Physician Assistant Students Planning to Work in Primary Care. 2. Pathways for Military Veterans to Enter Allied Health Careers. 3. The Workforce Needed to Integrate Behavioral Health Workforce with Primary Care. 4. Impacts of Greater Use of Low Skilled, Low-wage Workers in Health Care Delivery. 5. Characteristics of Veterans in Allied Health Care Jobs. Year 2: 1. Career Paths of Allied Health Professionals 2. Emerging Roles in Allied Health Occupations 3. Immigrants in Allied Health Professions 4. Leveraging Data to Monitor the Allied Health Workforce: Building a Database for Studies of Workforce Size, Distribution and Availability 5. Emerging Health IT Roles and Skillsets
Sample of Other Ongoing Projects • Sentinel Network: Real-Time Monitoring of Workforce Supply and Demand • Does Unrestricted Access to Physical Therapy Reduce Health Spending? • Longitudinal Analysis of EHRs and Patient Centered Medical Homes on Community Health Center Staffing Trends • Impact of Innovations on Primary Care Workforce Configurations • Use of Home Health Services among High Risk Rural Medicare Patients • Evaluation of VHA Group Practice Manager Initiative’s Implementation Process
Additional Activities • Write report, requested by National Research Council, on career pathways of allied health workers • Track Washington’s Health Workforce Demand in a Rapidly Changing Healthcare Environment • Present relevant health workforce research to Washington Legislature • Provide technical assistance to states on workforce planning through work with the National Governors Association • Support regional Area Health Education Centers with data on health career pathways
Health Spending and Health Workforce
Health System Design and Context Health Care Resources and Activities Use of Health Goods and Health Workforce Services Health Care System Performance - How does the health system perform? - What is the level of quality of care and access to services? - What does this performance cost? Cost/Expenditure Access to Care Quality of Care Non-Medical Determinants of Health Health Status
HCE as a Share of GDP under Alternative GDP+X Scenarios 40% by 2075 Source : Figure 8 from Technical Review Panel on the Medicare Trustees Report, “Review of Assumptions and Methods of the Medicare Trustees’ Financial Projections,” 2000.
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Bending the Cost Curve = Curbing Labor Growth? HCE / GDP Health Care Wage Rate Health Care Labor Force
Health Workforce Trends
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Absolute Difference in Number of People by Industry, 2003 and 2013 Health care Leisure and hospitality Professional, scientific and technical services Educational services Management, administrative and support, and Public Administration Mining Transportation and warehousing Other services Finance and insurance Social assistance Pharmacies and drug stores Medical equipment and supplies Pharmaceutical and medicine manufacturing Real estate and rental and leasing Utilities Agriculture, forestry, fishing and hunting Retail trade Information Wholesale trade Nondurable goods manufacturing Construction Durable goods manufacturing (1,500,000) (1,000,000) (500,000) - 500,000 1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 3,500,000 Absolute Difference of People within an Industry between 2003 to 2013
Ten Most Common Prior Year Industry for Entrants and Current Year Industry for Leavers of the Health Care Industry (UNPUBLISHED) Entrants’ Prior Year Industry Leavers’ Current Year Industry Not in the labor force or unemployed 13.0% Not in the labor force 34.7% (excluding in school) Leisure and hospitality 11.0 Unemployed 18.6 Retail trade 8.8 Educational services 5.6 (excluding pharmacies and drug stores) Educational services 8.4 Leisure and hospitality 4.6 In school 6.9 Professional, scientific and technical 4.3 services Professional, scientific and technical 6.3 Retail trade (excluding pharmacies 4.0 services and drug stores) Public Administration 6.0 Public Administration 3.9 Management, administrative and 5.7 Other services 3.8 support, and Other services 5.7 Management, administrative and 3.8 support, and Finance and insurance 5.1 Social assistance 3.2
Digging Deeper: Entry and Exit of Workers in Long-Term Care • Source: Frogner BK and Spetz J (2015). “Entry and Exit of Workers in Long - Term Care,” UCSF Health Workforce Research Center Report. Available at: http://healthworkforce.ucsf.edu/publication/entry-and-exit-workers-long- term-care • Funding: UCSF Health Workforce Research Center on Long-Term Care supported by Health Resources and Services Administration, National Center for Health Workforce Analysis, http://healthworkforce.ucsf.edu
Background • Aging Baby Boomer population • Living longer • Increasing chronic disease • Affordable Care Act, 2010 • Increasing health care demand • Impact on LTC service demand and supply? • Substantial job growth in long-term care sector • Growth especially for entry level jobs • Yet still high rates of turnover and unemployment
Question, Data and Methods • Research Questions: • Entrants: From where does LTC draw its workers and at what rate? • Leavers: To where do LTC workers leave and at what rate? • What characteristics are associated with entrants/leavers? • Data and Methods: • Current Population Survey, Annual Social and Economic Supplement (“March Supplement”) [2003 -2013] • Sample: Annual cross sectional survey of approximately 100,000 households (200,000 individuals); weighted for national representation • Track trends in self-reported current versus prior year occupation/industry and associated demographics/SES
Defining “Long Term Care” Sector 1. Home health care services 2. Nursing care facilities 3. Residential care facilities 4. Individual and family services 5. Community food and housing, and emergency services 6. Private households Derived from 2007 North American Industry Classification System (NAICS) codes
Top 2 Most Common Occupations by LTC Sector, 2013 Occupation Total Employment Most Common Second Most Common Home health care 1,111,737 41% Nursing, 28% Personal care services Psychiatric, and aides Home Health Aides Nursing care facilities 1,719,845 37% Nursing, 12% Registered Psychiatric, and nurses Home Health Aides Residential care 779,961 20% Personal care 13% Food prep & facilities aides service-related Individual and family 1,445,790 21% Personal care 18% Social workers services aides Community food and 120,393 19% Social workers 13% Office & admin housing, and support emergency services Private households 652,564 40% Bldg & grounds 36% Personal care & cleaning and services (excluding maintenance PCAs)
Average Entry and Exit Rate by LTC Sector, 2003-2013 40.0 35.0 30.0 25.0 20.0 15.0 Entry Rate Exit Rate 10.0 5.0 0.0 Home health Nursing care Residential Individual and Community Private care services facilities care facilities family food and households without services housing, and nursing emergency services
Industry and Occupation Transitions, 2003-2013 Industry Entry from what Most common occupation of Exit to what industry? industry? entrants Home Health Care Services 14% Hospitals 42% Nursing, psych & home 33% Out of labor force 14% Nursing care facilities health aides 18% Unemployed 23% Personal care aides Nursing Care Facilities 18% Hospitals 37% Nursing, psych & home 27% Out of labor force 12% Leisure & hospitality health aides 19% Unemployed 10% Registered nurses Residential Care Services 14% Leisure & hospitality 21% Personal care aides 25% Out of labor force 8% Out of labor force 13% Food preparation 16% Unemployed Individual & Family Services 10% Out of labor force 22% Personal care aides 30% Out of labor force 9% Education 16% Social workers 16% Unemployed Community Food & 10% Education 15% Office & administrative 22% Unemployed Housing, and Emergency 10% Retail support occupations 21% Out of labor force Services 11% Social workers Private Households 21% Out of labor force 43% Building & grounds 50% Out of labor force 14% Leisure & hospitality cleaning & maintenance 16% Unemployed occupations 39% Personal care and services occupations (excluding PCAs)
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