 Prusynski RA, Mroz TM, Frogner BK |
Differences in staffing for non-nursing occupations across U.S. skilled nursing facilities during 2018-2023 |
Center for Health Workforce Studies, University of Washington |
09-18-2024 |
Full Report |
Staffing of Allied Health Professionals in Skilled Nursing Facilities |
This study examined variability in non-nursing occupations (e.g., respiratory, pharmacy, social work) staffing levels and contract staffing across U.S. skilled nursing facilities (SNFs) from January 2018 through June 2023 with a goal of identifying workforce gaps that might reflect potential inequities in access to care. Specifically, we estimated relationships between facility factors (e.g., region, profit status, quality, urban/rural location, payer mix) and community factors (e.g., racial/ethnic composition, social deprivation) with staffing minutes per patient-day (MPPD) and percent contractors for all non-nursing healthcare occupations in SNFs.
Allied Health CHWS CHWS Home Complete Reports and Briefs |
| Stubbs BA, Nguyen NH, Guenther GA, Skillman SM |
Washington’s Health Workforce Sentinel Network: Summary of Spring 2024 Findings |
Center for Health Workforce Studies, University of Washington |
06-13-2024 |
Washington Health Workforce Sentinel Network Summary of Spring 2024 Findings |
Health Workforce Sentinel Network |
High-Level Findings From Spring 2024
- Employers are increasingly reporting that they are creating their own training programs or are implementing models based on apprenticeships and mentorships to “grow their own” employees.
- Lower wage occupations, such as nursing assistants, medical assistants and dental assistants, are reported to be difficult to hire and retain due to wage competition and, in some cases, switching to a field other than healthcare.
- While the overall use of contract/travel workers has decreased since the height of the COVID-19 pandemic, this strategy is still used by many Washington healthcare employers to fill staffing needs.
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| Bacci JL, Oster NV, Pollack SW, Skillman SM |
A Qualitative Analysis of Opportunities to Strengthen Pharmacy Technician Career Pathways Across Practice Settings |
American Journal of Health-System Pharmacy |
08-13-2024 |
URL |
Envisioning New Career Pathways for Pharmacy Technicians |
Disclaimer
In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
Purpose
To identify pharmacy technician career pathways across pharmacy practice settings and opportunities to strengthen and expand these pathways.
Methods
Interviews were conducted with 17 participants from national pharmacy organizations, community pharmacies, health systems, and academia from March to May 2023. Interview questions were designed to elicit participants’ perceptions of factors influencing entry into, recruitment and retention of, and advancement of the pharmacy technician workforce. Interview notes were analyzed using a rapid thematic analysis approach.
Results
Seven themes were identified, including 3 themes related to entry: (1) healthcare interest and prior exposure facilitate pharmacy technician career discovery; (2) variation in and quantity of entry-level requirements can impede entry into pharmacy technician careers; and (3) proactive promotion of pharmacy technician careers needed. Two themes were related to recruitment and retention: (4) pharmacy technician compensation not aligned with job demands and (5) career ladders or lattices create advancement opportunities. Two themes were related to professional advancement: (6) pharmacy technician advancement limited by weak professional identity and (7) scope-of-practice policies can facilitate pharmacy technician advancement.
Conclusion
This study highlights the challenges pharmacy technicians face in their careers. Key findings stress cultivating a professional identity for pharmacy technicians, establishing career ladders or lattices, and advocating for policies that facilitate pharmacy technician professional advancement. These efforts are vital for sustaining the pharmacy technician workforce and ensuring quality patient care amidst the changing landscape of the pharmacy profession.
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| Bacci JL, Oster NV, Skillman SM |
Insights into Decreasing Applicants to Schools and Colleges of Pharmacy in the United States |
Center for Health Workforce Studies, University of Washington |
08-16-2024 |
Full Report |
What is Driving the Enrollment Crisis at Schools and Colleges of Pharmacy |
This study sought to explore recent declines in pharmacy school applications by describing factors that influence undergraduate students’ decision to study pharmacy at selected research universities in the United States (US) with schools and colleges of pharmacy. Key findings include:
- Factors that positively influence undergraduate students’ decision to study pharmacy include the prestige of a doctorate degree, job security/stability, salary, job availability, the ability to improve people’s health and wellbeing, the opportunity to work in healthcare, and the range of possible careers within pharmacy.
- Family members, pharmacists, pre-pharmacy or pharmacy students, a college teacher or advisor, and pre-pharmacy clubs were more frequently reported as a positive factor in undergraduate students’ decision to apply or have an intent to apply to pharmacy compared to students who were still undecided.
- High tuition for pharmacy school negatively influences undergraduate students’ decision to study pharmacy.
These factors can help schools and colleges of pharmacy and professional organizations develop impactful practices and policies for promoting and recruiting individuals into the pharmacy profession.
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| Guenther GA, Pollack SW, Stubbs BA, Frogner BK, Skillman SM |
Characteristics of the Current Dental Hygienist Workforce in Washington State |
Center for Health Workforce Studies, University of Washington |
08-08-2024 |
URL |
Washington Oral Health Workforce Tracking Program |
Demand for dental hygienists (DHs) in Washington is high and is limiting access to dental services in the state. Using data from state licensure records and a survey of DHs in the state, along with a variety of other sources, this report provides insights into who selects dental hygiene as a career and their pathways into this important oral health occupation, descriptions of the types and locations of their work, as well as DHs’ views of their jobs and careers.
Survey findings suggest that about 84% of DHs with Washington licenses were practicing as a DH in the state. Analyses focused on these respondents, and key findings include:
- Nearly 98% of DH respondents working in Washington were female and 78% were white.
- Half of the DH respondents completed an associate degree and 45% completed a bachelor’s degree in dental hygiene, and a quarter completed their dental hygiene education in a state other than Washington.
- Washington DHs working in public and non-profit settings, such as public health departments and community health centers, reported they worked more weekly hours on average (30.2 hours) and earned lower average hourly wages ($55.32) compared with DHs in private practices where most DHs in the state were employed (26.8 hours and $60.35).
- DHs in public and non-profit settings as well as DHs overall who worked more weekly hours (35 or more) reported receiving more employment benefits (including medical insurance, retirement, and paid time off) than DHs working in private settings or DHs overall who worked fewer (fewer than 35) weekly hours.
- When asked their views of their jobs and careers, DH respondents were generally positive, but some indicated dissatisfaction with opportunities for growth and leadership development and opportunities for promotion in their jobs.
- Slightly more than half (55%) strongly agreed or agreed that they would recommend a career as a DH to a friend or relative.
- DHs reported recording health histories, performing subgingival planing, oral inspection, and applying topical fluorides and varnishes nearly every day. Just over half of DHs reported having ever applied silver diamine fluoride and about one quarter reported having ever placed and finished restorations.
- Most (89%) DH respondents reported experiencing pain or discomfort in the hands, wrists, arms, shoulders, or neck in the past 12 months, with 93% of those with pain attributing it to dental hygiene work. These findings are comparable to a similar Washington survey of DHs conducted in 2004.
- Despite some job dissatisfaction and high rates of musculoskeletal disorders (MSDs) attributed to their work, nearly three quarters of DH respondents planned to continue working as a DH in clinical practice over the next few years.
Conclusions from these findings include:
- Strategies to address the conditions and DH practices that contribute to MSDs could help to encourage DHs to work more weekly hours, reduce DH job vacancies, and help improve access to patient care.
- Extending the DH career pathway with more opportunities for advancing dental hygiene careers, including but not exclusively into dentistry, could make DH a career that attracts more, and more diverse, entrants.
- Ongoing tracking of the size, distribution, and characteristics of Washington’s dental workforce is important to determine if and where progress is achieved to address oral health workforce issues in the state.
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| Cole MB, Wright B, Kett PM, Johnson HM, Staloff J, Frogner BK |
COVID-19 Federal Funding To Health Centers: Tracking Distribution, Locations, And Patient Characteristics |
Health Affairs |
08-05-2024 |
URL |
How Financial Support During the COVID Crisis Affected the Federally Qualified Health Center Workforce |
In 2020 and 2021, health centers received federal funding to support their COVID-19 pandemic response, yet little is known about how the funds were distributed. This study identified ten sources of funding distributed to 1,352 centers, ranging from $19 to $1.22 billion per center. When we examined patient and organizational characteristics by quartiles of funding per patient, health centers in the highest-funded quartile (quartile 4) were more likely rural and in the South; employed lower percentages of physicians; and had the highest percentages of sicker, uninsured, and unhoused patients. Centers in the lowest-funded quartile (quartile 1) were more likely urban, employed lower percentages of nurse practitioners, and had the highest percentages of Medicaid enrollees. With the end of pandemic-related funding in 2023, combined with Medicaid unwinding concerns, targeted investment is needed to mitigate a financial cliff and help maintain health centers’ capacity to provide high-quality services to those most in need.
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| Kett PM, Cole MB, Wright B, Frogner BK |
Association of Federal COVID-19 Funding Distributions With Workforce and Capacity in Health Centers |
Journal of Ambulatory Care Management |
08-01-2024 |
URL |
How Financial Support During the COVID Crisis Affected the Federally Qualified Health Center Workforce: An Update |
Using novel national data, we examined the association between 2020 federal COVID-related funding targeted to health centers (i.e., H8 funding) and health center workforce and operational capacity measures that may be important for preserving patient access to care and staff safety. We assigned health centers to quartiles based on federal funding distribution per patient and used adjusted linear probability models to estimate differences in workforce and operational capacity outcomes across quartiles from April 2020 to June 2022. We found a nearly 6-fold difference in 2020 H8 funding per patient when comparing health centers in the lowest versus highest quartiles. Despite this difference, health centers’ outcomes improved similarly across quartiles over time, with the lowest-funded health centers having the greatest staffing and service capacity challenges. Our findings suggest that COVID-related health center funding may have contributed to stabilization of health centers’ workforce and operations. Amid concerns about staff turnover, sustained investments targeted to supporting workforce retention at health centers can help to ensure ongoing delivery of critical services.
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| Williams-York B, Guenther GA, Patterson DG, Mohammed S, Kett PM, Dahal A, Frogner BK |
Burnout, Exhaustion, Experiences of Discrimination, and Stress among Underrepresented and First-Generation College Students in Graduate Health Profession Education |
Physical Therapy & Rehabilitation Journal |
07-17-2024 |
URL |
The Potential Burden of Being Underrepresented in Health Professional Programs |
Objectives
Mental health disorders are increasing among health profession students. Compounding this, students from underrepresented backgrounds may face additional stressors and challenges. The aims of this study were to: 1) assess the extent to which burnout, exhaustion, experiences of discrimination, and stress exist among students in dentistry, nursing, occupational therapy, pharmacy, and physical therapist professional education programs; 2) determine if there are significant differences by key demographic characteristics (those who are first-generation college students [FGCS], a member of an underrepresented minority [URM] group), or both); and 3) highlight strategies and solutions to alleviate these challenges identified by students.
Methods
Cross-sectional survey using a mix of question types of a sample of graduate students from dentistry, nursing, occupational therapy, pharmacy, and physical therapy programs from February to June 2020. Utilizing the Maslach Burnout Inventory Student Survey (MBI-SS) and campus climate and stress survey, mean subscale scores were calculated for the following outcomes of interest: MBI-SS burnout, dimensions of stress, and observed racism. Logistic regressions examined student factors that may help explain these outcomes. Content analysis examined participants’ responses to open-ended questions.
Results
There were 611 individuals who completed all survey questions. FGCS were significantly more likely than non-FGCS to report exhaustion (adjusted odds ratio [AOR]: 1.50; 95% CI: 1.04–2.16), family stress (AOR: 3.11; 95% CI: 2.13–4.55), and financial stress (AOR: 1.74; 95% CI: 1.21–2.50). URM students reported not feeling supported in their program and mentioned needing additional support, particularly for well-being, from staff and faculty.
Conclusion
Findings from this study are consistent with literature that FGCS students experience additional stressors that may lead to burnout and exhaustion. URM students reported not feeling supported in their programs. This study’s findings point to the need for leadership and faculty of health professional schools to implement or strengthen current policies, practices, and strategies that support URM students and FGCS.
Impact
Research demonstrates that a diverse student body and faculty enhances the educational experience for health professional students, and that diversity strengthens the learning environment and improves learning outcomes, preparing students to care for an increasingly diverse population. However, this study finds that students from underrepresented backgrounds may still experience more burnout, exhaustion, discrimination, and stress than their peers. Programs and policies to support URM students and FGCS throughout their academic careers can help improve graduation and retention rates, leading to improved workforce diversity.
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| Dahal A, Frogner BK |
Mental and Physical Health Status of U.S. Health Care Workers |
Center for Health Workforce Studies, University of Washington |
06-11-2024 |
Full Report |
Are Allied Health Providers Sick? If So, Are There Wage Consequences Associated with Being Sick? |
This study is a cross-sectional analysis of the 2017 wave of the Panel Study of Income Dynamics (PSID), which is part of a longitudinal survey of the general US population. Individuals aged 18 years or older that were employed or were actively looking for a job categorized by whether they worked in health care or not were included in the study. We examined the prevalence of self-reported mental and physical health conditions such as cardiovascular diseases, cancer and respiratory illnesses among health care professionals compared to all other employed individuals in the US. We compared health status across health care occupations and three health care settings: hospitals, ambulatory care, and long-term care. Using multivariate regressions, we examined the risk factors associated with health conditions among health care providers by occupation and work setting. Survey weights were applied to generalize results to the national population. The following were key study findings:
- Our sample included 10,375,357 health care workers and 104,999,133 non-health care workers.
- Health care workers compared to workers in other industries were slightly younger (41.7 vs 42.4), fewer were female (76.3% vs. 79.2%) and more likely to have a bachelor’s degree or higher (60.7% vs. 48.1%).
- Compared to workers in other industries, health care workers had a higher prevalence of any mental illness (14.6% vs. 9.6%), especially depression (8.0% vs. 4.9%) and anxiety (2.9% vs. 1.9%).
- Health care workers also had a higher prevalence of some physical health conditions such as other chronic illnesses (19.2% vs. 12.3%) and cancer (4.6% vs. 4.2%) compared to other workers.
- Among health care workers, the prevalence of 3 or more chronic illnesses was highest among those who worked in long-term care (36.9% compared to 34.9% for the overall health care group).
- Multivariate regression analysis showed that long-term care workers had a higher prevalence of cardiovascular diseases, diabetes, and cancer, while ambulatory care workers had higher prevalence of respiratory illnesses and hospital workers had higher prevalence of having arthritis. These prevalences were not statistically significant across settings, however.
- No consistent pattern or significant differences were found in the adjusted probabilities of the prevalence of physical health conditions by occupation other than physicians generally having the lowest probability of having any physical health condition except for cancer where they had the highest probability. Licensed practical nurses/licensed vocational nurses followed by aides/assistants had the highest probability of having any mental illness, including depression, compared to other occupations, though the differences were not statistically significant.
Health care workers generally reported worse mental health and more comorbidities than non-health care workers, though the prevalences of physical health conditions were similar. It should be noted that given the survey relies on self-report, mental health conditions may be particularly underreported due to stigma associated with them. Nonetheless, findings from this study provide important baseline information about the prevalence of illnesses in health care workers in the pre-COVID era. Ongoing follow-up will be crucial in informing policymakers on the most prevalent mental and physical health conditions to help develop policies targeting the most at-risk health care workers.
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| Pollack SW, Guenther GA, Stubbs BA, Patterson DG, Frogner BK, Skillman SM |
Characteristics of the Current Dental Assistant and Expanded Function Dental Auxiliary Workforces in Washington State |
Center for Health Workforce Studies, University of Washington |
05-20-2024 |
URL |
Washington Oral Health Workforce Tracking Program |
Dental assistants (DAs) and expanded function dental auxiliaries (EFDAs; DAs with additional training allowing them to perform expanded functions) are two key occupations supporting the oral health workforce in Washington. We surveyed registered DAs and EFDAs in Washington to learn more about the supply, distribution, and characteristics of these occupations in the state. The survey received responses from 1,240 DAs and 113 EFDAs.
Key findings from respondents suggest DAs in Washington State include:
- DAs are primarily female, White, and in their mid-thirties, on average.
- Two-thirds attended private or public community college or technical school DA programs.
- DAs work 33 hours/week on average, and the majority indicated they were working as many hours as they would like.
- Most DAs received some benefits at work, with paid time off most common, followed by medical benefits and retirement.
- Two-thirds of respondents agreed that they would recommend a career as a DA.
- About a third agreed they were appropriately compensated for the work they do and less than half that they were satisfied with promotion opportunities.
- Among respondents, 42% indicated intent to begin education to advance to another dental occupation within five years.
- Workforce recruitment and retention may be enhanced by the availability of employer-provided benefits, opportunities for promotion, and satisfactory wages.
- Efforts to increase the diversity of the DA workforce entering the occupation through the multiple DA education and training pathways utilized by survey respondents could help the DA workforce better represent the demographics of the state population, and potentially increase supply size and address high demand.
Responses from EFDAs in Washington State suggest:
- EFDAs are primarily female, White, and in their mid-forties, on average.
- EFDAs work 29 hours/week on average, and the majority indicated they were working as many hours as they would like.
- Almost all EFDAs received paid time off, 87% received retirement benefits, and about three quarters received medical benefits.
- About half agreed they were appropriately compensated for the work they do, while higher percentages agreed they have opportunities for promotion, opportunities to learn and grow, and generally enjoy their work.
- Very few EFDAs reported they intended to seek employment in or training for another occupation in the next five years.
- Because EFDAs are not currently represented by a unique federal Standard Occupation Code, they cannot be identified separately from DAs in public datasets used to understand trends in the health workforce. Improved administrative data collection and monitoring of this occupation is needed.
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| Shahrir S, Kett PM, Bekemeier B |
Public Health Nurses in an Emergency Response: Highlighting Proficiencies and Training Needs (Blog) |
Journal of Public Health Management and Practice (JPHMP) Direct |
04-17-2024 |
Blog |
The Role of Public Health Nurses in Doing Health Equity Work |
Public health nurses and nurse-led local health departments possess unique skills that were important in responding to COVID-19, especially in areas related to justice, equity, diversity and inclusion, and applying evidence-based approaches. Areas for additional training were also identified to guide future public health nurse workforce development.
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| Kett PM, Shahrir S, Bekemeier B |
Public Health Nurses’ Proficiencies and Training Needs in an Emergency Response: A Cross-Sectional Observational Study |
Journal of Public Health Management and Practice (JPHMP) |
05-01-2024 |
URL |
The Role of Public Health Nurses in Doing Health Equity Work |
Objective: To address gaps in understanding the public health nursing workforce regarding competencies recognized as critical during an emergency response.
Design, Setting, and Participants: A cross-sectional observational study using data with information on local health department staff- and organizational-level characteristics collected from across the United States in 2021. We used logistic regression to estimate the association between 2 binary nurse-specific predictors—(1) whether the staff person was a nurse and (2) whether the staff worked in a local health department that was “nurse-led” (directed by a nurse)—and reported proficiencies important to the COVID-19 response. Models controlled for relevant local health department and community characteristics.
Results: In the sample, 19% were nurses and 37% were at nurse-led health departments. Nurse versus nonnurse staff had higher odds of reporting proficiencies in skills related to Justice, Equity, Diversity, and Inclusion and in the skill “identifying/applying evidence-based approaches to address public health issues.” However, nurses, compared with their nonnurse peers, had higher odds of reporting training needs in domains related to community engagement, policy engagement, and cross-sectoral collaboration. Conversely, staff at nurse-led health departments, compared with non–nurse-led staff, had higher odds of reporting proficiencies in many of these same areas, including “collaborating across the public health system” and “influencing policies external to the organization that affect community health.” There were no areas in which nurse-led staff had lower odds of reporting proficiencies or higher odds of identifying training needs.
Conclusions: Findings from this study highlight areas of strength for public health nurses, particularly strengths related to diversity, equity, and inclusion, as well as areas where more training is needed. Such findings can help guide future public health nurse workforce development as well as underscore the value of public health nursing leadership and staff at local health departments for supporting community health.
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| Smith D, Dula C, Fite C, Gattman N, Papadakis E, Hinton L |
Washington Long-Term Care Workforce Initiative Legislative Report |
Washington Workforce Training and Education Coordinating Board |
12-01-2023 |
URL |
N/A |
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| Stubbs BA, Nguyen NH, Guenther GA, Skillman SM |
Washington’s Health Workforce Sentinel Network: Summary of Fall 2023 Findings |
Center for Health Workforce Studies, University of Washington |
03-01-2024 |
Washington Health Workforce Sentinel Network Summary of Fall 2023 Findings |
Health Workforce Sentinel Network |
High-Level Findings From Fall 2023
- Staffing gaps have caused difficulties across multiple healthcare settings, including long waiting lists for appointments, the temporary inability to provide certain services and the reduction of intake for new patients/clients, among other challenges.
- Employers continue to report access to childcare, housing and transportation as factors that are hard for them to influence but affect their ability to hire and retain workers. These issues can be especially challenging in rural settings.
- Lower wage occupations, such as nursing assistants, medical assistants and dental assistants, are reported to be difficult to hire and retain due to wage competition and, in some cases, switching to a field other than healthcare.
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| Dill J, Frogner BK |
The Gender Wage Gap Among Healthcare Workers Across Educational and Occupational Groups |
Health Affairs Scholar |
12-27-2023 |
URL |
Gender-Based Wage Gaps Among Health Care Workers: Is There a Spillover Effect? |
Women perform 77% of healthcare jobs in the US, but gender inequity within the healthcare sector harms women’s compensation and advancement in healthcare jobs. Using data from 2003 to 2021 of the Annual Social and Economic Supplement of the Current Population Survey (CPS), we measure women’s representation and the gender wage gap in healthcare jobs by education level and occupational category. We find descriptively that women’s representation in healthcare occupations has increased over time in occupations that require a master’s or doctoral/professional degree (e.g., physicians, therapists), while men’s representation has increased slightly in nursing occupations (e.g., registered nurses, LPNs/LVNs, aides and assistants). The adjusted wage gap between women and men is the largest among workers in high-education healthcare (e.g., physicians, advanced practitioners) but has decreased substantially over the last 20 years, while descriptively the gender wage gap has stagnated or grown larger in some lower education occupations. Our policy recommendations include gender equity reviews within healthcare organizations, prioritizing women managers, and realigning Medicare and Medicaid reimbursement policies to promote greater gender equity within and across healthcare occupations.
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| Rochford H, Frogner BK |
Strategies for Advancing Diversity and Inclusion in Health Services Research |
AcademyHealth Blog |
06-07-2023 |
URL |
N/A |
Many professional organizations are updating their Professional Code of Conduct to address concerns about sexual harrassment. A Code of Conduct is one way to address these concerns, but not the only way. This blog aims to expand the conversation and equip readers with tools to take action to create a more inclusive work environment.
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| Prusynski RA, Frogner BK, Rundell SD, Pradhan S, Mroz TM |
Is More Always Better? Financially Motivated Therapy and Patient Outcomes in Skilled Nursing Facilities |
Arch Phys Med Rehabil |
08-03-2023 |
URL |
N/A |
Objective: To determine if financially motivated therapy in Skilled Nursing Facilities (SNFs) is associated with patient outcomes.
Design: Cohort study using 2018 Medicare administrative data.
Setting and participants: 13,949 SNFs in the United States.
Participants: 934,677 Medicare Part A patients admitted to SNF for post-acute rehabilitation (N=934,677).
Interventions: The primary independent variable was an indicator of financially motivated therapy, separate from intensive therapy, known as thresholding, defined as when SNFs provide 10 or fewer minutes of therapy above weekly reimbursement thresholds.
Main outcome measures: Dichotomous indicators of successful discharge to the community vs institution and functional improvement on measures of transfers, ambulation, or locomotion. Mixed effects models estimated relations between thresholding and community discharge and functional improvement, adjusted for therapy intensity, patient, and facility characteristics. Sensitivity analyses estimated associations between thresholding and outcomes when patients were stratified by therapy volume.
Results: Thresholding was associated with a small positive effect on functional improvement (odds ratio 1.07; 95% CI 1.06-1.09) and community discharge (odds ratio 1.03, 95% CI 1.02-1.05). Effect sizes for functional improvement were consistent across patients receiving different volumes of therapy. However, effect sizes for community discharge were largest for patients in low-volume therapy groups (odds ratio 1.27, 95% CI 1.18-1.35).
Conclusions: Patients who experienced thresholding during post-acute SNF stays were slightly more likely to improve in function and successfully discharge to the community, especially for patients receiving lower volumes of therapy. While thresholding is an inefficient and financially motivated practice, results suggest that even small amounts of extra therapy time may have contributed positively to outcomes for patients receiving lower-volume therapy. As therapy volumes decline in SNFs, these results emphasize the importance of Medicare payment policy designed to promote, not disincentivize, potentially beneficial rehabilitation services for patients.
Keywords: Functional status; Health policy; Medicare; Nursing homes; Patient discharge; Rehabilitation.
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| Prusynski RA, Frogner BK, Mroz TM |
Staffing Trends for Non-Nursing Occupations in Skilled Nursing Facilities in the United States Between 2018-2022 |
Center for Health Workforce Studies, University of Washington |
11-07-2023 |
Full Report |
Staffing of Allied Health Professionals in Skilled Nursing Facilities |
This study examined trends in staffing of non-nursing direct care occupations in skilled nursing facilities (SNFs) from 2018 to 2022 using the Payroll Based Journal, a publicly available data source with daily staffing information by occupation from the Centers for Medicare & Medicaid Services.
Key findings include:
Non-nursing occupations are a smaller proportion of all SNF staff compared to nursing occupations (i.e., registered nurses, licensed practical nurses, certified nursing assistants, and administrative and nursing support roles), such that nursing occupations accounted for about four times the staff hours compared to all non-nurse occupations.
The overall and many individual non-nursing occupations experienced a decline between 2018-2022, though when measured as staffing per patient-day, declines were mitigated in part due to concurrent declines in patient census.
Of the non-nursing occupations in SNFs, declines in census-adjusted staffing levels between 2018-2020 were the largest for therapy staff and feeding assistants.
Contractors are employed at higher rates for non-nursing occupations than for nursing occupations in SNFs. Specific occupations such as therapy staff, medical directors, and pharmacists were comprised of over 50% contract staff.
Between 2018-2022, contractor staffing decreased for non-nurse occupations while contractor staffing for nursing occupations increased.
Access to Care Allied Health CHWS CHWS Home Complete HRSA News Nursing Reports and Briefs |
| Bacci JL, Pollack SW, Skillman SM, Odegard PS, Danielson JH, Frogner BK |
Impact of the COVID-19 Pandemic on the Community Pharmacy Workforce |
Medical Care Research and Review |
10-13-2023 |
URL |
Impact of the COVID-19 Pandemic on Community Pharmacist Patient Care and Future Workforce Needs |
This study sought to describe the impact of the COVID-19 pandemic on community pharmacy practice and its workforce. Interviews were conducted with 18 key informants from pharmacy associations and community pharmacists representing chain and independent pharmacy organizations across the United States from January to May 2022. Interview notes were analyzed using a rapid content analysis approach. Four themes resulted: (a) patient care at community pharmacies focused on fulfilling COVID-19 response needs; (b) pharmacists’ history as immunizers and scope of practice expansions facilitated COVID-19 response efforts; (c) workforce supply shortages impeded COVID-19 response efforts and contributed to burnout; and (d) maintaining community pharmacy workforce’s readiness will be critical to future emergency preparedness and response efforts. Formalizing scope of practice expansion policies and reimbursement pathways deployed during the COVID-19 pandemic could facilitate the community pharmacy workforce’s ability to address ongoing public health needs and respond to future public health emergencies.
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| Prusynski RA, Humbert A, Mroz TM |
Skilled Nursing Facility Changes in Ownership and Short-Stay Medicare Patient Outcomes |
JAMA Network |
09-19-2023 |
URL |
N/A |
Importance Skilled nursing facility (SNF) changes in ownership are receiving attention in the national conversation regarding health care quality and oversight. SNF ownership changes have been cited as possible ways for SNFs to obscure financial arrangements and shift funds away from patient care; however, it is unclear whether ownership changes are associated with quality outcomes, especially for short-stay patients.
Objective To determine which SNF characteristics are associated with changes in ownership and whether ownership changes were associated with differences in short-stay patient outcomes.
Design, Setting, and Participants This cohort study was a secondary analysis of 2016 to 2019 Medicare administrative data including SNFs in the United States with complete data. Data were analyzed from January 2016 through December 2019.
Exposure SNF change in ownership.
Main Outcomes and Measures Outcomes of interest were facility-level risk-adjusted rates of hospital readmissions, emergency department visits, and community discharge for short-stay patients after admission to an SNF. Analyses were conducted using multivariable logistic regression and controlled interrupted time series.
Results Of 11 004 SNFs, 1459 (13.26%) changed ownership between 2016 and 2019. Compared with for-profit SNFs, nonprofit and government SNFs had lower odds of changing ownership (nonprofit: odds ratio [OR], 0.40; 95% CI, 0.32-0.49; government: OR, 0.26; 95% CI, 0.17-0.41). Chain SNFs had higher odds of changing ownership than nonchain SNFs (OR, 1.38; 95% CI, 1.21-1.59). Urban SNFs with lower occupancy rates (OR per 10–percentage-point decrease, 1.19; 95% CI, 1.14-1.25), larger Medicaid populations (OR per 10–percentage-point increase, 1.17; 95% CI, 1.13-1.22), and lower staffing ratings (OR per 1-star increase on staffing rating, 1.18; 95% CI, 1.14-1.25) had higher odds of changing ownership. Descriptively, all 3 quality outcomes were worse throughout the study in SNFs undergoing ownership change compared with controls that did not change ownership. However, results of interrupted time series models found no associations between an ownership change and hospital readmissions or community discharge rates. Ownership change was associated with a short-term increase of 0.32 (95% CI, 0.03 to 0.62) percentage points in emergency department visits.
Conclusions and Relevance In this cohort study of 11 004 SNFs in the US between 2016 and 2019, SNF characteristics historically associated with lower quality were more likely to change ownership; however, ownership changes were only associated with short-term increases in ED visits. These results suggest that SNF ownership changes may be a symptom, not a cause, of lower quality.
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| Buerhaus P, Fraher E, Frogner B, Buntin M, O’Reilly-Jacob M, Clarke S |
Toward a Stronger Post-Pandemic Nursing Workforce |
New England Journal of Medicine |
07-21-2023 |
URL |
N/A |
The deep effects of the Covid-19 pandemic on frontline health care providers have given rise to concerns about the demands of nursing work and the appeal of nursing careers. Though these concerns have special resonance right now, this is not the first time apprehensions about the adequacy and sustainability of the U.S. nurse workforce have felt especially acute. In the mid-1990s, financial pressures in the health care industry led to changes that created stress and insecurity among hospital nurses that culminated in substantial declines in the numbers of people enrolling in and graduating from nursing education programs. Nearly a quarter-century later, we have another opportunity to turn the tide of a workforce crisis, this one induced by the Covid pandemic, but the circumstances are notably different. In June 2022, a group of 25 workforce analysts (including us) met in Bozeman, Montana, to examine the pandemic’s effect on nurses, discuss evolving scenarios, and identify strategies for strengthening the current and future workforce.
CHWS CHWS Home COVID-19 Journal Article News Nursing |
| Islas IG, Brantley E, Portela Martinez M, Salsberg E, Dobkin F, Frogner BK |
Documenting Latino Representation In The US Health Workforce |
Health Affairs (Millwood) |
07-06-2023 |
URL |
N/A |
We compared the representation of the four largest Latino subpopulation groups in the health workforce with that group’s representation in the US workforce, using 2016–20 data. Mexican Americans were the most underrepresented subpopulation in professions requiring advanced degrees. All groups were overrepresented in occupations requiring less than a bachelor’s degree. Among recent health professions graduates, overall Latino representation has been increasing over time
Allied Health CHWS CHWS Home Journal Article National News |
| Patterson DG, van Eijk MS, Pollack SW, Stubbs B, Hanson C |
The EMS and Community Paramedic Workforces Respond to COVID-19 |
Center for Health Workforce Studies, University of Washington |
06-01-2023 |
Full Report |
The Emergency Medical Services and Community Paramedic Workforces Response to COVID-19 |
In this study, 17 key informant experts shared their perspectives on how the emergency medical services (EMS) and community paramedicine (CP) workforces responded to COVID-19 during the first year of the pandemic, 2020. Experts also described how the pandemic has affected EMS and CP. EMS responders provide 9-1-1 emergency services, while community paramedics (CPs), typically drawn from EMS personnel, provide non-emergent public health services and augment primary care services to patients in the community.
Access to Care Allied Health CHWS CHWS Home Complete HRSA Reports and Briefs |
| Pollack SW, Skillman SM, Mroz TM, Frogner BK |
Medical Assistants’ Telehealth Roles and Skills in Primary Care During the COVID-19 Pandemic |
Center for Health Workforce Studies, University of Washington |
05-18-2023 |
Full Report |
Shifting Roles and Skills of the Allied Health Workforce in Primary Care Due to Increased Use of Telehealth During the COVID-19 Emergency |
This study examined the roles of medical assistants (MAs) in the use of telehealth to deliver primary care during the COVID-19 pandemic. Through reviews of the literature and interviews with key informants, the study identified the skills and roles of MAs that supported rapid increase in the use of telehealth, policies and practices supporting these roles and skills, and longer-term needs to improve and maintain these skills and competencies. There were few mentions in the literature of MA specific roles associated with delivering telehealth. Key informants indicated that pandemic emergency rules enabled many of MAs’ roles to transfer from in-person to virtual and provided MAs with opportunities to rapidly take on new roles and increased responsibility. How and the extent to which MAs’ telehealth roles were implemented depended greatly on the size and location of the clinic facilities, and the variety and consistency of staffing at the clinics. MAs were generally not well-prepared by their education programs in specific telehealth skills and most of their telehealth training took place on-the-job. Iformants described the benefit of providing MAs with more technical training and education, with a focus on telehealth basics and general technology acumen. MAs will continue to be integral to both in-person and virtual health care teams and more roles for MAs in primary care are likely to emerge in the future. Meeting the current and growing demand for MAs across the US, however, requires increasing the supply of MAs. Without consistent availability of an MA workforce, and if turnover remains high, the path to expanded use of telehealth in primary care may be uneven.
Allied Health CHWS CHWS Home Complete Health Care Outcomes and Quality HRSA News Reports and Briefs |
| Frogner BK, Patterson DG, Skillman SM |
The workforce needed to address population health |
Milbank Quarterly |
05-17-2023 |
URL
Interview
|
N/A |
- Although a single definition of the population health workforce does not yet exist, this workforce needs to have the skills and competencies to address the social determinants of health, to understand intersectionality, and to coordinate and work in concert with an array of skilled providers in social and health care to address multiple health drivers.
- On-the-job training programs and employer support are needed for the current health workforce to gain skills and competencies to address population health.
- Funding and leadership combined are critical for developing the population health workforce with the goal of supporting a broad set of workers beyond health and social care to include, for example, those in urban planning, law enforcement, or transportation professions to address population health.
CHWS CHWS Home Journal Article News |
| Frogner BK |
How can we make caring for older adults desirable work? |
Generations Today |
05-17-2023 |
URL |
N/A |
Older adults need a high functioning and dedicated team with the appropriate training to provide the best care and social support so they can have the best years to come. While many people enter these professions with a commitment to serve older adults, we need to recognize and reward their dedication by investing in their future via increased wages and benefits and new career pathways. Solutions to the workforce crisis in caring for older adults are many, so now we need the political will to make them a reality.
Access to Care CHWS CHWS Home COVID-19 Journal Article News |
| Kett PM, Bekemeier B, Patterson DG, Schaffer K |
Competencies, training needs, and turnover among rural compared with urban local public health practitioners: 2021 public health workforce interests and needs survey |
American Journal of Public Health |
05-17-2023 |
URL
Editorial
Infographic |
Examining Local Public Health Workforce Capacity and Challenges in Addressing Population Health Needs |
Objectives. To compare rural versus urban local public health workforce competencies and training needs, COVID-19 impact, and turnover risk.
Methods. Using the 2021 Public Health Workforce Interest and Needs Survey, we examined the association between local public health agency rural versus urban location in the United States (n = 29 751) and individual local public health staff reports of skill proficiencies, training needs, turnover risk, experiences of bullying due to work as a public health professional, and posttraumatic stress disorder symptoms attributable to COVID-19.
Results. Rural staff had higher odds than urban staff of reporting proficiencies in community engagement, cross-sectoral partnerships, and systems and strategic thinking as well as training needs in data-based decision-making and in diversity, equity, and inclusion. Rural staff were also more likely than urban staff to report leaving because of stress, experiences of bullying, and avoiding situations that made them think about COVID-19.
Conclusions. Our findings demonstrate that rural staff have unique competencies and training needs but also experience significant stress.
Public Health Implications. Our findings provide the opportunity to accurately target rural workforce development trainings and illustrate the need to address reported stress and experiences of bullying.
Allied Health CHWS CHWS Home Journal Article Mental Health News |
| Dahal A, Kardonsky K, Cunningham M, Evans D, Keys T |
The Effect of Rural Underserved Opportunities Program Participation on Medical Graduates' Decision to Work in Rural Areas |
Academic Medicine |
02-01-2023 |
URL |
N/A |
There is a persistent rural physician shortage in the United States. Policies to scale up the health workforce in response to this shortage must include measures to draw and maintain existing and newly trained health care workers to rural regions. Prior studies have found that experience in community medicine in rural practice settings increases the likelihood of medical graduates practicing in those regions but have not accounted for selection bias. This study examined the impact of a community-based clinical immersion program on medical graduates’ decision to work in rural regions, adjusting for covariates to control for selection bias.
CHWS Journal Article |
| Lee D, Pollack SM, Mroz T, Frogner BK, Skillman SM |
Disability competency training in medical education |
Medical Education Online |
05-06-2023 |
URL |
Disability Competency Training in Medical Education |
Purpose. Lack of health care providers’ knowledge about the experience and needs of individuals with disabilities contribute to health care disparities experienced by people with disabilities. Using the Core Competencies on Disability for Health Care Education, this mixed methods study aimed to explore the extent the Core Competencies are addressed in medical education programs and the facilitators and barriers to expanding curricular integration. Method. Mixed-methods design with an online survey and individual qualitative interviews was used. An online survey was distributed to U.S. medical schools. Semi-structured qualitative interviews were conducted via Zoom with five key informants. Survey data were analyzed using descriptive statistics. Qualitative data were analyzed using thematic analysis. Results. Fourteen medical schools responded to the survey. Many schools reported addressing most of the Core Competencies. The extent of disability competency training varied across medical programs with the majority showing limited opportunities for in depth understanding of disability. Most schools had some, although limited, engagement with people with disabilities. Having faculty champions was the most frequent facilitator and lack of time in the curriculum was the most significant barrier to integrating more learning activities. Qualitative interviews provided more insight on the influence of the curricular structure and time and the importance of faculty champion and resources. Conclusions. Findings support the need for better integration of disability competency training woven throughout medical school curriculum to encourage in-depth understanding about disability. Formal inclusion of the Core Competencies into the Liaison Committee on Medical Education standards can help ensure that disability competency training does not rely on champions or resources.
Allied Health CHWS Complete Journal Article News |
| LeRouge C, Shahrir S, Frogner BK |
Landscape of the Health Informatics Workforce: Rapid Response Brief |
Center for Health Workforce Studies, University of Washington |
04-25-2023 |
Rapid Response Brief |
N/A |
Health informatics is an interdisciplinary field mixing science, innovation, and application. The ever-burgeoning health informatics field creates the need for a workforce distributed across multiple settings that can address the breadth of health information technology (HIT) functions and system interfaces while also keeping up with increasing demand for better integration and improvement of healthcare. However, the boundaries and areas of emphasis for this field are not always clear and frequently change, which creates ambiguity in defining a health informatics workforce. The workforce consists of a collection of professions and roles involved with health informatics at varying levels of administrative responsibility, patient service, and technology focus.
Using a framework identifying five subdomains of the health informatics workforce, this brief focuses on the clinical informatics and public health, population health and social service informatics subdomains. In addition to shared fundamental knowledge, basic skills, and a core vocabulary related to health informatics, most roles and job titles in the health informatics workforce can be associated with specific learning needs and educational requirements. Multiple pathways to careers in health informatics exist, ranging from continuing education opportunities to targeted education programs typically at the master’s degree level.
Allied Health CHWS CHWS Home Nursing Pharmacy Physicians Reports and Briefs |
| Al Achkar M, Dahal A, Frogner BK, Skillman SM, Patterson DG |
Integrating Immigrant Health Professionals into the U.S. Healthcare Workforce: Barriers and Solutions |
J Immigrant Minority Health |
04-21-2023 |
URL |
Accelerated Pathways for Internationally Educated Health Professionals |
Internationally educated immigrant healthcare workers face skill underutilization working in lower-skilled healthcare jobs or outside healthcare. This study explored barriers to and solutions for integrating immigrant health professionals. Content analysis identifying key themes from semi-structured qualitative interviews with representatives from Welcome Back Centers (WBCs) and partner organizations. 18 participants completed interviews. Barriers facing immigrant health professionals included lack of access to resources, financial constraints, language difficulties, credentialing challenges, prejudice, and investment in current occupations. Barriers facing programs that assist immigrant health professionals included eligibility restrictions, funding challenges, program workforce instability, recruitment difficulties, difficulty maintaining connection, and pandemic challenges. Long-term program success depended on partner networks, advocacy, addressing prejudice, a client-centered approach, diverse resources and services, and conducting research. Initiatives to integrate immigrant health professionals require multi-level responses to diverse needs and collaborations among organizations that support immigrant health professionals, healthcare systems, labor, and other stakeholders.
CHWS Journal Article |
| Lee D, Kett PM, Mohammed SA, Frogner BK, Sabin J |
Inequitable care delivery toward COVID-19 positive people of color and people with disabilities |
PLOS Glob Public Health |
04-19-2023 |
URL
Policy Brief |
Exploring Health Workforce Influence on Equitable Care Delivery and Stigmatization toward COVID-19 Positive People of Color and People with Disabilities |
This study aimed to explore provider observations of inequitable care delivery towards COVID-19 positive patients who are Black, Indigenous, and Other People of Color (BIPOC) and/or have disabilities and to identify ways the health workforce may be contributing to and compounding inequitable care. We conducted semi-structured interviews between April and November 2021 with frontline healthcare providers from Washington, Florida, Illinois, and New York. Using thematic analysis, major themes related to discriminatory treatment included decreased care, delayed care, and fewer options for care. Healthcare providers’ bias and stigma, organizational bias, lack of resources, fear of transmission, and burnout were mentioned as drivers for discriminatory treatment. COVID-19 related health system policies such as visitor restrictions and telehealth follow-ups inadvertently resulted in discriminatory practices towards BIPOC patients and patients with disabilities. As patients experience lower quality healthcare during the pandemic, COVID-19-related restrictions and policies compounded existing inequitable care for these populations.
CHWS Journal Article |
| Woodward KF, Kett PM, Willgerodt M, Summerside N, Hart J, Buchanan DT, Cunitz TC, Birkey C, Zierler BK |
Using an academic-practice partnership to enhance ambulatory care nursing skills |
Nurse Education Today |
12-01-2022 |
URL |
N/A |
Ambulatory nursing services are essential to healthcare in communities, but nursing curricula often omit ambulatory care training. The purpose of this project was to enhance ambulatory care competencies among nursing students and provide ongoing education for practicing nurses through an academic-practice partnership.
CHWS Journal Article Nursing |
| Prusynski RA, Humbert A, Leland NE, Frogner BK, Saliba D, Mroz TM |
Dual impacts of Medicare payment reform and the COVID-19 pandemic on therapy staffing in skilled nursing facilities |
Journal of the American Geriatrics Society |
12-26-2022 |
URL |
N/A |
Implementation of new skilled nursing facility (SNF) Medicare
payment policy, the Patient Driven Payment Model (PDPM), resulted in immediate
declines in physical and occupational therapy staffing. This study characterizes
continuing impacts of PDPM in conjunction with COVID-19 on SNF
therapy staffing and examines variability in staffing changes based on SNF
organizational characteristics.
CHWS CHWS Home COVID-19 Journal Article |
| Frogner BK |
Patients Receive Flexible And Accessible Care When State Workforce Barriers Are Removed |
Heath Affairs |
08-30-2022 |
URL |
N/A |
In response to COVID-19, many states increased their supply of health care workers, using emergency policies to remove barriers such as state licensure requirements. The experience in New Jersey suggests that most health care workers who obtained a temporary license, including physicians, nurses, and mental health providers, provided care for existing patients for COVID-19- and non-COVID-19-related conditions, mostly through telehealth. State variation in licensure requirements, as well as scope of practice, may be a barrier to patients having flexible, accessible, and continuous care. As states emerge from the pandemic, emergency policies that expand health workforce supply by removing these state-level barriers should be made permanent.
CHWS COVID-19 Journal Article |
| Frogner BK |
The Link Between Sick Leave Laws and Emergency Department Visits |
Tradeoffs |
08-30-2022 |
URL |
N/A |
|
| Nasseh K, Frogner BK, Vujicic M |
A closer look at disparities in earnings between white and minoritized dentists |
Health Services Research |
10-28-2022 |
URL |
N/A |
To examine the factors that account for differences in dentist earnings between White and minoritized dentists.
CHWS CHWS Home Journal Article |
| van Eijk MS, Prueher L, Kett PM, Frogner BK, Guenther GA |
Financial Instability of Federal Navigator Program Challenges Organizations to Help Uninsured Enroll in Health Insurance Coverage |
Journal of Health Care for the Poor and Underserved |
08-01-2022 |
URL |
The Role of Insurance Navigators in Mitigating the Financial and Health Risk of Unemployed Workers |
Under the Affordable Care Act, the federal Health Insurance Navigator Program aims to reduce the rate of uninsured in the United States. Under this program, navigators help people obtain insurance coverage through federally facilitated Marketplaces. However, the program’s financial instability and substantial budget cuts created a severe shortage of navigator assistance for the uninsured and underserved. The COVID-19 pandemic added further pressure to the already-strained program. Our study examined how unstable and unpredictable federal funding and the COVID-19 pandemic affected organizations’ navigator work in the federal program in 2020. The results study show (1) that navigator organizations provide vital, year-round resources; (2) that organizations feel pushed to direct scarce resources to grant management and cut service provision; and (3) that there are policy changes that can support navigator organizations in the future. Increased and ongoing federal investment is needed to support this vital health workforce and expand enrollment assistance for underserved communities.
CHWS Journal Article |
| Ornelas IJ, Schwartz M, Sabin JA, Frogner BK |
Using Experiential Education in Health Professions Training to Improve Health Equity: Lessons Learned from Interviews With Key Informants |
Journal of Higher Education Outreach and Engagement |
12-15-2022 |
URL |
Best Practices in Experiential Education to Educate Health Professionals on Heath Equity |
Health professions students can increase their understanding of how social determinants impact health equity through experiential learning opportunities. Using key informant interviews with faculty and staff familiar with experiential education programs in medicine, dentistry, nursing, pharmacy, public health, and social work, we sought to identify key features and best practices to inform the broader implementation of these programs. Interviews were recorded and compiled notes were reviewed to identify common themes across programs. Experiential learning helped teach students competencies related to health equity. However, many programs were challenged by limited infrastructure and the need for faculty training on health equity topics. Key informants noted that programs should be linked to accreditation and curricular requirements. Strong community partnerships also facilitated successful program implementation. Our findings can help guide other schools considering experiential learning programs, as well as future research in this area.
CHWS CHWS Home Journal Article Other |
| Skillman SM, Dunlap B |
Washington State’s Behavioral Health Workforce: Examination of Education and Training Needs and Priorities for Future Assessment |
Center for Health Workforce Studies, University of Washington |
07-01-2022 |
Full Report |
Health Workforce Sentinel Network |
Objectives of this examination include:
1. Understanding the range of education and training backgrounds of the behavioral health workforce in various settings
in Washington, and which positions are the most difficult to fill;
2. Identifying how the education and training preparation of behavioral health occupations meet the needs of employers
and clients, and areas that could be improved;
3. Discussing barriers and facilitators in policy and practice which may assist or impede workforce training and education
for Washington’s behavioral health workforce.
To meet these objectives, we spoke with individuals who held roles as behavioral health care employers, clinicians, educators,
and from policy and practice organizations (key informants) about the critical needs of the workforce, especially those related
to the education and training preparation of the workforce as well as strategies to address them. This assessment is intended to
provide information to help formulate future activities and recommendations for policy and practice to strengthen Washington’s
behavioral health workforce.
Allied Health CHWS Mental Health Nursing Physicians Reports and Briefs Washington |
| van Eijk MS, Frogner BK |
How are Health Care Workers Utilized in Health Equity Interventions? An Exploratory Review |
Center for Health Workforce Studies, University of Washington |
09-29-2022 |
Full Report |
Health Workforce in Health Equity Research: Who, What, When, Where, and How |
Health care workers play crucial roles in interventions and policies that promote health equity by providing culturally sensitive services, partnering with communities to promote population health, and addressing unconscious racial and ethnic biases in health care delivery. Despite their significance for eliminating health disparities experienced by historically marginalized communities, the roles that the health workforce plays within these interventions are not systemically monitored. In this study, we sought to understand how health care workers are expected to address issues of health equity in a burgeoning literature by answering the following questions:
1) Which health care workers have been charged with reducing health disparities?
2) Where are they positioned in the pathway toward improving health equity?
3) What training, if any, did they receive to address health equity?
Allied Health CHWS CHWS Home Complete HRSA News Reports and Briefs |
| Guenther G, Kett P, Skillman SM, Frogner BK |
The Birth Doula Workforce in the U.S.: Rapid Response Brief |
Center for Health Workforce Studies, University of Washington |
08-22-2022 |
Rapid Response Brief |
Increasing Access to Doulas to Support a Diverse Population |
Over the past couple of years, there has been an increased focus in both research and policy on the role of birth doulas as an intervention to address structural inequities in the US health care system and reduce health care disparities. In response to this interest in doula services, there has been multiple state bills to expand Medicaid coverage to pay for doula services. This rapid response brief provides an overview of research on the birth doula workforce that has been published since January 2021, including workforce challenges and the effect of the COVID-19 pandemic on doulas. We discuss the available data to study the doula workforce. We begin with a brief overview of the doula workforce for which literature has been emerging. We will also highlight opportunities and research needs to support the doula workforce in the US.
CHWS CHWS Home COVID-19 Other |
| Kett P, Skillman SM, Frogner BK |
The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Workforce: Rapid Response Brief |
Center for Health Workforce Studies, University of Washington |
08-22-2022 |
Rapid Response Brief |
N/A |
Home visiting—a service delivery model provided to families in their home or location of choice—is considered a cost-effective approach for providing needed services and supports and has been shown to have positive short- and long-term infant, child, and family outcomes. The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program supports evidence-based home visiting with the goal of improving outcomes for at-risk pregnant people, infants, children, and families. The focus of this rapid response brief is research published since March 2020 focused on the MIECHV and the broader home visiting workforce, the effect of the COVID-19 pandemic on this workforce, and available data. We begin with a brief overview of the MIECHV program to provide context for the recent research. We also highlight the complexities in summarizing or doing research on the workforce delivering programs supported by this funding, and discuss the opportunities, challenges, and future research needs related to this workforce.
Access to Care CHWS CHWS Home Complete Other |
| Skillman SM, Johnson HM, Frogner BK |
Pathways to Registered Nursing: Influences of Health-Related Work Experience and Education Financing |
Policy, Politics, & Nursing Practice |
08-22-2022 |
URL |
What are Career Pathways to Registered Nursing? |
A larger and more diverse registered nurse (RN) workforce in the U.S. is needed to meet growing demand and address social determinants of health and improve health equity. To improve understanding of pathways and barriers to becoming an RN, this study examined prior health care employment and financial assistance factors associated with completion of pre-licensure RN education programs, by initial entry degree (associate degree or bachelor of science in nursing) and across racial and ethnic groups, using the 2018 National Sample Survey of Registered Nurses. The study found higher percentages of associate degree-entry RNs held a health-related job prior to completing their initial RN program than did bachelor’s degree entrants. Employer support for education financing as well as reliance on loans and scholarships increased among RNs graduating in 2000 and later, and reliance on self-financing was reported less frequently. Hispanic associate degree-entry RNs reported education financing from only federal loans more frequently compared with White RNs, and higher percentages of Black, multiracial, and “some other race” baccalaureate degree entry RNs accessed federal loans compared with White baccalaureate degree-entry RNs. These findings indicate diversifying the RN workforce should remain a priority to increase representation by underrepresented racial and ethnic groups. Equitable pathways into the RN profession will be facilitated and expedited through policies that overcome financial and social barriers that enable individuals from population groups underrepresented in the nursing workforce to identify with the RN role and route to the profession.
CHWS CHWS Home Complete Journal Article Nursing |
| Van Eijk E, Guenther GA, Jopson AD, Skillman SM, Frogner BK |
Health workforce challenges impact the development of robust doula services for underserved populations in the United States |
The Journal of Perinatal Education |
07-31-2022 |
URL |
Increasing Access to Doulas to Support a Diverse Population |
Evidence of doulas’ positive impacts on maternal health outcomes, particularly among underserved populations, supports expanding access. Health workforce-related barriers challenge the development of robust doula services in the United States. We investigated organizations’ barriers regarding training, recruitment, and employment of doulas. We conducted literature and policy reviews and 16 semi-structured interviews with key informants who contribute to state policymaking and from organizations involved in training, certifying, advocating for, and employing doulas. Our study shows barriers to more robust doula services, including varying roles and practices, prohibitive costs of training and certification, and insufficient funding. This study underscores the importance of doulas in providing support to clients from underserved populations. Health workforce-related challenges remain, especially for community-based organizations seeking to serve underserved communities.
Access to Care CHWS CHWS Home Complete Journal Article News |
| Frogner BK |
Patients Receive Flexible And Accessible Care When State Workforce Barriers Are Removed |
Health Affairs |
08-01-2022 |
URL |
N/A |
In response to COVID-19, many states increased their supply of health care workers, using emergency policies to remove barriers such as state licensure requirements. The experience in New Jersey suggests that most health care workers who obtained a temporary license, including physicians, nurses, and mental health providers, provided care for existing patients for COVID-19- and non-COVID-19-related conditions, mostly through telehealth. State variation in licensure requirements, as well as scope of practice, may be a barrier to patients having flexible, accessible, and continuous care. As states emerge from the pandemic, emergency policies that expand health workforce supply by removing these state-level barriers should be made permanent.
Access to Care CHWS CHWS Home COVID-19 Journal Article Mental Health News Nursing Physicians |
| Dahal A, Skillman SM |
Washington State’s Physician Workforce in 2021 |
Center for Health Workforce Studies, University of Washington |
07-31-2022 |
Full Report |
Washington State’s Physician Workforce |
In 2021 the estimated number of physicians providing direct patient care in Washington was 17,736, approximately 15% higher than the estimated number practicing in 2014.
There were an estimated 228 physicians per 100,000 population providing direct patient care in Washington State in 2021, including 81 primary care physicians per 100,000 population.
The mean age of Washington’s practicing physicians was 52 years. Women comprised 41% of the state’s physician workforce and 52% of the primary care, including 68% of general pediatricians.
Compared with urban areas, most rural areas of Washington had fewer physicians per 100,000 population and many rural counties had high percentages of physicians age 55 or older.
CHWS CHWS Home News Physicians Reports and Briefs Washington |
| Dahal A, Skillman SM |
Montana’s Physician Workforce in 2021 |
Center for Health Workforce Studies, University of Washington, |
07-31-2022 |
Full Report |
Montana Physician Workforce |
In 2021 the estimated number of physicians providing direct patient care in Montana was 2,569, 26% higher than the estimated number practicing in 2014.
There were an estimated 238 physicians per 100,000 population providing direct patient care in Montana, including 83 primary care physicians per 100,000 population in 2021.
The mean age of Montana’s practicing physicians was 53 years. Women comprised 34% of the state’s physician workforce and 46% of the primary care, including 68% of general pediatricians.
Compared with urban areas, most rural areas of Montana had fewer physicians per 100,000 population and many rural counties had high percentages of physicians age 55 or older.
CHWS CHWS Home Montana Physicians Reports and Briefs |
| Dahal A, Skillman SM |
Wyoming’s Physician Workforce in 2021 |
Center for Health Workforce Studies, University of Washington |
07-31-2022 |
Full Report |
Wyoming’s Physician Workforce |
In 2021 the estimated number of physicians providing direct patient care in Wyoming was 1,043, 7% higher than the estimated number practicing in 2014.
There were an estimated 180 physicians per 100,000 population providing direct patient care in Wyoming, including 65 primary care physicians per 100,000 population in 2021.
The mean age of Wyoming’s practicing physicians was 53 years. Women comprised 26% of the state’s physician workforce and 38% of the primary care, including 49% of general pediatricians.
Most rural areas of Wyoming had fewer physicians per 100,000 population and many rural counties had high percentages of physicians age 55 or older than in urban areas.
CHWS CHWS Home News Physicians Reports and Briefs Wyoming |
| Dahal A, Skillman SM |
Alaska’s Physician Workforce in 2021 |
Center for Health Workforce Studies, University of Washington, |
07-31-2022 |
Full Report |
Alaska’s Physician Workforce |
In 2021 the estimated number of physicians providing direct patient care in Alaska was 1,751, 19% higher than the estimated number practicing in 2014.
There were an estimated 240 physicians per 100,000 population providing direct patient care in Alaska, including 95 primary care physicians per 100,000 population in 2021.
The mean age of Alaska’s practicing physicians was 52 years. Women comprised 41% of the state’s physician workforce with 54% of the primary care, including 65% of general pediatricians.
Compared with urban areas, most rural areas of Alaska had fewer physicians and many rural counties had high percentages of physicians age 55 or older.
Around 27% of Alaska’s family medicine physician workforce completed a residency in Alaska and 41% completed a residency in one of the WWAMI states: Washington, Wyoming, Alaska, Montana or Idaho.
Alaska CHWS CHWS Home News Physicians Reports and Briefs |
| Dahal A, Skillman SM |
Idaho’s Physician Workforce in 2021 |
Center for Health Workforce Studies, University of Washington |
07-31-2022 |
Full Report |
Idaho’s Physician Workforce |
In 2021 the estimated number of physicians providing direct patient care in Idaho was 3,180, 19% higher than the estimated number practicing in 2014.
In 2021, there were an estimated 174 physicians per 100,000 population providing direct patient care in Idaho, including 64 primary care physicians per 100,000 population.
The mean age of Idaho’s practicing physicians was 52 years.
Women comprised 28% of the state’s physician workforce but 37% of the primary care, including about 45% of general pediatricians.
Compared with urban areas, most rural areas of Idaho had fewer physicians per 100,000 population and many rural counties had higher percentages of physicians age 55 or older.
CHWS CHWS Home Idaho Physicians Reports and Briefs |
| Oster NV, Skillman SM, Frogner BK |
Health Workforce Issues in American Indian and Alaska Native (AI/AN) Populations |
Center for Health Workforce Studies, University of Washington |
07-01-2022 |
Rapid Response Brief |
N/A |
In this rapid response policy brief we provide an overview of the IHS, discuss tribally operated health services, and access to health services and insurance outside of tribal or IHS networks. Understanding how AI/AN populations obtain care is important to identify the health workforce that may serve the AI/AN community. We also describe the representation of AI/AN populations within the health care workforce. We highlight recommendations and strategies identified to strengthen the health workforce providing care for AI/AN populations based on the limited public information available on the IHS workforce and workforce-specific studies on AI/AN population needs.
CHWS HRSA Reports and Briefs |
| Kett PM, van Eijk MS, Guenther GA, Skillman SM |
"This work that we're doing is bigger than ourselves": A qualitative study with community-based doulas in the United States |
Perspectives on Sexual and Reproductive Health |
07-07-2022 |
URL |
Doula Project 2.0: Increasing the Use of Doulas by Underserved Communities |
Community-based doulas provide essential services and expertise which address inequities and systemic gaps in perinatal care. However, as they work to improve perinatal health, doulas themselves are providing equity work amidst an inequitable system and with insufficient political or financial support. Increased compensation and systemic support which acknowledges the breadth of services provided are needed to strengthen and sustain this critical part of the perinatal workforce.
Allied Health CHWS HRSA In-Progress Journal Article |
| Kett PM, Bekemeier B, Altman MR, Herting JR |
‘Not Everybody Approaches It that Way’: Nurse-Trained Health Department Directors’ Leadership Strategies and Skills in Public Health |
Nursing Inquiry |
03-09-2022 |
URL |
N/A |
Evidence points to nurses as possessing particular skills which are important for public health leadership; in particular, investigators have found that a nurse public health director is strongly associated with positive health department performance. To better understand this association and to guide the effective deployment of nurse leaders, researchers sought to explore the specific leadership strategies used by nurse public health directors, using a critical thematic analysis approach to examine these leadership strategies in the context of certain ideologies, power differentials, and social hierarchies. Data were collected via semistructured interviews conducted from July to September 2020 with 13 nurse public health directors from across the United States. Major themes illustrate a distinct picture of the nursing approach to public health leadership: (a) approaching their work with an other-focused lens, (b) applying theoretical knowledge, (c) navigating the political side of their role, and (d) leveraging their nursing identity. Findings articulate the nurse public health director’s distinctive combination of skills which reflect the interprofessional nature of public health nursing practice. Such skills demonstrate a specialized approach that may set nurse leaders apart from other types of leaders in carrying out significant public health work.
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| Jopson AD, Cummings AG, Frogner BK, Skillman SM |
Employers’ perspectives on the use of medical assistant apprenticeships: a qualitative study |
J Ambul Care Manag |
07-01-2022 |
URL |
Apprenticeships as Pathways to Healthcare Careers: Experiences of Employers Using Medical Assistant Apprenticeships |
Medical assistants (MAs) are among the fastest-growing occupations in the United States, yet health care employers report high turnover rates and difficulty filling MA positions. Employers are increasingly using apprenticeship to meet emerging workforce needs. This qualitative study examined the perspectives of 14 employers using registered MA apprenticeships in 8 states. The findings revealed motivations for using apprenticeship, perceived benefits to the organization, challenges with implementation, and reflections on successful implementation. We detail how MA apprenticeship is successfully meeting recruitment and training needs in a variety of health care organizations, especially where program support resources are available.
Access to Care Allied Health CHWS CHWS Home Health Care Outcomes and Quality HWRC In-Progress Journal Article Other Work Settings Washington |
| Harwood KJ, Pines J, Andrilla CH, Frogner BK |
Where to start? A two stage residual inclusion approach to estimating influence of the initial provider on health care utilization and costs for low back pain in the US. |
BMC Health Services Research |
05-01-2022 |
URL |
The Effects of Timing of Physical Therapy on Health Care Costs, Utilization, and Opioid Use |
|
| Dill J, Frogner BK, Travers J |
Taking the long view: understanding the rate of second job holding among long-term care workers |
Med Care Res Rev |
04-25-2022 |
URL |
N/A |
|
| Frogner BK, Dill J |
Tracking turnover among health care workers during the COVID-19 pandemic |
JAMA Health Forum |
05-01-2022 |
URL |
Where and From What Industries are Health Care Workers Entering Health Care Jobs and Where are We Losing Them During COVID-19? |
Abstract
Importance The health care sector lost millions of workers during the COVID-19 pandemic and job recovery has been slow, particularly in long-term care.
Objective To identify which health care workers were at highest risk of exiting the health care workforce during the COVID-19 pandemic.
Design, Setting, and Participants This was an observational cross-sectional study conducted among individuals employed full-time in health care jobs from 2019 to 2021 in the US. Using the data from the Current Population Survey (CPS), we compared turnover rates before the pandemic (preperiod, January 2019-March 2020; 71 843 observations from CPS) with the first 9 months (postperiod 1, April 2020-December 2020; 38 556 observations) and latter 8 months of the pandemic (postperiod 2, January 2021-October 2021; 44 389 observations).
Main Outcomes and Measures Health care workforce exits (also referred to as turnover) defined as a health care worker’s response to the CPS as being unemployed or out of the labor force in a month subsequent to a month when they reported being actively employed in the health care workforce. The probability of exiting the health care workforce was estimated using a logistic regression model controlling for health care occupation, health care setting, being female, having a child younger than 5 years old in the household, race and ethnicity, age and age squared, citizenship status, being married, having less than a bachelor’s degree, living in a metropolitan area, identifier for those reporting employment status at the first peak of COVID-19, and select interaction terms with time periods (postperiods 1 and 2). Data analyses were conducted from March 1, 2021, to January 31, 2022.
Results The study population comprised 125 717 unique health care workers with a mean (SD) age of 42.3 (12.1) years; 96 802 (77.0%) were women; 84 733 (67.4%) were White individuals. Estimated health care turnover rates peaked in postperiod 1, but largely recovered by postperiod 2, except for among long-term care workers and physicians. We found a 4-fold difference in turnover rates between physicians and health aides or assistants. Rates were also higher for health workers with young children (<5 years), for both sexes and highest among women. By race and ethnicity, persistently higher turnover rates were found among American Indian/Alaska Native/Pacific Islander workers; White workers had persistently lower rates; and Black and Latino workers experienced the slowest job recovery rates.
Conclusions and Relevance The findings of this observational cross-sectional study suggest that although much of the health care workforce is on track to recover to prepandemic turnover rates, these rates have been persistently high and slow to recover among long-term care workers, health aides and assistants, workers of minoritized racial and ethnic groups, and women with young children. Given the high demand for long-term care workers, targeted attention is needed to recruit job-seeking health care workers and to retain those currently in these jobs to lessen turnover.
Allied Health CHWS |
| Oster NV, Patterson DG, Skillman SM, Frogner BK |
COVID-19 and the Rural Health Workforce: The Impact of Federal Pandemic Funding to Address Workforce Needs |
Center for Health Workforce Studies, University of Washington |
03-01-2022 |
Policy Brief |
What is Being Done to Prepare the Rural Health Workforce for COVID-19? |
In this report we describe the workforce challenges faced by rural health care delivery systems and discuss how pre-pandemic financial instability in rural health care facilities may have contributed to the challenges experienced by the rural health workforce during the pandemic. We also discuss the availability of federal pandemic funding to address rural health workforce needs, the ability of rural facilities to access and utilize the funding, and the long-term needs of the rural health workforce and delivery system.
Allied Health CHWS CHWS Home Complete COVID-19 Hospitals HRSA National News Reports and Briefs |
| Pines JM, Harwood K, Andrilla CHA, Frogner BK |
Opioid Prescriptions, Radiography, and Costs for Self-Limited “One-and- Done” Lower Back Pain Visits in a Commercially Insured Population |
Center for Health Workforce Studies, University of Washington |
03-01-2022 |
Findings Brief |
The Effects of Timing of Physical Therapy on Health Care Costs, Utilization, and Opioid Use |
In this study, we explore a large sample of commercial beneficiaries with a single encounter with a clinician without further visits, termed “one-and-done” low back pain visits. The purpose was to examine the frequency of one-and-done low back pain patient visits across different clinician types in a commercial insured population, and compare imaging, opioid prescription rates, and costs across clinician types.
Allied Health CHWS CHWS Home Complete Reports and Briefs |
| Van Eijk MS, Guenther GA, Kett PM, Jopson AD, Frogner BK, Skillman SM |
Addressing systemic racism in birth doula services to reduce health inequities in the United States |
Health Equity |
02-02-2022 |
URL |
Increasing Access to Doulas to Support a Diverse Population |
Birth doulas support pregnant people during the perinatal period. Evidence of doulas’ positive impacts on pregnancy and birth outcomes, particularly among underserved populations, supports expanding access. However, health workforce-related barriers challenge the development of robust doula services in the United States. This study examined the various approaches organizations have taken to train, recruit, and employ doulas as well as their perspectives on what system-level changes are needed to redress health inequities in underserved communities and expand access to birth doula services.
Journal Article |
| van Eijk MS, Kett PM, Prueher L, Frogner BK, Guenther GA |
Lack of Consistent Investment in Federal Insurance Navigator Program Undermines Navigators' Equity Work in Vulnerable Communities |
J Public Health Manag Pract |
07-30-2022 |
URL |
The Role of Insurance Navigators in Mitigating the Financial and Health Risk of Unemployed Workers |
Navigators in the federal Insurance Navigator Program (“Navigator Program”), who are employed by organizations in states with Federally Facilitated Marketplaces, provide enrollment assistance, outreach, and education to individuals who are eligible for health insurance coverage. Such work is central to public health efforts to address inequities but continues to be poorly understood and undervalued. More information is needed to understand the components of navigators’ equity work and how decreases in program funding have affected their service provision.
CHWS Journal Article |
| Patterson DG, Stubbs BA, Nudell NG |
How Actual Practice of Emergency Medical Services Personnel Aligns with the Recommended National Scope of Practice in Rural Versus Urban Areas of the U.S. |
Center for Health Workforce Studies, University of Washington |
02-17-2022 |
Full Report |
Scope of Practice Alignment of Emergency Medical Services Personnel |
The 2019 National EMS Scope of Practice Model provides recommended guidelines for states to develop scopes of practice for emergency medical services (EMS) practitioners. This study had two main aims: (1) examine the extent to which EMS professionals perform skills that correspond to their credential levels as described in the national Model and (2) determine whether there are variations in adherence to Model guidelines between agencies serving rural versus urban populations and agencies with unpaid (volunteer) versus paid staffing models.
CHWS Reports and Briefs |
| Sabin J, Guenther G, Ornelas IJ, Patterson DG, Andrilla C, Morales L, Gurjal K, Frogner BK |
Brief online implicit bias education increases bias awareness among clinical teaching faculty |
Med Educ Online (Open Access) |
12-27-2021 |
URL |
Implicit Race and Gender Bias, Bias Awareness, and Impact of a Course for Clinical Faculty |
Healthcare provider implicit bias influences the learning environment and patient care. Bias awareness is one of the key elements to be included in implicit bias education. Research on education enhancing bias awareness is limited. Bias awareness can motivate behavior change. The objective was to evaluate whether exposure to a brief online course, Implicit Bias in the Clinical and Learning Environment, increased bias awareness.
CHWS Journal Article |
| Frogner BK |
How the Health Services Research Workforce Supply in the United States is Evolving |
Health Services Research |
01-04-2022 |
URL |
N/A |
Objective
To investigate how the health services research (HSR) workforce supply in the United States has evolved over the last five years.
Data Sources
Membership data of AcademyHealth participants, professional networking websites, PubMed, grant databases, and the Integrated Post secondary Education Data System.
Study Design
Descriptive study comparing size and characteristics of the HSR workforce and graduates identified across multiple data sources. Lists of authors and principal investigators (PIs) were merged and de-duplicated to identify unique counts. Pearson’s Chi Squared test was used to compare characteristics between members and non-members of AcademyHealth.
CHWS National |
| Jopson AD, Frogner BK |
An Examination of Health Care Workers in Nonstandard Work Arrangements and Self-Employment |
Center for Health Workforce Studies, University of Washington |
11-01-2021 |
Full Report |
Allied Health Professionals and the “Gig Economy”: Trends in Alternative Work Arrangements |
This study used data from the Contingent Worker Supplement (CWS) to the Current Population Survey (CPS) that was fielded in May 2017 by the US Census Bureau for the BLS. Using BLS definitions, we examined health care workers across three work arrangements: 1) self-employment, 2) contingent work, and 3) alternative work.
Allied Health CHWS CHWS Home Complete HRSA National News Nursing Physicians |
| Dahal A, Stubbs BA, Frogner BK, Skillman SM |
Leveraging Data to Monitor the Allied Health Workforce: State Supply Estimates |
Center for Health Workforce Studies, University of Washington |
11-01-2021 |
Full Report |
Phase II of Leveraging Data for Allied Health Occupations |
Securing up-to-date and accurate data on the number of the health care workers is crucial for health workforce planning. This study developed and compared national and state estimates of the supply of allied health occupations drawn from two publicly available national data sources (the American Community Survey [ACS] and the Occupational Employment and Wage Statistics [OEWS] from 2014 and 2017]), and from state license records (2016-17), expanding on the 2015-2016 UW CHWS study “Data for Allied Health Workforce Research.” The final report for this Phase II study describes uses and limitations of workforce supply estimates from the data sources examined.
Allied Health CHWS CHWS Home Complete HRSA News Reports and Briefs |
| Dunlap B, Basye A, Skillman SM. |
Background Checks and the Health Workforce: Practices, Policies and Equity |
Center for Health Workforce Studies, University of Washington |
11-01-2021 |
Full Report |
Criminal Background Checks and Drug Testing in Health Workforce Employment: Implications for Health Equity? |
Background checks are intended to prevent harms to clients and businesses and ensure a quality workforce, but they may also exclude qualified workers. This study examined why and how background checks are used; the broad variation of laws, regulations and policies that govern them; evidence relevant to their use and potential misuse; and ways to use background checks to help ensure patient/client safety while supporting health workforce development.
Allied Health CHWS CHWS Home Complete HRSA News Reports and Briefs Washington |
| Frogner BK |
How Do You Create a “Zero-Burnout” Primary Care Practice? |
Tradeoffs.org Newsletter |
07-02-2021 |
URL |
N/A |
Burnout among primary care providers (PCPs) has long been a concern in medicine. PCPs are often paid less than other specialists, have to deal with enormous amounts of administrative tasks that take away from patient time, and often (though increasingly rarely) own their own practices, adding the burdens and stresses of a small business owner. COVID-19 unsurprisingly exacerbated these stressors, and even as cases decrease, an ongoing survey of PCPs finds high levels of stress and burnout combined with workforce and workload challenges well over a year into the pandemic. There may be long-term consequences for clinician recruitment and retention and ultimately patient care if we do not have a robust health workforce.
CHWS Other |
| Kett PM, Bekemeier B, Herting JR, Altman MR |
Addressing Health Disparities: The Health Department Nurse Lead Executive's Relationship to Improved Community Health |
Journal of Public Health Management and Practice |
09-01-2021 |
URL |
N/A |
The nurse-trained local health department (LHD) lead executive has been shown to be positively associated with LHD performance; however, no other research has explored whether this association translates to improved community health.
CHWS Journal Article |
| Beck AJ, Spetz J, Pittman P, Frogner BK, Fraher EP, Moore J, Armstrong D, Buerhaus PI |
Investing In A 21st Century Health Workforce: A Call For Accountability |
Health Affairs Blog |
09-15-2021 |
URL |
N/A |
The US health workforce is receiving a massive boost in federal investment under the $1.9 trillion American Rescue Plan Act of 2021. Included provisions will allow states to receive higher federal matching funds through Medicaid, adding approximately $12.7 billion over the next year to strengthen the workforce for home- and community-based services; rural health providers will see an additional $8.5 billion in Provider Relief Fund dollars; more than $7.0 billion will be invested to expand, train, and retain the public health workforce; $1.55 billion will be allocated to expand critical programs that strengthen the workforce in underserved communities and address unmet health care needs; and nearly $250.0 million will be used to strengthen behavioral health workforce capacity. This infusion of health workforce investments comes on the heels of substantial provider support already allocated by the Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020 and is likely to be followed by additional investments under the infrastructure plan proposed by President Joe Biden.
Journal Article |
| Armstrong D, Moore J, Fraher EP, Frogner BK, Pittman P, Spetz J |
COVID-19 and the Health Workforce |
Medical Care Research and Review |
10-30-2020 |
URL |
N/A |
The health workforce has been greatly affected by COVID-19. In this commentary, we describe the articles included in this health workforce research supplement and how the issues raised by the authors relate to the COVID-19 pandemic and rapidly changing health care environment.
CHWS Journal Article |
| Frogner BK, Schwartz M |
Examining Wage Disparities by Race and Ethnicity of Health Care Workers |
Medical Care |
10-01-2021 |
URL |
Examining Wage Disparities by Race and Ethnicity of Healthcare Workers |
Prior studies demonstrated that wage disparities exist across race and ethnicity within selected health care occupations. Wage disparities may negatively affect the industry’s ability to recruit and retain a diverse workforce throughout the career ladder.
CHWS Journal Article Other |
| Dahal A, Frogner BK, Skillman SM, Patterson DG |
Accelerating Health Professions Pathways for Immigrants |
Center for Health Workforce Studies, University of Washington |
07-26-2021 |
Full Report |
Accelerated Pathways for Internationally Educated Health Professionals |
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| Prusynski R, Frogner BK, Skillman SM, Dahal A, Mroz TM |
Therapy Assistant Staffing and Patient Quality Outcomes in Skilled Nursing Facilities |
Journal of Applied Gerontology |
07-22-2021 |
URL |
Supply of and Demand for Therapy Services in Skilled Nursing Facilities |
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| Prusynski R, Frogner BK, Dahal A, Skillman SM, Mroz T |
Skilled Nursing Facility Characteristics Associated with Financially Motivated Therapy and Relation to Quality |
Journal of the American Medical Directors Association |
06-06-2020 |
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Supply of and Demand for Therapy Services in Skilled Nursing Facilities |
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| Oster NV, Guenther G, Frogner BK, Skillman SM |
The Clinical Laboratory Workforce in the U.S.: Supply, Distribution, Education Pathways, and State Responses to the COVID-19 Emergency |
Center for Health Workforce Studies, University of Washington |
06-14-2021 |
Policy Brief |
How are Allied Health Workers Being Deployed During COVID-19? |
|
| Oster NV, Skillman SM, Frogner BK |
COVID-19’s Effect on the Employment Status of Health Care Workers |
Center for Health Workforce Studies, University of Washington |
05-26-2021 |
Policy Brief |
What Types of Changes in Employment Status Have Been Most Common Among Health Care Workers as a Result of the COVID-19 Emergency? |
The COVID-19 pandemic has had a dynamic effect on the health workforce. Redeployment, furlough, and layoff are among the terms used to describe various work statuses. Some terms are related and overlapping, potentially causing confusion for employees, media, policymakers, and researchers who may be interested in tracking health care employment trends throughout the pandemic. In this report, we define the range of work statuses that one can hold and identify areas where overlap in terms may create confusion. We describe how work status relates to employees’ wages and/or benefits as well as eligibility for unemployment benefits. We examine how self-employed health care workers and those not currently in the labor force fit into ongoing employment discussions during the COVID-19 pandemic. In closing, we discuss the potential long-term impacts of the COVID-19 pandemic on employment in the health care industry.
Access to Care Allied Health CHWS CHWS Home COVID-19 Hospitals National Reports and Briefs |
| Prusynski R, Leland N, Frogner BK, Leibbrand C, Mroz TM |
Therapy Staffing in Skilled Nursing Facilities Declined After Implementation of the Patient Driven Payment Model |
JAMDA |
05-06-2021 |
URL |
Supply of and Demand for Therapy Services in Skilled Nursing Facilities |
Objective
The Patient Driven Payment Model (PDPM), a new reimbursement policy for Skilled Nursing Facilities (SNFs), was implemented in October 2019. PDPM disincentivizes provision of intensive physical and occupational therapy, however, there is concern that declines in therapy staffing may negatively impact patient outcomes. This study aimed to characterize the SNF industry response to PDPM in terms of therapy staffing.
Design
Segmented regression interrupted time series.
Setting and Participants
15,432 SNFs in the United States.
Methods
Using SNF Payroll Based Journal data from January 1, 2019, through March 31, 2020, we calculated national weekly averages of therapy staffing minutes per patient-day for all therapy staff and for subgroups of physical and occupational therapists, therapy assistants, contract staff, and in-house employees. We used interrupted time series regression to estimate immediate and gradual effects of PDPM implementation.
Results
Total therapy staffing minutes per patient-day declined by 5.5% in the week immediately following PDPM implementation (P < .001), and the trend experienced an additional decline of 0.2% per week for the first 6 months after PDPM compared with the negative pre-PDPM baseline trend (P < .001), for a 14.7% total decline by the end of March 2020. Physical and occupational therapy disciplines experienced similar immediate and gradual declines in staffing. Assistant and contract staffing reductions were larger than for therapist and in-house employees, respectively. All subgroups except for assistants and contract staff experienced significantly steeper declines in staffing trends compared with pre-PDPM trends.
Conclusions and Implications
SNFs appeared to have responded to PDPM with both immediate and gradual reductions in therapy staffing, with an average decline of 80 therapy staffing minutes over the average patient stay. Assistant and contract staff experienced the largest immediate declines. Therapy staffing and quality outcomes require ongoing monitoring to ensure staffing reductions do not have negative implications for patients.
CHWS Journal Article |
| Garcia E, Kundu I, Kelly M, Guenther G, Skillman SM, Frogner B |
The Clinical Laboratory Workforce: Understanding the Challenges to Meeting Current and Future Needs |
American Society for Clinical Pathology (Washington, DC) and Center for Health Workforce Studies, University of Washington (Seattle, WA) |
04-01-2021 |
Full Report |
Identifying the Barriers and Facilitators to Strengthen the Clinical Lab Professional Workforce |
Laboratory medicine is a critical component of the complex U.S. healthcare system, providing patients and medical providers with information essential for the prevention, diagnosis, treatment, and management of health and disease. The clinical laboratory workforce (also referred to as the medical laboratory workforce) supports a laboratory system that provides a variety of objective information used in clinical decision making. The laboratory workforce is diverse in terms of their roles, the types of tasks they perform, the types of qualifications needed, and the level of educational experience required to enter the field. However, many of them share common challenges facing the current and future state of the field, such as a declining number of accredited education programs and resulting decline in the number of students entering these programs, shortages of qualified personnel, increased demands on the workforce, and unmet employer demand. More information about factors contributing to these challenges is needed.
CHWS Reports and Briefs |
| Mohammed SA, Guenther GA, Frogner BK, Skillman SM |
Examining the Racial and Ethnic Diversity of Associate Degree in Nursing Programs by Type of Institution in the US, 2012–2018 |
Nursing Outlook |
07-01-2021 |
URL |
Racial/Ethnic Diversity in Associate Degree Programs in Nursing |
Abstract
Background
Increasing nursing workforce diversity is essential to quality health care. Associate Degree in Nursing (ADN) programs are a primary path to becoming a registered nurse and an important source of nursing diversity.
Purpose
To examine how the number of graduates and racial/ethnic student composition of ADN programs have changed since the Institute of Medicine’s recommendation to increase the percentage of bachelor’s-prepared nurses to 80%.
Methods
Using data from the Integrated Postsecondary Education System, we analyzed the number of graduates and racial/ethnic composition of ADN programs across public, private not-for-profit, and private for-profit institutions, and financial aid awarded by type of institution from 2012-2018.
Discussion
Racial/ethnic diversity among ADN programs grew from 2012-2018. Although private for-profits proportionally demonstrated greater ADN student diversity and provided financial aid institutionally to a higher percentage of students, public schools contributed the most to the number and racial/ethnic diversity of ADN graduates.
Conclusion
Given concerns regarding private for-profits, promoting public institutions may be the most effective strategy to enhance diversity among ADN nurses.
CHWS Journal Article |
| Frogner BK |
One Change That Could Help Nursing Homes Recover from COVID-19 Fears and Become Safer Places for Aging Parents |
The Conversation |
04-13-2021 |
URL |
N/A |
|
| Frogner BK, Skillman SM |
Op-Ed: It's Time to Address Staffing at Nursing Homes — The Elephant in the Room |
MedPage Today |
12-07-2020 |
URL |
N/A |
|
| O’Connor JG, Dunlap B, Gattman NE, Skillman SM |
Washington’s Behavioral Health Workforce: Barriers and Solutions. Phase II Report and Recommendations |
Washington Workforce Board and Center for Health Workforce Studies, University of Washington |
12-01-2020 |
Full Report |
Washington State Behavioral Health Workforce Assessment 2019-2020 |
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| Oster NV, Skillman SM, Stubbs BA, Dahal A, Guenther G, Frogner BK |
The Physical Therapist Workforce in the U.S.: Supply, Distribution, Education Pathways, and State Responses to the COVID -19 Emergency |
Center for Health Workforce Studies, University of Washington |
11-16-2020 |
Policy Brief |
How are Allied Health Workers Being Deployed During COVID-19? |
The traditional role of physical therapists is to prescribe exercises and provide hands-on care to help patients develop, maintain, and restore functional ability that may be limited by injuries, aging, and chronic or progressive diseases. Physical therapists may provide preventive care, rehabilitation, education, and treatment for those with chronic conditions including scoliosis, arthritis, obesity, amputations, and cerebral palsy.
CHWS COVID-19 National Reports and Briefs |
| Frogner BK, Skillman SM |
The Challenge in Tracking Unemployment Among Health Care Workers and Why It Matters |
JAMA Health Forum |
11-09-2020 |
URL |
N/A |
The health care industry lost 1.5 million jobs between March and April 2020, the height of the coronavirus disease 2019 (COVID-19) pandemic in the US. More than half a million jobs remain lost 6 months later, with losses spread across the major health care sectors of hospitals (22.7%), ambulatory care settings (39.6%), and long-term care (LTC) facilities (37.7%). The job loss in LTC facilities (eg, skilled nursing facilities, residential care, assisted living) represents 6.2% of their workforce compared with 2.8% in ambulatory care and 2.4% in hospitals. The LTC sector has seen a steady decline in employment since the start of the pandemic, while the other health care sectors have mostly rebounded. The job loss in LTC is concerning but not surprising, given reports of high COVID-19 risk and burnout. Tracking these unemployed workers is a challenge yet is necessary to develop a strategy to strengthen the LTC workforce and improve health care delivery
CHWS Journal Article |
| Oster NV, Pollack SW, Skillman SM, Stubbs BA, Dahal A, Guenther G, Frogner BK |
The Pharmacist Workforce in the U.S.: Supply, Distribution, Education Pathways, and State Responses to Emergency Surges in Demand |
Center for Health Workforce Studies, University of Washington |
09-24-2020 |
Full Brief
|
How are Allied Health Workers Being Deployed During COVID-19? |
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| Lai AY, Skillman SM, Frogner BK |
Is It Fair? How To Approach Professional Scope-Of-Practice Policy After The COVID-19 Pandemic |
Health Affairs Blog |
06-29-2020 |
URL |
N/A |
|
| Pollack SW, Skillman S, Frogner BK |
Assessing the Size and Scope of the Pharmacist Workforce in the U.S |
Center for Health Workforce Studies, University of Washington |
09-04-2020 |
Full Report |
Assessing the Size and Scope of the Pharmacist Workforce in the US |
Pharmacists are increasingly recognized as crucial members of the health care team. To date, no single source of information exists that best characterizes the increasingly complex nature of the pharmacist workforce. This study aimed to identify the many different settings where pharmacists work, their current and emerging roles, and the barriers and facilitators to greater involvement of pharmacists in patient care. We reviewed the literature and conducted interviews with key stakeholders from national pharmacy professional organizations. This study found that there is not a single, agreed upon categorization that captures the full range of pharmacists’ roles and functions. The most frequently mentioned roles for pharmacists identified from the literature and stakeholder interviews included medication dispensing, medication therapy management, chronic disease management, transition of care, and patient education, health promotion, and disease prevention. Pharmacist scope-of-practice laws and regulations vary by state with most states allowing prescriptive authority. Improving awareness of the potential roles of pharmacists would help to more effectively incorporate them into the health care team. As the pharmacist workforce expands its role in health care delivery, simultaneous changes in policies and financing are important to optimize the use of pharmacists to improve care.
CHWS Reports and Briefs |
| Mroz TM, Dahal A, Prusynski R, Skillman S, Frogner BK |
Variation in Employment of Therapy Assistants in Skilled Nursing Facilities Based on Organizational Factors |
Medical Care Research and Review |
08-28-2020 |
URL |
Supply of and Demand for Therapy Services in Skilled Nursing Facilities |
Employment of therapy assistants enables skilled nursing facilities to provide more therapy services at lower costs. Yet little is known about employment of therapy assistants relative to organizational characteristics. Taking advantage of publicly available Medicare administrative data from 2016, we examined the relationships between organizational characteristics of skilled nursing facilities and employment of therapy assistants. Therapy assistants represent approximately half of the therapy workforce in skilled nursing facilities. Regression analyses indicate significantly higher percentages of therapy assistants are employed in facilities that are staffed by contract therapists, provide more therapy, have more total stays, operate in rural areas, and are located in states with certificate of need laws or moratoria. Skilled nursing facility quality was not significantly associated with employment of therapy assistants. As new payment mechanisms change incentivizes for therapy in skilled nursing facilities, employment of therapy assistants may be a cost-effective way to continue to provide services when necessary.
CHWS Journal Article |
| Stubbs BA, Skillman SM |
Washington State’s 2019 Licensed Practical Nurse Workforce |
Center for Health Workforce Studies, University of Washington |
05-01-2020 |
Full Report
Supplement |
Washington State’s Nurse Workforce – 2019 |
|
| Mroz TM, Frogner BK, Patterson DG |
The Impact Of Medicare’s Rural Add-On Payments On Supply Of Home Health Agencies Serving Rural Counties |
Health Affairs |
06-01-2020 |
URL |
The Impact of Medicare’s Rural Add-on Payments in Home Health on Access to Care and Home Health Markets |
Intermittently since 2001, Medicare has provided a percentage increase over standard payments to home health agencies that serve rural beneficiaries. Yet the effect of rural add-on payments on the supply of home health agencies that serve rural communities is unknown. Taking advantage of the pseudo–natural experiment created by varying rural add-on payment amounts over time, we used data from Home Health Compare to examine how the payments affected the number of home health agencies serving rural counties. Our results suggest that while supply changes are similar in rural counties adjacent to urban areas and in urban counties regardless of add-on payments, only higher add-on payments (of 5 percent or 10 percent) keep supply changes in rural counties not adjacent to urban areas on pace with those in urban counties. Our findings support the recent shift from broadly applied to targeted rural add-on payments but raise questions about the effects of the amount and eventual sunset of these payments on the supply of home health agencies serving remote rural communities.
CHWS Journal Article |
| Fraher EP, Pittman P, Frogner BK, Spetz J, Moore J, Beck AJ, Armstrong D, Buerhaus PI |
Ensuring and Sustaining a Pandemic Workforce |
The New England Journal of Medicine |
04-08-2020 |
URL |
N/A |
|
| Frogner BK, Fraher EP, Spetz J, Pittman P, Moore J, Beck AJ, Armstrong D, Buerhaus PI |
Modernizing Scope-of-Practice Regulations — Time to Prioritize Patients |
The New England Journal of Medicine |
02-13-2020 |
URL |
N/A |
|
| Dahal A, Skillman SM, Patterson DG, Frogner BK |
What Commute Patterns Can Tell Us About the Supply of Allied Health Workers and Registered Nurses |
Center for Health Workforce Studies, University of Washington |
05-01-2020 |
Full Report
Policy Brief |
Commuting Patterns of Allied Health Workers and Registered Nurses |
Information on the available supply of workers in a local job market is important when determining whether there are qualified workers to fill health care jobs in demand. The American Community Survey (ACS), a publicly available annual survey of over 3.5 million households conducted by the U.S. Census Bureau, has been a regular source of information for mapping the geographic distribution of a wide range of occupations, describing the time, duration and distance of workers’ commutes, and identifying common forms of transportation for commuting. In this study, we explore what the ACS can tell us about commuting patterns among selected allied health occupations and registered nurses (RNs) as well as how these patterns may inform discussions of health workforce supply.
Allied Health CHWS CHWS Home Complete National News Nursing Reports and Briefs |
| Stubbs BA, Skillman SM |
Washington State’s 2019 Advanced Registered Nurse Practitioner Workforce |
Center for Health Workforce Studies, University of Washington |
03-01-2020 |
Full Report
Supplemental
|
Washington State’s Nurse Workforce – 2019 |
In order to better monitor health workforce changes, some states have implemented processes by which health care professionals, including ARNPs, complete workforce surveys at licensing and/or with license renewal. When data from workforce surveys are linked to licensure data, and if surveys are conducted online, data collection costs can be greatly reduced and response rates are typically higher than for separate mailed or phone-based surveys. In 2018, Washington’s Nursing Care Quality Assurance Commission (NCQAC) required that all nurses licensed in the state must provide workforce data at initial licensure and renewal through the Nursys e-Notify survey conducted by the National Council of State Boards of Nursing (NCSBN). With funding from the Washington Center for Nursing, the UW CHWS conducted analyses of these data following the first full year of mandated data collection for ARNPs, as well as for licensed practical nurses (LPNs) and registered nurses (RNs). This report describes the results of these analyses for Washington’s ARNPs.
CHWS Nursing Reports and Briefs |
| Skillman SM, Frogner BK, Dahal A, Stubbs BA, Guenther G |
The Respiratory Therapist Workforce in the U.S. Supply, Distribution, Education Pathways, and State Responses to Emergency Surges in Demand |
Center for Health Workforce Studies, University of Washington |
04-02-2020 |
Rapid Response Brief |
Phase II of Leveraging Data for Allied Health Occupations |
This Rapid Response Brief provides information about the respiratory therapist workforce in the U.S. It includes descriptions of the supply, distribution, education pathways, as well as COVID-19 emergency concerns about the respiratory therapist workforce capacity and examples of state approaches to address workforce gaps.
CHWS Reports and Briefs |
| Stubbs BA, Skillman SM |
Washington State’s 2019 Registered Nurse Workforce |
Center for Health Workforce Studies, University of Washington |
03-01-2020 |
Full Report
Supplement |
Washington State’s Nurse Workforce – 2019 |
Information about the demographic, education, and practice characteristics of the registered nurse (RN) workforce is needed to support health workforce planning in the state. In 2018, Washington’s Nursing Care Quality Assurance Commission required that all nurses licensed in the state provide workforce data through the Nursys e-Notify survey conducted by the National Council of State Boards of Nursing. This report, funded by the Washington Center for Nursing, presents findings from the University of Washington Center for Health Workforce Studies’ analyses of data from registered nurses (RNs) who had completed the survey as of May, 2019. These survey data greatly enhance and complement existing nurse workforce supply information from sources such as the state’s health professional licensing files and the occasional sample surveys that have focused on aspects the state’s RN workforce. Findings from the Nursys e-Notify survey, when linked with state RN license records, provide more precise and timely information about the characteristics, distribution, qualifications and practice settings of Washington’s RN workforce.
CHWS CHWS Home News Nursing Reports and Briefs Washington |
| LeRouge C, Sangameswaran S, Frogner BK, Snyder CR, Rubenstein L, Kirsh S, Sayre G |
The Group Practice Manager in the VHA: A View From the Field |
Federal Practitioner |
02-01-2020 |
URL |
N/A |
The VHA created the group practice manager (GPM), a new position responsible for improving clinical practice management and unifying access improvement across leadership levels, professions, and services within each local medical system.
In May 2015, the VHA began hiring and training GPMs to spearhead management of access to services. The US Department of Veterans Affairs (VA) Office of Veteran Access to Care spearheaded GPM training, including face-to-face sessions, national calls, webinars, and educational materials. Five local medical systems were selected by the VA Office of Veteran Access to Care to implement the GPM role to allow for an early evaluation of the program that would inform a subsequent nationwide rollout. Implementation of the GPM role remained in the hands of local medical systems.
CHWS CHWS Home Hospitals Journal Article |
| Pollack SW, Skillman SM, Frogner BK |
The Health Workforce Delivering Evidence-Based Non-Pharmacological Pain Management |
Center for Health Workforce Studies, University of Washington |
02-07-2020 |
Full Report
Policy Brief |
Role of Allied Health Professions in Treating Pain |
Chronic pain is widespread among U.S. adults, and overreliance on
pharmacological approaches to managing this pain has contributed to the
nation’s opioid addiction crisis. There is growing recognition of the importance
of directing patients towards non-pharmacological approaches to manage pain.
This study describes the health-related occupations that are able to deliver
evidence-based non-pharmacologic pain management, and how education-,
policy- and practice-related factors serve as barriers or facilitators to further
leverage this workforce to effectively help manage chronic pain.
Allied Health CHWS Reports and Briefs |
| Schwartz MR, Patterson DG, McCarty RL |
State Incentive Programs that Encourage Allied Health Professionals to Provide Care for Rural and Underserved Populations |
Center for Health Workforce Studies, University of Washington |
12-10-2019 |
Full Report
Policy Brief |
State Incentive Programs that Encourage Allied Health Professionals to Provide Care for Underserved Populations |
State-based programs that provide loans, scholarships, and other incentives for allied health professionals in exchange for service in rural and underserved areas are one approach to alleviating workforce shortages. This study examined the operation of these programs across the U.S., allied health professionals targeted, and efforts to gauge programs’ success in recruitment and retention through a review of publicly available information on state programs and interviews with program leaders in 27 states.
Allied Health CHWS CHWS Home Mental Health National News Oral Health Reports and Briefs |
| O’Connor JG, Gattman NE, Coleman L, Dunlap B, Skillman SM |
Washington’s behavioral health workforce: Barriers and solutions. Phase I |
Report and Recommendations |
11-01-2019 |
Behavioral Health Workforce Phase 1 |
Washington State Behavioral Health Workforce Assessment 2019-2020 |
Report and recommendations for the Washington Workforce Training and Education Coordinating Board
CHWS CHWS Home Mental Health News Reports and Briefs Washington |
| Frogner BK |
Interchangeability of PAs and NPs |
Journal of the American Academy of Physician Assistants |
12-02-2019 |
URL |
N/A |
Rod Hooker asked that Bianca Frogner reflect and add her perspective on his paper about whether NPs and PAs are interchangeable.
Allied Health CHWS Journal Article Nurse Practitioner physician assistant |
| Larson EH, Frogner BK |
Characteristics of Physician Assistant Students Planning to Work in Primary Care |
J Physician Assist Educ |
10-21-2019 |
URL
Policy Brief |
Characteristics of Physician Assistant Students Planning to Work in Primary Care |
Purpose: While the number of physician assistants (PAs) participating in the primary care workforce continues to rise, the proportion of PAs practicing in primary care rather than other specialties has decreased. The purpose of this study was to identify the characteristics of matriculating PA students planning to enter primary care specialties and compare them with students planning on entering other specialties.
Methods: Data from the Physician Assistant Education Association Matriculating Student Survey (MSS) from 2013 and 2014 were analyzed. In a series of bivariate analyses, demographic characteristics, educational backgrounds, clinical experiences, and practice expectations of students intending to enter primary care practice were compared with those of their counterparts who did not intend to enter primary care. Logistic regression was used to assess the overall importance of demographic, background, and practice expectations variables on practice intentions.
Results: A total of 9283 students responded to the MSS from 2013 and 2014. More than half (57.3%) stated an intention to practice in primary care upon graduation. Those students were more likely than their counterparts to be married, to be Hispanic or Asian, and to have participated in community service prior to starting PA training. They were also less likely to view high income as essential to their careers and more likely to view practicing in rural or underserved areas favorably.
Conclusions: The findings of this study could be used to identify student characteristics associated with an interest in primary care and could contribute to more successful student recruitment and PA curriculum design, especially for PA training programs with a mission focused on producing primary care PAs.
CHWS Journal Article National |
| Jopson AD, Skillman SM, Frogner BK |
Use of Apprenticeship to Meet Demand for Medical Assistants in the U.S |
Center for Health Workforce Studies, University of Washington |
09-27-2019 |
Policy Brief
Full Report |
The Role of Apprenticeships in Meeting Employers’ Demand for Allied Health Occupations |
Medical assistants (MAs) are key members of the health care team and are assuming
new and expanded roles amid health care delivery transformation. Some health
care employers are turning to apprenticeships to meet their MA workforce needs.
We conducted a literature review and semi-structured phone interviews in 2018 and
early 2019 with key personnel involved with registered MA apprenticeship programs
in 12 states. Interviews explored program origins, delegated responsibilities, and
resources and challenges with starting and maintaining MA apprenticeship programs.
Interviewees for this study identified 23 active MA apprenticeship programs and
one program in development across 12 states. Programs were found in a variety
of health care settings, including community health centers, school-based clinics,
tribal health centers, hospital systems, and hospice care among others. Programs
ranged in size from one apprentice in training per year to multiple cohorts of 20
apprentices per year.
Allied Health CHWS Reports and Briefs |
| Dahal A, Bellows BK, Jiao T, Biskupiak J |
A Cost-utility Analysis of Pregabalin vs. Duloxetine for the Treatment of Painful Diabetic Neuropathy |
J Pain Palliat Care Pharmacother |
06-01-2012 |
URL |
N/A |
The objective of the current study was to determine the cost-utility of pregabalin versus duloxetine for treating painful diabetic neuropathy (PDN) using a decision tree analysis. Literature searches identified clinical trials and real-world studies reporting the efficacy, tolerability, safety, adherence, opioid usage, health care utilization, and costs of pregabalin and duloxetine. The proportions of patients reported in the included studies were used to determine probabilities in the decision tree model. The base-case model included the Food and Drug Administration (FDA)-approved doses of pregabalin (300 mg/day) and duloxetine (60 mg/day), whereas “real-world” sensitivity analyses explored the effects over a range of doses (pregabalin 75-600 mg/day, duloxetine 20-120 mg/day). A 6-month time horizon and a US third-party payer perspective were chosen for the study. Outcomes from the model were expressed as cost per quality-adjusted life-year (QALY). In the base-case model, duloxetine cost less and was more effective than pregabalin (incremental cost -$187, incremental effectiveness 0.011 QALYs). Results from two real-world sensitivity analyses indicated that duloxetine cost $16,300 and $20,667 more per additional QALY than pregabalin. Using a decision tree model that incorporated both clinical trial and real-world data, duloxetine was a more cost-effective option than pregabalin in the treatment of PDN from the perspective of third-party payers.
CHWS Journal Article |
| Dahal A, McAdam-Marx C, Joy E, Brixner D |
A Retrospective Analysis of Follow-up Timing and Blood Pressure Outcomes after Initiation of Antihypertensive Therapy in Patients with Hypertension Treated in a Utah Community Setting |
Utah’s Health |
01-01-2012 |
|
N/A |
|
| Nelson R, Hicken B, Cai B, Dahal A, West A, Rupper R |
Utilization of Travel Reimbursement in the VA |
Journal of Rural Health |
04-02-2014 |
URL |
N/A |
To improve access to care, the Veterans Health Administration (VHA) increased its patient travel reimbursement rate from 11 to 28.5 cents per mile on February 1, 2008, and again to 41.5 cents per mile on November 17, 2008. We identified characteristics of veterans more likely to receive travel reimbursements and evaluated the impact of these increases on utilization of the benefit. Methods We examined the likelihood of receiving any reimbursement, number of reimbursements, and dollar amount of reimbursements for VHA patients before and after both reimbursement rate increases. Because of our data’s longitudinal nature, we used multivariable generalized estimating equation models for analysis. Rurality and categorical distance from the nearest VHA facility were examined in separate regressions. Findings Our cohort contained 214,376 veterans. During the study period, the average number of reimbursements per veteran was higher for rural patients compared to urban patients, and for those living 50‐75 miles from the nearest VHA facility compared to those living closer. Higher reimbursement rates led to more veterans obtaining reimbursement regardless of urban‐rural residence or distance traveled to the nearest VHA facility. However, after the rate increases, urban veterans and veterans living <50 miles from the nearest VHA facility increased their travel reimbursement utilization slightly more than other patients. Conclusions Our findings suggest an inverted U‐shaped relationship between veterans’ utilization of the VHA travel reimbursement benefit and travel distance. Both urban and rural veterans responded in roughly equal manner to changes to this benefit.
CHWS Journal Article |
| Dahal A, Fertig A |
An Econometric Assessment of the Effect of Mental Illness on Household Spending Behavior |
Journal of Economic Psychology |
08-01-2013 |
URL |
N/A |
This paper examines the relationship between individuals’ mental health status and their spending behavior. Compared to individuals without mental health problems, individuals with mental health problems may have higher discount rates and derive greater utility from spending (i.e., retail therapy). If the mentally ill have these characteristics, we would expect them to purchase goods and services that give immediate enjoyment, sacrificing longer-term savings goals. However, mental health disorders may result in a sense of worthlessness and lethargy such that less utility is derived from spending and less energy is available for spending, which would give us the opposite prediction. Using the Panel Study of Income Dynamics, we generally find a negative effect of mental illness on household spending, although the specific effects vary by the measure of mental illness, by the expenditure category, and by gender and couple status. Of particular concern, single and married women with mental illness reduce spending on education, which suggests a long-term financial cost of mental illness. In addition, we find some evidence of retail therapy with respect to a mental health screen for single and married women and with respect to a mental diagnosis for married men.
CHWS Journal Article |
| Dahal A, Bellows BK, Sonpavde G, Tantravahi SK, Choueiri TK, Galsky M, Agarwal N |
Incidence of Severe Nephrotoxicity With Cisplatin Based on Renal Function Eligibility Criteria: Indirect Comparison Meta-analysis |
Am J Clin Oncol |
05-12-2014 |
URL |
N/A |
The objective of this meta-analysis was to indirectly compare incidence of nephrotoxicity in trials using cisplatin (CIS) for treatment of solid tumors when renal function was assessed using serum creatinine (SCr) or creatinine clearance (CrCl) for eligibility criteria.
CHWS Journal Article |
| McAdam-Marx C, Dahal A, Jennings B, Singhal M, Gunning K |
The effect of a diabetes collaborative care management program on clinical and economic outcomes in patients with type 2 diabetes |
J Manag Care Spec Pharm |
06-01-2015 |
URL |
N/A |
Clinical pharmacy services (CPS) in the primary care setting have been shown to help patients attain treatment goals and improve outcomes. However, the availability of CPS in community-based primary care is not widespread. One reason is that current fee-for-service models offer limited reimbursement opportunities for CPS in the community setting. Furthermore, data demonstrating the value of CPS in this setting are limited, making it difficult for providers to determine the feasibility and sustainability of incorporating CPS into primary care practice.
CHWS Journal Article |
| Dahal A, McAdam-Marx C, Stout B, and McWhorter LS |
Improving Diabetes Care in Underserved Patients through a “Learning Your ABCs” Education and Screening Program |
Journal of Pharmaceutical Health Care and Sciences |
06-01-2015 |
URL |
N/A |
Pharmacists are accessible health care professionals and can provide diabetes education and counseling tounderserved patients. Knowledge of hemoglobin A1C, blood pressure and cholesterol (ABC) implications andtreatment targets may improve diabetes self-management. This article describes ABC education in a communitypharmacy with a large uninsured and underinsured patient population.
CHWS Journal Article diabetes underserved |
| Skillman SM, Dahal A, Frogner BK, Andrilla CHA |
Medical Assistants in Washington State: Demographic, Education, and Work Characteristics of the State’s Medical Assistant-Certified Workforce |
Center for Health Workforce Studies, University of Washington |
01-01-2019 |
Report |
Expanding Role of Medical Assistants |
Medical assistants (MAs) are a rapidly growing and increasingly important workforce. High MA turnover, however, is common and employers report applicants frequently do not meet their needs. We collected survey responses from a representative sample of Washington’s MAs with certified status (MA-Cs) to understand their demographic, education and employment backgrounds; job satisfaction; and career plans.
CHWS CHWS Home News Nursing Reports and Briefs Washington |
| Skillman SM, Stubbs BA, Aragon, SA |
Washington State’s Registered Nurse Workforce: Results of a 2018 Survey |
Center for Health Workforce Studies, University of Washington |
10-01-2018 |
Full Report |
Washington State’s Registered Nurse Workforce – 2018 |
The Washington Center for Nursing engaged the University of Washington Center
for Health Workforce Studies to survey Washington’s registered nurses (RNs) in 2018
to provide up-to-date information about the state’s RN supply. The survey included
questions from the Nursing Minimum Data Set (employment status, job characteristics,
demographics, education, and credentials) as well as questions about satisfaction with
their current nursing position, career plans, salary, and employment history. This report
summarizes the findings from this survey.
CHWS Reports and Briefs |
| Skillman SM, Dahal A, Frogner BK, Andrilla CHA |
Frontline workers’ career pathways: A detailed look at Washington State’s medical assistant workforce |
Medical Care Research and Review |
11-01-2018 |
URL
Policy Brief |
Expanding Role of Medical Assistants |
|
| Frogner BK, Stubbs BA, Skillman SM |
Emerging Roles and Occupations in the Health Workforce |
Center for Health Workforce Studies, University of Washington |
08-01-2018 |
Policy Brief
Full Report |
Emerging Roles in Allied Health Occupations |
Systematically quantifying and tracking the evolution of the health workforce is a challenge, yet is important for identifying emerging demands for different skills and competencies. Real Time Labor Market Information (RT-LMI), a source of data that is increasingly used to monitor workforce demand, extracts information from online job ads to track demand for general labor market skills, including for the health workforce. The purpose of this study is to identify how five domains of emerging roles in healthcare have been incorporated into the job titles and descriptions of healthcare occupations by using RT-LMI data from LinkUp, a job search engine company. The key findings from this study are:
- “Care coordination” was the most common emerging role appearing in healthcare job ads, either in the job title or job description, in both 2014 and 2015, and “disease management” and “patient education” were more frequently mentioned in 2015 compared to 2014.
- Physical therapists, social workers, nursing assistants and medical assistants were among the allied health occupations mentioned in job ads in which emerging roles appeared.
- Care coordination was a dominant emerging role for occupations across all education requirement categories in the job ads examined, and disease management became a more frequently requested emerging role between 2014 and 2015.
- Jobs requiring a high school degree or below rarely referenced an emerging role (2.0% in 2014 and 3.5% in 2015) despite the relatively high frequency of job ads for healthcare jobs at this education level.
- Often, where an emerging role was identified in the job title, no other specific healthcare occupation was identified within either the job title or job description, suggesting that these occupations may be becoming stand-alone healthcare occupations.
In this study we found that RT-LMI can provide valuable information on the emergence of new skills and roles in the health workforce, including for many allied health occupations. Findings from this study contribute to the development of methods for monitoring and tracking changing healthcare workforce demands using large electronic databases of job ads. This important information on how employers associate skills with posted job titles can help educational institutions, training programs, accrediting bodies and health workforce planners better prepare workers with the competencies to meet market demand.
Allied Health CHWS CHWS Home News Reports and Briefs care continuum navigator care coordinating care coordination care coordination navigator care coordinator care management care navigation care navigator case manager consumer education coordination of care coordination of patient care disease management disease manager health coach health coaching health educating health education health educator health service navigator health services navigator management of patient care managing disease managing risk navigate care navigate patient care navigation of care nurse navigator patient care coordination patient care management patient navigation patient navigator peer advisor peer advocate peer coach peer counselor peer education peer educator peer liaison peer mentor peer navigator peer partner peer recovery coach peer recovery specialist peer specialist peer support peer support specialist population health risk management |
| Stubbs BA, Skillman SM |
2018 Washington State data snapshot: registered nurses (RNs) |
Center for Health Workforce Studies, University of Washington |
05-01-2018 |
Snapshot |
2018 Registered Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| Stubbs BA, Skillman SM |
2018 Washington State data snapshot: registered nurses (RNs) |
Center for Health Workforce Studies, University of Washington |
05-01-2018 |
Snapshot |
2018 Registered Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| Stubbs BA, Skillman SM |
2018 Washington State data snapshot: licensed practical nurses (LPNs) |
Center for Health Workforce Studies, University of Washington |
05-01-2018 |
Snapshot |
2018 Licensed Practical Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| Stubbs BA, Skillman SM |
2018 Washington State data snapshot: advanced registered nurse practitioners (ARNPs) |
Center for Health Workforce Studies, University of Washington |
05-01-2018 |
Snapshot |
2018 Washington State Data Snapshot: Advanced Registered Nurse Practitioners |
|
| Skillman SM, Stubbs BA, Dahal A |
Maine’s physician, nurse practitioner, and physician assistant workforce in 2018 |
Seattle, WA: Center for Health Workforce Studies, University of Washington |
07-30-2018 |
Full Report |
N/A |
Compared with 2014, Maine had slightly fewer licensed physicians, and more NPs and PAs in Maine for every 100,000 state residents in 2018.
Mean ages of physicians were the same, but NPs’ and PAs’ mean ages each decreased by one year from 2014 to 2018.
Maine’s practicing physician supply, on a per capita basis, was somewhat larger than national averages, both overall and for primary care.
The number of primary care physicians per capita varied greatly by county, with more than twice as many in counties with the highest physician density compared with counties having the lowest density.
Half or more of the physicians in many of Maine’s most rural counties were age 55 or older.
Nearly a quarter of Maine’s total 2018 practicing physician supply graduated from medical school at one of the three colleges affiliated with Maine Medical Center.
About 27% of all of Maine’s physicians in 2018 – 42% of primary care physicians, and more than half in family medicine specialties – completed a residency in Maine, which is an overall increase from 2014.
Comparisons of county-level physician, NP and PA workforce supply with indicators of population health show some areas of the state where the availability of providers may be affecting access to healthcare, suggesting areas for further examination.
CHWS CHWS Home News Physicians Reports and Briefs AMA demographics Maine NP Nurse Practitioner PA Physician physician assistant residency supply |
| Frogner BK, Harwood K, Andrilla CHA, Schwartz MR, Pines JM |
Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs |
Health Services Research |
05-23-2018 |
URL |
Direct Access to Physical Therapists |
health care costs imaging insurance claims opioid Physical therapy |
| Frogner, BK |
Update on the Stock and Supply of Health Services Researchers in the United States |
Health Services Research |
06-04-2018 |
URL |
N/A |
diversity education health care Health services research workforce |
| Snyder CR, Dahal A, Frogner BK |
Occupational Mobility among Individuals in Entry‐level Healthcare Jobs in the United States |
Journal of Advanced Nursing |
03-31-2018 |
URL
Policy Brief |
Career Paths of Allied Health Professionals |
To explore career transitions among individuals in select entry-level healthcare occupations.
Journal Article News allied health career pathways health workforce job mobility nursing panel data |
| Snyder CR, Frogner BK, Skillman SM |
Facilitating Racial and Ethnic Diversity in the Health Workforce |
Journal of Allied Health |
03-01-2018 |
URL |
Facilitating Racial and Ethnic Diversity in the Health Workforce |
Racial and ethnic diversity in the health workforce can facilitate access to healthcare for underserved populations and meet the health needs of an increasingly diverse population. In this study, we explored 1) changes in the racial and ethnic diversity of the health workforce in the United States over the last decade, and 2) evidence on the effectiveness of programs designed to promote racial and ethnic diversity in the U. S. health workforce. Findings suggest that although the health workforce overall is becoming more diverse, people of color are most often represented among the entry-level, lower-skilled health occupations. Promising practices to help facilitate diversity in the health professions were identified in the literature, namely comprehensive programs that integrated multiple interventions and strategies. While some efforts have been found to be promising in increasing the interest, application, and enrollment of racial and ethnic minorities into health profession schools, there is still a missing link in understanding persistence, graduation, and careers.
Journal Article News |
| Gattman NE, McCarty RL, Balassa A, Skillman SM |
Washington State Behavioral Health Workforce Assessment |
Washington Workforce Training and Education Coordinating Board |
12-01-2017 |
Full Report |
Washington State Behavioral Health Workforce Assessment |
|
| McCarty RL, Skillman SM |
Washington State's Behavioral Health Workforce (profiles) |
Center for Health Workforce Studies, University of Washington |
12-01-2017 |
Chemical Dependency Counselors
Community Health Workers
...
View more |
Washington State Behavioral Health Workforce Assessment |
|
| Patterson DG, Andrilla CHA, Schwartz MR, Hager LJ, Skillman SM |
Assessing the Impact of Washington State’s Oral Health Workforce on Patient Access to Care |
Seattle, WA: Center for Health Workforce Studies, University of Washington |
11-09-2017 |
Final Report
Policy Brief |
The Status of the Oral Health Workforce in Washington State |
dentist licensure |
| Skillman SM, Dahal A |
Alaska's physician workforce in 2016 |
Center for Health Workforce Studies, University of Washington |
07-28-2017 |
Full Report |
Alaska’s Physician Workforce |
|
| Skillman SM, Dahal A |
Wyoming’s physician workforce in 2016 |
Center for Health Workforce Studies, University of Washington |
04-01-2017 |
Full Report |
Wyoming’s Physician Workforce |
|
| Stubbs BA, Frogner BK, Skillman SM |
The value of real time labor market information for monitoring health workforce demand: a case study examining employer demand for health information technology skills |
Center for Health Workforce Studies, University of Washington |
03-01-2017 |
Full Report
Policy Brief |
Emerging Health IT Roles and Skillsets |
|
| Skillman SM, Dahal A |
Montana’s physician workforce in 2016 |
Center for Health Workforce Studies, University of Washington |
03-01-2017 |
Full Report |
Montana Physician Workforce |
|
| Skillman SM, Dahal A |
Idaho’s physician workforce in 2016 |
Center for Health Workforce Studies, University of Washington |
02-01-2017 |
Full Report |
Idaho’s Physician Workforce |
|
| Boat TF, Land ML, Leslie LK, Haogwood KE, Hawkins-Walsh E, McCabe MA, Fraser MW, deSaxe Zerden L, Lombardi BM, Fritz GK, Frogner BK, Hawkins JD, Sweeney M |
Workforce development to enhance the cognitive, affective, and behavioral health of children and youth: opportunities and barriers in child health care training |
Perspectives: Expert Voices in Heath & Health Care, National Academy of Medicine. 29p |
11-29-2016 |
URL |
N/A |
|
| Frogner BK, Wu X, Ku L, Pittman P, Masselink LE |
Do years of experience with electronic health records matter for productivity in community health centers? |
Journal of Ambulatory Care Management |
01-01-2017 |
URL |
N/A |
This study investigated how years of experience with an electronic health record (EHR) related to productivity in community health centers (CHCs). Using data from the 2012 Uniform Data System, we regressed average annual medical visits, weighted for service intensity, as a function of full-time equivalent medical staff controlling for CHC size and location. Physician productivity significantly improved. Although the productivity of all other staff types was not significantly different by years of EHR experience, the trends showed lower productivity among nurses and other medical staff in CHCs with fewer years of EHR experience versus more years of experience.
CHWS Journal Article community health center electronic health records health IT productivity safety net providers workforce |
| Frogner BK, Wu X, Park J, Pittman P |
The association of electronic health record adoption with staffing mix in community health centers |
Health Services Research |
01-27-2017 |
URL |
N/A |
Objective
To assess how medical staffing mix changed over time in association with the adoption of electronic health records (EHRs) in community health centers (CHCs).
Study Setting
Community health centers within the 50 states and Washington, DC.
Study Design
Estimated how the change in the share of total medical staff full-time equivalents (FTE) by provider category between 2007 and 2013 was associated with EHR adoption using fractional multinomial logit.
Data Collection
2007–2013 Uniform Data System, an administrative data set of Section 330 federal grant recipients; and Readiness for Meaningful Use and HIT and Patient Centered Medical Home Recognition Survey responses collected from Section 330 recipients between December 2010 and February 2011.
Principal Findings
Having an EHR system did significantly shift the share of workers over time between physicians and each of the other categories of health care workers. While an EHR system significantly shifted the share of physician and other medical staff, this effect did not significantly vary over time. CHCs with EHRs by the end of the study period had a relatively greater proportion of other medical staff compared to the proportion of physicians.
Conclusions
Electronic health records appeared to influence staffing allocation in CHCs such that other medical staff may be used to support adoption of EHRs as well as be leveraged as an important care provider.
CHWS Journal Article News administrative data uses Econometrics health workforce: distribution/incomes/training information technology in health uninsured/safety net providers |
| Frogner BK |
The health care job engine: where do they come from and what do they say about our future? |
Medical Care Research and Review |
01-19-2017 |
URL |
N/A |
Health care has been cited as a job engine for the U.S. economy. This study used the Current Population Survey to examine the sector and occupation shifts that underlie this growth trend. Health care has had a cyclical relationship with retail trade, leisure and hospitality, education, and professional services. The entering workforce has been increasingly taking on low-skilled occupations. The exiting workforce has not been necessarily retiring or going back to school, but appeared to be leaving without a job, with potentially more child care duties, and with high rates of disability and poverty levels. This study also found that the number of workers staying in health care has been slowly declining over time. As the United States moves toward team-based care, more attention should be paid to the needs of the lower skilled workers to reduce turnover and ensure delivery of quality care.
Allied Health CHWS Hospitals Journal Article National News Nursing Other Work Settings Physicians health care industry health care workforce job growth job mobility turnover |
| Skillman SM, Dahal A |
Washington State’s physician workforce in 2016 |
Center for Health Workforce Studies, University of Washington |
02-01-2017 |
Full Report |
Washington State’s Physician Workforce |
|
| Patterson DG, Snyder CR, Frogner BK |
Immigrants in healthcare occupations |
Center for Health Workforce Studies, University of Washington |
01-01-2017 |
Full Report
Policy Brief |
Immigrants in Allied Health Professions |
|
| Skillman SM, Dahal A, Frogner BK, Stubbs BA |
Leveraging data to monitor the allied health workforce: national supply estimates using different data sources: data snapshot - diagnostic related technologists and technicians |
Center for Health Workforce Studies, University of Washington |
01-05-2017 |
Data Snapshot |
Leveraging Data to Monitor the Allied Health Workforce: Building a Database for Studies of Workforce Size, Distribution and Availability |
|
| Skillman SM, Dahal A, Frogner BK, Stubbs BA |
Leveraging data to monitor the allied health workforce: national supply estimates using different data sources: data snapshot - medical assistants |
Center for Health Workforce Studies, University of Washington |
01-05-2017 |
Data Snapshot |
Leveraging Data to Monitor the Allied Health Workforce: Building a Database for Studies of Workforce Size, Distribution and Availability |
|
| Skillman SM, Dahal A, Frogner BK, Stubbs BA |
Leveraging data to monitor the allied health workforce: national supply estimates using different data sources: data snapshot - occupational therapists |
Center for Health Workforce Studies, University of Washington |
01-05-2017 |
Data Snapshot |
Leveraging Data to Monitor the Allied Health Workforce: Building a Database for Studies of Workforce Size, Distribution and Availability |
|
| Skillman SM, Dahal A, Frogner BK, Stubbs BA |
Leveraging data to monitor the allied health workforce: national supply estimates using different data sources: data snapshot - physical therapists |
Center for Health Workforce Studies, University of Washington |
01-05-2017 |
Data Snapshot |
Leveraging Data to Monitor the Allied Health Workforce: Building a Database for Studies of Workforce Size, Distribution and Availability |
|
| Skillman SM, Dahal A, Frogner BK, Stubbs BA |
Leveraging data to monitor the allied health workforce: national supply estimates using different data sources: data snapshot - social workers |
Center for Health Workforce Studies, University of Washington |
01-05-2017 |
Data Snapshot |
Leveraging Data to Monitor the Allied Health Workforce: Building a Database for Studies of Workforce Size, Distribution and Availability |
|
| Skillman SM, Dahal A, Frogner BK, Stubbs BA |
Leveraging data to monitor the allied health workforce: national supply estimates using different data sources: data snapshot - speech-language pathologists |
Center for Health Workforce Studies, University of Washington |
01-05-2017 |
Data Snapshot |
Leveraging Data to Monitor the Allied Health Workforce: Building a Database for Studies of Workforce Size, Distribution and Availability |
|
| Skillman SM, Dahal A, Frogner BK, Stubbs BA |
Leveraging data to monitor the allied health workforce: national supply estimates using different data sources: data snapshot - clinical laboratory technologists and technicians |
Center for Health Workforce Studies, University of Washington |
01-05-2017 |
Data Snapshot |
Leveraging Data to Monitor the Allied Health Workforce: Building a Database for Studies of Workforce Size, Distribution and Availability |
|
| Skillman SM, Dahal A, Frogner BK, Stubbs BA |
Leveraging data to monitor the allied health workforce: national supply estimates using different data sources: data snapshot - dental hygienists |
Center for Health Workforce Studies, University of Washington |
01-05-2017 |
Data Snapshot |
Leveraging Data to Monitor the Allied Health Workforce: Building a Database for Studies of Workforce Size, Distribution and Availability |
|
| Skillman SM, Dahal A, Frogner BK, Stubbs BA |
Leveraging data to monitor the allied health workforce: national supply estimates using different data sources: data snapshot - respiratory therapists |
Center for Health Workforce Studies, University of Washington |
01-05-2017 |
Data Snapshot |
Leveraging Data to Monitor the Allied Health Workforce: Building a Database for Studies of Workforce Size, Distribution and Availability |
|
| Skillman SM, Dahal A, Frogner BK, Stubbs BA |
Leveraging data to monitor the allied health workforce: national supply estimates using different data sources |
Center for Health Workforce Studies, University of Washington |
12-01-2016 |
Policy Brief
Full Report |
Leveraging Data to Monitor the Allied Health Workforce: Building a Database for Studies of Workforce Size, Distribution and Availability |
|
| Frogner BK, Skillman SM, Patterson DG, Snyder CR |
Comparing the socioeconomic well-being of workers across healthcare occupations |
Center for Health Workforce Studies, University of Washington |
12-01-2016 |
Full Report
Policy Brief |
Impacts of Greater Use of Low Skilled, Low-wage Workers in Health Care Delivery |
|
| Frogner BK, Skillman SM |
Pathways to middle-skill allied health care occupations |
Issues in Science & Technology |
11-30-2016 |
URL |
N/A |
Better information about the skills required in health occupations and the paths to career advancement could provide opportunities for workers as well as improved health care.
Health care has been a “job engine” for the US economy, given the sector’s historically strong job growth, an aging population, and increasing demand for health care due to the Patient Protection and Affordable Care Act of 2010 (ACA). Health care professions dominate the list of the 20 fastest growing occupations, with growth rates between 25% and 50%, according to data compiled by the federal Bureau of Labor Statistics. With a good demand outlook and the relatively low entry requirements for several of these jobs, health care occupations appear to be a good career path.
Many of the growing health care professions are “middle-skill,” a term with considerable overlap with the term “allied health,” a category that encompasses a diverse and not precisely defined set of careers. The Association of Schools of Allied Health Professions has identified 66 such occupations; the Health Professions Network, a collaborative group representing the leading allied health professions, has identified over 45; and the Commission on Accreditation of Allied Health Education Programs provided accreditation in 2010 to 28 occupations. These jobs may or may not involve direct patient care, and some do not require specialized skill at entry. Many require less than a baccalaureate degree for entry.
The pathway to an allied health career can be unclear, especially in relatively new and emerging positions. Clear career pathways and ladders that lead to socioeconomic success need to be clarified in order to direct investments for attracting and retaining a competent workforce. Our task here, then, is to describe what is known about the career pathways into middle-skill allied health careers and the challenges that exist for individuals seeking such careers.
Allied Health CHWS Journal Article allied healthcare apprenticeship career pathways education health occupations training workforce |
| Gattman N, Reule R, Balassa A, Skillman SM, McCarty RL, Schwartz MR |
Washington's behavioral health workforce assessment: project phase I |
Washington State Workforce Training and Education Coordinating Board |
11-01-2016 |
Final Report |
Washington State Behavioral Health Workforce Assessment |
|
| McCarty RL, Schwartz MR, Skillman SM |
Washington’s behavioral health workforce assessment: input from key informants |
Center for Health Workforce Studies, University of Washington |
11-18-2016 |
Full Report
Policy Brief |
Washington State Behavioral Health Workforce Assessment |
|
| Roberts FA, DiMarco AC, Skillman SM, Mouradian WE |
Growing the dental workforce for rural communities: University of Washington’s RIDE program |
Generations: Journal of the American Society on Aging |
11-17-2016 |
URL |
N/A |
Older adults constitute a growing percentage of the rural population in the United States. This cohort is at special risk for oral health problems because access to dental care is an ongoing challenge in rural America. The University of Washington School of Dentistry’s Regional Initiatives in Dental Education (RIDE) program delivers intensive, community-based education that prepares dentists to meet the needs of rural and underserved populations, including the growing number of rural elders. Of those graduates who have completed their training, 70 percent are practicing in rural or underserved areas.
CHWS Journal Article News Washington aging in community dental education Generations health and wellness healthcare and aging oral health rural workforce |
| Frogner BK, Skillman SM, Snyder CR |
Characteristics of veterans in allied healthcare occupations |
Center for Health Workforce Studies, University of Washington |
11-11-2016 |
Full Report
Policy Brief |
Characteristics of Veterans in Allied Health Care Jobs |
|
| Miller SC, Frogner BK, Saganic LM, Cole AM, Rosenblatt RA |
Affordable Care Act impact on community health center staffing and enrollment: a cross-sectional study |
Journal of Ambulatory Care Management |
10-01-2016 |
URL |
N/A |
Over 500 000 Washingtonians gained health insurance under the Affordable Care Act (ACA). As more patients gain insurance, community health centers (CHCs) expect to see an increase in demand for their services. This article studies the CHCs in Washington State to examine how the increase in patients has been impacting their workload and staffing. We found a reported mean increase of 11.7% and 5.4% in new Medicaid and Exchange patients, respectively. Half of the CHCs experienced large or dramatic workload impact from the ACA. Our findings suggest that CHCs need further workforce support to meet the expanding patient demand.
CHWS Journal Article News Affordable Care Act community health centers |
| Pittman P, Masselink L, Bade L, Frogner BK, Ku L |
Factors determining medical staff configurations in community health centers: CEO perspectives |
Journal of Healthcare Management |
09-01-2016 |
URL |
N/A |
While financial incentives to adopt team-based care are mounting, little is known about how leaders of primary care organizations make decisions regarding medical staff configurations. This study explores perceptions of CEOs of community health centers (CHCs) that have a variety of staff configurations. We used the 2012 Uniform Data System to identify a maximum variety sample of CHCs with unusually high proportions of advanced practice providers, nurses, medical assistants, case managers, or community health workers. We conducted semistructured interviews with CEOs at 19 selected CHCs about factors that influenced their medical staff configuration decisions. We found that CEOs considered two major dimensions in their decisions: choice and balance of providers (physicians versus nurse practitioners [NPs] and physician assistants [PAs]) and configuration of clinical support staff. Across these decision domains, CEOs consider contextual issues (e.g., local labor supply, wage gaps between professions, scope of practice regulations, local payment policies, and institutional history), as well as their own perceptions of individual attributes, the quality of specific professions, and the likelihood of retention. Strong preferences emerged for a balance among physicians and NPs/PAs and the inclusion of nurses with “stackable” degrees. This study provides a preliminary framework for understanding how CEOs at CHCs weigh staffing options in a variety of contexts. This framework can serve to inform research on the comparative effectiveness of different staffing configurations and improve national and state workforce projection models.
CHWS Journal Article advanced practice providers case managers CEOs CHCs community health workers medical assistants NP nurse practitioners nurses PA primary care staff configuration |
| Lutfiyya MN, Tomai L, Frogner BK, Cerra F, Zismer D, Parente S |
Does primary care diabetes management provided to Medicare patients differ between primary care physicians and nurse practitioners? |
Journal of Advanced Nursing |
01-01-2017 |
URL |
N/A |
|
| Skillman SM, Andrilla CHA, Patterson DG, Fenton SH, Ostergard SJ |
Health information technology workforce needs of rural primary care practices |
J Rural Health. Winter 2015, 31(1):58-66 |
12-01-2015 |
|
N/A |
|
| Kaplan L, Klein TA, Skillman SM, Andrilla CHA |
Faculty supervision of NP program practicums: a comparison of rural and urban site differences |
The Nurse Practitioner |
07-01-2016 |
|
N/A |
|
| Andrilla CHA, Skillman SM |
Washington State data snapshot: licensed practical nurses (LPNs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
06-01-2016 |
Snapshot |
2018 Licensed Practical Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| Andrilla CHA, Skillman SM |
Washington State data snapshot: advanced registered nurse practitioners (ARNPs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
06-01-2016 |
Snapshot |
2018 Washington State Data Snapshot: Advanced Registered Nurse Practitioners |
|
| Andrilla CHA, Skillman SM |
Washington State data snapshot: registered nurses (RNs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
06-01-2016 |
Snapshot |
2018 Registered Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| Snyder CR, Wick KH, Skillman SM, Frogner BK |
Pathways for military veterans to enter healthcare careers |
Center for Health Workforce Studies, University of Washington |
05-01-2016 |
Full Report
Policy Brief |
Pathways for Military Veterans to Enter Allied Health Careers |
|
| Skillman SM, Snyder CR, Frogner BK, Patterson DG |
The behavioral health workforce needed for integration with primary care: information for health workforce planning |
Center for Health Workforce Studies, University of Washington |
04-20-2016 |
Full Report
Policy Brief |
The Workforce Needed to Integrate Behavioral/Mental Health Workforce with Primary Care |
|
| Frogner BK, Harwood K, Pines J, Andrilla CHA, Schwartz MR |
Does unrestricted direct access to physical therapy reduce utilization and health spending? |
Health Care Cost Institute and National Academy for State Health Policy State Health Policy Grant Program. Washington, DC: Health Care Cost Institute. |
01-01-2016 |
URL |
Direct Access to Physical Therapists |
|
| National Academies of Sciences Engineering and Medicine |
A framework for educating health professionals to address the social determinants of health |
Washington, DC: The National Academies Press |
01-01-2016 |
URL |
Educating Health Professionals to Address the Social Determinants of Health |
|
| Forte G, Graham K, Frogner BK |
Commentaries on health services research |
Journal of the American Academy of Physician Assistants |
01-01-2016 |
URL |
N/A |
A cornerstone of patient-centered medical homes (PCMHs) is team-based care; however, little information exists on the composition of providers delivering direct primary care in PCMHs. This study examined the number and distribution of primary care physicians, NPs, and PAs in New York state practices (n=7,431). Designated PCMHs had more NPs and PAs per primary care physician relative to non-PCMHs. The ratios of NPs to primary care physicians were almost twice as high in PCMHs compared with non-PCMHs (0.20 and 0.11), and ratios were similarly different for PAs to primary care physicians (0.16 and 0.09, respectively). The multivariate analyses also support that higher NP and PA staffing was associated with PCMH designation—that is, for every 25 primary care physicians, PCMHs had one additional NP and/or PA. The growth of PCMHs may require more NPs and PAs to meet the anticipated growth in demand for healthcare. Policy- and practice-level changes are necessary to use them in the most effective ways.
CHWS Journal Article NP PA patient-centered medical homes PCHM PCP primary care physicians primary care provider team-based care |
| Frogner BK, Pauley GC |
Do skill mix and high tech matter for hospitals’ competency in adopting electronic health records? |
Health Economics Outcomes Research (Open Access) |
01-01-2015 |
URL |
N/A |
Health workforce plays an important role in the adoption of electronic health records (EHRs). Hospitals have cited barriers around hiring a competent workforce to adopt EHRs. The literature does not adequately relate organizational and health workforce competency with EHR adoption, which makes it difficult to monitor and evaluate any programs targeting trying to improve this problem. In this study, we develop an index measuring hospitals’ competency in adopting electronic health records (EHRs) using Item Response Theory. We test to what extent hospitals’ skill mix and high tech capacity influence their competency. We use health IT data from Health Information and Management Systems Society
(HIMSS) Analytics Database and workforce and high tech data from the Centers of Medicare and Medicaid Services (CMS) Provider of Services file. We found that hospitals with a larger share of registered nurses (RNs) had higher EHR competency, but environments with more high tech potentially compete for their attention and results in lower EHR competency. Technicians, therapists, and lower skilled nurses that interact with high tech apparently transfer their knowledge and skills into higher EHR competency. Future EHR adoption incentives should target lower competency hospitals with insufficient workforce and less technological capacity
CHWS Journal Article Capital-skill complementarity EHR health IT health workforce Item response theory Organizational competency |
| Frogner BK, Parente ST, Frech HE |
Comparing efficiency of health systems across industrialized countries: a panel analysis |
BMC Health Services Research |
01-01-2015 |
URL |
N/A |
BACKGROUND:
Rankings from the World Health Organization (WHO) place the US health care system as one of the least efficient among Organization for Economic Cooperation and Development (OECD) countries. Researchers have questioned this, noting simplistic or inappropriate methodologies, poor measurement choice, and poor control variables. Our objective is to re-visit this question by using newer modeling techniques and a large panel of OECD data.
METHODS:
We primarily use the OECD Health Data for 25 OECD countries. We compare results from stochastic frontier analysis (SFA) and fixed effects models. We estimate total life expectancy as well as life expectancy at age 60. We explore a combination of control variables reflecting health care resources, health behaviors, and economic and environmental factors.
RESULTS:
The US never ranks higher than fifth out of all 36 models, but is also never the very last ranked country though it was close in several models. The SFA estimation approach produces the most consistent lead country, but the remaining countries did not maintain a steady rank.
DISCUSSION:
Our study sheds light on the fragility of health system rankings by using a large panel and applying the latest efficiencymodeling techniques. The rankings are not robust to different statistical approaches, nor to variable inclusion decisions.
CONCLUSIONS:
Future international comparisons should employ a range of methodologies to generate a more nuanced portrait of healthcare system efficiency.
CHWS Journal Article Efficiency Health systems International comparison Life expectancy Stochastic frontier analysis |
| Frogner BK, Spetz J, Oberlin S, Parente ST |
The Demand for Healthcare Workers Post-ACA |
International Journal of Health Economics and Management |
01-01-2015 |
URL |
N/A |
Concern abounds about whether the health care workforce is sufficient to meet changing demands spurred by the Affordable Care Act (ACA). We project that by 2022 the health care industry needs three to four million additional workers, forty percent of which is related to demand growth under the ACA. We project faster job growth in the ambulatory care sector, especially in home health care. Given the current profile, we expect that the future health care workforce will be increasingly female, young, racially/ethnically diverse, not US-born, at or below the poverty level and at a low level of educational attainment.
CHWS Journal Article health reform health workforce microsimulation projections |
| Ku L, Frogner BK, Steinmetz E, Pittman P |
Many paths to primary care: flexible staffing and productivity in community health centers |
Health Affairs |
01-01-2015 |
URL |
Impact of Electronic Health Records on Community Health Center Staffing |
Community health centers are at the forefront of ambulatory care practices in their use of nonphysician clinicians and team-based primary care. We examined medical staffing patterns, the contributions of different types of staff to productivity, and the factors associated with staffing at community health centers across the United States. We identified four different staffing patterns: typical, high advanced-practice staff, high nursing staff, and high other medical staff. Overall, productivity per staff person was similar across the four staffing patterns. We found that physicians make the greatest contributions to productivity, but advanced-practice staff, nurses, and other medical staff also contribute. Patterns of community health center staffing are driven by numerous factors, including the concentration of clinicians in communities, nurse practitioner scope-of-practice laws, and patient characteristics such as insurance status. Our findings suggest that other group medical practices could incorporate more nonphysician staff without sacrificing productivity and thus profitability. However, the new staffing patterns that evolve may be affected by characteristics of the practice location or the types of patients served.
CHWS Journal Article community health centers confidence intervals medicaid patients medical practice nurses nursing patient care physicians primary care uninsured |
| Skillman SM, Hager LJ, Frogner BK |
Incentives for Nurse Practitioners and Registered Nurses to Work in Rural and Safety Net Settings |
Seattle, WA: UW Center for Health Workforce Research Studies |
01-01-2015 |
Rapid Turnaround Brief |
N/A |
|
| Skillman SM, Palazzo L, Hart LG, Keepnews D |
The characteristics of registered nurses whose licenses expire: why they leave nursing and implications for retention and re-entry |
Nurs Econ |
05-01-2010 |
URL |
RNs with Expired Licenses in Washington |
Little is known about RNs who drop their licenses and their potential re-entry into the nursing workforce. The results of this study provide insight into reasons nurses leave their careers and the barriers to re-entry, all important indicators of the current professional climate for nursing. While representing only one state, these findings suggest that RNs who allow their licenses to expire do so because they have reached retirement age or, among those who do not cite age as a factor, because many are unable or unwilling to work in the field. Inactive nurses who might otherwise appear to be likely candidates for re-entry into the profession may not be easily encouraged to practice nursing again without significant changes in their personal circumstances or the health care work environment. Effective ways to address current and pending RN workforce shortages include expanding RN education capacity to produce more RNs who can contribute to the workforce across the coming decades, and promote work environments in which RNs want to, and are able to, practice across a long nursing career.
CHWS Journal Article Washington education license RN workforce |
| Skillman SM, Stover B |
Idaho's physician workforce in 2014 |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
09-01-2014 |
Full Report |
Idaho’s Physician Workforce |
|
| Skillman SM, Stover B |
Alaska’s physician workforce in 2014 |
Seattle, WA:WWAMI Center for Health Workforce Studies, University of Washington |
12-29-2015 |
Full Report |
Alaska’s Physician Workforce |
|
| Frogner BK, Westerman B, DiPietro L |
The value of athletic trainers in ambulatory settings |
Journal of Allied Health |
01-01-2015 |
|
Value of Athletic Trainers in Ambulatory Care Settings |
|
| Westerman B, Frogner BK, DiPietro L |
Hiring patterns of athletic trainers in ambulatory settings |
International Journal of Athletic Therapy and Training |
01-01-2015 |
|
Value of Athletic Trainers in Ambulatory Care Settings |
|
| Frogner BK, Spetz J |
Exit and entry of workers in long-term care |
San Francisco, CA: UCSF Health Workforce Research Center on Long-Term Care |
01-01-2015 |
URL |
Entry and Exit of Workers in Long-Term Care |
|
| Skillman SM, Stover B |
Wyoming's physician workforce in 2014 |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
10-11-2014 |
Full report |
Wyoming’s Physician Workforce |
|
| Patterson DG, Skillman SM, Andrilla CHA |
Data snapshots: Wyoming health care providers, 2009 |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
10-31-2009 |
Physicians
Physician Assistants
Advanced Practice Nurses
Pharmacists
Dentists
Psychologists
Licensed Professional Counselors
Licensed Clinical Social Workers
Licensed Marriage & Family Therapists
Licensed Addiction Therapists
|
Wyoming Health Care Workforce Distribution and Policy Analyses |
|
| Patterson DG, Skillman SM, Doescher MP, Andrilla CHA |
Obstacles to providing high-quality patient care: findings from a survey of Wyoming's medical care providers |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
08-31-2009 |
Full report
Policy brief |
Wyoming Health Care Workforce Distribution and Policy Analyses |
|
| Patterson DG, Skillman SM, Andrilla CHA, Doescher MP |
Workforce challenges in delivering health care to elderly and low-income populations in Wyoming: medical providers' acceptance of Medicaid and Medicare patients |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
09-30-2009 |
Full report
Policy brief |
Wyoming Health Care Workforce Distribution and Policy Analyses |
|
| Skillman SM, Andrilla CHA, Doescher MP, Robinson BJ |
Wyoming primary care gaps and policy options |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
12-01-2008 |
Full report |
Wyoming Health Care Workforce Distribution and Policy Analyses |
|
| WWAMI Center for Health Workforce Studies, University of Washington |
Data snapshot: current osteopathic physician workforce in the WWAMI states |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
10-01-2007 |
Snapshot |
Physician Workforce in WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho): 2005 |
|
| Chen FM, Fordyce MA, Hart LG |
WWAMI Physician Workforce 2005 |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
01-01-2005 |
Full report |
Physician Workforce in WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho): 2005 |
|
| Patterson DG, Skillman SM, Hart LG |
Washington State's radiographer workforce through 2020: influential factors and available data |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
01-01-2004 |
Full report
Policy brief |
Washington State's Radiographer Workforce Through 2020: Influential Factors and Available Data |
|
| Patterson DG, Skillman SM, Hart LG |
Washington State's pharmacist workforce through 2020: influential factors and available data |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
01-01-2004 |
Full report
Policy brief |
Washington State's Pharmacist Workforce through 2020: Influential Factors and Available Data |
|
| Skillman SM, Andrilla CHA, Alves-Dunkerson JA, Mouradian WE, Comenduley M, Yi J, Doescher MP |
Washington State's oral health workforce |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
08-31-2009 |
Full report |
Assessment of the Oral Health Workforce in Washington State |
|
| Andrilla CHA, Hart LG |
Practice patterns and characteristics of dental hygienists in Washington State |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
08-01-2007 |
Full report |
Washington's Dental Hygienists: 2004 Survey Findings |
|
| Patterson DG, Skillman SM, Hart LG |
Washington State's dental hygienist workforce through 2020: influential factors and available data |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
01-01-2004 |
Full report
Policy brief |
Washington State's Dental Hygienist Workforce through 2020: Influential Factors and Available Data |
|
| Skillman SM, Andrilla CHA, Tieman L, Doescher MP |
Demographic, education, and practice characteristics of registered nurses in Washington State: results of a 2007 survey |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
06-01-2008 |
Full report
Policy brief |
Demographic, Education, and Practice Characteristics of Registered Nurses in Washington State: Results of a 2007 Survey |
|
| Skillman SM, Andrilla CHA, Tieman L, McCook AU |
Washington State registered nurse supply and demand projections: 2011-2031 |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
12-31-2011 |
Full report
Policy brief |
Projections of Washington State RN Supply and Demand through 2031 |
|
| Skillman SM, Andrilla CHA, Hart LG |
Washington State registered nurse supply and demand projections: 2006-2025 |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
06-01-2007 |
Full report
Policy brief |
Projections of Washington State RN Supply and Demand through 2025 |
|
| Skillman SM, Andrilla CHA, Ostergard SJ |
Washington State registered nurses - analysis of RNs who did not renew their licenses: 2008-2014 |
Seattle, WA:WWAMI Center for Health Workforce Studies, University of Washington |
09-30-2014 |
Full report |
Washington State Registered Nurses – Analysis of RNs who did not renew their licenses: 2008-2014 |
|
| Skillman SM, Stover B |
Washington State's physician workforce in 2014 |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
08-14-2014 |
Full report |
Washington State’s Physician Workforce |
|
| Dresden GM, Baldwin LM, Andrilla CHA, Skillman SM, Benedetti TJ |
Influence of obstetric practice on workload and practice patterns of family physicians and obstetrician-gynecologists |
Ann Fam Med |
01-01-2008 |
URL |
Professional Liability Issues and Practice Patterns of Obstetrical Providers in Washington State |
PURPOSE:
Obstetric practice among family physicians has declined in recent years. This study compared the practice patterns of familyphysicians and obstetrician-gynecologists with and without obstetric practices to provide objective information on one potential reason for this decline–the impact of obstetrics on physician lifestyle.
METHODS:
In 2004, we surveyed all obstetrician-gynecologists, all rural family physicians, and a random sample of urban family physiciansidentified from professional association lists (N =2,564) about demographics, practice characteristics, and obstetric practices.
RESULTS:
A total of 1,197 physicians (46.7%) overall responded to the survey (41.5% of urban family physicians, 54.7% of rural familyphysicians, and 55.0% of obstetrician-gynecologists). After exclusions, 991 were included in the final data set. Twenty-seven percent of urban family physicians, 46% of rural family physicians, and 79% of obstetrician-gynecologists practiced obstetrics. The mean number of total professional hours worked per week was greater with obstetric practice than without for rural family physicians (55.4 vs 50.2, P=.005) and for obstetrician-gynecologists (58.3 vs 43.5, P = .000), but not for urban family physicians (47.8 vs 49.5, P = .27). For all 3 groups, physicianspracticing obstetrics were more likely to provide inpatient care and take call than physicians not practicing obstetrics. Large proportions of family physicians, but not obstetrician-gynecologists, took their own call for obstetrics. Concerns about the litigation environment and personal issues were the most frequent reasons for stopping obstetric practice.
CONCLUSIONS:
Practicing obstetrics is associated with an increased workload for family physicians. Organizing practices to decrease the impact on lifestyle may support family physicians in practicing obstetrics.
CHWS Complete Journal Article Nursing Physicians Washington Family medicine lifestyle obstetrics practice patterns rural health care workload |
| Benedetti TJ, Baldwin LM, Skillman SM, Andrilla CHA, Bowditch E, Carr KC, Myers SJ |
Professional liability issues and practice patterns of obstetrical providers in Washington State |
Obstet Gynecol |
06-01-2006 |
URL |
Professional Liability Issues and Practice Patterns of Obstetrical Providers in Washington State |
OBJECTIVE:
To describe recent changes in obstetric practice patterns and liability insurance premium costs and their consequences to Washington State obstetric providers (obstetrician-gynecologists, family physicians, certified nurse midwives, licensed midwives).
METHODS:
All obstetrician-gynecologists, rural family physicians, certified nurse midwives, licensed midwives, and a simple random sample of urban family physicians were surveyed about demographic and practice characteristics, liability insurance characteristics, practice changes and limitations due to liability insurance issues, obstetric practices, and obstetric practice environment changes.
RESULTS:
Fewer family physicians provide obstetric services than obstetrician-gynecologists, certified nurse midwives, and licensed midwives. Mean liability insurance premiums for obstetric providers increased by 61% for obstetrician-gynecologists, 75% for family physicians, 84% for certified nurse midwives, and 34% for licensed midwives from 2002 to 2004. Providers‘ most common monetary responses to liability insurance issues were to reduce compensation and to raise cash through loans and liquidating assets. In the 2 years of markedly increased premiums, obstetrician-gynecologists reported increasing their cesarean rates, their obstetric consultation rates, and the number of deliveries. They reported decreasing high-risk obstetric procedures during that same period.
CONCLUSION:
Liability insurance premiums rose dramatically from 2002 to 2004 for Washington‘s obstetric providers, leading many to make difficult financial decisions. Many obstetric providers reported a variety of practice changes during that interval. Although this study’s results do not document an impending exodus of providers from obstetric practice, rural areas are most vulnerable because family physicians provide the majority of rural obstetric care and are less likely to practice obstetrics.
LEVEL OF EVIDENCE:
III.
CHWS Complete Journal Article Nursing Physicians Washington certified nurse midwives family physicians gynecologists liability premiums licensed midwives maternity care midwifery obstetrician–gynecologists obstetricians practice patterns Professional liability registered nurses |
| Benedetti TJ, Baldwin LM, Andrilla CHA, Hart LG |
The productivity of Washington State's obstetrician-gynecologist workforce: does gender make a difference? |
Obstet Gynecol |
01-01-2004 |
URL |
Obstetrics and Gynecology Specialty Services: Supply, Distribution, and the Effect of Changing Demography in Washington State |
OBJECTIVE:
To compare the practice productivity of female and male obstetrician-gynecologists in Washington State.
METHODS:
The primary data collection tool was a practice survey that accompanied each licensed practitioner’s license renewal in 1998-1999. Washington State birth certificate data were linked with the licensure data to obtain objective information regarding obstetric births.
RESULTS:
Of the 541 obstetrician-gynecologists identified, two thirds were men and one third were women. Women were significantly younger than men (mean age 43.3 years versus 51.7 years). Ten practice variables were evaluated: total weeks worked per year, total professional hours per week, direct patient care hours per week, nondirect patient care hours per week, outpatient visits per week, inpatient visits per week, percent practicing obstetrics, number of obstetrical deliveries per year, percentage working less than 32 hours per week, and percentage working 60 or more hours per week. Of these, only 2 variables showed significant differences: inpatient visits per week (women 10.1 per week, men 12.8 per week, P < or =.01) and working 60 or more hours per week (women 22.1% versus men 31.5%, P < or =.05). After controlling for age, analysis of covariance and multiple logistic regression confirmed these findings and in addition showed that women worked 4.1 fewer hours per week than men (P <.01). When examining the ratio of female-to-male practice productivity in 10-year age increments from the 30-39 through the 50-59 age groups, a pattern emerged suggesting lower productivity in many variables in the women in the 40-49 age group.
CONCLUSION:
Only small differences in practice productivity between men and women were demonstrated in a survey of nearly all obstetrician-gynecologists in Washington State. Changing demographics and behaviors of the obstetrician-gynecologist workforce will require ongoing longitudinal studies to confirm these findings and determine whether they are generalizable to the rest of the United States.
LEVEL OF EVIDENCE:
II-3
CHWS Complete Journal Article Physicians Washington obstetrician–gynecologists practice productivity |
| Benedetti TJ, Baldwin LM, Andrilla CHA, Hart LG |
The productivity of Washington State's obstetrician-gynecologist workforce: does gender make a difference? |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
10-01-2003 |
Full report |
Obstetrics and Gynecology Specialty Services: Supply, Distribution, and the Effect of Changing Demography in Washington State |
|
| Andrilla CHA, Skillman SM, Tieman L |
Demographic, education, and practice characteristics of licensed practical nurses in Washington State: results of a 2007 survey |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
01-01-2009 |
Full report
Policy brief |
Demographic, Education, and Practice Characteristics of Licensed Practical Nurses in Washington State: Results of a 2007 Survey |
|
| Skillman SM, Andrilla CHA, Patterson DG, Tieman L, Doescher MP |
The licensed practical nurse workforce in the United States: one state's experience |
Cah Sociol Demogr Med |
06-01-2010 |
URL |
Projections of Washington State LPN Supply and Demand through 2025 |
BACKGROUND:
Licensed practical nurses (LPNs) are employed in multiple health care settings in the United States, with the largest portion providing nursing care in long-term care, skilled nursing, and nursing home facilities, which largely provide custodial care and rehabilitative services to elderly residents. Rapid growth in the size of the elderly population in the U.S., combined with retirements from an aging LPN workforce, are expected to increase the demand for LPNs in the coming decades. This paper describes the characteristics of LPNs in one state, Washington, and makes projections of LPN supply and demand in the state through 2026.
METHODS:
The study uses data from a 2007 survey of LPNs with Washington State licenses to describe the demographic, education, and practice characteristics of the workforce. The projections of LPN supply and demand were built from the baseline survey data and changes over time were estimated using available data and literature from a variety of sources.
RESULTS:
Of the 14,446 LPNs with Washington licenses in 2007, 72% practiced in the state. The work setting in which the largest percentage worked was long-term care (37%). Of the average 37 hours worked per week by LPNs, 25 hours were spent in direct patient care. The average age of practicing LPNs was 46 and 12% of LPNs were male. The racial/ethnic distribution of Washington’s LPNs resembled that of the overall state population, with 17% non-White and 4% Hispanic. Nearly three quarters obtained their LPN education within Washington. If the 2007 number of completions from LPN schools in Washington is sustained, the projected supply of practicing LPNs in 2026 will be more than 3,500 (24%) below estimated demand. If the current education completion number increased by 200 LPNs (nearly 20%) in 2011, and this number was maintained through 2026, the projected supply of practicing LPNs would increase but would still be 2,052 LPNs below estimated demand in 2026. Neither projection scenario produces enough LPNs to maintain the 2007 LPN-to-population ratio through 2026. CONCLUSIONS/POLICY IMPLICATIONS: It is not known precisely whether or how LPN workforce roles will change in the future, but the projected LPN shortages in Washington State mirror similar findings from other parts of the U.S., with major growth in projected LPN demand due to increases in, and aging of the state’s population. The number of LPNs completing education programs in the state is unlikely to keep pace with the decline in supply from retirements unless a significant expansion of education programs takes place. The LPN profession is an important entry point into the nursing profession, and increasing the number of LPNs educated in-state could expand the pipeline leading to registered nurse (RN) careers, another nursing profession for which major shortages are predicted. Carefully articulated LPN-to-RN education programs could improve the attractiveness of the profession and increase the supply of LPNs.
CHWS Complete Journal Article Nursing Washington licensed practical nurses LPN workforce |
| Skillman SM, Andrilla CHA, Patterson DG, Thomas A, Tieman L |
Washington State licensed practical nurse supply and demand projections: 2007-2026 |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
08-27-2009 |
Full report
Policy brief. |
Projections of Washington State LPN Supply and Demand through 2025 |
|
| Skillman SM, Hutson T, Andrilla CHA, Berkowitz B, Hart LG |
How are Washington's hospitals affected by the nursing shortage? Results of a 2001 survey |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
05-01-2002 |
Washington's Hospital Staffing Surveys – 2001, 2002, 2003-4, 2005 |
|
| Skillman SM, Andrilla CHA, Phippen E, Hutson T, Bowditch E, Praseuth T |
Washington State hospitals: results of 2005 workforce survey |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
10-01-2005 |
Full report
Policy brief |
Washington's Hospital Staffing Surveys – 2001, 2002, 2003-4, 2005 |
|
| Skillman SM, Andrilla CHA, Hutson T, Deacon H, Praseuth T |
Washington State hospitals: results of 2003/04 workforce survey |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
10-01-2004 |
Full report
Policy brief |
Washington's Hospital Staffing Surveys – 2001, 2002, 2003-4, 2005 |
|
| Skillman SM, Hutson T, Andrilla CHA |
Washington State hospitals: results of 2002 workforce survey |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
08-01-2003 |
Full report
Policy brief |
Washington's Hospital Staffing Surveys – 2001, 2002, 2003-4, 2005 |
|
| Skillman SM, Andrilla CHA, Kaplan L, Brown MA |
Demographic, education, and practice characteristics of advanced registered nurse practitioners in Washington State: results of a 2008 survey |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
04-01-2009 |
Full report
Policy brief |
Demographic, Education, and Practice Characteristics of Advanced Registered Nurse Practitioners in Washington State: Results of a 2008 Survey |
|
| Skillman SM, Sadow-Hasenberg J, Hart LG, Henderson T |
The effects of the Workforce Investment Act of 1998 on health workforce development in the states |
Washington, DC: Bureau of Health Professions, Health Resources and Services Administration, National Center for Health Workforce Analysis |
11-01-2004 |
Full report |
The Workforce Investment Act of 1998: Are States Targeting the Health Workforce? |
|
| Rosenblatt RA, Rosenblatt FS |
The role and function of small isolated public health departments: a case study in three western states |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
06-01-2001 |
Policy brief |
Rural-Urban Differences in the Public Health Workforce: Findings from Local Health Departments in Three Rural Western States (Alaska, Montana and Wyoming) |
|
| Rosenblatt RA, Rosenblatt FS |
The role and function of small isolated public health departments: a case study in three western states |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
06-01-2001 |
Policy brief |
Rural-Urban Differences in the Public Health Workforce: Findings from Local Health Departments in Three Rural Western States (Alaska, Montana and Wyoming) |
|
| Richardson M, Casey S, Rosenblatt RA |
Local health districts and the public health workforce: a case study of Wyoming and Idaho |
J Public Health Manag Pract |
01-01-2001 |
URL
Policy brief |
Rural-Urban Differences in the Public Health Workforce: Findings from Local Health Departments in Three Rural Western States (Alaska, Montana and Wyoming) |
This study of personnel in local health departments (LHDs) focused on two predominantly rural states: Idaho and Wyoming. Although in the same region of the country, the structure of local public health is different in each state. Idaho’s regionalized LHDs are relatively autonomous, whereas Wyoming’s are county based, with many public health functions retained at the state level. The majority of professionals are nurses followed by environmental health workers and sanitarians, similar to data reported nationally. With increased emphasis on core public health functions of policy, assurance, and assessment, rural LHDs will be challenged to redirect the functions of their workforce.
CHWS Complete Idaho Journal Article Nursing Other/Multiple Wyoming health workers local health districts (LHD) nurses sanitarians workforce |
| Rosenblatt RA, Casey S, Richardson M |
Rural-urban differences in the public health workforce: findings from local health departments in three rural western states |
Am J Public Health |
01-01-2002 |
URL
Policy brief |
Rural-Urban Differences in the Public Health Workforce: Findings from Local Health Departments in Three Rural Western States (Alaska, Montana and Wyoming) |
Most local health departments or districts are small and rural; two thirds of the nation’s 2832 local health departments serve populations smaller than 50000 people.1 Rural local health departments have small staffs and slender budgets, yet they are expected to provide a wide array of services2 during a period when the health care system of which they are a part is undergoing change.3
This study provided quantitative, population based data on the supply and composition of the rural public health workforce in 3 extremely rural states: Alaska, Montana, and Wyoming. The study focused on the relative supply of personnel in the principal public health occupational categories, differences across states in staffing levels, and difficulties experienced in recruiting and retaining personnel.
Alaska CHWS Complete Journal Article Montana Nursing Other/Multiple Wyoming local health departments public health professionals rural vs urban workforce |
| Skillman SM, Fordyce MA, Yen W, Mounts T |
Washington State primary care provider survey, 2011-2012: summary of findings |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
08-31-2012 |
Full report
Policy Brief |
Washington State Survey of Primary Care Physicians, Nurse Practitioners, and Physician Assistants–Technical Assistance |
|
| Patterson DG, Baldwin LM, Olsen P |
Supports and obstacles in the medical school application process for American Indians and Alaska Natives |
J Health Care Poor Underserved |
05-01-2009 |
URL |
An Analysis of Factors that Affect the Acceptance of American Indians and Alaska Natives (AI/ANs) into Medical School Training Programs |
Purpose. This study examines how a wide range of supports and obstacles are associated with the medical school admissions process of American Indians and Alaska Natives (AI/ANs), an under-studied population.
Method. All AI/AN applicants to the University of Washington School of Medicine during the 2002–2004 admissions cycles were sent a mail-in survey with numerical and open-ended items. We analyzed admissions data for all 107 applicants and data on supports and obstacles for 34 survey respondents.
Results. Compared with respondents accepted by at least one medical school, rejected respondents were older, more often were parents, submitted fewer applications, and reported receiving less support for the medical school application process. Obstacles included difficulty with the Medical College Admission Test, insufficient finances, and poor information about the process.
Conclusion. A conceptual framework that considers both supports and obstacles in the medical school application process will improve our understanding of the needs of AI/AN applicants.
CHWS Complete Journal Article National Physicians Washington Alaska Natives American Indians career choice education Indians medical North American students |
| Andrilla CHA, Skillman SM, Morrison CC, Reeves MA |
Washington State data snapshot: registered nurses (RNs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
04-01-2014 |
Snapshot |
2018 Registered Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| Skillman SM, Andrilla CHA |
Washington State data snapshot: registered nurses (RNs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
04-30-2013 |
Snapshot |
2018 Registered Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| Skillman SM, Andrilla CHA |
Washington State data snapshot: registered nurses (RNs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
03-01-2011 |
Snapshot |
2018 Registered Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| WWAMI Center for Health Workforce Studies and Washington Center for Nursing |
Washington State data snapshot: registered nurses (RNs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
09-01-2008 |
Snapshot |
2018 Registered Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| WWAMI Center for Health Workforce Studies and Washington Center for Nursing |
Washington State data snapshot: registered nurses (RNs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
10-01-2007 |
Snapshot |
2018 Registered Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| WWAMI Center for Health Workforce Studies and Washington Center for Nursing |
Washington State data snapshot: registered nurses (RNs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
10-01-2007 |
Snapshot |
2018 Registered Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| WWAMI Center for Health Workforce Studies and Washington Center for Nursing |
Washington State data snapshot: registered nurses (RNs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
08-01-2006 |
Snapshot |
2018 Registered Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| WWAMI Center for Health Workforce Studies, University of Washington |
Data snapshot: registered nurses (RNs) in Washington: demographics and employment characteristics |
Seattle, WA : WWAMI Center for Health Workforce Studies, University of Washington |
12-01-2001 |
Snapshot |
2018 Registered Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| WWAMI Center for Health Workforce Studies, University of Washington |
Data snapshot: pharmacists in Washington: demographics and employment characteristics |
Seattle, WA : WWAMI Center for Health Workforce Studies, University of Washington |
12-01-2001 |
Snapshot |
Pharmacists in Washington: Snapshot of Demographics and Employment Characteristics in 1999 |
|
| Andrilla CHA, Skillman SM, Morrison CC, Reeves MA |
Washington State data snapshot: licensed practical nurses (LPNs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
04-01-2014 |
Snapshot |
2018 Licensed Practical Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| Skillman SM, Andrilla CHA |
Washington State data snapshot: licensed practical nurses (LPNs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
04-30-2013 |
Snapshot |
2018 Licensed Practical Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| Skillman SM, Andrilla CHA |
Washington State data snapshot: licensed practical nurses (LPNs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
03-01-2011 |
Snapshot |
2018 Licensed Practical Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| WWAMI Center for Health Workforce Studies and Washington Center for Nursing |
Washington State data snapshot: licensed practical nurses (LPNs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
09-01-2008 |
Snapshot. |
2018 Licensed Practical Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| WWAMI Center for Health Workforce Studies and Washington Center for Nursing |
Washington State data snapshot: licensed practical nurses (LPNs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
10-31-2007 |
Snapshot |
2018 Licensed Practical Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| WWAMI Center for Health Workforce Studies and Washington Center for Nursing |
Washington State data snapshot: licensed practical nurses (LPNs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
09-01-2006 |
Snapshot |
2018 Licensed Practical Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| WWAMI Center for Health Workforce Studies, University of Washington |
Data snapshot: licensed practical nurses (LPNs) in Washington: demographics and employment characteristics |
Seattle, WA : WWAMI Center for Health Workforce Studies, University of Washington |
12-01-2001 |
Snapshot |
2018 Licensed Practical Nurses in Washington: Snapshot of Demographics and Employment Characteristics |
|
| Andrilla CHA, Skillman SM, Morrison CC, Reeves MA |
Washington State data snapshot: advanced registered nurse practitioners (ARNPs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
04-01-2014 |
Snapshot |
2018 Washington State Data Snapshot: Advanced Registered Nurse Practitioners |
|
| Skillman SM, Andrilla CHA |
Washington State data snapshot: advanced registered nurse practitioners (ARNPs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
04-30-2013 |
Snapshot |
2018 Washington State Data Snapshot: Advanced Registered Nurse Practitioners |
|
| Skillman SM, Andrilla CHA |
Washington State data snapshot: advanced registered nurse practitioners (ARNPs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
03-01-2011 |
Snapshot |
2018 Washington State Data Snapshot: Advanced Registered Nurse Practitioners |
|
| WWAMI Center for Health Workforce Studies and Washington Center for Nursing |
Washington State data snapshot: advanced registered nurse practitioners (ARNPs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
09-01-2008 |
Snapshot |
2018 Washington State Data Snapshot: Advanced Registered Nurse Practitioners |
|
| WWAMI Center for Health Workforce Studies and Washington Center for Nursing |
Washington State data snapshot: advanced registered nurse practitioners (ARNPs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
10-01-2007 |
Snapshot |
2018 Washington State Data Snapshot: Advanced Registered Nurse Practitioners |
|
| WWAMI Center for Health Workforce Studies and Washington Center for Nursing |
Washington State data snapshot: advanced registered nurse practitioners (ARNPs) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
08-01-2006 |
Snapshot |
2018 Washington State Data Snapshot: Advanced Registered Nurse Practitioners |
|
| Skillman SM, Palazzo L, Keepnews D, Hart LG |
Characteristics of registered nurses in rural vs. urban areas: implications for strategies to alleviate nursing shortages in the United States |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
01-01-2004 |
Full report
Policy brief |
Characteristics of Rural RNs in the U.S.: Analysis of the 2000 National Sample Survey of RNs |
|
| Skillman SM, Palazzo L, Keepnews D, Hart LG |
Characteristics of registered nurses in rural vs. urban areas: implications for strategies to alleviate nursing shortages in the United States. |
J Rural Health |
01-01-2006 |
URL |
Characteristics of Rural RNs in the U.S.: Analysis of the 2000 National Sample Survey of RNs |
Methods: This study compares characteristics of rural and urban registered nurses (RNs) in the United States using data from the 2000 National Sample Survey of Registered Nurses. RNs in 3 types of rural areas are examined using the rural-urban commuting area taxonomy. Findings: Rural and urban RNs are similar in age and sex; nonwhites and Hispanics are underrepresented in both groups. Rural RNs have less nursing education, are less likely to work in hospitals, and are more likely to work full time and in public/community health than urban RNs. The more rural an RN’s residence, the more likely he/she commutes to another area for work and the lower salary he/she receives.Conclusions: Strategies to reduce nurse shortages should consider differences in education, work patterns, and commuting behavior among rural and urban RNs. Solutions for rural areas require understanding of the impact of the workplace on these behaviors.
CHWS Complete Journal Article National Nursing commuting behavior education registered nurses RN rural vs urban shortages work patterns |
| Skillman SM, Hart LG, Bowditch E, Kirlin BA |
Retail pharmacies in Washington State: results of 2003 workforce survey |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
12-01-2004 |
Full report
Policy brief |
Retail Pharmacies in Washington: Results of a 2003 Workforce Demand Survey |
|
| Hollow WB, Patterson DG, Olsen P, Baldwin LM |
American Indians and Alaska Natives: how do they find their path to medical school? |
Acad Med |
10-01-2006 |
URL |
Factors that Promote the Recruitment of American Indians and Alaska Natives into (AI/ANs) Medicine |
BACKGROUND:
American Indians and Alaska Natives (AI/ANs) remain underrepresented in the medical profession. This study sought to understand the supports and barriers that AI/AN students encountered on their path to successful medical school entry.
METHOD:
The research team analyzed qualitative semistructured, one-on-one, confidential interviews with 10 AI/AN medical students to identify salient support and barrier themes.
RESULTS:
Supports and barriers clustered in eight categories: educational experiences, competing career options and priorities, health care experiences, financial factors, cultural connections, family and friends, spirituality, and discrimination. Some of the most notable findings of this study include the following: (1) students reported financial barriers severe enough to constrain participation in the medical schoolapplication process, and (2) spirituality played an important role as students pursued a medical career.
CONCLUSION:
Promoting AI/AN participation in medical careers can be facilitated with strategies appropriate to the academic, financial, and cultural needs of AI/AN students.
CHWS Complete Journal Article National Physicians Washington Alska Native American Indian cultural cultural needs financial medical profession medical students spirituality |
| Hollow WB, Buckley A, Patterson DG, Olsen P, Dorscher J, Medora R, Morin L, Padilla RS, Tahsequah J, Baldwin LM |
Clearing the path to medical school for American Indians and Alaska Natives: new strategies |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
01-01-2006 |
Full report
Policy brief |
Factors that Promote the Recruitment of American Indians and Alaska Natives into (AI/ANs) Medicine |
|
| Hollow WB, Patterson DG, Olsen P, Baldwin LM |
American Indians and Alaska Natives: how do they find their path to medical school? |
Seattle, WA:WWAMI Center for Health Workforce Studies, University of Washington |
01-01-2004 |
|
Factors that Promote the Recruitment of American Indians and Alaska Natives into (AI/ANs) Medicine |
|
| Larson E, Hart LG |
Growth and change in the physician assistant workforce in the United States, 1967-2000 |
J Allied Health |
09-01-2007 |
URL |
Historical Trends in Physician Assistant Education and their Contribution to Primary Health Care for Rural and Underserved Populations in the U.S. |
The physician assistant (PA) profession grew rapidly in the 1970s and 1990s. As acceptance of PAs in the health care system increased, roles for PAs in specialty care took shape and the scope of PA practice became more clearly defined. This report describes key elements of change in the demography and distribution of the PA population between 1967 and 2000, as well as the spread of PA training programs. Individual-level data from the American Academy of Physician Assistants, supplemented with county-level aggregate data from the Area Resource File, were used to describe the emergence of the PA profession between 1967 and 2000. Data on 49,641 PAs who had completed training by 2000 were analyzed. More than half (52.4%) of PAs active in 2000 were women. PA participation in the rural workforce remains high, with more than 18% of PAs practicing in rural settings, compared with about 20% in 1980. Primary care participation appears to have stabilized at about 47% among active PAs for whom specialty is known. By 2000, 51.5% of practicing PAs had been trained in the stateswhere they worked. The profession has grown rapidly; 56% of all PAs were trained between 1991 and 2000. In 2000, more than 42% of accredited PA programs offered a master’s degree, compared to master’s degree programs in 1986. Although many critical issues of scope of practice and patient and physician acceptance of PAs have been resolved, the PA profession remains young and continues to evolve. Whether the historical contribution of PAs to primary care for rural and underserved populations can be sustained in the face of increasing specialization and higher-level academic credentialing is not clear.
Allied Health CHWS Complete Journal Article National PA training programs physician assistant primary care rural workforce underserved populatioon |
| Larson E, Hart LG |
Geographic and demographic dimensions of the adoption of a health workforce innovation: physician assistants in the U.S., 1967-2000 |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
02-01-2006 |
Full report
Policy brief |
Historical Trends in Physician Assistant Education and their Contribution to Primary Health Care for Rural and Underserved Populations in the U.S. |
|
| Palazzo L, Hart LG, Skillman SM |
The impact of the changing scope of practice of physician assistants, nurse practitioners, and certified nurse-midwives on the supply of practitioners and access to care: Oregon case study |
Seattle, WA:WWAMI Center for Health Workforce Studies, University of Washington |
01-01-2002 |
Full report |
The Impact of the Changing Scope of Practice of Physician Assistants, Nurse Practitioners, and Certified Nurse-Midwives on the Supply of Practitioners and Access to Care: Oregon Case Study |
|
| Larson E, Palazzo L, Berkowitz B, Pirani MJ, Hart LG |
The contribution of nurse practitioners and physician assistants to generalist care in underserved areas of Washington State |
Health Serv Res |
01-01-2003 |
URL |
The Contribution of Generalist Nurse Practitioners and Physician Assistants to Primary Care in Rural Washington State |
OBJECTIVE:
To quantify the total contribution to generalist care made by nurse practitioners (NPs) and physician assistants (PAs) in Washington State.
DATA SOURCES:
State professional licensure renewal survey data from 1998-1999.
STUDY DESIGN:
Cross-sectional. Data on medical specialty, place of practice, and outpatient visits performed were used to estimate productivity of generalist physicians, NPs, and PAs. Provider head counts were adjusted for missing specialty and productivity data and converted into family physician full-time equivalents (FTEs) to facilitate estimation of total contribution to generalist care made by each provider type.
PRINCIPAL FINDINGS:
Nurse practitioners and physician assistants make up 23.4 percent of the generalist provider population and provide 21.0 percent of the generalist outpatient visits in Washington State. The NP/PA contribution to generalist care is higher in rural areas (24.7 percent of total visits compared to 20.1 percent in urban areas). The PAs and NPs provide 50.3 percent of generalist visits provided by women in rural areas, 36.5 percent in urban areas. When productivity data were converted into family physician FTEs, the productivity adjustments were large. A total of 4,189 generalist physicians produced only 2,760 family physician FTEs (1 FTE = 105 outpatient visits per week). The NP and PA productivity adjustments were also quite large.
CONCLUSIONS:
Accurate estimates of available generalist care must take into account the contributions of NPs and PAs. Additionally, simple head counts of licensed providers are likely to result in substantial overestimates of available care. Actual productivity data or empirically derived adjustment factors must be used for accurate estimation of provider shortages.
Access to Care Allied Health CHWS Complete Journal Article Nursing Physicians RHRC Washington generalist care nurse practitioners physician assistants provider shortage |
| Larson E, Palazzo L, Berkowitz B, Pirani MJ, Hart LG |
The contribution of nurse practitioners and physician assistants to generalist care in underserved areas of Washington State |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
06-01-2001 |
Full report
Policy brief |
The Contribution of Generalist Nurse Practitioners and Physician Assistants to Primary Care in Rural Washington State |
|
| Grumbach K, Hart LG, Mertz E, Coffman J, Palazzo L |
Who is caring for the underserved? A comparison of primary care physicians and nonphysician clinicians |
Ann Fam Med |
01-01-2003 |
URL |
The Contribution of Generalist Nurse Practitioners and Physician Assistants to Primary Care in Rural Washington State |
PURPOSE: Little is known about whether different types of physician and nonphysician primary care clinicians vary in their propensity to care for underserved populations. The objective of this study was to compare the geographic distribution and patient populations of physician and nonphysician primary care clinicians.
METHODS: This study was a cross-sectional analysis of 1998 administrative and survey data on primary care clinicians (family physicians, general internists, general pediatricians, nurse practitioners, physician assistants, and certified nurse-midwives) in California and Washington. For geographic analysis, main outcome measures were practice in a rural area, a vulnerable population area (communities with high proportions of minorities or low-income residents), or a health professions shortage area (HPSA). For patient population analysis, outcomes were the proportions of Medicaid, uninsured, and minority patients in the practice.
RESULTS: Physician assistants ranked first or second in each state in the proportion of their members practicing in rural areas and HPSAs, and in California physician assistants also had the greatest proportion of their members working in vulnerable populations areas (P < .001). Compared with primary care physicians overall, nurse practitioners and certified nurse-midwives also tended to have a greater proportion of their members in rural areas and HPSAs (P < .001). Family physicians were much more likely than other primary care physicians to work in rural areas and HPSAs (P < .001). Compared with physicians, nonphysician clinicians in California had a substantially greater proportion of Medicaid, uninsured, and minority patients (P < .001).
CONCLUSIONS: Nonphysician primary care clinicians and family physicians have a greater propensity to care for underserved populations than do primary care physicians in other specialties. Achieving a more equitable pattern of service to needy populations will require ongoing, active commitment by policy makers, educational institutions, and the professions to a mission of public service and to incentives that support and promote care to the underserved.
Access to Care Allied Health CHWS Complete Journal Article Nursing Physicians RHRC Washington family physicians Health Personnel Medically Underserved Areas nurse practitioners physician assistants Primary Health Care/manpower |
| Larson E, Hart LG, Ballweg R |
National estimates of physician assistant productivity |
J Allied Health |
01-01-2001 |
URL
Policy brief |
The Contribution of Generalist Nurse Practitioners and Physician Assistants to Primary Care in Rural Washington State |
Analysis of productivity data from a nationally representative sample of physician assistants (PAs) showed that PAs performed 61.4 outpatient visits per week compared with 74.2 visits performed by physicians, for an overall physician full-time equivalent (FTE) estimate of 0.83. However, productivity of PAs varies strongly across practice specialty and location, with generalist PAs performing more visits than their specialist counterparts. Rural PA productivity is higher than urban productivity because of the concentration of generalist PAs in rural settings. A generalist PA physician FTE estimate of 0.75 appears to be more accurate than the 0.5 currently under consideration in proposed modifications to Health Personnel Shortage Area designation regulations.
Access to Care Allied Health CHWS Complete Journal Article Nursing Physicians RHRC Washington generalist health personnel shortage area (HPSA) HPSA non-physician clinician (NPC) physician assistants (PAs) specialist |
| Thompson M, Skillman SM, Schneeweiss R, Hart LG, Johnson K |
The University of Washington Pacific Islands Continuing Education Program (PICCEP): Guam conference on structure and content of continuing clinical education programs in the U.S.-associated jurisdictions |
Pac Health Dialog |
03-01-2002 |
URL |
Pacific Islands Continuing Clinical Education Program (PICCEP) |
On July 20 and 21, 2000 a meeting was convened of individuals from the U.S.-associated jurisdictions of the Pacific region who play key roles related to clinical training institutions, provider professional organizations, and representatives of physicians and health policy leadership. The meeting, held in Guam was organized by the Pacific Islands Continuing Medical Education Program (PICCEP) based at the Center for Health Workforce Studies at the University of Washington in Seattle and funded by the Health Resources and Services Administration’s (HRSA’s) Bureau of Health Professions and Bureau of Primary Health Care. The overall goal of the meeting was to explore ways of developing a sustainable program of continuing clinical education (CCE) for physicians and other health professionals in the Pacific region. Specific objectives of the meeting included a review of previous CCE efforts in the region, assessment of current CCE needs, and discussion of PICCEP’s proposed CCE program. The meeting was also designed to foster further collaborative relationships among the various clinical education programs active in the region.
CHWS Complete International Journal Article Other/Multiple Physicians continuing clinical education (CCE) health professionals physicians Piccep training |
| Johnson K, Skillman SM, Ellsbury K, Thompson M, Hart LG |
Updating hospital reference resources in the U.S.-associated Pacific basin: efforts of the Pacific Islands Continuing Clinical Education Program (PICCEP) |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
09-01-2003 |
|
Pacific Islands Continuing Clinical Education Program (PICCEP) |
|
| Thompson M, Schneeweiss R, Johnson K, Skillman SM, Ellsbury K, Hart LG |
Assessing physician's continuing medical education (CME) needs in the U.S.-associated Pacific Basin jurisdictions |
Pac Health Dialog |
01-01-2002 |
URL |
Pacific Islands Continuing Clinical Education Program (PICCEP) |
OBJECTIVE:
To assess the self-perceived continuing medical education (CME) needs of physicians in American Samoa, Commonwealth of the Northern Mariana Islands, Guam, Federated States of Micronesia, Republic of the Marshall Islands, and the Republic of Palau.
METHODS:
Questionnaire-based survey of all physicians.
RESULTS:
Responses obtained from a total of 143 physicians in the region provided information on training backgrounds, previous experiences with CME, local access to regular CME sessions, perceived priority educational needs and preferred methods of CME delivery.
CONCLUSIONS:
Overall 64% of respondents had attended a formal CME event in 1999 or 2000, and 71% had access to local weekly or biweekly CME. However the perceived usefulness of these events varied by region. Priority learning needs were identified by physicians including non-communicable diseases such as diabetes, hypertension, cardiac disease; communicable diseases such as tuberculosis, HIV/AIDS and tropical diseases; as well as skills such as EKG and X-ray interpretation, trauma management and cardiac life support. Information on the most pressing educational needs and desired methods of delivery will be crucial in planning CME in this region.
CHWS Complete International Journal Article Other/Multiple Physicians communicable diseases continuing medical education diabetes mellitus electrocardiography heart diseases hypertensive disease jurisdiction life support tuberculosis |
| Thompson M, Schneeweiss R, Johnson K, Skillman SM, Ellsbury K, Hart LG |
Assessing physician's continuing medical education (CME) needs in the U.S.-associated Pacific Basin jurisdictions |
Pac Health Dialog |
01-01-2002 |
URL |
Pacific Islands Continuing Clinical Education Program (PICCEP) |
OBJECTIVE:
To assess the self-perceived continuing medical education (CME) needs of physicians in American Samoa, Commonwealth of the Northern Mariana Islands, Guam, Federated States of Micronesia, Republic of the Marshall Islands, and the Republic of Palau.
METHODS:
Questionnaire-based survey of all physicians.
RESULTS:
Responses obtained from a total of 143 physicians in the region provided information on training backgrounds, previous experiences with CME, local access to regular CME sessions, perceived priority educational needs and preferred methods of CME delivery.
CONCLUSIONS:
Overall 64% of respondents had attended a formal CME event in 1999 or 2000, and 71% had access to local weekly or biweekly CME. However the perceived usefulness of these events varied by region. Priority learning needs were identified by physicians including non-communicable diseases such as diabetes, hypertension, cardiac disease; communicable diseases such as tuberculosis, HIV/AIDS and tropical diseases; as well as skills such as EKG and X-ray interpretation, trauma management and cardiac life support. Information on the most pressing educational needs and desired methods of delivery will be crucial in planning CME in this region.
CHWS Complete International Journal Article Other/Multiple Physicians communicable diseases continuing medical education diabetes mellitus electrocardiography heart diseases hypertensive disease jurisdiction life support tuberculosis |
| Thompson M, Skillman SM, Johnson K, Schneeweiss R, Hart LG |
The University of Washington Pacific Islands Continuing Clinical Education Program (PICCEP): Guam Conference on structure and content of continuing clinical education programs in the U.S.-associated jurisdictions |
Pac Health Dialog |
01-01-2002 |
URL |
Pacific Islands Continuing Clinical Education Program (PICCEP) |
On July 20 and 21, 2000 a meeting was convened of individuals from the U.S.-associated jurisdictions of the Pacific region who play key roles related to clinical training institutions, provider professional organizations, and rep resentatives of physicians and health policy leadership. The meeting, held in Guam was organized by the Pacific Islands Continuing Medical Education Program (PICCEP) based at the Center for Health Workforce Studies at the University of Washington in Seattle and funded by the Health Resources and Services Administration’s (HRSA’s) Bureau of Health Professions and Bureau of Primary Health Care. The overall goal of the meeting was to explore ways of developing a sustainable program of continuing clinical education (CCE) for physicians and other health profes sionals in the Pacific region. Specific objectives of the meeting included a review of previous CCE efforts in the region, assessment of current CCE needs, and discussion of PICCEP’s proposed CCE program. The meeting was also designed to foster further collaborative relationships among the various clinical education programs active in the region.
CHWS Complete International Journal Article Other/Multiple Physicians continuing clinical education (CCE) physicians training |
| Porter A, Skillman SM, Johnson K, Schneeweiss R, Hart LG |
Pacific Islands Continuing Clinical Education Program (PICCEP) final report |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
01-01-2003 |
Pages 1-4
Pages 5-8
Pages 9-12
Pages 13-16
Pages 17-20
Pages 21-24
Pages 25-27
Page 28
|
Pacific Islands Continuing Clinical Education Program (PICCEP) |
|
| Johnson K, Skillman SM, Ellsbury K, Thompson M, Hart LG |
Updating hospital reference resources in the U.S.-associated Pacific Basin: efforts of the Pacific Islands Continuing Clinical Education Program (PICCEP) |
J Med Libr Assoc |
01-01-2004 |
URL |
Pacific Islands Continuing Clinical Education Program (PICCEP) |
This article describes a project by the Pacific Islands Continuing Clinical Education Program (PICCEP) at the University of Washington (UW) to supplement hospital reference materials in six jurisdictions in the US-associated Pacific Islands. It outlines a model for cooperatively developing a suite of clinical reference materials suitable to low-resource settings.
The US-associated Pacific Islands encompass the US flag territories of American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), and Guam, as well as the independent countries, “freely associated with the United States,” of the Federated States of Micronesia (FSM), the Republic of the Marshall Islands (RMI), and the Republic of Palau. The region contains 104 inhabited islands that cover an area of the Pacific that is larger than the continental United States. Nearly 500,000 total residents live in the jurisdictions. Gross domestic product per capita in 2000 varied from $1,600 in RMI to $21,000 in Guam. English is an official language throughout the region, although many people speak one or more other languages. The United States serves as the region’s primary funder of social and health services. Each jurisdiction has one or more secondary hospitals, with bed sizes ranging from under 50 to over 200. Only a few of them offer advanced specialty services.
In 1998, the federal Institute of Medicine (IOM) found numerous health care challenges in the region: deteriorating health infrastructure, high health care costs, serious health problems on some islands such as high rates of substance abuse and infant mortality, and particularly “shortages of adequately trained health care personnel”. The IOM recommended an emphasis on health workforce improvement, in large part through continuing medical education (CME). The federal government responded, in part, by funding PICCEP, a four-year effort implemented by the UW Center for Health Workforce Studies.
PICCEP conducted a needs assessment and concluded that, among other problems, the region’s health care providers lacked current clinical reference materials. Most hospitals did not have libraries or librarians. They all had at least a small collection of reference materials, but most physicians felt these materials were too limited to help solve specific clinical problems or maintain skills. Personal computers were few in number and not readily available for most clinicians. In addition, limited, slow, and expensive Internet access made computerized references impractical in all but the most developed jurisdictions, such as Guam and the Republic of Palau.
CHWS Complete International Journal Article Other/Multiple Physicians American Samoa clinical reference materials Commonwealth of the Northern Mariana Islands continuing clinical education Federated States of Micronesia Guam hospital reference resources library resources Piccep Republic of Palau |
| Andrilla CHA, Hart LG, Kaplan L, Brown MA |
Practice patterns and characteristics of nurse practitioners in Washington State |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
03-01-2007 |
Full report
Policy brief |
Demographics, Education, and Practice Characteristics of Nurse Practitioners in Washington |
|
| Kaplan L, Brown MA, Andrilla CHA, Hart LG |
The Washington State nurse anesthetist workforce: a case study |
AANA J |
02-01-2007 |
URL |
Demographics, Education, and Practice Characteristics of Nurse Practitioners in Washington |
The purposes of this study were to describe the Washington State Certified Registered Nurse Anesthetist (CRNA) workforce and analyze selected dimensions of their clinical practice. We developed the 31-item CRNA Practice Questionnaire. After receiving institutional review board approval, the questionnaire was mailed in 2003 to CRNAs licensed in Washington with an address in Washington, Oregon, and Idaho. Statistical analysis included descriptive statistics for all variables and was performed by University of Washington Center for Health WorkforceStudies staff. Results indicate that the typical Washington State CRNA is 50.7 years old, white, and equally likely to be a man or woman. More than half of the Washington State CRNAs are master’s educated and have an average of 19 years of CRNA experience. Most work at least 40 hours a week, take call, and earn more than 100,000 dollars per year. Almost all have hospital privileges, but only 30% believe they are equal colleagues with physicians. A chi2 analysis comparing urban and rural respondents yielded few differences except that rural CRNAs reported seeking significantly less consultation and were more likely to take call. Workforce data may assist CRNAs when negotiating with employers and institutions and in resolving interprofessional conflicts and can have implications for scope of practice, policy, and legislative issues.
CHWS Complete Journal Article Nursing Washington Certified Registered Nurse Anesthetist (CRNA) CRNA Idaho Oregon Washington workforce |
| Kaplan L, Brown MA, Andrilla CHA, Hart LG |
Barriers to autonomous practice |
Nurse Pract |
01-01-2006 |
URL |
Demographics, Education, and Practice Characteristics of Nurse Practitioners in Washington |
This article describes a Washington State law enacted in 2000 that mandated indirect physician involvement and a study on whether or not this eliminated barriers to nurse practitioner (NP) practice. The study also investigated the impact this had on Schedule II-IV prescriptive authority for NPs. Using the research from this article in testimony, NPs were able to eliminate the indirect physician involvement requirement in 2005.
CHWS Complete Journal Article Nursing Washington autonomous practice controlled substances legend drugs nurse practitioners prescribing authority Schedule II-IV |
| Chapman SA, Lindler V, Kaiser JA, Nielsen CS, Bates T, Hailer-O'Keefe L, Skillman SM, Patterson DG, Dawson D, Wijetunge G |
EMS workforce for the 21st century: a national assessment |
Washington, DC: National Highway Traffic and Safety Administration; Jun 2008 |
06-01-2008 |
Full report |
EMS Workforce for the 21st Century: A National Assessment |
|
| Skillman SM, Stover B |
Montana's physician workforce in 2014 |
Seattle, WA:WWAMI Center for Health Workforce Studies, University of Washington |
11-07-2014 |
Full report |
Montana Physician Workforce |
|
| Frogner BK, Skillman SM |
Pathways to middle skilled allied health occupations |
Committee on the Supply Chain for Middle-skill Jobs: Education, Training and Certification Pathways of the National Academies of Sciences/Engineering/Medicine. Washington, DC |
09-01-2015 |
Full report |
Pathways to Middle Skilled Allied Health Care Occupations |
|
| Baldwin LM, Patanian MM, Larson E, Lishner DM, Mauksch LB, Katon WJ, Walker E, Hart LG |
Modeling the mental health workforce in Washington State: using state licensing data to examine provider supply in rural and urban areas |
J Rural Health |
01-01-2006 |
URL |
Modeling the Mental Health Workforce in Washington State: Using Licensing Data to Examine Provider Supply |
CONTEXT:
Ensuring an adequate mental health provider supply in rural and urban areas requires accessible methods of identifying providertypes, practice locations, and practice productivity.
PURPOSE:
To identify mental health shortage areas using existing licensing and survey data.
METHODS:
The 1998-1999 Washington State Department of Health files on credentialed health professionals linked with results of a licensure renewal survey, 1990 US Census data, and the results of the 1990-1992 National Comorbidity Survey were used to calculate supply and requirements for mental health services in 2 types of geographic units in Washington state-61 rural and urban core health service areas and 13 larger mental health regions. Both the number of 9 types of mental health professionals and their full-time equivalents (FTEs) per 100,000 population measured supply in the health service areas and mental health regions.
FINDINGS:
Notable shortages of mental health providers existed throughout the state, especially in rural areas. Urban areas had 3 times the psychiatrist FTEs per 100,000 and more than 1.5 times the nonpsychiatrist mental health provider FTEs per 100,000 as rural areas. More than 80% of rural health service areas had at least 10% fewer psychiatrist FTEs and nonpsychiatrist mental health provider FTEs than the state ratio (10.4 FTEs per 100,000 and 306.5 FTEs per 100,000, respectively). Ten of the 13 mental health regions were more than 10% below the state ratio of psychiatrist FTEs per 100,000.
CONCLUSIONS:
States gathering a minimum database at licensure renewal can identify area-specific mental health care shortages for use in program planning.
Allied Health CHWS Complete Journal Article Mental Health Methods Nursing Other/Multiple Physicians Washington mental health provider rural services urban |
| Baldwin LM, Fay M, Larson E, Lishner DM, Mauksch LB, Katon WJ, Walker E, Hart LG |
Modeling the mental health workforce in Washington State: using state licensing data to examine provider supply in rural and urban areas |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
10-01-2003 |
Full report
Policy brief |
Modeling the Mental Health Workforce in Washington State: Using Licensing Data to Examine Provider Supply |
|
| Rosenblatt RA, Andrilla CHA |
The impact of U.S. medical students' debt on their choice of primary care careers: an analysis of data from the 2002 medical school graduation questionnaire |
Acad Med |
09-01-2005 |
URL |
Student Debt and the Decline in Primary Care: Can Medical School Graduates Still Afford to Become Primary Care Doctors? |
PURPOSE:
To examine the hypothesis that medical students’ rising total educational debt is one of the factors that explains the recent decline in students’ interest in family medicine and primary care.
METHOD:
The authors used results from questions on the Association of American Medical Colleges’ 2002 Medical School GraduationQuestionnaire that focused on students’ debt and career choices. Logistic regression was used to determine the independent association of students’ debt with career choices, while controlling for students’ demographic characteristics.
RESULTS:
In 2002, 83.5% of graduating students were in debt, and the average student owed US $86,870. Minority students had higher levels of debt. Students reported that higher levels of debt influenced their future career choices, and there was an inverse relationship between the level of total educational debt and the intention to enter primary care, with the most marked effect noted for students owing more than $150,000 at graduation. Total debt was associated with a lower likelihood of choosing a primary care career, but factors such as gender and race appeared to have more explanatory power. Female students were much more interested in primary care-and especially pediatrics-than were male students; African American students were more interested in inner-city practice than was any other identified racial or ethnic group.
CONCLUSION:
In 2002, students’ debt levels were high and increasing. Although students with higher debt levels were less likely than were their counterparts to pursue a career in primary care, the effect was modest when demographic characteristics were taken into consideration.
CHWS Complete Journal Article National Physicians career choice debt load ethnicity medical education medical students primary care race rural student debt |
| Patterson DG, Andrilla CHA, Skillman SM, Hanscom J |
The impact of Medicaid primary care payment increases in Washington state |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
12-01-2014 |
Full report |
The Impact of Medicaid Primary Care Payment Increases in Washington State |
|
| Skillman SM, Stover B |
Maine's physician, nurse practitioner and physician assistant workforce in 2014 |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
09-05-2014 |
Full report |
Maine’s Physician, Nurse Practitioner and Physician Assistant Workforce in 2014 |
|
| House PJ |
The direct-care paraprofessional workforce providing long-term care services in the United States: Wyoming case study |
Seattle, WA:WWAMI Center for Health Workforce Studies, University of Washington |
03-01-2002 |
Full report |
The Direct-Care Paraprofessinal Workforce Providing Long-Term Care Services in the U.S.: Wyoming Case Study |
|
| Johnson K, Hagopian A, Veninga C, Fordyce MA, Hart LG |
The changing geography of Americans graduating from foreign medical schools |
Seattle, WA: WWAMI Center for Health Workforce Studies |
01-01-2005 |
Full report |
The Sources and Distribution of International Medical Graduates (IMGs) |
|
| Johnson K, Hagopian A, Veninga C, Fordyce MA, Hart LG |
The changing geography of Americans graduating from foreign medical schools |
Seattle, WA: WWAMI Center for Health Workforce Studies |
01-01-2005 |
Full report |
The Sources and Distribution of International Medical Graduates (IMGs) |
|
| Hagopian A, Ofosu A, Fatusi A, Biritwum R, Essel A, Hart LG, Watts C |
The flight of physicians from West Africa: views of African physicians and implications for policy |
Soc Sci Med |
01-01-2005 |
URL |
The Sources and Distribution of International Medical Graduates (IMGs) |
West African-trained physicians have been migrating from the sub-continent to rich countries, primarily the US and the UK, since medical education began in Nigeria and Ghana in the 1960s. In 2003, we visited six medical schools in West Africa to investigate the magnitude, causes and consequences of the migration. We conducted interviews and focus groups with faculty, administrators (deans and provosts), students and post-graduate residents in six medical schools in Ghana and Nigeria. In addition to the migration push and pull factors documented in previous literature, we learned that there is now a well-developed culture of medical migration. This culture is firmly rooted, and does not simply fail to discourage medical migration but actually encourages it. Medical school faculty are role models for the benefits of migration (and subsequent return), and they are proud of their students who successfully emigrate.
CHWS Journal Article National Physicians Africa Ghana Health policy medical education Nigeria Physician migration |
| Johnson K, Hagopian A, Veninga C, Hart LG |
The changing geography of Americans graduating from foreign medical schools |
Acad Med |
01-01-2006 |
URL |
The Sources and Distribution of International Medical Graduates (IMGs) |
To study U.S.-born international medical graduates in order to analyze changes in their numbers and countries of training from the 1960s and before until the early 2000s.
This study was conducted from 2003–2004 at the Center for Health Workforce Studies, University of Washington. The analysis was based on data from March 2002 from the American Medical Association (AMA) for active physicians. AMA data were supplemented with data from several other sources. Descriptive statistics were produced on country of birth, country of medical school training, and year of training for all foreign-trained, patient-care physicians whose birth country was known.
At least 17,000 of the foreign-trained physicians practicing in the United States are known to have been born in the United States. American physicians have graduated from foreign medical schools in increasing numbers since the 1960s. The number of U.S.-born physicians who graduated from a foreign medical school peaked in the early 1980s, but the phenomenon endures today. However, the countries in which these physicians chose to attend medical schools have changed significantly from the 1950s to the early 2000s.
Over time, U.S.-born physicians have become much less likely to train in Europe and much more likely to train in certain Caribbean countries. U.S.-born physicians who graduate from medical schools abroad tend to train in just a handful of countries and attend a limited number of medical schools.
CHWS Journal Article National Physicians international medical graduates physicians US-born IMGs |
| Hagopian A, Thompson M, Kaltenbach E, Hart LG |
The role of international medical graduates in America's small rural critical access hospitals |
J Rural Health |
01-01-2004 |
URL |
The Sources and Distribution of International Medical Graduates (IMGs) |
Context: Critical access hospitals (CAHs) are a federal Medicare category for isolated rural facilities with 15 or fewer acute care beds that receive cost-based reimbursement from Medicare. Purpose: This study examines the role of foreign-born international medical graduates (IMGs) in the staffing of CAHs. Methods: Chief executive officers (CEOs) of CAH facilities answered a telephone survey on their use of IMGs and the characteristics of those IMGs in winter 2002 (388 responded, for a 96% response rate). This descriptive report presents roles and characteristics of IMGs in CAH facilities and the opinions of the CEOs about these practitioners. Findings: Overall, 1 (24%) in 4 admitting physicians in CAHs are graduates of non-US medical schools (compared with 23% of physicians nationally), although the rates are higher for CAHs in persistent poverty counties, CAHs that report recruitment problems, and CAHs with smaller medical staffs. Hospitals east of the Mississippi River are more heavily reliant on IMGs than hospitals in the west. Most IMGs are internists (59%) and most (61%) come from India, the Philippines, or Pakistan. Hospital administrators rate the clinical skills of their IMGs highly and their interpersonal skills only slightly lower. Almost half of CAH administrators said their communities recruited their first IMGs during or after 1994, the year of pro-IMG legislative changes. Conclusion: IMG physicians play a significant and possibly growing role in staffing CAHs.
CHWS Journal Article National Physicians critical access hospitals IMGs international medical graduates physicians rural |
| Hagopian A, Thompson M, Fordyce MA, Johnson K, Hart LG |
The migration of physicians from sub-Saharan Africa to the United States of America |
Hum Resour Health |
01-01-2004 |
URL |
The Sources and Distribution of International Medical Graduates (IMGs) |
Background
The objective of this paper is to describe the numbers, characteristics, and trends in the migration to the United States of physicians trained in sub-Saharan Africa.
Methods
We used the American Medical Association 2002 Masterfile to identify and describe physicians who received their medical training in sub-Saharan Africa and are currently practicing in the USA.
Results
More than 23% of America’s 771 491 physicians received their medical training outside the USA, the majority (64%) in low-income or lower middle-income countries. A total of 5334 physicians from sub-Saharan Africa are in that group, a number that represents more than 6% of the physicians practicing in sub-Saharan Africa now. Nearly 86% of these Africans practicing in the USA originate from only three countries: Nigeria, South Africa and Ghana. Furthermore, 79% were trained at only 10 medical schools.
Conclusions
Physician migration from poor countries to rich ones contributes to worldwide health workforce imbalances that may be detrimental to the health systems of source countries. The migration of over 5000 doctors from sub-Saharan Africa to the USA has had a significantly negative effect on the doctor-to-population ratio of Africa. The finding that the bulk of migration occurs from only a few countries and medical schools suggests policy interventions in only a few locations could be effective in stemming the brain drain.
CHWS Journal Article National Physicians Africa brain drain health workforce IMGs international medical graduates migration physicians |
| Hagopian A, Thompson M, Johnson K, Lishner DM |
International medical graduates in the United States: a review of the literature 1995 to 2003 |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
01-01-2003 |
Full report |
The Sources and Distribution of International Medical Graduates (IMGs) |
|
| Hagopian A, Thompson M, Kaltenbach E, Hart LG |
Health departments' use of international medical graduates in physician shortage areas |
Health Aff |
01-01-2003 |
URL |
The Sources and Distribution of International Medical Graduates (IMGs) |
The Conrad “State 20” Program places international medical graduates (IMGs) on J-1 visas in health professional shortage areas (HPSAs). The authors surveyed program administrators from health departments in forty-two participating states. Problems reported include unfair working conditions and compensation for physicians. Federal immigration agencies were reported to be unresponsive and difficult. Employers seem to be more satisfied than physicians with the program. After the exit of the U.S. Department of Agriculture as a sponsor for physician J-1 visa waivers, Congress expanded the Conrad Program, signaling a continued reliance on IMGs to serve in shortage areas.
CHWS Journal Article National Physicians Conrad Program health professional shortage areas HPSAs IMGs international medical graduates J-1 visa visa waivers working conditions |
| Johnson K, Kaltenbach E, Hoogstra K, Thompson M, Hagopian A, Hart LG |
How international medical graduates enter U.S. graduate medical education or employment |
Seattle, WA: WWAMI Center for Health Workforce Studies University of Washington |
01-01-2003 |
Full report |
The Sources and Distribution of International Medical Graduates (IMGs) |
|
| Hart LG, Skillman SM, Fordyce MA, Thompson M, Hagopian A, Konrad TR |
International medical graduate physicians in the United States: changes since 1981 |
Health Aff |
04-19-2007 |
URL |
International Medical Graduates: Changes in Characteristics Over Time |
Nearly a quarter of all active U.S. physicians are international medical graduates (IMGs)–physicians trained outside the United States and Canada. We describe changes in characteristics of IMGs from 1981 to 2001 and compare them with their U.S. medical graduate (USMG) counterparts. Since 1981, the leading source countries for IMGs have included India, the Philippines, and Mexico. IMGs were more likely to be generalists and to practice in designated underserved areas than USMGs but slightly less likely to practice in isolated small rural areas and persistent-poverty counties. IMGs are an important source of primary care physicians in rural and underserved areas.
CHWS Complete Journal Article National Physicians family practice HPSA counties international medical graduates persistent-poverty counties rural |
| Hart LG, Skillman SM, Hagopian A, Fordyce MA, Thompson M, Konrad TR |
International medical graduate (IMG) physicians in the U.S.: changes since 1981 |
National health workforce assessment of the past and agenda for the future: proceedings of an international symposium |
12-31-2006 |
URL |
International Medical Graduates: Changes in Characteristics Over Time |
Nearly a quarter of all active U.S. physicians are international medical graduates (IMGs)—physicians trained outside the United States and Canada. We describe changes in characteristics of IMGs from 1981 to 2001 and compare them with their U.S. medical graduate (USMG) counterparts. Since 1981, the leading source countries for IMGs have included India, the Philippines, and Mexico. IMGs were more likely to be generalists and to practice in designated underserved areas than USMGs but slightly less likely to practice in isolated small rural areas and persistent-poverty counties. IMGs are an important
source of primary care physicians in rural and underserved areas.
CHWS Complete Journal Article National Physicians international medical graduates (IMGs) physicians primary care physicians underserved |
| Hart LG, Skillman SM, Hagopian A, Fordyce MA, Thompson M, Konrad TR |
International medical graduate (IMG) physicians in the U.S.: changes since 1981 |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
01-01-2005 |
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International Medical Graduates: Changes in Characteristics Over Time |
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| Andrilla CHA, Hart LG |
Evaluation of alternative Health Professional Shortage Area (HPSA) definitions in Washington State |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
08-21-2006 |
Full report |
Health Professional Shortage Area (HPSA) Criteria Evaluation Project in Washington State |
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| Skillman SM, Basye A |
Report: Home care aides in Washington State: current supply and future demand |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
01-31-2011 |
Report/Brief |
Home Care Aides in Washington State: Estimating Current Supply and Future Demand |
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| Fenton SH, Joost E, Gongora J, Patterson DG, Andrilla CHA, Skillman SM |
Health Information Technology Employer Needs Survey: an assessment instrument for workforce planning |
Educ Perspect Health Inform Inf Manage |
12-16-2013 |
URL |
Health Information Technology (HIT) Workforce Demand in the State of Texas |
The widespread implementation of electronic health records (EHRs) has resulted in an increased need for a well-trained health information technology (HIT) workforce. The Texas HIT Workforce Development Project was initiated with an assessment of HIT employer needs as one of the major goals. The researchers were required to develop a new survey because no existing tool could be found. From the results of HIT employer focus groups, the team determined that quantitative outcome measures for the survey should include HIT skills categorized as basic, intermediate, or advanced. Other data collected included employer-perceived barriers related to the HIT workforce, as well as a determination of the number of employees needed presently and in the future. The development process for the resulting survey instrument is described here. The survey tool was utilized for the planned assessment and is now made available for others to use.
CHWS Complete Journal Article electronic health records health information technology informatics workforce workforce development |
| Texas HIT Workforce Development Team |
Texas health information technology: employer needs assessment report |
San Marcos, TX: Texas State University |
02-03-2012 |
URL |
Health Information Technology (HIT) Workforce Demand in the State of Texas |
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| Patterson DG, Skillman SM |
Health professions education in Washington State: 1996-2004 program completion statistics |
Seattle, WA:WWAMI Center for Health Workforce Studies, University of Washington |
11-01-2004 |
Full report |
Health Professions Education in Washington State: 1996-2004 Program Completion Statistics |
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| Patterson DG, Skillman SM |
Health professions education in Washington State: 1996-2000 program completion statistics |
Seattle, WA: WWAMI Center for Health Workforce Studies |
10-01-2002 |
Full report
Policy brief |
Health Professions Education in Washington State: 1996-2004 Program Completion Statistics |
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| Thompson M, Hagopian A, Fordyce MA, Hart LG |
Do international medical graduates (IMGs) "fill the gap" in rural primary care in the United States? A national study |
J Rural Health |
04-01-2009 |
URL |
Do International Medical Graduates Fill Rural Gaps |
CONTEXT:
The contribution that international medical graduates (IMGs) make to reducing the rural-urban maldistribution of physicians in the United States is unclear. Quantifying the extent of such “gap filling” has significant implications for planning IMG workforce needs as well as other state and federal initiatives to increase the numbers of rural providers.
PURPOSE:
To compare the practice location of IMGs and US medical graduates (USMGs) practicing in primary care specialties.
METHODS:
We used the 2002 AMA physician file to determine the practice location of all 205,063 primary care physicians in the UnitedStates. Practice locations were linked to the Rural-Urban Commuting Areas, and aggregated into urban, large rural, small rural, and isolated small rural areas. We determined the difference between the percentage of IMGs and percentage of USMGs in each type of geographic area. This was repeated for each Census Division and state.
FINDINGS:
One quarter (24.8% or 50,804) of primary care physicians in the United States are IMGs. IMGs are significantly more likely to be female (31.9% vs 29.9%, P < .0001), older (mean ages 49.7 and 47.1 year, P < .0001), and less likely to practice family medicine (19.0% vs 38%, P < .0001) than USMGs. We found only two Census Divisions in which IMGs were relatively more likely than USMGs to practice in ruralareas (East South Central and West North Central). However, we found 18 states in which IMGs were more likely, and 16 in which they were less likely to practice in rural areas than USMGs.
CONCLUSIONS:
IMGs fill gaps in the primary care workforce in many rural areas, but this varies widely between states. Policies aimed to redress the rural-urban physician maldistribution in the United States should take into account the vital role of IMGs.
CHWS Complete Journal Article National Physicians international medical graduates primary care rural-urban US medical graduates workforce |
| Thompson M, Hagopian A, Fordyce MA, Hart LG |
Do international medical graduates "fill the gap" in rural primary care in the United States? A national study |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
01-31-2006 |
Full report |
Do International Medical Graduates Fill Rural Gaps |
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| Thompson M, Hagopian A, Fordyce MA, Hart LG |
Do international medical graduates "fill the gap" in rural primary care in the United States? A national study |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
01-31-2006 |
Full report |
Do International Medical Graduates Fill Rural Gaps |
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| WWAMI Center for Health Workforce Studies, University of Washington |
Data snapshot: race and ethnicity of Washington State health professionals compared with state population |
Seattle, WA: WAMI Center for Health Workforce Studies, University of Washington |
12-01-2000 |
Snapshot |
Race and Ethnicity of Washington's Health Professionals Compared with the State's Population |
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| Snyder CR, Stover B, Skillman SM, Frogner BK |
Facilitating racial and ethnic diversity in the health workforce |
Seattle, WA:WWAMI Center for Health Workforce Studies, University of Washington |
07-02-2015 |
Full report |
Facilitating Racial and Ethnic Diversity in the Health Workforce |
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| Andrilla CHA, Hart LG |
Montana dental workforce technical report |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
05-01-2001 |
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State-Level Requirements Model of the General Dental Workforce in Montana |
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| Wright GE, Paschane DM, Baldwin LM, Domoto P, Cantrell D, Hart LG |
Distribution of the dental workforce in Washington State: patterns and consequences |
Seattle, WA:WWAMI Center for Health Workforce Studies, University of Washington |
03-01-2001 |
Policy brief |
The Distribution of the Dental Workforce and Its Relationship to Unmet Needs in Washington State |
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| Palazzo L, Skillman SM, Basye A, Morrison CC |
Health workforce demand in Washington State: employers' current and expected needs for home care aides, medical assistants, nursing assistants certified, licensed practical nurses, associate's degree registered nurses |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
07-31-2013 |
Full report |
Current and Future Demand for Home Care Aides, Nursing Assistants Certified, Medical Assistants, Licensed Practical Nurses, and Associate's Degree Registered Nurses in Washington State |
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| Skillman SM, Palazzo L, Hart LG, Keepnews D |
What happens to registered nurses whose licenses expire? An exploratory study in Washington State |
Seattle, WA: WWAMI Center for Health Workforce Studies, University of Washington |
11-16-2006 |
Full report
Policy brief |
RNs with Expired Licenses in Washington |
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