Transcription
Building a Workforce forHealth Care’s EvolvingNeedsKelley Withy, MD, PhDwithy@hawaii.edu
Hawaii Physician Workforce 2017 Over 9,000 licensed physicians Current supply of physicians is 3551 for2978 FTEs An Increase of 49 FTEs from last year At least 65 retirements and 136 movingout of state.
Statistics Shortage of about 419 with basic calculations, but 769when you examine island and specialty specific needs (lastyear numbers were 455 and 707) We only have 120 job openings in Hawaii www.ahec.Hawaii.edu/doctor-jobs/ Our average age of physicians is 54.4 with over half beingover 55. Percent of docs in groups of 5 or less fell from 54% to 52%.
Actual numbers until 2802280633992978344034813522305029002950
Newest Physician Shortage NumbersIsland(2016number)Oahu(339)BigMauiIsland County(183) ge16.5%38.7% 34%30%22.6%139
Primary Care Shortage 2.5Percentage22%25%26%16%22%
Hawaii Physician Ages Compared to US Average282726282522Percent by Age Group211283HawaiiUSunder 3535-4445-5455-6465 and over382128262728252212
Greatest Specialty Shortages (by percent) by Island:OahuBig IslandInfectious DiseaseColorectal SurgeryPathologyInfectious DiseaseGeneral & Family PracticeThoracic SurgeryPulmonologyNeurological SurgeryGeneral SurgeryNeonatal- PerinatalMaui CountyKauaiGeriatricsInfectious DiseaseColorectal SurgeryEndocrinologyNeonatal-PerinatalCritical ology
What progress have we made?AHEC promise: We will help ANY student from Hawaii interested in a health career get there! 812 students in long term mentoring pipelinehttp://www.ahec.hawaii.edu/phcc/ Shadowing, mentoring, research, test prep, college and career prep Looking for coordinator on Maui right now
Increase Rural TrainingIn order to expand class size, we have to train on neighbor islands Recruit, support and train students from and on neighbor islands Work with providers to increase training-bill in legislature to give taxcredit for teaching Work with communities to host students-rhondaro@Hawaii.edu Work with companies to sponsor travel
Increase Physician RecruitmentWe don’t train enough yet, so we have to recruit from elsewhere DocJobs: www.ahec.Hawaii.edu/doctor-jobs/ Loan Repayment!!! Including Solo and Small Practice programwww.ahec.Hawaii/loan/
Increase Physician Happiness“I’m overwhelmed” “Nobody listens” “I feel alone in this” Insurance Company Questions forum: http://www.ahec.hawaii.edu/ask-an-insurer/ Continuing Education Workforce Summit 9/8/2018 Project ECHO distance learning: Behavioral Health everyTuesday noon-1 and Geriatrics Second Wed at 4pm
Next Steps Increase teamwork Local Area Consortia-BH Bridge To Practice Mentoring Young Doctors’ Club Young clinician club?
APRN Workforce Has Increased APRN Nurse Practitioners aretrained and educated as primarycare providers The number of licensed APRNsresiding in-state increased by104% between 2005 and 2017 Reduction in regulatory barriersto APRN scope of practice hasbeen instrumental in supportingthe %11.5%7.5%200520072009Year-to-Year Rate of Change2011201320152017Total Active, In-State APRN Licenses
Characteristics of the APRN Workforce Average age of APRNs statewide is 48.5 years; 21% age 60 or over 8% of APRNs will leave the practice of nursing by the year 2021 53% of APRNs are employed in a primary care-related specialty 81% are licensed as nurse practitioners 30% work in a HRSA-defined medically underserved area/population 15% work in a HRSA-defined primary care provider shortage area 26% work in a federally-defined rural county
APRNs and the Future of Health Care APRNs are not a substitute or replacement for physicians but rathercontribute uniquely to an interprofessional healthcare workforce APRNs will continue to provide care in shortage and underservedareas and in difficult to fill specialties like behavioral health andprimary care
Building a Workforce for Hawaii’s Health Care’sEvolving NeedsCarolyn Ma, PharmD., BCOPDeanThe Daniel K. Inouye College of PharmacyU. Of Hawai’i at Hilo
Sandra Leal, PharmD, MPH, FAPhA, CDEsleal@sinfoniarx.com520-302-5325References available at www.pharmacistsprovidecare.com
Sandra Leal, PharmD, MPH, FAPhA, CDEsleal@sinfoniarx.com520-302-5325References available at www.pharmacistsprovidecare.com
Sandra Leal, PharmD, MPH, FAPhA, CDEsleal@sinfoniarx.com520-302-5325References available at www.pharmacistsprovidecare.com
HawaiiSandra Leal, PharmD, MPH, FAPhA, CDEsleal@sinfoniarx.com520-302-5325References available at www.pharmacistsprovidecare.com
National Pharmacist Demand Indicator 2017 Q3(1 demand much less than pharmacist supply available; 5 high demand difficult to fill)Ref: https://pharmacymanpower.com
Hawai’i PDI Trend Over Last 5 Yrs.2017 Q3 PDI 2 Demand is less than pharmacist supply available2.0Ref: https://pharmacymanpower.com
The Daniel K. Inouye CoPOpened in 2017Four year Professional Degree - Doctor of Pharmacy DegreeGraduated 7 classes (50% residents; over 500 students)Eligible for National Licensing Board Exam for RPh (pass rate90-93%) Residency Programs (1st year and 2nd year Specialized- CriticalCare) -Post-doctoral training
Opportunities to Utilize Pharmacists ToBridge GapsGrowing workforce ofhighly trainedpharmacistsHealthcare Needs
Trained to Bridge GapsPreventative and Chronic Disease ManagementRelated to Medication ManagementMedication Therapy Management – effective drugtherapy in acute and chronic diseases Patient education and health advocacy Vaccination Contraception Prescribing (6th State to Pass) Naloxone and Opioid Antibiotic Stewardship Program Stewards for proper drug efficacy Correct indication and selection, dose, interval,route Adherence – compliance Transitions of care betweeninstitutions/community and levels of careHowPharmacists CanBridge ProviderGapSafetyCosts and Drug Shortages Drug/drug interactions Drug/disease interactions Side effect and adverse drug management DSMT (group vs. individual) Pharmacy Benefit Managers Chronic Care Management Long term care
ChallengesDesignated Provider Status Federal Bill (S.109, HR 592)Pharmacy & Medically UnderservedAreas Enhancement Act -Hawai’i State 2017 Legislaturedeferred HB 1406, SB 187 – Expand RPhScope of Practice HB 156Relating to Reimbursements forPharmacistcodesvisitrevenueAbility to bill CMS/ CPTAbility to segregate RPhCB/HB billing andCapability of ElectronicMedical nt for time spent vs. operationexpenses (lease rent, utilities, supportstaff)Collaborative AgreementsCB/HB ability to pay RPH salary withoutreimbursementExpanding Scope of Practice
National: Pharmacy and Medically Underserved AreasEnhancement ActImplications of S109 and HR 592 for HawaiiSandra Leal, PharmD, MPH, FAPhA, CDEsleal@sinfoniarx.com520-302-5325
Federal H.R. 592/S. 109National: Pharmacy and Medically Underserved AreasEnhancement Act Section 2(a) Amends Section 1861(s)(2) of the Social Security Act byadding a new subsection “GG” to the law that wouldauthorize Medicare Part B coverage of “pharmacistservices.” Limits these services to services:– Provided by a State licensed pharmacist, individually or on behalf of apharmacy provider;– Defined based on what the pharmacist is legally authorized to performin the State in which the services are performed;– That would otherwise be covered by Medicare Part B if the serviceswere performed by a physician or incident to a physician’s service; and– Provided in a health professional shortage area, medicallyunderserved area, or medically underserved population (each ofwhich is defined within the Public Health Service Act).Sandra Leal, PharmD, MPH, FAPhA, CDEsleal@sinfoniarx.com520-302-5325
Federal H.R. 592/S. 109 Section 2(b) reimbursement for practitioners inunderserved areas Amends Section 1833(a)(1) of the Social SecurityAct by adding a new subsection “(AA)” to the lawto define payment of “pharmacist services.” Establishes reimbursement for these services asequal to 80% of the lesser of the actual charge or85% of the physician fee schedule amount(established in law), if these services had beenfurnished by a physician.Sandra Leal, PharmD, MPH, FAPhA, CDEsleal@sinfoniarx.com520-302-5325
Building a Workforce for Health Care’sEvolving NeedsJean MelnikoffVice President, Human ResourcesKaiser Permanente, Hawaii31 Copyright 2017 Kaiser Foundation Health Plan, Inc.
Hawaii faces common and unique challenges - PhysicianA University of Hawaii assessment found our doctorshortage is worsening.The pipeline of caregivers, including doctors, nurses,therapists, and elder care specialists has not keptpace with demand.Physician Shortage381Primary care are the largest group in short supply,followed by infectious disease and geriatricspecialists.13919653Our ability to educate and train the future workforcelocally is too often limited in what is available.We enjoy and are challenged by our geographiclocation.32OahuMauiBig IslandKauai
Hawaii faces common and unique challenges – NursingEducational Programs Offered in Hawai‘i'sAs of 2016, there were roughly 11,390 RNs in thestate of Hawaii.According to the Health Resources and ServicesAdministration (HRSA), it is anticipated that therewill be a shortage in Hawaii of 3,311 full-time RNsby 2025.There are not enough specialty RNs in Hawaiihospitals, so travelers are being utilized moreheavily, and at a greater cost. This shortage isdue in part to the lack of locally available training.These shortages are expected to continue as thenursing workforce ages and retires, and the needfor nursing services increases.Educational Programs Offered1CU2HCC3HPU45Kap. CC Kau. CC6UHH7UHM8UHMC9UOPXNon-Baccalaureate ProgramsLicensed Practical Nurse (LPN)XX“Ladder” Program: Licensed PracticalNurse (LPN) combined with an Associate'sdegree in nursing (AS)XLicensed Practical Nurse (LPN) toAssociate degree (AS)XAssociate's degree in nursing (AS)Associate's degreeAssistantAssociate's degreeTechnicianAssociate's degreeAssistantAssociate's degreeTechnologyXXXX- Occupational TherapyX- Medical LaboratoryX- Physical TherapistX- RadiologicXBaccalaureate ProgramsBachelor of science in nursing (BS)XXXXLPN to bachelor of science in nursing (BS).XRegistered Nurse (RN) to bachelor ofscience in nursing (BS)Accelerated RN to BSXBachelor of Social Work (BSW)XXRN to Master of Science in Nursing (MS)XXBS to MSNMaster's Entry Program in Nursing (MEPN)XXXMaster of Social Work (MSW)XXXXXXXMaster of Science ProgramsXDoctoral ProgramsDoctor of Nursing PracticeBS to Doctor of Nursing Practice (DNP)1 ChaminadeUniversity;Community College;3 Hawai‘i Pacific University;4 Kapi‘olani Community College;5 Kaua‘i Community College;2 Hawai‘i336 Universityof Hawai‘i at Hilo;University of Hawai‘i at Manoa;8 University of Hawai‘i Maui College;9 University of Phoenix7XXBS to Doctor Philosophy in Nursing (PhD)MS to DNPMS to PhDXXXX
Hawaii faces common and unique challenges – Other Job FamilyBehavioral HealthAccess to care is impacted by the lack of Psychologists (PhD), Medical SocialWorkers and others (LCSWs, MFTs).Allied HealthMany health care professionals work at the bedside or behind the scenes providinglaboratory, imaging and other critical services needed to diagnose and treatpatients.Due to the shortage in local pipeline program, we have partnered with educationalinstitutions in the lower 50 states to meet the workforce need in the region.Nursing ManagementNursing is the largest licensed professional group and to step into leadership requirednew skills and competencies.They are discouraged by administrative burdens, competing demands, and lack ofclarity in role and responsibility.34Ongoing study of Enterprise-wide High Reliability Operating Model (HRO) to reducenurse management burnout and turnover.
Examples of Supporting Workforce Planning and DevelopmentResidency and InternshipsThe Ben Hudnall Memorial TrustGraduate Medical Education to provideeducational support, guidance andsupervision of interns, residents and fellows.KP Primary Care Residency program is in it’s3 year.Front-line workforce is provided guidance forcareer development and resilience training toadapt to health care’s evolving needs. Nursesaccessed specialty training in NICU, L&D, andEmergency.Career Management ProgramSupporting for lifelong learning with financialsupport through tuition reimbursement,resources and on-line tools to support growthin current or new areas. Over 1,200 coursesand videos support individual development.Skills of the FutureNational and local focus on digital fluency,collaboration, process improvement to helpcreate a change-ready, highly-skilled, flexibleworkforce.
What Can We Do to Help?As an industry we have to articulate our needs and work together to push for educationthat is relevant to our emerging needs. Share information broadly about workforce future shifts. Invest in relationships with education institutions and common work across our industry. Create collective solutions not just individual ones. Promote the strengths of our location and culture to attract a workforce who values our manybenefits. Create an early warning system for upcoming workforce shortage36
Recruit Students-Wehave 800 students in the pipeline Encouragemiddle school and high school STEMprograms, provide mentoring, shadowing Weneed to increase and expand training andsupport them so that we can KEEP them all Professionals-Recruitenough herefrom elsewhere until we train HawaiiPhysician Recruiters Group, spreadingthe word to Hawaii students and across US Whatelse can we do?
PrepareExpand training: OT, PT (UHWO? UH Hilo?),specialty Nursing, Social Work Residencies: Psychology, Nurse, Pharmacy Internships/Apprenticeships-money available fromDepartment of Labor and Industrial Relations fortraining for interns, especially IT Jobs waiting upon graduation-partnership betweenacademia and industry Preceptor Tax Credit Early Warning System in development
Support Loanrepayment: MD/DO, APRN, PA, Psychology,SW, MFT Local area consortia to support current andupcoming health professionals Legislation to expand scope of practice forbetter inter-professional healthcare for patients Student stewardship programs Welcome wagon Create integrated clinics in areas of need?
Do you see yourself as part of the solution? Educational Institutions Legislators Employers Technology developers Healthcare providers and systems Patient advocates
Due to the shortage in local pipeline program, we have partnered with educational institutions in the lower 50 states to meet the workforce need in the region. Nursing Management
