Coronavirus Disease 2019 Planning and Response: A Tale of 2 Health Workforce Estimator Tools.

BACKGROUND: As coronavirus disease 2019 (COVID-19) rapidly progressed throughout the United States, increased demand for health workers required health workforce data and tools to aid planning and response at local, state, and national levels. OBJECTIVE: We describe the development of 2 estimator tools designed to inform health workforce planning for COVID-19. RESEARCH DESIGN: We estimated supply and demand for intensivists, critical care nurses, hospitalists, respiratory therapists, and pharmacists, using Institute for Health Metrics and Evaluation projections for COVID-19 hospital care and National Plan and Provider Enumeration System, Provider Enrollment Chain and Ownership System, American Hospital Association, and Bureau of Labor Statistics Occupation Employment Statistics for workforce supply. We estimated contact tracing workforce needs using Johns Hopkins University COVID-19 case counts and workload parameters based on expert advice. RESULTS: The State Hospital Workforce Deficit Estimator estimated the sufficiency of state hospital-based clinicians to meet projected COVID-19 demand. The Contact Tracing Workforce Estimator calculated the workforce needed based on the 14-day COVID-19 caseload at county, state, and the national level, allowing users to adjust workload parameters to reflect local contexts. CONCLUSIONS: The 2 estimators illustrate the value of integrating health workforce data and analysis with pandemic response planning. The many unknowns associated with COVID-19 required tools to be flexible, allowing users to change assumptions on number of contacts and work capacity. Data limitations were a challenge for both estimators, highlighting the need to invest in health workforce data and data infrastructure as part of future emergency preparedness planning.

The Emergency Medicine Physician Workforce: Projections for 2030.

STUDY OBJECTIVE: The goals of this study were to determine the current and projected supply in 2030 of contributors to emergency care, including emergency residency-trained and board-certified physicians, other physicians, nurse practitioners, and physician assistants. In addition, this study was designed to determine the current and projected demand for residency-trained, board-certified emergency physicians. METHODS: To forecast future workforce supply and demand, sources of existing data were used, assumptions based on past and potential future trends were determined, and a sensitivity analysis was conducted to determine how the final forecast would be subject to variance in the baseline inputs and assumptions. Methods included: (1) estimates of the baseline workforce supply of physicians, nurse practitioners, and physician assistants; (2) estimates of future changes in the raw numbers of persons entering and leaving that workforce; (3) estimates of the productivity of the workforce; and (4) estimates of the demand for emergency care services. The methodology assumes supply equals demand in the base year and estimates the change between the base year and 2030; it then compares supply and demand in 2030 under different scenarios. RESULTS: The task force consensus was that the most likely future scenario is described by: 2% annual graduate medical education growth, 3% annual emergency physician attrition, 20% encounters seen by a nurse practitioner or physician assistant, and 11% increase in emergency department visits relative to 2018. This scenario would result in a surplus of 7,845 emergency physicians in 2030. CONCLUSION: The specialty of emergency medicine is facing the likely oversupply of emergency physicians in 2030. The factors leading to this include the increasing supply of and changing demand for emergency physicians. An organized, collective approach to a balanced workforce by the specialty of emergency medicine is imperative.

The American Society of Pediatric Hematology/Oncology workforce assessment: Part 1-Current state of the workforce.

The American Society of Pediatric Hematology/Oncology (ASPHO) recognized recent changes in medical practice and the potential impact on pediatric hematology-oncology (PHO) workforce. ASPHO surveyed society members and PHO Division Directors between 2010 and 2016 and studied PHO workforce data collected by the American Board of Pediatrics and the American Medical Association to characterize the current state of the PHO workforce. The analysis of this information has led to a comprehensive description of PHO physicians, professional activities, and workplace. It is important to continue to collect data to identify changes in composition and needs of the PHO workforce.

Are we facing a physician assistant surplus?

The rapid growth in the physician assistant (PA) pipeline reflects in part a growing demand for health services that has created many opportunities for new PAs. However, the simultaneous growth in the production of physicians and NPs raises the question as to whether the nation will overproduce PAs and other clinicians. Although the growing supply of PAs will help meet the nation's healthcare needs, this study concludes that the job market for new PAs is likely to tighten. The authors recommend a system to track supply, demand, and distribution to inform the PA community and to encourage alignment of supply and demand.

Assessing the Racial and Ethnic Diversity of Physician Assistant/Associate Program Graduates from 2010 to 2012 and 2019 to 2021.

INTRODUCTION: To assess the racial/ethnic diversity of graduates of US Physician Assistant/Associate (PA) programs compared with the diversity of the populations from which they draw students and to assess diversity changes over time among PA graduates. METHODS: We calculated proportion of Black or Hispanic PA graduates nationally and by school between 2010 to 2012 and 2019 to 2021 using the Integrated Postsecondary Education Data System (IPEDS) and compared it with the diversity of the 20 to 35-year-old population using the American Community Survey. We created benchmark populations for each school based on whether the school was public or private, with in-state/out-of-state proportions provided by the Physician Assistant Education Association. A diversity index (DI) was calculated for each program. A DI of 0.5 means that the representation of Black/Hispanic graduates is half their representation in the benchmark population. RESULTS: Although the numbers of Black/Hispanic graduates increased from 2010 to 2012 to 2019 to 2021, the percentage of Black graduates decreased. Nationally, the DI for Black graduates decreased from 0.28 to 0.23 and the Hispanic DI increased from 0.28 to 0.37 between 2010 to 2012 and 2019 to 2021. Among 213 PA programs included in the 2019 to 2021 dataset, 5 schools had a DI >1.0 for Black graduates and 7 schools had a DI >1.0 for Hispanic graduates. DISCUSSION: Using the IPEDS data, we found that Black and Hispanic graduates are underrepresented among PA program graduates. The PA education community needs to develop new strategies for diversifying the profession consistent with the new US Supreme Court decision banning race-conscious admissions.

Documenting Latino Representation In The US Health Workforce.

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.

Utilization of a "Diversity Index" to Assess Racial Diversity of US School of Pharmacy Graduates.

OBJECTIVE: Diversity in the training environment for health professionals is associated with improved abilities for graduates to care for diverse populations. Thus, a goal for health professional training programs, including pharmacy schools, should be to pursue representation among graduates that mirrors that of their communities. METHODS: We evaluate racial and ethnic diversity among graduates of Doctor of Pharmacy (PharmD) programs across the United States (US) over time. Using a "Diversity Index", we quantify the relative racial and ethnic representation of each program's graduates compared with that of college-age graduates nationally and within the geographic region of the respective pharmacy school. RESULTS: Over the past decade, the number of US PharmD graduates increased by 24%. During this time, the number of Black and Hispanic PharmD graduates significantly increased. Still, representation of minoritized populations among graduates continues to be significantly lower compared with US benchmark populations. Only 16% of PharmD programs had a Diversity Index that matched or exceeded their benchmark comparator Black or Hispanic populations. CONCLUSION: These findings highlight the significant opportunity that exists to increase the diversity of graduates of US PharmD programs to better reflect the diversity of the US population.

Creation of an advisory group for physician workforce studies in obstetrics and gynecology.

OBJECTIVE: A projected shortage of obstetrician-gynecologists prompted us to query other major national medical and surgical organizations about internal efforts to examine their specialty's physician workforce needs. STUDY DESIGN: We sought the experience of the top 20 academies, societies or colleges of those medical or surgical specialties. Each organization had approximately 10,000 or more physician members. Those identified as being the most knowledgeable about physician workforce efforts in their specialty were asked to electronically complete a 14-question survey about the existence, structure and function of any workforce office or advisory group in their specialty. RESULTS: Each organization responded to the survey. A task force, permanent committee or office (in large organizations) was formed to ascertain their specialty's workforce needs and projections. The results prompted the Executive Board of the American Congress of Obstetricians-Gynecologists to approve in July of 2010 the creation of an advisory group to conduct research and inform members about trends that affect the obstetrician-gynecologist workforce nationally and in individual districts. CONCLUSION: In response to the potential shortage of obstetrician-gynecologists, an advisory group was approved by the American Congress of Obstetricians and Gynecologists to undertake workforce studies.

Limited, uneven progress in increasing racial and ethnic diversity of dental school graduates.

PURPOSE/OBJECTIVES: To assess racial and ethnic diversity of graduates of each dental school compared to the diversity of populations they draw from and to assess changes over time nationally and by school. METHODS: We calculated diversity of graduates by school and nationally between 2010-2012 and 2017-2019 using the Integrated Post-secondary Education Data System (IPEDS) and compared the diversity of each state's college age population using data from the American Community Survey. We accounted for differences between in-state and out-of-state students attending public and private schools based on data from the American Dental Association's Survey of Dental Education Series. A diversity index (DI) was calculated for each school. A DI of 0.5 means that the representation of Black or Hispanic individuals among the graduates is half of their representation in the benchmark population. RESULTS: Among the 63 dental schools analyzed, only seven had a DI of greater than 0.5 for Black graduates (two of which were Historically Black Colleges and Universities) in 2017-2019. For Hispanic graduates, 20 schools had a DI above 0.5. Nationally, while the number of Black graduates increased between 2010-2012 and 2017-2019, the percentage decreased from 5.8% to 5.1%. The percentage of Hispanic graduates increased from 6.4% to 8.7%. CONCLUSIONS: Black and Hispanic individuals are underrepresented among dental school graduates. Increasing the diversity of the dental workforce could help address significant oral health disparities experienced by Black and Hispanic people. More needs to be done by the dental education community to increase racial and ethnic diversity of dental graduates.

Estimation and Comparison of Current and Future Racial/Ethnic Representation in the US Health Care Workforce.

Importance: The COVID-19 pandemic coupled with health disparities have highlighted the disproportionate burden of disease among Black, Hispanic, and Native American (ie, American Indian or Alaska Native) populations. Increasing transparency around the representation of these populations in health care professions may encourage efforts to increase diversity that could improve cultural competence among health care professionals and reduce health disparities. Objective: To estimate the racial/ethnic diversity of the current health care workforce and the graduate pipeline for 10 health care professions and to evaluate whether the diversity of the pipeline suggests greater representation of Black, Hispanic, and Native American populations in the future. Design, Setting, and Participants: This cross-sectional study used weighted data from the 2019 American Community Survey (ACS) to compare the diversity of 10 health care occupations (advanced practice registered nurses, dentists, occupational therapists, pharmacists, physical therapists, physician assistants, physicians, registered nurses, respiratory therapists, and speech-language pathologists) with the diversity of the US working-age population, and 2019 data from the Integrated Postsecondary Education Data System (IPEDS) were used to compare the diversity of graduates with that of the US population of graduation age. Data from the IPEDS included all awards and degrees conferred between July 1, 2018, and June 30, 2019, in the US. Main Outcomes and Measures: A health workforce diversity index (diversity index) was developed to compare the racial/ethnic diversity of the 10 health care professions (or the graduates in the pipeline) analyzed with the racial/ethnic diversity of the current working-age population (or average student-age population). For the current workforce, the index was the ratio of current workers in a health occupation to the total working-age population by racial/ethnic group. For new graduates, the index was the ratio of recent graduates to the population aged 20 to 35 years by racial/ethnic group. A value equal to 1 indicated equal representation of the racial/ethnic groups in the current workforce (or pipeline) compared with the working-age population. Results: The study sample obtained from the 2019 ACS comprised a weighted total count of 148 358 252 individuals aged 20 to 65 years (White individuals: 89 756 689; Black individuals: 17 916 227; Hispanic individuals: 26 953 648; and Native American individuals: 1 108 404) who were working or searching for work and a weighted total count of 71 608 009 individuals aged 20 to 35 years (White individuals: 38 995 242; Black individuals: 9 830 765; Hispanic individuals: 15 257 274; and Native American individuals: 650 221) in the educational pipeline. Among the 10 professions assessed, the mean diversity index for Black people was 0.54 in the current workforce and in the educational pipeline. In 5 of 10 health care professions, representation of Black graduates was lower than representation in the current workforce (eg, occupational therapy: 0.31 vs 0.50). The mean diversity index for Hispanic people was 0.34 in the current workforce; it improved to 0.48 in the educational pipeline but remained lower than 0.50 in 6 of 10 professions, including physical therapy (0.33). The mean diversity index for Native American people was 0.54 in the current workforce and increased to 0.57 in the educational pipeline. Conclusions and Relevance: This study found that Black, Hispanic, and Native American people were underrepresented in the 10 health care professions analyzed. Although some professions had greater diversity than others and there appeared to be improvement among graduates in the educational pipeline compared with the current workforce, additional policies are needed to further strengthen and support a workforce that is more representative of the population.

From education to practice: What we can learn about the workforce from a survey of new nurse practitioners.

BACKGROUND AND PURPOSE: To understand the posttraining plans and job market for new nurse practitioners (NPs), a survey was conducted of new family NPs (FNPs) in 2017. The survey was also designed to test the logistics and feasibility of conducting such a survey on a national scale and the usefulness of data gathered. METHODS: A descriptive, cross-sectional study was conducted through an online survey administered to a national sample of 159 FNPs who graduated from an accredited NP program. CONCLUSIONS: Many new NPs are not willing or interested in moving out of their local community even if there are limited opportunities locally. There are high numbers of NPs going into private practice compared with community health or federally qualified health centers. Many new NPs have extensive previous work experience as registered nurses in hospitals; the career progression to NP shifts their work setting from inpatient to outpatient settings. IMPLICATIONS FOR PRACTICE: Although the job market for new NPs is generally good, with the rapid increase in NP graduates combined with the unwillingness or inability of many new NPs to move, some areas may have surpluses of NPs and limited job opportunities for new NPs, whereas other areas may have shortages upcoming. The survey of new NP graduates is a useful tool to monitor the experience of new NPs and provides valuable information to NP programs and prospective students. Future research should ensure a representative sample of new graduate NPs to accurately reflect the experience of new NPs.

Outlook for the future of the obstetrician-gynecologist workforce.

OBJECTIVE: The objective of the study was to assess the future physician workforce with a sample of obstetrician-gynecologists. STUDY DESIGN: Two separate surveys regarding career satisfaction and retirement plans were sent to random samples of obstetrician-gynecologists under age 50 years (n = 2,000) and over the age of 50 (n = 2,100). RESULTS: Obstetrician-gynecologists over the age of 50 years who were working part time or were female were more satisfied than those working full time or were male. Obstetrician-gynecologists (under and over age 50 years) who were concerned about liability and unable to balance their work and personal lives were more dissatisfied. Obstetrician-gynecologists retired earlier than planned because of rising malpractice costs and later than planned because of high career satisfaction. CONCLUSION: Low career satisfaction may be adding to the already shrinking physician workforce. Offering part-time work opportunities and alleviating liability concerns may increase career satisfaction and help to combat a future of the physician workforce shortage.

US residency training before and after the 1997 Balanced Budget Act.

CONTEXT: Graduate medical education (GME) determines the size and characteristics of the future workforce. The 1997 Balanced Budget Act (BBA) limited Medicare funding for additional trainees in GME. There has been concern that because Medicare is the primary source of GME funding, the BBA would discourage growth in GME. OBJECTIVE: To examine the number of residents in training before and after the BBA, as well as more recent changes in GME by specialty, sex, and type and location of education. DESIGN: Descriptive study using the American Medical Association/Association of American Medical Colleges National GME Census on physicians in Accreditation Council for Graduate Medical Education (ACGME)-accredited programs to examine changes in the number and characteristics of residents before and after the BBA. MAIN OUTCOME MEASURES: Differences in the number of physicians in ACGME-accredited training programs overall, by specialty, and by location and type of education. RESULTS: The number of residents and fellows changed little between academic year (AY) 1997 (n = 98,143) and AY 2002 (n = 98,258) but increased to 106,012 in AY 2007, a net increase of 7869 (8.0%) over the decade. The annual number of new entrants into GME increased by 7.6%, primarily because of increasing international medical graduates (IMGs). United States medical school graduates (MDs) comprised 44.0% of the overall growth from 2002 to 2007, followed by IMGs (39.2%) and osteopathic school graduates (18.8%). United States MD growth largely resulted from selection of specialties with longer training periods. From 2002 to 2007, US MDs training in primary care specialties decreased by 2641, while IMGs increased by 3286. However, increasing subspecialization rates led to fewer physicians entering generalist careers. CONCLUSION: After the 1997 BBA, there appears to have been a temporary halt in the growth of physicians training in ACGME programs; however, the number increased from 2002 to 2007.

The Growing Demand for Hospice and Palliative Medicine Physicians: Will the Supply Keep Up?

CONTEXT: The need for hospice and palliative care is growing rapidly as the population increases and ages and as both hospice and palliative care become more accepted. Hospice and palliative medicine (HPM) is a relatively new physician specialty, currently training 325 new fellows annually. Given the time needed to increase the supply of specialty-trained physicians, it is important to assess future needs to guide planning for future training capacity. OBJECTIVES: We modeled the need for and supply of specialist HPM physicians through the year 2040 to determine whether training capacity should continue growing. METHODS: To create a benchmark for need, we used a population-based approach to look at the current geographic distribution of the HPM physician supply. To model future supply, we calculated the annual change in current supply by adding newly trained physicians and subtracting physicians leaving the labor force. RESULTS: The current U.S. supply of HPM specialists is 13.35 per 100,000 adults 65 and older. This ratio varies greatly across the country. Using alternate assumptions for future supply and demand, we project that need in 2040 will range from 10,640 to almost 24,000 HPM specialist physicians. Supply will range from 8100 to 19,000. CONCLUSION: Current training capacity is insufficient to keep up with population growth and demand for services. HPM fellowships would need to grow from the current 325 graduates annually to between 500 and 600 per year by 2030 to assure sufficient physician workforce for hospice and palliative care services given current service provision patterns.

Physician workforce shortages: implications and issues for academic health centers and policymakers.

A physician shortage is likely given current levels of medical education and training. Because an increase in physician supply through expansion of U.S. medical school capacity will require ten or more years, there is little time left to affect the supply of new physicians in 2020 when a substantial number of baby boomers will be over 70 years of age. Even with a substantial increase in medical education and training capacity, it is unlikely that all of the increased demand for health services can be met with physicians. In addition to the challenges of expanding medical school enrollment, the nation will need to grapple with other ramifications of demand exceeding supply. This includes assessing how to deliver services more effectively and efficiently and the future roles of the physician and other health professionals. These challenges are particularly difficult for medical schools and teaching hospitals, the cornerstones of medical education and training in the United States. Osteopathic and off-shore schools targeted to Americans have been willing and able to grow more quickly and less expensively than U.S. medical schools, in part because of their more narrow approaches to medical education. In addition, physicians from less developed countries continue to migrate to the United States in significant numbers. Medical schools, teaching hospitals, and policymakers will need to address several major questions as they respond to the shortages. They will either confront and address these issues in the next few years or they will be forced to change by others in the future.

The need for real evidence in physician workforce decision making.

The analysis by Barbara Starfield and colleagues has serious methodological and conceptual shortcomings. Despite the reference to "evidence" in the title, there is little evidence to guide the health care community or policymakers. The paper faults specialists for most of the ailments of U.S. medicine and fails to recognize the critical role of specialists in improving Americans' health status. A variety of factors, including organizational and financing systems, discourage effective use of both primary care and specialty physicians. The nation would be better served by developing an evidence base on the relationship between outcomes and education, training, and specialty.

Is the Physician Shortage Real? Implications for the Recommendations of the Institute of Medicine Committee on the Governance and Financing of Graduate Medical Education.

In July 2014, the Institute of Medicine (IOM) Committee on the Governance and Financing of Graduate Medical Education released its report calling for a major overhaul of the financing of graduate medical education (GME). Several national organizations with an interest in GME faulted the report on the basis that the IOM Committee recommendations would worsen physician shortages. However, this conclusion is based on two questionable assumptions: first, that the nation is already facing a general physician shortage; and second, that the IOM Committee recommendations would make shortages worse. The author argues that although some communities and specialties do face shortages, currently and in the future a general national physician shortage is unlikely. Reasons cited include changes in the delivery system with an increased focus on efficiency and effectiveness; the increased use of interprofessional teams facilitated by the increasing supply of nurse practitioners, physician assistants and other health professionals; and technological advances.The author concludes that the IOM Committee recommendations would support an increase in GME positions in locations and specialties where there is a documented need, in effect removing the current cap on Medicare-funded GME positions. Given the current fiscal environment, the approach recommended by the IOM Committee--steady funding levels but improved targeting to meet documented needs--may be the best strategy for maintaining GME funds and meeting the nation's physician workforce needs.