1. No category

Health Care Workforce
Issues in Nevada
Primary Care Shortages, Population Demographics, Expanded
Insurance Coverage, and Education Pipeline
Tabor Griswold, PhD
Health Services Research Analyst
Office of Statewide Initiatives
University of Nevada School of Medicine
April 28, 2015
Forces Driving Health Workforce Demand
•
•
•
•
•
•
•
Demographic change
The economy
ACA, health insurance coverage expansions
Population health
Health care system change
Science and technological change
State and federal policy
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Tsunami of Demand for Health Care (and
Health Care Professionals) in Nevada
• Insurance coverage expansion since Jan 1, 2014
• Medicaid and Nevada Checkup: 115,000
• Silver State Health Insurance Exchange: 73,000
• Projected insurance coverage expansion by 2020
• Medicaid & Nevada Checkup: 197,000
• Silver State Health Insurance Exchange: 141,000
• Employer-Sponsored Plans & Medicare: 256,000
• Associated increase in health workforce demand –
especially primary care physicians and providers
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4
Forces Affecting Health Workforce Supply
• Higher education programs and capacity
• K-12 education pipeline
• Health professions licensing and regulation
• State policy and budget – esp. funding for higher
education health education programs and
undergraduate medical education (UME)
• Federal policy – esp. support for health workforce
education/training and graduate medical education
(GME)
5
Health Workforce Supply in Nevada
• Steady growth in the number of licensed health
professionals
• “Treading water” in the number of licensed
health professionals per capita
• Persistent specialty shortages and geographic
disparate distribution of physicians and most
other health professionals
• Severe health workforce shortages compounded
by an aging health workforce, ensuing ACArelated demand, and an improving economy
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Number of Licensed Allopathic Physicians (MDs)
per 100,000 Population in Nevada – 2004 to 2014
300
200
150.0
154.9
159.1
2004
2006
2008
170.0
171.3
172.3
2010
2012
2014
100
0
Urban North
Urban South
Rural and Frontier
Nevada Total
Source: Nevada State Board of Medical Examiners (2004, 2006, 2008, 2010, 2012, 2014), Nevada State
Demographer’s Office (2004, 2006, 2008, 2010, 2012, 2014).
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Number of Licensed Registered Nurses (RNs) per
100,000 Population in Nevada – 2004 to 2014
1000
800
704.5
600
579.6
612.5
734.9
762.3
637.4
400
200
2004
Urban North
2006
2008
Urban South
2010
2012
Rural and Frontier
2014
Nevada Total
Source: Nevada State Board of Medical Examiners (2004, 2006, 2008, 2010, 2012, 2014), Nevada State
Demographer’s Office (2004, 2006, 2008, 2010, 2012, 2014).
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Physician Workforce Rankings
•
•
•
•
•
•
•
Physicians, MDs – 47th among U.S. states
Physicians, DOs – 18th
Physicians, MD & DO – 45th
Patient Care Physicians – 48th
Primary Care Physicians – 48th
Residents & Fellows – 46th
Residents & Fellows in Primary Care – 47th
Source: American Medical Association (2014).
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Physician Workforce by Medical Specialty
•
•
•
•
•
•
General and Family Practitioners – 47th
Pediatricians – 46th
Obstetricians and Gynecologists – 46th
Internal Medicine – 32nd
Primary Care Sub-specialties – 43rd
All Other Specialties – 47th
Source: American Medical Association (2014).
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Primary Care
Number of MDs per 100,000 Population – 2015
70
58.4
60
50
40
30
56.9
47.8
47.5
42.8
40.4
38.8
40.9 40.1
37.2
32.0
29.0
26.8
23.2
19.8
20
13.7
10
1.7
1.8 2.51.7
1.9 3.0
1.4
14.9
13.5
13.0
11.0
21.9
14.7
12.2
10.5
14.4
10.2
4.9
4.2
Pediatrics
OB/Gyn
0
Family Medicine
Clark
Washoe
General Practice
Carson City
Internal Medicine
Rural and Frontier
Nevada
Mountain Region
US
Source: Nevada State Board of Medical Examiners (2015). AMA. Physician Characteristics and Distribution in the US (2014).
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Medical and Surgical Specialties
Number of MDs per 100,000 Population – 2015
35
29.2
30
25
20
16.4
14.6
15
11
10
5
13.5
12.4
10.1
8.0
7.6
11.9
5.5
5.3
6.9
8.1
10.5
8.6
6.2
5.8
4.9
9.5
7.6
6.4
5.1
4.8
2.9 3.4
2.6
0
General Surgery
Clark
Orthopedic Surgery
Washoe
Carson City
13.2
11
7.3
6.9
4.6
0.4
0.4
0.4
Cardiovascular
Disease
Gastroenterology
Psychiatry
Rural and Frontier
Nevada
Mountain Region
US
Source: Nevada State Board of Medical Examiners (2015). AMA. Physician Characteristics and Distribution in the US (2014).
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Physician Workforce in Nevada by SelfDesignated Medical Specialty – 2012
• Of 38 specialty areas, there is considerable
variation among the regions in Nevada
• Clark – Anesthesiology
• R and F – Transplant Surgeon in Pahrump
• Nevada – Public Health and Preventive Medicine
Source: AMA. Physician Characteristics and Distribution in the US (2014).
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Physician Workforce in Nevada by SelfDesignated Medical Specialty – 2012
• Across all medical specialty areas, the number of
MDs per capita in Nevada is 90.1% of regional
rates and 65.2% of national rates
• Physicians needed to reach US MDs per capita is
657 in rural counties and 2,104 in Clark County
• Across all surgical specialty areas, the number of
MDs per capita in Nevada is 83.4% of regional
rates and 69.2% of national rates
Source: AMA. Physician Characteristics and Distribution in the US (2014).
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UNSOM Match Results by Location and
Specialty – 2014
Location/Specialty
Primary Care
Specialties
Other
Specialties
Total
Nevada
6
(8.7)
1
(1.5)
7
(10.2)
Out of State
21
(30.4)
41
(59.4)
62
(89.8)
Total
27
(39.1)
42
(60.9)
69
(100.0)
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UNSOM Match Results by Location and
Specialty – 2004 to 2014
Location/Specialty
Primary Care
Specialties
Other
Specialties
Total
Nevada
66
(10.5)
35
(5.6)
101
(16.1)
Out of State
184
(29.4)
341
(54.5)
525
(83.9)
Total
250
(39.9)
376
(60.1)
626
(100.0)
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UNSOM GME Graduation and Retention
2014
Location/Specialty
Patient Care
Continuing GME
or Other
Total
Nevada
34
(42.0)
7
(8.6)
41
(50.6)
Out of State
30
(37.0)
10
(212.3)
40
(49.4)
Total
64
(79.0)
17
(21.0)
81
(100.0)
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UNSOM Graduation and Retention
2004 to 2014
Location/Specialty
Patient Care
Continuing GME
or Other
Total
Nevada
325
(42.0)
60
(7.8)
385
(49.8)
Out of State
282
(36.5)
106
(13.7)
388
(50.2)
Total
607
(78.5)
166
(21.5)
773
(100.0)
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Physicians with Nevada UME - GME
Percent of Total MDs Education by Region – 2014
80.0
70.0
68.8
60.0
50.0
40.0
30.0
23.2
23.0
20.0
10.0
14.5
4.2
15.0
14.8
10.3
6.7
3.7
5.3
6.1
0.0
Total Physicians
Clark
Undergaduate Medical Education
Washoe
Rural and Frontier
Graduate Medical Education
Carson City
Source: Nevada State Board of Medical Examiners (2015). AMA. Physician Characteristics and Distribution in the US (2014).
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Population – 2014 to 2019
Percent Change
25
20
Percent
15
10
Nevada Average
5
0
-5
-10
Rural & Frontier
Urban
Source: Nevada State Demographer’s Office. (2014). U.S. Census Bureau. (1990). See
Nevada Rural and Frontier Health Data Book 2015, p. 22, Table 1.2. and p. 24, Table 1.4.
Population Aged 65 and Over – 2014 to 2019
Percent Change
40
Percent
30
20
Nevada Average
10
0
-10
Rural & Frontier
Urban
Source: Nevada State Demographer’s Office. (2014). U.S. Census Bureau. (1990). See
Nevada Rural and Frontier Health Data Book 2015, p. 36, Table 1.12. and p. 37, Table 1.13.
Hispanic Population – 2014 to 2019
Percent Change
25
20
Percent
15
10
Nevada Average
5
0
-5
-10
-15
Rural & Frontier
Urban
Source: Nevada State Demographer’s Office. (2014). U.S. Census Bureau. (1990). See
Nevada Rural and Frontier Health Data Book 2015, p. 46, Table 1.22. and p. 47, Table 1.23.
Primary Care
Workforce Shortages
in Nevada
• Most regions of rural and
frontier Nevada are primary
care HPSAs
• 142,500 rural residents (51%)
live in a primary care HPSA
• 816,000 urban residents (32%)
live in a primary care HPSA,
including 612,000 residents of
Clark County
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Physician and Primary Care Workforce – 2014
Number per 100,000 Population
Rural &
Frontier
Urban
Nevada
Allopathic Physicians (MD)
72.8
183.4
172.3
Adv Practitioners of Nursing (APN)
19.7
33.2
31.9
Osteopathic Physicians (DO)
15.8
21.6
21.0
Physician Assistants (PA)
14.1
20.9
20.2
Primary Care Physicians (MD & DO)
49.6
90.4
86.3
Profession
Source: See references for Tables 4.6 through 4.42 in Nevada Rural
and Frontier Health Data Book 2015, p. 212, Table 4.48.
Dental Care
Workforce Shortages
in Nevada
• Most regions of rural and
frontier Nevada are dental care
HPSAs
• 145,500 rural residents (51%)
live in a dental care HPSA
• 758,000 urban residents (32%)
live in a dental care HPSA,
including 613,000 residents of
Clark County
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Oral Health Care Workforce – 2014
Number per 100,000 Population
Profession
Rural &
Frontier
Urban
Nevada
Dentists
38.0
56.8
54.9
Dental Hygienists
36.6
37.1
37.0
Source: See references for Tables 4.6 through 4.42 in Nevada Rural
and Frontier Health Data Book 2015, p. 212, Table 4.48.
Mental Care
Workforce Shortages
in Nevada
• All regions of rural and frontier
Nevada are mental care HPSAs
• 286,000 rural residents (100%)
live in a mental care HPSA
• 1.2 million urban residents
(31%) live in a mental care
HPSA, including 737,000
residents of Clark County (31%)
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Mental and Behavioral Health Workforce – 2014
Number per 100,000 Population
Profession
Rural &
Frontier
Urban
Nevada
Alcohol, Drug, & Gambling Counselors
55.5
42.0
43.4
Marriage & Family Therapists
17.3
25.1
24.3
Psychiatrists
0.7
7.0
6.4
Psychologists
6.0
14.0
13.2
27.1
40.9
39.5
Social Workers (LSWs)
Source: See references for Tables 4.6 through 4.42 in Nevada Rural
and Frontier Health Data Book 2015, p. 212, Table 4.48.
County Profile Reports
for Nevada
• Data from the Nevada Rural and
Frontier Health Data Book –
Seventh Edition
• Demographic, economic,
health, workforce, resources
data about 286,000 rural
residents and 1.2 million urban
residents
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Recap of Policy Levers to Address Health
Workforce Shortages in Nevada and the US
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•
•
•
Higher education programs and capacity
K-12 education pipeline
Health professions licensing and regulation
State policy and budget – esp. funding for
higher education health education programs,
UME, loan repayment and forgiveness policy
• Federal policy – esp. support for health
workforce education and training, GME
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Recent and Upcoming Reports from the
UNSOM Office of Statewide Initiatives
• Nevada Rural and Frontier Health Data Book – Seventh Edition
(February 2015)
• The Contribution of the University of Nevada School of Medicine to
the Nevada Economy (April 2015)
• Health Workforce in Nevada – 2015 Edition (May 2015)
• Nevada Residency and Fellowship Training Outcomes, 2006 to 2015
– Key Findings from the Annual UNSOM Graduate Medical
Education Exit Survey (July 2015)
• Health Career Careers in Nevada – 2016-2017 Edition (December
2015)
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Tabor Griswold, PhD
Health Services Research Analyst
Office of Statewide Initiatives
University of Nevada School of Medicine
(775) 682-8475
[email protected]
http://www.medicine.nevada.edu/statewide/