Current and Projected Health Workforce Supply and Demand in Nevada John Packham, PhD and Tabor Griswold, PhD Office of Statewide Initiatives University of Nevada School of Medicine February 24, 2016 Nevada s Health Workforce 2 Office of Statewide Initiatives Page 1
Health Workforce Demand Forces Driving Health Workforce Demand Primary Factors Population growth and aging ACA, health insurance coverage expansions Economic growth, Tesla/Faraday Important, but Secondary Factors Population health (demand need) Health care system change Science and technological change 4 Office of Statewide Initiatives Page 2
Insurance Coverage Expansion and the Demand for Medical Care Estimated percent change relative to current demand/utilization in the U.S. (range): Inpatient stays: -0.8 to +10.9% ED visits: -2.2 to +11.9% Office-based visits: +2.2 to +9.7% Prescribed medicines: +1.1 to +8.7% Source: Abraham, JM. How Might the Affordable Care Act s Coverage Expansion Provisions Influence Demand for Medical Care. Milbank Quarterly 92:1:63-87 (2014). 5 Health Care Employment in Nevada Number of Jobs (Thousands) 2005 to 2015 120 109.7 100 91.0 80 77.4 60 40 20 35.7 20.1 41.4 23.4 48.7 26.7 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Health Care and Social Assistance Ambulatory Health Care Services Hospitals Source: Nevada Department of Employment, Training, and Rehabilitation (2016). 6 Office of Statewide Initiatives Page 3
Health Care Employment in Las Vegas Number of Jobs (Thousands) 2005 to 2015 70 74.4 60 61.9 50 51.8 40 30 20 10 24.8 12.4 29.6 36.6 15.2 18.3 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Health Care and Social Assistance Ambulatory Health Care Services Hospitals Source: Nevada Department of Employment, Training, and Rehabilitation (2016). 7 Projected Demand for Health Care Workers by Industry in Nevada from 2012 to 2022 Total Health Care and Social Assistance Sector: + 17,661 jobs (+16.3%) Ambulatory Care: 6,877 jobs (+15.8%) Offices of physicians: 1,602 jobs (+9.5%) Offices of dentists: 708 jobs (+9.6%) Hospitals: 3,821 jobs (+11.9%) Skilled Nursing Facilities: 2,585 jobs (+22.7%) Source: Nevada Department of Employment, Training, and Rehabilitation (2016). 8 Office of Statewide Initiatives Page 4
Health Care Sector in Nevada Job Postings 2013 to 2015 25,000 21,311 20,000 16,160 15,000 12,751 10,000 5,000 0 2013 2014 2015 Source: OSI analysis of Burning Glass/Labor Insights data (2016). 9 Hospitals in Nevada Job Postings 2013 to 2015 16,000 14,000 12,000 11,624 13,904 10,000 8,000 8,594 6,000 4,000 2,000 0 2013 2014 2015 Source: OSI analysis of Burning Glass/Labor Insights data (2016). 10 Office of Statewide Initiatives Page 5
Ambulatory Care in Nevada Job Postings 2013 to 2015 7,000 6,000 5,908 5,000 4,000 3,000 3,369 3,623 2,000 1,000 0 2013 2014 2015 Source: OSI analysis of Burning Glass/Labor Insights data (2016). 11 Skilled Nursing Facilities in Nevada Job Postings 2013 to 2015 1,600 1,499 1,400 1,200 1,000 800 788 913 600 400 200 0 2013 2014 2015 Source: OSI analysis of Burning Glass/Labor Insights data (2016). 12 Office of Statewide Initiatives Page 6
Health Care Occupations in Nevada Job Postings 2015 Registered Nurses Medical and Health Services Managers Surgeons and Specialty Physicians Nursing Assistants Critical Care Nurses Physical Therapists Health Information Technicians Medical Secretaries Nurse Practitioners Primary Care Physicians Occupational Therapists Licensed Practical Nurses Medical Assistants Clinical Laboratory Technicians Physician Assistants Speech-Language Pathologists Pharmacy Technicians Educational and Vocational Counselors Pharmacists Mental Health Counselors 2,430 1,925 1,423 1,367 1,358 1,182 922 847 843 826 812 777 721 713 671 553 540 521 376 Source: OSI analysis of Burning Glass/Labor Insights data (2016). 8,645 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000 13 Physicians Job Postings from 2013 to 2015 2,500 2,214 2,000 1,500 1,000 1,586 1,116 500 380 369 494-2013 2014 2015 Health Care Other Industries Source: OSI analysis of Burning Glass/Labor Insights data (2016). 14 Office of Statewide Initiatives Page 7
Registered Nurses Job Postings 2013 to 2015 8,000 7,000 7,131 6,000 5,000 4,747 4,000 3,000 2,000 1,000 3,818 1,504 1,841 2,901-2013 2014 2015 Health Care Industries Other Industries Source: OSI analysis of Burning Glass/Labor Insights data (2016). 15 Physical Therapists Job Postings 2013 to 2015 1,400 1,200 1,203 1,000 800 600 659 863 400 200 0 146 155 62 2013 2014 2015 Health Care Industries Other Industries Source: OSI analysis of Burning Glass/Labor Insights data (2016). 16 Office of Statewide Initiatives Page 8
Health Information Technicians Job Postings 2013 to 2015 700 662 600 500 400 338 363 426 520 300 200 196 100 0 2013 2014 2015 Health Care Industries Other Industries Source: OSI analysis of Burning Glass/Labor Insights data (2016). 17 Physician Assistants Job Postings 2013 to 2015 600 539 500 400 300 200 100 333 337 105 110 198 0 2013 2014 2015 Health Care Industries Other Industries Source: OSI analysis of Burning Glass/Labor Insights data (2016). 18 Office of Statewide Initiatives Page 9
Health Workforce Demand in Nevada Overall growth in health care employment (16.3%) is projected to exceed the average for all occupations in Nevada (13.8%) through 2022 Population growth and aging, as well as ACArelated insurance coverage expansions will generate above average demand for health care workers in Nevada 19 High Demand Health Occupations in Nevada 11 high demand health care occupations are ranked among the top 100 occupations in Nevada with the largest projected job growth through 2022 20 of the top 35 high demand health care occupations possess an average annual salary greater than average annual salary of $42,310 for all occupations in Nevada 22 require a post-secondary degree for licensure in the State of Nevada 20 Office of Statewide Initiatives Page 10
Health Workforce Supply Health Workforce Supply in Nevada Steady growth in the number of licensed health professionals across most professions Treading water in the number of licensed health professionals per capita for some, not all Severe health workforce shortages compounded by an aging health workforce and ensuing ACArelated demand Persistent specialty shortages and geographic maldistribution of physicians and most other health professionals 22 Office of Statewide Initiatives Page 11
Current Physician Workforce Rankings Number of Active Licensees per 100,000 Population Physicians, MD & DO 48 th Patient Care Physicians 48 th Primary Care Physicians 50 th Patient Care Primary Care Physicians 50 th Residents & Fellows 47 th Residents & Fellows in Primary Care 48 th Source: UNSOM Office of Statewide Initiatives (2016). 23 Current Physician Workforce Rankings Number of Active Licensees per 100,000 Population Anesthesiology 24 th General and Family Practitioners 46 th General Surgeons 51 st Internal Medicine 30 th Obstetricians and Gynecologists 45 th Ophthalmologists 49 th Orthopedic Surgeons 51 st Pediatricians 47 th Psychiatry 47 th Source: UNSOM Office of Statewide Initiatives (2016). 24 Office of Statewide Initiatives Page 12
Current Nursing Workforce Rankings Number of Active Licensees per 100,000 Population Registered Nurses 51 st Nurse Practitioners 51 st Certified Nurse Anesthetists 50 th Licensed Practical Nurses 48 th Source: UNSOM Office of Statewide Initiatives (2016). 25 Current Health Workforce Rankings Number of Active Licensees per 100,000 Population Dentists 34 th Dental Hygienists 36 th EMTs and Paramedics 36 th Pharmacists 38 th Physical Therapists 45 th Physician Assistants in Clinical Practice 38 th Psychologists 47 th Source: UNSOM Office of Statewide Initiatives (2016). 26 Office of Statewide Initiatives Page 13
Number of Licensed Allopathic Physicians (MDs) per 100,000 Population in Nevada 2004 to 2014 300 250 254.9 Urban North 227.8 200 Urban South 150 150.0 154.9 159.1 170.0 171.3 172.3 160.8 Rural and Frontier 136.2 100 Nevada Total 50 65.6 60.9 2004 2006 2008 2010 2012 2014 Source: OSI analysis of unpublished data from Nevada State Board of Medical Examiners (2016). 27 Number of Licensed Registered Nurses (RNs) per 100,000 Population in Nevada 2004 to 2014 1,000 944.0 Urban North 800 600 776.7 614.9 612.5 586.1 637.4 704.6 735.0 762.3 738.3 Urban South Rural and Frontier Nevada Total 502.3 400 441.4 2004 2006 2008 2010 2012 2014 Source: OSI analysis of unpublished data from Nevada State Board of Nursing (2016). 28 Office of Statewide Initiatives Page 14
Number of Licensed Advanced Practitioners of Nursing (APNs) per 100,000 Population in Nevada 2004 to 2014 60 50 52.7 Urban North 40 Urban South 30 20 29.5 18.7 15.8 16.5 18.7 21.8 24.5 31.9 27.7 17.6 Rural and Frontier Nevada Total 10 11.7 0 2004 2006 2008 2010 2012 2014 Source: OSI analysis of unpublished data from Nevada State Board of Nursing (2016). 29 Number of Licensed Dentists per 100,000 Population in Nevada 2004 to 2014 65 62.1 55 45 55.6 45.3 47.5 52.3 49.9 54.5 54.9 54.6 Urban North Urban South 43.9 Rural and Frontier 37.9 35 Nevada Total 29.5 25 2004 2006 2008 2010 2012 2014 Source: OSI analysis of unpublished data from Nevada State Board of Dental Examiners (2016). 30 Office of Statewide Initiatives Page 15
Primary Care Physicians Number of MDs per 100,000 Population 60.0 56.0 50.0 40.0 30.0 20.0 10.0 0.0 40.5 39.6 31.4 29.6 26.7 20.9 20.0 14.3 14.0 11.9 10.3 1.0 1.2 2.1 Family Medicine General Practice Internal Medicine Pediatrics OB/Gyn Nevada Mountain Region U.S. Source: AMA. Physician Characteristics and Distribution in the US (2015). 31 Surgeons and Specialty Physicians Number of MDs per 100,000 Population 14.0 12.0 10.0 8.0 6.0 4.0 2.0 8.3 10.2 12.4 5.4 8.0 8.4 4.8 5.0 7.5 2.8 3.4 4.5 6.5 9.1 12.9 0.0 General Surgery Orthopedic Surgery Cardiovascular Disease Gastroenterology Psychiatry Nevada Mountain Region U.S. Source: AMA. Physician Characteristics and Distribution in the US (2015). 32 Office of Statewide Initiatives Page 16
60.0 Primary Care Physicians Number of MDs and DOs per 100,000 Population 50.0 40.0 40.3 45.7 50.7 30.0 20.0 10.0 0.0 29.3 23.6 21.6 15.2 15.1 15.1 10.7 5.9 6.7 1.0 0.9 0.9 Family Medicine General Practice Internal Medicine Pediatrics OB/Gyn Clark Washoe Balance of State Source: OSI analysis of unpublished data from the Nevada State Board of Medical Examiners and Nevada State Board of Osteopathic Medicine (2016). 33 Surgeons and Specialty Physicians Number of MDs and DOs per 100,000 Population 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 6.9 10.8 5.6 11.7 8.5 5.5 5.5 9.9 2.6 General Surgery Orthopedic Surgery Cardiovascular Disease 2.7 5.6 2.0 Gastroenterology Clark Washoe Balance of State 13.5 6.9 1.2 Psychiatry Source: OSI analysis of unpublished data from the Nevada State Board of Medical Examiners and Nevada State Board of Osteopathic Medicine (2016). 34 Office of Statewide Initiatives Page 17
Primary Care Health Professional Shortage Areas (HPSAs) 2016 962,156 Nevadans reside in a primary care HPSA (33.7%) 815,657 urban residents in Nevada (31.8% of urban residents) live in a primary care HPSA, including 613,000 residents of Clark County 142,476 rural residents (49.8% of rural residents) live in a primary care HPSA 9 single-county primary care HPSAs Source: OSI analysis of data from the Health Resources Services Administration (2016). 35 Dental Health Professional Shortage Areas (HPSAs) 2016 903,241 Nevadans reside in a dental HPSA (31.7%) 757,815 urban residents in Nevada (29.5% of urban residents) live in a dental HPSA, including 612,710 residents of Clark County 145,426 rural residents (50.8% of rural residents) live in a dental HPSA 8 single-county dental HPSAs Source: OSI analysis of data from the Health Resources Services Administration (2016). 36 Office of Statewide Initiatives Page 18
Mental Health Professional Shortage Areas (HPSAs) 2016 1.5 million Nevadans reside in a mental HPSA (53.3%) 1.2 million urban residents in Nevada (48.1% of urban residents) live in a mental HPSA, including 736,908 residents of Clark County 286,251 rural residents (100.0% of rural residents) live in a mental HPSA 16 single-county mental HPSAs Source: OSI analysis of data from the Health Resources Services Administration (2016). 37 Health Workforce Research, Planning, and Policy in Nevada Office of Statewide Initiatives Page 19
Policy Levers Higher education programs and capacity esp., public programs and opportunities Health professions licensing and regulation State policy and budget esp. funding for higher education health education programs Federal policy esp. support for health workforce education and training K-12 education pipeline 39 Proactive versus Reactive Health Workforce Research and Planning Need for better data on health workforce demand, esp., industry workforce needs Need for better data on current and projected supply of health workforce, esp., health professions MDS and graduate retention Need for real world health workforce supply and demand modeling and estimates, e.g., primary care demand 40 Office of Statewide Initiatives Page 20
Demographic Characteristics of the RN Workforce in Nevada 2015 Region Highest Level of RN Education Age Hispanic Associate Baccalaureate Clark County 44.8% 47.3% 46 6.2% Washoe County 53.5% 43.1% 45 3.8% Carson City 68.0% 25.5% 50 2.4% Rural Counties 74.4% 24.3% 49 6.0% Total 48.9% 44.3% 46 5.6% Source: OSI analysis of Nevada Nursing Minimum Data Set (MDS) data provided by the Nevada State Board of Nursing for the calendar year 2015 (N=8,690) (2016). 41 Retention of Physicians Completing UNSOM GME in Nevada 2006 to 2015 2015 (N=103) Beginning Practice Continuing GME or Other Total Remaining in Nevada 42.7% 7.8% 50.5% Leaving Nevada 33.0% 16.5% 49.5% Total 75.7% 24.3% 100.0% 2006 to 2015 (N=773) Beginning Practice Continuing GME or Other Total Remaining in Nevada 44.1% 7.4% 51.5% Leaving Nevada 35.8% 12.7% 48.5% Total 79.9% 20.1% 100.0% Source: Griswold & Packham. OSI Annual UNSOM GME Exit Survey (2015). 42 Office of Statewide Initiatives Page 21
Retention of Students Completing NSHE Nursing Education Programs 2010 to 2014 Current Employment Status at Graduation Number Percent Working or have been offered a job in Nevada 520 26.9% Seeking employment only in Nevada 781 40.3% Offered a job or seeking employment in another state 100 5.2% Seeking employment in multiple states, including Nevada 228 11.8% Continuing education or not actively seeking employment 307 15.9% Total 1,936 100.0% Source: OSI analysis of NSHE Survey of Graduating Nursing Students (2016). 43 John Packham, PhD Director of Health Policy Research Office of Statewide Initiatives University of Nevada School of Medicine (775) 784-1235 jpackham@medicine.nevada.edu http://www.medicine.nevada.edu/osi Office of Statewide Initiatives Page 22