Health Workforce Demand in Nevada Presented to the Western Interstate Commission for Higher Education (WICHE) Tabor Griswold, PhD Office of Statewide Initiatives University of Nevada School of Medicine April 18 th, 2016 Forces Driving Health Workforce Demand Primary Factors Population growth and aging Reform-related insurance coverage expansions Economic growth, e.g., Tesla/Faraday effects Important, but Secondary Factors Population health (demand need) Health care system change, e.g., integration Science and technological change, e.g., telehealth 2 Office of Statewide Initiatives Page 1
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). 3 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 4 Office of Statewide Initiatives Page 2
Recruitment and Retention Issues Shortage of workers Compensation for workers Non-competitive salary Licensure issues, reciprocity Personal networking Internet postings Recruiters Place of education and training Source: OSI analysis of unpublished data from the GME and workforce surveys (2014, 2016). 5 Health Care Occupations in Nevada Job Postings 2015 Registered Nurses Medical and Health Services Managers Surgeons and Specialty Physicians Critical Care Nurses Physical Therapists Nursing Assistants Health Information Technicians Medical Assistants Nurse Practitioners Primary Care Physicians Licensed Practical Nurses Occupational Therapists Physician Assistants Medical Secretaries Speech-Language Pathologists Pharmacists Clinical Laboratory Technicians Pharmacy Technicians Patient Representatives Medical Scientists Radiologic Technicians & Surgical Assistants Clinical Laboratory Technologists 1,990 1,650 1,524 1,359 1,329 1,152 1,046 1,329 1,000 972 822 809 751 672 634 569 547 463 461 376 3,224 10,640 0 2,000 4,000 6,000 8,000 10,000 12,000 Source: OSI analysis of Burning Glass/Labor Insights data (2016). 6 Office of Statewide Initiatives Page 3
Health Care Occupations in Clark County Job Postings 2015 Registered Nurses Medical and Health Services Managers Critical Care Nurses Nursing Assistants Health Information Technicians Primary Care Providers Physical Therapists Medical Assistants Nurse Practitioners Surgeons and Specialty Physicians Licensed Practical Nurses Occupational Therapists Physician Assistants Medical Secretaries Speech-Language Pathologists Patient Representatives Pharmacists Clinical Laboratory Technicians Medical Scientists Pharmacy Technicians Clinical Laboratory Technologists 1,418 1,027 1,076 1,005 900 877 761 747 712 682 679 579 499 454 452 390 388 380 292 2,625 8,472 0 2,000 4,000 6,000 8,000 10,000 Source: OSI analysis of Burning Glass/Labor Insights data (2016). 7 Health Care Occupations in Washoe County Job Postings 2015 Registered Nurses 1,170 Physical Therapists 429 Medical and Health Services Managers 402 Surgeons and Specialty Physicians 249 Health Information Technicians 222 Nursing Assistants 220 Occupational Therapists 197 Primary Care Providers 195 Medical Secretaries 159 Nurse Practitioners 148 Licensed Practical Nurses 144 Speech-Language Pathologists 142 Critical Care Nurses 139 Clinical Laboratory Technicians 137 Medical Assistants 130 Educational and School Counselors 112 Occupational Therapy Assistants 109 Physical Therapist Assistants 105 Pharmacy Technicians 100 Radiologic Technicians & Surgical Assistants 85 Mental Health Counselors 76 Physician Assistants 75 0 200 400 600 800 1,000 1,200 1,400 Source: OSI analysis of Burning Glass/Labor Insights data (2016). 8 Office of Statewide Initiatives Page 4
Statewide Job Postings in Nevada for Physicians 2010 to 2016 5,000 4,500 4,366 4,000 3,500 3,466 3,000 2,500 2,000 1,984 2,707 1,834 2,468 1,981 1,500 1,000 500 0 2010 2011 2012 2013 2014 2015 2016 Projected 9 Statewide Job Postings in Nevada for Registered Nurses 2010 to 2016 14,000 12,770 12,000 10,000 10,640 8,000 6,000 5,456 6,866 6,717 5,795 7,084 4,000 2,000 0 2010 2011 2012 2013 2014 2015 2016 Projected 10 Office of Statewide Initiatives Page 5
Statewide Job Postings in Nevada for Medical and Health Services Managers 2010 to 2016 4,500 4,000 3,924 3,500 3,224 3,000 2,500 2,000 1,863 2,414 1,922 1,870 2,201 1,500 1,000 500 0 2010 2011 2012 2013 2014 2015 2016 Projected 11 Primary Care Physicians Number of MDs and DOs per 100,000 Population 60.0 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). 12 Office of Statewide Initiatives Page 6
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). 13 Case Study: Estimating Primary Care Supply and Demand in Washoe County Demand Estimating primary care visits age, gender, income, zip code Evolving utilization patterns, e.g., insurance effects, Supply Family medicine and general practice, Pediatricians, Internists Retirees, part-time vs. full-time, productivity Role of nurse practitioners & physician assistants 14 Office of Statewide Initiatives Page 7
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). 15 Retention of Registered Nurses Completing NSHE programs in Nevada 2009 to 2015 2015 (N=287) Have a Job Seeking a Job or Other Total Remaining in Nevada 25.4% 62.7% 87.7% Leaving Nevada 1.1% 10.8% 12.3% Total 26.5% 73.5% 100.0% 2006 to 2015 (N=773) Have a Job Seeking a Job or Other Total Remaining in Nevada 29.0% 58.7% 88.2% Leaving Nevada 1.0% 11.3% 11.8% Total 30.0% 70.0% 100.0% Source: Griswold & Packham. OSI Analysis of Nursing Student Exit Surveys (2016). 16 Office of Statewide Initiatives Page 8
Recent Reports from the UNSOM Office of Statewide Initiatives Physician Workforce in Nevada - 2016 Edition (March 2016) Health Workforce Supply in Nevada - 2016 Edition (March 2016) The Contribution of the University of Nevada School of Medicine to the Nevada Economy (March 2016) Health Care Careers in Nevada - 2016-2017 Edition (February 2016) http://medicine.nevada.edu/statewide/reports 17 Tabor Griswold, PhD Health Research Analyst Office of Statewide Initiatives University of Nevada School of Medicine (775) 784-1235 tgriswold@medicine.nevada.edu http://www.medicine.nevada.edu/osi http://medicine.nevada.edu/statewide/instant-atlas Office of Statewide Initiatives Page 9