Hannah Maxey, PhD, MPH, RDH Assistant Professor and Director of The Bowen Center for Health Workforce Research and Policy

Hannah Maxey, PhD, MPH, RDH Assistant Professor and Director of The Bowen Center for Health Workforce Research and Policy

Health Workforce: The intersection of health sciences, health systems, and population/patient health

Defining the Health Workforce Health workers are "all people engaged in actions whose primary intent is to enhance health" (World Health Report 2006). Three categories are defined by the Bureau of Labor Statistics (http://www.nhpf.org/library/backgroundpapers/bp_workforce_4-03.pdf ) Health professionals in health service settings Health professionals in other settings Other workers in health service settings

Workforce Composition Indiana s Health Workforce Licensed Occupations Non-licensed Occupations

Indiana s Licensed Health Professions There are over twenty different licensed health professions in Indiana: Allopathic Physician (MD) Osteopathic Physician (DO) Physician Assistant Podiatrist Registered Nurse Licensed Practical Nurse Nurse Midwife Dentist Dental Hygienist Pharmacist Optometrist Audiologist Hearing Aid Distributor Psychologist Mental Health Counselor Marriage and Family Therapist Social Worker Clinical Social Worker Addiction Counselor Clinical Addiction Counselor Respiratory Care Practitioner Speech Pathologist Chiropractor Occupational Therapist Massage Therapist Dietician

Trends in Supply 30000 25000 20000 15000 10000 5000 Allopathic Physicians (MD) Osteopathic Physicians (DO) Physician Assistants Licensed Practical Nurses Advanced Practice Nurses Pharmacists Dentists Social Workers Clinical Social Workers Addiction Counselor Clinical Addiction Counselor Mental Health Counselor 0 2011 2012 2013 2014 2015 2016

Trends in Growth 0.200 AXIS TITLE 0.180 0.160 0.140 0.120 0.100 0.080 0.060 0.040 0.020 Allopathic Physicians (MD) Osteopathic Physicians (DO) Physician Assistants Registered Nurses Licensed Practical Nurses Advanced Practice Nurses Pharmacists Dentists Social Workers Clinical Social Workers Addiction Counselor Clinical Addiction Counselor 0.000 2013 2014 2015 2016 Mental Health Counselor

Headcount versus Capacity 2005 22,351 Total licensed physicians 5,237 Active Indiana physicians 2015 26,536 Total licensed physicians 10,057 Active Indiana physicians 30000 25000 20000 15000 10000 5000 0 2004 2006 2008 2010 2012 2014 2016 Total Licensed Physicians Total Active Physicians N=10,057

Even Year Renewals Dentists Dental Hygienists Licensed Practical Nurse Optometrists Physician Assistants Pharmacists Chiropractor Dietitian Occupational Therapist Physical Therapist Respiratory Care Practitioner Social Worker Clinical Social Worker Marriage & Family Therapist Marriage & Family Associate Mental Health Counselor Mental Health Associate Addiction Counselor Clinical Addiction Counselor Biennial Licensure Survey (Existing in black, New in Red) Odd Year Renewals Physicians (MD and DO) Registered Nurses Audiologist Speech Pathologist Massage Therapist (2017)

Workforce Data Reports

Diversity Race Race to White Ratio Asian 1:6 Black or African American 1:15 Other Ethnicities 1:14 Ethnicity Hispanic or Latino to Not Hispanic or Latino Ratio Hispanic or Latino 1:37 *Other Ethnicities is inclusive of multiracial ethnicities. **Data as of last license renewal period for physicians

Specialty, 2015 Primary care specialties: Family Medicine General Practice General Internal Medicine General Pediatrics Obstetrics & Gynecology HRSA definitions: http://bhpr.hrsa.gov/shortage/hpsas/designationcrit eria/primarycarehpsacriteria.html Primary Care 38% Unknown Specialty 1% Other Specialty 61% N=10,057

Practice Characteristics Hours in direct patient care 35% report practicing 40+ hours in primary practice location Safety-net capacity among Indiana physicians 53% do not offer a sliding fee scale 9% do not serve Indiana Medicaid recipients 35% report less than 10% of their patients are Indiana Medicaid recipients

Urban/Rural Geography, 2015 Urban Physicians Total Physicians 8,702 Mean Age 50.40 Average FTE 0.78 Percent Primary Care 77.02 Rural Physicians Total Physicians 1,042 Mean Age 52.70 Average FTE 0.76 Percent Primary Care 12.79 Note: 21.9% of Indiana s population resides in rural communities (as defined by the United State Office of Management and Budget (OMB)

Physician Distribution, 2015 764 Indiana residents per physician FTE Best ratio: Lake County (175 per FTE)

2015 PC-HPSA and MUA/P Designations

Leveraging Workforce Data to Assess Population Health/System Issues