Third Report of the Louisiana Health Works Commission

1 Third Report of the Louisiana Health Works Commission

3 rd Annual Report Louisiana Health Works Commission CONTINUING THE COMMITMENT TO MEETING THE HEALTHCARE WORKFORCE SHORTAGE April 2005 1

CONTINUING THE COMMITMENT TO MEETING THE HEALTHCARE WORKFORCE SHORTAGE 3 RD ANNUAL REPORT OF THE LOUISIANA HEALTH WORKS COMMISSION We are the only ones who have the power to accomplish what we set out to do. Author Unknown TABLE OF CONTENTS REPORT 3 Successes 6 Numbers Behind Success 9 Special Projects & Recommendations 10 Issues on the Horizon 12 Funding Recommendations 14 Summary 14 APPENDIX 15 Attachment 1: Health Works Committee Roster 16 Attachment 2: Allied Health Workforce Council 19 Attachment 3: Health Works Volunteers 21 Attachment 4: Dates and Places of Regional Meetings 23 Attachment 5: Regional Proposals (LMA # 1-8) 24 Attachment 6: Healthcare Workforce Supply and Demand Data 43 (Statewide & Regional) Attachment 7: HCR79 Faculty Salary Task Force Report 51 Attachment 8: Articulation Subcommittee Report 57 Attachment 9: Physician to Population Report 70 Attachment 10: Continuing Health Works Funding Available 72 in Board of Regents' Base Attachment 11: Health Works Commission Budget Request 73 for FY2005-06 Attachment 12: Medical Education Commission Report 74 (Summary) Attachment 13: Nursing Supply and Demand Commission 76 Report (Summary) Attachment 14: Allied Health Workforce Council Report 77 (Summary) 2

CONTINUING THE COMMITMENT TO MEETING THE HEALTHCARE WORKFORCE SHORTAGE 3 RD ANNUAL REPORT OF THE LOUISIANA HEALTH WORKS COMMISSION We are the only ones who have the power to accomplish what we set out to do. Author Unknown The third report of the Louisiana Health Works Commission, Continuing the Commitment, builds on the work of many committed individuals. This includes the members of the Commission itself, the members of the Allied Health Workforce Council, the Medical Education Commission, the Nursing Supply and Demand Commission and a number of volunteers who give their time and effort to address the healthcare workforce shortage in Louisiana. This year the Commission increased its collaborative efforts with the New Orleans Regional Task Force on Economic Development and Health Workforce Training by seating a member of the Task Force as an ad hoc member of the Commission and having a member of the Commission formally named to the Task Force. This has enabled both groups to work in a more collaborative manner to fashion solutions to the healthcare workforce shortage that are both regional and statewide in nature. Additionally, the Commission has strengthened its partnership with the state s four regional Area Health Education Centers (AHECs) partnering with them not only on healthcare workforce solutions but also in developing a new, more interactive and user friendly healthcare careers website. The Commission and its partners are especially grateful to the members of the Legislature who, during the past Legislative session, worked cooperatively with the Commission to meet the needs of the healthcare industry in the state. A special thanks goes to the Commissioner of Higher Education and the staff of the Board of Regents. From the inception of the Commission, Dr. Savoie and his staff have been active members of the Commission, the Executive Committee, the workgroups of the Commission and the Allied Health Workforce Council. The Board of Regents is the steward of the funds received from the Legislature and the staff has spent countless hours in administering and managing the capitation and stipend projects of the Commission as well as providing guidance to the Health Works staff. For the first time, Commission staff and members along with representatives of our state partner agencies held regional meetings to hear concerns of industry, education, workforce and economic development professionals regarding healthcare workforce shortages. At each meeting hosted and coordinated by the AHEC Directors and Staffs the Commission solicited proposals to meet region specific healthcare workforce needs. While the Commission is not able to recommend funding for these proposals at this time, it is grateful for the participation and work that the regional stakeholders submitted. (These are included as charts in the Appendix of this report along with the schedule and sites of the meetings.) It is important to note that there were no meetings held in Labor Market Area #1 (Orleans and surrounding parishes) and Labor Market #3 (Ascension, Terrebonne and Lafourche parishes) as these parishes are included and represented by the New Orleans Regional Task Force on Economic Development and Health Workforce Training with the 3

exception of Terrebonne Parish. Representatives of Terrebonne Parish were included by the Southwest Regional AHEC in their planning and submitted its own proposals. Additionally, representatives from a Louisiana Technical College site in Jefferson Parish attended the Labor Market Area #2 meeting and submitted a proposal separate and apart from the New Orleans Regional Task Force proposal. It was not possible to calculate the entire cost of the regional proposals, as there was no fiscal information available to calculate some costs. The total submitted to the Commission for its consideration (minus the New Orleans Regional Task Force request) amounts to $18,633,627. The Commission carefully considered the regional proposals and in its decision-making considered the precarious nature of the state s budget. As a result, the Commission decided to delay any new proposals. A number of the proposals have been referred to our state partners, as there may be alternative sources of funding available. Additionally, some of the proposals are calls for policy and/or changes in regulations, which have been referred to the respective boards and state agencies. The Commission is committed to building strong regional networks to address healthcare workforce shortages and while it cannot recommend funding for these initiatives at this time, it is committed to continued work with the regions to identify resources and solutions to address region specific needs. In future years, as the fiscal situation stabilizes, the Commission will be better able to recommend funding for specific regional initiatives. For the first time, Commission staff and members along with representatives of our state partner agencies held regional meetings to hear concerns of industry, education, workforce and economic development professionals regarding healthcare workforce shortages. The Commission s previous reports highlighted the importance of the healthcare sector to the state s economy. It bears repeating. More than 210,000 individuals are employed in the healthcare sector in Louisiana accounting for a $6.2 billion dollar payroll 15% of the state s total payroll and 14% of the state s total workforce. 1 The healthcare sector is especially important to rural areas as demonstrated through numerous studies. It is often the most important contributor to rural economies. A study by Kentucky Rural Health Works in 2002 defined five roles for healthcare in the rural setting. These are: 1) keeping local healthcare dollars at home, 2) attracting external dollars into the community, 3) attracting and retaining new industry, 4) attracting and retaining retirees to the area, and 5) promoting a healthy and productive workforce. 2 The Louisiana Department of Health and Hospitals, using impact for analysis planning (IMPLAN) data, has calculated the economic impact of the healthcare sector on our rural parishes. An examination of one parish alone indicates the importance of healthcare in rural economies. As the number one (1) employer in Avoyelles Parish healthcare consists of 1,390 employees creating an employee/facility income of $32,879,000, which of course results in payroll taxes. This sector produced an additional 2,147 jobs generating $48,495,000 in income. The sector created $15,906,360 in sales resulting in $159,064 directly to the parish in tax collections. 3 1 A Call to Action, Health Works 2 nd Annual Report, March 2004, p. 18. 2 Kentucky Rural Health Works Report, 2002, p.2. 3 The Importance of the Health Care Sector On the Economy of Avoyelles Parish, Louisiana, Jonathan Chapman and Kristy Nichols, September 2003, pp 23 24. 4

Healthcare is not just about economics though certainly the numbers bring home its importance to many who review the data. It is also a wellness issue. The Commission welcomes the added impetus of its importance as demonstrated by the Governor s Healthcare Reform Panel. At the present time, more of our parishes remain either totally or in part- underserved medical and dental areas as defined by the federal government. There are 11 parishes in our state that do not currently have an obstetrician/gynecologist physician - a statistic made all the more real by the infant mortality rate in our state. A study released by the Annie E. Casey Foundation indicated than while the national average is 6.8% (per 1,000 live births), Louisiana s infant mortality rate is 9.8%, the third highest in the nation. 4 Governor Blanco has set as a goal the recruitment of new businesses to the state as well a keeping our current businesses here. Healthcare, like education, is a quality of life issue. Without an adequate healthcare workforce, our economic and physical well-being are in jeopardy. The Louisiana Health Works Commission developed and presented to the Legislature and Governor last year a five-year plan to address the healthcare workforce shortage. The plan contains six recommendations and the Commission has made progress in achieving them. These include: 1) Improve the development and coordination of education, training and workforce policy for healthcare; 2) Increase the number of nursing and allied health educators and their salaries; 3) Increase the recruitment and the retention of healthcare professionals and improve workplace environment; 4) Increase the number of applicants and admissions to healthcare education/training programs and retain students in these programs; 5) Improve and streamline the education processes to facilitate entrants and advance existing workers; and 6) Develop supply and demand data bases and statistical models to facilitate planning, to serve as the basis for funding, program and legislative decision making, to assist in policy formation and to measure progress and results. The Health Works Plan is based on reliable, objective data, which is flexible enough to meet new and emerging trends. Stakeholder input at the local, regional and statewide level is essential. The plan is an in-depth diagram relying on state, regional and local partnerships. Stakeholders must be at the table to achieve our goals and to that extent we have been successful. The plan is based on reliable, objective data, which is flexible enough to meet new and emerging trends. The Commission looks forward to working with many partners as it strives to address and solve the healthcare workforce shortage in Louisiana. Over the past year, the Health Works Commission has had many successes. The Commission is especially pleased with the improved coordination and collaboration between the Commission and the Louisiana Department of Labor. There now exists a partnership that includes almost daily 4 15 th Annual Kids Count 2004 Data Book, Annie E. Casey Foundation, Baltimore, Maryland, June 2004. 5

conversations among staff and quarterly meetings between the Health Works Executive Committee and Secretary of Labor John Warner Smith and his staff. The result of this collaboration is greater use of both Incumbent Worker Training and Workforce Investment Act Funding. The Commission is committed to continuing these efforts, which result in a planned and fiscally responsible use of funds that avoids the duplication of effort and meets employers needs. Among the Commission s other successes over the past year are: 1. In collaboration with New Orleans Regional Task Force on Economic Development and Health and Workforce training secured $3 million to support healthcare workforce education and training during the 2004 Legislative session: o $1,700,000 nurse capitation program to enroll 300 additional nurse candidates; o $700,000 allied health capitation program to enroll 90 additional candidates into the clinical component of allied health programs (Physical Therapy, Physician s Assistant, Pharmacy, Surgical Technology, Respiratory Therapy); o $80,000 for Allied Health Recruitment Grants through Area Health Education Centers (AHECs) to support qualified students from rural areas who commit to return to rural areas to practice resulting in 2 students completing degrees in medical technology 4 students completing degrees in radiologic technology 1 student completing a degree as a pharmacy technician 2 students completing degrees as clinical laboratory technicians 1student completing a degree as pharmacist 1 student completing a degree as a physical therapist As part of the pilot there must be an employer commitment -- All have commitments from employers in rural areas Allen Parish Hospital, Ville Platte Medical Center, Jennings Hospital, Rite Aid (Bogalusa), Physical Therapy Practice (Assumption) Parish, Union General Hospital, Citizens Hospital (Columbia), Winn Parish Medical Center, Hessmer Pharmacy (Hessmer), Avoyelles Hospital, Bunkie General Hospital; o $50,000 for LPN Initiative to assess the quality, identify weakness and implement best practices prior to the establishment of a capitation LPN program; o $380,000 Nurse Faculty Stipend program begun in 2003, there are now 29 nurse educators who will complete their masters degrees in nursing this spring and an additional 20 nurse educators (Ph.D. and MSN) in the pipeline. This will increase the number of nurse educators at both public and private institutions in the state; o $25,000 for licenses for CD Roms for the Secondary Education Pharmacy Technician Pilot Project; and o $100,000 (separate appropriation not included in the $3 million) to the Workforce Commission to support Health Works Commission staff and Commission activities. 6

2. In collaboration with the Louisiana Department of Education and the Louisiana Pharmacy Board established a secondary Pharmacy Technician program at 40 high schools in Louisiana which this year will prepare 400 students to sit for national certification and complete 600 hours of internship leading to certification and licensure as pharmacy technicians. As part of this initiative, a statewide Secondary Pharmacy Technician Advisory Board has been formed. Membership includes pharmacists from each of the eight (8) pharmacy regions in the state as well as staff from the Department of Education and the Health Works Commission. The pharmacist members of the advisory group serve as advisors to the secondary pharmacy technician programs in their respective areas, assist with curriculum development, initiate policy changes and make recommendations for the future of the program. 3. Collaboration with CVS/pharmacy and state partners to assist conversion of Eckerd pharmacies to CVS/pharmacies affecting more than 1800 workers in Louisiana. This includes collaborative efforts with the Louisiana Department of Labor and the University of Louisiana at Monroe (Continuing Education) to develop an Incumbent Worker Training Program Proposal, which when implemented, will provide training to all current CVS employees. This is the beginning of a partnership which will eventually include outreach to local One-Stop Center consumers and other Louisiana citizens seeking good jobs with good salaries The CVS partnership which will eventually include outreach to local One- Stop Center consumers and other Louisiana citizens seeking good jobs with good salaries and benefits. and benefits. CVS/pharmacy is committed to the Career Ladder process and is proud that close to 50% of its managers have come through original entry-level hires. CVS/pharmacy also supports a pro-active high school education and training program and contributes scholarships for students planning to continue post-secondary programs in pharmacy. 4. Initiated the six regional meetings to seek solutions to regional-specific healthcare workforce shortages for inclusion in the third annual report to the Legislature. This is a first step. The Commission will continue to meet with and support regional groups seeking to identify resources to address their region-specific healthcare workforce shortages. 5. Data collection has provided the first ever survey of all post-secondary healthcare education and training programs in the state to assess the capacity (public, private and proprietary institutions), which is then matched against demand. The Commission reached agreement with the Louisiana Department of Health and Hospitals to include a demand questionnaire on all licensure submissions (new and renewal) of all entities licensed by DHH. The first step in this process will be an snap-shot in time study of demand. Subsequently, the Commission and DHH will survey employers at the time of licensure or license renewal. 6. Cooperation has resulted in first-ever survey of Louisiana-specific pharmacy demand data demonstrating a problem in the making. Working with its industry partners, associations and the Pharmacy Board, the Commission completed the first survey of pharmacy demand data. While the Commission was able to access national data, there had never been a survey of Louisiana pharmacists. Surveys were sent to 633 licensed pharmacies including the 7

7. large retail chains. Approximately 50% responded to the Commission s simple questionnaire which was also available online. The results show a vacancy rate of 7% for full-time pharmacists and 7% for full-time pharmacy technicians. The largest shortage occurs in the ranks of relief pharmacists more than 20%. This is especially serious for the small pharmacies as it means that their pharmacists cannot be ill or take a vacation. More than 79% of the respondents said it is very difficult or somewhat difficult to fill vacancies for full-time pharmacists. 78% indicated that it is very difficult or somewhat difficult to fill vacancies of part-time and/or relief pharmacists. 65% of respondents indicated it is very difficult or somewhat difficult to fill vacancies for full-time and/or part-time pharmacy technicians. All national data predicts that the shortages are expected to increase as the baby-boomers age. 8. HCR79 (Faculty Salary Task Force) recommended by Health Works Commission, authored and sponsored by Representative Sydnie Mae Durand (Chair, Louisiana House of Representatives Committee on Health and Welfare) to examine healthcare post-secondary faculty salary structures, which may hinder the recruitment and retention of healthcare faculty. The Task Force has issued its report and recommendations to the Health Works showing discrepancies which are particularly acute in the salaries paid to new hires and associate professors of nursing and allied health faculty at postsecondary institutions as compared to individuals with same level of education and experience in the private sector. 9. Articulation Subcommittee established within Health Works to examine the status of articulation (secondary to post-secondary and post-secondary to post-secondary) in response to concerns from Louisiana Legislators and various stakeholders. Having completed its work, the Articulation Subcommittee issued its report and recommendations, which were approved by the Health Works. As a result, the first statewide standardized articulation agreement for certified nursing assistants, licensed practical nurses, advanced degree nurses and bachelors of science nurses is now in effect. This fall, Louisiana s public post-secondary institutions will begin accepting students under the new agreement. Additional work and recommendations for allied health articulation is ongoing and recommendations for a statewide allied health articulation model will be presented to Health Works in 2006. At the present time, an additional 1,506 individuals are in healthcare education and training programs statewide through the use of IWTP. 10. Supported Louisiana Department of Labor and Louisiana Workforce Commission changes to Workforce Investment Act Unified State Plan, Eligible Training Provider List and Incumbent Worker Training Program rules and regulations to make the programs and funding more accessible and available for providers, employers and participants to increase the capacity of postsecondary healthcare education and training programs. The Health Works Commission and the Secretary of Labor and his staff now meet quarterly to coordinate healthcare education and training efforts. Through internal changes to the Incumbent Worker Training Program (IWTP), it is now possible to use this source of funds to train healthcare professionals. At the present time, an additional 1,506 individuals are in healthcare education and training programs statewide using IWTP funds. Additionally, the Health Works Commission supported the Workforce Commission and the Department of Labor in seeking a modification to local workforce investment area plans to use Title I funding for class size projects when there are an insufficient number of training providers or when programs are at capacity. As of this time, two local workforce investment areas (LWIA #10 St. 8

11. Bernard, St. Tammany and Plaquemines Parishes and LWIA #81 Ouachita Parish) have sought and had approved amendments to their local plans for class size projects. As a result, an additional twenty (20) LPNs are enrolled in a program in LWIA #10 and 20 RNs, 20 LPNs and 20 CNAs are enrolled in programs in LWIA #81. The Health Works Commission encourages other workforce investment boards to seek amendments to their local plans. 12. Established partnership with the Governor s Office of Rural Affairs to coordinate activities. Finding healthcare professionals for rural underserved areas is a daunting task. The Commission supports the Renewal Communities program as a venue to assist recruitment and hiring practices of eligible businesses as well as infrastructure improvements, which, may lead to additional healthcare services in rural areas. 13. Partnered with Louisiana Hospital Association, Metropolitan Hospital Council and the Area Health Education Centers (AHECs) to update design and information of the Louisiana Healthcare Resource Guide for a new and more interactive format on the World Wide Web. By June of 2005 a new website will be available for individuals interested in healthcare careers. The site has targeted middle and secondary students, adults seeking to change careers or adults who are involved in career exploration. 14. Increased public and legislative awareness of the need to address the healthcare workforce shortage. Over the past year numerous print and electronic stories have run building awareness of the shortage of healthcare professionals in Louisiana. Some of our post-secondary programs across the state are reporting record number of inquiries and applications for healthcare education and training programs. NUMBERS SHOW SUCCESSES As referenced previously, the use of Incumbent Worker Training Program funds and Workforce Investment Act funds has increased the numbers of individuals in training. The Appendix of this report contains the statewide and regional breakdowns of the healthcare workforce supply and demand as well as future projections. Additionally, the funding that the Commission has received from the Legislature over the past two years has increased the capacity of programs in nursing and allied health to enroll additional students. As noted in previous reports, one of the Of the sixteen (16) nursing programs in the state, eleven (11) had an excess of qualified applications in 2002-03 for the spaces available for admission. barriers to increasing the capacity of nursing programs is a lack of nurse educators. Of the sixteen (16) nursing programs in the state, eleven (11) had an excess of qualified applications in 2002-03 for the spaces available for admission. This is a national problem more than 5,000 qualified applicants were rejected nationally from nursing programs due to a lack of qualified faculty. At the present time, fifty (50) individuals in Louisiana are enrolled in Masters and Ph.D. level programs. A survey of the nursing programs throughout the state by the Louisiana Nursing and Supply Demand Commission (NSDC) indicates that, at a minimum, nursing programs across the state (public and private) anticipate hiring fifty-one (51) faculty members; however, the need may be as great as sixtyeight (68). Unfortunately, it is not as simple as locating individuals with Masters or Ph.D.s in nursing. Deans of Nursing must also find individuals who have specialties in specific clinical areas to meet certification requirements. Thus, while there are fifty (50) nurse educators in the pipeline, it 9

is just barely meeting the demand. As stated in previous reports, many of faculty are at or near retirement age ensuring the need for additional nurse educators. As noted previously in this report, the Commission has successfully implemented stipend and capitation programs to increase the number of healthcare professionals as shown in the Attachment section of this report. The Commission s data collection allows it to predict statewide as well as regional numbers of projected annual growth, projected annual replacement, projected annual demand, estimated vacancies, number of completers and the differences in long term and short term supply and demand. Included in this report is a prediction of the numbers of individuals who are expected to work in Louisiana once the education is completed. The Commission encourages policymakers to use these data in making decisions concerning the funding and/or continuation of our healthcare education and training programs. SPECIAL PROJECTS AND RECOMMENDATIONS The HCR79 Faculty Salary Task Force began meeting in August of 2004 to address possible discrepancies between faculty salary pay and that of their counterparts in the private sector. Dr. Elizabeth Humphrey (LSUHSC-New Orleans) and John Matessino (Health Works Commission Chair and President of the Louisiana Hospital Association) chaired the Task Force. The Task Force Report is included in the Appendix of this report. Commission members and others had long suspected that one of the reasons for difficulty in recruiting faculty is the salary discrepancy, but there was no objective research to confirm or reject the anecdotal suppositions. A survey of nursing faculty (both instructor and assistant professor level) found that salaries fall below faculty salaries in the southern region. The Southern Regional Education Board (SREB) ranks Louisiana 15 th out of 16 for public 4-year institutions and 13 th out of 16 for public 2-year institutions. As a result, Louisiana post secondary institutions not only have to compete with the private sector but with the other states in its efforts to recruit Masters and Ph.D. prepared nursing faculty. As noted previously in this report, nursing programs are at capacity and lack of faculty severely limits the number of individuals accepted into nursing programs each year. Licensed Practical Nurses are not eligible to teach in LPN programs. As a result, registered nurses hold the faculty positions in the LPN programs. The HCR79 survey reports a $2,000 to $5,000 differential between the pay of a faculty position in the LPN programs and that of a staff nurse (RN-2 or RN-3) in a hospital setting. As a result of this discrepancy, potential LPN instructors are foregoing teaching opportunities for hospital settings. There are similar discrepancies in the allied health fields as well. The HCR79 Task Force reported that it is especially the case in the fields of physical therapy, physician assistant and medical technology. Many allied health professions now require Master s or PhD s for entry-level faculty positions. Unless the salary differential is addressed it will be more difficult to both recruit and retain nursing and allied health faculty. Many allied health professions now require Master s or PhD s for entry-level faculty positions. The HCR79 Task Force made two (2) recommendations to the full Commission. The first, which relies on capitation increases, was accepted by the Commission as part of the report but not endorsed for further action. The Commission expressed concern that there may be potential legal 10

problems in the implementation of the recommendation. The Commission is asking the Legislature to consider the second recommendation for implementation at some point in time. The second recommendation is the creation of a pool for funds, which could be established for faculty salary increases. The fund would be available on a 50:50 match basis for state supported schools. Each institution would apply to the state for funding, which is matched by funds from their own budgets or funds solicited from community, industry or alumni partnerships. The state portion of the budget would become part of the institutions budgets in subsequent years. While the Commission recognizes that implementation of this recommendation for the upcoming fiscal year may not be possible, it is hoped that the Legislature will consider this in a more stable budget year. At a minimum, however, the Commission would recommend that nursing and allied health faculty be exempt from possible staff reductions should such reductions become a necessity. One of the first actions of the subcommittee was to define articulation as a process through which academic programs facilitate the educational progress with minimal loss of credit and The Health Works Committee on Education and Articulation, recognizing the importance of articulation, the Commission established an Articulation Subcommittee to address nursing and allied health articulation. The Subcommittee was charged with reviewing and making recommendations relative to the articulation process in nursing and allied health. One of the first actions of the subcommittee was to define articulation as a process through which academic programs facilitate the educational progress with minimal loss of credit and duplication of knowledge and skills. Although Act 818 of the 1991 Legislature required each institution to develop an articulation model, the model was not a statewide model. As a result, students and adults returning to school for additional education and training were often confused by the conflicting models in effect at post-secondary institutions. The Subcommittee, under the chairmanship of Dr. Donnie Booth (Southeastern Louisiana University), identified barriers to articulation and recommended the issue of nursing articulation to the Nursing Supply and Demand Commission. At the request of the Nursing Supply and Demand Commission, the Louisiana State Board of Nursing convened the Taskforce on Nursing Education Articulation. Representatives to the Taskforce included representatives of the State Board of Nursing, the Board of Licensed Practical Nurse Examiners and all post-secondary nursing programs. The Commission applauds the work of the LSBN Task Force for their commitment to developing an articulation model that will permit movement from CNA to LPN to RN (Associate and Baccalaureate). For the first time, Louisiana has a statewide, standardized articulation model that will be implemented in the fall of 2005. For students who wish to move within programs or adult professionals who wish to return for additional education and training, this agreement means less time spent taking duplicative coursework. For employers, it means nurses who are ready to enter the world of work in a shortened time period. The model is also applicable to our secondary students who complete coursework leading to careers in nursing. One outcome of the work of the Subcommittee is the realization that for the model to be truly successful, there is a need to standardize the curriculum for CNAs as there is for RNs and LPNs. This is now a formal recommendation from the Subcommittee in the formal report. A copy of the full report of the Subcommittee is contained in the Appendix. In the coming year, the Education and Articulation Committee of the Health Works Commission will examine the issue of a standardized curriculum for CNAs. The issue of allied health articulation is referred to the Allied Health Workforce Council for the same in-depth review and study that produced the nursing model. 11

ISSUES ON THE HORIZON As the Health Works Commission continued its work during the past year, other issues were on the horizon. The Commission is not static in its nature its role is to not only work to solve today s healthcare workforce shortage, but to look beyond today. Some of the issues are a direct result of the successes of the Commission and its partners and remind us, that solutions to the healthcare workforce shortage are often a matter of balance. The Commission wishes to present these as items, which require if not immediate solutions discussion and attention. Lack of Clinical Space: Over the past few months, as the capacity of our nursing programs (at all levels) and allied health programs have increased, many of the Deans of Nursing and others have expressed concern over the lack of clinical space. This is especially true of the rotations required on psychiatric, pediatrics, obstetrics/gynecology, intensive care and emergency wards. A number of programs are now offering rotations during the evening hours and on weekends. A matter of concern is the impact on the patient in hospitals with over-flow clinical conditions. It is important not to have patient burnout as it may adversely affect their physical condition. The Commission will work with the respective boards and industry stakeholders over the next year to examine the issue and may, at some point in time, make recommendations to address the issue. Other states have addressed the issue by recruiting retired faculty back to supervise clinical rotations in rural areas or during evening hours as well as providing transportation reimbursement for long commutes to reach clinical sites. Capacity of Nursing and Allied Health Programs: While capitation funds have permitted our public institutions to increase the capacity of their nursing and allied health programs, there are still large numbers of well-qualified individuals who are not permitted entry into nursing and allied health programs due solely to the capacity of these programs. This results in students who must then either switch majors and/or take additional courses merely to retain their academic status. The eventual outcome for these students on TOPs is that they exhaust their funding while waiting for acceptance to clinicals and leave many without the financial resources to continue. The Commission recognizes that while this is a capacity problem, it is not as simple as adding more instructors. It is often difficult to recruit new faculty in view of the education vs. private practice salary levels and with clinical sites reaching capacity, there is no simple answer. A resolution passed during the most recent session under the auspices of the Board of Regents, addresses the issue. The Commission will work with the Board of Regents and other stakeholders to address the issue. Postsecondary Budgets: As noted in the accomplishments section, the Commission and its partners have been successful in securing funding for fifty new nurse educators. While this is good news, the Commission is also aware that many of our post-secondary colleges and universities do not have the funding available to hire new faculty members. The recipients of the stipends are obligated to teach one year for every $10,000 received. While the Commission may have increased the number of potential faculty members through the stipends, if the colleges and universities do not have the funding available to hire new faculty, the capacity problem remains unsolved. Insufficient Number of Physicians: Recent studies indicate that the United States is soon to face (already does in a number of areas) a physician shortage. Richard Cooper predicts that we will have 12

200,000 fewer physicians than we need in 2020 5. Dr. Perry Rigby, Chair of the Medical Education Commission, reports that the trend is the same in Louisiana and as one solution suggests, that there should be a high priority to preserve and support the academic health centers and teaching hospitals where production of physicians take place. 6 According to the U.S. and News Report, Med school applications are 10,000 below the 1996 peak of 47,000 and the median debt level has increased more than 4.5 times. In 2003, the median debt for graduates of public medical schools was $100,000 and, for private schools $135,000. 7 At the present time, Louisiana s match of residents applying for medical school in Louisiana has remained relatively constant. Additionally, the number of physicians practicing in the state has remained relatively level. There is no doubt however, that there is a problem of distribution in the state. The Health Resources Services Administration ratio is 19.8 physicians to each 10,000 population. There are parishes within our state that according to this ratio are underserved thus showing a distribution problem rather than a current shortage. There is a need to address the current distribution problem now, before the forecasted national shortage occurs. The Appendix of the report is a breakdown of physician to population by parish. The Commission maintains its commitment to work with the Area Health Education Centers and others to recruit individuals from underserved areas into medical education with incentives to specialize in shortage specialties (family practice, pediatrics, obstetrics, etc.). Anthony E. Keck and Richard A. Culbertson in a paper prepared for the Louisiana Department of Health and Hospitals reported a study by Rabinowitz et al. in which they described predicators of individuals likely to provide healthcare to underserved populations. Two of those factors having a strong interest in practice in an underserved area prior to attending medical school and growing up in an underserved area 8 support the Commission s commitment to growing our own. The Commission s current pilot project with the AHECS while focusing on allied health students rather than medical students, is an example of such commitment. Standardized Certified Nurse Assistant Programs: The report of the Articulation Subcommittee which resulted in the newly standardized statewide articulation model for nursing in Louisiana has recommended a review of certified nurse assistant programs and a possible move to standardizing these programs. This would enhance the opportunities for CNAs across the state to move on to complete requirements for licensure as practical nurses or registered nurses. A number of states have such standardized programs as well as licensure for CNAs. Recent studies indicate that the United States is soon to face (already does in a number of areas) a physician shortage. Adult Leaning and Basic Skills: The Articulation Subcommittee also noted in its recommendations a need for workplace literacy and adult learning opportunities especially for CNAs. Many CNAs who would like to advance in their professions are not successful due to the academic rigors of the programs. Adult learning and workplace literacy classes conducted at their 5 Alan M. Garber, MD, PhD., Editorial/U.S. Physician Workforce, Annals of Internal Medicine, Volume 141, Number 9, November 2, 2004, p.732. 6 Perry Rigby, MD, Physician Production is at a Steady Supply, but Demand for Physician Services is Increasing, Louisiana State Medical Society, Volume 156, March/April 2004, p. 93. 7 Doctors Vanish From View, U.S. News and World Report, January 31, 2005 p. 50. 8 Anthony E. Keck and Richard A. Culbertson, Literature Review Influences on Physician Choice to Practice in Rural Areas, May 18, 2004, p. 7. 13

workplaces would be of great benefit. The Adult Learning Task Force submitted recommendations to the Governor and the Commission is supportive of the Task Force efforts and is hopeful that some of the solutions they propose will address this problem. While the Commission specifically addresses healthcare workforce needs, the statistics indicate that with more than 699,000 individuals 25 years of age or older in Louisiana who do not have high school diplomas, the crisis is very real and has an adverse impact not only on the healthcare workforce sector but the entire workforce. FUNDING RECOMMENDATIONS FY05-06 The Health Works Commission is requesting funding for FY2005-06 in the amount of $2,972,000. The breakdown of the budget amount and categories is contained in the Appendix of the report. While the Commission received more than $18 million dollars in proposals from regional areas, in view of the current fiscal status of the state, the Commission is not requesting this level of funding. While many of the regional proposals are worthwhile, the Commission recognized as its priorities the actual education and training of the healthcare workforce. Thus, the funding request for this year, is directed almost entirely for the actual education and training of nurses, nurse educators and allied health personnel. The two exceptions are $100,000 for data collection and management and statistical modeling for the Health Works Commission to move it beyond the current level of data collection and analysis and provide better predictive models. The Commission is also requesting $50,000 to develop, in partnership with the Louisiana Department of Education, a secondary pharmacy technician curriculum. At the present time, the secondary pharmacy technician program is using a curriculum provided by PASS ASSURED and approved by the Pharmacy Board of Louisiana. However, the costs of the diskettes for and licensing of the program exceed $23,000 per year and the consensus of the Commission is that these funds would be better spent developing a standardized state curriculum with a one-time cost rather than continuing the $23,000 per year. SUMMARY Although the Health Works Commission and the Allied Health Workforce Council have been in effect only three years, great strides have been made in addressing the shortage of healthcare professionals in the state. While Louisiana does not have the funding available for healthcare workforce and training that other states have dedicated, Louisiana has made the most of what it does have and will continue to do so. Early on the Commission established principles of operation. Two of these principles form the foundation of the Commission s work. The first is that all decisions are based on objective, reliable data not anecdotal. Adherence to this principle has enabled the Commission to make recommendations to the Legislature and the Governor that are sound and not subject to misinterpretation. Secondly, the Commission believes that when one benefits we all benefit that is, representatives of various interests and professions leave their hats at the door and work for the good of all. As a result, the Commission has made decisions to address the most serious of the shortages nursing first, addressing others as funding and resources are available. The Commission will continue its work and commitment to provide the Governor and the Legislature with the information needed to make the best use of the state s resources while benefiting the employers and citizens of Louisiana. 14

15 APPENDIX TO THE 3 RD ANNUAL HEALTH WORKS REPORT

Louisiana Health Works Commissioners (2004-2005)* Name of Member Address Phone, Fax, & Email Dr. Nancy Alexander, Director University of Louisiana at Monroe Graduate Building 1-142 700 University Avenue Monroe, LA 71209 (318) 342-1039 (ph) (318) 342-1042 (fax) nalexander@ulm.edu Mr. Ray A. Bias, Manager Acadian Ambulance Post Office Box 98000 Lafayette, LA 70509 (337) 291-1586 (ph) (337) 291-4486 (fax) rbias@acadian.com Dr. Donnie F. Booth, Dean *Chair, Nursing Supply and Demand Commission and Health Works Commission Executive Committee Dr. William Bourn, Associate Vice President for Development of the College of Health Sciences Miles Bruder, Healthcare Reform Policy Analyst Southeastern School of Nursing and Health Sciences SLU 10781 Hammond, LA 70402 University of Louisiana at Monroe 700 University Avenue Monroe, LA 71209 Office of the Governor Post Office Box 94004 Baton Rouge, LA 70804-9004 (985) 549-3772 (ph) (985) 549-5179 (fax) dbooth@selu.edu (318) 342-3621 (ph) (318) 342-1606 (fax) wbourn@ulm.edu (225) 342-7015 (ph) (225) 342-8249 (fax) bruderm@gov.state.la.us Gerald Bryant, President Louisiana Organization of Nurse Executives Lake Charles Memorial Hospital 1701 oak Park Boulevard Lake Charles, LA 70601 (337)- 494-3208 (ph) (337-494-2596) (fax) bryant@lcmh.com Ms. Lanette Buie, Human Resources Administrator Dr. Walter G. Bumphus, President Dr. James M. Cairo, Dean The Honorable Sydnie Mae Durand, Chair Ms. Patricia Faxon, Legislative Liaison *Health Works Commission Executive Committee LSUHSC Health Care Services Division 8550 United Plaza Blvd., 4 th Floor Baton Rouge, LA 70809 Louisiana Community and Technical College System 265 South Foster Drive Baton Rouge, LA 70806-4104 School of Allied Health Professions LSUHSC 1900 Gravier Street New Orleans, LA 70112 The House Committee on Health & Welfare Louisiana House of Representatives Post Office Box 2840 Parks, LA 70582 Louisiana Department of Health and Hospitals Post Office Box 629 1201 Capitol Access Road Baton Rouge, LA 70821-0629 (225) 922-0753 (ph) (225) 922-2285 (fax) lbuie@lsuhsc.edu (225) 219-8727 (ph) (225)-219-8710 (fax) wbumphus@lctcs.state.la.us (504) 568-4248 (ph) (504) 568-4249 (fax) jcairo@lsuhsc.edu (337) 845-4240 (ph) (337) 394-3142 (ph2) (337) 845-4095 (fax) larep046@legis.state.la.us (225) 342-4773 (ph) (225) 342-5568 (fax) pfaxon@dhh.state.la.us 16

Deborah Ford, President Mr. Ronald A. Goux, President Dr. Stephen Guempel, Vice Chancellor The Honorable Melvin l. Kip Holden, Chair Dr. Elizabeth Humphrey, Dean The Honorable Willie Hunter, Chair Dr. Melba Kennedy, Education Program Coordinator 3 Dr. Cathy Lazarus, M.D. Dr. Kim Edward LeBlanc, M.D., Professor and Head John Matessino, President and CEO *Chair, Health Works Commission and Health Works Commission Executive Committee Dr. Joseph McCulloch, *Chair Allied Health Workforce Council and Health Works Commission Executive Committee The Honorable William Joe McPherson, Chair Louisiana State Board of Nursing 3510 North Causeway Boulevard Suite 501 Metairie, LA 70002 Louisiana Nursing Home Association Post Office Box 1429 Mandeville, LA 70470-1429 Louisiana State University at Eunice Academic Affairs Post Office Box 1129 Eunice, LA 70535 The Senate Committee on Labor and Industrial Relations Louisiana State Senate Post Office Box 94183 Baton Rouge, LA 70804 LSUHSC School of Nursing 1900 Gravier Street New Orleans, LA 70112 The House Committee on Labor & Industrial Relations Louisiana House of Representatives Post Office Box 3105 Monroe, LA 71210-3105 Division of Career and Technical Education Louisiana Department of Education Post Office Box 94064 Baton Rouge, LA 70804 Tulane University School of Medicine 1430 Tulane Ave. SL 96 New Orleans, LA 70112 Department of Family Medicine LSUHSC 1542 Tulane Avenue, Room 123 New Orleans, LA 70112 Louisiana Hospital Association 9521 Brookline Avenue Baton Rouge, LA 70809-1431 LSU Health Sciences Center Shreveport Post Office Box 33932 Shreveport, LA 71130 The Senate Committee on Health and Welfare The Louisiana State Senate Post Office Box 94183 Baton Rouge, LA 70804 (504) 838-5332 (ph) (504) 838-5433 (fax) dford@lgmc.com (985) 626-1900 (ph) (985) 727-9963 (fax) pontrx@aol.com (337) 550-1301 (ph) (337) 550-1306 (fax) sguempel@lsue.edu (225) 342-2040 (ph) (225) 342-0617 (fax) lasen15@legis.state.la.us (504) 568-4106 (ph) (504) 599-0573 (fax) ehumph@lsuhsc.edu (318) 362-5492 (ph) (318)-362-4133 (fax) larep017@legis.state.la.us (225) 219-9334 (ph) (225) 219-7844 (fax) mkennedy@doe.state.la.us (504) 988-5503 (ph) (504) 988-6546 (fax) clazarus@tulane.edu (504) 568-4578 (ph) (504) 838-5349 (fax) pmccla@lsuhsc.edu (225) 928-0026 (ph) (225) 923-1004 (fax) jmatessino@lhaonline.org (318) 675-6800 (ph) (318) 675-4783 (fax) jmccul@lsuhsc.edu (225) 342-2040 (ph) (225) 342-0617 (fax) lasen29@legis.state.la.us 17

Michael J. Oliver, Secretary Dr. J.D. Patterson, M.D., President Dr. Norann Planchock, Dean Dr. Janet Rami, Dean Ms. Mary Regan, CEO Louis Reine, Secretary-Treasurer Dr. Perry Rigby, M.D., Professor of Medicine *Chair, Medical Education Commission and Health Works Commission Executive Committee Dr. E. Joseph Savoie, Commissioner *Health Works Commission Executive Committee John Warner Smith, Secretary Dr. Michael Smith CEO Ann S. Williamson, Secretary Louisiana Department of Economic Development Post Office Box 94185 Baton Rouge, LA 70804-9185 Louisiana Medical Association 1511 Orange Street Monroe, LA 71202-2325 College of Nursing Northwestern State University 1800 Line Avenue Shreveport, LA 71101-4653 Southern University and A&M College System School of Nursing Post Office Box 11794 Baton Rouge, LA 70813 Acadiana EAP, LLC 222 Rue De Jean, Suite A Lafayette, LA 70508 Louisiana State AFL-CIO Post Office Box 3477 Baton Rouge, LA 70821-3441 LSUHSC Clinical Science Research Building 533 Bolivar Street, Room 511 New Orleans, LA 70112 Louisiana Board of Regents 1201 N. Third Street, Ste. 6-200 Baton Rouge, LA 70802 Louisiana Department of Labor Post Office Box 94094 Baton Rouge, LA 70804 Our Lady of the Lake College 7434 Perkins Road Baton Rouge, LA 70808 Louisiana Department of Social Services Post Office Box 94185 Baton Rouge, LA 70804-9185 (225) 342-5388 (ph) (225) 342-9095 (fax) olivier@la.gov (318) 322-7798 (ph) (318) 322-1335 (fax) contactjdp@jam.rr.com (318) 677-3100 (ph) (318) 677-3127 (fax) planchockn@nsula.edu (225) 771-2166 (ph) (225) 771-2641 (fax) janetrami@suson.subr.edu (337) 993-0000 (ph) (337) 593-8105 (fax) mregan@acadiana-eap.com (225) 383-5741 (ph) (225) 383-8847 (fax) (504) 568-8977 (ph) (504) 568-4460 (fax) prigby@lsuhsc.edu (225) 342-4253 (ph) (225) 342-9318 (fax) commish@regents.state.la.us (225) 342-3011 (ph) (225 (342-9318 (fax) jwsmith@ldol.state.la.us (225) 768-1710 (ph) (225) 768-0811 (fax) msmith@ololcollege.edu (225) 342-7275 (ph) (225) 768-0811 (fax) ann.williamson@dss.state.la.us Commission Staff Address Phone, Fax, & Email KarenSue Zoeller Governor s Office of the Workforce Commission P.O. Box 94004 Baton Rouge, LA 70804 (225) 219-4491 (ph) (225-342-1494 )fax) kzoeller@idsmail.com The members on this Roster reflect those who served during the preparation and drafting of this year s report. 18