Current and Projected Health Workforce Supply and …...Physician Characteristics and Distribution...

Packham & Griswold 2/24/2016

Office of Statewide Initiatives

Current and Projected Health Workforce Supply and Demand in Nevada

John Packham, PhD and Tabor Griswold, PhD


University of Nevada School of Medicine

February 24, 2016

Nevada’s Health Workforce

2



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



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 NevadaNumber of Jobs (Thousands) – 2005 to 2015

6

77.4

91.0

109.7

35.741.4

48.7

20.1 23.4 26.7

0

20

40

60

80

100

120

Health Care and Social Assistance Ambulatory Health Care Services Hospitals

2006 2007 2008 2009 2010 2011 2012 2013 2014 20152005

Source: Nevada Department of Employment, Training, and Rehabilitation (2016).



7

Health Care Employment in Las Vegas Number of Jobs (Thousands) – 2005 to 2015

51.8

61.9

74.4

24.829.6

36.6

12.415.2 18.3

0

10

20

30

40

50

60

70

Health Care and Social Assistance Ambulatory Health Care Services Hospitals

2005 2006 2007 2008 2009 2010 2012 2013 2014 20152011

Source: Nevada Department of Employment, Training, and Rehabilitation (2016).

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%)

8Source: Nevada Department of Employment, Training, and Rehabilitation (2016).



Health Care Sector in NevadaJob Postings – 2013 to 2015

9Source: OSI analysis of Burning Glass/Labor Insights data (2016).

12,751

16,160

21,311

0

5,000

10,000

15,000

20,000

25,000

2013 2014 2015

10

Hospitals in NevadaJob Postings – 2013 to 2015

Source: OSI analysis of Burning Glass/Labor Insights data (2016).

8,594

11,624

13,904

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

2013 2014 2015



Ambulatory Care in NevadaJob Postings – 2013 to 2015

11

3,3693,623

5,908

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

2013 2014 2015


Skilled Nursing Facilities in NevadaJob Postings – 2013 to 2015

12

788

913

1,499

0

200

400

600

800

1,000

1,200

1,400

1,600

2013 2014 2015




Health Care Occupations in Nevada Job Postings – 2015

13Source: OSI analysis of Burning Glass/Labor Insights data (2016).

376521540553671713721777812826843847922

1,1821,3581,3671,423

1,9252,430

8,645

0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000

Mental Health Counselors

Pharmacists

Educational and Vocational Counselors

Pharmacy Technicians

Speech-Language Pathologists

Physician Assistants

Clinical Laboratory Technicians

Medical Assistants

Licensed Practical Nurses

Occupational Therapists

Primary Care Physicians

Nurse Practitioners

Medical Secretaries

Health Information Technicians

Physical Therapists

Critical Care Nurses

Nursing Assistants

Surgeons and Specialty Physicians

Medical and Health Services Managers

Registered Nurses

Physicians Job Postings – from 2013 to 2015

14

1,586

1,116

2,214

380 369 494

-

500

1,000

1,500

2,000

2,500

2013 2014 2015

Health Care Other Industries




Registered NursesJob Postings – 2013 to 2015

15

3,818

4,747

7,131

1,504 1,841

2,901

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

2013 2014 2015

Health Care Industries Other Industries


Physical TherapistsJob Postings – 2013 to 2015

16

659

863

1,203

62146 155

0

200

400

600

800

1,000

1,200

1,400

2013 2014 2015





Health Information TechniciansJob Postings – 2013 to 2015

17

196

363

520

338

426

662

0

100

200

300

400

500

600

700

2013 2014 2015



Physician AssistantsJob Postings – 2013 to 2015

18

333 337

539

105 110

198

0

100

200

300

400

500

600

2013 2014 2015





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 ACA-related 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



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 ACA-related demand

• Persistent specialty shortages and geographic maldistribution of physicians and most other health professionals

22



Current Physician Workforce RankingsNumber of Active Licensees per 100,000 Population

• Physicians, MD & DO – 48th

• Patient Care Physicians – 48th

• Primary Care Physicians – 50th

• Patient Care Primary Care Physicians – 50th

• Residents & Fellows – 47th

• Residents & Fellows in Primary Care – 48th

Source: UNSOM Office of Statewide Initiatives (2016).23

• Anesthesiology – 24th

• General and Family Practitioners – 46th

• General Surgeons – 51st

• Internal Medicine – 30th

• Obstetricians and Gynecologists – 45th

• Ophthalmologists – 49th

• Orthopedic Surgeons – 51st

• Pediatricians – 47th

• Psychiatry – 47th

Source: UNSOM Office of Statewide Initiatives (2016).

24

Current Physician Workforce RankingsNumber of Active Licensees per 100,000 Population



Current Nursing Workforce RankingsNumber of Active Licensees per 100,000 Population

• Registered Nurses – 51st

• Nurse Practitioners – 51st

• Certified Nurse Anesthetists – 50th

• Licensed Practical Nurses – 48th

Source: UNSOM Office of Statewide Initiatives (2016).25

Current Health Workforce Rankings Number of Active Licensees per 100,000 Population

• Dentists – 34th

• Dental Hygienists – 36th

• EMTs and Paramedics – 36th

• Pharmacists – 38th

• Physical Therapists – 45th

• Physician Assistants in Clinical Practice – 38th

• Psychologists – 47th

Source: UNSOM Office of Statewide Initiatives (2016).

26



27

227.8

254.9

136.2

160.8

65.6 60.9

150.0 154.9 159.1170.0 171.3 172.3

50

100

150

200

250

300

2004 2006 2008 2010 2012 2014

Urban North

Urban South

Rural and Frontier

Nevada Total

Source: OSI analysis of unpublished data from Nevada State Board of Medical Examiners (2016).

Number of Licensed Allopathic Physicians (MDs) per 100,000 Population in Nevada – 2004 to 2014

28

776.7

944.0

586.1

738.3

441.4

502.3

614.9 612.5637.4

704.6735.0

762.3

400

600

800

1,000

2004 2006 2008 2010 2012 2014

Urban North

Urban South

Rural and Frontier

Nevada Total

Source: OSI analysis of unpublished data from Nevada State Board of Nursing (2016).

Number of Licensed Registered Nurses (RNs) per 100,000 Population in Nevada – 2004 to 2014



29

29.5

52.7

11.7

27.7

18.717.6

15.8 16.518.7

21.824.5

31.9

0

10

20

30

40

50

60

2004 2006 2008 2010 2012 2014

Urban North

Urban South

Rural and Frontier

Nevada Total

Number of Licensed Advanced Practitioners of Nursing (APNs) per 100,000 Population in Nevada – 2004 to 2014

Source: OSI analysis of unpublished data from Nevada State Board of Nursing (2016).

30

55.6

62.1

43.9

54.6

29.5

37.9

45.347.5

52.349.9

54.5 54.9

25

35

45

55

65

2004 2006 2008 2010 2012 2014

Urban North

Urban South

Rural and Frontier

Nevada Total

Number of Licensed Dentists per 100,000 Population in Nevada – 2004 to 2014

Source: OSI analysis of unpublished data from Nevada State Board of Dental Examiners (2016).



Primary Care PhysiciansNumber of MDs per 100,000 Population

20.9

1.0

40.5

14.3

10.3

31.4

1.2

39.6

20.0

11.9

29.6

2.1

56.0

26.7

14.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Family Medicine General Practice Internal Medicine Pediatrics OB/Gyn

Nevada Mountain Region U.S.

31Source: AMA. Physician Characteristics and Distribution in the US (2015).

Surgeons and Specialty PhysiciansNumber of MDs per 100,000 Population

8.3

5.44.8

2.8

6.5

10.2

8.0

5.0

3.4

9.1

12.4

8.47.5

4.5

12.9

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

General Surgery Orthopedic Surgery CardiovascularDisease

Gastroenterology Psychiatry

Nevada Mountain Region U.S.

Source: AMA. Physician Characteristics and Distribution in the US (2015).

32



Primary Care PhysiciansNumber of MDs and DOs per 100,000 Population

33

23.6

1.0

45.7

15.2

10.7

40.3

0.9

50.7

15.1 15.1

29.3

0.9

21.6

5.9 6.7

0.0

10.0

20.0

30.0

40.0

50.0

60.0

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).

Surgeons and Specialty PhysiciansNumber of MDs and DOs per 100,000 Population

34

6.9

5.5 5.5

2.7

6.9

10.8 11.7

9.9

5.6

13.5

5.6

8.5

2.6 2.0

1.2

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

General Surgery Orthopedic Surgery CardiovascularDisease

Gastroenterology Psychiatry

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).



Primary Care Health Professional Shortage Areas (HPSAs) – 2016

35

• 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).

Dental Health Professional Shortage Areas (HPSAs) – 2016

36Source: OSI analysis of data from the Health Resources Services Administration (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



Mental Health Professional Shortage Areas (HPSAs) – 2016

37Source: OSI analysis of data from the Health Resources Services Administration (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

Health Workforce Research, Planning, and Policy in Nevada



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



Demographic Characteristics of the RN Workforce in Nevada – 2015

RegionHighest 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%

41

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).

Retention of Physicians Completing UNSOM GME in Nevada – 2006 to 2015

2015(N=103)

Beginning PracticeContinuing

GME or OtherTotal

Remaining in Nevada 42.7% 7.8% 50.5%

Leaving Nevada 33.0% 16.5% 49.5%

Total 75.7% 24.3% 100.0%

42

2006 to 2015 (N=773)

Beginning PracticeContinuing

GME or OtherTotal

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).



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%

43Source: OSI analysis of NSHE Survey of Graduating Nursing Students (2016).

John Packham, PhDDirector of Health Policy Research

Office of Statewide InitiativesUniversity of Nevada School of Medicine

(775) 784-1235 [email protected]

http://www.medicine.nevada.edu/osi

mailto:[email protected]

http://www.medicine.nevada.edu/osi

Current and Projected Health Workforce Supply and …...Physician Characteristics and Distribution...

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