Virginia’s Healthcare WorkforceHealthcare Workforce Data Center

Dianne Reynolds-Cane, MD

Director

Virginia Department of Health Professions

VHWDA Stakeholder Meeting

Richmond, VirginiaDecember 4, 2013

New DHP Licensees 2010-2013

Licensees12/31/2009

11/14/2013 Difference

Physician (MD &

DO)34,437 38,592 4,155

Registered Nurses 91,694 102,563 10,869

Total Licensees (all DHP

professions319,467 377,172 57,705

Healthcare Workforce Data Center• A Program of the Virginia Department of Health Professions• Survey regulated health professionals during renewal period• http://www.dhp.virginia.gov/hwdc/default.htm

Every March: Assisted Living Facility

Administrators Dental Hygienists

DentistsNursing Home Administrators

Every June:Clinical Psychologists

Licensed Professional Counselors

June, Odd YearsLicensed Clinical Social Workers

Every DecemberAudiologistsPharmacists

Pharmacy TechniciansSpeech-Language Pathologists

December, Odd YearsPhysician Assistants†

December, Even YearsDoctors of Osteopathy†

Medical Doctors†Physical Therapists

Physical Therapy Assistants

Every August*Certified Nurse Aides 

Licensed Practical NursesNurse Practitioners**

Registered Nurses

Reports Available at:

www.dhp.virginia.gov/hwdc

Updates on our blog:

www.vahwdc.tumblr.com

Agenda

• 2012-2013 Survey Report Findings• Medicaid Workforce Mapping Packet• AHEC Regional Reports• Work In Progress• Take Away

SURVEY REPORT FINDINGS

2012-2013

Practitioner Distribution• Supply

• HWDC periodic survey reports • Metro areas, towns, rural areas

• NP and PA surveys for 2012 have been released

• Demand• Geospatial Innovations• VHHA Healthcare Workforce Strategic Planning Task

Force• HRSA National Model

NP and PA Healthcare Practitioners

Physician Assistants– 1,891 in Workforce

– 1,775 FTEs– Median Age: 37

Nurse Practitioners– 6,056 in Workforce

– 6,435 FTEsHalf became NPs after Y2000

NP Scope of PracticeIntroduced by Virginia Council of Nurse Practitioners and Medical

Society of Virginia, HB346 includes:• Elimination of supervisory language– NP’s practice in collaboration and

consultation• Collaboration and consultation within Patient Care Teams - 54.1-2900(3)

– “Patient Care Team” means a multidisciplinary team of health care providers actively functioning as a unit with the management and leadership of one or more patient care team physicians for the purpose of providing and delivering health care to a patient or group of patients

• Patient Care Team Physician who actively provides “leadership and management” NO requirement for MD to regularly practice at the same location

• Collaboration and consultation may be via telemedicine• Ratios increased from 4:1 to 6:1• Periodic review of patient records, no requirements for site visits

PHYSICIANS

Snapshot of Virginia’s Physician WorkforceCouncil on Virginia’s Future Regions

2012 Northern EasternHampton

RoadsValley Central Southside

West Central

Southwest Virginia

Physicians 4,867 178 3,345 901 4,054 476 1,962 569 17,168

Primary Care

2,030 107 1,335 395 1,342 232 704 319 6,922

Percent Primary

Care42% 60% 34% 44% 33% 49% 36% 56% 40%

Primary Care

Physicians per

100,000 residents

74 75 79 81 83 61 96 76 85

Note: Regional estimates do not include physicians whose primary work location is outside of Virginia, or who worked in several localities/locum tenens or whose location could not be determined. Virginia totals do include these physicians.

Southside Virginia has a high proportion of uninsured adults and a low number of physician FTEs per resident.

Projected Virginia Physician Shortages to 2030Projected Change in the Patient Care Physician to Population Ratio, 2010 to 2030*

*assumes Virginia competes favorably in attracting new physicians

180

190

200

210

220

230

240

2010 2015 2020 2025 2030

Ph

ysic

ian

s p

er 1

00,0

00 R

esid

ents

Physicians FTE Physicians

– Source: Virginia Healthcare Workforce Data Center Analysis. Forecasts performed by the Lewin Group

PHYSICIAN EDUCATION AND TRAINING

Medical Schools 2010 (Matriculants,

class of 2014) Projected Class SizeProject Earliest Opening Note

Eastern Virginia 118      

UVA 148      

VCU-School of Medicine 200  250 (40 new slots)  

Projected to expand to 250.  New Medical School Building opened this year.

Edward Via Virginia College of Osteopathic Medicine  189      Data available on VCOM website

Virginia Tech Carilion School of Medicine  42      2010 was first year

Liberty University School of Osteopathic Medicine 0 150 2014 Seems on track

King College Osteopathic School of Medicine 0

60-75 expanding to 150 2014 Facing some delays

Martinsville College of Henricopolis   75-150 2015

Has provisional accreditation from LCME.

Annual Slots 697  Up to 1,238  Projected class size includes 748 current slots+490 projected slots

2012 Physician Survey Results• Medical Education and Residencies

• Graduated from Virginia medical schools: 20% (23%)• Completed residencies in Virginia: 27% (30%)

• Virginia Retains (unchanged):• 35% of its Medical School Graduates• 39% of its Residents

• Workforce Demographics• Work full-time : 83% (85%)• Work primarily in patient care: 86%• Work in primary care specialties: 42% (39%)

( )2010 Survey Results

Education and TrainingEducation Virginia Border

StateVA &

BorderingNY &

PARegional International

High School 20% 12% 32% 15% 47% 20%Undergraduate 19% 16% 35% 14% 49% 17%Medical School 20% 18% 38% 13% 51% 21%

Residency 27% 23% 50% 17% 67% NA

Regional:Virginia

Washington DCNew York

PennsylvaniaMaryland

North Carolina

The AAMC has committed to increasing the number of Medical School slots by 30% over 2002 numbers by 2017.

528 US Medical Students did not have a residency by the end of match week this year.*

*Rebecca Greenberg, AAMC Reporter, April 2013.

Geriatrics-Virginia Physicians

Physician WorkforceABMS-Certified Subspecialtists in Virginia:Family MedicineInternal MedicinePsychiatryTotal: 221 Self-Designated Geriatric Specialists: 894 (2010)

Virginia Geriatric Training ProgramsUniversity of VirginiaVirginia Commonwealth University Eastern Virginia Medical School Carilion Clinic

.

Specialties

Specialty Board-Certified Self-Designated

Internal Medicine* 20% 14%

Family Medicine* 9% 14%

Pediatrics* 8% 9%

Psych/Neurology 6% 6%

Radiology 4% <5%

Anesthesiology 4% 6%

Emergency Medicine 4% 8%

OBGYN* <4% 5%

*Primary Care 42%

MEDICAID WORKFORCE MAPPING

Open for BusinessProgram Physicians accepting

payment type

Physicians accepting new patients (with

insurance type)

Medicare 67% 59%Medicaid 61% 53%

Medicaid DistributionNP and PA

AHEC Regional Reports

Blue Ridge AHEC Region

Northern Virginia AHEC Region

Statistic Audiologists Pharmacist PharmacyTechnician

PhysicalTherapists

PhysicalTherapy

Assistants

Speech-Language

PathologistsPhysician Physician

Assistant

Response Rate (Renewals) 80% 84% 66% 79% 71% 73% 76% 76%WorkforceLicensees 101 2,116 2,534 1,571 378 899 6,718 505Full-Time Equivalency Units 99 1,365 1,571 1,198 281 560 4,553 485Licensees per FTE 1.02 1.55 1.61 1.31 1.34 1.61 1.48 1.04Expect to retire within 10 Years 19% 16% 14% 16% 18% 21% NA NADemographics% Female 96% 71% 75% 81% 83% 98% 43% 81%Median Age 41 42 31 40 43 40 49 35Rural Childhood 16% 17% 17% 17% 19% 16% NA NAUrban Childhood 9% 30% 33% 15% 17% 13% NA NAEmployment Characteristics

Median Income $70,001-$80,000

$55.01-$60.00(hrly)

$13.01-$15.00(hrly)

$70,000-$79,999

$30.01-$33.00(hrly) $60,0001-$70,000 $150k-$175k NA

Satisfied 99% 88% 88% 97% 97% 94% NA NA

Experienced Employment Instability in past 12 months 1% 23% 50% 37% 10% 21% NA NA

Employed over 2 years 61% 61% 54% 59% 63% 65% NAWork Setting (Primary Work Site)Private Practice 24% 5%† 6%*† 32% 23%* 25% 71% 52%Hospital or Health System 7% 24% 16% 14% 9% 11% 13% 26%Long-Term Care 0% 1% 1% 12% 26% 8% 12% 0%Federal Government 4% 4% 4% 2% 5% 2% NA NA

Northern Virginia AHEC Region

WORK IN PROGRESS

Telemedicine• Mandated for reimbursement in state regulated

private market (SB675-Wampler 2010)• Virginia Medicaid has reimbused telemedicine

since 2003• Certified telemedicine technologist training is

being developed at New College Institute• Begins 2014• Partially funded by the VHWDA

Military Credentialing and Licensing

• House Bill 1535 (2011)• Physicians and other officer-level professions can be licensed through

endorsement from other states.• Enlisted-level occupations require extensive, professional-level cross-

walking and gap analyses in comparison with civilian health professional licensure.

• In response to Delegate Stolle’s request and upon request to participate in the DoD multi-agency Task force on Military Credentialing, DHP has been contributing to this analysis since March 2012.

National Governors Association

• NGA-supported participation in the Veterans Licensing and Certification Policy Academy

• NGA-supported Statewide Plan to reduce prescription drug abuse in Virginia

Take HomeDemographics• Women represent more than half of the healthcare workforce

in several professions and in the younger physician age cohorts

• Nearly 25% of several healthcare professionals expect to retire in 10 years

Education and Training• Retention of medical school grads and residents is

essentially unchanged from 2010• While Virginia medical school slots are increasing,

residency slots are essentially unchanged

Take Home• About half of Virginia’s physicians are educated and trained in

bordering or nearby states

Workforce Mal-distribution• Many practitioner to population ratios are highest in some

urban areas and near employers such as hospitals and long term care facilities.

• Legislation such as HB346 and HB1501 enable efficiencies through patient care teams, collaborative care, and healthcare related IT to ease the burden of care carried by too few physicians.

Take HomePractice Related• Group, solo, and hospital practice sites are most common• Most physicians who accept Medicaid and Medicare are

accepting new patients.

Top Priorities• Enabling civilian licensing of veterans and spouses• DHP continues to collaborate with legislators and stakeholders

to provide data to help determine supply and demand of Virginia’s healthcare workforce in Virginia

9960 Mayland DriveSuite 300

Henrico, Virginia 23233

Thank You!

Perimeter Center Office