Angela Chou Montana Office of Rural Health/ Area Health Education Center

Health Care Workforce Summary Nationally, the health care workforce shortage is as real as it ever was. In Montana, the shortage is even more serious. Five type of health professions have been identified as critical to the future of Montanas health care: nurses, physicians, dentists, pharmacists, and technicians (laboratory and radiological). The following represents national and statewide trends concerning the above professions. Dentists: National: The dentist shortage is extremely critical, especially in rural areas. The U.S. Department of Health and Human Services says that: There are more than 31 million people living in designated shortage areas, and that about 4,650 dentists are needed to provide the proper level of care. Currently, there are only about 4,000 dental school graduates annually (USDHHS, ADA, 2003). Also, there are predictions that the number of dental school graduates will fall over the next decade since the number of dentists per 100,000 U.S. population has continued to fall since 1990 (ADHA, 2004). More qualified applicants will also be denied from dental school because of a severe shortage of dental school faculty (there are currently more than 350 vacant faculty positions), who are pursuing higher-paying occupations (Tomkins, 2003). Nationally, the number of dentists per 100,000 U.S. population is expected to decline from 63.6 (in 2000), to 52.7 by 2020 (ADHA, 2004).
Num ber of Dentists per 100,000 U.S. population 20002020
70 60 50 40 30 20 10 0 2000 2020

63.6 52.7

Sources: ADA, ADHA; http://www.adha.org/media/releases/archives/2004/070804_adhp.htm

Major issues concerning the dentist workforce shortage: Of about 152,000 active dentists, more than 33% of them are older than 55. (ADA, 2003) Currently, there is less than one full-time equivalent dentist per 4,000-5,000 people. (ADHA, 2004) Montana: The Department of Public Health and Human Services, along with the Montana Dental Association, conducted a survey of the Montana Dental Workforce in 2001i, and found: 70% of Montana dentists are older than 45; 26.7% are older than 55. In 2000, Montana had 51.9 dentists per 100,000 compared with the national average of 63.6 (ADA, US Bureau of the Census, 2000). Montana experienced a 16.9% drop in the dentist to population ratio. 35 of 56 Montana counties are designated health professional shortage areas, and some counties have no dentists.
Number of Dentists per 100,000 U.S. population in 2000 (Montana vs. National Average)
80 60 40 20 0
Source: Addressing the Dental Workforce in Montana: Regional Initiative in Dental Education (RIDE) Program

National Montana

Age of Montana Dentists (as stated in 2001 survey)

3% 26.70% 45 yrs or older 55 yrs or older 70% <45 yrs

Source: Addressing the Dental Workforce in Montana: Regional Initiative in Dental Education (RIDE) Program

The following is a map that represents the states dental health professional shortage areas:

Imaging/Radiology Technicians: National: While data on the shortage of imaging/radiology technicians is not nearly as plentiful as that of the nursing shortage, it is still apparent that this profession is on the verge of a shortage crisis. Applied Radiology documents the extreme present need in radiology and found that: 21% of hospitals surveyed are reporting severe shortages with average vacancy rates of above 20% (Applied Radiology, 2002). The American Hospital Association (AHA) published a study in 2001: There was a 15.3% national vacancy rate for imaging technologists and technicians, and that the vacancy rate in the western region of the U.S. was closer to 17% (AHA, 2001).

The U.S. Bureau of Labor Statistics estimates that the national need for radiology technologists and technicians will increase almost 15% by 2010:
Need for Radiology Technicians and Technologists 2000-2010
40% 35% 30% 25% 20% 1 5% 1 0% 5% 0% 2000 201 0 21 % 35%

Source: Applied Radiology; http://www.amicas.com/what/news/clippings/Applied%20Radiology%207.02.doc

Montana: Montana is already experiencing a severe shortage, and has already been contracting radiology services to other states, and even other countries. In Montana, the shortage of imaging/radiology technicians will also be compounded by the lack of educational programs geared towards radiology. Laboratory Technicians: National: The importance of lab technicians may be downplayed, but this profession is certainly crucial to health care. In a survey conducted by AFT Healthcare, 64% of the hospitals that participated reported an inadequate number of lab workers. The AHA did its own study and found the vacancy rate for lab technicians to be around 12%. Various organizations present data that shows the extent of the shortage of clinical laboratory technicians: There are a projected 7,000 new jobs each year in this profession with an additional 5,000 vacancies due to those leaving the field.ii Employment is expected to grow to 348,000 by 2010 (BHPR, HRSA, 2002). From 1995-2000, there was a -29% change in the number of clinical laboratory technician graduates (BHPR, HRSA, 2002). There was a -42.5% change in the number of medical laboratory technician and technologist education programs (BHPR, HRSA, 2002).

Clinical Laboratory Worker Job Growth 2000-2010

360,000 350,000 340,000 330,000 320,000 310,000 300,000 290,000 280,000 270,000 260,000 2000 2010 295,000 348,000

Source: BHPR, HRSA; http://www.phppo.cdc.gov/CLIAC/pdf/Addenda/cliac0902/Grover0902N.pdf

Change in Medical Laboratory Technologist and Technician Education Programs 1985-2000 1985 1990 1995 2000 % Change 1985-2000 Medical 584 420 357 255 -56.3% Laboratory Technologists Medical 281 256 260 242 -13.9% Laboratory Technicians Total Montana: In a survey conducted by the Clinical Laboratory Managers Association in 2002ii, the following data was reported: The average age of a clinical laboratory scientist (CLS) is 45. There is a 12% vacancy rate in Montana. Of 72 labs surveyed, 44 had three or less CLS in their lab. Montana has 68% of clinical laboratory professionals compared to the national average. (Center for Health Professions at UCSF) The shortage of laboratory personnel will dwarf the shortage of nurses in Montana. While there are programs preparing students for CLS educational opportunities, they are only affiliated with the Montana university system (undergraduate curricula exists at Montana State University, University of Montana, and Montana State University865 676 617 497 -42.5%
Source: BHPR, HRSA; http://www.phppo.cdc.gov/CLIAC/pdf/Addenda/cliac0902/Grover0902N.pdf

Billings). The universities participate in a collaborative effort with out-of-state institutions, and because the students are out-of-state for their training, the state suffers because it cannot retain nearly enough graduates:ii Out of 11 graduates from MSU in 2006, only one said she would return to Montana. Nursing: National: The nursing shortage is perhaps the most discussed problem in health care at the present time. Health care systems nationwide are scrambling to find solutions to ease the shortage occurring now, and to find ways to address the daunting amount of nurses who will be needed in the long-term. The Human Resources and Services Administration (HRSA) estimates that: About 800,000 more registered nurses (RNs) will be needed by 2020 to adequately meet demand (HRSA, 2006). 40% of the workforce will be older than 50 and nearing retirement in 2010, and that as of now, the percentage of nurses under the age of 30 is dropping (HRSA, 2006). Also, according to a survey conducted by AFT Healthcare, more than 20% of nurses who responded to the survey said that they were planning on leaving the profession within five years for reasons other than retirement(AFT, 2003). There will be a 12%, 20%, and 29% national shortage of RNs in 2010, 2015, and 2020, respectively (HRSA, 2006). Various organizations have published data concerning the nursing shortage, and while there are slight discrepancies, there is a unanimous agreement that the nursing shortage will only continue to get worse. A report by the American Association of Colleges of Nursing (AACN) predicts that there will be a need of more than one million new and replacement nurses by 2012. However, this gap will be hard to fill due to the relatively low number of nursing graduates. More people are applying to nursing school and being enrolled, but more qualified applicants are also being turned away due to a shortage of faculty, lack of clinical sites, budget constraints, etc. According to the AACN, 32,797 qualified applicants were denied from entry-level baccalaureate nursing programs in 2004, compared with the more than 11,000 qualified applicants who were turned away in 2003.

HRSA Projected National Nursing Shortages (show n as percentages) for 2010, 2015, 2020 35% 30% 25% 20% 20% 15% 10% 5% 0% 2010 2015 2020 29%

12%

Source: HRSA; http://bhpr.hrsa.gov/nursing/2003NELRPNSPRTC/Chapter2.htm

A majority of registered nurses are employed by hospitals (60%), and hospitals nationwide are experiencing alarming vacancy rates. The AHA published a report that stated: Over one in seven hospitals reported an RN vacancy rate of over 20% (AHA, 2001). RN vacancy rates will exceed 15% in the next two years (AHA, 2001). The AACN published a similar report, stating that about 126,000 nurses are presently needed in order to fill vacancies at hospitals, and that 75% of all hospital vacancies are for nurses. Montana: The following graph is a synopsis of data compiled by HRSA that examines the projected supply and demand of registered nurses in Montana from 2000 to 2020. Other state projections may be found at: http://bhpr.hrsa.gov/healthworkforce/reports/behindrnprojections/behindshortage.htm

Registered Nurses Supply vs. Demand Montana Projections: 2000-2020

10000 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 SUPPLY DEMAND

2000

2005

2010

2015

2020

Source: HRSA; http://bhpr.hrsa.gov/healthworkforce/reports/behindrnprojections/behindshortage.htm

According to the Western Interstate Commission for Higher Education (WICHE), nursing is one of Montanas fastest growing jobs, and that nursing will see a 33% increase in its need. WICHE estimates that approximately 4,300 registered nurses will need to be hired for new posts and to replace those leaving the field (WICHE, 2005). Pharmacists: National: As the baby boomers age, they will rely more heavily on prescription medication. The Healthcare Leadership Council reports: The number of retail prescriptions filled per year in the U.S. increased approximately 44% between 1992 and 1999 (from 1.9 billion to 2.8 billion), and that number is expected to only increase (Healthcare Leadership Council, 2006). The American Society of Health-System Pharmacists (ASHP) conducted a survey and found that more than half of pharmacy directors stated that the general lack of pharmacists have Delayed expansion of pharmacy programs and services into new areas and have resulted in reduction of services so that staff could be re-deployed or reassigned to cover other areas (ASHP, 2003). The need for pharmacists is clearly critical. Even with such a dramatic increase in the amount of prescription medication being dispensed, there is still an extremely strong demand for pharmacists. A 2001 AHA study reported a 21% hospital pharmacist vacancy rate. HRSA reports that pharmacy vacancy rates in the Federal sector are on the rise, and that some Department of Veterans Affairs and Native American health centers (5 in Montana) have some facilities with less than half of their authorized pharmacist positions filled (HRSA, 2000).

Montana: In Montana, this is one of the fastest growing professions, and the number of pharmacists is expected to grow 41% by 2012 (WICHE, 2005). Physicians: National: Even though data has shown that about 20,000 doctors have entered the workforce annually for the past 20 years, there is still growing concern about a physician shortage. More doctors are choosing more specialized fields within medicine (i.e. anesthesiology, surgery, etc.), or are pursuing dual degrees (MD/MBA, MD/JD, MD/MPH) and are not practicing medicine. While specialized doctors continue to increase, those in the more general fields (family medicine and primary care) continue to decline. The National Residency Matching Program showed: From 1997-2002, the number of physicians pursuing residencies in anesthesiology, radiology, and dermatology increased 288%, 95%, and 39%, respectivelythose pursuing family practice and general surgery declined by 40% and 28%, respectively (Cejka, 2005). HRSA has projected: There will be a 51,000-228,000 physician shortage by 2020 (HRSA, 2003). Physician requirements would increase about 28%, or around 996,400 doctors, by 2020 (HRSA, 2003). One part of the explanation for the shortage projection is that, currently, of 836,000 physicians, a third are older than 55 (HRSA, 2003). Montana: In Montana, the need for physicians is substantial. There is no official medical school in the state, and the only medical education offered is through the WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) program, which is run by the University of Washington. Because of this, Montana undergraduate students experience a severe disadvantage compared to other undergraduates in pursuing medical education: Currently, there is one slot (for medical school) per 46,000 people in Montana the national average is one slot per 17,400.iii Because of the limited number of slots for Montana students to participate in WWAMI, only about 1 in 3 qualified applicants are accepted.iii It will be difficult to replace those Montana physicians who will be leaving the workforce in the upcoming years, since 41% of Montanas physicians are already older than 55.iii Even with about 40% of Montana WWAMI graduates returning to practice in the state and 50% of total WWAMI graduates choosing to practice in Montana, there is still a severe need for physicians.iii The state already has two incentive programs in place to attract physicians to practice in rural areas:

The Montana Rural Physician Incentive Program (MRPIP) offers up to $45,000 in debt repayment to physicians who practice in rural Montana areas for at least five years. The program has experienced an 85% retention rate. iii The Rural Physicians Credit gives physicians practicing in an area without a 60 bed hospital within a 30-mile radius up to a $5,000 tax deduction against state tax liability for up to four years. iii

Even with these programs in place, they cannot compete with other state programs, which, on average, offer about $20,000 per year for four years. iii The following represents the primary care Health Professionals Shortage Areas (HPSAs) in Montana:

Mouradian, Wendy. Addressing the Dental Workforce in Montana: Regional Initiative in Dental Education (RIDE) Program. University of Washington, 2006. ii Letter from Barbara Hudson, MS, CLS and Tim Ford, Ph.D to John Van Zytveld, Ph.D. Clinical Laboratory Science Training Program within the Montana University System. 1-2. June 5, 2006. (copy on file with Author). iii Lipp-Sirota, Emily et al. Recommendations to the Montana Board of Regents Regarding Physician Education and Incentives in the State. March 2, 2006.

Online Data Sources: ProfessionSource WebsitesDentistsADHA:

http://www.ahda.org/media/releases/archives/2004/070804.htm Poynteronline (Tomkins Article): http://www.poynter.org/column.asp?id=2&aid=49010Imaging/Radiology

TechniciansApplied Radiology:
http://www.amicas.com/what/news/clippings/Applied%20Radiology%207.02.doc

The Center for the Health Professions (UCSF):

http://www.futurehealth.ucsf.edu/pdf_files/Diagnos_Imaging_Brief2.pdfLab http://www.aft.org/pubs-reports/healthcare/Vanishing-Nurse.pdf

TechniciansAFT Healthcare:

BHPR, HRSA:
http://www.phppo.cdc.gov/CLIAC/pdf/Addenda/cliac0902/Grover0902N.pdf

Healthcare Leadership Council: http://www.hlc.org/html/background6.htmlNursingAACC:

http://www.aacc.nche.edu/Content/NavigationMenu/HotIssues/Nursing/Facts[1].pdf

AACN:
http://www.aacn.nche.edu/Media/FactSheets/NursingShortage.htm

AFT Healthcare:
http://www.aft.org/pubs-reports/healthcare/Vanishing-Nurse.pdf

AHA:
http://www.aha.org/aha/key_issues/workforce/resources/Content/FcgWorkforceReport.pdf

HRSA:
http://bhpr.hrsa.gov/nursing/2003NELRPNSPRTC/Chapter2.htm http://bhpr.hrsa.gov/healthworkforce/reports/changedemo/default.htm

WICHE:
http://www.wiche.edu/Workforce/mt-05.pdfPharmacistsASHP: http://www.ashp.org/practicemanager/StaffSurvey2003.pdf

Healthcare Leadership Council:

http://www.hlc.org/html/background6.html

HRSA:
http://bhpr.hrsa.gov/healthworkforce/reports/pharmacist.htm

WICHE:
http://www.wiche.edu/Workforce/mt-05.pdfPhysiciansAMA: http://www.ama-assn.org/amednews/site/free/prsa0620.htm

Cejka Search:
http://www.cejkasearch.com/news/physician_recruitment_woes_of_medical_groups.htm

HRSA:
http://bhpr.hrsa.gov/healthworkforce/reports/changedemo/default.htm