Forecasting the Future Supply of Pediatric Subspecialists in the United States: 2020-2040

Concerns persist about whether the United States has an adequate supply of pediatric subspecialists and whether they are appropriately distributed across the nation to meet children's health needs. This article describes the data and methods used to develop a workforce projection model that estimates the future supply of 14 pediatric subspecialities certified by the American Board of Pediatrics at the national and US census region and division levels from 2020 to 2040. The 14 subspecialties include adolescent medicine, pediatric cardiology, child abuse pediatrics, pediatric critical care medicine, developmental-behavioral pediatrics, pediatric emergency medicine, pediatric endocrinology, pediatric gastroenterology, pediatric hematology-oncology, pediatric infectious diseases, neonatal-perinatal medicine, pediatric nephrology, pediatric pulmonology, and pediatric rheumatology. Hospital medicine was excluded because of the lack of historical data needed for the model. This study addresses the limitations of prior models that grouped adult and pediatric physician subspecialty workforces together and aggregated pediatric subspecialties. The model projects supply at national and subnational levels while accounting for geographic moves that pediatric subspecialists make after training and during their career. Ten "what if" scenarios included in the model simulate the effect of changes in the number of fellows entering training, the rate at which subspecialists leave the workforce, and changes in hours worked in direct and indirect clinical care. All model projections and scenarios are available on a public, interactive Web site. The model's projections can also be examined with other data to provide insight into the possible future of the pediatric subspecialty workforce and offer data to inform decision-making.

Bolstering the rural physician workforce in underserved communities: Are Rural Residency Planning and Development Programs finding the sweet spot?

PURPOSE

The purpose of this study is to describe the characteristics of Rural Residency Planning and Development (RRPD) Programs, compare the characteristics of counties with and without RRPD programs, and identify rural places where future RRPD programs could be developed.

METHODS

The study sample comprised 67 rural sites training residents in 40 counties in 24 US states. Descriptive statistics were used to describe RRPD programs and logistic regression to predict the probability of a county being an RRPD site as a function of population, primary care physicians (PCP) per 10,000 population, and the social vulnerability index (SVI) compared to a control sample of nonmetro counties without RRPD sites.

FINDINGS

Most RRPD grantees (78%) were family medicine programs affiliated with medical schools (97%). RRPD counties were more populous (P<.01), had a higher population density (P<.05), and a higher percent of the non-White or Hispanic population (P = .05) compared to non-RRPD counties. Both higher population (P<.001) and PCP ratio (P = .046) were strong predictors, while SVI (P = .07) was a weak predictor of being an RRPD county.

CONCLUSIONS

RRPD sites appear to represent a "sweet spot" of rural counties that have the population and physician supply to support a training program but also are relatively more socially vulnerable with high-need populations. Additional counties fitting this "sweet spot" could be targeted for funding to address health disparities and health workforce maldistribution.

Developing a Workforce for Health in North Carolina: Planning for the Future

Among the many trends influencing health and health care delivery over the next decade, three are particularly important: the transition to value-based care and increased focus on population health; the shift of care from acute to community-based settings; and addressing the vulnerability of rural health care systems in North Carolina.

Training Psychologists for Rural Practice: Exploring Opportunities and Constraints

PURPOSE

To examine trends in the psychologist workforce and training opportunities, including factors that may influence the decision of clinical psychologists to practice in rural settings.

METHODS

We use a mixed-methods approach to examine the psychologist workforce nationally and in North Carolina (NC), including (1) an analysis of the location of programs awarding doctoral degrees; (2) an analysis of the practice, demographic, and educational characteristics of the psychologist workforce; and (3) interviews with directors of doctoral programs in clinical psychology to understand where current graduates are getting jobs and why they may or may not be choosing to practice in rural communities.

FINDINGS

Fewer than 1% of programs and institutions awarding doctoral degrees in psychology in the United States are located in rural areas. In NC, approximately 80% of practicing psychologists have out-of-state degrees and about 80% of recent NC graduates are not currently licensed in the state. This juxtaposition undermines the utility of adding more in-state degree programs. While expansion of training programs within rural areas could help alleviate the shortages of mental health providers, adding new degree-granting programs alone will not necessarily increase supply. We discuss complementary recruitment and retention strategies, including greater incentives for rural training and practice as well as training in emerging technologies that don't require providers to be physically located in underserved areas, such as telemedicine.

CONCLUSIONS

Increasing the supply of psychologists practicing in rural areas will require a thoughtful, multipronged approach to training this critical part of the behavioral health workforce.

How many nurse practitioners provide primary care? It depends on how you count them

This study compares different approaches to measuring the number of nurse practitioners (NPs) providing primary care services using data from the 2012 U.S. National Sample Survey of Nurse Practitioners, North Carolina licensing data from 2011, and a 2010 California survey of nurse practitioners and nurse midwives. Estimates of the number and share of NPs providing primary care depend on how one defines primary care. If the definition is based on the field of NP education, the estimated shares in primary care specialties are 83.5% in North Carolina and 90.7% in California; if the definition is based on current or past fields of certification, the estimated shares are 79.9% in North Carolina and 74.5% nationally. The estimated number is even smaller if one considers employment setting (58.4% in North Carolina, 66.8% in California, and 67.8% nationally), and shrinks to about half of NPs if focusing on current field of clinical specialization.

The contribution of "plasticity" to modeling how a community's need for health care services can be met by different configurations of physicians

This article introduces the concept of "plasticity" to health care workforce modeling and policy analysis. The authors define plasticity as the notion that individual physicians within the same specialty each provide a different scope of service, while the scope of service of physicians in different specialties may overlap. This notion represents a departure from the current, silo-based conception of physician supply as physician headcounts by specialty; the implication is that multiple configurations of physicians (and, by further application, other health care professionals) can meet a community's utilization of health care services.Within-specialty plasticity and between-specialty plasticity are two facets of plasticity. Within-specialty plasticity is the idea that individual physicians within the same specialty may each provide a different mix and scope of services, and between-specialty plasticity is the idea that patterns of service provision overlap across specialties. Changes in physician specialty supply in a community affect both the between-specialty and within-specialty plasticity of that community's physicians. Notably, some physician specialties are more "plastic" than others.The authors demonstrate how to implement a plasticity matrix by assessing the sufficiency of physician supply in a specific community (Wayne County, North Carolina). Additional literature and data can provide further insights into the influences on (and of) plasticity, improving this approach and expanding it to include task-shifting across health care professions.

We're not keeping up with the Joneses: North Carolina has fewer dentists per capita than neighboring (and most other) states

This commentary provides a data-driven analysis that shows that North Carolina faces a geographically maldistributed dentist workforce that is inadequate in supply. Not only has North Carolina consistently lagged behind other states in dentists per capita for over 10 years, but projections of future workforce supply do not show improvement.

Workforce planning in the context of service redesign, workforce migration and changing demographics

Introduction

Healthcare is facing unprecedented challenges in which economic, demographic and policy changes will impact upon all aspects of workforce and service delivery both within the UK and internationally. How the rehabilitation workforce responds to the challenges will be a fundamental marker of the success of future service delivery.

Content

These changing imperatives require a reinterpretation of existing workforce planning. A more collaborative and patient-centred approach is now advocated within which productivity becomes a major player, with quality remaining at the heart of the agenda alongside an increasing emphasis upon prevention. This article describes how the workforce needs to realign itself with this directional change.

Conclusions

This article provides an overview of the current policy context shaping the health workforce agenda and suggests future strategies to assist planners in achieving an effective planning cycle within the rapidly changing and dynamic health care delivery system.

Factors affecting attrition from associate degree nursing programs in North Carolina

Projected nursing shortfalls have spurred the state of North Carolina to initiate a series of strategies to increase the number of graduates from pre-licensure Registered Nurse (RN) programs. These efforts have been largely successful, but attrition rates from Associate Degree Nursing (ADN) programs remain high. Only 58% of students entering ADN programs complete the degree. While policy makers are keenly aware that attrition from ADN programs is problematic, there is a lack of empirical evidence to identify the specific factors contributing to student attrition. In late 2007, the North Carolina Community College System (NCCCS) asked the Cecil G. Sheps Center for Health Services Research to conduct a study of Associate Degree Nursing program attrition and its causes. This paper summarizes the findings from that study and identifies the student- and program-level characteristics associated with more and less successful ADN programs. While this study was conducted in a single state in the US, the substantive findings--as well as the methodological approach--may be useful to other states and other countries. The study revealed that socioeconomically disadvantaged students (those with GEDs and those who received Pell Grants), non-white students, and younger and older students were less likely to graduate on-time. When programs were grouped into high and low performance categories on the basis of risk adjusted graduation rates, high performing programs were distinguished by more stringent admissions policies and better educated faculties. Nursing shortages have garnered significant attention and resources from state and national workforce planners in recent years. But to date, investments in expanding program capacity have not been matched by attention to program completion rates, with the result that we have enlarged the pipeline without fixing the leaks. Faculty shortages and recession-induced resource constraints limit further program expansion. Addressing attrition problems can expand RN production in the short-term at relatively lower costs.