Who is Entering/Exiting Health Care,
and Why Do We Care?
Bianca K. Frogner, PhD
Associate Professor, Department of Family Medicine
Director of Center for Health Workforce Studies
UCSF Healthforce Center Seminar
Thursday April 14, 2016
Setting the Stage
• Growing demand for health services will lead to greater need
for health workers
– Increasing needs for aging population with multiple chronic conditions
– Insurance (e.g., Medicaid) expansion
– Greater emphasis on primary care and team-based care
• Health care has been and will continue to be fastest growing
employment sector
– 12% of total labor force of the U.S. in 2013
Questions
•
•
•
•
What is the source of job growth?
Who is working in health care?
What will the future health workforce look like?
Why is there cause for concern?
Questions
•
•
•
•
What is the source of job growth?
Who is working in health care?
What will the future health workforce look like?
Why is there cause for concern?
Absolute Difference in Number of People by Industry, 2003 and 2013
Health care
Leisure and hospitality
Professional, scientific and technical services
Educational services
Management, administrative and support, and
Public Administration
Mining
Transportation and warehousing
Other services
Finance and insurance
Social assistance
Pharmacies and drug stores
Medical equipment and supplies
Pharmaceutical and medicine manufacturing
Real estate and rental and leasing
Utilities
Agriculture, forestry, fishing and hunting
Retail trade
Information
Wholesale trade
Nondurable goods manufacturing
Construction
Durable goods manufacturing
(1,500,000)(1,000,000) (500,000)
-
500,000 1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 3,500,000
Absolute Difference of People within an Industry between 2003 to 2013
Questions
•
•
•
•
What is the source of job growth?
Who is working in health care?
What will the future health workforce look like?
Why is there cause for concern?
Study 1: The Demand for Health Care Workers
Post-Affordable Care Act
• Study Question
– What is the profile of the health care workforce?
– What are the fastest growing sectors of health care and what is the expected
impact of the Affordable Care Act?
• Data and Methods:
– Profile of workforce using American Community Survey (ACS), 2012
– Project job growth by comparing 2 known models
• National Employment Matrix (NEM)
• Adjusted Risk Choice & Outcomes Legislative Assessment (ARCOLA)
Source: Frogner BK, Spetz J, Parente ST, and Oberlin S (2015). “The Demand for Health Care Workers Post-ACA,”
International Journal of Health Economics and Management, 15(1): 139-151.
Source: Frogner BK, Spetz J, Parente ST, and Oberlin S (2015). “The Demand for Health Care Workers Post-ACA,”
International Journal of Health Economics and Management, 15(1): 139-151.
Source: Frogner BK, Spetz J, Parente ST, and Oberlin S (2015). “The Demand for Health Care Workers Post-ACA,”
International Journal of Health Economics and Management, 15(1): 139-151.
Source: Frogner BK, Spetz J, Parente ST, and Oberlin S (2015). “The Demand for Health Care Workers Post-ACA,”
International Journal of Health Economics and Management, 15(1): 139-151.
11
Source: Frogner BK, Spetz J, Parente ST, and Oberlin S (2015). “The Demand for Health Care Workers Post-ACA,”
International Journal of Health Economics and Management, 15(1): 139-151.
Hospital
Ambulatory Care
Home health care services
(N=1199)
Other ambulatory care services (inc.
labs) (N=500)
Outpatient care centers (N=652)
Other offices of health care
professionals (N=484)
Offices of physicians (N=2,391)
Hospitals (N=5792)
•
•
345 from ACA
40% related to demand
increase
247
239
222 180
Home
119 health biggest driver
90
58
35 19
32 20
Offices of optometrists (N=116)
383
449
316
443
290
Residential care facilities (N=1529)
Health National
care jobs
areMatrix
growing in
US: 719
Employment
ARCOLA
3-4M new health care jobs over next decade
491
Offices of chiropractors (N=124)
670
Offices of dentists (N=853)
985
811
Nursing care facilities (N=1665)
Number of Additional Jobs between 2013 and 2022
(Reported in Thousands)
Long-Term Care
Source: Frogner BK, Spetz J, Parente ST, and Oberlin S (2015). “The Demand for Health Care Workers Post-ACA,”
International Journal of Health Economics and Management, 15(1): 139-151.
Growth in the Largest Occupations, 2010-2020
Red=HS degree or less; Purple=some college; Blue=graduate degree
Source; Frogner B and Spetz J. (2013) “Affordable Care Act of 2010: Creating Job Opportunities for Racially and Ethnically Diverse
Populations.” Report and presentation prepared for and published by Joint Center for Political and Economic Studies Report
Questions
•
•
•
•
What is the source of job growth?
Who is working in health care?
What will the future health workforce look like?
Why is there cause for concern?
Study 2: Entry and Exit of Workers in
Long-Term Care
• Research Questions:
•
•
•
Entrants: From where does LTC draw its workers and at what rate?
Leavers: To where do LTC workers leave and at what rate?
What characteristics are associated with entrants/leavers?
• Data and Methods:
•
•
•
Current Population Survey, Annual Social and Economic
Supplement (“March Supplement”) [2003-2013]
Sample: Annual cross sectional survey of approximately 100,000
households (200,000 individuals); weighted for national
representation
Track trends in self-reported current versus prior year
occupation/industry and associated demographics/SES
Source: Frogner BK and Spetz J (2015). “Entry and Exit of Workers in Long-Term Care,” UCSF Health Workforce
Research Center Report. Available at: http://healthworkforce.ucsf.edu/publication/entry-and-exit-workers-long-term-care
Industry and Occupation Transitions, 2003-2013
Industry
Entry from what
industry?
Home Health Care
Services
14% Hospitals
14% Nursing care
facilities
Nursing Care
Facilities
18% Hospitals
12% Leisure &
hospitality
Residential Care
Services
14% Leisure &
hospitality
8% Out of labor
force
Most common
occupation of
entrants
42% Nursing, psych &
home health aides
23% Personal care
aides
37% Nursing, psych &
home health aides
10% Registered nurses
Exit to what
industry?
33% Out of labor
force
18% Unemployed
27% Out of labor
force
19% Unemployed
21% Personal care
25% Out of labor
aides
force
13% Food preparation 16% Unemployed
Source: Frogner BK and Spetz J (2015). “Entry and Exit of Workers in Long-Term Care,” UCSF Health
Workforce Research Center Report. Available at: http://healthworkforce.ucsf.edu/publication/entryand-exit-workers-long-term-care
Demographic Characteristics of Transition Groups,
2003-2013
Industry
% white
% with child in
HH under 5
% age 16-24
years
% age 55-64
years
88%
90%
90%
49%
54%
51%
15%
15%
12%
14%
11%
7%
15%
17%
18%
85%
86%
86%
59%
58%
60%
14%
17%
13%
23%
21%
13%
10%
13%
17%
73%
73%
71%
60%
61%
65%
11%
12%
12%
24%
23%
14%
10%
13%
16%
% female
Home Health Care Services
Entrants
Leavers
Stayers
Nursing Care Facilities
Entrants
Leavers
Stayers
Residential Care Services
Entrants
Leavers
Stayers
Source: Frogner BK and Spetz J (2015). “Entry and Exit of Workers in Long-Term Care,” UCSF Health
Workforce Research Center Report. Available at: http://healthworkforce.ucsf.edu/publication/entryand-exit-workers-long-term-care
SES Characteristics of Transition Groups,
2003-2013
% not a
citizen
Home Health Care Services
Entrants
10%
Leavers
9%
Stayers
11%
Nursing Care Facilities
Entrants
8%
Leavers
7%
Stayers
8%
Residential Care Services
Entrants
6%
Leavers
7%
Stayers
6%
Industry
% rural
residence
% disabled
% below
poverty
% fulltime
Wages from
past year
20%
20%
19%
4%
10%
4%
18%
22%
14%
74%
59%
66%
$19,666
$15,289
$19,799
24%
25%
26%
2%
8%
2%
16%
16%
8%
75%
72%
78%
$20,677
$17,409
$22,527
17%
17%
19%
4%
8%
3%
14%
13%
5%
74%
73%
79%
$19,517
$16,123
$21,203
Source: Frogner BK and Spetz J (2015). “Entry and Exit of Workers in Long-Term Care,” UCSF Health
Workforce Research Center Report. Available at: http://healthworkforce.ucsf.edu/publication/entryand-exit-workers-long-term-care
Questions
•
•
•
•
What is the source of job growth?
Who is working in health care?
What will the future health workforce look like?
Why is there cause for concern?
20
Food for Thought
Median Pay
($, 2012)
Tuition & Fees
($)
Ratio of Tuition to
1 Yr Median Pay
Pharmacy Technician
29,320
17,067
58%
Medical Assistant
29,370
13,057-17,067
44 to 58%
Optical Technician
33,330
17,067
51%
Health Information Technician
34,160
35,112
103%
Dental Assistant
34,500
17,067
49%
Massage Therapist
35,970
17,067
47%
Vocational Nursing
41,540
34,110-35,112
82 to 84%
Surgical Technologist
41,790
35,112
84%
Respiratory Therapy
55,870
45,137
81%
Claims Adjuster or Biller
59,850
17,067
29%
Occupation Title
21
Source:
http://www.bls.gov/ooh/
http://americancareercollege.edu/misc/tuition-fees.html
Questions? Contact:
Bianca K. Frogner, PhD
Associate Professor, Department of Family Medicine
Director, Center for Health Workforce Studies
[email protected]
UW Center for Health Workforce Studies
https://depts.washington.edu/fammed/chws/
@uwchws