Remarks to the National Conference of State Legislatures 

Prepared Remarks of Sam S. Shekar, M.D., M.P.H.
Associate Administrator, Health Resources and Services Administration

National Conference of State Legislatures Meeting
Washington, D.C.
December 6, 2001

Introduction

Millions of Americans face barriers to quality health care because the right mix of health care professionals is not available to serve them. At HRSA, we know that access to quality affordable health care is directly linked to the availability of a well-trained and diverse workforce able to provide appropriate services where they’re needed most.

HRSA’s Bureau of Health Professions works to ensure that an adequate and competent health care workforce is available to meet the health care needs of all Americans, regardless of where they live or how much they make. 

Assuring an adequate health care workforce requires:

• Workforce planning and analyses to make sure we’re training the right people;
• High-quality education programs to ensure that health professionals have the right skills; and
• Equitable distribution efforts to make sure professionals are serving in the right places.

The current U.S. health care workforce looks like this:

• 31 percent are in health service occupations, such as nursing aides, home health care aides, and dental, medical and pharmacy assistants;
• 24 percent are health technicians and technologists;
• 21 percent are registered nurses.

Just 6 percent are physicians; 2 percent are dentists; 2 percent are pharmacists; 8 percent are in the mental and behavioral health occupations; and 5 percent are therapists.

Demand Expected to Grow

We expect that the demand for health professionals will grow at the twice the rate for all occupations between 1998-2008.  The greatest demand is expected for the largest group in the health care workforce: health service occupations, which we project will grow by 36 percent over the decade.  More than 3 million Americans are part of this group, which includes nursing and pharmacy aides, dental and medical assistants, and home health care aides.

Why such rapid growth?  Because tending to the health of the growing number of elderly Americans will call for many more nursing aides and home health care aides.  The Census Bureau estimates that some 40 million Americans will be over 65 in 2010, 5 million more than currently.  By 2030, the number is expected to grow to 66 million as a result of the aging of the large number of  “baby boomers” born between 1946 and 1964.

Another problem looms among registered nurses, who make up about a fifth of all health professionals.  Demand for their services is expected to grow 22 percent between 1998 and 2008, yet the registered nurse workforce is characterized by an aging population and declining entrants.  Since 1995, the number of RN graduates nationally has declined 31 percent.  We predict that a national nursing shortage – that is, the point at which demand exceeds supply -- will begin in 2007.

In California, for example, the number of nurses needed to maintain a stable registered nurse-to-population ratio is expected to fall below the target of 566 RNs per 100,000 residents as soon as 2005.  By 2010, California will need an additional 43,000 RNs to keep up with expected population growth.

Concerns about a nursing shortage are present in New York, as well.  The total number of graduating RNs there dropped by about 1,900 – a 25 percent decline – between 1995 and 2001. 

We also are confronting a national shortage of pharmacists.  In recent years, the growth in the number of prescriptions has been four times that of the growth in the number of pharmacists.

In the last two years, the number of vacancies for pharmacists has doubled.  Factors contributing to the shortage – beyond the increased use of prescription medication – include increased market competition among pharmacy companies and an increase in the time needed to verify third-party coverage.

The gap between supply and demand for pharmacists is growing by about 7.5 percent each year.  Last year, in 2000, the U.S. needed 14 percent more pharmacists than we had.  By 2005, we will need 35 percent more pharmacists than we expect to have.

We need to keep a close eye on a number of other health professions, too.  The number of clinical laboratory technician graduates is down 29 percent between 1995 and 2000; radiologic technologist graduates are down 14 percent over the same period.

Some parts of the country already are having severe problems finding qualified personnel.  In Washington state, 71 percent of hospitals report difficulties recruiting radiology technicians and 88 percent say they can’t recruit ultrasound technologists.

Distribution

That’s where we are on shortages among some health professions.  But distribution of the health care workforce, too, is a problem.  Some 50 million people live in more than 2,900 health professions shortage areas; 29 million people are underserved, most of them in predominantly rural counties. To alleviate these gaps in access to basic health care, we would need 13,000 primary care physicians willing to serve in these areas.

Incidentally, we have received from these underserved communities more than 2,900 requests for assistance to recruit National Health Service Corps clinicians.  [NHSC became part of the Bureau of Health Professions earlier this year as part of an  internal HRSA reorganization.]  Yet we estimate we’d need more than 21,000 NHSC clinicians to provide an adequate level of access to health care for all Americans.  That’s a huge gap.  Right now, we only have about 2,400 NHSC clinicians serving in needy areas nationwide.

The problem of distribution is a national one, but it’s especially acute in primarily rural states like Texas.  While the U.S. has an average of 59 active primary care physicians per 100,000 population, Texas has only 48 per 100,000 people.  More than two-thirds of Texas’ 254 counties have fewer primary care physicians than even the state average.

Distribution is a problem across states and across professions.  Earlier, I mentioned the expected shortage of registered nurses in California.  The reality is that in some parts of the state the shortage is already there, while other parts – especially in the San Francisco metropolitan area -- have far more than the target figure.

Also in California, large blocks of the state qualify as dental shortage areas, meaning that they have less than one dentist per 5,000 population.  These dental shortage areas tend to have a higher percentage of minorities, lower median incomes, and a higher percentage of children.  In 1995, 44 percent of California adults had no dental insurance.

Incidentally, last December HRSA released state-by-state profiles of the nation’s health workforce, the first time such a comprehensive study has been done.  I’ve brought summaries of each state profile to share with you.

Our State Health Workforce Profiles provide detailed data on the supply and demand for physicians, nurses, dentists, and 20 other health care professionals in all 50 states and the District of Columbia.  Each profile includes the number of health care professionals working in the state, their education, the communities they work in, and the range of services they deliver.  You can find the full profiles on the HRSA home page at: www.hrsa.gov.

HRSA’s Response

What is HRSA’s response to the distribution problem I just described?  We use targeted funding mechanisms to ensure that our funds support programs that train students who are much more likely than average to establish practices in underserved areas.  In 2000, for example:

·        A HRSA-supported Physician Assistants’ training program at Howard University in the District of Columbia graduated 33 PAs, 27 of whom (82 percent) went on to practice in underserved areas; and

·        At Michigan State University, a HRSA-funded Faculty Development program training osteopathic faculty produced 15 new faculty, 12 of whom (80 percent) went on to practice in underserved areas.

We know that graduates of HRSA-funded programs are 3 to 10 times more likely to practice in medically underserved inner-city and rural communities, where their services are needed most.

Diversity

This service is vital in a nation whose minority populations are expected to reach almost 50 percent of the total population by 2050.  Especially large increases are anticipated among Hispanics – whose numbers will grow to almost a quarter of the population -- and Asians, who will increase to more than 8 percent.

Yet already, the percentage of minorities who are physicians, dentists and registered nurses lags behind their percentage of the overall labor force.  And for African Americans and Hispanics, participation rates are especially low.

Why do we care?  Because we know that minority health care providers are more likely to practice in underserved minority communities.  African American physicians are five times more likely than other physicians to treat African American patients; Hispanic physicians are 2.5 times more likely to treat Hispanic patients.

So if we can improve the diversity of the health workforce, we will improve access to health care for the underserved groups that these health professionals are part of.

HRSA tries to narrow the diversity gap, again, by using targeted funding mechanisms to support programs that are successful in graduating a greater-than-average proportion of minority students.  For example, in 2000:

·        The Centers of Excellence program at the University of Kansas Medical Center graduated 107 students, 94 of whom (88 percent)were minorities; and

·        At East Tennessee State University, the Nursing Workforce Diversity program graduated 63 students, all of whom were minorities.

Our goal is a diverse health professions workforce that reflects not just present demographics in the United States, but one that will reflect what we will look like in the future – that’s why we look so closely at the Census Bureau’s population projections.

Health Professions Projections

Our work tracking trends in the health professions workforce makes it possible for those of us in the health care community to look ahead and identify and address future needs.  In the spring of 2002, we will release The Health Workforce: Trends, Issues, and Supply and Demand Projections, a document that will look at 15-year supply and demand projections for many different health professions.  Obviously, the ability to make accurate future projections has a tremendous impact on how we provide health care as a nation. Take geriatrics and genetics practitioners, for example.

As I said earlier, expected population trends pushes us to improve and expand the training of geriatric health professionals.  HRSA-supported Geriatric Education Centers provide the only national network that trains health care providers to serve a diverse community of older Americans.  We will be working to increase support for geriatric faculty training for all health providers, which will ultimately strengthen the health care services available to our older citizens.

We also expect the dramatic advances in genetic medicine and technology to have a profound impact on the development of new services that will prevent disease and reduce death rates from inherited conditions.  Unlocking the human genome has launched a revolution in medical practice and biological research.  Tomorrow’s health professionals must have in-depth training on a variety of issues that can blend genetics information into primary care practice.

These are just two examples of future demands that must be met.  There will be many others. While the challenges ahead are substantial, I want to emphasize that HRSA already has in place a variety of education and training programs that play a critical role in addressing our health care workforce needs now and in the future.

But the federal government cannot operate alone.  We are constantly looking to form critical linkages within the agency and with other federal agencies to make sure we are all working together to get the most out of the federal dollar.  We also must forge alliances and collaborations with state and local partners.  In our work with communities, we always encourage them to form broad local partnerships to leverage their resources, capitalize on their strengths, and coordinate efforts to benefit public health.

It is critical that we continue to seek out opportunities for collaboration with other national and local organizations – like the NCSL -- with a similar vision and mission.