Workforce

A sufficiently and adequately trained workforce with the competencies and skills necessary to deliver care across the physical and mental health of the patient is critical to the success of integration. Analysis of the healthcare workforce is increasingly complex. Several key factors impact workforce adequacy over the next decade, especially with regard to primary care practitioners. They include:

• the aging of Americans and corresponding increased demand for healthcare services,
• the increasing number of insured Americans,
• the aging of practicing physicians and nursing workforce and the corresponding likelihood of the retirement rate,
• the evolution of healthcare technology,
• the increasing student debt for medical school graduates, causing many to choose specialty, rather than primary care practice, and
• the implementation of the Affordable Care Act (ACA).

Some analysts project up to a 25% increase in the shortage of primary care physicians by 2025.

There is also a shortage of specialty mental health professionals, particularly in undeserved and rural areas.  In its publication Strategies to Support the Integration of Mental Health into Pediatric Primary Care (PDF - 360KB), the National Institute for Health Care Management reports a “critical shortage of child and adolescent psychiatrists, with the 7,000 currently in practice representing only about one-fifth of the projected need. Of those child psychiatrists in practice, many do not work in the public sector and/or accept only self-pay patients.

The National Association of State Mental Health Program Directors (NASMHPD) cited workforce shortages in its 2005 report Integrating Behavioral Health and Primary Care Services: Opportunities and Challenges for State Mental Health Authorities (PDF - 500KB) and called on Federal officials to examine the need with regard to mental health services delivery, including the needs for the delivery of mental health care in primary care practices.

In 2007, the Annapolis Coalition released Action Plan for Behavioral Health Workforce Development (PDF - 1.9MB), a multiyear study sponsored by the Substance Abuse the Mental Health Services Administration (SAMHSA). This report states that “workforce problems are evident in every element or dimension of the behavioral health field” and provides detailed assessment of the issues, along with recommendations on research needs and actions required. This report intentionally addressed the needs of the behavioral health workforce and chose not to address the needs of those in other areas, such as primary care, who they cited as playing a significant role in meeting behavioral health needs. The report noted that “more expansive analysis of workforce options that is beyond the scope of this initial effort to design a workforce plan” would be required at a future date”.

Recently, the SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) has undertaken workforce issues as one of its major initiatives.  As part of that initiative, they have released a report, Primary and Behavioral Health Guiding Principles for Workforce Development (PDF - 1000KB).  CIHS will be addressing these behavioral healthcare workforce development needs for behavioral health in a multiyear effort leading to the identification of priority action steps and targeted implementation plans.

The Academy team has been tasked to create workforce competencies for primary care and behavioral health providers in primary care. This Agency for Healthcare Research and Quality funded project uses an environmental scan and feedback from a national expert panel to inform the selection of clinical sites that will be observed to help develop the competencies. The research team will select a purposive sample of primary care practice sites that have integrated healthcare and have been documented as exemplars according to a project specific set of criteria.  The research team will consider and try to maximize variation on the following attributes when selecting sites:  a) organizational structure, b) geographic location, c) size and patient panel served, and d) integration model the practice follows. The ultimate goal of this AHRQ project is to define the competencies needed for workforce development to meet the needs of integrated care settings, thus improving the future of how behavioral health is delivered in primary care settings. Specifically, competencies and functions will be proposed for primary care providers and behavioral health providers writ large, and not discipline specific. Once completed (Summer 2013), these competencies will be found on the Academy site. 

The Academy has completed a literature review on integration education and workforce and we will keep you abreast of the latest efforts in this area.