1

VHWDA BoardDec. 4, 2013

VHHA Healthcare Workforce Development Plan

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VHHA Strategic Workforce Task Force

• Met for 24 months to develop recommendations to address looming workforce needs re: skills and numbers

• Included stakeholders from health systems, higher education and state agencies

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• Incremental change or maintaining the status quo will not provide a sufficient health professional workforce to meet the core commitment of providing compassionate care to all.

• Our current licensure-based system, even if improved, will not be sufficient to meet our growing and evolving workforce needs.

• State government is a key partner, but the health care community broadly must help lead the needed change efforts.

• Even relatively modest changes will meet fierce stakeholder resistance in some cases, so a long-term effort is necessary.

• Today’s policy recommendations are important and address near-

term priorities, but the conversation will need to continue.

Overall Findings

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1. Launch a Troops to Healthcare Initiative to bring a younger workforce into healthcare.

2. Increase clinical training slots in Virginia and strengthen retention of medical school and advanced practice professional graduates

3. Support healthcare workforce innovation and flexibility

Recommendation Themes

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Drivers of Need for Healthcare Workers

• Demographics– Pig in a python age wave for both patients and

providers– Continued Virginia population growth, particularly in

younger ages

• Medical Technology Advancements– Expanding demand, but also potentially labor-saving

• ACA coverage vs. Access to Care– ACA’s 250,000 to 400,000 potential newly insured– Access to effective primary care systems a challenge

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Virginia’s Population Will Continue to Grow

2012 2020 2030 20400

2

4

6

8

10

12

8.19

8.81

9.65

10.53

University of Virginia, Weldon Cooper Center Estimates (in millions)

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Aging Health Workforce

Physicians Nurse Practitioners Registered Nurses Pharmacists Virginia Workforce Overall38

40

42

44

46

48

50

49

48 48

43

42

DHP Health Workforce Data Center

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Aging of the Nursing Workforce is a Long-term Trend

HRSA National Sample Survey of Registered Nurse (2006)

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We Already Rely on Older Professionals

Physicians Pharmacists Nurse Practitioners Registered Nurses25%

30%

35%

34%

33%

32%

31%

DHP Health Workforce Data Center: % of health professionals 55+ years

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Virginia Has Added Substantial Medical School Capacity Over the Past Decade Plus

2001 20170

100

200

300

400

500

600

700

800

900

1000

200250

150

156

140

1420

280

0

42

2001 (490 Graduates) v. 2017 (770 Estimated Graduates)

Virginia Tech Carilion

VIA School

EVMS

UVA

VCU

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Medical School Location Does Not Determine Where a Physician Practices

Virginia Other Country Border State Other U.S.0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

22%21%

18%

39%

2010 DHP Physician Licensure SurveyWhere Virginia Licensed Physicians Attended Medical School

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Residency Site is more Determinative of Practice Site than Medical School Location

Virgini

a M

edica

l Sch

ool

Comple

ted

Reside

ncy

in Virg

inia

Med

ical S

choo

l in V

A or B

orde

r Sta

te

Reside

ncy

in VA o

r Bor

der S

tate

Med

ical S

choo

l & R

eside

ncy

in VA

Med

. Sch

ool &

Res

idenc

y in

VA or B

orde

r Sta

te

0%

10%

20%

30%

40%

50%

60%

22%

32%

40%

55%

13%

26%

2010 DHP Physician Licensure SurveyWhere Virginia Licensed Physicians Attended Medical School

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As Our Population Has Grown Substantially Since the Federal Residency Freeze

Age 55+

1995 20120

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

9,000,000

6,600,000

8,186,000

Source: U.S. Census Bureau Annual Estimates

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Good Intentions Negative Outcomes

• GA increases funding to produce more graduates to address growing population.

• Federal freeze makes graduates go out of state for residency.

• MDs likely to reside in state with residency.• VA becomes donor state for other states’

physician workforce.• Graduates unable to practice without

internship/residency.

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Virginia Has More Than 167,000 Veterans Under Age 40

Under Age 30 Age 30-390

20,000

40,000

60,000

80,000

100,000

120,000

59,797

107,496

Source: U.S. Department of Veterans Affairs, September 2012,Does Not Include Active Duty Military

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Recommendations (continued)

1. Increase clinical training slots and retention of medical school and advanced practice professionals by:• Making increased retention a priority at medical/health professional schools;• Supporting consortium models for adding clinical training slots; • Expanding state support for residencies and other key clinical training

opportunities via targeted Medicaid payments and public/private partnerships;• Creating incentives for and assistance with placing students/graduates in

certified training programs in geographic areas and specialties of high need;• Working federally to relax the Medicare freeze on residency slots for high

growth states that have expanded medical and health professional school capacity.

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Prioritized Recommendations

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Recommendations (continued)

2. Encourage healthcare workforce innovation and effective integration:• Make Virginia a best in class state in clinical team integration who collectively

provide care that fulfill the IOM six aims – health care that is Safe, Timely, Effective, Efficient, Equitable and Patient-centered (STEEEP);

• Develop new care team approach and health professions training to embody STEEP aims

• Include workforce innovation research and demonstration program as part of Virginia Health Innovation Plan;

• Continue push for additional workforce regulatory flexibility with next Governor.

3. Recognize veterans’ competencies and speed integration of qualified veterans into the Virginia healthcare workforce

• Troops to healthcare health system commitment;• Continued push on regulatory flexibility for qualified veterans.

4. Continue multi-stakeholder committee or commission to: • Update workforce analyses, target priority areas and track progress• Address the aging of the workforce

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Prioritized Recommendations (continued)