HWRCs’ ANNUAL REPORT
2020
IN THIS ISSUE INTRODUCTION 3 In Memoriam: Dr. Fitzhugh Mullan 4 A Note From HRSA 5 HRSA HWRC Program
RESEARCH CENTERS 7 Allied Health & Health Equity Workforce Research Centers 8 Behavioral Health Workforce Research Center 9 Carolina Health Workforce Research Center 10 Health Workforce Equity Research Center & Health Workforce Policy Research Center 11 Health Workforce Technical Assistance Center 12 Oral Health Workforce Research Center 13 UCSF Health Workforce Research Center on Long-Term Care
YEAR IN REVIEW 14 HWRC Research Studies 18 COVID-19 Research Activities 20 Insights: Scope of Practice 22 Spotlight: New Health Equity HWRCs 24 2019 Conference Season
In Memoriam Dr. Fitzhugh Mullan 1942 - 2019 Dr. Mullan’s activism started during medical school in the 1960s when he spent time in Mississippi as a civil rights worker with the Medical Committee for Human Rights. He was a leader of the Student Health Organization during his time as a medical student, an organizer of the Lincoln Collective at Lincoln Hospital in the Bronx while a pediatric resident, and the president of the Committee of Interns and Residents in New York City in 1971-1972. These events are captured in his memoir of the period, White Coat, Clenched Fist: The Political Education of an American Physician. He studied history at Harvard and obtained his medical degree from the University of Chicago. He joined the United States Public Health Service in 1972 and spent 3 years practicing medicine in a community clinic in New Mexico as one of the first members of the National Health Service Corps, a program of which he subsequently became director. He later returned to New Mexico to serve as Secretary of Health and Environment for Governor Toney Anaya, worked for Surgeon General C. Everett Koop, and led the Federal Bureau of Health Professions. He attained the rank of Assistant Surgeon General, and Rear Admiral, USPHS.
Dr. Fitzhugh Seumas MacManus Mullan of Bethesda, Maryland was an American physician, writer, educator, and social activist who has served on the faculty of the George Washington University since 1996 as a Professor of Health Policy and Management and Professor of Pediatrics. He helped to establish the GW Health Workforce Institute recently renamed the Fitzhugh Mullan Institute for Health Workforce Equity. He was an elected member of the National Academy of Medicine.
In 1996, Mullan retired from the US Public Health Service and worked as a writer/editor at Health Affairs, the health policy journal, where he founded the monthly column: “Narrative Matters”. He believed that people’s understanding of policy issues was often determined by experience and anecdote. No one disputed that data and evidence should be the standard for policy making, but Mullan contended that stories have always been powerful mediators of how we see the world. During his time at Health Affairs, Dr. Mullan resumed practicing pediatrics at the Upper Cardozo Clinic of Unity Health Care and wrote about the experience in a series of pieces in Health Affairs and the Washington Post. In 2002, he published Big Doctoring: Profiles in Primary Care, a book of oral histories gathered from primary care physicians and nurse practitioners in an effort to capture the beauty and plight of those who provide the foundation of the health care system. During his later years at the George Washington University, his research focused on health workforce and health equity. From 2008-2010, he led a Gates Foundation funded study of Sub-Saharan African Medical Schools and from 2010-2015, he directed the Coordinating Center for the Medical Education Partnership Initiative, a $135 million US government investment in medical education in Sub-Saharan Africa. Fitzhugh Mullan will be remembered as a leader in the field of health workforce research and for his enduring commitment to healthy equity and expanding access to care for the underserved.
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A NOTE FROM HRSA The Health Resources and Services Administration’s Bureau of Health Workforce (BHW) is committed to ensuring effective, evidence-based planning and policymaking, and the nine HRSA-sponsored Health Workforce Research Centers (HWRCs) are vital to this goal. By conducting and disseminating rigorous research, the HWRCs strengthen health workforce policy and illuminate workforce issues and trends. In their research and technical assistance roles, the Centers serve as nationally recognized experts, and, through their efforts across multiple workforce segments, they provide essential information and technical assistance to local, regional, state, and federal planners and policymakers.
the HWRCs have been active during the COVID-19 pandemic, providing timely workforce information and resources to stakeholders at all levels.
In 2019 alone, the HWRCs produced more than 25 reports and journal articles based on their research and made more than 30 presentations at national conferences. Collectively, this work addressed a wide range of workforce topics, including allied health, behavioral health, health equity, long-term care, oral health, and emerging issues related to community health, evolving healthcare delivery modes, and valuebased healthcare. In addition, the Health Workforce Research Alert System was launched to quickly disseminate HWRC research to broad audiences.
Torey Mack, MD
This year, the HWRC directors came together to produce two commentaries published in the New England Journal of Medicine, one on modernizing health professions regulation to prioritize the needs of patients and the second on ensuring and sustaining a strong pandemic health workforce. Most recently,
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BHW thanks the HWRCs for their efforts and looks forward to their important contributions in the future. Sincerely,
Deputy Associate Administrator, Bureau of Health Workforce Health Resources and Services Administration US Department of Health and Human Services
T
HRSA HWRC PROGRAM
he National Center for Health Workforce Analysis (NCHWA) is a national resource for health workforce research, information, and data. As a division within the Bureau of Health Workforce (BHW) at the Health Resources and Services Administration (HRSA), NCHWA supports policy makers with information and data to help inform decisions regarding health workforce education, training, and healthcare delivery (https://bhw.hrsa.gov/health-workforceanalysis/about). As part of these efforts, NCHWA oversees HRSA’s Health Workforce Research Center (HWRC) cooperative agreement program, which provides funding to 9 centers in the US. Collectively, these Centers offer expertise in the following arenas:
Allied health workforce (University of Washington)
Behavioral health workforce (University of Michigan)
Emerging health workforce topics (George Washington University; University of North Carolina at Chapel Hill)
Health equity in health workforce education and training (George Washington University; University of Washington)
Long-term care workforce (University of California, San Francisco)
Oral health workforce (State University of New York, Albany)
Technical assistance (State University of New York, Albany)
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COVID-19
Workforce Strategies in Response to the Pandemic
The Health Workforce Technical Assistance Center has developed a resource dedicated to sharing data and information on eorts to develop, deploy, and replenish the health workforce in response to the pandemic.
UPDATED DAILY
www.healthworkforceTA.org/COVID-19 6
The University of Washington Center for Health Workforce Studies (UW CHWS) was established in 1998 with funding from HRSA. It is based in the Research Section of the Department of Family Medicine, part of the University of Washington School of Medicine. UW CHWS houses 2 of 9 Health Workforce Research Centers (HWRCs) across the US funded by the National Center for Health Workforce Analysis at HRSA. Each HWRC focuses on a specific aspect of the health workforce. UW’s HWRCs are addressing 1) the allied health workforce and 2) health equity and health workforce diversity. The Allied Health HWRC is dedicated to research on trained professionals, other than registered nurses or physician assistants, who share “in the responsibility for the delivery of healthcare services or related services, including services relating to the identification, evaluation, and prevention of disease and disorders, dietary and nutrition services, health promotion services, rehabilitation services, or health systems management services.”
To ensure a
robust and diverse health workforce in the future, our research shows that we need to invest in our healthcare workers, particularly those in ‘low-skilled’ jobs, articulate the long-term healthcare
Allied Health & Health Equity Workforce Research Centers
career opportunities, and value these individuals appropriately for their hard work.
The Health Equity HWRC focuses on the health workforce’s role in promoting health equity by delivering culturally and linguistically competent care to reduce health disparities among a population diverse on a number of dimensions (eg, race, ethnicity, gender identity, sexual orientation, geography, socioeconomic status, disability status, language, and age) and partnering with communities to promote population health. depts.washington.edu/fammed/chws/
Director Bianca K. Frogner, PhD
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Our research
aims to improve understanding of the size, composition, and capacity of the behavioral health workforce. Valid and reliable data are important for informing workforce
planning efforts and improving delivery of mental health and substance use disorder services.
Director Angela J. Beck, PhD, MPH Director Angela J. Beck, PhD, MPH
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Behavioral Health Workforce Research Center Research to Produce a Workforce to Meet the Nation’s Behavioral Health Needs Nearly one-fifth of the adult US population is estimated to have a diagnosable mental illness. Mental and emotional well-being is essential to overall health, yet serious challenges exist in providing needed behavioral health care services to the population, and mental health disparities persist among minority and vulnerable populations. The Behavioral Health Workforce Research Center (BHWRC) was established in September 2015 and is housed at the University of Michigan School of Public Health. The Center aims to strengthen the workforce responsible for prevention and treatment of mental health and substance use disorders by conducting studies to inform workforce development and planning efforts. The Center works with a national consortium of partners that represent groups of professional and provider organizations engaged in mental health and substance use disorder prevention. The BHWRC Consortium guides the Center’s research efforts, which focus on addressing workforce shortages, assessing behavioral health worker characteristics and practice settings; and analyzing legal and professional scopes of practice. www.behavioralhealthworkforce.org
If the United States health care system is to successfully move from paying for volume to rewarding value, we will need to structure the training and deployment of the workforce to deliver value. The Carolina Health Workforce Research Center (CHWRC) seeks to meet this challenge by conducting and disseminating timely, policy-relevant research on emerging health workforce topics that help define and measure value in the health workforce.
As state and
federal policy makers face budget constraints, they are seeking more information about the value of health workforce investments, an area of inquiry that has been
Carolina Health Workforce Research Center
The Center’s work focuses on:
largely unaddressed in past
Developing new data collection and analytic methods to improve our understanding of the value of different skill mix configurations in new models of care
discussions about paying
Developing metrics and toolkits that state and federal policy makers can use to evaluate the return on investment of public funds spent on health workforce training
system.
Conducting studies to understand and measure the plasticity—or flexibility—of the workforce to move between specialties, employment settings and roles as new payment and care delivery models emerge
for value in the health care
Since 2013, our research has been used by a wide range of audiences to shape state and federal health workforce policy. We have developed innovative methods and data visualizations that have advanced the science of workforce research as we mentor students from a wide range of disciplines who will form the next generation of health workforce researchers. go.unc.edu/CHWRC
Director Erin Fraher, PhD, MPP
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Our studies have
included explorations of how and why care teams are formed and deployed in specific contexts,
measurement of the effects of
policy and payment changes on the health workforce, and
assessments of the impact of different workforce
configurations on quality, access, and costs.
Director Patricia Pittman, PhD
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Health Workforce Equity Research Center & Health Workforce Policy Research Center The Mullan Institute at George Washington University is home to 2 centers: 1) one focused on equity in health workforce education (Equity) and training and 2) one focused on emerging health workforce issues (Policy). Established in 2018, the Health Equity Workforce Research Center conducts workforce studies on equity in health workforce education and training. The Equity HWRC research portfolio looks across the continuum of education and training opportunities for all health professions and assesses them in relation to social mission outcomes. Established in 2013, the Health Workforce Policy Research Center conducts workforce studies on emerging health workforce issues. The center’s research portfolio examines how new payment and delivery models, patient centered medical homes, team-based care, telehealth, National Health Service Corps, and other emerging care management strategies impact access and quality of care for rural and underserved populations. We are committed to advancing the science of workforce analysis by 1) developing cutting edge research methods for documenting how workforce staffing configurations impact patient satisfaction and health outcomes, 2) employing innovative uses of available datasets to identify the workforce caring for patients living in health professional shortage areas, 3) publishing a portfolio of peer-reviewed publications that build off of each other to identify policies for improving care for vulnerable and underserved populations, and 4) training the next generation of health workforce researchers to carry the work forward into the future. www.gwhwi.org/hwrc.html
Providing Technical Assistance for Health Workforce Planning
The Health Workforce Technical Assistance Center (HWTAC) provides technical assistance to organizations that engage in health workforce planning. This includes support for health workforce data collection, analysis, and dissemination. Established in 2013, HWTAC is based at the Center for Health Workforce Studies (CHWS) at the School of Public Health, University at Albany, State University of New York. HWTAC’s website has an extensive resource library of videos, webinars, reports, resource briefs, relevant links, FAQs, and state health workforce data collection strategies. HWTAC also assists in the dissemination of HRSA funded studies produced by the HWRCs. This Research Alert System distributes these studies to a wider audience by email and social media. All research alerts are housed on the HWTAC website, with brief descriptions and links to each research study.
Our strength at
HWTAC is our experience and knowledge about health workforce research and planning. HWTAC has a history of working with states and organizations to address data
Health Workforce Technical Assistance Center
and analytic needs. HWTAC supports stakeholders in the health services research community.
To receive research alerts, webinar announcements, and other news right to your inbox, visit http://www.healthworkforceta.org/hwtac-list-subscription/.
www.healthworkforceTA.org
Director David Armstrong, PhD
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Efforts to expand
access to oral health services must consider the availability of a workforce equipped to meet the population’s need for both preventive and restorative oral health services. A key goal of OHWRC is to conduct research
that can inform workforce strategies that are best able to reduce oral health disparities in the US.
Oral Health Workforce Research Center Research to Improve the Oral Health of the Nation’s Population Access to oral health care has become a growing concern over the past decade. Despite efforts to improve the oral health of the nation’s population, disparities in access, utilization, and outcomes persist. An available, competent, and well distributed workforce is required to assure access to needed oral health services. The key goals of the Oral Health Workforce Research Center (OHWRC) are to provide timely, accurate data and conduct policy relevant research to assist in workforce planning for oral health services. Specific areas of focus include health services integration, mobile and portable dentistry, teledentistry, diversity in dentistry, consumer perspectives on access to care, dental therapy, dental hygiene scopes of practice, and dental safety net providers’ strategies to expand access to services for underserved populations, among others. The OHWRC is based at the Center for Health Workforce Studies (CHWS) at the School of Public Health, University at Albany, State University of New York. The OHWRC was formed as a partnership between CHWS and the Healthforce Center at the University of California, San Francisco. Visit the OHWRC website to access research reports, briefs, and a wealth of informational resources on the oral health workforce.
Director Jean Moore, DrPH, MSN
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www.oralhealthworkforce.org
UCSF Health Workforce Research Center on Long-Term Care
The aging of the
population is going to put
With the large cohort of Baby Boomers entering their 60s, a rapidly-increasing proportion of older Americans and people with disabilities will require long-term care (LTC), both at home and in the community. In addition, younger Americans living with disabilities also have long-term care needs. The Center closely examines the LTC workforce with the goal of generating information that can improve policies and programs to meet the care needs of our population, now and in the future. The UCSF HWRC has studied all aspects of the workforce involved in long-term care, ranging from the evolving roles of geriatricians, composition of palliative care teams, future demand for LTC workers, and training required for personal care aides in the home. Their expertise in understanding how the complex LTC workforce contributes to improving access, increasing quality, and attaining high-value health care has contributed to practice and policy change at the local, state, and national levels.
unprecedented pressure on our health care system to meet both acute and longterm care needs. Older people want to live and age
The UCSF Health Workforce Research Center on Long-Term Care (UCSF HWRC), based at the University of California, San Francisco‘s Institute for Health Policy Studies and Healthforce Center, is a dynamic hub of policy-oriented research and investigation. The mission is to help answer the essential question: Is our health care workforce prepared to meet the growing longterm care needs of the US population?
in their homes, and we hope our research
contributes to making that possible.
healthworkforce.ucsf.edu Director Joanne Spetz, PhD, FAAN
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Year in Review
Behavioral Health Service Provision by Primary Care Physicians: This project seeks to understand which behavioral health services primary care physicians currently provide for their clients and how often they do so. -Behaviorial Health Workforce Research Center
State Incentive Programs that Encourage Allied Health Professionals to Provide Care for Rural and Underserved Populations: This study describes Characteristics of Physician Assistant Students Planning to Work in Primary Care: The purpose of this study was to identify the
characteristics of matriculating PA students planning to enter primary care specialties and compare them with students planning on entering other specialties. -University of Washington Center for Health
Workforce Studies
The Role of the National Health Service Corps Clinicians in Enhancing Staffing and Patient Care Capacity in Community Health Centers: This study helps validate the
effectiveness of NHSC loan repayment and scholarship incentives as a recruitment strategy and to inform policies on the impact of NHSC on CHCs’ patient care capacity. -GW Health Workforce Research Center
allied health incentive programs at the state level as described during 30 semi-structured phone interviews with key informants from 27 states and information found online.
-University of Washington Center for Health Workforce Studies
Practice Patterns of Postgraduate Dental Residency Completers from Select Long-Term HRSA-Funded Primary Dental Care Training Programs: This report assesses
the impacts of HRSA’s postgraduate dental training programs on current practice patterns of ‘completers’ of these programs and on improving the capacity of dentists to meet the needs of the underserved.
-Oral Health Workforce Research Center
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Does Expanded State Scope of Practice for Nurse Practitioners and Physician Assistants Increase Primary Care Utilization in Community Health Centers?: This study examines the impact of expanded state scope of practice for nurse practitioners (NPs) and physician assistants (PAs) on primary care utilization in community health centers by NP, PA, and primary care physician. -GW Health Workforce Research Center
The Impact of Emerging Technologies on Long-Term Care and the Health Workforce: This report assesses which emerging technologies may facilitate,
replace, or enhance recruitment, training, and retention of the long-term care workforce. -UCSF Health Workforce Research Center on Long-Term Care
A National Study of the Practice Characteristics of Women in Dentistry and Potential Impacts on Access to Care for Underserved Communities: This report evaluates the differences by gender of dental professionals’ practice characteristics including employment status, working hours, and practice location. -Oral Health Workforce Research Center
Certified Community Behavioral Health Clinic Workforce and Service Delivery Trends: To better
understand behavioral health workforce factors and service delivery within Certified Community Behavioral Health Clinics, this mixed methods study helps inform policy makers and discusses future practice recommendations. -Behavioral Health Workforce Research Center
The Behavioral Health Workforce in Rural America: Developing a National Recruitment Strategy: This report describes state incentives for behavioral health provider recruitment, particularly in rural areas. -Behavioral Health Workforce Research Center
Consumer Survey of Barriers to and Facilitators of Access to Oral Health Services: This report evaluates factors identified by consumers as impacting their access to oral health services and explores differences in utilization of oral health services by demographically distinct population groups. -Oral Health Workforce Research Center
Supporting the Adult Protective Services Workforce: This study summarizes the current state of affairs with the APS workforce, highlights efforts being made to address their issues, and recommends actions that would further support these efforts to improve community APS in the US. -UCSF Health Workforce Research Center on
Long-Term Care
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Expanding Access to Care with Scope of Practice: The Oral Health
Workforce Research Center developed an infographic that visually depicts state-level variation in Dental Hygienists’ scope of practice to help better inform policy makers and other oral health stakeholders. -Oral Health Workforce Research Center
Use of Apprenticeship to Meet Demand for Medical Assistants in the US: This study identifies different apprenticeship models including alternative ways program administration, didactic instruction and clinical skills training are provided, and broadens information about healthcare apprenticeships’ value to employers. -University of Washington Center for Health Workforce Studies
Factors That Influence Access to Medication-Assisted Treatment:
This study examines factors that may influence access to MAT and to SUD treatment services, including negative perceptions associated with SUD treatment, cultural norms, and Medicaid and other insurance coverage. The study also examines state-specific initiatives to combat the opioid epidemic and SUDs. -Behavioral Health Workforce Research
Center
Assessing the Value of Pediatric Graduate Medical Education in Meeting State and National Needs: This study develops outcome metrics that can be used to evaluate pediatric GME investments in producing the workforce that meets state and national health care needs. -Carolina Health Workforce Research Center
Geriatrician Roles and the Value of Geriatrics in an Evolving Healthcare System: This study focuses on information
solicited from field experts in geriatrics as to how geriatrician roles are evolving as healthcare systems and organizations reorganize care in response to a changing environment. -UCSF Health Workforce Research
Center on Long-Term Care
Case Studies of 6 Safety Net Organizations That Integrate Oral and Mental/Behavioral Health With Primary Care Services: These case studies
describe benchmark strategies used by safety net provider organizations to integrate health services delivery for patients including screening for and identifying medical, dental, and mental health conditions during health care encounters and directing referrals to appropriate clinical providers. -Oral Health Workforce Research Center
The Health Workforce Delivering Evidence-Based Non-Pharmacological Pain Management: This study compares 10 different
health care occupations and certified practitioners in providing non-pharmacological pain management treatments to patients with chronic pain. -University of Washington Center for Health
Workforce Studies
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Behavioral Health Provider Geographic Distribution and Reimbursement Inequities: This cross-sectional
study examines the relationship between reimbursement and behavioral health provider geographic distribution and seeks to understand how Medicare and Medicaid reimbursement for behavioral health providers may limit service delivery. -Behavioral Health Workforce Research
Center
Consumer Survey Focused on Parents’ Experiences Accessing Oral Health Services for Their Children: This report highlights unique access barriers for specific high-needs children (racial/ethnic minorities, low-income parents, uninsured families, Medicaid beneficiaries, rural individuals) or geographic regions. -Oral Health Workforce Research Center
Social Work and Electronic Health Records: A New Frontier for Health Workforce Research: This study aims to demonstrate how electronic health records data can be used as a
workforce research tool to assess the scope, contributions, and value of social work, a profession still in the process of establishing its return on investment in health care. -Carolina Health Workforce Research Center
The Distribution of Advanced Practice Nurses Within the Psychiatric Workforce: This study examines
the size and distribution of the advanced practice psychiatric nurse workforce relative to the total psychiatry workforce to determine whether nurses are predominantly working in areas with higher or lower levels of behavioral health specialists. -Behavioral Health Workforce Research Center
Health Workforce Training Program Evaluation Toolkit: The Health Workforce Training Program Evaluation Toolkit is
a comprehensive “program evaluation 101” resource for both new and established programs seeking to learn new evaluation strategies. -Behavioral Health Workforce Research Center
Enhancing Staffing In Rural Community Health Centers Can Help Improve Behavioral Health Care: This study compares
behavioral health care staffing and services in rural and urban community health centers. -GW Health Workforce Research Center
Compendium of Innovations in Oral Health Service Delivery: This compendium summarizes best
practices in innovative oral health service delivery programs drawn from over 40 case studies conducted by the OHWRC in recent years. -Oral Health Workforce Research Center
Office Based Opioid Treatment (OBOT) - The Workforce Treating Opioid Use Disorder: This report assesses which professionals
comprise the workforce that provides MAT (medication-assisted treatment) in primary care, how OBOT teams communicate about patient care, and the behavioral components of MAT provided in primary care settings. -Carolina Health Workforce Research Center
The Respiratory Therapist Workforce in the US: Supply, Distribution, Education Pathways, and State Responses to Emergency Surges in Demand: This brief
describes the supply, distribution, education pathways, as well as COVID-19 emergency concerns about the respiratory therapist workforce capacity and examples of state approaches addressing workforce gaps. -University of Washington Center for Health
Workforce
State Health Workforce Deficit Estimator:
The Estimator is a tool to provide state-level data to state and federal planners considering different strategic approaches to ensure sufficient heath workforce for COVID-19. -GW Health Workforce Research Center
Want to see all the HWRCs’ work? Visit our Research Alert Archive. 17
COVID-19
HWRC Research Activities to Address Workforce Needs During COVID-19 Pandemic As the country responds to the COVID-19 pandemic, the health workforce has become a prominent issue. The Health Workforce Research Centers (HWRCs) supported by the Health Services and Resources Administration (HRSA) have provided assistance to states and other stakeholders to better inform workforce strategies. Below are brief summaries of contributions by the HWRCs to efforts in developing effective workforce strategies in response to the COVID-19 pandemic.
Carolina Health Workforce Research Center Dr. Erin Fraher, Center Director, has been working with North Carolina DHHS Secretary Cohen and Deputy Secretary Ben Money to identify strategies needed to surge and sustain the workforce needed for COVID-19. This includes producing data, synthesizing available evidence and best practices from other states, liaising with licensure boards regarding regulatory changes needed, drafting policy memos, and participating in daily huddles to inform state response. Dr. Fraher and her team developed a series of blogs around North Carolina professions critical to combatting COVID-19. Currently posted: infectious disease, primary care, and critical care nurses. To be posted soon: respiratory therapists, critical care medicine, and long term care. These blogs analyze whether the workforce will be able to surge to staff ICU and acute care beds as well as ventilators. Dr. Fraher is working closely with the NC Board of Respiratory Care to disseminate the results of a survey of health care systems and hospitals regarding RT capacity on the state. Dr. Tom Ricketts is preparing a report on roles preventive medicine physicians play in infectious disease management and public health. As Chair of Council on Graduate Medical Education (COGME), Dr. Fraher is working on COGME’s response to COVID-19.
Center for Health Workforce Studies (CHWS) at the University at Albany Dr. Jean Moore, director of the Center for Health Workforce Studies at the University of Albany’s School of Public Health, represented the State University of New York on a COVID-19 team established by New York State Governor Andrew M. Cuomo to build health workforce surge capacity during the pandemic. Dr. Moore and the staff of CHWS provided assistance on database development, data analysis, and management of the statewide volunteer database. CHWS provided up-to-date data and information on the state’s health workforce and the educational pipeline for health professions. CHWS helped with outreach to health professionals, education programs, and health care professional associations in efforts to build surge capacity.
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Fitzhugh Mullan Institute for Health Workforce Equity at the George Washington University (Mullan Institute) The Mullan Institute is hosting a mini-series of webinars on Emergency Workforce Strategies to Address COVID- 19. Accompanying resources and summary write-ups are posted alongside links to the recordings on the Mullan Institute website gwhwi.org/covid-19. Topics have included: Expanding Scope of Practice, 1135 Waivers, Tapping Retirees and Other Health Practitioners, Is There a Right to Not Work During COVID 19?, Mobilizing Health Professions Students, Telehealth, The Importance of Standards, Reproductive Health, Behavioral Health, Contact Tracing, and Social Mission of Health Professions Schools. The Mullan Institute developed a Healthcare Workforce Deficit Estimator to help state and federal policy leaders prepare for potential health workforce shortages. The Deficit Estimator allows states to assess the sufficiency of their health workforce to meet COVID-19 cases. The Deficit Estimator currently provides estimates for: intensivists, critical care nurses, hospitalists, respiratory therapists and pharmacists. The Mullan Institute developed The Contact Tracing Workforce Estimator for state and local leaders to prepare for COVID-19 contact tracing in order to safely reopen and protect the health of communities. The preset parameters assume number of case contacts with social distancing and work capacity to include some social needs evaluation and case management. As the dynamics of the pandemic vary regionally, users can adjust variables according to the circumstances and needs of their location.
UCSF Health Workforce Research Center on Long-Term Care/Healthforce Center at UCSF The Healthforce Center developed a rapid-response list of recommendations for California policy leaders to consider to facilitate a surge in health workforce capacity. Dr. Spetz worked closely with leaders from HealthImpact and the California Hospital Association to develop recommendations to support student employment to meet COVID-19 health care needs. The Healthforce Center developed an Excel workbook to create staffing plans for newly-opened acute care facilities that are caring for COVID-19 patients. The Healthforce Center is providing technical assistance in creation of job descriptions for alternative care sites for low-acuity and post-acute COVID-19 patients. The Healthforce Center is continuously crowd-sourcing information from other states to share with state and local leaders involved in the COVID-19 workforce surge.
University of Michigan Behavioral Health Workforce Research Center Dr. Angela Beck, Center Director, is assisting with state efforts related to contact tracing, public health capacity, and behavioral health capacity for COVID-19. Center researchers updated a comprehensive database of all scope of practice information related to provision of telehealth. Center researchers developed a summary of Medicaid emergency authority to inform strategies for flexing and surging the behavioral health workforce.
University of Washington Center for Health Workforce Studies (UW CHWS) Dr. Bianca Frogner, Center Director, estimated the number of health care workers who would be affected by COVID-19 and this analysis was disseminated to HRSA and other federal leaders. Dr. Frogner served as a panelist for a webinar hosted by GW Mullan Institute for Health Workforce Equity on state strategies to expand scope of practice of health care workers during COVID-19 pandemic. Sr. Deputy Director Sue Skillman led a UW CHWS team to develop a brief describing the national landscape of respiratory therapists and their roles during COVID-19. Dr. Frogner and Sr. Deputy Director Skillman contributed to the National Governors Association efforts to identify policy levers in Washington state to effectively deploy the health workforce to meet patient needs across multiple settings during the COVID-19 pandemic. Sr. Deputy Director Skillman and Dr. Frogner have been contributing to health workforce response discussions related to the COVID-19 emergency with several Washington State agencies, including the Washington Health Care Authority, the Department of Health and health professions boards, as well as the Washington State Workforce Training and Education Coordinating Board.
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Insights Collaborative, Timely, and Important Contributions from HRSA’s Workforce Center Directors By Peter Buerhaus, PhD, RN, FAAN Director, Center for Interdisciplinary Health Workforce Studies, Montana State University, Bozeman
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n Spring 2020, the directors of the HRSA workforce centers, together with the Center for Interdisciplinary Health Workforce Studies at Montana State University, came together to author two articles that were published as perspectives in the New England Journal of Medicine. Perspective articles focus on providing timely comments on relevant topics in health care and medicine in a brief and accessible style. The two publications reflected the experiences of the 7 authors who found their collaboration sparked by common concerns about issues affecting the nation’s health care workforce and the delivery of health care. The first issue focused on describing how state regulations governing the scope of practice of health professionals are counterproductive. At a time when health care delivery systems across the country are trying to experiment with new ways to increase access to health care, their ability to innovate is often handcuffed by restrictions
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imposed by state regulatory agencies, or even by their own institutional history, that unnecessarily limit the practice of many professionals. That is, such restrictions do not permit a clinician to provide all the services they are educated and competent in providing.
“At a time when health care delivery systems across the country are trying to experiment with new ways to increase access to health care, their ability to innovate is often handcuffed by restrictions imposed by state regulatory agencies, or even by their own institutional history, that unnecessarily limit the practice of many professionals.”
This constrains the ability of health care systems to innovate and also limits the capacity to increase access to care, lower costs, provide more care in community settings, and increase the value of the care provide by health professionals. The perspective article offered strategies and specific actions that policy makers and organizations could pursue to modify existing restrictions so that the nation’s health care workforce can be used more wisely and productively than it is currently. Shortly after this perspective was published on February 13, 2020, the COVID-19 pandemic began to dominate the attention of the media, health care delivery organizations, and federal and state public leaders. By the second week of March, it had become clear that the Corona virus was threatening New York City and concern began to grow over the realization that other “hot spots” would likely develop throughout the nation. All of us became familiar with a new term “social distancing” and our lives changed suddenly and profoundly. These developments were not lost on the author team of workforce directors who put their minds and writing pens together and quickly prepared a second article for the New England Journal of Medicine. At the time, most of the media and
(...Continued from page 20) government policy attention was directed at ensuring personal protection equipment and ventilators. The author team, however, focused on longer term issues and offered fresh ideas for hospitals and other health care organizations, educators, and government leaders on how the nation’s health care workforce could be “surged” and sustained over the course of the pandemic. Ideas ranged from how to ensure enough respiratory therapists, avoiding bottlenecks in the education pipeline, and removing regulatory restrictions that unnecessarily affected the use of health professionals. The article was published on April 8, 2020. What makes these two publications notable is that they were written by the nation’s health workforce leaders—smart, experienced, balanced and empirically oriented people who united as a group with a shared purpose and plenty of determination. Early on in the writing process, I believe, there was a realization of the truth to the saying “The whole is more than the sum of its parts”, and a realization that when the leaders of the HRSA workforce centers come together and convey messages in a prestigious journal, there is a good chance that people, policy makers, and the media will pay attention. More importantly, the topics that brought this team together—scope of practice restrictions and preparing the nation’s health workforce for the pandemic—were exactly the areas where the author team had something important and timely to communicate. Acting on the suggestions offered in these two publications could help strengthen the nation’s health care workforce and, in turn, improve the nation’s health care delivery systems.
Read the Publications: Frogner BK, Fraher EP, Spetz J, Pittman P, Moore J, Beck AJ, Armstrong D, Buerhaus PI. It’s Time to Modernize Health Professions Scope of Practice Regulations. New Engl J Med. 2020;382(7):591-593. DOI: 10.1056/NEJMp1911077. Fraher EP, Frogner BK, Spetz J, Pittman P, Moore J, Beck AJ, Armstrong D, Buerhaus PI. Ensuring and Sustaining the Pandemic Workforce. New Engl J Med. (Published online April 8, 2020). DOI: 10.1056/NEJMp2006376.
Q&A How do you work with licensure boards to collect and share data? Relationships are key. Licensure boards are important partners in health workforce data collection, but their main priority is regulation to protect patient safety. They often don’t have resources (ie, funding, staff, time) to collect additional data, and in some states, current legislation restricts their ability to share data. Show the boards the value of collecting additional workforce data as it relates to evidencebased regulation, and look for ways to minimize their burden, especially during the initial development period. Treat them as a valued partner and bring them into the conversation very early to build trust.
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SPOTLIGHT: NEW HWRCS H
Introducing 2 New Health Equity Centers
ealth equity has been described by the National Academies as the “state in which everyone has the opportunity to attain full health potential, and no one is disadvantaged from achieving this full potential because of social position or other socially defined circumstances�. The health workforce can address social determinants of health and promote health equity by delivering culturally and linguistically competent care to reduce health disparities among a population diverse on a number of dimensions (eg, race, ethnicity, gender identity, sexual orientation, geography, socioeconomic status, disability status, language, and age) and partnering with communities to promote population health.
In 2018, HRSA issued 2 coopertative agreements for 2 health equity centers: one with the University of Washington Center for Health Workforce Studies, and the other with George Washington University’s Fitzhugh Mullan Institute for Health Workforce Equity. 2019 was the first full year of operation for both equity centers. The goals of the equity centers are to conduct innovative, timely, and relevant health workforce research and evaluation that examines a range of topics on health equity in health workforce education and training. They aim to strengthen the evidence base that provides the health workforce with the knowledge, skills, and abilities to foster health equity in the delivery of patient care and population health. Their research strives to nurture partnerships among academic institutions, communities, and healthcare organizations that will help enable the health workforce to address social determinants of health and foster health equity within the US population.
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CURRENT RESEARCH STUDIES Health Equity Workforce Research Center at the University of Washington Center for Health Workforce Studies
Health Workforce Equity Research Center at George Washington University’s Fitzhugh Mullan Institute for Health Workforce Equity
Explaining Wage Variation Across Race/Ethnicity Among RNs and APRNs
Assessing the Impact of State Policies on Nursing Education Regulation and Program Outcomes
Best Practices in Experiential Education to Educate Health Professionals on Heath Equity
Assessing the Strength and Diversity of Medical Schools’ IPE and SDOH Offerings
The Potential Burden of Being Underrepresented in Health Professional Programs
Case Studies of Nurse Practitioner Residency Programs
Disability Competency Training in Medical Education
Developing a Social Mission Research Agenda
Increasing Access to Doulas to Support a Diverse Population
Do Health Professions’ Accreditation Standards Include Social Mission Metrics? Residency Training in Federally Qualified Health Centers: The Impact on Staffing Capacity and Productivity
Director Bianca Frogner of the Health Equity Workforce Research Center at the University of Washington Center for Health Workforce Studies.
Director Patricia Pittman of the Health Workforce Equity Research Center at George Washington University’s Fitzhugh Mullan Institute for Health Workforce Equity.
“The new health equity HWRCs are built on strong research teams with decades of health workforce research experience, and partnerships with experts from many scientific disciplines, to promote equitable and effective health care for all by strengthening the health workforce.” ~ Bianca Frogner, PhD
“The social mission of health professions education and training programs is one of the key drivers of health workforce equity.” ~ Patricia Pittman, PhD
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2019 CONFERENCE SEASON
GW’s Clese Erikson at the AcademyHealth Annual Research Meeting in Washington, DC
Staff from each of the HWRCs gathered to present their research at a variety of conferences and meetings across the country
11th World Congress of the International Health Economics Association (IHEA), Basel, Switzerland AcademyHealth Annual Research Meeting, Washington, DC American Association of Health Care Journalists – Rural Workshop, Aurora, CO American Congress of Rehabilitation Medicine Annual Conference, Chicago, IL
OHWRC’s Margaret Langelier discusses research findings during the American Public Health Association’s poster session in Philadelphia, PA
American Geriatrics Society, Portland, OR American Psychiatric Nurses Association Health Policy Summit, Falls Church, VA American Public Health Association (APHA) Annual Meeting and Expo, Philadelphia, PA American Society of Addiction Medicine (ASAM) Conference, Orlando, FL American Society of Health Economists, Washington, DC Association of American Medical Colleges (AAMC), Washington, DC Canadian Institutes of Health Research’s Best Brains Exchange Meeting, Ottawa, Canada
UCSF’s Joanne Spetz & UNC’s Erin Fraher with their Data Olympics awards from the International Health Workforce Collaborative meeting in Ottawa, Ontario
Cluj School of Public Health, Babes-Bolyai University, ClujNapoca, Romania Council on Graduate Medical Education, Washington DC Forum on Nursing Workforce Centers, Denver, CO Gerontological Society of America Annual Scientific Meeting, Austin, TX Health Services Research Colloquium, The Pennsylvania State University, State College, PA International Health Workforce Collaborative (IWHC), Ottawa, Canada
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UW’s Susan Skillman and members of the Washington State Workforce & Education Coordinating Board engaged with members of the WA State House Health & Wellness Committee
(...Continued from page 24) NALEO National Policy Institute on Workforce Development, Los Angeles, CA National Academy of Medicine Vital Directions for Health and Health Care Symposium, Durham, NC National Network for Oral Health Access (NNOHA) Annual Conference, Las Vegas, NV National Network of Public Health Institutes (NNPHI) Annual Conference, Orlando, FL National Oral Health Conference, Memphis, TN National Rural Health Association Annual Meeting, Atlanta GA New York State Oral Health Coalition, Troy, NY Nexus Summit 2019, National Center for Interprofessional Practice and Education, Minneapolis, MN Northwest Rural Health Conference, SeaTac, WA Robert Graham Center Primary Care Forum: Senate Staer Briefing, Washington DC Washington Medical Assistants Educators Meeting, Renton Technical College, Renton, WA Washington State Association of Health Care Recruiters, Renton, WA Washington State Health Workforce Council, Olympia, WA Washington State House of Representatives Health Care and Wellness Committee, Olympia, WA
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HEALTH WORKFORCE
RESEARCH ALERTS
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