August 2001 (Vol. 2, No. 9)
Will Wisconsin Have a Health Care Workforce to Meet Its Needs?
By: Brian Potter, Director of Health Care Information, Wisconsin Health and Hospital Association and Diane M. Peters, Vice President of Workforce Development Wisconsin Health and Hospital, Association

Wisconsin is beginning a lengthy period in which finding and retaining qualified health personnel will be a strategic imperative and challenge. The state is experiencing a demographic trend that will result in more workers retiring than entering health occupations. At the same time, the demand for health care services is increasing because of the aging population. Wisconsin's hospitals are already beginning to experience increased workforce challenges including emergency room crowding, reductions in bed availability, increases in surgery waiting time, cancellations of surgeries, emergency room diversions due to unfilled staff positions, and reduction in special services.

Economic Impact

Health services represents one of the top three industries in Wisconsin. It will account for one in every three new jobs between 1998-2008. The growth in the health service industry is due to the aging of Wisconsin's population and the advances in acute and chronic medical treatments, according to the Wisconsin Department of Workforce Development (DWD).

Workforce Projections

DWD projects health service positions to account for 270,430 NEW jobs by 2008, which represents a 20% or 45,530 increase from 1998. In addition, the industry will also have to replace the additional 43,720 employees who will retire or leave the industry by 2008.

By 2008, DWD anticipates a 156% (6,690) increase in new nursing aide positions; a 35% (10,270) increase in RN/LPN positions; a 147% (1,840) increase in new technician positions such as lab, xray, etc, and a 30.3% (3,200) increase in new therapy positions.

Workforce Vacancies

The Wisconsin Health and Hospital Association (WHA), in collaboration with the Wisconsin Department of Health and Family Service, Bureau of Health Information, completed a survey of Wisconsin hospitals to identify and benchmark the current personnel needs and other characteristics of 15 health care professions. Detailed personnel data from Wisconsin hospitals was previously unavailable. Data was received from 115 of the 150 hospitals in the fall of 2000.

Results from the survey indicate that registered nurses make up the highest portion of total vacancies (47% of vacancies), certified nursing assistants (27%), LPN's (7%) and radiology tech. (5%) round out the top four. Vacancy rates by position ranged from 14% for CNA's to 1.6% for occupational therapists (See Table 1).

Wisconsin Aging Population

Wisconsin is just beginning to feel the effects of a reduced supply of health care workers and an aging health care workforce. The U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) recently published a state-by-state profile of the health service workforce. According to HRSA's study, the total population of Wisconsin is only projected to grow by 9% by 2020, while the population over 65 is projected to grow 47% during the same time. This is in addition to a 25% growth of this age group between 1980 and 2000. As the state experiences the aging of the general population, there will be a corresponding increase in demand for health services. The WHA personnel survey identified the number of employees in a job classification over the age of 55. Values ranged from 14% of LPNs to 0% of occupational therapists that reported numbers of employees over the age of 55. Vacancy Rates for Selected Wisconsin Hospital Professions

Other occupations reporting numbers over the age of 55 include therapy aides (11%), pharmacists (9.1%), nursing assistants (8.8%), lab technologists and technicians and medical record technologists (8.0%) and registered nurses (7.2%). As the workforce ages, the demand for replacement positions will increase.

Education and Training Issues

The health service industry is faced with competition for the tight supply of 18 year olds entering the work force. In contrast to the documented increasing need for health service workers, the Wisconsin Technical College System reports declining graduates in several shortage occupations. Those include Associate Degree Nurse, Radiographic Technician, Surgical Technician, Licensed Practical Nurse and Lab Technician.

Policy Issues

Wisconsin needs to develop a multi-faceted approach that recognizes the impact and role that the health care industry plays in Wisconsin's economic infrastructure. Policies should be developed collaboratively among legislators, regulators, educators, health professionals, providers and consumers to ensure that Wisconsin has an adequate supply of health care personnel and resources to meet the needs of its citizens. Policies will not work unless all stakeholders share a future common good and goal. Changes in policy must incorporate new methods to meet needs and not exclusively rely on past traditions and solutions.

Acute care services continue to show strong demand in Wisconsin. However, based on the state's changing demographics, the need for chronic care services must also be addressed. This includes considering changes in health care delivery and payment from the current per visit basis to population management. The consumer's role in management will need to change from a passive role to an active preventive and management role. Professionals and educators will need to expand to include preventive and chronic disease and symptom management.

Federal and state legislators and regulators should to evaluate cost effectiveness of current regulations on the health care delivery system and work to ease the burden of ineffective legislation and regulation at both state and federal levels. A study completed by Price Waterhouse Coopers found a significant increase in paperwork needed to document regulatory compliance. Every hour of care that a Medicaid patient received in an acute care inpatient setting resulted in an additional 36 minutes of regulatory paperwork. In the emergency room, every hour of patient care resulted in one additional hour of paperwork. Can we afford this diversion of direct care resources as an industry or as a state?

The lack of statewide health care workforce data is a major policy issue. Data must be systematically collected in a manner that enables cross utilization and comparisons with state and national demographics and identifies regional workforce needs and specific issues to be addressed.

The funding of technical and university health education has to address the critical need for timely, useable data regarding students in health occupation programs. The data has to be useable among Wisconsin's technical college and university systems, and also by the healthcare industry, professionals, and departments concerned with the state health care workforce.

Policies related to the educational system should reward innovative educational styles and programs that encourage and reward competency based education, distance learning opportunities, educational ladders for growth and development, and expansion of public/private partnerships for clinical training and competencies.

Finally, education policies need to address the health and health occupation curriculums and programs of youth in the K-12 system. Policies that encourage self-care and foster exposure to health care services and occupations need to be identified and funded through public/private partnerships with the state school system and the health care industry.


References

HRSA State Health Workforce Profiles, U.S. Department of Health and Human Services Bureau of Health Professions, National Center for Health Workforce Information and Analysis, December 2000.

The Hospital Workforce Shortage: Immediate and Future, Trend Watch, AHA, June 2001, Vol. 3, No. 2

Patients or Paperwork? The Regulatory Burden Facing America's Hospitals, Price Waterhouse Coopers, AHA, 2001.

Wisconsin Projections 1998-2008, Wisconsin Department of Workforce Development, Division of Workforce Excellence, Bureau of Labor Market Information and Customer Services, January 2001.

Wisconsin Technical College System Board's Client Reporting System, May 2001.

Bureau of Health Information / Wisconsin Health and Hospital Association 2000 Hospital Personnel Survey.

Wisconsin Department of Regulation and Licensing RN and LPN License Data, September 2000.