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Health-Care Workforce

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Chronic Illness Care

Abstract

The health care workforce of the future will need more people to work in disciplines and places that serve the growing number of patients with chronic diseases. Current workforce projections suggest that the future number and distribution of primary care and specialty physicians will not be adequate to meet the growing burden of chronic disease. Care will be delivered by interdisciplinary teams of health-care providers who are working at the highest roles and functions allowed by their professional licenses. More health-care workers will be needed across the spectrum, from relatively low-skilled home aides to highly trained physicians, nurses, and therapists. Since chronic care is rendered in multiple settings, workers will be needed in long-term care, outpatient clinics, community health centers, public health departments, hospice settings, and, increasingly, patients’ homes. As care shifts from acute to outpatient and community-based settings, training will need to put more emphasis on preparing health professionals to work outside of hospitals. Compensation and retention remain ongoing challenges in the quest to establish and maintain the appropriate workforce for the future.

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References

  1. Dunn L. Getting a handle on hospital costs. 2015. Available from: http://www.hhnmag.com/articles/3614-getting-a-handle-on-hospital-workforce-costs.

  2. Centers for Medicare and Medicaid Services. National health expenditures 2015 highlights. In: Department of Health and Human Services, editor. 2015. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf.

  3. Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. Multiple chronic conditions chartbook: 2010 medical expenditure panel survey data. 2014.

    Google Scholar 

  4. Center for Interdisciplinary Health Workforce Studies [Internet]. Bozeman: Montana State University College of Nursing. 2015. Cited 2017 May 24. Second quarter data reveals continued increase in hospital employment and stagnating employment growth among younger RNs; [about 2 screens]. Available from: http://healthworkforcestudies.com/news/2015-second-quarter-data-reveals-continued-increase-in-hospital-employment-and-stagnating-employment-growth.html.

  5. Coffman JM, Chan K, Bates T. Profile of the licensed practical nurse/licensed. Vocational Nurse Workforce, 2008 and 2013. UCSF Health Workforce Research. Center on Long-Term Care; 2015.

    Google Scholar 

  6. Association of American Medical Colleges. The complexities of physician supply and demand 2016 update: projections from 2014 to 2025. 2016.

    Google Scholar 

  7. Golden AG, Silverman MA, Issenberg SB. Addressing the shortage of geriatricians: what medical educators can learn from the nurse practitioner training model. Acad Med. 2015;90(9):1236–40.

    Article  PubMed  Google Scholar 

  8. Golden AG, Silverman MA, Mintzer MJ. Is geriatric medicine terminally ill? Ann Intern Med. 2012;156(9):654–6.

    Article  PubMed  Google Scholar 

  9. Bodenheimer T, Grumbach K, Berenson RA. A lifeline for primary care. N Engl J Med. 2009;360(26):2693–6.

    Article  CAS  PubMed  Google Scholar 

  10. Federal Office of Rural Health Policy. Available from: http://www.shepscenter.unc.edu/rural/pubs/finding_brief/phy.html.

  11. Bindman AB, Grumbach K, Osmond D, Komaromy M, Vranizan K, Lurie N, et al. Preventable hospitalizations and access to health care. JAMA. 1995;274(4):305–11.

    Article  CAS  PubMed  Google Scholar 

  12. Bodenheimer T. Coordinating care – a perilous journey through the health care system. N Engl J Med. 2008;358(10):1064–71.

    Article  CAS  PubMed  Google Scholar 

  13. Dall TM, Gallo PD, Chakrabarti R, West T, Semilla AP, Storm MV. An aging population and growing disease burden will require a large and specialized health care workforce by 2025. Health Aff (Millwood). 2013;32(11):2013–20.

    Article  Google Scholar 

  14. Bodenheimer T, Chen E, Bennett HD. Confronting the growing burden of chronic disease: can the U.S. health care workforce do the job? Health Aff (Millwood). 2009;28(1):64–74.

    Article  Google Scholar 

  15. Altschuler J, Margolius D, Bodenheimer T, Grumbach K. Estimating a reasonable patient panel size for primary care physicians with team-based task delegation. Ann Fam Med. 2012;10(5):396–400.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Dower C, Moore J, Langelier M. It is time to restructure health professions scope-of-practice regulations to remove barriers to care. Health Aff (Millwood). 2013;32(11):1971–6.

    Article  Google Scholar 

  17. Statistics BoL. Occupational employment statistics. In: Labor UDo, editor. 2016. https://www.bls.gov/oes/current/oes319092.htm.

  18. Statistics BoL. Employment projections. In: Labor USDo, editor. 2016. https://data.bls.gov/projections/occupationProj.

  19. Chapman SA, Marks A, Dower C. Positioning medical assistants for a greater role in the era of health reform. Acad Med. 2015;90(10):1347–52.

    Article  PubMed  Google Scholar 

  20. Bodenheimer TS, Smith MD. Primary care: proposed solutions to the physician shortage without training more physicians. Health Aff (Millwood). 2013;32(11):1881–6.

    Article  Google Scholar 

  21. Bodenheimer T, Willard-Grace R, Ghorob A. Expanding the roles of medical assistants: who does what in primary care? JAMA Intern Med. 2014;174(7):1025–6.

    Article  PubMed  Google Scholar 

  22. Bodenheimer T. Lessons from the trenches – a high-functioning primary care clinic. N Engl J Med. 2011;365(1):5–8.

    Article  CAS  PubMed  Google Scholar 

  23. Bodenheimer T, Ghorob A, Willard-Grace R, Grumbach K. The 10 building blocks of high-performing primary care. Ann Fam Med. 2014;12(2):166–71.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ghorob A, Bodenheimer T. Share the care: building teams in primary care practices. J Am Board Fam Med. 2012;25(2):143–5.

    Article  PubMed  Google Scholar 

  25. Mastal M, Levine J. The value of registered nurses in ambulatory care settings: a survey. Nurs Econ. 2012;30(5):295–304.

    PubMed  Google Scholar 

  26. Bodenheimer T, Mason D. Registered nurses: partners in transforming primary care. In: Proceedings from Preparing Registered Nurses for Enhanced Roles in Primary Care Conference; 2016 June 15–18; Atlanta, GA. New York: Josiah Macy Jr. Foundation; 2017.

    Google Scholar 

  27. Sandberg SF, Erikson C, Owen R, Vickery KD, Shimotsu ST, Linzer M, et al. Hennepin health: a safety-net accountable care organization for the expanded Medicaid population. Health Aff (Millwood). 2014;33(11):1975–84.

    Article  Google Scholar 

  28. Isasi F, Krofah E. The expanding role of pharmacists in a transformed health care system. Washington, DC: National Governors Association Center for Best Practices; 2015.

    Google Scholar 

  29. Edwards ST, Landon BE. Medicare’s chronic care management payment – payment reform for primary care. N Engl J Med. 2014;371(22):2049–51.

    Article  CAS  PubMed  Google Scholar 

  30. Naylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS. Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. J Am Geriatr Soc. 2004;52(5):675–84.

    Article  PubMed  Google Scholar 

  31. McKinlay JB. A case for refocusing upstream: the political economy of illness in the sociology of health & illness: critical perspectives. 9th ed. New York: Worth Publishers; 2013.

    Google Scholar 

  32. First-ever CMS Innovation Center pilot project to test improving patients’ health by addressing their social needs [press release]. 2016.

    Google Scholar 

  33. Alley DE, Asomugha CN, Conway PH, Sanghavi DM. Accountable health communities – addressing social needs through Medicare and Medicaid. N Engl J Med. 2016;374(1):8–11.

    Article  CAS  PubMed  Google Scholar 

  34. Center for Medicare and Medicaid Services. Accountable health communities model. 2017. Available from: https://innovation.cms.gov/initiatives/ahcm/.

  35. Fraher EP, Ricketts TC 3rd. Building a value-based workforce in North Carolina. N C Med J. 2016;77(2):94–8.

    PubMed  Google Scholar 

  36. Fraher E. Workforce planning in a rapidly changing healthcare system. 2017. Available from: http://www.shepscenter.unc.edu/wp-content/uploads/2017/02/FraherSCHA_SCIOMFeb13.pdf.

  37. Sommers LS, Marton KI, Barbaccia JC, Randolph J. Physician, nurse, and social worker collaboration in primary care for chronically ill seniors. Arch Intern Med. 2000;160(12):1825–33.

    Article  CAS  PubMed  Google Scholar 

  38. Fraser M, Lombardi B, Wu S, de Saxe Zerden L, Richman E, Fraher E. Social work in integrated primary care: a systematic review. 2016.

    Google Scholar 

  39. Choi BY, Blumberg C, Williams K. Mobile integrated health care and community paramedicine: an emerging emergency medical services concept. Ann Emerg Med. 2016;67(3):361–6.

    Article  PubMed  Google Scholar 

  40. Goodwin J. Community paramedicine mobile integrated healthcare. 2013. Available from: http://www.emsworld.com/article/10957645/community-paramedicine-mobile-integrated-healthcare.

  41. McGinnis K. Rural and frontier emergency medicine services: agenda for the future. Kansas City: National Rural Health Association; 2004.

    Google Scholar 

  42. Szanton SL, Leff B, Wolff JL, Roberts L, Gitlin LN. Home-based care program reduces disability and promotes aging in place. Health Aff (Millwood). 2016;35(9):1558–63.

    Article  Google Scholar 

  43. Ogden LL, Richards CL, Shenson D. Clinical preventive services for older adults: the interface between personal health care and public health services. Am J Public Health. 2012;102(3):419–25.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Elliott L, McBride TD, Allen P, Jacob RR, Jones E, Kerner J. Health care system collaboration to address chronic diseases: a nationwide snapshot from state public health practitioners. Prev Chronic Dis. 2014;11:E152.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Darer JD, Hwang W, Pham HH, Bass EB, Anderson G. More training needed in chronic care: a survey of US physicians. Acad Med. 2004;79(6):541–8.

    Article  PubMed  Google Scholar 

  46. Pham HH, Simonson L, Elnicki DM, Fried LP, Goroll AH, Bass EB. Training U.S. medical students to care for the chronically ill. Acad Med. 2004;79(1):32–40.

    Article  PubMed  Google Scholar 

  47. Thomas DC, Kessler C, Sachdev N, Fromme HB, Schwartz A, Harris I. Residents’ perspectives on rewards and challenges of caring for ambulatory care patients living with chronic illness: findings from three academic health centers. Acad Med. 2015;90(12):1684–90.

    Article  PubMed  Google Scholar 

  48. White K, Clement D. Healthcare professionals. In: Fottler M, Fried B, editors. Human resources in healthcare: managing for success. Chicago: Health Administration Press; Association of University Programs in Health Administration; 2015.

    Google Scholar 

  49. Medscape Physician Compensation Report. In: Grisham S, editor. 2017. Available from: https://www.medscape.com/slideshow/compensation-2017-overview-6008547#1.

  50. Physician-Geriatrics Salaries. 2017. Cited 2017. Salary.com. Available from: http://www1.salary.com/Physician-Geriatrics-Salary.html.

  51. Span P. Even fewer geriatricians in training. New York Times. 2013 Jan 9.

    Google Scholar 

  52. Stanik-Hutt J, Newhouse RP, White KM, Johantgen M, Bass EB, Zangaro G, et al. The quality and effectiveness of care provided by nurse practitioners. J Nurs Pract. 2013;9(8):492–500.

    Article  Google Scholar 

  53. Bodenheimer T, Bauer L. Rethinking the primary care workforce – an expanded role for nurses. New Engl J Med. 2016;375(11):1015–7.

    Article  PubMed  Google Scholar 

  54. U.S. Bureau of Labor Statistics: US Department of Labor. Occupations with the most job growth, 2014 and projected 24. 2017. Available from: https://www.bls.gov/emp/ep_table_104.htm.

  55. PayScale.com. Seattle: PayScale; 2017. Nurse practitioner salary. Available from: http://www.payscale.com/research/US/Job=Nurse_Practitioner_(NP)/Salary.

  56. Mukamel DB, Spector WD, Limcangco R, Wang Y, Feng Z, Mor V. The costs of turnover in nursing homes. Med Care. 2009;47(10):1039–45.

    Article  PubMed  PubMed Central  Google Scholar 

  57. American Health Care Association 2012 Staffing Report. American Health Care Association; 2012.

    Google Scholar 

  58. Kristof-Brown AL, Zimmerman RD, Johnson EC. Consequences of individuals’ fit at work: a meta-analysis of person-job, person-organization, person-group, and person-supervisor fit. Pers Psychol. 2005;58(2):281–342.

    Article  Google Scholar 

  59. Frogner B, Spetz J. Entry and exit of workers in long-term care. San Francisco: Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS); 2015.

    Google Scholar 

  60. Fleshner I. On shift [internet]. 2015. Cited 2017. Available from: blog.onshift.com/perfect-storm-high-turnover-coupled-increasing-demand-ltc-workers.

    Google Scholar 

  61. Smikle J. Why they stay: retention strategies for long term care. Provider (Washington, DC). 2015;41(11):39–40. 2

    Google Scholar 

  62. Barbera E. The keys to reducing turnover in long-term care. McKnight’s [Internet]. 2014. 2014 Feb 06. Available from: http://www.mcknights.com/the-world-according-to-dr-el/the-keys-to-reducing-turnover-in-long-term-care/article/333071/.

  63. Holmes GM, Morrison M, Pathman DE, Fraher E. The contribution of “plasticity” to modeling how a community’s need for health care services can be met by different configurations of physicians. Acad Med. 2013;88(12):1877–82.

    Article  PubMed  Google Scholar 

  64. Organization WH. Task shifting: rational redistribution of tasks among health workforce teams: global recommendations and guidelines. Geneva: Organization WH; 2007. 2008

    Google Scholar 

  65. Edmondson A. In: Schein EH, editor. Teaming: how organizations learn, innovate, and compete in the knowledge economy. San Francisco: Wiley; 2012.

    Google Scholar 

  66. Valentine M, Edmondson A. Team scaffolds: how mesolevel structures enable role-based coordination in temporary groups. Organ Sci. 2014;26(2):405–22.

    Article  Google Scholar 

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Fraher, E., Fried, B.J. (2018). Health-Care Workforce. In: Daaleman, T., Helton, M. (eds) Chronic Illness Care. Springer, Cham. https://doi.org/10.1007/978-3-319-71812-5_43

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  • DOI: https://doi.org/10.1007/978-3-319-71812-5_43

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