#1Healthcare Workforce Commission Georgia Healthcare Workforce Commission Meeting One August 29, 2022#2Commission Timeline July Key Events Key Deliverables by Staff to Commission • Identify and schedule interviews with known key stakeholders Commission Kickoff 7/20 3p Wednesday, 20th • Healthcare workforce landscape (e.g., trends, pain points) and professions for focus Virtual Kickoff August Monday, 29th Meeting #1 • Analytics and material to support 1 st meeting & 1st open forum 8/29 2:30p • Preliminary insights from surveys and interviews Mercer University-Atlanta, Atlanta • September Thursday, 29th Open Forum #1 Analytics and materials to support 2nd Commission meeting 9/29 10a • Fact base on the current workforce for each preliminarily identified profession. Augusta University, Augusta . Fact base for scenarios on labor force entrants October Tuesday, 18th Open Forum #2 • Analytics and materials to support 2nd Forum meeting 10/18 2:30P • Consolidated evidence base to use for alignment on final list of priority areas and professions Albany Technical College, Albany . Fact base on potential opportunities to close the healthcare gap Meeting #2 • Analytics and materials to support 3rd Commission meeting November 11/30 1p • Synthesis of interviews with leading training and educational organizations Wednesday, 30th TBD, Savannah, Georgia • Draft final communications December Monday, 12th TBD, Atlanta, GA Meeting #3 . 12/12 1p Consolidated material to socialize findings, direction, initial conclusions and next steps with all stakeholders • Final communications outreach plan Note: Commission E-Mail Address: [email protected] 2#320 minutes Georgia Healthcare Workforce Commission Meeting #1 1 Review of Goals for Today 2 Review Healthcare Workforce Fact Base 10 minutes 60 minutes Agenda 3 Q&A and Open Discussion 13#4Today's Objectives Review projections and trends in healthcare workforce demand and supply Highlight perceived pain points within the healthcare workforce Review input from the survey and interviews of Commission members 4#5This fact base focuses on seven healthcare workforce categories Primary Care Examples: Family Medicine Physicians • Nurse Practitioners 1 4 Allied Nursing Care • Allied Primary Care Allied Primary Care Examples: • Medical Assistants Specialty Care Examples: • Surgeons • Medical Specialists Allied Specialty Care • Examples: Respiratory Therapists, Physical Therapist Aides Dentistry 7 2 Primary Care Nursing Care Nursing Care Examples: Registered Nurses Licensed Practical and Licensed Vocational Nurses Allied Nursing Care • Examples: Nursing Assistants Home Health and Personal Care Aides Behavioral Healthcare (20) 6 7 6 Examples: Allied Specialty Care Specialty Care Healthcare Workforce Behavioral Healthcare Allied Behavioral Healthcare Psychiatrists 2 1 Dentistry Pharmacy Psychologists Allied Behavioral Healthcare Examples: Psychiatric Aides Recreational Therapists Psychiatric Technicians Pharmacy Examples: 2 2 Examples: . Dentists, General Allied Dentistry Allied Pharmacy • Dentists, All Other Specialists • Allied Dentistry Examples: Dental Assistants Dental Hygienists All workforce positions match the BLS definition Researchers have been excluded from this analysis + Emergency Medical Services (1) • Pharmacists Allied Pharmacy Examples: Pharmacy Aides Pharmacy Technicians Therapists Counselors 5#6Healthcare Workforce Fact Base Demand/Supply Assessment Demand Assessment Supply Assessment 6#7While variations exist by profession, healthcare demand is growing faster than the supply of healthcare practitioners Overall population growth and Georgia's aging population are driving increased demand for healthcare At the same time, there is a shortage of healthcare practitioners in Georgia; the share of unfilled roles has nearly doubled since 2020 The supply of workers does not meet today's demand, and sources of new talent are not filling the growing gap 7#8The demand supply gap may grow in most categories as degree completions are lower than forecasted job openings Job category Nursing Care Employment, 2020, thousands 191 Projected annual avg. job openings 2020-2025, thousands 23 Degree/Certificate Gap Completions² 2020, thousands Annual opening - completions gap, thousands. 10.7 12.3 Specialty Care¹ Primary Care¹ Behavioral Health Pharmacy 27 85 3 26 26 3 21 21 Dentistry 18 Emergency Medical Services 11 9 4.2 1.4 4.8 1.6 4.0 (1.0) 1.1 2 0.9 2 1 1.4 0.6 0.5 0.5 1. Medical assistants are included both in primary care and specialty care. Jobs, openings and completions were distributed based on the relative workforce size of both groups (33% in primary care, 67% in specialty care) 2. To adjust for duplication, the number of completions within each instructional program (CIP) was distributed to each corresponding occupation (SOC) by way of a weighted average based on current employment within occupations. Completions were distributed taking into consideration typical entry level education requirements for each occupation. Graduates from doctor's degree in medicine (mapped to psychiatrists, as well as physicians in primary care and specialty care) are counted in the behavioral health, primary care and specialty care categories Source: Lightcast TM (formerly EMSI-Burning Glass) 80#9Georgia needs roughly 680 practitioners to remove Health Professional Shortage Area designations Peer states Virginia Total primary care HPSA1 designations² Population of designated HPSAS (M) Practitioners needed to remove HPSA designation³ 124 2.0 205 Louisiana 160 2.4 256 Tennessee 133 2.4 259 Colorado 120 1.1 260 North Carolina 213 2.8 416 Michigan 269 2.9 482 Illinois 263 3.3 534 Washington 203 3.0 626 Arizona 236 3.2 653 Georgia 243 3.2 673 Texas 424 7.3 969 Florida 276 6.3 1,505 1. Health professional shortage areas 2. 3. Area must have a population-to-provider ratio of at least 3,500-to-1 to be considered as having a shortage of primary medical care providers Number of additional primary care physicians needed to achieve a population-to-primary care physician ratio of 3,500 to 1 in all designated primary care HPSAs, resulting in their removal from designation Source: Kaiser Family Foundation (KFF); as of September 30, 2021 66 For physicians, we need to make the State more attractive for those who want to come, but also for those who want to go to less populated areas - Commission Member Quote 9#10Across Primary Care and Allied Primary Care, current completions are not enough to close the gap 66 66 physicians cannot get their work done without the support of the other staff involved in patient care" There were 292 new primary care physician openings in 2020. Of the 568 GA physician graduates, historic trends would suggest that roughly 200 become primary care physicians, and some of those may leave the state 1,2 Non-physician primary care completions (i.e., NP, PA, Allied Primary Care) fill less than 50% of the open positions. For example, there were 1,020 new openings for NPs but only 339 completions in 2020 "...Primary Care physicians that are well- educated [are the most challenging to recruit for]" + The challenge extends to the allied professions where there were 4,193 medical assistant openings and less than 900 completions in 2020 1.National average 37% of physicians in 2019 had a primary care orientation, applied to the 568 GA graduates. Source: AAMC Physician Specialty Data Report "[As] shown in multiple studies, a good core of primary care will be great for the overall health of the area as well as most cost effective" - Commission Member Quotes 99 10#11Both quantitative and qualitative evidence suggest imbalances within the nursing category 66 Nurses [are] the role of healthcare that provides the highest amount of direct care/interface with the patient There were 2,065 new openings for LVNs and 358 completions in 2020. This talent gap would grow over time if openings continue to outpace supply In a recent survey of nurses providing direct patient care, 29% indicated that they are likely to leave their current direct patient care position in the next year, up from 22% a year ago1 While there are shortages everywhere, bedside nurses are by far the most critical 1. 2022 NSI National Health Care Retention & RN Staffing Report Commission members' interviews suggest that most attention is needed in the Nursing segment where the perceived imbalance is most severe and consequential Nurses are leaving the profession in large numbers and there are many challenges to training new nurses - Commission Member Quotes 99 11#12Healthcare Workforce Fact Base Demand/Supply Assessment Demand Assessment Supply Assessment 12#13Demand for healthcare services is growing and reflected in the demand for healthcare workers 1 Overall population growth and Georgia's aging population are driving increased demand for healthcare 3 2 Diseases with significant existing care burden are expected to rise and further increase healthcare utilization Job postings have been increasing over the last two years - indicating increased demand for healthcare workers 13 33#14Growth of overall population, and more specifically of those over 65, is higher in Georgia, likely driving demand for healthcare Total population growth in Georgia and United States, Index: 2012=100 - Georgia National Population age 65+ in Georgia and United States, Percent, 2012-2019 Georgia National Population by age group Percent, 2019 Georgia National1 108 106 104 2012-19 CAGR 18 1.0% 17 0.6% 16 2012-19 CAGR 0-14 20 20 3.4% 102 100 98 96 13 94 18 14 15-24 13 14 25-34 15 14 4.2% 13 14 35-44 13 225 25 45-64 92 12 65 and older 25 14 16 90 2012 14 16 18 2020 2012 14 16 18 2020 Source: U.S Census Bureau, American Community Survey 14#15Except for cardiovascular and respiratory diseases, most other diseases with significant care resource burdens are expected to rise and further increase demand Top diseases by diseases burden in Georgia 2020, DALYS¹ Change in disease burden between 2020 and 2040 in Georgia, % change in disease burden measured in DALY1 Cardiovascular diseases 493,284 Neoplasms 459,694 Musculoskeletal disorders 292,690 Other non-communicable diseases 268,655 Mental disorders 232,261 Diabetes and kidney diseases 207,962 Neurological disorders 202,382 Chronic respiratory diseases 155,956 -14% Substance use disorders 155,842 Unintentional injuries 117,282 Skin and subcutaneous diseases 114,081 Transport injuries 102,292 1. DALY = Disability-adjusted life year | 2. STI = sexually transmitted infections. TB = tuberculosis. NCD = non-communicable disease. NTD = neglected tropical disease. Source: Global Disease Burden Database Institute for Health Metrics and Evaluation (IHME), University of Georgia (this view excludes "Other non-communicable diseases"), MGI Analysis -1% 16% 18% 13% 5% 7% 12% 10% 37% 47% 47% 15#16Job postings for healthcare roles in Georgia have increased over the last five years, though a 2021 dip may reflect COVID challenges Healthcare unique job postings in Georgia by category Thousands, January 2017-May 2022 40 55 35 30 30 25 22 20 15 10 LO 0 2017 18 19 20 1. 2. Job postings for nursing assistants are included both in the primary care and specialty care categories Growth rate for the remaining job categories are: dentistry (120%), pharmacy (49%), emergency medical services (2%) Source: Lightcast TM (formerly EMSI-Burning Glass) 24 21 22 Growth (%)² Jan20-Jun22 Nursing care 51% Specialty care 53% Primary care 42% Behavioral health 58% Pharmacy 49% Dentistry 120% EMS 2% 16#17Demand growth is expected to continue for healthcare occupations (page 1 of 2) Top 3 healthcare occupations for each category with largest projected demand by category in Georgia Average Annual Openings Category Occupation title Nursing Care Home Health and Personal Care Aides 2020-2025 Forecasted job growth 2020 2025, % 66 10,099 16.3% We need more Registered Nurses 5,200 6.3% Nursing Assistants 4,575 1.5% Primary Medical Assistants 4.198 16.6% Care Primary Care community-based physicians and fewer specialists Commission Member Quote Nurse Practitioners 1,025 32.8% 99 Physician Assistants 536 21.1% Specialty Medical Assistants 4,198 16.6% Care Clinical Laboratory Technologists and Technicians 1,079 8.3% Massage Therapists 587 32.8% Source: Lightcast TM (formerly EMSI-Burning Glass) 17#18Demand growth is expected to continue for healthcare occupations (page 2 of 2) Top 3 healthcare occupations for each category with largest projected demand in Georgia Occupation title Average Annual Openings Forecasted job growth 2020-2025 Category Behavioral Health Substance Abuse, Behavioral Disorder, and Mental Health Counselors 828 Child, Family, and School Social Workers 713 Healthcare Social Workers 427 Dentistry Dental Assistants 1,414 Dental Hygienists 611 Dentists, General 186 EMS Emergency Medical Technicians and Paramedics 981 Pharmacy Pharmacy Technicians 996 Pharmacists Pharmacy Aides Source: Lightcast TM (formerly EMSI-Burning Glass) 431 97 2020 2025, % 20.2% 5.8% 8.8% 16.4% 15.7% 15.8% 6.6% 5.1% 1.9% -3.2% Allied workforce 18#19Within nursing and allied nursing care, all job roles may continue to see high job growth Registered Nurses Job Growth %, 2020-2025 6.3% Home Health and Personal Care Aides 16.3% Nursing jobs in Georgia by occupation 2020-2025, thousands 80 75 70 65 60 55 50 35 30 25 20 15 10 Phlebotomists 5 Orderlies 0 2020 21 22 23 24 2025 Source: Lightcast TM (formerly EMSI-Burning Glass), Bureau of Labor Statistics, American Nursing Association, Nurse.com 1.5% Key factors influencing nursing demand . Nursing Assistants Licensed Practical and • 4.0% Licensed Vocational Nurses 16.6% 3.3% Share of Care Responsibility: Nurses could see increased utilization and care responsibility as physicians and surgeons may not fully meet the growing demand for healthcare services. That demand is further passed through to nursing partners Non-care Activities: Growth of nonclinical nursing careers (e.g., hospital administrators, health policymakers, and bioinformatic analysts) can take nursing labor out of nursing roles 19#20Healthcare Workforce Fact Base Demand/Supply Assessment Demand Assessment Supply Assessment 20 20#21Supply is constrained and not matching demand growth 3 2 1 Graduation pipeline is stable but not mirroring multiple professions' demand growth, hence insufficient to fill openings from new growth plus retirements A diverse group of private and public educators support the training of the workforce with nearly 50% of healthcare graduates coming from the top 20 institutions Beyond seats, qualitative findings suggest the future workforce is further constrained by other factors, such as staff availability, cost, and access 21 221#22The healthcare workforce in Georgia includes ~380K workers with a net addition of nearly 14,000 workers annually Supply pipeline of healthcare workers in Georgia, 2020, thousands Employment, 2020, thousands Healthcare employment¹ Talent outflow to other states² -16 Talent inflow from other states2 +18 Local healthcare grads retained³ Total supply 379 Nursing Care Specialty Care Primary Care 27 Behavioral Health 26 Pharmacy 21 +12 Dentistry 18 393 Emergency Medical Services 11 85 191 2. 1. Total employment in Georgia for 60 occupations across healthcare practitioners and technical (29-0000), healthcare support (31-0000), community and social service (21-0000) and life, physical and social science (19-0000) Net flow of healthcare and social assistant hires in Georgia (Hires into GA from out of state less hires out of GA to out-of-state). Annual average of 2017-2020 estimates from the U.S. Census, Job-to-Job Flows, 2017 Q1 - 2020 Q4 2020 completions in related programs to healthcare occupations. Instructional programs were mapped to occupations based on a crosswalk of SOC-CIP. Retention rate was estimated as the share of grads who remain in-region after completing their degree; based on profiles (LinkedIn, Career Builder, etc.) updated since 2018 for graduates of higher ed institutions 3. Source: Lightcast TM (formerly EMSI-Burning Glass), U.S Census Bureau, National Center for Education Statistics 22 22#23Roughly 20 percent of healthcare workers are over 55 and are likely to retire Healthcare employment¹ by age by category in Georgia, % of total employment, 2021 14-24 25-34 35-54 55+ Share of aging healthcare workforce¹ by geography (ages 55+), % of total employment, 2001-2023 25 24 Nursing Care 6% 21% 47% 26% 23 22222 United States Regional peers² Economic peers³ Georgia 66 [Over the past 3 years,] nursing witnessed a Great Resignation and a Great Retirement - Commission Member Quote 99 Dentistry 8% 27% 48% 16% 21 20 Specialty Care 5% 26% 49% 21% 19 18 Primary Care 9% 31% 46% 13% 17 Pharmacy 12% 31% 16 41% 17% 15 Emergency Medical Services 14% 39% 39% 8% 14 13 13 Behavioral Health 5% 28% 46% 22% 0 2000 05 10 15 20 2025 1. Includes 60 occupations across healthcare practitioners and technical (29-0000), healthcare support (31-0000), community and social service (21-0000) and life, physical and social science (19-0000) 2. 3. Virginia, North Carolina, South Carolina, Tennessee, Florida, Louisiana, Texas, Missouri, Alabama Michigan, Colorado, Arizona, Ohio 4. 2022 NSI National Health Care Retention & RN Staffing Report Source: Lightcast TM (formerly EMSI-Burning Glass) In a recent survey of nurses providing direct patient care, 29% indicated that they are likely to leave their current direct patient care position in the next year, up from 22% a year ago.4 23 23#24Georgia retains 58% of graduates, about average compared to regional peers; however, there is an opportunity to improve retention rates across all labor categories Estimated in-state talent retention after graduation for healthcare occupations¹ based on online profiles², % State, all healthcare job categories Job category, Georgia Emergency Medical Services 72% Dentistry 64% Pharmacy 63% +9 74 64 63 Nursing Care 60% 33 58 53 53 53 53 Behavioral Health 59% 42 Specialty Care 58% Primary Care 52% Texas Florida North Carolina Georgia Louisiana Tennessee Virginia 2. 1. Includes 60 occupations across healthcare practitioners and technical (29-0000), healthcare support (31-0000), community and social service (21-0000) and life, physical and social science (19-0000) Share of grads who remain in-region after completing their degree; based on profiles (LinkedIn, Career Builder, etc.) updated since 2018 for graduates of higher ed institutions Source: Lightcast TM (formerly EMSI-Burning Glass) 24 24#25Health professions are the top field of study, with stable number of degrees and declining number of certificates awarded Top fields of study in Georgia by number of completions¹, thousands, 2020 10.3 Healthcare completion trends, thousands Healthcare Degrees Healthcare Certificates 20 25.3 15 25.1 10 -4% p.a. 66 It's not as difficult to recruit students and faculty in Medicine and Dentistry, but it is very difficult in other areas of medicine - Commission Member Quote Health Professions and related programs Business, Management, Marketing, and related support services Liberal Arts and Sciences, General Studies and Humanities 5 Education 10.0 Computer and Information 0 9.8 Sciences and support services Mechanic and repair technologies/ 8.1 66 Technicians 20 Engineering 5.5 Culinary, Entertainment, and Personal services Visual and Performing arts 15 5.4 10 5.3 250 +1% p.a. 5 Biological and Biomedical Sciences 4.9 Other 0 43.7 2005 06 07 08 09 10 11 12 13 14 15 16 17 18 19 2020 Trend from 2015 - 2020 1. Includes both degree and certificate completions for all institutions in Georgia. Healthcare was defined as: health professions and related programs (CIP 51) Source: Lightcast TM (formerly EMSI-Burning Glass), National Center for Education Statistics-IPEDS dataset ୨୭ [We have trouble recruiting for] Nursing faculty - DNP and PhD prepared - Commission Member Quote ୨୭ 25#26Twenty institutions educate nearly half of all healthcare graduates in Georgia Private Public Certificates Associate's Bachelor's Master's Doctor's Healthcare program completions 1 from 20 largest institutions in Georgia Share of healthcare by award level #, 2020 Emory University completions in GA 1,212 5.7% Augusta University Georgia Southern University Mercer University Central Georgia Technical College Chattahoochee Technical College Georgia State University 1,004 4.5% 826 3.7% 772 3.0% 66 730 2.8% 719 2.7% 692 2.6% Gwinnett Technical College 686 2.5% University of Georgia 619 2.5% Southern Crescent Technical College 599 2.3% West Georgia Technical College 594 2.2% Coastal Pines Technical College 575 2.2% Wiregrass Georgia Technical College 574 2.1% South University-Savannah² 561 2.1% Georgia Northwestern Technical College 560 2.1% Savannah Technical College 528 1.9% Southern Regional Technical College 494 1.8% Ogeechee Technical College 492 1.8% Lanier Technical College 475 1.7% Atlanta Technical College 448 1.6% 1. Includes all degree and certificate completions for health professions and related programs (CIP 51) 2. Includes: South University- Savannah (139579) and South University- Savannah Online (475121). Completions for this institution were adjusted to only include on-ground completions as well as online completions from in-market students. According to Gray Associates, there were a total of 1858 completions in 2020. On-ground completions accounted for 301 grads. Online programs accounted for 1557 completions (17% from in-market students, for a total of 260 completions) Source: Lightcast TM (formerly EMSI-Burning Glass), National Center for Education Statistics-IPEDS dataset, Gray Associates Private colleges have had a strong positive impact [on the] nursing pipeline due to the ability to support the students and increase the acceptance of non- traditional students - Commission Member Quote 99 26#27Commission Members highlight the important role educational institutions play in the healthcare workforce supply and suggest ways to improve the status quo Survey responses from HWC Members Access: 66 Ensuring equitable access to financial support for students in both private and public institutions Capacity and Cost: 66 We need more medical school and nursing school spots. We make it too difficult to get in ୨୭ Certification Levels: 66 We have to look at the requirement for having all nursing aides certified. I am hopeful that our recently formed [initiative] can help bring more high school graduates into these critical positions „ 66 Early programs starting in grade school to introduce and connect healthcare interested students [are important in addressing the shortage] 99 [We should] examine increasing full-time academic salaries for nursing faculty in USG system institutions; stipends for RNs to attend USG institution programs for DNP or PhD degrees to increase pipeline of faculty and thereby increase student enrollment in our publicly funded schools and colleges of nursing We have to do more to reduce this cost. Students are leaving school with $200,000 + of debt (more if they have debt from college) 99 27 27#28Recap and open discussion ن • There is a shortage of healthcare workers in Georgia - across all professions • These are particularly acute in Nursing and Primary Care • The labor shortage may get worse over time due to aging & increasing incidence of disease Data suggests areas of potential inquiry for opportunities include: • Increase existing workforce through attraction and retention • Build and train new workforce through education, licensure, and up/reskilling • Increase effectiveness of new workforce through evolving care models ? We welcome questions from the Commissioners 28#29Next steps 01 Host Open-Forum #1 Query the community and select experts for insight on solutions 02 Prepare for Commission Meeting #2 Begin consideration of statewide solutions and identify case-studies of peer actions 29 29