Introduction
The size and characteristics of the future
health workforce are determined by the complex interaction of
the health care operating environment, economic factors, technology,
regulatory and legislative actions, epidemiological factors,
the health care education system and demographics. Efforts over
the past several decades to model the supply of and demand (or "requirements")
for health workers show there is a lack of consensus on the relationship
between the health workforce and its determinants, the future
values of many of these determinants, and forecasters' assumptions. [1]
Furthermore, past forecasts of impending surpluses and shortages of health professionals
often failed to materialize, leading to the general consensus that a much better
understanding is needed about the dynamics affecting the supply of and demand
for health professionals.
The Workforce Analysis Branch of the Bureau of Health Professions (BHPr), Health
Resources and Services Administration (HRSA), commissioned a report synthesizing
the literature on one set of factors that will have a profound impact on the
future health workforce-changing demographics. In addition, BHPr commissioned
the updating of two requirements forecasting models: the Physician Aggregate
Requirements Model (PARM) and the Nursing Demand Model (NDM).
This report discusses findings from the literature review of the implications
of important demographic trends for the health workforce. In addition, this report
presents findings from the NDM and PARM to quantify the impact of changing demographics
on demand for allopathic (MD) and osteopathic (DO) physicians, registered nurses
(RNs), licensed practical nurses (LPNs), nurse aides and home health aides (NAs),
physical therapists, optometrists, and podiatrists. This report also presents
forecasts from the PARM and NDM for several scenarios with different assumptions
regarding the future health care operating environment, the productivity of doctors
and nurses, and other factors.
Although the demographic trends discussed
here have implications for the entire health workforce, the discussion
in this report is heavily tilted towards the physician and nursing
professions. Reasons for this focus include the dominance of
these professions in the health workforce literature, the focus
on these professions by government commissions and policy makers,
and the availability of the PARM and NDM for forecasting requirements
for physicians and nurses.
Demographics are a major determinant of the size and characteristics
of the future health workforce, and demographic trends can be extrapolated
with reasonable accuracy one or two decades into the future. In
addition to the growth in size of the U.S. population in future
decades, three demographic trends have profound implications for
the future health workforce:
- First, the population is aging and the size of the elderly
population will increase substantially. An aging population will
place greater demands on the health care system at the same time
that many health professionals will be retiring. Also, as the
population ages there will be a continuing shift in the type
and setting of services provided.
- Second, the population is becoming more racially and ethnically
diverse. Concerns that minorities are underrepresented in the
health workforce have both equity implications for people who
need health care services and efficiency implications for the
health care system. As minorities constitute a larger proportion
of persons entering the workforce, the U.S. population will increasingly
rely on minority health workers for their care.
- Third, the population is shifting geographically and a significant
portion of the U.S. population will continue to reside in areas
with persistent shortages of health workers. These trends highlight
the need for forecasting models that can make State-level and
sub-State-level forecasts of health worker supply and demand.
Other demographic trends with implications
for the future supply of and demand for health workers include
changes in fertility patterns, family size and composition, longevity,
immigration, and overall health of the population. These trends
are discussed within the context of the three major trends discussed
above.
In both the PARM and NDM, requirements are defined as the number of health professionals
demanded based on the level of health care services that society is willing to
purchase given population needs and economic considerations. Other authors have
used “need” to define requirements, where need is based on the analyst’s
assessment of what constitutes an adequate supply of health workers, independent
of society's willingness or ability to purchase services.
Using the PARM and NDM, we forecast future demand for health care services and
the derived demand for 19 physician specialties, nurses, and the other health
workers listed previously. We forecast a “status quo” scenario that
assumes no change in per capita health care utilization patterns, health worker
productivity, and health worker staffing patterns. Under such a scenario, between
the years 2000 and 2020, changing demographics would cause an estimated 30 percent
increase in inpatient days, a 20 percent increase in outpatient visits, and a
17 percent increase in emergency department visits at general, short-term hospitals. Inpatient
days at non-general and long-term hospitals would increase by an estimated 33
percent; the number of nursing facility residents would increase by 40 percent;
the number of home health visits would increase by 36 percent; and the number
of visits to physicians’ offices would increase by 23 percent.
The change in demand for health care services would increase requirements for
physicians by approximately 33 percent, although the increase in requirements
would vary by medical specialty. For example, requirements for cardiologists
would increase by an estimated 52 percent while requirements for pediatricians
would increase by an estimated 11 percent. Requirements would increase approximately
28 percent for RNs, 30 percent for LPNs, and 33 percent for nurse aides (including
home health aides).
Although demographics are a dominant determinant
of the demand for health workers, other important factors are
the characteristics of the future health care system, economic
considerations, technological advances, and population needs.
A detailed discussion of these trends is outside the scope of
this project; however, the extant literature in this area is
relatively large. [2] Using the PARM and NDM,
we forecast future requirements for selected health care professions
under alternative scenarios regarding the future health care
operating environment.
The baseline scenario in both the PARM and NDM produce the forecasts that are
most likely to occur based on changing demographics and projected trends in the
factors listed above (e.g., trends in insurance coverage and economic considerations).
The baseline forecasts for physician requirements are slightly lower than under
the status quo scenario (28 percent growth between 2000 and 2020 instead of 33
percent growth), and the change in requirements for individual physician specialties
is quite different in some cases. Under the NDM’s baseline scenario, requirements
for RNs grow faster than under the status quo scenario (41 percent growth between
2000 and 2020 instead of 28 percent growth), reflecting different assumptions
about changes in average patient acuity levels and other factors. Under the baseline
scenario, total requirements for LPNs, nurse aides, and home health aides rise
faster than forecasts under the status quo scenario.
The remaining sections in this report discuss
the implications for the health workforce of the aging population
(Section 2), the changing racial and
ethnic composition of the population (Section 3), and population geographic location (Section
4). Each of these sections presents information on the demographic
trend, discusses the implications of the trend on demand for
health care services and derived demand for health workers, and
discusses the implications for the supply of health workers. Section
5 describes the recently updated PARM and NDM and presents
findings from these models. Section 6 summarizes
the main findings of this effort and discusses areas for additional
research.
Executive
Summary | Introduction | Aging
of the Population | Changing Racial
and Ethnic Composition of the Population | Geographic
Location of the Population | Modeling
the Impact of Changing Demographics on the Future Demand for Health
Professionals | Summary and Conclusions
| References
|
