GW Health Workforce Institute: Nonlicensed and tele-health savvy health workers to shape future healthcare staffing needs

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 - Patricia Pittman, PhD
Patricia Pittman, PhD, Co-founder, GW Health Workforce Institute

Health-policy educator and researcher Patricia (“Polly”) Pittman, PhD, co-founded the GW Health Workforce Institute at George Washington University (GWHWI) in April 2015. As part of its mission to strengthen health workforce policies in the United States and around the world, the Institute is now one of six health workforce research centers awarded federal funding to help determine the staffing needs of U.S. healthcare in the years ahead.

Each research center works with a particular focus; GW concentrates on “novel and flexible uses of healthcare workers” to improve care delivery and efficiency.  As part of a conversation with Medical Imaging Review, Pittman shared her insights gained by studying her own operation’s research data, as well as peer research and quantitative information from the Bureau of Labor Statistics. Key excerpts follow.

Q. With 10,000 baby boomers retiring and adding to the Medicare roles daily — around 4 million per year — what is the projected impact on healthcare staffing needs going forward?

Pittman: To the extent that payment reforms are moving us toward primary and team-based care, and to the extent that we are caring for more and more elderly people, the physician is no longer as central in the health workforce story. We are seeing shifts at several levels.

For example, we are seeing demand for more advanced practice providers (APPs), including nurse practitioners, physician assistants and clinical nurse specialists. And in a relationship that looks like substitution, for example at the level of community health centers, the number of physicians has actually gone down over the last 15 years, while the number of APPs has gone up.

The second part of the story is with the support staff, primarily in the area of home care. But it also is in community care and primary care where you see sicker patients now. There you see the role of what you might call the “clinical nonlicensed personnel” growing, particularly the nonlicensed personnel who are doing things that can be delegated by nurses.

Q. You have forecast an increase in the use of telemedicine. Can you put workforce numbers to that?

Pittman: We are in the midst of doing a study right now, looking at the use of telemedicine by National Health Service Corps doctors. Our preliminary analysis shows that utilization is still relatively low. If you take that sample of physicians, fewer than a quarter are engaged in some form of telemedicine.

Those who are so engaged tend to cluster in the places that are the most progressive in terms of reimbursement and financial support—Delaware, Maine, Mississippi, New Mexico, Nevada, Oklahoma, Tennessee, Virginia and Washington, D.C. These are the same places that got an “A” in the latest rankings from the American Telemedicine Association.

Our study is very preliminary, and it’s not representative of all sectors within the healthcare industry—but it is interesting that there is a correlation between high utilization and states that are more progressive in terms of payment policies.

What this suggests is that there is enormous room for growth. And certainly the business sector, which is always an interesting source of information about what will happen in the future, is expecting growth. Forbes magazine, for example, recently reported on market research projecting growth in the telehealth industry of more than 18% over the next few years. So telehealth is a robust business sector. There’s no question about that.

Q. Do you see this translating to more telehealth-related jobs within provider organizations as well?

Pittman: We don’t really know yet. Certainly doctors and nurses who are telehealth-savvy, who have some experience with telehealth technologies, are going to be in high demand, as opposed to those who are either unwilling or unable to participate in the technology. That much is clear already, and I think there will be additional jobs—everything from telehealth technicians to sort of multipurpose, mid-level individuals who must be very savvy with telehealth, as well as, more generally, health IT technologies.

It’s funny, because health IT training tends to cut across a lot of occupations as sort of an add-on. But certainly the ICD coders, patient navigators, care coordinators, population management executives—all of those people will have to have much better health IT training.

Part of the health IT story is, of course, telemedicine. It’s not just analysis of big data, but also imagining how to have