1. Who is Entering/Exiting Health Care, and Why Do We Care? Bianca K. Frogner, PhD Associate Professor, Department of Family Medicine Director of Center for Health Workforce Studies UCSF Healthforce Center Seminar Thursday April 14, 2016

2. Setting the Stage Growing demand for health services will lead to greater need for health workers – Increasing needs for aging population with multiple chronic conditions – Insurance (e.g., Medicaid) expansion – Greater emphasis on primary care and team-based care Health care has been and will continue to be fastest growing employment sector – 12% of total labor force of the U.S. in 2013

3. Questions What is the source of job growth? Who is working in health care? What will the future health workforce look like? Why is there cause for concern?

4. Questions What is the source of job growth? Who is working in health care? What will the future health workforce look like? Why is there cause for concern?

6. Questions What is the source of job growth? Who is working in health care? What will the future health workforce look like? Why is there cause for concern?

7. Study 1: The Demand for Health Care Workers Post-Affordable Care Act Study Question – What is the profile of the health care workforce? – What are the fastest growing sectors of health care and what is the expected impact of the Affordable Care Act? Data and Methods: – Profile of workforce using American Community Survey (ACS), 2012 – Project job growth by comparing 2 known models National Employment Matrix (NEM) Adjusted Risk Choice & Outcomes Legislative Assessment (ARCOLA) Source: Frogner BK, Spetz J, Parente ST, and Oberlin S (2015). “The Demand for Health Care Workers Post-ACA,” International Journal of Health Economics and Management, 15(1): 139-151.

11. 11 Source: Frogner BK, Spetz J, Parente ST, and Oberlin S (2015). “The Demand for Health Care Workers Post-ACA,” International Journal of Health Economics and Management, 15(1): 139-151.

12. Health care jobs are growing in US: 3-4M new health care jobs over next decade 40% related to demand increase from ACA Home health biggest driver Source: Frogner BK, Spetz J, Parente ST, and Oberlin S (2015). “The Demand for Health Care Workers Post-ACA,” International Journal of Health Economics and Management, 15(1): 139-151.

13. Growth in the Largest Occupations, 2010-2020 Red=HS degree or less; Purple=some college; Blue=graduate degree Source; Frogner B and Spetz J. (2013) “Affordable Care Act of 2010: Creating Job Opportunities for Racially and Ethnically Diverse Populations.” Report and presentation prepared for and published by Joint Center for Political and Economic Studies Report

14. Questions What is the source of job growth? Who is working in health care? What will the future health workforce look like? Why is there cause for concern?

15. Study 2: Entry and Exit of Workers in Long-Term Care Research Questions: Entrants: From where does LTC draw its workers and at what rate? Leavers: To where do LTC workers leave and at what rate? What characteristics are associated with entrants/leavers? Data and Methods: Current Population Survey, Annual Social and Economic Supplement (“March Supplement”) [2003-2013] Sample: Annual cross sectional survey of approximately 100,000 households (200,000 individuals); weighted for national representation Track trends in self-reported current versus prior year occupation/industry and associated demographics/SES Source: Frogner BK and Spetz J (2015). “Entry and Exit of Workers in Long-Term Care,” UCSF Health Workforce Research Center Report. Available at: http://healthworkforce.ucsf.edu/publication/entry-and-exit-workers-long-term-carehttp://healthworkforce.ucsf.edu/publication/entry-and-exit-workers-long-term-care

16. IndustryEntry from what industry? Most common occupation of entrants Exit to what industry? Home Health Care Services 14% Hospitals 14% Nursing care facilities 42% Nursing, psych & home health aides 23% Personal care aides 33% Out of labor force 18% Unemployed Nursing Care Facilities 18% Hospitals 12% Leisure & hospitality 37% Nursing, psych & home health aides 10% Registered nurses 27% Out of labor force 19% Unemployed Residential Care Services 14% Leisure & hospitality 8% Out of labor force 21% Personal care aides 13% Food preparation 25% Out of labor force 16% Unemployed Industry and Occupation Transitions, 2003-2013 Source: Frogner BK and Spetz J (2015). “Entry and Exit of Workers in Long-Term Care,” UCSF Health Workforce Research Center Report. Available at: http://healthworkforce.ucsf.edu/publication/entry- and-exit-workers-long-term-carehttp://healthworkforce.ucsf.edu/publication/entry- and-exit-workers-long-term-care

17. Industry% female% white% with child in HH under 5 % age 16-24 years % age 55-64 years Home Health Care Services Entrants88%49%15%14%15% Leavers90%54%15%11%17% Stayers90%51%12%7%18% Nursing Care Facilities Entrants85%59%14%23%10% Leavers86%58%17%21%13% Stayers86%60%13% 17% Residential Care Services Entrants73%60%11%24%10% Leavers73%61%12%23%13% Stayers71%65%12%14%16% Demographic Characteristics of Transition Groups, 2003-2013 Source: Frogner BK and Spetz J (2015). “Entry and Exit of Workers in Long-Term Care,” UCSF Health Workforce Research Center Report. Available at: http://healthworkforce.ucsf.edu/publication/entry- and-exit-workers-long-term-carehttp://healthworkforce.ucsf.edu/publication/entry- and-exit-workers-long-term-care

18. SES Characteristics of Transition Groups, 2003-2013 Industry% not a citizen % rural residence % disabled% below poverty % full- time Wages from past year Home Health Care Services Entrants10%20%4%18%74%$19,666 Leavers9%20%10%22%59%$15,289 Stayers11%19%4%14%66%$19,799 Nursing Care Facilities Entrants8%24%2%16%75%$20,677 Leavers7%25%8%16%72%$17,409 Stayers8%26%2%8%78%$22,527 Residential Care Services Entrants6%17%4%14%74%$19,517 Leavers7%17%8%13%73%$16,123 Stayers6%19%3%5%79%$21,203 Source: Frogner BK and Spetz J (2015). “Entry and Exit of Workers in Long-Term Care,” UCSF Health Workforce Research Center Report. Available at: http://healthworkforce.ucsf.edu/publication/entry- and-exit-workers-long-term-carehttp://healthworkforce.ucsf.edu/publication/entry- and-exit-workers-long-term-care

19. Questions What is the source of job growth? Who is working in health care? What will the future health workforce look like? Why is there cause for concern?

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21. Food for Thought 21 Occupation Title Median Pay ($, 2012) Tuition & Fees ($) Ratio of Tuition to 1 Yr Median Pay Pharmacy Technician29,32017,06758% Medical Assistant29,37013,057-17,06744 to 58% Optical Technician33,33017,06751% Health Information Technician34,16035,112103% Dental Assistant34,50017,06749% Massage Therapist35,97017,06747% Vocational Nursing41,54034,110-35,11282 to 84% Surgical Technologist41,79035,11284% Respiratory Therapy55,87045,13781% Claims Adjuster or Biller59,85017,06729% Source: http://www.bls.gov/ooh/ http://americancareercollege.edu/misc/tuition-fees.html

22. Questions? Contact: Bianca K. Frogner, PhD Associate Professor, Department of Family Medicine Director, Center for Health Workforce Studies bfrogner@uw.edu UW Center for Health Workforce Studies https://depts.washington.edu/fammed/chws/ @uwchws