Demographic Review of the Texas Health Professions Workforce Brian King, Program Director, HPRC Health Professions Resource Center Center for Health Statistics Texas Department of State Health Services

Texas Race/Ethnicity and Gender Demographics Male 49.6% 50.1 % Female 50.4% 49.9 % 2000 Data from US Census 2008 Data from the Texas State Data Center, Migration Scenario 2, 9/2/06 Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

Direct Patient Care Physicians Facts at a Glance – 2008 Direct Patient Care Physicians: Total – 38,387 White 65.0% Black 4.7% Hispanic11.6% Other18.7% Male74.3% Female25.7% Providers/100,000 Population: Texas158.8 Border Urban106.7 Non-Border Urban176.7 Border Rural50.1 Non-Border Rural91.2 Number of counties with no Direct Patient Care Physicians – 25 DPC Physicians per 100,000 Population DPC Physicians: Median Ages Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

Primary Care Physicians Facts at a Glance – 2008 Primary Care Physicians: Total – 16,528 White58.3% Black 6.3% Hispanic14.4% Other21.1% Male64.9% Female35.1% Providers/100,000 Population: Texas68.4 Border Urban52.8 Non-Border Urban72.7 Border Rural35.4 Non-Border Rural55.0 Number of counties with no Primary Care Physicians – 27 PC Physicians per 100,000 Population PC Physicians: Median Ages Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

Primary Care Physician Demographic Trends Race/Ethnicity Trends percent of total Supply Ratio Trends by Race/Ethnicity Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 5, 2009 As of April 2009 there were 118 Whole County Health Profession Shortage Areas (HPSAs) for primary care, and 109 sub- county geographic or special population HPSAs in Texas. Whole county HPSAs are predominately in rural counties and sub-county HPSAs are predominately in urban counties. 5,245,681 people lived in HPSAs. More people live in Partial County HPSAs than Whole County HPSAs It was estimated that 542 primary care physicians would have been needed to alleviate the mal-distribution. Physician Distribution – A Type of Shortage! Ratio needed to qualify – 3,500:1 Texas 2009 ratio – 1,478: Harris Ratio with 3,059 physicians = 1,313:1 # Physicians for 3,500:1 ratio = 1,146 Harris could lose 1,913 physicians and not qualify as shortage area

Examples of Mal-distribution There are several cases in Texas where counties of similar size have very different supply (in 2008): Nolan County had 15,813 people and 14 physicians for a ratio of 1,130:1 Karnes County had 15,969 people but only 4 physicians for a ratio of 3,992:1 Burnet County had 42,252 people and 33 physicians for a ratio of 1,280:1 Waller County had 42,816 people but only 3 physicians for a ratio of 14,192:1 - the highest ratio in the state Angelina County had 84,171 people and 68 physicians, for a ratio of 1,238:1 Orange County had 84,937 people and 28 physicians, for a ratio of 3,033:1 There were 27 counties with no physicians, the largest being Duval County with 13,756 people. Terrell County was the smallest county with a physician, population 1,101.

Physician Assistant Facts – 2008 Physician Assistants: Total – 4,191 White 73.2% Black 6.0% Hispanic14.0% Other6.8% Male41.7% Female58.3% Providers/100,000 Population: Texas17.3 Border Urban13.5 Non-Border Urban18.5 Border Rural16.0 Non-Border Rural12.8 Number of counties with no Physician Assistants – 63 Physician Assistants per 100,000 Population Physician Assistants: Median Ages Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009 Females became the majority in 2002

Physician Assistant Demographic Trends Race/Ethnicity Trends percent of total Supply Ratio Trends by Race/Ethnicity Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

Feminization of Workforce Studies show: Females work fewer hours than Males, and are more likely to work part-time Females often take more leave, but often retire later in life Females tend to spend more time with patients, but then see fewer patients Females less likely to practice in Rural areas May need more supply to counter fewer FTEs Publications Note: Some licensing boards in Texas do not collect information on Gender

Dentists: Total – 8,987 No race/ethnicity data available; in the future should be collected by new Minimum Data Set Male 73.3% Female 26.7% Providers/100,000 Population: Texas37.2 Border Urban16.5 Non-Border Urban41.8 Border Rural11.9 Non-Border Rural25.3 Number of counties with no Dentists – 46 *Excludes specialists General Dentist* Facts – 2008 General Dentists per 100,000 Population General Dentists: Median Ages Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

Dental Health Professional Shortage Areas As of January 1, 2009 there were 82 Whole County Dental Health Profession Shortage Areas (HPSAs), and 50 sub- county geographic or special population HPSAs in Texas. Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 6, 2009

Minimum Data Set In 2007, the 80 th Session of the Legislature passed Senate Bill 29, which calls for the creation of a Minimum Data Set for the collection of information on health professionals by the Statewide Health Coordinating Council (SHCC). Purpose: To standardize the types of information collected by the various health professions licensing boards, and to allow the SHCC, through HPRC, to gather more information on practice location, gender, age, and race/ethnicity. Limitations: Providers are not required to provide demographic data Legislation does not cover all professions Delays for some professions in collecting data (only approximately 55% covered, although others may voluntarily submit data; approximately 65% of professions expected to provide demographic data; most of those that aren’t covered or that will be delayed are Allied Health professions and Mental Health professions)

Registered Nurse Facts Registered Nurses: Total – 162,304 White 71.0% Black 8.3% Hispanic 9.8% Other 10.9% Male 10.1% Female 89.9% Providers/100,000 Population: Texas671.3 Border Urban483.1 Non-Border Urban730.9 Border Rural230.6 Non-Border Rural470.1 Number of counties with no Registered Nurses – 3 Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009 Registered Nurses per 100,000 Population Registered Nurse: Median Ages

Registered Nurse Demographic Trends Race/Ethnicity Trends percent of total Supply Ratio Trends by Race/Ethnicity Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

Pharmacist Facts Pharmacists: Total – 18,623 White 59.8% Black 13.5% Hispanic 8.6% Other18.0% Male49.6% Female50.4% Providers/100,000 Population: Texas77.0 Border Urban42.7 Non-Border Urban84.9 Border Rural31.5 Non-Border Rural56.4 Number of counties with no Pharmacists – 27 Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009 Pharmacists per 100,000 Population Pharmacist: Median Ages

Mental Health Professions Licensed Professional Counselors Licensed Chemical Dependency Counselors Marriage and Family Therapists Psychiatric Nurses Psychiatrists Psychologists Social Workers

Mental Health Professions Higher Median Ages than other professions, and median ages increasing at a faster rate Supply ratios decreasing – and not just supply ratios but actual numbers for some professions

Texas Psychiatrist Facts – 2008 Psychiatrists: Total – 1,617 White65.6% Black 3.8% Hispanic12.3% Other18.2% Male63.5% Female36.5% Providers/100,000 Population: Texas6.7 Border Urban2.6 Non-Border Urban7.8 Border Rural1.0 Non-Border Rural3.3 Number of counties with no Psychiatrists – 171 Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009 Psychiatrists per 100,000 Population Psychiatrist: Median Ages

Mental Health Health Professional Shortage Areas Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 6, 2009 As of March 10, 2009 there were 172 whole county Health Profession Shortage Areas (HPSAs) for mental health, and 12 sub-county geographic or special population HPSAs in Texas.

Mental Health Professions - Loss in Numbers Licensed Chemical Dependency Counselors Marriage and Family Therapists Psychiatric Nurses Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

Mental Health Professions – Median Age Trends Licensed Professional CounselorsLicensed Chemical Dependency Counselors Marriage and Family Therapists Psychiatric Nurses Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

Public Health Workforce Surveys Collected information from: Local Health Departments Federally Qualified Health Centers Health and Human Services Enterprise Agencies: Department of State Health Services Department of Aging and Disability Services Texas Health and Human Services Commission Department of Family and Protective Services Department of Aging and Rehabilitative Services

Public Health Workforce Summary of Surveys 13,063 Currently Staffed FTEs Largest Professions: Nursing – 4,173.0 Registered Nurses – 2,371.5 Licensed Vocational Nurses – 1,801.5 Mental Health Workers – 3,541.0 Psychiatric Nursing Aides, Psychiatric Nursing Assistants – 2,775.0 Social Workers, licensed and unlicensed – Psychological Associates – Psychiatrists – Psychologists – 68.5 Psychological Assistants – 10.0 Other – 37.0 Other Professions: Environmental Health Workers/Engineers/Sanitarians – Public Health Technicians – Physicians (not including Psychiatrists) – Nutritionists and Dietitians – Dentists – Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009

Public Health Workforce – Vacancies 2,003.8 Vacant FTEs – 13.3% Vacancy Rate Professions with the most Vacant FTEs: Additional FTEs Desired if Budgets Allowed Prepared By: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, August 2009 Registered Nurses – Other Mental Health Workers – Licensed Vocational Nurses – Public Health Technicians – Physicians – 117.8

Demographic Review of the Texas Health Professions Workforce Brian King, Program Director, HPRC Health Professions Resource Center Center for Health Statistics Texas Department of State Health Services