States Plan for Future Healthcare Workforce Needs

By Jennifer Larson, contributor

April 25, 2013 - As the national commission created by the Affordable Care Act (ACA) to research and analyze healthcare workforce issues continues to wait for funding, the states are doing their best to monitor their health workforce situations and plan for the future.

Maria Schiff and Josette Gbemudu of the National Governors Association (NGA) Center for Best Practices noted in a January blog post for the Health Workforce Information Center’s Health Workforce News, “As states work to address and avert potential problems resulting from a tight supply of health professionals, which could be further exacerbated by the impending expansion of health insurance, it is critical that states learn from each other. States are laboratories for experimentation, and many are developing workforce improvement programs aimed at addressing workforce shortages.” 

The ACA established the National Health Care Workforce Commission with the goal of creating an expert resource to guide Congress and other policymakers when considering issues affecting the nation’s supply of healthcare professionals. However, the commission has yet to receive any federal funding and has never met, despite a large body of healthcare professional associations urging congressional leaders to allocate $3 million in late 2012.

So, many states have taken up the baton and are solving their own health workforce issues.

Experts say that it’s crucial for states to learn as much as possible about their current workforces and plan strategically for the future; this might involve reviewing their scope of practice laws and examining the curricula in their health professions educational programs, said Deanna Okrent, senior health policy associate for the Alliance for Health Reform.

“They have to take a look at stuff that’s been around for awhile and see if it fits today’s needs and kind of adjust,” she said.

Having the right kind of data on the healthcare workforce is also important, said Mary Rita Hurley, RN, president of the Forum of State Nursing Workforce Centers, which advocates for the states to use minimum data sets. The forum promotes the National Nursing Workforce Minimum Datasets in the areas of nursing supply, nursing demand and nursing education programs, with the goal of collecting enough information to help maintain an appropriate supply of nurses to meet the healthcare needs of the population.

“Unless you have that data and have a picture, it’s kind of hard to decide,” said Hurley, who is also the executive director of the Oregon Center for Nursing.

Despite the national commission’s inactive status, the states can still share information and practices with each other. For example, the states can turn to the NGA’s State Health Policy Options online resource, as well as the HWIC’s State Health Workforce Resources guide.

Here is a snapshot of the workforce situation from two states:


The Montana Healthcare Workforce Advisory Committee, or MHWAC, was launched in 2006, well before the health reform law was passed. The state also released a Healthcare Workforce Statewide Strategic Plan in 2011 to help steer the state in the right direction for the future. The plan focuses on strategies to educate people about the need for a well-trained healthcare workforce, as well as educating, training, recruiting and retaining those professionals.

“We have problems that are specific to Montana, but we have good support and try to develop Montana-appropriate solutions to them,” said Cindra Stahl, MHWAC’s program coordinator.

Many of Montana’s challenges stem from being a predominantly rural state. Primary care physicians are particularly in demand, especially in the rural areas, as are nurses and mental and behavioral health providers.

“There are several counties that have no physicians, counties that have no hospital,” Stahl said. “We have healthcare facilities that are run by midlevel providers. There are no physicians there.”

The strategic plan projects that the need for more healthcare professionals to serve Montana’s population will continue to grow. The state’s population is aging rapidly--25 percent of the population is expected to be 65 or older by 2025--and an older population uses more healthcare resources. The state also anticipates an additional influx of people seeking care as a result of being added to health insurance rolls due to health reform.

“If you add more participants to that system that’s already experiencing shortages, that’s a frightening opportunity,” Stahl said.

However, the state still needs more information about its existing workforce to plan for the future. Montana’s workforce advisory committee had hoped to convince state lawmakers of the virtues of minimum data sets to obtain more accurate data about the state’s healthcare professionals. Unfortunately, two bills that would have established data collection at the time of license renewal were killed during the most recent legislative session, which just ended.

“We will keep trying,” said Stahl.


Colorado also has the challenges that come with having large rural swaths. But Colorado also has some urban areas that have underserved populations.

Jeff Bontrager: Montana's patients need more access to healthcare workforce.
Jeff Bontrager, Colorado Health Institute's director of research on coverage and access, noted that Colorado has access-to-care challenges in its rural and urban areas.

“It seems to be kind of a distribution issue,” noted Jeff Bontrager, director of research on coverage and access for the Colorado Health Institute.

The uneven distribution of healthcare professionals across the state was a key issue highlighted in a December 2012 report produced by the Colorado Health Institute, which analyzes healthcare workforce data in the state and looks at trends. And there will be an increasing need for primary care providers, given the state’s aging population and the difficulty attracting those primary care providers.

Health reform will also play a role. A December 2011 report estimated that approximately 510,000 Coloradans will gain access to health insurance between 2014 and 2016, due to the Affordable Care Act. The institute then predicted that the state would need between 83 and 141 additional primary care providers for those newly insured.

That report noted that some may have viewed the estimates as “more manageable than some had anticipated.” However, it’s also possible those numbers may have shifted in the months since the report was issued. Colorado’s state health exchange is expected to launch in October. The institute is currently working on an assessment of the current status of its healthcare workforce that will analyze the provider supply in relation to the population distribution.

Related articles:
Health Care Workforce Commission Still in Limbo
2012 Healthcare Workforce Summit


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