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WHAT WORKS
UNDERSTANDING AND MANAGING THE WORKFORCE
States that want to understand and manage their health care workforce have two major challenges 1) to better understand their current workforce and project future workforce supply, and 2), to manipulate their workforce to fill unmet needs. Programs in Iowa and Pennsylvania, respectively, are managing to address these challenges, with exceptional results.
Iowa
The Iowa Health Professions Inventory (IHPI) is a computer-based tracking system that contains demographic, educational and professional information on every active Iowa health practitioner in selected professions (physicians, nurse practitioners, physician assistants, dentists and pharmacists). The 31-year-old tracking system allows the state to have "real time" data about both the supply of and demand for health professionals in the state. For example, if a physician moves into the state, retires or changes office location, the information is captured in the database almost immediately. To do this, program staff collect information from many sources-membership rosters at the state's medical and professional organizations, reports from hospitals on staff changes, news clippings and word of mouth, among other sources-and continuously update the database. In addition, they track the number of job openings for health professionals across the state.
According to Roger Tracy, assistant dean at the University of Iowa Medical College where the IHPI was first developed and is now maintained, this tracking system enables the state to do several things: 1) characterize its health workforce in "real time;" 2) monitor workforce trends (age, supply, demand, etc.); 3) provide support and justification for new workforce initiatives, such as recruitment and retention programs; 4) evaluate existing workforce programs; and 5) conduct research that results in policy changes. In the future, Tracy hopes to expand IHPI to include registered nurses.
Pennsylvania
Uneven geographical distribution of health care professionals is a major challenge for states, and shortages of physicians in rural areas is a persistent occurrence. Several medical school programs are taking the lead to increase the number of rural physicians by selectively admitting students who come from rural areas in the belief that they will return to practice in those areas. The Physician Shortage Area Program (PSAP) at Jefferson Medical College of Thomas Jefferson University in Philadelphia, Pennsylvania, has been doing this for 25 years with great success. According to the PSAP's comprehensive tracking data, 87 percent of PSAP graduates were practicing rural family medicine five to 10 years after they first located in practice. In addition, PSAP graduates account for 21 percent of rural family physicians practicing in Pennsylvania who graduated from an in-state medical school, even though they represent only 1 percent of all graduates from the state's medical schools.
The program recruits and then selectively admits students who have grown up in rural areas or small towns and who intend to return to a similar rural area to practice family medicine. Once admitted, students are paired with advisors in the Department of Family Medicine and are provided with financial aid. During their first two years of medical school, PSAP students meet with these advisors several times and are given the opportunity to participate in summer research in family medicine. During their third and fourth years, PSAP students are required to complete their clerkships and subinternships in rural or small town family practice centers. Following graduation, PSAP participants are expected to complete rural family medicine residencies.
Dr. Howard Rabinowitz, director of the program and a professor of family medicine at the medical college, feels that establishing programs like this is relatively simple and represents the least costly policy option to solve maldistribution problems. "These programs work," he says. "When you examine the literature, this is very clear. Secondly, they are very cost-effective-they cost less than either widespread curriculum changes or loan repayment programs." However, he cautions, " ... they need state support. Most medical schools don't have an incentive to develop or continue these programs, especially at a time when competition is forcing them to align their missions with specific funding sources. Unfortunately, whatever does not receive external support is unlikely to be implemented or sustained."
Other successful programs similar to the PSAP include those at the University of Washington's Washington, Wyoming, Alaska, Montana, Idaho Program (WWAMI), the University of Minnesota-Duluth, the University of Minnesota's Rural Physicians Associate Program (RPAP), Michigan State University (the Upper Peninsula Program [UPP]), the University of Illinois-Rockford (the Rural Medical Education Program [RMED]) and Mercer University in Macon, Georgia.
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