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Bolstering the Health Workforce Starts With Good Data, Strong Incentives

All states face challenges recruiting and retaining health care professionals, but rural and underserved areas have been hit especially hard.

By Lisa Ryckman  |  September 6, 2023

Ask a roomful of legislators and staff to name the top three problems with the health care workforce in their states, and the answers are clear: recruiting new health care professionals, retaining those already on the job and ensuring health care access in the communities that need it most.

“We’re all aware that these are longstanding challenges,” says Hannah Maxey, an associate professor of family medicine at Indiana University. “In fact, it is very easy to find headlines from nearly any decade that discussed health workforce shortages in the United States.”

Maxey told a session at the 2023 NCSL Legislative Summit that expanded health care coverage through the Affordable Care Act and Medicaid is just a first step.

“If there are no professionals or health care providers or workers for you to see, having that insurance does not make a difference.”

—Hannah Maxey, Indiana University School of Medicine

“Once you have the golden ticket of insurance, if there are no professionals or health care providers or workers for you to see, having that insurance does not make a difference,” she says.

Bolstering the health workforce starts with knowing how many professionals already are working in the state and where they are, Maxey says, which means examining data from both federal and state sources.

“State licensing regulatory processes, such as initial license, application and renewal, offer a strategic opportunity for states to collect bare minimum data or information needed to really home in on who is not just licensed, but who’s actually practicing in your state and where are they actually practicing,” she says.

Maxey pointed to shortages of dentists in Indiana in 2009, and inconsistency between reports of access challenges and federally recognized shortage areas. Fast forward to 2018, when new legislation allowed the state licensing agency to collect data to support assessments, policy and planning.

“The result of that was identification of all qualifying shortage areas,” she says. “These led directly to opportunities for incentive programs, development of grants to support workforce development, recruitment and retention.”

Hawaii’s health worker shortage is driven by the state’s very high cost of living and its inaccessibility, says Sen. Joy San Buenaventura, chair of the Health and Human Services Committee. The state funds loan repayment programs for all health care professionals and offers a $1,000 credit for preceptors—“clinicians who take time out of their work to mentor and teach students on how they use what they learn in the classroom and how it’s actually working out in the open field,” she says. “We need to be able to have preceptors so that people are up and running when they graduate, and then they’ll be able to be out and practicing and working for us.”

The state has increased Medicaid matching funds to recruit more physicians to help those who are needy and those in rural communities, San Buenaventura says. It has also increased the independent authority of the medical professionals who are already in those places and expanded telehealth. In addition, the state has adopted an interstate compact that allows professionals licensed in other states to practice in Hawaii, she says—an approach many states have instituted or are considering.

Incentivizing workers to stay on

In Utah, the Health Workforce Advisory Council and the Health Workforce Information Center, both created by the Legislature, help identify holes in the state’s health care worker coverage and make recommendations to lawmakers about resource allocation, says Sen. Jacob Anderegg, chair of the Social Services Committee.

The state is using resources to incentivize health workers who are already in the profession to remain in the state and, especially, to work in rural areas, Anderegg says, noting that many students at Utah’s premiere medical school choose to leave the state to do their residencies. “So, we’re also doing incentives to help keep those people here, doing the residencies here.”

In New Mexico, Project ECHO, a worldwide medical knowledge and mentorship network created by Albuquerque physician Sanjeev Arora, has helped fill treatment gaps through virtual sharing of best practices by medical professionals, says state Rep. Joanne Ferrary, chair of the Consumer and Public Affairs Committee and a member of the Health and Human Services Committee.

Loan repayment programs, higher reimbursement levels and protections for reproductive health providers are other tools New Mexico lawmakers have used to help recruit and retain health care professionals, she says. And the state has invested heavily in programs to address physician shortages, including outreach, minority student services, and enhancing and expanding graduate medical education opportunities, Ferrary says.

Maxey says despite the persistent nature of health care worker shortages, new approaches have emerged regarding career pathways and alternative training mechanisms. “We’re seeing the growth in discussions and the emergence of new training models,” she says, “such as apprenticeship for health care professionals that, in prior decades, we really hadn’t seen.”

Lisa Ryckman is NCSL’s associate director of communications.

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