A Cross-Disciplinary Statewide Healthcare Workforce Analysis

Journal of Allied Health,  Summer 2008  by Rambur, Betty,  Palumbo, Mary Val,  McIntosh, Barbara,  Thomas, Colleen

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A statewide study was conducted to examine the healthcare workforce from the perspectives of the individual healthcare worker and employer as a basis for evidence-based workforce planning. The workforce minimum data set recommended by Colleagues in Caring was used to analyze job satisfaction, intention to leave current position, intention to leave profession, and reasons for such intentions in members of four professions (medical laboratorians, respiratory therapists, radiographers, and registered nurses) in a rural state. Statewide hospital vacancy and turnover rates for these disciplines also were analyzed. The study found that an aging workforce exists across these four healthcare disciplines. Despite relatively high satisfaction with their positions, a substantial proportion of this sample-over 20% for each profession-reported being "somewhat likely" or "very likely" to leave their position in the next 12 months. Top reasons for these intentions varied by profession and range from career mobility opportunities to job/organization dissatisfaction and stress. Nevertheless, vacancy and turnover rates in the hospital setting for all professions were comparatively modest. Implications for policy and research methods are detailed. J Allied Health 2008; 37:105-109.

QUALITY HEALTHCARE depends on integrated, highly functioning, interdisciplinary and interprofessional teams. Such teamwork, however, is increasingly compromised by widespread and growing shortages among the health professional workforce. Attention has been given to the workforce dynamics in some professions, typically medicine, nursing, and dentistry, but comprehensive, cross-disciplinary workforce analyses are undertaken far less commonly. Moreover, in rural areas, the swing between demand and supply excess in workforce has a much more dramatic effect than in areas with larger populations, suggesting that workforce analysis and projections in rural areas warrant particular attention.

The purpose of this study therefore was to explore health workforce dynamics across four diverse health professions-medical laboratorians, respiratory therapists, radiographers, and registered nurses-in a rural state from the perspective of the individual professional and the hospital employer. The overall goal was to test a more comprehensive assessment perspective and provide a beginning foundation for evidence-based health workforce planning and policy formulation.

Conceptual Framework and Literature Review

Conceptually, this research examines health workforce dynamics from a systems perspective, with human capital theory a key underpinning. The total labor force (aggregated human capital) must be examined in terms of its interdependent component parts for the system to be properly assessed. Thus, consistent with human capital theory, limitations in any aspect of the health workforce-such as types and numbers, as well as individual or collective knowledge, abilities, or experience-can limit the rate or quality of "production,"1-3 which in this case is health services delivery. Therefore, attention to each component of the workforce necessary to create the final "product" (healthcare services) is essential.

In particular, given the risk of impeding delivery of a service as essential to society as healthcare, it might be expected that ample attention is paid to ongoing, robust, and comprehensive healthcare workforce supply and demand measurements across disciplines and delivery settings. Instead, few such studies are available. A study of seven allied health occupations was undertaken in South Carolina.4 At that time, over a decade ago, shortages were found in occupational therapists, physical therapists, and certified registered nurse anesthetists. These authors concluded that states must develop a system-wide response to allied health workforce inadequacies, which includes ongoing communication between educators and employers.

To date, there has been scant evidence that this sound advice has been heeded, with notable exceptions coming from the reports of state and regional health workforce centers.5 Such state and regional data are important, given that workforce shortages across health professions, for example, can also be impacted by rural location and hospital size.6 On the other hand, state and regional approaches have weaknesses, such as a lack of inter-region comparability secondary to the use of differing data collection instruments, time frames, and methods. Moreover, the paucity of national data reflecting the aggregate and interactive impact of health workforce patterns does not provide a foundation for a national approach.

Such efforts have been undertaken in the past. A comprehensive national look at the growth and geographic distribution of selected health professions between the years of 1971 and 1996, for example, called for immediate attention to pharmacy and dentistry.7 This study, by Shih, found that although the total number of selected health professionals per 100,000 population had increased over three decades, growth in each of the eight professional groups studied had actually decelerated. The slowing of growth in the nursing profession in the 1980s was in turn suggested to have contributed to the current and continuing nursing shortage. At an overarching level, Shih's study illustrates a rationale for multiple and ongoing measures of health workforce issues and trends: timely and definitive intervention.