Minnesota Hospital Association Testimony
Legislative Health Care Workforce Commission
Aug. 25, 2014
On behalf of
the Minnesota Hospital Association’s (MHA) members, which include 143 hospitals
and their health systems serving communities across the state, I want to thank
you for the opportunity to speak to you today about our outstanding health care
workforce. MHA appreciates the Commission’s interest in ensuring that our
workforce remains strong and meets our communities’ needs now and into the
future.
Overview of our
workforce
Minnesota’s
health care workforce provides care for more than 560,000 inpatient visits and
more than 11 million outpatient visits a year. Multiple independent quality
organizations consistently rank Minnesota as having the best quality of care in
the country. These achievements would not be possible without our dedicated, well-educated
and trained employees who are committed to continuous improvement.
MHA members directly
employ more than 115,000 people and contribute almost $7 billion in salaries
and benefits. Another 100,000 jobs are indirectly tied to the care and services
our members provide, making up 8.3 percent of the total state workforce. In
many communities hospitals are the largest employer.
Minnesota’s
hospitals and health systems also play an important role in educating the state’s
future workforce by providing tens of thousands of hours of hands-on,
at-the-bedside clinical experiences for health care workers beginning or
furthering their education. For example, in 2013 our hospitals and health
systems provided well over 500,000 hours of clinical experience for registered
nurses alone.
As Minnesota
hospitals and health systems consider tomorrow’s health care workplace, in
addition to considering any potential workforce shortages, we anticipate
significant transformations, including:
- New team-based staffing models that will change the
roles and responsibilities of doctors, nurses, assistive personnel,
pharmacists, care coordinators, and a host of other direct and indirect
caregivers;
- Care teams that more closely reflect the increased
diversity of our patient population;
- Evolving and emerging technologies that may render
some manually intensive jobs obsolete, while creating new jobs that do not
exist today;
- Ongoing performance improvement, reliance on
evidence-based care protocols and transparency efforts; and
- Changes to the payment system that will continue to
move toward paying for outcomes and the value of care patients receive
rather than the number of services providers deliver.
Registered Nurses and
Primary Care Physicians - MHA report
Just this
year, MHA commissioned a study by Towers Watson, a global professional services
company, to understand how our talent pool will fare in the next ten years in
two of the largest segments of the health care workforce - Registered Nurses
and Primary Care Physicians. To the best of our knowledge, this study is the
first time three key variables have been looked at simultaneously - the rate of
exits from the current workforce; the supply of new graduates entering the
workforce; and the projected demand for health care labor.
Towers Watson
used data provided to MHA each year by a majority of our member hospitals as
well as publically available data from the Bureau of Labor Statistics and the state
of Minnesota.
Primary Care Physicians
findings
The complete
study is provided for you in your background materials. It found what many in
the health care industry have already warned - a shortage of primary care
physicians in Minnesota will develop over the next 10 years. Specifically,
according to the study, a cumulative shortfall of almost 850 primary care
physicians is projected by 2024 because of the lack of annual growth in
Minnesota’s graduate medical education and training programs.
Lack of graduate
medical education growth is one of our most significant health care workforce
challenges, as residency programs face funding and clinical space challenges. In
fact, in October 2013, the University of Minnesota announced it had no plans to
expand its medical student enrollments because of the lack of residency
training positions and funding. This is due mainly to the federal 1997 cap, or
freeze, on the number of physician residency positions available for Medicare
funding.
Primary Care Physicians
solutions
While MHA
continues to advocate with our federal congressional delegation to lift this
antiquated, 17-year freeze on residency positions, and to protect and even
increase graduate medical education funding, we know it is unlikely for this to
become a reality given the budget pressures federal lawmakers face. New and
creative state-level solutions are needed.
MHA supports
the development of new care delivery models, including increased use of
tele-health technologies, to relieve some of the demands on primary care
physicians while continuing to ensure timely and convenient access to primary
care for Minnesota residents. In addition, MHA supports increasing the funding
of Minnesota’s Medical Education and Research Costs (MERC) program that helps
hospitals and health systems offset some of the higher costs associated with
training physicians and other health care professionals.
Registered Nurses
findings
The projected
supply of Registered Nurses is more promising. The study found that the
state-level supply of Registered Nurses will slightly more than meet the demand
assuming that Registered Nurse educational programs continue to grow. However,
the study illustrates that this slight projected surplus of Registered Nurses is
sensitive to a few key variables and could turn into a shortfall if there is an
increase in the pace of retirements, or if nursing students’ access to
practical and clinical experiences were to significantly decline.
Registered Nurses and
Primary Care Physicians geographic distribution
The scope of
the study was to look at the statewide supply of Registered Nurses and Primary
Care Physicians, however we know that geographic distribution is also an
important factor to consider. Having an adequate supply statewide is certainly
a good start, but additional solutions to help rural providers with their
unique recruitment and retention issues should be considered.
Other workforce
challenges and initiatives
While
Registered Nurses and Primary Care Physicians are the focus of MHA’s remarks
today given a tight time-frame, a theme you have most certainly heard today and
throughout your work, is that the health care workforce is vast and
ever-evolving to meet the community needs.
Included in
your background materials you will find an inventory of workforce development
initiatives that MHA is either leading or involved in, in collaboration with
many in the room today.
We appreciate
that the commission is considering the immense amount of work that is already
underway in Minnesota to address our future workforce needs, and we hope we can
build upon the successes or lessons learned as we move forward.
Thank you for
the opportunity to speak to you today. MHA looks forward to assisting in
finding solutions and expanding successes to ensure Minnesota continues to support
our health care workforce and deliver nation-leading care.