There are healthcare shortages throughout many areas of the United States. New Mexico’s current and projected healthcare shortages are more severe than many other areas of the country. These are exacerbated by many of our state’s Social Determinants of Health, including poverty, race and ethnicity, and the fast-growing older adult population. 1
A recent study by UNM using 2015 data, and presented in November 2016 to the Legislative Health and Human Services Committee, noted healthcare workforce shortages in NM as a whole, especially in less-populated counties. New Mexico faces both healthcare staffing shortages now, and projected for the next few decades. Healthcare also represents an area of economic growth. These trends seem counterintuitive, however, they both exist, creating interesting challenges for providers.
Health Equity Funder Addresses the Issue
The Con Alma Health Foundation has been deeply concerned about this issue as it relates to both staffing shortages and underrepresentation of Hispanics and Native Americans within the current and projected workforce. Con Alma has conducted research and published reports on the state’s health care shortages, and identified the following as key issues impacting health shortages:
- Pipeline shortages in key health faculty positions at colleges and universities;
- Lack of close alignment between education programs and available jobs;
- Limited loan repayment assistance and/or incentives for newly graduated health professionals who face repayment of large student loans;
- Special challenges faced by rural communities;
- Significant levels of retirement of professionals during the coming decade;
- Low level of racial and ethnic diversity among health care professionals;
- Small cohort of young adults moving into the workforce, and its impact on health and allied health education, training, recruitment and placement;
- Funding and policy challenges (2).
Current and Future Picture of the Healthcare Workforce
The health care workforce that is retiring now and in the next decade is primarily male and white. It is not representative of the diverse population of the state. This workforce is not being replaced by enough new professionals with either the numbers or the diversity needed to provide adequate health care in the future. The NM Department of Workforce Solutions annual reports over the past few years show a significant increase in the percentage of healthcare related jobs, going from 10% in 2002, to a level of 16.1% in 2015. Nationwide, the healthcare industry is projected to represent 20 percent of all jobs by 2024, and New Mexico may well have a higher percentage of healthcare jobs. highest level of overall growth in a sector of the economy in the County. Continued growth is expected for the coming years, projected to be 28.8 percent growth between 2010 and 2020. 3
Shortages Amid a Picture of Significant Growth in the Healthcare Sector
Significant health care growth and substantial shortages are happening at the same time because much of the growth has come in the subsectors of health care that are in: a) private pay areas serving middle-income to high-income residents; b) home health care providers with low wage jobs for proprietary companies creating profits by minimizing worker pay; and c) the health insurance industry with thousands of jobs created due to Medicaid expansion and the ACA Health Information Exchange. These factors have little impact upon HPSAs, as most of these staff are in nonprofit and government sectors, which have been experiencing reductions in both staffing and funding. Even with overall growth in the healthcare industry, significant gaps in targeted areas have the most impact for those serving primarily low and limited income populations which are high priorities for the State of New Mexico.
An analysis by the NM Legislative Finance Committee (LFC) 4 suggests that even though there are healthcare shortages as outlined by HRSA, some of the gap issues could be addressed, at least in part, through more carefully delivered care, utilizing a range of strategies targeted to different types of patient needs and utilizing resources more effectively. In other words, patients with chronic conditions, hospital high utilizers, and people with other challenging conditions (1% of patients utilizing 22% of healthcare resources) require much more intensive, ongoing contact. However, those who are healthy need a different, less intensive level of care. 5
A major challenge for the next decade for the healthcare industry, as well as states and counties, is our ability to successfully address the education, training, recruitment and retention of a diverse workforce. This is especially true for rural and frontier health areas, communities with a high proportions of poor and near-poor, and those significant minority-majority populations. The retirements represent part of the “Silver Tsunami,” which is a very fast-moving trend.
1 Data from the U.S. Census and Con Alma Health Foundation shows that New Mexico will move from being 39th in the U.S. in proportion of older adults in 2010, to being 4th, in 2030. This represents a huge Silver Tsunami, or age wave.
2 The Power of Partnership, Project Diversity, Con Alma Health Foundation, 2010, a report on the nursing pipeline program to improve diversity in nursing.
3 New Mexico State of the Workforce Reports for 2014 and 2015, and Economic and Industry Snapshot: Santa Fe County/MSA New Mexico, 2014, NM Office of Workforce Solutions; Employment Projections 2014-2024, Bureau of Labor Statistics.
4 Adequacy of New Mexico’s Healthcare Systems Workforce, 2013, Department of Health and Allied Agencies, Legislative Finance Committee, 2013, at https://www.nmlegis.gov/handouts/LHHS%20100213%20Item%202%20A-1-2 Department%20of%20Health%20Adequacy%20of%20New%20Mexicos%20Healthcare%20Systems%20Workforce.pdf.
5 This article has utilized some of Anne Hays Egan’s research for the Leadership and Alignment: Santa Fe County Gap Analysis, 2017, with Hyde & Associates – Policy and Practice Consulting, LLC. The Gap Analysis report will be made available by Santa Fe County Community Service Department in October, 2017.