The healthcare workforce is expected to undergo seismic changes in the coming years, driven by changes in the healthcare reform law, the increasing focus on team-based care and accountability, the push to expand the role of nurse practitioners and other allied health professionals, and the growing emphasis on providing care in ambulatory settings. We’ll hear from a panel of experts who will describe how those trends are affecting the healthcare market in Dallas and other regions, and how they predict hospitals and health systems will adapt their staffing, hiring and training practices. The panelists: Joel Allison, CEO, Baylor Scott & White Health Dr. Nancy Dickey, Professor, Texas A&M University; President Emeritus,Texas A&M Health Science Center Edward Salsberg, Professor, George Washington University School of Public Health and Health Services The moderator: Maureen McKinney, Editorial Programs Manager, Modern Healthcare This event took place on May 6, 2014 from 7:30-9:30 a.m. in the Pegasus Ballroom of The Magnolia Hotel Dallas, 1401 Commerce St., Dallas, TX 75202

1. Joel Allison
CEO, Baylor
Scott & White
Health
Dr. Nancy Dickey
Professor, Texas
A&M University;
President
Emeritus,
Texas A&M
Health Science
Center
Edward Salsberg
Professor,
George
Washington
University School
of Public Health
and Health
Services
THE CHANGING HEALTHCARE
WORKFORCE
#MHBreakfast

2. #MHBreakfast
Agenda:
7:30-7:50 a.m. Registration & Networking
7:50-8:00 a.m. Opening & Speaker Introductions
8:00-9:00 a.m. Roundtable Presentation
9:00-9:30 a.m. Q&A & Closing
Panelists:
Joel Allison
CEO, Baylor Scott & White Health
Joel Allison is Chief Executive Officer of Baylor Health Care System and Baylor Scott & White Health. Allison joined
Baylor Health Care System in 1993 and served as Baylor’s senior executive vice president and chief operating officer
before being promoted to president and CEO in 2000. Nationally, he serves on the Healthcare Leadership Council and
is a member of the United Surgical Partners, International board. In 2005 Allison was awarded Modern Healthcare’s
“CEO IT Achievement Award” and was awarded the Dallas Historical Society’s “Award for Excellence in
Community Service.”
Dr. Nancy Dickey
Professor, Texas A&M University, President Emeritus
Texas A&M Health Science Center
Dr. Nancy W. Dickey serves as a professor in the Department of Family and Community Medicine and the Department
of Medical Humanities in the College of Medicine, and as a professor in the Department of Health Policy and
Management in the School of Public Health, Texas A&M Health Science Center. She also is the President Emeritus of
the Health Science Center. Dr. Dickey assumed the role of president of the Texas A&M Health Science Center and vice
chancellor for health affairs for The Texas A&M University System in 2002, and served in that role until 2012. Prior to
her current appointment, she served as interim dean of the TAMHSC-College of Medicine. Dr. Dickey is a past president
of the American Medical Association, and the was the first woman to be elected to that role. She was elected to the
prestigious Institute of Medicine in 2007 and to the Texas Women’s Hall of Fame in 2010.
Edward Salsberg
Professor, George Washington University School of Public Health and Health Services
Edward Salsberg has been a national leader in health workforce research, policy and data for over 25 years. He is
currently on the faculty at George Washington University. Until recently, Mr. Salsberg was the founding director of
the National Center for Health Workforce Analysis in the U.S. Department of Health and Human Services. Mr.
Salsberg previously established and directed the Center for Workforce Studies at the Association of American Medical
Colleges and the Center for Health Workforce Studies at the University at Albany, State University of New York. All
three health workforce centers have been leaders in providing information on the supply, demand, distribution and
use of the healthcare workforce, and they have pioneered approaches to collecting health workforce data.
Moderator:
Maureen McKinney
Editorial Programs Manager, Modern Healthcare
Maureen McKinney is the editorial programs manager for Modern Healthcare, overseeing webinars, conferences and
other healthcare leadership events. She also reports on timely issues affecting healthcare leaders, including clinical
and financial best practices. McKinney joined Modern Healthcare in 2010 as the magazine’s quality and patient safety
reporter. She has covered the healthcare industry for more than a decade.

3. A Modern Healthcare Briefing
Dallas, TX
May 6, 2014

4. Major Developments and
Trends Impacting the Health Workforce
• Demand for health care rising as the US population is growing and
aging and coverage expands
• Unsustainable cost increases
• Uncertainty about adequacy of health workforce supply
• Concern with inefficiencies and potential overuse
• Increasing interest in identifying ways to improve efficiency and
health outcomes
• Delivery system reforms and innovations and growing size of health
care organizations

5. States Are Central to Health Workforce Supply,
Distribution and Use
• State-supported education and training
• Scholarships and loan repayment
• State labor department- tracking employment and workforce
needs (LMI Directors)
• State Primary Care Offices
• Medicaid policies
• State employee health insurance
• Provision of state and local public health services
• Licensure and regulation of practitioners
• Regulation of service delivery

6. Delivery System Transformation and the
Workforce
• Pressure to do more with less
• The transformation is being driven by public policies as
well as the provider and payer community and patients
• The growing supply of PAs, NPs and other health care
practitioners will enable and stimulate the transformation
• Incentives to make better use of the workers we have;
• Teams and collaborative practice and education
• New categories/variations on support personnel
• Reassess scope of practice and scope of work
• Increased use of technology

7. • Comprehensive Primary
Care (CPC) Initiative
• Multi-Payer Advanced
Primary Care Practice
(MAPCP) Demonstration
• Federally Qualified Health
Center (FQHC) Advanced
Primary Care Practice
Demonstration
• Independence at Home
• Health Care Innovation
Awards
• State Innovation Models
• Graduate Nurse Education
Demonstration
Federal Initiatives Support Systems
Redesign
Source: CMMI

8. Federal Initiatives and the Workforce
• CMMI Health Care Innovation Awards
 Care coordinators and better management of patients;
 Use of inter-professional teams;
 Use of patient navigators;
 Use of community health workers;
 Use of patient care technicians, advanced aides, assistants;
 Improved care transitions and in home services.
• CMMI State Innovation Models (SIMS)
• Medical home initiatives
• ACOs/Bundled payment
• Texas 1115 Health Care Transformation Waiver

9. Growing Evidence of Systems Transformation
Health Affairs Workforce Issue, Nov. 2013
• Primary Care: Proposed Solutions To the Primary Shortage Without
Training More Physicians by Bodenheimer and. Smith
• Nurse-Managed Health Centers And Patient-Centered Medical Homes
Could Mitigate Expected Primary Care Physician Shortage by Auerbach, et.al.
• Physician Assistants And Nurse Practitioners Perform Effective Roles on
Teams Caring For Medicare Patients With Diabetes by Everett, et. al.
• Scope-Of-Practice Laws For Nurse Practitioners Limit Cost Savings That
Can Be Achieved In Retail Clinics by Spetz, et.al.
• Primary Care Technicians: A Solution To The Primary Care Workforce
Gap by Kellermann,et. al.
• It Is time to Restructure Health Professions Scope-Of-Practice
Regulations To Remove Barriers To Care by Dower, et.al.
8

10. Team for Comprehensive Care
Physicians
Nurse practitioners
Physician assistants
Psychologists
Optometrists
Registered Nurses
Pharmacists
Case Managers
Nutritionists/Dieticians
Physical Therapists
Community Health Workers
…And more

11. Recent HRSA Report:
“Projecting the Supply and Demand for Primary Care
Practitioners through 2020”
• Demand for primary care services will increase due largely to
population growth and aging
• Demand for PC physicians will grow more rapidly than supply resulting
in a projected shortage of approximately 20,400 FTE physicians
• The supply of primary care NPs and PAs, is projected to grow rapidly
and could mitigate the projected shortage of physicians if NPs and
PAs continue to be effectively integrated into the delivery system
• Assuming full deployment of available NPs and PAs, the projected
shortage of PC Practitioners in 2020 (6,400 FTEs) is very close to the
estimated shortage in 2010 (7,500 FTEs).
• The national numbers can mask regional and local shortages.

12. 7,261
6,979
6,611
6,526
6,900
7,583
8,014
8,865
9,698
11,135
12,273
14,310
16,031
5,500
7,500
9,500
11,500
13,500
15,500
17,500
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Source: American Association of Colleges of Nursing and National Organization of
Nurse Practitioner Faculties Annual Surveys
1Counts include master’s and post-master’s NP and NP/CNS graduates, and
Baccalaureate-to-DNP graduates.
Graduates
Growth in Nurse Practitioner Graduates
2001 - 2013

13. Physician Assistant Growth
Source: National Commission on Certification of Physician Assistants “Certified
Physician Assistant Population Trends ”; 2013 data from personal communication
with NCCPA January 2014
Newly Certified PAs, 2001 - 2013
NewlyLicensedPAs
4235
4009
4337
4512
4393
4654
4989
5215
5243
5823
5979
6479
6,607
3000
3500
4000
4500
5000
5500
6000
6500
7000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

14. Pharmacy School Graduation Trends
2000 - 2015
NumberofGraduates
* Graduation projection figure based on enrollment data
Data represent first professional degrees including B.S. Pharmacy, B.Pharm., and Pharm.D.1
Source: AACP 2012 Enrollment Data
7,260
7,000
7,573
7,488
8,158
8,268
9,040 9,812
10,500
10,988
11,487
11,931
12,719
13,335
14,213
14,930
4,000
6,000
8,000
10,000
12,000
14,000
16,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013* 2014* 2015*

15. Workforce Composition:
Growth of PAs/NPs Compared to Physicians
Source: Prepared by National Center for Health Workforce Analysis
Ratio of Types of Direct Patient Care Providers,
Supply and Production
82%
18%
In Practice in 2010
42%
58%
New Providers per Year
PAs/NPs
Physicians

16. What will the staffing of the Patient Centered Medical
Home look like*?
A. If no delegation: 1 physician for 983 patients =
315,000 PC physicians; Then significant shortage!
B. If significant delegation: 1 physician for 1,947 pts =
159,000 PC physicians; Then significant surplus!
But even with a national surplus, local shortages are likely !
The Importance of the Team in Assuring
Access to Primary Care Services
* “Estimating a Reasonable Patient Panel Size for Primary Care Physicians
with Team Based Delegation”, Altschuler, Margolis, Bodenheimer and
Grumbach; Annals of Family Medicine, Sept/Oct 2012

17. • Geographic and specialty mal-distribution is a serious
problem
• For many professions and many physician specialties,
the national supply may look adequate but there are
serious access problems for many people due to the
distribution of the supply
• Different strategies needed to address mal-distribution
compared to general shortages
• Targeted investments are needed
The Problem of Mal-distribution

18. • Demand is rising but it is usually for services not a
particular profession; there are multiple ways of
assuring access to care.
• Health systems transformation will drive changes in the
health workforce, including the mix and configuration of
the workforce, responsibilities and roles, and supply
and distribution.
• The increasing supply of non-physician clinicians and
other caregivers will facilitate delivery system change.
• While there are many unknowns related to the future
delivery system, we do know that more practitioners will
work in teams.
Closing Comments

19. Edward Salsberg
esalsberg@gwu.edu

20. Joel Allison
CEO, Baylor
Scott & White
Health
Dr. Nancy Dickey
Professor, Texas
A&M University;
President
Emeritus,
Texas A&M
Health Science
Center
Edward Salsberg
Professor,
George
Washington
University School
of Public Health
and Health
Services
THE CHANGING HEALTHCARE
WORKFORCE
#MHBreakfast

21. Modern Healthcare Leadership Breakfast
May 6, 2014
Dallas, TX
Nancy W Dickey, MD
President Emeritus, Texas A&M Health Science
Center
The Future of the
Healthcare Workforce

22. Factors impacting workforce:
1. “Baby Boomers” born between 1946 and 1964 will turn 65,
when health care utilization historically doubles.
2. Nation’s growing population
3. Growing burden of chronic diseases
4. Continued scientific progress and tech innovation
5. New health care payment models
6. Younger professionals desire a different lifestyle – life/work
balance
7. In the US, the supply of physicians and nurses is projected to
decrease (retirement, leaving the field)
a. We are producing more annually
b. The supply measure is numbers of professionals per
population) over the next 15 years
c. Productivity/hours worked per professional have decreased

23. 60
%
40
%
5 0
%
5 0
%
50
%
50
%
55
%
45
%
67
%
33
%
Canada France Singapore
Thailand Britain U.S.
Primary Care
Specialists
Primary Care/Specialty Mix

24. Current US System
Most
Highly
Specialized
Specialist
Generalist
Non-Physician Provider
Community Health
Worker
Patient Driven System Driven Professional Driven

25. Preferred System ?
Most
Highly
Specialized
Specialist
Generalist
Non-Physician Provider
Community Health
Worker
System Supported Professional Supported

26. What’s Next?
1. Several things exacerbating shortages in
the next decades
2. Takes a long time to expand the workforce
as it is currently composed
3. Solution may be to change the “needs” by
changing the make up of the workforce
4. More work as teams

27. Teams…Increased Efficiency, Everyone Working to
Their Full Potential
• Need to identify appropriate
ways to utilize a broader group of
care givers –
– Many requiring shorter/different
training periods
• Potential for changes of scopes of
practice
• Imperative that traditional
practitioners become more
collaborative, communicative

28. AAHC’s recommendation
• Solution is more complex than simply
increasing the numbers of providers
• Issues of:
– which specialties
–geographic distribution
–training to enhance work as
interdisciplinary teams
• Past due in preparing for future health
workforce
•

29. Without Planning…
• Currently we turn spigot off & on
• ACA included the establishment
of a National Health Care
Workforce Commission
• ACA also provided for state
health care workforce
development grants to address
shortages in each state

30. Going Forward…
Planning
Changes in training
Incentives to encourage efficiency
& quality

31. Joel Allison
CEO, Baylor
Scott & White
Health
Dr. Nancy Dickey
Professor, Texas
A&M University;
President
Emeritus,
Texas A&M
Health Science
Center
Edward Salsberg
Professor,
George
Washington
University School
of Public Health
and Health
Services
THE CHANGING HEALTHCARE
WORKFORCE
#MHBreakfast

32. Modern Healthcare
The Changing Healthcare Workforce
Tuesday, May 6, 2014
Joel T. Allison, FACHE
Chief Executive Officer

33. 32
Baylor Scott & White Health

34. Combined Assets
and Clinical Footprint/Access
33
• $8.6 billion in assets, based on most recent audited financial
statements
• $6.3 billion in total operating revenues
• Includes:
– 43 hospitals
– 500+ patient care sites
– 6,000+ affiliated physicians
– 36,000 employees
– Scott & White Health Plan
• Provided more than $850 million in community benefit FY13

35. Population Health
• Managing population health is critical to the
future of Baylor Scott & White Health.
• Not enough primary care physicians; only 20%
of all physicians in US
• Need to focus on growing, recruiting and
retaining PCPs
• Specialists may need to become medical
homes for some patients.
34

36. Quality Alliance
Focused on patient-centered clinical integration across all points of care
Entry Point Redesign:
Primary Care strength, PCP PCMH;
physician-designed best care and quality
improvement processes, access &
capacity challenge.
Care Integration/Specialty Alignment:
Standardized order sets, clinical
protocols, care redesign. Large scale
physician partnering, EHR adoption, and
connectivity via HIE challenges.
Population Health Infrastructure:
Predictive analytics, comparative
effectiveness, care coordination and
population health management.
Financing: New innovative payment
models, product & benefit redesign, data
repository and control.
Entry Point
Redesign
CI/ Specialty
Alignment
Population
Health
Infrastructure
Financing
Intended consequences: Quality
Improvement, patient satisfaction and
cost reduction – otherwise unachievable

37. Staffing the Population Health
Model
36

38. PCMH of the Future
• Typical physician practice will include:
– Physician
– Nurse practitioner
– Three medical assistants
– Care coordinator
– Receptionist
• Will be taking care of 4,000 patients instead of 2,200
37

39. Outpatient Growth
• Moving from hospital-focused world to an outpatient clinic world
– More folks will be needed to keep you out of the hospital as opposed to in it.
– New jobs created in outpatient medical labs and diagnostic imaging centers; i.e., lab techs,
sonographers, etc.
38

40. More Mid-levels
• Care coordinators (more elaborate care
coordination needed)
– R.N. w/several years clinical experience
• Good communication skills
• Broad knowledge
• Comfortable working in different environments, i.e., in
person, telephonic, etc.
39

41. • #9: Occupational therapist
• #10: Speech pathologist
• #11: Dietitians
• #14: Optometrist
• #15: Physical therapist
• #17: Medical lab technician
• #23: Medical records technician
• #24: Medical
technologist
• #29: Podiatrist
• #31: Physiologist
• #33: Pharmacist
• #34: Chiropractor
• #39: Optician
40
Top Healthcare Jobs
CareerCast’s Annual Report of Top 40 Jobs in America includes
the following thirteen healthcare jobs:
No health careers ranked among the 20 worst
careers.

42. High-demand Healthcare Jobs
Projected growth, 2012-20
Total
27% Healthcare social workers
19% RNs
11% All occupations
Ambulatory care jobs
52% Social workers
41% RNs
Acute-care hospitals
15% RNs
14% Social workers
Home health
52% Social
workers
43% RNs
Source: US Bureau of Labor Statistics Occupational Handbook
Modern Healthcare Magazine, March 31, 2014

43. Transformation of Top Administrative Healthcare Positions
• Addition of executive roles that previously did
not exist
– Chief medical information officer
– Chief population officer
– Chief population health officer
– Chief patient experience officer
42

44. Technology
• Surge in demand for technology experts to install,
upgrade and maintain IT infrastructure
– Population-centric data
– Need better ways to take care of the population
through technology – especially for younger patients
• Growing number of hospitals could not hire IT
workers fast enough to meet demand in 2012, with
67% of surveyed hospitals reporting a shortage.*
43
*College of Healthcare Information Mgmt Executives

45. Big Data
• Analytics
– Rising demand for workers
who can understand and
manipulate data
– Companies paying richly for
those with quantitative
skills
44

46. Triple Aim
Big data
Data analytics & predictive modeling
Social/community support
Transportation/housing
Priority setting
“The Mediterranean Diet”
Delivery redesign
Scope of practice
Lowest cost site of care
Telehealth
Digital substitution
Self-care
Palliative care
Transparency
CQI/Lean
Shared decision-making
Standardization
Clinical guidelines and
Care paths
Triple Aim
Information
Incentives
Integration
Integrity
Better Health
Better Health Care Lower Per Capita
Costs

47. Nate Kaufman, Kaufman Strategic Advisors, LLC
The New Winners:
46
•Well-capitalized health systems with high
functioning, data driven, digitally connected,
physician-lead TEAMS delivering evidence-
based, patient-centered health care
•Able to treat higher volumes of patients
•At lower predictable costs per episode
•Demonstrating consistent measurable high
quality

48. Questions/Discussion
47

49. Joel Allison
CEO, Baylor
Scott & White
Health
Dr. Nancy Dickey
Professor, Texas
A&M University;
President
Emeritus,
Texas A&M
Health Science
Center
Edward Salsberg
Professor,
George
Washington
University School
of Public Health
and Health
Services
THE CHANGING HEALTHCARE
WORKFORCE
#MHBreakfast