Healthcare Workforce Planning Techniques Lagging

Projecting future healthcare workforce demand is a backward-looking process that doesn't account for new technologies and other changes that greatly impact labor forecasts, according to a study from the Bipartisan Policy Center's Health Professional Workforce Initiative.

"We use a rear-view mirror. We always use lag indicators," says Paul Keckley, executive director of The Deloitte Center for Health Solutions, and the author a new study The Complexities of National Health Care Workforce Planning.

"It's a pretty simple formula. You take population growth times aging times prevalence of disease. How may are diabetic? How many have heart disease? Then we figure based on history that we need 2.2 visits per primary care doctor per year per capita. Then we add those up and come up to a shortage of 28,000 to 91,000 doctors."

New and immediate technologies that could greatly reduce in-person visits to the doctors' offices are not factored into this equation. "That assumes that all of those 2.2 visits were necessary and there were no other options that were either more attractive or affordable to consumers, like an e-visit," Keckley says.

"About 40% of visits to primary care physicians do not require physical examinations. You don't need to go to a doctor's office to get a script refilled, so we shouldn't be calculating the number of visits to doctors historically as the basis for determining how many we are going to need in the future when we have technologies that will replace some of that demand," he explains.

Improving healthcare workforce planning and development is a critical component of the Accountable Care Act, and Keckley says it's needed because labor costs are a huge driver of healthcare inflation.

One out of three respondents in the HealthLeaders Industry 2011 Survey cited labor costs as the top driver healthcare costs.

"The simple reason is that with 60% of the healthcare spend on payroll, compensation, labor costs, and with healthcare growing at 6% a year, you have to find better ways of reducing costs and the single biggest factor in healthcare is labor," he says.

"We have to find different ways to organized and train the workforce. We have to leverage technology to do things that technology does that today people might be doing. We have to recognize that the system, its incentives, its regulatory framework, the information we now have tells us there are better ways of doing things than having people show up in doctors' offices or have tests or procedures. The future is not a repeat of the past."

While identifying the problem may be relatively easy, Keckley says that fixing it could prove nettlesome. "Each profession has developed over the years its own methodology for determining supply and calculating demand," he explains. "Unfortunately those are not consistent across the professions. So we are finding it challenging to arrive at a common methodology for calculating demand."

Keckley adds that one of the biggest roadblocks toward determining healthcare workforce supply and demand may be the physicians themselves. He notes the dust up that ensued earlier this month after studies suggested that many prostate cancer screenings were not cost effective. "We have to get down to what is evidence-based and we need to build demand based on the evidence of what works instead of on what doctors say the evidence says. That is huge. That is a big deal," he says.

Organizations such as the Association of American Medical Colleges are already on board with the idea of healthcare workforce planning by exploring new concepts like team-based healthcare delivery and the use of technology and hard data. "Academic medicine seems to be already aligning its training programs with this new normal," Keckley says.

For any sort of workforce coordination and development to take hold, Keckley says, they will need the input and support of major medical trade groups. In addition, he says, any workforce development guidelines that develop should not be presented to healthcare providers as government mandates. "It has to become a set of tools, rather than rules. You can't regulate a workforce. You have to create tools so that market migrates to that model," he says.

He says that may prove to be a tough sell for many practicing physicians. "This is not being accepted quite as well is in Anytown, USA, where every one of these guilds likes to make its own rules and have no one else be a part of that discussion," he says. "How many doctors do you need on the staff at Anytown USA Community Hospital? Well, the medical staff wants to vote on that. They don't want to base that decision on input from anyone but the medical staff. So, if the government was to set out standards for the right demand of the workforce in your market and it was inconsistent with what a group of doctors said they wanted you'll have tension."