Kansas Health Institute | Information For Policy Makers. Health for Kansans.

TOPEKA — There is broad agreement among medical educators and others that Kansas faces a shortage of health care providers that could reach disastrous proportions in the next 10 years.

But putting exact numbers to the problem and figuring out how many new health professionals it will take to solve it is proving difficult for legislators, state universities that train workers and others.

In an effort to figure out how many current providers there are and how those numbers might change, the Kansas Health Policy Authority has assembled a group that includes representatives of the health licensing boards, and hospital and physician organizations.

“This question (of workforce) never goes away and we’re anxious to be able to answer it,” said Andy Allison, who heads up the health policy authority. “We want to know, specifically, where the greatest needs are.”

Filling the gaps

The Health Professions Workforce Data Workgroup’s first task was to figure out what information is currently collected by the various groups involved. From there, the group was able to identify what information was not being collected that would be helpful in getting an accurate picture of the state’s health workforce.

The state’s licensing boards collect demographic data about their workers, including age, gender, and location of practice. But they usually don’t collect other specifics that are needed to determine workforce needs more accurately. For example, they don’t record if the workers are full-time or part-time, work in a large office or small, or if they practice in a main location or a satellite branch.

“It’s very important to know in a state as rural and large as Kansas where those physicians and dentists are working and how much they are working,” Allison said. “That helps us assess whether there’s a need in a particular area and how big that need is. Just knowing a physician is licensed is not enough.”

And knowing how the physicians are organized becomes an issue for the health policy authority as it considers measures for improving quality of care across the state.

“To what extent does a physician provide care, compared to advanced nurse practitioners or physicians’ assistants? How do those providers work together? How large are their clinics? How many physicians work in solo practices, and how many are working in larger practices?

“It’s not just making sure there are enough providers in the right places. One of the biggest questions is how to organize care to improve its quality,” he said. “We need to know the answers to all of these things to design better policies, better payments to the programs we run.”

The health policy authority oversees Medicaid and the Children’s Health Insurance Program. It also manages the state employee health plan.

The workgroup has been meeting since late last year and is scheduled to provide by March recommendations to the health policy authority for a new data collection process.

One possible avenue for collecting workforce data is through a Web-based survey hosted by the health policy authority.

Many health care workers now renew their licenses online and there also has been some discussion of adding more questions to those online forms.

But modifying the software is expensive, said Mary Blubaugh, executive administrator of the Kansas Board of Nursing and a member of the data workgroup.

“It would be a cost to us if we had to develop the questions and transmit the information to the health policy authority,” she said. “And if we did put the questions in the software and so did the Board of Healing Arts and the Dental Board and the Board of Pharmacy, every time we needed to make a change it would be a charge for all of us.”

Instead, the group has discussed providing an online link to a single survey when health care workers complete their licensing forms.

“Last month, 88 percent of our nurses renewed their licenses online,” Blubaugh said. “If we had a link to shoot them into the survey that would be an easy way to get the information to the health policy authority that they need.”

The nursing board used to mail surveys to nurses with their license renewal paperwork. But in order to cut costs, the board quit sending renewal applications altogether.

“There’s really no other way for us to get that information out there,” Blubaugh said. “With finances the way they are and the money from the fee-funded agencies that was cut and moved to the state general fund, we’re trying to save money everywhere.”

Could be doing more

The Kansas Department of Health and Environment’s Primary Care Office also has struggled to get an accurate account of the state’s medical workforce.

The office, among other things, has been tasked by the federal government to formally designate cities and counties that are medically underserved.

Those areas are eligible for state and federal workforce incentives such as the National Health Service Corps and state loan repayment programs that pay student loans in exchange for service in underserved areas. The areas also are eligible for other federal grants that aid rural health clinics and Federally Qualified Health Clinics that provide safety net services.

Determining those designations is time and labor intensive, said Robert Stiles, the office’s director. But the federal government soon will require information on mid-level providers such as nurse practitioners and physicians’ assistants that will be even harder to collect.

“The (new) process will need information for more professions,” he said. “The system we have now does not allow us to collect that data.”

Even without the upcoming changes, he said, the office struggles to collect the required information.

“In Johnson County, the Kansas Association for the Medically Underserved, the local medical society and others are trying to collect data to see if there are areas of the county that are underserved and don’t have access to care,” he said. “Due to the number of doctors in the community, it would be an overwhelming task for us to survey that large number personally.

“There’s also a sense and a concern across the state about whether we have enough pharmacists and nurses in areas where they’re needed. We don’t have that kind of data about where they’re practicing and where they are needed. That work could also be done if we had a more complete set of data.”

Hard to tell need

The authors of a 2007 University of Kansas School of Medicine report on the state’s physician workforce said they also struggled with a lack of data in writing their report.

Dr. Michael Kennedy, associate dean and professor for rural health education, said it was immediately clear that the data currently collected on physicians was “imprecise and not totally clean” because the process relies entirely on a physician’s self assessment of where and how they spend their working hours.

“We found that you could have a surgeon who did surgery most of the time but primary care maybe 25 percent of the time,” he said. “But they could be doing that primary care in an adjacent county.

Given the lack of precise information it is particularly hard to forecast the state’s future workforce needs or for the state’s medical programs to adapt to meet those needs, he said.

“The (physician’s) licensure survey also had questions like ‘do you plan to retire?’” he said. “People can plan to retire for years before they actually do it. Those are pretty imprecise.”

The KU physicians report and a recent report on the state’s oral health workforce are helpful but limited in tracking the state’s needs over time, Stiles said.

“Those reports are snapshots in time when people have resources to commit to it,” he said. “You get a great picture at that point, but a year from now, we won’t know if that’s changed or how that’s changed. It would be nice if we had a continuing data collection so we could, at any point, look at the data to see what’s going on.”