You asked for information on healthcare workforce shortages in Connecticut.

SUMMARY

Well-documented healthcare workforce shortages have existed in Connecticut for a number of years according to the Department of Public Health (DPH; see “Toward Solving Connecticut's Health Care Workforce Shortages,” DPH, May 2002). While such shortages are not new to the state, DPH notes that the nature of shortages varies by discipline. In the past, nursing shortages have been cyclical. For other disciplines, current shortages have developed through a gradual process as the increase in supply does not meet the increase in demand.

Demand for health care services is steadily increasing due to an aging population and advances in medical technology. Also, the health care provider population itself is aging. Other career opportunities now compete with health care professions.

Training programs in a number of healthcare disciplines are achieving full enrollment (e.g., pharmacy, nursing), while others (respiratory therapy, radiation technology) are not. All health professional training programs are experiencing a significant rise in the student attrition rate, according to DPH. This is attributed to lack of academic preparation, competing demands of job and family responsibilities, and finances.

Connecticut is expected to have the second greatest decline nationally in the supply of nurses over the next few years and needs to expand nursing education and training programs.

CONNECTICUT AND NATIONAL DATA ON THE HEALTHCARE WORKFORCE

All of the information that follows in this section derives from statehealthfacts.org of the Kaiser Family Foundation.

Physicians

In 2004, there were over 820,000 nonfederal physicians in the United States. Of these, 12,918 were in Connecticut. The rate of physicians per 100,000 population in the state was 369 as compared to the U.S. average of 281, ranking Connecticut fifth nationally among the states and U.S. territories. Connecticut's physician population was roughly 70% male, 30% female. Of the total state physician population, 56% were white, 9% Asian, 2% black, 2% Hispanic, and 2% Native American.

In Connecticut, 38% of its total physicians were classified as primary care physicians ranking it 45^th among the states. The national average was 40%. The state's primary care physicians can be further classified as (1) internal medicine-52% (37% national average), (2) family practice-12% (29%), (3) pediatrics-19% (18%), (4) obstetrics/gynecology-5% (12%), and (5) general practice-1% (5%).

The following tables provide more information on all 50 states and national averages in various physician categories.

Table 1 Number of Nonfederal Physicians, 2004

Notes: U.S. total includes territories.

Nonfederal physicians are not employed by the federal government and include medical doctors and osteopaths. They represent 98% of total physicians.

Table 2: Rate of Nonfederal Physicians

per 100,000 Population, 2004

Notes: U.S. total includes territories.

Nonfederal physicians are not employed by the federal government and include medical doctors and osteopaths. They represent 98% of total physicians.

Table 3: Nonfederal Primary Care Physicians as a Percent of Total Physicians, 2004

Notes: Nonfederal physicians are not employed by the federal government and include medical doctors and osteopaths. They represent 98% of total physicians.

Definitions: Primary care physician specialties include Internal Medicine, Family Practice, Pediatrics, Obstetrics/Gynecology, and General Practice.

Table 4: Distribution of Nonfederal Primary Care Physicians

by Field, 2004

Notes: U.S. totals include territories.

Nonfederal physicians are not employed by the federal government and include medical doctors and osteopaths. They represent 98% of total physicians.

The total number of Primary Care Physicians includes Primary Care Subs and Other Specialities.

Nurses

Connecticut had 34,120 registered nurses (RNs) as of May 2005, ranking it 24^th nationally. In terms of RNs per 100,000 population, Connecticut was above the national average (972 vs. 799), ranking it ninth. The following two tables provide more information.

Table 5: Total Registered Nurses, as of May 2005

Notes: The U.S. total includes the territories. Estimates for detailed occupations do not sum to the totals due to rounding. Estimates do not include self-employed workers.

Definitions: Registered Nurses include advance practice nurses such as nurse practitioners, clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists.

Table 6: Registered Nurses per 100,000 Population, as of May 2005

Notes: The number of Registered Nurses per one hundred thousand population was calculated using the population estimates provided by the U.S. Census Bureau as of July 1, 2005.

Estimates for detailed occupations do not sum to the totals due to rounding. Estimates do not include self-employed workers.

Definitions: Registered Nurses include advance practice nurses such as nurse practitioners, clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists.

Physician Assistants

The projected number of physician assistants in Connecticut as of January 2005 was 1,066 or 30 per 100,000 population. The national average was 19 per 100,000.

Table 7: Projected Number of Physician Assistants in Clinical Practice, as of January 2005

Notes: U.S. total is the sum of data from the 50 states and the District of Columbia, and includes an additional 1,396 PAs who work or reside outside of the U.S., or whose locations are unknown.

Definitions: Physician Assistants must have graduated from an accredited educational program.

Table 8: Projected Number of Physician Assistants per 100,000 Population in Clinical Practice, as of January 2005

Notes: The number of Physician Assistants per ten thousand population was calculated using the population estimates provided by the U.S. Census Bureau as of July 1, 2005.

Definitions: Physician Assistants must have graduated from an accredited educational program.

Dentists

Connecticut had a total of 2,653 dentists in 2004, ranking it 23^rd among the states. Of that total, 14 were engaged in “dental public health,” defined as the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. There were 1,990 general practice dentists and 94 pedodontics, a dental specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

Table 9: Number of Dentists, 2004

Notes: US total does not include the territories.

Definitions: Dentistry: The evaluation, diagnosis, prevention and/or treatment (nonsurgical, surgical or related procedures) of diseases, disorders and/or conditions of the oral cavity, maxillofacial area and/or the adjacent and associated structures and their impact on the human body.

Table 10: Number of Dentists by Specialty Field

in Connecticut, 2004

Notes: US total does not include the territories.

Federally Qualified Health Centers (FQHCs)

Based on 2004 data, Connecticut had ten FQHCs, with 94 actual service delivery sites. These FQHCs served 182, 683 patients in 2004, with 802,642 total encounters or visits in the state. The various revenue sources for Connecticut's FQHCs in 2004 were (1) federal grants (19.7%), (2) state and local grants/contracts (12.8%), (3) foundation grants/private contracts (2.7%), (4) Medicaid (44.9%), (5) Medicare (5%), (6) other public insurance (5%), (7) private insurance (4.5%), (8) patient self-pay (3.4%), and (9) other revenue (2%). The table below indicates the number of service delivery sites operated by FQHCs in all states.

Table 11: Service Delivery Sites Operated by FQHCs,

2004

Notes: Data are for calendar year 2004.

The federally-funded Federally-Qualified Health Centers (FQHCs) meet federal health center grant requirements and are required to report administrative, clinical and other information to the federal Bureau of Primary Health Care. Other health centers known as "FQHC Look-Alikes" are not included here because they do not receive federal health center grants and do not report to the Bureau of Primary Health Care. The data provided here consequently underreport the services provided by FQHCs. There are approximately 100 FQHC Look-Alikes across the United States.

HEALTHCARE WORKFORCE TRENDS AND SHORTAGES

Allied Health Workforce

PA 04-220 established a Connecticut Allied Health Workforce Policy Board. Some of its responsibilities include monitoring (1) the state's current and future supply and demand for allied health professionals and (2) the current and future capacity of the state system of higher education to educate and train students in allied health professions.

The act states that “allied health workforce” and “allied health professionals” means professionals or paraprofessionals who are qualified by special training, education, skills and experience in providing health care, treatment, and diagnostic services under the supervision of or in collaboration with a licensed practitioner. It includes physician assistants, RNs, licensed practical nurses (LPNs), certified nurse assistants, home health aides, radiological technologists and technicians, medical therapists, and other qualified technologists and technicians.

According to the board's February 2006 Legislative Report (attached), data from the Connecticut Department of Labor (DOL) estimates that the total employment levels for health-related occupations, including physicians and dentists, was 141,110 for 2002. The employment level for 2012 is expected to be over 162,000, a 15.3% increase for the ten year period. The allied health occupation with the highest employment level in 2002 was RNs with over 31,000 jobs, and to a projected 15% increase (to over 36,000 jobs) for 2012. Nurse aides, orderlies, and attendants totaled almost 24,000 jobs in 2002, with a projected number of 26, 140 (8% increase) for 2012. (More detail on the nursing situation is provided in the next section.)

The fastest growing occupation in the health care field is medical assistants with 4,660 jobs in 2002 and 6,830 by 2012, a 46.4% increase over the ten years, according to the report. Radiation therapists show a 39.6% increase in need in the same ten-year span, while physician assistant openings are projected to increase by 38.1%. Other occupations show significant projected increases in openings during this ten year period: Occupational therapists (19%), physical therapy assistants (26%), cardiovascular technologists and technicians (26.6%), pharmacy technicians (20.8%), surgical technologists (18.2%), and medical records and health information technicians (31.3%).

A 2004 vacancy survey done by DOL of over 3,000 employers found that there were 1,677 vacancies in RN positions, 387 in dental hygienist positions, 305 LPNs , 114 physical therapists, and 73 occupational therapists. In the health support area, 476 vacancies were reported for nurse aides, orderlies, and attendants, and 402 among medical assistants.

A vacancy rate survey developed by the Connecticut Hospital Association also shows trends in the need for allied health workers. Although the 2005 vacancy rate of 4.7% for operating room and surgical nurses is not considered high, this nursing field has more mature nurses who are nearing retirement. Vacancy data provided by the Connecticut Association of Health Care Facilities indicate that at the end of June 2002, among the 242 health care facilities statewide, there was approximately an 18% vacancy rate for RNs, 16% for LPNs, and 6.2% for certified nurse aides (CNAs, which equates to about 742 open positions). There is also high turnover across the state with RNs at 43%, LPNs 35% and CNAs 50%.

Nursing

The U.S. Department of Labor predicts that the demand for RNs will increase by 623,000 positions nationwide, a 27% increase from 2002. Also, the demand for LPNs will increase by 142,000 positions, a 20% increase. Over a 20- year period, (2000-2020), total national demand is expected to reach over 1 million positions for RNs and 295,000 for LPNs, according to the National League for Nursing.

Connecticut is projected to have the second greatest decline in the supply of nurses nationally over the 20 year period, according to the federal Health Resources and Services Administration (HRSA). The Connecticut DOL projects the state needs to average 1,200 new RNs each year through 2012 to fill expected job openings. The following table provides more information on the demand for nurses in Connecticut.

Table 12: Connecticut Supply and Demand for Nurses, 2000-2020

Source: HRSA Registered Nurse, Demand and Shortage Projections for Connecticut, 2004, as reported in “Enhancing the Education and Supply of Nurses in Connecticut,” sponsored by the Connecticut League of Nursing (“CLN Report”) October 2005.

According to the CLN report, Connecticut nursing schools have far more qualified applicants than they can admit. This holds for both RNs and LPNs.

Table 13: Applicants and Available Slots for Connecticut RN Programs

Table 14: Applicants and Available Slots for Connecticut LPN Programs

The CLN report finds that there is a continuing need for nursing program expansion in the state. But a lack of nursing faculty is a significant barrier affecting program expansion. CLN also reported that 90% of nurse educators believed additional training sites for students (patient care delivery sites) were needed in all practice areas.

(The full CLN report is attached.)

HEALTH PROFESSIONAL SHORTAGE AREAS (HPSA)

HPSAs are a type of federal designation designed to focus resources (federal and otherwise) to meet identified local needs for certain health care providers. One federal program using HPSA designations is the National Health Service Corps which recruits and places physicians in needy communities.

HPSAs have shortages of primary medical care, dental, or mental health providers and may be geographic (a county or service area), demographic (low income population), or institutional (comprehensive health care center, FQHC, or other public facility). As of September 2005, Connecticut had 92 such designations representing all or part of the 36 towns in each of the state's counties (see http://www.dph.state.ct.us/PB/HISR/HPSA.htm).

LOAN REPAYMENT PROGRAMS

Connecticut has a loan repayment program for certain health care providers known as the “Connecticut State Loan Repayment Program (CSLRP). It is a state-federal partnership that assists states in addressing health professional shortages that cause disparities in access to health care (see CGS § 19a-7d, as amended by PA 06-195, § 84).

CSLRP is a DPH initiative to strengthen the health care workforce at the primary care level. It provides financial incentives in the form of student loan repayment to health professionals employed by health care organizations belonging to the state's healthcare safety network (community health centers and other eligible primary care sites in the state).

(See http://www.dph.state.ct.us/BCH/Family%20 Health/SLRP/slrp_home.htm for more information on the program.)

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