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July 15, 2002
The Health Resources and Services Administration appreciates this opportunity to testify before the Senate Health, Education, Labor and Pensions Committee on health professions workforce shortages.
Legislation authorizes HRSA to work to ensure that an adequate health care workforce is available to meet the health care needs of all Americans--regardless of their location or income. HRSA does this through a variety of programs such as: Titles VII and VIII of the Public Health Service Act which created programs that fund the training of health professionals, including nurses; and the National Health Service Corps (NHSC) which provides scholarships and loan repayment for individuals willing to work in underserved areas (similar to the Nursing Education Loan Repayment Program under Title VIII). Additionally, HRSA's National Center for Health Workforce Analysis, also under Title VII, provides data and analysis on workforce needs which is essential for identifying shortages and to advise planners and policymakers.
I would like to review for the Committee two recent in-depth studies produced by HRSA's National Center for Health Workforce Analysis which provide detailed information on workforce needs in two key areas of health professions whose services are well known to Americans on a daily basis.
The first, "Projected Supply and Demand and Shortages of Registered Nurses: 2000-2020" examines data on the most commonly recognized health care shortage, that for registered nurses. Registered nurses make up about a fifth of all health care professionals and serve across the spectrum of medical specialities and services. Current data indicate that the demand for registered nurses is expected to grow by 40% between 2000 and 2020. In contrast to this growth in need, the current projection for growth of this workforce during this same period is only 6 percent. Two facts underlie this deficit: the registered nurse workforce is an aging population with more and more registered nurses approaching retirement age, while at the same time the number of entrants to that workforce is declining. Since 1995, the number of registered nurse graduates has declined by 31 percent nationally according to the National Council of State Boards of Nursing.
"Projected Supply and Demand and Shortages of Registered Nurses: 2000-2020" estimates a 6% national shortage of registered nurses in 2000. By 2010, it projects the shortage at 12% and by 2015, twenty percent. If current trends continue, there will be a 29% shortage by 2020.
In 2000, thirty States and the District of Columbia were estimated by the National Workforce report to be experiencing shortages of registered nurses (shortages defined as shortages greater than 3 percent). By 2020, the number of States with shortages is projected to grow to 44. The national media recently widely reported a study which indicated that adequate ratios of registered nurses are a key to favorable patient outcomes, as reports from around the nation increasingly highlight the inability of medical facilities to adequately staff registered nurse positions.
Rhode Island statistics substantiate this national trend. Although the 2000 National Sample Survey from HRSA's Division of Nursing showed that Rhode Island had 1,101 registered nurses per 100,000 population in 2000-- significantly above the national average of 782 nurses per 100,000, it too is being affected by national trends. "Projected Supply and Demand and Shortages of Registered Nurses 2000-2020" estimated a 10% shortage in registered nurses in Rhode Island in 2000, a 16% shortage in 2005, a 26% shortage in 2010, a 38% shortage by 2015, and a 48% shortage by 2020.
In a national context, the report indicates that Rhode Island was one of 14 States in 2000 having a double-digit shortage in registered nurses, with most shortages in the 10 to12 percent range. By 2020, report data estimate that Rhode Island will have the eighth highest shortage among States, with 13 States having shortages of 40% or higher.
In response to the critical shortage in nursing and its effects on our entire health care system, under this Administration, funding for the Nursing Education Loan Repayment Program has increased four-fold--from $2.3 million to $7.3 million for fiscal year 2001 and to $10.3 million in fiscal year 2002. The President's fiscal year 2003 budget request is $15 million, another 50% increase. This program is one of the most expeditious means of targeting nurses to underserved areas, with nurses who already have degrees agreeing to serve a minimum of two years in a designated health shortage area in exchange for assistance with their educational loans.
The second National Center recently completed report "The Pharmacist Workforce: A Study of the Supply and Demand for Pharmacists" is an in-depth workforce study of pharmacists. The study details factors beyond population growth that are driving the demand this workforce area. Some of these factors include:
Rhode Island is fortunate, according to HRSA State Health Workforce Profiles in that it had 95.2 pharmacists and 107.3 pharmacy technicians and aides per 100,000 population in 1998, ranking Rhode Island first and second respectively among the 50 States in these areas.
However, Rhode Island too is being affected by data reported by the National Center Report on pharmacists showing that nationally the number of vacancies for pharmacists has doubled in the last two years. In 2000, "The Pharmacist Workforce" estimated that the United States needed 14% more pharmacists; by 2005, the estimated need will be 35% more. Report data indicate a decline in the late 1990s in the number pharmacy graduates, with a corresponding decline in the number of applications to pharmacy schools–the latter were 33% lower in 1999 than in 1994, the high point over the past decade.
The shortage of pharmacists, like that of registered nurses, crosses the entire spectrum of health care facilities including the federal service. Pharmacist vacancy rates in the Public Health Service are 11%; in the armed forced, 15 to 18%; and the Department of Veterans Affairs and Native American health centers have some facilities with less than half of their pharmacist positions filled. according to "The Pharmacist Workforce."
To ensure an adequate workforce, however, it is essential to realize that millions of Americans face barriers to quality health care because of the maldistribution of the health care workforce. Distribution of health care personnel is as important as the overall total of the workforce. In terms of health care, rural areas, inner city areas, and certain populations of Americans–most notably certain racial and ethnic populations–are underserved.
Statistics from HRSA's Shortage Designation Branch report that some 56 million people live in more than 3,100 health professional shortage areas; 33 million Americans are underserved, most of them in predominantly rural counties. To alleviate these gaps in access to basic health care, data estimate that an additional 15,000 primary care physicians would be required to fill this need. This is the equivalent of virtually an entire annual graduating class from US medical schools according to figures of the Association of American Medical Colleges..
In 2001, the National Health Service Corps, which has about 2,400 clinicians serving nationwide, received more than 3,800 requests from underserved areas for assistance in recruiting NHSC clinicians to provide basic health care.
The President has made increasing health care services for the underserved a priority of his Administration. Health centers are a primary source of health services for the underserved. The President's Initiative for Health Centers plans a multi-year expansion to increase the number of Health Center access points by 1200 and increase the number of patients served by 6.1 million.
Recognizing the key role of the HRSA's National Health Service Corps, the President has requested an increase of over $44 million for FY2003 for the NHSC. As the budget notes, the NHSC has been a significant source of staffing support for the Health Center program, with 46% of the NHSC clinicians currently serving in Health Centers. In many cases, the NHSC is the only source of clinicians to care for racially and ethnically diverse communities that lack access to services and experience increased health disparities.
This increase of $44 million for the NHSC program will support an additional 131 scholars who will be available for future service, an additional 454 NHSC Loan Repayment recipients who agree to serve in underserved areas in exchange for assistance with their educational training loans, and an additional 144 mental and behavioral health NHSC Loan Repayment professionals. These will provide needed services in underserved communities and help staff the growing Health Centers program.
The two HRSA reports I discussed on registered nurses and pharmacists as well as a major HRSA report issued last December of state-by-state profiles of the nation's health workforce are available from HRSA, and further information regarding these and other reports is available at the HRSA website at www.hrsa.gov. The state by state profiles are the first such compre- hensive detailed data on the supply and demand for physicians, nurses, dentists, and 20 other health care professionals in all fifty states and the District of Columbia.
Again, I thank you for HRSA's opportunity to testify regarding this important subject and willbe happy to answer any questions you might have.
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Last revised: October 16, 2002