The Challenge for Allied Health Care
The Campaign for College Opportunity did a great briefing on its recently released report titled Closing the Health Workforce Gap in California: The Education Imperative.
You’re well aware of the nursing crisis in California, and what California Community Colleges have been doing to try to address the nursing shortage. One of the three major recommendations of the Campaign’s report was that we must sustain the focus and energy on nursing. One of the invitees to the briefing cited a Board of Registered Nursing study indicating that California has had a 72% increase in the number of RN graduates since 2002, and that, if we continue on the current trajectory, by 2022 California will meet the national average in RNs. That’s good news, unless you think about how long it will take us merely to reach average! But most of the recent nursing growth has been the result of time-limited grants, and the challenge we’ll face going forward is sustaining the improved numbers.
The Study
The primary focus of the Campaign’s study was on the allied health workforce, which is said to encompass more than 200 occupations, or 60% of healthcare occupations. (Nursing is typically not considered to be part of the allied health workforce, but was included in the study.) The study looked at 15 health care occupations, and found projected workforce shortages in nine of the 12 professions for which data was available; the estimated annual shortages ranged from 11% to 559%. Of the occupations studied that require an AA degree or certificate, the estimated growth in graduates needed to meet the current demand reflects:
· 119% for Pharmacy Technicians (which requires a certificate)
· 72% for Cardiovascular Technologists and Technicians
· 122% for Dental Hygienists
· 60% for Diagnostic Medical Sonographers
· 178% for Physical Therapist Assistants
· 51% for Registered Nurses
Conversely, Medical Radiographers and Respiratory Therapists are experiencing no current shortage in the number of graduates needed to meet demand.
Although there are many factors affecting the supply of allied health workers (i.e., an aging population’s increasing demand for services, an aging workforce that is retiring, reduced migration into California, etc.), the report identified the educational systems that train health professionals as the greatest limiting factor. The California Community Colleges must take note, because health care is the number one sector, among all industries, requiring an AA degree; California Community Colleges will have to step up as they’ve done so successfully in recent years for nursing.
The study cited a number of problems on the educational front, including educational capacity in allied health programs. The programs are expensive to provide, and it’s difficult to hire faculty who can generally earn more by working in the field. Moreover, a lack of clinical placements limits capacity. The report also cited other barriers, such as “a lack of bridges between academic health programs,” causing some students to be waitlisted though there are seats in other programs; lack of systemwide agreement on prerequisites and curriculum, etc. Attrition and the nursing lottery or “first come first serve” system, with its inadequate focus on improving the preparation of incoming students, was cited as well.
These issues may improve somewhat with this year’s enactment and future implementation of AB 1559 (Chapter 712/2007), which permits RN programs to use a multi-criteria admissions process, and SB 139 (Chapter 522/2007), which requires creation of a Health Care Workforce Clearinghouse. However, the problem is more fundamental, with most students coming to community college unprepared for college level work. Some of the other factors cited—the lack of student supports leading to poor student outcomes—are costly, and will be difficult to address in the context of the now projected $14 billion State Budget deficit. The lack of “robust allied health workforce data,” which was also cited as limiting workforce planning and policymaking may also improve with implementation of the Health Care Workforce Clearinghouse.
Another factor limiting supply is the lack of awareness of certain health care careers. There’s a website, cited below, that contains basic information about which colleges offer some of the allied health occupations, but making students aware of the possibilities is a problem. It’s generally too late to wait until a student has started community college. The outreach should occur in middle school or high school.
Recommendations
The report made numerous policy recommendations. Some of the recommendations, such as expanding educational capacity through dedicated funding, will be difficult to implement given the state’s fiscal situation. But there are some areas that can be addressed in a shorter time frame. The report suggests improving communication between campuses, and encourages partnerships between schools and employers to both increase the supply of clinical faculty and to create a pipeline for local employers. Though funding and personnel are always difficult when it comes to outreach, the recommendation for improving public awareness of what’s required to prepare for allied health professions could be incorporated into existing outreach programs.
The report also suggests promoting career ladder programs for existing health workers. This is something many community colleges already do by admitting certified nursing assistants or licensed vocational nurses to their RN programs, for example, but partnering with employers to make their employees aware of potential career ladder paths within your district would be helpful.
The report makes a couple of other recommendations for educational providers that are important. First, they suggest reevaluating the distribution of full-time and part-time faculty, and utilizing part-time faculty for health programs where recruitment of full-time permanent faculty may prove difficult. We know this is an issue for nursing, and it’s probably an issue for expanding many allied health care programs. The report also suggests examining existing curriculum and removing unnecessary barriers. SB 139 addressed one such barrier; the new law prohibits a campus of the California State University or the California community colleges that operates a registered nursing program from requiring a student who has been admitted to that registered nursing program and who has already earned a baccalaureate or higher degree from a regionally accredited institution of higher education to complete general education requirements. The segments may instead require those students to complete only the coursework that is necessary to prepare them for licensing as an RN. What other barriers are there?
Conclusion
The most important message in all of the above is that, if the public and accessible community colleges aren’t able to step up and increase the number of allied health care workers they educate, the private sector will step in. That could translate, to begin with, into much higher student costs.
Additional Information
One helpful tool of which you may not be aware is a community college website for the Statewide Health Occupations Directory, which lists health occupation programs and the California Community Colleges that provide those programs. Though listing fewer than 50 of the more than 200 occupations included in the “allied healthcare” category, and in some cases not identifying a college with a program in the particular occupation, we understand that the website is constantly being updated. In the meantime, it might help your college/district identify whether a college in your region is already offering a program that you are considering offering, and, if there isn’t a program in your region, perhaps help you to identify someone at another college who would be willing to advise you on starting a program. The website address is: http://www.healthoccupations.org/ccchealth/index.cfm
Finally, AB 1559, which was signed into law this fall, authorizes community colleges to use a multi-criteria screening process to admit nursing students to their RN programs. The bill gives the nursing program considerable discretion in configuring a process for the demographics of its applicant pool, but also the ADN director advisory committee is working on the development of a model for AB 1559. Sub groups are working on aspects of the model for their next meeting, which will be in the beginning of March.
—Deborah Harmon