Legislature Looks at New Approach to Work Force Shortages

November 9, 2010 -- State Rep. Mitch Greenlick (D-Portland) wants the medical profession to renounce specialization and instead create “new models of generalist healthcare workers who can work across their licenses.”

 

But licensing boards and members of the Healthcare Workforce Committee say there are better ways of addressing the impending shortage of healthcare workers.

 

Greenlick’s proposal, which, in his words, “is just ruminating in my mind,” seeks to do away with what he characterizes as “specialist silos” in the current system. He cited physical and occupational therapists as an example of two different specialties “that perform essentially the same functions” yet require different licenses.

 

Under Greenlick’s plan, generalist medical providers – “like certified nurse assistants” – would all receive the same training in healthcare fundamentals, but could also become certified in a set of skills specific to the needs of the site where they’d be practicing.

 

Judith Woodruff, director of health workforce development for Northwest Health Foundation who’s also a member of the Workforce Committee, said she didn’t know enough about Greenlick’s proposal to comment. However, she added, “I’m not sure specific practices would agree with his idea, any more than nurses and nurse practitioners would agree that they’re interchangeable.”

 

Indeed, both the occupational therapy and physical therapy licensing boards took issue with Greenlick’s proposal. Felicia Holgate, OTLB’s director, said: “Occupational therapists work collaboratively with physical therapists, but there are fundamental differences in education, training, experience and the outcomes they want to achieve for patients. The goal should not be to have generalists, but rather to provide the best treatment each profession can give to Oregon patients.”

 

Woodruff said the Workforce Committee is struggling to figure out how to address short- and long-term services, and noted that the “turf wars” between different specialized professions battling for patients further aggravates the vexing situation.

 

“It’s about politics,” said Woodruff. “It’s not about what’s best for patients and communities. The health and welfare of citizens should be more important than who gets to do it. But people don’t want to share or talk to each other. There’s a long history of animosity between professions.”

 

While Woodruff disagreed with Greenlick’s generalist approach, she concurred on the broader need for systemic reform of Oregon’s healthcare delivery system. Determining just what sort of overhaul the system needs is the task of the Workforce Committee.

 

“We’re asking: what are the competencies we want practitioners to have? What are the specific things Oregonians need and will need? What kind of a [medical] team would provide the best services?” asked Woodruff. “It’s possible that profession hasn’t been invented yet.”

 

Dr. John Moorhead, who chairs the Workforce Committee, wasn’t aware of Greenlick’s proposal. But both he and Woodruff said that the impending dearth of doctors could be linked to current realities and future factors – namely, Oregon’s low Medicare reimbursement rate, and a population that’s living longer and requiring more care.

 

“The committee is looking at 258,000 new folks with coverage,” said Moorhead. “How is the system going to respond to meet this increased demand, but balance it with short-term needs?”

 

The healthcare system’s shortcomings are, ironically, the result of its overall success, Moorhead said. “National studies say that … the healthcare system’s been successful, in that people are healthier and living longer, but that means that they require more healthcare services of all kinds.”

 

Additionally, said Woodruff, “There’s a huge shortage of people who have any training at all in geriatric medicine. What does that mean for the population that’s coming?” -- especially when that population is expected to increase dramatically.

 

There’s also the money factor. “Oregon is near the bottom on Medicare reimbursement,” said Moorhead. “People get paid significantly less to be here. And although Oregon does a pretty good job of maintaining people in our workforce, some people follow a variety of incentives to locate their practices elsewhere.”

 

He noted that other Western states, such as Washington and Alaska, have funded physician recruitment programs such as loan forgiveness and scholarships for people who agree to work in underserved areas. Earlier this year, Oregon’s legislature passed a similar program, but didn’t fund it.

 

Moorhead said the Workforce Committee is focusing its efforts on practical solutions that won’t unduly burden the state’s beleaguered budget. “We need solutions like loan forgiveness programs for those who work in underserved areas, or improving recruitment from underrepresented areas and cultures. These are efforts that don’t require a lot of money up front but can start to move us in an appropriate direction.” 

For a glimpse of the recommendations proposed by the HealthCare Work Force Committee, click here.