Health Workforce Research e-Library

COVID‐19 placed incredible strain on health care systems and the global health workforce. The pandemic rapidly increased demand for health care services and created an acute need for the health workforce in many areas of care. Yet, it also brought the health workforce to the forefront of the policy agenda and revealed many innovative solutions that can be built upon to overcome persistent workforce challenges. This article is based on a policy brief prepared for the WHO Fifth Global Forum on Human Resources for Health, which explores global emergency workforce strategies implemented during the pandemic and lessons learned from them for the long-term sustainability of the health workforce. Don’t have access to the full text? Email Margaret Ziemann (mziemann@email.gwu.edu) to request a pdf version.

While many have documented the enduring impact of the COVID-19 pandemic on health workforce shortages and turnover, few have considered the changes it may bring about for providers and their practices. This webinar discusses experiences of registered nurses during the pandemic and their changed understanding of what it means to be “a good nurse”.

A well-trained public health workforce is the linchpin to addressing current and future public health challenges, but achieving this goal requires a significant overhaul of recruiting, hiring, training, and retaining staff. This webinar provides an introduction to the public health workforce, focusing on challenges that the workforce has faced since the COVID-19 pandemic. Topics covered include supply of the public health workforce, recruitment and retention, changing skills and occupations, and new directions in public health workforce research.

Our most recent oral health webinar discussed the state-to-state variability in dental hygiene (DH) scope of practice (SOP) and the impacts of DH SOP on access to care. This webinar explores best practices for community-based DH services in Oregon and Minnesota—both states that support a broad SOP for hygienists.

Dental therapists have been practicing in other parts of the world for decades, but in the U.S. they are relatively few and far between. Like a hygienist, dental therapists can do cleanings as well as some procedures usually reserved for dentists, like simple extractions. They could also be the solution to getting underserved, rural communities better oral care. Today on the show, new momentum for dental therapy and why the American Dental Association is pushing back.

Local, state, tribal, and territorial government public health departments in the United States act as the front-line against disease, but are severely understaffed. Although there are other factors that can attract job candidates, salary is known to be paramount in recruitment competition, including public health. While previous studies have compared salaries between different occupations within public health departments, few have contrasted salaries for the same occupations within government versus the private sector or ask directly about wage competition. This article assesses salary differences between workers within key public health occupations in local or state government and workers in the same occupations in the private sector.

Salary disparities emphasize the urgency of rectifying pay inequities in public health occupations. However, many public health positions are governed by state employee pay structures that cannot be changed for only one agency. Given the challenges of increasing governmental pay just for public health, additional approaches are needed for public health recruitment and retention that are within the public health sector’s control. This article discusses suggested strategies for public health recruitment and retention, informed by interviews with public health workers from across the country and public health workforce reports from the field.

Since 1883, the United States has had civil service laws in place to prevent cronyism and insulate public employees from political influence. Critics argue that such laws impose an undue burden on managers with regard to hiring and dismissing employees. Given that governmental public health agencies have experienced longstanding challenges in recruiting individuals at the state and local level, understanding civil service laws as they relate to the hiring processes is an important component of increasing public health workforce capacity. This article presents state hiring laws and regulations governing the public health government workforce to inform related policy changes to support workforce development.

The onset of the COVID-19 pandemic worsened mental health conditions due to sudden social distancing restrictions, prolonged isolation, and increased disruptions in mental health and substance use treatment and support services. Peer support specialists play a crucial role in helping individuals with mental health and substance use challenges explore various pathways to recovery. These services are provided by Certified Peer Support Specialists (CPSSs) or Peer Recovery Support Specialists (PRSS), who are individuals in recovery from serious mental health or substance use disorders, offering support to others facing similar struggles. This article investigates, from the perspective of CPSSs, whether their training sufficiently covers essential core competencies and adequately prepares them for their role as CPSSs. Don’t have access to the full text? Email Bernice Adjabeng (bkadjabeng@unc.edu) to request a pdf version.

Nurse workforce shortages are not new, yet concerns about a shortfall of nurses intensified across health care settings during the COVID-19 pandemic. To understand how a health care crisis such as COVID-19 can impact nurse turnover at national and regional levels, documentation of a baseline national turnover metric is needed for comparing future registered nurse (RN) workforce changes. This article aims to provide a baseline understanding of national RN turnover using a cross-sectional analysis of the most recent data from the 2018 National Sample Survey of Registered Nurses (NSSRN).

We evaluated the role of state scope of practice regulations on NP practice in nursing homes in 2012–2019. Using linear probability models, we estimated the proportion of NP-delivered visits to patients in nursing homes as a function of state scope of practice regulations.

This webinar featured panelists with master’s degrees who work for academic institutions, consulting firms, and professional associations. They described their respective career paths in health workforce research and insights they have gained along their professional journeys.

The physician assistant (PA) profession is among the least racially and ethnically diverse health professions requiring advanced education. Between 1995 and 2020, the percentage of Black PA graduates fell from 7% to 3.1%, while Hispanic representation increased from 4.5% to 7.9%. PA programs that transitioned from bachelor's to master's degrees experienced a 5.3% point decline in Black representation and a 3.8% point decline in Hispanic representation. This article examines the impact of transitions to master’s degrees for PAs on Black and Hispanic representation between 1995 and 2020, using the federal Integrated Postsecondary Education Data System and individual universities as the unit of analysis. Don't have access to the full text? Email jordan_herring@email.gwu.edu to request a pdf version.

Behavioral health needs are on the rise in the United States, significantly influencing health care utilization, costs, and outcomes. Social workers offer diverse services across health, behavioral health, and community settings. Although this variety enhances care delivery, it also makes health workforce analyses more complex. This article describes the various estimates provided by 5 national data sources on the number, types, and practice characteristics of social workers.

Among behavioral health clinicians working in rural safety net practices, this study assessed how the amount of exposure to care in rural underserved communities received during training relates to their confidence in skills important to their work settings, successes in their jobs and communities, and their anticipated retention.

The objective of this research was to describe the challenges posed by the pandemic on the ability of safety-net providers to deliver oral health care to underserved communities and to identify strategies that enabled care delivery during recent years but especially during the initial challenging months of 2020.

A national survey reported that 1 in 4 nurses left their position in 2021. Nurse turnover can impact the quality and continuity of home health care. Scope of practice laws, which determine the tasks nurses are allowed to perform and delegate, are an important element of autonomy and vary across states. This article uses human resource records from a multistate home health organization to assess the relationship between nurse turnover and whether nurses delegate tasks to unlicensed aides.

American physicians disproportionately suffer from burnout. Despite calls for solutions to the physician burnout crisis, there is little research on how multiple structural factors intersect in real-time as a system to shape well-being. This article examines pressures on physicians from societal, organizational, and professional levels, to assess how these structural factors work together to affect their experience and burnout level.

We used a qualitative approach to gain a richer understanding of states’ impetus for using Medicaid funds, the structure of their investments, the composition and charge of advisory bodies that helped guide these investments, and the degree of transparency and accountability to track whether Medicaid GME investments achieved desired workforce outcomes.

This tutorial uses distributions of mental health related 911 calls in New York City to demonstrate how to utilize ArcGIS and Geoda to conduct an Exploratory Spatial Data Analysis (ESDA).

The 2023 HWRCs’ Annual Report captures all of the HRSA-sponsored work conducted by the HWRCs throughout the past year. Topics include COVID-19, burnout, telehealth, health equity, health professions education, and more! This year’s report also introduces 2 new HWRCs: the UNC Behavioral Health Workforce Research Center and the Consortium for Workforce Research in Public Health.

To better understand the adequacy of the required training for peer support certification to provide peer support services, this study posed the following research questions: (1) Is the proportion of CPSS who adjudge their required training adequate in preparing them for their peer support roles significantly higher than those who do not perceive it as adequate? (2) What distinct subgroups can be identified based on CPSS' response patterns to questions about the sufficiency of the required training in preparing them for their peer support roles? (3) What topical areas would be beneficial in additional or continuing education training for CPSS?

In this study, 17 key informant experts shared their perspectives on how the emergency medical services (EMS) and community paramedicine (CP) workforces responded to COVID-19 during the first year of the pandemic, 2020. Experts also described how the pandemic has affected EMS and CP. EMS responders provide 9-1-1 emergency services, while community paramedics (CPs), typically drawn from EMS personnel, provide nonemergent public health services and augment primary care services to patients in the community.

This study examined the roles of medical assistants (MAs) in the use of telehealth to deliver primary care during the COVID-19 pandemic. Through reviews of the literature and interviews with key informants, the study identified the skills and roles of MAs that supported rapid increase in the use of telehealth, policies and practices supporting these roles and skills, and longer-term needs to improve and maintain these skills and competencies.

Lack of health care providers’ knowledge about the experience and needs of individuals with disabilities contribute to health care disparities experienced by people with disabilities. Using the Core Competencies on Disability for Health Care Education, this mixed methods study aimed to explore the extent the Core Competencies are addressed in medical education programs and the facilitators and barriers to expanding curricular integration.

Teledentistry is the use of information and communication technology to deliver virtual oral health services in real time (synchronous) or through store-and-forward (asynchronous) methods. Regulatory guidance during the COVID-19 pandemic facilitated the swift adoption and expansion of teledentistry. However, considerable variability in regulation of teledentistry by states limits the ability of clinicians to provide virtual oral health care. This infograph illustrates the variation in teledentistry regulation by state to help oral health stakeholders understand those differences.

The objective of this study is to describe new graduate physician associate/assistant (PA) and NP perspectives of onboarding programs in their first primary care position.

This study used a national data set identify key trends and disparities in use of office-based physician services for pediatric mental illness.

Social workers hold vital positions on interprofessional teams or integrated healthcare teams (IHC), increasingly in primary care settings, to deliver behavioral and mental health services. Electronic health records (EHR) serve as a communication tool within these teams, but little is known about how social workers interface with EHR. This article in the Journal of Technology in Human Services presents 3 themes that emerged from a qualitative study seeking to understand how social workers document their work in EHRs in integrated primary care settings.

Skilled nursing facilities (SNFs) have recently experienced 2 major disruptions impacting staffing: 1) the Medicare payment reform in October 2019, which significantly altered reimbursement incentives for post-acute stays, and 2) the subsequent COVID-19 pandemic. Extensive research has been conducted on how these events have affected nurse staffing in SNFs, including registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs). However, there is limited knowledge about the staffing patterns of non-nursing professions in SNFs, particularly regarding whether these roles are filled by employed or contract workers. This report examines trends in staffing of non-nursing direct care occupations in skilled nursing facilities (SNFs) from 2018 to 2022 using the Payroll Based Journal, a publicly available data source with daily staffing information by occupation from the Centers for Medicare & Medicaid Services.

The COVID-19 pandemic has severely impacted the US public health workforce. High turnover of local health department (LHD) personnel has created concerns about workforce needs and capacity. This strain has been particularly alarming among rural LHDs due to an historical lack of investment and limited workforce capacity compared to their urban counterparts. This article compares rural and urban local public health workforces, including competencies and training needs, COVID-19 impact, and turnover risk.

The health care sector, predominantly staffed by women, faces significant gender pay disparities. This inequity not only results in lower lifetime earnings for women but may also discourage them from pursuing advancement in health care careers. However, little is known about how the gender wage gap has changed in the health care workforce over the last decade, especially in relation to changes in the gender composition of the health care workforce. This article examines the wage gap between men and women comprehensively across health care jobs over time and how the gap may be related to the representation of women in the field.

Onboarding new graduate PAs and NPs has become a hot topic, especially given the provider shortages and financial shortfalls our healthcare system is experiencing. Onboarding is also an emerging area of research, and in this episode, we sit down with PA Nathalie Ortiz and NP Hilary Barnes to discuss what they have learned about the onboarding experience for PAs and NPs in primary care.

This study aimed to explore provider observations of inequitable care delivery towards COVID-19 positive patients who are Black, Indigenous, and Other People of Color (BIPOC) and/or have disabilities and to identify ways the health workforce may be contributing to and compounding inequitable care.

While several studies have documented the rapid growth in telehealth visits during the pandemic, none have examined its relationship with greater overall access to care among vulnerable populations. We use Association of American Medical Colleges' Consumer Survey data to examine the relationship between access to care and telehealth use before and during the pandemic.

Health centers serve millions of patients with limited English proficiency (LEP) through highly variable language services programs that reflect patient language preferences, the availability of bilingual staff, and very limited sources of third-party funding for interpreters. We conducted a mixed-methods study to understand interpreter services delivery in federally qualified health centers during 2009–2019.

This research brief examines the impact of COVID-19 on undergraduate medical education and on RN education from the start of the pandemic up to the present. However, it is likely that other health profession education programs that rely on clinical training for their students were also affected.

Medication for opioid use disorder (MOUD) in primary care includes a combination of medication, behavioral therapy, and/or other psychosocial services. This study assessed rates of colocation between waivered prescribers and behavioral health clinicians across the United States to understand if rates varied by provider type and geographic indicators.

This study provides an update on the income gap between men and women in dentistry, evaluating the impact of dentists’ household, personal, and employment characteristics on income differences.

The COVID-19 pandemic had a great impact on health care workers by increasing workloads and leading to burnout. The stress for workers may have also led to an increase in the risk of occupational injuries. This article assesses the impact of the COVID-19 pandemic on occupational injuries or illnesses among nursing care facility workers.

The purpose of this study was to identify barriers to oral health services experienced by children and evaluate variation across demographic and socioeconomic population groups.

This study addressed three research questions: (1) Who constitutes the community based HR workforce? (2) Who provides behavioral health services at HR organizations? (3) Do referrals differ by the type of HR?

Increasing the diversity of the behavioral health workforce is critical to providing culturally competent and responsive behavioral health care to minority communities. This study used the National Survey of College Graduates (NSCG) to understand the pipeline of diverse Bachelor of Social Work (BSW) graduates to Master of Social Work (MSW) programs in order to assess how student demographics, educational programs, and loan debt burden impact pathways into the profession.

Community health workers (CHWs) have critical importance in health departments as they often share the same cultural background (ethnicity and language), socioeconomic status, and life experiences as members of underserved communities. This shared culture increases the level of trust between the community and health department. However, as a professional group, CHWs face several challenges related to their occupation, including limited visibility, low compensation, and work-related stressors contributing to burnout. This article uses the Public Health Workforce Interests and Needs Survey data to explore the organizational factors that contribute to CHWs’ intent to leave their jobs within local and state health departments in the United States.

The COVID-19 pandemic exposed public health infrastructure gaps and the need for a strong public health workforce capable of supporting population health and promoting health equity. One of the major causes of the infrastructure gaps is ongoing public health workforce shortages. Recruiting and retaining public health employees and ensuring they have necessary skills are vital for meeting public health needs. This article examines workforce gaps identified by accredited health departments and what they plan to do to address those gaps.

We compared the representation of the four largest Latino subpopulation groups in the health workforce with that group’s representation in the US workforce, using 2016–20 data. Mexican Americans were the most underrepresented subpopulation in professions requiring advanced degrees. All groups were overrepresented in occupations requiring less than a bachelor’s degree. Among recent health professions graduates, overall Latino representation has been increasing over time.

The Agency for Healthcare Research and Quality (AHRQ) created the Physician and Physician Practice Research Database (3P-RD) which captures census data of physicians and physician practices in 13 states, including characteristics that may be useful for analytic purposes. This webinar describes how these databases were built and how to gain access to them for your research purposes. This webinar was cosponsored by HWTAC and AcademyHealth’s Health Workforce Interest Group.

Community pharmacies are among the most accessible health care sites in the United States. Community pharmacists offer many services including medication optimization, chronic and acute care management, wellness and prevention, and patient education. However, community pharmacies face several barriers that have impeded patients’ ability to universally access these services. This article describes the impact of the COVID-19 pandemic on community pharmacy practice and its workforce. Don’t have access to the full text? Email Jennifer Bacci (jbacci@uw.edu) to request a pdf version.

Understanding how the pandemic might have affected nurse turnover requires establishing a national baseline of turnover in the pre-pandemic period. This study sought to produce that baseline by conducting a cross-sectional analysis of data from a nationally representative survey of nurses in 2018.

The COVID-19 pandemic has placed considerable strain on the US public health workforce. High turnover of local health department (LHD) personnel has occurred, creating concern about workforce needs and capacity. This study compares rural versus urban local public health workforce competencies and training needs, COVID-19 impact, and turnover risk.