Health Workforce Research e-Library

The COVID-19 pandemic has had harsh impacts on low-income and racial and ethnic minority communities, as well as the clinicians who provide care to these communities. This article examines the results of a survey of safety-net health care practitioners (including physical, dental, and behavioral health providers) participating in the National Health Service Corps in 20 states to understand their experiences during the pandemic in regards to disrupted work, burnout, and related mental health challenges.

Health providers often attempt to capture social determinants of health (SDOH) in electronic health records (EHR) and use these data to adjust care plans. Standardizing SDOH documentation in the EHR between members of the health workforce may help ensure that patients’ social risk factors, including food and housing insecurity, are addressed. This article assesses how well EHR documentation identifies which health professionals act to address patient SDOH and what interventions are conducted.

This presentation focuses pathways to registered nursing using the 2018 National Sample Survey of Registered Nurses.

Using 2017 national data, we examined associations between therapy assistant staffing and three outcomes: patient functional improvement, community discharge, and hospital readmissions, controlling for therapy intensity and facility characteristics.

This brief describes the clinical laboratory workforce in the U.S.

The Patient-Driven Payment Model (PDPM), a new reimbursement policy for Skilled Nursing Facilities (SNFs), was implemented in October 2019. PDPM disincentivizes provision of intensive physical and occupational therapy, however, there is concern that declines in therapy staffing may negatively impact patient outcomes. This study aimed to characterize the SNF industry response to PDPM in terms of therapy staffing.

Health workforce research and planning consists of using supply data at multiple levels (i.e., national, state, local, etc.). Unfortunately, the variation in the allied health workforce means that supply data for these workers is less likely to be easily available. This report compares allied health workforce supply data (including 9 separate occupations) across multiple years from multiple data sources at the state level to national estimates to show how these estimates are impacted by the data source being used.

Nonstandard work arrangements includes overlapping concepts of: 1) contingent work (based on self-employment status, length of work, method of payment, and connection to employer), 2) alternative work (i.e., temporary agency worker, on-call worker, contract company worker, and independent contractor), and 3) electronically-mediated work (sometimes referred to as “gig work”). Between 1995 and 2015 the healthcare industry experienced one of the fastest growths in nonstandard work arrangements. However, there is little documentation on which health care occupations are frequently involved in these work arrangements, or the characteristics of these workers. This report examines healthcare workers in self-employment, contingent, and alternative nonstandard work categories, identifies occupations involved in these types of work, and discusses workers’ personal characteristics.

This study examined how the number of graduates and racial/ethnic student composition of Associate Degree in Nursing (ADN) programs have changed since the Institute of Medicine's recommendation to increase the percentage of bachelor's-prepared nurses to 80%.

Implicit race bias has been associated with poor patient/provider communication, less trust and confidence in the provider, and poor patient-centered communication, particularly with Black patients. This webinar explores an online course on implicit bias for academic teaching faculty and others developed by the University of Washington. Presenters discuss providers’ pre- and post-course bias awareness, pre- and post-patient centered communication, and their reflections on the impact of the course on teaching and clinical practice.

Health professions students can increase their understanding of how social determinants impact health equity through experiential learning opportunities. Using key informant interviews with faculty and staff familiar with experiential education programs in medicine, dentistry, nursing, pharmacy, public health, and social work, we sought to identify key features and best practices to inform the broader implementation of these programs.

The COVID-19 pandemic has had a dynamic effect on the health workforce. Redeployment, furlough, and layoff are among the terms used to describe various work statuses. Some terms are related and overlapping, potentially causing confusion for employees, media, policymakers, and researchers who may be interested in tracking health care employment trends throughout the pandemic. This brief defines the range of work statuses that one can hold, identifies areas where overlap may create confusion, and discusses the potential long-term impacts of the COVID-19 pandemic on employment in the health care industry.

Background checks are intended to ensure a quality workforce, but they may also exclude qualified workers. Though these background checks may appear straightforward, they rely on information from a variety of sources, and are governed by a complex regulatory environment. Various laws, industry norms, and court precedents shape what background information is gathered and/or maintained. This report examines why and how background checks on the health workforce are used, the broad variation of laws, regulations, and policies that govern them, their potential misuse, and ways to use background checks to help ensure patient safety while supporting health workforce development.

Studies have shown that wage disparities exist across race and ethnicity within selected health care occupations. These wage disparities negatively affect the industry’s ability to recruit and retain a diverse workforce in varying fields. This article aims to determine whether wage disparities by race and ethnicity persist across health care occupations and whether disparities vary across the skill spectrum.

Healthcare provider implicit bias influences the learning environment and patient care. Bias awareness is one of the key elements to be included in implicit bias education. Research on education enhancing bias awareness is limited. Bias awareness can motivate behavior change. The objective was to evaluate whether exposure to a brief online course, Implicit Bias in the Clinical and Learning Environment, increased bias awareness.

Since health professionals began administering 2 FDA-authorized COVID-19 vaccines in December 2020, the rollout has encountered several challenges and failed to meet initial targets for total vaccinations provided. The current health workforce has been identified as one possible bottleneck for distributing the vaccine, prompting a general call to authorize as many health care professionals to administer the vaccine as possible. This Health Affairs blog article reviews recommendations authorizing community health workers, retired professionals, health professions students, pharmacists, dentists, and veterinarians to administer the COVID-19 vaccine.

Prior studies of community health centers (CHCs) have found that clinicians supported by the National Health Service Corps (NHSC) provide a comparable number of primary care visits per full-time clinician as non-NHSC clinicians and provide more behavioral health care visits per clinician than non-NHSC clinicians. This present study extends prior research by examining the contribution of NHSC and non-NHSC clinicians to medical and behavioral health costs per visit.

The purpose of this study is to identify and synthesize the published research on medical scribe utilization in primary care and safety net settings.

The aim was to explore the association between community health centers’ (CHC) distance to a “maternity care desert” (MCD) and utilization of maternity-related health care services, controlling for CHC and county-level factors.

Community health centers (CHCs) are the cornerstone of primary care for 29 million people, most of whom are low-income, underserved, and live in rural populations. Until 2016, CHCs reported community health workers (CHWs) as part of their overall enabling services workforce, making it difficult to report CHW use in the annual Uniform Data System (UDS). This article examines changes in the community health worker (CHW) workforce among CHCs from 2016 to 2018 and factors associated with the use of CHWs.

We describe the development of 2 estimator tools designed to inform health workforce planning for COVID-19.

The objective of this study was to addresses the basic question of whether alternative legislative approaches are effective in encouraging hospitals to increase nurse staffing.

Health disparities have worsened over the last 20 years in the United States, and research has exposed the role of health care systems in contributing to these disparities. Based on race/ethnicity, sex, sexual identity, socioeconomic status, and geography, communities face disproportionately higher disparities in access, diagnosis, and treatment, ultimately resulting in adverse health outcomes. This article examines 6 important personal characteristics that determine whether and what kind of care patients receive from health providers.

The Teaching Health Center (THC) program was established in the Affordable Care Act to support new and expanded community-based primary care residency programs. THC programs are predominantly family-medicine programs located in community health centers, rural health clinics, and tribal health centers. This article evaluates the impact of new THC residency programs on health center staffing, patient service, quality of care, and provider productivity.

States responded to the COVID-19 pandemic with a variety of approaches to ensure adequate health workforce capacity as well as strategies to expand access to care for needed services. In order to better understand pandemic issues and challenges faced by states as well as strategies they used to address them, the Health Workforce Technical Assistance Center (HWTAC) conducted 32 key informant interviews with stakeholders in 23 states. In addition, the Health Workforce Policy Research Center at George Washington University conducted a policy analysis of regulatory actions taken by states. This research brief summarizes findings on how states prepared for and responded to the pandemic. Themes include regulatory flexibility, surge capacity for acute care services, and impacts on both ambulatory care services and the health professions educational pipeline.

This tutorial demonstrates how to create a travel polygon in ArcGIS that can be used to evaluate access to health care providers.

This webinar examines weighting issues associated with the 2018 National Sample Survey of Registered Nurses (NSSRN). Implications for conducting research using the 2018 NSSRN are discussed.

This webinar focuses on nurse practitioner (NP) research using the National Sample Survey of Registered Nurses (NSSRN). The first presentation examined evidence that registered nurses (RNs) are becoming NPs faster today than in the past and discusses the implications of that finding. The second presentation compares NPs that completed residencies to those who did not.

This collection of research articles authored by staff from HRSA-funded Health Workforce Research Centers (HWRCs) are published together as an open access supplement in the Medical Care Research and Review journal, providing a comprehensive picture of the US health care and health support workforce today.

This webinar focuses on registered nurse (RN) research using the National Sample Survey of Registered Nurses (NSSRN). Topics include the path to registered nursing, the validation of estimates of state-level RN distribution by hospital employment setting, and characteristics of RNs in long-term care.

Dental therapists (DTs) are primary care dental providers, which are used globally, and were introduced in the United States in 2005. This webinar focuses on the dental therapy movement and examines the role of health equity in its adoption.

The COVID-19 pandemic disrupted access to and the delivery of behavioral health services for both patients and social work providers. This webinar describes how practicing social workers transitioned to tele-behavioral health services during the pandemic. Presenters discuss challenges, practice innovations, and ethical/equity-focused implications to increase the use tele-behavioral health beyond the pandemic. Recommendations to ensure reimbursement parity, workforce preparation, and supports to engage patient use of tele-behavioral health are also highlighted.

Implicit race bias has been associated with poor patient/provider communication, less trust and confidence in the provider, and poor patient-centered communication, particularly with Black patients. This webinar explores an online course on implicit bias for academic teaching faculty and others developed by the University of Washington. Presenters discuss providers’ pre- and post-course bias awareness, pre- and post-patient centered communication, and their reflections on the impact of the course on teaching and clinical practice.

Increasing the diversity of health professionals enhances efforts to address underlying determinants of health, as providers from underserved backgrounds are more likely to provide care to patients who are at highest risk for disparities in access to health care. This webinar explores a career development program at the University of California, San Francisco School of Nursing. The FirstGenRN Program focuses on a learning community for nursing students, faculty development, and a visibility campaign. Research supports how first generation college health professions students are essential to improving our nation’s healthcare.

There are large variations in the level of agreement among areas that are identified as “rural” under various rurality definitions. Rural-urban disparities are sensitive to the specific definition and which population characteristic that is being considered. This webinar explores 8 federal rural definitions and the degree to which they identify the same areas as rural. Rural-urban disparities across socioeconomic, demographic, and health access and outcome measures are also evaluated.

View all of the research conducted by the HRSA-sponsored Health Workforce Research Centers (HWRCs) within the past year. Topics include COVID-19, telehealth, health equity, and more!

This tutorial demonstrates how to allocate county-level COVID-19 data into census tracts using population weights.

Social mission refers to the contribution of a school in its programs, and the performance of its graduates, faculty, and leadership in advancing health equity and addressing health disparities. The Social Mission Metrics Initiative focuses on the creation and use of metrics to measure social mission in dental, medical, and nursing schools across the United States. The Initiative provides school leaders with a tool to objectively assess the status of social mission at their school, with aims to 1) advance the field of social mission measurement and 2) enhance the national conversation around social mission in health professions education. This webinar describes the development and usage of social mission metrics and discusses implications for future work in this area.

This tutorial demonstrates how to develop a study area composed of different geographic units.

The Alliance for Disability for Health Care Education developed “core competencies” to help guide disability competency training in health care, including medical education. This webinar presents findings from a study that explores how medical education programs address these core competencies. Facilitators and barriers to integrating disability competency training in medical education are discussed, as well as recommendations for changes.

The health workforce is on the front line of the Coronavirus pandemic. There is a critical need to develop effective strategies to assure the availability of a sufficiently sized and well-trained health workforce to care for patients during the pandemic. Strategies must also be considered to replenish workforce supply as health workers fall ill, are quarantined, or need respite. This website is dedicated to sharing resources on efforts to develop, deploy, and replenish the health workforce in response to the pandemic.

Utilizing data from monthly population surveys, this webinar examines employment trends throughout the US health care delivery system, as well as employment and earnings trends of registered nurses, licensed practical nurses, and nursing assistants. Presenters discuss whether trends differ by employment setting and by different characteristics of the nursing workforce. Preliminary estimates of future growth of the RN workforce will be explored, and presenters identify threats to entry/exit from this workforce in coming years.

The onset of the COVID-19 pandemic created significant surges in patients and shortages of medical staff, supplies, and space. In times of heightened population health needs, the health workforce must have the ability to respond quickly and efficiently without legal restrictions. This webinar examines governor-issued executive orders that expanded scope-of-practice or reduced regulatory barriers for out-of-state healthcare practitioners during the COVID-19 pandemic.

A large dental accountable care organization piloted care coordination by retraining existing administrative staff to coordinate the care of high-risk patients. Following the pilot’s success, a formal “dental care advocate” (DCA) role was integrated system-wide. The goal of this new role is to improve care, patient engagement, and health outcomes while integrating staff into the clinical care team. We aim to describe the process of DCA role implementation and assess staff and clinician perceptions about the role pre- and post-implementation.

Dentists are 1 of the top 5 opioid analgesic prescribers among health care professionals in the US. However, most of these prescriptions remain unused after dental surgery, with upwards of 100 million opioid analgesic pills estimated to be left unused. This report describes dentists’ opioid prescribing patterns for Medicaid beneficiaries in 2 very different states—Oregon and New York—prior to the implementation of several national and state level opioid prescribing guidelines.

With the graduation of more females from dental school, the dental profession is becoming more gender diverse. This study, conducted by the Oral Health Workforce Research Center (OHWRC), builds on previous work on gender diversity in dentistry. Researchers used data from the 2014-2018 American Community Survey (ACS) to evaluate the impact of dentists' personal characteristics on variation in practice patterns and income. This report describes the demographic and other personal characteristics as well as household/family characteristics of dentists by gender and discusses observed differences in employment participation that might impact service delivery over time.

Many physician assistant (PA) education programs provide training in oral health competencies. However, little is known about how this education translates to clinical practice. This article describes an online survey of a national sample of 2014 PA education program graduates to determine how many PAs are educated in oral health competencies and how this education impacts the services they provide to patients.

One of the major challenges the oral health workforce faces is those that affect patient access and outcomes. Although Medicare programs provide almost 15 million a year in GME payments to teaching hospitals, there is little information about how the US invests in training the podiatry workforce. This article evaluates Medicare GME payments to teaching hospitals for dental and podiatry residents from 1998 to 2018.

The objective of this study is to qualitatively examine the drivers and outcomes of the US dental therapy movement through a health equity lens, including community engagement, implementation and dissemination, and access to oral health care.

The goal of this study was to explore challenges and opportunities that dental public health (DPH) residents and recent graduates experienced during and after their residency training programs in the US.