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Feb. 3, 2021
Contact: Philip Schmidt, 503-383-6079, Philip.Schmidt@dhsoha.state.or.us
Despite progress, challenges remain in delivering culturally responsive and accessible care
Today, Oregon Health Authority released its biennial Oregon Health Care Workforce Needs Assessment report, which shows that the racial/ethnic diversity of the health care workforce does not match the diversity of the Oregon population, with Hispanic/Latinx, African American/Black, and American Indian/Alaska Native providers underrepresented in most licensed health care professions. At the same time, OHA released its evaluation of the Health Care Provider Incentive Program (HCPIP), which showed how Oregon’s incentive programs are performing in addressing workforce challenges. Both reports concluded that despite some progress, there is more work to be done to diversify Oregon’s health care workforce and ensure access across the state and within key health care professions.
A core conclusion across the report is that there are shortages of certain health care professions across physical, behavioral and oral health, some of which can be particularly acute in rural areas. The needs assessment report was based in part on supporting reports on health care workforce diversity and licensed health care workforce supply, which were also made public in January.
“The data are clear, Oregon’s health care system is not staffed in a manner that is reflective of its diverse communities and also is not adequately staffed to meet some of our most challenging health care needs such as behavioral health services,” said Jeremy Vandehey, Director of Health Policy and Analytics at OHA. “But by evaluating existing programs and using data to identify gaps surrounding these issues, we can continue to make progress. COVID-19 showed the urgency of having an equitable health care system, and our health care workforce is at the center of it. We need our system to meet Oregonians where they are, with the services they need in a culturally responsive manner.”
“The conclusions of these reports confirm a hard truth about health care inequity in Oregon: Our workforce, while gradually increasing in its racial and ethnic diversity, is not changing quickly enough to ensure we meet the needs of all Oregonians today,” said Leann Johnson, Director of OHA’s Equity and Inclusion Division. “By understanding the scale and scope of the problem, we can continue to make meaningful progress to change our system and break down the barriers to health equity.”
The racial and ethnic makeup of many occupations is changing, and most occupations appear to be becoming gradually more diverse over time but still lag behind the diversity of the state. Since 2016, the percentage of white providers has decreased from 83.4 percent to 80.3 percent (a decrease of 3.7%), while many other racial/ethnic groups have increased. Over the same time period the proportion of Oregon’s population that is white has decreased by 2.1% (from by 77.6% to 76.0%), suggesting that the differences between the workforce and the state’s demographics are decreasing. There is generally more racial/ethnic diversity among younger providers compared with older providers.
HCPIP has provided a boost to expand the diversity of Oregon’s health professional workforce. Approximately 44% of the urban-based clinicians receiving loan repayment awards from the program are clinicians who identify as racially/ethnically diverse. Due to their participation in the program, these providers are obligated to remain in service for at least three years.
Generally, there is more racial/ethnic diversity among lower-wage health care occupations (e.g., certified nursing assistants and pharmacy technicians) compared with occupations that require more years of formal training (e.g., physicians, dentists). Women are overrepresented in most health care professions, while men tend to be overrepresented in fields requiring more formal training.
The overrepresentation of white providers is especially pronounced among behavioral health providers, where people of color comprise 13% of licensed behavioral health providers (compared with 24% in the population).
Twenty percent of Oregon’s health care professionals reported speaking languages other than English; (spacing – line needs to be brought up) however, only 11.3% report advanced proficiency or being a native speaker of another language, and only 9.4% report using a language other than English with patients. Spanish is the most reported language spoken other than English. While 10% of the workforce reports speaking Spanish, only 4.2% report advanced proficiency or being a native speaker of Spanish, and 6.8% of the workforce reports using Spanish with patients.
The needs assessment report concludes that throughout health care systems and organizations influencing those health care systems (e.g., payers, government, non-profits), more diversity among both front-line workers and management is needed to inform equitable programs and policies. This will require eliminating inequities throughout the educational system and workplace, including barriers to the advancement of people of color, from K-12 through graduate school, certification and licensure, and hiring and retention practices.
As noted, Oregon’s Health Care Provider Incentive Program is designed to increase the racial/ethnic diversity of the health care workforce and to increase capacity in rural and medically underserved parts of Oregon. With funding of $17.6 million for the 2019–2021 biennium, Oregon’s Health Care Provider Incentive Program achieves these goals by providing financial incentives to health care providers and students studying to become health professionals who will serve patients in underserved areas of the state. For example, about half of the loan repayment awardees worked in rural areas. Among awardees working in urban areas, most work at federally-qualified health centers (FQHCs), and 44% are people of color. There is more demand for these awards than the funding allows: just 45% of clinicians who apply for loan repayment are granted awards.
Rural areas struggle to recruit and retain providers, and so, on average, rural and frontier areas have more unmet health care need than urban areas in Oregon. The number of health care providers varies greatly across the state, with rural/frontier areas more likely to be underserved than urban areas. For instance, behavioral health provider full-time equivalent (FTE) per capita is 65% less in rural/frontier areas compared with urban areas. There are no licensed behavioral health providers in 21 rural and frontier service areas. And the dentist FTE per capita is 40% less in rural/frontier areas compared with urban areas. Also, the ability of current primary care providers to meet demand (as measured by the primary care capacity ratio) is 23% lower in rural/frontier areas compared with urban areas.
On a positive note, due in part to the work and investments of the HCPIP, 10 of Oregon’s 16 rural service areas have increased primary care FTE since 2018; only 2 two areas continue to lack primary care FTE. Also, telehealth may hold promise for people who have difficulty finding a provider close to home, such as patients in some rural and frontier areas. Telehealth has expanded dramatically with COVID-19 (by 40 times or more) and is likely to stay a larger part of health care delivery. However, this development brings up important issues around equity, access, effectiveness, and patient choice.
OHA’s Traditional Health Worker Program is working to facilitate seamless integration of the THW workforce across health systems, such as developing a toolkit with information for health systems, providers and THWs. The program is collaborating with philanthropic organizations and grant makers to support more efforts to increase the use of THWs, especially beyond the Oregon Health Plan. The effort to expand the use of THWs is hindered by the lack of consistent data on the THW workforce.
OHA is in the initial stages of planning for a new survey of THWs and Health Care Interpreters. These surveys will provide more accurate data on the providers in these workforces, their demographics, work environments, and training needs.
Behavioral health professionals are concentrated in the Portland metropolitan area and relatively underrepresented throughout the rest of the state. Oregon reports higher rates of identified mental health conditions when compared with national rates, and many people do not get the treatment they need. The distribution of licensed behavioral health providers varies widely across the state, with fewer providers per capita in rural/frontier areas. People of color are underrepresented among nearly all segments of the behavioral health workforce. Use of telehealth could potentially expand behavioral health treatment options, and research shows that telehealth can reduce costs and can be just as effective as in-person care for treating certain behavioral health conditions and patients. As with other telehealth delivery models, equity and access concerns must be resolved.
Statewide, licensed counselor and therapist FTE are increasing about 10% annually, licensed psychologist FTE are increasing about 1% annually, and licensed clinical social worker FTE are increasing 3% annually. Only 11% of licensed counselors and therapists are people of color; only 13% of licensed psychologists are people of color; and only 11% of licensed clinical social workers are people of color. These data show the urgent need for diversifying this workforce.
The HCPIP has focused on providers who are licensed or working toward licensure in primary care, behavioral health, and oral health. The evaluation noted a finding that OHA should expand the breadth of health professionals who can access this program, and OHA is in the process of revising administrative rules to accomplish that goal.
Background:
The Oregon Health Policy Board is required to assess Oregon’s health care workforce needs and submit a report to the Oregon Legislature as outlined in House Bill 3261 (2017). The Health Care Workforce Needs Assessment report is produced every two years and focuses on the diversity of the health care workforce and the needs of underserved parts of the state, especially rural areas. The findings from this report are used to inform the use of the Health Care Provider Incentive Fund.
An evaluation of the Health Care Provider Incentive Program (HCPIP) is required every two years. This evaluation is intended to identify the number, location, and specialty/discipline of the providers participating in the program, as well as capture the positive impacts the program has had on the health care professional workforce in the state.
The HCWF Diversity and Supply reports are produced by OHA’s Health Care Workforce Reporting program (HWRP) every two years and are released in January of odd years. For the first time, both reports incorporate interactive online data dashboards to provide a closer look at the data. The HWRP was created in 2009 with the passage of House Bill 2009, which required OHA to collaborate with seven health profession licensing boards to collect health care workforce data during their license renewal processes (typically every one or two years). During the 2015 Oregon Legislative session, Senate Bill 230 added ten more health licensing boards to this data collection program. The Health Care Workforce Reporting Program provides robust, high-quality data on Oregon’s licensed health care workforce to support research and policymaking. More information is available at: https://www.oregon.gov/OHA/HPA/ANALYTICS/Pages/Health-Care-Workforce-Reporting.aspx
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