Q&A with Sue Skillman, MS, Deputy Director of the WWAMI Rural Health Research Center and the WWAMI Center for Health Workforce Studies

Sue Skillman has spent many years researching health workforce issues, sharing her expertise at conferences, and advising health workforce committees, including chairing the U.S. Delegation to the International Health Workforce Collaborative. She currently serves as Deputy Director of the WWAMI Rural Health Research Center and the WWAMI Center for Health Workforce Studies. In an interview with Health Workforce News, she discusses current health workforce research projects, rural health workforce issues, and her thoughts on the value of sharing with and learning from other countries in regards to health workforce issues.

Given your work with the International Health Workforce Collaborative, what are your thoughts on the value of sharing experiences and information with researchers and policymakers in other countries, despite the differences in health care systems?

The exchange of health workforce policy and research issues among the participating IHWC countries (Canada, United States, Australia and the United Kingdom) helps to illustrate our commonalities as much as, if not more than, our differences and provides a forum to learn of possible new approaches to address workforce problems. For example, at the last IHWC meeting participants compared approaches to interprofessional education and practice, emerging issues associated with growth in physician supply, changes underway in the primary care workforce, and ethical practices for employment of internationally-educated health professionals. This exchange provided participants with new perspectives on the topics and fueled discussion of the most effective programs, policies, and research to address these issues. One area where participating countries clearly differ is how, and whether, they have government sponsored health workforce planning agencies. At last fall’s meeting, a forum explored the roles and impacts of such agencies and, in the case of the U.S., how the lack of funding for the PPACA’s National Health Care Workforce Commission may be limiting our country’s ability to meet the nation’s workforce needs.

You recently completed a project examining the rural/urban distribution of advanced practice registered nurses (APRNs) using National Provider Identifier data. What would you like to share from your findings?

Because there is not a single source of data to describe the nation’s APRN supply and urban/rural distribution, we wanted to see how useful CMS’s National Provider Identifier (NPI) data would be for this purpose. Providers need NPIs for Medicare and Medicaid billing transactions. This study, funded by the American Nurses Association, found that NPI data appear most complete for nurse practitioners (NPs) and certified registered nurse anesthetists (CRNAs). For these professionals, the report displays rural and urban per capita supply numbers for each state. Taking into account state practice regulations and using available data from the NPI, we found that CRNAs were more likely to work in rural areas in states that allowed them the most practice autonomy. While we found that the NPI data are useful for workforce analyses such as these, not all providers obtain an NPI and therefore the NPI dataset undercounts the workforce. As more providers obtain and update their NPIs, the NPI data will become even more valuable for national and state health workforce planning.

Tell me about your work on allied health education in rural community colleges. What have you learned so far?

This HRSA-funded study is nearly complete, and preliminary findings were recently published in the IOM’s compendium of presentations from their workshop on allied health workforce and services. Our purpose is to provide descriptive information about the locations of community colleges that provide allied health career education and indicate which are within commuting distance for rural residents. We also looked at programs’ proximity to small rural hospitals and where there appear to be rural areas with poor access to these programs. Experts helped us identify the allied health occupations whose education can be completed at community colleges and that are frequently employed by rural health care facilities; these are the occupations described by the study. We found, for example, that about half of rural populations in the U.S. were within an hour commute to a medical/clinical assistant program, and only 3% of critical access hospitals in the West Census region were within an hour of a clinical/medical laboratory technician program. We hope that the resulting report, soon to be released, will provide useful information for programs and policies designed to meet the demand for rural allied health providers.

You are conducting a survey on HIT workforce issues in primary care practices. What are some of the issues you address in this survey? What advice do you have for others who want to better understand their HIT workforce needs?

We’re very excited about this survey because while there has been considerable research looking at implementation of electronic health records (EHRs) and health information technology (HIT) across the U.S., much less attention has been paid to the workforce needed to implement and use EHRs and HIT. Staffing challenges may hinder adoption of this technology in small rural areas. Our survey, funded by HRSA, is currently being fielded to rural primary care practices in twelve states. We are assessing the extent to which the practices use EHR and HIT and will identify workforce-related barriers to their use of EHRs and HIT. We also are describing the kinds of HIT-related workforce resources the practices have now and those they expect to need (such as new staff hires, training and education for current staff, contractor/vendor services, etc.) by 2014. We hope this study will highlight workforce issues specific to rural primary care practices that affect their ability to use and benefit from EHRs and HIT. We recently assisted Texas researchers in developing a similar statewide survey. They found that HIT workforce demand in Texas was much greater than the available supply. It will be interesting to compare the Texas findings to those from our more targeted study of twelve states’ rural primary care practices.

Given your work evaluating national rural health workforce programs, what do you consider some of the most effective rural health workforce programs to date?

One key approach is pretty intuitive – many of the people who want to live and work in rural areas are already there. Exposing rural young people to health careers and providing them with strong K-12 education resources will encourage them to choose and succeed in health careers, and many will want to work in their home communities or somewhere similar. More research will help us better understand the many factors involved in building adequate rural health workforce supply, but building the workforce from rural communities is a smart place to start.

What do you consider the most significant steps we could take nationally to address rural health workforce issues?

I’m acutely aware of the need for more data that can be used to measure changes in the size and distribution of the health workforce supply, particularly for rural and underserved areas. Workforce demand data for rural areas of the country also are sorely lacking. The research and policy communities can work to meet these needs by promoting greater availability of geographic identifiers for individual records on national datasets, encouraging oversampling of rural and underserved populations on surveys so findings can be representative of those groups, and supporting regular updating and strengthening of data resources that can be used for health workforce analyses. With adequate resources for analysis, these data can be used to illuminate problems with the supply and distribution of the rural health workforce as well as progress toward meeting rural workforce needs.

Is there anything else you would like to add?

Yes – I want to acknowledge the great team of researchers at our Rural Health Research Center: Mark Doescher, Davis Patterson, Holly Andrilla, Meredith Fordyce, Gina Keppel, as well as myself, comprise the scientific and analytic team for the studies described above.

Sue Skillman can be reached at skillman@uw.edu or (206) 543-3557.

Please note that the views expressed in this article are the opinions of the interviewee and do not reflect the official policies, positions, or opinions of the Health Workforce Information Center or its funder.