State Policy Approaches to Address Healthcare Workforce Shortages

June 12, 2019|3:08 p.m.| ASTHO Staff

Healthcare workforce shortages can reinforce or contribute to health disparities. Rural communities tend to have fewer physicians, nurses, specialists, and other healthcare workers, while also facing higher rates of chronic disease, mental illness, and obesity than their urban counterparts. Retaining adequate healthcare personnel in shortage areas is a contributing factor, especially as healthcare personnel working in shortage areas often experience isolation from their peers and burnout from seeing a greater number of patients and working longer hours than those in non-shortage areas. An essential element to ensuring an adequate healthcare workforce is to improve the reach of provider recruitment programs, which can build a strong and diverse healthcare workforce that represents the population served.

State and territorial health officials and their primary care offices (PCOs) are working with federal partners to provide training and tools for providers and residency students currently working in or looking to work in underserved areas, such as through the J1 Visa Program, National Health Service Corps, and Nurse Corps. PCOs also manage data collection regarding healthcare provider shortage areas (HPSAs). In addition, state legislatures are attempting to reduce gaps in the available healthcare workforce through a variety of measures, including legislation that increases provider recruitment and retention programs and appropriating funding for healthcare workforce development programs. The following select legislation has been introduced or enacted recently by states looking to increase access to healthcare by addressing healthcare workforce shortages.

In April 2019, Washington state enacted a law to increase access to primary care by establishing the International Medical Graduate Workgroup, consisting of governor-appointed members that represent the department of health, health insurance carriers, community, and migrant health centers. This workgroup will study barriers to practice for international medical graduates and make recommendations on how the state can implement an international medical graduate assistance program by January 1, 2022. The legislation is intended to advance the integration of international medical graduates into the Washington state healthcare delivery system. In addition, Washington state enacted a law in May 2019 to establish the Washington Health Corps, a program that provides loan repayment and conditional scholarships to health professionals in return for completing a commitment to work in underserved areas of the state.

The California Senate passed Assembly Bill 1759 in May 2019, requiring the Office of Statewide Health Planning and Development to allocate appropriated funding for four programs that seek to increase the healthcare workforce in rural and underserved areas. Two of the funded programs focus on increasing opportunities for a diverse pool of students to pursue careers in healthcare: they aim to expand recruitment and training for students from areas of the state with a large disparity in patient-to-doctor ratios and students from other “underrepresented and low-income backgrounds.” The additional two programs focus on expanding loan repayment programs for primary care physicians and clinicians that agree to serve in HPSAs, as well as expanding the number of primary care physician and psychiatry residency positions in HPSAs.

In May 2019, both chambers of the Alaska state legislature passed a bill that would provide student loan repayments and direct incentive payments to eligible healthcare professionals, as defined by the Health Care Professional Workforce Enhancement program. This bill would also authorize the Commissioner of Health to appoint an advisory council to advise the department of health on the program. The advisory council would provide oversight and evaluation of the program in areas that include: identification and monitoring of underserved and professional shortage areas, eligible sites, and program data management.

Hawaii’s Senate and House passed S.B. 1404 in May 2019, which would expand the state’s loan repayment program to include additional eligible healthcare professionals such as nurses, registered nurses, and licensed clinical social workers. This bill would appropriate funds to the Hawaii Department of Health to fund a loan program supporting eligible healthcare professionals who serve in a federally designated HPSA or another rural or underserved area of Hawaii as defined by the state.

Lastly, Iowa enacted a law in May 2019 that will provide opportunities for residency students to participate in rural rotations for exposure to rural areas of the state. The University of Iowa will also conduct a physician workforce study on the state’s workforce challenges related to recruitment and retention of primary care and specialty physicians. The study will examine current physician workforce data, identification of projected physician workforce shortages by region of the state, and analysis of the availability of residency positions, with an emphasis on the need for recruitment and retention of physicians in rural Iowa.

Access to healthcare is an essential component of health and wellness. By providing financial incentives and collecting data on provider shortages, states can improve access to healthcare services in under-resourced communities and improve provider recruitment and retention. ASTHO will continue to monitor state legislation and policy related to improving access to healthcare.

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