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30 2014 Central Mass By The Numbers • Worcester Business Journal www.wbjournal.com HEALTH CARE T he health care industry is on the precipice of a "seismic shift," according to Dr. Armin Ernst, CEO of Reliant Medical Group of Worcester. And that's a good thing for people seeking to enter the health care workforce over the next decade. The Massachusetts Executive Office of Labor and Workforce Development (EOLWD) projects that all health care occupations it measures will experience employment growth between 2012 and 2022, but some jobs lead those growth projections by wide margins. Those include physician assistants, home health aides and a variety of medical technicians. The health care system requires a huge supply of these workers as payers begin reimbursing providers for qual- ity rather than quantity. Health care companies — chief- ly primary care organizations — are transitioning to systems that deliver cohesive medical care to patients to improve their treatment outcomes. Meanwhile, Ernst said there's a push to deliver health care away from hospitals and avoid expensive medical procedures that can lead to later health complications. That's leading to mounting demand for home health aides, which, according to EWOLD, is among the fastest growing industry occupation in Massachusetts, with employment levels expected to grow 40 percent by 2022. "Medicine has become a team sport and physicians are going to have to be part of that team," Ernst said. While physician employment levels are expected to grow 14 percent by 2022, employment of physician assis- tants is expected to grow nearly twice that, 28 percent, according to EOLWD. That's reflective of a growing practice within primary care offices to use physician assistants to treat patients with less serious illnesses, while doctors are freed up to handle more acute cases. It's a practice Reliant has been piloting in the last year and will expand within its Central Massachusetts offices, Ernst said. And he expects the same to take place across the industry. This improves access to primary care, a health care sector that has struggled with a shortage of doctors. But Ernst said there's more to it. "For me, it's not just an increase in workload num- bers," he said. "It's making the best use of your time." The fact that doctors must undergo many years of training before they can practice is one factor in the shortage, according to Ernst. Occupations that require fewer years of training, such as nurse practitioners and physician assistants, help fill the workforce needs within primary care. "We can't get enough people through the pipeline for the demand," Ernst said. So can we expect doctors to disappear from primary care? Ernst said "No," but they'll probably spend a lot more time working on urgent cases. Right now, much of their time is spent on paperwork and treating patients with minor illnesses that physician assistants and nurse practitioners are qualified to handle, he said. In general, physicians are happy to share the workload with other providers, said Dr. Richard Pieters, president of the Massachusetts Medical Society. Pieters said it allows physicians to see more patients efficiently. Still, he said, it's important not to blur the lines between mid- level providers and doctors who have completed medical school and a residency program. There's ample opportunity, but is the Massachusetts workforce ready to meet this demand? Nancy Snyder, president of Commonwealth Corporation, said the Massachusetts workforce is highly skilled, relatively speak- ing. But Snyder said health care employers are keenly interested in workforce training grants to strengthen the skills of existing employees, especially as technology plays an increasing role in health care delivery. Meanwhile, community colleges are on the front lines of delivering education to fill health care occupations. But because there are so many career options in health care, Snyder said it's challenging to make people aware of opportunities outside nursing. "I don't think people are aware of the range of oppor- tunities available in the health care field," she said . Snyder added that the myriad clinical and nonclinical positions available make the industry a fit for a wide array of people. For example, someone who faints at the sight of blood might enjoy working in health care IT. Others who prefer the nonclinical side may find work as community health workers. n By Emily Micucci Worcester Business Journal Staff Writer 'Seismic shift' opens door for more health care workers Sources: Henry J. Kaiser Family Foundation, State Health Facts "Other private" includes individuals and families who purchased or are covered as dependents by non-group insurance. Also includes individuals covered by private insurance from outside the household for which the origin (ESI or non- group) is unknown. "Other public" includes those covered under the military or Veterans Administration, as well as non-elderly Medicare enrollees. Health insurance coverage: 2013 The ranks of uninsured in the U.S. dropped last year as the Affordable Care Act, also known as Obamacare, took effect. Now 13 percent, that figure was 15 percent in 2011 and 2012. employer-provided 57% 48% other private 7% 6% Medicaid 17% 16% Medicare 14% 15% other public NA 2% Uninsured 4% 13% Sources: Mass. Center for Health Information and Analysis, Henry J. Kaiser Family Foundation, State Health Facts, Mass. Executive Office of Labor and Workforce Development QUICK HITS Number of Central Massachusetts hospitals – out of 11 – that finished fiscal year 2013 (ended Sept. 20, 2013) with positive operating margins. 8 Visits to hospital emergency departments in Mass. The number of visits has been consistently around 43,000 a year since 2006. Source: Massachusetts Medical Society: 2014 Physician Practice Environment Index. (Original data from AHA Hospital Statistics, 2012, American Hospital Association.) * Estimate based on a three-year average rate of change. Percentage of Massachusetts residents without health insurance in 2013. U.S. figure was 13 percent. 4% MA U.S. Projected number of family and general practitioners in Massachusetts in 2022, up from 1,068 in 2012. 1,133 Projected number of registered nurses in Massachusetts in 2022, up about 18.5 percent, from 78,750 in 2012. 93,307 20,000 25,000 30,000 35,000 40,000 45,000 50,000 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13 44,190* Number of visits