3-6-08
Addressing Healthcare Workforce Issues for the Future -- Senate HELP testimony 2-27
STATEMENT OF THE
AMERICAN OCCUPATIONAL THERAPY ASSOCIATION
SUBMITTED TO THE UNITED STATES SENATE COMMITTEE ON HEALTH, EDUCATION, LABOR AND PENSIONS, FOR THE HEARING ON
“ADDRESSING HEALTHCARE WORKFORCE ISSUES FOR THE FUTURE” FEBRUARY 12, 2008
The American Occupational Therapy Association (AOTA) submits this statement for the record of the February 12, 2008 hearing. We appreciate the opportunity to provide comment.
Occupational therapists and occupational therapy assistants change lives by helping people overcome obstacles to independent living, meaningful employment and full participation in their communities. Occupational therapy addresses the activity limitations of people experiencing health problems such as stroke, spinal cord injuries, cancer, congenital conditions, developmental disabilities, and mental illness. Occupational therapy interventions develop and restore skills that are essential for independent functioning, health, well-being, and participation in society and address the environmental barriers that interfere with everyday living. Therapy interventions are available for people of all ages and occur in a wide range of settings including schools, hospitals, skilled nursing facilities, home health, outpatient rehabilitation clinics, psychiatric facilities, and community health programs. Occupational therapy programs promote healthy lifestyles for individuals who are at risk for health problems and prevent secondary problems associated with chronic conditions or disabilities. The outcome of occupational therapy promotes independence in individuals who may otherwise require institutionalization or other long-term care and enables people with disabilities to be productive and contributing members of society. Lower health care costs and improved quality of life for individuals, families, and caregivers are also evident byproducts of occupational therapy services.
Occupational Therapy Workforce Issues:
Robert Martiniano and Jean Moore from The Center for Health Workforce Studies in Albany, NY, reported in June 2006 on “Health Care Employment Projections: An Analysis of Bureau of Labor Statistics Occupational Projections, 2004-2014,” which noted that health care continues to be the fastest growing employment sector in the country, projected to grow by more than 27% from 2004-2014. The report states that given the growing demand for health care workers, current health workforce shortages are likely not only to persist, but to worsen. In 2004, there were 113,000 occupational therapists and occupational therapy assistants in the workforce. The report affirms that occupational therapists and occupational therapy assistants are two of the 17 fastest growing health occupations with an increase in new jobs from 2004-2014 projected to be 34%, not including workers needed to replace existing workers who may retire or leave their jobs for other reasons. This means there will be 43,000 total new job openings due to growth and net replacements from 2004-2014.
According to the Midwest Center for Health Workforce Studies October 2007 report by Gail Fisher, MPA, OTR/L and Mary Keehn, PT, DPT, MHPE titled, “Workforce Needs and Issues in Occupational and Physical Therapy,” a shortage of occupational and physical therapy practitioners currently exists as a result of both increased demand and reduced supply. These shortages are felt on a number of fronts, including faculty shortages and the availability of clinicians.
After a prolonged period of increasing demand for services, the occupational therapy profession experienced a sudden downturn in 1997 after changes in Medicare reimbursement as part of the Balanced Budget Act (P.L. 105-33). The impact on the job market was lay offs and lower wages. The impact on the educational programs was fewer applicants, fewer graduates and program closures. However, the demand for rehabilitation services has grown in recent years due to the aging of the population and the expansion of other service markets which need the service of occupational therapists and occupational therapy assistants.
Fisher and Keehn report that the impact of the shortage situation includes the inability of providers to provide care that meets the standard of “best practice,” increasing demand on clinicians to work longer hours, practitioner stress and burnout, shortened individual treatment sessions, more therapy provided in groups, and delay in initiating care. The impact will be most felt by those who need occupational therapy services – actual clients, resulting in poorer health and function for those who do not receive therapy. Fisher and Keehn noted that identified barriers to increasing supply to meet demand includes a lack of direct funding for educational program expansion and a lack of loan forgiveness or scholarship programs for therapy students.
AOTA recognizes and has concerns with the future shortages of occupational therapy practitioners and the inability of programs to hire well-qualified faculty. With the retirement of the baby boomers, the entire nation will face the workforce shortage of occupational therapists and occupational therapy assistants. Congress should take steps now to slow and prevent this crisis by addressing faculty shortage and enrollment issues, fulfilling funding to Title VII of the Public Health Service Act and including occupational therapy in scholarship and loan repayment programs in the reauthorizations of the Higher Education Act and the National Health Service Corps.
Faculty Issues
Educational programs are now starting to rebound with increasing demand following stabilization in the Medicare market, but they face challenges in filling faculty vacancies with quality occupational therapy educators and scientists.
Fisher and Keehn cite data that indicate a significant decrease in enrolled students and new graduates from both occupational and physical therapy schools from 1999 to 2004. They point out that the numbers are starting to increase, but they are still well below the 1999 figures. They also suggest that potential higher salaries or more loan forgiveness programs in other fields will draw students away from physical and occupational therapy. In order to meet both current and future demand for occupational therapists, there is a need to find strategies to increase the supply of therapy providers. With the expanding applicant pool for occupational therapy, the report indicates that there is an academic program bottleneck in the system with applicant demand on one side and employer demand on the other. However, Fisher and Keehn point out that even if the pool of applicants is adequate to support an assumed expanding enrollment in existing and new programs, the faculty shortage prevents programs from ever expanding or opening.
Faculty credentials and doctoral preparation are the major challenges faced by occupational therapy programs. By July 1, 2012, the majority of full-time faculty who are occupational therapists must hold a doctoral degree. For entry-level doctoral programs, whose standards went into effect in January 2008, all full-time faculty members must hold a doctoral degree. Given that only 45% of occupational therapy faculty held doctoral degrees in Spring 2005, this will require a ramping up for both individuals and departments. In 2007, the vacancy rate for full-time core faculty at occupational therapy programs was approximately 10%. A recent faculty survey identified that the median age of faculty was 50 and the median age of program directors was 53. There are six institutions that have filed letters of intent to start new occupational therapy assistant programs, four of which have placed their applications on hold because they have been unable to recruit a qualified program director.
AOTA suggests that Congress provide opportunities for occupational therapy programs to increase the pipeline of occupational therapists and occupational therapy assistants while also providing support for professionals seeking to pursue career paths as faculty in occupational therapy programs. Federal funding should be considered to support expanding high quality programs for both occupational therapists and occupational therapy assistants that want to expand but don’t have the resources to do so.
Scholarship and Loan Repayment Issues:
Fisher and Keehn reported that providing scholarships or loan forgiveness programs for occupational therapists that practice in underserved areas will increase the number of applicants to therapy programs to reduce the current and future shortage of therapists. Below are lists of federal programs that AOTA believes can be instrumental in addressing the workforce crisis ahead.
Title VII of the Public Health Service Act
Title VII health professions programs are essential components of the nation's health care safety net, bringing health care services to our underserved communities. These programs support the training and education of health care providers with the aim of enhancing the supply, diversity, and distribution of the workforce, filling the gaps in the health professions' supply not met by traditional market forces. The Title VII health professions programs are the only federal programs designed to train providers in interdisciplinary settings to meet the needs of special and underserved populations, as well as increase minority representation in the health care workforce.
AOTA urges the restoration of the funding reductions proposed by the Administration to HRSA’s Health Professions programs. Many of these programs, such as the Area Health Education Centers Program, the Health Careers Opportunity Program, and the Centers of Excellence Program are all particularly effective in addressing faculty shortages, institutional barriers and other programs needed to support the cost of education for under-represented minority health practitioners and addressing the needs of underserved areas. These programs are particularly advantageous to Historically Black Colleges and Universities, where Departments of Occupational Therapy, for example, are at constant risk for faculty shortages.
AOTA recommends that Congress provide $550 million for the Title VII and VIII health professions and nursing programs in FY2009. In particular we would urge you to restore the funding for the Health Careers Opportunity Program, Centers of Excellence, Allied Health, and for the many other programs in Title VII of the Public Health Act that have lost their funding from FY2005 levels. In this we agree with the Health Professions and Nursing Education Coalition, through which we work with all the major health care professions to ensure our current and future service needs are met.
Higher Education Act
Occupational therapy is a profession listed in the Bureau of Labor Statistics highest category of growth and is expected to grow much faster than average between now and 2016. Shortages exist in most practice settings, but two prominent areas are in programs for children services and in the Veteran’s Administration (VA). The VA currently has a vacancy rate near 20% for occupational therapy positions and they are expecting to need additional therapists to meet growing needs for injured veterans returning from Iraq and Afghanistan. Loan forgiveness is very important to help meet the workforce needs of the profession and the health care needs of patients.
The College Opportunity and Affordability Act of 2008 (H.R. 4137), which reauthorizes the Higher Education Act, passed by the House expanded Sec. 428k which provides for loan forgiveness for areas of national need. While occupational therapy was not listed in the House bill, there has been agreement from Representative Joe Sestak (D-PA) and Representative Tom Price (R-GA), as well as Chairman George Miller’s (D-CA) staff and Ranking Member Howard McKeon’s (R-CA) staff to include occupational therapy in the House supported provisions as they move to conference with the Senate. Representative Sestak offered an amendment to add physical therapy to Sec. 428k based upon shortages similarly faced by occupational therapy practitioners working with adolescents and Veterans.
The program allows for up to $2,000 per year for 5 years in repayment if professionals work in particular areas. For therapists, the bill cites working with “children, adolescents, or veterans” as the criteria for loan repayment. AOTA urges the Senate to adopt Sec. 428k in addition to the aforementioned agreement to include occupational therapy as a profession eligible for loan forgiveness.
National Health Service Corps
The National Health Service Corps (NHSC) is a program under the Health Resources and Services Administration that is committed to improving the health of the underserved. The NHSC creates a link between medically underserved and vulnerable populations and professional health care, while supporting efforts for better systems of care. Congress is currently considering the reauthorization of the NHSC. The NHSC offers scholarships and loan repayment to providers who participate in the NHSC, however, the program is focused on primary health care clinicians, which defined as primary care physicians, nurse practitioners, dentists, mental and behavioral health professionals, physician assistants, certified nurse-midwives and dental hygienists.
AOTA believes that the loan repayment program offers tremendous opportunities for health care professionals and the patients they treat, particularly occupational therapists that work in underserved areas. Individuals that have access to occupational therapy and who receive prompt treatment significantly decrease the length of a hospital stay, reduce the need for institutionalization, promote early return to employment, reduce the care and services needed after discharge, and prevent complications and further injury and disability.
Congress has stated that the Secretary of the Department of Health and Human Services has the ability to utilize any provider necessary to accomplish the goal and mission of the NHSC, however, the Secretary has responded that the law does not provide such latitude. AOTA believes that by specifically adding occupational therapy to the list of providers eligible for loan repayment in the reauthorization of the NHSC, the NHSC will be better able to improve health care services for all people in underserved areas.
Finally, AOTA believes that continued funding for the Centers for Health Workforce Studies under Title VII of the Public Health Service Act will educate and inform policy-makers, professional provider associations and the public on workforce needs and issues in order to ensure that the public is aware of professional opportunities in rehabilitation and that beneficiaries have access to needed therapy services. The Workforce Information and Analysis line item under Title VII was stripped of its funding in FY2006 and FY2007. The Fisher and Keene report provided important information to determine occupational therapy workforce issues and trends; however, their center has been stripped of all funding. AOTA supports appropriate funding levels for the Centers for Health Workforce Studies to continue research on the supply, demand, distribution, education, and use of health care workers, including occupational therapy practitioners.
Contact: Daniel R. Jones
