Chapter 6: State and Local Health Care Shortages

by: Tony Glover, Workforce Information Supervisor

About the Data in this Chapter

This chapter examines the current health care workforce in Wyoming and sub-state regions and compares it to a national occupational staffing pattern. The estimates presented in this section are correspondingly conservative. The information in this chapter is presented in terms of jobs worked.

The Occupational Employment Statistics (OES) program collects occupational employment and wage data on jobs worked by industry and place of work. Data are collected from employers in all 50 states, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands, and are comparable across areas and nationally. This analysis combines national data on employment in health care-related occupations with data from Wyoming, Wyoming’s sub-state regions and metropolitan statistical areas (MSA), and six border state MSAs identified in Table 6.1. Employment data are combined with census population counts from the U.S. Census Bureau (see Table 6.1). Wyoming’s MSAs and substate regions are shown in Figure 6.1, while selected MSAs for surrounding states are shown in Figure 6.2.

Health care-related occupations in this analysis were selected based on the description in the Patient Protection and Affordable Care Act in Section 5101 i (1) and include “all health care providers with direct patient care and support responsibilities such as physicians, nurses, nurse practitioners… .” The OES program collects data on occupations by a Standard Occupational Classification (SOC) code; a complete list of SOCs and occupational titles are in the first two left hand columns of Table 6.2 and are listed in numerical SOC code order.

In Table 6.2, the column titled “U.S. Employment” is the total employment for the specific occupation in the U.S. in 2015. The column titled “U.S. Rate per 10,000” is calculated by dividing the U.S. total employment by the U.S. population from Table 6.1 and multiplying it by 10,000. The result is the employment per 10,000 persons. For example, referring to registered nurses (RNs) (SOC 29-1111; see Table 6.2), in 2015 there were 91.1 RNs per 10,000 individuals in the population in the U.S. This analysis assumes that the minimum number of RNs needed to meet the U.S. standard is 91.1 per 10,000 people. Therefore, a city with a population of 5,000 people should have 46 RNs and a city of 20,000 should have 182 RNs.

In Table 6.2, the data for Wyoming, Wyoming’s sub-state regions and MSAs, and border state MSAs are presented as the number of jobs by occupation needed or in excess relative to the national rate per 10,000. In many instances, employment estimates were not available at the sub-state regional level due to confidentiality. Occupational Employment Statistics (OES) data, which were used to prepare Table 6.2, are collected under a pledge of employer and worker confidentiality. Estimates are suppressed in instances where the identity of either the employer or the worker is at risk.

Positive numbers in Table 6.2 indicate a shortage, or how many more jobs that particular MSA or region needs in order to meet the U.S. rate per 10,000. Negative numbers indicate a surplus of jobs in a given occupation. For example, in the first row of data in Table 6.2, the U.S. employment of clinical, counseling, and school psychologists (SOC 19-3031) was 105,600 and the rate per 10,000 people of the population was 3.3. Using the assumption that the appropriate number of school psychologists is 3.3 per 10,000 persons in the population, it appears that Wyoming is overstaffed by 52.7 clinical, counseling, and school psychologists, while Wyoming’s northwest region needs 3.8 more.

The next occupation in Table 6.2 is substance abuse & behavioral disorder counselors (SOC 21-1011), with total employment in the U.S. of 87,090 or 2.7 per 10,000 population, and Wyoming is overstaffed by 35.2. Table 6.2 shows that Wyoming is overstaffed by 247 for family and general practitioners (SOC 29-1062), but understaffed by 277 for all other physicians and surgeons (SOC 29-1069).

The map in Figure 6.1 shows the six sub-state regions of Wyoming used by the OES program for sampling and estimation purposes. The geographical allocation of occupations to sub-state regions introduces additional problems in determining the number of health care workers needed or in excess relative to the national rate per 10,000. For example, 214.6 RNs (SOC 29-1111) are needed in Wyoming’s central-southeast region per 10,000 people, according to Table 6.2, while the Cheyenne and Casper MSAs show registered nurse excesses of 150.5 and 231.7, respectively. Other research conducted by R&P (Glover, in press) related to commuting patterns demonstrates that persons living in Fremont, Johnson, and Converse counties often commute to Natrona County – which includes Casper, Wyoming’s second largest city – for employment. It is possible that persons in these counties seek health care in Natrona County as well. The same scenario is relevant for the southeast corner of the state, with persons from Albany, Platte, and Goshen counties commuting to Laramie County, which includes Cheyenne, Wyoming’s largest city. The apparent excess of occupations such as RNs in these larger cities may indicate that MSAs like Cheyenne and Casper need more licensed health care professionals because they are regional destinations for health care consumers.

Table 6.2 identifies jobs by occupation that are needed or in excess relative to the national rate per 10,000. By comparison, Table 6.3 includes employment estimates (number of jobs worked) and rate per 10,000 for selected health care occupations at the MSA and sub-state regional levels. The occupations presented in Table 6.3 were chosen because statewide employment was at least 300 and there were relatively few confidentiality issues at the sub-state region level.

As previously noted, employment (the number of jobs worked) is not presented in Table 6.2 at the MSA or sub-state region level due to confidentiality. However, Table 6.3 provides employment estimates and the rate per 10,000 for some selected licensed health care occupations at the MSA and sub-state region level for comparison purposes. For example, as shown in Table 6.3, the national average rate of registered nurses per 10,000 individuals in the population was 91.1 in 2015. That rate was considerably higher in the Casper (119.3) and Cheyenne (106.6) MSAs and considerably lower in the southwest (65.2) and central southeast (67.9) regions of the state. This is consistent with the information presented in Chapter 5 of this publication, which shows that registered nurses made up a greater proportion of all licensed health care occupations in urban areas than in rural areas. As previously discussed in this chapter, the Casper and Cheyenne MSAs may have more licensed health care occupations per 10,000 people in the population because larger urban areas tend to be regional destinations for health care.

In conclusion, the current analysis is based on OES staffing pattern data collected at the state and national level and is therefore subject to sampling and nonsampling error. Consequently, estimation error could be expected to produce variability over time independent of change in real need. Given this limitation, it is important to focus on repeated measures (the same study done each year) and to address dramatic changes that may be a result of the aforementioned sampling error as they arise.

Advantages of the current analysis are that it is comprehensive (all occupations), inexpensive to compile, current, and readily adaptable to other norms and standards. This research proposed that the desired state of affairs for staffing ratios of health care occupations to the population is the distribution that occurs nationally. As research expands into the areas of access to care and desired staffing to population ratios for health care professionals, the current analysis could quickly be adapted to new standards at little to no cost.

The research presented in this section is exploratory in nature and future iterations will address the issues discussed in this section. In future research, it will be possible to look at access to health care professionals by the distance between health care seekers and health care services. The removal of nominal boundaries may provide a clearer understanding of what is available and where efforts should be focused to address Wyoming’s growing health care needs.