"From the Valley, for the Valley." Insights on Health Care Workforce Development in the San Joaquin Valley
California’s San Joaquin Valley faces a critical health workforce shortage that threatens access to care, particularly in its rural and low-income communities. This case study examines how locally led initiatives are addressing these shortages by building culturally responsive, regionally rooted…
Telehealth Use and Web-Based Patient Portal Activation Among Rural-Dwelling Patients: Retrospective Review and Policy Implications
Telehealth may redress rural health care shortages in the United States and improve related rural health disparities. However, following the expansion of telehealth related to the COVID-19 pandemic, telehealth use has been lower among rural populations compared to urban populations. Certain…
Rural Life, Rural Healthcare, and Telehealth: An Interpretive Phenomenology Study
Telehealth may help ameliorate rural healthcare shortages and related negative health outcomes for rural populations in the United States. However, telehealth utilization has been lower among rural than urban populations. Patient experiences are an essential determinant of healthcare utilization…
The National Dementia Workforce Study: Methods for Surveying Community Clinicians Who Provide Care to People With Dementia
People with dementia have complex medical, functional, and social needs and experience highly variable care quality and out- comes across the U.S. health care system. Community-based physicians, nurse practitioners, and physician assistants serve crit- ical roles in diagnosing and managing dementia…
Diversity Matters: Strategies to Diversify California’s Health Care Workforce
The evidence is clear: California needs a diverse health care workforce to meet the needs of an increasingly diverse population. This policy brief provides evidence-based policy recommendations. An accompanying issue brief explores what we know about the diversity of California’s licensed…
Diversity Matters: Evidence to Diversify California’s Health Care Workforce
The evidence is clear: California needs a diverse health care workforce to meet the needs of an increasingly diverse population. This issue brief explores what we know about the diversity of California’s licensed health care workforce, what works to increase the diversity of health care…
Using Public Data for Regional Health Workforce Planning: A Toolkit
Health workforce planning and development is a collaborative process requiring the engagement of multiple stakeholders with expertise across different domains, including health care systems, health professions training and education, and policymaking. This collaborative process also requires a…
The Role of Nurse Practitioner Diversity in Expanding Care Access in California
Despite California’s population becoming increasingly diverse, the current health workforce has yet to reflect these demographic shifts; however, Nurse Practitioners (NPs) play a critical role in addressing gaps in primary care access across the state. In 2023, California implemented new…
Artificial Intelligence and the Health Workforce: An Annotated Bibliography
This annotated bibliography aims to highlight seminal articles, reports, editorials, and other key pieces of literature that explore AI’s impact on the health workforce in a rapidly evolving landscape. It will be updated over time to reflect new developments.
Strengthening Personal Care Aide Workforce: Advancing Consistency, Training, and Equity
Personal Care Aides (PCAs) play a vital role in the direct care workforce, providing essential support to older adults and individuals with disabilities or serious illnesses. PCAs, working alongside home health aides, make up the largest occupational group in the U.S. workforce, helping individuals…
Accelerated Health Professions Education Programs in California
California has a well-documented health workforce shortage, especially in rural areas. Accelerated education programs are one of the many approaches being employed to reduce shortages by shortening the educational pathway and increasing the production of qualified health care providers.This issue…
Direct-Entry Midwife Education, Practice, and Patients in California
Improving access to midwifery care has been identified as a strategy to address shortages of reproductive health clinicians and ensure person-centered, equitable care. This article describes findings from a new survey of licensed midwives (LMs) in California, who enter the profession without a…
Clinician Type and Care Setting for Treatment of Medicare Beneficiaries With Dementia
Standardizing and improving the treatment that Medicare beneficiaries living with dementia receive requires understanding the settings where they are receiving care, the types of clinicians providing that care, and whether clinicians recognize the diagnosis of dementia in their encounters with…
Palliative Care Services in Long-Term Acute Care Hospitals: A National Survey Study
Each year, long-term acute care hospitals (LTACHs) care for over 70,000 individuals with complex and serious illness requiring prolonged inpatient care for weeks or months following a short-stay hospitalization. While LTACHs are most distinct from other post-acute care settings for their…
Impact of COVID-19 on Trends in Physician Payments from Traditional Medicare from 2017-2021
Physicians, especially in primary care, likely faced substantial revenue loss during the COVID-19 pandemic due to decreases in patient volume and deferred healthcare utilization. While studies have focused on projections and limited surveys, the impact of the pandemic on physician revenue is…
Relationship Between Nurse Staffing During Labor and Cesarean Birth Rates in US Hospitals
Highlights:
The U.S. cesarean birth rate was 32.4% in 2023 and continues to increase each year.
Avoiding morbidity and mortality risk associated with cesarean birth is critical.
RN staffing during labor and birth is linked to cesarean rates.
RN staffing aligned with national standards…
Relationship Between Safety-net Oral Health Care Practices and Income Among American Indian/Alaska Native, Black, and Hispanic/Latino Dentists
Background. American Indian/Alaska Native (AI/AN), Black (B), and Hispanic/Latino (H/L) people are underrepresented in dentistry, yet disproportionately constitute the safety-net dental workforce. We examined the relationship between serving as safety-net providers (SNPs) and self-reported income…
An Unclear Partnership: Key Questions about Physician and Advanced Practice Provider Collaboration in Primary Care
More than 83 million people in the United States live in primary care shortage areas. As the US healthcare system faces a contracting primary care physician workforce, advanced practice providers are playing an increasingly important role in the delivery of primary care services. In parallel,…
Training Standards for Personal Care Aides Across States: An Assessment of Current Standards and Leading Examples
As the largest occupational group in the United States (combined with home health aides), personal care aides (PCAs) provide care for millions of Americans. Despite the size of the workforce, PCAs still struggle with unaddressed job quality challenges – inadequate training being primary among them…
Policies and Initiatives Impacting Medi-Cal Dental Care: 2014 - 2023
Access to dental care for millions of Californians is tied to coverage by California’s Medicaid (Medi-Cal) Dental insurance program. While child dental coverage is federally mandated, adult dental coverage is optional. In 2009, adult dental coverage was mostly eliminated but was partially…
Tribal Community Health Representatives (CHR): Home Care Workforce Insights, Experiences, and Recommendations for Elder Care.
The Community Health Representative (CHR) Program was established by Congress in 1968 to provide an outreach component meeting the specific healthcare needs of tribes and tribal communities. This program predates the official recognition of non-tribal Community Health Workers (CHWs) by the American…
Spotlighting the Experiences of the Home Care Workforce Caring for Older Adults Living with Dementia
Medicaid Home and community-based services (HCBS) and home-based clinical care (i.e., Medicare home health care) aim to support independence and well-being in the community, especially for older adults living with disability and complex health conditions, such as dementia. Many older adults receive…
Clinician Type and Setting of Care Delivered to Medicare Beneficiaries with Dementia in the US
Improving care coordination for people living with dementia (PLWD) requires understanding of the types of clinicians delivering care and the settings in which they practice.
We identified all beneficiaries with dementia in traditional Medicare in 2019. We used the Medicare Carrier file — i.e…
Navigating Hostile Workplaces and Educational Spaces Within Health Services and Policy Research
Advancing health equity requires acknowledging and attending to inequities within the health policy and services research (HSPR) workforce. Although HSPR racial and ethnic diversity has been increasing, the profession still has considerable unfinished work: in 2021, Black, Hispanic, and Indigenous…
Nurse Practitioner Race and Ethnicity and Interest in Independent Primary Care Practice and Serving Medicaid Enrollees
Nurse practitioners (NPs) are important providers of primary care to underserved populations, particularly in areas with lower physician supply. In 2023, California implemented new regulations aimed at improving access to care, especially primary care services, by providing a pathway for NPs to…
2024 Annual Report: Update on California's Physician Workforce
This report provides California policymakers with up-to-date information about the state’s physician workforce and the pipeline of trainees in the state’s medical schools and graduate medical education (GME) programs, often referred to as residency programs. This report focuses on the five…
“My Voice Does Not Matter…” A Qualitative Analysis of Clinician Experiences with Psychological Safety, the Work Environment, and Burnout
Clinician burnout remains prevalent, exacerbated by factors such as inadequate staffing, a lack of organizational support, devaluation, and poor interpersonal relations. Amidst provider shortages, the nurse practitioner (NP) workforce is expanding, paralleling high rates of burnout. This study,…
Physicians’ Perspectives on Using Direct Observation to Assess Non-English Language Proficiency for Clinical Practice: A Qualitative Study
Communication barriers are known to adversely affect patient safety. Yet few health systems assess and track physician non-English language proficiency for use in clinical settings. Barriers to current assessments (usually simulated clinician oral proficiency interviews) include time constraints…
Cancer Registrar Workload and Staffing Study: Guidelines for Hospitals Cancer Registry Programs
Cancer registrars are vital to cancer surveillance -- the work includes collecting, coding, reporting, and curating national cancer data that are used to create national statistical data about cancer epidemiology and treatment.
However, cancer registrars are often considered a nonrevenue-producing…
Understanding California’s Midwife Workforce
Midwives are licensed clinicians who play a key role in the maternity care workforce. In California, licensed midwives (LMs) and nurse-midwives (NMs) provide comprehensive, person-centered care focused on pregnancy, childbirth, and the postpartum period.
To better understand the midwife workforce…
