A move towards a team-based approach to delivering health care, prompted by the Affordable Care Act, is driving changes in both the education and practice of Virginia's health professionals. The ACA offers incentives for comprehensive, coordinated care using a patient-centered model.
Results of surveys of the state's dentists, pharmacists, nurses and allied workers formed a jumping-off point for discussion of Virginia's future needs at the forum, "New Frontiers for Virginia's Healthcare Workforce," hosted by the Department of Health Professions in Henrico County on Wednesday.
A panel of seven experts cited the already changed role of various professionals and the need for health-care workers at all levels — pharmacy techs, dental assistants, nurse practitioners, for example — to be allowed to work to the full scope of their education in a team setting.
While the panel expressed some concern about the aging of the workforce, particularly in nursing, the supply of health workers was not generally cited as a problem. Rather, the high educational costs, which are resulting in much higher student debt — typically $150,000 for dental students — are driving distribution problems, said David Sarrett, dean of VCU School of Dentistry. "We don't need to train a lot more than we're doing now," he said, referencing a Weldon Cooper Center study showing that supply and demand for dentists in Virginia is "in pretty good shape."
Pharmacists, who skew young and female among health professionals, have changed the scope of their practice significantly in the past decade. "It has changed from a chemistry focus to patient-centered. They're the most accessible health-care professional in the community," said Victor Yanchick, dean of VCU School of Pharmacy, noting that one-third work in big-chain outlets. The downside is that operating in the community they tend to be isolated from other health-care practitioners, he said. Caroline Juran, executive director, Virginia Board of Pharmacy, noted the changed role of pharmacists that includes reviewing prescriptions, counseling patients and working with disease prevention and immunizations. She predicted the increased use of pharmacy techs in a team approach in coming years and new technology for dispensing medications.
The panel emphasized that team care is non-hierarchical and can take different forms, from one to 20 people, and that different professionals may take the lead in different settings. For example, a 2012 change in law regarding nurse practitioners, NPs, now allows the 7,000 in Virginia to operate with more flexibility and changed supervision requirements. "In rural areas, the supervision requirement was a barrier to care," said Jay Douglas, RN. "The code allows for greater flexibility, increased access to care, and allows people to practice to the full extent of their education." She emphasized that the licensure requirements for NPs had not changed.
The survey showed that the state's dentists, who are primarily male and over 55, have been slower to adopt the team approach to care. Most are in small private practices and use a traditional model in which the dentist is the chief contact and the main driver for care, said Sandra Reen, executive director, Virginia Board of Dentistry. As a factor, she pointed to the lack of educational programs in Virginia to train mid-level providers, such as higher-level assistants who could complete composite fillings, in order to free up dentists.
After further analysis, the results of the surveys will be used to identify specific workforce needs in particular areas of the state.
Results of the Healthcare Workforce Data Center's surveys are available at http://www.dhp.virginia.gov/hwdc/default.htmCopyright © 2015, The Baltimore Sun