Community Insight
Reversing the Shortage of Health Care Professionals in Colorado
Lou Ann Wilroy
Chief Executive Officer,
Colorado Rural Health Center,
The State Office of Rural Health
Imagine if all Coloradans had the right to see a doctor, but no one to care for them. We would have achieved our dream of securing health care coverage for all Coloradans. But for many, the clinics would be essentially empty – our coverage, worthless.
Colorado, like many other states around the country, already has a significant shortage of health providers. The challenges are most acute among low-income populations and in rural areas of our state. Four of Colorado's 64 counties do not have a single full-time primary care physician. In some communities, such as Trinidad in southern Colorado and Hugo on the Eastern plains, women having babies must pack up and leave town to give birth because there's no one to provide obstetrical care locally.
This predicament is no secret and the problem has been building for years. While
effective, systemic, long-term solutions are complex, it has become increasingly clear that we need coordinated action among the health care, education and labor sectors.
Enter the Colorado Health Professions Workforce Policy Collaborative. We are a group of 170 individuals representing more than 40 organizations. We include nurses, doctors, other health professionals, health care experts from higher education institutions and nonprofit agencies, along with managers of Colorado's health and labor departments. We are working to achieve consensus to reverse workforce shortages.
Already, the work of the Collaborative is generating tangible results.
This year alone, Colorado will have 10 times as much money to help pay off student loan debt for health professionals who agree to work for two years in underserved areas of the state. Last year, the state had about $200,000 in loan repayment funds to entice new health professionals to the neediest areas. That money funded seven new placements. This year, thanks to an injection of private contributions and matching federal stimulus dollars, that funding has increased to $2 million, helping to place as many as 40 new health professionals in underserved areas.
Funding support should continue to grow with new legislation that the Collaborative helped shape. Passed by the Colorado legislature in April 2010, House Bill 10-1138, the Colorado Health Service Corps will make it easier for private donors to add their financial support to the loan repayment fund and expand the program to a larger number of providers.
This fund will have a profound effect on future recruitment. On average, health professionals leave school burdened with debt between $150,000 and $200,000. Evidence shows that loan repayment is one of the greatest incentives we have to encourage professionals to practice in rural and underserved areas.
But while loan repayment is a powerful tool, it's not a perfect long-term solution. We must also work to retain health professionals in rural and low-income communities. And we need new students to replace our aging health care workforce. The Collaborative helped craft another piece of legislation, Senate Bill 10-58, that will dramatically increase the number of nurses we train.
Nursing shortages have been well publicized. But few people understand that we have plenty of people who would like to become nurses. We don't lack potential students, but we do lack teachers and training facilities. Most nursing schools have long waiting lists. In Colorado, there is already an 11% shortage of nurses statewide. This shortage is expected to triple by 2020.
Colorado's new law will help to counteract this problem by attracting more nurses to teaching jobs. They will be able to qualify sooner for loan forgiveness programs and be eligible if teaching part-time.
Collaborative members are pushing further policy changes. Through small working groups, our diverse members identified the following immediate policy interventions with slim impact on the state's budget:
- Collect key data through the state's existing professional licensing and certification processes
- Enact policies to support adequate reimbursement for primary care providers
- Make loan programs more effective
- Streamline professional training programs
- Increase opportunities for clinical experiences and residency programs
- Increase public funding for health professions education programs.
We're focusing first on low-cost solutions that can be quickly implemented, and we're being strategic about more costly challenges. For example, we know that we must increase the reimbursement rates that health professionals receive from Medicaid. Rates are currently so low that most physicians and other providers lose money when they agree to treat Medicaid patients. But given Colorado's economic challenges, we know we cannot immediately reverse this downward spiral.
A bill in the Colorado legislature would mandate Medicaid payment reform within five years, helping to stabilize our health care workforce and encouraging more providers to care for low-income patients in underserved areas.
Evidence proves – and Collaborative members believe – that the rewards of an adequate health professions workforce in Colorado will have a profound impact on both our state coffers and our residents. People with access to primary care suffer less from cardiovascular and pulmonary diseases, tap expensive emergency care less frequently, have lower death rates from colon and cervical cancer, spend less money on medications and benefit from improved vision, oral health and access to simple immunizations.
The path is clear. Investment today will guarantee that each of us can find the competent health professionals we need in the years ahead.
Colorado Health Professions Workforce Policy Collaborative
Front row, l.-r.:
Mark Levine, MD, Chief Medical Officer, Denver Region of the Centers for Medicare and Medicaid Services; Anita Glicken, Associate Dean of Physician Assistant Studies, School of Medicine, University of Colorado Denver; Diane Brunson, Director of Public Health and Community Outreach, School of Dental Medicine, University of Colorado Denver; Cherith Flowerday, Workforce Programs Manager, Colorado Rural Health Center; Cindy LeCoq, Career and Technical Education Program Director for Health, ACE, Public Safety and Criminal Justice; Lou Ann Wilroy, Chief Executive Officer, Colorado Rural Health Center, The State Office of Rural Health; Christine Demont-Heinrich, Research Analyst, Colorado Health Institute; Margo Schultz, Director of Student Exchange Programs, Western Interstate Commission for Higher Education; Mimi McFaul, Associate Director, Mental Health Program, Western Interstate Commission for Higher Education
Middle row, l.-r.:
Fran Ricker, Executive Director Colorado Nurses Association; Kaia Gallagher, PhD, President, Center for Research Strategies; Sue Hall, JD, Director of Health Care Policy, Colorado Commission on Family Medicine; Raquel Alexander, Chief Executive Officer, Colorado Academy of Family Physicians; Amber Galloway Stephens, Workforce Programs Manager, Primary Care Office, Colorado Department of Public Health and Environment; Tanah Wagenseller, Health Center Workforce Manager, Colorado Community Health Network; Mark Deutchman, MD, Professor, School of Medicine, University of Colorado Denver; Terry Boucher, Executive Director, Colorado Society of Osteopathic Medicine
Back row, l.-r.:
Suzanne White, Director of Policy and Planning, Center for Research Strategies; Chris Adams, President, TAG Strategies; Booker Graves, Colorado Workforce Development Council, Colorado Department of Labor & Employment; Sandra Steiner, Executive Director, Adams County Education Consortium; Laurel Petralia, Program Officer, The Colorado Trust; Jean Scholz, President and CEO, Colorado Center for Nursing Excellence; Gail Finley, Vice President, Policy Analysis and Strategic Planning Colorado Hospital Association; Kris Wenzel, Executive Director, Central Colorado Area Health Education Center; Liza Fox, Policy Analyst for Health, Office of the Governor; Stephen Kopanos, Former Vice President, Public Policy and Systems Advocacy, Mental Health America of Colorado
