Using Online Job Posting Data for Health Workforce Research Chair: - - PowerPoint PPT Presentation

Using Online Job Posting Data for Health Workforce Research

• Chair: Perri Morgan
• Lois Joy

– Uses, Strengths, and Limitations of Real-Time Labor Market Data for Health Workforce Research

• Kristine Himmerick (Perri Morgan)

– National Analysis of Employer Demand for Physician Assistants

• Linda Lacey

– Identifying Niche Markets for NPs in South Carolina

National and State-Level Analysis of Employer Demand for Physician Assistants

Perri Morgan, PhD, PA-C1 Christine Everett, PhD, MPH, PA-C1 Kristine Himmerick, PhD, MPAS, PA-C2 Katherine Humeniuk, MPH1 Brandi Leach1 Patricia Dieter, MPA, PA-C1

1Duke University, Dept of Community & Family

Medicine

2University of California San Francisco,

Healthforce Center

Background: Primary care need

• Shortfalls of primary care physicians are

widely predicted due to – Aging of the population – Increase in chronic disease prevalence – Increased insured population due to implementation of the ACA

• Physician assistants (PAs) and nurse

practitioners (NPs) are often suggested as a potential solution to fill primary care needs

PA specialization

• Over the past 20 years, the

proportion of PAs choosing specialty practice has increased

• In 2014, only 27% of PAs worked in

primary care (NCCPA data).

Efforts to increase primary care practice among PAs

• Federal

– Title VII training grants to PA programs who implement programs to enhance primary care training – National Health Service Corps scholarships and loan forgiveness programs for primary care practice

• State: Some states have similar loan forgiveness

programs

• PAEA: One of two major strategic goals is to increase

the proportion of PAs working in primary care

• PA training programs: Many have a primary care

mission

But the proportion of PAs in primary care continues to decline

50% 30% 19% 24% 8% 21% 10% 11% 13% 14%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60%

1997 2001 2005 2009 2013 Estimated % PAs in Clinical Practice Year Primary Care* Surgical Specialties Medical Subspecialties Emergency Medicine Other

Source: AAPA Census/Annual Survey Reports, 1997 -2013 *Primary Care includes Family Medicine (with and without Urgent Care), General Internal Medicine, Primary Care, General Pediatrics and Geriatrics. This differs slightly from the definition in other analyses in this paper due to limitations in the availability of trend data.

Factors that may affect PA specialty choice

SUPPLY

• Personal preferences

and values

• Potential earnings
• Debt levels
• Location
• Image of primary

care

• Professional

satisfaction DEMAND

• Availability of

physicians

• Resident work hour

regulations

• Demand for care

(needs of the population)

• Willingness of
• rganizations and

physicians to hire

Research on factors affecting PA specialty choice

SUPPLY

• Cawley J, Jones PE (2013). “Institutional

Sponsorship, Student Debt, and Specialty Choice in Physician Assistant Education”. The Journal of Physician Assistant Education 24(4).

• Singer, A. M. and R. S. Hooker (1996).

"Determinants of specialty choice of physician assistants." Academic Medicine 71(8): 917-919.

• Morgan, P

., C. Everett, K. Humeniuk and V. Valentin (2015). "Specialty choice among US physician assistants: Distribution, salaries, and comparison to physicians." JAAPA In press.

• Snyder J, Nehrenz G, Danielsen R, Pederen D

(2014). “Educational Debt: Does It Have an Influence on Initial Job Location and Specialty Choice?” The Journal of Physician Assistant Education 25(4).

• Wright, K. A. and V. L. Orcutt (2011).

"Physician assistant specialty choice: a factor analysis." The Journal of Physician Assistant Education 22(2): 20-24

• Many studies of physician specialty choice….

DEMAND

?

Evidence for low demand

• Recent graduates’ most often listed

barriers to securing a job were (NCCPA survey):

– Requirements for experience – Geographic limitations – Lack of jobs in preferred specialty

• PA faculty report that graduates have

difficulty securing primary care positions.

Research questions

• How do numbers of PA primary care

job postings compare to specialty job postings?

• Do other job market factors impede

the uptake of PAs into primary care?

– Geography – Requirements for experience – Jobs also posted for NPs

METHODS

• Cross-sectional descriptive study
• Compares primary care and specialty

job postings to each other and to

• ccupied PA positions

Job opening data

• National 2014 job posting data purchased

from Burning Glass Technologies (BGT)

• BGT spiders >38,000 websites continuously
• About 90% or more of highly skilled health

sector jobs are posted online

– Determined by comparing job posting #s with Bureau of Labor Statistics job opening estimates

• Data for variables is extracted from the job
• pening text by BGT
• Data is de-duplicated by BGT, with no

repeating job posting in a 60 day window

Variables

• Practice specialty:

– Trained coders in our office read each posting and assigned a specialty – A research analyst coded a subset of each coder’s work until agreement was >95%

• Location
• Experience required (< 1 year vs. 1

year or more)

• Whether job was posted for a PA or NP,
• r just for a PA

• 42,768 postings advertised PA jobs

– 336 were for non-clinical jobs – 5 were from Puerto Rico or Guam – 8290 no specialty could be determined

• 34,137 postings were analyzed

Primary care definition

• Family medicine
• General practice
• General internal medicine
• General pediatrics
• This definition was chosen to match

NCCPA definition

Data on occupied positions

• National Commission on Certification
• f Physician Assistants 2014

– 2014 Statistical Profile of Certified Physician Assistants

Methods of analysis

• Descriptive statistics
• Geographic information systems

methods were used to visualize data

RESULTS

18% of job postings were for primary care 27% of occupied positions were in primary care

27534 74443 6091 28047 10000 20000 30000 40000 50000 60000 70000 80000

Primary care* Specialty care

N

Occupied PA positions PA job postings

Primary Care includes Family Medicine (with and without Urgent Care), General Internal Medicine, Primary Care, and General Pediatrics Source: National job postings data from Burning Glass Technologies, coded by authors; and national data on occupied positions from National Commision on the Certification of Physician Assistants.

Job postings show stronger market demand for medical subspecialties and “other” specialties

Primary Care* 27% Surgery 26% Medical Subspecialties 21% Emergency Medicine 14% Other Specialties 12%

Occupied PA Jobs

Primary Care* 18% Surgery 27% Medical Subspecialties 26% Emergency Medicine 11% Other Specialties 18%

PA Job Postings

Care, and General Pediatrics Source: National job postings data from Burning Glass Technologies, coded by authors; and national data on

• ccupied positions from National Commision on the Certification of Physician Assistants.

Proportion of job postings that are for primary care varies widely, but tends to be higher in the mountain West

9.1% - 13.2% 13.3% - 15.8% 15.9% - 18.8% 18.9% - 24% 24.1% - 40.3%

Percent of Primary Care Jobs out of all PA Job Postings by State, 2014

Other factors that might affect job search

• One year or more experience required:

– Primary care 37% – Specialty care 29%

• Job also posted for NPs

– Primary care 40% – Specialty care 35%

Although these differences are small, these factors might make it harder for new graduate PAs to secure primary care positions

Discussion

• The PA job market appears to be

stronger for specialty jobs than for primary care jobs

• This may be especially true for new

graduates.

– There were 7556 graduates and 6100 primary care job postings in 2014, but

• 37% required experience
• 40% were posted for NPs also
• Jobs are not evenly distributed geographically
• New PAs must compete with experienced PAs for

these jobs

Potential explanations

• PAs might have a bigger impact on

practice profits in specialties  more incentive for specialists to hire PAs

• Sociology of medicine (Ferraro and

Southerland, 1989)

– Status differential is larger between specialist physicians and PAs than between primary care physicians and PAs – The larger status differential causes specialists to be less threatened by PAs on their turf

Limitations

• Not all jobs are posted online.
• Not all postings could be assigned a

specialty

• Some specialty categorization may

be incorrect

• Some variables could be miscoded

(especially experience required)

• Jobs posted over 60 days could be

included again

Strengths

• First study to examine nationwide

job market by practice specialty

• First study to use real-time labor

market information

– Advantage of ability to examine emerging trends. – Traditional labor market information does not provide the detail needed to answer these questions (practice specialty)

Conclusions

• A relatively weak primary care PA market

might contribute to the trend of specialization among PAs, especially among new graduates.

• If additional research confirms this problem,

policy approaches could include

– Financial incentives for hiring primary care PAs (such as current Rural Health Clinic incentives) – Education for primary care providers/organizations about how to best work with new graduate PAs – Services to match new grads to positions, using real-time labor market information.

Next steps

• Examine state-level factors

associated with job market for PAs

– # education programs – Availability of physicians, PAs, NPs – Socioeconomic and health need factors

• Specialty-specific studies
• State studies
• ?? Ideas suggested by collaborators

??

Funding

This project was funded by a grant award from the Physician Assistant Education Association, Washington, DC.

• Faculty Research Award, 2015

Funding of this project does not necessarily constitute an endorsement of the findings of this presentation by the Physician Assistant Education Association.

References

1. Association of American Medical Colleges (2015). The complexities of physician supply and demand: Projections from 2013 to 2025. Washington, D.C., AAMC. 2. Burning Glass Technologies. (2015). "Burning Glass: Careers in Focus." Retrieved September 1,, 2015, from http://burning-glass.com/. 3. Carnevale, A., T. Jayasundera and D. Repnikov. (2014, April). "Understanding Online Jobs Data: a technical report." from https://cew.georgetown.edu/wp-content/uploads/2014/11/OCLM.Tech_.Web_.pdf. 4. Cawley J, Jones PE. “Institutional Sponsorship, Student Debt, and Specialty Choice in Physician Assistant Education”. JPAE 24(4), 2013 5. Dall, T. M., P. D. Gallo, R. Chakrabarti, T. West, A. P. Semilla and M. V. Storm (2013). "An aging population and growing disease burden will require a large and specialized health care workforce by 2025." Health Aff (Millwood) 32(11): 2013-2020. 6. Ferraro, K. and T. Southerland (1989). "Domains of medical practice: physicians' assessment of the role of physician extenders." J Health Soc Behav 30(2): 192-205. 7. Kohn L (2013). Health Care Workforce: Federally Funded Training Programs in Fiscal Year 2012. Government Accountability Office. Washington, DC. 8. Morgan, P., C. Everett, K. Humeniuk and V. Valentin (2015). "Specialty choice among US physician assistants: Distribution, salaries, and comparison to physicians." JAAPA In press. 9. National Commission on Certification of Physician Assistants. (2015). "2014 Statistical Profile of Certified Physician Assistants." Retrieved April 24, 2015, from http://www.nccpa.net/Upload/PDFs/2014StatisticalProfileofCertifiedPhysicianAssistants- AnAnnualReportoftheNCCPA.pdf 10. Quella, A., D. Brock and R. Hooker (2015). "Physician assistant wages and employment: 2000-2025." Journal of the American Academy of Physician Assistants 28(6). 11. Singer, A. M. and R. S. Hooker (1996). "Determinants of specialty choice of physician assistants." Academic Medicine 71(8): 917-919. 12. Snyder J, Nehrenz G, Danielsen R, Pederen D. “Educational Debt: Does It Have an Influence on Initial Job Location and Specialty Choice?” JPEA 25(4), 2014. 13. U.S. Department of Health & Human Services, Health Resources and Services Administration and National Center for Health Workforce Analysis (2013). Projecting the Supply and Demand for Primary Care Practitioners Through 2020. Rockville, Maryland. 14. Wright, K. A. and V. L. Orcutt (2011). "Physician assistant specialty choice: a factor analysis." The Journal of Physician Assistant Education 22(2): 20-24.

Panel Summary

Contributions of Real-Time LMI for Health Workforce research

• Ability to search

thousands of online job postings by many different fields including region, industry, skills required, education, and experience.

• Data is more current

than comparable federal labor market sources.

• Can identify

emerging

• ccupations and

skills in-demand.

• Dynamic versus a

static picture of the labor market.

Cautions in using Real-time LMI for health workforce research

• Not all jobs are posted online.
• Job ads do not measure actual employment

(or actual vacancies)

• Jobs ads may represent multiple vacancies
• Jobs posted more than 60 days could be

included again

• Data needs to be checked for coding errors
• Volatility of data make longitudinal analysis

problematic (difficult to distinguish between changes in job ads and actual changes in labor demand.

Questions? Comments?

Supplemental slides

Number and Percent of Primary Care PA Job Postings by State, 2014

State Total # PA Job Postings # PC PA Job Postings Percent PC PA Job Postings State Total # PA Job Postings # PC PA Job Postings Percent PC PA Job Postings AK 288 95 32.99 MT 144 47 32.64 AL 180 19 10.56 NC 1526 273 17.89 AR 151 15 9.93 ND 135 33 24.44 AZ 1035 191 18.45 NE 353 80 22.66 CA 2952 615 20.83 NH 171 27 15.79 CO 745 156 20.94 NJ 735 81 11.02 CT 837 103 12.31 NM 380 77 20.26 DC 101 17 16.83 NV 344 70 20.35 DE 150 24 16 NY 2307 253 10.97 FL 1695 248 14.63 OH 856 137 16 GA 1199 163 13.59 OK 487 111 22.79 HI 67 27 40.3 OR 608 202 33.22 IA 313 75 23.96 PA 1484 216 14.56 ID 128 29 22.66 RI 254 23 9.06 IL 1104 183 16.58 SC 518 82 15.83 IN 427 62 14.52 SD 260 90 34.62 KS 317 76 23.97 TN 370 38 10.27 KY 253 27 10.67 TX 2469 632 25.6 LA 245 33 13.47 UT 430 121 28.14 MA 906 131 14.46 VA 735 110 14.97 MD 1047 136 12.99 VT 267 70 26.22 ME 335 63 18.81 WA 881 139 15.78 MI 1488 259 17.41 WI 750 127 16.93 MN 1012 202 19.96 WV 212 28 13.21 MO 313 38 12.14 WY 55 17 30.91 MS 118 20 16.95