How journalists can offer smarter coverage of the changing health care workforce

Late last month, University of Washington researcher Susan Skillman met with some of the leading nursing workforce forecasters in Big Sky, Montana. As they discussed predictions for how many nurses will be needed, they struggled with how to convey the various scenarios to the media.

“In a rapidly changing health system, we don’t know what the future will look like,” said Skillman, the deputy director of the University of Washington Center for Health Workforce Studies and a nationally recognized expert in health workforce research and policy. “How do we get people to not just pick the highest number off a graph?”

That’s the challenge with so much health reporting on workforce shortages, Skillman said in an interview with the Center for Health Journalism. A simple number detailing the size of health workforce shortages or surpluses can be very misleading. For one, forecasting must take into account the unpredictable future of health reform rollout. How soon will more bundled payments replace the old fee-for-service model? At what speed will health care move out of the hospital and into alternative models such as home health?  

“A lot depends on how the policy stuff plays out,” she said. “We’re making the best estimates we can – we’re not trying to compete for who can show the biggest shortage.”

Here are some of Skillman’s tips for journalists tracking the health workforce story in the wake of reform, as well as some ideas to spur future articles.

1. Understand the data’s limitations: “My plea to journalists is, ‘Don’t just go to the final conclusion,” she said. “Be able to read a little between the lines, particularly looking at the quality of the data source, and if the conclusions drawn are fair.’” For example, when researchers examine where health providers live, they often look at where their licensures are mailed. But that doesn’t necessarily mean that’s where they practice. Instead, they might keep a license active in more than one state, or keep it up to date even after they’ve retired. As a result, using those figures could over-estimate the supply in a particular area. Researchers who are doing it right will acknowledge the limitations of their predictions, Skillman said. “If a study doesn’t have limitations … that’s where I could be cautious.”

2. Take a critical look at studies: As with any study, journalists need to understand that various professional groups have agendas when it comes to health workforce shortage predictions. Make sure to interview other independent experts to get their take on the latest professional group’s predictions. “When reports come out of professional associations, ask questions,” Skillman said. Be sure to check who funded the study, and what motivations they might have on workforce issues.

3. Go beyond the usual suspects: Researchers who focus on the health workforce field tend to focus on physicians, nurses, and dentists. While it may be easier to find data on those professionals, “just studying the physician workforce isn’t going to tell us about health care in the future,” she said. “Things are changing and to really understand resources in the future, we need to look at the social workers, the pharmacists, the medical assistants, and other occupations that are part of the health care team.”   

4. Be careful with words like “shortage” and “surplus.” “I would love it if journalists would remove these two words,” she said. “They oversimplify the issue.” Seldom do researchers measure the extent there is a true surplus, Skillman said. Usually, what researchers mean is that the estimated demand is less than the estimated supply. But health care markets adjust, and using those words can trigger overreactions, such as limiting capacity at nursing schools. Sometimes, recent nursing graduates can’t get jobs in their desired market, often because employers are seeking more experienced nurses, Skillman said. Does that mean there’s really an overall surplus?

5. Put numbers in context: By some estimates, Washington state’s rural population is declining relative to its urban populations. Does that mean there’s less need for rural health providers? Not necessarily. Skillman points out that the relative decline in the rural percentage is because the urban portion of the state’s population has grown as huge employers such as Amazon expand rapidly in centers like Seattle. Journalists should ask: “How do we take the workforce estimates and make them meaningful” for readers?

Here are some story ideas Skillman suggests investigating:

Changing workforce: Try focusing your reporting on how the health workforce is changing. Physicians are the “bright, shiny objects” when it comes to workforce reporting, and much of the studies feature them. But as team-based approaches are emphasized under health reform, take a look at the emerging players. What is the changing role of home health aides? How are medical assistants being used? What is the turnover rate? Are they making living wages themselves? Even if there isn’t data available, you can still profile these providers and explore their experiences. Is the health care team approach becoming a reality in your area? Is it working?

Health reform: The Affordable Care Act sought to move care from the hospital to a more outpatient setting. A good question to ask is: “Where are we on the curve of transforming care?” It’s logical to want to keep people in their homes, but this isn’t a simple proposition. Delve into the nuances and challenges. Is it affordable and efficient? Who benefits financially? How do health outcomes change? Also, why aren’t we doing more with telehealth? Why do Medicare reimbursements still favor face-to-face encounters?

Rural nurse practitioners: In a recent study, Skillman found that rural nurse practitioners are highly satisfied and well paid. “There could be an interesting story here,” she said. “Take the data and then see what these folks are doing. Why are they happy? The data doesn’t tell us that but journalists can.”