House Ways & Means Subcommittee Issues Testimony From University of Washington School of Medicine Professor Frogne
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My name is
I bring to this testimony extensive health workforce research conducted over 20 years by my Center. Within my Center, I am currently the Principal Investigator of two large federal funded center grants, one of which focuses on allied health professionals and the other which focuses on health equity. Among the relevant topics about which my team has published include defining career pathways into and within the health care industry, identifying barriers to achieving a diverse health workforce, and examining policies and programs that support our health care workers in providing high quality and culturally competent care.
I have followed the HPOG program with great interest since its inception in 2010. My early research experience was examining the transitions of participants in the Temporary Assistance for Needy Families (TANF) program and their employment outcomes based on a large-scale
Health care has been a constant source of jobs in the economy, providing relatively low barriers to entry and opportunities for career growth for former TANF recipients and other low-income populations. Between 2009 and 2019, health care added approximately 2.6 million jobs to the economy4 and is projected to add another 2.4 million jobs by 2029./5 During tough economic times, health care has served as a job engine, most often drawing workers who have been unemployed or out of the labor force as well as those working in the hospitality and retail sectors.6
Given that hospitality has a 13.5% unemployment rate as of
Career progression to higher skilled jobs in high demand, such as a nurse practitioner or physician assistant, is possible with employer supported on-the-job training such as found in Registered Apprenticeship models, which is an integral component of the HPOG program.11 A pressure facing health care is high turnover rates among entry-level positions,12 as well as in specific settings such as skilled nursing facilities where the average turnover rates were estimated to be above 100% across skill levels before the pandemic and may remain high well after the pandemic.13,14 While low wages play a role in turnover, other contributing factors include burnout, lack of promotion opportunities, lack of employee assistance programs such as child care.15,16,17,18
We also know that many workers in entry-level health care positions are left without health insurance, rely on the
These services are also important to retain a diverse pipeline of health care workers given that minority populations are more heavily represented in entry-level positions rather than in higher skilled positions.22 These support services are likely to be contributing to the success of HPOG based on
In summary, to provide high-quality care to patients, we need a high-quality health workforce. To produce that workforce, we need to provide opportunities for career advancement through on-the-job trainings combined with support services to allow workers to focus on their careers. The HPOG program has a proven track record that is built on evidence, and with expanded investments, has the potential to strengthen our pipeline of health care workers in areas of greatest need.
Thank you again for the opportunity to testify today. I look forward to answering your questions.
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Footnotes:
1 Angel R, Burton L, Chase-Lansdale PL, Cherlin A,
2 Frogner B, Moffit R,
3 Cherlin A, Frogner B, Ribar D,
4 Calculation based on 2009 and 2019 data for NAICS codes 621, 622 and 632 extracted from
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6 Frogner BK. The health care job engine: where do they come from and what do they say about our future?
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9 Werner A, Schwartz D, Koralek R, Loprest P, Sick N. OPRE Report No. 2018-09: Final report: national implementation evaluation of the first round Health Profession Opportunities Grants (HPOG 1.0). 2018. Available at: https://www.acf.hhs.gov/sites/default/files/documents/opre/final_nie_final_report_1_11_18_clean_v2_b508.pdf
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11 Frogner BK, Skillman SM. Pathways to middle-skill allied health care occupations. Issues Sci Tech 2016. Available at: https://issues.org/pathways-to-middle-skill-allied-health-care-occupations/
12 Friedman JL, Neutze D. The financial cost of medical assistant turnover in an academic family medicine center. JABFM 2020; 33:426-430.
13 Gandhi A, Yu H, Grabowski DC. High nursing staff turnover in nursing homes offers important quality information. Health Affairs 2021; 40:384-391.
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16 Skillman SM, Dahal A, Frogner BK, Andrilla CHA. Frontline workers' career pathways: a detailed look at
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18 Fischer SH, McBain RK, Faherty LJ, Sousa JL, Kareddy V, Gittens AD, Martsolf GR. Strengthening the entry-level health care workforce: finding a path. ASPE Report 2020. Available at: https://aspe.hhs.gov/pdf-report/ehcw-finding-a-path 19 Frogner BK, Skillman SM, Patterson DG, Snyder CR. Comparing the socioeconomic status of workers across healthcare occupations.
20 Dahal A, Skillman SM, Patterson DG, Frogner BK. What commute patterns can tell us about the supply of allied health workers and registered nurses.
21 Skillman SM, Patterson DG, Coulthard C, Mroz TM. Access to rural home health services: views from the field.
22 Snyder SR, Frogner BK, Skillman SM. Facilitating race and ethnic diversity in the health workforce.
23 Peck LR, Litwok D, Walton D, Harvill E,
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