This is simple math: Health care equals jobs. And the new health care reform law means even more jobs. In many communities across the United States, the health care industry is the region’s top employer. Indeed, if you put this in a global perspective, the National Health Service in the United Kingdom now employs 1 in every 23 workers in that country, some 1.3 million people. (The NHS is the third largest employer in the world, only ranking behind the Chinese army and India Rail.)
The numbers in Indian Country show that same kind of growth. Look at the figures before President Johnson’s Great Society (and the expansion of federal programs): The Bureau of Indian Affairs employed 16,035 full time employees in 1969, while the Indian Health Service employed 5,740 people. That trend is now reversed. In 2009 the BIA employed 8,257 full time workers and the IHS had grown to 15,127 employees. These are just the number of federal employees, because tribes or organizations administer roughly half of the Indian health system.
The demand for health care workers in Indian Country represents a public policy paradox: We need jobs in communities where the official unemployment rate is about 50 percent and yet the Indian Health Service reports shortages of health professionals.
The IHS describes its employment situation this way:
“The physician vacancy rate now stands at approximately 21%, and the average length of service of the approximately 800 federally employed physicians in Indian health is 10 years.
The dental vacancy rate of 24% is higher than it has been in many years. Pharmacy vacancy rates have increased to 11% from 8% in FY 2008 and nursing vacancies are up to 26% nationwide. Of particular concern is the shortage of registered nurses nationwide in both the inpatient and outpatient settings. These are the nurses most needed throughout Indian health. The agency expects the shortage of registered nurses will increase markedly over the coming years due to the increasing age of the U.S. nurse population (the average age of nurses in the U.S. is 47 years) and decreasing numbers of nursing schools, graduates, and new students. Pharmacy is facing similar issues in that fewer people are entering pharmacy schools at a time when the need for pharmacists is projected to grow considerably over the next 8 – 10 years.”
The paradox represents a great challenge for American Indian and Alaska Native leaders. We know these jobs are there. Guaranteed. And this already rich opportunity is getting better because of the Patient Protection and Affordable Care Act (health care reform).
But the challenge is to get young people the kind of education needed to be successful. The way I look at it there needs to be a significant investment in terms of strategy, time and money to meet this demand. Imagine what it means to guarantee a young person a job – better yet, a career.
The health care reform bill has several provisions designed to increase the pool of people entering medical-related fields. The big push is in the area of “primary care.” There should be training and scholarship money for at least the next five years for new models for programs such as team management of chronic diseases, a practice the IHS does well now.
The law also calls for:
- A Workforce Advisory Committee to develop a national strategy;
- A significant increase scholarships and loans (including those with either repayment or retention incentives);
- Additional funding for training dollars for nurse practitioners. This is where the action is and a critical area because of the emphasis on nurse practitioners and physician assistants acting as a lead agent in primary care. The difference in the two jobs is interesting, both work under the direction of a medical doctor, and usually both fields require a Master’s Degree, but there are more hours of clinical training required for the PA and there are differences in the types of cases.
The Indian Health Care Improvement Act also opens up training and education dollars specifically for the Indian health system, specifically for paraprofessionals as Community Health Representatives and Community Health Practitioners.
There should be a wide range of jobs created by an expansion of the health system: Dieticians to help people stay well by eating better; ethicists to help families talk through difficult decisions; and administrators to move paperwork. The Center for American Progress estimates that between 2.5 million and 4 million jobs will be created during the next decade.
How big a number is 4 million new jobs? If even one-half of one percent of those jobs ends up in the Indian health system, that’s an increase 20,000 jobs or more people than work at IHS today. We’d better get ready for a great opportunity. Fast.
Mark Trahant is an advisory board member for InvestigateWest and a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes.