Magazine article Nursing Economics

Improving Nursing Workforce Forecasts: Comparative Analysis of the Cohort Supply Model and the Health Workforce Simulation Model

Magazine article Nursing Economics

Improving Nursing Workforce Forecasts: Comparative Analysis of the Cohort Supply Model and the Health Workforce Simulation Model

Article excerpt

BALANCING THE SUPPLY and demand of healthcare professionals is critical to a well-functioning healthcare delivery system. Shortages of providers can have severe consequences for patients who need care, and can induce burnout and overwork among scarce providers. Surpluses of providers can also have harmful effects; healthcare professionals invest heavily in their careers and cannot always easily shift to other careers when no jobs are available.

Forecast models can help policymakers, educators, and others to anticipate and take action to forestall or mitigate surpluses or shortages of key providers. For example, forecast models of the nursing workforce in the early 2000s were projecting large nursing shortages by the 2010s and 2020s as Baby Boomers retired and smaller cohorts of registered nurses (RNs) followed them (Buerhaus, Staiger, & Auerbach, 2000; U.S. Health Resources and Services Administration (HRSA) (2002). These forecasts were instrumental in fostering public and private initiatives to boost interest in nursing and enrollment into nursing education programs, which doubled between 2002 and 2012 (Auerbach, Staiger, Muench, & Buerhaus, 2013).

Forecast models rely on a number of predictable factors, such as demographic trends and observed workforce patterns to make inferences about potential future imbalances. Not surprisingly, because these highly complex models use different underlying data sources, model structures and assumptions, and serve somewhat different purposes and audiences, their projections often do not agree. In the case of the RN workforce, this variation in forecasts leads to confusion among the many stakeholders who rely on these forecasts (such as federal and state governments, healthcare delivery organizations, educational institutions, and staffing firms) to best prepare their organizations for the future (Spetz, 2015).

Given evolving changes in delivery systems, implementation of payment reform, adoption of a population focus, retirement of Baby-Boomer RNs, and physician shortages, the confusion and uncertainty over forecasts of RN supply, demand, and shortages is particularly unsettling to organizations, educators, and public policymakers (Buerhaus, Skinner, Auerbach, & Staiger, 2017). As a researcher recently noted about these varying forecasts, "what is a nurse leader or educator to do?" (Spetz, 2015, p. 178).

Partly in response to this challenge, two of the leading forecasters of the RN workforce - HRSA Bureau of the Health Professions, and Montana State University's Interdisciplinary Center for Healthcare Workforce Studies - jointly convened a meeting of the nation's experts on modeling the supply and demand for nurses to better understand and reconcile underlying model differences, and discuss communication, messaging, and other strategies around workforce forecasts.

Following the July 2016 Montana meeting, key investigators of both models discussed similarities and differences in the respective supply forecasting models. To elucidate the areas that make a major difference in each model's output, it was decided to conduct a sideby-side empirical analysis of underlying assumptions, variable definitions, and determine their impact on supply forecasts made from each model over the same projection time period. This article reports on the results of this comparative analysis, identifies the key factors that workforce analysts should monitor to anticipate changes in the future size of the nation's RN workforce, and makes recommendations for how the two forecast models can be modified.

Model Descriptions

Key details of the two supply forecasting models are discussed, beginning with the Cohort supply model and followed by the Health Workforce Simulation Model (HWSM) developed by IHS Markit and used by HRSA.

Structure of the Cohort Supply Model

The model first used by Buerhaus and colleagues (2000) (Cohort model) is an age-cohort based model derived from the field of labor economics that decomposes the proportion of each birth cohort (defined by birth year) working as RNs in each year into the product of two components: (a) a cohort effect that estimates propensity of individuals born in any given year to work as an RN (which captures, for example, changes across birth cohorts in perceived attractiveness of a nursing career relative to other occupations); and (b) an age effect that captures propensity of RNs to be working at different ages over their career lifespan (which captures, for example, life cycle patterns such as retirement and tendency of female RNs to work less during their childbearing years) (Auerbach, Buerhaus, & Staiger, 2015; Buerhaus et al. …

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