NC Health Care Recommendations: Healthcare Workforce

On April 11, 2006, the North Carolina House Select Committee on Health Care released recommendations for the 2006 legislative short session. Many of them will be controversial, and taken together they have the potential to significantly change the way that North Carolinians access health care and insurance (and how much we pay). Some of these topics are pretty technical, but no less important for their difficulty. I'm hoping that these posts will begin a conversation on the best course for North Carolina's efforts at healthcare reform.

I'll publish the recommendations of the six subcommittees in six posts, along with some of the background information from each report. The subcommittees are:

1. Nursing Faculty Fellows Program

The Subcommittee on Healthcare Workforce recommends that the House Select Committee on Health Care encourage the General Assembly to enact the Subcommittee's Proposed Committee Substitute for House Bill 1718 Nursing Faculty Fellows Program/Funds, which establishes a scholarship loan program enabling recipients to become full-time nursing teaching faculty.

North Carolina is suffering from a nurse shortage. The problem isn't a lack of nursing school applicants—there are long waiting lists. The problem is lack of faculty. The proposed legislation establishes a Fellows Program to be administered by the North Carolina Nursing Scholars Commission. The program's purpose would be "to provide up to a two-year scholarship loan [$8,000 per year] to selected recipients and extracurricular enhancement activities for scholarship loan recipients." The money would go to "only the best" candidates to become nursing school faculty. If the candidate finishes the necessary education to become faculty and then becomes faculty, the loan may be forgiven. There would be 50 scholarships offered in the next year.

2. Support NC NOVA

The Subcommittee on Healthcare Workforce recommends that the House Select Committee on Health Care support the North Carolina New Organizational Vision Award Program in an effort to address the shortage of direct care workers.

"Direct care workers," such as orderlies, nurse aides, home health aids, and personal care aids, are a rapidly growing part of the North Carolina health care system. They tend to get paid between $8 and $10 an hour, and the turnover in NC has been higher than the national average.

NC New Organizational Vision Award (NC NOVA) is a voluntary, incentive-based program that licenses home care agencies, adult care homes, and nursing homes. (It's a project of the Robert Wood Johnson Foundation and the Atlantic Philanthropies.) The subcommittee's recommendation is simply to provide state funds to further the NC NOVA program.

The report makes a good case that something like NC NOVA is required in the state, but it doesn't contain much that tends to show that NC NOVA is accomplishing its goals well. In other words, there is clearly a need, but is NC NOVA the right solution? I'd like to know more about NOVA's effectiveness.

3. Support Allied Health and Nursing Programs

The Subcommittee on Healthcare Workforce recommends that the House Select Committee on Health Care encourage the General Assembly to support proposals from the North Carolina Community College System to designate allied health and nursing training programs as "high-cost" programs in an effort to assure hiring and retention of qualified faculty and the acquisition of appropriate facilities, equipment, and technology.

NC's healthcare needs will balloon over the coming years. Meanwhile, the General Assembly has expressed an intention to provide additional funds to "high-cost" programs at the Community College level. This recommendation is simply to make sure that the programs that will provide the health workers we need for the future fall within that definition of "high-cost."

4. Support AHEC Funding Priorities Regarding Mental Health

The Subcommittee on Healthcare Workforce recommends that the House Select Committee on Health Care encourage the General Assembly to support the funding priorities proposed by the North Carolina Area Health Education Centers (AHEC) with regard to developing new models for preparing mental health professionals to practice in the reformed mental health system, and linking primary care professionals to behavioral health professionals in new models of care at the community level.

To go much beyond the language of the recommendation, I'd have to know much more about "the reformed mental health system" and AHEC. Anybody understand this one?


Thanks for all this, Lance.

It feels a little like homework! I'm planning on digging through it all when I get some free brain cells. Right now all I have the capacity for is bitchin' and moanin'.

It definitely is homework!

It's my sense that there could be some big positive changes to healthcare in North Carolina coming out of this legislative session, and I think we ought to be involved in that. So it definitely is homework.

But it isn't due on Monday, so enjoy your weekend!

These all sound on the

These all sound on the surface like very positive changes for the state of health in NC. It's something I've looked into, professionally as a pharmacist, and personally. I'm working in Oregon right now (and can't wait to get back to NC and out of the perpetual rain), and they've got some interesting things implemented. Of course, since there's no sales tax, they also have little funding for these things.

When I get home in July, I'd like to do something grassroot-y on this for sure.

I know what you mean

about their looking like good ideas "on the surface." I've tried not to be over-enthusiastic about any of the proposals because there's no telling: (a) what will come out of the legislature as a finished statute; (b) whether the new laws will be implemented the way the legislature meant for them to be; and (c) what the unintended consequences will be.

I think we can be happy

that they're even looking at the issue in a systematic way. And I really appreciate you bringing the substance here in an equally systematic way.

The challenge of workforce planning over the next five years is a potential nightmare. People on the leading edge of the boomers are walking away from jobs taking 30+ years of experience with them. The talent gap promises to be large and burdensome on many, many fronts.

On the upside,

people my age expect to be paid well for serving in that gap.

I like the way you think.

Truly. Even when I disagree . . . which I'm learning not to do.



I completely skimmed that line on the first read-through! The AHECs are the healthcare education centers in the state. (Er, not that that's any clearer.) Medical, pharmacy, and nursing students (among others) are trained in the various AHECs in the state. (I was in the Duke AHEC.)

The fairly-informative website is here.

In Chapel Hill

AHEC is mostly known as the organization that needs the local airport to stay open (the one in town) so medical people can quickly scoot around the state and be helpful. I think that's a pretty good reason to keep the airport open.


PS You registered! Welcome!

Thanks! I've been lurking

Thanks! I've been lurking about for about a month now, and now there's something to get me posting. And filling in the form every time was getting tedious ;)

Welcome, Diane!

we need someone to help dilute all the testosterone. Well, that's not really true. I just like typing testosterone.