GIS: A Healthcare Workforce Development Tool

This paper applies GIS to development of healthcare workforce. Demographic and workforce data have been juxtaposed in order to anticipate consequences of workforce location. Workforce location is critical to delivering effective healthcare services, especially in rugged, mountainous, rural terrain. Decisions regarding workforce often involve a geographical location; since, depending on its location, each localized workforce faces different populations with different health status characteristics. The problem is a logistical one -- How can West Virginia best deploy its healthcare workforce? What is the appropriate spatial design of healthcare workforce?

"West Virginia hospitals and Critical Access hospitals are seen against a population density backdrop in this first map."

"West Virginia health status stands in need of improvement. Total cancer deaths for a 9-year period from 1989 to 1998 stand at 221.2 average deaths per 100,000 population compared to 213 average U.S. deaths per 100,000 for the same period. Overall dancer death rates generally worsen from northern to southern West Virginia."

"West Virginia's breast cancer deaths average 30.2 per 100,000 population compared to a slightly higher U.S. average rate 34.3 deaths per 100,000 population) from 1989 to 1998."

"Lung cancer deaths exceed U.S. death rates by 11.7 deaths per 100,000 population from 1989 to 1998. West Virginia deaths per 100,000 averaged 70.7 per 100,000 population compared to 59.0 average deaths per 100,000 U.S. population. Note that lung cancer death rates are significantly worse in southcentral and southern West Virginia. Self-reported smoking percentages are also higher in these areas than elsewhere in the State."

"COPD deaths in West Virginia from 1989 to 1998 exceeded U.S. deaths by more than 10 deaths per 100,000 population. West Virginia averaged 50.2 deaths per 100,000 population; the U.S. averaged 40.5 deaths per 100,000. Deaths due to COPD were significantly higher in southcentral, eastcentral and southern West Virginia than elsewhere in the State."

"Diabetes is another problem disease for West Virginia. West Virginia averaged 28.2 diabetes deaths per 100,000 population from 1989 to 1998 compared to 22.7 deaths nationwide."

"Combined with health status problems are West Virginia's economic pressures. West Virginia has an uninsured population in excess of 25% in its eastcentral counties. Only the Northern Panhandle shows less than 10% uninsured."

"An obvious outcome of lack o insurance is a high rate of uncompensated care. The entire central portion of the State presented more than 10% uncompensated care in 1999."

"Per capita incomes for Year 2000 reached $22,000 to 27,000 per year in only a few counties in southcentral, northcentral, Northern Panhandle and Eastern Panhandle counties."

"Numbers for Potential Years of Life Lost are startling, especially for southern West Virginia. West Virginia averaged 5559 Potential Years of Life Lost from 1989 to 1998. The U.S. averaged 4846.6 Years of Potential Life Lost for the same period."

"Of 6.073 physicians licensed in West Virginia by the West Virginia Board of Medicine in 2000, only 58% resided in West Virginia. The MD 'Diaspora' extends across the U.S. with heavy concentrations along the northeastern U.S. Coast and in clusters along the West Coast, Gulf Coast, and in eastern Florida. Many West Virginia licensed physicians have chosen residence in Pennsylvania, Ohio, Kentucky, Virginia, and Maryland."

"Focusing in West Virginia, physicians reside in large numbers in Monongalia county (where the State's largest medical school is located), in Cabell county (where the State's second medical school is located), and in the Northern and Eastern Panhandles near large populations, as well as in a belt across the southcentral region of the State which corresponds to a 'population belt'."

"Total M.D.s in Monongalia (515), Kanawha (688), and Cabell (416) counties far outnumber those in the rural counties, where sometimes only a handful practice and fewer still reside."

"If a population denominator is included in our healthcare equation, only 3 West Virginia counties attained 3 to 6 M.D.s per 1000 population in year 2000. Most counties had less than one M.D. per 1000 population."

"Looking at West Virginia primary care physicians, it is evident that 13 of the State's 55 counties actually lost primary care physicians between 1994 and 2000."

"West Virginia licensed osteopaths were geocoded nationwide by office zipcode. Of 837 total osteopaths licensed in West Virginia in 2000, more than 41% operated offices outside West Virginia."

"Within West Virginia, osteopaths' offices were most concentrated in northcentral and in a belt across southcentral West Virginia."

"Adding a population denominator to osteopaths, only Greenbrier county shows more than one osteopaths per thousand county population. Greenbrier county hosts West Virginia's School of Osteopathy."

"Dentists are in extremely short supply. Most counties had far less than one dentist per 1000 population. Only 9 counties had between 0 and one dentist per 1000 population. The State's School of Dentistry is located in one of these counties (Monongalia)."

"Of 22,841 RNs licensed in West Virginia in year 2000, more than 70% resided within the State."

"It appears that RNs are often distributed according to areas of dominant influence (i.e., Washington, D.C., Pittsburgh)."

"Five counties within West Virginia lost licensed primary care RNs between 1994 and 2000. Only in Kanawha does a substantial number of primary care RNs display (599 primary care nurses)."

"Of 2,924 pharmacists licensed in West Virginia in 2000, only 56% resided within the State. Instead, they were scattered from East Coast to West Coast."

"Rate pf pharmacists per 1000 population by county shows only Hancock and Monongalia counties reaching 1 to 2 pharmacists per 1000 population. Monongalia county hosts the State's only School of Pharmacy."

"Enlarging the small population map causes the population across southern West Virginia to display."

"Married and related pharmacists living in the same household are noticeably numerous in West Virginia and neighboring states. Perhaps, there are implications for policy-makers in this map. Would incentives for married practicing pharmacists lead more to remain in West Virginia?"

Workforce Data Sources:

• WV Board of Examiners for Dentists & Dental Hygienists
• WV Board of Examiners for Licensed Practical Nurses
• WV Board of Examiners for Registered Professional Nurses
• WV Board of Osteopathy
• WV Board of Pharmacy
• WV Board of Medicine

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Center for Healthcare Policy and Research Robert Fulda, Dr. PH Research Associate e-mail: rfulda@hsc.wvu.edu

Kenna Levendosky. M.S. GIS Analyst West Virginia Health Care Authority 100 Dee Drive Charleston, WV 25311-1600 Phone: 304-558-7000 ext 245 FAX: 304-558-7001

West Virginia Health Care Authority e-mail: klevendosky@hcawv.org

Website: www.hcawv.org