Current Projects

Learn more about our ongoing projects here:

Year 11 Projects

Y11P1: Colocation of Primary Care, Dental, and Pharmacy Residencies: An Analysis of Interprofessional Post-Graduate Training

Investigators: Emily M. Hawes, PharmD, BCPS, CPP; Brianna Lombardi, PhD, MSW; Elizabeth Mertz, PhD; Cristen P. Page, MD, MPH; Marko Vujicic, PhD; Evan Galloway, MPS; Erin P. Fraher, PhD, MPP.

An integrated, interprofessional team-based model of practice is an essential element of delivering high- quality primary care. Integrating dentists and primary care physicians enhances access and coordination of care. Despite support for interprofessional education across national health organizations and accrediting bodies, little is known about the prevalence and composition of interprofessional post- graduate training on a national level. This project will produce a much-needed body of evidence on the prevalence, location and factors predicting co-location of dental, pharmacy and primary care residencies in the United States.

The aims of this study are:

  1. Identify the proportion of pharmacy and primary care physician post-graduate training programs that are collocated.
  2. Identify the proportion of pharmacy, dental, and primary care physician post-graduate training programs that are collocated.
  3. Examine predictors of pharmacy and primary care post-graduate training program colocation as well as pharmacy, dental, and primary care post-graduate training program colocation [such as program sponsor, residency specialty/size, training setting (e.g., FQHC, hospital.), state, and measures of underservice (e.g., Area Deprivation Indices, metro/non-metro)].

 

Y11P2: Investing in New Nurse Faculty Retention: Understanding Transitions, Onboarding and Integration into the Academic Environment

Investigators: Cheryl Jones PhD, RN; Sinhye Kim PhD, RN; Jill Forcina, PhD RN

Emerging discussions in nursing academia recognize the need to provide intentional onboarding to recruit, grow, develop, and retain new nursing faculty in response to nursing faculty shortages which are often described as a major bottleneck in preparing new nurses to enter nursing practice. This project will examine the prevalence and characteristics of faculty onboarding programs and the value of programs in achieving key program outcomes. The work will proceed in two phases: (1) a systematic review of the literature on nursing faculty onboarding programs and (2) a cross-sectional survey of U.S Schools of Nursing to describe the characteristics of existing faculty onboarding programs and examine leaders’ perceptions of these programs.

 

Y11P3: Intersecting Identities: The Influence of Race/Ethnicity, Sex and Undergraduate Historically Black College and University (HBCU) Education on Black Student’s Application, Acceptance and Graduation from Medical School

Investigator: Jasmine Weiss, MD, MHS

As a follow-up to a Year 10 study that highlighted the contributions of HBCU undergraduate institutions on the acceptance, matriculation, and graduation of Black physicians from 1980-2020, this project will explore differences in these trends by sex to characterize how intersectionality between race and gender may contribute to the production of Black physicians who complete their undergraduate studies at HBCUs. Findings from this study could serve as evidence of the changing dynamics of gender and race of those applying and matriculating into medicine from HBCUs vs. non-HBCUs. Understanding these dynamics is important to educational accrediting bodies, hospital systems, medical schools, and for federal and state policy makers to shape investments in undergraduate institutions that increase representation in the physician workforce.

 

Y11P4: Understanding State Trends of Workplace Violence for Health Care Workers by Worker Type and Setting

Investigators: Brianna Lombardi PhD, MSW; Evan Galloway, MPS; Todd Jensen PhD, MSW; Erin Fraher PhD, MPP

Workplace violence (WPV) continues to be a major factor impacting work conditions for the health workforce, with previous literature suggesting workplace violence leads to higher rates of burnout, reduced well-being, and intention to leave the workforce. As a follow-up to a Year 10 study that examined national rates of WPV for the health care workforce by setting (i.e., industry) and health care worker type (i.e., occupation), this project will extend upon this work by addressing the following aims:

  1. Estimate rates of WPV by state over the last 10 (2011-2021) years—examining if state rates vary by setting/occupation, the characteristics of health care workforce, and the effect of the presence/absence of state WPV laws
  2. Explore if, within different professions, there is variation in WPV rates by setting (e.g., nurses in hospitals compared to nurses in ambulatory care settings)

 

Y11P5: Backcasting FutureDocs: Understanding the Factors Affecting the Accuracy of Physician Workforce Projections

Investigator: Erin Fraher, PhD, MPP; Mark Holmes, PhD; Thomas C. Ricketts, PhD, MPH;  Andy Knapton, MSc; Evan Galloway, MPS

Comprehensive, accurate, timely data on physician supply and demand are critical to help policy makers identify which specialties, geographies, and settings to target for policy interventions to strengthen the workforce, which has become even more critical as the US responds to the COVID-19 pandemic. This project responds to calls for improved projection models by evaluating how well the supply projections made by the FutureDocs, a projection model developed by the Sheps Center in 2014, matched actual supply in 2019, 2020 and 2021—a process termed “backcasting.” We will compare the actual, observed number of physicians in the workforce to the number projected and assess factors associated with deviations from the projections.

 

Ongoing Projects 

The Changing Hospital Workforce

Principal Investigator: Erin Fraher, PhD, MPP

This project will examine staffing data from the American Hospital Association’s Annual Survey to understand whether, and how, hospital staffing composition has changed between 2005 and 2021. There is speculation that the number and skill mix of the hospital workforce has, and will continue, to change in response to the pandemic; this project provides the historical data needed to evaluate whether changes occur and, if they do, what hospital characteristics are associated with these changes.

 

The Increase in Numbers of Community Health Workers Billing for Services

Principal Investigator: Brianna Lombardi, PhD, MSW

Community Health Workers (CHWs) are an important workforce for health systems to achieve health equity and reduce health disparities in vulnerable communities. This study will use the CMS National Plan and Provider Enumeration System (NPPES) to understand the growth of CHWs with a National Provider Identifier (NPI) over the past ten years and examine characteristics of CHWs with NPIs including geographic location, setting type, and if the CHWs have additional taxonomy accreditations.

 

The Workforce Providing Social Risk Screenings in Community Health Centers

Principal Investigator: Brianna Lombardi, PhD, MSW

Community Health Centers (CHCs) are mandated to address the physical, behavioral, and social needs of the vulnerable communities they serve and the composition of staff in CHCs likely is associated with their ability to conduct social risk screenings. Using the Uniform Data System (UDS) for HRSA-supported CHCs, this study will examine if employment of social workers or enabling providers (i.e., community health workers, case managers, health educators) is associated with an increased documentation of social risk screening at CHCs.

 

Understanding the Contributions of Undergraduate Historically Black Colleges and Universities to Increasing the Diversity of the Physician Workforce: Supplement Funded

Principal Investigator: Jasmine Weiss, MD, MHS

Increasing the diversity of the physician workforce is critical to addressing health disparities in the United States, particularly for Black Americans. This study will examine the role of undergraduate Historically Black Colleges and Universities (HBCUs) in increasing the representation of Black physicians in medical schools and ultimately the physician workforce.

 

Toward a Better Understanding of the Career Trajectories of Physicians from Underrepresented Groups in Medicine.

Investigator: Erin Fraher, PhD, MPP, and William F. Owen, Jr., MD, FACP

The purpose of this study is to use life course theory as a conceptual and methodological framework to investigate how race/ethnicity, age, and gender influence the practice patterns of North Carolina’s primary care physician workforce in different time periods, including whether the physician provides prenatal care, if s/he performs obstetric deliveries, the number of hours worked per week, the type of employment setting in which s/he practices (hospital, group clinic, solo practitioner, medical school etc.) and whether s/he practices in an underserved community. Using data collected on physicians between 2005 and 2019, we will test the following hypotheses:

    1. Between cohort effects: Primary care physicians from URM groups who graduated medical school in different periods will exhibit different practice patterns than their white colleagues.
    2. Intracohort gender effects: Different practice patterns will be observed for male and female primary care physicians of different race/ethnicities within the same medical school cohort.
    3. Age effects: Male and female primary care physicians from URM groups will exhibit different practice patterns at the same age, depending on when they graduated medical school.

 

The Impact of COVID-19 on Primary Care Practice

Investigator: Valerie Lewis, PhD

COVID19 has caused dramatic changes to primary care access and delivery that present significant issues to the primary care workforce. First, primary care practices have cancelled large swaths of in person visits while working to rapidly implement telehealth. This is coupled with dramatic declines in revenue that present organizations with difficult financial choices.  The intensity of care under COVID19 likely may be increasing burnout among clinicians. Currently, information on these changes is largely anecdotal. We propose to conduct qualitative interviews with approximately 40 primary care practices in several states, purposively sampled across key dimensions (e.g. size, rurality, ownership).

 

Structural Factors Driving Burnout in Medicine: A Study of Pediatric Surgeons

Investigator: Tania Jenkins, PhD

While research on wellbeing and satisfaction in medicine has increased exponentially over the last ten years, much of this research has emphasized individual-level causes and interventions. Yet, individual-level approaches do little to address the broader structural factors that may be shaping physician satisfaction and wellbeing. A 2019 National Academies of Science, Engineering, and Medicine (NASEM) consensus study called for more research taking a more systemic approach to clinician burnout, but to date, no available study has comprehensively considered how these factors shape physicians’ everyday experience.

This study compared two specialties (pediatrics and pediatric surgery) to investigate:

  • How do societal- and institutional-level factors (factors external to the profession) work together to shape physicians’ professional satisfaction and wellbeing?
  • How do factors internal to the profession, such as training structures and specialty cultures, interact with external societal and institutional pressures to shape physicians’ satisfaction and wellbeing?
  • And how do societal, institutional, and professional factors affect physicians’ satisfaction and wellbeing across the career span?

 

How Institutional, Professional and Societal/System Factors Shape Career Satisfaction and Wellbeing among Physicians and Trainees

Investigator: Tania Jenkins, PhD

This mixed-methods study is a novel analysis of existing quantitative burnout and job satisfaction data and qualitative interviews (n=~125) and observational data (n=~500 hours) collected during previously funded work (2020-2022) to investigate new research questions including: 1) what ‘feeling valued’ means to physicians and trainees, 2) how workflow and work organization—often designed to optimize economic value—might exact a toll on workers, and 3) what workplace changes can be made to improve physician health. Findings from this study will generate evidence on the factors influencing physician and trainee well-being that can inform future rounds of HRSA funding to support health workforce resiliency and educators as well as guide employers seeking information about ways to address health care worker burnout.

 

State-Based Approaches to Leveraging Medicaid-Funded Graduate Medical Education

Principal Investigator: Erin Fraher, PhD, MPP

Total Medicaid funds invested in graduate medical education (GME) increased from $3.78 billion in 2009 to $7.39 billion in 2022. States have considerable flexibility in designing Medicaid GME payments to address population health needs. The goal of this study was to use states as “policy laboratories” to understand states’ impetus for using Medicaid funds for GME, the structure of their investments, the composition and charge of advisory bodies that guide these investments, and the degree of transparency and accountability in place to track whether Medicaid GME investments achieved desired workforce outcomes. Two rounds of structured interviews were conducted in 2015-2016 and 2019-2020 with key stakeholders from 10 states. Interview transcripts were analyzed and coded in six thematic areas: impetus for change, payment, advisory bodies, transparency, accountability, and challenges. Findings from this study can inform individual state efforts and guide federal policy makers interested in convening learning collaboratives to share best practices and strategies to address common challenges encountered by states in designing Medicaid GME to meet their workforce needs.


This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under Cooperative Agreement for a Regional Center for Health Workforce Studies #U81HP26495. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.