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Task Force
On Health
Care Workforce


Public Input Welcomed

Aug. 20, 2002
July 16, 2002
May 30, 2002
April 12, 2002

Competing for
Quality Care -
Findings and Proposals
for Montana's Health
Care Worforce
- Final Report

(Adobe Acrobat format - 650KB)

Governor's Blue Ribbon Task Force On Health Care Workforce Shortage

Wilderness Room, The Colonial Building
Thursday, May 30, 2002


To accurately assess the shortage of health care workers, and to develop recommendations and strategies to effectively address the issue.


Loren Soft, Chairperson, Billings
Jim Ahrens, Montana Hospitals Association
Sami Butler, Montana Nurses Association
Rose Hughes, Montana Health Care Association
Joyce Scott, Academic and Student Affairs
Sharon Kott, Area Health Education Center
Wendy Keating, Montana Department of Labor
Brian Zins, Montana Medical Association
Mary McCue, Montana Dental Association
Steve Yeakel, Helena, Montana
Representative Edith Clark, House District, 88
Joe McDonald, Salish Kootenai College
Jim McGarvey, Montana State AFL-CIO, MEA-MFT
Mike Hanshew, Montana DPHHS
Bob Bartholomew, Montana AARP
Jani McCall, Consulting with Communities
Desiree Taggart, Office of Economic Development
Jody Messinger, Office of Public Instruction
Patty Ehrhardt, Montana Clinical Laboratory Managers Association
Rita Harding, Billings Area Indian Health Service


Linda Ashworth, Secretary


Chairman, Loren Soft, in the Wilderness Room of the Colonial Building, called the meeting to order at 8:45 a.m.


Attendees: Loren Soft, Representative Edith Clark, Jody Messinger, Rita Harding, Sami Butler, Bob Bartholomew, Mary McCue, Sharon Kott, Rose Hughes, Jani McCall, Jean Branscum, Steve Yeakel, Jim McGarvey, Mike Hanshew, Patti Ehrhardt, Jim Ahrens

Guests: Laurie Ekanger, Trish Goudie, Dean of Nursing at MSU Northern, Arlene Parisot (representing Joyce Scott)


It was moved and seconded to approve the minutes of the previous meeting, as corrected.




(Letter submitted by Jody Messinger)

The Montana Office of Public Instruction’s Division of Career, Technical and Adult Education is seeking funding to hire a Health Occupations Education Specialist to help secondary schools throughout Montana to prepare students for careers in health occupations.

Unless steps are taken now to prepare for the future, Montana’s present health care workforce shortage will become a workforce crisis threatening both quality of care and community economic vitality.

The Looming Healthcare Crisis

Montana’s “baby boomers” (the nation’s largest population bubble, born between 1945 and 1964) are not babies any more. In fact, the leading edge of the boomers is approaching retirement age in 2010. A great proportion of the population will soon leave the workforce (including the health occupations workforce!) to join the age group that uses the health care system most heavily.

At the same time, the number of workers entering the health care field is diminishing. In fact, most health care occupations are facing a workforce shortage. And, the shortage is not short-term. The average age of health care workers is increasing. Hospitals and other health providers employ many members of the “baby boomer” generation. This extra large cohort of workers is followed by the “baby bust” generation - a relatively small pool of workers. Subsequent generations are entering the field in ever smaller numbers.

The “baby boomer” population entered the workforce at roughly the same time as Medicare and Medicaid were introduced, and many “baby boomers” were attracted to careers in health care. Now, “baby boomers” are approaching retirement, new generations have less interest in health care careers, and the inadequate supply of caregivers and support personnel is raising genuine operational problems as well as concerns about quality of care and continued community vitality.

Montana’s Health Care Workforce Shortage Profile

According to the U.S. Department of Health and Human Services’ recently published State Health Workforce Profiles, in Montana, some health care occupations - Licensed Practical/ Vocational Nurses (LPNs), nurse practitioners, certified nurse midwives, dentists, dental hygienists, dental assistants, pharmacists, psychologists, social workers, home health aides - are keeping pace with national average ratios of workers per 100,000 population. Other important occupations lag behind:

  • With 181 physicians per 100,000 population, Montana is below the national average ratio of 198 physicians per 100,000.
  • Montana has 764 licensed registered nurses (RNs) per 100,000 population, less than the national average of 798 per 100,000.
  • With 41 pharmacy technicians and aides per 100,000 population, Montana ranks 49th among the 50 states.
  • Montana has 6.5 psychiatrists per 100,000 population, well below the national average of 11.1 per 100,000.
  • With 19 occupational therapists per 100,000 population, Montana is below the national average of 24 per 100,000.
  • Montana has 25 respiratory therapists per 100,000 population compared to the national average of 31 per 100,000.
  • With 92 clinical lab technicians and technologists per 100,000 population, Montana is well below the national average of 105 per 100,000 population.
  • Montana ranks 40th in the nation in dieticians and nutritionists, with 14 per 100,000.

This snapshot does not tell the whole story. Montana needs nearly 1,000 more health care workers right now just to catch up to the national averages! And, as Montana’s population continues to age, demand for all occupations - including those that are now adequately staffed - will rise dramatically while the health care workforce diminishes. The impact will be felt more dramatically in Montana than in most other states because of our older-than-average population: by 2020, Montana’s population is projected to increase 15 percent, whilethe population over age 65 is projected to grow by 85 percent, compared to national growth projection of eighteen percent and fifty three percent respectively.

Impact on the Economy

Montana’s health care workforce is central to the state’s economy and crucial to local economic vitality. Health care is the largest single category of employment in Montana. More than 35,000 Montanans (approximately 10 percent of the workforce) work in the health services sector. Nearly half of them work in hospitals. In 2000, Montana’s health care payroll totaled more than $1 billion, representing approximately 12 percent of the state’s payroll economy.

Seeing Opportunity in Crisis

Montana’s health care workforce shortage offers an opportunity to address an urgent statewide need while providing comparatively well-paid employment in local communities throughout the state, not just the urban areas. The workforce shortage also offers an opportunity to increase the representation of Native Americans in health occupations. (Native Americans constitute six percent of Montana’s population, but there are no active Native American patient care physicians reflected in the profile.) However, Montana needs help to act on these opportunities.

Most other states are much better prepared than Montana to meet the growing demand for health care occupations. Health career preparation begins with education. Montana is one of only five states without a medical school and one of only seven states without a statewide Health Occupations Education curriculum. (The others are Alaska, Delaware, Louisiana, Nebraska, Nevada, and Rhode Island.) While the Office of Public Instruction cannot address the absence of a medical school, it is determined to promote appropriate health occupations curricula in Montana’s public schools.

K-12 Education Can Help Create a Health Occupations Workforce

K-12 education is the basic building block of the workforce. Unless primary and secondary schools provide students with skills and attitudes necessary to hold jobs and develop careers, employers of all types will face a workforce shortage. Today's health occupation options are vastly different from those of 10 or even five years ago. Students will only know and understand the opportunities that exist for them if there is a well-conceived, planned approach available in their schools. Career opportunities are not static.

They change as a result of various influences including technology, demographics, labor force, markets, etc. As career opportunities change, Montana’s schools must change with them to prepare students for real jobs in the real world. For now and the foreseeable future, many of those career opportunities in Montana are in health care.

Most health careers require a strong education in science and math throughout elementary and secondary school. But K-12 can and should provide more than the academic basics. Fortunately, most young people are healthy and have only limited contact with health care providers. As a result, many students do not appreciate the wide range of health care career opportunities. A health occupations program can introduce students to the wide range of health career options and provide instruction in basic skills that enable students to work in health care even while they pursue higher education. K-12 also can prepare students for entry level employment, licensing, and/or apprenticeship in health care careers such as Certified Nursing Assistant (CNA), Home Health Aide, Dental Assistant, Veterinary Assistant, Medical Receptionist, EMT, Dental Laboratory Technologist and others that do not require higher education.

To help schools throughout Montana prepare students for health occupations, the Office of Public Instruction proposes to employ a Health Occupations Education Specialist to:

  • serve as the primary liaison with local schools regarding health occupations education;
  • work with teachers and industry to develop programs;
  • facilitate development of content and performance standards;
  • facilitate teacher certification so that students can receive vocational education credits for health occupations courses;
  • design and present professional development opportunities for teachers;
  • organize site visits to and from model programs to expose teachers and students to best practices in K-12 health occupations education;
  • develop a rural schools pilot program to customize health occupations education to rural needs and opportunities;
  • spearhead affiliation with the Health Occupations Students of America (HOSA) national student organization to promote student leadership and advancement in health occupations; and,
  • manage state and federal program dollars.

A Strong Base of Support

Fortunately, we are not starting from scratch. Forward-thinking schools in Billings, Great Falls, Helena, Kalispell, and Shelby have initiated health occupations courses on their own. Other states have vast experience and successful models for establishing health occupations programs in rural areas such as Montana (and are willing to share their expertise). The Health Occupations Students of America (HOSA) student organization has well-structured models for cultivating and sustaining student interest and involvement in health occupations. Perhaps most important, the Governor’s Blue Ribbon Task Force on the Healthcare Workforce Shortage, and numerous health care organizations, associations, and providers (including the Montana Area Health Education Center – AHEC, Montana Health Care Association, Montana Hospital Association, Montana Nurses Association, Montana Department of Labor, Montana Department of Health and Human Services, Montana Dental Association, and the Montana Medical Association) support creation of this position. OPI is actively meeting with other stakeholder groups and will continue to expand this base of support. The unfortunate reality is that there is no money in the Montana state budget at this time to pay for the position.

Therefore, the Office of Public Instruction is looking to health care stakeholders and to the federal government for help to establish this position so we can help prevent a health crisis while demonstrating the value of this position to the Montana legislature in hopes of future funding.


The Office of Public Instruction projects that it will need $100,000 in the first year to launch the Health Occupations Education Specialist position:

Salary and benefits....................................................................$50,000

HOSA affiliation and participation (Schools)....................................$10,000

Professional development and technical assistance (Schools)............ $15,000

Start-up medical teaching equipment and materials for schools.......... $25,000

Total Budget...........................................................................$100,000


As a result of hiring a Health Occupations Specialist at the Montana Office of Public Instruction, we expect by the end of the first school year that:

  • A certification process for Health Occupations instructors will be in place;
  • A general health occupations curriculum guide will be developed;
  • At least 20 schools will commit to implement health occupations programs;
  • At least five rural and/or reservation schools will participate in piloting rural health occupations models;
  • Montana will be affiliated with the Health Occupations Students of America;
  • Montana industry representatives, health occupations instructors, students, parents, and local administrators will have visited at least three mature health occupations programs in other states;
  • At least three representatives of successful health occupations programs in other states will visit Montana schools to share experience and advice and mentor the development of Montana’s program;
  • At least 2,000 students will have been introduced to health occupations opportunities in Montana;
  • Evaluation baselines and data collection and analysis techniques and tools will be in place; and,
  • Funds will be secured to continue the program for at least two more years.

In the long term, we expect that, as a result of hiring a Health Occupations Specialist at the Office of Public Instruction, Montana students will find careers in health care in their local communities, helping to prevent a workforce crisis and ensuring quality of care and continued community vitality.


Jodi reminded the committee that the proposal would have to have statewide impact, include services that would include a large part of the population and have an impact on economic development. She suggested making a recommendation to the Governor asking her to look at this proposal.

Sharon Kott moved that the committee draft a letter to the Governor recommending that part of the workforce funds be accessed to fund part of the first year for the education specialist. The motion was seconded and passed unanimously. Sharon Kott volunteered to draft the letter for Chairman Soft’s signature.

Jodi also reported that the Office of Public Instruction had federal funds matched with state leadership funds that will be used for travel to Anaheim, CA on June 26-28 for the National Leadership Conference for HOSA (Health Occupations Students of America). She asked the taskforce to provide names of people that would be interested in attending. She felt this would be an opportunity to observe what other states were doing in the area of Health Occupations Education, which would provide ideas for replicating this effort in Montana.

After the trip to Anaheim Jody said that she would convene another group to work on the issues. She reiterated that this was a huge commitment on the part of the Office of Public Instruction.


Jean Branscum presented the committee members with the conclusions from each breakout section from the Health Care Summit held May 17 in Bozeman. She reported that the team leaders would be asked to elaborate on each point and continue the discussions. A copy will then be given to the SJ 22 interim committee. She felt the information presented was a good starting point for discussions. She said that conversations would continue from the governor’s office on what will be needed in regards to legislation, the Governor’s Office and the state’s Congressional Delegations.

Jim Ahrens reported on his breakout area pertaining to health care delivery in Montana. He stated that there was no overall health care policy in the state and wondered if the committee should address this issue.


Loren Soft introduced Laurie Ekanger and praised her work on the first draft proposal. Loren reminded the committee to look at the substantial issues in the proposal such as gaps and duplications. He cautioned against getting bogged down on trivia and the format.

Jean Branscum asked the committee to consider assessment incentive investment and provide comment on this concept to the Governor’s Office. She also asked the members to look at public programs and cost.

Loren Soft distributed a Montana map that showed the distribution of state physicians by county.

The council members suggested developing an overall health care policy. Representative Edith Clark moved to recommend that the state develop an overall health care policy. Rose Hughes seconded motion. After a brief discussion the motion passed unanimously. The committee felt that the constitutional framework and state law should be reviewed in order to formulate a state health care philosophy.


For the sake of discussion and simplicity, Laurie made changes in the proposal as the discussion preceded. All changes will be noted on the next draft and will be dispersed to the committee electronically. Laurie requested that any other information after the meeting be sent to her. If she has questions she will review the information with Mike Hanshew. Otherwise she will use her discretion.

The committee discussed whether to include examples and references to programs in other states under each proposal. Steve Yeakel moved to delete language that promotes out of state programs and insert a paragraph that would call attention to other available college programs, without listing specific programs. Representative Edith Clark seconded the motion and it was passed with Rose Hughes, Bob Bartholomew, Sharon Kott and Loren Soft opposed.

It was also decided that each area would recommend the agency or department that would deliver each program’s need and specific recommendations to the Governor.

Laurie asked the committee members to continue to collect data and return it to her in the appropriate format to be included in the final document. Trish Goudie offered to provide corrections related to current nursing statistics. It was reported that Joyce Scott would be asked to provide correct data to clear up discrepancies in the pharmacy data, prior to publication of the final report.

Laurie requested that each member study the data for their particular area and check for the correct data in each area. Jody Messinger offered to ask Mary McCue to check on dental data.

Arlene Parisot volunteered to check whether the data includes tribal and private school statistics.

Steve Yeakel stated that there were agencies that could provide money for retraining. He felt language should be included that would redirect funding throughout government. He cited examples stating that the AFL/CIO and local work force boards could offer training programs.

Sami Butler distributed a report from the American Nurses Association and asked that it be referenced in the report.

Jean Branscum recommended the committee encourage the use of technology, giving facilities more flexibility for staffing and demand reduction strategies. She felt the committee should be encouraging a healthier population. Jean also suggested encouraging policies that deal with caregivers and respite care, which would keep individuals out of the system.

Jani McCall and Mike Hanshew offered to draft language that would encourage prevention, the use of respite care/caregivers, along with language that would support private efforts in these areas.


The meeting was adjourned at 4:00 p.m. The next meeting date was scheduled for July 16th at 8:30 a.m. - noon in the Capitol. The public will be allowed input at 1:00 p.m. navigation footer
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