PRL-IHPS Research Focus: Workforce and Training

 

Behavioral Health Workforce and Dental Therapist Workforce

Janet Coffman, PhD, studies physicians but has branched out in recent years to lead projects on the behavioral health workforce, community paramedics, and dental therapists. She is currently leading two projects on the behavioral health workforce, one at the national level and one at the state level. Her team is conducting mixed methods research to describe the challenges employers face in recruiting and retaining behavioral health professionals. These challenges have become more acute over the past 18 months as the COVID-19 pandemic has led to an increase in the percentage of Americans experiencing symptoms of anxiety and depression. The organizations funding these projects will use our findings to develop and advance public policy agendas to improve the supplies of behavioral health professionals, their geographic distribution, and ability to meet the needs of diverse populations. 

Dr. Coffman is also leading an evaluation of The Pew Charitable Trusts’ efforts to establish the emerging profession of dental therapy. Dental therapists provide preventive and routine restorative care, including filling cavities, placing temporary crowns, and extracting badly diseased or loose teeth. They can expand access to dental care because they can care for patients with routine needs, enabling dentists to focus on caring for patients with more complex needs. This project has taken her back to her legislative roots and has reinforced a lesson she learned long ago: enacting legislation is only the first step toward changing public policy. To institutionalize change, advocates need to devote equal attention to rulemaking, budgeting, and other aspects of implementation.

The Patient Support Corps - increasing the diversity and capacity of the health workforce

Since 2012, the Institute for Health Policy Studies has been the administrative home of the Patient Support Corps (PSC), directed by Jeff Belkora, PhD. The PSC is a service learning program in which pre-health interns earn academic credit or a stipend and are trained as healthcare navigators or coaches at UCSF. In 2019, the PSC committed to acting on the goals of the California Future Health Workforce Commission. This Commission, which included strong representation from UCSF's Healthforce program, in 2019 announced the goal of adding 5,700 health professionals and 30,000 healthcare workers from under-represented backgrounds by 2030. In order to contribute more aggressively to this goal, the PSC sought to expand its clinical sites. In 2020, the PSC partnered with UCSF's Office of Population Health and Accountable Care to put 20 UC Berkeley interns to work on the COVID hotline. The Dean of UCSF's School of Medicine recognized this partnership with a Commendation for Exceptional Volunteerism and University Service for the COVID-19 Pandemic Response.  See https://ls.berkeley.edu/news/uc-berkeley-students-recognized-exceptional-contributions-ucsfs-covid-response.  Two students joined UCSF faculty and staff in publishing an account of this first collaboration with Population Health. See https://www.frontiersin.org/articles/10.3389/fpubh.2021.697515/full. In Summer 2021, we expanded this partnership to focus on Population Health's efforts to close care gaps in primary care - including many that had been exacerbated by care deferred or disrupted during the pandemic. In expanding our work with Population Health, we are also recruiting more students from under-represented backgrounds. Our goal is to increase the diversity and capacity of the population health workforce, while helping students gain more access to opportunities, experiences, skills, mentors, and role models.

Health Care Workforce Research 
Ulrike Muench, RN, PhD, FAAN is a nurse and nurse practitioner by training and her program of research focuses on the health care workforce, specifically nurses, advanced practice clinicians, and primary care physicians. In recent research funded by National Council for State Boards of Nursing she has been building upon her research on opioid prescribing patterns of nurse practitioners (NPs). Earlier research showed that NPs are less likely to prescribe an opioid compared to primary care physicians but might be more likely to prescribe opioids at a high dose. In the current study she examines if some of these patterns are related to NPs being more likely to take care of chronic pain patients while also examining the opioid prescribing patterns for Medicare beneficiaries with chronic pain and possible associations with full practice authority for NPs.

In another study funded by HRSA’s Workforce Center for long term care at UCSF she is examining prescribing patterns of primary care clinicians and behavioral specialist providers for Medicare beneficiaries with serious mental illness by rural and urban setting. The aim of this research is to investigate the role of primary care providers in the prescribing of psychiatric medications and to understand differences in psychiatric prescribing patterns in rural and urban settings by provider specialty (primary care versus behavioral health specialists) and provider type (physician and advanced practice clinicians).

Finally, in a study funded through UCSF’s RAP mechanism she has been examining the involvement of nurse practitioners (NPs) and physician assistants (PA) in the prescribing of buprenorphine, a medication used in the treatment for opioid use disorder. In 2016, the Comprehensive Addiction and Recovery Act (CARA), granted NPs and PAs waivers to prescribe buprenorphine after participating in buprenorphine specific training. Prior research by Joanne Spetz, PhD and colleagues had documented the growth of the numbers of waivered NPs, especially in states with full practice authority for NPs, however to what extend NPs and PAs are using their waivers to prescribe buprenorphine is less well understood.


National Clinician Scholars Program at UCSF
Committed to equity, the National Clinician Scholars Program (NCSP) at UCSF aims to train the next generation of health and healthcare change agents, prepared to work in diverse settings to achieve our goals of a healthier and more equitable world. Based at UCSF’s Philip R. Lee Institute for Health Policy Studies, the NCSP at UCSF is a partnership between UCSF’s Schools of Medicine and Nursing and the San Francisco VA Medical Center. Scholars train in a closely-knit cohort, receive mentorship from faculty from different disciplines, and build their skills in community partnered research, implementation and dissemination sciences, policy, and health system transformation. The two-year program has just begun its second year in July, 2021.  Read more about the research interests of the two cohorts of scholars here.