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Senate Judiciary Committee
Subcommittee on Immigration
Hearing on
"Rural and Urban Health Care Needs"
Oral Testimony of Susan Page
President and Chief Executive Officer
Pratt Region Medical Center
Pratt, Kansas

Chairman Brownback, members of the subcommittee, thank you for allowing me to comment on what is becoming a real threat to the health and welfare of the people of our country. My name is Susan Page. I am the chief executive officer of Pratt Regional Medical Center in Pratt, Kansas. In addition to my duties at Pratt Regional, I am the chair-elect of the Kansas Hospital Association's Board of Directors and chair the association's Committee on Workforce Strategies.

Attached to my testimony, for the record, is a copy of Critical Condition, a research monograph prepared for our Committee on Workforce Strategies. It examines the status, causes and suggested solutions of our workforce shortages. While it does not address immigration specifically, it details the need for immediate action. Easing immigration restrictions to allow qualified health care professionals to practice in places like Pratt, Kansas would provide some immediate relief allowing for other, more long-term strategies to come to fruition.

Like most industries, health care has undergone tremendous changes over the past decade. Unimagined advances in medical technology, drugs and pharmaceuticals, and diagnostic capabilities, combined with severe reductions in payments caused by the increase in managed care and the passage of the Balanced Budget Act, have totally altered the face of health care today. One of the manifestations of these changes is an increasing shortage of health care professionals, particularly nurses. During this past winter it was common for hospitals to divert patients to other hospitals, not because of a lack of available beds but rather a lack of nurses and other health care professionals to care for them.

For the first four months of this year at Pratt Regional, the cost for our use of temporary agency nurses would have funded two full-time nurses for an entire year, if they were available. And our policy of paying extra "bonus" shift premiums to fill uncovered shifts has cost us over $31,000, enough for another full-time RN. This despite the fact that over the last four years we have raised nurse's salaries 23 percent just to keep those we have.

Unlike other industries, it is difficult for health care to respond to traditional supply and demand economic remedies when it comes to workforce shortages. As a hospital's proportion of Medicare, Medicaid and managed care patients increases, the decreased revenues in the form of prospective payment systems and discounts increases, leaving little room for salary and benefit increases. However, higher salaries alone - even if the money to increase salaries were available - will not solve the problem. Population growth, aging, social changes and public and private health insurance payment policies are some of the underlying causes of the shortage. Therefore, a sustained, multi-faceted approach, including easing of current and ineffective immigration restrictions, will be required to overcome the problem. Current Shortages) The chart on page 2 of my written testimony illustrates how rapidly our workforce shortages are increasing. Between 1999 and 2000, 80% of the categories of clinical employee job vacancies increased significantly. This resulted from both an increase in demand based on volume and a decrease in the number of available workers. Selected Health Professions Job Vacancy Rates in Kansas Hospital 1999 - 2000 Position 1999 2000 O. R. Technicians 9.2 15.8 Nuclear Medicine Technologists 10.9 14.3 Certified Nurse Assistants (LTC) 8.1 11.2 Certified Nurse Assistants (Acute Care) 8.4 10.2 Ultrasound Technologists 10.1 9.9 Respiratory Therapists 8.9 9.2 Emergency Medical Technicians 5.0 8.6 Radiologic Technologists 6.0 7.6 Staff Nurses (RN) 4.3 6.1 Licensed Practical Nurses 9.7 5.3 (Projected Change in Health Care Workforce - pause for emphasis) Data from the Bureau of Labor of Statistics paint an even gloomier picture for the next five years. The table on page 3 of my testimony illustrates the projected percent change in necessary health employment in Kansas and the United States from 1996-2006. Within the next six years, Kansas will require from 20 to 70 percent more clinical workers like RNs, LPNs and Respiratory Therapists than it did in 1996. Projected Percentage Increase in Needed Positions Selected Health Professions 1996 - 2006 Health Profession Kansas U.S. Registered Nurses 25.3 20.9 Licensed Practical Nurses 15.9 18.5 Nurse Aides and Orderlies 26.6 23.3 Physician Assistants 36.8 46.7 Pharmacists 20.3 12.6 Pharmacy Aides and Technicians 26.1 11.0 Physical Therapists 47.7 70.8 Physical Therapy Assistants 50.0 78.5 Occupational Therapists 42.9 66.1 Occupational Therapy Assistants 60.0 68.7 Speech Pathologists and Audiologists 26.3 50.6 Respiratory Therapists 72.0 45.8 Emergency Medical Technicians 55.6 45.1 Radiologic Technologists 35.5 28.9 Laboratory Technologists 21.7 14.9 Medical Records Technicians 61.5 50.9 Dieticians and Nutritionists 22.2 18.2 Source: Bureau of Labor Statistics Supply Pipeline and Training Programs) Unfortunately, the supply of new health care graduates to fill these positions will not be enough. According to the American Association of Colleges of Nursing, enrollment of nursing students in entry-level baccalaureate nursing programs declined by over 19 percent in the five years form 1995 through 1999. In Kansas, enrollment in registered nurse education programs declined by over 17 percent in four years. Further, expanding the number of slots for health care professional training is limited by the availability of faculty and clinical practicum sites. And, even if every currently available slot in Kansas were filled there still would not be enough to meet the projected need for workers today. Potential Solutions So what can we do now? We have identified in our monograph a number of short, intermediate and long term strategies and goals to address the workforce crisis. While most of these goals are locally achievable, federal assistance is critical. Several good pieces of legislation have recently been introduced in both the House and Senate addressing the nursing shortage using education incentives, however I would also recommend this committee consider the following recommendations to ease immigration restrictions which would provide immediate, short-term relief: " Reinstate the H-1A visa program. In the past, this program was used specifically to allow RNs licensed in their own countries to enter the U.S. temporarily. " Modify and streamline the H-1C visa program to enable more hospitals to qualify. The program should also provide for expedited entry of qualified foreign nurses into the U.S. " Ensure that the North American Free Trade Agreement (NAFTA) is not altered to restrict the flow of health professionals from Canada and Mexico into the U.S. Mr. Chairman, thank you for the opportunity to address the subcommittee. I would be happy to answer any questions from the members.