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​About Us

Established in 2013, the Health Workforce Research Center (HWRC) on Emerging Health Workforce Topics, is part of the Fitzhugh Mullan Institute for Health Workforce Equity. The center’s research portfolio examines how new payment and delivery models, patient centered medical homes, team-based care, telehealth, National Health Service Corps, and other emerging care management strategies impact access and quality of care for rural and underserved populations.

We are committed to advancing the science of workforce analysis by 1) developing cutting edge research methods for documenting how workforce staffing configurations impact patient satisfaction and health outcomes, 2) employing innovative uses of available datasets to identify the workforce caring for patients living in health professional shortage areas, 3) publishing a portfolio of peer-reviewed publications that build off of each other to identify policies for improving care for vulnerable and underserved populations, and 4) training the next generation of health workforce researchers to carry the work forward into the future.

Leadership

Director: Patricia Pittman, PhD
Deputy Director: Clese Erikson, MPAff
PEER-REVIEWED PUBLICATIONS
  1. Erikson C, Tiunn H, Herring J, Luo E, Pittman P. 2025. Medicaid Billing for Community Health Worker Services Growing, but Remains Low, 2016-2020. Health Affairs Scholar. https://doi.org/10.1093/haschl/qxae164.
  2. Williams G, Ziemann M, Chen C, Forman R, Sagan A, Pittman P. 2024. Global Health Workforce Strategies to Address the COVID-19 Pandemic: Learning Lessons for the Future. The International Journal of Health Planning and Management. doi.org/10.1002/hpm.3762.
  3. Forrest C, Chen C, Perrin E, Stille C, Cooper R, Harris K, Luo Q, Maltenfort M, Parlett L. 2024. Pediatric Medical Subspecialist Use in Outpatient Settings. JAMA Network Open. doi:10.1001/jamanetworkopen.2023.50379.
  4. Luo Q, Erikson C. Changes in Waivered Clinicians Prescribing Buprenorphine and Prescription Volume by Patient Limit. JAMA. doi:10.1001/jama.2023.5038
  5. Erikson C, Park Y, Felida N, Dill M. 2023. Telehealth Use and Access to Care for Underserved Populations Before and During the COVID-19 Pandemic. Journal of Health Care for the Poor and Underserved. doi:10.1353/hpu.2023.0009.
  6. Regenstein M, Park YH, Krips M. 2023. The Use of Interpreters in Health Centers: A Mixed-Methods Analysis. J Health Care Poor Underserved. doi: 10.1353/hpu.2023.0015.
  7. Erikson C, Herring J, Park JH, Luo Q, Burke G. 2022. Association between State Payment Parity Policies and Telehealth Usage at Community Health Centers During COVID-19. Journal of the American Medical Informatics Association. doi: 10.1093/jamia/ocac104.
  8. Chen C, et al. 2021. Coronavirus Disease 2019 Planning and Response: A Tale of 2 Health Workforce Estimator Tools. doi: 10.1097/MLR.0000000000001606.
  9. Han X, Pittman P, Ku L. 2021. The Effect of National Health Service Corps Clinician Staffing on Medical and Behavioral Health Care Costs in Community Health Centers. Medical Care. doi: 10.1097/MLR.0000000000001610.
  10. Markus A, Pillai D. 2021. Mapping the Location of Health Centers in Relation to “Maternity Care Deserts”: Associations With Utilization of Women’s Health Providers and Services. Medical Care. doi: 10.1097/MLR.0000000000001611.
  11. Ziemann M, Erikson C, Krips M. 2021. The Use of Medical Scribes in Primary Care Settings: A Literature Synthesis. Medical Care. doi: 10.1097/MLR.0000000000001605
  12. Park J, Regenstein M, Chong N, Onyilofor C. 2021. The Use of Community Health Workers in Community Health Centers. Medical Care. doi: 10.1097/MLR.0000000000001607.​
  13. Han X, Pittman P, Barnow B. 2021. Alternative Approaches to Ensuring Adequate Nurse Staffing: The Effect of State Legislation on Hospital Nurse Staffing. Medical Care. doi: 10.1097/MLR.0000000000001614.
  14. Richwine C, Erikson C, Salsberg E. 2021. Does Distance Learning Facilitate Diversity and Access to MSW Education in Rural and Underserved Areas? Journal of Social Work Education. doi:10.1080/10437797.2021.1895929.
  15. Pittman P, Westfall N, Ziemann M, Strasser J. (2021, March 9). Who Is Allowed To Administer COVID-19 Vaccines? The List Is Growing. [Blog]. 10.1377/forefront.20210303.890600​.
  16. ​​​Pittman P, Park J, Bass E, Luo Q. 2020. Understanding Why Nurse Practitioner (NP) and Physician Assistant (PA) Productivity Varies Across Community Health Centers (CHCs): A Comparative Analysis. Medical Care Research and Review.
  17. Luo Q, Chong N, Chen C. 2020. Independent Freestanding Emergency Departments and Implications for the Rural Emergency Physician Workforce in Texas. Health Services Research. doi: 10.1111/1475-6773.13587.
  18. Luo Q, Dor A, Pittman P. 2020. Optimal Staffing in Community Health Centers to Improve Quality of Care. Health Services Research. doi: 10.1111/1475-6773.13566.
  19. Delhy R, Dor A, Pittman P. 2020. The Impact of Nursing Staff on Satisfaction Scores for U.S. Hospitals: A Production Function Approach. Medical Care Research and Review. doi: 10.1177/1077558720950572.
  20. Han X, Chen C, Pittman P. 2020. Use of Temporary Providers in Primary Care in Federally Qualified Health Centers. Journal of Rural Health. doi: 10.1111/jrh.12424.
  21. Park J, Dowling N. 2020. Do Nurse Practitioner-Led Medical Homes Differ from Physician-Led Medical Homes? Nursing Outlook, 68(5): 601-610. doi.org/10.1016/j.outlook.2020.05.010.
  22. Han X, Pittman P, Erikson C, Mullan F, Ku L. 2019. The Role of the National Health Service Corps Clinicians in Enhancing Staffing and Patient Care Capacity in Community Health Center. Medical Care, 57(12):1002–1007. doi: 10.1097/MLR.0000000000001209.
  23. Han X, Ku L. 2019. Enhancing Staffing In Rural Community Health Centers Can Help Improve Behavioral Health Care. Health Affairs, 38(12). doi: 10.1377/hlthaff.2019.00823.
  24. Park J, Han X, Pittman P. 2019. Does Expanded State Scope of Practice for Nurse Practitioners and Physician Assistants Increase Primary Care Utilization in Community Health Centers? Journal of the American Association of Nurse Practitioners. doi: 10.1097/JXX.0000000000000263.
  25. Park J, Erikson C, Han X, Iyer P. 2018. Are State Telehealth Policies Associated With the Use of Telehealth Services Among Underserved Populations? Health Affairs, 37(12): 2060-2068.
  26. Park J, Wu X, Frogner B, Pittman P. 2018. Does the Patient-centered Medical Home Model Change Staffing and Utilization in the Community Health Centers? Medical Care. doi: 10.1097/MLR.0000000000000965
  27. Frogner B, Wu X, Park J, Pittman P. 2017. The Association of Electronic Health Record Adoption with Staffing Mix in Community Health Centers. Health Services Research, 52(S1): 407-421.
  28. Frogner B, Wu X, Ku L, Pittman P, Masselink L. 2017. Do Years of Experience With Electronic Health Records Matter for Productivity in Community Health Centers? Journal of Ambulatory Care Management, 40(1): 36–47.
  29. Li S, Pittman P, Han X, Lowe T. 2017. Nurse-Related Clinical Nonlicensed Personnel in U.S. Hospitals and Their Relationship with Nurse Staffing Levels. Health Services Research, 52(S1): 422-436. 
  30. Malcarney M, Pittman P, Quigley L, Horton K, Seiler N. 2017. The Changing Roles of Community Health Workers. Health Services Research, 52(S1): 360-382
  31. ​Pittman P, Li S, Han X, Lowe T. 2017. Clinical Nonlicensed Personnel in U.S. Hospitals: Job Trends from 2010 to 2015. Nursing Outlook, 66(1): 35-45.​
  32. Pittman P, Masselink L, Bade L, Frogner B, Ku L. 2016. Factors Determining Medical Staff Configurations in Community Health Centers: CEO Perspectives. Journal of Healthcare Management, 61(5): 364-377.  
  33. Pittman P, Scully-Russ E. 2016. Workforce Planning and Development in Times of Delivery System Transformation. Human Resources for Health, 14: 56.
  34. Ku L, Frogner B, Steinmetz E, Pittman P. 2015. Community Health Centers Employ Diverse Staffing Patterns, Which can Provide Productivity Lessons for Medical Practices​. Health Affairs, 34(1): 95-103. 

Current Research Studies (2024-2025)

comparing provider's medicaid and commercial patient panels, 2018-2021
The availability of primary care providers (PCPs) is a key factor affecting access to care for Medicaid enrollees. Prior analysis by the Mullan Institute suggests that in 2019, about 87% of PCPs participated in Medicaid in the U.S., but participation varied considerably across states and by PCP specialty. This study will examine office visit panels of Medicaid-engaged PCPs using national-level claims data and compare it to their commercial patient office visit panels 

Key Questions:
  • What is the proportion of patients insured by payer type (i.e., Medicaid and Commercial) in primary care providers’ (PCPs) office visit panels?
  • Does the payer composition differ by PCP specialties and professions?
  • What practice-market- and policy-level factors are associated with differences in panel composition by payer type?

For questions about this study, contact Anushree Vichare. 
Concierge and Direct Primary Care Models Impact on the Primary Care Workforce for Underserved Communities in the Washington Metropolitan Area
In recent years, the primary care landscape in the United States has seen significant shifts due to the emergence of alternative practice models such as concierge medicine and Direct Primary Care (DPC). These models have gained attention as potential solutions to the growing challenges faced by traditional primary care, including high administrative burdens, clinician burnout, and barriers to patient access. This will be one of the first studies to examine the potential downstream effect of these models on the primary care workforce for underserved communities (e.g., possible loss of workforce for underserved communities).

To identify concierge and DPC practices and the clinicians who staff them, we will utilize existing public databases, including the APC Alliance Member Directory, the Direct Primary Care Coalition Mapper, and the DPC Frontier Mapper, complemented by a targeted online search focusing on the Washington, DC metropolitan area and the State of Texas. 

Key Questions:
  • What is the distribution and typology of concierge and direct primary care (DPC) practices in the Washington DC metropolitan area and the State of Texas, and what are the demographic and professional characteristics of the clinicians staffing these practices?
  • What were the prior practice settings of clinicians currently working in concierge and DPC models, with a specific focus on their service to Medicaid and Medicare populations, and to what extent are clinicians transitioning directly from residency or advanced practice training into these models?

For questions about this study, contact Eric Luo.
examining uilization of school-based health centers by medicaid beneficiaries, 2017-2021
As of 2022, approximately 39% of children in the U.S. were covered by Medicaid/CHIP, but many face transportation barriers and other challenges with seeking medical care. This study will examine the differences in health care access and utilization of services between Medicaid/CHIP-enrolled children who receive care from providers in school settings versus those who do not, and by beneficiary race/ethnicity and rurality. Our findings will inform workforce policies for expanding school clinics and using Medicaid to finance school-based clinical services.  

Research Aims:
  • Develop a strategy for identifying school-based health centers using the Transformed-Medicaid Statistical Information System (T-MSIS) Analytical Files (TAF) and other data sources.
  • Describe differences in outpatient utilization and service provision between Medicaid/CHIP-covered children who received care in schools according to beneficiaries’ race and ethnicity and those who received care in non-school clinics.
  • Examine the relationship, if any, between receiving school-based health services and emergency department (ED) utilization among children.  
​
For questions about this study, contact Jordan Herring.  
examining the effects of state nurse licensure compact participation on nursing labor supply
Demand for nurses is expected to slightly exceed supply in the United States over the next ten years. Many healthcare organizations face severe recruitment and retention challenges, and geographic distribution remains inequitable. One strategy that has grown in popularity is the use of the Nurse Licensure Compact (NLC), which reduces administrative obstacles in licensing if nurses wish to either move to another state or practice outside their primary state of residence in another NLC participating state.

To our knowledge, the only major evaluation of the NLC on nursing labor market outcomes was conducted by DePasquale and Strange, who did not find evidence that the NLC had any effect on nursing labor market outcomes among states that initially joined the NLC in the early 2000s. This studyl builds on DePasquale and Strange’s work by examining more recent periods that allow us to study the “enhanced” NLC that began in 2018 and using different data sources (the CPS and the NSSRN).

Research Aims:
  • Determine the relationship, if any, between adopting the NLC and permanent geographic mobility among RNs.
  • Determine the relationship, if any, between adopting the NLC and working outside the state of residence among RNs.
  • Determine the relationship, if any, between adopting the NLC and the likelihood of working in nursing.
  • Determine the relationship, if any, between the adoption of the NLC and vacancies for RNs at hospitals.

For questions about this study, contact Patricia Pittman.
  • Disclaimer
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These projects are supported by the Bureau of Health Workforce (BHW), National Center for Health Workforce Analysis (NCHWA), Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $450,000, with zero percent financed with non-governmental sources. The contents are those of the author[s] and do not necessarily represent the official views of, nor an endorsement by HRSA, HHS, or the U.S. Government.
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