Dr. Fraher holds a joint appointment as an Associate Professor in the Department of Family Medicine and Research Assistant Professor in the Department of Surgery. She is the Director of the Carolina Health Workforce Research Center, one of five national health workforce research centers funded by the Health Resources and Services Administration to provide impartial, policy-relevant research that answers the question: what health care workforce is needed to ensure access to high quality, efficient health care for the U.S. population.
Dr. Fraher is well known for her ability to communicate complex research findings in ways that are easily understood and policy-relevant. She has published extensively in peer reviewed journals, but her ability to publish policy briefs, fact sheets, data summaries, maps, and other documents that convey information in ways that reach diverse audiences has allowed her work to have broad impact. She is often called upon by state and national legislators, policy makers, government officials, health professional organizations and other workforce stakeholders to provide expertise on a variety of issues related to the education, regulation and payment of health professionals. Dr. Fraher is an expert on comparative health workforce systems, having worked for the National Health Service in England, the College of Nurses of Ontario and served for many years as a member of the International Health Workforce Collaborative, a consortium of health workforce researchers/policy analysts in the United States, Canada, United Kingdom and Australia.
Areas of Expertise (5)
Health Workforce Education Systems
Health Workforce Research Policy
University Research Council Award, 2016
Office of Research Development, UNC-CH
Junior Faculty Development Award, 2015
Office of the Executive Vice Chancellor and Provost, UNC-CH
Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC: PhD, Health Policy and Managemen
Graduate School of Public Policy, University of California, Berkeley, CA: MPP, Public Policy
Wellesley College, Wellesley, MA: BA, Economics and Spanish
Event Appearances (1)
South Carolina Healthcare Workforce Forum South Carolina
Primary Care Nurse Practitioner Wage Differences by Employment SettingNursing Outlook, July 2018
Yin Li, Mark Holmes, Erin Fraher, Barbara A Mark
Abstract Background: Previous studies reported that primary care nurse practitioners working in primary care settings may earn less than those working in specialty care settings. However, few studies have examined why such wage difference exists. Purpose: This study used human capital theory to determine the degree to which the wage differences between dingsPCNPs working in primary care versus specialty care settings is driven by the differences in PCNPs' characteristics. Methods: A cross-sectional, secondary data analysis was conducted using the restricted file of 2012 National Sample Survey of Nurse Practitioners. Findings: Feasible generalized least squares regression was used to examine the wage differences for PCNPs working in primary care and specialty care settings. Oaxaca-Blinder decomposition technique was used to explore the factors contributing to wage differences. Discussion: The results suggested that hourly wages of PCNPs working in primary care settings were, on average, 7.1% lower than PCNPs working in specialty care settings, holding PCNPs' socio-demographic, human capital, and employment characteristics constant. Approximately 4% of this wage difference was explained by PCNPs' characteristics; but 96% of these differences were due to unexplained factors. Conclusion: A large, unexplained wage difference exists between PCNPs working in primary care and specialty care settings.
Supply and demand in the pediatric NP workforce: Who will care for America's children?, July 2015JAAPA: official journal of the American Academy of Physician Assistants
Jonathan Bowser, Harrison Reed, Erin Fraher
Abstract Computer modeling was used to assess the pediatric NP workforce and to investigate the effect of potential policy changes to address forecasted shortages. Modeling included the admission of students into nursing bachelor's programs and followed them through advanced clinical programs. Prediction models were combined with optimal decision-making to determine best-case scenario admission levels. Two measures were computed: (1) the absolute shortage and (2) the expected number of years until the pediatric NP workforce will be able to fully satisfy pediatric NP demand (self-sufficiency). A shortage of pediatric NPs is predicted over the next 13 years. Under the best-case scenario, at least 13 years are needed for the workforce to fully satisfy demand. Analysis of potential policy changes revealed that increasing the specialization rate for pediatric NPs and increasing the certification examination passing rate to 96% would lead to self-sufficiency in 11 years. In addition, increasing the annual growth rate of master's programs to 36% from the current maximum of 10.7% would result in self-sufficiency in 5 years. Forecasts of demand for pediatric NPs indicate that the current workforce will be incapable of satisfying the growing demand.
FutureDocs: Nation has Enough Physicians to Meet the Nation’s Overall Needs – For Now. Distribution to WorsenFutureDocs
Emily K. Tierney, Thomas C. Ricketts, Andy Knapton, Erin P. Fraher
As the US healthcare system grapples with uncertainty over the future of the Affordable Care Act, the demand for health care services will continue to grow. Debate continues over whether there is an adequate supply of physicians to meet the current demand for healthcare services, and how the balance of demand and supply may change in the future due to new payment and care delivery models. The Association of American Medical Colleges (AAMC) forecasts a shortage of 40,800 to 104,900 physicians by 20301 , while a 2014 Institute of Medicine (IOM) report on the physician workforce and graduate medical education (GME) finds no shortage, but a maldistribution of physicians both geographically and by specialty2 . A New York Times article emphasized that geographic distribution may be the more important challenge, suggesting that better deployment of nurse practitioners (NPs) and physician assistants (PAs) and use of new technology could increase efficiency, freeing up physicians to see more patients3 . This Brief uses data from the FutureDocs Forecasting Tool (FDFT) to assess whether the supply and distribution of physicians in the United States will be sufficient to meet the future demand for healthcare services.
Social Work Student and Practitioner Roles in Integrated Care Settings.American Journal of Preventive Medicine, June 2018
Erin P. Fraher PhD, MPP, Erica Lynn Richman PhD, MSW Lisa de SaxeZerden PhD, MSW Brianna Lombardi PhD, MSW
Introduction Social workers are increasingly being deployed in integrated medical and behavioral healthcare settings but information about the roles they fill in these settings is not well understood. This study sought to identify the functions that social workers perform in integrated settings and identify where they acquired the necessary skills to perform them.
Community Use of Physical and Occupational Therapy After Stroke and Risk of Hospital ReadmissionArchives of Physical Medicine Rehabilitation, January 2018
Freburger JK, Li D, Fraher EP
Abstract OBJECTIVES: To determine whether receipt of therapy and number and timing of therapy visits decreased hospital readmission risk in stroke survivors discharged home. DESIGN: Retrospective cohort analysis of Medicare claims (2010-2013). SETTING: Acute care hospital and community. PARTICIPANTS: Patients hospitalized for stroke who were discharged home and survived the first 30 days (N=23,413; mean age ± SD, 77.6±7.5y). INTERVENTIONS: Physical and occupational therapist use in the home and/or outpatient setting in the first 30 days after discharge (any use, number of visits, and days to first visit). MAIN OUTCOME MEASURES: Hospital readmission 30 to 60 days after discharge. Covariates included demographic characteristics, proxy variables for functional status, hospitalization characteristics, comorbidities, and prior health care use. Multivariate logistic regression analyses were conducted to examine the relation between therapist use and readmission. RESULTS: During the first 30 days after discharge, 31% of patients saw a therapist in the home, 11% saw a therapist in an outpatient setting, and 59% did not see a therapist. Relative to patients who had no therapist contact, those who saw an outpatient therapist were less likely to be readmitted to the hospital (odds ratio, 0.73; 95% confidence interval, 0.59-0.90). Although the point estimates did not reach statistical significance, there was some suggestion that the greater the number of therapist visits in the home and the sooner the visits started, the lower the risk of hospital readmission. CONCLUSIONS: After controlling for observable demographic-, clinical-, and health-related differences, we found that individuals who received outpatient therapy in the first 30 days after discharge home after stroke were less likely to be readmitted to the hospital in the subsequent 30 days, relative to those who received no therapy.
The Value of Workforce Data in Shaping Nursing Workforce Policy: A Case Study from North Carolina.Nursing Outlook
Abstract BACKGROUND: In 2015, the Institute of Medicine's Committee for Assessing Progress on Implementing the Future of Nursing recommendations noted that little progress has been made in building the data infrastructure needed to support nursing workforce policy. PURPOSE: This article outlines a case study from North Carolina to demonstrate the value of collecting, analyzing, and disseminating state-level workforce data. METHODS: Data were derived from licensure renewal information gathered by the North Carolina Board of Nursing and housed at the North Carolina Health Professions Data System at the University of North Carolina at Chapel Hill. DISCUSSION: State-level licensure data can be used to inform discussions about access to care, evaluate progress on increasing the number of baccalaureate nurses, monitor how well the ethnic and racial diversity in the nursing workforce match the population, and investigate the educational and career trajectories of licensed practical nurses and registered nurses. CONCLUSION: At the core of the IOM's recommendations is an assumption that we will be able to measure progress toward a "Future of Nursing" in which 80% of the nursing workforce has a BSN or higher, the racial and ethnic diversity of the workforce matches that of the population, and nurses currently employed in the workforce are increasing their education levels through lifelong learning. Without data, we will not know how fast we are reaching these goals or even when we have attained them. This article provides concrete examples of how a state can use licensure data to inform nursing workforce policy.
A Methodology for Using Workforce Data to Decide Which Specialties and States to Target for Graduate Medical Education ExpansionHealth Services Research
Erin P. Fraher Ph.D., M.P.P. Andy Knapton M.Sc. George M. Holmes Ph.D.
Abstract Objective To outline a methodology for allocating graduate medical education (GME) training positions based on data from a workforce projection model. Data Sources Demand for visits is derived from the Medical Expenditure Panel Survey and Census data. Physician supply, retirements, and geographic mobility are estimated using concatenated AMA Masterfiles and ABMS certification data. The number and specialization behaviors of residents are derived from the AAMC's GMETrack survey. Design We show how the methodology could be used to allocate 3,000 new GME slots over 5 years—15,000 total positions—by state and specialty to address workforce shortages in 2026. Extraction Methods We use the model to identify shortages for 19 types of health care services provided by 35 specialties in 50 states. Principal Findings The new GME slots are allocated to nearly all specialties, but nine states and the District of Columbia do not receive any new positions. Conclusions This analysis illustrates an objective, evidence‐based methodology for allocating GME positions that could be used as the starting point for discussions about GME expansion or redistribution.
Appropriateness of care in ICUs, July 2015JAAPA: official journal of the American Academy of Physician Assistants
Jonathan Bowser, Harrison Reed, Erin Fraher
Abstract This study sought to determine the extent and characteristics of perceived inappropriate treatment among ICU physicians and nurses, defined as an imbalance between the amount or intensity of treatments being provided and the patient's expected prognosis or wishes. The researchers used a cross-sectional study of those providing care to patients in 56 adult ICUs in California; 1,363 physicians and nurses completed an electronic survey. Thirty-eight percent identified at least one patient as receiving inappropriate treatment. Respondents most commonly reported that the amount of treatment provided was disproportionate to the patient's expected prognosis or wishes, and that treatment was too much in 93% of cases. Factors associated with perceived inappropriateness of treatment were the belief that deaths in the ICU is seen as a failure, lack of collaboration between physicians and nurses, clinicians' intent to leave their job, and the perceived responsibility to control healthcare costs. Providers supported formal communication training and mandatory family meetings as potential solutions to reduce the provision of inappropriate treatment.
Commentaries on health services research, July 2015JAAPA: official journal of the American Academy of Physician Assistants
Jonathan Bowser, Harrison Reed, Erin Fraher
Abstract Computer modeling was used to assess the pediatric NP workforce and to investigate the effect of potential policy changes to address forecasted shortages. Modeling included the admission of students into nursing bachelor's programs and followed them through advanced clinical programs. Prediction models were combined with optimal decisionmaking to determine best-case scenario admission levels. Two measures were computed: (1) the absolute shortage and (2) the expected number of years until the pediatric NP workforce will be able to fully satisfy pediatric NP demand (self-sufficiency). A shortage of pediatric NPs is predicted over the next 13 years. Under the best-case scenario, at least 13 years are needed for the workforce to fully satisfy demand. Analysis of potential policy changes revealed that increasing the specialization rate for pediatric NPs and increasing the certification examination passing rate to 96% would lead to self-sufficiency in 11 years. In addition, increasing the annual growth rate of master's programs to 36% from the current maximum of 10.7% would result in self-sufficiency in 5 years. Forecasts of demand for pediatric NPs indicate that the current workforce will be incapable of satisfying the growing demand.1.