AcademyHealth defines health services research (HSR) as “the science of study that determines what works, for whom, at what cost, and under what circumstances. It studies how our health system works, how to support patients and providers in choosing the right care, and how to improve health through care delivery.” Identifying the workforce that carries out these activities has been a perennial challenge, especially as related fields emerge and evolve such as health economics, data science, translational science, and implementation science. Also, with ongoing concern that those researching these issues may not represent the lived experiences of the communities affected by the research, it is imperative that systems are in place to ensure the HSR workforce reflects the communities they work with.
In the study, “How the Health Services Research Workforce Supply in the United States is Evolving,” published in AcademyHealth partner journal Health Services Research, I replicated and refined methods used in previous studies[i] to ascertain whether the HSR field continues to grow, but also to unpack how its growth may be tied to the emergence of related fields and how the diversity of the field may be improving.
How Big is the HSR Workforce and Where Are They Found?
Using Linkedin.com, a professional social networking website, 9,610 individuals self-identified HSR as a skill within the U.S., which is on par with the count of individuals who were members of AcademyHealth at some point between 2016 and 2020. Individuals, however, may not identify primarily as a health services researcher yet still conduct HSR, especially when working in teams. This often happens among health economists like myself, where the Venn diagram between the fields is not clear – is health economics a subfield within HSR, a subfield within economics, or a field all its own? To that point, this study found 18,735 individuals self-identifying health economics as a skill and 24.3 percent a “healthcare services” job function (versus research, education, finance, etc.). The same can be said about fields such as bioinformatics (n=83,288) and data science (n=9,403).
Another gauge of the size of the HSR workforce is to count authors in key publications to the field (e.g., Health Affairs, Health Services Research, Medical Care) and investigators funded by federal grants from National Institutes of Health, Agency for Healthcare Research and Quality, and Patient-Centered Outcomes Research Institute. Using this approach, 28,136 unique individuals were identified, which is nearly double the count published in 2015. Of note was the minimal overlap between authors and investigators, which may be reflective of the many health services researchers working in organizations that do not rely on federal grant funding (though they may rely on federal contracts) as well as the team-science nature of the field.
How Diverse is the HSR Workforce and Are There Signs of Improvement?
Diversity of the HSR field has been difficult to assess in part because of the broadly defined nature of the field and the reliance on self-report to volunteer surveys. Based on data collected by AcademyHealth, one of the best sources available, the HSR field appears to have considerably lower representation of Black/African American and Hispanic individuals compared to the national population. While there has been growing representation of Hispanic graduates from master’s degree programs in HSR fields, there has not been much progress among doctoral graduates. The lack of representation of Hispanic individuals among new graduates was a concern in the last study. Black/African American individuals experienced growing representation at the master’s and doctoral levels over time, which may improve the gap among the current HSR workforce.
For-profit educational institutions, which were not considered previous studies, are playing a significant role in producing master’s and doctoral level graduates in the HSR field. While public and not-for-profit institutions saw about half of their master’s and doctoral graduates from racially minoritized groups, nearly three-quarters of for-profit graduates were from these groups, with Black/African American individuals representing about 40 percent of graduates. The concern is that studies have found graduates of for-profit institutions have struggled to find gainful employment after graduation and are often saddled with significant debt, which has resulted in calls for stronger oversight and remedies at the federal level. On the other hand, the model of for-profit education with its remote classes and flexible schedules may be working well for individuals, which should be considered by public and not-for-profit institutions (and have been during the pandemic).
There is evidence that the HSR field is growing based on multiple approaches used in the study. The magnitude of change should be interpreted with caution as the boundaries of the field of HSR are not absolute. The multidisciplinary nature of conducting HSR is what draws many to the field, yet it also makes capturing the size and composition of the field difficult.
While this and the previous study identified growing racial and ethnic diversity among new graduates, the existing HSR workforce still struggles with diversity. The lack of diversity within the HSR workforce is not a new concern, but is critical to address to ensure that research questions and resulting policies and programs reflect the needs of the community. AcademyHealth convened experts in the field to make recommendations on how organizations can take steps to improve the diversity of the HSR workforce. Also, findings will soon emerge on how workplace culture may be playing a role in the lack of diversity in the field.