Differentiated Staffing and Practice

Abstract

SEVERAL DECADES ago cost-conscious health-care providers began to look at their staffing practices. These companies found that many health-care needs were fairly routine in nature and that using highly qualified nurses rather than doctors to provide these services could be more cost-efficient. Nurse practitioners and physician assistants began successfully performing a number of duties that previously had been trusted only to doctors. These staff positions required more training and less supervision than a traditional nurse's position, so nurse practitioners and physician assistants were compensated at higher rates. Though these positions cost more, they allow organizations such as Kaiser Permanente to run more efficiently than many traditional medical providers. They also create career paths that encourage highly qualified nurses to stay in the profession and enable health-care providers to more effectively target their doctors at complex medical issues. The development of the positions of nurse practitioner and physician assistant is a good example of differentiating staffing and practice to meet individual needs in an effective and cost-efficient way. This type of differentiation has been confined to the healthcare industry, principally to health maintenance organizations, but perhaps those in education can draw some lessons for meeting the needs of our children with scarce resources. EARLY CARE AND EDUCATION The early care and education (ECE) community has used differentiated staffing to some extent--e.g., combining a lead teacher who has a bachelor's degree in ECE with assistant teachers who have lower-level credentials. However, a new study by the Economic Policy Institute (EPI), titled Losing Ground in Early Childhood Education: Declining Workforce Qualifications in an Expanding Industry, 1979-2004, indicates that there is less of this practice in place than I would have guessed. Parents can't afford to pay, teachers can't afford to stay, there's got to be a better way is cited as a common sentiment of ECE professionals, and the study's findings indicate that the industry has been unable to attract and retain qualified teachers over the past two decades. CENTER-BASED CHILD CARE The EPI study looked at center-based child care, rather than at school-based early education or home-based care, and examined data on the ECE work force from the 1979-2004 Current Population Surveys. The researchers included private, public, for-profit, and nonprofit child-care centers; Head Start programs; and stand-alone preschools and nursery schools. Losing Ground reminds readers that early childhood education outside the schools is a highly fragmented and competitive industry dominated by small firms and that families that use the services and states that subsidize the attendance of low-income children often have limited financial resources. Because of their clients' inability or unwillingness to pay higher rates, many ECE providers have not been able to raise tuition, thus limiting their ability to compensate staff at higher rates. The growth in center-based ECE providers has been tremendous, primarily because of the growing number of women working outside the home. The EPI study found that the number of center-based ECE teachers and administrators has grown from about 180,000 in the early 1980s to over 400,000 in recent years. The share of those teachers and administrators with at least a four-year college degree averaged 43% between 1983 and 1985 but only 30% over the last three years. The share with a high school education or less has grown by about 5% during that same period. Most of the decline in the education levels of ECE professionals occurred between 1984 and 1997. The hourly earnings of teachers and administrators in center-based ECE averaged $10 in 2002-04, compared to $19.23 overall for female college graduates. From 1984 to 1997 the average wage of ECE employees rose only 43 cents per hour, compared to an increase of $2. …