by Madison Bott | Feb 27, 2025 | Policy
You have seen our Indiana Medical Education Pipeline to Practice Report. Now you can take a deeper look into Indiana’s Physician Pipeline and how Indiana stacks up to our neighboring states with the Indiana Physician Pipeline-to-Practice: In Context brief. The medical education pipeline includes several steps before obtaining full medical licensure:
- Undergraduate Medical Education: Also known as medical school, this phase follows an undergraduate degree and lasts four years. It includes basic medical training and clinical hands-on experience with patients.
- Graduate Medical Education: This phase includes medical residency and fellowships. Residency is a structured series of clinical experiences preparing physicians to practice independently in their chosen specialty. Some physicians also complete additional fellowship training for 1-3 years.
- Practicing Physicians: These are fully licensed physicians who have completed all medical education requirements and can practice independently in their specialty.
The Bowen Center, along with the Indiana Department of Health, evaluated Indiana’s physician pipeline in family medicine, obstetrics/gynecology, and pediatrics. The study compares Indiana’s physician pipeline to neighboring states and national averages to support workforce planning.
Read and download the full brief below:
by Madison Bott | Feb 26, 2025 | Policy
We are halfway through the legislative session. It has been a busy two months at the Statehouse. Introduced bills must have been heard in committee 3 times and then heard by legislators in the originating chamber by 2/20/2025. If a bill met these conditions and was approved by legislators, then it continued through the legislative process and will now undergo a similar process in the chamber that did not originate the bill. For a refresher on the legislative process, please see the Policy 101 page. As of 02/20/2025, of the almost 300 bills related to health, health workforce or workforce introduced this session, 63 are still considered active and are now working through the second chamber. The Bowen Center will continue to track these bills as the session continues. The 2025 legislative session ends on 04/29/2025. Continue reading below for a mid-session update.
See more information on our Bowen Bill Brief page.
Nursing Workforce
- SB 181 has entered the second chamber. This bill seeks to require trauma informed care training as part of the curriculum for a nursing education program.
- There is a shortage of Licensed Practical Nurses in Indiana. According to workforce projections by Health Resources and Services Administration (HRSA), Indiana currently has 72% of the licensed practical nurses (LPNs) necessary to support the needs of Hoosiers. SB 176 has moved to the House and seeks to remove barriers to becoming an LPN in Indiana. Check out our Bowen Center Snapshot to learn more about Indiana’s shortage of LPNs and how we compare to neighboring states.
- APRNs are licensed registered nurses (RN) with additional training that provides the clinical knowledge and experience to deliver advanced nursing care. Currently, all Indiana APRNs are required to hold an Indiana RN license, and many, but not all, also hold an APRN prescriptive authority license. The advanced practice registered nurse (APRN) workforce bills for this session didn’t make it out of committee hearings. SB 447 and HB 1151 would have established a license specifically for APRNs in Indiana. The Bowen Center compiled a report on APRN licensing strategies across the country, which you can review here.
Physician Workforce
- HB 1555 focuses on foreign trained physicians and has moved into the second chamber in the legislature. HB 1555 seeks to establish a limited medical license for those who have graduated from international medical programs, obtained a sponsor, and agreed to work in a medically underserved area. In 2021, 22% of actively practicing physicians licensed in Indiana reported completing their education in another country. Check out the education tab on the Bowen Center’s Indiana Physician Workforce Dashboard to get information on where Indiana physicians complete medical school and residency.
- SB 475 has entered the second chamber. SB 475 seeks to prohibit physician noncompete agreements.
- The two bills that focused on physician recruitment, HB 1068 and HB 1400 failed on first reading. HB 1068 sought to establish a program for medical school loan forgiveness while HB 1400 aimed to provide a tax credit for preceptors in medical education. Many other states have implemented tax credits to support recruitment and retention of clinical preceptors. The Bowen Center’s research on tax credits as an incentive strategy can be found here, including important considerations if Indiana were to implement something similar.
Behavioral Health
- Opportunities to streamline licensing while maintaining safety and quality were identified as a top priority by many stakeholders as part of the Playbook Project. HB 1520 and SB 216 include proposed changes to licensing policies for selected behavioral health professions. While HB 1520 did not pass out of the house, SB 216 is continuing through the second chamber.
- Workforce incentive bills HB 1154 and HB 1261 both did not pass out of the House. HB 1154 aimed to establish a behavioral health preceptor tax credit. This bill, hoping to support retention of clinical preceptors, would have provided a $1,000 state tax credit for a behavioral health professional who precepts a qualified student. HB 1261 sought to establish a behavior analyst license, which would have added a profession to the licensed behavioral health and human services workforce in Indiana.
Direct Care Workforce
- Currently, statute does not allow an individual with a felony offense related to substances to work as a CNA within five years of the offense. HB 1385 would alter this requirement to allow an exception if the CNA becomes certified as a peer recovery coach. HB 1385 has moved into the second chamber. You can review a summary of the Bowen Center’s 2024 research on direct care workforce data here.
- Two bills HB1161 and SB449 died in their respective originating chambers HB1161 sought to establish a license, training, and competency requirements for home health aides. SB 449 sough to require home health agencies to run a criminal background check on employees on an annual basis.
Other Health Workforce Matters
HB 1031 seeks to adopt the dentist and dental hygienist compact in Indiana. The dentist and dental hygienist compact would facilitate interstate practice of dentistry and dental hygienist in compact eligible states. If HB 1031 passes, Indiana will join ten other compact member states, and fifteen states with compact legislation pending.1 You can check out the 2022 Oral Health data here. Look out for the Bowen Centers 2024 Oral Health Reporting coming out later this year.
The Indiana pharmacy workforce plays a vital role in the provision of healthcare services to Hoosiers. SB 96 has moved to the House and would expand the immunizations that a pharmacist can administer to include those recommended and approved by federal agencies. Current law allows a pharmacist to administer immunizations approved by a physician. This bill would allow pharmacists to administer more immunization to Hoosiers who need them. The Bowen Center Pharmacist Workforce brief takes a deeper dive into services provided. Check out the latest Pharmacy Workforce Brief here.
Some additional bills that have moved into the second chamber but were not highlighted in our introduction blog post are outlined below.
| Bill Title |
Summary |
| HB 1200: Opioid Prescription Supply limits
|
This bill would establish limits for opioid prescribing to 180-day supply of certain drugs. |
| HB 1572: Hearing aids and speech language pathologists |
This bill would expand telehealth services to include speech-language pathologists. |
| SB 419: Crimes against health care providers |
Enhances protections for healthcare workers by increasing penalties for crimes committed |
| SB 473: Various health care matters |
Establish a separate registry for home health aides. Transfers administration authority to the nursing commission. |
All health workforce related bills remaining can be tracked using the Bowen Bill Brief. It has been an exciting first half of legislative session! The Bowen Center will continue to track all Health Workforce related bills until the end of session.
by Madison Bott | Feb 13, 2025 | Policy
As of 2023, there were 9,134 Advanced Practice Registered Nurses (APRN) reported to be practicing in Indiana. These APRNs include Nurse Practitioners (NP), Clinical Nurse Specialists (CNS), Certified Nurse Midwives (CNM), and Certified Nurse Anesthetists (CRNA). APRNs are required to be licensed as Registered Nurses (RN) and meet certain educational criteria to provide APRN-level services. CNMs are the only APRNs required to hold a separate, dedicated license in Indiana. Many Indiana APRNs (NP, CNS, CNM only) hold a prescriptive authority license. This license enables APRNs to prescribe medications and requires collaborative practice agreements with a licensed physician, dentist, podiatrist, or optometrist. Approximately 71% of Indiana APRNs hold prescriptive authority licenses, meaning about 29% of RNs who self-identify as APRNs hold no APRN-level license.
In 2023, the Bowen Center conducted a fifty-state policy review of APRN licensing regulations and published the findings in a corresponding report. This policy review revealed that only Indiana and Wisconsin do not require APRN-level licensure for all practicing APRNs. Currently, Indiana has no formal process of tracking the number of APRNs, unless they are Certified Nurse Midwives, or hold prescriptive authority. Collection of data on APRNs is reliant on RNs self-reporting as APRNs. This leads to several potential challenges including the inability for individuals to easily verify credentials of APRN providers and lack of consistent and sufficiently granular data for workforce planning.
Based on the national policy review, the Bowen Center identified 4 prevailing implementation approaches to APRN licensure. SB447 and HB1151 aim to create separate licenses for each advanced nursing role, which aligns with Approach #4 outlined in the figure below.
Regardless of the approach, it’s important that APRNs do not face a complicated licensure process. Key consideration include:
- Ensuring reciprocity and portability of licenses
- Reducing administrative burdens for license holders and state agencies
- Minimizing additional licensure costs
Professional regulation ensures quality service and public safety. The question to consider: Would an Indiana APRN license be helpful to protect public health and safety and support modernization of regulation, or are the current regulatory strategies sufficient?
Check out the full report here: Advanced Practice Registered Nurse Licensing.
by Madison Bott | Feb 1, 2024 | Policy, Topics of Interest
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Total Bills introduced in Indiana’s 2024 Legislative Session
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Total Bills identified with direct impact on health, health workforce or workforce included in the 2024 B4
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Total bills identified with direct implications for health workforce & distinguished separately.
Top Health Workforce Themes in the 2024 Legislative Session
Let’s cut to the chase. What health workforce legislation has been introduced in the 2024 session? There were a few major themes that arose. We have conceptualized these themes and summarized the outcomes below.
Nursing Workforce
- This session has seen many legislative initiatives related to the nursing workforce. One such bill (SB 45) would establish additional training requirements in trauma-informed care for all licensed Registered Nurses (RN). One bill would modify certain licensure requirements for health facility administrators, allow NCLEX passage to satisfy English proficiency requirements for internationally-educated nurse applicants, and eliminate telehealth certification requirement for telehealth nurses and other telehealth providers (HB 132). The final nursing-focused bill making progress this session makes various changes to nurse licensing, education, and training regulations regarding requirements for clinical preceptors, and requirements for certain foreign nursing applicants (HB 1259).
- Bills under this theme that were introduced but did not progress include: a bill removing the collaborative practice agreement with physicians and APRNS, and allows a APRN with prescriptive authority to prescribe a schedule II substance (HB 1059); a requirement for nurses to complete implicit bias training as part of their continuing education requirements (HB 1167); establishment of nurse staffing councils within hospitals in order to develop nurse staffing plans (HB 1015); allowing Certified Registered Nurse Anesthetists to administer anesthesia under the immediate presence of a podiatrist or dentist, which is currently only allowed under the presence of a physician (HB 1371).
EMS
- There have been several bills introduced regarding Hoosier emergency medical services professionals (EMS) this session. HB 1142 would establish a program of recognition for first responders killed or injured in the line of duty. A new grant pilot program was introduced in SB 10 for the purpose of assisting in the costs of mobile integrated health care programs and mobile crisis teams across Indiana. Finally, SB 142 would require healthcare coverage for mobile integrated healthcare and emergency medical services for all state employees on the state employee health plan (and other insurers).
- Bills under this theme that were introduced but did not progress include: HB 1118 would establish a program to support the mental health of first responders through the Indiana first responders mental health wellness fund and program.
Regulatory Changes
- House Bill 1214 would add Indiana to the Dental and Dental Hygienist Licensure Compact.
- Bills under this theme that were introduced but did not progress include: A bill proposing the expansion of eligible clinical experience supervision to include physicians, and psychologists for the Clinical Social Work Licensure and expansion of supervision through telehealth (SB 261); bills that would establish new licenses – Professional Music Therapists (HB 1103) and Naturopathic Physicians (SB 262); and a bill (SB 110) that would add Indiana as a member of the Social Work Compact.
Behavioral Health Workforce
- A bill proposed in the House would allow a Social Worker licensee applicant to take the social worker examination during their last term of a program that meets educational requirements, and provides a letter of good standing from the director of the academic department (HB 1138). This bill would allow a student to sit for their professional exam early if all requirements in the bill are met. House Bill 1238 would add certain physician assistants and advanced practice nurses as potentially qualifying professionals to serve as competency evaluators in criminal proceedings (previously only psychiatrists and psychologists).
- Bills under this theme that were introduced but did not progress include: SB 166 which would have allowed community mental health center staff to provide social work services without a license and remove examination requirement for BHHS temporary permits; SB 261 which would have expanded the qualifications for clinical experience supervisors for clinical social workers and expanded tele-supervision.
Other health workforce themes from legislators that didn’t make it to the second chamber:
Health Workforce Incentives
- There were a few bills related to health workforce specific incentives, including a bill that would establish a medical school loan forgiveness pilot program (HB 1175). Another bill would establish an Indiana rural hospital and critical health care services fund, new health workforce student loan repayment program, and associated health workforce advisory board (advisory board (HB 1196).
There’s More on the B4!
One way we monitor health workforce trends is by tracking Indiana health workforce legislation through implementation of the Bowen Bi-Weekly Bill Brief or “B4.” There are many other health and workforce/education-related bills that have been introduced this session. Check out the full B4 to learn more about those bills and keep track of the active bills as they progress through the second half of session!
