Policy-makers involved in healthcare reform are making a mistake in disproportionately emphasizing our current doctor shortage while neglecting serious shortages of care providers in other fields of health. Rather than continuing a failed, piecemeal approach, the nation needs to establish a multi-professional, multi-disciplinary, national planning body charged with carrying out a comprehensive and coordinated national health workforce policy. National healthcare reform cannot be realized without effective national health workforce reform.
Yes, there is a critical need for more primary care physicians and internists. But it’s not only doctors who increasingly are in short supply. Our entire health work force is being strained by severely inadequate supplies of nurses, dentists, physical therapists, physician assistants, radiologists, mid-wives, pharmacists, and a host of other critical health professionals essential to the delivery of the care needed in any reformed system of health care access, delivery, and payment. These are important health disciplines that don’t garner attention through headlines. But if we continue to ignore the larger workforce crisis, we will find ourselves on the same disastrous path that has allowed other aspects of our health delivery system to deteriorate to their current state.
The current workforce is aging, and even the people to train them are in increasingly short supply. For example, the Robert Wood Johnson Foundation identifies the lack of nursing instructors as a critical lesion in our nation’s nursing shortage. A recent survey by the Association of Academic Health Centers (AAHC) showed that more than 90% of its members have faculty shortages in nursing, 80% in pharmacy, and 60-80% in radiation science and physical and occupational therapy. An inadequate supply of faculty limits the opportunities for the next generation of health professionals. These are just some of the many professions involved in healthcare delivery. To reform healthcare by addressing the doctor shortage alone means neglecting the largest portion of the health workforce. And healthcare is delivered by teams, not individuals.
Policy-makers truly committed to healthcare reform must look at the bigger picture. A recent report by the AAHC, aptly titled “Out of Order, Out of Time: The State of the Nation’s Health Workforce,” illustrates how the broader health workforce shortages can cripple reform efforts. The shortages are symptomatic of much greater flaws throughout America’s health system. For example, healthcare providers must be properly licensed to provide the care for which they are trained. But differences in states’ licensing requirements, scope of practice, and credentialing deter relocation of health providers from communities with an excess to those with a need. Policies covering the health workforce are fragmented among hundreds of federal, state and private policy-making bodies.
Another problem: The personal costs and time needed for a health education make the lower paying health careers less attractive and can greatly influence where health providers practice. For example, the loans for dental students at the end of training are on average >$125,000 per student; many simply cannot afford to serve in areas of great need with poor, underserved populations.
This means that we lack any meaningful national infrastructure to address our many workforce problems and to implement effective solutions in a timely manner. America urgently needs a national planning body to address training, deployment, and other health workforce issues. The costs for training this needed health workforce will depend on the health reform plan put in place. This underscores the need for workforce planning to preemptively be incorporated into discussions of healthcare reform. Policy-makers must think strategically and broadly about the many disciplines and professions critical to tending to the nation’s well-being and about the many barriers health professionals face in carrying out their sorely needed jobs. Steven A. Wartman, MD, PhD, is President and CEO, of Association of Academic Health Centers. William F. Owen, Jr. MD, is President, University of Medicine and Dentistry of New Jersey.