Archive for the ‘health workforce’ Category

June 9, 2010

Academic health center-community health center partnerships vital to health reform

89 percent of respondents to a recent survey (Academic Health Centers and Community Health Centers: The Landscape of Current Partnerships) by the Association of Academic Health Centers reported that the academic health centerution had an established partnerhsip with one or more community health centers.  These partnerships range from providing primary and preventive care to managing centers, training students, and conducting research. More than 60 percent of the partnerships are with federally qualified health centers (FQHCs).  The FQHC label is part of a designation category designed by the Health Resources and Services Administration and the Centers for Medicare & Medicaid Services indicating that the facility serves a medically underserved or health profession shortage area.

In this era of health reform, such partnerships are vital not only to expand access to care but also to address the nation’s health workforce needs.    Because community health centers provide care to more than 20 million people, of which a vast majority live in poverty, it is important to ensure that the policies and practices associated with the establishment,  operations, and collaborations of the community health center not only facilitiate effective care but also  promote innovation in care delivery.

The academic health center-community health center partnership is one that should be encouraged but improvement in federal policy is also needed so that the partnerships can adapt to changing needs.  Policymakers will need to examine regulatory, financing, management, and governance barriers that may be preventing collaborative models of care to flourish.

June 2, 2010

Baby Boomer Generation and the Need to Address the Health Workforce

The Baby Boomer generation has transformed America for decades.  Next year, when so many boomers turn 65, the U.S. will again feel their power as the population dramatically shifts in age.  The number of older Americans will increase dramatically from approximately 38 million to 72 million by 2030.

 The aging population presents a microcosm of the U.S. population in terms of the intense challenges facing the health workforce.  Perhaps for no other population is there such a close relationship between health and social issues and services.  Thus, examination of ways to improve and change the health workforce environment for the aging can provide valuable lessons for the nation.  

There is general agreement among experts that existing shortages across the health professions will become more acute as the elderly population grows.  However, shortages are only one part of the crisis.  Current models of workforce education and training are not adequately preparing the next generation of health care providers to meet the needs of older Americans.  In addition, an uneven patchwork of state and federal workforce policy continues to exacerbate provider shortages and hinder the delivery of quality care to the aging population.  Health care financing is particularly troubling in the long-term care arena, hindering innovation and the emergence of new models of care.  Finally, there is a lack of adequate data, research, and analysis of political, social, and demographic trends and their impact on the health workforce.

As the health needs of the aging increase and health workforce shortages grow policymakers, educators, health professionals, providers, industry leaders, and  other concerned stakeholders must consider how best to address the health workforce in a strategic and comprehensive fashion.  Policymakers must particularly question whether appropriate and effective decision-making can occur within the existing policy framework and, if not, the most promising alternatives to ensure an effective health workforce for the nation.

To resolve these issues and prepare the nation for increased health care needs, the health workforce must be made a priority domestic policy issue. For several years, the Association of Academic Health Centers (AAHC) has focused attention on the critical need for a new coordinated national health workforce planning initiative. During the health reform debate, the AAHC urged policymakers to develop an integrated, comprehensive national health workforce policy that recognizes and compensates for the weaknesses and vulnerabilities of current decentralized multi-stakeholder decision making.  The establishment of the National Health Care Workforce Commission is a powerful step to achieve that goal.

Today, with increasing pressures to meet the diverse needs of the aging for care in the coming decades, the AAHC recommends that leaders and decision-makers in both the public and private sectors:

  • Make the health workforce a priority issue.
  • Ensure that the  National Health Care Workforce Commission has the resources to plan and develop a comprehensive national health workforce policy.
  • Ensure that the National Health Care Workforce Commission engages federal, state, public, and private stakeholders with the goal of promoting harmonization of regulations and standards and addressing the pressing workforce issues of the nation.
May 3, 2010

New Models of Care Should Put Patients First

Recent comments on my blog related to one proposed new model of care reveal that many health professionals are not favorably disposed to any system that seems industrial.  People are not widgets, they say.  Health professionals across the board have revealed the amazing dedication and deep attachments they have for their patients.  Health professionals believe each patient is unique and want to ensure that any new system that emerges with health reform recognizes the value of the patient-health professional relationship.  An industrial model of care is not be an appropriate answer, they tell me.  Patients, many of whom have chronic or life threatening conditions,  require attention, caring, and commitments for the long term from health professionals.  Health professionals have been saying for a long time that policymakers need to ensure that this aspect of health care is recognized as health reform moves forward to the implementation stage.

February 27, 2010

Health Workforce: Find Free Info Online

When you’re trying to learn more about the health workforce, you may want to search the Health Workforce Information Center.  February marks the one year anniversary of the launch of the  center, a free online library of health workforce resources funded by the Health Resources and Services Administration (HRSA). If you haven’t already made use of our website or reference services to find statistics, funding, program ideas, or other information, check it out http://www.healthworkforceinfo.org/.

February 5, 2010

President Obama: Focus on Jobs in the Health Workforce

President Obama –and the Congress for that matter–need to focus on JOBS in the HEALTH WORKFORCE.  The Bureau of  Labor Statistics reports that the health sector ranks high among the areas that will provide the greatest number of new jobs over the next decade.  Four million jobs will be created in the health care sector will be a leader in producing new jobs,  including high-skill, high-paying jobs like doctors and nurses.  Among the top ten occupations needed will be:  Registered nurses, home  health aides, personal and home care aides,  and nursing aides, orderlies and attendants. 

With the aging baby boomer population, the need for a greater number of trained people in the health professions goes well beyond nurses and home care workers.  Shortages across the professions will be exacerbated by the retirement of physicians, nurses, pharmacists, dentists and other professionals.  In 2004, 23 percent of licensed pharmacists, for example, indicated they were leaving the profession within the year and 80 percent of pharmacy directors said they would leave within the decade. Substantial retirements of faculty in all schools of the health professions add to the problem.

With the overwhelming need for a health workforce for the nation, President Obama should be focusing his Jobs Initiative on education and innovative training programs for the health workforce.  President Obama should be looking for ways to provide incentives to academic health centers and their health professions schools for new ideas and innovative ways to develop a quality health workforce in a short time frame. 

One way is to receive funding and other incentives to create new career ladders for those people who are already employed within the health system and want to raise their skill levels and receive education in one of the more-skilled professions (and this can include the myriad allied health, imaging, medical records and IT jobs that are critical to the system).

There should also be funding to health professions schools to create innovative, perhaps fast tracked, retraining programs for the thousands of people who are losing their jobs in America’s dying manufacturing industries. 

The Obama Administration needs to look beyond small business and the green industries with regard to JOBS.  The health workforce should be the priority when it comes to jobs.

November 2, 2009

More on Interprofessional Education and Practice

As we have previously noted, interprofessional education and practice is somewhat of a buzz word these days.  While there might be an informal consensus of opinion that the health care of the future needs to involve meaningful integration of various health professions into patient-care teams, we have pointed out how the rhetoric in this area is far in front of the reality (see Oct 22 post).  We are aware of many fine institutions engaging in important interprofessional activity, but not enough has been done to focus on this issue at the national level.  At a recent meeting that we convened on the topic, the following observations emerged:

  • The current approach to interprofessional education is a study in grass roots development, as opposed to top-down leadership;
  • Interprofessional education and practice sometimes operate at the periphery of the institution, and are not engrained in the institutional fabric;
  • Attaining accurate predictions and assessments of the skill sets that will be required of health professionals in the future is vital;
  • Determining whether the “education tail” wags the “practice dog” or vice versa is important in developing the content and substance of these programs;
  • The drivers of interprofessional education and practice need to move beyond “belief” and be more empirically driven; and,
  • Health care reform may create demand for interprofessional education and practice by pushing to better  align health professional education with the evolving health care needs of the public.

Health care reform holds the potential to serve as a catalyst for disruptive innovation in health care, and, in so doing, bring interprofessional health care into the mainstream.  Indeed, the drive to create value in health care may lead to team-care as a paradigm that needs to be integrated with health professions education.

October 30, 2009

House Health Reform Takes AAHC Health Workforce Recommendation: More Needed

Yesterday, House Speaker Nancy Pelosi (D-Cal.) unveiled proposed health reform legislation from the House.  Put together from the work of three House Committees the bill  includes a public option. 

Also significant, the legislation also now includes language identical to the recommendation made by the Association of Academic Health Centers (AAHC) that a permanent health workforce advisory committee develop and implement “an integrated, coordinated, strategic national health workforce policy.”  The AAHC has advocated for a national workforce planning entity because it believes that the nation’s workforce policy must be changed; the nation’s customary piecemeal approach to the workforce is no longer viable or appropriate for the 21st century.

A  comparable Senate bill is still being negotiated. The Senate should not only include such language in any final bill but also move to ensure the creation of a permanent planning entity that operates continuously, makes ongoing findings and recommendations, and is available at any time to provide consultative support to federal, state, and private health workforce stakeholders. The planning entity must serve as an active policymaking partner, not a passive advisor.

The AAHC has been urging the congressional committees and congressional leadership to broaden the scope of activity of the proposed advisory committee/national commission to fully support a strategic national policy approach.

Specifically, the AAHC recommends the following modifications be incorporated into any health reform legislation considered by the full House and Senate:

  1. Make development and implementation of an integrated, coordinated, strategic national health workforce policy the primary objective of any advisory committee or national commission.
  2.  Constitute the advisory committee or national commission as a continuously available policy research and consultative resource, not simply as a body of external experts that convenes from time to time to make periodic recommendations.
  3. Amend the enumerated issues to be addressed by the advisory committee or national commission to include the harmonization of conflicting national and state-based regulatory and private self-regulatory standards (e.g., licensure, scope of practice, accreditation).

4.    As an interim step, create a national health workforce coordinator to assess current federal capabilities and prepare agencies for their interactions with the advisory committee or national commission once it is fully functional.

 This is the way to ensure that the nation  has the health workforce it needs for the short and long-term.

October 29, 2009

Create Health Workforce Jobs for U.S. Economic Recovery

We all know that the employment picture in the U.S. continues to be dark. One in 10 Americans who wanted a job last month were unemployed. What many do not know is that private sector employment growth fell short of the number of new people entering the labor force by more than 500,00 jobs each year throughout the 1990s! The bottom line: Economists say the U.S. job creation engine has been stalled for the better part of a decade.  New enterprises are not coming on line. As older industries die, established industry and entrepreneurs are not entering the market place and using capital to create jobs.

 So where will jobs come from? Health care is an obvious choice. It’s time for a public policy to support this growth industry with a Jobs Bill for Health Care (similar to the post World War II GI bill). The bill would provide funds to train all comers – from the returning war vets to the unemployed, from the dying manufacturing industries to the recent high school graduates. This will produce not only the health workforce that the U.S. so desperately needs in the near and long term but also create a “product” that can be exported overseas – trainers for other countries’ healthcare challenges.

 In addition to direct investment, the government should ensure funding from the insurance industry and providers who do not now train health professionals but depend on the health workforce . Let’s ensure the health and economic future of the United States with a public-private partnership that makes sense.

October 22, 2009

Interprofessional Education and Practice: Infrastructure Needed to Go From Rhetoric

For years there is talk about interprofessional teams.  For more than 20 years, educators and policymakers have put this forth as part of the health care vision for the 21st century.  It is also directly and indirectly referred to in health reform legislation before the Congress.  Policymakers are enamored of the idea of an interprofessional team of caregivers providing patient centered care (whatever that means).

 I learned about some of the latest innovations in  interprofessional programs in academic health centers throughout the nation.  Students from two or more health professions are educated together and/or engage in practice together and, in so doing, are not only improving the learning environment but also patient care and outcomes.

 

Rural practitioners tend to embrace interprofessional practice more fully than practitioners anywhere else in the country for obvious reasons.  However, in the last decades, interprofessional education has not gone mainstream and been fully embraced by health professions schools and academic health centers.  Interprofessional activities have been person directed (by a passionate advocate), thus remaining at the margins of health professions education.  Passion on the part of institutions is not quite as evident.

 What’s the problem.  Money is always an issue.  With universities and hospitals waiting for the next budget cut, institutions are hampered from creating new programs so needed for the future.  In addition, we still don’t have enough evidence that such practices make a difference.  There has not been enough study of the long-term impact of interprofessional initiatives.  Research is needed.  And that also cost money. Regulations don’t support it.  State licensing boards and accreditation agencies often inhibit innovation within institutions. Scope of practice laws are barriers to interprofessional practice.  Faculty incentives are still based on what makes a difference to the “profession,” whichever that may be—thus making it hard to engage appropriate teachers in the process. Finally, the current health care delivery system—specifically the reimbursement system—does not support interprofessional practice—and may not support it for the future. 

 The bottom line:  Interprofessionalism lacks focus.  There is no standardization, no uniformity anywhere in the nation.  There is no framework for programs, policy or practice.  There is no infrastructure and no guidelines for establishing the infrastructure that is needed within institutions, particularly academic health centers where most of health professions education takes place.    To fill this void, leaders of academic health centers are engaging on the issue—not only to mainstream interprofessional education and practice but to educate policymakers about the best way to deliver care for the future.

October 20, 2009

Challenges for the Health Care Sector

I recently returned from the World Health Summit in Berlin, a large substantive meeting dealing with many aspects of health and well-being.   On one of the meeting’s many panels, I was asked to address what the health care sector needs in order to thrive.  In thinking somewhat about this topic, I decided to focus on the serious challenges that health care, from a global perspective, faces, and chose to comment on five of them.

1. Increasing Dualism.  By this I refer to the growing health disparities that exist within and among countries, as well as the significant gap between what we know scientifically and what we practice clinically.

2. Overextension of the health system, such as in needed responses to pandemics, wars, natural or man-made disasters, emerging diseases, behavioral and planetary changes, and so forth.

3. Loss of Focus on the Patient and the Community.  Here the concern relates to growing economics of health care and the delicate balance between seeking profit and good health.

4. Shortage and Maldistribution of Healthcare Workers.  Readers of this Blog should not be surprised by this one.  These shortages range from a general lack of practitioners to specific kinds of medical specialties, and include ethical issues of the international migration of health workers.

5. Support of Research.  Research is a critical engine of progress for health care delivery.  Continuing the flow of these dollars and directing them to areas with the highest yield remain substantial challenges.

There has never been a more relevant opportunity for those institutions educating the next generation of health professionals, conducting biomedical and clinical research, and caring for patients to work together collaboratively.  In response, AAHC International has been created to foster the concept of an international academic health center community driven by the ideal of improving the public good.