Posts Tagged ‘health workforce’

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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.

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Posted in Health Reform, health care delivery models, health professions education, health workforce, jobs | 3 Comments »

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/.

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November 24, 2009

The Health Workforce and Health Reform: Progress Report

In the recently released Senate Bill on Health Reform, the establishment of a National Health Care Workforce Commission that “develops and commissions evaluations of education and training activities to determine whether the demand for health workers is being met” is proposed on page 1278.  (As an aside, I am concerned with the use of the word “demand” in the sentence, as the word “need” would more accurately reflect the spirit of true health reform).

Earlier this month, House Speaker Nancy Pelosi released the House’s proposal for reform, calling, on page 1275,  for the establishment of a “permanent advisory committee…[that would] develop and implement an integrated, coordinated, and strategic national health workforce policy relective of current and evolving health workforce needs.”

The Association of Academic Health Centers is pleased to see both recommendations, which in part reflect our advocacy efforts on Capitol Hill to make the health workforce a priority issue in health reform.

These Bills reflect some of the recommendations in our 2008 report Out of Order, Out of Time: The State of the Nation’s Health Workforce.  The report presented a comprehensive overview of health workforce policy (or, perhaps more aptly said, the lack of health workforce policy) and concluded that health reform cannot ultimately be successful without health workforce reform.  The report was widely circulated and followed up with testimony before the Senate Finance Committee, multiple meetings with offices in the White House, DHHS, and a variety of letters, news releases and so forth.

While neither the House or Senate Bill captures many of the critical recommendations in the AAHC Report, both attempt to address critical workforce issues and raise the significance of health workforce policy.   At this point, the fate of these Bills and the outcome of health reform is not known.  However, we are taking this opportunity before floor debate in the Senate to stress with the Congress the need for broad and comprehensive approaches to workforce policy, and the compelling need to connect the health reform with the health workforce.

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Posted in Uncategorized | 1 Comment »

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.

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Posted in Health Reform, Uncategorized, health professions education, health workforce | 1 Comment »

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.

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Posted in Health Reform, News, Policy, Uncategorized, health workforce | No Comments »

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.

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Posted in Health Reform, Policy, U.S. Economic Growth, health economics, health professions education, health workforce | No Comments »

October 8, 2009

Include Health Workforce Planning Entity in Health Reform Legislation

It’s still not too late to put a national workforce planning entity into health reform legislation (or I am supposed to say health insurance reform).  This would neither be a commission nor a short-term advisory or research group. This would be a permanent entity–perhaps a quasi-governmental organization that has some clout–not only to bring constituencies together but also to get things done that change the shape of health workforce policy in this nation.  The goal–plan so that the health workforce can care for the American people now and in the future.

Academic health center CEOs said as much this week when they told congressional staff and representatives of national health care organizations at a congressional briefing that pending health reform legislation(including the Senate Finance Committee proposal) does not yet reflect the strategic emphasis on health workforce needed to implement successful health system reform.

  “Pending bills include numerous important workforce-related provisions, but they lack sufficient means to effectively coordinate workforce policy among federal, state, and private laws, regulations, and standards,” said Dr. Steven A. Wartman, President and CEO of the Association of Academic Health Centers (AAHC).

Dr. Wartman was joined in the panel discussion by: Dr. Nancy Dickey, President, Texas A&M Health Science Center, and Vice Chancellor for Health Affairs, Texas A&M University System, and past chair of the AAHC Board of Directors; Dr. Philip A. Pizzo, Dean, School of Medicine at Stanford University, and chair of the AAHC Board of Directors; and Dr. M. Roy Wilson, Chancellor, University of Colorado Denver, and a member of the AAHC Board of Directors.

 Dr. Wilson told the group that the nation must have a national agenda for the workforce.  Without such an effort, federal, state and local governments and agencies will continue to work in isolated silos as they attempt to solve workforce issues.

 Dr. Dickey emphasized that health workforce reform has to start today so the nation can build a viable infrastructure and rationalize our health workforce policy.  With a permanent national workforce planning body, the nation can address the full range of workforce issues — from shortages and geographic disparities, to regulatory and policy conflicts that prevent health professionals from practicing to the full extent of their training, to the paucity of reliable data on the workforce — in a comprehensive and coordinated manner.

 Dr. Pizzo cautioned that when policymakers consider changes in health care reimbursement, they must take account of the unique academic health center education and research missions, which in part are dependent on clinical revenues.  The nation must ensure that reimbursement reform does not financially undermine these academic health center missions that are so vital to the nation’s economy and its preeminence in education and research worldwide.

 “Comprehensive health workforce reform is necessary for successful health system reform, and the key to health workforce reform is creation of a permanent, ongoing health workforce planning body,” concluded Wartman.

It’s about health care.  It’s about jobs.  It’s about the economic future of the nation.  We can’t make the health workforce a second-class issue.

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Posted in Health Reform, News, Policy, health workforce | 1 Comment »

October 2, 2009

Congress: Listen to the Academic Health Center Leaders on Health Reform

I heard today that congressional staffers are “punch drunk” from logging in so many hours working on health reform.  I am not comforted by that thought given they are trying to  write one of the most significant pieces of legislation in decades.  I am  wary of the urgent rush to produce something—good or bad—to show that Congress is not twiddling its thumbs.  Does the Congress really have all the facts?  Or are they also developing legislation based on minimal or biased information, evidence, experience, or truth?

 I would point to an opinion piece in the LA Times by Dr. Philip Pizzo, dean of the school of medicine of Stanford University and chairman of the board of the Association of Academic Health Centers, where he wrote, “Undertaking such an important shift in how we deliver healthcare requires a robust national debate.” With the members of Congress getting ready to say yea or nay on health reform,  we still have not had sufficient debate from all sides.  The nation has heard too much from those leaders who, as Dr. Pizzo says, “choose to rely on fear instead of facts to make their case.”

 Before the votes get counted, we need to hear from the patients who really use and have experience with the health care system as it exists today.  We need to hear more from the leaders of the nation’s academic health centers–some of the most experienced experts on health care in the nation.  Most are physicians who not only have practiced medicine for decades but also have had distinguished careers in academe (and sometimes government).  Most of all, they know what it means to lead and operate an institution, without which our communities–and the health system–cannot function. 

These leaders, who also include nonphysicians, can tell us about patient care, the impact of health on communities, the health and economic consequences of  having no insurance,  and the problems with the current reimbursement system.  They can tell us what it is like to run health professions schools–from medicine to allied health,   major departments at a children’s or other teaching hospital, or an entire teaching hospital or  health system–and what facilitates or impedes care delivery.  

Academic health center leaders are the people at ground zero, making sure that the nation can provide health professions education, biomedical research, and patient care.  They are sustaining the infrastructure that may determine the nation’s future.  Congress should be listening to these voices of experience and reason.

Academic health center leaders know what it takes to provide patient care and sustain a health system in challenging economic times. They not only know the problems but also how to resolve them.  Academic health center  leaders for example, will tell the Congress why we need to establish a permanent workforce planning entity or board so we can resolve primary care shortages and rural health problems–and  ensure the nation has a health workforce for the future.  

Congressional staffers—stop running on empty and get MORE input, advice, and recommendations from the academic health center community.

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September 3, 2009

Obama Trying to Salvage Match Point in U.S. Health Reform Open

What should have been a “love game,” with Obama easily cruising to victory in the U.S. Health Open, has now turned  into a grueling last set, last game battle, with the President having to save match point.  The President will address a joint session of Congress next Wednesday night to add specifics to his vision of health reform, according to media reports.   If conversations with White House health advisors are any indication, it is difficult to discern anything new in the messaging.  If the President tells the nation we need more primary care, health IT, and research to find out what treatments work and don’t work, America will not be enthused.

 America wants to know what systemic changes the President wants in a health reform bill. Will he stand for a strong public option?  Will he provide the roadmap and transition time for changing the current health insurance industry? Will he ensure that the health workforce is a priority and address workforce issues now—not later?  Will he go beyond primary care—and provide a new vision for how to deliver primary and specialty care to all segments of society or will he be satisfied with a 19th century view of the primary care doc going off alone to the rural regions of the country to solve the workforce crisis? 

Will the President explain to the nation that whatever happens in the delivery of services will ultimately affect  the nation’s research enterprise because of the unique  role that academic health centers play in the nation’s health system?  Will he explain how health reform must take account of how the clinical monies help to support the nation’s biomedical research through these institutions?  If the answers to these questions are what is meant  when the White House says  “specifics,” then America will listen.  If not,  the  President will be forced to make a quick exit from Center Court.

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Posted in Health Reform, News, Policy | 1 Comment »

August 20, 2009

Health care and jobs

The pressures to cut health care costs are enormous, but these cuts can also be a double-edged sword.  Certainly, no one would argue against cutting fraud and overuse.  But at a time when job creation is so important, the health sector is and will be a key player.  These jobs are not just for a broad variety of health care providers, but also for a large range of administrative and management positions.  A recent article points this out by focusing on individuals who cross over from other economic sectors to work in health care.  As health care exceeds one-sixth of the economy and one out of every ten jobs, it becomes increasingly difficult to disentangle needed job growth from excessive health care spending in terms of driving the economy.  This is especially true if there is some kind of health reform that increases access to a substantial number of persons who are currently either uninsured or underinsured.  As we have pointed out in our report, Out of  Order, Out of Time: The State of the Nation’s Health Workforce, we need to gain a more in-depth understanding of the kinds and numbers of health providers that are needed to take care of patients now and in the future.   Perhaps by engaging in this discussion we can address the complex issues around “right-sizing” health care.

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Posted in Health Reform, health economics, health workforce | No Comments »

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