On October 18, 2011, the Bipartisan Policy Center’s Health Professional Workforce Initiative released a joint study, The Complexities of National Health Care Workforce Planning, in collaboration with The Deloitte Center for Health Solutions. The study was released at a public event featuring Senator Bill Frist, Health Project Co-Leader, Dr. Don Berwick, Administrator of the Centers for Medicare and Medicaid Services (CMS), Dr. Mary Wakefield, Administrator of the Health Resources and Services Administration (HRSA), and a panel of health professional experts.
The Bureau of Labor Statistics estimates that the health care sector will grow 23 percent between 2008 and 2018, compared to approximately 9 percent for all other employment sectors, with over three million new jobs between 2008 and 2018 alone. While the health care sector will continue to expand, it is a struggle to identify and train the right mix of health care professionals to address the health care demands of the future.
With the data currently available, it is difficult to offer both a complete forecast of the national health care workforce supply and assess its capability for meeting the demand for services in coming years. With reforms underway, changes in demand for services, innovative clinical technology that facilitates diagnosis and treatment, payment reforms that influence provider behaviors, workforce policies that frame licensing and scope of practice, academic practices that encourage isolated care giving, as well as expansive changes to the overall structure of the system, it is almost impossible to fully capture a complete health care workforce picture.
To address these issues, BPC event brought together academic, policy, and health professional leaders to discuss the future of the health care workforce.
Dr. Paul Keckley, the lead author of the report and Executive Director of The Deloitte Center for Health Solutions, opened the event. The U.S. health care system, he explained, is capital intense, highly regulated and labor intensive, yielding a “complicated storm cloud in which organizations have to operate.” He emphasized that calculating the current and future supply of the health care workforce is not an easy task – the existing landscape of the health care workforce supply lacks a consistent and comprehensive national overview of the full extent of professions and health workers active in the system. This study examines the methodologies and assumptions that are applied to estimating the current and future supply of 12 different health professions and provides the tools needed to assess workforce supply in a more meaningful, comprehensive, and consistent way and improve data collection. The next steps, Dr. Keckley explained, are to develop a consistent methodology for determining demand for health care services and to translate these findings into a set of tools, policies, and approaches that would capture the true demand.
Senator Bill Frist, an experienced heart and lung transplant surgeon, emphasized the importance of health system transformation and applauded the report for being the first to aggregate all of this data into one study. “In a health system that promises more coordinated, inter-professional, integrated care, we must take an all-inclusive look at our future workforce needs,” Senator Frist explained, “A sustainable health care system will have enough professionals to care for all Americans in the right place at the right time.”
Dr. Mary Wakefield, Administrator of the HRSA, explored the role of HRSA in promoting access to health care services for people who are uninsured, isolated or medically vulnerable, in improving care coordination, in supporting and implementing workforce improvement provisions in the Patient Protection and Affordable Care Act, and in supporting state organizations, state workforce development grantees and other relevant entities. Dr. Wakefield reinforced the need for better data collection and a minimum data set, highlighting the work of HRSA’s analytics center, the National Center for Health Workforce Analysis. Dr. Wakefield also celebrated gains in The National Health Services Corps, which surged to more 10,000 primary care clinicians practicing in underserved rural and urban communities in 2011, almost three times as many as were in the program in 2008.
Dr. Don Berwick, Administrator of the CMS, emphasized the critical need for a well-trained and supported workforce to lead health system transformation. Dr. Berwick explained that our system is not configured for sustainability. It cannot meet the real needs of patients and families at the current level, notwithstanding the anticipated coverage expansion. It is an exciting time in health care, he explained, because it is in motion, and “although not all change is improvement, all improvement is change, and so if things aren’t in motion, improvement is unlikely.” Dr. Berwick believes we should focus on the triple aim: better care, better health, and lower costs and highlighted a number of innovative projects around the country that are achieving significant improvements, including the Virginia Mason and Denver Health Production Systems, regional extension centers, Beacon Communities, Project ECHO at the University of New Mexico, Baylor University Medical Center in Dallas and its effective heart failure treatment plan, and the Family Wellness Warriors Initiative in Alaska.
Dr. Kavita Patel, co-chair of BPC’s Health Professional Workforce Initiative, moderated a lively panel discussion featuring Dr. Michael Bleich, Dean and Professor of Nursing at Oregon Health & Science University, Dr. Christopher Kuzniak, General Surgeon at Piedmont Surgical Associates in Atlanta, Georgia, and Dr. Nicholas Wolter, Chief Executive Officer at the Billings Clinic in Billings, Montana.
Dr. Bleich emphasized the need for broad systems thinking, team-based care and overlapping competencies. He highlighted the need for a cultural shift and the importance of training health care providers to be systems-oriented, strong communicators, and architects of new models of care. He explained that we do not need to “homogenize every discipline” but to teach our students why and how patients benefit from “different professional lenses” and overlapping competencies.
Dr. Kuzniak stressed the generational differences between health care providers, reliance on health information technology by younger providers, and fiscal responsibility of all persons involved in the provision of health care services. He explained that medical education in silos results in rigidity; interdisciplinary and team-based training should be encouraged at the beginning of training.
Dr. Wolter explored the culture and sociology around changing professional identities. He maintained that while team based care will improve the delivery of care, providers face many challenges in learning how to be team players and how to work differently with other providers in order to achieve the triple aim – focusing on how we adapt a culture and how we train this kind of workforce are critical.
- BPC Health Project Showcases Healthy Ideas in Texas, October 13, 2011