Health care work force report questions how to plan for future

Washington -- Health care policymakers' ability to plan future work force needs is hindered by incomplete and inconsistent data on certain health professions, as well as a lack of training in new care delivery models, according to an analysis by a Washington think tank.

The Bipartisan Policy Center on Oct. 18 released a preliminary report, "The Complexities of National Health Care Workforce Planning," a review of existing work force employment and training.

The center, founded in 2007 by four former Senate majority leaders, plans to release a full version of the 28-page initial report in November.

The report concludes that work force planning does not sufficiently account for new technology, regional differences and potential consumer engagement in health care delivery. Nor does current training adequately emphasize team-based care models expected to become more prevalent through the health system reform law.

Greater care coordination will be a key to tackling chronic disease, said Donald M. Berwick, MD, administrator of the Centers for Medicare & Medicaid Services, who spoke at the report's release. "The new health care work force can deliver what we need. But we'll have to invest in them, train them, support them."

Extensive research exists on the supply of and demand for physicians and nurses, but not for chiropractors, home health aides, psychologists and others with less demanding licensing requirements, the report found. Information on certain health professionals is "limited, inconsistent, profession-specific and noncomparable," in part because states have different methods of collecting data.

The Health Resources and Services Administration is collecting more data. By late 2012, the agency plans to release statistics on the number of individuals practicing in 30 health professions, said HRSA spokeswoman Michelle Daniels.

HRSA Administrator Mary Wakefield, PhD, RN, said the report complements other ongoing health care work force research. "I can guarantee we'll be using it to inform our thinking," she said at the Oct. 18 event.

Projected demand for professionals tends to be based on past experiences and not on how financing and demographics could affect future demand, according to the report.

Health care leaders should agree on a common objective and define demand based on where the health system is going, not where it's been, said Paul Keckley, PhD, lead author of the report and executive director of the Deloitte Center for Health Solutions.

Demand for many health professionals is expected to continue to grow in part because more than 30 million Americans will gain coverage under the health reform law beginning in 2014. Health care employment was 10.5% of the total work force in 2008 and is projected to increase to 11.9% by 2018.

But demand for physicians and other highly trained health professionals could be lessened by giving greater roles to allied health professionals and less-credentialed health care workers, speakers at the center's event suggested.

Dr. Berwick said telemedicine in Alaska, for instance, has greatly reduced the need for patients living in remote towns to fly to cities to see physicians.

Other issue experts agreed that the U.S. needs better work force data. But health care leaders should not hesitate to ramp up health professional training whenever possible, said Atul Grover, MD, PhD, chief advocacy officer for the Assn. of American Medical Colleges. "Whatever we have now, it's not enough." Even if allied health professionals and others help relieve physicians' workloads, the nation still faces a significant shortage of doctors, he said.

Physician supply is on track to increase slightly, according to statistics AAMC released on Oct. 24. First-time medical school applicants reached an all-time high of 32,654 in 2011, a 2.6% increase from 2010. Total medical school applicants increased by 2.8% to 43,919.

But interprofessional education is lacking, said Michael Bleich, PhD, RN, dean and professor of nursing at Oregon Health & Science University in Portland. Physicians and nurses rarely interact with each other during their training, he said.

Medical schools are paying more attention to interprofessional education, said Sheldon Retchin, MD, MSPH, CEO of Virginia Commonwealth University Health System in Richmond. However, these models must be careful not to provide incentives to deliver more care, he said.

Health care payment reforms, such as pay bundling, will play a huge role in demand for health professionals, said Nicholas Wolter, MD, CEO of the nonprofit Billings (Mont.) Clinic.

"These payment policies are extremely important in terms of how they can drive changes in the delivery system," said Dr. Wolter, a former member of the Medicare Payment Advisory Commission. "The details of how those payment systems are built, however, are incredibly difficult."

Dr. Retchin noted that health care prices could be driven higher by shortages of health professionals.