An effective workforce is essential to achieving the goal of universal and equitable access to health care. This section addresses the acute and postacute care workforce. (For a discussion of workforce issues related to long-term services and supports, see Chapter 8, Long-Term Services and Supports.)
Workforce composition—to be most effective, the health care workforce should be of an appropriate size to ensure access for all without encouraging overuse of services. It should also include the right mix of providers, including physicians, nurses, pharmacists, dentists, therapists, direct-care workers, and allied health professionals, as well as the right balance of primary care providers and specialists. Members of the workforce should have the skills and education needed to meet the population’s care needs and must be allowed to function optimally, with the authority to practice to the full extent of their education and training. Our existing workforce faces deficits in each of these areas. These deficits threaten the success of health reform implementation and the health care of all Americans, especially older Americans, who face higher rates of illness and are more likely to be frail or have cognitive impairments.
The US faces shortages and unequal geographic distribution of various health care personnel, most notably nurse aides, registered nurses, advanced practice registered nurses (APRN), and primary care physicians.
The Affordable Care Act of 2010 (ACA) recognizes the need for more primary care providers and contains several provisions aimed at increasing their number, including offering temporary pay increases for primary care physicians who treat Medicare and Medicaid beneficiaries, increasing advanced education opportunities for nurses, and expanding student loan-forgiveness programs for primary care providers working in underserved areas. Such efforts are important but are likely to be insufficient to address the shortages.
The primary care provider shortage is especially problematic because these professionals will play an increasingly central role in managing care for chronically ill patients. Over the coming years, they’ll also have a crucial hand in providing medical homes for Medicare beneficiaries and in extending care to the millions of newly insured adults. The delivery system reforms discussed earlier in this chapter depend on having enough primary care providers with the training and skills to work in interdisciplinary teams and medical homes, and to manage patients with chronic diseases. (See this chapter’s section Health Care Coverage: Medicare—Medicare Program Administration and Outreach.)
Shortages in some health care specialty areas—particularly geriatric specialists, who are trained to deal with the special needs of older patients—will become particularly acute given the impending increase in the number of Medicare beneficiaries as the baby boomers continue to age. Shortages in other specialties may also threaten access, especially as the health care needs of the population change. Even in specialties with enough providers overall, geographic imbalances may reduce some people’s access to care.