Health Care Workforce

A well-educated and highly skilled workforce is essential to universal and equitable health care access. In addition, the health care system needs an optimal balance of primary care providers and specialists and sufficient numbers of each in all geographic areas. This section addresses the acute and postacute care workforce (see also Chapter 8, Long-Term Services and Supports).

The workforce should have the skills and education needed to meet the population’s care needs. They must be allowed to function optimally, with 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 U.S. faces shortages of various health care personnel. These shortages are distributed unequally across the country. Most notably, nurse aides, Registered Nurses, Advanced Practice Registered Nurses, and primary care physicians are in short supply. The lack of primary care providers is especially problematic because they play a central role in managing care for individuals with chronic conditions.

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 will also have a crucial hand in providing medical homes for Medicare beneficiaries and 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 also Medicare Program Administration and Outreach and Chronic Care Coordination and Accountable Care Organizations).

The country also faces shortages in some health care specialty areas, particularly geriatric specialists trained to deal with the unique needs of older patients. This problem will soon become particularly acute given the impending increase in 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. Policy solutions can involve streamlining standardized universal workforce training so that certified nurse aides, home health aides, personal care attendants, and others can easily move between jobs in workplaces. This would reduce training costs and would create efficiencies.