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 Long-Term Services and Supports for a discussion of workforce issues related to long-term services and supports). 

Workforce composition: 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. These include physicians, nurses, pharmacists, dentists, therapists, and direct-care workers, as well as allied health professionals. 

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 Affordable Care Act recognizes the need for more primary care providers. It 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 likely 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 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 this chapter’s section on Medicare Program Administration). 

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.