HHS in the 21st Century Charting a New Course for a Healthier America (2009) / Chapter Skim
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5 Strengthen the HHS and U.S. Public Healthand Health Care Workforces
5 Strengthen the HHS and U.S. Public Healthand Health Care Workforces
Pages 105-124
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RECOMMENDATION 4 Strengthen the HHS and U.S. Public Health and Health Care Workforces The secretary should place a high priority on developing a strategy and tools for workforce improvement (1)
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As this chapter documents, there appear to be impending shortages of people with the right backgrounds, training, and skills within the department's senior levels, within the nation's health care workforce generally, within state and local public health agencies, and within the science establishment. These shortages will cripple the ability of the department to carry out its work and negatively affect health care delivery, even as demands are increasing.
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From page 107... ...
A similar pattern is also occurring in state and local public health agencies. Outside the public health world, problems in the number, mix, and composition of the nation's health workforce also have a negative impact on the department and its agenda: • The United States has an overall imbalance between specialist and primary care physicians, and the higher costs that result from an overreliance on specialist care fall heavily on Medicare and Medicaid.
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From page 108... ...
To recruit professionals with the appropriate managerial experience and scientific expertise, the department will have to engage in creative recruitment of at least some people with deep private-sector experience, as well as cultivate talented employees within the department who have the ability to move into more senior roles. It will also need to establish a robust recruitment program for experienced, well-qualified economists, health services researchers, statisticians and epidemiologists, clinical scientists, biomedical engineers, computer scientists, information systems engineers, and other such disciplines.
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From page 109... ...
These retirees were an experienced group, with 28 years' service, on average; 22 were from the Senior Executive Service (SES) ; 370 were categorized as "professional." Three years later, in 2004, a somewhat larger number -- 1,700 -- of employees retired, 2.9 percent of the department's workforce.
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. 2 A separate Presidential Management Fellows program, intended for individuals with recent graduate degrees, is operational and provides HHS with about 50 Fellows annually.
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HHS agencies were asked to reduce the number of administrative man agement and support positions by 15 percent, moving some of these workers into frontline public health work. However, these former administrative and support staff did not necessarily have the requisite public health edu cation and experience.
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Related Recommendations a. The secretary should immediately strengthen workforce planning in the department and de velop a comprehensive strategy to recruit highly qualified public- and private-sector individuals, in order to offset the large number of experienced staff expected to retire soon.
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The Clinical Care Workforce The following problems in the clinical care workforce affect access to health services: • 63 million Americans live in a primary care practitioner shortage area. • 47 million live in a dental practitioner shortage area.
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The number and severity of chronic conditions increase with age, and people over 65 generally have more than one chronic disorder. Treatment of chronic conditions is expensive, accounting for almost 80 percent of the nation's $2 trillion in annual health care expenses (Kovner and Knickman, 2008)
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Advanced practice nurses (clinical nurse specialists, nurse practitioners, nurse midwives, and nurse anesthetists) and physician assistants can fill part of the gap in primary care access, and the country had
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Simply having an "Asian" health care provider does not necessarily meet the needs of individual AsianAmerican patients for culturally competent care. At a time of workforce shortages, minority groups may represent a large, relatively untapped pool of potential health professionals.
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They inspect restaurants and other food service establishments as well as environmental health problems; track diseases and intervene in disease outbreaks; improve emergency preparedness through complicated drills and exercises; maintain vital statistics; provide health education; and even, in some cases, provide mental health care, immunizations, school health services, home health services, maternal and child health services, migrant health screenings, and many other functions for vulnerable populations and community residents at large. Finally, in rural areas they spend remarkable amounts of time driving to outlying areas of their jurisdictions.
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From page 118... ...
, more than 100,000 individuals work in state public health agencies, 34 percent of whom are administrative and clerical personnel. According to a 2005 survey, local health departments employ approximately 160,000 public health workers, again approximately 34 percent of whom are administrative and clerical personnel (NACCHO, 2006)
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From page 119... ...
program to fund telemedicine projects, but in scale and ambition it is far short of the potential and the need for such investment. A strong collaboration among HHS, the Veterans Health Administration, the Department of Defense, the FCC, and private-sector organizations around a focused, well-funded initiative could expand telehealth systems as a component of strategies to address health workforce shortages.
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e. To help close projected gaps, the department should evaluate existing health care professional training programs, continued education pro grams, and graduate medical education funding and encourage Congress to invest in programs with proven effectiveness.
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2008. 2007 state public health workforce survey results.
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Rockville, MD: Bureau of Health Professions Council on Graduate Medical Education.
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2006. 2005 national profile of local health departments.
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:457-502. Sullivan Commission on Diversity in the Healthcare Workforce.
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