September/October 2002 | Health Workforce Policy Revisited

A vexing problem in health policy is getting the right number of physicians in the right specialties in the right locations at the right time. I examine market and public planning approaches to getting the number “right.” After discussing the basic ...

Information technologies have the potential to affect the types and distribution of jobs in the health care workforce. Against a background of an explosively growing body of knowledge in the health sciences, current models of clinical decision making by ...

A gap persists between what nurses can do and what they are employed to do, between the education nurses obtain and the work design of hospitals. Despite agonizing over standardization, current nursing education reflects the pluralistic nursing workforce, ...

Many registered nurses believe that nurse staffing in acute care hospitals is inadequate. In 1999 California became the first state to mandate minimum nurse-to-patient ratios in hospitals. State officials announced draft ratios in January 2002 and expect ...

By many measures, the practice of dentistry has improved for the dentist over the past decade. Hours of work are down, and compensation is increasing. However, there is a growing disconnect between the dominant pattern of practice of the profession and ...

There is a critical shortage of geriatrics-prepared health care professionals. In 2002 more than thirty-five million people were age sixty-five and older, and 23 percent of them reported poor or fair health. Older adults use 23 percent of ambulatory care ...

Increasing the racial and ethnic diversity of the health care workforce is essential for the adequate provision of culturally competent care to our nation’s burgeoning minority communities. A diverse health care workforce will help to expand health care ...

Many have recommended changing the professional development of physicians. Concluding that further educational process specification was inadequate, the Accreditation Council for Graduate Medical Education (ACGME) decided to specify six general ...

The size and shape of the U.S. health care workforce are in constant evolution. Using the metaphorical device of a time capsule, this essay examines the past and future of the workforce. It traces the growth, specialization, and diversification of health ...

Hospitals, nurses, the media, Congress, and the private sector are increasingly concerned about shortages of registered nurses (RNs) and the impact on safety and quality of patient care. Findings from a growing number of studies provide evidence of a ...

Nurse practitioners have evolved into a large and flexible workforce. Far too often, nurse practitioner and physician professional organizations do not work together but rather expend considerable effort jousting in policy arenas. Turf battles interfere ...

Based on a national survey of 2,014 randomly selected public and private firms with three or more workers, this paper reports changes in employer-based health insurance from spring 2001 to spring 2002. The cost of health insurance rose 12.7 percent, the ...

As managed care responds to the rising tide of consumerism in medicine, it is necessary to reexamine the functions that health plans have performed. Chief among the activities that demand resources but return minimal value is the process of physician ...

Projections of a substantial nursing workforce imbalance in the coming decade have galvanized policymakers, providers, private foundations, nurses, and others to proffer aggressive and sustainable strategies to ameliorate the looming shortage. The ...

Over the past twenty-five years the nation has struggled with a series of physician workforce issues: determining the appropriate number of physicians needed and the appropriate number to produce; the role of international medical school graduates; the ...

In 2001 an estimated 103,612 nurse practitioners (NPs) and physician assistants (PAs) were in clinical employment in the United States. The roles of PAs and NPs in providing comparable physician services are similar; they differ in that NPs are ...

Unexpected growth in medication use has escalated demand for pharmacists that has outpaced supply. Responses to the pharmacist shortage include larger workloads and greater use of pharmacist extenders and technology. As the profession has moved from a ...

Discussions surrounding nursing shortages typically focus on recruitment, but retention is also a problem. Emerging research suggests that intimidation in the nursing workforce is a problem that planners need to deal with as part of an overall strategy ...

Large employers’ roles in improving health care quality are shifting away from value-based purchasing toward direct efforts to improve health care delivery within local markets. Although most large employers adopted the tools required for value-based ...

Providers report maintaining, but not greatly enhancing, their quality improvement (QI) programs between 1999 and 2001. In addition, recent market developments are intensifying barriers to providers’ QI efforts. A notable exception is the tremendous ...

The backlash against managed care has pressured health plans to reexamine their approaches to controlling utilization and managing their members’ health care needs, but how much has really changed? Interviews with health plans and others in twelve ...

This paper is the first to compare health care purchasing in the retail versus other sectors of the Fortune 500. Employing millions of low-wage workers, the retail sector is the largest employer of uninsured workers in the economy. We found that retail ...

Although recent policy initiatives aimed at concentrating selected surgical procedures in high-volume hospitals may reduce mortality, their economic implications have not been considered fully. From the hospital perspective, the primary effect of these ...

Data from various national surveys find that approximately half the population with mental disorders is gainfully employed across the entire range of occupations; such persons have an employment rate of about two-thirds that of the general population. ...

Anecdotal reports in the wake of the Balanced Budget Act (BBA) of 1997 raised concerns about restricted access to postacute nursing facility care for Medicare beneficiaries requiring costly, medically complex services. Using all Medicare Part A hospital ...

Generous public investment in the National Institutes of Health (NIH) provides research foundations with a unique opportunity to more closely connect investments in basic research to a payoff in improved health. Foundations can support efforts to ...

The safety-net providers that serve the nation’s thirty-nine million uninsured residents are vulnerable organizations even in good economic times, yet efforts to monitor their capacity have been limited at best. This study of the safety-net in five cities ...

Health plans formed by safety-net providers serve large numbers of Medicaid beneficiaries. Through a series of case studies, we examined the care management tools used by leading safety-net plans. These plans do not rely on the coercive, command-style ...