Public Health Is…Building a Strong Healthcare Workforce

Earlier this summer, the Affordable Care Act (ACA) cleared its last major political hurdle, following the Supreme Court’s decision to uphold most of the law as constitutional.   Now that uncertainty about the law’s fate has largely dissipated (repeal is difficult, even after the election), healthcare leaders are shifting their focus to figuring out how in the world it will be implemented.

The next nail-biting moment in the ACA saga comes January 1, 2014, when Medicaid expansion and the state health insurance exchanges take effect.  There is no doubt it will be an historic moment, when millions of people finally gain access to affordable health coverage.  And yet, one small, logistical detail seems to have been overlooked: now that millions of people will have insurance, will they be able to find a doctor? Do we have enough doctors to meet the upcoming demand?

Doctor shortages are nothing new. In the 1960s, large amounts of Nurse Practitioners (NPs) and Physicians Assistants (PAs) entered the workforce in response to doctor shortages during that time.  Today, the number of new primary care providers entering the workforce is declining, as numbers of specialists grows.  And some areas in the U.S. suffer from extreme doctor shortages.  As of October 2012, the Health Services Research Administration estimates that 55 million Americans reside in Primary Care Health Professional Shortage Areas (HPSAs), defined as having a 1:1000 doctor to patient ratio.

So, what can we do?  As public health practitioners, we know that health problems cannot be solved with a magic bullet.  In light of this, a number of proposals aim to tackle the shortage from several different angles:

  • Enhance financial incentives to practice primary care: loan forgiveness for students pursuing primary care, higher reimbursements for primary care doctors, and direct incentives for doctors to practice in underserved areas.
  • Strengthen the “educational pipeline” from K-12 through college, to encourage more kids to pursue healthcare careers, especially targeting those who are underrepresented in medicine.
  • Increase the amount of foreign medical students and doctors to obtain visas to practice medicine in the U.S., especially if they serve in underserved areas.
  • Allow healthcare workers to practice at “the top of their license”, which means distributing work more efficiently between doctors, nurses and medical assistants.
  • Leverage pharmacists, paramedics, and community health workers in providing basic primary care services and/or education.
  • Use telehealth technology to enable remote consultations and health monitoring between patients and their providers.

With so many different levers for addressing healthcare workforce challenges, commitment from a wide array of leaders in government, healthcare, education and other areas will be needed to create and sustain change.

For more information on healthcare workforce challenges in California, visit:

This blog was contributed by Samantha DuPont, a Master of Public Health Student at UC Berkeley

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