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Out of Order, Out of Time
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Out of Order, Out of Time: The State of the Nation’s Health Workforce is a report undertaken by the Association of Academic Health Centers (AAHC) to focus attention on the critical need for a new, collaborative, coordinated, national health workforce planning initiative. The report’s seven chapters include more than 40 findings that document what is “out of order” with respect to the nation’s health workforce, as well as the looming social and economic forces that leave no time for further delay before the problems get dramatically worse.
The report draws several broad conclusions from the detailed findings including:
- A broader, more integrated national strategic vision than our historic approach to health workforce policymaking and planning is needed if complex and urgent health workforce issues are to be addressed effectively.
- A new mechanism is needed to serve the currently unfilled integrative role that existing health workforce policymaking and planning processes are not designed, and are ill-equipped, to serve.
- It is critically important to act immediately to develop and implement an integrated, comprehensive national health workforce policy before intensifying health workforce needs outpace available resources, putting the U.S. at risk of losing its status as the global health care leader.
Ordering Information
Copies are available free of charge as follows:
1 copy - sent free of charge.
2-10 copies - $10 for shipping.
11-25 copies - $20 for shipping.
More than 25 copies - contact the AAHC office.
Findings of Out of Order, Out of Time
- Healthcare workforce financing programs to meet shortages have been piecemeal or driven by crisis-response rather than a broad strategic vision. Resulting funding competition has produced uneven and imbalanced health workforce service and access.
- Public policy-making is lacking in integration between state and state, state and federal, and public and private entities. These divides produce frustrating barriers to healthcare research, education, data coordination, and harmonization of standards and practices.
- Inconsistent and/or overlapping laws, regulations, and practice requirements of multiple, uncoordinated jurisdictions have produced a workforce subject to professional turf issues, inhibited mobility, and problematic or conflicting licensure, accreditation, and scope of practice concerns.
- The health workforce environment is more often defined by adverse conditions and worker dissatisfaction. Occupational hazards, poor recruitment and retention strategies, and an increasingly specialized healthcare workforce resulting from oppressive education debt, high insurance, and other financial burdens have produced a work environment that is less rewarding and, consequently, less likely to meets public healthcare needs.
- The education institutional responses to health workforce issues have been hampered by persistent socioeconomic challenges. Student access to and support within the health professions educational environment is subject to obstacles including limited resources, negative perceptions, poor preparation, and evermore complex minimum credentials.
- Faculty shortages are on the rise; and mounting faculty dissatisfaction is a growing concern.
- Increased tensions between non-profit and for-profit institutions, as well as a decline in the inter-professional approach, foster a non-collaborative environment.
- The global migration of health professionals is playing a larger role in the U.S. labor market. A coherent national policy regarding the push/pull in the international mobility of professional healthcare workers is needed to assess potential benefits and offset detrimental consequences in labor, economic, and expertise arenas.
- Demographic and socioeconomic challenges are accelerating health workforce challenges and burdens.
- Increasing demands on healthcare services from aging baby-boomers, a growing population, and longer-living population may well soon outpace the supply of workers as the baby boomers who work in healthcare approach retirement, exacerbating the shortage of workers.
- At the same time, the healthcare workforce is not keeping pace with population diversity, location density, and specialized service needs (e.g. long-term care providers).
Conclusions of Out of Order, Out of Time
- The dysfunction in public and private health workforce policy and infrastructure is an outgrowth of decentralized decision-making in health workforce education, planning, development and policy-making (out of order); “An out of order system stymies desired policy outcomes through both sequential and concurrent systematic failures.”
- The costs and consequences of our collective failure to act effectively are accelerating due to looming socioeconomic forces that leave no time for further delay (out of time); “(T)he nation is running out of time to deal with the workforce challenge.”
- Cross-cutting challenges that transcend geographical and professional boundaries require an integrated and comprehensive national policy to implement effective solutions; “A new collaborative health workforce planning initiative, involving the active participation of private, state, and federal stakeholders is necessary to develop and implement a comprehensive national health workforce policy.”
- Despite many problems, prospects for positive change are high. “(There are) compelling reasons for making the health workforce a priority domestic policy issue that receives immediate attention to avert crises in national workforce capacity and infrastructure.”