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Questions & Answers About AAHC’s Report
Out of Order, Out of Time: The State of the Nation’s Health Workforce
Why was the report written?
Out of Order, Out of Time: The State of the Nation’s Healthcare Workforce was undertaken by the Association of Academic Health Centers (AAHC, www.aahcdc.org) to focus attention on the critical need for a new, collaborative, coordinated, national health workforce planning initiative.
Who contributed to the report?
The report was written by AAHC staff with input from a steering committee, commissioned papers, a series of workshops with key association stakeholders (e.g., professional, higher education, accrediting), and interviews with selected academic health center CEOs. Out of Order, Out of Time: The State of the Nation’s Health Workforce is part of an ongoing AAHC health workforce project and was supported in part by a grant from the Josiah Macy, Jr., Foundation.
What do you mean by “the health workforce”?
The term “health workforce,” as used in the report, refers to all people who work in health professions education, research and health service delivery, with particular emphasis on people with health professions degrees or post-secondary education or training.
What is “out of order”?
In the broadest terms, there are two things out for order.
First, the health workforce is suffering from serious problems, including (but not limited to): a significant decline in interest in health professions careers, deeply-embedded financial incentives that produce severe shortages of health professionals in some communities and oversupply in others, and barriers that prevent educational institutions from expanding access to health professions education and training and directing the pipeline of new health professionals to the communities where they are needed most.
Second, the health workforce policymaking process is effectively broken, resulting in a patchwork quilt of private standard-setting and fragmented state and federal public laws and regulations that have evolved in a piecemeal manner without any entity serving the integrative role necessary for effective, coordinated health workforce policy planning and implementation.
Can you provide a concrete example of what is “out of order”?
For example, our public and private reimbursement systems are not very flexible with respect to changing realities and priorities. The economic incentives they create have a tremendous impact on many aspects of the health workforce, including what professions and specialties students choose to pursue, as well as what communities they ultimately choose to practice in. This is a systemic issue that has to be addressed in a systemic manner, something that our current fragmented and uncoordinated health workforce policymaking structure is ill-suited and unprepared to do
Another example is the evolution of regulatory and professional standards resulting from the pursuit of quality and accountability by a multitude of health workforce stakeholders. The complexity and inconsistency produced as they pursue their individual agendas impact many aspects of the health workforce, especially the mobility of health professionals. Impediments to mobility create obstacles to a wide range of policy objectives, from addressing health professions shortages to helping educational institutions attract and retain high quality faculty.
Why are we “out of time”?
Powerful social and economic trends, including the aging of the baby boom generation, the increasing diversity of our population, and the globalization of health workforce are rapidly accelerating the already serious problems plaguing our health workforce.
Can you provide a concrete example of why we are “out of time”?
For example, the aging of the baby is increasing the demand for health services at the same time the retirement of baby boom generation decreases the supply of health professionals to provide those services. This problem is intensified in communities where the elderly are “aging in place” while working age residents migrate to communities that provide greater economic opportunity.
Another example is the impact of the growth of diverse minorities as a proportion of the overall population, which strains the ability of the health workforce to serve non-English speaking patients and challenges health professionals to interact with diverse patients in a culturally appropriate manner.
What are the report’s findings?
The report’s seven chapters include more than 40 individual findings concerning challenges facing the health workforce and reasons why the nation’s current fragmented health workforce policymaking and planning processes are ill-equipped and ill-prepared to address them effectively. The findings include (but are not limited to): inconsistencies in laws, regulations and standards across jurisdictions result in significant health workforce disruption; current public and private reimbursement policy have far-reaching adverse consequences for the health workforce; and barriers to students pursuing health professions careers will worsen already serious shortages in underserved communities.
What are the report’s key conclusions?
The report has seven key conclusions:
- First, a broader, more integrated strategic vision is needed if complex and urgent health workforce issues are to be addressed effectively.
- Second, a new mechanism is needed to serve an integrative role that existing health workforce policymaking and planning processes are not designed, and are ill-equipped, to serve.
- Third, the new policymaking and planning mechanism should assess and harmonize health workforce laws, standards and requirements to improve their effectiveness and removing arbitrary barriers and burdens created by a lack of consistency and compatibility.
- Fourth, the new policymaking and planning mechanism should develop innovative policies and strategies that counteract the social and economic factors discouraging pursuit of health professions careers at a time when the nation is already facing current and projected shortages in many health professions.
- Fifth, the new policymaking and planning mechanism should develop innovative policies and strategies that address the social and economic factors obstructing access to health professions education, burdening educational institutions, and distorting health workforce objectives.
- Sixth, the new policymaking and planning mechanism should develop consistent national policies with respect to global health workforce issues.
- Seventh, it is critically important to act immediately before rapidly intensifying health workforce needs outpace available resources, putting the U.S. at risk of losing its status as the global health care leader.
What are the report’s key recommendations?
The report recommends that all public and private stakeholders work together to:
- Make the U.S. health workforce a priority domestic policy issue.
- Begin addressing national health workforce issues immediately to avert crises in national workforce capacity and infrastructure.
- Develop an integrated, comprehensive national health workforce policy that recognizes and compensates for the inherent weaknesses and vulnerabilities of current decentralized multi-stakeholder decision-making.
- Create a national health workforce planning body that engages diverse federal, state, public and private stakeholders with a mission to:
- Articulate a national health workforce agenda;
- Promote harmonization in public and private standards, requirements and prevailing practices across jurisdictions;
- Address access to the health professions and the ability of educational institutions to respond to economic and social factors that impact the workforce; and
- Identify and address unintended adverse interactions among public and private policies, standards and requirements.
The report’s key recommendations include creation of a “national health workforce planning body.” What would this national health workforce planning body look like? How would it operate?
The report does not specify a particular model for this body. There are several models that could be used for such a planning body (e.g., a non-profit membership organization, a federally chartered private corporation, an independent government agency). The report’s recommendation is compatible with any approach that supports a more integrated, strategic, national health workforce policy.
How can copies of the report be requested?
The report can be downloaded in electronic form from AAHC’s website (www.aahcdc.org). Printed copies of the report can be requested through the AAHC website or by contacting: Association of Academic Health Centers, 1400 16th Street, NW, Suite 720, Washington, DC 20036, 202-265-9600.