The above links will take you to the Center for the Health Professions site.

Centering on...A National Imperative

Last year Newsweek featured the health care workforce as its cover story. It made the simple point that since 2001 the rest of the U. S. economy had netted exactly zero new jobs while the health care economy had added 1.6 million. This is, of course, not necessarily good news. Adding jobs in health care means the nation is spending more on health care and the simple truth is we can't afford such luxuries anymore. We need to focus on holding costs and even using some of that vaunted American market genius for lowering costs through innovation and new technology. But we will inevitably add new jobs to health care and they will be, for the most part, good jobs which are spread around the country and pay a much better than livable wage. Many of these jobs now go lacking - good jobs in primary care medicine, nursing and a great variety of the over 200 allied health professions. The shortage is now significant and it will grow even greater as the baby boom generation ages, in so doing demanding and needing more health care at a time when baby boomers are also retiring and leaving their posts as doctors, nurses and physical, respiratory and occupational therapists.

We will find ourselves with a pressing shortage of new entrants for these professions, and we will do the previously unthinkable. We will charter planes and go to other nations to recruit the best and brightest health care workers to provide care for our aging population. We should be ashamed for two fundamental reasons. First, as we take each nurse and each physician from another nation we are stealing human capital from people who are less well off than are we. These are not engineers or technicians that we are stealing, but the very individuals through whom each of these nations hopes to improve the physical well-being of the next generation. I do understand that nurses and doctors who come to this country do so because they are smart and have struggled and decided that the decision will improve the life prospects of their children and themselves. But each time we are party to such an act, we transfer wealth from India or the Philippines to our nation, and there is no honor in such an action.

And that is only half of the shame. Every time we rob another nation of this wealth, we also rob a member of the next generation in this nation of the chance to pursue a dream of becoming a health professional. Even more shameful, we have failed to do the hard work to give these jobs to those in our society who have found that life is full of road blocks and frustration. African-Americans and Latinos are underrepresented in every health professional group in America until we arrive at the lowest paid jobs in the health system, those near minimum wage, such as orderly and aid. We anguish about this, but we do not solve the problem. We rarely even address the issue. More likely, when the going gets rough we get going to the recruiter, because we haven't the will or the courage to push the issue.

I have listened to excuses for this situation for three decades. It is time to stop explaining and start acting. Here are my suggestions:

Invest in new capacity - How many training programs would a governor add if she were told that a new industry was coming to town? What if it were offering employment opportunities in high-tech areas with good wages and rewarding work environments? Better yet, what if the jobs would not be in just one town, but would be spread around to every polling place in the state? I dare say the community colleges would receive new dollars, regulations would be relaxed and new exits would be built on the Interstate. Well, health care jobs in the U.S. are a part of the sixth largest economic undertaking on the face of the globe. They are high-tech, pay a great wage and many of them won't go away. But they need attention, focused attention from a governor who wants to fill these jobs with their constituents. This will require that we re-frame health professions education not as an obligation, but as the opportunity it truly is. As the population has grown over the past three decades, there has been little new capacity added in health professions educational programs. It is time to catch up.

Break the status quo - We have an unusual penchant in this country for returning to techniques that have not worked in the past and trying harder, hoping for a different outcome. Maybe the problem is that our way of addressing this issue works for some, but no matter how we try to force it, it simply will not work for others. Achieving new outcomes requires new methods, which are driven by creativity and a willingness to give up on some of the values and positions that might have been held as sacred for many years. For instance, the health professions are created and remain in silos of education and practice. What if a portion of each entering class did not look exclusively for new entrants, but instead created a track for individuals who had proven themselves in another professional practice? Of course the net gain would be zero if there were not new ways created for taking in students into every training program. But doing more of what we have always done is not likely to change the outcome.

Pay for Performance - There is much said about the commitment of our health care educational and delivery institutions to the diversification of student and professional populations. Much said, but in most jurisdictions, little is done that actually pans out. We spend considerable resources designing new ways to respond to the challenge of creating a diverse workforce. Why not just pay for what we want and let policy makers and educational institutions redesign their programs to reap the benefits? The cost of doing so will be significant because of necessity it must cover the expense of redesigning programs and offer a premium for performance that will make the new arrangement attractive. In the 1970's the nation enlarged the number of health professionals in training by offering a per capita payment for larger classes. The program was simple, direct and effective.

Dr. King's birthday has come and gone for another year. Because of the election year, politicians were more prone to wrap their appeals in his words to justify the need for action. But as we face decades of failed performance in making the health professional community reflect the composition of our larger society, there is nothing that he taught that is more relevant to this task than the reminder that we must begin this work with "the fierce urgency of now."

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