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September 10, 2008

Improving Accountability for the Public Investment in Health Profession Education: It's Time to Try Health Workforce Planning

Author Affiliations

Author Affiliations: Center for Health Policy Research, Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, New Hampshire.

JAMA. 2008;300(10):1205-1207. doi:10.1001/jama.300.10.1205

There is widespread discontent with today's health workforce and its training pipeline. Patients cannot find primary care physicians who are accepting new patients and have difficulty navigating care that is fragmented over increasingly specialized clinicians. Some organizations warn that there will soon be a large gap in the number of physicians required to meet projected increases in patient utilization.1 Others point out that clinicians are ineffectively and inefficiently deployed across regions and predict that increases in the number of physicians will lead to an increase in expensive and marginally useful services that fail to improve health outcomes.2 The primary care workforce has been depleted by a shift of generalists to specialist, hospitalist, and emergency department services; little relief should be expected from the youngest physicians, who have a declining interest in primary care.3 Attention of workforce planners to the role of nonphysician clinicians is perfunctory even as the numbers and autonomy of nurses and physician assistants increase. Programs demonstrated to be highly effective in attracting physicians to care for underserved populations remain underfunded.4,5 Little progress has been made in improving racial and cultural diversity in clinicians, and many programs charged with doing so have been eliminated.6