Critical care workforce: a policy perspective

Abstract

Background: Workforce studies may be disconnected from the policies that affect supply and demand for health professionals. Sporadic review of the physician workforce in the last century has led to wide swings in perception about its adequacy. However, workforce research has influenced federal policy as well as the policies of institutions responsible for training and regulation of physicians. This discussion is intended to address workforce issues in the context of public policy at the federal level. It is also intended to serve as a starting point for new approaches to shaping workforce policy.

Discussion: The supply of and demand for physicians and other health professionals are affected by a number of factors that may or may not be under the control of policymakers and health professionals themselves. Productivity, practice patterns, the aging of the workforce and patients, and other major determinants are only minimally affected by most government policy. Despite several attempts throughout the 1980s and 1990s, demand for health care has been particularly difficult to control for policymakers. In contrast to the United States, most developed nations are extensively involved in the planning of the healthcare workforce, including the specialty mix, the number of physicians, and the number of other health professionals.

Conclusion: There are many barriers to successful workforce policy. Successful public policy change often involves multiple stakeholders, in and out of government. The task before those concerned about workforce issues is to educate policymakers about how changes in the physician workforce will affect cost, access, and quality, and to impress upon them that serious efforts to improve quality of care and reduce costs will not be effective unless qualified physicians are there to provide that care.