Health care workforce must change with new system

Nov. 8, 2013

The United States has just radically remade its health care system with the introduction of the Affordable Care Act (ACA), also known as “ObamaCare.” Yet the country’s training and integration of health care professionals remains moribund, stuck in outdated models that rely on a cobbled-together lattice of uncoordinated efforts that vary from profession to profession and state to state. This must change if Americans want better care and lower costs going forward.

These are conclusions drawn in the article “Reconfiguring Health Workforce Policy So That Education, Training, And Actual Delivery Of Care Are Closely Connected,” published in the November issue of Health Affairs and co-written by Thomas Ricketts, PhD, professor of health policy management at The University of North Carolina at Chapel Hill’s Gillings School of Global Public Health.

Co-author Erin P. Fraher, MD, is assistant professor of family medicine and surgery in the UNC School of Medicine.

Ricketts, who is also deputy director of UNC’s Cecil G. Sheps Center for Health Services Research and professor of social medicine at UNC, says that neither the policies or market forces that previously governed health care nor new regulations implemented through the ACA can keep up with the rapidly changing delivery systems that have appeared over the last several years.  

“Our health-care system is creating new professions as fast as it is creating new cures and treatment, and those professions are competing for recognition and respect as well as reimbursement,” Ricketts said. “This makes health care costs hard to constrain and coordination of care difficult.”

Ricketts and Fraher believe that the confluence of need and the new constructs being imposed on the health-care system by the ACA creates the perfect – if much delayed – moment to pursue an integrated approach to training physicians, nurses, therapists, technicians and other health-care providers.

The authors say this approach must be cohesive and prepare providers to work in patient-centered care models like the now-ubiquitous “medical home.”

“In the past, health-care professionals were seen more as parts of a puzzle that must be carefully fit together rather than as fungible resources that can be crafted or remade to help build a truly reformed and more effective health-care delivery system,” Fraher said.

The authors’ solution is to invest in “bottom-up” workforce planning, including research and implementation studies to determine the content of care needed in the new systems and the proper allocation of care roles among care professionals in specific care models.

“If we truly want to make the system patient-centered, then we have to train practitioners around the patient, for the patient and with the patient,” Ricketts said.

Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or