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Opinion: A critical issue in health care reform: Too few health workers

If every meteorologist in the state warned of torrential downpours all weekend, would you keep your plans for a picnic? No, you’d grab your umbrella, rain jacket and plan accordingly.

California’s policymakers, health providers and educators would be wise to heed the forecast for another brewing storm that will last longer and adversely affect millions of people throughout the state. For years, researchers, economists and health providers themselves have warned that much of the state will have too few health workers for patients who need care.

And if a population that was already growing and graying means dark clouds will turn to a steady drizzle, then the new health reform law – the Patient Protection and Affordable Care Act (ACA) – represents a monsoon that we are ill-prepared for. That’s one of the key findings in new research from the UCSF Center for the Health Professions (funded by a grant from The California Wellness Foundation). California’s Health Care Workforce: Readiness for the ACA Era shares data and recommendations for the opportunities and challenges that ACA presents for a workforce that is critical to the state’s economy and quality of care it provides its residents.

Under ACA, 4 to 6 million more Californians are expected to have insurance starting in 2014. Newly insured patients accessing services will strain a system already struggling to keep up with demand for physicians, nurses and allied health professions (the 50-plus positions – ranging from laboratory scientists to imaging specialists to respiratory therapists – that make up 60 percent of health workers).

While shortages are projected for numerous professions, the reasons behind these numbers should inform policy. For example the Bay Area, Los Angeles, Orange County and Sacramento generally have more health workers per population than the Inland Empire and San Joaquin Valley. This is partly due to training programs not being evenly distributed across the state (i.e., graduates tend to practice where they train, as opposed to returning to or choosing rural and underserved areas).

California’s health care workers also do not adequately reflect the languages and cultural backgrounds of their patients. (As many as half of the newly insured speak English “less than well.”)

While allied health workers tend to better reflect their patients’ ethnicities, and college programs for these professions are highly appealing to potential workers, attrition rates are high, and colleges don’t have the funds to expand programs to meet demand.

That’s why providers, educators and policymakers should prioritize the following recommendations:

• Create programs in regions facing shortages: For professions like pharmacy technicians, respiratory therapists, and medical assistants, ensure that college programs are located throughout the state, fully staffed and equipped with the latest technology and curriculum.

• Fully utilize existing workers: With too few primary care providers, physicians, nurse practitioners and physician assistants should practice at the “top of their competence” – their full potential based on education and training – and adopt new practice models and technologies such as telehealth to reach more people.

• Partner to improve training retention: For community colleges to increase retention and completion rates – especially for underrepresented populations – administrators, faculty, Workforce Investment Boards and communities must partner on tailored solutions.

• Match programs to local employers’ needs: Health providers and community colleges should partner to better match local employers’ needs with training opportunities.

• Improve cultural competency: Invest in interpretation and build career ladders that move allied health workers up (creating openings and diversifying the workforce).

Health reform should force a conversation – and action – about the workforce storm clouds on our horizon. Addressing projected shortages will create jobs, tax revenue, and ensure that we are providing the care that all Californians deserve.


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