If you keep on doing the same thing and nothing changes what does that say?

In 1959, the US Surgeon General identified a shortage of medically trained personnel (http://www.pahx.org/period01.html). Today over half a century later that condition apparently has not changed (AAMC, 2011). “For too long, our nation has suffered from a shortage of primary care health professionals. The Association of American Medical Colleges estimated that the nation would have a shortage of approximately 21,000 primary care physicians in 2015” (HHS, no date).

“Beginning in the 1960s, physician supply increased dramatically following the passage of the Kerr-Mills Act of 1960, which financed medical care for the elderly and the poor. These programs evolved shortly into Medicare and Medicaid, producing greater demand for doctors and federal subsidies for graduate medical education. This led the AMA to declare a physician “shortages” in the 1960s and to call for increasing physician supply. That trend continues today, as evidenced by a recent major report [Dill & Salsberg, 2008] from the Association of American Medical Colleges calling for a 30 percent increase in enrollment, citing an increasing disparity between physician demand and supply” (De Alessi & Pam, 2011).

The National Health Service Corps (NHSC), founded by the Emergency Health Personnel Act of 1970 by public law 91-623, was created to “improve the delivery of health services to persons living in communities and areas of the United States where health personnel and services are inadequate” and the Health Professional Shortage Area (HPSA) designation process was established in 1978 with an eye towards developing programs to encourage health care providers to work in designated shortage areas (APA, no date).

There are efforts being funded by Federal grants to train more health care workers at the aide/assistant/technician levels. One of many Federal projects can be seen in grants made under the American Recovery and Reinvestment Act of 2009 (DOL, 2010). The Department of Labor funded over fifty projects at between $2M and $5M each to train health care workers in mainly regions with known provider shortages. Also, the Affordable Care Act is investing $250M in training efforts for primary care providers (HHS, 2010)

The Federal government has been supporting the expansion of health provider training since the late 1960’s. What has been the effect of this effort?

There are many possible criteria but for now let’s just take quality of care.  Docteur & Berenson (2009) compared US care outcomes with an a limited international sample. They concluded that the quality of care in the US is lower in many ways than other developed countries.

Numbers don’t lead to quality.

We still think we have a shortage of providers.

Nothing seems to change.

Can we do something different?

(Join us for a discussion on this blog on Wednesday, 7:30 to 8:00 a.m. Link to the meeting room: http://tinyurl.com/cjfx9ag.  Also, see Discussion and SL tabs above for details)


  1. American Psychological Association (APA). History of Education GRO Initiatives on Federal Community Health Centers & National Health Service Corps. No date. (http://www.apa.org/about/gr/issues/nhsc/history.aspx).
  2. Association of American Medical Colleges (AAMC) Center for Workforce Studies. Recent Studies and Reports on Physician Shortages in the US. August 2011.(https://www.aamc.org/download/100598/data/recentworkforcestudiesnov09.pdf).
  3. De Alessi, M & Pam, R. Health Care in the Rural West: Persistent Problems, Glimmers of Hope. Stanford University Bill Lane Center for the American West, Rural West Initiative. 2011. Stanford University. (http://www.stanford.edu/group/ruralwest/cgi-bin/drupal/content/rural-health-care#_ftn25).
  4. Dill, M & Salsberg, E. The Complexities of Physician Supply and Demand: Projections Through 2025.  American Association of Medical Colleges Center for Workforce Studies, November 2008.
  5. Docteur, E & Berenson, RA. How Does the Quality of U.S. Health Care Compare Internationally? Robert Wood Johnson Foundation Urban Institute. August 2009.  (http://www.rwjf.org/files/research/qualityquickstrikeaug2009.pdf)
  6. US Department of Labor (DOL) Employment and Training Administration. American Recovery and Reinvestment Act of 2009: Healthcare and Other High Growth Emerging Industries Grants. 2010. (http://www.doleta.gov/factsheet/ARRA_Health_and_Other.pdf)
  7. US Department of Health and Human Services (HHS). Fact Sheet: Creating Jobs and Increasing the Number of Primary Care Providers. No date. (htttp://www.healthreform.gov/newsroom/primarycareworkforce.html)