This issue of Academic Medicine contains a number of important contributions on health care workforce topics. There is an increased awareness among policy makers, providers, and educators that the size, composition, geographic distribution, and skill mix of the health care workforce is of great importance in determining the likelihood of success in achieving our societal goals for health care reform.
There continues to be a healthy debate about the exact number of doctors, nurses, and other health professionals we will need to achieve better care, better health, and lower cost for our entire population. Participants in this debate need to be cautious. Past projections of workforce needs have often been over- or underestimated, in part because projections always are based on historical practice and utilization patterns. We do not yet know what effect new care and reimbursement models will have on workforce needs, nor do we know how dramatic increases over the past decade in the number of new registered nurses (108% increase), nurse practitioners (105% increase), and physician assistants (60% increase) will affect the need for other health professionals.1
What we do know is that, regardless of the total number of health professionals we will need, all practitioners (regardless of specialty) need to be better prepared to deal with different patient populations in different practice settings and to work together as teams. Health professionals will need to be trained to deal with more chronic illness in longitudinal, nonacute care settings, and they will need to care for a much more diverse patient population. They will also need to better understand systems of care, population health, and the economics of health care. It also is clear that we need to provide more health professionals with the skills, opportunities, and incentives to work in primary care2 and in underserved areas3 if we are to achieve the most efficient and equitable health care system.
As academic and governmental institutions work to address these pressing questions, private foundations can and should play an important role in supporting the design, execution, and evaluation of innovative educational programs that will address these needs. They also can and should play a role in generating information that will better inform health care workforce policies and in convening thought leaders to make recommendations that will advance the field of workforce studies. The Josiah Macy Jr. Foundation’s efforts toward promoting innovations in health professions education that better align education with the needs of the public are just one example of the potential for private foundations to support the development of an optimal health care workforce.
The Macy Foundation has focused especially on interprofessional education (IPE). A large body of evidence indicates that care delivered by well-functioning teams leads to better patient outcomes. Our system for educating health professionals, however, has historically kept learners in each of the health professions separate from learners in other disciplines, and has not made teamwork a core competency for the health professions. Well-designed and rigorous IPE experiences that allow learners from two or more professions to learn “about, from and with each other”4 can better prepare health professionals for collaborative practice. The Macy Foundation has supported IPE programs in more than 20 institutions, involving students of medicine, nursing, pharmacy, social work, dentistry, public health, and other health professions.5 Some of the Macy-funded IPE work has been done collaboratively with regional foundations. For instance, the health-center-wide IPE program at the University of Colorado, Anschutz Medical Campus was a joint endeavor with the Colorado Health Foundation, and the IPE program in geriatric education at the University of Pittsburgh School of Medicine was supported jointly with the Jewish Healthcare Foundation of Pittsburgh.
This work is helping to develop a new paradigm for health professions education to prepare students to work in teams, and it has been greatly aided by the development of the Core Competencies for Interprofessional Collaborative Practice by the Interprofessional Education Collaborative group.6 This foundational work on IPE has helped to form the basis for the creation of the new National Center for Interprofessional Practice and Education at the University of Minnesota. This national coordinating center was created through a competitive grant process by the Health Resources and Services Administration (HRSA) to “provide leadership, scholarship, evidence, coordination, and national visi bility to advance interprofessional education and practice as a viable and efficient health care delivery model.”7 The center has supplemental funding from four private foundations: the Josiah Macy Jr. Foundation, Robert Wood Johnson Foundation, John A. Hartford Foundation, and Gordon and Betty Moore Foundation. The center will serve as a central resource and convener around issues of best practices in interprofessional collaboration, it will promote scholarship to develop better metrics for assessing interprofessional practice and education, and it will help to create a national network of “incubators” for interprofessional practice and education. The center repre sents an excellent model for a public/private partnership to address important health care workforce needs.
The Macy Foundation also has partnered with HRSA and with the three primary care certifying boards (American Board of Internal Medicine, American Board of Family Medicine, and American Board of Pediatrics) to develop a pilot program for faculty development in teaching new models of primary care.
The Macy Foundation has supported other programs to better prepare a health care workforce for a changing world. These include the introduction of new content in areas such as quality, safety, cultural competence, and professionalism into health professions education; the development of new models of clinical education that are longitudinal and more community based; and programs targeted to prepare health professionals to serve underserved populations in rural and urban areas.
Many other foundations have made important contributions to shaping health professions education to better prepare health professionals to fulfill societal needs. The Robert Wood Johnson Foundation has played a key leadership role in improving the education and status of nurses as leaders in a redesigned health care system,8 and the Jonas Foundation has supported programs to increase the number of nurses earning doctoral degrees and moving into faculty positions. The John A. Hartford Foundation has been the leader in preparing health professionals to better care for an aging population, with a great emphasis on teamwork among health professionals. The Gordon and Betty Moore Foundation has invested heavily in innovative nursing education (including IPE) and in models that support patient- and family-centered care.
This is but a partial list of the contribu tions of private foundations and their partnerships in addressing important health care workforce needs. Sometimes lost in the debates about workforce num bers is the importance of innovation in the content of health professions edu cation to better prepare the workforce to meet contemporary needs in the most efficient and reliable way. Foundations can play important roles as catalysts for change in our educational processes, and they can serve as important links between education and health care delivery systems. Partnerships among foundations and between private foundations and federal agencies can be powerful forces in helping to better align the skills of future health professionals with changing patient demo graphics and a changing health care system.
Having a health care workforce of the proper size, composition, geographic distribution, and skill mix is essential if we are to fulfill our commitment to provide access to high-quality, reliable care to all our population at an affordable cost. This is a complex issue, and we will achieve this goal only if we make use of all the intellectual and other resources available from the public and private sectors, and only if we create closer alliances between academic institutions and our health care delivery systems. This interdependency is highlighted in recent reports calling for this transformation globally and domestically.9,10 Foundations are ideal partners with government, academia, and health care delivery systems in helping to bring about this transformation so that we will have a health care work force that “learns, teaches, cares, and collaborates”10 to meet the public’s needs.
1. Edward Salsberg, Director. National Center for Health Workforce Analysis, Bureau of Health Professions, Health Services and Resources Administration (HRSA), U.S. Department of Health and Human Services. July 19, 2013 Rockville, Md Personal communication with G.E. Thibault
2. Cronenwett J, Dzau V Who Will Provide Primary Care and How Will They Be Trained? Proceedings of a Conference Sponsored by the Josiah Macy Jr. Foundation. 2010 Durham, NC Josiah Macy Jr. Foundation
3. Mullan F, Chen C, Petterson S, Kolsky G, Spagnola M. The social mission of medical education: Ranking the schools. Ann Intern Med. 2010;152:804–811
4. World Health Organization. Framework for Action on Interprofessional Education and Collaborative Practice. 2010 Geneva, Switzerland World Health Organization
6. Interprofessional Education Collaborative Expert Panel. Core Competencies for Interprofessional Collaborative Practice: Report of an Expert Panel. May 2011 Washington, DC Interprofessional Education Collaborative
7. U.S. Department of Health and Human Services. Health Resources and Services Administration (HRSA). Funding Opportunity Announcement: Coordinating Center for Interprofessional Education and Collaborative Practice. June 2012 http://www.hrsa.gov/grants/apply/assistance/interprofessional/
. Accessed August 22, 2013
8. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. 2011 Washington, DC National Academies Press
9. Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. Lancet. 2010;376:1923–1958