Healthcare Workforce Commission
ASAHP’s Board of Directors has nominated its Executive Director Thomas Elwood to serve on the National Healthcare Workforce Commission. He was interviewed by staff at the Government Accountability Office (GAO). His responses to their questions are shown below. The Director of that agency will select commission members.
Would I be able to devote the time necessary to serve?
I responded yes to this question. The GAO staff members do not have a clear idea of what the time commitment might be. The commission will meet at least quarterly. The term of service is for three years, but there will be staggered appointments so that not every term will expire at the end of year three. Thus, it is possible that a member of the initial cohort of commissioners could serve for one, two, or all three years. A comparison was made with the Medicare Payment Advisory Commission (MedPAC) where it is estimated that service is the equivalent of 24 days per year, counting attendance at meetings, traveling, and time needed to prepare for meetings. Since the meetings will be in Washington, DC and I am here, traveling will not be a factor.
Why am I interested in healthcare workforce issues?
My first involvement in workforce matters occurred in 1968 when I was a graduate student in the School of Public Health at the University of California at Berkeley. As part of a practicum, I was assigned to the TB and Health Association, which eventually became the American Lung Association. My assignment was to design and implement a study of health personnel in northern California who were involved in providing respiratory care.
Upon completing graduate school, I moved to Washington, DC where I worked at the AARP for a little more than five years. My involvement in government relations included working on the establishment and subsequent funding of the National Institute on Aging at the NIH. That agency since its inception has been engaged in research that has enhanced the quality of health care provided to older persons. Related efforts included advocating the creation of financial support by Congress for geriatric training. I also was cited by President Carter for my work in having a rural health clinics act be signed into law by him. As a result, physician assistants became able to provide care and be reimbursed for their services even though a physician was not present to furnish direct oversight.
My next position was as a deputy director at the Johns Hopkins Comprehensive Cancer Center. A main function that was more involved with the notion of enhancing quality was to study what kind of care was being provided by solo practitioners who lived in geographic areas of Maryland far removed from the Center. A study revealed that physicians who were not cancer specialists practiced what they had learned in medical school. For example, the presence of a breast lump indicated to them that a radical mastectomy was the course of action to follow. No tests were being applied to determine if the disease had metastasized to other parts of the body. If it had done so, a radical mastectomy should not have been the treatment applied. Subsequently, physicians from Hopkins began to spend time in outlying clinics and local physicians came to Hopkins for additional training.
From Hopkins, I accepted a position at the American Public Health Association. A federally-funded workforce study was conducted, in which I was involved, that was aimed at defining and enumerating the public health workforce in the U.S. I also conducted an analysis of a new federal block grant program, which had the potential to have an adverse affect on the public health workforce.
Finally, while here at ASAHP, I have been the principal investigator on two different sets of projects that were funded by HRSA to develop a Minimum Data Set and determine what kinds of allied health workforce data were being collected by: professional organizations, the Department of Defense, the Veterans Health Care Administration, the Centers for Disease Control and Prevention (CDC), and the Health Care Financing Administration (presently called the Centers for Medicare & Medicaid Services). I also served as a member of the Associated Health Professions Review Subcommittee of the Special Medical Advisory Group at the Veterans Health Care Administration.
What types of contributions might I make to the work of the commission?
With more than 40 years experience in the health arena, I bring both a wide degree of breadth in addition to some depth, especially in a large segment of the health workforce as represented by allied health professionals. Serving as Editor of the Journal of Allied Health has increased my exposure to a broad range of workforce issues pertaining to education, training, and practice. As an adjunct professor at the University of Medicine & Dentistry of New Jersey where I teach a course on health policy and trends, this affiliation enables me to stay abreast of many different kinds of developments as they occur in the health field.
What experience do I have serving on boards, commissions, and advisory groups?
As noted previously, I have served on an advisory body to the Veterans Health Care Administration. I currently am a member of the Health Workforce Information Center Advisory Board, which is a five-year project funded by HRSA. I was Treasurer and an Executive Committee Member on the Board of Directors of the National Health Council. You have my CV in front of you and can see that I have served on several other similar kinds of groups.
What kinds of workforce issues pertain to allied health?
Unlike medicine and dentistry where post-baccalaureate education consists of four-year educational programs, many allied health professions either are increasing the number of years of education required or have the potential to do so. A consequence is that as associate degree programs move to the baccalaureate level and baccalaureate level programs go to masters and clinical doctorate levels, the graduates have increased skills and knowledge that can have an effect on their scope-of-practice. Presently, the American Medical Association and other professional medical organizations are examining scope-of-practice in states across the nation to determine if any other professions are encroaching on what these groups consider to be the sole province of medicine. An example of how such issues can affect the availability and delivery of health care services has to do with direct access. In some states, a physician is involved in deciding if a patient needs to be referred to a physical therapist whereas in other places it is possible for patients to obtain physical therapy services directly. Oral health care needs are not being met in the U.S. and dental hygienists are capable of meeting such needs, but in many cases they cannot do so without working under the direct supervision of a dentist. If regulations of this sort become less restrictive in the future, roles played by allied health professionals will become modified accordingly.
How familiar am I with the work of MedPAC?
I’ve attended MedPAC meetings and made comments when the discussion was opened to the public. I’ve also provided information about the portion of graduate medical education payments that have been allocated for allied health. In addition, I make an effort to be familiar with MedPAC reports that are issued at regular intervals.
What kinds of contributions do I see being made by a healthcare workforce commission?
The population of the United States is growing larger and older. A health care workforce is needed to keep pace with this growth. In addition, the composition of this population undergoes steady change. A shift is occurring such that Caucasians derived from European stock are gradually becoming less of a proportion of the citizenry. A challenge will be for the commission to provide guidance and suggest mechanisms for producing a health workforce that is more reflective of the diverse nature of the population. The commission also will be in a strong position to recommend ways in which students from low income families can obtain an education in a health profession without incurring unbearable levels of debt.