Health Workforce Center tackles policy-related issues

Many of the researchers working with the WWAMI Center for Health Workforce Studies gathered for a meeting in mid-January. Standing, from left to right, are Roger Rosenblatt, Gary Hart, Bobbie Berkowitz, Eric H. Larson, David Paschane, Ruth Ballweg and Mary Richardson. Seated, from left, are Susan Casey, Laura-Mae Baldwin, Denise Lishner, Heather Deacon and Peter Domoto.

More than 9 million Americans are directly employed in health care. Over the past few years the numbers of almost every type of health-care professional, including doctors and nurses, have climbed. Each year medical care is a bigger slice of the U.S. Gross National Product.

These figures on spending and staffing don’t necessarily translate into an optimal health workforce to care for the nation. The question still arises: Does the United States have the right mix of health professionals, with the right training, working in the towns, cities or neighborhoods where they are most needed?

Researchers at the new WWAMI Center for Health Workforce Studies are looking at the availability, education, distribution, practice patterns and licensing of health professionals, as well as many other factors that shape the region’s health workforce. They are creating models to understand the present nature of the health workforce in Washington, Wyoming, Alaska, Montana and Idaho and to predict future supply and demand in the WWAMI states. They also are determining how specific workforce issues affect the health of the public or of certain populations, such as children.

Dr. Gary Hart, a medical geographer, and Dr. Roger Rosenblatt, a physician, head the center. Both are professors of family medicine. A three-year, $750,000 grant from the Bureau of Health Professions of the Health Resources and Service Administration funds the center.

“We hope the center’s research will lead to meaningful government and higher education policies,” Rosenblatt said, “that will govern appropriate use of resources and ensure that people receive adequate care. Research findings could suggest alterations in the composition and size of the health workforce, changes that would further these goals.”

The center will work with several health officials in the WWAMI states to collect, analyze, compare and use workforce data. Government and UW researchers will collaborate to explore health workforce issues that have implications for state, regional and federal policies. Togther they will create descriptive and predictive models of the workforce, and assess the relationship between workforce maldistribution and unmet health needs, particularly in inner-city and rural areas.

The center is unusual in bringing together researchers from many health professions, such as dentistry, nursing, health-care administration, medicine, and allied health fields, as well as experts in economics, geography and other social sciences, to study the health workforce partnership, rather than dividing along professional lines.

“These professionals contribute many different talents and bring a lot of firepower to bear on health workforce studies,” Hart said, “because it’s one of the rare topics that truly cross all health and social sciences disciplines. It’s a topic that many disciplines perceive as a significant public issue, something that really matters to everyone.”

“The WWAMI states, like most U.S. states, heavily invest in the education of health care providers,” Rosenblatt said. “Government and higher education leaders need solid evidence gleaned from research to influence training policies.” The center plans to disseminate its findings in practical reports.

A major tension in the health workforce, according to Rosenblatt, occurs because of overlap in patient-care responsibilities among the health professions, what Rosenblatt calls the “who should do what to whom when?” debate. He hopes the research center’s data will help resolve some arguments over who is the appropriate professional to provide needed health services.

In addition to focusing on curative services, the center will also look at the provision of preventive, public, environmental and dental health services. Hart said the center will quantify the benefits and savings from investing in those sectors of the workforce. The center also hosts visiting scholars and national leaders. In January, Don Weaver, founder of the National Health Service Corps, which has placed thousands of doctors and other professionals in needy areas, came to the center to meet with researchers and talk with students.

Some projects the center will undertake include: models to determine, within small geographical areas, the adequacy of primary-care providers to meet population needs; physician assistant productivity in various practice settings; distribution of the dental workforce and whether it meets dental health needs; contributions of nurse practitioners, physician assistants and certified nurse midwives to primary care in medically underserved areas; and the effects of an expanded public health agenda on requirements for public health professionals.

“We realize that we will be walking into minefields of controversy in our research: Medicare funding of physician training, professional and economic competition, the setting of higher education policy, the allocation of educational funding, licensing regulations,” Rosenblatt said. “However, we believe that, because hard decisions will have to be made, it is better to make them with the most precise data that can be gathered and in a way that makes the most rational sense. We’re here to ask the tough questions.”

Among the center’s researchers are Dr. Eric H. Larson, a medical geographer and deputy director of the WWAMI Rural Health Research Center; Ruth Ballweg, a physician assistant and the director of the MEDEX Northwest physician assistant training program, Dr. Bobbie Berkowitz, a registered nurse and professor and chair of psychosocial and community health, School of Nursing; Dr. Peter Domoto, a children’s dentist and professor and chair of the Department of Pediatric Dentistry; Dr. John Coombs, a pediatrician/family physician, associate vice president for medical affairs, and the Theodore J. Phillips Professor of Family Medicine; Dr. Ed Perrin, a statistician and professor of health services, School of Public Health and Community Medicine; Dr. George Wright, a health economist and an associate professor of family medicine, Dr. Mary Richardson, director of the Graduate Program of Health Administration; and Dr. Tom Norris, a family physician and associate dean of the medical school. ¶

Leila Gray