【医疗研报】CED-解决医疗保健劳动力短缺：经济发展委员会医疗保健业务圆桌会议的见解和解决方案（英）

ADTALEMCED®G LORALE DUCATIONCOMMITTEEFORECONOMICDEVELOPMENTTHE PUBLICPOLICY CENTEROFFoundation THE CONFERENCE BOARDAddressingShortages in the Health CareWorkforceInsights andSolutionsfrom the Committee for Economic DevelopmentHealthcareBusiness RoundtableJanuary25,2023THECONFERENCEBOARDImmigration Reformto Increasethe Health Care WorkforceInternational talent,recruited forpositions in the US,has thepotential to fill many gaps in the UShealth care workforcein additionto theportion of the workforcealready composedof immigrants.For instance,in thelong-term care sector,one infive workers are non-citizens.Programs canhelpimmigrants transitioninto specifichealth carespecific careers.Language is often abarrier,as isthe costof training.The Federalgovernment can offer relieffor workforce shortages byallowingvisas forqualified medicalworkers.In thiscontext,it ispossible tobridge credentialgaps for foreign-trained medicalprofessionals byoffering thema levelbelow the role theyhad intheirhome countryand thenpermitting themto testup to the USequivalent of their foreignlicense.Immigrants arestrongly representedin ournursing population,and wedepend oninternationalrecruitment.Visas waiversunder theConrad30Waiver Programallow for foreign medicalgraduatesto applyforforeignresidence withthe goalof servingunderserved communities.However,it is also important to acknowledgetherolethat USrecruitment ofmedical workersplaysin“reverse foreignaid,as oneof thewealthiest countriesin the world pullingworkers fromsomeof thepoorest countries.In thisregard,we mustconsider whatconstitutes ethicalrecruitmentand howto incorporatethese individualswell into our systems,as therehas beenanunfortunate recordof abuses.Rural Health CareRural health care relieson bothlocal andremote providersbecause of the greaternumbers ofspecialistsin urbanareas.To getmore health workers intorural areas and lessendisparities,solutions that should beconsidered includeusing interprofessionalteams and removing barrierstoprofessional practice,expanding existingrules of the scope of practice,expanding telehealth,encouraging morecareers in health carefor ruralyouth throughapprenticeships athealth carefacilities,supporting nursingeducation atrural community colleges,encouraging ruralrotationsfor medical students,and makinggreater use of technologyin medical education,includingdistance learning.Improving Cultureand WorkEnvironment ThroughPublic-Private PartnershipsAnotherbroad solutionnotes theimportance ofconsidering a whole-person approachto holisticwell-being for employees,including financialassistance andsocial resourcesthat offera senseofbelonging.Upskilling can be usedto buildengagement within the workforce,with formalprocessesthat areboth concreteand understandableto employees.Employers mustthinkintentionally about the timingfor offeringsof upskillingforemployees,including thepossible useofpaid time.To bringback andretain olderworkers in health care,we mustincorporate wellnesssolutions to retain the agingworkforce andrethink atax systemthat penalizesthose beforeretirementage receivingbenefits.There can be particularcomplications aroundthe trainingand upskillingof independentworkers.Staffing firmsdeploy theseindividuals,often aslower skilledindependent contractors,and it willbe importantto considerhow theycan beupskilled sothat theseresources can best bedeployedin the health care workforce.Partnerships willneed to become thenorm,whetherregionally orvia distancelearning.Almost everyinstitution mustuse non-traditional strategies-offering bothbrick andmortar andvirtual trainingmust becomethe newnorm.Similarly,competition formedical technicianshas beenmade increasinglydifficult sincethebeginning of the pandemic.Reengaging theseemployees beginswith a focus onculture,wages,and modernizingthe work,as the lack oftechnological integration across thesector has been astrongbarrier to recruitment.Partnerships withuniversities canenabling employeesto optintoprograms forwhich theemployer coversthe cost;renaming oneprogram aseducationassistance insteadof tuitionreimbursement helpedraise participation,as someworkers wereunableto affordthe costof tuition.To improveworkplace culture,ustayn interviewscan fosterconnectionsbetween supervisorsand employeesand encouragea supportiveenvironment-and afocus ondiversity and inclusion isvery importantin aprofession inwhich manyworkersare womenof color,as is afocus on mentalwellbeing,increasing mental health benefitsanddiscussing mental health in the workplace.Building Public-Private Partnershipsto Expand the Workforceand AccesstoCareAs notedabove,the UShas vastlyunderinvested in mental health systems for decades,whichincreases the burden on the primary care system.In particular,there is a greatshortage ofmentalhealth practitioners in disadvantagedcommunities.This presentsan opportunityforbusiness to invest,and alongwith this,government canensure proper training programs forthese positionsexist in community colleges and public universities.Working togetherinpartnership,these actionscould have a materialimpact on the gapin care.More broadly,consortiums to build apprenticeship programs acrossthe health care industryand in particularregions area strongsolution;funding cancome from colleges,economic developmentagencies,and government.In thisand otherhealth care sectors,other solutionscan includeaccelerated graduation tracksand specialized programs incommunity collegesand broadaccess institutions.Health careemployers can work collaboratively with communitycolleges to ensure that theircurriculaprepare future workers not merely to pass a licensing exam but toexcel and advance intodayshealth care system.Insights forWhafs Ahead:In sum,the followinginsights and solutions werehighlighted inPart IIof the roundtablediscussion onThe BusinessRole inTraining andUpskilling the Health Care Workforce:BuildingStronger Public/Private Partnerships:■Addressing thelabor shortageand improvingthe quality of carewill require an emphasisonteam-based care,examining structuralissues thatprevent thefull utilizationof teams.Health care workers oftendo notknow whatothers aretrained todo,leading todisconnectand a lack oftrust.Having physicianstake leadershiptraining canhelp instillteamwork.■Some sectorswere hitharder thanothers during the pandemic,including the post-acutesector and mentalhealth.Building bettercultural engagementbetween employersandemployees andadopting toolsand technology to reduceadministrative workwill help,butculture must be addressedfirst.■Internationaltalenthas thestrong potentialtofillmanygapsin the workforce,even beyondthesignificant portionof the health care workforce composedof immigrants.The Federalgovernment can offermore visasfor trainedmedical personnel,and credentialingprogramscan bridgegapsforforeign medicalgraduates.■Interprofessional teamsandremovingbarriers topractice will help addressshortages inruralhealth care.■An aginghealth care workforce can be addressedthrough wellnesssolutions fromemployersto helpretain employees,and programscan bedesigned tobring retireesfromthe industryback into the workforceon flexibleschedules.■Public-private partnerships,including consortiumstobuildapprenticeshipprograms,accelerated graduationtracks and specializedprogramsincommunitycollegesandbroadaccess institutions,are effectivein buildingthe workforce and attractnew workers to theindustry.Health careemployerscanworkcollaborativelywithcommunitycollegesto ensurethat theircurricula preparefutureworkersnotmerelytopassalicensingexambutto excelandadvance intodays health care system.■Payment andregulatory issuesalso affectrecruitment tothe workforce.Inadequatereimbursement tohospitals,which providesthe perverseincentive toreduce staff,places agreaterburden onthose whodeliver care.Medicare andMedicaid onlycover65percent ofcosts,straining the system as awhole.Federal andstate regulationshave theintent toimprovequalityofcare butcan resultin excessiveadministrative burdensof documentingservicesto ensurecompliance.Similarly,poorly designedelectronic medicalrecordssystems,which againincrease administrativeburdens andadd toburnout.ConclusionThe challengesin addressingour nationsshortage of health care workersaregreat,but manypracticalsolutions existfor resolvingthe issue.Some,such asworking toinstill interestin healthcarecareers inearly education,will bearfruit overtime;others,such asraising immigrationlevelsand reforminggraduate medical education,canoffermore immediatebenefits.At thecorporatelevel,strategic communicationsefforts canrebuild passion around amission tocounterthe effectsof burnoutresulting from the pandemicand canintegrate health caresystems morecompletely,to addressshortages byenabling staffingto bemoved moreseamlesslyfrom onesite to another.Companies can also recruitamong workers in industrieswhichshare ascientific emphasis,such astechnology workers.Business models,too,mayneed tobe reconsideredin lightof currentand futureworkplace shortages.In theface of these challenges,itwill require bothinnovation andinnovative leadersto addressworkforceshortages andmove theindustry forward to servean agingpopulation inwhichdemand forhealth careservices of all typeswill bestrong.Systemic change,regulatory change,policy change,and businessleadership mustall combineto meetthe challenge.CED washonoredto hostthis roundtableand looksforwardto remaining stronglyengaged in this issuesoimportant forour economyand Americans5health.APPENDIXVirtual ParticipantsCEDTrustee Chair:•Peter Hahn,PresidentCEO,University ofMichigan Health-WestModerator:•Dr.Lori EspositoMurray,President,Committee for Economic DevelopmentGuestParticipants:•Candice Chen,MD,Associate Professor,Department ofHealth PolicyandManagement,Milken InstituteSchool of Public Health,George WashingtonUniversity•Bianca K.Frogner,PhD,Professor,Department ofFamily MedicineDirector,Centerfor HealthWorkforce Studies,University ofWashingtonTrustee Participants:•Jeff Alter,Chief ExecutiveOfficer,Summit Health•George Barrett,Former Chief Executive officer,Cardinal Health•Anthony Barrueta,Senior Vice President,Kaiser FoundationHealth Plan,Inc.•Michael Benstock,Chief ExecutiveOfficer,Superior Groupof Companies•Chris Bird,CEO,EHE Health•Neil deCrescenzo,President and CEO,Change Healthcare•Jean-Claude Dubacher,Chairman andCEO,B.Braun ofAmerica•Howard Fluhr,Chairman,The SegalGroup•Julian Francis,PresidentCEO,Beacon Building•Diane Hansen,CEO,Palomar Health•Hollis Hart,Former President,International FranchiseManagement,Citi•Hollie Heikkinen,CEO andFounder,iWorker InnovationsLLC•Pres Kabacoff,Executive Chairmanof theBoard ofDirectors,HRI Properties•Reece Kurtenbach,Chairman,President,Director,CEO,Daktronics•Jim Linder,MD,ChiefExecutiveOfficer,Nebraska Medicine•Cecilia McKenney,SVPChief HumanResources Officer,Quest Diagnostics•David Nash,Founding DeanEmeritus,Jefferson Collegeof PopulationHealth•Camille Olson,Partner,Seyfarth ShawLLP•Ned Rand,President,andCEO,ProAssurance•Terry Shaw,PresidentCEO,AdventHealth•John Thomas,Trustee,President andCEO,Physicians RealtyTrustAdditional Participants:•Lauren Rengel,Director,SustainabilityExternal GovernmentRelations,AdtalemGlobal Education•Juliann Barreto,Chief OperatingOfficer,Spectrum GamingGroup•Catherine BeldottiDonlan,President,Superior UniformGroup Healthcare•Erika Curran,VPGeneral Counsel-Global Auto,Assurant•Megan Gohsman,Real EstateCounsel,Physicians RealtyTrust•Mike McQuide,Director ofCreditResearch,Physicians RealtyTrust•Sonya Nelson,Division President,Aetna Medicaidat Aetna•Kate Veenstra,Associate ChiefNursing Officer/VP of Nursing,University ofMichiganHealth-West•Giuliana Walker,Senior GlobalSupply ChainSC PracticeLead,Chemonics•Patrick Wittmer,Corporate Vice President,Corporate Affairs,B.Braun ofAmericaCED Staff:•Michael Petro,Senior Advisor•John S.Gardner,VicePresidentof PublicPolicy•Cindy Cisneros,VicePresidentof EducationPrograms•Alan Cole,Senior EconomicPolicy Analyst•Mitchell Barnes,Senior EconomicPolicy Analyst•Michelle LaMarcheSmith,Senior Member Engagement Director•Danylo Jaworsky,Director•Tia Collier,Senior EducationProject Manager•Mallory Block,Research Associate•Katie Brunell,MemberEngagementAssociateSUSTAINING CAPITALISMAchievingprosperity forall Americanscould notbe moreurgent.Although the United Statesremainsthe mostprosperous nationon earth,millions ofour citizensare losingfaith in theAmerican dreamof upwardmobility,andinAmerican-style capitalismitself.This crisisofconfidence callsfor reasonedsolutions in the nationsinterest toprovide prosperityfor allAmericansand makecapitalism sustainablefor generationsto come.In1942,the foundersofthe Committeefor EconomicDevelopment CED,our nationsleading CEOs,took ontheimmense challengeof creatinga rules-based postwareconomic order.Their leadershipandselfless effortshelped givetheUnited States and theworldthe MarshallPlan,the BrettonWoodsAgreement,and theEmployment Actof

2033.The overallhealth care workforcehas declinedfrom its2019level.As ofDecember2022,physicians5offices,outpatient carecenters,home healthservices,and hospitalsemployed morepeoplethan inFebruary2020;however,given pre-pandemic trends,employment in these industriesisstill belowexpected levels.Turnover ishigh inmany health care jobs,from physiciansto healthaides,with health care workforceshortages peakingduring theOmicron surgein January2022when22percent of all UShospitals reportedcritical staffingshortages.As The ConferenceBoard notes,among thesectors stillsuffering fromlabor shortages,they remain particularlysevere inthe health caresector.The USrecruits manynurses fromabroad;yet theglobalshortage of nurses couldreach13million by

2030.All thisis notsurprising giventhe dailypressures health careworkershave facedwith littlereliefover thepast twoyears.In theworst-case scenario,as health care workforcescholar androundtableparticipant Dr.Bianca Frogner noted,as aidesand assistantsleave the health caresectordue tocompetition fromother industries,problems will“bubble upnto higher levelworkers;in particular,Registered Nurses,who willsuffer withoutnursing assistants available tothem,will actas aucanary inthe coalmine^^tothesystem.IHowever,shortages andmaldistribution ofhealth careworkers existedprior tothe pandemic,for instancein primary care,psychiatry,and behavioralhealth,as well as incertain regionalgeographies.Nursing providesan illustrativecase.One studyfrom2016forecasted a shortageof154,000Registered NursesRNs by2020and of510,000by2030,with statesintheSouthand Westfacing higherrisk thanthose inthe Northeastand Midwest-one importantdriver oftheshortages—expected retirementsofnurses.Similar shortagesare estimatedfor physicians,with pre-pandemic estimatespointing toa gapofup to124,000physicians by2033,split betweenshortfalls ofbetween17,800and48,000primary carephysicians andbetween21,000and71,100specialty physicians.A morerecent2021report focused on lower-wage criticalhealth careoccupations—medical assistants,homehealth aides,and nursingassistants—estimated thetotal shortageamong thoseworkers in2026tobeup to

3.2million.Limitations onthe availabilityof traininghave constrictedthepipeline forhealthworkers,particularly innursing.In2020,the AmericanAssociation ofCollegesofNursingreported thatmore than80,000qualified applicantswere notaccepted atnursingschools,due toshortfalls inclinical sitesand faculty.Strains alreadypresent onthe health care workforcewere sharplyexacerbated by theCOVID-19pandemic.Important lessonscanbelearned foraddressing todaysworkforceshortages from the effortsto counterthe devastatingimpact ofthe pandemiconthe health careworkforce.Starting almostimmediately andthroughout the pandemic,over200regulatorywaivers grantedthrough theimplementation ofthe nationalPublic HealthEmergency permittedhealth care providersgreatly neededflexibilities.CMS waiversprovided thatprivate cliniciansandstaff couldwork inhospitals ona temporarybasis andremoved barriersto hirephysicians,I Drs.Chen andFrogner agreedto havetheir commentsused publiclyin thisreport;our Trusteesparticipated,as isCEDs practice,under theChatham HouseRulenurses,and otherstaff bothfrom localcommunities as well asfrom thoselicensed inotherstates.States likeIllinois andNew Yorkwaived licensingfees andextended licenses;in NewYorkCity alone,1,000retired health careworkersapplied tohelp thefirst daythe cityasked.Physician assistants and nurse practitioners couldpractice tothe fullestextent possibleaccordingtoastates emergencypreparedness plan,including orderingtests orservices.Tohelp workerscovering exceptionallylong hours,CMS gavea blanketwaiver toallow hospitals toprovide meals,childcare forworkers,and otherservices forstaff.The waiversalso permittedretiredhealth careworkers toreturn tothe workforce,hospitalstoadopt flexiblecare modelspermittingcare outsidethe hospitalwalls andcoordinate careamong regionalgroupings,anddramatic expansionof andfar greateraccess totelehealth servicestoensure that carecouldcontinue throughoutthe crisis.Telehealth was,in fact,an importantsuccess inincreasing accessto careduring thepandemic.Its usegrew sharply,rising fromvirtually nothing

0.15percent in2019to13percent oftotaloutpatient visitsfrom Marchto August2020and remainedstrong at9percent of all outpatientvisitsfrom Marchto August2021,even asin-person outpatientvisits exceeded2019levels.Aswith telehealth,thepandemicregulatory waiversshould bereviewed forbest practicesand todeterminethose waiversthatshouldbe extendedor madepermanent toaddresstodayshealthcare workforceshortages.CED highlighted in itsSolutionsBriefon Preparingfor theNext PublicHealth Crisis:Lessons fromthe Pandemic:■Rebuild andrevitalize the health care workforce Workclosely withthe privatesectorand educationalinstitutions toaddress thecritical shortages inhealth care providers.Recruit newand retiredhealth carepersonnel.Ready theNational Guardfor emergencyhealthcare deployment.Implement acceleratedgraduationtracksandspecializedlearningin communitycolleges thatoffer newpathways toaddress healthcare workforceshortages.Regulatory reform,greater use of interdisciplinaryteams,and increaseduse oftelehealthwill allhelp address the healthcare workforceshortage in rural America.Registeredapprenticeships offera chancefor participantsto embarkona new careerwhile earningfundsto payfor learningthat career.Trustees oftheCommitteeforEconomicDevelopment ofTheConferenceBoardCEDwhoare leadersinthehealthcaresector remainconvinced that there aresolutions tothis dauntingchallengeand thatimportant lessonscanbelearned fromthepandemic.The HealthcareRoundtableAs part ofagrant CEDhas receivedfromtheAdtalemGlobalEducationFoundation,CEDhosted avirtual roundtableon January25,2023featuring CEDTrustees andhealthcare andacademic leaderswho sharedtheir insights andsolutionstotheindustr/s labor shortagesthat negativelyaffect healthoutcomes for too manyAmericans as wellasthe economyas awhole.CED takesthis opportunity to thankits Trusteeswho contributedtheir valuableinsightsand theacademic participantsin ourroundtable.The roundtableisafurther effortto engageCEDs distinguishedhealthcare businessleaders inadialogue withacademic expertsto developand refinesolutionstothis nationalchallenge thattheycan incorporatein theirhealthcare businesses.The roundtablediscussion agendawas dividedinto twoparts:■Part Iconsidered Training theHealthCareWorkforce:Views fromAcademia,focusing onsolutionsto current workforceshortagesthat involvehow andwhere thefuture healthcareworkforce willbe trained.■Part IIshifted thefocus fromacademia tothe businesscommunity inexamining TheBusinessRole inTraining andUpskilling theHealthCareWorkforce:Building StrongerPublic/Private Partnerships.Part I:TrainingtheHealthCareWorkforce:Views fromAcademiaSeveralcauses ofhealthcareshortages relatedirectly eitherto educationalack of support forSTEM educationortothe actualtraining ofthose whodo chooseto enterthehealthcareworkforce.It seemsclear,therefore,that therecanbeno solutionsto solvingshortages inthehealth careworkforce withoutunderstanding howbest to train thehealthcareworkforce ofthefuture.Two prominenteducators who have thoughtdeeply onthis issueare Dr.Candice Chen,Associate ProfessorintheDepartment ofHealth Policyand Management,Milken InstituteSchoolofPublicHealth,at theGeorge WashingtonUniversity,and Dr.Bianca Frogner,Professor,Department ofFamily Medicineand DirectoroftheCenter forHealth WorkforceStudies,at theUniversity ofWashington.Maldistribution ofWorkers Mistakenfor ShortagesAddressing the roundtable,Dr.Chen beganby notingthat there are persistent,ongoingconcerns aboutlaborshortagesin healthcarewhich theCOVID-19pandemic increased.Therehas beenboth a“Great Resignationand migrationof workersacross allsectors notjust healthcare,causing incrediblechaos inthehealthcare system.However,it isalso importantto notethatfor physicians,what sometimesappear tobe shortagesare infact maldistribution of supplyacrossspecialties affectingparticular regions.Graduate MedicalEducation NeedsReformMedical educationplays arole inwhether physicianspursue primarycare orspecialties.Medical studentsfrom disadvantagedbackgrounds aremore likelyto serverural andunderservedareas;therefore,the demographicsofthestudents that medical schoolsadmitgreatly impactsthe workforce.Additionally,diversity intheworkforcemakes forbetter patientcare.In medical schools,role models influence futurephysician choices,as doescommunitybasedtraining.Dr.Chens researchshows thatgraduate medicaleducation GMEdeterminesthe overallsize andgeography ofthe physicianworkforce.Over20percent of thesepositions arecurrently filledby graduatesof internationalmedical schools,of whom40percentare UScitizens.Evidence showsthat physicianshavea higher rateof locatingcloser toresidencyprograms.Medicare andMedicaid GMEisoftencriticized forbeing outdated:it linksGME paymentstohospitals,is maldistributedacross states,and lacksaccountability.Congress increasedMedicaresupportfor GME inthe lastthree years.Yet researchersare projectingashortage ofphysicians acrossspecialties,with anoversupply ofnurse practitionersand physicianassistants.There isa challengeand an opportunityto close workforce gaps sothesystemcanfully utilizethese workers and optimizehealthcareteams.High TurnoverAmong Assistantsand AidesDr.Frogner beganher presentationby notingthat17million peoplework inhealthcare.Doctorsand nursesmake uponly20percent ofthat total,with20to25percent ofthe workforcecomprisingassistants and aides.There isenormous turnoverin amongassistantsandaides,asthey struggletoremainin these positions asother industriesoutside healthcare competeforthese workers.In addition,Black andHispanic workersstruggle moreintheseroles,as dowomenwith youngchildren,even before the impactsofthepandemic areconsidered.Hospitals,especially thoseinruralcommunities,struggle withturnover ratesof theirRNs.A Focuson RetentionIn short,thehealthcare industryneeds afocuson retention.In Dr.Frogners view,thepandemic didnot turnstudents away fromthefield,but trainingisa longer andslower endeavortosecure thesepipelines.As salarytends tobe tiedto rankwithin theindustry,professionaldevelopment opportunitiesmust beimplemented toencourage retention.Dr.FrognernotedtheWorkforce Innovationand OpportunityAct WIOA,which canbe usedasamodel forapprenticeshipmodelsinsupporting thetraining ofhealthcareworkerstomove themintohigher skilledjobs.We mustincrease scope of practiceand ensurethat allworkers,includingphysician assistantsand nurse practitioners,are practicing atthe top of their license.Addressingthehigh turnoverof assistantsand aidsmustbeaddressed nowbeforetheissuebubbles upand affectshigherlevelsof workers.RNs willbe thefirst thiswill effect,as theywillsuffer whenthereareno nursingassistantsavailableto them.Encouraging MoreStudents toPursue PrimaryCareThe roundtablealso considereda strategyfocusedon primarycarewhich Dr.Chen identifiedasan importantpolicy issue.While thescope of practice acrosshealthcare professions isimportant,to raisethe numberof primarycare doctorswillrequireanewsystem,as primarycare often doesnot havethe attractionfor studentsthat medicalspecialties do.As apart ofthis,the nationneeds to recruit more doctors of color,and reachinto highschools andcollegesearlier torecruit students.However,some effortsin thisarea,such aspromoting greateraccountabilityforGMEas Dr.Chen haspromoted,raise politicaldifficulties,inpartbecauseMedicare taxdollars traininto aprofession inwhich manyparticipants eventuallyearn verylargeincomes,inpartbecause taxpayershave paidfor theirtraining.In allevents,because thepipelinetotrain an MDfromcollegeto residencyis solong,it isurgent toaddresstheissue now.We muststart workingonthepipeline,as it isalong pipeline.Equally,providers shouldbebetter trainedintheuse oftelemedicine anddigital healthand usetechnologytoease theburdenon all healthcareworkers.There aremany reasonswhy peoplechoose anycareer:it sparkstheir interest,brings personalandsocial fulfillment,meets financialneeds,and matchesskills.Equally,the reasonspeopleavoid orleave acareer aremultifunctional andvaried.A numberof factorscontribute tothecauses ofhealthcareshortages at all levels.Inshort,the sessionconcluded thatmore needstobe doneto fostertraining ofhealthcareworkersinthe populationsthey serve.The problemisparticularly acuteinhealthcare settingsthat treattypically underservedpopulations.For boththe public andprivate sectors,apprenticeships offera chanceto embarkonacareer inhealthcare whileearning fundsto payfor learningthat career.Insights forWhafs Ahead:In sum,the followinginsightsandsolutions werehighlightedinPart Iofthediscussion onTrainingoftheHealthCareWorkforce asimportant causes ofhealthcareworkforceshortages:■Simple supplyand demandleads toshortage,as fewerproviders andmore peoplerequiringcare because of agingandcareof chronicdiseases producesgreater strainsonthe systemthat inturn makecareers inhealthcareless attractive,as doesthelackof ahealthcare systemthat stretchesthe continuumfrom preventionto palliativecare.■Chronic underinvestmentin STEMeducation,which canspark interestin anddesire forhealthcareers earlyin life,has contributedto healthcareworkforceshortages.■The mismatchand imbalanceof workersthat existsin bothprimarycareand specialty careis drivenbythelocation ofmedical schools and trainingprograms whichare mainlyin moreurbanareas,incentives thatdraw theavailable healthcareworkforceawayfromrural andunderservedcommunities towardslarger cities.Many incentives,such aspayment policies,lead tocurrentworkforcemaldistributions.■Graduate medicaleducation needsreform;the geographicallocation ofmedicaleducation,for example,plays acrucial roleas physicianslocate atahigherrate wheretheir graduatemedicaleducation takesplace andhigher paydrives jobselection towardmore prosperousareas.Tools such as telemedicinewill improvethe effectivedistributionofworkers.■The industryshould focusonretentionatalllevels.About20-25percent ofthehealthcareworkforce playssupportive roles.High turnoverof assistantsandaidesresults partlyfromcompetition fromsectors suchas retailand hospitality.Training andprofessionaldevelopment programs,aswellas salary,will helpretention ofthese workers.As acomplementto thatapproach,a numberof supportjobs thatdo notrequireahigherleveloftraining canbe separatedfrom moreskilled basedjob descriptionsand thenhealthcareinstitutions canwork toattract andtrain candidateswho arenot participatingintheeconomyinto thehealthcareeconomy.■Recently separatedtech workers,whohaveSTEM backgrounds,can providea poolofpotential workersfor thehealthcareindustry.■Encouraging moremedicalstudentsto focusonprimarycare,rather thanspecialtycare,will helpreduce shortagesof physiciansand increaseaccesstocare.But thiswill requirereformingmedicaleducationandthehealthcare system,as primarycareoftendoes nothavethe attractionfor studentsthatmedicalspecialties do.As apartofthis effort,the nationneedstorecruitmoredoctorsofcolor,and reachinto highschoolsandcolleges earliertorecruit students.■It isimportanttoensurethatall licensedprofessionals,including physicianassistants PAsandnursepractitionersNPs are practicingatthetopof their license,doing allthe tasksforwhich theyhave beentrained,leaving physiciansto focuson interventionsthat requiretheirspecific training.This w川ensure quickercareanda betteruseofscarce resourcesandhelp toavoid burnoutamong alltypes ofhealthcareworkers.Part II:The BusinessRole inTraining andUpskilling theHealthCare Workforce:Building StrongerPublic/Private PartnershipsTheroundtable nextfeatured adiscussion amongour Trusteesas tocausesofworkforceshortages,moving towardssolutions,and promotingstronger public/private partnershipstosupport thenations healthcareworkforceneeds.Some solutions,suchasincreased accesstotelehealth andbringing olderhealthcare providers backinto theworkforceandkeeping theminit throughphased retirement,flexible workschedules,and part-time workopportunities,shouldbe positivelegacies ofthe experienceofthepandemic.Others arebroader solutionsfor whichthepandemic hasaccelerated theurgency ofaddressing.Major issuesdiscussed inthis portionoftheroundtableincluded:Promoting Team-Based CareTeam-Based Careis definedasadelivery modelwhere patientneeds areaddressed ascoordinatedefforts amongmultiple healthcareprovidersand acrosssettings ofcare.Inteambased care,itisessential toensurethatallhealthcare professionalsare practicingat”thetop oftheirlicense^^-doing allthings forwhich theywere trainedand licensed-while atthesame timeseeking toincrease theirscopeof practice.In thisway,shortages canbe alleviatedbothby makingthehealthcareprofessionsmore attractivebecause peoplearepracticingatthe topoftheirlicense andby providinggreater andhigher utilizationofallhealth carepractitioners.Yet severalbarriers,including structuralissues,often existto fullerimplementation ofteambased care.Health careworkers oftendo notknow whatothers aretrained todo,leadingto disconnectandalackoftrust.Education canplay arole here;medicalschoolscan orientaroundteam-based careand howphysicians canoperate ina team-basedcaresystem.Alleviating stresseson physicianswill help.Physicians areautonomous decisionmakersbutproviding themwith trainingto workinateam willreduce burnoutintheprofession.In oneorganization,however,implementation ofa primarycaresystembased onteam-based carehasbeen spotty,as somephysicians didnot wantto engagenursepractitioners,medicalassistants,andmentalhealth professionalsas partofateam.Having physicianstake leadershiptraining canhelp instillteamwork.Other waysto reducestresson physicianscould includethe betteruseofpharmacists inempowering themin theirrolesin engagingmore withpatients;yet underthe currentsystem,pharmacists arepaid morefordispensing thanfor chronicdisease management.Another issueconcerns thewide variationin scopeofpracticeamong theStates.States havedifferentregulations,as doinsurers,aboutthescopeofpractice ofworkersandthey areoftennot inalignment,with insurerssometimes raisingbarriers thatlimit whatstates haveallowed.Modernizing scopeofpracticeregulations,as Dr.Frogner hasurged,willhelp.Jobs requiringfewer skillscanalsobe separatedout toalleviate theresponsibilities ofthehigher trainedworkforce.This w川also allowfor theadditional opportunitiestorecruitand traintheUS workforcepopulation thatis notcurrently participatingintheworkforce.We mustbringhealth careproviders backinto theworkforce throughphased retirement,flexible workschedules,and part-time workopportunities.There isan opportunitytocloseworkforcegapssowe canfully utilizethese workersand optimizeour teams.Some HealthCare SectorsWere HitHarder ThanOthersThe impactof staffingshortagesinsome healthcare sectorshasbeenparticularly severe.Thisis particularlytrue inthe post-acute sector;being acaregiver inthis settingduring thepandemichas beenquite difficultbecauseofthe difficultiesof operatingunder lockdown,increaseddemands forcare froman agingpopulation,andthedisproportionate impactofthepandemic ontheelderly.The biggestproblem facingthepost-acute sectoris insufficientMedicare andMedicaidreimbursement,which isthe primarysource ofrevenue forso manyoftheseproviders.Absent greaterpay,employees willleave tomove ontoother sectors.Thus,chronicunderfunding andinvestment arealong-term issue.The mentalhealth sector,aswell,faces a great mismatchbetween supplyand demandforbehavioral healthservices,which hasrisen sharplyduringthepandemic.Demographicchanges froman agingpopulation acceleratesthe challengesinthissector.The UShas vastlyunderinvestedinmentalhealthsystemsfordecades,which increasestheburdenon theprimarycaresystem.There isagreatshortageofmentalhealthpractitionersindisadvantagedcommunities.This presentsanopportunityfor businesstoinvest,and onthepublicside,governmentcanmake surepropertrainingprogramsforthesepositionsexist incommunitycolleges andpublicuniversities.These actionscould havea materialimpact onthe gapin care.Job satisfactionwithin healthcaresectors,however,is morecontrollable.In anyindustry,takingcare ofemployees willlead tobetter performanceand ultimatelyto companies,financialsuccess.In thiscontext,addressing achronic staffingcrisis shouldstart withbuilding culturalengagementthrough careerladders,management training,recognition awardsprograms,andimproving communication.Tools andtechnology thatcanbeput inplace tomake thejob easier,resulting inless administrativework andless hassle,are important,but culturemust beaddressedfirst.。