ACU Workforce Column: Expanding and Supporting the Health Care Workforce

Trends and Anticipated Challenges in Health Care

With implementation of the Patient Protection and Affordable Care Act (PPACA), health insurance coverage will expand to an additional 34 million people in the United States.¹ In addition, the PPACA calls for increasing the number of patients served in federally qualified health centers (FQHCs) from 20 million to 40 million. When the Commonwealth of Massachusetts mandated health insurance in 2006, primary care wait times increased, even though the state had the country’s second highest ratio of primary care physicians to population, the third highest ratio of nurse practitioners to population, and a robust network of community health centers (CHCs).^2,3

For FY 2012, the Obama administration increased its target goal for primary care clinicians in health professional shortage areas by nearly 42% compared to FY 2010.⁴ Insurance expansion is expected to put additional demands on the primary care workforce, as the use of services by the 46.3 million people who are presently uninsured is likely to rise.⁴ President Obama has recognized this challenge and called for an immediate and long-term expansion of the nation’s primary care physicians, nurse practitioners, and physician assistants.

Coincident with this increased demand, primary care providers will face increasing patient diversity and complexity, accelerating adoption of new technology, heightened focus on measures of success and accountability, and an urgent need to provide interprofessional education (IPE) to facilitate collaborative care. This column seeks to highlight some of the efforts currently underway to address these challenges that might also serve as models to others who also seek to expand and support the health care workforce. These efforts include new approaches to education, mentoring, residency programs, and leadership training.

Educating a Diverse Health Care Workforce

The Florida State University College of Medicine was founded in the year 2000 with a mission to “. . . educate and develop exemplary physicians who practice patient-centered health care, discover and advance knowledge, and respond to community needs, especially through service to elder, rural, minority and other underserved populations.” This was a revolution of sorts in health care, and it was this compelling mission that convinced the leaders of the state to write the statute that formed the Florida State University College of Medicine (FSUCOM) in 2000.

Many characteristics of the college have been developed to fulfill this mission: a large family medicine department, a dedicated geriatrics department, a robust rural health program, and regional campuses throughout the state of Florida. In addition, FSUCOM students learn the medical disciplines in the outpatient setting with clerk-ships that are taught one-on-one in physicians’ offices and practices. Instead of being assigned to a team, each student is assigned to an attending physician during each rotation. This has allowed for student immersion into six different medical communities throughout the state.⁵

While FSUCOM teaches medical students to provide care for underserved minority patients, creating opportunities for main campus faculty to provide clinical care for these patients has been challenging. Increasing budget pressures have demanded increased financial output from clinical work and caring for the mission fit population is usually not financially profitable. The result is mission drift; the medical institution is not engaged in the care of underserved patients to the extent desired. This is a very difficult problem for Black, Mexican American, Puerto Rican, and Native American faculty, as they are the principal defenders of the mission; they spend the most time in clinical endeavors to help the underserved.⁶ Increased clinical activities of minority faculty can decrease underrepresented minority faculty in higher levels of academic leadership, such as full professor and chair. As is the case in most family medicine departments, minority faculty are assigned more clinical responsibilities than non-minority faculty.⁷

The Florida State University College of Medicine is dedicated to solving this problem. Among its many planned activities are targeted faculty development for minority faculty, formal instruction on institutional culture and values, and...