Insourced: How Importing Jobs Impacts the Healthcare Crisis Here and Abroad

7 | The Way Forward

The Way Forward The us healthcare-worker shortage will not be solved with initiatives focused on foreign healthcare workers. Only by fixing its own system will the United States be able to wean itself off its reliance on insourced foreign health workers. It will not be easy, but it can be done. Achieving workforce self-sufficiency in America’s largest economic sector will require the coordinated efforts of healthcare institutions, universities, citizen groups, and federal, state, and local governments. As a pediatrician serving some of the poorest communities in the United States and as a healthcare policy expert at the global level, I have examined many potential solutions to the healthcare-worker crisis. I have had the benefit of experiencing firsthand hundreds of different proposed and implemented solutions , in all types of settings—from rich to poor, urban to rural, democratic to autocratic—in systems ranging from centralized national to market based. I’ve seen approaches as different as the new Ethiopian strategy of flooding the market for healthcare workers, in the hope that sufficient numbers will stay in country , and the Thai requirement of a period of national service in primary care in underserved areas. As I have traveled the world helping countries with their healthcare-worker shortages, my mind has constantly traveled back to my own—to this country’s pivotal role in the global maldistribution and shortage of health7 The Way Forward 151 care workers, and to what we can do to provide every American with a decent level of healthcare. It is not enough for a solution to be technically correct; it must also be acceptable from the political, economic, and cultural point of view. There is no shortage of technically feasible policy proposals gathering dust in file cabinets because they were not affordable or could not get the backing of healthcare workers , legislators, or the general public. Here is what I think the United States should do to address its healthcare-worker maldistribution and shortage—and, in the process, to lead the world by example. Train More Healthcare Workers Without a doubt, the most important thing the United States can do is to invest in its own citizens and train more healthcare workers. Globally only 1.8 percent of all healthcare expenditures are invested in health-worker education. The United States spends only one-third of that, 0.5 percent of healthcare expenditures , on health-worker education.1 That is a surprisingly small investment in the education of the people who make the decisions in our nation’s largest and fastest-growing economic sector . What is needed now is similar to the World War II increase in production of health workers. For at least the next few decades , our production of nurses, nurse practitioners, pharmacists , behavior-change workers, and almost all other healthcare professionals will have to increase by at least 50 percent more than our current production. In general, the production of doctors will need to increase by at least 25 percent, and we’ll need to double the number of primary-care doctors. As in any emergency situation, the rules will need to change, and we’ll need to train more health workers better, faster, and more cost-efficiently. 152 I N S O U R C E D Later on, I will address how we will finance this massive investment in our own people. We need not fear training too many healthcare workers. If it appears that we have overcompensated and are training too many workers in a particular field, it is relatively easy to reduce the numbers of students entering the training programs. If the newly trained workers cannot find clinical positions, many or most should be able to find work in administrative, policy, or leadership positions within the healthcare sector. Finding the sites to train more healthcare workers is far easier than it may seem. Most classrooms and labs in health-science schools are empty more often than they are full. At the Johns Hopkins University School of Medicine, students are in class only during the morning hours; the school could easily double its output of physicians by running classes in the afternoon, too. The Johns Hopkins University School of Nursing has already done this, doubling the number of graduates each year and giving a second group of students the reverse classroom-clinic schedule as the original cohort. The United States has no shortage of medical school professors...