Panel on Health Care Work Force, Lacking a Budget, Is Left Waiting
Published: February 24, 2013 - New York Times
WASHINGTON — One of the biggest threats to the success
of President Obama’s health
care law comes from shortages of doctors, nurses and other health care
professionals. But a 15-member commission created to investigate the problem has
never met in two and a half years because it has no money from Congress or the
administration.
“It’s like ‘Waiting for Godot,’ ” said Dr.
Richard D. Krugman, the dean of the University
of Colorado Medical School and a member of the commission. “We are sitting
on a park bench, waiting for Godot. We’ll see if he shows up.”
With an aging population and 30 million people
expected to gain coverage under Mr. Obama’s health care law, the demand for
medical care is expected to increase. But Dr. Sheldon M. Retchin, the vice
chairman of the panel, the National
Health Care Workforce Commission, said, “We are prohibited from meeting and
discussing these issues.”
Members of the independent nonpartisan panel said they
wanted to address these questions: How many more doctors are needed? What is the
right mix of primary care physicians and specialists? Who will care for the
millions of people gaining Medicaid
coverage next year?
Should states rewrite their laws to allow nurse
practitioners and physician assistants to do more of the work done by
doctors? Could pharmacists play a larger role in coordinating care and managing
the use of medications?
The commission was created by the 2010 health care
law, the Affordable Care Act. Mr. Obama has requested $3 million for the panel
in each of the last two years, and some Democrats, like Senator Tom Harkin of
Iowa, chairman of the Appropriations subcommittee on health, have supported the
request.
But Republicans in Congress have been reluctant to
provide money for anything connected with the law, which they opposed. “Anything
authorized in the Affordable Care Act has a tough road with the Republicans,”
said Dr. Atul Grover, the chief lobbyist for the Association of American Medical Colleges.
The chairman of the commission, Peter I.
Buerhaus, a professor of nursing at Vanderbilt University, said: “It’s a
disappointing situation. The nation’s health care work force has many problems
that are not being attended to. These problems were apparent before health care
reform, and they will be even more pressing after health care reform.”
Dr. Krugman said the commission was “caught in a
broader political struggle, and in the gridlock between Congress and the
administration.”
Dr. Retchin, who is the senior vice president for
health sciences at Virginia Commonwealth University in Richmond, said “the
government needs to analyze the scope, caliber and composition of the health
care work force” because labor costs accounted for a large share of the nation’s
health care bill.
Members of the panel, appointed in September 2010 by
the comptroller general of the United States, have no staff, no budget and no
agenda.
Kim J. Gillan, the director of the work force training
program at Montana State University Billings, said federal officials had made
clear to her and other panel members that “we were not to function as a group or
have contact with one another.”
Ms. Gillan said some people apparently feared that the
commission might recommend the national licensing of health care professionals
or other steps that could interfere with state prerogatives.
Another panel member, Prof. Thomas C. Ricketts of the
University of North Carolina at Chapel Hill, said the Government Accountability
Office, an investigative arm of Congress, had advised the panel that “we were
not to work or be seen to be working.”
Dr. Krugman said, “We were told that we were to have
no conversations until we were funded because that would be a violation of some
federal law or rule.”
Chuck Young, a spokesman for the accountability
office, said, “Agencies generally cannot conduct business without an
appropriation.”
In a summary of research, the Department of Health and
Human Services said, “The United States faces shortages of primary care
physicians, dentists, nurses and other health professionals.”
Roger J. Moncarz, an economist at the Bureau of Labor
Statistics, said that employment in health care occupations was expected to grow
by 29 percent, with the addition of 3.5 million new jobs from 2010 to 2020.
Federal officials expect 712,000 new jobs for registered nurses — more than for
any other occupation in the country — and a total of 1.3 million new jobs for
home health and personal care aides, he said.
Edward S. Salsberg, the director of the National
Center for Health Workforce Analysis at the Health and Human Services
Department, said 57 million people were living in areas with shortages of
primary care practitioners.