Thomas C. Ricketts, PhD, MPH

Two Views on Health Reform and Two Views on Health Reform and WorkforceWorkforce

The negative, cynical view Congress added to the existing

macro-policy of “nudging” workforce market behavior through profession- specific, producer-focused, grant-structured programs. Little assessment of past performance No unifying goals stated

A Policy-Recommending Commission has been created with no clear guidance over how they are to influence policy—and no appropriation.

A potential rival to the GME “1000-pound gorilla” may emerge in the Community Health Center Trust. Teaching centers and primary care extensions may create conflict.

The positive, constructive view Experimentation is encouraged via

many new approaches Teaching health centers, a natural

extension of current activities givesmomentum to multiple programs

Outreach structures, that can build on successful AHEC-like activities, can unify the system

There is a potential for the expanded programs to create a “tipping-point” for primary care

Institutionalizing nurse leadership and acceptance of new professional roles will help meet needs and produce efficiencies

Structures for coordination across (all) workforce stakeholders are recognized if not encouraged

Doctors and Reform: New Stuff

New support for Trauma Care (a bona fide success) New incentive for surgeons in HPSAs Pediatric subspecialist loan repayment Redistribute GME slots to primary care, count OPT time ACA has a strong primary care bent and assumes primary

care can Lower costs and Improve Outomes NHSC and Teaching Health Centers Primary Care Grants to schools Bonus to primary care Primary Care Extension Centers (AHRQ)

Doctors and Reform: Unresolved

Regulatory ACOs and balance between generalists and specialists Medical Homes and the same Geographic adjustments to payment Relative Value (RVUs) and Bundling

Legislative SGR and Medicare payments Tort reform GME in general

Meanwhile…medicine will be affected by… Policy for Nurse Practice: A big report from some nursing

advocates lays claim to an expanded share of the primary care need. Medicine replies with a strong demurral, but in the words

of a leader of one discipline: “We haven’t solved the primary care problem ourselves”

Expansion “on the edge” continues with new medical schools, programs and plans CNPs (Creative New Practitioners) emerging to soak up the

prevention benefit under Medicare

Who, what where, when, why, how?

Who: Will program advocacy define roles (Grinch) What: Is there potential for a new interprofessional

policy culture? (Pollyanna) Where: The states have wildly different cultures and

conditions that affect the “mix” of policy approaches When: The urgency of “reform” runs up against the

realities of training cycles—inevitable frustration. Why: Have we turned a corner to patient and community

centered-ness? Will we now have clearer workforce policy

How: Will the money run out? Will it get off the ground?

Grinch or Pollyanna, you chooseGrinch or Pollyanna, you chooseThomas Ricketts(919) 966-5541

ricketts@schsr.unc.edu