The Users' Guide to the Health Reform Galaxy

Call to Action: Tapping Nurses' Leadership and Expertise

Susan Hassmiller, senior adviser for nursing at the Robert Wood Johnson Foundation, writes about the need for nurses to be full partners in reforming the health care system and improving patient care.

There’s image and there’s reality, and the two are not the same where nurses are concerned.  Nurses are seen as trusted, caring, compassionate, skilled health care providers. But that image doesn’t fully capture the reality of the roles nurses play in our health care system, which are much more extensive, substantive, pivotal and robust. 

Today, the Robert Wood Johnson Foundation and Gallup are releasing an unprecedented survey of 1,500 opinion leaders that provides insight into what we need to do to ensure nurses’ place at the decision-making table—and to give health reform every chance to succeed. In many ways, the  two objectives are inextricably connected.

For years, nurses have come out on top of Gallup’s annual poll of most trusted professionals. It’s a truism that the public trusts nurses. But this survey goes deeper. It finds that diverse opinion leaders—including those in insurance, health services, government, industry and academia—say that nurses should have more influence on health systems and services. 

Addressing the primary care workforce shortage to come

Deanna Okrent, senior health policy associate with the Alliance for Health Reform, writes here about a predicted shortage of primary care providers to treat a larger pool of insured Americans.

With the prospect that an additional 31 million Americans may gain insurance coverage under national health reform, many warn there may be too few primary care providers to treat them. 

Following enactment of reform in Massachusetts -- a state often studied to help inform the current debate -- increased demand for primary care led to longer waits for medical appointments and unmet needs for some types of care.  This may have been the result of pent-up demand from previously uninsured individuals. In a May 2009 paper on health reform in Massachusetts, Sharon Long notes that this demand is expected to stabilize as people have coverage for a full year and longer.

Many predict a similar phenomenon after national reform is implemented.  A contributing factor is the declining interest in primary care as a professional goal. Far fewer medical graduates entered residencies in family medicine and internal medicine in 2009 than they did in 1999. Among the reasons graduating physicians choose specialties and subspecialties over general practice are: 1) their large educational debts and  2) the relatively low compensation of primary care physicians, which means it takes longer to pay back that debt. 

Shortage of frontline health-care workers poses challenge to reform

Maria Flynn, director of Jobs to Careers, writes that the millions of health care workers on the front lines are key to the success of health reform - but they have been mostly absent from lawmakers' discussions.

As representatives on both sides of the aisle battle over the fine points of health care reform, the debate focuses primarily on the scope and cost of proposed changes.  Few on the Hill seem aware that one of the greatest challenges to achieving affordable, accessible health care is the persistent and severe shortage of frontline health-care workers.

There’s no doubt that increasing the number of primary-care physicians and nurses is needed to improve care. But the five million health aides, medical assistants, laboratory technicians and other workers who make it possible for the nation’s hospitals and clinics to operate nearly round the clock are also in increasingly short supply and in need of opportunities to increase their skills and education.