bonuses, merit-based pay, recognition awards, or other mechanisms of proven effectiveness.

  1. The secretary, in concert with other public and private partners, should develop a comprehensive national strategy to assess and address current and projected gaps in the number, professional mix, geographic distribution, and diversity of the U.S. public health and health care workforces.

  2. To help close projected gaps, the department should evaluate existing health care professional training programs, continued education programs, and graduate medical education funding and should encourage Congress to invest in programs with proven effectiveness.

  3. Congress should give the secretary authority to create new programs that invest in the future generation of biomedical and health services researchers, enabling the continued discovery of new, more effective methods of preventing, treating, and curing disease; promoting health; improving health care delivery and organization; and controlling health system costs.


The Institute of Medicine (IOM) committee was charged with considering how the activities of the department and its constituent agencies relate to the public health, health care quality, and health care cost challenges facing our nation. In each of these arenas, the Department of Health and Human Services (HHS) must interact with other organizations and, of course, their people. As this chapter documents, there appear to be impending shortages of people with the right backgrounds, training, and skills within the department’s senior levels, within the nation’s health care workforce generally, within state and local public health agencies, and within the science establishment. These shortages will cripple the ability of the department to carry out its work and negatively affect health care delivery, even as demands are increasing.

An array of new health challenges—not to mention the ongoing triad of access, quality, and cost control—confront the department just as a

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