large portion of its own workforce is near retirement. A similar pattern is also occurring in state and local public health agencies. Outside the public health world, problems in the number, mix, and composition of the nation’s health workforce also have a negative impact on the department and its agenda:

  • The United States has an overall imbalance between specialist and primary care physicians, and the higher costs that result from an overreliance on specialist care fall heavily on Medicare and Medicaid.

  • It would take 16,261 additional primary care physicians to meet the need in currently underserved areas, where federally funded safety net programs struggle to fill the gaps (HRSA, 2008).

  • A recent survey of medical school students revealed that a mere two percent are planning a career in general internal medicine (Hauer et al., 2008).

  • Nationally, minority groups are underrepresented among doctors, nurses, and other clinical disciplines, which affects access to care, especially for the vulnerable populations that are a high department priority (Sullivan Commission on Diversity in the Healthcare Workforce, 2004).

  • Rural areas and low-income communities are especially affected by shortages of health professionals, so, again, publicly funded health clinics try to pick up the slack.

  • At a time when there is a greater emphasis on improving the science base in many federal agencies, the nation faces a shortage of talent in the biological and other health sciences (National Science Board, 2008b).

These examples show how public programs and publicly funded services are affected by workforce shortages in the private sphere. As a consequence, as it attempts to address some of the nation’s key health challenges described in this report, the department must look beyond its own resources to the health workforce capacity of the entire nation. Developing and maintaining the health professions workforce will require broad-based strategies that include participation by the states, the private sector, the academic community, and other federal departments with substantial health system involvement.

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