only 65 percent say they understand how their own recent salary increase was determined (OPM, 2008). This suggests that the new performance-based pay system may need strengthening and clarification in order to achieve its desired effects.

For HHS, efforts to ensure the quantity and quality of the workforce should support the other fundamental organizational activities already touched upon in this report—the alignment of vision, mission, and goals, monitoring performance, and assuring effectiveness.

Related Recommendation

  1. Congress should provide the secretary with additional authority to reward performance, innovation, and the achievement of results, through bonuses, merit-based pay, recognition awards, or other mechanisms of proven effectiveness.


The total U.S. health workforce includes all the categories of workers and professionals who provide services related to the care of individual patients; the state and local public health workforce; and the scientists who perform basic biomedical, health services, and other research related to the prevention, tracking, and treatment of disease and disability. A number of problems in the number, mix, and distribution of the various components of this total workforce are straining today’s health system, and the trends bode ill for the future.

The Clinical Care Workforce

The following problems in the clinical care workforce affect access to health services:

  • 63 million Americans live in a primary care practitioner shortage area.

  • 47 million live in a dental practitioner shortage area.

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