• shortages of primary care physicians and professionals in certain fields, such as oral health, mental health, and nursing;

  • a shortage of talent in the biological and other health sciences; and

  • underrepresentation of minority groups in the HHS workforce and among the nation’s health professionals.

During the five-year period that began in 2007, half of all managers within HHS will be eligible to retire. Many are hard-to-replace, experienced senior managers and professionals. The committee believes that HHS will need to look for replacements not only within the department (using delayed retirements and appropriate advancement of current staff), but also toward more effective recruitment from the private sector and academic institutions. To make government service more attractive, federal hiring practices should be revised, and greater flexibility in fringe benefits and work patterns—such as telecommuting and flexible schedules—should be offered.

The health care workforce outside the department is also under strain. The balance between primary and specialist physicians continues to tip toward specialists, even though communities served by more primary care physicians have less costly care and better outcomes. Redressing this imbalance should be a key societal goal. Advanced practice nurses and physician assistants may help fill primary care gaps. Meanwhile, the aging of the U.S. population and associated increases in the prevalence of chronic diseases create growing demand for health care professionals skilled in geriatrics. Information technology may help alleviate some geographic or specialty shortages.

Constituting one-fourth of the nation’s population, African Americans, Hispanic Americans, and Native Americans collectively account for only six percent of the nation’s physicians. Certain Asian American groups experience similar underrepresentation. Minority professionals tend to practice in underserved minority communities and may be able to provide residents with more culturally competent care.

Federal support for health workforce training programs is uneven. Title VII support for public health, preventive medicine, and dental public health training was eliminated in the President’s fiscal year (FY) 2009 budget, despite the difficulties recruiting staff in these disciplines, as reported by state and local health departments.

To continue advances in the health-related sciences, the nation needs biomedical scientists, health economists, other health service researchers,



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