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REPORT OF A STUDY
A Manpower Policy
for Primary
Health Care
May 1978
NATIONAL
ACADEMY of
SCIENCES
Washington, D.C.
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NOTICE
This is the report of a project undertaken with the approval of the
Governing Board of the National Research Council, whose members are drawn
from the Councils of the National Academy of Sciences, the National
Academy of Engineering, and the Institute of Medicine. The members of
the committee appointed to conduct the project and prepare the report
were selected for recognized competence and with the due consideration
for the balance of disciplines appropriate to the project.
This report has been reviewed by a group other than the authors according
to procedures approved by a Report Review Committee consisting of members
of the National Academy of Sciences, the National Academy of Engineering,
and the Institute of Medicine.
Supported in part by grants from The Robert Wood Johnson Foundation and
the W.K. Kellogg Foundation.
The Institute of Medicine was chartered in 1970 by the National Academy
of Sciences to enlist distinguished members of medical and other profes-
sions for the examination of policy matters pertaining to the health of
the public. In this, the Institute acts under both the Academy's 1863
Congressional charter responsibility to be an advisor to the Federal
Government, and its own initiative in identifying issues of medical care,
research, and education.
TOM Publication 78-02
Library of Congress Catalog Card Number 78-56907
International Standard Book Number 0-309-02764-0
Available from
Printing and Publishing Office
National Academy of Sciences
2101 Constitution Avenue, N.W.
Washington, D.C. 20418
Printed in the United States of America
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I NSTITUTE OF MEDICINE
NATIONAL ACADEMY OF SCIENCES
2101 CONSTITUTION AVENUE WASHINGTON, D. C. 20418
DAVID A. HAMBURG, M.D.
PRESIDENT
David E. Rogers, M.D., Sc.D.
President
The Robert Wood Johnson
Foundation
The Forrestal Center
P.O. Box 2316
Princeton, New Jersey 08540
Dear Dr. Rogers:
May 7, 1978
I am pleased to present to The Robert Wood Johnson Foundation the
final report of the Study to Develop an Integrated Manpower Policy for
Primary Care, conducted by the Institute of Medicine of the National
Academy of Sciences. The study was undertaken with the foundation's
generous support to formulate a cohesive health manpower policy for
assuring the accessibility and appropriateness of primary care delivery.
The study was based on a determination of the functions served by the
primary care system and judgments about the roles of different catego-
ries of primary care manpower.
Entitled A Manpower Policy For Primary Health Care, the report con-
tains an introduction and summary, a definition of primary care indicating
its functions and distinctive characteristics, and background information,
policy alternatives, and proposed recommendations affecting the supply,
distribution, practice arrangements, education, and credentialing of
primary care practitioners. Appropriate time periods and responsible
groups are suggested for the implementation of each of the 20 recommen-
dations. Staff papers developed in the study are not contained in the
report but are publicly available in limited supply.
We shall be pleased to discuss this report in greater detail with
you and your colleagues in The Robert Wood Johnson Foundation.
Cordial ly,
3~ ~t ~ ~
Enclosure
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I NSTITUTE OF MEDICIN E
NATIONAL ACADEMY OF SCIENCES
2101 CONSTITUTION AVENUE WASHINGTON, D. C. 20418
DAVID A. HAMBURG, M.D.
PRESIDENT
Enclosure
May 7, 1978
Russell G. Mawby, Ph.D.
President
W. K. Kellogg Foundation
400 North Avenue
Battle Creek, Michigan 49016
Dear Dr. Mawby:
I am pleased to present to the W.K. Kellogg Foundation the final
report of the Study to Develop an Integrated Manpower Policy for Primary
Care, conducted by the Institute of Medicine of the National Academy of
Sciences. The study was undertaken with the foundation's generous sup-
port to formulate a cohesive health manpower policy for assuring the
accessibility and appropriateness of primary care delivery. The study
was based on a determination of the functions served by the primary care
system and judgments about the roles of different categories of primary
care manpower.
Entitled A Manpower Policy For Primary Health Care, the report
contains an introduction and summary, a definition of primary care
indicating its functions and distinctive characteristics, and background
information, policy alternatives, and proposed recommendations affecting
the supply, distribution, practice arrangements, education, and creden-
tialing of primary care practitioners. Appropriate time periods and
responsible groups are suggested for the implementation of each of the
20 recommendations. Staff papers developed in the study are not con-
tained in the report but are publicly available in limited supply.
We shall be pleased to discuss this report in greater detail with
you and your colleagues in the W.K. Kellogg Foundation.
Cordially,
An-- ~ ~
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INSTITUTE OF MEDICINE
Division of Health Manpower and Resources Development
STEERING COMMITTEE
Chairman
Ee Harvey ESTES, M.D., Professor and Chairman, Department of Community
and Family Medicine, Duke University Medical Center, Durham
Members
H. David BANTA, M.D., M.P.H., United States Congress, Office of Tech-
nology Assessment, Washington, D.C.
Douglas A. FENDERSON, Ph.~., Director, Continuing Medical Education,
University of Minnesota, Minneapolis
A. Alan FISCHER, M.D., Professor and Chairman, Department of Family
Medicine, Indiana University School of Medicine, Indianapolis
Loretta C. FORD, R.N., Ed.D., Dean and Director of Nursing, University
of Rochester Medical Center, Rochester
Charles A. JANEWAY, M.D., Physician-in-Chief, Emeritus, Children's
Hospital Medical Center, Boston
Charles E. LEWIS, M.D., Sc.D., Professor of Medicine, Public Health and
Nursing, Department of Medicine, UCLA School of Medicine, Los Angeles
Patricia A. McATEE, Ph.D., University of Colorado School of Medicine,
Department of Pediatrics, Denver
J. Warren PERRY, Ph.D., Dean and Professor, School of Health Related
Professions, State University of New York at Buffalo
Charles H. RAMMELKAMP, Jr., M.D., D.Sc. (Hon.), Director, Department of
Medicine, Cleveland Metropolitan General Hospital, Cleveland
David J. SANCHEZ, Jr., Ph.D., Assistant Professor of Ambulatory and
Community Medicine, San Francisco General Hospital, San Francisco
Continued
vii
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John B.TURNER, D.S.W., Kenan Professor of Social Work, University of
North Carolina, Chapel Hill
David G. WARREN, J.D., Professor of Health Administration, Department of
Health Administration, Duke University, Durham
Jerry L. WESTON, R.N., Sc.D., Nurse Director, Division of Extramural
Research, National Center for Health Services Research, Hyattsville
viii
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INSTITUTE OF MEDICINE
DAVID A. HAMBURG. M.D., President
Division of Health Manpower and Resources Development
Project Staff
Richard M. Scheffler, Ph.D., Division Director and
Project Director
Gloria Ruby, M.A.,
Research Associate
Neil Weisfeld, J.D., M.S.Hyg., Research Associate
Juliana Goldberg, M.A.
, Editor
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ACKNOWLEDGEMENTS
Many individuals and organizations assisted the committee and staff
in preparing this report and in offering valuable comments in earlier
drafts. Some of them whom I would like to acknowledge especially are
listed below.
A special thanks to Ouida Upchurch who was the study director until
September 1, 1977. She was largely responsible for the interim report,
A Definition of Primary Care (reproduced as part of Chapter 2 of this
some of the staff papers.
Sunny Yoder provided substantive and editorial comments on the final
draft of the report.
Thomas Delbanco, a Robert Wood Johnson Health Policy Fellow, Jack
Hadley of the Urban Institute, and Lauren LeRoy of the University of
California at San Francisco Health Policy Program provided useful com-
ments on the initial draft of the report.
Jon Gabel and William S. Sobaski of the Health Care Financing
Administration of the Department of Health, Education, and Welfare (DHEW)
consulted with the staff on reimbursement issues. The National Center
for Health Statistics, DREW, provided special tabulations from The
National Ambulatory Medical Care Survey.
Dr. Howard Stambler, Chief of the Manpower Analysis Branch, Office
of Program Development of the Bureau of Health Manpower, DREW, offered
important data and information on health manpower.
To Linda Depugh and Dawn Gustafson, I would like to express a deep
appreciation for their patience and hard work in the preparation and
typing of the report.
Richard M. Scheffler
Division Director and
Project Director
X1
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