Health work force panel awaits funding from Congress

Washington -- Republicans in Congress want to defund as much of the national health system reform law as possible, but they won't have to pull the funding from the National Health Care Workforce Commission. That's because it was never funded in the first place.

The commission was created to advise Congress and the White House on how to use federal resources and adjust federal policies to ensure that the supply of health professionals meets the nation's needs, especially in the next 10 to 25 years. The law also instructed the panel to help coordinate federal and state work force efforts.

The U.S. comptroller general appointed the panel's 15 members in September 2010, as required by the health reform law, but the commissioners have never met or hired staff because they lack the necessary funds. The commission's first report was due April 1, but instead the panel sent a letter to Congress, said Sheldon Retchin, MD, MSPH, the commission's vice chair and CEO of Virginia Commonwealth University Health System.

Dr. Retchin said bipartisan support for the commission exists. "Everybody would like to see oversight and a national resource on health care work force policy."

He still occasionally talks to the commission's chair, Peter Buerhaus, PhD, RN, director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center in Nashville, Tenn. But Dr. Retchin is disappointed that the commission has not even begun to examine existing work force policies and training programs, much less make recommendations on how to improve them.

The American Medical Association supports the purpose of the commission. "The AMA encourages the commission to take a hard look at solutions to meet work force needs and keep physicians caring for patients," said AMA President Cecil B. Wilson, MD. "The AMA supports measures including additional residency slots to train physicians in needed specialties and regions, incentives for those practicing in areas of need, and programs to address the educational needs of physicians re-entering the profession after clinical inactivity."

Budget uncertainty

President Obama included $3 million for the commission in his fiscal year 2012 budget request. But Congress is in the middle of a series of budget fights that could last at least until the next congressional and presidential elections in November 2012. The Republican-controlled House and Democratic-controlled Senate are drafting their fiscal 2012 appropriations bills, which will fund the government beginning Oct. 1.

In late 2009, the Medicaid and CHIP Payment and Access Commission faced a dilemma similar to the work force commission's. The CHIP Reauthorization Act of 2009 created MACPAC but provided no funding. The group began its work after the health reform law included $11 million for MACPAC to hire staff and cover other expenses. None of MACPAC's or the commission's board members are paid salaries.

But now Republicans are looking for ways to reduce spending. Funding for commissions and other elements of the health reform law are targets for the belt-tightening.

Rep. Mike Burgess, MD (R, Texas), said Congress needs to have a discussion about the nation's health care work force. He advises GOP members of the House Energy and Commerce Committee on health care issues, but he doesn't plan to lobby other members to fund the work force commission.

"I don't know whether the funding will occur for this board or not," he said. The panel might be better balanced if it had more practicing physicians and residents and fewer academics, he said.

The commission is not the only group examining health care work force issues. The National Center for Health Workforce Analysis at the federal Health Resources and Services Administration is a data-gathering group designed to supply the commission with information needed to make policy decisions, said Edward Salsberg, director of the national center. For example, the center is working with states to develop a better estimate of the number of practicing health professionals and the number of hours they work each week, he said.

"Our agenda is pretty clear with or without the commission. National policy would probably be better informed with the commission," Salsberg said.

The Assn. of American Medical Colleges tracks health care work force developments. The AAMC estimates that the U.S. will have a deficit of 90,000 physicians by 2020, said AAMC Senior Legislative Analyst Tannaz Rasouli, MPH. Medical schools have been increasing class sizes, but they are experiencing bottlenecks at the residency level.