ON THE HORIZON
OUR CHANGING HEALTH WORKFORCE: WHAT'S NEXT?
In the coming years, the health workforce will continue to grow and change to meet ever expanding demands. The growing elderly population, a group with greater than average health care needs, is increasing the demand for health services, especially for home health care and nursing and personal care, and advances in medical technology are improving the survival rates of severely ill and injured patients, increasing their need for extensive therapy..
The fastest growth sector is expected to be non-hospital-based health care workers, such as medical assistants and personal care aides who are working in nursing homes and home-based settings. Because of cost pressures, hospitals and many health facilities have adjusted-and will continue to adjust-their staffing patterns to lower bottom-line labor costs. Where patient care demands and outside regulations allow, certain institutions will substitute lower-paid providers and cross-train their workers.
Although reports from the early 1990s suggest that the overall physician supply will exceed the number of physicians needed in the coming years, the nature and extent of any physician surplus continues to be debated. [See the "Who Knows" section] Some experts argue that, because the number of physicians in training has leveled off and is likely to decrease during the next few years, the effects of any physician oversupply will be alleviated. In fact, some predict that a physician shortage may exist because future physicians may be more likely to work fewer hours, retire earlier, have lower earnings, or to practice in medically underserved areas.
Despite the increased pharmaceutical needs of a larger and older population and greater use of medication, employment of pharmacists is not expected to grow significantly in the near future due to the lack of training program capacity. The number of community pharmacists needed in the future likely will depend on the expansion rate of chain drug stores and the willingness of insurers to reimburse pharmacists for providing clinical services to patients who take prescription medications. Nearly all pharmacy programs now grant a doctoral degree that allows pharmacists to become more involved in drug therapy decision-making and patient counseling. Fast job growth is expected for pharmacists who are trained in research, disease management and pharmacoeconomics-determining the costs and benefits of different drug therapies. New opportunities for pharmacists appear particularly promising in managed care settings where the profession increasingly is being employed to analyze trends and patterns in medication use for their patient populations. Slower employment growth is expected in traditional chain and independent pharmacies and also in hospitals.
Finally, the significant increase in the number of non-physician clinicians (NPCs) and the amount of health care they deliver are having a profound effect on the delivery of basic health services. NPCs include nurse practitioners, certified nurse midwives, physician assistants, optometrists, podiatrists and nurse anesthetists, as well as practitioners in "alternative" or "complementary" disciplines such as chiropractic, naturopath, and acupuncture. Many workforce experts believe that the growth in both supply and demand for NPCs, although presenting new opportunities for increased collaboration and interdisciplinary practice, is likely to dampen demand for physician services, particularly in managed care settings.
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