STATE LEGISLATURES MAGAZINE | JUNE 2014
“I come from the heartland where the creative use of limited health care resources is just the way we do business.”
Dr. Mary Wakefield is the administrator of the Health Resources and Services Administration. She came from the University of North Dakota, where she directed the Center for Rural Health. She has served as director of the Center for Health Policy, Research and Ethics at George Mason University and has worked with the World Health Organization’s Global Programme on AIDS in Geneva, Switzerland. She is a fellow in the American Academy of Nursing and was elected to the Institute of Medicine of the National Academies. A native of North Dakota, Wakefield holds a doctoral degree in nursing from the University of Texas.
STATE LEGISLATURES: Is there a shortage of health care providers in our future?
DR. MARY WAKEFIELD: The Health Resources and Services Administration recently released a report projecting a shortage of about 20,400 primary care physicians in 2020. The overall growth in the U.S. population and the aging of the U.S. population are increasing the demand for health care services. And, to a far lesser extent, but still important, more people having health insurance coverage will also increase demand. Likely this will be lessened as primary care nurse practitioners and physician assistants are more fully integrated into health care delivery. Of course, national data masks substantial distribution shortages that exist across the country.
SL: What is the federal government doing about the possible shortages?
MW: The president’s budget for fiscal year 2015 supports increasing the number of primary care physicians by 13,000 by 2020 and expanding the National Health Service Corps from an annual field strength of 8,900 to 15,000. The president’s budget request also contains provisions to expand the number of primary care providers and place them in communities most in need of them. Decades of data tell us that strong primary care improves health and decreases use of expensive emergency rooms and hospitalizations.
SL: What can state policymakers do to address future shortages?
MW: One of the nation’s best tools for addressing maldistribution of our primary care workforce is the National Health Service Corps. This program recruits and retains primary care providers—doctors, dentists, psychologists and others—to work in underserved communities by offering scholarships or loan repayments for their medical educational costs. The program also has a very important component for states to participate in. The service corps’ State Loan Repayment Program allows states to receive federal matching funds to support an array of clinicians who are most needed in the state. Also, states control licensing laws of providers and related scope-of-practice provisions, which can significantly expand access to health care services.
SL: How is the federal government working with states to find solutions?
MW: In addition to the National Health Service Corp, the Maternal and Child Health Block Grant program allows states to support workforce development, especially of maternal and child health providers.
We also work with states on the problem of provider shortages and maldistribution of providers in rural areas with both funding and technical assistance to create a focal point for rural workforce issues within each state. In addition, many of the State Offices of Rural Health are co-located with their Primary Care Offices and work together on shortage designation and scholarship and loan forgiveness programs. Also, state Offices of Rural Health often work with the Rural Recruitment and Retention Network, which links clinicians looking to practice in rural areas with rural clinical sites in need of providers.
SL: What is the most important strategy in recruiting and retaining health care workers in rural or frontier areas?
MW: The most important strategy is to recruit the next generation of health care providers from rural areas and to help those who commit to serving in rural and frontier areas pay for their education. Data tell us that providers who are from or have trained in rural communities more often choose to work in rural communities. And about 85 percent of National Health Service Corps clinicians continue to work in underserved communities for up to two years after they have completed their service commitment. Furthermore, 55 percent of all service corps clinicians remain in service to the underserved 10 years after completing their commitment.
SL: What is your agency doing to help alleviate gaps in the availabiliity of behavioral health providers?
MW: We know that behavioral health care services are as important as primary care services. Consequently, we are working to make both as easily accessible to individuals and families as possible. For example, this year, HRSA is investing $50 million to expand access to behavioral health services through our network of community health centers. These funds will be used to support the hiring of new behavioral health providers to work alongside of physicians, nurse practitioners, dentists and others. And, through another new initiative, we will be supporting the training of more psychologists, clinical social workers, and marriage and family therapists, including paraprofessional training through community colleges.
SL: How can we train our future providers in the most efficient, cost-effective way?
MW: A number of our training and delivery programs are focusing sharply on team-based care. These include Accountable Care Organizations and Patient-Centered Medical Homes. In part, they are designed to decrease fragmented care and increase seamlessly coordinated care across both providers and settings.The president’s FY 2015 budget includes an initiative that emphasizes training physicians in community-based care settings where most Americans receive the majority of their health care services.
SL: How will we know what’s most effective?
MW: As we move forward, testing and advancing new health care models will be important. For example, 25 states will receive up to $300 million through the State Innovation Models initiative to support the development and testing of state-based models for payment and health care delivery system transformation. These funds will allow states to test and evaluate home-grown solutions to state and local health challenges.
SL: What excites you most about health care in America right now?
MW: The U.S. health care system has a rich array of strengths, but ample opportunities also exist to increase the value of our services. While change can be unsettling for some, the opportunity to provide better health care to more Americans in ways that are efficiently delivered is exciting. Much of the transformation at the state and federal levels will appropriately place greater emphasis on preventing illness in the first place, harnessing strategies that help people to remain healthy and effectively managing chronic illnesses.
SL: What might our future health care system look like?
MW: From health care delivered in patients’ homes and clinics harnessing health information technology to training institutions advancing interprofessional courses and state legislators considering their key role in health care policy—much of the work that is well underway in many settings will transform the future. I come from the rural heartland where partnerships and the creative use of limited health resources are just the way we do business. Necessity is the mother of invention. And so it is necessary that we use what we already know and combine it with what we are learning every day to strengthen health care and build a healthier nation.
Editor’s note: This interview is part of a series of conversations with national leaders. It has been edited for length and clarity. The opinions are the interviewee’s and not necessarily NCSL’s.