The Healthcare Professional Workforce Understanding
Human Capital in a Changing Industry
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Library of Congress Cataloging-in-Publication Data
Names: Hoff, Timothy J., 1965– , editor. | Sutcliffe, Kathleen M., 1950– , editor. | Young,
Gary J., editor.
Title: The healthcare professional workforce : Understanding human capital in a
changing industry /[edited by] Timothy J. Hoff, Kathleen M. Sutcliffe, Gary J. Young.
Description: Oxford ; New York : Oxford University Press, [2016] | Description based on
print version record and CIP data provided by publisher; resource not viewed.
Identifiers: LCCN 2016008601 (print) | LCCN 2016007431 (ebook) | ISBN
9780190215668 | ISBN 9780190215675 | ISBN 9780190215651 (pbk. : alk. paper)
Subjects: | MESH: Health Occupations—trends | Allied Health Personnel—trends |
Health Care Reform—organization & administration | United States
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Contents
Preface
Acknowledgments
Contributors
1. Introduction to the Book and the Forces Transforming the
Health Professional Workforce in the United States
Timothy J. Hoff, Kathleen M. Sutcliffe, and Gary J. Young
2. Not Your Parent’s Profession: The Restratification of Medicine
in the United States
Timothy J. Hoff and Henry Pohl
Commentary
Darrell G. Kirch
3. Transformation of the Nonphysician Health Professions
Joanne Spetz, James F. Cawley, and Jon Schommer
Commentary
Patricia M. Davidson
4. Health Professionals and Organizations—Moving Toward
True Symbiosis
Jeffrey A. Alexander and Gary J. Young
Commentary
Lynne Eickholt
5. The Paradoxes of Leading and Managing Healthcare
Professionals: Toward the Integration of Healthcare Services
Mirko Noordegraaf and Lawton Robert Burns
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Commentary
Ralph W. Muller
6. How Health Professional Training Will and Should Change
Alan Dow and Scott Reeves
Commentary
George Thibault
7. Implications of Professional Change for Health Policy,
Practice, and Management
Timothy J. Hoff, Kathleen M. Sutcliffe, and Gary J. Young
INDEX
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Preface
THE IDEA FOR this book came from our own view that much is
happening to the various health professions in the early 21st
century. This is particularly true in the United States. Nationwide
health reform, combined with continued problems of inflation,
quality, and access in the healthcare industry, has created an
everyday work environment for physicians, nurses, and other
medical professionals that upends traditional notions about what it
means to be a certain type of health professional, the types of
work and autonomy afforded various expert workers, and the
substance of professional relationships with fellow workers and
corporate organizations that now control much of American
healthcare. In these regards, and in other ways, it is a
transformative time for health professions in the United States.
This book’s motivation derives from a sense that it is an ideal time
for examining some of the important trends, issues, and
opportunities that affect health professionals. It is equally
important to analyze how these workers and contexts will evolve
into the future.
In all the upheaval around the healthcare system, the
professionals who work in it often get the least attention. This
observation points to something ironic in healthcare research,
management, and policymaking—that those individuals who
perform the bulk of the work of healthcare seem to have less
voice and command less attention than is warranted. Thus, new
payment systems are designed and implemented with little regard
for what physicians think may work to improve how they deliver
care; scopes of work for nurses and pharmacists are expanded
without much consideration of what these new opportunities mean
for their relationships with physicians, patients, and their
employers; and entire swaths of healthcare work are redesigned
for “efficiency” with less understanding of whether the
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professionals in those workflows will respond in desirable ways.
This book seeks in small part to correct this oversight. By placing
physicians, nurses, pharmacists, physician assistants, and others
center stage, we hope to encourage healthcare academics,
policymakers, practitioners, educators, and students to pay more
attention to these groups in the future.
That said, there are important realities all health professionals
face that will not go away any time soon. These realities require
both a rethinking and reexamination of important issues such as
professional training, professional belief systems, professional–
organizational alignment, professional diversity, leading
professionals, professional scopes of practice, talent management
of professionals, and interprofessional collaboration. These are
the kinds of issues addressed in this book. We are fortunate to
have contributing authors who are leading experts on the health
professions. They have done a terrific job in unpacking some of
these issues for us. Our intention is to address issues not only
critical for the present and near future, but also ones that affect
multiple professional groups in healthcare. Although the book
includes distinct chapters that focus on the medical profession
and certain types of other health professionals, the remainder of
the book discusses different issues with a variety of health
professions in mind.
If readers learn something new, or reflect differently on their
existing knowledge by reading this volume, then we believe that
our mission has been accomplished. As an incomplete dive into
the world of US health professional change, the work is not meant
as the full and final word on US health professions change.
Rather, it is a reference for moving certain existing discussions
along, for starting others, in the meantime pushing the health
professional agenda further into the mainstream of healthcare
education, policy, management, and research. We believe that
there is no more important time for thinking about health
professions than now. This means considering everything from
how we conceptualize and build theory around these expert
workers, to how we train and study them, and to how to organize
and manage their work. The book is written in an accessible way
to allow different audiences a chance to get something out of it
useful for themselves. Toward that end, we have also tried to limit
jargon, make abstract ideas more practically focused, and stay on
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point with specific themes that thread throughout the book.
Ultimately, readers can judge if we have achieved these goals.
Timothy J. Hoff
Kathleen M. Sutcliffe
Gary J. Young
February, 2016
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Acknowledgments
Every book is a labor of love, and edited books present additional
challenges of achieving coordination among different and often
very busy authors, cajoling these authors to meet tight timelines,
and then bringing the different voices together to make a coherent
whole. That said such books are not possible without the
dedication of individuals who give of their time and intellectual
capital so that a given scholarly area can be further illuminated for
a reading audience. We would like to thank all of the authors who
contributed to this volume. They are leaders in their respective
fields who thought it worthwhile to contribute around the topic of
the health professions workforce. We are all fortunate that they
made this decision.
Our academic institutions (Northeastern University, Johns
Hopkins University) also deserve sincere thanks. They both are
outstanding settings in which to engage in high-level scholarship.
The three of us benefit from being given the time and support to
develop and bring to fruition projects such as this one. Both
institutions have a rich history of training a variety of health care
professionals, so it is fitting that this volume has emanated from
these two places. As health professions continue to transform,
these universities and the others to which our co-authors belong,
as well as the professional associations and delivery systems led
by several of our commentators, will no doubt remain on the
cutting edge of innovation. That is encouraging to know.
Our debts to one another as co-editors also must be
acknowledged. A lot of time and effort was put into this work.
There were times during the process when the kinds of decisions
we had to make, the editorial imperatives, and our own writing of
chapters made compilation of the volume a complex endeavor.
However, we are optimistic that the book will make a meaningful
contribution to the field, and be an interesting read to several
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different audiences, and that feeling makes the effort we gave
worthwhile. Our colleagues at Oxford University Press, specifically
our editor Chad Zimmerman and his assistant Chloe Layman,
have been tremendous resources for us, consistently helpful, and
definitely made it much easier to pull this all together.
Finally, there are thanks which are more personal. For one co-
editor (T.H.), the constant love and support of his wife Sharon and
eight-year old son Kieran make everything in life easier and more
worthwhile. Another co-editor (K.S.) knows that none of this would
be possible without the loving patience and support of her family,
especially Tim Wintermute. The remaining co-editor (G.Y.) is
deeply thankful for the love and support of his family, wife Andrea,
and children Samantha and Spencer.
We hope readers enjoy the book, and gain something useful
from it. In preparing it, we believed (and still do) that there is
nothing quite like it right now in the scholarly marketplace. The
focus on multiple health professions, blend of different experts
writing about these various professions, and the incorporation of
important topics including training, talent management,
organizational integration, leadership, and diversity make for a
great primer on health professions change. Undoubtedly, the
volume raises more questions than it answers. But then that is our
intent—to have a work like this stimulate further dialogue around
issues to which our response as a society will shape the kind of
health care system we have for years to come.
Timothy J. Hoff
Kathleen M. Sutcliffe
Gary J. Young
July 2016
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Contributors
Jeffrey A. Alexander, PhD
Richard Carl Jelinek Professor of Health Management and Policy
Professor, Organizational Behavior and Human Resources
School of Business
University of Michigan
Lawton Robert Burns, PhD, MBA
James Joo-Jin Kim Professor
Director, Wharton Center for Health Management and Economics
The Wharton School
University of Pennsylvania
James F. Cawley, PA-C, MPH
Professor, Department of Community Health
Professor, Department of Physician Assistant Studies
Milken Institute School of Public Health
The George Washington University
Patricia M. Davidson, PhD, MEd, RN, FAAN
Professor and Dean, School of Nursing
Johns Hopkins University
Alan Dow, MD, MSHA
Assistant Vice President, Interprofessional Education and Collaborative Care
Professor, Internal Medicine
Virginia Commonwealth University
Lynne Eickholt, MBA
Chief Strategy Officer, Partners HealthCare System
Darrell G. Kirch, MD
President and Chief Executive Officer, Association of American Medical
Colleges
Ralph W. Muller, MA
Chief Executive Officer, University of Pennsylvania Health System
Mirko Noordegraaf, PhD
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Head, Utrecht University School of Governance
Professor, Utrecht University School of Governance
Henry Pohl, MD
Vice Dean for Academic Administration
Julio A. Sosa, MD, Chair of Medical Education
Albany Medical College
Scott Reeves, PhD, MSc, PGCE
Professor in Interprofessional Research at the Faculty of Health, Social Care &
Education
Kingston University & St George’s, University of London
Editor-in-Chief, Journal of Interprofessional Care
Jon Schommer, PhD
Peters Chair in Pharmacy Practice Innovation
Associate Department Head and Professor, Department of Pharmaceutical
Care and Health System
College of Pharmacy
University of Minnesota
Joanne Spetz, PhD
Professor, Institute of Health Policy Studies
Professor, Department of Family and Community Medicine
University of California, San Francisco
George Thibault, MD
President, Josiah Macy Jr. Foundation
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1
INTRODUCTION TO THE BOOK AND THE
FORCES TRANSFORMING THE HEALTH
PROFESSIONAL WORKFORCE IN THE UNITED
STATES
Timothy J. Hoff, Kathleen M. Sutcliffe, and Gary J. Young*
Introduction
In this first chapter, we discuss the myriad of sweeping
developments that are transforming the US health professional
workforce. The health professional workforce itself is both large
and diverse, comprising physicians, nurses, pharmacists,
therapists (e.g., physical therapists, speech pathologists),
dentists, podiatrists, physician assistants, and others. Based on
data compiled by the federal government’s National Center for
Health Workforce Analysis, more than 5 million individuals
currently work as health professionals in the United States
(National Center for Health Workforce Analysis, 2013). This
number is growing, and reflects an increasing diversity of jobs,
employment settings, work arrangements, training, and personal
expectations.
Both the makeup and expertise of various health professional
groups are changing as a result of various healthcare reform
initiatives, innovations in serving patients, changing patient
attitudes toward healthcare services and efforts within various
health professions to advance their specific claims to new or
evolving forms of healthcare work. Although some of the
developments that are transforming the health professions
workforce have been in motion for some time, until quite recently
the settings within which this workforce performed were relatively
stable. A variety of health professionals with circumscribed roles
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worked within well-defined patient care work domains so that little
competition for patients existed among them. For example, within
healthcare delivery organizations such as hospitals and
ambulatory care practices, the decision-making authority of
physicians for patient care was both well established and largely
unchallenged, and other health professionals functioned largely in
supporting roles. Health professionals were paid in ways that
rewarded them for “good work” that was largely centered on
patient volume rather than quality of care. Patients’ engagement
in their own healthcare was relatively limited, enabling health
professionals to largely determine when, where, and what
services should be delivered, often in a more paternalistic way.
Health professionals of all types were trained independently of
any recognition that their work should be collaborative and
interdisciplinary. Workflows within service delivery organizations
moved at a pace physicians determined.
Much has changed over the past two decades. For example,
the country’s expansive health reform law, the Patient Protection
and Affordable Care Act, has been an important catalyst for
change within the health professions, helping to accelerate trends
begun years earlier as a result of the modern quality movement,
managed care, and the growing corporatization of healthcare
delivery. Underlying key developments affecting the health
professions are noble goals—the country’s long-standing struggle
to contain healthcare costs, improve quality of care, and expand
access to healthcare services. These struggles have provoked
much soul-searching within the country in terms of what we can
and should expect from our health professionals in terms of
patient care and their own contributions to improving the system
on these different fronts. It has also unleashed structural and
cultural changes within health professional groups that require
profound reexamination such as professional training and
socialization, intraprofessional relationships, professional
autonomy, and the alignment of health professionals with
organizations.
The remainder of this chapter highlights some of the key
developments driving professional change in healthcare. It is not
intended as an exhaustive list but rather an overview of the most
important contextual issues now occurring that have an impact on
professionals.
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