1.4: Workforce
Recruit, develop and retain a competent health care workforce. Other Information:
In the coming years, the Nation faces shortages of critical health care workers, including nurses and long-term care providers.
In addition, all health care workers will need to be flexible and responsive enough to act on new challenges and maximize
the potential of new technologies. In addition to strategies to develop its own workforce, HHS is committed to helping the
field recruit and retain, as well as train, develop, and support, a competent professional and paraprofessional health care
workforce. Among the operating and staff divisions contributing to the achievement of this objective are AoA, ASPE, CMS, HRSA,
IHS, OPHS, and SAMHSA. HHS, in the health care programs it operates, faces the same recruitment and retention challenges encountered
by health care providers nationwide. The first performance indicator measures HHS’s success in meeting its goal to recruit
and retain the Commissioned Corps members needed to provide ongoing health care. The second measures the Corps’ readiness
to rapidly respond to medical emergencies and urgent public health needs. Recruitment /Retention Efforts: Commissioned Corps.
The mission of the Commissioned Corps of the United States Public Health Service (USPHS; Commissioned Corps) is protecting,
promoting, and advancing the health and safety of the Nation. The Commissioned Corps achieves its mission through rapid and
effective response to public health needs, leadership and excellence in public health practices, and the advancement of public
health science. As one of the seven Uniformed Services of the United States, the Commissioned Corps is a specialized career
system designed to attract, develop, and retain health professionals who may be assigned to Federal, State, or local agencies
or international organizations. The Commissioned Corps will continue to offer two excellent opportunities for students through
the highly competitive Junior Commissioned Officer Student Training and Extern Program and Senior Commissioned Officer Student
Training and Extern Program. Indian Health Service. The Indian Health Care Improvement Act of 1976 (Public Law 94-437), as
amended, authorized IHS to administer interrelated scholarship programs to meet the health professional staffing needs of
IHS and other health programs serving Indian people. In addition, IHS administers a Loan Repayment Program for the purpose
of recruiting and retaining highly qualified health professionals to meet staffing needs. The Indian Health Professions Program
provides scholarships, loans, and summer employment in return for agreements by students to serve in health facilities serving
American Indians and Alaska Natives in medically underserved areas. As a matter of law and policy, IHS gives preference to
qualified American Indians in applicant selection and in career development training. National Health Service Corps. Currently,
35 million people live in communities without adequate access to primary health care because of financial, geographic, cultural,
language, and other barriers. Since its inception, the National Health Service Corps (NHSC), managed by HRSA, has placed more
than 27,000 primary care clinicians, including dental, mental, and behavioral health professionals, in underserved areas across
the country including communities with Health Centers. In FY 2007, field strength for the NHSC is estimated to be more than
3,400 people. Approximately half of NHSC clinicians are assigned to service in Health Center sites. Nurses. The Bureau of
Labor Statistics estimates that by 2020 the Nation will have a shortfall of up to 1 million nurses, which includes new jobs
and “replacement” jobs that are open when today’s nurses retire and leave the field. As the population continues to grow and
age and medical services advance, the need for nurses will continue to increase. A report developed by HHS, What is Behind
HRSA’s Projected Supply, Demand, and Shortage of Registered Nurses, predicted that the nursing shortage is expected to grow
to more than 1 million by 2020. In 2007, HHS nursing programs will support recruitment, education, and retention of nursing
students, emphasizing new loan repayments and scholarships. Workforce Support Efforts: Cultural Competence. OPHS’s OMH is
mandated to develop the capacity of health care professionals to address the cultural and linguistic barriers to health care
delivery and increase access to health care for people with limited English proficiency. The Center for Linguistic and Cultural
Competence in Health Care was established in FY 1995 as a vehicle to address the health needs of populations with limited
English proficiency. National Standards on Culturally and Linguistically Appropriate Services. These standards have been developed
and are primarily directed at health care organizations; however, individual providers also are encouraged to use the standards
to make their practices more culturally and linguistically accessible. The principles and activities of culturally and linguistically
appropriate services should be integrated throughout an organization and undertaken in partnership with the communities being
served. The standards are organized by three themes: Culturally Competent Care, Language Access Services, and Organizational
Supports for Cultural Competence. Mental Health and Substance Use Disorders Prevention and Treatment. SAMHSA supports efforts
to identify and articulate key workforce development issues in the mental health and substance use disorders prevention and
treatment fields and to encourage the retention and recruitment of an effective compassionate workforce. These efforts include
support for programs that train behavioral health professionals to work with underserved minority populations, training for
mental health and substance abuse providers, and leadership training programs. Support to Family Caregivers. The National
Family Caregiver Support Program, developed by AoA, calls for all States working in partnership with local area agencies on
aging, faith- and community-service providers, and tribes to offer five direct services that best meet the range of family
and informal caregivers’ needs: information about available services; assistance in gaining access to supportive services;
individual counseling, organization of support groups, and training to assist caregivers in making decisions and solving problems
relating to their roles; respite care to enable caregivers to be temporarily relieved from their caregiving responsibilities;
and supplemental services, on a limited basis, to complement the care provided. Direct Support Workforce. To address the emerging
“care gap” between the number of long-term care workers and growing demand, providers, policymakers, and consumers are likely
to consider a broad range of strategies: improving wages and benefits of direct care workers, tapping new worker pools, strengthening
the skills that new workers bring at job entry, and providing more relevant and useful continuing education and training.
A key strategy in this mix will be a focus on workforce development—providing workers with the knowledge and skills they need
to perform their jobs. In addition, ASPE and its partners in and outside HHS are engaged in a series of research projects
aimed at more accurately enumerating the long-term care workforce, describing the types of tasks performed and assessing the
impact of workforce development programs.
Indicator(s):
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