Objective 1.5: Bolster the health workforce to ensure delivery of quality services and care

HHS supports strategies to bolster the health workforce to ensure delivery of quality services and care.  HHS is committed to facilitating coordinated efforts to address long-standing barriers to strengthening the health workforce.  HHS efforts focus on developing professional development opportunities to learn and use new skills to improve the delivery of quality services and care.  HHS is also strengthening the integration of culturally- and linguistically-appropriate and effective care into the services delivered by the health workforce.  

Objectives represent the changes, outcomes and impact the HHS Strategic Plan is trying to achieve.  This objective is informed by data and evidence, including the information below.

• HHS has classified more than 6,000 areas across the country as primary care Health Professional Shortage Areas (HPSAs).  HPSAs can be geographic areas, populations, or facilities that have a shortage of primary, dental, or mental healthcare providers.  Approximately 121 million people in the United States live in a HPSA for mental health, with an estimated 6,500 additional practitioners needed to meet the demand.  The nation also faces a shortage of more than 10,000 dental health providers to care for approximately 60 million people lacking dental health coverage.  (Source: Health Workforce Strategic Plan)
• At a national level, by 2025, demand is expected to exceed supply for several critical health professions, including primary care practitioners, geriatricians, dentists, and behavioral health providers, including psychiatrists, mental health and substance abuse social workers, mental health and substance use disorder counselors, and marriage and family therapists.  (Source: FY 2022 Annual Performance Plan and Report - Goal 1 Objective 4)
• Demand for long-term direct care workers (Nursing Assistants, Home Health Aides, Personal Care Aides and Psychiatric Assistants/Aides) will continue to increase nationally in all four occupations through 2030.  (Source: Long-Term Services and Supports: Direct Care Worker Demand Projections 2015-2030)
• In 2020, one in three National Health Service Corps clinicians served in a rural community.  (Source: Building Healthier Communities)  
• By 2030, in rural areas, demand for general surgeons is projected to exceed supply by at least 20 percent and demand for psychiatrists is projected to exceed supply by 37 percent.  (Source: Using HRSA’s Health Workforce Simulation Model to Estimate the Rural and Non-Rural Health Workforce)
• The supply mix and adequacy of supply of women’s healthcare providers varies across states and regions.  (Source: Projections of Supply and Demand for Women’s Health Service Providers: 2018-2030)  Only six percent of obstetrician gynecologists work in rural areas, and less than half of women in rural areas live within a 30-minute drive of a hospital with obstetric services.  (Source: Health Workforce Strategic Plan)
• A review of 2019 data found, Black, Hispanic, and Native American people were underrepresented in the 10 healthcare professions analyzed (advanced practice registered nurses, dentists, occupational therapists, pharmacists, physical therapists, physician assistants, physicians, registered nurses, respiratory therapists, and speech-language pathologists).  Although the educational pipeline shows some limited improvement, underrepresentation of these groups persists.  (Source: Estimation and Comparison of Current and Future Racial/Ethnic Representation in the US Health Care Workforce)  Many disability groups also remain underrepresented in certain health professions.  (Source: Health Workforce Strategic Plan)

Contributing OpDivs and StaffDivs

AHRQ, ASPE, CDC, CMS, FDA, HRSA, IHS, OASH, OGA, and SAMHSA work to achieve this objective.

HHS OpDivs and StaffDivs engage and work with a broad range of partners and stakeholders to implement the strategies and achieve this Objective.  They include: the Advisory Committee on Interdisciplinary Community Based Linkages, Advisory Committee on Training in Primary Care Medicine and Dentistry, and Council on Graduate Medical Education, National Advisory Council on the National Health Service Corps, and National Advisory Council on Nursing Education and Practice.

Strategies

Facilitate coordinated efforts to address long-standing barriers to strengthening the health workforce

• Fully implement the HHS Health Workforce Strategic Plan to expand the health workforce supply to meet evolving community needs, while strengthening and diversifying the health workforce, improve the distribution of the health workforce to reduce shortages, enhance healthcare quality through professional development, collaboration, and evidence-informed practice, and promote evidence-based healthcare practice.

This plan, defines the health workforce as follows: the occupations include all healthcare providers with direct patient care and support responsibilities, such as: physicians (including primary care physicians, preventive medicine physicians, and specialty physicians), nurses, nurse practitioners, optometrists, physician assistants, pharmacists, dentists, dental hygienists, and other oral healthcare professionals, allied health professionals, doctors of chiropractic, community health workers, healthcare paraprofessionals, direct support professionals, psychologists and other behavioral and mental health professionals (including substance abuse prevention and treatment providers), social workers, physical and occupational therapists, certified nurse midwives, podiatrists, the EMS workforce (including professional and volunteer ambulance personnel and firefighters who perform emergency medical services), licensed complementary and alternative medicine providers, integrative health practitioners, public health professionals, and any other health professional that the Comptroller General of the United States determines appropriate.

Develop and promote opportunities to learn and use new skills to improve the delivery of quality services and care

• Engage multilaterally and bilaterally, including through policy leadership and technical expertise, to advance global efforts to protect and invest in the health workforce.
• Partner with states to develop an access strategy to ensure ample high-quality providers to serve Medicaid and the Children’s Health Insurance Program (CHIP) beneficiaries.
• Strengthen the capacity of community health workers (CHWs), community health aid programs (CHAPs), community health representatives (CHRs) to promote access to services, improve the quality and cultural competence of service delivery, and improve health outcomes by establishing partnerships with other federal departments to encourage use of CHWs in community response.
• Partner with healthcare organizations, community partners, and other stakeholders to strengthen training to ensure the healthcare workforce can proactively deliver accessible tailored care to people with disabilities.
• Provide support and training at the local level for increased use and availability of community emergency medical services workforce to reduce the use of 911 for routine care, reduce the strain on emergency rooms, and mitigate the spread of the Coronavirus Disease 2019 (COVID-19) and other infections.
• Develop and disseminate resources and support convenings to help the health workforce increase its understanding of and access to evidence-informed best practices that improve quality of care and outcomes.
• Support national standards for state, tribal, and local health departments.
• Support academic degree programs and research training opportunities in occupational health nursing, occupational medicine, and related areas to provide qualified personnel to work in industry, labor, academia, and government to improve occupational health and safety for the U.S. workforce.

Strengthen the integration of culturally- and linguistically-appropriate and effective care into the services delivered by the health workforce

• Partner with states, Federally Qualified Health Centers (FQHC), clinics, colleges, universities, and schools, other community based organizations and the private sector to ensure the health workforce is appropriately and adequately trained with culturally-appropriate, evidence-based strategies and education modules for addressing systemic bias and racism, ableism, ageism, and transphobia to reduce health disparities in the communities they serve.
• Coordinate with grant recipients and other funded partners to support training, technical assistance, and use of the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in health and healthcare and cultural humility as foundations for effective and equitable provision of healthcare.
• Promote equity and inclusion, including as it relates to race, ethnicity, disability, gender, gender identity, and sexual orientation, in global commitments, resolutions, and strategies affecting the global health workforce.

Performance Goals

The HHS Annual Performance Plan provides information on the Department’s measures of progress towards achieving the goals and objectives described in the HHS Strategic Plan for FY 2022–2026.  Below are the related performance measures for this Objective. 

• Percent of clinical training sites that provide interprofessional training to individuals enrolled in a primary care training program
• Percent of individuals supported by the Bureau of Health Workforce who completed a primary care training program and are currently employed in underserved areas

Learn More About HHS Work in this Objective

• Commissioned Corps of the U.S. Public Health Service (USPHS Commissioned Corps): The USPHS Commissioned Corps works on the front lines of public health.  Medical, health and engineering professionals embedded in a federal agency fight disease, conduct research, and care for patients in underserved communities across the nation and throughout the world.
• Community Health Aide Program Expansion: The Community Health Aide Program (CHAP) is a multidisciplinary system of mid-level behavioral, community, and dental health professionals working alongside licensed providers to offer patients increased access to quality care in rural Alaskan areas.
• Disease Intervention Specialists (DIS) Workforce Development: Supports 21st century outbreak response needs by expanding and enhancing frontline public health staff, conducting DIS workforce training and skills building, building organizational capacity for outbreak response, and evaluating and improving recruitment, training, and outbreak response efforts.
• Health Workforce Strategic Plan: Provides a forward-looking framework for health workforce improvements.  It facilitates coordinated and intentional efforts to address long-standing barriers to strengthening the health workforce—barriers that have been amplified by ongoing crises including COVID-19, the economic condition for lower and middle-income families, changing health impacts due to climate change, and the need to advance racial equity.  The plan features a list of HHS Healthcare Workforce programs and activities.
• IHS Recruitment and Retention Resources: Feature case studies, resources, and practical advice on how to recruit, retain and support IHS health professionals, including successful strategies from Indian health leaders to encourage communication and teamwork among staff, recognize and develop future facility leaders and empower their teams to carry out the IHS mission, and the affiliation with the Uniformed Services University for the Health Sciences (USUHS) to earn advanced degrees in the healthcare or public health fields.  In exchange, recipients fulfill a 10-year service commitment to the IHS and the U.S. Public Health Service (USPHS).
• National Health Service Corps: Builds healthy communities by supporting qualified healthcare providers dedicated to working in areas of the United States with limited access to care.
• Public Health AmeriCorps: The program will establish future public health leaders who will help local communities respond to and recover from COVID-19.  The program has two main goals: address public health needs of local communities by providing local and state-level support and focusing on health equity for communities who are underserved and provide pathways to public health careers by offering onsite experience and training, and recruiting AmeriCorps members who reflect the communities in which they will serve.
• Think Cultural Health: Through this initiative, the HHS Office of Minority Health offers online continuing education programs and other resources to promote awareness and implementation of culturally and linguistically appropriate services and the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care among health professionals, health organizations, and students.