In addition to extending health care coverage to millions, the Patient Protection and Affordable Care Act (PPACA) is also focused on improving the national health care workforce. The Health Resources and Services Administration (HRSA) estimates that by 2020 there will be shortages in a number of physician specialties and a need for 67,000 primary care physicians. Currently there is a 6% shortage of nurses which is expected to grow to 20% by 2020. Furthermore, 65 million Americans live in communities where they cannot access a primary health care provider and an additional 16,500 practitioners are required to meet their needs.

To address these issues, the PPACA reaffirms and expands on many programs already established by the Public Health Service Act (PHSA), but also creates new programs and activities through grants, education, training, scholarships, and loan repayment programs. Larkin Hoffman is providing a four-part series on how the PPACA intends to innovate and make changes in the workforces of physicians, nurses, dentists, geriatrics, long term care, allied, and mental and behavioral health. See July 2010 Alert for the first article in the series regarding how the PPACA will be funded.

"Innovations"
National Health Care Workforce Commission
In an effort to create a cohesive approach to the national health care workforce, the PPACA establishes the National Health Care Workforce Commission. The Commission will be comprised of 15 members including individuals from across the health care industry such as researchers, employers, and health care professionals.

The Commission will review the current workforce supply and demand, and make recommendations to Congress and the Administration on priorities, goals, and policies. The Commission will focus its efforts on recruiting, training, retaining, and educating a health care workforce to meet the current and future needs of the country.

State Health Care Workforce Development Grant Program
A competitive health care workforce development grant program is established by the PPACA to enable state partnerships to plan and develop the health care workforce at the state and local level.

Assessment of the Health Care Workforce
The Secretary of Health and Human Services (HHS) will create a National Center for Health Workforce Analysis to collect workforce statistical information and analyze and assess the nation's health care workforce. Prior to the Center, there was no advisory board that examined the health care workforce as a whole to determine distribution and needs. The National Center for Health Workforce Analysis will work closely with the National Health Care Workforce Commission.

National Health Services Corp.
The National Health Service Corp. (NHSC) provides scholarships and student loan repayment for medical students, nurse practitioners, physicians' assistants, and others who agree to serve for a period of time as a full-time primary care provider in an area that has been designated as underserved. The scholarships and loan repayment program help pay for tuition, fees, and a stipend to students enrolled in qualifying medical programs.

In an effort to expand the health care workforce, the PPACA reauthorizes the NHSC and increases the funding available for scholarships and loan repayment. Money received under the NHSC loan repayment program or under a state loan repayment or forgiveness program is excluded for income tax purposes.

Additionally, the PPACA permits health care providers to work part-time to fulfill their service requirement to encourage more providers to participate in the program. Teaching time will also now count towards fulfillment of the NHSC service requirement.

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