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A health care system is only as good as the people working in it. The most valuable resource in health care is not the latest technology or the most state-of-the-art facility, but the health care professionals and other workers who are the human resources of the health care system.
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In this chapter, we discuss the nation’s three largest health professions—nurses, physicians, and pharmacists, as well as physician assistants and social workers (Table 7-1). What are the educational pathways and licensing processes that produce the nation’s practicing physicians, nurses (including nurse practitioners), pharmacists, physician assistants, and social workers? How many of these health care professionals are working in the United States, and where do they practice? Do we have the right number? Too many? Too few? How would we know if we had too many or too few? Are more women becoming physicians? Are more men becoming nurses? Is the growing racial and ethnic diversity of the nation’s population mirrored in the racial and ethnic composition of the health professions? To answer these questions, we begin by providing an overview of each of these professions, describing the overall supply and educational pathways. We then discuss several cross-cutting issues pertinent to all these professions.
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Susan Gasser entered medical school in 1997. During college, she had worked in the laboratory of an anesthesiologist, which made her seriously consider a career in that specialty. During her first year of medical school, the buzz among the fourth-year students was that practice opportunities were drying up fast in anesthesiology. Health maintenance organizations (HMOs) wanted more primary care physicians, not more specialists. Almost none of the fourth-year students applied to anesthesiology residency programs that year. Susan started to think more about becoming a primary care physician. In her third year of school, she had a gratifying experience during her family medicine rotation working in a community health center and started to plan to apply for family medicine residencies.
At the beginning of her fourth year of school, Susan spent a month in the office of a suburban family physician, Dr. Woe. Dr. Woe frequently remarked to Susan about the pressures he felt to see more patients and about how his income had fallen because of low reimbursement and higher practice expenses. He mentioned that the local anesthesiology ...