Will there be a doctor in the house?

Public health advocates rightfully cheered the passage of health reform in the form of the Affordable Care Act in 2010. Expanded insurance options and greater eligibility for Medicaid mean that more people will have the safety net of coverage.

But 30 million to 40 million more insured people also means more people making appointments at the doctors' offices, and, at a time when the primary care workforce is already stretched, how will we accommodate all of these new people? And as the U.S. grows more diverse, how will we find culturally and linguistically competent providers?

We'll need to be innovative, said presenters at a Tuesday session on "Who Will Serve Them? Health Workforce Shortages Under Expanded Coverage."

The current system creates too many barriers for those who wish to be health care providers, particularly if those people are licensed in their home countries, said Jose Ramon Fernandez-Pena, founder of the Welcome Back Initiative. The program, which seeks to build a bridge between internationally trained health workers living in the U.S. and the need for a culturally competent workforce, operates centers in California, Massachusetts, Rhode Island, Maryland, Texas, New York and Colorado.

"The lack of minority health professionals compounds the nation's persistent racial and ethnic health disparities," he said during his presentation.

"The Welcome Back Initiative asks 'Who were you, who are you and who do you want to be?' and we try to start rescuing pieces of their professional persona," Fernandez-Pena said.

One of the main problems faced by health professionals seeking to work in the U.S. is a lack of command of English, a problem the initiative addresses with an intensive English-as-a-second-language program aimed at medical professionals.

So far, the initiative has assisted 110 physicians to enter residency training, helped more than 3,400 validate their credentials, 1,900 pass licensing exams and 1,100 obtain licenses in their original professions, he said.

Another avenue for expanding the workforce is expanded use of nurse practitioners and physician assistants, said Catherine Dower, of the University of California–San Francisco's Center for the Health Professions.

In this area, state legislators can be important drivers of change. Studies of the variations among the jobs that nurse practitioners can do in each state showed that no two states are the same. In some, nurse practitioners have full prescribing power, while others require that they work in poorly defined "collaboration" with physicians.

This leads to a lack of clarity about who can do what as well as a lack of communication.

"People don't talk to each other when they don't know what each other can do," she said. "They're not working together in the patients' best interest."

Solutions include expanding the legal scope of practice for nurse practitioners and physician assistants, tapping into underused pools of providers, including military veterans who might have medical field experience, and expanding loan repayment programs, she said.

— C.T.