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Health Care Workforce: HRSA Action Needed to Publish Timely National Supply and Demand Projections

GAO-13-806 Published: Sep 30, 2013. Publicly Released: Oct 30, 2013.
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What GAO Found

Since 2008, the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) has awarded five contracts to research organizations to update national workforce projections, but HRSA has failed to publish any new reports containing projections. As a result, the most recent projections from HRSA available to Congress and others to inform health care workforce policy decisions are from the agency's 2008 report, which is based on data that are more than a decade old. While HRSA created a timeline for publishing new workforce projection reports in 2012, the agency missed its goal to publish a clinician specialty report by December 2012 projecting the supply of and demand for health care professionals through 2025. HRSA officials attributed the delay in publishing this report to data challenges and modeling limitations. HRSA has also revised its timeline to postpone publication of two other health care workforce reports, as shown in the table below. HRSA officials said that the agency does not have standard written procedures for preparing a report for publication after final reports are delivered from contractors, which may impede its ability to accurately predict how long products will take to review and monitor their progress through the review process.

Why GAO Did This Study

For over a decade, government, academic, and health professional organizations have projected national shortages of health care professionals, which could adversely affect patients' access to care. However, there is little consensus about the nature and extent of future shortages, partly because of the complexity of creating projections and uncertainty about future health care system changes. Up-to-date workforce estimates are essential given the significant federal investment in health care training programs. Within HHS, HRSA is responsible for monitoring health care workforce adequacy; to do this, HRSA conducts and contracts for workforce studies.

GAO was asked to provide information about health care workforce projections. This report examines the actions HRSA has taken to project the future supply of and demand for physicians, physician assistants, and advanced practice registered nurses since publishing its 2008 report. GAO reviewed HRSA's contract documentation, select delivered products, and timeline goals for publication. GAO also interviewed HRSA officials, workforce researchers, and provider organizations.


GAO recommends that the Administrator of HRSA expedite the review and publication of HRSA’s report on national projections for the primary care workforce, create standard written procedures for report review, and develop tools to monitor report review to ensure timeline goals for publication are met. HHS agreed with GAO’s recommendations and provided technical comments.

Recommendations for Executive Action

Agency Affected Recommendation Status
Health Resources and Services Administration The Administrator of HRSA should expedite the review of the report containing national projections to 2020 for the primary care workforce to ensure it is published in the fall of 2013 in accordance with HRSA's revised timeline.
Closed – Implemented
On November 27, 2013, HRSA published and released a report entitled Projecting the Supply and Demand for Primary Care Practitioners Through 2020.
Health Resources and Services Administration The Administrator of HRSA should create standard written procedures for completing the tasks necessary to review and publish workforce projection reports delivered from contractors; such procedures may include a list of necessary review steps, estimates of how long each step should take to complete, and designated internal and external reviewers.
Closed – Implemented
In November 2013, HRSA created a Framework for Reports Development that outlines the stages of report development and key tasks associated with each. Along with its framework, it developed two other documents --Standard Procedures for Reports Development and Reports Development Overview--that contain standard operating procedures and identify the stakeholders for each stage of the report development process and estimate how long their reviews will take. According to HRSA, senior staff members have been trained on the framework and procedures; and in June 2014, HRSA said that the framework and procedures have been used for three reports, one published and two that are forthcoming. HRSA also said that the office responsible for conducting and contracting for studies on the supply of and demand for health care professionals had developed a review process specific to workforce analyses and projections contracts and reports, which was in use for several of its briefing reports that were in progress as of June 2014.
Health Resources and Services Administration The Administrator of HRSA should develop tools for monitoring the progress of projection reports through the review process to ensure that HRSA's timeline goals for publication are met.
Closed – Implemented
HRSA developed a computer-based tool for monitoring the progress of reports through the review process. The Reports Calculator tool, accessible to staff on HRSA?s website as of November 2013, is used to make projections on the length of time HRSA and HHS review will take, as well as monitor reports through the clearance and approval stages. As of June 2014, HRSA said that this tool has been used for 3 reports, one published and two others that were forthcoming.

Full Report

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