	Background

An adequate supply of health care professionals is necessary to ensure  access to needed health care services. HRSA estimated that there were  approximately 780,000 physicians and 261,000 physician assistants and  advanced practice registered nurses engaged in patient care in 2010. At the federal level, HRSA is responsible for monitoring the supply of and  demand for health care professionals and disseminating workforce data  and analysis to inform policymakers and the public about workforce  needs and priorities. To meet this responsibility, HRSA conducts and  contracts for health care workforce research to document and project  shortages and to examine trends that influence the supply and distribution  of health care professionals, as well as the demand for their services. HRSA Has Taken Some Actions to Update National Projections, but Has Failed to Publish New Reports Since 2008

Since its last published report on physician supply and demand in 2008,  HRSA has initiated work to produce new workforce models and reports,  but has not published any new reports containing national workforce  projections. Given that HRSA’s 2008 report was based  on 2000 data, the most recent projections available from HRSA to  Congress, researchers, and the general public to inform health care  workforce policy decisions are based on data that are more than a  decade old. From 2008 to 2012, HRSA awarded five contracts to three  research organizations to update or create new workforce projection  models, generate new national workforce projections, and produce  reports. HRSA attributed the delay in publishing the clinician specialty report to  data challenges and modeling limitations. HRSA officials said that the agency does not have a standard written  work plan or set of procedures for accomplishing the tasks necessary to  prepare a report for publication after final reports are delivered from  contractors. Without  standard procedures, agency officials may not be able to accurately  predict how long products will take to review or to monitor their progress  through the review process to ensure they are completed in a timely  manner. While HRSA created a timeline for  publishing new projection reports in 2012, the agency has since revised  its timeline to postpone publication of two other health care workforce  reports after failing to meet its December 2012 publication goal for a  clinician specialty report projecting the supply of and demand for health  care professionals through 2025. Recommendations

We recommend that the Administrator of HRSA take the following three  actions:
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. Develop tools for monitoring the progress of projection reports through  the review process to ensure that HRSA’s timeline goals for  publication are met.
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.

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.

What GAO Recommends

GAO recommends that the Administrator of HRSA expedite the review and publication of HRSAs 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 GAOs recommendations and provided technical comments.