Innovations and Experiments in Uses of Health Manpower. The Effect of Licensure Laws

Abstract

Present trends indicate that growth in the output of personal health services will exceed the growth in population.' At the same time, the relative and absolute physician shortage will, in all probability, continue to deteriorate.2 These apparently contradictory predictions are evidence of fundamental problems confronting personal health care delivery systems. To understand this paradox it is necessary to examine the nature and distribution of available personal health care. Such an examination reveals that there is a national crisis in the provision of medical care, characterized by spiraling costs, inadequacies in services rendered to the disadvantaged, and widespread discontent with the restricted availability of professional health services despite greater numbers of health workers and more medical facilities per capita than ever before.3 In part, these shortages and higher costs may be traced to a lack of skilled health personnel.4 But they also reflect to an important degree the extraordinarily inefficient manner in which existing health manpower resources are currently used.5 Organizational changes must be made in the health care delivery system. Until such changes are accomplished, health care will cost more than it should, and it will not be possible to estimate with accuracy the need for additional health manpower in the future.6 As medicine develops new methods of treatment requiring specialized skills, innovations in functions for existing health personnel must be authorized, and