Health personnel: the challenges ahead

The interrelations between the changing supplies of health professional personnel and the evolving health care system have been conspicuously underresearched and underevaluated. In part this reflects the relative independence of the two sectors--health education and training, and health services--in ambulatory and hospital settings. In part it reflects the strong guild arrangements that make it difficult for health care managers to exercise much initiative/discretion in developing new patterns of personnel utilization aimed at greater efficiency and economy. Considering the fact that personnel costs account for about 60 percent of all health care costs, this relative neglect of improved personnel utilization is that much more costly. This article sets out the major dimensions of the three critical personnel groups--physicians, nurses, and allied health workers--and reviews the forces affecting their numbers and utilization. Finally, it raises some issues related to the near- and middle-term changes that lie ahead.