There has been a sudden rash of media reports about regional workforce shortages in American hospitals, clinics and rural communities. Some are calling it a crisis. Is that going too far?

I don’t think there’s much question that we’re looking at a crisis scenario, but it really does depend on where you live. One of the big mistakes that experts have made in trying to estimate the workforce supply over the years is that they’ve usually averaged it across the nation. They’ve run the numbers based on overall physician-to-patient ratios, for example, and concluded, ‘Well, this looks good; we have plenty of doctors, or dentists or nurses.”

But that really doesn’t tell us much if two-thirds of the clinicians in a given health profession are based in big medical centers in Boston, Philadelphia, Chicago, San Francisco, Denver, and Dallas — while the rest of the country goes without. And even where there appear to be adequate numbers of providers, some folks don’t have access to them because of poverty, lack of health insurance, etc.

What’s the consequence of our inability to describe the health professions workforce?

You’re just not getting an accurate picture. We wind up with denial in some places that there’s a problem, while people are crying out that they can’t find a doctor. So there is a lag in recognition that these might be leading indicators — until it’s too late. In the health professions, that’s been the historic pattern. This isn’t the first time this has happened, although it remains to be seen if this is the worst one we’ve faced.

The average person reading this might say, a shortage of a million nurses by 2025 — or 100,000 doctors — is kind of hard to miss. How did it reach this stage?

Well, certainly HRSA saw this coming a long time ago. But part of the historic pattern, and it’s a legitimate question, is whether state governments aren’t better situated to mind their own stores — at least in theory — to fund their own university systems and scholarship programs in the health professions.

Some state legislatures have done a fairly good job of monitoring their workforces. But other states face much bigger challenges...much tighter budgets. Frankly, the best data available in some regions of the country are largely anecdotal — which is a nice way of saying, there isn’t much hard evidence we can point to.

So what’s the current best guess, if you will?

When you have 49 million Americans without health care, and 20 states reporting significant health care workforce shortages, it’s not a subtle academic discussion anymore. And none of them, as we’ve seen in recent months, are well-positioned to deal with the huge economic and demographic shifts they’re now facing.

Most folks in the health care system understand now that we have a serious problem, because it’s begun to reach into places that have not traditionally been affected by this before. I’m usually the eternal optimist, but in this case I really do believe we’ve waited too long.

We need to do something now — right now — to have any hope of turning this around by the time the Baby Boomers hit the system in large numbers.