Health Professionals Training in the Era of the Patient Protection and Affordable Care Act (P.L. 111-148): Educating to Meet Workforce Demands

The 2010 Patient Protection and Affordable Care Act (P.L. 111-148) (PPACA) heralds new challenges for the education of health professionals and the development of a healthcare workforce primed to meet the influx of previously marginalized populations into healthcare systems. Changes in insurance coverage and mechanisms coupled with the focus on preventive care will require a healthcare workforce skilled in navigation, care coordination, ambulatory care models, and care for underserved populations. This dissertation is comprised of three studies that examine the current state of education for two professions impacted by the PPACA: social workers and physicians. The first study, a systematic review of accredited MSW programs (n=200), was undertaken to investigate the level of health- related preparation provided by social work training program. Bivariate statistics and logistic regression models revealed that of the 200 programs, only 13 (6.5%) offer targeted health concentrations (HC). Controlling for university-level characteristics, university size (β=1.69, p < .001) and presence of an MPH program (β=2.0, p<.0001) were associated with having a HC. The second study focused on education of medical students to meet PPACA stipulations of community-based training and graduates who go on to provide primary care. Using a grounded theory framework, 468 written assignments from a community-based experience were examined. Five domains emerged. Themes reflected a continuum of students' abilities to understand the experiences and perspectives of community members and communicate their understanding. The third manuscript examined resident experiences (N=22) in underserved communities through the lens of curricular requirements of community-based training. The assessment tool was found to have good reliability with Cronbach's alpha coefficients for the scales in the assessment tool ranging from 0.88 to 0.95. Significant differences in pre- and post- educational intervention mean scores were found.