This article reviews the special position that health professionals have occupied and the ways in which changes threaten the foundations of professional work. The application of modern management principles to health care runs the risk of overriding the "action orientation" that is a defining component of professional work. One goal of health workforce design should be the engineering of opportunities for the preservation of "professional voice" as a countervailing force to ensure high quality health care. Contemporary models of change applied to health care workforce include: (1) the system of professions models in which securing and maintaining jurisdiction are the mechanisms that professions employ to sustain their position, (2) a strategic adaptation model by which professions attempt to adjust to changing environments, (3) a model of redesigning patient care which applies Total Quality Management (TQM) and other "industrial techniques" to the health care workplace, and, (4) model of "consumer sovereignty" in which groups of citizens come together to determine the nature of care services and professional work, with the participation of the organizations and providers.

Contemporary models of change in the health professions.

Ridgecrest Community Hospital, a 72-bed hospital in rural California, uses a head-hunter to recruit high-technology technicians. This unusual measure is an attempt to ease the growing shortage of radiologists, sonographers, and others who operate expensive, sophisticated hospital equipment. Other hospitals are increasing salaries and modifying technologists' jobs to respond to the shortage. Hospitals report average vacancies of up to 21 percent for some high-technology positions, according to the Washington, DC-based Summit on Manpower, a coalition of 17 high-technology health professional associations.

Hospitals struggle to respond to the technologist shortage.

13 ways to ease the nursing shortage.

U.S. can't invoke key law in antitrust case.

Hospital closures top record at 79--AHA.

Current health care literature is replete with recent accounts of severe health care professional personnel shortages adversely impacting patient care and creating staffing dilemmas (Aiken, 1989; Arnwine, 1990; Boyd et al, 1990; Caine, 1990; Carter, 1987; Donovan, 1990; Eubanks, 1990; Greipp, 1989; Hall and Stevens, 1991; Kinney, 1991; Kirschner, 1988; Kirschner, 1989; Lomurno et aI, 1990; Mead and Nkongho, 1990; Morris, 1989; Mullner et al, 1989; Neuhs, 1991;O'Neill and Vocke, 1990; Perry, 1991; Rich and Aldridge, 1988; Rosenbach, 1990; Shepard, 1990; Stubson and White, 1988; Wagner, 1991; Warner and Grohman, 1990; and Werkema, 1990). This epidemic of insufficient professional health care manpower is widespread and touches literally all the health care professions. A listing of the significant health care articles on professional staffing shortages published during the last 10-years-plus period was obtained from a database search of the HEALTHPLAN 1981--8/91SilverPlatterTM (National Library of Medicine, 1991). This listing provides the results of a comprehensive literature search of articles pertaining to professional staffing shortages by discipline. Results

John C. Hyde

Papers

Determinants of rural hospital utilization of multiskilled health practitioners.