The ripple effect of healthcare workforce training cuts

Dr. Christine Riedy Murphy was leading three federally funded projects to improve training at the predoctoral, postdoctoral, and continuing education levels when she stopped receiving funding. Her work focuses on the education and clinical training of the healthcare workforce to better prepare clinicians to care for underserved and vulnerable communities—particularly older populations, and individuals living in rural areas. Riedy led a national center that provided training and resources for those in healthcare who treat geriatric patients in 1,400 community health centers. The centers care for over 31 million people nationwide.

Like many in the health research community, Riedy is closely watching the potential fallout from cuts to federally funded research and the consequential impact it will have across the country and in communities most in need. HSDM recently spoke with her about her journey into research and how halting her research funding will deeply affect the nation’s rapidly growing aging population.

Why did you get into your field of research?

Since coming to HSDM, I have explored how we train the healthcare workforce to meet the needs of the population, particularly underserved and vulnerable communities, through interprofessional and evidence-based approaches. 

For example, we know that the U.S. population is aging at a faster rate than ever before and that fewer healthcare providers are choosing advanced geriatric training. There is a compelling graphic from the U.S. Census Bureau that illustrates the dramatic shift in population age from a pyramid to a pillar — people are living longer, but not necessarily better as many have at least one chronic condition while others may have multiple chronic conditions such as diabetes and periodontal disease. Given our super-aged society, our healthcare workforce, especially our dental workforce, have the education and training to effectively meet their needs? 

What kind of federally funded projects were you working on?

The federally funded projects that we’ve primarily been working on focus on education and clinical training of the healthcare workforce, especially the dental workforce. The three federal awards that I currently lead focus on training at all three levels – predoctoral, postdoctoral, and continuing education. 

The predoctoral training grant is focused on enhancing the geriatric content in our HSDM predoctoral program through inclusion of lectures, experiences, and assessments as well as an aging and geriatric track for dental students. The educational approach is based on two frameworks for caring for older peoples: (1) Geriatric 5 M’s – what Matters Most, Medication, Mentation, Mobility, and Multi-complexity; and (2) The Seattle Care Pathway, which focuses on a patient’s level of functional dependence. The postdoctoral training grant allowed us to develop a new Advanced Education in General Dentistry (AEGD) residency program and enhance the Dental Public Health residency program for a focus on training dentists in rural settings in New Hampshire. We were recently notified that our competitive renewal to expand the program was successful, however it remains unclear if the federal funding will be unfrozen.

The third award is a National Training and Technical Assistance Partner (NTTAP) award. NTTAPs provide training and technical assistance to our nation’s health centers to ensure the workforce has evidence-based education and training to meet the needs of their communities. Our NTTAP, the National Center for Equitable Care for Elders, provides training to meet the needs of the growing older adult population, utilizing the Age-Friendly Health Center approach and understanding the interplay between interprofessional and team-based care approaches.

What is the impact of this research?

Generally, the impact of these three awards is to transform education and training by incorporating age-friendly, interprofessional, and non-medical factors of health into their educational and clinical training curricula to better prepare them to care for underserved and vulnerable communities, particularly rural and older adult populations. 

What does halting your research’s funding mean to the people most affected?

Halting the funding not only has an immediate impact on the staff and faculty involved in teaching/training on these topics, it has a consequential impact on the education and training of future and current dentists and other healthcare workers. It ultimately affects the larger community. The health centers that won’t have postdoctoral trainees to help expand care to more patients, the health center workforce that won’t receive continuing education on caring for the aging community, and the older people who won’t be treated with an age-friendly focus — centered on what matters most to them in leading a healthy and productive life — will all be affected.

Christine Riedy Murphy is the Delta Dental of Massachusetts associate professor of Oral Health Policy and Epidemiology at Harvard School of Dental Medicine.