Of the more than $4 trillion the world expends on health care each year, close to 60 percent is spent on the clinical workforce—the doctors, nurses, pharmacists, and other professionals who provide patient care. Yet few health systems estimate their future workforce needs accurately or are able to develop a strategy for their clinical workforce that effectively keeps supply and demand near equilibrium.

The resulting supply/demand imbalances impair patient care, demoralize clinicians, and make service delivery inefficient. As a consequence, they compromise a health system’s ability to deliver its service strategy—its goals for providing high-quality, accessible, cost-effective care. Those goals can be met only if the health system has the right number of the right clinicians in the right places.

At the heart of the problem lies what we have begun to call the workforce planning paradox: because education and training cycles in health care are often quite long, traditional supply/demand signals are frequently muffled or ineffective. The consequences of planning decisions can take many years to become clear, by which time the planners are rarely still in their posts. Furthermore, the evidence base required for good planning is difficult to gather and codify.