this provides additional time for physicians to spend on those medically complex patients with multiple chronic conditions some oecd countries have embraced the expansion of the workforce to include these personnel physicians nurses and other health professionals need to enter an environment that promotes the skills they leam in clinical training updating the education curriculum will not be very effective unless the research infrastructure creates the evidence base to guide education and patient care the payment and delivery systems help them administer the types of care they are trained to deliver and the quality metrics measure what they are being trained to provide