Over the last two decades, the health care sector has been a remarkable engine of job growth in the United States. Even as the economy plods along, health care has been responsible for adding an average of 22,500 jobs per month in 2011 through July. Health care jobs now represent about 11 percent of American employment, as compared to 8 percent in 2001. But rather than cheer this development, a number of health care experts are increasingly worried.

The reasoning behind wonks’ fears is that even as the health care sector has added jobs, the productivity of the average worker may have declined, indicating a labor force that is growing bloated and inefficient. As a recent paper in the New England Journal of Medicine by Bob Kocher and Nikhil Sahni showed, labor productivity growth in the health care sector actually fell by .6 percent between 1990 and 2010, a result which corroborates the findings of a 2010 paper by heath economist David Cutler. This conundrum raises an urgent question: How can we rethink health care labor to foster a more innovative, productive system? While a number of legal, cultural, and logistical hurdles remain, the most promising answer seems to lie in allowing basic medicine to be practiced in more places and by an increasingly diverse set of practitioners.

ACROSS THE FIELD, health care experts speak in unison about the need for health workers with varying credentials to take on a number of responsibilities that are currently the sole purview of doctors. In the same NEJM paper, Kocher and Sahni write that a “different quantity and mix of workers engaging in a higher value set of activities” is necessary to increase productivity, with one of their suggestions being to relax licensure and scope of practice requirements for nurse practitioners and other non-doctor health care workers. That’s a suggestion with which Joe Antos, a scholar at the American Enterprise Institute, agrees, saying “We need to make it possible for people without MD after their name to handle a richer set of tasks.” The theory behind this argument is that as technology becomes more advanced, so too should the nature of tasks that low- to medium-skilled workers are able to perform. As Ashish Jha, an associate professor at Harvard Public School of Medicine and a practicing physician, told me, “What you see in other industries is when there’s been an uptick of technology, it has allowed everybody to move up in terms of the kinds of work they do. [In health care] it [should] allow nurses do stuff only doctors could do before.”

Several obstacles stand in the way of this vision becoming a reality, however. To begin, a morass of state laws blocks nurses and other non-MDs from performing many tasks. According to a report from Kaiser Health News, Colorado recently became the 16th state to allow nurse anesthetists to work without a doctor’s oversight. The specificity of the change suggests the scope of the challenge: Each change is approved piecemeal, often over the objections of physicians’ groups. “The standard pushback [against allowing nurses to take a higher burden in health care] is it’s going to affect the quality of care,” says Jha. “My argument is it might! I don’t know that it won’t … but we can actually study that and monitor it closely. And if it starts affecting quality [negatively], we can back off. … [But] we can’t be so afraid to innovate that we’re locked into a completely unsustainable way of doing things.”

In addition, there’s another, cultural obstacle standing in the way of non-MDs taking on greater responsibilities. Kaiser Health News quotes another doctor saying that allowing nurses to take up a greater role is “exactly what people worry about” when they worry about health care reform—that is, their doctors will be taken away from them. Patients are biased in favor of physicians. As Antos asks rhetorically, “Nurses could do a lot of the work … but you look at my mother: Who does she listen to—the doctor or the nurse?”