ABSTRACT
This chapter argues that issues raised by the shadow workforce should be a central concern for the field of public administration in general and public personnel management in particular. It also argues that the shadow workforce is even larger that Light estimated. This is because his methodology did not explicitly include the vast phalanx of health care providers who serve well over 100 million Americans enrolled in two of government's largest programs—Medicare and Medicaid. The chapter suggests that focusing on the dynamics of payment policy for one subset of these providers—physicians—casts light on core issues of power, accountability and performance in the shadow workforce. It proceeds by detailing the institutions and related forces shaping payment to physicians serving Medicare and Medicaid beneficiaries, respectively. In 2014, a scandal involving a performance management system refocused the attention of policymakers on the deteriorating salary position of Veterans Health Administration (VHA) doctors.
