Category Archives: Physician Workforce
Given near-universal concern over rising health care costs, are new physicians being taught to keep costs in check?
Not enough of them, according to a research letter published in JAMA Internal Medicine in December. Lead author Mitesh Patel, MD, MBA, a Robert Wood Johnson Foundation (RWJF) Clinical Scholar at the University of Pennsylvania, and his research team analyzed survey responses from nearly 300 U.S. internal medicine residency programs. They found that fewer than 15 percent have curricula designed to teach residents to be more cost-conscious.
“Evidence shows that physicians who recently completed residency training practice medicine at a higher cost than more experienced physicians,” Patel and his team wrote. Among 295 programs that responded to a questionnaire on cost-conscious care in a 2012 survey from the Association of Program Directors in Internal Medicine, 14.9 percent indicated that they had a formal curriculum in cost-conscious care; another 49.8 percent responded that they did not, but were working on it.
The Robert Wood Johnson Foundation (RWJF) Human Capital Blog published nearly 400 posts in 2013. Which were your favorites? Today and tomorrow, as the year comes to an end, we’re taking another look at the posts published on this Blog in 2013 that attracted the most traffic.
A Closer, More Dispassionate Look at Obesity RWJF Scholar in Health Policy Research alumna Abigail Saguy, PhD, discusses how fatness went from being considered a fashion problem to a social problem, a medical problem, and finally the public health crisis we see it as today. She says social perceptions of weight have affected medical interpretations, and shares her concern that some efforts to promote healthy lifestyles will exacerbate weight-based discrimination. Saguy’s interview was also the post most-shared on social media this year, generating more than 2,200 “likes” on Facebook.
A Chief Nursing Officer Who Does Not Have a BSN-Only Hiring Policy in Place In a blog that is both personal and provocative, RWJF Executive Nurse Fellow alumnus Jerry Mansfield, PhD, RN, shares his journey to become a nurse, the setbacks he overcame, and how he has fulfilled his commitment to lifelong learning. He also addresses how he reconciled his support for the Institute of Medicine’s future of nursing education recommendations with the steps he had to take to meet demand for nurses at his institution. Mansfield is chief nursing officer at University Hospital and Richard M. Ross Heart Hospital, and a clinical professor at Ohio State University College of Nursing.
What’s on the minds of this year’s medical school graduates? Among top concerns for the country’s future physicians are uncertainty about health care reform, practice choices, and debt repayment, according to the 2013 Medical School Graduation Questionnaire administered by the Association of American Medical Colleges (AAMC). Overall, most medical students say they are satisfied with their education.
The 2013 graduates in the new survey report an average premedical education debt of $11,849, which is about eleven percent more than students reported in 2012. This ends a four-year trend in which the average premedical debt had been decreasing. In addition, the 2013 graduates report an average medical education debt of $135,084—an increase of two percent from 2012 graduates. Nearly two in five graduates this year (38.1%) say they plan to enter a loan-forgiveness program.
Fewer than 2 percent of 2013 graduates say they plan to go into full-time solo practice. Twenty percent have their sights set on a group practice of three or more. Nine percent expect to pursue hospital work.
Foreign-educated and foreign-born health professionals play a vital role in providing patient care in this country, but strategic shifts such as changes in immigration laws may be needed to stabilize the nation’s health workforce, according to a new RAND Corporation study.
The two groups fill important gaps, particularly among primary care physicians, nurses in hospital settings, and other areas with worker shortages, according to findings published in the November issue of Health Affairs.
However, continuing to rely on foreign-educated and foreign-born health workers may reduce incentives for the nation to address problems such as the inadequate supply of primary care physicians. This, in turn, could lead to a less-stable U.S. health care workforce, researchers said.
The website Physicians Practice has released its annual Physician Compensation Survey, which for the third straight year shows that a majority of U.S. physicians view the income from their medical practice as “disappointing.” In 2013, 54 percent defined their net income this way, the same number as a year earlier, but 5 percent more than those who took the survey in 2011.
Physicians Practice surveyed 1,474 physicians and staff for the survey, asking about personal income, practice overhead, practice outlook, and other financial issues. For the first time, the survey acknowledged the shift from volume-based reimbursement to value-based reimbursement, asking respondents to share how much of their income is tied to factors other than the number of patients they see.
Thirty-three percent of respondents said a portion of their compensation is tied to value (quality and cost of care provided), with 8.5 percent of that group saying this was the only factor in their pay. Furthermore, 24 percent of respondents said a portion of their compensation was tied specifically to patient satisfaction.
However, productivity remained the dominant factor in physician compensation, with 28 percent of survey respondents saying that their entire compensation package was factored on productivity alone. Another 37 percent said it made up a portion of their annual pay.
Rural counties throughout the United States may be hardest hit by the country’s anticipated shortage of primary care physicians (PCPs), according to a new study from the WWAMI (Washington, Wyoming, Alaska, Montana, and Idaho) Rural Health Research Center at the University of Washington School of Medicine.
Researchers point to several factors that have implications for rural counties: PCPs deliver the majority of health care in those areas; a substantial percentage of primary care providers in the United States are approaching retirement age at the same time that fewer new medical school graduates are opting for primary care specialties; and demand for health care services is expected to increase as the population ages and millions gain health insurance coverage as a result of the Affordable Care Act.
The study, which used data from the American Medical Association and the American Osteopathic Association 2005 Physician Masterfiles, found a higher percentage of PCPs near retirement in rural counties than in urban ones, with the percentage increasing as the degree of rurality increased. (Physicians 56 or older in 2005 were considered to be near retirement and were the primary focus of analysis.) The 184 counties in the top 10 percent of near-retirement PCPs were characterized by lower population density and lower socioeconomic status, as measured by low education, low employment, and persistent poverty.
The health care sector has created 166,800 new jobs so far this year, according to data from the Bureau of Labor Statistics—but that’s down from the 266,400 new jobs created in the first nine months of 2012. The sector created 6,800 jobs this September, compared with 36,600 in September of last year.
Experts note that these numbers have yet to reflect any slowing demand for physicians and other clinicians.
With health reform taking effect, consolidations and other changes in the health care industry, “what you are seeing is simple action-reaction,” Travis Singleton, senior vice president at the health care staffing firm Merritt Hawkins & Associates, told Health Leaders Media. “[A]nytime you have mass change to an industry you are going to get a reaction.” Singleton says that Merritt Hawkins saw a 14 percent increase in its physician and advanced practice recruiting assignments from 2012 to 2013, and he expects recruitment and hiring to continue to increase, especially in nursing.
Doctors, nurses, and other health professionals are increasingly taking on top leadership positions at hospitals, Fierce Healthcare reports, likely because of the changing health care delivery system.
The trend is taking root in several states. In Texas, Baylor All Saints is headed by a former surgeon. The president of Texas Health Harris Methodist Fort Worth is a former intensive care unit nurse, and her immediate superior who oversees operations for 12 regional hospitals is a physician, the Forth-Worth Star-Telegram reports.
Presence Saint Francis Hospital and Presence Saint Joseph Hospital in Illinois announced this month that a physician and board-certified specialist in infectious diseases would take over as president and CEO, according to Fierce Healthcare. Portsmouth Regional Hospital in New Hampshire is run by a registered nurse, Foster's Daily Democrat reports.
Among the Robert Wood Johnson Foundation (RWJF) scholars in top leadership positions at hospitals is RWJF Executive Nurse Fellow Kim Moore, RN, MSN, FACHE, the president of Saint Elizabeth Regional Medical Center in Lincoln, Nebraska.
With a primary care provider shortage looming, medical schools are trying a new approach to get physicians into the workforce quickly: condensing medical education from four years to three.
Mercer University (Georgia), Texas Tech University, and New York University offer three-year primary care programs, and will soon be joined by programs in Tennessee, Indiana, University of Wisconsin, East Carolina, and Kentucky, MedPage Today and Fierce Healthcare report.
Most of the schools are shortening or eliminating fourth-year clinical rotations to consolidate their programs, leaving the first three years—which often focus on medical science—untouched.
"We chose to do it on the clinical end rather than [the] basic science end because, as long as Step 1 is [and] as important as it is, our students need to be fully prepared for it,” Betsy Jones, EdD, vice chair of research in Texas Tech's Department of Family Medicine, told MedPage Today. “We didn't make any changes to the curriculum that would threaten our students' ability to do well on [the United States Medical Licensing Examination]. The changes are really at the fourth year level."
A three-year program also saves medical students tuition money, and allows them to earn money in the workforce sooner than in a conventional four-year program, according to Fierce Healthcare.
Although more hospitals and health care systems have been hiring physicians in recent years, more than half of the nation’s physicians are still self-employed. A survey from the American Medical Association finds that 53.2 percent of physicians were self-employed in 2012 and 60 percent worked in practices that were wholly owned by physicians.
The survey also found that only 5.6 percent of physicians were directly employed by a hospital. Twenty-three percent worked in practices that were at least partially owned by a hospital.
Although the researchers conclude hospital employment is part of a national trend, the data “offers an update on the status of physician practice arrangements, and allows for a nationally representative response to the numerous articles of the past several years that have highlighted a surge in the employment of physicians by hospitals and the ‘death’ of private practice.”
The data comes from the 2012 Physician Practice Benchmark Survey, a nationally representative random sample of post-residency physicians who provide at least 20 hours of patient care per week.