Category Archives: National
Graduate Medical Education Funding Is Not Helping Solve Primary Care, Rural Provider Shortages, Study Finds
From 2006 to 2008, 158 of the country’s 759 residency sponsoring institutions and teaching sites did not produce any primary care graduates, according to a study published online last week by Academic Medicine. Less than one-quarter of medical school graduates entered primary care during those years.
The study also found that physician shortages in rural and underserved areas persist; only 4.8 percent of 2006-2008 graduates practice in rural areas. Nearly 200 institutions produced no rural physicians, more than half produced no Health Service Corps graduates, and 283 produced no physicians practicing at Federally Qualified Health Centers or Rural Health Clinics.
Graduate medical education (GME) distribution is uneven, the researchers found, and provides more support to subspecialty programs than to primary care programs. The top 20 primary care producing institutions (where 41 percent of graduates were in primary care) received $292 million in total Medicare GME payments, while the bottom 20 (where only 6.4 percent of graduates were in primary care) received $842 million in these funds.
A report released Monday by the Health Resources and Services Administration (HRSA) indicate that efforts to grow and diversify the nursing workforce are showing results—a welcome finding given the looming shortage of nurses and primary care providers in general.
According to the data from HRSA's National Center for Health Workforce Analysis, the nursing profession grew substantially in the 2000s, adding 24 percent more registered nurses (RNs) and 15.5 percent more licensed practical nurses (LPNs). Significantly, the growth in the supply of nurses outpaced growth in the U.S. population, with the number of RNs per capita growing by about 14 percent and the number of LPNs per capita increasing by 6 percent.
The "pipeline" carrying nurses from school to the workforce also expanded during the past decade. The number of would-be nurses who passed national nurse licensing exams to become RNs more than doubled between 2001 and 2011, while the number of LPN test-passers grew by 80 percent. Significantly, the share of licensure candidates with bachelor's degrees increased during that time, as well.
The profession also is growing more diverse, according to the data. Non-white RNs are now 25 percent of the profession, up from 20 percent 10 years ago. Nine percent of RNs are men today, up slightly from 8 percent at the beginning of the decade.
The American Association of Colleges of Nursing (AACN) last week released preliminary findings from its annual nursing education survey showing an increase in enrollment in all types of nursing programs from 2011 to 2012.
The AACN survey finds a 3.5 percent increase in entry-level Bachelor of Science in Nursing (BSN) program enrollment, and a significant increase in the number of students in graduate nursing programs. Master’s degree nursing programs reported an 8.2 percent increase in enrollment, while Doctor of Nursing Practice program enrollment increased by 19.6 percent and PhD/DNS programs by 1.3 percent.
Baccalaureate degree completion programs (RN to BSN) saw an increase in enrollment of 22.2 percent, which marks the 10th year of enrollment increases for these programs.
Though enrollment has increased, the survey finds that many potential students are still being turned away. In 2012, more than 52,000 qualified applicants were turned away from entry-level baccalaureate nursing programs because of a shortage of clinical placement sites, faculty, and funding.
In addition to its annual survey, AACN also released data showing that baccalaureate nursing graduates are at least twice as likely as those in other fields to have a job at the time they graduate. The survey also finds hospitals and other employers prefer hiring new nurses with BSNs.
One goal of the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, is that 80 percent of nurses have bachelor’s degrees or higher by the year 2020.
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of RWJF’s nursing programs, and the latest news, research and trends relating to academic progression, leadership and other critically important nursing issues. Here are descriptions of some of the stories in the December issue:
In the weeks after Hurricane Sandy pummeled shores in New York and New Jersey, a number of stories surfaced about the critical role nurses played during and after the storm hit. Nurses are gaining widespread recognition for their emergency-relief work—even a nod from President Obama. But the contributions of nurses working as emergency responders is not new. Read the story.
CDC Recognizes Nurse Leader for Groundbreaking Research on Domestic Violence
RWJF Nurse Faculty Scholar program director Jacquelyn Campbell is being hailed as one of the 20 most influential researchers in injury prevention over the last 20 years by the Centers for Disease Control and Prevention (CDC). Campbell’s groundbreaking research has shown that nurses can work alongside partners in health care, law enforcement and social work to protect women from the ravages of domestic violence. The school nurse turned domestic violence prevention pioneer is the only nurse to receive the CDC’s prestigious distinction. Read the profile.
Signs of Progress in Addressing New Jersey’s Nurse Faculty Shortage
Legislators had praise and questions for the health, business and academic leaders who gathered at the State House in Trenton on Nov. 19 to provide updates on progress made so far by the New Jersey Nursing Initiative (NJNI)—a multi-year, multi-million-dollar project of RWJF and the New Jersey Chamber of Commerce Foundation that is working to fill nurse faculty positions in the state. Since its inception in 2009, NJNI’s Faculty Preparation Program has supported 61 New Jersey Nursing Scholars who are pursuing (or have completed) master’s or doctoral degrees that qualify them for nurse faculty positions. Read the story.
Why Nurses Go Back to School
A new study from the RWJF RN Work Project identifies the characteristics and factors that best predict whether nurses will return to school to earn higher degrees. The researchers identified internal and external motivators, and barriers, to advancing nurses’ education. Learn more.
The United States will need 52,000 additional primary care physicians by 2025 to meet demand that is growing due to three trends: population growth, population aging and insurance expansion. That is a key finding from a study published in the November/December issue of the Annals of Family Medicine. The researchers estimate that population growth will account for the majority of the needed increase in primary care doctors.
Given the current number of visits to primary care physicians and an expected population increase of 15.2 percent, the researchers predict that office visits to primary care physicians will increase from 462 million in 2008 to 565 million in 2025. This trend will be especially evident among people 65 and older, a segment of the population that is expected to grow by 60 percent. Population growth will require an additional 33,000 physicians, the study says, and aging another 10,000.
Insurance expansion under the Affordable Care Act will also require additional physicians, the researchers find. Eight thousand physicians will be needed to meet that growth.
The 52,000 additional primary care physicians would represent a 3 percent increase in the workforce.
New data from the Association of American Medical Colleges (AAMC) finds a 3.1 percent increase in the number of students applying to medical school this year. First-time applicants also increased (3.4 percent), which helped bring first-time enrollment at the nation’s medical schools up to an all-time high.
AAMC’s enrollment and applicant data also finds that this year’s entering class of medical students is more diverse than last year. There was an increase in applications and enrollees in all major racial and ethnic groups, and record high numbers for African American and Latino students.
If this year’s trends continue, medical schools are on track to increase total enrollment 30 percent by 2016, AAMC says.
“Medicine continues to be a very attractive career choice for our nation’s best and brightest,” Darrell G. Kirch, MD, AAMC president and CEO, said in a news release. “Given the urgent need our nation has for more doctors to care for our growing and aging population, we are extremely pleased with the continued growth in size and diversity of this year’s entering class of medical students.”
Data from the Bureau of Labor Statistics shows that health care employment rose by 44,000 jobs in September.
Most of the gains were in ambulatory care services (+30,000 jobs), with much of the growth in outpatient care centers. Hospitals added 8,000 jobs, and nursing and residential care added 6,000 jobs. Over the past year, employment in health care has risen by 295,000 jobs.
September’s gains are the second largest for the health care industry in a decade, according to a brief from the Altarum Institute, and the strong showing drove the health sector share of total employment to a new high of 10.81 percent.
The Health Resources and Services Administration (HRSA) last week announced that the University of Minnesota Academic Health Center will lead its new Coordinating Center for Interprofessional Education and Collaborative Practice. The Center will have a mission to accelerate teamwork and collaboration among nurses, doctors and other health professionals, with a particular focus on medically underserved areas.
“Health care delivered by well-functioning coordinated teams leads to better patient and family outcomes, more efficient health care services, and higher levels of satisfaction among health care providers,” said HRSA Administrator Mary K. Wakefield, PhD, RN, in a news release issued Friday. “We all share the vision of a U.S. health care system that engages patients, families, and communities in collaborative, team-based care. This coordinating center will help us move forward to achieve that goal.”
The Robert Wood Johnson Foundation (RWJF) and three other leading foundations this summer announced their support for the Center and committed up to $8.6 million over five years. RWJF, the Josiah Macy Jr. Foundation, the Gordon and Betty Moore Foundation, and The John A. Hartford Foundation aim to help make the Center the “go to” coordinating and connecting body for efforts to promote interprofessional education and collaborative practice, as well as a place to convene key stakeholders, develop interprofessional education programs, and identify and disseminate best practices and lessons learned.
“Interest in interprofessional education and team-based care has increased in recent years but we need to move faster,” Maryjoan Ladden, PhD, RN, FAAN, senior program officer at RWJF, said in announcing support from the four foundations. “We hope this Center will foster collaborations between educators and practice organizations to advance the field and improve how care is delivered to patients and families.”
This year, the National Diaper Bank Network is recognizing the week of September 10-17 as National Diaper Need Awareness Week, and local diaper banks across the country have asked their state and local officials to do the same. But more than merely declaring a week, we are acknowledging that the country is becoming more and more aware of the fact that diapers are a basic need for infants, toddlers, and those who suffer from incontinence, and that more people are willing to do something about it.
We have come very far in bringing attention to diaper need in the eight years since I began this journey in 2004. When I started The Diaper Bank in New Haven, CT there were very few diaper banks in America, so I looked to the example of the Diaper Bank of Southern Arizona, the nation’s first diaper bank. That program began in 1994 when a small consulting firm in Tucson, Arizona held a diaper drive during the holiday season to assist a local crisis nursery. Encouraged by the enthusiastic response, and seeing the great need in their community, the firm made the December Diaper Drive an annual tradition, and within five years they were collecting 300,000 diapers each December, benefiting families at 30 local social service agencies. In 2000, the diaper drive effort was spun off into an independent non-profit organization, the Diaper Bank of Southern Arizona, which continues to provide desperately needed diapers to the people of southern Arizona.
The Diaper Bank of Southern Arizona served as my inspiration in 2004 when I decided to start a diaper bank. Through my work with families in need New Haven, I learned that many of the hygiene products I took for granted, such as toilet paper, toothpaste, and diapers, were not available to people who had only food stamps to buy their groceries. The need for diapers, which are so critical for a baby’s health and comfort, was particularly acute. I started small, working out of my living room, but in a few years time, with the help of many others, what started as The New Haven Diaper Bank (now, The Diaper Bank) has grown into the nation’s largest diaper bank, distributing over 14 million diapers since its inception.
Last week, the Robert Wood Johnson Foundation (RWJF) and The Alliance for Health Reform sponsored a briefing to discuss oral health care in the United States, particularly for children and other vulnerable populations.
The discussion was co-moderated by David Krol, MD, MPH, FAAP, RWJF Human Capital Portfolio team director and senior program officer. “Oral health is an integral part of overall health,” he said. It faces the same challenges as overall health care, including “racial, ethnic, geographic disparities in disease and access to care, financing challenges, issues of determining and maintaining quality of care, and workforce controversies.” Krol said he would like to see “all conversations on health and health care… naturally include oral health.”
In 2009, preventable dental conditions accounted for more than 830,000 emergency department visits nationwide, Julie Stitzel, MA, of the Pew Center on the States’ Children’s Dental Campaign told the audience. Children were the patients for 50,000 of those visits. “There’s a real opportunity for states to save money because these visits, again, are totally preventable,” she said. “We know that getting treated in an emergency room is much more costly than the care delivered in a dental office, and states are bearing a significant share of these expenses through Medicaid and other public programs.”