Category Archives: National
Last week, NPR aired a story examining the prognosis for primary care providers in the United States. The country will have tens of thousands fewer health care providers than it needs to care for its the population by 2015, and the shortage is expected to hit rural and underserved areas especially hard.
Part of the problem, the story reports, is that medical students—often saddled with massive student loan debt—are choosing specialties over primary care and family medicine. In addition to higher salaries, specialties allow more schedule flexibility and predictability, and less stress. The nursing workforce, too, has a looming shortage. Many nurses are close to retirement, and a shortage of nurse faculty is making it difficult for nursing schools to educate the next generation.
Provisions of the Affordable Care Act may help alleviate the shortage in the areas most hard-hit, by providing loan forgiveness or other incentives for providers who practice primary care in underserved areas. “A lot of the money in the Affordable Care Act went to beef up programs that train primary care providers, not just doctors but nurse practitioners, physician assistants, what we call mid-level providers,” Julie Rovner, NPR health policy correspondent, said. Primary care “doesn’t necessarily have to be provided by someone with an MD after their name… [There are] lots of studies that say good primary care can be delivered by people like nurse practitioners, by physician assistants, by nurses.”
The show also took calls from listeners—a neurologist, a recent nursing school graduate, a surgical subspecialist, and a nurse practitioner, among them.
Listen to the NPR story or read the transcript here.
Samir Soneji, PhD, is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program, and an assistant professor at the Dartmouth College Institute for Health Policy and Clinical Practice and the Norris Cotton Cancer Center. His study on the statistical security for Social Security was published in the August 2012 issue of Demography. Read the study.
Human Capital Blog: This study is a follow-up to your previous research. Can you briefly describe what you’ve studied up to this point?
Samir Soneji: Previously we studied the impact of historical smoking and obesity patterns on future mortality and life expectancy trends. For men there’s been a steady decline in cigarette smoking, and so also a gain in life expectancy. Women have also experienced a decline in cigarette smoking, but not as quickly. The rise in obesity has been much more recent than the historic decline in smoking, and we don’t know yet the impact of that rise. There’s a lag—the effect of today’s obesity may affect the population in 15-20 years, or later. One possibility may be that the rise in obesity may partially offset what’s been achieved by the historic reductions in smoking. Taking these factors into account, we found that both men and women will have an increase in life expectancy in the next 25 to 30 years.
HCB: Your new study looks at the solvency of Social Security. Tell us more about what you were analyzing.
Soneji: The Social Security Administration and Medicare use the same mortality and demographic forecasts to determine the number of beneficiaries, and the number of working age adults who are contributing payroll taxes to support those retirees.
While they make up 73 percent of medical and health services managers, women account for only a small portion of CEOs at hospital and health care organizations, according to a report by RockHealth. The analysis of data from the U.S. Bureau of Labor Statistics and other surveys finds that just 4 percent of health care organization CEOs and 18 percent of hospital CEOs are women.
RockHealth’s report highlights a range of barriers to women’s advancement, including persistent gender roles in the workplace, a lack of mentors and role models for women, and more. To understand what women in the health care workforce thought, RockHealth conducted interviews with 100 women in the field. Nearly half the survey respondents reported that insufficient self-confidence was one of the biggest barriers to their career advancement. Among other reported obstacles: time constraints (45 percent) and the ability to connect with senior leadership (43 percent).
The Robert Wood Johnson Foundation has long championed leadership development, for women and men alike. Many of the Foundation’s programs offer leadership training for nurses, physicians and other health care professionals, to help advance their careers. Learn more about RWJF programs at RWJFLeaders.org.
What do you think? Are females underrepresented in health care leadership? What can we do to increase their representation? Register below to leave a comment.
How do nurse faculty members spend their time? How do they assess key aspects of their work-life?
In 2010 the Robert Wood Johnson Foundation’s Evaluating Innovations in Nursing Education program (EIN) conducted a nationwide survey of full-time nurse faculty focusing on their employment characteristics, workloads and attitudes toward work-life. More than 3,000 respondents completed the survey, answering questions about more than 60 characteristics of work-life.
Now, using an online tool—the Nurse Faculty Query (NuFAQs)—you can search the survey results. The interactive tool allows you to customize the findings to suit your interests in faculty with particular backgrounds or rank, in specific settings or circumstances.
To see a brief demonstration and begin using this resource, click here.
Read more about NuFAQs in the latest issue of Sharing Nursing’s Knowledge.
Robert Wood Johnson Foundation Executive Nurse Fellows program alumna Debra Toney, PhD, MS, BSN, FAAN, was one of 22 people selected by the Coca-Cola Company to carry the Olympic torch in Kirtlington, England, in a relay across the country leading up to the opening ceremonies for the 2012 Olympics. Here, Toney, director of nursing for Nevada Health Centers and immediate past president of the National Black Nurses Association, writes about the experience.
Have you ever done something that changes your life? Have you met people who inspire you to do more? These are just a few of the many feelings I have experienced after participating as an Olympic Torchbearer! They are certainly great feelings to have and I have been on cloud nine since returning home.
The opportunity to participate in this international event which celebrated the accomplishments of some very amazing people was a proud and humbling moment. Humbling because I never expected something this significant would happen to me. However, it is an experience that could happen to anyone.
While flying home I had plenty of time to pinch myself to wake up, but I was awake. Did this really just happen to me? The opportunity to spend time with people from different parts of the country and hear their stories of giving has given me the drive to do more. We came from different cultures, spoke different languages and enjoyed different food, yet we had a lot in common. We want to make the world a better place to live.
The Flame was finally delivered to London, after being transferred from one Torchbearer to another, spreading the message of peace, unity and friendship. It ended its journey as the last Torchbearer lit the cauldron at the opening of the Olympic Games. I experienced a feeling of honor and joy as I watched in awe the opening on television, knowing I played a role in this great history making event.
On Monday, U.S. Secretary of Health and Human Services Secretary Kathleen Sebelius announced a four-year, $200 million investment to support the training of advanced practice registered nurses (APRNs). The move was lauded by leaders of the Robert Wood Johnson Foundation (RWJF) and the Center to Champion Nursing in America.
The Secretary went to Duke University’s School of Nursing to announce that the Graduate Nurse Education Demonstration program will reimburse costs associated with training APRNS (nurse practitioners, nurse anesthetists, nurse midwives and nurse specialists) at five networks of hospitals, nursing schools, and community-based clinics and health centers. They are: the Hospital of the University of Pennsylvania, in Philadelphia; Duke University Hospital, in Durham, N.C.; Scottsdale Healthcare Medical Center, in Ariz.; Rush University Medical Center, in Chicago, Ill.; and Memorial Hermann-Texas Medical Center Hospital, in Houston, Texas.
The goal, officials said, is to help these highly skilled nurses gain the skills necessary to provide primary and preventive care for Medicare beneficiaries, including in underserved communities.
“This announcement marks a historic moment of investment in the crucial and growing role of nurses in our health care system,” RWJF President and CEO Risa Lavizzo-Mourey, MD, MBA, said. “With 8,000 baby boomers turning 65 and qualifying for Medicare daily, patients everywhere can benefit from the expertise of advanced practice nurses and the expanded access to care they potentially can provide. The decision to extend Medicare funding to nurses recognizes the urgent need to expand the workforce to care for the growing population of Medicare recipients.”
“This relatively modest investment will pay big dividends for consumers by preparing more highly skilled nurses to provide care when and where it is needed,” agreed Susan Reinhard, PhD, RN, FAAN, senior vice president of the AARP Public Policy Institute and chief strategist of the Center to Champion Nursing in America, an initiative of AARP, the AARP Foundation, and RWJF. “These new health professionals will improve access to crucial primary, preventive, and transitional care across a range of settings—from the hospital, to the home, to convenient care clinics,”
Half of the clinical training provided at the five demonstration sites must take place in the community, outside of hospital settings. The aim is to ensure that APRNs have skills to provide primary, preventive and transitional care, and to help patients manage chronic conditions. The funding is authorized under the Affordable Care Act.
This is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Gabriel R. Sanchez, PhD, is an associate professor of political science at the University of New Mexico, assistant director of the RWJF Center for Health Policy at the University of New Mexico, and director of Research for Latino Decisions.
The Supreme Court decision regarding the constitutionally of the signature policy victory of the Obama administration has been the most anticipated and hotly debated decision of the Court in recent memory. In the spirit of a prior Human Capital blog post I wrote back in November, I wanted to take advantage of the opportunity to participate in this series by providing a perspective on how this decision will likely impact the Latino population. I have been analyzing public opinion toward health care reform for some time now, and draw on some of this data to provide a few examples. I focus my attention here on some of the more intriguing relationships to emphasize the complexity of Latino’s views of this historic policy.
Latinos had a lot at stake in this decision, as the Affordable Care Act (ACA) is projected to expand insurance to 9 million Latinos. It is therefore not surprising that support for health care reform, and the ACA in particular, has been higher among Latinos when compared to non-Latinos. In fact, since Latino Decisions started collecting data in October 2011, on average 51 percent of Latinos have supported the ACA. Conversely, as reflected in the figure below, the percentage of Latino voters who want to repeal the law has been lower than what other polls have shown for the non-Latino population over this time period.
This is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Matthew D. McHugh, PhD, JD, MPH, RN, CRNP, is an assistant professor of nursing at the Center for Health Outcomes & Policy Research, University of Pennsylvania School of Nursing, and an RWJF Nurse Faculty Scholar.
By upholding the Affordable Care Act, the Supreme Court’s landmark ruling has allowed health reform to continue to move forward. But the promise and potential of health reform depends on having a robust, well-trained workforce that can meet the demands of a changing health care system, an aging population, and newly insured Americans with increasingly complex health care needs.
More than ever, the recommendations from the Institute of Medicine’s (IOM’s) report The Future of Nursing: Leading Change, Advancing Health will be critical to achieving the goals of health reform. For example, this defining moment provides an opportunity to redefine roles to take advantage of the fullest extent of all providers’ capabilities to improve health system efficiency and meet the health care needs of the population.
The first recommendation from the IOM report is that nurses should practice to the full extent of their education and training. Many of the Affordable Care Act’s provisions rely on the health care workforce, particularly the primary care workforce, working in new and expanded roles. Whether it is implementing new models of integrated care, providing much needed care to previously uninsured Americans, or delivering guaranteed preventive services and essential benefits, meeting the coming demand for primary care will require “all hands on deck”—every provider working at their fullest capacity. Although advanced practice nurses are one way to grow the primary care workforce, their ability to fully participate has been limited by legal barriers that restrict them from practicing up to the level they have been trained and often requiring physician oversight.
This is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Sara Rosenbaum, JD, is the Harold and Jane Hirsh Professor at George Washington University, School of Public Health and Health Services, Department of Health Policy. Rosenbaum received an RWJF Investigator Award in Health Policy Research in 2000, and is on the board of the RWJF Health Policy Fellows program.
In affirming the constitutionality of the Affordable Care Act, the United States Supreme Court assured the legal survival, not just of thousands of discrete legislative provisions, but also the big ideas embedded in the Act. One of the biggest is its emphasis on strengthening the juncture between health care and health, an opportunity whose potential is only beginning to be explored. The most publicly visible aspect of this emphasis is the Act’s expansion of coverage for clinical preventive services without cost-sharing across the principal health insurance markets recognized under the Act: Medicare; employer-sponsored health plans, state regulated individual and small group markets (including the new Exchange market) and the Medicaid “benchmark plan” market that will serve newly eligible beneficiaries. (Ironically, the Act leaves out of this expanded clinical preventive coverage design the health plan market serving traditional Medicaid beneficiaries; other than a state option to expand coverage at slightly favorable federal financing rates, the law does not require expanded clinical preventive benefits for the very poorest beneficiaries. Although family planning services are a required benefit for all beneficiaries of childbearing age, services such as screening colonoscopies and adult immunizations remain optional for the traditional coverage group).
But the opportunities to bridge the health/health care divide go well beyond the important, threshold question of coverage design. The biggest opportunities are those that are intended to change the way that two of the principal players in the health care system—physicians and hospitals—envision their role in society and position themselves in communities. In the case of physicians, the Act incentivizes formation of accountable care organizations (ACOs), entities that assume responsibility not simply for health care of a defined group of patients (like any practice network) but for the health of the population they serve. ACOs are expected to move beyond improvements in the quality of clinical services they furnish and to reach into their communities through greater involvement in community health improvement activities. Similarly, the Act expands and strengthens the community benefit obligations of the nation’s nonprofit hospitals seeking federal tax-exempt status, upping their responsibilities related to community health improvement planning, and incentivizing investment in community health improvements and community building.
This is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Andru Ziwasimon Zeller, MD, is co-founder of the Casa de Salud family medical office and the Community Coalition for Health Care Access in Albuquerque, and a 2010 RWJF Community Health Leader.
I’m a doctor and supporter of health care for all and happy that we as a nation have achieved almost universal health care. The Affordable Care Act has flaws and areas of disagreement. It was forged from 100 years of argument and compromise, bringing together liberal universal health care with conservative personal responsibility
I don’t love every detail of the law but I love that we as a nation, through the leadership of President Barack Obama, have removed a massive injustice in our society which has contributed significantly to stress, disease, death, medical debt and household bankruptcy. These have been “silent killers" since those affected tend to keep their suffering to themselves. Many of us have born witness to that suffering. I am so glad it is coming to an end.
Yet I feel the fear and anger of those in our nation who oppose this new law and see in it an assault on individual freedom, a government invasion of health care, and a grand plan to destroy what is perceived to be our founding principles.
I resonate emotionally with the first point—no one likes to be told what to do. Seat belts, car insurance, driver’s license to vote, passport to travel, taxes, and now health insurance? Why not let the hospitals eat that cost? Or drop it on the county health fund? Is this a slippery slope to dreaded socialism or an evolution towards health and personal accountability?
Facts are hard to come by. Trust is next to impossible. We are a nation of belief against belief in search of the ultimate political power to create a singular vision of the future—Republican vs. Democrat, and who knows what either of those really mean. This battle, more than anything, is the greatest threat to the vision and political prowess of our founding fathers. Democracy is conversation, compromise and decision-making for solutions that help us take care of each other and improve our place in this world.
This is our democracy in action. I give thanks that we fight the ‘war’ between liberals and conservatives with words and election ballots.
The decline of our schools, health care system, manufacturing, and prestige internationally stems from and contributes to our inability to care for each other. We are squandering our resources, fighting for control instead of forging a better society. This criticism is not about “hating” America. I’m saying that we Americans are wasting the equity that all of our forebears gave us. All of them. Native Americans and all of the immigrants who come to these shores by force, or hope for a better future. This hope and equity are not owned by any one segment of our society, they are our shared birthright as Americans.
It is time we each take a deep breath, do an internal inventory of our emotional tenor, and start to engage in perhaps stressful, but important conversations with people who have ideas that we don’t like. Passion is a beautiful thing when it can be restrained by reason and respect. Let’s embrace this challenge as a nation, hear what we each have to offer, and live better lives together.
Read more about Ziwasimon Zeller’s work, visit the Casa de Salud website, and learn about the Robert Wood Johnson Foundation Community Health Leaders.