Category Archives: Physician Workforce
There have been some unusual cooks in the kitchen at the Johnson & Wales University culinary institute in Providence, R.I., lately: medical students.
Doctors-in-training from Tulane University have been cooking alongside Johnson & Wales students for several weeks, NPR reports, to learn about nutrition. This unique program, which debuted this year and was organized by Tulane’s Goldring Center for Culinary Medicine, aims to change the way medical students think about food and, ultimately, how they will talk to future patients about nutrition and healthy eating.
Many health problems and diseases—like obesity and diabetes—could be prevented by lifestyle changes such as better eating habits.
"We basically learn how to take care of patients when things go wrong,” Neha Solanki, a fourth-year Tulane medical student, told NPR. “I think that we need to learn how to be able to make nutritious meals and to discuss diet in an educated manner."
In addition to the collaboration with Johnson & Wales, Tulane’s Goldring Center for Culinary Medicine has built relationships in its own community. Medical students help with an “edible schoolyard” program at local schools, and host hands-on cooking and nutrition education classes for community members at the nation’s first teaching kitchen affiliated with a medical school.
The Accreditation Council for Graduate Medical Education’s decision to limit the working hours of medical residents has not increased patient mortality rates, but it has decreased the time residents spend on direct patient care, according to two studies published in the August issue of the Journal of General Internal Medicine.
Researchers from the University of Pennsylvania studied 13.7 million Medicare patients admitted to hospitals between 2000 and 2008. In the first three years after the Accreditation Council enacted an 80-hour work week for residents in 2003, the researchers found no significant changes in patient mortality within 30 days of admission.
“We can reassure the public that patients did not appear to be harmed by the initial duty hour reform of 2003,” senior study author Jeffrey Silber, MD, PhD, told American Medical News. “We have published many papers prior to this looking at other outcomes [including prolonged length of stay following 2003 duty hour reform], and we have found similar results.”
A second change in resident hours came in 2011, when the Accreditation Council limited residents’ maximum shift length to 16 hours, down from 30. Researchers at Johns Hopkins University and the University of Maryland found that this change contributed to a reduction in the amount of time residents spent on direct patient care. Studies conducted in 1989 and 1993 found an average of 18 to 22 percent of residents’ time was spent on direct patient care; the new study finds residents only spent 12 percent of their time on direct patient care—or about eight minutes per patient, per day—in 2012.
Residents spent most of their time (64 percent) on indirect patient care tasks, such as talking with other health professionals, reviewing charts, and handoffs, the study concluded. Lead author Lauren Block, MD, MPH, told American Medical News that while residents aren’t spending as much time eating and sleeping at hospitals, “that time is not being made up spending time with patients, because they spend that time instead working at their computer stations.”
For years, medical students have been choosing specialties over primary care at a rate that has alarmed experts concerned about a shortage of primary care providers. Two new surveys shed light on the primary care workforce.
Primary care physicians were the most actively recruited professionals within the physician and advanced practitioner recruiting market by the health care staffing firm Merritt Hawkins & Associates from April 1, 2012 to March 31, 2013. Merritt Hawkins recently released a report summarizing the trends among its 3,097 recruiting assignments in 48 states conducted during that time period. For the seventh consecutive year, family physicians and general internists were the top two most requested physicians, the report says.
The firm also notes a rise in demand for physician assistants and nurse practitioners, as well as an acute shortage of psychiatrists.
In addition to being in high demand, another survey from the Hays Group, a global management consulting firm, finds primary care physicians could see a higher salary increase than specialists in 2014. The growth will be even greater for primary care physicians in hospital-based settings, the report says.
The news media has recently covered some innovative programs that are influencing the choices and attitudes of the next generation of doctors.
American Medical News reports on the Buddy Program, which pairs first-year medical students with early-stage Alzheimer’s patients and their caregivers. The program empowers patients, and also serves as a valuable learning tool for the students, heightening “their sensitivity and empathy toward people with the disease.” The program was developed at the Northwestern University Alzheimer’s Disease Center in Chicago; Boston University, Dartmouth College, and Washington University have replicated it.
NPR reports on a program at the University of Missouri School of Medicine that is encouraging more young doctors to pursue primary care in rural areas. During the summers, the school has been sending medical students to work alongside country doctors. While school officials caution they can’t be sure about the reasons, they have discovered that students who took part in the summer program were more likely to become primary care doctors who practice family medicine. Some 46 percent of participants are choosing to work in the country after completing their medical training.
Many physicians report flat or declining income, but few anticipate a career move in the short term, according to an annual survey from The Medicus Firm.
Fifty-four percent of physicians in training at the time of the survey indicated a preference for employment by a hospital or academic center.
When asked what limits their pay, many practicing physicians expressed frustration with the limits of hospital contracts and pay structures. They also cited time spent learning, using electronic medical records, and declining reimbursements.
“In an era when hospitals are competing on a national level for every physician they hire, practice preferences can be very helpful in composing a recruiting strategy and compensation package that will stand out and attract doctors," Medicus Firm President Jim Stone said in a news release about the survey. “With the majority of the nation's more than 5,000 hospitals currently recruiting doctors, physician recruiting trends impact the general patient population in addition to hospitals, as physicians choose where to settle and provide health care that is in higher demand than ever before.”
The survey also found that only 6.1 percent of physicians are open to practicing in a small town with fewer than 25,000 residents; nearly 60 percent prefer metropolitan or suburban locations.
The annual survey of more than 2,500 doctors was conducted by The Medicus Firm, a national physician recruiting firm based in Dallas and Atlanta.
The U.S. Department of Health & Human Services (HSS) last week announced that it will support twice as many primary care residencies during the 2013-2014 academic year as it supported last year, thanks to $12 million in funding from the Affordable Care Act. The new funds will support more than 300 residents at community-based Teaching Health Center programs across the country.
“Teaching Health Centers help attract students who are committed to serving communities of need and prepare them to practice in these communities,” HHS Secretary Kathleen Sebelius said in a news release. “Students exposed to training opportunities in health center settings are more likely to stay in these communities and continue to contribute to the care of their residents.”
Residents will be trained in family and internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and general and pediatric dentistry.
Emergency departments (EDs) play a key role in the nation’s health care system, according to a RAND Corporation study commissioned by the Emergency Medicine Action Fund, and policy-makers should pay closer attention to their operations—particularly their role as a “gateway to inpatient treatment.” It also is important to better integrate EDs into inpatient and outpatient settings, the new report says.
EDs have become an important source for hospital admissions. Nearly all of the inpatient admissions growth between 2003 and 2009 was due to an increase in scheduled admissions from EDs, the report finds, particularly among Medicare beneficiaries. As a result of this shift, ED physicians served as the major decision makers for approximately half of all hospital admissions.
The study also finds that most patients visited the ED for a non-emergent health problem because they believed they lacked a viable alternative or because they were sent by a health care provider. “Almost all of the physicians we interviewed—specialist and primary care alike—confirmed that office-based physicians increasingly rely on EDs to evaluate complex patients with potentially serious problems, rather than managing these patient themselves,” the report says. EDs also support primary care practices by performing complex diagnostic workups.
“Evidence generated by our study and other published work indicates that efforts to reduce non-emergent and non-urgent use of EDs are most likely to succeed if they focus on providing convenient and affordable options outside the ED, rather than directing ED staff to turn patients away,” the study concludes. EDs should be better integrated into inpatient and outpatient settings through more interconnected health information technology, greater user of care coordination, and interprofessional collaboration.
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.
Italo M. Brown, MPH, is a third year medical student at Meharry Medical College. He holds a BS from Morehouse College, and an MPH in epidemiology and social and behavioral sciences from Boston University, School of Public Health. He is a Health Policy Scholar at the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College.
In an ad-hoc poll among classmates, I recently inquired about the most important date (in 2013) to a second year medical student. The overwhelming majority of respondents cited their respective STEP 1 exam dates as most important, followed closely by the season finales of ABC’s Scandal and Grey’s Anatomy. While the top three responses are noteworthy, the one date that should bear the most gravity in the minds of medical students across cohorts is October 1st.
This October marks the launch of open enrollment for health insurance exchanges, a much-anticipated provision of the Affordable Care Act (ACA). The ACA seeks to reduce the number of nonelderly uninsured Americans by half; in other words, a projected 20 million new patients will enter the health care system over the next 18 months.
Noting that “online technologies present both opportunities and challenges to professionalism,” the American College of Physicians and the Federation of State Medical Boards recently issued a position paper offering guidance to physicians looking to “strike the proper balance” between harnessing opportunities and navigating challenges inherent to technology.
The paper takes five positions:
1. Standards for professional interactions should be consistent across all forms of communication between physician and patient, and care should be taken to preserve the relationship, and maintain confidentiality, privacy and respect. “Friending” or Googling patients can result in providers observing “risk-taking or health-adverse behaviors,” and can compromise trust between the two parties. The paper urges physicians to avoid using online forums to “vent” or air frustrations.
2. Physicians should make an effort to keep professional and social spheres separate and behave professionally and cautiously in both. They should be aware that information posted online can quickly be widely disseminated or taken out of context.
3. Electronic communications should only be used by physicians in an established patient–physician relationship and with patient consent. Documentation of these communications should be included in patient’s medical records, and physicians should be aware of legal and state medical board requirements for these communications in their state.