As students settle back into school and the nation finishes its Labor Day celebration, the Robert Wood Johnson Foundation (RWJF) Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? Today’s post is by Elizabeth Wiley, MD, JD, MPH, the national president of the American Medical Student Association and a recent graduate of George Washington University School of Medicine.

Ensuring the health professions workforce is prepared for the challenges to come demands a multifaceted approach. With the Supreme Court’s decision this summer to uphold the Affordable Care Act (ACA), it is more important than ever that our health professions workforce be prepared for health care reform implementation. The statistics detailing the growing demand for health professionals have been well-documented. The Association of American Medical Colleges (AAMC) estimates that there will be a shortage of 124,000 – 159,000 physicians by 2025. But, for medical education, increasing the number of medical graduates alone is likely to be insufficient. Rather, expansions in production could support a higher functioning workforce if accompanied by additional reforms. Five areas identified by the American Medical Student Association for reform include:

•      “Flipping the pyramid” and recalibrating specialty distribution: It is critical that we change the culture of medical education to better value primary care. Under the ACA, there is investment in meaningful opportunities for primary care training through programs like teaching health centers. Changing the specialty-driven culture of many medical schools, however, will also require addressing the primary care-specialty reimbursement rate gap.

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 latest nursing news, research and trends.  Here are descriptions of some of the stories in the July issue:

RWJF Fellow to Become Dean of Duquesne School of Nursing
Mary Ellen Glasgow, PhD, RN, ACNS-BC, the new dean of the school of nursing at Duquesne University, credits the RWJF Executive Nurse Fellows (ENF) program with helping her achieve her career goal. Several members of her ENF cohort are nursing school deans, and they rallied around her upon learning of her desire to join their ranks. Together, they helped prepare her to interview to become dean at Duquesne, even holding a mock interview so she could rehearse answers to potential questions.

Nurse Leaders React to the Supreme Court’s Affordable Care Act Ruling
Read a roundup of nurse leaders’ reactions to the Supreme Court’s ruling on the Affordable Care Act, touching on the law’s impact on patient care and the profession of nursing. Although the decision settles questions about the law’s constitutionality, it did not bridge the political divide over health care reform, including among nurses serving as members of Congress. Read more reactions from nurses and other health leaders in the RWJF Human Capital Blog “carnival” about the decision.

Peter Ubel, MD, is a physician and behavioral scientist.  He is the Madge and Dennis T. McLawhorn University Professor of Business, Public Policy and Medicine at Duke University, an alumnus of the Robert Wood Johnson Foundation (RWJF) Generalist Physician Faculty Scholar program, and the recipient of an RWJF Investigator Award in Health Policy Research.

I come from an ardent Republican family.  Suspicion of government, you could say, runs in my genes.  No surprise then that the first time my parents and siblings heard about Obama’s individual health insurance mandate, they were against it. 

I live in a college town.  Suspicion of Republicans, you could say, lurks in my ‘hood.  No surprise then that in the 1990’s, when the Republicans were proposing alternatives to President Clinton’s health care reform efforts, people in my neighborhood were against it.  Funny thing though: that Republican alternative was based, in part, on the idea of an individual health insurance mandate, an idea my current Chapel Hill neighbors largely support. 

That’s right, in a previous life the individual mandate was a Republican idea and now, in most people’s minds, it is a Democratic one.  Indeed, mere mention of the policy elicits strong emotion from people, even though public opinion polls have consistently shown that the majority of Americans do not understand how the mandate works, or why both parties have, at one time or another, viewed it as a good idea. 

So I decided to make a video with my twelve-year-old son, an unscripted discussion about health insurance (what twelve-year-old wouldn’t want to have that conversation?), to see how easily a middle schooler could understand the rationale for incentivizing people to buy health insurance.

Americans’ visits to physicians had become less frequent in recent years, at least in part because of patients’ financial concerns.  But they’re apparently beginning to pick up again. American Medical News reports that recent data from insurers, consultants and analysts shows physician visit volume has risen, and that patients are reporting fewer problems affording care.

Among the encouraging data points:

- A June research note from analyst Charles Boorady of Citigroup Investment Research shows physician visit volume rose by 4.8 percent over the second quarter of 2012. The number is good news on its own, but the trend line it represents may be just as telling: The comparable quarter of 2011 saw an 8.9 percent decline.
- In a March Gallup poll, 80.9 percent of respondents said they had no problem affording needed health care. Though this number is slightly lower than in February 2011, it is up from the 77.7 percent who responded similarly when the recession hit in late 2008.
- Data from Truven Health Analytics, formerly Thomson Reuters Healthcare, finds that visits to family doctors, internists, ob-gyns and pediatricians rose in May and June.

Though an easing of financial pressures could be behind the rising number of patient visits to physicians’ offices, the American Medical News story notes that some experts think the Affordable Care Act may also be playing a part: Now that many preventive services are covered free of charge, more patients may be seeking out these services.

What do you think? What’s behind the trend in increased physician visits? Is it due to patients’ finances, health reform, both or neither? Register below to leave a comment.

Read the American Medical News story.
Read the RWJF Human Capital Blog’s previous coverage of declines in physician visits here and here.

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. Michelle Scott recently graduated from Rowan University and is an intern at RWJF, working with The Future of Nursing: Campaign for Action.

I’m 22 and uninsured. I’ve only had health insurance for the four years I went to college, and now that I’ve just graduated, I no longer have that luxury. I survived the first 18 years of my life without it, but thanks to the Affordable Care Act, I don’t have to live without it for the rest of my life.

The day I received my college health insurance card in the mail, that flimsy piece of laminated paper with my name on it, I vividly remember thinking, “Wow. I’m allowed to be sick.” During my time at college I never got sick, nor injured in a serious accident of any kind where I actually needed medical attention. There was a brief period where I thought I smashed my hip and orbital bone in a skateboard incident my senior year of college, but after sitting on the ground at the skate park for a minute, and contemplating whether my family could afford to patch me up, I decided to walk it off. From my very early childhood, that’s how I learned to treat any kind of issue: Walk it off, or rest up until you can walk it off.

The Affordable Care Act will allow more Americans to access dental health services, former Surgeon General and Robert Wood Johnson Foundation Clinical Scholars almnus David Satcher, MD, PhD, said recently at forum on unmet oral health needs, but there are concerns that the current dental workforce will not be able to meet the increase in demand. Satcher spoke at “Unmet Oral Health Needs, Underserved Populations, and New Workforce Models: An Urgent Dialogue,” a July 17 forum sponsored by the Morehouse School of Medicine and the Sullivan Alliance.

“We now have an opportunity to dramatically increase coverage,” he said. “But adding dental benefits will not translate into access to care if we do not have providers in place to offer treatment.” More than five million additional children will be entitled to dental health benefits under the Affordable Care Act, according to a news release from the Morehouse School of Medicine.

“I think we need more dentists and I think we need more professionals who are not dentists but who can contribute to oral health care services,” Satcher said.  He was referring to mid-level dental providers, known as dental therapists.

Though improvements have been made in the 12 years since then-Surgeon General Satcher issued a report offering a framework for improving access to oral health, problems persist. Tooth decay is still common among children, he said, and many people do not have easy access to oral health providers.

Read the press release from the Morehouse School of Medicine.

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.  Margaret P. Moss, PhD, JD, RN, FAAN, is associate professor, Yale School of Nursing and an alumna of the RWJF Health Policy Fellows program (2008 – 2009).

As I reflect upon the monumental decision by the Supreme Court to uphold the Affordable Care Act, I can’t help but be awed by how the branches of government are alive and well and operating just as they were designed to work.  But as I filter what this decision will mean for the groups I am most closely tied with professionally and personally, I am struck at how the ‘system’—public and private—has largely let them down.

My professional focus has been in aging, and in particular American Indian aging.  My profession is nursing, with a background in law.  I am optimistic that these groups, both patient and provider, will be lifted and solidified by the spirit of this law.  But I am cautious that the letter of the law must be handled with an eye toward impact, unintended consequences, short-term pilot and demonstration projects, and authorized but unfunded rules.

There can be no question that there are provisions in the Act that no-one would dispute are positive.  The most cited are: 1) no more pre-existing condition exclusions, 2) the ability to keep adult children under parents’ plans until after college age, and 3) widening the net for coverage to include those now uninsured. The opposing point being moot now with the Supreme Court’s decision, we must look forward and responsibly carry out the law before us.  Unfortunately, the devil, as they say, is in the details.

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.