Category Archives: Shortage of medical or nursing personnel
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.
Staffing company AMN Healthcare has released the results of its 2013 Survey of Registered Nurses, highlighting generational differences that have implications for the imminent nursing shortage and the shape of the profession in years to come.
Among key findings, nearly 190,000 nurses may leave nursing or retire now that the economy is recovering, and nearly one in four nurses age 55 and older (23 percent) say they will change their work dramatically by retiring or pursuing work in another field.
Fewer than half the RNs with an associate degree or diploma who were surveyed say they will pursue additional education in nursing. However, younger and mid-career nurses are more likely to do so. The landmark Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health, recommends that 80 percent of the nation’s nurses have BSN or higher degrees by the year 2020.
While nurses of all ages say they are very satisfied with their career choice, younger nurses (19-39) are much more positive than nurses 55 and older about the quality of nursing today. Sixty-six percent of nurses 55 and older say they believe that nursing care has generally declined.
“The younger generation is more optimistic about the profession and more receptive to the changes the industry is experiencing,” Marcia Faller, PhD, RN, chief financial officer of AMN Healthcare, told Advance for Nurses. “These are differences that health systems must understand as they work with multiple generations of nurses.”
This was the fourth annual RN survey conducted by AMN Healthcare, which emailed 101,431 surveys in April to opted-in members of NurseZone.com and RN.com. The company received 3,413 responses, reflecting a response rate of 3.36 percent. Statistical analyses were run with a 95 percent confidence threshold.
What do you think about the survey findings? Do they reflect your views about the future of nursing? Register below to leave a comment.
Michael Hochman, MD, MPH, is medical director for Innovation at AltaMed Health Services, a 43-site federally qualified health center in Southern California. He completed the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program at the University of California, Los Angeles, and the U.S. Department of Veterans Affairs in 2012. While a Clinical Scholar, Hochman co-led a primary care demonstration that was published last month in JAMA Internal Medicine. He recently published, 50 Studies Every Doctor Should Know.
Primary care in the United States is at a crossroads. As health care becomes increasingly disjointed and costs continue to rise, primary care providers face increasing pressure to take charge of the health system. Indeed, we know that health care systems with more developed primary care infrastructures are more efficient and of higher quality than those with a weaker primary care foundation.
But at the same time, more and more health care professionals are shying away from careers in primary care. Not only is the work challenging (late-night phone calls, numerous tests and studies to follow up on, ever-increasing regulatory requirements), but the pay is lower than in other fields of medicine.
Human Capital News Roundup: The cost of disposable diapers, toxins in fish, fast food calories, and more.
Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:
WNYC in New York City broadcast an interview with RWJF Community Health Leader Joanne Goldblum about families reusing disposable diapers due to economic hardship. Goldblum, who is founder and executive director of the National Diaper Bank Network, conducted a study that shows how the practice leads to a range of problems for families living in poverty.
When it comes to digital health and new ways to deliver care, the focus should be on the consumer and improving outcomes, not on the technology, according to experts at a recent Connected Health Symposium in Boston, Massachusetts. Mobile Health News reports that Propeller Health (formerly Asthmapolis) CEO David Van Sickle, PhD, MA, an RWJF Health & Society Scholars alumnus, pressed for greater emphasis on outcomes. Read more about Van Sickle’s work here and here.
An American Thoracic Society panel of experts, including RWJF Interdisciplinary Nursing Quality Research Initiative (INQRI) grantee Richard Mularski, MD, is calling for better care for those who suffer severe shortness of breath due to advanced lung and heart disease. The Annals of the American Thoracic Society reports that the panel recommends patients and providers develop individualized actions plans to keep episodes from becoming emergencies, Medical Xpress reports.
In the latest installment in its “Quest for Care” series that looks at the country’s shortage of health care providers, NBC News reported over the weekend on the nursing workforce. As the nation struggles to train enough nurses to care for an aging population and the influx of patients who will be newly insured because of health care reform, one thing is holding them back: a shortage of nurse faculty.
“Just as the country needs nurses the most, a shortage of professors is curbing the capacity of nursing schools to crank out graduates with advanced degrees,” the story says, citing data from the American Association of Colleges of Nursing that nursing schools are turning away tens of thousands of qualified applicants because they lack the faculty to teach them.
The College of Nursing at the University of South Carolina is turning away a few hundred students each year for that very reason, its dean, Jeanette Andrews, told NBC. Andrews, PhD, RN, is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program.
But nurse faculty are hard to find: they need advanced degrees, and leaving the field for the classroom often requires nurses to take a pay cut. Hospitals and other care settings are competing for the same skilled nurses that colleges need, experts say.
“I have five faculty positions open right now,” Andrews added. “It is really hard to find qualified, doctorally prepared faculty who are willing to relocate or to move out of a higher-paying salary in the field.”
Linda H. Aiken, PhD, FAAN, FRCN, RN, is the Claire M. Fagin Leadership Professor in Nursing, a professor of sociology, and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing. She conducts research on the health care workforce and quality of health care in the U.S. and globally. Aiken is a research manager supporting the Future of Nursing: Campaign for Action and a National Advisory Committee member for the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative.
The May 16, 2013 issue of the New England Journal of Medicine features two very different examples of policy analysis on the important issue of the primary care workforce, plus a thoughtful editorial. John Iglehart, a national correspondent for the Journal and a widely acknowledged neutral and astute observer and reporter of contemporary health care, wrote an immensely valuable synthesis and integration of research and published professional opinion on the risks and rewards of expanding the role of nurse practitioners to address the perceived national shortage of primary care. Iglehart organized succinctly the themes and sources of agreement and disagreement emerging from a comprehensive review of 62 published research papers, policy reports, and professional and stakeholder opinions and positions.
In contrast, the second article by usually thoughtful polling enthusiasts seems off the mark and of questionable usefulness. How surprising is it that two-thirds of a very small sample of U.S. primary care physicians agree with the statement that primary care physicians provide a higher quality examination and consultation than nurse practitioners? Is this an example of cognitive dissonance? Nurse practitioners who are required to have a minimum of a Master’s degree have as many years of education as primary care physicians in many peer countries with better health outcomes than the U.S., which must be disconcerting to some U.S. primary care doctors.
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.
This is part of the May 2013 issue of Sharing Nursing's Knowledge.
“National Nurses Week gives us a chance to recognize the contribution of the health care providers at the heart of our health care system. Every day, nurses provide leadership, innovation and advocacy to meet the health care needs of Americans... The health care law’s emphasis on keeping people healthy, preventing illness, and managing chronic conditions, opens new opportunities for nurses to shape and lead the future delivery of healthcare and capitalizes on the expertise of the nursing profession... Please join me in thanking our nation’s nurses for the critical work they do in bringing better care and better health to all Americans.”
-- Health & Human Services Secretary Kathleen Sebelius, HHS Secretary Kathleen Sebelius on National Nurses Week, HHS.gov, May 6, 2013
“There are just over 180,000 APRNs [Advanced Practice Registered Nurses] in the United States, most of them in primary and long-term care ... extensive research finds they are able to handle 80 percent to 90 percent of primary care cases — and achieve outstanding results. APRNs can handle the vast majority of primary and preventive care needs and leave the more complex cases to physicians. This is a win-win situation, that frees nurses and physicians to spend more time with the patients who need them most. Utilizing APRNs provides the fastest and most cost-effective strategy for meeting the health and health care needs of millions more Americans ... Millions of Americans need help maintaining healthy lives or managing chronic conditions. Millions of older people need care in their homes. And millions of soon-to-be-insured patients need a health care provider with the time and training to listen, diagnose and educate. Unleashing the skills of nurse practitioners will improve health care. It is the right thing to do and it is the right time to act.”
-- Sheila Burke, Malcolm Wiener Center for Social Policy, Harvard University, and Future of Nursing: Campaign for Action strategic advisory committee (SAC); and Bill Novelli, McDonough School of Business, Georgetown University, and Future of Nursing: Campaign for Action SAC, Advanced Nurses Lower Costs, Improve Care, Politico, May 6, 2013
In light of concerns about the nation’s shortage of primary care providers—which is likely to be exacerbated as health reform takes effect—many have argued that nurse practitioners (NPs) can help increase capacity. But because state laws about NPs’ scope of practice vary widely, in some places NPs may not be able to help fill the gap and satisfy demand for primary care services.
A new report from the National Institute for Health Care Reform examines the scope-of-practice laws and payment policies that affect how and to what extent NPs can provide primary care. The report examines laws across six states (Arkansas, Arizona, Indiana, Maryland, Massachusetts and Michigan) that represent a range of restrictiveness. The National Institute for Health Care Reform is a nonprofit, nonpartisan organization that conducts health policy research and analysis.
Rather than spelling out specific tasks NPs can perform, scope-of-practice laws generally determine whether NPs must have physician supervision. Requirements for documented supervision—collaborative agreements—are seen “as a formality that does not stimulate meaningful interaction between NPs and physicians,” according to the report. Collaborative agreements can limit how NPs are used in care settings or prohibit them from acting as the sole care provider, and can limit NPs’ range or number of practice settings, which can have serious consequences for underserved rural communities, the report says.
This is part of the March 2013 issue of Sharing Nursing's Knowledge.
For three years, Congress has failed to fund a federal panel that was created to address a dire shortage of health care professionals—and now the news media is beginning to take note.
The unfunded panel broke through the media silence in January when Politico, an inside-the-Beltway publication that covers Congress and the White House, ran a story about it. In February, the New York Times followed up with its own piece.
Officially called the National Health Care Workforce Commission, the panel was created in 2010 under the health reform law to address concerns over a short supply of health care providers at a time when demand is growing, thanks to the aging population and an influx of newly insured people expected to enter the health care system next year.
A leading nurse researcher, Peter Buerhaus, PhD, RN, FAAN, a professor of nursing at Vanderbilt University, was tapped to chair the commission and 15 members were appointed. But Congress never appropriated funds for it—a phenomenon that was noted at a recent hearing before a U.S. Senate subcommittee.
“It’s a disappointing situation,” Buerhaus told the New York Times. “The nation’s health care work force has many problems that are not being attended to. These problems were apparent before health care reform, and they will be even more pressing after health care reform.”