Category Archives: Shortage of medical or nursing personnel
This is part of a series introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio.
New Jersey has a staggering 10.5 percent vacancy rate for nurse faculty.
If those positions are not filled, nursing schools may have to turn away prospective students, which would exacerbate the shortage of nurses required to meet the state’s growing health care needs. That shortage could have a significant negative effect on health and health care in New Jersey.
Additionally, many faculty at New Jersey nursing schools are approaching retirement, and there are not enough people in the pipeline to fill the positions. The situation is dire, but a relatively young statewide initiative is working to change that.
The New Jersey Nursing Initiative (NJNI) is a multi-year, multi-million-dollar project of the Robert Wood Johnson Foundation (RWJF) and the New Jersey Chamber of Commerce Foundation. NJNI’s goal is to increase the number of nurse faculty in the state, so there will be enough nurses to meet the health care needs of New Jersey residents.
Since its launch at a state Senate hearing in May 2009, the initiative has prepared young nursing scholars to take on leadership roles and has brought the issue of the nurse faculty shortage to the attention of policy-makers, businesses, academia, and health and community leaders.
Its signature Faculty Preparation Program is preparing 61 RWJF New Jersey Nursing Scholars to become the next generation of nurse faculty in the state. Of those, at least 21 will be doctorally prepared candidates.
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.
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.
Schools of nursing across the country continued to turn qualified students away in the 2010-2011 school year because of a lack of faculty and clinical sites, a survey from the National League of Nursing (NLN) confirms. The annual survey of nursing schools finds that the percentage of qualified students who were turned away rose between 2009 and 2011 for every post-licensure program type.
“Most strikingly, the percentage of MSN programs turning away qualified applicants jumped by 15 percent over the past two years from just one in three programs to almost half in 2011,” NLN said in a news release about the findings. “These trends threaten to perpetuate a vicious cycle, constraining the number of graduates prepared to take on faculty roles in nursing schools.”
The survey also finds that the percentage of racial-ethnic minority students enrolled in pre-licensure RN programs continued a steady decline from its high in 2009 (from 29 percent to 24 percent). Hispanics remain “dramatically underrepresented” in nursing, making up a mere 6 percent of associate degree and undergraduate nursing students.
The survey had good news on other fronts, however. The percentage of men in basic RN programs increased slightly to 15 percent, and the average age of nursing students—including those in doctoral programs—continues to drop.
Enrollment at U.S. medical schools is growing, according to new data from the Association of American Medical Colleges (AAMC). The annual Medical School Enrollment Survey finds that first-year medical school enrollment is expected to reach 21,376 by 2016, an increase of 29.6 percent since 2002. Combined first-year MD and DO (Doctor of Osteopathic Medicine) enrollment—which has already increased by 28 percent since 2002—is projected to reach 26,709, an increase of 37 percent, by 2016.
Forty-three percent of the schools surveyed say they have plans to target—or have already targeted—specific populations that are underrepresented in medical schools, including minorities and people from disadvantaged backgrounds, rural and underserved communities. Among the tactics the schools are using: scholarships, modified or targeted admissions criteria and outreach efforts, and branch campus locations.
Medical schools are also using other approaches to increase their enrollment and quickly put physicians to work. At least four schools have recently begun offering programs that allow medical students to get degrees in three years, instead of four, American Medical News reports. In addition, a consortium of six schools has applied for a $23 million federal grant from the Center for Medicare and Medicaid Innovation to expand the three-year model to more campuses.
Even as the number of nursing students in the United States increased last year, nursing schools were forced to turn away more than 75,000 qualified applications, primarily because they lacked the teaching faculty and facilities to do otherwise. Those were the good news/bad news findings from this year’s survey of the nation’s nursing schools by the American Association of Colleges of Nursing (AACN).
Despite the number of rejections, the study finds that nursing schools accepted more students at the baccalaureate, master’s and doctoral levels of nursing education last year. Enrollment in entry-level baccalaureate programs increased by 5.1 percent over the previous year. Similarly, enrollment in doctoral nursing programs was up 28.9 percent over the previous year. Applications numbers were up as well, with 255,671 applications submitted to baccalaureate programs, an eight-year high. The figure represented a 5.6 percent increase over 2010, and more than double the number of applications submitted in 2004.
AACN found that 80,767 students graduated from baccalaureate programs last year, including 52,922 from entry-level programs and 27,845 from baccalaureate-degree-completion programs. At the graduate level, 24,311 nursing students received master's degrees last year, while 601 graduated from research-focused doctoral programs and 1,595 from practice-focused doctoral programs.
Student diversity increased, as well. The percentage of entry-level baccalaureate nursing students from underrepresented backgrounds increased to 26.9 percent last year, according to AACN, with master’s and doctoral programs not far behind. Similarly, while men are just 6.6 percent of today’s nursing workforce, they account for 11.4 percent of nursing baccalaureate students and 9.9 percent of master's students.
The New York Times last week reported on how budget cuts are affecting training programs for careers that rely on skills that are in high demand, including nursing.
“Technical, engineering and health care expertise are among the few skills in huge demand even in today’s lackluster job market,” the story reports. “They are also, unfortunately, some of the most expensive subjects to teach.”
At Wake Technical Community College in Raleigh, N.C., for instance, nursing program applicants far outnumber available slots, forcing more than 1,000 students onto a waiting list. A 21-percent cut in state funding has prevented the school from expanding the program to satisfy demand so, instead, the school created a “pre-nursing” program that applicants must complete to stay on the waiting list. But now even that prerequisite program has a waiting list of more than 400 names. Like many other states, North Carolina faces what the New York Times describes as a “severe nursing shortage.”
Budget cuts aren’t the only reason qualified applicants are being turned away from schools of nursing. There aren’t enough nurse faculty to educate all the nurses the country needs. The Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, recommends doubling the number of nurses with master’s and doctoral degrees by 2020 to add to the pool of potential nurse faculty and researchers.
The New Jersey Nursing Initiative (NJNI), a program of the New Jersey Chamber of Commerce Foundation and the Robert Wood Johnson Foundation (RWJF), is working to increase the number of nurse faculty and transform nursing education in the state. NJNI’s Faculty Preparation Program provides generous benefits and support to nurses interested in becoming nurse faculty in the state, as they pursue their post-graduate degrees.
The Foundation also provides career development support for junior nurse faculty members—often stretched thin at schools with limited faculty slots, and paid less than peers who stay in clinical practice—through the RWJF Nurse Faculty Scholars program. It provides three years of mentorship and leadership training, as well as salary and research support to faculty as they begin their careers in academic nursing.
The Department of Health & Human Services (HHS) has awarded $9.1 million to medical students participating in the National Health Service Corps’ Students to Service Loan Repayment Program. In exchange for funds to repay their medical school debts, the 77 students in the pilot program commit to provide primary care services in communities with shortages of health professionals and limited access to care.
After their residencies, participants will spend three years full-time, or six years half-time, working in clinical practice in underserved or rural communities. They can receive annual student loan repayment funds of up to $30,000 while in the program.
The pilot program, created by the Affordable Care Act—the health reform law—aims to help alleviate a shortage of primary care professionals. “This new program is an innovative approach to encouraging more medical students to work as primary care doctors," HHS Secretary Kathleen Sebelius said in a statement.
Read more about the shortage of primary care providers and efforts to recruit primary care physicians in underserved areas.
Convincing a medical student, sometimes tens of thousands of dollars in debt, to take a lower-paying job or move to a low-income, rural community can be a tough sell. So perhaps it’s not surprising that many new physicians gravitate toward high-paying specialties or urban sprawls with modern-day conveniences. But with an aging population and millions of people poised to gain insurance coverage under the health reform law, the nation is in desperate need of general primary care physicians, particularly in rural and underserved areas.
Last week, NPR reported on a technique that one rural community has used successfully to recruit primary care providers – “mission focused medicine.” At the Ashland Health Clinic in southwest Kansas, CEO Benjamin Anderson is recruiting primary care providers not by pointing to all the advantages the community offers, but by highlighting its most severe needs. And to further appeal to prospective providers’ desire to do meaningful work, Anderson offers candidates eight weeks off to do missionary or other service work overseas. Anderson hopes to find providers who are engaged and motivated by the challenges associated with providing care in a rural community.
“When you recruit a mission-focused provider…,” Anderson said, “they want to know that there's no Spanish-speaking provider in more than a one-hour drive. They want to see houses that are falling down, widows that are uncared for. They want to know that there's need and that by them coming there, they would fill a disparity that would otherwise not be filled.”
Specialization also poses a challenge to building the primary-care workforce, the Washington Post reports. A medical resident who chooses a specialty over general primary care has the potential to earn millions more over a lifetime, making it an attractive option to the often deeply in debt medical student.
Last summer the White House launched the Primary Care Residency Expansion, providing financial support for three-year primary care residency training programs at 82 hospitals around the country. Participating residents are required to work in underserved areas. All of the 172 slots funded in the first year of the program have been filled, the story reports.
What do you think? How can we recruit more primary care physicians for general practice or in underserved areas? Register below to leave a comment.
Read the Washington Post story.
Human Capital News Roundup: Nurse faculty shortage, cervical cancer among Latinas, fitness benefits for Medicare beneficiaries, and more.
Here’s a sampling of recent news coverage of the work of Robert Wood Johnson Foundation Scholars and Fellows:
Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows alumna Juliann Sebastian, PhD, RN, FAAN, dean of the College of Nursing at the University of Nebraska Medical Center, wrote an op-ed in the Journal Star about Nebraska’s nursing shortage. “The growing shortage of nurses is not for lack of interest among students,” she writes. “We cannot accept more students, however, for two primary reasons: We lack adequate space to accommodate their instruction, and we do not have enough faculty to teach them.”
Teresa Garrett, MS, RN, also an Executive Nurse Fellows alumna, spoke to the Salt Lake Tribune about the importance of exercise in preventing colds. “We’re always telling people exercise is good for you,” she says. “It builds up your immune system, you are healthier, you drink more water, you do all the things you’re supposed to do.” Garrett is director of disease control and prevention at the Utah Department of Health.
Executive Nurse Fellows alumna Cynthia Barginere, RN, DNP(c), FACHE, vice president and chief nursing officer at Rush University Medical Center in Chicago, spoke to Nurse.com and WSL-TV about the Center’s new 14-story hospital building.
Researchers at UT Medicine, the faculty medical practice of the University of Texas School of Medicine in San Antonio, are looking for healthy, ethnic minorities in South Texas to participate in a research trial on the health effects of taking baby aspirin every day, according to the Southside Reporter. RWJF Harold Amos Medical Faculty Development Program scholar Sara Espinoza, MD, is the lead investigator for the “Aspirin in Reducing Events in the Elderly” study.
Zane Gates, MD, an RWJF Community Health Leader, spoke to WTAJ-TV about changes to eligibility criteria for food stamps in Pennsylvania – changes driven by state and federal funding cutbacks. The new criteria will reduce the number of state residents who qualify for assistance. Gates runs a free clinic in Altoona, and many of his patients receive food stamps, the station reports.