Lori Melichar Gadkari, PhD, MA, is a senior program officer at the Robert Wood Johnson Foundation (RWJF), in the Research and Evaluation Unit.

Yesterday the New England Journal of Medicine published the results of a study co-funded by the Robert Wood Johnson Foundation, Johnson & Johnson, and the Gordon and Betty Moore Foundation. “Perspectives of Physicians and Nurse Practitioners on Primary Care Practice” finds that 96 percent of nurse practitioners and 76 percent of physicians agreed with the Institute of Medicine report recommendation that “nurse practitioners should be able to practice to the full extent of their education and training.” The new study is authored by Karen Donelan, ScD, EdM, Catherine M. DesRoches, DrPH, Robert S. Dittus, MD, MPH, and Peter Buerhaus, PhD, RN.

When asked how increasing the supply of nurse practitioners would potentially affect the United States health care system, the authors found that the majority of physicians (73%) said increasing the supply of primary care nurse practitioners (PCNPs) would lead to improvements in the timeliness of care. A much smaller majority of physicians (52%) said increasing the supply of PCNPs would lead to improvements in access to care for people in the country. 

However, the new survey found significant disagreement between primary care physicians and PCNPs about whether increasing the supply of PCNPs would improve patient safety and the effectiveness of care, and whether it would reduce costs. There was also a large professional divide about proposed changes to PCNPs’ scope of practice, putting PCNPs in leadership roles, and the quality of care that PCNPs provide.

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.

An annual Physician Retention Survey from Cejka Search and the American Medical Group Association (AMGA) finds that medical groups had an average physician turnover rate of 6.8 percent in 2012, up from 6.5 percent in 2011 and the highest rate since 2005. The increased turnover correlates with the nation’s economic recovery; improvements in the housing market and recovery in stock prices may have made physicians more likely to move or retire, experts say.

The survey, which drew responses from 80 medical organizations that collectively employ more than 19,000 physicians, also finds that medical groups expect an increase in turnover in the coming year due to accelerating retirement and competition to hire and retain top physicians. Seventy-six percent of respondents plan to hire more primary care physicians in the next 12 months.

“The survey findings provide evidence that recruitment and retention continue to be major challenges for health systems,” Donald W. Fisher, PhD, CAE, president and chief executive officer of AMGA, said in a news release about the survey. “To rise to these challenges, medical groups are demonstrating remarkable leadership by investing in new staffing and delivery models, building and nurturing their teams in a strategic way, and making accountable care work for their patients and their communities.”

For the second year, the survey also asked about turnover among advanced practice clinicians, including physician assistants and nurse practitioners. That turnover rate in 2012 was 11.5 percent, essentially unchanged from the previous year.

Read more about the survey.

Antoinette L. Laskey, MD, MPH, FAAP, is an associate professor of pediatrics and division chief and medical director at the Center for Safe and Healthy Families at the Primary Children’s Medical Center at the University of Utah in Salt Lake City. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program (2001-2003).

During medical school at the University of Missouri-Columbia, I had my first exposure to child abuse pediatrics.  As a third-year student on my pediatrics clerkship, I had the opportunity to participate in the care of a child whom I suspected had been beaten.  From that point forward I knew this was where I wanted to spend my career. 

I started looking into fellowship opportunities even before I had started my residency.  Early in my intern year in 1998, I reached out to Des Runyan, MD, DrPH, a pioneer in child abuse pediatrics and an alumnus of the RWJF Clinical Scholars program (1979-1981) who was then at University of North Carolina at Chapel Hill and who is now national program director of the RWJF Clinical Scholars program.  We arranged a visit so that I could learn more about the field through his expert eyes.

Before child abuse pediatrics was recognized as an official subspecialty of pediatrics, there were two different paths to enter practice: a one-year “apprenticeship” or a two-year clinical and research fellowship.  In my short visit to Chapel Hill, it became apparent to me that an RWJF Clinical Scholars position was the way I needed to go to not only practice in the field of child abuse pediatrics but to also gain the knowledge base necessary to move the field forward. 

The American Indian Physicians and Association of American Medical Colleges will host a Cross Cultural Medicine Workshop, March 1-3 in Washington, D.C. The workshop is designed to provide physicians, faculty, medical students, health care professionals, and others with a greater understanding of Western and Traditional Medicine in order to enhance their cultural competence.

Participants will learn to identify strategies to improve cultural competency and communication between American Indian/Alaska Native patients and health care professionals, and learn about the role of traditional healers and the American Indian/Alaska Native approaches to healing and health.

The Association of American Medical Colleges provides technical assistance to the Robert Wood Johnson Foundation Summer Medical and Dental Education Program.

Learn more and register here.

Four in 10 physicians say their typical patient load “exceeds safe levels” at least once a month, causing the quality of care they provide to suffer, according to a study by researchers at Johns Hopkins University, published online in the Journal of the American Medical Association (JAMA). More than one-third of physicians (36%) reported their workloads exceeded safe levels at least weekly.

In the survey of more than 500 self-identified hospitalists in an online physician community, respondents said their workloads had caused patient care to suffer. Respondents reported that inadequate time with a patient had caused them to order potentially unnecessary tests or procedures, and that their workloads had “likely contributed” to a host of poor patient outcomes, including morbidity and mortality.

Among the other problems physicians attributed to excessive workloads: inability to fully discuss treatment options; delayed admissions and discharge; increased readmissions; worsened patient satisfaction; and worsened overall quality of care.

Read the study abstract.
Read more about the results in Medpage Today [free subscription required].

Andrea Gottsegen Asnes, MD, MSW, is an assistant professor of pediatrics at the Yale School of Medicine and a Robert Wood Johnson Foundation (RWJF) Clinical Scholars program alumnus (2001-2003).

Human Capital Blog: What kind of work do you do in the area of child abuse pediatrics?

Andrea Gottsegen Asnes: I am a child abuse pediatrician.  Nearly eight years ago, I joined former Robert Wood Johnson Foundation (RWJF) Clinical Scholar and fellow child abuse pediatrician John Leventhal, MD, as a member of the faculty of the Yale School of Medicine. In 2009, we both became board certified in the new pediatric sub-board of child abuse pediatrics. At Yale, I am the associate director of the Yale Child Abuse and the Yale Child Abuse Prevention programs.

Most often, I am asked to evaluate suspected cases of child abuse by other medical colleagues, by my state’s child protective services agency, or by local police departments. I am frequently asked to testify in court as a medical expert in cases of suspected child maltreatment. I also participate in several multidisciplinary, community-based teams that are designed to improve both criminal prosecutions of those who abuse children as well as the care that abused children receive. 

I have a particular interest in optimizing recognition of subtle signs of physical abuse by frontline pediatric providers, and I teach on this subject regularly. I also have a special interest in linking abused children and their non-offending caregivers to mental health treatment. In 2006, I started the Bridging Program, which provides immediate, evidence-based mental health care to sexually abused children and their non-offending family members. My hope for the future is to devote increasingly more time to work in child abuse treatment and prevention.

A report completed this month by the Congressional Research Service (CRS), which conducts analysis for members and committees of Congress, examines how the Affordable Care Act (ACA) will affect the nation’s supply of physicians. In particular, the report focuses on the workforce’s size, composition and geographic distribution.

Size
The health care system cannot work effectively or efficiently without a physician workforce of appropriate size. Too few physicians means delayed care, and too many physicians can mean unnecessary or duplicate care. But measuring the size of the physician workforce—and the future physician population—is challenging, and estimates vary. The CRS report notes that “predicting the timing, content, and effect of policy change is difficult, which adds to the uncertainty of the projections.”

The ACA authorizes funding for additional medical residency training programs through the Health Resources and Services Administration (HRSA) and the ACA’s own Prevention and Public Health Fund. It requires that Medicare-funded residency training slots be redistributed from hospitals that are not using them or that have closed, to hospitals seeking to train additional residents. It also includes provisions designed to increase physician productivity and the volume of physician services available. The law encourages care coordination—in medical homes and accountable care organizations, for example—and expands the non-physician workforce that can augment or substitute for physician services.

The Robert Wood Johnson Foundation (RWJF) provides grants for people and projects in the United States and U.S. territories that advance the Foundation’s mission to improve the health and health care of all Americans. The following are the current funding opportunities from RWJF’s Human Capital portfolio:

RWJF Nurse Faculty Scholars
The RWJF Nurse Faculty Scholars program is working to develop the next generation of national leaders in academic nursing through career development awards for outstanding junior nursing faculty. The program aims to strengthen the academic productivity and overall excellence of nursing schools by providing mentorship, leadership training, and salary and research support to young faculty. Applicants must be registered nurses who have achieved high levels of education and nursing research, and must be in an academic position that could lead to tenure for at least two years and no more than five years at the start of the program. Up to 12 awards will be given. The deadline is February 12, 2013. Learn more.

RWJF Clinical Scholars
The RWJF Clinical Scholars program, a collaboration of RWJF and the U.S. Department of Veterans Affairs, seeks to foster the development of physicians who will lead the transformation of Americans’ health and health care. These future leaders will conduct innovative research and work with communities, organizations, practitioners and policy-makers to address issues essential to the health and well-being of all Americans. Eligible applicants must be committed to a career in academic medicine, public health, health policy or another career congruent with the program’s purposes and priorities of developing physician leaders and skilled researchers; applicants must also have completed the clinical requirements of their residency training by the date of entry into the program. Up to 20 applicants will be selected in 2013 for an appointment beginning in summer 2014. The deadline is February 28, 2013. Learn more.

See all the current calls for proposals from the Robert Wood Johnson Foundation.

Brendan T. Campbell, MD, MPH, is an assistant professor of surgery and pediatrics at the University of Connecticut School of Medicine and an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program (2000-2002).

Human Capital Blog: What kind of work do you do in the area of child abuse pediatrics?

Brendan Campbell: I am a pediatric general and thoracic surgeon and the medical director of the pediatric trauma program at Connecticut Children’s Medical Center in Hartford. Connecticut Children’s is a Level I pediatric trauma center, which means we see patients with relatively minor and severe multisystem injuries. Caring for abused children is one of the most important services we provide. When children with non-accidental trauma are initially identified, they are admitted to the pediatric surgical service to rule out life-threatening injuries. During their admission we work closely and collaboratively with the suspected child abuse and neglect team (SCAN) to make sure children with inflicted injuries are identified, have their injuries treated, and are kept out of harm’s way.

HCB: Why did you decide to focus on this area?

Campbell: It can be challenging to get a pediatric surgeon interested in child abuse because caring for vulnerable children who are intentionally harmed is not easy, and most of these kids don’t have life-threatening injuries that require an operation. What draws me to the care of injured children is that they are the patients who need me the most.  If we don’t identify the risks they are up against at home, no one else will. They need someone to advocate for them.

The other thing that draws me to child abuse pediatrics is that there is an enormous need to develop better ways to screen for and to prevent abuse.  Over the last 30 years we’ve made enormous strides in lowering the number of children injured in car crashes by enacting seat belt laws, toughening drunk-driving laws, and improving graduated driver licensing systems. Child abuse in the United States, however, remains a significant public health problem that needs more effective screening initiatives and prevention programs.