Category Archives: Physician Workforce
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.
In 2011, the Accreditation Council for Graduate Medical Education (ACGME) limited shifts for first-year medical residents, or interns, to 16 hours, in an effort to improve their well-being. But two studies published online this week in the Journal of the American Medical Association (JAMA) find that these regulations may not be improving resident well-being—and that they may be decreasing both the quality of care they provide and their educational opportunities.
Although interns worked fewer hours after implementation of the shift length restriction in 2011, researchers found no change in their sleep duration or symptoms of depression. That study, led by Srijan Sen, MD, PhD, of the University of Michigan in Ann Arbor, also found an increase in self-reported medical errors among interns (from 20% in 2009 to 23% in 2011). The researchers hypothesize that the increase in errors may be due, in part, to interns having to perform more handoffs—where medical errors are known to occur—and to a lack of additional clinical staff that may mean “residents [are] expected to complete the same amount of work as previous cohorts but in less time.”
Another study, led by Sanjay V. Desai, MD, of Johns Hopkins University, also found “unintended consequences” of duty hour regulations. Although that study found more consistent sleep patterns for interns, it also found that nurses, as well as the interns themselves, believed the quality of patient care suffered. Desai’s research team found a concerning balance between the interns’ workload and their time spent on educational activities. “Concerns have been raised about the competency achievable with less hospital experience during any fixed duration of training,” they write. “Opportunities were reduced with restricted shifts, many of which occur solely during evening hours, precluding participation in traditional core educational components of medicine residency programs, such as noontime conference and morning rounds.”
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.
More U.S. medical students “matched” to primary care residency positions this year than in 2012, according to data from the National Resident Matching Program (NRMP). Almost 400 more students chose primary care fields— internal medicine, family medicine, and pediatrics—than last year. NRMP is a private, non-profit organization established in 1952 to provide a mechanism for matching the preferences of applicants for U.S. residency positions with the preferences of residency program directors.
Of the 17, 487 graduating seniors who participated in Match Day 2013, 3,135 matched to internal medicine—a 6.6 percent increase from last year. The number of seniors who matched to pediatrics (1,837) represents a 105 percent increase over last year.
This year’s Main Residency Match was the largest in NRMP history, with more than 40,000 student and independent registrants. NRMP attributes the increase to three new medical schools graduating their first classes, and expanded enrollment in existing medical schools.
Conducted annually by the NRMP, The Match uses a computerized mathematical algorithm to align the preferences of applicants with the preferences of residency program directors in order to fill the training positions available at U.S. teaching hospitals.