Category Archives: Workforce issues
More than half of the 50 jobs projected to be the nation's fastest-growing occupations over the next several years are in the health care industry, according to a new report from the human resources company CareerBuilder and its research affiliate, Economic Modeling Specialists International.
Among the 26 health care jobs in the top 50, the ones with growth rates of 15 percent or greater include biomedical engineers, personal care and home health aides, physical therapy and occupational therapy assistants, physical therapy aides, diagnostic medical sonographers, and medical scientists (except epidemiologists).
Foreign-educated and foreign-born health professionals play a vital role in providing patient care in this country, but strategic shifts such as changes in immigration laws may be needed to stabilize the nation’s health workforce, according to a new RAND Corporation study.
The two groups fill important gaps, particularly among primary care physicians, nurses in hospital settings, and other areas with worker shortages, according to findings published in the November issue of Health Affairs.
However, continuing to rely on foreign-educated and foreign-born health workers may reduce incentives for the nation to address problems such as the inadequate supply of primary care physicians. This, in turn, could lead to a less-stable U.S. health care workforce, researchers said.
The Association of American Medical Colleges (AAMC) has released its 2013 State Physician Workforce Data Book, a biennial report that examines current physician supply, medical school enrollment, and graduate medical education in the United States.
Between 2008 and 2012, there were small increases in the state median number of active physicians and active patient-care physicians, the state median percentage of female physicians, and the percentage of physicians age 60 or older. While the median number of students enrolled in undergraduate medial education has increased relative to the population, the number of students enrolled in graduate medical education per population has remained flat.
Among key findings, in 2012 there were 260.5 active physicians per 100,000 population in the United States, ranging from a high of 421.5 in Massachusetts to a low of 180.8 in Mississippi. The states with the highest number of physicians per 100,000 population are concentrated in the Northeast.
This is part of the November 2013 issue of Sharing Nursing's Knowledge.
Creating Healthy Workspaces for Older Nurses
The nursing workforce is aging, in part because the nation's economic difficulties have prompted some nurses to delay retirement. A new literature review by Jaynelle Stichler, DNSc, NEA-BC, FACHE, of the San Diego State University School of Nursing, examines ways hospital work environments might be fine-tuned to help older nurses navigate the health challenges associated with their physically demanding work. The article was published online on October 17 by the Journal of Nursing Management.
Noting that Centers for Disease Control & Prevention data indicate that older workers' on-the-job injuries tend to be more severe than those suffered by younger workers, Stichler offers recommendations culled from 25 separate studies conducted since 2002. They include:
- Ergonomic seating and countertops with the correct height for charting tables, and adequate space for keyboards, in order to prevent strains caused by working in improper body positions;
- Adequate lighting and non-slip floor surfaces to reduce the risk of falling;
- Decentralized linen, equipment, and supply storage in or near patient rooms, and decentralized nursing stations, in order to diminish walking distances;
- Electrical and medical gas outlets placed on either side of the patients' beds and at an easily accessible height, rather than behind or above the head of the bed, so that nurses won't have to strain to plug in equipment;
- Enhanced task lighting options over beds or on swing arms to ease eye strain and help nurses with visual acuity problems; and
- Barrier-free patient bathroom and shower designs, with floor drains and shower curtains, so nurses needn't use towels to mop up water.
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.
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More students than ever applied to and enrolled in the nation’s medical schools this year, according to data released by the Association of American Medical Colleges (AAMC).
Compared with last year’s figures, the total number of medical school applicants grew by 6.1 percent to 48,014, surpassing the previous record, set in 1996, by 1,049 students. Another important indicator of interest in medicine is first-time applicants, and they increased by 5.8 percent to 35,727 this year. The number of students enrolled in their first year of medical school exceeded 20,000 for the first time (20,055), a 2.8 percent increase over 2012.
“At a time when the nation faces a shortage of more than 90,000 doctors by the end of the decade and millions are gaining access to health insurance, we are very glad that more students than ever want to become physicians,” AAMC President and CEO Darrell G. Kirch, MD, said in a news release. “Students are doing their part by applying to medical school in record numbers. Medical schools are doing their part by expanding enrollment.” Kirch pushed for an expansion of residency training to accommodate the greater number of students studying to become physicians.
By Harvey V. Fineberg, MD, PhD, president of the Institute of Medicine, and Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation. This commentary originally appeared on the Institute of Medicine website.
Three years ago, the Institute of Medicine (IOM) released its landmark report The Future of Nursing: Leading Change, Advancing Health, made possible by the support of the Robert Wood Johnson Foundation (RWJF). In light of the tremendous need for nurses in health care today and in the future — due to the growing numbers of people with chronic diseases, an aging population, and the need for care coordination — the report provided a blueprint for how to transform the nursing profession. Recommendations put forth by the report committee included removing barriers to practice and care, expanding opportunities for nurses to serve as leaders, and increasing the proportion of nurses with a baccalaureate degree to 80 percent by 2020.1
Spurred by the 2010 IOM report, RWJF and AARP partnered to establish the Campaign for Action, an initiative to mobilize action coalitions in all 50 states and the District of Columbia to utilize nurses more effectively in confronting the nation’s most pressing health challenges. Although we have made measurable progress in the past 3 years, we have more work to do to fully realize the potential of qualified nurses to improve health and provide care to people who need it.
Although more hospitals and health care systems have been hiring physicians in recent years, more than half of the nation’s physicians are still self-employed. A survey from the American Medical Association finds that 53.2 percent of physicians were self-employed in 2012 and 60 percent worked in practices that were wholly owned by physicians.
The survey also found that only 5.6 percent of physicians were directly employed by a hospital. Twenty-three percent worked in practices that were at least partially owned by a hospital.
Although the researchers conclude hospital employment is part of a national trend, the data “offers an update on the status of physician practice arrangements, and allows for a nationally representative response to the numerous articles of the past several years that have highlighted a surge in the employment of physicians by hospitals and the ‘death’ of private practice.”
The data comes from the 2012 Physician Practice Benchmark Survey, a nationally representative random sample of post-residency physicians who provide at least 20 hours of patient care per week.
The Accreditation Council for Graduate Medical Education’s decision to limit the working hours of medical residents has not increased patient mortality rates, but it has decreased the time residents spend on direct patient care, according to two studies published in the August issue of the Journal of General Internal Medicine.
Researchers from the University of Pennsylvania studied 13.7 million Medicare patients admitted to hospitals between 2000 and 2008. In the first three years after the Accreditation Council enacted an 80-hour work week for residents in 2003, the researchers found no significant changes in patient mortality within 30 days of admission.
“We can reassure the public that patients did not appear to be harmed by the initial duty hour reform of 2003,” senior study author Jeffrey Silber, MD, PhD, told American Medical News. “We have published many papers prior to this looking at other outcomes [including prolonged length of stay following 2003 duty hour reform], and we have found similar results.”
A second change in resident hours came in 2011, when the Accreditation Council limited residents’ maximum shift length to 16 hours, down from 30. Researchers at Johns Hopkins University and the University of Maryland found that this change contributed to a reduction in the amount of time residents spent on direct patient care. Studies conducted in 1989 and 1993 found an average of 18 to 22 percent of residents’ time was spent on direct patient care; the new study finds residents only spent 12 percent of their time on direct patient care—or about eight minutes per patient, per day—in 2012.
Residents spent most of their time (64 percent) on indirect patient care tasks, such as talking with other health professionals, reviewing charts, and handoffs, the study concluded. Lead author Lauren Block, MD, MPH, told American Medical News that while residents aren’t spending as much time eating and sleeping at hospitals, “that time is not being made up spending time with patients, because they spend that time instead working at their computer stations.”