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New Physician Workforce Projections Show the Doctor Shortage Remains Significant

March 5, 2015 Comments off

New Physician Workforce Projections Show the Doctor Shortage Remains Significant
Source: Association of American Medical Colleges

The nation will face a shortage of between 46,000-90,000 physicians by 2025, according to a report released today by the AAMC (Association of American Medical Colleges). The study, which is the first comprehensive national analysis that takes into account both demographics and recent changes to care delivery and payment methods, projects shortages in both primary and specialty care, with specialty shortages particularly acute.

Notes from the Field: Prevalence of Risk Factors for Suicide Among Veterinarians — United States, 2014

February 24, 2015 Comments off

Notes from the Field: Prevalence of Risk Factors for Suicide Among Veterinarians — United States, 2014
Source: Morbidity and Mortality Weekly Report (CDC)

Veterinarians are believed to be at increased risk for suicide compared with the general population. Few data on the occurrence of suicidal behavior and suicide risk factors among U.S. veterinarians are available. Veterinarians participating in two wellness summits held during September 2013 concluded that more research is needed on veterinarians and their mental health.

During July 1–October 20, 2014, an anonymous, Web-based questionnaire was made available through the Veterinary Information Network (VIN), an online community for veterinarians; VIN News Service; JAVMA News; and monthly e-mail messages to veterinarians in 49 states (Maine was excluded) and Puerto Rico sent through the state’s veterinary medical association, agriculture or livestock department, or health department. The questionnaire asked respondents about their experiences with depression and suicidal behavior, and included standardized questions from the Kessler-6 psychological distress scale that assesses for the presence of serious mental illness. Respondents with nonresponses were included in the denominators when calculating prevalence estimates.

Responses were received from 10,254 currently employed veterinarians (10.3% of all employed U.S. veterinarians). The most commonly reported age category was 30–39 years (28.8%), and 31.3% were male. Thirty-four percent reported practicing veterinary medicine for <10 years, 24.6% for 10–19 years, 21.6% for 20–29 years, and 19.8% for ≥30 years. Most (68.6%) respondents practiced small animal medicine, and 37.8% were practice owners. In comparison, 44.4% of U.S. veterinarians are male, and 66.6% practice small animal medicine exclusively.

Approximately 6.8% (95% confidence interval [CI] = 5.9%–7.7%) of male and 10.9% (CI = 10.2%–11.6%) of female respondents were characterized as having serious psychological distress based on the Kessler-6 psychological distress scale, compared with 3.5% of male and 4.4% of female U.S. adults, respectively (5). Since graduating from veterinary school, 24.5% and 36.7% (CIs = 23.0%–26.0%, 35.6%–37.8%) of male and female respondents reported experiencing depressive episodes, respectively, 14.4% and 19.1% (CIs = 13.2%–15.7%, 18.2%–20.0%) suicidal ideation, and 1.1% and 1.4% (CIs = 0.7%–1.5%, 1.2%–1.7%) suicide attempts. In comparison, male and female U.S. adults had a lower lifetime prevalence of depressive episodes (15.1% and 22.9%, respectively) and suicidal ideation (5.1% and 7.1%) but a higher prevalence of suicide attempts (1.6% and 3.0%).

The findings in this report are subject to at least two limitations. First, the small number of veterinarians who responded compared with the number of those potentially eligible increases the likelihood of nonresponse bias. Second, the possibility exists for social desirability bias. Both of these factors could lead to overestimation or underestimation of the actual prevalence of risk factors for suicide among U.S. veterinarians. Nevertheless, these data suggest that nearly one in 10 U.S. veterinarians might suffer from serious psychological distress and more than one in six might have experienced suicidal ideation since graduation. Additional data, particularly data from representative samples, are needed to further characterize the underlying risk factors for suicidal behavior among veterinarians and identify effective prevention methods.

Divorce among physicians and other healthcare professionals in the United States: analysis of census survey data

February 20, 2015 Comments off

Divorce among physicians and other healthcare professionals in the United States: analysis of census survey data
Source: British Medical Journal (BMJ)

Objectives
To estimate the prevalence and incidence of divorce among US physicians compared with other healthcare professionals, lawyers, and non-healthcare professionals, and to analyze factors associated with divorce among physicians.

Design
Retrospective analysis of nationally representative surveys conducted by the US census, 2008-13.

Setting
United States.

Participants
48 881 physicians, 10 086 dentists, 13 883 pharmacists, 159 044 nurses, 18 920 healthcare executives, 59 284 lawyers, and 6 339 310 other non-healthcare professionals.

Main outcome measures
Logistic models of divorce adjusted for age, sex, race, annual income, weekly hours worked, number of years since marriage, calendar year, and state of residence. Divorce outcomes included whether an individual had ever been divorced (divorce prevalence) or became divorced in the past year (divorce incidence).

Results
After adjustment for covariates, the probability of being ever divorced (or divorce prevalence) among physicians evaluated at the mean value of other covariates was 24.3% (95% confidence interval 23.8% to 24.8%); dentists, 25.2% (24.1% to 26.3%); pharmacists, 22.9% (22.0% to 23.8%); nurses, 33.0% (32.6% to 33.3%); healthcare executives, 30.9% (30.1% to 31.8%); lawyers, 26.9% (26.4% to 27.4%); and other non-healthcare professionals, 35.0% (34.9% to 35.1%). Similarly, physicians were less likely than those in most other occupations to divorce in the past year. In multivariable analysis among physicians, divorce prevalence was greater among women (odds ratio 1.51, 95% confidence interval 1.40 to 1.63). In analyses stratified by physician sex, greater weekly work hours were associated with increased divorce prevalence only for female physicians.

Conclusions
Divorce among physicians is less common than among non-healthcare workers and several health professions. Female physicians have a substantially higher prevalence of divorce than male physicians, which may be partly attributable to a differential effect of hours worked on divorce.

See also: Doctors and divorce (editorial)

Tapping Nurse Practitioners to Meet Rising Demand for Primary Care

February 17, 2015 Comments off

Tapping Nurse Practitioners to Meet Rising Demand for Primary Care
Source: Kaiser Family Foundation

Over 58 million Americans reside in geographic areas or belong to population groups that are considered primary care shortage areas. In these areas, known officially as primary care Health Professional Shortage Areas (HPSAs), the supply of primary care physicians relative to the population falls below federally defined standards.1 The proportion of Americans living in HPSAs varies widely by state, from 1.4% (Nebraska) to 57.3% (Mississippi), but in almost half the states, it is at least 20%, including six states (including DC) where it exceeds 30%.

The demand for primary care is projected to rise over the next five years, due largely to population growth and aging, and to a smaller extent, to expanded health insurance.2 The Health Resources and Services Administration (HRSA), the federal agency focused on improving access to care and strengthening the health care workforce, projects a shortage of 20,400 primary care physicians in 2020, and other experts, too, have projected a large shortfall in the coming years.3 4 However, a recent Institute of Medicine (IOM) report on shaping the health care workforce for the future noted that such projections of primary care physician shortages are generally based on traditional health care delivery models and do not consider the potential of an expanded primary care role for physician assistants and advanced-practice nurses, redesign of health care, telehealth, and other innovations.5 This brief focuses on the untapped potential of one type of advanced-practice nurses – nurse practitioners – to increase access to primary care.

CBO — Medicare’s Payment to Physicians: the Budgetary Effects of Alternative Policies Relative to CBO’s January 2015 Baseline

February 5, 2015 Comments off

Medicare’s Payment to Physicians: the Budgetary Effects of Alternative Policies Relative to CBO’s January 2015 Baseline
Source: Congressional Budget Office

The table, Medicare’s Payment to Physicians: the Budgetary Effects of Alternative Policies, includes estimates for several replacement and short-term alternatives to the current rules for setting Medicare’s payment rates for physicians’ services. The starting date for all of these alternative policies would be April 1, 2015.

The table includes an updated estimate for H.R. 4015 and S. 2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, which are identical bills introduced on February 6, 2014. This updates the CBO cost estimate of that legislation for the April 2014 baseline—which incorporates H.R. 4302, the Protecting Access to Medicare Act of 2014 (Public Law 113-93), enacted on April 1, 2014—and the final physician fee schedule rule.

Fatigued Nurses: Assessing the Risk, Implementing the Defenses

February 2, 2015 Comments off

Fatigued Nurses: Assessing the Risk, Implementing the Defenses (PDF)
Source: Circadian

Sleep deprivation and fatigue are an ever-present challenge for health care workers. Thus far, most of the attention has been paid to sleep-deprived resident physicians and their increased risks of diagnostic errors, 1 needlestick injuries2 and complications in post-surgical patients, 3 which culminated in the 2011 decision by the Accreditation Council for Graduate Medical Education to limit resident duty hours. 4 However, fatigue represents a similar high-risk occupational health and safety exposure for nurses.

Many factors are converging today to increase fatigue risks and costs in the nursing profession, and the need to address nurse fatigue has never been more urgent. The increasing cognitive skill demands of medical technology, the rapidly expanding patient loads resulting from the enactment of national health care, and the need to retain experienced nurses in the workforce make addressing fatigue, and sustaining nurse alertness and job performance around-the–clock, a vitally important issue.

Hat tip: IWS Documented News Service

New From the GAO

January 30, 2015 Comments off

New GAO Reports
Source: Government Accountability Office

1. Defense Health Care: Additional Information Needed about Mental Health Provider Staffing Needs. GAO-15-184, January 30.
http://www.gao.gov/products/GAO-15-184
Highlights – http://www.gao.gov/assets/670/668209.pdf

2. Federal Workforce: OPM and Agencies Need to Strengthen Efforts to Identify and Close Mission-Critical Skills Gaps. GAO-15-223, January 30.
http://www.gao.gov/products/GAO-15-223
Highlights – http://www.gao.gov/assets/670/668203.pdf

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