Review of Current Healthcare Issues
Order Instructions
pls read below and see attached rubrics
If you were to ask 10 people what they believe to be the most significant issue facing healthcare today, you might get 10 different answers. Escalating costs? Regulation? Technology disruption?
These and many other topics are worthy of discussion. Not surprisingly, much has been said in the research, within the profession, and in the news about these topics. Whether they are issues of finance, quality, workload, or outcomes, there is no shortage of changes to be addressed.
In this Discussion, you examine a national healthcare issue and consider how that issue may impact your work setting. You also analyze how your organization has responded to this issue.
To Prepare:
Review the Resources and select one current national healthcare issue/stressor to focus on.
Reflect on the current national healthcare issue/stressor you selected and think about how this issue/stressor may be addressed in your work setting.
https://www.sciencedirect.com/science/article/abs/pii/S8755722316301132?via%3Dihub
Growing Ranks of Advanced Practice Clinicians — Implications for the Physician Workforce
Auerbach, David I, PhD; Staiger, Douglas O, PhD; Buerhaus, Peter I, PhD, RN. The New England Journal of Medicine; Boston Vol. 378, Iss. 25, (Jun 21, 2018): 2358-2360. DOI:10.1056/NEJMp1801869
Abstract
Nurse practitioners and physician assistants are providing an increasing share of health care services, and education programs have proliferated. These dynamics will have lasting effects on the health care workforce and on relationships among health professionals.
Full Text
0:00 /0:00
Throughout the history of modern American medicine, physicians have made up the vast majority of professionals who diagnose, treat, and prescribe medication to patients. Although demand for medical services has increased markedly over the years (and is projected to grow more rapidly as the population ages), the physician supply has grown relatively slowly. Increased delegation of work, new technology, and streamlined care processes can help practices meet patient needs with fewer physicians, but still require an increasing number of health professionals.1
Physician supply is constrained in the short run by long training times and in the longer run by medical school capacity and the number of accredited residency positions. Despite a 16% increase in graduate medical education (GME) slots in recent years, the Association of American Medical Colleges (AAMC) recently projected that the supply of physicians will increase by only 0.5% per year between 2016 and 2030.
A growing share of health care services are being provided by advanced practice registered nurses (APRNs), particularly nurse practitioners (NPs), who make up the majority of APRNs, and by physician assistants (PAs). NPs and PAs provide care that can overlap with care provided by physicians (both in primary care and increasingly in other specialties), and the AAMC recognizes this overlap in its physician-demand forecasts. The number of NPs and PAs is growing rapidly, in part because of shorter training times for such providers as compared with physicians and fewer institutional constraints on expanding educational capacity. Residencies aren’t required for APRNs — though organizations are increasingly offering them — and education programs have proliferated: according to the American Association of Colleges of Nursing, the number of NP degree programs (master’s or doctorate) grew from 282 to 424 between 2000 and 2016. Baccalaureate-prepared RNs typically require 2 to 3 years of graduate education to become certified NPs. PA programs typically take 2 years and also don’t require residencies. According to the National Center for Education Statistics, the number of PA degree programs grew from 135 to 238 between 2000 and 2016.
These dynamics will have lasting effects on the composition of the health care workforce and on working relationships among health professionals. To take a closer look at these trends, we estimated the number of full-time-equivalent physicians, NPs, and PAs between 2001 and 2016 using data from the U.S. Census Bureau’s American Community Survey, which included a roughly 0.4% sample of the U.S. population between 2001 and 2004 and a 1% sample between 2005 and 2016. Because the Census didn’t identify NPs until 2010, we obtained data on NPs from the National Sample Survey of Registered Nurses from 2000, 2004, and 2008. Figures were validated using data from health professional associations. The final data set includes 12,887 NPs, 12,801 PAs, and 166,103 physicians.
These data were used to project the number of NPs, PAs, and physicians through 2030 using methods described in greater detail elsewhere.2 Briefly, our model estimates the number of providers of various ages in each year as a function of both workforce-participation patterns associated with age and estimates of differences among birth cohorts in rates of entry into each profession, which reflect institutional constraints. Our projections assume that age-related workforce-participation patterns will remain stable after 2016 and that the size of the workforce for birth cohorts that have not yet entered the labor force will resemble that of the five most recent cohorts. In the case of physicians, to better capture the expansion in medical education and throughput in recent years, we assume that the size of future cohorts will resemble the size of only the most recent (largest) cohort. In our prior work, this model has successfully forecast health care workforce trends.2
As shown in the table, between 2001 and 2010, workforce supply increased by roughly 150,000 physicians (an increase of 2.2% per year), 27,000 NPs (an increase of 3.9%), and 44,000 PAs (an increase of 7.9%). Between 2010 and 2016, the combined increase in NPs and PAs (79,000) outpaced the increase in physicians (58,000), although the NP and PA workforces were roughly one tenth the size of the physician workforce in 2010. During this period, growth in the NP supply accelerated to nearly 10% per year, whereas growth in the PA supply slowed to 2.5% and growth in physician supply slowed to 1.1%. The number of NPs and PAs per 100 physicians nearly doubled between 2001 and 2016, from 15.3 to 28.2.
We project that these trends will continue through 2030. The number of full-time-equivalent physicians is expected to continue growing by slightly more than 1% annually, as increased retirement rates are offset by increased entry, whereas the numbers of NPs and PAs will grow by 6.8% and 4.3% annually, respectively. Roughly two thirds (67.3%) of practitioners added between 2016 and 2030 will therefore be NPs or PAs, and the combined number of NPs and PAs per 100 physicians will nearly double again to 53.9 by 2030. These shifts will probably be even more pronounced in primary care, where physician supply has been growing more slowly than in other fields and NPs tend to be more concentrated.
The changing composition of the workforce will have implications for provider teams. Primary care providers, in particular, increasingly work in larger groups of professionals with varying backgrounds and types of training. A 2012 national survey of primary care NPs and physicians found that 8 in 10 NPs worked in collaborative practice arrangements with physicians and 41% of physicians worked with NPs — a percentage that will probably grow over time.3 As more states expand practice authority for NPs, medical practices will have to adjust. A recent study of working relationships between NPs and physicians on primary care teams in New York and Massachusetts found that physicians, other staff, and patients often confused the roles and skills of various providers and that these misunderstandings often led to practices undermining the productivity and efficiency of NPs.4 Physicians, NPs, and PAs will all need to be trained and prepared for this new reality.
Greater reliance on nonphysician clinicians is unlikely to threaten quality of care or increase costs. There is growing evidence that the primary care provided by NPs and PAs is similar to that provided by physicians, and a recent national study of Medicare beneficiaries found that the cost of primary care provided by NPs was significantly lower than the cost of physician-provided care.5
As with other projections, our findings are subject to some degree of uncertainty. It is unlikely that the physician supply will grow more rapidly than we project: the AAMC projects even slower growth, the number of GME slots is constrained, and even an immediate expansion of medical school capacity and training opportunities wouldn’t substantially affect the physician supply for many years. Growth in the NP and PA workforces is more uncertain. Although shorter, more flexible training requirements for these providers have facilitated an unprecedented increase in new entrants, growth rates could fall if demand for nonphysician providers is lower than anticipated and job-market prospects worsen. Major changes are unlikely, however, given the expected increases in demand for care, growing use of team-based and interprofessional practice, and the fact that NPs disproportionately serve rural and underserved populations, whose needs would otherwise go unmet.
Despite these uncertainties, it is clear that patients will continue to encounter more NPs and PAs when they seek care. The shifting composition of the health care workforce will present both challenges and opportunities for medical practices as they redesign care pathways to accommodate new payment methods, new incentives regarding quality of care, and the demands of an aging population.
Disclosure forms provided by the authors are available at NEJM.org.
Disclosure Forms
Financial disclosure PDF file supplied by authors.
References
1. Bodenheimer TS, Smith MD Primary care:proposed solutions to the physician shortage without training more physicians. Health Aff (Millwood) 2013;32:1881-1886
2. Staiger DO, Auerbach DI, Buerhaus PI Comparison of physician workforce estimates and supply projections. JAMA 2009;302:1674-1680
3. Donelan K, DesRoches CM, Dittus RS, Buerhaus P Perspectives of physicians and nurse practitioners on primary care practice. N Engl J Med 2013;368:1898-1906
4. Poghosyan L, Norful AA, Martsolf GR Primary care nurse practitioner practice characteristics:barriers and opportunities for interprofessional teamwork. J Ambul Care Manage 2017;40:77-86
5. Perloff J, DesRoches CM, Buerhaus P Comparing the cost of care provided to Medicare beneficiaries assigned to primary care nurse practitioners and physicians. Health Serv Res 2016;51:1407-1423
Illustration
Historical and Projected Numbers of Physicians, Nurse Practitioners, and Physician Assistants.
[Image Omitted: See PDF]
From the Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, Bozeman (D.I.A., P.I.B.); the Department of Economics, Dartmouth College, Hanover, NH (D.O.S.); and the National Bureau of Economic Research, Cambridge, MA (D.O.S.).
Word count: 1443
Copyright © 2018 Massachusetts Medical Society. All rights reserved.
https://oce-ovid-com.ezp.waldenulibrary.org/article/00000446-201802000-00024/HTML
rubrics
Excellent Good Fair Poor
Main Posting
45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.
At least 75% of post has exceptional depth and breadth.
Supported by at least three credible sources.
Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
35 (35%) – 39 (39%)
Responds to some of the discussion question(s).
One or two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
Post is cited with two credible sources.
Written somewhat concisely; may contain more than two spelling or grammatical errors.
Contains some APA formatting errors.
0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only one or no credible sources.
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
10 (10%) – 10 (10%)
Posts main post by day 3.
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not post by day 3.
First Response
17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English.
15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
13 (13%) – 14 (14%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Second Response
16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English.
14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
12 (12%) – 13 (13%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Participation
5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
Collepals.com Plagiarism Free Papers
Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.
Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS
Why Hire Collepals.com writers to do your paper?
Quality- We are experienced and have access to ample research materials.
We write plagiarism Free Content
Confidential- We never share or sell your personal information to third parties.
Support-Chat with us today! We are always waiting to answer all your questions.
