Unsurprising News of the Week: Another Doc Is Against Full Practice Authority

Another week, another physician calling into question the ability of advanced practitioners to treat patients as the primary care shortage looms.

“Nurse Practitioners Can’t Do What Primary Care Docs Can Do” reads the headline of an MD-penned op-ed published this month by Managed Care Magazine.

The piece, written by Alan Adler, MD, a recently retired senior medical director for utilization management and precertification at Independence Blue Cross in Philadelphia, begins by setting forth three patient cases he had encountered: a 72-year-old man exhibiting concentration and memory issues, who Adler was able to diagnose with a large meningioma; a 50-year-old male who was experiencing loose stools, which Adler tied to a sugar-free candy habit after myriad GI testing; a man with an irregular heart rhythm, who had been suffering from fatigue and dizziness, who Adler had been able to help by identifying it was a case polypharmacy.

Adler then goes on to say the cases are “the intensely satisfying, salient episodes of intuition informed by our long hours of medical training,” before bringing up Nurse Practitioners and their quest for full practice authority in the face of the ballooning primary care physician shortage.

“[W]ould a nurse practitioner have recognized, diagnosed, and addressed the issues in the three cases I have just described? Are they comfortable delving into complex polypharmacy issues and stopping medications prescribed by physicians? Can they recognize Wencke-bach and its importance on an ECG in the office? I would argue probably not,” Adler debates in the piece, calling into question the ability of NPs to practice independent of physicians.

It is certainly clear that Adler, like many other physicians who have penned similar op-eds in recent months, opposes NPs as a viable solution to the physician shortage. However, like many others who have voiced their opposition, he falls short of offering an alternative, concluding his piece by calling for a model of care that has already been implemented across America and is proving to fall short of solving the problem: “I am not against new models of primary care. A primary care physician overseeing several nurse practitioners and physician’s assistants is an excellent way of increasing access to care without sacrificing quality.”

How do you feel about the op-ed and the constant opposition NPs and PAs face from physicians? Tell us below, or submit an op-ed of your own here.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Officials Caution 2019-2020 Flu Season May Be Severe

After the flu claimed the life of a 4-year-old in California, health officials are warning that the upcoming flu season could be severe.

Health officials are warning that the upcoming 2019-2020 flu season could be severe, as reported by U.S. News & World Report.

The warning comes on the heels of the first reported flu-related death, which claimed the life of a 4-year-old in California earlier this month.

“A death so early in the flu season suggests this year may be worse than usual,” cautioned Dr. Cameron Kaiser, a health official from Riverside County, where the child was from, in a press release.

The Centers for Disease Control and Prevention recently reported that the previous flu season, which ran from October 2018 to May of 2019, was of “moderate severity.” It should also be noted that the 2018-2019 flu season, which lasted 21 weeks, was the longest flu season in a decade, and that, according to the CDC, there were around 600,000 flu-related hospitalizations and between 36,400 and 61,200 flu-related deaths reported.

For the 2019-2020 flu season, officials have recommended flu shots be administered before the end of October, and caution against vaccinating too early, such as in July or August, as reduced protection against the flu may occur. The CDC states that “all persons aged 6 months and older are recommended for annual vaccination, with rare exception.”

Flu vaccines are updated to better combat the strains that are expected to be circulating in the United States. This year:

  • The A(H1N1)pdm09 vaccine component was updated from an A/Michigan/45/2015 (H1N1)pdm09-like virus to an A/Brisbane/02/2018 (H1N1)pdm09-like virus.
  • The A(H3N2) vaccine component was updated from an A/Singapore/INFIMH-16-0019/2016 A(H3N2)-like virus to an A/Kansas/14/2017 (H3N2)-like virus.
  • Both B/Victoria and B/Yamagata virus components from the 2018-2019 flu vaccine remain the same for the 2019-2020 flu vaccine.
  • All regular-dose flu shots will be quadrivalent.

For more in-depth information about the 2019-2020 flu season, the CDC offers a FAQ resource center, which can be accessed at https://www.cdc.gov/flu/season/faq-flu-season-2019-2020.htm.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Burnout Isn’t Just a Physician Problem

NPs and PAs are often touted as the solution to the growing primary care physician shortage, but at what cost? Burnout impacts them, too.

The growing primary care physician shortage has put an overwhelming strain on doctors in the United States, often in the form of burnout. A combined workforce of nearly 400,000 strong, Nurse Practitioners and Physician Assistants have been poised and ready to be, and often touted as, the most viable solution to the shortage. But at what cost? After all, NPs and PAs are not immune to burning out, themselves.

According to the International Classification of Diseases, which now classifies burnout as an occupational phenomenon, burnout is defined as “chronic workplace stress that has not been successfully managed.” Those suffering from burnout often experience feelings of energy depletion or exhaustion, increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job, and reduced professional efficacy.

Last fall, the Journal of the American Academy of Physician Assistants published the first report on national trends of burnout among PAs. The data revealed that 62.1% of PAs had enthusiasm for their work, while 21.4% reported some degree of cynicism, and 10.4% reported a low sense of personal accomplishment. The report also revealed that 12.8% had never left a position due to stress, but were considering quitting their current position due to stress, burnout, or a toxic workplace, and that 30% had quit once in the past due to stress. Another 11.7% of PAs had left more than one position due to burnout.

As for Nurse Practitioners, burnout in the nursing profession, as a whole, is well-documented. Nurses experience some of the highest risk and rate of burnout, with a third of all nurses in the U.S. reporting high levels of emotional exhaustion. Though Nurse Practitioners may outrank RNs, they seem to be experiencing similar levels of burnout. For instance, though the NP profession ranked #7 on U.S. News & World Report’s 100 Best Jobs list in 2019, it was also reported that NP experience above average stress and below average work-life balance.

Are you feeling burnt out in your role as an NP or PA? How do you combat work-related stress? Tell us in the comments below.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Tell CMS What You Think of an 8% Cut for Therapy Reimbursements

Under the 2020 Medicare Physician Fee Schedule Proposed Rule, therapy could see an 8% cut in Medicare reimbursements. Here’s what to do about it.

Under the 2020 Medicare Physician Fee Schedule Proposed Rule, therapy services could see an 8% cut in reimbursements. The cuts would be a direct result of an effort obtain budget neutrality, which would be impacted by the rule’s proposed increases to Evaluation and Management payments in 2021, as an increase in one code set throws off the balance for all others, and, thus, cuts would need to be made.

Because therapy professionals typically do not or cannot bill for Evaluation and Management services, the profession, as a whole, could certainly be negatively affected by the change and the 8% decrease in reimbursements, if the rule passes.

Centers for Medicare and Medicaid Services (CMS) is accepting comments on the proposed rule through September 27, 2019. To make your concerns heard, we encourage you to contact CMS directly by submitting a form here.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Americans Rank Pharma Industry as Least Favorable

According to a new poll, even the U.S. federal government is more well-liked by Americans than the pharmaceutical industry.

Even the U.S. federal government is more well-liked by Americans than the pharmaceutical industry, or so the findings of a recent Gallup poll indicate.

The poll, which asked Americans to say whether their overall view of 20 different industries was very positive, somewhat positive, neutral, somewhat negative, or very negative, ranked the pharmaceutical industry in dead last, unseating the federal government from the position they held from 2011 to 2018.

According to the findings, only 27% of Americans polled viewed the pharmaceutical industry positively, while 58% of Americans held a negative view of the industry. It is the lowest ranked the pharmaceutical industry has been since Gallup began polling Americans on their opinions of the industry in 2001.

“The new low in the pharmaceutical industry’s U.S. image comes amid a range of criticisms of industry norms, from generating the highest drug costs in the world to spending massive amounts in lobbying politicians to the industry’s role in the U.S. opioid crisis. Several Democratic candidates have called out the industry in their party’s presidential debates,” Gallup said as part of the findings.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

States with the Most Jobs for PAs and NPs

Physician Assistants and Nurse Practitioners are some of the most in-demand healthcare professionals in the nation, but where is demand highest?

Physician Assistants and Nurse Practitioners are some of the most in-demand healthcare professionals in the nation, but where, in particular, is that demand? We analyzed data on our site and came up with the three states with the most available openings for PAs and NPs right now, as well as a selection of noteworthy openings for each position type.

Nurse Practitioners

1. California

Number of NP Jobs Available in California: 427

Average Annual NP Salary in California: $126,890

Noteworthy Openings in California:

Click Here to Search NP Jobs in California

2. New York

Number of NP Jobs Available in New York: 350

Average Annual NP Salary in New York: $118,550

Noteworthy Openings in New York:

Click Here to Search NP Jobs in New York

3. Washington

Number of NP Jobs Available in Washington: 235

Average Annual NP Salary in Washington: $116,350

Noteworthy Openings in Washington:

Click Here to Search NP Jobs in Washington

Physician Assistants

1. California

Number of PA Jobs Available in California: 207

Average Annual PA Salary in California: $118,500

Noteworthy Openings in California:

Click Here to Search PA Jobs in California

2. New York

Number of PA Jobs Available in New York: 116

Average Annual PA Salary in New York: $117,060

Noteworthy Openings in New York:

Click Here to Search PA Jobs in New York

3. Connecticut

Number of PA Jobs Available in Connecticut: 71

Average Annual PA Salary in Connecticut: $126,320

Noteworthy Openings in Connecticut:

Click Here to Search PA Jobs in Connecticut

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

States with the Most Therapy Jobs

California appears to be the state with the highest demand across all therapy professions. What other states are seeing strong demand for PTs, OTs, and SLPs?

California appears to be the state with the highest demand across all therapy professions, having the most openings in Physical Therapy, Occupational Therapy, and Speech-Language Pathology. What other states are seeing strong demand for therapists? We analyzed data on our site and came up with the three states with the most available openings for PTs, OTs, and SLPs right now, as well as a selection of noteworthy openings for each position type.

Physical Therapy

1. California

Number of PT Jobs Available in California: 879

Average Annual PT Salary in California: $97,610

Noteworthy Openings in California:

Click Here to Search PT Jobs in California

2. Virginia

Number of PT Jobs Available in Virginia: 222

Average Annual PT Salary in Virginia: $90,960

Noteworthy Openings in Virginia:

Click Here to Search PT Jobs in Virginia

3. New York

Number of PT Jobs Available in New York: 200

Average Annual PT Salary in New York: $85,100

Noteworthy Openings in New York:

Click Here to Search PT Jobs in New York

Occupational Therapy

1. California

Number of OT Jobs Available in California: 326

Average Annual OT Salary in California: $97,260

Noteworthy Openings in California:

Click Here to Search OT Jobs in California

2. Texas

Number of OT Jobs Available in Texas: 208

Average Annual OT Salary in Texas: $87,780

Noteworthy Openings in Texas:

Click Here to Search OT Jobs in Texas

3. Illinois

Number of OT Jobs Available in Illinois: 116

Average Annual OT Salary in Illinois: $84,820

Noteworthy Openings in Illinois:

Click Here to Search OT Jobs in Illinois

Speech-Language Pathology

1. California

Number of SLP Jobs Available in California: 497

Average Annual SLP Salary in California: $92,750

Noteworthy Openings in California:

Click Here to Search SLP Jobs in California

2. Texas

Number of SLP Jobs Available in Texas: 241

Average Annual SLP Salary in Texas: $71,940

Noteworthy Openings in Texas:

Click Here to Search SLP Jobs in Texas

3. Florida

Number of SLP Jobs Available in Florida: 176

Average Annual SLP Salary in Florida: $76,820

Noteworthy Openings in Florida:

Click Here to Search SLP Jobs in Florida

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Number of Uninsured Americans up for the First Time in 10 Years

For the first time in a decade, the number of Americans without health insurance has risen, up by about 2 million people in 2018.

Phil Galewitz, Kaiser Health News

For the first time in a decade, the number of Americans without health insurance has risen — by about 2 million people in 2018 — according to the annual U.S. Census Bureau report released Tuesday.

The Census found that 8.5% of the U.S. population went without medical insurance for all of 2018, up from 7.9% in 2017. By contrast, in 2013, before the Affordable Care Act took full effect, 13.3% were uninsured. It was the first year-to-year increase since 2008-09, Census officials said.

Census officials said most of drop in health coverage was related to a 0.7% decline in Medicaid participants. The number of people with private insurance remained steady and there was a 0.4% increase in those on Medicare.

Many of those losing coverage were non-citizens, a possible fallout from the Trump administration’s tough immigration policies and rhetoric. About 574,000 non-citizens lost coverage in 2018, a drop of about 2.3%, the report found.

“Uninsured non-citizens account for almost a third of the increase in uninsured, which may reflect the administration’s more aggressive stance on immigration,” said Joseph Antos, a health economist at the American Enterprise Institute.

The increase in the number of uninsured people in 2018 was remarkable because uninsured rates typically fall or hold steady when unemployment rates drop. The U.S. unemployment rate fell slightly from about 4.3% in 2017 to 4% in 2018.

The uninsured rate continued to vary by poverty status and whether a state expanded its Medicaid program under Obamacare. Texas (17.7%), Oklahoma (14.2%), Georgia (13.7%) and Florida (13%) had the highest uninsured rates in 2018, according to the report. None of those states have expanded Medicaid under Obamacare.

The percentage of uninsured children under the age of 19 increased by 0.6 percentage points from 2017 to 2018, to 5.5%.

“The Census data are clear — the uninsured rate for kids is up sharply and it’s due to a loss of public coverage — mostly Medicaid,” Joan Alker, executive director of Georgetown University Center for Children and Families, said in a statement.

“These children are not getting private coverage as the Trump Administration has suggested but rather becoming uninsured,” she said. “This serious erosion of children’s health coverage is due in large part to the Trump Administration’s actions that have made health care harder to access and have deterred families from enrolling their children.”

The share of Americans without medical insurance fell steadily since 2014 but then leveled off in 2017, the year Donald Trump became president.

Health care advocates have complained that efforts by the Trump administration and Congress are jeopardizing insurance enrollment. They point to cuts in outreach programs that aim to tell consumers about their health care options under Obamacare and the elimination of the ACA’s tax penalty for people who don’t have health coverage.

Alker complained that the administration’s policies are causing the loss of children’s coverage. “In a period of continued economic and job growth, we shouldn’t be going backwards on health coverage,” said Judy Solomon, a senior fellow for the Center on Budget and Policy Priorities, a left-leaning think tank. “This backsliding almost certainly reflects, at least in part, Trump administration policies to weaken public health coverage.”

She attributed the drop to the Trump administration making it harder for families to enroll for coverage in Medicaid by curtailing outreach efforts, allowing states to ask for more paperwork and proposing a so-called public charge rule that would make it harder for legal immigrants to get permanent resident status if they have received certain kinds of public assistance — including Medicaid.

Tom Miller, a resident fellow at the American Enterprise Institute, a conservative think tank, said the drop in Medicaid coverage “is a positive.”

“When the economy grows Medicaid eventually drops,” he said.

One reason for the drop in health coverage is that middle-income families can’t afford the rising cost of insurance in the individual market, particularly if they don’t qualify for government subsidies, he added.

“On balance, this is some short-term noise,” he said of the uptick in the uninsured rate. “I would put more stake in it if happens for several years.”

Chris Pope, a senior fellow with the conservative Manhattan Institute, also said he considered the change “fairly small” and likely due to increasing wages “pushing people above the income eligibility cutoff in Medicaid expansion states.”

But he suggested that next year would be a better indicator of how changes in the ACA are playing out.

“I expect that the mandate repeal will make next year’s increase in the uninsured more significant,” he said.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Top 3 States with the Most Nursing Jobs

371,500 RN jobs are expected to be added in the U.S. in the next 10 years, so it’s safe to say nursing is booming. Where are the most jobs right now?

According to the U.S. Bureau of Labor Statistics, registered nurses are expected to see 12% job growth between 2018 and 2028, with an estimated 371,500 jobs predicted to added to the workforce during that same time frame. That’s all well and good, but where are the jobs now? We analyzed data on our site and came up with the three states with the most available openings for nurses right now, as well as a selection of noteworthy positions.

1. California

Number of RN Jobs Available in California: 2,411

Average Annual RN Salary in California: $104,410

Noteworthy Openings in California:

Click Here to Search RN Jobs in California

2. Texas

Number of RN Jobs Available in Texas: 1,709

Average Annual RN Salary in Texas: $72,000

Noteworthy Openings in Texas:

Click Here to Search RN Jobs in Texas

3. New York

Number of RN Jobs Available in New York: 831

Average Annual RN Salary in New York: $85,300

Noteworthy Openings in New York:

Click Here to Search RN Jobs in New York

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Top 3 States with the Most Physician Jobs

Given the growing physician shortage, it’s a buyer’s market, so to speak. If you’re thinking about a new job, you might want to consider these states.

Healthcare as a whole has added nearly half a million jobs so far in 2019, and with the physician shortage being a continual hot-button issue, it’s a buyer’s market, so to speak. So, where are the jobs? We analyzed data on our site and came up with the three states with the most available openings for physicians right now, as well as a selection of noteworthy positions.

1. California

Average Annual Physician Salary in California: $204,190

Noteworthy Openings in California:

Click Here to View All Jobs in California

2. New York

Average Annual Physician Salary in New York: $139,710

Noteworthy Openings in New York:

Click Here to View All Jobs in New York

3. Washington

Average Annual Physician Salary in Washington: $239,080

Noteworthy Openings in Washington:

Click Here to View All Jobs in Washington

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.