Definitions May Vary, but Burnout Is a Problem All the Same

Does defining burnout as a diagnosable condition, such as depression, even matter in regards to treating the problem, or should the focus fall elsewhere?

This month, The Journal of the American Medical Association published two major studies and one searing editorial on physician burnout.

The first study, entitled Prevalence of Burnout Among Physicians, A Systematic Review, is a summary of research to date on the prevalence of physician burnout. In conclusion, the review found, “there was substantial variability in prevalence estimates of burnout among practicing physicians and marked variation in burnout definitions, assessment methods, and study quality.”

The second study, Association of Clinical Specialty with Symptoms of Burnout and Career Choice Regret Among US Resident Physicians, followed doctors-in-training over the course of six years, and kept track of how they felt about their work. In conclusion, the study found that “reported symptoms of burnout occurred in 45.2% of participants and career choice regret in 14.1%.”

The accompanying editorial, Physician Burnout—A Serious Symptom, But of What?, written by Thomas L. Schwenk, MD and Katherine J. Gold, MD, MSW, MS, takes aim at these studies and the problem of burnout as a whole.

“The term burnout has taken on meaning far beyond what is understood about it as an actual diagnosis or even a syndrome. The medical profession has taken a self-reported complaint of unhappiness and dissatisfaction and turned it into a call for action on what is claimed to be a national epidemic that purportedly affects half to two-thirds of practicing physicians,” the editorial reads, in part.

It goes on to say, “There is clearly something important and worrisome happening to physician well-being.”

From where you stand, as a physician, does defining burnout as a diagnosable condition, such as depression, even matter in regards to treating the problem? Or do you believe the focus should fall elsewhere?

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.

Drama Series with NP Protagonist Heads to Netflix

A new romance drama series with a nurse practitioner at its heart is headed to the small screen, bringing exposure to the NP profession through entertainment.

Netflix has given the green light to a new romance drama series with a nurse practitioner at its heart.

“Virgin River,” a small screen adaptation of a book by the same name, tells the story of Melinda Monroe, an NP who answers an ad to work in the remote California town of Virgin River in an effort to start fresh and leave her past behind. “Virgin River” is the first book in a series of more than twenty Harlequin novels written by Robyn Carr, which have sold, combined, upwards of 13 million copies.

Representation matters, and though it may seem like a small win to some, this series is definitely a victory in terms of exposure for the NP profession.

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.

New Legislation Arms Advanced Practitioners in the Fight Against Opioids

More than 115 Americans die every day from opioid-related causes. The SUPPORT for Patients and Communities Act, which passed in the House last week, aims to stop that.

The U.S. opioid epidemic is a grave and serious crisis. Each day, more than 115 Americans die of opioid-related causes. A new “opioid package” passed in the U.S. House of Representatives last week, however, is taking aim at combatting the crisis.

H.R. 6, also known as the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018 is seen as a compromise between the House and Senate, which previously passed their own separate opioid abuse prevention packages. The SUPPORT for Patients and Communities Act, as it’s being called, is expected to be considered by the Senate in the coming days and then be sent to the President’s desk to be signed into law.

One of the major provisions of the SUPPORT for Patients and Communities Act applies directly to advanced practitioners:

“Enable clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists to prescribe buprenorphine; and make the buprenorphine prescribing authority for physician assistants and nurse practitioners permanent. In addition, H.R. 6 will permit a waivered-practitioner to immediately start treating 100 patients at a time with buprenorphine (skipping the initial 30 patient cap) if the practitioner has board certification in addiction medicine or addiction psychiatry; or if practitioner provides MAT in a qualified practice setting. Medications, such as buprenorphine, in combination with counseling and behavioral therapies, provide a whole-patient approach to the treatment of opioid use disorder (H.R. 3692)”

Both the AANP and AAPA consider this legislation a win.

“With this agreement, Congress has reaffirmed the power of America’s 248,000 NPs to fight and win the battle against opioid addiction. The legislation permanently authorizes NPs to prescribe Medication-Assisted Treatments (MATs), further expanding patient access to these critical treatments—prescribed and managed by NPs,” AANP President Joyce Knestrick, Ph.D., C-FNP, APRN, FAANP said in a statement released last week.

Jonathan E. Sobel, DMSc, MBA, PA-C, DFAAPA, FAPACVS, president and chair of the AAPA Board of Directors, echoed that sentiment in his statement, saying, “AAPA applauds Congress for including this crucial provision as part of comprehensive legislation aimed at stemming the tide of the U.S. opioid epidemic.”

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.

12 Grants Awarded to Fund New Treatments of Rare Diseases

A third of the new awards aim to accelerate cancer research, and another 25% of the new awards fund studies evaluating drug products for rare endocrine disorders.

The U.S. Food and Drug Administration announced this week that it has awarded 12 new clinical trial research to enhance the development of medical products for patients with rare diseases. The grants, which total more than $18 million over the next four years, were awarded to principal investigators from academia and industry across the United States through the Orphan Products Clinical Trials Grants Program.

The awarded grants include:

  • Alkeus Pharmaceuticals, Inc. (Cambridge, Massachusetts), Leonide Saad, phase 2 study of ALK-001 for the treatment of Stargardt disease – $1.75 million over four years
  • Arizona State University-Tempe Campus (Tempe, Arizona), Keith Lindor, phase 2 study of oral vancomycin for the treatment of primary sclerosing cholangitis – $2 million over four years
  • Cedars-Sinai Medical Center (Los Angeles), Shlomo Melmed, phase 2 study of seliciclib for the treatment of Cushing disease – $2 million over four years
  • Columbia University of New York (New York), Yvonne Saenger, phase 1 study of talimogene laherparepvec for the treatment for advanced pancreatic cancer – $750,000 over three years
  • Emory University (Atlanta), Eric Sorscher, phase 1/2 study of Ad/PNP fludarabine for the treatment of head and neck squamous cell carcinoma – $1.5 million over three years
  • Fibrocell Technologies, Inc. (Exton, Pennsylvania), John Maslowski, phase 1/2 study of gene-modified ex-vivo autologous fibroblasts for the treatment of dystrophic epidermolysis bullosa – $1.5 million over four years
  • Johns Hopkins University (Baltimore), Amy Dezern, phase 1/2 study of CD8-reduced T cells for the treatment of myelodysplastic syndrome or acute myeloid leukemia – $750,000 over three years
  • Oncolmmune, Inc. (Rockville, Maryland) Yang Liu, phase 2b study of CD24Fc for the prevention of graft versus host disease – $2 million over four years
  • Patagonia Pharmaceuticals, LLC (Woodcliff Lake, New Jersey), Zachary Rome, phase 2 study of PAT-001 (isotretinoin) for the treatment of congenital ichthyosis – $1.5 million over three years
  • The General Hospital Corporation (Boston), Stephanie Seminara, phase 2 study of kisspeptin for the treatment of dopamine agonist intolerant hyperprolactinemia – $1.4 million over four years
  • University of Minnesota (Minneapolis), Kyriakie Sarafoglou, phase 2a study of subcutaneous hydrocortisone infusion pump for the treatment of congenital adrenal hyperplasia – $1.4 million over three years
  • University of North Carolina at Chapel Hill (Chapel Hill, North Carolina), Matthew Laughon, phase 2 study of sildenafil for the prevention of bronchopulmonary dysplasia – $2 million over four years

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.

Majority of Patients Review Healthcare Experiences Online

51% of Americans surveyed said they share their personal healthcare experiences online via social media and review sites, such as Yelp, Google, and Facebook.

More and more, patients are consulting online reviews via sites such as Yelp and Google when determining which healthcare facility and provider to use, and are sharing their healthcare experiences online, as well, according to a new survey from Binary Fountain.

The results of the second annual Healthcare Consumer Insight & Digital Engagement Survey, released this week, indicate that:

  • 95% of the surveyed respondents find online ratings and reviews “somewhat” to “very” reliable.
  • Of the 95%, 100% of respondents between the ages of 18-24 and 97% of respondents between the ages of 25-34 find online ratings and reviews “somewhat” to “very” reliable.
  • 70% of Americans say online ratings and review sites have influenced their decision in selecting a physician.
  • 51% of Americans said they share their personal healthcare experiences online via social media and review sites, which is a 65% increase from the previous year.
  • Millennials are most likely to share their physician or hospital experiences online, with 70% saying they have done so.
  • 68% of Americans aged 18-24 said they have shared their healthcare experiences online, which is a staggering 94% increase over last year.
  • Facebook is the most used method of sharing healthcare experiences for ages 25-54.
  • Patients between the ages of 18-24 indicated that Google is their preferred online platform to share their healthcare experiences.

Have you Googled your facility lately?

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.

The Delicate Nature of Caring for Sexual Assault Patients

An American is sexually assaulted every 98 seconds. No matter your specialty, the odds are high you will treat a victim. Keep these things in mind, when you do.

This week, the hashtag #BelieveSurvivors has trended heavily across all forms of social media, due in part to the claims of sexual assault levied against Supreme Court nominee Brett Kavanaugh.

Politics aside, as a nurse, there is a strong likelihood you will encounter sexual assault patients during the course of your career, given that an American is sexually assaulted every 98 seconds, according to the U.S. Department of Justice. That prevalence means that even if you aren’t a forensic nurse examiner or don’t work in emergency or psych, it is important that you be equipped with an understanding of how to handle the unique emotional aspects of sexual violence, as well as a practical approach to caring for the victim.

While every sexual assault patient you encounter will be inherently different from the next, keep these things in mind, as you provide them with care:

  • Check Your Judgment at the Door: It is not your place to assign blame, especially not upon the victim. The task of assigning blame comes later; that is a legal process. No matter the physical or mental state your patient appears to be in—be they male or female or drunk or in a state of undress or crying hysterically—it is not your place to criticize them in any way. It is your place to help them and give them the care they need in a safe environment, free of skepticism, while documenting everything from injuries sustained to their mental state in an unbiased manner. Be mindful of your tone, actions, and facial expressions, and most importantly, listen to the patient.
  • The Victim Comes First: The comfort of the sexually assaulted patient should be paramount. Consult with the patient to conclude whether or not a gender preference of caregiver exists, and respect those wishes, if so. It is your responsibility to advocate for the patient’s needs, and this may require a level of patience and a time commitment your other patients do not demand of you.
  • Be Compassionate: As a nurse, compassion likely courses through your veins, and in this instance, that is a very good thing. Above all else, allow your humanity to shine through, while maintaining your professionalism. Believe them, empathize with them, put yourself in their shoes—after all, given the statistics, they could very well be you.

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.

Could Medical Scribes Be A Cure to Physician Burnout?

While there is no easy cure-all for burnout, the results of a new study indicate that utilizing medical scribes to assist with EHR documentation could help.

Time-consuming EHR documentation is a burden that is consistently found to be linked to increased physician documentation workload, and, in turn, physician burnout. Could the use of medical scribes alleviate that burden for physicians, improve productivity and patient communication, and enhance job satisfaction among physicians. A study published this month in JAMA Internal Medicine aimed to find out the answer to that question, and their conclusion is a resounding yes.

The 12-month crossover study randomly assigned eighteen primary care physicians to start the first three-month period of the study with or without scribes, and then had alternated exposure to scribes every three months over the course of the year. At the end of each study period, physicians completed a survey. Meanwhile, the researchers also surveyed patients of participating primary care physicians after scribed clinic visits.

Findings indicated that compared with periods that were not scribed, scribed periods were linked to less self-reported after-hours EHR documentation by physicians (<1 hour per day). Scribed physicians also self-reported that they spent more than 75% of the visit interacting with the patient and less than 25% of the visit on a computer. Patients also reported encouragingly in regards to the presence of medical scribes, with 61% of surveyed patients saying that scribes had a positive bearing on their visits and only 2.4% of them indicating a negative bearing.

While there is no easy cure-all for burnout, the results of this study certainly indicate that there are ways to help lessen the burdens thrust upon physicians by EHRs, and one of those is the utilization of medical scribes.

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.

Majority of Physicians Pessimistic about the Future of Medicine, New Report Finds

The results of the sixth biennial Survey of America’s Physicians have been released, and the findings can only be described as startling.

The Physicians Foundation has released the results of their sixth biennial Survey of America’s Physicians, and the findings are startling.

The survey “took the pulse” of nearly 9,000 U.S. physicians across the country, and examined, at its heart, what they think about the current state of the medical profession.

Over all, the findings indicate being a physician is an evolving medical profession, which continues to struggle with issues of burnout and low morale, despite more physicians now working fewer hours and seeing fewer patients.

Below are some key findings from the report:

  • 62% of physicians are pessimistic about the future of medicine.
  • 55% of physicians describe their morale as somewhat or very negative, which is consistent with findings in previous years.
  • 78% of physicians sometimes, often or always experience feelings of burnout.
  • 80% of physicians are at full capacity or are overextended.
  • 49% of physicians would not recommend medicine as a career to their children.
  • 46% plan to change career paths.
  • 46% of physicians indicate relations between physicians and hospitals are somewhat or mostly negative.
  • Physicians indicated patient relationships are their greatest source of professional satisfaction, while EHRs are their greatest source of professional dissatisfaction.

The survey also includes a portion where physicians are welcome to write in their own comments. Some of those highlighted in the report include:

  • “I could not in good conscience recommend medicine to a young person. It isn’t a profession anymore, it’s a business enterprise. If I had wanted to be a businessman, I’d have taken a less demanding path.”
  • “I am no longer a professional, I am an employee and treated with less respect and consideration than previously.”
  • “As a physician in her late 40’s, I have unfortunately seen the practice of medicine evolve from caring for the patient to caring for the administrator. The focus is on ticking off boxes rather than improving the health of the individual or community.”

Do you think the numbers and comments highlighted here accurately portray the overall sentiment of physicians today?

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.

Steal this Recruiter’s Tips to Land the Perfect Job

Seeking a competitive advantage to help you land your perfect job? Look no further than this advice from a clinician who has been involved in hiring.

By Jordan G Roberts, PA-C

No matter your profession, job searching can be hard. On top of the everyday challenges, the internet has no shortage of advice with questionable authority.

There are entire blogs written by human resources professionals filled with tips and insights they say will help you land any job. However, they don’t fully address the unique needs of a clinician’s job search.

When it comes to hiring healthcare professionals, employers have the advantage of hiring consultants if necessary. Where can clinicians turn when they need a new job?

Recruiters and healthcare-specific job boards like HealthJobsNationwide.com are one source. They can tell you what characteristics clients are seeking for certain positions, which is great.

Another strategy is to obtain insider tips. In today’s article, we have tips and advice from one of the premier sources for hiring PA’s and NP’s. Renee Dahring, FNP is a former owner of a clinician staffing agency and current correctional healthcare NP.

One of the best places you can find job search advice and strategies is a clinician who has been involved in the hiring process. This article expands on my interview with NP Dahring from the Clinician1 podcast.

Read the article and get the competitive advantage that will help you land your perfect job by clicking here. Once you’ve soaked it all up, come back to HealthJobsNationwide.com to put your new skills in action.


Jordan G Roberts, PA-C helps medical education companies create and distribute the best medical education around. He helps students and clinicians improve their clinical game by using his background in neuroscience to teach simple ways to learn complex medical topics. He is a published researcher, national speaker, and medical writer. He can be found at Modern MedEd where he promotes clinical updates, medical writing, and medical education.

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.

Insulin’s Steep Price Leads To Deadly Rationing

The price of insulin in the U.S. has more than doubled since 2012. Because of this, some diabetics have been forced to take drastic measures, like rationing their insulin.

Bram Sable-Smith, Side Effects Public Media

Diabetic ketoacidosis is a terrible way to die. It’s what happens when you don’t have enough insulin. Your blood sugar gets so high that your blood becomes highly acidic, your cells dehydrate, and your body stops functioning.

Nicole Smith-Holt lost her son to diabetic ketoacidosis, three days before his payday, because he couldn’t afford his insulin.

“It shouldn’t have happened,” Smith-Holt said, looking down at her son’s death certificate on her dining room table in Richfield, Minn. “That cause of death of diabetic ketoacidosis should have never happened.”

The price of insulin in the U.S. has more than doubled since 2012 alone. That’s put the lifesaving hormone out of reach for some people with diabetes, like Smith-Holt’s son Alec Raeshawn Smith. It has left others scrambling for solutions to afford the one thing they need to live. I’m one of those scrambling.

Not Enough Time

Most people’s bodies create insulin, which regulates the amount of sugar in the blood. The roughly 1.25 million of us in the U.S. with Type 1 diabetes have to buy insulin at a pharmacy because our pancreases stopped producing it.

My first vial of insulin cost $24.56 in 2011, after insurance. Seven years later, I pay more than $80. That’s nothing compared with what Alec was up against when he turned 26 and aged off his mother’s insurance plan.

Smith-Holt said she and Alec started reviewing his options in February 2017, three months before his birthday on May 20. Alec’s pharmacist told him his diabetes supplies would cost $1,300 a month without insurance — most of that for insulin. His options with insurance weren’t much better.

Alec’s yearly salary as a restaurant manager was about $35,000. Too high to qualify for Medicaid, and, Smith-Holt said, too high to qualify for significant subsidies in Minnesota’s Affordable Care Act insurance marketplace. The plan they found had a $450 premium each month and an annual deductible of $7,600.

“At first he didn’t realize what a deductible was,” Smith-Holt said. She said Alec figured he could pick up a part-time job to help cover the $450 per month.

Then Smith-Holt explained to her son what a deductible was.

“You have to pay the $7,600 out-of-pocket before your insurance is even going to kick in,” she recalled telling him. Alec decided going uninsured would be more manageable. Although there might have been cheaper alternatives for his insulin supply that Alec could have worked out with his doctor, he never made it that far.

He died less than one month after going off of his mother’s insurance. His family thinks he was rationing his insulin — using less than he needed — to try to make it last until he could afford to buy more. He died alone in his apartment three days before payday. The insulin pen he used to give himself shots was empty.

“It’s just not even enough time to really test whether [going without insurance] was working or not,” Smith-Holt said.

A Miracle Discovery

Insulin is an unlikely symbol of America’s problem with rising prescription costs.

Before the early 1920s, Type 1 diabetes was a death sentence for patients. Then researchers at the University of Toronto — notably Dr. Frederick Banting, Charles Best and J.J.R. Macleod — discovered a method of extracting and purifying insulin that could be used to treat the condition. Banting and Macleod were awarded a Nobel Prize for the discovery in 1923.

For patients, it was nothing short of a miracle. The patent for the discovery was sold to the University of Toronto for only $1 so that lifesaving insulin would be available to everyone who needed it.

Today, however, the list price for a single vial of insulin is more than $250. Most patients use two to four vials per month (I personally use two). Without insurance or other forms of medical assistance, those prices can get out of hand quickly, as they did for Alec.

Depending on whom you ask, you’ll get a different response for why insulin prices have risen so high. Some blame middlemen — such as pharmacy benefit managers, like Express Scripts and CVS Health — for negotiating lower prices with pharmaceutical companies without passing savings on to customers. Others say patents on incremental changes to insulin have kept cheaper generic versions out of the market.

For Nicole Smith-Holt, as well as a growing number of online activists who tweet under the hashtag #insulin4all, much of the blame should fall on the three main manufacturers of insulin today: Sanofi of France, Novo Nordisk of Denmark and Eli Lilly in the U.S.

The three companies are being sued in U.S. federal court by diabetic patients in Massachusetts who allege the prices are rising at the expense of patients’ health.

Eli Lilly and Company did not make anyone available for an interview for this story. But a company spokesman noted in an email that high-deductible health insurance plans — like the one Alec found — are exposing more patients to higher prices. In August, Eli Lilly opened a help line that patients can call for assistance in finding discounted or even free insulin.

A Dangerous Solution

Rationing insulin, as Nicole Smith-Holt’s son Alec did, is a dangerous solution. Still, 1 in 4 people with diabetes admit to having done it. I’ve done it. Actually, there’s a lot of Alec’s story that feels familiar to me.

We were both born and raised in the Midwest, just two states apart. We were both diagnosed at age 23 — pretty old to develop a condition that used to be called “juvenile diabetes.” I even used to use the same sort of insulin pens that Alec was using when he died. They’re more expensive, but they make management a lot easier.

“My story is not so different from what I hear from other families,” Smith-Holt recently told a panel of Senate Democrats in Washington, D.C., in a hearing on the high price of prescription drugs.

“Young adults are dropping out of college,” she told the lawmakers. “They’re getting married just to have insurance, or not getting married to the love of their lives because they’ll lose their state-funded insurance.”

I can relate to that too. My fiancée moved to a different state recently and soon I’ll be joining her. I’ll be freelancing, and won’t have health benefits, though she will, via her job. We got married — one year before our actual wedding — so I can get insured, too.

This story is part of a partnership that includes Side Effects Public Media, NPR and Kaiser Health News. A version of this story appears in The Workaround podcast.

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.