Your Nursing Job: The Same Old Bed of Nails or a Comfortable Old Shoe?

Complacency be just as bad for your career as outright misery. Whether you’re stuck in a rut or actively feeling pained by your job, it might be time for a change.

From Nurse Keith’s Digital Doorway

Some of us have nursing jobs that are feel like a bed of nails, and some of us nurses have jobs that feel like comfortable old shoes. Have you ever fallen into either of these categories in terms of your work experience as a nurse? I posit that either one can be detrimental to your career in the long run.

The Old Shoe Nursing Job

If you’ve been working at a decent enough nursing job for a number of years, it can begin to feel like an old worn shoe: comfortable, fraying at the edges, and perhaps less supportive than it used to be.

Perhaps you’ve had a work experience that reflects at least several of the following characteristics:

  • You like your colleagues well enough
  • Your bosses are decent
  • The work you do is relatively enjoyable — or at least tolerable
  • The salary is stagnant
  • Benefits (if you have them) are acceptable but not overwhelmingly generous
  • You’re not learning very much over time
  • You feel like you’re just this side of career stagnation

I hear from many nurses who are in a nursing position that matches a number of the above-named aspects. When a nurse feels stuck and in a rut, there are plenty of questions to ask, including but not limited to:

  • What about your current job is and is not satisfying?
  • What kind of learning happens for you on the job?
  • Do you feel like you’re growing professionally or just marking time?
  • Are you treated well enough? Could you find a more positive and supportive workplace culture?
  • Do you feel that you’re valued for what you do, or are you just a cog in an organizational wheel?
  • If you think about leaving for another opportunity, what kinds of thoughts and feelings do you have? Is it just too scary to consider?
  • Are you afraid to leave because it’s relatively comfortable? Are you avoiding looking for another job because you feel beholden to stay for your colleagues and/or your patients?
  • Do you simply not know what you’d rather do otherwise?

These types of questions can lead to very interesting discussions about self worth, career development, personal and professional history, and how you view yourself as a healthcare professional and nurse.

An old shoe may be comfy and familiar, but it can lose its supportive structure and allow your feet to really take a beating. Is your current job kind of like that old running shoe you just can’t let go of?

The Nursing Bed of Nails

A nursing job that feels like a bed of nails is just a bad fit. In this scenario, it hurts to get up and go to work. You feel pained, uncomfortable, and vaguely aware that this is a form of torture that would probably be good to escape from, but you may very well feel stuck and unable to move.

Don’t get me wrong: a challenging job that pushes you beyond your current comfort zone isn’t necessarily a bad thing. This type of situation can be good for your career as it can often motivate you to learn, grow, and take your skills and knowledge to the limit without violating your scope of practice or endangering your patients or your nursing license.

Having said that, many of us have likely been stuck in jobs that felt dangerous, edgy, beyond our ken, and simply too much to handle. A nursing job that pushes you too far and feels unnecessarily painful and difficult can have some of the following characteristics, as well as others not listed:

  • You feel as if you’re regularly pushed to work beyond your scope of practice
  • A bully (or bullies) stalk the halls and make people’s lives miserable
  • Management is inept, if not downright hostile
  • The workplace is riddled with gossip and backbiting
  • You don’t readily connect with the patient population and feel like caring for them is like nails on a chalkboard
  • You don’t feel challenged, and your skills, knowledge, and expertise are stagnating
  • You feel nauseous, anxious, or plainly fearful when you arrive to work
  • Overall, work is just a consistently unpleasant slog

Being miserable, stagnant, and pained at work is no picnic. And you know what? It’s not necessary at all — you always have the choice to make a move, look to a new horizon, or otherwise exit gracefully, stage left.

Do you have the gumption and wherewithal to leave? Even a bed of nails can feel oddly comfortable and familiar — after all, the devil you know can sometimes be better than the devil you don’t. Right?

Finding a New Career Frontier

Whether your job feels like a bed of nails or a comfortable old shoe, there’s often something that needs to change. If you’re not making plans to leave, consider where your resistance is coming from. Is it fear? Is it discomfort with change? Or is there a lack of self-confidence that needs to be overcome?

Whatever the feeling is that’s keeping you from busting out and moving on, consider the notion that change can be exciting, renewing, and occasionally revelatory. Fear can either be motivating or demotivating — which would you prefer?

Consider that if early homo sapiens and other ancient human species were overly afraid of change, they never would have crossed the Bering Straight and populated far-flung continents. If Civil Rights leaders had been too fearful of the reactions of white supremacists, they never would have marched, boycotted, and pushed back against the egregiously racist status quo. And if Florence Nightingale didn’t have the courage to buck the system of the good ol’ boys of medicine and create biostatistics and crucial practices of infection control, modern nursing might still be in the Dark Ages, serving coffee to physicians who see us as nothing but unskilled non-professional handmaidens.

Consider these questions:

  • Is your current job satisfying?
  • Are you learning enough to keep engaged and interested?
  • Does your workplace feel congenial enough?
  • Is the workplace culture positive and supportive?
  • Is management responsive and self-reflective?
  • Is this job leading somewhere in the context of your career?

A bed of nails and a comfy old shoe can be equally difficult to disengage from, albeit for different reasons. If you’re stuck in either of these scenarios, what would it take to get out of bed or throw that old shoe in the trash? What would you need in order to take that leap of faith and move on?

Nimbleness, professional and personal growth, forward movement, and the willingness to pivot throughout your nursing career are hallmarks of living and working in the 21st-century healthcare universe — are you ready for nice new nursing shoes and a more comfortable bed? If you’re feeling like you’re at the end of your rope, I’ll hazard a guess that you’re more than ready. What are you waiting for?

Keith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind NurseKeith.com and the well-known nursing blog, Digital Doorway. Please visit his online platforms and reach out for his support when you need it most.

Keith is co-host of RNFMRadio.com, a wildly popular nursing podcast; he also hosts The Nurse Keith Show, his own podcast focused on career advice and inspiration for nurses.

A widely published nurse writer, Keith is the author of “Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century,” and has contributed chapters to a number of books related to the nursing profession. Keith has written for Nurse.com, Nurse.org, MultiViews News Service, LPNtoBSNOnline, StaffGarden, AusMed, American Sentinel University, the ANA blog, Working Nurse Magazine, and other online publications.

Mr. Carlson brings a plethora of experience as a nurse thought leader, online nurse personality, podcaster, holistic career coach, writer, and well-known successful nurse entrepreneur. He lives in Santa Fe, New Mexico with his lovely and talented wife, Mary Rives.

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.

Tricky Nursing Interview Questions (And How to Answer Them)

The pay may be great, but that isn’t the answer to give when asked, “Why do you want to work here?” Here’s how to answer that and other hard interview questions.

Interviewing, in general, isn’t easy, but some questions prove tougher than others. Here are three questions that notoriously trip up even the most seasoned nurse and how best to answer them.

“Tell me about yourself.”

While not technically a question, this can be one of the hardest parts of any interview. While some people love talking about themselves (research suggests this is simply because it feels good), others do not, and even if you do like talking about yourself, landing in the sweet spot between giving the interviewer too little and sharing too much can be tricky, especially if you’re an anxious or nervous interviewee.

Instead of sharing your life story, and giving away too many personal details which may reflect poorly upon you, keep in mind that the interviewer is asking this because they want to know your background, more than anything, and a bit about your personality. Cover the basics about your education, professional experience, career goals, and strengths, while tying in some clues about your personality, such as, “I’ve always loved children and I’m upbeat by nature, so pediatric nursing was a seamless fit for me.”

“Why do you want to work here?”

The truthful answer to that may be, “Look, lady, it’s because I need a job,” or, “The pay is GREAT,” but those answers are not what the interviewer is looking for—and should definitely not come out of your mouth at any point during the interview process. They don’t want to hire any ol’ nurse, just as you don’t want to work at any ol’ hospital, so do your research, not only so you can impress them by knowing they were ranked #1 for neurosurgery by so-and-so publication, but so you can see if they are the right fit for you, as well.

Before you interview, Google them and read up on the organization, including their corporate values and culture, and be prepared to tell them why you’d be a good fit to work there. For example, perhaps the facility caters to a population you prefer to work with, they use progressive methods you are eager to learn, or have a reputation for professional advancement that aligns with your career goals. Or maybe it’s something as simple as they are a small practice with a family feel, and you are tired of working in hospitals where you hardly see the same person twice. Whatever it is that truly interests you in working there, from a professional standpoint, find a way to convey that in a way that shows you’re excited to be a part of what they’re doing.

“What are your weaknesses?”

No one likes to own up to their faults, particularly not in a setting where you’re trying to impress. However, we are all human. We all mess up. We all have less than desirable traits. And pretending like you don’t just comes across and being inauthentic and dishonest, and those are not desirable traits in an employee, let alone a nurse.

Whatever your weaknesses may be, find a way to tell the interviewer what you have learned from them, showing you are committed to self-improvement and professional growth. It is a best practice to sandwich your weakness between two positive attributes. For example, if you sometimes feel overwhelmed, try saying something along the lines of, “I’m committed to providing a high level of patient care, but sometimes I find myself getting a little overwhelmed when a patient or their family asks a lot of questions. I know that’s just the patient and their family wanting to be well-informed about their care, though, so I’ve learned to be more understanding, as a result.”

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 Possible Power of Physicians Speaking Positively

Freud is quoted as having said, “Words have a magical power,” and a new study may back up that theory in relation to how physicians speak to patients.

Sigmund Freud is quoted as having said, “Words have a magical power. They can either bring the greatest happiness or the deepest despair,” and a new study published in the Journal of General Internal Medicine just may back up that theory.

The study, entitled Physician Assurance Reduces Patient Symptoms in US Adults: An Experimental Study, set out to research the effects of physicians’ using reassuring words on their patients, in lieu of pharmacological treatment. Previous research on the power of positive speech from providers has varied, with some studies indicating positive assurances from the provider leads to improved patient health and outcomes, and others finding no effect on patient outcomes or other quantifiable benefits. The results of this study, however, fall into former, and indicate that the placebo effect of a doctor simply reassuring a patient can be fairly impactful. These findings are important, given that medication goes unmentioned in nearly a quarter of all doctor’s visits in the U.S. and as physicians face increasing time demands, the need to quantify the benefit of these types of visits is vital.

In the study, a healthcare provider administered a histamine skin prick to the forearm of 76 participants. The participants were asked to rate itchiness/irritation immediately before the skin prick and at 3, 9, 12, 15, and 18 minutes post histamine skin prick. After the 3-minute rating, a physician visually examined the participants’ reactions, and told some, at random, “From this point forward your allergic reaction will start to diminish, and your rash and irritation will go away,” while the physician made no remarks about the reaction for the control group of patients. After being reassured by the physician, itchiness declined significantly faster than for those who were not reassured.

Perhaps, there is some magical power in words, after all.

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.

Clinicians Who Learn Of A Patient’s Opioid Death Modestly Cut Back On Prescriptions

New research has found that physicians modestly reduced the volume of opioids they prescribed after being told one of their patients had died of an overdose.

Anna Gorman, Kaiser Health News

Physicians and other medical providers modestly reduced the volume of opioids they prescribed after being told one of their patients had died of an overdose, according to research published Thursday.

“You can hear a lot of statistics about the crisis,” said Jason Doctor, lead author of the study, published Thursday in the journal Science. “But it always feels like it is happening elsewhere if you are not aware of any deaths in your own practice.”

The research included more than 800 clinicians — doctors, nurse practitioners, physician assistants and dentists — comparing those who received a letter from the medical examiner about a patient’s death and those who didn’t. The ones who knew about the overdose death cut the overall volume of opioids they prescribed by almost 10 percent over three months, while those who didn’t know prescribed roughly the same amount as before.

The study shows that awareness and education can change prescribing behavior, said Doctor, a director at University of Southern California’s Schaeffer Center for Health Policy & Economics. The modest size of the reduction among those who were notified of a death suggests “that clinicians exercised greater caution with opioids rather than abandoning use,” according to the study.

The providers in the study who were informed about patients’ deaths were also 7 percent less likely to start new patients on opioids.

The letter did not blame providers for the deaths but showed that authorities were paying attention, according to the study.

“We were providing them with important information and also giving them a way to make things better by changing prescribing,” Doctor said. “Anyone who got the letter could continue to prescribe as much as they wanted, but we found that they didn’t. They became more judicious prescribers.”

Over 19,000 people died from prescription opioids in 2016, roughly double the number 14 years earlier, according to the National Institute on Drug Abuse. Most of that increase occurred from 2002 to 2011, and the numbers have been relatively stable since then, according to the NIDA.

Meanwhile, prescriptions of opioids are declining, and health officials are seeking ways to accelerate the trend.

The study did not measure whether the letters from the medical examiner or the changes in prescribing patterns had any effect on patient deaths.

Across the country, physicians have been accused of overprescribing opioids and have even faced charges related to patient overdose deaths. In an effort to better track prescribing patterns, states have started prescription drug monitoring databases.

The CDC recommends that providers avoid opioids if possible, but if they are necessary, they should start with the lowest effective dose.

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.

Best Non-Clinical Side Hustles Any Clinician Can Start – Part 2

Part two of this series explores the non-clinical options of landing clinical speaking opportunities or joining paid medical market research panels.

By Jordan G Roberts, PA-C

Welcome back to our series on non-clinical careers for healthcare professionals. In part I, we discussed opportunities to start teaching in non-traditional ways and how to get into medical writing.

Today’s post will expand on this topic. First, we’ll show you how you can land clinical speaking opportunities. Next, you will learn about how to join paid medical market research panels to supplement your income and shape the direction of industry.

Speaking

It turns out that not many of us like the sound of our own voice. Even fewer people jump at the prospect at getting in front of a large crowd. That’s unfortunate, because your colleagues really do want to hear what you have to say.

The good news is that you can reach your fellow clinicians in a variety of ways, with or without a podium and a lectern.

While speaking at conferences is generally the first thing that comes to mind, it’s generally labor-intensive to get started. You not only need a great presentation, but you will also have to plan, apply for, and be selected for the spot. Therefore, this rigorous process makes it a prestigious, if not occasional option.

Other avenues take advantage of technology and the information boom. Medical podcasts and videos online are becoming more popular and starting to catch up with other social media trends. There are podcasts specific to certain groups of clinicians, podcasts for CME, and even specialty-specific podcasts. What will yours be?

Of course, one of the most lucrative ways to speak is for industry. Key opinion leaders (KOLs) give promotional talks for products they use and find to be the most beneficial for their patients. Teaching others about what you already use is a great way to get into this line of work.

Medical Market Research Panels

There are several companies who license their pool of clinicians to their clients who are developing a new healthcare product or service. The best ones pay cash honorariums that are worth your hourly rate. You also help shape the direction of these companies by providing your expertise and experience for these companies to consider in their future strategy.

Learn the skills and get the resources you need to get started in the original article. Continue reading the second of our three-part series on non-clinical opportunities here

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.

Kim’s Blog: Stand Up and Support Patients’ Wishes

What effort does it take to support a patient’s wishes? It’s not merely documenting them, but putting the wheels into motion to do, or to NOT do things.

by Kimberly Spering, MSN, FNP-BC

What effort does it take to support a patient or family’s wishes? It’s often not merely documenting those wishes, but putting the wheels into motion to do, or to NOT do things.

I received a request from my staff the other day to open a palliative care case – a new patient, on a Friday. Typically, I like my new patients to be earlier in the week, as those visits can last for hours, and, quite frankly, I like to be done at a reasonable hour prior to the start of my weekend, rather than chart until 8 – 9 PM.

“We think she may need hospice support. It’s not urgent, of course,” I was told.

I reviewed the patient’s chart. A nonagenarian at almost 91 years old, she had dementia, which unfortunately worsened after a CVA several years ago. She had been a fully independent, active person until she fell and suffered pelvic fractures almost two months ago. She went to rehabilitation, came home, then was found lethargic with a low SpO2 in the 70s. She returned to the hospital and was diagnosed with bilateral pulmonary emboli. She was started on anti-coagulation, which was quickly stopped due to GI bleeding. An IVC filter was placed. The GI specialists felt she was too frail and declined any invasive evaluation of the bleeding. Our palliative care inpatient team saw her and discussed hospice, but the son was not ready to make that decision.

Due to concerns about her care with the nursing home with her first rehabilitation stay, her son requested that she come home, where she has had 16 hours/day of aide support.

I arrived to find her son on the phone with her PCP’s office. Her hemoglobin had decreased from 11.8 to 10.2 in several days, so the PCP recommended ED evaluation.

Three days ago, however, she had presented to the ED for black, tarry stools (which continued after anti-coagulation was stopped). Her hemoglobin was stable, so she was discharged home.

Her son was irate, because it took hours for an ambulance transport to bring her home (at 1:30 AM), and when she got there, she was full of feces that hadn’t been cleaned up.

So, when the PCP office called today, saying, “take her back to the ED,” he was less than willing to do so.

I spoke with the office staff during that call, telling them I was there to evaluate her, and we would see how she was.

I started the conversation by reviewing her hospital stays, then led this into discussion of their goals of care.

“I don’t want her to go back to the hospital,” he first said. “I want to keep her at home and care for her here.”

After much discussion of hospice support, he admitted that he wasn’t ready for hospice, as he wanted to keep checking her CBC and have her get blood if needed. At the same time, he declined an EGD and colonoscopy, and he really did not want her to go back to the hospital, although he “would if it was needed.”

We discussed her decreased Hgb level, as well as his wishes for further care. Because he wanted the option to return to the hospital, getting blood if needed, she would not be appropriate for hospice anyway.

I gently explained my worries that with a continued slow GI bleed, that she eventually would become hypoxic and more lethargic, but unfortunately, with her current Hgb of 10.2, likely the hospital would NOT transfuse her at this point. In fact, the hospitalist previously documented transfusions only if her Hgb was < 7.5. Going to the ED would not be beneficial today, given that her vitals were stable, she was not SOB, and did not appear toxic.

Her son was relieved after this discussion. He has his own significant health issues, and in fact had an appointment today. We reviewed danger signs – increased dyspnea, lower SpO2, increased lethargy/weakness, increased black stools, etc.

I made another phone call to the PCP office and also messaged the patient’s PCP about the symptoms, evaluation, and son’s preference for repeat labs in a few days. As of this blog, I have not heard back.

What was important was to advocate for the patient and son. Had she seemed toxic or decompensated, given that he wanted labs and blood, I would have reiterated the need for ED evaluation.

Looking at the bigger picture, however, brought up a few points:

  • GI did not want to perform invasive testing.
  • Her Hgb was stable and not at a level to warrant transfusion.
  • The son’s goal is to keep her at home and minimize any invasive testing or hospitalization.

So, can one simply look at a hemoglobin level and recommend ED evaluation?

Really, it’s an individual decision, based on individual factors. Not simply a hemoglobin level. I imagine that the ED staff would roll their eyes having a patient with this hemoglobin roll in, particularly since parameters were clearly set only days ago.

So, once again – it points out that we need to advocate for our patients, explain their diagnoses, treatment options, risks, and benefits. Discussing their goals of care is essential. Do the possibilities of treatment coincide with their goals? Are we simply chasing “numbers,” rather than looking at the whole picture?

I get it, from my palliative perspective, it’s all about quality of life. Function. Comfort. Goals of care.

In this case, however, I think her goals are clear. Minimize hospitalizations if possible, but still check labs and transfuse if needed. There will be more discussions of her goals at my next visit. This is an on-going conversation, not a once-and-done deal.

Think about discussing your patients’ goals of care, whether or not they currently face life-limiting illness. It may only occur during an annual wellness visit. It may occur after a significant health crisis. But please, discuss it. You may be the only person willing to do so.

Wouldn’t we all want the same? Think about it.

Kim Spering has been a nurse for over 25 years and worked as an NP over the past 15 years in Family Medicine, Women’s Health, Internal Medicine, and now Palliative Medicine. She serves as an editorial board member of Clinician 1 and submit blogs to the website, with a goal of highlighting both the clinician and patient experience in health care.

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.

First Generic EpiPen Approved by FDA

On the heels of a massive EpiPen shortage, the U.S. Food and Drug Administration has approved the first generic alternative.

The U.S. Food and Drug Administration has approved the first generic alternative to the EpiPen and EpiPen Jr (epinephrine) auto-injector, which is used for the emergency treatment of allergic reactions, including those that are life-threatening, in adults and children.

The approval of a generic alternative to the EpiPen and EpiPen Jr., made by Teva Pharmaceuticals USA, comes on the heels of a major EpiPen shortage that has left parents of school-age children scrambling to find them as the school year begins, and which has resulted in the FDA extending EpiPen expiration dates. The FDA came to this decision after Mylan, the manufacturers of the EpiPen, requested the extension, and provided data to show that it would be safe to use them past their 20-month listed shelf life.

This approval was described as, “part of our longstanding commitment to advance access to lower cost, safe and effective generic alternatives once patents and other exclusivities no longer prevent approval,” by FDA Commissioner Scott Gottlieb, M.D.

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.

Trump Administration Sinks Teeth Into Paring Down Drug Prices, On 5 Key Points

Three months after President Trump announced his blueprint to bring down drug prices, administration officials have begun putting some teeth behind the rhetoric.

Sarah Jane Tribble, Kaiser Health News

Three months after President Donald Trump announced his blueprint to bring down drug prices, administration officials have begun putting some teeth behind the rhetoric.

Many details have yet to be announced. But experts who pay close attention to federal drug policy and Medicare rules say the administration is preparing to incrementally roll out a multipronged plan that tasks the Centers for Medicare & Medicaid Services (CMS) and the Food and Drug Administration with promoting competition, attacking the complicated drug rebate system and introducing tactics to lower what the government pays for drugs.

Mark McClellan, director of the Duke-Margolis Center for Health Policy in Durham, N.C., and a former CMS administrator, said that although none of the initial steps has “fundamentally transformed drug prices,” there is “a lot going on inside the administration.”

Two HHS officials who are rolling out the plan, Dan Best and John O’Brien, described their efforts to Kaiser Health News not as a public relations strategy but a push to reform the system.

“This administration is trying to go after root causes” of high drug prices, said Wells Fargo analyst David Maris.

But others are not so optimistic.

Ameet Sarpatwari, an instructor in medicine at Harvard Medical School in Boston, said policies the administration has rolled out thus far “alone will not translate into meaningful cost savings for most Americans.”

Broadly, the strategy falls under a handful of steps:

1. Attacking The Rebates

Health and Human Services Secretary Alex Azar has said Americans “do not have a real market for prescription drugs” because drug middlemen and insurers get a wide range of hidden rebates from drugmakers, but those savings may not be passed on to consumers or Medicare. In July, the administration submitted a proposed rule that could change the way rebates are handled.

Details of the proposal have not been made public. But O’Brien, a deputy assistant secretary at HHS, explained during a recent conference on federal drug spending sponsored by the Pew Charitable Trust: “You don’t have to use market power to get rebates, you can use market power to obtain discounts, to actually lower the price of the drug on the front end.”

Umer Raffat, an investment analyst with EverCore ISI, said “it’s not clear [that drug prices are going down]” but the “rebate structure is changing.”

2. Bringing More Negotiation To Medicare

This week, CMS Administrator Seema Verma announced that Medicare Advantage insurers can use a step-therapy approach to negotiate better prices for Part B drugs — those administered in hospitals and doctors’ offices. These private plans will be allowed to require patients to first select the least expensive drug before stepping up to more costly drugs if the original medications aren’t working.

The administration is also looking at ways to introduce more competition into Part B drug purchasing. That idea was mentioned deep inside the annual Medicare outpatient payment rule released last month.

Peter Bach, director of Memorial Sloan Kettering’s Center for Health Policy and Outcomes in New York, pointed to the possible introduction of a competitive purchasing program in which a firm negotiates with drugmakers to buy their drugs and then sells them to the doctors and hospitals that will administer the medications. Bach said that helps ensure that hospitals and doctors can’t make more money by prescribing more expensive drugs.

Currently, Medicare pays the average sales price plus 6 percent to doctors or hospitals when they purchase drugs, a pricing mechanism that can benefit the providers if the drug costs go up. If there were a third party buying the drugs, it would “have a huge effect,” Bach said.

3. Paying For Value

Trump’s blueprint calls for CMS to encourage “value-based care” to lower drug prices, shifting from paying a set fee for drugs to basing payments on how well the patient does on them.

Louisiana’s Medicaid program could show the way. The state is working with CMS to explore a subscription-based model to pay for hepatitis C medicines. Louisiana would pay a fixed price to a drug manufacturer that would then get unlimited access to treat patients enrolled in Louisiana’s Medicaid program or in prison.

The program would move “from a big payment upfront to paying less over time based on actual outcomes,” said McClellan, who also serves on the boards of health care giant Johnson & Johnson and insurer Cigna.

CMS also approved a Medicaid waiver from Oklahoma in June. Medicaid programs are allowed to negotiate drug prices. Oklahoma’s plan would expand that to negotiate additional prescription price reductions based on value-based purchasing agreements.

Still, CMS’ recent rejection of a related Massachusetts proposal makes it difficult to believe negotiating drug prices will really happen, said Sara Rosenbaum, a professor of health law and policy at George Washington University.

That proposal would have allowed Massachusetts’ Medicaid program to choose drugs based on cost and how well the medicines work.

“They have been very good and quite careful with their [Medicaid] program and so why not let them try this?” Rosenbaum said.

4. Tackling Foreign Drug Costs

Pharmaceutical makers often sell their drugs at substantially lower prices in many foreign countries than they do in the United States. Trump emphasized in May that “it’s time to end the global freeloading once and for all,” saying U.S. consumers were paying part of the cost of the medicines that patients in other countries use.

He directed U.S. Trade Representative Robert Lighthizer to address the situation. Lighthizer’s office declined to comment.

When Sen. Todd Young (R-Ind.) asked during a Senate health committee hearing in June whether trade agreements with other countries should be used to “level the playing field,” Azar’s response was swift: “We absolutely believe we should be using our trade agreements to get them to pay more even as we have our job to pay less.”

Avalere Health President Matt Brow, who has been involved in talks with the administration, said it’s clear the focus on overseas pricing isn’t going away and the administration is “talking a lot about how to get the president what he wants.”

5. Increasing Competition

FDA Commissioner Scott Gottlieb has become the Trump administration’s lead proponent for increasing competition among drugmakers.

Competition resonates with Americans “because people see it every day in their experience in Costco and other places,” said Rena Conti, an associate professor at the University of Chicago.

Gottlieb has announced plans to bolster the use of generic drugs and an “action plan” to encourage the development of biosimilars, which are copycat versions of expensive biologic drugs made from living organisms.

And to combat anti-competitive behavior in the market, Gottlieb said the FDA has passed along information to the Federal Trade Commission and hinted at potential action to come: “I think we’ve handed them some pretty good facts.”

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

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.

Great Podcasts for PTs, OTs, and SLPs

Podcasts are a great way for busy therapy professionals to absorb practical advice and tips, and maybe even be entertained, while you’re on the go.

Podcasts are a fantastic and free way to absorb information—and often be entertained—while on the go, which can be quite beneficial for busy therapy professionals. Below are some great podcasts, broken down by specialty, for your listening pleasure.

Physical Therapy:

Senior Rehab Project – Listen Now
The Senior Rehab Podcast brings you helpful conversations for rehab clinicians that serve older adults. Dustin Jones, PT, DPT, CSCS, RKC, speaks with industry leaders to draw out useful, practical information for YOU – the rehab clinician. Whether you’re a physical therapist, PTA, student, or seasoned veteran, the Senior Rehab Podcast will prove to be helpful for you in your practice.

Dr. Scott Gray’s Redefining Physical Therapy Podcast – Listen Now
Sport and spine injury specialist, Dr. Scott Gray, interviews other elite level physical therapists helping to redefine the physical therapy profession. Practical advice and tips are shared on this podcast that clinicians can apply TODAY in their practice, not research.

Therapy Insiders Podcast – Listen Now
Hosts Gene Shirokobrod PT, DPT, OMPT, Joe Palmer PT, DPT, OMPT, CSCS, and Erson Religioso III, DPT, MS, MTC, CertMDT, CFC, CSCS, FMT, FAAOMPT interview prominent guests to help shed light on various therapeutic topics ranging from joint manipulations, functional training, business ownership while being a clinician, sports rehab and much more. We cover Physical Therapy (PT), Manual therapy, rehab, sports medicine, business practice, and many more topics.

The PT Source – Listen Now
The PT Source Podcast with Matt Laporte brings you the latest articles, blog posts, research and web content in an easily digestible format. Welcome to the easy way to stay up to date with the latest in the field of physical therapy and exercise science.

Physical Therapy Forensics – Listen Now
Evidence truly meets practice on this podcast where we take a look at the latest research affecting the treatment of your patients/clients. Taking a practical approach to evidence-based practice.

Occupational Therapy:

Seniors Flourish Podcast – Listen Now
The Seniors Flourish Podcast helps occupational therapy practitioners working with older adults be the best they can be – not only by showcasing relevant interviews, answering questions, current articles and hot topics, but also to get OT practitioners EXCITED about working with older adults, give actionable ideas that listeners can take and use in their own practice and have some FUN along the way.

Occupational Therapy Insights – Listen Now
Occupational Therapy Insights is a show for parents, educational professionals, and occupational therapists, that delves into the world of occupational therapy. Here occupational therapy is broken down into its simplest form for all to understand. The show is hosted by Dr. Frederick Covington, an occupational therapy professor, author, award winning inventor, and occupational therapy private practice owner.

Occupied – Listen Now
A creative project exploring all things Occupation, Occupational Science, and Occupational Therapy. Each fortnight I am to showcase a topic or therapist and to have a discussion exploring OT related ideas and concepts. My aim is to challenge you, make you think and provide you with guidance wherever possible.

Joyriding In Autismland: Autism Podcast with Kid Gigawatt – Listen Now
Launched by parents of an infectiously funny and *mostly* happy boy on the spectrum, the Joyriding in Autismland podcast chats with ASD parents, kiddos, therapists, writers, and artists about the unexpected, charming, and funny moments with autism. Because laughing? Is the best vacation.

ADHD Experts Podcast – Listen Now
Leading ADHD experts give real-life answers to questions submitted by ADD adults and parents raising children with attention deficit disorder across a range of topics covering symptoms, school, work, and family life. Note on audio quality: This podcast is a recording of a webinar series, and the audio has been captured from telephone conversations, not recorded in a studio.

Speech Therapy:

The Speech Space Podcast – Listen Now
Looking for some fresh ideas for your speech therapy sessions? The Speech Space podcast is a podcast full of tips and resources for speech-language pathologists working in the schools or private practice.

Speech and Language Kids Podcast – Listen Now
Carrie Clark, a speech-language pathologist from Columbia, Missouri, offers resources, information, and activities for speech therapists and parents of children with speech and language development and delays. While Carrie’s materials will provide great information for speech therapists, they will also empower families to use fun and easy activities to improve their child’s speech and language skills at home. Activities and information cover a range of ages, ability levels, and disabilities. Topics covered include: articulation, apraxia, phonology, language, late talkers, alternative/augmentative communication (AAC), autism, stuttering, reading, social skills, down syndrome, following directions, answering questions, grammar, etc. Educators and other professionals will also love this easy-to-follow information and the step-by-step guides.

Speech Therapy: Storm of the Brains – Listen Now
Speech therapist Carrie Clark brainstorms ideas and answers to your speech therapy questions. Carrie Clark will bring on guest speech-language pathologists to answer your questions. Speech therapists can call in questions for Carrie and her guest to answer on air. Listen in as Carrie Clark and her guest brainstorm ideas to help you with your toughest cases. Plus, tune in each week for a giveaway!

True Confessions with Lisa & Sarah – Listen Now
This is the true story of two school-based SLPs who decided to start a business and are stupid enough to record it. Find out what happens when we stop being polite and start getting real.

More than Child’s Play – Listen Now
Join Speech Therapist Lacy Morise and Physical Therapist Nicole Sergent as the host warm and helpful conversations around their table where the early childhood world and daily parenting life meet. The friends and professionals from their village will inspire, challenge, and support you in your own journey as a parent, early childhood professional, or therapist.

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.

3 Settings to Consider Working in as a Medical Assistant

The number of Medical Assistants is expected to increase 29% percent through 2026, but there’s more to medical assisting than working in a doctor’s office.

Medical Assistants support a wide range of essential functions in healthcare, performing an array of administrative and clinical tasks in a variety of settings, and the need for Medical Assistants is only growing. The U.S. Bureau of Labor Statistics estimates the number of Medical Assistants is expected to increase 29% percent through 2026, making it a booming field that is growing more rapidly than the 11% growth expected for all occupations.

As a career that is relatively quick to get into, with a certification taking just 10 months to obtain, and one that has an average annual salary of more than $32,000, it is a solid career choice that cements you in the fabric of the ever-growing healthcare industry. It also affords an array of employment options, meaning that as a Medical Assistant, you can work in a variety of settings—not just in a doctor’s office, though that is where an estimated 62% of Medical Assistants are employed.

Here are a few different settings to consider, if you are interested in diversifying.

Hospitals

If you’re looking for a fast-paced environment and don’t necessarily want to be tied to a 9-to-5, working in a hospital may be a good fit for you. Given their 24/7 business hours and the diversity of cases (you will likely see everything from life-threatening trauma to routine procedures), this could be the job to keep you on your toes—morning, noon, nights, and weekends. There are also more than 5,500 hospitals in the United States, making it pretty likely there’s one hiring nearby.

Laboratories

If you prefer not interfacing with patients nearly as much, this might be the setting for you. Working as a Medical Assistant in a diagnostic laboratory means you will run tests on samples, record results, and input data. You could also be tasked with supporting scientists if the lab you’re working at is at a research university, and work in medical research and development.

Assisted Living Communities

If you have a passion for helping people, participating in geriatric care at an assisted living community may be the perfect Medical Assistant role for you. As the Baby Boomer generation ages into retirement, the demand for assistance in senior living communities across the country will only continue to grow. Help them make the most of their final years by performing daily living tasks, taking vital signs, and maintaining medical records.

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.