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Yet Another Physician Speaks Out Against PAs, NPs

As the physician shortage worsens, there is no shortage of physicians speaking out against the idea of PAs and NPs being comparable substitutes.

A physician-penned op-ed published online this week entitled “NPs/PAs ‘Just as Effective’ as Physicians? I Don’t Think So” casts a negative spotlight on PAs and NPs, yet again.

The piece, which was written by Starla Fitch, MD, an ophthalmologist, speaker, and personal coach, brings up the oft talked about physician shortage and all but ridicules the idea of advanced practitioners as a comparable substitute, with Fitch stating in the piece, “With all due respect to our healthcare team, I beg to differ that going through four years of college and completing an additional two years – sometimes online, no less – can truly be “just as effective.””

Fitch takes issue with calling PAs and NPs equal to physicians, but admits support is needed by other members of the healthcare team.

“I’m not arguing against having the support of other healthcare members. Trust me. The shortage is real. And we need to find solutions,” Fitch writes, continuing on to say, “But please don’t say, we are “just as effective.” I realize that there are many duties that nurse practitioners and physician assistants can do with skill and authority. And the reasons why primary care physicians are declining is multifactorial, for sure. As I see it, though, putting physicians and our skill side-by-side, on equal footing, with those who are not physicians only serves to drive a deeper wedge between the healthcare folks who need, at this crucial time, to come together.”

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.

Optimizing EHR to Reduce Burnout? It’s Worth A Shot.

There is no one solution to fix physician burnout, considering it is a multifaceted issue, but optimizing EHR certainly can’t hurt.

Burnout, as we’ve reported over and over and over, is a pervasive problem impacting the physician workforce in the United States. There is no one solution to fix it, considering it is a multifaceted issue. However, the AMA has one suggestion—streamlining EHR.

EHR, which is often labeled as a factor of physician burnout, hasn’t exactly lived up to the hype surrounding it when it was introduced. It was supposed to be the wave of the future, a way to improve the healthcare experience for not only patients, but staff, as well. It’s done nearly the opposite, becoming a time-consuming burden for physicians and leading to breaches of patient data in a way that was never really possible with paper health records. However, it is seemingly here to stay, so optimizing it only makes sense, and one practice in Massachusetts may have cracked the code on how to do this.

In 2016, Reliant Medical Group, a 500-provider multispecialty practice in Massachusetts, ranked in the 97th percentile nationally for EHR usability. The system they have developed has reportedly resulted in a 25% reduction in physician in-basket message volume over an 18-month period.

How did they do it?

Establish A Comprehensive EHR Team

Reliant developed a team, which is comprised of five physicians, one physician assistant, and a nurse, who work in concert with 12 members of the IT division. This team meets weekly to identify ways to improve efficiency, and then the programmers go to work to implement changes.

Automate When Possible

Reliant created a system that can automatically gather and share patient information from multiple sources, such as affiliated hospitals and health plans. This has helped them to cut down on time-consuming tasks, such as calling around to other organizations for information.

Delegate Where Appropriate

A physician’s overflowing inbox is another source of burnout. Tweaking EHR so that other members of the staff, such as medical assistants, can gather and receive information without producing a message for the physician helps alleviate this. Within Reliant’s practice, only laboratory results are sent to the primary care physician’s inbox for review, while routine consultation notes are no longer delivered directly to the physician.

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.

Female PAs Still Paid Less than Male PAs

Female PAs earn $.91 to every dollar male PAs earn according to the newly released findings from the AAPA’s annual salary survey.

The results of the annual AAPA Salary Survey have been released, and they offer a stark look at pay disparities between male and female physician assistants.

The survey, which obtained responses from more than 8,000 PAs, found that full-time female PAs were, on average, being paid $13,380 less than their male counterparts, and that they were less likely to receive bonuses than male PAs—a rate of 40% for women and 53.4% for men. Even when taking into account other factors that could be expected to affect compensation, the survey found a 9% difference in pay between female and male PAs—or, to put it bluntly, female PAs earn $.91 to every dollar earned by male PAs.

The AAPA attributes this, in part, to more males entering the 52-year-old PA profession earlier than females, thus giving them more experience and seniority, which the survey found to result in higher compensation. However, the AAPA also notes, “The total compensation discrepancy begins almost immediately upon entering the profession—there is a disparity between male and female PAs in the first years of practicing as PAs. This difference may be exacerbated as PAs progress through their careers, since increases in pay are often based on increasing the previous salary by a certain amount, and new employers often base a PA’s starting pay in part on their previous salary. A compensation disparity that begins on a PA’s first day on the job could have lifelong implications for the PA.”

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 Codes Relating to Social Factors Proposed

New codes have been proposed relating to social determinants, also known as the non-medical factors in a patient’s life that have an impact on their health.

Social determinants of health—the conditions in which people are born, grow, work, live, and age, as well as the forces and systems shaping the conditions of their daily lives—are well known to impact health risks and outcomes. Because of this, the American Medical Association and UnitedHealthcare have teamed up in an effort to support the creation of twenty new ICD-10 codes related to social determinants.

The proposed codes aim to more effectively address non-medical issues that influence patient health, such as financial hardships, unemployment, and housing insufficiency.

In full, the proposed codes are:

  • Z55.5 Less than a high school degree
  • Z55.6 High school diploma or GED
  • Z56.83 Unemployed and seeking work
  • Z56.84 Unemployed but not seeking work
  • Z56.85 Employed part time or temporary
  • Z59.61 Unable to pay for prescriptions
  • Z59.62 Unable to pay for utilities
  • Z59.63 Unable to pay for medical care
  • Z59.64 Unable to pay for transportation for medical appointments or prescriptions
  • Z59.65 Unable to pay for phone
  • Z59.66 Unable to pay for adequate clothing
  • Z59.67 Unable to find or pay for child care
  • Z59.69 Unable to pay for other needed items
  • Z59.91 Worried about losing housing
  • Z60.81 Unable to deal with stress
  • Z60.82 Inadequate social interaction – limited to once or twice a week
  • Z60.83 Can hardly ever count on family and friends in times of trouble
  • Z60.84 Feeling unsafe in current location
  • Z60.85 Stressed quite a bit or very much
  • Z60.86 Stressed somewhat

The codes have been submitted to the ICD-10 Coordination and Maintenance Committee for consideration, and if approved, the would apply starting on October 1, 2020.

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.

Had a Tough Shift? Here’s 5 Ways to Recover.

Nursing is a hard job to begin with, but some days are harder than others. Here are five ways to help put that extra tough shift behind you and move forward.

Nursing is a hard job to begin with, not just physically, but also emotionally. And some days will be harder than others. Some days, your patience and your mettle will be tested in ways you never imagined—you’ll mess up something important, an extra combative patient will curse you out, a well-liked patient will die. How do you recover from those shifts? Here are five things to try.

Talk It Out

Whether it’s with a coworker or a close friend, take the time to honor what you are feeling and unload your emotions. Crying it out, if you need to, or simply saying aloud just how much your day truly sucked, can offer a cathartic release and help you let go of the negative emotions you are holding on to. Speaking to management, as well, can prove useful, as they can often help you to find the learning opportunities in your strife, or reassure you that you did the right thing in a hard situation.

Find Joy

Whatever makes you happy, do that. After your shift, snuggle your pets or your partner, cook a good meal or order in, curl up with Netflix or hit the gym, call a friend or read a book. Take the time to partake in whatever it is that typically brings you joy, instead of stewing in the negativity of your day.

Sleep It Off

After a noisy day at work—and let’s be honest, it can get very noisy—climbing into a cozy bed, surrounded by quiet, can offer comfort in a way that most other things cannot. This can be extra beneficial after a hard day, as well. Curl up and get some sleep—it’s going to be okay in the morning (or evening, if you’re working the night shift).

Focus on the Future

The next day is always a new day, with potential for new victories, no matter how trying the day before was. Focus on the fresh start tomorrow affords you and try not to dwell on the past. There are always new chances to help people and change lives in the days ahead, and isn’t that the best part of nursing?

Get Help

If you truly cannot move beyond what happened, do not be afraid to seek professional help. There is no shame in not being able to work through things on your own. A non-biased third-party, such as a therapist, can help you objectively look at whatever happened and move beyond it by talking things through in ways that your personal confidants might not be able to.

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.

2019’s “Best Hospitals” Announced

U.S. News & World Report has released their 30th edition of the Best Hospitals in the United States. Take a look at which hospitals scored top marks.

U.S. News & World Report has released their annual rankings of the Best Hospitals in the United States for 2019. The data-driven rankings, which are now in their 30th year, provide a multidimensional assessment of nearly every hospital in the nation, and are often recognized as the worldwide authority in hospital rankings. The rankings include “best of” lists for twelve specialties—Cancer, Cardiology & Heart Surgery, Diabetes & Endocrinology, Ear, Nose & Throat, Gastroenterology & GI Surgery, Geriatrics, Gynecology, Nephrology, Neurology & Neurosurgery, Orthopedics, Pulmonology & Lung Surgery, and Urology—as well as an Honor Roll, which takes into account both specialty rankings and procedure and condition ratings.

The hospitals that made the Honor Roll and are, thus, recognized as the twenty best in the nation include:

1. Mayo Clinic, Rochester, Minnesota
2. Massachusetts General Hospital, Boston
3. Johns Hopkins Hospital, Baltimore
4. Cleveland Clinic
5. New York-Presbyterian Hospital-Columbia and Cornell, New York
6. UCLA Medical Center, Los Angeles
7. UCSF Medical Center, San Francisco
8. Cedars-Sinai Medical Center, Los Angeles
9. NYU Langone Hospitals, New York
10. Northwestern Memorial Hospital, Chicago
11. University of Michigan Hospitals-Michigan Medicine, Ann Arbor
12. Stanford Health Care-Stanford Hospital, Stanford, California
13. Brigham and Women’s Hospital, Boston
14. Mount Sinai Hospital, New York
15. UPMC Presbyterian Shadyside, Pittsburgh
16. Keck Hospital of USC, Los Angeles
17. University of Wisconsin Hospitals, Madison
18. (tie) Hospitals of the University of Pennsylvania-Penn Presbyterian, Philadelphia
18. (tie) Mayo Clinic-Phoenix
20. (tie) Houston Methodist Hospital
20. (tie) Yale New Haven Hospital, Connecticut

To see the full rankings, click 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.

Where Are You Most Needed? 6 Nursing Shortage Facts.

The nursing shortage is a growing problem that’s putting serious pressure on nursing staff around the country. Here are 6 facts to know about it.

By Deborah Swanson

It’s no secret that the United States is in desperate need of nurses. Due to patients living longer, educational bottlenecks, and a staggeringly high turnover rate in the healthcare industry, the nursing shortage is a growing problem that’s putting serious pressure on nursing staff around the country.

As a nurse or nursing student, you’re probably well aware of these issues. In fact, it may even be one of the primary reasons you’ve pursued a nursing career in the first place. After all, what could be more fulfilling than providing care and support for patients who desperately need it?

There are several areas—both physical and occupational—where the need for nurses is at an all-time high. If your true calling is to make a difference in the lives of your patients, here are six nursing shortage facts that may influence where you end up.

  1. California has the greatest nursing shortage of any state.

    Although California employs the highest number of registered nurses in the country, it needs more—a lot more, in fact. According to a 2017 report by the Health Resources and Services Administration, California is predicted to have the highest demand for nurses in the country, with a shortage of nearly 45,000 registered nurses.

    With its strong economy and thriving metropolitan areas, California has long been a desirable place to live. If you’re thinking about working as a nurse in the Golden State, check out the California Nursing Students’ Association (CNSA) for mentorship and networking opportunities.

  2. Rural towns need the most help.

    If you prefer small town life to the hustle and bustle of urban living, healthcare institutions in rural America will gladly accept your help. Attracting and retaining qualified nurses has long been a problem for hospitals in rural locations, mainly due to the lower pay rate and less lively social scene.

    While the pay may be lower, the cost of living is often lower as well. Plus, you’ll never deal with the insane traffic that you’d find in a metropolitan area. For nurses who truly want to make a difference, the rural healthcare workforce is in desperate need of help.

  3. Demand for certified nurse midwives is growing.

    What could be more meaningful than caring for the newest generation? Certified nurse midwives are experiencing a huge surge in demand lately as more couples wish for positive and natural birth experiences.

    According to statistics from the Bureau of Labor Statistics, employment of nurse midwives is expected to grow 21 percent by 2026, with 1,700 jobs created in this occupation. As an added bonus, you’re looking at a median wage of $106,910 for this field, per estimates from the Bureau of Labor Statistics.

  4. Certified nurse anesthetists, dialysis nurses and other nurse specialties are growing, too.

    In addition to certified nurse midwives, there is a growing number of in-demand nurse specialties that nursing students should consider. Making one of these specialties your primary focus can help you facilitate change in the healthcare industry and pave the way towards a fulfilling career:

    • Certified Registered Nurse Anesthetist (CRNAs): CRNAs work with surgeons, anesthesiologists and other healthcare professionals to safely deliver anesthesia to patients. CRNAs are one of the higher-paying fields in the industry, with a mean annual wage of $174,790.
    • Certified Dialysis Nurse: As our population continues to age, the need for dialysis services is growing. A certified dialysis nurse assists their patients with kidney function issues by supporting the administration of dialysis with a physician. Growth for this job is steady and is expected to increase 26 percent over the next decade.
    • Pediatric Endocrinology (PED ENDO) Nurse: As a PED ENDO nurse, you’ll provide care and support for children with endocrine disorders such as diabetes or hypoglycemia. Unfortunately, the need for this occupation may be growing due to our increasing risk of diabetes and obesity.
  5. The need for nurse educators has never been greater.

    One of the reasons why the country is facing such an immense shortage of registered nurses is partly due to educational bottlenecks. With an aging faculty, budget issues, and low pay, the demand for nurse educators is at an all-time high.

    According to a 2017 study published in Nursing Outlook, one-third of current nurse educators are expected to retire by 2025. Most younger faculty members who may potentially replace them don’t have nearly the same level of experience as their older counterparts.

    To address this shortage, many nursing programs and organizations are providing more funding for nursing students to seek doctoral degrees to replenish the supply of nurse educators and researchers. If you’re a current nursing student, don’t be afraid to talk with your advisor or senior nursing students about pursuing a doctoral degree.

  6. Travel nurses can greatly benefit nurses and hospitals alike.

    Travel nursing is just one of the ways in which the nation is addressing the decades-long nursing shortage. Being a travel nurse is exactly what it sounds like: You sign a short-term contract and travel to wherever you’re needed most, often for much better pay than staff nurses.

    If you’ve always dreamed of packing your nursing bag to see more of the world while making a positive difference in the lives of your patients, becoming a travel nurse can help you achieve both. Although you need roughly 18 months of experience in a nursing specialty to be a travel nurse, the opportunity to travel internationally or across the country for a high pay rate is undeniably appealing.

As a nurse or nursing student, you have the potential to make a huge impact in your community. Whether it’s by pursuing a doctoral degree or living the life of a traveling nurse, your choices going forward can make all the difference. By keeping these six nursing shortage facts in the back of your mind, you can opt for an extremely rewarding career path that sets you up for success.

Deborah Swanson is a Coordinator for the Real Caregivers Program at allheart.com. A site dedicated to celebrating medical professionals and their journeys. She keeps busy interviewing caregivers and writing about them and loves gardening.

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.

More Doctors on the Way, as Med School Enrollment Exceeds Goals

As the physician shortage continues, it’s promising to know that medical school enrollment has outpaced growth goals. But the crisis isn’t over quite yet.

Medical school enrollment is not only up, but it has surpassed growth benchmarks set by the Association of American Medical Colleges, according to the results of the AAMC’s 2018 Medical School Enrollment Survey.

In 2006, the AAMC called for a 30% increase in medical school enrollment to help alleviate growing concerns regarding the long-predicted physician shortage. Medical school enrollment has now grown by 31% since 2002, just above the mark, and when combined with schools of osteopathic medicine, enrollment is now 52% higher than it was in 2002. The AAMC ties this growth to a number of factors, including increases in class sizes and the creation of 29 new medical schools.

Though the numbers are promising, concerns still remain high—particularly those regarding the availability of graduate medical education opportunities on state and national levels, as well as the number of clinical training sites and available preceptors. The AAMC is now seeking a shift of focus to increase the number of graduate medical education slots available, as well as calling on Congress to pass the bipartisan Resident Physician Shortage Reduction Act.

The full results of the survey can be found 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.

A PSA on How to Address PAs

A physician assistant took to Twitter this week to offer up a PSA on how to address PAs, something that many still manage to bungle.

A physician assistant took to Twitter this week to offer up a public service announcement on how to address PAs, an issue that seems to frequently arise, and one that many still manage to bungle.

“Physician assistant” seems like a straight-forward enough title. However, some still add ‘s to the end of “physician”, as if implying a physician’s ownership of a PA, as opposed to the PA being a colleague of the physician. To help avoid this, David J. Bunnell, MSHS, PA-C created a handy graphic that you, too, can share to help educate the public on how to correctly refer to PAs.

“PAs mean no disrespect to any other healthcare professional. We all share the same mission to help patients feel better and live longer,” Bunnell said when asked about his tweet, and we couldn’t agree more.

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.

Telehealth Is on the Rise

Telehealth is gaining in usage, says a new report, but there are still some barriers in place that are hindering wider implementation.

Telehealth is gaining in usage, or so found the State of the States Report: Coverage and Reimbursement from the American Telemedicine Association. However, there are still some barriers in place that are hindering wider implementation.

The report, which offers an in-depth analysis of telehealth laws and policies, was released last week, along with a statement from the ATA. In the statement, Ann Mond Johnson, Chief Executive Officer of the ATA, said, “This year’s ATA report illustrates the increasing recognition of telehealth, and can guide federal and state lawmakers to identify and address policy gaps. Collectively, states are realizing the many benefits of telehealth and are implementing policies that advance utilization.”

Key findings from the ATA report include:

  • The eight most common types of telehealth providers include physicians, physician assistants, nurse practitioners, licensed mental health professionals, psychologists, physical therapists, occupational therapists, and dentists.
  • Since 2017, when the ATA issued their last report, 40 states and the District of Columbia have adopted telehealth policies or have received awards to expand telehealth coverage and reimbursement.
  • 36 states and D.C. have parity policies for private payer coverage, and only 21 states and D.C. have coverage parity policies in Medicaid.
  • 28 states have Medicaid payment parity policies, and only 16 mandate payment parity for private payers.
  • The majority of states have no restrictions on eligible provider types; ten states have authorized six or more types of providers to treat patients through telehealth.
  • Currently, 29 states do not specify where a patient must be located in order to receive care via telehealth.

“It’s clear that more states are adopting telehealth solutions, but some lack the authority or resources needed to fully deploy telehealth across the state. ATA supports expanding research opportunities to increase innovation and reduce costs, to help incentivize states to continue to adopt telehealth services,” added Mond Johnson.

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.