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Everett CM, Thorpe CT, Palta M, Carayon P, Gilchrist VJ, Smith MA. The roles of primary care PAs and NPs caring for older adults with diabetes. JAAPA 2014; 27:45-9. [PMID: 24662258 PMCID: PMC4221794 DOI: 10.1097/01.jaa.0000444736.16669.76] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Electronic health record data linked with Medicare data from an academic physician group were used to propose a multidimensional characterization of PA and NP roles on panels of primary care patients with diabetes. Seven PA and NP roles were defined based on level of involvement, visits with complex patients, and delivery of chronic care. Findings suggest that PAs and NPs in primary care perform a variety of roles and frequently perform multiple roles within a clinic.
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Affiliation(s)
- Christine M Everett
- Christine M. Everett is an assistant professor in the PA program at Duke University School of Medicine in Durham, N.C. Carolyn T. Thorpe is an assistant professor in Health Services Research and Development at the Veterans Affairs Pittsburgh Healthcare System and in the Department of Pharmacy and Therapeutics at the University of Pittsburgh School of Pharmacy in Pittsburgh, Pa. Mari Palta is a professor in the Department of Population Health Sciences at the University of Wisconsin-Madison. Pascale Carayon is a professor in the Center for Quality and Productivity Improvement in the Department of Industrial and Systems Engineering at the University of Wisconsin-Madison. Valerie J. Gilchrist is a professor and department chair of the Department of Family Medicine at the University of Wisconsin-Madison. Maureen A. Smith is a professor in the departments of population health sciences, family medicine, and surgery at the University of Wisconsin-Madison. The authors disclose that funding for this project was provided by the Agency for Healthcare Research and Quality, grant numbers R21 HS017646 and R01 HS018368. Additional support was provided by the Health Innovation Program, which assisted with institutional review board application, Medicare data management, variable creation, and manuscript formatting; the Community-Academic Partnerships core of the University of Wisconsin Institute for Clinical and Translational Research (UW ICTR), grant 1UL1RR025011 from the Clinical and Translational Science Award (CTSA) program of the National Center for Research Resources, National Institutes of Health; and the UW School of Medicine and Public Health from the Wisconsin Partnership Program. One author was supported by the AHRQ/National Research Service Award T-32 Institutional Training Program Grant Number: 5-T32-HS00083 and the American Academy of Physician Assistants' Breitman-Dorn Fellowship. No other funding source had a role in the design or conduct; data collection, management
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O'Connor TM, Hooker RS. Extending rural and remote medicine with a new type of health worker: Physician assistants. Aust J Rural Health 2007; 15:346-51. [DOI: 10.1111/j.1440-1584.2007.00926.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Ellerin BE. Debt, Demographics, and Dual Degrees: American Medicine at the Crossroads. J Am Coll Radiol 2007; 4:537-46. [PMID: 17660117 DOI: 10.1016/j.jacr.2007.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Indexed: 11/26/2022]
Abstract
An alternative solution to the predicted physician workforce shortage would be the incorporation of nonphysician caregivers (NPCs) into the primary care workforce under the supervision of a limited number of internists, pediatricians, and family practitioners, thus freeing medical students and residents who currently enter primary care medicine for work in medical and surgical specialties in which there are current shortages that require specific medical training beyond the scope of NPCs' competencies. At the same time, the profession should follow the lead of the multidisciplinary ethic of contemporary natural science, in which collaboration among disciplines has become increasingly crucial for high-level research, by creating a training pathway, on the model of the Medical Science Training Program, for dual-degree physicians who seek to combine their medical expertise with training in the social sciences and the humanities. In addition to recognizing and rewarding an existing and growing trend within medical education, the creation of a cadre of dual-degree experts with access to centers of power and influence in law, business, government, and the media could create the nucleus of a medically trained intellectual elite that would be in a better position in the future to advocate for physician interests in crucial centers of power.
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Affiliation(s)
- Bruce E Ellerin
- New York University School of Medicine, Department of Radiation Oncology, New York, New York, USA.
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Huang PY, Yano EM, Lee ML, Chang BL, Rubenstein LV. Variations in nurse practitioner use in Veterans Affairs primary care practices. Health Serv Res 2004; 39:887-904. [PMID: 15230933 PMCID: PMC1361043 DOI: 10.1111/j.1475-6773.2004.00263.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Increasingly, primary care practices include nurse practitioners (NPs) in their staffing mix to contain costs and expand primary care. To achieve these aims in U.S. Department of Veterans Affairs medical centers (VAMCs), national policy endorsed involvement of NPs as primary care (PC) providers. OBJECTIVES To evaluate the degree to which VAMCs incorporated NPs into PC practices between 1996 and 1999, and to identify the internal and external practice environment features associated with NP use. STUDY DESIGN We surveyed 131 PC directors of all VAMCs in 1996 and 1999 to ascertain the staffing and characteristics of the PC practice and parent organization (e.g., academic affiliation, level of physician staffing, use of managed care arrangements), and drew on previously published studies and HRSA State Health Workforce Profiles to characterize each practice's regional health care environment (e.g., geographic region, state NP practice laws, state managed care penetration). Using multivariate linear regression, we evaluate the contribution of these environmental and organizational factors on the number of NPs/10,000 PC patients in 1999, controlling for the rate of NP use in 1996. PRINCIPAL FINDINGS From 1996-1999, NP use increased from 75 percent to 90 percent in VA PC practices. The mean number of NPs per practice increased by about 60 percent (2.0 versus 3.2; p<.001), while the rate of NPs/10,000 PC patients trended upward (2.2 versus 2.7; p=.09). Staffing of other primary care clinicians (e.g., physicians and physician assistants per practice) remained stable, while the NP-per-physician rate increased (0.2 versus 0.4; p<.001). After multivariate adjustment, greater reliance on managed-care-oriented provider education programs (p=.02), the presence of NP training programs (p=.05), and more specialty-trained physicians/10,000 PC patients (p=.09) were associated with greater NP involvement in primary care. CONCLUSIONS Staffing models in VA PC practices have, in fact, changed, with NPs having a greater presence. However, we found substantial practice-based variations in their use, suggesting that more research is needed to better understand how they have been integrated into practice and what impact their involvement has had on the VA's ability to achieve its restructuring goals.
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Affiliation(s)
- Patty Y Huang
- VA Greater Los Angeles HSR&D Center of Excellence, Sepulveda, CA 91343, USA
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Lin SX, Gebbie K, Fullilove R, Arons R. Characteristics of patient visits to nurse practitioners in hospital outpatient departments. J Prof Nurs 2003; 19:211-5. [PMID: 12964142 DOI: 10.1016/s8755-7223(03)00089-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Nurse practitioners (NPs) are the largest and the fastest growing groups among nonphysician practitioners in the United States. However, there has been lack of studies on the supply, demand, and use of nurse practitioners in hospital outpatient departments (OPDs) across the nation. Using the National Hospital Ambulatory Medical Care Survey (1997-2000), this study describes patient visits to NPs in general medicine, pediatrics, and obstetrics/gynecology clinics in hospitals across the nation. The percentage of patient visits involving NPs increased from 5.9 percent in 1997 to 7.3 percent in 2000. NPs have greater roles in hospital OPDs in nonmetropolitan areas than in metropolitan areas. Regional difference in patient visits to NPs supports the relationship between the practice environment and the use of NPs. As expected, NPs continue to serve the health care needs of women and children in hospital OPDs. Of all OPD visits with a NP service, NPs saw patients with no presence of a physician in 82 percent of these visits. As the role of the NP evolves in the U.S. health care delivery system, further studies on the clinical practice of NPs in hospital OPDs can help evaluate the impact of NPs in providing quality of patient care at minimum cost.
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Affiliation(s)
- Susan X Lin
- Columbia University School of Nursing, New York, NY 10032, USA.
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Hartley H, Gasbarro C. Forces promoting health insurance coverage of homebirth: a case study in Washington State. Women Health 2003; 36:13-30. [PMID: 12539790 DOI: 10.1300/j013v36n03_02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The movement of childbirth to the hospital in the early 1900s and the eventual establishments of health insurance reimbursement for hospital birth--but not for homebirth--solidified and reflected physician dominance in the area of obstetrics. Until recently, it was rare that a health insurer or a health maintenance organization (HMO) would cover a homebirth. However, in Washington State the majority of health insurance groups cover homebirths, which are generally attended by licensed midwives. In this context, our research is a case study focused on answering the question: What are the forces promoting the extensive coverage of homebirth by health insurers in Washington State? Data were gathered primarily through fourteen (14) in-depth, audiotaped interviews with key informants in relevant agencies and organizations in the state (i.e., state offices; midwife and other professional associations; and health insurance groups). Results suggest that consumer demand was an important precipitating factor without which changes to health insurance coverage would likely not have been made. Additionally, changes in state policies and professional mobilization on the part of licensed midwives were critical factors facilitating the widespread reimbursement for homebirth. Health care organizations' concerns for cost containment had little impact on this health insurance trend. Our study concludes that jurisdictional openings in the system of professions can be facilitated by a small number of strategically positioned individuals.
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Affiliation(s)
- Heather Hartley
- Department of Sociology, Portland State University, OR 97207, USA.
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Abstract
A telephone survey of 1,000 randomly selected women members of Kaiser Permanente examined preferences for care delivery. The majority of women under age 55 (80%) were interested in scheduling evening or Saturday appointments, and half (50%) of them were willing to switch doctors for this option. Although most (57%) said that physician gender 'did not matter,' women who preferred to see a female physician but were seeing a male were significantly less satisfied than women whose preferences were matched. Half (51%) of women were open to receiving health education in group classes. Information on when care is preferred, by whom, and in what setting sets the stage for mass customization strategies.
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Affiliation(s)
- M Thompson
- Kaiser Permanente, San Francisco, California, USA
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Anderson DM, Hampton MB. Physician assistants and nurse practitioners: rural-urban settings and reimbursement for services. J Rural Health 1999; 15:252-63. [PMID: 10511762 DOI: 10.1111/j.1748-0361.1999.tb00746.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Evidence based on productivity measures, salaries and costs of medical education indicates that physician assistants and nurse practitioners are cost-effective. Managed care suggests that health maintenance organizations (HMOs) would seek to utilize these professionals. Moreover, underserved rural areas would utilize physician assistants and nurse practitioners to provide access. This study examined the role of payment sources in the utilization of physician assistants and nurse practitioners using the 1994 National Hospital Ambulatory Medical Care Survey (NHAMCS) conducted by the National Center for Health Statistics, U.S. Centers for Disease Control and Prevention. Rural vs. urban results were compared. The study found that significant rural-urban differences exist in the relationships between payment sources and the utilization of physician assistants and nurse practitioners. The study also found that payment source affects varied for physicians, physician assistants and nurse practitioners who saw outpatients in hospital settings. Surprisingly, prepaid and HMO types of reimbursements are shown to have no relationship with physician assistant and nurse practitioner utilization, and this finding is the same for both rural and urban patient visits. After controlling for other influences, the study shows that physicians, physician assistants and nurse practitioners are each as likely as the other to be present at a rural managed care visit. However, physicians are much more likely than physician assistants and nurse practitioners to be present at an urban managed care visit.
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Affiliation(s)
- D M Anderson
- Economics Department, University of Wisconsin-La Crosse 54601, USA
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Hoffman E, Maraldo P, Coons HL, Johnson K. The women-centered health care team: integrating perspectives from managed care, women's health, and the health professional workforce. Womens Health Issues 1997; 7:362-74; discussion 375-9. [PMID: 9439197 DOI: 10.1016/s1049-3867(97)00074-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- E Hoffman
- Women's Health Program, Mt. Sinai School of Medicine, New York, New York, USA
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Kozak RJ, Kazzi AA, Langdorf MI, Martinez CT. The threat of funding cuts for graduate medical education: survey of decision makers. Acad Emerg Med 1997; 4:736-41. [PMID: 9223701 DOI: 10.1111/j.1553-2712.1997.tb03770.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess the potential actions of medical school deans, graduate medical education (GME) committee chairs, and hospital chief executive officers (CEOs) regarding future funding reductions for residency training. Specifically, institutions with emergency medicine (EM) residencies were surveyed to see whether EM training was disproportionally at risk for reductions. METHODS An anonymous 2-page survey was used. Ninety-eight EM residency programs were identified using the American Medical Association Graduate Medical Education Directory 1994-95. Seventy deans, 102 GME chairs, and 97 hospital CEOs were identified. The survey posed a hypothetical 25% forced reduction in residency positions and asked the decision makers for their responses. Options included: 1) proportional reductions of training positions from all residencies, 2) proportional reductions in either primary care or specialty residency positions, or 3) reduction or elimination of specific training programs. The survey asked for a first and second choice of residencies to be reduced or eliminated from an alphabetical list of 17. The survey elicited explanations for each program reduction. RESULTS 200 (74%) of 269 surveys were returned. Eighty-four responders selected specific residencies to be reduced or eliminated. EM was selected 8 times, making EM the seventh most vulnerable residency to be targeted for reductions. The decision makers who selected proportional reductions chose to reduce across all residencies 32 times, among only the specialty residencies 129 times, and among only the primary care residencies 3 times. CONCLUSIONS In the setting of anticipated residency cuts, favored proportional reductions in specialty residencies would likely affect EM training. However, most GME decision makers with an existing EM residency program do not consider the EM residency a top choice to be reduced or eliminated.
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Affiliation(s)
- R J Kozak
- University of California at Irvine, USA.
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Hart LG, Wagner E, Pirzada S, Nelson AF, Rosenblatt RA. Physician staffing ratios in staff-model HMOs: a cautionary tale. Health Aff (Millwood) 1997; 16:55-70. [PMID: 9018944 DOI: 10.1377/hlthaff.16.1.55] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Predictions of imminent large physician surpluses stem from two observations: rapid increases in the proportion of Americans in managed care plans, and the relatively lean physician staffing ratios reported for health maintenance organizations (HMOs). We use internal data from two large, mature staff-model HMOs to determine precise specialty-specific physician staffing ratios, to see whether these HMOs use fewer physicians than the fee-for-service sector uses. The two HMOs provided the equivalent of 180 physicians per 100,000 enrollees, which is near the national average and far above figures that typically are reported in the literature. Thus, caution regarding current workforce predictions is warranted.
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Freeborn DK, Hooker RS. Satisfaction of physician assistants and other nonphysician providers in a managed care setting. Public Health Rep 1995; 110:714-9. [PMID: 8570825 PMCID: PMC1381814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Health maintenance organizations have employed physician assistants, nurse practitioners, and other nonphysician providers for decades, yet there is little information on how satisfied these providers are with this form of practice. This paper examines how physician assistants evaluate their experience practicing in a large group model health maintenance organization and compares their attitudes and satisfaction levels with those of other nonphysician providers-nurse practitioners, optometrists, mental health therapists, and chemical dependency counselors. The data source is a 1992 survey of 5,000 nonphysician employees of a health maintenance organization. The survey instrument was a self-administrated questionnaire that included both structured and open-ended questions. The response rate averaged 88 percent for physician assistants and the other non-physician providers. Physician assistants expressed the most satisfaction with the amount of responsibility, support from coworkers, job security, working hours, supervision, and task variety. They were less satisfied with workload, control over the pace of work, and opportunities for advancement. Most physician assistants were also satisfied with pay and fringe benefits. Compared with other nonphysician providers, chemical dependency counselors expressed the highest levels of satisfaction across the various dimensions of work and optometrists the lowest. Nurse practitioners, chemical dependency counselors, and mental health professionals also tended to be satisfied with most aspects of practice in this setting. In a number of instances, they were more satisfied than the physician assistants. The findings are consistent with other studies that found health maintenance organizations to be favorable practice settings for physician assistants. The limits of physician assistant involvement and their role satisfaction and efficient use in HMOs are more likely to relate to physician attitudes and acceptance than to lack of support by coworkers and other attributes of the work environment.
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Affiliation(s)
- D K Freeborn
- Center for Health Research, Kaiser Permanente, Portland, OR 97227-1098, USA
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Dial TH, Palsbo SE, Bergsten C, Gabel JR, Weiner J. Clinical staffing in staff- and group-model HMOs. Health Aff (Millwood) 1995; 14:168-80. [PMID: 7657238 DOI: 10.1377/hlthaff.14.2.168] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Analysts frequently have used health maintenance organization (HMO) staffing patterns as a yardstick for estimating national clinical workforce requirements. Based on a nationwide survey of fifty-four staff- and group-model HMOs, the largest sample yet used in an analysis of this type, this DataWatch examines physician-to-member ratios, the use of nonphysician providers, and HMOs' methods of estimating clinical staffing needs. Overall physician staffing ratios and primary care physician staffing ratios closely resemble those reported in previous studies, but they exhibit wide variability and are strongly correlated with HMO size. Although caution should be exercised when using HMO staffing ratios in projections of physician workforce requirements, the ratios described here support projections of a specialty physician surplus.
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Affiliation(s)
- T H Dial
- Group Health Association of America (GHAA), Washington, DC, USA
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Louis M, Sabo CE. Nurse practitioners: need for and willingness to hire as viewed by nurse administrators, nurse practitioners, and physicians. JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 1994; 6:113-9. [PMID: 8003360 DOI: 10.1111/j.1745-7599.1994.tb00926.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The problem investigated in this project was the identification of need for and desire to hire nurse practitioners in a rural western state. Participants included licensed nurse practitioners, nurse administrators of licensed agencies, and licensed physicians in the state of Nevada. The survey examined the participant groups' views of the need for and their desire to hire nurse practitioners. The findings showed differences among the groups in relation to their education levels and whether they were practicing in rural or urban areas. The most pronounced finding was the indicated need for more information related to the role and functions of nurse practitioners before hiring them. Recommendations for future study are also included.
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Knedle-Murray ME, Oakley DJ, Wheeler JR, Petersen BA. Production process substitution in maternity care: issues of cost, quality, and outcomes by nurse-midwives and physician providers. MEDICAL CARE REVIEW 1994; 50:81-112. [PMID: 10125119 DOI: 10.1177/002570879305000106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Weiner JP. The demand for physician services in a changing health care system: a synthesis. MEDICAL CARE REVIEW 1993; 50:411-49. [PMID: 10131115 DOI: 10.1177/002570879305000403] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- J P Weiner
- School of Public Health, Johns Hopkins University, Baltimore, MD 21205
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Aaronson WE. The use of physician extenders in nursing homes: a review. MEDICAL CARE REVIEW 1991; 48:411-47. [PMID: 10160811 DOI: 10.1177/002570879104800403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- W E Aaronson
- School of Management, Widener University, Chester, PA 19013
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Anderson GF, Antebi S. A surplus of physicians in Israel: any lessons for the United States and other industrialized countries? Health Policy 1991; 17:77-86. [PMID: 10110074 DOI: 10.1016/0168-8510(91)90118-h] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Israel, there is a consensus that there is a surplus of physicians. An examination of the Israeli situation may suggest some responses that will be taken by policy makers and physicians in the United States and other industrialized countries as the supply of physicians continues to increase. Specifically, we examine the impact of rising physician supply on the geographic distribution of physicians in Israel, the length of the training period for residency programs, the interaction between physicians and other professionals, and the level of physician incomes compared to other Israeli workers.
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Affiliation(s)
- G F Anderson
- Center for Hospital Finance and Management, The Johns Hopkins Medical Institutions, Baltimore, MD 21205
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Dellasega C, Hupcey J. Intents and perceptions of graduating BSN students toward the nurse practitioner role. JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 1991; 3:30-4. [PMID: 2007060 DOI: 10.1111/j.1745-7599.1991.tb01056.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This descriptive study was an investigation of the intentions of 65 senior baccalaureate nursing students to become nurse practitioners (NPs). Students were given a Nurse Practitioner Inventory, which collected information on nine categories related to factors influencing specialization. The data show that a majority of nursing students do not have specific plans to become NPs, although most intend to further their education. The results suggest that this is in part related to a lack of exposure to and familiarity with the NP role.
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Abstract
A key component of the 1989 British National Health Service White Paper, 'Working for Patients', is the so-called budget holding plan for general practitioners. This controversial proposal calls on GPs to manage their patients' budgets for consultant (specialist) services and hospital care. Most aspects of the scheme, now only contemplated in the U.K., have functioned for years in American health maintenance organisations (HMOs). The thesis of this article is that an analysis of the GP budget holding proposal, in light of the many years of experience with HMOs, will provide valuable insight into how the British innovation might (or might not) function. Moreover, we believe the U.S. HMO experience has a high degree of relevance for the design, implementation and management of budget holding practices in the NHS of the 1990s, as well as other similar proposals being considered across the European continent.
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Affiliation(s)
- J P Weiner
- Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205
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Wilbur J, Zoeller LH, Talashek M, Sullivan JA. Career trends of master's prepared family nurse practitioners. JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 1990; 2:69-78. [PMID: 2354081 DOI: 10.1111/j.1745-7599.1990.tb00779.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The purpose of this study was to examine the career trends of family nurse practitioner (FNP) graduates of one master's program. A questionnaire was mailed to all FNPs (N = 113) who graduated 1-11 years earlier; there was a response rate of 83%. The survey revealed that for both first and present jobs the majority were providing direct patient care as a primary care provider or practicing in an indirect role. The study findings indicate that for these graduates there is a long term commitment (demonstrated through continued employment) as well as opportunity to practice in the nurse practitioner role in a direct or indirect capacity.
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Nolan JW, Beaman M, Sullivan JA. Activities and consultation patterns of nurse practitioners with master's and certificate preparation. Public Health Nurs 1988; 5:91-103. [PMID: 3387371 DOI: 10.1111/j.1525-1446.1988.tb00764.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Weiner JP, Steinwachs DM, Williamson JW. Response from Drs. Weiner, Steinwachs, and Williamson. Am J Public Health 1986. [DOI: 10.2105/ajph.76.11.1360-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cawley JF, Combs GE, Curry RH. Non-physician providers. Am J Public Health 1986; 76:1360. [PMID: 2876655 PMCID: PMC1646740 DOI: 10.2105/ajph.76.11.1360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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