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Bacci JL, Pollack SW, Skillman SM, Odegard PS, Danielson JH, Frogner BK. Impact of the COVID-19 Pandemic on the Community Pharmacy Workforce. Med Care Res Rev 2024; 81:39-48. [PMID: 37830446 DOI: 10.1177/10775587231204101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
This study sought to describe the impact of the COVID-19 pandemic on community pharmacy practice and its workforce. Interviews were conducted with 18 key informants from pharmacy associations and community pharmacists representing chain and independent pharmacy organizations across the United States from January to May 2022. Interview notes were analyzed using a rapid content analysis approach. Four themes resulted: (a) patient care at community pharmacies focused on fulfilling COVID-19 response needs; (b) pharmacists' history as immunizers and scope of practice expansions facilitated COVID-19 response efforts; (c) workforce supply shortages impeded COVID-19 response efforts and contributed to burnout; and (d) maintaining community pharmacy workforce's readiness will be critical to future emergency preparedness and response efforts. Formalizing scope of practice expansion policies and reimbursement pathways deployed during the COVID-19 pandemic could facilitate the community pharmacy workforce's ability to address ongoing public health needs and respond to future public health emergencies.
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Al Achkar M, Dahal A, Frogner BK, Skillman SM, Patterson DG. Integrating Immigrant Health Professionals into the U.S. Healthcare Workforce: Barriers and Solutions. J Immigr Minor Health 2023; 25:1270-1278. [PMID: 37084020 PMCID: PMC10119818 DOI: 10.1007/s10903-023-01472-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/22/2023]
Abstract
Internationally educated immigrant healthcare workers face skill underutilization working in lower-skilled healthcare jobs or outside healthcare. This study explored barriers to and solutions for integrating immigrant health professionals. Content analysis identifying key themes from semi-structured qualitative interviews with representatives from Welcome Back Centers (WBCs) and partner organizations. 18 participants completed interviews. Barriers facing immigrant health professionals included lack of access to resources, financial constraints, language difficulties, credentialing challenges, prejudice, and investment in current occupations. Barriers facing programs that assist immigrant health professionals included eligibility restrictions, funding challenges, program workforce instability, recruitment difficulties, difficulty maintaining connection, and pandemic challenges. Long-term program success depended on partner networks, advocacy, addressing prejudice, a client-centered approach, diverse resources and services, and conducting research. Initiatives to integrate immigrant health professionals require multi-level responses to diverse needs and collaborations among organizations that support immigrant health professionals, healthcare systems, labor, and other stakeholders.
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Affiliation(s)
- Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA.
| | - Arati Dahal
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA
| | - Bianca K Frogner
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA
| | - Susan M Skillman
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA
| | - Davis G Patterson
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA
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Abstract
PURPOSE Lack of health care providers' knowledge about the experience and needs of individuals with disabilities contribute to health care disparities experienced by people with disabilities. Using the Core Competencies on Disability for Health Care Education, this mixed methods study aimed to explore the extent the Core Competencies are addressed in medical education programs and the facilitators and barriers to expanding curricular integration. METHOD Mixed-methods design with an online survey and individual qualitative interviews was used. An online survey was distributed to U.S. medical schools. Semi-structured qualitative interviews were conducted via Zoom with five key informants. Survey data were analyzed using descriptive statistics. Qualitative data were analyzed using thematic analysis. RESULTS Fourteen medical schools responded to the survey. Many schools reported addressing most of the Core Competencies. The extent of disability competency training varied across medical programs with the majority showing limited opportunities for in depth understanding of disability. Most schools had some, although limited, engagement with people with disabilities. Having faculty champions was the most frequent facilitator and lack of time in the curriculum was the most significant barrier to integrating more learning activities. Qualitative interviews provided more insight on the influence of the curricular structure and time and the importance of faculty champion and resources. CONCLUSIONS Findings support the need for better integration of disability competency training woven throughout medical school curriculum to encourage in-depth understanding about disability. Formal inclusion of the Core Competencies into the Liaison Committee on Medical Education standards can help ensure that disability competency training does not rely on champions or resources.
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Affiliation(s)
- Danbi Lee
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Samantha W Pollack
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Tracy Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Bianca K Frogner
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Susan M Skillman
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
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Frogner BK, Patterson DG, Skillman SM. The Workforce Needed to Address Population Health. Milbank Q 2023; 101:841-865. [PMID: 37096630 PMCID: PMC10126981 DOI: 10.1111/1468-0009.12620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/27/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Although a single definition of the population health workforce does not yet exist, this workforce needs to have the skills and competencies to address the social determinants of health, to understand intersectionality, and to coordinate and work in concert with an array of skilled providers in social and health care to address multiple health drivers. On-the-job training programs and employer support are needed for the current health workforce to gain skills and competencies to address population health. Funding and leadership combined are critical for developing the population health workforce with the goal of supporting a broad set of workers beyond health and social care to include, for example, those in urban planning, law enforcement, or transportation professions to address population health.
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Affiliation(s)
- Bianca K Frogner
- University of Washington School of Medicine, Center for Health Workforce Studies
| | - Davis G Patterson
- University of Washington School of Medicine, WWAMI Rural Health Research Center
| | - Susan M Skillman
- University of Washington School of Medicine, Center for Health Workforce Studies
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Kaplan L, Pollack SW, Skillman SM, Patterson DG. Is being there enough? Postgraduate nurse practitioner residencies in rural primary care. J Rural Health 2022. [PMID: 36443985 DOI: 10.1111/jrh.12729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
PURPOSE Little research has been conducted on the outcomes of postgraduate nurse practitioner (NP) programs (referred to as residencies), particularly those located in rural communities. This study examined the purpose and characteristics of rural NP residencies that aim to promote the successful recruitment, transition, and retention of NPs in rural primary care practice. METHODS We compiled a list of rural NP residencies and verified the location of each clinic as rural if it met any of several federal definitions of rurality. We interviewed grant and project administrators, residency program directors, clinic personnel, and former and current NP residents using semistructured guides. FINDINGS Of 20 rural NP residencies identified, we interviewed 12 program directors or managers; 8 NPs; and 4 clinic personnel. All but 1 program was 12 months long. Three-quarters had federal funding. Each slowly increased residents' patient load and included didactic content and specialty rotations. We identified 2 different program models and 3 administrative models. Some NPs' intentionally chose rural practice, while others opted for a rural residency when unable to secure employment in an urban location. Most programs were new and not yet able to report on residents' subsequent employment locations. CONCLUSIONS It is premature to conclude definitively that rural NP residencies facilitate and promote NP connectedness to, and investment in, rural communities based on our investigation. Nonetheless, these programs are an option to encourage the recruitment and retention of NPs in rural practice, with further study needed to determine their long-term contribution to rural primary care practice.
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Affiliation(s)
- Louise Kaplan
- College of Nursing, Washington State University, Vancouver, Washington, USA
| | - Samantha W Pollack
- Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
| | - Susan M Skillman
- Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
| | - Davis G Patterson
- Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
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Kett PM, van Eijk MS, Guenther GA, Skillman SM. "This work that we're doing is bigger than ourselves": A qualitative study with community-based birth doulas in the United States. Perspect Sex Reprod Health 2022; 54:99-108. [PMID: 35797066 DOI: 10.1363/psrh.12203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CONTEXT Community-based birth doulas support pregnant women, transgender men, and gender non-binary individuals during the perinatal period and provide essential services and expertise that address health inequities, often taking on additional roles to fill systemic gaps in perinatal care in the United States (US). Despite the benefits that community-based birth doulas provide, there is little research exploring the work-related conditions and stressors community-based doulas experience. To address this gap, we examined the work experiences, related stressors, and stress management strategies of individual community-based birth doulas. METHODS In this qualitative, descriptive study we conducted 18 interviews in March through June 2021 with individuals who self-identified as community-based doulas working in underserved communities in the US. We analyzed the interviews for themes, which we defined and finalized through team consensus. RESULTS The doulas reported engaging in specific strategies in their work to address perinatal inequities. They also described facing several work-related stressors, including witnessing discrimination against clients, experiencing discrimination in medical environments, and struggling with financial instability. To mitigate these stressors and job-related challenges, interviewees reported they relied on doula peer support and reconnected with their motivations for the work. CONCLUSIONS Community-based doulas provide essential services and expertise which address inequities and systemic gaps in perinatal care. However, as they work to improve perinatal health, doulas themselves are providing equity work amidst an inequitable system and with insufficient political or financial support. Increased compensation and systemic support which acknowledges the breadth of services provided is needed to strengthen and sustain this critical part of the perinatal workforce.
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Affiliation(s)
- Paula M Kett
- Department of Family Medicine, Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
| | - Marieke S van Eijk
- Department of Anthropology, Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
| | - Grace A Guenther
- Department of Family Medicine, Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
| | - Susan M Skillman
- Department of Family Medicine, Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
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Skillman SM, Johnson HM, Frogner BK. Pathways to Registered Nursing: Influences of Health-Related Work Experience and Education Financing. Policy Polit Nurs Pract 2022; 23:228-237. [PMID: 35989641 DOI: 10.1177/15271544221120205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A larger and more diverse registered nurse (RN) workforce in the U.S. is needed to meet growing demand and address social determinants of health and improve health equity. To improve understanding of pathways and barriers to becoming an RN, this study examined prior health care employment and financial assistance factors associated with completion of pre-licensure RN education programs, by initial entry degree (associate degree or bachelor of science in nursing) and across racial and ethnic groups, using the 2018 National Sample Survey of Registered Nurses. The study found higher percentages of associate degree-entry RNs held a health-related job prior to completing their initial RN program than did bachelor's degree entrants. Employer support for education financing as well as reliance on loans and scholarships increased among RNs graduating in 2000 and later, and reliance on self-financing was reported less frequently. Hispanic associate degree-entry RNs reported education financing from only federal loans more frequently compared with White RNs, and higher percentages of Black, multiracial, and "some other race" baccalaureate degree entry RNs accessed federal loans compared with White baccalaureate degree-entry RNs. These findings indicate diversifying the RN workforce should remain a priority to increase representation by underrepresented racial and ethnic groups. Equitable pathways into the RN profession will be facilitated and expedited through policies that overcome financial and social barriers that enable individuals from population groups underrepresented in the nursing workforce to identify with the RN role and route to the profession.
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Affiliation(s)
- Susan M Skillman
- Center for Health Workforce Studies, 7284University of Washington, 4311 11th Ave NE, Suite 210, Seattle, WA 98105
| | - Hannah M Johnson
- Department of Health Systems and Population Health, 7284University of Washington, 3980 15th Ave NE, Fourth Floor, Box 351621, Seattle, WA 98195
| | - Bianca K Frogner
- Center for Health Workforce Studies, 7284University of Washington, 4311 11th Ave NE, Suite 210, Seattle, WA 98105
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Jopson AD, Cummings AG, Frogner BK, Skillman SM. Employers' Perspectives on the Use of Medical Assistant Apprenticeships: A Qualitative Study. J Ambul Care Manage 2022; 45:191-201. [PMID: 35612390 DOI: 10.1097/jac.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Medical assistants (MAs) are among the fastest-growing occupations in the United States, yet health care employers report high turnover rates and difficulty filling MA positions. Employers are increasingly using apprenticeship to meet emerging workforce needs. This qualitative study examined the perspectives of 14 employers using registered MA apprenticeships in 8 states. The findings revealed motivations for using apprenticeship, perceived benefits to the organization, challenges with implementation, and reflections on successful implementation. We detail how MA apprenticeship is successfully meeting recruitment and training needs in a variety of health care organizations, especially where program support resources are available.
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Affiliation(s)
- Andrew D Jopson
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Mr Jopson); and Center for Health Workforce Studies, Department of Family Medicine (Dr Frogner and Ms Skillman), Department of Family Medicine (Dr Cummings), University of Washington, Seattle
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Van Eijk MS, Guenther GA, Jopson AD, Skillman SM, Frogner BK. Health Workforce Challenges Impact the Development of Robust Doula Services for Underserved and Marginalized Populations in the United States. J Perinat Educ 2022; 31:133-141. [PMID: 36643390 PMCID: PMC9829116 DOI: 10.1891/jpe-2021-0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Evidence of doulas' positive impacts on maternal health outcomes, particularly among underserved populations, supports expanding access. Health workforce-related barriers challenge the development of robust doula services in the United States. We investigated organizations' barriers regarding training, recruitment, and employment of doulas. We conducted literature and policy reviews and 16 semi-structured interviews with key informants who contribute to state policymaking and from organizations involved in training, certifying, advocating for, and employing doulas. Our study shows barriers to more robust doula services, including varying roles and practices, prohibitive costs of training and certification, and insufficient funding. This study underscores the importance of doulas in providing support to clients from underserved populations. Health workforce-related challenges remain, especially for community-based organizations seeking to serve underserved communities.
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Affiliation(s)
- Marieke S. Van Eijk
- Correspondence regarding this article should be directed to
Marieke S. Van Eijk,
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Van Eijk MS, Guenther GA, Kett PM, Jopson AD, Frogner BK, Skillman SM. Addressing Systemic Racism in Birth Doula Services to Reduce Health Inequities in the United States. Health Equity 2022; 6:98-105. [PMID: 35261936 PMCID: PMC8896213 DOI: 10.1089/heq.2021.0033] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose: Birth doulas support pregnant people during the perinatal period. Evidence of doulas' positive impacts on pregnancy and birth outcomes, particularly among underserved populations, supports expanding access. However, health workforce-related barriers challenge the development of robust doula services in the United States. This study examined the various approaches organizations have taken to train, recruit, and employ doulas as well as their perspectives on what system-level changes are needed to redress health inequities in underserved communities and expand access to birth doula services. Methods: In addition to literature and policy reviews, we conducted 16 semistructured interviews from March to August 2020 with key informants from organizations involved in training, certifying, advocating for, and employing doulas, and informants involved in state policy making. We analyzed data using qualitative analysis software to identify cross-cutting themes. Results: The landscape of organizations involved in doula training and certification is diverse. In discussing their training and curriculum, interviewees from large organizations and community-based organizations (CBOs) stressed the importance of incorporating a focus on structural racism in maternal health into training curricula. CBOs specifically offered three areas of systems-level change that can help equitably grow doula services: the importance of addressing structural racism, changing the balance of power in decision making and policy making, and a cautious approach to Medicaid reimbursement. Conclusion: This study provides evidence of how doula organizations move the field toward better serving the specific needs of underserved populations. It recognizes the expertise of CBOs in developing policy to expand doula services to communities in need. The information from this study highlights the complexities of facilitating consistency across doula training and certification requirements and implementing a sustainable funding mechanism while also meeting communities' unique needs.
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Affiliation(s)
- Marieke S. Van Eijk
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Grace A. Guenther
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Paula M. Kett
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Andrew D. Jopson
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Bianca K. Frogner
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Susan M. Skillman
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
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11
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Prusynski RA, Frogner BK, Skillman SM, Dahal A, Mroz TM. Therapy Assistant Staffing and Patient Quality Outcomes in Skilled Nursing Facilities. J Appl Gerontol 2021; 41:352-362. [PMID: 34291695 DOI: 10.1177/07334648211033417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Therapy staffing declined in response to Medicare payment policy that removes incentives for intensive physical and occupational therapy in skilled nursing facilities, with therapy assistant staffing more impacted than therapist staffing. However, it is unknown whether therapy assistant staffing is associated with patient outcomes. Using 2017 national data, we examined associations between therapy assistant staffing and three outcomes: patient functional improvement, community discharge, and hospital readmissions, controlling for therapy intensity and facility characteristics. Assistant staffing was not associated with functional improvement. Compared with employing no assistants, staffing 25% to 75% occupational therapy assistants and 25% to 50% physical therapist assistants were associated with more community discharges. Higher occupational therapy assistant staffing was associated with higher readmissions. Higher intensity physical therapy was associated with better quality across outcomes. Skilled nursing facilities seeking to maximize profit while maintaining quality may be successful by choosing to employ more physical therapy assistants rather than sacrificing physical therapy intensity.
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12
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Mohammed SA, Guenther GA, Frogner BK, Skillman SM. Examining the racial and ethnic diversity of associate degree in nursing programs by type of institution in the US, 2012-2018. Nurs Outlook 2021; 69:598-608. [PMID: 33867155 DOI: 10.1016/j.outlook.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/29/2020] [Accepted: 01/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Increasing nursing workforce diversity is essential to quality health care. Associate Degree in Nursing (ADN) programs are a primary path to becoming a registered nurse and an important source of nursing diversity. PURPOSE To examine how the number of graduates and racial/ethnic student composition of ADN programs have changed since the Institute of Medicine's recommendation to increase the percentage of bachelor's-prepared nurses to 80%. METHODS Using data from the Integrated Postsecondary Education System, we analyzed the number of graduates and racial/ethnic composition of ADN programs across public, private not-for-profit, and private for-profit institutions, and financial aid awarded by type of institution from 2012-2018. DISCUSSION Racial/ethnic diversity among ADN programs grew from 2012-2018. Although private for-profits proportionally demonstrated greater ADN student diversity and provided financial aid institutionally to a higher percentage of students, public schools contributed the most to the number and racial/ethnic diversity of ADN graduates. CONCLUSION Given concerns regarding private for-profits, promoting public institutions may be the most effective strategy to enhance diversity among ADN nurses.
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Affiliation(s)
- Selina A Mohammed
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA.
| | - Grace A Guenther
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, WA
| | - Bianca K Frogner
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, WA
| | - Susan M Skillman
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, WA
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Prusynski RA, Frogner BK, Dahal AD, Skillman SM, Mroz TM. Skilled Nursing Facility Characteristics Associated With Financially Motivated Therapy and Relation to Quality. J Am Med Dir Assoc 2020; 21:1944-1950.e3. [DOI: 10.1016/j.jamda.2020.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/31/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
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Affiliation(s)
- Bianca K. Frogner
- Center for Health Workforce Studies, Department of Family Medicine, School of Medicine, University of Washington, Seattle
| | - Susan M. Skillman
- Center for Health Workforce Studies, Department of Family Medicine, School of Medicine, University of Washington, Seattle
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15
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Mroz TM, Dahal A, Prusynski R, Skillman SM, Frogner BK. Variation in Employment of Therapy Assistants in Skilled Nursing Facilities Based on Organizational Factors. Med Care Res Rev 2020; 78:40S-46S. [PMID: 32856545 DOI: 10.1177/1077558720952570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Employment of therapy assistants enables skilled nursing facilities to provide more therapy services at lower costs. Yet little is known about employment of therapy assistants relative to organizational characteristics. Taking advantage of publicly available Medicare administrative data from 2016, we examined the relationships between organizational characteristics of skilled nursing facilities and employment of therapy assistants. Therapy assistants represent approximately half of the therapy workforce in skilled nursing facilities. Regression analyses indicate significantly higher percentages of therapy assistants are employed in facilities that are staffed by contract therapists, provide more therapy, have more total stays, operate in rural areas, and are located in states with certificate of need laws or moratoria. Skilled nursing facility quality was not significantly associated with employment of therapy assistants. As new payment mechanisms change incentivizes for therapy in skilled nursing facilities, employment of therapy assistants may be a cost-effective way to continue to provide services when necessary.
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Skillman SM, Dahal A, Frogner BK, Andrilla CHA. Frontline Workers' Career Pathways: A Detailed Look at Washington State's Medical Assistant Workforce. Med Care Res Rev 2018; 77:285-293. [PMID: 30451087 DOI: 10.1177/1077558718812950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Medical assistants (MAs) are a rapidly growing and increasingly important workforce. High MA turnover, however, is common and employers report applicants frequently do not meet their needs. We collected survey responses from a representative sample of 3,355 of Washington's MAs with certified status (MA-Cs) to understand their demographic, education, and employment backgrounds; job satisfaction; and career plans. Descriptive analyses showed 93.0% were female with a $19.91 mean hourly wage, and while generally satisfied, 56.2% indicated they would seek training or employment in another health care occupation within 5 years, with higher percentages among MA-Cs who felt overwhelmed by their workload and/or not satisfied with promotion opportunities. Regression analyses showed Hispanic, Black, and Asian MA-Cs were more likely than White MA-Cs to express interest in other health care careers. Strategies that strengthen MA career pathways and retain qualified workers should reward both employers and MAs and contribute to a stable and diverse workforce.
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Affiliation(s)
- Susan M Skillman
- Center for Health Workforce Studies, University of Washington, Seattle, WA, USA
| | - Arati Dahal
- Center for Health Workforce Studies, University of Washington, Seattle, WA, USA
| | - Bianca K Frogner
- Center for Health Workforce Studies, University of Washington, Seattle, WA, USA
| | - C Holly A Andrilla
- Center for Health Workforce Studies, University of Washington, Seattle, WA, USA
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Mroz TM, Andrilla CHA, Garberson LA, Skillman SM, Patterson DG, Larson EH. Service provision and quality outcomes in home health for rural Medicare beneficiaries at high risk for unplanned care. Home Health Care Serv Q 2018; 37:141-157. [PMID: 29889645 DOI: 10.1080/01621424.2018.1486766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Multiple barriers exist to providing home health care in rural areas. This study examined relationships between service provision and quality outcomes among rural, fee-for-service Medicare beneficiaries who received home health care between 2011 and 2013 for conditions associated with high-risk for unplanned care. More skilled nursing visits, visits by more types of providers, more timely care, and shorter lengths of stay were associated with significantly higher odds of hospital readmission and emergency department use and significantly lower odds of community discharge. Results may indicate unmeasured clinical severity and care needs among this population. Additional research regarding the accuracy of current severity measures and adequacy of case-mix adjustment for quality metrics is warranted, especially given the continued focus on value-based payment policies.
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Affiliation(s)
- Tracy M Mroz
- a Department of Rehabilitation Medicine , University of Washington , Seattle , Washington , USA.,b WWAMI Rural Health Research Center , University of Washington , Seattle , Washington , USA
| | - C Holly A Andrilla
- b WWAMI Rural Health Research Center , University of Washington , Seattle , Washington , USA
| | - Lisa A Garberson
- b WWAMI Rural Health Research Center , University of Washington , Seattle , Washington , USA
| | - Susan M Skillman
- b WWAMI Rural Health Research Center , University of Washington , Seattle , Washington , USA
| | - Davis G Patterson
- b WWAMI Rural Health Research Center , University of Washington , Seattle , Washington , USA
| | - Eric H Larson
- b WWAMI Rural Health Research Center , University of Washington , Seattle , Washington , USA
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Snyder CR, Frogner BK, Skillman SM. Facilitating Racial and Ethnic Diversity in the Health Workforce. J Allied Health 2018; 47:58-65. [PMID: 29504021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/03/2017] [Indexed: 06/08/2023]
Abstract
Racial and ethnic diversity in the health workforce can facilitate access to healthcare for underserved populations and meet the health needs of an increasingly diverse population. In this study, we explored 1) changes in the racial and ethnic diversity of the health workforce in the United States over the last decade, and 2) evidence on the effectiveness of programs designed to promote racial and ethnic diversity in the U.S. health workforce. Findings suggest that although the health workforce overall is becoming more diverse, people of color are most often represented among the entry-level, lower-skilled health occupations. Promising practices to help facilitate diversity in the health professions were identified in the literature, namely comprehensive programs that integrated multiple interventions and strategies. While some efforts have been found to be promising in increasing the interest, application, and enrollment of racial and ethnic minorities into health profession schools, there is still a missing link in understanding persistence, graduation, and careers.
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Affiliation(s)
- Cyndy R Snyder
- Dep. of Family Medicine, Research Section, University of Washington, 4311 Roosevelt Way NE, Seattle, WA 98105, USA. Tel 206-616-9253.
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Abstract
Rural primary care shortages may be alleviated if more nurse practitioners (NPs) practiced there. This study compares urban and rural primary care NPs (classified by practice location in urban, large rural, small rural, or isolated small rural areas) using descriptive analysis of the 2012 National Sample Survey of NPs. A higher share of rural NPs worked in states without physician oversight requirements, had a DEA (drug enforcement administration) number, hospital admitting privileges, and billed using their own provider identifier. Rural NPs more often reported they were fully using their NP skills, practicing to the fullest extent of the legal scope of practice, satisfied with their work, and planning to stay in their jobs. We found lower per capita NP supply in rural areas, but the proportion in primary care increased with rurality. To meet rural primary care needs, states should support rural NP practice, in concert with support for rural physician practice.
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Skillman SM, Andrilla CHA, Patterson DG, Fenton SH, Ostergard SJ. Health Information Technology Workforce Needs of Rural Primary Care Practices. J Rural Health 2014; 31:58-66. [DOI: 10.1111/jrh.12081] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Susan M. Skillman
- WWAMI Rural Health Research Center; Department of Family Medicine; University of Washington; Seattle Washington
| | - C. Holly A. Andrilla
- WWAMI Rural Health Research Center; Department of Family Medicine; University of Washington; Seattle Washington
| | - Davis G. Patterson
- WWAMI Rural Health Research Center; Department of Family Medicine; University of Washington; Seattle Washington
| | - Susan H. Fenton
- School of Biomedical Informatics; University of Texas Health Science Center at Houston; Houston Texas
| | - Stefanie J. Ostergard
- WWAMI Rural Health Research Center; Department of Family Medicine; University of Washington; Seattle Washington
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Allen SM, Ballweg RA, Cosgrove EM, Engle KA, Robinson LR, Rosenblatt RA, Skillman SM, Wenrich MD. Challenges and opportunities in building a sustainable rural primary care workforce in alignment with the Affordable Care Act: the WWAMI program as a case study. Acad Med 2013; 88:1862-1869. [PMID: 24128621 DOI: 10.1097/acm.0000000000000008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The authors examine the potential impact of the Patient Protection and Affordable Care Act (ACA) on a large medical education program in the Northwest United States that builds the primary care workforce for its largely rural region. The 42-year-old Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) program, hosted by the University of Washington School of Medicine, is one of the nation's most successful models for rural health training. The program has expanded training and retention of primary care health professionals for the region through medical school education, graduate medical education, a physician assistant training program, and support for practicing health professionals.The ACA and resulting accountable care organizations (ACOs) present potential challenges for rural settings and health training programs like WWAMI that focus on building the health workforce for rural and underserved populations. As more Americans acquire health coverage, more health professionals will be needed, especially in primary care. Rural locations may face increased competition for these professionals. Medical schools are expanding their positions to meet the need, but limits on graduate medical education expansion may result in a bottleneck, with insufficient residency positions for graduating students. The development of ACOs may further challenge building a rural workforce by limiting training opportunities for health professionals because of competing demands and concerns about cost, efficiency, and safety associated with training. Medical education programs like WWAMI will need to increase efforts to train primary care physicians and increase their advocacy for student programs and additional graduate medical education for rural constituents.
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Affiliation(s)
- Suzanne M Allen
- Dr. Allen is clinical professor of family medicine and vice dean for regional affairs, University of Washington School of Medicine, Seattle, Washington. Ms. Ballweg is professor of family medicine and director, MEDEX Northwest Program, University of Washington School of Medicine, Seattle, Washington. Dr. Cosgrove is professor of medicine and vice dean for academic affairs, University of Washington School of Medicine, Seattle, Washington. Ms. Engle is director of operations, Office of Regional Affairs, University of Washington School of Medicine, Seattle, Washington. Dr. Robinson is professor of rehabilitation medicine and vice dean for graduate medical education and clinical affairs, University of Washington School of Medicine, Seattle, Washington. Dr. Rosenblatt is professor and vice chair of family medicine and director, Rural/Underserved Opportunities Program, University of Washington School of Medicine, Seattle, Washington. Ms. Skillman is deputy director, WWAMI Rural Health Research Center and UW Center for Health Workforce Studies, University of Washington School of Medicine, Seattle, Washington. Ms. Wenrich is affiliate assistant professor of biomedical informatics and medical education, University of Washington School of Medicine, and chief of staff, UW Medicine, Seattle, Washington
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Abstract
OBJECTIVES This review identifies the challenges to oral health in rural America and describes areas of innovation in prevention, delivery of dental services, and workforce development that may improve oral health for rural populations. METHODS This descriptive article is based on literature reviews and personal communications. RESULTS Rural populations have lower dental care utilization, higher rates of dental caries, lower rates of insurance, higher rates of poverty, less water fluoridation, fewer dentists per population, and greater distances to travel to access care than urban populations. Improving the oral health of rural populations requires practical and flexible approaches to expand and better distribute the rural oral health workforce, including approaches tailored to remote areas. Solutions that involve mass prevention/public health interventions include increasing water fluoridation, providing timely oral health education, caries risk assessment and referral, preventive services, and offering behavioral interventions such as smoking and tobacco cessation programs. Solutions that train more providers prepared to work in rural areas include recruiting students from rural areas, training students in rural locations, and providing loan repayment and scholarships. Increasing the flexibility and capacity of the oral health workforce for rural areas could be achieved by creating new roles for and new types of providers. Solutions that overcome distance barriers include mobile clinics and telehealth technology. CONCLUSIONS Rural areas need flexibility and resources to develop innovative solutions that meet their specific needs. Prevention needs to be at the front line of rural oral health care, with systematic approaches that cross health professions and health sectors.
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Skillman SM, Palazzo L, Hart LG, Keepnews D. The characteristics of registered nurses whose licenses expire: why they leave nursing and implications for retention and re-entry. Nurs Econ 2010; 28:181-189. [PMID: 20672540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Little is known about RNs who drop their licenses and their potential re-entry into the nursing workforce. The results of this study provide insight into reasons nurses leave their careers and the barriers to re-entry, all important indicators of the current professional climate for nursing. While representing only one state, these findings suggest that RNs who allow their licenses to expire do so because they have reached retirement age or, among those who do not cite age as a factor, because many are unable or unwilling to work in the field. Inactive nurses who might otherwise appear to be likely candidates for re-entry into the profession may not be easily encouraged to practice nursing again without significant changes in their personal circumstances or the health care work environment. Effective ways to address current and pending RN workforce shortages include expanding RN education capacity to produce more RNs who can contribute to the workforce across the coming decades, and promote work environments in which RNs want to, and are able to, practice across a long nursing career.
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Affiliation(s)
- Susan M Skillman
- WWAMI Center for Health Workforce Studies, University of Washington, Seattle, WA, USA
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Skillman SM, Andrilla CHA, Patterson DG, Tieman L, Doescher MP. The licensed practical nurse workforce in the United States: one state's experience. Cah Sociol Demogr Med 2010; 50:179-212. [PMID: 20653219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Licensed practical nurses (LPNs) are employed in multiple health care settings in the United States, with the largest portion providing nursing care in long-term care, skilled nursing, and nursing home facilities, which largely provide custodial care and rehabilitative services to elderly residents. Rapid growth in the size of the elderly population in the U.S., combined with retirements from an aging LPN workforce, are expected to increase the demand for LPNs in the coming decades. This paper describes the characteristics of LPNs in one state, Washington, and makes projections of LPN supply and demand in the state through 2026. METHODS The study uses data from a 2007 survey of LPNs with Washington State licenses to describe the demographic, education, and practice characteristics of the workforce. The projections of LPN supply and demand were built from the baseline survey data and changes over time were estimated using available data and literature from a variety of sources. RESULTS Of the 14,446 LPNs with Washington licenses in 2007, 72% practiced in the state. The work setting in which the largest percentage worked was long-term care (37%). Of the average 37 hours worked per week by LPNs, 25 hours were spent in direct patient care. The average age of practicing LPNs was 46 and 12% of LPNs were male. The racial/ethnic distribution of Washington's LPNs resembled that of the overall state population, with 17% non-White and 4% Hispanic. Nearly three quarters obtained their LPN education within Washington. If the 2007 number of completions from LPN schools in Washington is sustained, the projected supply of practicing LPNs in 2026 will be more than 3,500 (24%) below estimated demand. If the current education completion number increased by 200 LPNs (nearly 20%) in 2011, and this number was maintained through 2026, the projected supply of practicing LPNs would increase but would still be 2,052 LPNs below estimated demand in 2026. Neither projection scenario produces enough LPNs to maintain the 2007 LPN-to-population ratio through 2026. CONCLUSIONS/POLICY IMPLICATIONS: It is not known precisely whether or how LPN workforce roles will change in the future, but the projected LPN shortages in Washington State mirror similar findings from other parts of the U.S., with major growth in projected LPN demand due to increases in, and aging of the state's population. The number of LPNs completing education programs in the state is unlikely to keep pace with the decline in supply from retirements unless a significant expansion of education programs takes place. The LPN profession is an important entry point into the nursing profession, and increasing the number of LPNs educated in-state could expand the pipeline leading to registered nurse (RN) careers, another nursing profession for which major shortages are predicted. Carefully articulated LPN-to-RN education programs could improve the attractiveness of the profession and increase the supply of LPNs.
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Affiliation(s)
- Susan M Skillman
- Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
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Dresden GM, Baldwin LM, Andrilla CHA, Skillman SM, Benedetti TJ. Influence of obstetric practice on workload and practice patterns of family physicians and obstetrician-gynecologists. Ann Fam Med 2008; 6 Suppl 1:S5-11. [PMID: 18195307 PMCID: PMC2203382 DOI: 10.1370/afm.737] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Obstetric practice among family physicians has declined in recent years. This study compared the practice patterns of family physicians and obstetrician-gynecologists with and without obstetric practices to provide objective information on one potential reason for this decline--the impact of obstetrics on physician lifestyle. METHODS In 2004, we surveyed all obstetrician-gynecologists, all rural family physicians, and a random sample of urban family physicians identified from professional association lists (N =2,564) about demographics, practice characteristics, and obstetric practices. RESULTS A total of 1,197 physicians (46.7%) overall responded to the survey (41.5% of urban family physicians, 54.7% of rural family physicians, and 55.0% of obstetrician-gynecologists). After exclusions, 991 were included in the final data set. Twenty-seven percent of urban family physicians, 46% of rural family physicians, and 79% of obstetrician-gynecologists practiced obstetrics. The mean number of total professional hours worked per week was greater with obstetric practice than without for rural family physicians (55.4 vs 50.2, P=.005) and for obstetrician-gynecologists (58.3 vs 43.5, P = .000), but not for urban family physicians (47.8 vs 49.5, P = .27). For all 3 groups, physicians practicing obstetrics were more likely to provide inpatient care and take call than physicians not practicing obstetrics. Large proportions of family physicians, but not obstetrician-gynecologists, took their own call for obstetrics. Concerns about the litigation environment and personal issues were the most frequent reasons for stopping obstetric practice. CONCLUSIONS Practicing obstetrics is associated with an increased workload for family physicians. Organizing practices to decrease the impact on lifestyle may support family physicians in practicing obstetrics.
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Affiliation(s)
- Graham M Dresden
- Department of Family Medicine, Kaiser Permanente Northwest, Portland, Oregon, USA.
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Hart LG, Skillman SM, Fordyce M, Thompson M, Hagopian A, Konrad TR. International medical graduate physicians in the United States: changes since 1981. Health Aff (Millwood) 2007; 26:1159-69. [PMID: 17630460 DOI: 10.1377/hlthaff.26.4.1159] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nearly a quarter of all active U.S. physicians are international medical graduates (IMGs)--physicians trained outside the United States and Canada. We describe changes in characteristics of IMGs from 1981 to 2001 and compare them with their U.S. medical graduate (USMG) counterparts. Since 1981, the leading source countries for IMGs have included India, the Philippines, and Mexico. IMGs were more likely to be generalists and to practice in designated underserved areas than USMGs but slightly less likely to practice in isolated small rural areas and persistent-poverty counties. IMGs are an important source of primary care physicians in rural and underserved areas.
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Affiliation(s)
- L Gary Hart
- Rural Health Office, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
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Benedetti TJ, Baldwin LM, Skillman SM, Andrilla CHA, Bowditch E, Carr KC, Myers SJ. Professional Liability Issues and Practice Patterns of Obstetric Providers in Washington State. Obstet Gynecol 2006; 107:1238-46. [PMID: 16738147 DOI: 10.1097/01.aog.0000218721.83011.7a] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe recent changes in obstetric practice patterns and liability insurance premium costs and their consequences to Washington State obstetric providers (obstetrician-gynecologists, family physicians, certified nurse midwives, licensed midwives). METHODS All obstetrician-gynecologists, rural family physicians, certified nurse midwives, licensed midwives, and a simple random sample of urban family physicians were surveyed about demographic and practice characteristics, liability insurance characteristics, practice changes and limitations due to liability insurance issues, obstetric practices, and obstetric practice environment changes. RESULTS Fewer family physicians provide obstetric services than obstetrician-gynecologists, certified nurse midwives, and licensed midwives. Mean liability insurance premiums for obstetric providers increased by 61% for obstetrician-gynecologists, 75% for family physicians, 84% for certified nurse midwives, and 34% for licensed midwives from 2002 to 2004. Providers' most common monetary responses to liability insurance issues were to reduce compensation and to raise cash through loans and liquidating assets. In the 2 years of markedly increased premiums, obstetrician-gynecologists reported increasing their cesarean rates, their obstetric consultation rates, and the number of deliveries. They reported decreasing high-risk obstetric procedures during that same period. CONCLUSION Liability insurance premiums rose dramatically from 2002 to 2004 for Washington's obstetric providers, leading many to make difficult financial decisions. Many obstetric providers reported a variety of practice changes during that interval. Although this study's results do not document an impending exodus of providers from obstetric practice, rural areas are most vulnerable because family physicians provide the majority of rural obstetric care and are less likely to practice obstetrics. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Thomas J Benedetti
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
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Skillman SM, Palazzo L, Keepnews D, Hart LG. Characteristics of registered nurses in rural versus urban areas: implications for strategies to alleviate nursing shortages in the United States. J Rural Health 2006; 22:151-7. [PMID: 16606427 DOI: 10.1111/j.1748-0361.2006.00024.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
METHODS This study compares characteristics of rural and urban registered nurses (RNs) in the United States using data from the 2000 National Sample Survey of Registered Nurses. RNs in 3 types of rural areas are examined using the rural-urban commuting area taxonomy. FINDINGS Rural and urban RNs are similar in age and sex; nonwhites and Hispanics are underrepresented in both groups. Rural RNs have less nursing education, are less likely to work in hospitals, and are more likely to work full time and in public/community health than urban RNs. The more rural an RN's residence, the more likely he/she commutes to another area for work and the lower salary he/she receives. CONCLUSIONS Strategies to reduce nurse shortages should consider differences in education, work patterns, and commuting behavior among rural and urban RNs. Solutions for rural areas require understanding of the impact of the workplace on these behaviors.
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Affiliation(s)
- Susan M Skillman
- Center for Health Workforce Studies, University of Washington, Seattle, Washington 98105-4982, USA.
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Johnson KE, Skillman SM, Ellsbury KE, Thompson MJ, Hart LG. Updating hospital reference resources in the United States-associated Pacific Basin: efforts of the Pacific Islands Continuing Clinical Education Program (PICCEP). J Med Libr Assoc 2004; 92:495-7. [PMID: 15494766 PMCID: PMC521522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
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Thompson MJ, Skillman SM, Schneeweiss R, Hart LG, Johnson K. The University of Washington Pacific Islands Continuing Clinical Education Program (PICCEP): Guam Conference on structure and content of continuing clinical education programs in the U.S.-associated jurisdictions. Pac Health Dialog 2002; 9:119-22. [PMID: 12737429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Matthew J Thompson
- WWAI Center for Health Workforce Studies and Department of Family Medicine, University of Washington, Seattle, WA 98195-4696, USA.
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Thompson MJ, Skillman SM, Johnson K, Schneeweiss R, Ellsbury K, Hart LG. Assessing physicians' continuing medical education (CME) needs in the U.S.-associated Pacific jurisdictions. Pac Health Dialog 2002; 9:11-6. [PMID: 12737411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To assess the self-perceived continuing medical education (CME) needs of physicians in American Samoa, Commonwealth of the Northern Mariana Islands, Guam, Federated States of Micronesia, Republic of the Marshall Islands, and the Republic of Palau. METHODS Questionnaire-based survey of all physicians. RESULTS Responses obtained from a total of 143 physicians in the region provided information on training backgrounds, previous experiences with CME, local access to regular CME sessions, perceived priority educational needs and preferred methods of CME delivery. CONCLUSIONS Overall 64% of respondents had attended a formal CME event in 1999 or 2000, and 71% had access to local weekly or biweekly CME. However the perceived usefulness of these events varied by region. Priority learning needs were identified by physicians including non-communicable diseases such as diabetes, hypertension, cardiac disease; communicable diseases such as tuberculosis, HIV/AIDS and tropical diseases; as well as skills such as EKG and X-ray interpretation, trauma management and cardiac life support. Information on the most pressing educational needs and desired methods of delivery will be crucial in planning CME in this region.
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Affiliation(s)
- Matthew J Thompson
- WWAMI Center for Health Workforce Studies and Department of Family Medicine, University of Washington, Seattle, WA, 98195-4696, USA.
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Abstract
Risk adjustment may be a sensible strategy to reduce selection bias because it links managed care payment directly to the costs of providing services. In this paper we compare risk adjustment models in two populations (public employees and their dependents, and publicly-insured low income individuals with disabilities) in Washington State using two statistical approaches and three health status measures. We conclude that a two-part logistic/GLM statistical model performs better in populations with large numbers of individuals who do not use health services. This model was successfully implemented in the employed population, but the managed care program for the publicly insured population was terminated before risk adjustment could be applied. The choice of the most appropriate health status measure depends on purchasers' principles and desired outcomes.
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Affiliation(s)
- C W Madden
- Department of Health Services, University of Washington, Seattle 98195, USA.
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Kilbreth EH, Coburn AF, McGuire C, Martin DP, Diehr P, Madden CW, Skillman SM. State-sponsored programs for the uninsured: is there adverse selection? Inquiry 1998; 35:250-65. [PMID: 9809054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Risk contracting by states for coverage of previously uninsured populations has been hampered by uncertainty regarding likely claims experience. This study reports on the utilization experience of two state programs offering subsidized coverage in commercial managed care organizations to low-income and previously uninsured people. Program participants used services similarly to people enrolled through large employer benefit plans. There was no evidence of pent-up demand or an unusual level of chronic illness. Similarly, there was little evidence of underutilization, although dissatisfaction and reported barriers to service were more frequent among nonwhite enrollees.
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Affiliation(s)
- E H Kilbreth
- Institute for Health Policy, Edmund S. Muskie School of Public Service, University of Southern Maine, Portland 04104-9300, USA
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Wilson VM, Smith CA, Hamilton JM, Madden CW, Skillman SM, Mackay B, Matthisen JS, Frazzini DA. Case study: The Washington State Health Care Authority. Inquiry 1998; 35:178-92. [PMID: 9719786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- V M Wilson
- Washington State Health Care Authority, Olympia, WA 98504-2710, USA
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Martin DP, Diehr P, Cheadle A, Madden CW, Patrick DL, Skillman SM. Health care utilization for the "newly insured": results from the Washington Basic Health Plan. Inquiry 1997; 34:129-42. [PMID: 9256818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The risk of providing coverage for low-income people formerly without insurance is unknown. We conducted an evaluation to describe the use of services from 1989-1992 for members of the Basic Health Plan (BHP), a subsidized health insurance program for low-income individuals in the state of Washington. There was evidence of pent-up demand for care for those who had been without insurance for more than a year. Overall, members in the BHP program were not high users of care, although one of the three plans we examined had significantly higher utilization than the other two. BHP total expenditures were comparable to those for state employees and lower than those for Medicaid recipients.
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Affiliation(s)
- D P Martin
- Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle 98195-7660, USA
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Abstract
We studied members of the subsidized Basic Health Plan (BHP)from four managed health care organizations (MHCO). We compared low-income enrollees' and disenrollees' satisfaction with benefits, membership, and care from their MHCOs. Enrollees disenrolled primarily because they became insured through an employer, their income increased, or they moved out of the area. These disenrollees were less satisfied overall and with the amount of premiums and the total amount of medical costs covered. Disenrollees were also less satisfied with the ease and convenience of obtaining care, availability of phone advice, and quality of care. Disenrollees were more likely to be employed or to have a family member in fair or poor health. Satisfaction was high with MHCOs, although it varied considerably by site, particularly with ability to select doctors. Respondents reported affordability the most desired feature and lack of prescription coverage the least desired feature. Overall, disenrollment was not associated highly with dissatisfaction.
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Madden CW, Cheadle A, Diehr P, Martin DP, Patrick DL, Skillman SM. Voluntary public health insurance for low-income families: the decision to enroll. J Health Polit Policy Law 1995; 20:955-972. [PMID: 8770759 DOI: 10.1215/03616878-20-4-955] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A dominant issue in the health reform debate is whether insurance coverage should be voluntary or mandatory. Clearly, the factors that determine who will seek voluntary coverage are relevant to this policy issue. This article uses experience from Washington State's Basic Health Plan to examine the enrollment choices of low-income families in a state-subsidized voluntary insurance plan offered through managed care organizations. We hypothesize that the decision to enroll, which encompasses the decisions to purchase insurance coverage and to select a particular plan, is influenced by four factors: the family's financial vulnerability, their risk perception, the price of coverage, and the transition costs of enrolling. Our enrollment model is supported by the data and has important implications for the design of voluntary programs. Families who choose to enroll are more likely to have a female head of household, young children, and a family member who has a part-time job and some college education. Higher premiums and availability of other insurance coverage decrease the probability of enrolling.
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Affiliation(s)
- D L Patrick
- Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle 98195
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