Posts Tagged ‘nurse practitioners’

Healthcare Employment on a Strong Growth Trajectory

Monday, April 16th, 2012

Healthcare employment will continue to grow much faster than employment in general, with the number of jobs in home care and other ambulatory settings expected to grow by more than 40 percent by 2020, according to a new study from the Center for Health Workforce Studies (CHWS) at the State University of New York at Albany.

Recent statistics from the Department of Labor focus on an expected hiring shift away from hospitals, as the system emphasizes preventive care and fewer admissions, said Jean Moore, CHWS director.  “For a long time, acute-care services tended to trump everything else, and that seems to be changing,” Moore said.  “There’s a growing awareness that it’s penny-wise and pound-foolish not to pay attention to preventive and primary care.”

Hospitals also are expected to keep hiring — nearly one million between now and 2020 — for a growth rate of 17 percent – as baby boomers age and need more inpatient care.

Physicians’ offices and other healthcare professionals are projected to hire 1.4 million people by 2020, a 36 percent increase.  The number of home health care jobs will soar by 872,000 – that’s an 81 percent growth rate.  The total number of ambulatory-care jobs will grow by 2.7 million by 2020, or 44 percent.

According to Kaiser Health News, healthcare is projected to be a growth industry, even if the Supreme Court strikes down the Patient Protection and Affordable Care Act (ACA).  “One of the things I wasn’t expecting was how much growth there was even during the recession,” Moore said.  “I would have expected some tempering of the growth.”

Although total U.S. employment declined by two percent between 2000 and 2010, healthcare employment rose 25 percent — demonstrating the sector’s expanding share of the economy.  By 2020, nearly one of every nine American jobs will be in healthcare.  When you consider that four million new health jobs will be created and people retiring from existing ones, more than seven million new workers will be needed.  That includes more than one million nurses.

According to the report, administrative healthcare jobs were cut during the economic slump from 2008 to 2010, a time when providers added nursing and other clinical positions.  Recent reports suggest that hospitals are hiring additional administrative staff to keep up with the increased regulation required by the ACA.  “They may be rehiring the people they had to let go when times were tight,” Moore said.

Healthcare employment totaled 14.19 million in October of 2011, an increase from the 13.88 million a year earlier, according to the Bureau of Labor Statistics.  Hospital jobs increased by 84,000 during the same time period.  Ambulatory services — physician offices, outpatient clinics and home health agencies added more than 173,000 positions.

Demand is strongest for general practitioners, nurse practitioners and physician assistants at private practices, community clinics, hospitals and long-term care facilities.  Demand also is high for physical therapists.  Some analysts predict that the shortage of physical therapists will increase as healthcare reform goes into effect.  Fewer uninsured Americans translates to a greater demand for physical therapy.  In response, medical schools are expanding and developing physical therapy training programs.

If anything, the physical therapist shortage will worsen, because in 2000, 15.6 percent were between the ages 50 and 64; 10 years later, 32 percent were in that age bracket, according to a report from the American Physical Therapy Association (APTA).  Unemployment among physical therapists remains remarkably low: In 2010, only 0.4 percent — one in 250 — of physical therapists were jobless.  “Nobody knows how accountable-care organizations and medical homes will shake out, but healthcare reform in general will decrease the number of uninsured, which will increase demand for physical therapists,” said Marc Goldstein, senior director of research for the APTA.  “Physical therapy programs are being developed or expanded, so the current level of 6,000 graduates annually should creep up.”

A survey by Sullivan, Cotter and Associates, Inc., a nationally-recognized compensation and human resource management consulting firm, over the last year, nearly 75 percent of respondents reported they increased their physician staffing levels; adding an average of 12 specialists and nine primary-care physicians to their staffs.  Another 75 percent said they plan to increase their physician staffs and mid-level providers over the next year.  “These data are consistent with the labor market shift in physician employment that has been occurring over the past few years,” said Kim Mobley, practice leader for physician compensation.  “We expect this trend to continue for some time.  This shift in the labor market has resulted in what has become a highly competitive market for physicians as organizations and physicians align to provide services in a high quality, more efficient manner.”

Healthcare Jobs Still the Fastest-Growing Sector

Tuesday, February 7th, 2012

Job growth in the healthcare profession seems to be virtually recession-proof. In Florida, a state with a sizeable percentage of senior citizens, there are about 960,000 healthcare and social assistance jobs, approximately 13 percent of all nonfarm payroll positions in the state.

Some experts are not as optimistic about job growth in the healthcare sector.  “Reform may accelerate the trend toward healthcare’s being the dominant employment sector in the economy,” according to a recent New England Journal of Medicine (now known as NEJM) article.  A significant amount of the growth in healthcare that result from reform might be in support positions, rather than physicians and nurses, several economists said.  “As for jobs for health professionals, I doubt that this will or can increase the number of doctors or nurses.  While there will be greater demand for their services, there will also be offsetting effects as medically unnecessarily procedures are paid less,” said Amitabh Chandra, an economist and public-policy professor at Harvard University.

As the insured population grows under the federal Patient Protection and Affordable Care Act (ACA), healthcare workers will be in high demand.  These gains come on the heels of growth already required to serve an aging population.  In Florida, the aging population’s impact on healthcare employment is more dramatic than in the rest of the country: about 17 percent of the state’s population is older than 65, compared with a 13 percent average in the other states., according to the Census Bureau.

Other experts are far more sanguine about healthcare’s ability to create jobs.  “The big places we waste money is patients who are discharged and there’s not a lot of follow up and they end up in the hospital a month later,” said Leemore Dafny, an economist at Northwestern University whose expertise is competition in healthcare markets.  According to Dafny, reform will create new primary-care physicians and physician “extenders,” such as nurse practitioners; at the same time, it could decelerate growth in spending on medical specialists.  “If the ACA is repealed, it will be business as usual — except that more of the population is now uninsured — so the demand for primary-care professionals will increase much more slowly,” said Dafny.

In fact, according to the Bureau of Labor Statistics (BLS), the healthcare sector for some time has provided about the only bright spot in an otherwise drab report on job growth.  Healthcare employment created 205,100 new jobs in the first eight months of 2011.  Approximately 14.1 million people are employed in the healthcare sector with more than 4.7 million jobs at hospitals; more than 6.1 million jobs in ambulatory services; and more than 2.3 million jobs in physicians’ offices, according to BLS statistics.

According to Risa Lavizzo-Mourey, M.D., CEO of the Robert Wood Johnson Foundation, and Mark Pinsky, president and CEO of the Opportunity Finance Network, “The current economic recovery effort presents an opportunity to build stronger, healthier communities.  That’s a central goal, for example, of the Create Jobs for USA Fund that the OFN and Starbucks launched late last year to support job creation and retention.  Economic growth and job creation provide more than income and the ability to afford health insurance and medical care.  They also enable us to live in safer homes and neighborhoods, buy healthier food, have more leisure time for physical activity, and experience less health-harming stress.  The research clearly shows that health starts in our homes and communities and not in the doctor’s office.  In that way, economic policy is, in fact, health policy.  The end goal?  Create and sustain job growth across the country.  Improve communities.  Improve health.  Give people the opportunities to make smart, healthy decisions so that they can act in the best interests of their communities, themselves, and future generations.”

Healthcare added 17,200 jobs in November of 2011, an increase over the 11,600 jobs reported in October, according to BLS data.  Healthcare accounted for 14.3 percent of 120,000 new jobs created across all sectors in November.  On the whole, healthcare represented 24 percent of the 1.2 million non-farm jobs created this year and is expected to create 321,000 new jobs by year’s end.  That represents a 22 percent increase over the 263,400 healthcare jobs created in 2011.

The Doctor Can’t See You Now

Tuesday, February 22nd, 2011

As Baby Boomers celebrate their 65th birthdays at the rate of one every eight seconds, the nation’s physician shortage is growing. “This is not a surprise, of course, but I hope that the oft-repeated statistic will force our nation and our government to face the harsh reality of America’s current physician shortage, our growing underserved populations, and the dismal issue of access for those newly insured after 2014 under provisions of the Patient Protection and Affordable Care Act,” said Cecil B. Wilson, M.D., and president of the American Medical Association (AMA).

According to Wilson, the AMA anticipates that the nation will be short by at least 125,000 physicians by 2025.  This year, 22 states and 17 medical specialty organizations are reporting dwindling numbers of practitioners.  Many physicians have so many patients that they have to limit the number of Medicare enrollees they can see because reimbursement rates are not high enough to make a profit.  “For decades, we have watched the physician population move into cities and high-population areas, leaving vast areas of this country woefully underserved,” Dr. Wilson said.  “There still is a primary-care shortage — at least partially because pay differentials for primary-care physicians make it even more difficult to repay medical school debts, which average $155,000.  We see an even larger shortage in the Hispanic, black and other minority communities — partly because of high medical school costs but also because there are few role models for those kids.  And then there is 2014, the year of shrinking access.  That year, when the full provisions of the health reform law kick in, we will see 32 million more patients — people who up to now have been uninsured and often without a physician.”

Complicating the situation is the fact that the Department of Health and Human Services estimates that as many as 33 percent of physicians practicing today will retire over the next 10 years.

The outlook for primary-care physicians is especially grim, according to the Association of American Colleges (AAMC). The AAMC estimates that the nation will need an estimated 45,000 primary-care physicians and 46,000 surgeons and medical specialists once the new healthcare law is fully implemented.  “It’s certainly the worst (shortage) that we’ll have seen in the last 30 years,” said AAMC chief advocacy officer Atul Grover.  “For the first time since the 1930s, our number (of physicians) per capita will start to drop in the next couple of years.  That’s fewer doctors per person, but at the same time, since people are aging and have more chronic illnesses, each person is going to need more healthcare.  That’s a pretty bad situation.”

At present, the United States has 709,700 physicians (in all specialties) with a demand for 723,400 – that’s a shortfall of 13,700 doctors.  By comparison, in 2020, there will be 759,800 physicians (in all specialties) with a need for 851,300 physicians; essentially that represents 91,500 too few doctors.  Once healthcare reform kicks in, 32 million more Americans will have access to medical insurance and 36 million to Medicare.  “As more people get insured, they are going to seek out the care they probably should have been getting all along but haven’t been able to necessarily access.  That’s why those numbers look worse in the next 10 years than we previously had estimated,” Grover said.

Peter J. Weiss, M.D., respectfully disagrees.  In fact, he thinks that the physician shortage is all in the AMA’s Dr. Wilson’s head. “It’s simple, when the doctor supply goes up — the amount of care, and the profits, rise too,” according to Weiss.  “I’m not blaming physicians for this problem, the causes of inappropriate care are complex, but if we just got rid of unnecessary care, would we have a ‘physician shortage?’  Lastly, historically doctors have acted aggressively to protect their turf – both as a profession and within specialties.  How much routine healthcare could be rendered by nurse practitioners, nurses, pharmacists and other more numerous and less costly providers?  Studies suggest that a huge fraction of care doesn’t need to be rendered by a doctor, but what prevents this?  You know the answer — the physician lobby.”

HHS Has $250 Million to Train Primary-Care Physicians

Monday, July 12th, 2010

Healthcare reform provides $250 million to train primary-care physicians, physician assistants and nurse practitioners.  Medical schools and teaching hospitals that educate primary-care physicians and allied professionals can apply for $250 million in new grants through the Prevention and Public Health Fund.  According to Health and Human Services (HSS) Secretary Kathleen Sebelius, the grants are 50 percent of a $500 million fund created by healthcare reform legislation. The doctor deficit goes back to the 1980s and 1990s when medical schools capped their enrollments at 16,000 students per year because they believed that managed care would create a physician glut.

With the nation facing a shortage of 66,000 primary-care physicians just 10 years from now, including 7,000 in underserved urban and rural areas, according to HHS, the new funding is welcome news and represents a starting point to resolve the physician shortage.  The money will train approximately 1,700 new primary-care physicians, physician assistants and nurse practitioners through 2015.  Representative Lois Capps (D-CA) describes the new healthcare bill as a jobs bill because it provides funding to train new healthcare professionals.

The lion’s share of the grants — $168 million – will benefit physicians and be awarded to 105 eligible teaching hospitals and university medical schools.  An additional $32 million will fund 40 programs that train physician assistants.  Another $30 million will fund nurse practitioner training.

Although the 1,700 primary-care physicians this grant money will train is a drop in the bucket – considering that approximately 250,000 active physicians are expected to retire between now and 2020 – it represents a step in the right direction.

Healthcare Reform Provides Funding to Educate Advance-Practice Nurses

Wednesday, April 21st, 2010

Graduate Nurse Education Demonstration is a model program to educate advance-practice nurses.  A little-known provision of the healthcare reform bill is a $200 million appropriation that creates a demonstration program whose goal is to educate more advanced-practice nurses who will provide primary and preventative care, as well as chronic care management.  The Patient Protection and Affordable Care Act orders the Department of Health and Human Services to establish the Graduate Nurse Education Program.  Under the directive, five hospitals nationally will receive federal funding to train clinical nurse specialists, nurse practitioners, certified-registered nurse anesthetists and certified-nurse midwives.

Hospitals must partner – and share their federal dollars – with at least one qualified nursing education program and more than two community-based healthcare centers or walk-in clinics.  The four-year program will receive $50 million a year through Medicare and present a report on progress to Congress by 2017.

AARP immediately gave kudos to the program for its goal of educating nurses to learn the skills needed to care for Medicare patients.  According to Senior Vice President Susan Reinhard, “The Graduate Nurse Education Demonstration Program aims to increase the number of highly skilled advance-practice nurses available to care for Americans by providing $200 million to bolster the training of these key healthcare professionals.  Advance-practice nurses can provide the primary and preventive care, chronic care management and care coordination necessary to reduce waste and bring down costs while increasing access and quality.”

Healthcare’s Best-Kept Secret: Nurse Practitioners

Thursday, August 13th, 2009

If healthcare reform is to successfully overcome the realities of Washington politics, there is one problem in covering the millions of Americans who lack insurance coverage – the physician shortage.  Currently, there is a 30 percent shortage of primary-care physicians, and with less than 10 percent of 2008 medical school graduates choosing that career track.  When Massachusetts enacted mandates for universal health insurance in 2006, the state’s primary-care physicians48019286 were overwhelmed.  A similar scenario could occur on a national scale.

Nurse practitioners — who have advanced nursing degrees, are licensed by the state and often are allowed to prescribe medications — may fill that void because they can treat and diagnose patients at less cost than physicians.  Medicare reimburses nurse practitioners at 80 percent of what they pay doctors for similar services.

Nurse practitioners are vital to healthcare reform because they focus on patient-centered care and preventive medicine.  The House of Representatives has listed nurse practitioners as primary-care providers on their healthcare reform legislation bill.  The profession lobbied intensely to include this legislative language so they can play an important role in a revamped health system.

“We seem to be healthcare’s best-kept secret,” said Jan Powers, health policy director for the Academy of Nurse Practitioners.  Although nurse practitioners typically have less medical education than physicians, they are well trained in skills such as bedside manner and counseling.  “In the United States, we are so physician-centric in our health system.  But it should be about wellness and prevention, not about procedures and disease management,” said Rebecca Patton, president of the American Nursing Association.

Walk-In Clinic A Good Fit With the Healthcare Village

Thursday, May 28th, 2009

Urgent care centers (Illinois law mandates that they be called immediate or convenient care centers) are gaining ground nationwide as an alternative for families with minor medical emergencies that require quick treatment.  Although the walk-in clinic concept has been around for more than 20 years, the trend is picking up steam in an increasingly cost-conscious healthcare environment.  emergency_roomApproximately 8,000 such facilities currently are open for business in the United States.

A 2008 survey by the Urgent Care Association of America found that most centers are owned by physicians, and approximately 15 percent are hospital affiliated.  More than 55 percent are located in suburbs, where well-off patients with private insurance are unwilling to spend hours waiting in an emergency room.  The survey found that of an average of five employees, 1.7 are physicians; 0.4 are nurse practitioners; 0.7 are registered nurses; and 2.3 are clinical staff or medical assistants.  Sixty percent of patients are seen by a physician, nurse practitioner or physician’s assistant in just 30 minutes.

Alter+Care sees immediate care centers as a great fit with Alter+Care’s Healthcare Village concept (our concept of a wellness/preventive-focused outpatient campus, see www.healthcarevillage.net, because the village becomes a healthcare destination while generating visibility and visits for all services located in the village such as diagnostics/imaging, specialty clinics, physician practices, retail healthcare, laboratory and the wellness center.  For patients, the centers provide easy access and reasonably priced care because they typically charge far less than an emergency room visit.  Insurers who want to control costs are encouraging people to use urgent care facilities as an alternative, especially during after hours and on weekends.