Dr. Patricia Pittman co-authored this New England Journal of Medicine article that discusses ongoing payment reforms that are pressing health systems to reorganize delivery of care to achieve greater value, improve access, integrate patient care among settings, advance population health, and address social determinants of health. Many organizations are experimenting with new ways of unleashing their workforce’s potential by using telehealth and various forms of digital technology and developing team- and community-based delivery models. Such approaches require reconfiguring of provider roles, but states and health care organizations often place restrictions on health professionals’ scope of practice that limit their flexibility. These restrictions are inefficient, increase costs, and reduce access to care. As leaders of public and private research centers who interact with and study the U.S. health workforce, we believe it’s time to revise the country’s antiquated patchwork of laws that restrict the health system’s ability to innovate. We should improve our approach to regulating health professionals’ scope of practice so that regulations better serve the needs of patients, rather than protect turf in the battles among health professions.
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In this Academic Medicine piece, Dr. Fitzhugh Mullan recalls the summer of 1965, which he spent in Holmes County, Mississippi, as a medical civil rights worker. The poverty, bravery, ignorance, brotherhood, racism, hate, and love he experienced that summer led him to conclude he would become a civil rights doctor. When he returned to medical school in Chicago, the author and his classmates began organizing students around the idea of social justice. They intended to take on society’s big problems even as their medical education ignored them.
More than 50 years later, the author reflects on the sense of mission that attracts many people to medicine. A mission more than the desire to heal. A mission to recognize and address the inequities in the world and, more to the point, in access to health and health care. Medical schools have a unique role or “social mission” in that they are the only institutions that can build doctors for the future. The culture of the medical school is a powerful influence on the values of its graduates and, ultimately, the physicians of the country. The articulated, cerebrated, strategized mission that a medical school selects for itself has an enormous influence on who gets to be a doctor and what the values of that doctor are in the future, and that is why, the author argues, medical schools must incorporate social mission.
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In this JAMA piece by Dr. Candice Chen, discusses how Graduate medical education (GME), the training of resident physicians, is funded by GME payments to hospitals and health systems, largely from Medicare and Medicaid. The number, specialty, and practice locations of future physicians is heavily dependent on how GME positions are determined and placed. In 2015, Medicare alone provided $12.5 billion in GME payments to teaching hospitals. Yet, shortages persist in select specialties, such as primary care, and in rural and underserved areas. Read the entire full article.
The Role of the National Health Service Corps Clinicians in Enhancing Staffing and Patient Care Capacity in Community Health Centers
A new paper in Medical Care examines how National Health Service Corps (NHSC) clinicians may affect staffing in community health centers. Han, et al. found that the addition of clinical NHSC FTEs has the potential to significantly increase the visit capacity for community health centers. This is especially true for dental and mental health visits. Read Article
Does Expanded State Scope of Practice for Nurse Practitioners and Physician Assistants Increase Primary Care Utilization in Community Health Centers?
Jeongyoung Park, et al., found that granting independent practice and prescriptive authority for nurse practitioners (NP) resulted in statistically significant increases in NP visits and decreases in both physician assistant (PA) and primary care provider visits, for community health centers with a high proportion of NPs and PAs along with the increased provision of support staff. PA scope of practice liberalization had no statistically significant effect on PA visits. Read article