This study documents features of clinical departments in teaching hospitals that are using physician assistants (PAs) and nurse practitioners (NPs) to perform some tasks previously done by medical or surgical residents. More than 60 percent of teaching hospital medical directors surveyed reported experience with substitution in their hospitals. The experience overall appears to be positive; one-third of the departments are planning to increase the number of PAs and NPs they use. The results imply that some of the services lost in house-staff reductions called for in many physician workforce reform proposals could be provided by alternative health professionals.
We project the future racial and ethnic composition of the U.S. physician workforce under different assumptions. Our projections show that reaching racial and ethnic population parity with a managed care-based requirement of 218 physicians per 100,000 population would require the number of first-year residents to roughly double for Hispanic and black physicians, triple for Native American physicians, and be reduced by about two-fifths for white physicians and two-thirds for physicians of Asian or Pacific Island origin.
Achieving national goals of reduced aggregate physician production, reduced specialist supply, and generalist increases will require significant alterations in the GME pool. Adequate time and funding for resident substitution will be required for hospitals to develop alternate models of providing service to allow national workforce goals to be met.
Graduate medical education reform, while likely to result in substantial long-term cost savings, will necessitate transitions in service provision that are likely to generate some new costs in the short term.
It is unclear whether health risk assessment (HRA) or claims-based risk modeling is a superior indicator of the need for case management in Medicaid adults with disabilities. This is a prospective cohort study designed to compare the use of a claims-based Predictive Risk Report (PRR) to a HRA in a Medicaid Supplemental Security Income managed care population. Both the claims-based risk scores and HRAs proved to be significant predictors of case management placement and subsequent emergency department and hospital utilization. The PRR-derived risk scores, however, could be obtained on virtually all enrollees at the time of enrollment, while HRA scores were obtained on only 54% of enrollees by 210 days of enrollment. Furthermore, case management reduced the risk of emergency and hospital utilization. We conclude that the PRR and HRA are equally reliable predictors of need for case management. The PRR has the advantage of earlier availability and of being easier to obtain.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.