Posts Tagged ‘nurse practitioners’

As many of my readers here at Cartagena Surgery and my sister sites know – I came to the National Conference to present a poster on “Use of Social Media to Promote Specialty Practice.”

presenting my poster at the 27th AANP conference

The poster is about how the thoracic surgery website brings together thoracic surgery professionals (surgeons, NPs, PAs, Respiratory therapists) from around the world and how it connects patients with credible but easily understandable information.

While I was there – I got the chance to meet some of the other presenters.

Tulay Cakiner-Egilmez, ANP is an ophthalmology nurse practitioner at the Boston Veteran’s Administration.  She was presenting a poster talking about performing eye exams and screening for glaucoma and other eye conditions.   My poster was next to hers, so we were able to talk in-between visitors. She’s been a nurse practitioner for three years, but has worked in the field of ophthalmology for over 25 years so she has a lot of great experience!

Tulay Cakiner-Egilmez, ANP

Debbie Kantor, MSN, ARNP and Lt. Sherrin Whiteman, MA from Hero, Inc. had a great presentation so I wanted to be sure to mention them since they may be a good resource for our readers.   They were talking about “Health Education to Reduce Obesity” and their mobile patient / community health education program.

Sherrin Whiteman, MA and Debbie Kantor, ARNP, MSN of Mobile Hero provide health education to reduce obesity

They run a pretty cool program with a nurse practitioner, a fitness instructor and other health educators who travel around to different communities to provide people with information about fitness, exercise, diet and healthy eating to prevent/ reduce obesity and promote wellness.

Brenda Reed, DNP, FNP-BC, RN presents information of genetic screening and referrals for Ovarian and Breast Cancer

Dr. Brenda Reed, DNP, FNP-BC, RN is an absolutely delightful nurse practitioner who is on the nursing faculty at Texas Christian University (Harris College of Nursing and Health Sciences) presented a wonderful poster on the genetic screening for breast and ovarian cancers.  Not only was the poster visually stunning, but she presented a lot of great information.  I really enjoyed talking to her.  (I’m not sure if they give awards at the end of the conference for ‘best poster presentation’ but my bet is on Dr. Reed.)

I ran into one of my favorite professors from Vanderbilt. Dr. Joan King, PhD, ACNP-BC, RN (almost literally – I was a bit lost in thought at the time).  She was (and is) the director of the acute care nurse practitioner program.  She was lecturing at the conference, and surprisingly, remembered me immediately.  (It’s been more years than I care to admit and the Vanderbilt School of Nursing is a large school so I was very flattered that she recognized me.)

Lastly, I was thrilled to meet Dave Mittman, PA.  He’s the founder of Clinician 1 which is an online website/ community for nurse practitioners and physician assistants.  He’s really down to earth and charming in person, and didn’t seem to mind taking a few moments to talk to me.

with Dave Mittman, PA and founder of Clinician 1


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On the other side of the equation (from the doctor won’t see you now)- is the on-going physician shortage, which will impact millions of Americans just as the aging baby boomer generation places increased demands on our strained health care system..  Rural areas will be the hardest hit (and already have the hardest time attracting physicians and other care providers).

In this article by Beverly Miller, [re-posted below] the author suggests solutions to the blooming crisis.

 I would like to add my own.  In her article, Ms. Miller gives short shift to nurse practitioners and physician assistants filling the gap.  This is unfortunate as multiple studies have shown that NPs and PAs provide an excellent level of care, and patient satisfaction – and have served as the mainstay of primary care in many rural and inner-city communities since the late 1970’s.  Nurse practitioners and physician assistants are currently hampered by several federal and state legislative issues which limit compensation and billing by nonphysician providers.  Several attempts at open and earnest dialogs among legislators, nurse practitioners and physicians have been hampered by physician attitudes.  A new report from the Institute of Medicine on the future of nursing emphasises the need to utilize nurse practitioners in this role (as we discussed here) but without further community and public support – much of the utility of NPs will fail to be realized**.

But as this author (Dr. Richard Cooper) points out – there just aren’t enough NPs, PAs and MDs combined to fill the projected shortfalls.  (So we shouldn’t argue amongst ourselves – there are plenty of patients to go around.)

PBS special on Nurse Practitioners a look at NPs in primary care.

To support your local NPs – take legislative action!  Right now, NPs are lobbying to be able to order home health and hospice for our patients as part of the ‘Medical Home’ bill.

How to handle the physician shortage  – Beverly Miller

The primary goal of health care reform deals with providing health coverage for all Americans. Policymakers tell us that it will pay for itself, but with the influx of an estimated 40 to 50 million people who were previously uninsured and the baby boomer generation now becoming eligible for Medicare (some say at a rate of eight per second), who do these policymakers believe is going to take care of these patients?
The problem is one of basic economics: supply is simply not keeping pace with demand.
The physician shortage in the U.S. is not a new problem caused solely by health care reform. Twenty-two states and 17 medical specialty societies are already reporting shortages today, long before the 2014 influx under the provisions of the Patient Protection and Affordable Care Act. Aging and population growth have created a greater demand for physicians than ever before.
Family practice, internal medicine, and geriatric specialists will be the gatekeepers under the reformed system. These specialties require more knowledge in a broader spectrum of diseases than other specialty physicians, yet are paid less for these services. For those doctors choosing family practice, internal medicine or geriatrics as a career, it is often a social decision.
A large number of physicians, mirroring the rest of the population, are reaching retirement age. The American Medical Association (AMA) has reported that in 2017, more than 24,000 physicians will turn 63. The number of retiring physicians could be even higher if the economy rebounds and many who delayed retirement for financial reasons decide to retire.
For the fifth year in a row, family practice and internal medicine have topped the Merritt Hawkin’s recruiting and retention survey.
It has been noted that new physicians are:

– opting for higher paying specialties since student loan debt often exceeds $150,000 – opting to practice at hospitals and health care systems where better technologies are available – desiring more flexible scheduling for family time and social activities – desiring to live in high-population areas  leaving vast areas of the U.S. underserved.

Also, the availability of residency slots is not keeping pace with the demand for new physicians and often residency slots for family medicine and internal medicine often go unfilled. A cap on Medicare-funded residency programs by the Balanced Budget Act of 1997 has not kept pace with needs. Also, there has been less availability of graduate medical education (GME) funding through state Medicaid programs
The Patient Protection and Affordable Care Act does include a provision for redistribution of residency positions by the Health and Human Services (HHS) secretary if residency positions have been unfilled for three Medicare cost reporting periods. The slots, which appear to number approximately 600, will be redistributed giving preference to hospitals located in states with a low resident physician to population ratio; or with a large population living in primary care health professional shortage areas, rural hospitals, and urban hospitals with accredited rural training tracks.
Need is driving the demand for primary care physicians. Groups and hospitals are rushing to form Accountable Care Organizations, patient-centered medical homes and other employment models, all of which are centered around the foundation of primary care.
As we moved to a managed care delivery system, the overriding belief was that good primary care promotes better outcomes and prolongs life. In many respects, it was a success since preventive care was added to coverage and patients began to think in terms of quality rather than quantity of care.
Moving to the next stage, most believe that it must better connect consumers to the health care system and that it must use information technology to better manage costs and patients.
Demand for services will continue to increase as the economy rebounds, resulting in more covered workers, and the baby boomer generation continues to attain Medicare coverage. And if the provisions of the legislation stay on track, there will be even more demand in 2014.
What do we do?
Varying solutions are being discussed.
Nationally, medical school enrollments have been flat over the past 20 years. Policymakers are calling for a significant increase in new physicians, recommending increases in medical school enrollments and increases in GME positions.
Signing bonuses, relocation expense reimbursement and medical education allowances remain standard in most physician recruitment incentive packages. Higher base salaries and productivity bonuses are slowly becoming the norm for family practice and internal medicine.
The 2009 stimulus package and health reform law have designated nearly $300 million for the National Health Service Corps to offer medical loans repayment to new physicians who practice in underserved areas.
Increase in reimbursements for family practice and internal medicine services are necessary to entice physicians to specialize in these areas.
Nurse practitioners and physician assistants can fill some of the void, along with non-U.S. trained physicians becoming eligible to practice in the U.S.
Shorten the training time for primary care physicians from an average of ten years to a more targeted education taking five to eight years by eliminating undergraduate majors and moving straight to medical curriculum and clinical training.
Expand the role of telemedicine as technology becomes more widely adopted by healthcare providers and patients.
There are no certain answers to the problem, but physicians have always been flexible and innovative. In conjunction with other players in the system, physicians themselves will be the ones with the right ideas and solutions. [unfortunately, physicians have also used their strength and influence to prevent alternative solutions in the past – cartagena surgery].

Beverly A. Miller, CPA, CAPPM , is Manager of Physician Services with Hayflich & Steinberg, CPA’s, PLLC and the current president of the National CPA Health Care Advisors Association. She has been heavily involved in practice startups, as well as aiding existing practices with billing issues, accounting issues, staff modeling and selection, project analysis, financial management, compliance issues, and tax planning. Beverly can be reached at (304) 697-5700.

Hayflich & Steinberg, CPA’s, PLLC is also a proud member of the National CPA Health Care Advisors Association (HCAA). HCAA is a nationwide network of CPA firms devoted to serving the health care industry. Members provide proactive solutions to the accounting needs of physicians and physician groups. For more information contact the HCAA at info@hcaa.com.

** As mentioned previously on this site, Nurse Practitioners work in a variety of specialty medicine and surgery practices. As an acute care nurse practitioner in specialty surgery practice – I work directly with a surgeon (versus a NP in primary care practice.)

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A new study has been published online (on advance of print) looking at medical outcomes among physicians, nurse practitioners, clinical nurse specialists and nurse midwives.

Advance Practice Outcomes 1990 – 2008 : A Systemic Review discusses the role of advanced practice nurses in improving access to healthcare, and improving the quality of healthcare in the United States.

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