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Healthcare Recruiting Outlook – 2013 First Quarter Analysis Part I The first quarter of 2013 marked the second anniversary of the historical healthcare reform law signed by President Obama.
Hospital outpatient department visits attended only by physician assistants (PAs) or advance practice nurses (APNs) increased by 50% from 2000a€“2001 (10%) through 2008a€“2009 (15%). The more urban the hospital location, the lower the percentage of visits seen only by PAs or APNs; decreasing from 36% in nonmetropolitan areas to 6% in large central metropolitan areas.
A higher percentage of PA- or APN-only visits were to general medicine (21%) and obstetric or gynecology (19%) clinics compared with pediatric (8%) and surgical (5%) clinics. PAs and APNs saw a higher percentage of visits where a new problem was the major reason for the visit (22%) compared with visits for a chronic condition [routine (11%) or flare-up (14%)], or pre- or postsurgery care (6%).
Physician assistants (PAs) are state-licensed health professionals practicing medicine under a physician's supervision (1,2). Three-fourths of 103,010,000 hospital OPD visits in 2008a€“2009 were seen by a physician and 18% were seen by a PA or APN (4,5).
During the same time period, the percentage of OPD visits attended only by physicians declined from 77% in 2000a€“2001 to 72% in 2008a€“2009 (data not shown).
The percentage of visits not seen by a physician, PA, or APN remained the same (10%) and was excluded from the analyses that follow. The percentage of visits attended only by a PA or APN decreased as hospital size (number of beds) increased, from 24% among OPDs in hospitals with under 200 beds to 10% among hospitals with 400 or more beds.
The percentage of visits seen only by a PA or APN was higher in nonteaching hospital OPD clinics (22%) than in teaching hospital OPD clinics (8%) (Figure 2).
The percentage of visits seen solely by a PA or APN decreased as the hospital's location became increasingly more urban: from 36% in nonmetropolitan areas to 6% in large central metropolitan areas (Figure 3).
The percentage of visits seen only by a PA or APN was higher in general medicine (21%) and obstetrics and gynecology (19%) clinics than in pediatric (8%) and surgical (5%) clinics (Figure 4). PAs and APNs saw a higher percentage of visits where a new problem was the major reason for the visit (22%) compared with visits for a chronic condition [routine (11%) or flare-up (14%)], or pre- or postsurgery care (6%) (Figure 5). PAs and APNs saw a higher percentage of preventive care visits (17%) compared with visits for a routine chronic condition or pre- or postsurgery care. The percentage of visits seen only by a PA or APN was higher in OPD clinics reported to be the patients' primary care provider (22%) than in those clinics not identified as the patients' primary care provider (13%). A higher percentage of visits made by younger patients were seen only by PAs or APNs (19%) than were older patients (13%). A lower percentage of visits by non-Hispanic black patients (12%) than non-Hispanic white patients (18%) were seen solely by a PA or APN. PAs and NPs saw significantly higher percentages of visits by patients with Medicaid or the Children's Health Insurance Plan (18%) or no insurance (22%) compared with visits made by Medicare patients (12%).
This analysis shows that visits to PAs or APNs have become more common in hospital OPDs over the past decade.
PAs or APNs are providing an increasing share of care delivered in OPDs compared with the previous decade. APN: Refers to an RN with advanced training in areas not usual for RNs, such as diagnosing and managing common diseases, ordering tests, and prescribing medications.
Hospital outpatient department: Refers to a hospital facility where nonemergent ambulatory medical care is provided under the supervision of a physician. Hospital size: Refers to the number of inpatient beds as recorded in SDI Market Profile Database. Teaching hospital: Refers to a hospital that provides clinical education and training to current and future doctors, nurses, and other health professionals, in addition to delivering medical care to patients. Urban or rural classification of the hospital's ZIP code: Developed by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS) to study the association between urbanicity and health and to monitor the health of urban and rural residents. All estimates are from the 2008 and 2009 National Hospital Ambulatory Medical Care Survey (NHAMCS), an annual nationally representative survey of visits to nonfederal, general, and short-stay hospital emergency and OPDs. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.
Primary care physicians were more likely to work with NPs, CNMs, or PAs than physicians in other specialties. NPs, CNMs, or PAs were most likely to be associated with physicians who worked in large group practices. Physicians in multispecialty group practices were most likely to work with NPs, CNMs, or PAs. Physicians in practices with more revenue from Medicaid and less revenue from Medicare were more likely than others to work with NPs, CNMs, or PAs.
In 2009, 49.1% of office-based physicians were in practices that used nurse practitioners (NPs), certified nurse midwives (CNMs), or physician assistants (PAs). Primary care physicians were more likely to have NPs, CNMs, or PAs than physicians of other specialities. Physicians in larger and multi-specialty group practices were more likely to work with NPs, CNMs, or PAs than those in smaller and single-specialty group practices. Older physicians were less likely than middle-aged physicians to be in practices that had NPs, CNMs, or PAs.
Physicians in practices with a higher proportion of revenue from Medicaid and a lower proportion from Medicare were more likely to work with NPs, CNMs, or PAs.
The expansion of health insurance coverage through health care reform, along with the aging of the population, are expected to strain the capacity for providing health care (1a€“3). Overall, 49.1% of physicians in 2009 were in practices that had NPs, CNMs, or PAs (Figure 1). Among all three specialty categories, physicians in larger practices were more likely to have NPs, CNMs, or PAs compared with those in smaller practices. Physicians in surgical and medical specialties followed this same pattern, with those in larger practices being more likely to have NPs, CNMs, or PAs (Figure 2).


Physicians in multi-specialty group practices were most likely to work with NPs, CNMs, or PAs. Older physicians were less likely than middle-aged physicians to work with NPs, CNMs, or PAs (Figure 4). Conversely, physicians in practices with more revenue from Medicaid were more likely than those with less revenue from Medicaid to work with NPs, CNMs, or PAs (53% compared with 45.2%).
The expansion of health insurance coverage, as well as the aging baby-boomer population, are predicted to cause a surge in demand for health care services in the coming years. The role of NPs, CNMs, or PAs in the provision of health care is likely to increase in future years (12).
Specialty type: NAMCS samples physicians in 14 American Medical Association (AMA) specialties and a miscellaneous specialty category.
NAMCS utilizes a multistage probability sample design involving samples of geographic primary sampling units (PSUs), physician practices within PSUs, and patient visits within physician practices.
The sampling approach for NAMCS excludes the collection of information about NPs, CNMs, and PAs with independent practices. The Patient Protection and Affordable Care Act, HR 3590, Subtitle F: Strengthening Primary Care and Other Workforce Improvements, Section 5501. Our Decision Trees provide practice defined clinical pathways to help physicians see patients effectively and efficiently. Meets regulatory requirements and provides a cost-effective system that all but eliminates space for storage, cabinets, etc. With the amount of documentation that is received from the outside world, practices need an effective solution to integrate this data with the EMR. DavLong’s Intelligent Ordering System memorizes physician ordering patterns based on diagnosis code(s) assigned to a patient.
Allows lab orders to be processed electronically to most outside reference labs as well as many popular LIS programs (for those practices with internal labs).
Our online patient portal software allows patients to interact with your healthcare center at all hours of the day, securely over the internet. Patients can log in through the patient portal and complete patient forms required by your practice online.
She provides guidance and leads the teams responsible for job marketing, talent acquisition, training and internal administrative functions. Among visits to PAs or APNs, 65% were seen by an APN and 35% were seen by a PA (data not shown). The findings in this report suggest that PAs or APNs continue to provide a critical health care function by providing care in settings with fewer physicians, such as rural locations, small hospitals, and nonteaching hospitals.
Although there are several types of APNs, most APNs who work in OPDs are nurse practitioners or nurse midwives. Differences by type of provider and selected patient and visit characteristics were examined using t tests for differences in percentages and chi-square tests for differences in percent distributions at the p = 0.05 level.
Tapping the potential of the health care workforce: Scope-of-practice and payment policies for advanced practice nurses and physician assistants. Improving access to adult primary care in Medicaid: Exploring the potential role of nurse practitioners and physician assistants. National Hospital Ambulatory Medical Care Survey: 2008 outpatient department summary tables.
National Hospital Ambulatory Medical Care Survey: 2009 outpatient department summary tables. The contribution of nurse practitioners and physician assistants to generalist care in Washington state.
Physician assistants and nurse practitioners in hospital outpatient departments, 1993a€“1994.
Physician assistant and advance practice nurse care in hospital outpatient departments: United States, 2008a€“2009. Projections of the future physician workforce (4,5) predict declines in the supply of physicians and decreasing physician work hours (6,7) for primary care (8a€“10). Examining the current employment of NPs, CNMs, and PAs in physician offices is important in order to prepare for the future. The Patient Protection and Affordable Care Act legislation, signed into law on March 23, 2010, contains several provisions affecting the likely future supply of NPs, CNMs, and PAs (13).
These specialties are grouped into three major categories: primary care, surgical, and medical, as shown in Figures 1 and 2. NAMCS is a national probability sample survey of nonfederal, office-based physicians in the United States conducted by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS), Division of Health Care Statistics. PSUs are counties, groups of counties, county equivalents, or for some PSUs in New England, towns and townships.
In addition, information collected about visits to physicians in NAMCS does not routinely include information about visits to NPs, CNMs, or PAs except those in community health centers. Decker are with the Centers for Disease Control and Prevention's National Center for Health Statistics, Division of Health Care Statistics.
Vital signs: Health insurance coverage and health care utilizationa€”United States, 2006a€“2009 and Januarya€“March 2010.
Finding, recruiting, and sustaining the future primary care physician workforce: A new theoretical model of specialty choice process. Missing in action: Care by physician assistants and nurse practitioners in national health surveys. Nurse practitioners, certified nurse midwives, and physician assistants in physician offices. With over 80% of our clients in Primary Care, we are confident that we have the most comprehensive solution available for your practice.


With many trees already fully developed, our EMR for OB-Gyn can be used as is, or provide a great starting point to create your custom Decision Trees specific for your practice. DavLong’s Bulk Imaging provides a state-of-the-art imaging solution allowing practices to easily transfer data from external sources directly into the patients chart. Suggested orders can be retrieved based on an individual physician’s ordering history, or on the ordering history of the practice as a whole.
When results are received back from the lab or the LIS program, the interface updates results directly into the patient’s chart. Accessible through your practice website with a patient login and password, your patients can easily pre-register online, pay bills, or request appointments.
For new patients, this would include chief complaints, past, family, and social histories, allergies, current medications, or any other history your practice collects.
Seems either no one is talking about louis daguerre at this moment on GOOGLE-PLUS or the GOOGLE-PLUS service is congested. PAs and APNs have been expanding in supply and playing increasingly diversified roles in the U.S. General medical and obstetrics or gynecology clinics have higher percentages of PA or APN visits than either pediatric or surgery clinics. Large central metropolitan includes counties in a metropolitan statistical area (MSA) of 1 million or more population that contain the entire population of the largest principal city of the MSA, or whose entire population resides in the largest principal city of the MSA, or that contain at least 250,000 of the population of any principal city in the MSA. A weighted least-squares regression analysis was used to determine the significance of trends by year, hospital size, and location. The registered nurse population: Findings from the 2008 National Sample Survey of Registered Nurses. An expansion of care delivered by nurse practitioners (NPs), certified nurse midwives (CNMs), and physician assistants (PAs) is often cited as a solution to the predicted surge in demand for health care services and calls for an examination of current reliance on these providers (11,12). Specifically, these provisions include a 15% carve-out for PA educational programs in the funding for primary care medicine, making PA educational programs eligible for faculty loan repayment grants and grants for authorized nurse-midwifery education programs. Major specialties included in the primary care grouping are internal medicine, family practice or general practice, pediatrics, and obstetrics and gynecology. A sample weight is computed for each sample visit that takes all stages of design into account.
Long-term trend analysis on the employment of NPs, CNMs, and PAs in physician offices is not possible with NAMCS because this information was not collected for all physicians until 2007.
The Patient clipboard give your providers a clinical “snapshot” of the patient’s chart, including patient status, histories, alerts, etc. The physician who ordered the lab or the person designated to review results is messaged in MedInformatix’s messaging system that the results have arrived. PAs or APNs in hospital OPDs provide services to patients for whom the clinic serves as a primary care provider and for assessing new problems or provision of preventive care.
Among the two types of APNs not included in this report [nurse anesthetists (NAs) and clinical nurse specialists (CNSs)], 82% of NAs and 49% of CNSs worked in hospital settings in 2008 (3).
Large fringe metropolitan includes counties in an MSA of 1 million or more population that do not qualify as large central metropolitan. OPD data in this study were limited to visits seen by a physician, PA, or APN (n = 59,165), of which 52,718 were seen by a physician (including 3,016 seen by both physician and PA or APN) and 6,447 were seen only by PAs or APNs. Using a nationally based physician survey, we have described the employment of NPs, CNMs, and PAs among office-based physicians by selected physician and practice characteristics. Physicians in primary care were more likely to work with NPs, CNMs, or PAs than physicians in other specialties.
Major specialties in the surgical category include general surgery, orthopedic surgery, urology, ophthalmology, and otolaryngology. The survey data are inflated or weighted to produce unbiased national annual estimates of physician office visits and unbiased annual estimates of physician characteristics, including attributes of their practices. This decreases patient wait time, increases staff efficiency, and gives your practice the opportunity to verify insurance eligibility ahead of time.
An estimated 10% of visits in 2008a€“2009 did not involve a physician, PA, or APN (n = 8,294) and were attended by an RN or licensed practical nurse, mental health provider, or some other provider. Physicians in large and multi-specialty group practices, compared with solo and single-specialty practices, were more likely to work with NPs, CNMs, or PAs. Increasing the supply of these practitioners may, in turn, affect the types of practices that use NPs, CNMs, or PAs. Major specialties in the medical category are cardiovascular diseases, dermatology, psychiatry, and neurology. These visits were excluded from this report because they differed in character from physician, PA, and APN visits.
Older physicians were less likely than younger physicians to be in practices that had NPs, CNMs, or PAs. However, for analytic purposes, some subspecialties of pediatrics and obstetrics and gynecology are reclassified as medical or surgical.
Analysis was based on the sample of 1,592 physicians, after dropping 35 physicians missing information on employment of NPs, CNMs, or PAs. In 2008, 38% of NPs, 58% of nurse midwives (NMs), another type of APN, and 23% of PAs worked in hospital settings (1,3). Physicians in practices with less revenue from Medicare and those with more revenue from Medicaid were more likely to work with NPs, CNMs, or PAs. For a complete description of all specialties and subspecialties included in the specialty type groupings, see the 2009 NAMCS Public-use Data File Documentation [PDF - 1.3 MB].



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