Locums Digest 35: AMA Combats Primary Care Shortage, Doc Burnout; Enterprise Medical Acquired, Health Carousel’s Nurse Ed Push; New Staffing Regs & More

To Defeat Doctor Shortage, Eliminate Obstacles to Primary Care

(Edited from AMA article by Andis Robeznieks, 6/1/2022)

Experts predict that the U.S. will be short between 17,800 and 48,000 primary care physicians by 2034. For many, those numbers may seem too abstract to fathom or the year too far away to ponder given more immediate concerns.

But one small-town doctor knows what those numbers mean to patients, because he’s starting to see it in the worry on their faces and the concern in their voices.

“I’ve been practicing here for 20-plus years and in the past month, I’ve had half a dozen inquiries from people asking: ‘Are you still planning on staying? Are you going to retire? Are you getting to that retirement age?’” said AMA member Noel Deep, MD, a past president of the Wisconsin Medical Society and an internist in Antigo, Wisconsin, a town of about 7,800 people in the northeast corner of the state.

Dr. Deep said that he and his wife, AMA member Lakshmi Deep, MD, are the only two internists in the area. “You can see that worry” in patients’ faces, he said, “They think that, if we are gone, then they won’t find any replacements at all. So that is a worry that plagues us.”

It is not an unreasonable concern for his community, where residents have already felt the impact of the physician shortage in rural America.

“We had one psychiatrist in the area who retired two years ago,” Dr. Deep said. “We have not been able to replace her.”

The nation faces a projected shortage of between 37,800 and 124,000 physicians within 12 years, according to The Complexities of Physician Supply and Demand: Projections From 2019 to 2034 (PDF), a report released by the Association of American Medical Colleges (AAMC).

When paired with the US Census data, the projections become particularly grim, according to another small-town physician and AMA member Sterling Ransone Jr., MD. He practices family medicine in Deltaville, Virginia, a community of about 2,000 residents.

“By 2032, the US population’s going to grow by about 10%, but those of us who are age 65 or older, we’re going to grow by about 47%,” said Dr. Ransone, president of the American Academy of Family Physicians (AAFP) and a member of the AMA Scope of Practice Partnership’s advisory committee.

“By that same year, 2032, probably about one-third of active physicians are going to be over age 65, so our physicians—we’re aging as well,” he added.

Why Primary Care Matters

Primary care’s value to a community was documented in a 2019 JAMA Internal Medicine study showing that “greater primary care physician supply was associated with lower mortality.”

“The largest decreases in cause-specific mortality associated with increased primary care physician density were for cardiovascular disease, cancer and respiratory tract disease, conditions with strong evidence of amenability to primary care management or with delayed mortality conditional on early screening through primary care,” the study says.

Despite these proven benefits, “per capita supply decreased between 2005 and 2015,” wrote the study’s authors.

This incongruity was also noted by researchers at the AAFP’s Robert Graham Center for Policy Studies in Family Medicine and Primary Care in its 2020 publication, The State of Primary Care in the United States: A Chartbook of Facts and Statistics (PDF).

“Despite renewed interest in strengthening primary care in the United States in recent years, there remains an inadequate understanding of what primary care is and does, insufficient investment in its infrastructure and growth, inadequacy in its workforce numbers and distribution, and inefficient coordination with other sectors,” the chartbook says.

The AMA House of Delegates has adopted a 25-point comprehensive policy that identified principles of, and action to, address the nation’s primary care labor force.

“Our patients require a sufficient, well-trained supply of primary care physicians…to meet the nation’s current and projected demand for health care services,” says the policy, which specifies family physicians, general internists and pediatricians, and ob-gyns as primary care doctors.

Other AMA policies supporting primary care include:

Drs. Deep and Ransone [were to] attend the 2022 AMA Annual Meeting in Chicago this month, Dr. Deep with the American College of Physicians’ delegation and Dr. Ransone in the AAFP delegation.

Excited for Primary Care, but Then Loans Come Due

Medical school graduates typically finish school with about $200,000 in medical-student-loan debt, which is often seen as an influential factor in specialty choice. This was detailed in an AMA letter (PDF) to Education Secretary Miguel Cardona, EdD, MS, last September.

“One study indicated that 31% of medical students intended to pursue primary care in their first year of medical school, but due to debt and expected income, decided to switch to a higher-paying specialty by the end of their fourth year,” wrote AMA Executive Vice President and CEO James L. Madara, MD.

According to AMA policy, “the costs of medical education should never be a barrier to the pursuit of a career in medicine nor to the decision to practice in a given specialty.”

The AMA fights to ease young doctors’ financial burdens that contribute to physician shortages in areas underserved by limited access to health care.

This includes supporting the bipartisan “Resident Education Deferred Interest Act” that would allow borrowers to qualify for interest-free deferment on student loans while serving in a medical or dental internship or residency program. Learn about how Congress can save resident physicians $12,000 a year.

“That’s the elephant in the room,” Dr. Deep said, referring to the medical-student-loan debt burdens. “Some programs will provide loan forgiveness if they work in a rural or underserved area, but you’d probably make a lot more in other specialties and be able to pay off that debt sooner.”

For his part, Dr. Ransone worries that the discussion of debt turning young doctors away from primary care could be a self-fulfilling prophecy.

“The debt issue definitely is one that’s out there, but I think that, to a certain extent, it’s overplayed,” Dr. Ransone said. “As a family medicine physician, I’m very well paid for my community. That said, I am paid significantly less than other specialties with similar lengths of training and expertise.

Read about other avenues for ‘shoring up’ primary care–like permanently authorizing the Teaching Health Center Graduate Medical Education (THCGME) program and expanding telehealth–here.

Sharing Primary Care’s Rewards

Dr. Deep said primary care physicians need to show medical students what is possible, and to make sure they understand there are great rewards that go beyond financial implications.

“If you have physicians who are able to portray the happiness in your profession, in your specialty, and if I say, ‘Hey, primary care is rewarding–look at this,’ the students will learn from us,” he said.

When the frustrations of paperwork or insurance company prior authorization becomes too much, Dr. Deep advises physicians to go into their offices, close the door, vent, and then “go back out with a smile on your face.

“As a physician, it is your honor and privilege to take care of vulnerable people in society—some of them at the most vulnerable times in their lives,” he said. “That’s the greatest honor that you can get: serving somebody else.

“People hold your hands, you hold their hands, and you help them through those difficult times in their lives,” Dr. Deep added. “Then they go home, and they tell their families about you. There are lots of times when the families come in and they just want to meet you. The kids come from out of town because Mom or Dad said great things about you. That’s the greatest reward as a primary care physician.”

The Healthcare Staffing Story

Health Carousel Announces Substantial Multi-Year Commitment to Nurse Education

(Edited from Nature World News article by David Thompson,6/3/2022)

Health Carousel, LLC, a NALTO member with a prominent locum tenens division, recently announced a three-year commitment of $200,000 to fund a variety of nurse training and education programs in the United States and abroad. The announcement aligns with the company’s mission to support nurse education and expands on other company initiatives.

“Investing in nursing’s future is a tradition at Health Carousel that we quietly celebrate. Most don’t realize that we have helped hundreds of nurses earn their master of nursing degrees since our founding in 2004.,” Health Carousel Founder and Board Chair Bill DeVille said.

Building on Existing Initiatives

This three-year commitment is just a small part of the work Health Carousel does through its Light the Way initiative, which focuses on the ethical and sustainable recruitment of nurses throughout the world.

Health Carousel’s Light the Way initiative builds on services already provided by the company– specifically its international staffing program PassportUSA. Through this program, Health Carousel offers its clients turnkey recruitment, credentialing, visa sponsorship, relocation, US acclimation coaching, clinical transition assistance, and subject matter expertise through its Quality Improvement Team (QIN).

The $200,000 from Health Carousel’s latest multi-year commitment will be used to build nurse education capacity in the United States and beyond.

Health Carousel Chief Nursing Officer (CNO) Earl Dalton explains, “[Our] investment battles against industry trends that threaten patient care … Namely, experienced nurses in the United States are rapidly leaving the nursing workforce and our patient population is becoming older with much more complex care needs. The result is a widening experience-complexity gap.”

The company’s new initiative attempts to address the current crisis in nursing education: “According to the American Association of Colleges of Nursing, in 2019, US nursing schools turned away more than 80,000 qualified nursing applicants because of an insufficient number of faculty to teach them,” Dalton says.

“Put simply, there aren’t enough veteran nurses to mentor younger ones,” he concludes. “Health Carousel’s investment in nursing training and advanced degrees is an effective way to address this situation.”

For more details about these initiatives, click here.

AMA Pushes Physician ‘Recovery Plan’

(Edited from HealthLeaders Media article by Christopher Cheney, 6/14/2022)

The American Medical Association (AMA) has announced the “AMA Recovery Plan for America’s Physicians” to address pressing challenges facing US doctors, including physician burnout, payers’ prior authorization requirements, and inadequate Medicare payment,

Before the coronavirus pandemic, physician burnout was a national concern, and the pandemic has driven physician burnout to crisis proportions. The Association of American Medical Colleges projects there will be a shortage of physicians between 37,800 and 124,000 clinicians by 2034.

In comments before the AMA House of Delegates, AMA President Gerald Harmon, MD, said the need for action is urgent. “America’s doctors are a precious, and irreplaceable, resource. Physician shortages, already projected to be severe before COVID, have almost become a public health emergency. If we aren’t successful with this Recovery Plan, it’ll be even more challenging to bring talented young people into medicine and fill that expected shortage.”

The AMA Recovery Plan for physicians has five key elements:

  1. Supporting telehealth services including insurance coverage
  2. Reforming the way Medicare pays for physician services
  3. Stopping “scope creep” that expands the scope of practice of non-physicians such as nurse practitioners
  4. Reforming prior authorization of medical services to reduce administrative burden on physician practices and to avoid care delays for patients
  5. Tackling physician burnout and reducing stigma around physician mental health

Read more details about those here.

Read even more extensively about physician burnout in a HealthLeaders interview with Tait Shanafelt, MD, from September 2020.

ARR Healthcare Acquires Enterprise Medical Recruiting

(Edited from PR Newswire release on Yahoo Finance, 5/31/2022)

Enterprise Medical Recruiting, a national physician search and placement firm, announced today they have been acquired by ARR Healthcare (ARRH), Inc., a Dallas-based healthcare staffing corporation that operates a locum tenens company called Alliance Recruiting Resources, Inc. The addition of Enterprise Medical Recruiting will allow ARRH to offer both permanent and temporary physician staffing solutions.

Founded in 1990, Enterprise Medical Recruiting has grown to service multiple physician specialties across the US, through both contingent and retained search. As part of this transition, Executive Vice President Paul Smallwood is being promoted to chief operating officer and will run the day-to-day operations of the business, while Neal Fenster stays on as CEO.

“We are excited to be joining the ARRH team. I believe we have found the perfect partnership that aligns with our values and positions Enterprise for long-term growth,” Enterprise CEO and Founder Neal Fenster said. “Paul’s leadership has been integral to our success, and I look forward to his contributions as we continue to grow.”

ARR Healthcare, Inc., is the parent company of Alliance Recruiting Resources, Inc., which was established in 2001. With offices in both Dallas and Houston, Alliance Recruiting Resources offers locum tenens staffing across multiple physician, CRNA, and NP/PA specialties throughout the United States.

Tools to Try/News to Use

2022 NALTO Fall Fly-In Registration Now Open

(Edited from NALTO NewsBrief, 6/21/2022)

Registration is open for this year’s Fall Fly-In to be held in Denver! Locumpedia will be there. Will your agency? If so, come meet us at our first-ever exhibitor booth.

Learn more & register today!

Also, Save the Date:

National Locum Tenens Week, August 8-12
Marketing Toolkit Available by July 1

All News Is Locums

Kentucky Locum Tenens Internist Admits to Role in $11M Medicare Fraud Scheme

(Edited from MedPage Today article by Frankie Rowland, 6/27/2022)

A Kentucky-based locum tenens internist has agreed to pay $561,800 to resolve allegations that he knowingly violated the False Claims Act (FCA).

According to federal officials, between November 2017 and August 2020, Patrick C. Finney, MD, of Paducah, Ky, conspired and submitted more than $3 million in false claims to Medicare to obtain payment from the health insurance program.

Federal officials claim the submissions began after Finney was contracted by Barton Associates to provide telehealth services to the firm’s clients. Finney referred Medicare patients to be provided with durable medical equipment and genetic testing services when such services were not medically necessary.

Federal authorities allege the false claims were “tainted by kickbacks,” yielding profit for Finney. Officials further allege that Finney did not treat Medicare beneficiaries; had no physician-patient relationship with the beneficiaries, often not speaking with them, and knew the equipment and services he prescribed weren’t medically necessary.

“This provider leveraged his professional status to pursue illegitimate personal profit, undermining both patient trust and the integrity of federal healthcare programs,” said Tamala E. Miles, special agent in charge with the Department of Health and Human Services, Office of Inspector General. (See news release from the US Attorney’s office for the Department of Justice’s Western District of Kentucky for more details.)

By conspiring to defraud Medicare, Finney became liable to the United States for over $11 million under the FCA, which allows damages three times the government’s loss in addition to penalties.

According to the Kentucky Board of Medical Licensure, Finney obtained his license to practice in the state in 1999. That license expires in February 2023.

Socially Speaking

Staffing-Related Snippets

Illinois Governor Signs Healthcare Staffing Regulations into Law

(Edited from SIA Daily News, 6/2/2022)

Illinois Gov. JB Pritzker recently signed into law legislation that will restrict ‘noncompetes’ and conversion fees, while requiring healthcare staffing firms to submit reports to the state on the average charges for nurse staffing, the Illinois Department of Labor (IDOL) reported.

In a May 31 news release, the state said the new law, which takes effect July 1, will:

  • Prohibit nurse staffing agencies from entering into noncompete covenants with nurses and certified nurse aides.
  • Prohibit nurse staffing agencies from requiring the payment of liquidated damages, conversion fees, employment fees, buy-out fees, placement fees, and/or other compensation if a healthcare facility hires the agency’s contractor permanently.
  • Require nurse staffing agencies to disclose new healthcare facility contracts to the IDOL within 5 business days of the effective date (protected from Freedom of Information Act).
  • Pay wage rates that match those identified on the contract. Failure to do so allows the department to recover underpaid wages for the worker.
  • Add quarterly reporting requirements to the IDOL on average charges to healthcare facilities.

US Senator Introduces Bill to Study Healthcare Staffing Business Practices During COVID

(Edited from SIA Daily News, 6/7/2022)

Sen. Kevin Cramer (R-ND) introduced the “Travel Nursing Agency Transparency Act” announced on Monday, June 6.

The legislation would require the Government Accountability Office to conduct a study and report to Congress on the business practices and the effects of [staffing] agencies across the healthcare industry during the COVID-19 pandemic.

“Nurses…provide an essential service to our communities,” Cramer said in a news release. “However, [staffing] agencies are reportedly taking advantage of the demand created by workforce shortages, charging inflated rates and keeping a significant percentage for their own profits. [These practices] could have far-reaching effects on the quality of our health care system in rural America and must be reviewed.”

The bill is supported by the North Dakota Medical Association, North Dakota Hospital Association, and American Hospital Association.

FTC Looks to Restrict Use of Noncompetes

(Edited from Becker’s Hospital Review article by Molly Gamble, 6/9/2022)

The Federal Trade Commission (FTC) is considering a new regulation to tighten employers’ use of noncompete clauses and plans to target their use in individual cases through enforcement, The Wall Street Journal reports.

About 18 percent of all U.S. workers are affected by noncompete agreements, according to data analyzed by researchers cited by WSJ. Noncompete clauses are common practice in healthcare, particularly for executives and employed physicians, though the terms vary. In general, the covenants limit a person’s ability to get a new job with a competitor via restrictions on geography, time, or line of business.

The FTC’s move comes as companies increasingly make use of noncompete clauses in the hiring of hourly workers. President Biden in 2021 urged FTC Chair Lina Khan to exercise the agency’s statutory rulemaking authority to curtail the use of noncompete clauses and other clauses that may unfairly curb worker mobility.

Read the report in full here.

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