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01720610-201409000-0001501720610_2014_27_1_kuilman_commentaries_9miscellaneous< 35_0_10_0 >Journal of the American Academy of Physician Assistants© 2014 American Academy of Physician Assistants.Volume 27(9)September 2014p 1–2Commentaries on health services research[Citations]Kuilman, Luppo MPA; Levy, William PA; Ramos, Christal MPHLuppo Kuilman is coordinator of research and international affairs for the master PA program at Hanze University of Applied Sciences in Groningen, Netherlands. William Levy is a senior lecturer in the MEDEX Northwest program at the University of Washington in Seattle. Christal Ramos is a research associate at Urban Institute's Health Policy Center in Washington, D.C. The authors have disclosed no potential conflicts of interest, financial or otherwise.Richard W. Dehn, MPA, PA-C, DFAAPA, and Roderick S. Hooker, PhD, PA, department editorsPhysician assistants in Dutch healthcareABSTRACT“Physician assistants are trained to perform medical procedures that were traditionally the role of physicians. They were deployed not only to increase efficiency but to ensure the quality of care. What is not known is the primary motive for employing PAs within Dutch healthcare and whether their employment fulfills their perceived need. Supervising medical specialists who used PAs in their practices were interviewed about their primary motives and outcomes using a semi-structured approach. In total, 55 specialists were interviewed about their motives for employing a PA, and 15 were interviewed about the outcomes of employing a PA. The most frequent motive was to increase continuity and quality of care, relieving the specialist's workload, increasing efficiency of care, and substituting for medical residents. In conclusion, the primary motive for employing a PA in Dutch healthcare is to increase continuity and quality of care.”1When PAs were introduced into the Dutch healthcare system, the motive was to mitigate the predicted shortage of medical doctors.2 Overtaken by a changing healthcare landscape, the Netherlands has an abundance of freshly trained medical specialists and a persistent shortage of some specialties, such as geriatric medicine: in some instances filling vacancies is unattainable. The Dutch healthcare system is highly dynamic and is challenged by fluctuations in the demand and (over)supply of medical workforce staffing.3 Nevertheless, the PA workforce has taken root. Since the commencement of PA training, 725 PAs (including four students from the pilot project in 2001) have graduated. Another 278 PA students are enrolled at one of the five master PA programs in the Netherlands. The 2014 clinically active Dutch PA workforce is growing. The van Vught study recapitulates the attitudes leading up to the Dutch PA profession inauguration in 2002 and establishes that medical specialists perceive the necessity of PAs to improve the quality of healthcare overall. Even though this qualitative study is not generalizable to all who are collaborating with (and supervising) PAs, it is a stepping-stone to understanding the motivations of physicians that do embrace them.Commentary by Luppo KuilmanREFERENCES1. van Vught AJ, van den Brink GT, Wobbes T. Implementation of the physician assistant in Dutch health care organizations: primary motives and outcomes. Health Care Manag. 2014;33(2):149–153. [CrossRef] [Full Text] [Medline Link] [Context Link]2. Spenkelink-Schut G, Ten Cate O, Kort HSM. Training the physician assistant in the Netherlands. J Physician Assist Educ. 2008;19(4):46–53. [Context Link]3. Van Greuningen M, Batenburg RS, Van der Velden LF. The accuracy of general practitioner workforce projections. Hum Resour Health. 2013;11(1):31. [Context Link]Oncologist scarcitiesABSTRACT“The Lewin Group assessed the market impact of health reform on capacity and demand for chemotherapy and radiation therapy and projected through 2025. The Medical Expenditure Panel Survey, commercial claims, and Medicare claims determine patterns of use by patient characteristics such as age, sex, health insurance coverage, cancer site, physician specialty, and service type. Patterns of use projected the prevalence of cancer, using data from the National Cancer Institute. Beginning in 2012, 16,347 oncologists and radiation oncologists accounted for 15,190 FTEs [full-time equivalents] of patient care. An expanded insured population under the ACA [Affordable Care Act] could increase the demand for oncologists and radiation oncologists by 500,000 visits per year, increasing the shortage to 2,393 FTEs in 2025. Unless oncologist productivity can be enhanced, the anticipated shortage will strain the ability to provide quality cancer care.”1The authors have demonstrated through a workforce model that a shortage of oncologists and radiation oncologists over the next 10 years is unavoidable, with shortages ranging from 10% to 20%. Traditional fellowship programs are unlikely to grow and scarcities are inevitable. The authors note that PAs and NPs play a role in the care of cancer patients but were unable to quantify it because merged billing data hide the PA and NP contribution. More oncologic specific training along with improved use of PAs and NPs may be the optimal strategy to increase supply. This PA and NP strategy has been noted in a number of analyses, but the authors' failure to more fully integrate this important labor calculation into their workforce model compromises their analysis as well as their ability to offer potential remedies.2,3Commentary by William LevyREFERENCES1. Yang W, Williams JH, Hogan PF, et al. Projected supply of and demand for oncologists and radiation oncologists through 2025: an aging, better-insured population will result in shortage. J Oncol Pract. 2014;10(1):39–45. [Medline Link] [Context Link]2. Polansky M, Ross AC, Coniglio D. Physician assistant perspective on the ASCO workforce study regarding the use of physician assistants and nurse practitioners. J Oncol Pract. 2010;6(1):31–33. [Medline Link] [Context Link]3. Kinney AY, Hawkins R, Hudmon KS. A descriptive study of the role of the oncology nurse practitioner. Oncol Nurs Forum. 1997;24(5):811–820. [Medline Link] [Context Link]Regulating advanced practitioners: Restraint of trade?ABSTRACT“This Federal Trade Commission policy paper notes the potential benefits of improved competition in the provision of primary healthcare services, citing research that advanced practice nurses (APRNs) provide safe and effective care within the scope of their training, certification, and licensure. In addition, health policy experts have warned of significant shortages of primary care practitioners across the United States, and have suggested that APRNs might help to alleviate healthcare access problems if undue regulatory burdens were reduced. Moreover, effective collaboration among healthcare providers, including team-based care, does not always require physician supervision of APRNs. The policy paper sets forth recommended principles for evaluating APRN scope of practice proposals and concludes that expanded APRN scope of practice is good for competition and American consumers.”1The FTC suggests that the primary motivation for regulating APRN scope of practice is to protect patient health and safety, but argues that limiting competition works against this goal. Using a rather idealized competitive model, they describe regulation as a tool to correct market failure. However, masked by a concern for healthcare quality, the goal of these regulations may in many cases actually be intended to limit competition against physicians. Although the paper encourages legislators to consider the value of competition when considering APRN scope of practice, it is likely that physicians lobby to do just the opposite. If limiting competition is an underlying agenda, another argument is then needed to promote expanded APRN scope of practice for the benefit of consumers. Although regulation may not be the most effective way to promote collaboration, the competitive market has not exactly been successful, either. Continuing the language of “competition” among health professionals may in itself undermine collaboration and be detrimental to healthcare quality. Finally, although deregulation of APRNs could open the door for similar action regarding PA scope of practice, emphasis on competition may encourage APRNs to continue seeking to differentiate themselves in order to limit competition against their profession, as physicians have done.Commentary by Christal RamosREFERENCE1. Gilman DJ, Koslov TI, Feinstein DL, et al. Policy perspectives: competition and the regulation of advanced practice nurses. Federal Trade Commission, March 2014. www.ftc.gov/policy/reports/policy-reports/commission-and-staff-reports . Accessed July 1, 2014. [Context Link]ovid.com:/bib/ovftdb/01720610-201409000-0001500055781_2014_33_149_vught_implementation_|01720610-201409000-00015#xpointer(id(R1-15))|11065213||ovftdb|00126450-201404000-00009SL0005578120143314911065213P16[CrossRef]10.1097%2F01.HCM.0000440621.39514.9fovid.com:/bib/ovftdb/01720610-201409000-0001500055781_2014_33_149_vught_implementation_|01720610-201409000-00015#xpointer(id(R1-15))|11065404||ovftdb|00126450-201404000-00009SL0005578120143314911065404P16[Full Text]00126450-201404000-00009ovid.com:/bib/ovftdb/01720610-201409000-0001500055781_2014_33_149_vught_implementation_|01720610-201409000-00015#xpointer(id(R1-15))|11065405||ovftdb|00126450-201404000-00009SL0005578120143314911065405P16[Medline Link]24776833ovid.com:/bib/ovftdb/01720610-201409000-0001501437116_2014_10_39_yang_oncologists_|01720610-201409000-00015#xpointer(id(R4-15))|11065405||ovftdb|SL014371162014103911065405P25[Medline Link]24443733ovid.com:/bib/ovftdb/01720610-201409000-0001501437116_2010_6_31_polansky_practitioners_|01720610-201409000-00015#xpointer(id(R5-15))|11065405||ovftdb|SL01437116201063111065405P26[Medline Link]20539729ovid.com:/bib/ovftdb/01720610-201409000-0001500006549_1997_24_811_kinney_practitioner_|01720610-201409000-00015#xpointer(id(R6-15))|11065405||ovftdb|SL0000654919972481111065405P27[Medline Link]9201735Commentaries on health services researchKuilman, Luppo MPA; Levy, William PA; Ramos, Christal MPHCitations927
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