Focusing Efforts on Rural Health through a Workforce Approach
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Focusing Efforts on Rural Health through a Workforce Approach. Raymond Fang Joshua Umar, Ann Davis, Michael Powe American Academy of Physician Assistants. Presentation Outline. Determinants of Americans’ poor health. Physician shortage, high costs, and mal-distribution.

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Focusing efforts on rural health through a workforce approach

Focusing Efforts on Rural Health through a Workforce Approach

  • Raymond Fang

  • Joshua Umar, Ann Davis, Michael Powe

  • American Academy of Physician Assistants


Focusing efforts on rural health through a workforce approach

  • Presentation Outline

  • Determinants of Americans’ poor health

  • Physician shortage, high costs, and mal-distribution

  • Workforce approach as a solution to increase health care accessibility and affordability


Focusing efforts on rural health through a workforce approach

  • Challenges Facing American’s Health


Focusing efforts on rural health through a workforce approach

  • Disparities:

in life expectancy between the US and mainstream high-income nations

(Data source: OECD Health Data 2009)


Focusing efforts on rural health through a workforce approach

Disparities:in life expectancy between rich and poor Americans

(Source: Gopal K. Singh and Mohammad Siahpush (2006), Widening socioeconomic inequalities in US life expectancy, 1980–2000, International Journal of Epidemiology 35(4) PP. 969-979)


Focusing efforts on rural health through a workforce approach

Disparities:in life expectancy between ethnical groups in the US

(US CDC Quick Stats: Life Expectancy at Birth, by Race and Sex --- United States, 2000--2009* Weekly May 13, 2011 / 60(18);588)


Focusing efforts on rural health through a workforce approach

Disparities:in life expectancy across geographic areas in the US

6.7 Years

(Data Source: The data was taken from the American Human Development Project's second national report, Measure of America 2010-2011)


Focusing efforts on rural health through a workforce approach

Disparities:in mortality rates between urban and rural Americans

(Source: Cosby , AG et al (2008) Preliminary Evidence for an Emerging Nonmetropolitan Mortality Penalty in the United States, American Journal of Public Health 98(8) PP. 1470-1472)


Focusing efforts on rural health through a workforce approach

Determinants of Health

Genetic/Demographic Determinants

Physical/Built Environment

Health Outcomes

Social Exclusion

Disease

Social Determinants

Socio-Demographic Interaction

Death

Behavioural Determinants

Healthcare

Determinants


Focusing efforts on rural health through a workforce approach

  • Challenges Facing Healthcare Providers


Focusing efforts on rural health through a workforce approach

Challenges:The American Healthcare SystemandPhysiciansareExpensive

OECD (2006) Purchasing power parities (PPPs) are the rates of currency conversion that eliminate the differences in price levels between countries.

Healthcare expenditure as % of GDP


Focusing efforts on rural health through a workforce approach

Challenges: Physician Shortages

Including Shortage of 46,000 Primary Care Physicians

More shortages in rural and underserved urban areas

(Data source: AAMC Physician Workforce Report 2010)


Focusing efforts on rural health through a workforce approach

Challenges: Workforce Mal-distribution

States are ranked from left (lowest clinician density) to right (highest)

Poverty Rate

(Data source: American Academy of Physician Assistants 2009 census, American College of NP 2010 Report, 2011 State Physician Workforce Data Release, American Association of Medical Colleges, Center for Workforce Studies, March 2011 https://www.aamc.org/download/181238/data/state_databook_update.pdf, the American Human Development Project of the Social Science Research Council )


Focusing efforts on rural health through a workforce approach

  • Study Focus:

  • Exploring the potential roles of physician assistants (PAs) in addressing public health and health equity through strengthening primary care services to rural Americans


Focusing efforts on rural health through a workforce approach

  • Why is Primary Care Important?


Focusing efforts on rural health through a workforce approach

  • Why Is Rural Health Important?

■Rural residents are poorer: Poverty rate is consistently higher in rural areas than in urban areas. In 2010, poverty rates were16.5% and 14.9% in rural and urban areas, respectively.

■Rural residents are sicker: Rural adults are more likely to report having diabetes; Rural residents are more likely to be obese; Rural women are less likely to receive preventive screening tests. Suicide rate is higher in rural men and alcohol abuse is higher in rural youth.

■Health insurance is less sufficient: Rural residents are less likely to be medically insured at the same level of urban residents.

■Rural physicians are fewer and older: More physician shortage especially in primary care in rural areas. There were 55 primary care physicians per 100,000 residents in rural areas in 2005, compared with 72 in urban areas. More rural physicians are close to retirement age.


Focusing efforts on rural health through a workforce approach

Why Physician Assistants?

Physician Assistants (PAs): are clinicians licensed to practice medicine as members of physician-directed teams.

Currently there are about 90,000 practicing PAs in the US.

  • Median Compensation Level in the US in 2010

(Source: *MGMA Physician Compensation and Production Survey: 2011 Report based on 2010 data

** American Academy of Physician Assistants PA Census: 2011 Report Based on 2010 data

*** Primary care includes general internal medicine, family medicine, general pediatrics, and geriatrics)


Focusing efforts on rural health through a workforce approach

PAs and NPs are More Likely to Practice in Rural America

(Percentages of rural healthcare providers by level of rurality in 2010)

Percent (%)

(Data source: AHRQ Primary Care Workforce Facts and Stats No.3, AHRQ Pub. No. 12-P001-4-EF, January 2012)


Focusing efforts on rural health through a workforce approach

Distribution of PAs Practicing in Rural America in 2010

(Percentages of PAs by Level of Rurality with 95% Confidence Intervals)

■U.S. population in rural areas: 20%

■Physicians in rural areas: 11%

Level of Rurality

(Data source: American Academy of Physician Assistants, AAPA 2010 Census; 1.2% of PAs with unknown rurality were excluded)


Focusing efforts on rural health through a workforce approach

  • Study Goals:

  • Workforce solutions to

  • Increase accessibility to care

  • Address physician shortage and mal-distribution

  • Lower health care costs

  • Implement patient-centeredness

  • Strengthen prevention, coordination of care, chronic disease management, consultation, and other primary care interventions


Focusing efforts on rural health through a workforce approach

  • Definitions

  • Primary Care: includes family medicine, general internal medicine, general pediatrics and geriatrics.

  • Urban-Rural Areas: rural and urban designations are taken based on standard U.S. Census classification scheme. Roughly, urban populations≥500,000; large town populations =10,000-50,000; small town populations = 2,500–9,999; and remote village populations ≤2,500 people.


Focusing efforts on rural health through a workforce approach

  • Data and Methods

■Demographic/Certification Data: Demographic characteristics and certification status were from data from AAPA Masterfile

■Clinical Data: Clinical characteristics of PAs were examined with data from the American Academy of Physician Assistants’ (AAPA) 2010 annual census survey.

■Sample Weights: Post-stratification weights were assigned to base survey respondents based on demographic and certification status and to module survey respondents by additional stratification variables number of years as a PA, clinical setting and specialty to ensure the data would be representative of the entire PA population.

■Complex Survey Analysis: Complex survey analytic tool in SPSS was used to provide a stratified survey analysis with 95% confidence interval.


Focusing efforts on rural health through a workforce approach

PAs Perform Clinical Functions That Traditionally Physicians Do (Mean percentages of PAs with specific clinical functions with 95% CIs)

In Physician Offices

In Health Centers

In Hospitals

(Data source: American Academy of Physician Assistants, 2010 PA Census,)


Focusing efforts on rural health through a workforce approach

Level of Autonomy Varies across Clinical Work Settings

(Mean Percentages of Patient Visits Made to PAs without a Need for Physician Consultation with 95% Statistical Confidence Intervals)

Health Centers

Physician Offices

Hospitals

(Data source: American Academy of Physician Assistants, AAPA 2010 Census,)


Focusing efforts on rural health through a workforce approach

Rural PAs are More Likely to Practice in Primary Care

(Percentages of PAs in Primary Care with 95% Statistical Confidence Intervals)

Rural Areas: 55.1% (53.1% - 57.1%)

Urban Areas

(Data source: American Academy of Physician Assistants, AAPA 2010 Census)


Focusing efforts on rural health through a workforce approach

Rural PAs are More Likely to

Practice in Health Centers

(Percentages of PAs Working in Health Centers with 95% Confidence Intervals)

Rural Areas: 27.3% (25.5.% - 29.1%)

Urban Areas

(Data source: American Academy of Physician Assistants, AAPA 2010 Census)


Focusing efforts on rural health through a workforce approach

Rural PAs are More Likely to Perform

Clinical Preventive Services

(Percentages of PAs Performing Clinical Preventive Services with 95% Confidence Intervals)

Rural Areas: 69.8% (66.5% - 73.0%)

Urban Areas

(Data source: American Academy of Physician Assistants, AAPA 2010 Census)


Focusing efforts on rural health through a workforce approach

Rural PAs are More Likely to Perform

Chronic Disease Management

(Percentages of PAs Performing Chronic Disease Management with 95% Confidence Intervals)

Rural Areas: 69.3% (65.9% - 72.7%)

Urban Areas

(Data source: American Academy of Physician Assistants, AAPA 2010 Census)


Focusing efforts on rural health through a workforce approach

Rural PAs are More Likely to Perform

Coordination of Care

(Percentages of PAs Performing Care Coordination with 95% Confidence Intervals)

Rural Areas: 53.7% (50.0% - 57.3%)

Urban Areas

(Data source: American Academy of Physician Assistants, AAPA 2010 Census)


Focusing efforts on rural health through a workforce approach

PAs Practice at Top of License in Rural Areas

(Mean Percentages of Patient Visits Made to PAs without a Need for Physician Consultation with 95% Statistical Confidence Intervals)

Level of Rurality

(Data source: American Academy of Physician Assistants, AAPA 2010 Census; 1.2% of PAs with unknown rurality were excluded)


Focusing efforts on rural health through a workforce approach

Graduates from Rural PA Programs are More Likely to Practice in Rural Areas

(Percentages of PAs practiced in rural areas with 95% Confidence Intervals)

(Data source: American Academy of Physician Assistants, AAPA 2010 Census)


Focusing efforts on rural health through a workforce approach

  • Conclusions

  • PAs are more likely to practice in rural areas

  • PAs who practice in rural areas are more likely to practice in primary care with high autonomy

  • PAs who practice in rural areas are more likely to work in health centers where most underserved patients are seen

  • PAs who practice in rural areas are more likely to perform services in clinical prevention, chronic disease management, and care coordination

  • PAs who graduated from rural PA schools are more likely to work in rural areas

  • Both incentives and policy interventions are needed to engage PAs in practicing in rural areas


Focusing efforts on rural health through a workforce approach

  • Questions? Thank You!

  • Raymond Fang

  • Vice President for Research

  • American Academy of Physician Assistants

  • 2318 Mill Road, Suite 1300

  • Alexandria, Virginia 22314

  • United States of America

  • Email: [email protected]

  • Phone: (571) 319-4327


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