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IN THE ABSTRACT

GRADUATE MEDICAL EDUCATION

STUDY AND RESULTS: The Council on Graduate Medical Education's (COGME) 15th report assesses the current funding mechanisms for graduate medical education (GME). Increased competitiveness in health care markets was found to have placed educational institutions at a disadvantage, rendering the current funding systems inadequate. In addition, the report encourages the Residency Review Committee (RRC) to place minimum standards on ambulatory-based training. To increase incentives for expanding training in community-based sites, the COGME report recommends that a new, stable system be implemented that combines private and federal contributions.

WHAT'S IMPORTANT: Concerns about the solvency of the Medicare trust fund, the effects of continued Medicare spending cuts, and the weak linkage between Medicare GME funding and physician workforce goals have led to the advocacy of alternative methods for GME funding. The COGME report also highlights a conflict between beneficial residency instruction - found in the ambulatory setting because it is more similar to the eventual practice conditions of the residents -and its cost inefficiency. The report contrasts current funding with proposed alternative models.

FIND THIS STUDY: Financing Graduate Medical Education in a Changing Health Care Environment, published in December 2000 by the Council on Graduate Medical Education and the U.S. Department of Health and Human Services. For more information, contact Stan Bastacky at (301) 443-6326.

STUDY AND RESULTS: A new report by the American Osteopathic Association outlines several problems with the current public funding mechanisms for graduate medical education (GME). The report highlights the fact that the Balanced Budget Act of 1997 seriously reduced federal funding for GME. The report emphasizes four methods of state GME funding: Medicaid reimbursement, line-item appropriations, appropriations for each resident and an all-payer system. The report advocates in favor of an all-payor system for GME and uses New York state as an example of a successful all-payer system.

WHAT'S IMPORTANT: This proposal effectively raises some serious questions about the viability of the future of GME funding. The report philosophically establishes GME as a "public good" that should be funded by all payers-including private health insurers-and offers multiple reasons for the establishment of an all-payer system.

FIND THIS STUDY: Physician Education Advancing Community Health (PEACH): State Funding of Graduate Medical Education was published by the AOA Division of State Government Affairs in November 2000. For more information contact Kimberly Horvath at the American Osteopathic Association, (312) 335-1065.

STUDY AND RESULTS: This policy primer examines the change in the health workforce environment and its current funding system. The report illustrates that a changing health care market, increased participation from minority groups and international students, and increased supply of non-physician practitioners have significantly influenced the labor supply in the health care workforce. This increase in supply has been met by a decrease in funding for GME. The report outlines the roles of the federal government and the states in supporting GME and predicts impending problems.

WHAT'S IMPORTANT: The report elucidates that the financial instability of Medicare-which contributes approximately $7 billion dollars to GME-and its inadequate funding of ambulatory-based training, require a restructuring of federal aid to GME. The report recommends amendments to public sector funding through the implementation of effective mechanisms for holding recipients more accountable for producing public "goods," distribution of data on regional and national funding levels, and increased payments to ambulatory-based training. The report also recommends the use of an all-payer system to help fund GME.

FIND THIS STUDY: Graduate Medical Education and Public Policy: A Primer, authored by Tim Henderson of the National Conference of State Legislatures in December 2000, can be ordered by contacting Marilyn Biviano, Bureau of Health Professions in the Health Resources and Services Administration, (301) 443-9792.

NURSING

STUDY AND RESULTS: Research allowed demographic and statistical analysis of the increase in the average age of registered nurses. The study by Peter Buerhaus attempted to assess the key sources of changes in age distribution and total supply of the workforce up to 2020. Buerhaus found that a steady increase in the average age of registered nurses will continue until 2020, when more than 40 percent of the registered nurses will be over age 50, a result of the baby-boom generation. The number of registered nurses per capita will begin to decline by 2007, resulting in nearly 20 percent decline in the registered nurse population by 2020.

WHAT'S IMPORTANT: Because a rising number of career opportunities are becoming available to women, society must increase the incentives to enter the nursing profession. The study forecasts that this increase is unlikely to occur and, consequently, labor costs will rise with the decline of labor supply. The article recommends that registered nurses be recruited from overseas as the most feasible strategy to combat this labor supply crisis.

FIND THIS STUDY: "Implications of an Aging Registered Nurse Workforce" can be found in the Journal of the American Medical Association 283, no. 22.

STUDY AND RESULTS: Peter Buerhaus conducted another study on the policy responses to the aging registered nurse workforce. This study complements Implications of an Aging Registered Nurse Workforce. Buerhaus reports that the number of women registered nurses has fallen by 35 percent since the 1970s. In addition, the overall number of registered nurses has decreased by 5 percent each year since 1995. The study forecasts that there will be a shortage of an estimated 400,000 registered nurses by 2020.

WHAT'S IMPORTANT: The study emphasizes the need to take measures to avert under supply of registered nurses. Buerhaus recommends that society prepare for an aging registered nurse workforce. Society must also develop ways to maximize the performance of the existing nurses by enhancing the role of technology and unlicensed personnel. Moreover, the lack of interest in nursing programs must be compensated for by changing the curriculum to better suit realistic learning needs.

FIND THIS STUDY: Policy Responses to an Aging Registered Nurse Workforce authored by Peter Buerhaus, can be found in Nursing Economics 18, no. 6 (December 2000).

STUDY AND RESULTS: The survey provides information about the educational background, employment status, geographic distribution and demographic characteristics of registered nurses as of March 2000. Of the 2,696,540 nurses in the United States, 12.3 percent were from a minority background. Their average age was 45.2, and 7.3 percent were advanced practice nurses. Most of the registered nurse workforce (about 60 percent) worked in a hospital setting.

WHAT'S IMPORTANT: The report can help develop a recruitment program for future registered nurses because society now can target specific demographic groups. The report also will facilitate examination of problems related to the appeal of the nursing profession.

FIND THIS STUDY: The National Sample Survey of Registered Nurses 2000 was published in January 2001 by the Bureau of Health Professions. For more information contact the Division of Nursing in the Bureau of Health Professions of the Health Resources and Services Administration, 5600 Fishers Lane, Rockville MD 20857 or call (301) 443-5688.

THE HEALTH WORKFORCE

STUDY AND RESULTS: This research was funded by the U.S. Department of Health and Human Services to determine if a shortage of licensed pharmacists exists in the country. The study found that a huge increase in prescription drug orders, market growth and competition, and insurance coverage for prescription medication have increased the demand for pharmacists, while declining application rates to schools of pharmacy and longer periods of training have decreased their supply. The amount of retail prescriptions per year rose 44 percent between 1992 and 1999. The expanding role of community pharmacists-in terms of counseling patients, participating in disease management programs and assuring safe dispensing of medications-has exacerbated this labor shortage.

WHAT'S IMPORTANT: The study found that the pharmacist's role in public health care is expanding. The effects of the shortage upon medication errors and quality of patient care were detrimental to public health. The study predicted a need to expand enrollment in schools and colleges of pharmacy, implement a uniform prescription benefit card, increase use of state reciprocity and foreign-trained graduates, and increase the role of pharmacy technicians and automation.

FIND THIS STUDY: The Pharmacist Workforce: A Study of the Supply and Demand for Pharmacists was published by the Department of Health and Human Services in December 2000. For more information contact Marilyn Biviano, Bureau of Health Professions, Health Resources and Services Administration at (301) 443-9792.

STUDY AND RESULTS: This research documents and organizes the first-ever state profiles of the number of physicians, nurses, dentists, and other health care professionals from 26 disciplines. Researchers compiled 51 such profiles, one for each state and the District of Columbia, to provide detailed information about education, employment and demographic data in order to determine each state's future health workforce needs. The profiles are accompanied by the HRSA State Health Workforce Data Resource Guide.

WHAT'S IMPORTANT: The HRSA profiles are intended to aid in overcoming barriers facing millions of Americans' access to quality health care. The report highlights several key roles the states play in relation to health care (namely, they license and credential professionals, fund education, regulate private insurers and legislate reimbursement policies). The data resource guide describes various methodologies for analyzing and interpreting workforce data and presents approaches to data collection.

FIND THIS STUDY: The HRSA State Health Workforce Profiles, published by the HRSA in December 2000 is available in hard copy or on CD-ROM, from the HRSA Information Center at 1-888-ASK-HRSA and from the HRSA web site at http://bhpr.hrsa.gov/healthworkforce/profiles

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