Thomas Robert Konrad

Purpose: Physician turnover within Health Professional Shortage Areas (HPSAs), as in all settings, frequently occurs when physicians are dissatisfied with aspects of their work and employment. This study evaluates how physicians’ assessments of 6 aspects of their work and jobs relate to whether they anticipate remaining in their urban and rural HPSA practices for more than 2 years, and assesses differences for physicians in urban and rural HPSAs. Methods: Survey data on physicians’ assessments of 6 facets of their work and jobs were obtained from 747 physicians working in urban HPSAs and 355 in rural HPSAs across 33 states (54.9% response rate). Separate hierarchical logistic regression models identified work and job factors independently associated with anticipated retention beyond 2 years for each group. Z ‐tests assessed differences between the urban and rural models in odds ratios for each work and job factor. Findings: Anticipated retention was more likely in both urban and rural HPSAs when physicians felt they had good administration, they felt connected and supported at work, and work felt meaningful, and likely also if they provided their desired range of services, but in neither setting if they felt adequately compensated or not. Anticipated retention in rural but not urban HPSAs was more likely when physicians had a good work‐life balance. Conclusions: Physicians’ anticipated retention within HPSAs is associated with how they feel about various aspects of their work and jobs. These aspects of work and jobs are generally but not exactly the same in urban and rural HPSAs.

Primary care practices lack the time, expertise, and resources to perform traditional comprehensive geriatric assessment. In particular, they need methods to improve their capacity to identify and care for older adults with complex care needs, such as cognitive impairment. As the US population ages, discovering strategies to address these complex care needs within primary care are urgently needed. This article describes the development of an innovative, team-based model to improve the diagnosis and care of older adults with cognitive impairment in primary care practices. This model was developed through a mentoring process from a team with expertise in geriatrics and quality improvement. Refinement of the existing assessment process performed during routine care allowed patients with cognitive impairment to be identified. The practice team then used a collaborative workflow to connect patients with appropriate community resources. Utilization of these processes led to reduced referrals to the geriatrics specialty clinic, fewer patients presenting in a crisis to the social worker, and greater collaboration and self-efficacy for care of those with cognitive impairment within the practice. Although the model was initially developed to address cognitive impairment, the impact has been applied more broadly to improve the care of older adults with multimorbidity.

Sleeplessness is an ancient and cross‐cultural phenomenon that is socially structured and restructured against a backdrop of ideology and inequality. In an effort to make sense of sleeplessness, some scholars have invoked the medicalization framework, which highlights consumerism, managed care, biotechnology, and physicians as key “engines” that foster the transformation of this formerly “normal” condition to one that people view as a medical problem. However, this burgeoning literature has not answered the call of medical sociologists to situate the medicalization process in a political economic context. In this article, we employ the case study of sleeplessness and the creation of the “Sleep Industrial Complex” to expand the medicalization framework and illustrate how American neoliberalism creates an ideal environment for the primary engines of medicalization. We identify three critical features of American neoliberalism—enhancement culture, commodification of health, and a “productivity imperative”—that act in concert with the driving engines to foster an environment wherein medicalization not only survives but also thrives.

This paper outlines the way in which various concepts measuring doctor reactions to their jobs and careers (e.g., satisfaction, burnout, etc.) have been developed. The variety of measures, methods, and models reflect differing disciplinary and theoretical approaches and research traditions. In order to identify productive ways to advance the field, this paper presents a proposal for how multi-disciplinary, cross-national comparative research might be conducted to resolve some of the issues linking medical care organization, physicians' experiences, and patient outcomes. In seeking buy-in from stakeholders, researchers need to be cognizant that various ideologies and agendas shape the nature of the concerns that these interest groups (e.g., professional associations, clinical managers, payers, patient advocates, etc.) have about physician satisfaction, its precursors, and its consequences.Keywords: Physician satisfaction, burnout, measurement, methodology, medical autonomy

Objectives: This study describes the experiences of physician assistants (PAs) and nurse practitioners (NPs) in the National Health Service Corps' (NHSC) loan repayment program in 2010. Methods: In 2011, a stratified random sample of NHSC clinicians was surveyed. Data from the 148 PA and 137 NP respondents were analyzed (52.4% response rate). Results: PAs were younger than NPs (mean age 31 versus 35 years), less often female (68% versus 91%), and more often carried educational debt over $100,000 (56% versus 24%). Both groups were serving in states familiar to them and within communities where they felt accepted. The groups were generally satisfied on most measures of work, with PAs more satisfied than NPs on some measures. Conclusion: The NHSC's PAs and NPs are well matched to communities and satisfied with their work. Maximizing their NHSC experiences and retention requires recognizing their differences in demographics, debt, and areas of job satisfaction.

AIMThe aim of the study was to assess how state-based support-for-service (SFS) programs are used by deans and directors of nursing programs and to evaluate their perceived impact.BACKGROUNDGiven projected nurse faculty shortages, stakeholders are looking for ways to address the maldistribut

Effective management of care transitions for older adults require the coordinated expertise of an interprofessional team. Unfortunately, different health care professions are rarely educated together or trained in teamwork skills. To address this issue, a team of professionally diverse faculty from the Duke University Geriatric Education Center designed an interprofessional course focused on improving transitions of care for older adults. This innovative prelicensure course provided interactive teaching sessions designed to promote critical thinking and foster effective communication among health care professionals, caregivers, and patients. Students were assessed by in-class and online participation, performance on individual assignments, and team-based proposals to improve care transitions for older patients with congestive heart failure. Twenty students representing six professions completed the course; 18 completed all self-efficacy and course evaluation surveys. Students rated their self-efficacy in several domains before and after the course and reported gains in teamwork skills (p < .001), transitions of care (p < .001), quality improvement (p < .001) and cultural competence (p < .001). Learner feedback emphasized the importance of enthusiastic and well-prepared faculty, interactive learning experiences, and engagement in relevant work. This course offers a promising approach to shifting the paradigm of health professions education to empower graduates to promote quality improvement through team-based care.

Repayment of loans for health care education is a popular incentive among states to attract clinicians to underserved areas. As of 1996, 37 states offered loan repayment programs for primary care clinicians, co-sponsored loan repayment programs with the State Loan Repayment Program of the National Health Service Corps (NHSC), or offered both programs.¹ Seven states also offered direct financial incentive programs, which are like loan repayment programs but allow clinicians flexibility in using program funds. In this study, we identified all state loan repayment and direct financial incentive programs for health professionals of all types as of 2010, described changes in program numbers from 2007 to 2010 during the first years of the worldwide recession with tight state budgets, and characterized the disciplines and size of the collective workforce by state.

To understand how caring for grandchildren affects the physical and mental health of grandparents in Taiwan. Grandparents aged 50 and older from 4 waves of the Taiwan Longitudinal Study on Aging (1993–2003, n = 3,711) were divided into 7 categories based on living arrangement and caregiving history. Generalized estimation equations controlling for sociodemographic characteristics and disease status were used to estimate the relationship between caregiving and 4 outcomes: self-rated physical health, mobility limitation, life satisfaction, and depressive symptoms. Compared with noncaregivers, long-term multigenerational caregivers were more likely to report better self-rated health, higher life satisfaction, and fewer depressive symptoms. We found some evidence of reduced mobility limitations for both skipped-generation and nonresidential caregivers relative to noncaregivers. The associations in self-rated health and depressive symptoms were more pronounced in long-term caregivers than among those who recently started caregiving. Improvements in self-rated health and mobility associated with caregiving support our hypothesis that caring for grandchildren can be beneficial for grandparents in Taiwan, especially for long-term multigenerational caregivers. Comparing Taiwanese grandparents across different types of caregiving shows that the associations of grandparent caregiving with health vary by living arrangement and duration. However, these findings may not be causal because caregiving and health outcomes were observed simultaneously in our data.