Health care goes to school

September 30, 2011
by Beth Leibson, NA
This report originally appeared in the September 2011 issue of DOTmed Business News

To meet growing needs in health care, colleges and universities are working hard to boost their number of graduates. On a national level, we’re producing more nurses and general practitioners, while the graduation rates of radiation technologists are remaining steady.

Nursing us back to health
The United States has been experiencing a nursing shortage since 1998. And with a growing population of older Americans, the trend continues with no end in sight. For instance, Wanted Analytics, a business intelligence firm, found that employers and staffing agencies posted more than 121,000 new job ads for registered nurses in May 2011, up 46 percent from a year earlier. The U.S. Department of Labor estimates that the country will need an additional 1.2 million nurses by 2014.

Fortunately, graduation numbers are up. According to the American Association of Colleges of Nursing (AACN), graduation from entry-level baccalaureate programs has risen 30.2 percent between 2005 and 2010; graduation of RN baccalaureate programs has increased by 63.3 percent; master’s graduates are up 55.3 percent and research-focused doctoral program graduates have risen 22 percent over the past five years. Interestingly, private sector colleges and universities account for 11 percent of all nursing graduates, according to the Association for Private Sector College and Universities.

It is noteworthy that colleges and universities have boosted their numbers of graduates in the face of a number of challenges. According to the Robert Wood Johnson Foundation, which with the AACN provides funding for nursing scholarships, the main barriers to expanding admission to BSN-RN programs are: budgetary constraints (cited by 32.3 percent of schools); lack of classroom space (47.5 percent), lack of clinical preceptors (31 percent), lack of clinical sites (60.8 percent), and lack of faculty (61.4 percent).

Radiological technologists go nuclear
Tracking graduation rates for radiological technologists is a little more complicated than keeping track of nurses because educational programs for these health care professionals – including radiography, radiation therapy and nuclear medicine technology – are spread across various academic venues.

About 40 percent of the programs are located in community colleges or two-year institutions; 25 percent are in medical centers; 22 percent are in university or four-year institutions; 9 percent are in technical colleges; and 4 percent are in for-profit schools, according to the American Society for Radiological Technologists (ASRT).

According to the ASRT, 2010 saw approximately 15,948 students entering radiography programs, 1,462 starting radiation therapy programs and 1,534 students in nuclear medicine technology. Enrollment fell from 2009, dropping from 4.8 percent in radiography to 2.9 percent in radiation therapy programs. Nuclear medicine technology training is the outlier here; there, enrollment increased 5.3 percent between 2009 and 2010.

In general, attrition rates in these programs are low, the ASRT said; radiography had the highest attrition rate, with a mean of 23.3 percent, compared to 18.3 percent for radiation therapy and 12.9 percent for nuclear medicine technology.

Is there a doctor in the house?

Physicians are becoming a scarce commodity around the country. The U.S. Bureau of Labor Statistics anticipates a 24 percent increase in demand for physician services by 2014. The Association of American Medical Colleges (AAMC) Center for Workforce Studies predicts a shortage of about 63,000 doctors by 2015. This shortage, notes AAMC, will continue to rise, hitting 91,500 by 2020 and 130,600 by 2025.

Back in 2006, the AAMC anticipated this growing need and recommended that its member schools orchestrate a 30 percent increase in medical school enrollment by 2015.

Across the country, medical schools have boosted enrollment by 13.2 percent since 2002 and foresee a 27.6 percent increase by 2015 to an estimated 21,041 students, notes the AAMC. Seven new medical schools are in the pipeline, says the AAMC, which should help. But it might take until 2017 to reach that 30 percent increase in med school grads, according to the AAMC.

Of course, these statistics encompass all manner of physicians, whereas the shortage is most acute for general practitioners. But many students see greater financial rewards by becoming specialists: for instance, dermatologists earn more than twice as much as general practitioners, as an aggregate, according to the Medical Group Management Association 2011 physician compensation survey.

As a result, medical schools are trying to encourage students to become general practitioners. An AAMC survey indicates that three-quarters of respondents are instituting programs and policies to encourage interest in primary care.
Duke University Medical School, for example, has instituted a Primary Care Leadership Track that offers students a $10,000 scholarship in return for a commitment to general practice. The four-year curriculum requires coursework and on-the-ground experiences in epidemiology and leadership training, community engagement and the patient-centered medical home.

More specifically, 87 percent reported adding new or expanded extracurricular opportunities, 74 percent reported increased or expanded clinical rotations, 73 percent modified the required clinical rotations, 71 percent reported modified pre-clinical curriculum, 67 percent have redefined their admissions criteria and 60 percent have expanded their primary care faculty or resources.

Another boost to med school grads is taking place among osteopaths. Osteopathic physicians (D.O.s), like M.D.s, undertake four years of basic medical education followed by at least three years of internships, residencies, and fellowships. D.O.s use conventional methods of diagnosis and treatment, though they may place a greater emphasis on holistic methods. The American Association of Colleges of Osteopathic Medicine anticipates 5,020 graduating D.O.s in 2016, compared with 3,100 in 2007.

The challenge here is that graduation from medical school does not a physician make. Med school grads aren’t card-carrying physicians until they complete at least three years of residency programs. And the number of these federally funded programs, says the AAMC, has been frozen since 1997. So this means, while there may be more medical school graduates now and likely for the foreseeable future, that doesn’t automatically translate into more physicians hanging out their shingles.

Diversity concerns
Another concern among health professionals is the fact that there is still relatively little racial diversity among practitioners. The Association of American Medical Colleges notes that having a diverse group of health care providers improves access to and quality of care for racial and ethnic minority patients as well as enhancing patient satisfaction and choice, and improving the educational experience for medical students.

But we’ve got a ways to go on this front.

A University of California-San Francisco study found that in 2008, racial/ethnic minorities comprise about 37 percent of the 16,167 graduates from 130 medical schools, with some groups having made greater and more consistent gains than others. And the U.S. Department of Education found that minority nurses represent about 8.3 percent of all nurses.

While the overall graduation percentage is on par with the U.S. population, which is 16.3 percent Latino, 12.6 percent African American, 4.8 percent Asian, and 63.7 percent white, according to the most recent U.S. census, minority roles in nursing hold well below the respective population percentage.

The Robert Wood Johnson nursing scholarships will address this concern. Another, possibly inadvertent approach to remedying this situation is the influx of internationally trained physicians, who represent as much as a quarter of hospital house staff, according to Time magazine. These folks hail mostly from India, the Philippines and Mexico.

We are making strides both on numbers and diversity of our medical professional graduates. But the road ahead is long, too.