Rethinking the shortage of primary care physicians.

For decades, public concerns about a shortage of physicians led federal and state policy makers to pursue policies to increase the number of medical graduates. In response, the number of medical schools increased dramatically over the past decade. By 2016, the United States produced more new physicians than ever before. Expanding medical school enrollments, however, were not matched by a corresponding increase in the number of physicians choosing primary care. To date, few policy makers questioned the conventional wisdom that more is better when it comes to the supply of primary care physicians. Instead, policy makers should consider alternative approaches to increase access to patient-centered primary care.

Taking the Pulse of the Nursing Home Industry in Rhode Island.

INTRODUCTION: Nursing home facilities in Rhode Island face unprecedented challenges today. Most facilities find themselves in a difficult financial position with thin - or negative - operating margins. In addition, Rhode Island enacted new minimum staffing regulations for nursing homes in 2021. Facilities that fail to meet the new staffing requirements would incur significant financial penalties. The persistent shortage of direct care staff, however, limits administrators' ability to hire the workers needed to meet the required staffing levels. METHODS: We conducted an online survey of nursing home administrators at all of the licensed nursing facilities in Rhode Island over 30 days from September to October 2023. We received responses from 53 out of 77 nursing home administrators, for an overall response rate of 69%. RESULTS: A majority of respondents reported numerous vacancies for clinical staff at their facilities. Most administrators felt that it was difficult to hire new staff, despite a variety of financial incentives to recruit workers. As a result, nursing homes were unable to comply with Rhode Island's new minimum staffing requirements. CONCLUSION: Nursing homes in Rhode Island continue to experience a chronic staffing shortage. Furthermore, since a majority of nursing homes in Rhode Island have a negative operating margin, enforcing the state's minimum staffing requirements would impose significant financial hardship on the state's nursing facilities.