A Policy Analysis of Legally Required Supervision of Nurse Practitioners and Other Health Professionals.

The use of legally required supervision occurs across health professionals who provide similar services. Legally required supervision has the potential to disrupt the production of high-quality, cost-efficient, accessible health services across disciplines. This paper examines the effects of nurse practitioner collaborative practice agreements and similar models of health professional regulation, defined as legally required supervision, on the cost and delivery of health services. A policy analysis examines empirical, policy, and law literature between two health professionals providing a similar service. Analysis includes literature on dental hygienists, dentists, certified registered nurse anesthetists, midwives, nurse practitioners, physicians, and pharmacists. A framework for legally required supervision across health professionals is presented. Antecedents of legally required supervision include occupational licensure, reimbursement policy, and institutional policy. Legally required supervision inhibits provider entry to practice and the production of health services by supervised providers. The cost of care increases under legally required supervision. Costs are measured by wages for providers and the price of services for patients. This paper and proposed framework summarize the antecedents and consequences of legally required supervision. Discipline-specific antecedents and provider characteristics must be considered when calculating the full effect of legally required supervision on the delivery and cost of health services.

Minority Faculty Development Programs and Underrepresented Minority Faculty Representation at US Medical Schools.

IMPORTANCE: Diversity initiatives have increased at US medical schools to address underrepresentation of minority faculty. OBJECTIVE: To assess associations between minority faculty development programs at US medical schools and underrepresented minority faculty representation, recruitment, and promotion. DESIGN: Secondary analysis of the Association of American Medical Colleges Faculty Roster, a database of US medical school faculty. PARTICIPANTS: Full-time faculty at schools located in the 50 US states or District of Columbia and reporting data from 2000-2010. EXPOSURE: Availability of school-wide programs targeted to underrepresented minority faculty in 2010. MAIN OUTCOMES AND MEASURES: Percentage of underrepresented minority faculty, defined as self-reported black, Hispanic, Native American, Alaskan Native, Native Hawaiian, or Pacific Islander faculty. Percentage of underrepresented minority faculty was computed by school and year for all faculty, newly appointed faculty, and newly promoted faculty. Panel-level analyses that accounted for faculty clustering within schools were conducted and adjusted for faculty- and school-level variables. RESULTS: Across all schools, the percentage of underrepresented minority faculty increased from 6.8% (95% CI, 6.7%-7.0%) in 2000 to 8.0% (95% CI, 7.8%-8.2%) in 2010. Of 124 eligible schools, 36 (29%) were identified with a minority faculty development program in 2010. Minority faculty development programs were heterogeneous in composition, number of components, and duration. Schools with minority faculty development programs had a similar increase in percentage of underrepresented minority faculty as schools without minority faculty development programs (6.5%-7.4% vs 7.0%-8.3%; odds ratio [OR], 0.91 [95% CI, 0.72-1.13]). After adjustment for faculty and school characteristics, minority faculty development programs were not associated with greater representation of minority faculty (adjusted OR, 0.99 [95% CI, 0.81-1.22]), recruitment (adjusted OR, 0.97 [95% CI, 0.83-1.15]), or promotion (adjusted OR, 1.08 [95% CI, 0.91-1.30]). In subgroup analyses, schools with programs of greater intensity (present for ≥5 years and with more components) were associated with greater increases in underrepresented minority representation than schools with minority faculty development programs of less intensity. CONCLUSIONS AND RELEVANCE: The percentage of underrepresented minority faculty increased modestly from 2000 to 2010 at US medical schools. The presence of a minority faculty development program targeted to underrepresented minority faculty was not associated with greater underrepresented minority faculty representation, recruitment, or promotion. Minority faculty development programs that were of greater intensity were associated with greater increases in underrepresented minority faculty representation.

Supportive Practice Environments Are Associated With Higher Quality Ratings Among Nurse Practitioners Working in Underserved Areas.

Background: Deployment of nurse practitioners (NPs) to health professional shortage areas (HPSA) may help to address challenges in patient access to care. However, restrictive scope of practice imposed by regulatory and state legislative bodies or unsupportive organizational climates in clinical practice settings may constrain NP care delivery and perpetuate lower assessments of quality of care provided in these underserved communities. Purpose: The purpose of this study was to investigate the associations between state NP scope of practice regulations, NP practice environment, and self-reported ratings of quality of care in primary care practices located in HPSAs. Methods: This was a cross-sectional analysis of data from 1,972 participant NPs practicing across 1,711 primary care practices in six states representing full (Arizona and Washington), reduced (Pennsylvania and New Jersey), and restricted (California and Florida) NP scope of practice regulation. Survey data were merged with the Area Health Resource Files to determine practices located in primary care HPSAs. Logistic regression models estimated the relationship between quality ratings, scope of practice regulations, and practice environment scores while accounting for NP and practice characteristics. Results: Among all included NPs, 95.7% rated their practice as having "excellent," "very good," or "good" quality of care. Practice environments with higher scores had higher ratings of quality of care after accounting for NP and practice characteristics (OR = 3.73, 95% CI: 2.84, 4.89). Conclusion: Unsupportive clinical practice environments were associated with lower ratings of quality of care in HPSAs, suggesting that improvements in working conditions may be necessary adjuncts to greater deployment of NPs to improve primary care in shortage areas.

Making ENDS Meet: community networks and health promotion among Blacks in the city of Brotherly Love.

This historical inquiry illustrates the power of social networks by examining the Starr Centre and the Whittier Centre, two civic associations that operated in Philadelphia during the early 20th century, a time when Black Americans faced numerous public health threats. Efforts to address those threats included health initiatives forged through collaborative social networks involving civic associations, health professionals, and members of Black communities. Such networks provided access to important resources and served as cornerstones of health promotion activities in many large cities. I trace the origins of these two centers, the development of their programs, their establishment of ties with Black community residents, and the relationship between strong community ties and the development of community health initiatives. Clinicians, researchers, and community health activists can draw on these historical precedents to address contemporary public health concerns by identifying community strengths, leveraging social networks, mobilizing community members, training community leaders, and building partnerships with indigenous community organizations.

An environmental scan of faculty diversity programs at U.S. medical schools.

PURPOSE: To update the information available on the number and type of faculty diversity programs at U.S. MD-degree-granting medical schools. METHOD: The authors conducted an environmental scan of the 124 MD-degree-granting medical schools included in the 2010 Faculty Roster. They interviewed key informants in the faculty affairs and/or minority affairs offices and conducted Web site searches to identify relevant schoolwide programs. Using a conceptual framework, they categorized the faculty programs that they identified into four domains: mentorship, career development, social climate, and financial support. RESULTS: Of 124 eligible schools, the authors interviewed key informants from 84 schools (67.7%) and conducted Web site searches for 40 schools (32.2%). They identified diversity programs at 36 schools (29.0%) including mentoring (20/36; 16.1%), career development (20/36; 16.1%), social climate (17/36; 13.7%), and financial support programs (15/36; 12.1%). Schools with diversity programs were similar to schools without diversity programs in terms of year established, public/private status, and designation as historically black but were more likely to rank in the highest quartile and have a greater number of total faculty, and less likely to be located in the South. CONCLUSIONS: Less than a third of medical schools had programs targeting underrepresented minority (URM) faculty, and those programs that existed differed in scope and goals. These findings suggest that a lack of resources and a preference for programs that target all faculty may limit the development of programs targeting URM faculty. Future research should examine whether diversity programs contribute to URM faculty recruitment and retention.