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[image: Your daily Update] January 10th, 2012 No more " run faster "

goals <http://ptmanagerblog.com/google-reader>

Posted about 21 hours ago by [image: _portrait_thumb] Kovacek,

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Joan Crawford screamed, " No more wire hangers! " I'm screaming " No more 'run

faster' goals! "

" Run faster " goals are the ones where you decide to " increase sales " or

even " increase sales by 51.25396 percent " and the only change is that

you'll " do better. " Those are truly weak. If you make your goal, you pat

yourself on the back without knowing how you succeeded. If you don't, you

tell yourself that you tried.

Set a goal with a behavior in it. Like making an additional sales call

every day or thanking everyone on your team for their effort at least once

a week or making notes about what worked and what didn't at the end of

every day. If your behavior gets the result you want, great. If not change

it.

from Three Star Leadership Blog by Wally Bock

Healthcare Economist · Will Nurses Steal Market Share from

Physicians?<http://ptmanagerblog.com/healthcare-economist-will-nurses-steal-mark\

et>

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Will Nurses Steal Market Share from Physicians?

January 9, 2012 in

Nurses<http://healthcare-economist.com/category/supply-of-medical-services/nurse\

s/>|

No

comments<http://healthcare-economist.com/2012/01/09/will-nurses-steal-market-sha\

re-from-physicians/#respond>

Currently, physicians are the dominant force in determining how health care

is provided in the United States today. Nurses, however, also play a vital

role in the provision of health care services. Although there are about

660,000 <http://www.bls.gov/oco/ocos074.htm> physicians in the U.S., there

are 2.6 million <http://www.bls.gov/oco/ocos083.htm> registered nurses and

another 750,000 <http://www.bls.gov/oco/ocos102.htm> LPNs.

Leveraging the skills of these nurses the utmost capacity is vital to

maximizing the efficiency of the health care system. In a recent report

from the Institute of Medicine (IOM), the policy recommendations focused on

four main issues:

1. Nurses should practice to the full extent of their education and

training.

2. Nurses should achieve higher levels of education and training through

an improved education system that promotes seamless academic progression.

3. Nurses should be full partners, with physicians and other health

professionals, in redesigning health care in the United States.

4. Effective workforce planning and policy-making require better data

collection and information infrastructure.

In general, although the recommendations are sensible, physicians may fear

that nurses will begin taking some of their market share. A more detailed

explanation of my views of these recommendations is listed below.

Workforce Licensing

The Healthcare Economist has been a persistent

advocate<http://healthcare-economist.com/2008/10/10/medical-licensing-improving-\

or-harming-the-quality-of-medical-care/>of

loosing state and federal restrictions on the occupation scope of work

practices. For instance, nurse practitioners cannot prescribe medicine in

many states. The IOM advocates that the Federal Trade Commission and the

Department of Justice examine whether these laws are anti-competitive.

Opponents will claim that healthcare quality will decrease, but I have not

seen any empirical evidence of this claim. Further, by allowing nurses to

replace primary care doctors for some types of care, the cost of care will

decrease giving the poorest individuals increased access to the medical

care they need.

Increasing Nursing Autonomy

The second and third recommendation areas deal with increasing the autonomy

of nurses. By improving the education of nurses, the quality of care they

can provide will increase. One of the advantages of using nurses rather

than doctors to treat patients is that they are lower cost skilled

professionals. Increasing educational requirements will increase the cost

of nurses and nurses may end up being psuedo-physicians, who do not offer

material cost savings. As medicine does become more complex, however,

nurses may require more educations. An increase in the variance of the

education may increase efficiency, offering providers the ability to choose

from both very qualified nurses with a masters or Ph.D. to supervise other

nurses or deal with more complex cases, as well as nurses with much less

education which could focus on more routine tasks.

More education, however, isn’t an unambiguous good. More education is

costly and reduces the supply of workers. Further, although learning in

school is beneficial, learning on the job also imparts important skills.

The IOM’s 2nd and 3rd recommendation areas will likely cause complaints

from physicians. Increasing nursing education will not only drive up the

price for nurses, but may also make nurses competitors for the physician’s

services. Allowing nurses to be full partners in the redesign of the

healthcare system–although sensible–also infringes on the hegemony of

physicians. Thus, these two recommendations will likely meet fierce

resistance from the AMA and other physician organizations.

Improve Data Collection Processes

An unbiased observer would say that one should collect more data regarding

the demand and supply of nurses only when the benefit of this information

outweighs the cost. As a researcher who depends on high quality data to

make logical inference, more data is almost always good. Free data is even

better. There are significant fixed costs to collecting data; by providing

these data for free, the benefits from the use of the data can be shared

across many users.

via

healthcare-economist.com<http://healthcare-economist.com/2012/01/09/will-nurses-\

steal-market-share-from-physicians/>

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