Fraher EP, Pittman , Frogner BK, Spetz J, Moore J, Beck AJ, Armstrong D, and Buerhaus PI. Ensuring and Sustaining a Pandemic Workforce. N Engl J Med. April 2020; DOI: 10.1056/NEJMp2006376.
Available at: https://www.nejm.org/doi/full/10.1056/NEJMp2006376?query=featured_home
Current efforts to fight the COVID-19 pandemic aim to slow viral spread and increase testing, protect health care workers from infection, and obtain ventilators and other equipment to prepare for a surge of critically ill patients. But additional actions are needed to rapidly increase health workforce capacity and to replenish it when personnel are quarantined or need time off to rest or care for sick family members. It seems clear that health care delivery organizations, educators, and government leaders will all have to be willing to cut through bureaucratic barriers and adapt regulations to rapidly expand the U.S. health care workforce and sustain it for the duration of the pandemic.
Frogner BK, Fraher EP, Spetz J, Pittman P, Moore J, Beck AJ, Armstrong D, Buerhaus PI. Modernizing Scope-of-Practice Regulations–Time to Prioritize Patients. N Engl J Med. February 2020;382(7):591-593. DOI: 10.1056/NEJMp1911077.
Over the past decade, numerous reforms have been implemented by the federal government and by states to expand health insurance coverage, change payment models, motivate organizations to reconfigure the ways they deliver care, modify eligibility for Medicaid, and better prepare the health workforce for pressing behavioral care, primary care, geriatric care, and community care needs. To realize the potential of these laudable reforms, we believe that states should eliminate overly restrictive scope-of-practice regulations that they impose on the health professions. Doing so would allow us to unlock the full potential of the country’s health workforce.
Lo Sasso AT, Armstrong D, Forte G, Gerber SE. M. Differences in Starting Pay for Male and Female Physicians Persist; Explanations For the Gender Gap Remain Elusive. Health Affairs 39, No. 2 (2020); 256-263.
A large literature has documented differences in salary between male and female physicians. While few observers doubt that women earn less, on average, than men do, the extent to which certain factors contribute to the salary difference remains a topic of considerable debate. Using ordinary least squares regression and Oaxaca-Blinder decomposition models for new physicians who accepted positions in patient care for the years 1999–2017, we examined how the gender gap in total starting pay evolved and the extent to which preferences in work-life balance factors affect the gap. We found that the physician earnings gap between men and women persisted over the study period. Interestingly, despite important gender differences in preferences for control over work-life balance, such factors had virtually no ability to explain the gender difference in salary. The implication is that there remain unmeasured factors that result in a large pay gap between men and women.
Langelier M. Innovations in Scope of Practice. Dimens Dent Hyg. January 2020; 18(1):16-17.
Over the past decade, legislatures across the United States have grappled with scope of practice issues for health professions, including dental hygiene. Almost every state has provided new permissions or enabled conditions for broader practice in response to new technology, improved science, novel dental materials, or alternative methods for delivery of care. Downstream effects of these changes include opportunities for innovative dental hygiene practice. In addition, the fundamental shift in health care delivery away from the medical paradigm of identifying and treating existing disease toward early intervention in prevention of disease processes has had collateral effects on dentistry and dental hygiene. Dental hygienists’ competencies are grounded in patient education, motivational interviewing, and preventive and prophylactic clinical services. This expertise has positioned the profession to play a pivotal role in efforts to improve the oral health of the US population. Dental hygienists are now more commonly viewed as primary preventive oral health specialists with separate and critical responsibilities in the oral health care continuum of care.
Surdu S, Dall T, Langelier M, Forte G, Chakrabarti R, Reynolds R. The pediatric dental workforce in 2016 and beyond. JADA. July 2019; 150(7):609-617.
Supply and demand projections came from a health workforce tool that investigators have used to model the health care workforce for a wide variety of health occupations, including dentists.We provide a brief summary of the data, methods, and assumptions for modeling supply and demand, with additional information provided in a technical appendix (available online at the end of this article).
Moore J, Goodwin N. Expanding Access to Care with Scope of Practice. Dimensions of Dental Hygiene. 2019; 17(3):12-14.
There has been longstanding concern about uneven access to oral health services, particularly for some groups, including children, the elderly, racial/ethnic minorities, and the economically disadvantaged. Stakeholders with an interest in expanding access to care and improving the oral health status of the underserved are driving efforts to identify and adopt innovative strategies to improve population oral health. Dental hygienists (DHs), who are considered experts in prevention education and services, often play important roles in programs that improve access to needed oral health services
State-based laws and regulations define legal scopes of practice (SOP) for health professionals within a state. This contributes to variation in what DHs in different states are legally allowed to do. It is challenging to systematically describe these SOP differences, assess their impacts on population oral health and translate this into policy-relevant information. With support from HRSA’s National Center for Health Workforce Analysis, researchers at the Oral Health Workforce Research Center (OHWRC), Center for Health Workforce Studies (CHWS), developed a professional practice index to describe DH SOP across states and studied impacts of this variation on state oral health outcomes. Subsequently, researchers developed an infographic based on this work to depict state-level variation in DH SOP to help oral health advocacy groups, policy makers and other stakeholders better understand these issues.
Moore J. Health Professions Regulation in the United States. J Health Law (Revista de Direito Sanitario). October 2018;19(2):131-155.
In the US, states are primarily responsible for the regulation of health professions. The structure and content of state-specific health professions regulation has significant impacts on the delivery of health care services. This is particularly important given that health reform initiatives are designed to improve population health through the provision of accessible, high quality, and affordable basic health services. There is concern that existing state-based, profession-specific regulatory structures cannot easily support the workforce innovations necessary for health reform. Aspects of the current system that constrain the effective and efficient use of the health workforce include mismatches between professional competence and legal scopes of practice, lack of consistency in legal scopes of practice across states, limited flexibility to support overlap in scopes of practice across professions, and the slow and adversarial process for changing scope of practice rules.
Langelier M, Surdu S. Dental hygiene scope of practice regulation significantly impacts oral health outcomes in state populations. Perspectives on the Midlevel Practitioner (Dimens Dent Hyg suppl). October 2017;4(10):18-21.
Rapid changes in health care systems during the first decades of the 21st century have significantly affected the delivery of oral health care services. In the policy arena, the new emphasis on high-quality, value-based services;1 improvements in diagnostic and treatment technologies and materials; proliferation of information systems and health information exchanges; team-based service delivery models; and integration of primary care and oral health care2 has influenced the deployment of health and oral health workforces. The move toward prevention and management of oral disease and away from the historical treatment paradigm requires the engagement of a comprehensive professional team.3 Dental hygienists are well positioned to contribute to improvements in access to preventive oral health services and, ultimately, to oral health outcomes.3
Mertz E, Spetz J, Moore J. Pediatric Workforce Issues. Dent Clin N Am. 2017;61(3):577-588.
Langelier M, Continelli T, Moore J, Baker B, Surdu S. Expanded Scopes of Practice for Dental Hygienists Associated With Improved Oral Health Outcomes for Adults. Health Affairs. 2016;35(12):2207-2215.