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A Rural Healthcare Report Examines Physician Shortage Issues in Nebraska

April 16, 2018
by Mark Hagland
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A new report on rural healthcare looks at the physician shortage in Nebraska, and some of the alternatives, around mid-level professionals, that are emerging in order to address that ongoing shortage

A 2018 rural health care workforce report issued by the University of Nebraska Medical Center reveals that while there has been an 11 percent increase in the number of physicians in the state over the last 10 years, there are 13 counties that still do not have a primary care physician, according to a press release published by the University of Nebraska Medical Center.

According to the April 4 press release, that finding was one of a number of key findings that appeared in a the 64-page report, "The Status of the Healthcare Workforce in the State of Nebraska,” published this month. "The health care workforce is an essential component in making Nebraska the healthiest state in the union and timely and accurate data such as this report will help inform initiatives and policies to help address those challenges," said Jeffrey P. Gold, M.D., UNMC Chancellor, in a statement included in the press release.

The study was commissioned and funded by the Nebraska Area Health Education Center Program (AHEC) and used the most recent data from the UNMC Health Professions Tracking Service and the state of Nebraska.

"This report helps to measure the progress we have made in the state in dealing with some of the workforce issues in rural Nebraska and in planning for the future," said Mike Sitorius, M.D., professor and chair of family medicine in the UNMC College of Medicine.

"Some programs have helped increase the number of rural health professionals, but there still exist substantial recruiting challenges to bolstering the health workforce and access to health care in rural and underserved areas," said Fernando Wilson, Ph.D., acting director of the UNMC Center for Health Policy and lead author of the report.

Among those challenges, the report found these:

  • The reality that nearly one-fifth of physicians in Nebraska are more than 60 years old, and thus likely to retire in the near future;
  • 18 of 93 Nebraska counties have no pharmacist; and
  • Demographics in many counties are becoming more diverse, but the current health workforce doesn’t necessarily reflect the populations being served.

"In partnership with stakeholders from Scottsbluff to Omaha, we’ve made progress over the years. But the landscape of health care is rapidly changing, and we must remain diligent to sustain the progress we’ve made and close the gaps," Dr. Wilson said, in his statement in the news release.

Dr. Wilson led a nine-person research team representing several professions from UNMC and with input from Thomas Rauner, director of the primary care office in the Office of Rural Health for the state of Nebraska.

Interestingly, one inevitable response to the ongoing physician shortage in Nebraska has been that, “Since 2007, there has been a large increase in the number of active physician assistants (PAs) in the state,” the report noted. “There are 908 PAs (or 47.3 PAs per 100,000 population) versus 598 (33.5 {As per 100,000 population) in 2007—a 52-percent difference in number of PAs. PAs currently provide a total of 35,878 work hours, equating to 897 FTE PAs. Half of the PAs are 40 years old or younger, and over 70 percent of PAs are female.” Further, the reported stated, “Analysis of the distribution of PAs by county showed that 16 counties in Nebraska do not have an active PA.”

Meanwhile, the reported noted that, “In 2017, there were 1,148 nurse practitioners (NPs), 36 certified nurse midwives (CNMs), 49 clinical nurse specialists (CNSs), and 308 certified registered nurse anesthetists (CRNAs). The number of NPs rose from 767 to 1,148 in 2007-2017—a 50-percent increase. For CNMs, the increase was from 22 to 36 professionals.”

In their concluding section, the authors of the report noted that “The State of Nebraska has historically faced substantial challenges in maintaining access to healthcare in rural communities. Despite the importance of reducing rural-urban disparities in the state, a comprehensive study of the distribution of Nebraska’s healthcare workforce has not occurred since 2009. Our study uses recent data on numbers and work hours of licensed and active providers to provide a demographic profile of the current workforce.”

Importantly, the report’s authors state, “Our results highlight the substantial deficit in the supply of physicians across counties in Nebraska, particularly for the primary care specialties of internal medicine, OB/GYN and pediatrics. In addition, nearly one in five physicians in the state are older than age 65, and thus are likely to retire in the near future. In contrast, the number and rates of physician assistants and nurse professionals have grown substantially over the last decades and provide wide-ranging geographical coverage in Nebraska. The greater reliance on physician assistants and nurse practitioners,” they wrote, “has helped to offset the inadequate supply of primary care physicians. Legislative Bill 107 (passed in 2015) grants full practice authority to Nebraska nurse practitioners, so that they are now able to provide the full scope of services for which they are trained and educated. This legislative change will significantly enhance access to care in rural and underserved areas within Nebraska. However,” they noted, “there remains substantial variation in the rate of nurse professionals across the state, with relatively low numbers of RNs, LPNs and APRNs in west and central Nebraska.”

 

 

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Why A.I. Will Never Replace Recruiters

September 12, 2018
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AI can be a great tool, but recruiters aren’t going away

I remember fear settling in like a big dark cloud when I opened my search practice in 2005 with all the dire predictions of how the Internet and all the online hiring websites were going to put recruiters out of business. Many articles were written on the demise of the recruiter as Monster.com would literally scare us out of business.

Then came other job opening aggregators like Indeed.com, ZipRecruiter and a whole host of other websites chasing HR gold as if there was a switch they could simply flip to eliminate the human touch that recruiters bring to the table with engaging candidates, only to be replaced by a text message alert or an email notification of all the new jobs that were now open. The only thing they were missing were qualified applicants.

These predictions never came true and all the prognosticators simply forgot what recruiters actually do every day that their technologies will never replace. CIOs need to remember the critical nature of hiring leaders and team members for key roles in their organization. Candidates need to be vetted and coached to listen to an opportunity to join your team when we call the candidates. You have to remember:

  • We talk with people. Yes, we use a cell phone, or now a VOIP phone, and actually engage in a dialogue with candidates about opportunities. It’s a novel approach—I get it.
  • We engage with people that will never look on those job posting sites because they are not looking for a new job. Period.
  • We contact passive candidates that up until our call were never going to leave their job because they are so focused on the now that they don’t even think about looking on a website for a job they are not even interested in.
  • We help clients and candidates come together on the right offer and provide two-way communication during the hiring process, so each party has a deep understanding of the other party’s point of view. Online sites—well you get the picture…
  • We hammer out the details of relocation packages with our clients and the candidates and their families to make sure the move is done smoothly to allow the family to begin their transition to a new city. It’s the personal touch that matters here because we are dealing with people’s lives.

Fast forward: The next wave of artificial intelligence (AI) products for hiring are cropping up everywhere and we are hearing similar calls for recruiters to give up and retreat as the latest algorithm and data analytics tools are able to speed up the hiring process supplanting recruiters. Within seconds, these tools are touting they can determine who the perfect candidates are based on the analytics and machine learning tools designed for hiring. Guess what? It won’t happen.

AI can be a great tool, but it falls dreadfully short of meeting hiring managers' expectations. It won’t wave a magic wand suddenly making hiring enjoyable and much quicker with the same quality as the work performed by most search firms. I’ve been in technology in some form or fashion for a very long time. I love technology and what technology can do to speed up productivity and actionable data I can use every day in the work we do. It’s awesome!

But to be clear, I’m not going away. I have seen this movie before and I am fairly certain I can tell you how it ends. The work recruiters do to find and recruit great talent is something humans must do.

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Cerner President Zane Burke to Step Down This Fall

September 10, 2018
by Heather Landi, Associate Editor
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Cerner president Zane Burke, who first joined the company in 1996, will step down November2, the Kansas City, Mo-based electronic health record (EHR) company announced today.

“Cerner has been a disruptive force of positive change across health care throughout its history, and I’m pleased with the accomplishments we’ve achieved together with our clients and the broader industry community,” Burke said in a statement. “Complex and evolving challenges remain, and Cerner is uniquely positioned to continue innovating for the good of consumers and health care providers.”

 “We thank Zane for his contributions to Cerner across more than two decades,” Cerner Chairman and CEO Brent Shafer said in a statement. “Zane leaves the company with a strong client focus and commitment to continued innovation, partnership and sustainable growth deeply engrained in our culture and leadership philosophy. I am very confident in the capabilities of Cerner’s strong and experienced leadership team.”

John Peterzalek, executive vice president of worldwide client relationships, will assume Burke’s responsibilities and the title of Chief Client Officer.

Since joining Cerner in 1996, Burke had a range of executive positions across sales, implementation, support and finance. He was named President in 2013 after leading Cerner’s client organization. Burke came to Cerner in 1996 from the consultant KPMG, and has held a number of positions in the company, including president of Cerner west from 2003 to 2011, and, more recently, executive vice president of Cerner's client organization.

During his five years as president, Burke has been involved in a number of significant deals, including playing an instrumental role in Cerner winning two massive EHR modernization contracts, first with the U.S. Department of Defense (DoD) in 2015, a $4.3 billion contract, and then just this past May, with the U.S. Department of Veterans Affairs (VA) in a $10 billion contract.

During Burke’s tenure, Cerner also completed one of the biggest deals in healthcare IT history with the acquisition of Siemens healthcare IT business for $1.3 billion in 2014.

The Kansas City Business Journal reported on September 4 that Burke had exercised option to sell nearly $10 million in stock.

 

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Leadership Changes at HHS as CIO Transferred to New Role

August 21, 2018
by Heather Landi, Associate Editor
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Beth Killoran is stepping out of the role of CIO at the U.S. Department of Health and Human Services (HHS) and is moving over to a new role at the Office of the Surgeon General, within HHS.

The news was first reported by Federal News Radio. In an email, a HHS official confirmed that Killoran, who stepped up to the HHS CIO role in July 2016, has joined the Office of the Surgeon General at HHS to develop a "comprehensive information systems strategic plan for the U.S. Public Health Service Commissioned Corps.”

The HHS official also confirmed that Ed Simcox, the HHS Chief Technology Officer, will take on the added role of serving as the HHS Acting CIO, until a permanent selection is made. “Simcox has led multiple, large IT transformation efforts, both as an industry executive and consultant. As HHS’s CTO, he leads HHS’s efforts on enterprise data management, data sharing, technology-related healthcare innovation, and public-private partnerships,” the official said via email.

Simcox started as the HHS CTO in July after serving as acting CTO starting in May and deputy CTO since July 2017, according to Federal News Radio.

Killoran began working at HHS in October 2014, moving over from the Department of Homeland Security. At HHS, she has served as the acting Deputy Chief Information Officer and as the Executive Director for the Office of IT Strategy, Policy and Governance. The HHS official stated that Killoran has served in a number of high-level information technology positions at HHS, “providing leadership on a number of high priority projects.” Killoran also worked for the Department of the Treasury, where she provided IT infrastructure support and operations for over 20,000 employees across 1,500 locations.  During her tenure, she provided IT operational support in response to the 9/11 and Oklahoma City bombing events, the HHS official said.

Federal News Radio reporter Jason Miller reported that, during her time as HHS CIO, Killoran tried to move the agency forward in a number of areas through an updated strategic plan and a more aggressive approach to cloud adoption. “Recently, Killoran led a reorganization of the CIO’s office, naming Todd Simpson as the first chief product officer and promoting innovation,” Miller wrote.

Killoran becomes the fourth major agency CIO to be reassigned during the Trump administration, joining former Treasury Department CIO Sonny Bhagowalia, former Agriculture Department CIO Jonathan Alboum and FEMA CIO Adrian Gardner, according to Federal News Radio’s reporting.

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