Analysis of the geographical distribution of anesthesia manpower in the United States

The 1970 geographical distributions of total anesthesia manpower, anesthesiologists, and nurse anesthetists by state were analyzed by multiple regression to account for their unevenness. Independent variables included factors relating to prior professional contact in the state, professional satisfaction, practice income, demand for services, and environment. The distribution of training programs accounted for 41 per cent of the variance in the distribution of total manpower, but 55 per cent was explained by the number of operations, location of nurse anesthesia schools, and proportion of total state employment in service occupations (a proxy for the availability of consumer services). Location of training programs and the absence of the other type of personnel were good predictors for the manpower subgroups. The distribution of nurse anesthesia schools, anesthesiologists, number of surgical operations, and the relative value schedule conversion factor together accounted for 60 per cent of the variance in the nurses' distribution. The location of residency programs (or positions) was a better predictor for the anesthesiologists' location than medical schools or factors characterizing the demand for services. The distribution of nurse anesthetists, hospital cost per day (considered a proxy for a satisfying professional life and for regionalization of services), and residency programs explained 81 per cent of the variance in the anesthesiologists' distribution. Although the regression predicts that increasing the number of residency programs in an underserved state should be associated with an increase the number of anesthesiologists, such a policy may be infeasible dur to pending federal health manpower legislation unless matched by decreasing a greater number of programs in relatively oversupplied states.     

Analysis of the enantiomers of 3,4-methylenedioxy-N-ethylamphetamine (MDE, "Eve") and its metabolite 3,4-methylenedioxyamphetamine (MDA) in rat brain

A 1992 General Accounting Office (GAO) study on costs of anesthesia found that anesthetics administered by anesthesia care teams (ACTs) were more costly than those administered by Certified Registered Nurse Anesthetists (CRNAs) or anesthesiologists practicing alone. In 1994, Medicare implemented a single payment system in response to the GAO report and recommendations by the Physician Payment Review Commission. Restructuring of many anesthesia departments has followed. A study was conducted in a 370-bed public teaching hospital to: 1. Examine how one ACT functionally provided services. 2. Identify roles of CRNAs and anesthesiologists within this team practice. 3. Determine if medical direction was perceived as equally beneficial in all cases. 4. Identify practice modifications which could possibly lower costs. All anesthetics (n = 358), excluding obstetrics, were studied over a 4-week period. Sixty-four variables were collected on each case including patient demographics, case characteristics, provider functions, and outcome data. Most patients were healthy and had low complexity operations. Systat statistical software was used for data analysis. There were clear functional variations in the roles of anesthesiologists and nurse anesthetists within the anesthesia care team. Anesthesiologists provided most preoperative and postoperative care, while nurse anesthetists administered the majority of anesthetics. Anesthesiologists and nurse anesthetists in this study agreed in their perceptions that more than 70% of these cases did not need medical direction. Logistical regression of variables was used to construct a predictive equation for cases where providers perceived that medical direction was beneficial.(ABSTRACT TRUNCATED AT 250 WORDS)     

Anesthesia providers, patient outcomes, and costs: a critique

The June 1996 article in Anesthesia and Analgesia by Abenstein and Warner entitled "Anesthesia Providers, Patient Outcomes, and Costs" presents important information about anesthesia services, but it contains a number of errors and questionable interpretations that could lead to inappropriate programs and policies. Among the most important points of fact we clarify in our paper are: 1. Three organizations that accredit, certify, and govern nurse anesthetists are organized in similar fashion to three comparable bodies governing anesthesiologists. There is no justification for the implication that the AANA somehow controls the accreditation and certification of CRNAs. 2. The conclusion that anesthesiologistled care teams are the preferred model for all anesthesia services and settings because of improved patient outcomes is overly simplistic and is not borne out in the literature. 3. The attribution of reduced mortality from anesthesia over the past 40 years to the increase in numbers of anesthesiologists is not justified. Many other factors, including new anesthetic agents and improved patient monitoring, also are important. 4. The use of a hypothetical example related to Medicare reimbursement in New York to justify the implication that CRNA-delivered services are more costly than anesthesiologist-delivered services is misleading and not borne out in the literature. We hope that planners and policy makers will read the article by Abenstein and Warner with extreme caution. Taking some of their statements and conclusions seriously could lead to policies and programs that are not focused in science.     

Forecasting the nursing workforce in a dynamic health care market

The ability to discern the interacting factors that affect supply and demand for nurses could help nurse educators and nurse leaders allocate resources to meet these needs. Forecasting models must take into account the interactions of three crucial groups of health care providers--physicians, nurse practitioners, and physician's assistants. Buerhaus has noted that market size, wages, preferences for nursing services, and availability of substitutes influence the demand for nursing services. Changes in nurse supply resulting from Medicare reimbursement for nursing services have not been studied, though it could safely be projected that such reimbursement will increase nurse supply. Nurses with baccalaureate degrees and advanced practice preparation will be in the greatest demand in ambulatory care, managed care, public health, and home care settings, raising concerns again that the educational mix is in need of adjustment upwards.     

Financing nurse anesthesia education

Health care spending in the United States outpaces all other nations or 14% of the gross domestic product. Although the escalating increases in health care costs which have characterized the industry over the past quarter century have begun to slow down, if changes in the current health care policy are not implemented, spending is expected to increase at a rate of 11.5% during each of the next 5 years. Health care spending will reach $1.1 trillion or 15% of the gross domestic product in the near future. Both hospitals and universities are facing mounting pressures to reduce their costs and improve their services. In this environment, it becomes increasingly important for directors of nurse anesthesia programs to financially justify their existence. This discussion begins with a brief overview of nurse anesthesia education in the United States. The value of and need for nurse anesthetists in the US health care system is addressed. Advantages and disadvantages of hospital versus university-based programs are highlighted and funding sources identified. Future needs and challenges in nurse anesthesia education conclude this discussion.     

Optometric manpower in the Commonwealth of Puerto Rico: estimates and projections, 1982-2025

BACKGROUND: The 1982 study investigated the potential impact of the IAUPR School of Optometry on the adequacy of supply of optometrists in Puerto Rico for the years of 1980-2000. This article is designed to: (1) update the 1982 study; (2) appraise the accuracy of the 1982 projections; (3) re-evaluate the status of optometric manpower in Puerto Rico through the year 2025; and (4) provide the School of Optometry with information necessary to make informed judgments about future enrollments. METHODS: Estimates of supply are based on data from the Colegio de Optometras de Puerto Rico, the Sección de Oftalmología de la Asociación Médica de Puerto Rico, and the enrollment and graduation registries from the School of Optometry. Requirements are based on estimates of annual effective demand, provider-to-population ratios, per capita demand, and optometric productivity. RESULTS: Optometrists comprised 52.2% of Puerto Rico's actively practicing vision care manpower in 1995, with a mean optometrist-to-population ratio of 8.2 per 100,000. The number ranged from 28 in Mayagüez to 107 in San Juan. Under different assumptions regarding supply, productivity, and demand, surpluses and deficits are estimated and projected for the years 1995 to 2025. CONCLUSIONS: Depending on the assumptions used, an undersupply or an oversupply of optometrists may be found in Puerto Rico, currently and in the future. Projections of supply and demand predict a considerable range--from a surplus of 961 optometrists to a deficit of 2,085 optometrists in the year 2025.     

Sedation of adult critically ill ventilated patients in intensive care units: a national survey

Pain management presents exciting opportunities for nurse anesthetists. Today there are thousands of pain clinics and pain services dedicated to the diagnosis and treatment of chronic and acute pain. By becoming familiar with the principles involved in the management of chronic and acute pain, the different treatment modalities available, and the organization of pain clinics and pain services, nurse anesthetists will be able to take advantage of the opportunities they provide.     

A guide to understanding informed consent

Anesthesia providers are expected to provide information to the patient during the preanesthesia interview that enables the patient to make informed choices. Adequate disclosure during the informed consent process ensures the equalization of the practitioner/patient relationship and the decision-making rights of the patient. Both certified registered nurse anesthetists (CRNAs) and anesthesiologists are not only legally required to provide information that will allow a patient to make an informed judgment about how to proceed with various anesthetic modalities but are also obligated by their standards of practice. This article informs the CRNA about the principles of informed consent so that they can better understand their role in the informed consent process.     

A manpower data system for psychology.

Discusses the need for a manpower data system with respect to its use in (a) increasing participation and effective utilization of psychologists in programs that seek to ameliorate social and mental health problems; (b) adjusting supply to demand in various specialty areas and work settings; and (c) improving the equalization of opportunity for all psychologists. Use of a 1972 questionnaire designed to collect data for the proposed manpower program (sent to 63,000 psychologists in the United States and Canada) is discussed. The initial planning, concomitant design, and development of the automated manpower data system is further described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of the Vibrio harveyi toxicity test for evaluating mixture interactions of nitrobenzene and dinitrobenzene

Trauma during wartime has been the scourge of the ages. Conventional anesthesia with ether has been available since 1846 when it was demonstrated in Boston by a dentist named William Morton. Subsequently, ether was used during the Mexican-American War in 1847, and chloroform was used during the Crimean War from 1854 to 1856. Nurse anesthetists have made substantial contributions to care of the war-injured by initiating acute airway management and resuscitation efforts and by the administration of anesthesia care for critically injured war casualties undergoing surgical procedures. They have further contributed to goodwill in war-torn areas by providing anesthesia care to many civilian children and adults living in these areas of conflict. The evolution of nurse anesthesia contributions to the treatment of traumatized war casualties is the central focus of this article.     

Assessing dental manpower needs in Tennessee

Using a formula developed by the State of Kentucky and the best data available for the State of Tennessee, it is estimated that this state currently has a slight oversupply of dentists, but that by the turn of the century this will have become a shortage. There is no reason to doubt these estimates except that for confidence in them we will need state-specific data on the supply of dental manpower, the need for dental care, and the demand for dental care. Following the recommendations of the Institute of Medicine and others, the College of Dentistry has initiated the Dental Manpower Project to develop and maintain a database which will allow Tennessee to forecast and monitor trends in the supply of dental personnel and factors affecting need and demand. Hopefully, such an activity will help us avoid mistakes like those made 25 to 30 years ago which resulted in the education of too many dentists nationwide (and in this state) and an unfortunate breach between practitioners and dental education.     

Can we predict the future evolution of anesthesiology workforce in Belgium?

Two models are proposed to predict the evolution of anesthesiology workforce over the next 20 years. Each model features various scenarios according to different assumptions related to future numbers of female anesthetists, working hours, or regulations for postgraduates' working for conditions. However the main uncertainties derive from the unknown evolution of demands. Despite their differences both models agree on several important conclusions: a 13 to 14% shortage of anesthesiologists currently exists to satisfy O.R. demands, this shortage will decrease over the next ten years, and after 2010 a new shortage could arise under the combined pressure of the numerus clausus, of the number of female anesthesiologists and of the aging of the still young population of anesthesiologists.     

Perspective on the integration of substance user needs assessment and treatment planning

In the 1970s and 1980s, several techniques for assessing the needs for substance user treatment were developed. Generally these techniques relied upon the data developed from large-scale data-gathering systems, originally designed to assess the capacity of the substance user treatment system nationwide. The need assessment techniques generally require making estimates of the prevalence of substance use disorders in the population and then applying them to the national utilitization experience. As first attempts often do, these approaches tended to simplify complex problems and tended to rely too heavily on the only available data. The result was that they tended to reify current practice rather than to define best practice. In the 1990s, new challenges face those attempting to assess needs for substance user services. As a result of the last decade's emphasis on cost containment, new concepts have challenged traditional views of needs assessment. This paper will discuss those new concepts and their impact on the needs assessment endeavor. In particular, the impact of the concept of medical necessity will be examined.     

Mental health manpower and institutional change.

"The greatest social need for mental health services today comes from the low-income groups and the poor. Meeting this need is not primarily a problem of manpower but [one] of ideology. The task is to develop concepts, methods, programs, and services that are appropriate, effective, and related to the life styles of low-income people and to their needs, in a way which will create an effective demand for them. This will require significant institutional changes. Whatever manpower problems do exist are inseparable from the problem of institutional change. The solutions to manpower problems can reinforce existing institutionalized mental health or they can constitute a strategy for promoting institutional change." (20 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interactions of team mental models and monitoring behaviors predict team performance in simulated anesthesia inductions.

In the present study, we investigated how two team mental model properties (similarity vs. accuracy) and two forms of monitoring behavior (team vs. systems) interacted to predict team performance in anesthesia. In particular, we were interested in whether the relationship between monitoring behavior and team performance was moderated by team mental model properties. Thirty-one two-person teams consisting of anesthesia resident and anesthesia nurse were videotaped during a simulated anesthesia induction of general anesthesia. Team mental models were assessed with a newly developed measurement tool based on the concept-mapping technique. Monitoring behavior was coded by two organizational psychologists using a structured observation system. Team performance was rated by two expert anesthetists using a performance-checklist. Moderated multiple regression analysis revealed that team mental model similarity moderated the relationship between team monitoring and performance; a higher level of team monitoring in the absence of a similar team mental model had a negative effect on performance. Furthermore, team mental model similarity and accuracy interacted to predict team performance. Our findings provide new insights on factors influencing the relationship between team processes and team performance in health care. When investigating the effectiveness of a specific team coordination behavior, team cognition has to be taken into account. This represents a necessary and compelling extension of the popular process-outcome relationship on which previous teamwork research in health care has focused. Moreover, the current study adds further external validity to the concept of team mental models by highlighting its usefulness in health care. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Schedule Acceleration, Work Flow, and Labor Productivity

This paper details how construction labor efficiency is affected by deviations from the normal flow of work. A methodology is presented to estimate the loss of labor efficiency, based on variations in the percentage of labor hours used each week. The procedure can be used without the need for contractor production records. The theoretical basis for the method rests on the assumption that the rate of manpower utilization is consistent with the amount of work available for the contractor to perform. Using productivity data from three electrical projects that were accelerated, the labor efficiency is shown to be correlated to changes in the percentages of weekly work hours. Loss of efficiency curves are developed for various project phases. A case study is presented of an actual electrical construction project. Losses of efficiency are calculated for each phase, and it is shown that the contractor incurred an estimated loss of productivity of 25%. The analysis is validated by comparing a weekly inefficient work-hour profile to the chronology of events that occurred on the project.     

Psychologists in practice with older adults: Current patterns, sources of training, and need for continuing education.

Rapid population growth among older adults means an increased need for psychologists prepared to provide mental health services to this population. A representative survey of 1,227 practitioner members of the American Psychological Association yielded information about current patterns of practice with older adults, sources of training in geropsychology, perceived need for continuing education (CE) in geropsychology, and preferred CE formats. Most respondents provided some services to older adults, but typically very little. The services provided are inadequate to meet projected demand. Most respondents lacked formal training in geropsychology and perceived themselves as needing additional training. CE workshops at the regional level and distance education were the most popular formats. These data serve as a call to the field to expand training opportunities at all levels of training, with an emphasis on the need for empirically based, broadly accessible CE offerings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Redesigning medication distribution systems in the OR

Detroit Riverview Hospital's surgery suite recently converted to an automated medication distribution system. Focusing on control, access, documentation, and charging, the redesign has benefited pharmacists, nurse anesthetists, and OR nurses. Automation reduced nursing labor associated with ordering and restocking medications, counting narcotics, and investigating discrepancies. Storage and dispensing options, including innovative anesthesia trays, facilitate caregiver productivity, quality initiatives, and clinical pathways. System documentation pinpoints questionable events and patterns to ensure that all medications dispensed were administered to patients. Charges are captured and posted automatically. Overall, automated medication distribution has helped the OR improve clinical care quality and patient service.     

Nurse education in competitive markets: the case for relationship marketing

Since the National Health Service reforms of the late 1980s, nurse education has been increasingly subject to market forces. This new competitive environment presents not only threat, but also challenge and opportunity. Providers of nurse education who recognize the need for market orientation and develop responsive marketing strategies will maximize their potential for market retention and growth. Traditional marketing strategies have considerable limitations for public sector services. The new and growing field of relationship marketing offers nurse education an opportunity to retain and develop profitable relationships with both internal and external markets. This paper reviews the marketing arena in nurse education and proposes context-based qualitative research to ascertain definitive constructs of service quality. Such constructs might then be rooted in a theoretical framework of service quality measurement, and be measured within the disconfirmation paradigm of relationship marketing.     

A realistic appraisal of existing and future job opportunities for psychologists.

Explores the question of whether there is now an oversupply of doctoral level psychologists. Recent surveys about the supply of PhD psychologists, job openings in major employment settings, and the current employment status of recent doctoral graduates in all professions are discussed. For the field of psychology, only 1.1% were unemployed in 1969 and those were almost entirely noncitizens or psychologists not seeking employment. New psychologists, however, indicated a choice of only 2-4 positions in contrast to 5-8 offers a few yr. ago. While some reduction has occurred in the job market, virtually all psychologists are still finding positions in the type of work setting they desire. A shortage exists in the health services, where there are between 750 and 1000 vacancies. In addition, the 1970 Manpower Report of the President indicates a 75-100% increase in employer requirements for psychologists by 1980, the highest projected need of all professional groups except computer technologists. It is concluded that rather than an oversupply, a shortage exists, particularly in clinical and counseling psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)