Research roundup: Ameliorating physician shortages; Patients' perceptions of bias

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: Primary Care Physician Shortages Could Be Eliminated Through Use Of Teams, Nonphysicians, And Electronic Communication -- The authors note that there is a consensus "that the current shortage of primary care physicians will worsen over the next ten years as the nation's population grows and ages and as insurance coverage expands as a result of the Affordable Care Act." They examine whether workplace changes will impact that assessment.  "We show that the implementation of some increasingly popular operational changes in the ways clinicians deliver care-;including the use of teams or 'pods,' better information technology and sharing of data, and the use of nonphysicians-;have the potential to offset completely the increase in demand for physician services while improving access to care, thereby averting a primary care physician shortage," they write (Green, Savin and Yu, January 2013).

Annals Of Family Medicine: Clinicians' Implicit Ethnic/Racial Bias And Perceptions Of Care Among Black And Latino Patients – The researchers in this study had earlier conducted a study that found nearly two-thirds of primary care doctors showed some type of implicit bias that favored whites, "even as they rejected explicit expressions of bias." In the new study, they wanted to determine if the clinicians' explicit and implicit ethnic/racial bias is linked to minority patients' perceptions of the care they received. After surveying nearly 3,000 patients, they concluded that "clinicians' implicit bias may jeopardize their clinical relationships with black patients, which could have negative effects on other care processes. As such, this finding supports the Institute of Medicine's suggestion that clinician bias may contribute to health disparities. Latinos' overall greater concerns about their clinicians appear to be based on aspects of care other than clinician bias" (Blair et al., Jan-Feb/2013).

The Pew Center On The States: Falling Short: Most States Lag On Dental Sealants – "Dental disease also has serious consequences for state budgets. Between 2010 and 2020, annual Medicaid spending for dental services in the United States is expected to increase 170 percent, from $8 billion to more than $21 billion," the authors write. Children account for about 60 percent of Medicaid's total spending on dental services. But while a number of states are making progress, Pew's analysis suggests that most states are underusing the cost-effective tool of dental sealants – plastic coatings on the chewing surfaces of molars – proven to prevent tooth decay: "State policy makers also need to remove regulations that create unnecessary and costly barriers for dental hygienists, the primary practitioners who apply sealants in school-based programs" (1/8).  

The Kaiser Family Foundation: Medicaid's Role In Meeting The Long-Term Care Needs Of America's Seniors – The authors write: "This brief examines Medicaid's key role in meeting the long-term care needs of seniors in the United States, particularly those with limited incomes. Medicaid is the nation's primary payer of long-term services and supports, and state Medicaid programs provide a range of long-term care services. The brief includes state-by-state data on Medicaid enrollment and expenditures for elderly beneficiaries" (Reaves and Young, 1/15).

The Kaiser Family Foundation: Medicaid Provider Taxes And Federal Deficit Reduction Efforts – Implementation of the automatic spending cuts in January 2013 (the sequester) that was part of the "Fiscal Cliff" was delayed two months. Medicaid is exempt from the sequester; however, Medicaid cuts could be part of an alternate deficit reduction package. One option that has been mentioned in the debate concerns revenues that states receive from taxes on medical care providers and use for their share of Medicaid spending. This "quick take" highlights the role of provider taxes in states and the possible impact of proposals to limit the use of these taxes (1/10). 

Here is a selection of news coverage of other recent research:

Reuters: Patients Rarely Told About Medication Errors: Study
In what is likely to come as little surprise, a U.S. study has found that patients and their families are rarely told when hospitals make mistakes with their medicines. Most medication mistakes did not harm patients, the researchers said in a report published in Critical Care Medicine, but those that did were more likely to happen in intensive care units (ICUs) - with ICU patients and their families less likely to be told about errors (Seaman, 1/14).

Reuters: Some Docs Screen For Prostate Cancer Without Asking
One in four family doctors doesn't ask male patients before screening them for prostate cancer, according to a new survey. So-called prostate specific antigen (PSA) testing has been controversial in recent years because of uncertainty about whether it actually saves lives and concern about side effects from potentially unnecessary and invasive follow-up tests and treatments (Pittman, 1/14).

Medscape: Surgeons, Intensivists Often Disagree on Postoperative Goals
Surgeons and other intensivists are often at odds regarding postoperative goals of care, according to findings of a cross-sectional study published in the January issue of JAMA Surgery (formerly Archives of Surgery). Among 912 surgeons surveyed, 43% reported conflict with other intensive care unit (ICU) clinicians regarding postoperative goals of care, and 43% reported similar conflict with ICU nurses (Barclay, 1/16).

Medscape: Social Media Use by Physicians Can Spur Medical Board Action
A new study has identified several online activities by physicians that are likely to result in investigation by state medical boards. S. Ryan Greysen, MD, from the University of California, San Francisco, and colleagues published their findings in the January 15 issue of the Annals of Internal Medicine. The authors mention that this study was prompted by the lack of data on what activities were likely to result in investigation. "Previous research by our group has shown that 60% of U.S. medical school deans had concerns about students posting unprofessional content [such as depicted intoxication and sexually explicit material] and that 71% of U.S. state medical boards have investigated physicians for violations of professionalism online in 1 or more of these categories," the authors write (Barber, 1/15).