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  1. Article ; Online: The evolving sex, race, and ethnic composition of the surgical workforce: North Carolina is a bellwether of national change.

    Fraher, Erin P

    Surgery

    2021  Volume 170, Issue 4, Page(s) 1285–1287

    Abstract: Background: North Carolina, as a state with a significant Black population and fast-growing Hispanic population, serves as bellwether of demographic changes nationally and the challenges facing the nation to recruit and retain a general surgery ... ...

    Abstract Background: North Carolina, as a state with a significant Black population and fast-growing Hispanic population, serves as bellwether of demographic changes nationally and the challenges facing the nation to recruit and retain a general surgery workforce that mirrors the population.
    Methods: Annual licensure data from the North Carolina Medical Board were analyzed between 2004 and 2019. Physicians self-reporting a specialty of abdominal surgery, critical care surgery, colon and rectal surgery, general surgery, trauma surgery, proctology, and surgical oncology were categorized as general surgeons.
    Results: Female surgeons made the most gains from 2004, at just 8% of the workforce in 2004 to 26% of the workforce in 2019. Over the same period, Black surgeons increased from just 5% to 6% of the workforce, with those gains largely represented by Black female surgeons. Almost half of North Carolina's Black physicians are aged 46 and 55 and will be nearing retirement in the coming decade. Nearly two-thirds (64%) of Hispanic general surgeons were 45 or younger, and one-third of these young surgeons were international medical graduates.
    Conclusion: Although the general surgery workforce in North Carolina is slowly diversifying, growth in the Black surgeon workforce has stagnated in the last 15 years at levels much lower than their representation in the population. More research is needed on the individual and life course phenomena that drive this underrepresentation.
    MeSH term(s) Adult ; Aged ; Continental Population Groups ; Ethnic Groups ; Female ; Humans ; Male ; Middle Aged ; North Carolina ; Retrospective Studies ; Sex Factors ; Specialties, Surgical/trends ; Surgical Oncology ; Surgical Procedures, Operative/statistics & numerical data ; Workforce/trends
    Language English
    Publishing date 2021-03-20
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 202467-6
    ISSN 1532-7361 ; 0039-6060
    ISSN (online) 1532-7361
    ISSN 0039-6060
    DOI 10.1016/j.surg.2021.02.012
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  2. Article ; Online: Primary Care Teams: Past, Present and Future.

    Fraher, Erin P

    Journal of the American Board of Family Medicine : JABFM

    2020  Volume 33, Issue 4, Page(s) 495–498

    MeSH term(s) Family Practice ; Forecasting ; Interprofessional Relations ; Patient Care Team ; Primary Health Care
    Language English
    Publishing date 2020-07-16
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2239939-2
    ISSN 1558-7118 ; 1557-2625
    ISSN (online) 1558-7118
    ISSN 1557-2625
    DOI 10.3122/jabfm.2020.04.200260
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  3. Article ; Online: Lessons Learned From State-Based Efforts to Leverage Medicaid Funds for Graduate Medical Education.

    Fraher, Erin P / Rains, Jacob A / Bacon, Thomas J / Spero, Julie / Hawes, Emily

    Academic medicine : journal of the Association of American Medical Colleges

    2024  

    Abstract: Purpose: Total Medicaid funds invested in graduate medical education (GME) increased from $3.78 billion in 2009 to $7.39 billion in 2022. States have flexibility in designing Medicaid GME payments to address population health needs. This study assessed ... ...

    Abstract Purpose: Total Medicaid funds invested in graduate medical education (GME) increased from $3.78 billion in 2009 to $7.39 billion in 2022. States have flexibility in designing Medicaid GME payments to address population health needs. This study assessed states' impetus for using Medicaid funds for GME, structure of state Medicaid payments, composition and charge of advisory bodies that guide these investments, and degree of transparency and accountability to track whether Medicaid GME investments achieved desired workforce outcomes.
    Method: Structured interviews were conducted in 2015 to 2016 and 2020 to 2021 with subject matter experts representing 10 states. Interview transcripts were analyzed and coded in 6 thematic areas: impetus for using Medicaid funds, the structure of state Medicaid payments, the composition of advisory bodies, the degree of transparency of Medicaid investments, accountability of Medicaid investments, and challenges and changes.
    Results: States used Medicaid GME funding to address maldistribution of physicians by geography, setting, and specialty, respond to population growth and undergraduate medical education expansion, offset potential loss of teaching health center program funds, and launch new programs and sustain existing ones. States leveraged Medicaid funding by modifying state plan amendments and redesigning funding formulas to meet specific health workforce needs. Many states had advisory bodies to educate legislators, reach consensus on workforce needs, recommend how to disburse funds, and navigate competing stakeholder interests. States identified a need for improved data and analytic systems to understand workforce needs and monitor the outcomes of GME investments. Determining which accountability measures to use and implementing metrics were challenges.
    Conclusions: States have much to learn from each other about strategies to best leverage Medicaid funds to develop and sustain residency programs to meet population health needs. Learning collaboratives should be developed to provide a forum for states to share best practices and strategies for overcoming challenges.
    Language English
    Publishing date 2024-02-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 96192-9
    ISSN 1938-808X ; 1040-2446
    ISSN (online) 1938-808X
    ISSN 1040-2446
    DOI 10.1097/ACM.0000000000005678
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  4. Article ; Online: The value of workforce data in shaping nursing workforce policy: A case study from North Carolina.

    Fraher, Erin P

    Nursing outlook

    2017  Volume 65, Issue 2, Page(s) 154–161

    Abstract: Background: In 2015, the Institute of Medicine's Committee for Assessing Progress on Implementing the Future of Nursing recommendations noted that little progress has been made in building the data infrastructure needed to support nursing workforce ... ...

    Abstract Background: In 2015, the Institute of Medicine's Committee for Assessing Progress on Implementing the Future of Nursing recommendations noted that little progress has been made in building the data infrastructure needed to support nursing workforce policy.
    Purpose: This article outlines a case study from North Carolina to demonstrate the value of collecting, analyzing, and disseminating state-level workforce data.
    Methods: Data were derived from licensure renewal information gathered by the North Carolina Board of Nursing and housed at the North Carolina Health Professions Data System at the University of North Carolina at Chapel Hill.
    Discussion: State-level licensure data can be used to inform discussions about access to care, evaluate progress on increasing the number of baccalaureate nurses, monitor how well the ethnic and racial diversity in the nursing workforce match the population, and investigate the educational and career trajectories of licensed practical nurses and registered nurses.
    Conclusion: At the core of the IOM's recommendations is an assumption that we will be able to measure progress toward a "Future of Nursing" in which 80% of the nursing workforce has a BSN or higher, the racial and ethnic diversity of the workforce matches that of the population, and nurses currently employed in the workforce are increasing their education levels through lifelong learning. Without data, we will not know how fast we are reaching these goals or even when we have attained them. This article provides concrete examples of how a state can use licensure data to inform nursing workforce policy.
    MeSH term(s) Education, Nursing, Baccalaureate/statistics & numerical data ; Humans ; North Carolina ; Nurses/statistics & numerical data ; Nurses/supply & distribution ; Nursing/manpower ; Nursing/statistics & numerical data ; Personnel Management ; Workplace/organization & administration
    Language English
    Publishing date 2017-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 300568-9
    ISSN 1528-3968 ; 0029-6554
    ISSN (online) 1528-3968
    ISSN 0029-6554
    DOI 10.1016/j.outlook.2016.10.003
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  5. Article: Primary Care Clinicians in Low-Access Counties.

    Zolotor, Adam J / Galloway, Evan / Beal, Margaret / Fraher, Erin P

    North Carolina medical journal

    2022  Volume 83, Issue 3, Page(s) 163–168

    Abstract: Advanced practice providers comprise an increasing percentage of the health care and primary care workforce. This paper evaluates the weighted contribution of advanced practice providers to the primary care workforce in well-served and underserved ... ...

    Abstract Advanced practice providers comprise an increasing percentage of the health care and primary care workforce. This paper evaluates the weighted contribution of advanced practice providers to the primary care workforce in well-served and underserved counties across North Carolina using age- and sex-adjusted population measures of access.
    MeSH term(s) Delivery of Health Care ; Humans ; North Carolina/epidemiology ; Primary Health Care ; Workforce
    Language English
    Publishing date 2022-05-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 422795-5
    ISSN 0029-2559
    ISSN 0029-2559
    DOI 10.18043/ncm.83.3.163
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  6. Article ; Online: Where are the critical care nurses? A statewide analysis of actively practicing nurses' transitions out of the clinical area.

    Tran, Alberta K / Knafl, George J / Baernholdt, Marianne / Fraher, Erin P / Jones, Cheryl B

    Nursing outlook

    2023  Volume 71, Issue 3, Page(s) 101947

    Abstract: Background: Critical care nurse shortages and burnout have spurred interest in the adequacy of nursing supply in the United States. Nurses can move between clinical areas without  additional education or licensure.: Purpose: To identify transitions ... ...

    Abstract Background: Critical care nurse shortages and burnout have spurred interest in the adequacy of nursing supply in the United States. Nurses can move between clinical areas without  additional education or licensure.
    Purpose: To identify transitions that critical care nurses make into non-critical care areas, and examine the prevalence and characteristics associated with those transitions.
    Methods: Secondary analysis of state licensure data from 2001-2013.
    Discussion: More than 75% of nurses (n = 8,408) left critical care in the state, with 44% making clinical area transitions within 5 years. Critical care nurses transitioned into emergency, peri-operative, and cardiology areas. Those observed in recession years were less likely to make transitions; female and nurses with masters/doctorate degrees were more likely.
    Conclusion: This study used state workforce data to examine transitions out of critical care nursing. Findings can inform policies to retain and recruit nurses back into critical care, especially during public health crises.
    MeSH term(s) Humans ; United States ; Female ; Critical Care ; Licensure ; Burnout, Professional ; Educational Status ; Nurses
    Language English
    Publishing date 2023-03-24
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 300568-9
    ISSN 1528-3968 ; 0029-6554
    ISSN (online) 1528-3968
    ISSN 0029-6554
    DOI 10.1016/j.outlook.2023.101947
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  7. Article ; Online: Improving the Health of Rural Communities Through Academic-Community Partnerships and Interprofessional Health Care and Training Models.

    Fraher, Erin P / Lombardi, Brianna / Brandt, Barbara / Hawes, Emily

    Academic medicine : journal of the Association of American Medical Colleges

    2022  Volume 97, Issue 9, Page(s) 1272–1276

    Abstract: Health disparities between rural and urban areas are widening at a time when urban health care systems are increasingly buying rural hospitals to gain market share. New payment models, shifting from fee-for-service to value-based care, are gaining ... ...

    Abstract Health disparities between rural and urban areas are widening at a time when urban health care systems are increasingly buying rural hospitals to gain market share. New payment models, shifting from fee-for-service to value-based care, are gaining traction, creating incentives for health care systems to manage the social risk factors that increase health care utilization and costs. Health system consolidation and value-based care are increasingly linking the success of urban health care systems to rural communities. Yet, despite the natural ecosystem rural communities provide for interprofessional learning and collaborative practice, many academic health centers (AHCs) have not invested in building team-based models of practice in rural areas. With responsibility for training the future health workforce and major investments in research infrastructure and educational capacity, AHCs are uniquely positioned to develop interprofessional practice and training opportunities in rural areas and evaluate the cost savings and quality outcomes associated with team-based care models. To accomplish this work, AHCs will need to develop academic-community partnerships that include networks of providers and practices, non-AHC educational organizations, and community-based agencies. In this commentary, the authors highlight 3 examples of academic-community partnerships that developed and implemented interprofessional practice and education models and were designed around specific patient populations with measurable outcomes: North Carolina's Asheville Project, the Boise Interprofessional Academic Patient Aligned Care model, and the Interprofessional Care Access Network framework. These innovative models demonstrate the importance of academic-community partnerships to build teams that address social needs, improve health outcomes, and lower costs. They also highlight the need for more rigorous reporting on the components of the academic-community partnerships involved, the different types of health workers deployed, and the design of the interprofessional training and practice models implemented.
    MeSH term(s) Delivery of Health Care ; Ecosystem ; Hospitals, Rural ; Humans ; Rural Health Services ; Rural Population
    Language English
    Publishing date 2022-06-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 96192-9
    ISSN 1938-808X ; 1040-2446
    ISSN (online) 1938-808X
    ISSN 1040-2446
    DOI 10.1097/ACM.0000000000004794
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  8. Article ; Online: Bolstering the rural physician workforce in underserved communities: Are Rural Residency Planning and Development Programs finding the sweet spot?

    Fraher, Erin P. / Page, Cristen P. / Hawes, Emily M. / Galloway, Evan / Pathak, Shweta / Tomola, Lauren / Holmes, George M.

    The Journal of Rural Health. 2023 June, v. 39, no. 3 p.521-528

    2023  

    Abstract: ... RRPD counties were more populous (P<.01), had a higher population density (P<.05), and a higher percent ... of the non‐White or Hispanic population (P = .05) compared to non‐RRPD counties. Both higher population (P ... <.001) and PCP ratio (P = .046) were strong predictors, while SVI (P = .07) was a weak predictor ...

    Abstract PURPOSE: The purpose of this study is to describe the characteristics of Rural Residency Planning and Development (RRPD) Programs, compare the characteristics of counties with and without RRPD programs, and identify rural places where future RRPD programs could be developed. METHODS: The study sample comprised 67 rural sites training residents in 40 counties in 24 US states. Descriptive statistics were used to describe RRPD programs and logistic regression to predict the probability of a county being an RRPD site as a function of population, primary care physicians (PCP) per 10,000 population, and the social vulnerability index (SVI) compared to a control sample of nonmetro counties without RRPD sites. FINDINGS: Most RRPD grantees (78%) were family medicine programs affiliated with medical schools (97%). RRPD counties were more populous (P<.01), had a higher population density (P<.05), and a higher percent of the non‐White or Hispanic population (P = .05) compared to non‐RRPD counties. Both higher population (P<.001) and PCP ratio (P = .046) were strong predictors, while SVI (P = .07) was a weak predictor of being an RRPD county. CONCLUSIONS: RRPD sites appear to represent a “sweet spot” of rural counties that have the population and physician supply to support a training program but also are relatively more socially vulnerable with high‐need populations. Additional counties fitting this “sweet spot” could be targeted for funding to address health disparities and health workforce maldistribution.
    Keywords descriptive statistics ; labor force ; medicine ; population density ; probability ; regression analysis ; rural health ; socioeconomics
    Language English
    Dates of publication 2023-06
    Size p. 521-528.
    Publishing place John Wiley & Sons, Ltd
    Document type Article ; Online
    Note JOURNAL ARTICLE
    ZDB-ID 639160-6
    ISSN 0890-765X
    ISSN 0890-765X
    DOI 10.1111/jrh.12735
    Database NAL-Catalogue (AGRICOLA)

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  9. Article ; Online: The Evolving Role of Medical Assistants in Primary Care Practice: Divergent and Concordant Perspectives from MAs and Family Physicians.

    Fraher, Erin P / Cummings, Allison / Neutze, Dana

    Medical care research and review : MCRR

    2020  Volume 78, Issue 1_suppl, Page(s) 7S–17S

    Abstract: Medical assistants (MAs) are a flexible and low-cost resource for primary care practices and their roles are swiftly transforming. We surveyed MAs and family physicians in primary care practices in North Carolina to assess concordance in their ... ...

    Abstract Medical assistants (MAs) are a flexible and low-cost resource for primary care practices and their roles are swiftly transforming. We surveyed MAs and family physicians in primary care practices in North Carolina to assess concordance in their perspectives about MA roles, training, and confidence in performing activities related to visit planning; direct patient care; documentation; patient education, coaching or counseling; quality improvement; population health and communication. For most activities, we did not find evidence of role confusion between MAs and physicians, physician resistance to delegate tasks to properly trained MAs, or MA reluctance to pursue training to take on new roles. Three areas emerged where the gap between the potential and actual implementation of MA role transformation could be narrowed-population health and panel management; patient education, coaching, and counseling; and scribing. Closing these gaps will become increasingly important as our health care system moves toward value-based models of care.
    MeSH term(s) Allied Health Personnel ; Delivery of Health Care ; Humans ; North Carolina ; Physician Assistants ; Physicians, Family ; Primary Health Care
    Language English
    Publishing date 2020-10-19
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 1232314-7
    ISSN 1552-6801 ; 1077-5587
    ISSN (online) 1552-6801
    ISSN 1077-5587
    DOI 10.1177/1077558720966148
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  10. Article ; Online: Developing Physician Migration Estimates for Workforce Models.

    Holmes, George M / Fraher, Erin P

    Health services research

    2017  Volume 52 Suppl 1, Page(s) 529–545

    Abstract: Objective: To understand factors affecting specialty heterogeneity in physician migration.: Data sources/study setting: Physicians in the 2009 American Medical Association Masterfile data were matched to those in the 2013 file. Office locations were ... ...

    Abstract Objective: To understand factors affecting specialty heterogeneity in physician migration.
    Data sources/study setting: Physicians in the 2009 American Medical Association Masterfile data were matched to those in the 2013 file. Office locations were geocoded in both years to one of 293 areas of the country. Estimated utilization, calculated for each specialty, was used as the primary predictor of migration. Physician characteristics (e.g., specialty, age, sex) were obtained from the 2009 file. Area characteristics and other factors influencing physician migration (e.g., rurality, presence of teaching hospital) were obtained from various sources.
    Study design: We modeled physician location decisions as a two-part process: First, the physician decides whether to move. Second, conditional on moving, a conditional logit model estimates the probability a physician moved to a particular area. Separate models were estimated by specialty and whether the physician was a resident.
    Principal findings: Results differed between specialties and according to whether the physician was a resident in 2009, indicating heterogeneity in responsiveness to policies. Physician migration was higher between geographically proximate states with higher utilization for that specialty.
    Conclusions: Models can be used to estimate specialty-specific migration patterns for more accurate workforce modeling, including simulations to model the effect of policy changes.
    MeSH term(s) Adult ; Female ; Forecasting ; Health Manpower/statistics & numerical data ; Health Manpower/trends ; Human Migration/statistics & numerical data ; Human Migration/trends ; Humans ; Logistic Models ; Male ; Middle Aged ; Physicians/trends ; Primary Health Care/trends ; Rural Health Services/trends ; United States
    Language English
    Publishing date 2017-01-24
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 410435-3
    ISSN 1475-6773 ; 0017-9124
    ISSN (online) 1475-6773
    ISSN 0017-9124
    DOI 10.1111/1475-6773.12656
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