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Biomedical subjects

J M Geller

Publications and source records attributed to J M Geller.

15 recordsLinked to original sources
PubMed2001

Practice autonomy among primary care physician assistants: the predictive abilities of selected practice attributes.

The practice autonomy of primary care physician assistants (PAs) is of interest to those organizing, financing, and delivering health services. This study examined the predictive abilities of practice attributes with respect to multidimensional aspects of practice autonomy (clinical decision making and prescriptive authority) in primary care PAs. A sample of 225 practicing PAs was used to construct the 16-item Physician Assistant Autonomy of Practice Instrument (PAAPI), which includes three subscales, routine prescriptive authority, advanced prescriptive authority, and clinical decision making. All were used as dependent variables in multiple regression analyses. The most significant correlates of practice autonomy included years in practice as a PA, years in practice with supervising physician, annual income from practice, recognition as the exclusive primary care provider for patients, primary practice in a rural county, and primary employment setting (single-specialty group practice). More primary care PAs continue to be used in under-served rural areas and in managed care. Organizational structure of the work setting may influence these PAs' practice autonomy.

Adult↗
PubMed2000

The effects of clinical decision making on nurse practitioners' clinical productivity.

The degree of clinical decision making and clinical productivity among nurse practitioners (NPs) is of great interest to policy makers and planners involved in providing appropriate outpatient primary care services. The authors performed a statewide mailed survey of all NPs practicing either full-time or part-time in Wisconsin (response rate of 72.1%) to address the following research questions: Do the demographic characteristics, practice attributes, and primary practice settings of NPs impact their level of clinical decision making (e.g., the autonomy to order laboratory and radiological tests or to refer a patient to a physician specialist other than their collaborating physician)? Do NPs' levels of clinical decision making correlate with their outpatient clinical productivity, adjusting for demographic characteristics, practice attributes, and primary practice settings? The multiple linear regression results indicated that having more years in practice as an NP, practicing in the family specialty area (vs. a combined other category, which included pediatrics, acute care, geriatrics, neonatal, and school), treating patients according to clinical guidelines, practicing in settings with a fewer number of physicians, and practicing in a multispecialty group practice versus a single-specialty group practice were associated with greater levels of clinical decision making. However, NPs who primarily practiced in a hospital/facility-based practice, as compared with a single-specialty group practice, had lower levels of clinical decision making. After adjusting for demographic characteristics, practice attributes, and primary practice settings, NPs with greater clinical decision-making authority had greater outpatient clinical productivity. The conclusions discuss the policy implications of the findings.

Decision Making↗
PubMed1998

Job satisfaction among rural physician assistants.

Because increasing numbers of physicians are being trained in specialized medicine, health professional shortage areas remain common in the United States, and the role of physician assistants (PAs) in health services provision is becoming increasingly important, especially in rural and underserved areas. By most accounts, there is a shortage of PAs in the United States, particularly in rural areas. A nationwide survey was conducted in 1994 to determine what attracted PAs to rural settings and what they found satisfying about their work and community. This study involved a random sample of 1,263 PAs who practiced in rural (nonmetropolitan) areas of the United States. A 15-item scale was developed to measure job satisfaction. A statistical model was tested for its ability to predict levels of job satisfaction using multiple regression analysis. Independent variables included demographics, practice, and community factors. Findings indicated that rural PAs were generally satisfied with their work. The most significant predictors of satisfaction included practice factors (e.g., importance of autonomy and a good relationship with the supervising physician), extent of practice responsibilities (e.g., regular and on-call hours and the percentage of PAs' patient load that was not discussed with the supervising physician), and community factors (e.g., community satisfaction).

Adult↗
PubMed1998

A comparison of practice characteristics among physician assistants in HMO and non-HMO settings.

Health maintenance organizations (HMOs) have continued to grow in both number and enrollment. A major goal of HMOs and other managed care structures is the containment of health care costs. The utilization of physician assistants (PAs) would seem to nicely mesh with these organizations. This study examines the roles, productivity, and clinical autonomy of PAs in HMO settings. In this examination, PAs working with HMOs are compared with PAs working in non-HMO settings, both urban and rural. The results of the study document that PAs working in HMO environments primarily focus on ambulatory care, with few inpatient or administrative responsibilities. Further, PAs working in HMO settings have a highly autonomous practice with approximately 70 percent of patient visits never being discussed with a supervising physician. Lastly, the results suggest that many of the attributes of an HMO practice are found in rural practice as well. Consequently, as HMOs reach out farther into rural America, PAs in rural settings will have fewer practice modifications to make than urban PAs in their transition to practice in an HMO modality.

Adult↗
PubMed1997

Restrictive practice environment and nurse practitioners' prescriptive authority.

This study analyzes the impacts of several variables, including a restrictive practice environment, on a nurse practitioner's level of autonomy with respect to prescribing selected categories of medicines. A general linear model is applied to data from the 1992 national sample of nurse practitioners. Results show that among the significant independent variables, a restrictive environment of imposed state laws and regulations reduces nurse practitioners' level of autonomy in prescribing medications and acts as a barrier to their practicing to full potential. Results and policy implications are discussed.

Drug Prescriptions↗
PubMed1996

Predicting the degree of rurality of physician assistant practice location.

This study used a block multiple regression analysis to examine the impacts of different factors on the degree of rurality of physician assistants' (PAs') practice location and compared the power of each block of factors in predicting rurality. Differences in the models for PAs in primary care specialties and for PAs as a whole were also explored. The findings suggest that policies should provide support to PA students in primary care specialties and to rural-oriented PA education/training programs. Efforts to facilitate PA recruitment and retention should include, among other things, increasing practice responsibility/autonomy, broadening acceptance of PA prescriptive authority, and providing equitable reimbursement for nonphysician care of Medicare and Medicaid beneficiaries.

Career Choice↗
PubMed1995

Retainment incentives in three rural practice settings: variations in job satisfaction among staff registered nurses.

Researchers have demonstrated repeatedly the importance of the relationship linking job satisfaction to employee retention. In rural areas of the country, where a persistent maldistribution of nurses continues to hamper health care delivery, the potential benefits of bolstering retention via enhancements in job satisfaction are of utmost utility to administrators and providers alike. Data were gathered from a multistate survey of registered nurses (RNs) practicing in rural hospitals, skilled nursing facilities, and community/public health settings (N = 1,647; response rate = 40.3%). The investigators found that the use of tuition reimbursement corresponded significantly with increased levels of job satisfaction among nurses in all three practice environments, as did day care services for nurses in acute care settings. Also, among hospital-based RNs, level of nursing education was found to be a significant factor in the relationship between tuition reimbursement and job satisfaction, with the highest level occurring among diploma-prepared nurses.

Career Mobility↗
PubMed1995

A logit analysis of the likelihood of leaving rural settings for registered nurses.

This study examined the net effects of individual and community factors on the likelihood of registered nurses leaving current jobs using a logit analysis. Based on data from a survey of 2,509 rural nurses, four separate models were estimated and compared: one for nurses in rural settings as a whole and the other three for nurses in hospitals, skilled nursing facilities, and community/public health agencies. Results of the general model indicated that nurses' marital status, age, position, income, job satisfaction, and satisfaction with the community were significant determinants of the likelihood of leaving current jobs. Job satisfaction was the most significant factor, followed by satisfaction with the community. Findings from the models for three different employment settings were similar to those of the general model. However, the significance of factors and their strength of effect on nurses' decisions to leave or stay in their current jobs differed across the three types of facilities. Based on these findings rural nursing administrators and policy-makers should give priority to retention strategies that focus on improving the job environment. The development of different strategies for different groups of nurses (i.e., by age or marital status) and different types of facilities should increase the benefit/cost ratio. In addition, programs that involve rural health care agencies in community and economic development should be further explored as an avenue to increased nurse retention in rural areas.

Adult↗
PubMed1993

Recruiting registered nurses to rural practice settings: an assessment of strategies and barriers.

It has been suggested that in rural settings, the primary difficulty that faces nursing administrators is recruitment of registered nurses (RNs). This study examines the impact of recruitment strategies and barriers by comparing and contrasting corresponding RN full-time equivalent (FTE) vacancy rates. Data were gathered from a multistate telephone survey of directors of nursing (DONs) practicing in rural hospitals, skilled nursing facilities (SNFs), and public health settings (N = 556, response rate = 89.5%). The investigators found that DONs who perceived scheduling amenities and autonomy enhancements corresponded with RN FTE vacancy rates that were most reduced from the mean of the overall sample. Regarding recruitment barriers, geographic locale/isolation and job-related factors corresponded with RN FTE vacancy rates that were most elevated from the overall sample mean.

Humans↗
PubMed1992

Nursing supply and characteristics in the nonmetropolitan areas of the United States: findings from the 1988 National Sample Survey of Registered Nurses.

This study examines the supply and selected characteristics of nurses working in nonmetropolitan areas of the United States using the most recent data reported in the third national sample survey of registered nurses in 1988. Nursing supply is analyzed in terms of the ratio of registered nurses per 100,000 people for three standard nonmetropolitan census county size classifications and nine regional groupings of states. Seven dimensions relating to the educational background and current professional characteristics of registered nurses are studied. Findings indicate a notable difference in the ratio of nurses per population across county size and regions of the country. In terms of characteristics selected for this study, the educational background, salary gap, and time spent in various activities differentiate nurses in rural areas from those working in urban counties. Results of this study should be particularly relevant because a variety of educational, financial, and other incentives are being considered to address what is perceived to be a crisis in rural nursing availability.

Data Collection↗
PubMed1991

Effects of an expanded medical curriculum on the number of graduates practicing in a rural state.

In 1973 the University of North Dakota School of Medicine (UNDSM), following the national trend toward four-year medical programs, expanded its previous two-year medical school curriculum to include all four years of medical education. It was hoped that this change, along with a renewed emphasis on primary care-oriented residency training within the state, would encourage medical students to establish practices within the state. In 1985 the UNDSM's Center for Rural Health mailed questionnaires to the 2,230 living graduates of the UNDSM to document a variety of their personal and practice characteristics. Based on the responses to the 924 completed questionnaires, the authors found that (1) the students from rural North Dakota were more likely than were urban students to practice in rural areas of the state, as were the students with primary care specialty training; and (2) the alumni completing residencies in North Dakota following the curriculum expansion (1976-1985) were more than twice as likely to establish practices in North Dakota. It was concluded that recruiting medical students (preferably in-state "natives") from rural areas, training them in primary care specialty areas, and enabling them to remain in North Dakota for the duration of their medical training (including residency training) combined to exert a considerable "retaining" effect on the UNDSM alumni.

Curriculum↗
PubMed1991

Recruiting and retaining registered nurses in rural community hospitals. Some administrative assessments.

The costs and impacts associated with the recruitment and retention of nurses are substantial. In rural areas, these efforts are hampered by the recurring maldistribution of available nurses away from such environments. Based on a survey of 195 directors of nursing (DONs) practicing in rural community hospitals, the authors compare administrative assessments of recruitment and retention efforts of DONs practicing in various-sized rural facilities. Current full-time equivalent registered nurse staff vacancy rates are also reported in relation to these differing assessments.

Costs and Cost Analysis↗
PubMed1990

Rural physicians' market share retention.

In sparsely populated rural communities, the need to retain market shares for local providers has become increasingly important. Using data from the ARCH (Affordable Rural Coalition for Health) demonstration project, this study demonstrates the importance of information and the image of services for the retention of local clientele in rural communities. The unaware tend to migrate for health care to referral centers where needed services can be assumed present.

Colorado↗
PubMedDate not supplied

Understanding the interactions between physician assistants and their supervising physicians in the provision of patient care.

A great deal of discussion and debate has surrounded the issue of autonomy of practice among physician assistants (PAs) and other non-physician clinicians. This study further explores this issue by closely examining the interactions between PAs and their supervising physicians in the provision of patient care. Utilizing a national sample of 1,112 full-time practicing physician assistants, PA-MD interaction patterns are measured and weighted in a scale as a proxy for autonomy of practice. Further, these measures are then used as the dependent variable in a regression analysis to better explain the dynamics between PA personal and practice characteristics and autonomy of practice. Overall, the tested model explained 29% of the variation in PA-MD interaction patterns. Independent variables that were particularly influential in the model were proximity to supervisor, clinical productivity, the percentage of PA patients treated using written clinical guidelines, specialty of practice, and practice setting.

Humans↗