Meeting new health care service needs

As health care changes hit the workplace, nurse managers and paramedics have the opportunity to obtain more academic credentials and training here in Rhode Island this year and in the near future.
Likewise, physician assistants and medical-laboratory technicians are positions not only in demand in the marketplace, according to the U.S. Department of Labor’s Bureau of Labor Statistics’ Occupational Outlook Handbook, but sought after by students, for whom new training programs are being made available now, educators say.
Nowhere is the workplace demand more in evidence than through a certificate of graduate studies in nursing-care management being offered this fall in Rhode Island College’s School of Nursing. The program was developed this past spring and summer and began this fall in response to a need for practicing nurses to manage groups of high-risk patients coming out of nursing homes or coping with high-risk conditions, including diabetes.
Through the Rhode Island Care Sustainability Initiative, which promotes a patient-centered medical-home model of care, physicians’ offices more than ever need someone who can manage patient groups with these types of conditions and manage electronic medical records, says Susanne Campbell, CSI-RI’s senior project director.
As CSI-RI began to employ nurses as care coordinators within the past year, recalled Jane Williams, RIC’s dean of nursing, “even though they hired very experienced, expert nurses, there was a need for professional development, particularly of management skills. The new environment is calling for them to expand their skill set.”
Campbell confirmed that assessment.
Within a few months, RIC put together the graduate nurse management program in which 10 registered nurses who have their bachelor of science in nursing degree are taking five courses for 15 credits, Williams said.
“You need the clinical background and understanding of the patient care experience and disease process, which the nurses did have,” Williams said, “but you also need management and leadership skills.”
While there are no statistics on the growing need for nurse managers, openings for registered nurses are projected to have the second-highest growth rate through 2022, after personal-care aides, and are projected to grow by 526,800 new jobs in that time, bringing the national total to more than 2.7 million, according to the BLS’s Occupational Outlook Handbook. The median pay for the job in 2012 was $65,470, the handbook states. As the baby boomer population ages and needs more care – and many boomers who work in the health care system “age out” and retire – the need to expand training for health care practitioners intensifies, say educators from schools as diverse as the New England Institute of Technology, the Roger Williams University School of Continuing Education and Brown University.
That’s why, in addition to new courses this year for emergency medical technicians and paramedics, RWU’s School of Continuing Education will be offering up to three new certificates in 2015-16, along with the state’s first bachelor’s degree in emergency medical services, says Dean Jamie Scurry.
The certificates cover gerontology, paralegal and social and health services, and nursing home administration, she said. The latter two would be post-graduate programs, she added.
Particularly with regard to paramedics, the work in the field is changing, said Michael DeMello, program director of Emergency Medical Services Professions at RWU’s School of Continuing Studies.
“Mobile integrated health care teams are gaining traction,” he said.
As more people seek treatment more often, in part because they may have insurance through the Affordable Care Act, EMTs and paramedics are doing more than transporting a patient to a hospital emergency room, DeMello said.
“Now, we’re looking at paramedics following up with people post operatively – not taking the place of visiting nurses but easing readmissions by making sure people are following their discharge instructions,” he said.
The R.I. Department of Health is interested in seeing additional training and credentialing for these workers, said DeMello. Jason Rhodes, the state’s chief paramedic, could not be reached for comment.
“There’s been a demand from students and in the marketplace [for more training],” said DeMello. “You’re seeing emergency rooms overburdened and the people being served are very different from those being served before. [The state] is looking for [EMTs and paramedics] with multiple layers of competency: community development, leadership and being adaptable.”
As these programs grow, physician-assistant programs like the one just introduced this past June at Johnson & Wales University and one starting in January at Bryant University are finding wide demand here in Rhode Island and regionally.
The JWU program has 23 students, culled from a field of more than 1,000 applicants, said JWU Physician Assistant Program Director George Bottomley. The Bryant program has accepted 32 students from a field of 400, said its director, Robert Jay Amrien. The trend is for primary care physicians, who are in short supply, to lead teams of caregivers that include physician assistants, they said. “I think there’s absolutely room for both programs in the state,” said Amrien. “There’s a definite need for [physician assistants], primary care physicians and nurse practitioners. There’s going to be a growing need for primary health care under [the Affordable Care Act]. More people will have health insurance, but having a health insurance card doesn’t give you any greater opportunity to get care if there’s no one to see.”
JWU is also adding a biology bachelor’s degree in the fall of 2015, which – while not a prerequisite for the physician-assistant program – is “designed as a credible path to the PA,” said Laura J. Galligan, JWU’s assistant dean of the College of Arts and Sciences. In researching the topic, Galligan does not look at popularity per se but degrees that provide lifelong career growth.
“We know there is strong interest from graduating high school seniors as a group,” Galligan said. “We have found compared to other majors the unemployment for new biology grads is lower. They can make $40,000, go on to grad school and double that.”
Nationally, President Barack Obama’s goal to focus on science, math, engineering and technology and increase the number of life science graduates constitutes “an economic imperative [that] provides strong career growth [potential],” she said.
New England Institute of Technology’s new associate science degree in medical laboratory technology – the behind-the-scenes analysis of blood or bodily fluids after they are collected – began with 17 students Oct. 6 and could take up to 20, said Rebbecca Silva, chairperson of the department.
In the 18-month program, students will learn the technical skills and then, in the last two quarters, go into a clinical practicum at a hospital or private lab, she said.
“This program is really important for physicians, because they make about 80 percent of their decisions for diagnosis, treatment and monitoring of disease based on lab results,” said Silva. “In this area, there is a much older population currently working and in the next five years about 50 percent or more will be retiring nationally.” Steven H. Kitchin, NEIT’s vice president of corporate education and training, said the new program prepares students for today’s competitive labor market, in which this workforce is predicted to experience “above-average demand” due to attrition and the aging population.
In fact, the forecast is for a growth rate of 22 percent, with an increase of 70,600 jobs seen by 2022, according to the Occupational Outlook Handbook.
Growth in educational health care programming is also in evidence at both the Warren Alpert Medical School at Brown, and at the university’s School of Public Health.
Starting in the fall of 2015, the medical school will offer a new medical and master of science (M.D./Sc.M) degree in primary care and population medicine that helps develop physicians who can become leaders in community-based primary care.
The degree will focus on practical aspects of being a physician in the health care system and leading teams of health practitioners, according to Dr. Allan Tunkel, associate dean for medical education, and Dr. Paul George, director of second-year curriculum and director of the primary care population at Alpert.
“We know there is a tremendous shortage of primary care physicians,” said Tunkel. “By 2020, a shortage of 90,000 [primary care physicians] in the U.S. [is predicted]. Hopefully in this program we will be filling an important need to take care of citizens in the U.S.”
The goal, Tunkel and George said, is to create future leaders in medicine: physicians who will see patients but also lead as medical directors of large practices or academics or leaders in state departments of health.
“The jobs are out there, they’re popping up as health care changes, but the people filling them now weren’t trained for those positions,” George said.
At Brown’s School of Public Health, new programming this year includes a Ph.D. in behavioral and social sciences, as well as a broad-based new curriculum for undergraduates that includes new courses in biostatistics and epidemiology.
“We recognized there’s been a major growth and interest among the students, and we wanted to make sure we were offering courses that were really preparing them for grad school or the workforce with good, quantitative skills,” said Fox Wetle, the school’s dean, referring to the curriculum changes.
Of the 275 students taking public health courses of some kind, about 100 are “concentrators” majoring in public health, she said.

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