News Release: MDH report highlights need for retaining and recruiting health care workforce

Results from a Minnesota Department of Health survey confirm health care worker burnout and show workforce shortage trends are affecting a wide range of health care professionals.

The report, Minnesota’s Health Care Workforce: Pandemic-Provoked Workforce Exits, Burnout, and Shortages (PDF), is the first report of its kind covering the effects of the pandemic on most of the licensed health care workforce in Minnesota. It is based on the MDH health care workforce survey, which is administered at the time of license renewal for “front-line” providers including physician assistants, respiratory therapists, pharmacists, nurses, physicians, mental health providers and others.

The survey data indicates alarming projected workforce losses in Minnesota’s small towns and rural areas. Nearly 1 in 5 rural health care providers say they plan to leave their profession within the next five years. The largest projected losses are among physicians. One out of every 3 rural physicians report planning to leave their profession within the next five years.

“We are going to need several approaches and solutions aimed at both recruiting the future workforce and retaining the current one,” said Minnesota Commissioner of Health Jan Malcolm. “We in government and health care must do more to prioritize retention, work with educational institutions to expand clinical training opportunities, and focus more broadly on the care team, including nurses, physicians, physician assistants, respiratory therapists and others.”

Providers are seeing workforce shortages across Minnesota. The report found that vacancies have increased in nearly all health professions since their pre-pandemic levels, in some cases dramatically. The largest increases are in mental health and substance abuse counseling occupations, where 1 in 4 jobs is currently vacant and open for hire.

In nearly every profession, more providers than in prior years reported that they planned to leave their profession within the next five years, and a much higher share of these exits is due to burnout.

While burnout among nurses has been widely recognized, other providers are also struggling. Burnout or job dissatisfaction accounted for 26% of all physician assistant workforce exits, and 22% of respiratory therapy exits.

The report identifies potential solutions including retaining the incumbent workforce through programs such as loan forgiveness for health care providers, career exploration initiatives for new and dislocated workers, and programs aimed at increasing the diversity of the workforce. Employers can also focus on overcoming the hiring challenge by making health care jobs safe, flexible, well-paid and family-friendly.

Current legislative proposals aim at revitalizing our health care workforce. They include launching rural clinical training tracks to create a pipeline of primary care physicians and psychiatrists trained in greater Minnesota; funding to expand rural rotations and clinical training opportunities for pre-licensure nurse practitioners, physician assistants, behavioral health students and dental graduates; and financial supports to mental health providers to pay for the supervised training they are required to complete before becoming licensed to practice.  These efforts are designed to develop a continuous pipeline of health care professionals in high-need fields to ensure the health and economic vitality of rural areas.

The Walz-Flanagan Budget to Move Minnesota Forward also includes the following proposals:

Revitalize Our Health Care Workforce - The pandemic has highlighted the importance of investing in our health care workforce. Investing in this high-need career area is vital for the future health of our state. The governor and lieutenant governor’s budget makes critical investments in the health care workforce, building on recent programs like free certified nursing training and the Minnesota Future Together Grant, both of which provide tuition-free pathways for students in high-need career areas.

Recognize Frontline Workers - The Walz-Flanagan Budget to Move Minnesota Forward recommends $1 billion to provide payments to frontline workers who have sacrificed during the pandemic to keep Minnesotans safe, healthy, fed and cared for. This proposal would provide $1,500 payments to an estimated 667,000 workers, including health care, child care, school, grocery store, food service, transportation, long-term care, building service, public safety, retail and manufacturing workers. These frontline worker payments recognize the essential work of Minnesotans who have risked their health and continue to provide the vital services needed to keep our state running during this pandemic.

Support Minnesota’s Caregiver Workforce - Governor Walz has proposed more than $250 million to address the workforce shortage, including an incentive program that would provide retention and bonus payments for workers who join and stay in the caring professions, including those who provide care for people with disabilities, older adults, people with behavioral health needs and people experiencing homelessness. Critical workforce shortages in these sectors have deepened during the pandemic and pose a threat to the health, independence and stability of Minnesotans who rely on it.

The report is available at Health Care Workforce Reports and Presentations.

-MDH-

Capito (R-WV) and Amy Klobuchar (D-MN).  You will recall that this was one of two bills for which you encouraged support during your virtual Hill visits on March 24.  Many of you had been in contact with Senate offices who were very interested in learning more about the cardiac rehab bill once it had been introduced.  If that was you, you should now follow up with them and let them know that the Senate companion, S. 1986, has been introduced and is awaiting bi-partisan cosponsors.  You can read AAPA’s updated fact sheet here, and the official press release from Sen. Capito here.  

This summer will be a good time to touch base with those offices you met with, and encourage their support on both the cardiac rehab and the diabetic shoes bills (still waiting for the House companion to the diabetic shoes bill to be introduced).  AAPA has a toolkit to help PAs and students take advantage of summer district work periods.  You can find the tool kit here.

Read the complete AAPA update here.

For Title Change Investigation FAQs, please visit the AAPA website here.

For more information, log onto your NCCPA record at www.nccpa.net.

NCCPA understands that things can happen and have policies in place to help in specific situations. If you need to request an exception to policy (ETP) or extension of certification maintenance requirements, you can sign in to your online record to submit an ETP. For more information visit:  https://www.nccpa.net/Legal

As we eagerly await the official release of information from the Board of Medical Practice (BMP) on August 1st, it is vital that Minnesota PAs remain informed, and MAPA is here to provide updates as information becomes available. A few key points to know regarding the changes afforded in Senate File 13:

1. As of August 1, 2020, PAs will no longer require a specific supervisory relationship with a single physician.
2. The scope of practice, per the new law, is determined based on the PAs education, training and experience and established at the practice level in a practice agreement. This includes prescriptive practice. There is no delegation agreement for the scope of practice required for PAs in MN after July 31, 2020.
3. There is no immediate change that needs to occur for PAs already practicing:
   • The current delegation agreements can serve as the practice agreement until each organization determines how they would like to administer the practice agreement requirement.
   • Hospital systems and practices have time and flexibility to create the practice agreement in a format as they choose – such as using a formal job description or allowing credentialing and privileging processes to serve as their agreement. The Board of Medical Practice does not have the authority to define the terms of the practice agreement and it does not need to be filed with the Board. Per the law, the practice agreement must be reviewed annually by a licensed physician and a record of that review must be maintained at the practice level. It will only need to be submitted to the board upon request.
4. New graduates will need to have in their practice agreement a formal collaborative practice process for the first 2080 hours acknowledging that a Minnesota licensed physician is aware of and overseeing their practice in some formal way.This does not mean they must be on-site.There is no chart co-signature requirement, and no formal paperwork needs to be filed with the BMP regarding what this collaborative arrangement is.
5. After a new graduate completes the 2080 hours they will sign an affidavit form (currently being developed by the BMP) that attests to completion of the required 2080 collaborative practice hours.This will not need a co-signature and will not need to be notarized.

MAPA is awaiting the release of all information from the BMP to create intentional communications with invested stakeholders - including MN Licensed PAs, health systems, physicians and employers.The reduction in administrative burden will improve PAs abilities to see patients, allow PAs to practice at the top of their license and experience, as well as increase the flexibility of team-based care delivery and improve the ability to hire and employ PAs.  Information and forms will be available after August 1st on the Board of Medical Practice website.

View our updated page with more information here >>

What does the MN PA Practice Modernization Act (SF 13) accomplish?

• Removes the supervisory agreement:
  • PAs will no longer be required to be attached to a single physician in order to practice

•  Removes the delegation of scope of practice:
  •  Scope of practice is now established based on the PAs individual education, experience and training and determined at the practice level
  •  Prescriptive authority is now established in statute and no longer has to be delegated

•  Removes the location notification – no longer needed to begin practice.
• Removes the burden on physicians that practice with PAs, by eliminating the supervisory liability – which will save healthcare costs.
•  Maintains parity of practice for PAs in the healthcare marketplace by regulating PAs with similar standards as our APRN colleagues and removing burdensome paperwork that confuses hiring authorities.

What this bill DID NOT do:

• Create independent practice - there is an annual review requirement of the practice agreement by a MN licensed physician, completed at the practice level
• Change the way PAs are licensed or regulated – this still occurs through the MN Board of Medical Practice
• Change any educational or certification standards
• Remove the need for a collaborating physician – this requirement may still exist for some insurance plans, including Medicare and Medicaid as PAs do not have direct reimbursement:
  • This is a federal issue that AAPA has been working on for 5+ years

The changes within the PA Modernization Act will allow PAs to be more easily employed, as well as more flexible members of the medical workforce thereby improving access to care. The removal of the “single physician to PA tether” will result in significant cost saving thus reducing the overall cost of healthcare.

More information will follow in the next few months as the Board of Medical Practice makes determinations for how processes of PA licensure will change as a result of this bill. It is important to note this does not take effect until August 1, 2020, please renew your current license as usual and make sure your delegation agreements are up to date for the last time ever. 

MAPA Membership matters – please tell all your colleagues what has been accomplished.

Video Below: MAPA Legislative Co-Chair Leslie Clayton Milteer, PA-C, MPAS, DFAAPA

MDH encourages providers to continue vaccinating patients during this pandemic. We have put together a fact sheet for providers with guidance and tips for helping to provide a safe environment for patients and staff while continuing to provide vaccinations. See Pediatric Vaccination During COVID-19 on the MDH Immunization website (www.health.state.mn.us/immunize). Guidance for adult vaccination will be coming soon.

Because of personal, practice, or community circumstances related to COVID-19, some providers may not be able to provide well-child visits, including giving vaccinations, for all patients in their practice. If a practice can provide only limited well-child visits, we encourage providers to:

• Prioritize newborn care and vaccination of infants and young children (through 24 months of age).
•  Serve children from age 2-6 years in need of vaccinations for child care or school requirements as the next priority group.

Please refer to this attached handout for more information.

ACIP Update

Ebola: An Ebola vaccine was licensed in December 2019. ACIP voted to recommend Ebola vaccine for persons 18 years and older who are at risk of Ebola infection because they are:

1.       Ebola responders,

2.       Persons working in Ebola-specialized hospitals in the U.S., and

3.       Persons working in Biosafety Level 4 (BSL4) facilities. 

Influenza: Discussion included an epi update, vaccine efficacy update - 45% overall, a manufacturer presentation on the quadrivalent adjuvanted vaccine, and safety data comparing adjuvanted and high-dose vaccines.  The comparison study showed similar rates of side effects and no vaccine-related serious adverse events in either product.

Rabies: A discussion on a proposal for a 2-dose pre-exposure prophylaxis schedule had the committee asking for more data before considering a change to the recommendation.

Dengue Fever: ACIP heard about knowledge, attitude and belief surveys among Puerto Rican parents. In particular, parents were asked about the vaccines acceptability given that safety is tied into diagnostics of previous infection.

Update provided by the Minnesota Department of Health

Health officials stress importance of vaccination, especially during pregnancy

Minnesota health officials have confirmed an infant death related to pertussis, also known as whooping cough. The infant was diagnosed with pertussis in August 2019 and died in November after being hospitalized for three months. The last pediatric death related to pertussis in Minnesota was in 2013.

“We were extremely saddened to hear that this child passed away,” said Kristen Ehresmann, director of infectious disease at the Minnesota Department of Health (MDH). “Pertussis continues to be a concern in Minnesota, and we want to do everything we can to prevent future tragedies like this.”

Anyone can get pertussis, but it is most severe in infants. Preliminary data for 2019 shows there were 25 cases of pertussis in infants less than 6 months old in Minnesota. Of those, eight were hospitalized, and two of the hospitalized cases were severe.  

“Infants who get pertussis can get very sick and many need to be hospitalized,” said Ehresmann. “The severe cases often require lengthy hospital stays with weeks to months in an intensive care unit. It can be devastating for the family.”

Health officials are emphasizing the importance of vaccination, especially during pregnancy, to help prevent pertussis. The tetanus, diphtheria and acellular pertussis, or Tdap, vaccine is recommended during the third trimester of each pregnancy. This recommendation has been around since 2012.

Ehresmann explained that when the Tdap vaccine is given during pregnancy, the mother’s body creates antibodies to fight off the pertussis bacteria. Some of those antibodies are passed to the baby before birth and offer short-term protection until the baby can start to receive their own vaccines.

In 2018 and 2019, Minnesota had 41 cases of pertussis among infants less than 6 months of age. Upon review, only 18 (44%) of the mothers received Tdap during pregnancy.

“We’re missing opportunities to vaccinate during pregnancy and protect vulnerable infants from a serious disease,” said Ehresmann. “We are working with partners to make sure health care providers and pregnant women have the information they need to ensure on-time vaccination with this safe and effective vaccine.”

Many infants who get pertussis are infected by older siblings, parents or other caregivers. These people often do not know they have the disease because symptoms can be less severe in adolescents and adults.

There are two pertussis vaccines, and your age determines when you get each vaccine. The diphtheria, tetanus and acellular pertussis, or DTaP vaccine, is given to children starting at age 2 months. The Tdap vaccine is given to adolescents at age 11-12 years and adults. Families should talk to their health care provider to see what vaccines they need and when. People who have completed some or all of the recommended vaccinations for pertussis may still get the disease but will generally have a milder illness.

Read the Full Article here

WHEREAS: Rural health professionals, hospitals, and clinics in Greater Minnesota are dedicated to delivering high-quality and community-centered care to all Minnesotans; and

WHEREAS: Rural hospitals and health systems are often major employers and economic drivers of rural communities and regions; and

WHEREAS: Emergency medical services are vital in rural Minnesota because time­ critical lifesaving care is needed across wide regions with limited access to definitive critical care; and

WHEREAS: Meeting the health care needs of Minnesota's rural citizens requires commitment, innovation, and resourcefulness that reach across and beyond geographic boundaries or demographic challenges; and

WHEREAS: National Rural Health Day will be celebrated throughout the United States on November 21, 2019.

NOW, THEREFORE, I, TIM WALZ, Governor of Minnesota, do hereby proclaim Thursday, November 21, 2019, as:

 RURAL HEALTH DAY

SIGNATURES:

IN WITNESS WHEREOF, I have hereunto set my hand and caused the GREAT Seal of the State of Minnesota to be affixed at the State Capitol this 6th day of November.

Governor Tim Walz

Secretary of State Steve Simon

• ruralhealthday.pdf

Source: Office of Rural Health & Primary 

Governor Tim Walz has declared May 19-25, 2019 as Emergency Medical Services Week in the State of Minnesota.

To read the full declaration, please click here.

Physician Assistants (“PAs”) are one of three professions providing primary care in the United States, along with physicians and advanced practice registered nurses. The National Rural Health Association (NRHA) recognizes that, despite 50 years of high-quality cost-effective practice, there remain state and federal laws and regulations that prevent PAs from practicing to the fullest extent of their education and experience. Likewise, new and emerging models of care sometimes fail to fully recognize PAs, diminishing the value they could bring to rural patients and communities that are currently suffering from a dire shortage of qualified medical care. As health care evolves into a system of vertical and horizontal integration with new focus on team-based care, PAs—working at the top of their licenses—will be indispensable providers in rural areas. Modernizing of regulations restricting practice privileges, mental health laws and payer policies that unnecessarily restrict PA practice will increase PA value to employers and enable PAs to more efficiently contribute to ending the shortage of health care professionals accessible to rural patients and communities.

Read the full brief online here: https://www.ruralhealthweb.org/NRHA/media/Emerge_NRHA/Advocacy/Policy%20documents/04-09-18-NRHA-Policy-Physician-Assistants-Modernize-Laws-to-Improve-Rural-Access.pdf

• Previous and future participation in AAPA-accredited self-assessment activities will now be recognized by NCCPA with an additional 50% extra Category 1 CME credits.
• Previous and future completion of a PA's first 20 AAPA-accredited PI-CME credits will now be doubled when logged with NCCPA.
• All PAs, including those who have not yet transitioned to the 10-year testing cycle, are eligible to participate in self-assessment and PI-CME activities and receive the extra credit weighting as indicated.
• Changes to the NCCPA certification dashboard and logging system will take several months to reflect this change, and PAs should continue to log activities as usual during this transition.
• NCCPA will automatically apply the extra credit weighting within their logging system.
• Credits accumulated in excess of the 2-year 100 credit requirement as a result of this change for the 2014–2016 and 2015–2017 cycles will automatically be applied toward the next 2-year CME cycle.

Based on this information, PAs should log self-assessment and PI-CME credits exactly as they are reflected on their CME certificates, and CME providers should award credits exactly as indicated in their approval agreements. Constituent organizations and PAs need to remember that the extra credit for SA and PI-CME is only relevant to NCCPA certification. CME hours required by states for license renewal are not doubled for SA and PI-CME and must be stated as approved and claimed as awarded on the CME certificate.

AAPA will continue to accredit and provide high quality self-assessment and PI-CME activities to support PAs in their efforts to enhance patient health.

To learn more about NCCPA’s decision to “relax the self-assessment and PI-CME requirements,” PAs should visit www.nccpa.net/qanda.

Contributor: Daniel Pace, CHCP
Chief Strategy Officer/VP, Education and Research
AAPA

Your voices were heard.  Click the link below to read about the changes to CME Requirements for Self-Assessment and Practice Improvement.  


http://www.nccpa.net/Important-Announcement

You can obtain more information on the proposed changes, such as the proposed rules, the Notice of Intent to Adopt (which outlines the comment and hearing process), and the Statement of Need and Reasonableness (SONAR), at the MDH Communicable Disease Reporting Rulemaking Website at www.health.state.mn.us/divs/idepc/dtopics/reportable/rule/process/. You can also request a free copy of the rules from the agency contact person, Patricia Segal Freeman, at P.O. Box 64975. St. Paul, MN 55164-00975, phone 651-201-5414 or 1-800-657-3970, fax 651-201-5501, and email commdisrule@state.mn.us.

For your convenience, the proposed rules can be found here. 

http://www.twincities.com/2016/07/11/pioneer-press-letter-to-the-editor-for-july-11-2016/

Public Service Announcement for May is NOW available!

Learn more about Mosquitos!

Click Here to listen to the April Public Service Announcements!

March's Public Service Announcement Sound Bites are now available for distribution!

March - Safe Disposal of Medication - Listen now!

NCCPA Recertification Exam Proposal

The AAPA is already taking steps to examine and respond to this proposal to ensure that the collective voice of the profession is accurately represented.

MAPA would like to draft a letter to the NCCPA with the collective voice of Minnesota professionals and asks for your comments and feedback!

FIRST, BE INFORMED:

Please visit the AAPA News Center for the most comprehensive list of materials surrounding the issue.

• NCCPA's proposal
• AAPA's actions to advocate for evidence-based methods to assess competency
• AAPA -hosted discussion that have already take place
• Resources to help PAs and COs develop comments and responses to the proposal
• The potential risks to PAs and the potential impacts on both healthcare access and costs

THEN, TAKE ACTION!

Visit the MAPA NCCPA Re-Certification Exam Proposal Forum to provide your comments to the MAPA leadership.  

TRENDING ARTICLES

This week, all certified PAs will be asked to complete an important survey about potential changes to the PANRE.  A new examination model is being considered by the NCCPA Board of Directors and they are seeking feedback on the changes from certified PAs and other key stakeholders.

The new model would replace the PANRE with periodic take-at-home, open book core knowledge exams and a secure, times specialty-related assessment take at the end of every 10 year certification maintenance cycle.

During the Leadership and Advocacy Summit in Arlington, VA last week, an open forum was facilitated where some lively discussion and concerns were expressed.  Summary of Questions Raised by Attendees of LAS (PDF).  This survey is your opportunity to voice your opinion on the proposed changes and we encourage you to make your voice heard!

You can read more about the proposed re-certification at https://www.nccpa.net/panre-model. 

White Paper Proposal

Please email your comments and questions regarding the new process to

AAPA - recertificationcomments@aapa.org

NCCPA- newpanre@nccpa.net

from the Minnesota Academy of Physician Assistants

Independent Living Considerations for an Aging Population

A formal letter of request from the primary care providers for adjustment in Minnesota Community Measures was drafted and sent to Commissioner Edward Ehlinger, MN of the Minnesota Department of Health.  

Read more

January 2016 - Features Healthy Kids!