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D A Kindig

Publications and source records attributed to D A Kindig.

At least 37 records · Page 2Linked to original sources
PubMed1993

The elusive generalist physician. Can we reach a 50% goal?

National attention has focused on the goal of attaining 50% primary care practitioners to facilitate patient access and cost-effectiveness. To determine how long it might take to achieve this goal, we used the Bureau of Health Professions' aggregate physician supply model to forecast the generalist-specialist balance. Assuming that 30% of graduates will enter generalist practice after 1993 (the percentage in the mid-1980s), the number of generalists would increase from 174,940 in 1990 to 232,000 in 2040 (77 per 100,000 population), but the percentage would remain at about 30%; specialists would continue to make up about 70% of all active physicians, but their total number would grow from 345,600 to 537,000 (178 per 100,000 population). If 50% of graduates were to enter generalist practices, by the year 2040 the number of generalists would grow to 373,000, or 124 per 100,000 (48.4% of all physicians). If entry into generalist practice falls to 20%, as suggested by recent medical student preferences, the number of generalists would peak at 192,000 (26.4%) in 2010 and would fall to 160,000 (21%) by 2040, resulting in 53 generalists and 201 specialists per 100,000 population. We discuss the implications of these findings on aggregate physician supply and on policy initiative affecting the ratio of generalists to specialists. Reform proposals affecting the specialty mix should clearly identify the desired future ratio of generalists and specialists per capita.

Family Practice↗
PubMed1993

Physician supply in rural areas with large minority populations.

While much research has been conducted into physician supply in rural areas, very little is known about physician supply in areas with heavy populations of ethnic minorities. This study finds that in 1990 the number of physicians per thousand residents was lower than the national average in counties with predominantly black and Hispanic populations. For counties largely populated by Native Americans, the mean number of physicians was slightly higher than the national average.

Health Services Needs and Demand↗
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↗
PubMed1992

Age distribution and turnover of physicians in nonmetropolitan counties of the United States.

Using data for 1975 to 1985 from the Area Resource File (ARF), net number changes in different age groups of physicians practicing in nonmetropolitan counties are examined. Small net increases are seen in the higher age groups in most county size categories but the most striking change is large increases in the age groups up to age 44. Family practitioners show a net decline in all county size categories for ages 45-54, but these are offset by increases in medical specialists. In counties of less than 25,000 population, the rate of turnover of physicians over the 1983-1988 period was 25 percent; physicians exiting these counties had a mean age of 52.3 years. The data indicate that aging of physicians in rural counties should not affect maintenance of current supply in the short run, but that increasing the physician-to-population ratio in areas with less adequate supply will be difficult, particularly if the rate of increase of younger physicians in nonmetropolitan counties does not continue.

Adult↗
PubMed1992

Physician responses to fee-for-service and capitation payment.

The ability to achieve reductions in health care costs is determined in part by physician payment mechanisms. This study observes the response to a change in the reimbursement mechanism by a group of physicians who participated in a fee-for-service plan and then formed an IPA using capitation payment for primary care physicians and a reduced fee schedule for specialists. Patient benefits were similar under the two plans. Analyses of data for a group of continuous enrollees show that the change in the physician payment mechanism was associated with a reduction in hospitalizations but increases in length of hospital stay and number of ambulatory visits. These increases may have occurred because capitation for primary care physicians and a reduced fee schedule for specialists led to a greater number of referrals with no incentive in place for reductions in length of stay for specialty admissions.

Ambulatory Care↗
PubMed1991

Uncompensated and discounted Medicaid care provided by physician group practices in Wisconsin.

A survey of a sample of physician group practices in Wisconsin was undertaken to determine the amounts of charity care, bad debt, and discounted Medicaid care that were provided in 1988. Overall, the physician group practices in the sample reported dollar amounts of uncompensated care and discounted Medicaid care that averaged approximately 7.6% of their total billings for the year (1.6% of charity care, 3.0% of bad debt, and 3.0% of discounted Medicaid care). From the dollar totals reported, it was calculated that the individual physicians represented by this sample of group practices were responsible for, on average, +4300 of charity care, +9100 of bad debt, and +7500 of Medicaid discounted services, for a yearly per-physician total of +20,900 of uncompensated care and discounted care provided to uninsured and indigent patients. The results indicate that a majority of the group practices provided more charity care in 1988 than they had 5 years earlier and suggest that the burden of providing uncompensated care tends to fall disproportionately on those group practices that are also providing relatively high levels of service to Medicaid recipients.

Charities↗
PubMed1991

Career paths of physician executives.

Survey data from a sample of physicians whose primary professional activity is administration were used to examine their previous administrative positions and career paths. Forty percent reported administrative positions in more than one type of health care organization, and time spent in administration increased with age and years in administration. Most responders with senior titles had four or more positions in a single type of organization or two positions in different types of organizations. These findings should be useful for further investigation on the physician executive role, as well as in career planning.

Career Mobility↗
PubMed1990

Policy priorities for rural physician supply.

A number of efforts can be attempted in rural medical education initiatives in recruitment, socialization, curricular reform, and community technical assistance. Further work is needed in identifying strategies that are most appropriate and cost effective in different states and regions that may have different situations and needs. Careful consideration needs to be given to reasons why such ideas have not moved beyond the demonstration stage over the past 20 years; it is suggested that without substantial reform of payment systems favoring rural and primary care, educational reform will have marginal effectiveness and remain at the demonstration level.

Education, Medical, Undergraduate↗
PubMed1989

Changes in the location of death after passage of Medicare's prospective payment system. A national study.

We reviewed age-specific national mortality data for the years 1981 through 1985 to evaluate changes in the location of death among the nation's elderly after implementation of Medicare's prospective payment system (PPS). Although it was unchanged in 1981 and 1982, the percentage of deaths occurring in the nation's nursing homes increased from 18.9 percent in 1982 to 21.5 percent in 1985. The increases in nursing home deaths were greatest between 1983 and 1984, when 33 states showed larger-than-expected increases when compared with a base period before implementation of PPS. These changes were accompanied by a decline in the percentage of deaths that occurred in hospitals. These changes in the location of death were most pronounced in the Midwest, South, and West; they were very small in the Northeast and in states not affected by the PPS. Furthermore, the states with high population enrollments in health maintenance organizations and with large declines in the mean hospital length of stay in 1984 showed the greatest shifts in the location of death. We conclude that Medicare's PPS resulted in the increased transfer of terminally ill patients from hospitals to nursing homes. Further study is required to determine whether such transfer is medically appropriate.

Aged↗
PubMed1989

The changing managerial role of physician executives.

A survey of tasks performed by a sample of 517 physician executives from the AMA Masterfile was carried out to determine the role played by this group of administrators in health care organizations. In contrast to the findings of previous studies, physician executives appear to have responsibilities in general management as well as clinical management and do not focus primarily on physician and medical staff issues. No significant differences were found among respondents from hospitals, government, academic organizations, group practices/HMOs, and physician executives who spend more than 90 percent of their time in administration. Tasks identified as important for the future but not currently being done were primarily in the category of external activities such as "changing regulations and legislation" and "communicating goals to the public." These results identify an important boundary-spanning role for physician executives in balancing managerial and professional issues of cost, quality, and access in health care organizations. The implications of these findings for the educational needs of physician executives are discussed.

Hospital Administration↗
PubMed1989

Administrative medicine at the University of Wisconsin-Madison.

In summary, we have ten years of experience at the University of Wisconsin-Madison in graduate management education for clinician executives. We have designed the curriculum for the boundary-spanning role that such executives play; and the format aims to transcend the limitations of traditional methods for the active midcareer clinician executive. We believe that the need for such education will increase in the future and that some differentiation from standard health administration and business curricula is appropriate. We expect to continue to make changes in curriculum, technology, and format to meet the changing needs of this group of managers.

Curriculum↗
PubMed1987

Trends in physician availability in 10 urban areas from 1963 to 1980.

The overall growth in the physician supply has so dominated the public policy agenda that issues of physician distribution within urban areas have received little attention. In this study, we examined the changes in physician availability in the poverty and nonpoverty areas of 10 U.S. cities between 1963 and 1980. We found that the overall availability of patient care physicians increased in both poverty and nonpoverty areas, with greater growth in the nonpoverty areas. For office-based primary care physicians, however, there was a 45% decline in availability in the poverty areas and a 27% decline in the nonpoverty areas. We conclude that the overall increase in the physician supply may not adequately correct geographic and specialty maldistribution in urban areas. We suggest that special educational, service delivery, and financing strategies within urban areas continue to be needed to address problems of inequitable physician availability.

Adult↗