Friday, July 11, 2025

One Big Beautiful Bill Act offers medical practices new expansion opportunities

On July 4, President Donald J. Trump signed H.R. 1, commonly known as the One Big Beautiful Bill Act (“OBBBA”). This new legislative extends or enhances many of the tax provisions from the 2017 Tax Cuts & Jobs Act which were set to sunset at the end of this year. Many of the provisions in OBBBA will have a significant impact on tax compliance and deductible expense rules for medical practices making it easier for physicians to expand their healthcare practices.

The first significant change for medical practices is the enhanced bonus depreciation for capital expenses. The new deduction Section 179 expensing cap doubles from $1.25 million to $2.5 million phasing out at $4 million in purchases up from $3.13 million for property placed in service post-2024. Additionally, the bill permanently restores 100% bonus depreciation for qualified property including equipment and certain nonresidential real estate acquired and placed in service after January 19, 2025.

This incredibly strong provision means that medical practices can expand their offices, add new offices, and purchase new equipment immediately while taking the 100% bonus depreciation in the year the assets are placed in service. Given the expenses related to new medical equipment and expansions, physicians could reduce their taxable income significantly while boosting cash flow.

The OBBBA has also make the Qualified Business Income (QBI) deduction permanent for pass-through business owners. Medical practices are generally considered to be Specified Service Trade or Businesses (SSTB) so QBI deductions for owners with income exceeding current thresholds ($483,000 for married filing jointly and $241,950 for all other filing statuses) will still be disallowed. However, the permanent deduction of 20% supports long-term planning, especially if compensation is structured thoughtfully. Additionally, a two-step phased calculation was introduced for high-income taxpayers which will simplify compliance and reduce administrative burden.

One of the more controversial and complicated provisions in OBBBA is the new state and local tax (SALT) deduction caps. When the 2017 Tax Cuts & Jobs Act was passed, SALT deductions were capped at $10,000 for individual taxpayers. This led to many states creating what is called a pass-through entity tax (PTET) where a partnership or S Corporation business – including medical practices – would pay state and local taxes directly rather than the individual owners. These pass-through entity taxes could then be deducted from the overall revenue of the business which lowered the tax burden. With OBBBA, the new state and local tax deduction was increased to $40,000 per year effective 2024 through 2029 with 1 percent annual increases and then reverts back to $10,000 in 2030. However, the final bill does not limit the use of pass-through entity tax as a SALT cap workaround. Many pass-through entities will continue to utilize the PTET even with the enhanced individual SALT deductions.

Other employer related tax credits have also been expanded or enhanced which medical practices can take advantage of. First, OBBBA increased the amount of qualified childcare expenses taken into account from 25% to 40%. The maximum amount of the credit is now $500,000 or $600,000 for eligible small businesses. Additionally, the paid family and medical leave credit was amended to make the employer credit for paid and family medical leave permanent. As medical practices continue to recruit and retain talent, these new tax credits can make the quality of life for their employees more attractive.

For physicians themselves, there are numerous personal tax provisions in the OBBBA which could also be beneficial. These include extending the 2017 Tax Cuts & Jobs Act standard deductions as well as new credits for charitable contributions and estate planning.

OBBBA presents a unique opportunity for medical practices to greatly expand their practices over the coming years. The enhanced bonus depreciation for capital expenses and permanent 20 percent deduction means physicians will have greater clarity over the next five years when it comes to cash flow.


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Tuesday, July 1, 2025

Texting from referral to recovery: A communication blueprint for total joint surgery

Total joint replacement is one of the most complex and high-touch procedures in orthopedics. From the initial referral through postoperative recovery and rehabilitation, the path to a successful outcome requires much more than surgical skill. It requires consistent, timely communication and patient engagement. Compared to less invasive or more routine treatments, joint replacement demands an extended and coordinated communication strategy to support patient understanding, adherence and reassurance throughout the surgical and recovery journeys.

Two-way conversational text messaging, which allows patients to respond to messages directly, offers a powerful support solution to this challenge. Unlike cumbersome phone tag or one-way messaging, two-way texting, which can be automated, provides a streamlined method for practices, surgical facilities and patients to stay connected. For referring physicians and their offices, adding and further leveraging text messaging presents an opportunity to remain engaged with patients during key touchpoints before and after surgery — even after the patient is temporarily in the care of a surgical facility.

Total joint replacement patients face an intensive and extensive process that includes education, physical preparation, procedure logistics, recovery and rehabilitation. Missed instructions or lack of clarity at any stage can delay recovery, increase risk and complications, or erode patient confidence. Practices that maintain consistent communication before, during and after surgery are better positioned to ensure patients feel supported and stay on track.


Using text messaging throughout the joint replacement journey


Below are some of the more critical moments when practices should use two-way text messaging to engage patients undergoing joint replacement surgery.


Referral and confirmation


Patients often feel uncertain after receiving a referral for joint replacement. This is an ideal time to use text messaging to reinforce that their provider is involved and supportive.

Example message: "Hello, this is Dr. Smith's office. We have submitted your referral for total knee replacement to Main Street Orthopedic Surgery Center. You should hear from them shortly. Let us know if you have any questions."

Example message: "We are checking in to confirm that you heard from Main Street Orthopedic. Please reply YES if they have contacted you or NO if not."

This kind of communication assures the patient that their care team is still monitoring the process after the patient is being passed off to a surgical facility, thus helping reduce anxiety and better ensuring patient follow-through with their appointment and procedure.


Pre-procedure preparation


Once the procedure is scheduled, patients need to prepare their home and themselves for recovery. Text messaging can deliver timely reminders and provide a channel for questions.

Example message: "Your knee replacement is scheduled for July 10. Have you started preparing your home for recovery? You can access tips for safe setup at shortlink.co/surgprep."

Example message: "Remember to stop taking anti-inflammatory medications 7 days before surgery unless directed otherwise. Have questions? Text us here."

This form of outreach allows practices to stay involved in ensuring patients are ready and reduces the chance of cancellations or complications.


Immediate post-procedure follow-up


Although the surgical facility will provide post-operative care, referring practices should reach out shortly after the surgery to show continuity and support as well as flag potential issues quicker to help reduce the likelihood of serious infections, readmissions, or other adverse outcomes.

Example message: "We hope your surgery went well! We would love to hear how you are feeling. Text us an update when you are able."

Example message: "Your shoulder replacement recovery is important to us. If you have questions or concerns as you heal, please reach out. We are here to help and happy to answer any questions you have."

These messages reinforce the patient-provider relationship and provide a safety net in case the patient feels uncertain or has unmet needs.


Recovery and physical therapy coordination


Practices can continue supporting the recovery phase by helping patients stay engaged with physical therapy and follow-up appointments.

Example message: "Have you scheduled your physical therapy sessions yet? Let us know if you need a referral or location recommendations."

Example message: "How is physical therapy going this week? If you are having difficulty or need adjustments, let us know so we can help."

By sending periodic check-ins, practices can catch issues early and provide encouragement to keep patients motivated.


Follow-up and final appointments


Follow-up visits are crucial for monitoring progress, identifying complications and showing support to patients as they recover. Text messaging helps keep these appointments and their importance top of mind.

Example message: "It is time to schedule your six-week post-op appointment. Access our scheduling system at shortlink.com/schedule or text us here and we can help set it up."

Example message: "Do you have any lingering discomfort or questions as you reach the end of your hip replacement recovery period? Let us know so we can support you."

These messages signal that the practice remains committed to the patient's full recovery, even months after surgery.


Importance of coordinated messaging with surgical facilities


Since surgical facilities also communicate with patients, it is important for referring practices to coordinate communication and avoid mixed messages. Text messaging allows practices to better time outreach effectively and avoid duplication. Clear internal workflows and shared timelines can ensure the patient receives the right message at the right time from the right source.


Using analytics to inform strategy


Text messaging platforms may offer real-time, actionable analytics that enhance communication efforts. Practices can access data that reveals engagement trends and patterns, identifying which patients received and responded to messages, which received but did not act and which never received the message. More advanced platforms may also track interactions with short links embedded in messages, providing insights into which patients are engaging with educational materials, pre-operative instructions, appointment scheduling portals, or other linked resources. These analytics help practices refine their outreach strategies, better identify patients who may need or benefit from additional support and assess the effectiveness of their messaging over time.


Text messaging as the total joint communication backbone


Total joint replacement requires more than a successful procedure. It demands sustained communication and ongoing patient engagement and adherence. Two-way text messaging empowers practices to maintain their visibility, offer support and reinforce compliance throughout the surgical journey. Texting helps reduce the burden on office staff by streamlining interactions, while also creating a more responsive and reassuring experience for patients.

When used strategically, text messaging can become the communication backbone of total joint surgery. It keeps patients on track, fosters stronger connections between providers and patients, enhances patient and physician satisfaction and ultimately leads to better clinical outcomes. For practices aiming to improve care for joint replacement patients, investing in a thoughtful, coordinated texting strategy is both a practical and essential step.

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Monday, June 23, 2025

From revenue risk to resilience: A new financial model for rural physicians

Independent physicians in rural America are no strangers to adversity. An alarming 80% of rural America is medically underserved, and clinicians are feeling the pinch. In fact, between 2019 and 2024, the number of independent doctors in rural areas fell by 43%, and residents in rural areas had access to 11% fewer medical practices.

With many rural hospitals operating at a loss and at risk of closure, many small and medium-sized practices are now forced to shoulder a growing share of the patient care burden, without the financial infrastructure of larger systems. This financial strain is particularly acute in regions with older, diverse and low-income populations reliant on Medicare and Medicaid. Rural patients also have lower rates of employer-sponsored commercial insurance, resulting in higher out-of-pocket costs and greater financial pressure on physicians.


The proportion of U.S. adults classified as cost desperate, indicating an inability to afford necessary health care and medications, has reached a record high of 11%, with disparities emerging across demographic groups. Notably, Black and Hispanic adults, along with those from lower-income households, are disproportionately affected, exacerbating existing gaps in access to quality, affordable care.


The cost of traditional financial metrics


Historically, many health systems and private practices have used margin per patient as a benchmark of success. However, in rural care settings, that model can often fall short. Unlike urban, high-volume organizations that can prioritize profitable service lines, rural physicians must care for every patient who walks through the door, regardless of insurance status or income level.

When margins are thin and uncompensated care is on the rise, traditional financial models can push practices toward dangerous territory. Denying care isn’t an option, but delivering it without reimbursement isn’t sustainable. That disconnect isn’t just hurting the bottom line; it’s driving delayed care, skipped treatments and growing medical debt.


Medical debt is fueling the crisis


Unpaid medical bills are among the biggest threats to rural hospitals and their patients. Recent studies have found that a larger portion of adults in rural counties carry medical debt, higher than the national average and significantly higher than in urban areas. This debt doesn’t just sit on spreadsheets. It has real consequences: damaged credit, financial strain, skipped prescriptions and delayed treatment.

And it’s not just uninsured patients. High-deductible plans and rising out-of-pocket costs have made it harder for insured patients to manage their medical bills. In many cases, the bills they receive aren’t just unaffordable — they’re unpredictable.

This dynamic is especially harmful in rural areas, where many patients live on fixed incomes or don’t qualify for traditional credit. When affordability becomes a barrier to care, patients wait until it’s urgent. They often show up in the emergency room for a condition that could have been managed earlier and more affordably. These late-stage interventions cost more, strain the system and frequently go unpaid.


A shift in strategy: Financing with compassion


To survive, many forward-thinking rural physicians and other clinicians are adopting a different financial lens, one that prioritizes systemwide revenue margin and community economic health over per-patient profitability. One emerging solution is patient-first financing. Similar to retailers, this proactive approach introduces affordable payment options at the start, where the consumer, or in this case the patient, stands to gain 0% interest payment financing at the point of scheduling or care rather than months later when the bill arrives.

Instead of chasing payments after care is delivered or navigating an in-house system, physicians and their teams work with third-party partners to offer flexible payment plans based on a patient’s ability to pay. Providers are often paid within 48 hours of a procedure, even if the patient repays over time to the lender. That’s better not just for the books but for the patient. Studies show that when financing is discussed up front, patients are more likely to move forward with care and less likely to cancel or no-show due to cost. This approach also reduces the need to send unpaid balances to collections, protecting the patient-provider relationship.


Expanding the care model for long-term sustainability


Independent physicians are on the front lines of the rural health crisis and deserve financial models that reflect the realities they face, not just metrics designed for large, perfectly functioning systems. By rethinking success as “healthy patients, healthy practices,” small and rural practices can shift toward financial strategies supporting community well-being and long-term viability. This includes leveraging telehealth, expanding roles for advanced practice providers (APPs) and addressing critical gaps in physician availability.

Additionally, the American College of Physicians recently emphasized the need for policy makers to evaluate and implement investments to address rural health disparities and access challenges. Aligning clinical innovation with policy-level change can help ensure rural providers aren’t navigating this crisis alone. But as potential reimbursement cuts and regulatory rollbacks loom, health systems can’t afford to wait for policy change. They must focus on where they can take action internally, building financial resilience and expanding patient access through proactive care models.

Many practices are turning to advanced practice providers, including nurse practitioners and physician assistants, who can extend access and provide high-quality care, especially for routine or preventive services. At the same time, telehealth adoption, which surged during the pandemic, remains a powerful tool for maintaining access in hard-to-reach areas. However, broadband limitations, regulatory uncertainties and reimbursement inconsistencies still create barriers to broader use. Policy makers and health plans must continue supporting virtual care to ensure it remains viable for rural practices and their patients.

Patient-first financing is one of many steps toward that future, but it is a meaningful one. With the right tools, physicians do not have to choose between doing what is right for their patients and what is necessary for their practices.

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Wednesday, June 18, 2025

If doctors were trained in leadership, the entire health care system would benefit

If we can agree that leadership means influencing behavior to achieve a desired result, then it becomes obvious that all doctors are acting as leaders in many different health care environments.

But as I see it doctors aren’t formerly trained as leaders or even taught about the importance of leadership—i.e. Influencing behavior to achieve a desired result— in their daily work. Leadership training is not a standard part of medical school curricula.

This gives us an opportunity to change that paradigm. Medical education can absolutely prepare doctors for the challenges of being a leader—starting on the first day of medical school. Additionally, leadership development can be a cornerstone of each physician’s professional development throughout their career. In a future state where every physician is educated and trained in fundamental leadership skills, the entire health care system would reap the benefits—nurses, technicians, administrators, finance departments, HR professionals, and doctors themselves. But the chief beneficiary would be patients.


Leadership is a core competency – and should be taught as such


As a core competency for physicians, leadership is just as critical as clinical skills. Influencing thought and behavior is essential to achieving desired results in patient care. Leadership connects directly with the Accreditation Council for Graduate Medical Education’s (ACGME) six core competencies, encompassing all of them, either directly or indirectly​.

Therefore, we have an opportunity to teach leadership as a core competency for all physicians. Leadership involves a complex interplay of professionalism, communication skills (especially listening skills), cultural sensitivities, etc. And we are not necessarily born knowing these things. Fortunately, leadership is a learned skill. It can be improved through study of the theory and practice of leadership and through practical exercises and feedback.

We owe it to our medical students and residents to: 1)be explicit that they have a role as leaders in the healthcare environment, and 2) prepare them to lead in various environments as members of multidisciplinary teams under high levels of stress, including the responsibility for people’s lives and well-being.

But medical students and residents typically acquire leadership skills only in an ad hoc, inconsistent way. Students may gain some leadership experience through observation and even extracurricular activities, but this is largely unstructured and varies widely between institutions and individuals. The lack of intentional, cohesive, progressive leadership development leads to gaps in physicians' ability to lead effectively within health care systems.


Setting standards and getting oversight bodies on board


In visualizing how leadership should be taught in medical school, consider presenting it as foundational, much in the same way we teach physiology, pharmacology, or how to tie a surgical knot. I believe we should recognize that influencing thought and behavior to achieve desired results is a critical enabler of physician success numerous times each day, and we should build a foundation in how to accomplish that.

A physician who is a less effective leader is a less effective doctor. If you don’t start thinking about leadership until you’re 50, you’ve lost a huge opportunity to gain that mastery.

My personal vision is that we develop a set of standards for the leadership aspects of a physician’s training. Eventually, this set of standards would be adopted and refined by the oversight bodies that guide physicians’ careers, such as the Liaison Committee on Medical Education (LCME), the American Council on Graduate Medical Education (ACGME), and the American Board of Medical Specialties (ABMS).

These bodies have prescriptive authority. They can say to medical schools and training programs, “This is what you need to be teaching and practicing,” and can work with these entities over time to ensure that all doctors have a common training in a fundamental leadership skillset.

Standardization would benefit healthcare system leaders, as they would know that newly hired doctors possess a base level of leadership competency, much as they now know that all doctors possess a base level of clinical competency. Every physician will have been thinking about leadership, doing self-assessments, undergoing 360-degree assessments, and refining his or her leadership skills for years. The organization can then build on that base set of competencies to further develop the physician leader.


Advancing the leadership conversation


That is the vision. But we are a long way from seeing that as a reality. I have no illusions that such a change will happen overnight. The medical establishment changes slowly. Incorporating structured leadership training into every medical school and GME program can take decades.

Implementation should aim at codifying a set of base-level skills that can be generally agreed upon as a good leadership foundation for all doctors. In the meantime, let’s advance the conversation. Let’s start addressing leadership topics at conferences and symposia. Let’s get to work within our own organizations to develop in-house standards for physician leadership. Let’s start creating leadership curricula and sharing it with other institutions and organizations. Let’s start developing courses, implementing them, and measuring results. Let’s start assigning leadership coaches and mentors to doctors in our system.

Doctors should be trained in how to lead themselves, other individuals, and teams. Those who show interest and potential should be further trained in organizational leadership. Medical schools can lead the way in establishing the conviction in young physicians that they are leaders—that they have influence and impact every day—and igniting the desire to be trained as such. By linking leadership skills to the improved performance of health care teams and better patient outcomes, schools can change the current culture in which student doctors relegate “soft skills” to the back burner as they focus on clinical training.

Realistically, we can’t take hours of instruction away from core clinical courses. Nor would we want to. So, the trick is to find places in the curriculum where we’re already teaching “leadership-like” topics and to organize and revamp that material in a more cohesive and powerful way.

Once medical schools are doing this, residency training programs, physician practices, and healthcare systems can build from there. The leadership curriculum should never end. Everyone in medicine should ideally continue to seek and receive leadership training and feedback throughout their careers.


Doctors who know how to truly lead make a difference


Doctors are leaders, whether we recognize it or not. Our only real choice is whether to embrace our leadership role and commit to doing it to the very best of our ability. Or not.

Great physician leaders exude a presence. They bear themselves with confidence, but not cockiness. They look people in the eye. They listen to their patients, absorbing everything they’re saying—and not saying. They treat colleagues warmly and respectfully. They speak with directness but also with compassion and sensitivity. They welcome questions, invite feedback, and are always trying to improve. They address doubts and uncertainties. They strive for consensus.

That kind of leadership presence has a direct bearing on the way patients commit to treatment and the way colleagues rally together as a team. Don’t doubt for a second that it affects patient outcomes. It does.

If you are a physician, you should want to be the kind of leader who inspires people through your words, your actions, and your presence. And if you are in health care management, you should want to have a staff full of physicians who possess this kind of leadership ability.

My hope is that medical school deans, residency and fellowship program directors, health care administrators, and leaders of physicians’ societies feel inspired to work together and take up the cause of teaching better leadership skills to physicians. In doing this, we will enrich the future of medicine, create higher-performing health care teams, and improve patient outcomes.

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Wednesday, June 4, 2025

Two simple workflow tools cut physician message load by 16%

A new study from the University of Michigan shows that rethinking how patient portal messages are routed, and by whom, can significantly reduce the inbox load on primary care physicians, without additional tech or spending.

The study, published in the Journal of General Internal Medicine, tested a pair of workflow tools at a single academic internal medicine clinic. Compared with two control clinics, the intervention site saw a 16% reduction in monthly messages per full-time physician and a 65% drop in “carbon copy” messages that often flood physician inboxes.

The key change: assigning message responsibilities more clearly across the care team.

“We were able to significantly reduce the volume of messages by simply outlining roles and routing guidance for common issues,” said the study’s lead author and clinical assistant professor, Nicole Hadeed, M.D., in a university news release. “Focusing on getting the right message to the right place the first time was a simple and powerful intervention.”


A pandemic-era problem that never left


The volume of patient messages through electronic health record (EHR) portals surged during the COVID-19 pandemic — and has remained elevated ever since. That shift has increased administrative strain across primary care, where time spent managing inboxes is now a major source of burnout.

Researchers analyzed more than 340,000 messages across 31,000 patients over a one-year period. They found that a significant portion of message volume came not from patients but from internal routing inefficiencies, including duplicate messages sent to multiple staff or bounced among team members.

To address this, the clinic developed and implemented two simple tools:
  • A set of “best practice standards” for managing and routing common messages.
  • A “routing guide” clarifying which roles should handle what types of messages.

These tools were rolled out during meetings and huddles, and one staff member per week was temporarily assigned to manage the inbox on high-volume days.


Clearer roles and fewer clicks


Following the intervention, monthly messages per physician fell from 1,342 to 954. Messages sent directly to physicians dropped by 26%, and carbon copy messages declined from 4.4% of all messages to just 1.5%.

The percentage of portal message encounters involving physicians held steady, indicating the care team’s broader role in handling lower-acuity issues.

Survey data also pointed to improved team dynamics. Scores for clarity of expectations in portal messaging rose from 2.7 to 3.5 on a 6-point Likert scale. Staff reported that the routing guide, in particular, helped new team members get up to speed and made workflows more consistent.

“I like this document,” one medical assistant said in a post-intervention interview. “I feel like this document helps when you are orienting a new staff member to know the roles. It also says to you who gets what, where does this go.”


Staffing and sustainability challenges


The intervention did not come without complications, though. During the rollout period, the clinic faced a significant staffing shortage, which required physicians to take on more triage duties than anticipated. While the intervention still led to reduced message volume, the staff shortage may have skewed the degree of physician involvement.

“It’s pretty tough to route things to a team that is composed of one person who doesn’t have enough time to do their job,” one physician said.

Still, the study authors emphasized that the intervention’s success hinged not on added resources, but on clarifying how the existing team functions.

“While many clinician and staff reactions to the patient portal emphasize drowning under the brunt of clinical care happening over in-basket messages, it was evident that a significant proportion of messages are created by inefficient routing practices within the clinic itself, driven by a lack of transparency of each person’s role within the multidisciplinary team,” Hadeed said.


A model for inbox management?


The University of Michigan team believes their approach is both replicable and scalable. Unlike many tech-driven solutions, these tools require no EHR customization or new hires, just a clinic’s willingness to map its workflows and act on gaps.

The team plans to explore long-term sustainability next. While the initial intervention period lasted just four months, maintaining those gains as staff changes and workloads evolve will be key.

Ultimately, the authors suggest that other health systems take a similar approach to identifying local gaps in training and role clarification to enhance in-basket management, decrease volume and bolster well-being.

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Thursday, May 29, 2025

Access, coordinating care, communication — how can primary care physicians and oncologists improve their connections?

Successful patient outcomes can be a common goal for primary care physicians and oncologists, but achieving that goal can be a challenge, said a panel of health care experts that included two cancer survivors.

On May 6, the National Comprehensive Cancer Network (NCCN), a nonprofit alliance of 33 cancer centers, opened its 2025 NCCN Policy Summit: Primary Care and Oncology Collaboration for Better Patient Outcomes. The daylong meeting included panel discussions and speakers discussing health care practices and policies to fight the disease.

“We know how important this collaboration can be across the entire cancer care continuum, from screening and risk reduction through survivorship and end of life,” said NCCN CEO Crystal S. Denlinger, MD, an oncologist. “Unfortunately, we also know that there are quite a few challenges that come with this.”


The challenges


“If there’s ever been kind of a top 10 set of characteristics about the U.S healthcare system, it's that it’s fragmented,” said Clifford Goodman, PhD, a consultant on health care technology and policy. “And one of the things that we're finding people can often fall through the cracks, is between primary care and oncology, both at the sort of screening and diagnostic end and at the survivorship end.”

Goodman started “Pathways to Partnership: Strengthening Collaboration Between Primary Care and Oncology,” a panel discussion that lasted more than an hour with physician and expert speakers discussing the complexities of cancer care and the health care system generally.

Primary care physicians help the general quality of life and functioning of cancer patients from the moment of diagnosis to the end of life, said Veronica Panagiotou, PhD, director of advocacy and programs for the National Coalition for Cancer Survivorship, and a cancer survivor.

“And so why go through that rigorous cancer treatment, only to come out the other end and not be able to experience and function and do the everyday things that we take for granted, like walking to the mailbox, and showering without assistance for instance,” Panagiotou said. Those are the things that health care should be able to help patients with, she said.

Dorothy A. Rhoades, MD, MPH, professor of medicine at the University of Oklahoma Health Sciences, described her experience working with the Indian Health Service and patients’ misperception that it will take care of everything they need. She also is director of the Native American Center for Cancer Health Excellence at the Stevenson Cancer Center.

Redundancy can be a problem when a primary care physician and oncologist work in different health systems, said Andrea Porpiglia, associate professor and surgical oncologist at Fox Chase Cancer Center. Repeat scans or colonoscopies or lab work cause double the bills for patients. When patients don’t think their doctors are talking, they feel frustrated and abandoned, she said.

In patients, “we know that cancer doesn’t happen by itself,” said Linda Overholser, MD, an internal medicine physician at the University of Colorado Cancer Center. During cancer treatment, conditions such as diabetes or high blood pressure can get worse.

“There's missed opportunities there if care isn't coordinated to better control those comorbidities, and now that patients are living longer after a cancer diagnosis, I think it's really important to think about health promotion and implementing strategies we know that can reduce future comorbidities,” she said.

Skylar Taylor, MD, a medical hematology and oncology fellow at Mayo Clinic and a cancer survivor, echoed those concerns in describing management of blood pressure and diabetes in cancer patients, short- and long-term.


Successes in care


After elaborating on numerous challenges, Goodman also asked about successes, and the experts described examples as well.

Fox Chase Cancer Center started its Care Connect program that allows primary care physicians to get more involved with oncology care happening with their patients, Porpiglia said. It allows private practice physicians access to the cancer center’s electronic medical records (EMRs) for free. The network remains password protected but it makes it easier for oncologists to pass along patient updates via direct messages in the EMR, she said.

Taylor described his experience as a medical student seeing oncologists going door-to-door to primary care offices, and seeing a primary care doctor pick up the phone to call the oncologist to get an answer. That shows a lot of trust in front of the patient, he said, and he acknowledged those models are probably not scalable across the nation.

There are onco-primary models emerging at the University of Cincinnati, Duke University, and Kaiser Permanente in San Francisco, and those are exciting, Panagiotou said. “The idea that primary care is within the cancer center,” she said, and Goodman repeated the notion.

“Kind of, to the walking down the hall that Dr. Tyler just mentioned, the ability for primary care to see cancer patients solely and to be able to support their needs,” Panagiotou said.

American Indian and many minority populations have suffered from historical abuses within the health care system by people and research programs that were supposed to be trustworthy, Rhodes said. To counter those, there is orientation for people within the IHS, along with a pilot projects involving financial hardship screenings and supportive care huddles for physicians, other clinicians, health care navigators to coordinate care.

Health care navigators have benefited the communication between oncologists and primary care physicians, and the care coordination for patients, Overholzer said. She also discussed benefits of education for not just doctors, but for nurses, other medical staff, social workers, pharmacists, behavioral health specialists. “I think we need to keep in mind that we need to really be working with them too, to really fully support the survivorship,” she said.

The keys are communication, access and making sure primary care physicians know about resources available, Porpiglia said. “There’s things out there that could benefit the patients and making sure that the primary care is aware of that,” she said.

Friday, May 23, 2025

Nearly 30% of early-career APPs leave their first job within 3 years, study finds

Nearly 30% of early-career advanced practice providers (APPs) leave their initial job within three years, according to a new study published May 5 in JAMA Network Open. As the APP workforce continues to grow — nonphysician clinicians now make up 40% of the U.S. health care workforce — these findings raise questions about the stability, retention and potential onboarding investments for APPs.

Researchers analyzed Medicare billing data from 217,487 nurse practitioners, physician assistants, certified registered nurse anesthetists, nurse midwives and clinical nurse specialists who entered the workforce between 2010 and 2021.

Turnover was measured by sustained changes in the tax identification number (TIN) under which clinicians billed — serving as a proxy for changing practices.

In total, 26.8% of APPs moved to a different practice during the study period, with a median time to departure of just 13 months. Movement within the same large organization was not captured unless it involved a change in TIN, and consolidation events, like mergers, were excluded to avoid misclassifying structural changes as decisions made by APPs.


Turnover patterns by role and setting


The study found that turnover rates varied significantly based on licensure type, gender, practice size and clinical setting.
  • Physician assistants had the highest three-year turnover rate at 33.1%, followed closely by certified registered nurse anesthetists at 32.7%.
  • Nurse practitioners had a turnover rate of 28.4% within three years.
  • Certified nurse midwives and clinical nurse specialists had lower rates — 15.5% and 18.3%, respectively.

Male APPs were more likely to switch jobs than their female counterparts (29.9% vs. 26.2%), and those who moved were more likely to work in smaller practices. The median number of physicians in practices that experienced APP turnover was 16, compared to 57 among those that retained staff.

Turnover was also more common in certain specialties. Hospital-based clinicians had the highest turnover, with 43% moving within three years. In contrast, clinicians in obstetrics and gynecology and medical subspecialties had the lowest movement rates, at 23.3% and 30%, respectively.


One in seven leave within a year


The data show that turnover happens quickly for many early-career APPs. Within the first year, 14.4% had already changed practices. By year five, the cumulative rate rose to nearly 37%.

This rapid churn comes as the number of new APPs entering the field is expected to increase at five times the rate of physicians between 2023 and 2033, according to the Bureau of Labor Statistics.

The study notes that APPs face fewer regulatory and certification barriers to changing roles compared to physicians, which may contribute to the turnover, but specific drivers of turnover — compensation, job satisfaction, scope of practice, organizational culture — were not assessed in the study.

Regardless, for practices employing early-career APPs, the trend signals lost investments in onboarding and training, disruptions in patient continuity and added administrative costs for recruitment.

“Further work should investigate practice characteristics, specific tasks, remuneration and other potential factors associated with practice turnover,” the authors concluded.


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