Healthcare Workforce

The mix and distribution of health care providers. LDI Senior Fellows study how to transform health care delivery through the optimal training, mix, and placement of health care professionals and allied health workers to deliver cost-effective care.

Physician Consolidation and the Spread of Accountable Care Organizations

Research Brief
Nov. 4, 2019

Accountable Care Organizations (ACOs) are groups of physicians and hospitals that jointly contract to care for a patient population. ACO contracts incentivize coordination of care across providers. This can lead to greater consolidation of physician practices, which can in turn generate higher costs and lower quality. Given this, the study asks, as ACOs enter health care markets, do physician practices grow larger?

A National Comparison of Operative Outcomes of New and Experienced Surgeons

Research Brief
Oct. 25, 2019

In this national study, Medicare beneficiaries treated by new surgeons had poorer outcomes than those treated by experienced ones in the same hospitals. However, the type of operation and the patient’s emergency status – rather than physician inexperience – explains nearly all poorer outcomes. Higher-risk cases are disproportionately treated by new surgeons.

The Association of Geographic Dispersion with Outcomes among Hospitalized Pulmonary Service Patients

Oct. 16, 2019

Rachel Kohn, Michael O. Harhay, Gary E. Weissman, George L. Anesi, Brian Bayes, Hummy Song, Scott D Halpern, S. Ryan Greysen, Meeta Prasad Kerlin

Abstract [from journal]

Hospitals geographically localize clinically similar patients into wards to provide specialized care that improves patient outcomes and care and lowers costs. When these wards exceed capacity, patients become “geographically dispersed” to alternate locations. For example, critically ill patients may “board” in emergency departments (EDs) or alternate intensive care units (ICUs) when the clinically appropriate ICUs are at capacity. Such geographic dispersion has been demonstrated to be associated with increased hospital length of stay (LOS), ICU and in-...

Health Care Safety-Net Programs After The Affordable Care Act

Issue Brief
Oct. 1, 2019

Prior to the Affordable Care Act (ACA), health care safety-net programs were the primary source of care for over 44 million uninsured people. While the ACA cut the number of uninsured substantially, about 30 million people remain uninsured, and many millions more are vulnerable to out-of-pocket costs beyond their resources. The need for the safety net remains, even as the distribution and types of need have shifted. This brief reviews the effects of the ACA on the funding and operation of safety-net institutions. It highlights the challenges and opportunities that health care reform presents to safety-net programs, and how they have adapted and evolved to continue to serve our most vulnerable residents.

Trends in Racial/Ethnic Representation Among US Medical Students

Sep. 4, 2019

Lanair Amaad Lett, H. Moses Murdock, Whitney U. Orji, Jaya Aysola, Ronnie Sebro

Abstract [from journal]

Importance: With increasing efforts to create a diverse physician workforce that is reflective of the demographic characteristics of the US population, it remains unclear whether progress has been made since 2009, when the Liaison Committee on Medical Education set forth new diversity accreditation guidelines.

Objective: To examine demographic trends of medical school applicants and matriculants relative to the overall age-adjusted US population.

Design, Setting, and Participants:


Pediatric Resident Experience Caring for Children at the End of Life in a Children's Hospital

Jennifer K. Walter, MD, PhD, MS
Aug. 31, 2019

Amy Trowbridge, Tara Bamat, Heather Griffis, Eric McConathey, Chris FeudtnerJennifer K. Walter

Abstract [from journal]

Objectives: Pediatric residents are expected to be competent in end of life (EOL) care. We aimed to quantify pediatric resident exposure to patient deaths, and the context of these exposures.

Methods: Retrospective chart review of all deceased patients at one children's hospital over three years collected patient demographics, time and location of death. Mode of death was determined after chart review. Each death was cross-referenced with pediatric resident call schedules to determine residents involved within


Exploring social-based discrimination among nursing home certified nursing assistants

Aug. 9, 2019

Jasmine L. Travers, Anne M. Teitelman, Kevin A. Jenkins, Nicholas G. Castle

Abstract [from journal]

Certified nursing assistants (CNAs) provide the majority of direct care to nursing home residents in the United States and, therefore, are keys to ensuring optimal health outcomes for this frail older adult population. These diverse direct care workers, however, are often not recognized for their important contributions to older adult care and are subjected to poor working conditions. It is probable that social-based discrimination lies at the core of poor treatment toward CNAs. This review uses perspectives from critical social theory to explore the


Gender Differences Among Academic Pediatric Radiology Faculty in the United States and Canada

Jul. 29, 2019

William B. Counter, Kiran Khurshid, Sabeena Jalal, Mauricio Castillo, Ammie M. White, Hansel J. Otero, Savvas Nicolaou, Faisal Khosa

Abstract [from journal]

Objective: It is currently unknown whether efforts in recent years to create equal opportunities for female faculty in academic medicine have succeeded. We looked at faculty members in academic pediatric radiology departments across the United States and Canada to assess for evidence of gender disparities and differences in academic performance between males and females.

Methods: The analysis included diagnostic radiology programs across the United States and Canada, as specified by the American Medical


Showers, Culture, and Conflict Resolution: A Qualitative Study of Employees' Perceptions of Workplace Wellness Opportunities

Jul. 29, 2019

Michael Seward, Roberta Goldman, Stephanie Linakis, Paul Werth, Christina Roberto, Jason Block

Abstract [from journal]

Objective: Research on employee opinions of workplace wellness programs is limited.

Methods: At a large academic medical center in Boston, we conducted 12 focus groups on employee perceptions of wellness programs. We analyzed data using the immersion-crystallization approach. Participant mean age (N = 109) was 41 years; 89% were female; 54% were White.

Results: Employees cited prominent barriers to program participation: limited availability; time and marketing; disparities in access; and


Interactions Between Clinician and Organizational Characteristics to Predict Cognitive-Behavioral and Psychodynamic Therapy Use

Rinad Beidas head shot
Jul. 26, 2019

Emily M. Becker-Haimes, Nathaniel J. Williams, Kelsie H. Okamura, Rinad S. Beidas

Abstract [from journal]

Conceptual models of implementation posit contextual factors and their associations with evidence-based practice (EBP) use at multiple levels and suggest these factors exhibit complex cross-level interactions. Little empirical work has examined these interactions, which is critical to advancing causal implementation theory and optimizing implementation strategy design. Mixed effects regression examined cross-level interactions between clinician (knowledge, attitudes) and organizational characteristics (culture, climate) to predict cognitive-behavioral