College of Nursing
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The MSU-Bozeman College of Nursing was founded in 1937 and has received continuous national accreditation since 1949. Since its inception, the College has been a multi-campus program, making effective use of educational and clinical resources in the state. The College's administration is located on the main campus of MSU-Bozeman, where most undergraduate students complete lower division nursing requirements. Students move to one of the campuses located in the state's major populations areas, Bozeman, Billings, Great Falls, Kalispell, and Missoula, to complete their upper division course work. With their greater population concentrations, these communities possess health care facilities that provide the degree of complexity, size and diversity of patient population needed for upper division clinical experience. Each of the College's campuses has resident faculty who serve both undergraduate and graduate students.
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Item Marriage, Children, and Sex-Based Differences in Physician Hours and Income(American Medical Association, 2023-03) Skinner, Lucy; Yates, Max; Auerbach, David I.; Buerhaus, Peter I.; Staiger, Douglas O.Importance. A better understanding of the association between family structure and sex gaps in physician earnings and hours worked over the life cycle is needed to advance policies addressing persistent sex disparities. Objective. To investigate differences in earnings and hours worked for male and female physicians at various ages and family status. Design, Setting, and Participants. This retrospective, cross-sectional study used data on physicians aged 25 to 64 years responding to the American Community Survey between 2005 and 2019. Exposures. Earned income and work hours. Main Outcomes and Measures. Outcomes included annual earned income, usual hours worked per week, and earnings per hour worked. Gaps in earnings and hours by sex were calculated by family status and physician age and, in some analyses, adjusted for demographic characteristics and year of survey. Data analyses were conducted between 2019 and 2022.Results. The sample included 95 435 physicians (35.8% female, 64.2% male, 19.8% Asian, 4.8% Black, 5.9% Hispanic, 67.3% White, and 2.2% other race or ethnicity) with a mean (SD) age of 44.4 (10.4) years. Relative to male physicians, female physicians were more likely to be single (18.8% vs 11.2%) and less likely to have children (53.3% vs 58.2%). Male-female earnings gaps grew with age and, when accumulated from age 25 to 64 years, were approximately $1.6 million for single physicians, $2.5 million for married physicians without children, and $3.1 million for physicians with children. Gaps in earnings per hour did not vary by family structure, with male physicians earning between 21.4% and 23.9% more per hour than female physicians. The male-female gap in hours worked was 0.6% for single physicians, 7.0% for married physicians without children, and 17.5% for physicians with children. Conclusions and Relevance. In this cross-sectional study of US physicians, marriage and children were associated with a greater earnings penalty for female physicians, primarily due to fewer hours worked relative to men. Addressing the barriers that lead to women working fewer hours could contribute to a reduction in the male-female earnings gap while helping to expand the effective physician workforce.Item Ensuring and Sustaining a Pandemic Workforce(2020-06) Fraher, Erin P.; Pittman, Patricia; Frogner, Bianca K.; Spetz, Joanne; Moore, Jean; Beck, Angela J.; Armstrong, David; Buerhaus, Peter I.Current efforts to fight the Covid-19 pandemic aim to slow viral spread and increase testing, protect health care workers from infection, and obtain ventilators and other equipment to prepare for a surge of critically ill patients. But additional actions are needed to rapidly increase health workforce capacity and to replenish it when personnel are quarantined or need time off to rest or care for sick family members. It seems clear that health care delivery organizations, educators, and government leaders will all have to be willing to cut through bureaucratic barriers and adapt regulations to rapidly expand the U.S. health care workforce and sustain it for the duration of the pandemic.Item Developing a Workforce for Health in North Carolina: Planning for the Future(2020-05) Fraher, Erin; Balu, Rukmini; Buerhaus, Peter I.; George, Julie; Murillo, Crystal L.; Washington, A. EugeneAmong the many trends influencing health and health care delivery over the next decade, three are particularly important: the transition to value-based care and increased focus on population health; the shift of care from acute to community-based settings; and addressing the vulnerability of rural health care systems in North Carolina.Item Implications Of The Rapid Growth Of The Nurse Practitioner Workforce In The US(2020-02) Auerbach, David I.; Buerhaus, Peter I.; Staiger, Douglas O.Concerns about physician shortages have led policy makers in the US public and private sectors to advocate for the greater use of nurse practitioners (NPs). We examined recent changes in demographic, employment, and earnings characteristics of NPs and the implications of those changes. In the period 2010-17 the number of NPs in the US more than doubled from approximately 91,000 to 190,000. This growth occurred in every US region and was driven by the rapid expansion of education programs that attracted nurses in the Millennial generation. Employment was concentrated in hospitals, physician offices, and outpatient care centers, and inflation-adjusted earnings grew by 5.5 percent over this period. The pronounced growth in the number of NPs has reduced the size of the registered nurse (RN) workforce by up to 80,000 nationwide. In the future, hospitals must innovate and test creative ideas to replace RNs who have left their positions to become NPs, and educators must be alert for signs of falling earnings that may signal the excess production of NPs.Item Growing Ranks of Advanced Practice Clinicians - Implications for the Physician Workforce(2018-06) Auerbach, David I.; Straiger, Douglas O.; Buerhaus, Peter I.Nurse practitioners and physician assistants are providing an increasing share of health care services, and education programs have proliferated. These dynamics will have lasting effects on the health care workforce and on relationships among health professionals.Item Nurse practitioners and interdisciplinary teams in pediatric critical care(2018-06) Gigli, Kristin H.; Dietrich, Mary S.; Buerhaus, Peter I.; Minnick, Ann F.OBJECTIVE: To describe the members of pediatric intensive care unit interdisciplinary provider teams and labor inputs, working conditions, and clinical practice of pediatric intensive care unit nurse practitioners. METHODS: A national, quantitative, crosssectional, descriptive postal survey of pediatric intensive care unit medical directors and nurse practitioners was administered to gather information about provider-team members, pediatric intensive care unit nurse practitioner labor inputs, working conditions, and clinical practice. Descriptive statistics, cross-tabulations, and chi2 tests were used. RESULTS: Responses from 97 pediatric intensive care unit medical directors and 59 pediatric intensive care unit nurse practitioners representing 126 institutions were received. Provider-team composition varied between institutions with and without nurse practitioners. Pediatric intensive care units employed an average of 3 full-time nurse practitioners; the average nurse practitioner-to-patient ratio was 1 to 5. The clinical practice reported by medical directors was consistent with practice reported by nurse practitioners. CONCLUSION: Nurse practitioners are integrated into interdisciplinary pediatric intensive care unit teams, but institutional variation in team composition exists. Investigating models of care contributes to the understanding of how models influence positive patient and organizational outcomes and may change future role implementation. ©2018 American Association of Critical-Care Nurses.Item Improving Data for Behavioral Health Workforce Planning: Development of a Minimum Data Set(2018-06) Beck, Angela J.; Singer, Phillip M.; Buche, Jessica; Manderscheid, Ronald W.; Buerhaus, Peter I.The behavioral health workforce, which encompasses a broad range of professions providing prevention, treatment, and rehabilitation services for mental health conditions and substance use disorders, is in the midst of what is considered by many to be a workforce crisis. The workforce shortage can be attributed to both insufficient numbers and maldistribution of workers, leaving some communities with no behavioral health providers. In addition, demand for behavioral health services has increased more rapidly as a result of federal legislation over the past decade supporting mental health and substance use parity and by healthcare reform. In order to address workforce capacity issues that impact access to care, the field must engage in extensive planning; however, these efforts are limited by the lack of timely and useable data on the behavioral health workforce. One method for standardizing data collection efforts is the adoption of a Minimum Data Set. This article describes workforce data limitations, the need for standardizing data collection, and the development of a behavioral health workforce Minimum Data Set intended to address these gaps. The Minimum Data Set includes five categorical data themes to describe worker characteristics: demographics, licensure and certification, education and training, occupation and area of practice, and practice characteristics and settings. Some data sources align with Minimum Data Set themes, although deficiencies in the breadth and quality of data exist. Development of a Minimum Data Set is a foundational step for standardizing the collection of behavioral health workforce data. Key challenges for dissemination and implementation of the Minimum Data Set are also addressed.Item Prescribing Practices by Nurse Practitioners and Primary Care Physicians: A Descriptive Analysis of Medicare Beneficiaries(2017-04) Muench, Ulrike; Perloff, Jennifer; Thomas, Cindy Parks; Buerhaus, Peter I.Introduction Nurse practitioner (NP) prescribing continues to be a contentious policy issue, and studies systematically examining NP prescribing are lacking. The aim of this study was to conduct a descriptive analysis comparing the prescribing services of NPs with those of primary care physicians (PCPs) in providing care to Medicare beneficiaries. Methods Part D drug claims of beneficiaries who saw an NP or a PCP in 2009 and 2010 were examined for differences in the types of medications prescribed, the volume of prescriptions, and the duration of prescriptions across all drug classes in Medicare Part D. Results Data for 164,681 beneficiaries were analyzed. Results showed the same top 20 types of medications and the same share of generic medications for NP and PCP prescriptions. Differences in prescribing patterns were found for the number of prescriptions and for the duration of the prescriptions (days’ supply per claim). NP beneficiaries received, on average, approximately one more 30-day prescription per year than PCP beneficiaries. The mean duration for an NP prescription claim was 3 days shorter than that for a PCP prescription claim, indicating that NP beneficiaries need refills sooner than PCP beneficiaries. This pattern existed in most drug classes and was more pronounced in behavioral drug classes, such as antidepressants, antipsychotics, psychotherapeutics, and opioids and in patients with more comorbidities. Differences in state scope of practice laws did not affect these prescribing patterns. Conclusions Key differences were observed in the number and duration of prescriptions written by NPs and PCPs. Further research is needed to understand the impact of differences in NP and PCP patient populations on provider prescribing, such as the higher number of prescriptions issued by NPs for beneficiaries in moderate and high comorbidity groups and the implications of the duration of prescriptions for clinical outcomes, patient-provider rapport, costs, and potential gaps in medication coverageItem Comparing the Cost of Care Provided to Medicare Beneficiaries Assigned to Primary Care Nurse Practitioners and Physicians(2016-08) Perloff, Jennifer; DesRoches, Catherine M; Buerhaus, Peter I.Objective. This study is designed to assess the cost of services provided to Medicare beneficiaries by nurse practitioners (NPs) billing under their own National Provider Identification number as compared to primary care physicians (PCMDs). Data Source. Medicare Part A (inpatient) and Part B (office visit) claims for 2009-2010. Study Design. Retrospective cohort design using propensity score weighted regression. Data Extraction Methods. Beneficiaries cared for by a random sample of NPs and primary care physicians. Principal Findings. After adjusting for demographic characteristics, geography, comorbidities, and the propensity to see an NP, Medicare evaluation and management payments for beneficiaries assigned to an NP were $207, or 29 percent, less than PCMD assigned beneficiaries. The same pattern was observed for inpatient and total office visit paid amounts, with 11 and 18 percent less for NP assigned beneficiaries, respectively. Results are similar for the work component of relative value units as well. Conclusions. This study provides new evidence of the lower cost of care for beneficiaries managed by NPs, as compared to those managed by PCMDs across inpatient and office-based settings. Results suggest that increasing access to NP primary care will not increase costs for the Medicare program and may be cost saving.