Last month, the Centers for Medicare & Medicaid Services announced the start of a new program designed to give up to 10,000 Medicare patients with chronic conditions the ability to receive most of their primary care at home.

The idea behind the program is to bring back the old practice of house calls but with a modern day approach using today’s technology and team-based approach, said CMS Acting Administrator Marilyn Tavenner, RN, BSN, MHA. The new program, Independence at Home, significantly expands the scope of in-home services Medicare beneficiaries can receive.

The program not only helps the patient but it will also bring new avenues to care for medical practices nationwide. CMS will join with medical practices to test the effectiveness of delivering primary care services in a home setting to see if it improves care for Medicare beneficiaries with multiple chronic conditions. The program will also test whether home-based care can reduce the need for hospitalization, improve patient and caregiver satisfaction and lead to better health and lower costs to Medicare.

“In my days as a practicing nurse, I saw many patients whose health improved when they were happier with their living conditions,” Tavenner said. “When a critically ill patient can remain in familiar surroundings, the benefits are many: The person retains greater control over their daily lives, families and caregivers report greater satisfaction with the care and unnecessary hospitalizations are avoided.”

Home-based primary care generally allows health care providers to spend more time with their patients, perform assessments in a patient’s home environment and assume greater accountability for all aspects of the patient’s care. Independence at Home will build on these existing benefits by providing chronically ill patients a complete range of primary care services in the home setting.

Have you had experience in Home-Based Care? Medical practices wishing to participate must have in their employment physicians or nurse practitioners with experience in delivering home-based primary care. As many as 50 practices will be selected and each must serve at least 200 Medicare fee-for-service beneficiaries with multiple chronic conditions and functional limitations. Practices chosen to participate will be responsible for coordinating patient care with other health and social service professionals.

Medical practices chosen for the program that show a reduction in Medicare expenditures and succeed in providing high-quality care will receive an incentive payment. CMS will use quality measures to ensure that beneficiaries receive high quality care. Practices interested in joining the Independence at Home program can get more information by clicking here. Applications and letters of intent are due Feb. 6.

A drop of blood is enough to make some people queasy and for many like this the idea of a health care career is not even an option. So the caring among us who need to be on the front lines of patient care with warm hearts and empathetic natures are nowhere to be found. The fact is there are a number of health care related careers that have nothing to do with what’s traditionally thought of as health care and Hospital Dream Jobs is your source to find them.

An article on Schools.com outlines four health care related fields that don’t require a smock, cap and surgical gloves. In fact, experts suggest if you are thinking of a medical career that you do a trial run with some established health care organizations, like volunteering with your local ambulance contractors to see how you handle the stress and trauma. If you’re running for the hills after an hour in an ambulance you don’t necessarily have to scratch a career in health care, but you may want to look at these professions:

Personal or Home Health Care Aide

Certified home aids visit clients’ homes and help the elderly, sick and even those injured on the job. Health care aides provide company, do housework and shopping, drive clients to appointments and even help with personal care. A two-week course to earn national certification from the National Association for Home Care and Hospice is all that’s needed to get started. Projected job growth by 2018 is 51 percent.

Pharmacist

Pharmacists are considered an active part of a patient’s health care team especially now with new medications being developed every day. Pharmacists work at hospitals, clinics, commercial drug stores and even your local grocery store that has a pharmacy.  The primary job of a pharmacist is to dispense prescribed medication, create compounds as directed by physicians and monitor their patients’ prescriptions for possible negative interactions.  This position requires a Doctor of Pharmacy degree which takes a minimum of six years to complete. Projected job growth by 2018 is 22 percent.

Medical and Health Services Manager

This supporting role rarely deals with patients and are never involved with their health concerns. Instead, medical and health services managers, also called health care executives or health care administrators, supervise the delivery of medical care. These positions can cover specializations by department or even a whole organization. A bachelor’s degree in a relevant field is essential but a master’s in public administration, health sciences, public health, etc. is preferred. Projected job growth by 2018 is 16 percent.

Physical Therapist

This position is much more patient-centered but does not involve the gut-wrenching trauma you’d typically see inside a hospital. Physical therapists help rehabilitate people from injuries, surgery and even strokes which have affected their ability to move and perform everyday tasks. There are more than 200 physical-therapist training programs nationwide which are typically 24 to 30 month programs. Projected job growth by 2018 is 30 percent.

There was a time when alternative medicine was frowned upon in this country and the idea of using herbs, acupuncture, yoga and even massage was dismissed as archaic or scientifically irrelevant. But a recent study not only debunks that idea, but it also shows healthcare providers are using the services for themselves more than you might think.

Three out of four U.S. healthcare workers use alternative or complementary medicine for their own health needs. The survey of more than 14,300 working adults 18 years and older included 1,300 healthcare providers and covered 36 different alternative therapies including body manipulation, mind-body and biological-based therapies and energy-healing treatments. The report was published this month in the journal Health Services Research.

“No one has really done this sort of analysis before, so when I saw our results I was authentically surprised,” said Lori Knutson, co-author of the study who is also executive director of the Penny George Institute for Health and Healing with the Allina Health System in Minneapolis.

Knutson added that she was pleasantly surprised because the findings mean that U.S. healthcare workers recognize the need for alternative methods to improving health. Doctors and nurses were twice as likely as non-clinical healthcare workers to try alternative therapy. Additionally, they were three times more likely to have “self-treated” using complimentary/alternative approaches than their nonclinical counterparts.

The results of the study which collected data in 2007 showed 76 percent of healthcare workers had used alternative medicine in the previous year compared to 63 percent of people working in non-healthcare fields. According to the U.S. National Center for Complementary and Alternative Medicine about 38 percent of Americans currently use complimentary or alternative medicine.

“In general, Western culture has believed that complimentary services and techniques aren’t as well-researched and evidence-based as conventional medicine,” Knutson said. “But that is certainly no longer the case…What I hope comes from this insight into practitioner use of complimentary options is an opening up of the conversation between providers and patients about the use and potential of alternative medicine.”

The reasons cited by healthcare workers for looking into alternative therapies were similar to reasons seen elsewhere. The three most prevalent concerns were back, neck and joint pain. When diets, vitamins, minerals and/or herbal supplements were excluded from the study, healthcare workers still outpaced non-health workers to have tried an alternative medicine or service over the prior year – 41 percent to 31 percent.

Judy Blatman, a spokeswoman for the Council for Responsible Nutrition which represents the supplements industry, said the results are not surprising and they in fact are consistent with the group’s own research. She too is encouraged by the fact that healthcare providers are seeking these alternative treatments out.

“We find that often patients feel uncomfortable talking to their providers about non-traditional disciplines for fear of being discounted,” Blatman said. “So this should put everyone more at ease.

Melodie Chenevert is only loosely embracing the idea of retirement. She’s at work on a sixth nursing book, seeking museum status for her home/office which is full of nursing memorabilia, and continuing to advocate on behalf of nurses and nursing through her company, Pro-Nurse.

I had the fun and good fortune of visiting Melodie’s soon-to-be-museum and was duly impressed by her passion for all things nursing. She describes herself and her husband as “pack rats” that have enjoyed collecting everything from quilts to dirigibles. About 25 years ago she added vintage nursing items to the list — posters, photographs, uniforms, books, board games, dolls, original paintings and more. Some items date back to the Civil War.

Melodie didn’t start out with the idea of opening a museum but everyone who came to her office in Maryland kept going on about what a great “museum” she had. When she moved the collection to her new home/office on the West Coast the same thing kept happening. So she began the process of making it official. A museum will enable Melodie to share the art and history of nursing.

Melodie went to a diploma school in Minnesota and then got her bachelor’s and master’s degrees in nursing from the University of Washington. Ten years later she got a second master’s in journalism from the University of Wisconsin. During this time she was like a poster girl for the Women’s Movement. She was a full-time graduate student, half-time faculty member, married with two young sons. A chance meeting with a Mosby Publishing Company rep turned into a book contract.

Her first book was on assertiveness for women in the health professions. It remained in print for 30 years! More books followed. The spin-off of writing was speaking. Thanks to a solid message and a great sense of humor (costumes, siren whistles, kazoos, silly string, and magic wands), Melodie went on a lecture circuit that took her to 49 of the 50 states and halfway around the world.

Melodie continues to champion nursing as an excellent career choice. Her book Mosby’s Tour Guide to Nursing School: A Student’s Road Survival Kit is now in its 6^th edition. She also produces a coloring book to teach children about the many roles nurses play. As for Melodie, she’s been a staff nurse, play therapist, teacher, entrepreneur, and had the extraordinary privilege of setting up the school of nursing in Astoria, Oregon.

What’s next? She’s working on a book about the nurse who went to care for Robert Louis Stevenson when he was just a toddler. He dedicated A Child’s Garden of Verses to her.

And what is Melodie’s favorite thing about nursing? In addition to helping people, she love’s that there’s “a variety of career options available for an entire lifetime that you don’t get in many fields.” She has certainly proven that to be true!

You’ve just sent another patient to a specialist and by this time tomorrow, you may not remember his name. In fact, you may not even see him again! Is this really what it’s all about?

Isn’t it nice when your patient is your patient? When you are fully involved with her care for the long term? When you can greet her like an old friend and chat about little league and the school play? Well, the medical community is slowly embracing an idea called the “patient-centered medical home” which would allow doctors and patients to enjoy this kind of relationship.

In an article in Consumer Reports, Dr. Ronald Epstein, Professor and Director of the Center for Communication and Disparities Research at the University of Rochester Medical Center, says the medical home is designed to give patients a doctor who knows them as a person and ensures their needs are met and placed front and center. This idea is not a pipe dream; a bill being considered in the state of Oregon would set aside $400,000 to establish a “patient centered medical home” research and training center at Oregon Health & Science University.

Dr. Mark Kleinman, Vice President and Associate Medical Director for Primary Care for Kaiser Permanente, was recently quoted in the Oregonian regarding medical homes, “We want people to develop a years-long, longitudinal relationship with a single primary care provider and their team.”

Kaiser Permanente is planning to convert all of its clinics in Oregon and southwest Washington to the medical home model over the next year. Medicare is expected to launch a pilot program devoted to the medical home in the next few years.

Allowing primary care doctors to take part in the majority of a patient’s health care reduces visits to more costly specialists. Additionally, a study by Group Health Cooperative out of Seattle claims patients involved with this model of care required 29 percent fewer emergency room visits and six percent less hospital stays. This same study showed a return on investment of $1.50 for every dollar spent.

Kevin Grumbach, M.D., Chair of the Department of Family and Community Medicine at UC San Francisco, said this new model of health care allows a patient’s doctor to be their advocate, rather than a gatekeeper that restricts access to services. Grumbach, as quoted in Consumer Reports, said medical homes lower costs by reducing wasteful and duplicative services. He goes on to say that in our nation’s “large health-care delivery system . . . People are looking for someone they can recognize, who can lead them through the journey.”

Keep an eye on this emerging trend that may vastly improve your practice and your doctor-patient relationships!

It’s hard to put a price tag on ethics and very few of us can tout degrees on the subject, but we know it’s important to be “ethical” and we want to be seen as such by our employers or prospective employers. We know they notice and appreciate employees who demonstrate the ability to make good choices even in tough situations.

Yet it is increasingly difficult to define ethics, especially for healthcare professionals, when what is considered “the right thing” may be different depending on who you talk to – patients, peers, hospitals, clinics. But here are a few descriptors most would agree on: Honesty, integrity, carefulness, confidentiality, respect, non-discrimination, competence, legality and patient protection.

Most of us think these are no-brainers. We were raised on the “Golden Rule”, right? But start scanning healthcare headlines – the not so pretty ones – and ask yourself, “What would I do in that situation?” What at first glance may seem simple gets more complex when you put yourself in someone else’s shoes. For all that I was taught growing up and all that I believe, I’m not sure I would do right by everyone, including myself, if something unusual and unforeseen occurred.

That’s why I’m so impressed with the American Nursing Association’s continuing efforts to promote workplace ethics for. If you haven’t yet attended one of their ethics conferences, consider this the year. Enrollment is still open for the 2011 National Nursing Ethics Conference March 24-25 in Universal City, California.

The conference is open to Clinical Nurses, Nurse Administrators and Managers, Nurse Educators, Advanced Practice Nurses and Social Workers. While the definition of ethics could be debated forever there is a Code of Ethics for Nursing and this conference will give you a chance to review, discuss and dissect it with your peers. According to the American Nurses Association you will also “gain valuable information on how to balance your values and the values of the profession with appropriate goals of care, limited resources and professional responsibility and advocacy.”

There are 6 clearly defined topics/objectives that will be covered at the conference including advocacy, leadership practices and ways to incorporate self-care strategies. I very much appreciate that last one as it is very easy to neglect one-self when trying to do right by others.

This should be an intriguing and informative event that will add to your tool belt as you strive to be a valuable asset to your employer while being true to your morals, values and beliefs.

Planning to attend? Attended in the past? Tell us more in the comments section below.

First, all of us at Hospital Dream Jobs would like to wish you a happy, healthy New Year. We are grateful for the opportunity to provide the information and inspiration you need to follow your dreams as you pursue a career in healthcare. 2011 is sure to be memorable as a new legislative session gets under way in Washington and healthcare reforms begin to take shape. This week I decided to take a look at what is going on in the world of Physician Assistants.

In November, PA Karen Bass made national headlines when she was elected to Congress, the first PA to serve at this level. No stranger to the spotlight, Ms. Bass made history in 2008 when she was elected to be the Speaker for the California Assembly – the first African American woman in the country to serve in this legislative role. The American Association of Physician Assistants (AAPA) issued a press release after Bass’s election saying they looked “forward to the patient-centered health care perspective Bass is likely to bring to both the U.S. House of Representatives and the impending debates about health care reform implementation.”

Bass was a PA at the Los Angeles County-USC Medical Center where she practiced in an integrated team-based model of health care delivery that allows physicians, PAs and other non-physician providers more time with patients. This approach is considered by some to be the wave of the future as our healthcare system struggles under the burden of ever-rising costs, decreasing numbers of physicians and burgeoning numbers of patients.

As licensed and certified health care professionals, PAs practice medicine with physician supervision and bring a wide array of knowledge and skills to patient care. They perform a variety of procedures from conducting physical exams to diagnosing illnesses to assisting in surgery and more. In a survey conducted by the National Commission on Certification of Physician Assistants (NCCPA) 94% of PA’s employers reported that PAs helped increase the number of patients seen and 91% said that PAs enabled them to allow patients more time to ask questions during their office visits. In this same survey, 99% of the employers raved about the high-quality, compassionate care provided by their PAs.

 In 2010 the Six Key Elements of a Modern Physician Assistant Practice Act (elements address licensure, prescriptive authority, scope of practice, supervision requirements, chart co-signature requirements and the number of PAs a physician may supervise) was introduced.  Many state PA chapters hope to emphasize these elements to their state policy makers as the states look at making these and other changes to the delivery of patient care in advance of implementing federal health care reform.

This is going to be a groundbreaking year, not just for PAs, but for everyone working in healthcare and we at Hospital Dream Jobs look forward to accompanying you on the journey as you forge ahead in your healthcare careers!

One way to combat professional pitfalls that healthcare professionals face – chronic stress, fatigue and frustration – is to reinvigorate passion for your profession by volunteering. It may be tough at first to squeeze volunteer hours into an overloaded schedule, but volunteers often come away inspired and energized with new perspective. This week I spoke with a husband and wife team, Bruce and Donna C., who has given thousands of hours over the years volunteering. They are retired now and acknowledge that not everyone can give the time they do, but they strongly encourage others to give of their time when and where they can.

Donna, an RN with a BS in Public Health Nursing, had a 45-year nursing career working in various capacities including ER, post-op care, clinical instruction, home health care and more. And at different times, she took leave to be a volunteer nurse at youth summer camps. Bruce, with an AA degree as an Orthopedic Physician’s Assistant and a BA in Psychology, worked in a variety of industries over the years, including 15 years in medical related jobs from being a medic in the US Air Force to working as an EMT to serving in an orthopedic clinic. Although he officially logged fewer hours in healthcare than his wife, Bruce grew up in India where his parents were medical missionaries. So for Bruce medical practice and volunteerism have always gone hand in hand.

For the past 5 summers, Bruce and Donna have been volunteering with GANSU, INC. an organization headquartered in Georgia that started an eye-care ministry in China 18 years ago. The work began in the Gansu Province, thus their name, which is also an acronym: Gaining A New Sight for the Unseeing IN China. Gansu provides free eye care, primarily for the many people who have lost their sight to cataracts. Typically, Bruce and Donna are part of a 5-member team comprised of an ophthalmologic surgeon, a surgical nurse, a surgical assistant, a translator, and an “engineer/gofer”. Exams and surgery are performed in a converted pop-up tent trailer. Days are long and grueling, but unquestionably rewarding.

Bruce and Donna said they have greatly appreciated being able to help people who are hurting and to comfort them on a personal level “with the strength and comfort we have received from our personal faith.” They went on to say “there are medical organizations bringing health care and healing to the needy all around the country and the world and almost all are looking for volunteers who can give of their time and talents. Even a week or two during vacation time and in areas close to home would be a great way to get started.”

International Volunteer Day, established by the United Nations in 1985, was observed around the world on December 5^th to thank volunteers and increase public awareness.

So if you are feeling a bit burned out or ready to take a break from the medical profession, consider volunteering-it’s an effort that will invigorate your heart.

Job reviews are rarely fun or welcome. But with some forethought and preparation they can help you ascend the career ladder, make your job easier, open the door to new opportunities, improve your relationship with your boss and possibly even get you that raise you’ve been hoping for. Here are some tips to help you prepare:

• Know how the review process works by reading your employee handbook or asking coworkers, your boss or your Human Resources Manager.
• Keep a work journal, keeping track of your primary duties, listing obstacles you’ve encountered and how you overcame them as well as victories and how you accomplished them.
• Make a list of the qualities typically looked for in a person in this position and rate how well you are fulfilling these expectations.
• Make a wish list of things your boss can do or resources he/she can provide that would help you do a better job. Be specific, realistic and perhaps a little creative.
• Anticipate tough questions and rehearse your answers. If you committed a blunder or were involved in a workplace conflict, expect that to come up during your review even if it was already dealt with previously.
• Be prepared for criticism with an open mind and don’t get emotional. Prove you are a mature individual eager to improve your job performance.
• Make a list of short-term and long-term goals. Include new projects or responsibilities you’d like to be considered for. Outline how you plan to accomplish these goals, how your employer can help and how this will make you more of an asset to the company.
• Ask questions. Show you are actively listening and that you desire to understand their goals and expectations.
• If you plan to ask for a raise, do your research. Know what others in your field with your credentials and experience are being paid. If you have contributed to the company’s financial success, have the facts and figures to prove it. Be aware that pay scales and salary increases are often put in place months or years in advance when budgets are established.

Finally, if I might add a little whimsical touch to lighten the mood:

• Treat your review like a mini-New Year’s Eve Party. It’s a time to reflect on the year behind you and make resolutions for the year ahead. It may be bittersweet, but hopefully not too painful, and should end on a note of optimism.

This week I decided to revisit the topic of translating one’s personal passion into a career in healthcare and began delving into the world of sports medicine. My daughter is a cheerleader and a horseback rider. She is also gifted in math and science. I can easily see her in a career that combines her athletic interests with her academic gifts. Most of us think about football players and concussions when we hear the term “sports medicine,” but there are a LOT of “sports” out there each with their own distinct set of risks and common injuries. So if there’s a particular sport you love to play or watch chances are there are medical needs associated with that sport. Here are just a few of the career paths you may choose to follow as you ponder the possibilities:

Obviously, there are sports medicine physicians. Most are primary care physicians with fellowship training and added qualifications in sport medicine who combine their practice of sports medicine with their primary specialty. There are also those who focus solely on non-surgical sports medicine and serve as team physicians or who specialize in medicine and rehabilitation.

An equally interesting position requiring a less intensive education (and without the 6-figure salary to follow it up) would be Certified Athletic Trainer, or ATC. When I first heard this term I was picturing the trainers at my gym. But an ATC is actually an allied health care professional who specializes in prevention, assessment, treatment and rehabilitation of sports-related injuries. They work under the direction of a licensed physician as part of a sports medicine team.

Other healthcare professions in which you can focus on sports medicine include orthopedics, chiropractic, physical therapists and dieticians. Occupational therapists are also called upon to assist with sports-related injuries and there’s been some good press on occupational therapists recently. The American Occupational Therapy Organization reported on its website that “CNN Money ranked occupational therapy number 9 as a booming job with big opportunities, and number 19 as a best job in America. Forbes ranked [it] number 10 for best-paying jobs for women and number 14 for fastest-growing jobs for women.” The article goes on to report that in 2009 occupational therapy “topped the lists of recession-proof jobs, least stressful jobs, and best careers,” and highlights some folks who have made mid-life career shifts to work in occupational therapy.

We can’t all be professional athletes (and even if we could we couldn’t do it forever), but it’s great to know that we can choose careers that keep us involved in the “game” and allow us to help others along the way.