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White Paper

Mitigating Exposure for Advanced Practice Clinicians

America faces a looming primary care physician shortage. How bad is it? A study funded by the Association of American Medical Colleges notes that by 2020 there will be a shortage of 91,500 physicians.

White Paper Summary

America faces a looming primary care physician shortage.

How bad is it? A study funded by the Association of American Medical Colleges notes that by 2020 there will be a shortage of 91,500 physicians.1 Many physicians are scaling back the numbers of new patients or limiting the services provided to underserved populations, namely poor urban communities and rural populations where residents have no or limited access to healthcare clinics. Approximately 10 percent of America’s physicians have rural practices even though one-fourth of the population lives in these areas.2Further increasing the nationwide strain on the supply of physicians, the Affordable Care Act (ACA) could result in 15 million more Medicare-eligible Americans and more than 30 million Americans overall participating in the healthcare system by 2025.3

The physician shortage raises the risk for patient harm. In a 2012 study by the Physicians Foundation, physicians reported they were “at capacity” and were “overworked and over extended.”4 Physicians remaining in the marketplace face multiple liability challenges posed by errors due to exhaustion, longer patient wait times, the inability to quickly address worsening medical conditions, and the lack of time to provide preventative medical care.

One solution: increased use of APCs. But there are risks.

Increased use of advanced practice clinicians (APCs), including physician assistants (PAs) and nurse practitioners (NPs), has been one solution to the shortage of physicians. In some rural areas, APCs are the only healthcare professionals available for miles. For example, in 2011 South Dakota had 757 licensed primary care physicians, but 19 counties where there was no primary care physician at all.5APCs are also playing a critical role in modern healthcare team-based delivery systems designed to improve cost-effectiveness.

Increased use of advanced practice clinicians (APCs), including physician assistants (PAs) and nurse practitioners (NPs), has been one solution to the shortage of physicians. In some rural areas, APCs are the only healthcare professionals available for miles. For example, in 2011 South Dakota had 757 licensed primary care physicians, but 19 counties where there was no primary care physician at all.5APCs are also playing a critical role in modern healthcare team-based delivery systems designed to improve cost-effectiveness.

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Risk Management

The Profession

The risk manager for Boyd Gaming Corp. says curiosity keeps him engaged, and continual education will be the key to managing emerging risks.
By: | May 1, 2018 • 4 min read

R&I: What was your first job?

I was trained as an accountant, worked in public accounting and became a CPA. Being comfortable with numbers is helpful in my current role, and obviously, the language of business is financial statements, so it helps.

R&I: How did you come to work in risk management?

Working in finance in the corporate environment included the review of budgets and the analysis of business expenses. I quickly found the area of benefits and insurance — and how “accepting risk” impacted those expenses — to be fascinating. I asked a lot of questions. Be careful what you ask for — I soon found myself responsible for those insurance areas and haven’t looked back!

R&I: What is the risk management community doing right?

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I have found the risk management community to be a close-knit group, whether that’s industry professionals, risk managers with other companies or support organizations like RIMS and other regional groups. The expertise of the carriers and specialty vendors to develop new products and programs, along with the appropriate education, will continue to be of key importance to companies going forward.

R&I: What’s been the biggest change in the risk management and insurance industry since you’ve been in it?

As I’m sure many in the insurance field would agree, Hurricanes Katrina and Rita in 2005 changed our world and our industry. It was a particularly intense time and certainly a baptism by fire for people like me who were relatively new to the industry. This event clearly accelerated the switch to the acceptance of more risk, which impacted mitigation strategies and programs.

Bob Berglund, vice president, benefits and insurance, Boyd Gaming Corp.

R&I: What emerging commercial risk most concerns you?

The fast-paced threat that cyber security represents today. Our company, like so many companies, is reliant upon computers, software and IT expertise in our everyday existence. This new risk has forged an even stronger relationship between risk management and our IT department as we work together to address this growing threat.

Additionally, the shooting event in Las Vegas in 2017 will have an enduring impact on firms that host large gatherings and arena-style events all over the world, and our company is no exception.

R&I: What insurance carrier do you have the highest opinion of?

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With the various types of insurance programs we employ, I have been fortunate to work with most of the large national and international carriers — all of whom employ talented people with a vast array of resources.

R&I:  How much business do you do direct versus going through a broker?

We use brokers for many of our professional coverages, such as property, casualty, D&O and cyber. We are self-insured under our health plans, with close to 25,000 members. We tend to manage those programs internally and utilize direct relationships with carriers and specialty vendors to tailor a plan that works best for team members.

R&I: Who is your mentor and why?

I have been fortunate to have worked alongside some smart and insightful people during my career. A key piece of advice, said in many different ways, has served me well. Simply stated: “Seek to understand before being understood.”

What this has meant to me is try everything you can to learn about something, new or old. After you have gained this knowledge, you can begin to access and maybe suggest changes or adjustments. Being curious has always been a personal enjoyment for me in business, and I have found people are more than willing to lend a hand, offer information and advice — you just need to ask. Building those alliances and foundations of knowledge on a subject matter makes tackling the future more exciting and fruitful.

R&I: What have you accomplished that you are proudest of?

Our benefit health plan is much more than handing out an insurance card at the beginning of the year. We encourage our team members and their families to learn about their personal health, get engaged in a variety of health and wellness programs and try to live life in the healthiest possible way. The result of that is literally hundreds of testimonials from our members every year on how they have lost weight, changed their lifestyle and gotten off medications. It is extremely rewarding and is a testament to [our] close-knit corporate culture.

R&I: What’s the best restaurant you’ve ever eaten at?

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Some will remember the volcano eruption in Iceland in spring of 2010. I was just finishing a week of meetings in London with Lloyd’s syndicates related to our property insurance placement when the airspace in England and most of northern Europe was shut down — no airplanes in or out! Flights were ultimately canceled for the following five days. Therefore, with a few other stranded visitors like myself, we experimented and tried out new restaurants every day until we could leave. It was a very interesting time!

R&I: What is the riskiest activity you ever engaged in?

I am originally from Canada, and I played ice hockey from the time I was four years old up until quite recently. Too many surgeries sadly forced my recent retirement.

R&I: What do your friends and family think you do?

That’s a funny one … I am a CPA working in the casino industry, doing insurance and risk management, so neighbors and acquaintances think I either do tax returns or they think I’m a blackjack dealer at the casino!




Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]