PubMed · 9555316
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I Thiam. 1998. Cancelling immunization program a bad idea.. https://pubmed.ncbi.nlm.nih.gov/9555316/
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BACKGROUND: Health systems worldwide face persistent health workers challenges including nursing shortages, workforce strain, and inequities. In Canada, these challenges have prompted renewed national and provincial reforms to strengthen recruitment, retention, leadership, and sustainability. This paper compares nursing workforce policy directions across Canada, and international jurisdictions to inform policy and planning. METHODS: A cross-country comparative analysis of policies building on a comprehensive national funded review that included an umbrella review of 69 systematic reviews, a comparative policy review of nursing workforce strategies in five jurisdictions, and validation through national horizon-scanning and policy dialogues (n >100). Evidence was analyzed across system, organizational, and individual levels. RESULTS: At the system level, international jurisdictions demonstrate comprehensive, legislated approaches integrating data, governance, and multi-year funding have advanced key nursing strategies. In Canada, the advances show the importance of strategies to have national and provincial/territorial alignment emphasizing leadership, flexibility, and inclusion as key levers. Organizational and individual-level reforms such as mentorship, leadership development, and wellness initiatives are expanding but remain variably evaluated. Experts identified national workforce data strategies and policy integration with embedded evaluation as key enablers to inform scalability and sustainability of implemented strategies. CONCLUSIONS: Canada's nursing workforce reforms are advancing toward coordinated, equity-driven, and evidence-informed strategies. Continued investment in evaluation, leadership, and national integrated data systems along with integrating nursing workforce planning within broader intersectoral planning will consolidate these gains and position Canada as an international leader in sustainable nursing workforce policy.
Physicians' time is under assault in the current health care system. In particular, managed care payers are reducing compensation to physicians on a discounted fee-for-service basis. More demanding consumers, complex new technologies, and increased managerial and administrative burdens are placing further constraints on physicians' time. As we look ahead, it seems likely that these pressures will intensify and transform the ways in which physicians spend their time. Physicians will play eight key roles in the future: clinical data collector, shaman, health advisor and wellness coach, knowledge navigator, proceduralist, diagnostician, physician manager, and quality assurance specialist. They will need to lead the redesign of these roles and define the ways in which they should spend their time in the health care system of the new millennium.
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