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PubMed2004

New Zealand's psychiatrist workforce: profile, recruitment and retention.

OBJECTIVE: New Zealand is suspected of sharing other countries' difficulties of having inadequate numbers of practising psychiatrists and attracting psychiatrists to work outside its main urban centres, but there is no contemporary data on the socio-demographic and professional practice profile of its psychiatrists. This paper highlights some interesting trends about New Zealand's psychiatric workforce. METHOD: A postal questionnaire was sent to all actively practising vocationally registered psychiatrists with a New Zealand mailing address requesting information about basic demographic data, professional training experiences, current professional status, practise intentions, why they chose to work where they do and what factors might influence them to leave for another region of New Zealand or overseas. RESULTS: Of the 277 doctors on the vocational register for psychiatry, 159 responded, giving a response rate of 59.8%. Most psychiatrists were male (n = 102; 64.2%), European (n = 144; 90.6%), aged between 41 and 60 (69.2%), born overseas (n = 90; 56%), had English as their primary language (n = 142; 89.3%) and were in a long-term relationship with dependent children (n = 99; 62.3%). Nearly all (n = 149; 95%) did their psychiatry training in a metropolitan area and most (n = 108; 67.9%) held the Fellowship of the Royal Australian and New Zealand College of Psychiatry (FRANZCP). Most worked in a metropolitan area (n = 136; 85.5%) and either wholly or partly in the public sector (n = 145; 93%). Nearly one-quarter expected to retire over the next decade. Professional factors were rated more important as a reason for staying by metropolitan psychiatrists compared with their non-metropolitan counterparts (p < 0.001). Psychiatrists who did not have an FRANZCP (57%vs. 27%, p = 0.05), those who had spent more than 50% of their professional life in New Zealand (86%vs. 74%, p = 0.02) or those who had obtained their primary medical degree outside New Zealand were more likely to be in non-metropolitan areas (81%vs. 49%, p = 0.04). Metropolitan psychiatrists rated personal and social reasons more highly than non-metropolitan psychiatrists did for factors which might induce them to leave for another area, whereas professional development was ranked lower. CONCLUSIONS: This is the first contemporary study of New Zealand's psychiatric workforce and it highlights some interesting trends and has significant implications for those concerned with the recruitment and retention of psychiatrists. Further investigation is suggested, as a more complete picture of New Zealand's specialist psychiatric workforce would be gained by including psychiatrists who are not vocationally registered.

Adult↗

PubMedDate not supplied

A history of public health workforce enumeration.

During the 20th century, the United States' public health workforce has been of sufficient interest to policy makers that regular efforts have been made to enumerate it. Limited enumeration is found as early as 1908; the last direct federal survey occurred in 1964. After 1964, workforce size was estimated. The ratio of public health workers to population reached an estimated 220/100,000 in 1980. Data collected in 2000 yielded a ratio of 158/100,000--a 10 percent decrease. In the absence of a system to reliably collect public health workforce data such information is problematic to interpret or use for infrastructure planning and development.

Documentation↗

PubMedDate not supplied

Roadmap for public health workforce preparedness.

Major initiatives to improve the public health workforce since 1997 have been driven by a hundred-fold increase in federal financial support, technologies providing greater access to public health workers, and an emerging national priority to prepare for and respond to bioterrorism and other urgent threats. This report examines the status of the national public health workforce development agenda, including its major strategies and emphases, and offers a roadmap for assessing, enhancing, and recognizing competent performance through comprehensive public health workforce preparedness management systems.

Competency-Based Education↗

PubMedDate not supplied

The local public health agency workforce: research needs and practice realities.

There is a paucity of information about the nation's local governmental public health agency (LPHA) workforce. Without additional research, crucial questions about the individuals providing front-line public health services remain unanswered. Current national efforts to develop a public health workforce research agenda must include strategies for collecting basic data on local governmental public health workers. The work of enumerating and classifying LPHA staff is complicated, but not impossible. Projects to improve LPHA performance and discussions of the certification of public health workers are incomplete without current and accurate data on the individuals comprising our nation's public health system. The need to describe basic facets of the LPHA workforce is not trivial. As city and county budgets are cut and LPHAs are left scrambling to cover lost positions, data are needed to inform important decisions about what kinds of LPHA staff are needed to keep a community healthy.

Employment↗

PubMedDate not supplied

A research agenda for public health workforce development.

In the past decades, public health research has focused on categorical rather than cross-cutting or systems issues. Little research has been carried out on the infrastructure required to support public health programs. This article describes the results of an interactive process to develop a research agenda for public health workforce development to inform all those with stakes in the public health system. This research is defined as a multidisciplinary field of inquiry, both basic and applied, that examines the workforce in terms of costs, quality, accessibility, delivery, organization, financing, and outcomes of public health services to increase knowledge and understanding of the relationships among workforce and structure, processes, and effects of public health services. A logic model and five priority research areas resulted from meetings of expert panels during 2000 to 2003. Innovative public and private partnerships will be required to advance cross-cutting and systems-focused research.

Health Services Research↗

PubMed2006

The medical genetics workforce: an analysis of clinical geneticist subgroups.

PURPOSE: Clinical geneticists with a Doctor of Medicine degree face challenges to meet the growing population demand for genetic services. This study was designed to assist the profession with workforce planning by identifying clinically relevant subgroups of geneticists and describing their professional characteristics and clinical practices. Geneticists' patient care productivity is compared across subgroups and other medical specialists. METHODS: Part of a comprehensive national study of genetic services and the health workforce, this study uses data from a 2003 survey of geneticists certified by the American Board of Medical Genetics. This study includes 610 clinical geneticists who spend at least 5% of their time in direct patient-care services. An iterative approach was used to identify five subgroups based on the types of new patients seen. We conducted a descriptive analysis of subgroups by demographic, training, professional, and practice characteristics. RESULTS: The subgroups include general (36%), pediatric (28%), reproductive (15%), metabolic (14%), and adult (7%) geneticists. Clinically relevant variations across subgroups were noted in training, professional, and practice parameters. Subgroups vary across patient care hours (median, 15-33 hours/week) and total weekly work hours (52-60 hours). New patient visits (mean, 222-900/year) are higher than follow-up patient visits (mean, 155-405) for all subgroups except metabolic geneticists. CONCLUSION: Although many geneticists practice as generalist geneticists, this study provides an evidence base for distinguishing clinically relevant subgroups of geneticists. Geneticists provide similar numbers of new patient visits and far fewer follow-up visits than other medical specialists. These findings are relevant to geneticist workforce planning.

Data Collection↗

PubMed2004

NHS workforce issues: implications for future practice.

This analysis of the literature examines the implications of the changes in the National Health Service workforce and the ramifications for multi-professional working practices, patient care and delivery of health services. Changes in medical working practices and education, together with the increasing numbers of doctors, have resulted in proposals for nurses to extend their role and the removal of professional restrictions. Whilst the numbers of nurses in the workforce have marginally increased, the qualified nurse ratio has declined, as has the balance between medical and registered nurses. Few attempts have been made to evaluate these changes in relation to the quality of service and patient outcomes. The changing roles of nurses and their value need to be quantified. Demographic trends, together with international shortages and the lack of educational capacity have also been understated Adequate and accurate workforce information should be regularly collated and analysed.

Adult↗

PubMed2005

Viewpoint: HIV/AIDS and the health workforce crisis: what are the next steps?

In scaling up antiretroviral treatment (ART), financing is fast becoming less of a constraint than the human resources to ensure the implementation of the programmes. In the countries hardest affected by the acquired immunodeficiency syndrome (AIDS) pandemic, AIDS increases workloads, professional frustration and burn-out. It affects health workers also directly, contributing to rising sick leave and attrition rates. This burden is shouldered by a health workforce weakened already by chronic deficiencies in training, distribution and retention. In these countries, health workforce issues can no longer be analysed from the traditional perspective of human resource development, but should start from the position that entire societies are in a process of social involution of a scale unprecedented in human history. Strategies that proved to be effective and correct in past conditions need be reviewed, particularly in the domains of human resource management and policy-making, education and international aid. True paradigm shifts are thus required, without which the fundamental changes required to effectively strengthen the health workforce are unlikely to be initiated.

Africa, Southern↗

PubMed2005

Do health and medical workforce shortages explain the lower rate of rural consumers' complaints to Victoria's Health Services Commissioner?

OBJECTIVE: To identify which explanations account for lower rural rates of complaint about health services--(i) fear of consequences where there is little choice of alternative provider; (ii) a higher complaint threshold for rural consumers; (iii) lack of access to complaint mechanisms; or (iv) reduced access to services about which to complain. DESIGN: Ecological study incorporating consumer complaint, population and workforce distribution data sources. SETTING: All health care providers practising in Victoria. PARTICIPANTS: De-identified records of all closed consumer complaints made to the Health Services Commissioner, Victoria, between March 1988 and April 2001 by Victorian residents (13 856 records). MAIN OUTCOME MEASURES: Differences in the percentage of under-representation in complaint rates in total and for each of four categories of health services providers for different size communities. RESULTS: No consistent relationship was observed between community size and either degree of under-representation of complaints against any category of provider, or the proportion of serious or substantial complaints. Rural under-representation was highest (41%) for dentists, the provider category with the lowest proportion working in rural areas (17%), and lowest (18%) for hospitals, with the highest representation in rural areas (28% of beds). More rural complaints were about access issues (10.7% rural and 8.4% metropolitan). CONCLUSIONS: Reduced opportunity to use health services due to rural health and medical workforce shortages was the best-supported explanation for the lower rural complaint rate. Workforce shortages impact on the quality of rural health services and on residents' opportunities to improve their health status.

Health Services Accessibility↗

PubMed2004

The public health workforce.

The development of a fully-competent public health workforce as a key component of the nation's public health infrastructure has become the focus of increasing attention. The subject is included in one, and is the major topic of a second, report from the Institute of Medicine published late in 2002. Workforce issues have stimulated the convening of the majority of public health-related associations in a range of collaborations on the subjects of defining, enumerating, credentialing, educating, and studying the workforce. The authors review the major questions confronting the field and introduce key components of current thinking about approaches to improvement.

Disaster Planning↗

PubMed1998

A strategic approach to the psychiatric workforce dilemma.

To help build consensus in the field of psychiatry about future psychiatric manpower needs, a 13-step strategic approach to the workforce issue is described. The steps include recognizing the importance of the assumptions that underlie workforce requirements; selecting credible and professional leadership with vision and courage; adopting a strategic plan to clarify workforce assumptions; re-examining the structure and function of established programs; preparing trainees for work in the 21st century; preserving psychiatry's humanistic tradition; enlisting the support of nonacademic psychiatrists; and reinforcing involvement in the fiscal and political aspects of medicine. They also include focusing attention on important policy issues; securing the support of patients, families, and advocates; endorsing a multidisciplinary, biopsychosocial approach to the evaluation and treatment of mental illness; minimizing divisive conflicts within and between national organizations; and developing strategic alliances with other medical disciplines. Implications of the 13-step approach are outlined for psychiatric clinicians, educators, and researchers, as well as for the organizations that serve them.

Education, Medical↗

PubMed2005

New Zealand anaesthesia trainees and implications for the future workforce.

Attempting to ensure an adequate anaesthesia workforce for New Zealand requires many variables to be taken into consideration. The difficulty lies in trying to predict and match the future needs of the population and the future needs of the workforce itself. This paper examines variables that affect anaesthesia trainees' decisions in regard to future work plans which will affect anaesthesia distribution and manpower in New Zealand, particularly in smaller hospitals. It is already apparent that with distribution problems and/or actual shortages, the gaps in workforce availability for any professional group tend to be in the smaller centres. All New Zealand anaesthesia trainees were sent a questionnaire in 2002, with 110 of 138 trainees responding (79.7%). It appears enough specialists are being trained, with 80% indicating a desire to remain in New Zealand and 13% stating Australia as their choice of destination. The influence of student debt or encouragement of overseas training experience did not appear to be important in their decisions. Having a rotation during training to smaller hospitals had a positive effect on attitudes to working in smaller hospitals as specialists. The recruitment of these future specialists into smaller hospitals also depends upon broader lifestyle choices. Selection of smaller hospitals for anaesthesia practice is encouraged by good financial incentives, adequate professional support, including support by junior doctors, access to ongoing professional development and inclusion into a wider rotation with a larger hospital.

Anesthesiology↗

PubMed2006

Anaesthesia medical workforce in New Zealand.

This survey was conducted in all 28 New Zealand District Health Boards with a response rate of 100%. The Clinical Directors of Departments of Anaesthesia were asked to quantify their current anaesthesia service delivery and to assess their workforce level. Over half of the District Health Boards reported understaffing, fifty percent occurring in hospitals of provincial cities or towns with an inability to attract specialist anaesthesia staff. Financial constraint was the other main reason for understaffing. With the information from the survey, an attempt was made to predict future New Zealand anaesthesia workforce requirements. A model for Australasia established by Baker in 1997 was used. In comparing this survey to previous studies, there is evidence that the nature and expectations of the anaesthesia workforce are changing as well as the work environment. Currently, there is no indication that anaesthesia specialist training numbers should be reduced. Close, ongoing monitoring and planning are essential to ensure future demands for anaesthesia services can be met.

Anesthesia Department, Hospital↗

PubMed1997

Laboratories and the health care marketplace: the limits of state workforce policy.

Nearly every state has enacted its own effort to change both the composition and the practice patterns of America's medical workforce. At the same time, the health care marketplace is altering the nation's medical workforce, encouraging more medical students to enter primary care and fewer to become specialists. In this article, I consider various issues raised by these trends. Do the various state programs constitute an effective policy laboratory? Is the market solving problems government could not? Are the government initiatives now irrelevant? I conclude that the market is solving the problem of specialty maldistribution (too many specialists) but not the problem of geographic maldistribution (too many medically underserved communities). I also conclude that state workforce efforts have not constituted good policy laboratories and that only federal action can seriously address the geographic maldistribution problem.

Area Health Education Centers↗

PubMed1999

The effect of information technology on the physician workforce and health care in isolated communities: the Canadian picture.

The ratio of physicians to population in Canada peaked in the mid-1990s and is now falling. The decrease in the number of family physicians has had a disproportionate effect on rural and remote communities, and surveys have indicated that the availability of physicians and services is likely to deteriorate in rural and remote communities. Telemedicine is increasingly evident in every Canadian province and territory, and it could assist in more effective use of workforce resources by linking appropriate experts at central sites to patients and practitioners at remote sites. Positive effects on recruitment and retention of health providers and morale of the local workforce can be expected. In spite of national interest, evidence for the effect of telemedicine on staff distribution, roles and recruitment, use of health resources, health management and system integration is very limited. Telephone interviews were therefore conducted to collect information from 12 telehealth projects in Canada, one from each province or territory. The responses confirmed observations in the literature that telemedicine has positive outcomes for the workforce.

Canada↗

PubMed2000

Too few dentists? Workforce planning 1996-2036.

The development and use of forecasting models can stimulate the debate on workforce planning for dentists by improving the quality of the data available, by providing a framework within which the debate can be conducted and by providing a means whereby the effects of different trends and policy options can be measured in a consistent way. The number of dentists on the Dentists Register aged under 60 years may well fall over the 40 years between 1996-2036, while the proportion of female dentists is likely to grow from under 30% to almost 50%. If the present gender differences in dentists' output persist, the effective 'whole-time equivalent' (WTE) size of the dentist workforce could fall by 15%. While future patterns of disease and the efficacy of future treatments are difficult to predict, the demand for dentistry is very likely to increase, given the forecast ageing of the UK population. The number of people aged 65-74 years could increase by 50% to eight million and those over 75 years by 70% towards seven million. Further, almost of all of this greatly increased older population will have retained some of their own teeth. The edentulous adult population was 37% in 1968 and might fall to less than 5% by 2036. These trends taken together could increase the number of courses of treatment per WTE dentist by as much as 40% over these 40 years. Such modelling can help to reduce the degree of uncertainty in future workforce planning.

Adult↗

PubMedDate not supplied

A workforce analysis informing medical school expansion, admissions, support for primary care, curriculum, and research.

PURPOSE: This case study describes the findings of a physician workforce analysis and how an institution is using these findings to address the decreasing proportion of medical students choosing primary care careers. METHODS: A University of Washington School of Medicine committee commissioned an analysis of the American Medical Association Physician Masterfile. The analysis examined physician-to-population ratios, rural-urban geographic distribution, physician demographics, and physician graduation from the university or one of its affiliated residency programs for graduates of allopathic medical schools and residencies at the county level in the 5 states in the WWAMI partnership (Washington, Wyoming, Alaska, Montana, and Idaho). RESULTS: The analysis found that in 2005, the 5 WWAMI states ranked at the bottom of US states in the number of publicly supported medical school and residency slots per capita. Although physician-to-population ratios were comparable to those in the rest of the country, the 5 WWAMI states imported most of their physicians, including family physicians, approximately 70% of whom came from other medical schools or residency programs. Family physicians were the only specialty distributed across the population gradient from urban to isolated rural areas. The workforce analysis is informing planning for medical school expansion, admissions, support for primary care, curriculum, and research at an institution with a clear mission that includes training the health workforce for its region. CONCLUSIONS: The analysis has wide potential applicability, but it has special relevance for primary care and has been particularly useful in making the case for supporting primary care education in the WWAMI region.

Biomedical Research↗

PubMedDate not supplied

The case for diversity in the health care workforce.

Increasing the racial and ethnic diversity of the health care workforce is essential for the adequate provision of culturally competent care to our nation's burgeoning minority communities. A diverse health care workforce will help to expand health care access for the underserved, foster research in neglected areas of societal need, and enrich the pool of managers and policymakers to meet the needs of a diverse populace. The long-term solution to achieving adequate diversity in the health professions depends upon fundamental reforms of our country's precollege education system. Until these reforms occur, affirmative action tools in health professions schools are critical to achieving a diverse health care workforce.

Civil Rights↗