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PubMedDate not supplied

The personal assistance workforce: trends in supply and demand.

The workforce providing noninstitutional personal assistance and home health services tripled between 1989 and 2004, according to U.S. survey data, growing at a much faster rate than the population needing such services. During the same period, Medicaid spending for such services increased dramatically, while both workforce size and spending for similar services in institutional settings remained relatively stable. Low wage levels for personal assistance workers, which have fallen behind those of comparable occupations; scarce health benefits; and high job turnover rates highlight the need for greater attention to ensuring a stable and well-trained workforce to meet growing demand.

Activities of Daily Living↗

PubMedDate not supplied

The public health workforce, 2006: new challenges.

Efforts to develop the public health workforce since 2001 have benefited from increased funding resulting from concerns over terrorism and other public health threats. This largesse has been accompanied by the need for greater accountability for results. The size, composition, and distribution of the public health workforce have long been policy concerns. Production and retention of public health workers remain important issues, although new dimensions of readiness are also taking center stage. We offer here policy recommendations in the areas of assessing the public health workforce and its needs, organizing development efforts around essential competencies for public health practice, credentialing workers, and accrediting agencies.

Accreditation↗

PubMed2006

Family physicians in the child health care workforce: opportunities for collaboration in improving the health of children.

Pediatric workforce studies suggest that there may be a sufficient number of pediatricians for the current and projected US child population. These analyses do not fully consider the role of family medicine in the care of children. Family physicians provide 16% to 26% of visits for children, providing a medical home for one third of the child population, but face shrinking panels of children. Family medicine's role in children's health care is more stable in rural communities, for adolescents, and for underserved populations. For these populations, in particular, family medicine's role remains important. The erosion of the proportion of visits to family medicine is likely caused by the rapid rise in the number of pediatricians relative to a declining birth rate. Between 1981 and 2004, the general pediatrician population grew at 7 times the rate of the US population, and the family physician workforce grew at nearly 5 times the rate. The number of clinicians caring for children meets or exceeds most estimates of sufficiency; however, the workforce distribution is skewed, leaving certain populations and settings underserved. More than 5 million children and adolescents live in counties with no pediatrician. Unmet need, addressing health in the context of families and communities, and tackling "millennial morbidities" represent common ground for both specialties that could lead to specific, collaborative training, research, intervention, and advocacy.

Child↗

PubMed1990

The federal environmental health workforce in the United States.

This paper summarizes existing data on the size and composition of the federal environmental health workforce, delineates the major categories of activities carried out by its members, identifies current and emerging issues that are likely to affect workforce activities, and makes qualitative inferences about future trends and directions. Findings suggest that there is a current and future need for more and better qualified professionals in the federal environmental health workforce.

Environmental Health↗

PubMed1999

Workforce demand for neurosurgeons in the United States of America: a 13-year retrospective study.

OBJECT: The workforce demand for neurosurgeons was quantified by a review and an analysis of journal recruitment advertisements published over the past 13 years. METHODS: A retrospective analysis of recruitment advertisements from July 1985 through June 1998 was performed by examining issues of the Journal of Neurosurgery and Neurosurgery. Advertisement information that appeared in each journal during the last 3 years was collected from alternating months (July to May); information that appeared prior to that time was collected from alternating recruitment years back to 1985. The authors examined the following workforce parameters: practice venue, subspecialization, and practice size. They found no significant decrease in neurosurgical recruitment advertisements. There was an average of 102.7+/-22.4 (standard deviation) advertised positions per year during the most recent 3 years compared with 92.6+/-17.9 advertised positions per year during the preceding decade. Similarly, there has been no decline in advertised positions either in academic (33+/-6.1/year for the most recent 3 years compared with 32.8+/-5.9/year for 1985-1995) or private practice (69.7+/-21.6/year for the most recent 3 years compared with 59.8+/-13.4/year for 1985-1995). A shift in demand toward subspecialty neurosurgery was observed. During the past 3 years, 31.2+/-5.9% of advertised positions called for subspecialty expertise, compared with 18.5+/-2.8% for the preceding decade (p < 0.05). The largest number of subspecialty advertisements designated positions for spine and pediatric neurosurgeons. Private practice advertisements increasingly sought to add neurosurgeons to group practices. CONCLUSIONS: Contrary to previous reports and a prevailing myth, our data show no decrease in workforce demand for neurosurgeons in the United States over the past 3 years compared with the prior decade. A shift toward subspecialist recruitment, particularly for spine neurosurgeons, has been demonstrated in both academic and private practice venues.

Academic Medical Centers↗

PubMed1997

Identifying the active general practice workforce in one division of general practice: the utility of public domain databases.

OBJECTIVE: To identify the non-specialist medical practitioner workforce engaged in active general practice in the region served by the Division of General Practice-Northern Tasmania and to determine the usefulness of public domain databases for enumeration of individual non-specialists providing general practice services. METHODS: A masterlist of the active general practice workforce was compiled by obtaining the names and addresses/postcodes of all non-specialist medical practitioners who were listed in at least one of nine public domain databases and who were confirmed by selected local medical practitioners to be in active general practice in the three months prior to 30 June 1994. This masterlist was used in calculating the sensitivity and positive predictive value (PPV) of each of the nine databases for enumerating non-specialist practitioners in active general practice. RESULTS: Combining the databases resulted in a list of 475 practitioners, which was refined to 139 practitioners who, by our criteria, were in active general practice. Databases had a range of sensitivities and PPVs, but those with high sensitivity tended to have low PPVs, and vice versa. The most useful database for enumerating these practitioners was the mailing list for Australian Family Physician (sensitivity, 94%; PPV, 0.79). CONCLUSIONS: When used alone, no single database had both high sensitivity and high positive predictive value for identifying the active general practice workforce. Combining multiple databases may improve precision. Developing methods to identify recent departures from local active practice has the potential to improve the PPV of existing highly sensitive databases.

Australia↗

PubMed1999

Trends in the specialist workforce in internal medicine in Australia, 1981-1995.

OBJECTIVE: To describe trends over the period 1981 to 1995 in the supply of consultant physicians in adult medicine in Australia, and to project these trends into the early part of the 21st century. DESIGN: Analysis of workforce data collected by the Royal Australasian College of Physicians in censuses of Fellows in 1981, 1984, 1986, 1988, 1990, 1993 and 1995. MAIN OUTCOME: Number of physicians and ratio of population aged 50 years and older per physician. RESULTS: The workforce increased linearly from 1641 in 1981 to 2701 in 1995, while the population/physician ratio fell from 2180:1 to 1720:1, with a decreasing rate of decline. The ratio is projected to rise after 1996 to 1780:1 in 2016. Among the State and Territories, the higher the population/physician ratio in 1981 the greater the rate of subsequent decline. The proportion of women physicians rose linearly from 4.8% in 1981 to 10.6% in 1995. The age structure changed from a youthful triangular profile in 1981 towards a rectangular profile characteristic of an aged population. All specialty fields displayed a decreasing rate of decline in the population/physician ratio. The proportion of physicians practising in regional centres increased steadily from 9.3% in 1981 to 12.9% in 1995. CONCLUSIONS: Although the number of physicians has risen markedly since 1981 and the ratio of population aged 50 years and older per physician has fallen, trends suggest that the ratio will rise again early in the 21st century. Any deliberate attempt to limit the growth of the physician workforce might result in a deficit in the future when the demand for physicians is growing rapidly due to population ageing.

Adult↗

PubMed2006

When the tide goes out: health workforce in rural, remote and Indigenous communities.

There is compelling evidence for the success of the "rural pipeline" (rural student recruitment and rurally based education and professional training) in increasing the rural workforce. The nexus between clinical education and training, sustaining the health care workforce, clinical research, and quality and safety needs greater emphasis in regional areas. A "teaching health system" for non-metropolitan Australia requires greater commitment to teaching as core business, as well as provision of infrastructure, including accommodation, and access to the private sector. Workforce flexibility is mostly well accepted in rural and remote areas. There is room for expanding the scope of clinical practice by non-medical clinicians in both an independent codified manner (eg, nurse practitioners) and through flexible local medical delegation (eg, practice nurses, Aboriginal health workers, and therapists). The imbalance between subspecialist and generalist medical training needs to be addressed. Improved training and recognition of Aboriginal health workers, as well as continued investment in Indigenous entry to other health professional programs, remain policy priorities.

Australia↗

PubMed2000

Survey of Australian and New Zealand Oral and Maxillofacial Surgery trainees and recent specialists--workforce issues.

This study examined Oral and Maxillofacial Surgeon (OMS) workforce issues in relation to current training in Australia and New Zealand. Earlier findings identified that there was a requirement of approximately 6 additional OMS specialists per year in Australia and one per year in New Zealand to maintain an adequate level of supply in the profession. It was found in this study that through to the early part of the next decade the number of OMS entering the Australian workforce is appropriate (5.9 per annum), but there would appear to be concerns about the sufficiency of the number entering the New Zealand workforce (0.7 per annum). In addition, the study also found possible maldistribution in the location of intended future practices, with possible shortages outside of the metropolitan areas.

Australia↗

PubMedDate not supplied

The uneven landscape of newborn intensive care services: variation in the neonatology workforce.

CONTEXT: In the past 30 years, the number of neonatologists has increased while total births have remained nearly constant. It is not known how equitably this expanded workforce is distributed. OBJECTIVE: To determine the geographic distribution of neonatologists in the United States. DATA SOURCES: 1996 American Medical Association physician masterfiles; 1999 survey of all U.S. neonatal intensive care units; 1995 American Hospital Association hospital survey; and 1995 U.S. vital records. MEASURES: The number of neonatologists and neonatal mid-level providers per live birth within 246 market-based regions. RESULTS: The neonatology workforce varied substantially across neonatal intensive care regions. The number of neonatologists per 10,000 live births ranged from 1.2 to 25.6 with an interquintile range of 3.5 to 8.5. The weakly positive correlation between neonatologists and neonatal mid-level providers per live birth is not consistent with substitution of neonatal mid-level providers for neonatologists (Spearman rank-correlation coefficient, 0.17; P < 0.01). There was no difference in the percentage of neonatal fellows in the lowest and highest workforce quintile (14% vs. 16%) or in the percentage of neonatologists engaged predominantly in research, teaching, or administration (14% in lowest and highest quintiles). CONCLUSIONS: The regional supply of neonatologists varies dramatically and cannot be explained by the substitution of neonatal mid-level providers or by the presence of academic medical centers. Further research is warranted to understand whether neonatal intensive care resources are located in accordance with risk and whether more resources improve newborn outcomes.

Age Distribution↗

PubMedDate not supplied

Physician workforce reform in Lithuania: an inevitable transition.

The health system in Lithuania before independence was the same centralized system, the Semashko model that was prevalent throughout the former Soviet Union. The Soviet system focused more on quantity than quality, which resulted in a greater number of physicians per 100,000 than found in Western Europe. As in other Central and Eastern European countries, the health system in Lithuania has undergone substantial change since 1990. A major part of the reform of physician workforce in the former communist countries has been development of primary health care as a centerpiece of the health systems. This move in Lithuania has been hindered to some degree by the shortage of general or family practitioners. The focus on specialists in the old Soviet system led to a severe shortage of physicians in general practice. Only about 10% of physicians were general practitioners (GPs) in 1993 compared to a European Union average of 35%. That percentage had increased to 16% by 1998. Programs have been established to both train new GPs and to retrain specialists to become GPs, although a shortage of teachers and finances are problems facing these programs. Although the physician workforce in Lithuania has undergone substantial reform since 1990, real change has been slow. The physician to population ratio in Lithuania has failed to decline, moving from 387 per 100,000 population in 1991 to 398 in 1997, before dropping to 395 in 1998. The ratio remains substantially higher than current EU averages, reflecting a difficulty in reducing the number of physicians. Here we review what has happened to the physician workforce in Lithuania since independence and evaluate policies implemented. Efforts to reduce the number of physicians are also assessed. The results in Lithuania are compared to those in other CEE countries and to EU averages.

Adult↗

PubMedDate not supplied

The perils of healthcare workforce forecasting: a case study of the Philadelphia metropolitan area.

In 1996, a widely circulated and influential forecast for the Philadelphia Metropolitan Area stated that a decline in hospital and healthcare employment in the region would occur over the next five years. It also suggested that this decline would exacerbate the problem of an oversupply of nurses seeking hospital employment. The forecast reflected a regional leadership and expert consensus on the impact of the managed care transformation on workforce needs and was supported by short-term statistical trends in regional utilization and employment. Confounding these predictions was the fact that hospital and healthcare employment actually grew. By the end of 2001, hospitals in the region were experiencing problems in recruiting sufficient numbers of nurses, pharmacists, and technicians. The forecast failed to anticipate the impact of a strong regional economy on supply and underestimated the resilience of underlying forces that have driven the long-term growth in healthcare workforce demand. More effective ongoing monitoring can help moderate the fluctuation of workforce shortages and surpluses.

Adult↗

PubMed2005

Sustaining the rural primary healthcare workforce: survey of healthcare professionals in the Scottish Highlands.

INTRODUCTION: Many westernised countries face ongoing difficulties in the recruitment and retention of health professionals in remote and rural communities. Predictors of rural working have been identified by the international literature, and include: the individual having been born or educated in a rural location; exposure to rural healthcare during training; access to continuing professional education; good relationships with peers; spousal contentedness; adoption of a rural 'lifestyle'; successful integration into local communities; and educational opportunities for children. However, those themes remain unverified in the UK. The present study aimed to ascertain whether the internationally identified determinants of recruitment and retention of the rural health workforce apply in the Highlands of Scotland, which includes the most sparsely populated area of the UK mainland, as well as an urban area. METHODS: In 2003, a questionnaire was sent to all 2070 primary healthcare professionals working in the Highlands (which makes up one-third of Scotland's land area (9800 square miles) and has just 4% of the country's population (209,000)). Approximately one-quarter of the Highland's population live in Inverness. The area is ideal for investigating the rural workforce due to its population sparsity and the inclusion of small towns and Inverness, allowing urban/rural comparisons. The questionnaire asked about places of birth and education; intentions to stay/leave current location; professional isolation; access to amenities; and perceptions of belonging to the local community. RESULTS: The response rate was 53%. Compared with respondents working in urban areas, those working in rural areas were more likely to have been born in rural areas. Professionals living in rural areas were more likely to have been born outside Scotland and to have completed their secondary education and professional training outside Scotland, compared with those living in urban areas. Approximately one-third (34%) had lived in their current location for more than 10 years, and that proportion was higher for the urban group compared with rural dwellers. Similarly, the urban dwellers were more likely to have been in their current job for more than 10 years. Respondents' perceptions of being isolated, of their caring roles extending beyond their work; and of an inability to get away from work for holidays and study leave, were more common among rural dwellers. Eighty-one percent of respondents said that they felt part of their community and that proportion was higher for those working in rural areas, than for urban residents. Respondents indicated their perceived ease of access to five amenities and services: children's education (preschool, primary and secondary); access to a job for spouse; and health care. With the one exception of access to primary education, access was perceived to be most difficult by the professionals working in rural areas. CONCLUSIONS: Our survey confirms, in the UK, the association between rural background and rural working, and highlights the contribution of healthcare professionals from other parts of the UK to the Scottish rural workforce. It also suggests that professional isolation and perceived lack of access to amenities are important issues for those working in rural areas.

Adult↗

PubMed2006

The Israeli anesthesiology physician workforce.

BACKGROUND: Anesthesiology is a vital specialty that permits the safe and humane performance of painful procedures. Most Israeli anesthesiologists are immigrants, while only a minimal number of Israeli medical school graduates enter the specialty. Unfortunately, the supply of immigrant physicians is declining due to falling immigration rates. OBJECTIVES: To examine the current Israeli anesthesiology workforce and project future needs. METHODS: Demographic and professional information about Israeli hospital anesthesiologists was solicited from anesthesiology department heads. Data were also gathered about the past, present and projected future growth, age distribution and birth rate of the Israeli population. Needs and demand-based analyses were used to project future anesthesiology workforce requirements. RESULTS: Data on 711 anesthesiologists were obtained from 30 hospital anesthesiology department heads. Eighty-seven anesthesiologists (12.2%) graduated from Israeli medical schools and 459 (64.6%) graduated from medical schools in the former Soviet Union. Among the 154 anesthesiology residents < or = 40 years old, only 13 (8.4%) graduated from Israeli medical schools. There are approximately 10.8 anesthesiologists per 100,000 population. Projections for 2005-2015 revealed a need for 250-300 new anesthesiologists. CONCLUSIONS: The anesthesiology workforce is predominantly composed of immigrants. This has vast implications for the future viability of the specialty because of the continuing reduction in immigration, the lack of interest in the specialty by Israeli medical school graduates, and the projected need for many new anesthesiologists to replace retirees and to provide care to a growing and aging population.

Adult↗

PubMed1995

Calculating the workforce in general surgery.

OBJECTIVE: To provide a reasonable estimate of the patient care and resident physician workforce practicing general surgery in 1994. DESIGN: Data regarding general surgical residents and practicing general surgeons were obtained from four sources and compared with previously published numbers. DATA SOURCES: Information was derived from the American College of Surgeons' Longitudinal Study of Surgical Residents: 1992-1993; the American Medical Association's Physician Characteristics and Distribution in the United States, 1994 Edition; the American Board of Medical Specialties' database on general surgeons; and the American Board of Surgery recertification data from the files of diplomates since 1968. Each of these sources was analyzed separately to derive a count of graduates from general surgery residency programs and an estimate of fully trained general surgeons engaged in patient care activities. RESULTS: We found that approximately 600 graduates of general surgery residency programs enter the practice of general surgery each year, and we found a close correlation between maximum and minimum estimates of the number of fully trained general surgeons engaged in active patient care, certified general surgeons who are not retired, and currently certified general surgeons. This number (17,289 to 23,502) is approximately half that commonly used in calculations of the general surgery workforce (38,239). The larger number includes surgeons with subspecialty training beyond general surgery, surgical residents, and surgeons not engaged in patient care. CONCLUSIONS: Estimations of the workforce in general surgery and predictions of future needs for general surgeons must be derived from the appropriate number of general surgery residents and practicing general surgeons.

Career Choice↗

PubMed1994

Forecasting the effects of health reform on US physician workforce requirement. Evidence from HMO staffing patterns.

This article provides an estimate of the effects of health reform on the US physician workforce requirement. Its basic methodology is to extrapolate current patterns of staffing within managed care plans to the reshaped health care system of the year 2000. In this analysis it is assumed that 40% to 65% of Americans will be receiving care from integrated managed care networks in the near future, and that all citizens will be covered by some type of health insurance. On the basis of these assumptions, this article forecasts that in the year 2000, (1) there will be an overall surplus of about 165,000 patient care physicians; (2) the requirement and supply of primary care physicians will be in relative balance; and (3) the supply of specialists will outstrip the requirement by more than 60%. In summation, it appears that national health reform--based largely on an expansion of managed care networks--will have significant impact on the US physician workforce. Concerns have been raised by others that health system reform's shift toward more primary and preventive care will be stymied by workforce availability. This study underscores this concern to some degree. However, the evidence presented herein suggests that the issue is not so much a primary care provider shortage as a specialty care surplus.

Demography↗

PubMed1996

Gastroenterology workforce modeling.

OBJECTIVE: To examine the current supply and distribution of gastroenterologists and project future supply under various scenarios to provide a paradigm for workforce reform. DESIGN: An analysis of current practices and distribution of gastroenterologists and a demographic model, using the 1992 gastroenterology workforce as a baseline. MAIN OUTCOME MEASURE: Comparison of current supply, distribution, and practice profiles with past data and future projections, using analyses of data from the 1993 Area Resource File, 1992 Medicare Part B file, age- and sex-specific death and retirement rates from the Bureau of Health Professions, managed care staffing patterns, the National Survey of Internal Medicine Manpower, and the Bureau of the Census. RESULTS: Rapid growth in the number of US gastroenterologists has resulted in a gastroenterologist-to-population ratio double that used on average by health maintenance organizations. In addition, the work profile of gastroenterologists is shared significantly by primary care physicians and other specialists, with the exception of a few specific and uncommon procedures. CONCLUSIONS: Empirical evidence suggests that, even in the absence of detailed models to describe the desired supply/need balance for gastroenterology, the US health care system and clinicians may benefit from a reduction in gastroenterology training programs. The Gastroenterology Leadership Council endorsed a goal of 25% to 50% reduction in trainee numbers over 5 years, and recent National Resident Matching Program data indicate that a voluntary downsizing process is in full force. This study illustrates a paradigm for workforce planning that could be useful for other medical specialties.

Demography↗

PubMedDate not supplied

Downsizing the physician workforce.

OBJECTIVE: To estimate the need for downsizing the physician workforce in a changing health care environment. METHODS: First assuming that 1993 physician-to-population ratios would be maintained, the authors derived downsizing estimates by determining the annual growth in the supply of specialists necessary to maintain these ratios (sum of losses from death and retirement plus increase necessary to parallel population growth) and compared them with an estimate of the number of new physicians being produced (average annual number of board certificates issued between 1990 and 1994). Then, assuming that workforce needs would change in a system increasingly dominated by managed care, the authors estimated specialty-specific downsizing needs for a managed care dominated environment using data from several sources. RESULTS: To maintain the 1993 199.6 active physicians per 100,000 population ratio, 14,644 new physicians would be needed each year. Given that an average of 20,655 physicians were certified each year between 1990 and 1994, at least 6011 fewer new physicians were needed annually to maintain 1993 levels. To maintain the 132.2 ratio of active non-primary care physicians per 100,000 population, the system needed to produce 9698 non-primary care physicians per year, because an average of 14,527 new non-primary care physicians entered the workforce between 1990 and 1994, downsizing by 4829, or 33%, was needed. To maintain the 66.8 active primary care physicians per 100,000 population ratio, 4946 new primary care physicians were needed per year, since primary care averaged 6128 new certifications per year, a downsizing of 1182, or 20% was indicated. Only family practice, neurosurgery, otolaryngology, and urology did not require downsizing. Seventeen medical and hospital-based specialties, including 7 of 10 internal medicine subspecialties, needed downsizing by at least 40%. Less downsizing in general was needed in the surgical specialties and in psychiatry. A managed care dominated-system would call for greater downsizing in most of the non-primary care specialties. CONCLUSION: These data support the need for downsizing the nation's physician supply, especially in the internal medicine subspecialties and hospital support specialties and to a lesser extent among surgeons and primary care physicians.

Health Services Needs and Demand↗