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PubMed2004

Time for a new approach to medical workforce planning.

There are concerns that Australia is facing an impending shortage in the medical workforce, and there are significant changes occurring in key determinants of medical workforce supply and demand. To date, workforce planning has not taken into account the full range of dynamic variables that are involved, nor accounted for their inherent uncertainty and complex interactions. Future planning will require more careful monitoring and dynamic modelling within a full healthcare system perspective.

Australia↗

PubMed1990

Strategic planning for training: how to manage the competence of your workforce.

Peak performance in today's challenging business environment requires systematic management of workforce competencies. The strategic planning approach to training offers a systematic method for defining the competency requirements of the workforce; devising plans, policies and strategies for developing these competencies; allocating resources; and implementing a performance-based training system. The strategic training plan is a vehicle for putting management in control of the competence of the workforce by gaining control of the training system.

Competency-Based Education↗

PubMed2000

Information needs and uses of the public health workforce--Washington, 1997-1998.

Substantial efforts have been made to ensure that state and local public health agencies have the information technology and training needed for public health communications, information access, and data exchange. Numerous public health-related data and information resources are available on the World-Wide Web (e.g., MEDLINE, MMWR, CDC Prevention Guidelines Database, and Emerging Infectious Diseases); however, little systematic work has been done to understand the information needs of the public health workforce. To identify these needs and patterns of use and to set priorities for developing new online public health information resources, the University of Washington School of Public Health and Community Medicine (UW SPHCM) and the Washington State Department of Health (WSDoH) held structured and facilitated discussions with segments of the local public health workforce in Washington during 1997-1998. This report summarizes the results of those discussions, which indicate that different segments of the public health workforce have different information needs.

Congresses as Topic↗

PubMed2000

A Collaborative Approach to Workforce Transformation: Food and Nutrition Services Staff Education.

Recent health care system changes have required the food and nutrition services workforce to learn new job skills, and to work with significantly less supervision. At Baycrest Centre for Geriatric Care (892 beds), the Food and Nutrition and the Education and Organizational Development Departments collaborated to budget for, plan, and implement an educational program to transform a traditional food service workforce into an effective self-managing team. The workforce actively participated in a needs assessment process to identify the skills and behaviours requiring change. Clear behavioural objectives were developed. Training sessions involved realistic video modelling, role-playing, and discussion. Crucial to the success of the training were overcoming negative attitudes and promoting positive anticipation. Indicators, such as an incident audit sheet, were developed to evaluate program effectiveness. After taking the educational program, staff are more willing to identify and solve problems requiring intervention, and are better able to discuss change and suggest options. When problem-solving, work teams focus on the issue, rather than on accusing others or being defensive. This training process is ongoing and requires continual coaching and application. If follow-up training sessions are deferred, benefits may soon be lost.

Journal Article↗

PubMed2004

Prevalence of HIV in workforces in southern Africa, 2000-2001.

OBJECTIVES: Most data on HIV prevalence in low-risk populations in sub-Saharan Africa are drawn from sentinel surveys of pregnant women attending antenatal clinics and are not representative of formal sector workforces. We surveyed workforces in southern Africa to determine HIV prevalence among formally employed, largely male populations. METHODS: Voluntary, anonymous, unlinked seroprevalence surveys of 34 workforces with 44,000 employees were carried out in South Africa, Botswana, and Zambia in 2000-2001. Results were stratified to obtain estimates of prevalence by industrial sector, location, age, sex, and job level. RESULTS: Average HIV prevalence for the entire sample was 16.6% (95% CI: 16.3-17.0%). Country-wide prevalence was 14.5% (14.1-14.9%) in South Africa, 17.9% (17.1-18.7%) in Zambia, and 24.6% (23.6-25.7%) in Botswana. Among industrial sectors, mining (18.0%, 17.6-18.5%) and metal processing (17.3%, 15.9-18.7%) had the highest infection rates. Males, who comprised 85% of participants of known sex, were more likely (16.3%, 15.3-17.4%) to be infected than were females (10.7%, 8.7-12.7%). Contract (23%, 21.9-24.1%), unskilled (18.3%, 17.5-19.1%), and semi-skilled workers (18.7%, 18.1-19.4%) were much more likely to be infected than were skilled workers (10.5%, 9.5-11.4%) and managers (4.5%, 3.4-5.6%). Participation in the surveys averaged 63% of eligible employees. CONCLUSIONS: HIV prevalence among formally employed workers in southern Africa shows different patterns than among antenatal clinic attendees. Anonymous workplace surveys generate prevalence estimates for demographic groups that are not represented in antenatal surveys and can strengthen support for prevention and treatment interventions.

Adult↗

PubMed2004

Recruiting small manufacturing worksites that employ multiethnic, low-wage workforces into a cancer prevention research trial.

INTRODUCTION: Worksites, including those that employ multiethnic, low-wage workforces, represent a strategic venue for reaching populations at risk for developing cancer. METHODS: We surveyed 197 small manufacturing worksites prior to an effort to recruit their workforces into a randomized clinical trial designed to test the effectiveness of a cancer prevention intervention among multiethnic, low-wage manufacturing workers. This paper assesses the external validity of the trial based on three factors: the percentage of potential trial sites excluded from consideration, the percentage of eligible worksites that adopted the trial, and worksite characteristics associated with adoption. RESULTS: We found no statistically significant differences between worksites that adopted the trial and worksites that declined the trial with regard to employee demographics, anticipated changes in workforce size, and perceived importance and history of offering health promotion and occupational health and safety activities. CONCLUSION: Small manufacturing worksites present a viable venue for reaching multiethnic, low-wage populations with cancer prevention programs, although program adoption rates may be low in this sector. Worksites that adopted the trial are likely to represent worksites deemed eligible for the trial.

Biomedical Research↗

PubMed2005

An assessment of critical issues facing the clinical laboratory workforce.

The National Center for Health Workforce Analysis of the Health Resources and Services Administration (HRSA), Bureau of Health Professions contracted with the University of California at San Francisco Center for the Health Professions to conduct a study of the clinical laboratory workforce. The study utilized existing and new survey data, in collaboration with the American Society for Clinical Pathology (ASCP), as well as interviews with experts in the field. This paper will describe the demographic characteristics, roles, and scope of practice of this workforce, as well as identify factors that influence the current and future demand for and supply of workers. There is ample evidence of a shortage of workers over the past few years, indicated by double-digit vacancy rates, increasing salaries, and the use of other incentives to fill positions. Recent data show a reduction in vacancy rates, although an increase in per diem and contract workers may mask a continuing shortage. There is recent growing interest in the profession, as evidenced by an increase of applicants to educational programs. Several factors make it difficult to predict the future need for and role of clinical laboratory workers, including an aging population and the demand for increased services, the possible retirement of many current workers, automation, new technology and tests, and public health challenges.

Adult↗

PubMedDate not supplied

U.S. physician workforce forecasting: a tale of two states.

Physician workforce forecasting in the U.S. has returned to preeminence in the recent past. With the publication of the federal Council on Graduate Medical Education's Sixteenth Report: Physician Workforce Policy Guidelines for the United States, 2000-2020, efforts have begun to examine specialty- and geography-specific forecasts to determine the extent to which the projected national shortage of physicians will affect particular specialties and populations in particular areas. This article begins with a brief history of physician workforce forecasting in the U.S. over the past 25 years and summarizes the findings of two state-specific attempts to forecast physician supply and demand in the coming years. Discussions of the findings from the two studies as well as a brief commentary on how particular model assumptions obfuscate interpretation of the forecasts are provided. Finally, a brief discussion of how the forecasts were used by stakeholders in each state is presented.

California↗

PubMed2006

Workforce reentry for people with HIV/AIDS: intervention effects and predictors of success.

Treatment that prolongs the lives of people with HIV/AIDS and improves their quality of life is relatively recent and little is known about factors that may predict their successful re-entry to the workforce. No data exist concerning the effectiveness of programs to assist people with HIV/AIDS in their efforts to return to work. We used logistic regression and Kaplan-Meier survival curves to predict return to work using data from 126 individuals who participated in an HIV/AIDS return to work program. Results from the 24 month follow-up revealed that program participation, general health, benefits status, and gender, predicted successful re-entry to the workforce. We discuss these findings in the context of the need for more explicitly-defined interventions, as well as the need for additional information on factors that may hinder or facilitate workforce re-entry among people with HIV/AIDS.

Adult↗

PubMed1986

Stress and some associated factors in a representative sample of the New Zealand workforce.

Prevalence of self-reported stress was measured in a sample workforce of 1342 men. About 8% at all ages reported being "often stressed", while the peak was 11% at age 45-54 years. The socioeconomic profile of the workers approximated that of the New Zealand male workforce and it is suggested that the prevalence rate for the total workforce will be similar to that of the sample. In addition, information was obtained on blood pressure, alcohol intake, smoking, obesity, and exercise. There is a statistically significant positive association between stress and mild hypertension (p less than 0.001) and smoking (p less than 0.005) and a negative association between stress and exercise (p less than 0.025). This has implications for occupational health workers.

Adolescent↗

PubMedDate not supplied

The registered nurse workforce: infrastructure for health care reform.

As of March 1992, 83 percent of America's more than 2.2 million licensed registered nurses (RNs) were actively employed in nursing. RNs are the largest group of U.S. health care professionals and constitute a major part of the infrastructure necessary to any health care reform agenda. Therefore, it is critical to assess the extent to which the current nurse workforce is adequately prepared for its future role in a reformed health care system. Two central trends in the composition of the nurse workforce are noteworthy. First, while the number of RNs is large and continues to grow, cyclical, demand-driven shortages have occurred nationally since World War II. Further, hospital cost containment strategies periodically depress nurses' relative wages, contributing to the substitution of RNs for other workers. Second, there is concern in nursing, as in medicine, that the RN workforce is not optimally trained to meet future needs. While two-year associate degree programs now produce a majority of nursing graduates, the greatest need is for advanced practice nurses. Demand for such nurses is high and is expected to increase as more of the population gains access to health care services. The incentives put forth in the health care reform debate--expanded health insurance coverage, integrated health care delivery systems, and cost-effective practice--create the potential for expanded roles and increased job opportunities for nurses. Realizing this potential will depend largely on the profession's responsiveness to the changes confronting it under health care reform.

Adult↗

PubMed1996

From piety to platitudes to pork: the changing politics of health workforce policy.

Policy to subsidize the education of health professionals in the United States has become contentious and uncertain. This article examines the politics of workforce policy in the twentieth century, emphasizing the years since World War II. From early in the century until the 1970s, most decision makers viewed policy to subsidize the education of health professionals as self-evidently correct. As consensus eroded, proponents insisted to increasingly skeptical audiences that these subsidies created benefits for the public. Recently, decision makers outside health care institutions have come to regard workforce policy as serving particular rather than general interests. Thus health workforce policy, like other policies outside of health affairs, may be said, perhaps oversimply but not inaccurately, to have gone through three stages: from piety to platitudes to pork.

Academic Medical Centers↗

PubMed2026

Migration intentions among nigerian neurosurgeons: a national survey of workforce retention.

Physician emigration from low- and middle-income countries creates critical workforce shortages. This study explored factors influencing migration intentions among Nigerian neurosurgeons and trainees. We conducted an anonymized survey of consultant neurosurgeons, fellows, and residents practicing in Nigeria. Invitations were sent by email and professional messaging platforms, and snowball sampling was used to increase participation. The survey included quantitative and open-ended questions on demographics, income, migration plans, and retention factors. Seventy-nine respondents participated (61.5 % consultants; 93.7 % male; median age: 44 years). Nearly all practiced general neurosurgery (97.3 %), and many also performed trauma (65.3 %) and spine (61.3 %) neurosurgery. Most (85.7 %) reported that their earnings were insufficient to support their families. Nearly 40 % were considering emigration, most often citing financial pressures (88.5 %) and poor working conditions (63.5 %) as push factors. By contrast, personal or family ties (63.0 %) and relocation costs (45.2 %) were cited as reasons to stay. Respondents identified higher salaries (58.1 %) and greater investment in the health sector (51.4 %) as key measures to improve retention. In univariable analyses, younger age, income insufficiency, income dissatisfaction, and feeling undervalued at work were associated with migration intention. Financial insecurity emerged as the dominant driver of migration intentions among Nigerian neurosurgeons. In addition to salary increases, sustained investment in healthcare infrastructure and workforce support is essential to improve retention. International partnerships may complement these efforts by building neurosurgical capacity and mitigating brain drain.

Humans↗

PubMed1998

Subspecialty distributions of ophthalmologists in the workforce.

OBJECTIVE: To describe the distribution of the supply and requirements for subspecialty ophthalmologists. METHODS: Estimates from the Eye Care Workforce Study were used to provide subspecialty-based assessments of the supply and public health need, as well as market demand, for care provided by subspecialists. Reconciliation with the boundary models (optometry first, ophthalmology first) of the Eye Care Workforce Study and current market status also were performed. RESULTS: Whether subspecialists are in excess depends first on which boundary model most closely approximates the current market conditions. Under an optometry-first model, 70% of all ophthalmologists are in excess, although subspecialists (39%) are relatively less in excess than comprehensive ophthalmologists (91% excess). Under an ophthalmology-first model, no ophthalmologists would be in excess. Extrapolating from current market conditions, a slight excess of ophthalmologists exists, probably proportional across subspecialists and comprehensive ophthalmologists. Future growth in the ophthalmologist supply will be almost entirely among subspecialists. CONCLUSION: Under current market conditions, substantial excesses in subspecialist ophthalmologists are likely to develop and grow worse over time, given current training levels.

Health Services Needs and Demand↗

PubMed2005

Characterizing the general surgery workforce in rural America.

BACKGROUND: General surgeons form a crucial component of the medical workforce in rural areas of the United States. Any decline in their numbers could have profound effects on access to adequate health care in such areas. HYPOTHESIS: We hypothesize that the rural areas of the United States are relatively undersupplied with general surgeons. DESIGN AND SETTING: The American Medical Association's Physician Masterfile was used to identify all clinically active general surgeons as well as their locations and characteristics. Their geographic distribution was examined using the ZIP code version of the Rural-Urban Commuting Areas. Surgeons were classified as practicing in urban areas, large rural areas, or small/isolated rural areas. RESULTS: There are currently 17 243 general surgeons practicing in the United States. Nationally, the number of general surgeons per population of 100 000 varies from 6.53 in urban areas to 7.71 in large rural areas and 4.67 in small/isolated rural areas. Only 10.6% of the nation's general surgeons are female. Wide variations in numbers of general surgeons were found between and within individual states. General surgeons in the smallest rural areas are more likely than those in urban areas to be male (92.7% vs 88.3%, P<.001), 50 years of age or older (51.6% vs 42.1%, P<.001), or international medical graduates (25.2% vs 20.1%, P<.001). CONCLUSIONS: The overall size of the rural general surgical workforce has remained static over the last decade, but its demographic characteristics suggest that numbers will decline. Many rural residents have limited access to surgical services. Steps to reverse this trend are needed to preserve the viability of health care in many parts of rural America.

Adult↗

PubMed1993

Trends in the structure, productivity, effectiveness and unit costs of the Hospital and Community Health Services workforce in England: 1979-1991.

In this paper it is shown that there have been significant structural changes in the composition of the Hospital and Community Health Services (HCHS) workforce over the 1980s. The number of doctors, nurses and other medical professionals has grown at the expense of support staff such as ancillaries and maintenance workers. The number of agency and contract staff has risen rapidly, partly offsetting the loss of directly-employed support staff. Changes in the workforce have been compared with changes in activity, as measured by the cost-weighted activity index. According to this measure labour productivity has grown by a compound rate of 1.9% annually. Adjusting the labour force index for the wage bill of each group reveals productivity growth of 1.5%. The effectiveness of treatment, as proxied by the decline in avoidable perinatal mortality, has grown by 3.4% annually. Unit labour costs have fallen over the period at an average annual rate of 0.3%. The trend conceals wide fluctuations, with labour costs falling slowly during the first half of the decade, and rising strongly during the second half. Medical professionals benefited disproportionately from wage increases in comparison with other HCHS groups during the mid to late 1980s.

Community Health Services↗

PubMed1998

Pediatric nephrology workforce in Latin America.

Pediatric nephrology workforce issues were examined in a Latin American survey involving 14 countries. The number of children under 15 years per pediatric nephrologist varied widely among countries: Argentina, Cuba, Venezuela, and Uruguay had an unusually high number of pediatric nephrologists. Guatemala represents the opposite end of the spectrum of values (1,582.6 thousand children under 15 years per pediatric nephrologist). A significant inverse correlation was found between children under 15 years per pediatric nephrologist and national gross domestic product per capita (r=-0.52, P<0.05) and a significant correlation between children per pediatric nephrologist and infant mortality (r=0.82, P<0.005, Spearman's rank correlation coefficient). The same correlations were observed for total population per pediatric nephrologist. However, the pediatric nephrology workforce does not merely reflect national economic status. Official health care policies, market forces, and social regulations also have an influence. A study of the number of pediatric nephrologists necessary for adequate planning of care of children with renal disease in Latin America is urgently needed.

Child↗

PubMed2002

SCAR Radiologic Technologist Survey: analysis of technologist workforce and staffing.

One of the greatest dilemmas facing medical imaging departments today is the worsening personnel crisis in the radiologic technologist (RT) workforce. As the volume and complexity of medical imaging studies continues to increase, an unprecedented imbalance exists between RT supply and demand. A number of etiologic factors have been postulated to contribute to this RT shortage including decreasing morale, perceived inadequacies in compensation, decreasing number of training programs, and limitations in the career ladder. Previous studies have cited improved technologist productivity as imaging departments successfully transition from film-based to filmless operation. This study was undertaken to address the impact of digital technologies (information systems, PACS, digital radiography) on technologist productivity, in an attempt to determine whether these technologies can be used to positively affect the existing RT workforce imbalance. A total of 112 facilities participated in this nationwide study, with representation of imaging providers that paralleled the demographic profile of the marketplace as a whole. Survey results indicate the existing RT staffing shortage is greatest within academic and rural-based hospitals and is most severe in the area of general radiography, which accounts for 65-70% of imaging department volumes. For general radiography alone, respondents report an average shortage of 2 RT full-time equivalents (FTE's) per institution, when comparing the number of budgeted RT FTE's versus the actual number of RT FTE's. Preliminary results indicate that at this time, RT staffing shortages are not affected by the presence or absence of digital information technologies. Additional research is planned through a five-year longitudinal data collection, to better delineate the complex relationship that exists between implementation of digital technologies and RT staffing.

Data Collection↗