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PubMed1998

A position paper of the North American Society for Pediatric Gastroenterology and Nutrition. Pediatric gastroenterology Workforce Survey and future supply and demand.

BACKGROUND: The North American Society for Pediatric Gastroenterology and Nutrition (NASPGN) performed a Workforce Survey to determine the current number and distribution of pediatric gastroenterologists in the United States and Canada and to estimate the supply and demand in the future in the United States. METHODS: The response rate was more than 90%. There were 624 pediatric gastroenterologists in the United States, and 48 in Canada. RESULTS: There were 2.4 pediatric gastroenterologists per million population in the United States, ranging from 3.1 per million in the Northeast to 1.9 per million in the West, and 1.6 per million in Canada. In the United States, fewer than 5 pediatric gastroenterologists retire each year, but more than 40 fellows per year complete training. In the United States, 30% of pediatric gastroenterologists believe there is already an excess supply; only 12% believe there is a shortage (p < 0.001). CONCLUSIONS: If the number of fellows who complete training each year remains unchanged, in 10 years there will be more than 950 pediatric gastroenterologists in the United States (3.3 per million population). At the same time, if the demand for pediatric gastroenterologists remains 2.4 per million population, there will be a demand for only 675. If these assumptions are correct, it is necessary to reduce the number of fellows to be trained. Although it is difficult to predict future workforce needs reliably, we recommend that the number of fellowship positions in training programs in the United States be reduced by 50% to 75%. Changes in health care in the coming years will be challenging, and effective planning is necessary for pediatric gastroenterologists to achieve their clinical, research, and educational missions.

Adolescent↗

PubMed1997

Trends in hospital restructuring and impact on the workforce in Germany.

OBJECTIVES: The author describes the impacts of hospital restructuring and reform legislation in Germany on the nursing workforce. METHODS: A descriptive analysis using selected literature is presented. RESULTS: Driven by the increased service needs of an aging population and the imperative to contain health-care costs, the hospital sector is shrinking while increasing its intensity of care delivery. Within this environment, the demand for patient-focused, high-quality nursing care is high, whereas the number of new graduates entering the nursing field is declining. Despite absolute increases in the number of nurses employed by the hospital sector, evidence suggests that hospitals are operating with a nursing workforce deficit. The recent reform law of 1992 mandates several changes with large implications for nursing. These include a linking of the hospital sector with outpatient care; a focus on rigorous, interdisciplinary quality assurance; and a revaluing of the adequacy of hospital nurse staffing. CONCLUSIONS: Hospitals will remain the major employers of nurses, with new outpatient sector opportunities. Adequate nurse staffing methodologies, sound personnel retention strategies, and reform of care delivery models are needed to assure high-quality nursing care in the hospital sector.

Ambulatory Care↗

PubMed1999

Public health workforce information: a state-level study.

A two-stage sample survey was used to estimate the size of Texas' professional public health workforce and to describe its composition in terms of employment settings, job characteristics, and individual characteristics. The estimated 17,700 public health professionals employed in 1995 represented approximately three percent of the state's total health workforce. About 55 percent of all these professionals worked in agencies that provide population-based public health services. An estimated seven percent had formal public health education. These findings raise issues concerning the numerical adequacy of the state's supply of public health professionals, the adequacy of their educational preparation, and the human resources capacity of the state's official public health agencies.

Adult↗

PubMed2001

Partnership for front-line success: a call for a national action agenda on workforce development.

Despite more than a decade of dialogue on the critical needs and challenges in public health workforce development, progress remains slow in implementing recommended actions. A life-long learning system for public health remains elusive. The Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry in collaboration with other partners in federal, state, local agencies, associations and academia is preparing a national action agenda to address front-line preparedness. Four areas of convergence have emerged regarding: (1) the use of basic and crosscutting public health competencies to develop practice-focused curricula; (2) a framework for certification and credentialing; (3) the need to establish a strong science base for workforce issues; and (4) the acceleration of the use of technology-supported learning in public health.

Centers for Disease Control and Prevention, U.S.↗

PubMed2001

A systems approach to public health workforce development.

During the 1990s, several distinct but interrelated efforts to strengthen the public health infrastructure were launched. Defining public health work in terms of core functions and essential services, these efforts focused on the competence of the workforce and the performance of public health agencies. The systems approach offered here highlights the relationships and interdependencies among these three components of public health practice: (1) the work, (2) the worker, and (3) the work setting. The model suggests that advances in public health workforce development may require major public health organizational development efforts.

Competency-Based Education↗

PubMed2001

National Public Health Performance Standards: workforce development and agency effectiveness in Florida.

The Florida Department of Health (FDOH) was the first state to pilot test both the Centers for Disease Control and Prevention (CDC) state agency and local Public Health System Performance Standards. The standards were found to be complementary and supportive of the FDOH quality performance improvement system, which had been in place for a decade, and the new Quality Management initiative. The pilot test found uneven performance across the state's county health departments and identified several areas, especially workforce development, that required additional efforts. The FDOH, in collaboration with the Center for Leadership in Public Health Practice at the College of Public Health in the University of South Florida, have collaborated and will continue to collaborate to design and deliver training in critical workforce development areas.

Efficiency, Organizational↗

PubMed2001

Improving performance at the local level: implementing a public health learning workforce intervention.

In an effort to continually improve performance of the essential public health services with community partners, the diverse public health workforce in a major metropolitan area engaged in an organizational learning process. Core public health organizational competencies, identified in a multi-year collaborative applied research initiative, provided the curricula content for the public health learning experience. All members (about 600) of the Columbus and Franklin County (Ohio) Health Departments participated in four one-half day small group, highly interactive modules conducted during a 2-year period. The purpose of this article is to describe the design and implementation of this workforce intervention, the lessons learned, and implications for developing organizational capacity and improved performance.

Competency-Based Education↗

PubMed2005

Pediatric Gastroenterology Workforce Survey, 2003-2004.

BACKGROUND: The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) performed a workforce survey to determine the number, distribution, and work-related activities of pediatric gastroenterologists in the United States of America (USA) and Canada, and compared these findings with the first workforce survey completed in 1996. METHODS: The survey queried pediatric gastroenterologists in the USA and Canada between November, 2003 and June 2004. To permit the optimal comparison to the 1996 survey data, the original survey was used as a template for development of the current instrument and, when possible, the questions were left unchanged. Additional questions were added to address important contemporary issues not present in the initial survey. Limited income information was also collected. The survey was posted on the NASPGHAN website, and the NASPGHAN membership was notified of the survey by electronic mail via its electronic mail distribution list. This was followed by a three-part postal mail survey to all non-respondents. After the Internet and postal mail requests, all non-respondent physicians were telephoned a minimum of three times. If unsuccessful in contacting the physicians directly, office personnel were queried to facilitate survey completion regarding the provision of pediatric gastroenterology, nutrition or hepatology services in either clinical care or research. RESULTS: The response rate based on the potential contact list for Part I of the survey was 69%. The final phone call or electronic mail contact of an office staff member with questions regarding gender and delivery of pediatric gastroenterology services yielded a total contact rate of 88%. There were 699 pediatric gastroenterologists identified in North America, as compared with 672 in 1996. If known non-respondents are included, there could be as many as 794 pediatric gastroenterologists. Time spent in clinical activities increased from 60% to 66% in the USA and from 43% to 53% in Canada. The use of nurse practitioners and physician assistants has increased considerably over the past 7 years. Fifty-three percent of respondents feel there are too few pediatric gastroenterologists. Fifty percent of section and practice heads report that they are currently recruiting partners. Limited income information is presented. CONCLUSIONS: There is currently a self-perceived shortage of pediatric gastroenterologists as compared with 7 years ago, despite a constant proportion of pediatric gastroenterologists per million children. In the USA, nurse practitioners and physician assistants are being increasingly used to fill this need, and physicians in both Canada and the USA have increased the time they spend in clinical care.

Adult↗

PubMed1993

The supply of orthotist prosthetists. The application of workforce projection techniques in determining future national training places.

Discusses the application of workforce planning techniques in the context of "target" levels of demand and uses a study of the future supply of orthotists and prosthetists as an example. Describes the derivation of an appropriate model, the quantification of the labour market for the profession, and an analysis of the characteristics of the workforce. Information was gathered through two surveys and from discussions with relevant organizations.

Allied Health Personnel↗

PubMed1995

A missing link? Workforce demand as the link between two health care related markets.

Examines the links between workforce demand and two health care related markets, the first being the internal market between purchasers and providers of health care, and the second the market for education expressed between colleges of education as providers and NHS Trusts as purchasers of the courses. Workforce demand has to take account of the numbers of people on courses, but also specialist skills required to enable NHS Trusts to deliver changing health care needs of the future.

Education, Nursing↗

PubMed1996

The importance of workforce planning in the NHS in the 1990s.

Considers a variety of pressures, both internal and external to the National Health Service, which in recent years have ostensibly increased the importance of sound workforce planning initiatives. These include, among others: skill shortage; the drive towards cost-efficiency and effectiveness; an altered philosophy of care through technology; the develop of competence-based training initiatives; nationwide demographic changes; and the need to develop identifiable skill shortages. Presents reprofiling (skills alignment with organizational needs) and skill mix and distribution as useful approaches to workforce planning and concludes with a brief consideration of implications for planners of professional boundaries and changed educational priorities for health service personnel.

Health Planning↗

PubMed2004

Creating diversity in the healthcare workforce. The role of pre-registration nurse education in the UK.

It has been suggested that the introduction of first the diploma pre-registration course and then the three-year degree pre-registration course are likely to have an impact upon the diversity of the future nursing workforce in the UK. Using findings from three large-scale projects, this paper assesses the nature of these changes by comparing the diversity within recently qualified cohorts of graduate, diplomate and certificate-qualified nurses. Findings indicate little difference between the three groups in terms of gender and ethnic origin. A higher proportion of graduates had academic qualifications, which were generally higher than the qualifications held by the other groups of nurses. However, diplomates were the most diverse group overall, being older and more likely to have children, and also having greater previous working experiences. The overall conclusion is that, despite qualification differences, the level of diversity amongst degree-qualifiers was a return to the lower levels associated with qualifiers from certificate courses. Thus the introduction of degree courses may dilute the relative success of the diploma course in terms of the recruitment of a more diverse workforce. The findings are considered in the context of current debates about the future shape of nurse education in the UK.

Adult↗

PubMed1998

Supply dynamics of the mental health workforce: implications for health policy.

The U.S. mental health workforce is varied and flexible. The strong growth in supply of nonphysician mental health professionals, ranging from psychologists to "midlevel" professionals like social workers and nurse specialists, helps to offset the dwindling numbers of medical graduates entering the field of psychiatry. Primary care physicians often see patients who have some form of mental illness, which they are not always trained to recognize and treat. The data on the supply of several specialists--psychiatrists, clinical psychologists, and clinical social workers--indicate that the distribution of mental health professionals varies widely by state. The composition, supply, and distribution of workers in this field also affect the care of vulnerable populations. Broader policy questions, including the lack of parity between mental and physical health insurance coverage and barriers to entry by nonphysician professions, may limit the cost-effective expansion of this diverse and dynamic workforce.

Adolescent↗

PubMed2005

Oral health workforce in rural and remote Western Australia: practice perceptions.

OBJECTIVE: In this study an analysis was undertaken to determine: (i) the major factors that influence oral health professionals to practise in rural areas and determine practice location; (ii) what assists the professional oral health workforce to remain in rural practice; and (iii) what the main reasons are for leaving rural practice. DESIGN: A postal survey was undertaken among all registered oral health professionals in Western Australia. SETTING: Rural and remote Western Australia. PARTICIPANTS: Registered dental therapists, dental hygienists and dentists in rural and remote Western Australia. RESULTS: Results indicated that there are various factors that attract people to rural and remote areas, other than financial incentives. Incentives to remain in rural practice include the need for professional development. The most common reason for leaving rural practice was to access children's educational facilities. CONCLUSIONS: This study emphasises that many factors contribute to recruitment and retention of dental professionals in rural practice. A broad integrated retention strategy is needed to address oral health workforce shortage issues in rural and remote Western Australia.

Adult↗

PubMed2006

The Australian optometric workforce 2005.

BACKGROUND: This paper presents the findings of the Optometrists Association Australia 2005 optometric workforce study. METHODS: Data from the association's database, the Australian Bureau of Statistics, Medicare and the Department of Veterans Affairs were applied to create a profile of the optometric workforce in Australia, including the number of equivalent full-time optometrists (EFTOs), population to optometrist ratios and workloads. RESULTS: In February 2005, 2,866 (76.7 per cent) of the 3,738 optometrists registered to practise in Australia were in clinical practice. Adjusting for the number of hours worked, there were 2,712 EFTOs in Australia. The ratio of population to EFTO for Australia was 7,016. Ratios were higher in the states without schools of optometry (South Australia 9,413, Western Australia 8,810 and Tasmania 8,172) and in the remote and lightly populated Northern Territory (10,521). The lowest ratio was in New South Wales (6,053). The proportion of women in clinical practice has gradually increased since 1977 and was slightly more than 41 per cent in 2005. The percentage of the profession under the age of 40 years was 48.6. The percentages of female and male optometrists under the age of 50 were 89.3 and 72.5, respectively. On average, female optometrists worked approximately 82 per cent of the hours worked by male optometrists. The average time per week spent on Medicare and Veterans Affairs consultations was 25.8 hours. CONCLUSIONS: The profession of optometry in Australia is undergoing considerable change in age and gender make-up. In 2005, the number of optometrists was adequate for the needs of the Australian population. Further analysis is needed to determine whether the supply of optometrists meets community needs at local levels.

Adult↗

PubMed2004

National health workforce in discrete Indigenous communities.

OBJECTIVE: To identify areas of relative need and inform future planning of health workforce and health services in discrete Indigenous communities. METHOD: Descriptive analysis of relevant variables from the 1999 Community Housing and Infrastructure Needs Survey (CHINS), including all discrete Indigenous communities in Australia. RESULTS: Almost 90% of the Indigenous population of the Northern Territory live in discrete communities. The corresponding figure for Queensland, South Australia and Western Australia is around 25%, for New South Wales 8% and Victoria 1%. Just over 4000 people (5% of the population surveyed) live 100 kilometres or more from the nearest community health centre and almost 60,000 (54%) live 100 kilometres or more from the nearest hospital. Approximately 4000 Indigenous people (6% of population surveyed) have little or no access to a registered nurse or a doctor in their community. Access to Indigenous health workers is also limited, with more than 26,000 people (40%) having almost no access to a male Indigenous health worker and about 10,400 (16%) having almost no access to a female Indigenous health worker. More than 13,000 people (20%) have no access to a dentist and many thousands (30-50%) have no access to allied health or mental health care workers. An obstetrician or ENT/respiratory physician never visited the communities of almost 40,000 people (55% and 59%, respectively) and about 24,000 people (36%) have no access to an ophthalmologist. CONCLUSION: CHINS data provide a unique source of information to monitor the status of health services and the workforce in discrete Indigenous communities.

Australia↗

PubMed1996

An optimized model for substitution of expatriate workforce in a Gulf-Council country: the Kuwaiti case.

"This article is based on data from a research project carried out during 1992-1994 to achieve a replacement mechanism and a model for the substitution of expatriate labour by Kuwaiti nationals. Since Kuwait can readily enforce its Kuwaitization policy in the public sector, the presented model aims at reducing the share of non-Kuwaitis in that sector over five years. Published data on distribution of the workforce in the public sector by nationality indicate that the non-Kuwaiti share of the total workforce is 38 per cent. The majority of [migrant] workers are unskilled or semi-skilled and engaged in production, commerce and services. Sex ratios are unbalanced and workers exhibit a high rate of literacy...." (SUMMARY IN FRE AND SPA)

Asia↗

PubMed2005

Bridging the workforce gap for our aging society: how to increase and improve knowledge and training. Report of an expert panel.

The healthcare workforce is currently unprepared for the increasing number of older persons and the complexities of their healthcare needs. Too few healthcare workers are adequately trained in geriatrics, and developers of educational curricula across healthcare disciplines have been slow to incorporate or require geriatric training. In April 2003, leaders in geriatrics met in Washington, D.C., to discuss and recommend solutions to the growing shortage of an appropriately trained workforce for geriatric research, education, and patient care. After considering data, presenting statistics, and offering insights into the future, the conference concluded by formulating recommendations to meet specific challenges. This report is a summary of the conference proceedings and recommendations, and it serves as a reminder that demographic trends and an everexpanding geriatric knowledge base demand not only attention, but also action.

Clinical Competence↗