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PubMed1998

Workforce planning. Catching the drift.

NHS workforce planning has traditionally ignored the role of doctors and nurses trained in continental Europe and Scandinavia. At present doctors trained in the European Economic Area make up 10 per cent of senior house officers in England and Wales. But the numbers coming to the UK are falling. Falling medical unemployment in Europe will mean these doctors have less incentive to come to the UK, leaving a considerable gap in the NHS workforce. More local research is needed into working patterns and career plans of European-trained nurses and doctors.

European Union↗
PubMed2001

Wagging the dog: an analysis of year 2000 workforce and education outcomes from recommendations of the 1995 Pew Commission report.

Over-production in the number of hospitals and health care workers has led to increased cost of medical care and inequities within the health care delivery system. An increase in managed care penetration within the market-place is believed to mandate dramatic changes in the way that health care is structured and delivered. The 1995 Pew Commission report projected major changes in health care organizations and health manpower through the effects of managed care and public regulation. This paper describes the outcomes to health delivery organizations and the health care workforce five years since the Pew Commission Report and discusses the belief that market forces are more effective mechanisms for addressing health care delivery and workforce requirements than public regulatory initiatives.

Allied Health Personnel↗
PubMed2000

Strategic management and health workforce policy.

Among the many consequences of health care restructuring is the impact such changes have on the training requirements for the health professions. Since workforce planning has been difficult and sometimes controversial in relatively stable times, it is likely to be even more problematic amid the turbulent changes ahead as the U.S. health care system restructures for the 21 century. Strategic management models emphasizing stakeholder involvement offer a middle ground between the extremes of government mandates and free markets by engaging a variety of participants with a stake in the planning outcome. The following report on the New Jersey effort to engage a variety of health care stakeholders in a participatory management process to shape the state physician workforce may provide useful insights for both managers and policy-makers.

Delivery of Health Care↗
PubMed2000

Educating the nursing workforce in 2000 and beyond.

Changes in the health care delivery system have comparable impacts on both nursing practice and education, such that tomorrow's nursing practice would best emanate from innovative partnerships between leaders in practice and education. For the foreseeable future, an expert nursing workforce is needed in an expanded form, but an array of challenges to maintaining this workforce are evident. Recent and continuing scientific and technologic advances in health care make the matching of practice and education to evolving trends paramount. Regardless of what the future holds, generative leadership in any realm of practice is essential to move our profession into the forefront of health care.

Delivery of Health Care↗
PubMed2003

Medical workforce issues in Australia: "tomorrow's doctors--too few, too far".

The Australian medical workforce, like those of most developed countries, is increasingly "feminised" and exposed to the global market for doctors. Demand for healthcare services is increasing in the Australian community. Concern in relation to doctor shortages is increasing, particularly in rural areas. There should be greater flexibility for entry of highly-trained overseas doctors. There is an urgent need to increase medical school student intake. Issues of workforce practice, including "task" substitution, should be explored.

Australia↗
PubMed2003

The public health workforce in sub-Saharan Africa: challenges and opportunities.

The health crisis in sub-Saharan Africa (SSA) presents enormous challenges to the public health workforce, which is ill equipped to respond. Since the fate of SSA is central to the health and well-being of all regions, a long-term effort is now required to strengthen the public health workforce in SSA. This will require major support from national governments and a wide variety of international agencies. Several global initiatives present an opportunity for SSA to mount a response to the health crisis. However, unless these resources contribute to the development of infrastructure, human capacity, and management processes, the response is likely to have only a short-term impact on the most pressing health problems.

Africa South of the Sahara↗
PubMedDate not supplied

[Aging of population and medical workforce: a prospective view of health care provision in France in the year 2025].

In 2011, the first generations of the French baby-boom will reach their 65th anniversary. In the same year the first cohorts of the French medical "graduate boom" (doctors graduated during the boom period 1974-1994) will reach their retirement age. From 2010 to 2025, French population will increase 4% but the French elderly will increase 40%. Depending on medical student intake policy adopted today, the French medical profession will decrease slowly or drastically. But the most striking feature of the period will be the aging of the medical workforce. Doctors aged 55 years and over will be between 42% and 47% of the medical workforce in 2025, as compared to 41% in 2010 and 14% in 2000. A great amount of factors--of which the demographic ones--will contribute to raise the demand for health care in the two coming decades. On the other side, the demographic change undergone by the medical profession (decrease of the total number, increase of the aged doctors, increase of the female doctors...) will decrease the amount of supply. However, the first problem facing the country is not how to raise the amount of supply but how to finance the forthcoming sharp growth of demand. The problem is not specific to France, as pointed out in a paper drafted twenty years ago.

Age Factors↗
PubMed2005

Excess, shortage, or sufficient physician workforce: how could we know?

At least three models have been used to project the future physician workforce, and each produces different results. No physician workforce predictions can be relied on until there is more consideration of and agreement on desired health outcomes and what physicians must do to achieve them.

Family Practice↗
PubMed1996

Domestic production vs international immigration: Options for the US physician workforce.

OBJECTIVE: To determine alternate combinations for reductions in US medical school graduates (USMGs), international medical graduate (IMG) immigration, and graduate medical education (GME) residencies, based on future physician supply targets. DESIGN: A demographic projection model of the physician supply was constructed and calibrated to fit observed American Medical Association Physician Masterfile data and current supply forecasts. Total annual input to GME was backcast from given future supply targets, adjusting for the portion of IMGs in GME who do not enter the US workforce. MAIN OUTCOME MEASURES: The annual number of new physicians added to supply from domestic or international sources needed to reach future physician-to-population ratio targets. RESULTS: Because of the low rate of attrition from the physician supply, it takes up to 50 years for workforce policy to effectively stabilize the physician-to-population ratio at a target level. All target ratios considered here would require immediate reductions in the total number of GME positions. These reductions must be followed by gradual annual increases to account for population growth. The size of USMG and IMG reductions are interrelated and depend critically on the percentage of IMG trainees who remain to practice in the United States. CONCLUSIONS: Reductions in future physician supply can come from either the IMG or USMG component of physician production, or both. The model developed here allows the estimation of multiple combinations of both GME components.

Demography↗
PubMed1996

Allied health workforce shortages: the systemic barriers to response.

Over the last decade, the increasingly severe workforce shortages developing in some allied health professions have drawn the attention of university, government, and institutional researchers and policymakers. A 1991 American Hospital Association survey shows allied health professions dominating the "vacancy rate" list, with physical therapy (PT) and occupational therapy (OT) at the top. Separate surveys have documented growing shortages in the OT and Certified Registered Nurse Anesthetist (CRNA) areas. According to a recent survey by the South Carolina Hospital Association, hospital vacancy rates in OT and PT are particularly severe, but there are also significant shortages in the CRNA and Medical Technologist (ASCP) subfields. The imperatives of cost containment are increasing the demand in South Carolina and elsewhere for rehabilitative and outpatient care provided by many allied health professionals, but there is growing concern that the educational system will not be able to respond adequately to these growing workforce needs. These predictions of growing shortages are further confirmed by recent occupational forecasts issued by the US Bureau of Labor Statistics. Allied health researchers do not completely agree on the reasons for the development of subfield shortages, or on how severe they really are. Improving alternative career prospects for females low public and professional images, and employee burnout, among other factors, have been suggested. A survey of the allied health literature shows four additional broad areas of investigation.

Accreditation↗
PubMed1998

RAND study: workforce requirements and provider supply relevant to oculoplastic and orbital surgery.

The 1995 RAND study Estimating Eye Care and Workforce Requirements analyzes the United States' supply, demand, and need for eyecare providers. Portions of the RAND study were prepared along traditional ophthalmic specialty lines. This article extracts and further analyzes those portions of the study that are of interest to active subspecialty oculoplastic surgeons. The RAND study results indicate a significant current and very probable future oversupply of oculoplastics workforce personnel. This oversupply is further exacerbated when a RAND study underestimate of the number of new fellowship-trained oculoplastic surgeons is corrected.

Health Personnel↗
PubMed2006

Predictors of workforce turnover in a transported treatment program.

This study examined relations between workforce turnover and select clinician (demographic and professional characteristics and perceptions of treatment model features and job requirements) organizational (perceptions of organizational climate and structure) and program level (salary, case mix) variables in a sample of 453 clinicians across 45 organizations participating in a transportability study of an empirically supported adolescent treatment (i.e., MST). At 20% annually, turnover was lower than in the national mental health workforce (i.e., 50-60%). Clinician demographic, professional background, and perceptions of the treatment model and demands did not predict turnover. Perceptions of an emotionally demanding organizational climate, program salary level, and program case mix of youth did predict turnover.

Adult↗
PubMed2005

Applying educational gaming to public health workforce emergency preparedness.

From natural disasters to terrorism, the demands of public health emergency response require innovative public health workforce readiness training. This training should be competency-based yet flexible, and able to foster a culture of professional and personal readiness more traditionally seen in non-public health first-response agencies. Building on the successful applications of game-based models in other organizational development settings, the Johns Hopkins Center for Public Health Preparedness piloted the Road Map to Preparedness curriculum in 2003. Over 1500 employees at six health departments in Maryland have received training via this program through November 2004. Designed to assist public health departments in creating and implementing a readiness training plan for their workforce, the Road Map to Preparedness uses the core competencies of the Centers for Disease Control and Prevention for all public health workers as its basic framework.

Disaster Planning↗
PubMed2006

Work environment and workforce problems: a cross-sectional questionnaire survey of hospital nurses in Belgium.

OBJECTIVES: This study investigated Belgian hospital nurses' perceptions on work environment and workforce issues, quality of care, job satisfaction and professional decision making. METHODS: All eligible nurses in a selection of 22 hospitals received the BELIMAGE questionnaire for a total of 13,958 potential respondents. Of these, 9941 returned study materials (response rate=71.2%) of which 9638 were valid and useable for statistical analysis (valid response rate=69.1%). RESULTS: The study identified several areas of tension in the nursing profession. The commitment to being competent providers of quality care was remarkably strong among the nurses, but they also perceived the barriers in the work environment to be multiple and complex. Concerns about the quality of leadership and management, insufficient staff, time demands and stressful work environment are experienced as obstacles in providing good nursing care. Four out of ten nurses (39.2%) would not choose nursing again as a career and more than half of the nurses (54.3%) have contemplated leaving the profession at some point in time. CONCLUSIONS: To effectively tackle the professional and workforce issues in nursing, investments should focus on redesigning a work environment that supports nurses in providing comprehensive professional care.

Adult↗
PubMed1998

Achieving partnership: the contribution of nursing education to the production of a flexible workforce.

AIM: This paper examines education's contribution to labour force reform in the nursing profession within the United Kingdom. BACKGROUND: In a globalized society there is increasing demand for more flexible forms of working. Nursing faces radical change in its employment characteristics if it is to continue to meet the health care needs of the population in the new century. ORIGINS OF INFORMATION AND DATA ANALYSIS: Key sociological texts and contemporary analysis of nursing skill have been analysed and synthesized to identify the dynamic of change in nursing and nursing education's contribution to these changes. KEY ISSUES: Patterns of upskilling and multiskilling are leading to the breakdown of professional role boundaries in the broader workforce. These patterns can also be seen in nursing. Upskilling is associated with increased stress and 'risk' for the individual, therefore achievement of flexibility is not without cost. Changes in the skill level in nursing lead many to conclude that the profession will become divided into a core and periphery distinction. This simplistic analysis does not account for the complexities of nursing and nursing skill although there is clearly a growing need for a 'knowledge and technical elite'. CONCLUSIONS: The core-periphery distinction is too simplistic to analyse nursing skills and the dynamic of change in the workforce. A radical perspective of nursing characterized by workers with a range of skills and competencies is less likely to lead to rigid professional boundaries. There is a clear need for multiskilled and knowledgeable workers; the 'technical and knowledge elite'. These nurses may be recognized as advanced practice nurses. High quality education is required to prepare these practitioners. Adaptation of nursing to the postmodern world needs to be facilitated by changes in current educational policy and practice.

Clinical Competence↗
PubMedDate not supplied

Emphasis courses: preparing baccalaureate students for transition to the workforce.

In response to identified needs for stronger preparation of baccalaureate graduates to enter the workforce, the University of Maryland School of Nursing created, implemented, and evaluated the use of Clinical Emphasis Seminars and Practicum. A sequence of 3 courses was ultimately developed for students to take during the final year of their upper-division nursing curriculum. The courses, totaling 5 credits, allow students to develop their knowledge and experience in a focus area within 1 specific type of clinical nursing. These courses follow up completion of required foundational clinical courses. Emphasis areas include all clinical areas offered within the nursing curriculum such as cardiovascular, critical care, and community health. Courses begin and end with 1-credit seminars and include one 3-credit clinical Practicum. In the latter course, students work with a clinical preceptor, following the preceptor's work hours for a minimum of 9 hours a week over the 15-week semester. Advantages of the Emphasis Courses are many: students develop an in-depth knowledge and clinical skills in a selected area of clinical practice. Potential employers have an opportunity to observe students in a preemployment setting and to evaluate the fit of skills and personal attributes to the specific setting. Students are provided with "value-added" knowledge and experience. The emphasis course model offers advantages to students transitioning into the workforce, to employers, and, ultimately, to clients served.

Baltimore↗
PubMed2005

Improving health among culturally diverse sulbgroups: an exploration of trade-offs and viewpoints annong a regional population health workforce.

ISSUES ADDRESSED: This article addresses availability and implications of evidence about culturally diverse subgroups in population. OBJECTIVES: To determine implications of evidence about culturally and linguistically diverse (CALD) communities for decision-makers and practitioners in population health. METHODS: Self-administered questionnaire of a regional population health workforce. One hundred and four population health staff of the Division of Population Health in South Western Sydney Area Health Service (SWSAHS) were invited to participate (response rate 73%). RESULTS: The majority of respondents were positive about applying culturally appropriate approaches in population health practice in south-western Sydney, a region well known for its cultural diversity. Respondents' levels of uncertainty increased when considering more strident statements, for example deciding exactly what to do when evidence generalisable to specific CALD communities was limited. CONCLUSIONS: Culturally appropriate approaches to population health are needed. As there is uncertainty in the workforce about how to deal with the paucity of ethno-specific evidence, a concerted effort is needed to study population-based interventions in order to increase the evidence base.

Adult↗