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PubMedDate not supplied

Retirement among Florida's certified nurse-midwives: an impending workforce crisis.

An anonymous survey was mailed to 499 CNMs in Florida in May 2001 to examine the impact of CNM retirement on the Florida women's health provider workforce and to estimate the replacement demand for CNMs. The survey also investigated where Florida's CNMs studied midwifery, reasons for choosing education programs, reasons for moving to Florida, and causes of underemployment of CNMs. Two hundred eighty respondents returned the survey. Thirty-nine percent of respondents received their midwifery education in Florida. Eighty-one percent of respondents were working as CNMs. From 2010 through 2025, an average of 11 CNMs in Florida will reach age 65 each year. These data indicate that retirement will generate demand for new CNMs in the next two decades. These data, along with future research tracking midwifery education, employment, and retirement, could be used to plan program funding, clinical site needs, and legislative support of midwifery.

Aged↗

PubMed2006

The endodontic workforce.

The amount of endodontic care provided in the US requires an understanding of the supply and demand for such care. The supply side includes the number and location of endodontists, type of provider, and productivity. The demand side consists of the changing demographics of the age groups that endodontists predominantly treat along with changes in their dental health. To address these issues, we have compiled and analyzed data from American Dental Association (ADA) with other sources such as US government census data and the National Health and Nutrition Examination Surveys (NHANES). From 1982 to 2002, the supply of endodontists increased at a rate greater than that observed with general practitioners or the other specialty areas. The growth of endodontists in relation to general practitioners is important. The latter are co-providers of endodontic care as well as a primary source for referral of patients to endodontists. Demographic and disease changes are likely to impact the need and demand for endodontic services. Endodontists' patients are generally between the ages of 25 and 64 yrs. Currently, the majority of endodontists' patients are members of the large baby boom generation who in 2000 ranged in age from their late 30s to their late 50s. During the next 20 yrs the Baby Boom generation will be replaced by the numerically smaller Generation-X cohort. This generation has experienced substantially less total caries than baby-boomers and they most likely will have fewer endodontic sequela as they age. A moderating factor that could partially offset the predicted decline in numbers of patients is the increased number of teeth that Generation-Xers are likely to retain. A flexible endodontic workforce strategy must assess the impending demographic and disease trends in relation to future growth rates of both endodontists and general practitioners.

Adult↗

PubMed2005

Developing a speciality: regearing the specialist public health workforce.

OBJECTIVES: To identify issues surrounding the future training needs of the specialist public health workforce following the most recent restructuring of the National Health Service (NHS) in England. METHODS: All directors of public health (DsPH) based in strategic health authorities and nine senior staff working in public health at the regional level were invited to participate in a semi-structured telephone interview. RESULTS: Twenty-six people were interviewed. Many interviewees expressed concern that because consultants and specialists in public health will be working in much smaller teams than hitherto, they will have to generalize their skills to cover a much wider range of functions (including board-level duties). This may result in a loss of specialist expertise. Successful public health practice in the new structures will require new ways of interorganizational working that will add an administrative burden to specialists in public health. Also, the creation of a board-level post in each primary care trust (PCT) has resulted in more time spent on corporate responsibilities and less on public health for DsPH, who are often the only fully trained specialist in public health in their PCT. Furthermore, interviewees expressed their anxiety about the lack of diversity in the posts available to specialists in public health and particularly to those newly completing their specialist training. Generally, interviewees felt that traditional public health roles and responsibilities were being eclipsed by corporate and managerial ones. Professional development activities were being carried out, but in a rather ad-hoc fashion. Interviewees were hopeful that public health networks would lead professional development initiatives once they were more established. CONCLUSIONS: It is important that excellence in public health is maintained through a set of accreditable standards, whilst corporate skills, essential to successful public health practice in the new UK NHS, are developed among specialists in public health.

Accreditation↗

PubMed2005

A survey of the specialist public health workforce in the UK in 2003.

OBJECTIVES: To identify the number and distribution of public health specialists in the UK. STUDY DESIGN: Cross-sectional survey. METHODS: Postal survey of UK members and fellows of the Faculty of Public Health and primary care trust directors of public health in England in October 2003. RESULTS: Of 1993 individuals surveyed, 1566 (78%) responded, of whom 1331 reported working as consultants or specialists in public health in the UK. Of the 1331, 891 (67%) were on the General Medical Council Specialist Register, 53 (4%) were on the General Dental Council Register, and 92 (7%) were in the process of applying for the Voluntary Register; 295 (22%) did not appear to be on any professional register or in the process of applying to the Voluntary Register. This equated to a total UK rate of 14.1 per million 'service' public health. There was substantial variation by region from 9.3 per million population in Wales and the South West to 18.0 per million population in the West Midlands and 19.5 per million population in London. An increase of 218 (21%) additional consultants and specialists in public health across the UK would be required to bring other regions up to the level of the highest region. CONCLUSIONS: This survey, although limited, being based on a survey of members and fellows of the Faculty of Public Health, shows that specialist public health is under capacity, is resourced in a highly variable manner, and needs to be built up to meet the challenges we face. A comprehensive workforce plan for public health is urgently needed.

Adult↗

PubMed2006

Governance and the pharmaceutical workforce in England.

A key component of a commitment to patient safety is ensuring the fitness to practice of health professionals. This article uses the changing landscape of the regulation of the pharmaceutical workforce and the extended roles and responsibilities of pharmacy practitioners in England to explore the challenges for governance within contemporary pharmacy practice, and consider the powers and structures necessary for effective regulation. In England, it is recognised that the approach of the national regulatory body for pharmacy should be consistent with that of the regulators of other health professions, and focus on assuring the competence and performance of practitioners. Pharmacy employers will have complementary adjunct responsibilities. Attention is being concentrated on ensuring the continuing fitness to practice of health professionals, with regular revalidation certain to become a requirement for all. Particular challenges arise in the effective regulation of advanced practitioners, and in ensuring the continuing competence of prescribing practitioners, who in England may come from a range of health disciplines, including pharmacy, and practice in a variety of settings and circumstances. A separate professional register is to be established for pharmacy technicians, whereupon they will also have to demonstrate continuing competence to practice, and be subject to regulation in the same way as pharmacists. Significant change is also planned in the professional control of community pharmacies. In future the law will require a "responsible pharmacist" to be identified for each community pharmacy, rather than insisting on a pharmacist always being present to supervise the dispensing and sale of medicines.

England↗

PubMed2006

Contact dermatitis and workforce economics.

The roots of education in patch testing begin with Jadassohn and have been passed down through generations of dermatologists through didactic teachings and mentoring. Currently, we are faced with workforce economics tipping the balance of dermatology toward cosmetic and surgical practices. This imbalance is easily found in the subspecialty of contact dermatitis, where the current demand for patch test services is on the rise and the number of new dermatology-based patch test providers cannot keep up with the current demand. Steps are being made to remedy this discrepancy through societies and fellowships, yet the question remains: were the steps in time and were they big enough?

Costs and Cost Analysis↗

PubMed2003

What perioperative and emerging workforce nurses want in a manager.

The world is experiencing a critical shortage of RNs. As the number of nurses decreases, it is unclear how already vulnerable specialty areas, such as perioperative nursing, will be affected by the emerging workforce's career decisions. This descriptive, comparative study explores perioperative nurses' and nursing students' perceptions of the top 10 characteristics desired in a manager. Even with 70% congruency, significant differences were found in how nurses and students ranked the traits they valued. This study highlights the traits managers need to transform new graduate nurses into satisfied, productive members of the perioperative team.

Adult↗

PubMed1997

The general surgery workforce.

BACKGROUND: The workforce in general surgery has been the subject of studies in 1975 and 1994, as has the input of residency program graduates, their subsequent subspecialization, and the retirement pattern of practicing general surgeons. This study analyzes the distribution of general surgeons in the United States. DATA SOURCES: Certified general surgeons were identified from files of the American Board of Medical Specialties (ABMS). Included were general surgeons with no additional certificates except for Surgical Critical Care. Excluded were surgeons certified only by an osteopathic board, noncertified surgeons, retirees, missionaries, federal employees, and military surgeons. The Area Resource File of the Bureau of Health Professions was used to classify metropolitan and rural areas, and primary care health professions shortage areas (PC-HPSA). CONCLUSIONS: General surgeons are well distributed in the various states. More general surgeons are located in metropolitan than in rural areas, and few general surgeons practice in counties in which the whole county is designated as a PC-HPSA. The ratio of general surgeons to the population is similar to that found in 1975.

Adult↗

PubMed1995

Estimating eye care workforce supply and requirements.

PURPOSE: To estimate the workforce supply and requirements for eye care in the United States. METHODS: Three models were constructed for analysis: supply of providers, public health need for eye care, and demand (utilization) for eye care. Ophthalmologists, other physicians, and optometrists were included in the models. Public health need was determined by applying condition-specific prevalence and incidence rates from population-based and other epidemiologic studies. Demand was determined by use of national databases, such as the National Ambulatory Care Survey, National Hospital Discharge Survey, and Medicare Part B. Time requirements for care were obtained through a stratified sample survey of the membership of the American Academy of Ophthalmology. RESULTS: Under modeling assumptions that use a work-time ratio of one between optometrists and ophthalmologists and between specialist and generalist ophthalmologists, a significant excess of eye care providers exists relative to both public health need and demand. Changes in the work-time ratio, work-hours per year per provider, care patterns for the same condition, or other factors could significantly reduce or eliminate the surplus relative to need. CONCLUSION: If optometrists are the preferred primary eye care provider, ophthalmologists would be in excess under all demand scenarios and all need scenarios where the optometrist to ophthalmologist work-time ratio is greater than 0.6. No excess of ophthalmologists would exist if ophthalmologists are the preferred primary eye care provider. Data on the appropriate work time ratio will help refine estimates of the imbalance between supply and requirements.

Eye Diseases↗

PubMed2003

A national study of the substance abuse treatment workforce.

This study's purpose is to gain a current perspective on the substance abuse treatment field's workforce. The data are from the Retrospective Study of treatment professionals designed to document how the Treatment Improvement Protocols published by the Center for Substance Abuse Treatment have influenced the implementation of best practices. The Retrospective Study consisted of a two-wave cross-sectional survey with telephone follow-up. Data for this study were from demographic information on Wave 1 study participants, which had a response rate of 80.1% (N = 3,267). The results of the study showed that most treatment professionals are White (84.5%) and middle-aged (i.e., between 40 and 55 years old) and slightly more are female (50.5.0%) than male (49.5%). Treatment professionals tend to enter the field and stay in it, and almost 80.0% of respondents possess a bachelor's degree or higher. In addition, most treatment professionals are licensed or certified and treat clients from different racial and ethnic backgrounds than themselves. Implications for the provision of treatment services are discussed.

Adult↗

PubMed2002

Targetting out of the workforce nurses: a promising local recruitment strategy.

A successful pilot program to attract and orient 'out of the workforce' nurses to a hospital outreach acute and post acute care service is described. Three new staff members attended a one-month education program prior to commencing supervised clinical activity. Survey and focus group methods were used to evaluate the initiative. Principal lessons learned were that preceptoring and preceptor support is central to a positive outcome for new and existing staff. We also learned that a tendency to underestimate the complexity of the post acute care nursing role in the initial advertising was unhelpful.

Australia↗

PubMed2002

Variation in routine psychiatric workload: the role of financing source, managed care participation, and mental health workforce competition.

This study was conducted to examine the association between psychiatrists' demographic characteristics, payment source, and managed care participation and psychiatrists' practice workload, and between the supply of other mental health providers in a psychiatrist's county of practice and psychiatrists' practice workload. Data from the 1996 American Psychiatric Association National Survey of Psychiatric Practice were merged with national countywide measures of mental health workforce and environmental data from the 1996 Area Resource File. In comparison to male psychiatrists, female psychiatrists treat fewer patients per week, provide less total hours of weekly patient care, and obtain fewer new monthly referrals. An increase in psychiatrists' managed care participation was associated with only minor increases in the number of patients per week, weekly time spent in clinical care, and number of new monthly referrals. The supply of other mental health providers was not associated with variation in practice workload. Once psychiatrists participate in managed care plans, an increase in their participation rate does not significantly expand clinical practice workload. The supply of other mental health providers was not significantly associated with variation in psychiatrists' workload, which suggests that substitution effects may not be evident with this aspect of psychiatric practice.

Adult↗

PubMed1998

Changing supply and earning patterns of the mental health workforce.

The authors examine recent trends in the supply and earnings of various mental health providers from 1989 to 1995. The makeup of the mental health workforce is fundamentally different now than a decade ago. The number and earnings of psychiatrists have been relatively flat. The number of psychologists increased by 24%, with their earnings rising rapidly in the 1980s, and remaining level since 1990. The number of clinically trained social workers increased by 87% over the same period, and the number of advanced practice nurses certified in mental health specialties almost doubled, with the earnings of these master's-level providers increasing steadily over the period described. These trends are discussed in the context of major changes in the financing and delivery of mental health care.

Humans↗

PubMed2004

Best practices in behavioral health workforce education and training.

Dramatic changes have occurred in the delivery of mental health and substance abuse services over the past decade and a half. There is growing concern that education programs have not kept pace with these changes and that reforms are needed to improve the quality and relevance of training efforts. Drawing on the published works of experts and a national initiative to develop a consensus among stakeholders about the nature of needed reforms, this article outlines 16 recommended "best practices" that should guide efforts to improve workforce education and training in the field of behavioral health.

Behavioral Medicine↗

PubMed2004

Innovation in behavioral health workforce education.

This article describes an effort to promote improvement in the quality and relevance of behavioral health workforce education by identifying and disseminating information on innovative training efforts. A national call for nominations was issued, seeking innovations in the education of behavioral health providers, consumers, and family members. A review committee evaluated each nomination on four dimensions: novelty, significance, transferability, and effectiveness. Nineteen innovations were selected for recognition, all of which are briefly described.

Adult↗

PubMed2004

Transforming the workforce in children's mental health.

Building on the President's New Freedom Commission on Mental Health, this article highlights the twofold crisis in children's mental health: a critical shortage of practitioners in child-serving disciplines, and a mismatch between training and preparation and actual practice and service delivery. The authors discuss the challenges of transforming the workforce in the context of changing population demographics, the prevalence of complex childhood disorders, and emerging evidence-based practices. The authors conclude with recommendations targeted to states, community agencies, universities, professional associations, and advocates.

Behavioral Medicine↗

PubMed2002

Towards a Foucauldian reading of the Australian mental health nursing workforce.

This article reflects on the findings of the recently published Scoping Study of the Australian Mental Health Nursing Workforce from the perspective of Foucault's work on 'governmentality'. First, the policy background to the scoping study is described. This is followed by a discussion of Foucauldian concepts and method that will be used to explore selected aspects of the scoping study. The related concepts of 'governmentality' and 'technologies of the self' are used to begin a theoretically grounded analysis of mental health nursing education and practice, with particular attention to discourses of 'change' and 'survival'. The examples chosen are used to support the argument that competing discourses order multiple 'readings' of Australian mental health nursing, including whether or not it is thriving or surviving. The article ends with comments on whether a Foucauldian analysis adds anything to what has been reported in the scoping study.

Attitude of Health Personnel↗

PubMed2001

Radiation oncology in Australia: workforce, workloads and equipment 1986-1999.

Regular national surveys of all public and private radiation oncology facilities in Australia have been carried out between 1986 and 1999. Workforce data recorded were numbers of radiation oncologists and trainees, radiation therapists, medical physicists and physics technicians, nursing staff, data managers, social workers and clerical staff. Workloads included treatments with megavoltage beams (linear accelerators, cobalt-60), orthovoltage/superficial X-rays, brachytherapy, total body irradiation and stereotactic radiosurgery. Major equipment recorded included numbers of megavoltage and orthovoltage/superficial X-ray machines, planning simulators, computerized dosimetry systems and brachytherapy equipment. The use of radiotherapy beds and the public-private mix of treatments were also documented. Data were assembled for Australia based on each individual state. Within Australia the number of public and private treatment facilities has increased by 44% from 18 in 1986 to 26 in 1999. The population has increased by 16.4%, cancer incidence by 51.8% and megavoltage workloads (fields) by 102%. The number of radiation therapists and physicists and the number of linear accelerators have, in general, increased with the growth in workloads. The number of radiation oncologists has increased by 60% from 4.5 full-time equivalent (FTE) radiation oncologists per million population in 1986 to 7.2 per million in 1999. There is currently a deficit of at least 40 radiation oncologists to be able to treat the 50% of newly diagnosed cancer patients requiring radiotherapy. In addition, a significant deficiency exists in numbers of radiation therapists, nursing staff, data managers, social workers and clerical staff. Clearly the demands for medical physicists has increased but the data are insufficient to comment on deficiencies. Despite the increases in workloads the proportion of patients with cancer receiving radiotherapy remains below 40%. A positive correlation has been shown between the proportion of newly diagnosed cancer patients treated and the number of FTE radiation oncologists, the number of megavoltage machines and number of radiation therapists. This was shown for Australia as a whole, for each state and for the years 1986 to 1999. This was also the case when total megavoltage fields was used as the dependent variable. Multiple regression analysis using the same independent variables confirmed these positive correlations. It is concluded that the low treatment rate with radiation oncology for cancer patients in Australia is due mainly to the lack of resource allocation. The stated commitment of governments and health departments to a 50% treatment rate can only become a reality if there is a concerted effort to increase the numbers of radiation oncologists, radiation therapists, megavoltage machines and support staff. Otherwise at least one in every 10 newly diagnosed cancer patients will continue to be denied adequate and equitable access to radiotherapy - in 1999 that total figure was 9400 persons.

Australia↗