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PubMed2003

Dermatology: a unique case of specialty workforce economics.

Physician workforce economics in the United States have changed substantially over the past few years as a result of oversupply in many specialties and the emergence of managed care as the predominant health care delivery system. Some newly graduating residents have reported difficulty in finding jobs, unsatisfactory compensation levels, and low job satisfaction. However, dermatology as a specialty has experienced surprisingly prosperous employment opportunities. Recent studies have affirmed that recent dermatology residency graduates have had less difficulty than their colleagues in securing desirable positions. This article examines 4 different factors that may have set dermatology apart from the rest of the medical specialties: the supply of new dermatologists, the impact of managed care and shifting health care systems, the impact of changing professional demographics, and the changing scope of practice. Trends in these 4 areas have tightened the supply and increased the demand for dermatologists. Whether future residents will enjoy a similarly open market remains to be seen as the US health care system evolves.

Dermatology↗
PubMed2002

The nursing workforce in Canada and Australia: two sides of the same coin.

This paper compares characteristics of the nursing workforce in Canada and Australia and provides insights into reasons why the shortage of nurses is more critical today than ever before. Workplace issues are discussed in a global context. Factors that affect retention and recruitment are described. Factors that make the current shortage more serious and different than at other times are also presented. Despite the shortage of registered nurses, their replacement with unskilled workers jeopardizes the quality of care.

Australia↗
PubMedDate not supplied

Emergency medical services workforce in the city of Santo Domingo.

UNLABELLED: Santo Domingo is the largest city in the Dominican Republic. In recent years this city has experienced a significant increase in ambulance services. OBJECTIVE: To describe the current emergency medical services (EMS) workforce trends in Santo Domingo. METHODS: This was a cross-sectional descriptive study. Emergency medical services providers working within the city of Santo Domingo filled out a nine-item self-administered questionnaire. RESULTS: A total of 101 providers, 48 volunteer and 53 paid, returned the survey (response rates of 75% and 91.4%, respectively). The volunteers showed a mean of 7.48 +/- 2.02 years of involvement in EMS, whereas the paid providers had a mean of 3.58 +/- 2.91 years. When asked about planned long-term involvement in EMS, 93.8% of the volunteers responded positively, compared with 58.5% of the paid group. Nine (16.98%) of the paid providers were not satisfied with their jobs, whereas all the volunteers (100%) stated that they were satisfied; 46 (86.8%) and 27 (50.9%) of the paid providers agreed that better salary and better work hours, respectively, would influence their satisfaction. Among the volunteers, 40 (83.3%) stated that occupational health insurance would improve job satisfaction; and 39 (81.3%) stated that life insurance would bring satisfaction to their job. Logistic regression analysis showed no predictive association between job satisfaction and years of service (p = 0.342). CONCLUSION: Volunteers appeared to be less educated but with a higher long-term interest in EMS. Salary and better work hours seem to be important factors affecting satisfaction of paid providers, whereas occupational health and life insurance appear to affect the satisfaction of volunteers.

Adult↗
PubMed1999

Training for the mental health workforce: a review of developments in the United Kingdom.

OBJECTIVE: Implementation of the National Mental Health Strategy has important implications for education and training of the Australian mental health workforce. This paper discusses relevant developments in the United Kingdom that may provide some lessons for Australia. METHOD: A review was undertaken of a number of specific clinical education and training programs for mental health workers in the United Kingdom which have been subjected to published evaluation. RESULTS AND CONCLUSIONS: A finite mental health resource base dictates that education and training activity should: (i) be evaluated; (ii) target those clients most in need; (iii) include evidence-based approaches such as assertive community treatment, medication management, cognitive-behaviour therapy and family interventions; and (iv) prepare mental health workers in the core competencies needed to implement these approaches. Two programs, developed in the United Kingdom, which meet these criteria are presented as examples of best practice: the nurse therapy model established by Isaac Marks; and the Thorn initiative established in association with the Institute of Psychiatry, London and the University of Manchester.

Evidence-Based Medicine↗
PubMed2006

Developments in rheumatology consultant manpower provision: the BSR/arc Workforce Register 2003-05.

OBJECTIVES: To summarize the changes and continuing inequalities in rheumatology service provision in the UK between 2001 and 2005. METHODS: Questionnaires about demographics and workload were sent to all consultants on the BSR/arc Workforce Register in January 2003 and 2005. RESULTS: A total of 94% of 506 consultants responded in 2003 and 89% of 542 in 2005. About 19% of the consultants practice rheumatology with acute medicine. Levels of optimal provision exceed 60% in England and Wales, but are below 50% in Scotland and Northern Ireland. The levels of provision in London are substantially higher than anywhere else. The median number of hours worked per week has increased from 35.2 in 2003 to 41 in 2005. CONCLUSIONS: Rheumatology continues to expand. There is inequality with better provision in England (especially London) and Wales than Scotland and Northern Ireland. Patterns of nurse and Senior House Officer (SHO) provision correlate with consultant numbers. Thus, the catalyst for improved service is consultant expansion.

Consultants↗
PubMed2000

Workforce issues for the academic otolaryngologist.

BACKGROUND: The current medico-economic environment has led to profound changes in our health care system and questions of physician surplus. These issues have particularly affected the academic health care system, as research funding and departmental support have decreased, and many young otolaryngologists are questioning academic careers because of these uncertainties. The current study was undertaken to assess the workforce environment for the academic otolaryngologist, particularly the young physician. METHODS: Surveys were sent to the academic chairmen of all accredited otolaryngology residency programs in the United States, requesting information on faculty appointments--actual and projected-as well as subspecialty appointments and expectations of young faculty. RESULTS: The response rate was 60% (59/98). Faculty additions have been relatively stable from 1994 to 1998, with approximately 37 assistant professor and 5 associate professor positions filled yearly. Faculty additions were the result of departmental expansion in 83% of cases and spanned many subspecialties. The subspecialty positions most frequently added from 1994 to 1998 were generalists (57), head and neck oncologists (53), pediatric otolaryngologists (48), and otologists (39), with generalists filling 15 positions in 1998. Ninety-three percent of programs anticipate faculty additions in the next 5 years; most will be at the assistant professor level (77%), with 30% of positions for generalists, 20% for head and neck oncologists, and 18% for pediatric otolaryngologists. Faculty expectations are primarily clinical, with research being least important. CONCLUSIONS: Academic positions are available for the young otolaryngologist, particularly in the fields of general otolaryngology, head and neck oncology, and pediatric otolaryngology.

Data Collection↗
PubMed2001

Local health districts and the public health workforce: a case study of Wyoming and Idaho.

This study of personnel in local health departments (LHDs) focused on two predominantly rural states: Idaho and Wyoming. Although in the same region of the country, the structure of local public health is different in each state. Idaho's regionalized LHDs are relatively autonomous, whereas Wyoming's are county based, with many public health functions retained at the state level. The majority of professionals are nurses followed by environmental health workers and sanitarians, similar to data reported nationally. With increased emphasis on core public health functions of policy, assurance, and assessment, rural LHDs will be challenged to redirect the functions of their workforce.

Idaho↗
PubMed2001

Building the analytic capacity of the State Maternal and Child Health workforce--a history of the HRSA/MCHB Academic Partnership.

The Maternal and Child Health Bureau of the Health Resources and Services Administration (HRSA) in conjunction with Schools of Public Health has sponsored a variety of graduate education and continuing education initiatives during the last 15 years aimed at enhancing the analytic capacity of the maternal and child health (MCH) workforce. These initiatives are described, with lessons learned as well as recommendations for future efforts provided.

Child↗
PubMed2002

Public health workforce development: keeping population health goals in mind.

In the public health field, there is an identified need to develop the public health workforce strategically to meet the needs of a changing public health landscape. The "core competencies" that support the implementation of the core functions of public health must be tied to the mission and goals of the agency or program, and examined in light of the specific population health concerns they are meant to address. CAST-5 is offered as an example of a tool fulfilling this role for state Maternal and Child Health programs.

Child↗
PubMedDate not supplied

Evaluating workforce development: perspectives, processes, and lessons learned.

Evaluating workforce development for public health is a high priority for federal funders, public health agencies, trainees, trainers, and academic researchers. But each of these stakeholders has a different set of interests. Thus, the evolving science of training evaluation in the public health sector is being pulled simultaneously in a number of different directions, each emphasizing different methods, indicators, data-collection instruments, and reporting priorities. We pilot-tested the evaluation of a 30-hour, competency-based training course in a large urban health department. The evaluation processes included strategic, baseline assessment of organizational capacity by the agency; demographic data on trainees as required by the funder; a pre- and posttraining inventory of beliefs and attitudes followed by a posttraining trainee satisfaction survey as required by the trainers and the agency; and a 9-month posttraining follow-up survey and discussion of learning usefulness and organizational impact as desired by the academic researchers and the trainers. Routinely requiring all of these processes in training programs would be overly burdensome, time-consuming, and expensive. This pilot experience offers some important practical lessons for training evaluations in the future.

Adult↗
PubMedDate not supplied

Commentary: developing and retaining a public health workforce for the 21st century: readiness for a paradigm shift to community-based public health.

The Partnership for the Public's Health work in supporting partnerships between local health departments and community-based organizations has offered important insights into the difficulties of changing public health practice to a more community-based model. Keys to these difficulties are workforce issues: availability, appropriateness of initial training, recruitment, retention, and issues of continuing education. These challenges and some positive examples are discussed.

California↗
PubMed2006

Critical care nursing: workforce issues and potential solutions.

OBJECTIVE: To review the history and development of critical care nurses, the supply and demand issues related to critical care nursing, critical care nursing's contribution to patient outcomes, and recommendations to ensure a steady and strong workforce. DATA SOURCE AND SELECTION: Information presented in this article is based on a review of past and current literature including international and U.S. government reports, professional publications, monographs, newspapers, and journal articles identified by MEDLINE and CINAHL databases. The Internet was used to contact international and national professional organizations and specialists. DATA EXTRACTION AND SYNTHESIS: Original and selected review articles and guideline documents were reviewed for references to critical care nurses and their role on the multiprofessional critical care team. CONCLUSIONS: Critical care nurses are an essential and vital aspect of the critical care team. Nurses contribute to improved patient outcomes, reduced morbidity and mortality, reduced complications and errors, and reduced overall costs. More than 400,000 nurses practice in critical care, and additional opportunities exist and will develop. The challenge is to ensure an adequate supply of appropriately trained staff.

Critical Care↗
PubMed2004

The surgical workforce crisis: rising to the challenge of caring for an aging America.

In the past century, both the field of surgery and the population it serves have markedly changed. The number of elderly individuals in the United States is rapidly increasing. However, this increase has not been accompanied by commensurate growth in the surgical workforce. As the demographic characteristics of medical students have become more diverse, medical student interest in surgical training has declined. These trends raise two fundamental questions. (1) Will there be enough surgeons to meet the needs of an aging United States population? (2) Who will these surgeons be?

Aged↗
PubMed2000

Medical workforce planning. Comparing reality with aspirations.

The debate on reorganisation of hospital services is fertile ground for expert opinion. The Joint Consultants Committee (JCC) have produced the most recent view on the ideal acute hospital size and consultant staffing; however, their ideal is far removed from reality. A survey of trusts across the West Midlands found that many are falling short of the recommendations, such as meeting a one-in-five consultant on-call rota for the major admitting specialties and providing adequate cover in the core sub-specialties of general medicine and general surgery. While the JCC recommendations give a welcome direction and focus to workforce planning, reaching some of these will require a large financial investment and an increase in the number of trainees. Prioritising the recommendations may help to facilitate implementation by health-care providers.

Catchment Area, Health↗
PubMed1996

The impact of the EN conversion programme on the NHS nursing workforce.

States that the number of enrolled nurse conversions completed during the last ten years has had a significant impact on the number of registered nurses (RNs) available for employment in the National Health Service (NHS), and the contribution made by the enrolled nurse conversion course programme to the NHS workforce may have delayed the impact of the "demographic time bomb" on nursing recruitment. Emphasizes that the winding down of the conversion programme, and a fall in the number of RNs employed in the NHS, combined with a decline in entries to preregistration (initial) training, could signal the beginning of the long-awaited crisis facing the nursing profession.

Education, Nursing, Continuing↗
PubMed2006

New opportunities for nurses and other healthcare professionals? A review of the potential impact of the new GMS contract on the primary care workforce.

PURPOSE: The paper seeks to show that the new General Medical Services (GMS) contract will provide opportunities for NHS staff to enhance their roles, so it is important that adequate training assessment and quality control systems are set in place. This paper assesses the implications for NHS staff in primary care. DESIGN/METHODOLOGY/APPROACH: In this paper a review of policy documents was undertaken. FINDINGS: The paper finds that enhanced services set out in the new GMS contract may be provided by primary care organisations and healthcare professionals other than those located in general practitioner (GP) practices. As nurses and other healthcare professionals take on tasks previously conducted by GPs, so GPs will take on more consultant tasks previously confined to secondary care. Personal Medical Services (PMS) and GMS are converging in their contractual obligations and the opportunities offered to staff. As well as General Practitioners with Special Interests (GPwSIs), Practitioners with Special Interests (PwSIs) are important developments, which could promote recruitment and retention in the nursing and allied health professional workforce. Nurses and other healthcare professionals will be the main source of staffing for services shifted from secondary care. PRACTICAL IMPLICATIONS: The paper shows that it will be important to identify whether these professionals can substitute for GPs, the boundaries to that substitution, and whether recruitment and retention are enhanced. Training for GPwSIs and PwSIs will be introduced or expanded but also needs accreditation and validation. ORIGINALITY/VALUE: The paper provides an overview of the implications of the new GMS contract for nurses and other NHS professionals.

Adult↗
PubMed2005

Promoting a sustainable mental health nursing workforce: an evaluation of a transition mental health nursing programme.

The recruitment and retention of the mental health nursing workforce has been identified as a major issue both nationally and internationally. Transition to practice programmes has been identified as an important strategy in addressing these issues. There is, however, a paucity of literature addressing the potential or effectiveness of transition programmes in achieving these aims. This paper reports the findings of a survey administered to registered nurses at the commencement and completion of the Transition Programme into Mental Health Nursing, in Sydney, Australia. The findings suggest a high level of satisfaction with the programme. The results are directing the ongoing development of clinical placements, clinical supports, education programmes and recruitment and retention initiatives for nurses within the Central Sydney Area Mental Health Service.

Adult↗