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PubMed2000

Looking into tomorrow. Health workforce issues confronting physician assistants.

An important issue facing the physician assistant (PA) profession is how it can achieve a balance between supply of, and demand for, the services that PAs provide in the health workforce of the future. Recently, there has been debate and discussion about the implications of the recent expansion of the supply of PAs. In this article, we review and discuss (1) workforce data on physicians, PAs, and nurse practitioners and (2) projections of the number of these clinicians who will be trained in the future. We then analyze (1) data that describe the past 11 years of PA education and (2) data that address the experience of recent graduates of PA education programs who have sought employment. Some evidence suggests that, although demand has kept pace with expanding supply, a perception clearly exists that the PA job market may be tightening in some regions of the United States.

Physician Assistants↗
PubMed2006

Estimating health workforce needs for antiretroviral therapy in resource-limited settings.

BACKGROUND: Efforts to increase access to life-saving treatment, including antiretroviral therapy (ART), for people living with HIV/AIDS in resource-limited settings has been the growing focus of international efforts. One of the greatest challenges to scaling up will be the limited supply of adequately trained human resources for health, including doctors, nurses, pharmacists and other skilled providers. As national treatment programmes are planned, better estimates of human resource needs and improved approaches to assessing the impact of different staffing models are critically needed. However there have been few systematic assessments of staffing patterns in existing programmes or of the estimates being used in planning larger programmes. METHODS: We reviewed the published literature and selected plans and scaling-up proposals, interviewed experts and collected data on staffing patterns at existing treatment sites through a structured survey and site visits. RESULTS: We found a wide range of staffing patterns and patient-provider ratios in existing and planned treatment programmes. Many factors influenced health workforce needs, including task assignments, delivery models, other staff responsibilities and programme size. Overall, the number of health care workers required to provide ART to 1000 patients included 1-2 physicians, 2-7 nurses, <1 to 3 pharmacy staff, and a much wider range of counsellors and treatment supporters. We estimate from these data that the equivalent of 20,000 to 100,000 physicians, nurses, pharmacists and other core clinical staff will be needed to meet the WHO target of treating 3 million people by the end of 2005. The total number of staff, including counsellors, administrators and other cadres, could be substantially higher. DISCUSSION: These data are consistent with other estimates of human resource requirements for antiretroviral therapy, but highlight the considerable variability of current staffing models and the importance of a broad range of factors in determining personnel needs. Few outcome or cost data are currently available to assess the effectiveness and efficiency of different staffing models, and it will be important to develop improved methods for gathering this information as treatment programmes are scaled up.

Journal Article↗
PubMed2006

When the tide goes out: health workforce in rural, remote and Indigenous communities.

There is compelling evidence for the success of the "rural pipeline" (rural student recruitment and rurally based education and professional training) in increasing the rural workforce. The nexus between clinical education and training, sustaining the health care workforce, clinical research, and quality and safety needs greater emphasis in regional areas. A "teaching health system" for non-metropolitan Australia requires greater commitment to teaching as core business, as well as provision of infrastructure, including accommodation, and access to the private sector. Workforce flexibility is mostly well accepted in rural and remote areas. There is room for expanding the scope of clinical practice by non-medical clinicians in both an independent codified manner (eg, nurse practitioners) and through flexible local medical delegation (eg, practice nurses, Aboriginal health workers, and therapists). The imbalance between subspecialist and generalist medical training needs to be addressed. Improved training and recognition of Aboriginal health workers, as well as continued investment in Indigenous entry to other health professional programs, remain policy priorities.

Australia↗
PubMed2004

Decentralization's impact on the health workforce: Perspectives of managers, workers and national leaders.

Designers and implementers of decentralization and other reform measures have focused much attention on financial and structural reform measures, but ignored their human resource implications. Concern is mounting about the impact that the reallocation of roles and responsibilities has had on the health workforce and its management, but the experiences and lessons of different countries have not been widely shared. This paper examines evidence from published literature on decentralization's impact on the demand side of the human resource equation, as well as the factors that have contributed to the impact. The elements that make such an impact analysis exceptionally complex are identified. They include the mode of decentralization that a country is implementing, the level of responsibility for the salary budget and pay determination, and the civil service status of transferred health workers.The main body of the paper is devoted to examining decentralization's impact on human resource issues from three different perspectives: that of local health managers, health workers themselves, and national health leaders. These three groups have different concerns in the human resource realm, and consequently, have been differently affected by decentralization processes. The paper concludes with recommendations regarding three key concerns that national authorities and international agencies should give prompt attention to. They are (1) defining the essential human resource policy, planning and management skills for national human resource managers who work in decentralized countries, and developing training programs to equip them with such skills; (2) supporting research that focuses on improving the knowledge base of how different modes of decentralization impact on staffing equity; and (3) identifying factors that most critically influence health worker motivation and performance under decentralization, and documenting the most cost-effective best practices to improve them. Notable experiences from South Africa, Ghana, Indonesia and Mexico are shared in an annex.

Journal Article↗
PubMed2005

Assessment of public health workforce bioterrorism and emergency preparedness readiness among tribes in Washington State: a collaborative approach among the Northwest Center for Public Health Practice, the Northwest Portland Area Indian Health Board, and the Washington State Department of Health.

This article examines the collaboration, methodology, results, and lessons learned stemming from the experience of a unique university, state, and tribal collaborative model for public health emergency preparedness assessment activities. This collaborative model may be applicable to other public health preparedness efforts, as well as the broader range of general public health or workforce development partnerships between state, local, and tribal health departments and academic institutions.

Adult↗
PubMed2004

A baseline study of the demographics of the oral health workforce in rural and remote Western Australia.

BACKGROUND: A shortage of dental practitioners in Australia is predicted for the future, and the greatest effect of this will be felt in rural and remote areas. Strategies are needed to increase the recruitment and retention of dental practitioners in these areas. Part of this process is to assess the demographics of the oral health workforce. METHODS: A postal questionnaire survey was undertaken in 2002, that involved all registered dentists, therapists and hygienists in rural and remote Western Australia. RESULTS: Rural dentists are predominantly male, early middle aged, married, UWA trained, Australian born with one to two children. Rural dental therapists are predominantly female, in their mid-thirties, married, Australian born, trained in Western Australia, with two children. Male dentists worked slightly more hours per week than female dentists. The majority of the workforce does have access to email and the internet. Taking leave is a problem for most dentists because of difficulties in finding locums. CONCLUSIONS: The rural dental workforce capacity and demographic distribution need monitoring and analysis. This will determine the dental workforce's future ability to deliver the necessary services in rural and remote regions, where currently there is a dental workforce shortage.

Adult↗
PubMed2002

Planning for Canada's health workforce; past, present and present.

In a service enterprise, the front line is the product. Health human resources issues, however, continue to be treated as simple input problems. More data, in and of itself, will not solve health human resources planning challenges. The definition of how many and what types of healthcare providers are needed first requires a model of delivery of professional services built around professional healthcare workers. If we do not get this right, soon the shortage of healthcare workers will get even worse as young people choose careers in fields other than health services.

Canada↗
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↗
PubMed2006

Not enough there, too many here: understanding geographical imbalances in the distribution of the health workforce.

Access to good-quality health services is crucial for the improvement of many health outcomes, such as those targeted by the Millennium Development Goals (MDGs) adopted by the international community in 2000. The health-related MDGs cannot be achieved if vulnerable populations do not have access to skilled personnel and to other necessary inputs. This paper focuses on the geographical dimension of access and on one of its critical determinants: the availability of qualified personnel. The objective of this paper is to offer a better understanding of the determinants of geographical imbalances in the distribution of health personnel, and to identify and assess the strategies developed to correct them. It reviews the recent literature on determinants, barriers and the effects of strategies that attempted to correct geographical imbalances, with a focus on empirical studies from developing and developed countries. An analysis of determinants of success and failures of strategies implemented, and a summary of lessons learnt, is included.

Journal Article↗