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Neurosurgery workforce in Canada, 1996 to 2011. Canadian Neurosurgical Society.

OBJECTIVE: To determine the number of neurosurgeons in clinical practice in Canada on Jan. 1, 1996, and their practice profile and to determine requirements for 2001 and 2011. DESIGN: Telephone survey and national mail survey. SETTING: Canada. PARTICIPANTS: All 174 neurosurgeons in Canada engaged in active clinical practice on Jan. 1, 1996, and all residents enrolled in neurosurgery training programs in Canada during the 1995-96 academic year. OUTCOME MEASURES: Demographic characteristics, full-time equivalents, workload, attrition, reasons for exit, vacancies, supply and shortfall. RESULTS: All 174 neurosurgeons responded to the survey. There is a chronic shortage of 25 neurosurgeons in Canada. Sixty-two established neurosurgeons will have stopped practice by 2001 and 181 by 2011. They will need to be replaced, for a total requirement of 87 and 206 neurosurgeons by 2001 and 2011 respectively. Canadian neurosurgery training programs can currently generate only up to 69 and 177 graduates by 2001 and 2011 respectively. During the period 1985-95, 50% of neurosurgery graduates emigrated from Canada within 2 years of obtaining certification, creating potential deficits of up to 52 and 117 neurosurgeons by 2001 and 2011 respectively. CONCLUSIONS: Strategies need to be developed quickly to address not only the chronic shortfall but also the attrition of established neurosurgeons. Strategies to increase and retain the number of Canadian neurosurgery graduates are also needed.

Adult↗

Stabilizing the HIV/AIDS workforce: lessons from the New York City experience.

The Ryan White Title I Personnel Needs Study described here is an evaluation of the human resource needs of HIV/AIDS service agencies in New York City. The research presented here was conducted in collaboration with researchers from the Medical and Health Research Association and the New York City Department of Health and the Planning and Evaluation Committee of the New York City HIV Health and Human Services Planning Council. The assessment is divided into two components. The first component is a survey of 100 key informants from HIV/ AIDS service agencies. The second component is a detailed staffing survey of 70 personnel directors of HIV/AIDS service agencies. HIV/AIDS service directors perceived staff recruitment as a more difficult process than staff retention, regardless of agency type. Vacancy rates at the surveyed agencies varied by professional category; they were especially high in the category of nurse practitioners (13%) and outreach/education workers (15%). Agencies stressed that incentives that would positively affect recruitment and retention should be tailored to address the concerns of varied health care and social service professionals. In addition, agencies were not routinely able to provide some incentives deemed effective such as higher salaries, housing subsidies, and smaller caseloads. To reduce recruitment and retention problems, agency informants recommended a variety of incentive programs including malpractice insurance for physicians, flexible hours for full-time employees (including case managers, nurses, physician's assistants), smaller caseloads, and a decrease in the proportion of staff time devoted to direct client contact. Overall health care trends including truncated federal budgets, state Medicaid cutbacks, and the rapid conversion to managed care all affect the quality of patient care and of the work setting for health care and social service providers serving persons with AIDS. Medical Subject Headings (MeSH): AIDS, health personnel, employment supported, employee workload, staff attitude.

Acquired Immunodeficiency Syndrome↗

Managed care and the nurse workforce.

OBJECTIVES: To identify recent national trends in the employment and earnings of nursing personnel and determine whether managed care is associated with changes in the employment and wage growth of nursing personnel. DESIGN: Retrospective analysis of trends in data on employment and earnings of nursing personnel based on monthly US Bureau of the Census Current Population Surveys between 1983 and 1994, and comparison of trends between states with high and low rates of enrollment in health maintenance organizations (HMOs). POPULATION: Registered nurses (RNs), licensed practical nurses (LPNs), and nurse aides/assistants, orderlies, and attendants (referred to collectively as aides) between the ages of 21 and 64 years. OUTCOME MEASURES: Full- and part-time employment, unemployment, percentage of nursing personnel employed in key sectors of the nurse labor market, and inflation-adjusted hourly wages. RESULTS: From 1983 through 1994, there was strong overall growth in both RN employment (37%) and inflation-adjusted wages (22%). Beginning in the early 1990s, however, RNs experienced stagnant wages and a small but steady shift toward employment in lower-paying nonhospital settings, particularly in home health care. In states with high HMO enrollment, RN and LPN employment has grown more slowly since 1990, and the shift of RN employment out of the hospital was strongest. For aides and LPNs, the shift out of hospital employment occurred years before that of RNs and at a much greater rate. Since 1990 the employment of aides has grown rapidly in nursing homes and in home health care settings, whereas employment of LPNs has shifted primarily into physician offices and nursing homes. Overall, the movement toward nonhospital employment has had a modest negative impact on wages for all nursing personnel. CONCLUSIONS: Managed care is associated with slower employment growth for RNs in hospitals and a shift toward employment in nonhospital settings, but its effect on earnings has been overshadowed by other forces impacting nurse wages.

Adult↗