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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↗
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↗
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↗
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↗
PubMed1995

The 1994 Australian Radiology Workforce Committee Report.

The task assigned to the College Workforce Subcommittee by the RACR Federal Council is to define current radiologist and trainee numbers, analyse professional demographics, and attempt to forecast radiologist numbers and the medical demand for radiological services. The period of this forecast is for 7 years leading up to 2001. This time course has been chosen on the basis of a 2 year period before any recommendation by Council could be instituted by the Educational Board and 5 years before any change in trainee numbers would be reflected in radiologist numbers. By necessity, assumptions have been made in formulating the final calculations and recommendations; the most difficult being the designation of an 'optimum' number of radiologists for our population. This assignment is an ongoing review and prediction process. The results and conclusions should be compared and contrasted to previous reports, in particular the 1992 Manpower Study.

Australia↗
PubMed1997

1996 Australian radiology workforce report.

A questionnaire was sent to all radiologists in Australia using a mailing list supplied by individual State Workforce subcommittee members. A reply rate of 72% was obtained. There are currently 1061 radiologists (1010.5 full-time equivalents) or 55.5 radiologists per million population, placing Australia in the mid-range compared with other OECD countries. This has increased slightly from 54.1 in 1994. There is a small but definite State variation. Utilizing current trainee numbers and traditional attrition rates, there is no projected change in these figures (55.3 in 2001), but the continued introduction of 'migrant' radiologists is postulated to cause an increase (56.6 with 25 migrants and 58.4 with 50 migrants in 2001). Analysis of work-practice indicates a performance rate of 14,100 procedures per year per practising radiologist. There is again a State variation. It is estimated that the total number of medical imaging procedures per 1000 population per year (rendered by radiologists) is 815. These latter two figures place Australia in the mid-range compared with the United States and Great Britain. General radiography, mammography, ultrasound, and CT are the most common procedures (in that order), and are performed by the largest proportion of radiologists.

Adult↗
PubMed1993

The orthopaedic workforce in Queensland now and into the twenty-first century.

The objectives of this study were to determine the number and distribution of orthopaedic surgeons in Queensland at present and to assess the adequacy of trainee intake for the future. Characteristics of the orthopaedic workforce in Queensland in 1990 were analysed with regard to the total number of orthopaedic surgeons, their regional distribution, their ratio to the population and their age distribution. Similar statistics were derived for the years 1981 and 1986 and trends were examined. By projecting these trends, the number of surgeons likely to be practising in 2001 was estimated. Using projected population figures, the number of orthopaedic surgeons required in 2001 was calculated, assuming an optimum ratio of surgeons to population of one per 25,000. It was found that in 1990 sufficient orthopaedic surgeons were practising in Queensland but that there was some maldistribution. With the increased intake of five new training registrars per year, the number of orthopaedic surgeons in Queensland in 2001 should be appropriate, as long as current trends continue.

Forecasting↗
PubMed1998

Redesigning a school health workforce for a new health care environment: training school nurses as nurse practitioners.

Diminishing financial resources for school health dictate the most efficient possible deployment of the school health workforce. School nurses trained as nurse practitioners could help resolve the common problems of ready access to and appropriate use of primary care, early detection of potentially costly medical problems, and efficient use of school health staff. To determine how best to use existing resources to meet the increasingly varied and complex health care needs of children and adolescents, a pilot project was conducted in Denver from 1994 to 1996. With physician back-up and health aide support, school nurses were trained as nurse practitioners to provide in-school diagnostic and treatment services. Based on their evaluation study of this pilot project, the authors suggest ways to solve problems in role transition, including well-balanced training; clear role definition and assignment of responsibilities; appropriate back-up and mentoring support; and issues of sustaining long-term programs.

Adolescent↗
PubMed2000

Training the future neurology workforce.

OBJECTIVE: To address training demands on future neurologists, the American Academy of Neurology (AAN) surveyed its US members as to their views about training the future neurology workforce. METHODS: The survey was mailed to 575 US neurologists and 425 residents/fellows. Respondents (54%) were asked about their perceptions of current and future educational programs and settings needed to improve practice competence; issues related to subspecialization; and the role of non-neurologists in providing neurologic care. Views of neurologists were compared with those of neurology residents/fellows. RESULTS: Most respondents support additional training in outpatient, community, and staff model health maintenance organization settings. The majority of respondents oppose a required fifth year of training or a yearly competency examination, but neurologists who have a subspecialty interest and residents/fellows favor elective certification and higher fees by subspecialists. General neurologists oppose these ideas. Most neurologists feel that primary care physicians, nurse practitioners, and physician assistants can manage uncomplicated neurologic problems, although residents/fellows are less willing to accept the role of nonphysician providers for neurologic services. CONCLUSIONS: Neurology educational programs should consider addressing deficiencies that today's practitioners perceive. Increasing subspecialization, although favored by most neurologists, creates a challenge for the neurologic community as neurologists without subspecialty training see this trend as a threat to their livelihood.

Attitude of Health Personnel↗
PubMed1999

Barriers to achieving a cost-effective workforce mix: lessons from anesthesiology.

As pressures to control health care costs increase, competition among physicians, advanced practice nurses, and other allied health providers has also intensified. Anesthesia care is one of the most highly contested terrains, where the growth in anesthesiologist supply has far outstripped total demand. This article explains why the supply has grown so fast despite evidence that nurse anesthetists provide equally good care at a fraction of the cost. Emphasis is given to payment incentives in the private sector and Medicare. Laudable attempts by the government to make Medicare payments more efficient and equitable by lowering the economic return to physicians specializing in anesthesia have created a hostile work environment. Nurse anesthetists are being dismissed from hospitals in favor of anesthesiologists who do not appear "on the payroll" but cost society more, nonetheless. Claims of antitrust violations by nurse anesthetists against anesthesiologists have not found much support in the courts for several reasons outlined in this essay. HMO penetration and other market forces have begun signaling new domestic physician graduates to eschew anesthesia, but, again, Medicare payment incentives encourage teaching hospitals to recruit international medical graduates to maintain graduate medical education payments. After suggesting desirable but likely ineffective reforms involving licensure laws and hospital organizational restructuring, the article discusses several alternative payment methods that would encourage hospitals and medical staffs to adopt a more cost-effective anesthesia workforce mix. Lessons for other nonphysician personnel conclude the article.

Aged↗
PubMed1994

A new look at national medical workforce strategy.

The efforts of governments in medical workforce policy have been unimpressive, and this has had serious consequences. Political compromise, theoretical error and administrative laxity have all contributed. It is demonstrated that market evidence, viewed through the prism of orthodox price theory, allows useful prescriptions to be made. These can be implemented through vigorous continuing maintenance and adjustment work on the Commonwealth Medical Benefits Schedule, together with periodic adjustments to rates of undergraduate and specialist medical education and training.

Australia↗
PubMedDate not supplied

Understanding the demographics of the evolving workforce.

The author discusses the four age cohorts currently in the workplace and the fifth that will arrive by the year 2005: the Pre-Boomers, Boomers, Cuspers, Busters, and Netsters. She describes their workplace and lifestyle characteristics, their social values, and their communication styles. Strategies for motivating and communicating when managing a workforce of diverse ages also are included.

Age Factors↗
PubMed1995

Perspectives on the physician workforce to the year 2020.

Physician supply and demand for the period extending to 2020 were assessed from three perspectives: physician utilization in group- and staff-model health maintenance organizations, physician distribution, and the future supply of nonphysician clinicians. The national norm for physician demand in 1993 was estimated to be 205 per 100,000 population. Demand is projected to increase 18% by 2020, because of both an expansion in beneficial services and a reduction in physician work effort. Supply initially will increase more rapidly, resulting in a surplus of 31,000 physicians (5% of patient care physicians) in the year 2000 and increasing to 62,000 physicians (8%) in 2010, after which the gap will narrow. Similar results were obtained when previous studies that had projected surpluses of 73,000 to 165,000 physicians (15% to 30%) in the year 2000 were reevaluated. However, physician distribution is not homogeneous, and the number of physicians per capita currently varies by more than twofold among states. Relative to the national norm, surpluses already exist in some states and shortages in others. In addition, the supply of nonphysician clinicians with independent practice authority is increasing. Their numbers are projected to double by 2010, equaling 60% of the number of patient care physicians. Measured as physician equivalents, their growth will equal the growth in physician supply. Thus, in terms of physicians alone, there is no evidence of a major impending national surplus. Local surpluses will be influenced principally by how physicians distribute themselves geographically. The major determinant of overall physician surpluses in the future will be the extent to which patients continue to seek physicians for services that also will be offered by an expanded workforce of nonphysician clinicians. Policy is needed that encompasses the universe of clinicians who will be providing care to patients in the next century.

Demography↗
PubMed1995

The physician workforce in Louisiana, 1994: the quantity of doctors, residents, and fellows.

Health care system reform raises many issues for doctors, patients, and all components of the system: professional practice, health careers education, and medical research. This report was prepared to identify trends in the medical workforce and to quantify for 1994 the number of licensed physicians in Louisiana, the number of residents and fellows, their institutional locations and the types of educational programs. The yearly publication of the Louisiana State Board of Medical Examiners was utilized for physician numbers, and the 1994 house officer data was contributed by the several institutions with residency and fellowship educational programs. Of the 9031 licensed physicians located in Louisiana in 1994, 1769 were residents or fellows in educational programs. Over the four years from 1990 to 1994, total licensed physicians in Louisiana, including house officers in educational institutions, increased slowly from 8386 to 9031, a rate of 1.78% per year.

Family Practice↗
PubMed1996

Medical workforce policy making in Canada: are we creating more problems for the future?

The current approach to the management of physician resources in Canada needs to be re-examined by all concerned. Canada is about to enter a phase of accelerating depletion of physicians as the result of two separate and evolving circumstances. Because of the unusually large number of physicians who graduated from Canadian medical schools in the late 1960s and early 1970s, a significantly larger than usual number of practising physicians will reach their normal retirement age in the decade ahead. In addition, if the recent surge in the emigration of Canadian physicians continues, the loss of so many physicians will exaggerate the impact of the expected increase in retirements. Therefore, the decision to cut medical school class sizes in the 1990s would have been more suitable in the early 1980s. Existing physician work force policies may be leading to unexpected or undeclared consequences for health care across Canada. On the basis of current trends, the author concludes that policy makers now should reconsider current physician workforce policies in anticipation of a possible shortfall of physicians beginning in the early decades of the next century.

Canada↗
PubMed1997

Provider workforce model for regional TRICARE networks.

A model is presented that can estimate the total number and specialty mix of health care providers needed to serve a defined population. Military commanders in charge of TRICARE regions, known as "lead agents," can use this model to estimate the provider workforce composition needed to serve their area. Physician staffing patterns front managed-care organizations help define the provider-to-patient proportions on which this model is based. Data needed to perform the model's computations are derived from the regional enrolled beneficiary population and the number of active duty providers. As a result, the model provides an estimate of the number and type of civilian providers that need to be contracted to adequately serve the regional military network.

Forecasting↗