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PubMed2000

The workforce in otolaryngology-head and neck surgery: moving into the next millennium.

OBJECTIVE: The goal was to examine the current scope of otolaryngologists' practices, their geographic distribution, and the roles otolaryngologists and other specialists play in caring for patients with otolaryngic and related conditions of the head and neck. STUDY DESIGN: A large national survey and administrative claims databases were examined to develop practice profiles and compile a physician supply for otolaryngology. A focus group of otolaryngologists provided information to model future scenarios. RESULTS: The current and predicted workforce supply and demographics are at a satisfactory level and are decreasing as a proportion of the increasing population. Empiric data analysis supports the diverse nature of an otolaryngologist's practice and the unique role for otolaryngologists that is not shared by many other providers. Together with the focus group results, the study points to areas for which more background and training are warranted. CONCLUSIONS: This study represents a first step in a process to form coherent workforce recommendations for the field of otolaryngology.

Adult↗

PubMed2001

A critical review of rural medical workforce retention in Australia.

The problem of how best to recruit and retain doctors in rural and remote communities has led governments to adopt a range of medical workforce incentives, including retention grants. A comprehensive literature survey suggests that medical workforce retention has been poorly distinguished from other supply issues such as recruitment, and that its determinants and the process leading to retention are poorly understood. Such a knowledge gap is likely to limit the effectiveness of retention incentives. This article reports the results of this literature review, and advances a conceptual framework as the basis for ongoing research and evaluating how best to deliver effective retention interventions.

Australia↗

PubMed2002

Managing the healthcare workforce: cost reduction or innovation.

Labour costs are the largest proportion of total costs in the health industry in developed countries and are a target in health sectory reform. The Kennett government in Victoria introduced policies based on competition and cost reduction and the decentralisation of industrial relations through enterprise bargaining. These policies directly impacted on the health workforce leading to work intensification, labour shortages and poor morale. The Bracks government has since returned to centralisation. This paper argues that it is time for a more innovative approach to health workforce management based on recognising staff as an asset rather than a cost.

Capitalism↗

PubMed2002

Dietitians in New South Wales: workforce trends 1984-2000.

Complete surveys of the dietetic workforce in NSW were conducted in 1984 and 1991 and have now been updated with a new survey in 2000. In the nine years since 1991, the total active workforce grew by 48%. Although there were significant improvements in the ratios of hospital dietitians per 100 acute beds (from 0.88 to 1.08) and dietitians per million population (from 69.7 to 96.5), the supply of dietitians does not yet reach recommended levels, especially in rural areas. Other trends were significant increases in the proportion of dietitians employed outside hospitals (to 38% in 2000) and in non-clinical work (50% in 2000), and declines in the number of technical support staff for dietitians.

Allied Health Personnel↗

PubMed2002

Consultant rheumatology workforce in the UK: changing patterns of provision 1997-2001.

OBJECTIVES: To summarize the changes in rheumatology provision and working practice that have occurred on the basis of the results of the 1997, 1999 and 2001 surveys carried out to update the British Society for Rheumatology/Arthritis Research Campaign Rheumatology Workforce Register. METHODS: The Workforce Register includes all consultant rheumatologists in the UK who do at least one NHS clinical session per week. Questionnaires were sent to all consultants on the register at the beginning of 1997, 1999 and 2001. The questionnaires asked about clinical commitments and workload. RESULTS: The response rates for 1997, 1999 and 2001 surveys were 85, 86 and 92% respectively. Scotland, Wales and Northern Ireland all had fewer consultant rheumatologists per capita than any English region. Within England, the London region had 60% more rheumatologists per capita than any other English region. CONCLUSION: There are ongoing inequalities in the provision of rheumatology, especially between London and Scotland, Wales and Northern Ireland.

Consultants↗

PubMed2003

Analysis of the nursing workforce crisis: a call to action.

In our integrative review of reports on the health care workforce shortage, we examined 15 reports that focused primarily on nursing and were conducted by various stakeholders. We studied these reports objectively, identifying problems and solutions as described by the authors, which we then categorized by theme. We found problems at both the national and institutional levels and noted that the reports contained similar problem and solution "themes." Yet we also found gaps between these-some problems had no solutions and some solutions didn't address any of the suggested problems. Gaps occurred among problems and solutions listed in the following theme categories: demand, health care economics, workforce planning, research and data support, and technology. Despite the urgent need, we still lack a national strategy designed to avert the nursing shortage. This review may provide a foundation for such a plan.We present the results of our analysis and our recommendations to the federal government and national organizations, to institutions, and to nurses. These recommendations don't provide a comprehensive strategy for averting the nursing shortage, but they do offer a basis upon which one may be created.

Health Planning↗

PubMed1998

A position paper of the North American Society for Pediatric Gastroenterology and Nutrition. Pediatric gastroenterology Workforce Survey and future supply and demand.

BACKGROUND: The North American Society for Pediatric Gastroenterology and Nutrition (NASPGN) performed a Workforce Survey to determine the current number and distribution of pediatric gastroenterologists in the United States and Canada and to estimate the supply and demand in the future in the United States. METHODS: The response rate was more than 90%. There were 624 pediatric gastroenterologists in the United States, and 48 in Canada. RESULTS: There were 2.4 pediatric gastroenterologists per million population in the United States, ranging from 3.1 per million in the Northeast to 1.9 per million in the West, and 1.6 per million in Canada. In the United States, fewer than 5 pediatric gastroenterologists retire each year, but more than 40 fellows per year complete training. In the United States, 30% of pediatric gastroenterologists believe there is already an excess supply; only 12% believe there is a shortage (p < 0.001). CONCLUSIONS: If the number of fellows who complete training each year remains unchanged, in 10 years there will be more than 950 pediatric gastroenterologists in the United States (3.3 per million population). At the same time, if the demand for pediatric gastroenterologists remains 2.4 per million population, there will be a demand for only 675. If these assumptions are correct, it is necessary to reduce the number of fellows to be trained. Although it is difficult to predict future workforce needs reliably, we recommend that the number of fellowship positions in training programs in the United States be reduced by 50% to 75%. Changes in health care in the coming years will be challenging, and effective planning is necessary for pediatric gastroenterologists to achieve their clinical, research, and educational missions.

Adolescent↗

PubMed1997

Trends in hospital restructuring and impact on the workforce in Germany.

OBJECTIVES: The author describes the impacts of hospital restructuring and reform legislation in Germany on the nursing workforce. METHODS: A descriptive analysis using selected literature is presented. RESULTS: Driven by the increased service needs of an aging population and the imperative to contain health-care costs, the hospital sector is shrinking while increasing its intensity of care delivery. Within this environment, the demand for patient-focused, high-quality nursing care is high, whereas the number of new graduates entering the nursing field is declining. Despite absolute increases in the number of nurses employed by the hospital sector, evidence suggests that hospitals are operating with a nursing workforce deficit. The recent reform law of 1992 mandates several changes with large implications for nursing. These include a linking of the hospital sector with outpatient care; a focus on rigorous, interdisciplinary quality assurance; and a revaluing of the adequacy of hospital nurse staffing. CONCLUSIONS: Hospitals will remain the major employers of nurses, with new outpatient sector opportunities. Adequate nurse staffing methodologies, sound personnel retention strategies, and reform of care delivery models are needed to assure high-quality nursing care in the hospital sector.

Ambulatory Care↗

PubMed1999

Public health workforce information: a state-level study.

A two-stage sample survey was used to estimate the size of Texas' professional public health workforce and to describe its composition in terms of employment settings, job characteristics, and individual characteristics. The estimated 17,700 public health professionals employed in 1995 represented approximately three percent of the state's total health workforce. About 55 percent of all these professionals worked in agencies that provide population-based public health services. An estimated seven percent had formal public health education. These findings raise issues concerning the numerical adequacy of the state's supply of public health professionals, the adequacy of their educational preparation, and the human resources capacity of the state's official public health agencies.

Adult↗

PubMed2001

Partnership for front-line success: a call for a national action agenda on workforce development.

Despite more than a decade of dialogue on the critical needs and challenges in public health workforce development, progress remains slow in implementing recommended actions. A life-long learning system for public health remains elusive. The Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry in collaboration with other partners in federal, state, local agencies, associations and academia is preparing a national action agenda to address front-line preparedness. Four areas of convergence have emerged regarding: (1) the use of basic and crosscutting public health competencies to develop practice-focused curricula; (2) a framework for certification and credentialing; (3) the need to establish a strong science base for workforce issues; and (4) the acceleration of the use of technology-supported learning in public health.

Centers for Disease Control and Prevention, U.S.↗

PubMed2001

A systems approach to public health workforce development.

During the 1990s, several distinct but interrelated efforts to strengthen the public health infrastructure were launched. Defining public health work in terms of core functions and essential services, these efforts focused on the competence of the workforce and the performance of public health agencies. The systems approach offered here highlights the relationships and interdependencies among these three components of public health practice: (1) the work, (2) the worker, and (3) the work setting. The model suggests that advances in public health workforce development may require major public health organizational development efforts.

Competency-Based Education↗

PubMed2001

National Public Health Performance Standards: workforce development and agency effectiveness in Florida.

The Florida Department of Health (FDOH) was the first state to pilot test both the Centers for Disease Control and Prevention (CDC) state agency and local Public Health System Performance Standards. The standards were found to be complementary and supportive of the FDOH quality performance improvement system, which had been in place for a decade, and the new Quality Management initiative. The pilot test found uneven performance across the state's county health departments and identified several areas, especially workforce development, that required additional efforts. The FDOH, in collaboration with the Center for Leadership in Public Health Practice at the College of Public Health in the University of South Florida, have collaborated and will continue to collaborate to design and deliver training in critical workforce development areas.

Efficiency, Organizational↗

PubMed2001

Improving performance at the local level: implementing a public health learning workforce intervention.

In an effort to continually improve performance of the essential public health services with community partners, the diverse public health workforce in a major metropolitan area engaged in an organizational learning process. Core public health organizational competencies, identified in a multi-year collaborative applied research initiative, provided the curricula content for the public health learning experience. All members (about 600) of the Columbus and Franklin County (Ohio) Health Departments participated in four one-half day small group, highly interactive modules conducted during a 2-year period. The purpose of this article is to describe the design and implementation of this workforce intervention, the lessons learned, and implications for developing organizational capacity and improved performance.

Competency-Based Education↗

PubMed1993

The supply of orthotist prosthetists. The application of workforce projection techniques in determining future national training places.

Discusses the application of workforce planning techniques in the context of "target" levels of demand and uses a study of the future supply of orthotists and prosthetists as an example. Describes the derivation of an appropriate model, the quantification of the labour market for the profession, and an analysis of the characteristics of the workforce. Information was gathered through two surveys and from discussions with relevant organizations.

Allied Health Personnel↗

PubMed1995

A missing link? Workforce demand as the link between two health care related markets.

Examines the links between workforce demand and two health care related markets, the first being the internal market between purchasers and providers of health care, and the second the market for education expressed between colleges of education as providers and NHS Trusts as purchasers of the courses. Workforce demand has to take account of the numbers of people on courses, but also specialist skills required to enable NHS Trusts to deliver changing health care needs of the future.

Education, Nursing↗

PubMed1996

The importance of workforce planning in the NHS in the 1990s.

Considers a variety of pressures, both internal and external to the National Health Service, which in recent years have ostensibly increased the importance of sound workforce planning initiatives. These include, among others: skill shortage; the drive towards cost-efficiency and effectiveness; an altered philosophy of care through technology; the develop of competence-based training initiatives; nationwide demographic changes; and the need to develop identifiable skill shortages. Presents reprofiling (skills alignment with organizational needs) and skill mix and distribution as useful approaches to workforce planning and concludes with a brief consideration of implications for planners of professional boundaries and changed educational priorities for health service personnel.

Health Planning↗

PubMed1998

Supply dynamics of the mental health workforce: implications for health policy.

The U.S. mental health workforce is varied and flexible. The strong growth in supply of nonphysician mental health professionals, ranging from psychologists to "midlevel" professionals like social workers and nurse specialists, helps to offset the dwindling numbers of medical graduates entering the field of psychiatry. Primary care physicians often see patients who have some form of mental illness, which they are not always trained to recognize and treat. The data on the supply of several specialists--psychiatrists, clinical psychologists, and clinical social workers--indicate that the distribution of mental health professionals varies widely by state. The composition, supply, and distribution of workers in this field also affect the care of vulnerable populations. Broader policy questions, including the lack of parity between mental and physical health insurance coverage and barriers to entry by nonphysician professions, may limit the cost-effective expansion of this diverse and dynamic workforce.

Adolescent↗

PubMed1996

An optimized model for substitution of expatriate workforce in a Gulf-Council country: the Kuwaiti case.

"This article is based on data from a research project carried out during 1992-1994 to achieve a replacement mechanism and a model for the substitution of expatriate labour by Kuwaiti nationals. Since Kuwait can readily enforce its Kuwaitization policy in the public sector, the presented model aims at reducing the share of non-Kuwaitis in that sector over five years. Published data on distribution of the workforce in the public sector by nationality indicate that the non-Kuwaiti share of the total workforce is 38 per cent. The majority of [migrant] workers are unskilled or semi-skilled and engaged in production, commerce and services. Sex ratios are unbalanced and workers exhibit a high rate of literacy...." (SUMMARY IN FRE AND SPA)

Asia↗