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PubMed2005

Comparing the supply of pediatric subspecialists and child neurologists.

OBJECTIVE: To examine physician workforce characteristics and workforce projections of one vulnerable pediatric subspecialty, child neurology, and compare this subspecialty with other pediatric subspecialties, general pediatrics, and adult neurology. STUDY DESIGN: National survey of child neurologists compared with other pediatric specialties in the Community Tracking Study Physician Survey (CTS) and the American Medical Association (AMA) Masterfile, and input-output workforce projections. RESULTS: Child neurologists are more likely than other specialists to report that the complexity or severity of patients' conditions at the time of referral is less than it should be and that the number of patients being referred to them has increased. Projections of the future workforce reveal that by 2022 the number of pediatric subspecialists and pediatricians will increase substantially, to almost 180% and 150% of the current workforce, respectively. Among child neurologists and adult neurologists, practicing physicians will be only 109% and 105% of the current workforce by 2022. CONCLUSIONS: Child neurologists are more likely to face future workforce shortages than other pediatric subspecialists. To reduce future shortages, recruitment efforts need to be concentrated on the at-risk subspecialties such as child neurology. In the short-term, addressing the high prevalence of inappropriate low-acuity referrals to child neurologists may ease the gap between supply and demand.

Career Choice↗

PubMed2006

Australian general practice: where have the GP services gone?

BACKGROUND: While the number of GP services provided in Australia increased steadily from the inception of Medicare in 1984 until the mid 1990s, it declined by 6.6% from 1997-8 to 2003-4. This reflects a decline in average number of services provided per GP of 8.0%. In Australia, as in the US and Canada, there has been a change in the composition of the GP workforce in recent years, in particular an increased feminisation and aging of the GP workforce. We explore whether the decline in average level of services per GP is an inevitable outcome of changes in the composition of the GP workforce, or due to changes in the behaviour of individual GPs driven by attitudinal or economic factors. METHOD: Using 8 years of data on the levels of GP activity within the Medicare system, we apply standardisation techniques to examine the expected impact of changes in the composition of the GP workforce. We show that the increasing feminisation of the GP workforce over this period would lead to a reduction in overall GP activity levels, everything else being equal, but that the effect is small (1.9%). Aging of workforce would have led to an increase in overall activity levels (7.5%), as would increases in levels of vocational registration (4.2%) and increases in the proportion of overseas-trained GPs (0.6%). RESULTS: Overall, if GPs of a given age-sex-education/training category had continued to provide services at the same average level in 2003 as in 1996, the change in composition from 1996 to 2003 would have led to increases in the levels of services per GP of 3.9%. This is 11.4% above the level of services per GP actually observed. We have examined changes in the number of services per GP within 'pseudo cohorts' of GPs, and observe that young cohorts of GPs provide fewer services on average than previous young cohorts. Middle-aged GPs, particularly middle-aged male GPs, have reduced the number of services they individually provide. While this reduced level of activity of individual GPs could be due to changes in the underlying need for services, it is more likely to be as a result of reduced demand due to higher prices being charged (consistent with the observed increases in charging levels), or to changing attitudes of GPs seeking more family time. CONCLUSION: In planning for the future GP workforce, policy makers need to consider many factors. These include not only the demographic factors that influence the volume of GP activity, but also the changing behaviour of GPs and the factors that influence this behaviour.

Adult↗

PubMed2005

Baby boomer doctors and nurses: demographic change and transitions to retirement.

OBJECTIVES: To examine the effect of demographic change on employment patterns for general practitioners, medical specialists and nurses since 1986, and to compare their patterns of retirement. DESIGN AND SETTING: Secondary analysis of previously unpublished Australian Bureau of Statistics Census data for the years 1986, 1991, 1996 and 2001. MAIN OUTCOME MEASURES: Age distribution of GPs, specialists and nursing workforce; attrition rates as GPs, specialists and nurses left the workforce; and hours worked according to age group. RESULTS: The age profile of the GP, specialist and nursing workforce has aged since 1986 (P < 0.001), with the "baby boomer" generation making up more than half the workforce in 2001. A large proportion of GPs continued to work beyond the traditional retirement age of 65 years, with nurses retiring at a younger age than doctors (P < 0.001). All GP cohorts worked fewer hours in 2001 than they did in 1986 (P < 0.001), with "generation X" GPs working fewer hours than the baby boomers did at the same age (P < 0.001). CONCLUSIONS: Attrition of baby boomer clinicians will place unprecedented pressure on the medical workforce, and policy makers face a critical challenge to ensure workforce needs are met over the next 20 years. Policies and incentives to encourage ongoing employment among older clinicians, albeit at reduced hours, are crucial if the Australian health workforce is to be adequate to meet the growing community demand of the 21st century.

Adult↗

PubMed2003

Assessing human resources for health: what can be learned from labour force surveys?

BACKGROUND: Human resources are an essential element of a health system's inputs, and yet there is a huge disparity among countries in how human resource policies and strategies are developed and implemented. The analysis of the impacts of services on population health and well-being attracts more interest than analysis of the situation of the workforce in this area. This article presents an international comparison of the health workforce in terms of skill mix, sociodemographics and other labour force characteristics, in order to establish an evidence base for monitoring and evaluation of human resources for health. METHODS: Profiles of the health workforce are drawn for 18 countries with developed market and transitional economies, using data from labour force and income surveys compiled by the Luxembourg Income Study between 1989 and 1997. Further descriptive analyses of the health workforce are conducted for selected countries for which more detailed occupational information was available. RESULTS: Considerable cross-national variations were observed in terms of the share of the health workforce in the total labour market, with little discernible pattern by geographical region or type of economy. Increases in the share were found among most countries for which time-trend data were available. Large gender imbalances were often seen in terms of occupational distribution and earnings. In some cases, health professionals, especially physicians, were overrepresented among the foreign-born compared to the total labour force. CONCLUSIONS: While differences across countries in the profile of the health workforce can be linked to the history and role of the health sector, at the same time some common patterns emerge, notably a growing trend of health occupations in the labour market. The evidence also suggests that gender inequity in the workforce remains an important shortcoming of many health systems. Certain unexpected patterns of occupational distribution and educational attainment were found that may be attributable to differences in health care delivery and education systems; however, definitional inconsistencies in the classification of health occupations across surveys were also apparent.

Journal Article↗

PubMed2005

Profile of the physiotherapy profession in New South Wales (1975-2002).

This was the first study known to the authors exploring workforce data from the New South Wales Physiotherapists Registration Board over several decades. Labour force statistics were examined from various data sources over the years 1975 to 2002. The results indicate that the demographics and working patterns of physiotherapists in New South Wales have remained remarkably stable over time. The workforce continues to grow, however the growth rate has decreased markedly with only a 2.3% increase from 2001 to 2002. The proportion of men within the profession is steadily increasing; in 1975 men accounted for 5.2% of physiotherapists, in 2000 23.5% of physiotherapists were male. While the male workforce increases, the female workforce is ageing. The modal age for female physiotherapists has steadily increased from 25-29 years in 1975 to 40-44 years in 2001. Importantly, in relation to attrition, the degree of workforce participation has not undergone significant change since 1987. Although labour force analysis has demonstrated that the workforce is in shortage, attrition does not appear to be the major contributor to this situation. The proportion of the profession who are inactive has remained relatively stable since 1987. More pertinent to the current shortage is the slowing of the growth rate of the profession while demand for physiotherapy services continues to rise.

Adult↗

PubMed1997

Hospital reform and nursing labor market trends in Canada.

OBJECTIVES: Trends in the Canadian registered nurse (RN) workforce during the past 3 decades are examined, and the implications of current hospital sector retrenchment for RN employment are considered. METHODS: A descriptive review using relevant literature and existing databases on the nurse workforce is presented. RESULTS: From the 1960s through the 1980s, the Canadian RN workforce grew exponentially, fueled by expansions in the health-care delivery system under Medicare, rising inpatient acuity and skill-intensive patient care, enhanced access to nursing education, and increases in the numbers of women entering the workforce. Acute care hospitals have and continue to be the predominant employer of RNs. However, the 1990s have witnessed considerable hospital retrenchment, and with that retrenchment the growth of the hospital RN workforce has slowed dramatically. CONCLUSIONS: The ultimate outcomes of hospital retrenchment for the RN workforce remain unclear. Some speculate that the quality of care and working conditions will deteriorate in hospitals, as hospital administrators replace RN staff with lesser trained personnel to reduce costs. Others see change in the hospital sector as an opportunity for RNs to expand their scope of practice and responsibility in outpatient settings. The need for national and international research on the outcomes of hospital restructuring on patient care and the work of RNs is critical to sound policy making.

Adult↗

PubMed2004

Alcohol and other drug specialist treatment services and their managers: findings from a national survey.

OBJECTIVE: To examine the characteristics of alcohol and other drug (AOD) specialist treatment agencies, their workforce and workforce development issues. METHODS: A national survey of AOD specialist treatment agency managers was conducted using the Clients of Treatment Service Agencies (COTSA) database as the sampling framework. Agency managers across Australia were surveyed by phone or electronically between April and October 2002. Qualitative and quantitative data were collected. Two hundred and thirty-four managers participated, representing 318 agencies, and a response rate of 65%. More than 50% of managers from each State and Territory participated in the study. RESULTS: The study found a high prevalence of alcohol-related problems. Managers estimated 45% of clients nominated alcohol as their primary problematic drug and that 53% of poly-drug clients identified alcohol-related problems. Managers reported increasingly complex client needs such as co-occurring substance and mental health issues. A harm minimisation treatment approach was supported by more than three-quarters of AOD agencies. The majority of the AOD workforce were trained professionals and consisted of nurses (26%), general AOD workers (19%) and psychologists (9%). Approximately half the sample had been in their current managerial role for less than five years. Key workforce development issues identified were education and training, funding, and staff recruitment and retention. CONCLUSION: More information is required on the key characteristics of the AOD workforce and their workforce development needs. Such information can contribute to policies and strategies that develop the capacity of the AOD sector to manage and treat the increasingly complex needs of clients.

Adolescent↗

PubMed1996

The evolution of divergences in physician supply policy in Canada and the United States.

The size, geographic distribution, and specialty mix of the US physician workforce continue to interest American health policy analysts. Evidence suggests that the United States is on the verge of a serious oversupply of physicians, particularly nongeneralist physicians. Canada faces some of the same problems in physician supply, cost, and distribution as does the United States. Unlike the American states, however, the Canadian provinces, which have responsibility for financing health care, have in recent years made changes in their physician workforce policies that address these problems. Of particular note, Canadian provinces have developed policies that limit medical school enrollments, adjust the specialty training mix to better accord with needs, and establish physician practice location incentives. This article proceeds on the assumption that historical and contemporary similarities between medical care systems in Canada and the United States make comparisons between them potentially valuable. It offers a historical perspective on the evolution of workforce planning in the 2 countries and identifies 3 periods of policy development. It also compares and contrasts the relative size and specialty composition of the Canadian and US workforces and discusses how Canadian initiatives have diverged from American policy. Unless the United States devises its own coordinated workforce strategy, it will have considerable difficulty limiting physician workforce growth and influencing specialization and distribution in the future.

Canada↗

PubMed2004

Who will be there to nurse? Retention of nurses nearing retirement.

AIMS: To determine the impact on nursing work-force supply of delaying retirement. BACKGROUND DATA: The nursing workforce is aging, and the Baby Boomer generation is nearing retirement age. This potential loss of experienced nurses is likely to exacerbate current nursing shortages. METHODS: An analysis of loss rates of nurses in New South Wales (Australia) is provided using 2 different retirement ages--58 and 65 years. Supply numbers were used and then "aged" to determine the impact of retirement on workforce numbers. The impact of potential retention strategies on the numbers who could be retained were determined if 100% of 50- to 55-year-old nurses was retained, 75% of those 56 to 60 years, and 50% of those 61 to 65 years. RESULTS: By the year 2004, approximately 4139 nurses (registered and enrolled) will be lost through retirement at age 65 years. However, retirement at age 58 years sees 7328 lost by 2004. Potentially 2139 nurses in this age spectrum could be retained if strategies are focused on delaying retirement. CONCLUSIONS: Delaying the retirement of nurses could provide a significant human resource, not only in terms of absolute numbers but more importantly, in terms of experience and expertise. However, retention of this portion of the workforce may require different strategies than for younger members of the workforce. The needs of this segment of the nursing workforce may require nurse administrators to consider different approaches to nursing work and work allocation.

Adult↗

PubMed2003

Physicians resources in Lithuania: change comes slowly.

AIM: To analyze the structure of the physician workforce in Lithuania at the time when the country gained independence, changes it has undergone since 1990, and physician resource planning activities. METHODS: National and international databases were examined to determine the changes in the structure of physician workforce after 1990. Studies and reports, funded by international and national governmental organizations, were reviewed to examine the recommendations for physician resource planning and the rate of their acceptance. Since there was no government plan, a study using Delphi technique was conducted to find consensus among practitioners and policy makers on the physician-to-population ratio needed in Lithuania. Medical residents and physicians in Lithuania were surveyed to assess their emigration intentions. RESULTS: In comparison with other Baltic countries, the number of physicians in Lithuania has remained high despite dramatic reductions in the number of students enrolled to medical schools. There is still a maldistribution of physician resources geographically and by specialty. The government has accepted few recommendations based on the international studies. None of the internal databases provided all the needed information on the physician workforce and the existing databases could not be linked to gain access to all required information. CONCLUSIONS: The physician-to-population ratio remained high after Lithuania had gained independence. There has been little planning at the government level to determine the number of physicians needed in a reformed health system. Changes in the number of students admitted to medical schools did not follow from a well thought-out long-term plan for physician workforce the country will need in the future. To develop a frequently updated database of physicians is essential for the successful planning of future physician workforce.

Databases as Topic↗

PubMed2005

A profile of home care workers from the 2000 census: how it changes what we know.

PURPOSE: The goal of our study was to identify a representative sample of direct care aides to generate an accurate profile of the long-term-care workforce, with a special focus on home care workers. DESIGN AND METHODS: Data were taken from the 5% Public Use Microdata Sample (PUMS) of the 2000 Census. RESULTS: Variable coding in the 2000 Census data allowed for a more detailed identification of long-term-care workers than was available in previous studies. On the basis of this new sample, the estimated size of the home care workforce is much larger than that in previous estimates, and it is more heterogeneous. In addition, our analyses revealed more self-employed workers, higher salaries than previously reported, and greater ethnic diversity, with Hispanics or Latinos comprising a significant proportion of the home care workforce. IMPLICATIONS: Numerous state and federal programs are currently underway to increase the capacity of the long-term-care workforce. A more comprehensive understanding of the characteristics of the long-term-care workforce will facilitate more effective development of programs designed to enhance recruitment and retention of these workers to meet the increasing demands of future years.

Adult↗

PubMed2005

From patients to providers: prospects for self-care skills trainers in the National Health Service.

Changes in the National Health Service (NHS) workforce and user involvement have been key areas of contemporary health care policy. Potentially, the current separation of the agendas for patient participation and reconfiguration of the workforce are being brought closer together in the NHS through the Expert Patients Programme (EPP), and its potential to create a new community health 'workforce' of self-management and self-care skills trainers and tutors. The aim of the present paper is to assess the establishment and prospects of these trainers as a new workforce role in the EPP and the NHS. This is done through policy analysis and process evaluation recording the development and implementation of the EPP in the NHS. Telephone interviews with individual trainers were undertaken in order to identify the way in which they are being introduced into the NHS. A representative sample of 19 trainers from the 26 teams covering all the primary care trusts (PCTs) in England were interviewed. The EPP trainers are employed and appointed by the Department of Health and assist PCTs to run EPP courses. The analysis of trainer perspectives illuminated some of the tensions inherent in this new role, which emerge from the consequences of having a long-term condition, their relationship to other occupations operating within primary care and their structural position within the NHS. Prospects for the future development of self-management trainers remain uncertain. Two likely outcomes are examined. The first is that trainers and volunteer tutors will become increasingly integrated as a semi-professionalised group within the primary care workforce. The other option is for trainers to become freelance consultants commissioned by PCTs to run local self-management, self-care support or EPP programmes with the consequence of establishing a more distant relationship with mainstream NHS provision.

Female↗

PubMed2005

The future prospects of Lithuanian family physicians: a 10-year forecasting study.

BACKGROUND: When health care reform was started in 1991, the physician workforce in Lithuania was dominated by specialists, and the specialty of family physician (FP) did not exist at all. During fifteen years of Lithuania's independence this specialty evolved rapidly and over 1,900 FPs were trained or retrained. Since 2003, the Lithuanian health care sector has undergone restructuring to optimize the network of health care institutions as well as the delivery of services; specific attention has been paid to the development of services provided by FPs, with more health care services shifted from the hospital level to the primary health care level. In this paper we analyze if an adequate workforce of FPs will be available in the future to take over new emerging tasks. METHODS: A computer spreadsheet simulation model was used to project the supply of FPs in 2006-2015. The supply was projected according to three scenarios, which took into account different rates of retirement, migration and drop out from training. In addition different population projections and enrollment numbers in residency programs were also considered. Three requirement scenarios were made using different approaches. In the first scenario we used the requirement estimated by a panel of experts using the Delphi technique. The second scenario was based on the number of visits to FPs in 2003 and took into account the goal to increase the number of visits. The third scenario was based on the determination that one FP should serve no more than 2,000 inhabitants. The three scenarios for the projection of supply were compared with the three requirement scenarios. RESULTS: The supply of family physicians will be higher in 2015 compared to 2005 according to all projection scenarios. The largest differences in the supply scenarios were caused by different migration rates, enrollment numbers to training programs and the retirement age. The second supply scenario, which took into account 1.1% annual migration rate, stable enrollment to residency programs and later retirement, appears to be the most probable. The first requirement scenario, which was based on the opinion of well-informed key experts in the field, appears to be the best reflection of FP requirements; however none of the supply scenarios considered would satisfy these requirements. CONCLUSION: Despite the rapid expansion of the FP workforce during the last fifteen years, ten-year forecasts of supply and requirement indicate that the number of FPs in 2015 will not be sufficient. The annual enrollment in residency training programs should be increased by at least 20% for the next three years. Accurate year-by-year monitoring of the workforce is crucial in order to prevent future shortages and to maintain the desired family physician workforce.

Adult↗

PubMed2006

Public sector nurses in Swaziland: can the downturn be reversed?

BACKGROUND: The lack of human resources for health (HRH) is increasingly being recognized as a major bottleneck to scaling up antiretroviral treatment (ART), particularly in sub-Saharan Africa, whose societies and health systems are hardest hit by HIV/AIDS. In this case study of Swaziland, we describe the current HRH situation in the public sector. We identify major factors that contribute to the crisis, describe policy initiatives to tackle it and base on these a number of projections for the future. Finally, we suggest some areas for further research that may contribute to tackling the HRH crisis in Swaziland. METHODS: We visited Swaziland twice within 18 months in order to capture the HRH situation as well as the responses to it in 2004 and in 2005. Using semi-structured interviews with key informants and group interviews, we obtained qualitative and quantitative data on the HRH situation in the public and mission health sectors. We complemented this with an analysis of primary documents and a review of the available relevant reports and studies. RESULTS: The public health sector in Swaziland faces a serious shortage of health workers: 44% of posts for physicians, 19% of posts for nurses and 17% of nursing assistant posts were unfilled in 2004. We identified emigration and attrition due to HIV/AIDS as major factors depleting the health workforce. The annual training output of only 80 new nurses is not sufficient to compensate for these losses, and based on the situation in 2004 we estimated that the nursing workforce in the public sector would have been reduced by more than 40% by 2010. In 2005 we found that new initiatives by the Swazi government, such as the scale-up of ART, the introduction of retention measures to decrease emigration and the influx of foreign nurses could have the potential to improve the situation. A combination of such measures, together with the planned increase in the training capacity of the country's nursing schools, could even reverse the trend of a diminishing health workforce. CONCLUSION: Emigration and attrition due to HIV/AIDS are undermining the health workforce in the public sector of Swaziland. Short-term and long-term measures for overcoming this HRH crisis have been initiated by the Swazi government and must be further supported and increased. Scaling up antiretroviral treatment (ART) and making it accessible and acceptable for the health workforce is of paramount importance for halting the attrition due to HIV/AIDS. To this end, we also recommend exploring ways to make ART delivery less labour-intensive. The production of nurses and nursing assistants must be urgently increased. Although the migration of HRH is a global issue requiring solutions at various levels, innovative in-country strategies for retaining staff must be further explored in order to stem as much as possible the emigration from Swaziland.

Journal Article↗

PubMedDate not supplied

Racial/ethnic diversity management and cultural competency: the case of Pennsylvania hospitals.

Major demographic trends are changing the face of America's labor pool, and healthcare managers increasingly face a scarcer and more diverse workforce. As a result, healthcare organizations (HCOs) must develop policies and practices aimed at recruiting, retaining, and managing a diverse workforce and must meet the demands of a more diverse patient population by providing culturally appropriate care and improving access to care for racial/ethnic minorities. Ultimately, the goal of managing diversity is to enhance workforce and customer satisfaction, to improve communication among members of the workforce, and to further improve organizational performance. Research on diversity management practices in HCOs is scarce, providing few guidelines for practitioners. This study attempted to close that gap. Results show that hospitals in Pennsylvania have been relatively inactive with employing diversity management practices, and equal employment requirements are the main driver of diversity management policy. The number and scope of diversity management practices used were not influenced by organizational or market characteristics. The results suggest that hospitals need to adopt diversity management practices for their workforces and need to pay particular attention to marketing and service planning activities that meet the needs of a diverse patient population.

Cultural Diversity↗

PubMedDate not supplied

Recruitment, retention, and management of generation X: a focus on nursing professionals.

Two-thirds of the nurse workforce are now over the age of 40, and between 40 percent and 60 percent of these nurses are expected to retire within the next 15 years. Enrollment in programs at all nursing education levels is declining. Generation Xers, those born between 1963 and 1977, comprise between 10 percent and 15 percent of the current nursing workforce. Although relatively new to the workforce, Generation Xers have their own ideas of what constitutes an acceptable workplace, and usually the terms of their employment are not negotiable. Further complexity arises from the fact that management of this workforce falls primarily on Baby Boomers--those born between 1943 and 1960. Because of the events that molded their collective characteristics, Baby Boomers entered the workforce driven and dedicated. This group equates work with self-worth, contribution, and personal fulfillment. Many selected their profession not based on economic prospects but with the desire to make the world a better place. In addition, their competitive nature drives them to aspire for higher monetary compensation and titles. The challenge for healthcare leadership is understanding and creating harmony between these two generations. This article presents a summary of recent literature and studies that explain the basic distinctions in cultural characteristics and work ethics between Generation Xers and Baby Boomers. The summary, I hope, provides a guideline for recruiting, retaining, and managing Generation X workers in the nursing field.

Communication↗

PubMedDate not supplied

Report of recommendations: the Annapolis Coalition Conference on Behavioral Health Work Force Competencies.

In May 2004, the Annapolis Coalition on Behavioral Health Workforce Education convened a national meeting on the identification and assessment of competencies. The Conference on Behavioral Health Workforce Competencies brought leading consumer and family advocates together with other experts on competencies from diverse disciplines and specialties in the fields of both mental health care and substance use disorders treatment. Aided by experts on competency development in business and medicine, conference participants have generated 10 consensus recommendations to guide the future development of workforce competencies in behavioral health. This article outlines those recommendations. A collaborative effort to identify a set of core or common competencies is envisioned as a key strategy for advancing behavioral health education, training, and other workforce development initiatives.

Behavioral Medicine↗

PubMedDate not supplied

A statewide and regional analysis of New York State nurses using the 2000 National Sample Survey of Registered Nurses.

BACKGROUND: A national concern over the present and future workforce of registered nurses exists. A major initiative that would help professionals in workforce policy and education shorten their reaction time to surplus or shortage concerns is to improve the data about RNs in a given area. PURPOSE: To examine workforce data on New York State (NYS) nurses at the statewide and regional level of analysis using the 2000 National Sample Survey of Registered Nurses (NSSRN) Inc. METHOD: The NYS RN sample was drawn from the 2000 NSSRN by selecting the cases with Geocodes for NYS. This methodology yielded a sample of 1,928 NYS RNs. RESULTS: Data were examined in relation to RNs' demographic information, employment status/setting, transition/working conditions, and education. Consistent with national data, nurses were predominantly white, female, and in their mid-40s. However, important differences were found in age, minority representation, income, satisfaction, and work setting for NYS RNs when examining data at the regional and state level. DISCUSSION: Examining the 2000 NSSRN data at the statewide and regional level provides valid information on nursing workforce trends.

Adult↗