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PubMed2004

Preliminary evidence from Queensland that rural clinical schools have a positive impact on rural intern choices.

INTRODUCTION: The unequal and inequitable distribution of the medical workforce between rural and urban parts of Australia has been well documented. Commonwealth and state governments have introduced several significant initiatives in an attempt to address this imbalance, including recruitment of many overseas trained doctors. One longer-term initiative is the funding of university departments of rural health and rural clinical schools in medical schools. OBJECTIVE: To determine the impact of the rural clinical division of the School of Medicine at the University of Queensland (UQ), Australia, on the intern workforce in central and southern Queensland, Australia. METHODS: Time series analysis of first preferences for intern allocation among UQ graduates and source of interns (UQ, interstate and overseas) from 2001-2005, and comparison of trends between Rockhampton and Toowoomba (UQ student placements since 2003) with Mackay (no placements). RESULTS: First preferences for Rockhampton increased from six in 2001 to 10 in 2005, and for Toowoomba from five in 2002 to 12 in 2005, while for Mackay preferences were stable at two. At Rockhampton while two interns came from overseas in 2001 and three were from interstate in 2002, UQ provided all interns in 2004 or 2005. UQ has provided 12/13 interns in 2004 and 13/14 in 2005 for Toowoomba. Mackay continues to source interns from interstate and overseas with UQ providing only 3/5 interns in 2004 and 2005. At Rockhampton, among non-bonded UQ graduates the number of interns choosing to work there increased from zero in 2001 to six in 2005. For Toowoomba, numbers were seven and 10 respectively, while for Mackay it was zero. CONCLUSIONS: UQ's rural clinical division is having a positive impact on the intern workforce in the regional hospitals most closely allied with it.

Journal Article↗

PubMed2005

New Zealand general practitioners' characteristics and workload: the National Primary Medical Care Survey.

AIMS: To describe the characteristics and workload of New Zealand general medical practitioners (GPs). METHODS: Data were collected from a stratified random sample of GPs as part of the The National Primary Medical Care Survey carried out in 2001. RESULTS: Data were submitted by 244 practitioners; a 62% response rate. Women made up 63% of the GP workforce aged under 40 years, but only 19% of those aged over 50 years. New Zealand graduates made up 69% of GPs; graduates from other areas occupied particular niches in the GP workforce. Each week, GPs worked (on average) 4 days and saw 102 patients. Eighty percent undertook after-hours work, and the average on-call roster was 1-in-8. At least 8% of visits to GPs occurred after-hours. Parameters of workload were lower for women and for those working in community-owned clinics, and higher for those working outside cities. CONCLUSIONS: An increasing proportion of GPs are women, and more GPs are working part time. In addition, if the changes in primary healthcare add to GPs' responsibilities, then more doctors will be needed. At present, GPs' workload is high in rural areas, which suggests inadequate recruitment; the distribution of GPs is a more important workforce issue than absolute numbers.

Adult↗

PubMed2005

Every employee an owner. Really.

Surveys indicate that when new rules on expensing stock options take effect, many companies are likely to limit the number of employees who can receive equity compensation. But companies that reserve equity for executives are bound to suffer in the long run. Study after study proves that broad-based ownership, when done right, leads to higher productivity, lower workforce turnover, better recruits, and bigger profits. "Done right" is the key. Here are the four most important factors in implementing a broad-based employee equity plan: A significant portion of the workforce--generally, most of the full-time people--must hold equity; employees must think the amounts they hold can significantly improve their financial prospects; managerial practices and policies must reinforce the plan; and employees must feel a true sense of company ownership. Those factors add up to an ownership culture in which employees' interests are aligned with the company's. The result is a workforce that is loyal, cooperative, and willing to go above and beyond to make the organization successful. A wide variety of companies have recorded exceptional business performance with the help of employee-ownership programs supported by management policies. The authors examine two: Science Applications International, a research and development contractor, and Scot Forge, which shapes metal and other materials for industrial machinery. At both companies, every employee with a year or so of service holds equity, and employees who stay on can accumulate a comfortable nest egg. Management's sharing of financial information reinforces workers' sense of ownership. So does the expectation that employees will accept the responsibilities of ownership. Workers with an ownership stake internalize their responsibilities and feel they have an obligation not only to management but to one another.

Accounting↗

PubMedDate not supplied

The older nurse in the workplace: does age matter?

Between 2010 and 2020, over 40% of the RN workforce will be over 50 years of age, and many RNs are expected to retire and withdraw from the workforce. Given that older nurses are the fastest growing cohort of the workforce, the important findings presented in this article deserve careful consideration by policymakers, health care leaders, and managers.

Adolescent↗

PubMedDate not supplied

Occupational health services in South Carolina manufacturing plants: results of a survey.

A mailed survey of occupational health and safety practices in industrial manufacturing plants with more than 50 employees was carried out in South Carolina, with a response rate of 60 percent. The responding plants represented 73 percent of the total workforce in the industries. Data were analyzed in relation to the types of industry as delineated by the Standard Industrial Code. Eighty-three percent of the responding plants (a percentage that represented more than 92 percent of the total workforce in the industries) had some arrangements for the medical or nursing care of employees. For the study, occupational health services were defined at three levels: basic (mandatory), secondary (beneficial to management), and tertiary (health promotion-preventive medicine). The basic services provided by most of the industries surveyed appeared to be adequate. Secondary services were well developed except in the apparel and lumber industries. Tertiary services, in terms of five selected preventive programs, were moderately developed only in the paper, petroleum, and chemical industries. Only alcohol abuse control programs were commonly offered in the other types of industry. The size of the workforce in a plant partly dictated the level of occupational health services it offered but did not always account for all inter-industry variation.

Health Promotion↗

PubMed1993

Overview on drug and alcohol testing in the workplace.

A flashpoint in the debate over workplace responses to alcohol and drug use by members of the workforce centres on the chemical testing of current employees and job applicants for alcohol and drug use. Drug testing may be the most contentious issue faced by enterprises struggling to develop fair and effective programmes to deal with the consequences of substance use in the workplace. The present paper examines scientific evidence on the nature and extent of alcohol and drug use by members of the workforce, evidence linking alcohol and drug use to workplace problems, workplace strategies for managing alcohol- and drug-related difficulties, and arguments for and against drug and alcohol testing. To date, the evidence supportive of alcohol and drug testing is inconclusive. Testing programmes may be useful in identifying drug users in the workforce. Their deterrent value is uncertain, however, and they are not efficient tools for linking drug users to assistance programmes. Enterprises that are contemplating establishing testing programmes should consider: (a) whether substance use is a problem in their setting; (b) whether testing will respond to the problem; (c) the costs and benefits of testing; and (d) any ethical and legal questions raised by the programmes.

Cost-Benefit Analysis↗

PubMedDate not supplied

[Criteria for the reintegration to their jobs of workers with musculoskeletal pathologies of the upper limbs based on preliminary practical experiences].

The report presents a preliminary study on the return to the workforce of employees with WMSDs of the upper limbs, and their reallocation to jobs with "low exposure". The study, which is still underway, involves a large engineering firm and includes some 100 workers affected by WMSDs. The trial envisages: providing a definition of the criteria for characterising "accommodating" jobs (i.e. frequency of action < or = 20 actions per minute; virtual absence of other risk factors such as force, posture, inadequate pauses, etc.); concretely identifying jobs meeting such criteria (or jobs which, with minimal modifications, could be made suitable); classifying WMSDs workers, according to the type and severity of the disorder; matching WMSDs workers with the jobs best suited to them; specific training for the workers and their supervisors; carrying out a follow-up of the return of WMSDs workers to the workforce in organisational terms (i.e. need for further modifications to equipment or procedures) and clinical terms (i.e. symptom patterns, acceptability of the condition). The preliminary results, 6-12 months after the start of the trial, are extremely encouraging, and show that when workers return to the workforce in jobs that fully meet defined criteria, a significant prevalence of "improvements" are reported among the involved workers. The investigation will need to be extended, but already it shows quite convincingly that it is possible for workers with what can be described as a "reduced working capacity" to remain "productive" (albeit in jobs featuring a lower exposure potential than the acceptable threshold for "healthy" workers).

Arm↗

PubMed1997

Social theory and social class.

Concepts of class developed with the emergence of industrial society in the nineteenth century. For an understanding of current divisions, theories must reflect the advances of capitalism and the global economy that characterize the late twentieth century. In industrialized societies, reductions in the industrial workforce and the growth of finance, investment and real-estate industries worldwide have produced a new, largely female, service workforce. Large sectors of industry have departed in search of cheaper labour in poorer countries, which also have a rising number of women workers. In those areas, as a result, a new industrial workforce has emerged. Concomitantly, accumulation of land in less developed agricultural regions for production for the world market has led to an increase in mobile agricultural labour and a shift of landless labourers to the cities of less developed countries. In addition, both upward and downward mobility have occurred for individuals and groups in specific populations, as well as for particular diseases in developed and less developed countries. All these processes have precipitated fundamental changes in class, gender and family relationships and transformed the living conditions of populations in both developed and less developed societies. These changes have major implications for the patterns of health and disease in the world today. Objective measures of social change may be difficult to construct and use in epidemiological cancer research. Since questions of class and shifting social relations are directly implicated in the patterns of disease, they must be assessed in future research as accurately as possible.

Developed Countries↗

PubMed1997

The ageing worker.

In Singapore, the age for retirement has increased from 55 years to 60 years, and will eventually reach 67 years. At the same time, the proportion of workers aged above 45 years will continue to increase. The World Health Organisation has reported that in 1980, 32% of the working population were older than 45 years of age in countries of the Organisation for Economic Co-operation and Development (OECD). This proportion is expected to rise to 35.5% in the year 2000 and 41.3% in the year 2055. What are the implications of the emergence of an ageing workforce? This population represents a special group of individuals in the workforce that have special health, occupational and environmental needs. On the one hand, they have the problem of a reduction in physical work capacity, decreased adaptability, and a generally lower health status. On the other, ageing workers are more experienced and have greater expertise. They are also usually more motivated and may generally have a more positive attitude when compared with younger workers. Society, as well as health care professionals, needs to respond to this issue of an ageing workforce. The response should be three pronged. Firstly, prevention of the premature decline of physical capacities and adaptability of the worker could be addressed by health promotion and continuing job training. Secondly, some measures for adjusting work demands in accordance with functional capacities of the individual are needed. Thirdly, employers and fellow workers should be educated on the strengths of the ageing worker, and the capacity of such workers to continue contributing because of their experience, motivation and skills. If implemented, these measures would ensure a path towards productive ageing. The end results would be that ageing workers would have their functional capacity maintained, the concept of "age-adjusted workload" would be a reality, and ageing workers would not be discriminated against, but instead have their contributions to society maximised.

Aged↗

PubMed1999

A program to increase the number of family physicians in rural and underserved areas: impact after 22 years.

CONTEXT: The shortage of physicians in rural areas is a longstanding and serious problem, and national and state policymakers and educators continue to face the challenge of finding effective ways to increase the supply of rural physicians. OBJECTIVE: To determine the direct and long-term impact of the Physician Shortage Area Program (PSAP) of Jefferson Medical College (JMC) on the rural physician workforce. DESIGN: Retrospective cohort study. PARTICIPANTS AND SETTING: A total of 206 PSAP graduates from the classes of 1978 to 1991. MAIN OUTCOME MEASURES: The PSAP graduates currently practicing family medicine in rural and underserved areas of Pennsylvania, compared with all allopathic medical school graduates in the state, and with all US and international allopathic graduates. All PSAP graduates were also compared with their non-PSAP peers at JMC regarding their US practice location, medical specialty, and retention for the past 5 to 10 years. RESULTS: The PSAP graduates account for 21% (32/150) of family physicians practicing in rural Pennsylvania who graduated from one of the state's 7 medical schools, even though they represent only 1% (206/14710) of graduates from those schools (relative risk [RR], 19.1). Among all US and international medical school graduates, PSAP graduates represent 12% of all family physicians in rural Pennsylvania. Results were similar for PSAP graduates practicing in underserved areas. Overall, PSAP graduates were much more likely than their non-PSAP classmates at JMC to practice in a rural area of the United States (34% vs 11%; RR, 3.0), to practice in an underserved area (30% vs 9%; RR, 3.2), to practice family medicine (52% vs 13%; RR, 4.0), and to have combined a career in family practice with practice in a rural area (21% vs 2%; RR, 8.5). Of PSAP graduates, 84% were practicing in either a rural or small metropolitan area, or one of the primary care specialties. Program retention has remained high, with the number of PSAP graduates currently practicing rural family medicine equal to 87% of those practicing between 5 and 10 years ago, and the number practicing in underserved areas, 94%. CONCLUSIONS: The PSAP, after more than 22 years, has had a disproportionately large impact on the rural physician workforce, and this effect has persisted over time. Based on these program results, policymakers and medical schools can have a substantial impact on the shortage of physicians in rural areas.

Career Choice↗

PubMed2000

State scholarship, loan forgiveness, and related programs: the unheralded safety net.

CONTEXT: In the mid-1980s, states expanded their initiatives of scholarships, loan repayment programs, and similar incentives to recruit primary care practitioners into underserved areas. With no national coordination or mandate to publicize these efforts, little is known about these state programs and their recent growth. OBJECTIVES: To identify and describe state programs that provide financial support to physicians and midlevel practitioners in exchange for a period of service in underserved areas, and to begin to assess the magnitude of the contributions of these programs to the US health care safety net. DESIGN: Cross-sectional, descriptive study of data collected by telephone, mail questionnaires, and through other available documents, (eg, program brochures, Web sites). SETTING AND PARTICIPANTS: All state programs operating in 1996 that provided financial support in exchange for service in defined underserved areas to student, resident, and practicing physicians; nurse practitioners; physician assistants; and nurse midwives. We excluded local community initiatives and programs that received federal support, including that from the National Health Service Corps. MAIN OUTCOME MEASURES: Number and types of state support-for-service programs in 1996; trends in program types and numbers since 1990; distribution of programs across states; numbers of participating physicians and other practitioners in 1996; numbers in state programs relative to federal programs; and basic features of state programs. RESULTS: In 1996, there were 82 eligible programs operating in 41 states, including 29 loan repayment programs, 29 scholarship programs, 11 loan programs, 8 direct financial incentive programs, and 5 resident support programs. Programs more than doubled in number between 1990 (n = 39) and 1996 (n = 82). In 1996, an estimated 1306 physicians and 370 midlevel practitioners were serving obligations to these state programs, a number comparable with those in federal programs. Common features of state programs were a mission to influence the distribution of the health care workforce within their states' borders, an emphasis on primary care, and reliance on annual state appropriations and other public funding mechanisms. CONCLUSIONS: In 1996, states fielded an obligated primary care workforce comparable in size to the better-known federal programs. These state programs constitute a major portion of the US health care safety net, and their activities should be monitored, coordinated, and evaluated. State programs should not be omitted from listings of safety-net initiatives or overlooked in future plans to further improve health care access. JAMA. 2000;284:2084-2092.

Cross-Sectional Studies↗

PubMed2003

Trends in career choice by US medical school graduates.

CONTEXT: Trends in career choice among specialties have varied greatly. Most notable is the recent decrease in the percentage of US medical student graduates choosing a primary care career, which has important implications for the US physician workforce. OBJECTIVE: To review temporal trends in career choice by graduates of allopathic US medical schools, focusing on US medical doctors entering residencies since 1987. DATA SOURCES: Three databases, the Association of American Medical Colleges Graduation Questionnaire (AAMC GQ), the National Resident Matching Program, and the national Graduate Medical Education census, were used to review temporal trends in the number of US medical doctors entering residencies in primary care, general or subspecialty surgical, and non-primary care and nonsurgical specialties from 1987 to 2002. DATA SYNTHESIS: In 1987, 49.2% of all medical school graduates matched to one of the generalist residencies (internal medicine, pediatrics, or family medicine). The percentage of students matching to primary care specialties declined in the early 1990s, peaked at 53.2% in 1998, and declined to 44.2% in 2002. Concurrent with the latter decline, AAMC GQ data showed a decrease in medical student interest in primary care careers (35.6% in 1999 to 21.5% in 2002). The total percentage of US medical doctors matching to general or subspecialty surgical residencies remained stable at 11% to 12% from 1987 to 2002. During this same period, emergency medicine and plastic surgery increased as a match choice, while anesthesiology, pathology, and psychiatry were more variable over time. CONCLUSIONS: Distribution of medical students' career choices among specialties varied considerably from 1987 to 2002. The debate will continue regarding the appropriate specialty mix within the physician workforce.

Career Choice↗

PubMed2006

Shortages of medical personnel at community health centers: implications for planned expansion.

CONTEXT: The US government is expanding the capacity of community health centers (CHCs) to provide care to underserved populations. OBJECTIVE: To examine the status of workforce shortages that may limit CHC expansion. DESIGN AND SETTING: Survey questionnaire of all 846 federally funded US CHCs that directly provide clinical services and are within the 50 states and the District of Columbia, conducted between May and September 2004. Questionnaires were completed by the chief executive officer of each grantee. Information was supplemented by data from the 2003 Bureau of Primary Health Care Uniform Data System and weighted to be nationally representative. MAIN OUTCOME MEASURES: Staffing patterns and vacancies for major clinical disciplines by rural and urban location, use of federal and state recruitment programs, and perceived barriers to recruitment. RESULTS: Overall response rate was 79.3%. Primary care physicians made up 89.4% of physicians working in the CHCs, the majority of whom are family physicians. In rural CHCs, 46% of the direct clinical providers of care were nonphysician clinicians compared with 38.9% in urban CHCs. There were 428 vacant funded full-time equivalents (FTEs) for family physicians and 376 vacant FTEs for registered nurses. There were vacancies for 13.3% of family physician positions, 20.8% of obstetrician/gynecologist positions, and 22.6% of psychiatrist positions. Rural CHCs had a higher proportion of vacancies and longer-term vacancies and reported greater difficulty filling positions compared with urban CHCs. Physician recruitment in CHCs was heavily dependent on National Health Service Corps scholarships, loan repayment programs, and international medical graduates with J-1 visa waivers. Major perceived barriers to recruitment included low salaries and, in rural CHCs, cultural isolation, poor-quality schools and housing, and lack of spousal job opportunities. CONCLUSIONS: CHCs face substantial challenges in recruitment of clinical staff, particularly in rural areas. The largest numbers of unfilled positions were for family physicians at a time of declining interest in family medicine among graduating US medical students. The success of the current US national policy to expand CHCs may be challenged by these workforce issues.

Community Health Centers↗

PubMed2003

Health care utilization of carpenters with substance abuse-related diagnoses.

BACKGROUND: Persons in the construction trades in the US have high rates of alcohol and substance abuse. We had the unique opportunity to evaluate health care utilization through private insurance and workers' compensation for a group of carpenters at high risk of injury and substance abuse. METHODS: We identified a cohort of union carpenters. Their claims for medical care through union insurance and workers' compensation, and appropriate measures of time at risk were documented. Using methods of indirect standardization, we compared utilization and costs between carpenters with and without alcohol and substance-abuse related diagnoses (ASRD). RESULTS: Through private insurance, those with ASRD had 10% higher outpatient utilization and 2.1 times higher rates of hospitalizations for injury care; 2.6 times higher rates of outpatient care; and 2.9 times higher inpatient admissions for non-injury care. Individuals with ASRD had only modestly increased rates (10%) of outpatient utilization through workers' compensation. CONCLUSIONS: These findings support the need for alcohol and drug abuse prevention and treatment services for this workforce. Operationalizing this among highly mobile workforces, such as the construction trades, is a challenge. While not intending to minimize the problems of alcohol or substance abuse on the job among carpenters, the focus of prevention should not necessarily be in the workplace.

Adolescent↗

PubMed2005

Disability as diversity in Fortune 100 companies.

To investigate the inclusion of people with disabilities in the diversity policies of the most successful businesses in the United States, we examined the publicly available workforce and supplier diversity policies of the top 100 companies on Fortune Magazine's 2003 list of the 500 most profitable companies in the nation. The majority of these companies have extensive information about their diversity policies and practices available on their corporate website. The information was used to categorize the policies into those that include people with disabilities, do not define diversity, and enumerate what is meant by diversity (e.g. in terms of race or gender) but do not expressly mention disability. In addition, we looked beyond the diversity policies to information available on corporate websites relating to a variety of diversity initiatives. Findings suggest that the majority of the companies that top the Fortune 500 list have developed and implemented diversity policies. Of these, 42% have diversity policies that include people with disabilities in the definition of a diverse workforce. Furthermore, 47% of companies with workplace diversity policies discuss diversity in a way that neither expressly includes nor excludes people with disabilities. Far fewer (15%) supplier diversity policies include disability in the definition of diversity, but a significant number of companies use criteria that allow a business owner with a disability to benefit from the company's supplier diversity program.

Cultural Diversity↗

PubMed2006

Destination, future intentions and views on practice of British-based pharmacists 5 and 10 years after qualifying.

OBJECTIVES: The first ever Pharmacy Workforce Census of pharmacists in Great Britain (GB) was conducted in 2002, and repeated in 2003. Both census surveys aimed to gather empirical data on the employment profile of pharmacists to aid the workforce planning process. The aim of this paper is to compare the work profile and employment destination of two graduate cohorts of pharmacists to explore what changes take place in employment practices and how quickly they occur. SETTING: GB-based pharmacists. METHODS: A two-page postal questionnaire was sent to 38,000 GB-registered pharmacists in August 2003, to provide various data on employment patterns, intentions to work abroad, and desire to practise pharmacy. The pharmacists were contacted using addresses stored on the Pharmaceutical Register, a statutory record of all pharmacists and pharmacy premises held by the Royal Pharmaceutical Society of Great Britain (RPSGB). A sub-set of this large data set--pharmacists who qualified in 1992 and those who qualified in 1997--was selected for comparison. MAIN OUTCOME MEASURE: Sector of employment and strength of desire to practice. RESULTS: A response rate of 75% was achieved for the overall census, while the response rate from the two graduation cohorts was 62% and 58%. Larger proportions of women compared with men, even after only 5 years of working as a pharmacist, are either not working or work part-time. Among the women, these patterns increase significantly for those with a greater number of years on the Pharmaceutical Register. There is evidence that pharmacists move out of the two main sectors of practice (hospital and community) with increasing years on the Register, and some gender differences in job mobility are observed. The School of Pharmacy from which pharmacists graduate appears to have some effect on practice patterns although more research is needed to explore this further. Desire to practise pharmacy is weaker among those practitioners who work in the community sector of practice, and younger pharmacists are more likely to intend working abroad. CONCLUSIONS: Part-time work patterns are implemented fairly quickly after qualifying, particularly among the women pharmacists. Given that female students account for over 60% of all intake onto pharmacy courses current supply problems will continue if work patterns continue along this trajectory. The ability of the profession to meet current, never mind extended roles, is thus called into question.

Adult↗

PubMed1988

A study of the movement of nurses and nursing skills between the NHS and the private sector in England and Wales.

An investigation of 2165 qualified nurses joining eight NHS District Health Authorities (DHAs) and 72 private sector institutions was undertaken in order to measure the skills which move between these sectors and to estimate the likely impact on NHS nursing services of any future growth in the private sector. It was found that 42% (95% confidence interval: 36%, 48%) of the nurses joining private acute hospitals and 28% (95% CI: 21%, 37%) of those joining long-stay private nursing homes came directly from the NHS workforce. Fewer qualified nurses move from the private sector to the NHS. Private acute hospitals appear to attract recruits from a specific section of the NHS workforce: nurses under 30 years of age with specialist skills such as theatre nursing, renal nursing, intensive care and oncology.

Adult↗

PubMed1983

Women and health care in rural Pakistan.

The provision of medical facilities to rural areas is a major objective of development in Pakistan and the government has undertaken several programs to train and deploy auxiliary health workers on a large scale. Programs to train lady health visitors, dispensers and sanitary inspectors, have been in operation for decades and their graduates have a place in the workforce. Currently the Government is developing a Basic Health Program to train auxiliary health workers and to establish a network of rural health facilities throughout the country. The research here reported was meant to help plan this program. The 4 week study was conducted in four districts of the Punjab and North West Frontier Provinces. We first interviewed women patients of rural dispensaries in the four districts to determine their views of their needs and of the constraints of the purdah system when seeking health care. We then interviewed principals of medical colleges and training institutes, who were in a position to assess the availability of women to enter the medical workforce and female mid-level health workers who were currently serving in their posts. Finally, since allopathic medical institutions compete with indigenous medical specialists, we interviewed two hakims and a homeopathic physician to obtain their view of rural health needs, as well as their potential for contributing to a broad based rural health care system.

Female↗