Home About us Contact
|
Home About us Contact | ||
|
|
||
Physician Workforce (physician + workforce)
Selected AbstractsNational Health Service Corps Staffing and the Growth of the Local Rural Non-NHSC Primary Care Physician WorkforceTHE JOURNAL OF RURAL HEALTH, Issue 4 2006Donald E. Pathman MD ABSTRACT:,Context: Beyond providing temporary staffing, National Health Service Corps (NHSC) clinicians are believed by some observers to contribute to the long-term growth of the non-NHSC physician workforce of the communities where they serve; others worry that NHSC clinicians compete with and impede the supply of other local physicians. Purpose: To assess long-term changes in the non-NHSC primary care physician workforce of rural underserved counties that have received NHSC staffing support relative to workforce changes in underserved counties without NHSC support. Methods: Using data from the American Medical Association and NHSC, we compared changes from 1981 to 2001 in non-NHSC primary care physician to population ratios in 2 subsets of rural whole-county health professional shortage areas: (1) 141 counties staffed by NHSC physicians, nurse practitioners, and/or physician assistants during the early 1980s and for many of the years since and (2) all 142 rural health professional shortage area counties that had no NHSC clinicians from 1979 through 2001. Findings: From 1981 to 2001, counties staffed by NHSC clinicians experienced a mean increase of 1.4 non-NHSC primary care physicians per 10,000 population, compared to a smaller, 0.57 mean increase in counties without NHSC clinicians. The finding of greater non-NHSC primary care physician to population mean ratio increase in NHSC-supported counties remained significant after adjusting for baseline county demographics and health care resources (P < .001). The estimated number of "extra" non-NHSC physicians in NHSC-supported counties in 2001 attributable to the NHSC was 294 additional physicians for the 141 supported counties, or 2 extra physicians, on average, for each NHSC-supported county. Over the 20 years, more NHSC-supported counties saw their non-NHSC primary care workforces grow to more than 1 physician per 3,500 persons, but no more NHSC-supported than nonsupported counties lost their health professional shortage area designations.Conclusions: These data suggest that the NHSC contributed positively to the non-NHSC primary care physician workforce in the rural underserved counties where its clinicians worked during the 1980s and 1990s. [source] Assessment of Emergency Physician Workforce Needs in the United States, 2005ACADEMIC EMERGENCY MEDICINE, Issue 12 2008Carlos A. Camargo Jr MD Abstract Objectives:, The objective was to estimate emergency physician (EP) workforce needs, taking into account the diversity of U.S. emergency departments (EDs) and various projections of EP supply and demand. Methods:, The 2005 National ED Inventory-USA (http://www.emnet-usa.org/) provided annual visit volumes for 4,828 U.S. EDs. The authors calculated annual supply based on existing emergency medicine (EM) board-certified EPs, adding newly board-certified EPs, and subtracting board-certified EPs who died or retired. Demand was estimated at each ED by dividing the number of visits by the average EP volume (based on 2.8 patients/hour, 40 hours/week, and 34% nonclinical time). The models assumed that at least 1 EP should be present 24/7 in each ED, which would require at least 5.35 full-time equivalents (FTEs) per ED. Based on annual EP attrition estimates, results for best-case, worst-case, and intermediate scenarios were calculated. Results:, In 2005, there were approximately 22,000 EM board-certified EPs, but 40,030 EPs would be needed to staff all 4,828 EDs (55% of demand met). A total of 2,492 (52%) EDs had a visit volume that required the minimum number (5.35) FTEs, of which 47% were rural. In the unrealistic (no attrition), best-case scenario, it would take until 2019 to staff all EDs with board-certified EPs. In the worst-case scenario (12% attrition), supply would never meet demand. Our intermediate scenario (2.5% attrition) suggested that board-certified EPs would satisfy workforce needs in 2038. Conclusions:, Supply of EM residency-trained, board-certified EPs is not likely to meet demand in the near future. Alternative EP staffing arrangements merit further consideration. [source] Factors Associated with the Income Distribution of Full-Time Physicians: A Quantile Regression ApproachHEALTH SERVICES RESEARCH, Issue 5 2007Ya-Chen Tina Shih Objective. Physician income is generally high, but quite variable; hence, physicians have divergent perspectives regarding health policy initiatives and market reforms that could affect their incomes. We investigated factors underlying the distribution of income within the physician population. Data Sources. Full-time physicians (N=10,777) from the restricted version of the 1996,1997 Community Tracking Study Physician Survey (CTS-PS), 1996 Area Resource File, and 1996 health maintenance organization penetration data. Study Design. We conducted separate analyses for primary care physicians (PCPs) and specialists. We employed least square and quantile regression models to examine factors associated with physician incomes at the mean and at various points of the income distribution, respectively. We accounted for the complex survey design for the CTS-PS data using appropriate weighted procedures and explored endogeneity using an instrumental variables method. Principal Findings. We detected widespread and subtle effects of many variables on physician incomes at different points (10th, 25th, 75th, and 90th percentiles) in the distribution that were undetected when employing regression estimations focusing on only the means or medians. Our findings show that the effects of managed care penetration are demonstrable at the mean of specialist incomes, but are more pronounced at higher levels. Conversely, a gender gap in earnings occurs at all levels of income of both PCPs and specialists, but is more pronounced at lower income levels. Conclusions. The quantile regression technique offers an analytical tool to evaluate policy effects beyond the means. A longitudinal application of this approach may enable health policy makers to identify winners and losers among segments of the physician workforce and assess how market dynamics and health policy initiatives affect the overall physician income distribution over various time intervals. [source] Caring for Older Americans: The Future of Geriatric MedicineJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue S6 2005American Geriatrics Society Core Writing Group of the Task Force on the Future of Geriatric Medicine In response to the needs and demands of an aging population, geriatric medicine has grown rapidly during the past 3 decades. The discipline has defined its core values as well as the knowledge base and clinical skills needed to improve the health, functioning, and well-being of older persons and to provide appropriate palliative care. Geriatric medicine has developed new models of care, advanced the treatment of common geriatric conditions, and advocated for the health and health care of older persons. Nevertheless, at the beginning of the 21st century, the health care of older persons is at a crossroads. Despite the substantial progress that geriatric medicine has made, much more remains to be done to meet the healthcare needs of our aging population. The clinical, educational, and research approaches of the 20th century are unable to keep pace and require major revisions. Maintaining the status quo will mean falling further and further behind. The healthcare delivery and financing systems need fundamental redesign to improve quality and eliminate waste. The American Geriatrics Society (AGS) Task Force on the Future of Geriatric Medicine has identified five goals aimed at optimizing the health of older persons: ,,To ensure that every older person receives high-quality, patient-centered health care ,,To expand the geriatrics knowledge base ,,To increase the number of healthcare professionals who employ the principles of geriatric medicine in caring for older persons ,,To recruit physicians and other healthcare professionals into careers in geriatric medicine ,,To unite professional and lay groups in the effort to influence public policy to continually improve the health and health care of seniors Geriatric medicine cannot accomplish these goals alone. Accordingly, the Task Force has articulated a set of recommendations primarily aimed at the government, organizations, agencies, foundations, and other partners whose collaboration will be essential in accomplishing these goals. The vision described in this document and the accompanying recommendations are only the broad outline of an agenda for the future. Geriatric medicine, through its professional organizations and its partners, will need to mobilize resources to identify and implement the specific steps that will make the vision a reality. Doing so will require broad participation, consensus building, creativity, and perseverance. The consequences of inaction will be profound. The combination of a burgeoning number of older persons and an inadequately prepared, poorly organized physician workforce is a recipe for expensive, fragmented health care that does not meet the needs of our older population. By virtue of their unique skills and advocacy for the health of older persons, geriatricians can be key leaders of change to achieve the goals of geriatric medicine and optimize the health of our aging population. Nevertheless, the goals of geriatric medicine will be accomplished only if geriatricians and their partners work in a system that is designed to provide high-quality, efficient care and recognizes the value of geriatrics. [source] Medical education and the physician workforce of IranTHE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 3 2006Zinab Biabangardi MSc No abstract is available for this article. [source] Are There Enough Doctors in My Rural Community?THE JOURNAL OF RURAL HEALTH, Issue 2 2009Perceptions of the Local Physician Supply ABSTRACT:,Purpose: To assess whether people in the rural Southeast perceive that there is an adequate number of physicians in their communities, assess how these perceptions relate to county physician-to-population (PtP) ratios, and identify other factors associated with the perception that there are enough local physicians. Methods: Adults (n = 4,879) from 150 rural counties in eight southeastern states responded through a telephone survey. Agreement or disagreement with the statement "I feel there are enough doctors in my community" constituted the principal outcome. Weighted chi-square analysis and a generalized estimating equation (GEE) assessed the strength of association between perceptions of an adequate physician workforce and county PtP ratios, individual characteristics, attitudes about and experiences with medical care, and other county characteristics. Findings: Forty-nine percent of respondents agreed there were enough doctors in their communities, 46% did not agree, and 5% were undecided. Respondents of counties with higher PtP ratios were only somewhat more likely to agree that there were enough local doctors (Pearson's correlation coefficient = 0.09, P < .001). Multivariate analyses revealed that perceiving that there were enough local physicians was more common among men, those 65 and older, whites, and those with lower regard for physician care. Perceptions that the local physician supply was inadequate were more common for those who had longer travel distances, problems with affordability, and little confidence in their physicians. Perceptions of physician shortages were more common in counties with higher poverty rates. Conclusions: County PtP ratios only partially account for rural perceptions that there are or are not enough local physicians. Perceptions of an adequate local physician workforce are also related to how much people value physicians' care and whether they face other barriers to care. [source] National Health Service Corps Staffing and the Growth of the Local Rural Non-NHSC Primary Care Physician WorkforceTHE JOURNAL OF RURAL HEALTH, Issue 4 2006Donald E. Pathman MD ABSTRACT:,Context: Beyond providing temporary staffing, National Health Service Corps (NHSC) clinicians are believed by some observers to contribute to the long-term growth of the non-NHSC physician workforce of the communities where they serve; others worry that NHSC clinicians compete with and impede the supply of other local physicians. Purpose: To assess long-term changes in the non-NHSC primary care physician workforce of rural underserved counties that have received NHSC staffing support relative to workforce changes in underserved counties without NHSC support. Methods: Using data from the American Medical Association and NHSC, we compared changes from 1981 to 2001 in non-NHSC primary care physician to population ratios in 2 subsets of rural whole-county health professional shortage areas: (1) 141 counties staffed by NHSC physicians, nurse practitioners, and/or physician assistants during the early 1980s and for many of the years since and (2) all 142 rural health professional shortage area counties that had no NHSC clinicians from 1979 through 2001. Findings: From 1981 to 2001, counties staffed by NHSC clinicians experienced a mean increase of 1.4 non-NHSC primary care physicians per 10,000 population, compared to a smaller, 0.57 mean increase in counties without NHSC clinicians. The finding of greater non-NHSC primary care physician to population mean ratio increase in NHSC-supported counties remained significant after adjusting for baseline county demographics and health care resources (P < .001). The estimated number of "extra" non-NHSC physicians in NHSC-supported counties in 2001 attributable to the NHSC was 294 additional physicians for the 141 supported counties, or 2 extra physicians, on average, for each NHSC-supported county. Over the 20 years, more NHSC-supported counties saw their non-NHSC primary care workforces grow to more than 1 physician per 3,500 persons, but no more NHSC-supported than nonsupported counties lost their health professional shortage area designations.Conclusions: These data suggest that the NHSC contributed positively to the non-NHSC primary care physician workforce in the rural underserved counties where its clinicians worked during the 1980s and 1990s. [source] The need and total cost of Finnish eyecare services: a simulation model for 2005,2040ACTA OPHTHALMOLOGICA, Issue 8 2009Anja Tuulonen Abstract. Purpose:, The aims of this study were: (i) to create a structural simulation model capable of predicting the future need and cost of eyecare services in Finland; and (ii) to test and rank different policy alternatives for access to care and the required physician workforce. Methods:, Using the system dynamics approach, the number and cost of patients with cataract, glaucoma, diabetic retinopathy and age-related macular degeneration (AMD) were described with causal-loop diagrams and were then translated into a set of mathematical equations to build a computer simulation model. Mathematically, the problem was formulated as a set of differential equations that were solved numerically with specialized software. The validity of the model was tested against prevalence and administrative historical data. The costs covered by the public sector in Finland were obtained from 2003 from the Finnish Hospital Discharge Register (including outpatient care), the Finnish Social Insurance Institution and a survey of hospital price lists. Different levels of access to public care were then simulated in four eye diseases, for which the model estimated the need for services and resources and their costs in the years 2005,2040. Results:, The model forecasted that the adoption of the 2005 national ,access to care' criteria for cataract surgery would shorten waiting lists. If the workload of Finnish ophthalmologists were kept at the 2003 level, the graduation rate of new ophthalmologists would have to increase by 75% from the current level. If all glaucoma patients were followed in the public sector in future, even this increase in training would not meet the demand for physician workforce. The current model indicated that the screening frequency of diabetes can be increased without large sacrifices in terms of costs. AMD therapy has a significant role in the allocation of future resources in eyecare. The modelling study predicted that ageing alone will increase the costs of eyecare during the next four decades in Finland by about 1% per year in real terms (undiscounted and without inflation of unit costs). The increases in total yearly costs were on average 8.6% between 2001 and 2003. Conclusions:, The results of this modelling study indicate that policy initiatives, such as defining criteria for access to care, can have substantial implications on the demand for care and waiting times whereas the effect of ageing alone was relatively small. Measures to control several other factors , such as the adoption and price level of new technologies, treatments and practice patterns , will be at least equally important in order to restrain healthcare costs effectively. [source] | ||||||||||