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A conceptual framework for intelligence-based public health nutrition workforce development.

OBJECTIVE: This paper describes a conceptual framework and associated intelligence requirements for problem-based workforce development for public health nutrition. METHODS: A conceptual framework for public health nutrition workforce development was constructed based on a review of the literature and consideration of the intelligence needs to inform workforce development planning. RESULTS: A cyclical conceptual framework including five intelligence-linked components including public health nutrition problems and priorities, solutions and best buys, work needed, capacity to do the work and workforce development needs. This framework applied to the Australian situation illustrates its applications in workforce development research and planning. Although the existing availability of workforce development intelligence in each of these components varies, the framework does provide a systematic approach for workforce development research and planning directly related to public health nutrition problem resolution. CONCLUSIONS: This framework highlights deficiencies in the existing public health nutrition workforce development intelligence and the need for further research to inform workforce development strategy planning.

Australia↗

Health related selection and death rates in the United Kingdom Atomic Energy Authority workforce.

Follow up data on 37,355 employees of the United Kingdom Atomic Energy Authority (UKAEA) for the period 1946-79 were analysed to investigate the extent to which selection for work on the basis of health affected subsequent death rates. Causes of death were grouped into two broad categories for analysis: all cancers and all other causes of death. Evidence for an effect of selection of healthy individuals into the workforce was sought primarily by examining standardised mortality ratios (SMRs) by period since recruitment. SMRs for both categories were particularly low during the first two years after recruitment (SMR = 69, 95% confidence interval (CI) 48-97 for all cancers; SMR = 55, 95% CI 44-69 for all other causes of death). SMRs for all cancers did not increase significantly with period since recruitment (chi 2 for trend = 0.4, p = 0.53) but did increase for causes of death other than cancer (chi 2 for trend = 11.1, p = 0.001). Although adjustment for social class strengthened the association between death from causes other than cancer and period since recruitment (chi 2 for trend = 18.8, p less than 0.001), simultaneous adjustment for all confounding factors considered (age at death, sex, calendar period of death, geographical location of the workforce, and social class) produced results broadly similar to those obtained from the unadjusted analyses for both cause of death categories. SMRs remained low even after 25 years of follow up (SMR = 84, 95% CI 69-101 for all cancers; SMR = 81, 95% CI 72-91 for all other causes of death). The persistently low SMRs observed in this workforce are unlikely to be due to the selection of healthy individuals at the time of recruitment but may be due to differences in sociodemographic and lifestyle characteristics. The effect on mortality of selection of individuals out of the workforce due to ill health was also examined. SMRs were particularly high for both categories in the first two years after termination of employment in individuals who left before normal retirement age (SMR = 167, 95% CI 131-211 for all cancers; SMR = 149, 95% CI 128-173 for all other causes of death). In comparison, death rates for the subsequent three years after termination of employment were lower (SMR = 89, 95% CI 67-115 for all cancers, SMR = 99, 95% CI 85-115 for all other causes of death). The persistently low SMRs observed in this workforce are unlikely to be due to the selection of healthy individuals at the time of recruitment but may be due to differences in sociodemographic and lifestyle characteristics. The effect on mortality of selection of individuals out of the workforce due to ill health was also examined. SMRs were particularly high for both categories in the first two years after termination of employment in individuals who left before normal retirement age (SMR = 167, 95% CI 131-211 for all cancers; SMR 149,95% CI 128-173 for all other causes of death). In comparison, death rates for the subsequent three years after termination of employment were lower (SMR = 89, 95% CI 67-115 for all cancers SMR = 99, 95% CI 85-115 for all other causes of death). Apart from this initial fall, there was little evidence of a systematic increase or decrease in mortality with increasing period was not significantly associated with durationof employment for either cause of death category either before or after adjustment for confounding factors. Whereas selection of individuals into or out of the workforce on the basis of health affects the way in which death rates change with time, other factors such as sociodemographic characteristics or health related behaviour determine the general level of mortality in the longer run. The persistently low SMRs observed in this workforce throughout the follow up period suggest that selection on the latter factors are likely to have had a considerable effect on death rates in the UKAEA workforce.

Adult↗

More doctors, but not enough: Australian medical workforce supply 2001-2012.

OBJECTIVE: To project the future size of the Australian medical workforce, from 2001 to 2012. DESIGN AND SETTING: Stochastic simulation modelling of the Australian medical workforce, taking into account recent increases in medical school capacity and trends in the intake of foreign graduates. MAIN OUTCOME MEASURES: Number of full-time equivalent (FTE) medical practitioners per 100,000 persons within various occupation groups from 2001 (baseline) to 2012. RESULTS: The total medical workforce was projected to rise from 53,384 in 2001 to 67,659 by 2012 (95% CI, 63,924-71,036). On a per capita basis, the number of FTE clinicians was projected to rise from 331 per 100,000 persons in 2001 to 382 (95% CI, 359-403) per 100,000 persons in 2012. The general practice workforce was projected to fall from 133 FTE general practitioners per 100,000 persons in 2001, to 129 per 100,000 persons in 2003, and then remain at around this level through to 2012. The specialist workforce was projected to show steady growth, rising from 162 FTE specialists per 100,000 persons in 2001 to 206 (95% CI, 194-218) per 100,000 persons in 2012. CONCLUSIONS: The general practice workforce is likely to face continued chronic shortages, necessitating innovative policy responses to ensure that the community's need for primary medical care is met. Retirement rates are a key determinant of workforce supply, suggesting a need to encourage general practitioners to remain active as long as they remain effective. Further refinement of stochastic models will help facilitate a more proactive approach to workforce planning.

Australia↗

A cross-national comparison of generalist physician workforce data. Evidence for US supply adequacy.

OBJECTIVE: To assess the adequacy of the US generalist physician workforce using population-based, cross-national physician workforce data. DESIGN: A comparative analysis of physician workforce data obtained from primary sources in Canada in 1991 and from England and Germany in 1993. METHODS: Generalist physician-to-population ratios were calculated for each country and the results compared in the context of how primary care services are delivered. The findings were used to create a framework for analyzing the adequacy of the generalist physician workforce of the United States. MAIN OUTCOME MEASURE: The comparability of the number of primary care providers per 100 000 population in the US physician workforce with the number in Canada, England, and Germany. RESULTS: On a population basis, the size of the full-time US generalist physician workforce is larger than that of England, similar to that of Germany, and smaller than that of Canada. These size differences are largely reconciled when one takes into account differences in the way primary care services are delivered, the degree to which nurse practitioners are employed in each country, and the degree to which nongeneralist physicians provide primary care services. CONCLUSIONS: The size of the US generalist physician workforce is currently adequate to meet the needs of the population. Policies designed to greatly expand the size of the US generalist physician workforce are ill-conceived.

Canada↗

Investing in Canada's nursing workforce: a comprehensive review to inform policy innovations and directions.

BACKGROUND: Health systems worldwide face persistent health workers challenges including nursing shortages, workforce strain, and inequities. In Canada, these challenges have prompted renewed national and provincial reforms to strengthen recruitment, retention, leadership, and sustainability. This paper compares nursing workforce policy directions across Canada, and international jurisdictions to inform policy and planning. METHODS: A cross-country comparative analysis of policies building on a comprehensive national funded review that included an umbrella review of 69 systematic reviews, a comparative policy review of nursing workforce strategies in five jurisdictions, and validation through national horizon-scanning and policy dialogues (n >100). Evidence was analyzed across system, organizational, and individual levels. RESULTS: At the system level, international jurisdictions demonstrate comprehensive, legislated approaches integrating data, governance, and multi-year funding have advanced key nursing strategies. In Canada, the advances show the importance of strategies to have national and provincial/territorial alignment emphasizing leadership, flexibility, and inclusion as key levers. Organizational and individual-level reforms such as mentorship, leadership development, and wellness initiatives are expanding but remain variably evaluated. Experts identified national workforce data strategies and policy integration with embedded evaluation as key enablers to inform scalability and sustainability of implemented strategies. CONCLUSIONS: Canada's nursing workforce reforms are advancing toward coordinated, equity-driven, and evidence-informed strategies. Continued investment in evaluation, leadership, and national integrated data systems along with integrating nursing workforce planning within broader intersectoral planning will consolidate these gains and position Canada as an international leader in sustainable nursing workforce policy.

Canada↗

The pediatrician workforce: current status and future prospects.

The effective and efficient delivery of children's health care depends on the pediatrician workforce. The number, composition, and distribution of pediatricians necessary to deliver this care have been the subject of long-standing policy and professional debate. This technical report reviews current characteristics and recent trends in the pediatric workforce and couples the workforce to a conceptual model of improvement in children's health and well-being. Important recent changes in the workforce include (1) the growth in the number of pediatricians in relation to the child population, (2) increased numbers of female pediatricians and their attainment of majority gender status in the specialty, (3) the persistence of a large number of international medical graduates entering training programs, (4) a lack of ethnic and racial diversity in pediatricians compared with children, and (5) the persistence of marked regional variation in pediatrician supply. Supply models projecting the pediatric workforce are reviewed and generally indicate that the number of pediatricians per child will increase by 50% over the next 20 years. The differing methods of assessing workforce requirements are presented and critiqued. The report finds that the pediatric workforce is undergoing fundamental changes that will have important effects on the professional lives of pediatricians and children's health care delivery.

Benchmarking↗

Changes, challenges and choices for the primary health care workforce: looking to the future.

AIMS: The main aim of this paper is to draw attention to problems facing the primary health care workforce in terms of demand for treatment of minor illness over the next two decades. These predictions have implications for the community nursing workforce in particular and the flexibility of primary health care teams in general. BACKGROUND: Care delivered in the primary care sector influences, and is influenced by, the characteristics of the health care workforce. These characteristics fall into two main groups: firstly, the shape of the present medical and nursing workforce and manpower trends; and secondly, the changes in doctors' and nurses' workloads. DESIGN: This paper draws on two studies, both commissioned by the Department of Health; the first study focusing on skill mix and delegation in primary health care teams and the second addressing the implications of skill mix for medical workforce scenarios in the changing policy environment. FINDINGS: From the first study, general practitioners across ten general practices were prepared to delegate at least one topic from over a third of 836 consultations and a further 17% of entire consultations. This potential delegation fell mainly to practice nurses and nurse practitioners. The second study used data extracted from the National Morbidity Surveys of 1981 and 1991 predicting that minor consultations are set to increase by 11 million from the 1990s to 2020--a minimal estimate. The authors argue that many of these extra predicted consultations will find their way onto practice nurses' and nurse practitioners' caseloads. CONCLUSIONS: Workforce issues and questions of professional roles and boundaries, in the context of the "greying" community nursing workforce, demand solutions if patient/client demand is to be met over the next two decades.

Community Health Nursing↗

Methodological issues in medical workforce analysis: implications for regional Australia.

Medical workforce data have a profound impact on health policy formulation, but derived doctor population ratios (DPR) are often more relevant to plotting national trends than providing a detailed regional or local workforce perspective. Regional workforce data may be more useful if national approaches are augmented by local information. In developing a detailed workforce analysis for one region of Australia, the authors encountered several challenging methodological issues, including the accuracy of medical workforce databases, clarity of definition of community boundaries, interpretation of workforce definitions and the difficulty accounting for local community needs. This paper discusses the implications for regional workforce research.

Health Services Research↗

Strategic issues for managing the future physician workforce.

Physician workforce issues were among the most hotly debated components of the recent national health care reform effort. What are the United States' goals for its physician workforce? Will market forces be adequate to achieve these goals, or will regulatory intervention be needed? This chapter provides public and private policymakers with a framework for arriving at reasonable conclusions about this important subcomponent of national health policy. Physician supply and requirements are discussed first. A picture of the current U.S. physician workforce is presented, together with details of its size and the physician-to-population ratio. Future growth of the physician workforce is projected, and future requirements are discussed along with the potential for both surpluses and shortages in some areas. Graduate medical education, a crucial topic in this discussion, is covered. The issue of substitution of nonphysician providers for physicians is considered next, with special attention paid to the capabilities of nonphysician providers in performing certain tasks, as well as the productivity and cost-effectiveness questions involved. While the physician supply in the United States may be adequate overall, gaps in service and problems with access to services persist in many rural and inner-city areas. The geographic distribution of the physician workforce and the balance of subspecialists and generalists are addressed. Other topics of discussion include the need for greater minority representation in the physician workforce and the evolving role of the physician executive. Finally, this chapter ends with a wrap-up of policy considerations and themes central to the new delivery system of the twenty-first century. These themes include market forces versus regulation, cost containment and workforce cost-effectiveness, the global role of the United States, and nonfinancial barriers to access to care, as well as the impact of technology and the role of physician scientists.

Allied Health Personnel↗

Managing the workforce reduction: hospital CEO perceptions of organizational dysfunction.

Over the past few years many nations have undertaken activities aimed at restructuring and reengineering their health system as a means of achieving greater cost effectiveness and consumer responsiveness. Most efforts at reforming healthcare delivery have been accompanied by the downsizing of healthcare organizations. Organizations that are undergoing decline or significant workforce contractions are widely believed to experience a number of negative or dysfunctional attributes as a consequence of reductions in, or redeployments of, their labor force. For organizations undergoing planned workforce reductions, much speculation has been made in an attempt to identify a set of "best practices" that have the potential to mitigate the dysfunctional consequences associated with large permanent reductions in the workforce. This article explores the relationships among workforce-reduction practices and perceptions of organizational dysfunction in a large sample of Canadian hospitals. Results of the analysis suggest that the application of certain "progressive" workforce-reduction practices preceding, during, and subsequent to the downsizing process may play an important role in mitigating some of these dysfunctional organizational consequences. This research provides some evidence to suggest that how a workforce reduction is carried out may have a greater effect on organizational effectiveness than either the magnitude or severity of the overall workforce reduction.

Attitude of Health Personnel↗

Mothers in the workforce.

This evaluation of maternity leave was completed by the Australian Institute of Family Studies. The use of maternity leave was investigated in 3 separate surveys. In 1, all women throughout Australia who had borne a child during 1 week in May 1984 (2000 women) were surveyed 18 months after the birth. The 2nd and 3rd surveys examined the experience of maternity leave in 1252 private sector businesses of varying sizes and a smaller number of public sector organizations. The study found that 46% of women are in the workforce during pregnancy. However, looking only at women in employment before the 1st birth, 3/4 of them are in the workforce. 44% of women took maternity leave, 33% were eligible but did not take leave, and the remaining 24% were ineligible for maternity leave either because they were casual workers or because they had not been in continuous employment with their employer for the required minimum period of 12 months. Of all maternity leave taken, 78% is taken by public sector employees and only 21% by women employed in the private sector. 1/2 of the women eligible for maternity leave in the private sector who did not take up the option had no information about maternity leave provisions. The main determinants of taking maternity leave, apart from having information about it, are working in the public sector, having a strong attachment to the workforce, having values which see work and child rearing as complementary, being a member of a trade union, having a high education and high status occupation, and being employed in a large establishment. Other survey findings follow. 1) 55% of women who were in employment before their 1st child returned to the workforce within 18 months of the birth. 2) 45% of women returned to work used informal child care provided by family or friends (usually unpaid). 32% used formal care only. 23% used a combination of formal and informal child care. 3) Women are spending an average of between 20% and 25% of their income on child care. 4) Financial reasons are the main reasons given by women for their return to the workforce. 5) Cost and availability of child care is an important issue in determining women's workforce participation after the birth of a child. 6) 60% of women do not return to the workforce after childbirth; 90% of these women intend to do so in the future. 7) For the majority of women who give birth, motherhood emerges as their most important role in life. Almost 1/2 the women agree that a woman should give up her job if it inconveniences her husband and children. 8) 2/3 of working women can establish just as warm and secure a relationship as non-working mothers, compared with 4 out of 10 non-working mothers.

Adolescent↗

Too many, too few, too concentrated? A review of the pediatric subspecialty workforce literature.

OBJECTIVES: To summarize recent pediatric subspecialty workforce analyses and to highlight similarities and differences across studies. DESIGN: By using MEDLINE, we conducted a systematic search of the literature published from January 1, 1992, through December 31, 2002. We included research articles and task force reports, and abstracted author, year of publication, specialty, sample size, analytic perspective (eg, physician or academic department), inclusion of data on nonclinical activities, inclusion of an objective measure of demand, and workforce-related conclusions. RESULTS: We identified 41 relevant articles. Physician surveys provided data for most (n = 24) of these studies. Only 8 studies attempted to make future workforce projections; of these 8 studies, 1 explicitly accounted for nonclinical activities in its projections. An additional 16 studies presented data on involvement in nonclinical activities. While some studies suggest that additional pediatric subspecialists are not needed, these studies did not include objective assessments of demand in geographic areas where pediatric subspecialty physicians are not available. Of those studies that took a market perspective and attempted to account for demand, workforce recommendations varied considerably across specialties. CONCLUSIONS: We know little about the distribution of the pediatric subspecialty workforce relative to the demand for their services. Given concerns about the adequacy of the pediatric subspecialty workforce, future research should assess the availability of these physicians relative to need for their services and account for nonclinical activities in workforce projections.

Education, Medical↗

Population-based analysis of obesity and workforce participation.

OBJECTIVE: To describe the relationship between obesity class and workforce participation and the influence of demographic, socioeconomic, and comorbid disease states on this relationship using population-based Canadian data. RESEARCH METHODS AND PROCEDURES: Responses from 73,531 adults surveyed in the Canadian Community Health Survey 2000 to 2001 who provided complete information regarding variables of interest were analyzed. Workforce participation was defined as individuals reporting that they held and were present at a job or business in the week before survey administration. The association between obesity and workforce participation was explored using logistic regression after adjusting for demographic, socioeconomic, and obesity-related comorbidities. RESULTS: In univariate analysis, obese individuals had lower odds of participating in the workforce. In the fully adjusted model, increasing obesity was associated with decreasing odds of workforce participation, with Class I, II, and III obesity having odds ratios (95% confidence interval) of 0.94 (0.89 to 0.99), 0.85 (0.77 to 0.94), and 0.66 (0.57 to 0.78), respectively. Obese individuals were also less likely to be employed and more likely to be absent from work. DISCUSSION: Obesity is associated with lower workforce participation. This association appears to be independent of associated comorbidity and sociodemographic factors. These results indicate that the economic impact of obesity alone on workforce productivity is larger than previous reports suggest.

Adult↗

Public health workforce enumeration: beware the "quick fix".

The most common source of information on workforce in the United States is the Bureau of Labor Statistics (BLS), a branch of the Department of Labor. In 1998, 14 public health workforce titles were added to the BLS Standard Occupational Classification (SOC) system. While this was a constructive step, it is not a "quick fix," because these additional titles do not solve the longstanding problems inherent in capturing accurate PH workforce data. As is true for all currently available sources, BLS statistics capture a limited segment of public health's broadly defined and multidisciplinary workforce. A standard system of data collection is needed to guide planning to sustain the present and future workforce. Revision of the 1998 SOC in preparation for the 2010 Census is now underway. This presents an opportunity for the public health community to act on prior recommendations regarding workforce data and advocate for more inclusive enumeration of public health occupations that can inform policies and planning for the current and future workforce.

Employment↗

[Demographic forecasts of medical workforce supply in France (2000-2050). What numerus clausus for what future?].

UNLABELLED: In France, medical training and graduation of medical doctors are under the full control of the State. A numerus clausus barrier is established between the first year and the second year of medical schools. The first year is open to all students having successfully completed their secondary schooling (18 years old) but the number of those allowed to start the second year is decided every year by the government. Foreign medical graduates can practise only if they have obtained authorization from the State. Theoretically, the authorities have all means for shaping the size of the medical workforce, either in the short term (e.g. by importing foreign medical graduates to fill up vacant posts) or in the long run (by increasing or decreasing the numerus clausus, or student intake, to cope with shortage or oversupply of doctors). In practice, due to various constraints, the issue is far from simple (resistance to change, divergent lobbying forces and, more importantly, lack of relevant information). METHODS: In this study, the forecasting techniques of demography are used to assess the future trends of supply of medical doctors, on the basis of the formula t2 = t1 + e - l t1 is the medical workforce at the beginning of the period t2 is the medical workforce at the end of the period e is the number of doctors entering the medical workforce (new national graduates or foreign graduates) during the period l is the number of doctors leaving the medical workforce (death, retirement, out migration) during the period. Calculations are performed for each 5-year age group and for the successive 5-year periods. At the end of a 5-year period, one obtains the number of professionally active doctors in each 5-year age group and, by addition, the total number of active physicians in the country. The starting point of the projection work is December 31st 2000 when the French medical profession numbered 200,800 (i.e. 334 physicians per 100,000 population). As concerns the inflow e (physicians entering the profesion), calculations are performed step by step: number of students starting the 2nd year of medical schools: two basic hypotheses are adopted as concerns the future intake decided by the government, 8000 and 6000 (Table A) from the numerus clausus barrier (2nd year of medical training) to the 6th year of medical training from the 6th year to graduation (the residency period) from graduation to registering in the Medical Council (effective start of the career) moreover, it is assumed that from 2000 through 2025, for each 5-year period, 1200 foreign medical graduates are allowed to join the national medical workforce; after 2025, this number will decrease to 300. As concerns the outflow l, a "professional life table" is used to determine the numbers of doctors of each age-group who leave the career by death, retirement, outmigration ... during each 5-year period (Table B). CONTEXT: From 1965 onwards, the number of students entering the medical schools grew steadily. The numerus clausus system, established in 1972, became effective five years later. However, due to resistance to change, the number of students allowed to start the 2nd year of medical schools reached a really low level only at mid-80's. In other words, during the period 1974-1994, France experienced a significant "graduate boom". The young doctors graduated during these two decades were in extremely high numbers and fueled a strong feeling of manpower oversupply. But from mid-90's onwards, the annual number of new graduates decreased (as a result of the low numerus clausus decided from mid-80's). In hospitals, post vacancies became frequent. In ambulatory care, medical practitioners encountered great difficulties to find locum tenens. From 2000 onwards, the term of manpower shortage was openly evoked in public debates. Starting 1999, the authorities increased again the numerus clausus which reached 5100 in October 2003. The mood was in favor of an upward trend. As a matter of fact, the numerous physicians graduated during the 1974-1994 boom period will begin to retire around the year 2010 and the French medical profession would sharply decrease without a vigorous growth of the numerous clausus. As started above, this projection work adopts two basic hypotheses as concerns the numerus clausus: the number of medical students allowed into the 2nd year, will progressively increase in October 2007 either to 6000 or to 8000 and will remain constant later on. RESULTS: With a 8000 student intake, the number of physicians (200,800 in 2000) will increase to 209,300 in 2010 then will slowly decrease to 205,900 in 2030. After, it will grow again and reach 229,500 in 2050. With a 6000 student intake, the number of physicians will also increase to 209,300 in 2010, then will rapidly decrease to 173,700 in 2030. The downward trend will stop in 2035. After, a slow growth will take place and the medical profession will number 173,500 in 2050 (Table C and Fig. 1). In other words, if a numerus clausus of 8000 is decided, the large retirement of the 1974-1994 graduate boomers (during the period 2010-2030) will be nearly offset by the newcomers. At the same time, the aging of the medical workforce will be stopped. Instead, a new younging process of the medical profession will take place again after 2020 (Fig. 2 and Fig. 3). As it was the case during the early 70's, the younging process or pouring in of new graduates in great numbers may possibly fuel a strong perception of oversupply and lead to a sharp decrease of the numerus clausus after 2020 (sec variants Ib, Ic, IIb, IIc in Table A and C). As the numerus clausus has been increased during the first decade of the century, the two opposite moves (upward and downward) will create once again a phenomenon of "graduate boom". The boom will be far more important with a student intake of 8000 (Table F and Fig. 5) than a student intake of 6000 (Table G and Fig. 7). Even with 8000 students, the boom will not appear if the intake (numerus clausus) is not decreased after 2020. Consequently, if the decision is made today to increase sharply the student intake, we should be sure not to have to decrease it strongly in two or three decades. A less important increase decided today will not totally fill the gap when those graduated during the period 1974-1994 will retire and the national number of physicians will diminish. But such a decision will probably avoid the appearance of a feeling of oversupply in the coming decades and its subsequent problems (decreased student intake and, a decade later, a new graduate boom).

Adult↗

Pediatrician workforce statement.

This statement discusses the importance of pediatrician-workforce issues and their relevance to the provision of pediatric health care. It reviews previous work in the health policy arena on physician and pediatrician workforce. Key pediatrician-workforce trends are described, including the growth in the number of pediatricians in relation to the child population, the increase in the number of female pediatricians, the role of international medical graduates, the diversity of the pediatrician workforce, the contributions of internal medicine-pediatrics physicians, the increasing number of nonpediatrician providers of pediatric care, geographic distribution of physicians, and the future of pediatric subspecialists. Methods of influencing the pediatrician workforce are also considered. In the concluding series of recommendations, the statement identifies both overarching policy goals for the pediatrician workforce and implementation strategies designed to ensure that all of America's infants, children, adolescents, and young adults have access to appropriate pediatric health care.

Career Choice↗

Medical workforce planning in Australia.

The Australian Medical Workforce Advisory Committee (AMWAC) was established by the Australian Health Ministers' Advisory Council (AHMAC) in 1995 to provide information and analysis to AHMAC and the profession about the medical workforce to inform the policy process. This article provides a brief history of the events leading to the formation of AMWAC and of the work of this committee, particularly its approach to medical workforce planning and the outcomes of some of its research. The paper concludes that the forces leading to and maintaining workforce geographic and structural maldistribution are better understood as a result of AMWAC studies and the work of other stakeholders. Further research is required to improve understanding of the hospital medical workforce and the factors influencing the career decisions of young doctors and to monitor the impact of strategies to improve workforce distribution.

Australia↗

Selected demographic, social and work characteristics of the Australian general medical practitioner workforce: comparing capital cities with regional areas.

The aim of the present study was to compare selected characteristics of the Australian general medical practitioner workforce in capital cities and regional areas. Data were derived from the 1996 Census of Population and Housing. Characteristics included age, sex, full- or part-time work, place of birth and change in residential address. Analyses were performed for each state and territory in Australia, the statistical division containing each capital city and all other statistical divisions in each state and territory. Of the 26,359 general medical practitioners identified, 68% were male. More female than male general medical practitioners were aged < 45 years (74 vs 52%, respectively; P < 0.0001). The proportion of general medical practitioners aged < 35 years was higher in capital cities (30%) than regional areas (24%; P < 0.0001). Overall, 32% of the general medical practitioner workforce was female and almost 50% of those aged < 35 years were female. The proportion of female general medical practitioners was higher in capital cities than regional areas, by up to 30%. While 13% of male general medical practitioners reported part-time work, 42% of females also reported part-time work and these figures were similar in capital cities and regional areas. Approximately 40% of the Australian general medical practitioner workforce was born outside Australia and while fewer migrants have entered in recent years they were more likely to be living in regional areas than the capitals. The census provides useful medical workforce data. The regional workforce tends to be made up of more males and is older than in capital cities. Monitoring trends in these characteristics could help to evaluate initiatives aimed at addressing regional workforce issues.

Adult↗