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PubMed2005

Future of family medicine workforce in the United States.

In response to the Future of Family Medicine Leadership Committee's recommendations(1) The Ohio State University Department of Family Medicine convened 10 faculty development sessions covering the following strategic objectives: (1) Promoting a Sufficient Family Medicine Workforce, (2) the Role of Family Medicine in Academic Health Centers, (3)The New Model of Family Medicine, (4) Electronic Medical Records, (5) Family Medicine Education, (6) Lifelong Learning, (7) Enhancing the Science of Medicine, (8) Quality of Care, (9) Communications, and (10) Leadership and Advocacy. The focus of this editorial is on initiatives and programs to promote a sufficient family medicine workforce. In comparison to other industrialized countries, the United States ranked lowest in primary care functions and lowest in health care outcomes, but highest in health care expenditures. Despite this fact, the trend for United States medical school graduates to select subspecialty careers continues upward. Through collaboration and advocacy, we can all ensure a continued enthusiasm for the selection and retention of family medicine as a career.

Career Choice↗
PubMed2006

Mentoring matters: developing rural nurses knowledge and skills.

Mentoring, the alliance of two people with varying degrees of experience in order to create opportunities for support and learning, is being encouraged as a response to current workforce issues in Australian rural nursing. The nursing profession is beginning to recognise the benefits of mentorship in providing psychosocial support and role acquisition skills to novice practitioners. These outcomes are valuable for enhancing the recruitment and retention of staff. The Mentor Development and Support Project of The Association for Australian Rural Nurses (AARN), established in 2003, was a strategy for increasing mentoring in the rural nursing workforce. This project aimed to develop the capacity of rural nurses to mentor effectively, as well as provide support for them for the duration of the mentoring partnership. This article reports on aspects of the AARN project. It includes a discussion of the need for planned mentor development opportunities and provides the rationale for the curriculum content of project workshops. It also includes evaluated outcomes for participants in the project.

Australia↗
PubMed2004

The general pediatrician: projecting future workforce supply and requirements.

OBJECTIVE: Trends affecting both the supply and requirements of child health physicians call into question earlier assessments about the adequacy of the general pediatric workforce. To understand the effects of these trends over time, we developed a model that projects the national supply of practicing general pediatricians over a 20-year period (2000-2020). DESIGN: The model incorporates current data on the practicing pediatrician workforce in the United States, pediatric residency graduates entering general pediatrics, and gender- and age-specific measures of productivity and of retirement or death. In addition, it accounts for projected changes in the size and ethnicity of the child population and the proportion of children currently receiving outpatient care from family practitioners. MAIN OUTCOME MEASURES: Time trend of the supply of general pediatricians and the number of children in the population per practicing pediatrician. RESULTS: The baseline model projects that the number of general pediatricians will expand by nearly 25 000 by the year 2020, a 64% increase from the year 2000, whereas the child population is projected to expand by only 9%. The increase was robust to sensitivity analyses measuring the impact of each of the model's variables on the future supply of pediatricians. In all probable scenarios, the general pediatrician workforce will expand significantly more rapidly than the child population. In addition, the trend in pediatrics is in marked contrast to the other primary care specialties. CONCLUSIONS: Despite a number of factors that might attenuate the growth of the general pediatrician workforce, none seems sufficient to slow its expansion in relation to the pediatric population. To maintain practice volumes comparable to today, pediatricians of the future may need to provide expanded services to the children currently under their care, expand their patient population to include young adults, and/or compete for a greater share of children currently cared for by nonpediatricians.

Education, Medical, Graduate↗
PubMed1991

An evaluation of surgery departments in community-based medical schools.

Since 1960, most newer medical schools have been community-based and have used existing community hospitals and a large number of volunteer faculty. As these schools have evolved, many have developed more traditional characteristics. To assess the positive and negative features of these new schools, chairs of departments of surgery from 21 community-based medical schools and 17 traditional schools were surveyed to acquire information on policies and practices related to faculty development, undergraduate and graduate education, hospital relationships, clinical activities, research, and relationships with community physicians. Responses were analyzed and compared. Most community-based schools have succeeded in their mission, partly at the expense of controls usually found in more traditional schools.

Attitude of Health Personnel↗
PubMed1994

The declining marital-status earnings differential.

"Earnings differentials between married and unmarried [U.S.] men have been declining since the late 1960s. We consider two possible explanations for this decline: changes in the nature of selection into marriage; and changes in role specialization within marriage. Our analysis of changes in marriage differentials within cohorts supports only a small contribution of changes in selection. There is some evidence that differences in human-capital investment between married and unmarried men have fallen over time, but this effect has apparently been largely offset by increases in the return to that human capital." This is a revised version of a paper originally presented at the 1991 Annual Meeting of the Population Association of America.

Americas↗
PubMed2005

Central processing technician internship--a unique learning opportunity.

A critical shortage of qualified central processing technicians and the opening of a new central processing department (CPD) were driving forces behind the development of a CPD technician internship program at one facility. Classes focused on the principles and practices of central processing, and an OR observation gave interns the opportunity to see the impact that the work of the CPD has on OR function and patient care and safety. Program evaluations have been positive, and staff vacancies have been filled with the graduates of the internship program.

Allied Health Personnel↗
PubMed2003

When is the personal professional in public child welfare practice? The influence of intimate partner and child abuse histories on workers in domestic violence cases.

OBJECTIVE: The objective of this article is to examine children's services workers' (CSWs') personal histories of abuse and their influence on professional responses to allegations of domestic violence. METHOD: Using an anonymous questionnaire, data were collected from CSWs in two large urban counties in Southern California who participated in a domestic violence training program (n=303). It was hypothesized that CSWs' responses to domestic violence cases would be affected by personal histories of abuse and the degree to which the CSWs identified with battered women. RESULTS: Approximately one-half of the respondents reported experiencing physical and/or sexual violence by an intimate partner. One-third of respondents reported physical abuse, and 22%, sexual abuse during childhood. The experience of childhood sexual abuse, especially for female CSWs, was associated with increased support for removal of children whose mother is being abused. Those CSWs with a history of partner violence who identified with battered women were less likely to approve of removing children from the battered mother than were CSWs without partner abuse history or identification with battered women. CONCLUSIONS: Our findings provide support for expanded training efforts that recognize the ongoing impact of victimization on CSWs' professional functioning.

Adult↗
PubMed2003

Networked for change? Identifying obstetric opinion leaders and assessing their opinions on caesarean delivery.

The objective was to determine whether obstetric opinion leaders can be identified and to characterize them in terms of their demographic and professional characteristics and their attitudes toward caesarean delivery. In late 1998, we surveyed 527 obstetricians, 138 family physicians, and 80 certified nurse midwives (overall response rate, 57.8%) practicing in a stratified random sample of California hospitals with at least 1000 annual deliveries (n=52). Participants reported on demographic and professional characteristics and attitudes towards caesarean delivery; they also checked off those hospital colleagues from whom they had sought or would seek advice on labour and delivery. A composite measure of nomination frequency was used to characterize each respondent's degree of "opinion leadership". All analyses were corrected for the complex survey design. Using a nomination cutoff of 0.4 (0-1 scale), opinion leaders were identified in 31% of California hospitals; they were identified in 81% of hospitals using a cutoff of 0.2. Compared with their peers in the lowest fifth of the nomination distribution, clinicians in the top fifth were younger and more likely to be male, to speak English as a first language, to practice obstetrics, to have a maternal-foetal medicine subspecialty, and to practice in higher volume hospitals (p<0.05). Regardless of discipline, opinion leaders held attitudes concordant with reducing the caesarean delivery rate more often than non-opinion leaders. However, only 48% of obstetrical opinion leaders would support reducing the caesarean delivery rate to levels targeted by Healthy People 2000. In conclusion, obstetric opinion leaders could be identified in many California hospitals. However, they did not consistently support policies designed to reduce the caesarean delivery rate. The results have implications for the generalizability of opinion leader strategies.

Adult↗
PubMedDate not supplied

Meeting the challenge of funding and allocating resources to mental health across Europe: developing the Mental Health Economics European Network.

AIMS: There is growing demand for economic analysis to support strategic decision-making for mental health but the availability of economic evidence, in particular on system performance remains limited. The Mental Health Economics European Network (MHEEN) was set up in 2002 with the broad objective of developing a base for mental health economics information and subsequent work in 17 countries. METHODS: Data on financing, expenditure and costs, provision of services, workforce, employment and capacity for economic evaluation were collected through bespoke questionnaires developed iteratively by the Network. This was augmented by a literature review and analysis of international databases. RESULTS: Findings on financing alone suggest that in many European countries mental health appears to be neglected while mechanisms for resource allocation are rarely linked to objective measure of population mental health needs. Numerous economic barriers and potential solutions were identified. Economic incentives may be one way of promoting change, although there is no 'one size fits all solution. CONCLUSIONS: There are significant benefits and synergies to be gained from the continuing development of networks such as MHEEN. In particular the analysis can be used to inform developments in Central and Eastern Europe. For instance there is much that can be learnt on both how the balance of care between institutional and non-institutional care has changed and on the role played by economic incentives in ensuring that resources were used to develop alternative community-based systems.

Capital Financing↗
PubMed1999

The global distribution of physicians and nurses.

AIM: To explore the global distribution of physicians and nurses and the influence of gross national product per capita on this distribution, using available United Nations' (UN) sources. OBJECTIVES: to compare the international distribution of physicians and nurses by country; to examine the influence of gross national product per capita (GNP) on the global distribution of physicians and nurses; to explore the assumptions underlying the recommendations of The World Development Report 1993 Investing in Health for health workforce substitution; and to consider the implications for future studies of global health labour distribution. DESIGN: A database was compiled from various UN sources on 147 countries. Using some of the variables from this database, a general linear regression model for log GNP per capita on each of the two dependent variables (log nurses and log physicians per 1000 population) was produced. Standardized residuals obtained from these bivariate regressions were calculated and plotted against each other to determine the relationship between the global distribution of physicians to population and that of nurses. From this analysis outlying countries could also be identified. RESULTS: Ratios of physicians to population by country varied from 0. 02 to 4.4 per 1000 population (or from 1 to 227 and 1-50,000 population), and nurses from 0.03 to 16.4 (or from 1 to 61 and 1-33, 000 population). There was a positive correlation (r = 0.84, P < 0. 001) between the number of physicians per 1000 population and the number of nurses per 1000 population. GNP explained 49% of the variation in physicians and 40% in nurses. Ranking of countries according to their standardized deviation from mean regression lines for GNP against health personnel in countries with both the lowest incomes and lowest numbers of health personnel, resulted in little change from the original rankings of ratios of physicians and nurses relative to population. For some of the wealthiest countries, there was a marked fall in global ranking and for some middle income countries a marked improvement in ranking. CONCLUSION: 70% of the distribution of nurses globally can be explained by the distribution of physicians, and the influence of GNP per capita on the global distribution of physicians and nurses appears to be substantial. In only a minority of the world's very poorest countries is there evidence to suggest that higher numbers of nurses substitute for low numbers of physicians. Standardization of the distributions by GNP demonstrates that many countries (but not the poorest) regress to within one standard deviation of the mean expected distribution. This suggests that countries could set optimum levels of physicians and nurses within the limits of their GNP. More realistically, the findings suggest that recommendations for modification of the structure of countries' health labour forces as a component of health care reform may be more difficult to achieve than at first appears. The potential unreliability of the data sources used, and the implications for the accuracy of the findings, are discussed.

Female↗
PubMed2001

[Company approaches concerning workers with performance alterations or disablement: interview findings on the perspectives of the various parties involved].

This paper provides information about the research programme "In-plant interventions in the German car industry to increase job opportunities for employees with (severe) disabilities". The research was done in 2000 by the University of Trier and the International Research Unit for Work and Social Integration (IFASI). The purpose of the study was to capture, document, and analyse internal practices of occupational rehabilitation in five German car factories. Taking a qualitative approach, 23 persons of different company areas were interviewed, and numerous documents were analysed. The article reflects applied disability management strategies and points out success factors and barriers of inclusion.

Adult↗
PubMed2001

Through the years: a longitudinal study of physical education teachers from a research-based preparation program.

This study investigated factors that enhanced and constrained the career development of six teachers, who had graduated from the same university teacher education program, in their induction years (Woods & Earls, 1995) and again later in their career cycles. Three participants were physical education teachers (PETs), and three were former physical education teachers (FPETs). Fessler's (1985) Teacher Career Stage Model provided the theoretical framework. Data sources were: interviews with teachers and their teacher educators and direct observations of lessons. Results indicated that the PETs continued to have skill development as their primary teaching objective. The teachers maintained many of their teaching skills, and shifted between the career cycles of "competency building" and "enthusiastic and growing." All three FPETs left their physical education positions during the career frustration stage and at the time of publication were in the career exit stage.

Adult↗
PubMed1991

Hospice care for prisoners: establishing an inmate-staffed hospice program in a prison medical facility.

U.S. Prison populations are expanding at an explosive rate and many more men and women are dying in prison, often with little attention given to their unique psychological, palliative, and spiritual care needs. This paper describes the development of an innovative hospice program at a major federal prison hospital designed to meet those needs: an inmate-staffed, hospice volunteer program. A brief history of the program's start-up and development, data on the initial six month pilot program and evaluation, a set of program standards and guidelines, and recommendations for further development are presented as a model for future hospice programs in prison medical facilities.

Hospices↗