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PubMed2006

Critical care workforce: a policy perspective.

BACKGROUND: Workforce studies may be disconnected from the policies that affect supply and demand for health professionals. Sporadic review of the physician workforce in the last century has led to wide swings in perception about its adequacy. However, workforce research has influenced federal policy as well as the policies of institutions responsible for training and regulation of physicians. This discussion is intended to address workforce issues in the context of public policy at the federal level. It is also intended to serve as a starting point for new approaches to shaping workforce policy. DISCUSSION: The supply of and demand for physicians and other health professionals are affected by a number of factors that may or may not be under the control of policymakers and health professionals themselves. Productivity, practice patterns, the aging of the workforce and patients, and other major determinants are only minimally affected by most government policy. Despite several attempts throughout the 1980s and 1990s, demand for health care has been particularly difficult to control for policymakers. In contrast to the United States, most developed nations are extensively involved in the planning of the healthcare workforce, including the specialty mix, the number of physicians, and the number of other health professionals. CONCLUSION: There are many barriers to successful workforce policy. Successful public policy change often involves multiple stakeholders, in and out of government. The task before those concerned about workforce issues is to educate policymakers about how changes in the physician workforce will affect cost, access, and quality, and to impress upon them that serious efforts to improve quality of care and reduce costs will not be effective unless qualified physicians are there to provide that care.

Critical Care↗
PubMed1988

Algeria.

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Africa↗
PubMed1985

Guyana.

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Americas↗
PubMed1998

Use of immigration policy to manage nursing shortages.

PURPOSE: To examine long-term implications of using temporary, nonimmigrant nurse programs to manage fluctuations in the demand for registered nurses. ORGANIZING FRAMEWORK: This discussion is located in the full context of migration--reviewing theories and concepts of labor migration--referring to experience with guest-worker programs worldwide, outlining recent nursing shortages in the United States, describing the Immigration Nursing Relief Act (INRA), and raising questions for nurses in the United States and in the global marketplace. SOURCES: Review of scholarly literature on international migration, existing studies on nurse migration to the United States, and original research, conducted between 1992 and 1994, for the Immigration Nursing Relief Advisory Committee (INRAC) Report. METHODS: Policy analysis of theories, concepts, and perspectives related to nurse migration. FINDINGS: In the United States, highly skilled foreign nurses tend to complement rather than displace local labor. Yet recruiting foreign-educated nurses for entry-level jobs perpetuates patterns of dependency in the sending country and delays creative solutions to staff development in the host country. Nonimmigrant status creates a vulnerable workforce. There may be a disparity between the ideal of nurse migration as collaborative exchange and the reality of institutionalized occupational migration networks. CONCLUSIONS: While foreign nurse recruitment might solve short-term needs, repetitive temporary nurse migration programs create long-term consequences that are not in the best interests of the profession. The absence of consistent policy creates an opportunity for nursing to take an active role in developing the rules and direction of future nurse migration.

Emigration and Immigration↗
PubMed2002

Private practicing endodontists: production of endodontic services and implications for workforce policy.

The methods and techniques used by private practicing endodontists to provide patient care are at the core of endodontic workforce policy. Productivity influences both the amount of care provided and the required number of practicing endodontists in the future. Data was collected from practicing endodontists in order to characterize the technical methods of producing endodontic services. This data was then used to develop a statistical model for use in assessing the national endodontic workforce conditions in the United States. A survey was mailed to a random sample of 2,075 private practicing endodontists in the United States based on membership files from the American Association of Endodontists and the American Dental Association. The overall survey consisted of three means of data collection: (1) a survey about the endodontic practice as a whole; (2) a survey about the endodontist; and (3) patient encounter forms used when collecting detailed endodontic procedure data for a single day in the practice. The model was used to obtain a projection of 4,016 endodontists in the year 2005 and 4,671 practicing endodontists in 2010 required to meet the projected demand for endodontic care. The model and survey data provide valuable information to practicing endodontists for use in identifying critical elements used to render care, how the elements are combined in the practice of endodontics, and the minimum number of endodontists required to provide a given volume of endodontic care.

Adult↗
PubMed1998

United States neonatology practice survey: personnel, practice, hospital, and neonatal intensive care unit characteristics.

BACKGROUND: The efficiency and access to existing perinatal resources has become a focus of debate. Despite inconsistent references to the number of neonatologists and unsubstantiated personnel requirement recommendations, recent commentaries have suggested a current 30% to 50% excess in workforce. OBJECTIVE: To describe the current neonatology workforce and its practice patterns. DESIGN: Using a questionnaire developed by the Committee on Practice of the Section on Perinatal Pediatrics of the American Academy of Pediatrics and distributed to 675 neonatology practices identified in the United States Neonatologists Directory 1996, a survey was conducted from July 1, 1995 to June 30, 1996 requesting specific information relating to personnel, type and size of practice, and clinical services provided at practice hospitals. RESULTS: Respondents included 420 neonatology practices (62.2% response rate) representing 2006 neonatologists providing clinical care in 695 hospitals, 652 with delivery services that accounted for 1 646 881 live births in 1994. More than 95% of practices and neonatologists identified themselves as based in university, private, or hospital settings. Eighty percent of neonatologists were <50 years old. There was an overall 2:1 male to female gender distribution. Sixty percent of practices consisted of 4 or fewer neonatologists, 25% of practices 5 to 7 neonatologists, and 15% of practices 8 or more neonatologists. Sixty percent of practices provided clinical care in only 1 hospital and 1 neonatal intensive care unit (NICU) as compared with 15% of practices in 3 or more hospitals and <5% of practices in 3 or more NICUs. Of the total 478 NICUs (22 in children's hospitals), 67% had <501 annual admissions and 33% had more then 500 admissions. Of the 456 NICUs in 652 practice hospitals with delivery services, 61% of hospitals had <2501 annual deliveries (57% with NICUs) and 39% of hospitals had more than 2500 annual deliveries (90% with NICUs). The average inborn admission rate for these practice hospitals was 11.7%. University, private, and hospital practices had consistent rates of admissions for inborn and outborn NICU and special care nursery admissions. More than 60% of neonatology practices were involved in normal newborn care on a routine basis, in addition to staffing developmental clinics and providing inpatient and outpatient pediatric care. Additional information was analyzed for utilization of residents and neonatal nurse practitioners. By 1999, 50% of practices anticipated hiring 279 neonatologists and 575 neonatal nurse practitioners. CONCLUSION: Significant discrepancies between earlier projected neonatologist requirements and current neonatology workforce and service responsibilities are discussed in relation to demands of reallocation of subspecialty resources within an evolving health care system.

Adult↗
PubMed1993

The influence of educational theory on the development of nurse training to education in the United Kingdom.

This paper discusses the development of nurse training to education from its historical apprenticeship-style approach to the current position of professional education through diploma-level programmes. The influence of education theory on nurse training over the years is explored. The slowness of the transition from training to education is shown to have been dependent on the view of what is considered as appropriate preparation for the role. Historically, one can see that it was expedient that preparation for the role began as training, and the development to education was thwarted by the lack of resources, the shortage of nurses, and the medical and political ideologies of the day. The implementation of Project 2000, with students being supernumerary to the workforce, and the programme being educationally led, created the need for the development of professional education from the traditional training model.

Curriculum↗
PubMed2001

The global expansion of precarious employment, work disorganization, and consequences for occupational health: placing the debate in a comparative historical context.

Mounting research evidence suggests that the shift to contingent work arrangements in industrialized countries is having serious adverse effects on the health of workers, both directly and indirectly (by undermining regulatory and other protections). The authors place this research, and the issues surrounding it, in a comparative historical context. Extensive use of precarious employment is not essentially new. It was a characteristic feature of most if not all industrialized societies in the 19th and early 20th centuries. Though the two phases are not identical, historical comparisons are instructive for understanding recent experiences and ways of addressing them. The authors also make comparisons with the developing world, where the informal sector typically accounts for over half the workforce. Such comparisons are instructive in indicating the consequences of a shift to more precarious patterns of employment and disorganized work settings. There is also good evidence that precarious employment is expanding in the developing world. The growing precarious employment in both industrialized and developing countries is interconnected, and the authors identify a number of the mechanisms affecting workers' health.

Commerce↗
PubMed1987

Singapore.

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Asia↗
PubMed1996

Evaluating the impacts of human capital stocks and accumulation on economic growth: some new evidence.

"Various hypotheses have been put forward in recent years concerning the contribution of human capital to economic growth. This paper argues that school enrolment rates--by far the most commonly used human capital measure in growth regressions attempting to test these hypotheses--conflate human capital stock and accumulation effects and lead to misinterpretations of the role of labour force growth. An alternative education-related human capital measure is constructed which is capable of distinguishing between stocks and flows. Applying this measure to samples of developed and less developed countries during the 1960-85 period suggests not only that there are important growth effects associated both with 'initial' stocks of, and subsequent growth in, human capital, but also that this new measure out-performs the simple school enrolment rates used in previous analyses."

Developed Countries↗