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PubMed2005

Interventions to facilitate health workforce restructure.

There are recognised shortages in most health professions in Australia. This is evidence that previous attempts at health workforce planning have failed. This paper argues that one reason for such failure is the lack of appropriate structures for health workforce planning. It also suggests that Australia needs to move beyond planning for particular professions and that health workforce planning needs to be based on identifying skill shortages as much as shortages in particular named professionals. The paper proposes specific policy suggestions to facilitate workforce flexibility and health workforce planning in Australia.

Journal Article↗
PubMed2006

Ageing of the baby boomer generation: how demographic change will impact on city and rural GP and nursing workforce.

INTRODUCTION OBJECTIVE: To compare the impact of ageing on the GP and nursing rural and city workforce. METHOD: Cohort analysis of Australian Bureau of Statistics census data. The data was used to examine the age distribution of the city and rural GP and nursing workforce; patterns of attrition for those 50 years and over; and the impact of changes in working hours. RESULTS: The rural GP and nursing workforce is significantly older than their city counterparts (p<0.001) with the 'baby boomer' generation making up 52% of city GPs but 59% of rural GPs in 2001. While a large proportion of city and rural GPs continued to work past the age of 65 years, rural GPs left the workforce at a significantly younger age than city doctors (p<0.001). Rural nurses are older than their city peers (p<0.001) but retire at an older age than city nurses (p<0.001). In 1986, a significantly higher proportion of rural GPs in all age cohorts worked more than 41 hours per week compared with their city counterparts (p<0.001). By 2001, rural 'generation X' GPs were no more likely to work long hours than those in the city (p<0.001). However, significantly more rural than city 'baby boomers' continued to work long hours. CONCLUSIONS: Rural GPs are retiring faster than city GPs and strategies to attract rural GPs and nurses will be critical to ensure adequate rural health care and that current rural workforce shortage do not worsen.

Adult↗
PubMed2001

ACCCN national nursing workforce survey of intensive care units.

A descriptive study was designed and implemented by the Australian College of Critical Care Nurses (ACCCN) Workforce Planning Advisory Committee to capture data pertaining to workforce issues of intensive care nurses. All intensive care units (ICUs) within Australia were mailed a self reporting survey. Despite a low response rate (52 per cent) and difficulty reported by respondents in gaining the appropriate data requested, the results revealed an interesting snapshot of the intensive care nursing workforce. Types of services offered by units varied considerably; paid overtime hours were low (< 2 per cent of total hours worked) and use of both part-time and agency staff was also low (10 per cent of total hours worked). Private hospitals utilised a greater proportion of part-time and agency nursing staff than public hospitals (20:10 per cent). The turnover rate for registered nursing staff was estimated at 18 per cent, with education, skill acquisition and improved communication reported as the major incentives used by managers to attract and retain staff. This study demonstrated that valuable data are currently uncaptured and recommends a more refined process of a national database to record and manage this important information for future workforce planning.

Australia↗
PubMed2000

Toward gender balance in the Australian medical workforce: some planning implications.

Men and women doctors participate differently in the workforce. As the proportion of women in the workforce increases, gender-based differences in workforce participation are raising important planning questions. For example, how will differences in hours worked per week impact on the number of trainee doctors required to meet future demand, why do some disciplines attract more women, what will be the impact on the practice of medicine if these trends continue and how does the training environment impact on variation in career decision. In this paper we summarise and discuss the findings of recent research undertaken by the Australian Medical Workforce Advisory Committee and outline some public policy responses.

Adult↗
PubMed2001

Waiting times to see a dermatologist are perceived as too long by dermatologists: implications for the dermatology workforce.

BACKGROUND: The issue of workforce requirements in dermatology has come to attention in recent years because it affects the delivery of dermatologic care in the United States. OBJECTIVE: To determine the waiting times for appointments with dermatologists in order to assess the adequacy of the current level of dermatology workforce. METHODS: Waiting times were determined for new and return patient appointments by telephone survey of a random sample of American Academy of Dermatology members. Physicians' perception of the adequacy of the number of dermatologists in their area was used as a criterion standard to validate waiting times as a measure of workforce adequacy. Benchmark waiting times of 3 weeks for a new patient appointment and 2 weeks for a return appointment were established. RESULTS: Physicians' estimates of the waiting time for a new patient appointment and their perceptions of the adequacy of the number of practicing dermatologists in their area were closely correlated (r = -0.65; P<.001), validating the use of waiting times as a measure of workforce adequacy. More than 60% of the dermatologists surveyed exceeded the criterion cutoff waiting times, and more than 42% of the US population lives in areas underserved by dermatologists. Dermatologists practicing in areas of higher population density were more likely to have shorter waiting times for new patient appointments and were more likely to include cosmetic dermatology in their practices. CONCLUSION: The long waiting times for appointments suggests that the current supply of dermatologists is not adequate to meet the demand for dermatologists' services.

Attitude of Health Personnel↗
PubMed2004

Trends in general surgery workforce data.

BACKGROUND: During the past 25 years, there has been much debate about general surgical workforce supply and demand. In the late 1970s and early 1980s, concern was raised by the Study on Surgical Services for the United States and the Graduate Medical Education National Advisory Council that there would be a gross oversupply of total physicians and surgeons by the years 1990 and 2000. DATA SOURCES: In a 1990 report sponsored by the Council on Graduate Medical Education, reevaluation of the workforce data showed no surplus at that time and instead predicted a deficit of surgeons by 2010. Studies by other investigators in the mid-1990s supported these conclusions. Furthermore, a new workforce model published in 2002 predicted a significant overall deficit of physicians by 2020. The discrepancies in the projected and the actual data have been explained by a variety of factors including an aging population with increased surgical needs, an increasing number of outpatient surgical procedures, subspecialization within the field of general surgery, and decreasing interest in the field by United States medical students. CONCLUSIONS: Although it is difficult to compare data among studies, and there are many confounding factors in the data, review of the workforce data does support a future deficit of surgeons, a prediction that warrants further investigation.

Career Choice↗
PubMed2004

Special report: reassessment of the ORL-HNS workforce: perceptions and realities.

OBJECTIVE: This Workforce Study re-examined the current scope and geographic distribution of Otolaryngology practice and assessed the otolaryngologists' role in relation to other specialists in the diagnosis and treatment of disorders of the ear, nose, throat, and related structures of the head and neck. Study design A national survey and review of federal, corporate and administrative databases, coupled wih a focus group of otolaryngologists, were analyzed to compile physician manpower figures, state and regional demographic data, and prediction modeling of Managed Care and FFS environments. RESULTS: The current and predicted workforce supply and demographic data support a geographic and proportionate increase in the number of otolaryngologists practicing and entering the workforce. Additional findings involving the role of the specialty specifically identified an increase in the treatment of allergic disease within the Managed Care sector and a diminution of the gatekeeper concept. Demographic findings represent a stable age distribution of 40 to 49 and 50 to 59 year old otolaryngologists, with a noted increase in the number of women entering the field. Empiric data reflects the continuous, diverse and dominant role otolaryngologists maintain in the treatment and care of patients with otolaryngologic and head and neck disease. CONCLUSIONS: This study continues the effort to identify otolaryngology workforce demographic profiles and make recommendations for a future national practice model. Continuous reassessment of the specialty is required.

Adult↗
PubMed1999

The potential size of the hospitalist workforce in the United States.

PURPOSE: In the United States, there are currently 1,000 to 2,000 physicians who specialize in inpatient hospital care. The number of such hospitatists appears to be growing rapidly, but the ultimate size of the hospitalist workforce is not known. METHODS: We obtained workload data from 365 practicing hospitalists who completed a survey by the National Association of Inpatient Physicians. We then estimated the number of potential hospitalists, based on published national hospital census data. We assumed that hospitalists would care for all medical inpatients, but only at hospitals large enough to require > or = 3 hospitalists. We also made estimates based on the primary care physician referral base and international benchmarks. We estimated hospitalists' primary care referral base from telephone interviews with key informants. Official sources in England and Germany provided international workforce data. RESULTS: Hospitalists reported an average workload of 13 inpatients. To cover all adult medical inpatients in the United States, we estimate a potential workforce of 19,000 hospitalists. Sensitivity analysis yielded 10,000 to 30,000 hospitalists. Our alternative models yielded estimates within this same range. CONCLUSIONS: The future hospitalist workforce is potentially quite large. This finding highlights the need to evaluate the economic and clinical outcomes of hospitalist systems.

Bed Occupancy↗
PubMed2006

Unemployment in an underserviced specialty?: The need for co-ordinated workforce planning in Canadian neurosurgery.

BACKGROUND: A recent report suggested that newly trained Canadian neurosurgeons are experiencing difficulty finding employment in Canada. Such occurrences, in combination with recent certification restrictions imposed in the US, have resulted in increasing concern that we will shortly be seeing a surplus of graduating neurosurgeons in Canada. The purpose of this study was to develop a better understanding of training and employment patterns in the Canadian neurosurgical workforce. METHODS: Using a database provided by the Royal College of Physicians and Surgeons of Canada, the current practice location of recent (1990-2002) neurosurgical certificants and a list of all neurosurgeons practicing in Canada were generated. From these data the number of surgeons per 100,000 patient population, and the number of residents required to maintain this workforce were determined. RESULTS: Practice location could be identified for 183/189 individuals who passed their qualifying examination in neurosurgery during this time. Only 45% of them are currently practicing in Canada. The current service ratio for this specialty is 0.65 per 100,000 population overall. Although 14.6 residents/year are being trained, only 6.5/year are required to maintain the existing neurosurgical workforce. CONCLUSIONS: Our data supports the concern about an imminent employment crisis for young neurosurgeons in Canada with more than twice the required number of residents being trained. However, this shortfall of staff positions is at a time when the specialty may be underservicing the country's population. These results highlight the necessity for more cohesive workforce planning in Canada, and in particular, ensuring the appropriate balance between training and need.

Canada↗
PubMed2006

The feminisation of the orthodontic workforce.

OBJECTIVE: To describe the status and activity of women in the UK orthodontic workforce. DESIGN AND SETTING: Postal questionnaire based on the UK orthodontic workforce. SUBJECTS: All orthodontic providers in the UK. MATERIALS AND METHODS: A questionnaire was circulated to the total study population. The variables studied relating to sex were numbers, age, number of sessions worked, productivity, professional status and retirement intentions. RESULTS: The response rate was 72.7%. 31.4% of the participants were female. The average age of female providers was 42.7 (SE 0.48) years, who were on average 4 years younger than males. Sixty-six percent of specialist trainees are women and 34% men. 41.5% of male providers and 31.6% of female providers plan to retire in the next 15 years. The mean number of sessions worked by women was 7.2 (SE 0.1) and men 8.2 (SE 0.1). Women completed 24.2 (SE 1.9) cases per session and men 25.6 (SE 1.3). CONCLUSIONS: The orthodontic workforce is becoming increasingly feminised. The cumulative effect of more women completing fewer cases will mean that workforce planners will need to consider increasing numbers to allow for this feminisation.

Adult↗
PubMed2003

Predicting the pediatric workforce: use of trend analysis.

OBJECTIVE: To develop a predictive model for projecting the pediatric workforce and retrospectively test its accuracy at different points in time over the past several decades. METHODS: We applied a modified version of the physician workforce trend model developed by Cooper et al. We first analyzed and tested the relationship between economic activity and the number of active pediatric medical physicians for several periods from 1963 to 2000. To project economic activity and population changes in the United States, we conducted linear trend analyses by using the available historical data through the year before the forecast period of interest. RESULTS: There has been significant growth of the absolute numbers of the pediatrician workforce over the past several decades. There was a strong correlation (R2=.98) of gross domestic product per capita (using 1996 dollars) with the number of active pediatricians (generalists and specialists) per 100,000 children in the United States by year over a 37-year period from 1963 to 2000. Predictions of pediatrician supply using historical census and economic data to inform the trend analysis were also very highly correlated with actual supply. CONCLUSIONS: The methods used in this study to predict the pediatric workforce were very accurate and consistent over a 37-year period.

Forecasting↗
PubMed2003

Casualisation of the nursing workforce in Australia: driving forces and implications.

This article provides an overview of the extent of casualisation of the nursing workforce in Australia, focusing on the impact for those managing the system. The implications for nurse managers in particular are considerable in an industry where service demand is difficult to control and where individual nurses are thought to be increasingly choosing to work casually. While little is known of the reasons behind nurses exercising their preference for casual work arrangements, some reasons postulated include visa status (overseas trained nurses on holiday/working visas); permanent employees taking on additional shifts to increase their income levels; and those who elect to work under casual contracts for lifestyle reasons. Unknown is the demography of the casual nursing workforce, how these groups are distributed within the workforce, and how many contracts of employment they have across the health service--either through privately managed nursing agencies or hospital managed casual pools. A more detailed knowledge of the forces driving the decisions of this group is essential if health care organisations are to equip themselves to manage this changing workforce and maintain a standard of patient care that is acceptable to the community.

Australia↗
PubMed2005

Health workforce design for the 21st century.

The Australian health workforce has changed dramatically over the last 4 years, growing in size and changing composition. However, more changes will be needed in the future to respond to the epidemiological and demographic transition of the Australian population. A critical issue will be whether the supply of health professionals will keep pace with demand. There are current recorded shortages of most health professionals, but this paper argues that future workforce planning should not be based on providing more of the same. Rather, the roles of health professionals will need to change and workforce planning needs to place a stronger emphasis on issues of workforce substitution, that is, a different mix of responsibilities. This will also require changes in educational preparation, in particular an increased emphasis on interprofessional work and common foundation learning.

Australia↗
PubMed2001

Orthopaedic workforce studies: 1980 to 1985.

A committee was appointed by the American Academy of Orthopaedic Surgeons in 1981 to continue the orthopaedic workforce studies begun by D. Kay Clawson a decade earlier. The committee found that the rapid increase in orthopaedists graduating from residency programs between 1970 and 1982 had resulted in a workforce in which fully 1/2 of practicing orthopaedists certified by the American Board of Orthopaedic Surgery were younger than 45 years. At that time, orthopaedists graduated at the rate of 700 per year. If that rate continued and if nothing else changed, it was calculated that the number of practicing board-certified orthopaedists per 100,000 people in the United States would continue to increase for at least 20 more years. The effect of reducing resident output by 10% increments also was projected with the hope that this information might influence future planning. In fact, a 10% reduction in resident output was achieved and the current ratio of board-certified orthopaedists per 100,000 population is very close to that predicted. In addition, the 1981 orthopaedic workforce committee developed a map of the United States that showed the number of board-certified orthopaedists in each major zip code. This map was distributed to every allopathic residency program in the United States in the hope that displaying this map might encourage graduating residents to choose more underserved areas in which to begin their practices. Evidence obtained subsequently by interviewing candidates taking Part II of the American Board of Orthopaedic Surgery certifying examinations showed this map seemed to have had very little effect in correcting workforce maldistribution.

Humans↗
PubMed1999

The rural health care workforce implications of practice guideline implementation.

BACKGROUND: Rural health care workforce forecasting has not included adjustments for predictable changes in practice patterns, such as the introduction of practice guidelines. PURPOSE: To estimate the impact of a practice guideline for a single health condition on the needs of a rural health professional workforce. METHODS: The current care of a cohort of rural Medicare recipients with diabetes mellitus was compared with the care recommended by a diabetes practice guideline. The additional tests and visits that were needed to comply with the guideline were translated into additional hours of physician services and total physician full-time equivalents. RESULTS: The implementation of a practice guideline for Medicare recipients with diabetes in rural Minnesota would require over 30,000 additional hours of primary care physician services and over 5,000 additional hours of eye care professionals' time per year. This additional need represents a 1.3% to 2.4% increase in the number of primary care physicians and a 1.0% to 6.6% increase in the number of eye-care clinicians in a state in which the rural medical provider to population ratios already meet some recommended workforce projections. CONCLUSIONS: The implementation of practice guidelines could result in an increased need for rural health care physicians or other providers. That increase, caused by guideline implementation, should be accounted for in future rural health care workforce predictions.

Aged↗
PubMed2001

Enumeration of the public health workforce: developing a system.

Although it has been of interest to public health leaders, advocates, and policy planners for many years, decades have passed since the last organized count of public health workers. This article reports on methods used by the Columbia University School of Nursing, Center for Health Policy, to enumerate the public health workforce in 57 states and territories based on existing reports, summaries, and surveys. The complexity of public health workforce data is described and the scheme utilized to characterize the workforce using public agency categories is illustrated. The resulting "best current estimate" provokes many questions regarding future policy about a public health workforce database.

Data Collection↗
PubMedDate not supplied

The public health workforce in the year 2000.

It has been 20 years since the last estimate of the public health workforce's size and composition. This study provides a best estimate through secondary analysis of existing workforce reports, summaries, and information gathered from chief health officials in 50 states and 6 territories, public health organizations, and federal agencies. Results indicate that the workforce consists of some 448,254 persons in salaried positions as follows: 44.6 percent professionals, 4 percent officials/administrators, 14 percent technicians, and 13 percent clerical/support. Workforce size may have decreased by as much as 10 percent over the last 20 years, despite a 25 percent increase in population and rising health hazards.

Administrative Personnel↗
PubMedDate not supplied

Public health workforce development: progress, challenges, and opportunities.

The public health workforce is key to strengthening public health infrastructure. National partners have articulated a vision of a sustainable and competent workforce prepared to deliver essential public health services. Six strategic elements provide a framework for action: monitoring workforce composition; identifying competencies and developing related curriculum; designing an integrated life-long learning delivery system; providing individual and organizational incentives to ensure competency development; conducting evaluation and research and assuring financial support. Partners convened in January 2003 to review progress and to re-evaluate strategies in light of the recently released Institute of Medicine reports on infrastructure and workforce issues. Although significant challenges remain, there is convergence on priorities for competency development, research questions to be addressed and next steps in the national dialogue on certification and credentialing in public health.

Disaster Planning↗