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PubMedDate not supplied

Credentialing the public health workforce: an idea whose time has come.

The importance of a well-prepared public health workforce is widely recognized and appreciated. Strategies for enhancing workforce capacity and competency have been discussed by agencies, associations, committees, and expert panels since the landmark 1988 Institute of Medicine report. The need to foster the development of incentives for lifelong learning and career growth is of current interest to national public health associations and federal agencies. The fact that the public health workforce is not a single profession, but rather a fabric of many professions dedicated to a common endeavor, creates challenges to any singular approach. This article explores the relationships among competency, certification, and accreditation and summarizes the expert panel dialogue on workforce development incentives, specifically regarding certification and credentialing. The authors challenge public health leaders to become actively involved in framing the issues so the best possible strategies can be developed.

Accreditation↗
PubMed1997

Counting nurses: interpreting nursing workforce statistics.

Discusses the interpretation of nursing statistics, the problem of counting how many nurses there are in the workforce, and the need to be aware of how statistics are compiled when presenting numerical data to support arguments relating to nursing and the nursing workforce. Argues that NHS workforce statistics provide considerable evidence for claiming that there is a significant decline in the number of nursing staff doing the work of nursing in the NHS. Explains that although there was an increase in the number of qualified nurses working in the NHS throughout the 1980s (over a ten-year period the number of qualified nurses increased by 22 per cent), the increase in qualified nursing staff has not compensated for the loss of student learners in the workforce. Emphasizes that during the last three years for which figures are available, however, these gains have been wiped out, and the number of qualified nurses has declined to pre-Project 2000 levels.

Data Collection↗
PubMed2004

Can we measure how changes in the nursing workforce affect patient care?

Ward staff are the largest staff group in the hospital workforce and constitute the biggest budget item for most acute trusts. The nature of the ward workforce has changed considerably in the last 30 years but it is unclear what impact the changes have had on patient care. Understanding the link between resources and staffing levels on the one hand and outputs and outcomes for patients on the other is vital, particularly if further changes to the workforce are planned. In order to explore them, this article examines: (1) some of the reasons for changes to the workforce, (2) some of the research already available, and (3) the nature of research and information required. Finally, it looks at the work that the Audit Commission carried out in 2000 and which is currently being repeated by the Healthcare Commission.

Humans↗
PubMed2006

Primary medical care workforce enumeration in rural and remote areas of Australia: time for a new approach?

The rural and remote primary medical workforce continues to struggle to meet community needs. This paper looks at the strengths and weaknesses of the various datasets used to measure workforce. The analysis concludes that no current data set adequately describes workforce from a community need perspective. In particular, activity based data sets based on claims data do not capture issues such as service mix or the importance of issues outside activity collections, such as time on call. The paper calls for a new approach to workforce measurement based on a community needs model.

Australia↗
PubMed2005

Geographic distribution of the Australian primary health workforce in 1996 and 2001.

OBJECTIVE: To analyse the geographic distribution of medical and non-medical primary health professions in 2001, and to compare this with 1996. DESIGN AND SETTING: Census data on the number and characteristics of selected health professionals in Australia by remoteness areas (as measured by the Accessibility Remoteness Index of Australia) were obtained from the Australian Bureau of Statistics. MAIN OUTCOME MEASURES: Number of general medical practitioners, allied health professionals and nurses per capita in Australia by remoteness areas in 2001 and 1996. RESULTS: In 2001, the number of general medical practitioners per capita in major cities was significantly higher than the numbers in inner regional areas, outer regional areas, and remote areas. This was also true of the number of allied health professionals per capita. The number of nurses per capita did not show the same pattern. From 1996 to 2001, the number of general medical practitioners per capita showed the largest increase in outer regional areas (10%) and no change in remote areas. The allied health professional workforce per capita increased significantly in all regions, while the nursing workforce per capita showed no significant increases. CONCLUSIONS AND IMPLICATIONS: Supply of all primary health professionals in remote areas remains low, and distribution patterns changed little from 1996 to 2001. The implementation of numerous government health workforce initiatives has coincided with little observable change in geographic distribution of the health workforce up to 2001.

Australia↗
PubMed2006

Dental therapy in Western Australia: profile and perceptions of the workforce.

BACKGROUND: In 2002, the Centre for Rural and Remote Oral Health (CRROH) completed a rural oral health workforce survey which indicated that a high number of therapists, although registered, were not working as therapists. The aim of the present study was to develop a profile of the dental therapy workforce and analyse the perceptions of therapists. METHODS: In 2004, a postal questionnaire survey was undertaken amongst all registered dental and school dental therapists for 1999, 2000, 2001, 2002 and 2003. RESULTS: Valid information was obtained from 253 therapists (55 per cent response rate). The therapy workforce are almost exclusively female, have an average age of 40 years, are working in urban areas, obtained their qualification on average 20 years ago, work for the School Dental Service and qualified in Western Australia. More than a quarter no longer worked as therapists. Perceptions regarding the advantages and disadvantages of dental therapy as a career were identified. CONCLUSIONS: When trying to promote dental therapy and school dental therapy as a career, retain therapists and recruit new graduates, the opportunities identified in this survey should be embraced. A clear focus on the issues will be required to facilitate meeting the workforce objectives as outlined in Australia's National Oral Health Plan.

Adult↗
PubMed2003

Improvement, trust, and the healthcare workforce.

Although major defects in the performance of healthcare systems are well documented, progress toward remedy remains slow. Accelerating improvement will require large shifts in attitudes toward and strategies for developing the healthcare workforce. At present, prevailing strategies rely largely on outmoded theories of control and standardisation of work. More modern, and much more effective, theories of production seek to harness the imagination and participation of the workforce in reinventing the system. This requires a workforce capable of setting bold aims, measuring progress, finding alternative designs for the work itself, and testing changes rapidly and informatively. It also requires a high degree of trust in many forms, a bias toward teamwork, and a predilection toward shouldering the burden of improvement, rather than blaming external factors. A new healthcare workforce strategy, founded on these principles, will yield much faster improvement than at present.

Attitude of Health Personnel↗
PubMed1998

Analysis of health service areas: another piece of the psychiatric workforce puzzle.

Planning for development of a national or regional psychiatrist workforce that is the appropriate size must consider numerous issues. They include the dynamics of workforce distribution, effects of managed care, reduction in potential residency slots, participation of international medical graduates, apathy toward the field of psychiatry, service area variations, and increased interest in allied mental health professions, along with the burgeoning global burden of psychiatric illness. This paper examines the application of two benchmark standards for the number of psychiatrists needed per 100,000 population--the standard developed by the Graduate Medical Education National Advisory Committee and the Average Requirement Benchmark--to the supply of psychiatrists in Georgia in 1996 by county and by health service regions, which are geographical units based on health care utilization patterns of Medicare and Medicaid recipients. Areas with a surplus or deficit of psychiatrists are identified. The findings provide contextual evidence of a surplus of psychiatric physicians in the most populous areas of the state, given a substantial presence of health maintenance organizations. The state's less populated rural areas may potentially benefit from a redistribution of the psychiatrist workforce. The authors recommend continued refinement of models to estimate psychiatric workforce needs and suggest development of a comprehensive model that uses needs-based, demand-based, and benchmarking approaches.

Benchmarking↗
PubMed1997

Anaesthesia workforce in Australia and New Zealand.

A survey of anaesthetic workforce was undertaken in departments in Australia and New Zealand approved for specialist training by the Australian and New Zealand College of Anaesthetists. When compared to a previous survey 17 years before, the results showed that the number of anaesthetics administered rose, the number of operating theatres (OTs) remained the same, but the surgical beds were reduced. There was a small increase (20%) in full-time specialists with a number of vacancies in establishment. There was, however, a large increase (80%) in Visiting Medical Officer (VMO) sessions and a 40% increase in Registrar positions. At the same time there were very large increases in Recovery Romm nurses (125%) and Anaesthetic Assistants (100%). From this survey and other recent government workforce reports it is possible to derive certain workforce postulates--a specialist anaesthetist will on average anaesthetize approximately 1000 patients per annum, one in every nine people in the population will have an anaesthetic each year, and the working lifespan of a specialist anaesthetist is 30 years with 5% working half-time or less. All of this suggests that the correct Anaesthetists to Population Ratio (APR) should be reset to 1:8,500 for both Australia and New Zealand. The number of trainees required to supply a steady state replacement for this specialist workforce is also derived and the current number of training positions is shown to be in excess of these requirements. When the current shortfall in specialist anaesthetists is corrected there will need to be a gradual reduction (by approximately 40%) in the number of training positions to prevent an oversupply of anaesthetists. The factors which may potentially alter this forecast are addressed and include: change in the general population; ageing of the population; change in the average number of anaesthetics administered per anaesthetist per year; alteration in anaesthetists' working lifespan; change in the age distribution of anaesthetists; increased economic usage of operating theatres and changes in the number of College approved training positions.

Adult↗
PubMed2002

Medical workforce speciality review for genitourinary medicine 2001/2002-England, wales, northern ireland and Scotland.

This document addresses medical workforce needs for the speciality of Genitourinary Medicine (GUM) for the next 10 years. Data on current consultant numbers, working patterns and retirement are based on information from the Royal College of Physicians (RCP) Workforce Unit annual census undertaken on 30 September 2000. Information on specialist registrars is from the JCHMT. Senior house officers (SHO) data are from the RCP's General Professional Training department. Data on Non-Consultant Career Grade Doctors is from the Association of Genitourinary Medicine Survey. Data on incidence of Sexually Transmitted Infections (STIs) are from KC60 returns on STIs collected from GUM clinics by CDSC. There is considerable movement of doctors in GUM between countries in the UK both during progression from SpR to consultant and at consultant level. Data are therefore presented as amalgamated UK data and also by country. It is essential that workforce planning takes this lateral movement into consideration when undertaking calculations for future workforce requirements.

England↗
PubMed2003

Medical workforce speciality review for genitourinary medicine 2002/2003: England, Wales, Northern Ireland and Scotland.

This document is an updated version of that produced in October 2001 and addresses medical workforce needs for the speciality of genitourinary medicine (GUM) for the next 10 years. Data on current consultant numbers, working patterns and retirement are based on information from the Royal College of Physicians (RCP) Workforce Unit annual census undertaken on 30 September 2001. Information on specialist registrars (SpRs) is from the Joint Committee on Higher Medical Training and the GUM Specialist Registrars Group. Senior house officer data are from the RCP's General Professional Training department. Data on non-consultant career grade doctors is from the Association of Genitourinary Medicine Survey and the GUM Non-Consultants Career Grade Group. Data on incidence of sexually transmitted infections (STIs) are from KC60 returns on STIs collected from GUM clinics by the Communicable Diseases Surveillance Centre. There is considerable movement of doctors in GUM between countries in the UK both during progression from SpR to consultant and at the consultant level. Data are therefore presented as amalgamated UK data and also by country (Table 1). It is essential that workforce planning takes this lateral movement into consideration when undertaking calculations for future workforce requirements. The speciality continues to have inadequate consultant numbers and funding is also required to provide adequate number of non-consultant career grade sessions.

Ambulatory Care Facilities↗
PubMed1999

A proposed model for telemedicine to supplement the physician workforce in the USA.

Maldistribution of physicians is the norm in much of the USA. This paper explores the effect that the integration of telemedicine into the health system could have on physician workforce requirements in the USA. The analysis is based on preliminary evidence suggesting that telemedicine is an effective and efficient means of delivering a broad spectrum of health services to medically under-served rural and inner-city communities. While the emphasis here is on interactive, video-based telemedicine services, other telemedicine modalities, such as store-and-forward techniques and remote monitoring, are likely to have a parallel effect. As these new technologies become a normal part of health care, they will reshape the medical workforce and exert a profound influence on physician workforce requirements in the USA. This paper presents a potential model for this reshaped workforce that emphasizes an expanded role for mid-level health-care providers.

Health Workforce↗
PubMed2002

Healthcare workforce data and policy: local decisions and global implications.

The invited essay by Alvarez, Zelmer and Leeb provides baseline information about Canada's healthcare workforce that invites comparison with similar efforts in the United States to collect and analyze workforce numbers, trends and issues. Beyond the basic comparisons, such work also provokes discussion and dialogue about the intersection of workforce data analysis and policy. Examples of the use of data in legislative and regulatory decisions in the United States in general, and California in particular, offer some insight into how workforce data can inform policy decisions and how such decisions can also be influenced by other factors. The possible local and global implications of such policy-making should be considered.

Canada↗
PubMedDate not supplied

Pharmacist participation in the workforce: 1990, 2000, and 2004.

OBJECTIVE: To examine work variables for licensed pharmacists for 1990, 2000, and 2004. DESIGN: Three cross-sectional, descriptive studies. SETTING: United States. PARTICIPANTS: Licensed pharmacists: 1,623 in 1990; 2,092 in 2000; and 1,564 in 2004. These numbers of usable responses to the three respective surveys represented 54.0%, 42.7%, and 33.8% of those receiving surveys. INTERVENTION: Mailed survey from the 2004 National Pharmacist Workforce Survey; data from the national studies of the pharmacist workforce conducted in 1990 and 2000. MAIN OUTCOME MEASURES: Characteristics of pharmacists; work setting, work position and age distribution of actively practicing pharmacists. Work status of licensed pharmacists; proportion actively practicing pharmacy. Proportion of pharmacists working part-time overall and by age group, weekly hours worked by actively practicing pharmacists, and full-time equivalents (FTEs) by age group. Proportion of pharmacists with secondary pharmacy employment; work setting, hours worked, and weeks worked in secondary pharmacy employment. RESULTS: In each year studied, more than 86% of licensed pharmacists were actively practicing pharmacy. In 2004, the largest proportion of actively practicing women pharmacists was between the ages of 31 and 45, and the largest proportion of actively practicing men pharmacists was between the ages of 46 and 60. Across the survey years, the proportion of all actively practicing pharmacists working part-time increased, and the proportion of women working part-time was at least double that of men except in 2004. In 2004, the FTE contribution for women was 0.81 and 0.91 for men. CONCLUSION: The decrease in FTE contributions by all pharmacists and the aging of the male pharmacist population raise concerns about the adequacy of current and future pharmacist supply. As the demand for pharmacists continues to evolve, pharmacy must continue to monitor the pharmacist workforce to show how pharmacists react to changes to better inform projections of the pharmacist workforce.

Adult↗
PubMedDate not supplied

Time-capsule thinking: the health care workforce, past and future.

The size and shape of the U.S. health care workforce are in constant evolution. Using the metaphorical device of a time capsule, this essay examines the past and future of the workforce. It traces the growth, specialization, and diversification of health care workers during the twentieth century, emphasizing the particular expansion of the nonmedical aspects of the workforce. Looking ahead, the paper examines technology, informatics, nursing, provider distribution, and the global migration of health care workers as pivotal issues for the future of the workforce.

Clinical Medicine↗
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↗
PubMedDate not supplied

Occupational therapy workforce needs: a model for demand-based studies.

PURPOSE: To provide a model for assessing occupational therapy workforce needs by using a demand-based approach to determine current workforce status in the Northwest region. Regional information may have implications for addressing national occupational therapy service needs. METHOD: A questionnaire was sent to a proportional random sample of 234 facilities that hire occupational therapy practitioners. Data were collected in July-August 2003 using structured mailing and follow-up procedures. RESULTS: Response rate was 79%. Twenty-four percent reported occupational therapy vacancies and 11% occupational therapy assistant vacancies; 48% predicted an increase in occupational therapy positions in the next 2 years and 41% an increase in occupational therapy assistant positions. Sixty-three percent of respondents reported difficulty in hiring. DISCUSSION: This study identifies an occupational therapy workforce shortage in the Northwest. Management of a shortage is critical, for even short-term adjustments could lead to permanent changes in service provision. This study demonstrates the importance of current information on the status of the national workforce and serves as a model for future studies.

Employment↗
PubMed2007

Workforce trends in specialist and GP obstetric practice in Victoria.

OBJECTIVE: To provide a contemporary picture of the general practitioner and specialist obstetric workforce in Victoria. DESIGN, PARTICIPANTS AND SETTING: Postal census by questionnaire of all 317 Fellows and 961 Diplomates on the Victorian database of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists in September 2003. MAIN OUTCOME MEASURES: Sex, age and geographical distributions and patterns of retirement from and recruitment to the GP and specialist obstetric workforce in Victoria. RESULTS: 244 Fellows (77.0%) and 652 Diplomates (67.8%) participated. The average age of Diplomates was 42 years; only 20% were involved in procedural obstetrics. Of GPs practising procedural obstetrics, 56% intended to cease within 7 years. Two-thirds of specialist obstetricians continued to practise obstetrics. Among those ceasing obstetrics, almost half had done so since 2000. Among Fellows ceasing obstetric practice, there is a peak in the 50-60-years age group, but cessation of obstetric practice occurred across all age groups. CONCLUSION: The proportion of GPs involved in procedural obstetrics has fallen markedly over the past decade, with half of those ceasing practice in the 40-50-years age group. New GPs entering the workforce with the Diploma and overseas doctors are unlikely to meet the procedural workforce shortfall. Attracting the large cohort of doctors aged 40-50 years back to obstetric practice must be a priority. Given the pattern of retirements from obstetrics, there will be insufficient numbers of specialists to maintain current levels of service. The reasons include non-participation in obstetrics by new graduates and international medical graduates, the inadequate number of new graduates, and the predominance of women among specialists aged under 40 years, whose work output tends to be affected by family commitments.

Adult↗