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Nurse anesthesia manpower needs over a 20-year period from 1990 through 2010 are examined using data from a study conducted by Health Economics Research, Inc., which was submitted to Congress in February 1990. Two scenarios were considered: one representing no change in the capacity of the educational system and the other an annual increase. Under either scenario, the U.S. faces a significant shortage of CRNAs, now and in the future. The study points to a $1.2 billion savings to society through the increased use of CRNAs in anesthesia care.
Medical manpower is ordinarily expressed as a ratio of the number of physicians (e.g., neurosurgeons) to the population of the geographic area (e.g., country). The many other factors that go into assessing medical manpower needs and the manner in which those factors may vary from one country to another and from one time to another are described. Despite the paucity of physicians in some countries and in some parts of the world, there is a suplus of physicians worldwide.
Infectious disease-trained internal medicine physicians responding to a questionnaire survey (n = 1802) reported minor differences in time spent in patient care versus laboratory-based research whether they subsequently became practitioners or academicians. Both practitioners and academicians ranked hospital epidemiology first, followed by knowledge of hospital antibiotic policies in order of importance for new trainees to be taught. Internists with greater than 12 months of training in infectious diseases were divided into private practice versus academically based groups, and their distribution of time spent in various professional activities was analyzed by 5-year intervals for each cohort. These studies confirmed an increasing proportion of time spent in infectious disease-related patient care for new practitioners. Over time, patient care activities decreased and administrative activities increased in all groups. These data are important for estimating future manpower needs.
Current projections for ophthalmology manpower needs in the year 2000 suggest that the number of new ophthalmologists trained should be frozen at 500 a year. Factors that would cause a need to train more ophthalmologists would be a shorter workweek or workyear, an increased length of time for each patient visit, universal comprehensive health insurance, an earlier age of retirement, and an increased incidence of eye disease. The factor that would most likely reduce the need for new ophthalmologists would be the transfer of primary eye care delivery to nonophthalmologists. Modulation of resident numbers should be based on peer-judged program quality, not on geography or government edict.
A new survey of manpower requirements in the community hospital and private laboratory practice of pathology has been completed and analyzed. The survey used a new instrument, the National Pathology Manpower Database, which will be useful in conducting longitudinal surveys. This instrument will permit organized pathology to monitor changes in pathology manpower needs in the years ahead, which are likely to be fraught with change. The results of this survey foretell a significant deficit of pathologists in community hospital and private laboratory practice within the next five years.
Maldistribution with respect of medical practice location and specialty continues to present barriers to quality care for many Americans. Residents of rural communities in Colorado often lack access to health care services appropriate in number and nature to their needs. A valid determination of the severity of inaccessibility of medical care is a prerequisite to effective programming for alleviating the problem. Any such needs assessment must be predicated on the use of a reliable, detailed physician manpower data base. Physician data used in evaluating the adequacy of health care delivery systems serving small or sparsely populated rural areas have traditionally proved inadequate, causing loss of credibility in the findings derived from those efforts. A concerted attempt was made in rural Colorado to establish a physician inventory for identifying health manpower shortage areas and assessing the degree of medical underservice. This undertaking was organized and directed by staff members of the Statewide Educational Activities for Rural Colorado's Health (SEARCH) program, the area health education center program of the University of Colorado Health Sciences Center. Cooperative Health Statistics Systems (CHSS) physician data, collected in an annual survey conducted by the Colorado Department of Health, were determined to be exceptionally accurate in describing the physician manpower practicing in the State's federally designated medically underserved counties. CHSS proved to be an outstanding source of physician data upon which small area manpower needs assessment can be based for the purpose of designating medically underserved or health manpower shortage areas.
In response to the needs both to develop new, nonduplicative alcoholism services and to contain cost, and in order to plan for the labor-intensive alcoholism treatment system, planning techniques are needed to assist in the rational planning for and allocation of manpower. Using data from the 1980 National Drug and Alcoholism Treatment Utilization Survey, it is possible to analyze the staffing patterns of various modalities of alcoholism treatment. Two regression equations were developed to identify key variables for predicting manpower needs in various facilities. Budget, service type, and treatment capacity were statistically significant predictions of direct-care FTE staff in inpatient/residential units. The best predictive ability for direct-care FTE staff in detoxification and longer-term residential facilities was obtained with a general regression model which was based on all types of services (e.g., detoxification, longer-term residential, and outpatient). For outpatient settings, however, direct-care FTE staff was best predicted by considering budgets and treatment capacities within outpatient settings only. Based on this study, a planner can predict, with reasonable confidence, FTE direct-care staff by varying the values of the independent variables in the regression equation to reflect the various characteristics of the services being planned.
To estimate the number of full-time-equivalent (FTE) physicians and geriatricians needed to provide medical care in the years 2000 to 2030, we developed utilization-based models of need for non-surgical physicians and need for geriatricians. Based on projected utilization, the number of FTE physicians required to care for the elderly will increase two- or threefold over the next 40 years. Alternate economic scenarios have very little effect on estimates of FTE physicians needed but exert large effects on the projected number of FTE geriatricians needed. We conclude that during the years 2000 to 2030, population growth will be the major factor determining the number of physicians needed to provide medicare care; economic forces will have a greater influence on the number of geriatricians needed.
The future need for dermatologists is difficult to predict, as it depends on the structure of our health care delivery system, which is still rapidly evolving, and whose future shape is unknown. The best strategy to deal with this unpredictable situation is to de-emphasize trying to predict the future and focus on responding as rapidly as possible to whatever changes in dermatologic manpower needs the future may bring. From that perspective, it is best to train fewer rather than more dermatologists, as it is much quicker to rectify a shortage than an excess in medical manpower. Other issues that impact on dermatologist manpower include a very rapid increase in nonphysicians taking care of skin diseases, the maldistribution of dermatologists, the decreasing proportion of common skin diseases treated by dermatologists, and the need to upgrade the residency training to master the explosion in medical knowledge which has occurred, and to gain a greater expertise in the medical and cosmetic aspects of the specialty.
One of the value statements of the American College of Emergency Physicians states that, "Quality Emergency Medicine is best practiced by qualified, credentialed emergency physicians." To address this value ACEP has established the following goal: "The number of board-certified physicians will be sufficient to meet the manpower needs of the public." It is the position of ACEP that there is currently a severe shortage of appropriately trained and certified emergency physicians and, moreover, that the shortage will continue well into the next century. We discuss how ACEP arrived at this position and the role of academic emergency medicine in addressing this shortage. For many years, there has been a public debate as to whether there is a physician shortage or surplus. The Graduate Medical Education National Advisory Commission report of 1980 estimated that there would be 630,000 US physicians by 1990, with a surplus of 70,000. This report also identified emergency medicine as a shortage specialty, indicating there would be a need for 14,000 emergency physicians in 1990, with a supply of only 8,000. Schwartz included such factors as increased provision of administrative and research activity by physicians and concluded that there would be a shortage of 7,000 physicians by the year 2,000.
A survey of manpower supply and need in academic pathology departments was conducted by the Joint Task Force on Pathology Manpower of the College of American Pathologists, the American Society of Clinical Pathologists, and the Association of Pathology Chairmen by means of questionnaires distributed to chairmen and faculty of all departments of pathology and laboratory medicine in the United States. Of the 136 departments, responses were obtained from 131 (96%) chairmen and from 1,561 (45%) faculty members. The current total need for faculty members (funded vacant positions) is 272, and the projected aggregate need over the next five years is 693 members for new and replacement positions. The greatest needs are for research MD pathologists and surgical pathologists, followed by autopsy and chemical pathologists. Based on the estimate of current pathology trainees planning academic careers, there is a strong indication that the projected supply of MD pathologists is significantly less than the anticipated demand.
Using a formula developed by the State of Kentucky and the best data available for the State of Tennessee, it is estimated that this state currently has a slight oversupply of dentists, but that by the turn of the century this will have become a shortage. There is no reason to doubt these estimates except that for confidence in them we will need state-specific data on the supply of dental manpower, the need for dental care, and the demand for dental care. Following the recommendations of the Institute of Medicine and others, the College of Dentistry has initiated the Dental Manpower Project to develop and maintain a database which will allow Tennessee to forecast and monitor trends in the supply of dental personnel and factors affecting need and demand. Hopefully, such an activity will help us avoid mistakes like those made 25 to 30 years ago which resulted in the education of too many dentists nationwide (and in this state) and an unfortunate breach between practitioners and dental education.
Population-to-practitioner ratios have long been the primary index in the designation of health manpower shortage areas. This paper documents that application of the widely used population-to-dentist index results in understatement of the need for dental health manpower in rural areas. Through the analysis of utilization data collected from a statewide health screening program in Colorado, the practice of sole reliance on the population-to-dentist indices as an indicator of need was tested. Another measure, the area-(square miles) to-dentist ratio was formulated, examined, and found to be a more useful referent of the need for additional health manpower in rural areas. Utilization of dental services in sparsely settled rural counties of Colorado was unrelated to population-to-dentist ratios. A strong, statistically significant association of utilization with land area-to-dentist ratios was found. The findings of this analysis suggest a need for reevaluation of needs assessment methodologies used in the designation of health manpower shortage areas. Indices more sensitive to consumer circumstance than to the number of health care providers available must be considered.
A Joint Working Group of the WHO and FDI was formed in 1981 to investigate the dramatic decrease in caries in children and young people that had been observed in a number of industrialized countries in the 1970s. The results of this investigation are reported in this series of three articles. Parts 1 and 2 described the assembly and analysis of all available data on the decrease, and identified the widespread availability of fluoride toothpaste as the most probable cause. Inevitably in developed countries with declining caries incidence there will be a decreased need for dental services, and hence a change in the need for dental personnel. This third article will examine the likely effects on staffing needs and outline a suggested methodology for manpower planning. The lack of adequate data makes prediction a precarious procedure, and this review indicates the urgent need for regular dental health monitoring and better manpower planning in all countries.
By means of a set of questionnaires, the Joint ASCP/CAP Task Force on Manpower survey of fact and opinion regarding manpower problems and needs of pathology in the United States was completed. The response from pathologists approached 75%. From this survey, there appears to emerge an accurate picture of the number of pathologists in solo or group practice in the United States in terms of board certification and age group; so that over a five-year period, there will be a net addition of approximately 1,800 pathologists from 500--700 residents completing their training annually. This survey showed a demand of 22% of pathology practices seeking to fill funded positions with a projected need within the next five years of approximately 2,700 to meet primarily expanded patient loads. The number of pathologists in the graduate medical education "pipeline" revealed 2,153 residents with about 76% of the residency positions filled. A match of approximately 2,153 residents entering pathology practice against 2,160 vacancies anticipated in the next four years was identified. However, it is likely that there will continue to be a modest deficit of pathologists five years from now in view of the possibility that not all will enter practice. In conclusion, the demand for pathologists and supply from residency programs seem to match well in numbers so that supply and demand for pathology manpower are in approximate balance.
The survey of manpower in community hospital and private laboratory practice of pathology of 1988 presented herein verifies the conclusions of the 1986 survey that a growing deficit of manpower in this sphere of practice is highly likely in the next few years. It appears that the deficit will be even larger than that predicted by the 1986 survey. Steps are urgently needed to increase the flow of graduating medical students, especially those of top quality, into our specialty.
Research findings from various countries in West Africa clearly indicate that over 94 per cent of the adult population above 40 years of age suffer from periodontal disease in various degrees of severity. Those living in rural areas in West Africa, where dental health care services are not yet available, suffer more from this common disease. With progressive urbanization and changes in diet and eating habits, consumption of refined sugars is rising steeply (Table II) and dental caries has become a serious problem particularly in children from high socioeconomic homes. In Nigeria, DMF of 4-3 in the female and 3-9 in the male has been reported. There is general paucity of all cadres of dental manpower in all areas in West Africa. Dentist: population ratios range from 1 : 111,000 in Senegal to 1 : 1,935,000 in Tchad Republic (Table I). In Senegal, Ghana and Nigeria, Dental schools have been established and attempts are being made to meet the pressing need for dental manpower by the expansion of existing treatment centres and training institutions and the establishment of new ones (Table IV & V). Emphasis is laid on preventive dental health care programmes and the formal training of dental auxiliary personnel: Dental Therapists, Dental Hygienists, Dental Technicians and Dental Surgery Assistants, is taking place in Nigeria and Senegal. Dental Nurses/Therapists and Dental Hygienists if adequately trained in sufficient numbers can play an all-important role in the delivery of dental care and the execution of preventive programmes in the vast rural areas in the developing countries of West Africa with a population of over 122 million people.