Planning of Polish physician workforce – Systemic inconsistencies, challenges and possible ways forward

Medical education in Poland: a descriptive analysis of legislative changes broadening the range of institutions eligible to conduct medical degree programmes

BACKGROUND

The expansion of medical schools is one of the proposed solutions to shortages in health workforces. Poland has been struggling with limited human resources in healthcare for years. The aim of the study was to provide an analysis of the current situation of medical education in Poland and to describe the impact of the government's ongoing measures to provide a new influx of doctors.

METHODS

A retrospective, cross-sectional study presents a descriptive and comparative analysis of official governmental documents, showing the latest legal amendments, changes in admission limits, and geographical distribution of Higher Educational Institutions (HEIs) for the period of 2013-2023. We referenced the current number of physicians in each voivodship and used a dynamic index to analyse the changes in quotas. We performed statistical tests where needed, considering a p-value < 0.05 to be statistically significant.

RESULTS

The latest legislative changes enabled occupational HEIs to offer MD programmes. The mean distance between the two nearest HEIs decreased between 2013 and 2023. Total admission limits increased by 92.3%, reaching 10,289 available spots in 2023. The dynamic index was higher for quotas in private HEIs than in public institutions. The index was comparable, regardless of the teaching language. The number of students positively correlated with the number of physicians working in each voivodship.

CONCLUSIONS

This study highlights the uncontrolled expansion of medical education in Poland, driven by workforce demands but lacking a long-term strategy. Legislative inconsistencies hinder regulation, while new medical schools in rural areas may improve regional healthcare if properly planned. Recent policy changes emphasize the need for a national strategy based on demographic data and healthcare needs. Strengthening accreditation and quality control is crucial for sustainable medical education reform.

Working life expectancy of physicians: the case of primary care physicians in Czechia

BACKGROUND

The decrease in the number of healthcare workers and the resulting deterioration in healthcare quality and availability have been subjected to intensive discussion in Czechia in recent years. Estimating future healthcare worker capacities requires a detailed analysis of their "movement" within the healthcare system. This study focuses on exits of the primary care physicians from the healthcare system in Czechia.

METHODS

Using anonymised data obtained from the largest Czech health insurance company (2012-2022), we constructed working life tables and calculated working life expectancy, which indicates the expected average number of remaining years of work at the exact age of the physician. The study focuses on primary care physicians, who are crucial for the effective functioning of the healthcare system.

RESULTS

At age 50, working life expectancy was 20 years for female physicians and approximately 21 years for male physicians. Over the monitored period, working life expectancy decreased by 1 year for both genders. Gynaecologists had the longest working life expectancy, while dentists had the shortest.

CONCLUSIONS

The decrease in the working life expectancy and the length of tenure indicates the need to create favourable conditions for the extension of the working lives of physicians to avoid early exits from the system.

Are Polish doctors ready to start working right after graduation? The 2023 modification to physicians' postgraduate internship and possible paths forward

The Polish healthcare system faces many problems, among which the shortage of healthcare professionals is one of the most urgent. In less than ten years, more than twenty Higher Education Institutions (HEIs) have been allowed to add medical programmes to their offer, aiming to increase the number of doctors in Poland. Recently, the healthcare system was faced with a proposal to abolish the mandatory postgraduate internship which has been a mandatory component of medical training for years. Two main reforms were considered. The first one focused on the programme of the internship and aimed to update it. The second one recommended an abolition of the internship. The authors of this article analysed the opinions and positions of key players within the system regarding the postgraduate internship. Opinions in this regard are diverse, leading to the conclusion that additional actions would be required prior to the internship abolition. Undergraduate training has changed and currently students are taught in modern facilities, using new teaching methods. On the other hand, internship allows trainees to improve or even acquire skills they may not have obtained during their studies. The postgraduate internship is an essential part of doctors' training. However, in Poland, there is still a lack of a well-thought, long-term policy or strategy for physicians' workforce development. Our study presents a Polish perspective on common challenges in medical training and workforce policy, highlighting the clash over the growing demand for physicians and the limitations of the existing system.

Lithuanian physicians practising abroad: Reasons to leave and conditions to return to Lithuania. A survey

This study aimed to assess the factors of emigration and return among Lithuanian doctors practicing abroad. A call for participation in an online survey was distributed via social media. Questions covered demographics, reasons to emigrate and factors that would favor returning to practice in Lithuania. Survey data were analysed with appropriate statistical methods. Out of 465 respondents, the majority (453/465, 97.4%) work in Europe. The majority (334/465, 71.8%) were women, and 304/465 (65.4%) were trainees (residents). The top three factors to emigrate from and come back to Lithuania were: economic reasons, perceived corruption and the work environment. Most respondents listed more than two factors to emigrate and return (>70% in each category). Out of all respondents, 230 (49.5%) reported an attractive net monthly salary for a full-time post in Lithuania to be >3500 EUR; 173/465 (37.2%) respondents declared intention of not returning to practice in Lithuania. There were statistically significant gender- and training level-related differences in emigration factors. In conclusion, doctors' reasons for leaving and returning to practice in Lithuania are multifactorial, with economic and non-economic circumstances prompting them to choose to work in another country.

Is AI Augmenting or Substituting Humans?

In this paper, the authors focus on Artificial Intelligence as a tangible technology that is designed to sense, comprehend, act, and learn. There are two manifestations of AI in the medical service: an algorithm that analyzes and interprets the test result and a virtual assistant that communicates the result to the patient. The aim of this paper is to consider how AI can substitute a doctor in measuring human health and how the interaction with virtual assistant impacts one’s visual attention processes. Theoretically, the article refers to the following research strands: Human-Computer Interaction, technology in services, implementation of AI in the medical sector, and behavioral economy. By conducting an eye-tracking experimental study, it is demonstrated that the perception of medical diagnosis does not differ across experimental groups (human vs. AI). However, it is observed that participants exposed to AI-based assistant focused more on button allowing to contact a real doctor.

Financing Healthcare in Central and Eastern European Countries: How Far Are We from Universal Health Coverage?

After the fall of communism, the healthcare systems of Central and Eastern European countries underwent enormous transformation, resulting in departure from publicly financed healthcare. This had significant adverse effects on equity in healthcare, which are still evident. In this paper, we analyzed the role of government and households in financing healthcare in eight countries (EU-8): Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Slovenia. A desk research method was applied to collect quantitative data on healthcare expenditures and qualitative data on gaps in universal health coverage. A linear regression analysis was used to analyze a trend in health expenditure over the years 2000–2018. Our results indicate that a high reliance on out-of-pocket payments persists in many EU-8 countries, and only a few countries have shown a significant downward trend over time. The gaps in universal coverage in the EU-8 countries are due to explicit rationing (a limited benefit package, patient cost sharing) and implicit mechanisms (wait times). There is need to increase the role of public financing in CEE countries through budget prioritization, reducing patient co-payments for medical products and medicines, and extending the benefit package for these goods, as well as improving the quality of care.

Testicular cancer incidence predictions in Europe 2010-2035: A rising burden despite population ageing

Testicular cancer is the most common cancer among young men of European ancestry, with about one-third of all cases occurring in Europe. With the historically increasing trends in some high-incidence populations reported to have stabilised in recent years, we aimed to assess recent trends and predict the future testicular cancer incidence burden across Europe. We extracted testicular cancer (ICD-10 C62) incidence data from Cancer Incidence in Five Continents Volumes VII-XI and complemented this with data published by registries from 28 European countries. We predicted cancer incidence rates and the number of incident cases in Europe in the year 2035 using the NORDPRED age-period-cohort model. Testicular cancer incidence rates will increase in 21 out of 28 countries over the period 2010-2035, with trends attenuating in the high-incidence populations of Denmark, Norway, Switzerland and Austria. Although population ageing would be expected to reduce the number of cases, this demographic effect is outweighed by increasing risk, leading to an overall increase in the number of cases by 2035 in Europe, and by region (21, 13 and 32% in Northern, Western and Eastern Europe, respectively). Declines are however predicted in Italy and Spain, amounting to 12% less cases in 2035 in Southern Europe overall. In conclusion, the burden of testicular cancer incidence in Europe will continue to increase, particularly in historically lower-risk countries. The largest increase in the number of testicular cancer patients is predicted in Eastern Europe, where survival is lower, reinforcing the need to ensure the provision of effective treatment across Europe.

Inequality in the Distribution of Healthcare Human Resources in Poland

Human resources are the major input in health systems. Therefore, their equitable distribution remains critical in making progress towards the goal of sustainable development. The purpose of this study is to evaluate equity in the distribution of healthcare human resources across regions of Poland from 2010 to 2017. This research by applying specifically to Polish conditions will allow the existing gap in the literature to be closed. Data were derived from the Database of Statistics Poland, and the Lorenz Curve/Gini coefficient was engaged as well as the Theil index to measure the extent and drivers of inequality in the distribution of healthcare human resources in macro-regions. Population size along with crude death rates are employed as proxies for healthcare need/demand. This research has several major findings. Mainly, it was found, that the geographical distribution of all types of human resources is less equitable than is the case with population distribution. Relatively lower equity in the access to oncologists, family doctors, and cardiologists was found. There are some noticeable differences between macro-regions in the equity level of healthcare human resources distribution. This research provides various implications for policy and practice and will allow for improved planning and more efficient use of these resources.

A systematic review of the health-financing mechanisms in the Association of Southeast Asian Nations countries and the People's Republic of China: Lessons for the move towards universal health coverage

We systematically review the health-financing mechanisms, revenue rising, pooling, purchasing, and benefits, in the Association of Southeast Asian Nations (ASEAN) and the People’s Republic of China, and their impact on universal health coverage (UHC) goals in terms of universal financial protection, utilization/equity and quality. Two kinds of sources are reviewed: 1) academic articles, and 2) countries’ health system reports. We synthesize the findings from ASEAN countries and China reporting on studies that are in the scope of our objective, and studies that focus on the system (macro level) rather than treatment/technology specific studies (micro level).The results of our review suggest that the main sources of revenues are direct/indirect taxes and out of pocket payments in all ASEAN countries and China except for Brunei where natural resource revenues are the main source of revenue collection. Brunei, Indonesia, Philippines, Malaysia, and Viet Nam have a single pool for revenue collection constituting a national health insurance. Cambodia, China, Lao, Singapore, and Thailand have implemented multiple pooling systems while Myanmar has no formal arrangement. Capitation, Fee-for-Service, DRGs, Fee schedules, Salary, and Global budget are the methods of purchasing in the studied countries. Each country has its own definition of the basic benefit package which includes the services that are perceived as essential for the population health. Although many studies provide evidence of an increase in financial protection after reforming the health-financing mechanisms in the studied countries, inequity in financial protection continue to exist. Overall, the utilization of health care among the poor has increased as a consequence of the implementation of government subsidized health insurance schemes which target the poor in most of the studied countries. Inappropriate policies and provider payment mechanisms impact on the quality of health care provision. We conclude that the most important factors to attain UHC are to prioritize and include vulnerable groups into the health insurance scheme. Government subsidization for this kind of groups is found to be an effective method to achieve this goal. The higher the percentage of government expenditure on health, the greater the financial protection is. At the same time, there is a need to weigh the financial stability of the health-financing system. A unified health insurance system providing the same benefit package for all, is the most efficient way to attain equitable access to health care. Capacity building for both administrative and health service providers is crucial for sustainable and good quality health care.

Workforce requirements in rheumatology: a systematic literature review informing the development of a workforce prediction risk of bias tool and the EULAR points to consider

OBJECTIVE

To summarise the available information on physician workforce modelling, to develop a rheumatology workforce prediction risk of bias tool and to apply it to existing studies in rheumatology.

METHODS

A systematic literature review (SLR) was performed in key electronic databases (1946-2017) comprising an update of an SLR in rheumatology and a hierarchical SLR in other medical fields. Data on the type of workforce prediction models and the factors considered in the models were extracted. Key general as well as specific need/demand and supply factors for workforce calculation in rheumatology were identified. The workforce prediction risk of bias tool was developed and applied to existing workforce studies in rheumatology.

RESULTS

In total, 14 studies in rheumatology and 10 studies in other medical fields were included. Studies used a variety of prediction models based on a heterogeneous set of need/demand and/or supply factors. Only two studies attempted empirical validation of the prediction quality of the model. Based on evidence and consensus, the newly developed risk of bias tool includes 21 factors (general, need/demand and supply). The majority of studies revealed high or moderate risk of bias for most of the factors.

CONCLUSIONS

The existing evidence on workforce prediction in rheumatology is scarce, heterogeneous and at moderate or high risk of bias. The new risk of bias tool should enable future evaluation of workforce prediction studies. This review informs the European League Against Rheumatism points to consider for the conduction of workforce requirement studies in rheumatology.

Satisfaction of Physicians Working in Polish Hospitals-A Cross-Sectional Study

Physician satisfaction is a multidimensional concept associated with numerous factors. The objectives of the study were to evaluate the satisfaction of physicians practicing in hospitals in Poland and to identify factors associated with higher levels of satisfaction. A quantitative, cross-sectional survey of Polish hospitals was conducted between March and June 2018. All doctors working in the hospitals invited to the study were asked to fill in an online survey. Fifteen hospitals were included: seven general, five specialist, and three university ones. The total number of questionnaires analyzed was 1003. The questionnaire included 17 items to measure the level of satisfaction, classified into four dimensions: personal, professional, performance, and inherent. The statistical analyses included: assessment of association between levels of career satisfaction and basic demographic and work-related variables; and multivariable logistic regressions, conducted to determine which variables were associated with higher levels of career satisfaction. The mean level of career satisfaction, on a scale from 1 to 6, was 4.1 (SD = 0.69). Respondents reported high levels of inherent satisfaction: mean = 4.4 (SD = 0.66) and a low personal satisfaction: mean = 3.78 (SD = 0.98). 56.6% of respondents reported being satisfied, but only 8.2% reported a higher level of satisfaction (≥5). The satisfaction of Polish physicians is moderate. Gender, numbers of working hours/week, years of work experience, type of hospital, and stage of professional development were the identified factors associated with higher levels of career satisfaction.

Factors Associated with Satisfaction of Hospital Physicians: A Systematic Review on European Data

BACKGROUND

Physician satisfaction is a multidimensional concept related to many factors. Despite the wide range of research regarding factors affecting physician satisfaction in different European countries, there is a lack of literature reviews analyzing and summarizing current evidence. The aim of the article is to synthetize the literature studying the factors associated with physician satisfaction.

METHODS

We searched: MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Library from January 2000 to January 2017. The eligibility criteria included: (1) target population: physicians working in European hospitals; (2) quantitative research aimed at assessing physician satisfaction and associated factors; (3) use of validated tools. We performed a narrative synthesis.

RESULTS

After screening 8585 records, 368 full text articles were independently checked and finally 24 studies were included for qualitative analysis. The included studies surveyed 20,000 doctors from 12 European countries. The tools and scales used in the analyzed research to measure physician satisfaction varied to a large extent. We extracted all pre-specified factors, reported as statistically significant/non-significant. Analyzed factors were divided into three groups: personal, intrinsic and contextual factors. The majority of factors are modifiable and positively associated with characteristics of contextual factors, such as work-place setting/work environment. In the group of work-place related factors, quality of management/leadership, opportunity for professional development and colleague support have been deemed statistically significant in numerous studies.

CONCLUSIONS

We identified more studies appraising the effect of contextual factors (such as work environment, work-place characteristics), highlighting a positive association between those factors and physician satisfaction, compared with personal and intrinsic factors. Numerous studies confirmed statistically significant associations between physician satisfaction and quality of management, professional development and colleague support/team climate. Due to the health workforce crisis, knowledge regarding physician satisfaction and associated factors is essential to healthcare managers and policy makers for more stable human resources management.

If You Build It, Will They Come? An Analysis of Candidate Attitudes Toward A New Residency Program

This article was migrated. The article was marked as recommended. Background: To address looming healthcare workforce shortages, the Association of American Medical Colleges (AAMC) has recommended a substantial increase in residency positions. However, new residency programs face unique recruitment challenges. Objective: To identify new program characteristics and recruitment practices that most influence candidate-ranking decisions. Methods: In a post-match survey, applicants who interviewed during the first two recruitment seasons of a new program were asked to rate program characteristics and recruitment techniques regarding the effects they had on ranking decisions, and to describe the most attractive and concerning features. Somers' D directional coefficients were calculated to determine the correlation between applicants' ranking of the program and ranking of survey items. Qualitative responses were analyzed as word clouds. Results: 163/349 surveys were returned (47%). The strongest correlating items included the opportunities to work closely with faculty, to help shape a new program, and to be one of the first graduates. Influential recruitment practices included program communications and website vividness. Concerns included lack of senior residents, fear of unforeseen difficulties, and no evidence of outcomes. Conclusion: New programs have unique features that influence candidates' ranking decisions. Recruitment practices should be designed to identify candidates who embrace the unique opportunities of a new program.

Impact of the doctor deficit on hospital management in Poland: A mixed-method study

OBJECTIVES

The primary objective was to assess the scale and consequences of the doctor deficit in Poland with the main focus on hospital care providers. To provide the background for the above, an analysis of the system level responses to the problem was also conducted.

DATA AND METHODS

A mixed-method approach was used. We triangulated data collected using 3 methods: (1) a literature review, (2) an analysis of the national statistical databases, and (3) in-depth interviews with hospital managers.

RESULTS

Poland is characterized by the lowest number of physicians per 1000 population in the European Union (2.3 in 2015). Also, the age structure of the doctor working population constitutes an alarming factor (in 2015, approx. 48% of all practicing doctors and 61% of specialists were above 50). In recent years, numerous hospitals were forced to cease provision of specific services and/or close wards due to the doctor deficit. The high competition in employing doctors and pressure for wage increases puts hospital managers in situations where they must often choose between securing service provision (by offering higher wages for doctors) and maintaining the hospital's positive financial outcome (by containing costs).

CONCLUSION

In Poland, the long-term neglect of health workforce planning at the system level (there is neither a dedicated structure nor a formal strategy) has contributed to the current doctor deficit crisis. From the hospital managers' perspective, who are on the frontline of the problem impact, urgent solutions are needed that would at least alleviate its scale in the short term.

Migration intentions of Lithuanian physicians, nurses, residents and medical students

Due to a flow of healthcare professionals and students from emerging to industrialized economies, healthcare systems in source countries are facing increasing threats to a people-centered quality of care. This study investigates the prevalence and underlying reasons for emigration intentions among physicians, nurses, residents, and medical students in Lithuania (total N = 1080). In our sample, 39% of students, 21% of residents, 12% of nurses, and 6% of physicians had decided to emigrate within the next two years. Based on statistical analyses of the survey data, we conclude that emigration decisions are linked to socio-demographic (age, gender, family situation), financial, organizational (teamwork climate in hospital) and social (perceived social worth) factors. Implications for policy-making and retention of healthcare workforce are discussed.