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Xu X, Huang J, Zhao X, Luo Y, Wang L, Ge Y, Yu X, Zhu P. Trends in the mobility of primary healthcare human resources in underdeveloped regions of western China from 2000 to 2021: Evidence from Nanning. BMC Prim Care 2024; 25:154. [PMID: 38711072 PMCID: PMC11071274 DOI: 10.1186/s12875-024-02403-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/23/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE This research aimed to identify the fundamental and geographic characteristics of the primary healthcare personnel mobility in Nanning from 2000 to 2021 and clarify the determinants that affect their transition to non-primary healthcare institutions. METHODS Through utilizing the Primary Healthcare Personnel Database (PHPD) for 2000-2021, the study conducts descriptive statistical analysis on demographic, economic, and professional aspects of healthcare personnel mobility across healthcare reform phases. Geographic Information Systems (QGIS) were used to map mobility patterns, and R software was employed to calculate spatial autocorrelation (Moran's I). Logistic regression identified factors that influenced the transition to non-primary institutions. RESULTS Primary healthcare personnel mobility is divided into four phases: initial (2000-2008), turning point (2009-2011), rapid development (2012-2020), and decline (2021). The rapid development stage saw increased mobility with no spatial clustering in inflow and outflow. From 2016 to 2020, primary healthcare worker mobility reached its peak, in which the most significant movement occurred between township health centers and other institutions. Aside from their transition to primary medical institutions, the primary movement of grassroots health personnel predominantly directs towards secondary general hospitals, tertiary general hospitals, and secondary specialized hospitals. Since 2012, the number and mobility distance of primary healthcare workers have become noticeably larger and remained at a higher level from 2016 to 2020. The main migration of primary healthcare personnel occurred in their districts (counties). Key transition factors include gender, education, ethnicity, professional category, general practice registration, and administrative division. CONCLUSIONS This study provides evidence of the features of primary healthcare personnel mobility in the less developed western regions of China, in which Nanning was taken as a case study. It uncovers the factors that impact the flow of primary healthcare personnel to non-primary healthcare institutions. These findings are helpful to policy refinement and support the retention of primary healthcare workers.
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Affiliation(s)
- Xinyi Xu
- School of Humanities and Social Sciences, Guangxi Medical University, Nanning, China
| | - Jingyi Huang
- School of Humanities and Social Sciences, Guangxi Medical University, Nanning, China
| | - Xiaoqian Zhao
- School of Humanities and Social Sciences, Guangxi Medical University, Nanning, China
| | - Yumin Luo
- School of Humanities and Social Sciences, Guangxi Medical University, Nanning, China
| | - Linxuan Wang
- School of Humanities and Social Sciences, Guangxi Medical University, Nanning, China
| | - Yishan Ge
- School of Humanities and Social Sciences, Guangxi Medical University, Nanning, China
| | - Xingyin Yu
- School of Humanities and Social Sciences, Guangxi Medical University, Nanning, China
| | - Pinghua Zhu
- School of Humanities and Social Sciences, Guangxi Medical University, Nanning, China.
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Zuzelo PR. Promoting Clinician Health: Exploring the National Plan for Health Workforce Well-Being. Holist Nurs Pract 2024; 38:182-183. [PMID: 38709134 DOI: 10.1097/hnp.0000000000000647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
- Patti Rager Zuzelo
- Author Affiliation: Associate Dean for Academic Nursing Programs; College of Nursing and Health Professions, Drexel University, Philadelphia, PA
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Hayter CM, Allison S, Bastiampillai T, Kisely S, Looi JCL. The changing psychiatry workforce in Australia: Still lacking in rural and remote regions. Aust J Rural Health 2024; 32:332-342. [PMID: 38419201 DOI: 10.1111/ajr.13092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION There is a long standing and worsening shortage of psychiatrists in Australia particularly in rural areas. The majority of psychiatrists work in major cities. OBJECTIVE To identify recent trends in the Australian rural psychiatrist workforce compared with the metropolitan workforce. DESIGN We descriptively analysed population-level data from the National Health Workforce Data Set (NHWDS), the Australian Institute of Health and Welfare (AIHW) and the Australian Bureau of Statistics (ABS). A descriptive analysis of the numbers (count) and gender of psychiatrists from 1995 to 2022 working in Australia was conducted. For the period 2013 to 2022, we analysed for rurality, gender, years' experience, hours worked, Medicare-subsidised services provided and proportions of Specialist International Medical Graduates (SIMG) by sex, with a focus on the rural workforce. For international comparison, psychiatrist numbers were obtained for other OECD countries. The number of psychiatrists working in Australia, as per NHWDS and AIHW, was quantified. We analysed trends in demographics, hours worked and rurality of psychiatrists working in Australia in a serial cross-sectional design. FINDINGS Most psychiatrists are maldistributed to major cities, while outer regional and remote areas have few resident psychiatrists. Outer regional New South Wales (NSW) and South Australia (SA) have the lowest numbers of psychiatrists per capita. The full-time equivalent (FTE) of psychiatrists per 100 000 has increased from 12.6 in 2000 to 15.2 in 2022. However, the average hours worked by psychiatrists has declined. In total, available psychiatrist hours worked per 100 000 population has increased by 6.1% since the beginning of the millennium. DISCUSSION Rural areas in NSW and SA have the greatest shortage of psychiatrists. Specialist International Medical Graduates and females (43% of the overall workforce) are the predominant workforce in rural areas. Although Medicare-subsidised services per 1000 people have increased in rural areas, they remain lower than for those living in major cities. CONCLUSION There remains an acute shortage of psychiatrists in many regional and remote areas of Australia, with an increasing proportion of SIMGs and females working in these areas, in the context of future increased demand.
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Affiliation(s)
- Catherine Mary Hayter
- Mental Health, Justice Health, Alcohol and Drug Services, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Stephen Allison
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, Australian Capital Territory, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, Australian Capital Territory, Australia
- Discipline of Psychiatry, Monash University, Melbourne, Victoria, Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, Australian Capital Territory, Australia
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, Queensland, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
| | - Jeffrey C L Looi
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, Australian Capital Territory, Australia
- Academic Unit of Psychiatry and Addiction Medicine, Canberra Hospital, The Australian National University School of Medicine and Psychology, Canberra, Australian Capital Territory, Australia
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Lum ZC, Dennison S, Le HV, Bayne CO, Lee CA. Trends in Orthopaedic Surgery Workforce Diversity: Analyzing Changes Over Time. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202404000-00019. [PMID: 38648423 PMCID: PMC11037730 DOI: 10.5435/jaaosglobal-d-24-00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/11/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION There are many reasons why orthopaedic surgeons move or change careers. We asked the questions: (1) What is the geographic distribution of orthopaedic surgeons with respect to age, sex, and race and ethnicity? (2) How has our workforce changed over time with regard to these factors? (3) Are there any patterns or trends detected regarding policy or regulatory events that coincide with these differences? METHODS The American Academy of Orthopaedic Surgeons surveys over 30,000 members, collecting data on demographics, age, race sex, and practice statistics. We calculated geographic distributions and evaluated these differences over time-potential influences from malpractice suits or tort reform were investigated. RESULTS Overall surgeon density increased over time. The largest negative changes were noted in District of Columbia, Wyoming, and North Dakota and positive changes in Colorado, South Dakota, and West Virginia. Age across all states increased (mean 1.7 years). Number of female surgeons increased in most states (4.6% to 5.7%). Number of African Americans increased from 1.6% to 1.8%, Hispanic/LatinX from 1.8% to 2.2%, Asian from 5.5% to 6.7%, and multiracial from 0.8% to 1.2%. No change was noted in the percentage of Native American surgeons. DISCUSSION Surgeon density increased from 2012 to 2018; the cause for this change was not evident. Small increases in surgeon population, female surgeons, and in some underrepresented minorities were seen.
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Affiliation(s)
- Zachary C. Lum
- From the Department of Orthopaedic Surgery, School of Medicine, University of California, Davis Health System, Sacramento, CA (Dr. Lum, Dr. Le, Dr. Bayne, and Dr. Lee); the Nova Southeastern University, the Kiran C Patel School of Osteopathic Medicine, Fort Lauderdale, FL (Dr. Lum, and Mr. Dennison)
| | - Stanley Dennison
- From the Department of Orthopaedic Surgery, School of Medicine, University of California, Davis Health System, Sacramento, CA (Dr. Lum, Dr. Le, Dr. Bayne, and Dr. Lee); the Nova Southeastern University, the Kiran C Patel School of Osteopathic Medicine, Fort Lauderdale, FL (Dr. Lum, and Mr. Dennison)
| | - Hai V. Le
- From the Department of Orthopaedic Surgery, School of Medicine, University of California, Davis Health System, Sacramento, CA (Dr. Lum, Dr. Le, Dr. Bayne, and Dr. Lee); the Nova Southeastern University, the Kiran C Patel School of Osteopathic Medicine, Fort Lauderdale, FL (Dr. Lum, and Mr. Dennison)
| | - Christopher O. Bayne
- From the Department of Orthopaedic Surgery, School of Medicine, University of California, Davis Health System, Sacramento, CA (Dr. Lum, Dr. Le, Dr. Bayne, and Dr. Lee); the Nova Southeastern University, the Kiran C Patel School of Osteopathic Medicine, Fort Lauderdale, FL (Dr. Lum, and Mr. Dennison)
| | - Cassandra A. Lee
- From the Department of Orthopaedic Surgery, School of Medicine, University of California, Davis Health System, Sacramento, CA (Dr. Lum, Dr. Le, Dr. Bayne, and Dr. Lee); the Nova Southeastern University, the Kiran C Patel School of Osteopathic Medicine, Fort Lauderdale, FL (Dr. Lum, and Mr. Dennison)
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Affiliation(s)
- Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College, London
| | - Aisha Holloway
- School of Health in Social Science, The University of Edinburgh
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Dave S. Building the future medical workforce: helping students choose psychiatry. BMJ 2021; 375:n2665. [PMID: 34728493 DOI: 10.1136/bmj.n2665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Importance Projections to 2035 have demonstrated concern regarding a worsening urology workforce shortage. Objective To project the size and demographic characteristics of the urology workforce per capita into 2060 and to anticipate the timing and degree of the impending urology workforce shortage. Design, Setting, and Participants This population-based cross-sectional study used the 2019 American Urological Association Annual Census data and the Accreditation Council for Graduate Medical Education's Data Resource Book from 2007 to 2018. The cohort included practicing urologists in 2019. US Census data were used to approximate the projected US population. Data analysis was performed from June 2020 to March 2021. Exposures Continued growth stock and flow model of 13.8% and stagnant growth model of 0% increase of the incoming urology workforce with cohort projection per projected US population. Main Outcomes and Measures The primary outcome was urology workforce projection per the population aged 65 years and older. Urology workforce projections per capita and demographic characteristics of the urology workforce up to 2060 were calculated under guided assumptions with 2 stock and flow models. Results In 2019, there were 13 044 urologists (11 758 men [90.1.%]; 1286 women [9.9%]; median age range, 55-59 years), with 3.99 urologists per 100 000 persons and 311 new urologists entering the workforce. In a continued growth model, 2030 will have the lowest number of urologists per capita of 3.3 urologists per 100 000 persons, and recovery to baseline will occur by 2050. There are 23.8 urologists per 100 000 persons aged 65 years and older in 2020, which decreases to 15.8 urologists per 100 000 persons aged 65 years and older in 2035 and never recovers to its baseline level by 2060. In a stagnant growth model, there will be a continued decrease of urologists per capita to 3.1 urologists per 100 000 persons by 2060. There is a continued decrease in per capita urologists at each time point, with 13.1 urologists per 100 000 persons aged 65 years and older by 2060. Conclusions and Relevance With the impending urology workforce shortage, there will be an exaggerated shortage of total urologists per persons aged 65 years and older in both models. This projection highlights the need for structural changes and advocacy to maximize the available urology workforce.
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Affiliation(s)
- Catherine S. Nam
- Department of Urology, Michigan Medicine, University of Michigan, Ann Arbor
| | | | - Kate H. Kraft
- Department of Urology, Michigan Medicine, University of Michigan, Ann Arbor
| | - Lindsey A. Herrel
- Department of Urology, Michigan Medicine, University of Michigan, Ann Arbor
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Harper KJ. The Future of Nursing Report Set the Stage for Healthier Hoosiers. Nurs Adm Q 2021; 45:46-51. [PMID: 33259370 DOI: 10.1097/naq.0000000000000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since the introduction of the Future of Nursing report in 2011, Indiana nursing has successfully implemented many of the recommendations. This article describes these accomplishments. Notable examples include increasing the diversity of the workforce, placement of nurses on community boards and governmental appointments, promoting the advancement of nursing education, and increasing the number of nurses with baccalaureate degrees. Furthermore, Indiana supports the proliferation of new doctoral programs with a scholarship fundraising program to assist nurses with the cost of their education.
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Affiliation(s)
- Kimberly J Harper
- Indiana Action Coalition-Future of Nursing Campaign for Action, Indiana Center for Nursing, Indianapolis; and Nurses on Boards Coalition, Indianapolis, Indiana
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Dall TM, Reynolds RL, Chakrabarti R, Forte GJ, Langelier M, Wang S, Whyte J, Sridhara Ankam N, Annaswamy TM, Fredericson M, Jain NB, Perret Karimi D, Morgenroth DC, Slocum C, Wisotzky E. The Physiatry Workforce in 2019 and Beyond, Part 2: Modeling Results. Am J Phys Med Rehabil 2021; 100:877-884. [PMID: 33278133 DOI: 10.1097/phm.0000000000001659] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to assess the current and future adequacy of physiatrist supply in the United States. DESIGN A 2019 online survey of board-certified physiatrists (n = 616 completed, 30.1% response) collected information about demographics, practice characteristics, hours worked, and retirement intentions. Microsimulation models projected future physiatrist supply and demand using data from the American Board of Physical Medicine and Rehabilitation, national and state population projections, American Community Survey, Behavioral Risk Factor Surveillance System, Medical Expenditure Panel Survey, and other sources. RESULTS Approximately 37% of 8853 active physiatrists indicate that their workload exceeds capacity, 59% indicate that workload is at capacity, and 4% indicate under capacity. These findings suggest a national shortfall of 940 (10.6%) physiatrists in 2017, with substantial geographic variation in supply adequacy. Projected growth in physiatrist supply from 2017 to 2030 approximately equals demand growth (2250 vs. 2390), suggesting that without changes in care delivery, the shortfall of physiatrists will persist, with a 1080 (9.7%) physiatrist shortfall in 2030. CONCLUSION Without an increase in physiatry residency positions, the current national shortfall of physiatrists is projected to persist. Although a projected increase in physiatrists' use of advanced practice providers may help preserve access to comprehensive physiatry care, it is not expected to eliminate the shortfall.
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Affiliation(s)
- Timothy M Dall
- From the IHS Markit, Washington, DC (TMD, RLR, RC); Center for Health Workforce Studies, School of Public Health, University at Albany SUNY, Rensselaer, New York (GJF, ML, SW); Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (JW); Department of Rehabilitation Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (NSA); VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas (TMA); Stanford University School of Medicine, Stanford, California (MF); Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, Texas (NBJ); Departments of Physical Medicine & Rehabilitation and Anesthesiology & Perioperative Care and Neurological Surgery, University of California, Irvine, California (DPK); Department of Rehabilitation Medicine, University of Washington, Seattle, Washington (DCM); VA Puget Sound Health Care System Center for Limb Loss and Mobility (CLiMB), Seattle, Washington (DCM); Spaulding Rehabilitation Hospital, Boston, Massachusetts (CS); Harvard Medical School Department of Physical Medicine and Rehabilitation, Boston, Massachusetts (CS); and Georgetown University School of Medicine, Washington, DC (EW)
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Forte GJ, Langelier M, Wang S, Dall TM, Reynolds RL, Chakrabarti R, Whyte J, Ankam NS, Annaswamy TM, Fredericson M, Jain NB, Karimi DP, Morgenroth DC, Slocum C, Wisotzky E. The Physiatry Workforce in 2019 and Beyond, Part 1: Results From a Cross-sectional Survey. Am J Phys Med Rehabil 2021; 100:866-876. [PMID: 33443853 DOI: 10.1097/phm.0000000000001692] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of the study was to describe the current physiatrist workforce in the United States. DESIGN An online, cross-sectional survey of board-certified physiatrists in 2019 (N = 616 completed, 30.1% response) collected information about demographic and practice characteristics, including age, sex, practice area, practice setting, hours worked, patient characteristics, staffing, and work responsibilities. Physiatrists were stratified by substantive practice patterns using a cluster analysis approach. Survey responses were arrayed across the practice patterns and differences noted. RESULTS The practice patterns identified included musculoskeletal/pain medicine, general/neurological rehabilitation, academic practice, pediatric rehabilitation, orthopedic/complex conditions rehabilitation, and disability/occupational rehabilitation. Many differences were observed across these practice patterns. Notably, primary practice setting and the extent and ways in which other healthcare staff are used in physiatry practices differed across practice patterns. Physiatrists working in musculoskeletal/pain medicine and disability/occupational rehabilitation were least likely to work with nurse practitioners and physician assistants. Physiatrists working in academic practice, general/neurological rehabilitation, and pediatric rehabilitation were most likely to have primary practice settings in hospitals. CONCLUSIONS Physiatry is an evolving medical specialty affected by many of the same trends as other medical specialties. The results of this survey can inform policy discussions and further research on the effects of these trends on physiatrists and physiatry practice in the future.
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Affiliation(s)
- Gaetano J Forte
- From the Center for Health Workforce Studies, School of Public Health, University at Albany SUNY, Rensselaer, New York (GJF, ML, SW); IHS Markit, Washington, DC (TMD, RLR, RC); Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (JW); Department of Rehabilitation Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (NSA); VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, Texas (TMA); Stanford University School of Medicine, Stanford, California (MF); Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, Texas (NBJ); Departments of Physical Medicine & Rehabilitation and Anesthesiology & Perioperative Care and Neurological Surgery, University of California, Irvine, California (DPK); Department of Rehabilitation Medicine, University of Washington, Seattle, Washington (DCM); VA Puget Sound Health Care System Center for Limb Loss and Mobility (CLiMB), Seattle, Washington (DCM); Spaulding Rehabilitation Hospital, Boston, Massachusetts (CS); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (CS); and Georgetown University School of Medicine, Washington, DC (EW)
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English M, Vanstrum E. COVID-19's Impact on Residency Applicants. Acad Med 2021; 96:e26. [PMID: 34108374 PMCID: PMC8378438 DOI: 10.1097/acm.0000000000004199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Margaret English
- Fourth-year medical student, University of Southern California Keck School of Medicine, Los Angeles, California; ; ORCID: http://orcid.org/0000-0002-2494-0369
| | - Erik Vanstrum
- Fourth-year medical student, University of Southern California Keck School of Medicine, Los Angeles, California; ORCID: http://orcid.org/0000-0002-8052-4327
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Marchetti KA, Oerline M, Hollenbeck BK, Kaufman SR, Skolarus TA, Shahinian VB, Caram MEV, Modi PK. Urology Workforce Changes and Implications for Prostate Cancer Care Among Medicare Enrollees. Urology 2021; 155:77-82. [PMID: 33610652 PMCID: PMC8374001 DOI: 10.1016/j.urology.2020.12.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/28/2020] [Accepted: 12/15/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To characterize national trends in urologist workforce, practice organization, and management of incident prostate cancer. METHODS Using Medicare claims data from 2010 to 2016, we identified all urologists billing Medicare and the practice with which they were affiliated. We characterized groups as solo, small single specialty, large single specialty, multispecialty, specialist, or hospital-owned practices. Using a 20% sample of national Medicare claims, we identified all patients with incident prostate cancer and identified their primary treatment. RESULTS The number of urologists increased from 9,305 in 2010 to 9,570 in 2016 (P = .03), while the number of practices decreased from 3,588 to 2,861 (P < .001). The proportion of urologists in multispecialty groups increased from 17.1% in 2010 to 28.2% in 2016, while those within solo practices declined from 26.2% to only 15.8% over the same time period. A higher proportion of patients at hospital-owned practices were treated with observation (P < .001) and surgery (P < .001), while a higher proportion of patients at large single specialty practices were treated with radiation therapy (P < .001). CONCLUSION We characterized shifts in urologist membership from smaller, independent groups to larger, multispecialty or hospital-owned practices. This trend coincides with higher utilization of observation and surgical treatment for prostate cancer.
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Affiliation(s)
- Kathryn A Marchetti
- Division of Health Services Research, Department of Urology, University of Michigan.
| | - Mary Oerline
- Division of Health Services Research, Department of Urology, University of Michigan
| | - Brent K Hollenbeck
- Division of Health Services Research, Department of Urology, University of Michigan
| | - Samuel R Kaufman
- Division of Health Services Research, Department of Urology, University of Michigan
| | - Ted A Skolarus
- Division of Health Services Research, Department of Urology, University of Michigan; Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
| | - Vahakn B Shahinian
- Division of Health Services Research, Department of Urology, University of Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Megan E V Caram
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Parth K Modi
- Division of Health Services Research, Department of Urology, University of Michigan
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Kim HJ, Jeon K, Kang BJ, Ahn JJ, Hong SB, Lee DH, Moon JY, Kim JS, Park J, Cho JH, Lee SM, Lee YJ. Relationship between the presence of dedicated doctors in rapid response systems and patient outcome: a multicenter retrospective cohort study. Respir Res 2021; 22:236. [PMID: 34446017 PMCID: PMC8394678 DOI: 10.1186/s12931-021-01824-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rapid response systems (RRSs) improve patients' safety, but the role of dedicated doctors within these systems remains controversial. We aimed to evaluate patient survival rates and differences in types of interventions performed depending on the presence of dedicated doctors in the RRS. METHODS Patients managed by the RRSs of 9 centers in South Korea from January 1, 2016, through December 31, 2017, were included retrospectively. We used propensity score-matched analysis to balance patients according to the presence of dedicated doctors in the RRS. The primary outcome was in-hospital survival. The secondary outcomes were the incidence of interventions performed. A sensitivity analysis was performed with the subgroup of patients diagnosed with sepsis or septic shock. RESULTS After propensity score matching, 2981 patients were included per group according to the presence of dedicated doctors in the RRS. The presence of the dedicated doctors was not associated with patients' overall likelihood of survival (hazard ratio for death 1.05, 95% confidence interval [CI] 0.93‒1.20). Interventions, such as arterial line insertion (odds ratio [OR] 25.33, 95% CI 15.12‒42.44) and kidney replacement therapy (OR 10.77, 95% CI 6.10‒19.01), were more commonly performed for patients detected using RRS with dedicated doctors. The presence of dedicated doctors in the RRS was associated with better survival of patients with sepsis or septic shock (hazard ratio for death 0.62, 95% CI 0.39‒0.98) and lower intensive care unit admission rates (OR 0.53, 95% CI 0.37‒0.75). CONCLUSIONS The presence of dedicated doctors within the RRS was not associated with better survival in the overall population but with better survival and lower intensive care unit admission rates for patients with sepsis or septic shock.
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Affiliation(s)
- Hyung-Jun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byung Ju Kang
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jong-Joon Ahn
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Hyun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Jae Young Moon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jung Soo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Jisoo Park
- Division of Pulmonology, Department of Internal Medicine, CHA University, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - Jae Hwa Cho
- Division of Pulmonology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Abstract
This cross-sectional study examines national trends in representativeness in select health care occupations by race/ethnicity and sex.
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Affiliation(s)
- Dan P. Ly
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Anupam B. Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Boston
- National Bureau of Economic Research, Cambridge, Massachusetts
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Getachew T, Abebe SM, Yitayal M, Persson LÅ, Berhanu D. Association between a complex community intervention and quality of health extension workers' performance to correctly classify common childhood illnesses in four regions of Ethiopia. PLoS One 2021; 16:e0247474. [PMID: 33711024 PMCID: PMC7954333 DOI: 10.1371/journal.pone.0247474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 02/07/2021] [Indexed: 12/20/2022] Open
Abstract
Background Due to low care utilization, a complex intervention was done for two years to optimize the Ethiopian Health Extension Program. Improved quality of the integrated community case management services was an intermediate outcome of this intervention through community education and mobilization, capacity building of health workers, and strengthening of district ownership and accountability of sick child services. We evaluated the association between the intervention and the health extension workers’ ability to correctly classify common childhood illnesses in four regions of Ethiopia. Methods Baseline and endline assessments were done in 2016 and 2018 in intervention and comparison areas in four regions of Ethiopia. Ill children aged 2 to 59 months were mobilized to visit health posts for an assessment that was followed by re-examination. We analyzed sensitivity, specificity, and difference-in-difference of correct classification with multilevel mixed logistic regression in intervention and comparison areas at baseline and endline. Results Health extensions workers’ consultations with ill children were observed in intervention (n = 710) and comparison areas (n = 615). At baseline, re-examination of the children showed that in intervention areas, health extension workers’ sensitivity for fever or malaria was 54%, 68% for respiratory infections, 90% for diarrheal diseases, and 34% for malnutrition. At endline, it was 40% for fever or malaria, 49% for respiratory infections, 85% for diarrheal diseases, and 48% for malnutrition. Specificity was higher (89–100%) for all childhood illnesses. Difference-in-differences was 6% for correct classification of fever or malaria [aOR = 1.45 95% CI: 0.81–2.60], 4% for respiratory tract infection [aOR = 1.49 95% CI: 0.81–2.74], and 5% for diarrheal diseases [aOR = 1.74 95% CI: 0.77–3.92]. Conclusion This study revealed that the Optimization of Health Extension Program intervention, which included training, supportive supervision, and performance reviews of health extension workers, was not associated with an improved classification of childhood illnesses by these Ethiopian primary health care workers. Trial registration ISRCTN12040912, http://www.isrctn.com/ISRCTN12040912.
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Affiliation(s)
- Theodros Getachew
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Solomon Mekonnen Abebe
- College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Mezgebu Yitayal
- College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Lars Åke Persson
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Della Berhanu
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Perera SK, Jacob S, Wilson BE, Ferlay J, Bray F, Sullivan R, Barton M. Global demand for cancer surgery and an estimate of the optimal surgical and anaesthesia workforce between 2018 and 2040: a population-based modelling study. Lancet Oncol 2021; 22:182-189. [PMID: 33485458 DOI: 10.1016/s1470-2045(20)30675-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/14/2020] [Accepted: 10/27/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The growing demand for cancer surgery has placed a global strain on health systems. In-depth analyses of the global demand for cancer surgery and optimal workforce requirements are needed to plan service provision. We estimated the global demand for cancer surgery and the requirements for an optimal surgical and anaesthesia workforce, using benchmarks based on clinical guidelines. METHODS Using models of benchmark surgical use based on clinical guidelines, we estimated the proportion of cancer cases with an indication for surgery across 183 countries, stratified by income group. These proportions were multiplied by age-adjusted national estimates of new cancer cases using GLOBOCAN 2018 data and then aggregated to obtain the estimated number of surgical procedures required globally. The numbers of cancer surgical procedures in 44 high-income countries were divided by the actual number of surgeons and anaesthetists in the respective countries to calculate cancer procedures per surgeon and anaesthetist ratios. Using the median (IQR) of these ratios as benchmarks, we developed a three-tiered optimal surgical and anaesthesia workforce matrix, and the predictions were extrapolated up to 2040. FINDINGS Our model estimates that the number of cancer cases globally with an indication for surgery will increase by 5 million procedures (52%) between 2018 (9 065 000) and 2040 (13 821 000). The greatest relative increase in surgical demand will occur in 34 low-income countries, where we also observed the largest gaps in workforce requirements. To match the median benchmark for high-income countries, the surgical workforce in these countries would need to increase by almost four times and the anaesthesia workforce by nearly 5·5 times. The greatest increase in optimal workforce requirements from 2018 to 2040 will occur in low-income countries (from 28 000 surgeons to 58 000 surgeons; 107% increase), followed by lower-middle-income countries (from 166 000 surgeons to 277 000 surgeons; 67% increase). INTERPRETATION The global demand for cancer surgery and the optimal workforce are predicted to increase over the next two decades and disproportionately affect low-income countries. These estimates provide an appropriate framework for planning the provision of surgical services for cancer worldwide. FUNDING University of New South Wales Scientia Scholarship and UK Research and Innovation Global Challenges Research Fund.
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Affiliation(s)
- Sathira Kasun Perera
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute of Applied Medical Research, South West Clinical School, University of New South Wales, Sydney, NSW, Australia.
| | - Susannah Jacob
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute of Applied Medical Research, South West Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Brooke E Wilson
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute of Applied Medical Research, South West Clinical School, University of New South Wales, Sydney, NSW, Australia; Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Jacques Ferlay
- Section of Cancer Surveillance, International Agency for Research on Cancer, World Health Organization, Geneva, Switzerland
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, World Health Organization, Geneva, Switzerland
| | - Richard Sullivan
- Institute of Cancer Policy, School of Cancer Sciences, Kings College, London, UK
| | - Michael Barton
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute of Applied Medical Research, South West Clinical School, University of New South Wales, Sydney, NSW, Australia
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Davis J, Zuber K. The changing landscape of PAs and NPs in nephrology. JAAPA 2021; 34:1-8. [PMID: 33332839 DOI: 10.1097/01.jaa.0000723944.52480.d8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physician assistants (PAs) and NPs have expanded roles in nephrology as both the patient load and acuity of care needed for this population have increased. PURPOSE To evaluate the workforce patterns of PAs and NPs working in nephrology over the past decade. METHODS Using the biannual survey from the National Kidney Foundation Council of Advanced Practitioners, data were collected and analyzed over the past decade. RESULTS Surveys of nephrology practitioners show the evolution of the dialysis-focused practitioner to one encompassing all aspects of nephrology: hospital, ICU, research, office, and all types of dialysis. Salaries and benefits have increased to compensate for the expansion of responsibilities. CONCLUSIONS PAs and NPs in nephrology have the opportunity to use their skills and training in caring for this high-risk population.
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Affiliation(s)
- Jane Davis
- Jane Davis is an NP in the Division of Nephrology at the University of Alabama at Birmingham. Kim Zuber is executive director of the American Academy of Nephrology PAs in St. Petersburg, Fla. Ms. Davis is on the Amgen Speakers Bureau and the ANNA-Amgen chapter programs bureau. The authors have disclosed no other potential conflicts of interest, financial or otherwise
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Abstract
A compelling case exists that increasing the number of Black physicians trained and practicing in the United States is one effective intervention to promote health equity and reduce the persistent health disparities that have become glaringly evident during the COVID-19 pandemic. However, the U.S. physician workforce has relatively few Black physicians. Blacks comprise approximately 13% of the U.S. population but only 5% of practicing physicians. In this Invited Commentary, the authors caution that the COVID-19 pandemic may erode the meager progress that has been made in increasing the number of Black physicians. This loss of Black physicians may happen because Black patients are overrepresented among cases of COVID-19, Black physicians care for relatively more Black patients often in settings with less access to SARS-CoV-2 testing and personal protective equipment, and Black physicians have more comorbid chronic conditions that increase their own susceptibility to mortality from COVID-19. All organizations in which physicians train and practice must redouble their efforts to recruit, train, and retain Black physicians. If nothing else, the COVID-19 pandemic must make academic health centers and health care systems recognize Black physicians as the precious resource they are and protect and reward them accordingly.
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Affiliation(s)
- Amarette Filut
- A. Filut is associate researcher, Center for Women's Health Research, University of Wisconsin-Madison, Madison, Wisconsin
| | - Molly Carnes
- M. Carnes is director, Center for Women's Health Research, and professor, Departments of Medicine, Psychiatry, and Industrial Engineering, University of Wisconsin-Madison, Madison, Wisconsin
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Abstract
The COVID-19 pandemic has highlighted the limitations of the current health care workforce. As health care workers across the globe have been overwhelmed by the crisis, oversight entities and training programs have sought to loosen regulations to support ongoing care. Notably, however, workforce challenges preceded the current crisis. Now may be the time to address these underlying workforce challenges and emerge from the COVID-19 pandemic with a stronger health care workforce.Building upon historical exemplars in the context of the current crisis, the authors of this Perspective provide a roadmap to rapidly and safely increase the workforce for COVID-19 and beyond. The authors recommend the following: (1) a comprehensive approach to guide health care workforce development, (2) streamlining transitions to the next level of practice, (3) reciprocity among state licensing boards or national licensure, (4) payment reform to support a strengthened health care workforce, and (5) efforts by employers to ensure the ongoing safety and competence of the bolstered workforce. These steps require urgent collaboration among stakeholders commensurate with the acuity of the pandemic. Implemented together, these actions could address not only the novel challenges presented by COVID-19 but also the underlying inadequacies of the health care workforce that must be remedied to create a healthier society.
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Affiliation(s)
- Alan W. Dow
- A.W. Dow is assistant vice president, Interprofessional Education and Collaborative Care, and professor, internal medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia; ORCID: http://orcid.org/0000-0002-9004-7528
| | - Joseph T. DiPiro
- J.T. DiPiro is dean, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia; ORCID: http://orcid.org/0000-0002-5442-0129
| | - Jean Giddens
- J. Giddens is dean, Virginia Commonwealth University School of Nursing, Richmond, Virginia
| | - Peter Buckley
- P. Buckley is dean, Virginia Commonwealth University School of Medicine, and interim vice president and chief executive officer, Virginia Commonwealth University Health Sciences, Richmond, Virginia
| | - Sally A. Santen
- S.A. Santen is senior associate dean, Evaluation, Assessment and Scholarship, and professor of emergency medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia; ORCID: http://orcid.org/0000-0002-8327-8002
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Surash S. Racial equality in the NHS: we need objective data to support subjective experience. BMJ 2020; 371:m4496. [PMID: 33219134 DOI: 10.1136/bmj.m4496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Surash Surash
- Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
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Winkelmann J, Muench U, Maier CB. Time trends in the regional distribution of physicians, nurses and midwives in Europe. BMC Health Serv Res 2020; 20:937. [PMID: 33046077 PMCID: PMC7549210 DOI: 10.1186/s12913-020-05760-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Country-level data suggest large differences in the supply of health professionals among European countries. However, little is know about the regional supply of health professionals taking a cross-country comparative perspective. The aim of the study was to analyse the regional distribution of physicians, nurses and midwives in the highest and lowest density regions in Europe and examine time trends. METHODS We used Eurostat data and descriptive statistics to assess the density of physicians, nurses and midwives at national and regional levels (Nomenclature of Territorial Units for Statistics (NUTS) 2 regions) for 2017 and time trends (2005-2017). To ensure cross-country comparability we applied a set of criteria (working status, availability over time, geographic availability, source). This resulted in 14 European Union (EU) countries and Switzerland being available for the physician analysis and eight countries for the nurses and midwives analysis. Density rates per population were analysed at national and NUTS 2 level, of which regions with the highest and lowest density of physicians, nurses and midwives were identified. We examined changes over time in regional distributions, using percentage change and Compound Annual Growth Rate (CAGR). RESULTS There was a 2.4-fold difference in the physician density between the highest and lowest density countries (Austria national average: 513, Poland 241.6 per 100,000) and a 3.5-fold difference among nurses (Denmark: 1702.5, Bulgaria: 483.0). Differences by regions across Europe were higher than cross-country variations and varied up to 5.5-fold for physicians and 4.4-fold for nurses/midwives and did not improve over time. Capitals and/or major cities in all countries showed a markedly higher supply of physicians than more sparsely populated regions while the density of nurses and midwives tended to be higher in more sparsely populated areas. Over time, physician rates increased faster than density levels of nurses and midwives. CONCLUSIONS The study shows for the first time the large variation in health workforce supply at regional levels and time trends by professions across the European region. This highlights the importance for countries to routinely collect data in sub-national geographic areas to develop integrated health workforce policies for health professionals at regional levels.
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Affiliation(s)
- Juliane Winkelmann
- Department of Healthcare Management, Technische Universität Berlin, H 80, Straße des 17. Juni 135, 10623, Berlin, Germany.
| | - Ulrike Muench
- Department of Social and Behavioural Sciences, University of California San Francisco, School of Nursing, 3333 California Street, Ste 455, San Francisco, CA, 94118, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, School of Medicine, 3333 California Street, Ste 455, San Francisco, CA, 94118, USA
| | - Claudia B Maier
- Department of Healthcare Management, Technische Universität Berlin, H 80, Straße des 17. Juni 135, 10623, Berlin, Germany
- Center for Health Outcomes and Policy Research, University of Pennsylvania, School of Nursing, Claire Fagin Hall, 418 Curie Blvd, Philadelphia, PA, 19104, USA
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Chair ASB, Crabtree B, Franson K, Klepser D, Okere AN, Poirier T, Welch A, Gandhi N, Ragucci K. Report of the 2019-2020 AACP Academic Affairs Committee: Developing the Pharmacist Workforce for Society's Medication Use Needs in 2030. Am J Pharm Educ 2020; 84:ajpe8203. [PMID: 33149340 PMCID: PMC7596602 DOI: 10.5688/ajpe8203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The 2019-2020 Academic Affairs Committee was charged with identifying promising practices in academic-practice partnerships and professional pharmacy organization initiatives that are accelerating the transformation of a workforce prepared to assume responsibility for society's medication use needs in 2030 and determining the role AACP can plan in supporting these partnerships and initiatives. The committee identified a set of ideal principles, characteristics, and design elements of a high-quality, large-scale workforce development program. The committee also categorized current mechanisms for professional workforce development, in addition to identifying their strengths and weaknesses, with the realization that novel approaches are needed to accomplish the goal of large-scale workforce transformation. This report also highlights two existing initiatives aligned with accelerating the transformation of the workforce (ie, the Community Pharmacy Enhanced Services Network (CPESN) ACT (Academia-CPESN Transformation) Pharmacy Collaborative and the American Pharmacists Association ADVANCE platform) and is proposing a policy statement affirming AACP's support. Furthermore, the committee is proposing another policy statement supporting colleges and schools of pharmacy taking an active role in implementing innovative and novel approaches for the development of the current workforce. In order to truly understand the many factors influencing large-scale workforce transformation, the committee is also proposing a stakeholder conference with a wide range of participants and a targeted set of questions focused on current and future needs.
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Affiliation(s)
| | - Brian Crabtree
- Mercer University, College of Pharmacy, Atlanta, Georgia
| | - Kari Franson
- University of Southern California, College of Pharmacy, Los Angeles, California
| | - Donald Klepser
- University of Nebraska Medical Center, College of Pharmacy, Omaha, Nebraska
| | | | - Therese Poirier
- Southern Illinois University, Edwardsville School of Pharmacy, Edwardsville, Illinois
| | - Adam Welch
- East Tennessee State University, Bill Gatton College of Pharmacy, Johnson City, Tennessee
| | - Nidhi Gandhi
- American Association of Colleges of Pharmacy, Arlington, Virginia
| | - Kelly Ragucci
- American Association of Colleges of Pharmacy, Arlington, Virginia
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Feng PW, Ahluwalia A, Feng H, Adelman RA. National Trends in the United States Eye Care Workforce from 1995 to 2017. Am J Ophthalmol 2020; 218:128-135. [PMID: 32445703 DOI: 10.1016/j.ajo.2020.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe temporal and geographic trends in the US eye care workforce. DESIGN Cross-sectional study. METHODS We obtained data from the 2017 Area Health Resources File. The main outcomes were ophthalmologist and optometrist density, as defined as the number of providers per 100,000 individuals, the ratio of ophthalmologists ≥55 years of age to those <55 years of age, and county characteristics associated with the availability of an ophthalmologist. RESULTS From 1995 to 2017, the national ophthalmologist density decreased from 6.30 to 5.68 ophthalmologists per 100,000 individuals. Although rural counties experienced a mean annual increase in ophthalmologist density by 2.26%, they still had a lower mean ophthalmologist density (0.58/100,000 individuals) compared with nonmetropolitan (2.19/100,000 individuals) and metropolitan counties (6.29/100,000 individuals) in 2017. The ratio of older to younger ophthalmologists increased from 0.37 in 1995 to 0.82 in 2017, with the greatest ratio increase occurring in rural counties (0.29 to 1.90). The presence of an ophthalmologist was significantly associated with a greater proportion of individuals with a college degree and health insurance, and more developed health care infrastructure. From 1990 to 2017, the density of optometrists increased from 11.06 to 16.16 optometrists per 100,000 individuals. CONCLUSIONS Over the last 2 decades, the national density of ophthalmologists has decreased and the workforce has aged. In contrast, the density of optometrists has increased. Rural counties continue to have a disproportionately lower supply of eye care providers, although some growth has occurred. Given the rising ratio of optometrists to ophthalmologists, it is of interest for future work to determine how the optometrist workforce can best complement potential shortages of ophthalmologists.
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Affiliation(s)
- Paula W Feng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Aneesha Ahluwalia
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Ron A Adelman
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut.
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Abstract
The gender composition of physician specialties varies dramatically with some becoming increasingly female predominant while others remain overwhelmingly male. In their analysis of physician workforce data, the authors demonstrate that despite large increases in the number of female physicians over 4 decades, the degree of gender segregation between specialties has not declined. The authors describe lessons from the highly gender-segregated U.S. workforce as a whole to understand these demographic patterns in the physician workforce. Echoing U.S. workforce findings, women physicians are becoming overrepresented in certain specialties, and this appears to be associated with a relative decline in earnings for physicians in these specialties over time. The authors found a strong negative relationship between the proportion of female physicians in a specialty and its mean salary, with gender composition explaining 64% of the variation in salaries among the medical specialties.Female physicians face biases in the workplace and fall behind male peers in leadership attainment, academic advancement, and earnings. Tenacious gender stereotypes and the conflation of gender and status contribute to these biases and reinforce occupational gender segregation. The clustering of women in certain specialties means these specialties will be disproportionately affected by gender bias. Recognizing the consequences of gender demographics within physician specialties is important to maintain the strong and diverse physician workforce needed to support the health care needs of the populations who depend on these specialties for care.
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Affiliation(s)
- Elaine Pelley
- E. Pelley is associate professor, Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Molly Carnes
- M. Carnes is professor, Departments of Medicine, Psychiatry, and Industrial & Systems Engineering and director, Center for Women's Health Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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Lebovitz L, Rudolph M. Update on Pharmacist Workforce Data and Thoughts on How to Manage the Oversupply. Am J Pharm Educ 2020; 84:ajpe7889. [PMID: 33149327 PMCID: PMC7596609 DOI: 10.5688/ajpe7889] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/08/2020] [Indexed: 05/13/2023]
Abstract
The annual number of Doctor of Pharmacy (PharmD) graduates is projected to exceed the number of annual pharmacist job openings over the next 10 years. Loss of retail sector jobs will be partially offset by projected gains in several other sectors; however, oversupply will persist until the number of graduates is more reflective of job market capacity. Large-scale practice transformation will not happen overnight; consequently, schools and colleges of pharmacy must immediately change their perspective from producing graduates to fill pharmacist roles, to producing graduates who are prepared with expertise and professional skills to excel in many types of well-paying positions. Students need career advice including to convince potential employers how a PharmD education has prepared them with transferable high-level skills that are applicable beyond traditional pharmacist roles. Better communicating the value of pharmacy skills to students and employers may also have a positive impact on admission numbers as prospective applicants become more aware of the breadth of pharmacy career opportunities.
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Affiliation(s)
- Lisa Lebovitz
- University of Maryland School of Pharmacy, Baltimore, Maryland
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Patterson JM, Govender R, Roe J, Clunie G, Murphy J, Brady G, Haines J, White A, Carding P. COVID-19 and ENT SLT services, workforce and research in the UK: A discussion paper. Int J Lang Commun Disord 2020; 55:806-817. [PMID: 32770652 PMCID: PMC7436215 DOI: 10.1111/1460-6984.12565] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/15/2020] [Accepted: 06/28/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND The COVID-19 pandemic and the UK government's subsequent coronavirus action plan have fundamentally impacted on every aspect of healthcare. One area that is severely affected is ear, nose and throat (ENT)/laryngology where speech and language therapists (SLTs) engage in a diverse range of practice with patients with a range of conditions, including voice disorders, airway problems, and head and neck cancers (HNCs). A large majority of these patients are in high-risk categories, and many specialized clinical practices are vulnerable. In addition, workforce and research issues are challenged in both the immediate context and the future. AIMS To discuss the threats and opportunities from the COVID-19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership. METHODS & PROCEDURES The relevant sections of the World Health Organisation's (WHO) health systems building blocks framework (2007) were used to structure the study. Expert agreement was determined by an iterative process of multiple-group discussions, the use of all recent relevant policy documentation, and other literature and shared documentation/writing. The final paper was verified and agreed by all authors. MAIN CONTRIBUTION The main threats to ENT/laryngology SLT clinical services include increased patient complexity related to COVID-19 voice and airway problems, delayed HNC diagnosis, reduced access to instrumental procedures and inequitable care provision. The main clinical opportunities include the potential for new modes of service delivery and collaborations, and harnessing SLT expertise in non-instrumental assessment. There are several workforce issues, including redeployment (and impact on current services), training implications and psychological impact on staff. Workforce opportunities exist for service innovation and potential extended ENT/SLT practice roles. Research is threatened by a reduction in immediate funding calls and high competition. Current research is affected by very limited access to participants and the ability to conduct face-to-face and instrumental assessments. However, research opportunities may result in greater collaboration, and changes in service delivery necessitate robust investigation and evaluation. A new national set of research priorities is likely to emerge. CONCLUSIONS & IMPLICATIONS The immediate impact of the pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. It is unclear when any of these areas will resume operations and whether permanent changes to clinical practice, professional remits and research priorities will follow. However, significant opportunity exists in the post-COVID era to re-evaluate current practice, embrace opportunities and evaluate new ways of working. What this paper adds What is already known on the subject ENT/laryngology SLTs manage patients with a range of conditions, including voice disorders, airway problems and HNCs. The diverse scope of clinical practice involves highly specialized assessment and treatment practices in patients in high-risk categories. A large majority of active research projects in this field are patient focused and involve instrumental assessment. The COVID-19 pandemic has created both opportunities and threats for ENT SLT clinical services, workforce and research. What this paper adds to existing knowledge This study provides a discussion of the threats and opportunities from the COVID-19 pandemic for ENT/laryngology SLT with specific reference to clinical practice, workforce and research leadership. What are the potential or actual clinical implications of this work? The COVID-19 pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. Changes to clinical practice, professional remits and research priorities are of indeterminant duration at this time, and some components could be permanent. Significant clinical practice, workforce and research opportunities may exist in the post-COVID era.
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Affiliation(s)
- Joanne M Patterson
- Liverpool Head and Neck Centre/School for Health SciencesUniversity of Liverpool, LiverpoolUK
| | - Roganie Govender
- Head and Neck Cancer Centre and Research Department of Behavioural Science & HealthUniversity College Hospitals LondonUniversity College LondonLondonUK
| | - Justin Roe
- National Centre for Airway ReconstructionDepartment of Otolaryngology, Head and Neck SurgeryImperial College Healthcare NHS TrustLondonUK
- Department of Surgery and CancerImperial CollegeLondonUK
- Department of Speech, Voice and SwallowingThe Royal Marsden NHS Foundation TrustLondonUK
| | - Gemma Clunie
- National Centre for Airway ReconstructionDepartment of Otolaryngology, Head and Neck SurgeryImperial College Healthcare NHS TrustLondonUK
- Department of Surgery and CancerImperial CollegeLondonUK
| | - Jennifer Murphy
- Department of Speech, Voice and Swallowing, ENT OutpatientsNewcastle Upon Tyne Hospitals NHS TrustNewcastle Upon TyneUK
| | - Grainne Brady
- Department of Speech, Voice and SwallowingThe Royal Marsden NHS Foundation TrustLondonUK
| | - Jemma Haines
- Wythenshawe HospitalManchester University NHS Foundation TrustUniversity of Manchester NIHR Manchester Biomedical Research Centre Northwest Lung CentreManchesterUK
| | - Anna White
- Department of Ear, Nose and Throat, Queens Medical CentreNottingham University Hospitals NHS TrustNottinghamUK
| | - Paul Carding
- Oxford Institute of Nursing, Midwifery and Allied Health ResearchFaculty of Health & Life Sciences Oxford Brookes UniversityOxfordUK
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Abstract
IMPORTANCE Increasing diversity in the physician workforce is a fulcrum for reducing health disparities. Efforts to increase the diversity in the internal medicine (IM) workforce may improve health equity among an increasingly diverse population with increasing prevalence of chronic disease. OBJECTIVES To assess diversity trends in the academic IM workforce and evaluate how well these trends reflected medical student diversity and the changing demographic composition of the general population. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis of a cross-sectional study analyzed data from January 1, 1980, to December 31, 2018, from the Association of American Medical Colleges Faculty Roster and Applicant Matriculant File, which capture full-time US medical school faculty and matriculants, respectively, and population data through 2017 from the US Census Bureau. MAIN OUTCOMES AND MEASURES The study calculated the proportions of women and individuals from racial/ethnic groups that are traditionally underrepresented in medicine (URM) among IM faculty and faculty in all other clinical departments. These data were compared with the proportions of female and URM matriculants in US medical schools and the proportions of women and individuals from underrepresented racial/ethnic groups in the population. The analysis was stratified by sex, race/ethnicity, and intersections of sex and race/ethnicity. RESULTS From 1980 to 2018, the absolute number of full-time IM faculty increased from 10 964 to 42 547. Although IM was the department classification with the most women faculty, in 2018 it continued to have a lower proportion of women (n = 17 165 [40.3%]) compared with all other clinical departments (n = 48 936 [43.2%]). Among IM faculty, the percentage of URM faculty members more than doubled during the study period (from 4.1% to 9.7%) but still made up only a small portion of faculty members. The percentage of female matriculants among medical school matriculants increased steadily (from 28.7% in 1980 to 51.6% in 2018) and was nearly identical to their population representation in 2017 (50.7% compared with 50.8%). Although the percentage of URM matriculants had nearly doubled since 1980 (from 11.3% to 18.1%), it still lagged far behind the proportion of individuals in the US population who are members of underrepresented racial/ethnic groups (18.1% vs 31.5% in 2017). CONCLUSIONS AND RELEVANCE This cross-sectional study found that progress has been made in diversifying academic IM faculty; however, it does not yet reflect the diversity of medical students or the US population. Continued efforts to increase the diversity of the academic IM workforce are needed.
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Affiliation(s)
- S. Michelle Ogunwole
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Baltimore, Maryland
| | - Michael Dill
- Association of American Medical Colleges, Washington, DC
| | - Karen Jones
- Association of American Medical Colleges, Washington, DC
| | - Sherita H. Golden
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland
- Johns Hopkins Medicine Office of Diversity, Inclusion, and Health Equity, Baltimore, Maryland
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Glynn MK, Jenkins ML, Ramsey C, Simone PM. Public Health Workforce 3.0: Recent Progress and What's on the Horizon to Achieve the 21st-Century Workforce. J Public Health Manag Pract 2020; 25 Suppl 2, Public Health Workforce Interests and Needs Survey 2017:S6-S9. [PMID: 30720611 PMCID: PMC6519880 DOI: 10.1097/phh.0000000000000971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- M Kathleen Glynn
- Division of Scientific Education and Professional Development, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Glynn and Simone); Behavioral and Public Health Branch, Division of Nursing and Public Health, Bureau of Health Workforce, Health Resources and Services Administration, Rockville, Maryland (Mr Jenkins and Ms Ramsey)
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Ehrhardt T, Shepherd A, Kinslow K, McKenney M, Elkbuli A. Diversity and inclusion among U.S. emergency medicine residency programs and practicing physicians: Towards equity in workforce. Am J Emerg Med 2020; 46:690-692. [PMID: 32863121 DOI: 10.1016/j.ajem.2020.08.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Tori Ehrhardt
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Aaron Shepherd
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Kyle Kinslow
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA; Department of Surgery, University of South Florida, Tampa, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA.
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Bingmer K, Ofshteyn A, Bliggenstorfer JT, Steinhagen E, Stein SL. Where is the leak in the surgeon pipeline? Am J Surg 2020; 220:1174-1178. [PMID: 32654766 DOI: 10.1016/j.amjsurg.2020.06.048] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/10/2020] [Accepted: 06/25/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In order to care for an increasingly diverse population, the surgical workforce must improve in gender, racial, and ethnic diversity. We aim to identify deficiencies in the surgical pipeline. METHODS Data from the United States Census, Bureau of Labor Statistics, and Association of American Medical Colleges were collected from 2004 to 2018, and evaluated for changing population over time. RESULTS Women comprise 51% of the population, 32% of surgeons, and representation is increasing at a rate of 0.4% per year. 13% of the population and 6% of surgeons are black, and representation is decreasing at a rate of -0.1% per year. Hispanics represent 18% of the population, 6% of surgeons, and representation is increasing at a rate of 0.04% per year. CONCLUSIONS While the proportion of women and Hispanic surgeons is slowly increasing, the proportion of black surgeons is decreasing. Recruitment methods need to be focused to improve surgical workforce diversity.
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Affiliation(s)
- Katherine Bingmer
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Asya Ofshteyn
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jonathan T Bliggenstorfer
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Emily Steinhagen
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sharon L Stein
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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Herschell AD, Kolko DJ, Hart JA, Brabson LA, Gavin JG. Mixed method study of workforce turnover and evidence-based treatment implementation in community behavioral health care settings. Child Abuse Negl 2020; 102:104419. [PMID: 32088538 PMCID: PMC8699177 DOI: 10.1016/j.chiabu.2020.104419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 01/16/2020] [Accepted: 02/10/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Practitioner turnover in behavioral health settings is high and hinders the implementation of new interventions. OBJECTIVE This study examined practitioner and organizational characteristics that contribute to high staff turnover in community behavioral health settings. PARTICIPANTS AND SETTING Clinicians in nine community-based agencies participated. Included agencies treated a high volume of families referred from child welfare. METHODS This study was part of a larger trial testing the effectiveness of a Cognitive Behavior Therapy for family conflict. Authors assessed predictors of turnover quantitatively and qualitatively. Quantitative data was collected prospectively (n = 169) on practitioner and organizational-level variables (e.g., demographics, professional practice, job satisfaction, emotional exhaustion, organizational commitment). Semi-structured interviews with practitioners who left their agencies (n = 40) provided qualitative data retrospectively. RESULTS Forth-five percent of practitioners left their agencies over three years. Two predictors of final survival status (lower age and lower job satisfaction) were associated with leaving the agency at the p < .05 level; however, they accounted for very little variance. Qualitative themes highlighted the importance of job characteristics, compensation, productivity requirements, advancement opportunities, and co-worker relationships as influential in the decision to leave. CONCLUSIONS This study highlights the value of a mixed-method approach given that themes emerged from the qualitative interviews that were not accounted for in the quantitative results. Additional research is needed to better understand workforce turnover so that strategies can be developed to stabilize the behavioral health workforce.
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Affiliation(s)
- Amy D Herschell
- University of Pittsburgh School of Medicine; Community Care Behavioral Health Organization, UPMC Insurance Services Division
| | | | | | | | - James G Gavin
- Community Care Behavioral Health Organization, UPMC Insurance Services Division
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Leo J, Clark R. Creating Solutions to the Common Problems in Health Professional Workforce Learning Through Human-Centered Design. J Contin Educ Health Prof 2020; 40:279-282. [PMID: 33284180 DOI: 10.1097/ceh.0000000000000314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Health professionals operate within time and resource constrained environments, which can create barriers to engage in learning. There is increasing recognition that a large proportion of learning in the workplace is informal, unstructured, and occurring in the absence of an educator. The experiential nature of workplace learning, environmental constraints, and part-time health workforces require that learning be accessible, flexible, and engaging.
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Affiliation(s)
- Joan Leo
- Leo: Allied Health Educator, Education Department, Mercy Health, Melbourne, Australia. Clark: Accredited Mental Health Social Worker, Psychoanalyst and Supervisor in Private Practice
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Abstract
The fate of pediatric ophthalmology may be in jeopardy. For the past 20 years, there has been declining interest in the field compared to other subspecialties in ophthalmology, as fellowship positions and jobs remain unfilled. Of those fellows who do match in pediatric ophthalmology and strabismus, many are international medical graduates who often return to their native countries to practice, further diminishing the supply of pediatric ophthalmologists in the United States. In previous surveys, resident graduates have expressed disinterest in the field, reluctance to work with children, inadequate reimbursements, and insufficient interactions with faculty as reasons not to pursue this subspecialty. Millions of people throughout the United States do not have access to pediatric ophthalmologists, highlighting the issue of unequal distribution. As more pediatric ophthalmologists retire, there is concern that there will not be enough providers to meet the demands of this subspecialty. Although many of these factors deterring residents from entering this field have been resolved, the major issue of financial reimbursements has not been adequately addressed. [J Pediatr Ophthalmol Strabismus. 2020;57(1):9-11.].
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Harrison AA, Tugnet N, Taylor WJ. A survey of the New Zealand rheumatology workforce. N Z Med J 2019; 132:70-76. [PMID: 31830019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM To characterise the demographics, size and distribution of the New Zealand rheumatology workforce. METHOD An online survey was sent to New Zealand rheumatologists in February 2018. RESULTS The survey was completed by 63 of 64 practising New Zealand rheumatologists (response rate 98%). In public practice, the number of half-day clinics per FTE was five (R2 linear 0.87), so a half-day session in private practice was counted as 0.2 FTE. There were 28.71 FTE in the public sector, 14.97 in private and 43.68 total FTE. By district health board (DHB), public FTE per capita ranged from 0.20 FTE per 100,000 population in Nelson-Marlborough DHB to 0.96 in Whanganui DHB. None of the 20 DHBs met the Royal College of Physicians guideline of 1.16 FTE per 100,000 population in the public sector, and only four DHBs reached this level when private FTE were included. Rheumatologists under the age of 50 years were predominantly female (62% female), and older rheumatologists predominantly male (7.7% female, p<0.001). In the next five years 6.58 FTE public rheumatologists intended to retire, (94% male). 23/53 (43%) of public hospital rheumatologists offer appointments for non-inflammatory conditions, compared to 30/31 (97%) of private practice rheumatologists. Between 1999 and 2011, the FTE per 100,000 population increased by 35.4%, but the rate of improvement slowed in the interval between 2011 and 2018, increasing by 3.0%. CONCLUSION The New Zealand rheumatologist workforce is becoming more gender-balanced but is below recommended FTE levels, is unevenly distributed, and previously documented improvements in overall FTE have now reached a plateau.
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Affiliation(s)
- Andrew A Harrison
- Rheumatologist, Associate Professor, Department of Medicine, University of Otago, Wellington
| | - Nicola Tugnet
- Rheumatologist, Rheumatology Department, Auckland District Health Board, Auckland
| | - William J Taylor
- Rheumatologist, Associate Professor, Department of Medicine, University of Otago, Wellington
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Abstract
OBJECTIVES Fractional (part-time) appointments are becoming more commonplace in many professions, including medicine. With respect to the contemporary oncological landscape, this highlights a critical moment in the optimisation of employment conditions to enable high-quality service provision given growing patient numbers and treatment volume intensification. Data are drawn from a broader study which aimed to better understand the workforce experiences of medical oncologists in Australia. This paper specifically aims to examine a group of clinicians' views on the consequences of fractional work in oncology. DESIGN Qualitative, one-on-one semistructured interviews. Interview transcripts were digitally audio recorded and transcribed verbatim. Data were subject to thematic analysis supported by the framework approach and informed by sociological methods and theory. SETTING New South Wales, Australia. PARTICIPANTS Medical oncologists (n=22), including 9 female and 13 male participants, at a range of career stages. RESULTS Four key themes were derived from the analysis: (1) increasing fractional employment relative to opportunities for full-time positions and uncertainty about future opportunities; (2) tightening in role diversity, including reducing time available for research, mentoring, professional development and administration; (3) emerging flexibility of medical oncology as a specialty and (4) impact of fractional-as-norm on workforce sustainability and quality of care. CONCLUSION Fractional appointments are viewed as increasing in oncology and the broader consequences of this major shift in medical labour remain unexamined. Such appointments offer potential for flexible work to better suit the needs of contemporary oncologists; however, fractional work also presents challenges for personal and professional identity and vocational engagement. Fractional appointments are viewed as having a range of consequences related to job satisfaction, burnout and service delivery. Further research is needed to provide a critical examination of the multiple impacts of workforce trends within and beyond oncology.
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Affiliation(s)
- Emma Kirby
- Centre for Social Research in Health, UNSW, Sydney, New South Wales, Australia
| | - Alex Broom
- School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Deme Karikios
- Medical Oncology, Nepean Cancer Care Centre, Nepean Hospital, Penrith, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Rosemary Harrup
- Department of Medical Oncology/Haematology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Affiliation(s)
- Melissa R Kenevan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. https://twitter.com/KenevanMelissa
| | - Bhargavi Gali
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Tampi RR. Learning From the Past and Creating the Future: American Association for Geriatric Psychiatry (AAGP) and Geriatric Mental Healthcare in the United States. Am J Geriatr Psychiatry 2019; 27:1421-1427. [PMID: 31477458 DOI: 10.1016/j.jagp.2019.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Rajesh R Tampi
- Department of Psychiatry & Behavioral Sciences (RRT), Cleveland Clinic Akron General, Akron, OH; Section for Geriatric Psychiatry (RRT), Cleveland Clinic, Cleveland, OH; Department of Medicine (RRT), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH; Department of Psychiatry (RRT), Northeast Ohio Medical University, Rootstown, OH.
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Seleq S, Jo E, Poole P, Wilkinson T, Hyland F, Rudland J, Verstappen A, Bagg W. The employment gap: the relationship between medical student career choices and the future needs of the New Zealand medical workforce. N Z Med J 2019; 132:52-59. [PMID: 31778372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIMS To determine the career decision intentions of graduating doctors, and the relationship between these intentions and the predicted medical workforce needs in New Zealand in 10 years' time. METHODS A workforce forecasting model developed by the Ministry of Health (MOH) has been used to predict the proportion of doctors required in each medical specialty in 2028 in New Zealand. The future work intentions of recently graduated doctors at the Universities of Auckland and Otago were collected from the Medical Student Outcomes Data (MSOD), and compared with these predicted needs. RESULTS Between 2013 and 2017, 2,292 doctors graduated in New Zealand, of whom 1,583 completed the MSOD preferences section (response rate 69%). Of these only 50.1% had decided on a future medical specialty. The most popular were surgical specialties (26.2%), general practice (20.7%), and internal medicine (11.0%). Compared to the MOH workforce forecast model there appears to be insufficient interest in general practice at the time of graduation. CONCLUSIONS To shape the medical workforce to meet forecast needs, multiple stakeholders will need to collaborate, with a special focus on the early postgraduate years, as many doctors have yet to decide on specialisation.
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Affiliation(s)
- Sam Seleq
- Clinical Medicine Education Fellow, School of Medicine, University of Auckland, Auckland
| | - Emmanuel Jo
- Manager, Analytics and Modelling, Health Workforce New Zealand, Ministry of Health, Wellington
| | | | - Tim Wilkinson
- Director, MBChB Programme, Otago Medical School, University of Otago, Dunedin
| | - Fiona Hyland
- Assessment Manager, Otago Medical School, University of Otago, Dunedin
| | - Joy Rudland
- Director, Faculty Education Unit, Otago Medical School, University of Otago, Dunedin
| | | | - Warwick Bagg
- Department of Medicine, School of Medicine, University of Auckland, Auckland
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Kakpovbia E, Kim RH, Cohen DE, Ogbechie-Godec OA. The diminishing presence of dermatologists in the care of hospitalized patients receiving Medicare benefits. J Am Acad Dermatol 2019; 83:640-643. [PMID: 31682860 DOI: 10.1016/j.jaad.2019.10.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/20/2019] [Accepted: 10/28/2019] [Indexed: 11/19/2022]
Affiliation(s)
| | - Randie H Kim
- The Ronald O. Perelman Department of Dermatology, New York University, New York
| | - David E Cohen
- The Ronald O. Perelman Department of Dermatology, New York University, New York
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Shannon G, Minckas N, Tan D, Haghparast-Bidgoli H, Batura N, Mannell J. Feminisation of the health workforce and wage conditions of health professions: an exploratory analysis. Hum Resour Health 2019; 17:72. [PMID: 31623619 PMCID: PMC6796343 DOI: 10.1186/s12960-019-0406-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 08/12/2019] [Indexed: 05/31/2023]
Abstract
BACKGROUND The feminisation of the global health workforce presents a unique challenge for human resource policy and health sector reform which requires an explicit gender focus. Relatively little is known about changes in the gender composition of the health workforce and its impact on drivers of global health workforce dynamics such as wage conditions. In this article, we use a gender analysis to explore if the feminisation of the global health workforce leads to a deterioration of wage conditions in health. METHODS We performed an exploratory, time series analysis of gender disaggregated WageIndicator data. We explored global gender trends, wage gaps and wage conditions over time in selected health occupations. We analysed a sample of 25 countries over 9 years between 2006 and 2014, containing data from 970,894 individuals, with 79,633 participants working in health occupations (48,282 of which reported wage data). We reported by year, country income level and health occupation grouping. RESULTS The health workforce is feminising, particularly in lower- and upper-middle-income countries. This was associated with a wage gap for women of 26 to 36% less than men, which increased over time. In lower- and upper-middle-income countries, an increasing proportion of women in the health workforce was associated with an increasing gender wage gap and decreasing wage conditions. The gender wage gap was pronounced in both clinical and allied health professions and over lower-middle-, upper-middle- and high-income countries, although the largest gender wage gaps were seen in allied healthcare occupations in lower-middle-income countries. CONCLUSION These results, if a true reflection of the global health workforce, have significant implications for health policy and planning and highlight tensions between current, purely economic, framing of health workforce dynamics and the need for more extensive gender analysis. They also highlight the value of a more nuanced approach to health workforce planning that is gender sensitive, specific to countries' levels of development, and considers specific health occupations.
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Affiliation(s)
- Geordan Shannon
- Centre for Gender and Global Health, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
- STEMA, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
- Centre for Global Health Economics, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Nicole Minckas
- Centre for Gender and Global Health, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
- STEMA, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Des Tan
- STEMA, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
- Centre for Global Health Economics, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Hassan Haghparast-Bidgoli
- Centre for Global Health Economics, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Neha Batura
- Centre for Global Health Economics, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Jenevieve Mannell
- Centre for Gender and Global Health, Institute for Global Health, University College London, 3rd floor, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
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Passman J, Oresanya LB, Akoko L, Mwanga A, Mkony CA, O'Sullivan P, Dicker RA, Löfgren J, Beard JH. Survey of surgical training and experience of associate clinicians compared with medical officers to understand task-shifting in a low-income country. BJS Open 2019; 3:704-712. [PMID: 31592089 PMCID: PMC6773640 DOI: 10.1002/bjs5.50184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 04/23/2019] [Indexed: 11/07/2022] Open
Abstract
Background A workforce crisis exists in global surgery. One solution is task-shifting, the delegation of surgical tasks to non-physician clinicians or associate clinicians (ACs). Although several studies have shown that ACs have similar postoperative outcomes compared with physicians, little is known about their surgical training. This study aimed to characterize the surgical training and experience of ACs compared with medical officers (MOs) in Tanzania. Methods All surgical care providers in Pwani Region, Tanzania, were surveyed. Participants reported demographic data, years of training, and procedures assisted and performed during training. They answered open-ended questions about training and post-training surgical experience. The median number of training cases for commonly performed procedures was compared by cadre using Wilcoxon rank sum and Student's t tests. The researchers performed modified content analysis of participants' answers to open-ended questions on training needs and experiences. Results A total of 21 ACs and 12 MOs participated. ACs reported higher exposure than MOs to similar procedures before their first independent operation (median 40 versus 17 cases respectively; P = 0·031). There was no difference between ACs and MOs in total training surgical volume across common procedures (median 150 versus 171 cases; P = 0·995). Both groups reflected similarly upon their training. Each cadre relied on the other for support and teaching, but noted insufficient specialist supervision during training and independent practice. Conclusions ACs report similar training and operative experience compared with their physician colleagues in Tanzania.
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Affiliation(s)
- J. Passman
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - L. B. Oresanya
- Department of SurgeryLewis Katz School of Medicine at Temple UniversityPhiladelphiaPennsylvaniaUSA
| | - L. Akoko
- Department of SurgeryMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - A. Mwanga
- Department of SurgeryMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - C. A. Mkony
- Department of SurgeryMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - P. O'Sullivan
- Department of SurgeryUniversity of California, San Francisco School of MedicineSan FranciscoUSA
| | - R. A. Dicker
- Department of SurgeryUniversity of California, Los Angeles David Geffen School of MedicineLos AngelesCaliforniaUSA
| | - J. Löfgren
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - J. H. Beard
- Department of SurgeryLewis Katz School of Medicine at Temple UniversityPhiladelphiaPennsylvaniaUSA
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Bidwell SS, Miller MO, Lee EW, Yelorda K, Koshy S, Hawn M, Morris AM. Development and Implementation of a Hands-on Surgical Pipeline Program for Low-Income High School Students. JAMA Netw Open 2019; 2:e199991. [PMID: 31441933 PMCID: PMC6714018 DOI: 10.1001/jamanetworkopen.2019.9991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This qualitative study describes the development and implementation of a hands-on surgical pipeline program for low-income high school students.
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Affiliation(s)
- Serena S. Bidwell
- S-SPIRE Center, Department of Surgery, Stanford University, Stanford, California
| | - Miquell O. Miller
- S-SPIRE Center, Department of Surgery, Stanford University, Stanford, California
| | - Edmund W. Lee
- S-SPIRE Center, Department of Surgery, Stanford University, Stanford, California
| | - Kirbi Yelorda
- S-SPIRE Center, Department of Surgery, Stanford University, Stanford, California
| | | | - Mary Hawn
- S-SPIRE Center, Department of Surgery, Stanford University, Stanford, California
| | - Arden M. Morris
- S-SPIRE Center, Department of Surgery, Stanford University, Stanford, California
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Affiliation(s)
- Mukesh K Jain
- From the Harrington Discovery Institute and the Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, and the Case Cardiovascular Research Institute, Case Western Reserve University, Cleveland (M.K.J.); the Howard Hughes Medical Institute and the Departments of Pediatrics and Genetics, University of Michigan, Ann Arbor (V.G.C.); the Department of Medicine and the Institute for Immunity, Transplantation, and Infection (P.J.U.), and the Department of Molecular and Cellular Physiology (B.K.K.), Stanford University School of Medicine, Stanford, CA; Frazier Healthcare Partners, Seattle (T.Y.); and the Howard Hughes Medical Institute and the Departments of Medicine and Biochemistry, Duke University Medical Center, Durham, NC (R.L.)
| | - Vivian G Cheung
- From the Harrington Discovery Institute and the Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, and the Case Cardiovascular Research Institute, Case Western Reserve University, Cleveland (M.K.J.); the Howard Hughes Medical Institute and the Departments of Pediatrics and Genetics, University of Michigan, Ann Arbor (V.G.C.); the Department of Medicine and the Institute for Immunity, Transplantation, and Infection (P.J.U.), and the Department of Molecular and Cellular Physiology (B.K.K.), Stanford University School of Medicine, Stanford, CA; Frazier Healthcare Partners, Seattle (T.Y.); and the Howard Hughes Medical Institute and the Departments of Medicine and Biochemistry, Duke University Medical Center, Durham, NC (R.L.)
| | - Paul J Utz
- From the Harrington Discovery Institute and the Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, and the Case Cardiovascular Research Institute, Case Western Reserve University, Cleveland (M.K.J.); the Howard Hughes Medical Institute and the Departments of Pediatrics and Genetics, University of Michigan, Ann Arbor (V.G.C.); the Department of Medicine and the Institute for Immunity, Transplantation, and Infection (P.J.U.), and the Department of Molecular and Cellular Physiology (B.K.K.), Stanford University School of Medicine, Stanford, CA; Frazier Healthcare Partners, Seattle (T.Y.); and the Howard Hughes Medical Institute and the Departments of Medicine and Biochemistry, Duke University Medical Center, Durham, NC (R.L.)
| | - Brian K Kobilka
- From the Harrington Discovery Institute and the Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, and the Case Cardiovascular Research Institute, Case Western Reserve University, Cleveland (M.K.J.); the Howard Hughes Medical Institute and the Departments of Pediatrics and Genetics, University of Michigan, Ann Arbor (V.G.C.); the Department of Medicine and the Institute for Immunity, Transplantation, and Infection (P.J.U.), and the Department of Molecular and Cellular Physiology (B.K.K.), Stanford University School of Medicine, Stanford, CA; Frazier Healthcare Partners, Seattle (T.Y.); and the Howard Hughes Medical Institute and the Departments of Medicine and Biochemistry, Duke University Medical Center, Durham, NC (R.L.)
| | - Tadataka Yamada
- From the Harrington Discovery Institute and the Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, and the Case Cardiovascular Research Institute, Case Western Reserve University, Cleveland (M.K.J.); the Howard Hughes Medical Institute and the Departments of Pediatrics and Genetics, University of Michigan, Ann Arbor (V.G.C.); the Department of Medicine and the Institute for Immunity, Transplantation, and Infection (P.J.U.), and the Department of Molecular and Cellular Physiology (B.K.K.), Stanford University School of Medicine, Stanford, CA; Frazier Healthcare Partners, Seattle (T.Y.); and the Howard Hughes Medical Institute and the Departments of Medicine and Biochemistry, Duke University Medical Center, Durham, NC (R.L.)
| | - Robert Lefkowitz
- From the Harrington Discovery Institute and the Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, and the Case Cardiovascular Research Institute, Case Western Reserve University, Cleveland (M.K.J.); the Howard Hughes Medical Institute and the Departments of Pediatrics and Genetics, University of Michigan, Ann Arbor (V.G.C.); the Department of Medicine and the Institute for Immunity, Transplantation, and Infection (P.J.U.), and the Department of Molecular and Cellular Physiology (B.K.K.), Stanford University School of Medicine, Stanford, CA; Frazier Healthcare Partners, Seattle (T.Y.); and the Howard Hughes Medical Institute and the Departments of Medicine and Biochemistry, Duke University Medical Center, Durham, NC (R.L.)
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Lester J, Shinkai K. Diversity and inclusivity are essential to the future of dermatology. Cutis 2019; 104:99-100. [PMID: 31603960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Jenna Lester
- Department of Dermatology, University of California, San Francisco, USA
| | - Kanade Shinkai
- Department of Dermatology, University of California, San Francisco, USA
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